Cotard's Syndrome Research Articles

Cotard syndrome in Tumefactive Multiple Sclerosis- A case report

Cotard syndrome in Tumefactive Multiple Sclerosis- A case report

Cotard's Syndrome Triggered by Fear in a Patient with Intellectual Disability: Causal or Casual Link?

ABSTRACTCotard's syndrome is a neuropsychiatric disease characterized by a variety of nihilistic delusions, commonly associated with several psychotic and major affective disorders, and neurological diseases, including stroke, dementia, and mental retardation. A 39-year-old male with mental retardation developed Cotard's syndrome, following an important episode of fear. During admission to our neurological unit, the patient underwent an accurate assessment, including neuroradiological, clinical, and neuropsychological examinations. At the psychiatric evaluation, he presented nihilistic delusions, in which he negated the existence of his body parts and the existence of his family members. The neuropsychological assessment ruled out other possible causes of misidentification, including the post-traumatic stress disorder. Thus, since also organic causes of Cotard's syndrome were excluded, the correlation between fear and the syndrome has been postulated and the patient opportunely treated, using a multidisciplinary approach. Our case suggests that in predisposed individuals negative emotions, including fear, may lead to delusional syndromes.

Brief psychotic episode in a patient with chromosome 2q37 microdeletion syndrome

A 21-year-old woman with moderate learning disability secondary to chromosome 2 microdeletion at q37 was admitted to a general adult psychiatric ward following a period of agitation with incessant pressure...

Cotard Syndrome.

Cotard's syndrome is often described as the delusional belief that one is dead or non-existent. However, Jules Cotard's initial description (1880) of the "delusion of negations" was much richer and also involved delusions and claims of immortality and enormity, feelings of damnation, and illusions of bodily dissolution and transformation. Alternatively conceived as an extreme case of depression, hypochondria, or psychosis, the condition is considered rare and remains poorly understood. Cotard himself provided a taxonomy and several explanations for the condition, focusing on its distinction from classical persecutory delusions and suggesting that it could be a kind of reversed grandiosity. He proposed a psychosensory basis in the dissolution of mental imagery, which he then extended to a more general psychomotor impairment of volition. Other early authors highlighted a disorder of the bodily self, and more recent theories postulated an impairment of right hemispheric functions, leading to perceptual and somatosensory feelings of unreality, which coupled with reasoning impairments and an internalized attributional style led in turn to beliefs of non-existence. However, despite its striking presentation and its relevance to our understanding of self-awareness, Cotard's syndrome remains an elusive condition, rarely reported and poorly researched.

Cotard and Capgras delusions in a patient with bipolar disorder: “I’ll prove, I’m dead!”

ABSTRACTCotard is a syndrome that is characterized by ideas of damnation or rejection, anxious melancholia, insensitivity to pain, and nihilistic delusions concerning one’s own body or existence. It is most often encountered in middle age or older women who are severely depressed. Capgras syndrome is a rare psychiatric disorder with colourful symptoms. The patient believes that the identities of close relatives or friends are not real but are replaced by others. Co-existences of psychiatric and organic diseases with Cotard’s syndrome and Capgras syndrome are reported in different studies. There is still requirement of more research to establish a position in diagnostic classification systems for these syndromes which are thought to have a multifactorial etiology. In this report, we described a patient with bipolar disorder type-2 who displayed comorbid Cotard and Capgras delusions which were most evident at the onset of menstrual periods.

Rare health conditions 3: albinism, Jeune syndrome and Cotard's syndrome

The purpose of this series is to highlight a range of rare health conditions. Rare health conditions are those that affect no more and usually less than 1 person in every 2000 and many HCAs and nurses will encounter some of these conditions, given the high number of these conditions. This third article will explore three of these conditions: albinism, Jeune syndrome and Cotard's syndrome.

A Neuropsychiatric Analysis of the Cotard Delusion.

