Need for an Antipsychotic in a Case of Infective Insanity Between Siblings – A Therapeutic Approach

Vimalanathane Panneerselvam

doi:10.11648/j.ijpbs.20180302.11

Abstract

BACKGROUND: Shared Delusional Disorder is not uncommon and has been included in formal diagnostic classification systems. However, it is not frequently diagnosed. This is a case of a 21 year old female, unmarried, who presented to our OPD with prominent psychotic symptoms, particularly a fixed belief that she was being followed by someone for the last six years. Her elder sister, who was close to her emotionally also developed persecutory delusion of similar content within one year of its onset in the younger sister. Thus when they first presented to the OPD, both sisters had similar type of psychotic presentation. After separation of both sisters, psychotic symptoms improved in elder sister within one month. CONCLUSION: Shared Delusional disorder is not uncommon. The risk of induced delusion is more among those who have high emotional bonding and it disappears following separation of each other. So it is necessary to evaluate the family member of individuals suffering from psychiatric disorder to rule out Induced delusional disorders. The conceptual issues of the problem are also discussed.

Highlights

Historical PerspectivesShared psychotic disorder (SPD) or folie adeux, induced psychosis, and induced delusional disorder (IDD) is that which is shared by two or more people with close emotional links
ICD 10 - F24 Induced Delusional Disorder [11] a) Two or more people share the same delusion or delusional system and support one another in this belief; b) They have an unusually close relationship of the kind described above; c) There is temporal or other contextual evidence that the delusion was induced in the passive member (s) of the pair or group by contact with the active member
We found there was a definite improvement of symptoms in elder sister following separation. They fulfilled all the criteria for a folie à deux described by Dewhurst and Todd [13]: (i) definite evidence that the partners had been in intimate association; (ii) a high degree of commonality in the content of delusion, the formal psychosis may differ; and (iii) unequivocal evidence that the partners share support, and accept each other’s delusions

Summary

Historical Perspectives

Shared psychotic disorder (SPD) or folie adeux, induced psychosis, and induced delusional disorder (IDD) is that which is shared by two or more people with close emotional links The essence of this phenomenon is a transfer of delusions from one person (inducer) to another (recipient, involved or induced partner). ICD does not contain very strict exclusion criteria for psychotic comorbidity but emphasizes the traditional theory of the condition for induction—that the delusion is induced from active inducer to passive recipient. Various terms, such as “inducer-induced,” “principalassociate,” or “primary-secondary,” have been used to distinguish the partners in FAD. The complex of comorbidities could lead to a misdiagnosis [18]

Diagnosis

Case Report

Discussion

Conclusion