A fifteen year old girl is admitted to the hospital for severe depression. After a few days in a nearly catatonic state, she begins to move and speak again. An EEG scan (which measures electrical activity in the brain) and a CT scan (an X ray image of the brain) appear normal. Despite this, the girl maintains an unshakable conviction that she is dead and waiting in the hospital to be buried.

The girl in question shows a fairly classic presentation of Cotard’s Syndrome or Cotard’s Delusion. Cotard’s Syndrome is an exceedingly rare disorder in which the person suffers from the delusion that they are dead. Other permutations of the disorder include believing that one does not exist or that one is missing certain organs necessary for survival, such as the brain or heart.

No one knows for sure what causes Cotard’s Syndrome. In some cases, there may be obvious physical abnormalities such as a brain tumor or traumatic brain injury. However, as in the case of the girl, there is often no readily apparent physical cause of the delusion. It has been hypothesized that denial of the existence of one’s body parts is due to parietal lobe dysfunction, but this has yet to be conclusively proven. Cotard’s often co-occurs with depression, bipolar disorder, or schizophrenia.

Pharmacological treatments, most commonly antidepressants and antipsychotics, are usually the first option for treatment of Cotard’s. Some individuals respond well to drug therapy, but many require additional treatment in the form of electroconvulsive therapy (ECT). To administer ECT, electrical stimulation is used to induce seizures in an anesthetized individual. The mechanism of action by which ECT ameliorates psychological disorders is unknown, despite decades of research.

Surprisingly, Cotard’s syndrome responds fairly well to the above treatments. The 15 year old girl mentioned above was able to go back to school after two months and at a six month checkup showed no signs of psychotic symptoms. Because Cotard’s is so rare, there has been relatively little research on it; the reasons why it responds so well to treatment are as mysterious as the reasons why it appears in the first place.

Sources

Cohen, D., Cottias, C., & Basguin, M. (1997). Cotard’s Syndrome in a 15-year-old girl. Acta Psychiatrica Scandinavica, 95(2): 164-5.

Duggal, H.S., Jagadheesan, K., & Hague Nizamie, S. (2002). Biological basis and staging of Cotard’s Syndrome. European Psychiatry, 17(2): 108-9.

Reich, M., Comet, B., Le Rhun, E., & Ramirez, C. (2012). Cotard’s syndrome with glioblastoma multiforme. Palliative and Supportive Care, 24: 1-5.