TREATMENT OF PARANOIA
Paranoid people's mistrustfulness makes treatment of the
condition difficult. Rarely will they talk casually in
an interview. They are suspicious of the kind of
open-ended questions many therapists rely on to learn
about the patient's history (for example, "Tell me about
your relationships with your co-workers."). They may try
to avoid hospitalization and drugs, fearing a loss of
control or other real or imagined dangers.
Treatment with appropriate antipsychotic drugs may help
the paranoid patient overcome some symptoms. Although
the patient's functioning may be improved, the paranoid
symptoms often remain intact. Some studies indicate that
symptoms improve following drug treatment, but the same
results sometimes occur among patients who receive a
placebo, a "sugar pill" without active ingredients. This
finding suggests that in some cases the paranoia
diminishes for psychological reasons rather than because
of the drug's action. Paranoid patients receiving
medication must be closely monitored. Their fearfulness
and persecutory delusions often lead them to refuse or
sabotage treatment--for example, by holding the drug in
their cheek until they are alone and then spitting it
Reports on individual cases suggest that the regular
opportunity to express suspicions and self-doubts
afforded by psychotherapy can help the paranoid patient
function in the community. Although paranoid ideas do
seem to persist, they may be less disruptive. Other
types of psychotherapy that have reportedly led to
improved social functioning without appreciably
diminishing paranoid delusions are art therapy, family
therapy, and group therapy.
OUTLOOK FOR PARANOID PATIENTS
In spite of the treatment difficulties, patients with a
paranoid disorder may function quite well. Even though
their paranoid views are apparently unshakable, various
treatments appear effective in improving social
functioning, so that they do not often require lengthy
hospitalization. The symptoms are less bizarre than
those associated with paranoid schizophrenia. Also, the
paranoid disorders seem to cause less disorganization of
the personality and disruptions in social and family
life. Unlike schizophrenia, which can become
progressively worse, paranoid disorder seems to reach a
certain level of severity and stay there.
FOR FURTHER INFORMATION
Kendler, K.S.; Spitzer, R.L.; and Williams, J.B.W.
Psychotic disorders in DSM-III-R. The American Journal
of Psychiatry 146:953-962, 1989.
Munro, A. Delusional (paranoid) disorders. Canadian
Journal of Psychiatry Vol. 33(5):399-404, 1988.
Opjordsmoen, S. Long-term course and outcome in
delusional disorder. Acta Psychiatrica Scandinavica Vol.
78(5):576-586, 1988. Schizophrenia Bulletin Vol 7, No.
4, 1981 (available in most medical libraries).
Sorensen, D.J.; Paul, G.L.; and Mariotto, M.J.
Inconsistencies in paranoid functioning, premorbid
adjustment, and chronicity: Question of diagnostic
criteria. Schizophrenia Bulletin Vol. 14(2):323-336,
Williams, J.G. Cognitive intervention for a paranoid
personality disorder. Psychotherapy Vol. 25(4):570-575,
This booklet was produced by the National Institute of
Mental Health (NIMH), the U.S. Government agency that
supports and conducts research to improve the diagnosis,
treatment, and prevention of mental illness. NIMH-supported
studies alleviate suffering and bring hope to people who
have a mental disorder, to those who are at risk of
developing one, and to their families, friends and
coworkers. Thus mental health research benefits millions
of Americans and reduces the burden that mental
disorders impose on society as a whole. NIMH is part of
the National Institutes of Health, a component of the
U.S. Department of Health and Human Services.
National Institute of Mental Health
All material appearing in this volume is in the public
domain and may be reproduced or copied without
permission from the Institute. Citation of the source is
This brochure was revised by Margaret Strock, staff
member in the Office of Scientific Information, National
Institute of Mental Health (NIMH). An earlier version
was done under contract for NIMH by Wray Herbert. Expert
assistance was provided by David Shore, M.D., David
Pickar, M.D., and Darryl G. Kirch, M.D., NIMH staff
members. Their help in assuring the accuracy of this
pamphlet is gratefully acknowledged.
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
DHHS Publication No. (ADM) 89-1495
Printed 1987 -ôRevised 1989
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