[Insanity of two. Clinical symptomatology and psychosocial factors of induced paranoid disorder]. / Obled we dwoje. Objawy i psychospoleczne uwarunkowania indukowanych zaburzen urojeniowych.

AIM: The primary aim of the research was to identify factors which are associated with the appearance of induced psychotic disorders. The psychological and social factors and cultural diversity of symptoms and course of folie à deux were taken into account. METHOD: The author's review of literature on the topic of folie à deux. RESULTS: Folie à deux was first described in the 19th century. Since then the concept has been elaborated, and several psychosocial and demographical factors which favour a development of folie à deux have been described. Those involved are often isolated from society and have a close emotional relationship. Folie à deux has occurred most often in relationships within a nuclear family, especially between sisters, spouses, mother and child. The primary partner has been noted as being older, more intelligent and better educated. In most cases, the person in whom the delusions are induced is dependent on or submissive to the person with the psychotic disorder. CONCLUSION: Psychological, social and demographical factors play an important role in emergence of shared paranoid disorders.

Locura familiar: revisión clínica y a propósito de un caso / Folie a famille: clinical review and a case report

Introduction: Shared paranoia disorder, also known as folie à deux, is a fairly uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most often the symptoms are delusional. The 'primary' case, the individual who first develops psychotic symptoms, can be distinguished from one or more 'secondary' cases, in whom the symptoms are induced. Usually two people are involved, although full family case reports are described. These cases are even more uncommon and more difficult to treat. Case report: We describe a case of folie a famille, this condition being a type of shared paranoia disorder. The case involves a father and his three sons and clinical picture appears after fourth son 's suicide The dead son is the primary' case, whilst his three brothers and his father are 'secondary' cases. The father was admitted to psychiatric unit for in-patient treatment. Conclusions: Treatment success was modérate in terms of improving the features of folie a famille in the four individuals involved. The first step for a right treatment is a right diagnosis. Social features and family relationships need to be consider.

Introducción: El trastorno psicótico compartido, también conocido como folie à deux, es un cuadro muy poco frecuente caracterizado por la presencia de síntomas psicóticos similares en dos o más individuos. Principalmente los síntomas son delirantes. El caso primario, el individuo que primero desarrolla los síntomas psicóticos se puede diferenciar de uno o más casos secundarios en los que los síntomas son inducidos. Lo más habitual es que participen dos individuos, aunque se han descrito casos que afectan a familias enteras, siendo estos cuadros muy poco frecuentes y con un abordaje más complicado. Caso clínico: Presentamos el caso de una locura familiar, un subtipo de trastorno psicótico compartido. El cuadro abarca a un padre y sus tres hijos y se desarrolla a partir del suicidio del cuarto hijo. El hijo fallecido constituye el caso primario mientras que sus tres hermanos y el padre son los casos secundarios. El padre es ingresado en la planta de psiquiatría. Conclusiones: El éxito del tratamiento fue moderado en el sentido de mejorar las características de la folie a famille en los cuatro sujetos implicados. El primer requisito para un tratamiento correcto es un diagnóstico correcto que tenga en cuenta aspectos sociales y la dinámica familiar.

[Folie à deux - mental infection or individual psychosis]. / Die Folie à deux - Psychische Ansteckung oder eigenständige Psychoseerkrankungen?

The phenomenon of folie à deux has been a topical issue in psychiatry for more than a century. Mainly, genetic and psychodynamic factors are discussed controversially in terms of their relevance to the etiology of folie à deux. In this paper, effort is taken to reconceive the topic applying the criteria of a differentiated psychopathological classification. Based on the literature and on two own cases, we try to elaborate characteristical psychopathological features of folie à deux patients. We hypothesize that at least a substantial fraction could be classified as "folie simultanée" when Leonhard's criteria of the affect-laden paraphrenia are considered.

Folie induite: relato de um caso à margem das classificações atuais / Folie induite: report of a case outside of the actual classifications

Na classificação de Gralnick, de 1942, a folie à deux é dividida em quatro subtipos básicos: folie imposée, folie communiquée, folie simultannée e folie induite. O último termo se refere à adição de novas idéias delirantes por paciente previamente psicótico sob influência de outro paciente. Relatamos um caso de folie induite ocorrido entre mãe e filho primariamente psicóticos (transtorno delirante e esquizofrenia, respectivamente), que passaram a compartilhar delírios de natureza persecutória e sexual. Casos de folie à deux geralmente correspondem ao transtorno psicótico induzido (DSM-IV-TR) ou transtorno delirante induzido (CID-10). No entanto, o paciente deste relato não pode receber tais diagnósticos, já que nos critérios validados atualmente percebe-se a exigência de que o parceiro induzido não possua um transtorno psicótico anterior ao início do compartilhamento do delírio. Consideramos que o presente relato exemplifica a insuficiência das modernas classificações nesta área. Casos de folie induite podem necessitar de manejo distinto dos demais casos de psicose compartilhada ou não compartilhada. Sugerimos que os critérios diagnósticos correntes poderiam ser revisados para incluir condições psiquiátricas como essa.

