Paranoid schizophrenia is characterized by predominantly positive symptoms of schizophrenia, including delusions and hallucinations. These debilitating symptoms blur the line between what is real and what isn’t, making it difficult for the person to lead a typical life.
Schizophrenia occurs in about 1.1 percent of the population, while paranoid schizophrenia is considered the most common subtype of this chronic disorder.1 The average age of onset is late adolescence to early adulthood, usually between the ages of 18 to 30. It is highly unusual for schizophrenia to be diagnosed after age 45 or before age 16. Onset in males typically occurs earlier in life than females.2
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Early symptoms of schizophrenia may seem rather ordinary and could be explained by a number of other factors. This includes socializing less often with friends, trouble sleeping, irritability, or a drop in grades.3 During the onset of schizophrenia — otherwise known as the prodromal phase — negative symptoms mount. These negative symptoms might include an increasing lack of motivation, decreasing inability to pay attention, or social isolation.4
Warning signs that psychosis may be imminent include:5
- Seeing, hearing, or tasting things that others do not.
- Suspiciousness and a general fear of others’ intentions.
- Persistent, unusual thoughts or beliefs.
- Difficulty thinking clearly.
- Withdrawing from family or friends.
- A significant decline in self-care.
Displaying all these symptoms doesn’t necessarily indicate the presence of schizophrenia, but these are indications that a mental health evaluation is advised. If the person is experiencing the onset of schizophrenia, early intervention is the best chance of a positive outcome. 6
The positive symptoms of schizophrenia—things like hallucinations and delusions—are less likely to go unnoticed. After the prodromal phase, the patient enters the active phase of schizophrenia, during which they experience debilitating thoughts and perceptual distortions. They may experience impaired motor or cognitive functions, including disorganized speech and disorganized or catatonic behavior.
The paranoia in paranoid schizophrenia stems from delusions—firmly held beliefs that persist despite evidence to the contrary — and hallucinations — seeing or hearing things that others do not. Both of these experiences can be persecutory or threatening in nature. A patient may hear a voice or voices in their head that they do not recognize as their own thoughts or internal voice. These voices can be demeaning or hostile, driving a person to do things they would not do otherwise.
Odd, untypical behavior flows as a result of these delusions and hallucinations. Someone with schizophrenia may be convinced that the government is surveilling them in an attempt to harm them in some way. This can lead to boarding up their home, blacking out windows, putting objects in front of doors to impede entry, and otherwise blocking or removing items they believe contain listening devices or cameras. They may stay up late at night to catch culprits.
Someone with active paranoid schizophrenia is consumed by their delusions or hallucinations. The vast majority of their energy and attention is focused on keeping to and protecting their falsely held beliefs or perceptual distortions.7
The most common time a person seeks initial treatment for schizophrenia is during the active phase, when psychosis often makes a dramatic disruption in one’s life and the lives of those around them.
After the active phase, the patient enters the residual phase of schizophrenia. Much like the residual subtype, hallucinations and delusions attenuate at this point (usually with the help of antipsychotic medication and other forms of treatment), and the patient experiences primarily negative symptoms.
When schizophrenia is diagnosed, antipsychotic medication is most typically prescribed. This can be given as a pill, a patch, or an injection. There are long-term injections that have been developed which could eliminate the problems of a patient not regularly taking their medication (called “medication noncompliance”). This is a common concern in schizophrenia because of the symptom of anosognosia. Anosognosia is the lack of insight and an unawareness of the presence of a disorder. Someone with schizophrenia may not recognize that their behavior, hallucinations, or delusions are unusual or unfounded. This can cause a person to stop taking antipsychotic medication, stop participating in therapy, or both, which can result in a relapse into active phase psychosis.
While antipsychotic medication is effective in treating the positive symptoms of schizophrenia, it does not address negative symptoms.8 In addition, these drugs can have unwanted side effects including weight gain, drowsiness, restlessness, nausea, vomiting, low blood pressure, dry mouth, and lowered white blood cell count. They can also lead to the development of movement disorders, like tremors and tics, but these are more common with older generation antipsychotics (typicals), not newer generation antipsychotics (atypicals).
Psychotherapy also plays an important role in the treatment of schizophrenia. Cognitive behavioral therapy has been shown to help patients develop and retain social skills, alleviate comorbid anxiety and depression symptoms, cope with trauma in their past, improve relationships with family and friends, and support occupational recovery.9
Team care known as Coordinated Specialty Care (CSC) has shown promise in the treatment of schizophrenia. This utilizes a team of mental health professionals to perform case management, family support and education, medication management, education, and employment support, as well as provide peer support.10
Signs that immediate medical attention is needed
If the patient is a danger to himself or others and is unwilling to seek treatment, they can be involuntarily committed to a hospital and held for a period of evaluation usually lasting three to seven days. A court order is required for involuntary commitment to be extended.11
Film and news media have characterized schizophrenia as a violent condition, however, the majority of people with schizophrenia are not violent. The majority of violent crime is committed by individuals who do not suffer from this disorder. The risk of violence in schizophrenia drops dramatically when treatment is in place.12
Schizophrenia is associated with a higher risk of suicide.If the patient is suicidal contact the National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
- National Institute of Mental Health. Schizophrenia. Available at: www.nimh.nih.gov/health/statistics/prevalence/schizophrenia.shtml Last updated May 2018. Accessed May 13, 2019.
- National Institute of Mental Health. What is Schizophrenia? Available at: www.nimh.nih.gov/health/publications/schizophrenia/index.shtml. Accessed May 13, 2019.
- Nitin Gogtay, Nora S. Vyas, Renee Testa, Stephen J. Wood, Christos Pantelis, Age of Onset of Schizophrenia: Perspectives From Structural Neuroimaging Studies, Schizophrenia Bulletin, Volume 37, Issue 3, May 2011, Pages 504–513, https://doi.org/10.1093/schbul/sbr030.
- Expert Rev Neurother. 2010;10(8):1347–1359. doi:10.1586/ern.10.93.
- NAMI Early Psychosis. What’s Going On and What You Can Do. Available at: www.nami.org/getattachment/Learn-More/Mental-Health-Conditions/Early-Psychosis-and-Psychosis/NAMI-Early-Psychosis_What-s-Going-On.pdf.
- NAMI Early Psychosis. Available at: www.nami.org/earlypsychosis Accessed May 13, 2019.
- Center for Addiction and Mental Health. Schizophrenia Information Guide. Available at: https://www.camh.ca/-/media/files/guides-and-publications/schizophrenia-guide-en.pdf Accessed May 13, 2019.
- King DJ. Atypical antipsychotics and the negative symptoms of schizophrenia. Advances in Psychiatric Treatment. 1998;4(1):53-61. doi:10.1192/apt.4.1.53.
- Morrison AK. Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont). 2009;6(12):32–39.
- NAMI. Early Psychosis . Available at: https://www.nami.org/earlypsychosis Access May 13, 2019.
- NAMI. Getting Treatment During a Crisis. Available at: www.nami.org/Learn-More/Treatment/Getting-Treatment-During-a-Crisis. Accessed May 13, 2019.
- Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: Systematic review of risk factors. British Journal of Psychiatry. 2005;187(1):9-20. doi:10.1192/bjp.187.1.9.
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