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Delusions of Pregnancy in Saudi Arabia: A SocioCultural Perspective
Abstract
Delusion of pregnancy is an uncommon symptom that has been reported in both male and female patients who suffer from a variety of organic and functional psychiatric disorders. This study describes seven Saudi females who developed this symptom during the course of chronic schizophrenia (n= 5) and mood disorders (n= 2). This symptom serves multiple socio-cultural functions, which are described.
... Our initial search yielded 95 papers (140 cases total) of delusions of pregnancy. Of these, only 18 papers and 23 cases met our inclusion criteria [4,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Thus, we found that 16.4% of delusional pregnancy case reports also involved comorbid medical conditions. ...
... Out of the 23 cases, 15 mentioned an official psychiatric diagnosis. Nine of these 15 patients had schizophrenia [12(2 cases), 15,20,22,[24][25][26][27], two had bipolar disorder with psychotic features [4,13], two had schizoaffective disorder [4,21], one had psychosis not otherwise specified [28], and one had Parkinson's disease [19]. ...
... Physical examination led to the discovery of a large mass in the left hypochondrium which was removed and found to be a papillary carcinoma of the left kidney [13]. Ten cases described antipsychotic-induced hyperprolactinemia with symptoms of amenorrhea or galactorrhea [4(2 cases),8,12(2 cases), 15,20,21,[26][27]. Another case describes a 28-year-old woman with schizophrenia who was found to have hyperprolactinemia, amenorrhea, and Hashimoto's thyroiditis [25]. ...
Purpose: Delusions of pregnancy are associated with functional impairment and psychological distress. Previous works have focused on characterizing their etiology and identifying contributory social and cultural factors. The purpose of this review is to give an overview of the literature on medical or surgical comorbidities associated with delusions of pregnancy.
Methods: We searched Google Scholar, PubMed, and PsycInfo using the terms “pregnancy delusion,” “delusional pregnancy,” “pseudocyesis”, and “false/pseudo/phantom/spurious pregnancy” to identify all published cases of delusional pregnancies. We included cases in which medical or surgical factors might have contributed to the delusion. We extracted the following information from selected case reports: patient age, psychiatric diagnoses, medications, medical comorbidities, somatic complaints, treatment, and outcome.
Results: We found that 23 of 140 cases (16.4%) were potentially influenced by concomitant medical or surgical conditions including gallstones, abdominal tumors, hyperprolactinemia, constipation, a tubal cyst, and esophageal achalasia. Medical or surgical treatment was pursued in 15 of these 23 cases, followed by mitigation of the delusion in ten cases.
Conclusions: We emphasize the importance of a thorough workup including physical and gynecological examinations in patients presenting with a delusion of pregnancy. Clinicians should recognize and overcome potential barriers to undertaking comprehensive assessments in order to prevent delays in management and treatment of underlying medical or surgical conditions.
... In different contexts, some synonyms for pseudocyesis (a few of which are no longer in common use) have included pseudopregnancy, imaginary pregnancy, simulated pregnancy, phantom pregnancy, hysterical pregnancy, and spurious pregnancy (8)(9)(10). With pseudocyesis, physiological manifestations of pregnancy occur, including irregular menstruation (e.g., amenorrhea or hypo-menorrhea), abdominal distention, the subjective sensing of fetal movements, changes in breast size or shape, milk secretion, darkening of areolar tissue, galactorrhea, weight gain, nausea and vomiting, and changes in the uterus and cervix (6,7,(11)(12)(13). Of these symptoms, menstrual disorders and changes in breast size or shape are the most common (6,(14)(15)(16)(17). ...
... Studies in African countries have shown that the incidence of pseudocyesis is related to the importance of the fertility status of these women and is accounted of women values (19). In male- dominated societies (in which infertility usually results in divorce or a second marriage), infertile women use pseudocyesis as a defense mechanism to prevent these outcomes (12,58). ...
... The somatopsychic hypothesis asserts that pseudocyesis starts as random physiological changes and leads to the development of a pregnancy delusion in vulnerable individuals (18). The first studies on the disorder emphasized the physical characteristics of the disorder and its symptoms, and the etiology of pseudocyesis may be similar to that of delusions of pregnancy (1,12). ...
Background
Pseudocyesis is a psychopathological clinical syndrome in which a non-pregnant woman firmly believes herself to be pregnant and manifests many symptoms and signs of pregnancy. Although the exact etiology of pseudocyesis has not been determined.
Objective
This study was conducted with the aim of assessing the biopsychosocial view to pseudocyesis.
Materials and Methods
A comprehensive search in electronic databases such as Google Scholar, PubMed, ScienceDirect, Web of Science, and Scopus was conducted between 1943-2016 to retrieve pseudocyesis related articles. For this purpose, 1149 articles were collected and 66 items were used.
