Cotard's syndrome - the walking dead exist. What is Cotard's syndrome? Diagnostic and treatment methods

Cotard's syndrome (depressive delirium of a nihilistic nature) accompanies some psychiatric diseases. At the same time, the patient expresses grotesque thoughts and is also in a state of severe depression, close to a suicidal state.

The disease is quite rare. This syndrome includes several manifestations of mental disorders:

• severe depression;
• violation of adequate perception of the surrounding world;
• Cotard's actual nihilistic delirium - hypochondriacal thoughts extreme expressiveness.

Some experts believe that Cotard's syndrome is inherently a negative reflection of delusions of grandeur.

Historical data

Living dead syndrome was first described in 1880 by French psychiatrist and neurologist Jules Cotard. He called this syndrome delusion of denial.

His first patient was a woman who was sure that she had long since died. She convinced those around her that her veins were empty, her heart had long been gone. At the same time, the patient was observed severe depression. Jules Cotard believed that in this case there is a complete denial of one’s own existence and the life of all humanity.

The disease is now named after him. It is believed that with this syndrome there is a violation of temporal perception - patients cannot adequately assess the past and future. They think they are dead people, their body organs are missing. Some consider themselves aliens from other worlds.

Reasons for the development of deviation

The causes of the disease are a variety of mental disorders:

Cotard syndrome can develop in people of any age. It is more often observed in the elderly and elderly. Most cases occur in women.

A rare cause of the syndrome is severe somatic disease. A case of the disease occurring in a man who suffered serious illness intestines.

Manifestations and clinical picture - how to suspect something is wrong?

Based on the severity of mental changes, Cotard syndrome is divided into two degrees of severity:

1. At first degree patients experience pronounced disgust and hatred of their own personality. They are prone to masochism and strive to inflict various injuries on themselves. They often try to commit suicide. Patients justify their behavior by the fact that they are capable of causing harm to others or the whole world.
2. In the second degree, more severe, mental changes are more pronounced. Patients convince themselves and others that they have been dead for a long time, all organs and blood have disappeared from their body. They may also express thoughts that the organs are in place, but are subject to the process of decay. Patients are convinced that their body exudes foul odor. They also believe that everyone around them is dead.

Cotard syndrome has many symptoms. Since patients are sincerely convinced that they are right, this causes them to experience serious mental suffering. Main manifestations of pathology:

• megalomania;
• expressed nihilistic beliefs;
• excessive anxiety;
• severe depression, turning into suicidal tendencies;
• hallucinatory attacks;
• hypochondriacal thoughts.

Delusions of grandeur manifest themselves in the fact that patients consider themselves special - aliens from other worlds, destined to destroy all life. They believe that they bring various types of suffering to all humanity, that they are to blame for all catastrophes and natural disasters.

At the same time, hypertrophied nihilism is observed. A patient with Cotard's syndrome believes that neither his life nor the life of all humanity has any meaning. This symptom also includes thoughts about the absence of vital important organs in body. In this regard, patients often refuse to eat and may even die from exhaustion.

Anxiety and depression gradually increase. The result of this is suicide attempts. At the same time, the patient is convinced of his immortality, believing that it was given to him for an eternal test. It is this belief that causes patients to cause serious harm to themselves.

Cotard's syndrome is accompanied by the formation of all types of hallucinations:

• olfactory- the patient believes that he exudes a stench;
• auditory- voices talk about upcoming trials;
• visual- patients see all kinds of monsters.

Motor manifestations are also characteristic:

• neurosis-like movements- patients wring their hands, twist their hair, tug at their clothes;
• V severe cases there is a pronounced motor excitement- patients cannot sit still, constantly walk from side to side;
• speech stimulation- there may be an incoherent flow of words;
• after an attack of motor excitation is observed.

The diagnosis is made based on the typical clinical picture.

Therapeutic measures

Cotard's syndrome is practically untreatable, since the patient lacks a critical assessment of his condition. Most often, patients with a disease that is not caused by severe depression or somatic pathology are curable.
Initially, the underlying disease should be eliminated. Treatment includes the use of the following groups of drugs:

• antipsychotics;
• anxiolytics.

