A case of Cotard syndrome: 123I-IBZM SPECT imaging of striatal D2 receptor binding

Cotard’s syndrome: A review

“…These SPECT fi ndings persisted after remission. Before treatment, no perfusion abnormalities were found with 99m Tc-hexamethylpropyleneamine oxime (HMPAO) SPECT [12]. These fi ndings are consistent with data published for schizophrenic patients with depressive symptoms [12].…”

“…Recovery of bitemporal hypoperfusion also measured with 99m Tc-HMPAO SPECT was reported in patients with an underlying major depressive disorder [57]. Nevertheless, absence of abnormalities in cerebral perfusion or metabolism patterns was also shown in Cotard's syndrome (case 2) [12].…”

“…Cotard's syndrome has been diagnosed as part of several psychiatric and somatic diseases, with unipolar depression [5,7,[9][10][11][12][13][14][15] and bipolar depression [5,8•,11,16-18] being the most common associated psychiatric disorders. Psychotic disorder is also associated with Cotard's syndrome [4,5,19].…”

“…Before treatment, no perfusion abnormalities were found with 99m Tc-hexamethylpropyleneamine oxime (HMPAO) SPECT [12]. These fi ndings are consistent with data published for schizophrenic patients with depressive symptoms [12]. In one Cotard's syndrome patient diagnosed with a schizophreniform disorder, a left-sided hypoperfusion in the temporal, parietal, and frontal lobes with recovery of inferior frontal and left hypoperfusion and a minimal remaining hypoperfusion at the left temporal lobe after successful ECT treatment was measured with 99m Tc-HMPAO SPECT [19].…”

“…Monotherapy with agents such as amitriptyline [18], duloxetine [58], fl uoxetine [7], paroxetine [18], olanzapine [38], sulpiride [53], or lithium [18] has been reported to be effective. However, combination strategies often are used (clomipramine/amitriptyline [5], pimozide/amitriptyline [18], haloperidol/clomipramine [18], cyamemazine/ paroxetine [18], risperidone/fl uoxetine [59], haloperidol/ mirtazapine [14], risperidone/sertraline [2], risperidone/ citalopram [41], clozapine/fl uvoxamine/imipramine [12]). Adding bromocriptine to clomipramine and lithium had a benefi cial effect in one patient with bipolar disorder type I [11].…”