Schizoaffective Disorder

Schizoaffective disorder describes a condition that includes aspects of both schizophrenia and a mood disorder (either major depressive disorder or bipolar disorder).

Scientists are not entirely certain whether schizoaffective disorder is a condition related mainly to schizophrenia or a mood disorder. However, it is usually viewed and treated as a hybrid or combination of both conditions.

Schizoaffective disorder can be managed, but most people diagnosed with the condition have relapses.

A few definitions:

Schizophrenia  is a brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others.

Depression  is an illness that is marked by feelings of sadness, worthlessness, or hopelessness, as well as problems concentrating and remembering details.

Bipolar disorder  includes cycling mood changes, such as severe highs (mania) and lows (depression).



The symptoms of schizoaffective disorder may vary greatly from one person to the next and may be mild or severe. They may include:


  • Poor appetite
  • Weight loss or gain
  • Changes in sleeping patterns (sleeping very little or a lot)
  • Agitation (being very restless)
  • Lack of energy
  • Loss of interest in usual activities
  • Feelings of worthlessness or hopelessness
  • Guilt or self-blame
  • Trouble with thinking or concentration
  • Thoughts of death or suicide


  • Being more active than usual, including at work, in your social life, or sexually
  • Talking more or faster
  • Rapid or racing thoughts
  • Little need for sleep
  • Agitation
  • Being full of yourself
  • Being easily distracted
  • Self-destructive or dangerous behavior (such as going on spending sprees, driving recklessly, or having risky sex)


  • Delusions (strange beliefs that the person refuses to give up, even when they get the facts)
  • Hallucinations (sensing things that aren’t real, such as hearing voices)
  • Disorganized thinking
  • Odd or unusual behavior
  • Slow movements or not moving at all
  • Lack of emotion in facial expression and speech
  • Poor motivation
  • Problems with speech and communication




Scientists don’t know the exact cause of schizoaffective disorder. Things that may be involved include:

Genetics (heredity): Someone may inherit a tendency to develop schizoaffective disorder from their parents.

Brain  structure and function: People with schizophrenia and mood disorders may have problems with brain circuits that manage mood and thinking.

Environment: Environmental things — such as a viral infection, bad relationships, or highly stressful situations — may trigger schizoaffective disorder in people who are at risk for it. How that happens isn’t clear.

Schizoaffective disorder usually begins in the late teen years or early adulthood, often between ages 16 and 30. It seems to happen slightly more often in women than in men. It’s rare in children.

Because people with schizoaffective disorder have a combination of symptoms reflecting two separate mental illnesses, it is easily confused with other psychotic or mood disorders. Some people may be believed to have schizophrenia, and others may be believed to have just a mood disorder. As a result, it’s hard to determine exactly how many people actually have schizoaffective disorder. It’s probably less common than either schizophrenia or mood disorders alone.


There are no laboratory tests to specifically diagnose schizoaffective disorder. So doctors rely on a person’s medical history — and may use various tests such as brain imaging (like MRI scans) and blood tests — to make sure that a physical illness isn’t the reason for the symptoms.

If the doctor finds no physical cause, he may refer the person to a psychiatrist or psychologist. These mental health professionals are trained to diagnose and treat mental illnesses. They use specially designed interview and assessment tools to evaluate a person for a psychotic disorder.

In order to diagnose someone with schizoaffective disorder, the person must have periods of uninterrupted illness and, at some point, an episode of mania, major depression, or a mix of both, while also having symptoms of schizophrenia. The person must also have had a period of at least two weeks of psychotic symptoms without the mood (depression or bipolar) symptoms.


Treatment for schizoaffective disorder includes:

Medication : Some of the medicine a person needs depends on whether they have symptoms of depression or bipolar disorder, along with symptoms that suggest schizophrenia. The main medications that doctors prescribe for psychotic symptoms such as delusions, hallucinations, and disordered thinking are called antipsychotics.  All antipsychotic drugs likely have value in the treatment of schizoaffective disorder, but paliperidone extended release (Invega) is the only drug that the FDA has approved to treat schizoaffective disorder. For mood-related symptoms, someone may take an antidepressant medication or a mood stabilizer such as lithium. They often will also take an antipsychotic medication.


Psychotherapy : The goal of this type of counseling is to help the person learn about their illness, set goals, and manage everyday problems related to the disorder. Family therapy can help families become more effective in relating to and helping a loved one who has schizoaffective disorder.

Skills training: This generally focuses on work and social skills, grooming and self-care, and other day-to-day activities, including money and home management.

Hospitalization: Psychotic episodes may require a person to be hospitalized, especially if he/she is suicidal or threatens to hurt others.


Can You Prevent Schizoaffective Disorder?

No. But if someone gets diagnosed and starts treatment ASAP, it can help a person avoid or reduce frequent relapses and hospitalizations and help decrease the disruption to the person’s life, family, and friendships.


