Pregnancy delusion hinders the diagnosis of achalasia in a patient with life-threatening emaciation

Abstract

Abnormal eating behaviour among psychiatric patients is associated with several psychiatric conditions, but may also be caused by a comorbid physical condition. Clinical assessment of a psychiatric patient is often challenging, which contributes to an increased rate of undiagnosed medical conditions and an increased mortality rate. We present the clinical case of a 46-year-old woman with a long-term delusion of triplet pregnancy, and recurrent vomiting. She experienced intense weight loss and eventually faced a life-threatening situation due to achalasia, which was incidentally discovered on a chest X-ray during her second psychiatric hospitalization, after several other tests, including upper digestive endoscopy, returned normal results. After a successful laparoscopic Heller's myotomy, her digestive symptoms greatly improved. This report illustrates the difficulty of establishing clinical-surgical diagnoses in psychotic patients, as some delusions seem to explain clinical complaints, masking and delaying the diagnosis of comorbid conditions.

Delusion of Pregnancy: A Systematic Review of 84 Cases in the Literature

“…Four of the articles could not be obtained,[ 13 14 15 16 ] and hence the present review included 40 articles. The included articles varied in the number of cases described from one case,[ 1 2 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 ] two cases,[ 42 43 ] three cases,[ 44 45 46 ] four cases,[ 47 ] five cases,[ 48 49 50 51 ] six cases[ 52 ] to a maximum of seven cases. [ 53 54 ]…”

“…This suggests that the phenomenon is nosologically non-specific and attempts should be made to look for other symptoms and see whether syndromal criteria for a psychiatric disorder have been met. Organic disorders which can present with delusion of pregnancy include epilepsy,[ 2 20 32 48 ] motor neuron disease,[ 27 ] dementia,[ 45 49 ] delirium,[ 45 ] metabolic syndrome,[ 25 ] primary heperprolactinaemia and hasimotothyroidits,[ 23 ] lung sarcoidosis with lung fibrosis,[ 28 ] primary sterility due to tubal cyst,[ 31 ] hypothyroidism and achalasia[ 35 ] and intermittent polydipsia and hyponatremia syndrome. [ 21 ] The duration of the delusion was variable, with about one-tenth of the sample having the delusion over 10 years, and one case had the delusion over 20 years.…”