Neurologist Jules Cotard first presented the case of a 43-year-old woman who believed she had no brain, nerve, or intestine, claiming to be just a lump of skin and bones and claiming to have no have no need to feed at all. He thought he saw a new form of depression characterized by deep anxiety, hypochondriac ideas, belief in immortality, progressive destruction of the body and anesthesia of pain. Two years later, Cotard speaks rather of ” delirium of negations ».

In 1893, Régis described this affection under the name of ” Cotard’s delirium “Which is transformed into” Cotard syndrome “by the Anglo-Saxon world.

Several cases were then described by psychiatrists including the famous “Madame Zero” before Enoch and Trethowan defined the syndrome as a rare condition whose main symptom is based on a nihilistic delirium, which leads the person to reject his own existence as that of the world.

More than 200 cases have been listed in the scientific literature. A factor analysis made it possible to see the emergence of 3 different groups:

Psychotic depression : People have symptoms that are more reminiscent of a depressive state than of a nihilistic delirium.

Cotard de type 1 : people clearly present with Cotard syndrome marked by undeniable delirium.

Cotard de type 2 : people present mainly anxiety disorders, depressive states and auditory delusions. The delusional aspect is less marked.

The clinical conditions of Cotard syndrome are rarely seen today. It is highly probable that the syndrome is no longer encountered due to the rapid treatment of psychotic disorders and the reduction in institutionalized patients.

For this reason, the syndrome is no longer specifically listed as a particular disorder in the DSM-IV.

On the other hand, it remains inventoried in the International Classification of Diseases, as delusional disorders, and more particularly under the label of paranoid disorders. 

Symptoms differ from person to person, but psychiatrists have noted:

• Loss of mental vision;
• Negation of the world, of oneself and of its organs;
• Feeling of immortality;
• Impression of grandeur;
• Ideas of damnation and possession;
• Anxiety and depressive disorders;
• Suicidal thoughts;
• Hypondriacal concerns;
• Self-harm.

The origin of these symptoms remains very poorly understood even if we suspect a dysfunction at the level of the fusiform gyrus, a region of the brain associated with emotions. 

A 46-year-old woman, the youngest of 6 boys and girls.

Her mother was 40 when she was born. Parental quarrels, his father’s alcoholism, his mother’s cruelty and authority are the most vivid memories of his youth. His father died during his teenage years, which marked the onset of a first depression. At 21, the abandonment of her fiancé plunges her into a major depressive episode, then a second episode occurs after the same scenario at the age of 36. This time, the disease forces her to stop working and to consult dozens of specialists who diagnose “anxiety disorders”, “neurovegetative disorders” and prescribe anti-inflammatory, analgesic and anti-anxiety treatments without counting.

In 1999, 2 of her brothers took her to the psychiatric hospital after finding her naked on her balcony, ready to jump into the void. During her treatment, she will not stop claiming that no one can help her, that she is a “dead plant” and that she will stay that way forever.

During her interviews, she will claim:

“I haven’t eaten for months”

“All my organs are rotten”

“I have no heart, it no longer beats”

“You lie to me when you take my blood pressure because I no longer live, I have no blood”.

The patient was treated for 42 days after being recognized as a victim of “major depression with psychotic features”. Two months later, she was treated again for 23 days, when the symptoms had only slightly improved. The treatment was the same: a combination of antipsychotic drugs and antidepressants. 14 months later, she was treated a 3^st times for the same symptomatology for 46 days. Over the next 10 months, she continued her medication, was monitored by the hospital, and finally came out of the nightmare when it ended.