Capgras’ and Cotard’s Delusions Associated With a Particular Pattern of Cerebral Activity in a Severely Depressed Patient

• DOI: 10.4088/pcc.14l01641
• Publication Date: 2014-07-28T17:04:05Z
• Authors: Faycal Mouaffak; Pierre Lavaud; Franz Hozer; Haifa Helali; Patrick Hardy; Nicolas Hoertel; Aurelie Kas
• Keywords: Depression; Thought disorder; Citalopram

To the Editor: Major depressive disorder is a heterogenous disease considered as cluster of symptoms associated with disordered processing within specific neurobiological circuits. We report case patient suffering from melancholic depression Capgras’ and Cotard’s delusions in which clinical picture was particular pattern cerebral activity.

Case report. Mr A 72-year-old man, who brought to emergency service complaints insomnia, nonsense talk, aggressive behavior. For 2 weeks, had lived complete withdrawal showed great suspicion toward close relatives friends. He also presented depressed mood, pessimism, major sleep disturbances, marked weight loss.

Mr A’s psychiatric history notable for at least episodes that were not treated. Although he retirement home, full cognitive ability maintained reasonable level autonomy.

At initial assessment, claimed his been replaced by actors. told us body vanished devil it younger one.

Initial physical examination, laboratory tests, magnetic resonance imaging unremarkable. Single photon emission computerized tomography (SPECT) moderate prefrontal hypoperfusion. Pharmacologic management combining an antidepressant treatment citalopram 20 mg per day risperidone initiated first visit.

Throughout following month, dramatically improved. second brain SPECT performed 5-week follow-up persistent further explore perfusion, subtracted one using computer-aided method. statistically significant increased perfusion (> SD) shown anterior cingulate (ACC) left insula (LAI) (Figure 1).

Figure 1.

Increased Perfusion Left Anterior Insula (upper) Cingulate (lower) During Delusions

We developed severe episode features well Capras’ delusions. This activation. Co-occurrence syndrome has reported literature.1 The disorders seem share similar mechanisms arise external or internal perceptual-affective dissonance, produces feeling strangeness world one’s own commonly called derealization/depersonalization.2

Cerebral blood flow normalization 5 weeks successful antipsychotic suggests LAI ACC hyperactivity probably involved pathophysiologic disease.

Anterior suggested be supermodal structure, ACC, association affective perceptual recognition processes.3 Disturbances activity might result atmosphere emerge.

If we assume symptom dimensions reflect dysfunction neuronal circuits, could speculate depersonalization/derealization related complex network play role.