Symbiotic psychosis is a rare mental health problem where two or more people who are very close to each other share the same strange belief (delusion). One person usually has a true psychotic illness first, and the other person “catches” the belief because of the very close and dependent relationship.ncbi.nlm.nih.gov+2Psych Central+2
Symbiotic psychosis is an older name for what is now usually called shared psychotic disorder, folie à deux, or induced delusional disorder. In this condition, one person has a real psychotic illness with strong, fixed false beliefs (delusions). A second person, who is very emotionally attached and often lives very close to them, slowly starts to believe the same delusions, even though they did not have a psychotic illness before. Modern systems such as DSM-IV and ICD-10 describe this as a shared or induced delusional disorder, and DSM-5 asks doctors to diagnose it under delusional or other psychotic disorders rather than as a separate disease. Wikipedia+1
In many reports, symbiotic psychosis is seen in couples, close family members, or a mother and child who are almost always together and cut off from other people. Their strong emotional bond and isolation make it easier for the delusion to spread between them.The Guardian+3PubMed+3Lippincott Journals+3
Psychosis itself means a loss of touch with reality. The person may have delusions (fixed false beliefs) or hallucinations (seeing or hearing things that others do not see or hear). In symbiotic psychosis, two people share the same false belief, and both feel sure it is 100% true, even when there is clear evidence against it.ncbi.nlm.nih.gov+1
Other names and related terms
Symbiotic psychosis is closely related to a condition called folie à deux, a French term that means “madness of two.” This is also called shared psychotic disorder, shared psychosis, or shared delusional disorder in older diagnostic systems.Wikipedia+2ncbi.nlm.nih.gov+2
In the past, psychiatrists also used the term induced delusional disorder for this problem. In the ICD-10 classification, this is listed as F24 – Induced delusional disorder, where delusions are shared between people with close emotional ties.icd.who.int+2medentic.app+2
The word symbiotic highlights the very close and dependent relationship. In child psychiatry, “symbiotic infantile psychosis” or “symbiotic child psychosis” is used for severe early psychosis linked to a tight mother–infant relationship.Lippincott Journals+3APA Dictionary+3ScienceDirect+3
Some writers also talk about folie à famille (madness in a family) when the shared delusion involves several family members, and folie à plusieurs (madness of many) for larger groups. These are all related ideas where delusions spread within a very close and often isolated group.Wikipedia+2Cureus+2
Types of symbiotic psychosis
1. Symbiotic child psychosis
This type describes severe early psychosis in a small child, deeply linked with the mother–infant bond. The child and mother can seem almost like one emotional unit, and separation is very difficult. The child may show disturbed behavior, language problems, and poor contact with the outside world.ScienceDirect+2Taylor & Francis Online+2
2. Symbiotic couple psychosis
Here, a married couple or partners live in a very close, isolated way and share the same delusional ideas. Often, one partner has long-standing schizophrenia or a delusional disorder, and the other partner slowly adopts the same belief. Case reports describe couples developing shared jealousy or persecution delusions that strongly shape their lives.Psychiatrist.com+3PubMed+3Europe PMC+3
3. Folie imposée (imposed psychosis)
In this classic type, one person (the “primary”) already has a psychotic disorder. This person strongly influences a second person (the “secondary”), who was mentally healthier before. The secondary person takes on the same delusion. When the two people are separated, the induced person often loses the delusional belief.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
4. Folie simultanée (simultaneous psychosis)
In this pattern, both people have their own psychotic vulnerability from the start. Their illnesses develop around the same time, and because they are close, their delusions become very similar or almost identical. It is more like two psychoses growing together rather than one “infecting” the other.Wikipedia+2Psychiatrist.com+2
5. Folie communiquée (communicated psychosis)
In folie communiquée, the secondary person first resists the primary person’s delusion for some time. After long exposure and strong emotional pressure, the secondary person eventually accepts and shares the delusion. The delay and slow transmission are key features.Psychiatrist.com+1
6. Folie induite (induced psychosis)
In this pattern, both people already have psychotic illnesses, but one person’s delusion “adds on” to the other person’s existing delusional system. Over time their beliefs mix and become more complex, with elements borrowed from each other.Psychiatrist.com+2ncbi.nlm.nih.gov+2
Causes of symbiotic psychosis
Remember: these are risk factors and background causes. Doctors usually find several of them together, not just one.
