Cotard’s Syndrome

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1.Cotard’s syndrome is named after Jules Cotard, a French neurologist who described the condition in 1880. Also known as Délire de négation.

2. Cotard’s syndrome is characterized by nihilistic delusions focused on the individual’s body including loss of body parts, being dead, or not existing at all. [Debruyne et al., 2009]

Mrs X, affirms she has no brain, no nerves, no chest, no stomach, no intestines; there’s only skin and bones of a decomposing body. … She has no soul, God does not exist, neither the devil. She’s nothing more than a decomposing body, and has no need to eat for living, she cannot die a natural death, she exists eternally if she’s not burned, the fire will be the only solution for her. [Cotard J 1880]

3. The most prominent features of Cotard’s syndrome are depressive mood (89%), nihilistic delusions concerning one’s own body (86%), nihilistic delusions concerning one’s own existence (69%), anxiety (65%), delusions of guilt (63%), delusions of immortality (55%) and Hypochondriacal delusions (58%).

4. Berrios and Luque subdivided Cotard’s syndrome into three types. [Berrios and Luque, 1995]

  • A first type included a form of psychotic depression, characterized by anxiety, melancholic delusions of guilt, and auditory hallucinations.
  • A second type, described as Cotard’s syndrome type I, was associated with hypochondriac and nihilistic delusions and absence of depressive episodes.
  • The third group was the Cotard’s syndrome type II, with anxiety, depression, auditory hallucinations, delusions of immortality, nihilistic delusions, and suicidal behaviour as characteristic features

5. Based on the classification of Berrios and Luque, the suggestion was made that ECT is indicated in patients with Cotard’s syndrome and psychotic depression, while antipsychotics exert better effects in Cotard’s syndrome type I.