Treatment for Shared Delusional Disorder
The primary treatment for shared delusional disorder involves separation of the individuals involved, combined with antipsychotic medication for the primary (inducer) patient and potentially for the secondary (induced) patient if symptoms persist after separation.
Understanding Shared Delusional Disorder
- Shared delusional disorder (folie à deux) is a rare condition where a delusion is transmitted from one person (primary/inducer) who has an established psychotic disorder to another person or persons (secondary/induced) 1
- It can occur in various forms including folie à deux (between two people), folie à trois (three people), or folie à famille (within a family) 2, 3
- Risk factors include relative isolation, close emotional bonds, and genetic predisposition 1, 3
Treatment Approach
First-Line Interventions
- Separation of the individuals is considered the foundation of treatment to break the pathological relationship dynamic 1
- The primary (inducer) patient should receive appropriate antipsychotic medication to treat their underlying psychotic disorder 1, 3
- For the secondary (induced) patient, separation alone may be sufficient to resolve delusions in some cases 1
Pharmacological Management
- Antipsychotic medications are the mainstay of treatment for the primary patient based on their underlying disorder (typically schizophrenia or delusional disorder) 3
- For secondary patients who continue to exhibit symptoms after separation, antipsychotic medication may also be necessary 3
- Case reports have documented successful treatment using medications such as aripiprazole for induced patients with persistent symptoms 3
Psychotherapeutic Interventions
- Supportive psychotherapy may be beneficial for both primary and secondary patients 4
- Cognitive-behavioral therapy (CBT) has shown some promise in treating delusional disorders, though evidence specifically for shared delusional disorder is limited 4
Special Considerations
Risk Assessment
- Careful evaluation of the relationship dynamics is essential before implementing separation, as abrupt separation may lead to adverse outcomes in some cases 5
- One case report documented a fatal outcome following separation of two sisters with shared delusions, highlighting the need for careful monitoring during treatment 5
Treatment Settings
- Inpatient psychiatric treatment may be necessary, especially for the primary patient 2
- Community-based rehabilitation programs with regular psychiatric follow-up can be beneficial for long-term management 5
Monitoring and Follow-up
- Regular psychiatric follow-up is essential for both patients 5, 3
- Monitor for anxiety and agitation in both patients following separation, as these symptoms may worsen initially 5
- Assess for improvement in delusional thinking and functional status to guide ongoing treatment decisions 3
Evidence Limitations
- There is a paucity of high-quality randomized controlled trials specifically for shared delusional disorder 4
- Most treatment recommendations are based on case reports and clinical experience rather than controlled studies 4, 1
- Further research is needed to establish evidence-based treatment guidelines for this rare condition 4
Treatment Outcomes
- With appropriate treatment, the prognosis for secondary (induced) patients is generally favorable, especially when separation and treatment are implemented early 1, 3
- The primary patient's outcome depends largely on the nature and treatment response of their underlying psychotic disorder 1
- Social rehabilitation and reintegration should be part of the long-term treatment plan for both patients 5, 3