Exploring the neurobiological correlate of Cotard's syndrome: Evidence from a three cases series

Roca-Zela M.; Huarcaya-Victoria J. · Psiquiatria Biologica (2026) · DOI: 10.1016/j.psiq.2026.100910

Resumen

Introduction: Cotard's syndrome is a rare clinical entity first described in 1880, which has evolved from a monothematic delusion to a condition with multiple concomitant disorders, primarily psychotic depression. Its study remains challenging due to limited available data. This study analyzes the clinical and neurobiological characteristics of three patients. Materials and methods: Data were collected from three elderly female patients hospitalized in the Psychiatry service of the Guillermo Almenara Irigoyen National Hospital, Lima, Peru, in 2023. Medical records, psychiatric evaluations, laboratory tests, and neuroimaging studies were reviewed. Results: The first case involved a 64-year-old woman with no prior psychiatric history who developed a psychotic depressive episode characterized by nihilistic delusions. The second case was a 69-year-old woman with a history of bipolar affective disorder, admitted for a depressive episode with anxious and psychotic symptoms, also presenting nihilistic delusions. The third case involved a 66-year-old woman with longstanding bipolar affective disorder and multiple previous hospitalizations, who presented with a psychotic depressive episode accompanied by catatonia and a neurocognitive disorder. Neuroimaging findings revealed alterations in the frontal and temporal cortices on SPECT, along with MRI findings suggesting an underlying organic condition. Conclusions: The findings demonstrate variability in cerebral perfusion, with reductions in the frontal, parietal, and temporal cortices. These results, align with previous studies suggesting that such alterations may contribute to an impaired ability to integrate external stimuli with autobiographical memories, facilitating delusional misidentification.

Instituciones: Universidad Nacional Mayor de San Marcos; Universidad Privada San Juan Bautista