The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standardized diagnostic tool used by mental healthcare professionals to diagnose mental health conditions. The manual at one time divided schizophrenia into 5 subtypes: paranoid schizophrenia, catatonic schizophrenia, disorganized schizophrenia, undifferentiated schizophrenia, and residual schizophrenia. The most recent edition, though, no longer uses these subtypes as independent diagnoses. In the 5th edition (DSM-V), schizophrenia is categorized into 3 primary stages: 

  • Prodromal (stage 1): Symptoms may be starting to show
  • Active (stage 2): Symptoms are most pronounced and debilitating
  • Residual (stage 3): Symptoms are less severe and not as noticeable

Residual schizophrenia is categorized as the phase of schizophrenia that’s the least severe or intense in terms of being able to cope and function. Because symptoms can come and go during residual schizophrenia, there’s no set or given picture regarding what this phase looks like.  

During the residual phase of schizophrenia, positive symptoms of schizophrenia — like hallucinations, disorganized behavior, or delusions — are rarely experienced. However, someone can still show negative symptoms, such as difficulty concentrating, a lack of motivation, and social withdrawal. 

Read on to learn more about how to recognize residual schizophrenia symptoms and to hear how effective treatment options can help. 

Symptoms of Residual Schizophrenia

Residual schizophrenia symptoms tend to be much less severe than the symptoms present during other phases. That said, someone with residual schizophrenia has had, at some point in the past, at least 1 psychotic episode of more severe symptoms, like delusion, hallucinations, or catatonic behavior. While these symptoms may now be absent or reduced, people with residual schizophrenia will still show some negative symptoms that impact daily function. 

It’s important to understand the range of prominent psychotic symptoms associated with schizophrenia:

  • Positive symptoms — change in behavior, including visual or auditory hallucinations, delusion, disorganized speech and behavior
  • Negative symptoms— withdrawn, emotionless, flat, unmotivated, no sense of purpose, not interested in the world around them, unable to see, feel, or show joy
  • Cognitive symptoms — concentration and memory issues

While residual schizophrenia primarily involves negative symptoms, some people may also experience mild symptoms that impact cognitive function. 

Residual schizophrenia symptoms can include:

  • Distorted thought patterns 
  • Odd or unusual beliefs 
  • Reduced emotional expression 
  • Reduced speech
  • Difficulty experiencing pleasure
  • Social withdrawal
  • Disorganized thinking
  • Physical inactivity
  • A lack of motivation or purpose

A person is considered to be in the residual phase of schizophrenia if they’ve experienced a significant reduction in positive symptoms for at least 1 year. While the negative symptoms of schizophrenia are less severe, they can still have a significant impact on someone’s life.

It’s important to remember that a remission in symptoms doesn’t mean someone’s schizophrenia is cured. Schizophrenia is permanent, and positive symptoms can still reappear in the future. People with residual schizophrenia will still greatly benefit from seeking treatment for negative symptoms and learning how to better manage their condition.

“Symptoms of residual schizophrenia include minimal and/or reduced symptoms, negative symptoms such as flat affect and passivity, and inactivity. Medication and therapy is the best combination to help decrease these symptoms.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Diagnosing Residual Schizophrenia

The symptoms of schizophrenia usually appear in phases. Symptoms can first appear during the prodromal stage and intensify during the active phase. It’s important to note that not everyone who has schizophrenia will exhibit symptoms during the initial stage. Those who do, though, may feel symptoms of anxiety, find it difficult to concentrate, seem nervous, and/or experience depression. In the residual phase of schizophrenia, while they become less intense, symptoms are still present. 

Many people are diagnosed with schizophrenia during the active phase, when symptoms are most pronounced, obvious, and severe. However, someone can still be diagnosed with schizophrenia during a residual phase. Schizophrenia is a lifelong condition with no cure, and people still require treatment even if many of their symptoms have subsided. 

It’s standard for healthcare providers to rule out other conditions before diagnosing someone with schizophrenia. The diagnosis process may involve:

  • Lab tests and screenings: Brain imaging studies, such as MRIs and CTs scans, blood tests, and drug screenings can help rule out other conditions that could be causing schizophrenia symptoms.
  • Physical exams: During an examination, healthcare providers can check a patient’s health and look for complications that could be contributing to symptoms.
  • Psychiatric evaluation: Healthcare providers will ask patients questions about their moods, thoughts and behaviors, and symptoms. During a psychiatric evaluation, patients may also be asked about family history of mental illness.

