Cotard delusion
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The Cotard delusion or Cotard's syndrome,[1] also known as nihilistic or negation delusion, is a rare neuropsychiatric disorder in which a person holds a delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. Rarely, it can include delusions of immortality.[2]
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[edit] History
The syndrome is named after Jules Cotard[3] (1840–1889), a French neurologist[4] who first described the condition, which he called le délire de négation ("negation delirium"), in a lecture in Paris in 1880.[5] He described the syndrome as having degrees of severity that range from mild to severe. Despair and self-loathing characterize a mild state. Someone suffering the severe state begins to deny the very existence of the self.[citation needed]
In this lecture, Cotard described a patient with the pseudonym of Mademoiselle X, who denied the existence of God, the Devil, several parts of her body, and her need to eat. Later she believed she was eternally damned and could no longer die a natural death.
[edit] Signs and Symptoms
Young and Leafhead describe a modern-day case of Cotard delusion in a patient who suffered brain injury after a motorcycle accident:[6]
[The patient's] symptoms occurred in the context of more general feelings of unreality and being dead. In January, 1990, after his discharge from hospital in Edinburgh, his mother took him to South Africa. He was convinced that he had been taken to hell (which was confirmed by the heat), and that he had died of septicaemia (which had been a risk early in his recovery), or perhaps from AIDS (he had read a story in The Scotsman about someone with AIDS who died from septicaemia), or from an overdose of a yellow fever injection. He thought he had "borrowed my mother's spirit to show me round hell", and that he was asleep in Scotland.
[edit] Pathophysiology
Neurologically, Cotard's is thought to be related to Capgras's syndrome, and both are thought to result from a disconnect between the brain areas that recognize faces (fusiform face areas[7]) and the areas that associate emotions with that recognition (the amygdala and other limbic structures). This disconnection creates a sense that the observed face is not the person's it purports to be, and therefore lacks the familiarity that should be associated with it. If it is a relative's face, it is experienced as an impostor's (Capgras); if the sufferer sees their own face they may feel no association between it and their sense of self, resulting in a sense that they do not exist.
Cotard's syndrome is encountered primarily in psychoses such as schizophrenia and bipolar disorder.[7] It can arise in the context of neurological illness or mental illness and is particularly associated with depression and derealization. It has even been described in migraine.[7]
[edit] Treatment
Treatment is difficult, and tricyclic and serotoninergic antidepressant drugs have shown little efficacy. Electroconvulsive therapy has shown greater promise, "curing" Cotard's sufferers in five studies of its efficacy with that treatment.
[edit] Cultural references
- In the Scrubs episode "My Lucky Charm", a character suffering from Cotard syndrome complains of the hardships of being dead.
- British electronic musician Matt Elliott named a song for the condition on his 2003 album The Mess We Made.
- Chuck Klosterman makes reference to Jules Cotard and Cotard's syndrome in his book, Killing Yourself to Live: 85% of a True Story. The protagonist, Klosterman, feels like he might be a victim of the syndrome, especially when he is in airports.
- American serial killer Richard Chase's belief that his blood was turning into powder may have been caused by a mild case of Cotard delusion.
- In the 2008 Charlie Kaufman film Synecdoche, New York, the main character's surname is Cotard, reflecting his obsession with death and the deterioration of his body.
- In the novel The Echo Maker, by Richard Powers, the main character's brother suffers from Capgras Syndrome, as well as a few other delusions, including Cotard.
- Dinosaur Comics discussed the Delusion in a 2007 strip.[8]
- Radiolab discusses Cotard's delusion as one of the stories in this hour long broadcast about death.[9]
[edit] References
- ^ Berrios G.E. and Luque R. (1995) Cotard's delusion or syndrome?. Comprehensive Psychiatry 36: 218-223
- ^ Berrios G.E. and Luque R. (1995) Cotard Syndrome: clinical analysis of 100 cases. Acta Psychiatrica Scandinavica 91: 185-188
- ^ Cotard's syndrome at Who Named It?
- ^ Jules Cotard at Who Named It?
- ^ Berrios G.E. & Luque R. (1999) Cotard's 'On hypochondriacal delusions in a severe form of anxious melancholia'. History of Psychiatry 10: 269-278.
- ^ Young, A.W. & Leafhead, K.M. (1996) (in P.W. Halligan & J.C. Marshall. (eds.) Method in Madness: Case studies in Cognitive Neuropsychiatry). Betwixt Life and Death: Case Studies of the Cotard Delusion. Hove: Psychology Press. p. 155.
- ^ a b c Pearn, J. & Gardner-Thorpe, C (May 14, 2002). "Jules Cotard (1840-1889) His life and the unique syndrome that bears his name" (abstract). Neurology 58 (9): 1400–3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12011289&.
- ^ Dinosaur comics #973. 12 April 2007.
- ^ After Life at Radiolab. 27 July 2009.
