Paranoid schizophrenia is the most common sub-form of schizophrenia. In addition to the classic symptoms such as ego disorders and thought impulses, it is primarily characterized by the presence of delusions and / or hallucinations, which can often lead to paranoia.

Furthermore, the so-called negative symptoms, which occur primarily at the beginning of schizophrenia in the sense of a flattening of emotions or general indifference, are only very slight or not at all. Like most other forms of schizophrenia, the paranoid sub-form begins in young adulthood (20-30 years of age). Since paranoid schizophrenia generally responds well to drug therapy, a good prognosis can generally be assumed.

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What are the causes of paranoid schizophrenia?

The exact origin of schizophrenia is not yet fully understood. However, there is already agreement that schizophrenia is a disease with a so-called multifactorial origin.

This means that many different factors have to work together to lead to the development of the disease.
This includes hereditary factors, but also one's own stress resistance or external influences.

The best-known explanatory model in this regard is the so-called vulnerability-stress-coping model. This assumes that excessive stress, which can no longer be reduced by one's own stress defense mechanisms (coping), can ultimately lead to the development of schizophrenia.

However, triggers such as cannabis use can also trigger the disease. The role of the hereditary component remains controversial.

It is known that the children of those affected have a significantly higher risk (12%) compared to the general population (0.5-1%), but it is not yet clear which genetic changes cause this increased susceptibility.

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Would you like to find out more about the causes of schizophrenia? - Then read our article: What are the causes of schizophrenia?

Learn more about the consequences of cannabis use at: What are the consequences of smoking weed?

Is Paranoid Schizophrenia Hereditary?

It is undisputed that genetic factors play a role in the development of schizophrenia.

Knowledge of this relationship is based on observations that have shown that the children of those affected have a significantly higher risk of developing schizophrenia themselves in the course of their lives.

This risk increases further when both parents are affected. However, studies with identical twins have shown that the risk of both developing the disease is only 50%, which suggests that genetic factors cannot be the only cause of schizophrenia.

It is currently assumed that certain genetic changes can lead to a higher vulnerability (susceptibility) to stress, which would be in line with the vulnerability-stress-coping model (see above).

Would you like to receive more general information on this topic? - Then read our article on the question: Is schizophrenia hereditary?

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How do drugs affect paranoid schizophrenia?

It is currently still being discussed in science whether the consumption of drugs alone can lead to the development of schizophrenia.

A connection is suspected above all with the consumption of cannabis, LSD, cocaine or amphetamines. To what extent these act as triggers or merely worsen or accelerate the course of the disease is unclear.

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People with a genetic predisposition for this disease are particularly likely to be susceptible to such a course.

Find out more about the: Consequences of drugs


The diagnosis of schizophrenia can be extremely complicated due to the very diverse spectrum of symptoms. This is especially the case in the initial phase, since key symptoms such as hallucinations are mostly not yet or only very mildly pronounced.

In order to be able to diagnose schizophrenia, however, the presence of an ego disorder must always be proven. In paranoid schizophrenia in particular, delusions and perceptions and / or hallucinations are further obligatory symptoms.

A flattening of affect is rarely observed in this sub-form of schizophrenia. Furthermore, the symptoms described must last for over a month.

The diagnosis of schizophrenia is therefore mostly of a clinical nature and is based on a detailed medical history. However, in order to exclude possible other diseases that present themselves with a similar spectrum of symptoms, imaging and a detailed neurological examination are usually carried out.

Read more about this at: How can you test for schizophrenia?

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What tests are there for paranoid schizophrenia?

There is no specific test that can clearly diagnose schizophrenia.

Rather, there are numerous psychological test procedures that can quantify symptoms of schizophrenia, such as cognitive performance or the recognition of symbols.

In the context of faulty perception and thought disorders in schizophrenia, the tests usually show clear restrictions.

The "Eppendorfer Schizophrenia Inventory" is a very comprehensive test that covers many aspects of the cognitive impairment caused by schizophrenia. Although abnormalities can give clear indications of the presence of the disease, they are not conclusive.

In addition to these standardized psychological test procedures, numerous other tests are offered on the Internet. Since these usually do not meet scientific criteria, the results of these tests should be viewed very critically.

