Paranoid psychosis: how to recognize and treat a socially dangerous disease in time

Paranoid psychosis is distinguished by clearly formed, systematized delusions, which are accompanied by completely logical (for the patient’s consciousness) actions. At the same time, only minor personal changes are noted. As a rule, the pathology manifests itself at a relatively early age, with a peak exacerbation occurring at 30–40 years of age. Paranoid psychosis is extremely difficult to diagnose; a mild form of schizophrenia is often diagnosed and appropriate treatment is prescribed, which, of course, does not help. The specialists at the Leto Mental Health Center have sufficient experience to recognize the symptoms of the disease and differentiate it from other mental illnesses. A correct diagnosis determines the tactics of treatment, and in most cases we are able to achieve a positive result and stable remission.

Symptoms:

The systematization of delusional ideas of any content varies within very wide limits. If the patient talks about what the persecution is (damage, poisoning, etc.), knows the date of its beginning, the purpose, the means used for the purpose of persecution (damage, poisoning, etc.), the grounds and goals of the persecution, its consequences and final result, then we are talking about systematized delirium. In some cases, patients talk about all this in sufficient detail, and then it is not difficult to judge the degree of systematization of delirium. However, much more often paranoid syndrome is accompanied by some degree of inaccessibility. In these cases, the systematization of delirium can be judged only by indirect signs. So, if the pursuers are called “they”, without specifying who exactly, and the symptom of the pursued-persecutor (if it exists) is manifested by migration or passive defense (additional locks on the doors, caution shown by the patient when preparing food, etc.) - nonsense is rather systematized in general terms. If they talk about persecutors and name a specific organization, and even more so the names of certain individuals (delusional personification), if there is a symptom of an actively persecuted persecutor, most often in the form of complaints to public organizations, we are, as a rule, talking about a fairly systematized delusion. Sensory disorders in paranoid syndrome may be limited to true auditory verbal hallucinations, often reaching the intensity of hallucinosis. Typically, such a hallucinatory-delusional syndrome occurs primarily in somatically caused mental illnesses. The complication of verbal hallucinations in these cases occurs due to the addition of auditory pseudohallucinations and some other components of ideational mental automatism - “unwinding of memories”, a feeling of mastery, an influx of thoughts - mentism. When the structure of the sensory component of paranoid syndrome is dominated by mental automatism (see below), while true verbal hallucinations recede into the background, existing only at the beginning of the development of the syndrome, or are completely absent. Mental automatism can be limited to the development of only the ideational component, primarily “echo-thoughts”, “made thoughts”, auditory pseudo-hallucinations. In more severe cases, sensory and motor automatisms are added. As a rule, when mental automatism becomes more complicated, it is accompanied by the appearance of delusions of mental and physical influence. Patients talk about external influences on their thoughts, physical functions, the effects of hypnosis, special devices, rays, atomic energy, etc. Depending on the predominance of delusions or sensory disorders in the structure of the hallucinatory-delusional syndrome, delusional and hallucinatory variants are distinguished. In the delusional version, the delirium is usually systematized to a greater extent than in the hallucinatory version; among sensory disorders, mental automatisms predominate and patients, as a rule, are either inaccessible or completely inaccessible. In the hallucinatory variant, true verbal hallucinations predominate. Mental automatism often remains undeveloped, and in patients it is always possible to find out certain features of the condition; complete inaccessibility is rather an exception here. In prognostic terms, the delusional variant is usually worse than the hallucinatory variant. Paranoid syndrome, especially in the delusional version, is often a chronic condition. In this case, its appearance is often preceded by a gradually developing systematized interpretative delusion (paranoid syndrome), to which sensory disorders are added after significant periods of time, often years later. The transition from a paranoid state to a paranoid state is usually accompanied by an exacerbation of the disease: confusion, motor agitation with anxiety and fear (anxious-fearful excitation), and various manifestations of figurative delirium appear. Such disorders last for days or weeks, and then a hallucinatory-delusional state is established. Modification of chronic paranoid syndrome occurs either due to the appearance of paraphrenic disorders, or due to the development of the so-called secondary, or sequential, syndrome. In acute paranoid syndrome, figurative delusions predominate over intelligible delusions. Systematization of delusional ideas is either absent or exists only in the most general form. Confusion and pronounced affective disorders are always observed, mainly in the form of tension or fear. Behavior changes. Motor agitation and impulsive actions often occur. Mental automatisms are usually limited to the ideational component; true verbal hallucinations can reach the intensity of hallucinosis. With the reverse development of acute paranoid syndrome, a distinct depressive or subdepressive mood background often persists for a long time, sometimes in combination with residual delusions. Questioning patients with paranoid syndrome, as well as patients with other delusional syndromes (paranoid, paraphrenic) (see below), often presents great difficulties due to their inaccessibility. Such patients are suspicious and speak sparingly, as if weighing their words vaguely. Suspect the existence of inaccessibility by allowing statements typical for such patients (“why talk about it, everything is written there, you know and I know, you’re a physiognomist, let’s talk about something else,” etc.). With complete inaccessibility, the patient does not talk not only about the painful disorders he has, but also about the events of his everyday life. If accessibility is incomplete, the patient often provides detailed information about himself regarding everyday issues, but immediately becomes silent, and in some cases becomes tense and suspicious when asked questions - direct or indirect - concerning his mental state. Such a dissociation between what the patient reported about himself in general and how he reacted to the question about his mental state always suggests low availability of a constant or very frequent sign of a delusional state. In many cases, in order to obtain the necessary information from a “delusional” patient, he should be “talked” on topics that are not directly related to delusional experiences. It is rare that a patient during such a conversation will not accidentally drop some phrase related to delirium. Such a phrase often has seemingly the most ordinary content (“what can I say, I live well, but I’m not entirely lucky with my neighbors…”). If a doctor, having heard such a phrase, is able to ask clarifying questions of everyday content, it is very likely that he will receive information that is clinical facts. But even if, as a result of questioning, the doctor does not receive specific information about the subjective state of the patient, he can almost always conclude from indirect evidence that there is inaccessibility or low accessibility, i.e. about the presence of delusional disorders in the patient.

