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Indian Journal of Pharmacology, Vol. 36, No. 2, April, 2004, pp. 104-105 Case Report Sildenafil and morbid jealousy Mendhekar DN, Srivastav PK Department of Psychiatry, G. B. Pant Hospital, New Delhi - 110 002 Code Number: ph04040 We would like to report a case of morbid jealousy with sexual dysfunction in a middle-aged male. The patient showed a favorable response to sildenafil in both the symptoms. This report suggests that sildenafil might be useful for therapeutic purposes in cases where diagnostic dilemma persists on primary or secondary sexual dysfunction in relation to morbid jealousy. A 45-year-old government officer was living happily with his family till two and a half years back, when he saw a man talking to his wife romantically in his house and was very upset. After the man left, the patient asked his wife about the man but she was very hesitant in revealing information and only said that he was a distant relative. The patient learnt from his mother-in-law that the man who had visited his house had earlier proposed to the patient′s wife but was rejected by the patient′s father-in-law. He also learnt that his wife knew this man even before marriage since he was her neighbor. After this the patient got very distressed and challenged his wife′s fidelity saying that since she knew the man even before her marriage, she must be meeting him frequently and, must be having physical relations with him. He started living in a separate room in the same house and would not share the bed or food with his wife for 2 to 3 months. If he did not get satisfactory answers from his wife, he would start hitting his head against the wall. About 2 years back, his colleagues told him that one of his friends who worked in the same office had also proposed to his wife before the patient got married to her. Thus, he started believing that his wife was definitely having extramarital relations and that she was a characterless lady, despite repeated clarifications from her. He would feel depressed and at times think of getting divorced. He felt abandoned, as other family members did not share his belief. According to the wife, one year prior to the onset of the psychiatric illness, the patient′s sexual function had started decreasing by a mild degree. His frequency of sexual intercourse went down from four times a week to twice a week. However, both the partners had a very cordial relationship and the patient was never distressed over his sexual performance. His wife thought that decreased sexual performance may be age-related and she never displayed any dissatisfaction. After the onset of jealous behavior his frequency of sexual performance went down from twice a week to once in about 40 days and would end up with lack of erection or premature ejaculation, apparently due to preoccupation with infidelity as revealed by the patient. His wife denied all the allegations made by him and she was very distressed and helpless. His mental status examination revealed morbid jealousy, (?overvalued ideas / ?delusion) depressed affect and concern about his decreased sexual performance. He denied having any sexual dysfunction prior to her alleged relationship. Initially, he was put on fluoxetine 60 mg along with alprazolam 0.5 mg /day for 4 weeks, but he did not show any improvement. Fluoxetine was stopped and sertraline 200 mg / day was given for 6 weeks. The patient did not show any improvement with sertraline. Even psychosocial intervention could not help him for relieving the symptom of jealousy. After performing the relevant investigation, sildenafil citrate 50 mg was added gradually since decreased sexual desire was also one of his complaints. Within 3 weeks, there was marked improvement in not only his sexual symptoms but also in his symptoms of jealousy. Sertraline was gradually withdrawn and the patient was maintained only on sildenafil citrate 50 mg / day. The patient was doing well and had satisfactory sexual intercourse, twice a week. We are aware of the fact that reporting on the potential clinical indication of newer psychopharmacological agents such as sildenafil is definitely a very complex process. Literature showed that failure in the sexual relationship as a whole appeared to be frequently associated with jealousy, although whether this was primary or secondary was difficult to conclude. Morbid jealousy is best viewed as a descriptive term and not a diagnosis. The term portrays a unifying dominant theme of preoccupation with the partner′s sexual infidelity.[1] In our case though the patient had a belief regarding the infidelity of his wife, it was difficult to explain whether it was primary or secondary to sexual dysfunction. Non-response to psychotropic drugs and psychosocial intervention made us revise our diagnosis and we entertained the possibility of primary sexual dysfunction, as the patient was also concerned with his sexual performance. Probably, improvement in the sexual dysfunction by sildenafil[2] removed the feeling of abandonment and improved his self-confidence and confidence in sex, which led him to have better trust in marital relations. Sildenafil may be useful as a diagnostic as well as therapeutic test in such cases where diagnostic dilemma persists on primary or secondary sexual dysfunction in relation to morbid jealousy. Otherwise such cases may be labeled as primary psychiatric illness and they may worsen with unnecessary exposure to psychotropic drugs. A recent study also suggested that sildenafil is effective as a first line treatment for erectile dysfunction in men with untreated minor depression.[3] Though this case illustrated the successful effect of sildenafil on sexual dysfunction and associated jealousy, a systematic study is needed to generalize the finding to prove that there may be a subgroup of morbid jealousy cases (with sexual dysfunction) which may respond to this drug. REFERENCES
Copyright 2004 - Indian Journal of Pharmacology |
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