Nihilistic hypochondriacal delirium is characteristic of

Cotard's syndrome (depressive delirium of a nihilistic nature) accompanies some psychiatric diseases. At the same time, the patient expresses grotesque hypochondriacal thoughts, and is also in a state of severe depression, close to a suicidal state.

The disease is quite rare. This syndrome includes several manifestations of mental disorders:

• severe depression;
• violation of adequate perception of the surrounding world;
• Cotard's actual nihilistic delirium is hypochondriacal thoughts of extreme severity.

Some experts believe that Cotard's syndrome is inherently a negative reflection of delusions of grandeur.

What is Cotard's syndrome

Among severe nervous disorders, a special place is occupied by Cotard's delirium or living dead syndrome. In the medical literature, this rare pathology is called differently. ICD-10 code – F22 Chronic delusional disorders. Patients are obsessed with nihilistic delirium about the absence of their own body or a separate part of it; they deny the very fact of their existence. Patients are convinced that there is emptiness around them, they are dead and are aliens from another world.

Nervous pathology is a rare form of hallucinatory delusion, which is accompanied by suicidal behavior. Patients fall into severe depression, lose interest in the world around them, and do not take care of themselves. Taste and olfactory hallucinations are typical for their condition. Some patients deliberately injure themselves, proving that they are not in pain. Their ideas are enormous - not only did their lives end, the entire planet perished. According to some psychiatrists, this is nothing more than manic delusions of grandeur or mirror syndrome.

Jules Cotard, a famous French neurologist, was the first in the history of psychiatry (1880) to describe the denial syndrome. His first patient was completely convinced that she was dead, had no heart, and her veins were empty. The woman stopped eating and drinking, denied generally accepted values ​​and talked about the curse hanging over her. The doctor combined delusional thoughts about immortality, anxiety, depression, melancholy, and insensitivity to pain into one pathology. Later, the described syndrome received the name of its discoverer.

Chapter Nine Hypochondriacal Delirium

Chapter Nine

Hypochondriacal delirium

Delirium of physical impact, accompanied by pathological sensations, is a transition to the next type of delirium - hypochondriacal, the main obligatory core of which consists of ideas and thoughts associated with pathological sensations arising in one’s own body. The peculiarity of pure hypochondriacal delirium, which could also be called delirium of bodily changes, in contrast to the other forms of delirium described above, is that other people do not participate or have little participation in it; it is limited only to the patient's own body.

Hypochondriacal delirium includes several of its varieties. Belonging to one or another variety depends on what the patient is convinced of. He may be convinced, firstly, that his body is pathologically altered, while feeling vague somatic ailments in the body; secondly, that he is sick with some specific serious somatic disease that affects the entire body (cancer, syphilis, etc.

) or any part of the body; thirdly, that the contours of his body have changed, for example, the patient feels that he has become like a woman, mammary glands have appeared, the hair has acquired a different color, the penis has become smaller, etc.; fourthly, that there is something foreign in his body, for example, some animal, causing various unpleasant sensations that the patient clearly experiences and figuratively vividly describes.

With borderline, non-delusional syndromes, patients only experience various unpleasant sensations in the body, without having any definite conviction about their cause; this is observed, for example, in the so-called hypochondriacal form of schizophrenia, which we called “senestopathic.” It was described by G. N. Momot, and more recently by K. A. Skvortsov.

Hypochondriacal delirium was described by S. S. Korsakov under the name Paranoia neuralgica paraesthetica. However, the question of hypochondria in its various clinical manifestations, as reported by D. D. Fedotov, was developed by Russian authors much earlier, namely, starting from the 18th century (A. T. Bolotov, Z. I. Kibalchich, A. P. Bogoroditsky and etc.).[39])

Hypochondriacal delirium in schizophrenia is close to the cathethetic delirium described by V. A. Gilyarovsky, who rightly emphasized the real nature of the pathological sensations noted by patients. However, many foreign authors (Schule, Dupre and Levy, Mignard, etc.) mistakenly considered hypochondriacal delirium as an interpretation of pathological sensations.

