There is no diagnosis of “paranoid schizophrenia”; doctors usually talk about paranoid schizophrenia. In this form, in addition to the symptoms common to schizophrenia, there are also very specific ones. A psychiatrist must understand the nuances of diagnosis and treatment.
The main symptoms of this condition:
- delusional ideas of influence, special purpose, jealousy, damage and the evil eye, persecution, relationships and others;
- the most common hallucinations are auditory, threatening, inciting or imperative (commanding) in nature;
- less often hallucinations of other sense organs, the rarest are visual;
- disturbances of emotions and will (coldness, lack of will) can be hidden by a disorder of thinking in the acute period;
- The onset of the disease is usually 20–25 years.
The ICD-10 code for “paranoid schizophrenia” is F20.0. The manual states that the disease must be differentiated from epilepsy and paranoia, for which specialists resort to clinical, laboratory and instrumental diagnostic methods.
A psychiatrist must understand the nuances of diagnosing and treating paranoid schizophrenia.
The main hallucinatory-paranoid syndrome for this disease is characterized by delusional ideas of persecution, illusions and hallucinations of various senses. Patients feel that they are being talked about on the street and in transport, they are under special surveillance, and pursuers use conventional signs and codes.
Gradually, the delusion becomes more complicated, conspiracy theories appear, and fictitious and real forces and organizations are included in the delirium. Persecutors “cause” unpleasant thoughts, memories, painful sensations and even illnesses in patients, forcing them to act against their will. “Voices” and “visions” appear in the head.
Important
Fleeing from pursuers, “voices” and “visions”, patients can cause harm to themselves and others. Therefore, it is important to regularly see a specialist and take adequate supportive therapy.
Fleeing from hopelessness, patients in this state can cause harm to themselves and others. Therefore, it is important to be observed by a specialist and adhere to an adequate treatment regimen.
F20 Schizophrenia.
This general heading includes the common variants of schizophrenia, as well as some less common variants and related disorders.
F20.0-F20.3 General criteria for paranoid, hebephrenic, catatonic and undifferentiated schizophrenia:
G1. For the majority of a psychotic episode lasting at least one month (or for some time on most days), at least one of the features listed in checklist (1) or at least two of the features listed in checklist (2) must be present.
1) At least one of the following:
a) “echo” of thoughts, putting or taking away thoughts, or openness of thoughts; b) delusions of influence or influence, distinctly referring to movement of the body or limbs or to thoughts, actions or sensations; delusional perception; c) hallucinatory “voices”, which are a current commentary on the patient’s behavior or a discussion of it among themselves, or other types of hallucinatory “voices” emanating from any part of the body; d) persistent delusional ideas of another kind that are culturally inadequate and completely impossible in content, such as identifying oneself with religious or political figures, claims of superhuman abilities (for example, the ability to control the weather or communicate with aliens).
2) or at least two signs from the following:
a) chronic hallucinations of any kind, if they occur daily for at least one month and are accompanied by delusions (which may be unstable and half-formed) without a clear affective content; b) neologisms, breaks in thinking, leading to discontinuity or inconsistency in speech; c) catatonic behavior such as agitation, rigidity or waxiness, negativism, mutism and stupor; d) “negative” symptoms, such as severe apathy, speech impoverishment and flattened or inappropriate emotional reactions (it should be obvious that these are not caused by depression or antipsychotic therapy.
G2. The most commonly used exclusion criteria are:
1) If the case also meets the criteria for a manic episode (F30-) or a depressive episode (F32-), criteria G1.1 and G1.2 above must be met BEFORE the development of a mood disorder.
2) The disorder cannot be attributed to organic brain disease (as set out in F00-F09) or to alcohol or drug intoxication (F1x.0), dependence (F1x.2) or withdrawal state (F1x.3 and F1x.4).
Note:
When identifying the presence of the above abnormal subjective experiences and behavior, particular care should be taken to avoid false positive assessments, especially where there are culturally or subculturally determined forms of behavior and demeanor, as well as a subnormal level of mental development.
