How Does Cotard Syndrome Start?

Based on medical literature, Cotard syndrome has been diagnosed in patients suffering from other psychotic disorders, mood disorders (like depression), clinical depression, neurological diseases, head trauma and even migraine headaches. It has been hypothesized that the underlying pathophysiology of the disorder involves a severe lesion in the frontal lobe of the brain (which can be caused by all of the abovementioned conditions). Simply put, the patient does not recognize the face (his/her face) that he/she sees, which results in feelings of inexistence. In a more detailed explanation, the part of the brain that recognizes faces is the fusiform face area, and the part that associates emotions with memory is the amygdala. In Cotard Syndrome, there is an abnormal neurons firing or a disconnected pathway that prevents the subject from recognizing his/her faces, leading to self-negation. Even faces of relatives cannot be recognized, which leads the patient to see them as cons or impostors.

Cotard syndrome is exacerbated in patients suffering from psychosis and depression because of the fact that their mental status is already altered, thus predisposing them to the symptoms of this syndrome. In young people, the disorder is more likely to develop if they suffer from bipolar disorder, whereas in older subjects, predisposing mental illnesses are schizophrenia and depression.

Cotard Syndrome can also develop as a side effect of some medications. This is the case of acyclovir, an antiviral medication used to treat herpes simplex infections. The active metabolite of this drug has the ability to penetrate the central nervous system and cause damage, which explains the development of the condition following the intake of the drug. However, this mainly occur when the drugs level in the blood are high (overdose or under excretion, like in kidney disease for example).

In that setting, the disorder was first diagnosed in a patient who started developing the typical symptoms after having received acyclovir for the treatment of her shingles. However, once dialysis was initiated to flush out the drug from the body, the symptoms resolved. The doctors also reported that all other patients presented with high blood pressure as well, and because of that there might have been a possibility that the acyclovir metabolite could have induced blood vessels constriction in the brain, leading to a decreased in blood supply to the frontal lobe, therefore triggering the Cotard’s delusion.

See Also: Exotic Psychiatric Syndromes: From Alien Hand Syndrome To Munchausen By Proxy

How Can Cotard Syndrome be treated?

Cotard Syndrome has been successfully managed in the past with mood stabilizers, anti-depressants and anti-psychotic drugs. The reason this being the fact that controlling the underlying psychiatric illness can control the disorder which seems to be a mere complication of it.

Needless to say, Cotard Syndrome remains a medical challenge in the medical world, and because it is a rare condition, extensive studies are yet to be conducted to really elucidate the deeply buried reasons of the existence of supposedly “walking zombies”.