Cotard and Capgras Syndrome after Ischemic Stroke

doi:10.1016/j.jstrokecerebrovasdis.2015.01.001

Journal of Stroke and Cerebrovascular Diseases

Volume 24, Issue 4, April 2015, Pages e103-e104

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.001 Get rights and content

Capgras and Cotard are delusional misidentification syndromes characterized by delusions about oneself, others, places, and objects. To date, there are few cases of comorbidity of both syndromes. We describe a case of aphasic stroke patient affected by cerebral ischemia localized in right temporoparietal region. The patient showed a typical clinical picture of delusional disorder attributable, through psychological assessment, to comorbidity of both Capgras and Cotard syndromes.

Section snippets

Case Report

We report a case of a 30-year-old female patient affected by a right faciobrachial paresis and fluent aphasia. She underwent clinical, neuropsychological, and neuroradiologic examinations at baseline (T0) and after a week (T1). Computed tomography was normal. Magnetic resonance imaging examination revealed an extensive cerebral ischemia in the left temporoparietal region (Fig 1). Magnetic resonance angiography and arterial venous malformations were negative. After 24 hours, computed tomography

Discussion

Ramachandran¹⁰ supports the hypothesis that the origin of the disorder is to be attributed to a disconnection between the temporal cortex and the limbic system. We observed an improvement of clinical and neuropsychological examination. Our patient, with a left temporoparietal region, after a week, has presented a disconnection occurs between the face recognition cortex and the limbic system (Capgras syndrome) and all sensory areas are disconnected from the limbic system (Cotard syndrome).

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Cited by (20)