1. Primary psychotic disorders in the leading person
Often, the first cause is a psychotic disorder like schizophrenia, schizoaffective disorder, or chronic delusional disorder in the “primary” person. This person’s fixed false beliefs become the center of the shared psychosis.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
2. Bipolar disorder with psychosis
In some cases, the primary person has bipolar disorder with psychotic features during severe mood episodes. Their grandiose or paranoid beliefs can be passed to a very close partner or family member who depends on them.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
3. Severe depression with psychotic features
People with very severe depression can develop psychotic beliefs, such as strong guilt or hopelessness that is not based in reality. A close caregiver or partner may start to agree with these false ideas, especially in a stressed, isolated home.ncbi.nlm.nih.gov+2MD Searchlight+2
4. Long-term intense emotional dependence
A very strong, almost “fused” emotional bond, where one person is extremely dependent on the other, is a major risk. The dependent person may trust the other so deeply that they stop checking facts with anyone else and simply accept the delusion.ncbi.nlm.nih.gov+2Wiley Online Library+2
5. Social isolation from other people
Living alone together, avoiding friends and relatives, or being in a remote area can remove healthy outside opinions. Without fresh views, the shared delusion can grow stronger and never be challenged.ncbi.nlm.nih.gov+2Psych Central+2
6. Personality traits in the primary person
Some people with paranoid, controlling, or narcissistic personality traits may be more likely to strongly push their beliefs onto others. In the presence of underlying psychosis, these traits can make the secondary person feel they must agree.ncbi.nlm.nih.gov+2pep-web.org+2
7. Personality traits in the secondary person
The induced person is often described as suggestible, passive, anxious, or with low self-confidence. They may feel safer by agreeing with the stronger person and may fear being alone or abandoned if they disagree.ncbi.nlm.nih.gov+2Wiley Online Library+2
8. Cognitive problems or brain disease in the secondary person
Older age, dementia, brain injury, or learning disability can make someone less able to question strange beliefs. This can make them more vulnerable to “catching” the psychosis from a partner.PubMed+2Psychiatrist.com+2
9. Childhood trauma and insecure attachment
People with a history of neglect, abuse, or very insecure early relationships may cling strongly to a later partner or caregiver. This deep need for safety can make them accept unhealthy beliefs to keep the relationship.pep-web.org+2Wiley Online Library+2
10. Shared stressful life events
Hard life situations, such as job loss, migration, war, debt, or legal conflict, increase general stress. Two people under high stress, who already feel cut off from others, may form shared persecutory or conspiracy-type delusions as a way to explain their problems.ncbi.nlm.nih.gov+2Wiley Online Library+2
11. Poverty and poor living conditions
Long-term poverty can limit access to health care, education, and supportive social networks. This can delay help for the primary psychosis and allow shared delusional ideas to grow unchecked.Wiley Online Library+2Rupa Health+2
12. Strong cultural or religious belief systems misused by illness
Healthy beliefs are not a problem by themselves. But when psychosis twists cultural or religious ideas into extreme, rigid forms, a close partner who shares the same tradition may more easily accept the delusion as “faith” or “duty.”ncbi.nlm.nih.gov+2Right Decisions+2
13. Substance use and substance-induced psychosis
Alcohol, stimulants, hallucinogens, and some other drugs can trigger psychosis in vulnerable people. When this happens in a tightly bonded couple or family, the secondary person may adopt the drug-induced delusion of the primary person.Dr.Oracle+3ncbi.nlm.nih.gov+3Right Decisions+3
14. Medical and neurological illnesses
Conditions like epilepsy, brain tumors, infections of the brain, thyroid disease, or severe metabolic problems can sometimes cause psychotic symptoms. If one person in a close pair develops such a condition, the other may take on their delusional ideas rather than seeing them as illness.ncbi.nlm.nih.gov+3PubMed+3ncbi.nlm.nih.gov+3
15. Postpartum period (after childbirth)
After birth, some people develop postpartum psychosis, a severe and sudden mental health emergency. If the parent with postpartum psychosis and another close family member are very isolated and stressed, the other person can start sharing the delusional beliefs about the baby or the outside world.ncbi.nlm.nih.gov+1
16. Stopping or not taking prescribed psychiatric medicines
When a person with a psychotic disorder stops their medicine suddenly or does not take it correctly, their delusions can return or become stronger. In a symbiotic relationship, stronger delusions increase the risk that the partner will adopt them too.ncbi.nlm.nih.gov+2MD Searchlight+2
17. Long-term untreated psychosis
If psychosis is not treated early, delusions may become very fixed and detailed over years. In that long time, the partner or family member hears the same story again and again, which can slowly pull them into the same false belief.PubMed+2EPI-NC+2
18. Lack of mental health knowledge
If people have little information about mental illness, hallucinations and delusions may be misunderstood as “special messages,” “magic,” or “absolute truth.” Without understanding psychosis, the secondary person is less likely to question or seek help.Right Decisions+2Rupa Health+2
19. Family history of psychotic disorders
Genetic vulnerability can make several family members more sensitive to stress and psychosis. In such families, a shared delusional system can form more easily when relatives live closely together and avoid outside contact.ncbi.nlm.nih.gov+2EPI-NC+2
20. Media or internet exposure that fits the delusion
Sometimes, online groups, forums, or media stories support unusual beliefs or conspiracy ideas. If a close pair already has mild suspicious thoughts, such content can strengthen a shared delusion and make it more rigid.Wiley Online Library+2Rupa Health+2
Symptoms of symbiotic psychosis
1. Shared fixed false belief (core symptom)
Both people strongly believe the same false idea, such as being watched, poisoned, followed, or specially chosen. The belief does not match reality, but they hold it without doubt and repeat it often.ncbi.nlm.nih.gov+2Psych Central+2
2. Very close, dependent relationship
The two people are almost always together and depend heavily on each other for emotional support and daily decisions. They may say that only the other person truly understands them.ncbi.nlm.nih.gov+2Wiley Online Library+2
3. Social withdrawal and isolation
They slowly cut off friends, relatives, and normal social life. They may stop going to work, school, or community activities and avoid anyone who questions their shared belief.ncbi.nlm.nih.gov+2Wiley Online Library+2
4. Suspiciousness and paranoia
Both partners can become very suspicious of neighbors, doctors, or authorities. They might think others are plotting against them, spying, or wanting to harm them, even without evidence.ncbi.nlm.nih.gov+2Psych Central+2
5. Hallucinations
