Cotard Syndrome or Delusion is also known as the Walking Corpse Syndrome.
It is a rare neuropsychiatric condition in which an individual believes that their body parts,
organs, blood or soul are missing, or that they do not exist, are dying, dead or immortal.
They may think that nothing exists. The term for this delusion is a nihilistic delusion.
The person cannot be dissuaded from their belief, even with evidence to the contrary.
Cotard Syndrome is not recognized in ICD-10 or DSM-5 as a condition in its own right.
I'm Dr Beth Colby, a psychiatrist in London.
I'm going to be talking about the history of Cotard's Syndrome, the symptoms, risk factors possible pathophysiology and then the treatment.
Dr Jules Cotard gave a lecture in 1880 in which he described the case of '‘delire hypochondriaque’
in a 43 year old woman whom he termed Mademoiselle X.
Mademoiselle X claims that she had no brain, nerves or stomach.
She did not believe that God or the devil existed, and that she believed she was immortal.
She did not eat, as she believed that she was dead and therefore did not need nourishment,
and she went on to die of starvation.
A few years' later, Cotard introduced the term 'delire des negation'
for patients who denied their own existence or the existence of the world around them.
He reported that these delusions were associated with severe depression,
marked psychomotor retardation - that's when somebody's movements slow down so much as almost to a stop -
anxiety symptoms, suicidal behaviour and other depressive and delusional symptoms.
He characterized the cluster of symptoms as lypermania,
a kind of psychotic depression which had been described by Esquirol.
Emil Regis coined the term Cotard Syndrome to describe these patients in 1893.
Nowadays we refer to delusions of negation or nihilism as synonymous with Cotard Syndrome,
even if they are not associated with severe depression and the other symptoms that Cotard described.
Nihilism is the belief that nothing has any value or meaning.
It can also include the belief that nothing really exists.
As well as having nihilistic delusions, people with Cotard's Syndrome isolate themselves socially and neglect their diet and hygiene.
They may deny the existence of their marriage, parents, children, pregnancy, name, capacity to walk or eat, or even the world itself.
Suicide attempts are common in people with Cotard's Syndrome.
Some people try to kill themselves to prove that they're not alive to start with -
to show that they can't die again.
Other people feel trapped in a body and life that is unreal and want to die.
They hope that their life will get better or stop if they die again.
Risk factors for Cotard's Syndrome include female gender and being in one's fifties.
Children and adolescents can get Cotard's Syndrome, and those under the age of 25 are likely to have bipolar depression as a diagnosis.
Cotard's Syndrome can occur in people with severe depression, bipolar affective disorder,
schizophrenia, drug use, brain injury, brain tumours or infections, dementia, as well as other
disorders affecting the brain such as epilepsy, migraine, multiple sclerosis, Parkinson's, stroke, syphilis and typhoid fever.
In addition, Cotard's Syndrome appears to occur more often in people who feel that
it is themselves that affect their behaviour rather than the environment that affects their behaviour.
People who believe that is the environment that causes their behaviour are more likely to have Capgras Syndrome.
Cotard's delusion and Capgras syndrome may occur together.
In a review of research in 2011, 89% of the patients with Cotard's Syndrome had severe depression.
Regarding the pathophysiology of Cotard's Syndrome,
both in Cotard's Syndrome and Capgras Delusion, the patients can recognize the faces,
but it appears to be that there's a neural disconnect between the fusiform face area of the brain and the amygdala,
which associates emotions to a particular face.
This leads the patient to a sense that the face that they have looked at is not the face to whom it belongs, although it looks identical.
If the observed face is that of a person known to the patient and they do not get that emotional recognition,
even though they know it's identical to the person, then the patient will think that
that person's an imposter, and will have Capgras Syndrome.
However, if the face is of the person themselves, they might perceive no association between that face and that of themselves,
and they may then go on to believe that they do not exist.
Now on to treatment.
A review in 2009 showed that ECT - electroconvulsive therapy - was the most commonly used treatment for Cotards' Syndrome.
This is not surprising, as I've previously said that 89% of patients with Cotard's Syndrome also have severe depression, and ECT is very effective at treating this;
and also, as people with Cotard's Syndrome may neglect their diet and so be malnourished or dehydrated, and ECT works very quickly to improve people's mood.
I hope this has been interesting for you.
So we've covered Cotard's Syndrome - what it is, the history, the symptoms, risk factors,
possible pathophysiology and the treatment.
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