DOCSLIB.ORG

Cotard's Syndrome: Two Cases of Self-Starvation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cotard's Syndrome: Two Cases of Self-Starvation Caso Clínico / Case Report open-access Cotard’s Syndrome: Two Cases of Self-Starvation Síndrome de Cotard: Dois Casos de Recusa Alimentar Bruno Gonçalves Teixeira*, Ana Filipa Araújo*, João Ferreira Perestrelo* RESUMO Palavras-Chave: Síndrome de Cotard; De- Introdução: A Síndrome de Cotard é uma pressão; Delírio Niilista. condição clínica relativamente rara que se ca- racteriza por vários graus de delírios niilistas, ABSTRACT quase sempre na forma de auto-negação. Background: Cotard´s syndrome is a rela- tively rare condition characterized by vari- Objectivos: Descrever dois casos de Síndrome ous degrees of nihilist delusions, often in the de Cotard associados a recusa alimentar e rea- form of self-negation. lizar uma revisão do conceito e das caracterís- ticas clínicas desta síndrome. Aims: To report two cases of Cotard’s syn- drome associated with self-starvation and to Métodos: Realizou-se a recolha de informa- review the concept and clinical features of ção de dois casos clínicos associados a recu- the condition. sa alimentar. Procedeu-se a uma revisão do conceito e das características clínicas que lhe Methods: Two clinical cases of the syndrome estão associadas. were obtained and a literature review of the theme was shortly surveyed. Resultados e Conclusões: O primeiro caso versa sobre uma mulher que acreditava que Results and Conclusions: The first case is o seu esófago e estômago estariam colados. about a woman who believed that her eso- Foi medicada com sertralina, mirtazapina e phagus and stomach were glued. She was risperidona, com bons resultados. O segun- treated with sertraline, mirtazapine and ris- do caso descreve um homem que acreditava peridone with good results. The second case que a sua garganta fora queimada e que não describes a man who believed his throat was possuía nenhum órgão interno. Foi medicado burnt and he had no internal organs. He com clomipramina e risperidona, mostrando was treated with clomipramine and risperi- grande melhoria. Esta síndrome é uma enti- done showing great improvement. dade nosológica e clínica que não deve ser es- This syndrome is a nosological and clinical quecida. É essencial fornecer uma abordagem entity that should not be forgotten. It is es- terapêutica urgente e adequada em pacientes com esta síndrome. * Serviço de Psiquiatria e Saúde Mental do Centro Hospitalar de Vila Nova de Gaia/Espinho [email protected] Recebido / Received: 29/12/2014 • Aceite / Accepted: 10/08/2015 Revista do Serviço de Psiquiatria do Hospital Prof. Doutor Fernando Fonseca, EPE www.psilogos.com 124 Junho 2015 • Vol. 13 • N.º 1 Cotard’s Syndrome: Two Cases of Self-Starvation PsiLogos • pp 124-133 sential to provide an urgent and adequate the belief that they had in fact died revealed therapeutic approach to these patients. a consistent combination of additional symp- toms including depressed mood, abnormal Key-Words: Cotard Syndrome; Depression; feelings, depersonalization and derealization, Nihilistic Delusion. and evidence of face-processing impairments. More exotic concurrent symptoms have been INTRODUCTION reported elsewhere, including hydrophobia6 Few pathologies of the self are as profound and and lycanthropy2,7. striking as those reported in cases of Cotard’s During the 20th century, it continued to attract syndrome, which can involve the belief that the attention of diagnostic phenomenologists. one is dead. The assertions of some patients Currently, many investigators of the condition with this delusion come close to violating the conceptualize it as at least a component of a famous Cartesian dictum “cogito ergo sum”. mental disorder, frequently a major depressive Descartes explored the limits of radical skep- disorder4. However, the issue of whether the ticism and concluded that whereas one could Cotard’s phenomenon constitutes a unique certainly doubt the evidence of one’s senses, it mental disorder, a discrete syndrome (asso- was not possible to doubt one’s existence. Yet ciated with a range of conditions such as de- some Cotard patients maintain that they are pression, psychosis, organic conditions and so dead or that they do not exist1,2. on), or merely a psychiatric symptom remains The classic reports of this condition were pub- unanswered1,2. lished by the neurologist Jules Cotard3, who Berrios and Luque, in an extensive review of described a clinical state that he termed délire the conceptual history of Cotard’s syndrome, des négations. The French eponym délire de concluded that Jules Cotard probably viewed it Cotard was later adopted and translated into as a subtype of melancholia (anxious melan- English as Cotard’s syndrome4. Although this cholia)5. In as attempt to further understand later designation is often identified with the the phenomenology of the condition, Berrios belief that one is dead, it must be underlined and Luque, using an exploratory factor analy- that the condition is a syndrome and not a sis of 100 cases