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Fusick AJ, Davis C, Gunther S, Klippel C, Sullivan G. Psychotropic Management in Cotard Syndrome: Case Reports Supporting Dual Medication Management. Case Rep Psychiatry 2024; 2024:7630713. [PMID: 38633733 PMCID: PMC11022521 DOI: 10.1155/2024/7630713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
Cotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or psychiatric etiology and can be difficult to treat. Recently Couto and Gonçalves purposed that treatment should include an atypical antipsychotic alone or in combination with either a mood stabilizer or antidepressant. Here the authors advocate for a more specific but well-known psychotropic regimen, namely the combination of olanzapine and fluoxetine. We conducted a literature review and of 246 papers identified, only three reported using a combination of fluoxetine and olanzapine with many of them having limited or confounding information that make it difficult for us to comment on the historically efficacy of this medication combination. Therefore, the authors provide two case examples of patients being treated successfully with olanzapine and fluoxetine. One, a 66-year-old male veteran and another 76-year-old male veteran. Both of these cases hold significance as the patient's psychotic depression was so severe as to warrant ECT as a possible treatment. In both cases, this medication combination was able to avoid the procedure. Overall, with the addition of our cases and the sparse information available in the literature, we propose the combination of fluoxetine and olanzapine as an effective Cotard syndrome treatment.
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Affiliation(s)
- Adam J. Fusick
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
| | - Chemar Davis
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Steven Gunther
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
| | - Cory Klippel
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
| | - Gregory Sullivan
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
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2
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Robertson C, Dunn T. "A ghost doesn't need insulin," Cotard's delusion leading to diabetic ketoacidosis and a body-mass index of 15: a case presentation. BMC Psychiatry 2023; 23:551. [PMID: 37525179 PMCID: PMC10391858 DOI: 10.1186/s12888-023-05039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Cotard's Syndrome (CS) is a rare clinical entity where patients can report nihilistic, delusional beliefs that they are already dead. Curiously, while weight loss, dehydration, and metabolic derangements have been described as discussed above, a review of the literature revealed neither a single case of a severely underweight patient nor a serious metabolic complication such as Diabetic Ketoacidosis. Further, a search on PubMed revealed no articles discussing the co-occurrence of Cotard's Delusion and eating disorders or comorbid metabolic illnesses such as diabetes mellitus. In order to better examine the association between Cotard's Delusion and comorbid eating disorders and metabolic illness, we will present and discuss a case where Cotard's delusion led to a severe metabolic outcome of DKA and a BMI of 15. CASE PRESENTATION Mr. B is a 19 year old transgender man admitted to the hospital due to diabetic ketoacidosis secondary to Type 1 Diabetes Mellitus. Mr. B had a history of Obsessive-Compulsive Disorder, Major Depressive Disorder, and Post-Traumatic Stress Disorder. The primary pediatric team discovered that Mr. B had not been using his insulin appropriately and was severely underweight, and they believed this could be due to his underlying mental illness. The psychiatric consultation/liaison service found that Mr. B was suffering from Cotard's delusion leading him to be noncompliant with his insulin due to a belief that he was already dead. Cotard's delusion had in this case led to a severe metabolic outcome of DKA and a BMI of 15. CONCLUSIONS This case provides clinical insight into the interactions of eating disorders and Cotard's delusion as well as the potential medical complications when Cotard's delusion is co-morbid with medical conditions such as Diabetes Mellitus. We recommend that clinicians routinely screen patients for Cotard's delusion and assess whether the presence of which could exacerbate any underlying medical illness. This includes clinicians taking special care in assessing patient's caloric and fluid intake as well as their adherence to medications both psychiatric and medical. Further research could be conducted to explore the potential overlap of Cotard's delusion and eating disorder phenomenology.
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Affiliation(s)
| | - Thomas Dunn
- Behavioral Health - Adolescent Outpatient, Denver Health, 723 Delaware St., Pavilion M, Denver, CO, 80204, USA
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Dihingia S, Bhuyan D, Bora M, Das N. Cotard's Delusion and Its Relation With Different Psychiatric Diagnoses in a Tertiary Care Hospital. Cureus 2023; 15:e39477. [PMID: 37362522 PMCID: PMC10290442 DOI: 10.7759/cureus.39477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Background Cotard's delusion/Cotard's syndrome is a series of delusions ranging from a false, fixed, unshakeable belief that one has lost their soul, blood, organs, and body parts to the belief that one is dead. The syndrome was initially thought to be associated with only mood disorders but later was found in other psychiatric illnesses as well. Aim The study aimed to find an association between Cotard's delusion and the psychopathology of different psychiatric diagnoses. Method The clinical study comprised seven patients presenting with symptoms of Cotard syndrome with different presentations, diagnoses, and onset and meeting inclusion criteria. The study was carried out in the Department of Psychiatry, Assam Medical College and Hospital. The patients were hospitalized and, after a detailed history, mental status examination, and laboratory investigations, were treated with pharmacological and non-pharmacological methods. A descriptive statistical analysis was done. Results Denial of the existence of body organs was the most similar complaint encountered in the cases. The duration of illness onset ranged from weeks to months. The symptoms were found to be present in different psychiatric illnesses like schizophrenia, delusional disorder, depression, and intellectual disability. The patient had responded well to pharmacological agents with the exception of three patients who were treated with electroconvulsive therapy. Conclusion The study highlights the different subtypes of Cotard's syndrome and its associated symptoms, which provides a better understanding of the condition. The case series presents a finding of a higher proportion of male patients and adolescent cases than in previous reports. The study also provides valuable insights into its heterogeneity in the diagnosis and treatment of Cotard's syndrome, which may help in the early recognition and management of this rare condition.
