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

Shared psychotic disorder characterized by Capgras syndrome is an extremely rare condition. To our knowledge, there are only a few published papers on this condition. This paper presents a case of shared Capgras syndrome in two sisters. The inducer was a younger sister with schizophrenia, who passed on her Capgras delusion to her older sister after the death of their father. After committing a violent offense caused by Capgras delusion, a court ordered the sisters' involuntary admission to a psychiatric hospital. After being separated and receiving antipsychotic treatment, the sisters showed substantial improvement. However, shortly after hospital discharge, they stopped taking their medication and disappeared. After 15 years, their mother died and shortly afterwards, the sisters were re-admitted for forensic psychiatric evaluation after another violent crime caused by Capgras delusion. Timely recognition, adequate treatment and maintaining a therapeutic alliance could contribute to a better clinical course and outcome of this disorder, and reduce the risk of violent behavior.

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.

A case series of shared delusional infestation: folie à deux revisited.

Delusional infestation describes the unshakeable belief that one's skin is infected or infested with an external organism or inanimate material, in the absence of supportive medical evidence. It is one of the most challenging psychodermatological conditions to manage, given the rigidity of patients' physically focused health beliefs, and the competing need to introduce antipsychotic therapy to bring about resolution. This is rendered exponentially more complex when partners or family members are similarly afflicted. This situation is known as shared delusional infestation, shared psychotic disorder (SPD), or folie à deux. We present a series of three couples with SPD who were referred to our tertiary psychodermatology service during the same year. On examining the literature we were intrigued to discover that subtly different subtypes of SPD have been recognized since the late 1800s. These include folie simultanée, imposée, communiquée and induite. Our cases neatly demonstrate three of these variants, and highlight the difficulties in facilitating effective treatment.

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.

"Folie à trois", cuando la locura sobrepasa a una persona / "Folie à trois", when the madness exceed one perso

Presentamos el caso de un varón de 16 años al que le han transmitido ideas delirantes por parte de su madre y la pareja de ésta, constituyendo una "folie à trois" o trastorno psicótico compartido. Se trata de una entidad bastante rara debido a la escasa búsqueda de ayuda por parte de los afectados y una deficiente evaluación de las familias de los pacientes psicóticos. El principal tratamiento es la separación, por lo que el menor fue ingresado en la Unidad de Hospitalización de Psiquiatría Infanto-Juvenil y posteriormente un abordaje multidisciplinar por parte de Salud Mental y Servicios Sociales. Aún en nuestros días, la etiología de esta entidad sigue siendo un desafío por la falta de marcadores biológicos por lo que se suele apelar a las explicaciones de mecanismos psicológicos y ambientales

We report the case of a 16 year old man whose mother and her partner have transfer delusional ideas; they suffer a "folie à trois" or shared psychotic disorder. It is a rare illness due to the limited help searching of the members and the scarcity evaluation of families with psychotic members. The main treatment is the separation, the teenager was hospitalized in a child and adolescence psychiatry unit, and afterwards a multidisciplinary approach of mental health and social services was done. Nowadays, the etiology of this entity is a challenge, because of lacking of biological markers and the explanations of psychologycal and enviromental mechanisms

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.

[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.

Shared psychotic disorder with sexual delusions.

Shared psychotic disorder (SPD) is perceived as a relatively rare and poorly understood psychiatric phenomenon. Patients sharing sexual delusions may refer to sex therapists looking for treatment of an alleged sexual pathology. This might cause significant diagnostic and therapeutic challenges. The aim of this article was to discuss diagnostic and management difficulties of SPD with special interest in patients sharing sexual delusions. PubMed selective search was provided for publications with keywords including SPD, induced delusional disorder, folie à deux, and induced psychosis. One case is presented and discussed according to recent diagnostic criteria and the medical and legal issues of the therapy.

Delusional parasitosis: a rare cause of pruritus in hemodialysis patients.