Typical clinical picture of paranoid psychosis

Usually the patient carefully monitors his own appearance, is neat, there are no memory impairments, or orientation in time and space. The disease does not manifest itself “out of the blue”; exacerbation is provoked by a certain situation. After this, the violations progress quite quickly, and the detail and systematization of delusional ideas increases.

Without proper treatment, symptoms persist until the end of life in 60–70% of patients; cases of self-resolution are much less common. Favorable factors include favorable social status, female gender, and the first episode of exacerbation at an early age.

Paranoid psychosis is characterized by the following symptoms:

• hostility combined with criticism and frequent accusations towards others;
• low self-esteem, constant complaints, but at the same time the patient is usually confident in his own rightness, secretive;
• alertness;
• stubbornness;
• lack of sense of humor;
• pathological attention to minor details and trifles;
• severe irritability, rapid development of discontent, which ends in an outburst of anger and hostility towards others;
• gloominess and suspicion.

Main types of mental disorder

1. Delirium of grandeur. A person is sure that he has special talents that others cannot recognize and properly evaluate. These are some kind of superpowers, possession of enormous wealth (money, jewelry, antiques, etc.), secret knowledge, scientific discoveries made, close acquaintances or relationships with celebrities (for example, actors, musical performers). Sometimes they talk about a secret connection with God (such people often become either leaders or participants in semi-legal religious communities).
2. Erotomanic delirium (Clerambault syndrome). The patient imagines that someone is in love with him. Most often we are talking about a person with a higher social status and financial position. This could be a boss, a successful colleague, a celebrity. Often the feeling experienced is not of a sexual connotation, but rather of a romantic, spiritual attachment. More common in women. They usually keep their feelings and emotions secret, but they can also compulsively seek meetings with the “object of passion.”
3. Delusions of jealousy (sometimes called Othello syndrome). A person is sure that his partner is cheating on him, constantly talks about it, tries to catch him in infidelity, torments him with suspicions, surveillance, and persistent attempts to control.
4. Delusion of persecution (persecutory). It manifests itself as a clear belief that people are slandering you behind your back, trying to harm you, or preventing you from achieving any goals or career growth. Sometimes this type of disorder has a kind of “otherworldly” character, in which the patient is sure that all his problems are related to damage, curses, and conspiracies.
5. Somatic (hypochondriacal) delusion. Associated with false beliefs about one’s own injuries and health problems. As a rule, the disease develops in one of the following directions: the patient is sure that insects or parasites have appeared in his body, the conviction that his body, face, and hair have undergone dramatic changes. A disorder associated with a persistent belief in the stench of one's own body is often encountered. At the same time, they turn to a psychiatrist last; as a rule, first of all they consult dermatologists, dentists, plastic surgeons, parasitologists, etc.
6. Mixed (unspecified) form of pathology, in which the clinical picture is atypical. When collecting anamnesis, the presence of symptoms typical of various subtypes of the disease is noted.

