Shared psychotic disorder - a case study of folie à famille.

BACKGROUND: Folie à famille is a rare form of shared psychotic disorder. It is defined as the transfer of delusions from one person to another. CASE REPORT: This paper presents a case of shared psychotic disorder in two brothers, aged 16 and 17 and their mother who were admitted on the same day at the Clinic for psychiatry. The inducer was a mother, suffering from schizophrenia. She transferred her delusions to her sons. Both boys produced mostly the same paranoid delusions, that the others have been recording and monitoring them since their father died. After few days, the older boy, who had more severe psychotic symptoms, was treated with aripiprazole, while both received anxiolytics in low dosage. RESULTS: We observed a withdrawal of psychotic psychopathology in both kids. Genetic burden, social isolation and strong emotional connection of family members are factors that have contributed to the development of shared psychotic disorder in this case. CONCLUSIONS: The new approach of treatment for induced psychosis includes not only separation from the primary case, but also specific pharmacotherapy. It is necessary to think about this clinical entity, because this delusional disorder needs specific treatment, with better prognostic outcomes.

'Come share my world' of 'madness': a systematic review of clinical, diagnostic and therapeutic aspects of folie à deux.

Folie à deux, also known as shared psychotic disorder, shows intrinsic differences when compared to other psychiatric disorders. Literature about this condition is scanty and findings about its clinical correlates are not univocal. The present systematic review aimed at critically summarizing the existing evidence about folie à deux, also focussing on psychopathological, diagnostic and treatment features. The electronic databases PUBMED, Web of Science and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles reporting original data about socio-demographic, aetiological, clinical, diagnostic and treatment features of folie à deux, providing information about both primaries and secondaries, were included. Risk of bias was evaluated using the Critical Appraisal Skills Programme (CASP) instruments. The initial search yielded 834 records. After the screening process only 9 papers were deemed eligible for inclusion in the review. Folie à deux emerged to be a heterogeneous condition with a complex etiopathogenesis. The clinical presentation of the disorder included a multi-facet aspect, going beyond the classical description mainly focussed on delusions and possibly explaining conflicting outcomes of different treatments. Diagnostic categories appear to be often reductive and the need for a dimensional approach capable of global reliability emerged.

[Folie à deux, symptoms sharing us a relationship modality: a case report]. / Folie à deux ou le partage de symptômes comme modalité relationnelle: à propos d'un cas.

Shared Psychotic Disorder or Folie à deux is a rare and controversial entity that raises phenomenological, nosographic and psychopathological issues. It questions the nature of dilusion and its occurrence outside the psychotic structure and also the issue of symptoms contagion in psychiatry. We offer a semiological analysis of an intrafamilial case of Folie à deux, a case with the clinical specificity of sharing not only delusional symptoms but also non-delusional psychotic elements. We then dig back in the epidemiological characteristics and common factors to other reported cases in the literature of different cultures. Then we draw a history of the entity and its evolution over the classifications since its first description by Legrand to the DSM 5. From here, we emphasize the insufficiency of a purely descriptive approach and focus on the possible link with other more common clinical situations of mental symptoms transmission between two or more persons. Then, we propose a psychopathological reflection that essentially targets the sharing of the symptom rather than its nature while questioning the function of the delusion in a delusional couple.

Folie à deux / Case report: Folie à deux

JMCD, Sexo masculino, 19 años, soltero, sin hijos. Vive en Casas Compartidas de la Fundación Don Bosco. Examen Mental: Refiere que conversa con Dios en su corazón, y ahí siente el "fuego", pero no lo ve ni lo escucha. Dice tener la misión de predicar (sin mayor elaboración), y que no le gusta ninguna Iglesia. Discurso sin alteración del curso formal. Afecto de "templanza" forzada y superioridad. Al ingreso se agita y presenta postura antieconómica (también en el hogar: crucificado). Pone los ojos en blanco y parpadea rápidamente. Sin consciencia de enfermedad. Juicio de realidad alterado. Diagnósticos: Síndrome delirante lúcido. Folie à deux. Discusión: El trastorno de ideas delirantes inducidas, también conocido como Trastorno psicótico compartido o folie à deux es una condición poco común, caracterizada por síntomas psicóticos en 2 o más individuos que mantienen una relación cercana.

