“I Do Not Exist”—Cotard Syndrome in Insular Cortex Atrophy

Published:November 13, 2014DOI:
      Cotard syndrome is a condition of multiple etiologies involving delusional beliefs that one is dead, dying, or nonexistent or is putrefying with nihilistic thoughts regarding specific body parts or the whole self. Neurobiology of Cotard syndrome is controversial, and hence a peek into it may be very enlightening. We present here a case of dementia, developing severe depression and Cotard syndrome during the course of illness, whose subsequent magnetic resonance imaging (MRI) revealed insular cortex atrophy. We then discuss the possible mechanistic association between the atrophy and symptomatology of nihilism.
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        • Ramirez-Bermudez J.
        • Aguilar-Venegas L.C.
        • Crail-Melendez D.
        • Espinola-Nadurille M.
        • Nente F.
        • Mendez M.F.
        Cotard syndrome in neurological and psychiatric patients.
        J Neuropsychiatry Clin Neurosci. 2010; 22: 409-416
        • Seth A.K.
        Interoceptive inference, emotion, and the embodied self.
        Trends Cogn Sci. 2013; 17: 565-573
        • Craig A.D.
        How do you feel – now? The anterior insula and human awareness.
        Nat Rev Neurosci. 2009; 10: 59-70
        • Allman J.M.
        • Tetreault N.A.
        • Hakeem A.Y.
        • Manaye K.F.
        • Semendeferi K.
        • Erwin J.M.
        • et al.
        The von Economo neurons in frontoinsular and anterior cingulate cortex in great apes and humans.
        Brain Struct Funct. 2010; 214: 495-517
        • Singer T.
        • Critchley H.D.
        • Preuschoff K.
        A common role of insula in feelings, empathy and uncertainty.
        Trends Cogn Sci. 2009; 13: 334-340
        • Wright S.
        • Young A.W.
        • Hellawell D.J.
        Sequential Cotard and Capgras delusions.
        Br J Clin Psychol. 1993; 32: 345-349
        • McKay R.
        • Cipolotti L.
        Attributional style in a case of Cotard delusion.
        Conscious Cogn. 2007; 16: 349-359
        • Frith C.
        Explaining delusions of control: The comparator model 20 years on.
        Conscious Cogn. 2011; 21: 52-54
        • Fletcher C.
        • Frith C.D.
        Perceiving is believing: A Bayesian approach to explaining the positive symptoms of schizophrenia.
        Nat Rev Neurosci. 2009; 10: 48-58
        • Seeley W.W.
        Anterior insula degeneration in frontotemporal dementia.
        Brain Struct Funct. 2010; 214: 465-475
        • Critchley H.D.
        • Wiens S.
        • Rotshtein P.
        • Ohman A.
        • Dolan R.J.
        Neural systems supporting interoceptive awareness.
        Nat Neurosci. 2004; 7: 189-195
        • Berrios G.E.
        • Luque R.
        Cotard’s syndrome: Analysis of 100 cases.
        Acta Psychiatr Scand. 1995; 91: 185-188
        • Pearn J.
        • Gardner-Thorpe C.
        Jules Cotard (1840–1889): His life and the unique syndrome which bears his name.
        Neurology. 2002; 58: 1400-1403