Cotard syndrome, also known as Cotard delusion or walking corpse delusion is a rare mental health disorder where the person believes that they are actually dead or do not exist. It was first described by the neurologist Jules Cotard in 1880. Typical of a mild case of this delusion is despair and self-loathing. More severe cases were characterized by intense delusions of negation and chronic depression. 1
The delusions experienced can take many forms. Patients may believe that they are dead, do not exist, have lost their vital organs or are putrefying. In some instances, the afflicted even report smelling rotting flesh. Symptoms of guilt, negativity, and anxiety are sometimes seen as well. Paradoxically, some people may suffer delusions of immorality. Many studies show that this disorder is more prevalent in older patients. Similarly, it is more commonly observed in those who also have depression, bipolar disorder, schizophrenia, brain atrophy, brain injury, seizure disorders, stroke, migraines and delirium. It affects women more commonly than men. It is thought to be due to lesions in the frontal and temporal parts of the right hemisphere of the brain, although the etiology is uncertain. Some patients died of starvation since they didn’t think they needed food because they thought they were already dead. 2
The exact prevalence and incidence of this disorder is unknown. One study done in Hong Kong suggested the prevalence to be 0.57% of the population. When severely depressed elderly patients were included, the prevalence approached 3.2%. Another recent study in Mexico found a prevalence of 0.62% in primary psychiatric patients. 3 But, there is little known about the true prevalence.
At the current time, the only means of diagnosis is by clinical history. However, interesting findings were observed on PET scan studies in some patients.
Specifically, extensive low metabolism was seen across several regions in the brain in the frontal and parietal cortex. These regions control our conscious awareness and our sense of self. It was noted that the metabolism was lower and more wide-spread than is typically observed in major depression. In fact, in one patient, the PET scan resembled that of a brain under general anesthesia, asleep or otherwise in a vegetative stage. 4
Many suspect that brain atrophy and blood flow changes in the left hemisphere could be associated with Cotard’s. Several studies have discussed the use of ECT as therapy and it seems to have some benefit. In fact, in patients with psychotic symptoms, some suggest using ECT as first-line therapy. 5
While there is no cure for Cotard’s, antidepressants, antipsychotics and mood stabilizers are the main-stay of treatment. The patient can be treated with a single agent or a combination depending on the underlying condition. For patients who also have bipolar disorder, mood stabilizers appear to be beneficial. 6
Prognosis of this disorder is variable. Acute remission sometimes appears as suddenly as the onset. If the delusion is due to an acute psycho-organic syndrome, prognosis is usually good and often resolves. If there is an associated depressive disorder, it tends to persist. When the underlying condition is chronic, the delusion tends to wax and wane. When schizophrenia is an underlying disorder, the delusion tends to improve as the symptoms of the schizophrenia respond to treatment. Support from healthcare professionals is imperative as these patients have a high incidence of suicide and experience great degrees of distress and terror. 7
Currently, there is not much research going on regarding Cotard’s syndrome. Although a rare disorder, more research is needed because we do not have a very good understanding of the pathophysiology as of yet.
1-https://en.wikipedia.org/wiki/Cotard_delusion
2- http://www.medindia.net/patients/patientinfo/walking-corpse-syndrome.htm
3- https://www.researchgate.net/publication/26241741_Cotard’s_Syndrome_A_Review
4- http://www.united-academics.org/mind-brain/surprising-brain-scan-of-patient-with-walking-corpse-syndrome/
5- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC383346/
6- http://www.medindia.net/patients/patientinfo/walking-corpse-syndrome.htm
7- https://www.researchgate.net/publication/26241741_Cotard’s_Syndrome_A_Review
First published on SERMO.
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