5 Several demographic, social, and economic risk factors for paranoia have been identified. Some degree of paranoia is common in the general population, with mild symptoms in 20%–30% and severe symptoms in ~2%. 1,5 It also generates feelings that vary from mild discomfort to intense distress. Paranoia occurs on a spectrum of severity, with suspiciousness, mistrust, and self-consciousness on one end and delusions of persecution on the other. 3,4 How Often Is Paranoia Seen in Isolation or With Other Manifestations of Psychosis? 2 Psychotic symptoms, including paranoia, are linked to neurodevelopmental deficits, alterations in the neurocircuitry of the central nervous system, environmental factors, and insecure attachments during childhood. Untreated paranoia often leads to social isolation, emotional distress, poor quality of life, and psychiatric hospitalizations. However, patients with bipolar disorder, major depressive disorder (MDD), and other forms of mental illness and substance use disorders can also experience paranoia. 1 Paranoia is one of the most common delusions in people with schizophrenia-spectrum disorders. Paranoia is an irrational and persistent thought process involving feelings (of fear) and thoughts (of persecution, conspiracy, or threats). While the laboratory tests were unremarkable, the brain MRI showed an interval increase in the size of an extra-axial collection with air and fluid concerning for an infection as well as new areas of focal enhancement along the margins of the left temporal parietal resection cavity that was suspicious for tumor recurrence. Her medical workup included a computerized tomography (CT) scan and a magnetic resonance imaging (MRI) scan of her head and chest, as well as laboratory tests (eg, electrolytes, hemogram, urinalysis). No increases in goal-directed activity, mood elevation, grandiosity, decreased need for sleep, or perceptual disturbances were noted. She endorsed low energy, poor sleep, and poor appetite related to her physical symptoms. The mental status examination was notable for rapid but interruptible speech, an anxious affect, and ruminative thinking, as well as persecutory delusional beliefs about her family wanting to harm and steal from her. She was alert, cooperative, and oriented to self, situation, place, season, and year but not to the month or date. The initial examination demonstrated a cachectic woman who appeared older than her stated age and restless while in bed due to pain. Home medications included lamotrigine (100 mg twice/d), ziprasidone (80 mg twice/d), gabapentin (300 mg 3 times/d), methadone (5 mg every 8 hours), acetaminophen (975 mg 3 times/d), oxycodone (5–10 mg every 4 hours as needed), and hydromorphone (0.3 mg every 3 hours as needed). In addition to lung cancer and bipolar disorder, her past medical history was notable for diabetes mellitus type 2, peripheral arterial disease, asthma, and hyperlipidemia. Psychiatry and palliative care were consulted. The oncology team wondered whether her new-onset paranoia was related to her longstanding bipolar disorder, or whether it was secondary to her cancer and its treatments. She had no history of paranoid or persecutory delusions. Her outpatient psychiatrist similarly noted she had been asymptomatic, with no mood episode on her psychiatric regimen for over a decade. Collateral from her family confirmed that this paranoia was new and uncharacteristic for Ms A. When Ms A later self-presented to the emergency department for musculoskeletal pain and intractable vomiting, she was adamant that no one contact her son, daughter-in-law, or friend. She changed all the locks on her doors and declined to return to the hospital where she sought initial treatment because she felt that her providers could not be trusted. According to her son and daughter-in-law, Ms A became increasingly suspicious of them and of one of her best friends she refused to speak with them and accused them of trying to break into her home and steal from her. Although chemotherapy was scheduled to begin after her neurosurgery and radiation, she was lost to follow-up upon hospital discharge she declined all phone calls from social services, declined visiting nurse services, and failed to attend multiple scheduled appointments in the cancer center.
0 Comments
Leave a Reply. |