of Cotard’s syndrome reported symptom as it is often incorrectly conveyed in literature, extracted three factors: psychotic in literature. Cotard himself did not regard depression, Cotard type I and Cotard type II4. that belief as an essential defining feature The psychotic depression patients mostly had of the condition he described1,5. Young and depression and few nihilistic delusions. Cotard Leafhead’s analysis of Cotard’s cases revealed type I patients on the other hand, had only the a series of commonly occurring features and nihilistic delusions (pure Cotard’s syndrome) symptoms, including self-deprecatory delu- and few depressive symptoms, whereas Co- sions, suicidal ideation, feelings of guilt, and tard type II patients were a mixed group with denial of body parts. Young and Leafhead’s depression, anxiety and auditory hallucina- subsequent comparison of three patients with tions10. Revista do Serviço de Psiquiatria do Hospital Prof. Doutor Fernando Fonseca, EPE www.psilogos.com 125 Junho 2015 • Vol. 13 • N.º 1 Bruno Gonçalves Teixeira, Ana Filipa Araújo, João Ferreira Perestrelo PsiLogos • pp 124-133 In the same study, Berrios and Luque diag- the earlier classification of the syndrome by nosed depression in 89% of the 100 cases. The Berrios and Luque as follows: the germina- most frequent nihilistic delusions were related tion stage corresponds to psychotic depression, to the body (86%) and with existence (69%). the blooming stage to Cotard type II and the Anxiety (65%) and guilt (63%) were common, chronic stage to Cotard type I10. followed by hypochondriacal delusions (58%) The current diagnostic classifications (DSM-5 and immortality delusions (55%)11. and CID-10) exclude Cotard’s syndrome, con- There are several proposed mechanisms for firming the trend to reject it as a nosological Cotard’s syndrome. It may begin with anom- and clinical entity14. alous perceptual experiences or their discon- The aims of this article are to describe the clin- nection from emotional or limbic processes, ical presentation and the management of two and there may be a failure in belief evaluation cases of Cotard´s syndrome and to review the or a tendency to negative self-attribution2,8,9,12. concept and clinical features of the condition. Many patients have psychiatric disease with psychotic depression, an internalized attribu- CASE STUDY 1 tional style, or associated depersonalization2. The first case we report is about a 66-year-old It is worth emphasizing that the syndrome is woman that will be addressed as Mrs. H. best conceptualized as being on a spectrum Mrs. H. had no psychiatric background up un- (complete/incomplete): the complete form in til April 2012, when she was admitted to our which nihilistic delusions are clearly present department after developing a clinical picture and the incomplete forms which are often of depressed mood and progressive onset of de- combinations of depressed mood, delusions lusions of ruin, ill health, guilt and self-star- of guilt and hypochondriasis, and hallucina- vation. The patient started experiencing these tions. Also the nihilistic delusion itself could symptoms after her husband’s unexpected vary in its degree of severity – from severe death, approximately six months prior to ad- (patient denies his own and the world’s exist- mission. ence) to mild (patient feels that he is loosing Mrs. H. had a medical history of hysterectomy, his reasoning and feelings). Yamada et al.13 cholecystectomy and appendectomy. There attempted to trace the onset and longitudinal was no history of substance misuse and she progression of the condition from a phenom- was taking no medication when admitted to enological perspective and identified three our inward. distinct stages: the germination stage (prodro- Mrs. H. lived in Gaia for years in a symbiot- mal period associated with depression and hy- ic relationship with her husband. Their sons pochondriacal symptoms), the blooming stage were living in far distant cities, so they would (full blown development of the syndrome with only be present occasionally supporting their delusions of negation) and the chronic stage parents the way they could. After her hus- (chronic depressive type or chronic delusional band’s sudden death, Mrs. H. couldn’t face his type). They equated the above three stages to absence and the solitude. She started feeling Revista do Serviço de Psiquiatria do Hospital Prof. Doutor Fernando Fonseca, EPE www.psilogos.com 126 Junho 2015 • Vol. 13 • N.º 1 Cotard’s Syndrome: Two Cases of Self-Starvation PsiLogos • pp 124-133 depressed, describing insomnia, anorexia and tinued refusing to ingest any solid food, her intense anguish. A month later she developed daughter took her to a psychiatric emergency delusions of ruin, believing her pension wasn’t where she was transferred to our unit. enough to ensure her subsistence and alleging As she was admitted to our department, she her refrigerator wasn’t working well because looked very thin (she had lost 42 pounds in the the food had a bad taste and was constantly meanwhile and her BMI was 14 by the time).
