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Jules Cotard (1840-1889): His life and the unique syndrome which bears his name
Abstract
Dr. Jules Cotard (1840-1889) was a Parisian neurologist who first described the délire des négations. Cotard's syndrome or Cotard's delusion comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost organs, blood, or body parts to believing that one has lost one's soul or is dead. In its most profound form, the delusion takes the form of a professed belief that one does not exist. Encountered primarily in psychoses such as schizophrenia and bipolar disorder, Cotard's syndrome has also been described in organic lesions of the nondominant temporoparietal cortex as well as in migraine. Cotard's delusion is the only self-certifiable syndrome of delusional psychosis. Jules Cotard, a Parisian neurologist and psychiatrist and former military surgeon, was one of the first to induce cerebral atrophy by the experimental embolization of cerebral arteries in animals and a pioneer in studies of the clinicopathologic correlates of cerebral atrophy secondary to perinatal and postnatal pathologic changes. He was the first to record that unilateral cerebral atrophy in infancy does not necessarily lead to aphasia and was also the pioneer of studies of altered conscious states in diabetic hyperglycemia.
... Jules Cotard was born on June 1 st 1840s, in Issoudun, France. He studied medicine in Paris, and always showed interesting in pathologies that affected the central nervous system (CNS) [1,2]. During years, he studied melancholia, which it was associated with a specific delirium type, namely "délire des negations" (term from French) [3]. ...
... All observations led to a new term in psychiatric area, called Cotard's delirium [1,5] which during a long time was called Delirium of negations. This term was applied to cases of patients with negation symptoms, including the own existence and outside world [1,2,5,[8][9][10][11][12][13][14]. Often, these patients claimed to be a parallel spectral reality around the "real world", lying in hell or Gehenna (biblical valley near Jerusalem, which represented the purgatory, known as the Valley of the Son of Hinnom) [15]. ...
... Cotard's syndrome generally is defined as a nihilistic delusion [7,10,[16][17][18][19][20] in which the patient claims to be dead or be paradoxically immortal [9,15,[21][22][23][24][25][26][27][28][29][30][31][32]. In addition, the patient can affirm that has no soul, his biological functions are not supported, or is dismembered or internally decomposed [2,28,30,31,33]. In many cases, the patient might experience an olfactory hallucinations type and/or kinesthetic [34], with constant complaints as exposure to the decomposition of the his body or absence of organs [3,35]. ...
This study aimed to perform a literature review about Cotard's syndrome, or delusions of negations (as it is also called). Data collection was based on the following search websites: Science Direct, Web of Science, PsycINFO, Medline, PubMed, Lilacs and Scielo, without limit time between publications. All papers found in review literature, in total 297, were selected and analyzed. In according with results, it was possible to organize a general survey about this very rare syndrome, discussing their symptoms, probable etiology, neurochemical processes involved, clinical diagnosis and treatment. In addition, it was also possible to construct a list of the most commonly prescribed drugs by pshychiatrists, including per day dosage administered and the pharmacological class. In this view, it was observed among these most prescribed drugs, antidepressants represent the main class employed in treatment of these patients. After statistical analysis, it was observed the incidence of this syndrome in repoted cases, using sex and age as variables, showing a great incidence upon female individuos between 50 and 59 years old. © 2016, Journal of Chemical and Pharmaceutical Research. All rights reserved.
... Cotard's Syndrome (CS) is a rare clinical entity first described in detail in 1880 by the Parisian neurologist and psychiatrist Jules Cotard. By describing the case of a 43-year-old woman, he first characterized the syndrome as a collection of negation or nihilistic delusions, immortality delusions, and hypochondriac delusions [1,2]. As such, patients can report delusional beliefs that they are already dead, that their organs are rotting from the inside, that nothing can harm them further as they are already dead, or that they are already suffering from an incurable disease or gross malformity [1,2]. ...
... By describing the case of a 43-year-old woman, he first characterized the syndrome as a collection of negation or nihilistic delusions, immortality delusions, and hypochondriac delusions [1,2]. As such, patients can report delusional beliefs that they are already dead, that their organs are rotting from the inside, that nothing can harm them further as they are already dead, or that they are already suffering from an incurable disease or gross malformity [1,2]. While he initially described the syndrome as a form of anxious melancholia [3], Cotard's Syndrome is now more commonly conceptualized as a syndrome secondary to many other conditions both psychiatric (psychosis, mood disorders) and neurological (brain lesions, dementia) [4,5]. ...
Background
Cotard’s Syndrome (CS) is a rare clinical entity where patients can report nihilistic, delusional beliefs that they are already dead. Curiously, while weight loss, dehydration, and metabolic derangements have been described as discussed above, a review of the literature revealed neither a single case of a severely underweight patient nor a serious metabolic complication such as Diabetic Ketoacidosis. Further, a search on PubMed revealed no articles discussing the co-occurrence of Cotard’s Delusion and eating disorders or comorbid metabolic illnesses such as diabetes mellitus. In order to better examine the association between Cotard’s Delusion and comorbid eating disorders and metabolic illness, we will present and discuss a case where Cotard’s delusion led to a severe metabolic outcome of DKA and a BMI of 15.
Case presentation
Mr. B is a 19 year old transgender man admitted to the hospital due to diabetic ketoacidosis secondary to Type 1 Diabetes Mellitus. Mr. B had a history of Obsessive–Compulsive Disorder, Major Depressive Disorder, and Post-Traumatic Stress Disorder. The primary pediatric team discovered that Mr. B had not been using his insulin appropriately and was severely underweight, and they believed this could be due to his underlying mental illness. The psychiatric consultation/liaison service found that Mr. B was suffering from Cotard’s delusion leading him to be noncompliant with his insulin due to a belief that he was already dead. Cotard’s delusion had in this case led to a severe metabolic outcome of DKA and a BMI of 15.
Conclusions
This case provides clinical insight into the interactions of eating disorders and Cotard’s delusion as well as the potential medical complications when Cotard’s delusion is co-morbid with medical conditions such as Diabetes Mellitus. We recommend that clinicians routinely screen patients for Cotard’s delusion and assess whether the presence of which could exacerbate any underlying medical illness. This includes clinicians taking special care in assessing patient’s caloric and fluid intake as well as their adherence to medications both psychiatric and medical. Further research could be conducted to explore the potential overlap of Cotard’s delusion and eating disorder phenomenology.
