AN IMMACULATE CONCEPTION – THE DIFFERENTIAL DIAGNOSIS OF A DELUSION OF PREGNANCY

Introduction: Delusions of pregnancy (DP) have been described in various mental disorders such as schizophrenia and other psychotic disorders (including no longer used diagnosis such as paraphrenia), affective disorders, epilepsy, dementia and other organic brain disorders. There is limited data about the prevalence of this symptom, having been documented both in men and women.

Objectives: To describe and discuss a case report of a patient with DP
Methods: Review of the clinical case and literature
Results: A 40-year old woman without prior psychiatric history was admitted to an impatient psychiatric unit due to a delusion of pregnancy. During hospitalization she was mainly calm and collaborative, revealing the presence of auditory hallucinations which she believed were God’s words telling her she was pregnant with two babies coming from the Holy Spirit. The patient was mostly euthymic, but with the development of an exalted mood and excitement when questioned about the ideas of pregnancy. There was no evidence of disorder of thought or functional deterioration, with preserved personality. Antipsychotic medication was introduced, with limited response, which led to the initiation of clozapine. According to the clinical progression, the main diagnostic hypothesis were schizophrenia, delusional disorder and paraphrenia. At discharge, the patient maintained an encapsulated delusion of pregnancy, without insight.

Conclusions: This case shows the difficulty of finding a specific diagnosis from a symptom potentially present in multiple disorders. In face of the different diagnostic hypothesis, it is important to remind that Kraepelin himself said the diagnostic delimitation is sometimes difficult at the beginning, being necessary to wait for the clinical evolution.