Othello

The term Othello Syndrome was first coined by John Todd in 19551. 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. Non psychotic jealousy has also been seen as a part of a narcissistic or paranoid personality disorder4. It is thought to occur most often in association with chronic alcoholism and as a feature of affective disorders and schizophrenia 3. Organic causes of delusional jealousy have also been described 3, 5, 6, 7, 8.

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.

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. The case represents the first complete report of Othello syndrome in association with hypercalcaemia secondary to primary hyperparathyroidism.

Case report

A 75 year old lady was admitted to an acute old age psychiatric unit detained under Section 3 of the Mental Health Act 1983. She had developed the delusional belief that her husband was having an affair with a neighbour. She began to act on her belief system accusing her neighbours of "covering up for him". In the month preceding admission she was increasingly agitated and aggressive towards her husband. Her husband vehemently denied the accusation stating that it was absurd. Her daughter agreed explaining that he had recovered from a myocardial infarction and he rarely socialised. She had no past psychiatric history or history of alcohol abuse or learning disability.

Over the previous 12 to 18 months her family had noticed that