Residual Schizophrenia

What is residual schizophrenia?

Individuals who have been diagnosed with schizophrenia in the past but have not suffered from an acute psychotic episode for a year or more are deemed to have residual schizophrenia.

Usually, this is a transitional phase, since schizophrenia is a cyclical condition and most people experience multiple active psychotic phases during their lifetime.

However, some people may have residual schizophrenia for years without their condition escalating, and with appropriate medication, psychotherapy and support, they may be able to successfully function in society.

Overview of residual schizophrenia

Residual schizophrenia is diagnosed when an individual experiences mild symptoms of schizophrenia but with minimal intensity. The person will have experienced prominent schizophrenic symptoms in the past, but at the current point, they will be minor enough that they do not cause significant disruption to the individual’s daily life.

In many instances, residual schizophrenia is a temporary state as individuals with the condition typically experience recurrent, active episodes of the condition where their symptoms reach a peak. Firstly, an individual will experience mild symptoms, which might cause them to become socially withdrawn and anxious. This is known as the prodromal stage, which usually builds up towards the active stage.

In the active stage, symptoms will be acute and the individual will be noticeably psychotic. This can last for several weeks or months, depending on whether the individual seeks treatment. Eventually, symptoms begin to wind down again, psychosis becomes less prominent and although the individual will still experience some symptoms, they will be less severe and usually less noticeable to others. This is known as the residual phase. Eventually, residual symptoms will also subside and the individual might not experience any symptoms at all until the cycle begins again with a new prodromal phase.

People with schizophrenia tend to experience multiple active phases over the course of their lifetime. With each one they have, the length of their residual phases will become longer and longer. In some instances, people with schizophrenia will experience residual symptoms at all times in between active phases. In others, individuals may be able to manage their condition well enough with medication that they only experience residual symptoms and no longer experience active phases.

It’s essential to note that in order for someone to have been diagnosed with schizophrenia, they must have experienced at least one active episode in which they have had very prominent psychosis, and they must have experienced symptoms of schizophrenia for more than six months. Individuals with minor or manageable schizophrenia symptoms may be diagnosed with another, similar psychiatric disorder, such as schizophreniform disorder, but they will not have residual schizophrenia because they have never had a full blown active phase or long term symptoms.

Residual schizophrenia symptoms

There is a wide range of symptoms associated with residual schizophrenia, but the key factor is that they are not prominent, positive symptoms.

Positive symptoms are things that are added on to an individual’s normal behavior. In the case of schizophrenia, this includes things like hallucinations, delusions, catatonia, disorganized thoughts and speech and highly disorganized behavior, all of which are types of psychosis. Individuals with residual schizophrenia will have experienced these positive symptoms at least once in the past during an active phase of the disorder. However, during a residual phase, they may only have a couple of minor positive symptoms and will instead be more likely to experience negative symptoms.

Negative symptoms are things that are removed from an individual’s behavior. They can be more difficult for others to identify, since they are not as prominent and have less of an impact on the schizophrenic individual’s life.

Examples of negative symptoms include:

Flat effect

  • The individual may be unable to show or express emotions, their speech may be monotone, and they are might appear expressionless.

Psychomotor slowing

  • The individual struggles to concentrate, remember things, stay motivated or be active and they might become completely apathetic about all aspects of their life.

Physical inactivity

  • The individual may feel lethargic and struggle to complete basic tasks, and will often sit in the same position for long periods of time.

Passivity

  • The individual fails to respond to their environment or the people around them.

Poor communication

  • The individual struggles to communicate with others, both verbally and via nonverbal cues such as facial expressions, eye contact, and posture.

Neglected self-care

  • The individual’s personal and household hygiene habits suffer as simple tasks such as showering and doing laundry become difficult.

In order for a doctor or psychiatrist to diagnose an individual with residual schizophrenia, the low level, negative symptoms must have occurred for a year or more, without their condition developing into an active phase or full psychotic episode.

Residual schizophrenia causes

There is no real cause for the specific sub-type residual schizophrenia, but there are many theories about the causes of schizophrenia in general.

The first relates to biology and chemicals in the brain. It is thought that people with schizophrenia have increased levels of dopamine, which is a chemical which helps brain cells to communicate. Excess dopamine could result in faulty communications which might lead to schizophrenia symptoms. A similar theory is that people with schizophrenia are affected differently than most by dopamine, and it is this which causes the symptoms.

