Features of the disease: paranoid psychosis and its 5 types

This article is about psychosis. For paranoid (paranoid) personality disorder, see paranoid personality disorder; for a rare delusional disorder, see paranoia; For the syndrome of paranoid psychosis, see paranoid syndrome.

Paranoid

(from ancient Greek παρά-, νοῶ “to understand, to understand” and εἶδος “appearance”, “appearance”, “image”) or
paranoid psychosis
- more severe than paranoia, but lighter than paraphrenia, delusional psychosis, characterized by paranoid syndrome.

Paranoid syndrome is characterized by unsystematized paranoid delusions, varying in content; more often in the form of ideas of persecution, relationship, influence, destruction, accusation, damage, poisoning, etc.). Sometimes it is combined with pronounced affective disorders, for example, with depressive-paranoid or anxiety-paranoid syndrome. Paranoid delusions are characterized by the patient’s belief in external adverse influences [1].

Most often, paranoids are observed in disorders of organic origin, in somatogenic and intoxication psychoses (such as alcoholic paranoid). In endogenous disorders such as paranoid schizophrenia, psychosis sometimes manifests itself as a pure paranoid syndrome[2]. In other cases, paranoid psychosis is combined with pseudohallucinations (mainly auditory), sometimes with mental automatisms, collectively forming the Kandinsky-Clerambault syndrome.

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Etiological factors

The reasons for the development of the disease are not precisely known. Paranoid psychosis cannot be considered an early stage of schizophrenia, since there is no tendency to progress and worsen the person’s condition. Accordingly, there is no connection with any genetic mutations or hereditary predisposition.

According to one theory, the etiology may be associated with organic damage in certain areas of the brain. This assumption is confirmed by the similar symptoms of tumors and injuries of the limbic system and subcortical nuclei. A connection with external social factors is also possible: paranoid psychosis is often diagnosed in people who have experienced imprisonment, persecution by law enforcement agencies, migration, and severe psychological trauma. It is believed that in such situations a person can withdraw into himself, trying to find a way out of the problem, trying to explain to himself why everything turned out this way. The result of such an internal conflict is paranoid psychosis.

The following may also play a role in the development of the disease:

• difficulties in establishing trusting relationships, first, at an early age, with parents, and later with a spouse (by the way, most patients are divorced);
• lack of self-confidence and, as a result, the need to depend on others;
• fear of being rejected after trying a failed relationship, etc.

Some authors identify paranoid psychosis with an established cause as a separate group of mental disorders. In most cases, this is the use of psychoactive substances, congenital or acquired neurological disorders.

What are paranoid thoughts

Treatment is always carried out comprehensively, and psychotherapy is mandatory. It is important that a trusting relationship be established between the patient and the doctor. The goal of therapy at the first stage is to convince the patient to systematically take medications.

Paranoid psychosis manifests itself, including the following symptoms::

• Sudden change of mood;
• Anxiety;
• Poor general condition of the body.

It is important to eliminate these symptoms as a matter of priority. And when the medications begin to take effect, gradually show the patient the discomfort of his delusional ideas, their inconsistency, and interest him in reality, in life events. The obvious collaboration of the doctor with the patient’s relatives is usually problematic, since it is regarded by the patient as a “conspiracy.” But such cooperation must be mandatory. Relatives must trust the doctor, they must ensure that the patient follows all instructions and recommendations, and they must create a healthy atmosphere around the patient.

Typical clinical picture of paranoid psychosis

Usually the patient carefully monitors his own appearance, is neat, there are no memory impairments, or orientation in time and space. The disease does not manifest itself “out of the blue”; exacerbation is provoked by a certain situation. After this, the violations progress quite quickly, and the detail and systematization of delusional ideas increases.

Without proper treatment, symptoms persist until the end of life in 60–70% of patients; cases of self-resolution are much less common. Favorable factors include favorable social status, female gender, and the first episode of exacerbation at an early age.

Paranoid psychosis is characterized by the following symptoms:

• hostility combined with criticism and frequent accusations towards others;
• low self-esteem, constant complaints, but at the same time the patient is usually confident in his own rightness, secretive;
• alertness;
• stubbornness;
• lack of sense of humor;
• pathological attention to minor details and trifles;
• severe irritability, rapid development of discontent, which ends in an outburst of anger and hostility towards others;
• gloominess and suspicion.

Main types of mental disorder

1. Delirium of grandeur. A person is sure that he has special talents that others cannot recognize and properly evaluate. These are some kind of superpowers, possession of enormous wealth (money, jewelry, antiques, etc.), secret knowledge, scientific discoveries made, close acquaintances or relationships with celebrities (for example, actors, musical performers). Sometimes they talk about a secret connection with God (such people often become either leaders or participants in semi-legal religious communities).
2. Erotomanic delirium (Clerambault syndrome). The patient imagines that someone is in love with him. Most often we are talking about a person with a higher social status and financial position. This could be a boss, a successful colleague, a celebrity. Often the feeling experienced is not of a sexual connotation, but rather of a romantic, spiritual attachment. More common in women. They usually keep their feelings and emotions secret, but they can also compulsively seek meetings with the “object of passion.”
3. Delusions of jealousy (sometimes called Othello syndrome). A person is sure that his partner is cheating on him, constantly talks about it, tries to catch him in infidelity, torments him with suspicions, surveillance, and persistent attempts to control.
4. Delusion of persecution (persecutory). It manifests itself as a clear belief that people are slandering you behind your back, trying to harm you, or preventing you from achieving any goals or career growth. Sometimes this type of disorder has a kind of “otherworldly” character, in which the patient is sure that all his problems are related to damage, curses, and conspiracies.
5. Somatic (hypochondriacal) delusion. Associated with false beliefs about one’s own injuries and health problems. As a rule, the disease develops in one of the following directions: the patient is sure that insects or parasites have appeared in his body, the conviction that his body, face, and hair have undergone dramatic changes. A disorder associated with a persistent belief in the stench of one's own body is often encountered. At the same time, they turn to a psychiatrist last; as a rule, first of all they consult dermatologists, dentists, plastic surgeons, parasitologists, etc.
6. Mixed (unspecified) form of pathology, in which the clinical picture is atypical. When collecting anamnesis, the presence of symptoms typical of various subtypes of the disease is noted.

