Residual schizophrenia: symptoms, causes and treatment.

This type of schizophrenia is characterized by the presence of negative symptoms. Let's see what it looks like.

Residual schizophrenia appears after a diagnosis of schizophreniain 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 appear in 90% of patients with schizophrenia, and we will learn about its characteristics and how it can be treated at the clinical level.

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 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 is given when there has been at least one episode of schizophrenia, but in the current clinical picture the existence of delusional ideas, hallucinations, behavior or disorganized language is attenuated, and the negative symptoms (e.g., delusions, hallucinations, behavior or disorganized language) stand out.and the negative symptoms (affective dullness, poor language, anhedonia, apathy...) stand out.

The presence of attenuated positive symptomatology may be manifested for example by bizarre 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 stages (which include one or more episodes with psychotic symptoms that have satisfied the general patterns of schizophrenia) to the final stages characterized by the presence of negative symptoms and persistent, but not necessarily irreversible, impairment..

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 significant negative symptoms is required, such as psychomotor inhibition, affective blunting, lack of activity, passivity and lack of initiative.The symptoms include: impaired quality or content of language, impaired nonverbal communication (eye contact, intonation, posture and facial expression), and/or impaired grooming and social behavior.

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 florid symptomatology.

It is required that during a period of at least one year the intensity and frequency of florid symptomatology (delusional ideas and (delusional ideas and hallucinations) have been minimal, while the presence of negative symptoms was prominent.

4. Absence of other symptoms

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

Prevalence

From a clinical point of view and according to several 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

It occurs before the onset of the disease.In the prodromal phase, some attenuated psychotic symptoms appear. It can last 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, 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 common 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 impairment is severe.

In turn, the residual phase is divided into two sub-phases:

Stabilization (or post-crisis) phase 3.1.

The intensity of acute psychotic symptoms is reduced and may last 6 months or more.

3.2. Stable phase (or maintenance phase)

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

Treatment

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

Pharmacological treatment includes mainly 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 and level of functioning).

Logically, the treatment will focus on the negative symptoms since they are the most noticeable, without forgetting the positive symptomatology that, in case it appears, let us remember that it does so in an attenuated form.

Bibliographic references:

• WHO: CIE-10 (1992). Mental and Behavioral Disorders. Tenth Revision of the International Classification of Diseases. Clinical Descriptions and Guidelines for Diagnosis. 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 Guideline 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 sampling of patients with schizophrenia. Actas Esp Psiquiatr, 39(3), 147-54.