With this clinical case, we explore the difficulties in the pharmacological approach of delusional jealousy disorder and summarize the most recent findings in the treatment of this condition. ( 6 There is a higher prevalence in men, the age of onset is usually middle or late adulthood and there is frequent comorbidity with mood disorders, alcohol abuse and organic brain syndromes. It accounted for 11% of all delusional disorders in a large-scale community sample 5 and 8.1% in a hospital outpatient case series. Statistics on prevalence are difficult to obtain because these patients rarely seek help from a mental health professional. The available data suggests the role of altered dopaminergic activity in frontostriatal circuits and insula, as well as disturbance of reward processing and self-related processing of feelings of jealousy. ( 2ĭelusional jealousy is a subtype of delusional disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, as well as is in the International Classification of Diseases, 10th Revision. Two factors maintain jealousy: the idea of infidelity (triggered by partner's behaviour) and an individual emotional predisposition linked to personality traits (paranoid, or borderline) or concomitant psychiatric disorder. Accessed June 4, 2015.Delusional jealousy, also known as Othello syndrome, arises intuitively and is fortified by pathological interpretations, fabulations, and altered memories, forming a strong ideo-affective system of jealousy. Clinical features of delusional jealousy in elderly patients with dementia. (Pharmacotherapy generally consisted of an atypical neuroleptic, which was given with or without donezapil in the patients who had dementia with Lewy bodies.) Outcomes, according to the study researchers, suggested that prognosis of delusional jealousy in demented patients is relatively benign. Among patients with delusional jealously, outstanding features particular to those with dementia with Lewy bodies were visual hallucinations and misidentification of familiars, affecting 8 (80%) of the 10 patients in this subset.ĭelusional jealousy resolved within 12 months after pharmacotherapy in 15 (83%) of the 18 patients. However, the researchers observed that delusional jealousy was preceded by the onset of serious physical illness, including cancer, aortic aneurysm, and femoral neck fracture, in nearly half of affected patients. No significant differences between patients with and without delusional jealousy were identified regarding sex, age, education, presence of other persons living in the home, or Mini-Mental State Examination score. Delusional jealousy was identified in 5% of patients with vascular dementia. Whereas 7 (6%) of patients with AD had delusional jealousy, 10 (26%) patients with dementia with Lewy bodies were affected. The researchers ultimately found that prevalence of delusional jealousy was significantly higher among patients with dementia with Lewy bodies than patients with AD ( P <. The interviews assessed presence of coexisting psychiatric symptoms (eg, hallucinations, other delusions, or depression) severe physical disorders (defined as requiring hospitalization or severely affecting activity of daily living) aggressive behavior past history of infidelity by the spouse health of the spouse and whether the spouse was frequently absent from the home. In addition to comparing patient characteristics of the entire group, patients with delusional jealousy and their primary caregivers were interviewed. In all, delusional jealousy was identified in 18 (9%) patients. Diagnoses were based on DSM-III-R criteria. Frontotemporal lobar degeneration, idiopathic normal pressure hydrocephalus, progressive supranuclear palsy, and corticobasal degeneration were each diagnosed in fewer than 3% of patients. Among the study population, 127 (61%) patients had AD 38 (18%) dementia with Lewy bodies and 21 (10%) vascular dementia. The team compared prevalence of delusional jealousy, also known as Othello syndrome, in 208 outpatients with various forms of dementia. Jealousy was preceded by the onset of serious physical illness.This study found delusional jealousy is significantly higher among patients with dementia with Lewy bodies than in patients with AD.Delusional jealousy is an organic psychotic syndrome characterized by a pathologic belief in the infidelity of one’s spouse or partner.
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