Antipsychotic drugs

These include drugs used to treat psychoses of various origins:

1. Risperpet. Active substance in its composition - . The drug is able to reduce the manifestations of schizophrenia, including psychotic states. Prescribe with caution to patients with severe cardiovascular pathology,

   Taking anxiolytics

   The drugs in this group help suppress anxiety:

   

   Treatment of Cotard's syndrome is carried out in inpatient conditions under control medical personnel. At severe forms diseases, electroconvulsive therapy is used.

   After the underlying disease has been relieved, psychotherapeutic sessions are prescribed to directly eliminate Cotard’s nihilistic delirium.

   The disease cannot always be successfully treated, but it is possible to significantly reduce its manifestations.

Cotard's syndrome is a mental disorder in which patients claim that they have no brain, organs have rotted, or the soul has left the body. The name of the disease comes from a psychiatrist from France who for a long time was studying a questionable disease.

Working with such patients is definitely not for the faint of heart. Such tendencies appear in cases of deep depression with obvious suicidal signs.

Reasons for development

All patients with this diagnosis consider themselves dead, without some parts of the body and internal organs, besides, they claim that there is also no blood, and the heart has been gone for a long time. Most of them see themselves as killers or mythological figures who came to Earth to hurt people.

Cotard's disease is one of the rarest diseases. As a rule, the syndrome is characteristic of depressed elderly people. Rarely, schizophrenics are also among the patients.

According to scientific studies, scientists have found that the female half of humanity is most susceptible to the syndrome.

There are several reasons for this:

• their standard of living is higher than that of men, therefore, they are more likely to live to old age;
• they are highly susceptible to mental disorders;
• they have more nerve cells.

The cause of the syndrome may be previous infectious diseases or operations. There are cases when, after suffering from typhoid fever, a person became a “walking dead man.”

There is a manifestation without obvious reasons. After several weeks of strong excitement, stress, and irritability, the same syndrome develops.

Main characteristics of species

There are two types of Cotard's disease:

• average;
• very heavy.

With average, the patient develops disgust only for himself. This is followed by decisive action to commit suicide, they believe it will be better for everyone around them. In an attempt to bring death closer, he can deliberately injure himself and damage his entire body.

Severe degrees are accompanied by hallucinations and delusional remarks. Patients insist on their ghostly existence on Earth, without a soul. They come to the conclusion that there is nothing living left around, only they are soulless and “empty” creatures.

The disease is very difficult, tormenting the patient with constant thoughts about mental suffering. A significant proportion of people with Cotard's symptoms call themselves "the walking dead."

Video

Manifestations and clinical signs

Characteristic symptoms of Cotard's syndrome:

• suicidal tendencies (suicide);
• prolonged depression against the background of experienced events (stress);
• megalomania, delusions, hallucinations;
• hypochondria, constant feeling of anxiety.

Incomprehensible to the mind ordinary person compatibility of one's own inferiority and majesty at the same time occurs permanent shifts moods. The patient's cheerful mood and positive thinking are completely absent.

There are many examples of this syndrome, so some of the sick firmly believe that they brought the infection, spread it among people, and thereby caused the destruction of all living things.

Patients live their own lives, completely closed off from the outside world, preferring to adhere to a purely personal opinion and point of view.

Along with suicide is immortality, belief in one's super abilities. This idea pushes people to do absolutely desperate things, forcing them to jump from a bridge, cross the rails in front of a moving train, and so on.

Injuring yourself serious injuries, they are trying to assert themselves, to show everyone their immortality, greatness over the rest.

Possible prevention of the disease

Basically, to avoid of this state, you should devote more time to your emotional state.

Against the background of nervous overstrain, a depressive state with signs of suicide may occur:

1. At the slightest defeat (failure), you should not give up and hide in a corner. It is very important in any, even the most critical situation, to remain calm and in complete balance in terms of psychological stability.
2. Very often, in connection with the stress experienced, the first symptoms begin to appear - anxiety, fear. You should immediately seek help from a doctor.
3. Sometimes it is necessary to “pour out your soul” and talk about problems; it is not always possible to trust your loved ones with intimate, personal experiences. The best solution will make an appointment with a psychiatrist.
4. If you have a sensitive psyche and are very impressionable, completely forget about horror films and scary action films. Try to shoot nerve irritations or stress, with the help of a hobby that will distract from bad, anxious thoughts.

