Treatments and drugs

By Mayo Clinic Staff

Paranoid schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have lifted. You may feel as if you don't need treatment, and you may be tempted to ignore treatment recommendations. But effective treatment can help you take control of your condition and enjoy a happier and healthier life.

Treatment options are similar for all types of schizophrenia. But the specific treatment approach that's best for you depends on your particular situation and the severity of your symptoms.

Treatment teams

Paranoid schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well because the condition can affect so many areas of your life. Your treatment team can help make sure that you're getting all of the treatment you need and that your care is coordinated among all of your health care providers.

The team involved in treatment of paranoid schizophrenia may include your:

  • Family or primary care doctor
  • Psychiatrist
  • Psychotherapist
  • Pharmacist
  • Family members
  • Case worker
  • Psychiatric nurse
  • Social worker

Main treatment options

The main treatments for paranoid schizophrenia are:

  • Medications
  • Psychotherapy
  • Hospitalization
  • Electroconvulsive therapy (ECT)
  • Vocational skills training

Medications for paranoid schizophrenia

Medications are a key paranoid schizophrenia treatment. Among the medications most commonly prescribed for paranoid schizophrenia are:

  • First-generation (typical) antipsychotics. These medications are thought to control symptoms by affecting brain chemicals called neurotransmitters. These medications have traditionally been very effective in managing delusions and hallucinations. These medications, however, have frequent and potentially severe neurological side effects, including involuntary jerking movements. Typical antipsychotics, especially generic versions, are often cheaper than are their newer counterparts, which can be an important consideration when you need long-term treatment.
  • Second-generation (atypical) antipsychotics. These newer antipsychotic medications are effective at managing hallucinations, delusions and other symptoms, such as loss of motivation and lack of emotion. Atypical antipsychotic medications pose a risk of metabolic side effects, including weight gain, diabetes and high cholesterol.
  • Other medications. It's common to have other mental health issues along with paranoid schizophrenia. Antidepressants can be helpful if you have symptoms of depression. Anti-anxiety medications can be helpful if you have symptoms of anxiety or agitation. And mood-stabilizing medications may help with aggression or hostility.

Choosing a medication

In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depends on your own individual situation. It can take several weeks after first starting a medication to notice an improvement in your symptoms.

If one medication doesn't work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, antipsychotic medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.

Medication side effects and risks

All antipsychotic medications have side effects and possible health risks. Certain antipsychotic medications may increase the risk of diabetes, weight gain, high cholesterol and high blood pressure, for instance. Others can cause dangerous changes in your white blood cell count or cause health problems in older adults.

Be sure to talk to your doctor about all of the possible side effects and about being routinely checked for health problems while you take these medications. Antipsychotic medications can also have dangerous interactions with other substances. Tell your doctor about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Psychotherapy for paranoid schizophrenia

Although medications are the cornerstone of paranoid schizophrenia treatment, counseling (psychotherapy) also is essential. Psychotherapy may include:

  • Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life challenges brought on by paranoid schizophrenia. One approach, called cognitive behavioral therapy, has proven to be especially helpful in the treatment of paranoid schizophrenia. In cognitive behavioral therapy, a mental health provider helps you recognize — and change — harmful ideas and behaviors. As part of this process, your therapist will help you look back on your personal history. Together you're likely to gain insights into when, and why, you may have started to form those ideas and behaviors. Then, building from this new understanding, your therapist can help you start to change those patterns.

    Psychotherapy can help reduce the severity of your symptoms and improve communication skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about paranoid schizophrenia can help you understand it better, cope with lingering symptoms and understand how medications could be helpful. Therapy can also help you cope with stigma surrounding paranoid schizophrenia.

  • Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better and understand family conflicts. Family therapy can also help family members cope and reduce their distress about your condition.

Hospitalization for paranoid schizophrenia

During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure your own safety and that of others, and make sure that you're getting proper nutrition, sleep and hygiene. Partial hospitalization and residential care also may be options.

Electroconvulsive therapy (ECT) for paranoid schizophrenia

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your brain to trigger a brief seizure. This seems to cause changes in brain chemistry that can reduce symptoms of certain mental illnesses such as paranoid schizophrenia. Because ECT can provide significant improvements in symptoms more quickly than can medications or psychotherapy, electroconvulsive therapy may be the best treatment option in some cases. Deciding whether electroconvulsive therapy is a good option for you can be extremely difficult. Make sure you understand all the pros and cons.

Social and vocational skills training for paranoid schizophrenia

Training in social and vocational skills to live independently is an important part of recovery from paranoid schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help you with jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctor about getting one.

Dec. 16, 2010