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Transcript of Cotard's Syndrome
There are a few things Cotard's syndrome is associated with, for example schizophrenia is one thing that it is possibly related to as well as major depression
it can actually happen suddenly, without any history of psychiatric disorders G-stage - important hypochondria, cenesthopathy, and depressive mood
B-stage - nihilistic delusions, delusions of immortality together with anxiety and negativism
C-stage - persistent emotional disturbances and depressive symptoms (paranoia) People less than 25 yrs. old, with the disease have been associated with bipolar disorder. Before the symptoms of Cotard's actually occurs, there is a slight stage of anxiety which may last a few weeks to a few years. This stage may eventually lead to the delusions that patients with Cotard's experience. Furthermore, the patient will then lose touch with reality, resulting in the belief that they are in fact, dead. Causes The cause of this disease is not genetic, you are not born with it, it is in relation to a motor neuron disease. The cause is mainly due to severe head injury, extreme stress, emotional emptiness or anxiety. This means that the symptoms will show over time. The belief that the person does not exist is related to nihilistic delusion, it is just a very rare form of it. On the other hand, the non-existent body parts is actually caused by delusions of enormous body size, which allows the person to believe something may be bigger than it is or in this case, non existent. * Cotard's syndrome is also the result of a malfunction in the part of the brain called fusiform gyrus or in the amygdala. The fusiform gyrus is the area of the brain that allows you to recognize faces, this is related to the amygdala because the amygdala is a set of neurons that process emotion. Lack of the two results in the person losing touch with reality - or existence. A simple head injury may actually activate dangerous things in the brain. There are small factors that can activate this bizarre disease, such as loss of brain cells, or brain atrophy. Brain atrophy can be just a loss of brain cells or it can be a big loss in connection between those brain cells being lost. This disease is a result of the loss of connection between these cells. Since there is a loss of connection, the brain is less likely to function normally and more likely to become weak in certain areas. Along with the loss of neurons, there is a loss of brain tissue which will lead to neurological disorders, as well as cognitive problems. Head injury In depth... Looking at this in depth, there are many neurons being lost here. This includes spinal motor neuron degeneration, which affects the thoracic and cervical levels. This affects the CNS which controls main areas and movements in the body such as walking, talking, etc. In this situation the loss of motor neurons can be in relation to ALS (Amyotrophic lateral sclerosis) a motor neuron disease which affects the voluntary movement of muscle. ALS has recently shown that in rare cases, people will develop cognitive problems affecting areas like memory, decision making, and word fluency. This case has much to do with memory and decision making because the person is unable to recognize themselves as an existing human being and loses touch with reality. Pharmaceutic treatment has been known to be successful in treating Cotard's syndrome, along with monotherapy. Some examples would be amitriptyline, duloxetine, fluoxetine, paroxetine, olanzapine, sulpiride, or lithium. Some of these medications made be used together, as a combination in order to make it more effective depending on the disorder the disease originates from. Overall recovery can occur just as fast as the disease appears - suddenly. If the delusions are related to a psycho organic disease then recovery is likely. If it is related to a depressive illness then there are chances the disease will continue despite any recovery of other symptoms. This would mean that the intensity of the disease could increase or decrease with the treatment of therapy. ECT (electroconvulsive therapy) plays an important role for patients with psychotic depression. ECT's help with reducing any cerebral blood flow and dilation of lateral and third ventricles * The belief that the person does not exist is related to nihilistic delusion (delusions that things do not exist or it is unreal), it is just a very rare form of it. On the other hand, the non-existent body parts is actually caused by delusions of enormous body size, which allows the person to believe something may be bigger than it is or in this case, non existent. Continued... Looking into the brain itself, there are problems with delusion. The delusional problems come from malfunctions or damage to the fusiform gyrus, which just so happens to be located around the right inferior temporal (the damaged area), and the parahippocampal gyrus, the visual memory recall area. The fusiform gyrus is where the fusiform face area is (the area that allows you to recognize and identify objects, people, etc.), meaning, since the area is damaged, it also damages the person's perception of things. Now, since that is the area of recognition, the area of retrieval is located in the prefrontal cortex of the brain. The process of retrieval involves the help of the parahippocampal cortex, which it is now lacking in, making the retrieval process harder. In simpler terms, the lack of this process allows the brain to replace the memory that it trying to be retrieved with an experience from before, further known as "delusions". * The affected areas in the process are:
the frontotemporal lobe- temporal cortex - frontal cortex - hippocampal dentate gyrus neurons (neurons that allow you to keep memories and retrieve them) - nigral cells (grey matter in midbrain - produce dopamine) head injury damaged areas slowing down processes or breaking connections Dementia - due to extreme depression and loss of emotion or behavioral changes Cotard's - loss of reality Delusion believing you do not exist