Results
Findings were classified into 2 main categories: a) pseudocyesis etiology, which could include (biological psychological factors and psychiatric disorders, and social factors); and b) pseudocyesis management.
Conclusion
Pseudocyesis results from a multidimensional group of factors, and a holistic and comprehensive approach should be taken to its treatment. Cooperation between gynecologists and psychiatrists would likely be useful in addressing the condition.
... Concernant la présentation clinique, les délires de grossesse sont très hétérogènes. En effet, la durée peut varier de quelques jours [1,[8][9][10][11][12] à quelques semaines [5,[10][11][12][13][14] voire à plusieurs années [1,[4][5][6]12,13,15]. Le contenu délirant, en outre des idées de grossesse, est disparate ; des thèmes de zoopathie interne [1,4,11], de persécution [1,9,11,12,[16][17][18], de possession démoniaque [1,15,18], mystique [4,18] et érotomaniaque [4,18] peuvent être décrits. ...
... Concernant la présentation clinique, les délires de grossesse sont très hétérogènes. En effet, la durée peut varier de quelques jours [1,[8][9][10][11][12] à quelques semaines [5,[10][11][12][13][14] voire à plusieurs années [1,[4][5][6]12,13,15]. Le contenu délirant, en outre des idées de grossesse, est disparate ; des thèmes de zoopathie interne [1,4,11], de persécution [1,9,11,12,[16][17][18], de possession démoniaque [1,15,18], mystique [4,18] et érotomaniaque [4,18] peuvent être décrits. ...
... Concernant la présentation clinique, les délires de grossesse sont très hétérogènes. En effet, la durée peut varier de quelques jours [1,[8][9][10][11][12] à quelques semaines [5,[10][11][12][13][14] voire à plusieurs années [1,[4][5][6]12,13,15]. Le contenu délirant, en outre des idées de grossesse, est disparate ; des thèmes de zoopathie interne [1,4,11], de persécution [1,9,11,12,[16][17][18], de possession démoniaque [1,15,18], mystique [4,18] et érotomaniaque [4,18] peuvent être décrits. ...
Delusions of pregnancy are not well known. The delusion of pregnancy is defined as the belief of being pregnant despite factual evidence to the contrary. The clinical picture is heterogeneous (duration, mechanisms, topics and pre-existing psychiatric disorders). Several causes have been proposed to explain the occurrence of the delusions of pregnancy: cenesthetic theory, hyperprolactinemia, polydipsia and psychodynamic conflicts. Hyperprolactinemia is an interesting hypothesis (physiologic increase during pregnancy and similar manifestations in the course of gestation). The abductive inference theory is a probabilistic model that can clarify the role of hyperprolactinemia in the delusions of pregnancy. The purpose of this paper is to study the role of hyperprolactinemia in the delusions of pregnancy using a literature review. The abductive inference model is used to specify the etiopathogeny of this pathology.
A research in Medline, Sudoc, BIUM and PSYLINK using the following key words "delusional pregnancy" or "delusion of pregnancy" and "hyperprolactinemia" was conducted.
Three articles (case reports) about delusions of pregnancy associated with hyperprolactinemia were found. The cases have some similitudes. First of all, they have similar chronology: delusion appears at the same time as hyperprolactinemia and resolves with biological normalization. Secondly, hyperprolactinemia is always caused by a neuroleptic (haloperidol, olanzapine, risperidone). Concerning pre-existing disorders, a psychiatric pathology for each case was found (schizophrenia, schizo-affective disorder and bipolar disorder). Chronology, reproductivity and reversibility are strong arguments to involve hyperprolactinemia in the delusions of pregnancy (Bradford Hill criteria). Furthermore, this association is biologically plausible: physiologic increase during pregnancy (gestational signal), similar symptoms to those during pregnancy and the role in parental behavior (parental signal). Nevertheless, not everyone with hyperprolactinemia will develop a delusion of pregnancy; the interaction is more complex (non linear); the theory of abductive inference clarifies this relationship.
Abductive inference is a probabilistic model whose goal is to explain the occurrence of delusional beliefs. The first factor is the abnormal data. The second factor is the cognitive process (abductive inference), which uses Bayes' theorem to select the most likely hypothesis to explain the abnormal data. In the delusion of pregnancy, abnormal data is the hyperprolactinemia, signal of gestation without pregnancy. Hypotheses in order to explain this signal are then produced (pregnancy or no pregnancy). In the second part, probabilities associated with each hypothesis, given the hyperprolactinemia, are compared. Since hyperprolactinemia is a gestational signal, the pregnancy hypothesis is most likely. Probabilities associated with each hypothesis without taking hyperprolactinemia into account are compared (prior probability). Since any element of reality indicates a pregnancy, the absence of pregnancy is most likely. In the last step, the posterior probability is calculated using the first two comparisons. The probability associated with the pregnancy hypothesis (taking into account hyperprolactinemia) is relatively higher than the probability associated with the no-pregnancy hypothesis (without taking into account hyperprolactinemia). So, the posterior probability associated with the pregnancy hypothesis is more likely than the posterior probability associated with the no-pregnancy hypothesis. Thus, the subject believes in a pregnancy.
