Paranoid schizophrenia: symptoms, treatments and possible 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 currently the existence of schizophrenia is considered as a single diagnostic entity, the truth is that until a few years ago it was divided into several types. Among them is paranoid schizophrenia , of which we are going to speak 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 mental disorder of the psychotic type characterized by the presence during at least six continuous months of symptoms in which hallucinations, delusions, language alteration, catatonia, affective flattening or alterations of the mood, impoverishment of the thought or lack of motivation, must occur during at least one month. appear at least one of the first three.
These and other symptoms are usually grouped into two groups: positive symptoms, which involve an aggregation of some element to normative behavior (such as hallucinations, derailments in language, hallucinations or restlessness) and negative ones or those that imply a decrease or deficit of the subject's abilities and abilities (such as affective flattening, apathy or mental impoverishment).
But the presentation of symptoms is not the same for all patients with schizophrenia. In fact, you can find different groups of people who manifest similar symptoms to each other and whose alterations are very different from others, which is why traditionally formed different groups or types of schizophrenia and why even today (despite that the different types of schizophrenia, including the one in this article, have been eliminated in the DSM) some authors believe that more than schizophrenia should talk about disorders of the psychotic spectrum .
- You may be interested: "What is schizophrenia? Symptoms and treatments"
Paranoid schizophrenia: main symptoms
Paranoid schizophrenia is perhaps the most well-known and prototypical type of schizophrenia of this disorder. It is considered as such to that type of schizophrenia characterized by a predominant presence of positive symptoms, there being mainly psychic symptoms in which auditory hallucinations and delusions appear. The subject does not usually present other alterations common in other types of schizophrenia, such as catatonia, impoverishment of thought or alterations of speech or movement.
Also, we are facing the type of schizophrenia that minor cognitive deterioration causes (there are usually no negative symptoms) and what better response to treatment usually has.
Generally we find that the hallucinations of patients with this auditory disorder, often in the form of third-person voices that speak about the subject and that tend to have a pejorative and threatening content for the subject. These hallucinations and their content tend to be persecutory , the patient feeling that something or someone intends to harm them and may trigger reactions of fear, anguish or aggression (although contrary to what popular belief dictates, the possibility of unexpected aggression is relatively low and usually occurs in patients they do not follow treatment and high impulsivity).
The subject tends to rave because of these hallucinations, forming a narrative of distorted reality based on these perceptions. The subject can elaborate the belief that he is being persecuted or possessed . There may also appear delusions of greatness or even of messianic type, considering themselves a deity or someone with great powers or in possession of a truth that no one else knows. It is not uncommon that delusions of stealing or thought reading may also appear.
Causes
The exact causes of schizophrenia, whether we consider it as a single disorder or if we separate them into different types, are still unknown today. This does not mean that there are not different models and hypotheses about it, 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 suffering from schizophrenia some functional and anatomical alterations are observed at brain level that have been proposed as an explanation to the manifestation of symptoms.For example, the existence of a greater volume of the cerebral ventricles and of structures such as the hippocampus and amygdala is observed, together with a blood supply that is smaller than usual to the frontal lobes and the existence of asymmetries between the temporal ones.
In this sense we also contemplate the model of the three networks, in which we would find a hypofunctional neural network at the level of frontal structure, a hyperfunction of limbic structures and the continued activation of the so-called default network, a neuronal network that would be activated in absence of the activity of another network (only this or the other activity can be present, not both at the same time) and that in people with schizophrenia it would be permanently active (which makes it incompatible that the usual neural networks are activated).
Possible causes of symptoms
At symptom level, one of the most 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 whereas the negative symptom would be linked to a deficit of this hormone in the mesocortical pathway. As regards specifically 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 linkage with the birth season has also been observed, with the prevalence of this disorder being higher in children born in winter. Other theories talk about 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 to the previous theory).
At the psychological level it is indicated that the biological factors would suppose a permanent vulnerability, that could be activated depending on the possibility or impossibility of adapting to the vital and stressful circumstances to which the subject faces.
By last, in regards to the phenomenon of hearing voices that people with paranoid schizophrenia often experience, in addition to the aforementioned excess of dopamine in the mesolimbic pathway, speculation has been made with a disconnection between the prefrontal and the regions that generalize speech, the voices being self-generated mental content that is attributed to external causes: disconnection would make verbal content not recorded as part of one's conscious functioning.
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 schizophrenia modalities that have the best prognosis (given that they do not have as much risk of cognitive deterioration as other subtypes with negative symptoms) and that they have a better reaction to treatment. Despite this, there is currently no curative treatment for this disorder, but the therapies and treatments used are focused on the control of symptoms and the prevention of psychotic outbreaks.
Drug intervention
At a 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 atypicals is recommended because they have fewer side effects than the classic ones. The medication will be necessary in a continuous way, being very important not only in the treatment of a psychotic outbreak but also in the prevention of new outbreaks.
- Related article: "Types of antipsychotics (or neuroleptics)"
Intervention with psychological therapy
On a psychological level, psychoeducation is fundamental in the first place of face ca facilitate adherence to treatment and understanding of the symptoms and alterations that are being suffered. The implication and psychoeducation of the family and the immediate environment is also fundamental, which must include the nature of the problem, possible indicators of the future appearance of an outbreak and guidelines to be used if one should arise. Empathy and active listening of both the subject and the environment are fundamental, solving doubts and giving space to the expression of thoughts and emotions.
Regarding the psychological treatment of hallucinations, na 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 patient gradually focusing attention on different elements of the voices he hears, deepening them in order to achieve that little by little the subject ceases to attribute them to elements or external entities and he reallocates them to his own mental content. Usually start by focusing on the characteristics of the voice in question (tone, volume, if the voice is male or female ...), to continue working on the content and finally on the beliefs that the person has about them.
Although it is something that most professionals already know and should take into account, it is worth mentioning that it is fundamental not to trivialize or imply that the voices themselves are something non-existent or their imaginations: the subject really perceives them as something external, Although they are mental content that is not attributed to oneself, it 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, can not cause real harm.
Bibliographic references:
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
- Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.
