Paranoid schizophrenia is the most common subtype of schizophrenia. The disorder is characterized by various complaints such as persecutory delusions, visual and auditory hallucinations. The alternative name “paranoid-hallucinatory schizophrenia” also stems from this.
What is paranoid schizophrenia?
Schizophrenia has a multifaceted appearance and belongs to the so-called endogenous psychoses. These are clinical pictures that are associated, among other things, with loss of reality and disturbances of thinking and emotions and arise from a variety of internal factors. Schizophrenia is not, as is often wrongly assumed, a split personality. Nor is it related to reduced intelligence, but rather to errors in the perception and interpretation of the environment. About 25 out of 10,000 Germans suffer from schizophrenia. Women and men are affected with equal frequency, but in the latter the disease breaks out earlier on average. About half of all suffering patients show symptoms of paranoid schizophrenia in the course of the disease. This type often develops only in people in middle age and thus later than other schizophrenic disorders. Paranoid schizophrenia centers on disturbances of ego consciousness, hallucinations, and especially delusions, from which the name is derived.
Causes
It is not possible to single out a single cause of paranoid schizophrenia, but there are several risk factors that promote the onset of the disease. On a biochemical level, the messenger substances in the brain (neurotransmitters) are considered to be of great importance. Scientists suspect that a disturbed dopamine metabolism is associated with schizophrenia. This is supported by experience with amphetamines, which promote the release of dopamine and intensify symptoms. Serotonin is also suspected of influencing the course of the disease. The neurotransmitter affects the perception of pain, memory and happiness. Overactivity of individual neural pathways can cause increased release of these neurotransmitters. Some psychosocial risk factors are also defined that may trigger the onset of paranoid schizophrenia. If a certain genetic predisposition is present, psychological stress has particularly strong effects in some people. Critical and traumatic experiences, especially in early childhood, pose an increased risk. The same applies to a stressful social environment or an existing depression. In addition, schizophrenic disorders rarely occur as a result of infections from which the mother of the affected person suffered during pregnancy. These include, above all, Lyme disease and herpes simplex. Other possible somatic causes include lactose intolerance, celiac disease, and prenatal or postnatal hypoxia.
Symptoms, complaints, and signs
Paranoid schizophrenia is primarily manifested by three main symptoms: Delusions, ego disturbances, and hallucinations. Delusions are manifested by a very strong conviction, incomprehensible to healthy people, of being watched or followed, for example. The patient is mostly in a state of paranoia, in which he believes that all external events and persons are closely related to him. He interprets everyday events as signs or hidden messages and cannot move away from these thoughts. The disturbance of the ego is also related to this. The patient experiences demarcation problems between the ego experience and the environment and is no longer able to view things rationally from the outside. This is accompanied by disorders such as thought withdrawal, derealization, and depersonalization. Hallucinations usually occur on an auditory level; over 80 percent of all paranoid schizophrenia sufferers report such symptoms. They hear voices giving them orders, insulting them, or conveying paranoid thoughts. This can cause the sufferer to feel compelled to engage in self-injurious acts or aggressive behavior against others.
Diagnosis and course of the disease
The first and most important step in diagnosis is a discussion between the physician and the patient in which the psychotic signs that occur are questioned.Several criteria regarding the nature and duration of symptoms must be met in order to determine the illness. Complaints such as auditory hallucinations or paranoid thoughts that persist for at least one month make schizophrenia likely. Other critical signs include decreased emotional responsiveness (flattening of affect), disjointed thought patterns, and speech disorders. The interview is followed by a comprehensive neurological and physical examination. This is to rule out other conditions such as epilepsy, brain tumors, infections of the brain, or traumatic brain injury. It is also important to rule out hallucinations and delusions that occur as a result of drug abuse, such as LSD, cannabis, ecstasy, cocaine, or alcohol. If negative symptoms such as lack of drive and speech impoverishment predominate, it must be ensured that these are not part of a depression. Further, other mental disorders such as bipolar disorder, autism, obsessive-compulsive disorder, and [[personality disorder]9s should be distinguished.
Complications
Paranoid schizophrenia is usually accompanied by delusions and hallucinations. Affected individuals develop a veritable delusion of persecution, feeling constantly under surveillance, believing that other people are watching them and trying to harm them. They are excessively suspicious and believe that they are being watched and bugged even in their own homes. Some fall under the delusion that normal everyday events are trying to tell them hidden messages. With people talking to each other, they have the feeling that they are talking about them. Hallucinations are also not uncommon. Paranoid schizophrenics hear voices, perceive smells, and see things that do not exist in real life. This can go so far that they feel voices are giving them orders. In addition, they are often internally agitated, argumentative, and also angry to the point of violence if they suspect a threat. In this state, they are no longer amenable to reasonable arguments, and it is advisable to call 911 to prevent the sufferer from harming themselves or others. Sometimes, against the will of the schizophrenic, admission to a psychiatric hospital must be made.
When should you go to the doctor?
