Psychosomatic symptoms of the Couvade syndrome in Finnish and Polish expectant fathers.

OBJECTIVES: The aim of the study was to assess the occurrence of symptoms associated with the Couvade syndrome in two groups of men of Polish and Finnish nationality, and to perform a comparative analysis. MATERIAL AND METHODS: The study was conducted in two groups of men (expectant fathers): 51 Poles and 40 Finns using a self-constructed questionnaire prepared in Polish and English languages. The statistical analysis was performed in Micro-soft Office Excel 2010 and Statistica 12. The Pearson's test was calculated, and the statistical significance level was p < 0.05. RESULTS: The most common physical symptoms reported by the Polish men were weight gain (78%) and gastric disorders (80%), whereas the Finns most frequently declared weight gain (60%). As for emotional symptoms, mood swings (p = 0.0001) and sleep disorders (p = 0.00004) were significantly more common in the Poles, whilst the Finns experienced frustration (p = 0.0403) and nervousness (p = 0.01579) significantly more frequently. The Finnish respondents more often used profes-sional forms of preparation for childbirth and parenthood (p = 0.00229). CONCLUSIONS: Psychosomatic symptoms of the Couvade syndrome are significantly more common in Polish than in Finnish expectant fathers. Compared with Polish fathers, Finns significantly more frequently attend ante-natal classes. Ante-natal care should encompass education of men as they do experience the symptoms of the Couvade syndrome during their wives'/partners' pregnancies.

Psychosomatic disorders of gravida status: false and denied pregnancies.

OBJECTIVE: The authors review the literature on two dramatic psychosomatic disorders of reproduction and offer a potential classification of pregnancy denial. METHOD: Information on false and denied pregnancies is summarized by comparing the descriptions, differential diagnoses, epidemiology, patient characteristics, psychological factors, abdominal tone, and neuroendocrinology. Pregnancy denial's association with neonaticide is reviewed. RESULTS: False and denied pregnancies have fooled women, families, and doctors for centuries as the body obscures her true condition. Improvements in pregnancy testing have decreased reports of false pregnancy. However, recent data suggests 1/475 pregnancies are denied to 20 weeks, and 1/2455 may go undiagnosed to delivery. Factors that may contribute to the unconscious deception include abdominal muscle tone, persistent corpus luteum function, and reduced availability of biogenic amines in false pregnancy, and posture, fetal position, and corpus luteum insufficiency in denied pregnancy. For each condition, there are multiple reports in which the body reveals her true pregnancy status as soon as the woman is convinced of her diagnosis. Forensic literature on denied pregnancy focused on the woman's rejection of motherhood, while psychiatric studies have revealed that trauma and dissociation drive her denial. CONCLUSIONS: False pregnancy has firm grounding as a classic psychosomatic disorder. Pregnancy denial's association with neonaticide has led to misleading forensic data, which obscures the central role of trauma and dissociation. A reappraisal of pregnancy denial confirms it as the somatic inverse of false pregnancy. With that perspective, clinicians can help women understand their pregnancy status to avoid unexpected deliveries with tragic outcomes.

Delusion of pregnancy in frontotemporal lobar degeneration with motor neurone disease (FTLD/MND).

Psychotic phenomena such as delusions and hallucinations are rare in frontotemporal dementia syndromes but have recently been recognised as an early feature in some cases of frontotemporal lobar degeneration with motor neurone disease (FTLD/MND). A patient with delusion of pregnancy as an early feature of FTLD/MND is presented to illustrate the need to consider neurodegenerative disease as well as primary psychiatric disorder as the underlying cause of this striking symptom.

Hyperprolactinemia and delusion of pregnancy.

We describe the case of a 44-year-old woman admitted with mania with psychotic symptoms who presented with delusion of twin pregnancy a month after admission, which temporally correlated with hyperprolactinemia secondary to antipsychotic medication. Modification of antipsychotic medication was associated with fall in serum prolactin and disappearance of delusion of pregnancy. In light of this clinically striking temporal association between hyperprolactinemia and delusion of pregnancy, we review the literature to examine the hypothetical relationship. We highlight the clinical significance of examining the various factors, including antipsychotic-induced hyperprolactinemia, which could trigger the development of delusion of pregnancy.

[Recurrent pseudocyesis with polydipsia: a case report]. / Grossesse délirante récurrente avec polydipsie: à propos d'un cas.

