Professional Documents
Culture Documents
Cotard Syndrome: January 2008
Cotard Syndrome: January 2008
net/publication/228744471
Cotard Syndrome
CITATIONS READS
0 732
4 authors, including:
Sandeep Grover
Postgraduate Institute of Medical Education and Research
768 PUBLICATIONS 7,917 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
All content following this page was uploaded by Rajarshi Neogi on 05 June 2014.
Cotard Syndrome
Parmanand Kulhara, Rajarshi Neogi, Anindya Banerjee, Sandeep Grover
repeatedly voiced that “she would be held cope up with her daughter-in-law’s expectations
responsible if there would be any shortcomings in spite of the daughter-in-law being very friendly
during the marriage”. According to the husband, and accommodative. Occasionally when patient
everything was arranged as per the requirement would make attempts to carry out some
and the apprehensions raised by the patient were household chores, she would either leave the
ill founded though she could not be reassured work half done or if at all she would complete the
even after being explained about these again and work, she would frequently say that things have
again. She also started remaining sad, would voice been done in an awful way, and would not be
sadness, which would be noticed more in the reassured by the family members to the contrary.
morning, but would reduce as the day would pass Gradually patient became very slow in day to day
by. She also started voicing that other family activities, would express inability in taking bath,
members were not giving her due importance and self-care, washing clothes etc and family
she was not consulted for major decisions. The members had to encourage her repeatedly to
above symptoms kept on worsening over the complete her day to day activities. Her appetite
period of next 4-6 weeks and in addition to the also reduced.
above she also started having difficulty in falling She also started expressing that “my mind and
asleep and early morning awakening and would body don’t work”, “her brain was not working
frequently report lack of freshness after the night’s properly and hence she was not able to socialize
sleep. Following this she was taken to a or think”, would voice that she is no more going
psychiatrist who started her on T. Zolpidem 5- to improve, she has aches and pains through out
10mg at bedtime along with T. Clonazepam 0.5mg her body and she had no strength in her body.
twice daily. The above medications helped the During this time she became very lethargic, would
patient for a short while, only in the form of some speak in low and slow voice, would also take long
improvement in sleep, however other symptoms pauses while talking and would voice fear of
continued unabated. committing mistakes while talking.
Patient’s son’s marriage was held about 6 months On seeing neighbours, she also expressed that
after the onset of current symptomatology. She other ladies in her neighbourhood were avoiding
participated in her son’s marriage and did all the her and were discussing about her inabilities and
rituals, jobs and responsibilities that she needed her ill-health, which was actually not the case.
to perform though she remained apprehensive that When family members would try to reassure the
she would do something wrong. However, over patient against such beliefs, she would reluctantly
the next few days all her above symptoms agree with them, but would again repeat the same
worsened. Her irritability increased, she would after some time. She was taken to the
frequently voice sadness of mood, would appear psychiatrist after about 2 months of son’s
tense. Her sleep decreased further, she lost marriage and was prescribed T. Escitalopram
interest in household chores, her interaction with 20mg BD, T. Clonazepam 0.5mg BD, T.
family members decreased, stopped enjoying Nitrazepam 10mg HS, multivitamins and
pleasurable activities like sewing and watching Lorazepam 1mg SOS. Despite taking the above
television. Her interest in religious activities like medications with regular compliance for the next
reading holy books also decreased and she would 2 months, her symptoms continued at the same
mostly keep laying in her room. She would intensity. After a trial of escitalopram for 4 months,
frequently voice that she was inept in household the antidepressant was changed by the
chores, would sulk about her not being able to
psychiatrist to sertraline 100mg OD, Cap. rank symptoms, hypomanic/manic features, free
Venlafaxine 75mg/d, T. Clonazepam 1mg BD and floating anxiety, phobias, head injury, CNS
T. Lorazepam 2mg SOS. The above trial was infections, seizure disorders and substance use.
given for 6 months, with no improvement in her In the past history, as mentioned before, she had
symptoms. In the meanwhile her grandson was 2 similar episodes in the past, both of which lasted
born, but she did not show any happiness about for 4-5 months. In both the episodes she was
the same, and didn’t take care of the grandchild treated with medications, details of which are not
unlike her previous self when she did take care of available and electroconvulsive therapy. After the
other grandchildren in the past. Additionally, now second episode she was continued on
she started voicing that it would be better for her antidepressants for 1 year.
to die rather than live, would say that she is a
worthless person and burden on everyone. There was no family history of mental illness and
Occasionally would also tell the family members developmental and educational histories were not
to take her to some river, where she can end her contributory. Nothing significant emerged for the
life or she be given a lethal injection so that she sexual and marital history. Evaluation of premorbid
dies. personality revealed that patient has been an
introvert, non-assertive, adjustable, optimistic,
All her symptoms continued and additionally welcomed responsibilities, confident, tolerant of
about 3-4 months prior to admission in our others, adaptable, dependable, flexible,
inpatient unit she started voicing that “her head methodical, and calm with stable mood. Physical
had become empty, it did not have a brain at all examination did not reveal any abnormality.
and hence she could not think at all or do anything
that needs involvement of brain”. Family members On mental state examination patient avoided eye
would try to reason to the contrary but patient contact, rapport was established with much
would hold on to her belief very firmly and difficulty. She had psychomotor retardation,
resultantly became bed bound. Over the days the monotonous speech, sadness of mood with
frequency of voicing such beliefs increased, she restricted range and reactivity, expressed ideas
did not do any house hold work saying that as of unworthiness, hopelessness, hypochondriacal
she does not have brain and her head is empty, ideas, wish to die and delusion of nihilism. Pateint
hence she does not know how to do these things. said that “her head was empty, she did not have
She also stopped talking spontaneously with her brain”. Further, patient expressed that she is not
relatives at home as she maintained that as her able to think anything, say anything and do
head was empty her brain did not work, and anything because she does not have brain. Pateint
resultantly she could not think. She could not be remained convinced of her belief, even when the
reasoned out of this. therapist gave evidence contrary to her belief.
However, she did not have any perceptual
As her condition kept on worsening she was abnormality. In cognitive functions, she was
brought to the outpatient of our department after oriented to time, place and person, had poor
about 2 years of onset of initial symptoms in the attention and concentration, impaired immediate
current episode and was admitted for further and recent memory with preserved remote
management. memory. She did not cooperate for further
Throughout the period there was no history cognitive evaluation and had partial insight into
suggestive of any ideas of sin, guilt, suicidal her illness.
attempts, persecutory ideas, hallucinations, first
Corresponding author :
Parmanand Kulhara, Professor and Head
Department of Psychiatry, PGIMER, Chandigarh
Phone (O): 0172 2756811, Email : param_kulhara@yahoo.co.in