Paranoia is an unfounded or exaggerated distrust of others, sometimes reaching delusional proportions. Paranoid individuals constantly suspect the motivesof those around them, and believe that certain individuals, or people in general, are "out to get them."

Paranoid perceptions and behavior may appear as features of a number of mental illnesses, including depression and dementia, but are most prominent in three types of psychological disorders: paranoid schizophrenia, delusional disorder (persecutory type), and paranoid personality disorder (PPD).

Individuals with paranoid schizophrenia and persecutory delusional disorder experience what is known as persecutory delusions: an irrational, yet unshakable, belief that someone is plotting against them. Persecutory delusions in paranoid schizophrenia are bizarre, sometimes grandiose, and often accompaniedby auditory hallucinations. Delusions experienced by individuals with delusional disorder are more plausible than those experienced by paranoid schizophrenics; not bizarre, though still unjustified. Individuals with delusional disorder may seem offbeat or quirky rather than mentally ill, and, as such, may never seek treatment.

Persons with paranoid personality disorder tend to be self-centered, self-important, defensive, and emotionally distant.Their paranoia manifests itself inconstant suspicions rather than full-blown delusions. The disorder often impedes social and personal relationships and career advancement. Some individuals with PPD are described as "litigious," as they are constantly initiating frivolous law suits. PPD is more common in men than in women, and typically begins in early adulthood.

The exact cause of paranoia is unknown. Potential causal factors may be genetics, neurological abnormalities, changes in brain chemistry, and stress. Paranoia is also a possible side effect of drug use and abuse (for example, alcohol, marijuana, amphetamines, cocaine, PCP). Acute, or short term, paranoia may occur in some individuals overwhelmed by stress.

The diagnosis of patients with paranoid symptoms includes a thorough physicalexamination and patient history to rule out possible organic causes (such asdementia) or environmental causes (such as extreme stress). If a psychological cause is suspected, a psychologist will conduct an interview with the patient and may administer one of several tests to evaluate mental status.

Paranoia that is symptomatic of paranoid schizophrenia, delusional disorder,or paranoid personality disorder should be treated by a psychologist and/or psychiatrist. Antipsychotic medication such as thioridazine (Mellaril),haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be prescribed, and cognitive therapy or psychotherapy may be employed to help the patient cope with their paranoia and/or persecutory delusions. It is uncertain whether antipsychotic medication benefit individuals with paranoid personality disorder and may even pose long-term risks.

If an underlying condition, such as depression or drug abuse, is found to betriggering the paranoia, an appropriate course of medication and/or psychosocial therapy is employed to treat the primary disorder.

Because of the inherent mistrust felt by paranoid individuals, they often must be coerced into entering treatment. As unwilling participants, their recovery may be hampered by efforts to sabotage treatment (for example, not takingmedication or not being forthcoming with a therapist). They may also exhibita lack of insight into their condition or the belief that the therapist is plotting against them. Although their lifestyles may be restricted, some patients with PPD or persecutory delusional disorder continue to function in society without treatment.

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