The Finer Points of Delusional Jealousy

June 5, 2015

Although delusional jealousy was described as an initial symptom in Alois Alzheimer’s first case report, little is known about its clinical features and prognosis in dementia.

Delusional jealousy in patients with dementia may signal dementia with Lewy bodies disease, according a team of neuropsychiatrists.1 Delusional jealousy is an organic psychotic syndrome characterized by a pathologic belief in the infidelity of one’s spouse or partner. Although delusional jealousy was described as an initial symptom in Alois Alzheimer’s first case report of Alzheimer disease (AD), information about its clinical features and prognosis in dementia is lacking.

The team compared prevalence of delusional jealousy, also known as Othello syndrome, in 208 outpatients with various forms of dementia. Among the study population, 127 (61%) patients had AD; 38 (18%) dementia with Lewy bodies; and 21 (10%) vascular dementia. Frontotemporal lobar degeneration, idiopathic normal pressure hydrocephalus, progressive supranuclear palsy, and corticobasal degeneration were each diagnosed in fewer than 3% of patients. Diagnoses were based on DSM-III-R criteria.

In all, delusional jealousy was identified in 18 (9%) patients. In addition to comparing patient characteristics of the entire group, patients with delusional jealousy and their primary caregivers were interviewed. The interviews assessed presence of coexisting psychiatric symptoms (eg, hallucinations, other delusions, or depression); severe physical disorders (defined as requiring hospitalization or severely affecting activity of daily living); aggressive behavior; past history of infidelity by the spouse; health of the spouse; and whether the spouse was frequently absent from the home.

The researchers ultimately found that prevalence of delusional jealousy was significantly higher among patients with dementia with Lewy bodies than patients with AD (P < .01). Whereas 7 (6%) of patients with AD had delusional jealousy, 10 (26%) patients with dementia with Lewy bodies were affected. Delusional jealousy was identified in 5% of patients with vascular dementia.

No significant differences between patients with and without delusional jealousy were identified regarding sex, age, education, presence of other persons living in the home, or Mini-Mental State Examination score. However, the researchers observed that delusional jealousy was preceded by the onset of serious physical illness, including cancer, aortic aneurysm, and femoral neck fracture, in nearly half of affected patients. Among patients with delusional jealously, outstanding features particular to those with dementia with Lewy bodies were visual hallucinations and misidentification of familiars, affecting 8 (80%) of the 10 patients in this subset.

Delusional jealousy resolved within 12 months after pharmacotherapy in 15 (83%) of the 18 patients. (Pharmacotherapy generally consisted of an atypical neuroleptic, which was given with or without donezapil in the patients who had dementia with Lewy bodies.) Outcomes, according to the study researchers, suggested that prognosis of delusional jealousy in demented patients is relatively benign.

References:

1. Hashimoto M, Sakamoto S, Ikeda M. Clinical features of delusional jealousy in elderly patients with dementia. J Clin Psychiatry. 2015 Apr 28. [Epub ahead of print] http://www.psychiatrist.com/JCP/article/Pages/2015/aheadofprint/14m09018.aspx. Accessed June 4, 2015.