Read more about this at: How can you test for schizophrenia?

Are online tests for schizophrenia legitimate?

In principle, tests that are available online for free should be viewed with caution and the results questioned critically.

This is mainly due to the fact that most tests of this type do not meet scientific criteria and therefore cannot test for the presence of schizophrenia in a specific and sensitive enough manner.

Most tests focus on risk factors for the development of schizophrenia, in addition to a few questions about the current emotional state.

Since schizophrenia is an extremely complex and multifaceted disease, a diagnosis should always be carried out by a specialist and if you suspect you should contact him.

What are the accompanying symptoms of paranoid schizophrenia?

The main symptoms of paranoid schizophrenia are delusions and hallucinations.In addition to these two, however, there are numerous other symptoms that are commonly seen in this condition.

First of all, this includes emotional instability. Patients often feel very anxious, which further underlines the paranoid aspect of this condition.

However, it is not uncommon for such fear to turn into excessive anger that can even threaten others. Those affected can usually not be reassured with good persuasion.

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If this condition persists, compulsory admission may be necessary. In contrast to other forms of schizophrenia, there is no listlessness, motor disorders or flattened emotions, summarized under the term "negative symptoms".


Hallucinations are one of the leading symptoms of paranoid schizophrenia.

They are characterized by the perception of stimuli that do not actually exist, which distinguishes them from so-called illusions.

Because it is a simulated sensory perception, hallucinations can take on many different qualities.

Optical, taste, sensory or acoustic hallucinations can occur.

The latter, however, are significantly more common in this clinical picture, in the form of commenting or commanding voices that those affected can hear. In paranoid schizophrenia, the feeling of persecution is usually created or intensified by these voices.

As a source of the voice, those affected usually give previous caregivers. The content of acoustic hallucinations is very different here. In addition to commenting voices or expressing your thoughts (thoughts), directive instructions can also be given by the voice, which can be the case especially in delusional situations.

Even if they occur much less often, some patients experience olfactory or taste hallucinations, which in paranoid schizophrenia is often seen as an attempt at poisoning or something similar.


The fear of paranoid schizophrenics can often turn into increased aggressiveness.

The triggers for such an escalation can be numerous. In this way, those affected can imagine that they are being chased by someone they have to fight and that all people around are part of the "system".

It is not uncommon for this to result in people in acute schizophrenic psychosis having to be fixed in order not to endanger others. In addition to these extremely aggressive outbursts, which occur mainly in very severe disease processes, there is a permanently increased level of aggression in many patients, which is probably fed by the constantly felt fear.


Paranoia is characterized by the fact that actually harmless events are interpreted in terms of persecution or threat.

Affected people describe initially having a restless feeling (delusional tension) and concocting something concrete against them. These thoughts are usually clearly amplified by the hallucinations and the footsteps of pursuers are heard.

Almost all things that the person concerned perceives in such a phase is put in context with the persecution and thus perceived as a threat.


For every therapy for paranoid schizophrenia, a precise diagnosis and assessment of the individual symptoms should be carried out, since the therapy for schizophrenia shows great individual differences and can therefore be adapted to the patient's spectrum of symptoms.

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Basically, most patients can be cared for on an outpatient basis and do not have to stay in the clinic for a long time. The latter is especially necessary in acute phases.

Structural offers such as sport, physiotherapy or music therapy should always be used as basic therapy for schizophrenia. However, in most cases the core of schizophrenia treatment is the use of neuroleptics.

Depending on the exact form, many different neuroleptics can be used. The strongest effect of this therapy can be seen in the acute phase.

In the long-term treatment of schizophrenia, in addition to drug treatment, psychotherapy in particular plays an essential role. This usually consists of behavioral therapy, which is supported by cognitive therapy and psychoeducation.

Psychoeducation represents a relatively new therapy concept, the aim of which is to enable patients to deal intensively with their illness and thus to understand it better. In the treatment of paranoid schizophrenia, a very wide range of therapy options is available in order to do justice to the individual patient and to be able to find an optimal therapy for the spectrum of symptoms.

