Schizoaffective disorder represents a severe clinical entity located at the interface between schizophrenia spectrum disorders and affective disorders, with significant diagnostic and therapeutic implications. We present the case of an adult patient admitted to a psychiatric unit who developed a complex clinical presentation characterized by persistent productive psychotic symptoms, marked affective instability, and the concomitant presence of manic and depressive symptoms. Clinical and longitudinal assessment highlighted difficulties in the differential diagnosis with bipolar disorder with psychotic features and schizophrenia. The diagnosis was established according to DSM-5-TR and ICD-10 criteria. Under combined antipsychotic and mood stabilizer treatment, a progressive improvement of both psychotic and affective symptoms was observed. The discussion emphasizes the particularities of mixed episodes in schizoaffective disorder, the importance of longitudinal evaluation, and the need for an individualized therapeutic approach to optimize prognosis.
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