Saturday, March 1, 2014

Psuedocyesis - False Pregnancy

Pseudocyesis is a condition in which an individual believes herself or himself to be pregnant and develops objective pregnancy signs in the absence of an actual pregnancy. Although pseudocyesis usually occurs in women, there have been a few cases reported in men.

Several theories address the cause of pseudocyesis, and the following three theories are the most accepted. The first theory is the conflict theory, which states that a desire for a fear of pregnancy creates an internal conflict and causes endocrine changes. The endocrine changes are believed to cause the signs, symptoms, and laboratory findings that occur in patients with pseudocyesis. The second theory is the wish-fulfillment theory, which states that minor body changes initiate the false belief in pregnancy in susceptible individuals. The last theory is the depression theory. The depression theory states that pseudocyesis may be initiated by the neuroendocrine changes associated with a major depressive disorder (see Depression).

Evidence exists to support all of these theories. One or more of these theories may be simultaneously appropriate for some patients. Pseudocyesis is considered a heterogeneous disorder without a unifying cause.

Pseudocyesis occurs at a frequency of 1 to 6 cases per 22,000 births. However, many cases of pseudocyesis seem not to be reported. Between 1890 and 1910, 156 cases were reported in the English literature. Only 42 cases were reported between 1959 and 1979. Pseudocyesis has become uncommon in industrial societies, with the exception of a large number of cases reported in West and South Africa.

The age range of patients with pseudocyesis is 6 to 79 years of age (with the average age being 33 years). Eighty percent of individuals with pseudocyesis were married, 14.6% were unmarried, and 2.3% were widows. Pseudocyesis is more common in individuals who are in their second marriage. Symptoms usually last about nine months but can last for a few months up to several years.

Almost every symptom and sign of pregnancy (except for true fetal heart tones, fetal parts seen by imaging techniques, and delivery of the fetus) have been documented in patients with pseudocyesis. Abdominal distension is the most common sign of pseudocyesis. It is thought to be due to excess fat, gaseous distension, and fecal and urinary retention. The abdominal distension often resolves under general anesthesia.

Pseudocyesis has been considered a conversion symptom that is exclusive of pseudopregnancy (a medical condition), simulated pregnancy (malingering), or hallucinatory pregnancy (psychosis). Pseudocyesis, therefore, is considered a paradigm of psychosomatic disorders.

Findings in patients with pseudocyesis show variable results. Estrogen and progesterone values can be high, low, or normal. Prolactin tends to be elevated. Follicle stimulating hormones (FSH) tend to be low. Positive pregnancy tests have been documented in patients with pseudocyesis. Elevated prolactin levels have been implicated as the cause for many of the signs of pseudocyesis. An abdominal ultrasound can confirm and document the absence of a fetus and placenta.

Pseudocyesis is a heterogeneous condition with no one unifying cause and no one universally accepted therapy. There is no clear demographic or sociocultural indicators for a population at risk. The most successful and least invasive form of therapy currently used seems to be revealing to the patient that he or she is not pregnant by using an abdominal imaging technique, counseling and educating the patient, and treating any underlying depression that may exist. Successful treatment has been defined as a six-month symptom-free period.

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