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{{Infobox_Disease |
Historical Perspective:
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 34350 |
  ICD10          = {{ICD10|F|24||f|20}} |
  ICD9          = {{ICD9|297.3}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  MeshID        = D012753 |
}}
{{SI}}
{{CMG}}


==Overview==
It is a psychiatric syndrome that is historically known as a shared psychotic disorder due to its
'''Folie à deux''' (literally, "a madness shared by two") is a rare [[psychiatry|psychiatric]] syndrome in which a symptom of [[psychosis]] (particularly a [[paranoia|paranoid]] or [[delusion]]al belief) is transmitted from one individual to another. The same syndrome shared by more than two people may be called '''folie à trois''', '''folie à quatre''', '''folie à famille''' or even '''folie à plusieurs''' (madness of many). Recent psychiatric classifications refer to the syndrome as '''shared psychotic disorder''' ([[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]]) (297.3) and '''induced delusional disorder (folie à deux)''' (F.24) in the [[ICD|ICD-10]], although the research literature largely uses the original name.
transmitted properties that involve the sharing of symptoms from one individual to another. The
concept of the disease was first put forward in the 19th century by Lasègue and Falret in France and they
coined the term Folie à deux for this rare transmitted disease however some other terms are also used
synonymously such as double insanity and psychosis of association.<ref name="pmidPMID: 16895601">{{cite journal| author=Arnone D, Patel A, Tan GM| title=The nosological significance of Folie à Deux: a review of the literature. | journal=Ann Gen Psychiatry | year= 2006 | volume= 5 | issue=  | pages= 11 | pmid=PMID: 16895601 | doi=10.1186/1744-859X-5-11 | pmc=1559622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16895601  }} </ref>


==Presentation==
Pathophysiology:
This case study is taken from Enoch and Ball's 'Uncommon Psychiatric Syndromes' (2001, p181):
Shared psychiatric disorder(SPD) also known as folie à deux, is a rare chronic psychiatric problem in
which the symptoms are transferred from one psychotic individual to another or among multiple
healthy individuals who have close associations such as family members, or close friends with this disease
can extend from the original subject to three or more. based on the number of individuals involved this
the disorder can be named as, folie trios when three individuals are engaged in case of four  folie a
quatre, five  folie a cinq, or when sometimes a whole family is involved then it is termed as folie a
Famille   <ref name="pmidPMID: 33098221">{{cite journal| author=Torales J, García O, Barrios I, O'Higgins M, Castaldelli-Maia JM, Ventriglio A | display-authors=etal| title=Delusional infestation: Clinical presentations, diagnosis, and management. | journal=J Cosmet Dermatol | year= 2020 | volume= 19 | issue= 12 | pages= 3183-3188 | pmid=PMID: 33098221 | doi=10.1111/jocd.13786 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33098221  }} </ref> The pathophysiology of the diseases is not known but an investigation
suggest that the occurrence of the diseases may occur due to certain brain differences ( posterior fossa
lesion) but still, the association between brain abnormality and the diseases is not clear  the
the disorder can be of any type most commonly observed are persecutory and grandeur delusions but the
races are vary.


:Margaret and her husband Michael, both aged 34 years, were discovered to be suffering from ''folie à deux'' when they were both found to be sharing similar persecutory delusions. They believed that certain persons were entering their house, spreading dust and fluff and "wearing down their shoes". Both had, in addition, other symptoms supporting a diagnosis of [[Paranoia|paranoid]] [[psychosis]], which could be made independently in either case.
Causes:
The cause of the diseases is still not known, however, some risk factors are observed that can cause the
diseases including genetic and environmental factors are the determinants of the disease such as social
isolation and close association with the individual belief in unusual things.