The primary person, and sometimes the secondary person, may hear voices, see visions, or feel strange sensations that others do not experience. These hallucinations often seem to support their delusional story.ncbi.nlm.nih.gov+2MD Searchlight+2
6. Strong emotional reactions when challenged
If someone questions the shared belief, both people can become angry, frightened, or very defensive. They may refuse to talk about the topic or break contact with the person who doubts them.ncbi.nlm.nih.gov+2Wiley Online Library+2
7. Changes in daily behavior to match the delusion
They might change their home, job, finances, or routines based on the delusion. For example, they may move house to escape imaginary enemies or spend money on “protection” items that are not really needed.ncbi.nlm.nih.gov+2Cureus+2
8. Neglect of self-care
Over time, personal hygiene, diet, sleep, and medical care may be ignored. Basic tasks like bathing, cleaning, or taking medicines can be pushed aside while the delusion takes most of their time and energy.ncbi.nlm.nih.gov+2Right Decisions+2
9. Problems with thinking and speech
The primary person may show disorganized speech, jumping between topics or using odd logic. The secondary person might copy this way of talking when they discuss the shared belief.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
10. Anxiety and constant worry
Many people with shared psychosis feel tense and fearful. They may be always “on guard” and scanning for signs that match the delusion, such as watching for special signs, numbers, or gestures.ncbi.nlm.nih.gov+2Rupa Health+2
11. Depressed mood and loss of pleasure
Spending life in fear and isolation can lead to low mood, tiredness, and loss of interest in normal activities. They may feel hopeless but still cling tightly to the delusional explanation.ncbi.nlm.nih.gov+2MD Searchlight+2
12. Sleep problems
Trouble falling asleep, frequent waking, or staying up late to “watch out” for imagined threats are common. Poor sleep can worsen thinking problems and make delusions feel even more real.ncbi.nlm.nih.gov+2MD Searchlight+2
13. Poor insight (not seeing it as illness)
Both people usually believe that they are right and that the problem is other people, not themselves. They do not see their beliefs as symptoms of a mental health condition.ncbi.nlm.nih.gov+2Psych Central+2
14. Fear of separation from the other person
They may be extremely afraid of being split up, even for short periods. This fear can be so strong that they refuse hospital admission unless they can stay together.ncbi.nlm.nih.gov+2Wiley Online Library+2
15. Problems at work, school, or in the community
Because of the delusion and isolation, they may lose jobs, leave school, or have conflicts with neighbors and authorities. The shared psychosis affects almost all areas of daily life.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
Diagnostic tests for symbiotic psychosis
Doctors do not diagnose symbiotic psychosis with one simple blood test or scan. The main “test” is a careful talk (interview), mental health examination, and understanding of the relationship between the people. Other tests are used mainly to rule out physical causes of psychosis.Right Decisions+4PubMed+4ncbi.nlm.nih.gov+4
Physical examination tests
1. General physical examination
The doctor looks at the whole body: skin, eyes, heart, lungs, abdomen, and general appearance. This helps find signs of infection, malnutrition, organ disease, or drug use that might cause or worsen psychotic symptoms.Psychiatrist.com+2Right Decisions+2
2. Detailed neurological examination
Reflexes, muscle strength, movement, balance, and coordination are checked. Any abnormal findings may suggest brain or nerve disease, such as stroke, epilepsy, or other neurological problems that can present with psychosis.Psychiatrist.com+2PubMed+2
3. Vital signs assessment (pulse, blood pressure, temperature, breathing)
Abnormal vital signs can point to infection, drug intoxication, withdrawal, or metabolic problems. These conditions can mimic or worsen psychotic symptoms and need fast treatment.Psychiatrist.com+2Right Decisions+2
4. Nutritional status and weight check
Doctors look for weight loss, dehydration, or vitamin deficiency. People with long-term psychosis and isolation, like in symbiotic psychosis, may neglect food and self-care, which can harm brain function.ncbi.nlm.nih.gov+2MD Searchlight+2
Manual / clinical mental health tests
5. Detailed psychiatric interview
The psychiatrist asks about current symptoms, past mental health problems, family history, and life events. They also talk separately and together with both people to understand how the shared belief developed and how strong the bond is.ncbi.nlm.nih.gov+2PubMed+2
6. Mental status examination (MSE)
This is a structured way of observing appearance, mood, thought content, thought form, perception, and insight. The MSE helps identify delusions, hallucinations, disorganized thinking, and poor insight in each person.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
7. Assessment of relationship dynamics and family interview
Doctors often talk with family members or friends to understand the pattern of dependence and isolation. They look at who first had psychotic symptoms and how the other person came to share the belief.ncbi.nlm.nih.gov+2Cureus+2
8. Use of psychosis rating scales (for example, PANSS or BPRS)
Clinical rating scales such as the Positive and Negative Syndrome Scale (PANSS) or the Brief Psychiatric Rating Scale (BPRS) help measure severity of psychotic symptoms over time. They are not specific to symbiotic psychosis but help track progress with treatment.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
9. Cognitive screening tests (for example, MMSE or MoCA)
Simple paper-and-pencil tests can screen for memory and thinking problems. They are especially useful in older patients or those with suspected dementia, which can increase the risk of shared psychosis.PubMed+2Psychiatrist.com+2
10. Risk assessment for harm to self or others
Doctors carefully ask about any thoughts or plans of harming self or other people, and about past risky acts. This helps decide how urgent and intense the treatment and supervision should be, because untreated psychosis can sometimes lead to dangerous behavior.ncbi.nlm.nih.gov+2Psychiatrist.com+2
Laboratory and pathological tests
11. Complete blood count (CBC)
CBC checks red blood cells, white blood cells, and platelets. It can show anemia, infection, or some blood diseases that may affect brain function or be side effects of medicines used later.Dr.Oracle+3PubMed+3ncbi.nlm.nih.gov+3
12. Metabolic panel (electrolytes, kidney and liver function, glucose)
This group of tests looks at sodium, potassium, kidney and liver enzymes, and blood sugar. Abnormal results can cause confusion, mood changes, or psychosis-like symptoms and must be corrected as part of care.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
13. Thyroid function tests
Too much or too little thyroid hormone can affect mood and thinking and sometimes mimic psychosis. Testing helps rule out thyroid disease as a cause of symptoms.ncbi.nlm.nih.gov+2ncbi.nlm.nih.gov+2
14. Vitamin B12 and folate levels
Low levels of B12 or folate can cause confusion, memory problems, and behavior changes. Treating these deficiencies can improve mental symptoms and may reduce vulnerability to psychosis.ncbi.nlm.nih.gov+2Dr.Oracle+2
