Cotard Syndrome

Also known as Cotard delusion and nihilistic or negation delusion, Cotard syndrome is a rare neuropsychiatric disorder in which a person delusionally believes that he or she is dead or does not exist. It is named after Dr. Jules Cotard (1840-1889), a French neurologist who first described the syndrome of "negation delirium" at an 1880 lecture in Paris. It is associated with manic-depressive disorder, neurological disease, and derealization. The main character in Charlie Kaufman's movie Synecdoche, New York is named Caden Cotard (Philip Seymour Hoffman), and his wife is Adele Lack (Catherine Keener). This syndrome also consists of mental depression and suicidal tendencies, in which the patient believes s/he has lost everything from possessions to parts of or his/her entire body, often believing that s/he has died and is a walking corpse. Attempted suicide seems to provide a challenge to the patient to test the delusion of already being dead. Cotard syndrome is usually expanded to the degree that the patient might claim that he can smell his rotting flesh and feel worms crawling through his skin. Showers or baths don't seem to help. The latter phenomenon is a recurring experience of people chronically deprived of sleep or suffering amphetamine or cocaine psychosis. Paradoxically, being "dead" often gives the patient the notion of being immortal. Other megalomelancholic ideas may be present. Many patients complain bitterly to others of the enormous hardships of being dead. One can just imagine... The etiology of Cotard delusion is so far unknown. Because tricyclic and selective serotonin-reuptake inhibitor (SSRI) antidepressants are ineffective, the treatment most often used is electroconvulsive therapy.