How to help paranoid person

It is important to take your time, give the partner the opportunity to get to know the therapist better and talk about their experiences at a pace that is comfortable for him. Do not give up your feelings and experiences under the pressure of your partner's suspicions, remember that you are right. Remember that his unhealthy ideas have nothing to do with reality. nine0003

3. Never plead guilty if you are innocent. Do not accept false accusations. I have worked with one couple in which the husband, after endlessly abusive interrogations by his wife, "confessed" that he had kissed another woman when he had not actually done so. According to him, he just wanted to stop asking questions and decided that this would be the easiest way to achieve this. Unfortunately, his confession only further inflamed his wife's suspicions and she eventually filed for divorce. nine0003

4. Remember to take care of yourself. Find a way to relax and relieve emotional stress: yoga, sports or physical education, breathing exercises are good. A healthy diet is very important. If you develop depression or an anxiety disorder due to relationship problems, more serious treatment may be needed.

5. Ask for support from someone you trust. This could be a friend, colleague, psychotherapist. Having someone who can listen without judgment and take your concerns seriously will bring relief and help you stay balanced as you work through the problems that have accumulated. Paranoid partners often feel very lonely: shame does not allow them to talk about what is really going on in the relationship. Unfortunately, this only exacerbates their isolation. nine0003

6. Take a break from the relationship. This will allow you to think things over calmly, without rushing. If you live together, consider whether you can temporarily move to another place. While leaving may be scary for your partner, it's important to be able to deal with what's going on in a calm environment in order to find the right solution for both of you.

7. Do not self-diagnose. Paranoia is a sign of serious mental problems such as depression, post-traumatic stress disorder, psychosis, paranoid personality disorder, schizophrenia, or schizoaffective disorder. Don't try to diagnose your partner yourself. Contact a specialist who can correctly assess the entire set of symptoms. nine0003

If your partner's suspicions have deprived you of a normal life, don't be afraid, you can get it back.

Text: Nikolai Protsenko

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Paranoia - what kind of disease it is, how it affects the life of a person and the people around him. What is the relevance of the problem? What are the main causes and signs of paranoia, what is its differential diagnosis based on? Whether its effective treatment of this disease is possible or probable? The answers to these questions are offered by the Chief Physician of the Health Harmony Medical Center, a practicing psychiatrist, psychiatrist-narcologist and psychotherapist Vladislav Sipovich. nine0003

What is paranoia and how relevant is its problem?

Paranoia in Greek literally means "next to the mind", which can be regarded as a deviation from normal thinking in the direction of exaggeration of one's own personality and the ideas produced by it, while maintaining the logic of judgments. A person actually retains the ability to reason, but all his thoughts are aimed solely at proving his significance and the recognition by society of his overvalued ideas. At the same time, self-criticism is practically absent, but a critical attitude towards people who do not share ideas about the exclusivity of the patient himself literally rolls over. nine0003

Paranoia is a rare type of chronic mental disorder that develops mainly in people who have reached adulthood. According to statistics, among patients undergoing treatment in psychiatric hospitals, the proportion of patients with paranoia is only 0.5-1%, and among all mental disorders 2-4%. Perhaps such low statistics is due to low detection, which in turn is associated both with the difficulty of differential diagnosis and with the patient's non-recognition of his disease state and the ability to integrate and function in society. nine0003

