Year : 2014 | Volume
: 19 | Issue : 1 | Page : 39--40
Delusion of twin delivery in a post-menopausal woman: Another dimension of delusional procreation syndrome
Ajeet Sidana, Rajan Jain
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
Dr. Ajeet Sidana
Department of Psychiatry, 5th Level, D Block, Government Medical College and Hospital, Sector 32, Chandigarh
Delusional procreation syndrome (DPS) consists of sequential delusions in every possible stage of procreation such as having spouse/partner, getting pregnant, having delivered a child (labour and childbirth), and becoming parents/grand-parents and so on. Till now, only few case reports have been reported and that is from the southern part of India only. Here the authors reported a case of a post-menopausal woman having delusion of twin delivery and propose twin dimension of DPS.
|How to cite this article:|
Sidana A, Jain R. Delusion of twin delivery in a post-menopausal woman: Another dimension of delusional procreation syndrome.J Mental Health Hum Behav 2014;19:39-40
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Sidana A, Jain R. Delusion of twin delivery in a post-menopausal woman: Another dimension of delusional procreation syndrome. J Mental Health Hum Behav [serial online] 2014 [cited 2020 Oct 1 ];19:39-40
Available from: http://www.jmhhb.org/text.asp?2014/19/1/39/143891
The content of schizophrenic delusions is naturally dependent on the social and cultural background of the patient. Delusions of persecution, reference, morbid jealousy, grandiosity, guilt, nihilism are common types of delusions as per thought content. 
The recent addition to these is that of delusional procreation syndrome (DPS) described by Manjunatha et al. (2010).  DPS consists of sequential delusions in every possible stage of procreation such as having spouse/partner, getting pregnant, having delivered a child (labour and childbirth), and becoming parents/grand-parents and so on. These are the 'self-referential delusions' referring to the involvement of patient himself/herself in its content.
Hindu marriage is regarded as means to establish relation between two families and procreation of children is one of the predominant aims of Hindu marriage. However, it laid more stress on procreation of male children, as sons were supposed to enable a man to clear off one of his natal spiritual debts. 
Here, we report the first case of a post-menopausal schizophrenic woman having delusion of delivery of identical twin male babies, and hence, propose another dimension of DPS i.e. twin dimension.
Patient was a 47-year-old Hindu post-menopausal female, graduate, married for 21 years, homemaker from a middle socioeconomic status family. She was known case of psychiatric illness for past 16 years, with an episodic course, current being fifth episode for past 1.5 months. Each of the episodes was characterized by delusions of reference and persecution, auditory hallucinations, 2 nd person (voices commenting) and 3 rd person, odd behaviours, decreased self-care and socio-occupational dysfunction.
In addition, during the current episode for nearly 10 days before presentation, she also started saying for the first time that she had delivered two baby boys a few hours ago. She held this belief with conviction in spite of family member's confrontation. Associated behaviour and affective response was in keeping with her belief. She was behaving as if she was in post-partum period. She reported being very happy after 'birth' of two sons. She would complain of pain in her back. She did not do any household work because she said that her body was weak because of caesarean section. She even named her babies as 'Vaibhav' and 'Balwan'. On further exploration, she reported that her caesarean section was done by a team of doctors from abroad and she was given incision in her back. However, when confronted about absence of incision mark, she justified that incision would not be visible to naked eyes. She further explained that because of her narrow pelvic outlet, that caesarean section was done through her back to deliver the babies. She could feel the pain of that incision in her back till day of admission. She believed that her sons were under care of her elder sister. She explained that it was not good for the health of her babies and they could fall ill if they would be under her care. Whenever confronted that her belief was untrue, she did not agree and would get irritated. She confirmed that last sexual intercourse with her husband was more than a year ago and accepted that it is not possible to have babies without intercourse. But at the same time, she reported that her case was different since God blessed her with two sons and he can do whatever he wants.
She had a past history of complicated labour and intra uterine death during her first pregnancy 17 years ago, and a history of caesarean section during her 2 nd pregnancy for cephalo-pelvic disproportion. Patient is mother to 16-year-old girl, who is the only child.
Patient's menstrual cycles were irregular almost since 2 years and stopped completely due to menopause 1 year ago. She gained around 17 kg of weight during last nine months. However, there was no history suggestive of an underlying medical disorder. From the available information, there was no family history of psychiatric illness and she had a well adjusted pre-morbid personality. Physical examination revealed obese female with BMI 53. Mental status examination revealed euthymic affect, delusion of procreation, 2 nd and 3 rd person auditory hallucination, intact cognition with absent insight. A diagnosis of schizophrenia, paranoid subtype was made.
Her baseline positive and negative syndrome scale (PANSS) score (positive syndrome, 31; negative syndrome, 11; general psychopathology, 37) was 79.  She was started on atypical antipsychotic risperidone 4 mg/day which was increased to 6 mg/day after 1 week. Three weeks later, she no longer held the delusional belief nor any kind of hallucinations. Her positive and negative syndrome scale (PANSS) score (positive syndrome 10; negative syndrome 8; general psychopathology 18) was reduced to 36. She was maintaining well on same treatment during the last follow-up visit 6 months ago.
The stages of procreation in human life cycle are important and involve the establishment of relationships through sequences of marriage/partners, pregnancy and becoming parents, grandparents etc.
Jenkins et al. (1962) reported 'delusion of childbirth and labour' in a 19-year-old male bachelor.  Manjunatha et al. (2010) reported the similar delusion i.e. delusion of delivery and brought under the broad rubric of DPS.  Present case report is in continuation with original description of delusional procreation syndrome (DPS). Our patient presented with primary, bizarre delusions of childbirth and labour (delivery of two male babies with abnormal location of incision for caesarean section). She had affective and behavioural response with the same delusional beliefs.
Origin of current delusional belief can be understood in term of patient's socio-cultural background. It is widely believed that every Indian family should have at least one male offspring to inherit and transmit the values and customs to their next generation. In the present case; throughout her life, she wanted to have a male child. Patient was having past history of complicated labour, IUD and caesarean section in her past two pregnancies. The content of delusion is understandable in terms of patient's preference for male children and her earlier obstetrics history. There are different dimensions in procreation of human beings and similarly, DPS has different dimensions. Manjunatha et al. (2011) reported proxy dimension of DPS.  In this report, authors propose twin dimension of DPS.
The above case report adds to a limited literature on DPS especially from an Indian perspective. The content of the psychopathology in current episode can be understood in the light of the previous personal experiences and socio-cultural context of the patient.
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