Koreki Akihiro, Mashima Yuki, Oda Akihiko, Koizumi Teruki, Koyanagi Kazuhiro, Onaya Mitsumoto
Department of Psychiatry National Hospital Organization Shimofusa Psychiatric Medical Center Chiba Japan.
PCN Rep. 2023 May 21;2(2):e93. doi: 10.1002/pcn5.93. eCollection 2023 Jun.
While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected.
A woman aged in her 60s diagnosed with schizophrenia was admitted to our hospital for psychotic symptoms, including delusions of reference, delusions of guilt, auditory hallucinations, cenesthetic hallucinations, agitation, depression, suicidal ideation, and catatonia. During hospitalization, her cenesthetic hallucinations progressed to include nihilistic delusions. She described cenesthetic hallucinations along with various delusional descriptions, including the belief that various objects, such as spoons, irons, nails, rulers, bins, and coins, were inside her body and that her body was being burned or in danger of exploding. She also claimed an altered sense of her own body, that her body was larger than normal or reversed. Moreover, she reported nihilistic delusions that her face and body did not exist, that her heart was not functioning, and that she was going to die soon or was already dead. She occasionally refused to eat because of the feeling of being dead. Notably, during a severe episode, she claimed that a doctor in front of her was dead. Clozapine was effective in improving her symptoms. Ultimately, the patient regained her sense of being alive and acknowledged that the doctor was alive.
We report the case of a patient presenting with nihilistic delusions regarding both self and others, along with prior cenesthetic hallucinations. Aberrant interoceptive processing could be a potential link between these two forms of nihilistic delusions.
虽然“我已经死了”这一症状是科塔尔综合征（又称虚无妄想症）的一个标志，但“你已经死了”这一症状却一直被忽视。
一名60多岁被诊断为精神分裂症的女性因出现包括牵连观念、罪恶妄想、幻听、本体幻觉、激越、抑郁、自杀观念及紧张症等精神病性症状而入住我院。住院期间，她的本体幻觉进展为包括虚无妄想。她描述了本体幻觉以及各种妄想性描述，包括认为勺子、熨斗、钉子、尺子、垃圾桶和硬币等各种物体在她体内，以及她的身体正在被灼烧或有爆炸危险。她还声称自己对身体的感觉发生了改变，觉得自己的身体比正常的大或颠倒了。此外，她报告了虚无妄想，认为自己的脸和身体不存在，心脏不工作了，自己很快就要死了或已经死了。她偶尔会因为觉得自己死了而拒绝进食。值得注意的是，在一次严重发作期间，她声称面前的一名医生已经死了。氯氮平对改善她的症状有效。最终，患者恢复了活着的感觉，并承认医生还活着。
我们报告了一例患者，其同时出现了关于自我和他人的虚无妄想以及之前的本体幻觉。异常的内感受性处理可能是这两种虚无妄想形式之间的潜在联系。
