A diagnosis of OS is infrequent in PD patients, but its occurrence may have severe consequences. In a cross-sectional study of ICDs and OS in 1063 PD patients, 81 of them presented with ICDs (7.61%) and 23 presented with OS (2.16%), while 9 patients presented with both OS and ICDs.
The most recent update on treatments for non-motor symptoms of PD authored by the Evidence-Based Medicine Committee of the International Parkinson and Movement Disorder Society includes ICDs, whereas OS, which has a relatively lower prevalence, is reported less often. This visual hallucination was so vivid that he often asked family members to exorcise the ghosts.Īlthough PD is a common degenerative neurological disorder with typical motor symptoms, its non-motor symptoms have received increasing attention. Three months before his current admission to the hospital, he developed visual hallucinations of seeing ghosts in the window. At the same time, he began to show an obvious increase in libido presenting as frequent masturbation. The delusional belief was confirmed by his wife and two children. About six months ago, he began to accuse his wife of having an affair with someone, although he could not provide any evidence of infidelity. In the past year, his memory has declined, especially his recent memory. His pramipexole dosage was titrated up to 1.5 mg/d.
Six years ago, pramipexole (0.75 mg/d) and selegiline (1 mg/d) were prescribed. Seven years ago, the patient engaged in binge eating with a significant increase in food consumption, eating 3-4 times at night, and the symptoms lasted approximately one year. His symptoms then progressed to difficulty turning during a walk, constipation, olfactory dysfunction, and vivid anxiety-provoking dreams. Following treatment with levodopa-benserazide (200-50 mg/d), he initially showed significant improvement. He was diagnosed with PD by a neurologist approximately one year later. The patient noticed he had a right-hand tremor ten years ago and then developed akinesia and rigidity. We present the case of a male patient diagnosed with PD who developed OS and ICDs, and report the results of our review of the related literature. At present, there are only a few case reports and studies related to PD patients with concomitant OS and ICDs.
Both OS and ICDs in PD may be considered as side effects of dopamine agonists. As ICDs in PD have received increasing attention, the clinical symptom spectrum has gradually expanded to include dopamine dysregulation syndrome, hobbyism, and punding. These behaviors include pathological gambling, hypersexuality, compulsive shopping, and binge eating. Impulse control disorders (ICDs) refer to behaviors involving repetitive, excessive, and compulsive activities driven by intense desire. Hence, OS is an uncommon but potentially dangerous syndrome in patients with PD. In a retrospective study of 105 patients with OS at the Mayo Clinic, 69.5% had neurological disorders while 30.5% had psychiatric disorders voxel-based morphometry showed grey matter loss was greater in the patients with neurodegenerative diseases and OS, especially the dorsolateral frontal lobes. This syndrome has been observed in psychiatric patients and neurological patients, such as those with stroke, dementia, and Parkinson’s disease (PD). Othello syndrome (OS), also defined as delusional jealousy, is characterized by paranoid delusional beliefs concerning the infidelity of a partner, which may lead to extreme behaviors.