Othello syndrome in Parkinson's disease: A diagnostic emergency of an underestimated condition

Otmani, Hicham El; Sabiry, S.; Bellakhdar, Salma; Moutawakil, Bouchra El; Rafai, M.A.

doi:10.1016/j.neurol.2020.08.006

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…For some, both syndromes are assimilated to 'hyperdopaminergic' behaviours sharing the same physiopathology of hyperstimulation of limbic circuits of the basal ganglia, coupled with a lack of cortical inhibition. 10 Our patient took levodopa and had been suffering from DDS for a long time before showing delusional symptoms. It is thought that in DDS, sensitisation of the mesolimbic circuitry perhaps creates incentive salience to dopamine replacement therapy.…”

Section: Discussionmentioning

confidence: 87%

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Othello syndrome and dopamine dysregulation syndrome

Masmoudi,

Derbel,

Cherif

et al. 2024

Prog Neurol Psychiatry

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Othello syndrome is a paranoid delusional jealousy characterised by false absolute certainty of the infidelity of a partner, leading to preoccupation with a partner's sexual unfaithfulness based on unfounded evidence. Here, we present a case of Othello syndrome comorbid to dopamine dsyregulation syndrome in a patient suffering from juvenile Parkinson's disease. The case investigates the relationship between compulsive levodopa use and delusional jealousy, the serious consequences of these conditions and the difficulty in patient management.

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Section: Discussionmentioning

confidence: 87%

“…The link of causality remains to be determined. For some, both syndromes are assimilated to ‘hyperdopaminergic’ behaviours sharing the same physiopathology of hyperstimulation of limbic circuits of the basal ganglia, coupled with a lack of cortical inhibition 10 …”

Section: Discussionmentioning

confidence: 99%

Othello syndrome and dopamine dysregulation syndrome

Masmoudi,

Derbel,

Cherif

et al. 2024

Prog Neurol Psychiatry

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“…The network analysis identified meaningful clusters, such as delusional jealousy (also known as Othello syndrome [56]) and dopamine dysregulation syndrome (i.e., the excessive use of Anxiety and economic problems emerged as pivotal events that could be potentially targeted to disrupt the chain of events and alleviate the burden of drug-induced impulsivity: for instance, monitoring and effectively managing anxiety or providing financial guidance or legal guardianship to prevent wasteful spending. Since marital problems affect caregivers' QoL and increase the risk of early placement in nursing homes [22], addressing delusional jealousy and economic problems, identified as factors preceding marital problems, may be critical for preserving wellbeing in pramipexole recipients.…”

Section: Summary and Key Resultsmentioning

confidence: 99%

“…Disproportionality analysis revealed features of the impulsivity syndrome for each scenario, encompassing mainly psychosocial events but also organic conditions. Network analysis identified sub-syndromes such as delusional jealousy (also known as Othello syndrome 55 ) and dopamine dysregulation syndrome (i.e., the excessive use of levodopa) in pramipexole recipients, and obesity- hypoventilation syndrome (historically Pickwickian syndrome) and social issues in aripiprazole recipients. The Bayesian Network highlighted directional associations, potentially suggesting secondary consequences of drug-induced impulsivity.…”

Section: Discussionmentioning

confidence: 99%

“…The network analysis identified meaningful clusters, such as delusional jealousy (also known as Othello syndrome [56]) and dopamine dysregulation syndrome (i.e., the excessive use of levodopa) in pramipexole recipients, and obesity-hypoventilation syndrome (historically Pickwickian syndrome) and social issues in aripiprazole recipients. In particular, employing more sensitive network analyses like Phi and PPMI generated more interconnected networks, which identified potential macro-clusters combining several smaller clusters identified by the Ising model.…”

Section: Discussionmentioning

confidence: 99%

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Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System

Fusaroli,

Polizzi,

Menestrina

et al. 2023

Preprint

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IntroductionAdverse drug reactions significantly impact patients’ lives, yet their influence is often underestimated in treatment decisions and monitoring. Impulsivity induced by dopaminergic agents can lead to impaired social functioning and quality of life.AimThis study assesses impulsivity burdens from pramipexole and aripiprazole, pinpointing key symptoms for targeted mitigation.MethodLeveraging data from the FDA Adverse Event Reporting System (January 2004 - March 2022), we employed the Information Component to identify the syndrome of signs and symptoms disproportionately co-reported with drug-induced impulsivity. Using composite network analyses (PPMI, Ising,ϕ) we characterized clusters of co-reported events (i.e., subsyndromes). Finally, we assessed the secondary impact of drug-induced impulsivity modeling our dataset as a chain of directed connections (Bayesian network).ResultsThe drug-induced impulsivity syndrome (respectively 56 and 107 events in pramipexole and aripiprazole recipients), primarily encompassed psychiatric, social, and metabolic events, segregated into subsyndromes such as delusional jealousy and dopamine dysregulation syndromes among pramipexole recipients, and obesity-hypoventilation syndrome and social issues among aripiprazole recipients. Anxiety and economic problems emerged as pivotal nodes in the exacerbation of the syndromes.ConclusionDrug-induced impulsivity places a substantial burden on patients and their families, with manifestations shaped by the underlying disease. Network approaches, exploring intricate symptom connections and identifying pivotal symptoms, complement traditional techniques and clinical judgment, providing a foundation for informed prescription and targeted interventions to alleviate the burden of adverse drug reactions.

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Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System

Fusaroli,

Polizzi,

Menestrina

et al. 2024

Drug Saf

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Introduction Impulsivity induced by dopaminergic agents, like pramipexole and aripiprazole, can lead to behavioral addictions that impact on social functioning and quality of life of patients and families (e.g., resulting in unemployment, marital problems, anxiety). These secondary effects, interconnected in networks of signs and symptoms, are usually overlooked by clinical trials, not reported in package inserts, and neglected in clinical practice. Objective This study explores the syndromic burden of impulsivity induced by pramipexole and aripiprazole, pinpointing key symptoms for targeted mitigation. Methods An event-event Information Component (IC) on the FDA Adverse Event Reporting System (FAERS) (January 2004 to March 2022) identified the syndrome of events disproportionally co-reported with impulsivity, separately for pramipexole and aripiprazole. A greedy-modularity clustering on composite network analyses (positive pointwise mutual information [PPMI], Ising, Φ ) identified sub-syndromes. Bayesian network modeling highlighted possible precipitating events. Results Suspected drug-induced impulsivity was documented in 7.49% pramipexole and 4.50% aripiprazole recipients. The highest IC concerned obsessive-compulsive disorder (reporting rate = 26.77%; IC median = 3.47, 95% confidence interval [CI] = 3.33–3.57) and emotional distress (21.35%; 3.42, 3.26–3.54) for pramipexole, bankruptcy (10.58%; 4.43, 4.26–4.55) and divorce (7.59%; 4.38, 4.19–4.53) for aripiprazole. The network analysis identified delusional jealousy and dopamine dysregulation sub-syndromes for pramipexole, obesity-hypoventilation and social issues for aripiprazole. The Bayesian network highlighted anxiety and economic problems as potentially precipitating events. Conclusion The under-explored consequences of drug-induced impulsivity significantly burden patients and families. Network analyses, exploring syndromic reactions and potential precipitating events, complement traditional techniques and clinical judgment. Characterizing the secondary impact of reactions will support informed patient-centered decision making. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-024-01471-z.

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Othello syndrome in Parkinson's disease: A diagnostic emergency of an underestimated condition

Cited by 8 publications

References 14 publications

Othello syndrome and dopamine dysregulation syndrome

Othello syndrome and dopamine dysregulation syndrome

Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System

Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System

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