RESUMO

RESUMEN En 1880 Jules Cotard describió un conjunto de delirios en forma de negaciones que luego se denominó síndrome con su apellido como epónimo. Se trata de una condición infrecuente que se caracteriza por delirios nihilistas en los cuales la persona piensa que «se encuentra muerta o que el mundo ya no existe¼. En este documento se realiza el seguimiento de un par de casos en los que se evidencia una semiología amplia y enriquecedora desde el punto de vista descriptivo, lo que permite revisarlos junto con el delirio de Cotard a la luz de la psiquiatría moderna. El primero corresponde a un trastorno depresivo y el otro se da en el contexto de un trastorno psicótico no afectivo. Se plantea la revisión de la literatura desde lo descrito por Cotard hasta llegar a las clasificaciones psiquiátricas actuales

ABSTRACT In 1880, Jules Cotard described a set of delusions in the form of negations that later became his eponymous syndrome. Cotard's syndrome is an uncommon condition characterised by the presence of nihilistic delusions in which the person thinks that "they are dead or that the world no longer exists". This document describes two cases in which a broad and enriching semiology is evidenced from a descriptive point of view, which allows us to review them together with Cotard's syndrome in the light of modern psychiatry. The first case corresponds to a depressive disorder and the other occurs in the context of a non-affective psychotic disorder. A review of the literature is presented from what Cotard described until the current psychiatric classifications.

RESUMO

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per "Dead" Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment.

Assuntos

RESUMO

We report the case of a patient with ruptured middle cerebral artery aneurysm, subarachnoid hemorrhage and frontal intracerebral hemorrhage, who secondarily presented with delayed cerebral ischemia and bilateral occipital infarcts, with complete vision loss, visual anosognosia, and confabulations as the main symptoms. Additionally, the patient had defined features of Cotard syndrome, as revealed by persistent nihilistic delusions. The brain imaging studies showed a bilateral occipital ischemic lesion, as well as frontal and parietal hemorrhagic lesions in the right hemisphere. We address the general theories of anosognosia, confabulation and the problem of why a bilateral occipital lesion is not enough for these metacognitive defects to exist. The presence of right frontal and or parietal hemisphere lesions could be necessary features in most cases.

RESUMO

RESUMEN Introducción: El síndrome de Cotard es de rara aparición en la clínica psiquiátrica. Debido a esto, la información actual se basa principalmente en reportes y series de casos. Objetivo: Analizar las características psicopatológicas y la agrupación de los síntomas de los casos de síndrome de Cotard reportados en la literatura médica. Métodos: Se realizó en la base de datos MEDLINE/PubMed una búsqueda sistemática de la literatura de todos los casos de síndrome de Cotard reportados desde 2005 hasta enero de 2018. Se recolectaron variables demográficas y las características clínicas de cada caso. Se realizó un análisis factorial exploratorio de los síntomas. Resultados: La búsqueda identificó 86 artículos, de los cuales 69 eran potencialmente relevantes. Luego de la revisión de los textos completos, se seleccionaron 55 artículos para la revisión sistemática, entre los cuales se hallaron 69 casos. En el grupo de más edad con síndrome de Cotard fueron más frecuentes los diagnósticos de depresión mayor (p < 0,001) y trastorno mental orgánico (p = 0,004). El análisis factorial exploratorio arrojó 3 factores: depresión psicótica, en la que se incluye a los pacientes con delirios de culpa (0,721), ideas suicidas (0,685), delirios de condena (0,662), delirio nihilista del cuerpo (0,642), depresión (0,522) y delirios hipocondriacos (0,535); delirante-alucinatorio, con pacientes que sufrían delirio de inmortalidad (0,566), alucinaciones visuales (0,545) y delirio nihilista de la existencia (0,451), y mixto, con pacientes que sufrían delirio nihilista de los conceptos (0,702), ansiedad (0,573) y alucinaciones auditivas (0,560). Conclusiones: La psicopatología del síndrome de Cotard es más compleja que la simple asociación con el delirio de estar muerto, ya que abarca una estructura factorial organizada en 3 factores.

