Bott Nicholas, Keller Corey, Kuppuswamy Malathy, Spelber David, Zeier Joshua
Stanford University School of Medicine, Psychiatry and Behavioral SciencesStanford, CA, USA; VA Palo Alto Health Care SystemPalo Alto, CA, USA.
Stanford University School of Medicine, Psychiatry and Behavioral Sciences Stanford, CA, USA.
Front Psychol. 2016 Sep 7;7:1351. doi: 10.3389/fpsyg.2016.01351. eCollection 2016.
The Cotard delusion (CD) is one of a variety of narrowly defined monothematic delusions characterized by nihilistic beliefs about the body's existence or life itself. The presence of CD within the context of schizophrenia is rare (<1%), and remains understudied.
'Mr. C' is a 58-year-old veteran with a prior diagnosis of schizophrenia, who presented with CD in the context of significant depression, suicidal ideation, violence, and self-harm behavior. He perseverated in his belief that he was physically dead and possessed by demons for several weeks. This delusion was reinforced by his religious belief that life was an attribute of God, and by inference, he as a human, was dead. His condition gradually improved over the course of treatment with Divalproex and quetiapine with discussions about the rationale for his belief. Upon discharge, Mr. C. demonstrated awareness of his fixation on death and an ability to redirect himself.
This case highlights the need to better understand the co-occurrence of CD in schizophrenia, their differentiation, the increased risk of violence and self-harm behavior in this presentation, and how specific events and religious factors can influence delusional themes of CD. Pharmacotherapy and aspects of cognitive-behavioral therapy may be effective in ameliorating these symptoms in CD.
科塔尔妄想（CD）是多种狭义的单主题妄想之一，其特征是对身体存在或生命本身持有虚无主义信念。精神分裂症患者中出现CD的情况很罕见（<1%），且仍未得到充分研究。
“C先生”是一名58岁的退伍军人，此前被诊断为精神分裂症，他在严重抑郁、自杀观念、暴力和自我伤害行为的背景下出现了CD。他坚持认为自己身体已死且被恶魔附身达数周之久。他的宗教信仰认为生命是上帝的属性，由此推断，作为人类的他已死，这一妄想因此得到强化。在使用丙戊酸二钠和喹硫平治疗并对其信念的依据进行讨论的过程中，他的病情逐渐好转。出院时，C先生表现出对自己执着于死亡的认知以及自我调整的能力。
该病例凸显了有必要更好地理解精神分裂症中CD的共现情况、它们的区别、这种表现形式中暴力和自我伤害行为风险的增加，以及特定事件和宗教因素如何影响CD的妄想主题。药物治疗和认知行为疗法的某些方面可能对改善CD的这些症状有效。
