Generality
Paranoid schizophrenia is a mental disorder characterized by the significant manifestation of delusions and auditory hallucinations . In practice, the person suffering from it loses contact with the reality that surrounds it ( psychosis ) and is unreasonably suspicious or distrustful of others, in a context of preserved or minimally reduced cognitive functions.
Symptoms of paranoid schizophrenia are often associated with behavioral disorders, changes in affectivity, disorganized thoughts or speeches, a polemical or superior attitude, manifestations of anger or violence. This results in a strong maladjustment and difficulty in carrying out daily activities and establishing social relationships.
The specific causes are still unknown, but it seems that the development of paranoid schizophrenia is multifactorial and depends significantly on a genetic component and a biological basis . This predisposing substrate makes the subject vulnerable to manifesting the disease, especially when psychosocial or environmental stress events occur.
Paranoid schizophrenia can be tackled with targeted treatments that allow the symptoms of the disease to be managed in the best way over time.
What's this
Paranoid schizophrenia is a chronic disease in which, for a period exceeding six months, a persistent dysfunction of thought (delusions) and perception (hallucinations) occurs. These symptoms lead to a strong maladjustment of the person and limit the normal occupational and social activities.
Causes
Currently, the causes of paranoid schizophrenia are not yet known, but the clinical picture is likely to depend on the combination of various factors . The latter seem to act on a biological substrate and a genetic component, which make the subject predisposed to the development of the disease.
Genetic risk factors
Regarding genetic susceptibility, the familiarity for schizophrenia is considered an important risk factor. In particular, the probability of developing the disease is greater among first-degree family members. The genes involved in schizophrenia are different and could be detected on chromosomes 6, 13 and 22; also the genes that codify for the dopamine receptor (DRD3) and for that of serotonin (5HT2a), could play a significant role in the onset of the disease.
Biological risk factors
In the context of multifactorial aetiology, paranoid schizophrenia appears to have a biological basis, as evidenced by:
- Alterations in the brain structure (eg enlargement of the cerebral ventricles, decrease in the anterior hippocampal caliber and in other brain regions of the brain);
- Modifications of neurotransmitters (in particular, there is an altered dopaminergic and glutamatergic activity).
Environmental and psychosocial factors
A greater risk of developing paranoid schizophrenia was found in subjects suffering from neurodevelopmental disorders, secondary to prenatal events (eg maternal infections and malnutrition during fetal development), perinatal (obstetric complications associated with hypoxia) and post-natal.
Environmental risks for paranoid schizophrenia include psychosocial factors, such as serious interpersonal misunderstandings, problems at work, difficulties in relations with family members, etc. There is no evidence, however, that paranoid schizophrenia is caused by poor parental attention.
Triggering and favoring events
The onset, remission and recurrence of paranoid schizophrenia symptoms may be preceded and favored by stressful events . These can be represented above all by biochemical conditions (such as the use of some narcotic substances or drugs), environmental (eg exposure to toxic agents or pollutants) or psychological (eg job loss, end of a romantic relationship, etc. .); however, these situations are not enough to cause the disorder alone.
Symptoms and Complications
In the paranoid subtype of schizophrenia, the most characteristic manifestations are:
- Delusions : they are fixed ideas and erroneous convictions, not corresponding to reality, despite the contrary evidence. This manifestation is subjective and expresses the modification of the experience of the individual who suffers in relation to the external environment. In paranoid schizophrenia, delusions are generally of a bizarre or persecutory nature .
People who experience delusional symptoms may believe that they are being followed, poisoned, exploited, infected, spied on, deceived or hindered in pursuit of long-term goals. The paranoid schizophrenic has the perception that nothing happens by chance and everything that happens has logic in relation to his life. In this case, the subject withdraws from a world he considers hostile.
In addition, patients with paranoid schizophrenia:
- may be concerned about the loyalty or trustworthiness of friends;
- they refer to disparate and disconnected things or events;
- they tend to read threatening meanings in favorable situations;
- they think they are victims of other people's malevolent actions;
- they show an excessive reactivity with respect to stimuli that are perceived as facing.
This last declination of paranoid schizophrenia can lead the patient to carry out aggressive and violent behaviors towards others.
- Hallucinations : the subject mistakenly perceives what is imaginary as real (note: hallucinations are defined as false and distorted perceptions, without object). In paranoid schizophrenia, acoustic (or auditory) hallucinations are the most frequent (for example, the patient hears voices) and, usually, these are related to the content of the paranoid delirium.
Usually, these symptoms do not lead to a serious deterioration or change in personality, but, in the context of paranoid schizophrenia, the manifestations can gradually worsen. Furthermore, from hallucinations and paranoid delusions, violent behavior or manifestations of anger, injurious thoughts and behaviors (eg suicide attempts) can result.
