HOW PARANOID COULD A SCHIZOPHRENIC GET?

Updated: Jan 12

Hi guys! Don’t be surprised when you see me on your TV sets pretty soon, I interviewed my first star patient - A celebrity! I feel ecstatic to come your way with knowledge of a mental health condition that places a huge toil on a majority of patients seen at our clinic. These individuals usually deny the diagnosis until reality dawns on them and places its hands on their sanity affecting their patterns of thinking.

I had just finished my night duty and was cruising with the thought of enjoying my day off until suddenly, I encountered my Head of department (HOD) in the walkway on my way to get my bag. She motioned to me as I bypassed her with a smile and a wave. “Eliezer, I have a patient for you, and he happens to be the relative of a very influential man in Ghana”

The butterflies in my stomach leapt for joy upon arrival of this news, so I hurriedly pulled out my pen, wore my lab coat and entered the consulting room with a smile on my face like a boss.

Seated in the consulting room was a man and a woman of elderly age, with an adolescent female interlocked in the middle. You could tell from their countenance and interaction, they were a couple who had lived happily for a very long time, with this girl who was likely to be their offspring enjoying the fruit of their happiness.

Who was the patient in question? The man, the woman or the child? I guessed, as I pulled back my seat in the presence of an imaginary verbal request form in the tone of my HOD’s voice.

“What brings you to the hospital?” I asked the man, while I made glances at the wife and child , looking for clues could as to why they were seated in the consulting room. Their heavy face masks made it difficult for me to read signals that gave an indication to their presence there.

“My wife and I have been married for the past 21 years and we have lived happily ever after with minimal issues; issues we try as much as possible to solve before the sun goes down.

After our white wedding, we prayed to God to give us a child, but this took 7 solid years before we could conceive. You could imagine the pressure that was mounted on us from every angle. Friends, family and society! We underwent several tests which included semen analysis tests and tubal patency tests. But they all turned out to be normal ” He lamented.

“We were in despair and at our wits end but we kept trusting in God and He stayed true to his word by listening to us and then giving us a baby we were very content with. Alive, active and Kicking! He is currently a high school student performing academically well and we are so proud of him.”

“My wife is an introvert and I feel this personality trait places a heavy toil on her thought processes. Instead of reasoning out everything with me, she tends to overthink things and has her way of finding solutions to problems, even without my involvement and my approval. To make matters worse, she likes to spend too much time with herself locked indoors either reading or watching TV, instead of accompanying me to social gatherings.”

This man continued to give the vivid example of the premorbid personality of the woman. Premorbidity refers to the state of functionality prior to the onset of a disease or illness. A premorbid personality describes personality traits existing prior to illness or injury. Changes in personality are common in cases of traumatic brain injury involving the frontal lobes, the most famous example of this is the case of Phineas Gage who survived having a tamping iron shot through his head in a railway construction accident.

Her wife has been in perfect state of health where she worked as a teacher in one of the local schools until a week before presentation, she started experiencing the feel of a burning sensation all over her body; predominantly on her hands and knees. She initially assumed these were hot flushes caused by her recent menopausal state, however they persisted for a month to her dismay. These are known as somatic symptoms.

There is a term in psychiatry known as a somatic symptom disorder. Somatic symptom disorder, also known as hypochondriasis, is characterized by 6 or more months of a general preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms. This disorder is also viewed as a defense against guilt, a sense of innate badness, an expression of low self-esteem, and a sign of excessive self-concern. Pain and somatic suffering thus become means of atonement and can be experienced as deserved punishment for past wrongdoing (either real or imaginary).

Her symptoms are had lasted for just a month, so did not meet the criteria for a somatic symptom disorder.

Also, she presented with complaints of sleeplessness for a month. An important part in taking a history of patient with a sleep disorder involves inquiring, if the patient has problems either with initiating sleep, or maintaining sleep. It is also important to find out the quality of sleep if there is any, and measures undertaken to wile away time when this individual is unable to sleep. This would provide a clue to the best intervention that could be offered to correct the specific sleep disorder.

Then, her husband noticed something strange. She had began talking past the point in almost all her conversations. She could jump from one topic to another in an unending manner; making claims that her husband and son had conspired to eliminate her existence from this world; which was totally untrue– this symptom is known as believing she is the target of harm. Which is a core feature of Paranoia.

Over the past one month, her husband noticed her activities of daily living had been affected. She could relax on her bed the whole day without the desire to engage in thought provoking conversations and tasks. She had to be cajoled to cook home meals and even take her bath. Associated symptoms included a significantly reduced attention span for which she kept finding herself at wrong locations at home quite often.

A background check revealed she has been experiencing cyclical low mood after marriage which stemmed from reasons of initially being unable to conceive, and subsequently not bearing another child in addition to her only son. She had had suicidal ideations for

the later part of the month. However she had not laid down a detailed plan to carry out this daunting task.

Unsurprisingly, her labs turned out to be normal. Now I had to make a diagnosis. What would it be?

This was clear to me because she was presenting with typical signs of a depressive episode with associated somatic symptoms of experiencing a burning sensation all over her body. In addition to these symptoms, she had began to hear voices in clear consciousness which she could not terminate using her own will.

After discussion with a superior, my initial diagnosis of A Moderate Depressive Episode was revised to Paranoid Schizophrenia based on the additional findings of hearing her own

thoughts playing in her ear and an associated passivity phenomenon; where she felt her current actions were under the direct manipulation of an external agent she could not see.

I then counseled her, together with her husband extensively on the diagnosis and the need for compliance on her oral antipsychotics for which I scheduled them for a session in the next two weeks with a progression report on her current symptoms.

The man penned down my name

and number, thanked me and left the consulting room. Time check : 12:06pm.

Schizophrenia is a disorder that affects a person's ability to think, feel and behave clearly. This has a major impact on the individual’s quality of life. The exact cause of

schizophrenia isn't known, but a combination of genetics, environment, altered brain chemistry and structure may play a role in its development.

Schizophrenia is characterized by thoughts or experiences that seem out of touch with reality, disorganized speech or behaviour and decreased participation in daily activities. Difficulty with concentration and memory may also be present.

Patients with paranoid schizophrenia are typically tense, suspicious, guarded, reserved, and sometimes hostile or aggressive, but they can occasionally conduct themselves adequately in social situations. Their intelligence in areas not invaded by their psychosis tends to remain intact.

Classically, the paranoid type of schizophrenia is characterized mainly by the presence of delusions of persecution or grandeur. A delusion is a belief that is persistently held despite evidence or agreement to the contrary.

Patients in whom schizophrenia occurs in the late 20s or 30s have usually established a social life that may help them through their

illness, and may show less regression of their mental faculties, emotional responses, and behavior than do patients with other types of schizophrenia.

Treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated speciality care services.

It is important you seek specialist services when anyone you know presents with symptoms of schizophrenia because receiving health care at an earlier stage has a greater prognostic factor on the progression of the illness.

Let’s make the world a better place, with a better you in it.



Thanks for reading!

Eliezer


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