Need advice about how to deal with a friend's paranoia.

[snagglepuss]

I very recently rekindled a friendship from high school. Two weeks ago she was diagnosed with paranoia by a pyschiatrist she just started seeing. When she is telling me about her paranoid fantasies, I don't know whether I should simply listen or respond by telling her that she must not give in to paranoia.

Any advice would be greatly appreciated.

[TalkingDog]

1. As a person who grew up with a paranoid schizophrenic (mild case only hosp. once)

Your best bet is to be nonjudgmental. Telling her not to give in to her fantasies will only invalidate her, whether you intend to or not.

Psychiatrists are divided about whether it is healthy for you to enter and validate her view. Some (outliers) think it's okay. With the caveat that you stress that while she may have a point and other people might feel the same way, you don't see or hear that in social situations, so it's best to keep those things (spying robot cats, secret messages tapped out on the walls - in my instance- under "our" hats)

The safest route is to validate her feelings: That must be worrisome. Or I can see how that would bother you. - without directly buying into her views. Then guide the subject to more socially stable topics if you can.

I hope this helps.

[snagglepuss]

3. That's very helpful. Thank you.

[kestrel91316]

2. Paranoia isn't a diagnosis, it's a symptom. People with extreme paranoid fantasies are usually

paranoid schizophrenics, and need to be on antipsychotic medication.

Speaking from personal experience, it is virtually impossible to have any sort of meaningful relationship with an untreated or undertreated schizophrenic. Good luck.

[snagglepuss]

4. Can someone in their mid-fifties suddenly develop schizophrenia?

Her paranoia seems to be limited to her house, a belief people are coming in and changing a specific number of things.

[cbayer]

8. Highly unlikely. There are many causes of paranoia besides schizophrenia.

Her doctor will hopefully do a work up to look for possible non-psychiatric causes, but it may be purely psychiatric.

[Nay]

10. Paranoid schizophrenia is indeed unlikely, but some sort of early dementia was what

first came to my mind, if there is no psychiatric diagnosis.

[cbayer]

11. Could be, but there are so many other things one might look for first.

[kestrel91316]

12. My mom developed hers at age 39, and even that old is an outlier. I don't think it's

impossible, just very unlikely. There are other disorders that look a lot like schizophrenia due to delusions and paranoia. IIRC some cases of bipolar, and then there's schizoaffective disorder, and that's all I can recall offhand.

[cbayer]

15. There can also be things like endocrine diseases, toxicity from medications,

brain lesions, infectious disorders. The list goes on and on.

In terms of psychiatric disorders, longstanding severe depression can lead to psychosis.

And sometimes people develop a delusional disorder for no apparent reason.

[cbayer]

5. The best approach, imho, is to take this position:

I know that you believe what you are saying, but I don't believe it. I will do what I can to help you, but I can not buy into what you think is going on.

There is absolutely no point in trying to rationally dissuade a person who is delusional. In fact, it might cause them to include you in the delusion.

So sorry for your friend. Hopefully she is getting appropriate treatment and will have some relief very soon.

[snagglepuss]

7. TalkingDog in a post below cautions against invalidating her experience

which I think is excellent advice however what I like about your suggestion is that it doesn't make me party to her delusions.

[cbayer]

9. Right, it's that fine line between no dismissing or arguing with her, but not buying

into the delusions.

It's tough, but it's generally treatable.

I hope she is better soon, and bless you for being such a good friend.

[kestrel91316]

13. True. You Can NOT convince them their thinking is incorrect. But you can smile and change

the subject.

[cbayer]

14. Often the very best approach is exactly what you describe.

[Warpy]

6. It takes time, patience, and creativity to deal with paranoia

If you've been managing to listen without arguing, you're halfway there.

A patient years ago came in with full blown paranoia. He'd received a small inheritance and was utterly convinced his relatives had bribed everybody to poison his food. He was getting really weak and then I got him.

I pointed out there were old guys getting tube feedings on the floor, that the stuff was manufactured thousands of cans at a time, and if there was part of a case open in the stock room and none of the old guys had died, he could assume it was safe. I clued everybody in to expect him to start sneaking into the store room and that's what he did. After a week of drinking cans of the stuff he was feeling so much better physically, he was willing to listen to the docs talking about medicine that would make him less afraid. Just being able to feel so much better was confirmation that the bad guys couldn't get to him.

What I did there was address the physical problem he was having without confronting his delusion head on. Remember, crazy people know what they know. You can't talk them out of it and any sort of argument is just going to make them defensive. You will need to work with the delusions instead of against them.

If your friend is on medication, her delusions will start to fade. Just remember you're not her psychiatrist. You might be able to help her out when she's too paranoid to do simple things like drive to the store (car bombs and assassins) or pay her bills (bills dusted with ricin).

Good luck, paranoia is a real bugger to deal with if you're a civilian.