This paper details the grounds for compulsory treatment, compulsory admissions in an emergency department and compulsory out-patient treatment in Portugal. Portuguese mental health legislation has improved significantly over recent years, with enhanced safeguards, rapid and rigorous review and clear criteria for compulsory treatment, although much remains to be done, especially in relation to the ‘move into the community’.
IntroductionIn 1880 Cotard introduced the term, “délire de negation”, which referred to nihilistic delusions and has come to be known as Cotard’s syndrome. This condition is thought to be characterized by various degrees of delusional beliefs in which different aspects of existence are negated or experienced from a negative perspective.ObjectivesThe historical concept of Cotard’s syndrome, its clinical presentation and treatment is briefly reviewed.AimsTo report a case study of Cotard’s syndrome associated with self-starvation and to review the concept and clinical features of the condition.MethodsA detailed clinical history was obtained from several interviews and a literature review of the theme is shortly surveyed.ResultsA woman of 66 years, without any psychiatric history prior 2012, developed a clinical picture of depressed mood and sudden onset of delusions of ruin, ill health, guilt and self-starvation. She believed that her esophagus and stomach were glued together, so that it was not possible for her to ingest any food. She also refused to go outside because she believed she was malodorous (she had olfactory hallucinations). The patient started experiencing these symptoms after her husband’s unexpected death, a few months prior to admission. She was treated with high doses of antidepressants and an antipsychotic.ConclusionsCotard’s syndrome in this case study is associated with depression. Attempting to understand individuals with the condition from both a phenomenological as well as biological viewpoint may eventually pave the way for clearer connections between psychological and biological causation of the syndrome.
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