Cotard's Syndrome Research Articles

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.

CEFEPIME-INDUCED COTARD SYNDROME: A CASE REPORT

Background: Cotard syndrome features nihilistic delusions about one’s body or existence and is typically related to severe depression though is rarely associated with medical or neurological insults. Case presentation: The patient was a 62-year-old male with no past psychiatric history and a past medical history of congestive heart failure and consequent renal failure who presented for scheduled heart and kidney transplantation. He was started on routine post-transplant ganciclovir and steroids. Due to postoperative hypotension, empiric cefepime was initiated to cover for septic shock. One week postoperatively, the patient stated “I am dead.” He elaborated that “an intern overdilated me” during transplantation and declined tacrolimus. The patient also reported visual hallucinations of green algae and bubbles. He denied depression and was attentive and oriented. He had a Bush-Francis score of 9. MRI brain revealed no acute changes. Low-dose haloperidol was initiated for psychosis. Cefepime was discontinued, but ganciclovir and steroids were continued. Two days later, the symptoms fully resolved. Discussion: This is the first reported case of Cotard syndrome as an acute transplant complication. Though corticosteroid-induced psychosis was initially suspected, cefepime neurotoxicity is the more likely explanation given the correlation between the antibiotic and symptom courses. Older age and renal dysfunction were risk factors. Conclusions: Cotard Syndrome can be an acute complication of solid organ transplantation, where renal impairment and polypharmacy are common. Transplantation teams and consult-liaison psychiatrists should work together to manage this syndrome.

Cotard syndrome in anti-NMDAR encephalitis: two patients and insights from molecular imaging

ABSTRACT Cotard syndrome is a clinical condition defined by the presence of nihilistic delusions. We report two patients with Cotard syndrome in whom anti-NMDAR encephalitis (ANMDARE) was confirmed. Both cases showed features of affective psychosis, developed catatonic syndrome, and worsened after the use of antipsychotics. 18F-FDG PET brain studies showed a bilateral hemispheric pattern of hypometabolism in posterior regions, mainly in the cingulate cortex and in the medial aspects of parietal and occipital lobes. A more severe hypometabolism was observed in the right hemisphere of both patients. Both cases remitted with the use of specific immunotherapy for ANMDARE.

The living being dead: Cotard syndrome presenting as a dead spirit

Jules Cotard described a syndrome with melancholic anxiety, delusions of possession, ideas of suicide and, thoughts of the non-existence of their own body and/or soul. ‘Perethaya’ is a greedy dead spirit recognized in Sri Lankan culture who expresses a dangerous longing for food until their subsequent incarnation. A 68-year-old female previously diagnosed with depressive disorder stated she is deceased and turned to a ‘perethaya’. She ate from garbage bins and attempted to consume water from toilet bowls as a ‘perethaya’ would do. A 42-year-old male diagnosed with recurrent depression stated he has died and is now a ‘perethaya’. He believed any person who would talk to him is dead as well. These reports present a culturally unique way of Cotard syndrome in Sri Lanka.

My Body Is Rotting: A case report of Cotard’s syndrome in a postpartum woman

Abstract Introduction: Cotard’s syndrome (CS) is a rare set of psychopathological symptoms, the main symptom of which is nihilistic delusions concerning the negation of the existence of internal organs or the entire body Aim, material and methodology: The aim of the study is to present a case of a patient treated for postpartum depression who developed Cotard’s syndrome. The patient’s symptoms began immediately after her daughter. The clinical picture was dominated by anxiety and apathy, nihilistic delusions about the atrophy of the urethra and other lower abdominal organs, and olfactory hallucinations - she could smell rot. Discussion: The available literature on Cotard’s Syndrome does not allow us to indicate a certain reason for its development. Perhaps the birth of the first child - the woman doubted herself as a mother, she was afraid that she would hurt the cause of the disorders observed and described by us was transient ischemia of the CNS during delivery. Conclusions: Cotard’s syndrome can develop in the course of many mental and somatoform disorders. The described case is, to our knowledge, the first description of Cotard’s Syndrome in the deprivation period. Difficulties in establishing the etiopathogenesis and pathophysiology of Cotard’s Syndrome translate into therapeutic problems. It has been suggested that the treatment of the underlying disorder on the basis of which CS is developed remains the most effective method of therapy.

Marc Bourgeois et l’histoire de la psychiatrie

In his books and his articles, Marc Bourgeois has studied the history and the evolution of several morbid entities: Cotard's syndrome, melancholia, bipolar disorders (clinical cases of Ritti, observation of King Charles VI), folie du doute, nostalgia. He has described the context and the consequences of the bursting of the hysteria, criticized the disappearance of chronic hallucinatory psychosis in contemporary classifications, studied the evolution of the concept of awareness of illness in clinical psychiatry, distinguished scientific and psychological truths during a long time, analyzed the psychopathology of European sovereigns since the roman Antiquity, evoked the medication of mental disorders before the antipsychotic drugs. He has published eleven biographical notices in the Annales Médico-Psychologiques and narrated the history of psychiatry in Bordeaux. In the introduction of the collective book published under his direction, “2000 years of psychiatry”, he has adopted the periodization in paradigms described by Lantéri-Laura during the 19th and the 20th centuries and foretold for the 21th a psychiatric discipline dominated by the neurosciences, the influence of groups of “users” and the growth of the administrative power.

