Paranoid Schizophrenia: Symptoms, Treatments, and Causes

Schizophrenia is one of the most well-known psychotic disorders among most people, and one of the most socially stigmatized mental disorders throughout history. Although the existence of schizophrenia is currently considered to be a single diagnostic entity, the truth is that until a few years ago it was divided into several types. Among them is paranoid schizophrenia, which we are going to talk about in this article, explaining its associated symptoms, its treatments and its possible causes.

• Related article: "What is psychosis? Causes, symptoms and treatment"

Schizophrenia

Schizophrenia is a psychotic mental disorder characterized by the presence for at least six continuous months of symptoms in which hallucinations, delusions, language disturbances, catatonia, affective flattening or changes in mood, impoverished thinking or lack of motivation, at least one of the first three must appear.

These and other symptoms are usually grouped into two groups: positive symptoms, which involve the addition of some element to normative behavior (such as hallucinations, derailments in language, hallucinations or restlessness) and the negative ones or those that imply a decrease or deficit of the abilities and capacities of the subject (such as flattening affective, the

abulia or alogia or mental impoverishment).

But the presentation of symptoms is not the same for all patients with schizophrenia. In fact, different groups of people can be found who manifest similar symptoms to each other and whose alterations are very different from those of others, which is why different groups or types of schizophrenia were traditionally formed and why that even today (despite the fact that the different types of schizophrenia have been eliminated in the DSM, including the one that concerns us in this article) some authors believe that more than schizophrenia we should talk about psychotic spectrum disorders.

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Paranoid schizophrenia: main symptoms

Paranoid schizophrenia is perhaps the best known and prototypical type of schizophrenia of this disorder. It is considered as such that modality of schizophrenia characterized by a predominant presence of symptomatology positive, with mainly psychic symptoms in which auditory hallucinations and ideas appear delusional. The subject does not usually present other alterations common in other types of schizophrenia, such as catatonia, impoverishment of thought or disturbances of speech or movement.

Also, we are before the type of schizophrenia that causes the least cognitive impairment (generally there are no negative symptoms) and the best response to treatment usually has.

We generally find that the hallucinations of patients with this hearing disorder, often in the form of third-person voices that speak about the subject and tend to have pejorative and threatening content for the subject. These hallucinations and their content are usually of a persecutory nature., the patient feeling that something or someone intends to harm them and can trigger reactions of fear, anguish or aggressiveness in them (although contrary to According to popular belief, the possibility of unexpected aggression is relatively low and usually occurs in patients who do not follow treatment and high impulsiveness).

The subject tends to be delirious due to said hallucinations, forming a distorted narrative of reality based on said perceptions. The subject may elaborate the belief that he is being persecuted or possessed.. They can also appear delusions of grandeur or even of a messianic type, considering himself a divinity or someone with great powers or in possession of a truth that no one else knows. It is not uncommon for delusions of stealing or mind reading to also appear.

Causes

The exact causes of schizophrenia, whether we consider it as a single disorder or separate it into different types, remain unknown to this day. This does not mean that there are not different models and hypotheses in this regard, some of which are the following.

From a biological perspective, the existence of genetic factors has been proposed as predisposing the disorder, which generate problems of differentiation and neuronal migration throughout the development. In people with schizophrenia some functional and anatomical alterations are observed at the brain level that have been proposed as an explanation for the manifestation of symptoms. For example, the existence of a greater volume of the cerebral ventricles and structures such as the hippocampus and amygdala, along with a less than usual blood supply to the frontal lobes and the existence of asymmetries between the temporal lobes.

In this sense, the model of the three networks is also contemplated, in which we would find a hypofunctional neural network at the frontal structure level, a hyperfunction of limbic structures and the continued activation of the so-called default network, a neural network that would be activated in the absence of the activity of another network (only when this network could be present). or the other activity, not both at the same time) and that in people with schizophrenia it would be permanently active (which makes it incompatible for the usual neural networks to be activate).

Possible causes of symptoms

At the level of symptomatology, one of the best-known hypotheses is the one that tells us about alterations in dopaminergic systems: the positive symptomatology would be related to an excess or hyperfunction of the mesolimbic pathway while the refusal would be linked to a deficit of this hormone in the mesocortical pathway. With regard specifically to the paranoid subtype, the most visible and prominent alteration would occur at the mesolimbic level, and there may be no alterations in the mesocortical pathway.

Some association with the season of birth has also been observed, with the prevalence of this disorder being higher in children born in winter. Other theories speak of a possible incidence of some viruses or diseases during pregnancy that in some cases could alter the development of the fetus, such as the flu (something that would relate it to the previous theory).

At a psychological level, it is indicated that biological factors would imply a permanent vulnerability, which could be activated depending on the possibility or impossibility of adapting to the vital circumstances and stressors to which the subject makes forehead.

Finally, regarding the phenomenon of hearing voices that people with paranoid schizophrenia often experience, in addition to the previously mentioned excess of dopamine in the mesolimbic pathway It has been speculated that there is a disconnection between the prefrontal and the regions that generate speech, the voices being self-generated mental content that is attributed to external causes: such a disconnection would cause the verbal content not to register as part of the functioning itself aware.

Treatment

Although the symptoms of paranoid schizophrenia may seem more spectacular and striking than those of other types, the truth is that we are facing one of the modalities of schizophrenia with the best prognosis (since they do not have as much risk of cognitive deterioration as other subtypes with negative symptoms) and what better response to treatment they have. Despite this, there is currently no curative treatment for this disorder, but therapies and treatments used focus on the control of symptoms and the prevention of outbreaks psychotics.

drug intervention

At the pharmacological level, people who suffer from it are treated with antipsychotics or neuroleptics, which aim to correct the excess of dopamine in the mesolimbic pathway by blocking its receptors. Although in paranoid schizophrenia there are usually no negative symptoms, the use of atypical ones is recommended as they have fewer side effects than the classic ones. Medication will be necessary continuously, being very important not only in the treatment of a psychotic episode but also in the prevention of new outbreaks.

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Intervention with psychological therapy

On a psychological level, psychoeducation is essential in the first place in order to facilitate adherence to treatment and understanding of the symptoms and alterations that are being suffered. The involvement and psychoeducation of the family and close environment is also essential, which must understand the nature of the problem, possible indicators of a future outbreak, and guidelines to use if one did arise. Empathy and active listening to both the subject and the environment are essential, resolving doubts and giving space to the expression of thoughts and emotions.

Regarding the psychological treatment of hallucinations, none of the therapies that can be used is Focusing therapy on the voices of Slade, Haddock and Bentall. The operation of this therapy is based on the fact that the patient gradually focuses attention on different elements of the voices that he hears, delving into them in order to achieve that little by little the subject stops attributing them to external elements or entities and reattributes them to their own content mental. It usually begins by focusing on the characteristics of the voice in question (tone, volume, whether the voice is masculine or feminine...), to continue working on the content and finally on the beliefs that the person has regarding they.

Although it is something that most professionals already know and should take into account, it is worth mentioning that it is It is essential not to trivialize or insinuate that the voices themselves are something non-existent or their imaginations: the subject really does them. perceived as something external, even if they are mental content that is not attributed to oneself, is something that can generate a high level of suffering. It is also very useful to make the subject see that the voices, whatever they say, cannot cause them real harm.