This condition is very explicitly dened as monothematic delusions with distin­guishing features of nihilistic beliefs of one’s existence of body or life. It has been calculated that about less than 1% of elderly adults, 3% of older adults with depres­sion, and less than 1% with psychotic disorders developed Cotard syndrome. It is widely seen that some patients with Cotard syndrome have a belief that their life or specic body parts were debilitated. Even though Cotard syndrome is rare and essential, it has not been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classication of Diseases, tenth revision, clinical modication (ICD-10-CM). This is a rare and unique disease and neuropsychological mechanisms of this condition remain undisclosed [5, 7].

Even after being overseen by a psychiatrist, patient L’s mental health keeps dete­riorating, and there is no improvement on patients’ insomnia. After 3 weeks of treat­ment, the patient stated that she felt like a zombie pinning it toward antidepressants. She was persuaded by the thought that her organs started to decay. There was lack of food intake and purging to show that the food she had was not able to get digested which made her more weak and lethargic. Moreover she was denying to micturate and defecate as it was the belief of the patient that her intestine and bladder were not functioning. As the patient’s physical health continued to get worse, she was checked in to the public hospital in Klang Valley in September 2018. She was experiencing third-person auditory hallucination in which the voice was commenting on her actions. Patient L was paranoid that the ctional voice might try to hurt her. Neither any Schneiderian rst-rank symptoms nor delusions of misidentication were noticed. There were not any features of depression, mania, or hypomania noted by the patient’s family. There was no history of any signicant psychiatric illnesses from either side of the patient’s family. Patient was often associating her anxiety with her organs rotting and liquefying inside her. A differential of major depressive disorder with psychotic features, due to another medical condition and schizophre­nia, was made. A detailed workup of the patient was done to eliminate possible causes by acquiring an elaborate history of fever, seizures, connective tissue disor­ders, illicit drug use, or any neurological decits suggesting migraine, stroke, or meningitis. But all examinations of the patient were insignicant. Considering her rst episode of psychosis featuring Cotard syndrome, she was given a diagnosis of schizophrenia and Cotard syndrome. Later, patient L was admitted and her decision­making capacity was compromised, so the patient’s family was educated on avail­able treatment concerning the disorder. After that, the psychiatrist and family decided for her to stay in the hospital for 1 to 2 weeks. She was treated for her condition with atypical antipsychotic risperidone 2mg twice a day. Patient L has not shown adequate improvement on risperidone; even though she was on treatment, her nihilistic delusions remained the same during her stay in hospital. She demanded that she had to be assisted by a nurse each time she came toward the counter. Her physical examination was insignicant; on her mental health status examination, she had a direct effect, poor speech, apathy, inability to recognize reality (persecu­tory delusion), and hallucinatory behavior. She was later put on amisulpride 200 mg better than risperidone in effect. There was a slight improvement with patient L in her hygiene and meals after 2 weeks; she started to show signs and symptoms of Parkinson’s disorder at a dose of 600mg twice a day, which were resolved with 2mg of trihexyphenidyl. She was still showing persisting symptoms of psychosis upon her discharge. Sadly she was again admitted after a week due to several unsuc­cessful suicide attempts; her nihilistic beliefs were still present such as she could not swallow, micturate, or defecate. She showed extrapyramidal side effects that mani­fest due to amisulpride and amenorrhea because of hyperprolactinemia (316.2mU/l).