Paranoid Schizophrenia – Causes, Signs and Symptoms

Paranoid Schizophrenia

Also called: Paranoid Type Schizophrenia


Paranoid schizophrenia is a form of schizophrenia in which patients hear voices that others do not and/or experience feelings of persecution.

Schizophrenia is a chronic psychiatric disorder marked by an inability to distinguish between real and unreal events. Paranoid schizophrenia is the most common, and often mildest, form of schizophrenia. With proper treatment, patients with paranoid schizophrenia may be better able to function in the workplace and live on their own.

Scientists do not fully understand what causes paranoid schizophrenia, but believe that it results from a combination of genetic and environmental factors. Paranoid schizophrenia tends to run in families, but environmental factors that affect the development of the brain of a fetus may play a role in the development of the illness.

The primary symptoms of paranoid schizophrenia include auditory hallucinations (hearing voices that others do not) and delusions of persecution (feelings of being persecuted or plotted against). Patients may also experience anxiety, anger, and aloofness, and will often be argumentative or difficult.

Paranoid schizophrenia is diagnosed by a physician when patients report hearing voices and/or feeling as though they are being persecuted, but do not have symptoms distinguished by other types of schizophrenia, such as “flat affect” (reduced expression of emotion) and disorganized thoughts and behavior.Patients with paranoid schizophrenia are usually treated with antipsychotic medications. Psychotherapy may also be recommended to help them manage their illness, and establish and/or maintain healthy relationships. Educational, counseling and support programs are available to family members of those with paranoid schizophrenia as well.

About paranoid schizophrenia

Paranoid schizophrenia is a serious and chronic psychiatric disorder in which patients experience auditory hallucinations (hear voices that others do not) and have delusions of persecution (feelings of being persecuted or plotted against) or of grandeur (such as being famous or even a deity).

Paranoid schizophrenia is the most common type of schizophrenia, a disorder that impairs a person’s ability to distinguish between real and unreal experiences, think logically, have normal emotional responses and behave appropriately in social situations.

People with paranoid schizophrenia may also demonstrate symptoms of other forms of schizophrenia. Other types include:

  • Disorganized. Characterized by disorganized behavior and speech.
  • Catatonic. Characterized by abnormal physical movements.
  • Undifferentiated. Patients with schizophrenia that has not been identified as paranoid, disorganized or catatonic.
  • Residual. Patients previously diagnosed with schizophrenia, but who are no longer experiencing positive symptoms, such as catatonic behavior, delusions, hallucinations or disorganized speech or behavior.

Paranoid schizophrenia is often milder than other types of schizophrenia. In addition, the prognosis may be more positive. Many patients with this form of schizophrenia are better able to function in the workplace and live independently.

The onset of paranoid schizophrenia tends to occur later than with other forms, which often first appear in late adolescence or early adulthood. Some studies have shown the average age of onset for paranoid schizophrenia is 35. However, patients often demonstrate signs of the impending disorder at a younger age.

Risk factors and causes

As with schizophrenia in general, the cause of paranoid schizophrenia is unknown but it is believed that a combination of genetic and environmental factors may be responsible.

Schizophrenia tends to run in families. Although it occurs in 1 percent of the general population, it occurs in 10 percent of people who have a first-degree relative (parent, brother or sister) with schizophrenia. People with a second-degree relative (aunt, uncle, grandparent or cousin) also develop schizophrenia at higher rates than the general population. People with a twin with the disorder have the greatest risk, with a 40 to 65 percent chance of developing schizophrenia, according to the National Institute of Mental Health (NIMH).

In addition to genes, environmental factors may play a role, such as factors that may cause mild brain damage in a developing fetus and complications that occur during birth. Psychosocial factors, such as stressful conditions, may also contribute to the development of paranoid schizophrenia.It appears that schizophrenia is linked to abnormalities in brain chemistry and structure. People with schizophrenia appear to have an imbalance of the brain chemicals known as neurotransmitters, which allow nerve cells in the brain to send messages to each other. There are multiple neurotransmitters, but dopamine is considered to be the one primarily involved in the development of schizophrenia. Others such as serotonin and norepinephrine may also play roles in this disorder.

Signs and symptoms of paranoid schizophrenia

The primary symptoms of paranoid schizophrenia are auditory hallucinations (hearing voices that others do not) and delusions (false beliefs that a person holds despite evidence to the contrary) of being persecuted or plotted against. Patients may also have grandiose (over-the-top) delusions, which may include themes of jealousy or religion.

Patients may have more than one delusion, but there is usually a common theme among delusions. Patients may also experience hallucinations, but the hallucinations usually have the same theme as the delusions.

