Paranoid schizophrenia

Definition

Paranoid schizophrenia is one of several types of schizophrenia, a chronic mental illness in which reality is interpreted abnormally (psychosis). The classic features of paranoid schizophrenia are having beliefs that have no basis in reality (delusions) and hearing things that aren't real (auditory hallucinations).

With paranoid schizophrenia, your ability to think and function in daily life may be better than with other types of schizophrenia. You may not have as many problems with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many complications, including suicidal behavior. But with effective treatment, you can manage the symptoms of paranoid schizophrenia and work toward leading a happier, healthier life.

Symptoms

Signs and symptoms of paranoid schizophrenia may include:

• Auditory hallucinations, such as hearing voices
• Delusions, such as believing a co-worker wants to poison you
• Anxiety
• Anger
• Aloofness
• Violence
• Verbal confrontations
• Patronizing manner
• Suicidal thoughts and behavior

With paranoid schizophrenia, you're less likely to be affected by mood problems or problems with thinking, concentration and attention. Instead, you're most affected by what are known as positive symptoms.

Positive symptoms
Positive symptoms are symptoms that indicate the presence of unusual thoughts and perceptions that often involve a loss of contact with reality. Delusions and hallucinations are considered positive symptoms of paranoid schizophrenia.

• Delusions. In paranoid schizophrenia, delusions are often focused on the perception that you're being singled out for harm. Your brain misinterprets experiences and you hold on to these false beliefs despite evidence to the contrary. For instance, you may believe that the government is monitoring every move you make or that a co-worker is poisoning your lunch. You may also have delusions of grandeur — the belief that you can fly, that you're famous or that you have a relationship with a famous person, for example. Delusions can result in aggression or violence if you believe you must act in self-defense against those who want to harm you.
• 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. These voices may talk either to you or to each other. The voices are usually unpleasant. They may give a running critique of what you're thinking or doing, or they may harass you about real or imagined faults. Voices may also command you to do things that can be harmful to yourself or to others. When you have paranoid schizophrenia, these voices seem real. You may talk to or shout at the voices.

When to see a doctor
If you have any symptoms of paranoid schizophrenia, seek medical help as soon as possible. Paranoid schizophrenia doesn't get better on its own and may worsen without treatment. However, if you're like most people with paranoid schizophrenia, you may not recognize that you need help or that you even have symptoms, especially because your delusions or hallucinations are very real to you. Family and friends, or people at work or school, may be the ones who initially suggest you seek help.

Getting treatment from a mental health provider with experience in schizophrenia can help you learn ways to manage your symptoms so that you have the best chance to continue on with a productive and happy life. If you're reluctant to seek treatment, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.

Helping someone who may have paranoid schizophrenia
If you have a loved one you think may have symptoms of paranoid schizophrenia, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider. If your loved one poses a danger to himself or herself or to someone else, you may need to call the police or other emergency responders for help. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state.

Suicidal thoughts
Suicidal thoughts and behavior are common when you have paranoid schizophrenia. If you're considering suicide right now and have the means available, talk to someone now. The best choice is to call 911 or your local emergency services number. If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone:

• Contact a family member or friend
• Contact a doctor, mental health provider or other health care professional
• Contact a minister, spiritual leader or someone in your faith community
• Go to your local hospital emergency room
• Call a crisis center or hot line

Causes

It's not known what causes paranoid schizophrenia. However, a growing body of evidence suggests that paranoid schizophrenia and other forms of schizophrenia are caused by brain dysfunction. Why and how that brain dysfunction occurs is still under investigation, though.

It's thought that an interaction of genetics and environment may lead to brain dysfunction that causes paranoid schizophrenia. Problems with certain naturally occurring brain chemicals called neurotransmitters may also contribute to paranoid schizophrenia. Imaging studies show differences in the brain structure of people with schizophrenia, but researchers aren't yet sure about the significance of these changes.

Risk factors

Although the precise cause of paranoid schizophrenia isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering paranoid schizophrenia, including:

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

According to the National Institute of Mental Health, schizophrenia affects about 1 percent of the general population, and paranoid schizophrenia affects an even smaller percentage. Schizophrenia typically becomes apparent between the teenage years and the mid-30s, but paranoid schizophrenia may start later in life.

