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10 Case Reports of Cotard’s Delusion

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Cotard’s Delusion is a mental disorder where people suffer the nihilistic delusion that they are dead or no longer exist. First reported in the 1700s, the disorder is still largely a mystery today. The underlying cause isn’t understood; it’s been linked to bipolar disorder, depression and/or schizophrenia depending on the patient’s age. Here, ten people who went to their doctors and complained that they were dead.

1. In 1788, Charles Bonnet reported one of the earliest recorded cases of Cotard’s Delusion. An elderly woman was preparing a meal when she felt a draft and then became paralyzed on one side of her body. When feeling, movement, and the ability to speak came back to her, she told her daughters to dress her in a shroud and place her in a coffin. For days she continued to demand that her daughters, friends, and maid treat her like she was dead. They finally gave in, putting her in a shroud and laying her out so they could “mourn” her. Even at the “wake,” the lady continued to fuss with her shroud and complain about its color. When she finally fell asleep, her family undressed her and put her to bed. After she was treated with a “powder of precious stones and opium,” her delusions went away, only to return every few months.

2. Some 100 years after Bonnet met the old lady, French neurologist Jules Cotard saw a patient with an unusual complaint. Mademoiselle X, as Cotard called her in his notes, claimed to have “no brain, no nerves, no chest, no stomach and no intestines.” Despite this predicament, she also believed that she “was eternal and would live for ever.” Since she was immortal, and didn’t have any innards anyway, she didn’t see a need to eat, and soon died of starvation. Cotard’s description of the woman’s condition spread widely and was very influential, and the disorder was eventually named after him.

3. In 2008, New York psychiatrists reported on a 53-year-old patient, Ms. Lee, who complained that she was dead and smelled like rotting flesh. She asked her family to take her to a morgue so that she could be with other dead people. They dialed 911 instead. Ms. Lee was admitted to the psychiatric unit, where she accused paramedics of trying to burn her house down. After a month or so of a drug regimen, she was released with great improvement in her symptoms.

4. In 1996, a Scottish man who suffered head injury in a motorcycling accident began to believe he had died from complications during his recovery. Not long after he completed recovery, he and his mother moved from Edinburgh to South Africa. The heat, he explained to his doctors, confirmed his belief because only Hell could be so hot.

5. In 2012, Japanese doctors described a 69-year-old patient who declared to one of the doctors, “I guess I am dead. I’d like to ask for your opinion.” When the doctor asked him whether a dead man could speak, the patient recognized that his condition defied logic, but could not shake his conviction that he was deceased. After a year, his delusion passed, but he insisted on the truth of what happened during it. “Now I am alive. But I was once dead at that time,” he said. He also believed that Kim Jong-il was also a patient at the same hospital.

6. In 2009, Belgian psychiatrists reported the case of an 88-year-old man who came to their hospital with symptoms of depression. The man explained that he was dead, and was concerned and anxious that no one had buried him yet. His delusions subsided with treatment.

7. The same doctors also treated a 46-year-old woman who claimed to have not eaten nor gone to the bathroom in months, nor slept in years. She explained that all her organs had rotted, that she had no blood and that doctors who monitored her heart or took her blood pressure were deceiving her because her heart didn’t beat. After multiple admissions to the hospital and a lapse in taking her medication over the next 10 months, her condition gradually improved.

8. Greek psychiatrists received a patient in 2003 who believed he was literally empty-headed. He had attempted suicide years earlier because he thought it wasn’t worth living since he didn’t have a brain. He was not treated after the incident and simply returned to work. Once at the hospital he “claimed that he was born ‘without a mind,’ meaning that his head is empty without a brain and for this reason he is retarded.” He left against medical advice after several days, and was re-admitted the next year. This time he completed treatment and showed sustained improvement in a follow-up interview months later.

9. The Greek doctors also treated a 72-year-old woman who went to the ER claiming “all of her organs had melted; only skin had remained and that she was practically dead.” She was admitted to the hospital and her outcome not reported.