ABSTRACT Introduction: Cotard's syndrome is a rare psychiatric condition. As a result, current information is mainly based on reports and case series. Objective: To analyse the psychopathological characteristics and the grouping of the symptoms of the Cotard's syndrome cases reported in the medical literature. Methods: A systematic review of the literature of all reported cases of Cotard's syndrome from 2005 to January 2018 was performed in the MEDLINE/PubMed database. Demographic variables and clinical characteristics of each case were collected. An exploratory factor analysis of the symptoms was performed. Results: The search identified 86 articles, of which 69 were potentially relevant. After reviewing the full texts, 55 articles were selected for the systematic review, in which we found 69 cases. We found that the diagnosis of major depression (P < 0.001) and organic mental disorder (P =0.004) were more frequent in the older group with Cotard's syndrome. An exploratory factor analysis extracted 3 factors: psychotic depression, in which it includes patients with delusions of guilt (0.721), suicidal ideas (0.685), delusions of damnation (0.662), nihilistic delusions of the body (0.642), depression (0.522), and hypochondriacal delusions (0.535); delusive-hallucinatory, with patients who presented delusions of immortality (0.566), visual hallucinations (0.545) and nihilistic delusions of existence (0.451), and mixed, with patients who presented nihilistic delusions of concepts (0.702), anxiety (0.573), and auditory hallucinations (0.560). Conclusions: The psychopathology of Cotard's syndrome is more complex than the simple association with the delusion of being dead, since it encompasses a factorial structure organised into 3 factors.

Assuntos

RESUMO

Resumen El Síndrome de Cotard es una condición neuropsiquiátrica poco frecuente, descrito inicialmente por Jules Cotard como un delirio hipocondríaco y luego como Delirio de negación, en que el paciente niega la existencia de partes de su cuerpo, la propia existencia y/o del mundo entero. La aparición de un Síndrome Catatónico junto al Síndrome de Cotard es aún más infrecuente. Se presenta el caso de una paciente de 72 años con una Depresión psicótica, que desarrolla un Síndrome de Cotard y posteriormente Catatonía. Logra buena respuesta tras la adición de Lorazepam y Venlafaxina al esquema farmacológico en curso, por lo que se desestima el uso de Terapia Electroconvulsiva. Se constata remisión total de síntomas y posterior recuperación funcional ad integrum, siendo evaluada a través de entrevista clínica, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale e Índice de Barthel. Además, se revisan otros reportes de caso sobre esta comorbilidad, y a diferencia de la mayoría de éstos, se destaca la favorable evolución de la paciente sin necesidad de Terapia Electroconvulsiva. Aún no se ha dilucidado la relación entre ambos síndromes, aunque algunos autores han planteado la hipótesis de vías neurobiológicas compartidas y otros han postulado la aparición de síntomas catatónicos como la progresión del Síndrome de Cotard. Para aclarar estas interrogantes, son necesarios más estudios al respecto que permitan conocer la etiopatogenia de esta inusual combinación.

Cotard's Syndrome is a rare neuropsychiatric condition, initially described by Jules Cotard as a hypochondriacal delusion and then as Delusion of negation, in which the patient denies the existence of parts of his body, his own existence and / or the entire world. The appearance of a Catatonic Syndrome together with Cotard Syndrome is even more infrequent. We present the case of a 72-year-old patient with a psychotic depression, who developed Cotard's Syndrome and later Catatonia. She achieves good response after the addition of Lorazepam and Venlafaxine to the current pharmacological treatment, so the use of Electroconvulsive Therapy is dismissed. Total remission of symptoms and subsequent functional recovery ad integrum was observed, being evaluated through clinical interview, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale and Barthel Index. In addition, other case reports on this comorbidity are reviewed, and unlike most of these, the favorable evolution of the patient stands out without the need for Electroconvulsive Therapy. The relationship between the two syndromes has not been elucidated, although some authors have proposed the hypothesis of shared neurobiological pathways and others have postulated the appearance of catatonic symptoms such as the progression of Cotard's Syndrome. To clarify these questions, more studies are needed in order to know the etiopathogenesis of this unusual combination.

