Cotard's syndrome, also known as Cotard's delusion, nihile fantasy syndrome, walking corpse syndrome, or Living dead syndrome, is a rare form of mental paranoia. The mental health disorder was first described in 1880 by French neurologist and psychiatrist Cotard, after whom it has since been named.
Figure 1: Cotard
Disease Description
Patients with Cotard's syndrome, though clearly conscious, believe they are dead, do not exist, or have lost their organs or blood, and only the mind exists. In 1880, Cotard submitted a report to his colleagues about one of his patients. The 43-year-old believed her body was made up of skin and bone, with no intestines, blood, brain, or nerves, and that she was not really alive. Eventually, the patient died of starvation because she refused to eat.
Etiology and Risk Factors
Cotard's syndrome usually follows a traumatic event, such as severe typhoid fever or multiple sclerosis. Cotard's syndrome is associated with the parietal and prefrontal cortex of the brain and is caused by the disconnection of the areas of the brain responsible for recognizing faces and the emotional areas associated with cognition. The parietal cortex is responsible for the process of attention, while the prefrontal cortex is involved in hallucinations produced by some psychiatric disorders, such as schizophrenia. Although the exact mechanism of Cotard's syndrome remains unknown, people with the condition may use near-death experiences to try to rationalize the bizarre experiences they experience.
Figure 2: Parietal lobe and prefrontal lobe
Symptoms and Diagnosis
Symptoms of Cotard’s syndrome include anxiety, depression, slow or insensitive response to pain, a lack of self-awareness, a lack of agency, an abnormal mood or behavior, and delusions about one's body or being, which may be accompanied by food refusal, and high-risk self-harm or suicidal behavior. In a retrospective analysis of 100 patients with Cotard syndrome conducted by Berrios and Luque in 1995, the most common symptoms were depression (89%), body-related nihilism (86%), existential nihilism (69%), anxiety (65%), self-guilt (63%), hypochondriac delusion (58%), and immortality delusion (55%). They found that there was no gender difference in the primary psychiatric disorder and that the incidence increased with age.
Figure 3: Anxiety
Doctors generally divide the disease into three stages: the "Germination" stage, that is, the initial appearance of "depression" and "hypochondriac" symptoms; the "Blooming" stage, that is, comprehensive development of features and negative illusion; and the "Chronic" stage, in which the patient continues to have a sense of "severe delusion" and a prolonged period of "chronic depression."
Based on the results of the study, Cotard syndrome is divided into three types: psychotic depression, that is, patients have prominent depressive depression, but nihilistic delusion is rare; Cotard syndrome type 1, in which nihilistic delusions are more prominent than depressive symptoms; and Cotard syndrome type 2, which is characterized by a mixture of anxiety, depression, and auditory hallucinations.
Treatment and Management
Continuous "psychotherapy" and "medication" can gradually improve the condition, and the drug treatment of antidepressants, antipsychotics, and mood stabilizers, whether monotherapy or multiple therapy, has been successful. Similarly, for people with depression, electroconvulsive therapy (ECT) is more effective than medication. Cotard's syndrome is a side effect of valaciclovir and is thought to be caused by elevated serum levels of 9-carboxymethoxy-methylguanine (CMMG), one of Valaciclovir's metabolites. If treatment is successful, valaciclovir needs to be discontinued. Hemodialysis is associated with the timely removal of CMMG and the relief of symptoms.
Figure 4: Electroconvulsive therapy
Prognosis and Complications
Cotard's syndrome is often associated with major depression, and its complications often include intense thoughts of suicide, impaired daily functioning (neglect of basic self-care, such as diet and hygiene), leading to physical health complications, social isolation (individuals may withdraw from social interactions as they struggle with distorted perceptions of reality), and even resistance to therapy or medication because of delusional beliefs.
Latest Research, Treatment Advances, and Prevention Measures
Due to the rarity of Cotard syndrome (only a few hundred patients have been identified worldwide since its discovery), the judgment, analysis, and future treatment of the disease by different physicians remain controversial. Doctors suggest that developing good living habits, a balanced diet, and maintaining a good attitude can effectively prevent the occurrence of mental disorders.
Figure 5: Balanced Diet
Conclusion
Cotard's syndrome is a rare but severe mental delusion in which a person believes that he or she is dead or does not exist. The symptoms include depression and delusions and are often accompanied by suicidal behavior. Cotard's syndrome can be treated, but its rarity means doctors have little understanding of and treatment options for the mental disorder.
References
Mendao. “Cotard’s Syndrome, Mental Illness.” Www.sohu.com, 4 July 2016, www.sohu.com/a/246159163_100090365. Accessed 19 Jan. 2024.
Rath, Linda. “Cotard’s Syndrome: What Is It?” WebMD, 13 Feb. 2022, www.webmd.com/schizophrenia/cotards-syndrome.
Wangyi. “Peculiar Cotard Syndrome: The Sufferer Is Alive, but Thinks He Is Dead.” Www.163.com, 25 Sept. 2017, www.163.com/dy/article/CV722DLV0511EKTT.html. Accessed 19 Jan. 2024.
Wikipedia Contributors. “Cotard’s Syndrome.” Wikipedia, Wikimedia Foundation, 11 May 2023, en.wikipedia.org/wiki/Cotard%27s_syndrome.
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