Since antipsychotic drugs, which work to regulate dopamine levels, can be effective in treating schizophrenia, it seems clear that biology is an important factor in the cause of the disorder. However, what is less clear is why some people have excess dopamine or an unusual response to dopamine.

Experts know that genetics play some role, since schizophrenia can be inherited. Individuals with a parent or sibling with the disorder are more at risk of developing it themselves. However, there is also an environmental factor to consider, as people who live in certain areas, such as cities, and experience certain difficult life events, such as migration, are more likely to be diagnosed with schizophrenia than others. So, if multiple people within one household have schizophrenia, it could be a combination of genetic and environmental factors which have caused it.

We also know that certain recreational drugs can cause symptoms of schizophrenia, but the connection is complex. It is known that those who have already been diagnosed with the disorder can make their symptoms worse by using drugs like cannabis, cocaine, and amphetamines.

It’s also believed that these drugs can trigger a psychotic episode, but it’s not clear if schizophrenia can directly be caused by drug use, or if drugs simply trigger episodes in those who already have the disorder and have not yet shown acute symptoms. It might even be possible that those with schizophrenia are simply more likely to use recreational drugs, perhaps in an attempt to cope with the symptoms which are yet to be diagnosed.

Residual schizophrenia treatments

Antipsychotic drugs tend to be the first line of treatment for all types of schizophrenia, and doctors are likely to recommend these for residual schizophrenia. Not only will they help to manage the negative symptoms experienced in a residual phase, but they’ll work to prevent the disorder from escalating into an active phase.

Unfortunately, antipsychotics can cause side effects, such as blurred vision, dry mouth, drowsiness, muscles spasms and tremors, and weight gain. Everybody reacts differently to antipsychotics so it may take some time to find the type and dosage which provides you the most benefits with minimal side effects.

Antipsychotics can also lead to high cholesterol and they may increase the risk of diabetes, which means they may not be suitable for individuals who are already at an increased risk of heart disease, diabetes, and stroke.

Since many of the negative symptoms of residual schizophrenia are similar to those of depression, some people may respond well to antidepressants. SSRIs tend to be the most common type of antidepressants, but alternative medications may be considered if there is a risk that the antidepressant could interact with antipsychotics already being prescribed to the patient.

Psychotherapy can be very helpful for individuals with residual schizophrenia because it can give them an opportunity to learn how to cope with their symptoms both in the present and in the future if they relapse into another active phase. Therapy is an excellent opportunity for individuals to voice their concerns about their illness, receive emotional support and learn how to function more successfully in society.

It is rare that individuals with residual schizophrenia are hospitalized. Usually, hospitalization takes place when an individual is experiencing full psychosis during an active phase, where they may be a danger to themselves or others. Hospitalization in these instances helps to ensure the individual gets the urgent treatment they need while under the supervision of experts. When it comes to residual schizophrenia, outpatient treatment tends to be most effective. However, if symptoms suddenly become more severe, hospitalization may be necessary.

Prevention of acute schizophrenia symptoms

There is no known way to prevent schizophrenia, but there may be some ways to alleviate the risk of residual schizophrenia from developing into an acute phase.

Firstly, it is vital that individuals follow their treatment plan correctly, even if they feel that their symptoms have disappeared. Cessation of antipsychotics or other medications without the advice and approval of a doctor is not recommended as it can cause a sudden onset of acute symptoms.

Similarly, individuals should attend all assessments, meetings and therapy sessions arranged by their doctor or other healthcare professional in order that any changes in their symptoms are monitored.

It may be incredibly helpful for people with residual schizophrenia to surround themselves with a support network of trusted family and friends. Sometimes it can be difficult to notice subtle changes in symptoms in ourselves, and it might be others that notice them first.

A support network can therefore help you to monitor your condition and encourage you to seek professional help if more serious symptoms begin to develop. Not only that, but your friends and family could also help to remind you to take medication and visit your doctor’s appointments where necessary.

Finally, it’s important to avoid drugs and alcohol after having been given a diagnosis of schizophrenia. Even for those with mild, residual symptoms, alcohol and recreational drugs can worsen symptoms and even trigger psychotic episodes. Those struggling with addiction to alcohol or drugs are advised to speak with their doctor about rehabilitation.

It is important that this is done under the careful supervision of a medical professional, as withdrawing from drugs or alcohol after long term use can also trigger acute psychosis and could be particularly dangerous for those with schizophrenia.

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Last Reviewed:
September 12, 2017
Last Updated:
September 12, 2017