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OKAY BACK FROM THE ICU 🏥

A 2016 Medical Letter Describes A Patient Called Ms A

She Was A Woman In Her 50s

Her History Included Anxiety And Psychosis

Quadriplegia And A Tracheostomy Were Also In Her Medical History

She Came To The Emergency Department With Worsening Breathing

For 1 Week Before That Her Mental Status Had Been Altered

Doctors Admitted Her For Metabolic Encephalopathy

The Letter Says That Came From Sepsis And Hyponatremia

Further History Showed She Was Well Until 1 Week Before Admission

Then She Began Saying That She Was Dead

Afterward She Stopped Eating

She Also Tried To Remove Her Tracheostomy And Refused Medications

At First She Was Poorly Oriented And Could Not Hold A Conversation

Treating The Sepsis And Hyponatremia Improved Her Encephalopathy

Her Nihilistic Delusions Persisted After That

She Heard Voices Telling Her She Was Dead

The Voices Also Said She Had Died As An Infant

They Said Her Family Had Died As Well

She Described Ongoing Anxiety About Money And Health Insurance

Throughout Her Stay She Denied Thoughts Of Suicide Or Self Harm

Doctors Diagnosed An Anxiety Disorder And A Psychotic Disorder

The Diagnosis Also Named Cotard Delusion

Another Report Describes A Man Who Stopped Eating Before His Delusions

A 2022 Case Report Describes A 40 Year Old Man

He Had No Previous History Of Psychiatric Disturbance

Over The Previous Months He Had Adopted A Carbohydrate Free Diet

His Appetite Then Dropped Suddenly And He Lost Weight

Doctors Admitted Him For A Severe State Of Malnutrition

He Repeatedly Refused To Undergo A Psychiatric Evaluation

The Hospital Soon Discharged Him

Seven Months Later He Returned To The Emergency Department

He Weighed 38 Kilograms With A Body Mass Index Of 15

This Time Doctors Suspected An Eating Disorder

He Could Not Hold A Conversation And Kept Saying He Was Dead

Doctors Blamed His Symptoms On Delirium From Lack Of Nutrients

Cotard Was Suspected As His Symptoms Developed

After Six Weeks His Lab Results Stabilized And His Weight Rose

A Diagnosis Of Anorexia Nervosa Was Made

Doctors Moved Him To A Rehabilitation Facility For Eating Disorders

He Showed No Apparent Intention Or Plan To Harm Himself

Two Days Later He Died By Suicide

The Authors Say His Diagnosis Appeared Incomplete

In Their View It Focused Only On The Eating Disorder

They Write That His Symptoms Should Have Suggested Cotard

Doctors Had Given Him Low Dose Medicine For Only Seven Days

The Authors Warn That Missing Cotard Can Raise The Risk Of Suicide

Ms A Recovered From Her Cotard Delusion

In Hospital Ms A First Received Risperidone And Mirtazapine

That Trial Brought Minimal Improvement

Doctors Then Tried Aripiprazole On Its Own Again

Her Cotard Delusion Went Into Remission

Social Workers Also Reassured Her Often About Her Finances

Psychotherapy Helped As Well

She Began To Notice Things That Went Against Her Delusion

One Was Her Drive To Eat

Others Were Her Medical Condition And The Feeling Of Her Heartbeat

The Reassurance Of Other People Was Another

She Began To Believe She Was Alive

Doctors Discharged Her With Psychotherapy Delivered At Home

Other Patients With Cotard Have Received Different Treatments

A Mayo Clinic Series Recorded How Its Patients Were Treated

The List Included ECT And Medication And Behavioral Therapy

Psychotherapy And Rehydration Were Also On It

So Was Removing Drugs That Were Causing Harm

Cotard Is Rare And Most Published Literature On It Is Case Reports

In Cotard A Person Denies Their Own Existence Or Their Body Parts

It Appears Across A Relatively Wide Range Of Illnesses

Early Recognition Of Its Signs Can Be Vital To Prevent Worsening

The Mayo Authors Concluded That A Number Of Effective Treatments Exist