Cotard Delusion

Cotard’s Delusion, also called as Walking Corpse Syndrome, is a relatively rare condition that was first described by Dr. Jules Cotard in 1882. Cotard’s syndrome comprises any one of a series of delusions that range from a belief that one has lost organs, blood, or body parts to insisting that one has lost one’s soul or is dead.

It is a rare mental illness in which the affected person holds the delusional belief that they are already dead, do not exist, are putrefying, or have lost their blood or internal organs. Statistical analysis of a hundred-patient cohort indicates that the denial of self-existence is a symptom present in 45% of the cases of Cotard’s syndrome; 55% of the patients present delusions of immortality.

Cases have been reported in patients with mood disorders, psychotic disorders, and medical conditions. Most cases of Cotard’s are more responsive to electro convulsive treatment (ECT) than to pharmacological treatment. I’m presenting a old case with Cotard’s syndrome, in the context of depression, to illustrate both how impairing the condition can be and how a course of effective, individualized therapy can improve outcome.

Case Reports:

1. Mr X, a 53-year-old man, was admitted to a psychiatric unit when his family called 911 because the patient was complaining that he was dead, smelled like rotting flesh, and wanted to be taken to a morgue so that he could be with dead people.

Upon interview in the hospital, the patient expressed fear that “paramedics” were trying to burn down the house where he was living with his cousin and his brother.

He also admitted to hopelessness, low energy, decreased appetite, and somnolence.

Mr X reported that he had been on antidepressants while in the Philippines (where he had resided for the last 18 years, having moved to the US only a month ago from then), but could not recall the name or dosage of the medication.

After organic causes were ruled out, treatment with quetiapine and bupropione SR was started. The patient was initially reluctant to take medication or eat. He subsequently developed an electrolyte imbalance (hypokalemia and hyponatremia), which necessitated intravenous electrolyte repletion. The patient was also isolative, spending much of the day in bed and he also neglected his personal hygiene and grooming.

With his family’s support, the decision was made to take the patient to court for treatment over objection. Subsequently, the patient’s medication regimen was bupropion SR and olanzapine (intramuscular if he refused the oral form). A few days later, the patient had a questionable syncopal versus seizure episode, necessitating transfer to a medical unit.

After three days, he returned to the psychiatry floor where his medication regimen included olanzapine, escitalopram (because of the questionable seizure on bupropion), and lorazepam (for agitation).

Mr X showed improvement in symptoms over one month on olanzapine 25mg daily, escitalopram 20mg daily, and lorazepam 2mg daily. At discharge he denied nihilistic or paranoid delusions and hallucinations and expressed hopefulness about his future and a desire to participate in psychiatric follow-up care.

2. One patient, referred to as M for privacy reasons, was diagnosed with Cotard delusion after experiencing significant traumatic brain damage. Damage to the cerebral hemisphere, frontal lobe, and the ventricular system was apparent to his doctors after examining magnetic resonance imaging (MRI) and computed tomography (CT) scans.

In January 1990, M was discharged to outpatient care. Although his family had made arrangements for him to travel abroad, he continued to experience significant persistent visual difficulties, which provoked a referral for ophthalmological assessment. Formal visual testing then led to the discovery of further damage.

For several months after the initial trauma, M continued to experience difficulty recognizing familiar faces, places, and objects. He also was convinced that he was dead and experienced feelings of de-realization. Later in 1990, after being discharged from the hospital, M was convinced that he had been taken to hell after dying of either AIDS or septicemia. When M finally sought out neurological testing in May 1990, he was no longer fully convinced that he was dead, although he still suspected it.

Further testing revealed that M was able to distinguish between dead and alive individuals with the exception of himself. When M was treated for depression, his delusions of his own death diminished in a month.

– #sn👣

(Sanjana S, 1st Year Psychology)