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La négation du corps : à propos de trois observations concernant les délires de Jules Cotard

par Leistedt, Samuel ;Coumans, Nathalie ;Ladha, Karim;Linkowski, Paul
Référence Annales médico-psychologiques, 167, 9, page (669-676)
Publication Publié, 2009-11

Article révisé par les pairs

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Résumé :

In 1880, the French doctor Jules Cotard presents a clinical description of a physical negation delusion occurring in a melancholia context. In his classical clinical description, Cotard's syndrome is characterized by a semiological triad as: physical denial delusion, immortality and enormity delusion, and damnation ideas. Nowadays, there has been a decline in the appearance of this syndrome, probably due to the new psychopharmacological treatment approach and also because of the decrease in the number of institutionalized patients. The authors present three clinical vignettes of Cotard's syndrome. The cases are described through a summary of their personal history, the evolution of the disease and their psychiatric journey. A great part of the description of these cases is focused on the fine semiological analysis of the syndrome's presentation in each patient. Successively, mental and physical syndromes are described for the three patients. In the first patient, the authors insist on the "germinative phase" which is the period during the progressive development of the disease. In the second and the third cases, a "trigger factor" is well identified. The last case is more atypical because of the precocious disease's arising. It illustrates that fact, that nowadays, Cotard's syndrome is not the exclusiveness of seniors but can arise in young people. Secondly, a review of available literature on topic is presented - epidemiological, clinical, psychoanalytical and biological aspects - and analyzed, in order to elaborate a psychopathological study of these three patients. The psychopathological analysis shows the great heterogeneity of this syndrome in terms of way of apparition, clinical presentation, and evolution under specific therapeutics. Through the study of the Cotard's syndrome in the three patients, authors reveal also that the Cotard's syndrome is still present on the psychiatric's disease spectrum but not as in 100 years ago, but as an "uncompleted and modified Cotard's syndrome". Moreover, the apparition of new techniques of brain exploration, especially functional brain imagery, could be an encouraging way to study more and deeper this particular syndrome. In fact, nowadays, the pathophysiological mechanisms and phenomenological aspects of Cotard's syndrome are still unclear. © 2009 Elsevier Masson SAS. All rights reserved.