Residual schizophrenia is one of the 5 types of schizophrenia that is characterized by a long-term history of negative symptoms (i.e. psychomotor slowing), with very infrequent or rare occurrences of positive symptoms. To meet the criteria for diagnosis, the person must have experienced positive symptoms (e.g. hallucinations/delusions/etc.) at some point. With that said, the person may go years without experiencing any further positive or psychotic symptoms.
Individuals with residual-type schizophrenia may exhibit an array of symptoms during the active phase. Although this is considered one of the 5 main subtypes, there’s really no predictable set of symptoms – it varies depending on the person. Certain individuals with residual-type may experience an isolated schizophrenic episode or two, but may have gone months without symptoms.
Typically this subtype is considered the least severe and least debilitating of all unless psychomotor slowing becomes overwhelming. This type of schizophrenia may also be characterized as having “waxing” and “waning” phases. During the waxing phase, the symptoms increase in overall intensity. During the waning phase, the symptoms slowly decline in intensity and may completely disappear. However, most individuals still have to find ways to cope with the prevalence of the negative symptoms.
Residual Schizophrenia Symptoms
The symptoms experienced in this subtype are generally considered of less intensity and lower severity than others. This subtype generally involves a person experiencing minimal positive symptoms of the illness, with more negative symptoms, and in some cases, more cognitive symptoms. Below are some symptoms that a person with residual schizophrenia may experience if they have been formally diagnosed with this subtype.
- 1 year of minimal/reduced symptoms: In order to be diagnosed with residual schizophrenia, the person must undergo a period of at least one full year in which their symptoms are substantially reduced or are of minimal intensity. During this time the person may experience symptoms, but they may hardly be noticeable and may not impair functioning too much. The person may not experience many delusions, hallucinations or even notice negative symptoms. It is this long period of time with minimal or no symptoms (e.g. remission) that distinguishes residual from other subtypes.
- Absence of dementia / other diseases and disorders: In order to properly diagnose the condition, the person must first be cleared of any neurodegenerative disease such as dementia. They must also have major depression with psychotic features ruled out. In other words, all other medical conditions must be ruled out before the diagnosis of residual schizophrenia can be assumed.
- Negative symptoms: Although positive symptoms may be more common, a person with residual-type may experience negative symptoms. These symptoms include things like slowed psychomotor functioning, flat affect (i.e. inability to feel emotion), poverty of speech (or monotone speech), poor communication, social isolation, poor hygiene, and an overall slowness.
- Flat affect: The person may be incapable of showing or expressing their emotions. They may appear to have no emotion, and may appear to have an expressionless, blank look while talking in monotone.
- Psychomotor slowing: The person’s psychomotor activity is significantly slowed. This means they have a difficult time thinking, staying motivated, and active. They may become completely apathetic if there is too much slowing.
- Inactivity: The person may sit in one position for long periods of time or become under-active. In other words, they will appear lazy, lethargic, and without any motivation or energy to complete basic tasks.
- Passivity: The individual may become completely passive to his or her environment.
- Poor communication: The individual may not be able to communicate properly or exhibit deficiencies in speech. Not only does verbal communication suffer, but nonverbal cues such as eye contact, facial expressions, and posture also suffer.
- Poor hygiene: The person may neglect basic habits such as brushing their teeth, cleaning, bathing, doing the dishes, etc.
- Psychotic episode: The person will have experienced at least one psychotic episode at some point in their past. This episode may be characterized by hallucinations, delusions, etc. Most individuals with the residual subtype have experienced at least one episode of psychosis.
- Delusions: The person may experience false beliefs that other people are out to get them and/or that they are being followed or that the government is spying on them. These are false beliefs that the person with schizophrenia believes to be true even though there is significant evidence to the contrary. These aren’t experienced very often in people with residual subtypes.
- Hallucinations: The person may hear voices and/or see things that aren’t based in reality. The voices may tell them hurtful things and may encourage the person to engage in violence or self harm. Typically the person with residual subtype does not experience hallucinations very often.
Residual Schizophrenia Causes
Currently it is unknown as to what causes schizophrenia. Individuals with other subtypes such as: catatonic, disorganized, paranoid, or undifferentiated may go on to develop residual schizophrenia. As long as the illness goes into a long-term period of remission, the individual that was diagnosed could be classified as having “residual schizophrenia.” There are no known causes for this specific subtype or another subtype for that matter.
Some hypothesize that dopamine levels, glutamate levels, and traumatic experiences early in life may play a role in the development of this disease. Others believe that it is the result of biopsychosocial factors. Depending on the particular subtype that you have, there could be a number of different “causes.” For example, if you have the catatonic subtype, the symptoms of catatonia are largely due to problems with the GABA neurotransmitter. If you have paranoid schizophrenia, it could be a result of overactive dopamine receptors.
Residual Schizophrenia Treatment
In order to properly treat residual schizophrenia, it is highly recommended that you work with a psychiatrist. They will be able to help you find a medication or multiple medications that work to reduce symptoms and prevent symptom relapse.
- Antipsychotic medications: The first line of treatment for all types of schizophrenia is antipsychotic drugs. These medications target dopamine activity and can significantly reduce positive symptoms. Unfortunately they do come with a lot of side effects including weight gain and motor problems. The newer “atypical” class of these medications is thought to have less side effects than the older “typical” class.
- Antidepressants: In some cases, an antidepressant medication may be prescribed to help treat the negative symptoms. The most commonly prescribed class of medications is that of SSRI’s. However, doctors may also consider TCA’s and MAOI’s if they do not have an interaction with the antipsychotic. Antidepressants are sometimes used as an augmentation strategy when antipsychotics are not helping reduce negative symptoms.
- Hospitalization: In some cases, people with this subtype may be hospitalized for a period of time when symptoms get severe. A hospital visit may involve the injection of antipsychotic medication and behaviors may be closely monitored by a professional.
- Natural supplements: In some cases, people may have success when using natural remedies for schizophrenia. These include things like antioxidants, amino acids, etc.
- Psychotherapy: Usually the individuals with residual schizophrenia go into remission. During this phase of remission or “waning” of the illness, they may be able to benefit from therapy sessions. Therapy may provide the person with social and emotional support, help them better understand their symptoms, and learn how to better function in society.
- Social support network: A social support network of family, acquaintances, and friends may improve the symptoms in people with residual schizophrenia. This will help guide them during times when they are struggling. Individuals with social support tend to have a better long term prognosis than those who become isolated from society.
- Vocational skills training: If the schizophrenia is severe enough to impair the individual from getting a job, they may enroll in some sort of vocational skills training. This will help the person learn a skill and possibly qualify for a job. This will help them stay productive and contribute to society.
Residual Schizophrenia Prognosis
The prognosis for people with this subtype varies depending on the individual. People that have experienced episodes at a young age with more significant cognitive and negative symptoms may have a worse prognosis than someone who experiences a late onset. Most individuals will end up having a difficult time during their schizophrenic episodes, but when the symptoms “wane” people can function pretty normally in society.
In general, individuals that have a higher level of mental performance before the onset of this illness tend to have a better long-term prognosis. In general, more favorable outcomes tend to be linked with people who just experience “brief” episodes of symptoms. Women tend to not be as severely affected by symptoms as men. Individuals with structural brain abnormalities also tend to have a worse prognosis.