Cotard's Syndrome Research Articles

Cotard's Syndrome in a Patient with Schizophrenia: Case Report and Review of the Literature.

Jules Cotard described, in 1880, the case of a patient characterized by delusions of negation, immortality, and guilt as well as melancholic anxiety among other clinical features. Later this constellation of symptoms was given the eponym Cotard's syndrome, going through a series of theoretical vicissitudes, considering itself currently as just the presence of nihilistic delusions. The presentation of the complete clinical features described by Cotard is a rare occurrence, especially in the context of schizophrenia. Here we present the case of a 50-year-old male patient with schizophrenia who developed Cotard's syndrome. The patient was treated with aripiprazole, showing improvement after two weeks of treatment. A review of the literature is performed about this case.

When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard's Syndrome.

Cotard's Syndrome (CS) is a rare clinical event described for the first time in 1880 by the neurologist and psychiatrist Jules Cotard and characterized by negation delusions (or nihilists). Immortality and hypochondriac delusions are also typical. Nowadays, it is known that CS can be associated with many neuropsychiatric conditions. In this article, we describe the case of a patient that believed not having more organs and having the body deformed and whose CS was associated with a bigger depressive disorder. Although the electroconvulsive therapy is the most described treatment modality in the literature, the reported case had therapeutic success with association of imipramine and risperidone.

Síndrome de Cotard: a doença da imortalidade

Cotard syndrome is a rare condition characterized by anxious melancholy, delusions of non-existence of one’s own body, and delusions of immortality. In this article, we report the case of a 66-year old male patient diagnosed with Cotard syndrome resistant to pharmacological treatment and treated with electroconvulsive therapy. Some peculiarities of the diagnosis and treatment of this condition are discussed.

Symptom Dimensions of Psychosis – Opcrit Factorial Analysis of a Large Sample of Portuguese Psychotic Patients

Objectives To investigate the symptom dimensions of psychosis using factor analyses/FA of lifetime symptoms of a sample of Portuguese psychotic patients. Method FA of the OPCRIT items (56 signs and symptoms) of 684 patients - Schizophrenia/Sz (73.8%), Other non-organic psychotic disorders/ONPD (6.0), Schizoaffective disorders/SzA (1.4%), Bipolar disorders/BP (18.1%) and Severe depression with psychosis/SDP (.8%) – assessed with the Diagnostic Interview for Genetic Studies. Delusions of poverty, guilty delusions, nihilistic delusions, primary delusional perception, and somnolence, problems with appetite and weight and grandiosity were excluded from the final solution, as each were present in less than 10% of patients and did not load at any factor. Results Following the Kaiser and the Cattel's Scree Plot criteria, a four factors structure was selected, which explained variance (EV) was of 60.25%. Based on items content, the meaningful four factors were denominated as follows: F1 Depression (EV 21.77%; a=.97); F2 Mania (5.72%; a=.97); F3 Delusions and hallucinations (2.97%; a=.92); F4 Disorganization and Negative symptoms (2.07%; a=.90). Mann-Whitney U tests revealed that the symptom dimensions that distinguished better between Dx categories were Delusions and hallucinations (only SDP vs. BP and Sc vs. SzA did not significantly differ) and Disorganization and Negative symptoms (only SDP vs. BP and SDP vs. ONPD did not significantly differ), with Sz patients presenting the highest scores. Conclusions This factorial structure is in accordance with other reports. Given the Schizophrenia (Sz) and Bipolar disorder (BP) heterogeneity and overlap, the present study contribute to phenotypic refinement and formulation of alternative psychosis phenotypes.

Cotard Syndrome without Depressive Symptoms in a Schizophrenic Patient.

Introduction. Cotard syndrome is a rare condition characterized by nihilistic delusions concerning body or life that can be found in several neuropsychiatry conditions. It is typically associated with depressive symptoms. Method. We present a case of Cotard syndrome without depressive symptoms in the context of known paranoid schizophrenia. A literature review of Cotard syndrome in schizophrenia was performed. Results. Although there are few descriptions of this syndrome in schizophrenia, patients usually present depressive mood and psychomotor retardation, features not seen in our patient. Loss of the sense of the inner self, present in schizophrenia, could explain patient's symptomatology but neurobiological bases of this syndrome remain unclear. Conclusion. Despite not being considered in actual classifications, Cotard syndrome is still relevant and psychiatric evaluation is critical to diagnosing and treating this condition in psychiatric patients.