Remember, timely contact early stage, helps to treat more light drugs, which will be harmless to the functioning of the brain.

Helps you relax well:

• The favorite music;
• massage;
• aromatherapy;
• yoga classes.

Effective Treatment Options

If treatment is neglected, patients stop using “I”, and everything is renamed into the insignificant “it”.

So, before the eyes of those around him, a person turns into inanimate object(wood, stone).

An unhealthy imagination sometimes leads people into unusual, strange places. This is how patients try to escape from the ward to visit the cemetery and lie on the graves. Allegedly, such actions help them gather with the souls of the dead and gain strength from the other world.

At all existing stages, a person may be accompanied by auditory, visual and other hallucinations. In any case, treatment of Cotard's syndrome is not complete without taking prescribed psychotropic medications.

The main goal of the drugs is to overcome the source of delirium (schizophrenia, depressive disorders, etc.).

The course must be completed in a hospital department, under the constant supervision of the attending physician, who selects drugs for recovery mental health. It is very important to combine medication treatment with psychological support from a specialist.

Only with an integrated approach to the disease can results be achieved. Over the course of some time and fruitful work as a psychiatrist, a person has a chance to return to the real world.

Methods of electroconvulsive treatment of patients, previously known as electroshock, were practiced. The course differs from the number of wires applied, the current strength and the length of the procedure.

All these parameters are selected based on their physical properties person and his state of health.

This disease scares off many people with its mystery and mysticism, but by finding an approach to the patient, there is every chance of bringing him to a normal state at an early stage of the disease.

Remember, the slightest disorder over time can lead to mental disorders which can develop into this syndrome.

Cotard's syndrome

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The adaptive capabilities of the human psyche are not unlimited. Strong nervous shock, chronic depression, suffering from a state of shock, complications after severe infections - all this negatively affects the activity of the brain, and it begins to work incorrectly. The consequence of this is obsession with delusional ideas, different types schizophrenia, psychosis, impaired perception of oneself and the surrounding world.

What is Cotard's syndrome

Among severe nervous disorders, a special place is occupied by Cotard's delirium or living dead syndrome. In the medical literature, this rare pathology is called differently. ICD-10 code – F22 Chronic delusional disorders. Patients are obsessed with nihilistic delusions about the absence own body or a separate part of it, they deny the very fact of their existence. Patients are convinced that there is emptiness around them, they are dead and are aliens from another world.

Nervous pathology is a rare form of hallucinatory delusion that is accompanied by suicidal behavior. Patients fall into severe depression, lose interest in the world around them, and do not take care of themselves. Their condition is characterized by taste and olfactory hallucinations. Some patients deliberately injure themselves, proving that they are not in pain. Their ideas are enormous - not only did their lives end, the entire planet perished. According to some psychiatrists, this is nothing more than manic delusions of grandeur or mirror syndrome.

Jules Cotard, a famous French neurologist, was the first in the history of psychiatry (1880) to describe the denial syndrome. His first patient was completely convinced that she was dead, had no heart, and her veins were empty. The woman stopped eating and drinking, denied generally accepted values ​​and talked about the curse hanging over her. The doctor combined delusional thoughts about immortality, anxiety, depression, melancholy, and insensitivity to pain into one pathology. Later, the described syndrome received the name of its discoverer.

Causes

Cotard's disease develops at any age (even in young people), but is more common in older people. Women are more susceptible to the manifestation of the syndrome. Causes mental disorder not fully studied. Dysfunction of the frontal-temporo-parietal areas of the cortex or default of the brain system is the cause of the development of the disease, according to one of modern theories. This structure is responsible for cognitive processes (knowledge of the surrounding world and oneself).

Cotard's delusion occurs spontaneously or as a consequence of mental disorders, severe infectious diseases, physiological disorders. TO possible reasons include:

• long-term severe depressive states;
• senile depression (senile);
• melancholy;
• constant psycho-emotional overload;
• chronic stress;
• different types of schizophrenia;
• bipolar disorder personalities;
• psychoses;
• dementia (acquired dementia);
• epilepsy;
• multiple sclerosis;
• amnesia;
• progressive paralysis;
• cerebral atherosclerosis;
• traumatic brain injuries;
• regular use of strong antidepressants;
• previous operations;
• neoplasms in the brain;
• typhoid fever;
• severe intoxication;
• metabolic disease.

