Am J Gerontol Geriatr | Volume 1, Issue 2 | Case Report | Open Access

Complex Folie a Deux Related to Multiple Biopsychosocial Factors for an Elderly Patient and his Wife

Detweiler MB1,2*, Detweiler JG1 and Bader GM1,3

1Department of Psychiatry, Veterans Affairs Medical Center, USA
2Department of Psychiatry, Edward via College of Osteopathic Medicine, USA
3Department of Psychiatry, Virginia Tech-Carilion Psychiatry Residency Program, USA

*Correspondance to: Detweiler MB 

Fulltext PDF


The elderly frequently present to clinic with a complicated biopsychosocial picture requiring careful attention to each major contributing component of the triad. A relatively infrequent case of folie a deux in an elderly couple is presented. The unusual aspect is that the psychiatric phenomena were precipitated by metabolic factors initiated by diabetes mellitus. The progressing diabetes mellitus contributed to severe diabetic retinopathy with legal blindness, end-stage renal disease, advanced peripheral neuropathy and vascular dementia. These medical complications resulted in severe paranoid ideations in addition to visual, auditory and tactile hallucinations that had been ongoing for an indeterminate period of time prior to the patient arriving in our mental health clinic. The resultant folie a deux had isolated the couple from family and society leaving the patient’s wife to coexist in her husband’s world of believing that the hospital had placed a computer chip in his head which rendered him an agent of world saboteurs that shocked him and sent insects and snakes to bite him when he did not obey their commands. Despite the wife’s shared the delusional world of her husband’s severe psychosis, she was able to faithfully follow the treatment plan. This case illustrates the effectiveness of aggressive psychiatric medication management coupled with proactive social support and ongoing couple education.


Detweiler MB, Detweiler JG, Bader GM. Complex Folie a Deux Related to Multiple Biopsychosocial Factors for an Elderly Patient and his Wife. Am J Gerentol Geriatr. 2018; 1(2): 1008.

Subscribe to Our Newsletter