Cotard's syndrome, a condition in which the patient denies his or her own existence or the existence of body parts, is a rare illness that has been reported in association with several neuropsychiatric diagnoses. The majority of published literature on the topic is in the form of case reports, many of which are several years old. The authors evaluated associated diagnoses, neuroimaging, and treatments recorded in patients diagnosed with Cotard's syndrome at their institution. A search of the Mayo Clinic database for patients with mention of signs and symptoms associated with Cotard's in their records between 1996 and 2016 was conducted. The electronic medical records of the identified patients were then reviewed for evidence of a true diagnosis of Cotard's. Clinical and neuroimaging data were also recorded for these patients. The search identified 18 patients, 14 of whom had Cotard delusions. Two of the 14 were excluded due to them being under age 18. The resulting 12 patients had a median age of 52 years (range: 30-85 years). On neuroimaging, four patients exhibited frontal lobe changes, four demonstrated generalized volume loss, and five had ischemic changes; seven patients demonstrated right-sided or bilateral hemisphere lesions. Treatments included ECT, pharmacotherapy, behavioral therapy, psychotherapy, rehydration, and removal of offending drugs. To conclude, Cotard delusions occur in the context of a relatively wide spectrum of neurological, psychiatric, and medical disorders and present with various neural changes. Nondominant hemisphere lesions may play a role in the pathophysiology. A number of effective treatments are available.

Cotard syndrome: Pathology review

IntroductionCotard syndrome (CS) is a rare neuropsychiatric condition characterized by nihilistic delusions, which may range from negation of existence of parts of the body to delusion of being dead or negation of self-existence, and it requires an urgent and appropriate therapy.ObjectivesOur objective is to highlight the importance of CS, reinforcing that medical professionals should be aware of this pathology to prompt clinical description, diagnostic and treatment.AimsThe aim of this presentation is to alert psychiatrists to this remaining syndrome.MethodsReview of phenomenological and theoretical issues regarding SC.ResultsCS can be found in numerous psychiatric or neurologic pathologies but it is most seen in patients with severe depression. It is typically divided in three subtypes: psychotic depression, Cotard type I, with nihilistic delusions without mood symptoms, and Cotard type II, with mood symptoms and auditory hallucinations. There are numerous etiological hypothesis mechanisms, including unusual perceptual experiences, which can similarly be involved in Capgras delusion, disconnection from emotional or limbic processes, an impaired belief evaluation or a tendency to excessive self-attribution. Frontotemporoparietal circuitry also seems to have an important role in its pathology. Treatment usually involves electroconvulsive therapy, antidepressants and anti-psychotics and the prognosis depends on the underlying disorders.ConclusionsCS is a rare pathology with self-defeating risk and its clinical recognition and proper treatment are essential to improve the prognosis of these patients. Diagnostic criteria or clinical instruments for assessment of this syndrome should be encouraged, since its lack is a limitation for systematic studies and consequent management advances.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Nihilistic delusions (Cotard Type I) in a patient with paranoid schizophrenia

Nihilistic delusions (Cotard Type I) in a patient with paranoid schizophrenia

Assessment of psychotic symptoms in bipolar disorder

IntroductionBipolar disorder is a disabling condition characterized by the presence of manic, depressive, hypomanic or mixed episodes, affective symptoms that may coexist with several types of psychotic features.ObjectivesThe purpose is to evaluate the frequency of psychotic symptoms among bipolar disorder.MethodThe study included 55 bipolar patients admitted in the Psychiatry Clinical Hospital from January 2012 until May 2013. Inclusion criteria were represented by diagnosis of bipolar disorder, manic or depressive episode, according to DSM-IV-TR and ICD 10 criteria. Clinical instruments used to assess the severity of the current affective episode were Young Mania Rating Scale (YMRS) for manic patients and Hamilton Depression Rating Scale-17 items – (HDRS) for the depressive ones. Psychotic symptoms were evaluated with the Brief Psychiatric Rating Scale-18 items – (BPRS).ResultsOut of the 55 patients, 32 had psychotic symptoms upon admission to the hospital. BPRS results showed delusions of guilt, inutility, hypochondriac and nihilistic delusions for the depressed patients. Delusions of grandiosity and megalomania accounted for most of psychotic symptoms in manic patients. A smaller number of patients showed delusions of invention and reform. Perception disturbances such as auditory hallucinations were present in both diagnosis categories but in a higher percentage in depressive bipolar patients.ConclusionsEven if less frequently than in schizophrenia or schizoaffective disorder, psychotic symptoms are present in bipolar disorder. They influence the general functioning and the outcome of patients diagnosed with this illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Role of Emotions in Delusion Formation

