Residual schizophrenia: symptoms, causes and treatment

Residual schizophrenia appears after a diagnosis of schizophrenia, In the residual phase of the disorder. This implies the existence of significant negative symptoms and attenuated positive symptoms.

Although it does not appear in all people, it does in 90% of schizophrenic patients, let’s find out its characteristics and how it can be treated clinically.

    Reference Manuals

    Residual schizophrenia is included as a diagnosis in the ICD-10 (International Classification of Diseases) of the same name within 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”, in the category “Schizophrenia and other psychotic disorders”.

    Residual schizophrenia: characteristics

    This label diagnoses 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 reduced, And the negative symptoms emerge (emotional dullness, linguistic poverty, anhedonia, apathy …).

    The presence of an attenuated positive symptomatology can manifest itself, for example, with rare beliefs or unusual perceptual experiences.

    Thus, it is a chronic state of the course of schizophrenic disease, in which there has been a marked progressive course from the initial states (which include one or more episodes with psychotic symptoms that have met the guidelines general of 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 status, and therefore does not exclude them.

    symptoms

    The guidelines for the diagnosis of residual schizophrenia are as follows:

    1. Negative symptoms

    Important negative symptoms are needed, such as psychomotor inhibition, affective dullness, lack of activity, passivity and lack of initiative, Impoverishment of language quality or content, impoverishment of non-verbal communication (eye contact, intonation, posture and facial expression), and / or deterioration of personal cleansing and social behavior.

      2. Previous diagnosis of schizophrenia

      It is necessary that in the past there has been at least one clear episode that meets the diagnostic criteria for schizophrenia.

      3. A year with reduced flowering symptoms

      It is required for a minimum period of one year the intensity and frequency of flowering symptoms (The delusions and hallucinations) were minimal, while highlighting the presence of negative symptoms.

      4. Absence of other images

      There must be no dementia, Other disease, organic brain disorder, chronic depression or sufficient institutionalization to explain the observed deterioration.

      prevalence

      From a clinical point of view and according to several studies, residual schizophrenia occurs in 90% of cases (just like 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, Some attenuated psychotic symptoms appear. It can last for days, months, or even years.

      2. Acute phase or crisis

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

      3. Residual phase

      This is where residual schizophrenia appears, the period after the epidemic. After treatment, the positive symptoms usually go away.

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

      Here, the negative and cognitive symptoms become more intense and the personal, social and professional deterioration is severe.

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

      3.1. Stabilization phase (post-crisis)

      Sse reduces the intensity of acute psychotic symptoms, may last 6 months or more.

      3.2. Stable phase (or maintenance)

      Symptoms may be gone or be relatively stable, Although less severe than in the acute phase.

      treatment

      The treatment of residual schizophrenia is similar to that of schizophrenia itself and includes a multidisciplinary approach with pharmacological and psychological treatment.

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

      Logically, the treatment will focus on the negative symptoms because they are the most visible, not to mention the positive symptomatology which, in case it appears, it is remembered that it does so in an attenuated way.

      Bibliographical 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 (4th edition of the journal). Washington, DC: author.
      • Schizophrenia and Emerging Psychotic Disorder Consultation Tools. (2009). CLINICAL PRACTICE GUIDELINES AT THE MINISTRY OF HEALTH AND CONSUMPTION SNS.
      • Simões do Couto, F., Queiroz, C., Barbosa, T., Ferreira, L, Firmino, H., Viseu, M., Ramos, L., Romero, J. and Figueira, ML (2011). Clinical and therapeutic characterization of a Portuguese sample of patients with schizophrenia. Actas Esp Psiquiatr, 39 (3), 147-54.

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