... In 1880 French neurologist Jules Cotard described a condition characterized by a delusion of negation with corporeal themes in a melancholic context [1]. At first, he formulated it as a new type of depression characterized by anxious melancholia, the idea of damnation or rejection, the insensitivity to pain, the delusions of nonexistence concerning one's own body, and the delusions of immortality [2]. Cotard categorized it as Lypémanie, a kind of psychotic depression described by Esquirol [3]. ...
... Since then, the identification of this clinical entity has received multiple corroborations: however, the object of debate was whether Cotard's Syndrome may be a distinct disorder or a symptom of other disorders [6]. Cotard's purpose was to compare the delusion of negation to the delusion of persecution as stated by his mentor Laségue and he depicted its antinomic manifestation, the 'delusion of grandeur' [2] under the same perspective in 1888. ...
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
... En el transcurso de la charla, el médico de Issoudun, describe una curiosa afección nerviosa que afectaría a una de sus pacientes (la llamada en la literatura Madeimoselle X) convencida, al parecer, bien que delirantemente, de carecer de órganos internos y estar compuesta únicamente por su piel y por sus huesos. Al mismo tiempo, el caso clínico incluirá otros delirios como el de inmortalidad y eternidad así como ideaciones acerca de una situación personal de condenación eterna que la pobre mujer reportaba padecer (Pearnd y Garder- Thorpe, 2002). Dos años más tarde, en su tratado de 1882 Études sur les maladies cérébrales et mentales, Cotard re-conceptúa dicho cuadro sintomático bajo la categoría general de délire des negation que, a partir sobre todo de la intervención de Émile Regis y J. Seglas llegaría a ser asociada con su epónimo más famoso, a título de síndrome de Cotard (Álvarez, Colina y Esteban, 2009) y ello sin perjuicio de que como ponen de manifiesto revisiones historiográficas como las de Hans Förstl y Barbara Beats (1992), se disponga de reportes anteriores a Cotard debidos, por ejemplo, a Charles Bonnet a finales del siglo XVIII. ...
Este artículo propone un análisis de las relaciones entre una idea clave del pensamiento filosófico moderno como es la del llamado cogito cartesiano y un trastorno de naturaleza psiquiátrica descrito por el médico francés Jules Cotard en las últimas décadas del siglo XIX. Mientras que Descartes, y toda la estela de sus descendientes, habrían tendido a situar en la existencia auto-trasparente del sujeto el fundamento de la filosofía en la Modernidad, los pacientes aquejados del síndrome de Cotard piensan, con el mismo grado de evidencia clara y distinta, que no existen. El ensayo termina por sugerir que trastornos psicopatológicos como el de Cotard tienden a disolver la hipóstasis cartesiana del ego apuntando en la dirección de un sujeto concebido como anómalo y atravesado por discontinuidades.
... Cotard syndrome or Walking dead syndrome is a rare and bizarre neuropsychiatric disorder, first described by Jules Cotard on 28 th June 1880 with the case of a 43 year old female patient who claimed to have no brain, nerves or heart, but would live forever with just skin and bones. [1] Cotard syndrome presents with nihilistic delusions, ranging from the perception that one has lost organs, blood or body parts to claims of having lost his soul or is dead. [2] Here, the individual presumes to be a corpse and this disorder came to be known as the Zombie syndrome. ...
Cotard syndrome is a queer mental illness where the subject has delusional assumptions such that, they are dead, or have lost their limbs or internal organs or are imperishable. The patient ultimately suffers from nihilistic delusions that they no longer exist. Though the syndrome was first recognized in the 17 th century, it is neither classified under DSM-IV-TR nor ICD-10. One of the main consequences of this syndrome is self-starvation, refusal to consume medication and negligence to counseling. Though Cotard syndrome have been reported in association with many other affective disorders, it is less often found in patients with catatonia. In this article we are studying a 45-year-old patient, adamant about being dead and claiming that his abdomen was rotting.
... [2] Patients usually show extreme nihilistic delusions such as believing they are dead or rotting; some believe that they have lost some body parts and/or their blood. [1] [6] Patients exhibit denial of self-existence while a slim majority presents odd beliefs of immortality. Depressive and anxiety symptomatology are almost always present and psychotic symptoms such as auditory hallucinations are very common. ...
We report a case of a male patient who was possibly exhibiting Cotard’s syndrome symptoms. The patient presented himself at a refugee camp in Greece and sought psychological and psychiatric support for his condition.The patient reported odd nihilistic delusions, depressive, anxiety and psychotic symptoms. He was diagnosed with psychosis and was initially treated with antipsychotics, antidepressants and mood stabilizers. Cognitive Behavioral Therapy (CBT) was the main psychological/psychotherapeutic intervention used to help alleviate anxiety and depressive symptoms. Self-help techniques were also introduced to the patient in order to improve anxiety symptoms. Results suggested only minor improvement in anxiety and moderate improvement in depressive symptoms through the use of CBT and self-help techniques.
... En su forma más profunda, el engaño toma la forma de una creencia profesa de que uno no existe. 3 Se describen tres presentaciones: depresión psicótica (caracterizados por melancolía y pocos delirios nihilistas), Cotard tipo I (presenta tristeza patológica, ansiedad e ideas delirantes de tipos hipocondríaco y negación) y Cotard tipo II (configurado por alucinaciones auditivas, ansiedad, depresión y delirios de negación) 4 . ...
Introducción: el Síndrome o Delirio de Cotard (CS) es una condición psiquiátrica infrecuente caracterizada por la presencia de delirio de negación (o nihilista), donde el paciente refiere desde pérdida de capacidades intelectuales y expresión de sentimientos, hasta la negación de la propia existencia y la del cosmos. Fue descrito por primera vez por el neuropsiquiatra francés Jules Cotard en el año 1880.
El síntoma cardinal es el delirio nihilista, que consiste en un espectro de ideas de negación normalmente relacionadas con el cuerpo (negando la funcionabilidad o presencia de uno o más órganos internos) o con la existencia (pudiendo creer que está muerto o que todos en el mundo están muertos).