Symptoms of paranoid psychosis

The first signs of this psychosis can be considered suspicion without any reason, manifested beyond any measure, constant doubts about the fidelity of the wife, the devotion of friends, the honesty of business partners, and so on. Remarks from other people are elevated to the level of personal threats and humiliation. There is inadequacy in a person’s actions and actions. The affective reactions that accompany paranoid psychosis may seem delusional to a normal person.

The patient begins to experience a disturbance in perception, as well as hallucinatory experiences. Some thoughts are blocked and his associations become loose; he is also prone to hypochondria. The patient has thoughts that the world is unusual, objects and people are strange, and everyone around him has a negative, biased attitude towards him. The main feature of behavior becomes dissatisfaction with everything and everyone, rancor, painful perception of even a small failure, an insignificant refusal.

The eccentricity of paranoid psychosis causes quite a lot of problems for the patient’s relatives. Therefore, in order to avoid exacerbation of the condition when the above signs appear in one of your loved ones, you need to seek help from a psychiatrist or psychotherapist.

Diagnostic methods

Paranoid psychosis requires careful diagnosis. Psychotherapists at the Leto clinic carry it out in several stages:

1. Recognizing typical paranoid signs. In this case, both objective and subjective symptoms are important. The doctor carefully interviews the patient himself, collects all information related to a possible mental illness from family members, friends and relatives. And only after analyzing all the data, a specialist can decide whether this condition is pathological.
2. Assessment of the course of the disease, accompanying clinical manifestations. At this stage, it is very important for the doctor to identify signs of disturbances in consciousness, perception and other manifestations that may directly or indirectly indicate a possible cause of the disease.
3. Anamnesis collection, special attention is paid to hereditary factors, use of psychoactive substances, and alcohol. We recommend a complete somatic examination, laboratory tests (serology, immunology, endocrinology, etc.), radiography, ultrasonography, tomography (especially relevant if the presence of tumors or the consequences of thrombosis is suspected).

Basic diagnostic criteria

• Delusional disorders with content and behavior atypical for schizophrenia.
• Symptoms persist for 3 months or more.
• Absence of hallucinations (except for visions combined with the content of delusional beliefs).
• No organic brain damage.

Pathology is differentiated from:

• initial manifestations of Alzheimer's disease, in which cognitive impairment is pronounced;
• severe depression;
• manic, obsessive-compulsive, somatophoric disorder;
• schizophrenia;
• dementia;
• drug or drug intoxication.

What diseases can it develop?

It should be understood that paranoid psychosis is not an independent mental disorder, but a syndromic diagnosis. Identification of such a condition requires clarification of the nature of the underlying disease and, if possible, the causative factor, including:

• Schizophrenia and other endogenous schizophrenia spectrum disorders (paranoid schizophrenia). For them, hallucinatory-paranoid disorders are the most common type of psychotic exacerbation of the condition, the main reason for the initial visit to the doctor and repeated hospitalizations in psychiatric hospitals.
• Chronic delusional disorder, characterized by long-term delusions (mainly of a persecutory nature) and at the same time not meeting the clinical criteria of schizophrenia.
• Psychotic disorders that develop due to the use of alcohol and psychoactive substances (drugs).
• Involutional paranoid that develops in old age. According to the modern International Classification of the Disease, it is classified as a chronic delusional disorder.
• Psychogenic paranoid psychosis or reactive paranoid.

Induced paranoid psychosis stands out separately. It develops in a person who communicates closely with an affectively charged paranoid patient. This is often observed in families when a parent or spouse accepts as truth and supports the delusional statements of their sick family member. The development of such a disorder is predisposed by the low intelligence of the induced person, the individual characteristics of his personality, and social isolation.

Treatment of paranoid psychosis at the Leto clinic

Strict indications for hospitalization are suicidal thoughts, suicide attempts, and socially unacceptable behavior. In other cases, patients generally have a positive attitude towards treatment, agree to take prescribed medications and strictly follow the schedule prescribed by the doctor.

Antipsychotics (neuroleptics) and antidepressants are prescribed as medications. But individual psychotherapy plays a key role. The doctor makes every effort to establish a trusting relationship, in no way criticizing delusional ideas. But at the same time, the doctor does not agree with the patient and does not accept his reasoning. The specialist “works” with anxiety, irritability, and behavior in society.

We are ready to prove in practice that such mental disorder is amenable to medication and psychotherapy. Call us at 8(969)060-93-93 and make an appointment

Treatment: paranoid syndrome

The issue of placing a patient in a clinic is decided on an individual basis.

Placed in hospital if:

• The person has inappropriate behavior, he threatens others;
• Thoughts about suicide appeared;
• May cause damage during work;
• The person has obvious social maladaptation.

You also need to go to the hospital when you need to accurately diagnose the disease. More women or men independently agree to undergo examination. If a person resists and is negative, then forced hospitalization can be applied in agreement with close people of the sick person. To eliminate attacks of delirium, the nature of which is acute and occurs with motor overexcitation, the doctor prescribes tranquilizers. Medications for maintenance therapy – antipsychotics – are also prescribed.