Paranoid schizophrenia is the most common form – accounting for more than 50% of cases. This form of the disease is often late-onset and the negative symptoms appear slowly, so it is considered to have a more favorable prognosis than the remaining clinical forms.
More than 50% of patients with schizophrenia are paranoid
What is paranoid schizophrenia?
Paranoid schizophrenia (code F20.0) is one of the clinical forms of differential mental illness. The disease is divided into 6 clinical categories based on the presentation and prominent symptoms during the evaluation period. In which, paranoid form is the most common form, accounting for more than 50% of total schizophrenia patients.
As the name suggests, this form of the disease is characterized by delusions and hallucinations (paranoid means paranoia). Besides, the patient also has other manifestations of schizophrenia such as blunted emotions, depersonalization, misperception of reality, resounding thoughts, etc., but not as obvious as other diseases. .
Paranoid schizophrenia presents quite similar to paranoid personality disorder and paranoid disorder. However, this disorder has more severe symptoms and a worse prognosis than the mental disorders mentioned above. Compared with other diseases, the paranoid form has a better prognosis, the disease can be partially or completely remission, but there are also cases of chronic progression, lasting for life.
Recognizing paranoid schizophrenia
Paranoid schizophrenia is characterized by delusions and hallucinations (usually vocal hallucinations). In addition, patients also experience other symptoms but are often not obvious. Paranoid form has a later onset than other forms of disease, so it is considered to have a better prognosis and many patients still retain social functions to lead an independent life.
Signs of paranoid schizophrenia:
- Delusions are the most prominent symptom of the paranoid body. Among them, the most common are persecutory delusions, and delusions of control and control.
- Persecution delusion is a condition in which the patient has a belief that he or she is being targeted by an organization or individual and will be tortured, poisoned and killed in the future.
- Delusion of being controlled is the belief that one is being controlled by a certain force through special means.
- Some patients may also develop association delusions – the person believes that songs, comments, information on television, books and newspapers are implying something. Patients always try to connect this information to decipher the hidden meaning inside.
- A small number of people have bizarre and eccentric delusions.
- In addition to delusions, paranoid patients also experience hallucinations – most commonly vocal hallucinations. The audio is a commentary on the patient’s behavior. Sometimes the content is commands, threats, or words that are relevant to the patient.
- Other types of hallucinations such as olfactory hallucinations, visual illusions, taste hallucinations, etc. can sometimes appear but are quite rare.
- The patient is dominated by delusions and hallucinations that lead to difficulty concentrating, being wary of those around him, and sometimes violent behavior (especially with the patient thinking they will kill themselves). .
- The patient has mild emotions inappropriate to the situation such as doubt, anger, irritation, fear, etc.
- People with paranoid schizophrenia also experience a number of other symptoms such as reverberating thinking (hearing one’s own thoughts/thoughts such as hearing sounds from outside), forced thinking (sickness). the patient believes that his or her thoughts are imposed by external factors), the thinking is stolen (the patient believes that the people around him can hear and fully understand what he is thinking)
- Misperception of reality is also a common group of symptoms in the paranoid body. This condition is characterized by feelings of detachment from the body, a feeling of being outside observing one’s own life (depersonalization).
- Paranoid patients also have negative symptoms such as blunted emotions, poor language, and lack of will but not as profound as other forms of the disease. In particular, the negative symptoms in this form of the disease appear quite late – different from juvenile schizophrenia.
The severity of symptoms will vary from patient to patient. However, most people with paranoid schizophrenia have a slower progression and a better prognosis than other forms of the disease.
Causes of paranoid schizophrenia
The cause of schizophrenia is unknown. In addition, experts have not found out the specific pathogenesis and etiology of each disease form – including paranoid bodies.
Genetics and abnormalities in brain structure have been identified in association with paranoid schizophrenia
Currently, experts support the hypothesis that schizophrenia in general and paranoid schizophrenia in particular are related to genetics in combination with other exogenous factors.
