Paranoia: main symptoms and approaches to treatment of chronic psychosis

Mental disorders arise for various reasons, many of which have not yet been sufficiently studied by doctors and scientists. It is believed that such diseases manifest themselves in people who have a certain genetic predisposition, but only against the background of unfavorable environmental factors.

Speaking about what paranoia is, doctors note that such a disorder is characterized by the formation of delusions that negatively affect social, work activity and personality. In the treatment of this condition, psychotherapeutic techniques and a number of medications are used to suppress the symptoms of a paranoid state.

About the disease

Epidemiological studies indicate that this diagnosis is made in 0.1-1% of cases of patient hospitalization in psychiatric institutions. The prevalence of paranoia determines its relevance, since the immediate causes of the development of delusions cannot always be established, and signs of the disease can be detected in patients who did not have risk factors.

With paranoia, thinking disorders occur, characterized by the appearance of delusions. However, other areas of mental life are preserved, which ensures long-term normal functioning in society and later seeking medical help.

The occurrence of paranoid delusions is not detected by surrounding people and doctors for a long time. Diagnosis is often associated with a severe flare-up of the disorder associated with severe life stress. It is important to note that many relatives and colleagues of the patient may interpret his behavior and thoughts as personality traits, thereby preventing early detection of the disease.

Etiology

The development of paranoid disorder is based on personality traits and negative environmental influences. It is known that patients with symptoms of the disease suffer serious psychological traumatic events in childhood, which changes their thinking pattern towards negative judgments. In such a case, adolescents develop high self-esteem, belligerence towards other people, and a tendency to incorrectly interpret life events.

According to modern psychological theories, people begin to transfer their anxiety and aggressiveness to the people around them, forming symptoms of paranoia in themselves. Such conditions form a vicious circle - a situation where the incorrect interpretation of facts only confirms the conclusions, which leads to a constant deterioration of the entire situation.

In addition to the characteristics of upbringing and the environment in childhood, organic brain lesions are of great importance. It is known that when signs of paranoia appear in adulthood and old age, Parkinson’s disease, Alzheimer’s disease, atherosclerotic brain lesions, chronic alcohol abuse, etc. may play an important role in their occurrence.

Establishing the immediate cause of paranoia is not always possible. In its occurrence, a combination of factors is often observed: psychological predisposition, negative social conditions in childhood, as well as organic or mental diseases of the brain.

Paranoid schizophrenia

To understand the differences between paranoia and schizophrenia, it is worth considering the most common form of the latter - paranoid. It is characterized by the presence of delusions of criminal, sexual, reformist and other content. These are common features of both types of psychosis. However, schizophrenic disorder is usually accompanied by many other symptoms. In the active phase, that is, during an exacerbation (attack), the following symptoms are observed:

Hallucinations that are threatening in nature.

Senesthopathy is a painful sensation in the body.
Depersonalization is an incorrect perception of oneself.
Derealization - ideas about the unreality of the world.
Affective disorders, inappropriate emotions.
Cognitive impairment - problems with speech and memory.

During remission, these symptoms weaken. They are replaced, if the active signs have been stopped, by negative symptoms - apathy, lack of will, alienation, lack of initiative. An increase in such manifestations may indicate the onset of the next attack.

About 85-87% of schizophrenics have paranoid schizophrenia.

Paranoid schizophrenia develops in several stages. If its progression is not stopped, a complete collapse of the personality occurs, when a person ceases to react in any way to others.

Types of paranoia

Speaking about why the disease occurs and what symptoms are characteristic of it, it is necessary to consider the classification of types of paranoia used in practice by psychiatrists. The following forms are distinguished:

Paranoia associated with alcohol abuse. The appearance of paranoid thoughts is associated with toxic brain damage from ethanol and its breakdown products. The most typical forms are the formation of systematized delusions of jealousy and delusions of persecution. This form of pathology is more often detected in men.
The involutional variant of the disease is typical for people aged 40 to 60 years. Paranoia develops acutely in the form of systematized delusions of persecution, jealousy or relationship. Some people exhibit delusions of grandeur. The peculiarity of the course is the absence of progression.
Delusions of grandeur are the main manifestation of megalomaniac paranoia. The patient thinks about his discoveries, important changes in the life of society, work group or family, although such thoughts do not have any confirmation in the real world.
With persecutory paranoia, a person constantly feels pursuers who threaten or do not threaten his life. Most often, this condition is observed in middle-aged men.
Senile or senile paranoia develops against the background of organic diseases of the brain and is characterized by changes in character and the formation of various variants of delusions.

