Abstract
Delusion of pregnancy is not a common phenomenon. Some cases have been reported [1], many of them on male patients. Delusions of pregnancy have been reported in fictional psychosis [2] and a wide variety of organic psychiatric conditions [1], including association with urinary tract infection [3]. It has been reported, more commonly in men than in women [4, 5]. We report a patient of schizophrenia experiencing delusion of pregnancy that he attributed to sexual abuse occurring 10 years previously.
A 3 6-yea r-old single man living in supported accommodation presented with acute psychosis characterised by being abusive towards strangers and co-residents, shadow boxing in the front garden, marked irritability, poor sleep, and talk of a gay man following him around. He had complained of abdominal pain, which he believed was in the context of him being pregnant. He had nightmares and ruminations about his sexual abuse many years ago. He also had a background of mild to moderate intellectual disability.
He had a past history of a similar episode in which he experienced aggression, was suicidal and had homicidal ideations. He believed that he had been pregnant for 2–3 months and his abdomen was swollen due to spontaneous fertilisation. His mother was diagnosed as having schizophrenia. Ten years ago he had experienced sexual abuse involving penetration. Since then, he had developed a delusional belief about pregnancy when unwell. There was no history of drug or alcohol abuse.
Mental State Examination revealed him to be older than his age and guarded. He had ideas of reference, delusion of pregnancy, persecutory delusions, auditory hallucinations and poor insight. He was diagnosed as having schizophrenia and treated with antipsychotic medications. He showed a gradual response, and in 3 weeks his delusions started diminishing. His belief of pregnancy changed to an overvalued idea, and after 2 months he no longer believed in it.
Delusion of pregnancy attributed to sexual abuse in men (as in the case above) has not been reported. It is interesting that in both episodes the patient exhibited this delusion, although the sexual abuse occurred 10 years previously. The delusion in this patient could not be attributed to other factors such as contact with pregnant women [5], underlying a medical cause [3].
The aetiology of delusion of pregnancy is likely to be heterogenous. It has been hypothesised that delusion arises from normal cognitive processes directed at explaining abnormal perceptual experiences. Neuroleptic-induced hyperprolactinemia, galactor-rhoea and intestinal dilatation may stimulate, confirm or reinforce the belief of being pregnant [2, 6]. Maher [7] 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.