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. We will know 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 disorders of delusional ideas”.
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, behavior or disorganized language is attenuated, and negative symptoms stand out (affective dullness, language poverty, anhedonia, apathy…).
The presence of attenuated positive symptomatology may manifest, for example, with rare beliefs or unusual perceptive experiences.
Thus, it is a chronic state of the course of schizophrenic disease, in which there has been a clear progressive evolution from the initial stages (which include one or more episodes with psychotic symptoms that have satisfied the general patterns 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: undifferentiated chronic schizophrenia and residual schizophrenic state, and therefore does not exclude them.
The guidelines for diagnosing residual schizophrenia are the following:
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 (visual contact, intonation, posture and facial expression). ), and / or deterioration of personal hygiene and social behavior.
2. Previous diagnosis of schizophrenia
It is necessary that in the past there has been at least one clear episode that has met the criteria for the diagnosis of schizophrenia.
3. One year with attenuated florida symptomatology
It is required that during a minimum period of one year the intensity and frequency of florid symptoms (delusions and hallucinations) have been minimal, while highlighting the presence of negative symptoms.
4. Absence of other paintings
It is necessary that there is no dementia, another disease, organic brain disorder, chronic depression or institutionalization sufficient to explain the deterioration that is observed.
From a clinical point of view and according to various studies, residual schizophrenia occurs in 90% of cases (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 days, months or even years.
2. Acute phase or crisis
They are the outbreaks or crises; the symptoms that are produced are the positive ones (hallucinations, delusions, disorganized behavior …).
3. Residual phase
It is where residual schizophrenia appears, the post-outbreak period. After treatment, the positive symptoms usually disappear.
It is then common to observe a more or less marked deterioration of the premorbid level of functioning. Not all patients suffer.
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)
If the intensity of acute psychotic symptoms is reduced, it may last 6 months or more.
3.2. Stable phase (or maintenance)
The symptomatology may have disappeared or is relatively stable, although less severe than in the acute phase.
The treatment for schizophrenia residual resembles that of schizophrenia proper, and includes a multidisciplinary approach with pharmacological and psychological treatment.
The pharmacological treatment mainly includes 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 its level of functioning).
Logically, the treatment will focus on the negative symptoms since they are the most notable, without forgetting the positive symptomatology that, if it appears, we remember that it does so in an attenuated manner.