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Improvement of cognition in a patient with Cotard's delusions and frontotemporal atrophy receiving electroconvulsive therapy (ECT) for depression

Published online by Cambridge University Press:  16 April 2009

Giuseppe Fàzzari ,
Oliviero Benzoni ,
Alessio Sangaletti ,
Francesca Bonera ,
Stefano Nassini ,
Lorenzo Mazzarini ,
Isabella Pacchiarotti ,
Gabriele Sani ,
Alexia Emilia Koukopoulos  and
Livia Sanna
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Giuseppe Fàzzari
Affiliation:
Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy
Oliviero Benzoni
Affiliation:
Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy
Alessio Sangaletti
Affiliation:
Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy
Francesca Bonera
Affiliation:
Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy
Stefano Nassini
Affiliation:
Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy
Lorenzo Mazzarini
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy Clinical Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
Isabella Pacchiarotti
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy Clinical Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
Gabriele Sani
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
Alexia Emilia Koukopoulos
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
Livia Sanna
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
Roberto Gasparotti
Affiliation:
Neuroradiologia, Università degli Studi di Brescia, Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy
Pietro De Rossi*
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
Simone Lazanio
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
Valeria Savoja
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
Paolo Girardi
Affiliation:
Sapienza University, II Medical School, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Rome, Italy
*
Correspondence should be addressed to: Pietro De Rossi, M.D., II Medical School, Sapienza University, Department of Neurosciences and Acute Care Psychiatric Unit, Sant'Andrea Hospital, Via di Grottarossa 1035–1039, 00189 Rome, Italy. Phone: +39 0633775951; Fax: +39 0633775342. Email: [email protected].
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Abstract

A 69-year-old man presented with Cotard's delusions, insomnia, profound depression, amnesia, difficulty concentrating, and cognitive deficit after two different surgical interventions. Brain imaging showed frontotemporal-subcortical atrophy and lateral ventricular enlargement. He responded poorly to a combination of sertraline, amisulpride and mirtazapine, with modest benefit on insomnia, and developed hypotension. After 18 days he was switched to olanzapine and venlafaxine, but his cognition worsened. He underwent bilateral electroconvulsive therapy (ECT). His mood improved, cognitive performance increased and anxiety symptoms remitted. This improvement persisted through the one-month post-discharge follow-up and depression eventually remitted.

Keywords

Cotard's syndromeelectroconvulsive therapydelusionsfrontotemporal dementiasubcortical atrophy
Type
Case Report
Information
International Psychogeriatrics , Volume 21 , Issue 3 , June 2009 , pp. 600 - 603
Copyright
Copyright © International Psychogeriatric Association 2009

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