Paranoid schizophrenia: definition, causes and treatment

Surely on more than one occasion you have heard someone say that they are paranoid or that they are paranoid. Sometimes the human mind is like an intriguing labyrinth, where the boundaries between reality and fantasy can become blurred.

Have you ever wondered what happens in the minds of those people? This is a paranoid disorder. That is why it is not unusual for us to use the term paranoid to designate a person who believes that someone is after him, that they want to harm him, that they are making fun of him or that they are going against him.

However, Academically speaking, the term paranoid or paranoid is something more than that. In this entry we are going to talk to you about a subtype of schizophrenia: paranoid.

Paranoid schizophrenia, a subtype of schizophrenia

The term schizophrenia first appeared at the beginning of the 20th century. It was the Swiss psychiatrist Eugene Bleuler who united the Greek terms Skhizein (Split) and Phen (Mind). With these dimensions he expressed the division or fragmentation of the mind that is observed in people with this diagnosis.

Currently, within the Diagnostic and Statistical Manual of Mental Disorders(DSM -V) there is a section where Schizophrenia is defined as a psychosis (loss of contact with reality) characterized by hallucinations (false perceptions), delusions (false beliefs), disorganized communication and behavior, appealing affect, cognitive deficits, and occupational and social dysfunction.

It also includes other psychotic disorders such as schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder, etc.

However, it should be noted that Schizophrenia, especially paranoid, was one of the schizophrenia subtypes that was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), but was eliminated from the fifth edition. The American Psychiatric Association (APA) chose this measure due to the complexity and lack of reliability in the diagnosis.

Diagnosis of paranoid schizophrenia

The diagnosis of a particular subtype of schizophrenia is based on the clinical picture that the patient presents and the predominance of symptoms. In this way it is determined in the DSM IVthat Paranoid schizophrenia is characterized by:

The presence of delusional ideas or auditory hallucinations. However, the person does not present deficiencies in the course of thought or affectivity. Fundamentally, delusions are of persecution, grandeur, or both, but delusions with other themes can also occur (e.g., jealousy, religiosity, or somatization).Delusional ideas can be multiple, but They are usually organized around a coherent theme. It is also common for hallucinations to be related to the content of the delusional theme.No disorganized languageneither catatonic behavior, nor flattened affectivity.

Although this type of mental disorder is characterized by the presence of hallucinations and delusions, not all patients experience significant cognitive impairment. It can affect a person’s cognitive functions in various ways.

Therefore, some people may maintain relatively normal functioning, while others may suffer from severe cognitive difficulties that significantly interfere with their daily functioning.

In addition to the aforementioned criteria, diagnoses in psychiatry often consider the duration of symptoms, the degree of interference in the individual’s life, and the exclusion of other disorders that could better explain the symptoms.

Symptoms associated with paranoid schizophrenia

Associated symptoms include anxiety, anger, withdrawal, and a tendency to argue. These may be present due to the nature of the delusions and hallucinations, which often involve persecution or perceived hostility.

According to him Yearbook of legal psychology, l The combination of delusional ideas of persecution and grandeur with reactions of anger can predispose one to violence.. However, aggression is more common in young men and in individuals with a history of violence, lack of therapeutic compliance, substance abuse, and impulsivity.

Besides, Persecutory themes can predispose the person to suicidal behavior. According to Spanish Acts of Psychiatry, andl 21.1% of patients presented self-stigma, which was associated with a higher prevalence of suicidal ideation in the last year, a higher total number of suicide attempts, a higher current suicidal risk, worse self-compassion, higher self-esteem and worse depression scores, higher prevalence of depression and greater hopelessness

The person may present an air of superiority and condescension. He may also present pomposity, dapperness, lack of naturalness or extreme vehemence in personal relationships. These distinctive characteristics may be more stable over time.

Causes of paranoid schizophrenia

From a neurostructural perspective, it has been observed alterations in the size of certain brain regions, such as the hippocampus, amygdala, and frontal lobe. These anomalies are related to the cognitive and emotional symptoms characteristic of this mental disorder.

On the other hand, neuromolecular abnormalities imply imbalances in the transmission of neurotransmitters, such as dopamine and serotonin, which play a crucial role in the perception and regulation of mood. This can contribute to the appearance of psychotic symptoms.

For its part, in another study published in the journal Frontiers in Psychology they suggest that After paranoid schizophrenia there would be a metarepresentational problem, due to a deficit in math theory.

However, the causes of paranoid-type schizophrenia are still not completely clear and there is controversy about it. Anyway, Yes, more reliable and adjusted risk and prognostic factors have been established.

Environmental risk factors

Some studies have found that the incidence of schizophrenia is higher in children born in late winter or early spring in some areas. Besides, The incidence of schizophrenia and other related disorders has been found to be higher in children growing up in an urban environment and in some ethnic minority groups.

Genetic risk factors

There is an important contribution of genetic factors when determining the risk of developing schizophrenia. In fact, a study published in the journal Molecular Neuroscience, Explain of the interaction of genes interleukin-6 and interleukin-10. Thus, predisposition confers a range of common and rare risk alleles. These alleles are also associated with other mental disorders, such as bipolar disorder, depression, and autism spectrum disorder.

Physiological risk factors

Complications of pregnancy and childbirth with hypoxia or lack of oxygen, combined with older paternal age, are associated with a higher risk of suffering from schizophrenia for the developing fetus. Furthermore, a study published in the journal Schizophrenia Researchhas observed that cognition in schizophrenia is associated with inflammatory markers and prolactin function.

Similarly, other adverse prenatal and perinatal situations, such as stress, infection, malnutrition, maternal diabetes, and other medical conditions, have also been associated with schizophrenia. However, the vast majority of children who have these risk factors do not develop schizophrenia.

Treatment of paranoid psychosis

Some studies suggest that The prognosis for paranoid type may be considerably better than for other types of schizophrenia.. In general, these people are usually capable of leading a life with a high degree of autonomy.

Paranoid psychosis is treated with a combination of medications, mainly neuroleptics, antipsychotics, anxiolytics and support through psychotherapy. In addition, It is necessary for the patient himself to get involved in aspects such as psychoeducation to facilitate adherence to treatment and for the person to understand the reason for their symptoms. In severe cases, hospitalization should be considered.

As we have seen, paranoid type schizophrenia has characteristics that differentiate it from the other subtypes. It is common to have delusional ideas of persecution, grandeur, or both. However, its differential diagnosis is complex, as is identifying the causes that give rise to it.

Finally, it is important to highlight that each individual is unique and the treatment must be adapted to their specific needs. Through comprehensive and continuous support, The quality of life of those who suffer from this mental illness can be improved.

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