15. Urine and blood toxicology screen
These tests look for alcohol, street drugs, and sometimes certain medicines. Substance-induced psychosis must be distinguished from primary psychiatric illness and symbiotic psychosis.Right Decisions+2Dr.Oracle+2
16. Infectious and autoimmune screening (for example, HIV, syphilis, autoimmune markers)
In some patients, infections of the brain or autoimmune diseases can lead to psychosis. Screening tests help find these treatable medical causes early.Psychiatrist.com+2PubMed+2
Electrodiagnostic tests
17. Electroencephalogram (EEG)
EEG records brain electrical activity. It is used to check for seizures, certain types of encephalitis, or other brain disorders that can present with psychosis. While EEG is not specific for symbiotic psychosis, it helps rule out some important organic causes.mellanarkiv-offentlig.vgregion.se+2ResearchGate+2
18. Electrocardiogram (ECG)
ECG records the heart’s electrical activity. It is often done to check heart rhythm and general heart health, especially before starting some antipsychotic medicines that can affect the heart’s rhythm.ncbi.nlm.nih.gov+2MD Searchlight+2
Imaging tests
19. CT scan of the brain
A brain CT scan uses X-rays to show the structure of the brain. It is sometimes used in new-onset psychosis to look for tumors, bleeding, major strokes, or other clear structural problems. Many patients have normal scans, but the test can be important when certain warning signs are present.SAGE Journals+3eMedicine+3MDPI+3
20. MRI scan of the brain
MRI uses strong magnets to give more detailed images of the brain than CT. It helps rule out subtle structural causes of psychosis in selected cases. Like CT, MRI cannot “see” symbiotic psychosis itself, but it helps doctors be sure there is no hidden brain disease.SAGE Journals+3MDPI+3Cureus+3
Non-pharmacological treatments (therapies and other approaches)
Non-drug treatments are the heart of care in symbiotic psychosis. The main goals are to separate the people safely, reduce stress, help them understand the illness, and rebuild healthy thinking and relationships. Most guidance from case reports and reviews stresses that psychological and social interventions must go together with any medications. PMC+2Good Health Psych+2
1. Safe and gentle separation
The most important step is usually to separate the secondary person from the primary person in a calm, kind, and safe way. The purpose is to remove the constant pressure of hearing the delusional ideas all the time. When the secondary person is away from the inducer and has support from a care team, the shared delusions often become weaker or disappear. This works because the brain is no longer “fed” by the same repeated false messages. PMC+1
2. Psychoeducation for both people and the family
Psychoeducation means explaining the illness in clear, simple language to the affected people and their relatives. The purpose is to help everyone understand that psychosis is a medical problem, not a personal failure or a “curse.” Learning about symptoms, triggers, stress, sleep, and treatment options can reduce fear and blame. The mechanism is that good information can challenge mistaken ideas, build trust in doctors, and improve treatment follow-up. Harbor Psychiatry & Mental Health
3. Individual supportive therapy for the secondary person
The secondary person often feels confused, guilty, and frightened when they realize the shared belief was not true. Supportive therapy gives them a safe place to talk, express feelings, and rebuild a sense of self that is separate from the primary person. The goal is emotional stability and basic coping skills, not deep analysis at first. Over time, this support helps the brain relearn to test reality more carefully and to tolerate uncertainty. BetterHelp+1
4. Cognitive-behavioural therapy (CBT) for psychosis
CBT for psychosis uses gentle questioning to explore delusional beliefs, look for evidence for and against them, and build alternative explanations. The purpose is not to argue, but to help the person notice thinking habits like jumping to conclusions. The mechanism is that repeated practice in testing beliefs changes cognitive patterns, which can reduce distress even if some unusual ideas remain. Research in psychotic disorders shows CBT can reduce distress from delusions and improve functioning. Harbor Psychiatry & Mental Health
5. Family therapy and relationship work
Because symbiotic psychosis is built inside a close relationship, family-based work is very important. The purpose is to understand the pattern between family members, reduce over-dependence, and improve communication. Therapists help set healthy boundaries, support more equal roles, and reduce isolation from the outside world. This mechanism weakens the “closed system” where delusions grow and instead connects the family to broader, more realistic views. PMC+1
6. Social skills training and community support
Many people with shared psychosis are cut off from friends, school, or work. Social skills training and supported entry into groups (clubs, classes, support groups) help rebuild contact with others. The purpose is to fight isolation and create new, healthier relationships. The mechanism is simple: more varied, normal social feedback makes it harder for delusional ideas to stay strong and unquestioned. PMC+1
7. Stress-management and relaxation training
Stress can worsen psychotic symptoms. Teaching breathing exercises, muscle relaxation, mindfulness-style awareness, or simple body stretches can lower physical tension. The purpose is to give the person tools they can use every day when they feel afraid or overwhelmed. Lower stress hormones and calmer body signals make the brain less likely to jump to fearful explanations and may reduce the intensity of unusual experiences. BetterHelp
8. Sleep hygiene and daily routine support
Irregular sleep and chaotic daily routines often worsen symptoms in psychotic disorders. Building a regular pattern of waking, meals, activity, and bedtime is a basic but powerful therapy. The purpose is to stabilise the body clock and reduce confusion between dream-like states and waking reality. The mechanism is that stable sleep improves attention, mood, and reality-testing, which makes delusions easier to question. BetterHelp+1
9. Vocational and educational support
Returning to age-appropriate education or work, with support, helps rebuild identity outside the shared delusion. The purpose is to give the person a sense of competence and hope in ordinary life roles. The mechanism is that meaningful activity pulls attention away from the delusional world and provides natural rewards (achievement, social contact) that keep recovery going. Harbor Psychiatry & Mental Health
10. Crisis and safety planning
Because psychosis can sometimes lead to seriously unsafe situations, the care team often helps the person and family make a simple, clear crisis plan. This may include early warning signs, who to call, and how to reach emergency care. The goal is to act early before a situation becomes dangerous. The mechanism is that planning reduces panic, helps families respond in organised ways, and can prevent emergencies. BetterHelp+1
(Because of space, only ten key non-pharmacological options are described here, but in practice many small, everyday supports are also used.)