INTRODUCTION: Pseudocyesis is an imaginary pregnancy resulting from a strong desire or need for motherhood. Pseudocyesis has become increasingly rare in many parts of the world in which accurate pregnancy tests have become widely available. Cultures that place high value on pregnancy, or that make close associations between fertility and a person's worth, still have high rates of the disorder. A woman may believe in her pregnancy to the point of delusion and show acute depression when no baby is born. CASE-REPORT: This report describes a case of recurrent pseudocyesis and polydipsia in a 49-year-old woman. She was an illiterate housewife who had been married since she was 21 years old. Four years later, she divorced because of a problem of sterility. She got remarried, five years later, and the couple had no child. The patient was admitted into the Obstetric Unit thinking that she was about to give birth. She presented all the symptoms of true pregnancy. She had abdominal distension, amenorrhea, mammary tension, nausea and vomiting, and weight gain. She claimed to have felt foetal movements. Other than this, she exhibited a polydipsia syndrome. These symptoms had evolved over 20 months. The patient had previously presented six similar episodes. All these episodes were identical. The length of these episodes varied between three and five months, after which all the signs disappeared progressively. The patient had never consulted for these symptoms before the present episode. During her stay in the Obstetric Unit, she benefited from a complete gynaecological examination, including pelvic ultrasound examinations, and laboratory tests, notably hormone assays (FSH, LH, prolactin, ss-HCG) and serum electrolyte levels. A primary sterility and menopause were confirmed. Otherwise, the psychiatric assessment confirmed the delusion of pregnancy and the presence of a depressive syndrome. The patient reported that she was possessed. She explained the normality of the imagery and laboratory tests by the intervention of the demons that hid the foetus and modified the results. DISCUSSION: The contribution of psychological and physiological factors in the development of the delusion of pregnancy, possession and polydipsia, and the possible interactions between the two phenomena are discussed.

A current perspective of pseudocyesis.

Pseudocyesis is a diagnosis out of medical antiquity in with the physiological and psychological concomitants of pregnancy develop in the absence of the true gravid state. Along with other dramatic and polymorphous psychiatric disorders pseudocyesis appears to have decreased in frequency or altered its clinical manifestation in this century. The author discusses the reasons behind these changes and describes a comparable modern neuroendocrine diagnosis, the galactorrhea-amenorrhea hyperprolactinemia syndrome. He advocates the combined use of the term pseudocyesis for a selected population of patients.

Endocrine and psychological evaluation of women with recent weight gain.

A group of 13 consecutive regularly menstruating women who gained at least 5 kg the previous year (Group I) was compared to a control group of similar age, parity, and social class (Group II). The two groups were similar in estimated and observed food intakes; pre- and postprandial gastrin levels; hourly 24-h profiles of cortisol and insulin; urinary cortisol and 17-hydroxycorticosteroids. Group I had higher serum prolactin concentrations at all times than Group II (mean values 14.60 micrograms/l vs. 8.84 micrograms/l; p = .0121). Galactorrhea was observed in 5 women from Group I and in none of the women from Group II (p < .05). Group I also differed from Group II in a higher incidence of meaningful life-events the year preceding the study, higher prevalence of sexual dysfunction (9/13 vs. 4/13; p < .01) and higher indexes (p < .05) of several parameters in the MMPI and SCL 90. Median serum cortisol and prolactin concentrations were negatively correlated, both in Group I (R = -.669; p = .012) and in the whole sample (R = -.453; p = .0298). It is suggested that the rapid weight gain is part of a neuroendocrine response to environmental stimuli also characterized by hyperprolactinemia. The significant negative correlation between serum prolactin and cortisol indicates that this response differs from, and is possibly an alternative to, the sympathoadrenal "stress" response.

Impact of psychodynamic factors on the course and management of patients with pseudocyesis.

Comparing and contrasting two patients with pseudocyesis made it clear that differing psychodynamic factors specific to each patient resulted in divergent ways in which they sought out and used medical care. The propensity of these patients to distort reality was observed to interfere with the usefulness of sonography in convincing them that they were not pregnant. Management recommendations are suggested to aid the obstetrician in designing a treatment approach to assist the patient in accepting the diagnosis, giving up the symptom, and preventing future recurrences.

Opioid peptides in pseudocyesis.

