Diagnostic and Therapeutic Challenges in Schizoaffective Disorder with Schizoid Personality Comorbidity

Abstract

Schizoaffective disorder, depressive type, is a severe psychiatric condition characterized by the coexistence of psychotic symptoms and a major depressive episode, with substantial functional impairment and potential suicide risk. Diagnostic and therapeutic complexity may increase when the disorder co-occurs with schizoid personality disorder, particularly because social withdrawal, restricted affect, and anhedonia can resemble negative or depressive symptoms. This case report describes a 33-year-old woman diagnosed with schizoaffective disorder, depressive type, with comorbid schizoid personality disorder. Clinical assessment included psychiatric interviews, collateral information from family members, mental status examination, behavioral observation, reconstruction of symptom chronology, and review of psychosocial history. The patient developed auditory hallucinations and persecutory ideas approximately four weeks before admission, followed by prominent depressive symptoms and suicidal ideation after the sudden death of a primary support figure. Long-standing social detachment, preference for solitary activities, restricted emotional expression, and limited interpersonal relationships were present since early adulthood and preceded the psychotic episode, supporting the diagnosis of schizoid personality disorder. Inpatient management consisted of risperidone, sertraline, and low-intensity supportive psychosocial interventions adapted to the patient’s preference for limited interpersonal engagement. During approximately 14 days of hospitalization, hallucinations and suicidal ideation decreased and basic self-care improved. At two-week follow-up, no recurrent suicidal ideation was reported, although mild auditory hallucinations and social withdrawal persisted. This case emphasizes the importance of longitudinal assessment and collateral information in distinguishing enduring personality characteristics from state-related negative or depressive symptoms. Individualized treatment that combines pharmacological stabilization with appropriately paced psychosocial engagement may improve treatment acceptability and functional stabilization in complex psychiatric comorbidity.