Igama elithi nihilist livela kwisiLatini nihil, okungasho lutho. Inkohliso ye-Nihilistic ichazwa njengalezo zimpawu ze-psychopathology lapho labo abathintekayo bephika ubukhona bobuntu babo. Enye yazo yi- I-Cotard's syndrome, okuthi naphezu kokusukela ekhulwini le-19, incane kakhulu eyaziwayo kuze kube manje. Ngenxa yalesi sizathu, sinikeza esihlokweni esilandelayo incazelo ebanzi, kanye nezimpawu zayo, izimbangela ezingenzeka kanye nokwelashwa okukhona njengamanje.
Iyini i-Cotard syndrome?
I-Cotard syndrome, ebizwa nangokuthi Inkohliso kaCotard, noma i-nihilistic noma i-denial syndrome, Kuyi-psychopathology eyaziwa kancane kakhulu, lapho umuntu othintekile ehlangabezana neziqephu ezinzima zokucindezeleka nokudangala, okuholela ngisho nasekucabangeni ukuthi ushonile. Igama layo kuthiwa liqanjwe uJules Cotard, udokotela wezinzwa ongumFulentshi owachaza lesi sifo okokuqala ngqa edolobheni laseParis ngo-1880; nakuba kucatshangwa ukuthi amacala afanayo asevele enzeke endulo. Naye wambona ngaleso sikhathi ukuthi i-délire ye-negation, okuhunyushwa ngokwezwi nezwi ngokuthi “i-delirium of denial.”
Lo dokotela wengqondo wethula icala lesiguli asiqamba ngokuthi uMademoiselle X, esaphika ngokuphelele ukuthi kukhona izingxenye ezithile zomzimba waso, ngakho-ke, saphika nesidingo sokudla okunomsoco. Kamuva, isimo sakhe saba sibi kakhulu kangangokuthi ukuphikelela kwakhe ukwenqaba uNkulunkulu noDeveli kwamlahla futhi nethuba lokufa okungokwemvelo lingasekho.
Kuyisifo ihlobene eduze ne-hypochondria, njengoba iziguli eziphethwe yiso zithi zifile nokuthi izingxenye ezihlukene ezakha imizimba yazo empeleni azikho, noma zisesimweni sokubola. Kwezinye izimo, ngokuphambene nalokho, iziguli zikholelwa ukuthi azikwazi ukufa, njengoba kwenzeka ku-Mademoiselle X, okungabaholela ekwenzeni izenzo eziyingozi nezibulalayo, njengokucwiywa.
I-Cotard iphinde yethula ukuhlukaniswa kweziqephu ngaphakathi kwe-delirium yokuphika:
- Amacala ajwayelekile.
- Abakhungathekile.
- Lezo ze-phasic evolution.
- Labo abanenjabulo yohlanya.
I-Cotard syndrome ihlobene i-psychopathologies okubi kakhulu njenge-schizophrenia noma izinhlobo ezahlukene zokuwohloka komqondo. Kungakho abanye odokotela bengqondo namuhla bengakubheki njengokugula, kodwa njengokubonakaliswa okwedlulele kakhulu kokuhlukaniswa komuntu, okungukuthi, njengesigaba esibi kakhulu sezinye izifo zengqondo.
Kusukela ekuchazeni kwayo kokuqala ngo-1880, izifundo ezihambisana nalesi sifo zilinganiselwe kakhulu, uma kubhekwa ukuphindaphinda lapho ubuhlobo bawo nezinye izifo zenzeka khona. Kodwa-ke, kuze kube manje iningi lamacala ahloliwe enzeka kubantu asebekhulile.
Izimpawu ze-Cotard syndrome
Izimpawu ze-Cotard syndrome zicacile. Isiguli esiphethwe yiso ngokuqinisekile siyoveza ukuthi izitho ezakha umzimba waso zisesimweni sokubola, noma sezinyamalele ngenxa yokufa kwaso nje. Ngezansi izici ezihluke kakhulu zalesi sifo:
- Ukukhathazeka kwe-Melancholic.
- Ukuvezwa kwemicabango ye-hypochondriacal lapho beqinisekisa khona ukuthi izitho zomzimba wabo zisendleleni yokubola, ukuthi akukho umzimba wabo noma umphefumulo wabo.
- Ukukhohlisa kokungafi, ukubonakaliswa okuzethembayo kwemibono yokungaze ufe.
- Ama-hallucinations anuka kamnandi.
- Ukuzisika kanye nezinye izinhlobo zodlame olubhekiswe kubo ngenxa yenkolelo yokuthi azikho noma azifi.
- Ukuthambekela kokuzibulala kaningi.
Kuleli qophelo, kubalulekile ukugqamisa i-dichotomy yomcabango ekhona kule syndrome. Ngakolunye uhlangothi, umqondo wokufa komuntu siqu, ongaxhunyaniswa nokucindezeleka okukhulu kanye nemibono yokuzibulala ephuma kukho, nomqondo wokungafi, obangelwa umuzwa wokungabi khona.
