295.

3 Schizophrenia, Paranoid Type

Patient Education

• Because of the nature of schizophrenia, the patients may have difficulty understanding the illness. Nevertheless,
teaching the patient to understand the importance of medication compliance and abstinence from alcohol and other
drugs of abuse is important.
•
• If possible, teaching the patient to recognize early signs of a decompensation, such as insomnia or increased irritability,
is helpful.
•
• Family members should be referred to the National Alliance on Mental Illness (NAMI) (or other appropriate support
group if available), which provides many educational opportunities.
•
• Social skills training is helpful, but the effects are not long-lived. This kind of training, as well as other sorts of problem-
solving therapy, may need to be continued on an indefinite basis, similar to the medication.
•
• Physical illnesses in schizophrenia are common. The importance of a healthy lifestyle and regular health care should be
stressed.
•
• For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center. Also, see eMedicine's
patient education article Schizophrenia.

Prognosis

The prognosis of schizophrenia is guarded.

• Patients with schizophrenia have a 10% risk of suicide.

•
• Full recovery is unusual.
•
• Symptoms usually follow a waxing and waning course.
•
o The patient's pattern of symptoms may change over years.
o
o Positive symptoms respond fairly well to antipsychotic medication, but the other symptoms are quite persistent.
•
• Early onset of illness, family history of schizophrenia, structural brain abnormalities, and prominent negative symptoms
are associated with poor prognosis.
•
• We have poor understanding of this illness and unacceptably poor treatment. Research is ongoing into the
pathophysiology and treatment of this illness. With earlier intervention with improved agents the goal is complete
resolution of all symptoms of this illness and continuation or resumption of a full meaningful life.

Family members can play an important role in helping to keep their schizophrenic relatives supported and oriented. Before
they can be properly supportive, however, they must first understand and accept that schizophrenia is a disorder of the brain just
like diabetes is a disorder of the body; not anyone's fault; and not an indication of moral or spiritual failure. Family members need
to know this so that they do not blame their schizophrenic relatives for being schizophrenic, or think of them as willfully lazy.
Patients are often incapacitated, and a drain on family energy and resources, but this is not intentional on the part of patients,
who are in many ways victims more than anything else.

The single most important thing family members can do to support their ill relatives is to help them remain oriented and on
task with their therapeutic routines; helping them stay on medications, and attend scheduled psychotherapy sessions and doctor
visits, for instance. Family members can also benefit their ill relatives by helping them with with personal care, eating a well-
balanced diet, and getting regular exercise (even if it's just a walk).
 Therapy is work for schizophrenic patients, who already suffer from a condition that robs them of their better judgment.
When left to their own devices, many schizophrenic patients are prone to avoid therapy or to attend it only intermittently. Either of
these outcomes add up to trouble. Family members can thus help their schizophrenic relatives by continually encouraging them
to keep their therapy appointments, and doing things to make it more likely that treatment is maintained.

Caring for sick relatives is frequently painful and heartbreaking. Family members may benefit from seeking out therapy for
themselves as well as for their ill relatives. Participating in a self-help group for families of psychiatric patients is known to reduce
family member's sense of burden, aloneness and stress.

Coping with an illness as serious as paranoid schizophrenia can be challenging. Medications can have unwanted side effects,
and you may feel angry or resentful about having a condition that requires lifelong treatment. During periods when you feel
better, you may be tempted to stop treatment, which can trigger a relapse. Here are some ways to cope with paranoid
schizophrenia:

• Learn about paranoid schizophrenia. Education about your condition can empower you and motivate you to stick to
your treatment plan.
• Join a support group. Support groups for people with schizophrenia can help you reach out to others facing similar
challenges.
• Stay focused on your goals. Recovery from paranoid schizophrenia is an ongoing process. Stay motivated by
keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working
toward your goals.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational
activities.
• Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
• Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily
tasks.

Paranoid schizophrenia isn't an illness that you can treat on your own. But you can do some things for yourself that will build on
your treatment plan:

• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you
stop, schizophrenia symptoms are likely to come back.
• Pay attention to warning signs. You and your caregivers may have identified things that may trigger your paranoid
schizophrenia symptoms, cause a relapse or prevent you from carrying out your daily activities. Make a plan so that you
know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you
feel. Involve family members or friends in watching for warning signs. Addressing schizophrenia symptoms early on can
prevent the situation from worsening.
• Avoid drugs and alcohol. Alcohol and illicit drugs can worsen schizophrenia symptoms. Get appropriate treatment for
a substance abuse problem.
• Check first before taking other medications. Contact the doctor who's treating you for paranoid schizophrenia before
you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins,
minerals or supplements. These can interact with your schizophrenia medications.

The DSM-IV-TR Multiaxial System

The multiaxial system (sometimes referred to as multidimensional) is used to promote an all-inclusive evaluation of client
function. The axes are as follows:

• Axis I: Clinical Disorders. The first axis describes symptoms of clinical disorders, such as mood disorders and eating
disorders.
• Axis II: Personality and Mental Retardation. The second axis describes symptoms of disorders that cannot be
accounted for on axis one, such as personality disorders.
• Axis III: Medical Conditions. This axis includes medical conditions that may affect disorders of the previous axes, such
as brain injury.
• Axis IV: Psychosocial and Environmental Problems. This axis refers to social or environmental stressors that may
impact on the client’s function, such as bereavement.
• Axis V: Global Assessment of Functioning. This axis is used to evaluate the client’s function overall.