Assuntos

RESUMO

Augusto dos Anjos (1884 - 1914) is one of the most original Brazilian poets of the twentieth century. He does not belong to a strict literary style and his poetry is marked by the use of scientific terms, by the existential suffering and by metaphysical questions. The personality of Augusto dos Anjos is described as melancholic and tormented, and he was known as "Doctor Sadness". He also had migraine. This paper reviews the biography of Augusto dos Anjos and investigates how his poetry echoes his psychopathological traits. We analyze the relations between creative genius and mental disorders. We also discuss the relations between migraine and psychopathology.

Augusto dos Anjos (1884 ­ 1914) é uma das vozes mais singulares da poesia brasileira do século XX. Sem nítida afiliação a uma escola literária específica, seus versos são marcados pelo léxico científico, pela inquietação metafísica e pelo sofrimento existencial. Observações biográficas relatam que o poeta tinha uma personalidade melancólica e angustiada, que lhe valeu a alcunha de "Doutor Tristeza". O autor também sofria de migrânea. Este trabalho revisita a biografia e a obra de Augusto dos Anjos, analisando como sua poesia repercute seus possíveis traços psicopatológicos, e discute sobre as relações entre gênio criativo e transtorno mental, além das relações entre migrânea e psicopatologia.

Assuntos

RESUMO

O estudo aborda a melancolia desde a psiquiatria até a psicanálise, chegando à formulação de Lacan de que, nesta afecção, trata-se da presença real - e não metafórica ou por identificação - do objeto no campo do sujeito. Percorre-se brevemente a definição desta entidade nosográfica desde Esquirol até Kraepelin, com destaque para o delírio hipocondríaco de negação descrito por Cotard. Retoma-se a tese de Freud de uma identificação do eu com objeto, para chegar a Lacan, que distingue o objeto idealizado da relação de amor e o objeto causa de desejo, que deve permanecer velado. Na melancolia, trata-se da relação direta do sujeito com este objeto. A vinda ao primeiro plano do objeto a dá a fórmula geral do estatuto do sujeito na psicose, na qual é o objeto que está no comando.

This study addresses melancholia in both its psychiatric and its psychoanalytic concepts, including Lacan's formulation. According to Lacan, melancholia consists of a real presence of the object in the field of the subject - rather than presence as metaphor or by identification. We briefly discuss the history of the definition of melancholia from Esquirol to Kraepelin, then take up Cotard's work on hypochondriac delusions. Freud's thesis of identification by the ego is then discussed and followed by Lacan's considerations. Lacan distinguishes the idealized object of the love relationship from the object cause of desire, which remains hidden. In melancholia the question is the direct relation of the subject with this object. The emergence of object "a" to the foreground provides the general formula of the status of the subject in psychosis, where the object is in command.

Cet article analyse la mélancolie de la psychiatrie à la psychanalyse et aboutit à la formulation de Lacan selon laquelle, en ce qui concerne cette condition, il s'agit de la présence réelle - et non pas métaphorique ou par identification - de l'objet dans le champ du sujet. Nous reprenons rapidement la définition de cette entité nosographique d'Esquirol à Kraepelin en soulignant le délire hypocondriaque des négations décrit par Cotard. Nous discutons la thèse de Freud de l'identification du moi avec l'objet et aboutissons à Lacan qui distingue l'objet idéalisé de la relation amoureuse de l'objet cause du désir qui doit rester caché. En ce qui concerne la mélancolie, il s'agit du rapport direct du sujet avec cet objet. L'apparition au premier plan de cet " objet a " nous livre la formule générale de la condition du sujet dans la psychose, dans laquelle l'objet commande.

