Residual Schizophrenia: definition, symptoms, and treatments

Residual schizophrenia is a type of schizophrenia where patients don’t experience hallucinations and delusions anymore, but negative symptoms persist. It is not an official diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) by the American Psychiatric Association, but doctors still use this term to describe the phase where a schizophrenia patient doesn’t have psychosis.

Residual schizophrenia symptoms include unusual ideas, bizarre perceptual encounters, unrealistic thinking, flat affect, lack of motivation for activities, reduced enjoyment, impaired speech, and asociality.

The treatment methods for residual schizophrenia are medications and psychotherapy. With adherence to the treatment protocol, patients are able to improve their quality of life and prevent relapse.

What is residual schizophrenia?

Residual schizophrenia is a subtype of schizophrenia indicated by reduced positive symptoms while negative symptoms still remain. Positive symptoms of schizophrenia are thoughts or behaviors that weren’t present before this mental illness. They are hallucinations, delusions, and paranoia.

On the other hand, negative symptoms are changes to behaviors and thoughts that existed before. Good examples are social withdrawal, unusual thoughts, and loss of interest. More precisely, a person with residual schizophrenia does not have hallucinations and delusions anymore, but they have a loss of interest and other symptoms.

Residual schizophrenia, like other types of this mental illness, was present in the DSM-4. However, DSM-5 eliminated these subtypes, which is why residual schizophrenia is not an official diagnosis. Doctors still use this term to describe a patient’s condition that isn’t in the active phase anymore.

Before DSM-5, residual schizophrenia was diagnosed when a person had experienced at least one episode of schizophrenia but wasn’t exhibiting positive symptoms any longer, or they appeared to a lesser degree.

How common is residual schizophrenia?

It is not known how common residual schizophrenia is, but it is not as prevalent as other subtypes of schizophrenia.

According to a 2022 fact sheet titled, “Schizophrenia” from the World Health Organization (WHO), about 24 million people in the world have schizophrenia. That accounts for one in 300 persons or 0.32% of the global population.

In the United States, approximately 2.8 million adults have schizophrenia. Children rarely have schizophrenia, and an article titled, “Childhood Schizophrenia” last reviewed in October 2023 by Cleveland Clinic estimated that approximately one in every 10,000 children suffers from the condition.

When it comes to teenagers, a review by Ch Androutsos published in the June 2012 issue of Psychiatriki asserted that 0.23% of them have schizophrenia. Finally, according to a 2009 feature article written by Rosenberg et al., for the journal Annals of Long-Term Care, in individuals 45–64 years old, the prevalence of schizophrenia is roughly 0.6%; in those 65 and beyond, it varies from 0.1% to 0.5%.

There is not much difference in the prevalence of residual schizophrenia among men and women. However, men develop this mental illness sooner than women.

What are the causes of residual schizophrenia?

The causes of residual schizophrenia involve multiple factors that play a role in its development. The causes of residual schizophrenia are listed below.

• Genetics: Residual schizophrenia has a genetic component. Multiple gene variations are involved in its development. That explains why the disease tends to run in families. Since several people with schizophrenia don’t have a family history of this mental illness, heredity is not the only cause.
• Brain structure: At times, changes in the structure and function of certain regions in the brain contribute to the onset of schizophrenia symptoms. Disruptions with neurotransmitters play a role as well.
• Environment: Complications in pregnancy contribute to residual schizophrenia. These include malnutrition, lack of oxygen, or exposure to harmful pathogens in the womb.
• Substance abuse: Alcohol and drugs make a person more likely to develop a wide range of mental illnesses, including schizophrenia. These substances are addictive and have a major influence on the brain and its functioning.

What are the symptoms of residual schizophrenia?

Symptoms of residual schizophrenia are less extreme than those in other subtypes, but they still have a major impact on a person’s well-being. The symptoms of residual schizophrenia are listed below.

• Unusual ideas
• Bizarre perceptual encounters
• Unrealistic thinking
• Decreased emotional expression or a flat affect
• Lack of drive to carry out meaningful activities (avolition)
• Reduced enjoyment from good stimuli (anhedonia)
• Reduced speech (alogia)
• Lack of desire to communicate with others (asociality)

1. Unusual ideas

Unusual ideas refer to strange beliefs that people with residual schizophrenia have. These beliefs aren’t the same as delusions, which tend to be severe. Instead, unusual ideas are eccentric beliefs that lead to bizarre behaviors.

The physical effects of this symptom depend on the type of unusual ideas but typically involve a lack of hygiene and healthy lifestyle practices, which increase the risk of various health problems. A person’s behaviors additionally change, become difficult to comprehend, and are closely tied to a specific strange or unusual belief.

