fsiqikuri aslilobebi, adreuli gamovlena, profilaqtika; carevis,zrunvisa da mkurnalobis metodebi
Post on 12-Jan-2016
70 Views
Preview:
DESCRIPTION
TRANSCRIPT
fsiqikuri aSlilobebi, adreuli gamovlena, profilaqtika;
Carevis,zrunvisa da mkurnalobis meTodebi
neli maWaraSvili;“samSabaToba”; 02.02.10
ra aris fsiqikuri janmrTeloba?
fsiqikuri jamrTeloba ufro metia vidre fsiqikuri daavadebis
ar qona.
fsiqikuri jamrTeloba gulisxmobs keTildReobis mdgomareobas, rodesac:
• adamians SeuZlia sakuTari SesaZleblobebis realizacia;
• cxovrebiseul stresebTan gamklaveba; • nayofieri da produqtiuli muSaoba; • sazogadoebis cxovrebaSi wvlilis Setana.
• msoflioSi daaxloebiT 450 milion adamians aReniSneba Pfsiqikuri janmrTelobis problemebi; • fsiqikuri aSlilobebi yvelaze gavrcelebul
daavadebaTa ricxvSi Sedis;• depresia avadmyofobis da Sromisuunarobis
gamomwvev mizezTa Soris meoTxe adgilzea;• saSualo da dabal Semosavlian qveynebSi
daavadebaTa tvirTis 10-% swored fsiqikur daavadebebze modis;
• es ricxvi axlosaa gulsisxlZarRvTa daavadebebis Sesabamis maCvenebelTan;
invalidobis gamomwvevi 10 umTavresi mizezis naxevari fsiqikuri daavadebebiTaa gamowveuli, esenia:
1. depresia, 2. alkoholizmi, 3. maniakalur-depresiuli fsiqozi,4. Sizofrenia.
2020 wlisaTvis msoflioSi invalidobis uxSiresi mizezi depresia iqneba;
daavadebaTa klasifikaciis rigSi depresia gulsisxlZarRvTa daavadebebis Semdeg
meore adgils daikavebs.
• Hharvadis universitetis kvlevis Sedegebis Tanaxmad fsiqikurad seriozulad daavadebulTa 80_% umuSevaria;
• moxucTa da xandazmulTa depresiuli aSlilobebi 8-%ia;
• maTgan 63-% ver axerxebs mkurnalobas; • depresia am asakobriv jgufSi iwvevs: insultebis,parezebis,kardio-vaskularuli, infeqciuri daavadebis, maT Soris
tuberkulozis provocirebas
• zrdasruli martoxela usaxlkaro mosaxleobis 1/3-s seriozuli fsiqikuri daavadebebi awuxebs, rasac xSirad alkoholizmi da narkomania emateba.P
• pirveladi daxmarebis kabinetebSi misul pacientTa Civilebis 30-80 % daudgeneli xasiaTis fsiqikur aSlilobebs ganekuTvneba;
• aSS-Si sikvdilianobis mizezTa Soris TviTmkvleloba mecxre adgilzea.
kvlevis ”globaluri iniciativa fsiqiatriaSi” Sedegebis Tanaxmad fsiqikuri aSlilobis mqone
adamianebi erT-erT yvelaze daucvel jgufs miekuTvnebian
• maTi absoluturi umravlesoba (90-%) umuSevaria;
• fsiqikuri aSlilobis mqone pirTa socialuri urTierTobebi Raribia - 88-%-ze meti ZiriTadad saxlSia gamoketili; F
• fsiqikuri aSlilobis mqone pirTa 88-%-s konfliqti aqvs ojaxebSi;
• mzrunvelTa 68-% umuSevaria radgan dRis umetes nawils fsiqikuri aSlilobiT daavadebuli piris movlas uTmobs, 70-%-s ar dausvenia ramodenime wlis ganmavlobaSi
fsiqikuri statusis gamokvlevis mizani:
fsiqikuri aSlilobis simptomis dadgena;P
pacientis mxridan TviT an sxvisi dazianebis saSiSorebis Sefaseba;
Semdgomi mkurnalobis gegmis Sedgena.
arsebobs fsiqodiagnostikis sxvadasxva meTodi:1) fsiqo statusis gamokvleva (kognicia, koncentracia,
saxis gamometyveleba, intonacia, manerebi, TviT Sefaseba, laparakis manera, tonaloba, aRqma);
2) testireba (arsebobs msoflioSi miRebuli depresiis kiTxvarebi:bk-is,hopkin-si,luSeri-s,mmpa da a.S.)
testis Sedegebis damuSavebis Semdeg fsiqologi akeTebs daskvnas da isazRvreba mkurnalobis Semdegi taqtika, mZime depresiis SemTxvevaSi aucilebelia fsiqiatris CarTva da farmako Terapia;
mkurnalobis 14 dRis Semdeg saWiroa samkurnalo reJimis adeqvaturobis ganmeorebiTi Sefaseba
depresia laTinuri sityvaa da niSnavs daTrgunuls
depresia adamianis fsiqiuri aSlilobaa, romelsac axasiaTebs:
• negatiuri ganwyoba, • sevda, • daTrgunuloba • gunebisa da TviTSefasebis
gauareseba,• cxovrebis interesis dakargva.depresia advilad gankurnebadia _
pacientebis 80 %-sruliad ikurneba.
