Paranoid schizophrenia
The term "paranoid schizophrenia" is no longer used in the United States, since the 2013 change in the DSM-V that classifies the range of symptoms of former sub-types all under "schizophrenia". Schizophrenia is defined as "a chronic mental disorder in which a person is withdrawn from reality". Before 2013, schizophrenia had been divided into subtypes based on the "predominant symptomatology at the time of evaluation". The subtypes were classified as paranoid, disorganized, catatonic, undifferentiated, and residual type. However, they are not completely separate diagnoses, and cannot predict the progression of the mental illness.
This disorder is considered dominated by relatively stable delusions that are often real, however can be accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. These symptoms can have a huge effect on a person's functioning and can negatively affect their quality of life. Paranoid schizophrenia is a lifelong disorder, but with proper treatment, a person with the illness can attain a higher quality of life.
Although these two symptoms are especially pronounced in what had been defined as paranoid schizophrenia, this type also lacks certain symptoms common to the other forms. The following symptoms are not prominent: "disorganized speech, disorganized or catatonic behavior and flat or inappropriate affect". Those symptoms are present in another form of schizophrenia, disorganized-type schizophrenia. The criteria for diagnosing paranoid schizophrenia must be present from at least one to six months. This helps to differentiate schizophrenia from other mental disorders, such as bipolar disorder.
In the United States, paranoid schizophrenia is defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, but was dropped from the 5th Edition in 2013, along with the other four subtypes of schizophrenia. The five subtypes of schizophrenia were eliminated from the DSM by the American Psychiatric Association due to the lack of clear distinction among the subtypes and low validity of classification. Targeted treatment and treatment response vary from patient to patient, depending on his or her specific symptoms. Treatment options must be based on the severity of the symptoms in the patient.
Symptoms
Paranoid schizophrenia manifests itself in an array of symptoms. Common symptoms for paranoid schizophrenia include auditory hallucinations and paranoid delusions.Two symptoms have been defined as separating this form of schizophrenia from other forms. One such criterion is delusion. In all but rare cases, these beliefs are irrational, and can cause the person holding them to behave abnormally. Another criterion present in patients with paranoid schizophrenia is auditory hallucinations, in which the person hears voices or sounds that are not really present. The patient will sometimes hear multiple voices and the voices can either be talking to the patient or to one another. These voices can influence the patient to behave in a particular manner. Researchers at the Mayo Foundation for Medical Education and Research provide the following description: "They may make ongoing criticisms of what you're thinking or doing, or make cruel comments about your real or imagined faults. Voices may also command you to do things that can be harmful to yourself or to others." A patient exhibiting these auditory hallucinations may be observed "talking to them" because the person believes that the voices represent people who are present.
Early diagnosis of schizophrenia is critical for the successful treatment of the disease.
Diagnosis
According to the DSM-5, in order to be diagnosed with schizophrenia an individual must express at least two of the common symptoms for a minimum of six months. Symptoms include but are not limited to delusions, hallucinations, disorganized speech, and disorganized behavior. As previously stated, the DSM no longer recognizes any distinct subtypes of schizophrenia, including paranoid schizophrenia, due to their lack of validity. In previous editions of the DSM, paranoid schizophrenia was differentiated by the presence of hallucinations and delusions involving the perception of persecution or grandiosity in one's beliefs about the world. With the removal of the subtypes of schizophrenia in the DSM-5, paranoid schizophrenia will no longer be used as a diagnostic category. If a person expresses symptoms of schizophrenia, including symptoms previously associated with paranoid schizophrenia, they will be diagnosed with schizophrenia and be treated accordingly.Awareness and treatment
According to the Mayo Clinic in 2013, before the subtype was dropped from the DSM, paranoid schizophrenia should be treated as early as possible and the person should maintain the treatment throughout life. Continuing treatment will help keep the serious symptoms under control and allow the person to lead a more fulfilling life. While the illness is typically not preventable, it is important that the disorder be diagnosed and treated as soon as possible. Some common signs to be aware of are changes in mood, lack of motivation, irregular sleep, and disorganized behavior.Persons at high risk of being diagnosed with schizophrenia are among the homeless population; that is, many may be homeless because schizophrenia interferes with their functioning in life. Some studies indicate that as much as twenty percent of the homeless population is suffering from schizophrenia. Because of their circumstances, a large portion of those suffering will go undiagnosed and untreated.