2. Bizarre perceptual encounters

Bizarre perceptual encounters are unusual experiences involving the way a person perceives the world around them. More precisely, a person with residual schizophrenia perceives events that others do not.

For instance, people with this condition feel like someone is sitting next to them even though no one’s there or they don’t see anyone or they are lying on the bed and feel like they’re levitating. The surroundings look different to a person with residual schizophrenia, as if they’re wearing glasses with filters.

Physical effects of bizarre perceptual encounters involve problems with vision (affecting the way a person views colors, facial expression, and space) and sensitivity to noise. This symptom leads to bizarre and eccentric behaviors, confusion, and social withdrawal.

3. Unrealistic thinking

Unrealistic, or distorted thinking refers to a way of thinking that is inaccurate or negatively biased. Eventually, this thinking pattern leads to viewing things more negatively than they really are.

A study by Ventura et al., published in the August 2010 issue of Schizophrenia Research stated that in people with schizophrenia, unrealistic thinking is a separate entity from positive symptoms such as delusions and hallucinations.

A person with residual schizophrenia quickly loses his train of thought. Their thoughts tend to be disconnected from one another entirely. Unrealistic thinking leads to problems with speech and expressing oneself, which contributes to frustration and irritable behavior, and social isolation.

This way of thinking affects confidence, body image, emotions, and how a person sees themselves and others. Affected people even start misusing alcohol and drugs. The physical effects of this symptom are related to behaviors that a person exhibits. For example, alcohol misuse leads to dependence, addiction, and problems with health.

4. Decreased emotional expression or a flat affect

Flat affect refers to a person’s inability to express their emotions in the same way as other people do. A person with a flat affect shows no facial expressions to show they’re happy or sad. Verbal reactions are missing too. They often speak in a monotone voice and avoid eye contact.

The decreased emotional expression occurs due to unusual brain activity. The inability to express or react to emotions pushes people into social isolation. This symptom doesn’t have specific physical effects; they are largely behavioral and revolve around social withdrawal and avoidance of people and places.

5. Lack of drive to carry out meaningful activities (avolition)

Avolition is a complete lack of motivation that makes it difficult for a person to complete tasks or engage in activities. A person with this symptom of residual schizophrenia can’t start or finish simple, everyday tasks. For example, even washing the dishes seems like such a difficult task to do.

People with avolition don’t wash and groom themselves as they should. The lack of proper hygiene and inability to perform everyday tasks like maintaining a healthy lifestyle put a person at a higher risk of problems such as cavities, weight gain, and diabetes.

Behavioral effects of avolition include reduced productivity at work, failing to show up at meetings, neglecting responsibilities, and social withdrawal. All these lead to frustration and depression.

6. Reduced enjoyment from good stimuli (anhedonia)

Anhedonia is the inability to feel pleasure in pleasurable situations or circumstances. According to an article written by Jennifer Purdie last updated in May 2023 by Healthline, there are two types of anhedonia. They are social and physical.

Social anhedonia is a complete lack of interest in all kinds of interpersonal relationships. People find it difficult to enjoy themselves in social settings. Physical anhedonia, on the other hand, is the incapacity to experience tactile pleasure from activities like eating, moving, having sex, or touching.

One of the most pronounced physical effects of anhedonia is loss of libido and impaired sexual function or performance. Behavioral effects include social isolation, losing interest in hobbies, and problems with friends or family due to a lack of motivation to make an effort and enjoy certain activities.

7. Reduced speech (alogia)

Alogia, or “poverty of speech,” is a lack of conversation or the inability to speak. People with alogia either do not speak at all, or they do very little due to impairment in their brains. An individual with alogia uses fewer words, answers solely what is directly asked, and speaks in a way that others perceive as repetitive or vague.

People with alogia have slurred speech or a dull facial expression during the conversation. While alogia doesn’t affect the body or physical health, it leads to behavioral effects such as social isolation, anger and frustration over not being able to express better, bizarre behaviors, and depression.

8. Lack of desire to communicate with others (asociality)

Asociality is the lack of motivation or desire to engage in social interaction. A person with residual schizophrenia prefers solitary activities instead. Asociality goes hand in hand with avolition.

When discussing this symptom of residual schizophrenia, it’s important to clarify that asocial and antisocial are two different terms. Antisocial is a term that describes a person who is antagonistic toward society or even a threat to it.

