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Paranoid Schizophrenia

Definition


Disease: Paranoid Schizophrenia Paranoid Schizophrenia
Category: Psychiatric diseases
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Disease Definition:

Paranoid schizophrenia is one of several types of schizophrenia, a chronic mental illness in which a patient interprets reality in an abnormal manner (psychosis). A paranoid schizophrenic may believe things that are untrue (delusions) and hear things that have no basis in reality (auditory hallucinations).

 

Still, a paranoid schizophrenic has a better ability to think and function in daily life than other types of schizophrenics. As he/she might not have problems involving memory, concentration or dulled emotions. But this does not make it any less serious than other types of schizophrenia, for it is a lifelong condition that may result in many complications, including suicidal behavior. With proper treatment, a paranoid schizophrenic can decrease the effects of the condition, and be closer to having a normal life.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms of paranoid schizophrenia are:

 

  • Delusions, like believing that people intend to harm him/her
  • Auditory hallucinations, like hearing voices
  • Anxiety
  • Violence
  • Anger
  • Verbal confrontations
  • Aloofness
  • Patronizing manner
  • Suicidal thoughts and behavior

 

Paranoid schizophrenics are usually not affected as badly by mood problems or problems with thinking, concentration and attention. But, the most prominent effects of the condition are called positive symptoms.

 

POSITIVE SYMPTOMS:

The presence of unusual thoughts and perceptions that are often far from reality are called positive symptoms. These symptoms might be delusions and hallucinations.

 

Delusions:

A paranoid schizophrenic often believes that he/she is targeted for harm. Despite evidence to the contrary, the mind of the patient fails to interpret reality and concentrates on this mis-belief. These include constant monitoring from the government, or attempts of being poisoned by another co-worker. One may also harbor delusions of grandeur, about having extraordinary abilities or holding a high social position. A patient may become violent and aggressive in the attempt of self defense against those who intend harm to him/her.

 

Auditory hallucinations:

As the name implies, in this case a patient starts hearing sounds and voices that are not real. There might be a single voice or many, and they can address the patient or each other. Usually, these voices cause uneasiness to the patient, for they try to critique his/her every move, action or thought apart from causing harassment about faults that are either imaginary or real. These voices may also dictate harmful actions, which have their negative effect on the patient or others. Paranoid schizophrenics think that these voices are real, and even try to communicate with them.

 

One should not hesitate in seeking medical help after noticing the symptoms of the condition. Unless treated, the condition may deteriorate for it does not go away by itself. But in most cases, a paranoid schizophrenic is not aware of the condition, for these hallucinations seem very real to the patient, and the people who are in contact with the patient will probably be the first to notice the presence of the condition.

 

With the help of a mental health provider, a paranoid schizophrenic is taught methods of managing the symptoms, in an attempt to regain normal life to the most possible extent. If a patient is unwilling or hesitant about treatment, the encouragement of a trusted person may encourage him/her to change his/her thoughts about it, which can be the first step into successful treatment.

 

HOW TO HELP SOMEONE WITH PARANOID SCHIZOPHRENIA:

People entrusted by a paranoid schizophrenic should try and have an honest discussion about their concerns, for although this might not be sufficient to force a patient into treatment, but can have its positive effect on convincing him/her to seek the help of a mental health provider. In some cases, when the patient is threat to himself/herself or others, there might be the need of contacting emergency medical services or even the police, for emergency hospitalization is needed.

 

SUICIDAL THOUGHTS:

Paranoid schizophrenics usually have suicidal thoughts and behavior. In case a paranoid schizophrenic has suicidal thoughts along with the means necessary, but for some reason is hesitant, the following may be of help if no professional help is available:

 

  • A family member or friend
  • A physician, mental health provider or other health care professional
  • A minister, spiritual leader or someone in the faith community
  • A hospital emergency room
     

Causes:

The exact causes of paranoid schizophrenia are yet unknown. But the accumulated evidence points to brain dysfunction as a probable cause for paranoid schizophrenia among other forms of schizophrenia. Though the reasons and the manner in which this dysfunction occurs is yet being investigated.