First signs

An unreasonable, inexplicable feeling of anxiety is the first sign of living dead syndrome. Then the person has the thought that he has already died, there is no world around. To these delusional ideas is added a feeling of immortality, and the perception of the size of one’s own body is disrupted. Patients express thoughts that the body is huge, terrible transformations are happening to their organs (for example, the intestines have rotted), and strange hallucinations occur (for example, an electric current passes through the skin).

Symptoms

Manifestations of mental abnormalities are varied. Cotard's syndrome is a multisymptomatic disease. The ideas that patients express are colorfully exaggerated and have an alarming and melancholy character. TO characteristic features relate:

• denial of one's own existence;
• psychomotor agitation;
• pathological feeling of loss of one’s own body or individual internal organs;
• the belief that the body is rotting and decomposing;
• pathological feeling of guilt;
• decreased pain threshold;
• self-harm;
• suicidal tendencies.

All pathological manifestations can be combined into several groups that accurately characterize a patient with Cotard syndrome:

1. Megalomania. Awareness of oneself as an alien, a destroyer, a savior, a super being to accomplish great things in relation to all humanity, the world, the planet.
2. Hypertrophied nihilism. Complete confidence in the meaninglessness own life or existence poses a threat to all humanity.
3. Depression. The condition is characterized by constant increased nervousness, alertness, irritability, concern.
4. Hallucinations (visual, auditory, olfactory). Patients smell a decaying body, hear orders and threats about upcoming trials, and see monsters.
5. Motor reactions. Walking from side to side, an incoherent stream of words, wringing of hands, twisting of clothes and hair.

The paradoxical nature of delusional ideas is striking in its inconsistency:

• The patient is convinced of his own worthlessness, but at the same time considers himself a messenger with a mission on a planetary scale (sent to bring suffering and illness, to infect all people on earth deadly diseases).
• Beliefs in the insignificance not only of one’s life, but of the existence of humanity and the planet as a whole. According to some patients, any progress is meaningless, unsuccessful and irrational. Patients are sure that they do not have a heart, brain, stomach and other vital organs.
• Along with suicidal manifestations, the thought of one’s own immortality coexists in the sick brain. Attempts to inflict severe injuries on oneself (amputation of limbs, numerous cutting wounds of soft tissues) are attempts to convince oneself of immortality.
• The patient’s idea that he does not exist alleviates mental suffering; he firmly believes in the fact of accomplished death. This complicates the treatment; the patient does not see any point in it, because he is dead.

Forms

Based on the accumulated data on Cotard's disease, three forms of the disease are distinguished. They are characterized to varying degrees gravity:

1. Psychotic depression. Feelings of guilt, anxiety, depression, auditory hallucinations– main symptoms light form diseases. Cotard's disease develops in 1-2 weeks and can last for several years.
2. Nihilistic delirium, hypochondria ( constant worry O possible emergence one or more diseases). Average form of denial syndrome. The patient develops self-hatred. By deliberately injuring himself, he tries to punish himself for his worthless existence.
3. Manic delirium, suicidal behavior. A severe form of the syndrome develops as a result of strong pathological changes central nervous system patient. He plunges into the world of the dead, wanders through cemeteries, and maintains contact with the other world. A person experiences severe mental anguish, he is haunted by hallucinations, and he attempts suicide.

Treatment

Psychiatrists, based on a conversation with the patient and his relatives, make an initial conclusion about the presence of Cotard’s disease. The diagnosis is clarified using hardware techniques - computer and magnetic resonance imaging. These studies help determine the extent of pathological changes in the brain. In most cases, patients do not seek treatment at the first symptoms of the disease. medical care due to an obsession with the ideas of uselessness and meaninglessness of one’s existence.

Identify in a timely manner mental pathology the patient's relatives help. Treatment dangerous syndrome occurs exclusively in a hospital setting under constant medical supervision. This necessary measure, because patients are aggressive and pose a social danger. To restore the patient’s mental health, special medications and the electroshock method are used (as one of the methods emergency care), psychotherapy. Combinations of methods are more effective.

