Delusional Jealousy and Localized Cerebral Pathology
SIR: Delusional jealousy is a rather uncommon psychiatric syndrome with prevalence estimates of approximately 1% in psychiatric inpatients.1 Apart from patients with schizophrenia and alcohol abuse, delusional jealousy can be frequently found in patients with organic psychosis, as for example in Alzheimer's disease.2,3 The pathophysiological and psychological mechanisms underlying the development of the syndrome in patients with cerebral disorders are not yet fully understood. Most authors feel that cognitive impairment plays a significant role in the development of the syndrome,2 but no consistent relationship between pathology of certain brain structures and development of organic Othello syndrome has been established yet.
Case Report
The patient, a 74-year-old right-handed former carpenter with no psychiatric history, was admitted to our hospital because of delusions of jealousy. In 1992 and 1993 he had suffered from three right hemisphere cerebrovascular infarctions. Various CT scans indicated lesions to both the paraventricular areas and in the thalamus, which resulted in a mild dementia syndrome and a partial left hemiparesis. In 1993 a resection of the prostate due to an adenocarcinoma and an additional plastic orchiectomy had to be undertaken. Following a thalamic infarction on the right side, the patient accused his wife of infidelity and attacked her with a knife. After admission to a psychiatric ward the patient was found to have vivid delusions of jealousy, depressive mood, and moderate cognitive impairment. After low-dose neuroleptic treatment (200 mg thioridazine and 1 mg pimozide/day) the delusions disappeared within a few weeks' time.
As Silva and Leong4 pointed out, delusional jealousy has been linked to various organic disorders, including metabolic disturbances, Alzheimer's disease, encephalitis, and substance abuse, among others. In most cases of organic Othello syndrome no clear association with lateralized brain dysfunction can be established, but the subject warrants further study. Richardson et al.5 reported a case of Othello syndrome following right cerebrovascular infarction, and Silva and Leong4 described the case of a 48-year-old man with delusions of infidelity following left frontal lobe infarction. In the case described, the development of delusional jealousy closely followed a thalamic infarction, and symptoms of cognitive impairment were obvious. However, the additional role of psychological stress or physical impairment (impotence or urogenital disorder as in the case described) must also be emphasized.2,3 Since there is an excessive prevalence of delusional jealousy in organic mental disorders, future research should focus on pathology of certain brain areas in the development of the syndrome.
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