Paranoid patients

Items most consistently answered true (or false) by each diagnostic subgroup are useful indicators of that diagnosis. For example, patients with paranoid symptoms usually check tme when asked if they think other people often talk behind their backs, while non-paranoid patients usually do not. Eventually 13 scales were established - for example, the Ma Scale (manic tendencies), D Scale (depressive tendencies) and Pd scale (psychopathic tendencies.)... 

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 the event that one is able to convince the paranoid patient to take a medication, a trial of a low dose atypical antipsychotic may be warranted. 

Psychiatric patients Schizophrenic or paranoid patients may exhibit a worsening of psychosis with TCA therapy, and manic-depressive patients may experience a shift to a hypomanic or manic phase this may also occur when switching antidepressants and withdrawing them. In overactive or agitated patients, increased anxiety or agitation may occur. Paranoid delusions, with or without associated hostility, may be exaggerated. Reduction of TCA dosage and concomitant antipsychotic therapy may be necessary. 

DiBella, G. A. W. (1979). Educating staff to manage paranoid patients. American Journal of Psychiatry, 136, 333—335. 

The issues encountered with paranoid patients often surround struggles over control and autonomy. These people are especially frightened by others assuming a position of control over them, and being "medicated" often touches on this theme. In more-psychotic paranoid patients, this issue not uncommonly takes the form of delusions in which the patient feels the therapist is trying to poison him or her. 

The goal of medication treatment is to reduce symptoms so that the person can function better and benefit more from other forms of treatment, such as individual, group, or family therapy and social or vocational rehabilitation. An important part of such therapy involves educating the patient to prodromal symptoms and effects and side effects of medications. It is also important to address patients beliefs that taking medications means they are sick (and conversely, that not taking medications means they aren t). Especially with paranoid patients, the belief that medications are a means of being controlled by others must be worked through. 

Patients should be shown a series of photographs showing what the face looks like day by day during the first week after a peel. Ideally, the patient s immediate family should also see these photographs. Without this precaution, paranoid patients, friends and family may not believe it when the doctor tells them that everything is proceeding as normal. 

The postulation of a possible role of trace amines in the context of schizophrenia was kindled early on by the structural similarity between PEA and amphetamine. Symptoms such as hallucinations and paranoid episodes caused by a prolonged amphetamine intoxification are reminiscent of patients suffering from acute schizophrenia. Further support for a role of trace amines in the context of schizophrenia comes from clinical studies... 

When the anabolic steroids are administered with anticoagulants the anticoagulant effect maybe increased. Administration of methyitestosterone with imipramine may cause a paranoid response in some patients The anabolic steroids may increase the hypoglycemic action when administered with thesulfonylureas... 

Sensorium. Patients with PCP intoxication can have a clear sensorium, or they can be disoriented, confused, stuporous, lethargic, or comatose. Signs of cerebral stimulation, such as pressured speech, verbigerations, and echolalia, may also occur. Frank psychotic symptoms, including hallucinations, delusions, and paranoid ideation, are not unusual. 

Toxic Psychosis. Any patient who is not catatonic but has hallucinations, delusions, paranoid ideation, or other psychiatric manifestations is classified as having toxic psychosis. These patients are often difficult to differentiate from those with acute agitated psychosis, and about 25 percent appear manic. 

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]. 

Self-Report Symptom Inventory. Each of the 90 items in the SCL-90 uses a five-point scale of distress. It was designed as a general measure of symptomatology for use by adult psychiatric outpatients in either a research or clinical setting. It rates either the present or previous week. It requires about 15 minutes for the patient to complete this form and about 5 minutes for a technician to verify identifying information. This test is sensitive to drug effects and may be used with inpatients. Nine subscales are measured somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, and psychoticism. 

The mental status examination remains an essential part of the evaluation. Often patients with schizophrenia will appear nnkempt or otherwise oddly dressed. Sometimes they will be friendly and affable, but when they are paranoid, they can be angry and hostile. Patients may have odd stereotypical movements that can become extreme in catatonic states. The patient with schizophrenia is usually quite alert and well oriented to his/her surroundings. This observation helps to distinguish the psychosis of schizophrenia from that of a delirium due to a medical illness or substance use. 

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. 

Psychosis for demented patients usually takes the form of paranoid delusions. Demented patients may believe family members have turned against them, or they may misidentify their loved ones as intruders in their home. Although hallucinations are not listed in the DSM-IV criteria, they may also occur. When psychosis occurs in a demented patient, it is a serious problem. It is very distressful to the patient, makes it difficult (if not impossible) for family members to provide care, may lead to episodes of violence, and commonly leads patients to be hospitalized or placed in nursing homes. Fortunately, most patients with dementia do not develop delusions or other psychotic symptoms. 

Those with STPD also have few friends, and they are likewise seen as aloof and eccentric. While the schizotypal patient may be paranoid, similar to the patient with PPD, there are other features that set him/her apart. Namely, the schizotypal patient is prone to preoccupations with magical or superstitious thinking and reports unusual sensations including bodily illusions. (S)he may find special personal meaning in the way things are arranged about him/her or in events reported in the news. 

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. 

In psychiatric practice, chlorpromazine is used in various conditions of psychomotor excitement in patients with schizophrenia, chronic paranoid and also manic-depressive conditions, neurosis, alcohol psychosis and neurosis accompanied by excitement, fear, stress, and insomnia, hi comparison with other neuroleptics, chlorpromazine is unique in that it has an expressed sedative effect. It is sometimes used in anesthesiological practice for potentiating narcosis. It also has moderate anticonvulsant action. The most common synonyms are aminazine, megaphen, largactil, thorazine, prompar, and others. 

In psychiatric practice, triflupromazine is used for psychomotor excitement in patients with schizophrenia for paranoid and manic-depressive conditions, and for neurosis. The most common synonym is vesprin. 

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. 

Drug abuse and dependence Prolonged abuse of ephedrine can lead to symptoms of paranoid schizophrenia. Patients exhibit such signs as tachycardia, poor nutrition and hygiene, fever, cold sweat, and dilated pupils. Some measure of tolerance develops, but addiction does not occur. 

Adverse reactions occurring in 3% or more of patients include euphoria, nausea, vomiting, dizziness, paranoid reaction, and somnolence. 

LSD can also provoke a prolonged psychiatric reaction which includes paranoid delusions, schizophreniform auditory hallucinations and overwhelming panic. This reaction, which closely resembles schizophrenia, occurred in 1-2 per cent of patients administered LSD for psychotherapeutic purposes (Malleson, 1971). Medical use of LSD is now obsolete but similar psychoses are seen in recreational users (Seymour Smith, 1991). 

In addition to prominent and persistent hallucinations, delusions and delusional misidentifications occur in over half of DLB patients (Ballard and Oyebode, 1995 Ballard et al., 1999), more commonly than in AD (Ballard et al., 1999). These delusions are defined as persistent false unshakeable beliefs, which cannot be understood in terms of the individual s peer group or culture, and are generally of a paranoid nature. 

Delirium is a clinical diagnosis, based on the recent and abrupt appearance of clouded consciousness, with disorientation in time, and then in place and person. The patient can appear perplexed at first, gradually becoming frankly paranoid and aggressive, often with visual hallucinations. In elderly patients without clear localizing signs, acute toxic confusion is most often related to urinary tract infection. 

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