An approach to pregnancy delusion in bipolar affective disorder: Case report

Abstract

Introduction: Bipolar affective disorder (F31) can present with 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 presentation: A young woman diagnosed with bipolar I affective disorder, with multiple hospitalizations for 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. Evaluations 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. Discussion: Pregnancy delusions can occur in the context of affective disorders with psychotic symptoms, such as pseudocyesis. These strongly held and maladaptive beliefs pose risks to the patient's physical and mental health. This case demonstrates how the combination of neuropsychiatric factors, cognitive impairment, and complex psychotic symptoms hinders clinical stabilization and compromises social functioning. The literature suggests that intervention should be multidisciplinary, early, and intensive. Conclusion: Early recognition of somatic delusions, such as pregnancy delusions, and a comprehensive approach are essential to prevent relapses and improve prognosis.