Ayurvedic Approach to Schizoaffective Disorder, Depressive type, with combined with AUD: A Case report

Abstract

Background: Schizoaffective disorder, depressive type with comorbid alcohol use disorder, is a complex condition with overlapping psychotic, mood, and substance-use symptoms. Diagnosis and management are challenging. In Ayurveda, it aligns with Sannipataja Unmada, where there is a coexistence of psychotic and mood symptoms, including both positive symptoms like hallucinations, delusions, and negative symptoms like social withdrawal, impaired cognition, blunted affect, and it's a highly debilitating condition. Clinical findings: A 50-year-old alcoholic male with a known case of Type 2 Diabetes Mellitus and Hypertension for 15 years,  on treatment with irregular adherence leading to suboptimal glycaemic and blood pressure control, presented with longstanding low mood, frequent anxiety, occasional hallucinations, paranoid ideation, and persistent alcohol use despite repeated medical advice. Mental health examination revealed impaired memory and concentration, partial insight, and mild psychomotor agitation. Standardised assessments revealed moderate-to-severe depressive symptoms (HDRS), mild anxiety, harmful drinking (AUDIT), cognitive impairment (MMSE), and positive suicidality (C-SSRS). Based on clinical presentation and ICD-11, Schizoaffective Disorder, Depressive Type with Alcohol Use Disorder was diagnosed. Intervention: protocol was administered alongside ongoing pharmacotherapy. This included Panchakarma (Nasya), external therapies (Shirodhara, Shiropichu, etc.), Shamana medicines (Brahmi Vati, Draksharishtam, etc.), Satwawajaya Chikitsa (psychotherapy), Marma therapy, and Yoga. Outcome: The patient showed significant overall improvement over 90 days of treatment, with cognitive function (MMSE) improving by 43.8%. There was a marked reduction in depressive (65.4%), anxiety (50%), insomnia (33.3%), alcohol use (46.7%), suicidality (90.9%), and psychotic symptoms (34.9%). These findings indicate clinical recovery and stabilization, but not remission, and thus require continued management. Alcohol dependence made abstinence challenging, though intake was reduced, with the last use before admission. Conclusion: A multidimensional Ayurvedic treatment approach can help to address and manage diagnostic and therapeutic challenges in schizoaffective disorder with alcohol use disorder. While outcomes are promising, validation through larger controlled studies is required.