Presentación de caso: se realizó el reporte de un caso de un paciente masculino de 54 años de edad, proveniente de Los Hidalgos, Provincia Puerto Plata, República Dominicana, con antecedentes de diabetes mellitus, hipertensión y trastorno esquizoide no especificado. Dicho paciente presentó los característicos delirios nihilistas, además de alucinaciones olfativas y auditivas, verborrea, aumento de la motricidad, anorexia, insomnio y soliloquio.
A pesar de la limitada bibliografía, se pretendió comparar la presentación de dicho paciente con otros casos de Delirio de Cotard.
... Los delirios nihilistas se reportan como ejemplo de delirios congruentes con el estado de ánimo, principalmente en episodios depresivos con síntomas psicóticos 15 (3). Pero también se ha asociado con esquizofrenia y trastorno afectivo bipolar, además de describirse durante la hipertermia causada por enfermedades infecciosas, tras un traumatismo craneoencefálico y otras enfermedades neurológicas 5,16 . Es así que sigue siendo de importancia el reconocimiento de este conjunto de síntomas, especialmente para tener en cuenta los mecanismos, el pronóstico y el tratamiento 3 . ...
Resumen
En 1880 Jules Cotard describió un conjunto de delirios en forma de negaciones que luego se denominó síndrome con su apellido como epónimo. Se trata de una condición infrecuente que se caracteriza por delirios nihilistas en los cuales la persona piensa que «se encuentra muerta o que el mundo ya no existe». En este documento se realiza el seguimiento de un par de casos en los que se evidencia una semiología amplia y enriquecedora desde el punto de vista descriptivo, lo que permite revisarlos junto con el delirio de Cotard a la luz de la psiquiatría moderna. El primero corresponde a un trastorno depresivo y el otro se da en el contexto de un trastorno psicótico no afectivo. Se plantea la revisión de la literatura desde lo descrito por Cotard hasta llegar a las clasificaciones psiquiátricas actuales.
... Jules Cotard (1840-1889) [ Fig. 1], was a Parisian neurologist who first described the syndrome "délire des négations" (negation delirium). Cotard's syndrome comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost an organ, blood, or body parts to believing that one has lost his soul or in its most profound form, the delusion takes the form of a professed belief that one does not exist anymore, that he is a dead man, just a walking corpse [1]. ...
Jules Cotard (1840-1889), a Parisian neurologist, described a syndrome of delirium negations which was later named after him. Some physicians in antiquity and medieval times, especially in Asia, have noticed this syndrome and categorized it as a symptom of melancholy. They have presented it as a "walking corpse syndrome", inflicting most probably veteran soldiers after suffering during ferocious battles, presenting the first cases of a post war traumatic stress disorder. Philotimus (3 rd-2 nd century BC) was the first to record it around 3rd century BC, and proposed a simple but pioneering treatment, by just putting a lead hat on the men's heads. Although various combined treatment strategies were proposed by modern psychiatry including pharmaceutical, electroconvulsive therapy, behavioural therapy and supportive psychotherapy, it seems that in antiquity a simple external intervention of supportive therapy was the main concept of confrontation, while drug administration was to be avoided.
... Cotard's syndrome was originally described in 1880 by the French psychiatrist Jules Cotard, and this relatively rare disorder is characterized by the presence of nihilistic delusion (Pearn & Gardner- Thorpe, 2002). Typically, patients believe they have lost their organs, blood or body parts, or even they are dead; the delusion is accompanied by guilt as well as the belief to be immortal. ...
Cotard'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.
... Patients presenting with Cotard's syndrome report beliefs and experiences directly contradicting Descartes' famous tenet that the one thing that can never be doubted is one's very own existence, captured in the sentence cogito ergo sum . Indeed, these patients will oftentimes claim that they are dead or that they do not exist, and as such perhaps manifest "the only self-verifying delusion of psychosis in all of medicine" [1] , as well as an embodied reductio ad absurdum (the condition "looks like cogito without ergo sum " [2] ). ...
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.
... This condition was described with details in 1880 by the Parisian neurologist and psychiatrist Jules Cotard [5]. He described the clinical condition of a 43-year-old woman who affirms not to have many organs, but only a body in decomposition. ...
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.
... (11) Mental retardation may not present or appear years after the onset of hemiparesis (12) . As Jules Cotard firstly recorded that unilateral cerebral atrophy in infancy does not necessarily lead to aphasia (13) , DDMS patient not necessarily be aphasic. ...
We report the clinical and imaging features in 16 years old girl presented with seizures, right-sided hemiparesis, hemi atrophy of the right side of the body and mental retardation. Brain MRI showed loss of left side cerebral volume with ipsilateral hypertrophy and hyperpneumatization of the paranasal sinuses and mastoid cells, suggestive of congenital type of cerebral hemi atrophy (CH) diagnosis of DDMS was made.
... 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, schizophrenia 1 , subdural hemorrhage 2 , multiple sclerosis, brain atrophy 3 and cerebral infarction 4 among others [5][6][7] . ...
... He hadn't good response to antipsychotics. Delusions were formed, fixed, unshakable belief opposite overt Evidences, non-systematized and persistence as a variant of Cotard's syndrome: the delusional theme was of the nihilistic [1]. ...
hizophrenia more than 15 years ago was admitted in psychiatry ward. He was social withdrawn, low educated from south area of Iran belong. Low socioeconomic family. He believed that he hadn’t glob in one orbit and one low extremity . He expressed that there was a blue hole in supra thyroidal that passed out water and food and it connected with his heart. Despite of all odd complaints, he hadn’t problem for see, walking and eating. He hadn’t good response to antipsychotics. Delusions were formed, fixed, unshakable belief opposite overt Evidences, non-systematized and persistence as a variant of
... First is the two-factor model or misattribution theory, according to which a subjective sense of unusual experiences like loss of emotional resonance or emptiness due to abnormal affective processing, when superimposed upon internalizing attribution causes Cotard delusion and with externalizing attribution results in Capgras delusion (12). Second is the neuroanatomical theory that states disconnection of limbic area from only face recognition cortex causes Capgras delusion, while disconnection from the whole of sensory area leads to Cotard delusion (13). ...
