Within schizoaffective disorder, the diagnosis requires either a severe manic and/or depressive episode concurrent with the criterion A for schizophrenia. Along with that, the psychotic symptoms must still be present for 2 weeks without mood symptoms.
Criterion A states that 2+ of the following must be present for a significant portion of a 1 month period: Disorganized Speech, Grossly Disorganized or Catatonic Behavior, Hallucinations, Delusions, and Negative Symptoms(like diminished emotion expression).
Irfam checks off all except for negative symptoms.
Disorganized Speech
Irfam experiences some level of disorganized speech regardless of if he’s in the midst of a manic or depressive episode, but the level and kind do fluctuate at times due to episodes. So… I’ll explain each type of disorganized speech that Irfam deals with first and then go over when and severity. The types he deals with are Pressured Speech, Tangential Speech Pattern, Thought Blocking, Circumstantial, and Thought Derailment.
Pressured speech is when someone speaks rapidly, to a point where it’s hard to follow. They may also not stop their flow of speech or stop at appropriate intervals normally expected during conversation.
Tangential speech pattern is when someone goes on so many different tangents while speaking that the original point might be difficult to remember, and the tangents might also be hard to follow.
Thought blocking is when someone displays breaks in their speech as if interrupted or having lost focus.
Circumstantial is the inability to determine what information is essential and what isn’t, the person might speak about something technically connected but ultimately unimportant. Like the temperature while being asked how their day’s going.
Thought derailment is when someone is speaking in a flow, or fluidly, but then suddenly stops as if they forgot what they were saying.
Now that I went over that– Let’s go over when and severity of each in relation to Irfam.
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Starting with pressured speech, this is especially severe in manic episodes but substantially less severe in a depressive episode. Regardless of if he’s having an episode or not, he does tend to exhibit some pressured speech. So the order of severity for this one is manic episodes, no episodes, and then depressive episodes.
Next off is tangential speech patterns and this tends to be severe in manic and depressive episodes. While he does still exhibit it without the episodes, it’s definitely not as severe. It’s especially severe in a manic episode. So the order of severity for this one is manic episodes, depressive episodes, and then no episode.
Next is thought blocking, which Irfam deals with quite a bit. Especially during a depressive episode, though it’s present most of the time no matter what. If there’s ever a moment where he seems to not deal with this as much, it’s during a manic episode. So the order of severity for this one is depressive episodes, no episodes, and then manic episodes.
Now to go over circumstantial, this one tends to be specific to manic episodes. Irfam still deals with it from time to time outside of manic episodes, but during a manic episode he’s much more likely to go off on tangents or circumstantial patterns. So the order of severity for this one is manic episodes, no episodes, and then depressive episodes.
Lastly is thought derailment and while you can definitely see it without the episodes or during a manic episode, it is infinitely more severe during a depressive episode where it’s hard to tell if he’s lost focus or if he’s just given up on what he was going to say. It’s by far also the most consistently severe, other than perhaps tangential. So the order of severity for this one is depressive episodes, no episodes, and then manic episodes.
Grossly Disorganized/Catatonic Behavior
Out of the four criteria that he meets, this one is the least severe. So- Let’s go over this. Catatonic or grossly disorganized behavior is a very broad term first of all, so let’s get more specific by breaking up the two.
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Catatonic behavior refers to movement, specifically either disturbed/erratic movement or lack of movement. Terms like catatonic excitement or catatonic agitation refer to the disturbed/erratic movements and terms like catatonic stupor or catatonic posturing refer to the lack of movements. When catatonic behavior is involved, Irfam mostly deals with catatonic excitement rather than stupor or posturing. He’ll do repetitive, seemingly random or unnecessary, gestures or movements. Such as waving his hand in a circle as he speaks (stereotypy would be the specific term). The behaviors that count as catatonic excitement tend to get worse while he’s having manic episodes. Meanwhile, during a depressive episode, his catatonic behaviors tend to lean more towards the lack of movement variety. During depressive episodes, both things like catatonic stupor and catatonic posturing become much more likely to appear.
