CASE REPORT

Delusions of Pregnancy in the Elderly

RACHEL FRANCES HARLAND* AND NICHOLAS JAMES WARNER{

*Senior House O�cer in Old Age Psychiatry, {Consultant in Old Age Psychiatry, St Cadoc's Hospital,Newport, Gwent, UK

ABSTRACT

We present ®ve case reports of elderly ladies with delusions of pregnancy. This symptom is discussed with reference tothe cases and a review of the literature.

KEY WORDSÐcase report; pregnancy; delusions; elderly

Delusion of pregnancy is a rare symptom at anyage and particularly in the elderly. We report on®ve patients with this symptom who have pre-sented from a catchment population of 18 000people over the age of 65 in the last 4 years.

CASE 1

An 80-year-old woman, a mother of two children,who had a 20-year history of bipolar a�ectivedisorder presented in a manic phase of her illnesswith psychotic symptoms. She had several previousadmissions, mostly for depression with psychoticfeatures, and was maintained on lithium. Onadmission she was overactive, disinhibited andher mood elated. She was claiming that herhusband hit her with a stick and had beenincreasingly physically aggressive towards her. Inaddition, she had the delusional belief that she was20 years old and was pregnant with twins and thatthe consultant was the father. She had not had thisdelusion before. Later she developed a distendedabdomen, due to constipation, and breast enlarge-ment and claimed her waters had broken. Hersymptoms resolved after 5 weeks' treatment withhaloperidol to a maximum dose of 20 mg daily.

CASE 2

A 71-year-old unmarried lady with no childrenpresented with a recurrence of depressive disorderwith psychotic symptoms. Two years previouslyshe had been treated with ECT and dothiepin75 mg for a depressive episode. On admission shewas quite agitated and complaining of abdominalpain. She had the delusion that this was her babymoving inside her, though could give no explana-tion of how a pregnancy could have arisen. Herabdomen was distended due to obesity and she alsosu�ered from constipation. She had no cognitiveimpairment. She had been living by herselfpreviously but was becoming increasingly depen-dent on her family, who were keen for her to beplaced in a residential home. There was a strongfamily history of depressive illness with three of hersiblings having committed suicide. Her symptomsresolved after a course of electroconvulsive therapyand she was discharged to a residential home.

CASE 3

An 86-year-old widow with two children wasadmitted due to a progression of a dementingillness probably Alzheimer's type. She had beenwidowed for 20 years and was living with her son.She consistently refused the o�er of a day centrethough it was felt she was lonely and unstimulated.She was fully oriented and fully self-caring thoughhad di�culty in remembering recent events. In theprevious year she had been admitted as a medical

Address for correspondence: Dr R. F. Harland, St Cadoc'sHospital, Caerleon, Newport, Gwent, NP6 1XQ, UK. Tel:(01633) 421121.

CCC 0885±6230/97/010115±03 Received 23 July 1995# 1997 by John Wiley & Sons, Ltd. Accepted 26 February 1996

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 12: 115±117 (1997)

emergency three times complaining of abdominalpain. On each occasion she had been diagnosed asconstipated and the appropriate treatment given.On admission she had the delusion that she waspregnant and said the pain was due to the babymoving. She described her pregnancy as a miraclebut had no other explanations. Her abdomen wassigni®cantly distended due to spastic colon and¯atulence. On treatment with tri¯uperazine 1 mgbd her delusion resolved within 3 days.

CASE 4

A 75-year-old widowed lady with no children wasadmitted to the medical ward for an assessment ofosteoporosis. She had been diagnosed as havingvascular dementia 8 years previously and hadmanaged well by herself with the support of hersister. She had an acute episode of verbal andphysical aggression coinciding with a signi®cantdeterioration of her cognitive state. She becamesuspicious of sta� and started responding toauditory hallucinations. She was transferred tothe psychiatric ward and was started on tri¯uper-azine 2 mg od which improved the psychoticsymptoms. She was unable to mobilize indepen-dently and needed full assistance in dressing andwashing. She was disorientated in time with grosslyimpaired short-term memory. There was no mooddisorder. Over the next week she developed thedelusional belief that she was pregnant, which stillpersists. She also believes she gave birth to a babygirl one morning recently. This lady had adistended abdomen due to obesity but she claimedthat this was due to pregnancy and said she couldfeel the baby moving. The fact that she believed shewas pregnant did not distress her and sherationalized it by referring to a lady in her sixtiesin Italy who had recently given birth.

