Folie a Deux: Shared Psychotic Disorder in a Medical Unit

Abstract

Introduction. A shared psychotic disorder is a system of delusions shared by two or more individuals. Shared psychotic disorders typically develop in pairs or groups with a close relationship who are socially isolated. The function and affect of those inflicted with shared psychotic disorders usually remain intact. For these reasons, a shared psychotic disorder is seldom identified, diagnosed, and treated. This case describes a shared psychotic disorder incidentally discovered in a medical unit. Case. The patient was a 47-year-old woman with no known past psychiatric history who had been medically admitted for gastroenteritis. On the day of discharge, a psychiatric consult was requested for “paranoia and bizarre behavior.” The patient was seen making statements that she needed security and the FBI to escort her as she left the hospital. Another person in the patient’s room was discovered to be the patient’s mother who had been staying with her in the hospital. Evaluation of the patient along with observation of her mother revealed that the two shared a complex system of delusions revealing a diagnosis of shared psychotic disorder. Discussion. A shared psychotic disorder is a unique psychiatric diagnosis. It may be even rarer to diagnose in the inpatient medical setting because multiple individuals from a shared system are typically not seen. In this case, the patient and her mother had multiple clinical characteristics of a shared psychotic disorder, including an enmeshed relationship and social isolation. The treatment for shared psychotic disorders involves separation of the individuals and pharmacotherapy with antipsychotics. This case also presented a unique ethical dilemma as the psychiatric team was called to evaluate a patient and found a patient and another individual to have symptoms. Conclusion. A shared psychotic disorder is important to consider on the differential when cases of psychosis with delusional systems are seen on medical floors.

Importance of Capgras syndrome in shared psychotic disorder: a case report

“…It is important to mention that both sisters met almost all of the risk factors for the development of shared psychotic disorder: delusions present in the inducer, a prolonged close relationship with each other, female gender and stressful negative life events (death of parents). 1,4 In addition, this case featured a socially withdrawn family with weak social support and rigid boundaries that contributed to a restricted social environment; this characteristic is an important factor in the emergence of shared psychotic disorder.…”

“…The risk factors for induced persons include a passive personality, cognitive impairment, stressful negative life events, younger age than inducers and female gender. 1,4 The incidence of shared psychotic disorder is difficult to estimate, but some studies report that it is responsible for approximately 2% of psychiatric hospitalizations. 2 However, this figure may be underestimated as the disorder is often missed in clinical practice because psychiatrists may treat the inducer or induced while being unaware of the existence of the delusion in the other patient(s).…”

Occultism and playing with the dead: When rituals go wrong

“…Case study research is less persuasive as a theory within the high number of papers aimed at shedding light on the philosophical and sociological aspects of a very intriguing disorder. 25,26…”

“…Case study research is less persuasive as a theory within the high number of papers aimed at shedding light on the philosophical and sociological aspects of a very intriguing disorder. 25,26 The issue of an intimate partner giving birth, fomenting and consolidating the psychotic situation of two persons living under the same roof, has no single biological explanation, and the situation might become more complex where more than two people share the same delusion: folie a`trois. 27 When discussing these events, psychiatric authors readily group this diverse cluster within the very wide classification of delusions.…”

A Case Report of Family Relations in Shared Psychotic Disorder

“…A delusion shared by two or more people is known as shared psychotic disorder (SPD), and it was first noted in France in the 19th century. The term folie à deux (FAD) or SPD, which translates to "madness for two" was first used in 1877 to describe shared delusions between two individuals [1]. According to DSM III in 1980, FAD, also known as "shared paranoid disorder," is characterized by the operation of a delusional system that arises from a close relationship with a person who already has paranoid psychosis.…”