Genetics: The role of genetics in the pathogenesis of schizophrenia is clear. The risk of developing this condition increases significantly for people with a family history of the disease. Many experts believe that genetic defects are the cause of brain abnormalities that lead to disturbances in perception, thinking and emotions. However, this hypothesis is only confirmed when the human genome map is completely decoded and experts identify the specific gene.
Abnormalities in brain structure: Biological and biochemical studies show that most patients with schizophrenia have enlarged ventricles, cortical atrophy, decreased hippocampal size, and thalamus. , abnormalities in cell structure in the prefrontal region, disorders of dopamine metabolism and abnormalities of the glutamate transmission system.
Other factors: Experts have found that schizophrenia in general and paranoids in particular are associated with factors such as pregnancy, malnutrition, obstetric complications and traumatic events. However, there are also many cases of spontaneous disease without sudden trauma or chronic stress.
In general, the etiology and pathogenesis of schizophrenia are still unclear. However, up to now, it is possible to confirm the role of genetics. Most genetic disorders are difficult to treat, and tend to be persistent and chronic. Therefore, schizophrenia is one of the severe psychotic disorders, the prognosis is not favorable and the patient often requires lifelong consolidation treatment.
Is paranoid schizophrenia dangerous?
All cases of schizophrenia should be treated as soon as possible. Without timely intervention, the disease often progresses gradually over time, tends to be chronic and persistent. Most patients have positive symptoms first (hallucinations, paranoia, dystonia), then gradually decrease and be replaced by negative symptoms (poor language, impaired thinking, lack of will, blunted emotions).
Negative symptoms are more difficult to recognize than positive symptoms, but the prognosis is poor because there is no treatment. Meanwhile, positive symptoms often have a strong onset, but most of them respond well to drugs.
Paranoid schizophrenia has a later onset than other forms of illness, characterized by positive symptoms such as hallucinations and delusions. Negative symptoms in this form of the disease appear quite late and are not obvious. Therefore, according to experts’ assessment, the paranoid form has a better prognosis than other diseases.
With active treatment, the patient can maintain an independent life and regain function. According to statistics, about 22% of patients have only 1 disease period and completely recover after that. Some groups of patients have many relapses, but between attacks are usually stable or have mild symptoms. The remaining cases relapsed frequently, between episodes showed signs of mental deficits and difficulties to maintain life.
In general, schizophrenia has a very diverse prognosis, and the paranoid form has the most favorable prognosis. Therefore, the family should encourage the patient to have early examination and treatment. In addition to active treatment, the family also needs to monitor the patient during consolidation treatment to prevent recurrence. Discontinuation of drug use is the main cause of recurrent disease and high risk of treatment resistance.
If left untreated, the patient is more likely to abuse alcohol, smoke, and use drugs
Patients with schizophrenia in general and the paranoid body in particular, who are not treated, will have an increased risk of abuse of alcohol, tobacco, and stimulants. The person is unable to maintain work or school and has many relationship problems. Those who do not have the support of the family will become homeless and be drawn to participate in social evils.
For these reasons, prompt examination and treatment for paranoid schizophrenia is essential. Although the possibility of cure is not high, paranoid patients can live independently if treated aggressively.
Diagnosis of paranoid schizophrenia
Paranoid schizophrenia is diagnosed based on clinical presentation. In addition, the doctor may also ask the patient to perform psychological testing to support the diagnosis and do some laboratory tests to rule out the possibility.
As mentioned, paranoid schizophrenia is characterized by delusions and hallucinations. Accompanying symptoms may be vocal thinking, stolen thinking, forced thinking, misperception of reality, and depersonalization. Some cases have negative symptoms, but all are characterized by a late onset and not as profound as other forms of the disease – especially juvenile schizophrenia.