Hallucination négative, conscience de soi et avancée en âge

Negative hallucinations are characterized by a defect in perception of an object or a person, or a denial of the existence of their perception. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. They have a close relationship with Cotard's syndrome, delusional theme of organ denial observed in melancholic syndromes in the elderly. Phenomenological approach. The phenomenology of negative hallucinations provides quite an amount of information on the origin of the psychotic symptoms when one is rather old. The connections between hallucinations, mood disorders and negative symptoms are often difficult to live with for the nearest and dearest. Negative hallucinations require a strict approach to identify their expression that is crucial because a wide heterogeneity exists within the pathological pictures, as in Cotard's syndrome. Although the negative hallucination has an anti traumatic function in elderly people fighting against mental pain, it still represents a deficiency in symbolization. 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, which cannot be revealed. 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 what is in connection with the body, aiming at a strong impact and thus to offer non-pharmacological approaches, such as somatic ones, which can be either invasive (electroconvulsive therapy) or not (transcranial magnetic stimulation).

Why Are We Certain that We Exist?

Descartes was certain that he was thinking and he was accordingly certain that he existed. Like Descartes, we seem to be more certain of our thoughts and our existence than of anything else. What is less clear is the reasonwhywe are thus certain. Philosophers throughout history have provided different interpretations of thecogito, disagreeing both on the kind of thoughts it characterizes and on the reasons for its cogency. According to what we may call theempiricist interpretationof thecogito, I can only claim to be certain of havingexperiences, and this certainty, as well as that of my own existence, stems from their phenomenal and subjective character. According torationalist interpretations, on the other hand, I am certain of having some self‐reflexivepropositional attitudes, and this certainty derives from their rational features. Psychiatric patients suffering from acute forms of depersonalization or of the Cotard syndrome often doubt that they think and exist, and might even believe that they don't. I argue that their study allows us to favor the empiricist interpretation of thecogito.

Dysmetropsia and Cotard's syndrome due to migrainous infarction – or not?

Migrainous infarction accounts for 12.8% of ischemic strokes of unusual etiology. A 59-year-old woman with longstanding migraine with aura experienced what appeared to be migrainous infarction characterized by dysmetropsia and transient Cotard's syndrome. Imaging demonstrated right temporal-parietal-occipital changes with apparent cortical laminar necrosis. The spectrum of the pathophysiology of migrainous infarction has not been established; however, cortical spreading depression may explain the appearance of imaging findings that do not obey a vascular territory.

Cotard’s Syndrome: Clinical Case Presentation and Literature Review

In 1880 French neurologist Jules Cotard described a condition characterized by delusion of negation (nihilistic delusion) in a melancholia context. Recently, there has been a resurgence of interest in Cotard’s syndrome. The most prominent symptoms of Cotard’s Syndrome are depressive mood, nihilistic delusions concerning one’s own body and one’s own existence, delusions of guilt, immortality and hypochondria. The aim of the present

A Case of Cotard Syndrome in a Woman With a Right Subdural Hemorrhage

A Case of Cotard Syndrome in a Woman With a Right Subdural Hemorrhage

ON VOICES AND MEDIUMSHIP IN THE TRILOGY

my sane and ordinary inner speech is itself likely to be a swarm of quotations, often from anonymous and vanished others. dead chatter away as inner speech of living.Jean-Jacques Lecercle and Denise Riley, Force of LanguageAll dead voices.Samuel Beckett, Waiting for Godot^What follows is not an attempt to avoid or plug epistemological vortex of Unnamable (Connor 2010, xix-xx), but to think about mediumship's role in forming this vortex. Voices are extremely important in trilogy - indeed, C. J. Ackerley suggests that mystery of may be profound literary creation (40) - and these acousmatic and disembodied voices often defy explanation. Yet, there are numerous references to voices in work that could be interpreted as forms of mediumistic channelling (that is, when a person channels voice of dead), such as in late television play Eh Joe. I want to suggest that this later exploration of mediumship is already present in a more obscured, vague, and spectral form in trilogy. Peter Fifield has analysed references to voices that persist after death, specifically protagonists of Unnamable, Malone Dies and The Calmative, in terms of Cotard's syndrome; as a supplement to this insightful neuropsychological analysis, I want to suggest that mediumship might also offer an appropriate frame for use of voice in these texts. was interested in possibility that strange, unknown, foreign voices might end up in one's brain; trilogy is testament to this enduring fascination.Numerous critics have linked writing to occultism, with varying degrees of playfulness. In The Death of Author, Roland Barthes suggests that writing itself begins when the voice loses its origin [and] author enters his own death (49). Although Barthes doesn't push this metaphor, skirts close to what we might term au dela - literally beyond, land of dead. is quite willing, where Barthes is not, to engage with these occult associations. Beyond Barthes, Nicholas Royle's Telepathy and Literature has suggested that literature and telepathy are deeply interdependent. As Pamela Thurschwell puts it, telepathic question par excellence is: whose thoughts are these, inhabiting my inner world (125)? This a question Unnamable asks with frantic urgency. Telepathy shares with mediumship an inexplicable transference of knowledge and voices, but of living rather than dead - and transferred content often remains internal rather than being externally channelled or performed through voice or automatic writing. Leon Surette has compellingly argued that occultism had an important influence on modernism, suggesting that Ezra Pound read T. S. Eliot's Waste Land (1922) as a text which shared certain traits (its seemingly random jumps in time and space as well as across multiple disembodied voices) with seances (69). But most prominent modernist with an interest in mediumship is W. B. Yeats, as evidenced in Words Upon Window Pane (1934).Beckett's voices raise many issues, as critics have long been aware. As Wilma Siccama observes: Beckett's characters hardly ever speak 'themselves': voices come to them, or they say as they hear it (175). Anthony Cordingley adds that: the narrators and characters of novels are increasingly haunted by sense that their voices are legacy of not only 'their' past selves/characters in earlier works by Samuel Beckett, but also of an estranged voice or voices inside them (135). Extending trope to author himself, Siccama suggests that Beckett does not 'speak' with his own voice: he is more like a medium, a receiver and transmitter of another voice, one that he hears in his head (186). Although this is a rather unusual proposal, numerous interviews suggest that consciously invoked trope of mysterious voices when discussing his compositional process. …

