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LETTERS TO EDITOR

Delusion of pregnancy in a 70-year-old male

Gaikwad, Bhagyashree H.; Dharmadhikari, Amit R.; Subramanyam, Alka A.; Kedare, Jahnavi S.; Kamath, Ravindra M.

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Indian Journal of Psychiatry: Jan–Mar 2017 - Volume 59 - Issue 1 - p 130
doi: 10.4103/psychiatry.IndianJPsychiatry_307_16
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Sir,

“Delusion of pregnancy” according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), within the realms of schizophrenia spectrum and other psychotic disorders, is described as delusional disorder somatic type. The literature on the topic has included multiple case reports, but large-scale epidemiological descriptive or cohort studies are lacking. A review of forty articles by Bera and Sarkar included 84 cases that showed that about one-fourth of the patients had developed delusion of pregnancy after the age of 50 years, and it has been found to present in equal proportion in both genders.[1] However, there is barely any literature available on delusion of pregnancy in geriatric age group.

We here report a case, Mr. A, 70-year-old male patient, referred from the Endocrinology Outpatient Department (OPD), with complaints of feeling guilty, having low mood and passive suicidal ideas. After a homosexual encounter with a friend, 4 months back, the patient started believing that he had become pregnant, and he stated that he was getting converted into a female, started noticing bodily changes such as enlargement of his breasts, trying to hide them by wearing loose clothes, would repeatedly check his body parts in mirror, reduced his food intake to avoid weight gain, for which he approached the Endocrinology OPD. On further enquiry, we found that the patient had been suspicious of his wife for having extramarital affair which was false as confirmed by their son and the wife herself, and owing to which, he had no sexual relationship with her for the last 8 years. He also suspected his daughter-in-law of infidelity toward his son.

On mental status examination, we found that he had sad mood, delusion of pregnancy, delusion of infidelity, ideas of hopelessness, helplessness, worthlessness, and passive suicidal ideations.

We admitted him in the inpatient psychiatric unit and conducted a battery of tests, which ruled out his gynecomastia and hormonal changes as age related, for which he had first approached the endocrinology services. A cognitive evaluation including serum Vitamin B12 level and serum homocysteine and Vitamin D3 levels was done, which was normal. Magnetic resonance imaging brain showed no abnormality. Cognitive assessment with Addenbrooke's cognitive examination showed no decline. The patient improved with 30 mg of trifluoperazine in 3 weeks.

Delusion of pregnancy can be caused by biological factors and psychological factors.

Biologically, delusion of pregnancy has been described in schizophrenia, schizoaffective disorder, delusional disorder, senile dementia, metabolic syndrome, frontotemporal lobar degeneration.[2]

Psychologically, delusion of pregnancy may be conceptualized as cognitive misinterpretation of bodily sensations and physical changes, severe ego pathology, and poor reality testing, an unconscious attempt to change the life situations, a release of suppressed cultural attitudes and fears.[2]

The patient believed that he had become pregnant after a homosexual act, and his cognitive misinterpretation led him to believe that all his bodily changes such as breast enlargement and weight gain were because he had been converted into a female and because he had become pregnant.

The patient fulfilled the criteria for delusional disorder somatic type as per DSM-5.

Thus, biological and psychological theories offer complementary viewpoints in the genesis of this phenomenon. Hence, while we diagnose such patients, it is important to look for patient's cognitive functioning. Pharmacological treatment remains the mainstay for the treatment of delusion of pregnancy.[3]

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Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Bera SC, Sarkar S. Delusion of pregnancy: a systematic review of 84 cases in the literature Indian J Psychol Med. 2015;37:131–7
2. Chatterjee SS, Nath N, Dasgupta G, Bhattacharyya K. Delusion of pregnancy and other pregnancy mimicking conditions: Dissecting through differential diagnosis Med J DY Patil Univ. 2014;7:369–72
3. Makhal M, Majumder U, Bandyopadhyay GK. Psychodynamic and sociocultural perspective of pseudocyesis in a non-infertile Indian woman: A case report Malaysian Journal of Psychiatry. 2013;22(1)
© 2017 Indian Journal of Psychiatry | Published by Wolters Kluwer – Medknow