Grossly disorganized behavior meanwhile refers to unpredictable, inappropriate, or lacking basic behaviors. And while Irfam does admittedly check off the box, his grossly disorganized behaviors aren’t nearly as severe as his other symptoms. Partly because, other than a few here and there, most of them are confined to his manic or depressive episodes. But mostly it’s because the behaviors he exhibits that are grossly disorganized aren’t too severe either. Grossly disorganized behaviors that he has would include stuff such as talking to himself (mood-neutral), laughing at inappropriate times (mood-congruent, manic episodes), and difficulty with sustaining goal-directed self-care behaviors (mood-congruent, depressive episodes).
Hallucinations
So, Irfam deals with almost every type of hallucination. Auditory, tactile, visual, and multimodal tend to be the most common. Usually, unless it’s part of the multimodal hallucinations, he doesn’t tend to deal with olfactory hallucinations. Gustatory hallucinations happen more than olfactory ones but are still unlikely to show up without being part of a multimodal one. Overall, the majority of his hallucinations are multimodal.
But since all of that is such a complicated system to categorize his hallucinations with… There’s two general categories for Irfam’s hallucinations. Ones directly related to trauma and ones that aren’t (either directly or at all).
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Let’s go over the ones not directly related to trauma first. So, more specifically, let’s start off with the major hallucinations.
The first major hallucination to show up was when Irfam was around 10, and was a little girl presenting maybe a year or two older than Irfam that introduced herself as Angelita and was basically like a sister to him which is why Irfam mostly just calls her Sis. His parents either assumed her to be an imaginary friend or simply didn’t care all that much. While on his medication, he didn’t see her. But since he’s been off of it for the past like, 8 years, she’s come back (she actually came back rather quickly too, by the time he was 21 she was back, though her own appearance seems to be somewhere around late teens to early 20s, it’s hard to tell). She’s changed a bit over time, such as her appearance, mostly because of an incident that took place during a manic episode.
The second major hallucination to show up was during that same year, while he was 10, and was a white Polish chicken that could talk, he introduced himself as Rooster and quickly became Irfam’s best friend. Similar to Angelita, either his parents didn’t care or assumed Rooster was an imaginary friend. A talking chicken made sense to a 10 year old, and an Irfam that’s 8 years without medication? Yeah, that still seems believable. Besides, Rooster’s still awesome. While on medication, he didn’t see him. Which was actually kind of sad, same with Angelita. Rooster came back though, and actually came back second too while he was 20, only a bit before Angelita.
The third major hallucination to show up was a bit later, when he was 12, and was a black Himalayan cat with one torn ear that could talk, and was introduced as Pewter and was not nearly as nice as Rooster or Angelita. Pewter is very critical and actually feeds into quite a few of Irfam’s bad ideas, thoughts, and episodes. Similar to the previous two though, Pewter was either assumed to be an imaginary friend or they simply didn’t care. While on medication, he didn’t see Pewter. Unfortunately, Pewter was also the first to show back up after he stopped taking his medication, months before Rooster while he was 20. The aforementioned incident during a manic episode might’ve been instigated/egged on by Pewter too, not that the cat takes any responsibility for it. And well— Why would he?
The fourth major hallucination showed up when he was 14, mostly to combat Pewter, and was an orange and white St Bernard that could talk, he introduced himself as Beel and though he scared off Pewter, Beel was otherwise pretty distant. Not nearly as interactive as Rooster, Angelita, or Pewter. Again, Beel was written off as an imaginary friend or just not acknowledged at all. While on medication, he didn’t see Beel. Unfortunately, Beel was also the last to show up after he stopped taking his medication again. Too late to stop the aforementioned incident, Beel showed up when Irfam was already 22, barely two weeks after the aforementioned incident had transpired.
The fifth major hallucination is actually kind of new, and by far probably the most confusing. Showing up when he was 25, this one is a rock. Just a typical, no mouth, no eyes, nothing but a rock. Only nothing is ever that simple, because a British voice that’s introduced themself as Duane always seems to accompany the rock, so Irfam’s assumed that the voice is the rock. Because what else would make sense. That being said, Duane isn’t mean or nice, all Duane does is remind Irfam to take care of himself. Remind him of tasks, ask if he did stuff he was supposed to, that sort of stuff. It’s kind of annoying, actually. Especially during an episode. But what is Irfam supposed to do to a rock? Nothing. He can’t do anything to a rock. So Duane stays safe.
The rest aren’t nearly as major as those five. Onto to the rest that aren’t directly (or at all) trauma related though! Starting off the non-major ones of this section will be the simple ones and/or less distressing ones and I’ll slowly work up to ones closer to major and/or to ones that are more distressing.
