|Year : 2021 | Volume
| Issue : 1 | Page : 47-49
Delusion of pregnancy in a woman with mental retardation
Siddharth Sethi, Ganpat K Vankar
Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
|Date of Submission||06-Aug-2019|
|Date of Acceptance||05-Jun-2020|
|Date of Web Publication||4-Mar-2021|
Resident, 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
A false, fixed and firm belief of being pregnant despite factual evidence to the contrary is a delusion of pregnancy. This can occur in both men and women and is associated with many psychiatric and biological disorders. It should be differentiated from pseudocyesis, pseudopregnancy, simulated pregnancy and Couvade syndrome. We report a case of delusion of pregnancy in a woman with mental retardation.
Keywords: Delusional pregnancy, mental retardation, schizophrenia, wish fulfilment
|How to cite this article:|
Sethi S, Vankar GK. Delusion of pregnancy in a woman with mental retardation. J Clin Sci Res 2021;10:47-9
| Introduction|| |
A false and fixed belief of being pregnant despite factual evidence to the contrary is a delusion of pregnancy.
This important and interesting phenomenological symptom occurs both in men and women. The symptom occurs as a part of another mental disorder such as schizophrenia, schizoaffective disorder, dementia, delusional disorder and cerebral syphilis or as a squeal to encephalitis and drug-induced lactation and mental retardation. However, we could not find a detailed description of a case of delusion of pregnancy in a patient with mental retardation, despite extensive literature search.
Pseudocyesis, pseudopregnancy, simulated pregnancy and Couvade syndrome are the four differential diagnoses. Pseudocyesis can be defined as the development of classical signs of pregnancy, i.e., amenorrhoea, nausea, morning sickness, abdominal distension, breast enlargement and pigmentation and labour pains, in the absence of a pregnancy. Pseudopregnancy is a result of organic factors, such as, endocrine tumours, which presents as a somatic state resembling a pregnancy.
Simulated pregnancy is characterised by a conscious falsification of pregnancy, i.e., the woman is aware that she is not pregnant yet admits to be pregnant.
Couvade syndrome is the appearance of variety of somatic symptoms in the father before, during or after the birth of the child. His behaviour can resemble that of a pregnant woman, despite knowing that he is not pregnant.
We report here a case of delusion of pregnancy in a woman with mental retardation.
| Case Report|| |
A 43-year-old unmarried woman, educated up to 4th standard (though she is unable to read and write), was brought to the psychiatry outpatient department. She lives in a town with her widow sister and belongs to lower socioeconomic status. Ten years back, she had onset of illness where she had difficulty falling asleep and was irritable without provocation. Although they had very congenial relationship with neighbours, she became suspicious towards neighbour women without any apparent reasons. She believed that they were talking ill of her. She heard abusive voices of neighbours who threatened her that they would take away her house as they had already taken away her husband, when, in fact, the patient was never married. She began to talk to herself and was negligent of her household chores.
She was a full-term hospital delivery, her developmental milestones were delayed, where started walking at 2 years, and speech development occurred only at 3 years. Although she went to school at 6 years, she could study up to only 4th standard. As she started having difficulty at school after that, her schooling was discontinued by parents. She was living with her parents and her elder sister who was widowed. Although the patient was independent with regard to daily self-care, she could not learn to cook or do any household chores well.
She had menarche at the age of 16 years, and her last menstrual period was 2 years back and she had never engaged in sexual activity. On enquiry, she had hardly any sexual knowledge about reproductive anatomy and physiology related to reproduction. The patient was intermittently treated with antipsychotics, haloperidol and risperidone. The sister reported that for the last 2 years, she was on olanzapine 10 mg orally daily.
For the last one-and-half years, she had a strong belief that she is pregnant. As a neighbour touched her back, she felt that she was pregnant. She believed that she was planted with a remote-controlled device by her at that time. The device first developed three foetuses inside her, out of which one was a boy and two were girls. The device could also be used to control the foetuses inside her womb. The male foetus would come out of her anus whenever she defecated and would go back up inside her once she was done. The neighbour could also control the foetus's movements through a remote-controlled device.
