Her parathyroid level varied between 24 and 30 pmol/L. On investigations her corrected calcium was found to be consistently between 3 to 3.4 mmol/litre. Her neck felt entirely normal on palpation. In particular central nervous system examination revealed no focal neurological signs. Her physical examination was unremarkable. She described herself as feeling very well and in particular she denied any bone pain, aches, constipation, polyuria, polydipsia or cognitive problems. She was commenced on the atypical antipsychotic quetiapine and the sedating antidepressant mirtazepine however as she believed that there was nothing wrong with her, her compliance was poor. Cognitive impairment was noted and she was referred to a Day Hospital for a Memory Disorders assessment, however she refused to attend. She was assessed by a psychiatrist on a domiciliary visit at the request of her general practitioner where a diagnosis of the Othello Syndrome was made. She was self caring but increasingly relied upon her husband to undertake the majority of activities of daily living such as cleaning, cooking and shopping. She began to loose weight and appeared sullen, low in mood and irritable. This appeared insidious in onset and slowly progressive. Over the previous 12 to 18 months her family had noticed that she was becoming increasingly forgetful. She had no past psychiatric history or history of alcohol abuse or learning disability. Her daughter agreed explaining that he had recovered from a myocardial infarction and he rarely socialised. Her husband vehemently denied the accusation stating that it was absurd. In the month preceding admission she was increasingly agitated and aggressive towards her husband. She began to act on her belief system accusing her neighbours of “covering up for him”. She had developed the delusional belief that her husband was having an affair with a neighbour. The case represents the first complete report of Othello syndrome in association with hypercalcaemia secondary to primary hyperparathyroidism.Ī 75 year old lady was admitted to an acute old age psychiatric unit detained under Section 3 of the Mental Health Act 1983. We present the case of a previously happily married elderly woman who developed the delusion of her husband's infidelity while at the same time demonstrating evidence of cognitive impairment. While most reports of Othello Syndrome have not included adequate neurological evaluation it has been estimated that in at least 30% of cases in the recent literature most probably had a neurological basis for their delusion of infidelity 9. Organic causes of delusional jealousy have also been described 3, 5, 6, 7, 8. It is thought to occur most often in association with chronic alcoholism and as a feature of affective disorders and schizophrenia 3. Non psychotic jealousy has also been seen as a part of a narcissistic or paranoid personality disorder4. It has also been referred to as pathological, morbid or delusional jealousy and describes a content specific delusion characterised by the unshakeable false belief of the spouse's infidelity 2, 3. The term Othello Syndrome was first coined by John Todd in 19551. The Othello Syndrome in association with Primary Hyperparathyroidism This case highlights the first complete report of Othello syndrome in association with primary hyperparathyroidism. She was concomitantly diagnosed with primary hyperparathyroidism. We present the case of an elderly woman who developed the delusion of her husband's infidelity while at the same time demonstrating evidence of cognitive impairment. Othello syndrome is a content specific delusion characterised by the unshakeable false conviction of the spouse's infidelity and can arise from a number of psychiatric and organic disorders. Othello Syndrome in association with Primary Hyperparathyroidism Goggins, Emerson and Nowers Abstract
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