Paranoid disorder

A 36-year-old woman with a history of psychiatric illness, including paranoid disorder, depression with panic episodes, and stress disorder, was found dead in bed. Caffeine, risperidone, and zolpidem were found in her urine. 

Mental Retardation Paranoid Disorder Postconcussion Syndrome Schizophrenia Substance use disorders Temporal lobe epilepsy... 

Amphetamine Clinically used for narcolepsy (sudden day-time onset sleep) and Attention Deficit Hyperactivity Disorder (ADHD) formerly used as a short-term slimming agent, as an antidepressant and to boost athletic performance recreational use widespread tolerance develops readily highly addictive regular users suffer many health problems and a reduced life expectancy amphetamine psychosis may develop, with similar symptoms to acute paranoid schizophrenia. 

The positive symptoms are the most responsive to antipsychotic medications, such as chlorpromazine or halo-peridol. Initially, these drugs were thought to be specific for schizophrenia. However, psychosis is not unique to schizophrenia, and frequently occurs in bipolar disorder and in severe major depressive disorder in which paranoid delusions and auditory hallucinations are not uncommon (see Ch. 55). Furthermore, in spite of early hopes based on the efficacy of antipsychotic drugs in treating the positive symptoms, few patients are restored to their previous level of function with the typical antipsychotic medications [2]. 

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

Psychotic Disorder Due to Generai Medical Condition. Certain medical illnesses occasionally present with symptoms of paranoid delnsions or hallucinations that resemble schizophrenia (Table 4.4). When these illnesses are snccessfully treated, fnll resolntion of the psychotic symptoms invariably occnrs. All patients presenting with new-onset psychosis shonld nndergo a thorongh medical evaluation including a physical exam, family and personal medical history, and laboratory stndies inclnding electrolytes, thyroid function tests, syphilis screen, vitamin B12 and folate levels, and a CT or MRI brain scan. A lumbar puncture (spinal tap) and electroencephalogram are sometimes also warranted. 

Cluster A Personality Disorders (Schizotypal PD, Schizoid PD, Paranoid PD). These are the odd and eccentric personality disorders. They all share certain features in common with schizophrenia, but schizotypal PD in particular appears to be most closely related to schizophrenia. The schizophrenia-like symptoms of these personality disorders (e.g., magical thinking, paranoia, social withdrawal) are less severe and generally don t impair social or employment function as severely as schizophrenia. 

Deiusionai Disorder. It can be particularly difficult to distinguish patients with delusional disorder from those with a PPD. Again, the key difference is one of degree. The patient with a paranoid personality has vague suspicious thoughts, but these do not reach delusional intensity. In addition, the delusions of someone with a delusional disorder are often very focused and circumscribed, whereas the paranoia of the patient with PPD is more generalized. 

Paranoid Personaiity Disorder (PPD). There is a relative lack of data to support the usefulness of medications in the treatment of PPD. Nevertheless, clinical observation suggests that psychiatric medications may be helpful for some patients. The biggest problem is typically in getting the paranoid patient to agree to pharmacotherapy. 

In terms of pharmacological action, pimozide is similar to haloperidol. It is used in hospitals as well as in outpatient settings for supportive therapy of patients suffering from schizophrenia, paranoid conditions, and mental and neurotic disorders with paranoid characteristics. It is unfit for use in severe psychoses because it does not possess psychomotor-sedative action. It is used for treating patients who suffer from Turretts s syndrome. Pimozide has a number of side effects, many of which are similar to those of phe-nothiazine and a number of others. A synonym of this drug is orap. 

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