Paranoid Schizophrenia: The Most Effective Treatments

Schizophrenia is a serious mental illness associated with symptoms of psychosis, which can include disordered thinking and behavior, hallucinations, and impaired daily functioning. The American Psychiatric Association (APA) used to sort this disorder into five subcategories of diagnosis: paranoid, disorganized, catatonic, undifferentiated, and residual schizophrenia. However, in the most updated version of the APA’s DSM-V, the five subcategories of schizophrenia were eliminated. The APA explains that this choice was because the five subcategories had “limited diagnostic stability, low reliability, and poor validity.” In other words, the subcategories did not require distinct treatment plans and were not consistent over the course of the disease’s progression. The World Health Organization also eliminated paranoid schizophrenia from the most recent version of the International Classification of Diseases.

Defining this mental illness

While the phrase “paranoid schizophrenia” is outdated, the DSM-V does have an option to rate the severity of symptoms of this mental health disorder. The DSM recognizes that some people with schizophrenia may experience more symptoms of paranoia while others experience more symptoms of catatonia, and so on. A patient who was once diagnosed with this type of schizophrenia may display symptoms of the condition that are predominantly associated with paranoia. If you are concerned that you or someone you know may be experiencing symptoms related to a potential mental health condition, keep reading to learn more about this condition and how it is treated. 

Schizophrenia – Overview of this mental illness

Schizophrenia is a mental health condition that can result in psychotic episodes and experiences as well as other negative symptoms that may impact a person’s ability to function. While there is still no unified theory of the exact cause of this condition, a family history of psychotic disorders (e.g., schizophrenia or schizoaffective disorder), pre-natal or birth complications, and recreational drug use are considered risk factors for developing this disorder. 

Several common mental health disorders can be comorbid with schizophrenia, including depressive disorders, post-traumatic stress disorder, and obsessive-compulsive disorder. Additionally, according to the National Institute on Drug Abuse, individuals with schizophrenia are at increased risk of developing substance use disorder.  

Common symptoms

Common symptoms can include: 

Hallucinations and delusions 

Hallucinations and delusions are some of the defining symptoms of schizophrenia. Hallucinations involve perceiving things that aren’t part of reality, whether that is by seeing, hearing, or feeling something that isn’t there. Delusions are false beliefs or thought patterns that are also not rooted in reality and may influence the decision-making abilities of someone with schizophrenia.

Negative symptoms

Unlike the positive symptoms of chronic schizophrenia (e.g., hallucinations and delusions), which are sensations, beliefs, or behaviors that are atypically present, negative symptoms are feelings, thoughts, or behaviors that are atypically impaired or absent. Negative symptoms can include anhedonia (difficulty experiencing pleasure), avolition (lack of motivation), or social isolation. 

Interpersonal difficulties

People with this disorder may not be able to read other people’s facial expressions and tones of voice as successfully, and as a result, they may react to others with behavior that can seem socially inappropriate. Some individuals living with schizophrenia can also have a flat affect, meaning they appear completely emotionless. All these symptoms can negatively impact interpersonal relationships and potentially cause a person with schizophrenia to withdraw from social interactions entirely.

Impaired functioning

People with schizophrenia may no longer be able to complete day-to-day tasks associated with meeting their basic needs, such as showering or remembering to feed themselves. Cognitive symptoms can interfere with their ability to provide for themselves or to live independently.

Anosognosia

Anosognosia is the official diagnostic term for a lack of awareness of one’s mental well-being. With schizophrenia, individuals may not be able to recognize that they are behaving in an unusual manner or that they need psychiatric help. Anosognosia can be one of the biggest barriers to people with schizophrenia seeking treatment. 

Paranoid schizophrenia symptoms

While anyone with schizophrenia can experience any of the above symptoms, certain symptoms may be more common in some people than others. This illness can occur on a spectrum, with some individuals having more experiences with paranoia because of the disease.

Symptoms associated with paranoia include hallucinations and delusions, most commonly auditory hallucinations (what some may call “hearing voices”) and delusions that involve a belief that someone is plotting against the individual or trying to harm them. These symptoms can often result in an impaired ability to trust other people, meaning people on this end of the spectrum may be more likely to experience damaged relationships. In some cases, the hallucinations and delusions may be so severe that they impact a person’s ability to function or lead to thoughts of self-harm. 

Paranoia-related symptoms of schizophrenia can often be relieved by antipsychotic medications. People with schizophrenia who experience paranoia and receive treatment may be able to avoid some of the more severe cognitive decline associated with other types of symptoms.  