Cotard syndrome is a fascinating entity, in which the patient lingers under extreme nihilistic delusions. While its etiology is still unclear, modern imaging techniques have revealed interesting possibilities regarding the role of insular cortex in mediating interoception and self-perception. Our paper reports development of Cotard syndrome in a 65-years old female suffering from symptoms of dementia and depression, who’s subsequent MRI revealed atrophy of bilateral insular cortices. We propose that etiology of Cotard syndrome in this case may be a reduction in her ability to validate internal perception against external information and subsequent coloring of anomalous perceptions by depressive cognitions.
... He presented a female patient with "délire des negations" [137,138]. The syndrome "comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost organs, blood, or body parts to believing that one has lost one's soul or is dead" [139]. Cotard's can persist for a long period, even for years. ...
... Cotard syndrome (CS), on the other hand, was first described by Jules Cotard in 1880 [6] as a negation delusion, which may range from the negation of the patient's body parts to that of their own existence or of the entire world. ...
The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as "I do not have a heart," "my heart is not beating," "I can not breathe," "I am breaking apart," "I have no head" (ideas of negation) and statements about the patient being responsible for the "death of the whole world" (ideas of enormity). Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.
... 3,4 In 1868, Jules Cotard studied children who suffered early massive brain diseases with damaged broca's areas and children with absence of one hemesphere, found out that these children can speak normally contrary to the one function, one location hypothesis. 5 then came the great question, "Is the brain plastic enough to reorganize its so called hardwired map, if necessary when circumstances demand?." Latter in 1876, Otto Soltmann, 6 in his landmark experiment demonstrated that even if the motor cortex of infant dogs and rabbits are removed, they are still able to move. But unfortunately, these findings could never emerge into limelight because of the exuberant dominance of localizationist enthusiasm. ...
Neuroplasticity (also referred to as brain plasticity, cortical plasticity or cortical re-mapping) is the changing of neurons, organization of their networks, and their function via new experiences. The brain consists of nerve cells or neurons and glial cells which are interconnected, and learning may happen through changing of the strength of the connections between neurons, by adding or removing connections, or by adding new cells. "Plasticity" relates to learning by adding or removing connections, or adding cells. Contrary to the traditional belief of neurolocalizationism, which states that each region of brain is dedicated for a particular type of activity, neuroplasticity has struggled a long way and has created a safe niche in the neuroscientific hall of honor. Salute to the neuroplasticians for their efforts to revolutionize the doctrine of neurology for the better understanding of the remarkable powers of brain. This article is a brief attempt to fathom the mysterious and scientific ways of neuroplasticity.
... Cotard's delusion relates to nihilistic belief of non-existence of self and the external world (Cotard's original definition of 'le délire de négation'). Patients may believe that their body is rotting, putrefying and malodorous and that they lost their blood or internal organs [6]. In a case series of 100 patients with Cotard's syndrome, depression was reported in 89% of the subjects. ...
Dysfunction of higher cortical function and neurobehavioral syndromes may be present in up to 87% of stroke patients. These symptoms may occur less often in patients with transient ischemic attacks (36%). Approximately 22% of stroke patients may present only with cognitive and neurobehavioral symptoms without elementary neurological deficits. In this chapter we concentrate on delusions, hallucinations, misidentification syndromes, anosognosia of hemiplegia, aggressive behavior and also extended self syndrome.
Background
Cotard's delusion/Cotard's syndrome is a series of delusions ranging from a false, fixed, unshakeable belief that one has lost their soul, blood, organs, and body parts to the belief that one is dead. The syndrome was initially thought to be associated with only mood disorders but later was found in other psychiatric illnesses as well.
Aim
The study aimed to find an association between Cotard's delusion and the psychopathology of different psychiatric diagnoses.
Method
The clinical study comprised seven patients presenting with symptoms of Cotard syndrome with different presentations, diagnoses, and onset and meeting inclusion criteria. The study was carried out in the Department of Psychiatry, Assam Medical College and Hospital. The patients were hospitalized and, after a detailed history, mental status examination, and laboratory investigations, were treated with pharmacological and non-pharmacological methods. A descriptive statistical analysis was done.
Results
Denial of the existence of body organs was the most similar complaint encountered in the cases. The duration of illness onset ranged from weeks to months. The symptoms were found to be present in different psychiatric illnesses like schizophrenia, delusional disorder, depression, and intellectual disability. The patient had responded well to pharmacological agents with the exception of three patients who were treated with electroconvulsive therapy.
Conclusion
The study highlights the different subtypes of Cotard’s syndrome and its associated symptoms, which provides a better understanding of the condition. The case series presents a finding of a higher proportion of male patients and adolescent cases than in previous reports. The study also provides valuable insights into its heterogeneity in the diagnosis and treatment of Cotard’s syndrome, which may help in the early recognition and management of this rare condition.
Cotard syndrome is a mysterious and severe disorder. Many therapeutic interventions are reported as potentially efficacious mostly when an underlying psychotic depression or melancholia is diagnosed. However, the classification of depression has long been a contentious issue. Even though the major guide for therapeutic choice is severity, the binary model between endogenous and reactive depression is still widely employed in clinical practice. These considerations impact most clearly in in-between presentations. The authors present the case of R., a 64 year old woman, who was admitted with a major depressive episode with psychotic features, captured as a Cotard-like syndrome. After a two-months inpatient period and apparent clinical remission with high dose antidepressants and antipsychotic combination, she displayed an acute worsening leading to a re-admission just a day after discharge. The management in this second admission was tortuous, due to SARS-CoV2 related contingencies, the refractoriness of the presentation and iatrogenic intercurrences. The authors expose the course and treatment options employed, while reflecting on the question endogenous v. reactive, concluding that even seemingly clear clinical presentations may resist our different conceptualizations.
CME Educational Objectives
1. Identify clinical features and longitudinal course of Cotard's syndrome.
2. Manage patient outcome by better diagnostic clarification.
3. Evaluate complexity of clinical presentation of mood disorder.
In 1880, Jules Cotard described a set of delusions in the form of negations that later became his eponymous syndrome. Cotard's syndrome is an uncommon condition characterised by the presence of nihilistic delusions in which the person thinks that "they are dead or that the world no longer exists". This document describes two cases in which a broad and enriching semiology is evidenced from a descriptive point of view, which allows us to review them together with Cotard's syndrome in the light of modern psychiatry. The first case corresponds to a depressive disorder and the other occurs in the context of a non-affective psychotic disorder. A review of the literature is presented from what Cotard described until the current psychiatric classifications.