Síndrome de Cotard asociado a demencia degenerativa. Presentación de tres casos

Síndrome de Cotard asociado a demencia degenerativa. Presentación de tres casos

The meaning of life given by death and the metaphysics of time : What immortality in Cotard Syndrome reveals

The meaning of life given by death and the metaphysics of time : What immortality in Cotard Syndrome reveals

High plasma monoamine metabolite levels in Cotard's syndrome

Cotard's syndrome, characterized by nihilistic delusions, mostly occurs in presenile women and is accompanied by depression. The French physician Jules Cotard first presented a case of this syndrome in 1880.1 Its cause, however, still remains unclear. ‘I have no brain, heart, stomach or entrails. My body has entirely fallen into decay and only spirit exists. I can't even die and would live forever.’ These are the words of a 62-year-old woman diagnosed with Cotard's syndrome at our hospital. We consider this case significant because of the marked biochemical changes that occurred in her body, or ‘the dead body,’ according to her. The patient commenced treatment for depression in 2007, and was admitted to our hospital in April 2010 because of nihilistic delusions, appetite loss, and furious excitement. Before admission, her adherence to medication was poor, and she took only paroxetine (10 mg/day) irregularly. On admission, she had neither fever nor consciousness-related disorders. The results of various tests revealed only minor changes, for example, slight dehydration and undernourishment. No laboratory finding indicated renal failure, inflammation, or endocrine abnormality. The brain magnetic resonance imaging scan showed slight cortical atrophy compatible with her age. However, considerable changes were observed in the plasma monoamine metabolite levels on admission; the homovanillic acid (HVA, dopamine metabolite) level was 154.8 ng/mL (normal range for 50–60-year-old subjects, 4–15 ng/mL); the total 3-methoxy-4-hydroxyphenylglycol (MHPG, noradrenaline metabolite) level was 202.1 ng/mL (normal range, 16–26 ng/mL); and the free MHPG level was 57.9 ng/mL (normal range, 4–7 ng/mL). The patient was diagnosed with Cotard's syndrome that developed during the course of psychotic depression. After admission, she was treated with an antidepressant (amoxapine, 50–90 mg/day) and antipsychotics (mainly olanzapine, 2.5–10 mg/day). The varied psychotic symptoms gradually improved, and the monoamine levels returned to approximately normal. At the time of discharge in June, the patient said ‘My spirit comes back to my body.’ Recently, researchers have tried to formulate a neuropsychological theory to explain this syndrome and to identify the structural changes associated with this syndrome.2 However, these approaches have failed to adequately explain the severe and enigmatic symptoms of this syndrome, even though previous studies have demonstrated high dopaminergic activities in psychotic depression.3 In this case, we focused on the plasma monoamine metabolite levels, which had drastically increased, and then normalized, on improvement of clinical symptoms. The high levels of HVA and total and free MHPG were not thought to be due to medication before admission, taking into account that her adherence to medication was poor. In addition, laboratory findings did not suggest any physical condition that could be responsible for the increased plasma monoamine metabolite levels. We attribute the symptoms of this patient to the broad disruption of the neurotransmission systems, including the dopamine and noradrenaline systems. In conclusion, we introduce a new standpoint: some patients develop Cotard's syndrome in the presence of other neurochemical disorders.

