1
|
Ballerini M, Raimbaud M, Joly L, Bottemanne H. [The invisible pregnancy: Clinical characteristics and perspectives about denial of pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:322-332. [PMID: 35272081 DOI: 10.1016/j.gofs.2022.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.
Collapse
Affiliation(s)
- M Ballerini
- Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - M Raimbaud
- University of Paris, GHU Paris Psychiatrie Neurosciences, Sainte-Anne Hospital, Paris, France
| | - L Joly
- Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), Inserm, CNRS, Sorbonne University, Paris, France
| | - H Bottemanne
- Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), Inserm, CNRS, Sorbonne University, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Huarcaya-Victoria J, Bojórquez-De la Torre J, De la Cruz-Oré J. Factor Structure of Cotard's Syndrome: Systematic Review of Case Reports. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:187-193. [PMID: 32888662 DOI: 10.1016/j.rcp.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cotard's syndrome is a rare psychiatric condition. As a result, current information is mainly based on reports and case series. OBJECTIVE To analyse the psychopathological characteristics and the grouping of the symptoms of the Cotard's syndrome cases reported in the medical literature. METHODS A systematic review of the literature of all reported cases of Cotard's syndrome from 2005 to January 2018 was performed in the MEDLINE/PubMed database. Demographic variables and clinical characteristics of each case were collected. An exploratory factor analysis of the symptoms was performed. RESULTS The search identified 86 articles, of which 69 were potentially relevant. After reviewing the full texts, 55 articles were selected for the systematic review, in which we found 69 cases. We found that the diagnosis of major depression (P<0.001) and organic mental disorder (P=0.004) were more frequent in the older group with Cotard's syndrome. An exploratory factor analysis extracted 3 factors: psychotic depression, in which it includes patients with delusions of guilt (0.721), suicidal ideas (0.685), delusions of damnation (0.662), nihilistic delusions of the body (0.642), depression (0.522), and hypochondriacal delusions (0.535); delusive-hallucinatory, with patients who presented delusions of immortality (0.566), visual hallucinations (0.545) and nihilistic delusions of existence (0.451), and mixed, with patients who presented nihilistic delusions of concepts (0.702), anxiety (0.573), and auditory hallucinations (0.560). CONCLUSIONS The psychopathology of Cotard's syndrome is more complex than the simple association with the delusion of being dead, since it encompasses a factorial structure organised into 3 factors.
Collapse
Affiliation(s)
- Jeff Huarcaya-Victoria
- Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación en Salud Pública, Lima, Perú; Departamento de Psiquiatría, Hospital Central de la Policía Nacional del Perú Luis N. Saenz, Lima, Perú.
| | - José Bojórquez-De la Torre
- Servicio de Enfermedades Psiquiátricas Agudas, Departamento de Hospitalización, Hospital Víctor Larco Herrera, Lima, Perú
| | - Jorge De la Cruz-Oré
- Departamento de Emergencia, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| |
Collapse
|
5
|
Lende M, Freeman E, Hoq R, Cottrell C, Savitski J. Multidisciplinary Approach to Managing an Obstetrical Patient with Delusional Denial of Pregnancy. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20191007-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
6
|
Dua D, Grover S. Delusion of denial of pregnancy: A case report. Asian J Psychiatr 2019; 45:72-73. [PMID: 31520883 DOI: 10.1016/j.ajp.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Devakshi Dua
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
Delusional denial of pregnancy: Unique presentation of Cotard's syndrome in a patient with schizophrenia. Asian J Psychiatr 2017; 30:26-27. [PMID: 28710951 DOI: 10.1016/j.ajp.2017.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/02/2017] [Indexed: 11/24/2022]
|
9
|
