Cotard's Syndrome Research Articles

The risk of early suicide and diagnostic issues in Cotard's syndrome associated to self-starvation.

Cotard's syndrome is a rare neuropsychiatric disorder in which the patient holds nihilistic delusions concerning his/her own existence, including the conviction of being dead or having lost parts of the body. There are occasional reports of Cotard's syndrome being accompanied by nutritional deficiencies or self-starvation. The authors describe the peculiar case of a 40-year-old man who developed severe malnutrition within a few months. At first, a diagnosis of anorexia nervosa was made. The man was admitted to the hospital where other significant psychopathological symptoms emerged. One of the consequences of Cotard's syndrome is self-starvation because of negation of existence of self. The presented case points out that, although Cotard's syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, loss of appetite and nutritional deficits can erroneously lead to mistake this diagnosis for anorexia nervosa, thus underestimating the high risk of these patients of committing suicide following hospital discharge. Taking into account its rarity and possible subdiagnosis, as a distinct clinical entity the aim of this case report is to emphasize that these patients may initially be addressed to general practitioners, due to the dysmetabolic consequences of malnutrition, rather than to psychiatrists. An early recognition of signs indicative of Cotard's syndrome can be vital to prevent the situation from worsening. In fact, missed diagnoses can put these patients at an higher risk of suicidal behaviour.

A vessel without a pilot: Bodily and affective experience in the Cotard delusion of inexistence

The initial cause of Cotard delusion is pervasive dyshomeostasis (dysregulation of basic bodily function).This explanation draws on interoceptive active inference account of self‐representation. In this framework, the self is an hierarchical predictive model made by the brain to facilitate homeostatic regulation. The account I provide is an alternative to two factor accounts of the Cotard delusion that treat depersonalisation experience as the first factor in genesis of the Cotard delusion. I argue that depersonalisation experience and the Cotard delusion are produced by different breakdowns in the process of self‐modelling.

Cotard delusion, emotional experience and depersonalisation

ABSTRACT Introduction Cotard delusion—the delusional belief “I am dead”—is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea “I am dead” comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if “I am dead” were true, there would be no emotional responsivity to the world. Methods We scrutinised the literature on people who expressed the delusional belief “I am dead”, looking for data on whether such patients are reported as entirely lacking in emotional responsivity. Results In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry. Conclusions We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea “I am dead” comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.

Case Report: Cotard's Syndrome in Anti-N-methyl D-aspartate (NMDA) Receptor (Anti-NMDAR) Encephalitis

Cotard's syndrome is uncommon psychopathology among patients with psychotic illnesses. Limited cases had been reported regarding the occurrence of this syndrome in anti-NMDAR encephalitis which itself is a relatively new disease that often presents with florid psychotic symptoms. This poses difficulties in differentiating it from a primary psychiatric illness. Late recognition of anti-NMDAR encephalitis can lead to death as it can progress to autonomic instability in its natural course of illness. We report a patient who first presented with psychotic symptoms with initial negative findings from baseline investigations. Further investigation revealed anti NMDAR antibodies in the cerebrospinal fluid. Prompt treatment was initiated and despite early poor response to the first-line treatment with the development of allergic reaction, our patient recovered completely after 1 month of hospitalization. This case report aims to highlight the importance of early detection of anti-NMDAR encephalitis and the possibility of uncommon psychopathology such as Cotard's syndrome occurring in this disease.

(PO-088) Comorbid SARS-CoV2 and Cotard Syndrome: Is there an association?

(PO-088) Comorbid SARS-CoV2 and Cotard Syndrome: Is there an association?

