Cotard delirium and schizophrenia: signs and treatment

Cotard’s delirium, or Cotard’s syndrome, occurs when a person believes that they are dead, that they do not exist, that they have missing body parts or body parts that are disappearing. It is a rare and serious syndrome that can signify schizophrenia. However, other conditions can also cause Cotard syndrome.

It is not always true that a person with Cotard syndrome has schizophrenia. Many conditions can cause Cotard syndrome, and some people experience it as a short-lived symptom after a seizure.

Some scientists believe Cotard’s syndrome may be related to lesions in the non-dominant hemisphere of the brain. It is the side of the brain that is on the same side of the body as a person’s dominant hand. However, a series of factors can influence its development.

This article takes a closer look at Cotard syndrome and schizophrenia, including their relationship, signs and symptoms, and treatment.

Cotard’s delirium, or Cotard’s syndrome, is a rare and serious change in a person’s perception of their body or their existence. It encompasses a group of false but strong beliefs that can vary in nature.

For example, some people with this syndrome may believe they are dead, while others may believe they are immortal.

Delusions are different from unusual or mistaken beliefs. A person with Cotard syndrome is convinced that their perceptions are true, even when the evidence points to the contrary.

This can cause them to engage in behaviors they otherwise wouldn’t. For example, a person who believes they are dead may stop eating.

Other names for Cotard syndrome include “walking corpse syndrome” or nihilistic delirium.

Learn more about delusional disorder here.

The main symptom of Cotard syndrome is a false belief about a person’s existence. They may believe that:

  • They do not exist
  • they are dying or dead
  • some parts of their body are missing
  • they are immortal, or that they died and started a new life

People with this syndrome may also believe that their organs are falling apart, disappearing, or being eaten.

A 2017 review found that 8 of 12 people identified as having Cotard syndrome believed they had died. Of these, three believed medical professionals had killed them. Four said they were dying.

Learn more about types of schizophrenia here.

Yes, Cotard’s delirium can be a symptom of schizophrenia. However, it is rare. A 2021 article reports that less than 1% of people with schizophrenia have it. A person does not need to have this syndrome to be diagnosed with schizophrenia.

Schizophrenia is a recognized cause of Cotard syndrome. The small 2017 review of 12 people with Cotard syndrome found that two also had schizophrenia.

People with schizophrenia, bipolar disorder, and other mental health issues may experience one or types of delusionsincluding:

  • delusions of grandeur, which is the belief that a person is powerful, special, or more important than others.
  • delusions of persecution, which is when a person mistakenly believes that someone or something is trying to hurt them
  • delusions of misidentification, which is the false belief that two people or places have changed places
  • religious delusions, which is when a person believes they are a god or god-like entity
  • erotomaniac delusions, which is when a person believes that someone, such as a celebrity, is in love with them

Learn more about the myths and truths about schizophrenia here.

Researchers don’t quite understand what causes Cotard syndrome or why it can occur in people with schizophrenia.

Cotard syndrome is a rare diagnosis and most people with conditions that may cause it never develop it. This may mean that a combination of biological, psychological, social and environmental factors play a role.

Researchers have found that people with Cotard syndrome tend to have changes in their brains, suggesting that underlying neurological issues may play a role in its development. For example, the 2018 article of 12 people with Cotard syndrome found that:

  • four people had changes to the frontal lobe of the brain
  • four had generalized loss of brain volume
  • five showed signs of reduced blood flow to certain areas of the brain
  • seven had lesions on at least one side of the brain

Eight of the participants had a history of psychiatric diagnoses, such as schizophrenia, depression or substance abuse. Five also had neurological symptoms.

Some of the conditions that can increase the risk of Cotard syndrome include:

  • Epilepsy: A person may have delusions because of brain damage related to epilepsy or in the post-seizure period.
  • Neurological diseases: Conditions that cause brain damage, such as dementia, stroke, and traumatic brain injury (TBI), can cause delusions.
  • Substance abuse: A person can develop delusions under the influence of drugs or due to drug-related brain damage.
  • Psychiatric conditions: Mental health disorders such as depression often occur in people with Cotard syndrome.
  • Infections: Infections, especially in the brain, can cause delusions and other neurological symptoms.

Learn about the link between depression and substance abuse here.

Doctors can usually identify Cotard syndrome by talking with a person about how they feel. However, since this syndrome is a symptom of an underlying disease, they will also need to identify the cause.

If a doctor suspects a person may have schizophrenia, they may recommend a psychiatric evaluation. It involves answering a series of questions that tell a mental health specialist about a person’s mental state.

To be diagnosed with schizophrenia, a person must meet certain criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that a person may have schizophrenia if they experience two or more of the following symptoms for a significant duration within 1 month:

  • delusions
  • hallucinations
  • disorganized speech
  • disorganized or catatonic behavior
  • reduce emotional expression or avolition, which is a complete lack of motivation

At least one of the symptoms must be delusions, hallucinations, or disorganized speech, and they must have a significant negative impact on a person’s ability to function in various aspects of life.

If the cause is not schizophrenia, doctors may recommend:

  • blood tests to check for infections
  • brain imaging scans to look for damage in the brain
  • drug testing

Learn more about hallucinations here.

Because various conditions can cause Cotard’s delirium, there is no single treatment that will treat all cases. Instead, doctors treat the underlying cause. Depending on the underlying cause, treatment may involve:

Another potential treatment is electroconvulsive therapy (ECT), which delivers an electric shock to the brain. It can alter neurotransmitters and brain function, which can improve symptoms for some.

Learn more about ECT, including its benefits and risks.

A person should see a doctor if they think they are dead, dying, or have a missing part of their body, as this could signify a delusion.

If a loved one shows signs of delirium, offer them support and compassion. Don’t try to argue or persuade them that they’re wrong, as that won’t change their minds. Instead, suggest he see a doctor and offer to go with him.

Some people with Cotard’s delirium may believe that they no longer have to take care of themselves.

A person needs emergency care if they engage in behavior that could hurt themselves or others, such as:

  • jump off buildings or bridges
  • do not eat or drink
  • threatening to harm oneself
  • violence or aggression

If any of the above situations occur, call 911 or the nearest emergency service number.

Cotard’s delirium, or Cotard’s syndrome, occurs when a person believes they are dead, dying, or immortal. They may also believe that parts of their body are missing or missing. For example, they may think that a virus is destroying their organs.

Cotard syndrome is rare, including in people with schizophrenia. However, among people with the syndrome, schizophrenia is one of the potential causes. People with schizophrenia can have different types of delusions.

Other potential causes of Cotard syndrome include neurological conditions, such as epilepsy, drug abuse, dementia, and brain infections. Therefore, it is essential that people with this syndrome seek treatment so that a doctor can identify and treat the cause.

Learn more about mental health issues in our dedicated hub.

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