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Delirium of jealousy
Medical expert of the article
In the symptom-complex of disorders of the thinking process, a special place is occupied by delusions-erroneous belief, reasoning, conclusions, interrelated with very personal disturbances of the person, in which it is impossible to convince him of any arguments.
One of the manifestations of delirium is the delirium of jealousy or Othello's syndrome. Jealousy is a natural emotion, a manifestation of feelings of resentment toward a more prosperous rival. Normally a person is jealous only when there is strong evidence, he is ready to receive new information, in the light of which he can change his mind. Usually one opponent is assumed.
The geographic intrasonality and ethnic specifics of delirium are not studied, although observations of such patients are systematized, scientific articles on this topic are published in European, North American publications, as well as in the Australian region. There is an opinion that in societies where the proprietary positions with respect to the partner do not matter, the delirium of jealousy appears less often.
Practicing psychiatrists often encounter pathological jealousy in various mental pathologies, although it can be assumed that in most such cases people do not seek psychiatric care.
The results of an analysis of a sample of jealousy episodes conducted in the United States in individuals receiving psychiatric care show that out of 20 patients there was only one woman, most of them (80%) were family people. The average age of the appearance of psychic abnormalities is 28 years, the manifestations of delirious jealousy were noted about after ten years. The elder patient is a 77-year-old patient. The correspondence between belonging to a particular ethnic group and the development of delusions of jealousy is not revealed.
Gender aspects of delusions of jealousy
As a rule, in men the delirium of jealousy begins after 40 years, people who have a history of mental disorders, drunkenness, and sexual dysfunctions are exposed to it. If the background of mental illness ravings of jealousy occurs rapidly, then with alcoholism it is formed gradually. At first the patient is jealous in a state of intoxication, and this is perceived as a commonplace abuse. Further, suspicions of infidelity the patient expresses not only when drunk, but also sober. Often there is an imaginary rival, often a well-known person. A man checks each step of the spouse, while making illogical conclusions. Living with him becomes difficult and dangerous, aggression increases, he often raises his hand on his wife, occasionally - on the opponent.
Among women, jealousy is much less common. Usually, these are women drinking. The consequences of female delirious jealousy are no less dangerous. Sensations acquire a pathological emotional color that does not correspond to reality. Jealousy accompanies a woman everywhere, causes scandal, causes insomnia and depression
Bred jealousy in women is accompanied by paroxysmal aggression, followed by a depressed state. With delirious jealousy, the level of serotonin (a hormone of happiness) drops sharply. To cover his deficit, the woman is predisposed to quarrel properly, which helps to increase the level of dopamine (a pleasure hormone).
In contrast to men who simply dismiss their hands, among women's affective acts, a thirst for revenge must be singled out, since revenge activates the production of dopamine. The feeling of pleasure from revenge becomes habitual and leads to sophisticated and cruel revenge.
Causes of the delirium of jealousy
Modern psychiatry does not know the exact answer to the question about the causes of delirium jealousy. There are several theories of the pathogenesis of Othello's syndrome, each of which has the right to exist.
The significance of various factors triggering the mechanism of pathological jealousy is still in the stage of study.
It can be stated with certainty that heredity plays an important role in this. As with other mental disorders, delusions of jealousy are often observed in people in whose family older relatives also had more or less this pathology.
Also the effect of pathological processes of different parts of the brain on the appearance of symptoms of delirium is studied. The inadequacy of any neurotransmitter (mediator transmitting signals between neurons of the brain), which arises from a congenital or acquired mental illness, causes disruption of the mechanisms of normal brain functioning and triggers unnatural processes: depression, aggression, delusional disorders.
The impetus to the development of pathological jealousy can give stress, the abuse of alcohol, drugs. Poor vision, hearing, disability, and trends towards isolation also become factors contributing to the development of delusional disorders.
Delirium is a frequent symptom of a number of mental illnesses, but it is not their initial stage, since delusions of jealousy develop later than, for example, schizophrenia.
Risk factors that may contribute to the commission of socially dangerous actions by patients during periods of delirium are considered to be: pre-sick epileptoid characteristics of the behavior of the jealous; presence of hallucinations and / or paranoid personality disorders, dysphoric affect, difficulties in communicating with the opposite sex, causing the behavior of the sexual partner, psychological incompatibility with the partner, material unhappiness in the family, the appearance of "enlightenment" regarding the relationship of the partner with a particular person, the presence of sadistic inclinations, spying on a partner, conducting investigations, inspections, and searches.
