Paranoid schizophrenia is a subtype of schizophrenia in which the patient has delusions (false beliefs) that a person or some individuals are plotting against them or members of their family. Paranoid schizophrenia is the most common schizophrenia type.
The majority of people with paranoid schizophrenia, as with most schizophrenia subtypes may also have auditory hallucinations - they hear things that are not real. They may also have delusions of personal grandeur - a false belief that they are much greater and more powerful and influential than they really are.
An individual with paranoid schizophrenia may spend a disproportionate amount of time thinking up ways of protecting themselves from their persecutors.
Typically, a person with paranoid schizophrenia has fewer problems with memory, dulled emotions and concentration compared to those with other subtypes; which allows them to think and function more successfully. Even so, paranoid schizophrenia is a chronic (long-term, lifelong) condition which may eventually lead to complications, including suicidal thoughts and behavior.
With proper treatment and support, patients have a very good chance of leading happy and productive lives.
Signs and symptoms of paranoid schizophrenia?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
The patient will have relatively stable, frequently paranoid delusions, which are usually accompanied by auditory hallucinations (hearing things that are not there) and perceptual disturbances.
Some schizophrenia symptoms are not prominent, such as disturbances of volition, affect, speech and catatonia.
- Auditory hallucinations - hearing voices that are not there (they don't exist). Visual hallucinations are possible, but rare.
- Delusions - beliefs that are not real; false personal beliefs that are not subject to reason or contradictory evidence. The patient may firmly believe something, even though there is incontrovertible evidence that it is false. An example may be a belief that a neighbor is plotting to kill or poison the patient.
- Anxiety - a patient with paranoid schizophrenia will usually suffer from periods of high anxiety.
- Anger - this emotional state may range from mild irritation, which most healthy individuals sometimes have, to fury and rage. Anger may raise heart rate, blood pressure and levels of adrenaline and noradrenaline.
- Detachment - the patient may sometimes be physically or emotionally; reserved and remote (aloofness)
- Aggression and violence - aggression may reach levels in which violent outbursts occur.
- Condescension - sometimes the patient may seem patronizing; perhaps they may feel they know stuff other people don't and subsequently assume such a manner.
- Suicidal thoughts and behavior - these may be noticeable by people around the individual, with statements such as "I wish I were dead", I am going to kill myself", or "I wish I had never been born". The patient may go further and obtain the means to kill himself/herself, such as getting a weapon or accumulating pills. Other warning signs may be:
- Becoming socially withdrawn
- Mood swings - however, mood disorders and problems with thinking are less common in this type of schizophrenia
- Being obsessed with death, dying or violence
- Feeling trapped or desperate
- Increased consumption of drugs (including illegal ones) and alcohol
- Changing eating or sleeping patterns
- Starting to get their affairs in order and giving away belongings
- Saying goodbye to people in a specific way (as if they are never going to see them again).
Risk factors for paranoid schizophreniaA risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
The risk factors for paranoid schizophrenia are basically the same as those for most schizophrenia sub-types, including:
- Genetics - individuals with a family history of schizophrenia have a higher risk of developing it themselves. If there is no history of schizophrenia in your family your chances of developing it (any type) are less than 1%. However, that risk rises to 10% if one of your parents was/is a sufferer.
- Viral infection - if the fetus (unborn baby in the womb) is exposed to a viral infection, there is a bigger risk of developing schizophrenia.
- Fetal malnutrition - if the fetus suffers from malnutrition during the mother's pregnancy there is a higher risk of developing schizophrenia.
- Stress during early life - experts say that severe stress early on in life may be a contributory factor towards the development of schizophrenia. Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems. These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.
- Childhood abuse or trauma
- Parental age when baby is born - older parents have a higher risk of having children who subsequently develop schizophrenia, compared to younger parents.
- Drugs - the use of drugs that affect the mind or mental processes may sometimes raise the risk of developing schizophrenia.
Causes of schizophrenia
Nobody is certain what the causes of paranoid schizophrenia and all other schizophrenia sub-types are. Research suggests that most forms of schizophrenia are caused by brain dysfunction; we just don't know why that brain dysfunction happens. Most probably, it is caused by a combination of genetics and environmental triggers.
What are environmental triggers? Imagine your body is a series of buttons, and some of those buttons result in schizophrenia if somebody comes and presses them enough times and in the right sequences. The buttons would be your genetic susceptibility, while the individual pressing them would be the environmental factors.
Experts think that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They also believe that this imbalance is most probably caused by your genes making you susceptible to the illness. Some scientists say the levels of other neurotransmitters, such as serotonin, may also be involved.
Changes in key brain functions, such as perception, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.
Diagnosing paranoid schizophreniaIf the doctor suspects the patient has paranoid schizophrenia, a series of diagnostic tests will be ordered to help with diagnosis; these tests may include:
- Physical exam - the patient's height, weight, heart rate, blood pressure, temperature are checked. The doctor will listen to the heart and lungs, and check the abdomen.
- CBC (complete blood count) - this is a blood test, which in this case is done mainly to check for thyroid function, alcohol and drugs.