In the majority of patients with schizophrenia in paranoid-hypochondriacal syndromes, there is a close cohesion of false ideas and perceptions with sensations. Ideas about impaired body functions are most often accompanied by corresponding sensations; one can thus think of a constant irradiation of irritations emanating from the sensory sphere (both the visceral organs and the thalamus, in which the irritations emanating from them are summed up) to the cerebral cortex, in which ideas about the body are formed, and back.

The purest type of hypochondriacal delirium is represented by the first of the varieties described above, so we will begin the clinical analysis with it. At the same time, patients feel vague but severe changes in their body, which they describe approximately in the following general expressions: “drying,” “rotting,” “smoldering,” “the whole body is atrophying, etc.

Sometimes these changes are localized predominantly in the stomach: “the stomach atrophies,” but the entire bodily disorder, even where it depends in the patient’s mind on one organ, is general, affecting the entire body, causing “malignant changes” in it, leading to organism to its death.

Patients rarely describe the nature of bodily sensations clearly. Sometimes they say that they experience coldness, weakness, etc. throughout their body. These experiences are usually combined with a general depressed mood, often with suicidal thoughts and tendencies, and therefore these patients require special supervision. In older authors we find a description of this syndrome within the framework of “melancholia” with hypochondriacal delirium. It is close to Cotard's syndrome.

We present the corresponding observation.

Patient R., 32 years old. Worker. He was in the 1st Moscow Psychiatric Hospital in 1940. He was admitted with complaints of weakness and discomfort in the stomach. According to the patient and his wife, it is known that the uncle had some kind of mental illness, was in a psychiatric hospital, where he died. The patient developed normally as a child, studied at school, and had average abilities. By nature he was always unsociable, taciturn, “strange.” According to the patient, he was always interested in medical issues. In 1924 (15 years old) I was ill with some disease for two and a half months, felt weakness, headaches, spent a month in a somatic hospital, where nothing special was found. After that I worked and felt satisfactory. No special deviations were noted either in well-being or in external behavior. He didn’t go to the doctors: “I was confident in my body.” I did not abuse alcohol. Denies sexually transmitted diseases, as well as other somatic diseases. I started feeling unwell a few months ago. According to his wife, he became strange, said that his family was dead or that she would die of starvation, and tried to hang himself. The patient himself, according to him, from that time on began to feel weakness, discomfort in the stomach: emptiness, dryness in it, and felt hungry all the time. Once I saw a poster that bad teeth can have various consequences, and I thought that his weakness depended on this. I spent some time in a somatic hospital, where nothing special was found, then I rested outside the city for a month, but I could not start work, and at home I could not do even light physical labor. In connection with this, he was admitted to a psychiatric hospital.

When examining internal organs and the nervous system, no deviations from the norm were found.

Mental status: oriented in place and time, behaves correctly, but mostly keeps to himself, speaks about himself outwardly calmly, indifferently, deliberately, as if thinking about something and not finishing speaking. Not quite accessible. The mood is low, but does not reveal any particular melancholy or depression. Development is sufficient, formal abilities are not impaired. He does not consider himself mentally ill and denies psychopathological symptoms. Fixed on the somatic condition. Complains of general weakness, discomfort in the stomach, a feeling of emptiness in it, dryness; it seems that the stomach does not cook well and the food comes out undigested, so it feels weak, wants to eat all the time, all the muscles are relaxed, there is a bad taste in the mouth: “the teeth are drying up,” “all the teeth are rotting,” “the stomach has not digested food for 10 years.” Previously, I was attached to my family, but now my attitude has changed: “they are definitely not my comrades.” He does not develop his idea in more detail. At the same time, he is afraid that he will not be able to feed his family. He doesn’t hope for treatment, because “he’s already tried everything.”

Subsequently, the patient continues to express hypochondriacal ideas; he assures that his stomach has already rotted, it is not filling and fat is coming from the muscles; it dries up and rots; he has already begun to die, and his entire family will die of starvation. Despite the initiation of insulin treatment, the patient's condition does not improve. He suddenly hanged himself.

https://www.youtube.com/watch?v=ytpressru

In this patient, as in others like him, the main thing is the delusional belief that he is in mortal danger not from his enemies, as is observed, for example, with delusions of persecution, but from his own body, without participation in this other people. The statements of patients are usually not constant, they vary;

The patient does not have clear and definite sensations that could lead to delusional interpretations, but he still has vague sensations that create the belief of some kind of trouble in the body, combined with the idea of ​​​​its decomposition, atrophy, etc., making up with it one indivisible whole.

