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Abstract：
Cotard\'s syndrome is a relatively rare condition that involves a delusion of negation in which an individual believes he or she has lost his or her soul, is dead, or is without functional body systems. This syndrome is observed in various neuropsychiatric disorders but most commonly in mood disorders. Pramipexole has often been used in the adjunctive treatment of both bipolar and unipolar depression, and it is known to cause rare but serious adverse effects such as compulsive behaviours in the treatment of Parkinson\'s disease. Here we report a case of Cotard\'s syndrome in treatment-resistant major depression associated with abnormal behaviours that might be caused by pramipexole. In the present case, the patient\'s abnormal behaviours gradually disappeared about 2 months after the discontinuation of pramipexole. The hypoperfusion in the bilateral parieto-occipital lobe found on single-photon emission computed tomography suggests the presence of Lewy body disease pathology. Nonetheless, the patient\'s abnormal behaviours disappeared after the discontinuation of pramipexole, indicating that they are mainly attributable to pramipexole treatment. However, the possible existence of Lewy body pathology could facilitate the emergence of abnormal behaviours after treatment with pramipexole. The patient\'s abnormal behaviours, such as eating other patients\' food and taking her medicine before the scheduled time, might differ from typical compulsive behaviours induced by pramipexole (such as pathological gambling and hypersexuality), but they could be regarded as disinhibition. Therefore, we should follow up on the clinical course of this case carefully through neuroimaging investigation and neurocognitive assessment.
摘要：
科塔德综合症是一种相对罕见的疾病，涉及一种否定的错觉，即个人认为他或她已经失去了灵魂，死了,或者没有功能性身体系统。这种综合征在各种神经精神疾病中观察到，但最常见于情绪障碍。普拉克索经常用于双相和单相抑郁症的辅助治疗，并且已知在帕金森病的治疗中会引起罕见但严重的不良反应，如强迫性行为。在这里，我们报告了一例Cotard综合征，该综合征与普拉克索可能引起的异常行为相关的难治性抑郁症。在目前的情况下,停用普拉克索2个月后，患者的异常行为逐渐消失。在单光子发射计算机断层扫描中发现的双侧顶枕叶灌注不足表明存在路易体病病理。尽管如此，停药普拉克索后，患者的异常行为消失，表明它们主要归因于普拉克索治疗。然而,路易体病理的可能存在可能促进普拉克索治疗后异常行为的出现。病人的异常行为,比如在预定时间之前吃其他病人的食物和服药，可能不同于普拉克索诱导的典型强迫行为（如病理性赌博和性欲亢进），但它们可以被视为抑制。因此,我们应该通过神经影像学检查和神经认知评估，仔细跟踪该病例的临床过程。
