Othello’s syndrome

Pendahuluan
 J EALOUSY, DEFINABLE as the emotional state linked with
the desire to preserve one’s possession, sits high atop a list
comprised of the most human emotional experiences; among
the more differentiated human emotions, it is an extremely
common, heterogeneous and complex emotion ranging from
normality to pathology, with different degrees of intensity,
persistence and insight
 According to Kingham and Gordon, pathological jealousy is a
set of irrational thoughts and emotions, with extreme or
unacceptable behavior, in which the dominant theme is the
concern with the sexual partner’s infidelity not based on
concrete evidence
 There are synonyms for pathological jealousy; it has been
referred to in such terms as delusional jealousy, sexual
jealousy, erotic jealousy syndrome, morbid jealousy,
psychotic jealousy, pathologic jealousy, conjugal paranoia and
the delusion of infidelity
 The target of the Othello delusion can involve persons
besides a spouse or significant other
THE DANGEROUS PASSION
 It is a psychiatric condition in which the degree of jealousy and/or
belief in infidelity of one’s spouse reaches delusional intensity
 The patients may gather evidence based on random events, bits of
conversation, or misplaced household items to support their
suspects. Clinical reports have noted the association of this morbid
condition in both organic and functional psychoses, such as
paranoid schizophrenia or mood disorder with psychotic features
 it has been associated with neurological disorders including
strokes, Parkinson’s disease, brain trauma, brain tumors,
neurodegenerative disorders, encephalitis, multiple sclerosis, and
normal pressure hydrocephalus.
 A Mayo Clinic study demonstrated that coexistent delusions
and hallucinations are frequent in patients with OS,
occurring in approximately 30% and 40% of patients,
respectively.
 Current diagnostic classification is unclear and may vary with
the intensity of the belief, the presumed cause and whether
the jealousy is seen as a symptom or a syndrome.
 DSM-IV-TR includes the category of delusional disorder –
jealous type. To be diagnosed, individuals must experience
delusions concerning the fidelity of their long-term romantic
partner (i.e., the individual is convinced that their partner is
or has been unfaithful, but without reasonable or objective
evidence)
 Diagnosis requires the exclusion of coexistent psychiatric
disorders, such as depression or other psychotic disorders, as
well as secondary causes, such as dementia or structural
lesions
 According to the literature, men are largely represented
among the persons who murdered due to jealousy
 It does not mean that men are more jealous than women.
Pathological jealousy is a more dangerous condition in men,
which may be why psychiatrists give more attention to
jealous men. Their behavior is more often homicidal and
suicidal.
OTHELLO SYNDROME AND DEMENTIA
 In 1906 Alois Alzheimer described the case of Auguste Deter,
which will be linked forever with the most common cause of
dementia.48 The patient presented with ideas of jealousy
toward her husband, a rapidly worsening memory weakness
and pronounced psychosocial impairment.
 This intuitively shows that delusional jealousy is a frequent
problem in demented patients.
 To the best of our knowledge there are not systematic
researches about the clinical characteristics of OS in persons
suffering from dementia, but only case reports, and it is not
possible to differentiate or compare differences of delusional
jealousy across the various types of dementia or distinguish
the syndrome in demented patients from the syndrome in
other psychiatric disorders.
 At magnetic resonance imaging analysis, the
neurodegenerative patients LBD, Alzheimer’s disease [AD],
behavioral variant of frontotemporal dementia [FTD], and
Parkinson’s disease with dementia [PDD]) with OS showed
greater gray matter loss predominantly in the dorsolateral
frontal lobes, particularly in superior frontal gyri, and right
posterior lateral temporal lobe compared to the matched
neurodegenerative patients without delusions.
 The authors suggest one hypothesis linking right frontal lobe
lesions to delusion: the lobe of frontal lobe function impairs
the ability to monitor interactions with oneself and with
others leading to false beliefs
CONCLUSION
 Jealousy is a common emotion that can be considered
pathological in some circumstances; sometimes, this disorder
takes on the characteristics of delusion
 Delusional jealousy is a frequent problem in dementia. There
are not systematic researches about the clinical
characteristics of OS in persons suffering from dementia, but
only case reports and it is not possible to differentiate or
compare differences of delusional jealousy across the various
types of dementia, or distinguish the syndrome in demented
patients from the syndrome in other psychiatric disorders.