Treatment
Paranoid schizophrenia is an illness that typically requires lifelong treatment with neuroleptics or 5-HT2A antagonists to enable someone with the disorder to have a relatively stable and normal life. In order to be successfully treated, a person with schizophrenia should seek help from family or primary care doctors, psychiatrists, psychotherapists, pharmacists, family members, case workers, psychiatric nurses, or social workers. In some cases, the person may not be able to do so, as many people with the disorder are unable to accept their condition. This denial can also result in lack of compliance with taking neuroleptics, especially if the patient considers the side effects to be more debilitating than the condition itself. The main options offered for the treatment of paranoid schizophrenia are the following: neuroleptics, psychotherapy, hospitalization, electroconvulsive therapy, and vocational skills training, often in combination.Many different types of disorders have symptoms similar to those of schizophrenia. Psychiatrists typically perform tests to achieve a correct diagnosis. These evaluations include "psychiatric evaluation, in which the doctor or psychiatrist will ask a series of questions about the patient's symptoms, psychiatric history, and family history of mental health problems; medical history and exam, in which the doctor will ask about one's personal and family health history and will also perform a complete physical examination to check for medical issues that could be causing or contributing to the problem; laboratory tests in which the doctor will order simple blood and urine tests can rule out other medical causes of symptoms".
As noted, side effects are associated with antipsychotic medication. Neuroleptics can cause high blood pressure and high cholesterol. Many people who take them exhibit weight gain and have a higher risk of developing diabetes.
History
Since the early 19th century, schizophrenia has been recognized as a psychiatric disorder. It was described in 1878 by Emil Kraepelin as dementia praecox, or the premature deterioration of the brain. He identified four types: simple, paranoid, hebephrenic and catatonic, based on how they presented clinically. He classified patients presenting with simple dementia praecox as exhibiting slow social decline, apathy, and withdrawal. Patients that were classified as having paranoid dementia praecox exhibited a high amount of fear and persecutory delusions. The hebephrenic type was described as being "silly". Finally, the catatonic type were those with increased motor symptoms. His definition of schizophrenia was primarily defined by early onset rather than deterioration. During Kraepelin's time, very few people were diagnosed with dementia praecox, due to the small range of symptoms recognized specifically as signs of this disorder. In 1908, Eugen Bleuler found that schizophrenia was less definitive than Kraepelin believed and that it could range from severe to mild cases. He used this information and coined the term schizophrenia, which literally means "split mind", to cover the range of the disorder.Bleuler thought that the disorder could be distinguished as cases that were beneficial or harmful and acute or chronic. He defined four main characteristics associated with the disease, commonly referred to as "the four As". The characteristics were as follows: autism, affect, associations, and ambivalence. This categorization was accepted widely in the United States for most of the 20th century, as Bleuler's hypothesis was broader than Kraepelin's and included many other assumed mental processes.
In Europe, however, Kurt Schneider developed a five-rank system in 1959 intended for practical use. His system relied on physical presentations and symptoms, rather than mental assumptions. Eventually, the broad diagnosis of schizophrenia was narrowed to a set of specific types of symptoms that were necessary in order to diagnose the disorder, and was also classified as several different types: paranoid, disorganized, and catatonic, along with undifferentiated and residual schizophrenia, which are a combination or very few residual symptoms of schizophrenia.
During World War II, the Nazi Party attempted to eradicate schizophrenia by compulsory sterilization of patients who had it, and also the murders of psychiatric patients.
As of 2013, with the publication of the new DSM-5, the different subtypes of schizophrenia are no longer specified or differentiated from schizophrenia in the manual. Instead, schizophrenia is viewed as one mental disorder with an array of different symptoms. Treatment for persons suffering from schizophrenia is based on the type of symptoms that are exhibited in each individual case. -->
As of 2018, the ICD-11 uses the following criteria as basis for diagnosis of schizophrenia: