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.
Diagnosis
Can be seen in multiple sclerosis, stroke, and other pathologies. Accompanying symptoms include scanning speech, intention tremor, incontinence, and nystagmus. See also
Multiple sclerosis
One and a half syndrome

References


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