Find out more about treating schizophrenia at: Therapy for schizophrenia

Drugs used to treat paranoid schizophrenia

Drug therapy is one of the most important pillars in the treatment of schizophrenia. The clearest effect is achieved in the acute treatment of schizophrenic psychoses, whereas other therapeutic strategies such as psychotherapy become more important in long-term treatment.

There are basically numerous medications that can be used to treat schizophrenia. These include antipsychotics and neuroleptics, but also benzodiazepines and antidepressants.

Antipsychotics are nowadays divided into 2 large groups, which are characterized by different side effect profiles. The “typical” antipsychotics include slightly to highly potent substances (haloperidol, melperon, ...) that show very good claims rates in acute schizophrenic psychosis.

What they have in common, however, is that they can lead to motor disorders that are very similar to Parkinson's disease. These side effects are grouped together as so-called extrapyramidal motor disorder (EPMS).

“Atypical” antipsychotics, on the other hand, lead to this serious side effect significantly less often, but are more often associated with weight gain or changes in cardiac activity. The most commonly used atypical antipsychotic is clozapine.

In addition to the antipsychotic effect, many drugs in this class of substances also have a positive effect on any negative symptoms (reduced drive, flattening of affect, ...).

How long a drug therapy should be taken depends largely on the previous course of the disease. If only six to nine months of use are recommended for the first schizophrenic episode, the period of use after the second episode is extended to three to five years.

Further information on this topic can be found at: Schizophrenia - These Drugs Are Used!

How long does paranoid schizophrenia last?

The duration of paranoid schizophrenia can vary greatly from person to person, and a distinction must be made between schizophrenic episodes and the general course of the disease.

Schizophrenia is a disease which in almost all patients consists of acute phases (2-4 weeks) and “symptom-free” intervals in between.

It is not uncommon for those affected to have only one schizophrenic episode and not suffer a so-called relapse later, i.e. the recurrence of an episode.

Unfortunately, in most cases there are several recurrences in the course of the disease, which are separated by ever shorter time intervals. In these patients, so-called residual states often occur, which have a spectrum of symptoms similar to that of depression and, if insufficiently treated, can persist permanently.

Thus, no general statement about the duration of schizophrenia can be given.

Can paranoid schizophrenia be cured?

Schizophrenia and thus also its various sub-forms are generally not considered to be curable, as no causal or causal therapy for the disease is currently possible.

This is due to the fact that the exact origin of schizophrenia has not yet been fully understood and therefore no specific therapy can be developed.

The current treatment of the disease is therefore only a symptom-oriented therapy. Through this, however, the symptoms of schizophrenia can be significantly alleviated and, with consistent use, a significantly better course of the disease up to lifelong freedom from symptoms can be achieved.

Can you get a driver's license with paranoid schizophrenia?

Basically, patients with paranoid schizophrenia are considered to be entitled to drive a car and thus also to obtain a driver's license.

The only exception to this is the circumstance of an acute episode, since the attending physician can revoke the fitness to drive for this period of time, which is the case in the vast majority of cases in order to prevent harm to others or oneself.

After this episode has subsided, a detailed psychiatric and psychological examination is usually carried out to check whether the driver is unfit to drive.

Does paranoid schizophrenia have a shorter life expectancy?

Life expectancy in patients with paranoid schizophrenia is generally considered to be reduced.

This fact is mainly due to numerous comorbidities and the increased drug consumption in this group of patients. Cardiovascular and pulmonary diseases, which can be caused by frequent intensive consumption of cigarettes and other drugs, play a decisive role here.

In addition, some antipsychotics, especially so-called "atypical", side effects in the cardiovascular system. Furthermore, patients with paranoid schizophrenia have an increased risk of self-harm in the form of suicide.

Do you suspect a friend is having thoughts of suicide or are you struggling with them yourself? - Then read our article: What can be signs of suicide?

What is a schizophrenic residual?

The so-called schizophrenic residual describes a personality change that occurs in about two thirds of all schizophrenic patients after an acute episode.

The residue is characterized by a pronounced lack of drive, impaired concentration, neglect of social contacts and a generally depressed mood. This spectrum of symptoms is very similar to the definition of depression.

The duration of a schizophrenic residual can vary significantly and can last from a few weeks until the symptoms have completely subsided to several years.

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