Generality
Cotard syndrome is a rare psychiatric disorder in which the subject is firmly convinced that he is dead.
The underlying causes of this condition are not yet completely clear, but it has been shown that a dysfunction occurs in the part of the brain (in particular, the area between the frontal and parietal lobe) involved in the transduction of emotions . This syndromic picture is supported by a delusion of chronic negation, referring to life.
In practice, the subject suffering from Cotard syndrome no longer perceives any kind of emotional stimulus and his conscience explains this phenomenon by convincing himself that he is no longer alive or that he has lost all the internal organs responsible for this purpose.
Cotard syndrome can be tackled with a long-term drug therapy which, together with psychotherapy, helps to manage the symptoms of the disease. In the most serious cases, the doctor may indicate the use of electroconvulsive therapy.
What's this
Cotard syndrome is a psychiatric illness, characterized by the belief of having died or having lost all vital organs. Those who suffer from this disease can totally deny their existence . This belief, defended with certainty, entails a serious difficulty in finding meaning in reality . People with Cotard syndrome gradually begin to stop caring for themselves or have suicidal feelings.
Synonyms and some curiosity
- Cotard syndrome is also known as " dead man syndrome " or " walking corpse syndrome " (from the English "Walking Corpse Syndrome").
- The name of the syndrome is due to the French neurologist Jules Cotard, who first described it by calling it "le délire de négation" (delusion of negation), in 1880. The doctor described a patient, Mademoiselle X (fictitious name attributed by Cotard), who he denied the existence of certain parts of his body and claimed to be damned for eternity.
- It should be noted that Cotard syndrome is a very rare and poorly documented pathology: to date, about one hundred episodic cases have been described and generally related to psychiatric disorders, severe organic brain impairment and previous manic-depressive episodes.
Causes
The causes of Cotard syndrome are not yet fully known. However, it has been hypothesized that at the origin there is a pathological interruption of nerve fibers, normally responsible for connecting the sensory areas to the center of emotions. This could be due to brain injury or atrophy of the mid frontal lobe and / or parietal lobe. In most cases, it appears that the subject manifests this dysfunction following head trauma, brain tumors, severe mental impairment and dementia.
With imaging techniques, such as CT, it has been shown that the brain function of patients suffering from Cotard syndrome is comparable to that of a person during anesthesia or sleep . Furthermore, the area between the frontal and parietal lobes has similarities with that of patients in vegetative coma .
In any case, nothing succeeds in having any emotional relevance for the patient, to the point that the only way to rationally explain this total absence of emotions remains to believe that he is dead .
Although Cotard syndrome is not reported in the DSM (Diagnostic and Statistical Manual of Mental Illnesses), sufferers have some typical symptoms of specific psychiatric disorders, such as depression, anxiety, depersonalization and derealization.
The syndromic picture is very serious and medical intervention must be timely: Cotard syndrome extremely alters the patient's sense of identity, leading to death by suicide or refusal of food.
Risk factors
Cotard syndrome appears to be influenced by environmental factors. In particular, the delirium of being dead can be supported by cultural elements and superstitious beliefs .
Associated disorders
- The delusion of denial found in Cotard syndrome is often found in patients with schizophrenia . The pathology was also observed in association with psychotic disorders and clinical pictures characterized by mood alteration, depersonalization and / or derealization .
- The disease has many similarities with Capgras syndrome . This last psychiatric pathology is characterized by the belief that one or more familiar persons have been replaced by doubles, strangers or aliens.
Symptoms and Complications
The patient suffering from Cotard syndrome fails to attribute any emotional relevance to the things that surround him or to the situations he lives. The only way to rationally explain this total absence of emotions remains to believe that you are dead . Consequently, in those suffering from the Cotard syndrome, the total denial of existence generates a detachment from reality and from the perception of oneself .
People with Cotard syndrome gradually begin to withdraw from social life ( isolation ) and no longer take care of themselves. One of the problems that results from the disease is the risk of the person starving or manifesting suicidal tendencies .
Cotard syndrome: how it occurs
Cotard syndrome manifests itself in a delusion of negation, referring to life.
Typically, this pathology leads those affected to be convinced of:
- To be dead;
- You have lost some of your vital organs, such as your liver or heart, or entire parts of your body;
- To be bled;
- Smell your decaying body.
In extreme cases, the Cotard syndrome leads to the claim of having lost the soul or even not to exist. At other times, individuals who are affected believe their body has turned or petrified.
In addition to these typical delusions, the patient may experience depressive episodes, anxiety, auditory hallucinations, hypochondria, melancholy, aggression towards others and self-injurious behavior.
Diagnosis
The diagnosis of Cotard syndrome is formulated by the psychiatrist specialist.
To understand the extent of the disease and establish an adequate intervention plan, the doctor organizes interviews with the patient and / or family members, in order to gather information on the syndromic picture and the level of general compromise.
This evaluation also aims to find the links between the discomfort experienced by the patient and the factors that trigger or contribute to maintaining the disorder.
Treatment
Usually, Cotard syndrome is treated with antidepressant and antipsychotic medicines, associated with psychotherapy sessions . In this process, we generally tend to involve family members, as the patient may not recognize his or her own state in full autonomy, as well as not realizing what factors are responsible for the development and maintenance of the disorder.
The patient suffering from Cotard syndrome must also be regularly evaluated by the specialist doctor, to highlight any improvements or worsening of the clinical condition.
In some severe cases, recourse to electroconvulsive therapy may be suggested, in order to re-establish the connection between the nerve fibers responsible for the emotional response to sensory stimuli.
drugs
The drugs that are usually prescribed for the treatment of Cotard syndrome may include:
- Antipsychotics (also called neuroleptics) : drugs useful for the treatment of psychotic symptoms, such as delusions and hallucinations;
- Mood stabilizers ;
- Antidepressants : help manage feelings of sadness and despair.
In general, long-term treatment is necessary for the correct management of Cotard syndrome and the prognosis varies from person to person.
Psychotherapy
In the presence of Cotard syndrome, psychotherapeutic interventions are an important complement to pharmacological treatment, as they contribute to improving the prognosis of the disorder, taking into account the complexity of the pathology and the specific individuality of the subject.
This path is aimed, in particular, at:
- Favor an adequate reality check;
- Restore the person's main functions;
- Favor the overcoming of the symptomatic episode, in a constructive way to reach a new balance, no longer pathogenic.
