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Emergence of Othello Syndrome (Morbid Jealousy) in the Context of Executive Dysfunction and Stroke

Graham Blackman1,2*, Elina Ziukelis2,3, Florian Ruths2, Joerg Ederle4, Jacob Bird5, Lina Nashef4, Sylvia Hejda Forde3, Vaughan Bell3,6, David Okai2,3,7

Morbid jealousy is a pathological state in which an individual becomes convinced that their partner has become unfaithful. Morbid jealousy can emerge as either part of a primary psychiatric disorder or secondary to an underlying medical condition. We report a 46-year-old male who presented with Othello syndrome and depression 24 years after a left frontotemporal haemorrhagic stroke complicated by epilepsy. Neuropsychological assessment identified evidence of executive dysfunction. Antipsychotic and antidepressant medication, alongside Cognitive Behaviour Therapy (CBT) resulted in full remission of his delusions of jealousy and associated psychiatric symptoms. Neuropathological and neuropsychological factors in the case are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning morbid jealousy remain elusive, the case illustrates the potential role of executive dysfunction in the aetiology of morbid jealousy.