On the flip side, an asocial person is an individual who is not motivated or interested in social interactions, but is not hostile. That person doesn’t have anything against society, nor do they behave in a way that annoys or threatens others.

Being asocial has many physical effects because it increases the risk of health problems ranging from being overweight or obese to a higher risk of Alzheimer’s disease, and cardiovascular conditions. People with this symptom tend to be quiet and reserved and go to extra lengths to avoid communicating or interacting with friends, colleagues, family, or acquaintances.

What are the risk factors for residual schizophrenia?

Risk factors for residual schizophrenia are difficult to define mainly because the causes of this condition are unclear. The most significant risk factors of residual schizophrenia are listed below.

• Family history: A person is more susceptible to developing residual schizophrenia if their family members, particularly parent or sibling, has a history of this mental illness.
• Parent’s age: A first child born to either younger or older parents is more likely to develop schizophrenia.
• Taking drugs: Substance abuse makes a person more likely to have residual schizophrenia. The risk is higher for people who use hallucinogenic or mind-altering drugs such as ecstasy or PCP.
• Pregnancy and birth complications: Malnutrition during pregnancy increases the risk of residual schizophrenia in a child. The same happens with exposure to toxins and viruses because they affect brain development.

How is residual schizophrenia diagnosed?

Residual schizophrenia is diagnosed after a thorough physical and psychiatric evaluation. The healthcare provider starts with a physical exam to rule out potential medical problems that cause symptoms and to see whether there are any complications.

Physical exams include screenings such as MRI and blood tests. The latter is mainly used to test for the presence of drugs. Once the physical exam shows no presence of other medical problems, the doctor refers the patient to a psychiatrist.

The psychiatric evaluation includes checking the mental status of a patient by observing their moods, thoughts, symptoms, and potential for suicide or violence. The psychiatrist asks questions about family and personal history as well.

To make an accurate diagnosis, the psychiatrist checks DSM-5 diagnostic criteria. Keep in mind that residual schizophrenia, and other types aren’t in DSM-5, but doctors still use these terms to easily describe the phase of a patient’s illness.

So, if a patient has experienced an active episode and no longer has positive symptoms, just negative ones, they are likely to have residual schizophrenia.

When does residual schizophrenia occur?

Residual schizophrenia occurs at any age. Generally speaking, the age of onset of schizophrenia isn’t the same for men and women. Men tend to develop this mental illness between late adolescence and early 20s.

The age of onset for women is in the late 20s to early 30s. They reach the residual phase once they stop experiencing positive symptoms. These symptoms last for weeks or months.

How does residual schizophrenia affect the body?

Residual schizophrenia affects the body through a higher risk of weight gain and abdominal obesity. At the same time, people with this condition are more likely to develop diabetes and metabolic syndrome. They are additionally more susceptible to cardiovascular diseases.

The physical effects of residual schizophrenia occur due to negative symptoms such as loss of interest. Not only does a person lose interest in activities they once enjoyed, but in their health and hygiene too. People with this mental illness are less likely to choose healthier food and exercise regularly.

How does residual schizophrenia affect the brain?

Residual schizophrenia affects the brain through structural and functional changes. The most significant effects of this mental illness on the brain include decreased alterations in gray and white matter, as well as volume reductions in the temporal lobe, a 2006 paper by DeLisi et al., from the Dialogues in Clinical Neuroscience reported.

Furthermore, a 2010 study by Karlsgodt et al., published in Current Directions in Psychological Science revealed that schizophrenia is linked to alterations in the structure and operation of various important brain systems, such as the prefrontal and medial temporal lobe areas responsible for working memory and declarative memory, respectively.

In addition, residual schizophrenia is associated with atypical neural activity in patients during the execution of diverse cognitive tasks, encompassing evaluations of decision-making, emotion processing, short-term memory, and long-term memory.

Besides reductions and disruptions in several brain areas, residual schizophrenia affects neurotransmitters. It strongly affects dopaminergic, serotonergic, cholinergic, glutamatergic, and GABAergic systems. Changes in neurotransmitter functioning contribute to issues regarding behaviors, emotions, and thoughts.

What are the possible treatments for residual schizophrenia?

Possible treatments for residual schizophrenia depend on the symptoms that a person is still experiencing and their severity. Treatment for residual schizophrenia is patient-centric, meaning it is fully adapted to the specific needs of each individual. Possible treatments for residual schizophrenia are listed below.

• Psychotherapy
• Medications

1. Psychotherapy

Psychotherapy refers to the usage of psychological methods to help a person modify their behavior, overcome problems, and manage mental illnesses. There are many types of psychotherapy, but cognitive behavioral therapy (CBT) is the most frequently used for patients with residual schizophrenia.

