A Neuropsychiatric Analysis of the Cotard Delusion

Abstract

Cotard's syndrome, a condition in which the patient denies his or her own existence or the existence of body parts, is a rare illness that has been reported in association with several neuropsychiatric diagnoses. The majority of published literature on the topic is in the form of case reports, many of which are several years old. The authors evaluated associated diagnoses, neuroimaging, and treatments recorded in patients diagnosed with Cotard's syndrome at their institution. A search of the Mayo Clinic database for patients with mention of signs and symptoms associated with Cotard's in their records between 1996 and 2016 was conducted. The electronic medical records of the identified patients were then reviewed for evidence of a true diagnosis of Cotard's. Clinical and neuroimaging data were also recorded for these patients. The search identified 18 patients, 14 of whom had Cotard delusions. Two of the 14 were excluded due to them being under age 18. The resulting 12 patients had a median age of 52 years (range: 30-85 years). On neuroimaging, four patients exhibited frontal lobe changes, four demonstrated generalized volume loss, and five had ischemic changes; seven patients demonstrated right-sided or bilateral hemisphere lesions. Treatments included ECT, pharmacotherapy, behavioral therapy, psychotherapy, rehydration, and removal of offending drugs. To conclude, Cotard delusions occur in the context of a relatively wide spectrum of neurological, psychiatric, and medical disorders and present with various neural changes. Nondominant hemisphere lesions may play a role in the pathophysiology. A number of effective treatments are available.

My Body Is Rotting: A case report of Cotard’s syndrome in a postpartum woman

“…The available literature on Cotard's syndrome does not allow to identify a specific cause of its development. There are reports indicating structural changes in the central nervous system, which are perceptible in neuroimaging techniques [9]. Sahoo and Josephs (2018) performed brain MRI analysis of 12 patients with Cotard's syndrome, without specifying one location responsible for the syndrome.…”

“…Sahoo and Josephs (2018) performed brain MRI analysis of 12 patients with Cotard's syndrome, without specifying one location responsible for the syndrome. Researchers suggest that such symptoms may occur when different brain structures are damaged, including the frontal lobe, the right or both hemispheres, or when generalised brain volume reduction or ischemic (postictal) lesions are observed [9]. Perhaps the cause of the observed and described by us disorder was transient ischemia of the CNS during child delivery.…”

“…Jedyne informacje pochodzą z badań klinicznych, w których częstość występowania różniła się w zależności od miejsca, od 0,57% osób z wybranej populacji pacjentów psychogeriatrycznych w Hongkongu do 0,87% pacjentów chorych na schizofrenię w Australii. [6,9]. Nie ma również jednoznacznych danych, dotyczących charakterystycznego wieku i płci pacjentów, jednakże zauważono pozytywną korelację pomiędzy zwiększoną ilością zmian w mózgu, a wiekiem pacjenta z ZC [9,10,11,12].…”

“…It is estimated that Cotard's syndrome is very rare, although no epidemiological studies that provide accurate data on the prevalence of this disorder have been conducted yet. The only information comes from clinical trials where the prevalence varies from country to country, ranging from 0.57% of the selected population of psychogeriatric patients in Hong Kong to 0.87% of patients with schizophrenia in Australia [6,9]. There is little data on the distinctive age and gender of patients, however, a positive correlation between the increased number of changes in brain and the age of the patients with Cotard's syndrome had been noted [9,10,11,12].…”

A Complete Biological Theory of Sleep

“…The feeling of being alive depends on attending to interoceptive sensory inputs, which arrive at highly specific cortical locations [Craig, 2014]. This is supported by Cotard's syndrome, in which patients deny being alive and which is associated with right frontal (especially insular) lesions [Sahoo and Josephs, 2017]. Note that the right insula receives the strongest heart inputs.…”