Brain SPECT in Patients with Cotard's Syndrome: Report of Two Cases
2022, Revista Colombiana de Psiquiatria
El síndrome de Cotard es un hallazgo, poco frecuente en psiquiatría, que se caracteriza por la negación del paciente de la existencia de partes de su cuerpo, su propia corporalidad y hasta su misma existencia. A pesar del gran número de reportes y series de casos que buscan inferir la neurobiología del síndrome de Cotard, hasta el momento existen pocos estudios con descripciones detalladas sobre un posible correlato neurobiológico.
Reporte de 2 casos y revisión no sistemática de la literatura relevante.
El primer caso, una mujer de 24 años con síntomas de síndrome de Cotard y Capgras, manifestaba estar muerta, pudriéndose por dentro, y que su familia fue suplantada por clones. La segunda, una mujer de 50 años, mencionaba estar muerta y no poseer arterias y venas. En los estudios de neuroimagen funcional se encontraron hipoperfusión en las regiones frontales, parieto-temporales y ganglios basales.
Existe poca literatura respecto a la relación entre el síndrome de Cotard y los estudios de neuroimagen funcional. Al igual que lo reportado en la literatura, en nuestras pacientes se encontró una disminución de la perfusión cerebral frontal, parietal y temporal.
En nuestras pacientes con síndrome de Cotard había una hipoperfusión frontal, parieto-temporal y de ganglios de la base.
Cotard's syndrome is a rare finding in psychiatry in which the denial of body parts, corporality and even existence, are the main features. In spite of the large number of reports and case series trying to elucidate the neurobiology of Cotard's syndrome, to date there are few studies with detailed descriptions of a possible neurobiological correlate.
Report of two cases and non-systematic review of the relevant literature.
The first case, a 24-year-old female patient with symptoms of Cotard's and Capgras syndrome, stated that she was dead, rotting inside her and that her family was supplanted by clones. The second case was a 50-year-old woman who mentioned being dead, not having arteries and veins. In functional neuroimaging studies, hypoperfusion was found in the frontal, parietal-temporal and basal ganglia regions.
There is little literature regarding the relationship between Cotard's syndrome and functional neuroimaging studies. As reported in the literature, in our patients we found a decrease in cerebral perfusion at the frontal, parietal and temporal levels.
We found frontal, parieto-temporal and basal ganglia hypoperfusion in our patients with Cotard's syndrome.
Psychotic depression and Cotard's syndrome in a patient with Graves-Basedow disease: a case report
2021, Psiquiatria Biologica
La presentación de trastornos afectivos y psicosis en el contexto de hipertiroidismo es muy rara. Exponemos el caso de una paciente de 65 años quien presentó un miedo intenso a la enfermedad por el nuevo coronavirus (COVID-19), ánimo deprimido, ansioso, delirios nihilistas, de culpa, somáticos y apatía. Se le diagnosticó de un trastorno depresivo mayor con psicosis el cual desarrolló un síndrome de Cotard además de tener una enfermedad de Graves-Basedow. El tratamiento consistió en venlafaxina 150 mg/día, quetiapina 50 mg/día, tiamazol 30 mg/día y propranolol 60 mg/día. Luego de 2 semanas de tratamiento la paciente mejoró y fue dada de alta. El artículo se complementa con una revisión de la literatura en torno a la asociación entre síntomas mentales, síndrome de Cotard e hipertiroidismo.
The presentation of affective disorders and psychosis in the context of hyperthyroidism is very rare. We present the case of a 65-year-old patient who presented an intense fear of the new coronavirus disease (COVID-19), depressed mood, anxious, nihilistic delusions, guilt, somatic and apathy. He was diagnosed with a major depressive disorder with psychosis which developed Cotard's syndrome in addition to having Graves-Basedow disease. Treatment consisted of venlafaxine 150 mg/day, quetiapine 50 mg/day, thiamazole 30 mg/day, and propranolol 60 mg/day. After two weeks of treatment, the patient improved and was discharged. The article is complemented with a literature review on the association between mental symptoms, Cotard's syndrome and hyperthyroidism.
A Rare Case of Capgras Syndrome in Moyamoya Disease
2021, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
Capgras syndrome occurs in functional disorders such as schizophrenia, schizoaffective and bipolar affective disorders, and psychotic depression. In 43% of Capgras syndrome patients, the syndrome develops in organic diseases including dementia, traumatic brain injury, drug related and cerebrovascular diseases.4–8 Neuroanatomical mechanisms of Capgras syndrome have yet to be elucidated.
Moyamoya disease is a rare cerebrovascular disorder with unknown etiology and psychiatric symptoms occasionally manifest initially. Capgras syndrome is a unique neuropsychiatric symptom that is a delusional misidentification of a familiar person replaced by an identical imposter. We report the case of a 51-year-old woman with frontal lobe ischemic stroke caused by moyamoya disease, presenting with Capgras syndrome. Dysfunction of frontal areas may be attributable to development of Capgras syndrome.
In fear of the most loved ones. A comprehensive review on Capgras misidentification phenomenon and case report involving attempted murder under Capgras syndrome in a relapse of a schizophrenia spectrum disorder
2019, Journal of Forensic and Legal Medicine
Citation Excerpt :