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Affiliation(s)
- Sabita Dihingia
- Department of Psychiatry, Nalbari Medical College & Hospital, Nalbari, IND
| | - Dhrubajyoti Bhuyan
- Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, IND
| | - Mridusikha Bora
- Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, IND
| | - Nikhita Das
- Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, IND
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Onofrj M, Ajdinaj P, Digiovanni A, Malek N, Martinotti G, Ferro FM, Russo M, Thomas A, Sensi SL. Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources? Front Psychiatry 2023; 14:1120981. [PMID: 37009111 PMCID: PMC10064068 DOI: 10.3389/fpsyt.2023.1120981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
In recent years, some neurologists reconsidered their approach to Medically Unexplained Symptoms and proposed Functional Neurologic Disorders (FND) as a new entity, claiming that neurology could offer alternative treatment options to the psychotherapies provided in psychiatry settings. FNDs, for this purpose, should include only the disorders listed as Conversion from the Somatic Symptom and Related Disorders (SSRD) group. The present review analyzes the rationale of this position and challenges the arguments provided for its support. The review also discusses the systematization of these disorders as provided by public health systems. It outlines risks stemming from economic support and public funding uncertainty, given their negligible epidemiological dimensions resulting from the parcellation of SSRD. The review underlines the unresolved issue of Factitious Disorders, which are in the same SSRD category of the international classification but are, nonetheless, overlooked by the theoretical proponents of the FND entity. Comorbidity with other psychiatric disorders is also analyzed. We propose a model that supports the continuum between different SSRD conditions, including Factitious Disorders. The model is based on the emergence of feigned death reflex and deception from frontal lobe dysfunction. Finally, the paper summarizes the wealth of historical psychiatric and psychodynamic approaches and critical reviews. The study also puts in context the categorization and interpretation efforts provided by the most eminent researchers of the past century.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- *Correspondence: Marco Onofrj,
| | - Paola Ajdinaj
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Naveed Malek
- Barking, Havering, and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | - Filippo Maria Ferro
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Stefano Luca Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
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Huan WY, Wan Azlan WA, Lee YT. Cotard delusion in a depressed patient: "My throat is missing!". Asia Pac Psychiatry 2023; 15:e12524. [PMID: 36575636 DOI: 10.1111/appy.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 11/24/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
Cotard's syndrome is a rare neuropsychiatric disorder characterized by marked nihilistic delusions. This report describes an Indonesian woman from a small town in Malaysia who was diagnosed with depression and Cotard's delusion. The diagnosis was confirmed after thorough history-taking, clinical examination, and relevant laboratory tests. Herein, we highlight the unique psychopathology of a possible Cotard's syndrome subtype and efficacy of pharmacological combination strategies, rather than monotherapy and electroconvulsive therapy, for its treatment.
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Affiliation(s)
- Wen Yi Huan
- Psychiatric Department, Hospital Enche' Besar Hajjah Khalsom, Kluang, Johor, Malaysia
| | - Wan Asyikin Wan Azlan
- Psychiatric Department, Hospital Enche' Besar Hajjah Khalsom, Kluang, Johor, Malaysia
| | - Yee Tieng Lee
- Psychiatric Department, Hospital Enche' Besar Hajjah Khalsom, Kluang, Johor, Malaysia
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Davies M, Coltheart M. Cotard delusion, emotional experience and depersonalisation. Cogn Neuropsychiatry 2022; 27:430-446. [PMID: 36112925 DOI: 10.1080/13546805.2022.2119839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Cotard delusion-the delusional belief "I am dead"-is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea "I am dead" comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if "I am dead" were true, there would be no emotional responsivity to the world. METHODS We scrutinised the literature on people who expressed the delusional belief "I am dead", looking for data on whether such patients are reported as entirely lacking in emotional responsivity. RESULTS In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry. CONCLUSIONS We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea "I am dead" comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.
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Affiliation(s)
- Martin Davies
- Corpus Christi College, Oxford, UK and Philosophy Department, Monash University, Clayton, Australia
| | - Max Coltheart
- School of Psychological Sciences, Macquarie University, Sydney, Australia
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Chen JQ. A rare case of severe postpartum anti-NMDAR encephalitis. Intern Emerg Med 2022; 17:2419-2420. [PMID: 35857209 DOI: 10.1007/s11739-022-03051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jia-Qi Chen
- Department of Neurology, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315000, Zhejiang, China.