Cotard syndrome, self-awareness, and I-concepts

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that a HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states.

Case reports of Cotard's syndrome in Japan: a review.

Case reports of Cotard's syndrome in Japan: a review.

“Extant of the living dead”: a case report on Cotard's syndrome and its treatment aspects from a tertiary care hospital in India

Cotard's syndrome has always borne a historical construct, being linked to pure psychosis, affective disorders as well as organic disorders like Parkinson's, temporal lobe epilepsy, migraine, and cerebral infarction. Emphasis has remained on the psychopathology, involving beliefs of negation, damnation, guilt, and denouncing of body organs. Treatment aspects has been focused on less frequently; moreover, sparsely from India. We present a case of bipolar affective disorder, current episode severe depression with psychotic symptoms (Cotard's syndrome) with special focus on treatment.

EVENT-RELATED POTENTIALS AS AN INDEX OF LOST COGNITIVE CONTROL AND LOST SELF IN A TBI PATIENT WITH DURATION INCREASING POST-TRAUMATIC DELUSIONAL MISIDENTIFICATION SYNDROME CONCLUDED WITH COTARD SYNDROME

The goal of the study was twofold: 1) to evaluate the QEEG/ ERPs indexes of functional brain impairment in a TBI patient diagnosed with chronic lost cognitive control and lost self caused by post traumatic, and here increasing over time, delusional misidentification syndrome concluded with Cotard syndrome in the blooming stage, with nihilistic delusions concerning the body and existence, and the delusion of being dead, and 2) to explore the mind of a patient whose identity has been disengaged, and who experiences the loss of his self and relations with his immediate surroundings with all the tragic consequences that entails. I herein present a 52-year-old patient, who – after a serious head injury due to a car accident 20 years ago, which re- sulted in focal injuries in the frontal and temporal areas of the right hemisphere – developed Cotard syndrome. After arousal from a 63-day coma and 98 days of post-traumatic amnesia, he manifested: (1) the loss of autobiographical memory, (2) a lost self, (3) forgotten family ties (including his lover). The study revealed that the patient’s cognitive control system is completely destroyed: no cognitive components have been found. Recall from memory has been completely disturbed (a low amplitude of N170). The two hemispheres work inco- herently with the right hemisphere revealing a serious delay in memory recall.

FDG-PET in Cotard syndrome before and after treatment: can functional brain imaging support a two-factor hypothesis of nihilistic delusions?

ABSTRACTIntroduction: Cotard syndrome is a neuropsychiatric entity recognised by the presence of nihilistic delusions. Although different models have been proposed for the development of monothematic delusions, including Cotard syndrome, functional neuroanatomical models are lacking.Methods: A case report of a 19-year old male with autoimmune encephalitis and Cotard syndrome, in whom Positron Emission Tomography (18F-FDG-PET) scans were performed before and after successful treatment with electroconvulsive therapy (ECT), is presented. Literature review on brain imaging is provided to discuss a functional neuroanatomical model of Cotard syndrome, in accordance with the two-factor theory of delusions.Results: The patient’s 18F-FDG-PET showed marked insular and prefrontal metabolic abnormalities. Except for insular hypometabolism, metabolic abnormalities improved after ECT. Previously reported structural neuroimaging studies in Cotard syndrome showed a predominance of right hemisphere lesions, in which frontal lobes were more frequently involved, followed by parietal and temporal lesions. Functional neuroimaging studies reported abnormalities in frontoparietal circuits as well as midline structures included in the “default mode network”.Conclusions: Abnormalities in the functioning of the insular cortex and the prefrontal cortex could be related to the development of nihilistic delusions when a two-factor theory of delusions is considered.

Rates and Risk Factors for Suicide Ideas among Schizophrenia Patients in Indonesia.

BACKGROUND:Schizophrenia is associated with a high rate of suicide.AIM:Our study was aimed to identify the rates of suicide ideas in patients with schizophrenia as well as the risk factors associated with suicide ideas.METHODS:As many as 1130 subjects were evaluated using the Indonesian version of Diagnosis Interview for Psychosis (DIP) to establish the diagnosis of schizophrenia. Subjects aged 18-65 years. The risk factors were socio-demographic data, mental disorder history in the family, clinical symptoms and clinical course of schizophrenia. Risk factors that have the strongest correlation with suicide ideas were analysed using multivariate logistic regression analysis.RESULTS:About 6.1% of subjects reported suicide ideas in their life. The age of disease onset (p = 0.006), family history of schizophrenia (p = 0.013), poor concentration (p = 0.032), loss of enjoyment (p = 0.000), guilty feeling (p = 0.000), family history of mental illness (p = 0.000), nihilistic delusion (p = 0.001) and alcohol abuse (p = 0.000) were significantly associated with suicide ideas.CONCLUSION:Suicide idea is quite common in people with schizophrenia. Evaluation and management of risk factors associated with suicide ideas should be performed to prevent suicide attempts or death. Suicide ideas and risk factors can become clinical parameters in the instrument of suicide prevention.

