Cotard’s Syndrome
Other Known Aliases – Cotard delusion, Walking Corpse Syndrome
Definition – Rare mental illness in which a person feels they are dead, do not exist, parts of them are decaying or rotting, or they have lost internal organs, blood, or extremities.
Clinical Significance – The pathophysiology is not well understood and the two thoughts are that it is due to lesions or atrophy in the parietal and/or frontal lobes, or due to neural misfiring in the fusiform gyrus that is responsible for facial recognition.
The core concept of Cotard’s syndrome is a delusion of negation and classically progresses through three stages:
- Germination Stage – symptoms of psychotic depression and hypochondria
- Blooming Stage – full development of the syndrome and the appearance of the delusions of negation
- Chronic Stage – severe delusions with chronic depressive symptoms
It is most common in patients with underlying schizophrenia and psychosis and patients often withdraw from society and the outside world. Partly because of the delusions and partly due to personal neglect of appearance and hygiene. There is no DSM-V diagnosis for Cotard’s syndrome, so it falls under the category of somatic delusions.
History – Named after Jules Cotard (1840-1889), a Parisian neurologist, psychiatrist, and surgeon who received his medical doctorate in 1868 from the University of Paris and worked at the Hospice de la Salpétriére under Jean Martin Charcot. In June 1880, he read a report on “Du délire hypochondriaque dans une forme grave de la mélancolie anxieuse” where he described a case of a 43yo woman who believed she had no brain, nerves, or entrails and that she did not need food, for she was eternal and would live forever. Emil Régis was the first to coin the eponym in 1893. In 1889, his daughter contracted diptheria and for 15 days he refused to leave her bedside until she recovered. Unfortunately, he contracted the same illness and succumbed to disease later that year.
References
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Berrios GE, Luque R. Cotard’s delusion or syndrome?: a conceptual history. Comprehensive psychiatry. ; 36(3):218-23. [pubmed]
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Pearn J, Gardner-Thorpe C. Jules Cotard (1840-1889): his life and the unique syndrome which bears his name. Neurology. 2002; 58(9):1400-3. [pubmed]
- Cotard J. Du délire hypocondriaque dans une forme grave de la mélancolie anxieuse. Ann Med Psychol (Paris). 1880;4:168-174.
- Régis E. Note historique et clinique sur le délire des négations. Gaz Med Paris. 1893;2:61-64.
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