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I have chosen this topic because it gives me an opportunity to analyze and evaluate the materials provided and also to gain more knowledge about the subject. Paranoid Schizophrenic Disorder being a chronic, mental illness has affected a number of people and its side effects make it an interesting field of study.
Nature of Paranoid Schizophrenia
Black and Boffeli (1989) define Schizophrenia as a chronic, more or less debilitating illness, which is characterized by perturbations in cognition and behavior. All these have a bizarre aspect. Also, hallucinations may occur to the victims of this disease. Emil Kraepelin, a German psychiatrist, was the first one to coin a name for this illness by terming it as “dementia praecox”. It is his description of the illness that has been the focal point for modern day investigators. Butcher et al. (2013) describes Paranoid Schizophrenia as a relatively common illness with lifetime prevalence of about 1%. Generally, males tend to have an earlier onset than females.
Subtypes of Schizophrenia
Various subtypes are characterized by a particular combination of symptoms. They include paranoid, hebephrenic, catatonic and simple types. A patient who suffers from an illness that cannot be classified under the stated subtypes is to have an undifferentiated subtype. Butcher et al. (2012) illustrates that clear knowledge about the subtypes will equip one with sufficient information about Schizophrenia and also help someone else confidently predict how any given patient might react in any specific situation. It can also help to gain an adequate knowledge about Paranoid Schizophrenic Disorder.
Features of Paranoid Schizophrenia
This subtype of Schizophrenia tends to have a later onset than other ones. Certain signs and symptoms are consistently present in patients, although they may vary widely. These symptoms include hallucinations, disorganized speech, delusions and bizarre behavior. The delusions are, in general, persecutory and referential. In most cases, these patients tend to suspect their co-workers and make fun of them. At times, these patients may appeal for the police for assistance and guidance. They tend to have an intense attitude and constrained suspiciousness and anger. These patients may vent their anger and turn on their supposed attackers violently.
Onset of the illness
The range of the development of Schizophrenia is very wide; whereby even the childhood onset may occur, but in some scenarios symptoms may only appear after one has reached sixty years (Andreasen, 1982). Some peculiarities may be witnessed for years, before the appearance of the disease. Normally, a prodrome may be present or not before the actual start of symptoms. History may reveal peculiar interests and introversion in cases where the prodrome began in childhood. Family members are normally questioned about the development and change witnessed in the patient. The onset of Schizophrenia symptoms may either be insidious or acute. In cases of a deceptive one, the patient may not be troubled at all. However, acute onsets may be characterized by depressive symptoms or confusion. Acute development normally tends to occur for a number of weeks.
Symptoms of Paranoid Schizophrenic Disorder
After thorough analysis and evaluation, it was realized that hallucinations are the most common symptom of Schizophrenia. Barta et al (1990) states that patients who suffer from this illness tend to hear or see fallacious things. Also, hallucinations of touch, taste and smell may occur. Nevertheless, hearing of voices is the most common characteristic of Schizophrenia. These voices can come from the air, television or radio. Basically, a clear scrutiny may reveal that these voices can come from anywhere. The disadvantage is that the patient will find it hard to recognize the identity of the speaker. Certain themes are relatively common in the voices, although what they say is extremely varied.
Another type of hallucinations experienced is visual hallucinations (Andreasen, 1982). They are compelling realistic and play a less prominent part in the illness than other hallucinations; for example, cases of the strange people walking down the halls or heads floating in the air. Other patients have an imaginary picture of the devil in the red suit appearing in front of them. Strange enough; also a chorus of sympathetic angels was seen by few patients diagnosed with Schizophrenia.
Lasly, hallucinations of taste, touch and smell may be particularly compelling, though not common to many patients. For example, when a patient smells putrefied flesh, he imagines the corpses being buried in the vicinity; when he smells poison gas, he/she will feel it coming from the heating ducts. Hallucination of touch is a bit more common, unlike the ones of smell and taste. A patient feels all sorts of things at night (Barta et al., 1990). For example, when something is crawling on them, this means that the pricking is approaching from behind. In other cases, the patient may feel things inside their bodies like their intestines were shrinking.
Another major symptom is delusion. The patients may feel being persecuted; this thought may be quite stable and become an obsession. They often fell controlled and influenced by outside forces. In the early stages, the patient may only have suspicion, but with time the conviction deepens. In some cases, a person may have lingering doubts about the truth of these beliefs and argue with those who disagree. The delusions ate typically contradictory, poorly elaborated and coordinated in nature.
In cases when the patient is suffering from Schizophrenia and has experienced delusions, the plain-clothes officers are engaged in pursuing him/her. In some special scenarios, usage of satellites is recommended. It involves an intense operation coordinated by the FBI in capturing and prosecuting such a victim. Mostly, the patient may feel less secure and attempt to flee to another state just to be off the vicinity of the prosecutors (Butcher et al, 2013).
Complications of Paranoid Schizophrenic Disorder
The complications are experienced both at the business angle and academic level. There are numerous reports about these patients ascertaining the effects of the sickness. About the half of patients attempt suicide and most of them are incapable of sustaining intimate relationships. These suicides normally occur in the early stages of the illness. One uncommon complication that is often ignored is hypernatremia. It makes patients the uncontrollable water drinkers; nonetheless, it appears not being caused primarily by excessive intake of water.
