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21 APRIL 2026, TUESDAY
PP-50 Beyond Nothingness: A Case of Immortality Delusion in Cotard Syndrome

PP-50 Beyond Nothingness: A Case of Immortality Delusion in Cotard Syndrome

Özgü Şişman1, Erdem Kettaş2

1. Department of Psychiatry, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Türkiye; Department of Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Türkiye
2. Department of Psychiatry, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Türkiye; Department of Psychiatry, Sancaktepe Sehit Prof. Dr Ilhan Varank Training and Research Hospital, Istanbul, Türkiye

DOI: 10.5080/61upk.ozt530 Page 246
OBJECTIVE:Cotard syndrome is a rare neuropsychiatric condition characterized by nihilistic delusions, most commonly involving beliefs of being dead or non-existent. Rarely, patients may present with inverse themes such as delusions of immortality, considered atypical variants within the Cotard spectrum. This case report describes an uncommon presentation of psychotic depression dominated by an immortality delusion, emphasizing diagnostic considerations and treatment challenges in later life. CASE (The patient consent must be provided and specified with appropriate terms.):A 60-year-old married woman with a two-year history of depressive symptoms was admitted due to worsening depressed mood, insomnia, social withdrawal, and a fixed belief that she was immortal. She also reported auditory hallucinations predicting poor recovery. Her psychiatric history included generalized anxiety disorder and a previous psychotic episode during pregnancy. Past psychotropic treatments were poorly tolerated because of sedation and extrapyramidal side effects. Mental status examination revealed depressed mood, congruent affect, preserved orientation, and a persistent delusion of immortality accompanied by themes of nothingness and worthlessness. No active suicidal or homicidal intent was present. Medical history included hypertension and diabetes mellitus. Neuroimaging was unremarkable, and cognitive screening showed borderline impairment. Treatment with sertraline, aripiprazole, and low-dose quetiapine led to gradual improvement in depressive and psychotic symptoms, with resolution of insomnia and appetite disturbance. The patient was discharged with outpatient follow-up plans. Written informed consent was obtained from the patient for publication of this case. DISCUSSION:Although Cotard syndrome classically involves delusions of death, atypical presentations such as immortality delusions are recognized within the same psychopathological spectrum. In this case, denial of death and nihilistic themes emerged in the context of severe depression, supporting a diagnosis of psychotic depression with a Cotard variant. Advanced age, borderline cognitive functioning, and chronic medical illness may have increased vulnerability. Awareness of such atypical presentations is essential to prevent misdiagnosis and guide individualized treatment. Keywords: Cotard syndrome, Depression, Nihilism, Psychosis.