Tag Archives: antipsychotic medication

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

Schizophrenia, Downward Social Drift, and Interpersonal Adjustment


Everyday social encounters present people with schizophrenia a considerable amount of difficulty.  They show significant impairment in both “instrumental relationships” and social-emotional relationships.  This impairment is demonstrated by “downward social drift” and, perhaps more importantly, the fact that the majority of people with schizophrenia never marry.  Of note is that interpersonal adjustment issues are much more prevalent in the male portion of the schizophrenia population that in the female portion.

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Social competence is a global or “macro” measurement of social role performance.  Global social competence issues continue to be a marker not only for people who have schizophrenia, but for people who are considered “high risk.”  I still don’t quite understand the etiology of these social deficits however… which came first, the social deficits or the disorder?

Social skills are less global and more molecular, thereby representing skills that enable a person to competently perform a social task.  They include “specific verbal, non-verbal and paralinguistic (e.g., voice tone) behavioral components that together form the basis for effective communication.”  (Blaney & Millon, 2009, p. 335)  To my own personal delight, I really enjoy any opportunity to utilize role-play… and this is one of them.  Typically, people with schizophrenia will show weaker verbal and nonverbal skill development, they tend to be less assertive, and they tend to deny making errors or lie as opposed to apologize or explain.  I am really looking forward to utilizing role-play with this population, I believe it to be one of my strong suits (and one of the pieces I really enjoy).

People with schizophrenia can have remarkably impaired ability to solve social problems.  This might manifest in difficulty recognizing interpersonal problems, formulating solutions to that problem, or perhaps most importantly implementing a solution that has a probably degree of success.  They are generally less able to recognize poor problem solutions (e.g., solutions that are unlikely to work).

Gender is an often neglected variable when studying schizophrenia.  Female patients typically have later onset, shorter and less frequent psychotic episodes, and show better response to treatment when compared to make counterparts.  They are more likely to be marked, to live independently, and to be employed (despite having similar symptoms to men).  Women often require less antipsychotic medication to stabilize them.  This leads some authors to speculate about the neuroprotective properties of estrogen… interesting concept to say the least.  This might be off-base, but could this possibly explain the late life crisis that women often experience around menopause?

Positive and negative symptoms should not be viewed in the context of “good and bad.”  Positive symptoms are “added,” like delusions or hallucinations for example.  Negative symptoms are typically features that are removed, reduced, or blunted.  This typically manifests as emotional withdrawal or anhedonia.  Negative effects have been shown to predict both unemployment and reduced social network size.  In total, positive symptoms, negative symptoms, and “disorders of relating” represent three distinct dimensions of schizophrenia.  (Blaney & Millon, 2009, p. 340)

Of particular interest to me is the discussion on interpersonal stress, relapse, and the apparent foundation of the above in family systems theory.  Specifically, “the social environment into which schizophrenia patients were discharged after they left the hospital was significantly associated with how well patients fared psychiatrically over the next several months.”  (Blaney & Millon, 2009, p. 349)  Expressed emotion (EE) reflects the extent to which the relatives of a psychiatric patient talk about that patient in a critical, hostile, or emotionally over-involved way.  EE has been found to be a reliable predictor of relapse, and as a result, family therapy focused on dealing with living with a schizophrenic patient is definitely in order.  This can assist family members in overcoming their apparent difficulty in accepting, and understanding, the disorder.

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.