In the late 19th century in Paris, French neurologist Jules Cotard described a patient under the pseudonym Mademoiselle X, who claimed her organs had died. As she denied increasing numbers of her body parts, she also decided to forgo eating, as only the living need to eat. Eventually, she claimed that she had lost her soul and could no longer die. Cotard called her condition “le délire de negation“, or negation delirium. The modern diagnosis is the Cotard delusion, or informally, the Walking Corpse Syndrome.
Patients suffering the Cotard delusion, a mental disorder, believe either they or some part of their bodies have died and are putrefying. In some instances, patients are so convinced they are already dead they cease to eat. Mademoiselle X eventually died of starvation.
Pathophysiology of the disease is postulated to involve a disconnect between areas of the brain involved in self-recognition and areas that impart an emotional connection to experiences (amygdala and limbic system). As a result, patients dissociate themselves from their own appearances and become detached emotionally. The Cotard delusion is also associated with parietal lobe lesions and frontal lobe atrophy. Some cases present with multiple ischemic foci and cortical atrophy.
In 2008, physicians from the Beth Israel Medical Center in New York documented findings on a relatively recent case of the Cotard delusion:
Ms. L, a 53-year-old Filipino woman, was admitted to the psychiatric unit when her family called 911 because the patient was complaining that she was dead, smelled like rotting flesh, and wanted to be taken to a morgue so that she could be with dead people. Upon interview in the hospital, the patient expressed fear that “paramedics” were trying to burn down the house where she was living with her cousin and her brother. She also admitted to hopelessness, low energy, decreased appetite, and somnolence.
Several different treatments are reported to be successful. Literature recommends a combination of antidepressants, mood stabilizers, and antipsychotics. Some cases note electroconvulsive therapy in conjunction with pharmacological treatment is effective. Ms. L was discharged after over a month of using olanzapine 25mg daily, escitalopram 20mg daily, and lorazepam 2mg daily.
However, a number of cases are not responsive to treatment methods. Researchers from Università degli Studi, Torino noted one such patient, a 61 year old male diagnosed with the Cotard delusion:
Treatment with tricyclic and serotoninergic antidepressants was ineffective. Three years after the onset of depressive symptoms Cotard’s syndrome is virtually unchanged and shows ingravescent mental deterioration.