Medical Oddities: Alive, but convinced otherwise

A deadly conviction, healing vanilla, stormy lungs, and a COVID tea party await.

By
Teraya Smith
October 15, 2026
5 min

MDSpire News

Overview

A 2026 case report described a man with schizophrenia and nihilistic delusions consistent with Cotard’s delusion, including the belief that he was dead and no longer existed. His delusions nearly resolved after oral risperidone was initiated and long-acting injectable paliperidone palmitate was given, but sustained remission could not be assessed because follow-up was unavailable.

Background

Cotard’s syndrome describes nihilistic delusions, such as believing oneself to be dead or to lack organs, and is not a formal diagnosis in DSM-5-TR or ICD-11. The term is used for a delusional theme reported across mood, psychotic, and neurological disorders. A previous study cited in the case report found Cotard’s delusion in 0.62% of 1,321 inpatient psychiatric consultations. Case-based literature also describes Cotard phenomenology after acquired brain injury, highlighting neurological conditions as a possible context for these beliefs.

Data Highlights

Measure	Finding
Patient	Man in his 40s with schizophrenia
Initial treatment	Oral risperidone, started at 1 mg nightly and gradually increased to 2 mg twice daily
Long-acting treatment	Paliperidone palmitate 234 mg on day 5
Clinical course	Delusions had decreased by day 4; the belief that he was dead had nearly resolved by day 6
Follow-up	Unavailable, so sustained remission could not be confirmed

Key Findings

The patient presented with migraine and joint pain and reported believing that he was dead, no longer existed, and had had his throat cut.
His presentation was described as consistent with Cotard’s delusion. He had discontinued psychiatric medication; his drug screen was negative despite a history of substance use.
Risperidone was initiated and gradually increased as paranoia, disorganized thinking, and nihilistic delusions persisted. By day 4, the delusions had decreased, while paranoia and disorganized thinking remained.
Paliperidone palmitate 234 mg was administered on day 5 to address medication nonadherence. By day 6, the belief that he was dead had nearly resolved, with minor somatic complaints remaining.

Clinical Implications

The case report describes improvement in nihilistic delusions during treatment with oral risperidone followed by long-acting paliperidone palmitate. Because follow-up was unavailable, sustained remission could not be assessed; the case does not establish comparative treatment efficacy.

Conclusion

This case describes near-resolution of Cotard-type nihilistic delusions over six days during antipsychotic treatment in a patient with schizophrenia. The absence of follow-up leaves the durability of the improvement unknown.