Disorganized or Residual Schizophrenia

The presentation of an individual with disorganized schizophrenia compared to one with residual schizophrenia will likely be quite opposite. A patient with disorganized schizophrenia will probably appear unkempt and display an inappropriate, silly, and childlike behavior (Sadock, 2003). They may laugh at the most serious of statements, as well as grinning and grimacing frequently. However, the extreme happiness may develop into extreme rage very quickly. The emotional liability of these patients is high. Before sedated or restrained, these patients may seem very anxious because of their constant activity, which normally consists of meaningless and often repetitive movements. Their speech will also come across in the same fashion. Though fairly spontaneous, it is normally unintelligible and may include rhyming and clanging. The break with reality is generally intense; and delusions and hallucinations may also accompany (2003).

On the other hand, someone with residual schizophrenia may seem to be withdrawn and show little emotions about anything (Sadock, 2003). They may appear very passive and even depressed because of their lack of initiative in speech or behavior. Speech is normally understandable, unlike in disorganized schizophrenia. However, one may link completely unrelated thoughts together or use nonverbal communication when possible. These patients usually have strange mannerisms or ways of thinking. They may wear eccentric clothing or have peculiar philosophies. Positive symptoms are very mild or infrequent. While delusions and hallucinations can occur, these are not prominent (2003).

While individuals with the paranoid schizophrenic subtype normally have a better prognosis, there is little variation on prognosis by subtype alone. If this was the first hospitalization for each patient, I would start by explaining the general prognosis for schizophrenia. I would inform them that only ten to twenty percent have a favorable outcome, but that the disorder does not always run a debilitating course (Sadock, 2003). In addition, I would tell them it is likely that their family member will have to be readmitted to the hospital within the next two years even with treatment.

After the general prognosis is described, I would then look at some of the other factors affecting the patient. If the patient is extremely young, has a family history of schizophrenia or perinatal trauma, a prior history of violence, or primarily negative symptoms (as seen in the residual type), then the outlook is probably going to be poor. I would then inform them that having the support or a family, friends, or spouse will improve the prognosis. On the other hand, if the patient is older, has a sudden onset, a positive social history, affective symptoms, or positive symptoms then I would say the prognosis is going to be brighter.

Reference:

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.