Cotard's syndrome with glioblastoma multiforme

Abstract

This case report points to the necessary collaboration between psychiatrists, neuro-oncologists and radiation oncologists in improving the patient's management and quality of life.

Subtle neuropsychiatric symptoms of glioblastoma multiforme misdiagnosed as depression

“…Mood disorders were associated with tumours involving the frontal lobes,10 12–14 22–25 34 temporal lobes14 16 17 20 30 and limbic structures 17 31. Patients manifested psychotic symptoms in 35% (9/26) of cases 11 15 22 25–28 30 32. Psychotic symptoms tended to be predominantly associated with tumours localised in the temporal lobes,15 26 27 30 31 although some of the cases reported here also traced the emergence of psychotic symptoms to tumours predominantly effecting the frontal lobes11 22 25 and corpus callosum 28 32.…”

“…Patients manifested psychotic symptoms in 35% (9/26) of cases 11 15 22 25–28 30 32. Psychotic symptoms tended to be predominantly associated with tumours localised in the temporal lobes,15 26 27 30 31 although some of the cases reported here also traced the emergence of psychotic symptoms to tumours predominantly effecting the frontal lobes11 22 25 and corpus callosum 28 32. There was a paucity of GBM cases involving the parietal lobe and none involving the occipital lobes; it has been argued that such tumours tend to be relatively ‘silent’ with regard to psychiatric manifestations 17 31 35 36…”

“…Depression was the primary psychiatric symptom manifestation of the underlying GBM in 62% (16/26) of retrieved cases 3 10 13 14 16–18 20–23 25 28 30 32 33. Other mood disturbances reported among GBM patients included pseudobulbar affect-like states,24 manic-like states27 31 and anxiety,3 12 13 17 34 some of the latter of which co-occurred in depressed patients.…”

“…In only a few cases was it possible to establish some support for a causal association when symptoms resolved following after tumour resection 10 13 24 30. In other cases, the evolution of new or unusual psychiatric symptoms3 11 13 16 21 26 28 30 32 33; poor response to treatment in a person who had previously responded favourably to psychiatric treatment14 25; or the emergence of new cognitive and neurological symptoms11 12 15 17 18 20 23 29 34 provided clues to the presence of the tumour. For example, in one well described case,3 a patient with a 4-year history of mood disturbance had a series of multiple brain images undertaken during the course of her psychiatric illness.…”

When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard’s Syndrome

“…Nowadays, it is known that this syndrome may be secondary to many conditions such as psychotic depression [8–11], schizophrenia [3], bipolar disorder [12, 13], dementia [14], cerebral neoplasm [15], cerebral hemorrhage [16], and use of psychoactive substances [17], among other neuropsychiatric conditions. Besides that, associations of CS with other syndromes are described, such as catatonic syndrome [18], malignant neuroleptic syndrome [19], lycanthropy [20], hydrophobia [21], and capgras syndrome [22, 23].…”