Cotard’s syndrome: Case report and a brief review of literature

Abstract

The term "Cotard's syndrome" is used to describe a number of clinical features, mostly hypochondriac and nihilistic delusions, the most characteristic of which are the ideas "I am dead" and "my internal organs do not exist". Besides, anxious and depressed mood, delusions of damnation, possession and immortality, suicidal and self-mutilating behavior are included. The first description of the syndrome was made in 1880 by Cotard, who presented the case of a female patient in a lecture. He originally named it "hypochondriac delusion", and some years later "delusion of negations", while it was named "Cotard delusion" after his death. In international literature, the terms "nihilistic delusion" and "Cotard's syndrome" prevailed over "delusion of negations" and "Cotard delusion". In the present study we report the case of a 59 year-old woman, who was admitted to our department after a suicide attempt, and who showed symptoms of Cotard's syndrome for about two years, namely depressed mood, hypochondriac and nihilistic delusions, delusions of immortality and damnation, suicidal ideation, severe psychomotor retardation, diminished motivation and tendency to stay in bed. She never took the medication she was prescribed, and at times she refused to eat. During her hospitalization, there was performed a full blood panel and medical imaging, that showed chronic ischemic infarctions, periventricular leukoencephalopathy and diffuse cerebral atrophy in MRI. All the other test results were normal. She was administered treatment with haloperidol, mirtazapine and venlafaxine. Gradually, her psychomotor ability, motivation and mood improved, she didn't express suicidal ideation, her delusions were less intense and she was able to question them, but they weren't eliminated. She was discharged in improved condition, after 44 days. Cotard's syndrome isn't mentioned in the current classification systems (ICD-10, DSM-5). In literature though, it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II, and three stages have been proposed: germination stage, blooming stage and chronic stage. It has been associated with various medical conditions, such as cerebral infractions, frontotemporal atrophy, epilepsy, encephalitis, brain tumors, traumatic brain injury. Furthermore, it has been associated with psychiatric conditions, such as mental retardation, postpartum depression, depersonalization disorder, catatonia, Capgras syndrome, Fregoli syndrome, Odysseus syndrome, koro syndrome. Several reports about successful pharmacological treatments have been published, both monotherapies with antidepressants, antipsychotics or lithium, and by antidepressant and antipsychotic combination treatments. The most reported successful treatment strategy for Cotard's syndrome is electroconvulsive therapy (ECT), administration of which should follow current treatment guidelines of the underlying conditions.

Food Refusal: A Rare Presenting Symptom of Cotard’s Syndrome

“…There is though demand to consider it as secondary syndrome in cases of unipolar depression, bipolar depression and primary psychotic disorders. 5 Though this condition is quite commonly found in psychiatric settings but it may be present in other neurological diseases like Parkinson's disease, migraine, brain tumors, traumatic brain injury, arterio-venous malformations, and multiple sclerosis as well as neurosyphilis, stroke, and viral encephalitis. Understanding cotard's syndrome requires an unravelling of both of its psychiatric and neurological underpinnings.…”

Delusional Misidentification Syndromes: Psychopathology and Culture

“…Treatment for Cotard's syndrome can include both psychological and medical modalities, though the psychiatric treatments are more prevalent, psychotherapy, including behavior therapy, is also used with Cotard's syndrome patients. Psychiatric medications for Cotard's syndrome include antipsychotics, sometimes in combination with SSRI antidepressants (Chan et al, 2009;Moschopoulos et al, 2016) Electroconvulsive therapy (ECT) has been used successfully for Cotard's syndrome. This is especially true for type I Cotard's syndrome, while for type II antipsychotic medication is the preferred treatment (Madani & Sabbe, 2007).…”

Jaded selves and body distance: a case study of Cotard’s syndrome in “Infinite Jest”

“…The idea expressed by Marathe about American citizens that "you cannot kill what is already dead" (319) is also seen in Hal Incandenza. The contradiction is seen in the case studies of Cotard, the living dead who want to commit suicide (Moschopoulos et al 2016). Hal becomes a living corpse unable to communicate due to Too Much fun.…”