Paranoid schizophrenia is a subtype of schizophrenia in which the patient has hallucinations, false beliefs, and delusions that a person or group of individuals, regardless if they are his close friends or loved ones, are continuously plotting against him. At times, the patient may even believe that these individuals are planning to do him harm. Individuals who suffer from the paranoid form constitute the majority of the cases that are deemed as schizophrenic. They are far larger in number than the other types.
However, the percentages vary according to historical and geographical contingencies and diagnostic criteria of the local psychiatric profession. The cases are usually classified as paranoid present. If you need a consult on behalf of a loved one, you can seek an appointment with a specialist or ask your doctor for a recommendation.
In a greater percentage of the cases, the onset of psychosis tends to occur later in the individual’s life than in the various other types. Although many cases of this type take place as early in a person’s life as puberty, they are also discovered in the 4th and 5th decade of life. The further the patient has progressed in age, the more troublesome it becomes to decide whether their symptomatology is that of a schizophrenic or one that’s classified better as paranoia or paranoid state.
Paranoid individuals are, as a rule, of greater intelligence than other patients with schizophrenia, although all levels of IQ are found. From the start of the illness, individuals may appear suspicious and are bound to interpret certain events or things in a way that is demeaning to themselves. The underlying feeling regarding oneself is instantly lost, transforming into a symptomatology.
This is where "projection" takes place. Projection is the act of attributing to others a greatly negative feeling about the patient. Not only does a patient claim the other individuals around him accuse him of traits he dislikes in himself, but he will eventually ascribe to others the traits that he cannot accept within himself. He will start by being suspicious and soon become certain that other individuals conspire or plot against him.
He witnesses or collects the alleged evidence of this conspiracy. From here, he may either assume the angry, bitter, defiant, and antagonistic attitude of an individual who is unjustly victimized, or he may adopt the attitude of an individual who is submissive and wants help, but he doesn’t know what to do, because “weird things are happening.”
The thought content of these individuals is characterized by reference, ideas, and delusions, even greater here than in other forms of schizophrenia. Although the delusions are un-systematized in a majority of cases, they are of a more systematized nature than in hebephrenic type and can be well systematized at the start of the condition. In patients from the United States, the delusions that are experienced are nearly always persecutory in nature, especially at the start of the ailment. Syndromes that were characterized by delusions of a grandiose nature from the start of the disease were more typical in the past.
In a substantial number of cases, the delusions become systematized; the affected individual doesn’t accept them as beliefs that are unrelated, but he will explain or rationalize them logically in relation with the rest of his life or what he observes in the world.
A completely delusional system may be structured around the belief that the affected individual is persecuted due to his philosophy, ideology, or religion. The individual may structure a system of beliefs. They will then try to give this system a plausible philosophical, theological, or scientific structure. Delusions can have all different types of content.
It is absolutely impossible to list all of the facts and things they may refer to. They reflect the affected individual's cultural, social, and familial conditions. Sometimes, this cultural influence can be manifested in a paradoxical manner. For example, where religion as a whole has a lesser influence in the lives of people presently than in previous eras, reports have recently shown an increase of delusions that contain religious content.
The delusion of being the Christian messiah is common in both patients that are of the Christian faith and Jewish patients who are living in a predominantly Christian country. The delusion of being Moses appears both in female and male Jewish patients. The delusion of being the Virgin Mary, Saint Paul, Saint Peter, and so forth, is also relatively common. Contrary to common belief or what is written in popular literature about psychiatry, there are cases that have been reported in which a patient claims to be Napoleon Bonaparte.
The paranoid type can present itself in a subtype known as ‘monosymptomatic.’ That is, at a manifest level, the ailment is detected by the presence of merely a single delusion, usually involving persecution, whereas the remainder of the personality stays apparently intact. Many of these isolated delusions, like, for example, the belief of being able to influence weather, are fairly harmless.
Other monosymptomatic delusions, that are fortunately rare, are dangerous and can lead to what is known as unmotivated crimes. These delusions can result in the murder of a mother, father, sibling, or even a series of unknown persons. These delusions can be difficult to recognize, and the differential diagnosis from a psychopathic personality can be doubtful in some cases.
Hallucinations, especially those of an auditory nature, are common in the paranoid form of schizophrenia. They can be completely absent in cases where the personality is relatively well preserved and the delusions well systematized.
Based on the symptoms that impact the behavior of the patient, the monosymptomatic delusions are a subcategory of schizophrenia that have the most severe effects on the patient's mental functioning. As a side effect, the affected individual loses grasp on how they are supposed to behave in society.
Treatment for Paranoid Schizophrenia
Patients suffering from paranoid delusions often require a strict regimen of treatment, along with advanced medical care and hospice. Some of these patients are categorized as being at high-risk to themselves and those around them, resulting in them being sequestered for a certain duration, during which the treatment process would continue.