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.
Cotard's syndrome is a relatively rare condition that involves a delusion of negation in which an individual believes he or she has lost his or her soul, is dead, or is without functional body systems. This syndrome is observed in various neuropsychiatric disorders but most commonly in mood disorders. Pramipexole has often been used in the adjunctive treatment of both bipolar and unipolar depression, and it is known to cause rare but serious adverse effects such as compulsive behaviours in the treatment of Parkinson's disease. Here we report a case of Cotard's syndrome in treatment‐resistant major depression associated with abnormal behaviours that might be caused by pramipexole. In the present case, the patient's abnormal behaviours gradually disappeared about 2 months after the discontinuation of pramipexole. The hypoperfusion in the bilateral parieto‐occipital lobe found on single‐photon emission computed tomography suggests the presence of Lewy body disease pathology. Nonetheless, the patient's abnormal behaviours disappeared after the discontinuation of pramipexole, indicating that they are mainly attributable to pramipexole treatment. However, the possible existence of Lewy body pathology could facilitate the emergence of abnormal behaviours after treatment with pramipexole. The patient's abnormal behaviours, such as eating other patients' food and taking her medicine before the scheduled time, might differ from typical compulsive behaviours induced by pramipexole (such as pathological gambling and hypersexuality), but they could be regarded as disinhibition. Therefore, we should follow up on the clinical course of this case carefully through neuroimaging investigation and neurocognitive assessment.
Objective:
Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, i.e., the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition.
Method:
To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD.
Results:
Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy.
Conclusions:
Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
An important unmet need in the care of Parkinson's disease (PD) is the prediction, prevention, and satisfactory treatment of PD-associated psychosis (PDP). Psychosis in PD is predominantly medication induced and all antiparkinsonian drugs in current use are capable of producing PDP. Dementia and depression are strong predictors of risk for the development of PDP. Hallucinations and delusions can occur at any time in the course of PD, but they are most commonly seen as a later complication in susceptible individuals. Visual hallucination is the most common feature of PDP, although other types of hallucination have also been reported. Delusions, particularly paranoid type, are less common but represent a more serious clinical problem. The mechanisms responsible for producing PDP are not fully elucidated but important advances have been made. Treatment should be approached in a stepwise manner. A triggering factor, such as infection, should be excluded first. Then careful tapering of antiparkinsonian medication, starting with adjunctive medication, should be undertaken. If increased motor disability prevents adequate dosage reduction, quetiapine is a reasonable first-choice antipsychotic agent followed by clozapine. © Springer Science+Business Media New York 2013. All rights reserved.
Psychotic symptoms are common, disabling non-motor features of Parkinson's disease (PD). Despite noted heterogeneity in clinical features, natural history and therapy response, current dogma posits that psychosis generally progresses in a stereotypic manner through a cascade of events that begins with minor hallucinations and evolves to severe hallucinations and delusions. Further, the occurrence of psychotic symptoms is believed to indicate a poor prognosis. Here we propose a classification scheme that outlines the pathogenesis of psychosis as it relates to dysfunction of several neurotransmitter systems. We hypothesize that several subtypes exist, and that PD psychosis is not consistently indicative of a progressive cascade and poor prognosis. The literature was reviewed from 1990 to 2017. An overview of the features of PD psychosis is followed by a review of data indicating the existence of neurotransmitter-related subtypes of psychosis. We found that ample evidence exists to demonstrate the presence of multiple subtypes of PD psychosis, which are traced to dysfunction of the following neurotransmitter systems: dopamine, serotonin and acetylcholine. Dysfunction of each of these systems is recognizable through their clinical features and correlates, and the varied long-term prognoses. Identifying which neurotransmitter system is dysfunctional may help to develop targeted therapies. PD psychosis has various subtypes that differ in clinical features, underlying pathology and pathophysiology, treatment response and prognosis. A novel classification scheme is presented that describes the clinical subtypes with different outcomes, which could lead to the development of targeted therapies. Future research should focus on testing the viability of this classification.
Whilst the vast majority of headaches are minor ailments, some patients develop chronic symptoms that have psychiatric dimensions. These symptoms can be immensely challenging to manage and can have a serious impact on the patient's quality of life. The relationship between headache and psychiatric disease is often rationalized as cause and effect; however, the interplay between the two is complex. Management of each of the co-morbid disorders affects the other one in positive and/or negative ways. The Neuropsychiatry of Headache details the current concepts of various headache conditions and the psychiatric syndromes; topics covered include migraine, mood disorders, medication overuse and personality disorders. Headache specialists, neurologists, psychiatrists, neuropsychiatrists and neuropsychologists will find this an invaluable resource for understanding and co-managing these conditions.
Fluctuations of mood including happiness, sadness, joy, and elation are a normal part of life. Those suffering from mood disorders, however, experience extreme mood states that can impair functioning and threaten life. Psychiatric disorders are classified by groupings of symptoms and their duration in The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) [1]. Mood disorders are grouped into four broad categories: depressive disorders, bipolar disorders, mood disorder due to a general medical condition, and substance-induced mood disorders. Although we have a growing database of the biological and genetic components of the mood disorders, we are not yet able to group these disorders into more precise categories on the basis of specific pathophysiology. Patients with mood disorders are often seen in the emergency department (ED). In one recent screening study, 32% of ED patients met criteria for depression and 4% met criteria for mania [2]. In this chapter, we will provide some guidelines on the assessment and management of mood disorders in the ED setting.
This essay offers a new interpretation of the butterfly dream in the Zhuangzi, which has been the focus of vigorous inquiries and heated debates in recent years. The novelty of this attempt lies in identifying a line of reasoning in the “Qiwulun” chapter that embodies a deep puzzle about the nature of self and in unpacking how the butterfly dream passage at the end of that chapter addresses the puzzle in question. Such a reading is cast within a larger context of the Inner Chapters of the Zhuangzi, where death is a major theme. The idea of interpreting the butterfly dream in connection with the issue of death is not new. However, this idea has never been made sufficiently clear. An attempt will be made to provide a sensible and plausible reading of the butterfly dream that it is hoped will be relevant and beneficial to contemporary philosophy of self and death.