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Atilgan H, Doody M, Oliver DK, McGrath TM, Shelton AM, Echeverria-Altuna I, Tracey I, Vyazovskiy VV, Manohar SG, Packer AM. Human lesions and animal studies link the claustrum to perception, salience, sleep and pain. Brain 2022; 145:1610-1623. [PMID: 35348621 PMCID: PMC9166552 DOI: 10.1093/brain/awac114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022] Open
Abstract
The claustrum is the most densely interconnected region in the human brain. Despite the accumulating data from clinical and experimental studies, the functional role of the claustrum remains unknown. Here, we systematically review claustrum lesion studies and discuss their functional implications. Claustral lesions are associated with an array of signs and symptoms, including changes in cognitive, perceptual and motor abilities; electrical activity; mental state; and sleep. The wide range of symptoms observed following claustral lesions do not provide compelling evidence to support prominent current theories of claustrum function such as multisensory integration or salience computation. Conversely, the lesions studies support the hypothesis that the claustrum regulates cortical excitability. We argue that the claustrum is connected to, or part of, multiple brain networks that perform both fundamental and higher cognitive functions. As a multifunctional node in numerous networks, this may explain the manifold effects of claustrum damage on brain and behaviour.
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Affiliation(s)
- Huriye Atilgan
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Max Doody
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - David K. Oliver
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Thomas M. McGrath
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Andrew M. Shelton
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | | | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and Merton College, University of Oxford, Oxford OX3 9DU, UK
| | | | - Sanjay G. Manohar
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Adam M. Packer
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
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Ramesh S, Ratliff J. Improved Cotard Delusion and Motor Function in Parkinson’s Disease following Electroconvulsive Therapy (ECT). JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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López ACC. "Cotard's syndrome", a description of two cases. Delusion of negation in melancholia versus delusion of negation in paranoia. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:158-162. [PMID: 35753979 DOI: 10.1016/j.rcpeng.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/05/2020] [Indexed: 06/15/2023]
Abstract
In 1880, Jules Cotard described a set of delusions in the form of negations that later became his eponymous syndrome. Cotard's syndrome is an uncommon condition characterised by the presence of nihilistic delusions in which the person thinks that "they are dead or that the world no longer exists". This document describes two cases in which a broad and enriching semiology is evidenced from a descriptive point of view, which allows us to review them together with Cotard's syndrome in the light of modern psychiatry. The first case corresponds to a depressive disorder and the other occurs in the context of a non-affective psychotic disorder. A review of the literature is presented from what Cotard described until the current psychiatric classifications.
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Bassett D, Boyce P, Lyndon B, Mulder R, Parker G, Porter R, Singh A, Bell E, Hamilton A, Morris G, Malhi GS. Guidelines for the management of psychosis in the context of mood disorders. Schizophr Res 2022; 241:187-196. [PMID: 35139458 DOI: 10.1016/j.schres.2022.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 12/19/2022]
Abstract
Psychotic episodes occur in a substantial proportion of patients suffering from major mood disorders (both unipolar and bipolar) at some point in their lives. The nature of these episodes is less well understood than the more common, non-psychotic periods of illness and hence their management is also less sophisticated. This is a concern because the risk of suicide is particularly high in this subtype of mood disorder and comorbidity is far more common. In some cases psychotic symptoms may be signs of a comorbid illness but the relationship of psychotic mood to other forms of psychosis and in particular its interactions with schizophrenia is poorly understood. Therefore, our targeted review draws upon extant research and our combined experience to provide clinical context and a framework for the management of these disorders in real-world practice - taking into consideration both biological and psychological interventions.
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Affiliation(s)
- Darryl Bassett
- Gaps in Guidelines Group, Australia; Consultant Psychiatrist, Perth, WA, Australia.
| | - Philip Boyce
- Gaps in Guidelines Group, Australia; Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bill Lyndon
- Gaps in Guidelines Group, Australia; The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Gaps in Guidelines Group, Australia; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Gordon Parker
- Gaps in Guidelines Group, Australia; School of Psychiatry, University of New South Wales. Sydney, Australia
| | - Richard Porter
- Gaps in Guidelines Group, Australia; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet Singh
- Gaps in Guidelines Group, Australia; The Geelong Clinic Healthscope, IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Erica Bell
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Amber Hamilton
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Grace Morris
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Gin S Malhi
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia; Visiting Professor, Department of Psychiatry, University of Oxford, United Kingdom
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Onofrj M, Russo M, Carrarini C, Delli Pizzi S, Thomas A, Bonanni L, Espay AJ, Sensi SL. Functional neurological disorder and somatic symptom disorder in Parkinson's disease. J Neurol Sci 2021; 433:120017. [PMID: 34629180 DOI: 10.1016/j.jns.2021.120017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022]
Abstract
The occurrence of Functional Neurological Disorder (FND) and Somatic Symptom Disorder (SSD) in PD was not commonly accepted until recently, despite some evidence that emerged in the pre and early L-Dopa era. More recently, the recognition of FND and SSD were noted to be relevant for the management of PD. FND and SSD appear early in the course of PD, often preceding motor symptoms, may interfere with treatment outcomes, often acquire psychotic features during progression, and are mixed with and often concealed by the progressive cognitive decline. We review the related features from the range of the available reports and discuss theoretical models conceived to explain the potential pathophysiological background of these disorders. Finally, we suggest that FND and SSD should be included among the non-motor symptoms of PD and be considered a prodromal feature in a subset of patients. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States.
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Subhas N, Naing KO, Su C, Loo JL, Shahbudin AF, Sivasubramaniam V, Thyagarajan R. Case report on Cotard’s syndrome (CS) in a patient with schizophrenia: a rare case from Malaysia. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00359-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Cotard’s syndrome (CS) is a neuropsychiatric condition marked by nihilistic delusional(s). Due to its rarity, misdiagnosis of the syndrome often occurs. The current case study is of a Malaysian woman who was misdiagnosed for several years by professionals due to the presence of hypochondriac symptoms before receiving the correct diagnosis.