Cotard syndrome. History and modern view

In this review, we have collected the latest data on Kotar syndrome. The question of its nosological affiliation is considered, etiological theories and epidemiological indicators are presented. The options for the development of the clinical picture are described, data on the results of neuroimaging diagnostic studies are presented.

Post-ictal Cotard delusion in focal epilepsy patients

Post-ictal Cotard delusion in focal epilepsy patients

NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

A study on the symptom profile of depressive disorder in elderly Turkish patients: A factor analysis study

Aim: Depressive disorder manifests itself differently in elderly patients due to the symptom profile. We conducted this study on a population of elderly major depressive disorder patients in Turkey with the aim of determining the sociodemographic characteristics, distribution, and associations of their symptoms.Material and Method: A retrospective study of 137 patients hospitalized during the last ten years in the Geropsychiatric Clinic of the Department of Psychiatry, Cerrahpasa School of Medicine, Istanbul University. The patients were diagnosed according to the DSM IV criteria.Results: Majority (51.8%) of the patients were female, most of which were married (65%). The most common symptoms in elderly patients in order of frequency were distress 112 (81.8%) anxiety 97 (70.8%), and insomnia 96 (70.1%). The least frequently observed symptoms were disorientation 5 (3.6%), nihilistic delusions 5 (3.6%), and increased appetite 2 (2.2%). The symptoms clustered in accordance with the DSM IV system.Conclusion: It was concluded that the sociodemographic characteristics and weighted distribution of symptoms in Turkish geriatric depression patients were closely in parallel with the existing literature. However, results indicate a need to repeat this study in order to explore the same in a general Turkish population.Keywords: Elderly; depression; sign; symptom; factor analysis.

Uncommon psychopathological syndromes in psychiatry

Abstract Introduction: The development of biological sciences, as well as cultural and civilizational changes have led to the emergence of practice within the medicine of science, called psychiatry. Already at the turn of the 19th and the beginning of the 20th century, Karl Jaspers - a German scholar - father of psychopathology - in the work “Allgemeine Psychopathologie” crystallized his intuitions in the field of psychopathology, which classifies and describes states that are deviations from the physiological mental state of a human being. Material and method: his paper reviews available literature to approximate the symptoms of the most interesting psychopathological syndromes in psychiatry such as: Clerambault syndrome, Otheller syndrome, Cotard syndrome, Ekboma syndrome and Folie à deux. Results: A multitude of psychopathological syndromes results from the wealth of survival of psychiatric patients. They represent the delusions of different contents that develop in a primitive way or as a consequence of other types of disorders. Psychopathological teams have been inspiring the poets and directors for centuries. The relationship between psychiatry and culture, film and literature undoubtedly testifies to its interdisciplinary nature. Discussion: Despite the passage of time, the descriptions of these syndromes with a rich historical description, symptomatology and criteria have not lost their relevance and are still a clinical reality.

When Dementia Kills Before One Passes Away: Case Report of Cotard's Syndrome.

Cotard's Syndrome (CS), among the noncognitive changes in the forms of dementia, is a seldom-found manifestation (1). This syndrome is characterized by the delusion of having lost organs (the individual experiences huge changes in the body and believes that he/she no longer has one or more organs) and by nihilistic delusion (the individual believes he/she or everyone in the world has died or been destroyed) (2). In 1880, Jules Cotard (1840-1889) described a clinical condition that he believed corresponded to a new subtype of depression, which he called anxious melancholia. He proposed that a state of acute depression and morbid anxiety could foster the development of structured delusions of hypochondria. Two years later he referred to the same clinical condition using the term délires des négations for the first time (3). The eponym CS was only introduced in 1893 by Emil Regis, who stated that Cotard had not described a new clinical entity but rather a syndrome - a cluster of symptoms that could also be found in other mental illnesses apart from depression and in which anxiety was the central characteristic (4). The most prominent symptoms found in an analysis of one hundred cases were: depressed mood (89%), nihilistic delusion (69%), anxiety (65%), delusion of guilt (63%), delusion of immortality (55%) and hypochondriacal delusions (58%) (12). Currently, CS is not classified as an isolated disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association or in the International Statistical Classification of Diseases and Related Health Problems (ICD-10). There is a growing consensus to consider it a secondary syndrome of an underlying disorder, of which the most associated disorders are: unipolar depression, bipolar depression and primary psychotic disorders. Other conditions have also been described, such as dementia, severe intellectual disability, cerebrovascular accident, brain tumor, and Parkinson's disease, among others (5).

Cotard’s Syndrome: A Detailed Description of the Stages

Cotard’s Syndrome: A Detailed Description of the Stages