This syndrome is most commonly diagnosed when the two or more individuals concerned live in proximity and may be socially or physically isolated and have little interaction with other people.  
Genetic factors:
SPD can be influenced by genetic predisposition to psychosis, such as blood relations with the primary
patient investigation has suggested that the individual with the disease is initially diagnosed with
schizophrenia which is a psychotic disorder that is caused by genetic factors. Studies suggest
that the patients diagnosed with shared psychotic disorder are reported as monozygotic twins.
<ref name="pmidPMID: 30328525(3)">{{cite journal| author=Vigo L, Ilzarbe D, Baeza I, Banerjea P, Kyriakopoulos M| title=Shared psychotic disorder in children and young people: a systematic review. | journal=Eur Child Adolesc Psychiatry | year= 2019 | volume= 28 | issue= 12 | pages= 1555-1566 | pmid=PMID: 30328525(3) | doi=10.1007/s00787-018-1236-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30328525  }} </ref>


Various sub-classifications of ''folie à deux'' have been proposed to describe how the delusional belief comes to be held by more than one person.
Isolation:
Isolation from the social environment can act as a risk factor for the development of diseases it can
cause individuals to believe in unusual things and it can be spread to others who are in a relationship
because they rely on each other’s information, making it easier to spread false belief.


* '''Folie imposée''' is where a dominant person (known as the 'primary', 'inducer' or 'principal') initially forms a delusional belief during a psychotic episode and imposes it on another person or persons (known as the 'secondary', 'acceptor' or 'associate') with the assumption that the secondary person might not have become deluded if left to their own devices. If the parties are admitted to hospital separately then the delusions in the person with the induced beliefs usually resolve without the need of medication.
Close Association:
* '''Folie simultanée''' describes the situation where two people, considered to independently suffer from psychosis, influence the content of each other's delusions so they become identical or strikingly similar.
Stressful life events can lead to delusional beliefs. In a relationship, if one partner holds unusual
beliefs, it can create stress, leading the other to adopt those false ideas to avoid conflict.
<ref name="pmidPMID: 22810994">{{cite journal| author=Lew-Starowicz M| title=Shared psychotic disorder with sexual delusions. | journal=Arch Sex Behav | year= 2012 | volume= 41 | issue= 6 | pages= 1515-20 | pmid=PMID: 22810994 | doi=10.1007/s10508-012-9992-9 | pmc=3501166 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22810994  }} </ref>


Folie à deux and its more populous cousins are in many ways a psychiatric curiosity. The current [[Diagnostic and Statistical Manual of Mental Disorders]] states that a person cannot be diagnosed as being delusional if the belief in question is one "ordinarily accepted by other members of the person's culture or subculture" (see entry for [[delusion]]). It is not clear at what point a belief considered to be delusional escapes from the ''folie à...'' diagnostic category and becomes legitimate because of the number of people holding it. When a large number of people may come to believe obviously false and potentially distressing things based purely on hearsay, these beliefs are not considered to be clinical delusions by the psychiatric profession and are labelled instead as [[mass hysteria]].  
Epidemiology and Demographics:
The incidence of the cases reported in the mental hospital is around 1.7-2.6 % and the true rate
of prevalence is still unknown due to undocumented and under diagnostic cases<ref name="pmidPMID: 30328525">{{cite journal| author=Vigo L, Ilzarbe D, Baeza I, Banerjea P, Kyriakopoulos M| title=Shared psychotic disorder in children and young people: a systematic review. | journal=Eur Child Adolesc Psychiatry | year= 2019 | volume= 28 | issue= 12 | pages= 1555-1566 | pmid=PMID: 30328525 | doi=10.1007/s00787-018-1236-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30328525  }} </ref>


Being defined as a rare pathological manifestation, folie à deux is rarely found in general psychology or [[social psychology]] text books, and is relatively unknown outside [[abnormal psychology]], [[psychiatry]] and [[psychopathology]].
Age:
This disease is observed in various age groups with cases reported in children, adults, and the elderly
Gender:
This shared psychotic disorder is common in Female <ref name="pmidPMID: 17521515">{{cite journal| author=Shimizu M, Kubota Y, Toichi M, Baba H| title=Folie à deux and shared psychotic disorder. | journal=Curr Psychiatry Rep | year= 2007 | volume= 9 | issue= 3 | pages= 200-5 | pmid=PMID: 17521515 | doi=10.1007/s11920-007-0019-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17521515  }} </ref>
Symptoms:
The syndrome is diagnosed when two or more individuals who live in proximity are isolated from
the social environment and have very little interaction with other people. These people have
psychotic symptoms, major depression and anxiety, auditory and visual hallucinations, and delusional
beliefs.<ref name="pmidPMID: 27906088">{{cite journal| author=Vargas Alves Nunes A, Odebrecht Vargas Nunes S, Strano T, Pascolat G, Schier Doria GM, Nasser Ehlke M| title=Folie à Deux and its interaction with early life stress: a case report. | journal=J Med Case Rep | year= 2016 | volume= 10 | issue= 1 | pages= 339 | pmid=PMID: 27906088 | doi=10.1186/s13256-016-1128-8 | pmc=5134243 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27906088  }} </ref>


