Residual schizophrenia was a subtype of schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4). However, healthcare professionals no longer use these subtypes in diagnosis. The DSM-5 includes several other changes in the diagnostic criteria for schizophrenia.
Unlike the DSM-4, the DSM-5 does not list the subtypes of schizophrenia. Due to this, residual schizophrenia is no longer a valid diagnosis.
This article discusses how the changes in the DSM-5 affect the diagnosis and treatment of schizophrenia.
Schizophrenia is a long-term mental health condition that can cause hallucinations, delusions, and altered or disorganized thinking, among other symptoms. It may disrupt a person’s thinking, emotions, and relationships.
The symptoms can present at any time, but on average, they begin in late adolescence and early adulthood.
Read the articles below to find out more about schizophrenia.
When experts updated the DSM-4 to create the DSM-5, they made several changes to the classification of schizophrenia.
Firstly, they renamed schizophrenia “schizophrenia spectrum disorder.”
Healthcare professionals see this as a more accurate term, as schizophrenia is a variable and complex condition. The symptoms of schizophrenia can vary significantly among individuals.
According to the DSM-5, a person must experience certain symptoms to receive a diagnosis of schizophrenia spectrum disorder. These
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms, such as not showing feelings or having a complete lack of motivation
A person must experience at least two of these symptoms frequently over 1 month to receive a diagnosis, and one of these symptoms must be delusions, hallucinations, or disorganized speech.
In the older DSM-4, a person could receive a diagnosis if they had one symptom and experienced one of the following:
- bizarre delusions
- auditory hallucinations of a running commentary
- two or more voices talking with each other
However, this additional method of diagnosis is not present in the more recent DSM-5.
These subtypes featured in the DSM-4, allowing doctors to diagnose people with
The DSM-5 does not include these subtypes, so healthcare professionals no longer use them to classify schizophrenia.
The DSM-4 advises a diagnosis of residual schizophrenia when a person has had at least one schizophrenic episode but is no longer experiencing positive symptoms.
Positive symptoms are symptoms that cause a change in thoughts and behavior, such as:
- disorganized speech or behavior
A person with residual schizophrenia will still have negative symptoms. These are symptoms that cause people to withdraw and feel emotionless or flat.
- flat affect, or not showing emotion
- alogia, or restricted quantity of speech
- avolition, or a total lack of motivation
In the DSM-4, the criteria for a catatonic schizophrenia diagnosis state that a person must be experiencing at least two of these symptoms:
- lack of movement, being near-unconscious, or holding a rigid posture
- excessive motor activity that seems to have no purpose
- refusal to speak or follow instructions
- placing themselves in inappropriate positions, repeatedly doing purposeless movements, or making exaggerated movements or grimaces
- repeating what other people say or mimicking their movements
The DSM-4 lists disorganized schizophrenia as a subtype that involves all of the following symptoms:
- disorganized speech
- disorganized behavior
- expressing no emotions or inappropriate ones
According to the DSM-4, a person likely has paranoid schizophrenia if they exhibit one or more delusions or auditory hallucinations that happen regularly.
However, the person must have no experience of disorganized speech or behavior, catatonic behavior, or inappropriate or lack of emotions.
In the DSM-4, a person who has undifferentiated schizophrenia meets the criteria for having schizophrenia, but their symptoms do not fit into any of the other subtypes.
The DSM-5 saw the removal of the different schizophrenia subtypes. There were several reasons for their removal,
- they did not allow for the variable nature of schizophrenia
- healthcare professionals only used some of the subtypes clinically
- there were no significant differences in brain function between subtypes
- the subtypes did not predict the course of the condition
- some people did not fit into a subtype based on their symptoms
- scientific reports were no longer using them
Experts also made
This table shows the major changes in more detail:
|Disorder||schizophrenia and other psychotic disorders||schizophrenia spectrum and other psychotic disorders|
|Symptoms||two or more of the following symptoms, if they are present for longer than a month:|
• disorganized speech
• catatonic or disorganized behavior
|stayed the same, although a person’s symptoms must include delusions, hallucinations, or disorganized speech|
|negative symptoms, such as flat affect, alogia, or avolition||changed slightly to say “restricted emotional expression or avolition”|
|only one symptom required for diagnosis if the person also has bizarre delusions or hallucinations that involve a running commentary on the person’s actions or involve two or more voices conversing together||removed|
|Duration||signs continue for at least 6 months||same|
|now includes a symptom severity scale from 0–4, with the rating based on the number and severity of symptoms in the past 7 days|
0 means no symptoms, and 4 means severe symptoms
Research from 2014 found that more than
The authors state that the removal of the subtypes was justified, as they did not help predict a person’s response to treatment. They also note that the addition of a symptom severity scale may help healthcare professionals choose the best course of treatment for an individual.
Residual schizophrenia is a subtype of schizophrenia. However, according to the DSM-5, it is no longer a valid diagnosis.
Experts made changes to the criteria for a schizophrenia diagnosis to help healthcare professionals make more accurate diagnoses.
These changes have not affected the number of people who receive a diagnosis of schizophrenia.
Additionally, these changes may lead to improvements in the treatment of schizophrenia symptoms.