In the next type of hypochondriacal delusion, which is close to the one described above, the patient’s judgments are more specific. They do not refer to the whole body, but mainly to any part of it, which, in the patient’s mind, is affected by some serious disease. Its presence is undeniable for the patient.

One patient, for example, experienced constant pain and discomfort in his back and claimed that he had tabes dorsalis. Another patient, who at first fixed his attention on his throat (he had previously choked on a bone), subsequently, accidentally overhearing doctors talking about cancer, was imbued with the conviction that he had cancer, which, as he felt, was growing throughout the body, passing through the lungs, back, gives off shoots.

The mood of patients is often depressed or anxious, but to a lesser extent than in previous patients. The sensations in the affected organs are of the nature of pain, burning, coldness, pressure, twitching, etc. While in some patients these sensations undoubtedly have a sensory basis, in others the absurdity of the statements, their crude concreteness, bizarre imagery, hyperbolicity, and symbolism come to the fore.

So, for example, patient Ch. claimed that he had a switch in his stomach, etc. All this gives grounds for the incorrect assumption that here we are talking only about delusional ideas, that is, pathological products of patients who are deprived of any was sensory based. However, these states and those in which sensations appear more convincingly are interconnected by a number of transitional states in which it is difficult to decide which component predominates.

Causes

Cotard's disease develops at any age (even in young people), but is more common in older people. Women are more susceptible to the manifestation of the syndrome. The causes of mental disorder are not fully understood. Dysfunction of the frontal-temporo-parietal areas of the cortex or default of the brain system is the cause of the development of the disease, according to one of the modern theories. This structure is responsible for cognitive processes (knowledge of the surrounding world and oneself).

Cotard's delirium occurs spontaneously or as a consequence of mental disorders, severe infectious diseases, and physiological disorders. Possible reasons include:

• prolonged severe depressive states;
• senile depression (senile);
• melancholy;
• constant psycho-emotional overload;
• chronic stress;
• different types of schizophrenia;
• bipolar personality disorder;
• psychoses;
• dementia (acquired dementia);
• epilepsy;
• multiple sclerosis;
• amnesia;
• progressive paralysis;
• cerebral atherosclerosis;
• traumatic brain injuries;
• regular use of strong antidepressants;
• previous operations;
• neoplasms in the brain;
• typhoid fever;
• severe intoxication;
• metabolic disease.

Preventive measures

To protect yourself from the development of such a disease, try to get rid of depressive conditions in a timely manner. Protect yourself from stress, do not allow psychosis to occur. Naturally, lead a healthy lifestyle and avoid all kinds of head injuries.

In principle, there are no special preventive measures. However, if you feel unhappy or have unexplained anxiety, then do not hesitate to visit a psychologist or psychiatrist. It's not shameful, but it could save your life one day. Now you know what Cotard's syndrome is. You also know the symptoms and treatment of the disease. However, do not try to use the drugs yourself. It is much better if you consult a doctor. Be healthy!

First signs

An unreasonable, inexplicable feeling of anxiety is the first sign of living dead syndrome. Then the person has the thought that he has already died, there is no world around. To these delusional ideas is added a feeling of immortality, and the perception of the size of one’s own body is disrupted. Patients express thoughts that the body is huge, terrible transformations are happening to their organs (for example, the intestines have rotted), and strange hallucinations occur (for example, an electric current passes through the skin).

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Three stages of the disease

Based on patient observations and clinical experiments, researchers were able to identify three stages of Cotard syndrome.

• The first stage is the germination stage.

This is the stage at which delusion, a distorted reality, has appeared in the patient’s mind. The patient appears depressed, sad, and changes in daily life habits. In addition, due to the feeling that something is wrong with the body, he worries about his health and develops a certain level of hypochondria.

• Blooming is the second stage of the disease.

At this stage, the illusions become full-blown, more intense. The denial of the body is much more pronounced, actions begin to reflect this belief: self-isolation, self-forgetfulness, carelessness, inadequate hygiene.

• The last stage of the disease is the Chronic stage.

When depression worsens, misconceptions arise. The stage is associated with chronic mood changes and systematization of delusions. At this stage, it is more difficult to rid a person of his beliefs.