===Related phenomena===
Diagnosis:
There have been reports that a similar phenomenon to folie à deux had been induced by the military [[incapacitating agent]] [[3-Quinuclidinyl benzilate|BZ]] in the late 60s, and most recently again by anthropologists in the South American rainforest consuming the [[hallucinogen]] [[ayahuasca]] (Metzner, 1999).
Laboratory Findings:
Like other diseases, there is no Laboratory test or scan available to rule out the SPD.
Physical Examination:
Physical examination will be done by the respected physician to check out the problem that is
causing symptoms like brain injuries, infection, and drug use.
Psychiatric evaluation:
Later physical evaluation both partners will be asses by the mental health professional to understand
their thoughts feelings and emotions and this part of the diagnosis is challenging because sometimes
primary partner will try to hide the problem and protect the delusion.
Past History:
It is important to find out the history of the individual from the third person to get the complete
picture of the situation<ref name="pmidPMID: 17521515">{{cite journal| author=Shimizu M, Kubota Y, Toichi M, Baba H| title=Folie à deux and shared psychotic disorder. | journal=Curr Psychiatry Rep | year= 2007 | volume= 9 | issue= 3 | pages= 200-5 | pmid=PMID: 17521515 | doi=10.1007/s11920-007-0019-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17521515  }} </ref>


==In the media==
Treatment:
* (1994) [[Heavenly Creatures|Heavenly Creatures]] is a film directed by [[Peter Jackson|Peter Jackson]] and starring [[Kate Winslet|Kate Winslet]] and [[Melanie Lynskey|Melanie Lynskey]]. It was set in [[New Zealand|New Zealand]] and inspired by a true story where two teenage girls develop a relationship so strong and peculiar that they believe the only way to stay together was to kill one of the girls's mother. These girls were thought to have folie à deux.
The treatment plan varies from person to person each case is unique so the treatment plan should be
tailored. The available treatment options for the patient are separation and pharmacotherapy with
* (1998) ''Folie à deux'' was the title of an episode from season 5 of [[The X-Files]], aired in 1998, where [[Fox Mulder|Agent Mulder]] shares the belief with a telemarketer that employees of the telemarketing firm are monsters.
antipsychotics
 
Separation:
* (2006) [[Folie à Deux (Film)|'Folie à Deux']] is the title of a short film written and directed by [[Devin Anderson]]. The film was shot in 2006 and is currently in post-production.
Separating the partners can improve the symptoms sometimes but it makes the situation worsen.
 
Pharmacotherapy with antipsychotics:
* (2006) ''Folie à deux'' was referenced and defined in an episode from season 2 of [[Criminal Minds]] entitled "The Perfect Storm", which aired October 4, 2006 on CBS, in which a pair of serial killers kidnapped, tortured, and murdered several young women; in this episode, the primary, or dominant, perpetrator was a woman.
It can play a significant role in the treatment of diseases these are used to manage the symptoms
 
associated with the diseases it stabilizes the individual by reducing the intensity of the delusion the
* (2007) The film ''[[Bug (2007 film)|Bug]]'' portrays a ''folie à deux'' involving a man and woman who believe they are infested with government-implanted, nano-technological insects.
Antipsychotics are effective in the acute phase of the diseases it include quetiapine, aripiprazole,
 
benzodiazepines, and a second generation antipsychotic<ref name="pmidPMID: 35548660">{{cite journal| author=Schopfer Q, Eshmawey M| title=Shared Psychotic Disorder in Old Age: Syndrome of Folie à Deux. | journal=Case Rep Psychiatry | year= 2022 | volume= 2022 | issue= | pages= 8811140 | pmid=PMID: 35548660 | doi=10.1155/2022/8811140 | pmc=9085334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35548660  }} </ref>
==See also==
* [[Delusion]]
* [[Delusional disorder]]
* [[Psychosis]]
 