Izinkinga ze-Cotard syndrome
Njengoba sekushiwo, i-Cotard syndrome ibhekwa ochwepheshe abaningi njengophawu lwakamuva lwezinye izimo zengqondo, ngokuvamile ezimweni zokucindezeleka okukhulu kanye nezinye izifo zemizwa. Ngaphezu kwalokho, i- ukuhlukumezeka kwasebuntwaneni, okuye kwafakazelwa esimweni ngasinye esifundweni kuze kube manje, yingakho nayo kuthiwa ingenye yezimbangela.
Ukungasebenzi kahle kwe-parietal lobe:
I-parietal lobe ingenye yamangqamuzana egazi amakhulu kunawo wonke ebuchosheni, futhi inesibopho esikhulu sokuthwebula izisusa ngokuthinta, ukushisa, amakhaza, ukucindezela, ubuhlungu, kanye nokuxhumanisa ibhalansi. Izimpawu zokuphika umzimba ziye zabangelwa izilonda noma ukungasebenzi kahle kulesi sifunda sobuchopho, nezinye izindawo ezifana ne-dorsolateral frontal lobe, i-cingulate gyrus, i-thalamus, ne-neocortex (i-caudate ne-putamen).
Izinguquko ku-metabolism yobuchopho:
Ngokufanayo, i-hypometabolism (ukusetshenziswa kwe-glucose ephansi) kuye kwabonwa kulezi, futhi kwezinye izimo, ngokuphambene nalokho, i-hypermetabolism, okungukuthi, ukusetshenziswa okukhulu kwe-glucose, kuye kwabonwa ku-cerebellum, i-thalamus nesiqu sobuchopho.
Izindawo ezishiwo ngenhla zinendima enkulu ekubumbeni ulwazi lomuntu siqu, kanye nolwazi. Kuze kube manje, ukuhlolwa kwezithombe ezisetshenziswa kwezinye iziguli kuye kwaqinisekisa izinsolo zalesi sitatimende; kodwa kusenobufakazi obuncane kakhulu bokusho ukuthi iyimbangela esemthethweni ye-Cotard syndrome.
Ukuxilongwa kwe-Cotard syndrome
Izimpawu ezichazwe ze-Cotard syndrome zicacile. Kodwa-ke, ukuxilongwa kwayo kuhlala kuyinkimbinkimbi ngenxa yokungabikho kolwazi olwanele oluhambisana nakho. Ngokuvamile kuhilela i- ukubhekwa kwengqondo kwesiguli (isithombe somtholampilo), nakuba ukuhlolwa okuhlukile kwe-neuroimaging nakho kungasetshenziswa; kodwa lezi ziwusizo kakhulu kulokhu ukukhipha amanye ama-syndromes kunokukhomba.
Ukwelashwa kwe-Cotard syndrome
Mayelana nokuphathwa kwezidakamizwa, okuvame kakhulu ama-tricyclic antidepressants kanye ne-serotonergics, ngokuhambisana nokwelashwa kwe-electroconvulsive.
Ukwelashwa kwe-Electroconvulsive (ECT)
Okwaziwa nangokuthi i-electroconvulsive therapy noma i-electroshock therapy, ukwelashwa kwengqondo lapho ukuquleka kukhiqizwa khona esigulini ngokushukumisa ugesi. Isetshenziswa ezimeni zokucindezeleka okukhulu, nasezifweni ezinzima zengqondo, njenge-schizophrenia. Lokhu kuye kwasetshenziselwa ukwelapha i-Cotard syndrome, ezimisweni njalo emahoreni angu-48 izinyanga ezithile, futhi iziguli zibonise ukuthuthuka, nakuba kuhilela ukulahlekelwa inkumbulo yesikhashana noma engapheli (amnesia).
- Njengamanje, i-ECT iyindlela ephumelela kakhulu yokuvimbela lesi sifo, njengoba amacala angu-80% aphendule kahle ekusetshenzisweni kwayo. Kodwa-ke, lokhu kufanele kusetshenziswe kuphela ochwepheshe abanekhono endaweni, ngaphansi kokulawulwa okuqinile nokuhambisana nokwelashwa kwemithi.
- Ngokuphathelene nokubikezelwa kwayo, ngenxa yobunzima besifo, amacala okubuyisela ngokuphelele ambalwa kakhulu, ngisho nangemva kokwelashwa okuqinile kwengqondo. Izinga lokuzibulala okubangelwa i-Cotard syndrome liphezulu kakhulu, eqinisweni.
Sithemba ukuthi usithandile lesi sihloko mayelana ne-Cotard syndrome. Uma ungathanda ukuthola ulwazi mayelana nokunye ukuphazamiseka kwengqondo noma ama-pathologies, sikumema ukuthi uthintane nezinye izihloko kuleli khasi, lapho uzothola khona idatha ehlukahlukene efanele nekhwalithi.