A paranoid person is a person who is convinced of the value of his ideas and the prejudice of others. Attempts to prove the irrationality and unreality of the thoughts put forward by the paranoid cause only anger, distrust, hostility and even aggressiveness not only towards outsiders, but also to close people themselves, as well as to specialists trying to help. Establishing contact with such a patient is extremely difficult and requires, at the initial stage, a partial recognition of the supervalue and uniqueness of even the most delusional ideas. Paranoia is a disease that has such features as:
• Gradual development without aggravation of the pathological dynamics of symptoms and without an increase in personality changes. In practice, this means the absence of apathy, a decrease in vitality, abulia (loss of will and motivation). The nervous and energy potential of the patient remains consistently high, aimed at achieving the goal, and internal dissatisfaction finds a way out in conflict with the outside world and the fight against imaginary injustice.
• Logical validity and consistency of false ideas, which is almost impossible to refute. All objections have seemingly logical antitheses. nine0079 • The topic of ideas is usually monodirectional, i.e. concerns a certain sphere of knowledge and activity of society. A classic example is graphomania, when a person, having once achieved the publication of his poems or story, begins to consider himself an outstanding and unsurpassed poet or writer. The constant refusals of publishers to publish his "masterpieces" are perceived as the intrigues of envious people, unprofessionalism and bias of editors, publishers, and so on. It is almost impossible to prove the inconsistency of the claims of the paranoid, tk. he takes criticism as a personal insult and reacts with extreme hostility. Switching to another topic is uncharacteristic, the patient stubbornly achieves his goal and attacks various publishing houses ad infinitum. All these torments last for years and decades, causing extreme anger and hostility to the whole world. nine0079 • Absence of hallucinations, i.e. distortions in the perception of reality. By the way, experts do not have a unanimous opinion on this matter, many sources recognize the existence of various types of illusions in paranoid people, but usually these symptoms are observed in combined mental disorders, for example, delusions similar to paranoia in schizophrenics. These phenomena have nothing to do with classical "pure" paranoia.
• Consistent and generally predictable behavior based on the formal connection of many real elements with the paranoid's false ideas. nine0003

A person with paranoia is characterized by extreme suspicion, blaming imaginary enemies for his failures, and a tendency to construct conspiracy theories against him in his imagination.
The urgency of the problem is that one paranoid person can complicate the lives of many people, including not only those closest to him, but also those to whom he addresses with his "projections". The circle of interests of the paranoid includes officials, specialized specialists, writers, directors, producers, public figures, judicial authorities, etc. The received refusals to satisfy requests and logical explanations do not stop the paranoid, but only increase his perseverance. Sometimes he turns into a manic persecutor and can even stoop to physical violence against those who refused him protection. nine0003

What is the differential diagnosis of paranoia based on?

If earlier in classical psychiatry paranoia was considered as an independent disease for a long time, then according to the modern international classification of diseases of the 10th revision (ICD-10), it is not distinguished into a separate heading, but is referred to as a subheading of delusional disorder.
Paranoia should be differentiated from a similar paranoid (paranoid) personality change. The latter often accompanies many mental disorders, in particular, schizophrenia, paraphrenia, social phobias, anxiety disorders, post-traumatic stress and borderline conditions, and alcoholic psychoses. nine0003

The difference between paranoia and paranoid personality disorders (hereinafter BPD):
• Paranoia is characterized by following one idea, for example, if a paranoid person is convinced that a neighbor is harming him, then he will not communicate with him, maintaining communication with another environment. A hostile and aggressive attitude towards certain people develops when they do not recognize the overvalued ideas of the patient and when they make critical statements about him. With paranoid disorder, distrust of everyone and everything comes to the fore, colleagues, the CIA, the FSB and the whole world can be objects of distorted ideas. At the same time, the presence of an initial overvalued idea is absolutely not necessary. nine0079 • Paranoia is always distinguished by a consistently built and logically connected system of ideas, which is based on the acceptance of some idea as an axiom that does not require proof. Otherwise, thinking retains its rationality and allows paranoids to exist and function normally in society. They usually do not make friends, but they may have family relationships. In BPD, delusions are unsystematized and inconsistent.
• In paranoia, there are no hallucinations or illusions. Paranoid disorder is characterized by a distorted perception of reality. nine0079 • Paranoid disorders are much more common than paranoia. For example, in the United States, about 2-4% of the population suffer from more or less pronounced mental disorders of the paranoid type. This is due to the fact that the very concept of BPD is broader and includes paranoia itself, endogenous (paranoid schizophrenia) and exogenous (provoked by stress, an unusual situation, etc.) paranoid psychoses.
• In BPD, there is a progressive change in personality, which can lead to a complete disorganization of thinking, which is not typical for classical paranoia with the preservation of structured, consistent and logical thought processes. nine0079 • Cause of paranoia unknown. There are only hypotheses about a genetic predisposition, but the gene responsible for its development has not been found. An external trigger that starts the psychopathological process can be any event that is extremely difficult to identify. A number of factors predispose to the development of a paranoid disorder. These include schizophrenia and delusional disorders in close relatives, problems of upbringing in a family with violence, totalitarianism and increased parental care, as well as restriction of communication due to physical defects or illness. In fact, paranoid disorder is formed as a hypertrophied self-preservation instinct, which leads to isolation, pathological suspicion and distrust of close and distant environment, constant readiness to defend oneself from hostile, harmful persons and events. In addition, hallucinogens, amphetamines, alcohol, and other chemicals can cause a temporary paranoia-like disorder. nine0003

