The authors intend to analyse through a historical and philosophical perspective, the relationship between nihilistic delusions content and ideas expressed in remarkable literary works addressing the Nihilism theme.

Report of two clinical cases of patients with nihilistic delusions. Review of relevant literature collected from PubMed and other medical internet databases under key-words “nihilistic delusions”, “nihilism”, “Cotard syndrome” and “psychotic depression”. Review of relevant historical and philosophical literature.

First descriptions of nihilistic delusions were made by Jules Cotard, who described a syndrome with his name in middle nineteenth century. First references to the Nihilistic philosophy are contemporary to that, initially by Jacobi and later on by other philosophers, including Nietzsche, who was its main propeller. Some literature propose that Nietzsche suffered from migraine and mental illness, namely bipolar disorder.

Cotard's Syndrome refers to the delusional belief held by patients that they are dead, do not exist, are putrefying or have lost their blood or internal organs. Nihilistic philosophy posed great influence to world's thinking of XIX and XX centuries. Analysis of Nihilistic philosophy works show ideas that resemble the ones reported by patients with nihilistic delusions.

Cardinal ideas expressed by Nietzsche in some of his works, relating to the nihilistic thematic, may have been influenced by an altered mental state, with manifestations compatible with Cotard syndrome which can be associated with bipolar disorder, migraine or organic cerebral pathologies.