These Are Not the Droids You Are Looking For: Mechanical Variant of Cotard’s Syndrome

Cotard's syndrome is a nihilistic delusion where the individual believes they are dead, partly dead, or replaced by an animal. The delusion that their body has been replaced by a purely inanimate azooic (but physical entity), such as a robot or a droid, has not hitherto been described. Case study: This 60-year-old, right-handed, female, with a past history of schizophrenia presented with complaints of depression, irritability, and anger. When confronted with commitment papers signed by her father, she denied their truthfulness, insisting that he had been replaced by an imposter. This belief persisted unabated, despite treatment with 20mg of haloperidol per day. Over time, she expressed the belief that she had been replaced by another person, whom she refused to identify. The following day she refused all food and water proclaiming that she had died and been replaced by a machine revealing, "I am not her. I am a robot." Soon thereafter she developed tremulousness, stiffness, and rigidity. After haloperidol was decreased and benztropine started, these parkinsonism symptoms subsided, but her delusions persisted. Abnormalities in physical examination: General: decreased blink frequency. Neurologic examination: Mental status examination: bradyphrenia, hypoverbal, blunted affect. Oriented ×2. Motor examination: bradykinetic, cogwheel rigidity in both upper extremities. Gait examination: slow shuffling gait, reduced bilateral arm swing. Cerebellar examination: resting tremor in both upper extremities at 3 cycles per second. Other: EEG: focal sharp transients in the left temporal region. MRI with and without contrast: normal. Toxicological, metabolic, endocrine screening: normal. This illustrated sequential presentations of three delusions of misidentification. Upon presentation, she exhibited Capgras syndrome, the delusional belief that a familiar person has been replaced by a double. The nidus for this may have been the discovery that her father had signed her commitment papers. This was followed by the belief she was a double of herself, which is the syndrome of Reverse Subjective Doubles. Finally, she manifested Cotard's syndrome in a previously undescribed manner, believing she had died and become a robot. Cotard's and Capgras syndromes are known to present sequentially rather than concurrently, whereas the patient presented concurrently with all three syndromes. Drug-induced parkinsonism may have made the patient subjectively feel stiff, which she interpreted as being rigid like a robot. She was bradykinetic, did not eat or drink, and had rigidity, suggesting that these were somatic manifestations of her underlying delusion of being a robot or alternatively, may have been the somatic nidus for the delusion. Those who present with Cotard's syndrome warrant evaluation for underlying medical conditions, serving as a substrate for this delusion. No funding.

Improved Cotard Delusion and Motor Function in Parkinson’s Disease following Electroconvulsive Therapy (ECT)

• ECT can be used for PD with refractory motor and neuropsychiatric symptoms. • The current definitions of type 1 vs. Type II Cotard do not account for the temporality of patients’ mood symptoms. • Our modern categorization of the two syndromes requires further clarification.

COTARD SYNDROME TRIGGERED BY THE COVID-19 PANDEMIC: CASE REPORT

Cotard syndrome (CS) is a rare one characterized by the presence of nihilistic delusions. It is typically associated with depression and is mostly seen in middle-aged women (1). A few cases have been reported in youth, of which 90% are women. Here we present a young female case diagnosed with CS. This patient is the first report of the syndrome triggered by the COVID-19 (Coronavirus disease 2019) pandemic.

Abstract- Poster

Introduction:Cotard’s syndrome is characterised by extreme kind of nihilistic delusions. In this condition a person believe that he has no organs, he is not alive and is a dead man. Usually occur in severe depression.Aim:To present a case where a patient believe that he is dead and is continuously searching for his soul and for that he is restless, agitated and wander from place to place.Discussion:Cotard’s syndrome is frequently reported in settings of depressive symptoms with decrease energy, decreased psychomotor activity and hopelessness. In our case patients is restless, agitated, has increased motor activity and have a purpose of searching his soul.Conclusion:Patient with severe depressive disorder with cotard’s delusion can present with atypical presentations.

