Abstract :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.