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Paranoid Schizophrenia: definition, symptoms, treatments

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Paranoid schizophrenia is a subtype of schizophrenia where people experience paranoia that feeds into their hallucinations and delusions. While DSM-5 changed the classification of schizophrenia, doctors may still use the term paranoid schizophrenia to describe cases when people have paranoid thoughts in addition to other symptoms of this condition. It is considered the most common and the most severe subtype of schizophrenia.

The symptoms of paranoid schizophrenia can be both positive and negative. Positive symptoms include delusions, hallucinations, disorganized speech, and disorganized behavior. Negative symptoms of paranoid schizophrenia include losing interest and motivation in life and activities, lack of concentration, and social isolation, among others.

The treatments for paranoid schizophrenia include medications, psychotherapy and electroconvulsive therapy.

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What is paranoid schizophrenia?

Paranoid schizophrenia is a type of schizophrenia where paranoia usually occurs with other symptoms such as hallucinations, delusions, and hearing voices.

Paranoia is an irrational and persistent feeling of being threatened even when there is no evidence or reason to feel that way. A person with paranoia feels someone’s out to get them and doesn’t trust that person or multiple people thinking they want to harm them.

Impaired perception of reality causes severe anxiety that significantly disrupts a person’s quality of life and limits their functioning at home, work, and in society.

A paper from Schizophrenia Research: Cognition reported that around 50% of people with schizophrenia experience paranoia.

Paranoid schizophrenia used to be a separate diagnosis, but it is not anymore. In the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-4) by the American Psychiatric Association, schizophrenia as a spectrum disorder was categorized into several subtypes. Paranoid schizophrenia was the most common and serious subtype of this mental illness.

With the publishing of the fifth edition, DSM-5, things changed. The new edition eliminated different subtypes of schizophrenia. For that reason, paranoia isn’t a type anymore, but a symptom. Some healthcare professionals may still use the term paranoid schizophrenia, however.

How common is paranoid schizophrenia?

Cleveland Clinic reports that paranoid schizophrenia affects 85 out of 10,000 people at some point in their lifetime. Around 2.77 million people worldwide develop paranoid schizophrenia each year. The reported prevalence of this mental illness ranges from 0% to 5%, according to the International Encyclopedia of Public Health (Second Edition).

The prevalence of schizophrenia in children is low. Cleveland Clinic reveals 0.4% of children and teens in the world have childhood-onset schizophrenia.

When it comes to genders, the prevalence of paranoid schizophrenia is similar in men and women. In one study from BMC Psychiatry of 1284 patients with schizophrenia, paranoid schizophrenia affected 74.6% of males and 64.0% of females. While the prevalence of paranoid schizophrenia is similar among men and women, female onset is three to five years later than males, according to a paper from the Journal of Translational Neuroscience.

In the elderly population, the prevalence of schizophrenia is 0.1% to 0.5%.

What are the causes of schizophrenia?

According to NHS reports, a combination of different factors is highly likely the main culprit behind the development of schizophrenia. The causes of schizophrenia are listed below:

screaming girl lighted in red and blue lights
  • Genetics: schizophrenia tends to run in families. According to a study from the Frontiers in Human, Neuroscience genetics plays a major role in the onset of schizophrenia. There is no specific gene that implies a person will develop this mental illness. However, scientists have identified several genes that could be involved. In most cases, variations in multiple genes, each with a small effect, combine the higher susceptibility to developing schizophrenia. Evidence shows schizophrenia belongs to a group of pathologies known as complex genetic disorders.
  • Brain development: people with schizophrenia have subtle differences in the structure and function of their brains. They also have impaired functioning of certain neurotransmitters. Changes in the functionality of certain brain regions may also contribute to the onset of schizophrenia. This subject is discussed further in this post.
  • Pregnancy and birth complications: people with schizophrenia are more likely to have experienced complications before or during their birth. These complications include low birth weight, asphyxia (lack of oxygen) during birth, and premature labor.

What are the symptoms of schizophrenia?

