Othello syndrome in Parkinson's disease patients: About 4 cases

Abstract

Othello syndrome (OS), is a type of paranoid delusional jealousy, characterized by the false absolute certainty of partner infidelity, rarely described in patients with Parkinson's disease (PD) using dopamine agonists (DA). The aim of our study was to analyse the clinical features and the underlying cause behind OS occurrence, being an unusual psychiatric disorder with an unknown neuropsychological profile. We identified 4 patients suffering from OS. Their records were retrospectively analysed and some clinical data were included: sex, age at PD onset, age at OS onset, PD timeline, types and duration of DA consumption All patients were males. Mean age at OS onset was 50.25 years (39–62). Time from PD until OS onset was of 4 to 9 years. All patients were using dopaminergic agonists, 3 of whom were on Levodopa/Piribedil combination and one patient on Pramipexole alone. Two patients exhibited impulse control disorders and the neurological examination in 2 cases revealed a cognitive impairment. Two patients suffered from divorce as a consequence of OS. Patients’ follow up showed total disappearance of OS in one patient after DA tapering and a partial improvement in another case. OS is an uncommon neuropsychiatric disorder seen in Parkinson's patients, associating persistent paranoid and sexual delusions. These results suggest that DA usage is a risk factor of OS in patients with PD, regardless of dementia’s presence or not. OS is more common in patients with early disease onset. It should systematically be scanned for, at each consultation, to avoid dramatic marital distress and conflict.