En 1880, el neurólogo francés Jules Cotard describió la enfermedad como «el delirio de la negación”, un síndrome psiquiátrico de gravedad variada. Un caso leve se caracteriza por la desesperación y el odio hacia uno mismo, mientras que un caso grave se caracteriza por delirios intensos de negación y depresión psiquiátrica crónica.
Este trastorno mental poco frecuente provoca que la persona afectada tenga la creencia delirante de que está muerta, no existe, se está pudriendo o ha perdido sangre u órganos internos. Básicamente, el paciente está convencido de ser un zombie. El análisis estadístico de una cohorte de cien pacientes indicó que la negación de la autoexistencia es visible en el 45% de los casos del síndrome de Cotard. El otro 55% presentó delirios de inmortalidad, lo cual también ha llevado a muchos enfermos a arriesgar sus vidas con la finalidad de comprobar que, como ya están muertos, no pueden morir nuevamente.
El síndrome de Cotard es bastante raro, solamente hay alrededor de 200 casos conocidos en todo el mundo. Aunque la sintomatología es extrema, la mayoría de las personas mejora con el tratamiento.
Síntomas
Las personas con este síndrome se vuelven mucho menos sociales. A veces, pueden dejar de hablar en absoluto. Algunos escuchan voces que les dicen que están muertos o muriendo. Otros se niegan a comer (porque, entre otras razones, no le encuentran ninguna razón ya que «están muertos»). Algunos pueden intentar hacerse daño o suicidarse.
En un caso bien documentado del síndrome de Cotard reportado en 2008, una mujer de 53 años ingresó en el hospital después de que su familia llamara al número de emergencias. Dijeron que la mujer creía estar muerta, se veía en el espejo y decía tener el cuerpo en completo estado de desomposición, con pedazos de piel colgando. Acotaba que todos sus sentidos le indicaban lo mismo, percibía que su olor era de pescado podrido.
Los casos más avanzados de esta enfermedad generan alucinaciones muy vívidas de las manifestaciones fisicas que creen tener. Al final, esta mujer también pidió que la llevaran a una morgue porque quería compartir el espacio con personas muertas.
![Trastorno mental de Cotard](https://tintaindomita.com/wp-content/uploads/2020/06/Trastorno-de-cotard.jpg)
Causas del síndrome de Cotard
No está claro qué causa el síndrome de Cotard. Sabemos que a menudo es síntoma de un problema médico más profundo que afecta el cerebro, como:
- Demencia.
- Encefalopatía (una enfermedad en la que un virus o una toxina afecta al funcionamiento del cerebro).
- Epilepsia.
- Migraña.
- Esclerosis múltiple.
- Enfermedad de Parkinson.
Algunos expertos creen que el síndrome de Cotard es la combinación de dos tipos de daño cerebral. El primero cambia la forma en que las personas se ven a sí mismas. El segundo hace que sigan creyendo esta visión falsa, incluso cuando se les muestra que no es verdad. Sin embargo, los científicos no se ponen de acuerdo, ya que muchos tienen opiniones que distan de estos argumentos.
¿Quién es candidato a presentar el síndrome?
El síndrome de Cotard puede ocurrir a casi cualquier edad, aunque de media afecta a muchas personas en sus primeros 50 años. Los pacientes que lo tienen también tienen antecedentes de problemas de salud mental, especialmente:
- Depresión.
- Ansiedad.
- Esquizofrenia.
- Abuso de sustancias.
La mayoría tiene algún tipo de daño cerebral que aparece en las pruebas de imagen. El daño puede provenir de un golpe, un tumor, un coágulo sanguíneo o una herida.
Además, el síndrome de Cotard puede causar trastorno bipolar en adolescentes y adultos jóvenes.
Diagnóstico
Debería ser fácil de detectar. El problema es que es un síntoma de otra afección, no una enfermedad en sí misma, y no figura en el DSM (manual utilizado para diagnosticar problemas de salud mental). El hecho de que no esté allí significa que no hay reglas firmes para guiar a los médicos.
Por lo general, se diagnostica después de que los médicos descartan otras afecciones que se parecen. Uno de esos trastornos es el síndrome de Capgras, cuando una persona cree que un amigo o familiar ha sido reemplazado por una falsificación idéntica. También se llama «síndrome del impostor».
Tratamiento del síndrome de Cotard
Los médicos tienen muchas formas de tratar el síndrome de Cotard. El enfoque habitual es tratar el problema médico que lo está causando.
A otras personas les va mejor con una combinación de medicamentos y terapia de conversación, como la terapia cognitiva conductual (TCC) o la psicoterapia. Ambos proporcionan un lugar seguro para que las personas hablen sobre cómo se sienten y les ayudan a encontrar formas más saludables de pensar y actuar. Aunque se ha comprobado que por sí misma la psicoterapia no funciona, no hay manera de lograr que se den cuenta que están vivos, solamente con el diálogo.
Los medicamentos utilizados para tratar el síndrome de Cotard incluyen antipsicóticos, ansiolíticos y antidepresivos.
La mayoría de las personas generalmente necesitan más de un tipo. Si los medicamentos y la terapia de conversación no ayudan, la terapia electroconvulsiva (TEC) es una opción. Aunque suena muy arcaico y salvaje, este método sí ha logrado mejorar el estado de los pacientes. Envía pequeñas corrientes eléctricas a través del cerebro, esto cambia su química y puede eliminar algunos síntomas de salud mental.
La terapia de shock puede causar efectos secundarios como pérdida de memoria y confusión. Por lo tanto, a menudo es un último recurso. No se sabe con exactitud cuántas personas pudieron haber padecido este síndrome antes que se le identificara y se desarrollara un tratamiento. Pero puedo imaginar perfectamente a los doctores de antaño optando por algún padecimiento de locura incurable, el cual se derivaba en el ingreso a un manicomio o tratamiento poco ortodoxo. Al final la mayoría de nosotros nunca sabrá lo que se siente al ser un zombie en vida. Y eso está bien.
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