A case of Cotard syndrome associated with central pontine myelinolysis as a result of normally corrected hyponatremia

A case of Cotard syndrome associated with central pontine myelinolysis as a result of normally corrected hyponatremia

P.0474 New variants, new symptoms in COVID-19: first episode psychosis and cotard's syndrome after infection with the B.1.1.7 variant of coronavirus

P.0474 New variants, new symptoms in COVID-19: first episode psychosis and cotard's syndrome after infection with the B.1.1.7 variant of coronavirus

A unique case of neurofibromatosis 1 (NF1) with Cotard syndrome – A case report

Neurofibromatosis type 1 is a neuro-cutaneous autosomal dominant disorder that is often associated with various psychiatric disorders. Cotard syndrome is a rare neuropsychiatric disorder seen in a variety of neurological and psychological illnesses. The complex course of the neurofibromatosis predisposes the individual towards higher physical and psychiatric morbidity. Here we present a case of Cotard syndrome in a patient with neurofibromatosis. The patient was brought with an alleged history of self-harm and pervasive sadness of mood; a diagnosis of recurrent depressive disorder current episode severe with psychotic features was made. Patient was treated with oral psychotropic agents and responded well to the treatment.

Síndrome de Cotard en trastorno depresivo recurrente: reporte de caso

The Cotard Syndrome, also known as delirium of negation or nihilistic delirium, was described by the French neurologist, Julius Cotard, on June 1880. From that time until the end of the 20th century, in scientific literature, approximately 100 cases were reported that presented symptoms of depression, anxiety, nihilist delusions concerning the body and existence, hypochondriacal and immortality delusions, as well as auditory and visual hallucinations. We present the case of a female patient, 73-years old, from Ayacucho, with a history of sexual assault at the age of 12 and suicidal attempts on 2 occasions, diagnosed with depression at 40 years of age, received treatment with quetiapine, trazadone and clonazepam. She remained with fluctuating medical progress, with symptoms worsening with stressors such as the death of her mother and husband and when she underwent surgeries. Currently, she presents sad and anxious mood, daily crying, ideas of guilt, disability and death, insomnia of conciliation, nihilistic delusive ideas concerning the body, referring that her stomach and bladder do not work, reason why she doesn’t want to eat or drink water. Due to the total refusal of food intake and persistent suicidal ideation, she was hospitalized to receive psychiatric treatment and nutritional support. It is concluded that there are few cases reported on the use of psychotherapy in Cotard's syndrome. Therefore, this case in which psychotherapy was indicated to reduce anxious-affective symptoms, to avoid isolation of the person and to redirect his personal and social life, is important.

COTARD SYNDROME IN A MIDDLE AGED MAN WITHOUT ORGANICITY

Cotard's syndrome is a rare neuropsychiatric condition characterized by delusions of nihilism / non-existence concerning one's own body first described in 1880. Most commonly seen in severe depression, psychoses mostly associated with organic lesions of the nondominant temporoparietal regions of brain. Till now E.C.T remains the treatment of choice.Presented case report is of middle aged man with cotard syndrome with duration of untreated illness of few months and without any organic cause.

A Jungian & Nietzschean Approach to Todd Phillips’ Joker

Todd Phillips’ Joker (2019) is an origin story which not only portrays a psychological drama but also forms a good example of a detailed character study case. The film embodies two main layers which are psychological and social. Within the context of the psychological layer, the viewers witness the gradual metamorphosis of a mentallyill person into an evil villain. This article aims to analyse Todd Phillips’ Joker from a Jungian and Nietzschean perspective. By interpreting Arthur Fleck’s mental condition through the window of Jungian archetypes, the article reveals that Arthur experiences an intense inner struggle against his shadow, which he ultimately loses. His efforts to resist these attacks using his persona, ego, and self are in vain. To that end, Jung’s views are interconnected with Friedrich Nietzsche’s notion of nihilistic delusions which are referred to with an overview of Nietzsche’s nihilism. In addition, the nihilistic delusions are associated with the cotard syndrome and the notion of depersonalization within the field of psychiatry. The study also exposes the common ground between Nietzsche and Jung by exploring the interactions in specific periods of their lives. Thus, it has been concluded that Arthur’s nihilistic delusions are the ultimate cause of the events leading to the supremacy of the shadow in Joker.

