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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.

Drug Treatment

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 out.

Psychotherapy

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, 1988.

Williams, J.G. Cognitive intervention for a paranoid personality disorder. Psychotherapy Vol. 25(4):570-575, 1988.

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.

Director
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 appreciated.


Acknowledgments

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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