Treatment of Paranoid Schizophrenia
Pilling et al. (2002) argues that the treatment of Paranoid Schizophrenic Disorder should always involve the usage of an antipsychotic drug. Generally, patients are engaged productively in supportive psychotherapy either as individuals or in a group. Commitment and involvement of families is vital for the successful treatment of patients with Paranoid Schizophrenia. Families are important in assisting the patient in securing employment and housing as well. The antipsychotics used can be broadly divided into the two groups, i.e. first generation and second generation drugs.
The commonly used first generation drugs include fluphenazine, haloperidol and chlorpromazine. Unlike in the past, nowadays there is an increasing number of secondary antipsychotic drugs in the market. They include clozapine, risperidone, olanzapine, aripiprazole and ziprasidone. Most second generation drugs, such as clozapine and risperidone are therapeutically superior to the first generation drugs (Volavka et al., 2002). The second generation drugs are usually better tolerated, than the first generation antipsychotics, but it has not been established why they are therapeutically superior.
It is recommended that patients start treatment with the second generation drugs, such as risperidone or olanzapine, in order to avoid severe side effects caused by clozapine. A patient can still use other second generation antipsychotics such as ziprasidone and quetiapine; although they cannot be strongly recommended despite being better tolerated than first generation drugs. It is a very difficult hurdle to choose between risperidone and olanzapine, because it is not proven which one is therapeutically superior to another.
It is vital to identify the side effects of each of the drugs before recommending it to the patient. Risperidone is more likely to cause extrapyramidal side effects, such as Parkinsonism and Akathisia, than olanzapine. The price is an important issue to the patients and in such cases usage of first generation agents might be appropriate. Unlike the secondary generation agents, the oral preparation of the first generation agent may be available in the generic form; hence, patients can save their hard-earned money. It is at this point that the usage of first generation drugs is recommended. Importantly, one shouldn’t forgeet about the history of the patient’s response to the drugs. For example, it will not be essential to change if the patient did well with the first generation agent. The same case applies to the secondary antipsychotics.
As it was illustrated, the choice of first generation drugs is very simplified. This is done by dividing them into high potency drugs, such as fluphenazine, and low potency drugs, such as chlorpromazine. The usage of low potency agents tends to result in sedation, anticholinergic effects and hypotension. However, it has a small tendency of causing extrapyramidal side effects, such as Parkinsonism, Akathisia and dystonia. On the contrary, the high potency drugs display a high potential for extrapyramidal side effects.
The choice between high potency and low potency drugs is in most cases made on the basis of the side effects. For example, a patient with postural dizziness should not be given a low potency antipsychotic drug that might exacerbate postural hypotension. However, a patient in traction might not tolerate a dystonia very well, and it would be advisable to serve him with low potency drugs. There are special cases where the side effects are not a compelling issue, and in such situations, the patient may use fluphenazine or haloperidol.
The treatment of Paranoid Schizophrenic Disorder should not be rushed and must follow the doctor’s guidelines. After choosing the antipsychotic, Pilling et al. (2002) recommends that the drug be administered at an adequate trial. Generally, it is estimated that, after two weeks, the patient may see an initial response only if he has taken an adequate doze. Lower doses are usually prescribed for the feeble and elderly and also for patients with significant hepatic dysfunction. In rare cases, a patient may use higher doses of antipsychotic drugs, but this may expose the patient to worse side effects.
The administration of the prescribed agent may be continued if the patient gets an initial good response. However, if there is a partial response, but promising, the treatment can only be continued for an additional period of four weeks. After this period, one needs to ascertain the nature of the response of the patient to the antipsychotic administered. One may move to maintenance treatment if the response is good and satisfactory. Otherwise, if the response is less than adequate, then one should review the case and ensure that the diagnosis is correct. One ought to significantly increase the dose if the diagnosis is found to be correct.
It is advised that all patients undergo maintenance treatment. Cautious dose adjustments are considered once every four months if they are stable in the community. Some patients may become so distressed at side effects that they may find a mild increase in the symptoms of the disease unbearable. In circumstances where the patients become almost symptom free, psychiatrists may decide to decrease the prescription in a step-wise fashion. This process may continue until either drug discontinuation is achieved or symptoms reappear. Generally, it is suitable to keep the dose as low as possible to lessen the risk of tardive dyskinesia.
The involvement of family members is vital in forming psych-educationally oriented groups that are very useful to the patient. Butcher et al. (2012) states that it is very important to inform the family members that they did not cause the illness. They should also be educated that there is no connection between the way they brought up their children and the development of Paranoid Schizophrenia. Commitment of family members and family therapy helps reduce the number of hospital stays required; although, the patients need to be hospitalized at some point of their illness.
In conclusion, it is worth stating that Paranoid Schizophrenic Disorder is an illness that is increasingly affecting people of different ages. It is through analysis and evaluation of vital information about the illness that people come into realization that an impact of this illness on the patient and other family members cannot be simply overlooked. From the symptoms and complications associated with this illness, it is very important that the family members are engaged into the treatment of the patient. Efforts should not merely focus on treating this mental illness, but also pay attention to the engagement of the whole family in the treatment process of one of their own who unfortunately, is suffering from Paranoid Schizophrenia. Evidently, enough efforts need to be put to educate family members about this illness.