Folie à deux (folly of two, or madness [shared] by two), also known as shared psychosis or shared delusional disorder (SDD), is a collection of rare psychiatric syndromes in which symptoms of a delusional belief, and sometimes hallucinations, are transmitted from one individual to another. The same syndrome shared by more than two people may be called folie à... trois (three) or quatre (four); and further, folie en famille (family madness) or even folie à plusieurs (madness of several). The disorder, first conceptualized in 19th-century French psychiatry by Charles Lasègue and Jules Falret, and is also known as Lasègue–Falret syndrome.Recent psychiatric classifications refer to the syndrome as shared psychotic disorder (DSM-4 – 297.3) and induced delusional disorder (ICD-10 – F24), although the research literature largely uses the original name. This disorder is not in the current, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which considers the criteria to be insufficient or inadequate. DSM-5 does not consider Shared Psychotic Disorder (Folie à Deux) as a separate entity; rather, the physician should classify it as "Delusional Disorder" or in the "Other Specified Schizophrenia Spectrum and Other Psychotic Disorder". Signs and symptoms
This syndrome is most commonly diagnosed when the two or more individuals of concern live in proximity, may be socially or physically isolated, and have little interaction with other people.
Indeed, 17-25% of children with NAFLD develop a NASH in general, and up to 83% for children with severe obesity (versus 29% for adults), further suggesting that hepatic fibrosis seems to follow a more aggressive clinical course in children compared to adults.Early diagnosis of NAFLD in children may help prevent the development of liver disease during adulthood. This is challenging as most children with NAFLD are asymptomatic, with only 42-59% showing abdominal pain. Other symptoms might be present, such as right upper quadrant pain or acanthosis nigricans, the latter of which is often present in children with NASH. An enlarged liver occurs in 30–40% of children with NAFLD.The AASLD recommends a diagnostic liver biopsy in children when the diagnosis is unclear or before starting a potentially hepatotoxic medical therapy. The EASL suggests using fibrosis tests such as elastography, acoustic radiation force impulse imaging, and serum biomarkers to reduce the number of biopsies. In follow up, NICE guidelines recommend that healthcare providers offer children regular NAFLD screening for advanced liver fibrosis every two years using the enhanced liver fibrosis (ELF) blood test. Several studies also suggest magnetic resonance elastography as an alternative to the less reliable ultrasonography.Intensive lifestyle modifications, including physical activity and dietary changes, are the first line of treatment according to AASLD and EASL as it improves the liver histology and aminotransferase levels. In terms of pharmacological treatment, the AASLD and EASL do not recommend metformin, but vitamin E may improve liver health for some children.