PARANOID SCHIZOPHRENIA

-- Steven had not liked high school very much and was glad to graduate and get a job. But when he realized he needed more education to reach his goals, he applied for admission into a nearby college. He rented a house with several other young men and did well in his studies. Near the end of his second year, Steven stopped eating with the others and ate only food directly out of a can so he could be sure it wasn't poisoned. When he crossed the campus, he tried to avoid girls as he felt they shot poisoned webs at him that encompassed his body like a giant spider web. When he began to feel that his housemates had put poisoned gas in his room, he dropped out of school and returned home. He cleaned up his room at home and put a lock on the door so his parents could not enter it and contaminate it. He bought a small electric hot plate and prepared all his own food. If his mother urged him to eat a meal with the family, he accused her of wanting to poison him. His parents finally were able to convince him to see a psychiatrist who diagnosed "schizophrenia, subtype paranoia." With medication, individual and group therapy, Steven has improved enough to work in an office under the supervision of an understanding and supportive employer.
Paranoid thinking and behavior are hallmarks of the form of schizophrenia called "paranoid schizophrenia." Individuals with paranoid schizophrenia commonly have extremely bizarre delusions or hallucinations, almost always on a specific theme. Sometimes they hear voices that others cannot hear or believe that their thoughts are being controlled or broadcast aloud. Also, their performance at home and on the job deteriorates, often with a much diminished degree of emotional expressiveness.

In contrast, people with relatively milder paranoid disorders may have such symptoms as delusions of persecution or delusional jealousy, but not the prominent hallucinations or impossible, bizarre delusions of paranoid schizophrenia. Those with milder paranoid disorders are customarily able to work, and their emotional expression and behavior are appropriate to their delusional belief. Apart from their delusions, their thinking remains clear and orderly. On the other hand, those with paranoid schizophrenia are often intellectually disorganized and confused.


CAUSES OF PARANOIA

Genetic Contribution

Little research has been done on the role of heredity in causing paranoia. Scientists have found that the families of paranoid patients do not have higher than normal rates of either schizophrenia or depression. However, there is some evidence that paranoid symptoms in schizophrenia may be genetically influenced. Some studies have shown that when one twin of a pair of identical twins with schizophrenia has paranoid symptoms, the other twin usually does also. And, recent research has suggested that paranoid disorders are significantly more common in relatives of persons with schizophrenia than in the general population. Whether paranoid disorder--or a predisposition to it--is inherited is not yet known.

Biochemistry

The discovery that psychosis (a state in which the individual is out of touch with reality) is treatable with antipsychotic drugs has led scientists to look for the origins of severe mental disorders in abnormal brain chemistry. The search has become very complex, as more and more of the chemical substances that carry messages from one nerve cell to another--the neurotransmitters--have been discovered. So far, no clear-cut answers have been found. As with the genetic studies, biochemical studies have not examined paranoia except as a subtype of schizophrenia. There is, however, limited evidence that paranoid schizophrenia is biochemically distinct from nonparanoid forms of the disorder.

Abuse of drugs such as amphetamines, cocaine, marijuana, PCP, LSD, or other stimulants or "psychedelic" compounds may lead to symptoms of paranoid thinking or behavior. Patients with major mental disorders like paranoid schizophrenia may have their symptoms become worse under the influence of these drugs. Scientists are studying the biochemical actions of such drugs to determine how they produce their behavioral effects. This may help us to learn more about the neurochemistry of paranoid disorders, which is poorly understood at this time.

Stress

Some scientists believe paranoia may be a reaction to high levels of life stress. Lending support to this opinion is the evidence that paranoia is more prevalent among immigrants, prisoners of war, and others undergoing severe stress. Sometimes, when thrust into a new and highly stressful situation, people suffer an acute form--called "acute paranoia"--in which delusions develop over a short period of time and last only a few months.

Some studies indicate that paranoia has become more prevalent in the twentieth century. The connection between stress and paranoia does not, of course, rule out other contributing factors. A genetic defect, a brain abnormality, an information-processing disability--or all three--could predispose a person to paranoia; stress may merely act as a trigger.
 

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