Cotard’s Syndrome: A Detailed Description of the Stages

BACKGROUND: Cotard’s syndrome (CS) was first reported by Jules Cotard in 1880, presenting the case of a woman who believed that she had no internal organs and would live forever, and who made various suicide attempts. It was considered as a new type of depression characterized by anxious melancholia, ideas of damnation or demon possession, suicidal behavior, insensitivity to pain, and delusions of nonexistence and immortality.
CASE REPORT: We report the case of a 63-year-old man with CS secondary to depression. The man progressed through 3 stages in the course of the CS. The first stage was the germination stage, in which hypochondriasis and depressive symptoms occurred before the development of delusions. The second stage consisted of nihilistic and hypochondriacal delusions, anxiety, and depression, constituting a mixed group named the blooming stage, which is the period of full development of symptoms of CS. The third and last stage was the chronic stage, in which only various delusions persisted. None of the examinations performed found any specific abnormalities. Electroconvulsive therapy (ECT) combined with pharmacotherapy as the treatment strategy was effective.
CONCLUSIONS: ECT combined with pharmacotherapy is effective in treatment of depressive patients with psychotic features. Apart from drug and ECT therapies, special safety measures are essential because of the high suicide risk.

Keywords: Depression, Negativism, Therapeutics