Psychotherapies and treatment

Various therapeutic approaches have shown efficacy in mitigating the symptoms. Some may work better for others or in combination with other treatments or therapies. Early intervention is considered particularly important for individuals with schizophrenia. A healthcare professional can help you determine which pathway may be best suited for your long-term needs and treatment goals.

Antipsychotic medications

Other medications, such as antidepressants, may be prescribed to alleviate co-occurring symptoms of depression or anxiety. Antipsychotic medications can have unpleasant side effects, including weight gain, increased cholesterol and blood sugar levels, blurred vision, dizziness, and fatigue. Less common and more severe side effects can include low blood pressure, nausea, constipation, seizures, and decreased white blood cell count, which can affect the body’s immune system. Since taking antipsychotic drugs may cause negative side effects, and because a common symptom is the belief that nothing is wrong and medication is unnecessary, antipsychotic medication prescriptions often go hand-in-hand with a process called abidance therapy. Always consult with a healthcare professional prior to starting or stopping any medication. A medical or mental health provider can help you understand the potential benefits, side effects, and treatment duration associated with a particular medication. 

Importance of medication adherence

This therapy involves teaching a patient with schizophrenia to follow a schedule around taking their medications. Treatment adherence interventions are often deployed when a patient is first diagnosed with the condition, or after a patient has been released from hospitalization following a psychotic episode. In some cases, a treatment team of doctors, psychiatrists, therapists, and social workers will collaborate to create a therapy plan for a patient. 

Psychosocial therapy

Psychosocial therapy involves focusing on both the psychological and social well-being of a person with schizophrenia. Since one significant symptom is decreased ability to read other people’s emotions, many people experiencing the condition can find themselves isolated from others, which in turn can worsen their symptoms. Psychosocial interventions like talk therapy, social skills training, and family therapy can treat schizophrenia symptoms related to interpersonal relationships and social functioning. Practicing social skills could involve role-playing or participating in group outings with other individuals living with schizophrenia and their loved ones. 

Psychosocial rehabilitation programs for schizophrenia may include cognitive behavioral therapy (sometimes called cognitive behavior therapy), cognitive remediation (sometimes called cognitive training), and cognitive enhancement therapy. Cognitive behavioral therapy (CBT), for example, can help an individual with schizophrenia identify and replace negative thought patterns that may be underlying certain symptoms. These treatment options may be used alongside modalities like medication management. 

Electroconvulsive psychotherapy 

Electroconvulsive therapy is also known as shock therapy, though this term is outdated and rarely used anymore. Today, it is commonly known as ECT and is considered one of the quickest and most effective ways of treating schizophrenia symptoms, including those related to paranoia. ECT has the potential to be used as a treatment method for other psychotic disorders (e.g., schizoaffective disorder) and mental health conditions (e.g., major depressive disorder). 

With ECT, a doctor administers a general anesthetic to relax a patient’s body and then attaches small electrodes to the head. These electrodes deliver a controlled electric current to the brain and cause a brief controlled seizure. Patients typically participate in several ECT sessions a week for about a month of treatment in total. 

Can complementary treatments help symptoms?

In addition to the above treatment options, individuals with schizophrenia may benefit from complementary approaches, such as the use of nutritional supplements, physical activity, and other lifestyle changes. Research shows that exercise can help individuals with schizophrenia manage symptoms related to cognition, executive functioning, and mood. There is also evidence that a healthy diet can alleviate certain symptoms of schizophrenia, as experts have linked schizophrenia to increased consumption of cholesterol, sodium, and saturated fat. Additionally, research shows that mindfulness therapy—which focuses on helping participants foster awareness of the present—can reduce paranoid thinking. 

Finding support for a mental health diagnosis

Schizophrenia symptoms are unlikely to resolve on their own or over time. If you are concerned that you or a loved one may be experiencing schizophrenia, it can be imperative to talk to a mental health professional. If your potential schizophrenia symptoms are related to paranoia, it may seem daunting to consider leaving your house and traveling to an in-person mental health appointment. In this instance, you may want to consider online therapy through a platform like BetterHelp. 

Online therapy

With the option to chat through phone calls, video calls, or in-app messaging, you can take your care into your own hands according to your comfort level. Speaking with an online provider can help you gain additional insight into your symptoms and allow you to decide on what steps to take next. 

Research

Scientific research has demonstrated that online therapy may be just as effective as traditional in-person therapy at treating a range of mental health conditions. While some schizophrenia treatments require a physical presence, such as electroconvulsive therapy, treatment for social skills training and family therapy may be more easily available online. One study found that a course of online therapy helped to reduce symptoms of suicidal ideation in combat veterans who had been diagnosed with schizophrenia. Online therapy can be part of a comprehensive approach to treating schizophrenia and improving the quality of life for someone with this disorder.