To report a case of Cotard’s syndrome in an 88-year-old man following a suicide attempt and to explore the interplay between delirium, severe depression, and neurocognitive impairment as it relates to the case.
Approach:
Case Description: An 88-year-old man with no prior psychiatric treatment was admitted after a medication-overdose suicide attempt during a severe depressive crisis.
Clinical Presentation: He exhibited a fluctuating confusional state with disturbances in orientation, attention, paranoid ideation, and nihilistic beliefs, including claims of being dead.
Treatment: The patient was treated with risperidone, mirtazapine, somatic stabilization, and supportive psychotherapy, leading to gradual resolution of symptoms.
Key Findings:
Nihilistic beliefs persisted even during lucid intervals, indicating a complex symptomatology.
The patient presented with severe depressive symptoms, metabolic abnormalities, and mild neurocognitive impairment, which may have contributed to the clinical picture.
This case illustrates the intricate relationship between delirium, severe depression, and neurocognitive vulnerability in older adults.
Interpretation:
The clinical picture was interpreted as Cotard-type nihilistic delusions arising during a fluctuating delirious state in the context of severe depression and suicidal behavior.
Limitations:
The case study is based on a single patient, which limits the generalizability of the findings to broader populations.
The underlying neurocognitive vulnerabilities were not fully explored, which may affect the understanding of the condition.
Conclusion:
This case highlights the importance of differential diagnosis when nihilistic delusions occur in medically and cognitively vulnerable older adults, specifically in the context of the presented case.
