Delirio de Cotard: presentación de caso y revisión de literatura

Introducción: el Síndrome o Delirio de Cotard (CS) es una condición psiquiátrica infrecuente caracterizada por la presencia de delirio de negación (o nihilista), donde el paciente refiere desde pérdida de capacidades intelectuales y expresión de sentimientos, hasta la negación de la propia existencia y la del cosmos. Fue descrito por primera vez por el neuropsiquiatra francés Jules Cotard en el año 1880. El síntoma cardinal es el delirio nihilista, que consiste en un espectro de ideas de negación normalmente relacionadas con el cuerpo (negando la funcionabilidad o presencia de uno o más órganos internos) o con la existencia (pudiendo creer que está muerto o que todos en el mundo están muertos). Presentación de caso: se realizó el reporte de un caso de un paciente masculino de 54 años de edad, proveniente de Los Hidalgos, Provincia Puerto Plata, República Dominicana, con antecedentes de diabetes mellitus, hipertensión y trastorno esquizoide no especificado. Dicho paciente presentó los característicos delirios nihilistas, además de alucinaciones olfativas y auditivas, verborrea, aumento de la motricidad, anorexia, insomnio y soliloquio. A pesar de la limitada bibliografía, se pretendió comparar la presentación de dicho paciente con otros casos de Delirio de Cotard.

Are Drugs Always the Proper Solution to Therapeutic Dilemmas? Non-drug Approaches to the Post-traumatic Stress “Waking Corpse” Syndrome

Jules Cotard (1840-1889), a Parisian neurologist, described a syndrome of delirium negations which was later named after him. Some physicians in antiquity and medieval times, especially in Asia, have noticed this syndrome and categorized it as a symptom of melancholy. They have presented it as a "walking corpse syndrome", inflicting most probably veteran soldiers after suffering during ferocious battles, presenting the first cases of a post war traumatic stress disorder. Philotimus (3rd-2nd century BC) was the first to record it around 3rd century BC, and proposed a simple but pioneering treatment, by just putting a lead hat on the men's heads. Although various combined treatment strategies were proposed by modern psychiatry including pharmaceutical, electroconvulsive therapy, behavioural therapy and supportive psychotherapy, it seems that in antiquity a simple external intervention of supportive therapy was the main concept of confrontation, while drug administration was to be avoided.

Síndrome de Cotard, catatonía y depresión: reporte de un caso.

El síndrome de Cotard es una condición psiquiátrica relativamente infrecuente y de características clínicas a veces dramáticas. El paciente niega la existencia de algunas partes de su cuerpo, o incluso, su propia existencia. Inicialmente descrito por Jules Cotard en 1880, este síndrome ha pasado por varias vicisitudes conceptuales a lo largo de su historia. Actualmente las delusiones de negación o nihilistas se consideran como sinónimos del síndrome de Cotard, en tanto que la presencia de síntomas catatónicos ha sido generalmente descrita como poco frecuente. Se presenta el caso de un paciente varón de 47 años con trastorno depresivo mayor que desarrolló un síndrome de Cotard y catatonía; el paciente mejoró consistentemente con venlafaxina 150 mg/día, aripiprazol 15 mg/día y diazepam 40 mg/día después de cuatro semanas. El artículo se complementa con una revisión de la literatura en torno al síndrome.

Cotard’s Syndrome

Cotard’s syndrome involves nihilistic delusions about the patient’s own body, such as believing that he or she is a walking corpse. The syndrome is named for Jules Cotard (1840–1889), a French neurologist who first described this condition in 1880. He formulated the syndrome as a new type of depression characterized by symptoms such as anxious melancholia, ideas of damnation or rejection, insensitivity to pain, delusions of nonexistence concerning one’s own body, and delusions of immortality. Along with discussing the typical progression of symptoms and associated features, this chapter situates Cotard’s syndrome within the context of several other disorders and well-known neuropsychological deficits.

Cotard’s Syndrome in a Patient with Schizophrenia: Case Report and Review of the Literature

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.

When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard’s Syndrome

Cotard’s Syndrome (CS) is a rare clinical event described for the first time in 1880 by the neurologist and psychiatrist Jules Cotard and characterized by negation delusions (or nihilists). Immortality and hypochondriac delusions are also typical. Nowadays, it is known that CS can be associated with many neuropsychiatric conditions. In this article, we describe the case of a patient that believed not having more organs and having the body deformed and whose CS was associated with a bigger depressive disorder. Although the electroconvulsive therapy is the most described treatment modality in the literature, the reported case had therapeutic success with association of imipramine and risperidone.

The Painful Analgesia of Cotard’s Syndrome

In the present paper, we look into what is painful psychical analgesia in relation to what 19th century clinicians have named “moral pain” in melancholia, and more particularly in the delusion of negation described by the French psychiatrist Jules Cotard in 1880, a form of delusion that can be seen mostly in cases of chronic anxious melancholia. This condition is characterized by a painful absence of emotions, which occurs when the subject, in the Lacanian sense of the word, ceases to be touched by the signifiers, and consequently ceases to exist as a subject. Hence, these patients often declare themselves to be already dead or incapable of dying. The psychoanalytical approach to this delusion allows an understanding of the ‘’lack of lack’’ concept, as these patients, having lost the lack, affirm that their body’s orifices are clogged, that they have lost their mental vision, that they miss various visceral organs etc. The completeness of their body – the absence of orifices – can sometimes attain universal dimensions and these patients can thus identify themselves to the universe, which contains everything. The delusion of negation teaches us something important concerning the essence of desire, in relation to what has been named by Lacan area-between-two-deaths. This Lacanian concept refers essentially to the tragic hero, but also, more generally, to the lonely condition where anyone’s desire should be able to exist beyond any narcissistic commitment, which means beyond the pleasure principle as well.