Revisiting Cotard’s Syndrome: Illustration of Two Psychiatric Clinical Cases

Abstract

Background: Cotard’s Syndrome (CS) is a rare and severe neuropsychiatric condition in which the central feature is the existence of nihilistic delusions. Controversy has ensued about the precise clinical picture Jules Cotard meant to describe and attempts have been made, more recently, not only to clarify the terminology, but also to define different types of this syndrome and explore its biological basis.

Aims: We intend to briefly review the terminology, etiology, epidemiology and differential diagnosis of this syndrome, based on two clinical cases.

Methods: Bibliographic search conducted through the electronic databases Medline and Gallica (French National Library), consultation of clinical records and direct interviews with the patients.

Results and Conclusions: Typically the patients diagnosed with CS manifest the delusional idea that they are dying or already dead. However, it is also possible that they deny the existence of only some parts of their own body, or the functioning of some organs, and they may even sometimes deny the existence of the external world. We illustrate the case of a 66-year-old woman, diagnosed with bipolar affective disorder, admitted in the context of a severe depressive episode with psychotic symptoms, compatible with CS type II and the case of a young male aged 22, admitted due to a first  psychotic episode with schizophrenia like characteristics, presenting with nihilistic delusions compatible with CS type I.