Case presentation
In this case presentation, we describe the case of L, a 42-year-old Malaysian lady who was first misdiagnosed with depression. The diagnosis of schizophrenia and CS was confirmed after thorough clinical examination, diagnostic investigations, and deliberation at a departmental forum. The patient improved after receiving electroconvulsive therapy (ECT) along with antipsychotic medications.
Conclusions
This case study highlights the importance of early recognition of CS by professionals as it can save time for both parties when setting up a treatment plan. Essentially, early recognition of CS in schizophrenia is paramount in the process of rapid stabilization through ECT and promotion of patient recovery.
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Cotard and Capgras Syndrome in a Patient with Treatment-Resistant Schizophrenia. Case Rep Psychiatry 2021; 2021:6652336. [PMID: 33552609 PMCID: PMC7847348 DOI: 10.1155/2021/6652336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
The presentation of both Cotard and Capgras syndromes is uncommon in schizophrenia. We present a case of a 23-year-old male with the diagnosis of schizophrenia with Cotard syndrome who later developed Capgras syndrome. By persisting significant symptoms despite the use of two antipsychotics, he was given the diagnosis of treatment-resistant schizophrenia, and his symptoms improved with clozapine. This is one of the few cases of Cotard and Capgras syndromes in a patient with schizophrenia.
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López ACC. "Cotard's Syndrome", a Description of Two Cases. Delusion of Negation in Melancholia Versus Delusion of Negation in Paranoia. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30122-0. [PMID: 33735056 DOI: 10.1016/j.rcp.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/19/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
In 1880, Jules Cotard described a set of delusions in the form of negations that later became his eponymous syndrome. Cotard's syndrome is an uncommon condition characterised by the presence of nihilistic delusions in which the person thinks that "they are dead or that the world no longer exists". This document describes two cases in which a broad and enriching semiology is evidenced from a descriptive point of view, which allows us to review them together with Cotard's syndrome in the light of modern psychiatry. The first case corresponds to a depressive disorder and the other occurs in the context of a non-affective psychotic disorder. A review of the literature is presented from what Cotard described until the current psychiatric classifications.
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My Body Is Rotting: A case report of Cotard’s syndrome in a postpartum woman. CURRENT PROBLEMS OF PSYCHIATRY 2020. [DOI: 10.2478/cpp-2020-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Cotard’s syndrome (CS) is a rare set of psychopathological symptoms, the main symptom of which is nihilistic delusions concerning the negation of the existence of internal organs or the entire body
Aim, material and methodology: The aim of the study is to present a case of a patient treated for postpartum depression who developed Cotard’s syndrome. The patient’s symptoms began immediately after her daughter. The clinical picture was dominated by anxiety and apathy, nihilistic delusions about the atrophy of the urethra and other lower abdominal organs, and olfactory hallucinations - she could smell rot.
Discussion: The available literature on Cotard’s Syndrome does not allow us to indicate a certain reason for its development. Perhaps the birth of the first child - the woman doubted herself as a mother, she was afraid that she would hurt the cause of the disorders observed and described by us was transient ischemia of the CNS during delivery.
Conclusions: Cotard’s syndrome can develop in the course of many mental and somatoform disorders. The described case is, to our knowledge, the first description of Cotard’s Syndrome in the deprivation period. Difficulties in establishing the etiopathogenesis and pathophysiology of Cotard’s Syndrome translate into therapeutic problems. It has been suggested that the treatment of the underlying disorder on the basis of which CS is developed remains the most effective method of therapy.
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Abstract
The aim of this article is to emphasize that starvation is an important potential consequence of psychosis and to provide recommendations for management of this condition. A review of the literature on food refusal and starvation in patients with psychotic illnesses was performed. Our search strategy returned 54 articles with one article meeting inclusion criteria. Additional independent research returned an additional four cases of patients with psychosis engaging in self-starvation. The cases of several patients from our institution who engaged in self-starvation behaviors as a result of psychosis are also presented. The management and outcomes of each of these 10 patients are discussed. Starvation secondary to psychosis is an important but underappreciated consequence of psychosis that can lead to serious adverse outcomes in these patients. Few cases have been reported in the literature. More study is warranted to develop evidence-based management guidelines.
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Tomasetti C, Valchera A, Fornaro M, Vellante F, Orsolini L, Carano A, Ventriglio A, Di Giannantonio M, De Berardis D. The 'dead man walking' disorder: an update on Cotard's syndrome. Int Rev Psychiatry 2020; 32:500-509. [PMID: 32500801 DOI: 10.1080/09540261.2020.1769881] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In 1880, Jules Cotard described a peculiar syndrome after observing the case of a 43-year-old woman, which was characterized by melancholic anxiety, delusions of damnation or possession, a higher propensity to suicide ideation and deliberate self-harm, analgesia, hypochondriac thoughts of non-existence or ruin of several organs, of the whole body, of the soul, of divinity, and the idea of immortality or inability to die. Several expansions and reinterpretations have been made of the so-called Cotard's syndrome, which is often encompassed in different neurological and psychiatric disorders, complicating and worsening their symptomatic frameworks and making more difficult their treatments. However, the nosographic characterization of Cotard's syndrome remains elusive and is not now classified as a separate disorder in both ICD and DSM-5. Here, we try to give an update, as well as a putative systematization, of current views and opinions about this nosological entity in the light of the recent progress in the clinic, psychopathology and psycho-neurobiology.
