Paranoid schizophrenia is one of several types of

schizophrenia, a chronic mental illness in which reality is

interpreted abnormally (psychosis). The classic features of
paranoid schizophrenia are having beliefs that have no basis
in reality (delusions) and hearing things that aren't real
(auditory hallucinations).

With paranoid schizophrenia, your ability to think and

function in daily life may be better than with other types of
schizophrenia. You may not have as many problems with
memory, concentration or dulled emotions. Still, paranoid
schizophrenia is a serious, lifelong condition that can lead to
many complications, including suicidal behavior. But with
effective treatment, you can manage the symptoms of
paranoid schizophrenia and work toward leading a happier,
healthier life.

Symptoms
By Mayo Clinic staff
Signs and symptoms of paranoid schizophrenia may include:

 Auditory hallucinations, such as hearing voices

 Delusions, such as believing a co-worker wants to

poison you

 Anxiety

 Anger

 Aloofness
  Violence

 Verbal confrontations

 Patronizing manner

 Suicidal thoughts and behavior

With paranoid schizophrenia, you're less likely to be affected

by mood problems or problems with thinking, concentration
and attention. Instead, you're most affected by what are
known as positive symptoms.

Positive symptoms
Positive symptoms are symptoms that indicate the presence
of unusual thoughts and perceptions that often involve a loss
of contact with reality. Delusions and hallucinations are
considered positive symptoms of paranoid schizophrenia.

 Delusions. In paranoid schizophrenia, delusions are

often focused on the perception that you're being
singled out for harm. Your brain misinterprets
experiences and you hold on to these false beliefs
despite evidence to the contrary. For instance, you may
believe that the government is monitoring every move
you make or that a co-worker is poisoning your lunch.
You may also have delusions of grandeur — the belief
that you can fly, that you're famous or that you have a
relationship with a famous person, for example.
Delusions can result in aggression or violence if you
believe you must act in self-defense against those who
want to harm you.
  Auditory hallucinations. An auditory hallucination is
the perception of sound — usually voices — that no one
else hears. The sounds may be a single voice or many
voices. These voices may talk either to you or to each
other. The voices are usually unpleasant. They may give
a running critique of what you're thinking or doing, or
they may harass you about real or imagined faults.
Voices may also command you to do things that can be
harmful to yourself or to others. When you have
paranoid schizophrenia, these voices seem real. You
may talk to or shout at the voices.

When to see a doctor

If you have any symptoms of paranoid schizophrenia, seek
medical help as soon as possible. Paranoid schizophrenia
doesn't get better on its own and may worsen without
treatment. However, if you're like most people with paranoid
schizophrenia, you may not recognize that you need help or
that you even have symptoms, especially because your
delusions or hallucinations are very real to you. Family and
friends, or people at work or school, may be the ones who
initially suggest you seek help.

Getting treatment from a mental health provider with

experience in schizophrenia can help you learn ways to
manage your symptoms so that you have the best chance to
continue on with a productive and happy life. If you're
reluctant to seek treatment, try to work up the courage to
confide in someone, whether it's a friend or loved one, a
health care professional, a faith leader or someone else you
trust. They can help you take the first steps to successful
treatment.
Helping someone who may have paranoid
schizophrenia
If you have a loved one you think may have symptoms of
paranoid schizophrenia, have an open and honest discussion
about your concerns. You may not be able to force someone
to seek professional help, but you can offer encouragement
and support and help your loved one find a qualified doctor
or mental health provider. If your loved one poses a danger
to himself or herself or to someone else, you may need to
call the police or other emergency responders for help. In
some cases, emergency hospitalization may be needed. Laws
on involuntary commitment for mental health treatment vary
by state.

