Parental Alienation Syndrome (PAS) was proposed by Richard A. Gardner in 1985. It is assumed to occur in some distressing marriage break-ups, when a parent “brainwashes” his children so they reject the other parent in an unjustified way. But, is it the result of a conscious act as Gardner suggests? Or could it also appear as part of a shared psychosis?

To assess the possibility of the appearance of PAS as a consequence of paranoid contagion or shared psychosis.

We present the case of a 45-year-old patient and her 9-year-old daughter, who is allegedly assaulted by her father during visits, according to both. Mother and daughter continually request attention in the emergency department for this reason, with no obvious injuries. A bibliographic review is carried out on the PAS and shared psychosis. We compare the existing data with our case.

A paranoid cognitive style is observed in the 45-year-old patient, and it is observed that her daughter stops rejecting the father when she spends time separated from her. The contagion of delirium is the nuclear mechanism of shared psychosis. It is known that children with PAS may have distorted memories and incorporate beliefs of others through suggestion. There is also an inverse relationship between the number of visits by the alienated parent and the undervaluation of the child. We have not found any studies linking shared psychosis with PAS.

The existing bibliography on PAS is scarce. The possibility of an existing paranoid contagion mechanism has not been addressed yet.

No significant relationships.

The suspiciousness of a paranoid patient could reach extremes.

To present the lessons learned after an interview with a similar patient.

Case report.

Fifty-two year old woman suffering from paranoid schizophrenia (F20.0). Symptoms almost identical to her previous (two) hospitalizations: delusions of thought reading and of being surveilled by electronic equipment in her house/neighborhood. This time, though, she was additionally convinced of being the object of medical experiments and of being electronically surveilled even within the ward. Treatment: risperidone 12mg/day, lorazepam 3.75mg/day, biperiden 2mg/day. Three weeks after admission, the author noted a slight tremor in her hands (most certainly of extrapyramidal origin). I asked her to place both hands in front of her, fingers wide open, to assess it better. The patient followed with the fingers attached, though. Consequently, I approached my hands to hers -to show how it should be done correctly-, touching them lightly. Then, a spark was generated between our hands. Evidently, it was an electrostatic discharge (I was wearing a wool sweater that day; static electricity could easily accumulate on wool). She became outraged: “what kind of experiments are you doing to me?”, “what electronic devices are you using?”, “this is the proof of what I have been constantly saying”.

The symptoms of psychotic relapses could evolve over time. A clinician should refrain from any strictly unnecessary physical contact with an exceedingly paranoid patient, particularly when the latter claims that is the object of “medical experiments”. The elaborative “ability” of such patients could be, simply, astounding.

No significant relationships.

The nosological status of olfactory reference syndrome (ORS) is a matter of debate and there is uncertainty as to what treatments are effective.

The world literature was searched for reports of cases of ORS. Clinical, nosological and therapeutic information from cases meeting proposed diagnostic criteria for the disorder was summarized and tabulated.

A total of 84 case reports (52 male/32 female) were found. Age of onset was <20 years in almost 60% of cases. Smell-related precipitating events were recorded in 42%. Most patients could not smell the smell or only did so intermittently. Authors of the reports expressed reservations about the delusional nature of the belief in slightly under half of the cases. Over two-thirds were improved or recovered at follow-up, with the disorder responding to antidepressants and psychotherapy more frequently than to neuroleptics.

ORS is a primary psychiatric syndrome that does not fit well into its current classification as a subtype of delusional disorder, both in terms of its nosology and its response to treatment.