Load more

Recommended publications
  • Paranoid – Suspicious; Argumentative; Paranoid; Continually on The
    Disorder Gathering 34, 36, 49 Answer Keys A N S W E R K E Y, Disorder Gathering 34 1. Avital Agoraphobia – 2. Ewelina Alcoholism – 3. Martyna Anorexia – 4. Clarissa Bipolar Personality Disorder –. 5. Lysette Bulimia – 6. Kev, Annabelle Co-Dependant Relationship – 7. Archer Cognitive Distortions / all-of-nothing thinking (Splitting) – 8. Josephine Cognitive Distortions / Mental Filter – 9. Mendel Cognitive Distortions / Disqualifying the Positive – 10. Melvira Cognitive Disorder / Labeling and Mislabeling – 11. Liat Cognitive Disorder / Personalization – 12. Noa Cognitive Disorder / Narcissistic Rage – 13. Regev Delusional Disorder – 14. Connor Dependant Relationship – 15. Moira Dissociative Amnesia / Psychogenic Amnesia – (*Jason Bourne character) 16. Eylam Dissociative Fugue / Psychogenic Fugue – 17. Amit Dissociative Identity Disorder / Multiple Personality Disorder – 18. Liam Echolalia – 19. Dax Factitous Disorder – 20. Lorna Neurotic Fear of the Future – 21. Ciaran Ganser Syndrome – 22. Jean-Pierre Korsakoff’s Syndrome – 23. Ivor Neurotic Paranoia – 24. Tucker Persecutory Delusions / Querulant Delusions – 25. Lewis Post-Traumatic Stress Disorder – 26. Abdul Proprioception – 27. Alisa Repressed Memories – 28. Kirk Schizophrenia – 29. Trevor Self-Victimization – 30. Jerome Shame-based Personality – 31. Aimee Stockholm Syndrome – 32. Delphine Taijin kyofusho (Japanese culture-specific syndrome) – 33. Lyndon Tourette’s Syndrome – 34. Adar Social phobias – A N S W E R K E Y, Disorder Gathering 36 Adjustment Disorder – BERKELEY Apotemnophilia
    [Show full text]
  • Cotard's Syndrome: Two Case Reports and a Brief Review of Literature
    Published online: 2019-09-26 Case Report Cotard’s syndrome: Two case reports and a brief review of literature Sandeep Grover, Jitender Aneja, Sonali Mahajan, Sannidhya Varma Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India ABSTRACT Cotard’s syndrome is a rare neuropsychiatric condition in which the patient denies existence of one’s own body to the extent of delusions of immortality. One of the consequences of Cotard’s syndrome is self‑starvation because of negation of existence of self. Although Cotard’s syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, it is less often reported to be seen in patients with catatonia. In this report we present two cases of Cotard’s syndrome, both of whom had associated self‑starvation and nutritional deficiencies and one of whom had associated catatonia. Key words: Catatonia, Cotard’s syndrome, depression Introduction Case Report Cotard’s syndrome is a rare neuropsychiatric condition Case 1 characterized by anxious melancholia, delusions Mr. B, 65‑year‑old retired teacher who was pre‑morbidly of non‑existence concerning one’s own body to the well adjusted with no family history of mental illness, extent of delusions of immortality.[1] It has been most with personal history of smoking cigarettes in dependent commonly seen in patients with severe depression. pattern for last 30 years presented with an insidious However, now it is thought to be less common possibly onset mental illness of one and half years duration due to early institution of treatment in patients precipitated by psychosocial stressors.
