Pseudocyesis and Delusion of Pregnancy are often conflated. Both presentations are associated with false beliefs of pregnancy in patients who are not pregnant. Pseudocyesis is associated with physiological changes of pregnancy such as amenorrhea, galactorrhea, abdominal distention, and hyperprolactinemia. Delusion of Pregnancy is not associated with physiological signs/changes. We describe a case to demonstrate the phenomenological and physiological differences between these entities and how these influence treatment considerations.

1.Phenomenology of Pseudocyesis vs Delusion of Pregnancy 2.Elucidate the physiological underpinnings of both 3.Treatment considerations

Comprehensive literature review following a 29-year-old-female with no known psychiatric history presenting to the emergency department with mixed complaints of twin-pregnancy, menorrhagia, and concern for threatened abortion. Psychiatry was consulted for decisional capacity to leave against-medical-advice due to concerns for ectopic pregnancy. Patient reported a recent ultrasound with fetal heartbeat and sensation of fetal “kicks”. She was concerned the menorrhagia was threatening her pregnancy. The patient appeared irritable, paranoid, endorsed ideas of reference and a fixed false belief that she was pregnant with twins, despite quantitative HCG, abdominal and transvaginal ultrasounds being negative. On examination, while there was vaginal bleeding, there were no stigmata of pregnancy.

Diagnosis- Delusion of Pregnancy.

Delusion of Pregnancy have been associated with polythematic content. Pseudocyesis may be confounded by conditions such as abdominal neoplasms, leiomyoma, and endocrinologic changes (eg- hyperprolactinemia). Potent D2R antagonists carry increased risk of hyperprolactinemia and subsequent galactorrhea which may paradoxically exacerbate misattributions of pregnancy. Careful consideration of psychotropic choice is therefore needed in the management of these conditions.

No significant relationships.

Delusion of pregnancy has been described as a false and fixed belief of being pregnant despite factual evidence to the contrary. Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. There has been described symptoms as abdominal distention, cessation of menses, morning sickness, etc.

The aim of this work was to distinguish between pseudocyesis and pseudopregnancy. This case presents a single 49-year-old woman, who developed the delusion of being pregnant after months of lonely confinement during Covid-19 quarantine.

She had missed her period for 10 months. She was convinced that she could feel the fetal movements. Her thought content revealed delusion of persecution, reference, and delusion of being pregnant. She did not reveal any hallucinations. Blood tests and brain imaging revealed no abnormalities. □The treatment was started with Paliperidone 100mg/month, and clonazepam 2mg/d.

The patient showed a substantial improvement within 10 weeks of treatment. Pseudocyesis and delusional pregnancy have been rarely described on scientific bibliography. A distinction has been demonstrated based on the consideration of the associated psychotic features that might be present in delusions of pregnancy, which were described in the current case. On the other hand, pseudocyesis clinical presentation is centered on the false signs and symptoms of pregnancy.

Antipsychotics played a key role in the delusion of pregnancy. Psychodynamic and supportive psychotherapy could play a pivotal role in the management of pseudocyesis.

No significant relationships.