Dr Shyamanta Das
Cotard’s syndrome has always borne a historical construct, being linked to pure psychosis, affective disorders as well as organic disorders like Parkinson’s, temporal lobe epilepsy, migraine, and cerebral infarction. Emphasis has remained on the psychopathology, involving beliefs of negation, damnation, guilt, and denouncing of body organs. Keya Das, P Liji, and VSSR Ryali presented a case study of Cotard’s syndrome with bipolar affective disorder that was published in the Open Journal of Psychiatry & Allied Sciences (OJPAS).
A 40-year-old widow, a tea-garden worker currently unemployed for the past one year with poor social support, with a moderately well-adjusted personality and no significant psychiatric family history, presented to the psychiatry outpatient department (OPD) with a history of feeling persistently sad, associated crying spells, death wish, poor sleep and appetite, and inability to work over the last one year. Worsening of symptoms over a period of six months with complaints that her uterus was ‘rotten’ and ‘leaking’ was reported. According to her, the bones were malformed and she did not have a backbone, associated it with severe back pain and hence, she could not sit or walk. She reported having ‘shrunken’ and ‘shrivelled’, with a body of a very old woman and expressed guilt over sexual activity, stating that her lower body was now destroyed as a result of such acts. Suicidal ideas and a suicide attempt by self-immolation was discovered three months back, which had resulted in minor burns. Past history revealed similar episodes of crying spells, death wish, sense of worthlessness, hopelessness, and auditory hallucinations three years ago, for which the patient had been admitted to psychiatric care and received three electroconvulsive therapies (ECTs) and pharmacotherapy, with remission of symptoms. Further, three episodes of excessive cheerfulness, overfamiliarity, and hyper-sexuality in the form of soliciting multiple partners was also reported. Frequent altercations with family over this were reported by the informants, having occurred 13 years, eight years, and two years back, respectively.