Paranoid schizophrenia is the most common type of schizophrenia characterized by the presence of persecutory or grandiose delusions, often accompanied by hallucinations. Schizophrenia is a chronic brain disorder that affects about 1% of the population. When schizophrenia is active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation. Paranoid schizophrenia is no longer included in DSM-5. DSM-5 is an authoritative volume published by the American Psychiatric Association, which is used by psychiatrists and other clinicians and researchers to diagnose and classify mental disorders. Psychiatrists now refer to paranoid schizophrenia as schizophrenia with paranoia. Not everyone with schizophrenia will develop paranoia. The average age of onset is late adolescence to early adulthood, usually between the ages of 18 to 30.
Symptoms of Paranoid Schizophrenia
Prominent symptoms of paranoid schizophrenia are delusions, sometimes accompanied by hallucinations. Other symptoms, which are less common, can include disorganized speech, disorganized behavior, and negative symptoms. Suicidal thoughts can also occur. Depression and anxiety might accompany the disease.
Delusions are fixed false beliefs about things, which the patient is resistant to correct even if shown opposite evidence. Usually, these beliefs are not in keeping with the prevalent beliefs in the culture they belong to.
The delusions might make you falsely believe (WebMD, 2017):
- A co-worker is trying to hurt or kill you.
- Your spouse is cheating on you.
- The government is spying on you.
- Neighbors are plotting against you.
These unreasonable, untrue, and unjustified suspicions about others’ motives and intended actions can make it hard for them to hold a job, run errands, have friendships, and even consult a doctor (WebMD, 2017).
Hallucinations are false sense perceptions of things that are not really there. For example, you may hear voices that are talking about you, discussing about you, making fun of you or insulting you, and even urging you to do harmful things. These are auditory hallucinations. Other types of hallucinations, such as visual or tactile, are not common (WebMD, 2017).
The speech might be disorganized in the form of repetition of words and phrases or interrupting in the middle of a sentence. You may make up your own words as you go along (neologisms). These symptoms usually result due to difficulties with concentration (Healthline, n.d.).
This refers to behavior that is inappropriate to the circumstances of work life, social life, or home life in which it occurs. You are not in control of this behavior. You may:
- Neglect ordinary daily activities
- Be unable to control your impulses
- Be overemotional
- Indulge in odd or inappropriate behavior (Healthline, n.d.).
They do not usually resort to violence. But sometimes, they may feel threatened and angry on account of their delusions. If they are pushed to their limits, they might take out their frustration on the family members at home rather than on the public (WebMD, 2017).
These symptoms include (Healthline, n.d.):
- Diminished range of emotions
- Blunted facial expressions and gestures
- Marked loss of interest in the world
- Lack of motivation to do anything
- Social withdrawal
- Neglect of personal hygiene and self-care
Causes and Risk Factors
The exact cause is unknown. A combination of genetic factors and environmental triggers are thought to be at work. Symptoms may result from an imbalance of the neurotransmitters (naturally occurring chemicals in the brain) dopamine and serotonin.
The most important influence is genetic, with about 80% of the risk being inherited. The genes—some of which have recently been identified—act as risk factors, not determinants of illness (Harrison, et al., 2018).
At present, no single, or major, environmental risk factor influencing the incidence of schizophrenia or other psychoses has been conclusively demonstrated (Sadock, et al., 2017). Environmental risk factors can be (Harrison, et al., 2018):
- Maternal infections
- Maternal malnutrition
- Birth complications
- Winter birth
- Advanced paternal age
- Urban birth and upbringing
- Childhood trauma and adversity
- Being an immigrant
- Cannabis smoking
- Tobacco smoking
- Life events
Treatment of Paranoid Schizophrenia (Harrison, et al., 2018)
There is a strong evidence base supporting the use of antipsychotic drugs in the treatment of schizophrenia for the prevention of relapse. However, there are important limits to their effectiveness, and significant side effects and other potential harms. About two-thirds of patients show a significant therapeutic response, but one cannot predict whether an individual patient will respond. Importantly, antipsychotic drugs only treat the positive symptoms of schizophrenia. They have little or no clinically significant effect on negative or cognitive symptoms, although a recent clinical trial reports efficacy of the new atypical antipsychotic cariprazine against negative symptoms.
A 2014 study reported a 1-year recurrence rate of 77% in those who discontinued medication, but only 3% in those who remained on medication.
However, there is less evidence as to how long maintenance treatment should last after an acute episode, reflected in differences between guidelines: some suggest 1–2 years, whereas others recommend 2–5 years.
Partial or non-adherence to treatment with antipsychotic drugs is common and is associated with worse outcomes. Long-acting depot injections of antipsychotics were introduced to deal with the problem of non- (or uncertain) adherence to treatment. Depot injections are more successful than oral medication in preventing relapse, presumably due to improved compliance, with a meta-analysis showing a relative risk reduction of about 30%.
Some of the antipsychotics are:
The traditional indications for electroconvulsive therapy (ECT) in schizophrenia are catatonic stupor (periods where the individual moves very little and does not respond to instructions), severe comorbid depressive symptoms, and severe behavioral disturbance. In this, the patient’s brain is zapped with electricity via electrodes placed on the scalp. During treatment, the patient is usually put under anesthesia and often also given a muscle relaxant to prevent any physical injuries due to convulsive movements.
The development of community-based services and concerns about the limitations of medication has led to an increasing emphasis on psychosocial interventions in the treatment of schizophrenia. These interventions are of several different kinds, but share the following aims: (1) Enhancement of interpersonal and social functioning, including promotion of independent living in the community, and (2) Attenuation of symptom severity and associated comorbidity. They are:
- Family therapy (psychoeducation)
- Cognitive behavior therapy
- Cognitive remediation
- Art therapy
- Social skills training
- Illness management skills
- Supported employment
- Integrated treatment for comorbid substance misuse
- Social skills training
Harrison, P., Cowen, P., Burns, T. & Fazel, M., 2018. Shorter Oxford Textbook of Psychiatry. 7 ed. Oxford: Oxford University Press.
Healthline, n.d. What Is Paranoid Schizophrenia?. [Online]
Available at: https://www.healthline.com/health/schizophrenia/paranoid-schizophrenia
[Accessed 21 Sep 2019].
Sadock, B. J., Sadock, V. A. & Ruiz, P., 2017. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer.
WebMD, 2017. What Is Paranoid Schizophrenia?. [Online]
Available at: https://www.webmd.com/schizophrenia/guide/schizophrenia-paranoia#1
[Accessed 21 Sep 2019].