Symptoms of schizophrenia are both positive and negative. The term “positive symptoms” refers to experiencing symptoms such as thoughts and behaviors that a person didn’t have before developing schizophrenia. A good example is hallucinations. On the other hand, negative symptoms are changes to thoughts and behaviors that a person already had before this mental illness. A good example is becoming socially isolated. The symptoms of schizophrenia are listed below:

  • Delusions
  • Hallucinations
  • Disorganized or incoherent speech
  • Disorganized or unusual behavior
  • Negative symptoms

1. Delusions

Delusion is a fixed and false belief that contradicts reality. This kind of belief indicates an abnormality in a person’s content of thought. A person with delusions keeps believing in things that aren’t true even when others show there is no evidence or reason for them.

There are different kinds of delusions such as persecutory, erotomanic, somatic, and grandiose. Persecutory delusion is a false belief of being mistreated or threatened by someone even without any evidence whatsoever. The term erotomanic delusion refers to believing someone is in love with you, despite no evidence. Somatic delusion is the belief of having an illness or strange condition, even without any evidence to support that belief. Grandiose delusion is a false belief of being superior to others.

When discussing delusions, it’s important to mention that schizophrenia and delusional disorder aren’t the same. Their similarity is that delusions are among dominating symptoms. Delusional disorder is rare and while it has delusions, there are no other psychotic symptoms as in schizophrenia.

Delusions can have physical and behavioral effects on people with paranoid schizophrenia. Physical effects include unwanted weight gain and body image concerns. Excess weight can increase the risk of multiple health conditions.

Behavioral effects of delusions include anxiousness, bizarre behaviors, conflicts, aggressiveness, and impulsiveness. Keep in mind not every person with paranoid schizophrenia is aggressive.

2. Hallucinations

Hallucination is defined as a false perception of events or objects involving the senses such as sight, smell, sound, taste, and touch. While hallucinations may seem real, they are not. In people with schizophrenia, hallucinations include hearing or seeing things that don’t exist.

Delusions and hallucinations are often mistaken for one other, but they are entirely different. Both revolve around the impaired perception of reality. While hallucinations are hearing or seeing things that aren’t there, delusions are false beliefs.

Hallucinations, like delusions, fall into the category of positive symptoms of schizophrenia. Research shows that between 60% and 80% of people with schizophrenia have auditory hallucinations i.e. they hear sounds other people can’t hear, including music or someone speaking in a language they don’t recognize.

People with schizophrenia can have multimodal hallucinations. These hallucinations include more than one sense. It’s not entirely clear why hallucinations happen, but it could be due to spontaneous activation in certain brain regions that trigger sensory details linked with hallucinations.

The physical effects of hallucinations include their effects on vision, hearing, bodily sensations, and other senses. Behavioral effects of hallucinations include social withdrawal due to severe anxiety and depression. People may develop paranoid, aggressive, and unusual behaviors.

3. Disorganized or incoherent speech

Disorganized or incoherent speech is defined as any interruption in a speech that makes communication difficult or impossible to understand. People with schizophrenia may experience difficulties concentrating and maintaining a train of thought, which affects the way they speak.

The exact cause that triggers the development of disorganized speech is unknown. This symptom of schizophrenia could be related to differences in the central nervous system and impaired neural connectivity.

Disorganized or incoherent speech doesn’t have specific physical effects other than high-stress levels. Behavioral effects include incoherent speech, answering questions with unrelated answers, changing topics frequently, or saying things that aren’t logical. Other behavioral effects include repeating things constantly, making up new words, and a lack of confidence when other people don’t understand.

4. Disorganized or unusual behavior

Disorganized or unusual behavior refers to impairment in daily activities and communication with other people. An individual with schizophrenia may experience difficulties beginning a specific task or they may not be able to complete it.

The cause of this symptom is the same as that of disorganized speech i.e. impaired neural connectivity in addition to other factors could be the problem.

Physical effects of disorganized behavior may include a higher risk of health problems due to lack of hygiene and difficulty taking care of oneself.

Behavioral effects of disorganized behavior include difficulty in independent functioning, unpredictable and/or inappropriate emotional responses, lack of impulse control, bizarre behaviors forgetting or losing things frequently, severely impaired routine behaviors such as brushing teeth or dressing, and behaviors that have no purpose.

5. Negative symptoms

Negative symptoms of schizophrenia are defined as an absence of something common to most people. They refer to changes in behaviors or functions that a person had before developing schizophrenia.

