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Presentación de caso
Delusion of Pregnancy in Bipolar Affective Disorder
Un acercamiento al delirio de embarazo en trastorno
afectivo bipolar
José Alejandro Valdevila Figueira
1,2,3
Consuelo María Villacís Álava
1,4
María Emilia Andrade Hidalgo
1
Indira Dayana Carvajal Parra
1,3
1
Instituto de Neurociencias de Guayaquil. Guayaquil, Ecuador
2
Universidad Ecotec. Guayaquil, Ecuador
3
Red de Investigación en Psicología y Psiquiatría (RIPYP). Ecuador.
4
Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
Recibido: 08/10/2025
Aceptado: 01/11/2025
An Approach to Delusion of Pregnancy in Bipolar Affective Disorder
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Abstract
Introduction: Bipolar affective disorder (F31) can show complex psychotic symptoms that
worsen its clinical course, such as delusions of pregnancy. These manifestations, although
uncommon, pose a diagnostic and therapeutic challenge due to their functional and social
impact.
Case report
: A young woman diagnosed with bipolar I affective disorder, with multiple
hospitalizations due to affective and psychotic episodes. The persistent presence of delusions
of pregnancy was notable, accompanied by thought disorganization, bradypsychia, and risky
behaviors such as IUD removal. Assessments revealed subclinical hypothyroidism, focal
EEG abnormalities, and a borderline IQ. Treatment included mood stabilizers, atypical and
typical antipsychotics, and depot medications. Despite intensive management, poor
therapeutic adherence and frequent relapses were evident.
Conclusion
: Early recognition of somatic delusions, such as delusions of pregnancy, and a
comprehensive approach are essential to prevent relapses and improve prognosis.
Keywords
: bipolar affective disorder, delusions of pregnancy, pseudocyesis, affective
psychopathology, therapeutic adherence.
Resumen
Introducción
: el trastorno afectivo bipolar (F31) puede presentar síntomas psicóticos
complejos que agravan su curso clínico, como los delirios de embarazo. Estas
manifestaciones, aunque infrecuentes, suponen un reto diagnóstico y terapéutico por su
impacto funcional y social.
Presentación del caso
: mujer joven con diagnóstico de trastorno afectivo bipolar tipo I, con
múltiples hospitalizaciones por episodios afectivos y psicóticos. Destaca la presencia
persistente de delirios de embarazo, acompañados de desorganización del pensamiento,
bradipsiquia, y conductas de riesgo como la retirada del DIU. Evaluaciones revelaron
hipotiroidismo subclínico, alteraciones focales en EEG y un coeficiente intelectual limítrofe.
El tratamiento incluyó estabilizadores del ánimo, antipsicóticos atípicos y típicos, así como
medicación en depósito. A pesar del manejo intensivo, se evidenció pobre adherencia
terapéutica y recaídas frecuentes.
Conclusión
: el reconocimiento temprano de los delirios somáticos, como los de embarazo, y
el abordaje integral son fundamentales para prevenir recaídas y mejorar el pronóstico.
Palabras clave
: trastorno afectivo bipolar, delirio de embarazo, pseudociesis, psicopatología
afectiva, adherencia terapéutica
An Approach to Delusion of Pregnancy in Bipolar Affective Disorder
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Introduction
Delusion of pregnancy has been documented across diverse clinical contexts from an
epidemiological perspective. In a systematic review of 84 cases, it was found that the
majority involved young women diagnosed with schizophrenia or bipolar disorder. Although
more common in women, it has also been reported in men, sometimes associated with gender
dysphoria or hormonal imbalances.
(1)
Pseudocyesis is more often observed in regions where
motherhood is considered an essential value therefore infertility carries significant emotional
or social burden. Cultural factors play a crucial role in the genesis and maintenance of the
condition.
(2)
In the diagnostic differentiation, key elements must be considered. In pseudocyesis, physical
symptoms mimicking pregnancy predominate, whereas in delirium, these signs are absent or
misinterpreted. Moreover, delusion is characterized by the rigidity of belief, lack of insight,
and coexistence with other psychotic symptoms. Antipsychotic treatment is fundamental in
such cases, and the therapeutic response tends to be partial or fluctuating. In some patients,
electroconvulsive therapy (ECT) has proven useful, although delusion symptoms may
reappear quickly.