    [Show full text]
  • Monothematic Delusions: Towards a Two-Factor Account Davies, Martin, 1950- Coltheart, Max
    Monothematic Delusions: Towards a Two-Factor Account Davies, Martin, 1950- Coltheart, Max. Langdon, Robyn. Breen, Nora. Philosophy, Psychiatry, & Psychology, Volume 8, Number 2/3, June/September 2001, pp. 133-158 (Article) Published by The Johns Hopkins University Press DOI: 10.1353/ppp.2001.0007 For additional information about this article http://muse.jhu.edu/journals/ppp/summary/v008/8.2davies.html Access Provided by Australian National University at 08/06/11 11:33PM GMT DAVIES, COLTHEART, LANGDON, AND BREEN / Monothematic Delusions I 133 Monothematic Delusions: Towards a Two-Factor Account Martin Davies, Max Coltheart, Robyn Langdon, and Nora Breen ABSTRACT: We provide a battery of examples of delu- There is more than one idea here, and the sions against which theoretical accounts can be tested. definition offered by the American Psychiatric Then we identify neuropsychological anomalies that Association’s Diagnostic and Statistical Manual could produce the unusual experiences that may lead, of Mental Disorders (DSM) seems to be based on in turn, to the delusions in our battery. However, we argue against Maher’s view that delusions are false something similar to the second part of the OED beliefs that arise as normal responses to anomalous entry: experiences. We propose, instead, that a second factor Delusion: A false belief based on incorrect inference is required to account for the transition from unusual about external reality that is firmly sustained despite experience to delusional belief. The second factor in what almost everyone else believes and despite what the etiology of delusions can be described superficial- constitutes incontrovertible and obvious proof or evi- ly as a loss of the ability to reject a candidate for belief dence to the contrary (American Psychiatric Associa- on the grounds of its implausibility and its inconsis- tion 1994, 765).
    [Show full text]
  • Cotard's Syndrome
    MIND & BRAIN, THE JOURNAL OF PSYCHIATRY REVIEW ARTICLE Cotard’s Syndrome Hans Debruyne1,2,3, Michael Portzky1, Kathelijne Peremans1 and Kurt Audenaert1 Affiliations: 1Department of Psychiatry, University Hospital Ghent, Ghent, Belgium; 2PC Dr. Guislain, Psychiatric Hospital, Ghent, Belgium and 3Department of Psychiatry, Zorgsaam/RGC, Terneuzen, The Netherlands ABSTRACT Cotard’s syndrome is characterized by nihilistic delusions focused on the individual’s body including loss of body parts, being dead, or not existing at all. The syndrome as such is neither mentioned in DSM-IV-TR nor in ICD-10. There is growing unanimity that Cotard’s syndrome with its typical nihilistic delusions externalizes an underlying disorder. Despite the fact that Cotard’s syndrome is not a diagnostic entity in our current classification systems, recognition of the syndrome and a specific approach toward the patient is mandatory. This paper overviews the historical aspects, clinical characteristics, classification, epidemiology, and etiological issues and includes recent views on pathogenesis and neuroimaging. A short overview of treatment options will be discussed. Keywords: Cotard’s syndrome, nihilistic delusion, misidentification syndrome, review Correspondence: Hans Debruyne, P.C. Dr. Guislain Psychiatric Hospital Ghent, Fr. Ferrerlaan 88A, 9000 Ghent, Belgium. Tel: 32 9 216 3311; Fax: 32 9 2163312; e-mail: [email protected] INTRODUCTION: HISTORICAL ASPECTS AND of the syndrome. They described a nongeneralized de´lire de CLASSIFICATION negation, associated with paralysis, alcoholic psychosis, dementia, and the ‘‘real’’ Cotard’s syndrome, only found in Cotard’s syndrome is named after Jules Cotard (1840Á1889), anxious melancholia and chronic hypochondria.6 Later, in a French neurologist who described this condition for the 1968, Saavedra proposed a classification into three types: first time in 1880, in a case report of a 43-year-old woman.