Flow type
Given the significant variability in the course of schizophrenic disorders, it may be advisable (especially for research purposes) to specify the type of course using the fifth character. The course should be coded at a minimum follow-up of one year (for remission, see note 5 in the introduction).
- F20.x0 continuous (during the entire observation period there are no remissions in psychotic symptoms)
- F20.x1 episodic with progressive development of the defect; progressive development of “negative” symptoms in the intervals between psychotic episodes
- F20.x2 episodic with a stable defect persistent but not progressive “negative” symptoms between psychotic episodes
- F20.x3 episodic remitting with complete or virtually complete remissions between psychotic episodes
- F20.x4 incomplete remission
- F20.x5 complete remission
- F20.x8 other type of flow
- F20.x9 course undetermined, observation period too short
- F20.0 Paranoid schizophrenia.
A. The general criteria for schizophrenia must be met (F20.0-F20.3) B. Delusions and hallucinations must be pronounced (such as delusions of persecution, meaning and relationship, high kinship, special mission, bodily change or jealousy; “voices” of a threatening or imperative nature, olfactory or gustatory hallucinations, sexual or other bodily sensations). B. Emotional flatness or inadequacy, catatonic symptoms or interrupted speech should not dominate the clinical picture, although they may be present in mild severity.
F20.1 Hebephrenic schizophrenia.
A. The general criteria for schizophrenia (F20.0-F20.3) must be met. B. Must be noted (1) or (2): 1) clear and prolonged emotional smoothness; 2) clear and prolonged emotional inadequacy. B. Must be (1) or (2): 1) behavior that is characterized more by aimlessness and absurdity than by purposefulness; 2) a distinct thought disorder, manifested by broken speech G. The clinical picture should not be dominated by hallucinations or delusions, although they may be present in a mild degree.
F20.2 Catatonic schizophrenia.
A. The general criteria for schizophrenia (F20.0-F20.3) should be identified, although at first this may not be possible due to the patient’s inability to communicate.
B. One or more of the following catatonic symptoms have been clearly identified for at least two weeks:
1) stupor (significant decrease in reactivity to external stimuli and decrease in spontaneous movements and activity) or mutism; 2) excitement (motor activity without a visible goal, which is not influenced by external stimuli); 3) freezing (arbitrary adoption and preservation of inadequate or bizarre poses); 4) negativism (resistance without visible motives to all instructions and attempts to move, or even movement in the opposite direction); 5) rigidity (maintaining a rigid posture despite attempts to change it); 6) waxy flexibility (preservation of body members in the position that is given to it by other people); 7) automatic obedience (automatic execution of instructions).
F20.3 Undifferentiated schizophrenia.
A. The general criteria for schizophrenia (F20.0-F20.3) must be met.
B. One of two:
1) the symptoms are not sufficient to identify the criteria for any of the subtypes F20.0, F20.1, F20.2, F20.4 or F205; 2) there are so many symptoms that criteria for more than one of the subtypes listed above in B (1) are identified.
F20.4 Post-schizophrenic depression.
A. The general criteria for schizophrenia (F20.0-F20.3) should have been met within the last 12 months, but are currently missing. B. One of the conditions noted in criterion G1 (2) a), b), c) or d) in sections F20.0-F20.3 must persist. B. Depressive symptoms must be of sufficient duration, severity, and variety to meet the criteria for at least a mild depressive episode (F32.0).
F20.5 Residual schizophrenia.
A. The general criteria for schizophrenia (F20.0-F20.3) should have been identified at some time in the past, but are not currently present. B. Over the previous 12 months, at least 4 of the following “negative” symptoms must be present: 1) psychomotor retardation or hypoactivity; 2) distinct emotional smoothness; 3) passivity and lack of initiative; 4) impoverishment of speech in volume or content; 5) poverty of nonverbal communication, determined by facial expression, contact in the gaze, voice modulation or posture; 6) low social productivity or poor self-care.
F20.6 Simple schizophrenia.
A. Slow progressive development over at least a year of all three signs:
1) a clear change in premorbid personality, manifested by loss of drives and interests, inactivity and aimless behavior, self-absorption and social withdrawal; 2) the gradual appearance and deepening of “negative” symptoms, such as severe apathy, impoverished speech, hypoactivity, emotional flatness, passivity and lack of initiative and poverty of non-verbal communication (determined by facial expression, contact in the gaze, voice modulation or posture); 3) a clear decrease in social, educational or professional productivity.
