1
|
Hjiej G, Abdellaoui M, Khattab H, Haddouali K, Bellakhdar S, El Moutawakil B, Rafai MA, El Otmani H. Jealousy's stroke: Othello syndrome following a percheron artery infarct. Neurocase 2024; 30:204-207. [PMID: 39632716 DOI: 10.1080/13554794.2024.2436159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024]
Abstract
INTRODUCTION Othello syndrome is a psychosis with delusions of infidelity, where the patient harbors a persistent, unfounded belief - a "delusion" - that their partner is being unfaithful. This condition can manifest in certain psychiatric conditions and neurological disorders, such as neurodegenerative diseases, as parkinson's disease treatment side effects, or occasionally after a stroke. CASE We report a rare case of a 50-year-old woman, with no previous psychiatric history, who developed a delusion of infidelity, leading to verbal and physical aggressions with bladed weapons, days after experiencing a bi-thalamic infarct due to the occlusion of the Percheron artery. DISCUSSION Psychosis is the third most common psychiatric symptom post-stroke, with delusional disorders being the most prevalent type. Within this category, delusional jealousy is the second most common subtype, following persecutory delusions. Although no specific brain lesions are exclusively responsible for jealousy delusions, lesions in various regions, particularly in the right hemisphere, have been implicated. Thalamic strokes disrupt the frontal-subcortical-thalamic circuitry, crucial for executive functions, and the dorsomedial nuclei, leading to alterations in limbic circuitry and emotional regulation. These damages can result in significant impairments in impulse control and judgment, manifesting as behavioral disorders due to a flawed interpretation of a partner's actions as infidelity. In this case, our patient experienced a bi-thalamic infarct predominantly on the right side. CONCLUSION Othello syndrome represents a challenging post-stroke complication, highlighting the intricate relationship between neurological damage and psychiatric manifestations. Recognizing and promptly addressing this syndrome is crucial, given its potential for dangerous outcomes.
Collapse
Affiliation(s)
- Ghita Hjiej
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
| | - Maha Abdellaoui
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
| | - Hajar Khattab
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
| | - Kamal Haddouali
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
| | - Salma Bellakhdar
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
- Laboratoire de génétique et pathologie moléculaire. Faculté de Médecine et de Pharmacie de Casablanca, Casablanca, MA, Morocco
| | - Bouchera El Moutawakil
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
- Laboratoire de génétique et pathologie moléculaire. Faculté de Médecine et de Pharmacie de Casablanca, Casablanca, MA, Morocco
| | - Mohammed Abdoh Rafai
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
- Laboratoire De Recherche Sur les Maladies du Système nerveux, Neurosensorielles et Handicap, Faculté de Médecine et de Pharmacie de Casacblanca, Casablanca, MA, Morocco
| | - Hicham El Otmani
- Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco
- Laboratoire de génétique et pathologie moléculaire. Faculté de Médecine et de Pharmacie de Casablanca, Casablanca, MA, Morocco
| |
Collapse
|
2
|
Johnson L. Jealousy as a correlate of intimate partner homicide-suicide versus homicide-only cases: National Violent Death Reporting System, 2016-2020. Suicide Life Threat Behav 2024; 54:663-672. [PMID: 38554063 DOI: 10.1111/sltb.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 02/07/2024] [Accepted: 03/13/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION The objective of this study was to compare jealousy as a correlate of intimate partner homicide-suicide cases to homicide-only cases using data from the National Violent Death Reporting System (NVDRS), a state-based surveillance system maintained by the Centers for Disease Control and Prevention. Jealousy is categorized as jealous feelings or distress over a current or former intimate partner's relationship or suspected relationship with another person. METHODS NVDRS data from a 5-year period (2016-2020) was used to estimate frequencies and identify significant differences in jealousy and other sociodemographic, mental health, relationship, and incident-related correlates of intimate partner homicide-suicide compared to homicide-only cases. Cases were included if they involved an intimate partner single homicide or a single homicide followed by suicide. RESULTS The study sample included 5335 cases (intimate partner homicide-suicide n = 1402; homicide-only n = 3933). A significantly higher percentage of intimate partner homicide-suicide cases reported jealousy preceding the event (9%) compared to homicide-only cases (6%). Compared with homicide-only cases, homicide-suicide cases had 3.5 greater odds of recording jealousy as a precipitating event. CONCLUSION Findings suggest that intimate partner homicide-suicide cases are distinct from homicide-only cases both in terms of individual- and incident-level and situational factors, including the presence of jealousy.
