ABSTRACT
This chapter reflects a number of case reports and studies of paranoid disorders which eventually show themselves to be related to schizophrenia, or which follow a deteriorating course. A number of physical and environmental influences may precipitate paranoid delusions. Deafness, for example, particularly in the elderly, may be a treatable cause of the delusions and may cause one to change the diagnosis. The author has seen several cases of paranoia, with and without delusions, related to vitamin absorption syndromes such as pernicious anemia. In general, the longer the symptoms have been present, the more refractory they are to simple treatment such as explanation, education, or medication. Psychotherapy, when accepted, tends to be the treatment of choice, and should be begun in such a way that the patient is likely to see some benefit from it and some support from the therapist. The patient is often quite uncomfortable, particularly in situations of persecutory, somatic, or even erotomanic delusions.