Cotard's syndrome as an adverse effect of acyclovir treatment in renal failure

Cotard's syndrome as an adverse effect of acyclovir treatment in renal failure

Predicting Diagnostic Change Among Patients Diagnosed With First-EpisodeDSM-IV-TRMajor Depressive Disorder With Psychotic Features

Longitudinal studies beginning from onset of major depressive disorder (MDD) with psychotic features in young adults are rare; therefore, in this study, subjects across a wide age range were included. Since psychotic MDD may be unstable diagnostically, we systematically evaluated such patients prospectively from first episode to ascertain predictors of later diagnostic change. In this prospective naturalistic study, we recruited patients with DSM-IV-TR psychotic MDD from 1989 through 2003 at psychiatric inpatient units in Massachusetts and Italy and followed them from first hospitalization to compare demographic, antecedent, and first-episode clinical characteristics for associations with later changes of diagnosis based on interviews using the Structured Clinical Interview for DSM-III-R, Patient Version. Within a mean (SD) of 4.0 (2.7) years, diagnoses among 107 subjects aged 34.6 (16.2) years (range, 10-82 years) who were experiencing a first lifetime DSM-IV-TR psychotic MDD episode changed in 29.9% to DSM-IV-TR bipolar disorder (18.7%) or schizoaffective disorder (11.2%). Factors associated with stable diagnoses of psychotic MDD included ontological anguish (χ(2) = 13.8, P < .0001), nihilistic delusions (χ(2) = 4.47, P = .034), and weight loss (χ(2) = 4.69, P = .030) at initial syndromal presentation. Factors preceding diagnoses of bipolar disorder included antecedent impulsivity (χ(2) = 9.10, P = .003), ICD-10 mixed states at intake (χ(2) = 19.4, P < .0001), and previous hypomanic symptoms (χ(2) = 13.7, P = .002). Factors predicting later schizoaffective diagnoses included mood-incongruent delusions (χ(2) = 9.17, P = .002) and somatosensory hallucinations (χ(2) = 9.53, P = .033) at intake, previous functional decline (χ(2) = 8.13, P = .008), initial Schneiderian first-rank symptoms (χ(2) = 10.6, P = .005), and meeting criteria for ICD-10 schizoaffective disorder at intake (χ(2) = 24.9, P < .0001). Among patients who initially met DSM-IV-TR criteria for first-episode psychotic MDD, early indications of features typically associated with bipolar disorder or with nonaffective psychoses, respectively, strongly predicted later diagnostic change to bipolar disorder or schizoaffective disorders. The findings support the value of psychopathological details in improving diagnostic and prognostic criteria for complex illnesses.

Lyme disease or a complication of delusional parasitosis?

Australian & New Zealand Journal of Psychiatry, 48(1) severe depression with delusional thoughts about inappropriate digestive tract function, aversion to eating and further weight loss continued. We also observed further life-threatening weight loss despite a high-calorie diet. Apart from hyperthyroidism other diseases were excluded. The patient maintained compliance of all prescribed drugs (sertraline 100 mg/ day, risperidone 5 mg/day, mirtazapine 45 mg/day and methimazole 40 mg/day). Repeat blood tests showed TSH 46.8039 uIU/ml, fT4 1.47 ng/dl and fT3 1.60 pg/ml. On the basis of these results the endocrinologist diagnosed hypothyroidism. Treatment with 25 μg/day of levothyroxinum up to a dose of 150 μg/day was started and after a few weeks euthyroid (normal thyroid function) was obtained. Despite this the patient still had suicidal thoughts, nihilistic delusions and hypochondriacal delusions related to the necrobiosis of his digestive tract. As a result, ECT was commenced. The patient received a course of 12 procedures of ECT under anaesthesia every second day. Simultaneously, the patient received venlafaxine 225 mg/day and olanzapine 10 mg/day. ECT together with pharmacotherapy was effective. The patient’s mood, appetite and psychomotor drive increased and delusions with suicidal thoughts disappeared. This case report distinctly shows that the coexistence of a somatic disease (thyroid hormone imbalance) might cause a significant delay in the onset of starting ECT in patients with drugresistant depression. Therefore, it is crucial to obtain euthyroid as soon as possible, otherwise the inability to use ECT and antidepressant drugs can be fatal.

Cotard Syndrome with Catatonia: Unique Combination

Cotard syndrome is a rare psychiatric condition characterized by extreme nihilistic delusions. Catatonia though common, its combination with the Cotard syndrome is exceeding rare and more so the response with the pharmacotherapy as in our case. Since, both are found in organic conditions the importance of studying such a case is to understand the underlying neurobiologic determinants.

Cotard delusion after stroke

Cotard delusion after stroke

Cotard's syndrome and major depression with psychotic symptoms

Cotard's syndrome and major depression with psychotic symptoms