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20 Issue 1 2005 [Doi 10.1002%2Fgps.1220] P. J. Connelly; C.
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INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Int J Geriatr Psychiatry2005; 20: 8384.
Published online in Wiley InterScience
(www.interscience.wiley.com). DOI: 10.1002/gps.1220
RESEARCH LETTER
Odysseus syndrome: nihilism by proxy
P. J. Connelly*, C. Rodriguez-Castello and L. M. Robertson
Murray Royal Hospital, Perth, Scotland
INTRODUCTION
Onset of Cotards syndrome after age 70 is uncom-mon (Berrios and
Luque, 1995), but older peopleare more likely to have
hypochondriacal delusions,
delusions of non-existence and of immortality, rarelywith a
feeling of enormity of the body (Berrios andLuque, 1995). To our
knowledge, no cases have beenreported in which the patient believed
firmly thatwhilst they were personally unaffected, relatives
hadsuffered significant degenerative change or hadindeed died
despite clear evidence to the contrary.
CASE 1
An 81-year-old lady presented to psychiatric servicesfor the
first time with sudden onset of ideas that hergrandson had
developed grossly swollen legs, inflam-
mation of the brain, lethargy and extreme tirednessafter
infection by a fly which had picked up radioac-tive waste in the
English Channel. Despite speaking tohim over the telephone, she
believed that he had died.She believed that he had no stomach or
internalorgans, that his eyes had been removed and replacedwith
glass eyes, that his brain had died and beenreplaced by a clock and
that he had expanded tobecome grossly obese. She described
hallucinationsof police providing commentary on his actions, butno
other first rank symptoms of schizophrenia. Hermood was
subjectively depressed but this clearlypost-dated the onset of her
delusions. Vegetative
symptomatology, including psychomotor retardationand agitation,
were absent. Mini Mental State Exam-
ination (MMSE) score was 27/30 and verbal fluencywas reduced.
Her only physical problem was well-controlled atrial fibrillation.
Haematology, biochem-istry, serology and CT brain scan were normal.
Onesister had a long term diagnosis of schizophrenia.
Over the next five years these delusions remainedvirtually
unchanged. She was very intolerant of anti-psychotic medication
including clozapine. Sherefused to consider ECT. Two years after
initial pre-sentation, she had a brief depressive episode
whichresponded to Lofepramine, though this did not alterher
delusions. Currently, she continues to harbourthese
mood-incongruent beliefs but functions reason-ably independently
within a residential home, with acurrent MMSE of 18/30.
CASE 2
A 73-year-old lady with a 40 year history of
paranoidschizophrenia presented with grossly elated
mood,over-activity, over-talkativeness, distractibility
andgrandiose beliefs. She sought help to prevent experi-mentation
on her lovers health in the flat next door.
She maintained he had developed The Pox lead-ing to his limbs
rotting away, his heart being replacedby a machine and his brain
requiring removal. Shebelieved nonetheless that he could send
messages toher via television to which she could respond
byarranging candles in a certain fashion. She wasobserved to be
hallucinating to his voice. She main-tained that he had died but
come back to live in her
mattress in a grossly distorted form, being very muchlarger than
he had been in real life.
Her mood stabilised on a combination of Lithiumand Sodium
Valproate. Conventional and atypicalantipsychotics including
clozapine all proved ineffec-tive in changing the intensity or
content of her delu-sions, which remained mood-incongruent over
five
Received 24 May 2004Copyright# 2004 John Wiley & Sons, Ltd.
Accepted 12 August 2004
*Correspondence to: Dr P. J. Connelly, Murray Royal
Hospital,Muirhall Road, Perth, PH2 7BH, UK. Tel: 01738 562335.
Fax:01738 440431. E-mail: [email protected]
8/10/2019 International Journal of Geriatric Psychiatry Volume
20 Issue 1 2005 [Doi 10.1002%2Fgps.1220] P. J. Connelly; C.
2/2
years. Initially MMSE was 30/30, but recently hasdeclined to
13/30.
DISCUSSION
Our two cases meet diagnostic criteria for schizophre-nia,
albeit with an affective element, though variation
in prevailing mood made no difference to the intensityor content
of the delusional ideation. Case 2 sufferedfrom partition delusions
a characteristic of late lifeparanoid schizophrenia (Herbert and
Jacobsen, 1967).Cognitive deterioration on long-term follow-up
ofsimilar patients is common (Hymas et al., 1989) asis chronicity
of delusions (Hymas et al., 1989)although Enoch and Trethowan
(1991) report that epi-sodes of Cotards syndrome are usually
short-lived.Strikingly, in the series of Berrios and Luque(1995),
none of the 100 patients had any delusionwhich is comparable to
those reported in our twocases.
In both our cases, patients express nihilistic feel-ings of
decay and death of bodily organs or the personas a whole, despite
evidence to the contrary, withenormity of the body and immortality
of the sufferer,
who was able to function despite having died. Ifexpressed in
relation to themselves, a diagnosis ofCotards syndrome would be
appropriate. We believeit is reasonable to consider these patients
as showingevidence of nihilism by proxy and we suggest thename
Odysseus syndrome for this delusion.
In Homers Odyssey, Odysseus was a hero in the
Greco-Trojan War who took many years to returnhome. His wife
Penelope believed him dead. On hiseventual return, the Goddess
Athene made him looktaller and stronger so that he took on the
appearanceof an immortal. Then he was presented to his wifewho
continued to believe him dead for a time despiteevidence to the
contrary.
REFERENCES
Berrios GE, Luque R. 1995. Cotards syndrome: analysis of
100cases. Acta Psychiatr Scand91: 185188.
Enoch D, Trethowan W. 1991. Cotards Syndrome. In
UncommonPsychiatric Syndromes, 3rd edn. Butterworth-Heinemann:
Oxford; 162183.Herbert ME, Jacobson S. 1967. Late Paraphrenia.
Br J Psychiatry
113: 461469.Hymas N, Naguib M, Levy R. 1989. Late paraphreniaa
follow-
up study. Int J Geriatr Psychiatry 4: 2329.
84 p. j. connelly ET AL.
Copyright# 2004 John Wiley & Sons, Ltd. Int J Geriatr
Psychiatry2005; 20: 8384.