Besides schizophrenia itself, other factors can contribute to the onset of negative symptoms. These include medications, withdrawal from medication, hospitalization, isolation, substance abuse, depression, and personality disorders. Negative symptoms of schizophrenia can be more persistent than positive symptoms.

Physical effects of negative symptoms include weakened physical health due to poor hygiene habits and high-stress levels.

Behavioral effects of negative symptoms include loss of interest in activities once enjoyed, losing motivation, and having no interest or making no effort with relationships and sex.

Other behavioral effects of this symptom include lack of pleasure, social withdrawal, and lack of emotion, gesturing and eye contact, neglecting personal hygiene, and low self-esteem. Additionally, negative symptoms lead to behavioral effects such as changes in sleeping or eating patterns, a sedentary lifestyle, ambivalence with decision-making, and social isolation.

What are the risk factors of paranoid schizophrenia?

Risk factors of paranoid schizophrenia are situations that make one more susceptible to developing this mental illness. Worthy is to mention that not every person who meets these factors is bound to have schizophrenia. Paranoid schizophrenia is a lot more complicated than people believe. Various factors and mechanisms play a role, not just one, and many of them require further research. The most significant risk factors of paranoid schizophrenia are listed below:

woman sitting on a chair near the wall holding the hand of another woman in another room sitting in a chair
  • Family history of schizophrenia: a person is more likely to develop schizophrenia if their family member, especially a parent or sibling, also has this serious mental illness. This isn’t only due to genetic connection, however. Genetic mutations are insufficient to cause paranoid schizophrenia on their own; other risk factors are involved as well.
  • Environment: a person’s environment may also increase the risk of schizophrenia. This is particularly the case for neglect, urban birth or residence, famine, birth/pregnancy complications, migrant status, and seasonal effects. Exposure to certain toxins is also an environmental risk factor for schizophrenia. The same applies to traumatic experiences. For example, having traumatic childhood in an unsafe household may also contribute to the development of this mental illness.
  • Recreational drug use: people who take drugs, particularly mind-altering substances, are more susceptible to developing schizophrenia. Remember, these drugs also produce hallucinations and delusions.
  • Other mental health problems: patients with depression are at a higher risk of developing psychosis. According to a study from the Frontiers in Psychiatry, depression is often observed in individuals who are at high risk for schizophrenia before the development of psychotic symptoms.

How is paranoid schizophrenia diagnosed?

Paranoid schizophrenia is diagnosed with a combination of tools and techniques. It typically starts with a physical exam to rule out other problems that could be behind symptoms or related complications. The physical exam may also include laboratory tests (blood, urine, and cerebrospinal fluid tests) and screenings such as MRI and CT scans. Some patients may need brain activity testing with an electroencephalogram (EEG) to rule out epilepsy and seizures.

If a patient’s symptoms aren’t a result of a physical problem, the doctor will refer them to a psychiatrist. The psychiatrist performs psychiatric evaluation by closely observing a patient’s appearance and behavior. They may also ask questions about symptoms, thoughts, substance abuse, suicidal tendencies, and a potential for violence. To get a closer insight into a patient’s mental health, a psychiatrist may also speak to family members.

The psychiatrist will take DSM-5 to check for diagnostic criteria. A patient is diagnosed with schizophrenia when they meet the criteria i.e. display at least two out of five symptoms and behaviors mentioned above in this post. The main symptoms of schizophrenia should last at least a month in order to meet the criteria for schizophrenia. But, the effects should last at least six months. Patients’ symptoms affect their quality of life and can’t be explained by other causes.

When does paranoid schizophrenia occur?

Paranoid schizophrenia occurs between the ages of 15 and 25 in men and between 25 and 35 in women. This mental illness usually starts in late adolescence or young adulthood, which explains why it’s rare for children to have paranoid schizophrenia.

Some patients develop this mental illness earlier or later than the average age of onset. Childhood-onset schizophrenia is a good example, and it refers to cases when this disease is diagnosed before the age of 13.

At the same time, around 20% of people with paranoid schizophrenia first developed their symptoms after 40 years old, according to a paper from the Current Opinion in Psychiatry.

How does paranoid schizophrenia affect the body?

