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A case is presented of a socially isolated married couple who developed a shared paranoid disorder preceded by their cannabis abuse with the wife initiating the delusions. After the couple were separated the wife feared that she would be killed and assaulted her child and mother. Delusions in the pair ceased quickly and a return to cohabitation did not result in relapse in the absence of cannabis abuse.
Reports of folie à famille are rare; this may be the first reported case involving a Vietnam veteran. Expression of his paranoid schizophrenia involved delusions and hallucinations relating to Vietnam, and his wife and children shared his paranoia. Typical of folie à famille were the dominant family member, the threat of violence, and the family's social isolation, frequent crises, and stable membership. Although the veteran's intrusive recollections of his Vietnam experience were typical of posttraumatic stress disorder, he acted on rather than avoided them. Treatment focused on the entire family, partly to minimize future problems in the children.
OBJECTIVE AND METHOD: Since the 19th century, many studies have reported on folie à deux (FAD) in subjects with endogenous psychosis. However, the etiology of FAD in patients with schizophrenia has remained unclear, primarily because the possible psychogenic or reactive mechanisms of delusional contagion supposed in FAD were not compatible with the classical concept of endogenous psychosis. However, possible psychogenic mechanisms of FAD in schizophrenia were argued by Bleuler, E and Bleuler, M. The problem of how to distinguish the endogenesis from the psychogenesis (reaction) in FAD results in an aporia well-discussed in the German-speaking psychiatry: how induction in endogeneous psychosis might be possible? In the present study, first, a case of FAD in a husband and wife both with schizophrenia was reported. Three case reports of FAD in schizophrenic married couples from Japanese literature were also examined and the concept of the mind which lies in the background of psychogenesis/endogenesis dicotomy was discussed. CASE REPORT: A 34-year-old housewife had constructed a persecutory delusion shortly after the death of her father. She became convinced that her relative who was a Yakuza (Japanese Mafia) member was planning to kill her. She also reported auditory hallucinations. Her 41-year-old husband, who had been diagnosed with schizophrenia six years before the incident, first denied the claim of his wife that she had become a target of the Yakuza. However, shortly after that, he came to be convinced that he had become a target of another Yakuza. The couple took refuge in the husband's parents' home. Nevertheless, each of them thought that only he or she would be assassinated and not his or her spouse. After hospitalization, the husband was separated from his wife and soon recovered from his delusional state. However, the wife partially kept her persecutory delusion and full insight into her mental disorder could not be obtained after treatment. According to Gralnick's definition and sub-classifications of FAD, this case was diagnosed as FAD, subtype of "folie induite". DISCUSSIONS: Observed delusions of folie à deux in schizophrenic couples were classified into the following two categories, based on the subjective pronoun of the delusional statement: 1) We-type: "We are persecuted", generally observed in cases of paranoid type schizophrenia, paranoid disorder, and shared paranoid disorder; 2) I-type: "I am persecuted", observed in cases of non-paranoid schizophrenia in particular. It could be argued that the We-type suggests the establishment of a delusional community within participants not seen in the I-type delusion. However, according to clinical observations, even in We-type delusion, subjects ignored the wills and thoughts of their partners and somehow constructed the delusional community in a somewhat one-sided and egocentric way. In both We-type and I-type delusional formation, true communication was not established because of the limitation to the solipsistic view point inherent to the subjects involved. Therefore, we designated the We-type delusional view point as Paranoid Solipsism in FAD and the I-type as Schizophrenic Solipsism in FAD. According to German traditional psychiatry, We-type Paranoid Solipsism may correspond to "psychogenic" delusional formation mechanism and I-type Schizophrenic Solipsism to "endogenous" mechanism. The structural similarity between Paranoid Solipsism and the Husserlian concept of transcendental ego was also discussed. The author suggested that classical "psychogenesis" theory in psychiatry was founded on the modern concept of mind, which is inseparable from the European philosophical tradition of self-concept by Descartes and Husserl. From the Japanese literature, the author pointed out that the majority of FAD cases in Japan took the form of possession psychosis until the 1970's, and that We-type and I-type delusional formation in FAD appeared only after the late 70's. The implication of these transformations of FAD phenomenology in accordance with social structure change was briefly discussed regarding the relationship between the modernity and FAD delusion.
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.
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.
Shared psychotic disorder develops in an individual in the context of a close relationship with another one who has an established delusion that he/she also believes. It is classified within paranoid disorder. Herein, we present a case of two sisters with their mother. The elder sister was the origin of paranoid delusion. Her delusion was with a dentist who tries his best to prevent her for marrying. They separated completely from all their relatives for two years.
Delusional parasitosis is characterized by the unshakeable belief of being infested with tiny (microscopic) insects. Patients spend much time trying to get rid of the bugs and suffer from these symptoms. Patients prefer to go to dermatologists because they have a strong conviction over the presence of a somatic disease and do not accept any psychiatric advice for their complaints. Folie a deux or shared psychotic disorder (SPD) is a relatively rare syndrome, which has long attracted clinical attention. Delusional parasitosis is associated in 5-15% of SPD and can run within a family. We experienced delusional parasitosis as Folie a Deux between a mother and her son and successfully treated them through early psychiatric intervention. We believe that attention should be drawn to DP with SPD.
We report on a 59-year-old teacher suffering for approximately 5 years from multiple dermatological changes, some of which are artificially induced and some of which are imaginary. The patient believes these manifestations are the result of neighbors shooting at her with lasers. Her husband is also convinced of the veracity of these impressions. We interpret her notion of almost daily laser attacks to a skin-related paranoid/hallucinatory psychosis with the involvement of her husband in a "folie à deux".
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The definition and division of symbiontic psychoses (induced insanity, folieà deux,, psychosis of association) and their significance for the genesis of delusional developments are referred to at the beginning of the paper. After a presentation of environmental reactions on delusion, personality traits and mutual dependence in the predominance-subordination relationship of the partners of delusional symbioses are pointed out. The isolation of this symbiosis against the environment and its influence on this loneliness by twos are demonstrated. Besides the described suppositions, the primary delusion is essential for the pathodynamics of symbiontic psychoses because the delusional structure of the primary delusion, its compositional elements and especially the delusional motif are decisive for the transformation of a symbiosis which is still stable into a pathological we-formation. 5 case histories illustrate the pathodynamics of symbiontic psychoses.
A case of folie a deux is presented in which the child is the dominant psychotic partner and his mother is the passive partner in whom a paranoid psychosis is induced. The conditions under which folie a deux may occur, the diagnosis, and the treatment of the disorder are discussed.
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A case of folie à six is described in which the persecutory delusions of the central figure spread to her husband and their 2 sons, and even to her sister-in-law and a nephew. The main factor in the development of this shared paranoid disorder seems to have been the dominant personality of the inducer. In contrast to reports in the literature, there was no family history of such disorders and there were no adverse social or environmental circumstances.