It is important to note that other variants of delirium may appear as part of these forms of the disease, which complicates the diagnosis and selection of medications.

What it is

Paranoia is an instinct strongly influenced by anxiety or fear, often to the point of delusion. This fear begins with a slight feeling of discomfort, gradually progresses and reaches an anxious way of thinking. This suggests that the mental well-being of the individual is under serious threat. At the same time, the adequacy of perception and logic of thinking in areas not related to painful ideas is preserved.

The term "paranoia" when translated from Greek means madness.

Psychosis is manifested by beliefs of persecution or self-conspiracy. Aggressive impulses change and are attributed to others in a form changed beyond recognition. The disease is expressed by a general distrust of others and false accusations. For example, a paranoid person thinks that the incident happened intentionally, while most people view it as an accident or coincidence.

Paranoia borderline state

This happens to many people. Even if a person knows that their problems are not based in reality, they can be bothersome if they happen too often. But the clinical form is a more severe pathology. This is a persistent state of constant and unfounded mistrust. This is a rare form of mental health in which the sufferer believes that others are unfair, lying and trying to harm him. Such patients do not consider themselves paranoid because they are convinced that they are right.

Clinical manifestations

The development of a paranoid state is observed long before its detection. As a rule, the formation of highly valuable ideas underlying delusions is noticeable several years before the diagnosis is made.

The main symptom is delusion, which varies depending on the idea behind it. For example, a person gradually begins to notice in his neighbors signs of their disdain or aggressiveness, which in fact are not there. Such a situation gradually forms a systematization of delirium, which leads to the fact that the patient himself becomes belligerent, begins to persecute neighbors, expressing his dissatisfaction and can complain to public authorities, seeking apparent justice.

Due to the peculiarities of the ways of interpreting the behavior of others, the patient finds a hidden meaning in each of their actions or statements and sees a threat to himself and his freedom. The formation of such observations leads to the formation of a whole system of views and beliefs around a neighbor, relative or colleague at work, providing a distortion of reality for the patient.

Persecution paranoia is characterized by seeing people around you as a threat to life. Very often, such nonsense is formed in relation to random passers-by who may travel with a person every day in the same direction on public transport or work in the same building.

In addition to such ideas, there is a change in character. Detachment and indifference to surrounding events and people appear in behavior. Typically, a patient with paranoia is unable to understand emotions or empathize with anyone. As the disease progresses and there is no treatment, it becomes difficult for the patient to be in any group, for example, at work, since all the people around him are perceived as hostile and pose a threat to his personality, discoveries, etc.

Frequent paranoid attacks lead to delusions of grandeur or persecutory paranoia. In these cases, the patient begins to feel superior to the people around him, associating this with his power or genius. Many patients actively talk about their professional, creative or inventive talents and achievements. The neutral reaction of colleagues or relatives to such statements leads to the patient convincing himself of a conspiracy on their part.

Persecutory delusions are characterized by the perception of surrounding people as a threat. An important difference from grandiosity paranoia is the absence of attempts on the part of the patient to talk about his thoughts to anyone, for example, his wife or children. When discussing the patient’s delusional ideas together, the interlocutor may form his own delusional system, closely related to the patient’s thoughts.

If treatment is refused, the mental disorder progresses. With the long-term existence of systematized delusions, therapy is extremely difficult and may have limited effectiveness.

Differences

One of the important differences between paranoia and schizophrenia, regardless of the form of the latter, is the symptoms. The first is characterized by delusional ideas, usually on one topic, which deepen and become more complex over time. In schizophrenic disorders, in addition to delirium, which may not exist at all, as in the sluggish variety, dozens of other signs are observed.