Symptoms

Manifestations of mental abnormalities are varied. Cotard's syndrome is a multisymptomatic disease. The ideas that patients express are colorfully exaggerated and have an alarming and melancholy character. Characteristic features include:

• denial of one's own existence;
• psychomotor agitation;
• pathological feeling of loss of one’s own body or individual internal organs;
• the belief that the body is rotting and decomposing;
• pathological feeling of guilt;
• decreased pain threshold;
• self-harm;
• suicidal tendencies.

All pathological manifestations can be combined into several groups that accurately characterize a patient with Cotard syndrome:

1. Megalomania. Awareness of oneself as an alien, a destroyer, a savior, a super being to accomplish great things in relation to all humanity, the world, the planet.
2. Hypertrophied nihilism. Complete confidence in the meaninglessness of one's own life or existence poses a threat to all humanity.
3. Depression. The condition is characterized by constant increased nervousness, alertness, irritability, and concern.
4. Hallucinations (visual, auditory, olfactory). Patients smell a decaying body, hear orders and threats about upcoming trials, and see monsters.
5. Motor reactions. Walking from side to side, an incoherent stream of words, wringing of hands, twisting of clothes and hair.

The paradoxical nature of delusional ideas is striking in its inconsistency:

• The patient is convinced of his own worthlessness, but at the same time considers himself a messenger with a mission on a planetary scale (sent to bring suffering and illness, to infect all people on earth with deadly diseases).
• Beliefs in the insignificance not only of one’s life, but of the existence of humanity and the planet as a whole. According to some patients, any progress is meaningless, unsuccessful and irrational. Patients are sure that they do not have a heart, brain, stomach and other vital organs.
• Along with suicidal manifestations, the thought of one’s own immortality coexists in the sick brain. Attempts to inflict severe injuries on oneself (amputation of limbs, numerous cutting wounds of soft tissue) are attempts to convince oneself of immortality.
• The patient’s idea that he does not exist alleviates mental suffering; he firmly believes in the fact of accomplished death. This complicates the treatment; the patient does not see any point in it, because he is dead.

Forecast

It must be said that treatment does not always give good results. Often the patient's beliefs are so persistent that no explanation can change them. The prognosis of this pathology in most cases is unfavorable. Delirium leads to the destruction of one's own personality.

The fact is that the patient is no longer tied to reality and cannot soberly assess his condition. He does not feel the need for treatment, does not consider it necessary. It is not always possible to convince such a person to undergo treatment. In addition, patients may refuse therapy while already in a medical institution.

The difficulty of dealing with the problem also lies in the difficulties of diagnosing it. Since patients try to hide from others, it is not always possible to identify the disease. But with timely initiation of therapy, a positive outcome is likely.

Forms

Based on the accumulated data on Cotard's disease, three forms of the disease are distinguished. They are characterized by varying degrees of severity:

1. Psychotic depression. Guilt, anxiety, depression, auditory hallucinations are the main symptoms of a mild form of the disease. Cotard's disease develops in 1-2 weeks and can last for several years.
2. Nihilistic delusions, hypochondria (constant worry about the possible appearance of one or more diseases). Average form of denial syndrome. The patient develops self-hatred. By deliberately injuring himself, he tries to punish himself for his worthless existence.
3. Manic delirium, suicidal behavior. A severe form of the syndrome develops as a result of severe pathological changes in the patient’s central nervous system. He plunges into the world of the dead, wanders through cemeteries, and maintains contact with the other world. A person experiences severe mental anguish, he is haunted by hallucinations, and he attempts suicide.

Footnotes from the book

P. P. Malinovsky - Insanity. St. Petersburg. 1855, p. 8.

An attempt to criticize some aspects of Jaspers’s teaching and the phenomenological direction has already been made by the author in his work “On the problem of so-called intelligible connections.” Journal Neurop. and Psychiatrist. 1938, No. 3.

The above does not exhaust the critical remarks that could be made to Freudianism, but here we touch upon it only in terms of the problem of delusion formation.

The problem of delusion was discussed in detail at the International Congress of Psychiatrists, held in Paris in 1950. The reports and debates revealed various directions in the study of delusions - purely psychopathological (phenomenological), experimental, psychoanalytic and their varieties. The dominant direction was the phenomenological direction and the “existential” one, which emerged mainly in the post-war years and is a type of phenomenological.

