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Cited by 30Schizophrenia research and treatmentMental Health and PsychiatryHallucinations in medical conditions

Cotard delusion in the context of schizophrenia: a case report and review of the literature

Open access
Bott, Nicholas, Keller, Corey, Kuppuswamy, Malathy, Spelber, David, Zeier, Joshua·2016·Frontiers in Psychology
DOI 10.3389/fpsyg.2016.01351PMC PMC5013050
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Abstract

BACKGROUND: The Cotard delusion (CD) is one of a variety of narrowly defined monothematic delusions characterized by nihilistic beliefs about the body's existence or life itself. The presence of CD within the context of schizophrenia is rare (<1%), and remains understudied. CASE: 'Mr. C' is a 58-year-old veteran with a prior diagnosis of schizophrenia, who presented with CD in the context of significant depression, suicidal ideation, violence, and self-harm behavior. He perseverated in his belief that he was physically dead and possessed by demons for several weeks. This delusion was reinforced by his religious belief that life was an attribute of God, and by inference, he as a human, was dead. His condition gradually improved over the course of treatment with Divalproex and quetiapine with discussions about the rationale for his belief. Upon discharge, Mr. C. demonstrated awareness of his fixation on death and an ability to redirect himself. DISCUSSION: This case highlights the need to better understand the co-occurrence of CD in schizophrenia, their differentiation, the increased risk of violence and self-harm behavior in this presentation, and how specific events and religious factors can influence delusional themes of CD. Pharmacotherapy and aspects of cognitive-behavioral therapy may be effective in ameliorating these symptoms in CD.

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  • In clinical populations, delusions of death or dying, classically known as the Cotard delusion, are extremely infrequent in psychotic patients (<1% prevalence) and are often associated with conditions such as dementia or psychotic depression.

    “In clinical populations, delusions of death or dying, classically known as the Cotard delusion, are extremely infrequent in psychotic patients (<1% prevalence) (Bott et al., 2016; Dihingia et al., 2023), and are often associated with such conditions as dementia (Cipriani et al., 2019) or psychotic depression (Faunce and Tennant, 2024).”

    From “I was trying to save the world”: delusion-like ideation and associated impacts reported by Western practitioners of Buddhist meditation (2025) · cites this paper as Bott et al., 2016

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Authors
Bott, N., Keller, C., Kuppuswamy, M., Spelber, D., & Zeier, J.
Affiliations
  • VA Palo Alto Health Care System (US)
  • Stanford Medicine (US)
Corresponding author
Bott, Nicholas
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2016-09-07
Volume
7
Pages
1351-1351
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2016.01351
PMC
PMC5013050
OpenAlex
W2518719241
Cited by
30
References
27
Citations by year
2026: 4 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 7 · 2020: 4 · 2019: 2 · 2018: 5 · 2016: 1
FWCI
2.37
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
Keywords
schizophrenia, nihilistic delusions, religious delusions, self-harm, suicidal ideation, violence, veterans, divalproex, quetiapine, cognitive behavioral therapy, pharmacotherapy

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