Cotard's syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder


  • This work was supported by a grant to DC from Sanofi-Synthélabo France for research on the ‘Outcome of Bipolar Type I Disorder in Adolescents’. AC, DP and DC are investigators on a study relating to the use of ‘Valproate in Adolescent Bipolar Disorder’. DC has received speaker's honoraria from Janssen and Eli Lilly & Co. CS, M-LT, CL, RL and GEB have no conflicts of interest relevant to this manuscript.

Professor David Cohen, MD, PhD, Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpétrière, 47 Bd de l'Hôpital, F-75651 Paris cedex 13, France. Fax: +33 1 42 16 23 31; e-mail:


Objectives:  To assess the effect of age at onset on the phenomenology of Cotard's syndrome (CS) as a recent study reported a high rate of occurrence of bipolar disorder (BD) in adolescents and young adults with CS followed up for ≥2 years.

Methods:  We reviewed all cases of CS reported since it was first described. A statistical analysis was carried out to determine the effect of age at onset on CS phenomenology.

Results:  We found 138 cases including 21 cases aged 25 years or younger. In these younger CS patients, BD was more frequent, and the risk of associated BD was increased nine times (p < 0.0001). Within the BD sub-group (n = 27), admixture analysis identified two sub-groups with mean ages at onset of 18.7 years [standard deviation (SD) = 3.2] and 50.5 years (SD = 11.7).

Conclusions:  Young people with CS should be monitored carefully for the onset of BD, and families should be educated about this risk. Treatment with mood stabilizers can be helpful for those who develop BD. Within BD associated with CS, early versus late onset should be distinguished.