No language restriction was applied. Overall one hundred nine109 cases from articles and books deriving from various scientific areas concerning Capgras syndrome were studied thoroughly dating from 1971 to July 201725,30,47–70,71–90,91-110,111–130. All relevant articles were reviewed and evaluated by the authors.
The present paper aims to describe a case of a schizophrenia spectrum disorder relapse leading to attempted murder, review literature, and investigate the epidemiological data and expression of violent behavior among Capgras-related incidents. 109 case reports deriving from various scientific areas dating from 1971 to 2017 were evaluated and juxtaposed with an equivalent comparison group of random psychiatry inpatients, who were examined for the same variables. Quantitative and qualitative differences were observed between samples. High level of interpersonal violence was disclosed among Capgras-related incidents, especially towards the main care-givers, with higher propensity among male patients. Homicidal behavior was also expressed in higher levels among male patients experiencing the Capgras delusion. A multidisciplinary approach is vital for the optimal management of these incidents. Further research on the pathophysiology of Capgras delusion with the utilization of functional imaging techniques is of exceptional significance for the understanding of issues of neuroscience.
Factor Structure of Cotard's Syndrome: Systematic Review of Case Reports
2020, Revista Colombiana de Psiquiatria
El síndrome de Cotard es de rara aparición en la clínica psiquiátrica. Debido a esto, la información actual se basa principalmente en reportes y series de casos.
Analizar las características psicopatológicas y la agrupación de los síntomas de los casos de síndrome de Cotard reportados en la literatura médica.
Se realizó en la base de datos MEDLINE/PubMed una búsqueda sistemática de la literatura de todos los casos de síndrome de Cotard reportados desde 2005 hasta enero de 2018. Se recolectaron variables demográficas y las características clínicas de cada caso. Se realizó un análisis factorial exploratorio de los síntomas.
La búsqueda identificó 86 artículos, de los cuales 69 eran potencialmente relevantes. Luego de la revisión de los textos completos, se seleccionaron 55 artículos para la revisión sistemática, entre los cuales se hallaron 69 casos. En el grupo de más edad con síndrome de Cotard fueron más frecuentes los diagnósticos de depresión mayor (p < 0,001) y trastorno mental orgánico (p = 0,004). El análisis factorial exploratorio arrojó 3 factores: depresión psicótica, en la que se incluye a los pacientes con delirios de culpa (0,721), ideas suicidas (0,685), delirios de condena (0,662), delirio nihilista del cuerpo (0,642), depresión (0,522) y delirios hipocondriacos (0,535); delirante-alucinatorio, con pacientes que sufrían delirio de inmortalidad (0,566), alucinaciones visuales (0,545) y delirio nihilista de la existencia (0,451), y mixto, con pacientes que sufrían delirio nihilista de los conceptos (0,702), ansiedad (0,573) y alucinaciones auditivas (0,560).
La psicopatología del síndrome de Cotard es más compleja que la simple asociación con el delirio de estar muerto, ya que abarca una estructura factorial organizada en 3 factores.
Cotard's syndrome is a rare psychiatric condition. As a result, current information is mainly based on reports and case series.
To analyse the psychopathological characteristics and the grouping of the symptoms of the Cotard's syndrome cases reported in the medical literature.
A systematic review of the literature of all reported cases of Cotard's syndrome from 2005 to January 2018 was performed in the MEDLINE/PubMed database. Demographic variables and clinical characteristics of each case were collected. An exploratory factor analysis of the symptoms was performed.
The search identified 86 articles, of which 69 were potentially relevant. After reviewing the full texts, 55 articles were selected for the systematic review, in which we found 69 cases. We found that the diagnosis of major depression (P < 0.001) and organic mental disorder (P = 0.004) were more frequent in the older group with Cotard's syndrome. An exploratory factor analysis extracted 3 factors: psychotic depression, in which it includes patients with delusions of guilt (0.721), suicidal ideas (0.685), delusions of damnation (0.662), nihilistic delusions of the body (0.642), depression (0.522), and hypochondriacal delusions (0.535); delusive-hallucinatory, with patients who presented delusions of immortality (0.566), visual hallucinations (0.545) and nihilistic delusions of existence (0.451), and mixed, with patients who presented nihilistic delusions of concepts (0.702), anxiety (0.573), and auditory hallucinations (0.560).
The psychopathology of Cotard's syndrome is more complex than the simple association with the delusion of being dead, since it encompasses a factorial structure organised into 3 factors.
“A ghost doesn’t need insulin,” Cotard’s delusion leading to diabetic ketoacidosis and a body-mass index of 15: a case presentation
2023, BMC Psychiatry

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Case ReportCotard and Capgras Syndrome after Ischemic Stroke

Section snippets

Case Report

Discussion

Cognitive approaches to delusions: a critical review of theories and evidence

Br J Clin Psychol

Delusional thinking and perceptual disorder

J Individ Psychol

Delusional misidentification

Psychiatr Clin North Am

Face familiarity feelings, the right temporal lobe and the possible underlying neural mechanism

Brain Res Rev

Assessment of coma and impaired consciousness. A practical scale

Lancet

Case Report
Cotard and Capgras Syndrome after Ischemic Stroke