From Big Medical Encyclopedia

QATAR SYNDROME (J. Cotard, fr. psychiatrist, 1840 — 1887; synonym: melancholic paraphrenia, melancholic nonsense of imagination, megalomelankholichesky nonsense) — one of stages of development of the alarming agitated depression accompanied hypochiondrially - the depressive delusion of negation and hugenesses extending to moral and physical properties of an individual, the various phenomena of the world around or to everything at the same time.

A combination psikhopatol, the frustration forming To. pages, features of their emergence and development during a disease were for the first time described by Kotar in the 80th 19 century. In 1892 on the congress of fr. psychiatrists in Blua the symptom complex of mental disorders allocated with Kotar was called a Cotard delusion. To the middle of 20 century the main researches which are specially devoted To. pages, belonged to exclusively fr. psychiatrists. Development of clinic of psychoses of advanced age, first of all involutional melancholy (see. Presenile psychoses ), schizophrenia (see), maniac-depressive psychosis (see), carried out by domestic psychiatrists in the 2nd half of 20 century, allowed to add the doctrine about To. page new facts. In it. psychiatry set of the frustration forming To. page, specially it was not studied. A row is mute. researchers are designated by separate manifestations To. page term «nigilistic nonsense».

Among patients with depressive psychoses of advanced age of frustration, entering in To. pages, are noted in 10 — 25% of cases. At women To. the page meets considerably more often than at men.

A clinical picture

In spite of the fact that manifestations To. pages are noted at various nozol. forms, it has a number of common features both in a symptomatology, and in features of the development. At it it is always possible to reveal intensive affective frustration which are characterized or a depression with the expressed concern, or a depression with fear. Usual disturbance is melancholic depersonalization (see) more often in the form of anesthesia dolorosa psychica, is more rare in the form of so-called loss of mental sight when patients have an impossibility of representation of familiar faces, furnishings, events of antecedents accompanied with painful feeling of sincere exinanition. A depression at To. the page is always combined with agitation of various degrees — from simple breaking off of fingers of hands to conditions of violent motive excitement, including and in the form of melancholic raptus (violently sad excitement with feeling of despair). Often agitation is followed by speech excitement, usually in the form of alarming verbigeration (see. Depressive syndromes ). At height of motive excitement there can be episodes of a depressive substupor or a stupor (see. Struporous states ). Thus, at To. pages are, as a rule, noted the mixed states, various on the manifestations, which are «a preferable affective background, on Krom arises To. page». Touch frustration are most often presented verbal illusions (see), it is frequent in the form of illusory hallucinosis, more rare auditory hallucinations and mental avtomatizm, first of all ideatorny — a mentism (the involuntary rapid current of thoughts accompanied with figurative representations and feeling of vague alarm), unwinding of memoirs, acoustical and visual pseudohallucinations (see. Kandinsky — Klerambo a syndrome ). In some cases at To. the page arises stupefaction, usually in the form of oneiroid (see. Oneiric syndrome ).

Against the background of the listed frustration there is a fantastic nonsense, the main signs to-rogo are denial and hugeness. Denials can be partial, concerning most often moral, intellectual or physical. properties of the patient («there are no feelings, conscience, compassion, knowledge, ability to think; there is no stomach, intestines, lungs, heart, a bladder»), or can speak not about absence, and about destruction of internals («the brain dried, lungs clenched, intestines were corked»). The ideas of denial concerning physical «I» usually define as hypochiondrially - nigilistic or just nigilistic nonsense. In some cases personal categories are denied («there is no name, age, education, specialty, a family, never lived»). Denial can be generalized, extending to various concepts of the outside world which can be dead, destroyed, lose qualities inherent in them, or be absent at all («the whole world is dead, the planet cooled down, on it nothing grows, there is nobody in the world, is not present white, black, Europe, Africa, winter, spring, stars, years, centuries»). The patient can consider that it remained one in all Universe, can deny existence of all («there is nothing»).

Along with delusion of negation and hugenesses it is often possible to reveal nonsense of self-accusation, fantastic on contents (patients consider themselves by the prime cause of the taken place world cataclysms; attribute themselves improbable crimes; call themselves monsters, reptiles, monsters; correlate quite often the acts to those that were made by mythical or historical characters, call themselves Antichrist, Cain, Judas, Hitler; go on about deserved punishments, listing sometimes the most improbable ways of payment for deeds). In some cases the fantastic nonsense of self-accusation accepts retrospective character. At the same time patients can speak about the forthcoming eternal tortures or impossibility to die as in general, and as deserved punishment. Impossibility to die and eternal tortures, according to patients, can be carried out even then when «I» disappear their physical — «will burn a body, and spirit it will be necessary forever — to suffer».

The combination of the ideas of immortality to nonsense of a metamorphosis — turning into an animal, in a corpse, in metal, a tree or a stone is possible. Distinctive feature of crazy statements of patients with To. the page is existence in them of clear elements of figurativeness and visualization. Quite often patients pay attention to it («each pronounced word expands in mind in something big; the imagination turns the fact into the whole history; the imagination draws the whole scenes, the word acquires one thousand words and there is a picture»). Features of nonsense of self-accusation and its verbal expression also caused such synonyms To. page as «megalomelankholichesky nonsense», «a melancholic paraphrenia», «melancholic nonsense of imagination».