Commentary: Diagnostic Challenges in Evaluating Adolescents.

Three cases presented in this issue highlight diagnostic challenges in evaluating adolescents, in particular those with a constellation of symptoms that includes hallucinations. These cases raise the question of the accuracy of patient reports and the importance of further exploring symptoms before rushing to a diagnosis or treatment. The first case involved an 18-year-old female patient with Cotard syndrome. She had the syndrome's typical delusions and hallucinations, but her case was unusual because this syndrome is more common in adults and usually involves prominent mood symptoms. The second case involved a 14-year-old girl with depressive symptoms, suicidal ideas, and auditory and visual hallucinations, as well as sexually predatory behavior. This case was unusual in that girls and women are less commonly sexual predators although such behavior is more common among survivors of sexual abuse, as was the case with this patient. The authors believe that the patient's "hallucinations" were more likely related to posttraumatic stress disorder and dissociation. The third case involved a 16-year-old girl diagnosed with schizophrenia and treated with antipsychotics based merely on her report of "visions" of demons but absent any auditory hallucinations, delusions, or thought disorder. The authors, consulting on the case, identified more prominent depression, anxiety, and trauma-related symptoms as a result of school bullying and concluded that the patient did not have schizophrenia. Only the patient in the first of these 3 cases actually met the criteria for a psychotic disorder and warranted medication treatment. These cases highlight the importance of a full differential diagnosis in evaluating adolescent patients presenting with what appear to be psychotic symptoms to avoid the harm that can occur in terms of stigma and unnecessary treatment with the risk of side effects from antipsychotic medications when an incorrect diagnosis is made.

PARANOID SCHIZOPHRENIA -BETWEEN HYPERSEXUALITY AND SADOMASOCHISM

Motivation/Background: In this paper we aimed at clinically analyzing a patient diagnosed with paranoid schizophrenia, who also displays features specific to multiple personality disorders, in the context of a presentation whose key topic is sexuality. Given the global prevalence and the severity of schizophrenia, it is increasingly important to appropriately adapt and identify the patients' clinical and non-clinical personality profile. This paper also aims at making the profile of a patient diagnosed with axis I disorder ever since the age of 19, who also has got traits specific to certain personality disorders. At the same time, the work provides an interpretation of the behaviour from the psycho-dynamic point of view.
 Method: The following instruments were used for performing the analysis: a clinical interview, heteroanamnesis, psychological tests, clinical course monitoring, psychodynamic interpretations, defence mechanisms identification, psychiatric observation and treatment.
 Results: Based on the materials aforementioned, it has been established a possible diagnosis which includes multiple disorders: Antisocial Personality Disorder, Histrionic Personality Disorder, Schizotypal Personality Disorder, Obsessive Compulsive Personality Disorder, Cotard Syndrome, Kandinsky-Clérambault Syndrome. and there were identified defense mechanisms and coping strategies, under the influence of sexuality and sadomasochistic impulses.
 Conclusions: It is highlighted the clinical picture of a patient with paranoid schizophrenia, who presents symptoms for differential diagnoses, with disorganized discourse focused on sexuality, with delusional ideation, psychotic manifestation, but also with high suggestibility, especially on the paternal line

Cotard syndrome in a patient with multiple sclerosis: A case report

Introduction“Cotard syndrome” is a rare condition characterized by a constellation of clinical features, including hypochondriac and nihilistic delusions, the most characteristic of which are the ideas that one is dead or that their organs do not exist. It is more commonly associated with psychotic depression and schizophrenia but can also be found in several neurological disorders. In the clinical practice it generally appears as an “incomplete Cotard”, reduced to hypochondriac delusions attributed to the malfunction or occlusion of the organs, usually the digestive tract and abdominal viscera. Consequently it is common for these patients to reject food or medications. In literature it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II.ObjectivesLiterature review on Cotard Syndrome and its link with Multiple Sclerosis, based on a clinical case.MethodsPubmed and Google Scholar search using the keywords Cotard Syndrome, Multiple Sclerosis.ResultsHereby we present a clinical case of a 53-year-old female patient, with multiple sclerosis, who presented with hypochondriac and nihilistic delusions and refusal of food and medication. The patient was treated with olanzapine with rapid remission of delusional activity.ConclusionsMultiple sclerosis is an immunemediated chronic disease, affecting predominantly the sensory and motor function. In addition, psychiatric comorbidity is very frequent with up to 50 % lifetime risk of depression. While various neurological disorders have been described in association with Cotard syndrome, its link with multiple sclerosis has been scarcely reported.DisclosureNo significant relationships.

