Cotard’s syndrome: A review

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.

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References and Recommended Reading

  1. 1.

    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4 (text revision). Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  2. 2.

    Van den Eynde F, Debruyne H, Portzky M, et al.: The syndrome of Cotard: an overview [in Dutch]. Tijdschr Psychiatr 2008, 50:89–98.

    PubMed  Google Scholar 

  3. 3.

    Berrios GE, Luque R: Cotard’s delusion or syndrome?: a conceptual history. Compr Psychiatry 1995, 36:218–223.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Hansen ES, Bolwig TG: Cotard syndrome: an important manifestation of melancholia. Nord J Psychiatry 1998, 52:459–464.

    Article  Google Scholar 

  5. 5.

    Enoch D, Trethowan W: Cotard’s syndrome. In Uncommon Psychiatric Syndromes, edn 3. Oxford: Butterworth & Heinemann; 1991:162–183.

    Google Scholar 

  6. 6.

    Berrios GE, Luque R: Cotard’s syndrome: analysis of 100 cases. Acta Psychiatr Scand 1995, 91:185–188.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Chiu HFK: Cotard’s syndrome in psychogeriatric patients in Hong Kong. Gen Hosp Psychiatry 1995, 17:54–55.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Consoli A, Soultanian C, Tanguy ML, et al.: Cotard’s syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder. Bipolar Disord 2007, 9:665–668.

    PubMed  Article  Google Scholar 

  9. 9.

    Hamon JM, Ginestet D: Delusions of negation: 4 case reports [in French]. Ann Med Psychol (Paris) 1994, 152:425–443.

    CAS  Google Scholar 

  10. 10.

    Petracca G, Migliorelli R, Vazquez S, et al.: SPECT findings before and after ECT in a patient with major depression and Cotard’s syndrome. J Neuropsychiatry Clin Neurosci 1995, 7:505–507.

    PubMed  CAS  Google Scholar 

  11. 11.

    Kondo S, Hayashi H, Equchi T, et al.: Bromocriptine augmentation therapy in a patient with Cotard’s syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2003, 27:719–721.

    PubMed  Article  Google Scholar 

  12. 12.

    De Risio S, De Rossi G, Sarchiapone M, et al.: A case of Cotard syndrome: 123I-IBZM SPECT imaging of striatal D2 receptor binding. Psychiatry Res 2004, 130:109–112.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Madani Y, Sabbe BGC: Cotard’s syndrome. Different treatment strategies according to subclassification [in Dutch]. Tijdschr Psychiatr 2007, 49:49–53.

    PubMed  CAS  Google Scholar 

  14. 14.

    Wani ZA, Khan AW, Baba AA, et al.: Cotard’s syndrome and delayed diagnosis in Kashmir, India. Int J Ment Health Syst 2008, 2:1–4.

    PubMed  Article  Google Scholar 

  15. 15.

    Chan JH, Chen CH, Robson D, et al.: Case report: effective treatment of Cotard’s syndrome: quetiapine in combination with venlafaxine. Psychiatry Clin Neurosci 2009, 63:125–126.

    PubMed  Article  Google Scholar 

  16. 16.

    Cohen D, Cottias C, Basquin M: Cotard’s syndrome in a 15-year old girl. Acta Psychiatr Scand 1997, 95:164–165.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Nejad AG, Toofani K: Co-existence of lycanthropy and Cotard’s syndrome in a single case. Acta Psychiatr Scand 2005, 111:250–252.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Soultanian C, Perisse D, Révah-Levy A, et al.: Cotard’s syndrome in adolescents and young adults: a possible onset of bipolar disorder requiring a mood stabilizer? J Child Adolesc Psychopharmacol 2005, 15:706–711.

    PubMed  Article  Google Scholar 

  19. 19.

    Caliyurt O, Vardar E, Tuglu C: Cotard’s syndrome with schizophreniform disorder can be successfully treated with electroconvulsive therapy: case report. J Psychiatry Neurosci 2004, 29:138–141.

    PubMed  Google Scholar 

  20. 20.

    Silva JA, Leong GB, Weinstock R, et al.: A case of Cotard’s syndrome associated with self-starvation. J Forensic Sci 2000, 45:188–190.

    PubMed  CAS  Google Scholar 

  21. 21.

    Nejad AG: Hydrophobia as a rare presentation of Cotard’s syndrome: a case report. Acta Psychiatr Scand 2002, 106:156–158.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Wolff G, McKenzie K: Capgras, Fregoli and Cotard’s syndromes and Koro in folie à deux. Br J Psychiatry 1994, 165:842.