Drug treatments (medications)
There is no medicine that is approved only for “symbiotic psychosis.” Doctors usually treat the primary person according to guidelines for schizophrenia, schizoaffective disorder, or delusional disorder, and the secondary person if they keep strong psychotic symptoms after separation. Antipsychotic medicines (also called neuroleptics) are the main drugs, and their official U.S. product information is available on accessdata.fda.gov for conditions like schizophrenia and bipolar disorder. FDA Access Data+2FDA Access Data+2
Important note: Doses and timing must always be decided by a qualified clinician. The brief dose ranges below are general and based on adult label information, not personal advice, and may be very different for teenagers or people with other illnesses.
1. Risperidone (RISPERDAL, RISPERDAL CONSTA)
Risperidone is a second-generation antipsychotic that blocks dopamine D2 and serotonin 5-HT2 receptors. FDA labels describe it as effective for schizophrenia and bipolar mania. Many doctors also use it (often off-label) when strong delusions are present. Typical adult oral starting doses can be around 1–2 mg per day, slowly adjusted by a specialist. Common side effects include sleepiness, weight gain, movement problems, and raised prolactin (a hormone). Long-acting injections help people who struggle to take tablets regularly. FDA Access Data+2FDA Access Data+2
2. Olanzapine
Olanzapine is another second-generation antipsychotic used for schizophrenia and bipolar disorder. It works by blocking several brain receptors, including dopamine and serotonin, which reduces hallucinations and delusions over weeks. Adult doses are usually once daily and adjusted slowly by the psychiatrist. Its purpose in shared psychosis is to calm severe symptoms so psychological therapies can work. Weight gain, increased appetite, sleepiness, and changes in blood sugar and lipids are important side effects doctors must monitor carefully using blood tests and physical checks. Wikipedia+1
3. Quetiapine
Quetiapine is used for schizophrenia, bipolar disorder, and as an add-on in major depression. It has strong sedative and antipsychotic effects and is often given in divided doses that are slowly increased. In symbiotic psychosis, it may be chosen when anxiety, insomnia, and mood swings are also present. The mechanism includes blocking dopamine and serotonin receptors and calming over-active brain circuits. Common side effects are sleepiness, dizziness, dry mouth, and changes in weight and metabolism. Doctors check heart rhythm and metabolic health regularly. Wikipedia+1
4. Aripiprazole
Aripiprazole is sometimes called a “dopamine stabiliser” because it partially stimulates, rather than fully blocks, dopamine receptors. FDA labels cover schizophrenia in adults and adolescents, bipolar disorder, and some other indications. It may be used when a person needs antipsychotic treatment but is sensitive to sedation or weight gain from other drugs. Dosing is once daily and adjusted by the prescriber. Side effects may include restlessness, insomnia, nausea, and movement symptoms, so careful follow-up is needed. Wikipedia+1
5. Haloperidol
Haloperidol is an older, first-generation antipsychotic used for acute agitation and chronic psychosis. It strongly blocks dopamine D2 receptors. In emergencies, it can be given by injection in hospital; for ongoing treatment, tablets or liquid are used. Its purpose is rapid control of severe delusions, agitation, or aggression so that the person and others stay safe. Side effects can include stiffness, tremor, restlessness, and, rarely, serious movement disorders, so it is usually used at the lowest effective dose for the shortest necessary time. Wikipedia+1
6. Clozapine
Clozapine is a powerful second-generation antipsychotic for treatment-resistant schizophrenia. It is rarely a first choice, because it can lower white blood cell counts and has other serious risks. For that reason, it requires strict blood monitoring programs. In unusual cases of shared psychosis where the primary person has not improved with other medicines, doctors may consider clozapine. Its mechanism involves complex effects on dopamine, serotonin, and other systems, and it can help with both positive and negative symptoms. Weight gain, drooling, constipation, seizures, and blood changes are key risks. Wikipedia+1
7. Long-acting injectable antipsychotics (LAIs)
For people who often miss doses or stop medicine when they go home, long-acting injections—such as depot risperidone or other LAIs—can be very useful. The purpose is stable medicine levels over weeks, so symptoms stay controlled and the shared delusional system does not easily rebuild. The mechanism is the same as the oral drug, but the slow release from the muscle keeps blood levels more even. Doctors choose type and dose based on response and side-effects, and regular clinic visits are needed. FDA Access Data+1
8. Short-term benzodiazepines (for acute distress)
Medicines like lorazepam may be used for a short time to reduce very strong anxiety, agitation, or severe insomnia that comes with psychosis. They work by boosting the calming GABA system in the brain. The purpose is brief stabilisation, not long-term treatment. Side effects can include drowsiness, confusion, and dependence if used for too long, so they are used carefully and tapered under medical supervision. BetterHelp
Dietary molecular supplements (adjunctive, not cures)
Dietary supplements cannot cure psychosis, but some nutrients are being studied as add-ons to standard treatment in schizophrenia and early psychosis. Evidence is still developing, and any supplement should be checked with a doctor or pharmacist to avoid interactions.