B. Absence at any time of abnormal subjective experiences indicated in G1 in F20.0-F20.3, as well as hallucinations or sufficiently fully formed delusions of any kind, i.e. the clinical case should never answer criteria for any other type of schizophrenia or any other psychotic disorder.
B. No evidence for dementia or other organic mental disorder as presented in section F00-F09.
F20.8 Another form of schizophrenia.
F20.9 Schizophrenia, unspecified.
Questions and answers
Can schizophrenia be treated with tranquilizers or antidepressants?
Mental disorder is treated exclusively in a hospital setting. Such drugs are prescribed by the doctor after a thorough examination of the patient.
Does treatment for schizophrenia lead to complete recovery?
Schizophrenia is an incurable disease. It is possible to achieve a long stage of remission, during which time the patient is able to return to normal life.
Does the patient understand that he is sick?
This is not always the case. He takes delusional ideas and hallucinations for reality. In moments of “enlightenment” he may understand that he has disturbances in the emotional-volitional sphere. This occurs at the first or second stage of pathology development.
F21 Schizotypal disorder.
A. At least 4 of the following must be present continuously or periodically for at least two years:
1) inadequate or narrowed affect, the patient looks cold and aloof;
2) oddities, eccentricities or peculiarities in behavior or appearance; 3) impoverishment of contacts and a tendency towards social withdrawal; 4) strange views (beliefs) or magical thinking that influence behavior and are not consistent with subcultural norms; 5) suspiciousness or paranoid ideas; 6) obsessive chewing gum without internal resistance, often with dysmorphophobic, sexual or aggressive content; 7) unusual perceptual phenomena, including somato-sensory (bodily) or other illusions, depersonalization or derealization; amorphous, detailed, metaphorical, hyper-detailed and often stereotypical thinking, manifested in strange speech or in other ways without pronounced discontinuity; 9) rare transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusional ideas, usually occurring without external provocation.
B. The case must never meet the criteria for any disorder in schizophrenia in F20- (schizophrenia).
Treatment of mental retardation
Mental retardation is a chronic disease, so therapeutic measures must be systematic and consistent. The earlier therapy begins, the greater the chance of preserving the psyche and compensating for impaired functions.
Treatment methods for mental retardation:
- Psychological and correctional work.
- Educational and pedagogical work.
- Psychotherapy.
- Psychotherapy and psychoeducation for parents.
- Physiotherapy.
- Drug treatment.
- Exercise therapy, massage, diet therapy.
A psychiatrist, psychologist, speech pathologist or speech therapist, rehabilitation therapist, massage therapist, and neurologist should participate in the treatment process.
F22 Chronic delusional disorders.
F22.0 Delusional disorder.
A. The presence of a delusion or a system of interrelated delusional ideas other than those that were listed as typical schizophrenic under criteria G(1) b) or d) for F20.0-F20.3 (i.e., excluding those that are completely impossible in content or culturally inadequate). The most common examples are delusions of persecution, grandeur, hypochondriacal, jealousy or erotic.
B. Delirium in criterion A must last for at least 3 months.
B. The general criteria for schizophrenia (F20.0-F20.3) are not met.
D. There should not be chronic hallucinations of any kind (but there may be transient or rare auditory hallucinations in which the patient is not discussed in the third person and which are not commentary in nature).
E. Depressive symptoms (or even a depressive episode (F32-)) may be present from time to time, but delusions persist even when mood disorders are not noted.
E. Most commonly used exclusion criteria. There should be no evidence of a primary or secondary brain disorder as specified in F00-F09 or a substance use disorder (F1x.5).
Indication for identifying possible subtypes.
If desired, the following types can be distinguished:
- persecutory type;
- litigious type;
- type with ideas of relationship;
- the type with ideas of greatness;
- hypochondriacal (somatic) type;
- the type with ideas of jealousy;
- erotomanic type.
F22.8 Other chronic delusional disorders.