(3)
Delusion of pregnancy, while not frequent, represents a complex and clinically relevant
psychopathological phenomenon. In such cases, the firm conviction of being pregnant occurs
in the absence of somatic signs compatible with gestation and despite multiple medical tests
contradicting it, thus allowing its classification as a genuine delusion rather than
pseudocyesis. This distinction is essential, since pseudocyesis involves physiological
changes induced by psychogenic mechanisms, whereas delusional pregnancy belongs to the
realm of psychotic disorders, with impaired reality testing as its core feature.
(4)
The presence of this type of delusion has been reported in various mental disorders,
particularly in schizophrenia and affective disorders with psychotic symptoms.
(5)
Within
bipolar disorder, the underlying diagnosis allows the delusion to be interpreted as part of a
broader psychotic theme, likely influenced by cultural, affective, and identity-related factors.
Symbolic aspects associated with pregnancy and motherhood (or fatherhood, in male cases)
may play a significant role in determining the content of the delusion, as noted by several
authors.
(6)
From a psychodynamic perspective, delusion of pregnancy has been conceptualized as a
defensive reaction against feelings of emptiness, loneliness, or loss, through the delusional
construction of a “new life” within the body.
(7)
This perspective may enrich understanding of
the phenomenon when the patient’s life context and biographical background are taken into
consideration. However, advances in neurobiology have identified potential cerebral
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correlates, particularly in limbic and prefrontal regions, as well as alterations in dopaminergic
systems, consistent with findings in other psychotic disorders.
(8)
Regarding treatment, the literature suggests that delusions of pregnancy generally respond to
conventional antipsychotic management, although partial persistence of delusional content is
not uncommon, especially in chronic patients or those with poor insight.
(9)
It is crucial to conduct a thorough medical and gynecological evaluation to rule out physical
causes. Pharmacological regimens should be reviewed and optimized, favoring
antipsychotics with fewer side effects and strategies to enhance adherence, and considering
electroconvulsive therapy when appropriate.
(10)
Psychotherapeutic interventions should
focus on the cognitive restructuring of delusional beliefs and on working with the family to
manage beliefs and strengthen social support. Furthermore, they must address the
psychosocial and cultural factors that may perpetuate the delusion. Finally, close clinical
monitoring and continuous risk assessment are required, given the potential coexistence of
additional psychotic symptoms.
Case report
This clinical case illustrates the complexity and severity that bipolar affective disorder (F31)
can reach, particularly when combined with specific psychotic symptoms such as delusions
of pregnancy and associated neuropsychiatric comorbidity. During outpatient follow-up and
multiple psychiatric hospitalizations, a recurrent pattern of decompensation was observed,
marked by fluctuating phases between depressive, manic, and psychotic episodes,
particularly with the surfacing of persecutory and somatic delusions related to a non-existent
pregnancy.
The case involves a 39-year-old female patient with a long-standing history of mental illness.
She exhibited marked psychic disorganization characterized by bradypsychia, hypoprosexia,
and bradylalia, along with significant risk behaviors such as the removal of her intrauterine
device (IUD) under the wrong belief of conceiving more children, and the negative influence
of an elderly relative with dementia to engage in dangerous acts. This reflects severe
impairment in judgment, impulse control, and functional impairment—factors that worsen
treatment adherence and justify prolonged hospitalizations for clinical stabilization.
Complementary examinations revealed relevant findings, including mild subclinical
hypothyroidism (decreased FT4) and focal electroencephalographic alterations, suggesting
potential cortical irritability contributing to the affective and psychotic symptomatology.
Neurocognitive evaluations indicated a borderline intellectual quotient and slowed verbal
and executive processing, which may compromise social and academic adaptation, as well as
therapeutic adherence.
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Somatic and pharmacological management. The patient underwent 12 sessions of
electroconvulsive therapy (ECT). She was prescribed long-acting injectable risperidone 25
mg every 14 days and received trials with typical antipsychotics haloperidol and
levomepromazine and atypical antipsychotics risperidone, quetiapine, and aripiprazole both
as monotherapy and in combination with valproic acid. Despite therapeutic dosing and
adequate trial durations, the overall response was limited, with recurrent decompensations
and persistence of the pregnancy delusion.
This specific psychotic symptom (delusion of pregnancy) has acted as both a trigger and a
perpetuating factor of clinical decompensation. Although uncommon, such delusions
represent a complex psychiatric manifestation that generates psychosocial and family
conflicts, as well as risky decisions that affect the patient’s physical and mental health.
Literature indicates that these delusions are associated with greater deterioration in reality
testing and require specialized therapeutic interventions that address both the psychotic
dimension and its psychosocial consequences.
