Jules Cotard described, in 1880, the case of a patient characterized by delusions of negation, immortality, and guilt as well as melancholic anxiety among other clinical features. Later this constellation of symptoms was given the eponym Cotard's syndrome, going through a series of theoretical vicissitudes, considering itself currently as just the presence of nihilistic delusions. The presentation of the complete clinical features described by Cotard is a rare occurrence, especially in the context of schizophrenia. Here we present the case of a 50-year-old male patient with schizophrenia who developed Cotard's syndrome. The patient was treated with aripiprazole, showing improvement after two weeks of treatment. A review of the literature is performed about this case.

Automutilación genital y de falanges en un paciente con esquizofrenia: reporte de un caso. RESUMENLa automutilación es una rara, pero a la vez dramática y devastadora complicación de diversos trastornos mentales, más frecuente en pacientes con psicosis que presentan delusiones de contenido religioso. Las variedades más reportadas de automutilaciones mayores, que ocurren súbitamente e implican considerable daño tisular son la ocular, genital y de extremidades. Se revisan algunos factores predisponentes, características clínicas y tratamiento, a raíz del caso de un paciente varón de 49 años con esquizofrenia crónica, de larga evolución que, previamente se había mutilado varias falanges de ambas manos y recientemente el pene y los testículos, siguiendo las órdenes de sus alucinaciones. El paciente fue tratado con clozapina y ácido valproico, mostrando mejoría conductual pero también persistencia de las alucinaciones auditivas que lo conminan a que se ampute el miembro inferior derecho.PALABRAS CLAVE: Automutilación genital, esquizofrenia, trastornos psicóticos. SUMMARYSelf-mutilation is a rare, yet dire and dramatic complication of various mental disorders, more frequently seen in psychotic patients with delusions of religious content. The most reported cases of major self-mutilation, which occurs suddenly and with considerable tissue damage affect the ocular, genital and limb areas. Some predisposing factors, clinical features and treatment approaches are reviewed a propos of the case of a 49-year-old male patient with chronic schizophrenia who had previously mutilated several phalanges in both hands and, recently, cut out his penis and testicles following orders from his hallucinations. The patient was treated with clozapine and valproic acid, showing behavioral improvement, but persistence of the imperative auditory hallucinations that compel himto amputate his right lower limb.