Year : 2011  |  Volume : 53  |  Issue : 4  |  Page : 372--373

Folie `a famillie in a family multiply affected with schizophrenia


Ivan Netto1, Nilesh Shah2,  
1 Consultant Psychiatrist, Parmar Plaza Clinic, Fatimanagar, Pune, India
2 Department of Psychiatry, L. T. M. Medical College and General Hospital, Sion, Mumbai, Maharashtra, India

Correspondence Address:
Ivan Netto
Consultant Psychiatrist, Parmar Plaza Clinic, Fatimanagar, Pune
India




How to cite this article:
Netto I, Shah N. Folie `a famillie in a family multiply affected with schizophrenia.Indian J Psychiatry 2011;53:372-373


How to cite this URL:
Netto I, Shah N. Folie `a famillie in a family multiply affected with schizophrenia. Indian J Psychiatry [serial online] 2011 [cited 2021 Oct 22 ];53:372-373
Available from: https://www.indianjpsychiatry.org/text.asp?2011/53/4/372/91916


Full Text

Sir,

Induced delusional disorder (IDD) or Folie `a deux includes several syndromes in which mental symptoms like paranoid delusions are transferred from one person to others so that they come to share the delusional ideas due to intimate association. Folie `a famille is said to be present when more than two members of the same family are involved. [1] Multiply affected families with schizophrenia are families containing at least two schizophrenic members who are first- or second-degree relatives, where the diagnosis of schizophrenia is confirmed. [2]

A certain family staying together consisted of a 60-year-old father (F), 57-year-old mother (M) and three daughters (D1, 25 years; D2, 23 years; and D3, 21 years). F and M had a non-consanguineous marriage. M, D1, and D3 were diagnosed cases of schizophrenia. M had shown considerable improvement with treatment, but D1 and D3 had not shown improvement. D2 had schizoid and dependant personality traits, but never showed any evidence of psychosis. F had developed a paranoid psychosis which was difficult to classify as he was uncooperative for evaluation.

F developed persecutory delusions that his wife and daughters would be kidnapped and raped. F slowly dissuaded relatives from coming to meet his family, changed his house, and finally lost contact with his relatives. They moved to a new locality and were isolated from the neighbors. F kept M, D1, D2, and D3 locked up at home for nearly 7 years. M and D2 gradually began to accept that their lives were in danger, and hence remained indoors. The insight and judgment of D1 and D3 were severely lacking due to untreated schizophrenia, so they followed the orders of F.

After much planning and psycho-education, the police, social workers, and the neighbors stormed into the house when F had gone out and finally rescued M, D1, D2, and D3. They were dressed in rags and D3 was chained. The house was in a mess and emitted a foul odor as the doors and windows were shut.

A police case was lodged against F who was sent for a psychiatric evaluation, but he was lost to follow-up. M was sent to a shelter for battered women and D2 to a rehabilitation center. D1 was admitted to a mental hospital and D3 to a private psychiatric nursing home. They all improved with treatment.

F and M, D1, D2, and D3 were living in close proximity and in relative social isolation from their relatives and neighbors. F was the dominant person suffering from a paranoid psychosis. M, D1, D2, and D3 looked up to F and were dependent on him being the only male family member, "protector" and "bread winner" of the family. F was the "principal" who transferred his delusions to M and D2, "the associates," who came to share the delusions of F.

Folie `a deux or "insanity or psychosis of two" was first described by two French psychiatrists, Lasegue and Falret, in 1987. [3] Women are found to be predominant in the reported cases due to restricted social roles of women and the frequent caring role of women in relationships. [4]

This is a case of Folie `a famillie or IDD [International Classification of Diseases (ICD)-10 edition (code 24)] in a family multiply affected with schizophrenia. [5] It emphasizes the serious consequences of Folie `a famillie in a family multiply affected with schizophrenia. It describes the interplay of genetic and environmental factors in the causation and maintenance of mental illness. It highlights the role of team work in patient management, involving psychiatrists, social workers, police, and even common neighbors. It also stresses the importance of separation of members of a dysfunctional family and the reduction of the burden of care by distribution of care among different institutions.

References

1Enoch D, Ball H. Uncommon Psychiatric syndromes. Delhi: Viva Books Private Limited; 2001. p. 179-208.
2Griffiths TD, Sigmundsson T, Takei N, Rowe D, Murray RM. Neurological abnormalities in familial and sporadic schizophrenia. Brain 1998;121:191-203.
3Lasegue C, Falret J. La Folie `a deux. Ann Med Psychol 1877;18:321.
4Gralnick, A. Folie `a deux: The psychosis of association: A review of 103 cases in the English literature. Psychchiatr Q 1942;16:230.
5The ICD -10 Classification of Mental and Behavioral Disorders. Geneva: World Health Organization; 1992.