From a functional perspective, the patient continues her university studies in Journalism but
displays demotivation, irregular attendance, sleep and appetite disturbances with weight gain,
and significant family conflicts. These factors reflect persistent residual affective symptoms
and highlight the need for comprehensive therapeutic strategies, including psychological
support, psychoeducation, management of medical comorbidities (such as weight control),
and strengthening of family support systems.
Multidisciplinary follow-up is essential in such cases, as the clinical complexity demands a
coordinated approach integrating pharmacotherapy, psychotherapy, neurological care, and
psychosocial support. Close collaboration among primary care, neurology, psychiatry, and
social services may improve adherence, reduce recurrent hospitalizations, and enhance
quality of life.
In summary, this case underscores the importance of recognizing and treating specific
delusions, such as delusions of pregnancy, within the spectrum of bipolar affective disorder.
It further emphasizes the need for a comprehensive and sustained approach that addresses
neuropsychiatric, functional, and familial aspects, with the goal of promoting clinical
stability, functionality, and relapse prevention. The standard structure (CARE guidelines)
(11)
was used for the case report, as recommended for this type of scientific report.
Treatment consisted of 12 sessions of electroconvulsive therapy, depot risperidone 25 mg
every 2 weeks, and combinations of typical neuroleptics (haloperidol and levomepromazine),
atypical neuroleptics (risperidone, quetiapine, and aripiprazole), and both groups combined
with valproic acid, with unfavorable results despite medium and high doses and sufficient
time.
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Discussion
This clinical case exemplifies the complexity of bipolar affective disorder (F31) with specific
psychotic manifestations, such as delusions of pregnancy, which present both diagnostic and
therapeutic challenges. The patient exhibited a fluctuating course with episodes of psychotic
decompensation characterized by persecutory and somatic delusions, particularly related to a
non-existent pregnancy. Although rare, this psychopathological phenomenon has been
described in the literature under the terms delusion of pregnancy and pseudocyesis or false
pregnancy.
Pseudocyesis is a syndrome in which the patient presents physical signs and symptoms of
pregnancy without actually being pregnant, and it is frequently associated with severe
psychiatric disorders such as schizophrenia, mood disorders with psychotic symptoms, or
delusional disorders. In this context, the coexistence of bipolar disorder with somatic
delusions related to pregnancy has been reported in several studies, indicating that such
delusions can significantly complicate clinical evolution and therapeutic management.
For instance, Stoop et al.,
(12)
describe in their review that delusions of pregnancy can manifest
in affective psychotic disorders and are frequently associated with risky behaviors affecting
physical and mental health, such as the manipulation of contraceptive methods — as
observed in this patient, who removed her intrauterine device (IUD) in an attempt to conceive
more children. These delusions have also been linked to an increased risk of violent or self-
injurious behavior due to the intense distress and the disorganization of judgment they
produce.
(13)
In line with these findings, Spiridion, Tran and Sundararajan
(14)
report cases of pseudocyesis
in patients with affective disorders, where the delusional content of pregnancy manifests
through somatic symptoms and strong beliefs that defy reality. Such cases require
multidisciplinary and personalized management, integrating psychopharmacological and
psychotherapeutic interventions. These authors also emphasize the importance of early
detection and intervention for these symptoms to prevent serious obstetric and psychiatric
complications.
The coexistence of neurophysiological alterations, such as the theta and sharp waves
observed in the patient’s EEG, has also been associated with focal cortical irritability and
vulnerability to complex psychotic episodes. This finding suggests the need for a joint
neurological–psychiatric approach to optimize treatment.
(15)
This aligns with literature
emphasizing the relevance of assessing neurobiological comorbidities in affective disorders
with psychotic symptoms.
16)
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Recurrent nonadherence to therapy, common in patients with bipolar disorder and delusions
of pregnancy, contributes to the recurrence of acute episodes and prolonged hospitalizations.
Treatment adherence is a key factor for stabilization and relapse prevention; therefore, the use
of depot antipsychotics and psychoeducation or family support programs is recommended.
(17)
Integration of psychosocial strategies, multidisciplinary follow-up, and early intervention are
fundamental pillars for improving quality of life, functionality, and long-term prognosis —
particularly in cases with complex psychotic symptomatology and cognitive comorbidity.