First off is when Irfam hallucinates flashes of light. Whether it be in the corners of his eyes, his peripherals. Or if they’re right in front of him. Or actually seem to be coming from somewhere. Random flashes of light aren’t uncommon and, for the most part, Irfam’s kind of used to them enough for them to just be ignored.
Next one is that Irfam will often just hear static noise in the background. Like from a TV or some other malfunctioning electronic device. He finds the noise more annoying than anything else. Not very distressing at all. Maybe a bit distracting, but that’s it.
After that is the sound of knocking, which is, again, mostly just annoying. Especially since he can almost never tell whether or not someone’s actually knocking. Which has happened before, by the way. He has thought it was a hallucination but was actually real, and he has thought it was real but was actually a hallucination.
Next off is another auditory hallucination where Irfam will just hear someone or something whistling. Very annoying, and it can even be a bit distressing at times if he just suddenly hears someone whistling right behind him since he’d have no idea how they got in.
A bit worse than just whistling is hearing his name being called from somewhere by someone. Especially when he doesn’t recognize the voice calling his name. Which is, unfortunately, what usually happens. So, very annoying and a bit distressing.
This next one is extremely annoying and, while not usually distressing, it can be very disorientating. Sometimes, it’ll seem like walls are moving or have moved, which means he can’t just rely on memory of where everything is to get around. And also a lot of questions as to how they’re moving or why or if they even moved at all or if he just can’t remember where the wall was before and so it looks weird but didn’t actually move… Yeah, this one’s mostly just very disorientating.
The next one is probably only distressing to Irfam, but it is definitely annoying. Textures. He’ll be holding a smooth sheet of paper in his hand and suddenly it’ll feel fuzzy or bumpy or sharp or rough and it’s incredibly jarring. Or it could be visual and he’ll be looking at something shiny and metallic and suddenly it looks similar to the texture of satin fabric or fuzzy or some other texture and it’s jarring. Something changing textures is jarring, annoying, disorientating, and at least a little distressing to Irfam. Especially if it happens while he’s actually eating something. Very annoying, jarring, disorientating, and definitely at least a bit distressing.
After that is when he sees people in the corner of his eye, not people he knows like Angelita, but just random people that aren’t even doing anything except staring at him or going on with their own lives. It’s incredibly confusing. And quite a bit distressing to suddenly see someone in the corner of his eye without knowing how they got in. The one good part is that if he looks over, they usually go away.
Next one is shadow people. Unlike the people in the corner of his eye though, the shadow people don’t just stare or go on with their lives, and they don’t tend to leave if he looks over at them. They tend to interact with him, though never with words and the range is somewhat limited for them. That being said, having a shadow person lunge at you is definitely a bit distressing. Which has happened before.
Next is a solely auditory hallucination and probably what you’ve been wanting for here. Irfam does hear voices other than just the random calling of his name, and other than just the major hallucinations. Whether the voices are ones whispering from another room about him, or voices shouting indiscernibly, or voices talking to him. Sometimes they’re pleasant, sometimes they’re neutral, and sometimes they’re negative. No matter what, they’re very annoying. And depending on what they’re saying, they can definitely be distressing.
Last one in the section of not directly (or at all) trauma related ones. Random body parts, on the ground, on tables, on chairs, on desks, on couches, on beds– Literally could be found anywhere. Irfam will just see random body parts, usually limbs, just chilling somewhere. And while that definitely sounds distressing, Irfam’s mostly used to it. And has taken to ignoring them or moving them out of his way depending on where they are. Mostly, they’re just annoying to him.
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Now for the directly trauma related ones.
So the only ones that would count as major hallucinations here are when he’s having a combination of PTSD flashbacks and hallucinations, having to basically relive traumatic experiences completely. Other than that, it’s not uncommon for multiple of the hallucinations I’ll be going over below to be happening at the same time. With that stuff out of the way, we’ll just get straight (ha) into the other hallucinations here, starting with the less distressing ones and then working my way up.
Irfam will hear the sound of something dripping, and usually the sound is always the same. No matter how many unconnected times he hears a dripping sound in the background, it’s almost always the same. More than that, sometimes he’ll feel a drop land on him, always either his face, neck, or arms.