In the Gralnick classification of 1942 the term folie à deux is classically divided into four basic subtypes: folie imposée, folie communiquée, folie simultannée and folie induite. This last one refers to the addiction of new delusions in a previous psychotic patient, under the influence of another patient. We report a case of folie induite that occurred between mother and son, both diagnosed previously with psychotic disorders (delusional disorder and schizophrenia, respectively), who started to share persecutory and sexual delusions. Cases of folie à deux generally correspond to the induced psychotic disorder in the DSM-IV-TR or the induced delusional disorder in the ICD-10. However, our patient do not meet neither diagnosis, since, in both, it is necessary that the induced delusional patient do not have any previous psychotic disorder. We think that our report underscores the insufficiency of the modern classifications in this area. Cases of folie induite may require a management different from those used in other cases of shared or non-shared psychosis. We suggest that modern criteria should be revised to include cases such as the present one.

[A remarkable case of folie à deux]. / Ein bemerkenswerter Fall von Folie à deux.

This article reports the noteworthy case of a couple who developed three clearly separate delusions after marriage. An elaborated delusion of descent was shared by the two people, while two further delusions remained private convictions. Probable biographical connections of the shared delusions and diagnostic problems are discussed, especially the monocausal etiologic hypotheses behind the respective categories for shared psychotic disorders of ICD and DSM.

Shared psychotic disorder: a critical review of the literature.

OBJECTIVE: To search the literature to reassess the concept of shared psychotic disorder (SPD) using modern nosology and current biopsychosocial formulation. METHOD: Analyzing published case reports from 1942 through to 1993 that meet DSM-IV criteria for SPD according to patient age, sex, nature and duration of the relationship with the "primary", length of exposure to primary's psychosis, family psychiatric history, comorbidity, social isolation of the dyad, presence of hallucinations, delusional type, and the diagnosis of the primary. RESULTS: Findings revealed: 1. males and females were affected with equal frequency; 2. there was equal prevalence in younger and older patients; 3. the majority of shared psychoses (90.2%) were equally distributed among married couples, siblings, and parent-child dyads; 4. comorbid dementia, depression, and mental retardation were common; 5. hallucinations were common; 6. the majority of dyads (67.3%) were socially isolated. CONCLUSIONS: SPD probably occurs in premorbidly disposed individuals in the context of social isolation which is shared with a psychotic person.

Induced psychosis.

When two or more individuals share delusions and hallucinations, psychotic material has often been transferred to, or induced in, one of the sufferers. A guide to the terminology, aetiology, diagnosis and treatment of induced psychoses is given, together with a description of two cases of folie à deux.

Folie à deux: Revisáo crìtica da literatura / Folie à deux: Critical review of literature

Os autores apresentam uma revisáo histórica do tema "Folie à Deux", abordando desde o estudo pioneiro de Lasegue & Falret, no século passado, até as publicaçöes mais atuais. Fazem uma análise crìtica acerca da nomenclatura e categorizaçäo desse distúrbio nas classificaçöes recentes. Neste sentido, defendem que a "Folie à Deux" seja designada de "Disturbio Delirante Induzido" e incluida entre os "Distúrbios Delirantes". O termo "Folie à Deux" seria empregado apenas de forma genérica. Referindo-se a quaisquer relaçöes interpessoais patológicas onde haja um delìrio compartilhado, independente dos diagnósticos individuais dos parceiros. Enfocam, ainda, aspectos do quadro clìnico, evoluçäo e terapêutica da "Folie à Deux"

Folie à deux em gêmeos monozigóticos: Relato de caso / Folie à deux in monozigotic twins: Case report

Os autores apresentam um caso de "Folie à Deux" em gêmeos, cuja originalidade prende-se a uma inversäo dos papéis de indutor/induzido, entre os parceiros de menor e maior capacidade intelectual, respectivamente. Fazem, ainda, uma discussäo acerca de aspectos referentes ao diagnóstico e classificaçäo desta condiçäo e defendem a separaçäo como uma conduta útil ao esclarecimento diagnóstico e, muitas vezes, importante para a terapêutica