RESUMO
BACKGROUND: Treatment of shared delusional disorder (folie à deux) often involves separation and use of antipsychotic medication, with uncertain outcomes and potential risks. METHODS: We report on two highly interdependent and chronically psychotic sisters with shared systematic delusion, followed by psychiatrists over several years. RESULTS: The dominant patient was diagnosed with schizoaffective disorder and her non-dominant sister with paranoid schizophrenia. Both received antipsychotics and supportive therapy as outpatients and allowed to continue conjoint therapy with individual psychiatrists-therapists. They returned for follow-up visits for 20 months, when the dominant decided to continue treatment alone, as her sister gradually improved symptomatically and functionally. After separation, the dominant became increasingly anxious. She impulsively ingested an overdose of the non-dominant sister's medicines and died of cardiac arrest, despite her sister's efforts to seek medical assistance. The surviving non-dominant sister developed anxiety and increasing agitation requiring psychiatric hospitalization and increased pharmacotherapy. She improved gradually, but continued to be dysfunctional and required placement in a psychiatric inpatient unit for several months, eventually doing better in a community-based rehabilitative program with regular psychiatric follow-up. CONCLUSIONS: Combined treatment of patients with folie à deux may encourage continuous pathological interactions, but separation may increase risk of adverse outcomes.
Assuntos
Transtorno Paranoide Compartilhado , Suicídio , Adulto , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Benzodiazepinas/administração & dosagem , Benzodiazepinas/uso terapêutico , Clozapina/administração & dosagem , Clozapina/uso terapêutico , Terapia Combinada , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Evolução Fatal , Feminino , Haloperidol/administração & dosagem , Haloperidol/análogos & derivados , Haloperidol/uso terapêutico , Humanos , Nordazepam/administração & dosagem , Nordazepam/uso terapêutico , Olanzapina , Cooperação do Paciente , Psicoterapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/genética , Transtornos Psicóticos/terapia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamento farmacológico , Esquizofrenia Paranoide/terapia , Transtorno Paranoide Compartilhado/complicações , Transtorno Paranoide Compartilhado/tratamento farmacológico , Transtorno Paranoide Compartilhado/terapia , Relações entre Irmãos , Ácido Valproico/administração & dosagem , Ácido Valproico/uso terapêuticoAssuntos
Atitude do Pessoal de Saúde , Medicina de Família e Comunidade/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Competência Clínica , Comportamento Cooperativo , Humanos , Itália/epidemiologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Administração em Saúde Pública , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Depression in people related to delivering women is documented in their mates, but only anecdotal in other family members. We describe a case of depression in a woman who had previously experienced postpartum depression after the birth of her nephew. METHOD: A clinical description of the case. RESULTS: A 53-year-old woman, hysterectomized at age 47 years, was admitted for attempted suicide. She developed major depressive episode 1 month after her daughter had delivered a son. She had a past history of two postpartum depressive episodes clinically identical to the current episode. The episode resolved after 5 weeks. At 1-year follow-up, the patient is still asymptomatic. CONCLUSION: Psychological and cultural factors were at play in this case more than hormonal and biopsychosocial ones.