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Cannabis and Work

Cannabis and Work

With the Constitutional Court judgment on 18th September 2018 effectively legalizing cannabis, some questions can be asked around Labour Law.
Jan du Toit, a Senior Consultant with SA Labour Guide asks the question, “Does the fact that one will have the right to private consumption of cannabis imply that employers will have to amend their policies and disciplinary codes?”

Cannabis is a psychoactive drug derived from the Cannabis plant. The main psychoactive part of the plant is tetrahydrocannobinol (THC). Cannabis can be used by smoking, vaporizing with a ‘bong’, within food or as an oil extract. Cannabis is a depressant drug, which means it slows down messages travelling between your brain and body.

The physical effects of cannabis is an altered state of consciousness – a general change in perception of time and space, heightened mood (euphoric and sociable), increased sensitivity to taste, sight, smell and hearing, impaired coordination and concentration, decrease in short term memory, decreased motivation, increased pulse and heart rate, dilated and blood shot eyes and at times negative experiences like paranoia and anxiety.
Long-term effects of cannabis use are widely debated but include dependency, damage to heart and lungs, the reproductive system, and adolescent brain development. There is evidence of a link between schizophrenia and cannabis use.

Cannabis oil is used to combat a wide variety of different illnesses such as effects of cancer treatment, pain relief and epilepsy.

Cannabis can be detected in urine for a few days (occasional user) or longer than a month (chronic user). This means that a joint smoked on a Saturday night at a party may be detectable in the urine on a Monday morning – despite the effects of the cannabis having probably worn off.

So will it be permissible for employees to have cannabis in their system when they present for work?
The General Safety Regulation 2A of the Occupational Health and Safety Act, requires that an employer may not allow any person who is or who appears to be under the influence of an intoxicating substance, to be allowed access to the workplace. Neither may an employer allow any person to have intoxicating substances in his or her possession in the workplace.

Jan du Toit suggests that this means that the legislation of private cannabis use is probably not a defence for a positive urine test of cannabis at work.

Cannabis – what the Constitutional Court did not say

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How to talk to your teenager about drugs

How to talk to your teenager about drugs


What happened to your 13 year old who hated smoking and gave you a look if you had a second glass of wine? People who took drugs were ‘stupid and they were never going to be that foolish’.


Two years later you find cigarettes in your child’s school bag, or pick them up from a party drunk or perhaps even find drug paraphernalia in their cupboard.


Here are some tips on how to talk to your teenager about drugs.


  1. Firstly, it should be your pre-teen that you are talking too. Start talking about drugs and alcohol abuse early – from age eight whenever the subject comes on – on TV for example.
  2. Ask your child what they know about drugs and alcohol abuse. Include cigarettes/vaping and cannabis in your discussion.
  3. Tell them what you feel about drug and alcohol abuse and about how concerned you would be if they ever participated in this behaviour.
  4. Don’t just talk about the harm of drug and alcohol abuse, talk about the positive aspects and why people do drugs and drink – to feel good, to escape, to avoid feelings or a situation.
  5. Focus on the short term problems that come from drugs and alcohol rather than the long term. Talk about bad breath and skin problems, difficulties with sports and academics.
  6. Explain that some people cannot stop once they have started and one never knows who that is going to be.
  7. Also that teenage brains are wired to take risks and experiment – let them know that one day they will be faced with making the decision of whether to use or not.
  8. Set up some ‘family rules’ about drug and alcohol use – allow your child to participate – include random drug testing in the agreement.
  9. Set up a safety net in case your child is in a risky situation and wants to get out – no questions asked.
  10. Keep on talking about it and make it safe for your children to tell you about the drug and alcohol use that they see or hear is going on around them.


If you find that they are already using:

  1. Don’t respond in anger. Be compassionate and understanding but firm.
  2. Direct them to the family rules that were made together.
  3. Put consequences in place that will keep them safe.
  4. Drug test them regularly.
  5. Speak to the school. Don’t hide the problem.
  6. Get some help – take your child to an addiction therapist.


Don’t  ever let your child sleep over at a friend after a party or get together unless you are very sure that there will be adequate supervision.





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Prescription Drug Abuse

Prescription drug abuse


With the legalization of cannabis on the increase it is now prescription drugs rather than tik, cocaine or heroin that is most used illicitly.


Most people take medicines only in the manner in which their doctors prescribe them. However a significant amount of people are predisposed to become addicted when they start to abuse prescription drugs after a legitimate prescription was written for them by their doctor. The prescription may have been written due to chronic pain, injury, surgery or depression.


Pain killers, sleeping tablets and anti-anxiety medications are all highly addictive and easily available on prescription.


Morphine, heroin, codeine and methadone – all opiates – are now considered among the most highly abused and addictive drugs available in the world.