Persons suffering from delusions of jealousy often resort to violence in order to obtain confirmation of their rightness.
A partner accused of treason is guilty until he proves the opposite, but it is impossible to refute the charges, because reasonable justifications can not convince the madman.
Violence is often characterized by a relationship that is accompanied by jealousy, nevertheless, with delirious jealousy the danger multiplies. Both the denial of the fact of treason and the false confessions of a partner who is tired of the unending suspicions can provoke the jealousy's irritation and push him to violence.
Victims of jealous killers are usually sexual partners, real and former. This is typical for the vast majority of criminal activities committed by both men and women. Much less often accusations are made or violence is committed against people identified as rivals.
Men with Othello syndrome, more often than women suffering from this pathology, direct aggression to their own half, the injuries caused are more severe.
With cases of unlawful actions, paranoid delusions are often associated with hallucinations that order the guilty to be punished. Abuse of psychotropic drugs (alcohol and drugs) increases the possibility of committing violence. All this confirms that individuals with delirium of jealousy commit crimes, often being under the influence of additional psychotic symptoms.
It is impossible to accurately assess the degree of difference in the nature of violent actions depending on the reasons for the delusions of jealousy, since physical violence committed in the family is most often concealed, with both spouses both an offender and a victim. The same can be said about which of the ideas of jealousy (delusional, obsessive or overvalued) increases the likelihood of violence. Nevertheless, the psychotic variety of delirious jealousy, which is characteristic of all psychoses, often accompanies the use of force. In general, the delusional obscuration of reason has a high degree of probability of committing violence.
Children, whose father (much less often - the mother) is morbidly jealous, suffer emotionally, and often physically. They are involuntary participants in frequent conflicts between parents, can be traumatized accidentally, and sometimes - intentionally, as patients often have the conviction that they raise a child of an opponent.
Children can be involved in detective activities, for example, spying on the "guilty" parent. They often witness crimes or suicides.
Partners pathological jealous are prone to the development of mental disorders, they are accompanied by a state of constant anxiety. They often begin to abuse antidepressants, alcohol, drugs, sometimes they can resort to violence themselves, unable to withstand the constant pressure from the patient.
Factors that reduce the risk of socially dangerous actions of the patient can be considered a monotonous, not growing new details, the content of delusions of jealousy, a depressed state, the lack of candidacy for the role of lover (s) and investigative activities.
However, the jealousy's depression conceals the threat of his suicide, as previous acts of violence towards a partner can lead to deep repentance.
Theories of the pathogenesis of delirious jealousy, based on psychoanalysis, with the easy hand of Freud consider it the cause of self-protection from hidden homosexuality. A man-paranoid is jealous of his wife to a man who caused him unconscious sex drive. This hypothesis is not supported by clinical studies, since the overwhelming majority of patients with this symptom do not show a tendency to unisexual love, and most homosexuals do not suffer from paranoia or delusional disorders.
Bowlby and his attachment theory explain the emergence of the jealousy of the individual as a lack of confidence in his partner's attachment to him. As a rule, people with an unreliable attachment pattern (for example, in their childhood for a long time separated from their parents) suffer from delirium of jealousy.
There is a theory that the development of pathological jealousy in humans has a sense of personal insolvency and a lack of security, hypersensitivity. People with such characteristics often perceive and interpret information in a distorted way, an event can cause an incorrect guess and trigger a mechanism of delirious jealousy. This theory is conceptually similar to the theory of attachment.
Certainly, not the least role in the development of Othello's syndrome plays a decrease in male potency, as well as real or contrived anatomical shortcomings of the genital organs. However, not all psychiatrists tend to regard sexual dysfunction as the primary cause of pathological jealousy.
Do not underestimate the importance of family and social factors. In societies where a man occupies a dominant position, and a woman is a subordinate, any manifestation of her independence can be perceived as infidelity. Jealousy in this case justifies the violence applied to the traitor.
Some paranoid patients, as shown by clinical observations, can not form a trusting relationship even with a loved one. Probably, the lack of trust is caused by a stable unfriendly relationship in the parents' family, where the total control of the mother and the distancing or sadistic attitudes from the father's side were often noted.