Drug treatment

The psychiatrist selects the patient medications taking into account the severity of Cotard's delirium, general condition, individual characteristics, availability of other mental illness. Several groups of drugs are used. Their pharmachologic effect aimed at eliminating the source of delirium. For this purpose they use the following drugs:

• Antidepressants – Melipramine, Amitriptyline, Fevarin. Amitriptyline is used intramuscularly and intravenous injections 3-4 times a day. The dosage of the drug is increased gradually, the maximum daily amount is 150 mg. After 1-2 weeks, Amitriptyline injections are replaced with tablets. TO side effects include constipation, hyperthermia (overheating, accumulation of excess heat in the body), increased intraocular pressure, blurred vision.
• Antipsychotics (neuroleptics) – Tizercin, Rispolept, Haloperidol, Ariprizole, Aminazine. To reduce motor and speech excitation in schizophrenia, paranoia, and hallucinations, Aminazine (dragees or injection solution) is used. Initial daily dose is 0.025-0.075, maximum – 0.3-0.6 g. This amount is divided into several doses. A dosage of 0.7-1 g is prescribed to patients with chronic delirium and psychomotor agitation. TO side effects include indifference, visual impairment and thermoregulation, convulsions, tachycardia, allergic reactions.
• Anxiolytics (tranquilizers) – Afobazol, Grandaxin, Fenzepam, Diazepam, Elenium, Relanium, Stresam. Reduce the excitability of the subcortical areas of the brain, which are responsible for the emotional state. Three generations of drugs in this group are known. Stresam is a new generation drug. Stabilizes the condition when anxiety disorders, goes well with drugs from other groups. Does not cause lethargy or drowsiness.

Psychotherapy

A special place in complex treatment denial syndrome is addressed by psychotherapy. Establishing contact and trusting relationships with the patient – necessary condition efficiency treatment sessions. With a severe manifestation of a mental disorder, this is not easy to achieve, because patients perceive themselves as an inanimate object and deny the existence of the world around them. More mild course mirror syndrome allows for individual psychotherapeutic sessions based on suggestion.

Forecast

Cotard's delirium has a disappointing prognosis. As evidenced medical practice, remission (weakening of symptoms of the disease, complete recovery) are the rarest cases. It comes spontaneously. Even long-term treatment does not bring effective results. The emergence of delusional nihilistic ideas is worse than the depressive version of Cotard's disease. Confusion of consciousness, destruction of personality, chronic nervous excitement lead to fatal outcome.

Prevention

Controlling your own emotional state is the most important preventative measure living dead syndrome. When the first signs of the disease appear, you should seek qualified medical help. To increase stress resistance and strengthen the nervous system, doctors recommend:

• avoid stressful situations, mental overstrain;
• avoid depression, psychosis and other nervous disorders;
• Healthy food;
• do what you can physical exercise;
• include walks in the fresh air in your daily routine;
• practice hardening procedures, relaxation practices, aromatherapy;
• have a hobby;
• undergo massage sessions;
• listen to music, communicate in pleasant company;
• Periodically, if your emotional state is unstable, use mild sedatives.

Video

Cotard's delirium is one of the most unusual options delirious state. It was first described back in the century before last by the famous French specialist in the field of neurology and psychiatry, J. Cotard.

The doctor worked with a woman who claimed that in reality she was long dead, there was no blood in her body, and her heart had been replaced by some unknown mechanism.

In combination with such hallucinations, she had suicidal and depressive tendencies. In accordance with the scientist’s conclusions, the syndrome was based on the principle of the patient’s denial of her own life and the existence of living things in general.

This deviation was subsequently classified as a severe disorder of temporal perception, in the presence of which the patient becomes unable to assess past events and imagine future phenomena.

Almost every patient who suffered from this disorder declared that he was already dead. Many people believed that they were some kind of fairy-tale characters or great maniacs who came from parallel universes with the goal of harming others.

In practice, denial of one's own existence is a very rare delusional disorder, often occurring in severe depression, as well as schizophrenia and serious brain damage.

Features of clinical manifestation

The syndrome comes in 2 forms of severity: moderate and very severe.
The average form of the disease is characterized by the patient’s self-hatred. A person may seriously harm himself or even attempt suicide, believing that he brings nothing but suffering to others.