- Imaging scans - this may include MRI or CT scans, to look for brain lesions or any abnormalities in the brain structure.
- EEG (electroencephalogram) - to check for brain function.
- Psychological evaluation - the psychiatrist will ask the patient about their thoughts, feelings and behavior patterns. They will talk about symptoms, when they began, their levels of severity, and how they may affect the patient's life. The doctor will also try to find out how often and when episodes had occurred.
The doctor will most probably try to find out whether the patient had any thoughts about self-harm or harming other people.
The psychiatrist will try to talk to friends and family.
For diagnosis of paranoid schizophrenia to be officially confirmed, the patient must beat specific DSM symptom criteria. DSM stands for the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. This manual is used by health care professionals to diagnose mental conditions.
The diagnostic criteria for paranoid schizophrenia include:
- A preoccupation (obsession) with at least one delusion
- The presence of recurrent auditory hallucinations.
Testing a sample of neurons from the nose to diagnose schizophrenia
Scientists from Tel Aviv University, Israel, explained in Neurobiology of Disease (April 2013) that collecting neurons from a patient's nose may be a fast way to test for schizophrenia.
Noam Shomron of TAU's Sackler Faculty of Medicine, and colleagues describe how they created a potential way of diagnosing schizophrenia by testing microRNA molecules that exist in the neurons inside the patient's nose. A sample can be taken via a simple biopsy.
The authors say this could become a "more sure-fire" way of diagnosing schizophrenia. With this method, the disease could also be detected early on. Early diagnosis and treatment for schizophrenia usually results in more effective treatment.
Treatment options for paranoid schizophreniaParanoid schizophrenia is an illness that lasts all the way through the individual's life - it is a chronic condition. Patients with paranoid schizophrenia require treatment on a permanent basis; even when symptoms seem to have receded - a tempting time for schizophrenia patients to say they are fine and need no more help. Treatment is basically the same for all forms of schizophrenia; there are variations depending on the severity and types of symptoms, the health of the patient, his/her age, as well as some other factors.
A team of health care professionals will be involved in treating a person with paranoid schizophrenia. Schizophrenia can affect many areas of the patient's life - thus the team will include a wide range of dedicated professionals, including:
- A case worker
- A GP (general practitioner, primary care physician, family doctor)
- A pediatrician
- A pharmacist
- A psychiatric nurse
- A psychiatrist
- A psychotherapist
- A social worker
- Members of the patient's family.
Atypical antipsychotics (2nd generation antipsychotics) - a group of antipsychotic drugs used for the treatment of psychiatric conditions. Atypicals differ from typical antipsychotics in that they do not tend to cause extrapyramidal symptoms (EPS). EPS include Parkinsonian-type movements, rigidity and tremor.
Side effects may include:
- Weight gain
- Elevated blood cholesterol levels.
Other drugs (medications) - individuals with schizophrenia are susceptible other mental health problems, such as depression. The doctor may prescribe an antidepressant, an anti-anxiety drug, or a mood-stabilizing medication.
Hospitalization - when symptoms are severe the patient may need to be hospitalized. A hospital setting may be safer, where proper nutrition may be provided, and the patient may get better sleep and receive help with hygiene. Sometimes partial hospitalization is also possible.
Psychotherapy - for patients with paranoid schizophrenia, medications are the key part of treatment; however, psychotherapy is also important. (What is psychotherapy?)
Social and vocational skills training - this may help the patient live independently; a vital part of recovery for the patient. The therapist can help the patient learn good hygiene, prepare nutritional meals, and have better communication. There may be help in finding work, housing and joining self-help groups.
Compliance (adherence) - compliance or adherence in medicine means following the therapy regime (the treatment plan). Unfortunately, lack of compliance is a major problem for patients with schizophrenia. Patients can go off their medication for long periods during their lives, at enormous personal costs to themselves and often to those around them as well.
As a significant percentage of individuals go off their medication within the first 12 months of treatment, a life-long regimen of both drug and psychological/support therapies are important for treatment to be effective and long-lasting.
ECT (electroconvulsive therapy) - in this procedure an electric current is sent through the brain to produce controlled seizures (convulsion). It may be used on patients with severe symptoms or depression who either have not responded to other treatments or cannot take antidepressants. It is also sometimes used for patients at high risk of suicide. Experts believe that ECT triggers a massive neurochemical release in the brain, caused by the controlled seizure. Side effects may include short-term memory loss (usually resolves rapidly). It is important that the doctor explain clearly the pros and cons of ECT to the patient and/or guardian or family member.
Possible complications of paranoid schizophreniaIf the patient's paranoid schizophrenia is left untreated there is a serious risk of severe mental health, physical health, financial, behavioral and legal problems, which may have an enormous impact on every part of the individual's life. Possible complications may include:
- Suicidal thoughts
- Suicidal behavior
- Hygiene problems (more common in other types, such as catatonic schizophrenia)
- Substance abuse
- Inability to study
- Being a victim of crime
- Illnesses related to tobacco smoking - a significant number of people with schizophrenia smoke heavily and regularly. Some medications may clash with tobacco ingredients.