Characteristics Of Shared Psychotic Disorder And Its Prediction

In French, folie á deux can be translated into “madness of two”. This “madness” is referring to a shared psychosis. Shared psychotic disorder is when two people that are in an intimate relationship share delusions. These delusions stem from close emotional ties to a mentally unstable person that is greatly delusioned. Usually the two people involved in this type of situation are isolated and most likely in an actively romanticly relationship.

When a person loses touch with reality and mistakes things to be real, doctors call this psychosis. Psychosis comes along with delusions and hallucinations that lead to paranoia and a false sense of reality. Although it is widely believed to be a mental illness, psychosis is actually a symptom for other psychotic disorders. This symptom can be caused by intense stress or intense physical abuse. Different types of psychotic disorders include shared psychotic disorder, schizophrenia, and paraphrenia. About one percent of the world’s population suffers from a psychotic disorder. Younger demographics are mostly diagnosed with psychosis due to the under development of their brains. The brains of these young men and women can become easily manipulated since the brain is still developing. Addiction can also very easily consume a young adults mind.

Shared psychotic disorder can be described as “delusional symptoms in a partner of an individual with a delusional disorder.” A major factor of this shared psychotic disorder is a delusion that develops in an individual who is involved in a close relationship with another person who already has a psychotic disorder with prominent delusions. The person that develops these delusions is most commonly known as the inducer or the primary case.

The inducer can share their delusions to another person by interacting with them on an intimate and emotional level. Once the victim has spent so much time with the diagnosed, then it is possible for that person to take on the delusions that the primary case experiences. The inducer must be able to get inside the head of the victim, and if the victim is especially weak minded, then the delusions that occur could induce greater effects.

There have been several case studies written that involve shared psychosis. One in particular reads about a mother, a 45-year-old divorced female, that was admitted into a psychiatry hospital. She was brought to hospital by her sisters, brothers, and nephews. Her daughter came with her mother, and both were blaming their relatives for forceful psychiatric consultation, which means that they feel like their family forced them to get psychiatric help. Neither patient left the other’s side the entire duration of their stay.

According to documents given by the relatives, the mother had had her first episode of psychosis at the age of 20. At the onset, she held delusions of persecution against her sisters and believed the reason was that her sisters were jealous of her beauty. Meanwhile, the mother took treatment on and off from a psychiatrist and was diagnosed with paranoid schizophrenia for the next 12 years. Electro-convulsive therapy was also given, although complete documentation was not available. The mother married at the age of 25, and had divorced at 28 due to extremely frequent conflicts between the couple.

Since then, the mother had been living with her daughter at the mother's home. Since her separation from her husband, she believes that there is a man (who actually helped as an inter-mediator in solving the divorce terms between the couple, but never saw her again) in her ex-husband's city who wants to marry her and is ready to accept her with her daughter. She believes that it is her family members, who don't let this man meet her and that the family members want to declare her mentally ill, so that this imaginary man will not marry her. Six months back, the mother discontinued her treatment and for the 3 months after her discontinuation of treatment, she confided her daughter and herself to home, and threatened her own mother to leave the home. She had no contact with any other family members since then; she did not even allow her daughter to attend her school, as she thought that the family members may harm her daughter too.

The daughter who is 17-year-old, also held the same belief for those 3 months. According to her, the man came to her school 3 months back and gave his name as her father's name in school documents (which was actually given by her mother). She also believes that this man came over to her school multiple times in past 1 year, but she could never meet him because of the relatives, who along with her teachers conspired against them and never let them meet. One week back, the duo went to the city, they believed the man lives in and started searching for him for days. The family members searched for them and found them wandering here and there in shaggy unwashed clothes, no slippers, and not taken proper meal in past 2 days. That is when the family members brought them to psychiatrist for treatment. This is a prime example of the shared psychotic disorder.

There is not a specific test or exam that will diagnose folie á deux, but psychiatrists are able to recognize shared psychosis if the person spends time isolated with someone that is psychotic or the delusions are on the same level with another person’s delusions. Another determinant that helps to diagnose patients with folie á deux is when a person suffers self-isolation and only maintains close social contact with one other person. This helps the patient to lose their grasp on reality, and take on the delusions induced by psychosis as reality.

This type of psychosis mostly affects the nervous system. Any type of psychosis that occurs is due to lack of communication in the brain. According to MedicalNewsToday, a new study is being undergone that may help to predict which people are more vulnerable to developing psychosis. At first, scientists used modern imaging to allow them to view the volume of gray matter in the brain. They believed this change in gray matter throughout the brain could help with predicting someone’s vulnerability to psychosis, but changes in this gray matter could also be seen in people prior to psychosis beginning, during onset, or after psychosis has begun. This leaves that method to be unreliable.

Researchers from the University of Basel in Switzerland focused on this issue of predicting psychosis. Drs. Andre Schmidt and Lena Palaniyappan focused on the anatomy of the brain as a whole in order to predict psychosis. They took a different approach to this and started looking at the surface of the brain, also known as the cortex. Lumps and bumps are formed on top of the brain to form the cortex. This process of forming the cortex is called gyrification. Gyrification is an important process of the brain; when gyrification is interrupted or an error occurs, conditions such as schizophrenia and other mental disorders have greater possibility of occurring. Since psychosis is due to lack of communication in the brain, these doctors decided to look at the way the gyri communicate amongst themselves.

The team hypothesized that if they found enough differences in cortical communication within the gyri, they could possibly make an early diagnosis of psychosis. The doctors tested this method on about 160 patients. Of these patients, they predicted that 44 were healthy, 38 had already experienced their first psychotic episode, and 79 were at high risk of developing acute psychosis. Of the 79 that were predicted to be at high risk of developing acute psychosis, 16 went on to actually develop acute psychosis. These results show that examining gyri will provide a better understanding of psychosis so that a diagnosis can be provided earlier in the process, which is an alternative screening solution..

To further investigate communication between gyri, they used MRI scans to take a closer look into the gyri. Using the MRI scans, they were able to “reconstruct” the nerve pathways of the brain to provide a clearer blueprint of how gyri communication occurs. Dr. Schmidt and his partner came to the conclusion that the formation of gyri varies when the brain of a healthy person is compared to the brain of someone who has gone through a psychotic episode. When the first episode brains were compared with the individuals who developed acute psychosis, there was a reduction in integration and increased segregation between gyri. The doctors concluded, “These findings suggest that there is poor integration in the coordinated development of cortical folding in patients who develop psychosis.”

There are also different sub-classifications of folie á deux. There is folie imposée as well as folie simultaneé. Folie imposée is where a dominant person (known as the ‘primary’) initially forms a delusional belief during a psychotic episode and imposes it on another person or persons (known as the ‘secondary’) with the assumption that the secondary person might not have become deluded if left to his or her own devices. If the parties are admitted to hospital separately, then the delusions in the person with the induced beliefs usually resolve without the need of medication. Folie simultanée describes either the situation where two people that suffer independently from psychosis influence the content of each other's delusions so they become identical or extremely similar, or one in which two people 'morbidly predisposed' to delusional psychosis mutually trigger symptoms in each other.

Shared psychotic disorder can also occur amongst a group of people. The name for these different situations is in accordance to how the French count. For example, folie a deux refers to a shared psychotic disorder shared between two people, while folie a tre is between three people, and so on. The type and extremity of the delusions that occur amongst a group of people compared to two individuals are too different. The only factor that can really cause a difference between the two situations is the type of delusion that the primary is suffering from as well as the level of belief that the inducer is able to instill into the secondaries.