Moreover, delusions in schizophrenia can be very diverse and only in the paranoid form does it become monothematic, which makes it similar to paranoia. But even in this case, we see many other symptoms, both positive and negative.

The paranoia of a jealous person is described in detail in Buñuel's film HE. Psychoanalyst Jacques Lacan showed it to students in his psychiatry courses.

But there is another difference that can be considered key. With paranoia, personality disintegration does not occur. A paranoid person, if we exclude his delusional ideas, is not much different from other people. He can think, act and reason logically and consistently. He begins to rave only when moving to a specific topic that evokes an emotional response in him.

A typical example of a paranoid person in literature is Don Quixote. Cervantes describes him as a wise and judicious man. In many ways, he is superior to others in intellectual and moral parameters. However, as soon as we start talking about chivalry, Don Quixote instantly turns into a madman who believes in wizards and giants and throws himself at the mills with a spear.

Let us formulate the main points by which paranoia differs from schizophrenia:

Number of ideas. For paranoia - one, and for schizophrenia - many (except for paranoid syndrome).
Attitude towards opponents. A paranoid person is extremely intolerant, and a schizophrenic person can pretend that he agreed with someone else's opinion.
Interest in people. The paranoid person is suspicious of everyone and often watches others. With schizophrenia, the patient, as a rule, does not notice anyone except himself.
Accuracy. With paranoia, a person can be neat and pedantic. A schizophrenic is absolutely irresponsible. He neglects his affairs, his appearance, hygiene, etc.
Progression. Paranoia progresses according to the type of deepening of the delusional idea. In general, a person retains his personality. Schizophrenia develops until it completely disintegrates.

At the same time, it cannot be denied that the mechanism of delusion formation in paranoia and schizophrenia may be similar. However, the first cannot lead or cause the second, since it does not cause a schizophrenic defect that affects personal qualities.

Diagnostic measures

Identifying paranoia and establishing the causes of its development is a difficult diagnostic task. Sick people are reluctant to go to medical institutions and often spread their delusional ideas to the attending physician and medical staff. The most suitable specialist to work with this group of patients is a psychotherapist.

The doctor’s primary task is to identify paranoid ideas and systematized delusions that disrupt a person’s socialization. For this purpose, conversations are held with the patient and his relatives, who can indicate how long ago paranoia developed and its main manifestations. It is important to note that in many cases, the patient may not share his thoughts with people around him.

Of great importance for determining the causes of the development of the disease is the study of the characteristics of childhood and adolescence. Patients often themselves focus on the events when paranoid ideas first appeared, however, their precursors are hidden. Psychological tendencies towards systematic delusions can be identified when talking with parents.

When excluding psychological factors, doctors use laboratory and instrumental examination methods:

Clinical and biochemical blood tests to assess general health and identify metabolic disorders.
If atherosclerosis of the cerebral vessels is suspected, an ultrasound examination is performed in combination with Doppler sonography.
Neuroimaging is the “gold standard” in diagnosing brain diseases, recommended for all patients with symptoms of brain damage. The greatest information content is observed when performing magnetic resonance imaging.

Only the attending physician should interpret the results obtained. It is important to note that paranoia is diagnosed in cases where a person does not have signs of other mental pathologies, such as schizophrenia. Otherwise, the diagnosis is not made, since systematized delirium is not an independent disease, but only a symptom.

Therapeutic approaches

Relatives of the patient often ask doctors whether paranoia can be treated? With the proper use of medications and psychotherapy, symptoms can be significantly reduced or disappear completely. It should be noted that if you refuse therapy, a relapse is possible.

