Cotard’s Syndrome

Cotard syndrome Graphics courtesy of Medical News TodayOpens in new window

Cotard’s syndrome involves delusions or thoughts of self-negation often accompanied by symptoms of depressionOpens in new window, anxietyOpens in new window, depersonalizationOpens in new window (a sense of detachment from the perception of the self and the body), and/or derealizationOpens in new window (a sense of strangeness or unreality).

Individuals suffering from the syndrome may think they are dead or that some of their body parts are missing or putrefied. They may hold the paradoxical beliefs that they are immortal, yet they continue to function and exist, although they have died.

French psychiatrist Jules Cotard (1840 – 1889) was a student of Broca and worked under Charcot (Berrios & Luque, 1995a). In 1889, Cotard presented a case involving tehse delusions to the French Psychiatric Society in Paris. He referred to similar cases by other doctors from as early as 1814.

In 1882, he introduced the term délire de negation (which has been translated as nihilistic delusion), which later became known as Cotard’s delusion or Cotard’s syndrome (Berrios & Luque, 1995a).

Cotard’s syndrome may be accompanied by symptoms of depression, anxiety, depersonalization (a sense of detachment from the perception of the self and the body), and/or derealization (a sense of strangeness or unreality).

It has been reported in individuals who have schizophreniaOpens in new window, depressionOpens in new window with psychotic features, bipolar disorderOpens in new window, dementiaOpens in new window, migraine, brain lesions, brain tumors, traumatic brain injury, seizure disordersOpens in new window, typhoid fever, Parkinson’s diseaseOpens in new window, and multiple sclerosis (Gardner-Thorpe & Pearn, 2004; Shorter, 2005; Taylor, 2007).

It has also been reported as an adverse reaction in patients with kidney failure taking the antiviral drug acyclovir (Hellden, Odar-Cederlof, Larsson, Fehrman-Ekholm, & Linden, 2007).

Cotard’s has been associated with structural abnormalities in the brain, including atrophy (wasting away) of the cerebellum and dilated (enlarged) lateral ventricles (Kudlur, George, & Jaimon, 2007).

Dilated lateral ventricles (part of the telencephelon of the brain) are often found in individuals with schizophrenia or bipolar disorder. Cotard’s may also be associated with an impaired ability to recognize faces (Kudlur, George, & Jaimon, 2007).

In 1995, British psychiatrists German E. Berrios and Rogelio Luque analyzed 100 cases of Cotard’s. Most common symptoms reported included:

  • depression (in 89% of cases),
  • nihilistic delusions concerning the body (86%),
  • nihilistic delusions concerning existence (69%),
  • anxiety (65%),
  • guilt (63%),
  • hypochondriacal delusions (58%), and
  • delusions of immortality (55%).

On the basis of tehri analysis, Berrios and Luque divided cases into three types: psychotic depression, Cotard type I, and Cotard type II (Berrios & Luque, 1955b).

The psychotic depression type includes depression and few nihilistic delusions; Cotard type I is mostly delusional with no depression; and Cotard type II includes anxiety, depression, and auditory hallucinations.

The type of Cotard’s may offer information about the etiology (cause) and have implications for appropriate treatment. Cotard’s has been most successfully treated with electroconvulsive therapy (ECT; Caliyurt, Vardar, & Tuglu, 2004).

Cotard’s fits within the category of delusional misidentification syndromes, which also includes Capgras syndromeOpens in new window and Fregoli syndromeOpens in new window.

  • Capgras involves the delusion that a friend or loved one has been replaced by an imposter or clone.
  • Fregoli syndrome involves delusions of being persecuted by a familiar person who can change his shape and appearance.

All the delusional misidentification syndromes are extremely resistant to correction. For example, someone with Cotard’s will remain convinced that s/he is dead, even when presented with strong evidence to the contrary (Taylor, 2007).

An unusual adjunct to Cotard’s syndrome is something that has been termed Odysseus syndrome, or nihilism by proxy. This is a delusional disorder in which an individual believes that a loved one has died or that a loved one’s body parts or organs have been replaced or are putrefying, despite evidence to the contrary (Connelly, Rodriquez-Castello, & Robertson, 2005).

See also:
  1. Berrios, G. E. & Luque, R. (1995a). Cotard’s delusion or syndrome? A conceptual history. Comprehensive Psychiatry, 36, 218 – 223.
  2. Berrios, G. E., & Luque, R. (1995b). Cotard’s syndrome: Analysis of 100 cases. Acta Psychiatrica Scandinavica, 91, 185 – 188.
  3. Caliyurt, O., Vardar, E., & Tuglu, C. (2004). Cotard’s syndrome with schizophreniform disorder can be successfully treated with electroconvulsive therapy: Case report. Journal of Psychiatry and Neuroscience, 29, 138 – 141.
  4. Gardner-Thorpe, C., & Pearn, J. (2004). The Cotard syndrome. Report of two patients: With a review of the extended spectrum of “délire des negations.” European Journal of Neurology, 11, 563 – 566.
  5. Hellden, A., Odar-Cederlof, I., Larsson, K., Fehrman-Ekholm, I., & Linden, T. (2007). Death delusion. British Medical Journal, 335, 1305.
  6. Kudlur, S.N.C., George, S., & Jaimon, M. (2007). An overview of the neurological correlates of Cotard syndrome. European Journal of Psychiatry, 21, 99 – 116.