Often the delirium of jealousy provokes hormonal dysfunctions, pathologies of cerebral vessels, chronic alcoholism. Usually, this disorder occurs among men who abuse alcohol for a long time, men who, as a result, have sexual, psychological and social problems that feel insolvent. The situation is exacerbated gradually: first, delirium of jealousy occurs only in a state of intoxication, then accusations of infidelity increase, later the joint existence turns into a continuous scandal. The man controls his partner constantly, he suspects all those around him. Living with him becomes unsafe.
Symptoms of the delirium of jealousy
In the case of pathological jealousy, the individual's fantasies and fantasies often do not have real confirmations, he does not give up his considerations even before convincing arguments of the opposite and quite often bring charges of treason with several rivals. The jealousy of jealousy is inherent in confidence, formed from fantasies, not facts, and the lack of logic.
In fact, painful jealousy is one of the symptoms of various mental illnesses. For example, schizophrenia. In this case, the so-called Othello syndrome, as a rule, manifests itself to 40 years, it is accompanied by aggressive manifestations in men and depressive in women.
The presence of delusions of jealousy can be assumed by the presence of groundless accusations of treason and their categorical nature, the full belief of the patient in his rightness, illogical interpretation of any actions of the second half (any actions are considered as a desire to deceive and change), talkative, expansive, non-perception of his pathology.
The plot of this pathology is a strong concern for the fictional betrayal of a sexual partner. Typical forms of symptomatology of this mental pathology are delusional, obsessive and overvalued ideas.
There is an opinion that the delirium of jealousy is a variation of the delusional disorder, hence the name "delirium of jealousy" does not correspond to the truth. The key psychiatric pathology in this case is the delusion of a partner's infidelity, which is often combined with the patient's guesses that the guilty party is trying to poison him; slips funds that reduce sexual activity; lulls the patient and at this time has sex with an opponent. These delusional ideas are related to delirium of persecution, and delirium of jealousy is its variety.
Delusional ideas of infidelity are the initial symptoms of schizophrenia or additional signs of an existing mental illness. These are the own conjectures of the individual, not acceptable by others, but do not cause inconvenience to him. The patient himself considers them to be true, these thoughts he does not resist.
The delusion of jealousy is seen as a modification of the delusional disorder in the American Association of Psychiatrists (the fourth edition) and the International Classification of Diseases (tenth edition), which is used today by domestic doctors.
It happens that delusional ideas of infidelity do not figure on the background of other mental illnesses and exist on their own. Their content is logical, consistent and plausible, not to mention the strange associations inherent in schizophrenic delirium.
Disorders of the function of the psyche, which are characterized by delirium, belong to disorders of the emotional state (clinical depression, manic-depressive psychosis), and in general, it can occur in any violation of the functions of the brain.
In the case of obsessive ideas, jealousy about meditating on a partner's change is taken almost all the time, it is impossible for a patient to not think about it, committing violations of relations with a partner, limiting his freedom, controlling his actions.
In this case, the thought of change in the perception of the patient is something abstract, but he can not get rid of them. Such patients realize that their fears are groundless, they are sometimes ashamed. They are all the time in a stressful situation, caused by obsessions, contrary to the real situation. As a result, a continuous process of the transition of obsessive pathological jealousy into a delirious one can begin.
At the end of the last century, it was suggested that Othello's syndrome could manifest itself as an overvalued idea, namely, a perfectly acceptable, understandable belief in which the patient was concentrated in an inadequate measure. It does not cause an internal protest in the patient, and although it is not considered delusional, the patient checks the partner's actions, trying to make sure there is no betrayal. How widespread is this form of pathology unknown, since it is assumed that patients with overvalued ideas are usually beyond the area of attention of psychiatry. It is believed that overvalued ideas are a delusion of jealousy.
To any manifestations of delirious jealousy are predisposed persons with emotional disorders of the border type, in particular - with paranoid ones.
They are distinguished by a negative and completely unformed self-identification, a sense of their low value, anxiety about a possible denial of intimate relations, betrayal of a partner, affective instability, projection of unacceptable attractions for a partner.
In the delusion of jealousy, common disorders are common, in the pure form it is very rare. The presence of a variety of combinations (with personality disorders, mental pathologies, alcohol and drug abuse) usually creates a very complex and ambiguous clinic of the disease.
