Cotard’s Syndrome: A Review

Öz

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.

Anahtar Kelimeler

• nihilistic delusions
• neuropsychiatric disorders
• Cotard's syndrome

Cotard Sendromu: Bir Derleme

Öz

Cotard sendromu, nihilistik ve varoluşsal içerikli sanrılarla karakterize edilen nadir bir nöropsikiyatrik tablodur. İlk olarak 1880 yılında Jules Cotard tarafından tanımlanan bu sendrom, çoğunlukla psikotik depresyon bağlamında ortaya çıkmakla birlikte, bipolar bozukluk ve şizofreni spektrum bozuklukları gibi diğer psikiyatrik durumlarla da ilişkili olarak gözlenebilmektedir. Klinik seyir, genellikle hipokondriyak yakınmalar ve depresif belirtilerle başlayan bir süreçten, bireyin kendi varlığını, bedenini ya da organlarını inkâr ettiği nihilistik sanrıların belirginleştiği bir evreye doğru ilerleyebilmektedir. Bu süreçte sanrıların şiddeti artabilmekte ve klinik tablo daha karmaşık bir görünüm kazanabilmektedir. Epidemiyolojik veriler, sendromun oldukça düşük prevalansa sahip olduğunu ve özellikle orta ve ileri yaş gruplarında daha sık bildirildiğini, ayrıca kadınlarda daha yüksek oranlarda görüldüğünü göstermektedir. Bununla birlikte, Cotard sendromunun yalnızca psikiyatrik bozukluklarla sınırlı olmadığı; Parkinson hastalığı, Alzheimer hastalığı, epilepsi ve serebrovasküler lezyonlar gibi nörolojik durumlarla da ilişkili olabileceği bildirilmektedir. Klinik prezentasyon sıklıkla depresif duygudurum, yoğun suçluluk duyguları, anksiyete, derealizasyon ve depersonalizasyon gibi belirtilerle birlikte kendine zarar verme davranışlarını içermektedir. Tedavi yaklaşımı temelde altta yatan psikiyatrik ya da nörolojik durumun yönetimine dayanmakta; farmakoterapide antidepresan ve antipsikotik kombinasyonları yaygın olarak kullanılmaktadır. Dirençli olgularda elektrokonvülsif tedavi etkili bir seçenek olarak öne çıkmakta, özellikle ağır depresyon ve yüksek intihar riski bulunan hastalarda hızlı klinik yanıt sağlayabilmektedir. Ayrıca psikoterapötik yaklaşımlar, hastalığın seyrinde içgörü gelişimini destekleyerek tedaviye uyumu artırmada önemli bir tamamlayıcı rol üstlenmektedir.

Anahtar Kelimeler

• Cotard Sendromu
• nihilistik sanrılar
• nöropsikiyatrik bozukluklar

Kaynakça

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