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Shared Psychotic Disorder - Causes, Symptoms and Management

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Shared psychotic disorder or folie à deux, translated literally as madness shared by two. Read the article to know more.

Written by

Dr. Kirti Maan

Medically reviewed by

Dr. Vishal Anilkumar Gandhi

Published At September 23, 2022
Reviewed AtSeptember 23, 2022

What Is Shared Psychotic Disorder?

Shared psychotic disorder, also known as induced delusional disorder, is a rare mental illness wherein a perfectly healthy and sound person starts to experience delusions, fallacies, or mistaken beliefs with someone they share an intimate bond with. The other person may possibly be suffering from psychotic disorders such as schizophrenia, paraphrenia, or delusional disorder. This could be shared by a group of people having close emotional connections or ties. For example, a person suffering from a psychotic disorder starts to believe in the presence of his late forefather spirits, and due to the proximity of this person with others, another individual will experience it or starts to believe in it despite being mentally sound and having completely normal behavioral and thought processes. Several criminal cases have been associated with this type of mental disorder.

What Are Psychotic Disorders?

  • Psychotic disorders are mental disorders where the individual suffering develops or experiences a disconnection from reality. People suffering from psychotic disorders find it challenging to keep in touch with reality and are unable to deal with usual day-to-day activities.

  • The severity of the psychotic disorder is essential to understand and detect as it can be life-threatening for the patients and their surroundings.

  • Different types of psychotic disorders are schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, and psychosis. Psychotic disorders are treatable conditions only when prompt diagnosis and apt treatment are provided.

What Causes Shared Psychotic Disorder?

Several factors could lead to the development of the shared psychotic disorder in both individuals, one who is having this delusionary behavior and others who tend to believe in all the delusionary statements and behaviors. Some of them are:

  • Dominating and passive nature of the primary and secondary individuals, respectively.

  • Societal seclusion and rejection of both primary and secondary people.

  • Continuous exposure to stressful situations.

  • Intimate nature of the relationship between both individuals. For example, family, couple, brother-sisters, or parent-child.

  • Secondary individuals suffer from past medical histories such as hysteria, schizophrenia, clinical depression, or post-traumatic stress disorder (PTSD).

  • Secondary individuals’ over-dependence on the primary person due to excess physical and emotional attachment.

  • Untreated disorder in the primary individuals.

Note: Here, the primary person is being referred to as the individual who is having delusionary behavior and the secondary who starts to get delusions due to their close relationship with the primary individual otherwise exhibiting the normal behavior.

What Are the Subtypes of Shared Pshycotic Disorder?

The subtypes of shared psychotic disorder include;

  • Subtype A:

Subtype A is termed as folie imposee or imposed psychosis. In this subtype, the delusions from an individual with psychosis is transferred to an individual without psychosis in an intimate relationship.

  • Subtype B:

Subtype B is termed as folie simultanee or simultaneous psychosis. This subtype involves both individuals simultaneously sharing the psychosis and delusions.

  • Subtype C:

Subtype C is termed as folie communiquee or communicated psychosis. In this delusions in the secondary partner occurs after longer periods of resistance.

  • Subtype D:

Subtype D is termed as folie induite or induced psychosis. New delusions are adopted by an individual with psychosis who is being influenced by another individual with psychosis.

What Are the Symptoms of Shared Psychotic Disorder?

Symptoms of the shared psychotic disorder may have direct signs and indirect implications on the person suffering. The golden sign and much more visible symptoms are hallucinations and delusions. Both the individuals suffering share the common disorder and experience these symptoms. Some direct symptoms are described more in detail below:

1. Direct and Visible Symptoms:

  • Hallucinations: Hallucination is a psychotic condition wherein the person may start to observe, feel, smell, hear, or taste things that are, as a matter of fact, not truly present. The primary person suffering from the psychotic disorder may experience the condition at a much deeper severity. There could be several reasons behind this condition. Some of them are alcohol and drug abuse, chronic depression, or in general, it could be a signal of psychosis.

