When symptoms of psychosis and big changes in mood happen together, it can be confusing and frightening — and even hard to put a name to. Schizoaffective disorder is a treatable condition, and with steady care many people live full, connected lives. You are welcome here.

What schizoaffective disorder is

Schizoaffective disorder brings together features of two conditions: the psychosis seen in schizophrenia (such as hallucinations or delusions) and a major mood episode (depression or mania). What sets it apart from a mood disorder with psychosis is the timing — in schizoaffective disorder, psychotic symptoms are present for two weeks or more without prominent mood symptoms at some point in the illness. It affects roughly 0.3% of people over a lifetime (American Psychiatric Association, 2022).

The two types

  • Bipolar type — the mood side includes manic episodes (and often depression too).
  • Depressive type — the mood side involves major depression only.

Naming the type matters, because it shapes the treatment plan.

Signs and symptoms

People may experience a mix of:

  • Psychotic symptoms — hearing or seeing things others do not, fixed false beliefs, or disorganized thinking.
  • Depressive symptoms — deep sadness, low energy, hopelessness, or loss of interest.
  • Manic symptoms (bipolar type) — elevated or irritable mood, less need for sleep, racing thoughts, or impulsive choices.

How it is understood and evaluated

Schizoaffective disorder is one of the harder diagnoses to make, because it depends on the pattern of psychosis and mood over time. A careful evaluation across several visits — ruling out medical causes, substances, and other conditions — is how we get it right, and the diagnosis is sometimes refined as we get to know you.

How it is treated — and how we approach it at OhanaPsych

Treatment usually combines an antipsychotic medication with treatment aimed at the mood side. Paliperidone is the antipsychotic with specific FDA approval for schizoaffective disorder, used on its own or alongside a mood stabilizer and/or antidepressant (Canuso et al., 2010), and it is available as a long-acting injectable, which can lower the risk of relapse and hospitalization (Kishimoto et al., 2021). For the bipolar type we typically add a mood stabilizer; for the depressive type, an antidepressant — always paired with psychosocial support such as therapy and help with daily life (American Psychiatric Association, 2020).

Through our pharmacy partnerships, injectable medications can be delivered and given in your own home, on any island. We hold this work with aloha and person-first respect, partnering with your case-management team and working toward lōkahi (balance and harmony) so you can stay connected to your ʻohana and community. (You can also read our Serious Mental Illness & Injectables and Schizophrenia pages.)

Getting care by telehealth

Much of this care can be delivered by secure video, and injectable medications can be given at home, so distance does not have to stand between you and steady treatment. Some parts of care — such as certain controlled medications — still follow the federal Ryan Haight Act and DEA rules and may call for an in-person step; we will tell you clearly if that applies to you.

Lasting access by telehealth

As we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. For our patients, that means dependable, lasting telehealth access to the care you need.

Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.

When to reach out

You do not need to be in crisis to reach out — new patients are welcome. Call (808) 777-9460 or start your request online.

If you or someone you love is thinking about suicide or self-harm, or is losing touch with reality and may be unsafe, get help right away. Call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.

This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a mental health condition, reach out to us or another licensed provider. In an emergency, call 911.

References

American Psychiatric Association. (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 177(9), 868–872. https://doi.org/10.1176/appi.ajp.2020.177901

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

Canuso, C. M., Lindenmayer, J.-P., Kosik-Gonzalez, C., Turkoz, I., Carothers, J., Bossie, C. A., & Schooler, N. R. (2010). A randomized, double-blind, placebo-controlled study of 2 dose ranges of paliperidone extended-release in the treatment of subjects with schizoaffective disorder. Journal of Clinical Psychiatry, 71(5), 587–598. https://doi.org/10.4088/JCP.09m05564yel

Kishimoto, T., Hagi, K., Kurokawa, S., Kane, J. M., & Correll, C. U. (2021). Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: A systematic review and comparative meta-analysis of randomised, cohort, and pre–post studies. The Lancet Psychiatry, 8(5), 387–404. https://doi.org/10.1016/S2215-0366(21)00039-0


Frequently Asked Questions

Does OhanaPsych accept QUEST, Medicaid, and insurance for schizoaffective disorder care?

Yes. We are in network with the Hawaiʻi QUEST Integration plans — AlohaCare, HMSA, ʻOhana Health Plan, and UnitedHealthcare Community Plan — and we also accept Medicare and most commercial insurance. If you are not sure about your coverage, contact our office and we will help you check.

Can I receive schizoaffective disorder care by telehealth, or do I need to come into the office?

We offer both. You can be seen in person at our Honolulu or Hilo office, or by secure telehealth from anywhere in Hawaiʻi. Some visits or treatments may require an in-person appointment, and we will let you know if that applies to your care.

How do I make an appointment for schizoaffective disorder care?

You can request an appointment through our online scheduling page, or call us at (808) 777-9460 for Honolulu or (808) 867-8002 for Hilo. We welcome new patients and will help match you with the right provider.

Who provides schizoaffective disorder care at OhanaPsych?

Care is provided by our team of licensed, board-certified psychiatric providers. You can read about each member of our team on our Providers page.