What Causes Residual Schizophrenia?

Schizophrenia doesn’t have one, single cause, and though we don’t fully understand the exact causes for it, we do have a lot of research and theories. 

Research thus far suggests that there are many different factors that may influence whether a person develops the condition or not. People with all types of schizophrenia can experience a reduction of symptoms and develop residual schizophrenia

“Currently there are no known causes for this type of schizophrenia. There are some hypotheses around the causes, such as early life trauma and dopamine levels. There’s no conclusive evidence at this time. Therapy and medication can help an individual cope with these symptoms.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Genetics
While genetics isn’t the sole cause of schizophrenia, research suggests that it plays a significant role. Some studies estimate that the heritability of schizophrenia can be as high as 79%. Researchers have not identified a schizophrenia gene, but believe that some chromosomal regions may influence a person’s vulnerability to schizophrenia.

Brain structure
Brain scans show us that people with schizophrenia have significant differences in their brain structure and chemistry. For example, those with schizophrenia have less gray and white brain matter, especially in regions of the brain related to language processing. Some studies show that these differences can become more pronounced over time, suggesting that schizophrenia could be a progressive brain disease.

Additional risk factors
Even if someone is susceptible to schizophrenia because of their genetics, they might not go on to develop the condition unless they’re exposed to certain risk factors. Though more research is needed to determine for sure, some risk factors might include: 

Treatment for Residual Schizophrenia

There’s no cure for schizophrenia, but it is possible to manage symptoms with the appropriate treatment. While the symptoms of schizophrenia are less severe in the residual stage, treatment is still essential. Typically, it involves a combination of medication and therapy.

Medication

Schizophrenia medication can be quite effective in reducing some of the symptoms associated with schizophrenia. 

Antipsychotics
Positive symptoms of schizophrenia can be treated with antipsychotic medication. While antipsychotics can cause a range of side effects, newer medications called atypical antipsychotics are less likely to cause adverse symptoms. In some cases, a healthcare provider may recommend that a person with residual schizophrenia continues taking antipsychotics even if they’re not experiencing psychotic symptoms. 

Antidepressants
Antidepressants might also be suggested to treat negative symptoms. They might be used to augment antipsychotics or used as a standalone treatment. The most prescribed form of antidepressants are selective serotonin reuptake inhibitors (SSRIs), which boost serotonin levels in the brain. 

Today, in cases where other types of antidepressants haven’t been effective, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) might be beneficial. 

Therapy

People with schizophrenia often have more insight into their behavior when they’re in a residual phase. Psychotherapy can be highly effective during this time. Working with a therapist can help people learn more about their symptoms and develop skills that greatly enhance and improve quality of life. 

Although there are many types of therapy that can be used to treat schizophrenia, research has found that cognitive therapy (CT) can help people with schizophrenia who are recovering from a psychotic episode. Other forms of therapy that have proven effective in treating schizophrenia include:

  • Individual psychotherapy: Regular sessions can help people understand their condition and how to identify distorted thinking and beliefs that they experience during more pronounced phases of the condition. 
  • Cognitive behavior therapy (CBT): CBT can provide patients with insight into their thought and behavior patterns.
  • Cognitive enhancement therapy (CET): CET helps someone learn to spot and react to triggers.
  • Support groups: Valuable insight and coping tools can be garnered in a supportive environment. 
  • Family therapy: Schizophrenia symptoms can impact loved ones. Family therapy is an excellent way for families to learn more about schizophrenia and recognize symptoms. Studies show that when a person with schizophrenia participates in family therapy, they’re less likely to experience relapses.

Learn to Cope with Talkspace

Even though residual schizophrenia has less severe symptoms than other presentations of schizophrenia, it can still interfere with the ability to engage in everyday activities and enjoy life. 

If you have residual schizophrenia symptoms, seek out a formal diagnosis so that you can learn how to manage your condition. Treatment can help you understand your symptoms and keep them under control. 

If you’re ready to get help, but are struggling with how to start, consider Talkspace. Our online therapy platform is a convenient and accessible way to start your therapy journey. Licensed, experienced therapists are waiting to help you navigate the struggles you may be experiencing due to residual schizophrenia. Learn more about how Talkspace can help you today.