Collapse
Affiliation(s)
- Laura Johnson
- Temple University School of Social Work, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Critical Issues in the Management of Agitation, Aggression, and End-of-Life in Delusional Disorder: A Mini-Review. Healthcare (Basel) 2023; 11:healthcare11040458. [PMID: 36832992 PMCID: PMC9956049 DOI: 10.3390/healthcare11040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Background: Compared to other psychotic disorders, there is little information about staging care in delusional disorder (DD). Unlike schizophrenia, this is a disorder that begins in middle age, a time at which chronic medical comorbidities have already begun to impact global functioning. With age, the combination of psychological and somatic conditions leads to new behaviours, e.g., agitation, aggression, and behaviours that require specific preventive and interventive measures. With further age, knowledgeable end-of-life care becomes necessary for this population. Aim: The aim of this article was to review existing evidence on the management of these successive phases. Methods: We conducted a narrative review using PubMed and ClinicalTrials.gov and searched for the following terms: (agitation OR aggressivity OR aggression OR palliative OR "end-of-life") AND ("delusional disorder"). Results: We found that the literature was sparse. Existing evidence suggests that medical causes are frequently at the root of agitation and aggression. With respect to management, de-escalation strategies are generally preferred over pharmacotherapy. Specific delusional syndromes, e.g., de Clérambault, Othello, Capgras, Fregoli, as well as folie à deux, are associated with aggression. The somatic subtype of DD is the one most often requiring palliative care at the end of life. Conclusions: We conclude that insufficient attention has been given to the care needs of the accelerated aging process in DD.
Collapse
|
4
|
Abstract
Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.
Collapse
Affiliation(s)
- Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London.,Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Foundation Trust, London, England
| | - Nichola Raihani
- Department of Experimental Psychology, University College London
| | - Sam Wilkinson
- Department of Sociology, Philosophy and Anthropology, Exeter University
| |
Collapse
|
5
|
Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies. Clocks Sleep 2020; 2:399-415. [PMID: 33118525 PMCID: PMC7711969 DOI: 10.3390/clockssleep2040030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Abstract
Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review’s findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen. As one symptom can aggravate another, comorbidities in patients with serious mental illness all need to be treated, a task that requires close liaison among medical specialties.
Collapse
|
6
|
Falato E, Capone F, Ranieri F, Florio L, Corbetto M, Taffon C, Niolu C, Di Lorenzo G, Di Lazzaro V. Celiac Disease Diagnosed in an Older Adult Patient with a Complex Neuropsychiatric Involvement: A Case Report and Review of the Literature. Brain Sci 2020; 10:brainsci10070426. [PMID: 32635319 PMCID: PMC7408423 DOI: 10.3390/brainsci10070426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
We present a case of celiac disease (CD) diagnosis in a 75-year-old woman with a long-term history of chronic delusional jealousy and a complex neurological involvement. The case describes a very unusual clinical picture, provides some clinical clues, and highlights the importance of being aware of CD extraintestinal manifestations in order to get a timely diagnosis.
Collapse
Affiliation(s)
- Emma Falato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.C.)
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.C.)
| | - Federico Ranieri
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Lucia Florio
- Unit of Neurology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Marzia Corbetto
- Department of Neurology, Santa Maria Goretti Hospital, 04100 Latina, Italy;
| | - Chiara Taffon
- Unit of Pathology, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy;
| | - Cinzia Niolu
- Unit of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (C.N.); (G.D.L.)
| | - Giorgio Di Lorenzo
- Unit of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (C.N.); (G.D.L.)
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.C.)
- Correspondence:
| |
Collapse
|
7
|
Addressing Delusions in Women and Men with Delusional Disorder: Key Points for Clinical Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124583. [PMID: 32630566 PMCID: PMC7344970 DOI: 10.3390/ijerph17124583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Delusional disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this narrative review is to select from the clinical literature the psychosocial interventions that appear to work best for these conditions and to see whether similar strategies can be modeled or taught to family members so that tensions at home are reduced. Because the content of men's and women's delusions sometimes differ, it has been suggested that optimal interventions for the two sexes may also differ. This review explores three areas: (a) specific treatments for men and women; (b) recommended psychological approaches by health professionals, especially in early encounters with patients with DD; and (c) recommended psychoeducation for families. Findings are that there is no evidence for differentiated psychosocial treatment for men and women with delusional disorder. What is recommended in the literature is to empathically elicit the details of the content of delusions, to address the accompanying emotions rather than the logic of the presented argument, to teach self-soothing techniques, and to monitor behavior with respect to its safety. These recommendations have only been validated in individual patients and families. More rigorous clinical trials need to be conducted.