The use of tablets to obtain peaceful detachment from worries, pain and demands of life can begin slowly but can then quickly escalate as the brain adjusts to the drugs requiring more and more to get the same effect.  This is called tolerance.


Stopping the medication is no easy feat due to the uncomfortable and sometimes dangerous withdrawal symptoms. Symptoms such as feelings of irritability, anxiety and agitation, restlessness and insomnia, hot and cold sweats and goose bumps, muscle ache and pains, abdominal cramping, nausea, vomiting and diarrhoea.

Drug-seeking behaviours are the primary warning signs of prescription drug abuse, regardless of the chemical make up of the medication. These behaviours include:

  • Frequent requests for refills from physicians
  • Losing prescriptions and requesting replacements regularly
  • Crushing or breaking pills
  • Stealing or borrowing prescription medications from family members, friends, or co-workers
  • Consuming prescriptions much faster than indicated
  • Visiting multiple doctors for similar conditions
  • Stealing or forging prescriptions
  • Ordering prescription medications over the internet


Recovery from prescription medication addiction


Recovery from a prescription drug addiction is very difficult and it is for this reason that professional medical treatment is recommended to assist withdrawal, while professional therapeutic intervention and strong aftercare support gives the best chance of addiction recovery and long term rehabilitation success.



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Gaming – can it become an addiction?

Gaming – can it become an addiction?


The World Health Organization has recently classified gaming disorder as a mental health condition. Whilst it is not an official disorder in the DSM-5, the APA is encouraging further research on the disorder for possible inclusion in future editions of the DSM.

An Oxford University study in 2016 estimated that 0.5 percent of the general population has a gaming addiction.  That is millions of people.  Games include “World of Warcraft”, “Fortnite”, “Grand Theft Auto” and “Call of Duty, and yes even games like Candy Crush.

The thrill of the game gives the brain a hit of dopamine – similar to a drug addict taking a hit. Warning signs of addiction include social withdrawal and isolation, sleeplessness and irritability and changes in weight.

Do you think you may have a problem? Gamers can ask themselves whether they have experienced “significant impairment in personal, family, social, educational, occupational or other important areas of functioning” for at least a year.

There are severity modifiers for Internet Gaming Disorder: mild, moderate, or severe. These modifiers are based on how much time is spent playing the games, and how much they impact a person’s overall functioning. In summary, the diagnostic criteria for Internet Gaming Disorder may include:

  1. Repetitive use of Internet-based games, often with other players, that leads to significant issues with functioning.  Five of the following criteria must be met within one year:
  2. Preoccupation or obsession with Internet games.
  3. Withdrawal symptoms when not playing Internet games.
  4. A build-up of tolerance–more time needs to be spent playing the games.
  5. The person has tried to stop or curb playing Internet games, but has failed to do so.
  6. The person has had a loss of interest in other life activities, such as hobbies.
  7. A person has had continued overuse of Internet games even with the knowledge of how much they impact a person’s life.
  8. The person lied to others about his or her Internet game usage.
  9. The person uses Internet games to relieve anxiety or guilt–it’s a way to escape.
  10. The person has lost or put at risk and opportunity or relationship because of Internet games.


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The Regulation of Gambling in Kenya

The Regulation of Gambling in Kenya

The regulation of gambling in Kenya has led to the closing down of gambling dens and the offering of online gambling services which has increased the ease with which one can place bets.  Kenya reportedly has the highest number of young people in sub-Saharan Africa who gamble frequently (age 17-35).  Also it is estimated that 78% of all Kenya university students were problem gamblers.

Government attempts to control the gambling by taxing winnings up to 20%.  It is suggested that these attempts fail to understand the psychology behind problem gambling.

Whilst millions of people use gambling as a form of entertainment, for many gambling becomes an obsession.

Problem gamblers gamble with more money than they can afford to lose, and experience other adverse consequences in their lives due to the gambling.

The illusion of control over a game driven chance is the core belief that influences the disordered thinking of problem gamblers

Beliefs like certain machines are ‘lucky’ or due for a big win.  A near win is seen as sign that a win in imminent.  Selective recall of winnings rather than losses is common place for problem gamblers.

To meet the criteria for gambling disorder, a person has to have at least four of the problems identified below, within a 12 month period, in conjunction with “persistent and recurrent problematic gambling behaviour”

  • Needing to gamble with more money to get the same excitement from gambling as before
  • Feels reckless or irritable when trying to reduce or stop gambling
  • Keeps trying to reduce or stop gambling without success
  • Gambling is frequently on the persons mind – both reliving past gambling experiences, and planning future gambling events
  • Gambles when feeling depressed, guilty or anxious
  • Tries to win back gambling lossess
  • Tries to cover up how much they are gambling
  • Loses not only money, but also relationships, their job, or a significant career opportunity as a result of gambling
  • Becomes dependent on other people to give them money to deal with financial problems that have been caused by gambling.


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