Schizophrenia, as defined by the national institute of mental illness (2009), is mental disorder that exposes individuals to traits of forgetfulness, hearing of voices, or feelings of paranoia over being harmed by others. According to national mental alliance, it is a severe mental disorder that obstructs the ability of an individual to think abstractly, control emotions, and decision-making and how to relate to others (NAMI, 2013). It has a long history of occurrence and according to research, its incidence is neither culture distinct nor group influenced rather it is environmentally and genetically controlled (Jablensky, 2000; Tsaung et al. 2011; Castle and Buckley 2011). There are at least five subtypes of schizophrenia that do exist: paranoid, Undifferentiated, residual, catatonic and disorganized schizophrenia (Bengston, 2013). In catatonic schizophrenia, the predominant characteristic is disturbances in motion. In that individuals may exhibit voluntary movement reduction and in some cases the exhibit activity increase. According to Bengston (2013) paranoid schizophrenia is often characterized by auditory hallucinations and delusional thinking about getting persecutions or conspiracies by the patient. The only different feature about paranoid schizophrenia is that individuals with this subtype may be more functional in relationships than people with the other four types of schizophrenias (Bengston, 2013). The earliest onset of paranoid schizophrenia symptoms is in teens of 20’s and does not occur before the age of 12 years for a student (NAMI, 2013). Epidemiological studies have focused on its features but there much-conflicting information over its: prevalence, causes and sometimes cure. The present paper will look at some of the issues surrounding the paranoid subtype schizophrenia disorder and offer some insights for future dynamic analysis and research.
Individuals diagnosed with the paranoid subtype of schizophrenia may depict features of hallucination illustrated by a particular theme, and this idea seems to reoccur over some time. (Bengston, 2013)They may not appear unusual and are always unwilling to discuss their symptoms to anyone close to them. They also may show some signs of high temperaments which is often about the content of disturbances of their thoughts. For instance, individuals who believe that they are being persecuted unjustly or there is a conspiracy taking place underneath their comprehension may be angered so easily.
Further, individuals diagnosed with this ailment may only locate a psychiatric doctor at the time they experience some form of stress disturbance in their life and may not be willing to do it in ordinary circumstances. At this juncture, they may be identified with a peculiar characteristic which directly shows they are seeking attention or are in need of help (Bengston, 2013).Often, the paranoia features make them to be isolated with their conditions, and this is predominant in almost all forms of schizophrenia subtypes. They may not want to talk to any stranger, and this makes their situations to become much more severe.
These patients exhibit a broad gamut of symptoms at a particular time of their ailment. When symptoms are in exacerbation (extreme) stage, the thought process may be disorganized as well. At this point, they may experience trouble more often than normal in remembering recent events in their lives, speaking coherently or usually acting in an organized and rational fashion (Bengston, 2013, Castle and Buckley, 2011, Tsuang et al. 2005). While these symptoms may be common to almost all types of schizophrenia, supportive friends and family members may be needed to get professional help in these patients.(Bengston, 2013, Castle and Buckley, 2011, Tsuang et al. 2005)
For over a century, epidemiological research on paranoia schizophrenia indicates that its prevalence in population ranges from 1.4 to 4.6 per 1000 and its occurrence rates ranges from 0.16-0.42 per 1000 population (Jablensky, 2000). According to the very many contradicting research findings on the prevalence of schizophrenia, it is highly adaptive and different from region to region. The World Health Organization and other multi-centre organization indicate that there is a difference between western world nations and third world nations regarding schizophrenia’s course and outcome (Jablensky 2000; Castle and Buckley, 2011). But regarding its prevalence Tsuang et al. (2011, p.29) pointed out to the fact that schizophrenia is not cultured particular, and it does not discriminate whether one is from east or west or between developed and poorly developed countries. In Ghana for example, Schizophrenia’s prevalence rate was at 0.6 and Sweden was at 4.7 percent. Also, a study by Lemkao in 1936 indicated that United States prevalence rate was at 2.9 percent in population while Wing in 1967 saw a rise in the rates per 1000 population to at 7.0 percent in the United States and 4.4 percent in England (Tseung et al., 2011). Surprisingly Book studied in 1978 and pointed that schizophrenia rates per 1000 population in Sweden were at 17.0 which according to this paper, was the highest.