Not limiting themselves to describing the experiences of patients, its supporters set as their task “intuitive knowledge” of the new pathological “being” of the patient, caused by the disease process, widely drawing on various philosophical theories when analyzing it. This direction, which does not correspond to the tasks of psychiatry as a medical science, has a clearly expressed idealistic overtones.

At the congress, various aspects of the problem of delirium were discussed: the question of its primary or secondary origin and the legitimacy of this division, its nosological affiliation, in particular paraphrenic and paranoid delusions, etc. Attempts to pathophysiological (neurophysiological) understanding of delirium were made in the aspect of Jackson’s concept, as well as the doctrine of chronaxy without providing any experimental data.

Quoted from the work of K. N. Zavadovsky.

N. M. Popov. Lectures on general psychopathology. Kazan, 1897, p. 65.

S. S. Korsakov. Psychiatry course. Moscow, 1904, p. 180.

I. G. Orshansky. Textbook of general psychiatry. Kharkov, 1910. p. 270

I. G. Orshansky. Textbook of general psychiatry. Kharkov, 1910, p. 272.

V. X. Kandinsky. About pseudohallucinations. Medgiz. 1952, p. 74.

Ibid., pp. 116–117.

https://www.youtube.com/watch?v=ytaboutru

I. P. Pavlov, Complete Works, vol. 3, book 2, 1951 pp. 245–7, 251, 339.

Pavlovsky "Environments", volume III, 1949, pp. 152, 316, 318, 319.

Ibid., pp. 316, 318, 319.

The significance of K. M. Bykov’s works for understanding the mechanisms of some forms of delirium will be indicated in the relevant chapters.

Lecture on issues of higher nervous activity. Ed. Ak. Sciences USSR, 1945, p. 160.

A. L. Epstein. On the protopathic nature of mental automatism. Nev. and Psych., 1937, No. 5, pp. 31–32.

These abortive delusional states are described by us in the work: “On unfinished paranoid phenomena within the framework of schizophrenia.” Proceedings of the 1st Moscow Psychiatric Hospital, vol. 1, 1938.

Pavlovsky “Environments”, volume 3, 1949, p. 140.

I. P. Pavlov also pointed out the role of the affect of fear in delusions of persecution (Pavlov’s Wednesdays, volume 3, p. 316, 1949).

A. G. Ivanov-Smolensky. The teachings of I. P. Pavlov and pathological physiology, 1952, p. 75.

Quoted from A. S. Chistovich - “On the pathophysiology and pathogenesis of some forms of delirium.” Novosibirsk, 1939, p. 31.

E. N. Kameneva. On the problem of so-called understandable connections. Nev. and Psycho... 1938. No. 3.

I. P. Pavlov. Full composition of writings. 1951, volume 3, book 1, page 198.

I. P. Pavlov. Feelings of mastery and the ultraparadoxical phase. Complete Works, vol. 3, book 2, page 245. 1951

V. X. Kandinsky. About pseudohallucinations. page 102. 1952

I. M. Sechenov. Reflexes of the brain. 1926, pp. 82–83.

https://www.youtube.com/watch?v=ytcopyrightru

For the first time, the concept of general sensitivity - “organic feeling”, which, unlike the “inner sense”, does not give accurate ideas, was formulated by the Russian doctor A.P. Bogoroditsky at the beginning of the 19th century. Quoted from the article by D. D. Fedotov - “The views of Russian doctors on hypochondria in the first half of the 19th century.” Journal Neurop. and Psychiatry, 1954, No. 4, p. 355.

K. M. Bykov. Preface to the book by A. T. Pshonik “Cerebral cortex and receptor function of the body”, 1952, p. 5.

This observation will be presented with an even more detailed analysis from a different angle in the chapter on delusional variants.

V. A. Gilyarovsky. The doctrine of hallucinations. 1949, pp. 146–152.

M.I. Middle. On the disruption of the joint activity of the first and second signaling systems in chronic alcoholic hallucinosis. Journal of Higher Nervous Activity, volume 3, no. 6, 1953.