Suicidal thoughts
Suicidal thoughts and behavior are common when you have
paranoid schizophrenia. If you're considering suicide right
now and have the means available, talk to someone now.
The best choice is to call 911 or your local emergency
services number. If you simply don't want to do that, for
whatever reason, you have other choices for reaching out to
someone:

 Contact a family member or friend

 Contact a doctor, mental health provider or other health

care professional

 Contact a minister, spiritual leader or someone in your

faith community

 Go to your local hospital emergency room

  Call a crisis center or hot line

 Causes
 By Mayo Clinic staff
 It's not known what causes paranoid schizophrenia.
However, a growing body of evidence suggests that
paranoid schizophrenia and other forms of schizophrenia
are caused by brain dysfunction. Why and how that
brain dysfunction occurs is still under investigation,
though.

 It's thought that an interaction of genetics and

environment may lead to brain dysfunction that causes
paranoid schizophrenia. Problems with certain naturally
occurring brain chemicals called neurotransmitters may
also contribute to paranoid schizophrenia. Imaging
studies show differences in the brain structure of people
with schizophrenia, but researchers aren't yet sure
about the significance of these changes.

Risk factors
By Mayo Clinic staff
Although the precise cause of paranoid schizophrenia isn't
known, researchers have identified certain factors that seem
to increase the risk of developing or triggering paranoid
schizophrenia, including:

 Having a family history of schizophrenia

 Exposure to viruses while in the womb

  Malnutrition while in the womb

 Stressful life circumstances

 Trauma or abuse during childhood

 Older paternal age

 Taking psychoactive drugs during adolescence

According to the National Institute of Mental Health,

schizophrenia affects about 1 percent of the general
population, and paranoid schizophrenia affects an even
smaller percentage. Schizophrenia typically becomes
apparent between the teenage years and the mid-30s, but
paranoid schizophrenia may start later in life.

Complications
By Mayo Clinic staff
Left untreated, paranoid schizophrenia can result in severe
emotional, behavioral, health, and even legal and financial
problems that affect every area of your life. Complications
that paranoid schizophrenia may cause or be associated with
include:

 Suicidal thoughts and behavior

 Self-destructive behavior

 Depression

 Abuse of alcohol, drugs or prescription medications

  Poverty

 Homelessness

 Incarceration

 Family conflicts

 Inability to work or attend school

 Health problems from antipsychotic medications

 Being a victim or perpetrator of violent crime

 Heart and lung disease related to smoking

Preparing for your

appointment
By Mayo Clinic staff
In some cases, a health care provider, family member, friend
or another acquaintance may ask about your behavior,
thoughts and mood or suggest that you be evaluated by a
mental health provider. Or you may decide on your own to
schedule an appointment with your family doctor or mental
health provider to talk about your concerns. In some cases,
you may be taken to a hospital for an emergency psychiatric
evaluation. But when possible, try to be an active and willing
participant in your own care.

What you can do

Being an active participant in your care can help your efforts
to manage your condition. One way to do this is by preparing
for a planned medical or psychiatric appointment. Think
about your needs and goals for treatment. Also, write down a
list of questions to ask. These questions may include:

 Why do you think I have paranoid schizophrenia?

 How do you treat paranoid schizophrenia?

 How can treatment help me?

 Are there medications that might help?

 Will psychotherapy help?

 How long will treatment take?

 What can I do to help myself?

 Are there any brochures or other printed material that I

can take home with me? Or can you recommend reliable
Web sites to visit?

In addition to your prepared questions, don't hesitate to ask

questions at any time during your appointment if you don't
understand something.

What to expect from your doctor

During your appointment, your doctor or mental health
provider is likely to ask you a number of questions about
your thoughts, behavior and mood. You may be asked such
questions as:
  When did you first notice symptoms?

 How is your daily life affected by your symptoms?

 Do you hear or see things other people don't seem to?

 Do you have certain powers that other people don't?

 What have you tried on your own to feel better or to

control your symptoms?

 What things make you feel worse?

 Have friends or family commented on your thoughts or

behavior?

 Have any relatives had a mental illness?

 What medications or over-the-counter herbs and

supplements do you take?

