Pseudocyesis associated with folie à deux.

DeMontyel (1881) divided folie a deux into three subgroups: fo!ie simu!tanée, in which there is the coincidental, simultaneousbutindependent appearance of psychotic symptoms in two family members who are predisposed to a psychosis and who are living together; bIle communiquée,in which two persons who are at risk from developing a psychosis become psychotic, but each subject adopts one or more delusions from the other and retains them after separation; and fo!ie imposde, in which the psychotic subject transmits symptoms to a previously healthy individual who elaborates on these. Pseudocyesis is the conviction of a non-pregnant woman that she is pregnant. It is distinguished from other forms of false pregnancy such as that stemming from a psychosis, pregnancy associated with malingering, and pseudopregnancy occurring when a tumour or other defect causes endocrine changes simulating pregnancy (Steinberg, 1946). It has been considered to originate from an awareness of a recent bodily change or disturbance linked to a conscious wish, fantasy or fear about pregnancy (Brown & Bargiow, 1971). The condition may be a form of hysterical conversion (Hardwick & Fitzpatrick, 1981) or depression may be present (Murray & Abraham, 1978). Several findings have been noted in pseudocyesis: elevation of prolactin levels (Devane et a!, 1985), a trend towards low levels of follicle stimulating hormone (FSH) (Zarate et a!, 1974), and the occasional persistence of a corpus luteum (Moulton, 1942). It has been suggested that the physiological changes seen in pseudocyesis may be caused by an imbalance of pituitary-ovarian function mediated by neurotransmitters in the pituitary and/or hypo thalamus (Starkman et al, 1985). Brown & Bargiow (1971) suggested that depression via cortical and limbic systems causes a decrease in available biogemc amines, resulting in an abnormality of the release of luteinising-hormone releasing factor (LRF), FSH releasing factor (FRF), and prolactin inhibitory factor (PIF) at the median eminence of the hypothalamus. This results in decreased levels of luteinising hormone (LH) and FSH, which lead to the suppression of ovulation and result in amenorrhoea. The increased level of prolactin leads to lactation and also possibly a persistent corpus luteum which may also lead to amenorrhoea. This hypothesis may explain some of the symptoms in pseudocyesis.