Paranoid schizophrenia: symptoms, treatments and possible causes.

This is one of the types of schizophrenia with the best response to treatment.

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 schizophrenia is now considered to exist as a single diagnostic entity, the fact is that until a few years ago it was divided into several types. Among them is paranoid schizophrenia, which we are going to discuss in this article.of which we are going to speak in this article explaining its associated symptoms, its treatments and its possible causes.

Schizophrenia

Schizophrenia is a mental disorder of psychotic type. characterized by the presence for at least six continuous months of symptoms in which hallucinations, delusions, language disturbance, catatonia, affective flattening or mood disturbances, impaired thinking or lack of motivation are present for at least one month, and at least one of the first three must be present.

These and other symptoms are usually grouped into two groups: positive symptoms, which involve an addition of some element to the normative behavior (such as hallucinations, language derailments, hallucinations or restlessness) and negative symptoms or those involving a decrease or deficit of the subject's skills and abilities (such as affective flattening, 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 symptomatologies and whose alterations are very different from those of others, which is why traditionally different groups or types of schizophrenia were formed and why even today (although the different types of schizophrenia have been eliminated in the DSM, including the one we are dealing with in this article) some authors believe that rather than schizophrenia should be referred to as psychotic spectrum disorders..

Paranoid schizophrenia: main symptoms

Paranoid schizophrenia is perhaps the best known and prototypical type of schizophrenia. Schizophrenia is considered as such when it is characterized by a predominant presence of positive symptomatology, with mainly psychic symptoms in which auditory hallucinations and delusional ideas appear. The subject does not usually present other alterations common in other types of schizophrenia, such as catatonia, impoverished thinking or speech or movement disorders.

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

Generally we find that the hallucinations of patients with this disorder are auditory, often in the form of voices in third person that speak about the subject and tend to have a pejorative and threatening content for the subject. These hallucinations and their content are usually of a persecutory nature, with the patient feeling that something or someone is trying to harm them.The patient feels that something or someone is trying to harm them and may trigger reactions of fear, anguish or aggression (although contrary to popular belief, the possibility of unexpected aggression is relatively low and usually occurs in patients who do not follow treatment and are highly impulsive).

The subject tends to become delusional due to such hallucinations, forming a distorted narrative of reality based on such perceptions. The subject may elaborate the belief that he/she is being persecuted or possessed.. Delusions of grandeur or even messianic delusions may also appear, considering oneself a divinity or someone with great powers or in possession of a truth that no one else knows. It is not infrequent that they can also appear delusions of theft or thought reading.

Causes

The exact causes of schizophrenia, whether we consider it as a single disorder or whether we separate it into different typologies, remain unknown to this day. This does not mean that different models and hypotheses do not exist, some of which are as follows.

From a biological perspective, genetic factors have been proposed as predisposing to the disorder, which generate problems of differentiation and neuronal migration throughout development. In persons suffering from schizophrenia some functional and anatomical alterations are observed at the cerebral level, which have been have been proposed as an explanation for the manifestation of symptomatology. For example, the existence of a larger volume of cerebral ventricles and structures such as hippocampus and amygdala is observed, together with a lower 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 considered, in which we would find a hypofunctional neuronal network at the level of the frontal structure, a hyperfunction of limbic structures and the continuous activation of the so-called default network, a neuronal network that would be activated in the absence of the activity of another network (only this one or the other can be active, not both at the same time) and that in people with schizophrenia would be permanently active (which makes it incompatible for the usual neuronal networks to be activated).

Possible causes of symptoms

At the level of symptomatology, one of the best known hypotheses is the one that speaks to us of alterations in the dopaminergic systemsPositive symptomatology would be related to an excess or hyperfunction of the mesolimbic pathway, while negative symptomatology would be related to a deficit of this hormone in the mesocortical pathway. With specific regard 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.

A certain link with the season of birth has also been observed, with a higher prevalence of this disorder 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 influenza (something that would relate it to the previous theory).

At the 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 life circumstances and stressors faced by the subject.

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 speech-generating regions, 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 one's own conscious functioning.

Treatment

Although the symptoms of paranoid schizophrenia may seem more dramatic and striking than those of other types, the fact is that we are in front of one of the schizophrenia modalities that have better prognosis (since they do not have as much risk of cognitive deterioration as other subtypes with negative symptomatology) (given that they do not have as much risk of cognitive deterioration as other subtypes with negative symptomatology) and that have the best reaction to treatment. Despite this, there is currently no curative treatment for this disorder, but the therapies and treatments used are focused on symptom control and prevention of psychotic outbreaks.

Drug intervention

At the pharmacological level, sufferers are treated with antipsychotics. are treated with antipsychotics or neurolepticswhich are intended 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 as they have fewer side effects than the classical ones. Medication will be necessary on an ongoing basis, being very important not only in the treatment of a psychotic break but also in the prevention of new outbreaks.

Intervention with psychological therapy

At the psychological level, firstly, psychoeducation is essential in order to facilitate adherence to antipsychotic in order to facilitate adherence to treatment and understanding of the symptoms and alterations that are being suffered. It is also essential the involvement and psychoeducation of the family and close environment, which must understand 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 to both the subject and the environment is essential, resolving doubts and giving space for the expression of thoughts and emotions.

As for the psychological treatment of hallucinations, one of the therapies that can be employed is Slade, Haddock and Bentall's voice focus therapy.. The operation of this therapy is based on the patient gradually focusing his attention on different elements of the voices he hears, deepening in them in order to achieve that little by little the subject stops attributing them to external elements or entities and reattributes them to his own mental content. It usually starts 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 about them.

Although this is something that most professionals already know and should take into account, it is not superfluous to mention that it is essential not to trivialize or imply that the voices themselves are something non-existent or their imaginations: the subject really perceives them as something external, even if 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, cannot cause real harm.