Tests and diagnosis

By Mayo Clinic staff
If your doctor or mental health provider believes you may
have paranoid schizophrenia or another mental illness, he or
she typically runs a series of medical and psychological tests
and exams. These can help pinpoint a diagnosis, rule out
other problems that could be causing your symptoms and
check for any related complications.

These exams and tests generally include:

  Physical exam. This may include measuring height and
weight, checking vital signs, such as heart rate, blood
pressure and temperature, listening to your heart and
lungs, and examining your abdomen.

 Laboratory tests. These may include a complete blood

count (CBC), screening for alcohol and drugs, and a
check of your thyroid function.

 Psychological evaluation. A doctor or mental health

provider will talk to you about your thoughts, feelings
and behavior patterns. He or she will ask about your
symptoms, including when they started, how severe
they are, how they affect your daily life and whether
you've had similar episodes in the past. You'll also
discuss any thoughts you may have of suicide, self-harm
or harming others. Your doctor may also want to talk to
family or friends, if possible.

Diagnostic criteria for paranoid schizophrenia

To be diagnosed with paranoid schizophrenia, you must meet
the symptom criteria spelled out in the Diagnostic and
Statistical Manual of Mental Disorders (DSM). This manual is
published by the American Psychiatric Association and is used
by mental health providers to diagnose mental conditions
and by insurance companies to reimburse for treatment.

Diagnostic criteria for paranoid schizophrenia include:

 A preoccupation with one or more delusions

 Frequent auditory hallucinations

It can sometimes be difficult to diagnose paranoid
schizophrenia, especially because other conditions may have
similar symptoms. Be sure to stick with it, though, so that
you can get appropriate treatment.

Treatments and drugs

By Mayo Clinic staff
Paranoid schizophrenia is a chronic condition that requires
lifelong treatment, even during periods when you feel better
and your symptoms have subsided. Treatment can be
challenging because you may feel as if you don't need
treatment, and you may refuse to follow treatment
recommendations. But effective treatment can help you take
control of your condition and enjoy a happier and healthier
life.

Treatment options are similar for all types of schizophrenia.

But the specific treatment approach that's best for you
depends on your particular situation and the severity of your
symptoms.

Treatment teams
Paranoid schizophrenia treatment is usually guided by a
psychiatrist skilled in treating the condition. But you may
have others on your treatment team as well because the
condition can affect so many areas of your life. Your
treatment team can help make sure that you're getting all of
the treatment you need and that your care is coordinated
among all of your health care providers.
The team involved in treatment of paranoid schizophrenia
may include your:

 Family or primary care doctor

 Psychiatrist

 Psychotherapist

 Pharmacist

 Family members

 Case worker

 Psychiatric nurse

 Social worker

Main treatment options

The main treatments for paranoid schizophrenia are:

 Medications

 Psychotherapy

 Hospitalization

 Electroconvulsive therapy (ECT)

 Vocational skills training

Medications for paranoid schizophrenia
Medications are the cornerstone of paranoid schizophrenia
treatment. Among the medications most commonly
prescribed for paranoid schizophrenia are:

 First-generation (typical) antipsychotics. These

medications are thought to control symptoms by
affecting brain chemicals called neurotransmitters.
These medications have traditionally been very effective
in managing the positive symptoms of paranoid
schizophrenia, including delusions and hallucinations.
These medications, however, have frequent and
potentially severe neurological side effects, including the
possibility of tardive dyskinesia, or involuntary jerking
movements. Typical antipsychotics, especially generic
versions, are often cheaper than are their newer
counterparts, which can be an important consideration
when long-term treatment is necessary.

 Second-generation (atypical) antipsychotics. These

newer antipsychotic medications are effective at
managing hallucinations, delusions and other symptoms,
such as loss of motivation and lack of emotion. Atypical
antipsychotic medications pose a risk of metabolic side
effects, including weight gain, diabetes and high
cholesterol.

