Abstract
IntroductionPsychosis in Parkinson’s disease (PD) is common and consists of hallucinations, illusions, and delusions. Among the latter, delusional jealousy, also named Othello syndrome (OS), might impair the quality of life of both patients and their partners. We aimed to perform a systematic review and report a series of PD patients presenting with OS.MethodsA systematic review research was performed in PubMed database, excluding non-English articles, single case reports, reviews and neuropathology articles, comments, and articles concerning OS associated with deep brain stimulation (DBS) and levodopa-carbidopa intestinal gel infusion. We also described eleven PD patients (9 M and 2 F) with OS, identified in a cohort of consecutive 153 patients, comparing them with eleven matched no OS (nOS) PD subjects taken from the same cohort.ResultsWe included eight articles (four case series and four cross-sectional studies). OS resulted more common among males than females. We did not find higher levodopa dose and levodopa equivalent dose for dopamine agonists and for all anti-parkinsonian drugs in our OS group. In our case series, OS patients showed visual hallucinations (p=0.001) and a trend to have depression (p=0.080) more frequently than nOS ones.ConclusionsOS is not a rare disorder in PD, probably due not only to abnormal dopaminergic stimulation but also to serotonergic dysfunction in biologically predisposed subjects. Visual hallucinations and other concomitant psychiatric diseases, in particular depression, might represent a risk factor for the OS development.
Highlights
Introduction Psychosis inParkinson’s disease (PD) is common and consists of hallucinations, illusions, and delusions
The reasons for exclusion were the following: articles concerning deep brain stimulation (DBS) and levodopa-carbidopa intestinal gel infusion (2), neuropathology article (1), comments to other articles (3), single case reports (9; three of them were in non-English language), reviews (3; one of them was in non-English language), and article partially duplicating previously published data (1)
The mean age at PD onset was significantly lower among Othello syndrome (OS) patients in comparison to no OS (nOS) patients [12], ranging between 39 and 57 years [11, 13, 15], whereas the OS onset was between 49 and 77 years [11, 13–15] (Table 1)
Summary
Parkinson’s disease (PD) is common and consists of hallucinations, illusions, and delusions. Among the latter, delusional jealousy, named Othello syndrome (OS), might impair the quality of life of both patients and their partners. Psychosis in PD (PDP) has a lifetime prevalence of 47– 60% and is characterized by minor phenomena, as “presence and passage hallucinations” (patients feel that someone or something indefinite is nearby or fleeting shadows pass by them), formed visual and other sensory modality hallucinations with or without insight, and delusions, which are fixed false beliefs [2, 3]. Risk factors for PDP development have consistently shown to be cognitive impairment, attention, executive, and visuospatial skill dysfunction, REM behavior disorder (RBD), dopaminergic and anti-cholinergic treatment, and Glucocerebrosidase gene mutations, whereas association with older age and late onset of disease seems to be unconfirmed [3].
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