Cotard's syndrome is a relatively rare condition that involves a delusion of negation in which an individual believes he or she has lost his or her soul, is dead, or is without functional body systems. This syndrome is observed in various neuropsychiatric disorders but most commonly in mood disorders. Pramipexole has often been used in the adjunctive treatment of both bipolar and unipolar depression, and it is known to cause rare but serious adverse effects such as compulsive behaviours in the treatment of Parkinson's disease. Here we report a case of Cotard's syndrome in treatment-resistant major depression associated with abnormal behaviours that might be caused by pramipexole. In the present case, the patient's abnormal behaviours gradually disappeared about 2 months after the discontinuation of pramipexole. The hypoperfusion in the bilateral parieto-occipital lobe found on single-photon emission computed tomography suggests the presence of Lewy body disease pathology. Nonetheless, the patient's abnormal behaviours disappeared after the discontinuation of pramipexole, indicating that they are mainly attributable to pramipexole treatment. However, the possible existence of Lewy body pathology could facilitate the emergence of abnormal behaviours after treatment with pramipexole. The patient's abnormal behaviours, such as eating other patients' food and taking her medicine before the scheduled time, might differ from typical compulsive behaviours induced by pramipexole (such as pathological gambling and hypersexuality), but they could be regarded as disinhibition. Therefore, we should follow up on the clinical course of this case carefully through neuroimaging investigation and neurocognitive assessment.
A rare syndrome, Dyke-Davidoff-Masson Syndrome (DDMS), with a diagnostic conundrum, and the way it was solved is presented. DDMS is one among the syndromes associated with refractory epilepsy. We have come across a case of Dyke-Davidoff-Masson syndrome while investigating a case of refractory epilepsy. When cerebral hemi atrophy is associated with the radiological features of osseous hypertrophy of calvarium, hyper-pneumatisation of sinuses dilatation, DDMS is to be considered.Bangladesh J Medicine Jan 2014; 25 (1) : 31-34
We consider a number of syndromes incorporating paradoxical phenomena that lie at the boundary between neurology and psychiatry. Amongst the phenomena we examine are Cotard's Syndrome (belief that one is dead/dying), Capgras Syndrome (belief that a personally familiar person has been replaced by an imposter), and Apotemnophilia (desire to have a limb amputated). We use these phenomena to speculate on the manner in which the brain constructs a sense of self. We propose that, despite the extraordinary variety of paradoxical symptoms encountered in neuropsychiatry, certain key assumptions can help explain most of these self-related phenomena. (1) Discrepancies and conflict between the information dominating different brain systems. (2) Disturbance of Me/Other distinctions caused by dysfunctional interactions between the mirror neuron system, frontal lobe structures and sensory input. (3) Misattribution of symptoms to spurious causes, so as to minimize internal discrepancies. (4) The existence of three functionally distinct visual systems, as opposed to the two conventionally accepted ones, with selective damage or uncoupling between them. (5) Recruiting one neural map for another unrelated function, or one neural structure serving as a template for transcribing on to another neural structure. We suggest that, paradoxically, the mechanisms that give rise to psychiatric delusions and illusions may themselves sometimes have adaptive value in evolutionary terms.
El alumnado de enfermería requiere un estado óptimo en su salud mental, puesto que resulta imprescindible para un buen posterior desarrollo profesional. Sin embargo, son numerosos los estudios elaborados que determinan que el alumnado de enfermería presenta niveles altos de ansiedad.
Objetivo: Conocer los niveles de ansiedad rasgo y estado en estudiantes de enfermería, así como su correlación con el bienestar en el contexto académico. Se plantea la hipótesis que un nivel elevado de ansiedad se relaciona con una baja percepción de bienestar.
Metodología: Proyectaremos esta investigación aplicando una metodología cuantitativa mediante un estudio de tipo observacional, descriptivo y de corte transversal. Para tal de medir el grado de ansiedad Rasgo y Estado, se empleará el cuestionario STAI (State-Trait Anxiety Inventory). Obtendremos el bienestar en el contexto académico mediante la escala UWES-S (Utrecht Work Engagement Scale-Student).
Resultados: Se encuestó a una muestra de 37 alumnos de enfermería con una edad media de 24,97 años (DT=6,631). Se constató como 13,5% de los estudiantes presentan unos niveles elevados en cuanto a Ansiedad Rasgo, mientras que el 40,5% manifestaron unos niveles medios. Respecto a la Ansiedad Estado, un 8,1% presentan niveles altos, mientras que el 64,9% señalaban un grado medio de ansiedad. Se registró una puntuación elevada en todas las dimensiones referentes al engagement.
Conclusiones: Se observó la existencia de correlación negativa entre la Ansiedad Estado y el Engagement, especialmente en el Vigor. Por otro lado, aquellos alumnos más jóvenes presentan unos niveles de ansiedad más elevados. Conviene reflexionar sobre la necesidad de detectar y orientar los trastornos de salud mental de los estudiantes.
Palabras clave: Estudiantes, Enfermería, Ansiedad, Engagement
Introduction: In 1880, the French psychiatrist Jules Cotard described several patients who suffered from a syndrome referred to as délire de négation. This relatively rare condition is characterized by the presence of nihilist delusions in which the person who has it thinks it is dead or the world does not exist. Method: This article reports the case of a patient with a history of depressive events following a financial loss who developed symptoms consistent with Cotards Syndrome. Conclusion: This case report includes a description of the clinical course of the disorder and a systematic review of the literature.
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.
Grundlagen
Das Cotard Syndrom (CS), die Überzeugung tot zu sein, wurde erstmals 1880 beschrieben und fand seither immer wieder das Interesse von Psychopathologen, aber auch von Philosophen. In der Fachliteratur findet es sich vorwiegend in Kausuistiken über ängstlich-depressive, demente oder paranoide Patienten. Die vorliegende Arbeit versucht, die Prävalenz sowie den psychopathologischen Kontext des CS bei schizophrenen Erkrankungen zu erfassen.
Methodik
Ausgewertet wurden die Daten des österreichischen Samples (N = 346) der International Study on Psychotic Symptoms in Schizophrenia.
