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Nomura K, Kobayashi R, Shirata T, Noto K, Suzuki A. Longitudinal Changes of Regional Cerebral Blood Flow on a Single-Photon Emission Computed Tomography (SPECT) Scan in a Patient With Schizophrenia Having Cotard's Syndrome. Cureus 2024; 16:e58263. [PMID: 38752030 PMCID: PMC11093889 DOI: 10.7759/cureus.58263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/18/2024] Open
Abstract
Cotard's syndrome is a rare clinical condition characterized by the presence of nihilistic delusions, delusions of immortality, depressive mood, and anxiety. Longitudinal changes in regional cerebral blood flow (rCBF) obtained under different conditions with and without Cotard's syndrome have rarely been reported in the literature. We report a case of a patient with Cotard's syndrome in whom longitudinal rCBF was assessed using single-photon emission computed tomography (SPECT). The patient was a 52-year-old man suffering from schizophrenia and mild mental retardation. He was transported to our hospital because of lumbar fractures caused by a suicidal attempt. In the second week after admission, he displayed Cotard's syndrome, i.e., nihilistic delusions, suicidal thoughts, and depressive mood. SPECT with 99mTc-ethyl cysteinate dimer was performed, and the rCBF increased in the bilateral prefrontal cortex but decreased in the occipital and parietal lobes. He was treated with pharmacotherapy mainly using lurasidone, and his Cotard's symptoms disappeared. SPECT was performed again. The increased rCBF in the bilateral prefrontal cortex and the decreased rCBF in the right occipital and parietal lobes were improved. The present case suggests that increased rCBF in the prefrontal cortex and decreased rCBF in the right occipital and parietal lobes are associated with the development of Cotard's syndrome.
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Affiliation(s)
- Konoka Nomura
- Psychiatry, Yamagata University Faculty of Medicine, Yamagata, JPN
| | - Ryota Kobayashi
- Psychiatry, Yamagata University Faculty of Medicine, Yamagata, JPN
| | | | - Keisuke Noto
- Psychiatry, Yamagata University Faculty of Medicine, Yamagata, JPN
| | - Akihito Suzuki
- Psychiatry, Yamagata University Faculty of Medicine, Yamagata, JPN
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2
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Akahane T, Takahashi N, Kobayashi R, Nomura K, Akiho M, Shikama Y, Noto K, Suzuki A. Case report: A case of anti-recoverin antibody-positive encephalitis exhibiting Cotard and Capgras delusions that was successfully treated with electroconvulsive therapy. Front Psychiatry 2024; 15:1330745. [PMID: 38333894 PMCID: PMC10850254 DOI: 10.3389/fpsyt.2024.1330745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Recoverin is a neuron-specific calcium-binding protein that is mainly located in the retina and pineal gland. Few reports have described patients with anti-recoverin antibody-positive encephalitis, and no cases of psychosis associated with this encephalitis have been reported. We report a patient with anti-recoverin antibody-positive encephalitis with Cotard and Capgras delusions who was successfully treated with electroconvulsive therapy (ECT). The patient was a 25-year-old woman. She exhibited disorientation, executive function deficits, tremors in the upper limbs, generalized athetoid-like involuntary movements, hallucinations, incontinence, and fever, which led to her admission to our hospital. Upon admission, she complained of Cotard delusions. Various diagnostic tests, including cerebrospinal fluid analysis, antibody screening, and brain imaging, were unremarkable, except for positivity for serum anti-recoverin antibodies, non-specific general slowing on electroencephalography and decreased regional cerebral blood flow (rCBF) in the frontal and occipital lobes, and increased rCBF in the basal ganglia and pons on single-photon emission computed tomography. She was eventually diagnosed with encephalitis positive for anti-recoverin antibodies and treated with immunoglobulins and steroids. Her neurological symptoms improved temporarily, but three months later, psychiatric symptoms, i.e., suicidal thoughts and Cotard and Capgras delusions, were exaggerated. After ECT, her condition significantly improved. In conclusion, the present report suggests that pineal gland dysfunction due to anti-recoverin antibody or its cross-reactivity with neuron-specific calcium-binding proteins may contribute to the neuropsychiatric symptoms observed in anti-recoverin antibody-positive encephalitis and that ECT can be a viable treatment option if immunotherapy proves ineffective. Additionally, decreased rCBF in the prefrontal cortex may be associated with the clinical features of Capgras and Cotard delusions.