The large disparity between Ghana’s 0.6 percent prevalence and Sweden’s 17.0 percent may be as a result of different environmental adaptations and factors.(Tseung, et al. 2011) The populations studied, in this case, may be an isolated case which prefer a particular lifestyle that individuals with schizophrenia do prefer(Tseun et al. 2011; Jacksterby, 2000).
According to Castle and Buckley, the population of people living in inner cities in Northern Ireland and Sweden had high prevalence rates of Schizophrenia than anywhere else in the world or outer cities. Living in the larger city say in Denmark is associated with high risks of Schizophrenia as compared to living in the rural towns or just small townships.(Castle and Buckley, 2011; Jablensky, 2000). In a study by Faris and Dunham (1939), of 34, 864 mental disorder cases that were admitted to 4 individual hospitals and in about eight private sanitariums, there was a close relationship between insanity and ecological mapping. They also deducted that such is the same relationship depicted by schizophrenic dementia. In that, in 100,000 persons in a population there was a striking decrease in the rates of incidence from 362 in the disordered regions near city centers to 55.4 in residential areas that are on the outskirts of the city. Further, paranoid and hebephrenic schizophrenia subtypes have a high incidence in rooming-house of the towns where the family unit is broken down, and isolation is rampant among individuals because of lifestyle changes and economic desires (Faris and Dunham, 1939). The studies are essential in determining the rate at which paranoid schizophrenia incidence occurs in the population and the length of its prevalence in the current world as much as its historical epidemiological perspective.
Regarding etiology, Paranoia Schizophrenia shares the strongest risk factor in genetics (Castle and Buckley, 2011) with a gradient based on loading. Family studies have pointed out to both genes and the environment to be the main causes of Schizophrenia in all cultures. The two do not exist discretely, but they complement one another in a patient. Individuals with specific gene variations such as the catechol-O-methyl transferase (COMT) gene which involves the breakdown of dopamine makes a person’s vulnerability to the expression of schizophreniform psychosis to increase in case the take cannabis. In this, the taking of cannabis is multifaceted with the desire to achieve gratification due to a deficiency of the nucleus accumbens –the pleasure seeking part of the brain (Castle and Buckley, 2011)
According to Tsaung et al., (2011) schizophrenia runs in families and a lifetime risk for children from parents who had the disorder rising to between 4 and 14%, which averages almost ten times higher than in general population. Specifically, children from schizophrenic parent pose a threat of contacting the disorder at 12.3 percent. The figures translate to about fifteen times higher than the risk of the general population (Tsaung et al., 2011). According to the works by Jenny Koller, she examined the aggregation in families of about 284 probands and 370 normal and healthy families (Jablensky, 2000). She found out that, hereditary loading in healthy participants was much higher than imagined and that loading in distant family relation is much lower unless the individual at risk is exposed to multiple different issues.(Jablensky, 2000). Further evidence points to variation in the random distribution of the Schizophrenia incidences with ‘urbanicity’, guy sexual category, history of migration that is associated with the illness (Tandon, et al. 2008).
Regarding Identical twins, Tsaung et al. (2011) point to the fact that it is true the disease is caused as a gene resulting in either, being identical or fraternal twins. If the gene causes the disease in identical twins, they are stated to be concordant for schizophrenia and discordant if it causes schizophrenia in one of them (p.36). Thus, schizophrenia paranoia manifests in kids born out of this relationship at a later stage, and it is only through epidemiology that such factors be determined.
The other non-hereditary causes of schizophrenia are debatable but are of different dimensions. According to Castle and Buckley (2011) these issues include, the season of birth, in which individuals born in winter or in the northern hemisphere have demonstrated high chances of having the disorder. Also, exposure to influenza type A2 increases the chances of contracting the disease later in life. Ethnic migration, substance abuse and maternal issues like anemia and stress contribute the increased chances of developing the disease later on in life.
