Paranoid Schizophrenia

Paranoid schizophrenia is the most common subtype of schizophrenia. The disease is characterized by various symptoms such as paranoia, visual and auditory hallucinations. This is also where the alternative term “paranoid-hallucinatory schizophrenia” comes from.

Paranoid Schizophrenia

What is paranoid schizophrenia?

Schizophrenia has many forms and is one of the so-called endogenous psychoses. These are clinical pictures that are associated, among other things, with a loss of reality and disorders of thinking and emotions and arise from a variety of internal factors. See ezhoushan for What does Hypesthesia Stand for.

Contrary to what is often wrongly assumed, schizophrenia is not a question of a split personality. Nor is it related to reduced intelligence, but rather to errors in perception and interpretation of the environment. Around 25 out of 10,000 Germans suffer from schizophrenia.

Women and men are equally affected, but the disease breaks out earlier in the latter on average. About half of all suffering patients show symptoms of paranoid schizophrenia in the course of the disease. This type often develops in middle-aged people and thus later than other schizophrenic disorders.

At the heart of paranoid schizophrenia are disturbances in ego-consciousness, hallucinations and, above all, delusions, from which the term is derived.


It is not possible to pinpoint a single cause of paranoid schizophrenia, but there are several risk factors that favor the onset of the disease. On the biochemical level, the messenger substances in the brain (neurotransmitters) are of great importance. Scientists suspect that disturbed dopamine metabolism is related to schizophrenia.

This is supported by experience with amphetamines, which promote the release of dopamine and intensify symptoms. Serotonin is also suspected of influencing the course of the disease. The messenger has an effect on the perception of pain, memory and happiness. Overactivity of individual nerve tracts can cause the increased release of these neurotransmitters.

It also defines some psychosocial risk factors that can trigger the onset of paranoid schizophrenia. If there is a certain genetic predisposition, psychological stress has particularly strong effects on some people. Critical and traumatic experiences, especially in early childhood, represent an increased risk.

The same applies to a stressful social environment or an existing depression. In addition, schizophrenic disorders rarely occur as a result of infections from which the mother of the affected person suffered during pregnancy. These include, above all, Lyme disease and herpes simplex. Other possible somatic causes include lactose intolerance, celiac disease, and prenatal or postnatal hypoxia.

Symptoms, Ailments & Signs

Paranoid schizophrenia has three main symptoms: delusions, ego disturbances and hallucinations. The delusion is expressed by a very strong conviction, which is not comprehensible for healthy people, that they are being monitored or persecuted, for example.

The patient is usually in a state of paranoia in which he believes that all external events and people are closely related to him. He interprets everyday events as signs or hidden messages and cannot withdraw from these thoughts. Related to this is the disruption of the ego.

The patient experiences demarcation problems between the experience of the I and the environment and is no longer able to look at things rationally from the outside. Associated with this are disorders such as thought withdrawal, derealization, and depersonalization. Hallucinations usually occur on an acoustic level, over 80 percent of all those suffering from paranoid schizophrenia report such symptoms.

They hear voices giving them orders, insulting them, or conveying paranoid thoughts. This can lead to the sufferer feeling compelled to engage in self-injurious acts or aggressive behavior towards others.

Diagnosis & course of disease

The first and most important step in the diagnosis is a conversation between the doctor and the patient, in which the psychotic signs that occur are questioned. Various criteria regarding the type and duration of the symptoms must be met in order to be able to diagnose the disease. Symptoms such as auditory hallucinations or paranoid thoughts lasting at least a month make schizophrenia likely.

Other critical signs are reduced emotional responsiveness (flattening of affect), disorganized thought patterns and speech disorders. The interview is followed by a comprehensive neurological and physical examination. This should rule out other diseases such as epilepsy, brain tumors, brain infections or traumatic brain injuries.

It is also important to rule out hallucinations and delusions that occur as a result of substance abuse such as LSD, cannabis, ecstasy, cocaine or alcohol. If negative symptoms such as lack of drive and lack of speech predominate, it must be ensured that these are not part of a depression. Other mental disorders such as bipolar disorders, autism, obsessive -compulsive disorders and [[personality disorders]9s must also be differentiated.


Paranoid schizophrenia is usually associated with delusions and hallucinations. Those affected develop a veritable paranoia, feel constantly under surveillance, believe that other people are monitoring them and want to harm them. You are overly suspicious and believe that you are under surveillance and being bugged even in your own home.

Some fall into the delusion that normal, everyday events want to communicate hidden messages to them. When people talk to each other, they feel like they’re talking about them. Hallucinations are also not uncommon. Paranoid schizophrenics hear voices, smells, and see things that don’t really exist. This can go so far that they feel like voices are giving them orders.

In addition, they are often restless, argumentative and even angry to the point of violence if they suspect a threat. In this state, they are no longer open to reasonable arguments and it is advisable to call an ambulance so that the person concerned does not harm himself or others. Sometimes the schizophrenic has to be admitted to a psychiatric clinic against their will.

When should you go to the doctor?