The research and the treatment of hyperprolactinemia must be conducted when faced with a delusion of pregnancy.
... Although the majority of the patients showed a favourable initial response to treatment, only a few papers specified the duration of follow-up (Al-Krenawi & Graham, 1997;Broch, 2001;Colac¸o Belmonte, 1976;Qureshi, Al-Habeeb, Al-Ghamdy, Abdelgadir, & Quinn, 2001;Salvatore, Bhuvaneswar, Ebert, & Baldessarini, 2008). In some of those cases the results of medical treatment were quite striking. ...
... In another noteworthy case, partial recovery was only achieved after a switch from classic antipsychotics to clozapine . Four other noteworthy cases involved delusions of pregnancy, in three of which pharmacological treatment was efficacious (Qureshi et al., 2001). One patient diagnosed with mood disorder received electroconvulsive therapy without any favourable response. ...
... She relapsed a few weeks later, at which time a hypomanic episode was diagnosed. Three cases of mood disorder treated with pharmacotherapy Lim et al. 7 showed an equally favourable initial response (Qureshi et al., 2001;Studer, 2010;Younis, 2000). One of the patients had a relapse after cessation of the medication (Studer, 2010). ...
Patients with an Islamic background who suffer from hallucinations or other psychotic symptoms may attribute these experiences to jinn (i.e., invisible spirits). In this paper, we review the medical literature on jinn as an explanatory model in the context of psychotic disorders. We conducted a systematic search for papers on jinn and psychosis in Pubmed, EMBASE, Ovid Medline, PsycINFO, and Google Scholar databases. Our search yielded 105 scientific texts on jinn and their relationship with mental disorders, including 47 case reports. Among the case reports a definite biomedical diagnosis was provided in 66% of the cases, of which 45.2% involved a schizophrenia spectrum disorder. Fully 10 of 16 hallucinating patients experienced multimodal hallucinations. Although infrequently documented in the biomedical literature, the attribution of psychiatric symptoms to jinn appears to be quite common among Islamic patients, and to have significant impact on the diagnosis, treatment, and course of mental disorders, particularly psychotic disorders.
... She stopped eating, lost weight, and died 18 months later. It is nosologically nonspecific, occurring in a wide variety of organic states (posttraumatic epilepsy, 17 new variant of Creutzfeldt-Jakob disease, 18 and other organic brain syndromes), and functional psychoses, that is, psychotic conditions for which no organic lesions and no toxins have been consistently demonstrated (schizophrenia and mood disorders) 19 as well in medical conditions like drug-induced lactation. 20 It has been reported both among male [21][22][23] and female patients (also in postmenopausal women). ...
... 24 The number of recorded instances of delusions of pregnancy in men seems to be very small, 21 and they have been occasionally reported as symptoms of a wide variety of psychotic states including schizophrenia, 21 schizoaffective disorders, 21 and bipolar mood disorders. [12][13][14][15][16][17][18][19][20][21][22] Organic brain damage plays a strong part in the development of these delusional believes in men being reported in mental retardation, 21 postencephalitic syndrome, 25 and general paresis. 26 The coexistent appearance of delusions of pregnancy and infestation was reported in a male patient with posttraumatic epilepsy. ...
... 29 Another example, a Muslim man can marry 4 times and hence can have 4 wives; given these social realities, the patient with delusional pregnancy may seek to prevent her husband from marrying another woman who might insist that her prospective husband divorce the patient. 19 Maher and Spitzer 41 explains that the patient is delusional because he or she actually experiences anomalies that demand explanation. The delusional explanation offers relief from puzzlement, and that relief works against abandonment of the explanation. ...
Background:
Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy.
Objective:
To identify the characteristic of a psychotic symptom, the phenomenon of delusion of
pregnancy, in the context of dementia.
Method:
MEDLINE and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2014. Search terms used included delusion of pregnancy, uncommon presentation,
behavioral and psychological symptoms, dementia, Alzheimer’s disease, and frontotemporal dementia (FTD). Publications found
through this indexed search were reviewed for further relevant references. We included case reports that highlight the relationship and overlap between dementia presenting as schizophrenia-like psychosis and schizophrenia.
Results:
Literature on delusion of pregnancy in the course of dementia consists mostly of case reports and small samples of patients.