Paranoid schizophrenia affects the body by increasing the risk of multiple health problems. Compared to the general population, people with this mental illness are at a higher risk of weight gain, especially abdominal obesity. They are also more susceptible to developing diabetes, metabolic syndrome, and cardiovascular disease. All these health problems can further decrease a patient’s quality of life and lower their self-esteem.

Schizophrenia may also reduce life expectancy. As The Conversation reports, people with schizophrenia die 15 to 20 years earlier than their counterparts who don’t have this mental illness.

The poor physical effect is the secondary effect of schizophrenia. It’s not just because of the symptoms that make a person less involved in their health, exercise, and quality of life. Instead, medications that manage symptoms of schizophrenia take some of the blame too.

Antipsychotic drugs can increase the risk of weight gain and type 2 diabetes. These health effects may also result from stress in people with schizophrenia. For example, excess weight and type 2 diabetes are linked to higher levels of cortisol (stress hormone).

How does paranoid schizophrenia affect the brain?

Paranoid schizophrenia affects the brain through changes in the structure and functioning of multiple brain systems. These include prefrontal and medial temporal lobe areas that regulate working and declarative memory.

In MRI studies of paranoid schizophrenia, the most consistent findings involve decreased gray matter volume of the medial temporal lobe, superior temporal, and prefrontal areas. Besides memory, these areas are also involved in the processing of auditory information and decision-making.

Interestingly, in people with this mental illness, scientists observed greater brain surface contraction away from the skull compared to individuals who never developed psychosis.

Paranoid schizophrenia may also reduce or disrupt neural connectivity. As a result, the communication between brain regions is disrupted, which leads to cognitive changes and symptoms of this mental illness.

The Scientific American reported schizophrenia acts on the neurotransmitter dopamine in the brain. The idea behind this results from the fact that dopamine blockers drugs are therapeutically useful in the management of schizophrenia.

A similar theory applies to NMDA receptors, which respond to the excitatory neurotransmitter glutamate and are important for cognition and memory. Drugs that act on these receptors can induce schizophrenia-like hallucinations. For that reason, it is believed that paranoid schizophrenia is linked to the dysfunction of NMDA receptors.

To sum up, schizophrenia affects neural connectivity and induces structural and functional changes in different parts of the brain. As a result, the communication and effectiveness of these regions become impaired, thus paving the way to symptoms of schizophrenia with paranoia.

What are the possible treatments for paranoid schizophrenia?

Possible treatments for paranoid schizophrenia depend on the severity of symptoms and their impact on a person’s life. Medications play an important role in the treatment of paranoid schizophrenia. Doctors usually prescribe typical or atypical antipsychotic medications to effectively manage symptoms of schizophrenia at the lowest possible dose. Sometimes a combination of different drugs, including anti-anxiety medications and antidepressants, is necessary. Medications aren’t the only way to manage this condition. Possible treatments for paranoid schizophrenia are listed below:

a schizophrenic woman laying on the lap of older woman
  • Psychotherapy
  • Electroconvulsive therapy (ECT)

1. Psychotherapy

Psychotherapy, or talk therapy, is the use of psychological methods to help a patient change behavior, overcome problems, and manage their mental illness. There are different types of psychotherapy available for the treatment of schizophrenia. The most common type is cognitive-behavioral therapy (CBT).

In the treatment of paranoid schizophrenia, the role of psychotherapy is to help patients understand their condition and adapt to it more effectively. Additionally, therapy helps people manage the mental health concerns that occur due to schizophrenia.

A growing body of evidence confirms the effectiveness of psychotherapy in the management of this mental illness. For example, a study from the journal Psychosis found that dialogue therapy leads to improvements in symptoms and functioning compared to standard psychiatric treatment for schizophrenia.

During therapy sessions, which are held in individual or group settings, a patient learns how to deal with their thoughts and behaviors. The therapist also strives to educate a patient about their mental illness and its effects. Patients also learn to tell what’s real or not in the world around them.

Therapy sessions also serve to help patients to learn to manage hallucinations, voices, and other symptoms of schizophrenia, including paranoia. Sometimes psychotherapy is combined with medications to achieve the best effects.

An important place in the treatment of schizophrenia belongs to learning skills necessary to cope with symptoms and complications.