Conclusion
This clinical case highlights the complexity of managing bipolar affective disorder with
specific psychotic symptoms, such as delusion of pregnancy, and the necessity of
comprehensive therapeutic approaches. The combination of neurobiological factors,
cognitive impairment, medical comorbidities, and poor treatment adherence generates a high
risk of relapse and functional deterioration. Multidisciplinary follow-up, psychoeducational
interventions, and optimized pharmacological treatment are essential to improving
prognosis. Early recognition of such delusions enables the implementation of strategies that
minimize clinical, familial, and social impact, thereby promoting long-term stability and a
better quality of life for the patient.
References
1.
Guillén Bobé A, Murillo Martín A, Cortés Izaga M, Martínez Barredo L, González
Guillén V, de Urgencias Hospitalarias FEA. Pseudociesis: estudio del embarazo psicológico.
Medicina. 2024; 23(02). Disponible en: https://revistamedica.com/pseudociesis-estudio-
embarazo-psicologico/
2.
Cárdenas CM, Alcaraz JJV, Madelaire B, Delvalle C, González W. Pseudociesis.
Reporte de caso. In Anales de la Facultad de Ciencias Médicas. 2024;57(1): 89-94.
Disponible en: https://doi.org/10.18004/anales/2024.057.01.89
3.
Herrera Sosa S. Desarrollo De Protocolos De Capacitación Enfermera Ante El
Embarazo Psicológico (Pseudociesis) (Bachelor's thesis). 2024. Disponible en:
https://accedacris.ulpgc.es/handle/10553/131559
4.
Mehan V, Wehner M, Oberdorfer K, Khalid Z. Delusion of pregnancy in a 64-year-
old male: a case report. Cureus. 2025 May 20;17(5):e84478. doi:10.7759/cureus.84478.
PMID: 40539169; PMCID: PMC12178316. Available in:
https://pubmed.ncbi.nlm.nih.gov/40539169/
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5.
Das S, Prasad S, Ajay Kumar S, Denise Makonyonga R, Saadoun M, Mergler R.
Delusion of Pregnancy: A Case Report and Literature Review. Clin Med Insights Case Rep.
2023 Apr 2;16:11795476231161169. doi: 10.1177/11795476231161169. PMID: 37033675;
PMCID: PMC10074635. Available in: https://pubmed.ncbi.nlm.nih.gov/37033675/
6.
Gogia S, Grieb A, Jang A, Gordon MR, Coverdale J. Medical considerations in
delusion of pregnancy: a systematic review. J Psychosom Obstet Gynaecol. 2022
Mar;43(1):51-7. DOI: 10.1080/0167482X.2020.1779696
7.
Nagaraj AKM, Vishwanath R, Manjunatha N. Delusional Procreation Syndrome: A
Citation Analysis and Review from the First 12 Years of Publication. Indian J Psychol Med.
2025 Mar;47(2):108-11. DOI: 10.1177/02537176241251616
8.
Okasha A. Psychiatry in the Arab world. Am J Psychiatry. 2004;161(1):3–10. DOI:
10.1016/j.wpsyc.2012.01.008
9.
Narlesky MR, Rasul F, Braaten S, Powell A, Wooten RG. Denial of pregnancy in a
patient with a history of pseudocyesis. Cureus. 2021 Apr 30;13(4):e14773.
doi:10.7759/cureus.14773. PMID: 34094738; PMCID: PMC8168990. Available in:
https://pubmed.ncbi.nlm.nih.gov/34094738/
10.
Vieta E, et al. Bipolar disorder management and treatment adherence. Eur
Psychiatry. 2018;50:27-37. Available in: https://pubmed.ncbi.nlm.nih.gov/15693749/
11.
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group. The
CARE guidelines: consensus-based clinical case reporting guideline development. J Clin
Epidemiol. 2014 Jan;67(1):46-51. doi:10.1016/j.jclinepi.2013.08.003. DOI:
10.1111/head.12246
12.
Stoop T, Kager A, et al. Delusions of pregnancy: A systematic review. Schizophr
Res. 2020;215:48-54. DOI: 10.4103/0253-7176.155609
13.
De S, Bhatia T, Thomas P, Chakraborty T, Prasad S, Nagpal R, et al. Uncovering
the realities of delusional experience in schizophrenia: a qualitative phenomenological study
in Belgium. Lancet Psychiatry. 2021 Sep;8(9):740-51. Available in:
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00196-6/abstract
14.
Spiridion ED, Tran T, Sundararajan R. A rare case of pseudocyesis in a patient with
bipolar disorder. Cureus. 2020 Sep 17;12(9):e10500. doi:10.7759/cureus.10500. PMID:
33062475. Available in: https://www.cureus.com/articles/40598-a-rare-case-of-
pseudocyesis-in-a-patient-with-bipolar-disorder#!/
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15.