Conclusion:
Psychotic phenomena such as delusion of pregnancy may be a feature in some cases of dementia. If this bizarre features of dementia appears as early presentation of FTD whose usual onset is in the presenium, it may be mistaken for schizophrenia
... The included articles varied in the number of cases described from one case, [1,2,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41] two cases, [42,43] three cases, [44,45,46] four cases, [47] five cases, [48,49,50,51] six cases [52] to a maximum of seven cases. [53,54] The demographic characteristics of patients having delusion of pregnancy are presented in Table 1. Amongst 84 reported cases, 47.6% patients were in the age range of 21 to 40 years, and 28.6% patients were more than 50 years of age. ...
... [59] The role of socio-cultural factors in the development of delusion of pregnancy has been reported in patients, suggesting that contextual variables may exert influence particularly when pregnancy confers a higher valued social status. [24,32] Chronic social deprivation, [23,48] excessive societal pressure to have children [31,49] and belief in the ability of spiritual deities or an evil eye to induce pregnancy [47,48,53] have been suggested to lead to delusion of pregnancy. Chowdhury et al. [54] reported seven unusual cases of delusional puppy pregnancy in rural West Bengal, India wherein detailed phenomenological analysis revealed the special cultural background of the delusions. ...
Case reports of delusion of pregnancy have emanated from all over the world, yet the rarity of this phenomenology has precluded systematic large scale descriptive or cohort studies. This systematic review was conducted to assess the demographic characteristics, clinical profile, treatment outcome and aetiological factors from the published case reports of delusion of pregnancy. Electronic databases including PubMed, PsychInfo and Google Scholar were used to identify case reports relating to delusion of pregnancy published in peer-reviewed English language journals. All such cases were systematically evaluated by investigators, and information was extracted using a structured proforma. A total 40 articles were reviewed which included 84 cases. Demographic characteristics revealed that about half of the patients were aged 20-40 years. The most common diagnoses were schizophrenia (35.7%), bipolar disorders (16.7%) and depression (9.5%). Single foetus was reported by 79.8% of the patients, and 45.2% perceived foetal movements. Good treatment response was noted in 64.3 % of the cases. The prominent aetiological factors that were implicated included psychosocial factors, coenaesthopathological processes, socio-cultural factors and hyperprolactinaemia. Delusion of pregnancy is a heterogeneous symptom which emerges during the course of various neuropsychiatric disorders. A range of aetiopathological mechanisms have been implicated in the causation of this disorder.
... The epidemiology of delusion of pregnancy is not well known, but recent reports suggest that it is not so uncommon (Dutta and Vankar, 1996;Michael et al., 1994). The delusion of pregnancy is reported in both female (Manjunatha and Saddichha, 2008;Michael et al., 1994) and male patients (Bitton et al., 1991;Chaturvedi, 1989) and present in variety of organic conditions (Chaturvedi, 1989;Jenkins et al., 1962) as well as functional conditions (schizophrenia and mood disorders) (Qureshi et al., 2001). Michael et al. (1994) suggested differentiation of delusion of pregnancy from pseudocyesis, simulated pregnancy, pseudo-pregnancy, and Couvade syndrome. ...
... The temporal correlation of development and resolution of delusion of pregnancy with antipsychotic-induced hyperprolactinemia (Ahuja et al., 2008a(Ahuja et al., , 2008b and rechallenge with same antipsychotics and stopping also correlated with appearance and disappearance of delusion of pregnancy with hyperprolactinemia (Ali et al., 2003) lead to linking of prolactin as biological basis in delusion of pregnancy. Qureshi et al. (2001) implicated organic, coenaestho-pathological (disordered experience of exaggerated or distorted proprioceptive, kinaesthetic or haptic sensations of which the subject is not normally aware), socio-cultural, and religious factors in the etiology of delusion of pregnancy. However, authors feel that the 'never married' status of all patients reported here is interesting to explain the etiological basis of DPS psychodynamically. ...
The content of delusions in delusional syndrome has fascinated psychiatrists from antiquity. Delusions are classified on different principles such as, degree of inexplicability, subverted mental function, degree of independent nosological status, and on thematic content (traditional and logical). Delusions in sequence of procreation in three cases of schizophrenia along related delusions in published literatures are described under the broad rubric of term "delusional procreational syndrome" (DPS) (in the model of delusional misidentification syndrome), based on "logical thematic content" in the sequential phases of procreation. The DPS consists of numbers of delusions such as 'delusion of having spouse', 'delusion of pregnancy', 'delusion of delivery (child birth and labour)', 'delusion of being parents (paternity/maternity)' and so on. Authors also reviewed published literatures on these delusions. Though the concept of DPS is fascinating, further studies are needed to validate the concept of DPS.