  • Delusions: Delusion is the psychotic condition in which a person starts to perceive things and situations differently in comparison to how they would normally. In this symptom, the primary person having the psychotic disorder may have strong delusional beliefs, which tend to reflect on the thinking of the second person over a period of time. This can lead to changes in thinking of the second person when and if exposed persistently to the primary, which could later develop into a much more severe illness than shared psychotic disorder.

2. Indirect Implications:

  • Continuous exposure to the symptoms, as mentioned earlier, can lead to some severe effects on one’s mental as well as physical health. Individuals dealing with delusional behavior can develop severe implications on their health due to increased stress of the disorder.

  • The individuals suffering from the shared psychotic disorder may lose any semblance of real situations around them, which could be a proven haphazard in life.

  • It can also lead to mental health conditions and issues such as anxiety, clinical depression, and major depressive disorder because of constant exposure to the psychotic disorder.

  • Difficulty living everyday life.

  • Paranoid behavior.

  • Individuals may become a threat to family members or society in general.

  • Aggressive behavior.

  • Easily agitated.

  • Suicidal behavior and tendencies.

3. Common Signs and Symptoms:

  • Hyperactivity.

  • Social isolation.

  • Restlessness.

  • Poor hygiene.

  • Shows too much emotion or no emotion at all.

  • Nightmares (in case the primary suffers from it too).

  • Memory loss (commonly observed in both).

How to Diagnose Someone With Shared Psychotic Disorder?

Generally, this order may go unnoticed as it is complicated for the two individuals suffering from it to identify and then reflect on this problem themselves. Furthermore, even if the primary person stops exhibiting delusionary behavior, it becomes very tough to recognize the secondary individual suffering from it. Medical experts may find it challenging to find the exact cause of illness. But still, some techniques can assist the medical expert in diagnosing shared psychotic disorder. Some of them are as follows:

  1. Thorough psychiatric examination of the individual's brain in order to rule out any other possibility of mental disease.

  2. The medical experts carry out consultations with the patients or sufferers next of kin.

  3. A thorough study of medical history or background by the medical experts of both individuals.

  4. The medical expert carried out a mental state examination consisting of all the modern legal techniques.

What Is the Management of Shared Psychotic Disorder?

Due to the rarity of the disease, there are no prescribed treatments to provide a quick fix to these shared psychotic disorders. Management options vary between cases and should be appropriately carried out in the purview of a licensed medical expert. Some of the possible management techniques are listed below:

  • Psychiatric treatment of both individuals under the influence of mood enhancers or antidepressant drugs. Commonly prescribed antidepressants are Fluoxetine, Paroxetine, and Citalopram. Commonly prescribed mood enhancers are Carbmazepines, Lamotrigine, Valproic acid, and Lithium.

  • Common or separate psychotherapy for both individuals under the supervision of the medical expert. Commonly prescribed psychotherapy is cognitive-behavioral therapy (CBT), which helps develop a safe and stable cognition for both the primary and the secondary individual.

  • Compassionate care and treatment should be given by the family, keeping in mind the sensitivity of the illness. Families must try to create a conducive atmosphere around the patients and help the individuals to look at the positive aspects of life.

Conclusion:

The shared psychotic disorder is a rare serious mental disorder that often affects people sharing a close relationship with individuals suffering from a psychotic disorder. Shared psychotic disorder, like its namesake, is sharing of a mental disorder amongst two or, in rare cases, in a group. Shared psychotic disorder, however rare of a disorder, is a treatable condition when diagnosed at an early stage. However, prompt treatment is a necessity and must be provided at the earliest to avoid fatality to the individuals suffering and their surroundings.

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Dr. Vishal Anilkumar Gandhi
Dr. Vishal Anilkumar Gandhi

Psychiatry

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