In practice, the great majority of cases are of the type described, often known as folie imposée because the belief is impressed on the non-deluded person by the primary patient.

However, one occasionally sees an alternative presentation, the so-called folie simultanée, in which two predisposed people develop illnesses with delusions and through long and over-close association come to share identical false beliefs. This is said to be most likely when there is a genetic link (for example two siblings) and the situation may be most common in older people who have lived together in considerable isolation for many years.

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