    PubMed  CAS  Google Scholar 

  23. 23.

    Conchiglia G, Della Rocca G, Grossi D: When the body image becomes ‘empty’: Cotard’s delusion in a demented patient. Acta Neuropsychiatr 2008, 20:283–284.

    Article  Google Scholar 

  24. 24.

    Kearns A: Cotard’s syndrome in a mentally handicapped man. Br J Psychiatry 1987, 150:112–114.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Campbell S, Volow MR, Cavenar JO: Cotard’s syndrome and the psychiatric manifestations of typhoid fever. Am J Psychiatry 1981, 138:1377–1378.

    PubMed  CAS  Google Scholar 

  26. 26.

    Drake MEJ: Cotard’s syndrome and temporal lobe epilepsy. Psychiatr J Univ Ott 1988, 13:36–39.

    PubMed  Google Scholar 

  27. 27.

    Hu WT, Diesing TS, Meissner I: Cotard’s syndrome in a patient with superior sagittal sinus thrombosis [abstract]. Biol Psychiatry 2006, 56:263S.

    Google Scholar 

  28. 28.

    Bathia MS: Cotard syndrome in parietal lobe tumor. Indian Pediatr 1993, 30:1019–1021.

    Google Scholar 

  29. 29.

    Greenberg DB, Hochberg FH, Murray GB: The theme of death in complex partial seizures. Am J Psychiatry 1984, 141:1587–1589.

    PubMed  CAS  Google Scholar 

  30. 30.

    Mendhekar DN, Gupta N: Recurrent postictal depression with Cotard delusion. Indian J Pediatr 2005, 72:529–531.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Gardner-Thorpe C, Pearn J: The Cotard syndrome. Report of two patients: with a review of the extended spectrum of ‘délire des negations.’ Eur J Neurol 2004, 11:563–566.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Bathia MS, Agrawal P, Malic SC: Cotard’s syndrome in migraine (a case report). Indian J Med Sci 1993, 47:152–153.

    Google Scholar 

  33. 33.

    Lerner V, Bergman J, Greenberg D, Bar-El Y: Laurence-Moon-Bardet-Biedl syndrome in combination with Cotard’s syndrome. Case report. Isr J Psychiatry Relat Sci 1995, 32:291–294.

    PubMed  CAS  Google Scholar 

  34. 34.

    Cannas A, Spissu A, Floris GL, et al.: Bipolar affective disorder and Parkinson’s disease: a rare, insidious and often unrecognized association. Neurol Sci 2002, 23(Suppl 2):S67–S68.

    PubMed  Article  Google Scholar 

  35. 35.

    Factor SA, Molho ES: Threatening auditory hallucinations and Cotard syndrome in Parkinson disease. Clin Neuropharmacol 2004, 27:205–207.

    PubMed  Article  Google Scholar 

  36. 36.

    Young AW, Robertson IH, Hellawell DJ, et al.: Cotard delusion after brain injury. Psychol Med 1992, 22:799–804.

    PubMed  CAS  Article  Google Scholar 

  37. 37.

    Paulig M, Böttger S, Sommer M, Prosiegel M: Depersonalization syndrome after acquired brain damage. Overview based on 3 case reports and the literature and discussion of etiological models [in German]. Nervenarzt 1998, 69:1100–1106.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Butler PV: Diurnal variation in Cotard’s syndrome (copresent with Capgras delusion) following traumatic brain injury. Aust N Z J Psychiatry 2000, 34:684–687.

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Kundlur SNC, George S, Jaimon M: An overview of the neurological correlates of Cotard syndrome. Eur J Psychiatry 2007, 21:99–116.

    Google Scholar 

  40. 40.

    Nejad AG, Kerdegari M, Kermani HR: Self-mutilation of the nose in a schizophrenic patient with Cotard syndrome. Arch Iran Med 2007, 10:540–542.

    Google Scholar 

  41. 41.

    Walloch JE, Klauwer C, Lanczik M, et al.: Delusional denial of pregnancy as a special form of Cotard’s syndrome: case report and review of the literature. Psychopathology 2007, 40:61–64.

    PubMed  Article  Google Scholar 

  42. 42.

    Reif A, Murach WM, Pfuhlmann B: Delusional paralysis: an unusual variant of Cotard’s syndrome. Psychopathology 2003, 36:218–220.

    PubMed  Article  Google Scholar 

  43. 43.

    Yamada K, Katsuragi S, Fujii I: A case study of Cotard’s syndrome: stages and diagnosis. Acta Psychiatr Scand 1999, 100:396–399.