... Antes se privilegió la hipótesis psicodinámica, y actualmente se enfatiza el correlato neurobiológico (4). Verbigracia, es interesante encontrar en la bibliografía reciente reportes de delirios de embarazo asociados con niveles elevados de prolactina en pacientes psicóticas y usuarias de neurolépticos (7)(8)(9) Desde la perspectiva transcultural, repetidamente se ha constatado que la expresión de los delirios y otros síntomas psicóticos varía en buena parte según el contexto específico de los individuos (10). Adicionalmente, se ha señalado que en culturas no occidentales, la prevalencia de delirios de embarazo podría ser mayor, debido al importante significado social de la gestación (11). ...
Introduction: Pregnancy delusions have usually been considered as symptoms of psychotic disorders in opposition to the hysterical and psychosomatic nature of pseudocyesis, though several authors have described some semiologic intersection between the two phenomena. Method: Introduction of four cases of patients with pregnancy delusions as well as review and discussion of relevant bibliography. Results: In fact, there are symptoms shared by pregnancy delusions psychosis and pseudocyesis, without detriment of nosological differentiation between the two phenomena. There is certain confusion regarding conceptual and terminological issues that does not contribute to mark precise boundaries. Conclusion: A comprehensive and holistic approach for the study of pseudocyesis and pregnancy delusion is proposed. Maybe, these disorders are more frequently observed in Latin America.
... Antes se privilegió la hipótesis psicodinámica, y actualmente se enfatiza el correlato neurobiológico (4). Verbigracia, es interesante encontrar en la bibliografía reciente reportes de delirios de embarazo asociados con niveles elevados de prolactina en pacientes psicóticas y usuarias de neurolépticos (7)(8)(9) Desde la perspectiva transcultural, repetidamente se ha constatado que la expresión de los delirios y otros síntomas psicóticos varía en buena parte según el contexto específico de los individuos (10). Adicionalmente, se ha señalado que en culturas no occidentales, la prevalencia de delirios de embarazo podría ser mayor, debido al importante significado social de la gestación (11). ...
Introduction:
Pregnancy delusions have usually been considered as symptoms of psychotic disorders in opposition to the hysterical and psychosomatic nature of pseudocyesis, though several authors have described some semiologic intersection between the two phenomena.
Method:
Introduction of four cases of patients with pregnancy delusions as well as review and discussion of relevant bibliography.
Results:
In fact, there are symptoms shared by pregnancy delusions psychosis and pseudocyesis, without detriment of nosological differentiation between the two phenomena. There is certain confusion regarding conceptual and terminological issues that does not contribute to mark precise boundaries.
Conclusion:
A comprehensive and holistic approach for the study of pseudocyesis and pregnancy delusion is proposed. Maybe, these disorders are more frequently observed in Latin America.
... There are several physical manifestations of metabolic syndrome (Bonow and Eckel 2003); however, the psychological and psychiatric impact of metabolic syndrome has not been studied to date, which may be important not only for predicting outcome, but also may determine presentation of psychopathology (Bitton et al. 1991; Wirshing et al. 2002). Delusion of pregnancy is one such rare symptom seen due to organic, functional or drug-induced causes (Qureshi et al. 2001). An earlier report had described delusion of pregnancy in young girls due to drug-induced lactation and amenorrhea accompanied by breast changes (Cramer 1971). ...
Metabolic syndrome is currently the research topic of several studies. Although physical manifestations of metabolic syndrome have been described, the psychological and psychiatric impact of metabolic syndrome has not been studied to date. We report the first case of antipsychotic-induced metabolic syndrome which was associated with development of delusions of pregnancy in a post-menopausal woman.
Diatoms are a group of unicellular algae that have been recorded and classified for over 200 years and have been used in a range of applications in forensic field. Diatom analysis is a valuable tool in forensic field and it is useful in diagnosis of drowning cases. The basic principal of the "diatom test" in drowning is based on correlation between diatoms present in the medium where the possible drowning took place and inhalation of water causes penetration of diatoms into the alveolar system and blood stream. These diatoms got deposited into the brain, kidneys and other organs. For solving of drowning cases, hard bones like sternum or clavicle as well as soft tissues (lungs and liver) of drowned bodies and sample of water in which possible drowning take place are usually sent to the Forensic Science Laboratories for detection of diatom. A retrospective study was conducted in the department of Forensic Medicine and Toxicology, G.G.S. Medical College, Faridkot which included all cases brought by police referred from Faridkot district and nearby districts to department from a period of October 2012 to October 2014 with alleged history of drowning. During this period a total of 100 cases were brought by police to the department of Forensic Medicine and Toxicology, G.G.S. Medical College, Faridkot. The male to female ratio of the cases was 5.25:1. The most common age group was 20-40 years for males as well as females. Thirty eight percent victims were from rural background while twenty seven percent victims were of urban background. Background of rest of the cases was unknown. Diatom test was found to be positive in 38 cases while it was negative in rest of the cases.
This case report describes the longstanding course of a delusion of pregnancy in a 51-year-old schizophrenic Ghanaian woman suffering from multiple symptoms of delusions and hallucinations. In addition to these symptoms, the patient was affected by multiple coenesthesias, ego disturbances and bizarre delusions of being influenced by external forces. A multi-causal aetiology of delusional pregnancy is discussed.