In severe stages, significant mental pathologies are noted in the form of delusional states and hallucinations. The patient believes that he has died and his organs have been replaced by some kind of machinery. There are also more complex variations of the syndrome.

For example, there is a known case when a woman claimed that there was no longer a single living creature on the planet, and she existed here in the form of a “shell devoid of a soul.”

The syndrome is very rare. It often accompanies senile depression, sometimes schizophrenia. Female patients are more susceptible to the disease

The syndrome is considered as a multisymptomatic disease, characterized by a severe, complex and multifaceted course. The patient experiences severe torment and internal suffering. Some patients consider themselves “zombies” for many years and even decades.

Characteristic signs of the disease

The disease being studied is accompanied by the following manifestations:

• delusions of grandeur;
• excessive excitability and anxiety;
• suicidal tendencies;
• nihilistic delirium;
• depression;
• hallucinations;
• hypochondriacal conditions.

What is noteworthy is that patients usually simultaneously assert their own worthlessness and grandeur. For example, some believe that they were sent from a parallel world to harm the population, infect all living things with fatal diseases, etc.

As manifestations of nihilistic delirium, they regard, first of all, the belief in the insignificance of one’s own existence and all living things in general. It may seem to the patient that real life in its universal understanding is meaningless, and all development is irrational.

The “faithful companions” of the syndrome are states of tension and anxiety. As a rule, before the disease develops, concern arises, then nervousness and anxiety.

In combination with suicidal tendencies, thoughts about one’s own immortality may develop. Believing in immortality, a person can take desperate actions, trying to end his life as subtly as possible.

It is also interesting that the disorder in question is accompanied by various hallucinations; it is possible that their very rare form is olfactory. The patient may feel a foul odor coming from inside his body. Some hear voices, see demons, etc.

Reasons for deviation

The onset of the disease is most often caused by severe depression, mainly characteristic of old age.

A prolonged depressed state, as well as self-deprecation (the patient’s underestimation of his physical or moral properties, emphasizing his insignificance, insignificance) and anhedonia (lack of the ability to feel pleasure) - all this can make the patient believe that he does not exist

Along with this, not everything is so simple. Every day the belief in one's death leaves a heavy imprint. The person experiences hallucinations and ingrained delusions of denial.

Most often, the syndrome is formed against the background of the following diseases:

• schizophrenia;
• severe depression;
• psychosis in the elderly.

Old people suffering from depression are most susceptible to the disease.
It is noteworthy that in some cases the syndrome appears without good reason.

That is, a person may have everything in order mentally, but on the eve of an attack he becomes irritable and too anxious.
There are known cases when deviations resulted from serious illnesses affecting internal organs.

Treatment Options

No favorable forecasts are given regarding the deviation in question, because delusion can lead to irreversible self-destruction of the individual.

At the same time, medicine knows cases when patients recovered. People with depression or somatic diseases have the best chances.

In this case, the main efforts are made to combat the underlying disease. Methods of drug therapy are used.

The doctor may prescribe antidepressants (for patients suffering from depressive disorders), as well as drugs of anti-anxiety and psychotropic groups. In advanced cases, electroconvulsive therapy is practiced.

The rest of the treatment procedure is determined exclusively by a qualified specialist, taking into account the individual characteristics of the patient. The patient’s loved ones can only not give up and hope for the best.

Be healthy!

Cotard's syndrome is a manifestation of certain psychiatric diseases, combining the following symptoms: disturbance of self-perception, derealization, delusion. This disorder is associated with the ideas of nihilism about the absence human body or parts thereof. Patients with Cotard's syndrome claim that there is only emptiness around. Cotard's delirium has fantastic content and ideas of grandiosity. General destruction, denial of generally accepted values ​​and life on earth are the basic principles that occupy a central place in this mental phenomenon.

For the first time in the history of psychiatry, delusions of denial were described by French neurologist Jules Cotard. He combined depression, melancholy, anxiety, insensitivity to pain, delusional thoughts about immortality into one pathology. His first patient claimed that she had died long ago, that her veins were empty and her heart was gone. The woman stopped eating and drinking, believing in good and evil, and believed that she was cursed. Jules Cotard took the delusion of denial as the basis for this pathology. Thanks to his research, the syndrome received the name of its discoverer.

