Residual schizophrenia: symptoms, causes and treatment

Residual schizophrenia appears after a diagnosis of schizophreniain 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 appear in 90% of patients with schizophrenia. We are going to know its characteristics and how it can be treated at a clinical level.

• Related article: "What is psychosis? Causes, symptoms and treatment"

Reference Manuals

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

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 language is attenuated, and the negative symptoms stand out (affective dullness, poor language, 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 of the course of the schizophrenic disease, in which there has been a clear progressive evolution from the initial states. (including one or more episodes with psychotic symptoms that have met the general guidelines for 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: undifferentiated chronic 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, affective dullness, lack of activity, passivity and lack of initiative, impoverishment of the quality or content of language, impoverished non-verbal communication (contact visual, intonation, posture and facial expression), and/or deterioration of personal cleanliness and behavior social.

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2. Previous diagnosis of schizophrenia

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

3. One year with attenuated florida symptoms

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

4. Absence of other frames

It is necessary that there is no dementia, other illness, organic brain disorder, chronic depression, or institutionalization sufficient to account for the impairment being 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. 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...).

3. residual phase

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

It is then frequent to observe a more or less pronounced 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 work deterioration is serious.

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

3.1. Stabilization phase (or post-crisis)

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

3.2. Stable (or maintenance) phase

Symptoms may have disappeared or are relatively stable, although less severe than in the acute phase.

Treatment

Treatment for residual schizophrenia is similar to that for schizophrenia itself, and includes a multidisciplinary approach with pharmacological and psychological treatment.

Pharmacological treatment basically includes typical and atypical antipsychotics.. On the other hand, psychological intervention includes a variety of techniques such as family therapy (psychoeducational guidelines, improving the dynamics relatives,...) and individual therapy (especially cognitive-behavioral, aimed at improving the patient's state of mind as well as their level of functioning).

Logically, the treatment will focus on the negative symptoms since they are the most notable, without forget the positive symptomatology that, in case it appears, remember that it does so dimmed.

Bibliographic references:

• WHO: ICD-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 (4th Edition Reviewed). Washington, DC: Author.
• Clinical Practice Guideline on Schizophrenia and Early 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. Actas Esp Psiquiatr, 39(3), 147-54.