Pseudocyesis presenting in a Case of Bipolar 1 Disorder, Manic with Psychosis
Introduction: By DSM-5, pseudocyesis occurs in non-psychotic individuals whereas delusion of pregnancy occurs in psychotic patients. We present a case of pseudocyesis in a psychotic patient and discuss this presentation's ramifications on our clinical management. Pseudocyesis presents with signs and symptoms of pregnancy (abdominal distension, breast enlargement, menses cessation, lordotic posture, and weight gain) except for fetal confirmation. Delusional pregnancy is the fixed and false belief of being pregnant without any fetal confirmation, without any physical signs and symptoms of pregnancy, and may be a presenting symptom of a psychotic episode. Clinical management warrants a psychotherapeutic approach towards pseudocyesis and a psychopharmacological approach towards delusion of pregnancy. Case Report: 41 year-old Caucasian female, admitted involuntarily for physical aggression (assaulting police), suicidal ideation, grandiose delusions, claimed she was pregnant, manifested symptoms of pregnancy and declared the baby as the "savior of the world". Her pregnancy test was negative. On admission, her diagnosis was Bipolar 1 disorder, manic with psychosis for which she had been hospitalized multiple times. Prior to admission, she had been stable on quetiapine until it was lowered secondary to excessive "grogginess". She had a miscarriage in 2012 followed by a tubal ligation in 2013. Her most recent romantic relationship ended a few months prior to this admission. During her hospitalization, oral risperidone along with supportive psychotherapy were employed. She achieved clinical stability (including resumption of menses) on this combination and was discharged. Discussion: Certain psychological antecedents which include a loss of fertility (ie, secondary to tubal ligation) and loss in general (ie, the end of a romantic affair within months of presentation) have been strongly implicated in the development of pseudocyesis. The presence of these antecedents in our case allows us to argue for a psychosomatic etiology rather than a somatopsychic etiology and gave direction to our supportive psychotherapy. This case is unique as it challenged the distinction between delusion of pregnancy and pseudocyesis. This, in turn, had a profound effect on our clinical management wherein we combined supportive psychotherapy with psychotropic intervention by which she achieved clinical stability. Conclusion: Pseudocyesis is managed clinically primarily by supportive psychotherapy while delusion of pregnancy is treated with neuroleptic agents. We offer a case of pseudocyesis in a psychotic patient which responded to the implementation of both psychotherapy and psychotropic agents. This case provided the use of seperate interventions on a single patient to treat both conditions.