Cotard Syndrome

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Classification according to ICD-10
F22.0 Delusional disorder
F06.2 Organic delusional [schizophrenic] disorder
ICD-10 online (WHO version 2019)

The Cotard syndrome (after Jules Cotard , Paris, 1840–1889, French " délire des négations " ), also nihilistic delusion or English walking corpse syndrome (in German about: Wandelleichen Syndrome ), describes a clinical picture in which the person concerned mistakenly believes that she is dead, that she does not exist, that she is decayed, or that she has lost her blood and internal organs. The clinical picture is one of the content- related thought disorders and is assigned to delusion . It is mostly found in schizophrenic or affective psychoses , also occurring in temporo parietally damaged, non-dominant hemisphere of the brain and migraines . The Cotard syndrome is often a consequence of severe brain diseases.

Historical background

The Cotard syndrome was named after the French neurologist Jules Cotard (1840-1889), who was the first to describe this condition. In 1880 he described the case of a 43-year-old patient who believed she had no brain and was dead, which is why she asked to be cremated. Cotard described their condition as " délire des négations " (delusional belief in their own non-existence).

Symptoms

Young and Leafhead described a recent case of Cotard Syndrome that occurred in a patient who suffered a brain injury from a motorcycle accident.

“The patient's symptoms are related to the feeling of unreality and being dead. After he was released from Edinburgh hospital in January 1990, his mother took him to South Africa with her. He was convinced that he would have been taken to Hell (which was reinforced by the heat) and that he would have died of sepsis (which was a risk factor during his recovery) or maybe AIDS (he had a story in "The Scotsman") read in which someone with AIDS died of sepsis) or an overdose of a yellow fever injection. He thought he was "lending his mother's spirit" to show him what hell was like and that she was sleeping in Scotland. "

Pathophysiology

From a neurological point of view, the Cotard syndrome is based on the Capgras syndrome . Both are believed to be the result of a separation between the areas of the brain that are responsible for facial recognition and the areas that associate emotions with these recognitions ( amygdala and limbic structures ). This lack of connection leads to the perception that the face being viewed is not who it claims to be. It follows that there is a lack of familiarity that normally should be present in a familiar face. If it is a relative's face, they will be experienced as a fraud. When the person concerned sees their own face, there is no association between the face and their own perception of themselves. It follows that they feel like they don't exist.

Cotard syndrome is mainly found in psychoses such as schizophrenia or bipolar disorder . It can occur in the context of neurological or mental illnesses and is partly associated with clinical depression and derealization . It was also mentioned in connection with migraines.

In 2007, two cases of Cotard syndrome were reported as a side effect of the drug acyclovir .

treatment

Treatment should follow a careful diagnostic work-up of the underlying disorder. There have been some reports of successful pharmacological treatments. Also mono therapy and combined strategies have been reported.

Antidepressants and neuroleptics have been found to be useful. There have been many positive reports of electroconvulsive therapy in conjunction with drug therapy . An all-encompassing prognosis mostly seems to be determined by the treatment options and the prognosis of the underlying disorder.

Literature and film

  • Franz Peschke, Christian Hoffstadt : The dead self. A note on Cotard Syndrome. In: Chr. Hoffstadt, F. Peschke, A. Schulz-Buchta, M. Nagenborg (eds.): The foreign body. Projekt Verlag, Bochum / Freiburg 2008, ISBN 978-3-89733-189-1 , pp. 119-131.
  • Volker Arolt, Christian Reimer, Horst Dilling: Basic knowledge of psychiatry and psychotherapy. 6th edition. Springer Verlag, 2007, ISBN 978-3-540-32672-4 , p. 43.
  • In the 14th episode of the fourth season of Scrubs , Cotard's Syndrome is thematized by a patient.
  • The protagonist Fiona Griffiths in the Harry Bingham crime series suffers from Cotard Syndrome.
  • In the 10th episode of the first season of the US television series Hannibal , the character Georgia Maedchen is diagnosed with Cotard Syndrome.

Individual evidence

  1. ↑ a b Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 969.
  2. ↑ GE Berrios, R. Luque: Cotard's delusion or syndrome? In: Comprehensive Psychiatry. 36: (1995) pp. 218-223.
  3. ↑ Cotard's Syndrome. whonamedit.com, accessed June 11, 2014 .
  4. ↑ Helen Thomson: Back from the dead: Reversing walking corpse syndrome. New Scientist, October 16, 2013, accessed June 21, 2014 .
  5. ↑ AW Young, KM Leafhead: Betwixt Life and Death: Case Studies of the Cotard Delusion . In: PW Halligan, JC Marshall (Eds.): Method in Madness: Case studies in Cognitive Neuropsychiatry . Psychology Press, Hove 1996, pp. 155 .
  6. ↑ J. Pearn, C. Gardner-Thorpe: Jules Cotard (1840-1889) His life and the unique syndrome that bears his name . In: Neurology . tape 58 , no. 9 , May 14, 2002, p. 1400-3 , PMID 12011289 (abstract).
  7. ↑ A. Helldén, I. Odar-Cederlöf a. a .: Death delusion. In: BMJ. Volume 335, number 7633, December 2007, p. 1305, doi : 10.1136 / bmj.39408.393137.BE , PMID 18156240 , PMC 2151143 (free full text).
  8. ^ A b H. Debruyne, M. Portzky, F. Van den Eynde, K. Audenaert: Cotard's syndrome: a review. In: Current psychiatric reports . tape 11 , no. 3 , June 2010, p. 197-202 , PMID 19470281 (review article).