JMCD, male, 19 years old, single, childless. Live in shared houses of the Don Bosco Foundation. Mental examination: Refers conversing with God in his heart, and there he feels the "fire", but neither sees nor hears God. He claims to have the mission of preaching (without further processing), and he does not like any church. Speech without altering the formal course. Forced "temperance" affection and superiority. Agitation at Income and presents uneconomical posture (also at home: crucified). He rolls his eyes and blinks rapidly. Without awareness of disease. Reality trial actually altered. Diagnosis: Lucid delusional syndrome. Folie à deux. Discussion: The disorder of induced delusional thoughts, also known as shared psychotic disorder or folie à deux is a rare condition characterized by psychotic symptoms in 2 or more individuals who maintain a close relationship.

Delusional sharing: a history focus-on and case report of folie à deux.

Folie à deux (FAD) is a clinical condition that was first described by Lasègue and Falret in 19th century. They reported a rare condition where two or more people shared delusional ideas from a person to another. Nowadays a trace of this historical diagnosis and its theoretical framework, could be found on ICD-10 where FAD is translated in "Shared Psychotic Disorder". Given the lack of literature and a well-defined set of symptoms it is hard to detect the clinical limits of FAD. Furthermore, the complex of comorbidities could lead to a misdiagnosis. In this paper we report a peculiar case of FAD with an historical focus trying to give a wider point of view and tools to recognize this unconventional psychiatric diagnosis.

[A typical shared psychotic disorder: about a case]. / Trouble psychotique partagé atypique: à propos d'une observation.

Shared psychotic disorder is a rare entity characterized by the transmission of delusional symptoms from one patient ("inducer") to another ("induced" partner). We here report a clinical observation of atypical shared psychotic disorder involving delusion of persecution and of grandeur in a teenager induced by two subjects (grand-father and paternal uncle) with two different types of psychiatric disorders, all of which present in the same subject (third-party). The nature of the content transmitted to the third subject was the sum of the ideas of the first two subjects. These three subjects had a close relationship and lived in a closed environment, without access to the outside world.

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

BACKGROUND: Folie 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 PRESENTATION: We 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. CONCLUSIONS: The 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.

[A case of shared psychotic disorder (folie à deux) with original aspects associated with cross-cultural elements]. / Un caso di disturbo psicotico condiviso (folie à deux) con aspetti di originalità connessi a elementi di natura transculturale.

Shared psychotic disorder (folie à deux) is a rare condition characterized by the transmission of delusional aspects from a patient (the "dominant partner") to another (the "submissive partner") linked to the first by a close relationship. We report the case of two Moroccan sisters who have experienced a combined delusional episode diagnosed as shared psychotic disorder. In these circumstances, assessment of symptoms from a cross-cultural perspective is a key factor for proper diagnostic evaluation.

The Psychotic Couple--Sharing Drugs or Delusions?

Mephedrone and methylenedioxypyrovalerone (MDPV) are common compounds found in "Bath Salts," a recreational drug which has skyrocketed in popularity, resulting in increasing annual emergency room visits across the country. As users are often young and without previous psychiatric history it is often difficult to discern if symptoms are substance induced or related to an organic disorder. Our patient was a 38-year-old woman with no history of psychosis who presented to the emergency room following two failed suicide attempts via overdose and self-mutilation. On initial examination, the patient was somnolent yet arousable and oriented. She endorsed auditory and visual hallucinations as well as paranoid delusions regarding being spied on by her son. Upon further questioning, patient admitted to use of bath salts one day prior to admission and urine toxicology was positive for phenycyclidine. She was admitted for stabilization but despite improvement in her hallucinations, her paranoia persisted. She was visited by her husband who also expressed similar paranoid delusions, raising the question as to whether her symptoms were truly substance induced or if the patient was experiencing a shared psychotic disorder with her spouse. Prior to discharge, her hallucinations and paranoia had improved with abstinence from bath salts and the initiation of olanzapine. She was able to gain some insight, recognizing the delusions were false yet her husband still continued to believe they were true. As such, we concluded that the couple's psychotic symptoms were more likely related to shared bath salts rather than shared delusions.