Abstract The text concerns the role of emotions in delusion formation. Provided are definitions from DSM-V and DSM-IV-R and the problems found in those definitions. One of them, the problem of delusion formation, is described when providing cognitive theories of delusions. The core of the paper is a presentation of the emotional and affective disorders in delusions, especially Capgras delusion and Cotard delusion. The author provides a comparison of the kinds of delusions and the conclusions taken from neuroimaging studies. As a result of the fact that an explanation of delusion formation focusing on emotional problems turns out to be insufficient, the author provides examples of the reasoning impairments which coexist with them. At the end of the article, some hypotheses are proposed concerning the role of emotions and reasoning in delusion formation and the relation between belief disorders and emotional disorders.

Cotard Delusion in the Context of Schizophrenia: A Case Report and Review of the Literature

Background: The Cotard delusion (CD) is one of a variety of narrowly defined monothematic delusions characterized by nihilistic beliefs about the body’s existence or life itself. The presence of CD within the context of schizophrenia is rare (<1%), and remains understudied.Case: ‘Mr. C’ is a 58-year-old veteran with a prior diagnosis of schizophrenia, who presented with CD in the context of significant depression, suicidal ideation, violence, and self-harm behavior. He perseverated in his belief that he was physically dead and possessed by demons for several weeks. This delusion was reinforced by his religious belief that life was an attribute of God, and by inference, he as a human, was dead. His condition gradually improved over the course of treatment with Divalproex and quetiapine with discussions about the rationale for his belief. Upon discharge, Mr. C. demonstrated awareness of his fixation on death and an ability to redirect himself.Discussion: This case highlights the need to better understand the co-occurrence of CD in schizophrenia, their differentiation, the increased risk of violence and self-harm behavior in this presentation, and how specific events and religious factors can influence delusional themes of CD. Pharmacotherapy and aspects of cognitive-behavioral therapy may be effective in ameliorating these symptoms in CD.

Somatic Symptom Disorder in Semantic Dementia: The Role of Alexisomia

Semantic dementia (SD) is a neurodegenerative disorder characterized by loss of semantic knowledge. SD may be associated with somatic symptom disorder due to excessive preoccupation with unidentified somatic sensations. To evaluate the frequency of somatic symptom disorder among patients with SD in comparison to comparably demented patients with Alzheimer׳s disease. A retrospective cohort study was conducted using clinical data from a referral-based behavioral neurology program. Fifty-three patients with SD meeting criteria for imaging-supported semantic variant primary progressive aphasia (another term for SD) were compared with 125 patients with clinically probable Alzheimer disease. Logistic regression controlled for sex, age, disease duration, education, overall cognitive impairment, and depression. The prevalence of somatic symptom disorder was significantly higher among patients with SD (41.5%) compared to patients with Alzheimer disease (11.2%) (odds ratio = 6:1; p < 0.001). Somatic symptom disorder was associated with misidentification and preoccupation with normal bodily sensations such as hunger, bladder filling, borborygmi, rhinorrhea, and reflux; excessive concern over the incompletely understood meaning or source of pain or other symptoms; and Cotard syndrome or the delusion that unidentified somatic symptoms signify death or deterioration. SD, a disorder of semantic knowledge, is associated with somatic symptom disorder from impaired identification of somatic sensations. Their inability to read and name somatic sensations, or "alexisomia," results in disproportionate and persistent concern about somatic sensations with consequent significant disability.

