Cotard syndrome: An important manifestation of melancholia

Author(s): Bolwig, T. G.

Journal/Book: Nord J Psychiatr. 1998; 52: PO Box 2959 Toyen, Journal Division Customer Service, N-0608 Oslo, Norway. Scandinavian University Press. 459-464.

Abstract: In 1880 Cotard described a syndrome, the hallmark of which is the delusion of being dead. Since then the debate has centred on whether it is a distinct psychiatric entity or an extreme form of depression. The syndrome has been observed in schizophrenia, confusional states, epilepsy, and senile and presenile conditions. We report five cases of Cotard delusion in patients in whom the differential diagnosis was difficult, immediately pointing to organic or paranoid psychosis being the primary cause of illness. On the basis of the clinical decision that the nihilistic ideation was the prominent feature of a psychotic depression, the patients underwent a series of electroconvulsive therapy (ECT) with striking effect, both on the delusional and on concomitant symptoms. The psychopathology and therapy of delusional depression are discussed. The case histories show the importance of considering depressive illness in patients with nihilistic delusional symptoms with or without depressed mood, and the therapeutic efficacy of ECT in depression with severe psychotic manifestations.

Note: Article Hansen ES, Rigshosp, Dept Psychiat, Ctr Neurosci, Blegdamsveg 9, DK-2100 Copenhagen, DENMARK

Keyword(s): Cotard syndrome; delusional depression; electroconvulsive therapy; DEPRESSION

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