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Death delusion.

Journal article
Authors Anders Helldén
Ingegerd Odar-Cederlöf
Kajsa Larsson
Ingela Fehrman-Ekholm
Thomas Lindén
Published in BMJ (Clinical research ed.)
Volume 335
Issue 7633
Pages 1305
ISSN 1468-5833
Publication year 2007
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 1305
Language en
Keywords Cotard's, Death, Delusion, Neglect, Alien-Hand, Neurology, Psychiatry, Neuropsychiatry, Acyclovir/*adverse effects, Adult, Antiviral Agents/*adverse effects, *Attitude to Death, Bipolar Disorder/*chemically induced, *Delusions, Female, Herpes Labialis/drug therapy, Herpes Zoster/drug therapy, Humans, Male, Middle Aged, Syndrome
Subject categories Clinical pharmacology, Toxicology, Neurology, Psychiatry, Communication Studies, Philosophy, Psychology of religion


We report two cases of Cotard’s syndrome that occurred as an adverse drug reaction to aciclovir and its prodrug valaciclovir. In the 1880s Jules Cotard first described his eponymous syndrome, a rare psychiatric condition with strong delusions of being dead. Aciclovir or valaciclovir may cause neuropsychiatric side effects such as confusion, somnolence, and hallucinations, mainly in patients with impaired renal function. To our knowledge, Cotard’s syndrome has never been reported as a suspected adverse drug reaction but associated with severe somatic stress as well as general and localised cerebral pathologies. Our findings add adverse response to an antiviral drug as another cause and provide clues to the syndrome’s possible neuropsychiatric origin. Clinicians should be aware of the association between body scheme disturbances and (val)aciclovir. Affected patients with Cotard’s syndrome and renal failure should preferably be sent to the dialysis unit, not to the department of psychiatry.

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