Objective: To assess the prevalence of Othello syndrome amongst patients with Parkinson’s disease in a rural based movement disorders clinic. 

Background:  Othello syndrome (OS) is an organic delusional disorder with prevailing jealousy symptoms presumably appearing as side effect of anti-parkinsonian therapy.

Methods: 186 patients with Parkinson’s disease attending Movement Disorders Clinic of Shree Krishna hospital, Karamsad, Gujarat, India, from January 2012 to June 2016, were reviewed for presence of Othello syndrome .Othello syndrome was diagnosed on the basis of criteria for Delusional disorder of jealous type DSM4-TR classification.

Results: 5 patients were identified to have Othello syndrome.  All these patients were males [mean age 44], with young onset Parkinson’s disease [YOPD] with Hahn and Yahr stage 3 disease.  They all had delusion of infidelity by their spouse, associated with accompanying jealousy, attempts at monitoring and control, and violence. These symptoms had developed in absence of any delirium, encephalopathy or intoxication. In 2 patients, the symptoms began after increase in the levodopa to >/= 500 mg /day. One patient developed symptoms on increasing pramipexole >2.0 mg/day while 2 patients had it after addition of amantadine. All of them had erectile dysfunction leading to feeling of guilt as well as shame, leading to genesis of thoughts of infidelity by the spouse.  All these patients improved after multipronged approach including counselling, reduction in the dose of levodopa or dopa agonist and addition of 50-100mg/day of quetiapine.

Conclusions: OS is a very disturbing, often underestimated, symptom predominantly in males with YOPD, with erectile dysfunction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/othello-syndrome-amongst-patients-with-parkinsons-disease-in-a-rural-movement-disorders-clinic-in-western-india/