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Pseudocyesis

Topic updated on 03/15/17 4:13pm

Snapshot
  • A 21-year-old woman presents to her primary care physician for prenatal care. The patient states that her last menstrual period was approximately 5 months ago. She has experienced breast tenderness and increased urinary frequency. Prior to this event, she reports feelings of stress due to cultural pressures for her to become pregnant. She does not take any medications, supplements, or home remedies. On physical examination there is mild abdominal enlargement. Urine β-hCG is negative.
Introduction
  • Clinical definition
    • a rare somatic symptom disorder where a non-pregnant and non-psychotic woman thinks she is pregnant
      • patients also exhibit signs and symptoms of pregnancy
  • Epidemiology
    • incidence
      • not known
      • decreased incidence in developed countries where there is a trend towards having a smaller family
    • demographics
      • female
      • 20-39 years of age
    • risk factors
      • perhaps more common in cultures that highly value childbearing which may lead to
        • psychological stressors
      • misinterpretation of somatic stimuli
  • Pathophysiology
    • unclear but may involve
      • psychological mechanisms
      • neuroendocrine mechanisms
  • Prognosis
    • natural history of disease
      • not well described; however,
        • symptoms can last a few weeks, 9-months, or years
      • patients may experience spontaneous recovery
      • patients may have more than one episode of pseudocyesis
    • prognostic variables
      • positive
        • probably resolving the psychological and/or interpersonal factors that may have contributed to the patient developing pseudocyesis
Presentation
  • Symptoms
    • belief that they are pregnant
    • menstrual irregularities
    • feeling that there is fetal movement
    • urinary frequency
    • breast changes such as
      • breast tenderness
      • nipple and areola pigmentation
  • Physical exam
    • abdominal enlargement (most common)
      • no effacement of the umbilicus, as would be seen in normal pregnancy
Studies
  • Diagnostic criteria
    • the patient must
      • not be pregnant and psychotic
      • exhibits signs and symptoms of pregnancy
Differential
  • Pregnancy
  • Delusion of pregnancy
    • these patients have relatively absent symptoms suggestive of pregnancy and patients may have a psychotic disorder
  • Medical conditions such as
    • gestational trophoblastic disease (e.g., hydatidiform mole)
    • prolactinoma
    • pelvic tumors
  • Factitious disorder or malingering
Treatment
  • Conservative
    • explaining the diagnosis in a therapeutic manner
      • indication
        • a key type of intervention in patients with pseudocyesis
    • counseling
      • indications
        • for treating patients with pseudocyesis
Complications
  • Patients may become depressed if not appropriately managed


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