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Case Study Of Residual Schizophrenia Delusions

A 22-year-old white male who met the criteria for schizophrenia, paranoid, chronic (DSM-III 295.32) was treated via a social reinforcement-assisted cognitive intervention. Treatment sessions were designed to directly modify “strength of belief” in the validity of specific delusional ideas utilizing a collaborative style along with active avoidance of confrontation. An ABAB experimental design was used to allow assessment of changes in strength of belief as a function of presence or absence of the treatment intervention. During treatment phases, therapy sessions along with completion of a “self-therapy” log focused on repeated evaluation and interpretation of delusional beliefs. Social reinforcement was used to enhance compliance. Baseline phases included placebo control sessions. Dependent measures which showed improvement during treatment phases of the experiment were self-reports of (1) frequency and of (2) strength of belief in the validity of schizophrenic delusions, and (3) frequency of need for administration of p.r.n. medication (thorazine 100 mg) given by nursing staff blind to the experimental conditions. A three-month follow-up showed partial persistence of therapeutic gains, including apparent maintenance of acquired “metacognitive skills.” Replication studies incorporating specific treatment components are suggested.

By Dr. Cheryl Lane, Wed, December 02, 2015

By Dr. Cheryl Lane, PhD

Residual schizophrenia is the mildest of the five types of schizophrenia. Individuals who are diagnosed with residual schizophrenia are often in a transitional stage of the disorder.

Their clinical history includes at least one full-blown episode of schizophrenia, during which they met the criteria for one of the other four types. However, as the name implies, the symptoms that are currently present are “residual” rather than dominant.


Symptoms of residual schizophrenia

Patients who meet the criteria for residual schizophrenia are still showing some signs of their illness, but they don’t have any prominent positive symptoms. Positive symptoms of schizophrenia include hallucinations, delusions, catatonic behavior, severely disorganized behavior, or disorganized speech. They must, however, be exhibiting some negative symptoms (e.g. limited verbal expression, loss of initiative, or little to no expression of emotions) or at least two or more diminished positive symptoms, such as magical thinking, odd behavior, or somewhat disorganized speech.

Associated Characteristics

In many cases, residual schizophrenia is only a temporary phase of the bigger clinical picture. The schizophrenic individual may be transitioning from an acute psychotic episode to a period of full remission, or vice versa. However, this isn’t always the case. The individual may have been in a period of remission, and then something triggers the flare-up of mild symptoms but not another acute episode. The symptoms of residual schizophrenia may vary in terms of duration. For some patients, they last for only a short period of time. Others, however, may remain in a residual phase for several years.


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