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716
ELGADDAL
symptoms,maybeseeninavarietyofpsychoticconditions.Morecaseswithfulldetailsneedtobereportedforthenatureandtheaetiologyoferotomaniatobeunderstood.
References
AMERICANPSYCHiATRICASsowIoN(1988)DiagnosticandStatistical
ManualofMentalDisorders(3rdedn,revised)(DSM—IIl-R).
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secondoClérambault.RiuSperimdiFreniatria,80,407.
CLERAMBAULT,G.0.DE(1942)Lespsychosespassionelles.Oevre
Psychiatrique.Paris:PressesUniversitairesdeFrance.
CUMMINGS,J.L.(1985)Organicdelusions:phenomenology,ana
tomicalcorrelationsandreview.BritishJournalofPsychiatry,146,184—197.
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ENOCH,M.D.&TasmowAN,W.H.(1979)UncommonPsychiatric
Syndromes(2ndedn).Bristol:ohnWright&Sons.
FEDER,S.(1973)Clérambaultintheghetto:pureerotomania
reconsidered.nternationalJournalofPsychoanalyticPsycho
therapy,2,240—247.
LovEl-rousr,J.W.&CHRISTIE,.(1978)Thepathologyoflove:someclinicalariantsofdeClérambault'syndrome.Social
Science&Medicine,12.99—106.
SCHACHTER,M.(1977)Erotomanieouconvictiondéliranted'ëtre
aimé:ontributionaIapsychopathologicdeIavieamoureuse.
AnnalesMedico-Psychologiques,135,748.
SIGNER,S.F.&CUMMINGS,3.L.(1987)DcClérambault's
syndromeinorganicaffectivedisorder:twocases.BritishJournal
ofPsychiatry,51,404—407.
—¿&SWINSON,R.P.(1987)Twocasesoferotomania(de
Clérambault'syndrome)inbipolaraffectiveisorder.ritish
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SLATER,E.,BEARD,A.&GLITHERO,E.(1963)Theschizophrenia
likepsychosisofepilepsy.BritishJournalofPsychiatry,109,
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WELLER,M.(1985)Thesequelaeofheadinjuryandthepost
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Y.Y.ElGaddal,MB,BS,MRCPsych,RegistrarinPsychiatry,SeftonGeneralHospital,LiverpoolL152HB
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BritishJournalofPsychiatry(1989),154,716—718
DelusionsofPregnancyinMen
CaseReportandReviewoftheLiterature
SANTOSHK.CHATURVEDI
Thecaseofayoung,unmarriedboy,whohadmoderatementalretardation,epilepsy,and
post-ictalpsychosis,isdescribedhere.Duringthepsychosis,hebelievedhewaspregnant,andhadrelatedbehaviouraldisturbances.Thereviewofothersuchcasesrevealsthatorganic
braindamagewasevidentinallcases.Braindamageseemstobethemorelikelycausative
factorthanpsychodynamicfactors.ThefirstcaseinvolvingadelusionofpregnancywasreportedbyEsquirolinthe19thcentury(Vie&Bobe,1932).Delusionsofpregnancyinmenarerelatively
rare,andhavebeenoccasionallyreportedas
symptomsofawidevarietyofpsychoticstates,includingschizophrenia,melancholia,seniledementia,
andgeneralparesis,andfollowingencephalitis
(Baonvilleeta!,1935;Focquet,1935;Jacobson,1950;Neveu&Boyer,1950;Alliezeta!,1956;Jenkinseta!,
1962).Thesmallnumberofrecordedinstancesseemstobeverysmall,andalthoughtheremaybesome
commonpsychodynamiclinkdeterminingthecontent
ofthedelusion,thisstatedoesnotappeartobearanyrealrelationshiptotheCouvadesyndrome,inwhichalmostbydefinitionthesuffererdoesnotentertaintheideathatheispregnant(Enocheta!,1967).Delusionsofpregnancyhavebeenreportedbothinsingleandinmarriedmen,without,inthelatter,bearinganydefiniterelationshiptotheirwives'pregnancies.Baonvilleeta!(1935)describedtwo
cases:onewasa73-year-oldmansufferingfrom
chronicorganicbrainsyndrome;theotherwasa44year-olddepressedpatient.Marchand(Alliezeta!,
 
717
ELUSIONSOFPREGNANCY1956)notedthatmenwithgeneralparesisfrequentlyhadtheideathattheywerepregnant.Alliezeta!(1956)describedanotherpatientwhothoughthehad
multiplepregnancyandwouldreportthatthe
childrenweremovinginhisabdomen.Neveu&
Boyer(1950)describedapatientwithpost-encephalitic
Parkinsoniansyndromewhoexpresseddelusionof
pregnancy.Thelatestcaseofdelusionofpregnancy
wasreported25yearsagobyJenkinseta!(1962).Theyreporteda19-year-oldsingleboywhowas“¿veryonfused,disoriented,incoherentandirrelevant―andhadlowIQ(verbalintelligencerecordedas61onWechsler'sAdultIntelligenceScale).Itisdifficulttocommentastowhetherdelusionsofpregnancyinunmarried(ormarried)menhave
beensubsequentlyencounteredclinicallyornot,but
somehowforthelast25yearsnocaseshavebeenreported.ThepresentationofdelusionofpregnancyinayoungunmarriedIndianmaleisreportedhere.Also,thepossibleaetiologicalmechanismsforthedevelopmentofsuchaphenomenon,whichare
evidentfromthepresentcaseandthepreviously
reportedones,arediscussed.