In addition, the doctor will also rely on family history and the time of disease onset to diagnose the disease and the type of disease. This disease will be differentially diagnosed with neurasthenia, paranoid personality disorder, paranoid disorder, mood disorder with psychosis, acute stress disorder, etc.
Treatment of paranoid schizophrenia
Similar to other forms of the disease, paranoid schizophrenia is treated primarily with chemotherapy. In addition, psychotherapy, electric shock and rehabilitation also play an important role in controlling and preventing disease recurrence.
Treatments for paranoid schizophrenia:
1. Pharmacotherapy
Drug use is an effective therapy in the treatment of schizophrenia. Depending on the type of disease, the doctor will prescribe the appropriate drug and dose. Currently, the drug can only improve positive symptoms, almost no effect on negative symptoms. In addition, using the drug can also control some other accompanying symptoms such as mood disorders, insomnia, etc.
Using medication can reduce symptoms of delusions, hallucinations and some of the accompanying symptoms
Medications used in patients with paranoid schizophrenia:
- Antipsychotics: Antipsychotics are an important class of drugs in the treatment of paranoid schizophrenia and other disorders. The drug is used in a loading dose for 4-6 weeks, then switched to a consolidation dose.
- Currently, some antipsychotic drugs such as Olanzapine can also improve negative symptoms after 6-12 months of use.
- Antidepressants: Antidepressants are used if the patient has a depressed mood, pessimism, loss of interest and interest in things around. This class of drugs helps elevate mood and improve some physical symptoms. However, in the early stages, antidepressants can increase suicidal behavior by triggering intense hallucinations and delusions.
- Other drugs: In addition, patients with paranoid schizophrenia can also be prescribed anti-Parkinson’s drugs, mood-regulating drugs, etc. Nerve tonics, vitamins and minerals can also be used. to improve health and reduce related physical symptoms.
Patients with paranoid schizophrenia are usually prescribed Aminazin or Haloperidol. Initially, patients will be treated with injections and then switched to oral medications.
For mentally ill patients who refuse to take daily medication, long-acting neuroleptics may be considered. In addition, it should be combined with raising awareness of the family and the patient so that the patient can actively reinforce treatment. In fact, after only about 2 years of stopping the drug, the chance of relapse is up to 90%. Meanwhile, the rate of patients relapsing on drug consolidation treatment is very low.
2. Electric shock therapy
Electroconvulsive therapy is rarely indicated in paranoid schizophrenia. However, this therapy will still be considered in cases of resistance to treatment, patients are in a state of intense agitation and cases of suicidal behavior. In general, electroconvulsive therapy works quite well in these cases.
Today, anesthetic techniques have been improved, so the risks and side effects of electric shock therapy are also significantly reduced. After the patient is stabilized, the doctor will consider using drugs for consolidation treatment.
3. Psychosocial therapy
Previously, psychotherapy has not been interested in the treatment of schizophrenia in general and paranoid schizophrenia in particular. However, now doctors often encourage patients to combine the use of drugs with psychotherapy to restore good social functions.
Psychosocial therapy plays an important role in the rehabilitation of patients
Psychotherapy helps patients release emotions, learn to deal with conflicts in life, and help patients change inappropriate behaviors and emotions. When performing this therapy, the specialist will also rationally explain and raise the patient’s awareness of the role of consolidation therapy. In addition to individual therapy, group and family psychotherapy also plays a significant role in the rehabilitation of patients.
In addition, occupational therapy and social re-adaptation are also considered for patients with paranoid schizophrenia. This therapy helps patients recover their work function, study, integrate well with the community and take initiative in life. Combining medication and psycho-social therapy will help patients recover well, can limit the risk of disease recurrence and stabilize long-term life.
Paranoid schizophrenia is the most common form with a favorable prognosis. If diagnosed and treated early, patients can stabilize their lives and are likely to still be able to study and work as usual. In addition to the patient’s efforts, the family needs to support the patient to have a healthy living environment, learn to love, share and have clear life goals.
