Likewise, with the depressed patient, electroconvulsive therapy (ECT) is more effective than pharmacotherapy.Cotards syndrome resulting from an adverse drug reaction to valacyclovir is attributed to elevated serum concentration of one of valacyclovirs metabolites, 9-carboxymethoxymethylguanine (CMMG). Successful treatment warrants cessation of valacyclovir. Hemodialysis was associated with timely clearance of CMMG and resolution of symptoms. Case studies
Society and culture
The protagonist of Charlie Kaufmans 2008 movie Synecdoche, New York, is named Caden Cotard. Throughout the film Cotard thinks he is dying, and we see other examples of Cotard delusion with scenes such as when his daughter, Olive, begins to scream about having blood in her body and, as the film goes on, Cotard disappears from the play he is writing about his own life and is portrayed by other actors as he takes the role of a cleaning lady.It is speculated that Per "Dead" Ohlin, lead vocalist for the black metal bands Mayhem and Morbid, had Cotard delusion as a result of a bullying incident in his youth that left him clinically dead for a short time. He developed an obsession with death shortly after (hence his stage name and use of corpse paint), often self-harmed onstage and among friends, and became increasingly depressed and introverted eventually resulting in his suicide in 1991. His suicide note contained the lines "I belong in the woods and have always done so. No one will understand the reason for this anyway. To give some semblance of an explanation Im not a human, this is just a dream and soon I will wake."
If the observed face is that of a person known to the patient, they experience that face as the face of an impostor (Capgras delusion). If the patient sees their own face, they might perceive no association between the face and their own sense of self—which results in the patient believing that they do not exist (Cotards syndrome). Cotards syndrome is usually encountered in people with psychosis, as in schizophrenia. It is also found in clinical depression, derealization, brain tumor, and migraine headaches. The medical literature indicate that the occurrence of Cotards delusion is associated with lesions in the parietal lobe. As such, the Cotards delusion patient presents a greater incidence of brain atrophy—especially of the median frontal lobe—than do people in control groups.Cotards delusion also has resulted from a patients adverse physiological response to a drug (e.g., acyclovir) and to its prodrug precursor (e.g., valaciclovir). The occurrence of Cotards delusion symptoms was associated with a high serum-concentration of 9-carboxymethoxymethylguanine (CMMG), the principal metabolite of acyclovir.As such, the patient with weak kidneys (impaired renal function) continued risking the occurrence of delusional symptoms despite the reduction of the dose of acyclovir. Hemodialysis resolved the patients delusions (of negating the self) within hours of treatment, which suggests that the occurrence of Cotards delusion symptoms might not always be cause for psychiatric hospitalization of the patient. Treatment
Pharmacological treatments, both mono-therapeutic and multi-therapeutic, using antidepressants, antipsychotics, and mood stabilizers have been successful.