People who suffer from behavioral abnormalities that are perceived by the environment as greatly deviating from the norm should be examined by a doctor. In most cases, mental illness results in a lack of insight into the illness. This means that the affected person himself feels healthy and has no awareness of the presence of a health disorder. Delusions or hallucinations must be examined by a physician as soon as possible. If the affected person reports hearing voices or having intuitions, this is considered unusual. If there is a firm conviction that a power is controlling one’s thoughts or taking them away, medical help is needed. If the affected person perceives himself outside of his own body, the conversation with a doctor should be sought. Aggressive or self-destructive behavior is worrisome. In severe cases, an emergency physician is needed or a public health officer must be informed so that compulsory hospitalization can be initiated. Insults or sudden verbal abuse of fellow human beings frequently occur in sufferers of paranoid schizophrenia. Affected persons perceive the environment as a potential threat and lose touch with reality. Everyday life cannot be managed without outside help. Therefore, a medical consultation is recommended already at the first abnormalities.
Treatment and therapy
Treatment of paranoid schizophrenia nowadays promises good prognosis, although the disease is not always curable. It is built on a combination of drug treatment, psychotherapy, and other therapeutic procedures that are individually tailored to the patient. For drug treatment, especially in an acute phase, an antipsychotic is often used. This regulates the metabolism of neurotransmitters, suppresses psychotic symptoms and inhibits the absorption of stimuli. However, a significant improvement in symptoms only occurs after a few weeks. If the symptoms subside, the dosage is reduced. Therapeutic measures can only be taken if the patient shows a willingness to cooperate.Psychotherapy focuses on coming to terms with the experience of the illness, coping with life problems and self-help. Sociotherapy focuses on the damage within the family and the entire environment that has occurred as a result of the illness. Work therapies, structuring measures and the involvement of the family are part of this. After the symptoms have subsided, many affected persons suffer from cognitive impairments. These are treated as part of cognitive rehabilitation.
Outlook and prognosis
Paranoid schizophrenia is readily treatable today. Drugs such as neuroleptics on the one hand and therapeutic treatment on the other counteract the delusions. Early treatment is important. In the course of psychotherapy, the triggers of the illness are worked through. In the long term, comprehensive therapy can prevent relapses. Frequently occurring concomitant diseases such as depression or alcohol or drug addiction have a negative effect on the prognosis. If physical diseases such as diabetes are present at the same time, life expectancy is also reduced. In addition, people suffering from paranoid schizophrenia have an increased risk of suicide. The prognosis is made jointly by psychotherapists and medical specialists. Because paranoid schizophrenia can have a wide variety of causes and is manifested by numerous symptoms, it is usually impossible to make a reliable prognosis. Instead, the prognosis must always be adjusted to the patient’s current state of health. The prospect of recovery is also good. With the administration of neuroleptics and comprehensive therapeutic support, a majority of patients overcome the disease. Continued support after recovery reduces the risk of relapse and secondary disorders such as depression.
Prevention
To reduce the risk of paranoid schizophrenia, the main thing to do is reduce overall stress levels. This means addressing problems in the family or workplace early on and working to overcome them. Traumas from the past and psychological stresses should be dealt with, also with the help of psychotherapeutic measures, before a schizophrenic clinical picture develops from them. In this context, it is important to recognize and treat early symptoms such as sleep disturbances, fatigue, restlessness, and behavioral changes in a timely manner.
Follow-up
Family plays an important role in relapse prevention. On the one hand, family members can be a resource and supportive – but on the other hand, an unfavorable family climate can also be a trigger for relapse. In addition, it is often easier for other people than for the schizophrenic to recognize a relapse. For these reasons, it is often useful in paranoid schizophrenia for the family to be involved in treatment and follow-up. Because paranoid schizophrenia is not completely curable in every case, medications may also be part of the aftercare. These are used to control the psychotic illness as much as possible and reduce the risk of relapse. A psychiatrist decides together with the patient whether and which medications are suitable for this purpose. Vocational and social rehabilitation can also be part of aftercare. Vocational rehabilitation deals, for example, with the question of whether the patient can continue in his or her previous job and what changes, if any, are needed to make continued employment possible. Social training or sociotherapy may also be considered to help the schizophrenic resume a self-determined life. However, all measures must be tailored to the individual, as paranoid schizophrenia can vary widely.
What you can do yourself
Sufferers of paranoid schizophrenia normally experience a loss of reality. Because they are often unable to take sufficient care of themselves, they need outside help. Relatives and people from the close social environment should get comprehensive professional information about the disease, the symptoms and the necessary measures. This makes it easier to deal with the disease and leads to timely intervention. Medical care is necessary for patients with paranoid schizophrenia to improve the quality of life.In addition, cognitive and behavioral therapies help to alleviate the symptoms in the long term. A good relationship of trust between the patient, the relatives and the treating physician is important for optimal care. The affected person experiences delusions and hallucinations, which can be anxiety-provoking for people in the social environment. Through education and an intensive exchange with other affected persons, fears can be reduced and hints for a better handling of the disease in everyday life can be promoted. In many cases, the patient is unable to work. Nevertheless, finding sufficient employment and pursuing a task is important to improve the general quality of life. Risk factors of schizophrenia should be minimized in parallel. The number of stimuli that flow to the patient through existing environmental influences should be reduced to improve health.