    [Show full text]
  • The Misidentification Syndromes As Mindreading Disorders
    COGNITIVE NEUROPSYCHIATRY 2010, 15 (1/2/3), 233Á260 The misidentification syndromes as mindreading disorders William Hirstein Elmhurst College, Elmhurst, IL, USA The patient with Capgras’ syndrome claims that people very familiar to him have been replaced by impostors. I argue that this disorder is due to the destruction of a representation that the patient has of the mind of the familiar person. This creates the appearance of a familiar body and face, but without the familiar personality, beliefs, and thoughts. The posterior site of damage in Capgras’ is often reported to be the temporoparietal junction, an area that has a role in the mindreading system, a connected system of cortical areas that allow us to attribute mental states to others. Just as the Capgras’ patient claims that that man is not his father, the patient with asomatognosia claims that his arm is not really his. A similar account applies here, in that a nearby brain area, the supramarginal gyrus, is damaged. This area works in concert with the temporoparietal junction and other areas to produce a large representation of a mind inside a body situated in an environment. Damage to the mind-representing part of this system (coupled with damage to executive processes in the prefrontal lobes) causes Capgras’ syndrome, whereas damage to the body-representing part of this system (also coupled with executive damage) causes asomatognosia. Keywords: Capgras’ syndrome; Misidentification; Asomatognosia; Theory of mind; Mindreading; Executive processes. INTRODUCTION Capgras’ syndrome is a misidentification disorder in which people deny the identities of people close to them, claiming that they have been replaced by impostors.
    [Show full text]
  • Supreme Court of the United States ______JAMES K
    No. 18-6135 IN THE Supreme Court of the United States __________ JAMES K. KAHLER, Petitioner, v. STATE OF KANSAS, Respondent. __________ On Writ of Certiorari to the Supreme Court of Kansas __________ BRIEF OF AMERICAN PSYCHIATRIC ASSOCIATION, AMERICAN PSYCHOLOGICAL ASSOCIATION, AMERICAN ACADEMY OF PSYCHIATRY AND THE LAW, THE JUDGE DAVID L. BAZELON CENTER FOR MENTAL HEALTH LAW, AND MENTAL HEALTH AMERICA AS AMICI CURIAE IN SUPPORT OF PETITIONER __________ DAVID W. OGDEN AARON M. PANNER PAUL R.Q. WOLFSON Counsel of Record ALEXANDRA STEWART KEVIN D. HORVITZ WILMER CUTLER PICKERING MICHAEL S. QIN HALE AND DORR LLP KELLOGG, HANSEN, TODD, 1875 Pennsylvania Ave., N.W. FIGEL & FREDERICK, Washington, D.C. 20006 P.L.L.C. (202) 663-6000 1615 M Street, N.W. Suite 400 NATHALIE F.P. GILFOYLE Washington, D.C. 20036 DEANNE M. OTTAVIANO (202) 326-7900 AMERICAN PSYCHOLOGICAL ([email protected]) ASSOCIATION Counsel for American 750 First Street, N.E. Psychiatric Association Washington, D.C. 20002 and American Academy of (202) 336-5500 Psychiatry and the Law Counsel for American Psychological Association June 7, 2019 (Additional Counsel Listed On Inside Cover) IRA ABRAHAM BURNIM JENNIFER MATHIS BAZELON CENTER FOR MENTAL HEALTH LAW 1101 15th Street, N.W. Suite 1212 Washington, D.C. 20005 (202) 467-5730 Counsel for The Judge David L. Bazelon Center for Mental Health Law MARK J. HEYRMAN CLINICAL PROFESSOR OF LAW UNIVERSITY OF CHICAGO LAW SCHOOL 1111 East 60th Street Chicago, Illinois 60637 (773) 702-9611 Counsel for Mental Health America TABLE OF CONTENTS Page TABLE OF AUTHORITIES ...................................... iii INTEREST OF AMICI CURIAE ...............................
    [Show full text]
  • De-Rationalising Delusions
    De-Rationalising Delusions Authors: Vaughan Bell,1,2 Nichola Raihani,3 Sam Wilkinson4 1. Research Department of Clinical, Educational and Health Psychology, University College London 2. Psychological Interventions Clinic for outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust 3. Department of Experimental Psychology, University College London 4. Department of Sociology, Philosophy and Anthropology, Exeter University 1 Abstract Due to the traditional conceptualisation of delusion as ‘irrational belief’, cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that i) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; ii) delusions are overwhelmingly socially-themed; iii) delusions show a reduced sensitivity to social context, both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition – processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organisation, and the ongoing reconceptualisation of belief as serving a social organisational function.
