Schizoaffective disorder — structured clinical viva

Rebuild the life-chart before defending any label. The history of mania plus a full month of delusions while euthymic is the critical discriminator against pure bipolar with psychosis confined to mood episodes. If mood episodes occupy the majority of total illness duration and Criterion A symptoms have been concurrent with mood, schizoaffective disorder, bipolar type is the operational diagnosis — not “schizophrenia with a bit of mood.”^[1]

Acute management treats mania and psychosis together: safety, sleep, legal status, antimanic antipsychotic ± lithium/valproate, stop unprotected antidepressant (sertraline without mood-stabiliser cover is a red flag in bipolar-type illness).^[2][4]

Longer-term plan: antipsychotic adherence strategy, polarity-safe maintenance (lithium if suitable — anti-suicide evidence in mood disorders), metabolic monitoring, cannabis/substance review, family psychoeducation. Clozapine enters if high suicidality or TRRIP resistance.^[3][5][4]