Cotard delusion
Encyclopedia
The Cotard delusion or Cotard's syndrome or Walking Corpse Syndrome is a rare neuropsychiatric
disorder
in which people hold a delusion
al belief that they are dead
(either figuratively or literally), do not exist, are putrefying
, or have lost their blood
or internal organs. In rare instances, it can include delusions of immortality.
(1840–1889), a French
neurologist
who first described the condition, which he called le délire de négation ("negation delirium"), in a lecture in Paris
in 1880. He described the syndrome as having degrees of severity that range from mild to severe. Despair and self-loathing characterize a mild state.
In this lecture, Cotard described a patient with the pseudonym
of Mademoiselle X, who denied the existence of God
, the Devil
, several parts of her body, and her need to eat. Later she believed she was eternally
damned
and could no longer die a natural death. She later died of starvation.
accident:
, and both are thought to result from a disconnect between the brain areas that recognize faces (fusiform face area
s) and the areas that associate emotions with that recognition (the amygdala
and other limbic structures). This disconnection creates a sense that the observed face is not the person's it purports to be, and therefore lacks the familiarity that should be associated with it. If it is a relative's face, it is experienced as an impostor's (Capgras); if the sufferer sees their own face they may feel no association between it and their sense of self, resulting in a sense that they do not exist.
Cotard's syndrome is encountered primarily in psychoses
such as schizophrenia
and bipolar disorder
. It can arise in the context of neurological or mental illness
and is particularly associated with depression
and derealization
. It has even been described in migraine
.
Cotard delusion has also been the result of adverse drug reactions to (val)acyclovir. The symptoms were associated with high serum concentrations of CMMG, the principal metabolite
of acyclovir. Patients with impaired renal function
seem to be at risk even after dose reduction; in the cited case, haemodialysis cured the delusions in a few hours and it is suggested that this mental state may not always be a cause for psychiatric hospitalization.
Antidepressants, antipsychotics and mood stabilisers are used. Many report positive effect with electroconvulsive therapy
, mostly in combination with pharmacotherapy
. An overall prognosis seems to be mostly determined by the treatment options and prognosis of the underlying disorder.
Neuropsychiatry
Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....
disorder
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
in which people hold a delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
al belief that they are dead
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
(either figuratively or literally), do not exist, are putrefying
Putrefaction
Putrefaction is one of seven stages in the decomposition of the body of a dead animal. It can be viewed, in broad terms, as the decomposition of proteins, in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs.-Description:In terms of...
, or have lost their blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
or internal organs. In rare instances, it can include delusions of immortality.
History
The syndrome is named after Jules CotardJules Cotard
Jules Cotard was a French neurologist who is best known for first describing the Cotard delusion, a patient's delusional belief that they are dead, do not exist or do not have bodily organs.-Education:...
(1840–1889), a French
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
who first described the condition, which he called le délire de négation ("negation delirium"), in a lecture in Paris
Paris
Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...
in 1880. He described the syndrome as having degrees of severity that range from mild to severe. Despair and self-loathing characterize a mild state.
In this lecture, Cotard described a patient with the pseudonym
Pseudonym
A pseudonym is a name that a person assumes for a particular purpose and that differs from his or her original orthonym...
of Mademoiselle X, who denied the existence of God
God
God is the English name given to a singular being in theistic and deistic religions who is either the sole deity in monotheism, or a single deity in polytheism....
, the Devil
Devil
The Devil is believed in many religions and cultures to be a powerful, supernatural entity that is the personification of evil and the enemy of God and humankind. The nature of the role varies greatly...
, several parts of her body, and her need to eat. Later she believed she was eternally
Eternity
While in the popular mind, eternity often simply means existence for a limitless amount of time, many have used it to refer to a timeless existence altogether outside time. By contrast, infinite temporal existence is then called sempiternity. Something eternal exists outside time; by contrast,...
damned
Damnation
Damnation is the concept of everlasting divine punishment and/or disgrace, especially the punishment for sin as threatened by God . A damned being "in damnation" is said to be either in Hell, or living in a state wherein they are divorced from Heaven and/or in a state of disgrace from God's favor...
and could no longer die a natural death. She later died of starvation.
Signs and symptoms
Young and Leafhead describe a modern-day case of Cotard delusion in a patient who suffered brain injury after a motorcycleMotorcycle
A motorcycle is a single-track, two-wheeled motor vehicle. Motorcycles vary considerably depending on the task for which they are designed, such as long distance travel, navigating congested urban traffic, cruising, sport and racing, or off-road conditions.Motorcycles are one of the most...
accident:
Pathophysiology
Neurologically, Cotard's is thought to be related to the Capgras delusionCapgras delusion
The Capgras delusion theory is a disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor...
, and both are thought to result from a disconnect between the brain areas that recognize faces (fusiform face area
Fusiform face area
The fusiform face area is a part of the human visual system which might be specialized for facial recognition, although there is some evidence that it also processes categorical information about other objects, particularly familiar ones.-Localization:...
s) and the areas that associate emotions with that recognition (the amygdala
Amygdala
The ' are almond-shaped groups of nuclei located deep within the medial temporal lobes of the brain in complex vertebrates, including humans. Shown in research to perform a primary role in the processing and memory of emotional reactions, the amygdalae are considered part of the limbic system.-...
and other limbic structures). This disconnection creates a sense that the observed face is not the person's it purports to be, and therefore lacks the familiarity that should be associated with it. If it is a relative's face, it is experienced as an impostor's (Capgras); if the sufferer sees their own face they may feel no association between it and their sense of self, resulting in a sense that they do not exist.
Cotard's syndrome is encountered primarily in psychoses
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
such as schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
. It can arise in the context of neurological or mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
and is particularly associated with depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
and derealization
Derealization
Derealization is an alteration in the perception or experience of the external world so that it seems unreal. Other symptoms include feeling as though one's environment is lacking in spontaneity, emotional coloring and depth. It is a dissociative symptom of many conditions, such as psychiatric and...
. It has even been described in migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
.
Cotard delusion has also been the result of adverse drug reactions to (val)acyclovir. The symptoms were associated with high serum concentrations of CMMG, the principal metabolite
Metabolite
Metabolites are the intermediates and products of metabolism. The term metabolite is usually restricted to small molecules. A primary metabolite is directly involved in normal growth, development, and reproduction. Alcohol is an example of a primary metabolite produced in large-scale by industrial...
of acyclovir. Patients with impaired renal function
Renal function
Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate describes the flow rate of filtered fluid through the kidney...
seem to be at risk even after dose reduction; in the cited case, haemodialysis cured the delusions in a few hours and it is suggested that this mental state may not always be a cause for psychiatric hospitalization.
Treatment
Treatment should follow a thorough diagnostic work-up of the underlying disorder. There are several reports of successful pharmacological treatment. As well monotherapeutic as combination strategies are reported.Antidepressants, antipsychotics and mood stabilisers are used. Many report positive effect with electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
, mostly in combination with pharmacotherapy
Pharmacotherapy
Pharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy....
. An overall prognosis seems to be mostly determined by the treatment options and prognosis of the underlying disorder.