Psychiatric illness and the wish to conceive

Abstract

This case was considered important to publish because it was a clinical and ethical challenge with various controversial points, the patient was considered «difficult» and the familiar approach was important to reach conclusions about the diagnosis and clinical procedure. The report is about a 43 years old woman with a heavy psychiatric precedent history who presents amenorrhoea and symptoms of being pregnant. After demonstration of no pregnancy with normal clinical examination and various complementary diagnostic tests, she maintains her firm conviction on her pregnancy and refers maintenance of the amenorrhoea, pregnancy symptoms and feelings of «the baby moving» for four more months. Meanwhile, she refers her desire of getting pregnant. In this case, because of her precedent psychiatric history, the diagnosis of pseudocyesis is not clear. It may be considered an isolated somatization disturb or, in the other hand, a delusion, part of a very complex psychiatric problem of borderline personality, determining different approaches for the pregnancy hypothesis. This nuliparous woman, widowed and retired, with heavy familiar and personal psychiatric history, lives with her father and recent boyfriend, both with alcohol abuse related problems. She asks her family doctor for consultation about 15 times a year, always with renewed complaints and claims frequently for new diagnostic exams and analysis, maintaining manipulative manners and transferring the responsibility of her health decisions to the doctors. The psychiatric diagnosis, the therapeutic approach and the pre-conceptional counselling were discussed with other family doctors and psychiatrists, without reaching any consensus.