Schizophrenia is one of the most complex and mysterious mental disorders. Scientists have been studying it for centuries but have never understood exactly why it occurs and whether it can cure it forever. It occurs in about one person out of 100. At the same time, the most common form of the pathology is paranoid schizophrenia. This article will discuss its main features, causes, symptoms, and treatment methods.
Paranoid schizophrenia (ICD 10 code F20) is also called paranoid schizophrenia. However, this is more of a household name than a medical one. This pathology is necessarily accompanied by delirium and hallucinations. It is primarily characterized by delusional disorders, which appear in various forms.
Because of this disease, the person cannot adequately assess the surrounding reality, loses touch with reality, and retains the ability to think. During remission, he can lead an almost everyday life.
Paranoid schizophrenia is diagnosed in about 1% of people. The first signs usually become apparent at the age of 30. However, other types of schizophrenia, such as mild-to-progressive, develop later. In either case, comorbid symptoms may be present for a long time. At the same time, people do not pay attention to them until the first attack, that is, the moment when it is impossible not to notice the “weirdness” in the person’s behaviour.
According to statistics, 24 million cases of schizophrenia are diagnosed annually globally. Approximately 85-87% of them are patients with paranoid form. Often it is diagnosed in men. Almost all of the patients have pronounced symptoms. Negative symptoms are present in 96%, delusions in 93%, chronic signs in 67%, verbal hallucinations in 59% of patients, and catatonic syndrome in 13% of men and 2% of women.
The leading cause of paranoid schizophrenia is a functional disorder of the brain. However, many factors can provoke it. One of the main ones that scientists usually cite is genetics. Put, having a family history of mental illness is more likely to develop schizophrenia.
Another factor is related to the hormone dopamine. Violation of its production causes a breakdown in some brain regions, which causes delirium and hallucinations.
Physicians also name the risks that can hypothetically provoke the symptoms of paranoid schizophrenia:
- Infectious diseases in the pregnant woman;
- Starvation during pregnancy;
- Constant stress and depression;
- Psychological childhood trauma;
- Drug and alcohol abuse;
- Head trauma, including childbirth.
These factors do not always lead to schizophrenia. Still, if there is a genetic predisposition when a person has relatives with similar diagnoses in the family, all risks should be excluded, especially alcohol and drugs.
The symptoms of paranoid schizophrenia are as varied as any other type. Its stages can be episodic and chronic. Remission can be complete and incomplete. Sometimes the illness recedes, but in other cases, it develops gradually, leading to the disintegration of personality and consciousness.
The primary symptoms of any paranoid schizophrenia are:
- Delusions of persecution (criminal, sexual, etc.), jealousy, exposure, delusions of grandeur or particular purpose;
- Hallucinations are auditory, verbal, and tactile (less often visual);
- Seizures of synaptopathy – oppressive sensations on the body’s surface or in internal organs;
- Depersonalization – a psychopathological disorder of self-perception;
- Affective disorders – bipolar, depressive, inadequate emotions, etc.;
- Decreased volitional qualities, lack of initiative, and interest in anything;
- Cognitive disorders – memory impairment and problems with articulating thoughts.
The form and stage determine symptomatology. At first, primary symptoms are observed, making it difficult to suspect the disease. Then delusions and hallucinations appear. After that, delusions become fantastical. In the final stage of the disease, the personality is destroyed.
The first signs
In paranoid schizophrenia, positive symptoms are more common than negative ones. It means that delirium, hallucinations, and thought disorders predominate, rather than apathy and lethargy, as with other types of pathology before seizures. At the outset, the patient has delusions and thoughts. He may say that he expects something terrible, scary, or destructive. He cannot calm down until, for example, he has counted to 100.
Along with such thoughts, hypochondria worries. The person is very concerned about his health and is afraid of getting sick or catching a disease. Senestopathies often occur when there are unusual and unpleasant sensations in the body: a hoop squeezing the head, stabbing pain in the heart as if a needle were stuck in it, etc.
In the initial stage of paranoid schizophrenia, the person’s sleep is disturbed, which affects his daytime state. His emotional background is characterized by scantiness and inflexibility, and his emotions are dulled. He seems to be a rigid, uninterested individual who doesn’t care about the world around him. At the same time, aggression toward relatives is possible. The circle of communication is narrowed, to establish relations with people becomes difficult.
Symptomatology also depends on each case. Some patients, though few, can be violent at the initial stage. They have sadistic tendencies. They bully animals, especially cats and dogs.
Almost all patients develop fear and anxiety. Because of this, the patient turns into a confused person who cannot fully navigate the new situation. He has difficulty making decisions.
