Pseudocyesis

Pseudocyesis - a clinical syndrome seen in non-psychotic woman, known since the time of Hippocrates. Pseudocyesis has a psychological basis in which a woman's wish for pregnancy is essential to their identity and self-esteem. Normally, pseudocyesis is seen in women who desperately want to become pregnant, especially those with longstanding infertility. Basically, the treatment of Pseudocyesis is to help these patients recognize the illness and to educate and counsel them. Here is the case of pseudocyesis in which there is no history of long standing infertility. This case is rare and liable to be missed.

[Recurrent pseudocyesis with polydipsia: a case report]

INTRODUCTION

Pseudocyesis is an imaginary pregnancy resulting from a strong desire or need for motherhood. Pseudocyesis has become increasingly rare in many parts of the world in which accurate pregnancy tests have become widely available. Cultures that place high value on pregnancy, or that make close associations between fertility and a person's worth, still have high rates of the disorder. A woman may believe in her pregnancy to the point of delusion and show acute depression when no baby is born.

CASE-REPORT

This report describes a case of recurrent pseudocyesis and polydipsia in a 49-year-old woman. She was an illiterate housewife who had been married since she was 21 years old. Four years later, she divorced because of a problem of sterility. She got remarried, five years later, and the couple had no child. The patient was admitted into the Obstetric Unit thinking that she was about to give birth. She presented all the symptoms of true pregnancy. She had abdominal distension, amenorrhea, mammary tension, nausea and vomiting, and weight gain. She claimed to have felt foetal movements. Other than this, she exhibited a polydipsia syndrome. These symptoms had evolved over 20 months. The patient had previously presented six similar episodes. All these episodes were identical. The length of these episodes varied between three and five months, after which all the signs disappeared progressively. The patient had never consulted for these symptoms before the present episode. During her stay in the Obstetric Unit, she benefited from a complete gynaecological examination, including pelvic ultrasound examinations, and laboratory tests, notably hormone assays (FSH, LH, prolactin, ss-HCG) and serum electrolyte levels. A primary sterility and menopause were confirmed. Otherwise, the psychiatric assessment confirmed the delusion of pregnancy and the presence of a depressive syndrome. The patient reported that she was possessed. She explained the normality of the imagery and laboratory tests by the intervention of the demons that hid the foetus and modified the results.

DISCUSSION

The contribution of psychological and physiological factors in the development of the delusion of pregnancy, possession and polydipsia, and the possible interactions between the two phenomena are discussed.

Delusional pregnancy in a patient with primary sterility

The case of a patient suffering from primary sterility who developed a well-systemized delusion of pregnancy is described. The patient did not have a history of psychiatric disorder or organic cerebral pathology. No history of epilepsy was detected in this patient contrary to the reports in the literature, and these facts have pathogenic relevance in delusional pregnancy. The importance of psychological factors in the development of a delusion of pregnancy is discussed.

Effects of oestrogen supplementation and space restriction on PGF2alpha-induced nest-building in pseudopregnant gilts

This study examined the role of oestrogen supplementation on PGF2alpha-induced nest-building in pseudopregnant gilts. Oestradiol valerate (5 mg/day) injections were given on Days 11-15 of the oestrous cycle to induce pseudopregnancy. A further series of injections of either oestradiol valerate (5 mg/day) or vehicle were given on days 44-46 of pseudopregnancy to reflect more closely the hormone profile seen in pregnancy. Nest-building was induced by a single intramuscular injection of 15 mg of PGF2alpha (Lutalyse) on Day 47 of pseudopregnancy. The gilts were housed in pens (2.8 x 1.7 m) containing straw in experiment 1 or chronically confined in crates (0.6 x 1.7 m) that did not contain straw on days 44-48 of pseudopregnancy for experiment 2. Oestrogen supplemented gilts had significantly higher concentrations of circulating 17beta-oestradiol on day 47 of pseudopregnancy but there were no significant differences between treatments for circulating levels of prolactin, progesterone, cortisol or oxytocin, or for any behavioural measure in either experiment. These results indicate that there is no direct effect of supplementing already pseudopregnant gilts with oestradiol valerate on PGF2alpha-induced nest-building. The results also show that the pre-partum environment has a pronounced effect on nest-building behaviours and that non-pregnant pigs might be a useful model for pre-partum nest-building in this species.

Delusion of maternity

A few case reports on the delusion of pregnancy can be found in the published literature. However, the delusion of maternity, a delusional conviction of the patient that she is a mother of one or more children, has not yet been studied closely. The author describes the case of a 62-year-old childless patient with a diagnosis of chronic paranoid schizophrenia. She developed a delusion of maternity, persistent for many years. This markedly influenced her behaviour.

Delusions of pregnancy in the elderly

We present five case reports of elderly ladies with delusions of pregnancy. This symptom is discussed with reference to the cases and a review of the literature.

