Trouble psychotique partagé ou trouble délirant induit ? Étude d’un cas clinique - 22/04/21
Shared psychotic disorder or induced delusional disorder? A case report
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Résumé |
Le trouble délirant induit (CIM 10) ou trouble psychotique partagé (DSM-IV) est un trouble à part entière décrit depuis le XIXe siècle. Il s’agit d’un trouble psychotique au cours duquel un des sujets, dit inducteur, propage son délire à une autre personne, souvent plus vulnérable, dite induite. Ce trouble rare a fait l’objet de nombreuses publications à son sujet, divisant à la fois sur son épidémiologie, ses critères diagnostiques, et le traitement spécifique à proposer. Les deux définitions récentes issues des classifications actuelles peuvent d’ailleurs illustrer cette dichotomie sur certains critères, au-delà de la sémantique même qui oppose ici les termes « délirant induit » et « psychose partagée ». De plus, ce trouble a la particularité de questionner sur sa réelle existence puisqu’elle est remise en cause actuellement dans les nouvelles classifications du DSM-5 et de la CIM-11. Pourtant, ce trouble continue d’être observé. Quel avenir imaginer alors pour cette pathologie ? À travers le cas clinique d’un « délire à deux » concernant deux personnes issues de deux familles différentes partageant un délire de filiation, nous avons étudié les enjeux actuels autour de ce trouble. Nous avons effectué pour cela une revue récente de la littérature.
Le texte complet de cet article est disponible en PDF.Abstract |
Can a delusional idea be contagious? This question may seem paradoxical when we know that the very definition of delirium correspond to “an erroneous belief (…) maintained despite the very generally shared opinion” (DSM4) and so implies that peers do not share the beliefs expressed by the subject. However, cases of collective delirium have been described for many years, and have been the subject of numerous scientific publications since the 19th century. Among them, an entity emerged : “folie à deux”, in which a primary active subject could induce his delusions to a secondary subject, more vulnerable, said induced and passive. In 1877, Lasègue and Falret first introduced the term “folie à deux” and proposed the diagnostic criteria. They describe nine essential criteria among which, three would be the sine qua non conditions that can allow the outbreak of a delirium shared by two. They are the presence of an active element of superior intelligence, the existence of a common life between the two individuals, sufficiently long and intimate and a “closed and isolated” environment. These criteria were subsequently supplemented to arrive at the current definitions of induced delusional disorder (ICD10) and shared psychotic disorder (DSM4). This rare disorder has been the subject of numerous publications. However, these publications were often divided over both its epidemiology, its diagnostic criteria, and the specific treatment to be offered. The two recent definitions resulting from current classifications can also illustrate this dichotomy on certain criteria, beyond the very semantics which here oppose the terms “induced delusional” and “shared psychosis”. Moreover, this disorder has the particularity to question its real existence as it is currently challenged in the new classifications of the DSM V and ICD 11. We can therefore see that if the subject fascinates, it divides. What is it really? Can a delirium really be transmitted? Can a psychosis really be shared? And if so, is one of the two definitions more suitable to describe this disorder? What future can we imagine for this pathology? During the hospitalization of a patient for a “délire à deux”, concerning two persons from two different families sharing a delirium of filiation, we observed the current issues around this disorder and we asked ourselves which treatment to administer to these patients. The hospitalization took place over two stages: the first stage to understand the disorder, the second one to treat it. À family interview was conducted in the presence of the dyad of patients, to explore the interactional elements together, and establish the diagnosis. A preliminary step essential to therapeutic work on the question of loyalty and differentiation. This clinical case recalls the value of an integrated approach based on the systemic epistemology, both for the diagnostic phase than during therapeutic support. The objective of this work is to study, through an atypical clinical case and a review of recent literature, the different diagnostic, therapeutic and evolutionary perspectives of this particular pathology.
Le texte complet de cet article est disponible en PDF.Mots clés : Délire à deux, Délire de filiation, Folie à deux, Trouble délirant induit, Trouble psychotique partagé
Keywords : “folie à deux”, Filiation delirium, Induced delusional disorder, Shared psychotic disorder
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