 Other medications. It's common to have other mental

health issues along with paranoid
schizophrenia. Antidepressantscan be helpful if you
have symptoms of depression. Anti-anxiety
medications can be helpful if you have symptoms of
anxiety or agitation. And mood stabilizing
medications may help with aggression or hostility.
Choosing a medication
In general, the goal of treatment with antipsychotic
medications is to effectively control signs and symptoms at
the lowest possible dosage. Which medication is best for you
depends on your own individual situation. It can take several
weeks after first starting a medication to notice an
improvement in your symptoms.

If one medication doesn't work well for you or has intolerable

side effects, your doctor may recommend combining
medications, switching to a different medication or adjusting
your dosage. Don't stop taking your medication without
talking to your doctor, even if you're feeling better. You may
have a relapse of psychotic symptoms if you stop taking your
medication. In addition, antipsychotic medication needs to be
tapered off, rather than stopped abruptly, to avoid
withdrawal symptoms.

Medication side effects and risks

All antipsychotic medications have side effects and possible
health risks. Certain antipsychotic medications may increase
the risk of diabetes, weight gain, high cholesterol and high
blood pressure, for instance. Others can cause dangerous
changes in your white blood cell count or cause health
problems in older adults.

Be sure to talk to your doctor about all of the possible side

effects and about being routinely checked for health
problems while you take these medications. Antipsychotic
medications can also have dangerous interactions with other
substances. Tell your doctors about all medications and over-
the-counter substances you take, including vitamins,
minerals and herbal supplements.

Psychotherapy for paranoid schizophrenia

Although medications are the cornerstone of paranoid
schizophrenia treatment, psychotherapy is also important.
Psychotherapy may not be appropriate for everyone, though,
especially if symptoms are too severe to engage in a
therapeutic process that requires two-way communication.
Psychotherapy may include:

 Individual therapy. Psychotherapy with a skilled

mental health provider can help you learn ways to cope
with the distress and daily life challenges brought on by
paranoid schizophrenia. Therapy can help reduce the
severity of your symptoms and improve communication
skills, relationships, your ability to work and your
motivation to stick to your treatment plan. Learning
about paranoid schizophrenia can help you understand it
better, cope with lingering symptoms and understand
the importance of taking your medications. Therapy also
can help you cope with stigma surrounding paranoid
schizophrenia. There are many types of psychotherapy
that may be useful, such as cognitive behavioral
therapy.

 Family therapy. Both you and your family may benefit

from therapy that provides support and education to
families. Your symptoms have a better chance of
improving if your family members understand your
illness, can recognize stressful situations that might
trigger a relapse, and can help you stick to your
treatment plan. Family therapy can also help you and
 your family communicate better with each other and
understand family conflicts. Family therapy also can help
family members cope and reduce their distress about
your condition.

Hospitalization for paranoid schizophrenia

During crisis periods or times of severe symptoms,
hospitalization may be necessary. This can help ensure your
own safety and that of others, and make sure that you're
getting proper nutrition, sleep and hygiene. Partial
hospitalization and residential care also may be options.

Electroconvulsive therapy (ECT) for paranoid

schizophrenia
Electroconvulsive therapy (ECT) is a procedure in which
electric currents are passed through your brain to trigger a
brief seizure. This seems to cause changes in brain chemistry
that can reduce symptoms of certain mental illnesses such as
paranoid schizophrenia. Because ECT can provide significant
improvements in symptoms more quickly than can
medications or psychotherapy, electroconvulsive therapy
may be the best treatment option in some cases. Deciding
whether electroconvulsive therapy is a good option for you
can be extremely difficult. Make sure you understand all the
pros and cons.

Social and vocational skills training for paranoid

schizophrenia
Training in social and vocational skills to live independently is
an important part of recovery from paranoid schizophrenia.
With the help of a therapist, you can learn such skills as good
hygiene, cooking and better communication. Many
communities have programs that can help you with jobs,
housing, self-help groups and crisis situations. If you don't
have a case manager to help you with these services, ask
your doctors about getting one.