Most of these patients would have been subject to rigorous treatment therapies, and these can often vary depending on the severity of the patient’s condition. Paranoid schizophrenic patients often require full time care, and as a result, many of these hospice and mental health centers will have a complete set of mental health care professionals working around the clock to provide their patients with optimal care, while ensuring that their patients remain comfortable and relaxed.
Some of these health care centers carry a complete staff of dedicated health care professionals who provide the following services:
- Case worker
- Social worker
Treatment therapy and medications
The doctor may often recommend that the patient be given anti-psychotics, and this is provided after a review of the current condition, and the case worker’s report is sent in for a complete review. The case worker often makes an initial assessment, after which a final one is done on a complete review of the patient’s condition, delusions, and fears. Usually the patient would be prescribed atypical anti-psychotic drugs, which often differ from other drugs in the sense that they have proven to be more effective and have fewer side effects when compared to others.
Some of the side effects of anti-psychotic drugs are:
- Weight gain
- Higher cholesterol levels
Psychotherapy: Often patients are made to undergo psychotherapy, where they would be expected to address their fears and delusions in a comfortable atmosphere. The whole objective here is to get the patient to communicate about their fears and how they plan to resolve their issues with certified counselors providing the guidance to help them along. Psychotherapy may also consist of role playing, as well as other social exercises, where the patient is expected to react to the others in the room. Each patient’s reaction is gauged and recorded by the staff for further review of the patient’s case file.
Social and vocational training: Patients are often taught about the basic social mores, how to interact with society, as well as learning a few skills which can be of use to them later in their lives. There are various self-help groups that help the patients to settle down and integrate back into society upon being released from the health center.
Adherence and compliance: Patients are expected to take their medications regularly, and often paranoid schizophrenics do the exact opposite and often refuse to take their medication or hide them away. As a result, this can impact their treatment process, and it can further impede a return to normalcy for them.
Even though the staff is highly trained to ensure that all the patients comply and take their medications accordingly, most of them find a way to give it a miss. This sadly pushes many over the edge, causing their condition to deteriorate further. This is why all the patients are carefully monitored around the clock and even have their rooms searched on a periodic basis to ensure that they are complying with their medications and are taking it regularly.
Electro-convulsive therapy (ECT)
This form of therapy is often used on those who are deemed to be unresponsive to traditional forms of medication, to those suffering from depression, and those who suffer from suicidal thoughts. The process is about using electrical current to shock the patient’s brain into having controlled seizures. The whole basis for the treatment works on the principle that the ECT induces the brain to release certain neurochemicals in the brain, which in turn activates the patient’s brain. Although studies are still being conducted to study the efficacy of this form of therapy, it has been proven to work, time and time again.
In most of the cases where there is mental pressure or there is any issue related to mental health, people avoid getting the treatment in a proper way, or they avoid getting any treatment at all. However, one should always take care of this and should not avoid treatment in this type of case. There are several paranoid schizophrenics whose family members have opted not to admit them into healthcare centers and seek treatment for them. Left untreated, paranoid schizophrenics can develop some of the following symptoms:
- Suicidal thoughts
- Substance abuse
- Petty crime
- Being a victim of crime
- Inability to focus
- Limited functionality
- Heavy smoking
If the patient is not ready or not convinced to take care of himself, then the family of the patient plays a major role. It becomes the responsibility of the family to get the patient treated in a proper way, and morally supporting the patient can help him to come out of this. It is essential that the family members of these paranoid schizophrenics contact the nearest health center for more information on the treatment process, the treatment protocol, and the various success stories.
It is time that these patients were cared for and treated correctly. Being left untreated can cause most paranoid schizophrenics to experience the very worst of their fears combined. This is why it is essential that the close family members of these patients do make a point to learn more about the treatment process and the fact that there is hope that their cherished family member may well return as a normal human being.
It is time that these family members thought about doing what is right for these patients. After all, caring is a form of healing, and the only way for you to make your loved one better is to take the first step and get him admitted to the program. The family members also should behave in proactive way to the patient and treat the patient in a positive way so that that he will get well soon.
The Bottom Line
The progression of the disorder can be rapid and may result in advanced regression over a short span of time. However, the majority of paranoid individuals regress at a less rapid pace than the other types. Many remain indefinitely at a stage of the illness that is not very advanced. Paranoid individuals remain in better contact with their environment and can adjust better to a hospital routine.
Often, their activities may be channeled into work that is useful. On the other hand, their delusions, ideas of reference, and overall suspiciousness can make them rebellious, antagonistic, and even violent. Homicidal impulses and escapes from the hospital are more common in this group. Being calm and patient is the best way for friends and family to deal with an individual who is diagnosed with schizophrenia.
- From the start of the illness, individuals may appear suspicious and are bound to misinterpret certain things or events in a way derogatory to themselves.
- A definite delusional system may be structured around the idea that the affected individual is persecuted due to his philosophy, ideology, or religion.
- Hallucinations, especially of an auditory nature, are common in the paranoid form of schizophrenia.