Treatment:

For treatment the following is prescribed:

Complex therapy is used based on the disease that caused the syndrome. Although, for example, in France, there is a syndromic type of treatment. 1. Mild form: aminazine, propazine, levomepromazine 0.025-0.2; etaperazine 0.004-0.1; sonapax (meleril) 0.01-0.06; Meleril-retard 0.2; 2. Moderate form: aminazine, levomepromazine 0.05-0.3 intramuscularly 2-3 ml 2 times a day; chlorprothixene 0.05-0.4; haloperidol up to 0.03; triftazine (stelazine) up to 0.03 intramuscularly 1-2 ml 0.2% 2 times a day; trifluperidol 0.0005-0.002; 3. Aminazine (tizercin) intramuscularly 2-3 ml 2-3 per day or intravenously up to 0.1 haloperidol or trifluperidol 0.03 intramuscularly or intravenously drip 1-2 ml; leponex up to 0.3-0.5; motidel-depot 0.0125-0.025.

The term "paranoid" can refer to symptoms, syndromes, or personality types. Paranoid symptoms are delusional beliefs most often (but not always) associated with persecution. Paranoid syndromes are those in which paranoid symptoms form part of a characteristic constellation of symptoms; an example would be pathological jealousy or erotomania (described below). The paranoid (flax) personality type is characterized by such traits as excessive concentration on one’s own person, increased, painful sensitivity to real or imagined humiliation and neglect of oneself by others, often combined with an exaggerated sense of self-importance, belligerence and aggressiveness. The term "paranoid" is descriptive, not diagnostic. If we qualify a given symptom or syndrome as paranoid, then this is not yet a diagnosis, but only a preliminary stage on the way to it. In this regard, we can draw an analogy with the situation when the presence of stupor or.

Paranoid syndromes present significant difficulties in classification and diagnosis. The reason for this can be explained by dividing them into two groups. The first group includes cases where paranoid traits manifest themselves in connection with a primary mental illness, such as schizophrenia, affective disorder or organic mental disorder. In the second group, in the presence of paranoid traits, no other - primary - mental disorder, however, is detected; thus, paranoid traits appear to have arisen independently. In this book, in accordance with the DSM-IIIR and ICD-10 classifications, the term "" is applied to the second group. It is with the second group that significant difficulties and confusion are associated with classification and diagnosis. For example, there has been much debate about whether this condition is a special form or stage in the development of schizophrenia - or whether it should be recognized as a completely independent nosological entity. Since such problems often arise in clinical practice, an entire chapter is devoted to them.

This chapter begins by identifying the most common paranoid symptoms; The following is an overview of their reasons. This is followed by a summary of the relevant personality disorder. This is followed by a discussion of primary mental disorders, such as organic mental states, affective disorders, and mood disorders, in which paranoid manifestations are common. These diseases are discussed in detail in other chapters of the book, while here the focus is on differentiating them from those discussed below. At the same time, a special place is given to paraphrenia; these terms are discussed in historical context. It then describes a number of characteristic paranoid symptoms and syndromes, some of which are quite common and some that are extremely rare. In conclusion, the basic principles of assessing the condition and treating patients with paranoid manifestations are outlined. .

As noted in the introduction, the most common paranoid delusion is perceiving

Kutorny (). The term “paranoid” also refers to less common types of delusions - grandiosity, jealousy; sometimes to delusions associated with love, litigation or religion. It may seem counterintuitive that such different types of delusions should be grouped into one category. The reason, however, is that the central disorder, defined by the term “paranoid,” is a painful distortion of ideas and attitudes regarding the interaction, the relationship of the individual with other people. If someone has a false or unfounded belief that he is being persecuted, or deceived, or exalted, or that he is loved by a famous person, then this in each case means that the person interprets the relationship between himself and other people in a painfully distorted way. Many paranoid symptoms are discussed in Chap. 1, but the main ones will be briefly described here for the convenience of readers. The following definitions are taken from the PSE glossary (see Wing et al. 1974).

