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Paranoid Schizophrenia - Signs, Symptoms, Diagnosis, and Treatment

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Paranoid schizophrenia is characterized by positive symptoms of schizophrenia which include delusions and hallucinations.

Medically reviewed by

Dr. Vishal Anilkumar Gandhi

Published At October 31, 2022
Reviewed AtNovember 9, 2022

What Is Paranoid Schizophrenia?

Paranoid schizophrenia is a mental disorder that predominantly comprises positive symptoms of schizophrenia-like hallucinations and delusion. It is the most common subtype of schizophrenia, the most common age of occurrence is between 18 to 30 years, and rare occurrence is spotted after the age of 45 or before 16 years of age, with higher male preference when compared to females. Individuals with paranoid schizophrenia, when affected by schizophrenia, worsen the situation as these people face difficulties differentiating between reality and their imaginations. Paranoid can be considered the early stage of schizophrenia; therefore, every individual with schizophrenia would present with the symptoms of paranoia, but it is not true; the other way is different.

What is the Difference Between Paranoid Schizophrenia and Schizophrenia?

Paranoid is a subtype of schizophrenia with predominant symptoms like hallucinations and delusions. Paranoid does not present with other signs of schizophrenia-like disorganized speech, catatonic behavior, or lack of emotion.

How Is Paranoid Schizophrenia Presented?

The symptoms of paranoid schizophrenia are similar to the initial symptoms of schizophrenia which develop slowly and are not noticed during the initial stages as they are acquired during the early teenage years.

Symptoms of paranoid schizophrenia are as follows:

  • Hallucinations are when someone sees, hears, smells, tastes, or feels things that do not exist outside their mind. For example, the most common hallucination is hearing voices.

  • A delusion is held with complete conviction. It may affect the way the person behaves.

  • Fantasies can begin or develop over weeks or months.

  • Irritability.

  • Difficulty in falling asleep.

  • I am socializing less often.

  • Fear and anxiety.

  • Inability to distinguish between real and imagined.

These symptoms make a living of a person difficult as they worsen their social and personal life by having thoughts like:

  • Their spouse or partner is cheating on them.

  • Co-workers are planning to harm them.

  • The government is spying on them.

  • People around are trying to harass them.

These thoughts create a fearful picture in the mind of an individual, which keeps them awake at night waiting for the person to come and attack; they at times, try to block the doors to prevent anyone from coming in. These individuals also try to isolate themselves to prevent any threat to life. They also avoid engaging in any relationships due to a lack of trust. These individuals have firmly held beliefs though there is strong evidence of the contrary. If the stages progress, these individuals have thoughts or hear commanding voices and are compelled to follow those reel voices, which can turn life-threatening. The voice heard sometimes includes commands to kill oneself, or a belief is implanted that people around are harmful to them.

What Are the Early Warning Signs of Paranoid Schizophrenia?

  • The person diagnosed with schizophrenia is most likely to have an underlying mental health condition like depression and social withdrawal.

  • Has an extreme reaction to criticism.

  • Compromised hygiene.

  • Expressionless face.

  • Oversleeping.

  • Inappropriate expression of feelings.

How Is Paranoid Schizophrenia Diagnosed?

The diagnosis of the disorder is based on the detailed clinical history that your physician obtains through a set of questions asked during consultations. These questions include questions related to symptoms or behaviors during the episodes and the questions to rule out the cause, trigger events, etc.; an individual diagnosed as schizophrenic must have at least five main symptoms.

In addition, the individual must present with at least five symptoms mentioned above, which include:

  • Delusions.

  • Hallucinations.

  • Disorganized speech.

  • Unusual movements.

  • Negative symptoms.

Duration of Symptoms: The symptoms must be present for a month before a diagnosis is concluded. At least 5 of the above symptoms, when present, confirms the diagnosis. The frequency and intensity of the symptoms also play a major role in the diagnosis of paranoid schizophrenia.

Social Dysfunction: This condition affects your personal and social life. Various laboratory tests and imaging tests like computed tomography (CT), magnetic resonance imaging (MRI), blood urine, cerebrospinal fluid test, and brain activity testing can help diagnose the disease.

How Is Paranoid Schizophrenia Treated?

The disorder is not curable; thus, treatment mainly aims at controlling the symptoms and avoiding the triggers. Sometimes, a person recovers completely and does not present with the symptoms, but the relapse is unpredictable.

Treatment includes a multidisciplinary approach with a prolonged period of treatment and multiple visits. The prognosis of the disease is better if the condition is diagnosed in the early stages. Treatment usually includes medications, self-management techniques, Therapy, and counseling.

What Are the Medications Prescribed?

Paranoid schizophrenia can be treated with typical and atypical antipsychotic medications, also called first and second-generation antipsychotic drugs. Typical antipsychotics block the dopamine action that facilitates neural communication in the brain. Atypical antipsychotic blocks the action of dopamine and serotonin in the brain, the most commonly used and most effective drug when other antipsychotics are ineffective is clozapine. However, These medications can have severe side effects, so they must be taken only on prescription, and a person must regularly visit the physician to check for the symptoms and monitor the blood.


