Folie a Deux: Shared Psychotic Disorder in a Medical Unit.

Saumya Bhutani,Damir Huremovic,Erik J Nsson

doi:10.1155/2021/5520101

Abstract

Introduction A shared psychotic disorder is a system of delusions shared by two or more individuals. Shared psychotic disorders typically develop in pairs or groups with a close relationship who are socially isolated. The function and affect of those inflicted with shared psychotic disorders usually remain intact. For these reasons, a shared psychotic disorder is seldom identified, diagnosed, and treated. This case describes a shared psychotic disorder incidentally discovered in a medical unit. Case The patient was a 47-year-old woman with no known past psychiatric history who had been medically admitted for gastroenteritis. On the day of discharge, a psychiatric consult was requested for “paranoia and bizarre behavior.” The patient was seen making statements that she needed security and the FBI to escort her as she left the hospital. Another person in the patient's room was discovered to be the patient's mother who had been staying with her in the hospital. Evaluation of the patient along with observation of her mother revealed that the two shared a complex system of delusions revealing a diagnosis of shared psychotic disorder. Discussion. A shared psychotic disorder is a unique psychiatric diagnosis. It may be even rarer to diagnose in the inpatient medical setting because multiple individuals from a shared system are typically not seen. In this case, the patient and her mother had multiple clinical characteristics of a shared psychotic disorder, including an enmeshed relationship and social isolation. The treatment for shared psychotic disorders involves separation of the individuals and pharmacotherapy with antipsychotics. This case also presented a unique ethical dilemma as the psychiatric team was called to evaluate a patient and found a patient and another individual to have symptoms. Conclusion A shared psychotic disorder is important to consider on the differential when cases of psychosis with delusional systems are seen on medical floors.

Highlights

A shared psychotic disorder is a system of delusions shared by two or more individuals
While shared psychotic disorders are not limited to two individuals, the deux is replaced with many people are within the system of beliefs
When Laségue and Falret first introduced the term folie à deux, they posited three criteria that were part of the condition as follows: within a pair, a more active and intelligent individual imposes delusions onto a more passive, less intelligent individual; both individuals suffering from the delusions live together closely without any external influence; and the delusions have some degree of likelihood referencing “common experience, hopes, and anxieties” [1, 2]

Summary

Introduction

A shared psychotic disorder refers to delusions that are shared between two or more people. Some common themes and risk factors that have emerged in the study of folie à deux reflect the historical descriptions These include a close, prolonged relationship between the inducer of the delusion and the recipient, a lack of another psychotic disorder explaining the development of the delusions, a delusion that is usually persecutory in nature, and maintenance of function without intellectual or affective disorganization in those afflicted [7]. Other risk factors for the “recipient” include a passive personality, cognitive impairment, language difficulties, and negative life events [10] These themes, the close relationship between those sharing the delusion, their social isolation, and the maintenance of their function, are likely responsible for the underestimation of incidence of shared psychotic disorders. Patients on medical floors are almost invariably seen as individuals and rarely within the familial context; shared psychotic disorders seldom get consideration in the differential diagnosis

Case Report

Findings

Discussion