Cotards syndrome

HISTORY OF THE DISEASE:

Founder: 

Jules Cotard, a French neurologist and psychiatrist born in 1840 and died 1889 founded Cotard's syndrome only nine years before his death. Originally he named the disease “hypochondriac delusion”, and some years later changed it to “delusion of negations.” While it was only named after the psychiatrist after his passing, the name “cotard's syndrome” prevailed over other names such as “delusions of negations” and “cotard's delusion”.

What is Cotard's syndrome?:

Cotard's syndrome in its most basic of terms is a nihilistic psychotic depressive disorder. People with this disorder experience feeling as if they are dead, rotting, immortal, missing blood, organs or limbs. At its base it is a delusional disorder that derives most commonly from depression that's been left untreated. This syndrome is not in either current diagnostic systems the DSM-5 or the ICD-10. Although it is still recognised by modern psychiatrists and doctors as a diagnosable and treatable condition. 

MANIFESTATION:

Causes:

In a review of literature, Berrios GE and Luque R, two French psychiatrists who specialise in the field of neuro study and psychology. looked into 100 cases of cotard's syndrome they identified that depression was the main cause of the illness, Although That being said cotards is not purely formed from mental illness. It can also be caused through a brain injury, dementia, or any other degenerative brain disorder.

Symptoms:

To experience this disorder is to feel dead. People describe themselves as dead, rotting, missing blood or organs, immortal, or like they've lost their souls, and oftentimes these feelings come with thoughts of sin and guilt. People who believe they are dead neglect their bodily needs. They sometimes starve themselves, don't bathe or wash, and isolate themselves. After looking through 100 cases Berrios and Luque had categorized cotard's syndrome into three main types:

Cotard's syndrome type 1: categorized as psychotic depression with nihilistic delusions.

Cotard's syndrome type 2: has the same nihilistic delusions but without the history of mental illness. includes symptoms like paranoia and hallucinations.

Cotard's syndrome type 3: is a mixed type. Meaning it can't be categorized into type 1 or 2 alone.

TREATMENTS:

It depends on each person and what type of cotard's syndrome they have but typically there is three main treatments for it:

1.Therapy: psychiatric therapy for a prolonged period can help people with a delusional mental state.

2.Medication: oftentimes people are given mood stabilizers or antipsychotic to bring them back to baseline.

3.ECT: electroconvulsive therapy, typically a last resort, can be helpful where other options were not. 

Oftentimes these three treatments are used together. For instance in Mr. B’s case (case study below) he was treated with mood stabilizers, antipsychotics, and a few sessions of ECT. keep in mind this man had no previous serious mental illness history until that point. In Ms. A’s case (case study also below) she was also put on mood stabilizers and was treated with ECT when other medications did not work.

Case Studies:

1. The first case is with Mr. B, a 65 year old man with no previous history of mental illness.. He was admitted to the hospital after developing feelings of sadness, anxiety, along with feelings of sin and guilt. He had attempted to kill himself, and within his suicide note he believed that he had an illness that would spread to everyone in his villiage and kill them all. He also noted believing there were cracks in his walls and that his house would collapse on him. Mr. B was prescribed ECT(electroconvulsive therapy) sessions, Mood stabilizers, and Antipsychotics. In the end his symptoms resolved completely over a period of seven weeks. To me this would fall into the category of cotard's syndrome type 2 due to the lack of previous mental illness and the paranoia joined by hallucinations.

2.The second case with Ms. A, 62 year old who had been suffering from bipolar affective disorder for most of her adult life. She was admitted due to a “relapse” in her disorder. Her symptoms included a depressed mood, anxiety, decreased socialization, loss of appetite and subsequent weight loss, decreased interest in the household, poor self-care, ideas of worthlessness, pessimistic views of future, forgetfulness and psychomotor retardation. She then started developing nihilistic delusions. She believed her body parts weren't real and denied the existence of her family as well which is odd for a case of this type. The negation of self is typical with cotard's syndrome but the negation of others is something i haven't seen here before. She believed much like Mr. B that her home was going to collapse and kill her, even though she already believed herself to be dead. She was also treated with ECT and mood stabilizers. I would consider this to be a mixed type of cotards, otherwise known as type 3. I would put it in type 2 but because of her previous diagnosis of bipolar, and the psychosis that she's experienced in the past with that, I cannot say that her symptoms are from cotard's syndrome alone.

I typically don't like bringing up religion when talking about a medical issue as most times there is no reason for it to be brought up in the first place. But with cotard's syndrome there seems to be an odd fixation throughout different case studies of people feeling sinful, or god-like well feeling dead. There's a big theme with cotard's surrounding death obviously. But what people don't seem to understand is the delusion of immortality, and the extent of that feeling. To die and still be moving, and talking, and breathing, but not alive. That in of itself is immortality. Hence why people with cotard's describe being dead but also that they are immortal and cannot die. (ie: lacking a soul to die with) I think maybe to feel immortal is to feel godly. I cannot imagine what that must feel like delusion or not. what a burden to bear.

if you or someone you know believes they are experiencing cotards syndrome contact your doctor/therapist/psychiatrist immediately to start recieving proper help.