Othello syndrome in Parkinson disease patients without dementia.
BACKGROUND
Delusional jealousy or Othello syndrome (OS) is a well-described psychiatric disorder with paranoid features reported in both organic and functional psychoses. In organic psychoses, the disorder occurs more frequently among chronic male alcoholics and in demented patients. To date, only 2 anecdotal cases of OS have been reported in Parkinson disease (PD) during dopaminergic treatment.


OBJECTIVE
To investigate the presence of OS in PD patients and to study the relationship between dopaminergic treatment, avoiding the possible influence of dementia.


METHODS
Five hundred sixty-three PD patients without dementia encountered in our movement disorders practice were included in the study. All patients who developed OS were studied. Relationships between clinical and familial history and dopaminergic therapy and OS were assessed.


RESULTS
Six patients with OS were identified. They were all male, with a relatively recent diagnosis of PD characterized by mild-moderate motor deficit. Dopaminergic treatment had been prescribed at low dosages. Neither confusional states (including agitated confusion) nor delirium were associated with OS. The disorder became manifest mainly at time of introduction/increment of antiparkinson treatment. Invariably, OS decreased or receded after reduction/suspension of the antiparkinson drug and prescription of an atypical neuroleptic, usually clozapine or quetiapine.


CONCLUSIONS
We hypothesize that nondemented PD patients affected by OS do not necessarily present with severe motor complications and may well have a biologic predisposition for psychiatric disorders. In our opinion this paranoid delusion is rarely considered in PD.
Cannas
Antonino
A
Centro per i Disordini del Movimento. Dipartimento di Scienze Cardiovascolari e Neurologiche, Sezione Neurologia. University of Cagliari, Italy.
Solla
Paolo
P
Floris
Gianluca
G
Tacconi
Paolo
P
Marrosu
Francesco
F
Marrosu
Maria Giovanna
MG
D000328:Adult; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D003702:Delusions / Q000139:chemically induced; D003704:Dementia; D003987:Dibenzothiazepines / Q000627:therapeutic use; D006801:Humans; D007578:Jealousy; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy*; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D012563:Schizophrenia, Paranoid / Q000139:chemically induced* / Q000150:complications*
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D003024:Clozapine