“Being Pregnant Would Mean Everything”: Delusions of Pregnancy in a Young, Female Patient With Schizoaffective Disorder, a Case Report
Delusions of pregnancy are fixed beliefs that one is pregnant despite evidence to the contrary. Several psychosocial factors are implicated in such delusions. This case report discusses such factors in a 24-year-old female diagnosed with schizoaffective disorder with a history of two hospitalizations for psychosis. She was taking lurasidone, benztropine, topiramate, and escitalopram. She was adherent with medication until two months prior to hospitalization. She had no substance use history, family history of psychiatric illness, or relevant medical history. She had been isolated from peers since her first hospitalization and did not work, socialize, or have many hobbies. However, she had strong family support. She was admitted for worsening command auditory hallucinations after self-discontinuing her medication. She was prescribed aripiprazole in the hospital. She developed hypnagogic twitching and initiated ferrous sulfate and benztropine. Ferrous sulfate was discontinued due to GI pain. During pain episodes, the patient reported feeling like she was pregnant. She reported feeling heartbeats in her stomach, having a different body odor, feeling her stomach and breasts growing, and pelvic discomfort. She endorsed urinary retention and was found to have a UTI on urinalysis. Symptoms resolved with Bactrim. Urine pregnancy test was negative. Auditory hallucinations resolved. Delusions of pregnancy persisted at discharge. The patient’s misinterpretation of pelvic pain from her UTI, social isolation, and wish for improved social status due to her sense of dependence on others demonstrate the deficit and motivational models of pregnancy delusion formation that may be addressed through psychotherapy.
