Cotara Syndrome

Cotar syndrome is rare, not a particular clinical disease, but rather a disorder associated with nihilistic delusions about the absence of the whole body or one part of it. Patients may think that there is one void around.

For the first time in medical practice, Cotard's syndrome was described in 1880 by the French neurologist Jules Cotard. This is a kind of psychotic depression, in which melancholy, anxiety, insensitivity to pain, delusions about the body and a sense of immortality have united.

[1], [2], [3], [4], [5], [6]

Causes of the syndrome

Unfortunately, they are still not known. Previous studies are ambiguous, they can be reduced to the statement that, most likely, a significant role in the formation of the Kotar syndrome belongs to the frontal-temporal-parietal neuronal schemes. At the same time, there are cases where there are no anomalies in the structure and functioning of the brain of people with this disease.

Cotard syndrome is the most common in the case of affective disorders: depression and bipolar disorder. There are also cases when Cotard's syndrome is detected, in particular, in schizophrenia, dementia, epilepsy, brain tumors, migraine, multiple sclerosis or craniocerebral trauma. Most often this occurs in middle-aged and older people, but cases of this disorder are also known among people younger than 25, mainly with bipolar disorders. According to statistics, this disorder affects more women than men. Why this happens, science has not yet found an explanation.

British filmmakers even created a short film "Pursuing Cotard's Syndrome", dedicated to people suffering from this syndrome. They showed one of the causes of the onset of the disease and its consequence.

[7], [8], [9], [10], [11], [12], [13], [14]

Pathogenesis

After severe stress, such as, for example, loss of a loved one, there may come a severe depression, in which there comes a complete apathy to everything around him.

A person loses his own identification, denies his own existence. In addition, the patient does not perceive his own body. He claims that his body is rotten, can not perceive sounds, smells. Despite the fact that he can not explain how it is possible to talk and move without the brain, heart and other organs, but he is absolutely convinced that he does not have them;

The walk of such patients is very specific, it can resemble movements of "living dead" from horror films;

Can feel a kind of connection with the dead and often walk through the cemeteries, which seem to him the most suitable place for him.

A lowered pain threshold increases the risk of self-aggressive behavior. Suicide is also a way to get rid of a dead body, on which the patient is supposedly doomed.

Does not take hygienic procedures, does not eat or drink (food and drink do not make sense to them if they are dead). Hunger and exhaustion are after suicide the second cause of death of the patient.

These symptoms are accompanied by an extreme degree of anxiety and guilt. The mentally ill tries to explain why he should live further on earth if he is already dead. In the end, he comes to the conclusion that death is a punishment for his sins and disobedience.

[15], [16], [17], [18], [19], [20], [21], [22], [23], [24],

Symptoms of the syndrome

Some insane people are in the firm belief that they lack, vital organs, such as the heart, the brain or others. They are visited by a fantasy that their bodies can be huge and reach the dimensions of the sky or the whole universe. Such patients have a propensity for suicide, but can still imagine themselves immortal.

They wholeheartedly believe that they are dead and insist that they be destroyed. Often hear the voices that guide their actions.

Cotara syndrome is a side effect of nihilistic delirium or self-denial. What are its symptoms? Let us dwell on the more typical:

• the patient denies his own existence,
• is convinced that he has died,
• feeling of loss of the whole body or the main internal organs,
• conviction in the rotting body and the decay of the body,
• strong anxiety,
• guilt,
• reduction of pain threshold,
• psychomotor agitation,
• self-harm and suicidal tendencies.

First signs

The first feature is the appearance of a sense of anxiety. Then the person begins to think that he has already died, he is not. In addition, patients can believe that nothing exists - neither of them, nor the world, nor the people around. Sometimes the disease is accompanied by a sense of immortality or ridiculous errors about the size of your own body.

Because of the reduction of pain and conviction in their own non-existence, patients suffering from this disorder often commit self-harm. They deliberately damage tissues and harm themselves. They want to prove to others that in reality their bodies do not live and do not bleed.

Nihilistic delirium can be manifested as a sensation of unreality of the body, the transformation of organs or strange hallucinations of the skin (for example, the sensation of flow of electric current through the body).

[25], [26], [27], [28]

The film "Pursuing Kotar's Syndrome"

At the beginning of the film quiet music sounds, there are no monologues and conversations. At the end of the credits, the inscription "Two weeks after the funeral" comes up. We see a room in which things are chaotically located. In it on the armchair the main hero named Hart is located. Before him on the wall hangs a portrait of a blue-eyed young woman with red hair. This is the late wife of Hart - Elizabeth. The hero glances at her briefly, then turns away and rises from the chair. He approaches the broken mirror and looks at his reflection, then looks up at the portrait of the spouse. Then there is a change of scenery. A faint light breaks through the curtained window. The main character sitting at the desk is looking at his ring. Hart is right in what he is wearing, with full indifference begins to take a bath. Then he sits down to read the book, but can not concentrate on it. He hears a knock on the door, but does not react to it. He is in complete apathy. Then he moves the vase with dried flowers as if he wants to tell the deceased Elizabeth that he still has not lost his love for her. At the entrance to the room is a pile of letters. Hart takes the letter, opens it, but can not read it. He tries to cook, but he can not force himself to eat something. Hart's face is distorted by the grimace of suffering, the need to eat is the cause of the pain and he angrily throws the plate. Having risen, the hero with reproach looks at the portrait that she left early. Making an attempt to remove food from the floor, he throws this venture. In thoughtfulness turns his gaze to the wreckage of a broken mirror and one of them cuts his wrist. His devastated eyes become clear. Time starts counting down. The room, which was dark and gloomy, transforms and becomes cozy and warm. There is a beloved Elizabeth, full of strength and energy. She gently kisses him and a smile appears on the lips of the protagonist. The meeting is not long, the wife leaves, making it clear that she, as before with him. Looking over the last time with a portrait and a room, Hart opens the door and moves to meet the bright rays of light.