Treatment challenges in paranoid schizophrenia

When you have appropriate treatment and stick to your
treatment plan, you have a good chance of leading a
productive life and functioning well in daily activities. But be
prepared for challenges that can interfere with treatment.

For one thing, you, like many others with schizophrenia, may
find it hard to follow your treatment plan. You may believe
that you don't need medications or other treatment. Also, if
you're not thinking clearly, you may forget to take your
medications or to go to therapy appointments. Talk to your
doctors about tips to stick to your treatment plan, such as
taking an antipsychotic medication that's available in a long-
lasting injectable form. Even with good treatment, you may
have a relapse. Have a plan in place to deal with a relapse.

Smoking, and often heavy smoking, is common when you

have schizophrenia. Some evidence suggests that smoking
improves thinking and concentration in schizophrenia. If you
smoke, you may need a higher dose of antipsychotic
medication because nicotine interferes with these
medications. Be honest with your doctors about your
smoking habits. And be sure you understand the serious
health risks of smoking.

Similarly, using alcohol and drugs can make paranoid

schizophrenia symptoms worse. If you have a problem with
alcohol or substance abuse, you may benefit from treatment
programs that include care for both schizophrenia and
substance abuse.

Lifestyle and home

remedies
By Mayo Clinic staff
Paranoid schizophrenia isn't an illness that you can treat on
your own. But you can do some things for yourself that will
build on your treatment plan:

 Take your medications as directed. Even if you're

feeling well, resist any temptation to skip your
medications. If you stop, schizophrenia symptoms are
likely to come back.

 Pay attention to warning signs. You and your

caregivers may have identified things that may trigger
your paranoid schizophrenia symptoms, cause a relapse
or prevent you from carrying out your daily activities.
Make a plan so that you know what to do if symptoms
return. Contact your doctor or therapist if you notice any
changes in symptoms or how you feel. Involve family
members or friends in watching for warning signs.
Addressing schizophrenia symptoms early on can
prevent the situation from worsening.

 Avoid drugs and alcohol. Alcohol and illicit drugs can

worsen schizophrenia symptoms. Get appropriate
treatment for a substance abuse problem.
  Check first before taking other
medications. Contact the doctor who's treating you for
paranoid schizophrenia before you take medications
prescribed by another doctor or before taking any over-
the-counter medications, vitamins, minerals or
supplements. These can interact with your schizophrenia
medications.

Coping and support

By Mayo Clinic staff
Coping with an illness as serious as paranoid schizophrenia can be challenging. Medications
can have unwanted side effects, and you may feel angry or resentful about having a
condition that requires lifelong treatment. During periods when you feel better, you may be
tempted to stop treatment, which can trigger a relapse. Here are some ways to cope with
paranoid schizophrenia:

 Learn about paranoid schizophrenia. Education about your condition can

empower you and motivate you to stick to your treatment plan.

 Join a support group. Support groups for people with schizophrenia can help you
reach out to others facing similar challenges.

 Stay focused on your goals. Recovery from paranoid schizophrenia is an ongoing

process. Stay motivated by keeping your recovery goals in mind. Remind yourself
that you're responsible for managing your illness and working toward your goals.

 Find healthy outlets. Explore healthy ways to channel your energy, such as
hobbies, exercise and recreational activities.

 Learn relaxation and stress management. Try such stress-reduction techniques

as meditation, yoga or tai chi.

 Structure your time. Plan your day and activities. Try to stay organized. You may
find it helpful to make a list of daily tasks.

Prevention
By Mayo Clinic staff
There's no sure way to prevent paranoid schizophrenia.
Evidence shows that some signs of schizophrenia may be
present from early childhood or even infancy. Early
identification and treatment for people at risk of
schizophrenia, perhaps starting in childhood, may help get
symptoms under control before serious complications develop
and may help improve the long-term outlook. Also, sticking
with your treatment plan can help prevent relapses or
worsening of paranoid schizophrenia symptoms.