El texto trata de la melancolía desde la psiquiatría hasta el psicoanálisis con la tesis de Lacan de que, en esta patología, la presencia del objeto es real en el campo del sujeto - y no una presencia metafórica o por identificación. Se traza brevemente los pasos de la definición de esta categoría desde Esquirol hasta Kraepelin, destacando el delirio hipocondriaco de negación descrito por Cotard. Se retoma la tesis de Freud de una identificación del yo con el objeto llegando a Lacan que propone que se haga la distinción entre el objeto idealizado de la relación de amor y el objeto causa del deseo, que debe permanecer velado. En la melancolía, ocurre la relación directa del sujeto con este objeto. La ascensión al primer plan del objeto a proporciona la fórmula general de la condición del sujeto en la psicosis, en la cual es el objeto que está en el comando.

Assuntos

RESUMO

O estudo aborda a melancolia desde a psiquiatria até a psicanálise, chegando à formulação de Lacan de que, nesta afecção, trata-se da presença real - e não metafórica ou por identificação - do objeto no campo do sujeito. Percorre-se brevemente a definição desta entidade nosográfica desde Esquirol até Kraepelin, com destaque para o delírio hipocondríaco de negação descrito por Cotard. Retoma-se a tese de Freud de uma identificação do eu com objeto, para chegar a Lacan, que distingue o objeto idealizado da relação de amor e o objeto causa de desejo, que deve permanecer velado. Na melancolia, trata-se da relação direta do sujeito com este objeto. A vinda ao primeiro plano do objeto a dá a fórmula geral do estatuto do sujeito na psicose, na qual é o objeto que está no comando. .(AU)

This study addresses melancholia in both its psychiatric and its psychoanalytic concepts, including Lacan's formulation. According to Lacan, melancholia consists of a real presence of the object in the field of the subject - rather than presence as metaphor or by identification. We briefly discuss the history of the definition of melancholia from Esquirol to Kraepelin, then take up Cotard's work on hypochondriac delusions. Freud's thesis of identification by the ego is then discussed and followed by Lacan's considerations. Lacan distinguishes the idealized object of the love relationship from the object cause of desire, which remains hidden. In melancholia the question is the direct relation of the subject with this object. The emergence of object "a" to the foreground provides the general formula of the status of the subject in psychosis, where the object is in command.(AU)

Cet article analyse la mélancolie de la psychiatrie à la psychanalyse et aboutit à la formulation de Lacan selon laquelle, en ce qui concerne cette condition, il s'agit de la présence réelle - et non pas métaphorique ou par identification - de l'objet dans le champ du sujet. Nous reprenons rapidement la définition de cette entité nosographique d'Esquirol à Kraepelin en soulignant le délire hypocondriaque des négations décrit par Cotard. Nous discutons la thèse de Freud de l'identification du moi avec l'objet et aboutissons à Lacan qui distingue l'objet idéalisé de la relation amoureuse de l'objet cause du désir qui doit rester caché. En ce qui concerne la mélancolie, il s'agit du rapport direct du sujet avec cet objet. L'apparition au premier plan de cet " objet a " nous livre la formule générale de la condition du sujet dans la psychose, dans laquelle l'objet commande.(AU)

El texto trata de la melancolía desde la psiquiatría hasta el psicoanálisis con la tesis de Lacan de que, en esta patología, la presencia del objeto es real en el campo del sujeto - y no una presencia metafórica o por identificación. Se traza brevemente los pasos de la definición de esta categoría desde Esquirol hasta Kraepelin, destacando el delirio hipocondriaco de negación descrito por Cotard. Se retoma la tesis de Freud de una identificación del yo con el objeto llegando a Lacan que propone que se haga la distinción entre el objeto idealizado de la relación de amor y el objeto causa del deseo, que debe permanecer velado. En la melancolía, ocurre la relación directa del sujeto con este objeto. La ascensión al primer plan del objeto a proporciona la fórmula general de la condición del sujeto en la psicosis, en la cual es el objeto que está en el comando.(AU)

Assuntos

RESUMO

Retomada de um tipo de delírio, o de negações, também conhecido como Síndrome de Cotard,destacando a sintomatologia presente neste quadro, aproximando-o com a história da psiquiatriafrancesa no século XIX.(AU)

Review of certain type of delirium, the negation delirium, also know as syndrome of Cotard,have a history in Psychiatry, in particular the XIX century French.(AU)