Cotard parasomnia: le délire de negation that occur during the sleep-wake dissociation?

Summary

Unpleasant dreamlike experiences during non-REM parasomnias can trigger panic attacks and significant distress, often going unreported. In three cases of Cotard delusion, patients expressed beliefs of being dead or disconnected from their bodies. Notably, a sample analysis showed right-hemispheric hypoactivity following confusional arousals, indicating disrupted brain function. This disruption involved unusual activation patterns in the salience and default mode networks, which are crucial for wakefulness. Addressing these experiences is vital to improving clinical outcomes for affected individuals.

Abstract

Unpleasant dreamlike mentation can occur during non-rapid eye movement parasomnias, leading to associated panic attacks. The mentations are rarely remembered and are likely underreported. However, they may lead to significant personal distress and, if not addressed, may contribute to poorer clinical outcomes. Cotard le délire de negation are very rare nihilistic delusions, historically described with psychotic disorders. Their association with a variety of neurologic disorders, including migraine and cluster-headache, has also been reported. Here we present three cases of Cotard parasomnia during which distinct states of consciousness defined by nihilistic ideation occurred. Patients described believing they are dead or dying, while unable to perceive or experience their bodies in whole, or in part, as their own. A source analysis of the electroencephalographic fingerprint of these mentations suggests right-hemispheric hypoactivity subsequent to confusional arousals. Mechanistically, an aberrant activation of two major intrinsic brain networks of wakefulness, the salience network and the default mode network, is argued.

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