Other symptoms of paranoid schizophrenia include anxiety, anger, aloofness, disorganized thinking and behavior, and a decline in functioning. People with the condition also tend to be more argumentative, difficult and patronizing. Interpersonal interactions may have a formal or intense quality. Research also indicates that people with schizophrenia may have difficulty interpreting others’ body language.

Because they have delusions of being persecuted or plotted against, patients with paranoid schizophrenia may be more prone to suicide. They may also be more likely to engage in violent behavior because patients sometimes experience anger in addition to delusions. If a patient with paranoid schizophrenia commits an act of violence, it is usually directed at a family member and typically takes place at home.

Patients with paranoid schizophrenia usually do not have symptoms that are present in other types of schizophrenia, such as disorganized speech, “flat affect” (reduced expression of emotion) and disorganized behavior.

Patients with paranoid schizophrenia may exhibit negative symptoms (symptoms that involve a loss of normal emotional and behavioral functioning), but they are less prominent than other symptoms.

Because of the nature of the condition, individuals with paranoid schizophrenia are not likely to seek treatment. Therefore, loved ones of individuals experiencing signs and symptoms of the disorder must often intervene and report signs and symptoms to a physician on the patent’s behalf.

Diagnosis methods for paranoid schizophrenia

The diagnosis of paranoid schizophrenia usually begins with a physical examination that includes a medical history. A physician will also inquire about family history of mental illness.

A physician may try to rule out other mental or physical illnesses that may be causing symptoms. Blood or urine tests may be conducted to determine whether medications, substance abuse or illness is contributing to symptoms. Some infections, cancers, nervous system disorders, thyroid disorders and immune system disorders can produce psychotic symptoms. Psychosis may also be a side effect of some medications.

A patient may be referred to a psychiatrist, who will likely conduct a psychiatric evaluation, which may include a description of signs and symptoms and an overview of psychiatric history.

In general, a patient must be experiencing psychotic symptoms or “loss of reality” for at least six months to be diagnosed with schizophrenia. After diagnosing schizophrenia, a mental health professional may attempt to determine what type of schizophrenia a patient has by evaluating symptoms.The primary symptoms of patients with paranoid schizophrenia are auditory hallucinations (hearing voices that others do not) and delusions of persecution (feelings of being persecuted or plotted against). In addition, patients with paranoid schizophrenia do not usually experience symptoms experienced with other types of schizophrenia, such as disorganized speech, disorganized or catatonic behavior and flat affect (reduced expression of emotion).

Treatment options for paranoid schizophrenia

Since the cause of paranoid schizophrenia is still unknown, the focus of treatment is to control symptoms. There is no cure but, with proper treatment, the condition can be managed.

Patients are usually treated as outpatients. However, they can be treated in a hospital if they experience acute symptoms, such as severe delusions or hallucinations, serious suicidal thoughts or an inability to care for themselves.

The most common treatment for schizophrenia is antipsychotic medication. Patients respond differently to medications, so sometimes several different drugs must be tried before finding the appropriate one. Although medication is effective in controlling symptoms, relapses can occur if patients stop taking them. Patients with schizophrenia sometimes stop taking medications because they feel better, forget to take them or take them sporadically because they think regular use is not important.

In addition to medication, patients with schizophrenia are sometimes treated with psychosocial rehabilitation (therapy that involves both social and psychological behavior). Research has shown that patients treated with rehabilitation and medication are better able to manage their illness.

Some psychosocial treatment techniques include rehabilitation, which emphasizes social and vocational training to help patients live and work in the community, and illness management skills, which teach patients how to recognize signs of relapse and plan accordingly.

In addition, cognitive behavior therapy may be used for patients who still experience symptoms of paranoid schizophrenia after taking medication.Although patients with schizophrenia usually receive treatment through antipsychotic medications, therapy or other means, it is important that patients receive support from family members, friends and others.

Questions for your doctor

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding conditions. Patients and their loved ones may wish to ask their doctor the following questions related to paranoid schizophrenia:

  1. What is paranoid schizophrenia?
  2. What are the most common symptoms of paranoid schizophrenia?
  3. How can you tell the difference between paranoid schizophrenia and other types of schizophrenia?
  4. What is the best way to treat my loved one’s paranoid schizophrenia?
  5. In addition to medication, should my loved one receive therapy to treat his/her paranoid schizophrenia?
  6. What type of therapy would be most effective in treating my loved one’s paranoid schizophrenia?
  7. Will my loved one require medication monitoring to ensure that he/she is taking his/her medications correctly?
  8. Can I be cured of paranoid schizophrenia?
  9. Will I be able to live on my own with paranoid schizophrenia?
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