Pink teeth can occur in the living or as a postmortem phenomenon. In the context of forensic pathology, pink teeth are most commonly found in asphyxial deaths like drowning and strangulation; sudden and unnatural deaths, drug intoxications and carbon monoxide toxicity. However, their pathognomonic value is still doubtful as there is no obvious connection between the cause of death and this non specific phenomenon. The surrounding humid or wet environment appears to be essential in their formation. The process behind pink staining is hemolysis of erythrocytes and subsequent diffusion of hemoglobin pigment and/or its derivatives into the dentine tubules. A time delay is suggested between death and the occurrence of pink phenomenon. Two cases of putrefied corpses are described who died due to drowning and ligature strangulation, respectively. The autopsy revealed pink coloration of all the teeth in both cases which was more marked at their neck and cementum-enamel junction. The current view on the underlying chemical process, relation to the cause of death and the factors affecting the pink teeth phenomenon are explained with the help of both cases.
Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.
Case study and review of the literature We review the nosology and phenomenology of delusion of pregnancy. Two cases with post partum delusion of pregnancy which can be regarded as a delusion with bizarre content are described. The possible etiological factors particularly aspects of the novel cognitive theories of delusion formation and the hyperprolactinaemia caused by antipsychotic treatment are considered. While discussing the cases with post partum delusion of pregnancy we integrate the false sensory and cognitive processing of the puerperal somatic changes with the motivation theory of delusion formation and with the effect of the cultural environment.
Somatic delusional disorder is an uncommon psychiatric disorder that has been typically reported in elderly women. This article reviews the literature and describes a Saudi female patient who presented with novel somatic delusion of turabosis--the conviction that she was continually being covered by sand from sandstorms. Although the systematized delusional convictions remained unshakable, her anxiety and mood symptoms responded to a regimen of tricyclic antidepressants and her delusional beliefs resolved within eight weeks of treatment with risperidone. Sociocultural themes and therapeutic approaches to somatic delusional disorder are discussed.
We report four cases (three women, one man) having delusions of pregnancy seen over a four month period at a short - stay in-patient facility in a General Hospital Psychiatry Department. None had organic factors and all could be explained on the basis of psychological mechanisms. Delusions of pregnancy may not be as uncommon as was previously believed.
This sub-study of the WHO Determinants of Outcome of Severe Mental Disorders research project was aimed at characterizing the behavioral and expressive qualities of schizophrenia in two highly diverse cultures. Early research has indicated that the core elements involving affect, perceptual and cognitive dysfunction in schizophrenia are highly similar in form in most cultures of the world. Much of the cross-cultural literature emphasizes, however, strong differences in the ways in which schizophrenia is actually expressed and manifested in different settings. The basic methodology for psychiatric description and diagnosis in the WHO program was the Present State Examination. In five of the field centers a method for investigating the expressive quality and the social behavior of patients in their own communities through the eyes of significant others was applied. This method was then subjected to psychometric tests of cross-cultural applicability and found to be valid for comparing behavior across settings. The expressive patterns of the Indian and Nigerian patients were studied from two perspectives. Indian schizophrenics were described by family members as manifesting a more affective and "self-centered" orientation; the Nigerian patients presented with a highly suspicious, bizarre, anxious quality to the basic behavioral pattern. The main features of pathology were in general accord with the descriptions of indigenous psychiatrists. The special qualities of the psychosis in the two cultures were interpreted against the background of traditional psychopathological and anthropologic theories concerning the psychodynamics and the influence of differing social conflictual themes in the two cultures. Analysis of psychopathology in this manner was found to enhance understanding of underlying mechanisms and the role of cultural conflicts in its expression.
On the basis of clinical observations, psychic disturbances have been recognized as an etiological factor in some cases of menstrual dysfunction and female sterility, apparently acting through mediation of the endocrine system.1 The lack of objective studies has led some to consider the need for more definite proof, especially in infertility cases.2 Pseudocyesis, a condition in which a woman firmly believes herself to be pregnant and in which develop many of the symptoms and signs of pregnancy, however, lends itself well to an evaluation of the relation of the psyche to the female sex-endocrine mechanism. Although 465 case reports of pseudocyesis may be found in the literature, they have been recorded chiefly as medical curiosities, with but few observations or studies that might shed light on the modus operandi of this interesting psychosomatic disturbance.3 The present report is an evaluation of the data obtained by gynecologic, endocrinologic
Cauterization, an indigenous treatment technique, is widely used by psychiatric and non-psychiatric patients in Saudi Arabia. This research aimed at describing the socio-demographic and clinical parameters of psychiatric patients who consult traditional healers practising cauterization. A sample of 198 patients, 121 with and 77 without cautery, were randomly selected from inand out-patient departments of Buraidah Mental Health Hospital, Saudi Arabia. In addition to an extensive review of medical records, each patient and a key relative were interviewed to collect sociodemographic and clinical data and details of cautery treatment. Patients with less education, from a rural background or suffering from chronic psychotic disorders, were significantly more likely to utilize cautery. Parents were the main influence on seeking cautery treatment. Cephalic cautery was not associated with therapeutic improvement among patients with psychoses. Infection at the site of cautery was common and 45.5% of cauterized patients required antibiotic therapy. Given the probable lack of therapeutic benefit and the risk of complication, the use of cautery should be discouraged through health education programmes.
