Daily Archives: November 29, 2010

Comparing Parnaoid Schizophrenia and Delusional Disorder


In comparing delusional disorder and paranoid schizophrenia I noticed that paranoid schizophrenia is actually a step or two further than delusional disorder, even though these two disorders are not related.

The delusions in delusional disorder are not out of the ordinary meaning the delusion a person is currently suffering from could actually happen, but is still considered to be slightly farfetched.  Generally the delusion is something that does not happen to a large amount of people.  The disorder is generally undetectable until the person suffering from it decides to talk about what they feel is happening to them.  This is because the person suffering from delusional disorder had no abnormal behavior and there are either no or very minimal hallucinations.  People suffering from this disorder usually have a scapegoat.  That is, they can always find a way for things that go wrong to be someone else’s fault rather than accept responsibility.  There are several subtypes of delusional disorder.  People suffering from persecutory delusional disorder believe other people are out to get them.

Erotomanic sufferers walk around proclaiming that there is someone of importance is secretly in love with them.  The grandiose delusion disorder causes a person to believe that they are extremely important, or that they have some type of super human powers.  Where the somatic delusion disorder occurs the person believes there is something significantly wrong with their own body, and with the jealous subtype the person believes their spouse has cheated on them even when there is no evidence to support that.

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Research supports findings that a genetic link to a close relative who suffers from delusional disorder is possible.  Another cause could be dysfunctional cognitive processing, in which the patient has a indistinguishable way of looking at life.  The speculations they develop are by assuming everything instead of fact checking.  Another cause could be through stress, through being unable to handle stressful situations.  Treatment for delusional disorder most often involves an antipsychotic medication and sometimes involves therapy either on an individual level or on a familiar level, but treatment is only as successful as the patient allows it to be.

Paranoid schizophrenia patients do not have hallucinations that are possible, the hallucinations these patients suffer from are a much distorted view of their own reality.  There are various symptoms for paranoid schizophrenia patients; these can include auditory hallucinations, anxiety, anger, having a patronizing manner and serious thoughts of suicide, along with suicidal behavior.  These people are less affected by these kinds of symptoms and are generally more affected by what are known as positive symptoms, which are symptoms that are point toward a loss of the knowledge of what reality is.  This usually involves an abnormal view.  While the cause of this disorder is unknown, there is evidence to imply that it is caused by a brain dysfunction and that there are factors which increase the likely hood of paranoid schizophrenia.  These factors seem to be things that people would be unable to avoid, like having a family history or being exposed to viruses in the womb or being malnourished in the womb, or having severe trauma such as childhood abuse.  Even with such early risk factors taking place, paranoid schizophrenia is not generally seen until sometime between the teenage years and the mid-thirties.

Several treatments are available for this disorder but there is no cure, so treatment is there to help people learn how to cope and to learn life skills so they can have a full and productive life.  There are medications which are antipsychotics and they have two different levels.  Tier one medications are typical and have been found to be effective in helping a patient with the positive symptoms such as delusions and hallucination.  There is a side effect of some movements which are completely uncontrolled and seem erratic.  The second generation antipsychotics are atypical and help the patient cope with hallucinations and delusions as well as helping with increasing drive.  The side effect for these medications however is a slow in the metabolism, resulting in weight gain, or worse.  Other treatments available are psychotherapy which is usually recommended with the use of medications and can include social and vocational skills training.  ECT or electroconvulsive therapy and hospitalization are also available if the patient and the therapist feel they are appropriate.  If this disorder is left untreated, adverse affects may start to become visible.  Symptoms become much worse and turn into dangerous and/or deviant behavior.  Abuse of alcohol or drugs may become prevalent, family conflicts, self destructive behavior which can then lead to poverty, homelessness and health problems.  Any of these behaviors can lead to incarceration.

These two disorders seem to have a lot of similarities but in reality they are very different in almost every way including the outcomes of each one.  A more in depth article would be able to show the variations of each in a much better light.

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References

Child and Adolescent Psychological Disorders.

Oxford Textbook of Psychopathology.

