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Delusional Jealousy: a Brief Literature Review and a Case Report of 'Unfaithful Husband' with Sociocultural Repercussions

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Delusional Jealousy: a Brief Literature Review and a Case Report of 'Unfaithful Husband' with Sociocultural Repercussions International Neuropsychiatric Disease Journal 6(2): 1-18, 2016; Article no.INDJ.22583 ISSN: 2321-7235, NLM ID: 101632319 SCIENCEDOMAIN international www.sciencedomain.org Delusional Jealousy: A Brief Literature Review and a Case Report of 'Unfaithful Husband' with Sociocultural Repercussions Naseem Akhtar Qureshi 1*, Dalal Salem Al-Dossari 2, Abdullah Mohammad Al-Bedah 1, Sara O. Salem 2 and Abdulhameed Al-Habeeb 3 1National Center of Complementary and Alternative Medicine, Ministry of Health Riyadh, Saudi Arabia. 2King Saud Medical City, Ministry of Health Riyadh, Riyadh, Saudi Arabia. 3General Directorate of Mental Health and Social Services, Ministry of Health Riyadh, Saudi Arabia. Authors’ contributions This work was carried out in collaboration among all authors. Authors NAQ, DSAD, AMAB, SOS and AAH designed the study and wrote the protocol. Authors NAQ, DSAD and SOS preformed the statistical analysis, managed the literature search and wrote the first draft of the manuscript with assistance from authors AMAB and AAH. All authors read and approved the final manuscript. Article Information DOI: 10.9734/INDJ/2016/22583 Editor(s): (1) Vincenzo La Bella, Department of Clinical Neurosciences, ALS Clinical Research Center, University of Palermo, Italy. Reviewers: (1) Takashi Ikeno, National Center of Neurology and Psychiatry, Japan. (2) Alexandre González-Rodríguez, University of Barcelona, Spain. Complete Peer review History: http://sciencedomain.org/review-history/12478 Received 12 th October 2015 th Review Article Accepted 16 November 2015 Published 27 th November 2015 ABSTRACT Background: Pure delusional jealousy [DJL] is an uncommon disorder and is characterized by unshakable false belief of infidelity, lack of hallucination, thought disorder and mood disturbance, and not associated with alcohol or other drug abuse or any co-morbid illness. Objective: This paper aims to review qualitatively the relevant literature (2000-2015) and present a case of delusional jealousy. Case History: A 31-year-old housewife with three minor children developed an unshakable belief that her husband was having an extramarital affair since 5 years and no longer loved her. She was diagnosed with delusional jealousy and was managed with aripiprazole and brief psychotherapy. _____________________________________________________________________________________________________ *Corresponding author: E-mail: [email protected]; Qureshi et al.; INDJ, 6(2): 1-18, 2016; Article no.INDJ.22583 Within three months, most of her symptoms improved, however she developed post-psychotic depression and attempted suicide by taking 125 mg diazepam. She was immediately rushed to a private hospital and admitted to the intensive care unit (ICU). She recovered within five days and was shifted to the public hospital for the management of depression, where she was stabilized and discharged after two weeks. Conclusion: Typical and atypical antipsychotic drugs combined with psychotherapy are the main treatment options for patients with DJL with or without co-morbid physical and psychiatric disorders. Post-psychotic depression and suicide attempts, devastating biosocial consequences among patients with DJL need timely and appropriate interventions and continued follow up. Keywords: Delusional jealousy; infidelity; aripiprazole; psychotherapy; depression; suicide attempt. 1. INTRODUCTION These disorders are frequently missed in respective settings resulting in poor outcome and According to Diagnostic and Statistical Manual of poor quality of life. Phillips and colleagues Mental disorder V, delusional disorder [DD] is reported outcome of these patients: 10% patients classified into 7 types based on predominant do not improve; a third of patients (35.3%) single theme; persecutory, somatic, erotomania, improved significantly with pimozide; 49.3% of jealous, grandiose, mix and unspecified type [1]. patients tend to recover and another 40.3% Previously, we have reported several cases of improve [7]. According to Trabert, the pure form somatic delusional disorder including delusional of delusion of parasitosis (DP) is reported pregnancy [2], delusion of bromosis/olfactory commonly in female population with advancing reference syndrome [3], and novel somatic age; however DP syndrome could be found in delusion of turabosis–the conviction of body schizophrenia, affective disorder, organic continually being covered by sand from psychosis and neurotic disorder. The estimated sandstorms [4] and also reviewed the pertinent frequency of induced DP is between 5 to 15%. literature [2-4]. Therefore, we briefly shed light on Full