depresiis klinikadepresiis gancda adamianisTvis damaxasiaTebeli
normaluri reaqciaa garegan movlenaze, an raime mniSvnelovan personalur danakargze. gaxangrZlivebuli reaqcia, romelic moicvas ara mxolod guneba-ganwyobis moSlas, aramed sxva cvlilebebsac, diagnostirdeba rogorc depresia
depresia moicavs:Secvlil guneba-ganwyobas (daqveiTebuli guneba-
ganwyoba an/da anhedonia, anu siamovnebisa da interesis dakargva);
fizikur simptomebs (darRveuli mada, Zili, seqsualuri ltolva da motoruli niSnebi: aJitacia an Seneleba, daRliloba);
kognitur siptomebs (negatiuri azrovneba, danaSaulis araadekvaturi gancda, gulmaviwyoba, yuradRebis koncentraciis daqveiTeba, suiciduri azrebi).
depresiis formebi:mZime depresiuli aSliloba -
ganmeorebiTi, sul cota 2 kviriani epizodebiT;
mcire depresia - vlindeba naklebi simptomebiT vidre didi depresiis forma;
disTimia – xasiaTdeba qronikuli mimdinareobiT, ara nakleb 2 wlis xangrZlivobiT;
depresiis statistika
• aSS-Si cxovrebis manZilze qalebis 10-24% da mamakecebis 5-12% imyofeba depresiis gamovlenis riskis qveS;
• yoveli rva qalidan erTs uviTardeba depresia;• samidan mxolod erTi mimarTavs eqims
daxmarebisaTvis;• mZime depresiis mqone hospitalizirebuli pacientebis 15
% sicocxles TviTmkvlelobiT asrulebs;• didi depresia iwyeba axalgazrda asakSi - meore
aTwleulis bolos;• qalebSi depresia piks aRwevs 25-44 wlis asakSi;• depresia xSirad Tanaarsebobs sxva qronikul
daavadebebTan.
tuberkulozi da depresia
TB pacientebSi gansakuTrebiT maRalia guneba-ganwyobis moSliT mimdinare mdgomareobebi, Semdegi faqtorebis gamo:
• stigma; • mgb+ mdgomareobiT gamowveuli
epidsaSiSroeba; • stacionaluri mkurnalobis periodSi specifiuri
reJimi;
MD
tuberkulozisa da filtvis daavadebaTa erovnuli centris 100 DR-TB (Poly, MDR da XDR) pacienti gamokiTxul iqna PQR-
11 skrining kiTxvariT.
Mmsubuqi depresia dafiqsirda 9 pacientTan
zomierad gamoxatuli depresia -11-Tan
mZime depresia 18 qalbatonTan
fsiqiatris daxmareba saWiro gaxda zomierad da mZimed gamoxatuli depresiebis dros
38 DR-TB qali pacienti
62 DR-TB mamakaci pacienti
msubuqi depresia dafiqsirda12 pacientTan
zomierad gamoxatuli 8 pacientTan
MmZime depresia32 pacientTan
fsiqiatris daxmareba saWiro gaxda zomierad da mZimed gamoxatuli depresiebis dros
depresiis TandarTva aqveiTebs TB pacientebis mkurnalobaze damyolobas da axangrZlivebs mkurnalobis vadebs;
daavadebis simZimis, mkurnalobis xangrZlivobis da reJimis gamo MDR-TB pacientebSi mZime da zomierad gamoxatuli depresiebi procentulad ufro metia, vidre regularuli TB-iT daavadebul pacientebSi;
PQR-11 skrining kiTxvariT gamoikiTxaHkvlevaSi CarTuli regularuli TB-iT daavadebuli 30 pacienti:
• msubuqi depresia dafiqsirda 12 pacientTan;
• zomierad gamoxatuli - 10 pacientTan (maT Soris 3 warsulSi namkurnalebi iyo);
• mZime depresia dafiqsirda 8 pacientTan - CarTulia fsiqiatri.
depresiis gamomwvevi mizezebi:
eqspertebi Tvlian, rom genetikur winaswarganwyobas udidesi mniSvneloba eniWeba cxovrebaSi mimdinare stresul situaciebTan erTad;
zogierT faqtorebs SeuZliaT konkretuli qimiuri nivTierebebis - Tavis tvinis e.w. neiromediatorebis, disbalansi gamoiwvion, rac iwvevs depresias.
depresiuli Setevebis maprovocirebeli faqtorebi;
medikamentozuri moqmedeba – Zlieri tkivilis moxsnis mizniT narkotikebis moxmareba da steroidebiT mkurnaloba (depresiuli simptomebi xSirad ukvalod qreba am faqtorebis moxsnis Semdeg);
hormonaluri sekreciis darRveva _ farisebri jirkvlis da Tirkmelzeda jirkvlis disbalansi.
qronikuli daavadebebi _ arTriti, gulis -sisxlZarRvTa paTologia, simsivneebi, virusuli da qronikuli infeqciuri daavadebebi.
depresiis mkurnalobis mizani:
depresiuli aSlilobis yvela niSnisa da simptomis Semcireba da moxsna;
asimptomuri mdgomareobis doneze avadmyofobis samsaxureobrivi da fsiqosocialuri aqtivobis aRdgena;
recidivis ganviTarebis albaTobis Semcireba;
depresiis mkurnalobis saxeobebi:
1. fsiqoTerapia;
2. farmakoTerapia.
gmadlobT yuradRebisTvis !
top related