Exploratory Laparatomy in a Schizophrenic Patient with Parasiticide as a High Risk Behavior; Ekbom Syndrome: A Case Report

Introduction Delusions of parasitosis or Ekbom syndrome are a psychotic disorder that causes a patient to suffer from the substantial false belief that he or she is infested with a parasite or helminth..Case Presentation The patient was a 44-year-old, unemployed divorced man with a past psychiatric history of schizophrenia. He was referred to the emergency department (ED) with a complaint of a rupture of the abdomen. He believed that a large, threatening helminth or macro parasite had entered in his abdomen and was eating and destroying his intestines, liver and other internal organs. Therefore, following these thoughts, he decided to explore his abdomen and to remove of this “vampire.”.Conclusions Delusional infestation or parasitosis may be detected in context and secondary to schizophrenia with nihilistic delusion and may create a high degree of suffering for patients, ultimately cause mortality, because of threatening behaviors toward the self..

Making Sense of the Cotard Syndrome: Insights from the Study of Depersonalisation

AbstractPatients suffering from the Cotard syndrome can deny being alive, having guts, thinking or even existing. They can also complain that the world or time have ceased to exist. In this article, I argue that even though the leading neurocognitive accounts have difficulties meeting that task, we should, and we can, make sense of these bizarre delusions. To that effect, I draw on the close connection between the Cotard syndrome and a more common (and better studied) condition known as depersonalisation. Even though they are not delusional, depersonalised patients seem to have experiences that are quite similar to those of Cotard patients. I argue that these experiences are essentially characterised by a (more or less important) lack of subjective character and of two other structural features of experience, which I call ‘the present character’ and ‘the actual character’. Cotard's nihilistic delusions simply consist in taking these anomalous experiences at face value.

The sense of death and non-existence in nihilistic delusions

The sense of death and non-existence in nihilistic delusions

Sudden onset of Cotard&amp;#8217;s syndrome as a clinical sign of brain tumor

We report the clinical case where the sudden onset of a Cotard syndrome in a 69 year old lady lead to the discovery of a multifocal glioblastoma in the right temporo-parietal lobe. Cotard’s syndrome is a rare psychiatric disorder in which the afflicted patient believes he or she is dead. These nihilistic thoughts are the expression of a rare syndrome first described by Jules Cotard in late XIX century. The Cotard’s syndrome has been studied and it seems that its psychopathology can be ascribed to the temporoparietal cortex. Although the Cotard’s syndrome is not part of the DSM-V it is common in psychiatric literature and is included in ICD-10-CM within code F22. It has been described associated with organic lesions and atrophy of the non-dominant temporo-parietal cortex, in pathologies like bipolar disorder, schizophrenia1, subdural hemorrhage2, multiple sclerosis, brain atrophy3 and cerebral infarction4 among others5-7. We observed the case of a female patient, 69 years old, with no relevant past medical history, that was admitted to the John Radcliffe Hospital in Oxford (UK) with an episode of numbness in the left hand and an episode of dizziness whilst at home, duration of symptoms was of 15 minutes and then resolved entirely. She had no history of head trauma. Neurological exam was unremarkable and the stroke team felt a CT scan was not required, however she failed occupational therapy assessment and was not sent home. During the night she developed the delusion of being dead. When being interviewed, in the next day early in the afternoon, she stated: – “I think I’m dead (...) it started during the night, like it was some kind of a dream, but this remain until now” (...) – “Do you rationally think you are dead?” – “I do. It may not make much sense since I realize I have blood pressure when they measure it but I rationally think I am dead.”

Psychose, mélancolie et hallucinations négatives chez le sujet âgé

Negative hallucinations are an apparent abnormal inability to perceive an object or a person that is right before one's eyes. To erase the reality hallucinate as well to about nothing is a paradoxical phenomenon. Negative hallucinations are characterized by a defect in perception of an object or a person, and a denial of their existence. This term highlights a specific defense mechanism, clumsy and ineffective attempt to represent an absence. Psychological trauma and negative hallucinations have a close relationship with Cotard's syndrome, delusional theme of organ denial, observed in melancholic syndromes in geriatric psychiatry. Negative hallucinations require a phenomenological approach to identify their sense. A deficiency in symbolization is supposed in connection with neuropsychological deficits. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. The prevalence of this symptom is without doubt underestimated, although its presence often underlines thymic suffering that is more striking. These hallucinatory symptoms have an important impact on the patients’ daily life, and they appear to be prisoners of a suffering, that they cannot communicate. We propose in this article to review the clinical symptoms of negative hallucinations in the elderly and the way to manage them. The medicinal approaches are not always effective. A greater place must be given to non-pharmacological approaches, such as somatic ones, which can be either invasive (electroconvulsive therapy) or (transcranial magnetic stimulation).

