Paranoid Schizophrenia This Work Details

Paranoid Schizophrenia

This work details the disorder paranoid schizophrenia. The work discusses the disorder in general the social, cultural clinical implications of it, treatment trends in the past and in the present as well as assessment, diagnosis, expected outcomes, therapeutic relationships, psychopharmacology, milieu management and evaluation of the disease which is a subtype of schizophrenia associated with delusions.

Paranoid schizophrenia, better known and schizophrenia with paranoid ideologies is a significant and enduring psychological diagnosis. Though the accepted diagnostic criterion for Schizophrenia (with paranoid ideologies) is that of the DSM-IV there are several ways to diagnose the disorder and to separate it from that of other psychiatric disorders as well as to add to the therapeutic knowledge of the individual. (Hilsenroth, Fowler & Padawer, 1998, p. 514) in general the disorder is one type of schizophrenia that is distinguished by the fact that the individual has psychotic ideologies relating to delusions, in the form of hallucinations or auditory hallucinations where the individual either sees or hears information that is not present in reality but nonetheless believes it to be true.

Positive symptoms are behaviors that are notably odd and socially deviant, such as hallucinations (sensory experiences in the absence of any environmental stimuli) and delusions (false beliefs, often bizarre and firmly held, even in the face of disconfirming evidence). The negative symptoms consist of patterns of nonresponsivity: passivity, a lack of spontaneity, flat affect (a lack of emotional responsivity), the inability to initiate goal-directed activity, social withdrawal, a lack of motivation, and anhedonia (an inability to experience pleasure) (Crow, 1980). Recently, cognitive deficits have received increasing attention (Green, 1996). Cognitive deficits include problems with memory, attention span and concentration, and executive functioning (judgment and decisionmaking). (Bond & Meyer, 1999, p. 9)

The reason it is called paranoid schizophrenia is because the delusions frequently experienced manifest into ideas of others wishing to hurt or control you, even when such realities are not present (positive or present symptoms) (Rowe & Shean, 1997, p. 197). The individual may also experience general anxiety, but unlike other forms of schizophrenia may have fewer or lesser symptoms of impaired memory, concentration or dulled emotion (negative or absent symptoms). (Mayo Clinic, 2008, NP) the individual is generally diagnosed via psychologist according to DSM standards, as a result of the fact that the individual has shown impairment in his or her life, and stories, interviews and interactions are used. Currently there are no clinical test (labs) identified with schizophrenia.

Background and Significance

The PS disorder is significant and though it may have fewer cognitive impairment symptoms than other forms of schizophrenia it is still functionally difficult to manage, for the individual as he or she is in a near constant state of paranoia and may frequently alter his or her actions and reactions to respond to delusion information. Onset of the disease is also difficult to manage, as schizophrenia of all forms manifests in early adolescent-young adult years and may seriously impair the previously relatively normal individual in his or her ability to build his or her future life, going to college, becoming gainfully employed, beginning and maintaining life long relationships, all issues being faced by people in this age group, and specifically as they are becoming independent of family relationships. Paranoid schizophrenics may also isolate themselves as symptoms begin to take over their psyche and their reactions to delusions pepper their relationships and create conflict internally and when expressed, externally. It is for this reason that whenever possible many sources are often used to diagnose the disorder, not limited to the individual's own offered information.

Cultural Considerations

The time which symptoms begin to manifest is likely the most significant cultural consideration as it can seem to the individual with the disorder that unlike their peers they are being stopped in their developmental goals. Families may be more or less supportive of creating therapeutic support to help the individual cope with the disorder and stabilize, or due to age and separation may believe that the disorder is a sever aspect of normal "though dramatic" development in life. It is only when the individual shares delusions that are known to be incorrect with others around them (often in the form of accusations) that the family or other support persons may begin to see that something more is wrong. (Mayo Clinic, 2008, NP)

Trends in Management historical and current

Management trends for PS have always included psychotherapy and other forms of long-term counseling. Medication has been utilized over the last 50 or so years with greater or lesser success to manage symptoms and historically, depending on the functional ability of he individual this was often done institutionally, though currently it is more frequently done on an outpatient basis. The deinstitutionalization trend affected this subgroup of psychiatric patients in excess, as a result of new medication success and the apparent lack of cognitive ability found in these patients. Medications have also improved significantly with regard to symptom treatment over the years, as is attested to by Higgins, who empirically compares Clozapine with other more effective and newer medications and briefly discusses the history of deinstitutionalization through medical intervention and treatment with the drug thorazine. (Higgins, 1995, p. 124) Medications have been one of the greatest hopes and realizations for people with PS as it has allowed them to function almost normally in society and even retain employment, independently or with a vocational rehab system that can help support them and is more capable of developing systems that aide in functioning, though less so for PS as formal systems are not always needed and sometimes frowned upon as they seem to limit the employment possibilities of the individual to those accepted and supported by the system, and PS patients are often capable of supporting independent employment as a result of their reduced negative symptomology.

A more recent trend in management of the disorder has also stressed the need to develop strong community-based support systems for these individuals, even supporting the idea of having other psychiatric outpatients serve to assist individual in the community as support systems, with some real success. (Turner, Korman, Lumpkin & Hughes, 1998, p. 35) it must also be said that many of these individuals are dependant on support from family and psychiatric personnel, mostly a single therapist, while in the community and often experience frequent institutionalization periods where they are supported in healing by psych nurses and other staff in addition to their own therapist and the institution supported therapists.

Evidenced-Based Nursing Practice