Cotard delusion, emotional experience and depersonalisation

Cotard delusion—the delusional belief “I am dead”—is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea “I am dead” comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if “I am dead” were true, there would be no emotional responsivity to the world. We scrutinised the literature on people who expressed the delusional belief “I am dead”, looking for data on whether such patients are reported as entirely lacking in emotional responsivity. In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry. We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea “I am dead” comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.

科塔尔妄想（Cotard delusion）——即妄想性信念“我已死亡”——其命名源于首次对该病症进行描述的法国精神病学家儒勒·科塔尔（Jules Cotard）。拉马钱德兰（Ramachandran）与布雷克斯利（Blakeslee）提出，当神经病理状态导致个体对周遭世界完全丧失情绪反应性（emotional responsivity）时，便会萌生“我已死亡”这一想法。该想法可作为一种推测性解释出现：若“我已死亡”为真，则个体不会对周遭世界产生情绪反应性。我们对报告有“我已死亡”这类妄想性信念的患者相关文献进行了系统梳理，旨在检索此类患者是否被报道存在完全丧失情绪反应性的相关数据。在诸多临床案例中，科塔尔妄想患者被描述为能够体验到焦虑、恐惧、内疚、痛苦、欣快以及担忧等多种情绪。本研究据此得出结论：情绪反应性完全缺失并非诱发“我已死亡”这一妄想性信念的原因。我们进一步提出，在至少部分案例中，“我已死亡”的想法是针对人格解体（depersonalisation）或现实解体（derealisation）症状所产生的——这类症状常伴随科塔尔妄想病例出现，并列举了存在各类脑区异常的科塔尔患者案例，而这些脑区异常或正是此类症状的致病基础。