My brother has schizophrenia and I have heard that he may benefit from testosterone. Is this true?

Schizophrenia is a serious mental health disorder which affects close to 1% of the population. The only decent treatment available are anti-psychotic medications but these have a number of unpleasant side effects. Thus, many people have been turning to alternative treatments. One such treatment is testosterone derivatives. There are anecdotal reports that people treated with DHEA (testosterone derivative) plus anti-psychotics may have a positive response. Unfortunately the trials were small and not everyone obtained the same benefit. One should also remember that testosterone has many side effects which are very unpleasant. As of now, testosterone is not an accepted treatment for schizophrenia and there are no large scale studies to show that it works.

I tend to worry a lot. Is this a sign that I have paranoia?

Paranoia is more than too much concern or worry; it tends to involve a more intense sense of doubt and mistrust. This is different from worry - which is more a feeling of anxiety, hesitation, nervousness and uneasiness without automatically thinking and/or believing that other people are trying to harm you. Most people who worry can tell fact from fiction and have a good sense of situation. On the other hand, paranoid psychosis is a phony, rigid belief that doesn't dislodge even when one is confronted with evidence that disproves the belief.

Is paranoia only associated with schizophrenia?

NO.  Paranoia is a symptom that can occur in several other mental disorders including bipolar I disorder. More than 50% of individuals with bipolar I disorder have psychotic symptoms -- delusions or hallucinations -- when they develop mania.

Paranoia though is most common in schizophrenia. One may see it in people who abuse illicit drugs like cocaine, LSD or methamphetamine.

There are also some people who have mild degrees of paranoia and tend to function well in life. These people have a paranoid personality but are not delusional.

There are many examples of paranoia in people who have suffered brain trauma. Paranoia is also common in hospital patients but in such cases the paranoia is only mild and rarely reaches the severe intensity seen in schizophrenia. People who have borderline personality do tend to have a certain paranoia and tend not to trust people. These people live on the fringe of neurosis and psychosis.

Can you please tell me if paranoia is the same thing as not trusting someone?

Well, paranoia is much more than that. Paranoia is an overstated and unsubstantiated sense of suspicious or mistrust of someone. During paranoia, you may develop false beliefs that someone or something is planning to harm you or has evil intentions toward you. If you cannot distinguish fact from fiction there you have an impairment in relative awareness. If you are absolutely persuaded that others are against you and you cannot figure out alternative explanations for how you feel, then your paranoia is delusional in nature and intensity.  In psychosis this is the major problem- people cannot tell what is real and what is fiction. 

Does everyone with schizophrenia need treatment?

If schizophrenia is untreated, it can result in severe behavioral, emotional and physical health problems. Complications that are common with schizophrenia include suicide, self-destructive behaviors, depression, poverty, homelessness, difficulty in interpersonal relationships and family conflicts. Moreover, even if you are treated, the medications have many side effects. In general, schizophrenic individuals are often victims of crime because of their inability to differentiate safe from dangerous (and there are many evil people who take advantage of these unfortunate individuals). It is important for family members to read about schizophrenia so that they have a better understanding of the disorder and help provide care to the affected individual. 

Are there any risk factors that may precipitate schizophrenia?

While the cause of schizophrenia is not understood, some risk factors have been identified. These include a family history of schizophrenia, stressful life circumstances during childhood, older parental age at birth, use of illicit drugs during adolescence and perhaps exposure of the mother to certain virus or toxins during pregnancy. Again, these are only speculations and no one really knows why or how the disorder occurs.

What is the cause of schizophrenia?

The cause of schizophrenia is a mystery and despite intense research over the past 40 years, no physical cause has ever been identified. The diagnosis of the condition is based on history and clinical presentation. There are no laboratory studies or x-rays available that can help make the diagnosis. Once the diagnosis is made, treatment is lifelong. Individuals who do not undergo treatment develop disabling thoughts, hear voices and are not able to function in life.