Ergebnisse
Ein CS fand sich in drei Fällen (0,87 %). Bei allen drei Patienten entwickelte es sich aus einem nihilistisch-hypochondrischen Wahn und einem seit längerer Zeit bestehenden progredienten Energieverlust. Die logischen Brüche der Wahnerzählung wurden in zwei Fällen durch illusionäre Verkennungen, im dritten Fall durch eine wahnhafte Situierung in einem Zwischenreich zwischen Diesseits und Jenseits überbrückt.
Schlussfolgerungen
Das CS kann einerseits als eine besondere Form der Verarbeitung der Todesthematik im Wahn, andererseits als eine nihilistische Wahnidentität aufgefasst werden. Dieses seltene, jedoch überaus faszinierende und bizarre psychotische Phänomen wird wohl noch länger Gegenstand des Interesses sowohl der allgemeinen Psychopathologie als auch der Philosophie des Geistes sein.
Introduction: In 1880, the French psychiatrist Jules Cotard described several patients who suffered from a syndrome referred to as délire de négation. This relatively rare condition is characterized by the presence of nihilist delusions in which the person who has it thinks "it is dead or the world does not exist". Method: This article reports the case of a patient with a history of depressive events following a fi nancial loss who developed symptoms consistent with Cotard's Syndrome. Conclusion: This case report includes a description of the clinical course of the disorder and a systematic review of the literature.
A rare syndrome, Dyke-Davidoff-Masson Syndrome (DDMS), with a diagnostic conundrum, and the way it was solved is presented. A 13-yearold boy presented with recurrent seizures for the past 10 years. He had been treated with anticonvulsant medication which was satisfactory at first but later the seizures recurred. Recently, the frequency of the seizures increased with preictal dizziness and postictal drowsiness. Physical examination revealed mild left hemiparesis and left deviated gait irregularity. He was mentally alert but had not achieved all the developmental milestones as compared to normal child of his age. CT and MRI scan of the head showed hemiatrophic cerebral parenchyma with prominent sulci and encephalomalacia. 24-hour intensive video EEG monitoring revealed suppression of alpha rhythm and local slow wave activity on the side of the atrophic hemisphere. PET-CT showed highly functional left cerebral hemisphere and less functional right cerebral hemisphere. The patient underwent functional hemispherectomy under neurophysiological monitoring and the nonfunctional brain tissues were resected while selectively preserving the functional areas detected by fMRI and PET-CT scan. During follow up, the patient was seizure free as well as without difficulties in performing his daily activities and communications. Functional hemispherectomy for DDMS patient has a good prognosis.
BACKGROUND: The Cotard-Syndrome (CS), the belief of being dead, was described for the first time in 1880. Since then it met the interest not only of psychopathologists but also of philosophers. With a few exceptions, the literature is mainly restricted to case reports of anxious-depressive, demented or paranoid patients. It was the aim of our study to investigate the prevalence and the psychopathological context of the CS. METHODS: We analyzed the Austrian data (N = 346) of the International Study of Psychotic Symptoms in Schizophrenia. RESULTS: A CS could be diagnosed in three cases (0.87 %). In all of them, CS developed on the basis of nihilistic-hypochondriac delusions and a progressive loss of energy. Two patients bridged the logical inconsistencies between obviously being alive and the belief of being dead by visual illusions, the third patient, however, by locating himself in an intermediate region between this world and the afterworld. CONCLUSIONS: On the one hand the CS can be considered as a special manifestation of the topic of death in schizophrenic delusions, on the other as a nihilistic delusional identity. Without doubt, this uncommon and bizarre psychotic phenomenon will be an object of interest for general psychopathology as well as for the philosophy of mind also in future.
Studies of young children with unilateral perinatal stroke (PS) have confirmed the plasticity of the developing brain for acquiring language. While recent studies of typically developing children have demonstrated the significant development of language well into adolescence, we know little regarding the course of language development in the PS group as they mature. Will children with PS continue to show the same remarkable plasticity that they exhibited at younger ages? In the present paper we investigate later language and discourse in children with perinatal stroke (ages 7-16) using spoken personal narrative as the discourse context. In contrast to the findings of the discourse studies of younger children with PS, children with left hemisphere lesions made more morphological errors, used less complex syntax and fewer syntactic types than controls; they also produced more impoverished story settings. In contrast, those with right hemisphere lesions performed comparably to controls, except in their impoverished use of complex syntax. The findings provide insight into the nature of later spoken language development in these children, revealing both the nature and extent of neuroplasticity for language as well as potential regional biases.
The clinical assessment of non-communicative brain damaged patients is extremely difficult and there is a need for paraclinical diagnostic markers of the level of consciousness. In the last few years, progress within neuroimaging has led to a growing body of studies investigating vegetative state and minimally conscious state patients, which can be classified in two main approaches. Active neuroimaging paradigms search for a response to command without requiring a motor response. Passive neuroimaging paradigms investigate spontaneous brain activity and brain responses to external stimuli and aim at identifying neural correlates of consciousness. Other passive paradigms eschew neuroimaging in favour of behavioural markers which reliably distinguish conscious and unconscious conditions in healthy controls. In order to furnish accurate diagnostic criteria, a mechanistic explanation of how the brain gives rise to consciousness seems desirable. Mechanistic and theoretical approaches could also ultimately lead to a unification of passive and active paradigms in a coherent diagnostic approach. In this paper, we survey current passive and active paradigms available for diagnosis of residual consciousness in vegetative state and minimally conscious patients. We then review the current main theories of consciousness and see how they can apply in this context. Finally, we discuss some avenues for future research in this domain.
Im Jahre 1880 beschrieb der Pariser Neurologe und Psychiater Dr. med. Jules Cotard (geb. 1840, verstorben 1889) ein psychisches
Zustandsbild, das er als einen speziellen Typus einer agitierten Melancholie/Depression verstand und als dessen Besonderheit
er ein „délire des négations“ herausstellte; später ging dieses Bild als „Cotard-Syndrom“ in die Literatur ein (Arenz 2003, Arenz u. Lange 2002, Berrios u. Luque 1995a, Berrios u. Luque 1995b, Colthaert et al. 2007, Cotard 1880, 1882, Eynde van den et al. 2008, Haupt u. Kretschmar 2002, Hüll u. Förstl 2009, Pearn u. Gardner-Thorpe 2002, Peschke u. Hoffstadt 2008, Talbott 2001, Tölle 2008, Young et al. 1994).
