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F25.1

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✔ Medically Reviewed Last reviewed on June 30, 2025.

ICD-10 F25.1: Schizoaffective disorder, depressive type

ICD-10 Code F25.1 refers to the depressive type of schizoaffective disorder, a psychiatric condition characterized by a combination of mood disorder symptoms (specifically depressive symptoms) and psychotic features. It is distinct from both schizophrenia and mood disorders in its clinical presentation and diagnostic criteria.

Core characteristics

The condition involves two major symptom domains:

  1. Psychotic symptoms: Delusions, hallucinations, disorganized speech, or other manifestations typical of schizophrenia.
  2. Depressive symptoms: Persistent low mood, anhedonia, feelings of worthlessness or guilt, and other features of major depressive disorder.

These symptoms occur simultaneously or within the same episode and are not better explained by separate diagnoses of schizophrenia or a mood disorder.

F25.1 diagnostic criteria (Based on ICD-10)

  1. Presence of schizophrenic symptoms:

    • At least one of the following must be present for a significant portion of the illness:
      • Delusions (often persecutory, nihilistic, or somatic in nature).
      • Hallucinations (auditory, visual, or tactile).
      • Disorganized thinking or speech (e.g., incoherence, tangentiality).
      • Severely disorganized or abnormal motor behavior, including catatonia.
    • These symptoms must align with ICD-10 criteria for schizophrenia.

  2. Prominent depressive symptoms:

    • Depressive mood most of the day, nearly every day, for at least two weeks.
    • Anhedonia (loss of interest or pleasure).
    • Significant weight changes or appetite disturbances.
    • Insomnia or hypersomnia.
    • Psychomotor agitation or retardation.
    • Fatigue or loss of energy.
    • Feelings of worthlessness or excessive guilt.
    • Recurrent thoughts of death or suicide.
    • These symptoms must meet the criteria for a major depressive episode in ICD-10.

  3. Temporal relationship:

    • Depressive and psychotic symptoms must overlap during the same illness episode.
    • Psychotic symptoms (e.g., hallucinations, delusions) must persist without depressive symptoms for at least two weeks during the same illness episode.

  4. Exclusion criteria:

    • The symptoms should not be attributed to the use of substances, prescribed medications, or an underlying medical condition.
    • The symptoms are not better explained by schizophrenia, a mood disorder with psychotic features, or another psychotic disorder.

F25.1 symptoms

Psychotic:

  • Hallucinations: Primarily auditory, often with themes of persecution, guilt, or self-deprecation.
  • Delusions: May include persecutory delusions (belief someone intends to harm them) or nihilistic delusions (belief in impending doom or personal annihilation).
  • Thought Disorders: Disorganized thinking and speech patterns, such as tangentiality or word salad.
  • Catatonia: Motor symptoms ranging from agitation to immobility.

Depressive:

  • Persistent feelings of sadness and hopelessness.
  • Anhedonia: A loss of the ability to experience enjoyment from activities that were once found pleasurable.
  • Reduced energy or chronic fatigue.
  • Difficulty concentrating or making decisions.
  • Social withdrawal and reduced functioning.

