Makindo Medical Notes

Related Subjects: |Depression |Mania |Schizophrenia |Suicide |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Cotard Delusion |Anorexia Nervosa

🧠 The Cotard Delusion (Cotard's Syndrome)

• A rare neuropsychiatric disorder usually linked to severe depression, though it can also occur in psychosis or neurological disease.
• Defined by the delusional belief that the person:
  • ⚰️ is dead, non-existent, or has lost their identity
  • 🩸 is putrefying or decomposing
  • 🫀 has lost vital organs, blood, or body parts

📋 Clinical Presentation

• Marked by nihilistic delusions and feelings of profound hopelessness.
• Symptoms may include:
  • 😞 Severe depressive features
  • 👂 Hallucinations
  • 😰 Anxiety and detachment from reality
• 🧍‍♂️ Self-neglect is common, due to the belief that care is futile if they are "already dead."

🔗 Associated Conditions

• Major Depressive Disorder with psychotic features (most common).
• Schizophrenia and bipolar disorder.
• Neurological insults: stroke, traumatic brain injury, dementia.

🧪 Pathophysiology (Possible Mechanisms)

• Exact cause unknown.
• Thought to involve dysfunction in brain areas regulating self-perception and reality testing (parietal and frontal lobes).
• Neuroimaging may show hypoperfusion or hypometabolism in these regions.

🩺 Diagnosis

• Clinical, based on reported delusions and psychiatric evaluation.
• Organic causes (neurological or substance-induced) should be ruled out with bloods and imaging.

💊 Management and Treatment

• Pharmacological: Antidepressants, antipsychotics, and mood stabilisers, tailored to the underlying disorder.
• ECT: Effective in severe or treatment-resistant cases.
• Psychological support: Helpful for mood, coping, and safety, though the core delusion often resists psychotherapy alone.

📌 Key Point

Cotard's Syndrome is a rare but severe psychiatric condition where patients deny their existence or believe they are dead. It is a psychiatric emergency due to the risk of suicide and self-neglect, requiring urgent assessment and often aggressive treatment.

Cases — Cotard Delusion (“Walking Corpse Syndrome”)

• Case 1 — Major depression with psychosis 😔: A 58-year-old woman with severe depression reports that she is already dead and that her internal organs have rotted away. She refuses food, saying there is no point as she “no longer exists.” Diagnosis: Cotard delusion in psychotic depression. Managed with urgent psychiatric admission, antidepressants, and ECT consideration.
• Case 2 — Neurological association 🧠: A 67-year-old man post-stroke presents with nihilistic delusions, claiming his brain has dissolved and he does not have a heart. CT shows infarcts in the parietal and frontal lobes. Diagnosis: Cotard delusion secondary to cerebrovascular disease. Managed with combined neurological and psychiatric input, including antipsychotic therapy.

Teaching Point 🩺: Cotard delusion is a rare nihilistic delusion where patients believe they are dead, do not exist, or have lost organs/blood. It is most often seen in severe depression with psychosis, but can also occur in neurological disease. Treatment may include antidepressants, antipsychotics, or ECT.