Objective: A case report of a phantom pregnancy in a patient with Parkinson’s disease (PD) resulting from impulse control behaviour.

Background: Impulse Control Disorders (ICDs) are behaviours that affect more than 20% [1] of PD patients, whereby they may carry out activities which could be harmful to them, often caused by dopaminergic therapy. A 42-year-old female diagnosed with PD 15 years ago attended clinic for a routine review. She displayed symptoms of marked dyskinesia, having been well controlled previously. She reported multiple sexual encounters with men arising from online dating sites, and that she was 10 weeks pregnant, but that nobody believed her. Pregnancy symptoms perceived by the patient included enlarged breasts, painful darkened distended nipples, daily nausea, and weight gain around her abdomen, all comparable to pregnancy 16 years previously. On examination these symptoms were not evident. Dopaminergic medication included modified release ropinirole 18mg, co-careldopa 250mg t(otal daily dose), and entacapone 200mg tds. The patient had self-discontinued amantadine and rasagiline believing they could cause congenital abnormalities in the baby.

Method: Case study report.

Results: The patient had taken 20 pregnancy tests, all negative. Pregnancy and blood tests by her local general practitioner were also negative. She reported having not menstruated for 2 months, but previously had a regular monthly cycle. Nothing else appeared causative of these symptoms, such as early menopause. Despite physical examination, negative pregnancy results, and an ultrasound of the pelvis, the patient was still convinced she was pregnant. Clearly the patient was experiencing an ICD, initially in the form of hypersexuality, and that the ICD had progressed into the delusion of pregnancy. Over 8 weeks the ropinirole was gradually discontinued, without inducing dopamine agonist withdrawal syndrome. A month later the patient’s pregnancy symptoms no longer existed. The patient had previously been on a stable dose of her medication without changes in the previous 12 months.

Conclusion: This case highlights the importance of robust recognition of ICDs and the possibility that they can present in a unique form such as that of phantom pregnancy in PD.

References: 1 – Antonini A , et al. J Neurol Neurosurg Psychiatry 2017;88:317–324. doi:10.1136/jnnp-2016-277

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MDS Abstracts - https://www.mdsabstracts.org/abstract/phantom-pregnancy-a-novel-impulse-control-behaviour-in-parkinsons-disease-a-case-report/