Understanding Subjects with Paranoid Schizophrenia

By Mohandie, Kris; Duffy, James E. | The FBI Law Enforcement Bulletin, December 1999 | Go to article overview

Understanding Subjects with Paranoid Schizophrenia


Mohandie, Kris, Duffy, James E., The FBI Law Enforcement Bulletin


Throughout their careers, law enforcement officers may encounter individuals who have paranoid schizophrenia. Some of these individuals may not have a home and may actually live on the street. They may dress in layers of shabby clothing and have poor personal hygiene; but contrary to this outward appearance, many of these people are harmless. Fortunately, doctors can prescribe medication to treat most phases of schizophrenia. However, individuals with schizophrenia may refuse or ignore their prescribed medications because they dislike the side effects or cannot afford the medication. Some individuals may deny their illness altogether. At this point, they become at risk for committing violent acts, which may bring them into contact with law enforcement.

Law enforcement first responders and negotiators must understand individuals diagnosed with paranoid schizophrenia by learning the characteristics they may exhibit. This understanding will help officers respond to these individuals and peacefully resolve conflicts with them.

SYMPTOMS

A variety of symptoms characterize a person living with paranoid schizophrenia. Generally, these symptoms are present in individuals who remain untreated or unresponsive to their medication. All of the symptoms of paranoid schizophrenia cause major social or occupational dysfunction, and experts cannot explain the symptoms by some other disorder, such as drug abuse or a medical condition. Individuals with schizophrenia will have two or more of the following characteristic symptoms, each of which exists for a significant portion of time during a 1-month period (or less if successfully treated): [1]

* delusions;

* hallucinations;

* disorganized speech;

* grossly disorganized or catatonic behavior; and

* negative symptoms (no emotion).

A delusion is an erroneous or false belief that usually involves a misinterpretation of perceptions or experiences. The delusion may be somatic ("My body is rotting on the inside"), persecutory ("They are trying to poison me"), religious ("I am on a mission for God"), referential ("That actor on TV was sending me a special message"), or grandiose ("I am God"). Most frequently, however, the themes are persecutory, hence the descriptive label paranoid." Delusions may range from the bizarre ("I was kidnapped and am now being stalked by aliens") to the merely paranoid ("People at work are conspiring against me").

Hallucinations can be associated with any one of the five senses, but subjects most frequently experience auditory hallucinations. That is, they hear voices, distinct from their own thoughts, that are usually critical, demeaning, or threatening.

Several subtypes of schizophrenia exist. The paranoid type is characterized primarily by delusions or auditory hallucinations in the context of otherwise-normal cognitive and emotional functioning. Compared to other forms of schizophrenia, paranoid schizophrenic thoughts are coherent, and delusions generally revolve around an organized theme. Anxiety, anger, aloofness, and argumentativeness are common symptoms associated with this illness. Furthermore, individuals often will have a superior or patronizing manner. The persecutory themes may predispose individuals to suicidal behavior, and the combination of persecutory and grandiose delusions with anger may predispose individuals to violence. [2] The fact that many who have paranoid schizophrenia have coherent thinking that accompanies consistent delusions makes them potentially lethal. Although they misperceive events, their behavior is generally organized, making them capable of significant, premeditated, goal-directed behavior. [3]

PREVALENCE, CAUSES, AND TREATMENT

At least 1 to 2 people out of 100 will be diagnosed with schizophrenia at some point in their lives. [4] An estimated 2.5 million Americans live with schizophrenia, and about one-third of them have paranoid schizophrenia. …

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