Pseudocyesis

[animas]

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Has anyone ever seen this?

 

[whopper]

Several times...but most of the cases were last year.

I ran an all female forensic unit. Several of the patients had this phenomenon. Before I ran that unit, I probably only saw less than five patients with this phenomenon.

 

[sonofthesouth]

I had a patient once who was actually pregnant and she believed that her fetus was Jesus Christ. I had another patient who was not pregnant but believed she was pregnant with Christ. I suppose the latter might qualify as pseudocyesis, although I don't remember off the top of my head if she had any symptoms of pregnancy. Those are my only 2 experiences with pregnancy in psychiatry. Working at the VA Hospital skews my patient population, though.

 

[hippiedoc13]

I had a case earlier this year. Extremely ill young woman with schizophrenia. She believed she was pregnant with triplets who were "3 of the 12 tribes of Israel." Kept refusing psychotropic medications because she was concerned about the effects they would have on her "unborn children."

But here's the best part: I picked her up about a month into her hospitalization, was getting to know her, decided to do a little reality testing. I asked her if she actually had any evidence that she was pregnant. She looked right at me and said, "My periods have stopped and now I'm making milk for my babies." Wouldn't you know it...ironically, she had been put on high-dose risperidone and developed hyperprolactinemia. Way to take the delusionally "pregnant" lady and give her some actual physical "evidence" to support her delusion...

 

[whopper]

I'll try to one-up you hippiedoc.

I had a patient with a known history of pseudocyesis claiming she was pregnant. She was arrested several weeks before, and placed in the all-female wing of a jail. She was then transferred to us.

She was found to not be pregnant while in jail. No one ordered a pregnancy test because she was in a no-male environment (except for guards). I ordered a pregnancy test on her anyway for the heck of it. It was positive. This caused ripples up the system because how could she get pregnant in an all-female wing of jail or in the all female unit of a psychiatric ward. My theory? She was getting it on with one of the male guards or the original test was in error.

I had another patient who had pseudocyesis that was ruled to not be pregnant by an ob-gyn doctor. So, for that reason, her case manager for weeks was trying to convince the patient she was not pregnant. I ordered a pregnancy test and it's positive. The ob-gyn doctor said she still wasn't pregnant, and the (+) test was a false one because she gave birth a few weeks before. The B-HCG is still being secreted by placental remnants. Okay fine. I didn't trust this guy, after all if there are placental remnants, he should've been freaking out to get them out but his attitude is whatever....

I figured either way, if she's pregnant or not, she's supposed to be seen by the ob-gyn doctor, at least so the placental fragments can be removed. The ob-gyn said there was no need for any further treatment.

So I ordered a quantitative B-HCG test every 48 hrs, and as I thought, they doubled, which if you remember, would only be the case if she were pregnant. I told the Ob-Gyn doctor to put her back under his care (of course only on an office basis, she was too dangerous to be discharged). He refused to take her back. We had her sent to the medical hospital twice to re-establish Ob-Gyn coverage. Each time they sent her back saying she was not pregnant.

I took it up with the administration. The patient had some pains in her abdomen. Hey, in the strategy of Rahm Emmanuel, never let a crisis go to waste. I insisted she go to the ER, and I specifically wrote that she needed an ultrasound of her abdomen. The ER doctor did an ultrasound (we don't have an US machine in the psychiatry hospital). The US showed a fetus.

In your face ob-gyn doctors!

 

[sunlioness]

This isn't about pseudocyesis, but your story, Whopper, reminds me of something that happened to me during residency.

A woman with a known psychiatric history presented to the emergency department complaining of severe itching and that bugs were crawling on her. I get called down for the consult and talk to the ED resident who assured me that a thorough physical exam had been done and that the woman was delusional and there was no evidence of any bugs or rash or anything.

The woman ends up admitted to psychiatry (and I don't remember why off the top of my head --I don't think it was only because of her "delusion" of bugs") and comes up to the floor. Where she is found to have a raging case of scabies.

After that all of us were thinking we were covered in bugs for a while.

 

[Doc Samson]

This isn't about pseudocyesis, but your story, Whopper, reminds me of something that happened to me during residency.

A woman with a known psychiatric history presented to the emergency department complaining of severe itching and that bugs were crawling on her. I get called down for the consult and talk to the ED resident who assured me that a thorough physical exam had been done and that the woman was delusional and there was no evidence of any bugs or rash or anything.

The woman ends up admitted to psychiatry (and I don't remember why off the top of my head --I don't think it was only because of her "delusion" of bugs") and comes up to the floor. Where she is found to have a raging case of scabies.

After that all of us were thinking we were covered in bugs for a while.

Same thing happened to me in residency - we had to treat the entire inpt unit prophylactically. Nothing quite so fun as telling 24 psychotic/manic/borderline patients that they have to rub lotion on their skin to "kill the bugs that might be all over you."

 

[whopper]

I get called down for the consult and talk to the ED resident who assured me that a thorough physical exam had been done and that the woman was delusional and there was no evidence of any bugs or rash or anything.

Same here.

We had a mentally ill patient with scabies. The ER doctor immediately had her turfed to psychiatry. The problem was that the psychiatry inpatient unit would not allow her to be admitted until the scabies were treated. The psychiatrist called in the ER doctor noting the scabies needed to be treated. The ER doctor came in and wrote there were no scabies, even though it's in plain site and glaringly obvious that the patient had it. I even told the ER doctor, "hey doc, if you're so confident, I dare you to rub your hand on those scabes sores." He of course refused.

So, in the state on NJ, you can only hold a patient for 24 hours in a crisis unit. About 5 hours ticked away. The inpatient unit is sticking to their guns. The nurse is not supposed to take the psychiatrist's order to treat the scabies (hospital bureacracy) and the ER doctor is clearly ignoring his responisbility because he's sick of psychiatrists asking him to do something he feels they should be doing. Meanwhile the nurses in the crisis unit are all ticked off because they know their nurse manager is going to yell at them because this patient sat in the crisis unit for hours when she could've been out of there much earlier.....

 

[ClinPsycMasters]

This isn't about pseudocyesis, but your story, Whopper, reminds me of something that happened to me during residency.

A woman with a known psychiatric history presented to the emergency department complaining of severe itching and that bugs were crawling on her. I get called down for the consult and talk to the ED resident who assured me that a thorough physical exam had been done and that the woman was delusional and there was no evidence of any bugs or rash or anything.

The woman ends up admitted to psychiatry (and I don't remember why off the top of my head --I don't think it was only because of her "delusion" of bugs") and comes up to the floor. Where she is found to have a raging case of scabies.

After that all of us were thinking we were covered in bugs for a while.

Not only is delusion difficult to diagnose, it's also difficult to define. As Bentall noted: "Diagnosis looks for the ‘How' (form) not the ‘What?' (the theme or content)."

Sometimes it's rather easy. It's very very unlikely that you are really a wolf...unless I'm deluded too. However, it is possible that your relatives want to have you killed, that the government/police/FBI is after you, or you have a fatal undiagnosed illness. The sad thing is that we may never know the truth...or learn of it when it's too late.

 

[Daftrage]

The very first patient I had on my 3rd year psych rotation had pseudocyesis. It was a fun and interesting case to start on. We decided to reality test her, and also cover our butts even though she had claimed this since being admitted 4 months prior, and order an US. It said not pregnant. Well the funny thing about it was that our Attending tried to reason her out of this delusion (not because he thought he actually could, but more of an educational experience for us to see the power of delusions) and she was adamant. I showed her the report and she simply goes "huh, well there you go. Guess I am not pregnant."

It probably also helped that we had adjusted meds in the meantime.