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Affiliation(s)
- Carmine Tomasetti
- Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, NHS, Hospital "Maria SS dello Splendore," ASL 4, Giulianova, Italy
| | | | - Michele Fornaro
- Department of Psychiatry, Federico II University, Naples, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Clinical Neurosciences/DIMSC, Section of Psychiatry, Polytechnic University of Ancona, Ancona, Italy
| | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso", San Benedetto del Tronto, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, NHS, Hospital "G. Mazzini," ASL 4, Teramo, Italy
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Fields C, Glazebrook JF. Do Process-1 simulations generate the epistemic feelings that drive Process-2 decision making? Cogn Process 2020; 21:533-553. [PMID: 32607801 DOI: 10.1007/s10339-020-00981-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
Abstract
We apply previously developed Chu space and Channel Theory methods, focusing on the construction of Cone-Cocone Diagrams (CCCDs), to study the role of epistemic feelings, particularly feelings of confidence, in dual process models of problem solving. We specifically consider "Bayesian brain" models of probabilistic inference within a global neuronal workspace architecture. We develop a formal representation of Process-1 problem solving in which a solution is reached if and only if a CCCD is completed. We show that in this representation, Process-2 problem solving can be represented as multiply iterated Process-1 problem solving and has the same formal solution conditions. We then model the generation of explicit, reportable subjective probabilities from implicit, experienced confidence as a simulation-based, reverse engineering process and show that this process can also be modeled as a CCCD construction.
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Affiliation(s)
| | - James F Glazebrook
- Department of Mathematics and Computer Science, Eastern Illinois University, 600 Lincoln Ave., Charleston, IL, 61920-3099, USA.,Department of Mathematics, University of Illinois at Urbana, Champaign, Urbana, IL, 61801, USA
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Restrepo-Martínez M, Espinola-Nadurille M, Bayliss L, Díaz-Meneses I, Kerik NE, Mendez MF, Ramírez-Bermúdez J. FDG-PET in Cotard syndrome before and after treatment: can functional brain imaging support a two-factor hypothesis of nihilistic delusions? Cogn Neuropsychiatry 2019; 24:470-480. [PMID: 31597522 DOI: 10.1080/13546805.2019.1676710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Cotard syndrome is a neuropsychiatric entity recognised by the presence of nihilistic delusions. Although different models have been proposed for the development of monothematic delusions, including Cotard syndrome, functional neuroanatomical models are lacking.Methods: A case report of a 19-year old male with autoimmune encephalitis and Cotard syndrome, in whom Positron Emission Tomography (18F-FDG-PET) scans were performed before and after successful treatment with electroconvulsive therapy (ECT), is presented. Literature review on brain imaging is provided to discuss a functional neuroanatomical model of Cotard syndrome, in accordance with the two-factor theory of delusions.Results: The patient's 18F-FDG-PET showed marked insular and prefrontal metabolic abnormalities. Except for insular hypometabolism, metabolic abnormalities improved after ECT. Previously reported structural neuroimaging studies in Cotard syndrome showed a predominance of right hemisphere lesions, in which frontal lobes were more frequently involved, followed by parietal and temporal lesions. Functional neuroimaging studies reported abnormalities in frontoparietal circuits as well as midline structures included in the "default mode network".Conclusions: Abnormalities in the functioning of the insular cortex and the prefrontal cortex could be related to the development of nihilistic delusions when a two-factor theory of delusions is considered.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, México
| | | | - Leo Bayliss
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, México
| | - Ivan Díaz-Meneses
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, México
| | - Nora E Kerik
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, México
| | | | - Jesús Ramírez-Bermúdez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, México
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Abstract
Background: Cotard syndrome is a rare condition whose main feature is a nihilistic delusion ranging from the denial of body parts to that of the existence of one's own life or even the entire universe. Objectives: The aim of this article is to review the nosological significance of Cotard syndrome and to explore the disorder among patients with dementia. Methods: Medline and Google Scholar searches were conducted for relevant articles, chapters and books published before 2018. Search terms used included Cotard delusion, Cotard syndrome and dementia, nihilistic delusion. Publications found through this indexed search were reviewed for further relevant references. Results and conclusion: In this narrative review we emphasise the fact that cases of Cotard syndrome involving patients with dementia are reported quite infrequently. Published studies are limited to very short series or isolated cases. Clinicians are obliged to treat the disorder. They should be alert to the potential high risk inherent in this condition. Keypoints Cotard syndrome is a rare condition characterised by nihilistic delusions that may range from negation of existence of parts of the body to delusion of being dead. The prevalence and incidence of this rare syndrome are not known. Since Cotard's syndrome is conceptualised as part of an underlying disorder, several psychiatric and somatic diseases have been associated with the syndrome. The syndrome may occur in patients suffering from dementia.