Relationship ideas

occur in overly shy people. The subject is unable to get rid of the feeling that he is being paid attention to in public transport, in restaurants or in other public places, and those around him notice a lot of things that he would prefer to hide. A person realizes that these sensations are born within himself and that in reality he is no more conspicuous than other people. But he cannot help but experience the same sensations, completely disproportionate to any possible circumstances.

Delusional relationship

represents a further development of simple ideas of relation; the falsity of the ideas is not realized. The subject may feel that the whole neighborhood is gossiping about him, far beyond what is possible, or he may find mention of himself in television programs or on the pages of newspapers. He hears someone talking on the radio about something related to the question he was just thinking about, or he imagines that he is being followed, his movements are being watched, and what he says is being recorded on a tape recorder.

.

The subject believes that some person or organization or some force or power is trying to harm him in some way - to ruin his reputation, cause bodily harm, drive him to madness, or even lead him to the grave.

This symptom takes various forms - from the subject’s simple belief that people are persecuting him, to complex and bizarre plots in which any kind of fantastic constructions can be used.

A constant stay in a near-delirium state is natural for patients diagnosed with paranoid syndrome. Moreover, people with such a disorder are divided into two types: those who can systematize their delirium, and those who are unable to do this. In the first case, the patient clearly understands and can tell others when he noticed that he was being watched; can name the date of the onset of a persistent feeling of anxiety, how it manifests itself, and, moreover, even names a specific person from whom he feels danger.

Most patients, unfortunately, cannot systematize delirium. They understand their condition in general terms and create conditions for preserving life: they often change their place of residence, observe increased security measures in various situations, and lock all doors.

The most well-known human disorder is schizophrenia, a paranoid syndrome in which thinking is partially or completely impaired and does not correspond to natural thinking.

Symptoms of paranoid psychosis

The first signs of this psychosis can be considered suspicion without any reason, manifested beyond any measure, constant doubts about the fidelity of the wife, the devotion of friends, the honesty of business partners, and so on. Remarks from other people are elevated to the level of personal threats and humiliation. There is inadequacy in a person’s actions and actions. The affective reactions that accompany paranoid psychosis may seem delusional to a normal person.

The patient begins to experience a disturbance in perception, as well as hallucinatory experiences. Some thoughts are blocked and his associations become loose; he is also prone to hypochondria. The patient has thoughts that the world is unusual, objects and people are strange, and everyone around him has a negative, biased attitude towards him. The main feature of behavior becomes dissatisfaction with everything and everyone, rancor, painful perception of even a small failure, an insignificant refusal.

The eccentricity of paranoid psychosis causes quite a lot of problems for the patient’s relatives. Therefore, in order to avoid exacerbation of the condition when the above signs appear in one of your loved ones, you need to seek help from a psychiatrist or psychotherapist.

Causes of the disease

Doctors find it difficult to name the exact cause or their complex, which can provoke a violation of a person’s psycho-emotional state. The etiology can be completely different and is formed under the influence of genetics, stressful situations, congenital or acquired neurological pathologies, or due to changes in brain chemistry.

Some clinical cases of the development of paranoid syndrome still have a clearly established cause. To a greater extent, they occur under the influence of psychotropic and narcotic substances and alcohol on the body.

Classification and symptoms of the disorder

Doctors agree that they are paranoid and have similar symptoms:

• patients are more likely to be in a state of secondary delusion, which manifests itself in the appearance of various images, rather than in a state of primary delirium, when they do not understand what is happening to them;
• in each clinical case, a predominance of auditory hallucinations over visual phenomena was noted;
• the state of delirium is systematized, which allows the patient to tell the reason and name the date of origin of anxious feelings;
• in most cases, each patient clearly understands that someone is spying on him or stalking him;
• the views, gestures and speech of strangers are associated with hints and a desire to harm them;
• sensory impairment.