This is a residual category for chronic delusional disorders that do not meet the criteria for delusional disorder (F22.0). Disorders in which delusions are accompanied by chronic hallucinatory “voices” or schizophrenic symptoms that do not fully meet the criteria for schizophrenia (F20.-) should be coded here. Delusional disorders lasting less than 3 months should nevertheless be coded at least temporarily in F23.-.
F22.9 Chronic delusional disorder, unspecified.
Signs of delusion and hallucinations
The following behavioral factors may indicate the presence of auditory or visual hallucinations:
- a person talks to himself in the form of a conversation or remarks;
- at the moment when the patient becomes silent, those around him get the impression that he is listening to something. At the same time, the impression arises that he sees and hears what others do not see;
- causeless, hysterical laughter or, conversely, anxiety and concern may occur;
- During a conversation, it is difficult for the patient to concentrate on one topic.
The following signs indicate the presence of delirium:
- the individual’s attitude towards others changes sharply, unjustified hostility or isolation, alienation appears;
- statements become dubious, implausible, meaningful, and incomprehensible to others;
- a person begins to fear for his life or for the lives of loved ones; fear and anxiety are clearly manifested, which can be expressed in constantly locking doors, curtaining windows, checking food for the presence of poisons, etc.
It is necessary to react to the above behavior of the patient with the utmost restraint and delicacy. It is strictly forbidden to mock, argue with him, discuss his hallucinations, or detail them. The main thing in such a situation is to help the person feel protected, to inspire trust, and to carefully persuade them to see a doctor for advice. Relatives need to be especially vigilant towards a patient whose suicidal tendencies have worsened during the course of the disease.
F23 Acute and transient psychotic disorders.
G1. Acute development of delusions, hallucinations, incoherent or broken speech, occurring alone or in any combination. The time interval between the onset of any psychotic symptom and the development of the full clinical picture of the disorder does not exceed 2 weeks.
G2. If transient states of confusion, false recognition or disturbances of attention occur, then they do not meet the criteria for organically caused clouding of consciousness as set out in F05.-, criterion A.
G3. The disorder does not meet the symptom criteria for a manic episode (F30.-), a depressive episode (F32.-) or a recurrent depressive disorder (F33.-).
G4. There is insufficient information on recent use of a psychoactive substance that would meet the criteria for intoxication (F1x.0), use with harmful consequences (F1x.1), dependence (F1x.2) or withdrawal states (F1x.3, F1x.4). Chronic and largely unchanged use of alcohol or drugs in the amount and frequency to which the patient is accustomed does not in itself preclude the use of rubric F23 This should be decided on the basis of clinical judgment and depending on the requirements of the specific research project
G5. Most commonly used criticisms of exclusion Absence of organic brain disease (F00-F09) or serious metabolic disorder affecting the central nervous system (this does not include childbirth) The fifth character should be used to indicate the association of the acute onset of the disorder with acute stress (which occurs during 2 weeks before development of acute psychotic symptoms):
F23.x0 without combination with acute stress
F23.x1 In combination with acute stress
For research purposes, further specification of the development of the disorder from a non-psychotic state to a psychotic state (development within 48 hours) or acute (development within 48 hours to 2 weeks) is recommended.
F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia.
A. General criteria for acute and transient psychotic disorders should be identified (F23)
B. Symptoms change rapidly in both type and intensity from day to day or even within one day
B. Presence of any type of hallucinations or delusions for at least several hours at any time since the onset of the disorder
D. Symptoms from at least two of the following categories occurring at the same time:
1) emotional turmoil, characterized by intense feelings of happiness or ecstasy, or overwhelming anxiety or marked irritability; 2) confusion or false recognition of people or places; 3) increased or decreased activity, reaching a significant degree.
E. Any of the symptoms listed in the schizophrenia section (F20.0-F20.3), criteria G1 and G2, if present, are present for a short time from the onset of the condition, i.e. criterion B in F23.1 is not met .
E. The total duration of the disorder does not exceed 3 months.
F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia.
