Paranoia: Drug, Causes and Treatment

The Word Paranoia is mainly used by mental health specialist to describe suspicion that is either highly exaggerated. Paranoia is used in everyday conversation, often in anger. Simple suspiciousness is not paranoia-not if it is based on past experience or expectations learned from the experience of others.

Paranoia can be mild and the affected person may function fairly well in society, or it can be so severe that the individual is incapacitated. Because some paranoid features accompany many psychiatric disorders, diagnosis is sometimes difficult. Paranoia's can be classified into three main categories-paranoid personality disorder, delusional (paranoid) disorder, and paranoid schizophrenia.

Cause of Paranoia

Genetic Contribution

Little research has been done on the role of heredity in causing paranoia. Scientists have found that the families of paranoid patients do not have higher than normal rates of either schizophrenia or depression. However, there is some evidence that paranoid symptoms in schizophrenia may be genetically influenced. Some studies have shown that when one twin of a pair of identical twins with schizophrenia has paranoid symptoms, the other twin usually does also. And, recent research has suggested that paranoid disorders are significantly more common in relatives of persons with schizophrenia than in the general population. Whether paranoid disorder-or a predisposition to it-is inherited is not yet known.

Biochemistry

The discovery that psychosis (a state in which the individual is out of touch with reality) is treatable with anti psychotic drugs has led scientists to look for the origins of severe mental disorders in abnormal brain chemistry. The search has become very complex, as more and more of the chemical substances that carry messages from one nerve cell to another--the neurotransmitters--have been discovered. So far, no clear-cut answers have been found. As with the genetic studies, biochemical studies have not examined paranoia except as a subtype of schizophrenia. There is, however, limited evidence that paranoid schizophrenia is bio chemically distinct from non-paranoid forms of the disorder. Abuse of drugs such as amphetamines, cocaine, marijuana, PCP, LSD, or other stimulants or "psychedelic" compounds may lead to symptoms of paranoid thinking or behavior. Patients with major mental disorders like paranoid schizophrenia may have their symptoms become worse under the influence of these drugs. Scientists are studying the biochemical actions of such drugs to determine how they produce their behavioral effects. This may help us to learn more about the neurochemistry of paranoid disorders, which is poorly understood at this time.

Stress

Some scientists believe paranoia may be a reaction to high levels of life stress. Lending support to this opinion is the evidence that paranoia is more prevalent among immigrants, prisoners of war, and others undergoing severe stress. Sometimes, when thrust into a new and highly stressful situation, people suffer an acute form-called "acute paranoia"-in which delusions develop over a short period of time and last only a few months.

Some studies indicate that paranoia has become more prevalent in the twentieth century. The connection between stress and paranoia does not, of course, rule out other contributing factors. A genetic defect, a brain abnormality, an information-processing disability-or all three-could predispose a person to paranoia; stress may merely act as a trigger.

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 anti psychotic 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.

Paranoid Personality Disorder

Suspicious

An unmistakable sign of paranoia is continual mistrust. People with paranoid personality disorder are constantly on their guard because they see the world as a threatening place. They tend to confirm their expectations by latching on to any speck of evidence that supports their suspicions and ignore or misinterpret any evidence to the contrary. They are ever watchful and may look around for signs of a threat.

Anyone in a new situation-beginning a job or starting a relationship, for example-is cautious and somewhat guarded until he or she learns that the fears are groundless. People suffering from paranoia cannot abandon their fears. They continue to expect trickery and to doubt the loyalty of others. In a personal relationship or marriage, this suspiciousness may take the form of pathological, unrealistic jealousy.

Hypersensitive

Because persons with paranoid personality disorder are hyper alert, they notice any slight and may take offense where none is intended. As a result, they tend to be defensive and antagonistic. When they are at fault, they cannot accept blame, not even mild criticism. Yet they are highly critical of others. Other people may say that these individuals make "mountains out of molehills."

Cold and Aloof

In addition to being argumentative and uncompromising, the people with paranoid personality disorder are often emotionally cut off from other people. They appear cold and, in fact, often avoid becoming intimate with others. They pride themselves on their rationality and objectivity. People with a paranoid outlook on life rarely come to the attention of clinicians--it is not in their nature to seek help. Many presumably function competently in society. They may seek out social niches in which a moralistic and punitive style is acceptable, or at least tolerated to a certain degree.

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