Cotard’s Syndrome

Rana Ibrahim

In 1880, Jules Cotard described the condition as Le délire des négations ("The Delirium of Negation"), a psychiatric syndrome of varied severity.

He described the case of Mademoiselle X who believed she had ‘no brain, no nerves, no chest, no stomach, no intestines and was ‘nothing more than a decomposing body’. She believed that she had no soul. As she could not die a natural death, she had ‘no need to eat’. She later died of starvation.

History

The delusional belief that the person is dead (figuratively or literally) and does not exist.

Is putrefying and/or has lost his blood and/or internal organs.

In some instances delusions of immortality are present.

What is Cotard’s Syndrome

Three types of CS exist and each type may need to be treated differently and has different therapeutic implications.

1. The Psychotic Depression type includes individuals with melancholia and a few nihilistic delusions.

2. The Cotard Type I includes individuals with no depression or other disease and comprises a “pure” CS whose nosology is closer to delusional disorders.

3. The Cotard Type II includes individuals with anxiety, depression and auditory hallucinations and comprise a mixed group.

According to exploratory factor analysis in a 1995 issue of Acta Psychiatrica Scandinavica, Dr. G.E Berios and Dr. R. Luque,

Signs and SymptomsCotard's syndrome exists in three stages:

(i) Germination stage: The symptoms of psychotic depression and of hypochondria appear.

(ii) Blooming stage: The full development of the syndrome and the delusions of negation.

(iii) Chronic stage: Continued, severe delusions and chronic psychiatric depression completely distorted view of the world.

The condition has been tentatively linked to bipolar disorder in young people, as well as severe depression and schizophrenia in older patients. Other symptoms include:Analgesia, mutism, preoccupation with guilt, despair, and migraine headache.

2011 issue of ”Mind and Brain”:

“The prevalence and incidence of this rare syndrome is not known. Only one study reported on prevalence in a selected psychogeriatric population in Hong Kong. In 2 out of 349 patients, Cotard’s syndrome was diagnosed suggesting a prevalence of 0.57% in this population. A prevalence of 3.2% was reached when severely depressed elderly were included.

Prevalence

Graham Harrison, who had attempted suicide 9 years earlier by taking an electrical appliance with him into the bath, and awoke in the hospital believing he was dead. He said:When I was in hospital I kept on telling them that the tablets weren’t going to do me any good ’cause my brain was dead. I lost my sense of smell and taste. I didn’t need to eat, or speak, or do anything. Graham was referred to Dr Adam Zeman, a neurologist at the University of Exeter, and Dr Steven Laureys, a neurologist at University of Liège. They used positron emission tomography (PET) to monitor his metabolism. What they found was unsettling.‘Graham’s brain function resembles that of someone during anaesthesia or sleep. Seeing this pattern in someone who is awake is quite unique to my knowledge’, Dr Laureys told New Scientist. ‘I’ve been analysing PET scans for 15 years and I’ve never seen anyone who was on his feet, who was interacting with people, with such an abnormal scan result’.

Case Example

Neurologically, related to the Capgras delusion (people replaced by impostors) neural misfiring in the fusiform face area of the brain (which

recognizes faces) and in the amygdalae (which associate emotions to a recognized face).

Lesions in the parietal lobe, patients present a greater incidence of brain atrophy — especially of the median frontal lobe.

The Cotard delusion also has resulted from a patient's adverse physiological response to a drug (e.g., aciclovir) and to its prodrug precursor (e.g., valaciclovir). The occurrence of Cotard delusion symptoms was associated with a high serum-concentration of 9,CMMG , the principal metabolite of the drug aciclovir.

Pathophysiology

Pharmacological treatments such as antidepressant, antipsychotic, and mood stabilizing drugs.

Electroconvulsive therapy (ECT) is more effective than pharmacotherapy.

Hemodialysis was associated with timely clearance of CMMG and resolution of symptoms.

Treatement

• http://www.hindawi.com/journals/crim/2010/602783/

• Research article: Cotard's delusion or syndrome?: A conceptual history

• https://www.psychologytoday.com/blog/in-excess/201410/dead-strange

• http://thechirurgeonsapprentice.com/2014/10/07/disturbing-disorders-cotards-delusion-walking-corpse-syndrome/

References