Cotard Syndrome in an Adolescent: Case Report From Georgia
Out on PubMed, from clinicians in Georgia, USA, is this case report:
Cotard Syndrome in an Adolescent With a First Episode of Psychosis.
J Psychiatr Pract. 2021 May 5;27(3):224-227. doi: 10.1097/PRA.0000000000000545.PMID: 33939377
The abstract is copied below:
This case report describes a unique presentation of Cotard syndrome in an 18-year-old female patient experiencing first-episode psychosis. Cotard syndrome was first described in 1880 by Jules Cotard as a novel subtype of anxious depression and is presently understood as a rare cluster of mood and psychotic symptoms centered on nihilistic delusions including the absence of organs and a perception of being dead. Although rare, Cotard syndrome has been described in a variety of neurological and psychiatric illnesses, but it is most commonly seen in middle-aged adults with a history of chronic mood disorders. It is rarely reported in childhood or adolescence, and it has not previously been described in first-episode psychosis. This report describes a unique presentation of full Cotard syndrome in an adolescent patient experiencing first-episode psychosis without reported mood symptoms. The patient displayed limited improvement over the first week of treatment with quetiapine but improved rapidly during the second week of hospitalization after a medication change to risperidone. The patient's rapid response to risperidone is unique, as most existing evidence suggests that electroconvulsive therapy is the most effective treatment for Cotard syndrome. This response indicates an opportunity for the implementation of a second-generation antipsychotic medication in patients with Cotard syndrome in areas where electroconvulsive therapy is not available.And from the text:
CASE DESCRIPTION
An 18-year-old female presented to a psychiatric
intake center following a referral from her outpatient psychiatry office with acute psychosis, suicidal ideation, and severe anxiety after discarding
her psychiatric medications 3 weeks before admission. The patient was appropriately dressed and
groomed, with psychomotor agitation, pressured
speech, an anxious mood, flat affect, racing, tangential, and perseverative thoughts, and delusional
and hallucinatory thought content. At intake, the
patient was extremely preoccupied with delusions
of being dead, consistent with the Cotard delusion,
stating, “the devil has destroyed all my organs,” “I
do not eat because I do not have a digestive system,”
and “I do not need my blood pressure medication
because I have no blood.” The patient also endorsed
suicidal ideation, but denied a current suicidal plan,
stating, “I cannot kill myself because I am already
dead.” She reported auditory hallucinations of the
devil’s voice and stated that the devil had tricked
her into thinking that he was her father. The
patient also reported severe anxiety centered on her
delusion of being dead, as well as insomnia and
decreased appetite for the past several weeks. She
denied current or previous manic symptoms or
depressed mood.
This is an interesting case report, mainly because of the classic delusions of Cotard syndrome occurring in an adolescent. The first two authors are medical students; some of the symptom descriptions and psychiatric diagnostic conclusions in the report are inconsistent, in keeping with their level of experience. (To me it sounds like this patient has bipolar disorder, like her sibling...) Their literature review of Cotard syndrome is excellent and their mention of ECT as the usual treatment is appropriate.
The patient's response to a neuroleptic is a good reminder that sometimes ECT can be postponed; however, it may well be that this patient will need ECT in the future for definitive response.
This case is worth a full, quick (~7 minutes) read, mostly for the details of the clinical presentation.
Comments
Post a Comment