Deboleza: culturally determined behaviour in Istria

Deboleza is a behavioural construct among the inhabitants of Istria (a peninsula in the Adriatic Sea which belongs mainly to Croatia); it has peculiar social, ethno-psychological and historical characteristics because it is a relatively small region which has been the intersection of various cultures and civilizations. In this research the concept is analysed from the psychomedical point of view. As deboleza does not have the status of an illness, it functions as a culture-bound syndrome which, because of its emotional expressions, belongs to the 'shame' family. This interesting construct should be thoroughly studied not only in a peculiar and dynamic Croatian culture and in Croatian psychiatry, but also within European culture and psychiatry.

Arrested pregnancy syndrome in Haiti: findings from a national survey

This report describes findings from a national survey of pregnant women in Haiti regarding the social epidemiology of pedisyon (perdition), or "arrested pregnancy syndrome," a condition believed to be associated with infertility. Data collected on mortality of respondents' sisters were used to indirectly measure the prevalence of this culture-bound syndrome in the adult female population and to compare its distribution in urban and rural areas. Perdition appears to be a fairly common event that affects a large proportion of Haitian women. Reported cases of pedisyon were significantly higher in urban areas, which also differed from rural areas on respondent education, economic status, use of prenatal care, and fertility. No differences were found on sociodemographic, health, or fertility variables when women reporting perdition deaths were compared with women who reported other sister deaths. The utility and limitations of the proxy respondent method are discussed. Possible explanations for the higher rate of pedisyon among urban Haitian women are discussed, and suggestions are made for future research on arrested pregnancy syndrome.

Is there a physiological basis for the couvade and onset of paternal care?

Couvade is the male experience of pregnancy and couvade syndrome incorporates a range of symptoms suffered by "pregnant" men. The aetiology of the couvade syndrome is unknown. Anthropologists, psychiatrists, nurses and sociologists have provided explanations for behaviour changes in "pregnant" men in terms of cultural pressure, intrapsychic processes and psychosocial adaptation to a new situation. The adoption of a biological perspective allows us to ask a new question: is there a physiological basis for the couvade syndrome? A fresh research agenda would include measurement of physiological change and a search for causation. Implications for nursing are outlined.

Delusion of pregnancy in males: a case report and literature review

Delusions of pregnancy in males are bizarre delusions that are rare in occurrence. Variables in characterization of such delusions include organic factors, neuroendocrine abnormalities, sexual identity confusion, misinterpretation of mechanical factors, and wishes for another baby. In this report we describe a persistent delusion of pregnancy in a 43-year-old man with chronic schizophrenia in the background of poor sexual adjustment.

Endocrine and psychological evaluation of women with recent weight gain

A group of 13 consecutive regularly menstruating women who gained at least 5 kg the previous year (Group I) was compared to a control group of similar age, parity, and social class (Group II). The two groups were similar in estimated and observed food intakes; pre- and postprandial gastrin levels; hourly 24-h profiles of cortisol and insulin; urinary cortisol and 17-hydroxycorticosteroids. Group I had higher serum prolactin concentrations at all times than Group II (mean values 14.60 micrograms/l vs. 8.84 micrograms/l; p = .0121). Galactorrhea was observed in 5 women from Group I and in none of the women from Group II (p < .05). Group I also differed from Group II in a higher incidence of meaningful life-events the year preceding the study, higher prevalence of sexual dysfunction (9/13 vs. 4/13; p < .01) and higher indexes (p < .05) of several parameters in the MMPI and SCL 90. Median serum cortisol and prolactin concentrations were negatively correlated, both in Group I (R = -.669; p = .012) and in the whole sample (R = -.453; p = .0298). It is suggested that the rapid weight gain is part of a neuroendocrine response to environmental stimuli also characterized by hyperprolactinemia. The significant negative correlation between serum prolactin and cortisol indicates that this response differs from, and is possibly an alternative to, the sympathoadrenal "stress" response.

The couvade syndrome

The couvade syndrome can be considered to be the psychosomatic equivalent of primitive rituals of initiation into paternity. Various symptoms have been described in the husbands of pregnant women with an incidence from 11% to 65%. The most common of these are: variations in appetite, nausea, insomnia and weight gain. Seventy-three couples with the women in the last month of pregnancy were given a questionnaire; as a reference group, 73 men without pregnant wives or children under 1 year of age were taken. An emotional involvement connected with pregnancy was reported in 91.78% of the men. This involvement was expressed as changes in sexual habits in 87.67% of cases, fear and anxiety in 36.98% and curiosity in 47.94%. With the exception of nausea, physical symptoms were less frequent in the men with pregnant wives than in those without pregnant wives. These data cannot confirm the existence of the couvade syndrome with its own physical symptoms but we think that some male experiences, which constitute a peculiar imaginary and behavioral reality of the father-to-be, do exist.

