COTARD-SYNDROME IN THE ELDERLY - HISTORICAL AND CLINICAL ASPECTS

This article explores the conceptual construction of Cotard's syndrome and includes an analysis of 100 cases of which 20 were over 65. Jules Cotard took the view that delire des negations was only a subtype of depressive illness characterized by sadness, guilt, marked anxiety, su icidal behaviour, insensitivity to pain, and delusions of negation, da mnation and enormity. Soon after his death, however, a debate ensued a s to whether what he had described was specific to melancholia or coul d be found associated with other psychoses. This view predominated for more than 80 years. Currently, and despite the fact that the French t erm delire means more than 'delusion', some authors use 'Cotard's delu sion' to refer to the isolated belief or 'being dead'. From clinical a nd evolutionary perspectives, it is unclear why an isolated delusion s hould merit (as some have suggested) a special brain location. Analysi s of the cases so far reported suggests that it is only in the elderly that Cotard's syndrome tends to acquire its clinical completeness. Th ere is no evidence, however, that its presence is a function of diseas e 'severity'.