CasereportMrA.,aged23years,anunmarriedmaneducateduptothirdclass(threeyearsofschooling),wasbroughtbyhisfatheranduncletoourout-patientclinicatBangalore.ThefatherandunclereportedthatMrA.hadbeenhighlydisturbedforsevendays.Theonsetwassuddenandtherewereno
psychologicalprecipitatingfactors.Thepatienthadbecome
excitedandovertalkative(mainlyirrelevant)andwas
shouting.Hereportedasensationthatsomeonewas
pressinghischestandthathehadachildinhisabdomen.
Hewasverydisturbed,asheheardmanyvoicescallinghim
butcouldnotseeanybodyaround.Herepeatedlymentionedthatsomeonehadgivenachildtohimandthat
hehad“¿conceived―.ecriedincessantlyandrequested
hisparentstoforgivehimashehadcommittedthisimmoral
act(ofbearingthechild).Hedeniedanysexualassault.
Hedidnotstophisshoutingdespitefranticreassurancesaboutthisimpossiblehappeningbyhisparentsandrelatives.Hedidnotsleepforthreedaysandateverylittle.He
worshippedexcessively.Hissocialandworkfunctioning
weremarkedlyimpaired.Thispsychoticbehaviourwas
precededbyanepilepticseizure(leftfocalbecominggeneralised),whichthepatienthadabout8—10oursbefore
thepsychoticexcitement.Aftertheseizurethepatienthadsleptfor8—10hours,andonawakeningshowedthisabnormalbehaviour.
Afamilyhistoryofanepisodicmentalillness(typenot
knownduetoinadequateinformation)wasreportedinamaternaluncle.Thepatienthadnopasthistoryofany
mentalillness.Thepatienthadhadpost-natalcomplications
andhaddevelopedcyanosisatbirth.Convulsionsstarted
inearlychildhoodandwereinadequatelycontrolledby
phenobarbitone(120mgperday).Hismotordevelopmentalmilestonesweredelayed(walkingandtalking,for4-5years;
bowelcontrol,7years;self-care,dependenttill18years).Hecouldnotcopewiththestudiesandhencediscontinued
schoolingafterthreeyears.Sincethenhehasbeenworking
asahelperinthegarden,underhisfather'ssupervision.
Hismentalstateshowedanunkemptappearance,
restlessness,mannerisms,takingdeepbreaths,manytimesholdinghisabdomen.Hehadnoconfusionordis
orientation.Hewouldsuddenlylaughloudlyandin
appropriately.Adiagnosisofmoderatementalretardation
withepilepsyandpost-ictalpsychosiswasmade.Thepatient
wasprescribedhaloperidol(10mg),diazepam(10mg),anddiphenylhydantoin(200mg)daily,inadditiontopheno
barbitone(120mgperday).Thepatientreportedtwoweekslater.Hisexcitementhad
reduced,buthereportedsecond-andthird-personauditoryhallucinations.Hewasconvincedthathewaspregnantandsomebodywastryingtoharmhim.Hehadasillysmile,
andhistalkwasirrelevantonlyonoccasions.Hehadno
seizureandhissleephadimproved.Therewasno
disorientationorconfusion.Haloperidolwasincreasedto
15mgperdaybecauseofcontinuingpsychoticsymptoms.
Afollow-upamonthlatershowedthatthepsychosishad
remitted.Heshowednoabnormalbehaviourandhadalmostreachedhispre-morbidleveloffunctioning.The
totaldurationofpsychosiswassixweeks.MrA.felt
embarrassedtotalkabouthisabnormalbelief(ofbeing
pregnant)andcouldnotexplainhoworwhathadhappened
tohim.Thebeliefofbeingpregnantwasnotduetoanyabnormalsensationsorinanywayrelatedtohisauditoryhallucinations.Heconfirmedthathehadbelievedhewaspregnantandhenolongerbelievedsoaftertreatment.His
IQwastestedandfoundtobe42.Therewerenoapparent
disturbancesinhisrelationshipwithhismotheroranyotherfamilymember.Discussion
Thenumberofrecordedinstancesofdelusionsofpregnancyinmenseemstobeverysmall,andthepossibilityofacommonpsychodynamiclinkdeterminingthecontentofthedelusionhasbeenmentionedinthecasesreportedearlier(Enocheta!,1967).Jenkinsetal(1962)speculatedthatinthecasereportedbythem:“¿byarryingthisbabyinhisstomachhewasdoingmorethanactingoutarebirthfantasy.Hewasplayingboththeroleofthegood
bearingmotherandtherebornself.―Similardynamicexplanationsinvolvingthemother'sattitude
wereofferedinothercasesofdelusionsofpregnancy.
Inthecasepresentedhere,noobviousdisturbance
ofmother—childrelationshipwasnoted,butitis
difficulttoconfirmordenytheroleofsuchafactor.
Thepsychosisinourcasewascharacterisedbyexcitement,auditoryhallucinations,delusionofpregnancyandpersecution,andinappropriateaffect,followinganepilepticattack.Mentalretardation(IQ
42)andepilepsy(leftfocal,becominggeneralised)
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