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Case reports of Cotard's syndrome in Japan: a review

In 1880, a neurologist, Jules Cotard, reported a 43-year-old female hypochondriac who claimed to have no brain, nerves, lungs, or stomach/intestines and believed she was dead. In 1882, Cotard termed the symptom as ‘delusion of negation’. Subsequently, in 1893, Emil Régis referred to delusion of negation as Cotard’s syndrome, which became the widely accepted term. Since then, many case reports and reviews have been published. Herein, we describe our investigation of the sex, age, diagnosis, and treatment methods of patients included in case reports of Cotard’s syndrome published in Japan over a period of 35 years. A literature review was conducted using the Japana Centra Revuo Medicina, a medical database of Japanese papers. A search was conducted for cases reported as ‘Cotard’s syndrome’ between 1984 and 2018. A total of 102 patients (19 men, 83 women) were studied. The mean SD age of onset was 60.5 13.6 years. The majority of patients were aged 50–79 years (Fig. 1(a)). Age throughout the course of the disease had been recorded in the medical histories of 71 patients. We investigated their age at initial consultation with the department of psychiatry (Fig. 1(b)). Although the mean age of onset in these 71 patients was 59.2 13.6 years with a peak at 60–69 years, the mean age at initial consultation was 52.1 14.8 years with a peak at 40–59 years. The mean interval from the time of initial consultation to the onset of Cotard’s syndrome was 7.2 9.8 years. In the 102 cases, the psychiatric diagnosis was mood disorder in 72 patients (depression in 63, bipolar disorder in 9), schizophrenia in 9, dementia in 5, other (i.e. atypical psychiatric disease, herpes virus encephalitis, Parkinson’s disease, panic attacks, somatoform disorders, adjustment disorder, steroid psychiatric disease, anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, and brain tumour surgery) in 9, and Cotard’s syndrome without specific diagnosis in 7. Relief or remission was achieved in 82 (80.4%). Electroconvulsive therapy was administered to 22 patients (21.6%), and 57 patients (55.9%) responded to drug therapy. Spontaneous cure was observed in two cases, and one patient responded to psychotherapy. Of the 57 drug responders, antidepressants were administered to 17, an antidepressant and an antipsychotic to 13, an