1. Omega-3 polyunsaturated fatty acids (fish oil)
Omega-3 fatty acids, especially EPA and DHA from fish oil, have been studied in people at high risk of psychosis and in schizophrenia. Some trials found that about 1–1.2 g/day of omega-3 reduced the chance of developing full psychosis and improved symptoms, while others were less clear. The proposed mechanism is that omega-3s stabilise cell membranes, support anti-inflammatory pathways, and may protect brain cells from oxidative stress. They are generally safe but can cause stomach upset or a fishy taste. PubMed+2Springer Nature Link+2
2. N-acetylcysteine (NAC)
NAC is an antioxidant that increases glutathione levels in the brain. Several randomised trials and meta-analyses in schizophrenia used around 2 g/day as an add-on to antipsychotics and showed modest improvements, especially in negative symptoms and cognition, over months of treatment. The mechanism seems to involve reducing oxidative stress and inflammation and modulating glutamate signalling. Side effects are usually mild, such as nausea or stomach discomfort, but medical supervision is still needed. PubMed+2ScienceDirect+2
3. B-complex vitamins (folate, B12, B6)
Some people with psychotic disorders have low folate or B12, or genetic variants that affect folate metabolism. Correcting these deficiencies with doctor-supervised doses of folic acid, B12, and sometimes B6 may support better response to antipsychotic medicines in some cases. The function of these vitamins is to help with methylation reactions, DNA repair, and neurotransmitter synthesis. The mechanism for benefit is probably through improved brain energy and signalling. Blood levels should always be checked before high-dose use. Cambridge University Press & Assessment
4. Vitamin D
Low vitamin D levels have been linked in some studies to a higher risk of psychotic disorders, although the relationship is complex. Supplementing vitamin D in deficient people may support overall brain and immune health, but it is not a direct antipsychotic. Vitamin D helps regulate calcium, bone health, and immune function, and receptors are found in the brain. Doses must be chosen by a clinician, because too much vitamin D can be harmful. Cambridge University Press & Assessment
5. Probiotics and gut-brain support
Research suggests that gut bacteria can influence brain function, mood, and inflammation. Probiotics (live “good bacteria”) and prebiotic fibres are being studied as add-ons in psychiatric disorders. The idea is that improving gut health may reduce systemic inflammation and affect brain signalling molecules made by microbes. Evidence in psychosis is still early and mixed, so these products should be seen as general digestive support, not as a treatment on their own. Cambridge University Press & Assessment
6. Magnesium and zinc
Magnesium and zinc are minerals involved in hundreds of enzyme reactions in the brain, including those that control NMDA-type glutamate receptors and antioxidant defences. Deficiency may worsen irritability, sleep, and cognitive function. Doctor-guided supplementation can correct low levels, which might indirectly help coping and mood. Too much, however, can cause diarrhoea (magnesium) or stomach upset and copper imbalance (zinc), so blood tests and professional advice are important. Cambridge University Press & Assessment
(Other supplements are being studied, but none should replace standard medical and psychological care.)
Immunity-booster, regenerative and stem-cell-related drugs
At present, there are no approved immune-booster or stem-cell drugs specifically for symbiotic psychosis or shared psychotic disorder. However, researchers are exploring biological treatments that may protect brain cells or modulate immune and inflammatory pathways in schizophrenia and related conditions. These are experimental and usually only available in clinical trials. Nature+3PMC+3Frontiers+3
Scientists have tested transplanted inhibitory interneurons from embryonic stem cells in animal models of schizophrenia and found improvements in behaviour, but this is far from everyday clinical practice. Other work uses patient-derived stem cells to study how their brain cells behave in the lab and to screen possible drugs. The mechanism is to repair or compensate for abnormal brain circuits, but safety, ethics, and long-term effects must be fully understood before such methods can be used widely in humans. libd.org+3PMC+3PMC+3
Anti-inflammatory strategies, antioxidants like NAC, omega-3 fatty acids, and investigational antipsychotics with novel mechanisms (for example, ulotaront, a trace-amine receptor agonist) are also part of a broader move toward “neuroprotective” treatment. For now, they remain add-ons or research tools, not stand-alone cures. PubMed+2JAMA Network+2
Procedures and surgerie
There is no standard surgical operation for symbiotic psychosis. However, a few medical procedures can sometimes be used in very severe or resistant psychotic illnesses, usually when other treatments have failed and risk is very high. These decisions are always made by specialist teams in hospital.