Next is one of the few gustatory hallucinations he has. At times, he’ll get a sudden sour, strong acidic taste in his mouth. It’s probably the one he can best ignore, as long as it’s not at the same time as other hallucinations. Which it usually is.
Another gustatory hallucination is the taste of blood. A sudden metallic, salty iron taste that can only be described as tasting like blood. A bit harder to ignore than the one above too. Again though, unless it’s happening at the same time as other hallucinations, he can usually ignore it. Unfortunately, it’s usually happening at the same time as other hallucinations. So it’s not as easy to ignore.
On a similar note, one of the only olfactory hallucinations he deals with at all is the smell of blood. Which is actually easier to ignore than the taste of blood. Which is nice. Still, this only tends to happen with other hallucinations happening too.
Next to go over is another auditory hallucination. Irfam will hear debris falling or crumbling or shattering, just a cacophony of destruction, to be honest. Which can be a bit distressing whenever you’re used to explosions happening. Not in the ‘I’m going to die!’ way but the ‘What’s exploding?’ kind of way, mostly. Still, Irfam doesn’t even try to ignore this one. If he hears it, he’s trying to figure out what happened. Assuming this one’s a hallucination isn’t really a choice for him, basically.
Again, another auditory hallucination. Screaming. Irfam will hear people screaming at random. Very annoying, very disorientating, and can definitely be distressing at times. Usually, this one happens along with other hallucinations too, but it happens alone quite a bit too. Usually, Irfam tries to ignore it, but depending on the volume or how sudden it is, that can be quite a bit difficult at times.
A bit of an odd one here, and a very general one, is that Irfam can (and has) hallucinate pain. Which isn’t too distressing, sure, except that Irfam has a chip in his brain in order to turn off his pain receptors. Which makes hallucinating pain a bit more distressing for him. Especially since the pain tends to be extreme and identical to pain he’s experienced before. Am I going to elaborate on the types of pain? No, that’d make this way too long and it already is. So you’ll just have to see.
Okay, and now we’re getting into more of the actually distressing ones. Read with caution? That’s probably a fair warning.
So, again hearing voices. This time, usually accompanied by other hallucinations and the voices are ones he can recognize as the voices of people he’s met, or people that he knows. The content of what’s said basically echo either what had been said during traumatic experiences or something similar to what had been said. Which are the main reasons as to why they’re actually distressing.
Okay first truly distressing one to even read/write about. Usually tactile, and sometimes multimodal for both visual and tactile, is when Irfam hallucinates hands roaming over his body… At best. It can get worse than that though.
After that is when Irfam hallucinates that some of his flesh is rotting. Which does not help his Cotard Syndrome, at all. Either way, you can probably blame at least some of the cybernetic ‘upgrades’ of his on this, since one way he has of responding to this hallucination is to cut off the rotting flesh. And then he just has to replace whatever was just cut off… Very distressing to just suddenly see and/or feel and/or smell your flesh rotting.
Last one! And part of why he has every mirror is covered. Irfam will at times hallucinate that his face is melting (tactile and/or visual). Usually, this doesn’t happen by itself, but it can. And it is still extremely distressing whenever it happens by itself. Not to mention, while it’s usually his face, it can also be his arms or neck or some other body part. Usually, it’s his face. If not his face, then his arms or neck. Or it could be all three or some combination of the three choices listed. No matter what, it is incredibly distressing.
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That’s the end of the section. A fair warning, hallucinations not listed might happen too, this is just supposed to be an overview of the ones you’re most likely to see. It took quite a while to figure all of the hallucinations out, haha.
Delusions
So, uh. Irfam experiences a lot of delusions. Out of all four categories, delusions are more-or-less constant, consistent, and numerous. And while the other categories might check one or two of those, delusions check all three.
The four starting categories for delusions are ‘Bizarre’ (a delusion of something impossible, like being abducted by aliens), ‘Non-Bizarre’ (a delusion of something technically possible, like being followed), ‘Mood-Congruent’ (delusions held in certain moods, like superiority during a manic episode), and ‘Mood-Neutral’ (delusions held regardless of mood).
