Cotard parasomnia: le délire de negation that occur during the sleep-wake dissociation?

Abstract

Unpleasant dreamlike mentation can occur during non-rapid eye movement parasomnias, leading to associated panic attacks. The mentations are rarely remembered and are likely underreported. However, they may lead to significant personal distress and, if not addressed, may contribute to poorer clinical outcomes. Cotard le délire de negation are very rare nihilistic delusions, historically described with psychotic disorders. Their association with a variety of neurologic disorders, including migraine and cluster-headache, has also been reported. Here we present three cases of Cotard parasomnia during which distinct states of consciousness defined by nihilistic ideation occurred. Patients described believing they are dead or dying, while unable to perceive or experience their bodies in whole, or in part, as their own. A source analysis of the electroencephalographic fingerprint of these mentations suggests right-hemispheric hypoactivity subsequent to confusional arousals. Mechanistically, an aberrant activation of two major intrinsic brain networks of wakefulness, the salience network and the default mode network, is argued.

A Novel Group Cognitive Behavioral Therapy Approach to Adult Non-rapid Eye Movement Parasomnias

“…The understanding of the exact neurobiology and the maladaptive arousal mechanisms that underlie phenotypes of NREM parasomnia remains in its infancy (3,(6)(7)(8). Management is commonly multifaceted with an emphasis on psychoeducation and ideally on non-pharmacological measures (3).…”

Non-REM parasomnias: a scoping review of dreams and dreamlike mentation

“…Of the 16 articles, 10 (62.5%) were case reports ( 38 - 47 ) and 6 (37.5%) were cohort studies ( 24 - 27 , 48 , 49 ). All of the studies were conducted in high-income countries.…”

“…All of the included articles reported at least one dream mentation content, however seven characterized the dream content in relation to the NREM parasomnia observed ( 26 , 40 , 41 , 43 , 47 - 49 ). A total of 115 patients reported dreamlike mentation.…”

“…I do not exist. I worry if I will be able to return into my body and I have to pinch myself to check if my body is alive” ( 47 ).…”

Nocturnal visual hallucinations in patients with disorders of arousal: a novel behavioral and EEG pattern

“…DOA represent a form of sleep-wake state dissociation ( 2 , 11 , 27 , 28 ). During transitions between NREM sleep and wakefulness, in predisposed subjects, a dissociation of states can occur among different brain structures manifesting as DOA episodes ( 2 , 11 ).…”