I. P. Pavlov. Complete Works, 1951, volume 3, book 2, p. 313.

I. P. Pavlov. Full composition of writings. Volume 3, book 2, page 260. Ed. USSR Academy of Sciences, 1951.

A. G. Ivanov-Smolensky. Methods for studying conditioned reflexes in humans. Medgiz, 1933, p. 89.

V. H. Kandinsky. About pseudohallucinations. 1952, p. 116.

Pavlovsk Wednesdays, volume 3, 1949, p. 321.

A. S. Chistovich. On the pathophysiology and pathogenesis of some forms of delirium. 1939, p. 24.

D. D. Fedotov. Views of Russian doctors on hypochondria in the 1st half of the 19th century. “Nevr. and psych.”, 1954, No. 4, pp. 351–356.

E. N. Kameneva and A. I. Kudinov. About archaic forms of delirium. Proceedings of the 1st Moscow Psychiatric Hospital, vol. III, 1940.

A. S. Chistovich. On the pathophysiology and pathogenesis of some forms of delirium. 1939 p. 23.

I. P. Pavlov. Complete works, volume 3. book 2, page 260, 1951.

K. M. Bykov. Preface to the book by A. T. Pshonik. The cerebral cortex and the receptor function of the body. 1952, p. 5.

I. P. Pavlov, 20 years of experience. 1951, vol. 3, book. 1, pp. 198–199

https://www.youtube.com/watch?v=ytpolicyandsafetyru

This is how I.P. Pavlov interprets some hysterical states. However, one must think that the same mechanisms may occur in schizophrenia I. P. Pavlov. Complete works, 1951, vol. 3, book. 2. pp. 206–216.

Quoted from A. S. Chistovich. “On the pathophysiology and pathogenesis of certain forms of delirium,” 1939, p. 38.

A. G. Ivanov-Smolensky. On the neuro-dynamic structure of eidetic and verbal delirium. Archives of Biological Sciences, vol. 36, c. 1, 1934, p. 156.

A. S. Chistovich. On the pathophysiology and pathogenesis of some forms of delirium. 1939.

See the medical history of patient K., given in the chapter on hypochondriacal delirium.

E. N. Kameneva. Delusions of self-blame in schizophrenia. Proceedings of the 1st Moscow Psychiatric Hospital, vol. 3, 1940.

It is also possible that some of these patients have some other unknown, chronic infection.

A. G. Ivanov-Smolensky. Biogenesis of speech reflexes and the basic principles of the methodology for their study. Psychiatry, neurology and experimental psychology. 1922, issue. 2.

It's him. Methods for studying conditioned reflexes in humans. Medgiz, 1933, p. 84.

S. D. Vladychko. The nature of associations in patients with chronic primary insanity. St. Petersburg, 1909.

A. G. Ivanov-Smolensky. Methods for studying conditioned reflexes in humans. Medgiz, 1933, p. 90.

A table is attached at the end of the chapter.

Affective reactions were not considered inferior

S, S. Korsakov. Psychiatry course. 1901, p. 888.

I. P. Pavlov. Full composition of writings. 1951. Volume 3, book. 2, page 233.

The genesis of this disorder is not entirely clear.

This pathological irradiation, along with dissociation, is also one of the characteristic disorders in schizophrenia.

Engels. The role of labor in the process of humanization of the ape. Dialectics of nature. Moscow, 1934.

Treatment

Psychiatrists, based on a conversation with the patient and his relatives, make an initial conclusion about the presence of Cotard’s disease. The diagnosis is clarified using hardware techniques - computer and magnetic resonance imaging. These studies help determine the extent of pathological changes in the brain. In most cases, patients do not seek medical help at the first symptoms of the disease due to an obsession with the ideas of uselessness and meaninglessness of their existence.

The patient’s relatives help to identify mental pathology in a timely manner. Treatment of this dangerous syndrome occurs exclusively in a hospital setting under constant medical supervision. This is a necessary measure because patients are aggressive and pose a social danger. To restore the patient’s mental health, special medications, the electroshock method (as one of the emergency methods), and psychotherapy are used. Combinations of methods are more effective.