Paranoid syndrome can develop in one of two directions: delusional or hallucinatory. The first case is more severe, because the patient does not make contact with the attending physician and loved ones; accordingly, making an accurate diagnosis is impossible and is postponed indefinitely. Treatment of delusional paranoid syndrome takes longer and requires strength and perseverance.

Hallucinatory paranoid syndrome is considered a mild form of the disorder, which is due to the patient’s sociability. In this case, the prognosis for recovery looks more optimistic. The patient's condition can be acute or chronic.

Diagnostic criteria

Prescription of therapeutic therapy is possible only after an accurate diagnosis has been made. The doctor initially assesses the patient's condition visually. Then the patient is interviewed on various topics.

The adequacy of answers, behavior during a session, and a person’s personal characteristics are the key factors that are analyzed when establishing a diagnosis.

Complete denial of current events indicates that the patient is suffering from paranoid psychosis and requires treatment.

Hallucinatory-paranoid syndrome

This syndrome is a complex mental disorder of a person in which he feels the constant presence of strangers who are spying on him and want to cause physical harm, even murder. It is accompanied by frequent occurrence of hallucinations and pseudohallucinations.

In most clinical cases, the syndrome is preceded by the strongest in the form of aggression and neurosis. Patients are in a constant feeling of fear, and their delirium is so diverse that against its background the development of automaticity of the psyche occurs.

The progression of the disease has three stable stages, following one after another:

1. A lot of thoughts swarm in the patient’s head, which every now and then pop up on top of those that have just disappeared, but at the same time it seems to him that every person who sees the patient clearly reads thoughts and knows what he is thinking about. In some cases, it seems to the patient that the thoughts in his head, not his, but those of strangers, are imposed by someone through the power of hypnosis or other influence.
2. At the next stage, the patient feels an increase in the heart rate, the pulse becomes incredibly fast, cramps and withdrawal begin in the body, and the temperature rises.
3. The culmination of the condition is the patient's awareness that he is in the mental power of another being and no longer belongs to himself. The patient is sure that someone is controlling him by penetrating his subconscious.

Hallucinatory-paranoid syndrome is characterized by the frequent appearance of pictures or images, blurry or clear spots, while the patient cannot clearly describe what he sees, but only convinces others of the influence of an outside force on his thoughts.

Features of the clinical picture

Paranoid psychosis, like any other disease, has a number of characteristic symptoms. As a result of pathological changes in the psyche, the disease manifests itself with the following symptoms:

• excessive suspicion of everything around you;
• not a trusting attitude even towards close and dear people;
• emotional perception of any criticism or comments;
• unpredictability of reactions;
• fear of betrayal by others;
• a constant state of resentment;
• lack of desire to forgive;
• unwillingness to forget grievances;
• pliability to the influence of stressful situations;
• constant feeling of anxiety;
• irritability;
• phobias;
• sudden changes in mood and activity;
• lack of ability to concentrate on something;
• tendency to depression;
• reluctance to communicate with other people, which leads to a narrowing of the circle of friends;
• showing interest in magical rituals and other mysticism;
• constant desire to be alone;
• episodic manifestations of hallucinations;
• dissatisfaction with oneself and others.

This is not a complete list of symptoms that can be observed in a patient. Each case is individual and can be supplemented by other manifestations, such as, for example, groundless jealousy and endless suspicions of treason.

In most cases, paranoid psychosis is not a permanent condition, but manifests itself episodically. If the above-described symptoms occur, then at their first manifestations it is necessary to urgently contact a specialist who, after a detailed study of the clinical picture, will be able to make a final diagnosis and prescribe adequate treatment.

Under no circumstances should you hesitate, because if proper measures are not taken in a timely manner, the disease can become chronic. The life of the patient and the people around him will become simply unbearable.

Depressive-paranoid syndrome

The main cause of this form of the syndrome is the experience of a complex traumatic factor. The patient feels depressed and is in a state of depression. If these feelings are not overcome at the initial stage, sleep disturbance subsequently develops, up to complete absence, and the general condition is characterized by lethargy.

Patients with depressive-paranoid syndrome experience four stages of disease progression:

• lack of joy in life, decreased self-esteem, impaired sleep and appetite, sexual desire;
• the emergence of conditions caused by the lack of meaning in life;
• the desire to commit suicide becomes persistent, the patient can no longer be convinced otherwise;
• the last stage is delirium in all its manifestations, the patient is sure that all the troubles in the world are his fault.

