A Case of Psychosis with Concurrent Cotard and Koro-like Syndrome in the Context of Bestiality: Presenting with Homicidal and Suicidal Behavior

Cotard and Koro syndromes are rare psychiatric phenomena, with their concurrent occurrence being exceptionally uncommon, that too in context of the unusual history of bestiality. Cotard syndrome involves nihilistic delusions, such as beliefs of body part disappearance, while Koro is characterized by intense fear of penile retraction, often linked to thoughts of impending death. We report a case of a 32-year-old male with psychosis who presented with both syndromes following guilt related to a childhood history of bestiality. The patient developed persecutory delusions, delusions of guilt, beliefs of penile shrinkage (Koro-like), and nihilistic delusions involving his body and the world, finally exhibiting homicidal and suicidal behavior stemming from these fixed beliefs. This case highlights the complex interplay of guilt, nihilism and psychosis in context of bestiality, shaping rare syndromic presentations leading to extreme forms like homicidal and suicidal behavior. Recognizing such patterns is vital for accurate diagnosis, risk assessment, and tailored treatment planning in psychotic disorders.