Schizoaffective Disorder With Emotional Dependence and Psychosomatic Symptoms : A Case Report and A Biopsychosocial Approach

Abstract

Background: Schizoaffective disorder is a complex psychiatric condition characterized by the concurrent presence of psychotic symptoms and mood disturbances. Cases presenting with pronounced emotional dependence on family members and prominent psychosomatic manifestations are infrequently documented in Indonesia, posing diagnostic and therapeutic challenges. Case Presentation: A 36-year-old unmarried male presented with a 10-year history of uncontrolled emotions, auditory and visual hallucinations, persistent fear, chest heat sensation, and an impending sense of death. Symptoms were exacerbated when anticipating separation from his parents. The patient had experienced occupational decline, marital dissolution due to aggressive behavior, and progressive social withdrawal. Clinical assessment using DSM-5 criteria established a diagnosis of schizoaffective disorder, depressive type, comorbid with paranoid schizophrenia. The patient exhibited significant emotional dependence on his parents and impaired psychosocial functioning. Management and Outcome: A comprehensive biopsychosocial approach was implemented, comprising pharmacotherapy (risperidone, chlorpromazine, lorazepam, and clozapine), cognitive-behavioral therapy, psychoeducation, and family therapy. Multidisciplinary interventions resulted in reduced psychotic symptom severity, improved emotional regulation, and enhanced family support systems. Conclusion: Schizoaffective disorder with psychosomatic manifestations and emotional dependence necessitates an integrated biopsychosocial framework. Combined pharmacotherapy, psychotherapy, psychoeducation, and family-centered interventions are essential to promote patient autonomy, improve social functioning, and enhance overall quality of life. This case underscores the importance of recognizing caregivers as integral partners in psychiatric rehabilitation.