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Cotard Syndrome

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Submitted By aliffrazak
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Background
Cotard’s syndrome is named after Jules Cotard (1840-1889), a French neurologist who described this condition for the first time in 1880 in a case report of a 43 years old woman. He formulated a new type of depression characterized by anxious melancholia, ideas of damnation or rejection, insensitivity to pain, delusion of nonexistence one’s own body and delusions of immortality. He categorized this under ‘lypemanie’ a type of psychotic depression. Later on Cotard introduced ‘délire des negations’ as a new terminology for the syndrome. Seglas introduced the eponym ‘Cotard’s syndrome’ in 1887. A few years later, Regis linked the syndrome to other psychiatric disorders.
Relationship with Brain
There are two factor hypothesis is proposed to explain Cotard’s syndrome. The first factor is due to the total lack of autonomic response to anything (as in pure autonomic failure), the second to not being able to reject the hypothesis ‘‘I’m dead.’ In this hypothesis the loss of affect (first factor) is more pronounced and generalized than in Capgras patients. On the other hand, the difference in attributional style could also be an explanation for the different hypothesis formation in the first factor. The importance of the right dorsolateral prefrontal cortex (RDLPFC) for hypothesis evaluating was demonstrated with fMRI. It has also been observed that right frontal damage is commonly occurring in cases of delusional misidentifications (including Cotard’s syndrome). Not only that, based on neuro-imaging data show no gross structural changes in the brain in Cotard’s syndrome. However, left lesions are also described. Using molecular neuro-imaging modalities, not all studies show right-sided hypofunctionallity. There seems to be a correlation between prefrontal dysfunction and nihilistic beliefs in neurological patients.

Symptom
The symptoms of cotard delusions is believing that she or he already died ,missing internal organ( brain, heart , lung) or part of their body. They also denied their existence in this world. Some of them died because of starvation because they think that they should not eat, not feel pleasure toward anything, loses of their smell and taste or in the other words is everything is meaningless. They also complain about lack of knowledge, intelligence and conscience. For them, god or devil is does not exist. In some cases, they can feel rotten flesh or blood. In addition, patient that suffers from this disorder tend to commit suicidal easily.

Diagnosis
Walking corpse syndrome is diagnosed based on patient’s history and symptoms. People, who suffer from these diseases, were diagnosed with multifocal brain atrophy and inter-hemispheric enlargement. Others also describe these diseases due to enlargement of the third and lateral ventricle, a specific lesion to the temporoparietal areas, and changes in the nondominant temporoparietal areas, sometimes together with frontal damage. There are several test conducted to diagnose these diseases which are Computed Tomography (CT), Ethyl Cysteine Dimer (ECD) and single-photon emission computed tomography (SPECT).

Treatment
The most reported treatment strategy for Cotard’s syndrome is electroconvulsive therapy (ECT). Based on the classification of Berrios and Luque, one suggestion was made that ECT is indicated in patients with Cotard’s syndrome and psychotic depression, while antipsychotics exert better effects in Cotard’s syndrome type 1. Therapeutic support is also one of the treatment strategies for Cotard’s syndrome.

References
Debruyne, H., Portzky, M., Peremans, K., & Audenaert, K. (2011). Cotard’s Syndrome retrieved from http://www.researchgate.net/publication/26241741_Cotard%27s_syndrome_a_review

http://www.newscientist.com/article/dn23583-mindscapes-first-interview-with-a-dead-man.html#.VO2WXPmUeQM

http://www.medindia.net/patients/patientinfo/walking-corpse-syndrome.htm

--------------------------------------------
[ 1 ]. Mind & Brain Journal of Psychiatry 2011; 2: (1). July 2011, Cotard Syndrome, Hans Debruyne, Michael Portzky, Kathelijne Peremans and Kurt Audenaert
[ 2 ]. Towards Understanding Cotard’s Syndrome : an overview, Hans Debruyne & Kurt Audenaert © 2012 Future Medicine Ltd Neuropsychiatry (2012) 2(6), 481–486
[ 3 ]. Mind & Brain Journal of Psychiatry 2011; 2: (1). July 2011, Cotard Syndrome, Hans Debruyne, Michael Portzky, Kathelijne Peremans and Kurt Audenaert
[ 4 ]. Towards Understanding Cotard’s Syndrome : an overview, Hans Debruyne & Kurt Audenaert © 2012 Future Medicine Ltd Neuropsychiatry (2012) 2(6), 481–486

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