Folie à deux

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.

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   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.

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.

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

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

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.

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

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