0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
We Are All Zombies Anyway: Aggression in Cotard's Syndrome
Christian G. Huber, M.D.; Agorastos Agorastos, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2012;24:E21-E21. doi:10.1176/appi.neuropsych.11070155
View Author and Article Information

None of the authors received funding for this article.

AA treated the patient; CGH conducted literature research and wrote the first draft of the manuscript; AA revised the manuscript for important intellectual content. Both authors have contributed to, read, and approved the final version of the manuscript.

There are no conflicts of interest. None of the authors received funding for this case report.

Dept. of Psychiatry and Psychotherapy University Medical Center Hamburg-Eppendorf Hamburg, Germany

Correspondence: Christian G. Huber, M.D. e-mail: c.huber@uke.uni-hamburg.de

To the Editor: Cotard’s syndrome is an infrequent condition with monothematic, nihilistic delusions. The delusion of being dead is common, but delusions of immortality can also be present.1 Patients tend to act according to their belief and so are at an increased risk of self-mutilation and suicide.2 In theory, Cotard’s syndrome could also lead to a lower threshold for violence against others, but no such case has been reported. We provide first evidence of Cotard’s syndrome resulting in repeated aggressive behavior.

"Mr. H.," a 32-year-old patient, was involuntarily admitted to our closed ward in February 2011. He had been diagnosed with paranoid schizophrenia and cannabis abuse at the age of 22, when he had been taken into police custody after a fight with his neighbors. In the following years, multiple involuntary admissions were necessary. After clozapine treatment had been started and a legal custodian was installed, the frequency of intimidating and hostile behavior could be reduced. The current hospitalization had become necessary after the patient had been reluctant to continue medication and had again started showing violent behavior.

During psychopathological examination, we saw an agitated, suspicious patient with severely affected formal thinking. He reported being dead since he had drowned in a lake years before, and said that he had been reanimated as a zombie by radiation from mobile telephones. He was under the impression that he was still under water, and that everybody else had also drowned and become a zombie. The patient explained that although it was morally wrong to exert violence on living persons, there was nothing wrong with beating up zombies. He wasn’t afraid of retaliation or legal prosecution, because he believed himself to be dead and to have no feelings.

After acute treatment with orally administered haloperidol and diazepam and injections of zuclopenthixol, clozapine treatment could be resumed. Delusions of being dead decreased in intensity, and the patient became less intimidating and hostile. By the time of dismissal, the patient showed no aggressive behavior.

For our patient, there were no records of aggressive behavior before the onset of schizophrenia, and his clinical file documented that he had frequently committed aggressive acts afterward, and multiple episodes of involuntary treatment and physical restraint had become necessary. The patient repeatedly used the belief that he and all persons were zombies as justification for his violent behavior. This is in line with the literature, as acting because of a belief is a typical criterion for severe delusions, and has been found to be associated with violent crime in delusional patients.3 Thus, Cotard’s syndrome in our patient can be seen as a condition facilitating aggressive behavior.

We therefore suggest critical assessment the risk of violent behavior in patients with delusions justifying aggression. Nevertheless, dangerousness has to be constantly re-evaluated to avoid stigmatization and unjustified retention in the penal system.4

Ramirez-Bermudez  J;  Aguilar-Venegas  LC;  Crail-Melendez  D  et al:  Cotard syndrome in neurological and psychiatric patients.  J Neuropsychiatry Clin Neurosci 2010; 22:409–416
[CrossRef] | [PubMed]
 
Debruyne  H;  Portzky  M;  Van den Eynde  F  et al:  Cotard’s syndrome: a review.  Curr Psychiatry Rep 2009; 11:197–202
[CrossRef] | [PubMed]
 
Teixeira  EH;  Dalgalarrondo  P:  Violent crime and dimensions of delusion: a comparative study of criminal and noncriminal delusional patients.  J Am Acad Psychiatry Law 2009; 37:225–231
[PubMed]
 
Ciompi  L;  Harding  CM;  Lehtinen  K:  Deep concern.  Schizophr Bull 2010; 36:437–439
[CrossRef] | [PubMed]
 
References Container
+

References

Ramirez-Bermudez  J;  Aguilar-Venegas  LC;  Crail-Melendez  D  et al:  Cotard syndrome in neurological and psychiatric patients.  J Neuropsychiatry Clin Neurosci 2010; 22:409–416
[CrossRef] | [PubMed]
 
Debruyne  H;  Portzky  M;  Van den Eynde  F  et al:  Cotard’s syndrome: a review.  Curr Psychiatry Rep 2009; 11:197–202
[CrossRef] | [PubMed]
 
Teixeira  EH;  Dalgalarrondo  P:  Violent crime and dimensions of delusion: a comparative study of criminal and noncriminal delusional patients.  J Am Acad Psychiatry Law 2009; 37:225–231
[PubMed]
 
Ciompi  L;  Harding  CM;  Lehtinen  K:  Deep concern.  Schizophr Bull 2010; 36:437–439
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 44.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 5.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 7.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 50.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 50.  >
Topic Collections
Psychiatric News
PubMed Articles
We are all zombies anyway: aggression in Cotard's syndrome. J Neuropsychiatry Clin Neurosci 2012;24(3):E21.