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Affiliation(s)
- Gabriele Cipriani
- a Neurology Unit, Versilia Hospital , Lido di Camaiore , Italy.,b Psychiatry Unit, Versilia Hospital , Lido di Camaiore , Italy
| | - Angelo Nuti
- a Neurology Unit, Versilia Hospital , Lido di Camaiore , Italy
| | - Sabrina Danti
- c Psychology Unit , Hospital of Pontedera , Pontedera , Italy
| | - Lucia Picchi
- d Psychology Unit , Hospital of Livorno , Livorno , Italy
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Vyshka G, Çomo A. Delusions of Immortality in a Post-War Society: The Albanian Case. Front Psychiatry 2019; 10:613. [PMID: 31507470 PMCID: PMC6716475 DOI: 10.3389/fpsyt.2019.00613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/01/2019] [Indexed: 02/05/2023] Open
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Hong CCH, Fallon JH, Friston KJ, Harris JC. Rapid Eye Movements in Sleep Furnish a Unique Probe Into Consciousness. Front Psychol 2018; 9:2087. [PMID: 30429814 PMCID: PMC6220670 DOI: 10.3389/fpsyg.2018.02087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/10/2018] [Indexed: 01/07/2023] Open
Abstract
The neural correlates of rapid eye movements (REMs) in sleep are extraordinarily robust; including REM-locked multisensory-motor integration and accompanying activation in the retrosplenial cortex, the supplementary eye field and areas encompassing cholinergic basal nucleus (Hong et al., 2009). The phenomenology of REMs speaks to the notion that perceptual experience in both sleep and wakefulness is a constructive process - in which we generate predictions of sensory inputs and then test those predictions through actively sampling the sensorium with eye movements. On this view, REMs during sleep may index an internalized active sampling or 'scanning' of self-generated visual constructs that are released from the constraints of visual input. If this view is correct, it renders REMs an ideal probe to study consciousness as "an exclusively internal affair" (Metzinger, 2009). In other words, REMs offer a probe of active inference - in the sense of predictive coding - when the brain is isolated from the sensorium in virtue of the natural blockade of sensory afferents during REM sleep. Crucially, REMs are temporally precise events that enable powerful inferences based on time series analyses. As a natural, task-free probe, (REMs) could be used in non-compliant subjects, including infants and animals. In short, REMs constitute a promising probe to study the ontogenetic and phylogenetic development of consciousness and perhaps the psychopathology of schizophrenia and autism, which have been considered in terms of aberrant predictive coding.
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Affiliation(s)
- Charles C.-H. Hong
- Patuxent Institution, Correctional Mental Health Center — Jessup, Jessup, MD, United States
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - James H. Fallon
- Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
| | - Karl J. Friston
- The Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
| | - James C. Harris
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States
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Abstract
Multiple sciences have converged, in the past two decades, on a hitherto mostly unremarked question: what is observation? Here, I examine this evolution, focusing on three sciences: physics, especially quantum information theory, developmental biology, especially its molecular and “evo-devo” branches, and cognitive science, especially perceptual psychology and robotics. I trace the history of this question to the late 19th century, and through the conceptual revolutions of the 20th century. I show how the increasing interdisciplinary focus on the process of extracting information from an environment provides an opportunity for conceptual unification, and sketch an outline of what such a unification might look like.
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Örüm MH, Kalenderoğlu A. Cotard and Capgras delusions in a patient with bipolar disorder: “I’ll prove, I’m dead!”. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1371661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Mehmet Hamdi Örüm
- Department Psychiatry, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Aysun Kalenderoğlu
- Department Psychiatry, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
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When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard's Syndrome. Case Rep Med 2016; 2016:5101357. [PMID: 28003827 PMCID: PMC5149641 DOI: 10.1155/2016/5101357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
Cotard's Syndrome (CS) is a rare clinical event described for the first time in 1880 by the neurologist and psychiatrist Jules Cotard and characterized by negation delusions (or nihilists). Immortality and hypochondriac delusions are also typical. Nowadays, it is known that CS can be associated with many neuropsychiatric conditions. In this article, we describe the case of a patient that believed not having more organs and having the body deformed and whose CS was associated with a bigger depressive disorder. Although the electroconvulsive therapy is the most described treatment modality in the literature, the reported case had therapeutic success with association of imipramine and risperidone.
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Bott N, Keller C, Kuppuswamy M, Spelber D, Zeier J. Cotard Delusion in the Context of Schizophrenia: A Case Report and Review of the Literature. Front Psychol 2016; 7:1351. [PMID: 27656159 PMCID: PMC5013050 DOI: 10.3389/fpsyg.2016.01351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background: The Cotard delusion (CD) is one of a variety of narrowly defined monothematic delusions characterized by nihilistic beliefs about the body’s existence or life itself. The presence of CD within the context of schizophrenia is rare (<1%), and remains understudied. Case: ‘Mr. C’ is a 58-year-old veteran with a prior diagnosis of schizophrenia, who presented with CD in the context of significant depression, suicidal ideation, violence, and self-harm behavior. He perseverated in his belief that he was physically dead and possessed by demons for several weeks. This delusion was reinforced by his religious belief that life was an attribute of God, and by inference, he as a human, was dead. His condition gradually improved over the course of treatment with Divalproex and quetiapine with discussions about the rationale for his belief. Upon discharge, Mr. C. demonstrated awareness of his fixation on death and an ability to redirect himself. Discussion: This case highlights the need to better understand the co-occurrence of CD in schizophrenia, their differentiation, the increased risk of violence and self-harm behavior in this presentation, and how specific events and religious factors can influence delusional themes of CD. Pharmacotherapy and aspects of cognitive-behavioral therapy may be effective in ameliorating these symptoms in CD.
