Cotard syndrome

Description

A rare condition characterized by nihilistic delusions, where a patient believes that they are dead, have missing organs, or have decaying or failing body parts.

The other prominent symptoms in a patient with Cotard syndrome are depressed mood (89% of cases), anxiety (65%), delusions of guilt (63%), delusions of immortality (55%) and hypochondriac delusions (58%)

Cotard syndrome can result from both psychiatric and neurological disorders. It has been observed in depression, schizophrenia, bipolar affective disorder, traumatic brain injury, cerebrovascular disease, brain neoplasm, multiple sclerosis, and encephalitis.

Treatment options include the use of antidepressants, mood stabilisers, antipsychotics and electroconvulsive therapy.

History of Cotard syndrome

1880 – Jules Cotard delivered a lecture at the Société Medico-Psychologique entitled Du d´elire hypocondriaque dans une forme grave de la m´elancolie anxieuse describing the case of a 43 year old woman who had asked to be burned alive and had made various suicidal attempts. She believed that she had

…no brain, nerves, chest, or entrails, and was just skin and bone…that neither God or the devil existed. She did not need food, for “she was eternal and would live forever.

Jules Cotard. 1880; 4: 168-174

1882 – Cotard introduced the term délire des negations  (delirium of negation) to describe a new type of depression/melancholia with the central feature of the syndrome being a nihilistic delusion, in which the patient denies his or her own existence or of a part of their body, and that of the external world.

1893 – Emil Regis coined the term Cotard’s syndrome and stated that it might be linked to psychiatric disorders other than depression [1893; 64: 61-64]. The eponym was made popular by Jules Séglas [1887; 46: 417-419].

1933 – Loudet and Martinez attempted to classify different types of the syndrome into non-generalised delire de negation, associated with paralysis, alcoholic psychosis or dementia and the “real’ Cotard syndrome only found in anxious melancholia and chronic hypochondria.

1968 – Saavedra proposed 3 classifications: depressive; mixed; and schizophrenic

1995– Berrios and Luque reported three types of Cotard’ syndrome after conducting a thorough review of the literature;

• Psychotic depression where patients have melancholia and nihilistic delusions
• Cotard type 1which are the pure forms of nihilistic delusions without depressive symptoms
• Cotard type 2 with a mixed group of symptoms of anxiety, depression and auditory hallucinations and nihilistic delusions

Associated Persons

• Jules Cotard (1840 – 1899)

Alternative names

• Cotard’s delusion; Cotard’s syndrome (described 1880; attributed 1893)
• Le délire des négations
• nihilistic delusional disorder
• Walking corpse syndrome

Controversies

The idea of melancholia had been around for centuries and some academics have the opinion that Cotard did not describe a new disorder, but rather a severe form of melancholia.

There are no exact criteria for Cotard’s syndrome and it is not listed as a specific disorder in the 5^th edition of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or the International Classification of Disease (ICD-10). It may be viewed as belonging under the category of somatic delusions or as mood-congruent delusions within a depressive episode with psychotic features.

References

• Cotard J. Délire hypochondriaque dans une forme grave de la mélancolie anxieuse. Annales médico-psychologiques. 1880; 4: 168-174
• Cotard J. Du délire des négations. Archives de neurologie, 1882; 4: 152-170, 282-296
• Régis E. Note historique et clinique sur le délire des négations. Gazette médicale de Paris. 1893; 64: 61-64.
• Séglas J. Mélancholie anxieuse avec délire des negations. Le Progrès Médical. 1887; 46: 417-419
• Loudet O, Martinez DL. Sobre la psicoe´nesis y el valor pronostico del sindrome de Cotard. Archivos Argentinos de Neurologíal. 1933;1:1-12.
• Saavedra V. El syndrome de Cotard. Consideraciones psicopathologicas y nosograficas. Revista de Neuro-Psiquiatria. 1968;11:175-211.
• Berrios GE, Luque R. Cotard’s delusion or syndrome?: a conceptual history. Compr Psychiatry. 1995 May-Jun;36(3):218-23.
• Berrios GE, Luque R. Cotard’s “On hypochondriacal delusions in a severe form of anxious melancholia”. Hist Psychiatry. 1999 Jun;10(38 Pt 2):269-78. [PMID 11623880]
• Debruyne H, Portzky M, Van den Eynde F, Audenaert K. Cotard’s syndrome: a review. Curr Psychiatry Rep. 2009 Jun;11(3):197-202.
• Debruyne H, Portzky M, Peremans K, Audenaert K. Cotard’s syndrome. Mind Brain. 2011;2:67–72.
• Ramirez-Bermudez et al. Cotard Syndrome in Neurological and Psychiatric Patients. J Neuropsychiatry Clin Neurosci. 2010;22:409-416.
• Morgado P, Ribeiro R, Cerqueira JJ. Cotard Syndrome without Depressive Symptoms in a Schizophrenic Patient. Case Rep Psychiatry. 2015
• Huarcaya-Victoria J, Ledesma-Gastanadul M, Huete-Cordova M. Cotard’s Syndrome in a Patient with Schizophrenia: Case Report and Review of the Literature. Case Reports in Psychiatry. 2016
• Grover S, Aneja J, Mahajan S, Varma S. Cotard’s syndrome: Two case reports and a brief review of literature. Journal of Neurosciences in Rural Practice. 2014;5:S59-S62
• Cipriani G et al. ‘I am dead’: Cotard syndrome and dementia. Int J Psychiatry Clin Pract. 2019 Mar 8:1-8. [PMID 30848970]

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