Paranoid Schizophrenia

What is paranoid schizophrenia?

The term “paranoid schizophrenia” is an outdated name for a subtype of schizophrenia. Experts no longer use or recognize this term. Instead, experts recognize schizophrenia as a specific disease, which is part of a spectrum of related conditions that involve psychosis.

The American Psychiatric Association removed paranoid schizophrenia from the list of official diagnoses when updating the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), published in 2013. The World Health Organization removed paranoid schizophrenia from the International Classification of Diseases when updating to the 11th edition (ICD-11) in 2019.

What is the difference between paranoid schizophrenia and schizophrenia?

The term “paranoid schizophrenia” is obsolete. It previously described schizophrenia with very noticeable paranoia and delusions.

Who does it affect?

Schizophrenia usually happens at different ages depending on biological sex, but it doesn't happen at different rates. It usually starts between ages 15 and 25 for people assigned male at birth and between 25 and 35 for people assigned female at birth. Schizophrenia in children is rare but possible, and these cases are usually much more severe.

How common is this condition?

Schizophrenia is an uncommon — but widely known — condition. Experts estimate about 85 people out of every 10,000 will develop this condition at some point in their lifetime. Worldwide, there are about 2.77 million new cases each year.

How does this condition affect my body?

Schizophrenia is a mental health condition that disrupts several different areas of your brain. This condition typically affects your thinking abilities, memories .and senses. People with schizophrenia commonly struggle to tell what's real and what isn't. They often have hallucinations and delusions (see below to learn more about these symptoms) and struggle with disorganized thinking.

What are the symptoms?

Schizophrenia typically happens in three stages. The active stage of schizophrenia is when symptoms are at their worst. The key symptoms of schizophrenia are:

• Delusions.
• Hallucinations.
• Disorganized or incoherent speech.
• Disorganized or unusual behavior.
• Negative symptoms.

Paranoia and what it looks like

Paranoid schizophrenia was once a subtype of this condition because paranoia commonly happens with schizophrenia. Paranoia is a pattern of behavior where a person feels distrustful and suspicious of other people and acts accordingly.

Delusions and hallucinations are the two symptoms that can involve paranoia.

• Delusions. These are persistent false beliefs. A person who has a delusional belief usually won't change their mind even if faced with strong evidence. Delusions involving paranoia are often "persecutory," which means a person believes that someone is trying to harm them or negatively affect their life.
• Hallucinations. These are events a person imagines (usually in the form of something that a person hears or sees). A person who has a hallucination typically can't tell that what they're experiencing isn't real. These commonly feed into delusions by giving the person additional "evidence" to confirm that someone is trying to harm or upset them.

Lack of insight

A common feature of schizophrenia is a symptom known as anosognosia. This condition, often described as “lack of insight,” means that a person’s brain can’t recognize any signs, symptoms or other evidence of a medical condition that they have. This lack of insight is very common with schizophrenia, which is why people with schizophrenia often don't believe that they have the condition and are more likely to resist treatment.

What causes schizophrenia, and does it have any triggers?

Schizophrenia doesn't have a single confirmed cause. Experts suspect that several factors play a role, but none of these guarantees that you'll develop schizophrenia. The three main reasons that schizophrenia happens include:

• Chemical imbalances in your brain. The chemicals involved are those that your brain uses to communicate between brain cells.
• Congenital brain problems. These are problems that affect your brain’s development before you're born.
• Communication disruptions between areas of the brain. Your brain relies on intricate networks of connections between its various areas. Experts suspect that schizophrenia happens because those connections deteriorate.

Experts believe several risk factors contribute to developing schizophrenia. Those risk factors include genetic mutations you inherit from one or both parents, exposure to certain chemicals or substances, complications during pregnancy and recreational drug use. However, experts have yet to uncover any confirmed triggers or causes for this condition.

Is it contagious?

Schizophrenia isn't contagious. It doesn’t spread from person to person.

How is it diagnosed?

A healthcare provider, usually a mental health specialist like a psychiatrist, diagnoses schizophrenia using a combination of tools and techniques. Some of the techniques involve analyzing your medical and personal history, asking you questions about your experiences and symptoms, and observing your behavior and actions.

Combining those methods is necessary because diagnosing schizophrenia requires the following:

• At least two of the five main symptoms.
• Main symptoms that have lasted at least one month, and overall effects that have lasted at least six months.
• Disruption in your social or work life.

What tests will be done to diagnose this condition?

Many possible tests can happen with schizophrenia. While none can diagnose the condition directly, they can rule out other conditions and problems that cause similar symptoms.

The possible tests include:

• Imaging tests. These can include computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans and other imaging tests.
• Blood, urine and cerebrospinal fluid (spinal tap) tests. These tests look for chemical changes in bodily fluids, as well as heavy metal poisoning, infections and more.
• Brain activity testing. An electroencephalogram (EEG) analyzes and records the electrical activity in your brain, which can rule out seizures or epilepsy.

How is it treated, and is there a cure?

Schizophrenia is almost always treatable, but it isn’t curable. Some people can recover from schizophrenia entirely and never have it return. However, experts consider people in that situation “in remission” because there’s no way to predict if it will or won’t return.

Treating schizophrenia generally involves multiple methods applied in sequence or at the same time. Medication, therapy and self-management techniques are common, and all three can help treat this condition when applied consistently and effectively. Diagnosing and treating this condition sooner rather than later also increases the likelihood of a good outcome.

What medications or treatments are used?

Medication is a cornerstone of most treatment plans for schizophrenia. People with schizophrenia often undergo other treatments that complement or enhance the effects of medications.