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Affiliation(s)
- Nicholas Bott
- Stanford University School of Medicine, Psychiatry and Behavioral SciencesStanford, CA, USA; VA Palo Alto Health Care SystemPalo Alto, CA, USA
| | - Corey Keller
- Stanford University School of Medicine, Psychiatry and Behavioral Sciences Stanford, CA, USA
| | - Malathy Kuppuswamy
- Stanford University School of Medicine, Psychiatry and Behavioral SciencesStanford, CA, USA; VA Palo Alto Health Care SystemPalo Alto, CA, USA
| | - David Spelber
- Stanford University School of Medicine, Psychiatry and Behavioral Sciences Stanford, CA, USA
| | - Joshua Zeier
- Stanford University School of Medicine, Psychiatry and Behavioral SciencesStanford, CA, USA; VA Palo Alto Health Care SystemPalo Alto, CA, USA
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Solimine S, Chan S, Morihara SK. Cotard Syndrome: "I'm Dead, So Why Do I Need to Eat?". Prim Care Companion CNS Disord 2016; 18:15l01862. [PMID: 27486535 DOI: 10.4088/pcc.15l01862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Although psychotic features have long been recognized in association with frontotemporal dementia (FTD), recent genetic discoveries enabling further subtyping of FTD have revealed that psychotic symptoms are frequent in some forms of FTD. Hallucinations and delusions can even precede onset of other cognitive or behavioural symptoms in patients with FTD. In this review, we explore the frequency and types of psychotic symptoms reported in patients with FTD, as well as in other neuropsychiatric disorders, to aid practitioners' consideration of these features in the diagnosis of FTD and related disorders.
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Cotard Syndrome without Depressive Symptoms in a Schizophrenic Patient. Case Rep Psychiatry 2015; 2015:643191. [PMID: 26101683 PMCID: PMC4458527 DOI: 10.1155/2015/643191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/14/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction. Cotard syndrome is a rare condition characterized by nihilistic delusions concerning body or life that can be found in several neuropsychiatry conditions. It is typically associated with depressive symptoms. Method. We present a case of Cotard syndrome without depressive symptoms in the context of known paranoid schizophrenia. A literature review of Cotard syndrome in schizophrenia was performed. Results. Although there are few descriptions of this syndrome in schizophrenia, patients usually present depressive mood and psychomotor retardation, features not seen in our patient. Loss of the sense of the inner self, present in schizophrenia, could explain patient's symptomatology but neurobiological bases of this syndrome remain unclear. Conclusion. Despite not being considered in actual classifications, Cotard syndrome is still relevant and psychiatric evaluation is critical to diagnosing and treating this condition in psychiatric patients.
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Najjar ES, Santos JPMD, Chaves AC, Pitta JCDN. A case report of Cotard’s syndrome with catatoniform symptoms. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parks NE, Rigby HB, Gubitz GJ, Shankar JJ, Purdy RA. Dysmetropsia and Cotard's syndrome due to migrainous infarction – or not? Cephalalgia 2014; 34:717-720. [DOI: 10.1177/0333102414520765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Migrainous infarction accounts for 12.8% of ischemic strokes of unusual etiology. Case report A 59-year-old woman with longstanding migraine with aura experienced what appeared to be migrainous infarction characterized by dysmetropsia and transient Cotard’s syndrome. Imaging demonstrated right temporal-parietal-occipital changes with apparent cortical laminar necrosis. Conclusion The spectrum of the pathophysiology of migrainous infarction has not been established; however, cortical spreading depression may explain the appearance of imaging findings that do not obey a vascular territory.
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Affiliation(s)
- Natalie E Parks
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
| | - Heather B Rigby
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
| | - Gordon J Gubitz
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
| | - Jai J Shankar
- Department of Radiology, Dalhousie University, Canada
| | - R Allan Purdy
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
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Abstract
Cotard syndrome is a rare psychiatric condition characterized by extreme nihilistic delusions. Catatonia though common, its combination with the Cotard syndrome is exceeding rare and more so the response with the pharmacotherapy as in our case. Since, both are found in organic conditions the importance of studying such a case is to understand the underlying neurobiologic determinants.
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Affiliation(s)
- Aniruddha Basu
- Department of Psychiatry, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Machado L, Peregrino A, Azoubel S, Cerqueira H, Lima Filho LED. Cotard's syndrome and major depression with psychotic symptoms. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:212. [DOI: 10.1590/1516-4446-2012-1044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 12/08/2012] [Indexed: 11/21/2022]
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Mughal F, Menezes SB. Severe Depression with Cotard's Phenomenon: Treatment of a Capacitated Patient Within the United Kingdom's Mental Health Act 2007. Ment Illn 2013; 5:e3. [PMID: 25478127 PMCID: PMC4253391 DOI: 10.4081/mi.2013.e3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/10/2013] [Accepted: 01/30/2013] [Indexed: 11/23/2022] Open
Abstract
Treatment of Cotard's syndrome with electroconvulsive therapy (ECT) has been seen to be an effective treatment option when pharmacological options are not successful. Recent changes in the Mental Health Act 2007 used within the United Kingdom has resulted in clinicians unable to prescribe treatment for patients who have capacity but are not providing consent for treatment. We report a case of a patient in the UK with Cotard's phenomenon and severe depression, where the only effective treatment of ECT was restricted due to changes in mental health law. The role of maintenance ECT as well as the ethical dilemma faced is discussed.
