A single woman in her 30s presented with a claim to be pregnant. She felt foetal movements. But she was NOT pregnant!
A 30-year-old, single woman, presented to the emergency department after the police found her naked in the woods. When the police found her, she had signs of psychosis including delusions and auditory hallucinations. Moreover, she was also agitated. The patient lived with her mother and 4 children. Additionally, the patient claimed to be pregnant and had symptoms of pregnancy including a distended abdomen, and whitish nipple discharge. Besides, she also felt foetal movements.
Past psychiatric history revealed a diagnosis of bipolar disorder and post-traumatic stress disorder (PTSD). However, she was well-managed with medications and routine psychotherapy.
Sexual history revealed that she had her last sexual encounter 7 months prior to the presentation. After that intercourse, she had 3 months of amenorrhea. She had taken several home pregnancy tests. However, each came out negative. Moreover, her family physician also had confirmed she was not pregnant at that time.
Although she had multiple confirmations that she wasn’t pregnant, she continued to believe that she had conceived. She insisted that she feels the foetal movement in her lower abdomen. Moreover, she also reported having milky discharge from her nipples bilaterally. She denied nausea, vomiting, breast enlargement, or skin changes.
A month before presentation, she had stopped taking her psychiatric medications, including risperidone, oxcarbazepine, and topiramate, as she thought she might harm the developing baby.
Since, she had stopped taking her anti-psychotics, her symptoms resurfaced. She reported feeling excessively energetic and slept only 2 hours at night for the last two weeks.
On examination, she was an obese woman with messy hair, and poor dentition. However, she was oriented, alert, and awake. The patient was poorly groomed, agitated, talked with rapid and pressured speech, anxious, and had persecutory delusions. Moreover, she was having auditory hallucinations of her deceased great-grandmother. Her affect was full range and euthymic.
Her thoughts was illogical and tangential and her judgment and insight were poor.
Abdominal examination revealed a non-distended abdomen with a non-palpable uterus. Breast examination ruled out breast enlargement.
Blood beta hCG ruled out pregnancy. Serum prolactin (PRL) level was 3.8 ng/mL and thyroid-stimulating hormone was 3.08 uIU/mL.
During management, she pulled out her intravenous line several times and threatened to leave the hospital. She was aggressive and threw a cellphone at her nurse.
The patient received olanzapine, haloperidol, and lorazepam. The doctors restarted her regular medications, including risperidone, oxcarbazepine, and topiramate for her bipolar disorder and propranolol for her migraine.
Pseudocyesis is a rare psychiatric condition usually in patients with other psychiatric disorders. Patients usually present with oligomenorrhea or amenorrhea, an increase in abdominal size, nipple discharge, and other signs of pregnancy. Patients also claim to feel the foetal movements. However, pregnancy tests are negative. Management of such cases requires a multidisciplinary approach.
Source: Espiridion E D, Fleckenstein C, Boyle P, et al. (September 10, 2020) A Rare Case of Pseudocyesis in a Patient With Bipolar Disorder. Cureus 12(9): e10352. doi:10.7759/cureus.10352