What Is Paranoid Schizophrenia?

Medically reviewed by Timothy J. Legg, PhD, CRNPWritten by Kristeen Cherney on June 20, 2017

Overview

Paranoid schizophrenia is the most common form of schizophrenia, a type of brain disorder. In 2013, the American Psychiatric Association recognized that paranoia was one of the positive symptoms of schizophrenia, not a separate diagnostic condition. As a result, the name of this disorder was changed to simply “schizophrenia.” Still, people are familiar with the term paranoid schizophrenia because it has been used for decades.

If you have it, schizophrenia can make it difficult for you to tell the difference between reality and fantasy. In turn, the symptoms can significantly affect the way you perceive and interact with the world.

Not everyone with schizophrenia will develop paranoia. However, paranoia is a significant symptom. It’s important to be able to recognize early symptoms of it so you can seek treatment and improve your quality of life.

Keep reading to learn more.

Types of symptoms

This condition has marked symptoms that can evolve and even improve over time. Not everyone will experience paranoia with schizophrenia. Some will develop other symptoms, such as:

  • delusions
  • hallucinations
  • disorganized speech
  • disorganized behavior
  • negative symptoms
  • suicidal thoughts

Delusions

Delusions are strongly-held beliefs that are untrue. There are many different types of delusions. Some of the more common types include:

  • Delusions of control: You might believe that you’re being controlled by an external force, such as the government or aliens.
  • Delusions of grandeur: You might believe that you have exceptional abilities, wealth, or importance.
  • Delusions of persecution: This is the belief that everyone (or perhaps just one person) is out to get you.
  • Delusions of reference: You might believe that an otherwise insignificant item was designed specifically for you.

About 90 percent of people with schizophrenia experience delusions. Not everyone will have the same types of delusions.

Hallucinations

Hallucinations are sensations of things that you perceive to be real that actually don’t exist. Hearing voices is the most common hallucination in schizophrenia with paranoia. The voices may even be attributed to people you know.

The symptoms can get worse when you’re isolated from others.

Disorganized speech

If you have schizophrenia, you may also have disorganized speech. You might repeat words or phrases or start talking in the middle of a sentence. You may even make up your own words. This symptom is a result of concentration difficulties common with schizophrenia.

Disorganized speech in this disorder is not the same as a speech impairment.

Disorganized behavior

Disorganized behavior refers to an overall inability to control your behavior across contexts, such as at home and work. You may have trouble with:

  • performing ordinary daily activities
  • controlling your impulses
  • keeping your emotions in check
  • containing behaviors that are considered odd or inappropriate

This symptom can affect your work life, social life, and home life.

Negative symptoms

Negative symptoms refer to a lack of behaviors that are found in people who don’t have schizophrenia. For example, negative symptoms can include:

  • anhedonia, or lack of enthusiasm for activities that are generally perceived as fun
  • lack of emotions
  • blunted expression
  • decreased overall interest in the world

Suicidal thoughts

Suicidal thoughts and behaviors are another common symptom of schizophrenia. They happen more often in cases that are left untreated. If you or someone you know is having thoughts of suicide or self-harm, call your local emergency services right away. They can connect you with a mental health professional who can help.

Learn more: What is avolition in schizophrenia? »

Causes and risk factors

The precise cause of schizophrenia with paranoia isn’t known. Schizophrenia itself can run in families, so there’s a possibility that the condition is genetic. However, not everyone with a family member who has schizophrenia will develop the disorder. And not everyone who develops schizophrenia will have symptoms of paranoia.

Other risk factors for the condition include:

  • brain abnormalities
  • childhood abuse
  • low oxygen levels at birth
  • separation or loss of a parent at a young age
  • virus exposure during infancy or before birth

How it’s diagnosed

A diagnosis of schizophrenia requires a series of tests and evaluations. Your doctor will look at your:

  • blood work and other medical test results
  • medical history
  • neuroimaging test results
  • results from a physical exam

Your doctor may also order a psychiatric evaluation.

You may be diagnosed with this condition if you’ve experienced at least two major symptoms in the last month. These symptoms must be severe enough to interfere with your everyday activities.