Forms

In recent years, based on the available data in such cases, there are three types of Kotar syndrome:

• The first is psychotic depression, in which symptoms of anxiety and depressed mood predominate, feelings of guilt, delusions and auditory hallucinations;
• The second is associated with the mania of hypochondria and nihilistic delirium, but without symptoms of depression;
• The third is anxiety, depression, hallucinations, delirium, a mania of immortality and suicidal tendencies.

[29], [30]

Diagnostics of the syndrome

Diagnosis of the disorder is based on the characteristics of clinical manifestations. It occurs in patients prone to melancholia and manic-depressive psychoses. Is a companion of depressive conditions, can occur if the patient has lost memory and is prone to hallucinations.

[31], [32], [33], [34], [35]

Treatment of the syndrome

The most common drugs in the treatment of Kotar syndrome are antidepressants and antipsychotics. Any medication should be used after the appointment of a doctor. Only a doctor is able to assess the severity of the condition and prescribe adequate treatment. Quite often, amitriptyline or melipramine drugs are used.

With prolonged depression, intramuscular or intravenous injections of amitriptyline 10-20-30 mg are used. Take it at least four times a day, gradually the dose of the drug increases. The maximum dosage per day is 150 mg. After one or two weeks, patients go to the tablet form. There may be side effects - blurred vision, increased intraocular pressure, constipation, hyperthermia.

Melipramine belongs to the group of antidepressants. Assign for all kinds of depression and panic conditions. Produced in the form of tablets and injection solutions.

Adults prescribe from the beginning 25 mg of the drug, which must be used for one-three meals after a meal. It is permissible to use up to 200 mg per day, this is the maximum dose. After the therapeutic effect is achieved, the dose can be reduced to 50-100 mg / day.

Elderly and youthful persons are prescribed standard 12.5 mg once in the evening. It is necessary that the daily dose is 75 mg. After this dosage is reduced. To maintain and consolidate the positive effect appoint a half dose of the dosage for adults.

Side effects affect the cardiovascular system, the central nervous system and the gastrointestinal tract.

To reduce motor and speech excitation, use aminazine.

He is prescribed for various conditions of increased excitation in schizophrenia, paranoid states and hallucinations. At the beginning of the course, the dose is assigned 0,025-0,075 g per day. It is usually divided into several doses, then gradually brought to 0.3-0.6 g. In patients with chronic disease and psychomotor agitation can reach 0.7-1 g. The course of treatment with large doses should be from one to one and a half months.

Possible side effects: indifference, neuroleptic syndrome, fuzzy vision, thermoregulatory disorders, tachycardia, pruritus, rash. Very rarely possible cramps.

To reduce anxiety, tizercin is often used. Tablets are prescribed from 25-50 mg per day. They are divided into several receptions. The greatest dose is prescribed before bedtime. Gradually bring the dose to 200-300 mg. After stabilization of the patient's condition, the dose is started to decrease. The maintenance dose is determined individually. If there is no possibility to take the drug in the form of tablets, then injections are prescribed. The daily dose is 75-100 mg, which is divided into two or three doses. Injections are carried out under the condition of bed rest with constant monitoring of blood pressure and pulse. If necessary, the amount of the drug per day is increased to 200-250 mg. Injections are done deeply intramuscularly or intravenously. When diluting tizertsina should use solutions: sodium chloride or glucose.

In addition to the above, effective use of electric shock.

Often, predictions for patients with Cotard syndrome are not comforting. But, there are cases of sudden and spontaneous remission.

Prevention

There are no special preventive measures for this disorder. The main role is played by the timely diagnosis and the beginning of therapy in anxious depression, which appeared for the first time in old age.

[36], [37], [38], [39], [40], [41], [42], [43], [44]

Forecast

Despite the patient's denial of logical arguments, it is important to convince him that, despite his nonsense, he is alive. Even if you can do this, you need to often remind him about it. It is necessary to provide the patient with medical care, in the first place - psychiatric and psychotherapeutic. Unfortunately, treatment is difficult and there is no guarantee of recovery.

Depending on the characteristics of the underlying disease and treatment methods depends on the output of remission. If there are clearly expressed crazy nihilistic ideas, then this is worse than a depressive version of Kotar's syndrome. Nihilistic delusions combined with speech and motor excitement and darkened consciousness in older people in the absence of treatment can lead to a fatal outcome.

[45], [46], [47], [48]