==Further reading==
* Halgin, R. & Whitbourne, S. (2002) ''Abnormal Psychology: Clinical Perspectives on Psychological Disorders''. McGraw-Hill. ISBN 0072817216
* Enoch, D. & Ball, H. (2001) Folie à deux (et Folie à plusieurs). In Enoch, D. & Ball, H. ''Uncommon psychiatric syndromes (Fourth edition)''. London: Arnold. ISBN 0340763884
* {{cite journal |author=Wehmeier PM, Barth N, Remschmidt H |title=Induced delusional disorder. a review of the concept and an unusual case of folie à famille |journal=Psychopathology |volume=36 |issue=1 |pages=37-45 |year=2003 |pmid=12679591 |doi=10.1159/000069657}}
* {{cite book |author=Hatfield, Elaine, Caccioppo, John T., & Rapson, Richard L. |title=Emotional contagion (Studies in Emotional and Social Interaction) |publisher=Cambridge University Press |location=Cambridge, UK |year=1994 |pages= |isbn=0-521-44948-0 |oclc= |doi=}}
* {{cite book |author=Metzner, Ralph, editor |title=Ayahuasca: Human Consciousness and the Spirits of Nature |publisher=Thunder's Mouth Press |location=New York, NY |year= |pages= |isbn=1-56025-160-3 |oclc= |doi=}}
 
[[Category:Psychiatry]]
[[Category:Mature chapter]]
 
[[de:Folie à deux]]
[[fr:Folie à deux]]
[[nl:Gedeelde psychotische stoornis]]
[[pl:Indukowane zaburzenie urojeniowe]]
[[sr:Фоли а ду]]
[[sv:Folie à deux]]
 
 
{{WH}}
{{WS}}

Revision as of 06:57, 7 September 2024

Historical Perspective:

It is a psychiatric syndrome that is historically known as a shared psychotic disorder due to its transmitted properties that involve the sharing of symptoms from one individual to another. The concept of the disease was first put forward in the 19th century by Lasègue and Falret in France and they coined the term Folie à deux for this rare transmitted disease however some other terms are also used synonymously such as double insanity and psychosis of association.[1]

Pathophysiology: Shared psychiatric disorder(SPD) also known as folie à deux, is a rare chronic psychiatric problem in which the symptoms are transferred from one psychotic individual to another or among multiple healthy individuals who have close associations such as family members, or close friends with this disease can extend from the original subject to three or more. based on the number of individuals involved this the disorder can be named as, folie trios when three individuals are engaged in case of four  folie a quatre, five  folie a cinq, or when sometimes a whole family is involved then it is termed as folie a Famille   [2] The pathophysiology of the diseases is not known but an investigation suggest that the occurrence of the diseases may occur due to certain brain differences ( posterior fossa lesion) but still, the association between brain abnormality and the diseases is not clear the the disorder can be of any type most commonly observed are persecutory and grandeur delusions but the races are vary.

Causes: The cause of the diseases is still not known, however, some risk factors are observed that can cause the diseases including genetic and environmental factors are the determinants of the disease such as social isolation and close association with the individual belief in unusual things.

Genetic factors: SPD can be influenced by genetic predisposition to psychosis, such as blood relations with the primary patient investigation has suggested that the individual with the disease is initially diagnosed with schizophrenia which is a psychotic disorder that is caused by genetic factors. Studies suggest that the patients diagnosed with shared psychotic disorder are reported as monozygotic twins. [3]

Isolation: Isolation from the social environment can act as a risk factor for the development of diseases it can cause individuals to believe in unusual things and it can be spread to others who are in a relationship because they rely on each other’s information, making it easier to spread false belief.

