Conjoined twins and psychosis

Two minds, one body. What happens if one of the minds goes bonkers?

Perhaps the most interesting pair of conjoined twins are the Hensel sisters. Two heads sit atop what appears to be a single body.
Hensel Twins Photo

From what I understand, the Hensel sisters have exclusive control of one half of their shared body. I have seen a film clip which portrays the twins sharing the complex task of riding a bicycle together, each sharing the control of a pedal and a handgrip. The twins also perform other common tasks requiring two cooperating hands.

Imagine with me now that one of the twins is afflicted with schizophrenia or another pernicious mental disorder. Suddenly one twin becomes violent or at the very least, uncooperative. How would a psychiatrist treat this affliction? Has this happened to any conjoined twins?

Would both twins have the disease? Does that happen with a disease like schizophrenia? It is a result of the brain producing too much dopamine. Is one twin destined to get it while the other gets away with not having it?

The second twin would be at no greater risk than any other sibling. How the meds would work, considering the blood flow patterns, is another story. It certainly looks like they share one circulatory system, meaning both sisters get the same meds. I’m not familiar with the effects of psych drugs on a normal brain.

The cause of schizophrenia, from what I understand, is not completely understood. The overabundance of dopamine is one hypothesized cause; other possible causes are stress and genetics.

In the case of conjoined twins, if one twin developed schizophrenia, the other twin would probably have at least the same likelihood of developing it that he or she would were they not conjoined, which is roughly a 50% chance. (By comparison, a non-twin sibling has a less than 10% chance of developing schizophrenia.)

How do you treat conjoined twins when one has schizophrenia? Typically, drug treatments are supplemented with slew of different therapies: behavior therapy, cognitive therapy, family therapy, group therapy, etc. My guess is that they’d do the same thing, but then again, I don’t know what effects the drugs they use (clozapine, for one) has on people who don’t have schizophrenia. If the drugs pose serious risks to the non-schizophrenic twin, then they have a problem. Therapy alone might not be enough to help the schizophrenic one, but it might be their only option.

I just did a quick search for journal articles on conjoined twin and schizophrenia, and came up with nothing. (There were tons of stuff for twins in general and schizophrenia, but not conjoined twins.) I suspect this is because there are very few cases, if any, of conjoined twin-schizophrenia. My guess is that the odds of conjoined twins who can’t be separated who survive to the average age of onset for schizophrenia (20s to 30s), combined with the overall odds of developing schizophrenia (1% general population) form a chance of such a case so unlikely that it hasn’t happened yet.

Thanks for the in depth answer. Perhaps I didn’t word my question correctly, it was not just treatment for schtizophrenia that I was curious about, I was wondering about any mental condition which affects only one of the twins.

I am just out fishing for information, I realize that this is probably not something that has occured in many conjoined twins but due to the unique life that they are living, I can only figure that a twin or two has gone haywire sometime in the past.

IBBen–

I just searched for articles on conjoined twins, and all of them had to do with caring for or separating them. I guess there’s never been any studies done on mental disorders and conjoined twins. There’s probably a couple interesting case studies out there, though.

AudreyK, you are absolutely right.
I didn’t take into consideration that conjoined twins would be identical. DUH!!