Cotard syndrome: Pathology review

Abstract

Introduction

Cotard syndrome (CS) is a rare neuropsychiatric condition characterized by nihilistic delusions, which may range from negation of existence of parts of the body to delusion of being dead or negation of self-existence, and it requires an urgent and appropriate therapy.

Objectives

Our objective is to highlight the importance of CS, reinforcing that medical professionals should be aware of this pathology to prompt clinical description, diagnostic and treatment.

Aims

The aim of this presentation is to alert psychiatrists to this remaining syndrome.

Methods

Review of phenomenological and theoretical issues regarding SC.

Results

CS can be found in numerous psychiatric or neurologic pathologies but it is most seen in patients with severe depression. It is typically divided in three subtypes: psychotic depression, Cotard type I, with nihilistic delusions without mood symptoms, and Cotard type II, with mood symptoms and auditory hallucinations. There are numerous etiological hypothesis mechanisms, including unusual perceptual experiences, which can similarly be involved in Capgras delusion, disconnection from emotional or limbic processes, an impaired belief evaluation or a tendency to excessive self-attribution. Frontotemporoparietal circuitry also seems to have an important role in its pathology. Treatment usually involves electroconvulsive therapy, antidepressants and anti-psychotics and the prognosis depends on the underlying disorders.

Conclusions

CS is a rare pathology with self-defeating risk and its clinical recognition and proper treatment are essential to improve the prognosis of these patients. Diagnostic criteria or clinical instruments for assessment of this syndrome should be encouraged, since its lack is a limitation for systematic studies and consequent management advances.

Disclosure of interest

The authors have not supplied their declaration of competing interest.