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.

Faith, folie à famille, and mummification: a brief review of the literature and a rare case report.

Folie à deux is a rare clinical syndrome characterized by the transference of delusional ideas from one person to one or more other people in close association with the primary affected patient. Mummification indicates the preservation of the corpse of a person for a variable period of time. A brief review of the literature in this field is presented, and an exceptional case is described, characterized by the association of both these rare phenomena. The case is an example of folie à fammille which developed out of a condition of extreme religiousness and seclusion of an entire family. The shared psychosis led to the horrible death of some of the family members, while the last surviving member of the family lived for more than a year and a half with their mummified remains. The Judge commissioned a forensic psychiatry assessment to verify the survivor's ability to bear witness. The development of the psychiatric syndrome and its consequences are extensively discussed.

Transmitting delusional beliefs in a hypnotic model of folie à deux.

Folie à deux is the transference of delusional ideas from one 'primary' individual to one or more 'secondary' individuals (Lasègue & Falret, 1877). However, it is difficult to investigate experimentally because often only one patient is identified as delusional. We investigated whether hypnosis could model the experiences of the secondary in this delusion. Our primary was a confederate, who displayed two delusional beliefs and attempted to transmit them to hypnotised subjects. We manipulated the status of the confederate so that they were portrayed as either "credible" or merely "interesting".Many high hypnotisable individuals adopted the confederate's beliefs and confabulated evidence in support of them.Also, subjects who interacted with a credible confederate extended their delusions beyond those displayed by the confederate. We discuss the strengths and limitations of this approach and suggest ways to improve the validity of this model.

Antisocial personality by proxy: the Norton-Sims syndrome.

An antisocial personality disorder by proxy is defined by a proposed set of diagnostic criteria and a general description of proxy and perpetrator characteristics. Subtypes, dynamics, and features of this proposed disorder are described, and five-factor personality model (Costa & Widiger, 1994) loadings for the proxy and perpetrator are hypothesized. The relationship to abuse trauma and the five-factor personality model are discussed along with implications and suggestions for future research.

A psychoanalyst looks at a hypnotist: a study of folie à deux.

This paper traces my personal development from anesthetist to hypnotist, psychotherapist, and, finally, psychoanalyst. The change was precipitated by the successful treatment of a patient with congenital organic skin disease by hypnotism. Alongside my change of profession, I attempt to illustrate my change of ideas and the change of my relationship to patients which accompanies these other changes. I feel that my personal experience throws some light on the nature of suggestion and hypnotism and how they differ from each other and from psychoanalysis. I believe that observations support the idea that hypnotism is a folie à deux caused by mutual projective identification between two people and that in a less dramatic form this condition commonly occurs in normal development as well as in pathological psychological states. Several cases illustrate these ideas.

Induced psychotic disorder: clinical aspects, theoretical considerations, and some guidelines for treatment.

We describe our experience with a case of folie à famille with role reversal, including the long-term course. In addition, the case reports published since 1974 were reviewed and an overview is given of the psychoanalytic and system theory concepts on the pathogenesis of induced psychotic disorder. The inductor often appears to be suffering from schizophrenia. No further indications could be found in the literature for a hereditary predisposition in the recipient. It is sometimes difficult to distinguish between the inductor and the recipient, owing to the circular character of induced psychotic disorder and the role reversal that sometimes occurs. The DSM-III-R criteria for induced psychotic disorder were found to be lacking in practice because of their disregard for the circular causality and the strict exclusion criteria. In the short term, physical separation of the inductor and recipient leads to better treatment results than nonseparation, particularly in the case of recipient children. Long-term results are seldom mentioned. On the basis of theoretical considerations, interventions that aim at separation in psychological terms are necessary to achieve favorable long-term treatment results.

Mental illness complicated by the santeria belief in spirit possession.

Santeria, a religious system that blends African and Catholic beliefs, is practiced by many Cuban Americans. One aspect of this system is the belief in spirit possession. Basic santeria beliefs and rituals, including the fiesta santera (a gathering at which some participants may become possessed), are briefly described, and four cases in which the patients' belief in possession played a role in their mental illness are presented. The belief in possession can complicate the diagnosis and treatment of mental illness, but it should not be considered a culture-bound syndrome. Rather, it may be a nonspecific symptom of a variety of mental illnesses and should be evaluated in the context of the patient's overall belief system and ability to carry out usual activities.

Monoideism in psychiatry: theoretical and clinical implications.

The incessant repetition of disturbing monoideistic thoughts which cannot be eliminated from the patient's mind is a symptom of a variety of psychiatric conditions. The persistent monoideistic preoccupation tends to acquire the quality of a repetitive hypnotic suggestion or "inner commands" and creates an altered state of consciousness that transcends the limits of volitional control. The one-sided ideational context permeates interpersonal relations, intensifies family conflict and drains a considerable portion of available psychic energy. Disregard or an incorrect approach to this factor may result in painful therapeutic failure, since no exploratory psychotherapy or verbal intervention technique will be able to penetrate the monoideistic armour. THe continuous repetition of the dominant idea functions as a cumulative suggestion stimulus leading to disruption of spontaneous processes and self-defeating thinking, behavioral, motivational, and affective changes. The monoideistic preoccupation may be total and pervade the individual's entire life. Any comprehensive form of therapy should offer formulations and precise procedures--for the identified patient, nuclear family, and network of significant others--to block the feedback supplying system attached to the monoideistic pattern.