Course of the Disorder
According to Tsuang et al., (2011) the studies conducted by several researchers including the World Health Organization reflect the findings of Kraeplin’s research. That the course and outcome of schizophrenia cases are on average worse than in mood disorders and its onset is gradual over course of time or rapid and shortly. Further, patients who have had a history of paranoid schizophrenia or any other type may recover from the illness or at some point experience a comparatively benevolent outcome.(Tsuang et al., 2011) Further, the course and outcome of schizophrenia subtypes like paranoia may be categorically improved through environmental issues such as stress and family interaction.(Tsuang et al., 2011)
It happens so that paranoia schizophrenia and other forms of schizophrenia occur along a non-linear course. In a study conducted by Tschacher et al., (1997) over the hypothesis that, schizophrenia may be viewed as a nonlinear dynamical ailment daily rating, 14 psychotic dynamics patients were observed daily. In the results, eight patients showed the features resembling non-linear evolutions of schizophrenic course. Four patients were modeled linearly and two under random processes. The results give a backing that schizophrenic course is along a nonlinear direction of analysis.
The World Health Organization has conducted research regarding course and outcome of schizophrenia and evidence point to the fact that the disorder might have different course and outcome in developed and developing nations (Jablensky, 2000). They state that there is a better prognosis in developing countries as compared to developed nations. The reason pointing out to this difference is the different interactions between gene variations and environment. The results place paranoid schizophrenia and other diseases such as cancer and diabetes into genetically complex ailments that are characterized by polygenic transfer, locus heterogeneity and environmental causation (Jablensky, 2000).
Medically there is limited knowledge on the correct treatment of paranoid schizophrenia or any other subtype of schizophrenia. Although research is still in place, the actual cure to schizophrenia seems a distant epoch to achieve. According to Tsuang et al., (2011, p.87) only neuroleptic medications are available in the medicine industry not to cure but to control and manage the positive symptoms of schizophrenia. Although this may be the case, these types of treatments have side effects on the patients and many people may shun them citing the side effects of the drugs.
On the other hand, there is increasing evidence pointing to the fact that cognitive behavioral treatments of paranoia and other forms of disillusions are the only solutions available (Combs, 2011).According to research done by Combs (2011), cognitive therapy for the psychosis came up as a result of treatment methods for anxiety and depression. Since psychotic symptoms are aligned to information processing prejudices such as appraisal and attention as in paranoia, cognitive therapy becomes the ideal method for managing the ailment. It can also treat certain specific symptoms such delusions, hallucinations and negative symptoms as depicted by paranoid schizophrenia. These when combined with other social training ability, coping skills, and family care, paranoid schizophrenia can be reduced considerably in a population (Combs, 2011). Regarding delusions, cognitive treatment can only be effective when combined with behavioral challenge or confrontation of the delusion. In this scenario, the family of the patient plays a significant role in helping the patient to establish this form of confrontation.
There are different subtypes of schizophrenia in population which seem to persist over the course of time. These forms of disorder subtypes include: paranoid, undifferentiated, catatonic, residual and disorganized schizophrenia. The current paper aimed at establishing the common: symptoms, causes, prevalence and treatment of paranoid schizophrenia. Though it is a common form of schizophrenia, individuals suffering from this disorder may have hallucinated features and delusions. The most prominent dimension of this ailment is the tendency to function properly in relationships and high temperaments by the patients. The prevalence and incidence of schizophrenia is relatively low over population in rural towns but high to individuals in inner cities. Those close to the northern hemisphere have an increased tendency of contracting it and can only handle the disease through several stress modification methods and family interactions. Other mechanisms necessary for its management are like cognitive behavioral therapy as proposed by Combs (2011). Further, empirical data and research is needed to ascertain the real cause of paranoid schizophrenia and the possible reasons that embed its management to cognitive behavioral therapy and not just proper medication.