Cotard's Syndrome in Adolescents and Young Adults: APossible Onset of Bipolar Disorder Requiring a Mood Stabilizer?

Abstract

This paper reviews all reports of Cotard's syndrome (délire de négation) in adolescents and young adults and summarizes four consecutive cases seen at our institution during the past 10 years. Cotard's syndrome occurs infrequently in young people (19 cases have been reported so far, including a 15-year-old boy who died at hospital) but appears to be a severe syndrome in adolescents of both genders. Ten patients received electroconvulsive therapy (ECT) despite their young age. Among the 14 cases reported with at least a 2-year follow-up, 13 patients (93%; 11 female) exhibited a bipolar outcome. The use of mood stabilizers should be considered in this rare, but potentially severe, condition.

The supernatural guilt trip does not take us far enough

“…CS generally occurs in patients suffering from major depression with psychotic features, but it can also occur in patients suffering from schizophrenia or organic mental conditions (e.g., general paralysis, epilepsy) (Berrios & Luque 1995). In young people, it is often associated with bipolarity (Consoli et al, in press;Soultanian et al 2005). While the descriptions of many psychiatric conditions have changed during the last century (e.g., catatonia, hysteria), CS has been shown to have very stable clinical characteristics since it was first described in 1880 (Berrios & Luque 1995).…”

Catatonia, Neuroleptic Malignant Syndrome, and Cotard Syndrome in a 22-Year-Old Woman: A Case Report

“…Patients with CS are typically in their mid-years or are elderly and present mood disorders, but CS is also observed in patients with schizophrenia and organic disorders [7, 8]. Very few cases of CS in adolescents and young adults have been described [9]. …”

Cotard’s syndrome: A review

“…Monotherapy with agents such as amitriptyline [18], duloxetine [58], fl uoxetine [7], paroxetine [18], olanzapine [38], sulpiride [53], or lithium [18] has been reported to be effective. However, combination strategies often are used (clomipramine/amitriptyline [5], pimozide/amitriptyline [18], haloperidol/clomipramine [18], cyamemazine/ paroxetine [18], risperidone/fl uoxetine [59], haloperidol/ mirtazapine [14], risperidone/sertraline [2], risperidone/ citalopram [41], clozapine/fl uvoxamine/imipramine [12]). Adding bromocriptine to clomipramine and lithium had a benefi cial effect in one patient with bipolar disorder type I [11].…”

“…Especially with an underlying mood disorder, ECT was reported as a very useful technique in many case reports [4,5,7,10,13,[16][17][18][19]21,24,40,42,43,60,61]. In most reports, ECT was followed by a pharmacologic maintenance treatment, usually combination strategies (zuclopenthixol/oxcarbazepine [4], olanzapine/mirtazapine [42], trimipramine/perphenazine [21], mianserine/amisulpride [16], lithium/amisulpride [18], imipramine/haloperidol with addition of biperiden due to oculogyric crisis [60]), but monotherapy also has been reported (nomifensine [24], imipramine [5], isocarboxazide [4], lithium [18,43], risperidone [40], and olanzapine [19]). One report of spontaneous recovery after two grand mal seizures was also reported, illustrating the usefulness of the effect of seizures [62].…”