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Affiliation(s)
- Takaki Akahane
- Department of Psychiatry, Okitama Public General Hospital, Yamagata, Japan
| | - Naomi Takahashi
- Department of Neurology, Okitama Public General Hospital, Yamagata, Japan
| | - Ryota Kobayashi
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Konoka Nomura
- Department of Psychiatry, Okitama Public General Hospital, Yamagata, Japan
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Masakazu Akiho
- Department of Radiology, Okitama Public General Hospital, Yamagata, Japan
| | - Yukihiro Shikama
- Department of Neurology, Okitama Public General Hospital, Yamagata, Japan
| | - Keisuke Noto
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Akihito Suzuki
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
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3
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Koreki A, Mashima Y, Oda A, Koizumi T, Koyanagi K, Onaya M. You are already dead: Case report of nihilistic delusions regarding others as one representation of Cotard's syndrome. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e93. [PMID: 38868142 PMCID: PMC11114400 DOI: 10.1002/pcn5.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/25/2023] [Accepted: 04/11/2023] [Indexed: 06/14/2024]
Abstract
Background While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected. Case presentation A woman aged in her 60s diagnosed with schizophrenia was admitted to our hospital for psychotic symptoms, including delusions of reference, delusions of guilt, auditory hallucinations, cenesthetic hallucinations, agitation, depression, suicidal ideation, and catatonia. During hospitalization, her cenesthetic hallucinations progressed to include nihilistic delusions. She described cenesthetic hallucinations along with various delusional descriptions, including the belief that various objects, such as spoons, irons, nails, rulers, bins, and coins, were inside her body and that her body was being burned or in danger of exploding. She also claimed an altered sense of her own body, that her body was larger than normal or reversed. Moreover, she reported nihilistic delusions that her face and body did not exist, that her heart was not functioning, and that she was going to die soon or was already dead. She occasionally refused to eat because of the feeling of being dead. Notably, during a severe episode, she claimed that a doctor in front of her was dead. Clozapine was effective in improving her symptoms. Ultimately, the patient regained her sense of being alive and acknowledged that the doctor was alive. Conclusion We report the case of a patient presenting with nihilistic delusions regarding both self and others, along with prior cenesthetic hallucinations. Aberrant interoceptive processing could be a potential link between these two forms of nihilistic delusions.
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Affiliation(s)
- Akihiro Koreki
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Yuki Mashima
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Akihiko Oda
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Teruki Koizumi
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Kazuhiro Koyanagi
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Mitsumoto Onaya
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
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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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5
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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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6
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Couto RAS, Moreira Gonçalves L. A medical algorithm for Cotard delusion based on more than 300 literature cases. Int J Psychiatry Clin Pract 2021; 25:220-232. [PMID: 32935595 DOI: 10.1080/13651501.2020.1819335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, i.e., the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition. METHOD To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD. RESULTS Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy. CONCLUSIONS Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
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Affiliation(s)
- Rosa A S Couto
- School of Medicine, University of Minho, Braga, Portugal.,REQUIMTE, LAQV, Laboratory of Applied Chemistry, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Luís Moreira Gonçalves
- Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo (USP), São Paulo, Brazil
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Gnoni V, Higgins S, Nesbitt AD, Wasserman D, Duncan I, Birdseye A, Pérez-Carbonell L, Drakatos P, Koutramanidis M, Ferini-Strambi L, Leschziner GD, Rosenzweig I. Cotard parasomnia: le délire de negation that occur during the sleep-wake dissociation? J Clin Sleep Med 2021; 16:971-976. [PMID: 32195661 DOI: 10.5664/jcsm.8430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
None Unpleasant dreamlike mentation can occur during non-rapid eye movement parasomnias, leading to associated panic attacks. The mentations are rarely remembered and are likely underreported. However, they may lead to significant personal distress and, if not addressed, may contribute to poorer clinical outcomes. Cotard le délire de negation are very rare nihilistic delusions, historically described with psychotic disorders. Their association with a variety of neurologic disorders, including migraine and cluster-headache, has also been reported. Here we present three cases of Cotard parasomnia during which distinct states of consciousness defined by nihilistic ideation occurred. Patients described believing they are dead or dying, while unable to perceive or experience their bodies in whole, or in part, as their own. A source analysis of the electroencephalographic fingerprint of these mentations suggests right-hemispheric hypoactivity subsequent to confusional arousals. Mechanistically, an aberrant activation of two major intrinsic brain networks of wakefulness, the salience network and the default mode network, is argued.