Only an experienced specialist can differentiate paranoia from paranoid disorder. Moreover, there is no complete clarity on this issue in psychiatry. The importance of the problem is that the choice of an effective method of its treatment depends on the nature of a mental disorder.

What are the types of paranoia?

The classification of certain types of paranoia is based mainly on the prevailing fixed idea. Depending on this, the most common forms of paranoia are distinguished:
• Involutional paranoia that develops at a mature age of 45-60 years, in women often coinciding with menopause. It is characterized by systematized delusions of persecution, jealousy, less often grandeur. The onset is usually acute, the course is long, the treatment is stationary.
• Paranoia of greatness, or megalomaniac with ideas of reforming society, science and art, as well as inventions and "great" discoveries.
• The paranoia of jealousy is based on the dogma of adultery or adultery. Moreover, treason does not need fixation and proof, but is accepted as an axiom. No arguments of the second half are able to shake the confidence of the pathological jealous that he is right. Initially, the patient accuses the partner of coquetry, the desire to attract the attention of the opposite sex, cheeky behavior, shameless snuggling during the dance, and even a bashful reaction to compliments. This goes on for several years, after which suspicions develop into a firm belief in treason. nine0079 • A religious form that develops against a background of religious beliefs.
• Erotic paranoia, in which the main content of delusional ideas is erotic fantasies. It develops mainly in women between 40 and 50 years of age.
• Persecutory form - paranoia with systematized delusions of persecution.
• Senile paranoia of old age, often coinciding with senile dementia, Alzheimer's, Parkinson's and other degenerative diseases of the brain. nine0079 • Alcoholic paranoia, which is a chronic psychosis caused by alcoholic encephalopathy. Most often occurs in men and is manifested by delusions of jealousy and / or persecution.
Other types of paranoia are also identified, such as those with the complainer's delusions or hypnotic charms, but these are much less common.

What are the main signs of paranoia and its clinical picture?

