Delusional Jealousy and Localized Cerebral Pathology

Case Report

The patient, a 74-year-old right-handed former carpenter with no psychiatric history, was admitted to our hospital because of delusions of jealousy. In 1992 and 1993 he had suffered from three right hemisphere cerebrovascular infarctions. Various CT scans indicated lesions to both the paraventricular areas and in the thalamus, which resulted in a mild dementia syndrome and a partial left hemiparesis. In 1993 a resection of the prostate due to an adenocarcinoma and an additional plastic orchiectomy had to be undertaken. Following a thalamic infarction on the right side, the patient accused his wife of infidelity and attacked her with a knife. After admission to a psychiatric ward the patient was found to have vivid delusions of jealousy, depressive mood, and moderate cognitive impairment. After low-dose neuroleptic treatment (200 mg thioridazine and 1 mg pimozide/day) the delusions disappeared within a few weeks' time.

As Silva and Leong⁴ pointed out, delusional jealousy has been linked to various organic disorders, including metabolic disturbances, Alzheimer's disease, encephalitis, and substance abuse, among others. In most cases of organic Othello syndrome no clear association with lateralized brain dysfunction can be established, but the subject warrants further study. Richardson et al.⁵ reported a case of Othello syndrome following right cerebrovascular infarction, and Silva and Leong⁴ described the case of a 48-year-old man with delusions of infidelity following left frontal lobe infarction. In the case described, the development of delusional jealousy closely followed a thalamic infarction, and symptoms of cognitive impairment were obvious. However, the additional role of psychological stress or physical impairment (impotence or urogenital disorder as in the case described) must also be emphasized.^2,3 Since there is an excessive prevalence of delusional jealousy in organic mental disorders, future research should focus on pathology of certain brain areas in the development of the syndrome.

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