Complications

Left untreated, paranoid schizophrenia can result in severe emotional, behavioral, health, and even legal and financial problems that affect every area of your life. Complications that paranoid schizophrenia may cause or be associated with include:

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

Preparing for your appointment

In some cases, a health care provider, family member, friend or another acquaintance may ask about your behavior, thoughts and mood or suggest that you be evaluated by a mental health provider. Or you may decide on your own to schedule an appointment with your family doctor or mental health provider to talk about your concerns. In some cases, you may be taken to a hospital for an emergency psychiatric evaluation. But when possible, try to be an active and willing participant in your own care.

What you can do
Being an active participant in your care can help your efforts to manage your condition. One way to do this is by preparing for a planned medical or psychiatric appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These questions may include:

• Why do you think I have paranoid schizophrenia?
• How do you treat paranoid schizophrenia?
• How can treatment help me?
• Are there medications that might help?
• Will psychotherapy help?
• How long will treatment take?
• What can I do to help myself?
• Are there any brochures or other printed material that I can take home with me? Or can you recommend reliable Web sites to visit?

In addition to your prepared questions, don't hesitate to ask questions at any time during your appointment if you don't understand something.

What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your thoughts, behavior and mood. You may be asked such questions as:

• When did you first notice symptoms?
• How is your daily life affected by your symptoms?
• Do you hear or see things other people don't seem to?
• Do you have certain powers that other people don't?
• What have you tried on your own to feel better or to control your symptoms?
• What things make you feel worse?
• Have friends or family commented on your thoughts or behavior?
• Have any relatives had a mental illness?
• What medications or over-the-counter herbs and supplements do you take?

Tests and diagnosis

If your doctor or mental health provider believes you may have paranoid schizophrenia or another mental illness, he or she typically runs a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms and check for any related complications.

These exams and tests generally include:

• Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
• Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
• Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide, self-harm or harming others. Your doctor may also want to talk to family or friends, if possible.

Diagnostic criteria for paranoid schizophrenia
To be diagnosed with paranoid schizophrenia, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for paranoid schizophrenia include:

• A preoccupation with one or more delusions
• Frequent auditory hallucinations

It can sometimes be difficult to diagnose paranoid schizophrenia, especially because other conditions may have similar symptoms. Be sure to stick with it, though, so that you can get appropriate treatment.

Treatments and drugs

Paranoid schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have subsided. Treatment can be challenging because you may feel as if you don't need treatment, and you may refuse to follow treatment recommendations. But effective treatment can help you take control of your condition and enjoy a happier and healthier life.

Treatment options are similar for all types of schizophrenia. But the specific treatment approach that's best for you depends on your particular situation and the severity of your symptoms.

Treatment teams
Paranoid schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well because the condition can affect so many areas of your life. Your treatment team can help make sure that you're getting all of the treatment you need and that your care is coordinated among all of your health care providers.

The team involved in treatment of paranoid schizophrenia may include your:

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

Main treatment options
The main treatments for paranoid schizophrenia are:

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

Medications for paranoid schizophrenia
Medications are the cornerstone of paranoid schizophrenia treatment. Among the medications most commonly prescribed for paranoid schizophrenia are:

• First-generation (typical) antipsychotics. These medications are thought to control symptoms by affecting brain chemicals called neurotransmitters. These medications have traditionally been very effective in managing the positive symptoms of paranoid schizophrenia, including delusions and hallucinations. These medications, however, have frequent and potentially severe neurological side effects, including the possibility of tardive dyskinesia, or involuntary jerking movements. Typical antipsychotics, especially generic versions, are often cheaper than are their newer counterparts, which can be an important consideration when long-term treatment is necessary.
• Second-generation (atypical) antipsychotics. These newer antipsychotic medications are effective at managing hallucinations, delusions and other symptoms, such as loss of motivation and lack of emotion. Atypical antipsychotic medications pose a risk of metabolic side effects, including weight gain, diabetes and high cholesterol.
• Other medications. It's common to have other mental health issues along with paranoid schizophrenia. Antidepressants can be helpful if you have symptoms of depression. Anti-anxiety medications can be helpful if you have symptoms of anxiety or agitation. And mood stabilizing medications may help with aggression or hostility.

Choosing a medication
In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depends on your own individual situation. It can take several weeks after first starting a medication to notice an improvement in your symptoms.

If one medication doesn't work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, antipsychotic medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.

Medication side effects and risks
All antipsychotic medications have side effects and possible health risks. Certain antipsychotic medications may increase the risk of diabetes, weight gain, high cholesterol and high blood pressure, for instance. Others can cause dangerous changes in your white blood cell count or cause health problems in older adults.

