Cancer and folie a deux - Case report, treatment, and implications

PURPOSE: This report describes the uncommon psychopathological state best k nown as folie a dem, or shared psychotic disorder, in a unique case in whic h the grandiose, religious delusions of a woman with uterine cancer are sha red with her husband. OVERVIEW: More than 50% of patients with cancer meet the criteria for diagn osis of major psychiatric disorders. Certainly, these disorders may occur a s a result of the stress of the cancer diagnosis and treatment, but also be cause of a predisposition to psychiatric illness or a pre-existing psychiat ric illness. In the medical setting, the phenomenon of folie A deux poses s ignificant problems not only for the patient, but also for the involved fam ily member, psychiatric consultant, and healthcare team. CLINICAL IMPLICATIONS: in this case, the patient's delusional system had a grave impact on her ability to make rational healthcare decisions, for whic h she was deemed incompetent. The first choice for her healthcare surrogate , her husband, was so affected by his sharing of her psychotic condition th at he could not fulfill this role. In assessing a suspected case of folie a deux, awareness of several issues-the point at which religious overideatio n becomes delusional, the spectrum of competency, informed consent, and tre atment refusal-is important.