Schizoaffective disorder — structured clinical viva

Interpretation

Escalating questions (model answers)

1. Why not bipolar I with psychotic features?

Because psychosis persisted for a month after mood resolution — the ≥2-week psychosis-without-mood rule is met. Bipolar with psychosis confines psychosis to mood episodes.[1]

2. Why not schizophrenia?

If major mood syndromes truly occupy the majority of total active and residual duration, schizophrenia (mood as minority) is less accurate. Confirm with collateral and records; if mood was only brief relative to years of pure psychosis, keep schizophrenia.[1]

3. What will you do with sertraline today?

Hold/stop antidepressant monotherapy risk in bipolar-type illness while mania is active. Restart any antidepressant later only with antipsychotic/mood-stabiliser cover, short intentional duration, and polarity monitoring — many patients need none once psychosis and polarity are controlled.[4][2]

4. Name a drug, dose framework, and monitoring for tonight’s mania + psychosis.

Example: olanzapine 10 mg oral (titrate toward 10–20 mg) with metabolic baseline, plus consider lithium start 400–800 mg/day with eGFR/TFT and 12-hour trough plan, or ensure antimanic SGA cover alone if lithium unsuitable. Document QTc/ECG as indicated. Restore sleep; de-escalate environment.[2][3][4]

5. Where does InterSePT fit if he develops severe suicidal behaviour?

InterSePT supports clozapine over olanzapine for suicidal behaviour in schizophrenia spectrum including schizoaffective disorder — still combine with means restriction and service intensity.[5]

Key points