Patients with Cotard syndrome fall into severe depression and are close to suicide. This rare disease is manifested by mental disorders: a disorder of perception of the surrounding world, ideas of nihilism, severe hypochondria, and a violation of time orientation. Patients are convinced that they are dead, that they are aliens from other worlds sent to destroy all humanity. Some patients deliberately injure themselves and make it clear that they do not feel pain or bleed.

Cotard's syndrome is a rare form of hallucinatory delusion, often accompanied by suicidal tendencies. The patients have no lungs, no brain, no heart, no family, everyone around them is dead, their bodies have long since cooled down. Patients become increasingly depressed, lose interest in the world around them, and stop taking care of themselves. They are often haunted by taste and olfactory hallucinations. This rare disease capable of taking over several hundred people at any moment. It manifests itself in delusional ideas that life is over, the body has rotted, everything on the planet has perished.

The disease occurs at any age, but more often affects older people. There are known cases of this disorder among young people. Women develop the syndrome more often than men. This is due to more high level life and greater susceptibility to psychosis. They more often live to an advanced age and have large quantity nerve cells.

Paroxysmal delirium occurs suddenly, without previous mental disorders. Often the syndrome appears after some anxiety and irritability. The course of Cotard's syndrome is severe. Complications develop in cases where patients refuse treatment. In this case, the connection with reality is lost. Patients are sure that they cannot be helped.

Causes

The etiopathogenetic factors of the disease are currently not fully understood. One of the modern theories states that the causes of Cotard's syndrome are brain abnormalities, namely dysfunction of fronto-temporo-parietal neuronal circuits.

Possible causes of Cotard's syndrome:

• severe depression
• long-term use large doses antidepressants,
• previous operations,
• prolonged psycho-emotional stress, chronic stress, irritability are factors that eventually lead to the development of the syndrome.

Cotard's syndrome has not been identified as a separate nosology. It is a manifestation of various mental illnesses.

Pathologies manifested by Cotard's syndrome:

1. schizoid disorders,
2. dementia,
3. depression,
4. seizures,
5. brain tumors,
6. multiple sclerosis,
7. progressive paralysis,
8. atherosclerotic damage blood vessels brain,
9. psychoses,
10. infectious diseases - typhoid fever,
11. melancholy,
12. amnesia,
13. severe intoxication,
14. metabolic disorders.

Chronic stress leads to fatigue, tiredness, isolation, persistent reluctance to see anyone, dissatisfaction with oneself, self-doubt, hopelessness, headaches, insomnia, exacerbation of skin problems, loss of interest in sex life, craving for alcoholic beverages and psychotropic substances. Severe depression and complete indifference to everything around develops. Outwardly, patients resemble dead people from horror films. Mentally ill people have a decreased pain threshold. They are constantly haunted by pathological anxiety and feelings of guilt. Patients' behavior becomes aggressive over time. They do not take care of themselves, do not eat or drink. If patients do not commit suicide, they die from hunger and exhaustion.

Clinic

First clinical sign the disease is a feeling of anxiety. Some patients think that they are dead, others, on the contrary, feel their immortality. They are ridiculously delusional about their body size.

Thanks to statements about their own non-existence, their painful sensations. By causing pain and harm to themselves, they are trying to prove that their bodies do not live, they are huge, but dead, there is no blood in their vessels. Patients often hear voices that direct their actions and destroy them. The patient is the greatest criminal who has infected everyone around him fatally dangerous infections And incurable diseases, became the cause of child mortality and the culprit of all wars. For this he will be severely punished.

Patients believe in the rotting and disintegration of the body, experience severe anxiety, do not make contact well, look for a catch in everything, and do not trust anyone.

• A mild degree is manifested by an inexplicable feeling of guilt and anxiety. Depending on the severity of the etiological factors, this form can last several years or reach full development in one to two weeks. Patients acquire a negative attitude, become gloomy and irritable.
• The average degree of Cotard's syndrome is manifested by the patient's disgust and hatred of himself, a tendency towards masochism, and a desire to harm himself or commit suicide. Patients inflict bodily harm on themselves, thereby trying to punish themselves for their miserable existence.
• A severe degree develops in the case of significant pathological changes in the central nervous system of patients. They plunge into the world of the dead, often visit the cemetery, and “talk” with the dead. Mentally they maintain a certain connection with the dead. Patients become extremely anxious, experience mental anguish, become depressed, and often commit suicide. The thought of the absence of life on the planet drives them crazy. At this stage, delusions and hallucinations appear.

