Case Presentation: The patient is an 82-year-old female with multiple medical problems including stroke who presents with change in mental status. The patient is normally alert and oriented x3 but 3 days ago, she noted that she was depressed. She started to talk about things that did not make any sense. She stated that she was in a morgue and then stated that she was dead. She stopped eating, drinking, she stopped taking her medication. No fevers, chills, or night sweats were reported. The patient was loudly laughing and screaming that she is dead, has been dead for a while, and that her heart has stopped. She continued with mantras about being dead and having no heart beat or existence. CT of brain showed chronic ischemic changes. No acute process. Chest x-ray and urinalysis were both negative. Laboratory results including CBC, BMP, BNP, Troponin, blood gases, lactic acid, magnesium and phosphorus were normal. Psychiatry was consulted and an EEG showed no epileptiform activity but encephalopathy. 

Discussion: Walking Corpse Syndrome, Cotard Syndrome, is a rare condition and its exact prevalence is unknown but was first described by Dr. Jules Cotard in 1882. Cotard’s syndrome is a delusional disorder in which one believes that he or she is dead or has lost organs, blood, or body parts to insisting that one has lost one’s soul (Ruminjo & Mekinulov, 2008). The patient does not eat or focus on personal hygiene because the patient considers him/herself dead. This causes self-destruction by self-starvation leading to various nutritional and electrolyte imbalances  (Susmitha, Selvakumar, & Sriram, 2016). Walking corpse syndrome is often seen in coexistence with other psychological disturbances. Symptoms appear to vary depending on the progression of the syndrome. According to Yamada, et al. (1999), Cotard‘s delusion has three stages. The germination stage is characterized by hypochondriasis, depression and abnormal sensations. The blooming stage is characterized by delusions, negative feelings, and anxiety. The chronic stage characterized by mood swings and systemization of delusions (Susmitha, Selvakumar, & Sriram, 2016).

Conclusions: Cotard’s Syndrome is a rare delusional disorder. It should be considered when patients exhibit characteristic features without medical causes. ECT is the choice of treatment for Cotard‘s delusion. Antidepressants and/or antipsychotics have shown positive results in the treatment of Cotard‘s syndrome as well.

References: 

Ruminjo, A. & Mekinulov, B. (2008). A case report of Cotard’s Syndrome. Psychiatry, 5(6), 28-29. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695744

Susmitha, A, Selvakumar, S., & Sriram, N. (2016) Walking corpse syndrome: A delusion of being dead. International Journal of Allied Medical Sciences and Clinical Research, 4(1), 70-74.

Yamada K, Katsuragi S, & Fujii I. (1999). A case study of Cotard’s syndrome: stages and diagnosis. Acta Psychiatrica Scandinavica, 100(5), 396-399.