«Mademoiselle X»

Abstract

Cotard syndrome is a very rare diagnostic entity, described by Jules Cotard on the basis of a patient («Mademoiselle X»), characterized by delusions of negation of one’s own body, of existence and of immortality, and frequently associated with severe affective disorders; in the presence of delusions, many authors propose electroconvulsive therapy (ECT) as the treatment of choice. We present the case of a 77-year-old woman with major depressive disorder with psychotic symptoms (Cotard syndrome) who is admitted to a brief hospitalization unit for refusal to eat and to walk with somatic delusions (she believed she was dead and lacked a pharynx and legs), neglect of basic care and catatoniform behaviour. After assessment according to Marjory Gordon’s functional health patterns, a care plan was developed with the NANDA, NOC and NIC taxonomies (disturbed sensory perception, imbalanced nutrition, anxiety and risk of suicide) and ECT was applied. Results began to be observed from the third session (of nine), with the disappearance of psychotic symptoms, affective improvement and recovery of eating and autonomy at discharge, confirming the efficacy of ECT combined with nursing care in severe resistant depression.