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.

All Alone Together: Case Report of Folie à Trois With Schizoaffective and Negative Symptoms in Monozygotic Triplets.

We present a case of folie à trois with schizoaffective and negative symptoms in monozygotic triplets, which to our knowledge is unique. For 4 years starting in their late teens, the 3 male siblings withdrew socially, adopted a primitive lifestyle, and exhibited poor self-care with increasing aggression, which led to their admission to the hospital at the age of 22 years. Over the subsequent 8 years, 1 brother recovered fully with treatment, resumed academic and social functioning, and does not need medication therapy currently. The other 2 brothers have disengaged from clinical care and moved back in together, following a socially isolated, disengaged way of life. They have relapsed gradually, displaying their previous symptomatology of suspiciousness, grandiosity, irritability, and affective flattening. This case demonstrates that shared psychosis can merge with endogenous psychopathology, including negative symptoms, in the context of genetic susceptibility. In closely associated individuals, such phenomena may go unnoticed or be misinterpreted, and therefore not receive appropriate management. In such a situation, separation as a part of the treatment plan should be approached gradually in combination with a therapy that emphasizes each patient as a separate individual.

[Shared psychotic disorder (Folie à deux) and Huntington's disease]. / "Induzierte wahnhafte Störung" (Folie à deux) bei Chorea Huntington.

INTRODUCTION: Folie à deux describes a rare psychiatric disorder of mostly closely related persons. The main feature of this disease is the unconditional adoption of the delusions of the primarily diseased person by the second person. This disturbance most frequently originates from a paranoid schizophrenia. METHOD: Our case is the first published description of a married couple with shared psychotic disorders which were caused by a genetically verified Chorea Huntington of the husband. RESULTS: The symptoms of the wife quickly declined after spatial separation from her primarily diseased husband. Thus, in her case it was assumed that she suffered from a Folie imposée which is a sub form of the Folie à deux. DISCUSSION: Our case report demonstrates that not only a paranoid schizophrenia but also an organic psychosis may cause this very interesting form of shared psychotic disorder.

Folie à deux and shared psychotic disorder.

Folie à deux (FAD) was first described in 19th century France. Since then, the concept has been elaborated, and several subtypes of FAD have been successively reported in France. In contrast, studies in German-speaking psychiatry mainly focused on the conceptual boundary between reactive/endogenous psychosis and etiological hypothesis (ie, psychogenesis vs genetic predisposition). In North America, Gralnick wrote a seminal review and redefined four subtypes of FAD by adopting the European classical concepts. More recently, "shared psychotic disorder" in DSM or "induced delusional disorder" in ICD-10 was branched off from FAD. However, several classical subcategories of FAD were not included in these recent definitions, the nosological significance of which should not be underestimated. We examined demographic data of FAD case reports published from the 19th to the 21st century and found that some of the earlier hypotheses, such as females being more susceptible, older and more intelligent individuals being more likely to be inducers, and sister-sister pairs being the most common relationship, were not supported. The controversial issue of the etiology of FAD-association of subjects or genetically driven psychosis-was re-examined in light of recent studies.

Folie a deux versus genetically driven delusional disorder: case reports and nosological considerations.

Folie a deux is thought to occur in persons who live close together, so that delusions of the primarily ill patient are adopted by the partner. Alternatively, if both patients are related, they may share the same genetically driven psychiatric illness. We present the cases of two psychotic couples (monozygotic twins and a mother and daughter pair, respectively), in which both subjects featured an almost identical psychopathological syndrome with the same delusional content and thus fulfilled the diagnostic criteria of folie a deux. When Leonhard's diagnostic system was applied, all four patients were found to suffer from affect-laden paraphrenia, arguing against the presence of folie a deux in those dyads. Thus, thorough psychopathological examination in suspected folie a deux settings can help to obtain valid diagnoses.

Induced delusional disorder. a review of the concept and an unusual case of folie à famille.