Paranoid schizophrenia is a mental disorder that is a type of schizophrenia with relatively positive symptoms. Paranoid dystonia presents delusions, hallucinations, disorganized speech, unusual movements, and other negative symptoms. These patients are anxious and fearful due to the thought that their colleagues might harm them; at times, these patients fear falling asleep, thinking they would be attacked; treatment in such instances comprises multiple aspects that include medications, self-motivation therapies, and psychotherapies. Antipsychotics are the common medications used to treat paranoid schizophrenia.

Frequently Asked Questions


How to Diagnose Paranoia?

The diagnosis of paranoia is based on clinical observation for at least six months before locking the diagnosis. The symptoms include delusion, hallucinations, disorganized speech, social and occupational dysfunction, catatonic behavior, and emotional flatness. The diagnosis can only be finalized when the reporting symptoms are not correlated to drug or alcohol abuse or moss disorders. The time frame for reaching a diagnosis may be long.


How to Best Treat Paranoia?

The best treatment for paranoia is talking, also known as cognitive behavioral therapy. This can also help reduce worry and anxiety. Other treatment modalities include psychodynamic therapy, counseling, and family or systemic therapy. Pharmacotherapeutic approaches include antipsychotic drugs.


What Is Considered the First-Line Therapy for Schizophrenia?

Anti-psychotic drugs are considered first-line therapy against schizophrenia. These include drugs like Chlorpromazine, Fluphenazine, Perphenazine, and Haloperidol. This is usually prescribed along with psychosocial therapy. Patients have also been prescribed antidepressants or anti-anxiety drugs.


What Causes Paranoia?

Some of the causes of paranoia are:
- Life experiences.
- Childhood experiences.
- External environment.
- Anxiety, depression, or low self-esteem.
- Physical illnesses.
- Lack of sleep.
- Recreational drugs.
- Alcohol abuse.
- Genetic predisposition.


What Is the Onset of Paranoid Schizophrenia?

Paranoid schizophrenia can happen at any age, sex, and at different rates. However, the average onset of paranoid schizophrenia is usually between the ages of 15 and 25 in males and between 25 to 35 years in females. Childhood-onset of schizophrenia is a rare occurrence but is usually much more severe.


What Five Initial Symptoms Denote Schizophrenia?

The five initial symptoms of schizophrenia are:
- Delusions.
- Hallucinations.
- Disorganized speech and thinking.
- Disorganized or abnormal motor behavior.
- Lack of hygiene and emotions.


What Is the Behavior of a Paranoid Schizophrenic Like?

Paranoid schizophrenics are distrustful and suspicious of others, along with symptoms like hallucinations and delusions. The patient loses touch with reality, and their apparent beliefs are concrete. They believe that they are followed, chased, poisoned, harassed, or persecuted, even by their own family and friends.


Which Paranoia Is the Most Common Type?

There are three main types of paranoia: paranoid personality disorder, delusional disorder, and paranoid schizophrenia. In addition, there are multiple subtypes: persecutory, grandiosity, litigious paranoia, and erotic paranoia. However, persecutory paranoia is considered the most common subtype of paranoia.


Can Brain Damage Cause Paranoia?

Brain damage can cause paranoia. Most commonly, following brain injury, paranoid and persecutory paranoia. The paranoia is mostly seen during post-traumatic amnesia when the patient loses memory after the traumatic event. Post-traumatic paranoia is a rare but serious complication of traumatic brain injury.


What Are Examples of Paranoia?

Some examples of paranoia include the following:
- Exaggerated suspicion.
- Feeling of getting chased or persecuted.
- Feeling of imminent threat.
- The world is out to get one.
- Some nasty comments may reflect an apparent hate campaign.


How to Treat a Paranoid Personality?

The patients are prescribed anti-anxiety, antidepressant, or antipsychotic drugs by the specialists. In addition, the specialist would also recommend psychotherapy like cognitive behavioral therapy or dialectic behavior therapy.


Can Trauma Cause Paranoia and What Are Those?

Some of the traumas that cause paranoia are:
- Severe childhood abuse.
- Non-victimisation events.
- Sexual assault.
- Domestic violence.
- Car accidents.
- Natural disasters.
- War refugees.
- Veterans.


Which Is the Brain Segment Controlling Paranoia?

Amygdala is a part of the brain responsible for all emotional processes. It is located in the medial temporal lobe, just in front of the hippocampus. Incidentally, amygdala hyperactivity has also been reported to be responsible for paranoia.


Are Paranoid Schizophrenics Aware of Their Illness?

Paranoid schizophrenics are usually not aware of their illness. The prodromal phase of a paranoid event can mimic normal life changes. For example, an event may be preceded by falling grades or loss of work efficiency; this may be due to other factors but may also be part of paranoid prodrome.
Dr. Vishal Anilkumar Gandhi
Dr. Vishal Anilkumar Gandhi



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