To determine whether primary delusional jealousy can be treated effectively with antipsychotics or antidepressants, and whether any clinical variables are associated with response to pharmacotherapy, we carried out a retrospective case series observational study by reviewing clinical records of patients with an International Classification of Disease, 9th ed., diagnostic code of 297 (delusional disorders) who were treated at the Department of Psychiatry of a university affiliated hospital from January 2010 to December 2015. Only those records showing obvious delusional jealousy not secondary to other medical conditions, dementia, or schizophrenia were scrutinized thoroughly with respect to types of pharmacotherapy, treatment response, and other demographic and clinical variables likely to be associated with clinical outcomes. All except one of 32 patients, 16 men and 16 women, between 37 and 79 (60.9±10.6) years of age, were treated with low-dose antipsychotics. The general response was favorable as 19 (59.4%) were rated as good and 13 as inadequate responders (seven partial and six limited). Compared with antipsychotic monotherapy, concomitant therapy with antidepressants had a higher rate of good response, although statistically insignificant (75 vs. 53%, P=0.21). Younger age (P=0.01) and presentation at the index visit with their suspected unfaithful spouse were associated with a good response (P=0.036); comorbidity with delusions other than the jealous type was associated with a poor response (P=0.006). The overall outcome for delusional jealousy looks promising if the patients can accept pharmacotherapy in an outpatient setting.

Non-bizarre delusion, defined as a false belief possible although highly unlikely, is the main manifestation of delusional disorders, previously known as paranoia. Based on the predominant delusional themes, 5 main subtypes may be described - erotomanic, grandiose, jealous, persecutory, and somatic. We present here 2 main delusional disorders, the De Clérambault syndrome and the Othello syndrome, and another closely related to the previous ones - Folie à deux. In the De Clérambault syndrome, the main delusional theme is erotomanic type, related to passional delirium where the patient has strong sexual feelings towards another person and has the belief that this other person is deeply in love with him or her. Patients with the Othello syndrome present a delusional disorder of jealous type, a pathological delusion that the partner is unfaithful. In Folie à deux, 2 individuals shared the same psychiatric symptom. However it may be variable, describing variants such as folie imposée or folie simultenée. The risk of aggressive behavior exists in these patients. Knowledge of these syndromes is essential to allow an accurate diagnosis and prompt treatment.

Delusional disorder-jealous type is a new diagnostic category in the Diagnostic and Statistical Manual for Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) in which delusions concerning a partner's infidelity must be present. Therefore, patients who experience a jealousy disorder, but do not experience delusions will not fit the diagnostic criteria. Using a database of 398 case histories of jealousy disorders reported in the literature from 1940-2002, we examined the percentage of these cases that met the diagnostic criteria for delusional disorder-jealous type. Only 4% of the cases met all diagnostic criteria. This is the first systematic comparison of the prevalence of these disorders. The results provide evidence that the diagnostic criteria are not inclusive, as most individuals suffering with a jealousy disorder were excluded from the diagnosis.

Epidemiology and the study of subtypes of delusional disorders is a poorly researched area. This study tries to fill this lacuna and provides the evidence contrary to the accepted fact that the persecutory type is the most common subtype of persistent delusional disorder (paranoia). Out of 4234 patients who attended psychiatry outpatient department during the year 1994-1997, 45 patients received the ICD-10 diagnosis of persistent delusional disorder. Charts of these patients were used for the study. The prevalence of delusional disorder and delusional parasitosis were around 1% and 0.5% respectively making delusional parasitosis the most common sub-type in our setting. Patients with delusional parasitosis had significantly lesser education compared to the patients with persecutory or jealous delusions. These observations are explained on the basis of cultural practices and linguistic competence.

The authors present a pilot statistical study of murder-suicide comprising 32 cases from the years 1990-1992, collected from the offices of the medical examiners of seven counties in five of the United States. The study includes brief reviews of previous statistical surveys of murder, murder-suicide, and suicide. This present study's conclusions parallel the findings of previous research on the demographic characteristics of the perpetrators of murder-suicide, the relationship between killers and victims, the types of weapon used, locations of the incidents, and the time intervals between the murder and suicide. It also highlights the similarities between the characteristics of the perpetrator of murder-suicide and those of persons who commit only suicide, supporting the thesis that murder-suicide is an extended suicide. Suggestions for prevention of such a type of crime are offered.

Delusional disorder, the contemporary conceptualization of paranoia, is an uncommon condition characterized by the presence of one or more nonbizarre delusions and the relative absence of associated psychopathology. The delusions concern experiences that can conceivably occur in real life, such as being followed (persecutory type), having a disease (somatic type), being loved at a distance (erotomanic type), having an unfaithful sexual partner (jealous type), and possessing inflated worth, power, identity, or knowledge (grandiose type). The diagnosis requires at least 1 month's duration of the delusion; impact on functioning that is consistent with the delusion or its ramifications; generally normal appearance and behavior; and the exclusion of schizophrenia, mood disorder, substance-induced toxicity, and medical disease. Typically, patients are unaware of the psychiatric nature of the condition. They may present to internists, dermatologists, plastic surgeons, lawyers, or the police rather than to psychiatrists. Although the prevalence is low, delusional disorder is not rare. Age at onset is usually middle or late adulthood, and the course is variable. Familial transmission is suspected, and comorbidity (frequently mood disorders) may exist. Successful management is difficult and may include hospitalization, pharmacotherapy, and certain forms of psychotherapy.

The criminal behaviors of harassment and menacing are difficult to control, and of increasing concern to the general public and local law enforcement officials. In 1992, the New York State Legislature modified the Penal Law, responding to public fears and concerns that stalking behavior may become violent. Some persons charged with these types of offenses are suffering from psychiatric disorders. Among these disorders are those classified as Delusional Disorders. According to both DSM-III-R (1987-1993) and DSM-IV (1994), there are five specific types of Delusional Disorder: erotomanic, grandiose, jealous, persecutory and somatic. This type of disorder tends to be chronic. Forty eight cases of persons charged with harassment and menacing in the New York County Criminal and Supreme Court and referred for evaluation to the Forensic Psychiatry Clinic between January 1987 and January 1994 are reviewed. When cases of erotomania and other affectionate/amorous complaints were compared with persecutory/angry forms of harassing behavior, there was a great deal of similarity. When all harassers were compared to the Clinic population as a whole, major differences in ethnicity, age, educational level and sex were noted. Findings are presented regarding incidence, other demographic data, recidivism, violence and clinical diagnosis. The researchers conclude that erotomania does exist, however, there are other psychiatric disorders which can also be diagnosed in individuals accused of harassing and menacing behavior. From the point of view of the victim and the criminal justice system, the similarities in behavior patterns are more important than the different diagnoses.