Induced delusional disorder (or shared paranoid 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. Usually the 'primary' case, i.e. the individual who first develops psychotic symptoms, can be distinguished from one or more 'secondary' cases, in whom the symptoms are induced. We discuss the concept of shared paranoid disorder and consider various aetiological, clinical and diagnostic issues related to the disturbance. We also describe a case of folie à famille, this condition being a type of shared paranoid disorder. The case involves a couple and their 12-year-old son. The boy's father is the 'primary' case, whilst the boy and his mother are both 'secondary' cases. The boy was admitted to our child and adolescent psychiatric unit for in-patient treatment. Treatment success was moderate in terms of improving the features of folie à famille in the three individuals involved.

Monozygotic twins, folie à deux and heritability: a case report and critical review.

A case report of shared delusional disorder, with a primary diagnosis of delusional disorder, is described in identical twins of proven zygosity. A review of literature shows that the primary diagnosis in identical twin pairs, suffering from folie à deux, is delusional disorder. This is in contrast to the reported excess of schizophrenia, as a primary diagnosis, in non-twin cases of folie à deux. Moreover, schizophrenia is poorly related to delusional disorders on the basis of demographic and familial studies. In the light of this paradox, nosological status of this disorder and the sociogenic and genetic factors are critically discussed.

Folie simultanée in monozygotic twins.

OBJECTIVE: To present a case report of folie simultanée in monozygotic twins. The literature describing folie à deux in twins is also reviewed and the common clinical findings are presented. METHOD: Case presentation and review of the literature. RESULTS: Clinical observations of monozygotic twins with folie simultanée suggest that the delusions tend to progress over time with each twin reinforcing the delusion in the second. CONCLUSIONS: The concept of a delusion resonating between individuals may account for the rapid progression and escalation of these delusions.

Shared-induced paranoid disorder folie à deux between mother and son.

A case of shared-induced paranoid (psychotic) disorder (DSM III-R, 1987) between mother and son is presented. This disorder may be a more frequently occurring disorder than is generally recognised. It is suggested that more detailed family and social investigations be undertaken to unearth psychopathology in the social environment of the patient. In cases involving relatives, this may be another dimension to the genetic influence on mental illness. This is the first case reported in the West Indian medical literature.

The frequency of shared delusions in delusions of infestation.

The phenomenon of shared delusions was found in 9 (8.4%) of 107 personally investigated patients suffering from delusions of infestation (88 females, 19 males). A greater number of females (ratio of females to males 3.5:1) "induced" others, whereas a gender ratio of 1:1 was evident in the group of affected patients. Since the ratio of blood relations to non-blood relations was 1:2.3, genetic factors seem to play a less important role than the direct impact of deluded patients on their environment. The rare occurrence of shared delusions of infestation leads to the conclusion that only persons with a paranoid predisposition (paranoide Bereitschaft) may be affected. Cases of induced delusions are also described in which attending physicians act as "inducers".

Folie à deux.

A review of folie à deux or induced psychotic disorder (DSM-III-R) is provided. The author believes it to be a more frequent phenomenon than usually thought, especially when hospitalized patients are evaluated with their families. An argument is made for viewing it as a description of a relationship and possible influence between individuals who may have very different disease processes. This includes, in the secondary partner, a continuum from being very "impressionable" to having an autonomous and independent delusional disorder. A case report and suggestions for treatment are given.

Folie à deux in Down's syndrome. A case report.

A case of folie à deux in a 29 year-old man with Down's syndrome, whose mother had a paranoid psychosis, is described. Successful treatment of the mother's illness also resulted in full recovery of the son without the need for medication.

Late-onset folie simultanée in a pair of monozygotic twins.

A case-report is presented of folie simultanée in a pair of female monozygotic twins with onset at the remarkable age of 81. The twins demonstrated no evidence of dementia or other psychopathology apart from delusions. Folie simultanée in monozygotic twins provides a model example of the potential role of genotype-environment correlation in the etiology of psychiatric illness.

A relapsing folie à trois.

A case of folie à trois affecting a mother and her children is described. The subjects fully recovered with treatment, but all relapsed two months later, when the primary subject discontinued medication.

Anorexia Nervosa in twins: case report and review.

The cases of a pair of monozygotic female twins simultaneously concordant for anorexia nervosa area reported. About half of the previously reported cases of anorexia nervosa in twins are concordant; however, interpretation of the clinical data reviewed is difficult because diagnostic criteria are not always clear. Clinical parallels between anorexia nervosa and folie à deux are discussed.