The first signs of the development of delusions of jealousy - a gloomy reverie with the often repeated obsessive talk about infidelity, first it's rare episodes. Then they become more frequent, concrete and categorical accusations begin, often devoid of elementary logic, non-acceptance of any justifying arguments. The patient does not realize his pathology.
Dynamics of delirium of jealousy
Appearing in schizophrenics crazy ideas of jealousy are attributed to intellectual delirium. They have significant differences from similar ideas in sensory delirium in epileptics, alcoholics or in patients with cerebral atherosclerosis with mental disorders.
Dynamics of alcoholic delirium jealousy is characterized by a gradual increase in symptoms. Initially, patients report their doubts or are accused of cheating episodically, in a state of intoxication or against withdrawal symptoms. After some time, the delusional treatment of earlier cases appears already in a sober state. At the beginning of the illness, the real change to the worst family relationships, caused by long-term drunkenness of the patient, plays a role.
Since the content of delirium is based on the current state of affairs in the family, the statements of a jealous man seem very plausible to those around him. Further, the interpretation of events is made less real, filled with a lot of fictional details. The plot of delusions of jealousy can expand, enriching with new details. The patient begins to show aggression and becomes dangerous.
Dynamics of delirium jealousy in individuals with schizophrenic spectrum disorders is observed in two variants of continuous flow - with an increase in symptoms and with the forthcoming replacement of the delusions of the delirium, and in two variants of the paroxysmal course - without the increase in symptoms and with its increase. Malignancy of the process can also be observed - the increase in symptoms and the transition from paroxysmal to continuous flow.
The aggravation of the process of pathological jealousy in persons with schizophrenic spectrum disorders occurs according to the scheme: the paranoid delirium of jealousy gradually acquires the features of a paranoid → the appearance of elements of delirium of other content → the addition of hallucinations → the emergence of paraphrenic components of delirium jealousy.
The paranoia of jealousy in people with schizophrenia disorders is mostly formed as a sudden insight, occasionally there is a gradual understanding based on overvalued ideas of jealousy. At first, the patient's reasoning does not seem morbid. But their mood is low, with elements of irritability and even malice.
The paranoid delirium of jealousy is characterized by illogicality, absurdity, often absurdity. The subject of jealousy is connected with other topics, it is accompanied by hallucinations. The mood is dominated by depressive affective elements, and the behavioral line does not coincide with delusional unrest.
Paraphrenia is the apotheosis of chronic delusional psychoses. For this stage, combined megalomania of grandeur, persecution and influence, a change of affect, an automaticity appears in reasoning, actions and movements. The fabric of delirium is enriched by variations, overgrown with new details, expanding. In this state, patients do not even try to justify their speculation, they seem to the madmen axioms. For paraphrenia, imaginary memories are typical, real events in which are mixed up with fantastic ones. Usually, the patients are in a state of euphoria: from more restrained to frankly manic.
The development of delusional disorder occurs gradually, its beginning can not be noticed even by the closest people.
It all starts with a delusional mood, when a patient has a premonition of some negative changes, an alarming state about the threat that threatens him or his well-being.
These thoughts are persistently present, the sense of anxiety grows and delusions of past and current events appear, the delusional explanation of individual facts begins to form, the accused appears. For example, in the case of delirious jealousy, a husband who abuses alcohol will explain the conflicts in the family not with his drunkenness, but with the appearance of the lover of the unfaithful wife. This idea takes the patient more and begins delusional interpretation of all events taking place in the light of the confirmation of the delusion of infidelity.
After a while there is a crystallization of delirium, formed a harmonious structure of delirium, at this time, any attempts to prove the opposite to the patient are aggressively perceived. Usually cases of violence occur at this stage. And if it is possible to survive this stage without losses (for example, by placing the patient in a medical institution where he will be assisted), then one can see the attenuation of delirium when the criticism of delusional assertions, the proof of the innocence of the partner begins to be perceived.
For a long time after the treatment, there is residual idiocy. It is usually present in cases of paranoid disorders with hallucinations, exit from delirium and from the twilight state of epilepsy.