Delusional Disorder. Psych-uknet.com.  http://psychnet-uk.com/dsm_iv/delusional_disorder.htm

Paranoid Schizophrenia.  Mayoclinic.com.  http://mayoclinic.com/health/paranoid-schizophrenia/DS00862

Paranoid Schizophrenia. Schizophrenia.com  http://www.schizophrenia.com/szparanoid.htm

What Kind of Therapy is Out There?


In reviewing treatments for depression, it seems the three most common, two of which are very broad, treatments are anti depressant medications, electro-convulsive therapy or ECT, and psychotherapy. Each of these treatments has their own purpose and regimen and can be combined in various ways even though they are different. In fact it is most likely because they are so different that they work well together.

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Antidepressant medication gives a therapist and a patient many options. These options have both positive and negative effects. There are different side effects with each type of medication, some tolerable, some need to be managed with other medications. It is different for everyone; this is why it is important to continue trying different combinations until an agreeable treatment plan is found. One example of medication is SSRIS, which are Selective Serotonin Reuptake Inhibitors. This medication is usually the first choice for treatment. The reasoning behind this is that SSRI’s are the most tolerated with very little side effects and most people find they work very well for them. Some side effects are headache or insomnia, but often any side effects subside in the first month. This medication allows a high amount of serotonin to be blocked in the synapse. By doing this, the cells that are neglected are resaturated allowing relief from depression symptoms.

Tricyclic anti-depressants or TCAs are a second choice in medications, if for some reason the SSRI is unable to help the patient. This medication was developed sometime during the 1950’s and 60’s. TCAs seem to be used for more moderate or severe depression because the side effects are more likely to be serious. TCAs work in the brain synapses and increase norepinephrine. Some of the side effects include dry mouth or visual focus, but the more serious side effects include things such as urinary obstruction or delirium. People who have had a lot of strokes or have been diagnosed as having seizure disorders should not be given any TCAs as medication.

MAOIs or monoamine oxidase inhibitors are another common medication prescribed to depression patients. These are generally a last choice because the side effects are often serious. MAOIs are usually effective in treating depression and were actually the first anti-depressant. It works by blocking monoamine oxidase in the brain synapses and increasing norepinephrine. MAOIs inhibit the body’s ability to break down tyramine which is found in very common foods such as wine, nuts, and chocolate. When this food is consumed while the person is taking an MAOI, it is possible for the tyramine to cause blood pressure to rise to dangerous levels.

While anti-depressants can be mixed or left as a single treatment, they do provide a lot of options to help deal with side effects or other issues that may come up.  They are always the best option; another treatment option for depression is electroconvulsive therapy or ECT.

When electroconvulsive therapy is chosen as treatment the patient receives an electrical current which is passed through the brain causing a seizure. The seizure usually continues for twenty to ninety seconds. This treatment is said to offer a patient a quick relief of their depression symptoms. A common side effect of this treatment is confusion that can last up to several hours and short term memory loss, both of which are short term.

Psychotherapy is the last type of treatment discussed and is often referred to as talk therapy. There are various types of psychotherapy such as cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. The most common type of talk therapy is the cognitive behavioral therapy. During sessions a patient not only talks about their depression, they have the opportunity to learn more about it. The patient is then able to focus on knowing what their negative patterns are and changing those into positive behaviors. Interpersonal therapists’ help their patients look at the destructive relationships a person is in that may be helping to grow the depression instead of helping to keep it at bay. Psychodynamic therapy helps a patient work through and resolves whatever internal conflicts the patient may be living with.

All of these types of psychotherapy focus on one thing, helping the patient talk through and learn how to deal with events in their lives so they don’t feel like they are drowning in depression.

Out of all of these treatments I would actually think electroconvulsive therapy to be the quickest and most effective. I can’t imagine going under sedation in order to endure treatment and then waking up not only with memory loss but also being confused about your whereabouts, among other things, even if only temporarily.

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References:

Child and Adolescent Psychological Disorders.

Oxford Textbook of Psychopathology.

Depression. medicinenet.com. http://www.medicinenet.com/script/main/art.asp?articlekey=342&pf=3&page=6

Depression (Major Depression).  Mayoclinic.com. http://www.mayoclinic.com/health/depression/DS00175/METHOD=print&DSECTION=all