Close Association: Stressful life events can lead to delusional beliefs. In a relationship, if one partner holds unusual beliefs, it can create stress, leading the other to adopt those false ideas to avoid conflict. [4]

Epidemiology and Demographics: The incidence of the cases reported in the mental hospital is around 1.7-2.6 % and the true rate of prevalence is still unknown due to undocumented and under diagnostic cases[5]

Age: This disease is observed in various age groups with cases reported in children, adults, and the elderly Gender: This shared psychotic disorder is common in Female [6] Symptoms: The syndrome is diagnosed when two or more individuals who live in proximity are isolated from the social environment and have very little interaction with other people. These people have psychotic symptoms, major depression and anxiety, auditory and visual hallucinations, and delusional beliefs.[7]

Diagnosis: Laboratory Findings: Like other diseases, there is no Laboratory test or scan available to rule out the SPD. Physical Examination: Physical examination will be done by the respected physician to check out the problem that is causing symptoms like brain injuries, infection, and drug use. Psychiatric evaluation: Later physical evaluation both partners will be asses by the mental health professional to understand their thoughts feelings and emotions and this part of the diagnosis is challenging because sometimes primary partner will try to hide the problem and protect the delusion. Past History: It is important to find out the history of the individual from the third person to get the complete picture of the situation[6]

Treatment: The treatment plan varies from person to person each case is unique so the treatment plan should be tailored. The available treatment options for the patient are separation and pharmacotherapy with antipsychotics Separation: Separating the partners can improve the symptoms sometimes but it makes the situation worsen. Pharmacotherapy with antipsychotics: It can play a significant role in the treatment of diseases these are used to manage the symptoms associated with the diseases it stabilizes the individual by reducing the intensity of the delusion the Antipsychotics are effective in the acute phase of the diseases it include quetiapine, aripiprazole, benzodiazepines, and a second generation antipsychotic[8]

  1. ↑ Arnone D, Patel A, Tan GM (2006). "The nosological significance of Folie à Deux: a review of the literature". Ann Gen Psychiatry. 5: 11. doi:10.1186/1744-859X-5-11. PMC 1559622. PMID 16895601 PMID: 16895601 Check |pmid= value (help).
  2. ↑ Torales J, García O, Barrios I, O'Higgins M, Castaldelli-Maia JM, Ventriglio A; et al. (2020). "Delusional infestation: Clinical presentations, diagnosis, and management". J Cosmet Dermatol. 19 (12): 3183–3188. doi:10.1111/jocd.13786. PMID 33098221 PMID: 33098221 Check |pmid= value (help).
  3. ↑ Vigo L, Ilzarbe D, Baeza I, Banerjea P, Kyriakopoulos M (2019). "Shared psychotic disorder in children and young people: a systematic review". Eur Child Adolesc Psychiatry. 28 (12): 1555–1566. doi:10.1007/s00787-018-1236-7. PMID 30328525(3) PMID: 30328525(3) Check |pmid= value (help).
  4. ↑ Lew-Starowicz M (2012). "Shared psychotic disorder with sexual delusions". Arch Sex Behav. 41 (6): 1515–20. doi:10.1007/s10508-012-9992-9. PMC 3501166. PMID 22810994 PMID: 22810994 Check |pmid= value (help).
  5. ↑ Vigo L, Ilzarbe D, Baeza I, Banerjea P, Kyriakopoulos M (2019). "Shared psychotic disorder in children and young people: a systematic review". Eur Child Adolesc Psychiatry. 28 (12): 1555–1566. doi:10.1007/s00787-018-1236-7. PMID 30328525 PMID: 30328525 Check |pmid= value (help).
  6. ↑ 6.0 6.1 Shimizu M, Kubota Y, Toichi M, Baba H (2007). "Folie à deux and shared psychotic disorder". Curr Psychiatry Rep. 9 (3): 200–5. doi:10.1007/s11920-007-0019-5. PMID 17521515 PMID: 17521515 Check |pmid= value (help).
  7. ↑ Vargas Alves Nunes A, Odebrecht Vargas Nunes S, Strano T, Pascolat G, Schier Doria GM, Nasser Ehlke M (2016). "Folie à Deux and its interaction with early life stress: a case report". J Med Case Rep. 10 (1): 339. doi:10.1186/s13256-016-1128-8. PMC 5134243. PMID 27906088 PMID: 27906088 Check |pmid= value (help).
  8. ↑ Schopfer Q, Eshmawey M (2022). "Shared Psychotic Disorder in Old Age: Syndrome of Folie à Deux". Case Rep Psychiatry. 2022: 8811140. doi:10.1155/2022/8811140. PMC 9085334 Check |pmc= value (help). PMID 35548660 PMID: 35548660 Check |pmid= value (help).
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