Othello Syndrome Induced by Dopamine Agonists in Parkinson's Disease: A Case Report

Background: Othello syndrome (OS) is a rare psychiatric disorder characterized by delusional jealousy and unfounded suspicions of infidelity. It has been associated with neurological diseases such as Parkinson's disease (PD), particularly in patients receiving dopamine agonists (DAs). Case Presentation: A 69-year-old man with a longstanding diagnosis of PD developed OS after transitioning from levodopa/carbidopa to ropinirole due to intolerance. Six months after initiating ropinirole, the patient began experiencing intense, delusional beliefs regarding his wife's fidelity, despite no cognitive decline or psychiatric history. The delusional symptoms significantly strained his marital relationship. Clinical Findings and Diagnostic Assessment: Neurological examination remained consistent with PD, and no structural brain abnormalities were observed on magnetic resonance imaging (MRI). The temporal association between ropinirole use and symptom onset led to the diagnosis of ropinirole-induced OS. Ropinirole was gradually discontinued over 4 weeks, and quetiapine was introduced. The patient showed substantial improvement in psychiatric symptoms with resolution of delusional beliefs and restoration of spousal rapport. Conclusion: This case highlights the potential for DAs, including ropinirole, to induce OS in PD patients. Clinicians should remain vigilant for psychiatric side effects during PD treatment and consider timely intervention, including medication adjustment and antipsychotic therapy, to prevent severe psychosocial consequences.