The main symptoms of paranoia include such mental manifestations as:
• The presence of overvalued ideas that become fixed ideas and haunt the patient throughout his life. At the same time, paranoids are as persistent as possible, they spend all their strength and finances on proving the importance of their invention, discovery or method of reforming society. The literature describes a case when a man from Vladivostok "discovered" a new way of fishing, taking into account the location of the stars. He arrived in Moscow, knocked on the thresholds of various authorities, which gradually began to ignore him, went down and even spent the night at railway stations. At the same time, the fate of the family abandoned in Vladivostok - parents, wife and children, did not bother him at all. nine0079 • Overestimation of the role of one's own personality, leading to megalomania or persecution. In the first case, the patient considers himself capable of doing good to all mankind, and in the second, that all the forces of the world are directed against him. For example, the neighbor's dog barks because the neighbors tease her to spite him, the March cats yell specifically to prevent him from sleeping, the children in the yard make noise in order to annoy him, etc.
• Pathological suspicion, in which a person sees in everything the intrigues of enemies and ill-wishers. He connects even the most insignificant events into a conspiracy theory built by him against himself. All this is accompanied by suspiciousness, vindictiveness, vindictiveness, inadequate assessment of criticism and a complete lack of a critical attitude towards one's own actions. The patient does not perceive someone else's opinion, it is useless to prove the fallacy and inconsistency of his ideas. The paranoid is convinced that everyone around wants to harm him, take away his property, downplay his merits, exploit him and try to manipulate him in their own interests. As a result, a hostile attitude towards everyone around is formed, which, with an attack of acute paranoia, can turn into aggressive actions and make the patient dangerous even for the closest people. nine0079 • Extreme susceptibility to stressful situations. The state of affect lasts for a long time and at any memory of it “comes to life with renewed vigor. Even if the paranoid does not show his emotions, then only with an eye on future revenge, because. he does not forgive insults.
One's own failures, mistakes made are experienced very sharply because of wounded pride. Paranoids are extremely ambitious, distinguished by arrogance and a tendency to overestimate their abilities and achievements.

What are the main ways to treat paranoia and how should others behave during an attack of paranoia? nine0073

Paranoia is a psychiatric illness that is very difficult to treat. This is explained by the fact that because of his supernatural suspicion, the patient does not trust anyone or anything, extending his suspicions to the doctor and the drugs prescribed by him. He perceives psychotherapy as another attempt to manipulate his mind. In addition, the paranoid categorically denies the morbidity of his condition, and relatives who prove the need for treatment are transferred by the paranoid into the category of "enemies". nine0003

The need for treatment becomes especially acute if a person ceases to be socialized, which is manifested by a willingness to isolate himself from the “persecuting” society or even attack an object that is harmful in his opinion. Such a transition from the passive course of the disease to the active phase is an indication for inpatient treatment.

In the event of an attack of paranoia, it is necessary to call an ambulance, and unnoticed by the patient. Before the arrival of a specialized team, in no case argue with the patient, accept his position and even play along a little. Do not try to prove something or appeal to common sense. This is useless and even dangerous, since the delusions of the paranoid cannot be corrected. If the arrived specialists cannot stop the attack and relieve the psycho-emotional stress on the spot, the patient is hospitalized. nine0079 In the chronic course of paranoia, outpatient complex treatment is indicated, the main element of which is drug therapy with the use of anti-delusional antipsychotics. Their action is aimed at normalizing the exchange of neurotransmitters and blocking the excitation of the nerve centers responsible for the symptoms of paranoia. The appointment of other pharmacological drugs is symptomatic and is aimed at eliminating the symptoms of paranoia that prevail in a particular patient. For example, antidepressants are used to relieve depressive moods, tranquilizers - to eliminate fear and anxiety, sleeping pills - to normalize sleep. nine0003

An additional and important direction in the complex treatment of paranoia is psychotherapy. It is aimed primarily at restoring socialization and eliminating elements of irrational behavior in patients with paranoia.

At the first stage of treatment, the main thing is to establish contact and trusting relationships with the patient. This is extremely difficult to achieve, but possible. If the patient himself decided to be treated and correctly assesses his condition, this is already half the success in getting rid of paranoia. Unfortunately, this development is rare. Most of these patients remain outside the attention of psychiatrists and psychotherapists (what is the difference between a psychiatrist and a psychotherapist) for a long time, sometimes for decades. If, during an exacerbation, situations occur that are dangerous to the life of the patient himself (auto-aggression) and / or his environment, then only then treatment begins, usually in stationary conditions. nine0003

The choice of drugs, as well as psychotherapeutic methods of correction, depends on many factors - on the general physical condition of the body, mental characteristics, gender, age and the main symptoms.

In drug treatment, it should be borne in mind that abrupt discontinuation of drugs can lead to the so-called withdrawal syndrome, when, after stopping treatment, the symptoms of the disease return again and sometimes with more force than before treatment.

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