Another Major Syndrome of the Minor Hemisphere Othello Syndrome
Abstract & Commentary
By John J. Caronna, MD, Professor of Clinical Neurology, Weill Cornell Medical College. Dr. Caronna reports no financial relationships relevant to this field of study.
Synopsis: Neurological disease affecting the non-dominant frontal lobe has been associated with a syndrome of "delusional jealousy," referred to as Othello syndrome.
Source: Graff-Radford, J, et al. Clinical and imaging features of Othello's syndrome. Eur J Neurol 2012;19:38-46.
The left hemisphere has been termed the "major or dominant" hemisphere because of its linguistic and lexical abilities. The term "minor," however, does not do justice to the right hemisphere's role in attention, in the integration of polymodal sensory information, and in emotional processes. Damage to the right hemisphere can impair the affective aspects of communication that are manifested by dysprosody, inability to abstract, loss of understanding of the figurative aspects of language, and lack of comprehension of facial expressions. Other "syndromes of the right hemisphere" include unilateral spatial neglect, topographical disorientation, anosognosia, misidentification syndromes, and neuropsychiatric disorders.1
The delusion of infidelity of a spouse or lover, also called delusional jealousy, has been termed Othello syndrome (OS) after the character in Shakespeare's play. OS has been associated with psychiatric conditions, but occurs more commonly in neurological disorders including stroke, brain trauma, brain tumor, neurodegenerative disease, normal pressure hydrocephalus, endocrinopathy, and dopaminergic drug use.2
In the present study, a retrospective case review, the authors sought to document the clinical and MRI features of OS. One hundred and five patients with delusional jealousy were identified in the medical records of the Mayo Clinic. The average age at onset was 68 years (range 25-94), and 62% of the patients were men. OS was associated with a neurologic disorder in 73 (69.5%) and with a psychiatric condition in 32 (30.5%).
Of the 73 patients with a neurologic disorder, 56 (77%) had a neurodegenerative disorder: 20 had diffuse Lewy Body disease, six had Parkinson's disease (PD), and three had PD with dementia. Six patients with PD without dementia developed OS after starting or increasing the dose of dopamine agonists. One other patient developed drug-induced OS after increasing the dose of valproic acid. Symptoms of OS resolved after decreasing the dose. Eight patients with OS had structural lesions (meningioma, stroke, encephalomalacia, subdural or cerebral hemorrhage), and seven of them had right frontal pathology.
The authors conclude that OS occurs more frequently in neurologic than in psychiatric disorders, and this delusion is associated with dysfunction of the frontal lobes, especially the right frontal lobe.
Commentary
A delusion is a fixed, idiosyncratic belief that is held to, despite evidence or arguments brought against it. Delusions usually are taken to indicate mental illness; for example, the delusions of grandeur or persecution in schizophrenics and the delusions of unworthiness in depressed patients.
In contrast, Othello Syndrome, like the Capgras and Fregoli misidentification syndromes, is due to organic causes: dopaminergic hyperactivity or defective information processing due to a brain lesion in the right hemisphere. Unlike the aphasic syndromes of the left hemisphere and the misidentification syndromes of the right, both of which have been explained in terms of "disconnection syndromes," the Othello Syndrome has yet to be interpreted in terms of a neuroanatomical map. Therefore, although the syndrome has been associated with lesions of the right frontal lobe, the association remains more phrenological than physiological. The right hemisphere specific syndromes remain an area of active neuroscience research.
By now, most readers will have come to the conclusion that Othello, in fact, did not have his eponymous syndrome. Othello was deceived rather than deluded about Desdemona's alleged infidelity. Therefore, those who prefer to use the term "delusional jealousy" rather than "Othello syndrome" are encouraged to do so.
References
1. Carota A, et al. Major syndromes of the minor hemisphere. EMC – Neurologie 2005;2:475-504.
2. Cummings JL. Organic delusions: Phenomenology, anatomical correlations, and review. Br J Psychiatry 1985;146:184-197.
Neurological disease affecting the non-dominant frontal lobe has been associated with a syndrome of "delusional jealousy," referred to as Othello syndrome.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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