Steroid-induced psychosis in context a SARS-CoV-2 pandemic. about a case

IntroductionSARS-CoV-2 is having an important direct impact, and also due to treatments used such as corticosteroids. Among its effects, we have focused on psychosis.ObjectivesThe objective of this paper is to study, from following case, incidence of steroid-induced psychosis in context of COVID-19.MethodsA bibliographic search was performed from different database (Pubmed, TripDatabase) about psychiatric symptoms associated with use of corticosteroids during pandemic. 64-year-old woman with no psychiatric history, who is hospitalized for pneumonia secondary to SARS-Cov2 and treated with antibiotics, bronchodilators, and corticosteroids. At 4 days she began with injury and nihilistic delusions. The corticosteroids were progressively reduced, adding 2.5 mg Risperidone, resolving after ten days.ResultsCorticosteroids are currently being used to treat the systemic inflammatory response associated with COVID-19, but they can produce other effects such as psychiatric symptoms (3-6%): 75% affective (mainly hypomanic symptoms); and 25% psychotic. Steroid-induced psychosis are characterized by confusion, delusions, and hallucinations, and they usually begin 3-4 days after onset, and resolve within a week. They are associated especially with oral systemic steroids and high doses: 1.3% with 40mg of prednisone, and 18% with 80mg; increased this incidence due to the greater use that is being made to treat COVID-19 and the higher doses used in severe cases (up to 120 mg).ConclusionsTo conclude, we need to know characteristics of these episodes in order to be able to prevent and treat them properly (minimum effective dose and less time), since they will probably occur more frequently at this time.

Psychiatric symptoms and COVID-19, the importance of differential diagnosis. about two cases

Introduction The COVID-19 pandemic presents symptomatic heterogeneity, so the differential diagnosis is even more relevant and more in patients with mental disorders. COVID-19 is a new disease that is under study and affects people over 65 with the greatest severity worldwide. The most frequent psychiatric symptoms are behavioral disturbances and confusional syndrome among those affected.Objectives The objective is to demonstrate the importance of differential diagnosis in patients with psychiatric symptoms and covid-19.MethodsPatients aged 71 and 77, admitted to psychiatry. They present drowsiness that alternates with episodes of psychomotor agitation in which they verbalize fear of the coronavirus. Personal history: bipolar disorder and schizoaffective disorder. Psychopathological exploration: Spatial-temporal disorientation, uncooperative, fluctuating state of consciousness, verborrheic, salty and incoherent speech at times. Dysphoric mood. Psychomotor restlessness predominantly at night, verbal heteroaggressiveness. Negative to ingestion due to odynophagia. Sensory-perceptual alterations and nihilistic delusions “the virus has killed me, I’m already dead.” Upon admission, they present a cough and fever and are treated with azithromycin and dexamethasone for suspected COVID-19. Complementary tests: chest X-ray bilateral pleural effusion. Cranial CT: Diffuse cortical and subcortical brain parenchyma retraction pattern. PCR positive coronavirus.ResultsAfter overcoming the infection and with psychopharmacological treatment the confusional syndrome remitted.ConclusionsConfusional syndrome can present with different psychiatric symptoms, so the differential diagnosis is very important and even more so in patients older than 65 years who present somatic pathologies or acute infections. The differential diagnosis of confusional syndrome is key to adequate treatment and favor the prognosis.