Cotard’s Syndrome: A Review
Cotard’s Syndrome: A Review

Summary/Abstract: Cotard’s syndrome is a rare neuropsychiatric condition characterized by nihilistic and existential delusions. First described by Jules Cotard in 1880, this syndrome most commonly emerges in the context of psychotic depression, although it may also be observed in association with other psychiatric conditions, including bipolar disorder and schizophrenia spectrum disorders. The clinical course typically progresses from an initial phase marked by hypochondriacal concerns and depressive symptoms to a more advanced stage in which nihilistic delusions—such as denial of one’s own existence, body, or organs—become prominent. During this progression, the severity of delusional content may increase, resulting in a more complex clinical presentation. Epidemiological data indicate that Cotard’s syndrome has a very low prevalence and is more frequently reported in middle-aged and older individuals, with a higher incidence among females. In addition to psychiatric disorders, the syndrome has also been associated with neurological conditions, including Parkinson’s disease, Alzheimer’s disease, epilepsy, and cerebrovascular lesions. Clinically, patients commonly present with depressive mood, excessive guilt, anxiety, derealization, depersonalization, and self-harm behaviors. The treatment approach primarily focuses on the management of the underlying psychiatric or neurological condition. Pharmacological interventions typically involve combinations of antidepressants and antipsychotics, while electroconvulsive therapy is considered an effective option in treatment-resistant cases, particularly in patients with severe depression and high suicide risk. Furthermore, psychotherapeutic interventions may serve a supportive role by enhancing insight and improving treatment adherence.

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