Cotard’s Syndrome

Cotard’s syndrome is considered a mental disorder in which a person thinks they are dead without being dead. That is, it assures its inexistence as if it were an undeniable fact.

Above all, it is a type of delusion, also known as a nihilist delusion or denial. It is uncommon, but a few cases have been documented over the years.

People who suffer from Cotard syndrome deny that their bodies exist, that they have nerves, brain, blood and internal organs, just like the other parts of it. They think they live in an improbable and fictitious way. They even think that their organs are rotting, even capable of hallucinations, smelling rotten.

Some data on Cotard syndrome

Syndrome characteristics

The individual usually experiences a change in the intensity of their emotions, loses vital energy and is overwhelmed by negativity. This can give rise to Cotard syndrome.

Hyperactivity also starts in the amygdala, there is damage in the temporo-parental areas, inhibition in the left front part of the brain, among other things. In addition, the presence of dopamine decreases in its receptors.

Etymology

The syndrome is named after the French neurologist Jules Cotard, who discovered it. He began to study this syndrome after several patients with psychiatric disorders had the delusions that characterize it.

The first patient J. Cotard saw was a 43-year-old woman. She claimed to have “no brain, no nerves, no heart, no entrails, just skin and bones”. The patient’s case, presented at a conference in Paris in 1880, under the pseudonym Mademoiselle X, denied the existence of God and the devil, as well as the need to nourish oneself. She also believed that she was eternally doomed, as she could not have a natural death.

It should be noted that the case presented by Dr. Cotard was not spared the criticism and skepticism of the scientific community at the time.

Characteristic (pathological) symptoms

• Depression
• Suicidal thoughts
• Belief that your body doesn’t exist
• Belief that they are running out of blood
• Negative thoughts
• Belief that they are already dead – with olfactory delusions, they even smell rotten, because they believe they are rotting.
• Belief that worms are under your skin
• belief that they are immortal
• Belief that they are decomposing
• Belief that they don’t have internal organs
• Analgesia or absence of pain
• self mutilations

Before being proven and documented by Dr. Cotard, these symptoms were associated with assumptions and disturbances in human conduct, associated with culture, religion, ethnicity and any other element different from what was established as the moral and healthy standard of the time.

Description of the pathology in patients

It can present as a delusion typical of the most severe depressions (psychotic or delusional), but also in other cases of severe mental illness (dementia with psychotic symptoms, schizophrenia, psychosis resulting from diseases or toxic substances).

Nevertheless, it is important to highlight that patients come to believe that their internal organs have completely stopped working, that their intestines do not work, that their heart does not beat, that they have no nerves, no blood, no brain, and even that are rotting. As a result, they even present some olfactory hallucinations that confirm their delirium (unpleasant odors, such as putrefying meat), they can even say that there are worms slipping under their skin.

Some possible treatments

This type of disease is not easy to treat, especially when the diagnosis involves elements of other diseases already classified and less controversial, but here we describe a series of steps that doctors apply, depending on the complexity and the situation in which the individual is. :

• Pharmacological combination (pills, injections, sedatives, etc.).
• Antidepressant medications, such as mirtazapine, or antipsychotics, or olanzapine.
• If medications are not effective, it can be treated with electroconvulsive therapies.

Etiology or disease classification

Cotard’s syndrome is a neurological-mental illness,  which makes it a tremendous mystery for professionals in this medical field, due to the few diagnosed cases and the controversy between dementia and delirium-type disorders.