Dr Suhaib Ashraf Bhat
Paranoid schizophrenia, or schizophrenia with paranoia as doctors now call it, is the most common example of this mental illness.

Schizophrenia is a mental disorder, which is sometimes mistakenly called “split personality”.

Dr. Yaasir Bakkaar said: There is no basis for what some people say about the schizophrenic patient having two personalities in one body. This is something that was invented by the writers of movie scripts. In reality, the patient is suffering from a mental disorder that causes disconnect between reason, emotions and behaviour.

He also said: Schizophrenia is a chronic mental disorder that affects several brain functions, such as cognition, understanding, emotions and behaviour.

Dr. Husayn ‘Abd al-Qaadir – a mental health consultant – said:

Psychological studies confirm that the affected person is described as having a mental disorder. Schizophrenia is a chronic illness that the patient will suffer from for the rest of his life.

As for the symptoms of this disease, it affects a person’s cognition, ability to feel emotion, and understanding; it causes loss of willpower and of control over behaviour.

With regard to willpower, the schizophrenic patient loses a great deal of willpower and is unable to take any decision; it has a negative impact on his behaviour, then he loses self-awareness.

In terms of behaviour, the schizophrenic patient loses interest in himself, his personal hygiene and his health in general. He pays no attention to what happens around him on a daily basis, and he may exhibit strange patterns of behaviour, such as repeated movements; or phases of agitation, mania or aggression; or he may withdraw from people and stop going to the mosque or to see his friends; or he may lose interest in his surroundings and keep away from people. He also neglects his studies and his work completely, to the extent that he is dismissed, and he sits cocooned in his imaginary world.

Dr. Sayyid al-Barjeesi said – explaining what the schizophrenic patient suffers from in terms of symptoms:

Delusions: this refers to false beliefs that are deeply rooted in his mind and it is very difficult to convince him on the basis of logic that these ideas are not true. The presence of delusions does not indicate that his intelligence is deteriorating, because they have nothing to do with intelligence. The most significant delusions in schizophrenia are:

Paranoia, where the patient believes that people are after him, or that the security forces are tracking his every move, or that some people hate him and want to get rid of him, either by putting poison in his food or by some other means.
Megalomania, where the patient believes that he is the smartest and strongest of all people, or that he is a messenger sent to guide people, or that he is a great scholar, or that he is an inventor, or that he has been given supernatural powers, or that he has knowledge of the unseen.
Misinterpretation of things, where he thinks that what people say hints at him or refers to him, and believes that every move on the part of people around him is referring to or hinting at his behaviour. This causes him to either be in a state of continual contact with society, or to withdraw from people.
Delusions of being subject to influences, where the patient thinks that he is under the influence of either internal or external forces, and he becomes a prisoner to these thoughts, which may involve imaginary laser beams, audible vibrations or wireless vibrations and the like.

Detailed view:

Schizophrenia is a kind of psychosis, which means your mind doesn’t agree with reality. It affects how you think and behave. This can show up in different ways and at different times, even in the same person. Paranoid schizophrenia is characterized by predominantly positive symptoms of schizophrenia, including delusions and hallucinations. These debilitating symptoms blur the line between what is real and what isn’t, making it difficult for the person to lead a typical life.

Schizophrenia occurs in about 1.1 percent of the population, while paranoid schizophrenia is considered the most common subtype of this chronic disorder. The average age of onset is late adolescence to early adulthood, usually between the ages of 18 to 30. It is highly unusual for schizophrenia to be diagnosed after age 45 or before age 16. Onset in males typically occurs earlier in life than females.

People with paranoid delusions are unreasonably suspicious of others. This can make it hard for them to hold a job, run errands, have friendships, and even go to the doctor.

Capgras syndrome is a psychological condition. It’s also known as “imposter syndrome” or “Capgras delusion.” People who experience this syndrome will have an irrational belief that someone they know or recognize has been replaced by an imposter. They may, for example, accuse a spouse of being an imposter of their actual spouse. This can be upsetting for both the person experiencing the delusion and the person who is accused of being an imposter.