Collapse
|
8
|
Strobbe-Barbat M, Macedo-Orrego LE, Cruzado L. Othello Syndrome Secondary to Cerebral Tuberculoma: A Case Report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:116-120. [PMID: 32446418 DOI: 10.1016/j.rcp.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/26/2018] [Accepted: 09/04/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Othello syndrome, an eponym of Shakespeare's character, is a transnosological diagnostic term that designates a clinical picture characterised by the presence of delusions of infidelity with respect to a partner and that, consequently, can lead to typical jealousy attitudes and violent behaviour towards the partner. In its pure form, it corresponds to delusional disorder of infidelity, but it may also be secondary to brain organicity and drug use. METHODS Case report and non-systematic review of the relevant literature. CASE PRESENTATION A 26-year-old man, with a history of drug abuse and a victim of domestic violence as a child, presented with tonic-clonic seizures and intracranial hypertension three years ago, for which he underwent a craniotomy with the finding of a right frontal cerebral tuberculoma. After a lapse, he developed a clinical picture of delusions of infidelity regarding his partner and violent behaviour towards her. LITERATURE REVIEW Delusional jealousy is associated, like other delusions, with lesions of the right frontal lobe. Despite the high and growing prevalence of tuberculosis worldwide, there are no reported cases of Othello syndrome secondary to cerebral tuberculoma in the literature. CONCLUSION Othello syndrome, although not the main cause of domestic violence, can be associated with particularly violent manifestations and be secondary to cerebral tuberculoma. This is the first published case of its kind.
Collapse
Affiliation(s)
- Mariella Strobbe-Barbat
- Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Luis Enrique Macedo-Orrego
- Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Lizardo Cruzado
- Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú; Universidad Peruana Cayetano Heredia, Lima, Perú.
| |
Collapse
|
9
|
Samad FDA, Sidi H, Kumar J, Das S, Midin M, Hatta NH. Subduing the Green-eyed Monster: Bridging the Psychopharmacological and Psychosocial Treatment Perspective in Understanding Pathological Jealousy. Curr Drug Targets 2018; 20:201-209. [DOI: 10.2174/1389450118666170704142708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/27/2017] [Accepted: 06/15/2017] [Indexed: 11/22/2022]
Abstract
Human being is not spared from a broad-ranged emotional state, including being jealous.
Jealousy has both affective-cognitive and behavioural-evaluative dimension where the person perceives,
or experiences a real threat on a valued relationship. As this complex emotion becomes irrational
and not amenable to reason, it later transforms into a dangerously ‘green-eyed monster’. This
perilous situation which is viewed as pathological jealousy is a form of delusion, which is maintained
by a fixed and false reasoning in an originally entrusted intimate relationship. Pathological jealousy is
equally prevailing among both gender, and with a greater ubiquity among the geriatric population. The
role of dopamine hyperactivity in the fronto-parietal-temporal region was implicated, with the anatomical
mapping of the ventromedial prefrontal cortex (vmPFC), cingulate gyrus (CG), and amygdala
involvement in the context of the disease’s neurobiology. The etiology of pathological jealousy includes
major psychiatric disorders, i.e. delusional disorder, schizophrenia, mood disorder, organic
brain syndrome, and among others, the drug-induced psychosis. The role of relationship issues and
psychodynamic perspective, i.e. psychological conflicts with dependence on a romantic partner, and
low self-esteem are involved. Pathological jealousy inherits high-risk forensic psychiatry entanglement,
which may warrant intensive intervention, including hospital admission and antipsychotic
treatment. Treatment options include an early recognition, managing underlying neuropsychiatric disorders,
psycho education, cognitive psychotherapy, and choosing an effective psychopharmacological
agent. The management strategy may also resort to a geographical intervention, i.e. separation between
both persons to complement the biological treatment.
Collapse
Affiliation(s)
- Farah Deena Abdul Samad
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Jaya Kumar
- Department of Physiology, Universiti Kebangsaan Malaysia, Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | | |
Collapse
|