|Ahead of print publication
Secondary delusion of pregnancy in an antipsychotic Naïve patient
Parul Gupta, Mamidipalli Sai Spoorthy, Pradeep Shriram Patil
Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
|Date of Submission||05-Sep-2021|
|Date of Decision||13-Dec-2021|
|Date of Acceptance||19-Dec-2021|
|Date of Web Publication||18-Feb-2022|
Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Delusion of pregnancy is relatively rare phenomenon encountered in psychiatric patients but is reported frequently in developing countries. It can be associated with both psychiatric and neurological disorders. We are reporting a case of delusion of pregnancy that developed in a drug-naïve young woman secondary to auditory hallucination with normal body mass index with no neurological cause due to paranoid schizophrenia. Till date, only seven such cases were reported where auditory hallucinations were reported along with the belief in pregnancy. It should be differentiated from pseudocyesis/pseudopregnancy/simulated pregnancy/Couvade syndrome. Workup should include the identification of the psychosocial/cultural factors leading to the development of this phenomenon, although pharmacological treatment remains the mainstay of the treatment.
Keywords: Antipsychotics, delusion of pregnancy, delusional pregnancy, schizophrenia
| Introduction|| |
Delusion of pregnancy is a relatively uncommon phenomenon encountered in patients suffering from a psychiatric disorder. Depending on the presence of outward signs such as spotting, quickening, and abdominal distension a demarcation has been made between pseudocyesis and delusion of pregnancy. The introduction of antipsychotics can further worsen conviction in such patients due to the side effects such as amenorrhea, galactorrhea, and weight gain. It can occur as a sole symptom or can be due to a range of disorders such as schizophrenia, schizoaffective disorder, delusional disorder, mental retardation, senile dementia, and cerebral syphilis following encephalitis.
Although this phenomenon is not uncommon in developing countries, the prevalence of secondary delusion of pregnancy is rare. As per a review, only 8% (seven cases) of the patients with such phenomenon had auditory hallucinations related to the belief of pregnancy. Hereby, we report a case of delusion of pregnancy secondary to the auditory hallucinations in an antipsychotic naïve patient.
| Case Report|| |
Our patient is a 24-year-old female unmarried graduate belonging to middle socioeconomic status and hailing from a Hindu nuclear family. She presented to our OPD with an illness of 6-month duration which was insidious in onset, gradually progressive, and continuous in course. Her illness was characterized by self-absorbed behavior in which she prefers to be alone and seems to be in her own world, she does not show any concern for her parents and also reduced interacting with them and with her friends, relatives have seen her muttering to self and doing gestures like she is talking with someone in alone and plays with toys, she showed aggressiveness toward her parents and was sometimes verbally abusive toward them when they tried to talk to her and make her understand the facts or when they asked her with whom she was talking, she was suspicious that her friends and neighbors were talking about her day-to-day activities, about her movement in and out of the house, whether she was having an affair and would make fun of her, and the same was denied by relatives when cross-checked, later on, she started believing that she was raped by her father and brother after an altercation with her father. She also had poor self-care, disturbed sleep, and appetite. For the last 2 weeks, she started having auditory hallucinations. She would hear voices of two males known to her one of them is her friend whom she was in a relationship in the past and another one is her college friend and of a female who was her college friend, she heard these voices in clear consciousness discussing among themselves about the patient. The voices would also sometimes talk to the patient and tell her that “she was pregnant.”
After that, she started believing that she was “pregnant” and she felt the movements of a single baby in her womb. She would be firm on her belief and would tell her family members that a man whose picture she saw on Instagram is the father of her baby. She would say that this man whom she saw on Instagram comes to her home daily and performs sexual intercourse with her in her dream. She also started buying things for the baby such as clothes, baby talc, cream, diapers, and toys. The patient's family member tried to explain her that no one came to meet her at night and every door of the house was locked, and she slept beside her mother. They tried to make the patient understand that her belief was just imaginary. She had menarche at the age of 14 years, and her last menstrual period was 20 days back. When she was enquired she had some sexual information and knowledge about reproduction. The patient's parents did not seek any treatment for the above symptoms till she visited our OPD due to the stigma attached to a psychiatric illness.
She had no family or past history of psychiatric illness, was premorbidly well adjusted. In her personal history, it was found out that she was in a relationship with a friend for the past 2 years. However, the person broke up with her 2 months before the onset of illness. She denied any sexual relationship with him.
Her mental state examination revealed flat affect, a delusion of persecution, a delusion of reference, delusional pregnancy, 2nd person auditory hallucinations, and grade 1 insight. Her cognitive functions were intact. A urine pregnancy test was done which was negative. A gynecology referral was taken, and the USG pelvis was suggested to be double sure about the diagnosis. There was no evidence of pregnancy. Her laboratory investigations revealed low hemoglobin, and normal total leukocyte count, differential leukocyte count, serum creatinine, and serum bilirubin. Her thyroid function test, blood sugar levels, liver function tests, and kidney function tests were normal.
She was diagnosed with paranoid schizophrenia as per ICD-10 and was prescribed tablet olanzapine 5 mg which was gradually increased to 20 mg, and combination of trifluoperazine 5 mg and trihexyphenidyl 2 mg twice a day was added. Overall she had 60%–65% of improvement with treatment in further 2 follow-ups within 2 months. Family members were psychoeducated about the nature of illness, treatment, and course.
| Discussion|| |
Our patient was a young female who developed delusion of pregnancy secondary to her auditory hallucinations, despite being drug naïve. Delusion of pregnancy should be distinguished from the closely related phenomenon, i.e. pseudocyesis, pseudopregnancy, simulated pregnancy, and Couvade syndrome. In the current case, the patient had a firm belief about being pregnant and also experienced sensations of the fetus moving inside her. Hence, we had labeled it as the delusion of pregnancy rather than pseudocyesis which is more toward the category of somatoform disorder.,
The etiological factors behind these phenomena can be organic factors, a range of psychosocial/sociocultural factors, hyperprolactinemia, drug-induced lactation, and metabolic syndrome. The diagnosis in these patients can range from schizophrenia, mental retardation, schizoaffective disorder, delusional disorder, dementia, and psychotic depression. This signifies that the delusion can occur as a part of different disorders but it is not specific to any. In the index patient, the psychosocial risk factor implied in the causation of delusion of pregnancy can be the recent loss of love. A third of these patients are drug-naïve at the time of development of the delusion as per a review. The same is the case with our patient who was drug naïve and had a normal BMI at the time of development of the illness.
What is unique about the development of delusion in our patient is that she has developed it as a secondary phenomenon to auditory hallucinations. Till date, only seven such cases were reported where auditory hallucinations were reported along with the belief in pregnancy. About 60% of these patients respond well to treatment as per literature, the same is the case with our patients.
Delusion of pregnancy as a symptom can be associated with both psychiatric and neurological disorders. Workup also should include the identification of the psychosocial/cultural factors leading to the development of this phenomenon. Although pharmacological treatment remains the mainstay, proper addressal of these factors in the maintenance phase of treatment can prevent recurrence of psychosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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