Paranoid Schizophrenia

Paranoid Schizophrenia

Table of Contents

What is Paranoid Schizophrenia?

Feeling paranoid or nervous is common in appropriate situations, such as a young child in a dark room or someone walking alone down a street late at night. In these cases, it’s normal to feel uncertain or insecure. Experiencing a pattern of paranoia, however, may indicate a more severe issue.

Schizophrenia is a mental disorder that disrupts an individual’s capability to interpret reality logically. Schizophrenia can result in a mix of hallucinations or delusions alongside disordered thinking and behavior patterns. Schizophrenia can greatly impair one’s function and day-to-day life.

Schizophrenia is a spectrum disorder that affects an individual’s perception. Paranoid schizophrenia specifically includes the constant feeling of paranoia, of being threatened, or of being watched by others.

Symptoms of Paranoid Schizophrenia

Paranoid Schizophrenia includes several cognitive, emotional, and behavioral issues. Although the symptoms may vary from person to person, they usually include the following:


Delusions are a form of psychosis where the individual cannot differentiate what is real from imagined.

Delusions cause one to experience situations that could occur in real life but that are significantly misinterpreted. Delusions of paranoid schizophrenia may include an individual feeling that they are being followed, poisoned, loved, or conspired against by someone else. Delusions are either false or greatly exaggerated in the individual’s mind.1


According to the U.S. National Library of Medicine, “Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.” 2

Forms of hallucinations include:

  • Feeling sensations in the body, such as a crawling feeling on the skin or internal organs movement.
  • Hearing sounds, such as music, footsteps, windows, or doors banging.
  • Hearing voices when no one has spoken (the most common type of hallucination). These voices may be positive, negative, or neutral. They may command someone to do something that may cause harm to themselves or others.
  • Seeing patterns, lights, beings, or objects that are not there.
  • Smelling an odor that is not there.

Disorganized Speech

A common symptom of paranoid schizophrenia is incoherent or disorganized speech. Communication may be impaired. The individual may speak on odd topics or give unrelated answers to questions. They may also make a “word salad,” meaning a jumble of meaningless words.3

Disorganized Behavior

An individual’s illogical behavior can be manifested in several ways such as childlike silliness or unpredictable agitation. Achieving tasks becomes challenging for the individual with inconsistent behavior, and they may be resistant to instructions or unable to function normally.3

Negative Symptoms

The negative symptoms include those needed for one to function. An example of a negative sign is the lack of attention to one’s hygiene. Another example is that the individual may have a lack of emotions. Someone experiencing negative symptoms may lose interest in typical activities or withdraw from society.3

Suicidal Thoughts

Out of all paranoid schizophrenia symptoms, suicidal thoughts are the most dangerous. The National Library of Medicine states that “Suicide is one of the leading causes of premature death among people with schizophrenia. Epidemiological investigation has established suicidal behaviour as more frequent in patients with schizophrenia than in the general population.”4

Studies show that approximately 40 to 50% of people with schizophrenia experience suicidal ideation in their lives. Around 20–50% have attempted suicide, and 4 to 13% successfully commit suicide.4

Causes and Risk Factors

Although Paranoid Schizophrenia can be triggered, the direct cause has yet to be discovered. Researchers believe that a sum of factors contributes to the development of the disorder.5


Individuals with schizophrenia in their family history may be at higher risk of developing the disorder.6

Brain Abnormalities

Because Schizophrenia is a neuropsychiatric disorder, the brain’s chemicals and possible deficiencies can contribute to developing the condition. According to Mental Health America, “Scientists believe that people with schizophrenia have an imbalance of the brain chemicals or neurotransmitters: dopamine, glutamate and serotonin. These neurotransmitters allow nerve cells in the brain to send messages to each other.” 7

Childhood Abuse

Childhood sexual abuse (CSA) causes permanent damage in victims. Schizophrenia has been discovered as a result of CSA cases. One of the most common symptoms for those who develop schizophrenia due to childhood abuse is hallucinations.8

Substance Use and Paranoid Schizophrenia

Researchers have studied the link between substance use and schizophrenia. Specific attention to usually paid to genetic vulnerability, neurobiological aspects, side effects of possible medications, and psychological factors.

What is the Connection?

The discussion between potential links of substance use and paranoid schizophrenia develops controversial ideas. One explanation for the link between the two is the self-medication hypothesis. According to the National Library of Medicine, “self -medication is primarily used in order to deal with negative symptoms, such as social withdrawal and apathy, dysphoria, and sleeping problems, as well as drug use, in an attempt, to decrease discomfort from the side effects of antipsychotic medication.”9


Up to 50% of patients with schizophrenia exhibit either alcohol or illicit drug dependence

More than 70% are nicotine-dependent

In one study, 47% of the subjects with a lifetime diagnosis of schizophrenia met the criteria for some form of substance abuse.

How is Paranoid Schizophrenia Diagnosed?

Paranoid schizophrenia is diagnosed by testing and screening for other possible mental disorders and ruling out others.10

This process includes:

Physical exam:This helps to rule out any other issues possibly causing symptoms and checking for any related complications.

Tests and screenings: Tests and screenings rule out conditions with similar symptoms while also screening for present alcohol or drugs. This may also require imaging studies such as MRI or CT scans.

Psychiatric evaluation: This evaluation requires a mental health professional or doctor to observe one's appearance and demeanor and ask about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. The psychiatric evaluation also includes a discussion of family and personal history.

Diagnostic criteria for schizophrenia: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is used to diagnose the individual.

Treating Paranoid Schizophrenia

Paranoid schizophrenia is a lifelong disorder. Treatment may include medication and psychosocial therapy to help manage the effects of the condition, and it is guided by an experienced schizophrenia psychiatrist. Treatment may also require further expertise, such as a psychologist, a social worker, a psychiatric nurse, and a case manager.10

Treating Paranoid Schizophrenia and SUDs as a Dual Diagnosis

Treating substance use disorders (SUD’s) and paranoid schizophrenia as dual diagnoses pose challenges for individuals seeking recovery. Despite these challenges, research has discovered positive findings and results via different methods of therapy.

A study done by the National Library of Medicine states, “Several trials have yielded positive findings for naltrexone in reducing drinking compared to placebo in this population. Motivational and cognitive-behavioral interventions are associated with decreased substance use in several trials.”11

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