There are two main types of medications that treat schizophrenia, typical antipsychotic medications and atypical antipsychotic medications. Other medications may also help treat schizophrenia directly or help reduce the side effects of antipsychotic medications.

Other treatments or techniques that may help include:

• Psychotherapy: Mental health therapy can help people with schizophrenia understand their condition and adapt to it better. It can also help them manage mental health concerns that may happen with or because of schizophrenia.
• Electroconvulsive therapy (ECT): This is especially helpful when schizophrenia resists medications, or a person has such severe psychosis symptoms that they are a danger to themselves or others.

How do I take care of myself or manage the symptoms?

You should never try to self-diagnose schizophrenia or diagnose it in a loved one. Schizophrenia isn't always an easy condition to diagnose, and it takes training and experience to diagnose it accurately. This condition also involves symptoms that can happen with other conditions, such as paranoid personality disorder or delusional disorder. Because of all these factors, a healthcare provider should be the one to diagnose this condition.

How soon after treatment will I feel better?

If you have questions about how long it will take before you notice the effects of your treatments, the best source of information is your healthcare provider. Your provider is the most accurate source of information because they can consider the factors in your life that might affect when you notice the effects of treatments. They can also talk to you about other available treatment options when initial treatments aren't effective.

How can I reduce my risk or prevent this condition?

Schizophrenia happens unpredictably, so it's impossible to prevent it or reduce your chances of developing it.

What can I expect if I have this condition?

Schizophrenia is a condition that can cause severe disruptions in a person’s life because it affects their connection to reality. That means a person with schizophrenia has trouble knowing what’s real and what isn’t. That can be a scary and very disorienting feeling.

When a person experiences paranoia that feeds into delusions and hallucinations, it’s common for them to feel afraid and unable to trust others. A person with schizophrenia may see others trying to help them and mistake their efforts as attempts to cause harm.

With treatment, schizophrenia is often manageable. Without treatment, or if there are long delays or gaps in treatment, people with schizophrenia are more likely to struggle with the effects of this condition.

This can have severe or even dangerous impacts on a person’s life, increasing the risk of problems with maintaining relationships and holding a job. That can lead to problems like housing insecurity or social isolation. People with schizophrenia also have a higher risk of dying by suicide, which means treatment can be life-saving, not just helpful.

How long does schizophrenia last?

Schizophrenia is a lifelong, incurable condition. Some people may have only one episode of schizophrenia in their lifetime. However, healthcare providers consider these cases “in remission” instead of cured or resolved because the symptoms can return unpredictably.

How do I take care of myself?

Taking care of yourself and managing schizophrenia is possible, especially when people with this condition build a strong, trusting relationship with a healthcare provider and their loved ones. Some of the most important things you can do to take care of yourself include:

• Take your medication as prescribed (and don’t stop taking it without first talking to your provider).
• See your provider as recommended (these visits can help with adjusting medication or treatment plans to help you best).
• Don’t ignore or avoid your symptoms.
• Avoid alcohol and recreational drug use (these can worsen your symptoms or cause other problems).
• Consider seeking support.
• Build relationships with people you trust — especially loved ones and your healthcare provider — and don’t isolate yourself from them.

When should I see my healthcare provider?

You should see your healthcare provider as recommended, or if you notice a change in your symptoms or the effectiveness of your medication(s).

When should I go to ER?

You should go to the ER or call 911 (or your local emergency services number) if you have thoughts about harming yourself, including thoughts of suicide or about harming others. If you have thoughts like this, you can call any of the following:

• National Suicide Prevention Lifeline (United States). To call this line, dial 1-800-273-TALK (1-800-273-8255).
• Local crisis lines. Mental health organizations and centers in your area may offer resources and help through crisis lines.
• 911 (or your local emergency services number): You should call 911 (or the local emergency services number) if you feel like you’re in immediate danger of harming yourself. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

What can I do if a loved one shows signs of schizophrenia or a similar condition?

Because people with schizophrenia often can't recognize their symptoms or condition, they often don't believe they need medical care or treatment. That can be frustrating or frightening for both the person with the symptoms and those who care about them.

If you notice a loved one showing signs of schizophrenia or a related condition, you can try to help them by doing the following:

• Ask how you can help. Listening and offering your help keeps a line of communication open and helps them feel connected to others.
• Encourage them to see someone who can help. Treatment for schizophrenia, especially medication, can improve a person's symptoms. In many cases, that's enough to help them recognize that they have a medical condition that needs care.
• Don’t judge or argue. People with schizophrenia have trouble recognizing what’s real and what isn’t. Avoid judging them or trying to convince them that they’re experiencing hallucinations or delusions. That may cause them to lose trust or fuel feelings of paranoia.
• Stay calm. Anger and frustration can negatively affect your relationship with a loved one who has schizophrenia. It's also easy for them to feel overwhelmed in noisy or hectic environments. Try to pick quiet and calming environments, and do what you can so they feel as safe and comfortable as possible.
• Get help in emergencies. If someone with schizophrenia talks about harming themselves or others, or if they show severe paranoia, agitation or act violently, you should call your local emergency services immediately.

A note from Cleveland Clinic

Paranoid schizophrenia is an outdated term for the condition schizophrenia, but paranoia is still a common part of the symptoms that people experience. Schizophrenia is a disorienting and often frightening condition for people who have it, causing them to lose touch with reality and their ability to tell what’s real and what isn’t.

When people experience paranoia, they may struggle to trust people who want to help. That can make diagnosing and treating this condition very difficult. However, with medical care, especially medications, people with schizophrenia can avoid severe complications and can live fulfilling lives.