People who suffer from behavioral problems that are perceived by the world as severely abnormal should be examined by a doctor. In most cases of mental illness, there is a lack of insight into the illness. This means that the person concerned feels healthy and has no awareness of the presence of a health disorder. Delusions or hallucinations need to be evaluated by a doctor as soon as possible.

If the person concerned reports hearing voices or having inspirations, this is considered unusual. When you firmly believe that a power is controlling or draining your thoughts, medical attention is needed. If the person concerned perceives himself outside of his own body, a conversation with a doctor should be sought. Aggressive or self-destructive behavior is a concern.

In serious cases, an emergency doctor is needed or a medical officer must be informed so that compulsory admission can be initiated. Insults or sudden abuse of others are common in people with paranoid schizophrenia. Those affected perceive the environment as a potential threat and lose touch with reality. Everyday life cannot be managed without outside help. Therefore, a medical consultation is recommended at the first signs.

Treatment & Therapy

The treatment of paranoid schizophrenia nowadays promises good prognosis, even if the disease is not always curable. It is based on a combination of drug treatment, psychotherapy and other therapy methods that are individually tailored to the patient. For drug treatment, especially in an acute phase, an antipsychotic is often used.

This regulates the metabolism of neurotransmitters, suppresses psychotic symptoms and inhibits the absorption of stimuli. However, a significant improvement in the symptoms only occurs after a few weeks. If the symptoms subside, the dosage is reduced. Therapeutic measures can only be taken if the patient is willing to cooperate. In psychotherapy, the focus is on processing the experience of illness, coping with life problems and self-help.

Sociotherapy focuses on the damage within the family and the entire environment that has occurred as a result of the illness. Work therapies, structuring measures and the involvement of the family are part of this. After the symptoms have subsided, many suffer from cognitive impairments. These are treated as part of cognitive rehabilitation.

Outlook & Forecast

Paranoid schizophrenia is now easily treatable. Drugs such as neuroleptics on the one hand and therapeutic treatment on the other counteract the delusions. Early treatment is important. In the context of psychotherapy, the triggers of the disease are worked through.

In the long term, comprehensive therapy can prevent relapses. Frequently occurring comorbidities such as depression or alcohol or drug addiction have a negative effect on the prognosis. If physical diseases such as diabetes are also present, life expectancy is also reduced. In addition, people suffering from paranoid schizophrenia have an increased risk of suicide.

The prognosis is made jointly by psychotherapists and specialists. Because paranoid schizophrenia can have a wide variety of causes and manifests itself through numerous symptoms, it is usually not possible to make a reliable prognosis. Instead, the prognosis has to be continually adapted to the current state of health of the patient. The prospect of recovery is also good. With the administration of neuroleptics and comprehensive therapeutic support, the majority of patients overcome the disease. Further support after recovery reduces the risk of recurrence and secondary diseases such as depression.


In order to reduce the risk of paranoid schizophrenia, the general stress level should be reduced. This means addressing problems in the family or at work at an early stage and working to overcome them.

Trauma from the past and psychological stress should be worked through, also with the help of psychotherapeutic measures, before a schizophrenic clinical picture develops from it. It is important to recognize and treat early symptoms such as sleep disorders, tiredness, restlessness and behavioral changes.


The family plays an important role in relapse prevention. On the one hand, family members can be a resource and provide support – on the other hand, an unfavorable family climate can also be a trigger for relapses. In addition, other people often find it easier to recognize a relapse than the schizophrenic. For these reasons, it is often useful in paranoid schizophrenia to involve the family in treatment and follow-up care.

Since paranoid schizophrenia cannot be completely cured in every case, medication can also be part of the aftercare. These serve to control the psychotic illness as well as possible and to reduce the risk of a relapse. A psychiatrist decides together with the patient whether and which medications are suitable for this.

Occupational and social rehabilitation can also be part of aftercare. Occupational rehabilitation deals, for example, with the question of whether the patient can continue to practice his previous job and what changes may be necessary to enable him to continue working.

Social training or sociotherapy may also be considered to help the schizophrenic lead a self-determined life again. However, all measures must be individually tailored to the respective person, since paranoid schizophrenia can take very different courses.

You can do that yourself

Patients suffering from paranoid schizophrenia normally suffer a loss of reality. Since they are often unable to take care of themselves, they need outside help. Relatives and people from the immediate social environment should obtain comprehensive expert information about the disease, the symptoms and the necessary measures. This makes it easier to deal with the disease and leads to timely intervention.

Medical care is necessary in patients with paranoid schizophrenia to improve quality of life. In addition, cognitive and behavioral therapies help with long-term relief of symptoms. A good relationship of trust between the patient, their relatives and the doctor treating them is important for optimal care. The person affected suffers delusions and hallucinations, which can be anxiety-provoking for people in the social environment. Through education and an intensive exchange with other affected people, fears can be reduced and tips for better dealing with the disease in everyday life can be promoted.

In many cases the patient is unable to work. However, finding adequate employment and having a job is important to improve the overall quality of life. Risk factors of schizophrenia should be minimized in parallel. The number of stimuli that flow to the patient through existing environmental influences should be reduced to improve health.