Progesterone facilitates cognitive recovery and reduces secondary neuronal loss caused by cortical contusion injury in male rats

The ability of progesterone to reduce the cerebral edema associated with traumatic brain damage first became apparent when we observed that males had significantly more edema than females after cortical contusion. In addition, edema was almost absent in pseudopregnant female rats, a condition in which progesterone levels are high relative to estrogen. Progesterone injections given after injury also reduced edema and were equally effective in both males and females. The present experiment was done to determine if the progesterone-induced reduction in edema could also prevent secondary neuronal degeneration and reduce the behavioral impairments that accompany contusion of the medial frontal cortex. Progesterone-treated rats were less impaired on a Morris water maze spatial navigation task than rats treated with the oil vehicle. Progesterone-treated rats also showed less neuronal degeneration 21 days after injury in the medial dorsal thalamic nucleus, a structure that has reciprocal connections with the contused area.

Suppression of estrus in female mice by the presence of conspecifics or by foot shock

The reaction of reproductive system of outbred female mice to crowded conditions or electric foot shock was investigated. Both experimental factors inhibited estrous cycle, and decidual cell reaction (DCR) was observed after traumatization of uterine horns in tested animals. Further investigations showed that corpora lutea in females subjected to social stress were significantly larger than those in mice stressed by classical stressor. Also, plasma progesterone level increased only in females exposed to grouped females. These results indicate that social interaction among female mice lead to the development of typical pseudopregnancy, whereas inhibition of ovulation and DCR in females subjected to electric foot shock are not related to the increase of activity of corpora lutea.

Couvade syndrome in expectant Thai fathers

The occurrence of somatic symptoms by expectant fathers, commonly referred to as the couvade syndrome, has been reported to exist in American and European males. The purpose of this study was to describe the incidence of the couvade syndrome in Thai males. Responses provided by 172 expectant Thai fathers indicate that they also experience somatic symptoms during their partner's pregnancy.

Pseudopregnancy and postpartum psychosis: a case study

We report on an uncommon case of a woman who presents with pseudopregnancy. In the past she suffered from postpartum psychosis and an episode characterized by pseudohallucinations. No such association was reported in the literature survey we have made. We discuss the distinction between the overvalued idea as presented in pseudopregnancy and delusion as presented in the postpartum psychosis and suggest that the two phenomena can be viewed as a continuum rather than dichotomized, especially in cases like the one reported here.

Pseudocyesis in an adolescent incest survivor

This case is an example of pseudocyesis in an incest survivor. Symptoms of pregnancy were unconsciously created by the patient to shield her from the memory of her incest and at the same time confront the reality of her abuse. Her symptoms allowed her entrance into the medical system. Once in the system, it was just a matter of time before she was referred for psychological evaluation. The authors recommend that family physicians consider incest when evaluating patients who present with pseudocyesis.

Phantom pregnancy at Muhimbili

This is a case report on phantom pregnancy at Muhimbili. Relevant factors pertaining to personality of the patient, the experienced psycho-social stresses, the medical history and possible causes of symptom formation culminating in pseudocyesis are looked into and discussed.

Pseudocyesis in Organic Mood Disorders

Pseudocyesis, the delusion of pregnancy, has had an uncertain nosology, primarily because of the concentration on the content of the beliefs and lack of interest in the underlying phenomenology. Six patients with a major mood disorder caused by cerebral dysfunction are presented in this article. The delusion is reviewed with respect to the entities it overlaps, and the clinical manifestations are related to the mood disorders. Although no clear neuroanatomic localization was possible with this group of patients, there may be some association with desomatization caused by parietal lobe dysfunction.

Aggression by a female rat cohabitating with a sterile male: termination of pseudopregnancy does not abolish aggression

At the end of that time, each female was assessed for aggressiveness toward an unfamiliar female intruder once each week for 3 weeks. Those females displaying a high level of aggression had their male cagemate changed. For half of the females, the new male cagemate was a castrated male with a testosterone implant. For the other half, the new cagemate was a castrated male without a testosterone implant. Replacement males had been subjected to surgery 9 weeks previously. There were no differences in the aggressiveness of females of the two groups on any of 3 subsequent weekly tests of aggression. In a 3-h evaluation of male sexual behavior, none of the 9 castrated males without testosterone replacement displayed sexual activity with an estrogen/progesterone primed ovariectomized female, but 6 of 9 males with testosterone replacement did. Reanalysis of the aggression data comparing the females whose males had no testosterone replacement and females housed with the 6 males that were sexually active also revealed no differences in aggression over the 21-day test period. Since pseudopregnancy is known to last 13 days, these results indicate that the continuous presence of pseudopregnancy is not required for maintenance of aggression by a female cohabiting with a sterile male.