In a nutshell, CBT works by enabling patients to identify negative thoughts and beliefs in order to replace them with more positive or realistic alternatives. Cognitive behavioral therapy is based on the theory that negative beliefs influence emotions and lead to unwanted or negative behaviors.

Therapy is patient-centric and relies on establishing a nourishing therapeutic relationship with a therapist. The therapist helps patients overcome their problems in a welcoming setting without being judged or criticized.

Cognitive-behavioral therapy works for residual schizophrenia by helping patients improve social, communication, and problem-solving skills as well as decrease the severity of symptoms. With regular CBT sessions, patients learn coping mechanisms to prevent relapse.

In the treatment of schizophrenia, CBT helps patients change how they think and react to things. In addition, the therapy teaches people to handle negative stimuli in a more positive manner so that they don’t contribute to or worsen symptoms of schizophrenia.

The main goal of CBT in residual schizophrenia treatment is to encourage a patient to take control of their emotions. A paper from the Archives of Neuropsychiatry reported that the goal of CBT is to eliminate the distress that psychotic experiences induce, or at the very least, to equip the patient with the means to manage this distress.

In most cases, people have individual therapy sessions, but family or group therapy are useful in certain situations.

2. Medications

Medications include the use of pharmacotherapy to reduce the symptoms of residual schizophrenia and improve a patient’s quality of life. They work by acting on the brain to regulate emotions, behavior, and processes that cause symptoms of schizophrenia.

Doctors usually prescribe antipsychotic medications in a pill or liquid form. Taking these medications regularly helps decrease the severity of symptoms. Antipsychotics work by inhibiting dopaminergic neurotransmission i.e., they block the effects of dopamine.

Medications work best when combined with other treatment approaches, such as psychotherapy. Healthcare professionals prescribe medications to manage underlying mental illness that aggravates symptoms of schizophrenia. A good example is an antidepressant medication for people who experience co-occurring depression.

How to prevent residual schizophrenia?

There is no sure way to prevent residual schizophrenia or any other type of this mental illness. However, it’s possible to prevent relapse or worsening of symptoms by adhering to the doctor-recommended treatment plan.

The reason there’s no certain way to avoid residual schizophrenia is that the causes and risk factors of this mental illness are still unclear. A paper by Klosterkotter et al., published in the October 2011 issue of World Psychiatry explained that early and prevalent symptoms are nonspecific, making it difficult to differentiate them from depressive episode impairment in mood, motivation, interaction, and focus.

It is possible for people with a family history of schizophrenia to reduce the risk of this condition by avoiding drugs, especially hallucinogenic substances. Other things that lower the odds of developing this illness include managing stress, socializing, getting help in processing trauma, seeing a psychiatrist regularly, and modifying lifestyle by eating a well-balanced diet and exercising regularly.

What to expect in the residual schizophrenia condition?

In the residual schizophrenia condition, it’s safe to expect that it mirrors the prodromal phase. The term “prodromal phase” refers to the early stage of the disease and the symptoms that occur at that time.

Patients’ hallucinations, delusions, and other intense symptoms are all expected to fade in residual schizophrenia. However, strange beliefs are still likely to persist. People in this stage of schizophrenia tend to retain negative symptoms of the condition, which is why it is to be expected that they are going to withdraw and talk less.

A patient with residual schizophrenia has difficulty concentrating. As they realize their struggles with thoughts, they tend to develop depression.

After each new active stage, people with this mental illness must expect the residual symptoms to get more serious. However, a well-structured treatment plan and a consistent follow-up work well and help improve a patient’s quality of life.

What is the difference between residual schizophrenia and catatonic schizophrenia?

The difference between residual schizophrenia and catatonic schizophrenia is that the latter affects movement while the former doesn’t.

Catatonic schizophrenia is indicated by striking motor behavior. People with catatonic schizophrenia experience either marked decreases in voluntary movement or agitation and hyperactivity. The patient may in certain circumstances continue to be virtually immobile, as per an article titled, “Catatonic Schizophrenia” last updated in January 2024 by Britannica.

On the other hand, residual schizophrenia indicates positive symptoms such as catatonia decrease, but negative symptoms are still there.

A person with residual schizophrenia doesn’t experience hallucinations, delusions, and catatonia. On the other hand, an individual with catatonic schizophrenia experiences hallmark symptoms of schizophrenia, such as hallucinations, delusions, and disorganized speech or thoughts. They additionally experience symptoms such as stupor, mutism, and grimacing.