 

Brain dysfunction that causes paranoid schizophrenia is believed to be the result of an interaction of genetics and environment.  These reasons include problems with certain normal brain chemicals called neurotransmitters. The ongoing studies in imaging has revealed differences in the brain structure of people with schizophrenia, but the interpretations of these changes are not yet complete. Despite the fact that the exact reasons behind paranoid schizophrenia are yet unknown, some factors that increase the risk of developing paranoid schizophrenia have been identified. These factors are:

 

  • Taking psychoactive drugs during adolescence
  • Having a family history of schizophrenia
  • Older paternal age
  • Exposure to viruses while in the womb
  • Trauma or abuse during childhood
  • Malnutrition while in the womb
  • Stressful life circumstances

 

Statistically, only 1% of people have some form of schizophrenia and an even smaller percentage has been diagnosed with paranoid schizophrenia. When the symptoms of schizophrenia appear between the teenage years and mid-thirties, paranoid schizophrenia symptoms may appear in the later stages of life.
 

Complications

Complications:

Unless treated, paranoid schizophrenia can affect almost all aspects of life ranging from emotional, behavioral, health, to legal and financial problems. Paranoid schizophrenia can lead to or be associated with the following complications:

 

  • Homelessness
  • Incarceration
  • Poverty
  • Family conflicts
  • Abuse of alcohol, drugs or prescription medications
  • Inability to work or attend school
  • Depression
  • Health problems from antipsychotic medications
  • Self-destructive behavior
  • Being a victim or perpetrator of a violent crime
  • Suicidal thoughts and behavior
  • Heart and lung disease related to smoking
     

Treatments:

As paranoid schizophrenia is a chronic condition, its treatment should not stop throughout the life of the patients even if the symptoms have virtually disappeared. Treatment might become a challenging task in case of an uncooperative patient who is not following the treatment program accurately or refusing it altogether. Treatment has been proved effective in helping patients regain normal life to the most possible extent. All types of schizophrenia share some similarity in their treatments. But treatment is tailored for each patient because it depends on each particular situation and the severity of its symptoms.

 

TREATMENT TEAMS:

A skilled psychiatrist in treating paranoid schizophrenia usually guides the course of treatment, but treatment is not restricted with that psychiatrist alone, for paranoid schizophrenia can have its effects in various aspects of the patient's life. Thus, a treatment team ensures the patient is getting all the necessary help in a coordinated manner. The above mentioned team can include:

 

  • Primary care doctor
  • Social worker
  • Psychiatrist
  • Psychiatric nurse
  • Psychotherapist
  • Case worker
  • Pharmacist
  • Family members

 

MAIN TREATMENT OPTIONS:

The main methods of paranoid schizophrenia treatment are:

 

  • Medications
  • Psychotherapy
  • Hospitalization
  • Electroconvulsive therapy (ECT)
  • Vocational skills training

 

MEDICATIONS:

The basis of paranoid schizophrenia treatment is the medications. Most commonly prescribed for paranoid schizophrenia include:

 

First-generation (typical) antipsychotics:

Brain chemicals called neurotransmitters are affected by these medications that control the symptoms. Delusions and hallucinations, which are considered the positive symptoms of paranoid schizophrenia, are treated effectively with these traditional medications. However, they might make way to tardive dyskinesia, or involuntary jerking movements among other potentially severe neurological side effects. Typical antipsychotics, especially generic versions, are usually less expensive than are their newer counterparts.

 

Second-generation (atypical) antipsychotics:

Loss of motivation and lack of motion, along with hallucinations and delusions are treated effectively with these newer antipsychotic medications. Weight gain, diabetes and high cholesterol among other metabolic side effects are caused by these medications.

 

Other medications:

Other mental health issues are commonly present along with paranoid schizophrenia. In case a patient has depression or anxiety, antidepressants or anti-anxiety medications can help in the improvement of these conditions. Aggression or hostility can also be managed by mood stabilizers.

 

HOW TO CHOOSE A MEDICATION:

Antipsychotic medications, in general, are meant to effectively control signs and symptoms with the minimum dosage. Each individual situation has its most effective medications. Improvement might not be noticed until several weeks from starting medication.

