A Contagious Disorder: Folie à Deux and Dementia

Folie À Trois: A Case of Shared Delusions Between a Patient, Her Sister, and Another Patient in the In-Patient Psychiatric Unit

Folie à deux is a rare condition in which a single person (often with a psychiatric disorder) develops a delusion that is shared by another person. Folie à troix is when a delusion is shared by three people. This case report documents the unusual case of an individual who shared delusions with two different people simultaneously. This report inspires questions about this person, her delusions, and what made them so believable to others. It is known that the development of shared delusions most commonly occurs in relative isolation and disproportionately affects individuals with preexisting psychiatric comorbidities. Because of these risk factors, delusions in a psychiatric unit may be even more "contagious" than in the general population. To our knowledge, this case report is the first to document a newly developed delusion shared between two unrelated patients in a single psychiatric unit. While physical separation of patients is the best practice in such cases, a risk-benefit analysis is needed prior to this intervention given the social barriers that may limit such an approach. Further research is needed to diagnose, manage, and optimize treatment for shared delusions in settings such as inpatient psychiatric facilities.

Shared Psychotic Disorder Associated With Bipolar Disorder in the Primary Case in the Context of Opioid Misuse

Bipolar disorder (BD) is a serious chronic mood disorder associated with high rates of co-occurring substance use disorders. Shared psychotic disorder (SPD) is a rare clinical phenomenon and has been reported in only a few cases of individuals diagnosed with BD. Furthermore, reports concerning SPD being induced by substance use or withdrawal are lacking. We report the case of a married couple endorsing simultaneous psychosis, a form of SPD. The primary case (the wife) had a diagnosis of BD, without any history of psychotic episodes before the current episode, while the secondary case (the husband) had a diagnosis of posttraumatic stress disorder. Both individuals were misusing prescribed synthetic opioids, and their psychosis was most likely induced by a withdrawal state. Cases of SPD involving patients with BD have rarely been reported. Considering the high rates of dual diagnoses among patients with BD, clinicians should be aware of the risk of substance-induced psychosis among these individuals and the manifestation of these psychotic episodes. This case report strengthens previous reports suggesting that SPD is a clinical entity that can occur not only in situations where the primary case involves an individual diagnosed with delusional disorder or schizophrenia, but that it may also occur when the primary case has a diagnosis of BD.

Folie à Deux in the Setting of COVID-19 Quarantine

We relay the case of a middle-aged male and his mother, an elderly female, who presented with folie à deux in the context of shared delusions of persecution and somatization during the COVID-19 quarantine period. The delusions were described as electric microwave shocks being transmitted to their internal organs by neighbors, followed by somatic symptoms of palpitations, headaches, and a shock-like perception. To the best of our knowledge, there have not been any reports that describe the development of folie à deux in the setting of the COVID-19 quarantine. Folie à deux may be defined as delusions affecting two or more individuals, usually first-degree relatives. Delusions classically transmit from one person, coined the inducer, to one or several individuals, the induced, who share and may expand on the communicated delusions. The preconditions that must exist for folie à deux to develop are an intimate emotional association between the inducer and the induced and a genetic predisposition to psychosis, such as blood relations with primary relatives. Isolation from society has also been considered a potential risk factor for shared psychosis in the recent literature. Given that to the best of our knowledge, there have not been any reports describing the development of folie à deux in the setting of the COVID-19 quarantine, the authors aim to dissect how extended periods of shared isolation from society during such a significant time in history may have served as a significant precipitating factor in the onset of shared psychotic disorder, while simultaneously illustrating a parallel relation to how such conditions may predispose certain subgroups to similarly dynamic-based mental health disorders. In addition, an evaluation of the origins and multifactorial etiology of folie à deux, along with that of existing treatment modalities, and the emphasis on advancement toward more effective treatment approaches will be provided.

Categorising a problem: alcohol and dementia

Alcoholism is a chronic relapsing disorder that can include extended periods of abstinence followed by relapse to heavy drinking. Decades of evidence have clearly shown that long-term, chronic ethanol exposure produces brain damage in humans. The article aims to review the relationship between alcohol use and dementia. Medline and Google Scholar searches were conducted for relevant articles, chapters and books published until 2019. Search terms used included alcohol consumption, alcohol-related dementia, alcohol use disorders, chronic alcoholism, dementia. Publications found through this indexed search were reviewed for further relevant references. Alcohol acts on the central nervous system via both direct and indirect effects, frequently a combination of the two. There is consensus that alcohol contributes to the acquisition of cognitive deficits in late life. However, there are doubts regarding the aetiopathogenesis, nosological status and prevalence of alcohol-related dementia and still, there is much debate over how much alcohol consumption will lead to alcohol-related dementia.

A case series of shared delusional infestation: folie à deux revisited

Delusional infestation describes the unshakeable belief that one's skin is infected or infested with an external organism or inanimate material, in the absence of supportive medical evidence. It is one of the most challenging psychodermatological conditions to manage, given the rigidity of patients' physically focused health beliefs, and the competing need to introduce antipsychotic therapy to bring about resolution. This is rendered exponentially more complex when partners or family members are similarly afflicted. This situation is known as shared delusional infestation, shared psychotic disorder (SPD), or folie à deux. We present a series of three couples with SPD who were referred to our tertiary psychodermatology service during the same year. On examining the literature we were intrigued to discover that subtly different subtypes of SPD have been recognized since the late 1800s. These include folie simultanée, imposée, communiquée and induite. Our cases neatly demonstrate three of these variants, and highlight the difficulties in facilitating effective treatment.