Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
Int Rev Psychiatry. 2021 Feb-Mar;33(1-2):23-28. doi: 10.1080/09540261.2020.1810425. Epub 2020 Oct 5.
Cotard's syndrome usually presents as combined symptoms occurring in a broad series of neurological, psychiatric, and medical disorders, being severe depression the most frequent. The syndrome is not classified as a distinct clinical entity in the nosological systems but appears solely as a clinical condition in case reports. Thus, the diagnosis of Cotard's syndrome mainly centres on the psychiatric interview and the ability of the clinician to recognise specific symptoms due to the absence of both clinical instruments and diagnostic criteria. Cotard's syndrome has never been described to date in patients with a history of obsessive-compulsive disorder (OCD). We report a case of a 49-year-old woman presenting obsessive symptoms and related compulsions for more than 30 years. Cotard's syndrome appeared after 3 years from a tragic event that had caused a psychological trauma. Such an occurrence may have contributed to worsening OCD and leading to a second major depressive episode followed by a suicidal attempt. Since then, the subject of our patient's obsessive thoughts changed, and the belief of being dead appeared. The repetitive and stereotyped thoughts caused severe distress, and accompanied the compulsive nature of reassurance seeking, temporarily beneficial to the anxiety arousing. The transition from obsession to delusion occurred when resistance was abandoned, and insight was lost. Once Cotard's syndrome had stabilised, OCD was no longer present. Additional distinctive features were the absence of psychiatric family history and the persistent nature of the affective psychosis. We concluded that Cotard's syndrome represented the evolution of the initial obsessive-compulsive disorder. Furthermore, we differentiated the clinical condition of our patient from other psychiatric diseases with similar clinical features. Larger-scale research is needed to consider topics other than comorbidity and also to explore significant elements of the patient's clinical history to discover what may influence the evolution and/or the persistence of the diseases.
卡特尔综合征通常表现为广泛的神经、精神和医学疾病中出现的合并症状，其中最常见的是严重的抑郁症。该综合征在分类系统中未被归类为独特的临床实体，仅作为病例报告中的临床情况出现。因此，卡特尔综合征的诊断主要集中在精神科访谈和临床医生识别特定症状的能力上，因为缺乏临床仪器和诊断标准。到目前为止，卡特尔综合征从未在强迫症（OCD）病史的患者中描述过。我们报告了一例 49 岁女性的病例，该患者有 30 多年的强迫症状和相关强迫行为。卡特尔综合征在 3 年前的一次悲惨事件造成心理创伤后出现。这种情况可能导致 OCD 恶化，并导致第二次重度抑郁发作和自杀未遂。从那时起，我们患者的强迫性思维的主题发生了变化，并且出现了死亡的信念。重复和刻板的思想引起了严重的困扰，并伴随着寻求安慰的强迫性，暂时缓解了焦虑。当抵抗被放弃，洞察力丧失时，从强迫思维到妄想的转变就发生了。一旦卡特尔综合征稳定下来，强迫症就不再存在。额外的特征是没有精神疾病家族史和情感性精神病的持续性质。我们得出结论，卡特尔综合征代表了初始强迫症的演变。此外，我们将患者的临床状况与其他具有相似临床特征的精神疾病区分开来。需要进行更大规模的研究，除了共病之外，还要探讨患者临床病史的重要因素，以发现可能影响疾病演变和/或持续的因素。