A. Criteria A, B, C and D for acute polymorphic psychotic disorder must be met. B. Some criteria for schizophrenia (F20.0-F20.3) are met for most of the time from the onset of the disorder, but they do not necessarily meet this diagnosis completely, i.e., at least: 1) any of the symptoms in F20, F1.1 a-d or 2) any of the symptoms F20, G1.2 from e) to h) C are noted. Symptoms of schizophrenia of the previous criterion B are detected no more one month.
F23.2 Acute schizophrenia-like psychotic disorder.
A. General criteria for acute and transient psychotic disorders are identified (F23). B. The criteria for schizophrenia (F20.0-F20.3) are identified, with the exception of the duration criterion. B. The disorder does not meet criteria B, C, or D for acute polymorphic psychotic disorder (F23.0). D. The total duration of the disorder does not exceed one month.
F23.3 Other acute predominantly delusional psychotic disorders.
A. General criteria for acute and polymorphic psychotic disorders are identified (F23). B. Relatively stable delusions and/or hallucinations are noted, but they do not meet symptomatic criteria for schizophrenia (F20.0-F20.3). B. The disorder does not meet the criteria for acute polymorphic psychotic disorder (F23.0) D. The total duration of the disorder does not exceed 3 months.
F23.8 Other acute and transient psychotic disorders.
Any other acute psychotic disorders that cannot be classified elsewhere in F23 should be coded here (eg, acute psychotic conditions in which distinct delusions or hallucinations occur, but only for a short time). States of undifferentiated excitation should also be encoded here if it is not possible to obtain information about the patient’s mental state, but only in the absence of evidence for organic conditioning.
F23.9 Acute and transient psychotic disorder, unspecified.
Diagnostics
A psychiatrist, conducting an examination, assesses the dynamic development of symptoms, finds out the order and pattern of their manifestation over a certain period of time. It is important to determine the cause-and-effect relationships that provoked the intensification of the development of mental disorders.
The main method for diagnosing paranoid schizophrenia is clinical and anamnestic examination. During this process, the doctor finds out the following:
- whether the patient has a hereditary predisposition to the disease;
- the onset of symptoms of mental deviation, factors (events, phenomena, episodes) that became their provocateurs;
- the dynamics of the development of the disease, the study of which makes it possible to predict its further course.
A competently structured conversation with a patient by a specialized doctor is the main method of diagnosing the disease. Therefore, you should not refuse to communicate with a specialist or describe your condition to him superficially. Timely diagnosis and proper therapy gives a chance to avoid possible complications and will help to adapt the patient to the world around him as much as possible.
Modern methods for diagnosing the paranoid form of mental illness include:
- neurotest;
- neurophysiological test system.
These methods (laboratory and instrumental) make it possible to make an accurate diagnosis and determine the severity of the ongoing process. This allows you to select the most adequate therapy and promptly and timely adjust the dosage of medications.
F25 Schizoaffective disorders.
Note This diagnosis is based on the relative "balance" of the amount of severity and duration of schizophrenic and affective symptoms
G1. The disorder meets the criteria for one of the mood disorders (F30.-, F31-, F32.-) of moderate or severe severity, as defined for each subtype.
G2. For most of the time, for at least a two-week period, symptoms of at least one of the following symptom groups (which almost coincide with the symptom groups of schizophrenia (F20.0-F20.3)) are clearly present:
1) “echo” of thoughts, insertion or subtraction of thoughts, openness of thoughts (F20.0-F20.3, criterion G1.1 a)); 2) delusions of influence or influence, clearly relating to movements of the body or limbs or to certain thoughts, actions or sensations (F20.0-F20.3, criterion G1.1 b)); 3) hallucinatory “voices” commenting on the patient’s behavior or discussing it among themselves; or other types of hallucinatory “voices” emanating from any part of the body (F20.0-F20.3, criterion G1.1 c)); 4) persistent delusional ideas of any kind that are culturally inadequate and completely impossible in content, but these are not just ideas of grandeur or persecution (F20.0-F20.3, criterion G1.1 d)), for example, that the patient visits other worlds, can control clouds with his breath, communicate with plants or animals without words, etc.; 5) clearly inadequate or broken speech or frequent use of neologisms (expressed form of criterion G1.2 b) in the category F20.0-F20.3); 6) frequent occurrence of catatonic behaviors such as freezing, waxy flexibility and negativism (F20.0-F20.3, criterion G1.2 b)).