Be sure to talk to your doctor about all of the possible side effects and about being routinely checked for health problems while you take these medications. Antipsychotic medications can also have dangerous interactions with other substances. Tell your doctors about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Psychotherapy for paranoid schizophrenia
Although medications are the cornerstone of paranoid schizophrenia treatment, psychotherapy is also important. Psychotherapy may not be appropriate for everyone, though, especially if symptoms are too severe to engage in a therapeutic process that requires two-way communication. Psychotherapy may include:

• Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life challenges brought on by paranoid schizophrenia. Therapy can help reduce the severity of your symptoms and improve communication skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about paranoid schizophrenia can help you understand it better, cope with lingering symptoms and understand the importance of taking your medications. Therapy also can help you cope with stigma surrounding paranoid schizophrenia. There are many types of psychotherapy that may be useful, such as cognitive behavioral therapy.
• Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse, and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and understand family conflicts. Family therapy also can help family members cope and reduce their distress about your condition.

Hospitalization for paranoid schizophrenia
During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure your own safety and that of others, and make sure that you're getting proper nutrition, sleep and hygiene. Partial hospitalization and residential care also may be options.

Electroconvulsive therapy (ECT) for paranoid schizophrenia
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your brain to trigger a brief seizure. This seems to cause changes in brain chemistry that can reduce symptoms of certain mental illnesses such as paranoid schizophrenia. Because ECT can provide significant improvements in symptoms more quickly than can medications or psychotherapy, electroconvulsive therapy may be the best treatment option in some cases. Deciding whether electroconvulsive therapy is a good option for you can be extremely difficult. Make sure you understand all the pros and cons.

Social and vocational skills training for paranoid schizophrenia
Training in social and vocational skills to live independently is an important part of recovery from paranoid schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help you with jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctors about getting one.

Treatment challenges in paranoid schizophrenia
When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in daily activities. But be prepared for challenges that can interfere with treatment.

For one thing, you, like many others with schizophrenia, may find it hard to follow your treatment plan. You may believe that you don't need medications or other treatment. Also, if you're not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk to your doctors about tips to stick to your treatment plan, such as taking an antipsychotic medication that's available in a long-lasting injectable form. Even with good treatment, you may have a relapse. Have a plan in place to deal with a relapse.

Smoking, and often heavy smoking, is common when you have schizophrenia. Some evidence suggests that smoking improves thinking and concentration in schizophrenia. If you smoke, you may need a higher dose of antipsychotic medication because nicotine interferes with these medications. Be honest with your doctors about your smoking habits. And be sure you understand the serious health risks of smoking.

Similarly, using alcohol and drugs can make paranoid schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you may benefit from treatment programs that include care for both schizophrenia and substance abuse.

Lifestyle and home remedies

Paranoid schizophrenia isn't an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan:

• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, schizophrenia symptoms are likely to come back.
• Pay attention to warning signs. You and your caregivers may have identified things that may trigger your paranoid schizophrenia symptoms, cause a relapse or prevent you from carrying out your daily activities. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Involve family members or friends in watching for warning signs. Addressing schizophrenia symptoms early on can prevent the situation from worsening.
• Avoid drugs and alcohol. Alcohol and illicit drugs can worsen schizophrenia symptoms. Get appropriate treatment for a substance abuse problem.
• Check first before taking other medications. Contact the doctor who's treating you for paranoid schizophrenia before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals or supplements. These can interact with your schizophrenia medications.

Coping and support

Coping with an illness as serious as paranoid schizophrenia can be challenging. Medications can have unwanted side effects, and you may feel angry or resentful about having a condition that requires lifelong treatment. During periods when you feel better, you may be tempted to stop treatment, which can trigger a relapse. Here are some ways to cope with paranoid schizophrenia:

• Learn about paranoid schizophrenia. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Join a support group. Support groups for people with schizophrenia can help you reach out to others facing similar challenges.
• Stay focused on your goals. Recovery from paranoid schizophrenia is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
• Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
• Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.

Prevention

There's no sure way to prevent paranoid schizophrenia. Evidence shows that some signs of schizophrenia may be present from early childhood or even infancy. Early identification and treatment for people at risk of schizophrenia, perhaps starting in childhood, may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Also, sticking with your treatment plan can help prevent relapses or worsening of paranoid schizophrenia symptoms.