Maniacal delirium of jealousy - a variation of manic psychosis, when the most valuable idea is the betrayal of a sexual partner. At the same time, the patient is overexcited, hyperactive, easily excited, and is disposed to aggressive paroxysms. The individual possessed by the mania of jealousy does not accept any arguments in defense of the accused, he is firmly convinced of adultery, and the excitability, aggressiveness and inclination to active actions accompanying this kind of pathology makes the patient unpredictable and dangerous.
Depressive delirium of jealousy is often overlooked, as a person turns off communication, avoids sympathetic questioning, and his close environment tries not to pester, hoping that the depression will recede. And they begin to sound the alarm only when the patient stops eating or appears at work.
Hypertrophic jealousy is expressed in an excellent degree of demonstration of ordinary jealousy. For example, the seller's or the bartender's on-duty smile can suddenly cause a flash of jealousy.
Paranoid delirium of jealousy - the most complex, persistent and insidious form of delirium. From the manic delirium of jealousy differs inexorable, not correlated with the circumstances of jealousy of everything and everyone. Paranoid delirium of jealousy is usually complex in content, with a clear, logical and complete structure of circumstances and conclusions, absolutely unreal and existing exclusively in the mind of the patient.
Fear of divorce also provokes delirious jealousy. This kind is more vulnerable to women. Panic fear of divorce makes everywhere look for razluchnitsu, threatening to destroy her family nest. As a result - constant searches, checks, investigations and scandals.
Alcoholic delirium of jealousy
Delusional disorder, accompanied by pathological jealousy towards a sexual partner, developing on the basis of alcoholism, occurs quite often, since alcohol is the most accessible psychoactive substance.
Observations suggest that this mental pathology for the I-III stage of alcoholism is completely ordinary. The causes of alcoholic delirium of jealousy are: organic brain damage due to regular drunkenness, paranoid or epileptoid behavior of the personality, degradation of the person, violation of sexual function against the background of alcoholism, manifestation of jealousy before the occurrence of alcohol dependence.
The acute form of alcoholic delirium of jealousy is formed during a hangover syndrome or approximately on the third day of an exit from a drinking-bout. Under the influence of visual and / or auditory hallucinations, the patient accuses the partner of infidelity, leads "evidence" of treason.
Chronic form usually occurs at the stage of systemic alcohol intoxication. Pathological jealousy acquires more dangerous traits - checks, tracking, searches, aggressive behavior, beating begin.
Signs that you need to pay attention to: a person constantly has a contrived idea of infidelity, he is engaged in detective work with the goal of this betrayal, seeks subtext in every word, tries to isolate the partner from communicating with others, displays aggression and violence. If you have these symptoms, you need to seek medical help from a psychiatrist and an expert in narcology. Dynamics of alcoholic delirium jealousy is described above.
Often the disease remains unrecognized for a long time, since aggression is not uncommon in alcoholism, and some patients do not voice their suspicions until the complete crystallization of delirium. In this case, there is a real danger first of all for the wife of the patient, "non-native" children, aggression to the opponent is observed much less often. The consequences and complications of alcoholic delusions of jealousy can be sad.
The structure of alcoholic delirium of jealousy on observations is always paranoid. The plot of alcoholic delirium is more believable than, for example, schizophrenic. In alcoholism, the rival in all cases was a specific person. Quite often there were accusations of incest, delirium of jealousy, combined with delusions of persecution, for example, an unfaithful spouse was accused of attempting to poison a patient.
Alcoholic delirium of jealousy is accompanied by rapid degradation of personality. Affective disorders are often dysphoric, and not anxious-depressive. The patient's behavior is aggressive and quite consistent with the delusions of delirium.
Diagnostics of the delirium of jealousy
People with alcoholic delirium of jealousy are socially dangerous. Given that they are predisposed to withhold their pathology, especially from representatives of medicine, when suspicion of alcoholic delusions of jealousy is often done with a sample of ethyl alcohol. Introduce the patient intravenously 20% solution of ethyl alcohol. After a quarter of an hour, alcohol intoxication begins with an exacerbation of delusional ideas, during which the patient confides with the doctor about his suspicions and puts out evidence of the wife's infidelity.
Diagnosis of delirious jealousy requires a multifaceted attitude. There is a detailed psychiatric history, and it is desirable to conduct repeated joint and individual interview of both partners.