Karakasi MV, Markopoulou M, Tentes IK, Tsikouras PN, Vasilikos E, Pavlidis P. Prepartum Psychosis and Neonaticide: Rare Case Study and Forensic-Psychiatric Synthesis of Literature. J Forensic Sci 2017; 62:1097-1106. [DOI: 10.1111/1556-4029.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 10/03/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Maria-Valeria Karakasi
- Adult Psychiatry, Psychiatric Department; G. Papanikolaou General Hospital of Thessaloniki; Exohi, Asvestoxori GR 57010 Thessaloniki Greece
| | - Maria Markopoulou
- Department of Forensic Psychiatry; Psychiatric Hospital of Thessaloniki; GR 56429 Stavroupolis, Thessaloniki Greece
| | - Ioannis K. Tentes
- Department of Biochemistry; School of Medicine; Democritus University of Thrace; GR 68100 Alexandroupolis Greece
| | - Panagiotis N. Tsikouras
- Department of Obstetrics and Gynecology; University General Hospital of Evros; School of Medicine; Democritus University of Thrace; GR 68100 Alexandroupolis Greece
| | - Epameinondas Vasilikos
- Adult Psychiatry, Psychiatric Department; G. Papanikolaou General Hospital of Thessaloniki; Exohi, Asvestoxori GR 57010 Thessaloniki Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences; School of Medicine; Democritus University of Thrace; GR 68100 Alexandroupolis Greece
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Seeman MV. Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion. World J Clin Cases 2014; 2:338-344. [DOI: 10.12998/wjcc.v2.i8.338] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/14/2014] [Indexed: 02/05/2023] Open
Abstract
Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.
Collapse
|
12
|
Seeman MV. Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion. World J Clin Cases 2014; 2:338-44. [PMID: 25133144 PMCID: PMC4133423 DOI: 10.12998/wjcc.v2.i8.328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/26/2014] [Accepted: 07/12/2014] [Indexed: 02/05/2023] Open
Abstract
Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.
Collapse
Affiliation(s)
- Mary V Seeman
- Mary V Seeman, Institute of Medical Science, Department of Psychiatry, University of Toronto, Toronto, Ontario, ON M5S, Canada
| |
Collapse
|
13
|
Muhlstein J, Martrille L, Guillet-May F, Routiot T, Coudane H, Judlin P. [Post-rape pregnancy]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2013; 41:110-115. [PMID: 23375987 DOI: 10.1016/j.gyobfe.2012.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 12/19/2012] [Indexed: 06/01/2023]
Abstract
A rape is a traumatizing circumstance for the victim. This aggression often has, regrettably, immediate repercussions, and then medium and long-term ones. Its complications are psychological, but also sometimes somatic, like pregnancy. Through an international literature review, and the study of the national legislation, we will summarize the main essential elements of the medical and forensic care of a pregnancy arising after a rape.
Collapse
Affiliation(s)
- J Muhlstein
- Service de gynécologie, pôle de gynécologie-obstétrique et reproduction, maternité régionale Adolphe-Pinard, 10, rue du Dr-Heydenreich, CS 74213, 54042 Nancy cedex, France.
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
OBJECTIVE Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. DATA SOURCES AND SEARCH STRATEGY: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008. DATA SELECTION All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations. CONCLUSIONS Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred.
Collapse
Affiliation(s)
- Salvatore Gentile
- Department of Mental Health ASL Salerno 1, Mental Health Center n. 4, Piazza Galdi, 841013 Cava de' Tirreni (Salerno), Italy.
| |
Collapse
|
15
|
Abstract
Cotard's syndrome is a rare disorder in which nihilistic delusions concerning one's own body are the central feature. It is not listed as a specific disorder in the DSM-IV, as it is typically viewed as a part of other underlying disorders. However, it remains important to recognize the syndrome because specific underlying mechanisms are present, and prognostic and therapeutic consequences have to be taken into account. This review presents an up-to-date overview of Cotard's syndrome, which was initially described more than a century ago.
Collapse
Affiliation(s)
- Hans Debruyne
- Department of Psychiatry, University Hospital Ghent, De Pintelaan 185, Ghent 9000, Belgium.
| | | | | | | |
Collapse
|