Residual schizophrenia is a classic subtype marked by a decrease in positive symptoms, while negative symptoms still persist.

Schizophrenia is a complex mental disorder that affects how a person thinks, feels, behaves, and perceives reality. The condition is known primarily for the “positive” symptoms of psychosis, such as hallucinations and delusions.

However, residual schizophrenia — one of the classic subtypes of schizophrenia — is most notable for its reduction (or lack) of positive symptoms as well as its ongoing negative symptoms.

Residual schizophrenia is no longer a clinical diagnosis, as all historical schizophrenia subtypes have been removed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

What does “residual” mean in mental health?

In psychology, the term “residual” describes a condition in which the most severe symptoms have reduced, but mild or persistent symptoms still remain.

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Residual schizophrenia is one of the classic subtypes of schizophrenia. This diagnosis is no longer used in the current version of the DSM.

Residual schizophrenia was diagnosed when a person had experienced at least one schizophrenia episode but was no longer exhibiting significant positive symptoms (hallucinations, delusions) or disorganized speech or behavior — or at least to a much lesser degree.

Rather, people with this subtype primarily displayed negative symptoms, such as social withdrawal, apathy, or slowed speech patterns.

The residual subtype should not be confused with the “residual phase” of schizophrenia.

The residual phase refers to the last of three subsequent schizophrenia phases – prodromal (early phase), acute (active phase), and residual (recovery phase). The residual, or recovery, phase refers to medicated individuals who no longer show positive symptoms.

Removal of schizophrenia subtypes from the DSM-5

The classic subtypes of schizophrenia are:

  • paranoid
  • catatonic
  • disorganized
  • residual
  • undifferentiated

These subtypes were not included in the DSM-5, published in 2013. The American Psychiatric Association (APA) decided that these subtypes were not helpful to clinicians since the symptoms often overlapped and shifted from one subtype to another.

Today, the DSM-5 refers to schizophrenia as a spectrum with varying levels of severity, rather than as a single disorder with subtypes.

Unlike other subtypes of schizophrenia, a diagnosis of residual schizophrenia was primarily based on certain symptoms being less severe or non-existent.

According to the DSM-IV, a diagnosis of residual schizophrenia would involve either negative symptoms only or at least two very mild forms of positive symptoms, such as odd beliefs or unusual perceptual experiences.

Specifically, the following symptoms were either non-existent or at least much milder in residual schizophrenia:

The following negative symptoms may have been present in residual schizophrenia:

Currently, there is no cure for schizophrenia. However, with the right treatment and support, symptoms can be managed well enough so that people with this condition can live independent and meaningful lives.

Residual schizophrenia may be treated with the following:

Atypical antipsychotics

Atypical antipsychotics are the first-line treatment for schizophrenia and are found to be effective for symptoms of psychosis. However, they may do more harm than good for people with only negative symptoms.

For instance, the authors of a 2015 study note that it’s “questionable” whether people with the residual subtype can benefit from antipsychotics.

However, certain atypical antipsychotics seem to work better than others for negative symptoms.

Research from 2012 shows that people with schizophrenia who took aripiprazole (Abilify) showed significant improvement in anhedonia and subjective well-being scores compared with those on risperidone (Risperdal).

Social skills training

Social skills training classes can help improve social functioning skills, such as living independently, managing money, dealing with anger or frustration, and establishing relationships.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps you identify and correct inaccurate thought processes and behaviors.

For people with schizophrenia, this might involve targeting thoughts related to both positive symptoms (such as hearing voices) and negative symptoms (like a decreased sense of purpose or social withdrawal).

Cognitive remediation

This intervention targets cognitive skills such as attention, memory, and flexible thinking to improve daily functioning. Studies show the success of these programs, especially for those in the very early stages of the disorder.

If you live with schizophrenia, there are many ways you can enhance your daily life:

  • Engage in therapy. Therapy can help you challenge your false beliefs, manage your delusions or hallucinations, and help you develop important social and cognitive skills.
  • Mindfulness meditation. Research from 2019 shows that a mindfulness intervention led to improved positive emotions, reduced negative symptoms, and better psychosocial functioning in people with schizophrenia.
  • Seek social support. Consider getting involved in a schizophrenia support group, either in-person or online. Sharing emotional support with others who are experiencing similar things can be deeply therapeutic.
  • Work toward life goals. Continue to pursue your life goals and interests.
  • Pursue a hobby. Consider taking time to pursue activities that you enjoy. This can be anything from playing your favorite sport or video game to cooking or reading books.
  • Take care of your health. It can help to eat a healthy diet, engage in daily exercise, and try to get plenty of sleep.

Residual schizophrenia is one of the five classic subtypes of schizophrenia. It’s an older diagnosis that’s no longer included in the current DSM-5.

According to the DSM-IV, a person with residual schizophrenia would exhibit only negative symptoms or at least two very mild forms of positive symptoms, such as odd beliefs or unusual perceptual experiences.

Schizophrenia treatments include various therapies and interventions, including CBT, social skills training, and cognitive remediation.