Drug treatment

The psychiatrist selects medications for the patient, taking into account the severity of Cotard’s delirium, general condition, individual characteristics, and the presence of other mental illnesses. Several groups of drugs are used. Their pharmacological action is aimed at eliminating the source of delirium. The following drugs are used for this:

• Antidepressants – Melipramine, Amitriptyline, Fevarin. Amitriptyline is used in the form of intramuscular and intravenous injections 3-4 times a day. The dosage of the drug is increased gradually, the maximum daily amount is 150 mg. After 1-2 weeks, Amitriptyline injections are replaced with tablets. Side effects include constipation, hyperthermia (overheating, accumulation of excess heat in the body), increased intraocular pressure, blurred vision.
• Antipsychotics (neuroleptics) – Tizercin, Rispolept, Haloperidol, Ariprizole, Aminazine. To reduce motor and speech excitation in schizophrenia, paranoia, and hallucinations, Aminazine (dragees or injection solution) is used. The initial daily dose is 0.025-0.075, the maximum is 0.3-0.6 g. This amount is divided into several doses. A dosage of 0.7-1 g is prescribed to patients with chronic delirium and psychomotor agitation. Side effects include indifference, blurred vision and thermoregulation, convulsions, tachycardia, and allergic reactions.
• Anxiolytics (tranquilizers) – Afobazol, Grandaxin, Fenzepam, Diazepam, Elenium, Relanium, Stresam. Reduce the excitability of the subcortical areas of the brain, which are responsible for the emotional state. Three generations of drugs in this group are known. Stresam is a new generation drug. Stabilizes the condition of anxiety disorders and combines well with drugs from other groups. Does not cause lethargy or drowsiness.

Psychotherapy

Psychotherapy occupies a special place in the complex treatment of denial syndrome. Establishing contact and trusting relationships with the patient is a necessary condition for the effectiveness of treatment sessions. With a severe manifestation of a mental disorder, this is not easy to achieve, because patients perceive themselves as an inanimate object and deny the existence of the world around them. The milder course of mirror syndrome allows for individual psychotherapeutic sessions based on suggestion.

Diagnostic features

Be sure to consider consulting a psychiatrist at the Leto mental health center if one of your loved ones has the problems described above. Clinic specialists make a diagnosis based on the characteristic symptomatic picture.

Doctors use:

• Conversation with the patient and his relatives.

• Inspection and observation.
• Additional methods: computed tomography, MRI (if a tumor is suspected, consequences of traumatic processes).

When meeting with the client and the people accompanying him, the difficulty of upcoming communication caused by the reluctance of medical intervention on the part of the sick person is taken into account. She considers the doctors' participation to be a measure without any meaning, citing the fact that the deceased no longer needs anything. That is why it is very important to see a psychiatrist in a timely manner.

Treatment

To accommodate patients in our hospital, we offer different types of comfortable wards, nutritious meals, and round-the-clock supervision by medical staff. You can choose the most suitable option for yourself.

Treatment for Cotard syndrome includes prescribing medications to relieve the main symptoms.

For treatment the following are used:

• Antipsychotics that suppress delusional disorders and hallucinations.
• Antidepressants that relieve symptoms of depression.
• Calming agents that eliminate fear and anxiety.

In psychiatry, electroconvulsive impulses are used as a complement to pharmacotherapy, and sometimes as an alternative method. Its effect is based on the influence of direct current of insignificant strength on individual areas of the brain. Electroshock may be useful as part of an emergency treatment.

At the Leto clinic, our specialists combine medicinal forms of treatment with psychotherapy. The doctor very carefully and persistently selects an individual approach to each client. It is important to overcome the barrier of painful mistrust. This action is only available to a highly qualified psychiatrist.

The doctor combines rational forms of psychocorrection with techniques of suggestion and persuasion. Hypnotic influence is used with caution.

Prevention

Controlling your own emotional state is the most important preventive measure for living dead syndrome. When the first signs of the disease appear, you should seek qualified medical help. To increase stress resistance and strengthen the nervous system, doctors recommend:

• avoid stressful situations, mental overstrain;
• avoid depression, psychosis and other nervous disorders;
• Healthy food;
• engage in vigorous physical exercise;
• include walks in the fresh air in your daily routine;
• practice hardening procedures, relaxation practices, aromatherapy;
• have a hobby;
• undergo massage sessions;
• listen to music, communicate in pleasant company;
• Periodically, if your emotional state is unstable, use mild sedatives.