1. Electroconvulsive therapy (ECT)
ECT is a medical procedure, done under general anaesthesia, where controlled electrical currents are passed through the brain to trigger a brief seizure. It is mainly used for severe depression with psychosis or life-threatening catatonia, not usually for shared psychosis itself. The purpose is rapid relief of symptoms when a person is very unwell and other treatments have not worked. The exact mechanism is still being studied but likely involves resetting brain network activity and neurotransmitter balance. Harbor Psychiatry & Mental Health
2. Repetitive transcranial magnetic stimulation (rTMS)
rTMS uses magnetic pulses delivered through a coil on the scalp to modulate activity in specific brain areas. It is approved in many places for depression and is being researched for auditory hallucinations and negative symptoms in schizophrenia. The purpose is to gently change the excitability of brain circuits linked to symptoms. Because it is non-invasive and done while awake, it is not a surgery, but it is still a hospital-based procedure and not a first-line treatment for shared psychosis. arXiv
3. Deep brain stimulation and psychosurgery (very rare, experimental)
Deep brain stimulation (DBS) and other psychosurgical methods involve placing electrodes or making tiny lesions in deep brain structures. These are used mainly for severe movement disorders and obsessive-compulsive disorder, not routine psychotic disorders, and remain highly specialised and controversial. Their purpose is to change abnormal activity in specific circuits. For psychosis, such approaches are still experimental and would not be considered in typical cases of symbiotic psychosis. PMC+1
Prevention and risk-reduction tips
Treat primary psychotic illness early. Quick, continuous treatment for the person with the original psychosis reduces the intensity of delusions, so there is less “pressure” on close relatives to adopt those beliefs. Wikipedia+1
Reduce social isolation. Encourage safe contact with friends, community groups, school, or work. More varied contact offers reality checks and makes it harder for delusional systems to become the only story. PMC+1
Support healthy boundaries in close relationships. Families can gently avoid over-dependence, encourage separate hobbies, and respect privacy. This lowers the chance that one person’s thoughts completely dominate another’s. PMC+1
Educate families about psychosis. When families understand common symptoms, they are better able to notice early warning signs and seek help instead of silently going along with delusional ideas. Harbor Psychiatry & Mental Health
Manage stress and trauma. High stress and traumatic events can worsen psychotic conditions. Teaching coping skills, offering counselling, and reducing conflict at home can lower overall risk. BetterHelp+1
Support good sleep, nutrition, and exercise. A stable daily routine with enough sleep, balanced meals, and regular physical activity helps brain health and resilience, which may reduce symptom flare-ups. Cambridge University Press & Assessment
Avoid alcohol and non-medical drug use. Substances like cannabis, stimulants, and alcohol can increase the risk of psychosis or make it harder to treat. Clear, age-appropriate education about these risks is protective. Wikipedia+1
Keep regular follow-up with mental health services. Consistent appointments allow small problems to be caught early, before they grow into severe shared delusions. Harbor Psychiatry & Mental Health
Encourage independent thinking in teenagers and partners. Simple skills like checking facts from multiple sources, asking questions, and talking to trusted adults can protect against simply copying another person’s extreme beliefs. PMC+1
Have a plan for early warning signs. Families can agree on steps to take if one person’s beliefs become very odd, fearful, or rigid—such as booking an urgent appointment with a clinician. This can prevent a shared psychotic system from forming. Harbor Psychiatry & Mental Health
When to see a doctor
You should see a doctor or mental health professional quickly if you or someone close to you:
Starts to believe very unusual ideas that do not change even when there is clear evidence against them.
Becomes extremely suspicious, fearful, or convinced that others are plotting against them without good reasons.
Begins to share another person’s strange beliefs in a way that causes big problems at school, work, or in relationships.
Seems very withdrawn from others, stops normal activities, or shows big changes in personality or behaviour.
Appears disconnected from reality, hearing or seeing things that others do not, or talking in a confused way.
If the person seems very unsafe, completely out of control, or others are very worried about immediate danger, emergency medical help should be contacted at once. Early help often leads to better recovery and less long-term impact on life. Wikipedia+2BetterHelp+2
What to eat and what to avoid
1. Eat: oily fish (salmon, sardines, mackerel) once or twice a week.
These fish are rich in omega-3 fatty acids, which may support brain and heart health and are being studied as an add-on in psychotic disorders. Springer Nature Link+1
2. Eat: plenty of fruits and vegetables every day.
Colourful plant foods provide antioxidants, vitamins, and minerals that support overall brain and body health and may help reduce inflammation. Cambridge University Press & Assessment
3. Eat: whole grains and legumes.
Foods like brown rice, oats, lentils, and beans give slow-release energy and fibre, helping to keep blood sugar stable and mood more even. Cambridge University Press & Assessment
4. Eat: nuts and seeds in small handfuls.
Walnuts, flaxseed, chia seeds, and almonds provide healthy fats, magnesium, zinc, and plant protein, all of which support brain function. Cambridge University Press & Assessment
5. Eat: fermented foods if tolerated.
Yogurt with live cultures, kefir, or other fermented foods can support gut bacteria, which may have gentle positive effects on mood and thinking. Cambridge University Press & Assessment
6. Avoid: very high sugar and ultra-processed snacks.
Sugary drinks, sweets, and many packaged snacks can cause sharp blood sugar swings, weight gain, and metabolic problems, which are already a risk with some antipsychotics. FDA Access Data+1
7. Avoid: energy drinks and too much caffeine.
High caffeine can worsen anxiety, sleep problems, and even trigger or increase strange thoughts in some people. It also interferes with good sleep, which is vital in psychosis recovery. BetterHelp+1