Psychotherapy focuses on establishing basic trust through a caring and warm attitude alongside the exchange of feelings between a therapist and a patient. This is particularly important since a person with paranoid schizophrenia doesn’t trust other people and is convinced they want to harm them. By establishing trust, the therapist helps lessen these symptoms of schizophrenia.

2. Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a medical procedure where a mild electric current is passed through the brain to cause a short seizure and change brain chemistry for reversal or management of symptoms of mental disorders.

The use of ECT is usually recommended in cases when a patient doesn’t respond to medications. It’s also helpful when symptoms of psychosis are so severe that a person is a threat to themselves and others.

The simple procedure is performed under general anesthesia. The seizure produced by the electric current lasts less than 60 seconds. Multiple treatments, usually six, are necessary to experience significant improvements after ECT.

Evidence confirms ECT in the management of schizophrenia is a safe treatment modality, especially in severely ill populations. Not only is it a viable strategy for treatment-resistant schizophrenia, but it’s also effective for the treatment of schizophrenia in other situations, evidence shows.

How to prevent paranoid schizophrenia?

Since paranoid schizophrenia develops unpredictably, there is no sure way to prevent it. Scientists are working on studies that would help reduce the risk of paranoid schizophrenia. This complex mental illness involves numerous factors such as genes, but a person’s environment may also play a role in its development.

For that reason, a possible way to reduce the risk of schizophrenia could be to avoid using mind-altering drugs. This is particularly important for adolescents whose brain is still developing.

Yet another important thing to do is to avoid abusive or traumatic situations. People who have experienced or witnessed traumatic situations may want to get help in order to cope and process it in a healthy manner.

Since socializing helps lower stress, improve confidence and self-esteem, and eliminate the feeling of loneliness, it’s a good way to improve mental health and possibly lower the risk of schizophrenia.

A healthy diet and regular exercise may also improve both physical and psychological health. Most importantly, it’s important to see a psychiatrist regularly if a person is experiencing symptoms similar to paranoia and hallucinations. Receiving mental health support, whether it’s just for stress or much bigger problems, is a good way to detect problems early and get much-needed help in a timely manner.

Keep in mind the abovementioned recommendations don’t necessarily mean a person is protected against paranoid schizophrenia. Multiple factors play a role in its development, but they can help support the mental health of an individual.

What to expect in paranoid schizophrenia condition?

There are many things to expect in paranoid schizophrenia condition, most importantly, significant disruptions in a person’s life. Bear in mind a person with schizophrenia experiences difficulties in perceiving reality and can’t tell what’s real and what’s not. Impaired perception of reality is a scary and disorienting feeling.

concerned man looking in a big mirror with his hand on a countertop

Paranoia is particularly difficult for people with this mental illness. People with this symptom are afraid and feel like they can’t trust other people. This leads to avoiding people and places. More precisely, people become socially isolated.

When left unmanaged, schizophrenia can contribute to or worsen anxiety and depression. Other problems to expect in paranoid schizophrenia include aggressive behavior, health and medical problems, financial difficulties, work problems, and substance abuse. The scariest effect of paranoid schizophrenia is suicidal ideation, thoughts, or tendencies.

Another thing to expect is that adherence to the treatment program can help reduce the intensity of symptoms and improve a patient’s quality of life. Even though schizophrenia is a lifelong condition, it’s possible to reach the stage of remission i.e. the period when the symptoms aren’t active.

What is the difference between paranoid schizophrenia and schizophrenia?

The main difference between paranoid schizophrenia and schizophrenia is that the latter is a name for a mental illness characterized by hallucinations and delusions. On the other hand, the term paranoid schizophrenia is just one type or subtype of this mental illness. As seen in this post, paranoid schizophrenia is the most common type of schizophrenia.

Not all cases of schizophrenia belong to the paranoid subtype i.e. not all patients with schizophrenia develop paranoia as a symptom. People can also have catatonic, disorganized, residual, and undifferentiated schizophrenia.

Paranoid schizophrenia was a type of this mental illness with paranoia as the common symptom. While DSM-5 doesn’t divide schizophrenia into different types, many healthcare professionals may still use this term for cases when a patient with schizophrenia exhibits strong paranoia.

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