![]() ![]() Given that neurodegenerative disorders are associated with cerebral atrophy, we used Voxel-based morphometry (VBM)( 17) to assess patterns of grey matter loss in the OS patients that had a neurodegenerative disorder and a T1-weighted volumetric MRI performed after the onset of OS as previously described.( 18) These neurodegenerative patients were matched by age and gender to patients that had the identical clinical diagnoses but no evidence of delusions on the Neuropsychiatric Inventory (NPI),( 19) and to healthy controls. The group of patients with diseases, where Lewy bodies are the predominant pathology included the following subtypes: dementia with Lewy bodies (DLBD), Parkinson's disease (PD) and Parkinson's disease with dementia (PDD).( 15, 16) There are approximately thirty two inpatient adult neurology beds and fifty five inpatient psychiatric beds available. diagnosis): psychiatric, drug-related, neurodegenerative (Alzheimer disease (AD), Lewy body disease (LBD) and behavioral variant of frontotemporal dementia (bvFTD)), vascular dementia and focal lesions. ![]() This study was approved by the Mayo Clinic Institutional Review Board in Rochester, Minnesota.Īll 105 subjects were initially divided into the following groups for comparison based on the context of the occurrence of the delusion of infidelity (i.e. Clinical data were abstracted in all 105 cases that met our inclusion criteria, including age at onset of delusion of infidelity, age at onset of first neurological sign/symptom, gender, description of the infidelity delusion, first and final clinical diagnosis, treatment and response to treatment of the infidelity delusion, physical findings on examination, behavioral or personality changes, hallucinations and other delusions. These were cases in which either OS was incorrectly used or the delusion did not involve infidelity or jealousy. Cases not meeting criteria (n=80) were excluded. Specifically, the delusion had to be one of infidelity or jealousy, clearly stated in the medical records and described. These medical records were reviewed to determine whether the patient met inclusion criteria for OS. Given this approach, any case where the delusion was mentioned as present or absent by the examining physician was identified (n=185). Using a text word search for “Othello” or “Delusions and Infidelity” or “Delusions of Jealousy or Infidelity”, the Mayo Clinic Medical Records Linkage system was used to identify patients with possible OS who were evaluated at our institution in any department between January 1 st, 1998 and October 31 st, 2009. The aim of the study was to investigate clinical and imaging characteristics of OS in patients with different neurological and psychiatric conditions. While cases reports and small cases series have associated OS with neurological and psychiatric diseases, there are no comprehensive studies on a large series of patients with OS. In one study assessing the prevalence of delusional jealousy in psychiatric patients, delusional jealousy was most frequently associated with an organic cause.( 6) ![]() Several case reports have suggested that the right frontal lobe is the neuroanatomical correlate for OS( 9– 12) although, others have reported thalamic and left frontal lobe lesions.( 13, 14) There are no quantitative imaging studies on OS. OS has been associated with psychiatric and neurological disorders including strokes, brain trauma, brain tumors, neurodegenerative disorders, encephalitis, multiple sclerosis, normal pressure hydrocephalus, endocrine disorders, and drugs.( 1– 8) Many of these reports, however, have been single case reports or small case series. Othello's syndrome (OS), named after the character in Shakespeare's play refers to the delusion of infidelity of a significant other, which is sometimes used interchangeably with delusional or morbid jealousy. ![]()
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