Residual schizophrenia appears after a diagnosis of schizophrenia , in the residual phase of the disorder. It involves the existence of significant negative symptoms and attenuated positive symptoms.

Although it does not appear in all subjects, it does in 90% of patients with schizophrenia.

Reference manuals

Residual schizophrenia is included as a diagnosis in the ICD-10 (International Classification of Diseases) under this name within the types of schizophrenia, in the section “Schizophrenia, schizotypal disorder and delusional disorders”.

In the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) it is included as “Residual Type of Schizophrenia”, within the category “Schizophrenia and other Psychotic Disorders”.

Residual schizophrenia: characteristics

This diagnostic label when there has been at least one episode of schizophrenia, but in the current clinical picture the existence of delusions, hallucinations, behaviour or disorganised language is attenuated , and the negative symptoms (emotional numbness, language poverty, anhedonia, apathy…) stand out.

The presence of attenuated positive symptoms can manifest itself for example through rare beliefs or unusual perceptual experiences.

Thus, it is a chronic state in the course of schizophrenic illness, in which there has been a clear progressive evolution from the initial states (which include one or more episodes with psychotic symptoms that have satisfied the general guidelines of schizophrenia) towards the final stages characterized by the presence of negative symptoms and persistent, although not necessarily irreversible, deterioration .

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The diagnosis of residual schizophrenia is compatible with and does not exclude two other variants: chronic undifferentiated schizophrenia and residual schizophrenic state.

Symptoms

The guidelines for diagnosing residual schizophrenia are as follows:

1. Negative symptoms

The presence of important negative symptoms is necessary, such as psychomotor inhibition, emotional numbness, lack of activity, passivity and lack of initiative , impoverishment of the quality or content of language, impoverished non-verbal communication (eye contact, intonation, posture and facial expression), and/or deterioration of personal hygiene and social behaviour.

2. Previous diagnosis of schizophrenia

There needs to have been at least one clear episode in the past that has met the criteria for a diagnosis of schizophrenia.

3. One year with attenuated flowery symptoms

It is required that during a minimum period of one year the intensity and frequency of the florid symptomatology (delusions and hallucinations) have been minimal, while the presence of the negative symptoms was highlighted.

4. Absence of other tables

It is necessary that there is no dementia , other disease, organic brain disorder, chronic depression or institutionalization sufficient to explain the deterioration observed.

Prevalence

From a clinical point of view and according to various studies, residual schizophrenia occurs in 90% of cases (the same as paranoid and undifferentiated schizophrenia).

Phases of Schizophrenia

The course of schizophrenia can be divided into three phases:

1. Prodromic phase

It occurs before the onset of the disease , some attenuated psychotic symptoms appear. It can last for days, months or even years.

2. Acute phase or crisis

These are the outbreaks or crises; the symptoms that occur are the positive ones (hallucinations, delusions, disorganised behaviour…).

3. Residual phase

This is where residual schizophrenia appears, the period after the outbreak . After treatment, positive symptoms usually disappear.

It is then frequent to observe a more or less marked deterioration of the premorbid level of functioning. Not all patients suffer from it .

Here the negative and cognitive symptoms become more intense and the personal, social and occupational deterioration is serious.

In turn, the residual phase is divided into two subphases:

3.1. Stabilisation (or post-crisis) phase

If the intensity of the acute psychotic symptoms is reduced, it can last 6 months or more.

3.2. Stable (or maintenance) phase

The symptomatology may have disappeared or is relatively stable , although less severe than in the acute phase.

Treatment

Treatment for residual schizophrenia resembles that of schizophrenia itself, and includes a multidisciplinary approach with pharmacological and psychological treatment.

The pharmacological treatment includes mainly the typical and atypical antipsychotics . On the other hand, psychological intervention includes a variety of techniques such as family therapy (psychoeducational guidelines, improving family dynamics,…) and individual therapy (especially cognitive-behavioral, aimed at improving the patient’s mood as well as his or her level of functioning).

Logically, the treatment will focus on the negative symptoms since they are the most notable, without forgetting the positive symptoms which, in case they appear, we must remember that they are attenuated.

Bibliographic references:

  • WHO: CIE-10 (1992). Mental and Behavioral Disorders. Tenth Revision of the International Classification of Diseases. Clinical Descriptions and Diagnostic Guidelines. World Health Organization, Geneva.
  • American Psychiatric Association (2000). DSM-IV-TR. Diagnostic and statistical manual of mental disorders (4thEdition Reviewed). Washington, DC: Author.
  • Clinical Practice Guidance on Schizophrenia and Incipient Psychotic Disorder (2009). CLINICAL PRACTICE GUIDELINES IN THE SNS MINISTRY OF HEALTH AND CONSUMPTION.
  • Simões do Couto, F., Queiroz, C., Barbosa, T., Ferreira, L, Firmino, H., Viseu, M., Ramos, L., Romero, J. and Figueira, M.L. (2011). Clinical and therapeutic characterization of a Portuguese sample of patients with schizophrenia. Proceedings Esp Psiquiatr, 39(3), 147-54.