Subjective pseudocyesis (false pregnancy) and elevated temporal lobe signs: an implication

Twenty-two percent of 106 undergraduate university women reported symptoms of pseudocyesis: cessation of menstruation, abdominal enlargement, morning sickness, and breast changes. These women also displayed significant elevations in temporal lobe signs with particular involvement of putative right hemispheric processes. Women prone to pseudocyesis displayed more memory blanks, nocturnal akinesia, awareness of abdominal sensations, and exotic beliefs such as alien intelligence; the phenomenon was 10 times more frequent in Roman Catholic women than in Protestant women.

The early abortion of a pseudocyesis. Some observations from the analysis of an adolescent girl

Clinical material relevant to the emergence and resolution of a pseudocyesis during the analysis of an adolescent girl is presented. This case provides evidence that psychodynamic factors can alter human behavior, produce significant mental disturbance, and even alter physiological functions. The data not only validate the psychoanalytic approach but are relevant to its very origins. The importance of the transference neurosis and the interrelationship of oedipal and preoedipal conflicts are emphasized. A brief comment is addressed to the patient's penis envy which appeared as a secondary phenomenon.

[From pseudopregnancy to anorexia nervosa]

Translated in the primeval environment where humanization evolved during millions of years (man's environment of evolutionary adaptation, according to Bowlby), the characteristic behaviours of anorectics and bulimics do not look unfavourable but on the contrary adaptive, helping to the survival of the group or kinship (hyperactivity, altruistic feeding, etc.). Analogies, indeed homologies, exist in many animal species, distant or closely related to us (social insects, birds, mammals including primates) observed in nature. It concerns altruistic behaviours described among individuals, for the most part females, referred to as allomothers (aunts) or helpers (co-operative breeding) in ethological terms. From this evolutionary perspective, a biological genetic basis would exist in anorexia and bulimia, as a component of a phylogenetic inheritance of the K-selection strategy of reproduction. At the present time, anorexia would be a pathological extreme of this strategy, whereas pseudocyesis would be, on the contrary, one of the r-selection. Diverse and varying sociocultural and demographic conditions prevailing in modern world would revive either of these phylogenetic programs of reproductive strategies, leading as the case may be, to adaptive or pathological reproductive or helping behaviours.

Three thousand days of pregnancy. A case of monosymptomatic delusional pseudocyesis responding to pimozide

An unusual case of pseudocyesis of almost ten-year duration, characterised by a monosymptomatic hypochondriacal delusion and a selective response to pimozide is reported. The nosological status of the diagnosis, delusional (paranoid) disorder, is suggested to be a variety of the Kraepelinian concept of paranoia. The therapeutic pitfalls of relying on a phenomenological distinction between overvalued ideas and delusional beliefs are discussed.

Pseudocyesis associated with folie à deux

A case of a mother and daughter who both believed in their own pregnancy and that of the other is described.

Case study analysis of pseudocyesis: consideration of the diagnosis of child sexual abuse

Pseudocyesis is a condition in which an individual has the symptoms of true pregnancy and believes that he or she is pregnant, but pregnancy does not exist. Pseudocyesis is not confined to one nationality, race, social class or sex, and clinicians may encounter this condition in practice. Physiologic, psychodynamic and social components of pseudocyesis are described. A case study is presented that illustrates the correlation between pseudocyesis and childhood sexual abuse. The importance of accurate assessment of childhood sexual abuse in successful resolution of the condition is emphasized.

Pseudocyesis--a review and report of six cases

Pseudocyesis is a rare condition in which a woman believes herself to be pregnant when she is not. Its incidence has fallen in the last fifty years, probably due to a number of sociocultural and medical factors. Six cases are described which show common features of recent pregnancy loss or infertility, psychological and medical naivete, social isolation, recent loss and membership in a cultural or religious group that focuses on childbearing as the central role of women. Etiology includes psychological, sociocultural and endocrine factors which interact with each other demonstrating the reciprocal interplay between mind and body. Guidelines are provided for the assessment and management of this ancient and fascinating condition.

Pseudocyesis preceding psychosis

Pseudocyesis is an uncommon condition in which the psychological and somatic phenomena are usually thought to arise with neurotic rather than psychotic illness. We report a patient whose pseudocyesis took a course not previously described, culminating in an acute schizophrenic episode. Despite this she demonstrated many similarities with neurotic patients previously described in the literature. A phenomenological explanation, the belief of pregnancy as an overvalued idea, is discussed.

Abdominal proptosis: a case report

A case history of abdominal swelling of psychological origin is described. The clinical presentation and psychogenic pathogenesis of the disorder provide a differentiation from pseudocyesis. The psychodynamics of this case are discussed emphasizing the conflict involving strong elements of pre-oedipal aggressivity towards the father image.