title: Folie à deux: double case-report of shared delusions with a fatal outcome.
abstract: BACKGROUND
  Treatment of shared delusional disorder (folie à deux) often involves separation and use of antipsychotic medication, with uncertain outcomes and potential risks.
  
  
  METHODS
  We report on two highly interdependent and chronically psychotic sisters with shared systematic delusion, followed by psychiatrists over several years.
  
  
  RESULTS
  The dominant patient was diagnosed with schizoaffective disorder and her non-dominant sister with paranoid schizophrenia. Both received antipsychotics and supportive therapy as outpatients and allowed to continue conjoint therapy with individual psychiatrists-therapists. They returned for follow-up visits for 20 months, when the dominant decided to continue treatment alone, as her sister gradually improved symptomatically and functionally. After separation, the dominant became increasingly anxious. She impulsively ingested an overdose of the non-dominant sister's medicines and died of cardiac arrest, despite her sister's efforts to seek medical assistance. The surviving non-dominant sister developed anxiety and increasing agitation requiring psychiatric hospitalization and increased pharmacotherapy. She improved gradually, but continued to be dysfunctional and required placement in a psychiatric inpatient unit for several months, eventually doing better in a community-based rehabilitative program with regular psychiatric follow-up.
  
  
  CONCLUSIONS
  Combined treatment of patients with folie à deux may encourage continuous pathological interactions, but separation may increase risk of adverse outcomes.
authors: Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso "NESMOS", Ospedale Sant'Andrea, Sapienza, Università di Roma, Italia. atalamo@mclean.harvard.edu
authors: A
authors: A
authors: Talamo
authors: A
authors: A
authors: Vento
authors: V
authors: V
authors: Savoja
authors: D
authors: D
authors: Di Cosimo
authors: S
authors: S
authors: Lazanio
authors: G D
authors: GD
authors: Kotzalidis
authors: G
authors: G
authors: Manfredi
authors: N
authors: N
authors: Girardi
authors: R
authors: R
authors: Tatarelli
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D003708:Nordazepam / Q000008:administration & dosage / Q000627:therapeutic use; D000077152:Olanzapine; D010349:Patient Compliance; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000628:therapy; D012563:Schizophrenia, Paranoid / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D012753:Shared Paranoid Disorder / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D012801:Sibling Relations; D013405:Suicide; D014635:Valproic Acid / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D014635:Valproic Acid; D003708:Nordazepam; D003024:Clozapine; D006220:Haloperidol; C006820:bromperidol; D000077152:Olanzapine