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Paranoid schizophrenia is one of the most frequently diagnosed subtypes of this challenging disorder. It is characterized by the presence of auditory hallucinations and / or delusions.
Individuals with paranoid schizophrenia usually have a better overall prognosis than other subtypes. This may be due to the fact that their cognitive, behavioral, and emotional functioning is relatively intact.
Paranoid schizophrenics do, however, have prominent delusions and/or frequently experience auditory hallucinations. These psychotic symptoms, unfortunately, can wreak havoc in their ability to function in the world.
The delusions of a paranoid schizophrenic typically revolve around a specific theme. While they are often paranoid or persecutory (e.g. believing someone is attacking or conspiring against them) in nature, other themes may also be present. For example, paranoid schizophrenics often have grandiose delusions (e.g. believing that they are God, a powerful political figure, or someone with special powers). Another fairly common delusional belief is that everyone can hear their thoughts (known as “thought broadcasting”) or that some external person or thing is controlling the thoughts they are thinking or putting thoughts into their head (known as “thought insertion”).
Auditory hallucinations – which are frequently related to the delusional content – almost always involve hearing one or more voices. The voices may be carrying on a conversation or constantly commenting on the person’s activities or behaviors. They may warn the person that danger is imminent or instruct the person to carry out a specific behavior. The latter can be detrimental or even dangerous if the command is to stop taking medication, commit suicide, or harm someone else, for example.
Command hallucinations are often very compelling and difficult for the person to resist. While many individuals with schizophrenia do end up committing suicide due to the despair associated with the illness, a suicide attempt may also be due to command hallucinations or persecutory delusions during a psychotic episode.
Individuals with this type of schizophrenia may be condescending, argumentative, unusually formal, or very intense when they interact with others. Hostility, anxiety, and the tendency to be aloof are also not uncommon traits in paranoid schizophrenics. Violent behavior, which is relatively uncommon in schizophrenia, may occur if anger is intertwined with grandiose and persecutory delusions.
In many cases, paranoid schizophrenia responds fairly well to antipsychotic medication. However, they may discontinue their medication due to delusional beliefs (e.g. that the medication is poisonous and part of a conspiracy to harm them) or persistent command hallucinations telling them to stop taking the medication. They may also stop taking it due to intolerable side effects. Unfortunately, the delusions and hallucinations often return or become much more pronounced at some point if the medication is discontinued.
Hospitalization is often necessary – particularly at the onset - if the patient has become dangerously psychotic, and at various points in time. Inpatient treatment is crucial if symptoms become too serious to manage in an outpatient setting.
Once stable, other treatment may be provided including individual or group therapy, family therapy, skills or vocational training, and other types of psychosocial interventions.
Compared to other types of schizophrenia, paranoid schizophrenia often develops at a slightly later age. Many people with this particular subtype are able to function reasonably well, working and living on their own – with proper treatment. This is especially true when compared to those with disorganized or catatonic schizophrenia.
Photo by Marco Castellani
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