Cotard's syndrome can occur in a mild form, in which a number of symptoms are absent. The pathology can have a fulminant or episodic course.

Main symptoms of the disease:

1. Megalomania is the awareness of oneself as someone special: an alien destined to destroy all life, a destroyer or savior of the world, a being created to accomplish great things.
2. Hypertrophied nihilism - the patient’s life has no meaning, thoughts of the absence of internal organs, refusal of food, water and treatment.
3. Depression - increased anxiety, anxiety, nervousness, constant vigilance, suicide attempts, hypochondriacal state, immortality. Patients commit desperate acts, inflicting mortal wounds on themselves.
4. Hallucinations - olfactory, auditory, visual. Patients feel bad smell from their body, they see monsters, they hear orders about upcoming trials.
5. Motor manifestations include wringing of hands, twisting of hair and clothes, constant walking from side to side, incoherent flow of words.

Cotard's syndrome is a multisymptomatic disease that develops gradually, has a complex and severe course, requiring others to have a special attitude towards the patient.

Video: patient with Cotard's syndrome

Diagnostics

Diagnosis of Cotard's syndrome is based on clinical symptoms pathology. Psychiatrists diagnose and treat the disease. They talk with the sick person and his loved ones. Use if necessary instrumental methods- CT and MRI to clarify anatomical and physiological characteristics brain.

Difficulties in diagnosis are explained by the reluctance of patients to seek medical help. In their opinion, visits to specialists are pointless and impractical. They assure that treatment will not help the corpse. Only close people can notice in time the changes occurring in the patient’s behavior and take him to the doctor. Patients often get an appointment with a specialist too late.

Treatment

Treatment of Cotard syndrome is carried out in a neuropsychiatric hospital under the supervision of medical personnel. Only a specialist in psychiatry will be able to correctly select medications to restore mental health.

Drug treatment Cotard's syndrome is aimed at eliminating the focus of delirium. It consists of the use of the following groups of drugs:

• antidepressants - Amitriptyline, Fevarin, Melipramine;
• antipsychotics - “Rispolept”, “Ariprizol”, “Aminazin”, “Tizercin”;
• anxiolytics - “Grandaxin”, “Afobazol”,
• tranquilizers - “Phenazepam”, “Amizil”.

Electroconvulsive therapy is a method of exposure to constant electric current small force on brain structures in order to achieve therapeutic effect. Electroconvulsive treatment is currently a worthy alternative to psychopharmacotherapy. Indications for its implementation are psychoneurological diseases for which other treatment methods have proven ineffective. Thanks to high efficiency and the speed of onset of effect, electroconvulsive therapy is used as an emergency aid.

During psychotherapeutic sessions, pathology is fought. This requires an individual approach to the patient and optimal contact with him. Trust must be established between doctor and patient. Rational psychotherapy is based on suggestion.

For achievement maximum effect drug therapy should be combined with electroshock treatment and psychotherapy. If these recommendations are neglected and not treated, the patient will sooner or later turn into an inanimate object.

Prevention

To avoid developing Cotard's syndrome, you need to monitor your emotional state. Nervous strain and frequent stress lead to the development of depression with signs of suicide. It is necessary to remain calm and control yourself in any situation.

When the first symptoms appear, you should seek help from qualified specialists. Your favorite hobby, yoga, will help you relieve moral stress on your own. good music, massage, bath with aroma oils. If these methods do not help, then it’s time to use mild sedatives.

• avoid stress and head injuries,
• avoid depression and psychosis,
• eat right,
• play sports
• toughen up,
• walk a lot in the fresh air,
• try to find beauty in the ordinary.

Forecast

Cotard's syndrome has a disappointing prognosis. Extremely in rare cases remission suddenly occurs. Treatment is often ineffective. No psychiatrist can guarantee recovery. Delirium, which destroys personality, is often combined with speech and motor agitation, as well as confusion. IN similar cases death occurs.

Video: about Cotard's syndrome