    [Show full text]
  • Cotard's Syndrome in a Patient with Schizophrenia: Case Report And
    Hindawi Publishing Corporation Case Reports in Psychiatry Volume 2016, Article ID 6968409, 7 pages http://dx.doi.org/10.1155/2016/6968409 Case Report Cotard’s Syndrome in a Patient with Schizophrenia: Case Report and Review of the Literature Jeff Huarcaya-Victoria,1,2 Mario Ledesma-Gastañadui,2 and Maria Huete-Cordova2,3 1 School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru 2Department of Psychiatry, National Hospital Guillermo Almenara Irigoyen, Lima, Peru 3School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru Correspondence should be addressed to Jeff Huarcaya-Victoria; [email protected] Received 23 July 2016; Revised 23 October 2016; Accepted 9 November 2016 AcademicEditor:ErikJonsson¨ Copyright © 2016 Jeff Huarcaya-Victoria et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jules Cotard described, in 1880, the case of a patient characterized by delusions of negation, immortality, and guilt as well as melancholic anxiety among other clinical features. Later this constellation of symptoms was given the eponym Cotard’s syndrome, going through a series of theoretical vicissitudes, considering itself currently as just the presence of nihilistic delusions. The presentation of the complete clinical features described by Cotard is a rare occurrence, especially in the context of schizophrenia. Here we present the case of a 50-year-old male patient with schizophrenia who developed Cotard’s syndrome. The patient was treated with aripiprazole, showing improvement after two weeks of treatment. A review of the literature is performed about this case.
    [Show full text]
  • Case Report on Cotard's Syndrome (CS) in a Patient with Schizophrenia
    Subhas et al. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery The Egyptian Journal of Neurology, (2021) 57:107 https://doi.org/10.1186/s41983-021-00359-4 Psychiatry and Neurosurgery CASE REPORT Open Access Case report on Cotard’s syndrome (CS) in a patient with schizophrenia: a rare case from Malaysia Natasha Subhas1 , Khin Ohnmar Naing2* , Chaw Su3, Jiann Lin Loo4 , Aishah Farhana Shahbudin2 , Vevehkanandar Sivasubramaniam1 and Reenisha Thyagarajan1 Abstract Background: Cotard’s syndrome (CS) is a neuropsychiatric condition marked by nihilistic delusional(s). Due to its rarity, misdiagnosis of the syndrome often occurs. The current case study is of a Malaysian woman who was misdiagnosed for several years by professionals due to the presence of hypochondriac symptoms before receiving the correct diagnosis. Case presentation: In this case presentation, we describe the case of L, a 42-year-old Malaysian lady who was first misdiagnosed with depression. The diagnosis of schizophrenia and CS was confirmed after thorough clinical examination, diagnostic investigations, and deliberation at a departmental forum. The patient improved after receiving electroconvulsive therapy (ECT) along with antipsychotic medications. Conclusions: This case study highlights the importance of early recognition of CS by professionals as it can save time for both parties when setting up a treatment plan. Essentially, early recognition of CS in schizophrenia is paramount in the process of rapid stabilization through ECT and promotion of patient recovery. Keywords: Cotard’s syndrome, Depression, ECT, Hypochondriac, Schizophrenia Background Nihilistic delusions due to CS can occur in patients First described in the 1880s by French neurologist Jules with schizophrenia but its prevalence is rare (< 1%) [1, Cotard, Cotard’s syndrome (CS) is a form of monothe- 6].
