I Actually Don’t Exist: Cotard’s Syndrome

Ben Aslında Yokum: Cotard Sendromu

Cotard’s Syndrome, also known as “the living dead syndrome”, is a rare neuropsychiatric disorder, in which the individual believes he or the parts of his body are dead or dying.

It is named after Jules Cotard, who defined the disorder in 1880. Even though Cotard’s Syndrome is not defined as a separate disorder in psychiatric diagnosis books, studies have put forward that Cotard delusions are strongly associated with previous neurological disorders. Neuroimaging techniques, such as MRI and EEG, are utilized in order to comprehend the underlying mechanisms of Cotard’s syndrome, which is associated with diseases that cause brain damage, such as migraine, Parkinson’s disease, cerebral hemorrhage, loss of brain cells, parietal lobe tumor, or temporal lobe epilepsy.

In a study conducted by Sahoo and Joseph in 2017, the clinical findings of 12 Cotard’s Syndrome patients were analyzed, along with their MRI and EEG data. Of the 12 patients whom they analyzed, 8 claimed that they were dead, while 4 reported that they were about to die. Of the 8 patients who claimed to be dead, one half reported that they were killed by healthcare professionals, while 3 of the patients who claimed that they were dying, reported that their internal organs were being chewed on by various viruses, worms, and insects. One patient was diagnosed with delusional parasitosis, which stands for the delusions that insects or harmful parasites are infecting the body without any medical reason whatsoever. The patients were also observed to have carried psychiatric symptoms, such as depression, schizophrenia, substance addiction, and catatonia.

As per the neuroimaging results; a reduction in the frontal lobes and general brain volume, various lesions in the right hemisphere or in both hemispheres, as well as infarctions in frontal and occipital regions, were found in patients with Cotard’s Syndrome, while the EEG data showed a generalized retardation in the patients.

The treatment of Cotard’s Syndrome usually includes the use of electroconvulsive therapy, and pharmacotherapy (dopamine antagonists, selective serotonin reuptake inhibitors, and Citalopram). Furthermore, it has been found that behavioral psychotherapy, along with pharmacotherapy, can also be effective in the treatment of delusions (Sahoo and Joseph, 2017).

Sahoo, A., & Josephs, K. A. (2018). A neuropsychiatric analysis of the Cotard delusion. The Journal of neuropsychiatry and clinical neurosciences30(1), 58-65.