Other categories for delusions include ‘Grandiose Delusions’ (delusions of grandeur, superiority, possessing special abilities or talents), ‘Persecutory Delusions’ or ‘Paranoid Delusions’ (being hunted, targeted, threatened, or anything of that nature), ‘Jealous Delusions’ (delusions that a partner is unfaithful), ‘Somatic Delusions’ (delusions of being infested with bugs, being pregnant, something being wrong with a specific body part, having specific diseases), ‘Erotomanic Delusions’ (delusions that someone is in love with them when that person isn’t, such as a celebrity), ‘Religious Delusions’ (delusions of religious figures speaking to them, controlling them, or having a secret plan/purpose for them), ‘Guilty Delusions’ (delusions of being a bad/evil person undeserving of kindness or delusions that they’re going to be punished due to bad deeds), and ‘Nihilistic Delusions’ (delusions that life has no purpose, that they don’t exist, life isn’t real, reality is artificially constructed, or delusions like Cotard’s Syndrome).
Also, just for the sake of not having this be insanely long… I’m going to keep the distorted self-image stuff not in this.
That being said, let’s get into this.
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Irfam has mostly non-bizarre delusions. Some are mood-neutral and some are mood-congruent. Only one or two are bizarre.
One delusion is his Cotard’s Syndrome that I’ve mentioned. The belief that one is dead, rotting, or has lost organs/limbs/their soul. This one is, for the most part, mood-neutral but especially severe for depressive episodes. During manic episodes, if he believes it at all, it tends to be quite a bit less severe. Especially when compared to other delusions he has during manic episodes. If not in an episode currently, then he does still tend to believe this to a certain extent. It’s just extremely severe in the case of his depressive episodes, and especially so in a more-severe-than-usual depressive episode.
One of his bizarre delusions is mood-congruent to manic episodes. Which is his belief that explosions cannot kill him (yes, just explosions). He’s been in so many at this point that if they were able to kill him, he’d already be dead. Which is a main reason why this delusion and his Cotard’s Syndrome don’t majorly/severely co-exist. When they do co-exist, it’s minorly, and usually under the specification of Cotard’s Syndrome that he’s lost his soul instead of his life. Unless it’s under that specification, they don’t co-exist.
Another delusion that Irfam has, and that’s mood-neutral and non-bizarre, is that certain people are out to get him. On a similar note, another delusion (that’s mood-neutral and non-bizarre) is that people are after his secrets. On a very similar note, another delusion that’s mood-neutral and non-bizarre is that people are constantly trying to watch him or keep him under surveillance/keep tabs on him. On another similar note, another delusion that’s mood-neutral and non-bizarre is that people are trying to steal his work or ideas. On a similar, but much more extreme note, is a mood-neutral delusion that someone/someones are trying to kill or hurt him in one way or another.
Irfam also deals with some guilty delusions, and while they tend to be mood-neutral, they do get more severe during his depressive episodes. One guilty delusion is that he’s a bad person that doesn’t deserve… Anything. Kindness, friends, success, life— Anything. Well, anything good, at least. Another guilty delusion is that he’ll eventually be punished for past deeds (or lack of deeds, in this situation). And yet another guilty delusion he has, that’s actually mood-congruent to depressive episodes (most of the time) is that he deserves every bad thing that’s happened to him, will happen to him, and that he just deserves to go through every bad experience ever before he’d ever deserve anything even remotely good.
A non-bizarre, mood-congruent delusion he has is of grandeur. During a manic episode, he does fall into a delusional state of being superior, of being incapable of mistakes. In fact, during a manic episode, if asked if he’s sure if something will work— He’s more likely to laugh at the person’s audacity to question him rather than do anything else.
A different delusion he has that’s non-bizarre and mood-congruent to all but manic episodes is basically the opposite. That something will go wrong, that he’s made a mistake and needs to check. To run through another calculation or equation or something to try and make sure ahead of time (again) that what he’s doing will work.
Another delusion, that’s non-bizarre and mood-neutral, he tends to deal with is that certain parts of his body are wrong, which is part of what drives him towards the cybernetic ‘upgrades’. To fix what’s wrong.
And yet another delusion he’s developed over time, that’s mood-neutral but especially severe during an episode (either manic or depressive, but for different reasons), is that he’s responsible for The Collapse.
Another mood-neutral delusion that he’s developed is that he doesn’t need to take medication. Which is partly why he’s off of it. Another delusion he has is a mood-congruent one to depressive episodes that he doesn’t deserve to take medication either.
Winter 
Day 
Blizzard