CASE 5

A 73-year-old widow with two children presentedwith a 9-year history of progressive cognitiveimpairment due to dementia of probable Alz-heimer's type. She was disorientated in time andplace and had been found wandering from homeon many occasions. On the ward she was agitatedand responding to auditory hallucinations. Shebelieved that she was now pregnant and had alsogiven birth 2 years previously and that her ownfather was looking after this baby. This was

explained by saying that she was the same age asher daughter who had a young family and so shecould have one too. This lady also had abdominaldistention due to obesity. All these symptomsresolved after treatment with tri¯uperazine2 mg bd. It was felt there was also an underlyingmood disorder as she was expressing ideas of poorself-worth and this improved when she was treatedwith sertraline 50 mg bd.

DISCUSSION

In the previous cases of delusions of pregnancy inelderly women one was in a lady su�ering fromhypomania (Michael et al.,1994) and the other hada diagnosis of organic mood disorder (Singer et al.,1991). The diagnoses in these ®ve cases weredementia in Alzheimer's disease with late onset,dementia in Alzheimer's disease with early onset,vascular dementia, bipolar a�ective disorder,current episode manic with psychotic symptomsand recurrent depressive disorder, current episodesevere with psychotic symptoms.

In a review of delusions of pregnancy (O'Gradyand Rosenthal, 1989), the following symptoms aremost commonly found: menstrual abnormalities69%, abdominal enlargement 68%, hallucinationof foetal movement 63%, breast changes 59%.

Interestingly, all patients had some physicalsymptom mimicking pregnancy. They all haddistended abdomens and the delusion of pregnancyserved to provide them with an explanation for thisdistention. The sensation of gastrointestinal peri-stalsis then served to be misinterpreted as the babymoving.

Psychologically it is possible to speculate thatthe content of the delusion relates to a wishful®lment. Previous pregnancies may have been atime of great satisfaction contrasting with morerecent increasing dependency. The fact that thepregnancy was accepted without any distress innearly all cases would support this view.

Case 3 was unwilling to accept her increasing ageand refused to go to a day centre on the groundsthat they were full of elderly people. She had noinsight into her dementing illness. The patient incase 5 would also lend support to the theory by heridentifying with her daughter's age and recentpregnancies. It is interesting that in case 4 thecontents of the patient's delusion were elaboratedby reference to the publicity about the Italian ladyin her sixties responding successfully to infertility

116 R. F. HARLAND AND N. J. WARNER

treatment. Case 1 had a poor relationship with herhusband, who was physically aggressive towardsher. By being pregnant she was citing herself asonce more important and in a role where he wouldneed to protect her. Case 2 was living by herselfand becoming dependent on elderly siblings. Bybecoming pregnant she could reasonably expectthe extra care that she believed herself to need. Thiswas partly borne out by her readiness to move intoa residential home.

Even though there may be a psychologicalreason for the content of the delusions, they allresponded to medical treatment. Treatment of theunderlying mood disorder in cases 1 and 2 resolvedtheir delusions of pregnancy. In two of the threepatients with organic disease there was resolutionafter treatment with antipsychotic medication.

REFERENCES

Cohen, L. M. (1982) A current perspective of pseudo-cyesis. Am. J. Psychiat. 139, 1140±1144.

De Pauw, K. W. (1990) Three thousand days ofpregnancy: A case of monosymoptomatic delusionalpseudocyesis responding to pimozide. Brit. J. Psy-chiat. 157, 924±928.

Michael, A., Joseph, A. and Pallen, A. (1994) Delusionsof pregnancy. Brit. J. Psychiat. 164, 244±246.

O'Grady, J. and Rosenthal, M. (1989) Pseudocyesis:A modern perspective on an old disorder. Obstetr.Gynaecol. Surv. 44, 500±511.

Shankar, R. (1991) Delusion of pregnancy in schizo-phrenia. Brit. J. Psychiat. 159, 285±286.

Singer, S., Weinstein, R., Munoz, R., Bayardo, F., Katz,M. and Saben, L. (1991) Pseudocyesis in organicmood disorders. Psychosomatics 33, 316±323.

117DELUSIONS OF PREGNANCY