A Family in Delusion: Shared Psychotic Disorder An Interaction of Delusion and Beliefs: A Case Report

Abstract

Introduction: Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognising what is real and what is not. Shared psychosis (previously termed folie à deux) is now considered a subset of delusional disorder. It is a rare disorder that usually occurs in a person or group of people (usually a family) who are related to a person with a significant delusional disorder. Aim: The aim of this case report is to illuminate the understanding and presentations of shared psychotic disorder in the Indian context with respect to a strong community belief around religious and superstitious explanations of the illness. Case description: Pt MK age 32, was presented with complaints of self-muttering, inappropriate behaviour, wandering tendencies, poor self-hygiene, episodes of loss of consciousness and social withdrawal. Discussion: Shared psychotic disorder is a rare psychotic disorder that evolves through interaction between individuals who have genetic predispositions to psychosis and have close emotional and physical bonds with delusional individuals. In this case the patient’s family members [father, mother, younger brother, elder sister, and aunt] also have a history of the same. According to the informant (elder brother), he mentioned that the family made her sit in the temple when she was in a state of possession and people from her village along with the neighbouring villages came to seek blessings from her. The patient also developed complaints of self-muttering, wandering tendencies, poor self-hygiene, episodes of loss of consciousness and social withdrawal. The patient and the family have visited many faith healers before visiting the psychiatry department, pertaining to the traditional linkages of psychosis to religious and spiritual aspects. In this case, pharmacotherapy was initiated, along with psychoeducation for the family to challenge their beliefs and reinforce reality-based thinking. Cognitive-behavioural therapy (CBT) was initiated to improve reality orientation, cognitive restructuring, social engagement and family therapy sessions aimed at reducing the emotional reinforcement of delusions.