Paranoid state

Introduction Paranoid state and paranoid psychosis are considered synonymous by scholars. However, some scholars believe that the paranoid state is characterized by prominent paranoia and no hallucination. Its clinical manifestations are similar to paranoia, but the paranoid structure is not a paranoid system, nor is it fixed. It can be accompanied by hallucinations, but it is different from the paranoia of paranoid schizophrenia and the bizarre, absurd, illusion, and personality decline. It is believed that the paranoid state seems to be a state between paranoia and paranoid schizophrenia. Patients with paranoid status generally had a better prognosis, but during follow-up, some patients eventually turned to mental decline.

Cause

(1) Causes of the disease

There is no accepted argument about the cause of the paranoid state, which may be the result of the interaction between personal qualities and certain predisposing factors. That is, it is caused by long-lasting mental stress on the basis of certain personality defects. Acute trauma can be used as a predisposing factor.

(two) pathogenesis

According to clinical observations, the patient's pre-existing personality characteristics have certain defects, such as subjective, self-centered, inferiority, sensitive and suspicious or stubborn. Some also use psychosocial factors as incentives, such as isolation, immigration, exile or being captured.

Hearing impairment may also be one of the triggering factors. Hearing impaired people often feel that they are being left out and scorned because of the difficulty in mutual understanding between people. Especially in the case of a large number of people, they think that they are excluded and even feel ridiculed, which leads to delusions (Tolle R, 1997).

an examination

Related inspection

White blood cell count (WBC) neurological examination

Paranoid state symptom standard

The behavior is significantly different from the social culture in which the individual is located, and the behavior is consistent with the following three items:

1. There are special behavior patterns: manifested in emotions, alertness, impulsive control, perception and way of thinking, and have distinct attitudes and behaviors.

2, has a special behavior pattern is long-term, continuous, not limited to the onset of mental illness.

3. Its special behavioral patterns are universal, resulting in poor social adaptation.

Severity criterion

The severity criteria must be consistent with one of the following two:

1. Social or professional functions are significantly impaired.

2, subjectively feel pain.

Disease standard

Beginning in childhood, adolescents or early adulthood, now 18 years of age or older (under 18 years of age who meet the above criteria are usually not diagnosed as a personality disorder, but may be diagnosed with other types of disorders).

Exclusion criteria

Personality disorder is not caused by the following diseases:

1. Severe physical illness;

2. Brain organic diseases;

3, mental illness: such as schizophrenia, affective psychosis;

4. Severe or catastrophic mental stimulation.

Laboratory examination: There is no specific laboratory examination for this disease. When complications such as infections occur, laboratory tests show positive results of complications.

Differential diagnosis

Differential diagnosis

For the differential diagnosis of paranoid state, it is often necessary to exclude organic mental disorders (such as endocrine diseases, brain degeneration and drug-induced mental symptoms), affective disorders (such as exaggerated delusions of mania).

1. Identification with the paranoid type of schizophrenia, it is difficult in the early stage of the disease. The paranoia of paranoid schizophrenia is peculiar and fragmentary, and is associated with other schizophrenia symptoms. It is not difficult to identify with the paranoid state. The paranoid state usually lacks the first symptoms of schneider and the four "A" symptoms of Bleuler.

2. The identification of affective disorders is easier, because the paranoid state is more persistent, and the social function remains relatively good. In the case of affective disorders, most of them are episodes of disease, although the social function is obviously impaired, but the treatment effect is good.

3. Paranoia and paranoia are characterized by system delusions. Paranoia is not as paranoid as systemic, fixed, delusional content can change due to environmental changes, and the prognosis is better. However, it is difficult to identify at the beginning of the disease.

The onset of depression is mostly slow, mainly due to the development of delusion. Common delusions are forms of murder, jealousy, litigation, love, exaggeration, and illness. Imagine the system, but the structure is not rigorous, and the firmness is not as strong as paranoia. I want to be close to reality, often involving family members, neighbors and colleagues, and generally not generalized. The patients with this disease have no hallucinations and rarely decline. Most of the victimization delusions are related to litigation delusions. They always think that they are completely correct, and they end up complaining endlessly. They will be strong and will not give up until they reach their goal.

There are considerable variations in the symptoms of paranoid state, and there is no consensus among the scholars. This is mainly due to the lack of definitive clinical studies and long-term follow-up observations of the disease. From the term "paranoid", it includes all the delusions. In many delusions, regardless of their content and nature, the concentration is a patient's distorted belief in their living conditions and interpersonal relationships, and it is difficult to be persuaded.

diagnosis

The term paraphrenia is basically not used, but similar patients are seen in the clinic, which is part of the patient isolated from schizophrenia (Kraepelin, 1920). The disease is mostly caused by middle-aged patients. In addition to the dominant fixed delusions, there are symptoms such as disordered thinking, lack of emotion and lack of intention of schizophrenia, which may be accompanied by auditory hallucinations. According to the outstanding clinical performance, it can be divided into 4 subtypes:

1 systemic mental paranoia (paraphrenia systematiea), this type is difficult to identify with paranoia;

2 exaggerated sexual paranoia (paraphrenia expansive);

3 fictional paranoia (paraphrenia confabulation);

4 fantasy mental paranoia (paraphrenia phantastica),

This type is the rarest. The course of the disease is slow and progressive. As time progresses, the delusional structure tends to fragment, but the patient's social function remains relatively good, with no obvious mental decline. Some scholars believe that it can be regarded as a special type of schizophrenia (Mckenna PJ, 1994).

For patients with suspected delusions as the main symptom, it is difficult to diagnose and treat. In the early stages of the disease, patients pay too much attention to their health status and feel certain uncomfortable discomforts, such as headache, tinnitus or sleep disorders, which are often misdiagnosed if not understood. When the condition develops further and the symptoms can be fixed in a certain organ or a certain part, it is considered to be a malignant lesion and an incurable disease is obtained. Although carefully examined, including precision instruments such as magnetic resonance, to prove that everything is normal, the patient is still unable to relieve, and is convinced that it is cancer. Even if you don't care about the doctor's advice, you need to have a surgical exploration.

For the diagnosis of paranoid state, we should pay attention to the systemic and relative fixation of delusion. The disease is based on personality defects, and mental stimulation is the cause. There are more delusions, more systematic, and appropriate emotional responses. There are no hallucinations, the personality remains relatively complete, the intelligence is good, and there is no mental decline. There are no characteristic symptoms of schizophrenia, and delusion lasts for at least 3 months.

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