 

Combining medications, switching to a different medication or adjusting dosage might be recommended if one medication is not sufficiently effective or has intolerable side effects. Patients should be warned about the necessity of taking their medications continuously with the prescribed doses, for they might have a relapse of psychotic symptoms. To avoid withdrawal symptoms, the medication doses should be gradually reduced and not cut off.

 

SIDE EFFECTS AND RISKS OF MEDICATIONS:

Side effects and possible health risks are persistent with all antipsychotic medications. For example, risks of developing diabetes, weight gain, high cholesterol and high blood pressure are increased with certain antipsychotic medications, where other types may lead to serious changes in the white blood cell count or cause health problems in older adults.

 

While taking these medications, the patient should consider routine checkups to avoid possible health problems, and the physician should warn the patients about the probable side effects. There is also the chance of dangerous interactions between antipsychotic medications and other substances. A physician should know what types of medications or substances the patient is using, even vitamins, minerals and herbal supplements, before prescribing antipsychotic medications.

 

PSYCHOTHERAPY:

Regardless of the fact that medications are the basis of treatment, psychotherapy also has its important role. Psychotherapy might not work for all patients, though, especially in some severe cases, where a patient is unable to communicate with others. Psychotherapy may include:

 

Individual therapy:

A skilled mental health provider can help a patient by psychotherapy, where the patient learns how to cope with paranoid schizophrenia in daily life. In this method, communication skills, relationships, the ability to work and the motivation to stick to the treatment plan are improved, and the severity of the symptoms is reduced. A mental health provider should ensure the proper education of the patient about the condition to improve the overall outcome of treatment. Stigma surrounding paranoid schizophrenia is also improved by therapy. Cognitive behavioral therapy, among other forms of therapy, can be useful in treatment.

 

Family therapy:

Sometimes, families of the patients should receive therapy as well, to provide support and education. This way, a family member can better understand the illness and recognize stressful situations that might trigger a relapse, along with the help that they can provide to the patient in following the treatment plan. By undergoing family therapy, the patient will be able to better communicate with the other members of the family, which takes part in resolving possible conflicts.

 

HOSPITALIZATION:

Hospitalization may be necessary during crisis periods or times of severe symptoms. This is a safety measure for the patient and other people, which also ensures that the patient is having the necessary physical care. Other options are partial hospitalization and residential care.

 

ECT (ELECTROCOMPULSIVE THERAPY):

In this procedure, electric currents are passed through the brain to trigger a brief seizure. The symptoms of certain mental illnesses such as paranoid schizophrenia are reduced by the change of brain chemistry cause by the electrical currents. Electroconvulsive therapy may be the best treatment option in some cases, for its results are faster than medication and psychotherapy. But it is not an easy task at all to determine the exact benefits and potential risks of electroconvulsive therapy.

 

SOCIAL AND VOCATIONAL SKILLS TRAINING:

Training in social and vocational skills to live independently is an important part of recovery from paranoid schizophrenia. With the help of a therapist, the patient can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help with jobs, housing, self-help groups and crisis situations. If a person doesn’t have a case manager to help with these services, he/she can ask the doctor.

 

CHALLENGES OF TREATING PARANOID SCHIZOPHRENIA:

When a patient is carefully following the treatment plan, chances of regaining normal life are high. But the course of treatment is not free of challenges. The first difficulty is the accurate commitment to the treatment plan, as is the case with many other forms of schizophrenia, for the patient thinks that he/she does not need treatment. Also, the proper dosage might not be taken or therapy appointments can be skipped if the mental state of the patients is at question. For this reason, in some cases, the physician should recommend a long-lasting injectable form of antipsychotic medication, if applicable. Relapse may occur regardless of the quality of treatment, for this reason a physician should have a backup plan in hand.

 

Schizophrenics are commonly heavy smokers. There is some evidence that the ability of thinking and concentration with schizophrenics improves with smoking. Because nicotine interferes with antipsychotic medications, a smoker should take a higher dose. So, physicians should be aware of their patients’ smoking habits, as is the case with alcohol and drugs, for these also have their negative effect on the symptoms of schizophrenia. If this is the case, a physician should recommend that the patient participates in a treatment program that includes care for both schizophrenia and substance abuse.
 

Prognosis:

Not available

Expert's opinion

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