    [Show full text]
  • Sudden Onset of Cotard's Syndrome As a Clinical Sign of Brain Tumor
    Letter to the editor Sudden onset of Cotard’s syndrome as a clinical sign of brain tumor LUÍS MOREIRA GONÇALVES1,2, ALBERTO TOSONI3,4 1 REQUIMTE/LAQV, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto (FCUP), Porto, Portugal. 2 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. 3 Department of Medical Sciences, Internal Medicine and Gastroenterology Unit, Catholic University of Rome, Gemelli Hospital, Rome, Italy. 4 Acute General Medicine, John Radcliffe Hospital, Oxford, UK. Gonçalves LM, Tosoni A / Arch Clin Psychiatry. 2016;43(2):35-6 Received: 3/1/2016 – Accepted: 4/6/2016 DOI: 10.1590/0101-60830000000080 Dear Editor, We report the clinical case where the sudden onset of a Cotard syndrome in a 69 year old lady lead to the discovery of a multifocal glioblastoma in the right temporo-parietal lobe. Cotard’s syndrome is a rare psychiatric disorder in which the afflicted patient believes he or she is dead. These nihilistic thoughts are the expression of a rare syndrome first described by Jules Cotard in late XIX century. The Cotard’s syndrome has been studied and it seems that its psychopathology can be ascribed to the temporo- parietal cortex. Although the Cotard’s syndrome is not part of the DSM-V it is common in psychiatric literature and is included in ICD-10-CM within code F22. It has been described associated with organic lesions and atrophy of the non-dominant temporo-parietal cortex, in pathologies like bipolar disorder, schizophrenia1, subdural hemorrhage2, multiple sclerosis, brain atrophy3 and cerebral infarc- tion4 among others5-7.
    [Show full text]
  • Stanford Encyclopedia of Philosophy) Stanford Encyclopedia of Philosophy Delusion
    03/05/2017 Delusion (Stanford Encyclopedia of Philosophy) Stanford Encyclopedia of Philosophy Delusion First published Wed Sep 16, 2009; substantive revision Fri Oct 11, 2013 This entry focuses on the phenomenon of clinical delusions. Although the nature of delusions is controversial, as we shall see, delusions are often characterised as strange beliefs that appear in the context of mental distress. Indeed, clinical delusions are a symptom of psychiatric disorders such as dementia and schizophrenia, and they also characterize delusional disorders. The following case descriptions describe one instance of erotomania, the delusion that one is loved by someone else, often of higher status, and one instance of Cotard delusion, the delusion that one is dead or disembodied. She realized he was empty without her and was pursuing her, but enemies were preventing them from uniting. The enemies included a number of people: people in her family, her classmates, neighbours and many other persons who were plotting to keep them apart. She knew that her conclusions were accurate because he would send messages to her proving his love. These messages would often present themselves as the license plates on cars of a certain state, the color purple and other indications that she received from the environment that proved to her that he loved her. (Jordan et al. 2006, p. 787) She repeatedly stated that she was dead and was adamant that she had died two weeks prior to the assessment (i.e. around the time of her admission on 19/11/2004). She was extremely distressed and tearful as she related these beliefs, and was very anxious to learn whether or not the hospital she was in, was ‘heaven’.
    [Show full text]
  • Metadata of the Chapter That Will Be Visualized Online
    Metadata of the chapter that will be visualized online Chapter Title The Doxastic Status of Delusion and the Limits of Folk Psychology Copyright Year 2018 Copyright Holder Springer International Publishing AG Corresponding Author Family Name Porcher Particle Given Name José Eduardo Suffix Division Organization/University Faculdade Jesuíta de Filosofia e Teologia Address Belo Horizonte, MG, Brazil Abstract Clinical delusions are widely characterized as being pathological beliefs in both the clinical literature and in common sense. Recently, a philosophical debate has emerged between defenders of the commonsense position (doxasticists) and their opponents, who have the burden of pointing toward alternative characterizations (anti-doxasticists). In this chapter, I argue that both doxasticism and anti-doxasticism fail to characterize the functional role of delusions while at the same time being unable to play a role in the explanation of these phenomena. I also argue that though a more nuanced view of belief in which mental states are more or less belief-like instills a healthy skepticism towards the precision of folk-psychological concepts, such a stance fails to be of use in building a theory of delusion that will be able to bridge different levels of explanation, such as the phenomenology and neurobiology of delusion. Thus, I advocate moving past the question ‘Are delusions beliefs?’ and their description as propositional attitudes toward the description of the processes that generate delusion, with a view toward explaining, rather than explaining away, the personal-level aspects of the phenomenon that have been made inscrutable by investing in doxastic terminology. Chapter 11 1 The Doxastic Status of Delusion and the Limits 2 of Folk Psychology 3 José Eduardo Porcher 4 Abstract Clinical delusions are widely characterized as being pathological beliefs 5 in both the clinical literature and in common sense.
    [Show full text]