[A case of Munchausen Syndrome by proxy in the context of folie a famille]. / Paylasilmis ailesel psikoz kapsamindabir "bakim verenin yapay bozuklugu" olgusu.

The occurrence of similar psychotic symptoms in two or more people is called shared paranoid disorder. In this disease, the person who exhibits psychotic symptoms first is the "primary patient". The symptoms are contracted by the other people through persuasion. This disorder is seen among people who share the same house or are emotionally bound. In some cases, shared paranoid disorder may include other diagnoses, such as Munchausen Syndrome. This report discusses the case of a six-year-old, sexually abused boy who, when admitted to the hospital at the age of 10, claimed to have been repeatedly sexually harassed by several different people. His family's frequent changes in hospitals, negative perceptions of and accusations against medical staff, and improper methods of responding to harassment led clinicians to a diagnosis of Munchausen by proxy syndrome. In addition, both parents believed the abuse story, suggesting a potential diagnosis of shared psychotic disorder. In the literature, Munchausen by proxy has rarely been reported with symptoms of sexual abuse. The psychotic symptoms were shared by the family, complicating the case. This report emphasizes that psychodynamic evaluations of Munchausen by proxy and shared psychotic disorder may be helpful in understanding underlying factors.

[Folie a deux: a nosographic question or just a shared madness?]. / Folie a deux: una cuestión nosográfica o solo una locura compartida?

Folie a deux was described by Lasègue and Falret in 1877. The concept evolved thus giving rise to different variants of the same reported phenomenon. Taking a clinical case as an example, a review of the nosological definition of shared psychotic disorder was performed. Limitations were found in its descriptions of the subtypes of this unique clinical picture. In this paper we evaluate if its argument has real implications for the purpose of establishing a diagnosis and performing a definite therapeutic approach.

Folie à deux: a case report.

Folie à deux is a relatively rare mental disorder first described in France in 1877 by Lasègue and Falret. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists. The aim of our work is to report a clinical case of folie à deux, subtype A of Gralnick, between an inducer daughter and an induced mother who lived quite socially isolated and had a strong and close relationship. In the clinical case presented, folie à deux was easily diagnosed but its treatment proved to be a higher challenge. The main diagnosis of the inducer patient was also quite interesting. Many years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists, especially concerning its pathophysiology and treatment.

[Parental alienation syndrome (PAS): unknown in medical settings, endemic in courts]. / La sindrome di alienazione parentale: sconosciuta negli ospedali, endemica nei tribunali.

A purposed syndrome of so-called parental alienation (PAS), unsupported by any evidence-based data, unknown in medical settings, unquoted in medical books, absent in DSM and ICD, never demonstrated by controlled studies published in high scientific level journals, is rampant in Courts where it can lead to loose parental custody. During a divorce trial, almost always the mothers and the children, become joint in a sort of folie au deux, in a denigration campaign of ex-husband/father. From a review on this issue it seems evident its theoretical roots lie on a theory that justify gender violence and children sexual abuse. The bias that both of them are layers and that he children have not autonomy block their possibility of any defence in front of a Court. In severe cases, PAS becomes a new and efficient tool of intra-familiar violence. The treatment of severe cases is to stop any contact between mother and children. The resort to PAS in Courts must be strongly rejected.

[Folie à famille: a Surinamese-Hindustani family with a shared paranoid delusion and severe undernourishment]. / Folie à famille: een Surinaams-Hindoestaans gezin met een gedeelde paranoïde waan en ernstige ondervoeding.

Folie à famille is a rare psychiatric condition in which several family members develop similar psychotic symptoms. We describe the case of a family of four with a shared paranoid delusion, who all obtained complete remission after being treated with antipsychotics on different psychiatric wards.