Depression Presenting as Folie a Deux : an Atypical Presentation

Folie a deux is characterised by the appearance of delusions in a patient due to a close relationship with another person who already has similar delusions. Folie imposee the commonest clinical form-is more common in women and is frequently seen between two sisters (Gralnick. 1942). We want to share our experience regarding a case of folie a deux in two elderly, widowed sisters, who lived together and supported themselves by selling vegetables. The elder sister had 2 grown up children who lived elsewhere, while the younger sister was issueless. While building a Kucha house, their money finished before the completion of the construction, following which their problems began. Initially the elder sister began worrying over trivial matters, which slowly progressed into a full blown depressive episode with psychotic features, characterised by persecutory delusions against certain neighbours. Within a few days the younger sister also developed similar features along with identical persecutory delusions. Neither of them had any past history of psychiatric illness nor any family history. Both required admission. The elder sister responded well to imipramine (maximum dose 150 mg/day) and got discharged within 4 weeks, while the younger sister required antipsychotic along with antidepressants, and still relapsed despite being compliant to treatment, and had to be readmitted, and was given 7 E.C.Ts.