Treatment can be carried out either on an outpatient basis for mild symptoms, or during hospitalization in a psychiatric clinic. An important element in effective therapy is the use of drugs:

antipsychotic drugs characterized by anti-delirium action (the most commonly used are Fluanxol and Clozapine);
the use of tranquilizers and antidepressants (Fluoxetine, Amitriptyline) is indicated for excessive agitation or the development of depression, respectively;
individual therapy within the framework of a positive or cognitive-behavioral direction allows us to identify pathological judgments and methods of their formation, in cases where the patient understands that such conclusions contradict logic and have no real reasons, remission is observed during paranoid disorder (it should be noted that most patients experience negative feelings and transfer their delusional ideas to the psychotherapist, which significantly complicates the therapy process);
when delusions of jealousy are identified, family psychotherapy is recommended to normalize relationships within a family or couple;
sedatives from herbal and chemical production are used in treatment in the early stages of the disease, when it is possible to combat paranoia with the help of “light” medications.

Medicines are always prescribed by a doctor, since the drugs have indications and contraindications for their use. In severe cases of delirium, it is possible to use complex drug therapy using drugs from various pharmacological groups.

Relatives should know how to behave with a paranoid person. Psychiatrists make the following recommendations:

If a relative exhibits symptoms consistent with paranoid disorder, you should consult with your doctor about additional diagnostic tests and procedures.
One should not contradict a person in his judgments, despite the fact that the ideas of nonsense do not have any justified reasons or logical judgments. Otherwise, the patient may begin to view the person as a threat to his or her identity.
It is necessary to create a comfortable atmosphere in the family and listen to the patient, however, one should never accept his conclusions, since in this case the development of induced delirium in a healthy person is possible.

The development of paranoid disorder in a family member is a serious condition that brings significant psychological discomfort. In order to find out how to get rid of paranoia, you need to consult a medical specialist, since self-medication is unacceptable.

Paranoid schizophrenia

Paranoid schizophrenia also includes the term “paranoia”. This disorder can be considered as a separate mental illness or a stage of a paranoid form of psychopathology with a protracted stage of paranoid syndrome.

It is worth mentioning that schizophrenia is a very complex disease with many symptoms and varieties. A large role in treatment is given to differential diagnosis. Even an experienced doctor is not always able to immediately distinguish one diagnosis from another. However, it is not by chance that individual types are identified, since they are treated using different methods and doses of medications.

Let's return to paranoid schizophrenia. It is characterized by the presence of monothematic (logically grounded) delusions. This is the similarity of this syndrome with paranoia. However, there is a difference. With schizophrenia of this type, negative symptoms increase, which is not observed in paranoid personality disorder.

As for delusional ideas, they are associated with reformism, persecution, erotic fantasies, slander, delusions of grandeur, etc.

Paranoid schizophrenia develops slowly, often manifests in adolescence, and then increases over 10-15 years.

A schizophrenic can easily justify his delusions, so he does not consider himself sick. This makes treatment very difficult. Much depends on at what stage it was started. There are three stages of accepting a delusional idea in paranoid schizophrenia:

Anticipation accompanied by anxiety.
An insight in which a person suddenly “understands something.”
Systematization, that is, the logical justification of delirium.

Sometimes the transition to the paranoid stage does not occur. Throughout the illness, the person retains basic cognitive abilities, and signs of the active phase of schizophrenia are not observed.

Course of the disease and prognosis

The pathology tends to persist or progress for life, and therefore the prognosis for most patients is unfavorable. With proper drug treatment and long-term psychotherapy, stabilization of the disease is observed without an increase in symptoms and a decrease in the expression of overvalued ideas.

Disorders associated with organic diseases of the central nervous system stabilize or disappear when the underlying disease is treated. Alcohol-induced brain damage and its symptoms are persistent and difficult to treat. In cases where delusions arose due to short-term use of narcotic substances, paranoia may completely disappear when they stop using them.

Symptoms take several years to develop. During this period, the patient develops a systematized delusion associated with the people around him. The nature of the delusion often depends on the situation in the family or workplace. Timely detection of paranoia and initiation of early combination therapy ensures stabilization of the condition and reduction in the severity of pathological symptoms. This ensures the normalization of mental activity and the restoration of social relationships. In the absence of treatment, systematized delusions constantly become more complex, which can lead to criminal actions against people around him, including close relatives.