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Diseases & Conditions

Psychotic Disorder

What is a psychotic disorder?

A psychotic disorder is a mental illness that causes abnormal thinking and perceptions. Psychotic illnesses alter a person’s ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. People with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life.

The most obvious symptoms of a psychotic disorder are hallucinations and delusions. Hallucinations are sensory perceptions of things that aren’t actually present, such as hearing voices, seeing things that aren’t there, or feeling sensations on the skin even though nothing is touching the body. Delusions are false beliefs that the person refuses to give up, even in the face of contradictory facts. Schizophrenia is an example of a psychotic disorder.

What is shared psychotic disorder?

Shared psychotic disorder is also known as folie a deux ("the folly of two"). It is a rare condition in which an otherwise healthy person (secondary case) shares the delusions of a person with a psychotic disorder (primary case), such as schizophrenia, who has well-established delusions. For example: A person with a psychotic disorder believes aliens are spying on him or her. The person with shared psychotic disorder will also begin to believe in spying aliens. The delusions are induced in the secondary case and usually disappear when the people are separated. Aside from the delusions, the thoughts and behavior of the secondary case usually are fairly normal.

This disorder usually occurs only in long-term relationships in which one person is dominant and the other is passive. In most cases, the person in whom the delusions are induced is dependent on or submissive to the person with the psychotic disorder. The people involved often are reclusive or otherwise isolated from society and have close emotional links with each other. The disorder also can occur in groups of individuals who are closely involved with a person who has a psychotic disorder.

What are the symptoms of shared psychotic disorder?

The person with shared psychotic disorder has delusions that are similar to those of someone close who has a psychotic disorder.

What causes shared psychotic disorder?

The cause of shared psychotic disorder is not known; however, stress and social isolation are believed to play roles in its development.

How common is shared psychotic disorder?

The true frequency of occurrence is unknown, but shared psychotic disorder is rarely seen in clinical settings, such as hospitals, outpatient clinics, or doctors’ offices. In many cases, only one of the affected individuals seeks treatment, making a diagnosis of shared psychotic disorder difficult. As a result, many cases might go undetected.

How is shared psychotic disorder diagnosed?

If symptoms are present, the doctor will perform a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose shared psychotic disorder, the doctor might use various diagnostic tests—such as X-rays or blood tests—to rule out physical illness or a drug reaction as the cause of the delusions.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder.

The doctor or therapist bases his or her diagnosis on the person’s report of symptoms and his or her observation of the person’s attitude and behavior. The doctor or therapist then determines if the person’s symptoms point to a specific disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which is published by the American Psychiatric Association and is the standard reference book for recognized mental illnesses. According to the DSM-IV, shared psychotic disorder occurs when a person develops a delusion as the result of a close association with another person who has an already-established delusion.

How is shared psychotic disorder treated?

The goal of treatment is to relieve the secondary case of the induced delusion and stabilize the primary person’s psychotic disorder. In most cases, treatment involves separating the secondary case from the primary case. Other approaches might be necessary if separation is not possible.

Treatment options for the person with shared psychotic disorder might include the following:

  • Psychotherapy — Psychotherapy (a type of counseling) can help the person with shared psychotic disorder recognize the delusion and correct the underlying thinking that has become distorted. It also can address relationship issues and any emotional effects of a short-term separation from the person with a psychotic disorder.
  • Family therapy — Family therapy might focus on increasing exposure to outside activities and interests, as well as the development of social supports, to decrease isolation and help prevent relapse. Family therapy also might help to improve communication and family dynamics.
  • Medication — Short-term treatment with anti-psychotic medication might be used if the delusions do not resolve after separation from the primary case. In addition, tranquilizers or sedative agents such as lorazepam (Ativan) or diazepam (Valium) can help alleviate intense symptoms that might be associated with the disorder. These symptoms include anxiety (nervousness), agitation (extreme restlessness), or insomnia (inability to sleep).

What are the complications of shared psychotic disorder?

Left untreated, shared psychotic disorder can become chronic (ongoing).

What is the outlook for people with shared psychotic disorder?

With treatment, a person with shared psychotic disorder has a good chance for recovery.

Can shared psychotic disorder be prevented?

Because the cause is unknown, there is no known way to prevent shared psychotic disorder. However, early diagnosis and treatment can help decrease the disruption to the person’s life, family, and friendships.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/8/2009...#9601