DATE: July 05, 2025 at 06:00PM
SOURCE: PSYPOST.ORG

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TITLE: Othello syndrome: Woman’s rare stroke leads to psychotic delusions of infidelity

URL: psypost.org/othello-syndrome-w…

A recently published case report in the journal Neurocase describes an unusual and distressing psychiatric condition that developed in a 50-year-old woman shortly after a stroke. With no history of mental illness, she suddenly became consumed by the belief that her husband was unfaithful—an unshakable conviction that ultimately escalated into violence. Doctors diagnosed her with Othello syndrome, a rare form of psychosis involving delusional jealousy. The case sheds light on how specific types of brain damage can dramatically alter perception, emotion, and behavior.

Othello syndrome is a rare psychiatric disorder characterized by the fixed, false belief that a partner is being unfaithful. This belief persists despite clear evidence to the contrary. Named after the jealous protagonist in Shakespeare’s Othello, the condition is a form of delusional jealousy, a subset of psychotic disorders.

While jealousy is a common human emotion, it becomes pathological when it is based on no real evidence, dominates the person’s thoughts, and results in harmful behavior. Othello syndrome has been observed in people with psychiatric disorders, substance use problems, and some neurological conditions. In rare cases, it can emerge after a stroke, particularly when the stroke affects brain regions involved in judgment, emotional regulation, and attention.

The woman described in the case report had lived a stable life with her husband for over 30 years. She had no history of psychiatric illness, substance abuse, or previous strokes. The only known health issue was hypertension, which had not been adequately controlled. One day, while preparing a meal, she experienced a sudden, intense headache followed by confusion and memory problems. These symptoms led her to seek emergency medical care.

Magnetic resonance imaging revealed that she had experienced a rare type of stroke known as a bilateral paramedian thalamic infarct. This type of stroke is caused by a blockage in a unique artery known as the artery of Percheron. Instead of supplying only one side of the brain, this artery provides blood to both sides of a deep brain structure called the thalamus. In her case, the damage was more pronounced on the right side. The thalamus plays a key role in regulating attention, emotion, and the integration of sensory and cognitive information. When this area is damaged, it can have far-reaching effects on a person’s behavior and personality.

During her hospital stay, the woman was sometimes agitated, experienced visual hallucinations, and had trouble moving her eyes vertically—symptoms consistent with damage to the thalamus. After about two weeks, she was discharged from the hospital. Only a few days later, she began accusing her younger sister of having an affair with her husband. The accusations came out of nowhere, as her sister had only come to visit after the hospital stay. The woman told friends and family that her husband’s supposed infidelity was the cause of her illness. Over time, her suspicions shifted. She no longer accused her sister, but now believed her friend’s daughter was involved with her husband.

Her behavior became increasingly erratic. She would try to check her husband’s phone without his knowledge. She stayed up late watching him, sometimes waking him in the middle of the night to accuse him of cheating. These outbursts escalated into two separate violent incidents in which she attacked him with a bladed weapon. Although she later denied these attacks, her jealousy remained intense and unrelenting.

A psychiatric evaluation revealed signs of cognitive decline, such as impaired memory, reduced attention span, and a narrowed focus on her jealous suspicions. On two common cognitive screening tools—the Mini-Mental State Exam and the Montreal Cognitive Assessment—she scored well below the threshold for normal function. The clinicians ruled out other possible causes, such as dementia, drug intoxication, or metabolic disorders. The timing of her symptoms and brain imaging supported the conclusion that her psychiatric symptoms were linked to the stroke. Doctors diagnosed her with Othello syndrome stemming from her thalamic infarct.

She was initially treated with quetiapine, an antipsychotic medication, which appeared to improve her symptoms for a few months. But she relapsed, and her jealous beliefs returned with the same intensity. Her care team then switched her to another antipsychotic, olanzapine, which led to much greater improvement. Over the course of the following year, she continued to take the medication at a reduced dose, with no reappearance of symptoms. She eventually recognized that her past beliefs were false, and she no longer viewed her husband with suspicion.

Although this case is striking, it is not without precedent. Psychotic symptoms can emerge after a stroke, although they are far less common than anxiety or depression. Among people who develop post-stroke psychosis, delusional jealousy is one of the more frequently observed subtypes. The brain regions most commonly associated with these delusions include areas of the right hemisphere, particularly the frontal and parietal lobes, as well as the thalamus.

The thalamus acts as a central relay station in the brain. It connects with both cognitive regions, such as the prefrontal cortex, and emotional areas, such as the limbic system. Damage to the thalamus, particularly on the right side, can disrupt networks responsible for attention, self-monitoring, and emotional processing. This kind of disruption can impair judgment and heighten suspicious thoughts. In this case, the patient’s stroke likely disrupted the normal communication between brain regions responsible for interpreting social cues and regulating emotional responses, paving the way for delusional jealousy.

The researchers emphasized that the patient’s test results showed no signs of underlying dementia or small vessel disease. This helped rule out alternative explanations for her cognitive problems. Instead, the stroke itself appeared to be the primary cause of her psychiatric symptoms. The selective damage to her thalamus seemed to explain not only her delusional thinking but also her memory and attention problems.

This case also illustrates how Othello syndrome can pose a danger not only to mental well-being but to physical safety. The woman’s false beliefs led to violent behavior against a loved one. Because of the risks associated with this syndrome, recognizing the signs early and initiating treatment is essential.

At the same time, the authors of the study acknowledged the limitations of a single case. Case reports cannot establish how common a condition is or how often it is caused by a particular type of brain injury. Nor can they predict how other individuals might respond to the same treatment. Each brain injury is unique, and many factors influence how symptoms develop and change over time.

However, case studies remain a valuable part of medical science. They allow researchers and clinicians to document rare conditions, identify patterns, and generate hypotheses that can later be tested in larger studies. In particular, unusual cases like this one can help draw attention to the diverse ways that brain injury can manifest—not just as physical or cognitive disability, but also as profound changes in personality and behavior.

The study, “Jealousy’s stroke: Othello syndrome following a percheron artery infarct,” and Ghita Hjiej, Maha Abdellaoui, Hajar Khattab, Kamal Haddouali, Salma Bellakhdar, Bouchera El Moutawakil, Mohammed Abdoh Rafai, and Hicham El Otmani.

URL: psypost.org/othello-syndrome-w…

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