Cotard's syndrome

Written by: Sreejana Basu

What is it?

Cotard’s syndrome or the walking corpse syndrome is an extremely rare neuropsychiatric condition in which the affected person holds the delusional belief and preconceived mindset that they are deceased, do not exist, are putrefying, or have suffered damage that caused blood loss or damage to internal organs.

Who discovered it?

Jules Cotard (1 June 1840 – 19 August 1889) was a French national and neurologist who is known for first describing the Cotard delusion. His discovery in the 1880s led us to conclude about the same. A mild case is characterized by despair and self-loathing, while a severe case is characterized by intense delusions of negation and chronic psychiatric depression. The earliest known case of this syndrome is the infamous case of “Mademoiselle X” which describes a woman who denied the existence of her body and of her need to eat and eventually died of starvation.

Pathophysiology?

The psychopathology of Cotard syndrome is perhaps related to problems of delusional misidentification. Neurologically, Cotard's delusion (negation of the Self) is thought to be related to Capgras delusion (people replaced by impostors).

These types of delusion result from various neural misfiring in the brain(fusiform face) which recognizes faces, and in the amygdala, which undergoes sensory stimulation to evoke emotions to recognize faces. This neural disconnection creates a lack of familiarity (recognition) normally associated with faces and results in mental disconnection from the environment, and thus the idea of being alive and well.

This tends to exist in around 200 people and is extremely rare with it being usually encountered in patients with psychosis and schizophrenia. It is also found in people with a terminal illness such as brain cancer or people with abnormal brain functioning. (Frontal and parietal lobe)

Cases of Cotard's delusion has also resulted from a patient's adverse physiological response to drugs (e.g. acyclovir and valaciclovir). The occurrence of Cotard's delusion symptoms was associated with a high serum concentration of 9-carboxy methoxymethyl guanine (CMMG), the principal metabolite of acyclovir and is also thus seen in patients suffering from renal failure.

Treatment?

As such no fixed treatment for this exists but according to doctors, pharmacological treatments, both mono-therapeutic and multi-therapeutic, using antidepressants, antipsychotics, and mood stabilizers have been used.