My Wife is having an Affair… is it true?

My Wife is having an Affair… is it true?

Mr. P. Piccadilly is a 35-year-old married man who runs a Gas station. He has been referred to a private psychiatrist for assessment by his family doctor. His wife accompanies him.

His family doctor is concerned, as Mrs. Piccadilly reported that her husband has become increasingly suspicious of her over the previous 3 months, accusing her of having an affair.

He apparently has been searching for evidence of this, and she believes that he has been following her. She has become quite frightened of him, although he has never actually threatened or hurt her in the past.

Mr. Piccadilly tells the Psychiatrist that he knows his wife is having an affair, although he is unsure exactly who her partner is. He has recently employed the services of a private detective and checks her phone bills, receipts, and cloth¬ing for evidence. He denies any history of violence.
He has no past Psychiatric illness and he denies abuse of or dependence on Alcohol or illicit substances. He has never been a victim of violence himself nor has he had legal problems.

He has Appendectomy several years ago. There is no contributory history of mental illness in the family.

Mr. Piccadilly is the eldest of two sons. His parents are alive and well. He has been married for 10 years and claims that they were happy until recently. They have two children aged 8 and 6 years. He started running the gas station after college and is very successful.

The Psychiatrist noted that Mr. Piccadilly appears appropriate with his stated age with good hygiene. He had eye contact intermittently and the rapport was fair. He was guarded, suspicious. There were no abnormal movements but he becomes agitated and some¬what hostile during the interview. He described his mood "Fed up with all this carry-on." His thought process seems to have systemized delusions but he denies any perceptual abnormalities or experiencing any auditory hallucination. He denies suicidal ideation but he admits to thinking about following his wife and murdering her with her lover (or murdering the man who he thinks is her lover).

His Cognitive function was intact but his insight and judgment was impaired. The Family Doctor has done some blood test but all was within normal range. His wife confirms that she has not been having an affair, and that she is concerned about the safety of herself and the children.

The Psychiatrist after careful assessment made a diagnosis of Delusional disorder, jealous type (This is a rare disorder, which usually affects men. It may appear suddenly in those with no known past psychiatric history. Antipsychotic medication may be tried, but it can be difficult to treat and may only be resolved by separation, divorce, or the death of a spouse.) and suggested hospital admission and treatment. However Mr. Piccadilly refuses voluntary admission and is admitted involuntarily to psychiatry ward for further evaluation and a trial of antipsychotic medication.

Dr. Shaikh Wahab
Psychiatry Registrar , Australia

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