Cotard syndrome: causes, symptoms and treatment - medical - 2023



The field of study of the human mind is undoubtedly one of the most fascinating in the world of science. And it is that ironic as it may seem, our own mind continues to hold countless secrets that, little by little, we are deciphering. The problem is that These secrets can sometimes be terrifying.

The world of Psychiatry continues to be surrounded by many stigmas. And it is difficult for us to understand, as a society, that, after all, the brain is just another organ and that, as such, it can become ill. And we all know about depression, anxiety, schizophrenia, obsessive compulsive disorder, bipolar disorder… All of these psychiatric conditions are common (sadly) and popular knowledge.

But we cannot forget that there are more than 400 different mental disorders, some of them being, at least, incredible. And among these strangest psychiatric pathologies, there is one that takes your breath away: Cotard's syndrome. A disease in which the person is convinced that they are dead and that their organs are decomposing.

A syndrome that makes us believe that we are dead. And in today's article, from the maximum respect for the world of Psychiatry and from the hand of the most prestigious scientific publications, We will explore the clinical bases of Cotard syndrome, analyzing its causes, symptoms and treatment options.. Let's go there.

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What is Cotard syndrome?

Cotard syndrome is a strange psychiatric disease in which the person who suffers from it is convinced that they are dead and are suffering from a decomposition of their organs. Also known as delusion of denial, it is a clinical condition related to hypochondria in which the patient believes, both figuratively and literally, to be dead, to be suffering from putrefaction or simply not to exist.

We are facing a psychiatric pathology whose bases are not entirely clear, because in some cases, the person believes and feels incapable of dying. Due to its expressions, many media outlets refer to it as “the zombie patient syndrome”. But this is disrespectful to people who have it and a very unspecific way of talking about a disease.

This disease, which gets its name from the French neurologist Jules Cotard, who recognized it as an entity and described it in 1880, makes people unable to function socially. They come to believe that their organs are paralyzed and even in a state of decomposition, being able to even experience olfactory hallucinations that confirm their delusions.

There is not always the belief of being dead, but in the most serious cases there is. Patients can come to digest the idea of ​​being dead and communicate the news to their loved ones. Hence, it is considered a delusion of denial or nihilistic, since the disorder makes people question their own existence.

Even so, keep in mind that this syndrome is not recognized by DSM-5 or by the World Health Organization, so its clinical bases, as we have already mentioned, are not as well described as would be necessary.

What is clear, however, is that the (few) people who suffer from this disease are exposed to very high levels of suffering, since not only does it present a clear association with major depression, but they deny their own life .

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Causes of Cotard syndrome

Cotard syndrome is a very strange psychiatric illness. In fact, although there are no exact figures about its prevalence (remember that it is not yet recognized by the WHO or in the DSM-5), it is estimated that in recent years only about 200 cases have been diagnosed worldwide.

This extremely low incidence, together with the lack of scientific literature on this entity, makes the causes behind Cotard's syndrome, to a great extent, a mystery. Even so, there is a hypothesis about its origin that many psychiatrists (not all) defend.

This theory says that the appearance of Cotard syndrome is due to the combination of two factors. On the one hand, a neurological abnormality that gives rise to subjective experiences linked to delusions. That is to say, one condition is the biological alterations in our neurological system.

And, on the other hand, some kind of failure in the brain mechanisms associated with logic. This alteration in the belief evaluation system is what, in conjunction with delusions and subjective experiences, can cause the person to conclude that he is dead. Delusions and difficulties in reasoning. Hence, it is possible to reach this extreme of nihilism and doubt our existence.

What's more, Cotard's syndrome appears to be part of another underlying psychiatric (or non-psychiatric) illness. There seems to be a correlation with major depression, Parkinson's, dementia, schizophrenia, multiple sclerosis, traumatic brain injury, anxiety, cardiovascular disease ...

This does not mean that people with these physical or psychological health problems are at risk for this disease. It simply means that Cotard syndrome appears to be linked to these conditions. Although other times it has been observed in people who did not have any underlying health problems.

Cotard syndrome symptoms

Cotard's syndrome is a very rare psychiatric illness that is not clinically well defined. Even so, we do know what its main symptoms are. It is a delusion of extreme denial, so the main manifestations are denial of one's own body (86%), denial of existence (69%), hypochondria linked to the sensation of being dead (58%) and feeling of immortality (55%).

Therefore, although the most famous of this syndrome is the association with the belief of being dead, this is experienced in approximately half of the cases. The patient generally believes that his vital organs are paralyzed and comes to experience sensory delusions that confirm this belief.

Actually, your brain interprets that the heart does not beat, that the lungs do not inhale air, that the intestines do not work, that they have no senses, that the blood does not flow ... All these hallucinations can lead to the firm belief that they are in a state of decomposition.

People affected by Cotard's syndrome, in addition to denying their existence or that of their body, can come to feeling like your organs are in a state of decay and putrefaction, being able to have olfactory (smelling like rotten meat) and visual (seeing worms crawling on their skin) delusions to confirm their own belief that they are dead.

It is in the most serious and clinically complex cases that the person can come to believe, within the delusion of being dead, that they have become a kind of immortal being condemned to be a “living dead”. Hence the media name that we have discussed above and that is used by somewhat sensationalist media.

It must be taken into account that all these delusions about death, in combination with the emotional affectation of depression or other psychiatric conditions linked to Cotard's syndrome, make the affected person have a very high risk of suicide or behaviors that, believing that they will not cause harm (because the person thinks that he is dead and / or that he is immortal), could lead to his true death.

Cotard syndrome treatment

The treatment and prognosis of Cotard syndrome depends, to a great extent, on the underlying psychiatric condition. In fact, the current scientific literature does not clearly describe the exact prognosis of this disease. Apparently, varies widely from sudden and unexplained recovery to conversion to a severe chronic disorder that is difficult to recover.

In any case, the treatment of Cotard syndrome should be based on the therapeutic options of the underlying condition (if it is depression, this condition should be treated with antidepressant drugs), as studies have not yet been carried out to find treatment lines to address this strange and terrifying syndrome.

Even so, the most indicated treatment for Cotard syndrome seems to be electroconvulsive therapy (in combination with drug therapy), a clinical procedure that is performed under general anesthesia and that is based on passing small discharges of electrical currents through the brain and thus triggering a brief seizure that alters brain neurochemistry and that can reverse some of the the symptoms related to this pathology.

It should be borne in mind, however, that this electroconvulsive therapy is only used when other treatments have not worked (that is why it is one of the few alternatives to treat Cotard's syndrome) and that it is not useful in everyone. And as surprising as it is to deliver electricity to the brain, this therapy is much safer today than it was years ago. Obviously, there are risks (like any treatment), but no memory loss or other serious side effects are seen.

As we can see, Cotard's syndrome is a serious mental illness that, although it is strange and seems to be a symptom of another underlying psychiatric condition, due to its implications and the severity of its symptoms, needs more studies, recognition and, above all, respect.