Residual Schizophrenia: Symptoms, Causes And Treatment
Residual schizophrenia appears after a diagnosis of schizophrenia, in the residual phase of the disorder. It implies the existence of important negative symptoms and attenuated positive symptoms.
Although it does not appear in all subjects, it does in 90% of patients with schizophrenia. Let’s learn about its characteristics and how it can be treated clinically.
Residual schizophrenia is included as a diagnosis in the ICD-10 (International Classification of Diseases) with 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, disorganized behavior or speech is attenuated and the negative symptoms stand out (affective dullness, poor speech, anhedonia, apathy…).
The presence of attenuated positive symptoms can manifest itself, for example, with strange 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 deterioration, although not necessarily irreversible
The diagnosis of residual schizophrenia is compatible with two other variants: chronic undifferentiated schizophrenia and residual schizophrenic state, and therefore does not exclude them.
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 dullness, lack of activity, passivity and lack of initiative impoverished quality or content of language, impoverished non-verbal communication (eye contact, intonation, posture and facial expression), and/or deterioration in personal hygiene and social behavior.
2. Previous diagnosis of schizophrenia
There needs to be at least one clear episode in the past that met the criteria for the diagnosis of schizophrenia.
3. A year with attenuated florid symptoms
It is required that for a minimum period of one year the intensity and frequency of florid symptoms (delusions and hallucinations) were minimal, while the presence of negative symptoms was highlighted.
4. Absence of other paintings
It is necessary that there is no dementia another illness, 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 (as do paranoid and undifferentiated schizophrenia).
Phases of schizophrenia
The course of schizophrenia can be divided into three phases:
1. Prodromal phase
Occurs before the onset of the disease, some attenuated psychotic symptoms appear. It can last days, months or even years.
2. Acute phase or crisis
They are outbreaks or crises; The symptoms that occur are positive (hallucinations, delusions, disorganized behavior…).
This is where residual schizophrenia appears, the period after the outbreak After treatment, positive symptoms usually disappear.
It is then common to observe a more or less pronounced deterioration in 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 work deterioration is serious.
In turn, the residual phase is divided into two subphases:
3.1. Stabilization phase (or post-crisis)
Sse reduces the intensity of acute psychotic symptoms, it can last 6 months or more.
3.2. Stable (or maintenance) phase
Symptoms may have disappeared or are relatively stable although less serious than in the acute phase.
Treatment
Treatment for residual schizophrenia is similar to that of schizophrenia itself, and includes a multidisciplinary approach with pharmacological and psychological treatment.
Pharmacological treatment mainly includes 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 as their level of functioning).
Logically, the treatment will focus on the negative symptoms since they are the most notable, without forgetting the positive symptoms which, if they appear, we remember that they do so in an attenuated way.
