Folie à Deux and its interaction with early life stress: a case report

Abstract

BackgroundFolie à deux is a very rare psychiatric syndrome in which a psychotic symptom is transmitted from one individual to another. We present a case of folie à deux occurring during childhood, which is not an usual presentation of this syndrome. In this case, the disorder is correlated with child abuse and neglect, which possibly had a role in the development of the symptoms in our case.Case presentationWe present a case of folie à deux between an “induced” 9-year-old black Brazilian boy and the “inducer”, his grandmother. They were found to be sharing similar auditory and visual hallucinations and delusional beliefs. The boy was neglected by his parents and was being cared for by his grandmother, who had a history of mental disorder.ConclusionsThe close relationship between the boy and his grandmother, the family history of first-degree psychosis, and the child abuse and neglect suffered by the boy may have altered his vulnerability to early-onset psychosis and, in this case, folie à deux.

Folie à Deux in the Setting of COVID-19 Quarantine

“…According to Lazurus, two preconditions must exist before folie à deux can develop: an intimate emotional association between the inducer and the affected person and a genetic predisposition to psychosis, such as blood relations with the primary patient [ 7 ]. Although debated, social isolation has also been considered a potential risk factor for shared psychosis in recent literature [ 2 , 8 ]. As of 2020, the existing literature on clinical, diagnostic, and therapeutic aspects of folie a deux describes 7 reported cases documented in the timeframe between 1995 and 2019, wherein social isolation was mentioned as a major risk factor, with a prevalence higher than 60% in the listed cases (Arnone et al, 2006; Silveira & Seeman, 1995) [ 9 ].…”

A case report of Folie à deux with delusion of pregnancy

“…11 Case reports suggest childhood trauma as risk factors for the secondary (induced) patient. 12 Social isolation limiting environmental input and opportunities for reality testing is also common. 13,14 There is a similar prevalence of schizophrenia in families of both individuals in Folie à Deux.…”

A Contagious Disorder: Folie à Deux and Dementia

“…The content of the shared delusional beliefs may depend on the diagnosis of the primary case and can include bizarre delusions, or nonbizarre delusions characteristic of delusional disorder, and delusions congruent with mood. 21 All kinds of delusional contents can be seen in this disorder. 22 However, persecutory, religious, and grandiose themes are the most common.…”

“…[64][65][66][67][68][69][70][71] In addition, it has been reported that individuals who develop FaD have a high risk of schizophrenia in their families, with a very high prevalence of schizophrenia in firstdegree relatives (6.5%-26.2%), which is similar to the prevalence seen in first-degree relatives of schizophrenic patients (5.0%-16.9%). 21 Despite this evidence, the extent of genetic influence is difficult to determine. 26 Socioclinical substrates such as suggestibility and some cultural traits and religious beliefs could also provide the soil for the sharing of delusions.…”

“…38 The disorder usually starts with a difference in power and influence between the two, in which the one that induces the psychotic symptoms is the “real” psychotic and is an individual with energetic and active character. 21 According to Nielssen and colleagues, 39 the source of delusional content in the principal subject is generally conceived as reflecting endogenous processes and arising from the patient’s distinctive personal and natural history and particular vulnerabilities, whereas the source in secondary patients in FaD is purely exogenous. Individuals who develop shared psychosis often have suspicious, antisocial, dependent, and histrionic traits.…”