Schizophrenia is one of the most well-known psychotic disorders in most people and one of the most socially stigmatized mental disorders in history. While the existence of schizophrenia is currently considered a single diagnostic entity, the truth is that until a few years ago it was divided into several types. Among them is paranoid schizophrenia, Which we will talk about in this article explaining its associated symptoms, treatments and possible causes.
Schizophrenia is a type of psychotic mental disorder characterized by the presence for at least six consecutive months of symptoms in which hallucinations, delusions, speech impairment, catatonia, emotional flattening or altered mood, impoverishment of thinking or lack of motivation, appeared in at least one of the first three.
These and other symptoms are generally grouped into two groups: positive symptoms, which involve an aggregation of certain elements of normative behavior (such as hallucinations, language derailments, hallucinations or agitation) and negative symptoms or those involving a decrease or deficit in the subject’s abilities. and abilities (such as emotional flattening, abulia, or allergy or mental impoverishment).
But the presentation of symptoms is not the same for all patients with schizophrenia. In fact, one can find different groups of people who have similar symptoms to each other and the alterations are very different from each other, which is why different groups or types of schizophrenia were traditionally formed and for which even today ( although the different types of schizophrenia have been ruled out in the DSM, including the one in this article) some authors believe that more than schizophrenia should talk about psychotic spectrum disorders.
Paranoid schizophrenia: main symptoms
Paranoid schizophrenia is perhaps the most well-known and typical type of schizophrenia. It is considered as such in this modality of schizophrenia characterized by a predominant presence of positive symptomatology, mainly existing psychic symptoms in which appear auditory hallucinations and delusional ideas. The subject usually does not have other alterations common in other types of schizophrenia, such as catatonia, impoverishment of thought, or alterations in speech or movement.
We are also ahead the type of schizophrenia that causes the least cognitive impairment (There are usually no negative symptoms) and what better response to treatment than you usually have.
The hallucinations of patients with this hearing disorder are generally seen, often in the form of third-person voices that speak to the subject and tend to have derogatory and threatening content to the subject. These hallucinations and their content are therefore often persecutions, The patient feels that something or someone is trying to hurt him and may trigger reactions of fear, anxiety or aggression in him (although contrary to popular belief, the possibility of a unexpected aggression is relatively mild and usually occurs in patients who do not follow treatment and have high impulsivity).
The subject tends to delirium because of these hallucinations, forming a distorted account of the reality underlying these perceptions. The subject can develop the belief that this being persecuted or possessed. Illusions of grandeur or even of a messianic type may also arise, seeing oneself as a deity or someone with great powers or in possession of a truth that no one else knows. It is not uncommon for clothing delusions or thought readings to appear as well.
The exact causes of schizophrenia, whether we think of it as a single disorder or separate them into different types, remain unknown today. This does not mean that there are no different models and assumptions in this regard, some of which are as follows.
From a biological point of view, the existence of genetic factors has been proposed as predisposing to the disorder, which generate problems of differentiation and neuronal migration throughout development. In people with schizophrenia some functional and anatomical alterations are observed at the cerebral level which have been proposed to explain the manifestation of the symptomatology. For example, we observe the existence of a greater volume of the cerebral ventricles and structures such as the hippocampus and the amygdala, as well as a lower than normal blood supply to the frontal lobes and the existence of asymmetries. between storms.
In this sense, we also consider the model of the three networks, in which we find a hypofunctional neural network at the level of the frontal structure, a hyperfunction of the limbic structures and the continuous activation of the so-called default network, the neural network. that it would be activated in the absence of activity from another network (it can only be such or such activity, not both at the same time) and that in people with schizophrenia would be permanently active (which makes it incompatible that the usual neural networks are activated).
Possible causes of symptoms
At the level of symptomatology, one of the best known hypotheses is the one we are talking about alterations in dopaminergic systems: Positive symptoms would be related to an excess or hyperfunction of the mesolimbic pathway while negative symptoms would be related to a deficiency of this hormone in the mesocortical pathway. With regard to the paranoid subtype specifically, the most visible and important alteration would occur at the mesolimbic level, and there might be no alteration in the mesocortical pathway.
There has also been some connection with the season of births, with a higher prevalence of this disorder in children born in winter. Other theories speak of a possible incidence of certain viruses or diseases during pregnancy which, in some cases, could alter the development of the fetus, such as influenza (which would tie it to the previous theory).
At the psychological level, it is indicated that the biological factors would be a permanent vulnerability, which could be activated depending on the possibility or the impossibility of adapting to the vital and stressful circumstances with which the subject is confronted.
To finish, as for the phenomenon of hearing voices that people with paranoid schizophrenia usually experience, in addition to the above mentioned excess dopamine in the mesolimbic pathway, it has been assumed a disconnection between the prefrontal and the regions that generally speak it, being the self-generated mental content of the voice which is attributed to external causes: this disconnection would ensure that the verbal content is not recorded as part of its own conscious functioning.
While the symptoms of paranoid schizophrenia may seem more dramatic and striking than those of other types, the truth is that we are faced with one of the modalities of schizophrenia that have the best prognosis (Since they don’t have as much risk of cognitive impairment as other subtypes with negative symptoms) and they respond better to treatment. Despite this, there is currently no cure for this disorder, but the therapies and treatments used focus on controlling symptoms and preventing psychotic flare-ups.
Intervention with drugs
At the pharmacological level, people who suffer from it they are being treated with antipsychotics or neuroleptics, Which aim to correct excess dopamine in the mesolimbic pathway by blocking its receptors. Although in paranoid schizophrenia there are usually no negative symptoms, the use of atypics is recommended as they have less side effects than the classics. Medicines are needed all the time, because they are very important not only in the treatment of a psychotic epidemic, but also in the prevention of new epidemics.
Intervention with psychological therapy
At the psychological level, Psychoeducation is fundamental in the first place in order to facilitate adherence to treatment and the understanding of the symptoms and alterations suffered. The involvement and psychoeducation of the family and the immediate environment, which must understand the nature of the problem, possible indicators of a future outbreak of an epidemic and the guidelines to be used if one occurs, is also essential. Empathy is essential and an active listening to the subject and the environment, dispelling doubts and giving space to the expression of thoughts and emotions.
Regarding the psychological treatment of hallucinations, one of the therapies that can be used is target therapy in the voices of Slade, Haddock and Bentall. The operation of this therapy is based on the fact that the patient gradually focuses his attention on different elements of the voices he hears, deepens in them so that the subject gradually ceases to attribute them to external elements or beings and reassigns them to his own mind. content. It usually begins by focusing on the characteristics of the voice in question (tone, volume, whether the voice is male or female …), to continue working on the content and finally on the beliefs that the person has about it. .
While this is something most professionals are already familiar with and should take into account, it should be mentioned that it is essential not to trivialize or imply that the voices themselves are a bit nonexistent or their imaginations: the subject matter. Really perceives them as something external, even if it is mental content not attributed to oneself, is something that can generate a high level of suffering. It is also very helpful to show the subject that the voices, whatever they say, cannot cause them real harm.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
- Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.