Atypical neuroleptic malignant syndrome in adolescence

Objective To report re-challenges of antipsychotic drugs after neuroleptic malignant syndrome (NMS) in a case of Cotard syndrome and considering electroconvulsive treatment as an option in these cases. Case report A 17-year-old adolescent, treated for acute psychotic attack with multi-antipsychotic (olanzapine, risperidone) for 15 days, developed NMS within 48hours of the addition of low doses of clozapine to his regimen. Symptoms included fever, agitation, dysautonomia, pulmonary edema, ventricular failure and laboratory findings, which included elevation of CK levels, leukocytes, transaminase, resolved after discontinuation of psychotropics, supportive management and 6 days of treatment with bromocriptine and amantadine. At first, patient was treated with low doses of quetiapine. Then, we decided to imply ECT because of two reasons. The first reason is low dosage of quetiapine was not believed to control symptoms which included Cotard syndrome based on assertions such as I am dead, I cannot breathe, My teeth and my bones are melted, suicidal thoughts, incoherence speech. The second reason is increasing quetiapine dose rapidly could have caused relapsing of NMS. Finally, we transferred our patient to another child psychiatry clinic where ECT can be applied. Discussion Starting atypical antipsychotic drugs in re-emergence of post NMS psychosis and catatonia is a challenge. Because of the risk of relapsing NMS, anti-psychotic drugs must be started lower dosage, titrated up slowly then patient should be monitored at least two weeks until resumption of therapy. Process of monitoring depends on existing of clinical residua. Moreover, it is unclear when clinical residua exist, thus it is difficult to interpret the existing guidelines on safe reintroduction of antipsychotics. At that point, ECT can be considered as an option in order to control psychotic symptoms. Conclusions Clinicians should closely monitor patients when restarting anti-psychotic drugs after NMS owing to risk of relapsing NMS and ECT should be considered as an option in order to control symptoms.

Cotard syndrome in a young man?

IntroductionAnti-NMDA encephalitis normally appears as a characteristic syndrome with typical symptoms that undergoes with multiphase evolution. However, it sometimes develops atypical symptoms so we must perform a careful differential diagnosis.ObjectivesTo conduct a current review of detection and management of anti-NMDAr encephalitis, and psychiatric manifestations.MethodSystematic review of the literature in English (PubMed), with the following keywords: “Autoimmune encephalitis”, “psychosis”, and “NMDA receptor”.ResultsWe present the case of a 15-year-old boy referred to evaluation for a first psychotic episode. He had no past history of psychiatric illness or substance abuse. The only relevant antecedent is multiple sclerosis in a first degree relative. For the last months, he presented high levels of anxiety symptoms apparently related to college stressful events and fluctuating hypoesthesia of left cranial side. Days later, it appeared autolimited gastrointestinal symptoms, headache and fever. During the next days it appeared psychomotor retardation, choreic movements, suicide ideation and mood-congruent paranoid and nihilistic ideation, auditory and visual hallucinations, perplexity and catatonic symptoms so he was hospitalized. We observed cognitive functions impairment, unsteady gait, dysartria, dysphasia, clonus and left babinsky sign. EEG showed slow waves on right frontal area. CFS showed protein elevation and immunologic study revealed positive anti-NMDA antibodies. Treatment with methylprednisolone and gammaglobuline was started with partial response, needing addition of rituximab.ConclusionsIn this case, we highlight the importance of early detection and a detailed differential diagnosis, to determine whether the etiology of psychiatric symptoms in order to achieve an accurate and early treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.