remission attributed to a short duration of somatic delusions and then will focus on illness was reported in 50% of cases during delusional jealousy which is the main topic of this followup, pharmacotherapy further increased paper. In a recent review, Robles and colleagues remission rate by 18% [8]. Over the past two described somatic delusions in details; delusions decades, many patients with somatic DD were of parasitosis, i.e., false and fixed belief about reported in the literature who tends to improve worm-creeping like sensations under the skin; with selective serotonin reuptake inhibitors Morgellons disease, i.e., fixed and false belief (SSRIs) and cognitive behavior therapy (CBT) or that some material or fibres are imbedded or additional antipsychotic medication might be emerging from the skin; body dysmorphic required in some cases [9-17]. disorder (BDD), i.e., imagined defect in normal body appearance and it is not a psychotic 1.1 Aims, Significance and Relevance condition because of intact insight. However, a person with bodily imagined defect is highly This paper provides a narrative review and an preoccupied that gives a sense of delusion with update of relevant literature on delusional lack of insight – psychotic type; and olfactory jealousy (DJL) published after year 2000. In reference syndrome (delusions of bromhidrosis), addition, a case of DJL is presented with a focus i.e., false and fixed belief in unpleasant odor on its serious sociocultural consequences. The emanating from skin; and highlighted their significance of this study is that it will increase treatment seeking pathways [5]. Similarly, a large awareness of DJL among mental health number of young patients with psychiatric professionals in particular physicians. This diagnoses including dysmorphophobia/BDD with research will ensure early recognition of the poor social adjustment consult cosmetic disease along with timely and appropriate surgeons [6]. Furthermore, a team of researchers interventions as most recently suggested by a advocated the concept of delusional BDD to be team of researchers based on four included in DSM-5 [7]. Evidently, patients with psychopathological dimensions in terms of somatic delusions pose diagnostic and paranoid, cognitive, affective and schizoid and therapeutic challenges both for dermatologists complexity of DD [18]. Evidently, most cases of and cosmetologists who need to keep abreast DJL seek psychiatric help very late, are with these uncommon psychiatric conditions. misdiagnosed and remain untreated. Notably, 2 Qureshi et al.; INDJ, 6(2): 1-18, 2016; Article no.INDJ.22583 people with DJL largely contribute to family paranoid jealousy, jealousy disorder, delusional dysfunctions, marriage breakups, violent jealousy, Othello complex, and Othello syndrome behavior, suicide and homicide. To our are also mentioned in the literature. Jealousy is a knowledge, no case of DJL has been reported mix of various emotions including envy [20,21] form the Kingdom of Saudi Arabia. and is reported to have emotional, cognitive and behavioural components. Jealousy is categorized 1.2 Search Methods into two types; psychotic and non- psychotic/neurotic. People with neurotic type of Computer searches of several databases jealousy have no delusion or hallucinations and including PubMed/MEDLINE, Quertle® and their insight is preserved [22]. Unlike jealousy, Google Scholar (2000 to 2015) were made using envy is used in context of possession of keywords such as delusional jealousy, morbid inanimate objects [23]. There is a difference jealousy, pathological jealousy, conjugal between being jealous and being suspicious. paranoia, Othello syndrome, paranoid jealousy, Jealousy often develops as a result of perceived insane jealousy and jealousy disorder. These threat to a romantic intimate relationship and is searches retrieved thousands of references with coupled with behaviors planned to retain a abstracts [n=4370], without abstracts [n=3205], romantic partner [24]. In normal romantic full access articles [n=100], purchasable articles jealousy, it would diminish as the relationship [n=2430], unrelated articles [n=6520], and non- strengthens and partners have faith in each English language articles [n=1105]. When other. Morbidly jealous partners continue to be computer search removed words 'disorder', intensely suspicious, possessive and dominating. 'paranoid' and 'syndrome' from keywords, the In early 1920s, Sigmund Freud described three number of articles retrieved reduced grades/layers of jealousy which are normal or considerably [n=1230]. All these articles were competitive, projected and delusional jealousy screened with a focus on delusional jealousy. [quoted from 18]. Interestingly homosexual Articles related to single case report (level D), delusional jealousy, i.e., 'the phantom other' is a case series (level C), case-controlled person of the same gender as the individual
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