Delusion of Pregnancy: An Atypical Presentation of Schizophrenia

Delusion of pregnancy is an uncommon psychopathological phenomenon in which an individual holds a fixed belief of being pregnant despite clear medical evidence to the contrary. It is most often described in the context of schizophrenia and other psychotic disorders and may be influenced by multiple biological, psychological, and sociocultural factors. We report the case of a 50-year-old married, postmenopausal woman with a 20-year history of schizophrenia who presented with a six-month history of a firm conviction that she was pregnant. Repeated gynecological evaluations, including serial serum β-hCG assays, abdominal and pelvic ultrasonography, and relevant biochemical investigations, consistently ruled out pregnancy, and neuroimaging showed no structural abnormalities. In the absence of any other medical explanation, the presentation was conceptualized as a delusion of pregnancy secondary to schizophrenia. Optimization of antipsychotic treatment, short-term use of benzodiazepines for associated anxiety and agitation, along with supportive psychotherapy, resulted in a gradual attenuation of the delusional conviction and improvement in insight over follow-up. This case underscores the complex interplay between chronic psychosis and deeply embedded cultural meanings associated with motherhood, and highlights the importance of a culturally sensitive, biopsychosocial approach combining pharmacotherapy, psychological interventions, psychoeducation, and family involvement to improve adherence and clinical outcomes.