Differential Diagnosis Chart: F25.1 – Schizoaffective Disorder, Depressive Type
Condition / Category Key Overlapping Symptoms with F25.1 Key Differentiating Features / Clues Primary Diagnostic Approach / Considerations
MOOD DISORDERS WITH PSYCHOTIC FEATURES
Major Depressive Disorder with Psychotic Features Depressive episode + Psychotic symptoms (delusions, hallucinations).
  • Psychotic symptoms occur exclusively during the major depressive episode(s).
  • No period of psychosis in the absence of mood symptoms for 2 weeks or more.
 Crucial: Longitudinal history. Determine if psychosis resolves when depression remits. If psychosis persists after mood symptoms resolve for >2 weeks, consider schizoaffective.
Bipolar I or II Disorder, Current or Most Recent Episode Depressed, with Psychotic Features Depressive episode + Psychotic symptoms.
  • Requires a history of at least one manic or hypomanic episode.
  • Psychotic symptoms occur exclusively during mood episodes (depressive or manic).
  • No psychosis in euthymia for >2 weeks.
 Thorough history for past (hypo)manic episodes. If present, and psychosis is mood-episode-bound, then Bipolar Disorder.
PSYCHOTIC DISORDERS
Schizophrenia Psychotic symptoms (Criterion A), negative symptoms (can mimic depression), social/occupational dysfunction.
  • Mood episodes (depressive or manic) are brief relative to the total duration of the active and residual periods of the illness.
  • If mood symptoms are prominent and persistent, Schizophrenia is less likely.
 Crucial: Longitudinal history. Evaluate the proportion of time mood symptoms are present versus the overall duration of psychotic illness. Schizoaffective has more prominent mood component.
Delusional Disorder Presence of one or more delusions for at least 1 month.
  • Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
  • Criterion A for Schizophrenia has never been met.
  • Mood episodes are brief.
 Assess if full Criterion A for Schizophrenia is met. Hallucinations, if present, are not prominent and are related to the delusional theme. Less pervasive functional decline.
Brief Psychotic Disorder Psychotic symptoms (delusions, hallucinations, disorganized speech/behavior).
  • Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.
 Duration of symptoms is key.
Schizophreniform Disorder Psychotic symptoms (Criterion A).
  • An episode of the disorder lasts at least 1 month but less than 6 months.
 Duration of symptoms is key.
SUBSTANCE/MEDICATION-INDUCED DISORDERS
Substance/Medication-Induced Psychotic Disorder Delusions and/or hallucinations.
  • Symptoms develop during or soon after substance intoxication or withdrawal or after exposure to a medication.
  • The involved substance/medication is capable of producing the symptoms.
  • Not better explained by an independent psychotic disorder.
 Detailed substance use history, toxicology screen, medication review. Symptoms should improve after cessation of substance/medication (may take time).
Substance/Medication-Induced Depressive Disorder Depressed mood, anhedonia.
  • Symptoms develop during or soon after substance intoxication or withdrawal or after exposure to a medication.
  • The involved substance/medication is capable of producing the symptoms.
 As above. Consider if both psychotic and depressive symptoms are substance-induced.
DISORDER DUE TO ANOTHER MEDICAL CONDITION
Psychotic Disorder Due to Another Medical Condition Prominent hallucinations or delusions.
  • Evidence from history, physical exam, or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition (e.g., neurological, endocrine, autoimmune).
 Thorough medical workup (neurological exam, labs, imaging as indicated) to identify underlying medical cause.
Depressive Disorder Due to Another Medical Condition Depressed mood, anhedonia. As above. As above. Consider if both psychotic and depressive symptoms are due to a medical condition.
PERSONALITY DISORDERS (with overlapping features)
Schizotypal Personality Disorder Odd beliefs/magical thinking, unusual perceptual experiences, suspiciousness, social anxiety, restricted affect (can overlap with negative symptoms or depression).
  • Pervasive pattern of social/interpersonal deficits and eccentricities.
  • Frank psychotic symptoms (sustained delusions/hallucinations) are absent or very brief/transient if present.
  • Mood symptoms may be present but not to full syndromal criteria for prolonged periods.
 Focus on pervasive, long-standing personality traits vs. episodic illness. Psychosis, if present, is typically subthreshold or very brief.
Borderline Personality Disorder Mood instability (including depressive periods), transient stress-related paranoid ideation or dissociative symptoms (can be misconstrued as psychosis).
  • Pervasive pattern of instability in interpersonal relationships, self-image, affects, and marked impulsivity.
  • “Psychosis” is often transient, stress-related, and lacks the organization seen in schizophrenia spectrum disorders.
 Assess core BPD features (instability, impulsivity, fear of abandonment, etc.). Nature and context of “psychotic” experiences.

Key considerations:

  1. Longitudinal History is CRUCIAL: The timeline of psychotic versus mood symptoms is the most critical factor.
    • When did psychotic symptoms first appear?
    • When did mood symptoms first appear?
    • Have there been periods of psychosis without significant mood symptoms lasting at least 2 weeks?
    • How much of the total illness duration has been characterized by mood symptoms?
  2. Rule out Substance Use: Obtain a thorough substance use history and consider toxicology screening.
  3. Rule out Another Medical Condition: Conduct a medical review of systems, physical exam, and appropriate laboratory/imaging studies if indicated.
  4. Collateral Information: Information from family members or previous treaters can be invaluable in establishing the timeline and nature of symptoms.
  5. Severity and Pervasiveness: Evaluate the severity of both psychotic and mood symptoms and their impact on functioning.
  6. Response to Treatment: While not solely diagnostic, observing response patterns to antipsychotics vs. mood stabilizers/antidepressants can offer clues over time.

Disclaimer:

This chart is for informational and educational purposes for understanding diagnostic considerations. It is not a substitute for a comprehensive clinical evaluation by a qualified mental health professional. Diagnosis should be made based on a full assessment, including clinical interview, mental status examination, and consideration of all DSM-5/ICD-10-CM criteria.

Diagnostic challenges

  • Schizoaffective disorder is often underdiagnosed or misdiagnosed due to symptom overlap with schizophrenia and mood disorders.
  • The timing and persistence of symptoms are critical for distinguishing it from other psychiatric illnesses.
  • Cultural and individual differences in the expression of symptoms can complicate diagnosis.

Management

  1. Pharmacological Treatment:
    • Antipsychotics: To address psychotic symptoms (e.g., Risperidone, Olanzapine).
    • Antidepressants: For depressive symptoms (e.g., SSRIs like Fluoxetine or Sertraline).
    • Combination therapy is often necessary to manage both symptom domains.
  2. Psychotherapy:
    • Cognitive Behavioral Therapy (CBT): To address cognitive distortions and improve coping mechanisms.
    • Supportive Therapy: To enhance social functioning and emotional resilience.
  3. Hospitalization:
    • May be required in cases of severe psychosis or suicidal ideation.
  4. Long-Term Care:
    • Regular psychiatric follow-ups.
    • Social and occupational rehabilitation.

Prognosis

  • The course of schizoaffective disorder varies. Some patients may achieve complete remission, while others experience chronic symptoms.
  • Timely intervention and thorough treatment have the potential to greatly enhance outcomes.
  • Factors influencing prognosis:
    • Duration of untreated psychosis.
    • Severity and frequency of episodes.
    • Patient adherence to treatment.

Emergency Resources

If you believe you are experiencing a medical emergency, call your local emergency number immediately.