Cotard’s Delusion: A Clinical and Conceptual Overview

Abstract

Background:

In 1880, the French neurologist Jules Cotard described a specific kind of nihilistic delusion which the patient believed that she no longer existed. Since then, this rare condition known as Cotard's Syndrome or Cotard's Delusion (CD) has intrigued clinicians and investigators.

Aims:

To present CD's features, including historical, clinical, etiopathological, and treatment issues.

Method:

Case report of a 49-year-old woman with fully developed CD; review of the literature.

Results:

There is still a considerable debate concerning the nature of this phenomenon - whether it should be conceptualized as a psychiatric symptom or as a syndromatic entity.

CD may appear in different severity levels, and most authors accept the idea of a spectrum of clinical presentations, ranging from the belief of loosing intellectual capacities to the extreme belief of non-existence of life and the universe.

This manifestation has been identified in patients with distinct diagnosis, mostly in severe depression, but also in schizophrenia and psycho-organic syndromes.

Treatment should be chosen according to the underlying pathology.

Conclusion:

Over the last few years, new contributions from neuropsychological and imaging studies have brought interesting approaches to understand CD's underlying mechanisms. At the moment, CD does not fit clearly into any category of the current systems of classification. Future investigations should address the pathophysiological nature of CD and its place in the new, etiopathologically-oriented, classification systems.