The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as “I do not have a heart,” “my heart is not beating,” “I can not breathe,” “I am breaking apart,” “I have no head” (ideas of negation) and statements about the patient being responsible for the “death of the whole world” (ideas of enormity). Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed. 1. Introduction Catatonia is a neuropsychiatric disorder that was initially described by Kahlbaum in 1874 and is characterized by motor disturbance in which patients are unable to move normally despite full physical capacity in the limbs and trunk, also it is associated with behavioral and affective disorders [1]. This condition is associated to both psychiatric and organic disorders and may impact approximately 15% of acute psychiatric patients [2]. Currently, people with affective disorders constitute the largest subgroup of catatonic patients, although catatonia has historically been associated more with schizophrenia [3]. Also linked to catatonia and even considered to be an intrinsic aspect of it is neuroleptic malignant syndrome (NMS), which involves rigidity, fever, dysautonomia and changes, in mental state caused by neuroleptics. It is considered to be a life-threatening condition, due to its high mortality index recorded to date [4, 5]. Cotard syndrome (CS), on the other hand, was first described by Jules Cotard in 1880 [6] as a negation delusion, which may range from the negation of the patient’s body parts to that of their own existence or of the entire world. Patients with CS are typically in their mid-years or are elderly and present mood disorders, but CS is also observed in patients with schizophrenia and organic disorders [7, 8]. Very few cases of CS in adolescents and young adults have been described [9]. This study reports on the case of a young woman who, while struggling with psychotic depression, developed NMS and
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