BRIEF REPORT OF THREE CASES PRESENTING THE FEELING OF UNREALITY (COTARD'S SYNDROME)
Harry W. Miller
Journal of Nervous and Mental Disease
These cases displayed in life feelings of unreality, nihilistic delu¬ sions and various other signs which tended to mark them as approxi¬ mating the features of Cotard's syndrome. The readers did not insist that the characteristic feelings of unreality displayed by these victims of melancholia are never found in patients subject to disease other than melancholia. The cases discussed were those of a clerk, aged forty-eight; a mason, age seventy-five, and a shoemaker, age sixty-five. The as¬
... ble causes were: in the clerk, financial worry; in the mason, senil¬ ity and domestic worry; in the shoemaker, nothing. All three cases showed more or less arteriosclerosis. The alcoholic and venereal his¬ tories were practically negative. The mothers of two patients had suf¬ fered at the close of life with continuous depressions. All cases showed ideas of negation, developing in the clerk after slight increase of de¬ pression and agitation, with delusions about self and family; in the mason, after gradual senile failure; in the shoemaker, after a slowly developing hypochondria. The senile case made a suicidal attempt. The most remarkable feature of the autopsies in these cases was the practically normal character of the brains when examined micros¬ copically. The visible arteriosclerosis was confined in all cases to the large branches of the circle of Willis. The senile case showed a small old cyst of softening in the occipital region, the shoemaker showed a mild chronic exudative process. The brains gave little evidence of general or focal atrophy. No striking alterations in topography or arrangement in layers were de¬ tected microscopically. Perivascular pigmentation was found and was attributed by the readers to the results of advancing years rather than of a special factor. Common to all three cases was a neuroglia cell pigmentation in intermediate layers of the cortex. Satellite cell pig¬ mentation was not constantly found. Nerve cell pigmentation was con¬ stantly found in the elements of moderate size in all parts of the cor¬ tex examined. This pigmentation was strikingly brought out by use of Heidenhain's iron hematoxylin stain. The larger elements failed to show this characteristic pigmentation. The interest of the work, ac¬ cording to the readers, lodged in the somewhat peculiar topographical distribution of the pigment and its absence in the larger elements re¬ lated with the projection system. The readers promised further work on melancholia. BRIEF REPORT OF THREE CASES PRESENTING THE FEEL¬ ING OF UNREALITY (COTARD'S SYNDROME). By Dr. Harry W. Miller. Dr. Miller said he wished to offer in as brief a manner as possible a few types illustrating the Cotard Syndrome or a feeling of unreality involving the different fields of consciousness; namely, the conscious¬ ness relating to the outside world, the physical and the mental person¬ ality, designated respectively by Wernicke as the allopsychic, the soma¬ topsychic and the autopsychic fields. It was his intention to summarize those cases in which he had observed the feeling of unreality as present in any degree of intensity.