Cotard Delusion- A Review
Out on PubMed, from researchers in Portugal and Brazil, is this review:
A medical algorithm for Cotard delusion based on more than 300 literature cases.
Objective: Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, i.e., the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition.
Method: To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD.
Results: Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy.
Conclusions: Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
Keywords: Clinical psychiatry; Cotard syndrome; death delusion; delusional disorder; psychiatric disorder; psychosis.
And from the text, the last paragraph of the section on ECT:
To sum up, ECT has been widely used in CD and seems to produce suitable therapeutic results (Delay et al. 1946), an author goes to the point of saying (Bourgeois et al. 1986): ‘ECT was applied with spectacular immediate results’. Its performance appears to be particularly useful in severe CD conditions or when a rapid response in needed, being also a valuable option in cases refractory to pharmacological treatment. Although it has been used as a first-line treatment in several cases, its use appears to be limited by the lack of availability in several medical centres. By examining Supplementary Table S1, at least 88% of patients responded favourably to ECT, with remission in ca. 67% of the cases.
This is an exhaustive (and it must have been exhausting to compile) review of the cases in the world literature of Cotard Delusion (aka Cotard Syndrome). The authors discuss its occurrence in the context of various psychiatric and medical/neurological diagnoses, emphasizing the need for comprehensive medical evaluation. The most common contexts are psychotic depression, schizophrenia and catatonia. The role of ECT is well documented here, including in a very useful, and well diagrammed, treatment algorithm.
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