G3. Criteria G1 and G2 must occur during the same episode and at least for some time simultaneously. In the clinical picture, symptoms of both G1 and G2 criteria should be pronounced.
G4. Most commonly used exclusion criteria. The disorder cannot be attributed to an organic mental disorder (in the sense of F00-F09) or to intoxication, dependence or withdrawal states associated with the use of psychoactive substances (F10-F19).
F25.0 Schizoaffective disorder, manic type.
A. The general criteria for schizoaffective disorder (F25) must be met.
B. The criteria for manic disorder (F30.1 or F31.1) must be met.
F25.1 Schizoaffective disorder, depressive type.
A. The general criteria for schizoaffective disorder (F25) must be met. B. The criteria for a depressive disorder of at least moderate severity (F31.3, F31.4, F32.1 or F32.2) must be met.
F25.2 Schizoaffective disorder, mixed type.
A. The general criteria for schizoaffective disorder (F25) must be met. B. The criteria for mixed bipolar disorder (F31.6) must be met.
F25.8 Other schizoaffective disorders.
F25.9 Schizoaffective disorder, unspecified.
Note
If desired, the following subtypes of schizoaffective disorder can be distinguished depending on its dynamics:
F25.х0 Only simultaneous development of schizophrenic and affective symptoms. Symptoms are defined in criterion G2 from rubric F25. F25.x1 Simultaneous development of schizophrenic and affective symptoms with subsequent persistence of schizophrenic symptoms outside of periods of presence of affective symptoms
Causes
As already mentioned, the main “culprit” of organic mood disorder is a physiological factor. The most common reasons:
- Brain damage – tumor, traumatic brain injury affecting the frontal lobes.
- Diseases of the endocrine system - Itsenko-Cushing's disease, thyrotoxicosis, consequences of partial or complete removal of the thyroid gland, premenstrual and menopausal syndrome.
- Long-term use of hormonal drugs or their withdrawal. Those who suffer from autoimmune diseases and are forced to take glucocorticosteroids are especially at risk.
- Overdose of antihypertensive drugs, rarely - antibiotics, sedatives, antitumor drugs, narcotic analgesics.
The above-mentioned circumstances negatively affect the state of neurotransmitters responsible for transmitting impulses between nerve cells, and from them to the glands and muscle tissue. An imbalance of these biologically active substances disrupts this process, and the parts of the brain responsible for instinctive behavior, feelings and emotions end up working incorrectly.
Excess serotonin and norepinephrine speed up neurotransmission, making receptors more sensitive. This contributes to a manic state. A deficiency of these hormones provokes depression.
F28 Other non-organic psychotic disorders.
Psychotic disorders that do not meet the criteria for schizophrenia (F20.0-F20.3) or psychotic types (affective) mood disorders (F30-F39), and psychotic disorders that do not meet symptomatic criteria for chronic delusional disorder (F22.-) should be coded here. ) (an example is chronic hallucinatory disorder). This also includes combinations of symptoms that are not covered by the previous (F20.- categories (F20.-F25), for example, a combination of delusional ideas other than those listed as typical schizophrenic in F20.0-F20.3, criterion G1.1 b) or d) (i.e., in addition to completely incredible in content or culturally inadequate), with catatonia.
Forecasts
Regardless of the type of schizophrenia, it is classified as an incurable mental pathology. The prognosis of the disease is particularly influenced by the timeliness of the start of treatment, its intensity and combination with social rehabilitation measures.
According to research by practicing psychotherapists, patients who sought help in a timely manner and followed all the instructions and recommendations of doctors experienced stable remission followed by complete social rehabilitation.
Do not despair if you or one of your family and friends has been diagnosed with paranoid schizophrenia. In modern psychiatry, innovative methods are used to treat mental pathologies. Timely, competent diagnosis, unquestioning compliance with all the requirements of the attending physician, support from loved ones provide a chance to minimize the negative consequences of the disease and normalize the quality of life.