Uremic pruritus is a common symptom in patients undergoing hemodialysis (HD) or peritoneal dialysis, but its exact pathogenesis remains rather unclear. However, severe or "intractable" pruritus may be the manifestation of another underlying disease or disorder other than uremia. Delusional parasitosis, or Ekbom syndrome, is a rare psychiatric disorder characterized by the false conviction of being infested with parasites, and it can be primary, or secondary to several medical and psychiatric disorders. We report 2 elderly HD patients who presented one after another, with delusional parasitosis. At some point in time, the delusional beliefs of the first patient were adopted by the second patient who was waiting to start his HD session on the same bed and HD machine, on a subsequent shift. They were both diagnosed with Ekbom syndrome and described as having monosymptomatic hypochondriac delusion. They were both prescribed antipsychotic medications. During follow-up they admitted feeling better than before; however, they remained concerned about the "insects/parasites."

Folie à deux: double case-report of shared delusions with a fatal outcome.

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.

Shared obsessive-compulsive disorder: broadening the concept of shared psychotic disorder.

OBJECTIVE: Folie a deux (shared psychotic disorder) is often described in the context of schizophrenia. In this article we present this syndrome in a non psychotic context. METHOD: We report a case of induced obsessive-compulsive disorder (OCD) in a married couple. Six months after the deterioration in the patient's OCD, his wife developed the same symptoms with no preceding history of an Axis I disorder. Neither spouse demonstrated psychotic symptomatology. The husband was successfully treated on an outpatient basis with Citalopram and Clonazepam. His wife's OCD spontaneously resolved without medication in parallel with the resolution of her husband's OCD. RESULTS: We highlight the uncommon phenomenon of shared psychiatric disorder occurring in the context of OCD. In the current psychiatric diagnostic nomenclature, (DSM IV and ICD10), there is no category for a non-psychotic shared psychiatric disorder. We raise the question of broadening the concept of shared disorder so as to include shared OCD and perhaps other shared psychiatric syndromes. CONCLUSIONS: More controlled studies are required in order to better understand the psychopathology and mechanisms of psychotic and non-psychotic shared disorders in psychiatry. We believe there are important treatment implications of such an understanding.

[Folie á deux between two unrelated individuals]. / Akrabalik Iliskisi Olmayan Iki Insan Arasinda Paylasilmis Psikoz.

Folie à deux is a rare condition characterized by transmission of delusions from a primary patient to another individual, usually a blood relative or spouse, while living in relative isolation. We report a case of folie à deux, which resembled folie communiquée, in a 37-year-old man that acquired it from an older woman (primary patient). Although not related by blood, the patient was emotionally very close to the woman and they shared common features, including grandiose delusions about the supernatural powers of the primary patient and persecutory delusions concerning office colleagues, as the woman had, and then neighbors, fellow villagers, and even family members. Behavioral changes were observed in the secondary patient as he started wearing strange clothing and peculiar ornaments, and neglected his personal hygiene. He also started following the same rituals and routines as the primary patient, and changed his religious practices, which he had followed devoutly since adolescence. He began seeking her opinion concerning almost all decisions he had to make, including personal and professional matters. Yet, unlike the usual clinical picture, they did not live in social isolation; rather, they lived in an apartment in a well-known residential area of the city and he regularly worked at his office until the late stage of illness. Premorbidly, there were no features suggestive of dependency or low intelligence in the secondary case. After separation from the primary case, improvement was observed about 7 weeks after beginning risperidone treatment (6 mg/day).

Shared psychotic disorder ("folie a deux") between mother and 15 years old son.

We presented a rare case in clinical practice: fifteen (15) years old male adolescent with shared psychotic disorder with his thirty seven (37) years old mother. In this case of "folie d deux" child was the passive psychotic partner and his mother who was the dominant psychotic partner. Both patients shared the same paranoid and imperative delusions. With complete psychiatric anamnesis, clinical interview, psychological testing, EEG (examination-electroencephalography) examination and control examinations we came to the diagnosis and efficacious pharmacological intervention for son.