Zhang Y, Mei L, Wang Z, et al. Correlation between resting theta power and
cognitive performance in patients with schizophrenia. J Clin Neurophysiol. 2022;39(5):437–
444. doi:10.1097/WNP.0000000000000940. Available in:
https://journals.lww.com/clinicalneurophys/abstract/2023/11000/validation_of_a_model_fo
r_targeted_eeg_monitoring.4.aspx
16.
Jayarajah CG. 'False positive': understanding pseudocyesis through old and new
perspectives. Br J Psychiatry. 2025 Jul 16:1–5. doi:10.1192/bjp.2025.57. Epub ahead of
print. PMID: 40665647. Available in: https://pubmed.ncbi.nlm.nih.gov/40665647/
17.
Sharma M, Singh R, Sahu S, Pruthi S. Delusion of pregnancy: Case series. Indian J
Psychiatry. 2024 Jun;66(6):576-580. doi:
10.4103/indianjpsychiatry.indianjpsychiatry_699_23. Epub 2024 Jun 19. PMID: 39100380;
PMCID: PMC11293775. Available in: https://pubmed.ncbi.nlm.nih.gov/39100380/
Conflicts of interest
The authors declare that there are no conflicts of interest related to the research presented.
Author contributions
José Alejandro Valdevila Figueira: participated in conceptualization, data curation, formal
analysis, funding acquisition, investigation, methodology, project administration, resource
management, software use, supervision, validation, visualization, writing – original draft,
and writing – review and editing.
Consuelo María Villacis Alava: participated in conceptualization, data curation, formal
analysis, investigation, methodology, validation, visualization, writing – original draft, and
writing – review and editing.
María Emilia Andrade Hidalgo: participated in conceptualization, formal analysis,
methodology, writing – original draft, and writing – review and editing.
Indira Dayana Carvajal Parra: participated in conceptualization, formal analysis,
methodology, writing – original draft, and writing – review and editing.
Funding Source
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The research and/or preparation of this article did not receive funding from any sponsor. The
study design; data collection, analysis, and interpretation; report writing, and the decision to
submit the article for publication were not supported by any funding source.
Data Availability Statement
The anonymized data supporting the findings of this study are available from the
corresponding author upon reasonable request.
Ethical Considerations
This study was conducted in accordance with the ethical principles established in the
Declaration of Helsinki and complied with national and institutional research ethics
guidelines. Participation was voluntary, and informed consent was obtained electronically
from all students prior to data collection. Participant confidentiality and anonymity were
strictly maintained throughout the study.
(Annex 1)
Informed Consent
Annex 1. Informed Consent for Publication of a Clinical Case Report
I, ____________________________________________, with identity card number
________________________, as the legal representative and mother of patient
____________________________________________, freely, voluntarily, and with full
information, authorize the use of clinical information contained in my daughter's medical
history for the preparation, publication, and dissemination of a scientific article under the
guise of a clinical case report.
I declare that I have been clearly and sufficiently informed of the following points:
1. That the clinical case will be used for scientific, academic, and educational purposes,
without profit.
2. That the patient's identity will be fully protected through the use of codes, and that no
personally identifiable information (such as full name, ID number, address, face, etc.) will
be included in the publication.
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3. That the material may be presented at medical conferences, articles in scientific journals,
or academic documents, and that the information used will be strictly necessary to illustrate
relevant clinical, diagnostic, and therapeutic aspects.
4. That I have the right to revoke this consent at any time before publication of the article,
without affecting the medical care the patient receives.
5. I understand the minimal risks associated with the publication of clinical cases, as well as
the measures that will be taken to protect the patient's privacy and confidentiality.
6. Participation in this case report does not imply financial compensation or direct benefits.
Having understood all the information provided, I give my consent for the use of clinical
data for scientific and academic purposes.
Place and date: _______________________
Signature of mother or legal representative: ____________________________
Full name: ______________________________________________
ID: ____________________________
Signature of treating professional or person responsible for the article:
____________________________
Full name: Jose Alejandro Valdevila Figueira
Position / Specialty: Inpatient attending physician
Health institution: Guayaquil Institute of Neurosciences
Contact: 0995567382
▭
I have received a copy of this document.
Note: This consent is issued in compliance with the ethical principles of the Declaration of
Helsinki and local regulations regarding privacy and the use of medical information.