Available treatments

Successful long-term treatment relies on a combination approach. This primarily includes medications in conjunction with various forms of therapy. In severe cases where symptoms create an unsafe environment for you or others, hospitalization may be needed.

Medications

Medications called antipsychotics can help alleviate major symptoms, such as delusions and hallucinations. These drugs work by controlling dopamine in the brain.

Options include:

Your doctor may also prescribe newer medications with fewer side effects.

It may take some time to find the right medication and a dosage that works best for you. You may experience decreased symptoms right away. Sometimes, though, you may not see the full effects of treatment for 3 to 6 weeks. For some, the medication may take up to 12 weeks to reach full effect.

Some medications may continue to improve your symptoms over the course of many months. Talk to your doctor about all the pros and cons of antipsychotics. There’s a risk of side effects, such as:

  • dizziness
  • drowsiness and fatigue
  • dry mouth
  • low blood pressure
  • nausea
  • vomiting
  • uncontrollable movements
  • vision changes
  • weight gain

Sometimes, your doctor may prescribe other medications to treat other symptoms. These drugs might include antianxiety drugs or antidepressants.

Therapy

Therapy options can include group or psychosocial therapies. Group therapy can be helpful because you’ll be with other people who are going through similar experiences. It also builds a sense of community to help fight the isolation people with schizophrenia commonly face.

Psychosocial therapies can help you cope with daily life more effectively. These methods combine talk therapy with social strategies to help you function in a variety of settings. During therapy sessions, you learn mindfulness and stress management techniques, as well as warning signs that you need to communicate to your doctor or loved ones.

Hospitalization

When detected early, schizophrenia with paranoia may respond successfully to medications and therapy. However, if you’re at risk of harming yourself or others, hospitalization may be necessary.

Hospitalization is also sometimes used for people who can no longer provide themselves with basic necessities, such as clothing, food, and shelter.

Possible complications

People who undergo treatment for schizophrenia can improve to a point where symptoms are mild to almost absent. Lifelong treatment is required to prevent other conditions associated with the disorder from occurring, such as:

Untreated schizophrenia can become disabling. In severe cases, people who don’t seek treatment are at risk of homelessness and unemployment.

Ways to cope

Managing paranoid schizophrenia requires self-care. Do your best to follow these tips:

  • Manage your stress levels. Avoid situations that increase stress and anxiety. Make sure to invest in time for yourself to relax. You can read, meditate, or take a leisurely walk.
  • Eat a healthy diet. Plant-based foods and nonpackaged items can increase your energy levels and make you feel better.
  • Exercise regularly. Staying physically active increases serotonin, the “feel good” chemical in your brain.
  • Maintain social events. Keeping social commitments will help decrease isolation, which can worsen your symptoms.
  • Get adequate sleep. A lack of sleep can worsen paranoia, delusions, and hallucinations in people with schizophrenia.
  • Avoid unhealthy behaviors, including smoking, alcohol consumption, and drug abuse.

Tips for caregivers

If you’re a caregiver for someone who has schizophrenia, you can help your loved one by following these tips:

Advocate for treatment. The symptoms might be so advanced that your loved one may not be able to seek treatment on their own. Call their doctor and explain what’s going on. Your doctor may also ask you questions about your loved one’s recent behaviors.

Keep track of their appointments. People with this disorder may also lack the skills to keep up with appointments with their doctors and therapists. You can help by adding these appointments to your calendar, too. Offer gentle reminders and a ride to the appointment, if needed.

Investigate support groups. Isolation is common with paranoid schizophrenia. The disorder causes such severe delusions that your loved one may not be social. Finding a support group can help.

Acknowledge their symptoms and perceptions. Though you might not understand your loved one’s symptoms, it’s important to acknowledge what they’re going through. Keep in mind that symptoms you can’t see or experience are indeed very real to them. Mocking your loved one or talking down to them will only increase isolation.

Offer unconditional respect and support. Perhaps the most important thing you can offer as a caregiver is respect and support, no matter what your loved one is going through. Remember that symptoms of schizophrenia can fluctuate. Treatment can take time, but it can also be successful.

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