There has been a growing recognition that psychosis, its impact on the treatment of motor symptoms, and its interaction with
cognitive dysfunction, represent a major unmet need in the treatment of advanced Parkinson’s disease (PD). Psychosis in PD
is predominantly, although perhaps not exclusively, medication-induced. All anti-Parkinsonian drugs in current use, not just
levodopa, are capable of producing drug-induced psychosis in patients with PD. Cognitive impairment and depression are strong
predictors of risk for the development of hallucinations with PD. Hallucinations and psychosis can occur at any time in the
course of PD, but they are most commonly seen as a late complication in susceptible individuals. Visual hallucinations are
the most common feature of drug-induced psychosis in PD, although other types of hallucinations have also been reported. Insight
that the images are not real may be retained. The mechanisms responsible for producing drug-induced psychosis in PD are poorly
understood, and treatment can be approached in a stepwise manner. A triggering factor, such as infection, should be excluded.
If one is not discovered, step-by-step tapering of anti-Parkinson medication should then be undertaken. If increased motor
disability prevents adequate dosage reduction, quetiapine is a reasonable first-choice antipsychotic agent to employ.
We report the case of a middle-aged woman with Cotard's syndrome in whom clinical course was evaluated according to stages. Longitudinally this syndrome seems to have three stages, namely germination, blooming and chronic (depressive type/paranoid type) stages. In this patient, the chronic stage, primarily characterized by delusions, was observed without raising suspicion of affective disorder. She did not respond to any pharmacotherapies, but improved dramatically after ECT performed during the chronic stage. Although symptoms change according to the stage, most cases of Cotard's syndrome may belong to the affective spectrum and are probably best treated with ECT, as documented here. In evaluation of the mode of separation between emotion and cognition during follow-up it is important to consider stage and diagnosis.
An elderly woman developed the delusion that she was dead ('Cotard's delusion') and that she was in another place ('reduplicative paramnesia'). Charles Bonnet reported this unique combination of symptoms a century before Cotard's influential description of the nihilistic delusions and of Pick's description of 'reduplicative paramnesia'.
The hallmark of Cotard's syndrome is the delusion of being dead. The literature indicates that it is often associated with parietal lobe lesions. This association was investigated by blindly comparing the computed tomographic scans of eight patients who had Cotard's syndrome (one of whom is described) with those of eight controls matched as closely as possible for age, sex, race, and principal psychiatric diagnosis. Two trends emerged. Compared with controls, patients with Cotard's syndrome had more brain atrophy in general and more median frontal lobe atrophy in particular. Parietal disease did not discriminate between the index and control groups. Cotard's syndrome may be associated with multifocal brain atrophy and medial frontal lobe disease.
In 1880, Jules Cotard reported a clinical state he believed was a new type of agitated melancholia. A statistical analysis has been carried out of 100 cases of Cotard's syndrome to determine how this clinical concept has fared since its inception. In terms of clinical profile, no difference was found between men and women or between underlying diagnostic categories; age seemed to increase the likelihood of developing délire des négations. Depression was reported in 89% of subjects; the most common nihilistic delusions concerned the body (86%) and existence (69%). Anxiety (65%) and guilt (63%) were also common, followed by hypochondriacal delusions (58%) and delusions of immortality (55). An exploratory factor analysis extracted 3 factors: psychotic depression, Cotard type I and Cotard type II. The psychotic depression factor included patients with melancholia and few nihilistic delusions. Cotard type 1 patients, on the other hand, showed no loadings for depression or other disease and are likely to constitute a pure Cotard syndrome whose nosology may be closer to the delusional than the affective disorders. Type II patients showed anxiety, depression and auditory hallucinations and constitute a mixed group. This new grouping cuts across the more traditional view and may have therapeutic implications. Authors, in general, have considered délire des négations as a syndrome rather than a new disease and do not seem to support the view that the completeness of the syndrome is a function of presence or severity of depression. The view that délire des négations refers only to the delusion of being dead has also carried little favour as its likely to waste information.
We explore the relation between the Capgras delusion (the belief that your relatives have been replaced by impostors) and the Cotard delusion (the delusional belief that you have died). At first sight, these delusions would seem to have little to do with each other, except that they both involve bizarre claims about existence (for self or others). On closer examination, however, there are other parallels. Here, we summarise similarities in associated impairments of face perception, and argue that both delusions reflect an interaction of impairments at two levels. One set of contributory factors involves perceptual impairment, or anomalous perceptual experience. The other factors lead to an incorrect interpretation of this, for which we offer an explanation in terms of attribution theory. Although the Capgras and Cotard delusions are phenomenally distinct, they may therefore represent attempts to make sense of fundamentally similar experiences.
Cotard's syndrome is a psychotic condition often associated with nihilistic delusions. This syndrome can be associated with destructive behaviors directed at the self and/or others. In this report we highlight the psychiatric-legal issues involving a case of Cotard's syndrome associated with self-starvation.
The aim of this paper is to document regular nocturnal intensification of delusional nihilistic and persecutory ideas (Cotard delusion) linked with extreme depersonalisation and hypervivid dreaming.
A 17-year-old man presented with Cotard and Capgras delusions after sustaining multiple cognitive impairments secondary to traumatic brain injury. Treatment and outcome: Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily.
This patient's experience of perceptual abnormalities and impairments in meta-abilities related to self-monitoring and critical inferencing lends support to multicomponent sensory processing accounts of brain injury related, content-specific delusional syndromes.
Public events can be incorporated into the mental life and life narratives of children with psychiatric illnesses. A 10-year-old boy who was not in Oklahoma City at the time of the 1995 bombing of the Murrah Federal Building and who knew no one directly impacted, claimed that he himself was dead, then that his grandfather, and finally that a peer and the peer's family had been killed in the blast. This is the first known reported case of Cotard's syndrome, the delusion of being dead, in a prepubescent child. The article also explores the relationships between this boy's symptoms, transference phenomena, real life events, themes of loss, abandonment, neglect, and death, and his fabricated stories.
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Etudes Physiologiques et Pathologiques sur la Ramollissement Cerebral [with Coloured Plates I to IV]. Paris: Adrien DelahayeThis book also contains the reference to Cotard's and Charcot's joint presentation of a clinical case of herpes infection of the neck
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