COTARD SYNDROME ASSOCIATED WITH SEVERE MAJOR DEPRESSIVE DISORDER WITH PSYCHOTIC FEATURES: CASE REPORT AND NARRATIVE REVIEW
Keywords:
Cotard syndrome; major depressive disorder; psychotic depression; nihilistic delusions; electroconvulsive therapy; case reportAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0874
Abstract
Introduction: Cotard syndrome is an uncommon neuropsychiatric phenomenon characterized by nihilistic delusions involving nonexistence of the self, death, bodily decay, or loss of internal organs. Although it may occur in primary psychotic disorders, neurological disease, and medical conditions, its classic association is severe major depressive disorder with psychotic features. Objective: To present a clinical case of Cotard syndrome associated with severe major depression and to review the most relevant diagnostic, differential, and therapeutic aspects for clinical practice. case report: A 46-year-old man with no previous psychotic history was admitted after eight weeks of depressed mood, anhedonia, terminal insomnia, weight loss, delusional guilt, delusions of ruin, and a progressive conviction that he was dead and had no internal organs. He showed food refusal, high suicide risk, mild dehydration, and severe functional impairment. Medical, toxicological, neurological, and metabolic assessment did not reveal an acute organic etiology. Severe major depressive episode with psychotic features and Cotard syndrome were diagnosed. He received multidisciplinary inpatient care, antidepressant medication, antipsychotic medication, and electroconvulsive therapy because of life-threatening refusal of intake. Clinical evolution was favorable, with progressive remission of nihilistic delusions and partial functional recovery at discharge. Conclusion: Cotard syndrome should be considered a clinical emergency when associated with psychotic depression, suicidality, food refusal, or dehydration. Management requires exclusion of organic causes, structured risk assessment, and individualized intensive treatment.
Keywords: Cotard syndrome; major depressive disorder; psychotic depression; nihilistic delusions; electroconvulsive therapy; case report.
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