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What You Should Know about Pseudocyesis (False Pregnancy)

What is Pseudocyesis?

Pseudocyesis or false pregnancy is one of the psychological disorders experienced by women, both of productive age and post-menopause. This disease can affect women from all ethnic groups, races, and economic classes.

Pseudocyesis most commonly occurs in non-psychotic women aged 20 to 39 years. Pseudocyesis is quite rare but can have quite a psychological impact, especially on infertile women or depressed to have children. Doctors often miss this condition, so it lasts long to disrupt the daily work activities of sufferers.

Pseudocyesis is a nonspecific somatoform disorder in the form of a belief in pregnancy in a non-pregnant woman. Patients believe that they are pregnant because they experience signs and symptoms of pregnancy, such as morning sickness, irritability, low back pain, and enlarged abdomen. This condition has been recognized since the 1800s and is still happening today.

What You Should Know about Pseudocyesis (False Pregnancy)


What causes pseudocyesis?

The cause of pseudocyesis is still unknown with certainty. The existing theory states that pseudocyesis is the result of neuroendocrine interactions and psychological factors. In patients with pseudocyesis, there is a dysfunction of the hypothalamic-pituitary-ovarian axis (HPO) is suspected.

Patients with pseudocyesis are also suspected of having deficits in the catecholaminergic pathway, which is involved in secretion of the anterior pituitary hormone. So that the impact on increased activity and secretion of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and prolactin hormone.

Disorders of these hormones cause symptoms similar to polycystic ovary syndromes (PCOS), such as amenorrhoea and galactorrhea. The sympathetic nervous system also experiences dysfunction, causing abdominal-phrenic nerve disorders. Disorders of the nerves cause abdominal enlargement.

The risk of pseudocyesis is increased in infertile women who want to have children, women with delusional disorders, women ages 20-39, childhood experiences, interpersonal pressure to have children, and fear of having pregnancy.

How to Diagnosis of Pseudocyesis

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) -5, pseudocyesis is included in the new classification, namely disorders of somatic symptoms and related unspecific abnormalities (not otherwise specified). 

Symptoms that can occur in pseudocyesis, include:

a. Gastrointestinal symptoms: abdominal pain, bloating, nausea, vomiting
b. Menstrual disorders: amenorrhoea, spotting
c. Other uncertain signs of pregnancy: morning sickness, breast pain, enlarged breasts, enlarged abdomen, galactorrhea, quickening, weight gain, urine frequency
d. Mood disorders: hypomania, depressive symptoms.

The diagnosis of pseudocyesis can be determined if:

(1) women who are not pregnant and not psychotic,
(2) have confidence that she is pregnant, and
(3) showing signs and symptoms of pregnancy.

These symptoms can last for several weeks, and then some symptoms can subside, however, pseudocyesis can generally last for 9 months or more. This condition must be distinguished from hypochondriasis and other somatoform disorders.

Medical Examinations

Examinations that can be performed to determine the diagnosis of pseudocyesis are:
  • Hormone level tests: LH, FSH, estrogen, progesterone, prolactin
  • Routine blood test
  • Liver function test
  • Kidney function test
  • Beta HCG (b-HCG) test


Examination results that can be found in pseudocyesis patients include 
(1) b-HCG negative, 
(2) hyperprolactinemia, 
(3) increase in LH levels, 
(4) levels of progesterone within normal limits, 
(5) levels of FSH, TSH, LH within normal limits in postmenopausal patients, 
(6) routine blood tests, liver, and kidney function within normal limits.

In addition to laboratory tests, abdominal ultrasound examination can also be performed. These tests are performed to ensure there is no pregnancy. 

Some tests such as MRI or CT Scan can be performed if there is a suspicion of an organic problem causing symptoms, such as a pituitary tumor, and others. Mental status checks can also be performed to look for and rule out comorbidities with other mental disorders.

How to Treat Pseudocyesis

Management of pseudocyesis is focused on improving the social function and quality of life of patients, changing the patient's view of the disease experienced, eliminating symptoms that arise, and reducing the risk of recurrence of pseudocyesis. Management procedures that can be given in the form of psychotropic drugs, hormonal drugs, and counseling.

Psychotropic drugs
Give antidepressants or antipsychotics if the patient shows symptoms of depression or psychosis, but the use of psychotropic drugs is not the primary therapy for pseudocyesis.

Hormonal medicine
Progesterone or a combination of estrogen/progesterone can be given to treat withdrawal bleeding symptoms in women who have decreased estrogen and amenorrhoea.

Counseling
Counseling is the primary key in pseudocyesis therapy, but patients often do not want to do psychotherapy. Counseling can be done informally by conducting communication, information, education (IEC) to patients and families.

In some cases that are quite difficult or show comorbidities with other psychological disorders, patients can be referred to a psychiatrist. Psychological disorders that often occur together with pseudocyesis include depression, mania, psychotic disorders (such as schizophrenia or delusional disorders), and other somatoform disorders.

Information, Communication, and Education to Pseudocyesis Patients

The diagnosis of pseudocyesis can be a very heavy psychological burden for sufferers, especially for infertile women or women who are carrying out a pregnancy program. Doctors must possess excellent communication skills in conducting Information, Communication, and Education (IEC) to pseudocyesis patients, especially when diagnosed for the first time.

Coaching a positive report card with the patient will significantly assist the doctor in delivering the diagnosis and helping patients deal with the emotional burden they experience. The steps in delivering a diagnosis of pseudocyesis are:

  • Establish good report cards with patients
  • Showing and explaining the results of physical examination, laboratory, or other support objectively.
  • Explain the risk factors and possible causes.
  • Provide conclusions that, based on the results of examinations, the patient is not pregnant.
  • Demonstrate empathy for the patient's condition and the doctor's willingness to continue to treat the patient.
  • Having experience and skills in delivering bad news can help doctors do IEC about pseudocyesis to patients.

If the patient keeps believing that she is pregnant, the doctor must avoid excessive confrontation with the patient. Generally, it occurs because the patient is not ready to accept the information submitted.

In dealing with this, doctors should act by scheduling the next meeting with the patient and re-doing IEC. If the patient keeps believing that she is pregnant, the consultation with a psychiatrist can be considered.

References
1. American Pregnancy Association. Pseudocyesis: What Exactly Is a False Pregnancy. Am Pregnancy Assoc. 2017. : http://americanpregnancy.org/getting-pregnant/pseudocyesis-false-pregnancy/
2. Avni-Barron O, Gupta R, Miller L. Pseudocyesis. UpToDate. 2017. : https://www.uptodate.com/contents/pseudocyesis
3. Campos S, Link D. Pseudocyesis. J Nurs Pract. 2016;12:390–4.
4. Lowenfels A. The Case of the Famous Woman With a Bloated Belly. Medscape. 2010. : https://www.medscape.com/viewarticle/714607
5. Cohen L. A current perspective of pseudocyesis. Am J Psychiatry. 1982;139:1140–4.
6. Tarín J, Hermenegildo C, García-Pérez M, Cano A. Endocrinology and physiology of pseudocyesis. Reprod Biol Endocrinol. 2013;11.
7. Dubravko H. Pseudocyesis in peri- and postmenopausal women. Cent Eur J Med. 2010;5:372–4



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