Five women with pseudocyesis were evaluated during a two-year period. A random, nontimed blood sample was obtained from each woman at the time of initial encounter that revealed a hormone pattern most consistent with polycystic ovarian disease; mean (+/- SE) concentration of luteinizing hormone (LH) was 14.2 +/- 2.1 mIU/mL, follicle-stimulating hormone (FSH) was 3.3 +/- 0.7 mIU/mL, prolactin (PRL) was 23.5 +/- 1.3 ng/mL, estrone was 74.7 +/- 15.0 pg/mL, and estradiol was 54.7 +/- 13.0 pg/mL. In four of these patients, serum progesterone concentration was elevated over expected follicular phase values. The opiate antagonist, naloxone, was administered to four women before disclosure of their diagnosis. Naloxone treatment failed to induce LH or PRL release. Because naloxone did not cause a change in hormone concentration, naloxone-sensitive opioid mechanisms are apparently not involved in this disorder. After resolution of pseudocyesis, naloxone-induced LH release was appropriate for the phase of the cycle in which the narcotic blocking agent was administered.

Receptivity, proceptivity and attractivity of pregnant and pseudopregnant rats.

In the present study the effects of pregnancy and of pseudopregnancy on oestrogen-induced receptivity, proceptivity and attractivity in female rats were investigated. Receptivity and proceptivity were determined in heterosexual pair tests. Attractivity was determined using a new method: a residential plus-maze. It was found that during the second half of pregnancy oestrogen treatment did not induce the above-mentioned behaviours. However, during the second half of pseudopregnancy oestrogen treatment resulted in high levels of these behaviours. Also, combined oestrogen plus progesterone treatment showed similar high frequencies of these behaviours in pseudopregnant rats.

A study of the sensory requirements for eliciting the pseudopregnancy response.

Stimulations of the vagina and cervix were performed with a stimulator designed to grade intravaginal penetration of a rod. Single cervicovaginal stimulations performed in estrus or in diestrus II elicited immediate or delayed luteal responses, respectively. The probabilities of both types of response increased as a function of the strength (penetration) and duration of the stimulus. Immediate responses were significantly more probable than delayed responses. The other observed parameters of the response (plasma progesterone and diestrus length) were not related to stimulus magnitude. The probabilities of immediate or delayed responses were related to rod penetration by power functions, implying an exponential transformation of the received stimulus. An exponential transformation of rod penetration into pressure on the cervix, which occurs at the vaginal level, seems not to contribute substantially to the final exponential transformation. The relationship between stimulus duration and response probability could not be defined mathematically. No further increase in probability of response was caused by prolonging a deep penetration (24 mm) beyond 5 s (immediate responses) and 15 s (delayed responses). The novel stimuli from an unusual procedure to immobilize the rat may interfere with the response to cervicovaginal stimulation. However, the extravaginal stimuli the female receives during coitus did not seem to facilitate or inhibit the response to a deep (24 mm) penetration of the rod. The results establish some quantitative relationships between stimulus and response parameters and indicate the importance of cervicovaginal stimuli, among the multiple sensory stimulation of mating, to induce the luteal response.

Aggression by a female rat cohabitating with a sterile male: termination of pseudopregnancy does not abolish aggression.

At the end of that time, each female was assessed for aggressiveness toward an unfamiliar female intruder once each week for 3 weeks. Those females displaying a high level of aggression had their male cagemate changed. For half of the females, the new male cagemate was a castrated male with a testosterone implant. For the other half, the new cagemate was a castrated male without a testosterone implant. Replacement males had been subjected to surgery 9 weeks previously. There were no differences in the aggressiveness of females of the two groups on any of 3 subsequent weekly tests of aggression. In a 3-h evaluation of male sexual behavior, none of the 9 castrated males without testosterone replacement displayed sexual activity with an estrogen/progesterone primed ovariectomized female, but 6 of 9 males with testosterone replacement did. Reanalysis of the aggression data comparing the females whose males had no testosterone replacement and females housed with the 6 males that were sexually active also revealed no differences in aggression over the 21-day test period. Since pseudopregnancy is known to last 13 days, these results indicate that the continuous presence of pseudopregnancy is not required for maintenance of aggression by a female cohabiting with a sterile male.

Suppression of estrus in female mice by the presence of conspecifics or by foot shock.