A complete psychiatric history should include data on the family, the quality of the relationship, the presence of mental illness. During the interview, it is necessary to show interest in the pathological manifestations of jealousy, the use of psychoactive drugs, the use of violence both in the past and in the present. Both partners need to be interviewed about clashes, scandals, intimidation and the criminal actions of jealous people. If a couple has children, you need to take care of their safety.
To assess the patient's condition and the degree of its danger to others, based on the results of the interview, differential diagnosis is performed, which determines the symptoms of delirium, which makes it possible to distinguish delusional ideas of jealousy from intrusive or overvalued ones.
Assessing the possibility of suicide, it is also necessary to interview both partners.
Carrying out the diagnosis it is necessary to take into account that the mental disorder that causes delirium of jealousy arose and manifested itself earlier, its signs manifest simultaneously with jealousy, the pathological processes of both disorders are interrelated, delusions are not based on real facts.
Treatment of the delirium of jealousy
After the diagnosis and diagnosis is established, it is necessary to familiarize both partners with the consequences and complications of this state of mind. Usually the patient must agree to treatment, exceptions are cases that threaten the life of his partner.
Preventive measures are being taken to protect the likely victim and create safe conditions for children. If the degree of risk is high, the patient with symptoms of delirium jealousy must urgently be placed in the hospital.
Treatment of delusions of jealousy is carried out in two directions: therapy of mental illness and reduction of the risk of violence.
Treatment includes drug therapy, psychosocial interventions and hospitalization (including compulsory). Drug therapy is performed with the help of neuroleptics and antidepressants.
Delusional disorders of jealousy and schizophrenic delirium of infidelity are treated with the use of neuroleptics. With symptoms of an obsessive idea of jealousy with a depressive component or without it, antidepressants give a good effect.
Psychosocial interventions include narcological care, cognitive behavioral adjustment, family therapy, psychoanalyst support, and measures to ensure the safety of a potential victim and children.
Cognitive-behavioral therapy is effective in the case of an obsession, and psychoanalytic psychotherapy is also used for this symptom, and it is also used to treat jealousy in persons with borderline and paranoid disorders.
The greatest effect of therapeutic and preventive measures is achieved with early recognition of the symptoms of delirium jealousy.
In more mild cases, with pathological jealousy for fear of divorce or caused by personality disorder, there may be enough psychological or psychotherapeutic help. If the delirium of jealousy is a symptom of a mental illness, then psychiatric and medicamental treatment is necessary.
Since persons suffering from delusions of jealousy are usually sure that there is no need for treatment, since they are healthy, therefore they are trying to ignore the doctor's appointment, respectively, and the therapeutic effect is small.
If delirious jealousy is associated with obvious suffering, the risk for both the jealous and his surroundings, as well as the ineffectiveness of outpatient therapy, requires inpatient treatment. However, there is a frequent pattern - in the hospital, the patient shows a positive therapeutic effect quickly, and in the family circle the disease recurs.
If the treatment does not have an effect, it is recommended that the couple live separately for safety reasons.
Jealousy as an emotional manifestation in accordance with the situation, no danger.
If jealousy accompanies a violation of the human psyche, it spills emotion aggressively, then there is a risk of injury, murder or suicide.
If the situation in the family is injected and not controlled, and delusions of jealousy are repeated daily, it is necessary to turn to a psychologist (psychotherapist).
Preventive measures recommended by psychologists: do not ask about past hobbies of a partner, do not investigate, ignore defiant behavior, do not provoke outbreaks of jealousy.
The prognosis of delirious jealousy is influenced by the underlying disease, the presence of concomitant mental disorders and resistance to therapy. Persons with psychotic disorders can be treated worse.
It is very likely the return of delusions of jealousy after some time after treatment, therefore it is recommended to be under the supervision of a doctor for a long time. In psychiatric practice there were relapses of murders on the basis of pathological jealousy, committed after many years of apparent well-being.
The delirium of jealousy is a symptom observed with various mental deviations, manifestations of which are delusional, obsessive, overvalued ideas or their combinations. Its manifestations, the degree of severity of the disease, identified on the basis of medical history and diagnosis of mental disorders, will indicate the underlying pathology and associated conditions, will allow appropriate treatment to be prescribed. An essential circumstance, aggravating the course of delusions of jealousy, is alcoholism, drug addiction, substance abuse.
Given the likelihood of dramatic consequences, delusional jealousy is a condition requiring active medical intervention.