The combination of delusion of negation and hugeness hypochiondrially - nigilistic and depressive contents characterizes full or developed To. page. If one of these components prevails some, speak about the corresponding options K. page — nigilistic or depressive. They meet considerably more often than developed To. pages Krom of these two options, allocate types To. the pages based both on a symptomatology, and on features of a current To. the village of Segla (J. E. Seglas, 1897) allocated: 1) typical cases, i.e. such at which there were all components K. page; 2) the erased cases — with lack of a number of symptoms, napr, the ideas of hopelessness on eternal torment, the ideas of immortality etc.; 3) cases with very bystry emergence of all symptoms forming To. page; 4) cases with similar development only parts of symptoms; 5) cases, where the symptoms forming To. pages, arise in the form of episodes.

The most characteristic stereotype of development of depressions during which develops To. the page (regardless of them nozol, accessory and features of a current — pristupoobrazny or chronic), is the following sequence of emergence of stages of mental disorders: a stage of an alarming depression without ideomotor braking; a stage of the alarming agitated depression with the crazy ideas of self-accusation, self-humiliation, charge, melancholic depersonalization, verbal illusions and other touch frustration; emergence of the symptoms forming in the set To. page.

Use electroconvulsive therapy (see) and especially psychotropic drugs for treatment of depressive psychoses exerted considerable impact on a wedge, manifestations To. page. Less often the developed his pictures, and depressive and nigilistic options K began to meet. pages are more often shown by the reduced symptomatology. Patients speak, e.g., about the unusual fault, but in general, without any specific facts, and also without identification of with someone; there can be thoughts of impossibility to die, but they are not followed by conviction in immortality and in hopelessness on eternal torment. Instead of the generalized ideas of denial or destruction of internals only statements about not functioning meet more often went. - kish. path or respiratory organs. In certain cases the statements characteristic for To. pages, represent not nonsense, and fantastic contents the persuasive phenomena, with to-rymi the patient tries to fight. If before introduction of methods of active therapy existence To. the village spoke about hron, depressions, dominate now the cases proceeding attacks.

A pathogeny

To. the page represents a combination of depressive and crazy frustration therefore its pathogeny matches a pathogeny of the corresponding syndromes (see. Nonsense , Depressive syndromes ). Important factor in development To. the page is advanced age. However the frustration relating here can arise and in the middle age, and separate symptoms even at children.

The diagnosis

the Diagnosis is made on the basis of features by a wedge, pictures. To. the page meets at the most various mental diseases: first of all at involutional melancholy, schizophrenia and maniac-depressive psychosis; it is described at patients with a general paralysis, in particular after carrying out a pyrotherapy by it, at vascular and senile and atrophic psychoses, epilepsy, epidemic encephalitis, acute and protragirovanny symptomatic psychoses.


At development To. first of all therapy is shown to page by psychotropic drugs. In connection with complexity a wedge, pictures treatment by psychotropic drugs shall be combined. From antidepressants most often apply amitriptyline, Melipraminum is more rare; for stopping of speech motor excitement — aminazine, Stelazinum; the condition of alarm decreases by means of Tisercinum; in the presence of senesthopathias the good effect gives use of Theralenum. When the intensive speech motor excitement accompanied with deterioration in a somatic state is noted, preference should be given to electroconvulsive therapy.

The forecast

the Forecast is in many respects connected with features of a basic disease and the applied methods of treatment. Emergence developed To. than page or the expressed nigilistic crazy ideas concerning recovery predictively it is worse, than existence of depressive option K. page. The combination of delusion of negation and hugeness to the expressed speech motor excitement and oneiric stupefaction at elderly people at insufficient treatment can lead to death.

Prevention — the timely beginning of active therapy in all cases of the alarming depressions which are especially developing for the first time at advanced age.

Bibliography: Kaubish V. K. About use for patients with a Cotard delusion of electroconvulsive therapy, Zhurn, a neuropath, and psikhiat., t. 62, No. 10, page 1544, 1962; about N, About delusion of negation and a Cotard delusion, in the same place, t. 64, No. 6, page 876, 1964, bibliogr.; Morozova T. N and Shuysky N. G. Klinika of involutional melancholy and its dependence on an age factor, in the same place, t. 66, No. 4, page 598, 1966, bibliogr.; Rotstein G. A. Hypochiondrial schizophrenia, M., 1961, bibliogr.; Sokolova B. V. Periodic schizophrenia with dominance of acute fantastic delirium, Zhurn, a neuropath, and psikhiat., t. 67, No. 9, page 1378, 1967, bibliogr.; Shternberg E. I. and Noise-with to and y N. G. O some forms of depressions of senile age, in the same place, t. 59, No. I, page 1291, 1959; Bourgeois M. Le syndrome de Cotard aujourd'hui, Ann. med. - psychol., t. 2, p. 534, 1969, bibliogr.; Cotard J. Du d61ire hypochondriaque dans une forme grave de la melancolie anxieuse, ibid., ser. 6, t. 4, p. 168, 1880; it, Du delire des negations, Arch. Neurol. (Paris), t. 4, p. 152, 1882; E y H. Etudes psychiatriques, t. 2, p. 427, P., 1950, bibliogr.; &Sgl as J. Le d^lire des negations, P., 1894.

H. G. Shumsky.