8/13/2023 0 Comments Morbid jealousy syndromeShe decided to leave their home, but the patient still called threatening her. The patient missed an appointment and his wife came to describe his symptoms in the last month: he had become progressively more defiant and refusing to take oral medication, arguing that it made him forget her infidelities. Nine months after discharge, stabilized with risperidone 1 mg, the psychotic symptoms re-emerged. We stopped the injectable antipsychotic and slowly introduced oral risperidone. The patient was discharged in an ambulatory involuntary treatment regime.ĭuring the first months home, he presented symptomatic episodes of hypotension. As it was not possible to ensure he would continue medication, we prescribed 25 mg/mL long-acting injectable risperidone as ambulatory treatment. He showed progressive affective distancing from the delusional content but maintained doubts about his wife's fidelity. The patient was treated with risperidone, titrated to 2 mg/day. The Montreal cognitive assessment (MoCA) test quoted 27/30. His wife referred that since a year ago her husband waited for her when she came home after work, examined her underwear and, sometimes, she saw his car surveilling her workplace.Īt admission, all blood tests, including serologies and vitamins, were in the normal range, and the cerebral computed tomography did not show changes. Based on neutral signals in his wife behaviour (small routine changes, to greet a man on the subway or to return home in a co-worker's car) and suspicious feelings, he created the irreducible idea that she was betraying him with several men. The patient had an involuntary admission to a psychiatric inward due to threats of physical aggression with an axe to his wife in the context of irreducible ideas of her infidelity. He described himself as not very sociable and careful to trust others. He consumed 12 g of alcohol per day and denied (confirmed by his relatives) past or current abuse of substances. Relevant personal medical history included the diagnosis of hypertension, overweight and benign prostatic hyperplasia. Until his first admission to the Psychiatric department, the patient had no psychiatric history. The patient is a 76-year-old man, currently retired and living with his wife. In order to protect confidentiality, we do not reveal information that could easily identify him. The patient consented to the publication of this clinical case. 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. 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.
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