The belief started 2 months after her niece gave birth to a baby boy. She had visited the niece after her delivery and found that her newborn as well as the niece was receiving utmost care from her in-laws family.
Mental status examination revealed delusion of persecution, delusion of reference, delusional pregnancy and delusion of control. She also had a flat affect, aroused but ill sustained attention and concentration. Gynaecological and surgical referral ruled out pregnancy as well as prolapse of rectum. She had sub-average intelligence and impaired abstraction. She totally denied that she had any mental disorder. Formal intelligence quotient (IQ) testing by clinical psychologist found IQ 60, i.e., in the range of mild mental retardation.
Her laboratory investigations revealed normal haemoglobin, total leucocyte count, differential leucocyte count, serum creatinine and serum bilirubin. Her thyroid function test, blood sugar levels, liver function tests and kidney function tests were normal. Her serum prolactin levels were 23.92 ng/mL, i.e., normal.
She was diagnosed as a having paranoid schizophrenia with mild mental retardation.
She was prescribed tablet olanzapine 10 mg and tablet clonazepam 0.5 mg. She reported 40%–45% improvement in her symptoms on her follow-up after 1 month.
| Discussion|| |
Delusions can be defined as false, fixed, firm and unshakable ideas that cannot be corrected by reasoning and are contrary to the patient's socio-cultural and educational background. Delusional pregnancy is an aetiologically heterogeneous phenomenon that can be triggered purely by organic factors or they can develop as an adaptation to stress induced by organic and/or psychological factors.
Biologically, delusion of pregnancy has been described in hyperprolactinaemia, drug-induced lactation, post-partum thyroiditis, metabolic syndrome, polydipsia, frontotemporal lobar degeneration with motor neuron disease, schizophrenia, schizoaffective disorder, delusional disorder, mental retardation, dementia and psychotic depression.,
Our patient described above had normal serum prolactin levels, and hence, her delusion was not due to antipsychotic treatment. Psychologically, delusion of pregnancy may be conceptualised as the following: cognitive misinterpretation of bodily sensations and physical changes, severe ego pathology and poor reality testing, wish-fulfilment, an attempt to recapture the lost love object, emotional attachment, i.e., a strong emotional bond between mother and daughter, sustainment and perpetuation of cultural beliefs, unconscious attempt to change the life situations of women in conservative societies and amplification of cultural themes.
In a systematic review of 84 case reports of delusional pregnancy the authors reported that out that most of the patients (47.6%) were between the age of 21 and 40 years and 28.6% patients were more than 50 years of age. Twenty of the reports analysed (23.8%) were males; 38.1% of the patients unmarried. The most common diagnoses of patients with delusional pregnancy were schizophrenia (35.7%), bipolar disorders (16.7%) and depression (9.5%). Most patients (79.8%) reported single foetus, triplets and 4 or more foetuses were more common than twin pregnancy. Seven patients (8.3%) reported that they could hear the voice of their foetus, while a majority (45.2%) claimed that they could feel their foetus move. While psychosocial factors were implicated in the psychopathology of majority (64.3%) of the patients, wish fulfilment was the most implicated factor. Socio-cultural factors were the apparent reasons for development of delusion of pregnancy in 42.9% of the patients, with societal pressure to have children being the most common cause.
The basis for her delusional pregnancy can be attributed to her wish fulfilment. She was never married and never had any children. However, her niece gave birth to a baby boy, about 2 months before the development of her delusion. In Indian society, as other developing countries, women's perception of their inherent powerlessness in a patriarchal society leads to the development of pseudocyesis. In fact, because pregnancy is a highly respected state and women are treated, especially well during this time by their spouses, in-laws, and society, in general.
Psychosocial factors sit at the helm of development of delusional pregnancy. In mild mental retardation, the prevalence and pattern of psychiatric morbidity are similar to that seen in people with normal intelligence. Sociocultural factors are similarly operative though perhaps modified by limited intellectual abilities.
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 understand 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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