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Affiliation(s)
- Valentina Gnoni
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, United Kingdom.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, United Kingdom.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alexander David Nesbitt
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, United Kingdom.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Headache Group, Department of Clinical Neurosciences, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Danielle Wasserman
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, United Kingdom.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Iain Duncan
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Adam Birdseye
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Panagis Drakatos
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Clinical Neurosciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Guy Doron Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, United Kingdom.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, United Kingdom.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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8
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Ramirez Bermúdez J, Bustamante-Gomez P, Espínola-Nadurille M, Kerik NE, Dias Meneses IE, Restrepo-Martinez M, Mendez MF. Cotard syndrome in anti-NMDAR encephalitis: two patients and insights from molecular imaging. Neurocase 2021; 27:64-71. [PMID: 33390066 DOI: 10.1080/13554794.2020.1866018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cotard syndrome is a clinical condition defined by the presence of nihilistic delusions. We report two patients with Cotard syndrome in whom anti-NMDAR encephalitis (ANMDARE) was confirmed. Both cases showed features of affective psychosis, developed catatonic syndrome, and worsened after the use of antipsychotics. 18F-FDG PET brain studies showed a bilateral hemispheric pattern of hypometabolism in posterior regions, mainly in the cingulate cortex and in the medial aspects of parietal and occipital lobes. A more severe hypometabolism was observed in the right hemisphere of both patients. Both cases remitted with the use of specific immunotherapy for ANMDARE.
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Affiliation(s)
| | | | | | - N E Kerik
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - I E Dias Meneses
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - M F Mendez
- National Institute of Neurology and Neurosurgery, Mexico City; and the Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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9
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Ricardo BAM, Mariana LIE, AL SO, Manuel CCJ, Jesus RB. Anton syndrome after subarachnoid hemorrhage and delayed cerebral ischemia: A case report. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100023. [PMID: 36324705 PMCID: PMC9616440 DOI: 10.1016/j.cccb.2021.100023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
Bilateral occipital damage is not sufficient for the onset of visual anosognosia. Anton syndrome may result from bilateral occipital and right frontoparietal lesions. Anosognosia can be understood as a metacognitive deficit. Disturbed metacognition is related to right fronto-parietal dysfunction. Delusions of being dead (Cotard syndrome) may appear after right hemispheric damage.
We report the case of a patient with ruptured middle cerebral artery aneurysm, subarachnoid hemorrhage and frontal intracerebral hemorrhage, who secondarily presented with delayed cerebral ischemia and bilateral occipital infarcts, with complete vision loss, visual anosognosia, and confabulations as the main symptoms. Additionally, the patient had defined features of Cotard syndrome, as revealed by persistent nihilistic delusions. The brain imaging studies showed a bilateral occipital ischemic lesion, as well as frontal and parietal hemorrhagic lesions in the right hemisphere. We address the general theories of anosognosia, confabulation and the problem of why a bilateral occipital lesion is not enough for these metacognitive defects to exist. The presence of right frontal and or parietal hemisphere lesions could be necessary features in most cases.
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Affiliation(s)
| | | | - Sosa-Ortiz AL
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Ramirez-Bermudez Jesus
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
- Corresponding author.
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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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