Sometimes these signs appear 10 or even 25 years after any injury.
This stage can last for several years. Gradually, the number of symptoms increases as the pathology continues to progress.
The paranoia syndrome is the next stage of paranoid schizophrenia, which is characterized by the presence of a mild form of systematized delirium. It means that the patient can interpret it well and explain it. Typical delusions:
- Reformatory – the patient is convinced that he has invented or created something ingenious that can change the structure of the world.
- Erotic – belief in the existence of a maniac who constantly stalks.
- A belief in one’s selectness, a high degree of origin, belonging to a royal family or representatives of “blue blood.”
- Querulous – the nagging, filing complaints, and the constant struggle for their rights.
In paranoia syndrome, delirium is structured and systematized. The patient can logically justify arguments and provide evidence for his theories. Hallucinations or automatisms do not torment him, so he does not consider himself sick. It exacerbates the situation, as he will encounter people’s incomprehension. It will lead to depression and further development of the disease.
Stages of acceptance of delusional thought:
- Expectation is inner anxiety, a feeling that something unbelievable should happen.
- Illumination – suddenly, the person understands where his fear comes from, and he begins to see everything. Differently, he looks at the world with “new eyes.”
- Systematization – everything adds into one picture, which the patient can rationally explain and describe.
If the disease is detected at this stage, a “paranoia schizophrenia” diagnosis will be made.
The third stage of paranoid schizophrenia is the Kandinsky-Clerambaud syndrome, named after the Russian psychiatrist and French physician. It is characterized by the development of several types of automatisms in the patient:
Ideatorial (associative). The patient feels that someone is putting thoughts into his head. He also suspects that outsiders hear his thought process. Mentalism is observed as a symptom of an influx of thoughts and memories. It is common for the patient to believe that extraneous forces are forcing them to remember certain events.
Sensory (Senestopathic). At this stage, automatisms concern bodily sensations. It seems to the person that they are caused from outside. Cold, warmth, or excitement are sensed, the sources of which are not, in fact, there.
Motor (kinesthetic). These automatisms are associated with physical activity. The patient now believes that someone else performs all their actions, not them. It is especially true of speech-motor movements.
Wizards, aliens, hypnotists, etc., may act as an outside force that forces the person to think, feel and act.
At this stage, hallucinations, if any, are auditory. The patient hears swearing in his direction, comments, and commands.
In Kandinsky-Clerambaut syndrome, pseudo-hallucinations are possible when patients distinguish hallucinations from natural objects. Both familiar and unfamiliar people, pictures, voices, etc., appear in the visions.
Paraphrenia is the fourth stage of paranoid schizophrenia. It begins to form as early as the stage of Kandinsky-Clerambaut syndrome when patients feel intense anxiety. Subsequently, however, the symptomatology becomes more pronounced as far as the patient’s perception by others is concerned.
At first, the person’s pseudo-hallucinations and hallucinations are aggressive. He is afraid of them and is constantly in a state of anxiety. But later, they become benevolent, and the patient feels elated. He begins to say that he has superpowers and can influence people and the world, such as reading the thoughts of others.
Unusual processes in memory begin. In particular, the person suddenly recalls a critical event that either did not happen or slightly in how they are presented to him now.
Further development of the pathology is accompanied by the formation of fantastic and absurd delusions. The patient may feel he is a messiah and believe that the world has divided into two hostile camps – his supporters and opponents. The following signs are also observed:
- False recognitions. Strangers seem essential as if they are seriously involved in the patient’s life.
- A feeling of euphoria, high spirits, and a desire to move and do great things “for the world’s salvation.”
- Confabulation – the process of filling the memory with false memories, which the patient cannot distinguish from true ones
Functional studies reveal that the brain begins to grossly disrupt metabolic processes and excessive neuronal activity in the subcortex.
Paraphrenia may be a stage of paranoid schizophrenia or a symptom of another disorder, such as bipolar or schizoaffective. In all cases, it takes two forms, acute when symptoms develop rapidly and are well controlled, and chronic, which can last continuously for decades.
In schizophrenic disorder, there is the ongoing destruction of personality. As a rule, it can be noticed during the remission period when the main signs recede. In these cases, doctors can assess how badly the core of the personality has been affected.
Schizophrenic defects are discussed when any of the four signs are observed:
- Emotional coldness.
- Decreased physical activity.
- Complete lack of motivation.
- Constant silence.
- Slow expressive facial expressions.
- Indifferent attitude to their appearance.
Often there are symptoms of schizophasia, in which the person speaks quite distinctly, but the speech does not carry any semantic load. The words used by the patient are random. The condition is similar to delirium, but classical delirium may be absent at this stage. At the last stage, may change the diagnosis from paranoid schizophrenia to residual schizophrenia (ICD 10 code – F20.5).