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.
This is the second of a two-volume psychoanalytical study of feminine psychology (see
18: 2840). Chapter headings are: social and biologic aspects; motherhood, motherliness, and sexuality; the preliminary phases; the psychology of the sexual act; problems of conception: psychologic prerequisites of pregnancy; pregnancy; delivery; confinement and lactation: first relations with the child; the mother-child relation; unmarried mothers; adoptive mothers; stepmothers; and the climacterium. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the African population, pseudocyesis is not an uncommon gynecologic disorder. The high premium on childbearing, as well as the deep-rooted cultural belief that children are a "security of old age" and continuation of the family, exposes the infertile woman to constant stress. The social and psychological satisfaction of parenthood is very important in this culture; while, for some patients, perception of the economic implication of children enhances the desire to have children.
A case is described of a delusion of pregnancy in a 32-year-old schizophrenic Indian woman following loss of a baby daughter and rejection by her husband, who also denied her access to her son.
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.
A case of a mother and daughter who both believed in their own pregnancy and that of the other is described.
Delusions of pregnancy in men - Volume 155 Issue 3 - K. N. R. Chengappa, S. Steingard, J. S. Brar, M. S. Keshavan
Pseudocyesis probably represents only one position along a spectrum of aberrations of psychoneuroendocrine control of the gonads. Amenorrhea is often mentioned as a symptom of depression. Other menstrual disturbances of unknown etiology which are usually classified as hypothalamic amenorrhea might also be a part of this spectrum. The connection between depression and alterations in gonadal function may have further psychophysiological implications. This could, in part, be due to the sequence of neuroendocrine events associated with depression, leading to decreased FSH and LH secretion from the anterior pituitary. Future studies using these constructs will be of use in further clarifying psychological and neuroendocrinological relationships.
The author presents the case of a psychotic girl who developed galactorrhea and a delusion of pregnancy while taking chlorpromazine. The delusion developed as a result of the interaction of the side effects of chlorpromazine and the psychological makeup characteristic of pseudocyesis patients. Galactorrhea and breast changes are often found among patients taking high doses of chlorpromazine and conflicts about pregnancy are frequent; thus delusions of pregnancy may often occur among female institutionalized patients treated with chlorpromazine.
This report describes a case of pseudocyesis in a male patient and reviews the literature in pseudocyesis in the male and female. Pseudocyesis is a rare psychiatric syndrome with only about 100 cases reported in females and three in males in the past 45 years. The authors suggest that somatic factors may play a role in the genesis of some cases of pseudocyesis by stimulating pregnancy wishes and interacting with these wishes to set up a psychophysiological interaction leading to the clinical syndrome of pseudocyesis.
Pseudocyesis is a diagnosis out of medical antiquity in with the physiological and psychological concomitants of pregnancy develop in the absence of the true gravid state. Along with other dramatic and polymorphous psychiatric disorders pseudocyesis appears to have decreased in frequency or altered its clinical manifestation in this century. The author discusses the reasons behind these changes and describes a comparable modern neuroendocrine diagnosis, the galactorrhea-amenorrhea hyperprolactinemia syndrome. He advocates the combined use of the term pseudocyesis for a selected population of patients.
Pseudocyesis is rare in childhood and adolescence. Moreover, in all age groups, there has been little written on its therapeutic handling. The authors describe a case of pseudocyesis in a fifteen-year-old girl and discuss the therapy in some detail.
We report five cases of delusions of pregnancy of whom three were women and four had chronic schizophrenia. We draw the attention of clinicians to this symptom which is not as rare as has previously been thought.
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.
Cultural aspects of illness behaviour
- M F El-Islam
El-Islam, M. F. (1995). Cultural aspects of illness behaviour. The Arab Journal of
Psychiatry, 6, 13-18.
The couvade syndrome in uncommon psychiatric syndromes
- M D Enoch
- W Trethowan
Enoch, M. D., & Trethowan, W. (1991). The couvade syndrome in uncommon
psychiatric syndromes. Oxford, UK: Butterworth-Heinemann.
Dreams, images, and perceptions
- C Fischer
Fischer, C. (1956). Dreams, images, and perceptions. Journal of American Psychoanalytical Association, 4, 5-48.