8. Avoid: alcohol and non-medical drugs.
Alcohol, cannabis, and other recreational drugs can interact with psychiatric medicines, worsen symptoms, and increase relapse risk. Avoiding them is a key part of staying stable. Wikipedia+1
9. Avoid: crash diets and severe food restriction.
Extreme dieting can disturb mood, concentration, and medication levels. Any weight-management plan should be slow, supported, and supervised. FDA Access Data+1
10. Avoid: very salty, fatty fast foods as a regular habit.
These foods add to the risk of high blood pressure, diabetes, and heart disease, which are already higher in many people taking antipsychotics, so they should be occasional, not daily. FDA Access Data+1
Frequently Asked Questions (FAQs)
1. Is symbiotic psychosis the same as folie à deux?
Yes. “Symbiotic psychosis” is one of several names used in older literature for what is now usually called folie à deux, shared psychotic disorder, or induced delusional disorder. All these terms describe the same basic idea of a delusion spreading from one person to another in a very close relationship. Wikipedia+1
2. Is symbiotic psychosis still in DSM-5 as a separate diagnosis?
No. DSM-5 removed shared psychotic disorder as its own category. Instead, clinicians are advised to diagnose delusional disorder or “other specified schizophrenia spectrum and other psychotic disorder,” but the shared nature of the symptoms can still be described in the clinical notes. Wikipedia+1
3. Can a child or teenager develop shared psychosis with a parent?
Yes, case reports describe children and teenagers who developed shared delusions with a parent, especially when they were very dependent and isolated from others. This is one reason why early detection, school engagement, and outside support are so important in high-risk families. PMC+1
4. Does the secondary person always have a mental illness?
Not always. Many secondary people do not have a psychotic disorder before the shared delusion starts. They may, however, have personality traits (such as high suggestibility or dependence) or other mental health issues that increase vulnerability. After separation and treatment, many no longer have psychotic symptoms. Wikipedia+1
5. How long does it take for the shared delusion to fade after separation?
It can vary. Some secondary people quickly improve over days or weeks once separated and supported. Others may need months of therapy and, in some cases, medicine. The speed depends on how long the delusion existed, how strong the relationship is, and whether the secondary person has other mental health conditions. PMC+2PMC+2
6. Can non-drug therapies alone be enough?
For some secondary people, especially when symptoms are mild and short-lived, careful separation, psychoeducation, and therapy may be enough. For the primary person, who usually has a full psychotic disorder, medicine plus therapy is often needed. The exact plan is always individual and guided by a specialist team. PMC+2Good Health Psych+2
7. Are antipsychotic medicines safe?
Antipsychotics have well-described benefits and risks. They can greatly reduce delusions and hallucinations but can also cause side effects such as weight gain, movement problems, sleepiness, and metabolic changes. FDA labels on accessdata.fda.gov explain these in detail. Doctors balance benefits and risks, choose the lowest effective dose, and monitor closely with physical exams and tests. FDA Access Data+2FDA Access Data+2
8. Will medicines have to be taken for life?
Some people need long-term treatment to prevent relapse; others may slowly reduce medicines under close supervision after a stable period. Decisions depend on diagnosis, number of past episodes, side effects, and personal goals. Sudden stopping without medical advice is dangerous and can quickly lead to symptom return. Wikipedia+2BetterHelp+2
9. Can diet and supplements replace antipsychotics?
No. While omega-3 fatty acids, NAC, vitamins, and other supplements may support brain health and slightly improve some symptoms, they are add-ons, not substitutes for antipsychotic medicines and therapy in psychotic disorders. Stopping medicine and only taking supplements can be very risky. PubMed+2PubMed+2
10. Is stem-cell therapy available for shared psychosis?
No. Stem-cell-based treatments for schizophrenia and related conditions are still at the research stage, mostly in animals or lab studies. They are not approved treatments for psychosis or symbiotic psychosis, and any websites offering such cures outside clinical trials should be treated with great caution. PMC+2PMC+2
11. Can shared psychosis return after recovery?
It can, especially if the people move back into an isolated situation with the same unhealthy patterns, and the primary person’s illness becomes active again without treatment. Staying in care, keeping social contacts, and maintaining healthy boundaries help reduce the chance of relapse. PMC+1
12. Does shared psychosis mean someone is “weak-minded”?
No. Shared psychosis is not a sign of weakness or low intelligence. It usually develops in the context of strong emotional bonds, high trust, isolation, and exposure to very convincing delusional ideas from a loved one. With proper care, both people can recover and build healthier patterns. PMC+1
13. Can online communities cause something like shared psychosis?
Some researchers worry that tightly closed online groups with intense, unusual beliefs can act in a similar way, especially if members cut off outside contact. However, classical symbiotic psychosis usually involves face-to-face, very close relationships. More research is needed to fully understand digital versions of shared beliefs. PMC+1
14. How can families support recovery?
Families can encourage treatment, keep appointments, support regular routines, listen without judgement, and gently challenge delusional ideas by asking for evidence instead of arguing. They can also look after their own wellbeing, because caring for someone with psychosis is stressful and carers need support too. BetterHelp+1
15. Where can someone get reliable information and help?
Reliable information usually comes from licensed mental health professionals, major hospital websites, government health agencies, and peer-reviewed journals. For treatment, local mental health services, psychiatrists, psychologists, and counsellors are the key contacts. In any crisis or if someone seems at risk of serious harm, emergency medical services should be contacted immediately. Wikipedia+2BetterHelp+2
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: December 31, 2025.
