COTARD’S SYNDROME

DON’T TRUST THE LIVING

CONTENTS

 What is Cotard’s syndrome?

 Origins
 What causes Cotard’s syndrome?
 Signs and Symptoms?
 Biological basis
 Diagnosis
 Treatment
 Prognosis
 Conclusion
WHAT IS COTARD’S SYNDROME?

 Cotard’s delusion 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.
 Cotard’s syndrome is named after Jules
Cotard (1840 – 1889), a French
neurologist who described this condition
for the first time in 1880.
ORIGINS

 Mrs. X, a 43 year old woman affirms she had no brain, nerves, no chest, stomach or
intestines.
 There’s only skin and bones of a decomposing body.
 She denied the existence of part of her body and her need to eat.
 She said that she was condemned to eternal damnation and therefore, could not die a
natural death.
 In the course of suffering, she died of starvation.
WHAT CAUSES COTARD’S SYNDROME?
 The medical condition is characterized
by mental disorders and delusions.
 Most often the syndrome appears in the
case of schizophrenia or affective
psychosis and often associated with
temporal lesions of subdominant
hemisphere of the brain and migrane
attacks.
 Often Cotard’s delusion is the result of
organic brain syndrome.
 The risk factors are depressive disorders,
mental problems like schizophrenia,
bipolar disorders and dementia.
 Also Cotard’s syndrome is associated
with brain atrophy, brain tumors, brain
injuries, seizure disorders, strokes and in
some cases Parkinson’s disease.
SIGNS AND SYMPTOMS

 The first stage of Cotard’s is the germination stage. Here, the patient suffers from
psychotic depression and hypochondria, neglect of personal hygiene and physical health.
The patient has no interest in social life.
 This is followed by the blooming stage. Here the disorder is fully developed and there
are delusions of negation. This prevents the patient from perceiving external reality
which then produces a distorted view of the external world. It also leads to severe
hallucinations, suicidal tendencies, negativity or insensitivity to pain.
 The final stage is called the chronic stage. It is characterized by continued severe
delusions, chronic psychiatric depression. Patients deny self existence or the existence of
one or more body parts. They believe they are putrefying (they can even smell rotting
flesh) or lost vital organs.
BIOLOGICAL BASIS

 Cotard’s syndrome is caused due to

damage to the brain particularly in the
frontal and parietal lobes.
 These delusions are thought to be caused
by a malfunction in the Fusiform Gryus
and Amygdala.
 While examining brains of patients
suffering from this syndrome researchers
concluded that the syndrome could also be
attributed to multifocal brain shrinkage,
internal hemispheric enlargement and
brain atrophy in the frontal lobe.
DIAGNOSIS

 There’s no specific diagonistic criteria for the Cotard’s syndrome. According to the
DSM-5, (Diagnostic and Statistical Manual of Mental Disorder, 5th edition), Cotard
delusion falls under the category of Somatic delusions, those that involve bodily
functions or sensations.
 There are no further diagnostic criteria for Cotard’s syndrome within the DSM-5, and
identification of the syndrome relies heavily on clinical interpretation.
 Cotard delusion should not be conused with delusional disorders as defined by DSM-5,
which involve a different spectrum of symptoms that are less severe and have lesser
detrimental effect on functioning.
 Cotard’s syndrome is mainly diagnosed in association with the mental illness that
triggered it like bipolar disorder, schizophrenia, etc.
TREATMENT

 Some treatments were reported successful using anti-depressants, anti-psychotic and

mood stabilizing drugs. Likewise, with a depressed patient electroconvulsive therapy
(ECT) is more effective than pharmacotherapy.
 Cotard’s delusion can also be caused by the syndrome of inappropriate secretion of
antidiuretic hormone (SIADH) and treated with Demeclocycline, salt tablet and fluid
restrictions.
 It can also be treated successfully with dopamine agonist. Medications like Paroxetine
and Pramipexole were continued in some cases for about 8 weeks after the discharge to
keep anxiety, depression and delusions in check.
PROGNOSIS

 A complete recovery might occur as spontaneously and as suddenly as its onset, even in the most
severe cases. The prognosis can mostly be linked to the underlying disorder.
 If the nihilistic delusions are related to an acute psycho-organic syndrome, the prognosis is good
and the condition tends to resolve. If however, it is associated with a depressive illness, it may
well persist even when the other symptoms of the depressive illness have cleared.
 Under this circumstance, and where the conditions become chronic, the delusional state of
negations usually waxes and wanes in intensity depending on the fluctuation of the depressive
disorder.
 When the phenomenology is part of a schizophrenic illness, it usually improves when the other
symptoms respond to therapy, but it can also persist for years as part of a chronic schizophrenic
condition.
CONCLUSION

 Research shows Cotard’s syndrome is a serious, life threatening condition that should be
examined further so individuals know more about it and get proper treatment. There are
many forms of Cotard’s syndrome that affect patients in somewhat different but similar
ways.
 It is unpredictable because not much is known about the causes of Cotard’s syndrome.
With further research the causes of Cotard’s syndrome may become clearer, more
treatment options may become available, and a more predictable, and hopefully positive,
prognosis may arise.