Cotard delusion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-in-chief: Soumya Sachdeva


The Cotard delusion or Cotard's syndrome, also known as nihilistic or negation delusion, is a rare neuropsychiatric disorder in which a person holds a delusional belief that he or she is dead, does not exist, is putrefying or has lost his/her blood or internal organs. Rarely, it can include delusions of immortality.

It is named after Jules Cotard (18401889), a French neurologist who first described the condition, which he called le délire de négation ("negation delirium"), in a lecture in Paris in 1880.

In this lecture, Cotard described a patient with the moniker of Mademoiselle X, who denied the existence of God, the Devil, several parts of her body and denied she needed to eat. Later she believed she was eternally damned and could no longer die a natural death.

Young and Leafhead (1996, p155) describe a modern-day case of Cotard delusion in a patient who suffered brain injury after a motorcycle accident:

[The patient's] symptoms occurred in the context of more general feelings of unreality and being dead. In January, 1990, after his discharge from hospital in Edinburgh, his mother took him to South Africa. He was convinced that he had been taken to hell (which was confirmed by the heat), and that he had died of septicaemia (which had been a risk early in his recovery), or perhaps from AIDS (he had read a story in The Scotsman about someone with AIDS who died from septicaemia), or from an overdose of a yellow fever injection. He thought he had "borrowed my mother's spirit to show me round hell", and that he was asleep in Scotland.

It can arise in the context of neurological illness or mental illness and is particularly associated with depression and derealization.

Treatment is difficult, and tricyclic and serotoninergic antidepressant drugs have shown little efficacy. Electroconvulsive therapy has shown greater promise, "curing" Cotard's sufferers in five studies of its efficacy with that treatment.


Cotard described hypochondriac ideas that varied from the spontaneous destruction of different organs, the entire body, or soul to the complete denial of one’s own existence as the most important characteristic elements of the syndrome. The most prominent symptoms of Cotard’s syndrome are depressive mood (89%), nihilistic delusions concerning one’s own body (86%), nihilistic delusions concerning one’s own existence (69%), anxiety (65%), delusions of guilt (63%), delusions of immortality (55%), and hypochondriac delusions (58%). Some delusions present as special forms of Cotard’s syndrome (eg, delusional denial of one’s pregnancy despite clear morphologic signs and delusional paralysis in a patient with psychomotor agitation ). In its early course, Cotard’s syndrome is characterized by a vague feeling of anxiety lasting from weeks to years. The patient then further loses touch with reality [5]. With the delusion of being dead, patients show an increased tendency toward self-mutilation or suicidal behavior.


Monotherapy with agents such as amitriptyline , duloxetine , fluoxetine , paroxetine , olanzapine , sulpiride, or lithium has been reported to be effective. However, combination strategies often are used (clomipramine/amitriptyline , pimozide/amitriptyline , haloperidol/clomipramine, cyamemazine/ paroxetine , risperidone/fluoxetine, haloperidol/ mirtazapine , risperidone/sertraline, risperidone/ citalopram, clozapine/fluvoxamine/imipramine). Adding bromocriptine to clomipramine and lithium had a benefi cial effect in one patient with bipolar disorder type I . ECT (Electroconvulsive therapy) is also an important treatment option in Cotard’s syndrome.

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de:Cotard-Syndrom it:Sindrome di Cotard nl:Syndroom van Cotard fi:Cotardin syndrooma