When connections between them are disrupted, you see these strange delusions and behaviors.” “There’s something unique about the right frontal and the right temporal lobes. “Damage to the right frontal lobe seems to be associated with lot of unusual and strange behaviors,” Josephs said. The data supported what has long been assumed -that Othello syndrome emerges from neurological disorders that frequently produce dysfunction in the right frontal lobe. They found that 73 of the patients with Othello syndrome had an overt neurological disorder such as Lewy body dementia, a tumor, or a stroke, usually involving the right frontal lobe the remaining 32 had psychiatric disorders such as delusions, depression, or schizophrenia.
I thought, if I have seen two patients with this, and everyone else sees two, no one would ever notice the connection, but when you pull 100 patients together into one study, you really have some valuable data.”īy drawing on electronic records available at the Mayo Clinic, Josephs assembled information on 105 cases of Othello syndrome for a study he and his colleagues recently published in the European Journal of Neurology. “I reviewed the literature and came across Othello syndrome, which described my patient. The man was a bundle of impulse control disorders, a recognized side-effect of dopamine agonists given to Parkinson’s patients to boost their inadequate levels of dopamine, but Josephs had never seen the drugs produce such an intense belief in a spouse’s infidelity. He also lost $3,000 while trying to satisfy a sudden urge to gamble, and came home one day with two new fishing poles even though he already owned five. He obsessively watched the driveway because he expected to find a car parked there, waiting to pick up his wife so she could go off and have sex. Under the influence of these drugs, the man started to accuse his wife of having an affair.
The man also was taking a combination of carbidopa and levodopa, which work together to boost levels of dopamine in the brain. “It’s as though a man decides, ‘My wife is having an affair, and no one is going to talk me out of believing that.’”Īs an illustration, Josephs describes a 42-year-old man with Parkinson’s disease who started to demand frequent sex from his wife while he was taking pramipexole, a drug that binds to dopamine receptors and mimics the action of dopamine. “I think of Othello syndrome as a delusion -an abnormal thought, sort of like believing in aliens,” said Josephs, winner of the 2009 Judson Daland Prize for outstanding achievement in patient-oriented research.
The sheer strangeness of Othello syndrome aroused the curiosity of Keith Josephs, a professor of neurology at the Mayo Clinic College of Medicine in Rochester, Minn. In rare cases the treatment, which attempts to boost dopamine levels, brings on this stubborn delusion, which can transform a previously trusting relationship into a nightmare of suspicion, bitterness, and relentless accusations of infidelity. Now, however, it appears that the syndrome may also result from medication intended to restore fluent movement to people with Parkinson’s disease, whose muscles have become slow and rigid because a region of their brain known as the substantia nigra has stopped producing sufficient levels of the neurotransmitter dopamine. A stroke, a tumor, or some other injury, especially to the right frontal lobe, may produce delusional jealousy so intense that it leads to violence or divorce. Othello syndrome -the delusional belief that one’s partner is having sexual relations with someone else -has long been recognized as a product of brain damage.
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