Paranoia--prognosis and treatment: a review

Contemporary research indicates that paranoia is directly related to good premorbid adjustment. Also, paranoids tend to have shorter hospitalizations and better recovery of social functioning than nonparanoids, although prognosis for full remission of symptoms is poor. A substantial minority of patients with an early diagnosis of paranoia deteriorate into a more withdrawn nonparanoid psychosis. When remission of paranoid symptoms occurs without chronic deterioration, there is a greater likelihood of relapse than there is for nonparanoid psychoses. In regard to treatment, good premorbid paranoid schizophrenics respond rather well to phenothiazines, whereas good premorbid nonparanoid schizophrenics tend to deteriorate under the influence of standard medication. Systematic desensitization is effective in reducing delusional behavior, but generalization is limited. Many discussions and case studies support the use of psychotherapy with paranoids, but no conclusive outcome studies have been reported. Group therapy, cognitive therapy, and milieu therapy hold promise but need systematic evaluation.