Improvement of cognition in a patient with Cotard's delusions and frontotemporal atrophy receiving electroconvulsive therapy (ECT) for depression

• Published in: International psychogeriatrics Vol. 21; no. 3; pp. 600 - 603
• Main Authors: Fàzzari, Giuseppe, Benzoni, Oliviero, Sangaletti, Alessio, Bonera, Francesca, Nassini, Stefano, Mazzarini, Lorenzo, Pacchiarotti, Isabella, Sani, Gabriele, Koukopoulos, Alexia Emilia, Sanna, Livia, Gasparotti, Roberto, De Rossi, Pietro, Lazanio, Simone, Savoja, Valeria, Girardi, Paolo
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2009
• Subjects: Adult and adolescent clinical studies; Aged; Antidepressive Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Cognition & reasoning; Cognition Disorders - epidemiology; Cognition Disorders - psychology; Cognition Disorders - therapy; Combined Modality Therapy; Comorbidity; Delusions - drug therapy; Delusions - epidemiology; Delusions - therapy; Dementia - drug therapy; Dementia - epidemiology; Dementia - therapy; Depression; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Depressive Disorder - therapy; Electroconvulsive therapy; Electroconvulsive Therapy - methods; Functional Laterality; Geriatric psychology; Geriatrics; Humans; Italy - epidemiology; Male; Medical sciences; Mental depression; Mood disorders; Organic mental disorders. Neuropsychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Syndrome; Treatment Outcome; Treatments; Italy; frontotemporal dementia; electroconvulsive therapy; delusions; Cotard's syndrome; subcortical atrophy; Mood disorder; Human; Nervous system diseases; Electroconvulsive therapy; Cotard syndrome; Central nervous system; Delusion; Depression; Cognition; Encephalon; Cerebral disorder; Psychosis; Atrophy; Treatment; Central nervous system disease; Degenerative disease; Frontotemporal dementia; Subcortex; Elderly
• ISSN: 1041-6102; 1741-203X
• DOI: 10.1017/S1041610209008990

A 69-year-old man presented with Cotard's delusions, insomnia, profound depression, amnesia, difficulty concentrating, and cognitive deficit after two different surgical interventions. Brain imaging showed frontotemporal-subcortical atrophy and lateral ventricular enlargement. He responded poorly to a combination of sertraline, amisulpride and mirtazapine, with modest benefit on insomnia, and developed hypotension. After 18 days he was switched to olanzapine and venlafaxine, but his cognition worsened. He underwent bilateral electroconvulsive therapy (ECT). His mood improved, cognitive performance increased and anxiety symptoms remitted. This improvement persisted through the one-month post-discharge follow-up and depression eventually remitted.