    PubMed  CAS  Google Scholar 

  44. 44.

    Critchley M: Psychiatric symptoms and parietal disease: differential diagnosis. Proc R Soc Med 1964, 57:422–428.

    PubMed  CAS  Google Scholar 

  45. 45.

    Gerrans P: Refining the explanation of Cotard’s delusion. Mind Lang 2000, 15:111–122.

    Google Scholar 

  46. 46.

    Young AW, Leafhead KM: Betwixt life and death: case studies of Cotard delusion. In Method in Madness: Case Studies in Cognitive Neuropsychiatry. Edited by Halligan PW, Marshall JC. East Sussex, England: Taylor & Francis; 1996:147–171.

    Google Scholar 

  47. 47.

    Ellis HD, Young AW, Quayle AH, et al.: Reduced autonomic responses to faces in Capgras delusion. Proc Biol Sci 1997, 264:1085–1092.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Hirstein W, Ramachandran VS: Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons. Proc Biol Sci 1997, 264:437–444.

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Young AW, Leafhead KM, Szulecka TK: The Capgras and Cotard delusions. Psychopathology 1994, 27:226–231.

    PubMed  CAS  Article  Google Scholar 

  50. 50.

    McKay R, Cipolotti L: Attributional style in a case of Cotard delusion. Conscious Cogn 2007, 16:349–359.

    PubMed  Article  Google Scholar 

  51. 51.

    Joseph AB: Cotard’s syndrome in a patient with coexistent Capgras’ syndrome, syndrome of subjective doubles, and palinopsia. J Clin Psychiatry 1986, 47:605–606.

    PubMed  CAS  Google Scholar 

  52. 52.

    Wright S, Young AW, Hellawell DJ: Sequential Cotard and Capgras delusions. Br J Clin Psychol 1993, 32:345–349.

    PubMed  Google Scholar 

  53. 53.

    Shiraishi H, Ito M, Hayashi H, et al.: Sulpiride treatment of Cotard’s syndrome in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2004, 28:607–609.

    PubMed  Article  Google Scholar 

  54. 54.

    Vinkers DJ: Reaction to ‘the syndrome of Cotard: an overview’ [in Dutch]. Tijdschr Psychiatr 2008, 50:391–392.

    PubMed  CAS  Google Scholar 

  55. 55.

    Joseph AB, O’Leary DH: Brain atrophy and interhemispheric fissure enlargement in Cotard’s syndrome. J Clin Psychiatry 1986, 47:518–520.

    PubMed  CAS  Google Scholar 

  56. 56.

    Hashioka S, Monji A, Sasaki M, et al.: A patient with Cotard syndrome who showed an improvement in single photon emission computed tomography findings after successful treatment with antidepressants. Clin Neuropsychopharmacol 2002, 25:276–279.

    Article  Google Scholar 

  57. 57.

    Lohmann T, Nishimura K, Sabri O, Klosterkötter J: Successful electroconvulsive therapy of Cotard syndrome with bitemporal hypoperfusion [in German]. Nervenarzt 1996, 67:400–403.

    PubMed  CAS  Google Scholar 

  58. 58.

    Kozian R: Brief case report. Duloxetine in Cotard syndrome [in German]. Psychiatr Prax 2005, 32:412–413.

    PubMed  Article  Google Scholar 

  59. 59.

    Christensen RC: Cotard’s syndrome in a homeless man. Psychiatr Serv 2001, 52:1256–1257.

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Baeza I, Salva J, Bernado M: Cotard’s syndrome in a young male bipolar patient. J Neuropsychiatry Clin Neurosci 2000, 12:119–120.

    PubMed  CAS  Google Scholar 

  61. 61.

    Mahgoub NA, Hossain A: Cotard’s syndrome and electroconvulsive therapy. Psychiatr Serv 2004, 55:1319.

    PubMed  Article  Google Scholar 

  62. 62.

    Malone K, Malone JP: Remarkable resolution of an uncommon psychosyndrome—epilepsy-induced remission of Cotard’s syndrome. Ir J Psychol Med 1992, 9:53–54.

    Google Scholar 

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Correspondence to Hans Debruyne.

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Debruyne, H., Portzky, M., Van den Eynde, F. et al. Cotard’s syndrome: A review. Curr Psychiatry Rep 11, 197–202 (2009). https://doi.org/10.1007/s11920-009-0031-z

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Keywords

  • Risperidone
  • Duloxetine
  • Attributional Style
  • Underlying Disorder
  • Schizophreniform Disorder