The word nihilist comes from Latin nil, which means nothing. Nihilistic delusions are defined as those signs of psychopathology in which those affected deny the existence of their own being. One of them is the Cotard's syndrome, which despite dating from the 19th century, is very little known until now. For this reason, we offer in the following article an extensive definition, together with its symptoms, possible causes and currently existing treatment.
What is Cotard syndrome?
Cotard syndrome, also called Cotard's delusion, nihilistic or denial syndrome, It is a very little-known psychopathology, in which the affected person experiences severe episodes of depression and delirium, which even lead him to think that he has died. Its name is attributed to Jules Cotard, a French neurologist who described the disease for the first time in the city of Paris in 1880; although it is presumed that similar cases had already occurred in ancient times. He himself recognized her at that moment as the délire of négation, which literally translates as “the delirium of denial.”
This psychiatrist presented the case of a patient whom he nicknamed Mademoiselle X, who completely denied the existence of some parts of her body, and therefore, also denied the need for nutrition. Subsequently, her condition worsened to such an extent that her persistent rejection of God and the Devil had condemned her and the possibility of a natural death was completely ruled out.
It is a disease closely related to hypochondria, since the patients who suffer from it claim to be dead and that the different parts that make up their body in reality do not exist, or are in a state of putrefaction. In some cases, on the contrary, patients believe that they cannot die, as happened with Mademoiselle X, which can lead them to carry out dangerous and lethal actions, such as mutilation.
Cotard also presented a subdivision within the delirium of denial:
- The typical cases.
- The frustrated ones.
- Those of phasic evolution.
- Those of manic excitement.
Cotard syndrome is related to psychopathologies serious such as schizophrenia or different forms of dementia. That is why some psychiatrists today do not consider it as an illness, but as the most extreme manifestation of depersonalization, that is, as the most serious phase of other mental pathologies.
Since its first description in 1880, the studies associated with this disorder have been very limited, in view of the infrequency with which its relationship with other diseases occurs. However, so far the majority of cases evaluated have occurred in elderly people.
Symptoms of Cotard syndrome
The symptoms of Cotard syndrome are quite clear. A patient who suffers from it will most certainly express that the organs that make up his body are in a state of putrefaction, or have disappeared as a result of his general death. Below are the most distinctive features of this disease:
- Melancholic anxiety.
- Expression of hypochondriacal thoughts in which they assure that the organs of their body are in the process of decomposition, that neither their body nor their soul exist.
- Delusions of immortality, confident expression of ideas of never being able to die.
- Olfactory hallucinations.
- Self-mutilation and other forms of physical violence towards themselves due to the belief that they do not exist or are immortal.
- Propensity to commit suicide very frequently.
At this point, it is important to highlight the dichotomy of thought present in this syndrome. On the one hand, the idea of one's own death, which can be linked to severe depression and the suicidal ideas that arise from it, and the idea of immortality, fueled by the feeling of non-existence.
Causes of Cotard syndrome
As has been said, Cotard syndrome has been considered by many specialists as a late symptom of other mental conditions, generally in cases of severe depression and some neurological syndromes. Furthermore, the early childhood trauma, which has been corroborated in each of the cases studied so far, which is why it is also attributed as one of the causes.
Parietal lobe dysfunction:
The parietal lobe is one of the largest blood cells in the brain, and is mainly responsible for capturing stimuli by touch, heat, cold, pressure, pain, and the coordination of balance. Symptoms of body denial have been attributed to lesions or dysfunction in this region of the brain, and other areas such as the dorsolateral frontal lobe, the cingulate gyrus, the thalamus, and the neocortex (caudate and putamen).
Alterations in brain metabolism:
Likewise, hypometabolism (lower glucose consumption) has been observed in these, and in other cases, on the contrary, hypermetabolism, that is, greater glucose consumption, has been observed in the cerebellum, thalamus and brain stem.
The aforementioned areas have a significant role in shaping the individual's own information, as well as consciousness. So far, imaging tests applied to some patients have confirmed the suspicions of this statement; but there is still very little evidence to attribute it as a formal cause of Cotard syndrome.
Diagnosis of Cotard syndrome
The described symptoms of Cotard syndrome are quite specific. However, its diagnosis remains quite complex due to the absence of sufficient information associated with it. It generally involves the psychological observation of the patient (clinical picture), although different neuroimaging tests can also be applied; but these are more useful in this case to rule out other syndromes than to identify it.
Treatment of Cotard syndrome
Regarding drug administration, the most common are tricyclic antidepressants and serotonergics, in conjunction with electroconvulsive therapy.
Electroconvulsive therapy (ECT)
Also known as electroconvulsive therapy or electroshock therapy, it is a psychiatric treatment in which seizures are generated in the patient through electrical stimuli. It is used in cases of extreme depression, and in severe mental illnesses, such as schizophrenia. This has also been used to treat Cotard syndrome, in sessions every 48 hours for some months, and patients have shown improvement, although it involves the loss of temporary or permanent memory (amnesia).
- Currently, ECT is the most effective method for inhibiting this disorder, since 80% of cases have responded positively to its application. However, this should only be applied by competent specialists in the area, under strict control and compliance with pharmacological treatment.
- Regarding its prognosis, due to the severity of the disease, cases of complete recovery are very few, even after strict psychological treatment. The rate of suicides caused by Cotard syndrome is quite high, in fact.
We hope you liked this article about Cotard syndrome. If you are interested in obtaining information about other mental disorders or pathologies, we invite you to consult other articles on this page, where you will get a variety of relevant and quality data.