Abstract
Denial of pregnancy is a condition in which a pregnant patient does not believe she is pregnant. This case describes a 23-year-old Caucasian female, with a past psychiatric history of pseudocyesis, stimulant use disorder, and schizophrenia, who was admitted to the inpatient psychiatric unit for the treatment of psychosis, suicidal thoughts, and homicidal ideation. During her hospitalization, an intrauterine pregnancy was confirmed with three serum quantitative human chorionic gonadotropin (hCG) levels and a transabdominal ultrasound. Despite definitive evidence of pregnancy, the patient reported it was impossible she was pregnant and stated she had not had intercourse for more than a year. The patient was treated with IM haloperidol decanoate and PO haloperidol. Care was coordinated with the obstetrics team to ensure the patient and her fetus received adequate prenatal care. After acute stabilization, the patient was discharged with close follow-up. This case presentation describes one of the few documented cases of pregnancy denial in a patient with a history of pseudocyesis. Additionally, this case highlights the ethical issues associated with the treatment of pregnancy denial patients. Additional studies are necessary to fill in the gaps in the literature on this unique condition.
Highlights
Denial of pregnancy is a condition in which a pregnant patient does not believe she is pregnant
In the interest of completeness, it is worth noting that pseudocyesis, a condition characterized by the belief of being pregnant despite medical evidence to the contrary, exists on the opposite side of the spectrum of pregnancy-related delusions [5]
The patient, in this case, exhibited unwavering denial, which is in contrast with the vacillation between denial and awareness frequently seen in psychotic denial of pregnancy [12]
Summary
Denial of pregnancy is a condition in which a pregnant patient does not believe she is pregnant. After five days of treatment, the patient continued to be verbally aggressive and delusional, voicing a bizarre conspiracy about not being discharged so the treatment team could inappropriately observe her in the shower Because of her persistent psychotic symptoms, her haloperidol dose was increased to 5 mg p.o. q.a.m. and 5 mg p.o. q.h.s. The treatment team repeatedly attempted to counsel the patient about her pregnancy and the need for prenatal care, but she continued to be resistant to any additional evaluation of her pregnancy. The patient had claimed her blood type had led to an erroneous pregnancy test result during a prior admission for pseudocyesis, at that time she claimed it had led to a false negative At this point, the team was presented with an ethical dilemma regarding whether to evaluate legal options for initiating treatment. The patient was discharged with appointments for therapy, medication management, and obstetric follow-up
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