The Walking Dead… Not Just a TV Show

This is an odd one. There’s a condition, called Cotard’s syndrome, where patients believe they are dead! We’re not talking zombies who have cravings for brains or human flesh. These patients believe that they are no longer alive and are having trouble getting to grips with why they are, literally, the walking dead.

A person who has Cotard’s syndrome is literally described as someone who believes that their body or parts of their body are either dead or are no longer there (this has got to be the weirdest definition of a syndrome I have ever come across). Cotard’s syndrome isn’t very well known because it is incredibly rare and is usually associated with other conditions, such as severe depression or psychosis. So it’s not only difficult to diagnose but there’s also not much out there on how to treat it.

I came across two articles, one in English and one in German, describing two patients who have Cotard’s syndrome, and I managed to find the case study for one of them. The opening paragraph was a clincher:

A 48 year-old man with no medical history, apart from a previous short depressive illness, was seen by a psychiatrist after a self-electrocution attempt. Eight months later, he first told his general practitioner that his brain had died. He further explained that “I am coming to prove that I am dead”, that he no longer needed to eat or sleep and was condemned to a kind of half-life, with a dead brain in a living body. He acknowledged that his abilities to see, hear, think, remember and communicate proved that his mind must be alive: he could not explain how his mind could be alive if his brain was dead, but he was certain that this was the case.’

How do you convince someone to take medication that well help them get better when there is nothing to make better because they are dead? Patient’s with Cotard’s syndrome not only believe that they are dead or a part of them is dead, they also don’t have any reason or desire to do their everyday things, such as eating, brushing their teeth, smoking, drinking, socialising, and so on. Some patients with Cotard’s syndrome have reportedly (actually) died from starvation because why would you need to eat when you’re dead?

Now this is where I get to tell you a bit about PET (Positron Emission Tomography) scans. A PET scan is a type of imaging test. A patient is first injected with a radioactive dye called a tracer. The patient is then scanned and tracer and the scanner work together to look at how well the organs and tissues are working. This video on how a PET scan work from the Imperial College London gives a great explanation:

The Psychiatrists did a PET scan on their patient and found that the metabolic activity in the parts of his brain that are needed for conscious awareness were so low (hypometabolic) that they were similar to patients who are in a coma. These areas of the brain that were in this vegetative state are responsible for our ability to recollect the past, to think about ourselves, to create a sense of self and it allows us to realise that we are the agent responsible for an action. If these parts of the brain are not functioning as they should then that would explain why patients believe that either a part of them or they themselves are dead, and why they cannot explain why they feel this way. It also explains why patients lose their lust for life.

So what can be done?

As the Psychiatrists of this particular patient pointed out, they could not convince the patient that he was alive. But with time, patience, and a lot of psychotherapy and drug treatment, the patient gradually found a way to take pleasure in life again. As this condition is so rare there is not yet one standardise treatment that Psychiatrists can try. So even though it is a fascinating case to take on, it is the ultimate challenge of bringing patients ‘back from the dead’ before they end up… well… dead.

Written by Alison Holland

References

Charland-Verville et al. (2013). Brain dead yet mind alive: A positron emission tomography case study of brain metabolism in Cotard’s syndrome.

Mindscapes: First interview with a dead man

BewusstseinIch existiere nicht

Carano et al. (2014). Cotard’s Syndrome: Clinical Case Presentation and Literature Review