You are already dead: Case report of nihilistic delusions regarding others as one representation of Cotard's syndrome

Abstract

Background: While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected.Case presentation: A woman aged in her 60s diagnosed with schizophrenia was admitted to our hospital for psychotic symptoms, including delusions of reference, delusions of guilt, auditory hallucinations, cenesthetic hallucinations, agitation, depression, suicidal ideation, and catatonia. During hospitalization, her cenesthetic hallucinations progressed to include nihilistic delusions. She described cenesthetic hallucinations along with various delusional descriptions, including the belief that various objects, such as spoons, irons, nails, rulers, bins, and coins, were inside her body and that her body was being burned or in danger of exploding. She also claimed an altered sense of her own body, that her body was larger than normal or reversed. Moreover, she reported nihilistic delusions that her face and body did not exist, that her heart was not functioning, and that she was going to die soon or was already dead. She occasionally refused to eat because of the feeling of being dead. Notably, during a severe episode, she claimed that a doctor in front of her was dead. Clozapine was effective in improving her symptoms. Ultimately, the patient regained her sense of being alive and acknowledged that the doctor was alive. Conclusion:We report the case of a patient presenting with nihilistic delusions regarding both self and others, along with prior cenesthetic hallucinations. Aberrant interoceptive processing could be a potential link between these two forms of nihilistic delusions.

Walking Corpse Syndrome: A Case Report of Cotard's Syndrome

“…Research indicates promising outcomes with paroxetine administration for 36 days, supplemented by pramipexole starting from day 37, leading to significant improvement and complete resolution within 15 days [ 9 ]. In cases of paranoid schizophrenia, studies demonstrate the efficacy of paliperidone at 12 milligrams per day alongside lorazepam at 5 milligrams per day [ 10 ].…”

“…Cotard delusions manifest across a broad spectrum of neurological, psychiatric, and medical conditions, exhibiting diverse neural alterations. Lesions in the nondominant hemisphere may contribute to the syndrome’s pathophysiology, with several effective treatment modalities at hand [ 8 , 9 ].…”

“…De Risio investigated D2 receptor binding using SPECT, noting reduced striatal D2 receptor binding with greater uptake on the left side [ 8 ]. Brain electrical activity mapping has also been employed in Cotard’s syndrome, revealing electrophysiological abnormalities with a right temporal predominance [ 9 ]. Neuropsychological studies have indicated severe impairment in facial recognition tasks, including the Warrington Recognition Memory Test, recognition of emotional facial expressions, and familiar faces [ 6 ].…”

“…CT/MRI studies have indicated abnormalities in the non-dominant frontal, temporal, and occasionally parietal lobes in Cotard's syndrome cases [ 6 ]. Other research has also linked Cotard’s syndrome to abnormalities in the non-dominant cerebral hemisphere [ 9 ].…”

Hypocretins, sleep, and maternal behavior

“…Of note, the Food and Drug Administration (FDA) has approved DORA for treatment of insomnia (Yang, 2014;Scott, 2020), but its effects on lactating mothers and their babies, since this drug has been detected in cord blood and breast milk (Koreki et al, 2023), are still unknown. Therefore, additional research is needed to better understand the impact of these drugs during this critical stage of life, as well as to ensure their safety for use in lactating women.…”