Corpus Christi College, Oxford, UK and Philosophy Department, Monash University, Clayton, Australia.
School of Psychological Sciences, Macquarie University, Sydney, Australia.
Cogn Neuropsychiatry. 2022 Nov;27(6):430-446. doi: 10.1080/13546805.2022.2119839. Epub 2022 Sep 16.
Cotard delusion-the delusional belief "I am dead"-is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea "I am dead" comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if "I am dead" were true, there would be no emotional responsivity to the world.
We scrutinised the literature on people who expressed the delusional belief "I am dead", looking for data on whether such patients are reported as entirely lacking in emotional responsivity.
In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry.
We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea "I am dead" comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.
卡塔德妄想——妄想“我死了”——是以首次描述它的法国精神病学家朱尔斯·卡塔德（Jules Cotard）的名字命名的。拉马钱德兰和布莱克斯利（Ramachandran and Blakeslee）提出，当神经病理学状况导致对世界的情感反应完全消除时，就会产生“我死了”的想法。这个想法会产生一个假设性的解释：如果“我死了”是真的，那么对世界就不会有情感反应。
我们仔细研究了表达妄想“我死了”的人的文献，寻找这些患者是否被报告完全缺乏情感反应的数据。
在许多情况下，患有卡塔德妄想的患者被描述为经历了包括焦虑、恐惧、内疚、痛苦、欣快和担忧在内的情绪。
我们的结论是，完全没有情感反应不可能是促使人们产生自己已经死亡的妄想的原因。我们提出，在至少一些情况下，“我死了”的想法是由于人格解体或现实解体的症状而产生的，这些症状在卡塔德妄想中经常出现，并举例说明了一些卡塔德患者在各种神经区域存在异常，这些异常可能导致出现这种症状。