This form of paranoid syndrome develops over a fairly long period of time, about three months. Patients become skinny, their blood pressure is compromised, and their heart function suffers.

Description of manic-paranoid syndrome

Manic-paranoid syndrome is characterized by elevated mood for no good reason, patients are quite active and mentally excited, they think very quickly and immediately reproduce everything they think. This condition is episodic and is caused by emotional outbursts of the subconscious. In some cases, it occurs under the influence of drugs and alcohol.

Patients are dangerous to others because they are prone to pursuing the opposite sex for sexual purposes, with possible physical harm.

Quite often, the syndrome develops against the background of severe stress. Patients are confident that those around them are plotting criminal acts against them. This results in a constant state of aggression and mistrust; they become withdrawn.

Symptoms

With paranoid psychosis, a person believes that everyone around him is against him. This shows in his behavior.

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The main feature becomes:

• constant aggression;
• suspicion;
• painful perception of refusal, the slightest failure;
• Accusations from friends and family that they underestimate a person are constantly whispered behind his back.

Everyone around him is seen by the patient as enemies, plotting evil deeds against him. The object of delirium can be absolutely any person, relative or stranger on the street. The patient perceives all comments regarding appearance or behavior as a threat or personal insult.

The classification of paranoid psychosis is based on the presence of various delusional ideas in the patient.

Delirium may be of the following nature:

1. Somatic. The patient is absolutely sure that he has a physical injury or a fatal disease.
2. Majestic. The patient considers himself a superman, ascribes to himself various discoveries and inventions.
3. Zealous. The patient constantly suspects his partner (husband or wife) and former lovers of cheating.
4. Unspecified. In this case, symptoms that are uncharacteristic of various types of delirium are observed.
5. Stalking. The patient feels that he is constantly being watched with the aim of killing him or using him for experiments (for example, aliens).
6. Erotic. A person attributes to himself novels with famous people, and it is not necessary that he knows them.

There are a lot of delusional variants in a person suffering from paranoid psychosis. And from them, relatives and close people can determine that not everything is all right with a person.

All forms of paranoid psychosis have similar features. It is simply impossible not to notice such a change in behavior.

Eccentric behavior causes a lot of problems for the patient’s relatives and friends, so you should immediately consult a psychiatrist or psychotherapist.

Diagnostic methods

If paranoid syndrome is suspected, it is necessary to take the person to a clinic, where they should undergo a thorough general medical examination. This is a method of differential diagnosis and allows us to clearly exclude mental disorders associated with stress.

When the examination is completed, but the cause remains unclear, the psychologist will schedule a personal consultation, during which a number of special tests will be performed.

Relatives should be prepared for the fact that after the first communication with the patient, the doctor will not be able to make a final diagnosis. This is due to reduced communication skills of patients. Long-term observation of the patient and constant monitoring of symptomatic manifestations are required.

For the entire diagnostic period, the patient will be placed in a special medical facility.

Therapy[edit | edit code]

Cognitive-behavioural[edit | edit code]

The primary task of the therapist is to establish a trusting relationship with the client. A secondary strategy can be considered an attempt to achieve an increase in the client's own effectiveness, which will lead to a weakening of the defensive position. This in turn will facilitate the implementation of common cognitive interventions, such as changing dysfunctional automatic thoughts, maladaptive interpersonal behavior, and the client's core assumptions that are the basis of the disorder.

Psychoanalytic[edit | edit code]

Psychoanalytic therapy of paranoid individuals is a rather labor-intensive task that requires the therapist to have high professional qualities and, above all, the ability to tolerate negative emotions directed at themselves. A paranoid client tends to project his negative (in the client’s opinion) qualities onto the therapist, suspect the therapist of all mortal sins and actively seek evidence of his fantasies, including provoking the therapist to have a negative attitude towards himself (the so-called “projective identification”).

Another tendency the therapist may encounter is temporary idealization. Typically, a paranoid client, denying those qualities of his that seem negative to him, perceives himself as a victim of external aggression, and sees those around him (including the therapist) as aggressive carriers of many vices. However, in the initial stages of therapy, he may identify with the therapist and idealize him along with himself. The more painful it will be for the therapist to face the inevitable wave of negativity when the period of idealization ends.

