A Rare Case of Delusion of Procreation Syndrome Manifesting as Delusion of Maternity in a Patient with Schizophrenia
Year: 2025
Type: article
Study design: Case Report
Abstract: INTRODUCTION Delusion of maternity or procreation is a rare kind of delusion in a female characterized by a belief that they are the mother of one or more children. The first case of delusion of maternity was described by Hrdlicka[1] in a 62-year-old childless female patient with schizophrenia. The description also possibly included a description of the delusion of labor and childbirth. After this, few more case reports have accumulated for the delusion of maternity.[2-4] Overall, the available literature includes a description of only seven cases of delusion of maternity in schizophrenia patients [Table 1].Table 1: Review of reported cases of delusion of maternity/procreationA “delusion of childbirth and labor” was for the first time described by Jenkins et al.[5] in a 19-year-old single male patient presenting with psychosis. As described earlier, the first description of the delusion of maternity is also possibly a description of childbirth and labor.[1] Later delusions of childbirth and labor were described in a 25-year-old single female.[2,3] Given the limited literature, we aim to describe a case with the delusion of labor and childbirth and the delusion of maternity in an adult female diagnosed with pregnancy. CASE REPORT A 44-year-old unmarried female, who was premorbidly well-adjusted, presented to the inpatient with an illness of 22 years. Evaluation of the history revealed that she had an insidious onset mental illness, characterized by auditory hallucinations (of discussing type characterized by discussing about day-to-day issues of the patient’s current life situation and important issues of the past and commenting type, characterized by giving a running commentary on patient’s day-to-day activities), delusions of persecution and reference, thought withdrawal and insertion, delusion of mind reading (i.e., others can read their thoughts), delusion of maternity, anhedonia, avolition, alogia, and social withdrawal. When asked further about the delusion of maternity, she explained that she was raped (which was untrue) long back and had got pregnant. However, at term, while going through the labor pain, her fetuses fell, and then the fetuses were thrown out in the street. As per her, she had given birth to 16 children at one go and they are now on the street and begging for their living. She would also claim to hear their voices, complaining that they were not getting her love. She would report worries related to the fate of her children. She had received adequate trials of paliperidone and trifluoperazine with no improvement in symptoms. One year before her presentation to the inpatient unit, in addition to the positive and negative symptoms, she developed a depressed mood, easy fatiguability, bleak and pessimistic views of the future, disturbed sleep, decreased appetite, ideas of guilt and unworthiness, and suicidal ideation. There was no history of other psychotic symptoms, manic symptoms, obsessive–compulsive symptoms, head injury, and seizures. Her physical examination was unremarkable, except for obesity (body mass index – 29.5 kg/m2). At the time of presentation, on mental status examination, she was cooperative, ill-kempt, had the sadness of mood, delusion of reference and persecution, bizarre delusion of maternity, thought withdrawal, thought insertion, delusion of mind reading, and auditory hallucinations (second person commenting and third person discussing type), preserved judgment, concrete abstraction, and impaired insight. Her routine investigation, fasting blood sugar, serum lipids, thyroid profile, electroencephalography, and magnetic resonance imaging of the brain did not reveal any abnormality. Based on the available information, a diagnosis of schizophrenia with secondary severe depression without psychotic symptoms as per the International Classification of Diseases, Tenth Revision was considered. She was started on clozapine with close monitoring of the hemogram. The dose of clozapine was gradually increased to 300 mg/day. In addition, the patient and the family were psychoeducated about the illness, and regular supportive sessions were taken with the patient. She also underwent activity scheduling and lifestyle modification for weight loss. She showed significant improvement in psychopathology including the delusion of maternity with 3 months of clozapine therapy. Later, she maintained well for the next 3 years on clozapine. After that, she dropped out of treatment, and the family migrated to another city. DISCUSSION Delusion of procreation syndrome (DPS) is a broad term that also encompasses delusion of maternity. The broad term DPS has been used to describe all the delusions related to various “stages of procreation,” i.e., formation of a relationship through marriage/partners (delusion of having a spouse/partner/fiancé), pregnancy (delusion of pregnancy in both female/male), delivering a child (delusion of delivery), becoming parents (delusion of maternity/paternity), grandparents, etc.[3] In addition, authors have also included the delusion of proxy procreation in this broad gamete of delusions.[3] It is also suggested that this group of delusion can also include delusions of having a test-tube baby, not having periods, a dead fetus, having multiple partners, having a family, parents being alive (or dead), being fertile (also in men), having a puppy pregnancy, etc.[6] These are considered to be self-referential delusions.[3] Almost all cases of delusion of maternity have been described in female patients with schizophrenia who were single and did not have a child in the past. Our case is also in the same line. The description of our patient also reflects the presence of delusion of delivery and becoming a mother. In one of the first reports of delusion of maternity, the women had reported having given birth to four children.[1] In contrast to most of the previous reports, our patient reported giving birth to 16 fetuses at one go. Previous reports of delusion of maternity have also described patients reporting that they have been separated from their children for one or the other reason. Our index case also reported the same and it was associated with significant distress. When we look at the literature, the description of many cases is cursory, and the authors have failed to describe the full range of psychopathology in patients presenting with DPS. Hence, to improve the understanding of this group of delusions it is important that in the future, the syndrome is described along with other associated symptoms. Based on the available literature, it can be concluded that delusions of childbirth/labor and maternity are less frequently described delusions in the literature and our case adds to the limited literature. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Data Availability Statement Not applicable. Use of AI The Authors declare that authors have not used AI for writing the manuscript. Author contribution Both authors contributed to the concept, review of literature, drafting of the manuscript, editing the manuscript, and gave approval to the final version of the manuscript. Declaration of use of copyright tools Not applicable. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Journal of Psychiatry Spectrum
Authors: Sandeep Grover, Devakshi Dua
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411838756