Symptoms in women
There are no serious differences between the signs of paranoid schizophrenia in women and men. However, family, health, and appearance always come first for the former, so delusions are related. Concern for such problems also determines the character of hallucinations.
Women fear they will harm the child, that she is ageing quickly, etc. According to her, there are ill-wishers around. Sometimes they give specific names of people who exist, such as neighbours, colleagues, or relatives.
Symptoms in men
In men, paranoid schizophrenia manifests as other delusions. As a rule, they are related to the wife’s lovers, espionage, enemies, etc. These are the main differences. That is, they consist only of delusions and hallucinations. As for the stages and risk of schizophrenic defects, they are the same in women and men.
Delusional and hallucinatory illness
Several researchers, including L.M. Elgazina and E.D. Sokolova, distinguish two variants of a course of paranoid schizophrenia – hallucinatory (or pseudohallucinatory) and delusional. Hallucinations characterize the first but few delusions and an absence of automatisms. In the second case, on the contrary, delirium and automatisms are of concern.
At the same time, acute and chronic development of the pathology is possible when the symptomatology develops rapidly and slowly, respectively. Anxiety, fear, confusion, unsystematic delirium, and all kinds of automatisms are characteristic of the acute form.
Less vivid symptoms accompany the chronic or continuously flowing variety of the disease. It complicates diagnosis because outwardly, the person may for a long time not differ in any way from healthy people. Only after several years do the delusions become more complicated. They include more and more characters, both real and fictional.
In the hallucinatory form, primarily auditory and verbal hallucinations are observed. If these occur, the patient becomes dangerous, primarily to himself but sometimes to others.
There are several signs by which relatives of a sick person can suspect schizophrenia:
- He isolates himself from society, sees friends less often, becomes increasingly withdrawn, and does not share his worries with family members.
- The person drops out of school and stops showing up at the university or work.
- Gradually he begins to take less care of himself, does not shave, rarely washes, and does not follow the state of his clothes.
- The patient becomes obsessed with all ideas and becomes interested in the mystic and religious doctrines, studies the paranormal, etc.
- The person begins to hear less and constantly interrogates or does not respond to questions.
The difficulty is that the person does not think they are ill, so persuading them to be examined is difficult. Often it can be done when the symptoms become more pronounced.
Schizophrenia itself is more accessible to detect than a particular type of schizophrenia. It takes more than one examination. The patient must almost always be under the supervision of specialists and relatives. Treatment does not stop even during periods of remission. It is impossible to cure schizophrenia completely, as well as to learn its true causes.
Diagnosis is made with the help of the following methods:
- Neuro testing is a set of techniques and tests to study mental processes.
- Neurophysiological tests, e.g., recordings of eyeball movements to certain stimuli.
- Pathopsychological research – consultations with a psychiatrist, psychotherapist, and psychologist.
You will also have to take tests, study your relatives’ history of mental disorders, and consult other specialists if you have specific somatic pathologies.
It will take time for differential diagnosis because it is essential to distinguish the paranoid form of schizophrenia from its other varieties. Delusion, voices, and unrealistic beliefs are decisive symptoms to differentiate the diagnosis.
Most likely, the patient will have to be admitted to a clinic. Sometimes, it is necessary to hospitalize the patient urgently when he is a danger to others and himself.
Treatment of paranoid schizophrenia is a complex process that does not stop even during remissions. After all the symptoms have subsided, the diagnosis remains. It is not sure that they will ever appear, but the person remains at risk forever.
Depending on the stage of the pathology, may prescribe the following therapies:
- Medication – the use of psychotropic substances, neuroleptics, and antidepressants. In severe cases, insulin comatose treatment is prescribed;
- Psychotherapeutic – regular sessions with a psychotherapist, not only the patient but his relatives, who will have to learn how to interact with people with schizophrenia appropriately;
- Electroconvulsive. These are used in exceptional cases when the patient is immune to medications or has contraindications. The therapy is based on exposing the person to current until convulsions occur. The convulsions are believed to allow you to run specific neurochemical processes in the brain and turn on short-term memory.
During the remission period, supportive therapy is given, which includes taking medication, avoiding alcohol, and having frequent conversations with a psychologist. It helps to prevent an attack and improve the patient’s quality of life. Sometimes it is possible to get rid of all symptoms forever or for many years.
In general, with schizophrenia, it is essential to begin treatment as early as possible. Then the prognosis will be relatively favourable. The following is another pattern: the more severe the impact on the personality and psyche of the disease, the younger the person who first notices it.