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Schizophrenia, Paranoid

Definition :
Schizophrenia is a chronic mental illness. People with schizophrenia don't perceive and respond to the world as most other people do.

Paranoid schizophrenia is a subtype of schizophrenia. People with paranoid schizophrenia hold untrue beliefs (delusions) or hear things others don't hear (auditory hallucinations).

The onset of schizophrenia in men is usually in the teens or 20s. The onset in women is usually in the 20s or early 30s. Paranoid schizophrenia tends to appear toward the later end of this range.

Although there's no cure for paranoid schizophrenia, medications and well-coordinated mental health care services can help people manage the disease.

Most researchers believe that schizophrenia results from problems with early brain development. Studies have focused on the way brain cells communicate with each other through nerve pathways. Too many or too few connections in the important pathways of emotional regulation may lead to psychotic symptoms. More specifically, certain areas of the brain that are rich in the chemical dopamine seem to be affected most often in schizophrenia.

The contributing factors associated with the development of these brain-pathway problems are controversial and are being carefully investigated. Some of the areas of current research include risk-associated genes, exposure to certain viruses or malnutrition in the womb, and stressful childhood environments in genetically susceptible children.

When to seek medical advice :
A person with paranoid schizophrenia isn't likely to seek treatment because the delusions and auditory hallucinations are perceived as real. If you believe a family member or friend is exhibiting signs of paranoid schizophrenia, help that person seek medical advice. Instead of identifying delusions or hallucinations as problems, you may suggest that he or she see a professional to help cope with recurring anxieties or fears.

Early signs and symptoms of schizophrenia — such as social withdrawal, unusual behaviors, anxiety and decline in daily functional abilities — may begin gradually before the primary symptoms of schizophrenia, known collectively as psychosis, are manifested. But disease onset may also be acute with the sudden appearance of psychosis.

Delusions and auditory hallucinations are the prominent psychotic symptoms in people with paranoid schizophrenia.

When people have delusions, they believe something to be true that essentially no one else in their culture believes. A person with paranoid schizophrenia misinterprets experiences and then holds on to those interpretations despite evidence or reasoning to the contrary.

Delusions are commonly focused on the perception of being persecuted and often result in the mistrust of other people :

  • The FBI is spying on me.
  • Someone is poisoning my food.
  • My thoughts are being broadcast over the radio.

Delusions can become complex stories, and interpretations of experiences often "confirm" the person's view of reality. For example, a traffic officer blowing a whistle is alerting FBI agents on the trail of the person with paranoid schizophrenia. A man who looks at the officer is an agent. When he uses his cell phone, he's reporting the person's location.

Delusions may result in a violent outburst if a person believes a perceived threat creates a dangerous situation in need of self-defense.

A person with paranoid schizophrenia may also have delusions of grandeur — holding the belief that he or she has superhuman skills, is famous, has a relationship with a famous person or is a historical figure. These delusions can be dangerous, as when a person believes he or she can fly and acts on that belief.

Auditory hallucinations
An auditory hallucination is the perception of sound — usually voices — that no one else hears. The sounds may be a single voice or many voices, either talking to the person or to each other.

The voices are usually unpleasant. They may give a constant critique of what the person is thinking or doing, or they harass the person about real or imagined faults. Voices may also command the person to do things that can be harmful to himself or herself or to others. They may be thematically related to the person's delusions. For example, the voices may say that the FBI is after the person with schizophrenia because of some crime they say he or she committed.

To a person with paranoid schizophrenia, these voices are real. The person with paranoid schizophrenia may talk to or shout at the voices. However, after years of relatively successful disease management, some people may learn to recognize the voices as manifestations of the disease.

Other paranoid schizophrenia symptoms
If people with paranoid schizophrenia have other characteristic signs or symptoms of schizophrenia, they are mild. These psychotic behaviors, which are more prominent in other schizophrenia subtypes, include :

  • Disorganized thinking
  • Grossly disorganized, irrational behavior
  • Physical immobility
  • Excessive mobility with no purpose
  • Absent or inappropriate emotional expression
  • Little verbal communication with other people
  • Inability to initiate plans

The other main subtypes of schizophrenia are catatonic, disorganized and undifferentiated schizophrenia.

A doctor makes a diagnosis of paranoid schizophrenia when delusions or hallucinations are present, when other psychotic symptoms are either nonexistent or mild, and when symptoms can't be attributed to another medical or psychiatric disorder. There are no blood or brain-imaging tests that can be used to make a diagnosis of schizophrenia.

Diagnosis of any schizophrenia subtype may change. Although a person may have only paranoid symptoms at the time of initial assessment, other symptoms may appear and become prominent during the course of the disease.

Paranoid schizophrenia is a chronic disease. While episodes of symptoms may vary in intensity and duration, people with the disorder don't return to their previous functional abilities without treatment. The condition can often be managed with coordinated treatments, including:

  • Antipsychotic medications that may prevent the recurrence or lessen the intensity of psychotic episodes
  • Individual therapy
  • Family or group therapy
  • Vocational and social skills training

Some research suggests that people with paranoid schizophrenia may experience better long-term disease management than people with other types of schizophrenia.

However, people with paranoid schizophrenia may have difficulty taking medications as directed. The symptoms of the disease themselves may lead people with the disease to think that nothing is wrong with them or that mental health professionals play some role in perceived persecution or other delusions.

For these reasons, many people with paranoid schizophrenia may need access to social service programs, long term care in a supervised setting or hospitalization.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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