Successful psychoanalytic therapy requires the client to recognize that the qualities and desires that he does not like in others are his own qualities and desires. One of the main means of achieving this awareness is through transference analysis, during which the client can see that his fantasies about the therapist have no objective basis. To do this, the therapist needs to actually not give such reasons - to successfully withstand the client's provocations and to cope well with his feelings, especially negative ones.

Paranoid clients' reliance on denial has a significant impact on the speed of therapy. This defense mechanism works by categorically refusing to acknowledge something (and not by forgetting, as with repression). Direct interpretations of transference run into even greater denial. It takes considerable time and support from the client's observing position for him to begin to accept the very possibility that what he sees in others may come from within himself.

Despite all these difficulties, Nancy McWilliams notes in her book that the therapy process turns out to be extremely significant for such clients who, although they express a huge number of reproaches and complaints to their therapists, stubbornly continue to attend sessions. McWilliams suggests that for a person with a paranoid personality type, who sees the whole world in dark, alarming tones, psychotherapy sessions in which someone listens to his negativity without responding with retaliatory attacks are a rare and very valuable outlet [7].

Treatment of patients diagnosed with paranoid syndrome

Depending on what symptoms the paranoid syndrome shows, in each clinical case the treatment regimen is selected individually. In modern medicine, most mental disorders can be successfully treated.

The attending physician will prescribe the necessary antipsychotics, which, when taken in combination, will help bring the patient into a stable mental state. The duration of therapy, depending on the severity of the syndrome, is from a week to one month.

In exceptional cases, if the form of the disease is mild, the patient can undergo therapy on an outpatient basis.

Drug therapy

The leading specialist in solving problems of mental personality disorder is a psychotherapist. In certain cases, if the disease is caused by the influence of drugs or alcohol, a specialist must work in tandem with a narcologist. Depending on the degree of complexity of the syndrome, medications will be selected individually.

For the treatment of mild forms, the following remedies are indicated:

• "Propazine."
• "Etaperazine."
• "Levomepromazine."
• "Aminazine."
• "Sonapax".

Moderate syndrome is treated with the following drugs:

• "Aminazine."
• "Chlorprothixene."
• "Haloperidol."
• "Levomepromazine."
• "Triftazine"
• Trifluperidol.

In difficult situations, doctors prescribe:

• "Tizercin."
• "Haloperidol."
• "Moditen Depot".
• "Leponex".

The attending physician determines which medications to take, their dosage and regimen.

Paranoid psychosis: diagnosis and treatment

The disease is diagnosed by interviewing the patient and external examination. The diagnosis is established in the presence of an imbalance of personal positions and disharmonious behavior. If the patient categorically denies the need for treatment to correct his behavior, then the diagnosis is completely confirmed.

If paranoid psychosis is confirmed, a psychotherapist or psychiatrist works with the sick person. Long-term psychocorrection of behavior is carried out, aimed at improving the quality of a person’s social life and strengthening his sense of self-worth for society.

Drug therapy is prescribed only in the presence of severe aggression, when the patient becomes dangerous to others.

The doctor prescribes the following medications:

• to eliminate depressive conditions - antidepressants;
• to relieve symptoms of psychosis - antipsychotics;
• to reduce motor agitation - tranquilizers.

Sometimes treatment is carried out in a hospital setting. This is necessary in cases where the patient has suicidal tendencies or social maladjustment. Also, observation in a hospital setting is recommended for an unspecified diagnosis.

Paranoid psychosis is a serious illness that, without treatment, can lead to the formation of a socially dangerous personality. Treatment must begin as early as possible, as soon as the patient begins to behave inappropriately. In this case, with the help of psychotherapy and medications, the person can be returned to normal life.

Prognosis for recovery

It is possible to achieve a stage of stable remission in a patient diagnosed with paranoid syndrome, provided that the request for medical help was made in the first days of detection of mental disorders. In this case, therapy will be aimed at preventing the development of the exacerbation stage of the syndrome.

It is impossible to achieve an absolute cure for paranoid syndrome. The patient’s relatives should remember this, but with an adequate attitude to the situation, the disease can be prevented from worsening.