Clinical Scorecard: Cotard’s delusion in a patient with schizophrenia
At a Glance
Category
Detail
Condition
Cotard’s delusion, a rare neuropsychiatric phenomenon involving beliefs of being dead or no longer existing
Key Mechanisms
The case report describes nihilistic delusions in a patient with schizophrenia; it does not establish a mechanism.
Target Population
A man in his 40s with schizophrenia, medication nonadherence, and a history of substance use
Care Setting
Inpatient psychiatric care described in a single case report
Key Highlights
The patient presented with migraine and joint pain and reported believing he was dead, no longer existed, and had his throat cut.
His drug screen was negative, and he had discontinued psychiatric medications.
Oral risperidone was increased from 1 mg nightly to 2 mg twice daily; delusions had decreased by day 4, although paranoia and disorganized thinking persisted.
He received 234 mg of long-acting injectable paliperidone palmitate on day 5 to address medication nonadherence; by day 6, the belief that he was dead had nearly resolved, leaving minor somatic complaints.
Electroconvulsive therapy was not needed; sustained remission could not be confirmed because follow-up was unavailable.
Guideline-Based Recommendations
Diagnosis
The case describes symptoms consistent with Cotard’s delusion; no diagnostic criteria or workup recommendations are provided.
Management
In this case, clinicians initiated oral risperidone and later administered long-acting injectable paliperidone palmitate to address medication nonadherence.
Electroconvulsive therapy was not required in this case.
Monitoring & Follow-up
The report notes that sustained remission could not be confirmed because follow-up was unavailable.
Risks
The patient had discontinued psychiatric medications; the report does not provide broader risk estimates or safety guidance.
Patient & Prescribing Data
One man in his 40s with schizophrenia, a history of substance use, and a negative drug screen.
Risperidone was started at 1 mg orally nightly and increased to 2 mg twice daily. On day 5, the patient received 234 mg of long-acting injectable paliperidone palmitate. His nihilistic delusion had nearly resolved by day 6.
Clinical Best Practices
The case report describes assessing the patient’s reported beliefs alongside his psychiatric history, medication discontinuation, and drug-screen result.
The report describes use of an injectable antipsychotic in this case to address medication nonadherence.
The report does not establish long-term treatment outcomes because follow-up was unavailable.
This Neuroscience Grand Rounds session, led by Yasaman Movahedi and Deanna Aghbashian, explores psychosis in adolescence through both clinical and neurocognitive lenses, emphasizing early recognition and multidisciplinary management.