The reaction of reproductive system of outbred female mice to crowded conditions or electric foot shock was investigated. Both experimental factors inhibited estrous cycle, and decidual cell reaction (DCR) was observed after traumatization of uterine horns in tested animals. Further investigations showed that corpora lutea in females subjected to social stress were significantly larger than those in mice stressed by classical stressor. Also, plasma progesterone level increased only in females exposed to grouped females. These results indicate that social interaction among female mice lead to the development of typical pseudopregnancy, whereas inhibition of ovulation and DCR in females subjected to electric foot shock are not related to the increase of activity of corpora lutea.

Pseudocyesis in an adolescent using the long-acting contraceptive Depo-Provera.

PIP: A case report documents a Hispanic adolescent, 17 years of age, with pseudocyesis, who became amenorrheic using Depo-Provera to prevent a second pregnancy. Pseudocyesis includes classic symptoms of pregnancy such as nausea, breast enlargement and pigmentation, abdominal distention, and amenorrhea in nonpregnant women. It demonstrates the to control one's physical aspect at the level of hypothalamus. The involvement that contributed to her pseudocyesis--in this case, of her mother and boyfriend -- was not unusual. The abrupt resolution was brought on by normal menstrual period that began after she voluntarily missed her Depo-Provera injection. However, her ambivalence about a pregnancy became clear after she and her family received counseling. While the agenda had been to help her prevent a pregnancy, hers had not been as clear and uncomplicated. Her subsequent conception was a very positive one for her and her family, which helped to resolve the situation.^ieng

The couvade syndrome.

The couvade syndrome can be considered to be the psychosomatic equivalent of primitive rituals of initiation into paternity. Various symptoms have been described in the husbands of pregnant women with an incidence from 11% to 65%. The most common of these are: variations in appetite, nausea, insomnia and weight gain. Seventy-three couples with the women in the last month of pregnancy were given a questionnaire; as a reference group, 73 men without pregnant wives or children under 1 year of age were taken. An emotional involvement connected with pregnancy was reported in 91.78% of the men. This involvement was expressed as changes in sexual habits in 87.67% of cases, fear and anxiety in 36.98% and curiosity in 47.94%. With the exception of nausea, physical symptoms were less frequent in the men with pregnant wives than in those without pregnant wives. These data cannot confirm the existence of the couvade syndrome with its own physical symptoms but we think that some male experiences, which constitute a peculiar imaginary and behavioral reality of the father-to-be, do exist.

Delusional pregnancy in a patient with primary sterility.

The case of a patient suffering from primary sterility who developed a well-systemized delusion of pregnancy is described. The patient did not have a history of psychiatric disorder or organic cerebral pathology. No history of epilepsy was detected in this patient contrary to the reports in the literature, and these facts have pathogenic relevance in delusional pregnancy. The importance of psychological factors in the development of a delusion of pregnancy is discussed.

Effects of oestrogen supplementation and space restriction on PGF2alpha-induced nest-building in pseudopregnant gilts.

This study examined the role of oestrogen supplementation on PGF2alpha-induced nest-building in pseudopregnant gilts. Oestradiol valerate (5 mg/day) injections were given on Days 11-15 of the oestrous cycle to induce pseudopregnancy. A further series of injections of either oestradiol valerate (5 mg/day) or vehicle were given on days 44-46 of pseudopregnancy to reflect more closely the hormone profile seen in pregnancy. Nest-building was induced by a single intramuscular injection of 15 mg of PGF2alpha (Lutalyse) on Day 47 of pseudopregnancy. The gilts were housed in pens (2.8 x 1.7 m) containing straw in experiment 1 or chronically confined in crates (0.6 x 1.7 m) that did not contain straw on days 44-48 of pseudopregnancy for experiment 2. Oestrogen supplemented gilts had significantly higher concentrations of circulating 17beta-oestradiol on day 47 of pseudopregnancy but there were no significant differences between treatments for circulating levels of prolactin, progesterone, cortisol or oxytocin, or for any behavioural measure in either experiment. These results indicate that there is no direct effect of supplementing already pseudopregnant gilts with oestradiol valerate on PGF2alpha-induced nest-building. The results also show that the pre-partum environment has a pronounced effect on nest-building behaviours and that non-pregnant pigs might be a useful model for pre-partum nest-building in this species.

Pseudocyesis in infertile patients.

In the African population, pseudocyesis is not an uncommon gynecologic disorder. The high premium on childbearing, as well as the deep-rooted cultural belief that children are a "security of old age" and continuation of the family, exposes the infertile woman to constant stress. The social and psychological satisfaction of parenthood is very important in this culture; while, for some patients, perception of the economic implication of children enhances the desire to have children.