10. In 2005, Iranian doctors described what may be the most unusual case recorded. A 32-year-old man arrived at their hospital saying that not only was he dead, but that he had been turned into a dog. He said that his wife had suffered the same fate. His three daughters, he believed, had also died and had turned into sheep. He said that his relatives had tried to poison him, but that nothing could hurt him because God protected him even in death. He was diagnosed with Cotard’s and clinical lycanthropy, treated with electro-convulsive therapy and relieved of his major symptoms. (You can read more about this case at my website.)

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science
New Patient Test Could Suggest Whether Therapy or Meds Will Work Better for Anxiety
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Like many psychological disorders, there's no one-size-fits-all treatment for patients with anxiety. Some might benefit from taking antidepressants, which boost mood-affecting brain chemicals called neurotransmitters. Others might respond better to therapy, and particularly a form called cognitive behavioral therapy, or CBT.

Figuring out which form of treatment works best often requires months of trial and error. But experts may have developed a quick clinical test to expedite this process, suggests a new study published in the journal Neuropsychopharmacology.

Researchers at the University of Illinois at Chicago have noted that patients with higher levels of anxiety exhibit more electrical activity in their brains when they make a mistake. They call this phenomenon error-related negativity, or ERN, and measure it using electroencephalography (EEG), a test that records the brain's electric signals.

“People with anxiety disorders tend to show an exaggerated neural response to their own mistakes,” the paper’s lead author, UIC psychiatrist Stephanie Gorka, said in a news release. “This is a biological internal alarm that tells you that you've made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder.”

Gorka and her colleagues wanted to know whether individual differences in ERN could predict treatment outcomes, so they recruited 60 adult volunteers with various types of anxiety disorders. Also involved was a control group of 26 participants with no history of psychological disorders.

Psychiatrists gauged subjects’ baseline ERN levels by having them wear an EEG cap while performing tricky computer tasks. Ultimately, they all made mistakes thanks to the game's challenging nature. Then, randomized subjects with anxiety disorders were instructed to take an SSRI antidepressant every day for three months, or receive weekly cognitive behavioral therapy for the same duration. (Cognitive behavioral therapy is a type of evidence-based talk therapy that forces patients to challenge maladaptive thoughts and develop coping mechanisms to modify their emotions and behavior.)

After three months, the study's patients took the same computer test while wearing EEG caps. Researchers found that those who'd exhibited higher ERN levels at the study's beginning had reduced anxiety levels if they'd been treated with CBT compared to those treated with medication. This might be because the structured form of therapy is all about changing behavior: Those with enhanced ERN might be more receptive to CBT than other patients, as they're already preoccupied with the way they act.

EEG equipment sounds high-tech, but it's relatively cheap and easy to access. Thanks to its availability, UIC psychiatrists think their anxiety test could easily be used in doctors’ offices to measure ERN before determining a course of treatment.

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Food
A Pitless Avocado Wants to Keep You Safe From the Dreaded 'Avocado Hand'
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The humble avocado is a deceptively dangerous fruit. Some emergency room doctors have recently reported an uptick in a certain kind of injury—“avocado hand,” a knife injury caused by clumsily trying to get the pit out of an avocado with a knife. There are ways to safely pit an avocado (including the ones likely taught in your local knife skills class, or simply using a spoon), but there’s also another option. You could just buy one that doesn’t have a pit at all, as The Telegraph reports.

British retailer Marks & Spencer has started selling cocktail avocados, a skinny, almost zucchini-like type of avocado that doesn’t have a seed inside. Grown in Spain, they’re hard to find in stores (Marks & Spencer seems to be the only place in the UK to have them), and are only available during the month of December.

The avocados aren’t genetically modified, according to The Independent. They grow naturally from an unpollinated avocado blossom, and their growth is stunted by the lack of seed. Though you may not be able to find them in your local grocery, these “avocaditos” can grow wherever regular-sized Fuerte avocados grow, including Mexico and California, and some specialty producers already sell them in the U.S. Despite the elongated shape, they taste pretty much like any other avocado. But you don’t really need a knife to eat them, since the skin is edible, too.

If you insist on taking your life in your hand and pitting your own full-sized avocado, click here to let us guide you through the process. No one wants to go to the ER over a salad topping, no matter how delicious. Safety first!

[h/t The Telegraph]

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