Pseudocyesis in a fifteen-year old girl
- Fear
Fear, folie, and phantom pregnancy: Pseudocyesis in a fifteen-year old girl. British Journal of Psychiatry,139, 558–560.
On the expression of psychosis in different cultures: Schizophrenia in an Indian and in a Nigerian community: A report from the World Health Organization project on determinants of outcome of severe mental disorders
- M M Katz
- A Marsella
- K C Dube
- M Olatawura
- R Takahashi
- Y Nakane
- L C Wynne
- T Gift
- J Brennan
- N Sartorius
- A Jablensky
Katz, M. M., Marsella, A., Dube, K. C., Olatawura, M., Takahashi, R., Nakane,Y.,
Wynne, L. C., Gift, T., Brennan, J., Sartorius, N., & Jablensky, A. (1998). On
the expression of psychosis in different cultures: Schizophrenia in an Indian
and in a Nigerian community: A report from the World Health Organization
project on determinants of outcome of severe mental disorders. Culture,
Medicine and Psychiatry, 12, 331-355.
Consultant Psychiatrist and Assistant Professor His main academic interests include the history of psychiatry in Muslim countries, hysteria, substance abuse disorders, and writing short books on different aspects of psychiatry
- Ksuf Psych
- Head
TARIQ ALI AL-HABEEB, KSUF PSYCH, Head, Consultant Psychiatrist and Assistant
Professor, King Khalid University Hospital, Riyadh. His main academic interests
include the history of psychiatry in Muslim countries, hysteria, substance abuse
disorders, and writing short books on different aspects of psychiatry.
PHD, is Director and Associate Professor, Continuous Medical Education and Community Services. His main interests include health education, health promotion
- Muzamil H Abdelgadir
MUZAMIL H. ABDELGADIR, PHD, is Director and Associate Professor, Continuous
Medical Education and Community Services. His main interests include health
education, health promotion, and training.
is Medical Director and Consultant Psychiatrist at the Buraidah Mental Health Hospital His main interests include substance use disorders, primary care psychiatry and transcultural psychiatry Kingdom of Saudi Arabia
- Naseem Akhtar
NASEEM AKHTAR QURESHI, M.D., is Medical Director and Consultant Psychiatrist at
the Buraidah Mental Health Hospital. His main interests include substance use
disorders, primary care psychiatry and transcultural psychiatry. Address: Buraidah
Mental Health Hospital, P.O. Box 2292, Buraidah, Kingdom of Saudi Arabia.
[E-mail: qureshinasseem@hotmail.com]
MBA (UK), is Nursing Director, Al-Qassim Psychiatric Rehabilitation Center, Buraidah. His main interests include nursing education, training, and developing rehabilitation programs for drug abusers
- John G Quinn
JOHN G. QUINN, RMN (UK), MBA (UK), is Nursing Director, Al-Qassim Psychiatric Rehabilitation Center, Buraidah. His main interests include nursing
education, training, and developing rehabilitation programs for drug abusers.
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FRCP, is Consultant Pediatrician and Director General of Health Affairs, Al-Qassim Region. His main research interests include behavioral disorders in paediatric population
- Yasser S Al-Ghamdy
YASSER S. AL-GHAMDY, FRCP, is Consultant Pediatrician and Director General of
Health Affairs, Al-Qassim Region. His main research interests include behavioral
disorders in paediatric population, paediatric neurological disorders, and medical
education and training.
is Medical Director and Consultant Psychiatrist at the Buraidah Mental Health Hospital His main interests include substance use disorders, primary care psychiatry and transcultural psychiatry
- Naseem Akhtar Qureshi
NASEEM AKHTAR QURESHI, M.D., is Medical Director and Consultant Psychiatrist at
the Buraidah Mental Health Hospital. His main interests include substance use
disorders, primary care psychiatry and transcultural psychiatry. Address: Buraidah
Mental Health Hospital, P.O. Box 2292, Buraidah, Kingdom of Saudi Arabia.
[E-mail: qureshinasseem@hotmail.com]
is Consultant Pediatrician and Director General of Health Affairs, Al-Qassim Region. His main research interests include behavioral disorders in paediatric population, paediatric neurological disorders, and medical education and training
- Yasser S Al-Ghamdy
- Frcp
YASSER S. AL-GHAMDY, FRCP, is Consultant Pediatrician and Director General of
Health Affairs, Al-Qassim Region. His main research interests include behavioral
disorders in paediatric population, paediatric neurological disorders, and medical
education and training.
Pseudocyesis: A paradigm for psychophysiological interactions
- E Brown
- P Banglow
Brown, E., & Banglow, P. (1971). Pseudocyesis: A paradigm for psychophysiological interactions. Archives General of Psychiatry, 24, 221-229.