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Affiliation(s)
- Faraz Mughal
- The Oleaster, National Centre for Mental Health , Birmingham, UK
| | - Simon B Menezes
- The Oleaster, National Centre for Mental Health , Birmingham, UK
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Stompe T, Schanda H. [The Cotard syndrome in schizophrenic disorders]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2013; 27:38-46. [PMID: 23307614 DOI: 10.1007/s40211-012-0046-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Cotard-Syndrome (CS), the belief of being dead, was described for the first time in 1880. Since then it met the interest not only of psychopathologists but also of philosophers. With a few exceptions, the literature is mainly restricted to case reports of anxious-depressive, demented or paranoid patients. It was the aim of our study to investigate the prevalence and the psychopathological context of the CS. METHODS We analyzed the Austrian data (N = 346) of the International Study of Psychotic Symptoms in Schizophrenia. RESULTS A CS could be diagnosed in three cases (0.87%). In all of them, CS developed on the basis of nihilistic-hypochondriac delusions and a progressive loss of energy. Two patients bridged the logical inconsistencies between obviously being alive and the belief of being dead by visual illusions, the third patient, however, by locating himself in an intermediate region between this world and the afterworld. CONCLUSIONS On the one hand the CS can be considered as a special manifestation of the topic of death in schizophrenic delusions, on the other as a nihilistic delusional identity. Without doubt, this uncommon and bizarre psychotic phenomenon will be an object of interest for general psychopathology as well as for the philosophy of mind also in future.
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Affiliation(s)
- Thomas Stompe
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Abstract
AbstractObjective:Brain tumors are classically associated with neurological and/or psychiatric symptomatology. Behavioral or cognitive disorders can underlie delirium, personality changes, psychotic reactions, and mood disorders.Method:To illustrate this, we report the case of a 60-year-old male patient confronted with an inoperable glioblastoma multiforme on the splenium of the corpus callosum, of poor prognosis, treated by concomitant radiochemotherapy with temozolomide, who developed psychotic depression with Cotard's syndrome. Clinical manifestations of this syndrome with untoward consequences in terms of prognosis are classically characterized by intense moral suffering, indignity and pessimistic fixations, suicidal ideations, and a nihilistic delusion relating to one's own body.Results:Nevertheless, this association between Cotard's syndrome and glioblastoma has been seldom described. To our knowledge, this is the first time that this has been described as a complication of this particular tumor location. Some neuropsychopathological hypotheses are proposed, which involve medical, iatrogenic, and psychogenesis issues.Significance of results:This case report points to the necessary collaboration between psychiatrists, neuro-oncologists and radiation oncologists in improving the patient's management and quality of life.
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Freudenreich O, Basgoz N, Fernandez-Robles C, Larvie M, Misdraji J. Case records of the Massachusetts General Hospital. Case 5-2012. A 39-year-old man with a recent diagnosis of HIV infection and acute psychosis. N Engl J Med 2012; 366:648-57. [PMID: 22335743 DOI: 10.1056/nejmcpc1005311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Desseilles F, Mikolajczak G, Desseilles M. [Suicide and nutrition: a bio-psychosocial approach]. SANTE MENTALE AU QUEBEC 2012; 37:65-94. [PMID: 23666282 DOI: 10.7202/1014945ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article proposes a new bio-psychosocial perspective on the links between mental health, more specifically suicide, and nutrition. We first discuss the links between nutrition, its social role and suicide. The act of eating is studied as a social integrator and regulator, in the light of Durkheim's theorization. Nutrition is also examined as self-destruction, with particular cases of "diet-related suicide." De-structuring of meals and alienating foods are identified as contributing factors to the de-structuring of "nutrition models." We then discuss the place of food within the psychopathology, and finally, the links between biological parameters reflected in food and suicide risk. Avenues of research and intervention along this bio-psychosocial approach are also proposed.
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Affiliation(s)
- François Desseilles
- Unité de droit économique et de théorie du droit, Université de Liège, Belgique
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Use of modified electroconvulsive therapy in a case of polymyositis presenting with delusion of nihilism of proxy (Odysseus syndrome). J ECT 2011; 27:e32-4. [PMID: 21233766 DOI: 10.1097/yct.0b013e3181eb308c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of psychotic depression with polymyositis presenting with the distinct phenomenon of nihilism by proxy, which was treated with electroconvulsive therapy (ECT). A female patient with polymyositis was initially treated with pharmacotherapy. After initial response, there was deterioration in her mental state and hence, after careful consideration, neurological, and anaesthetic consultations, modified ECT was given with close monitoring. The mental state of the patient improved with a course of ECT, which proceeded without any complications. Her depressive symptoms including the delusion of nihilism by proxy responded to ECT. To the best of our knowledge, the use of ECT has not been reported in a case of polymyositis before, and this case shows that modified ECT can be given successfully in patients with polymyositis.
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