The Modern Concept of Schizoaffective Disorder: A Narrative Review.

Background: Schizoaffective disorder (SAD) is one of the most complex and controversial diagnoses in clinical psychiatry. Despite the significant changes that have occurred in the conceptualization of SAD in modern classifications and the publications of recent years, many unresolved issues remain regarding the disease, from the point of view of clinical psychiatry and basic neuroscience.

Aim: The purpose of this paper is to summarize published data on the concept of SAD, its clinical characteristics, cognitive profile, potential biomarkers, as well as the place of the disease in the following modern international classifications: the International Classification of Diseases (ICD) 9^th, 10^th and 11^th revisions, and the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5).

Methods: We undertook a review of the scientific studies in the relevant bibliographic systems and databases (eLIBRARY, PubMed) of the past 15 years. The descriptive analysis method was used to summarize the collected information. A total of 70 publications were selected for review, including different versions of international classifications of diseases (ICD and DSM-5).

Results: There has been some improvement in the inter-rater reliability of SAD criteria in modern classifications, but this has not yet led to a clearer understanding among mental health specialists, while the various subtypes of SAD identified so far fail to account for the heterogeneity in the clinical presentation of the disorder. The dimensional approach to diagnosing SAD, according to which the intensity of psychotic and affective symptoms can fluctuate over time and they can influence one another, more accurately reflects the disease's ability to embody different forms. Basic research does not support the identification of a distinct cognitive, neuroimaging, or immunological SAD endophenotype that differs qualitatively from schizophrenia and affective psychoses.

Conclusion: The conceptualization of SAD remains incomplete, and new approaches rooted in neuroscience are needed to better understand the coexistence of affective and psychotic symptoms.