During periods of exacerbation of the disease, the patient may present other disorders. However, it should be noted that these symptoms may be absent during the paranoid schizophrenia episode, therefore they are not considered relevant in the same way as hallucinations and delusions.
These events include:
- Disorganized speech (incoherent or incomprehensible);
- Bizarre behavior (catatonia, agitation, inadequacy in conduct or appearance, sloppiness in clothing and personal hygiene);
- Flattened or inadequate affectivity (eg emotional distance).
Positive and negative symptoms of schizophrenia
Schizophrenia is often described in terms of "positive" and "negative" symptoms.
- Positive symptoms : they reflect an excess or distortion of the functions that normally occur in healthy people. Usually, these disorders respond well to drugs. Examples: delusions, disorganized thought and language, bizarre and inadequate motor behavior (including catatonia), hallucinations, etc.
- Negative symptoms : refer to a decrease or lack of normal emotions and behavior. The response of these deficits to drug therapy is often limited. Examples: little accentuated affectivity, inability to feel pleasure (anhedonia) and lack of motivation (abulia).
Over time, paranoid schizophrenia can cause a loss of contact with reality (psychosis) and the processing of unusual thoughts, which can lead the subject to isolation or asociality (lack of interest in human relations).
Compared to other forms of schizophrenia, the onset is later and patients have less cognitive impairment and reduced impairment in social and professional functioning.
Course
Paranoid schizophrenia is a chronic disease . The onset is late, but almost always acute.
The disease manifests itself with limited or continuous symptomatic periods. The duration of these episodes, in which exacerbations and remissions are easily identifiable, can vary.
In the late phase of paranoid schizophrenia, the presentation pattern of symptoms can stabilize and result in a total disability.
Diagnosis
The diagnosis of paranoid schizophrenia is clinical and is formulated by the psychiatrist specialist based on the following considerations:
- For a significant period of time, the characteristic behaviors and experiences of the disease must be manifested (one or more delusions and frequent auditory hallucinations).
- In the symptomatic periods of the disease, the patient presents symptoms, not to be considered relevant for the schizophrenia subtype:
- Disorganized speech;
- Disorganized or catatonic behavior;
- Flattened or inadequate affectivity.
To establish the diagnosis, the signs of the disorder must persist for at least 6 months .
During the evaluation, the psychiatrist must exclude that paranoid schizophrenia is the manifestation of:
- General medical conditions (such as, for example, metabolic disorders, systemic infections, syphilis, HIV infection, epilepsy or brain injury);
- Effect of the use of drugs or drugs;
- Mood disorders (such as major depression with psychotic manifestations).
To ascertain other possible organic causes that can produce similar psychoses, the doctor can indicate to the patient a neurological examination and the performance of blood chemistry or instrumental tests.
Treatment
The treatment of paranoid schizophrenia involves three main types of strategies:
- Drug therapy : prescribed for the purpose of controlling symptoms and preventing relapses of the disease.
- Psychotherapy : consists in providing the patient with clear and specific information on his disorder (eg symptoms, course, etc.), to help him manage the symptoms and decrease the social dysfunction that it involves.
- Social and professional rehabilitation : implemented to promote the social reintegration of people with schizophrenia, exploiting their educational and occupational skills.
Pharmacological therapy
The basis of the treatment of paranoid schizophrenia is the administration of an antipsychotic, which mainly suppresses the activity of the dopamine receptor and, sometimes, of serotonin.
The drugs used to treat paranoid schizophrenia include:
- First generation antipsychotics : this category includes the so-called neuroleptic drugs, useful in the treatment of "positive" symptoms of paranoid schizophrenia; they can also be useful in alleviating aggression. The side effects of these drugs are mainly on the extrapyramidal system (eg dyskinesia and parkinsonism).
- Second generation antipsychotics : they are able to improve negative symptoms (such as apathy, anti-sociability and poverty of thought) and present a lower risk of inducing extrapyramidal effects.
Psychotherapy
Psychotherapeutic interventions, such as cognitive-behavioral interventions, are an important complement to drug treatment, as they contribute to improving the prognosis and course of paranoid schizophrenia. This path is aimed at reducing social, cognitive and psychological difficulties. Thanks to psychotherapy, the patient is able to control delusions and auditory hallucinations.
Rehabilitation of occupational and social skills
Rehabilitation aims to restore normal occupational functions and facilitate social reintegration in patients suffering from paranoid schizophrenia, taking into account the complexity of the pathology and the specific individuality of the subject.
