What Are the Symptoms of Paranoid Schizophrenia?

Paranoid schizophrenia is marked by the erroneous and overwhelming feeling of persecution by hallucinated tormentors, conspiracies or other delusions.

Paranoid schizophrenia is a subtype of schizophrenia, a form of psychosis, that can cause people to see or hear things that aren't there, or to believe things that aren't true. People with paranoid schizophrenia can become overwhelmed with delusions and hallucinations. 

Paranoid schizophrenia can cause what is called “positive” symptoms, which are abnormal experiences or behaviors that occur due to the mental illness. Symptoms of paranoid schizophrenia include: 

• Delusions
  • Believing things that aren’t true
  • Persistent, unusual thoughts or beliefs
  • Suspicion and a general fear of others’ intentions
  • Delusions of persecution or jealousy
  • Delusions of being someone exalted or being on a special mission
• Hallucinations 
  • Hearing, seeing, feeling, smelling, or tasting things that aren't there
  • Hearing voices that threaten or give commands
• Disorganized thinking or speech
  • Problems thinking in an organized way/difficulty thinking clearly
  • Talking about a lot of things before getting to the point
  • Making up words 
  • Saying things that make no sense
• Withdrawal from family or friends

“Negative” symptoms of schizophrenia are not as common in patients with paranoid forms of the disorder, though they can occur and may include: 

• Lack of display of emotion 
• No changes in facial expression 
• Minimal movement or talking
• Decline in self-care
• Lack of interest in spending time with others or having fun

The exact cause of paranoid schizophrenia is unknown but several risk factors may contribute to the development of the disorder, such as: 

• Genetics
  • Schizophrenia can run in families
• Environmental factors
  • It is believed that interactions between the genetic risk and environment may play a role in the development of schizophrenia
  • Living in poverty
  • Stressful surroundings
  • Exposure to viruses
  • Nutritional problems before birth
• Brain structure and function
  • Differences in brain structure, function, and interactions among neurotransmitters may contribute to the development of schizophrenia, for example:
    • Differences in the volumes of specific components of the brain
    • Variations in the way regions of the brain are connected and work together
    • Differences in neurotransmitters, such as dopamine
    • Differences in brain connections and brain circuits that may begin developing before birth
    • Changes to the brain that occur during puberty may trigger psychotic episodes in people who are vulnerable due to genetics, environmental exposures, or certain brain differences

Paranoid schizophrenia is diagnosed using criteria as outlined by The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association and includes the presence of 2 or more of the following, each present for a significant portion of time during a 1-month period, with at least 1 of them being delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms.

• For much of the time since the onset of the disturbance, the patient’s level of functioning in one or more major areas (e.g., work, interpersonal relations, or self-care) is significantly below the level it was before onset; when the onset is in childhood or adolescence, the expected level of interpersonal, academic or occupational functioning is not achieved
• Signs of the disturbance persist for at least 6 months, and must include at least 1 month of symptoms
• Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out 
• The disturbance is not due to drug abuse, use of medications, or another medical condition
• If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms or schizophrenia are also present for at least 1 month 

Paranoid schizophrenia is treated with medications and counseling and other support.

Medications used to treat schizophrenia can often cause uncomfortable side effects which may cause patients to stop taking them. Never stop taking a prescribed medication without first talking to your doctor. It may take a number of tries with different medications to find one that works best with the least side effects. 

Types of medications used to treat paranoid schizophrenia include: 

• Antipsychotics
• Anti-anxiety medications
• Antidepressants 

Counseling and other support for schizophrenia include: 

• Cognitive behavioral therapy (CBT)
• Behavioral skills training
• Supported employment
• Cognitive remediation interventions to help address the negative and cognitive symptoms of schizophrenia
• Family education and support programs
• Coordinated specialty care (CSC), which is recovery-oriented treatment programs for people with first episode psychosis, an early stage of schizophrenia
• Assertive Community Treatment (ACT) for individuals with schizophrenia who are at risk for repeated hospitalizations or homelessness