What is Cotard’s Delusion?

Cotard’s Delusion (also known as walking dead syndrome) is a very rare mental disorder in which the person feels as though they are literally dead. Often these people walk around believing that they are invisible, cannot be killed because they are already dead, that they have no blood in their body and that their body is rotting somewhere in the ground.

As a paramedic, is is very rare to see Cotard’s  Delusion, however, it is important to be aware of it, because some of the apparent suicide attempts that we attend are not suicide attempts at all but persons with Cotard’s Delusion who walk in front of trains, cars, or off cliffs because they literally believe that they are already dead.

These people are not necessarily depressed, but will often inadvertently injure themselves believing that they are already dead and therefore immortal.

Pathophysiology of Cotard’s Delusion

Neurologically Cotard’s delusion is thought to be closely related to Capgras Syndrome as both conditions appear to involve a disconnection between the areas of the brain that recognise faces and emotions.  Psychologically, Cotard’s delusion is often related to schizophrenia and an acute psychosis (often causes by certain drug use).

Constant reassurance in a calm and confident tone is important for these patients. Within the hospital system, treatment aims at mood stabilisation through antidepressant therapies, antipsychotic medications, and in severe cases, electro-convulsive therapy has been seen to improve the person’s condition.