Paranoid Schizophrenia (ICD-10): Features

Prior to the latest edition of the International Identification of Diseases and Related Health Problems (ICD-11), paranoid schizophrenia was characterized in the ICD-10 as a mental disorder "dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or relatively inconspicuous." It can be helpful for those who believe they may be experiencing symptoms related to schizophrenia to reach out to a licensed mental health professional for further evaluation and guidance.

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The ICD

The International Identification of Diseases and Related Health Problems (ICD) was developed by the World Health Organization (WHO). The ICD-10 was published in 2015 and replaced by the ICD-11 in 2022.

Viewed as the standard for international information and health reporting, the ICD-10 had two main versions: one for the clinician and another to identify research populations. Another simplified version existed for use in primary care, containing only 26 disorders that were considered more common. 

• The ICD-10 statistical version of the classification featured a short glossary of definitions for each category of mental and behavioral disorder. It was primarily intended for use by coders and clerical workers.
• The Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-10 Mental and Behavioral Disorders were largely intended for "general clinical, educational, and service use" and offered diagnostic specificity with more detailed categories for mental health professionals. 
• The ICD-10 Classification of Mental and Behavioral Disorders tended to be most used in primary care settings. It listed 26 of the more common disorders and included "disorder presenting complaints, diagnostic features, differential diagnoses, and management guidelines."

Features of the ICD-10 for schizophrenia, schizotypal, and delusional disorders

As noted in an article on the development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioral Disorders, in the ICD-10, "the only disorder in F20-F29 (Schizophrenia, Schizotypal, and Delusional Disorders) with a differential diagnosis section is F20.0 Paranoid Schizophrenia." A differential diagnosis generally refers to a list of other conditions that present similar symptoms. Since psychotic features can be present in other mental health disorders, there can be differentials for schizophrenia, which usually include paranoid personality disorder, schizotypal disorder, schizoid personality disorder, and psychosis due to known physiological conditions.

The ICD-10 placed schizophrenia in subcategories based on individuals’ main symptoms. Categories included paranoid schizophrenia, undifferentiated schizophrenia, post-schizophrenic depression, and residual schizophrenia.  

Paranoid schizophrenia and other related disorders in the ICD-10 

Disorders defined as schizophrenic are typically characterized by distortions in thinking patterns and altered perception, resulting in blunted or inappropriate affect. Those experiencing schizophrenia disorders may experience symptoms like thought echoes, hallucinatory voices, thought disorders, and negative symptoms. Negative symptoms often include a lack of motivation, social withdrawal, and decreased speech and movement. 

The course of the possible listed disorders can present continuously or occur in episodes with complete or incomplete remission. When extensive depressive or manic symptoms are present, a diagnosis should not be made unless symptoms of schizophrenia clearly began first. Moreover, a diagnosis should not be made if a person is experiencing the effects of or withdrawal from certain substances, or if they are living with a physical illness that could affect the brain. 

Below are several of the subcategories that can be found under the category of "Schizophrenia, Schizotypal and Delusional Disorders" (F20-F29) in the ICD-10.

• (F20.0) Paranoid schizophrenia is primarily characterized by relatively stable paranoid delusions, which often come with auditory hallucinations. A person with paranoid schizophrenia usually doesn’t experience catatonia or other negative symptoms related to affect, speech, and volition. 
• (F20.5) Chronic undifferentiated schizophrenia is defined as "a chronic stage in the development of a schizophrenic illness in which there has been a clear progression from an early stage to a later stage characterized by long-term, though not necessarily irreversible, negative symptoms."
• (F22.0) Delusional disorder can be characterized by persistent, sometimes lifelong delusions. A delusion can be defined as a false belief that cannot be changed, even when a person is presented with evidence to the contrary.
• (F25.0-25.2) Schizoaffective disorder usually involves a combination of positive or psychotic symptoms and symptoms of depression or bipolar disorder. In the ICD-10, it is divided into manic type, depressive type, and mixed type. 
• (F23.3) Brief psychotic disorder is normally characterized by acute symptoms of schizophrenia that have lasted for less than one month.
• (F60) Paranoid personality disorder usually features extreme sensitivity to setbacks, as well as a tendency to be suspicious of others and to perceive neutral or friendly actions as hostile. Those with paranoid personality disorder may also experience an excessive sense of self-importance. 

Considering therapy

Therapy with an empathetic mental health professional can help you manage challenging symptoms, develop healthy coping skills, and learn to better manage daily life. Many licensed therapists who understand the nuances of schizophrenia offer online therapy sessions. If you are interested in exploring therapy from the comfort of your own home, online therapy platforms like BetterHelp generally allow you to have sessions by phone, video, or online chat. However, individuals experiencing acute psychotic symptoms may need to seek care in person.

A review that synthesized findings of several studies noted that that online interventions may be "both feasible and acceptable to individuals with psychotic disorders." It stated that online therapy interventions "are associated with medium effects for improving auditory hallucinations, depressive symptoms, self-efficacy, motivation and functioning in randomized controlled trials."

Takeaway

Disorders defined as schizophrenic in the ICD-10 are usually characterized by distortions in thinking patterns and altered perception, resulting in inappropriate or blunted affect. Paranoid schizophrenia (ICD-10) normally involves relatively stable paranoid delusions, often accompanied by auditory hallucinations and perceptual distortions. Those who think they may be living with schizophrenia or another mental health disorder may benefit from speaking with a licensed therapist online or in their local area.