In some cases, the person experiencing the delusion may believe an animal, object, or even a home is an imposter. Capgras syndrome can affect anyone, but it’s more common in women. In rare cases, it can also affect children.

Capgras syndrome is most commonly associated with Alzheimer’s disease or dementia. Both of these affect memory and can alter your sense of reality.

Schizophrenia, especially paranoid hallucinatory schizophrenia, can cause episodes of Capgras syndrome. Schizophrenia also affects one’s sense of reality and can cause delusions.

In rare cases, a brain injury that causes cerebral lesions can also cause Capgras syndrome. This is most common when the injury happens in the back of the right hemisphere, as that’s where our brains process facial recognition. People with epilepsy may also experience Capgras syndrome in rare cases.

There are several theories on what causes the syndrome. Some researchers believe that Capgras syndrome is caused by a problem within the brain, like atrophy, lesions, or cerebral dysfunction. Some believe that it’s a combination of physical and cognitive changes, in which feelings of disconnectedness contribute to the problem. Others believe that it’s a problem with processing information or an error in perception, which coincide with damaged or missing memories.

Early symptoms of schizophrenia may seem rather ordinary and could be explained by a number of other factors. This includes socializing less often with friends, trouble sleeping, irritability, or a drop in grades. During the onset of schizophrenia — otherwise known as the prodromal phase — negative symptoms mount. These negative symptoms might include an increasing lack of motivation, decreasing inability to pay attention, or social isolation.

Warning signs that psychosis may be imminent include:

Seeing, hearing, or tasting things that others do not.
Suspiciousness and a general fear of others’ intentions.
Persistent, unusual thoughts or beliefs.
Difficulty thinking clearly.
Withdrawing from family or friends.
A significant decline in self-care.

Displaying all these symptoms doesn’t necessarily indicate the presence of schizophrenia, but these are indications that a mental health evaluation is advised. If the person is experiencing the onset of schizophrenia, early intervention is the best chance of a positive outcome.

Right now, there is no prescribed treatment plan for people with Capgras syndrome because more research needs to be done. But there are treatment options that may help relieve the symptoms.

Treatment aims to address the underlying cause. For instance, if someone with poor symptom control in schizophrenia experiences Capgras syndrome, treating the schizophrenia can improve the Capgras syndrome. However, if Capgras syndrome occurs during the course of Alzheimer’s disease, the treatment options are limited.

The most effective treatment is to create a positive, welcoming environment where the person affected by the syndrome feels safe.

Some care facilities will use validation therapy. In validation therapy, delusions are supported instead of rejected. This can reduce anxiety and panic in the person experiencing the delusion.

Reality orientation techniques may be helpful in some circumstances. This means that the caregiver gives frequent reminders of present time and location, including reminders of major life events, moves, or any substantial changes.

Paranoid Symptoms:
Delusions are fixed beliefs that seem real to you, even when there’s strong evidence they aren’t. Paranoid delusions, also called delusions of persecution, reflect profound fear and anxiety along with the loss of the ability to tell what’s real and what’s not real. They might make you feel like:

A co-worker is trying to hurt you, like poisoning your food.
Your spouse or partner is cheating on you.
The government is spying on you.
People in your neighbourhood are plotting to harass you.

These beliefs can cause trouble in your relationships. And if you think that strangers are going to hurt you, you may feel like staying inside or being alone.

People with schizophrenia aren’t usually violent. But sometimes, paranoid delusions can make them feel threatened and angry. If someone is pushed over the edge, their actions usually focus on family members, not the public, and it happens at home.

You could also have related hallucinations, in which your senses aren’t working right. For example, you may hear voices that make fun of you or insult you. They might also tell you to do harmful things. Or you might see things that aren’t really there.

Counselling can help you get along with others, hold a job, go to school, take care of yourself, and have friends. People with schizophrenia who get counselling are also more likely to stick with their medications.

A kind of counselling called cognitive behavioural therapy can teach you how to manage symptoms that don’t go away, even when you take your medicine. You’ll learn to test whether you’re having delusions and how to ignore voices inside your head. Positive, encouraging support from family and friends really helps, too. Because some antipsychotic drugs can make you gain weight, you might also want to get help with diet and exercise.