Cotard Delusion (Cotard's Syndrome)
Cotard's syndrome, also known as Cotard's delusion or walking corpse syndrome, is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. Statistical analysis of a hundred-patient cohort indicated that denial of self-existence is present in 45% of the cases of Cotard's syndrome; the other 55% of the patients presented with delusions of immortality.
In 1880, the neurologist and psychiatrist Jules Cotard described the condition as le délire des négations ("the delirium of negation"), a psychiatric syndrome of varied severity. A mild case is characterized by despair and self-loathing, while a severe case is characterized by intense delusions of negation, and chronic psychiatric depression.
Symptoms
Delusions of negation are the central symptom in Cotard's syndrome. The patient usually denies their own existence, the existence of a certain body part, or the existence of a portion of their body. Cotard's syndrome exists in three stages:
Germination stage: symptoms such as psychotic depression and hypochondria often appear;
Blooming stage: full development of the syndrome and delusions of negation; and;
Chronic stage: continued severe delusions along with chronic psychiatric depression.
Cotard's syndrome withdraws the person with the condition from other people due to neglect of their personal hygiene and physical health. Delusions of negation of self prevent the patient from making sense of external reality, which then produces a distorted view of the external world. Such delusions of negation are usually found in schizophrenia. Although a diagnosis of Cotard's syndrome does not require the patient to have had hallucinations, the strong delusions of negation are comparable to those found in schizophrenic patients.
Treatment Options
Because various conditions can cause Cotard’s delusion, there is no single treatment that will treat all cases. Instead, doctors treat the underlying cause. Depending on what the underlying cause is, treatment may involve:
- antipsychotic medications to treat schizophrenia or other psychiatric disorders
- other medications, such as antidepressants
- psychotherapy to help a person understand their delusions and better manage them
- stopping drugs that cause symptoms
- rehydration via intravenous fluids, especially for people experiencing drug-induced delusions or malnourishment
Another potential treatment is electroconvulsive therapy (ECT), which delivers an electrical shock to the brain. This can alter neurotransmitters and brain function, which may improve symptoms for some.