sizofrenia da sxva fsiqozuri aslilobani
TRANSCRIPT
1
Sizofrenia da sxva fsiqozuri
aSlilobani
klinikuri praqtikis erovnuli rekomendacia
(gaidlaini)
2
klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
`Sizofrenia da sxva fsiqozuri aSlilobani~ miRebulia
klinikuri praqtikis erovnuli rekomendaciebis (gaidlainebi) da
daavadebaTa marTvis saxelmwifo standartebis (protokolebi)
SemuSavebis, Sefasebis da danergvis erovnuli sabWos 2008 wlis
5 noembris #1 sxdomaze da damtkicebulia saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis ministris 2008 wlis 18
dekembris # 277/o brZanebiT.
3
Sizofrenia da sxva fsiqozuri aSlilobani
daavadebaTa jgufSi _ “Sizofrenia da sxva fsiqozuri aSlilobani”
gaerTianebuli aSlilobebi xasiaTdebian klinikur suraTSi fsiqozuri
simptomebis, rogorc daavadebis ganmsazRvreli niSnebis arsebobiT. jgufs
saerTo ganmarteba ar gaaCnia, vinaidan sxvadasxva aSlilobis gaerTianeba
moxda fsiqozuri simptomatikis xazgasmis safuZvelze.
I. Sizofrenia
1. daavadebis definicia, sinonimebi, klasifikacia da terminologia
definicia (1)
Sizofrenia warmoadgens ZiriTad fsiqiatriul daavadebas, romelsac
axasiaTebs azrovnebisa da aRqmis Zireuli darRvevebi Seusabamo emociuri
reagirebiTa da/an emociuri sferos gasadavebiT. Cveulebriv, pirovnebas
inteleqtualuri SesaZleblobebi/unarebi da cnobiereba formalurad
SenarCuebuli aqvs, Tumca daavadebis mimdinareobis manZilze udaod xSiria
kognituri deficitis ganviTareba. aSliloba vrceldeba iseT bazisur
funqciebze, romlebic fsiqikurad janmrTel adamians aniWebs
individualobisa da unikalurobis gancdas. xSirad pirovnebis yvelaze
piraduli, intimuri azrebi, grZnobebi da qmedebani subieqtis mier
SeigrZnoba/ganicdeba, rogorc sxvebisTvis cnobili, gaxsnili. aRniSnulis
asaxsnelad, mas SesaZloa ganuviTardes zemoqmedebis bodva. Sizofreniuli
aSilobisas halucinaciebi ZiriTadad smeniTia, romelic komentars
ukeTeben individis qcevebsa da azrebs. dabneulobis fonze, romelic
fsiqozis erT-erTi ZiriTad adreul niSans wamoadgens, pacienti midis iseT
myar Sexedulebamde, rom TiTqosda yoveldRiur situaciebs misTvis
gansakuTrebuli mniSvneloba gaaCnia. amdenad, azrovnebis procesi irRveva,
xdeba abneuli, Sesabamisad, metyvelebac Znelad misawvdomi da gasagebia. am
dros guneb-ganwyoba cvalebadia, gamRizianeblobis elferiT, zogjer
bodviTi azrebis Seusabamoa, arakongruentuli. aseve, SesaZloa ganviTardes
ambivalentoba da darRvevebi nebelobiTi sferos mxriv, inertulobis,
negativizmis an stuporis da katatoniuri simptomebis saxiT.
Sizofreniuli aSliloba SeiZleba daiwyos mwvaved, qcevis mniSvnelovani
darRvevebiT, an Semparavad, ucnauri, odiozuri ideebis da qceviTi
aSllilobebis TandaTanobiTi ganviTarebiT. am aSlilobebis mimdinareoba
ar aris gardauvlad qronikuli da damangreveli (mimdinareobas
gansazRvravs ICD-klasifikaciis mixedviT V niSani, ix. klasifikacia).
calkeul SemTxvevebSi gamosavali SesaZloa iyos sruli an TiTqmis sruli
gamojanmrTeleba (sxvadasxva kulturul jgufebSi da populaciaSi).
sinonimebi da terminologia (2)
istoriulad, Sizofreniuli aSlilobani pirvelad aRweril iqna frangi
fsiqiatris morelis (Benedict Morel, 1809-1873) mier, romelmac mozardobis
asakSi ganviTarebul fsiqikur darRvevebs uwoda Demence precoce. kalbaumma
(Kahlbaum) pirvelad aRwera katatoniuri simptomebi, hekerma (Hacker) ki
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hebefreniis dros pcientTa qcevis Taviseburebani. mogvianebiT aRniSnuli
simptomebi krepelinma (Emil Kraepelin, 1856-1929) erT nozologiad gaaerTiana
da uwoda Dementia precox (naadrevi Wkuasustoba), xolo maniakalur-
depresiuli fsiqozi calke nozologiad gamoyo.
krepelinma saxelwodebiT_Dementia precox, daavadebis adreul dawyebasTan
erTad, xazi gausva pacientTa specifikur kognitur process (deficits).
halucinaciebTan da bodvebTan erTad igi klinikur suraTSi wamyvan
mniSvnelobas aniWebda aSlilobis xangrZliv, fsiqikisaTvis damangrevel
mimdinareobas. bloilers (Eugen Bleuler) miuZRvis yvelaze didi wvlili
Sizofreniis da saerTod, Sizofreniuli aSlilobebis Tanamedrove xedvis
CamoyalibebaSi. man pirvelad mogvawoda es saxelwodeba _ Sizofrenia
(fsiqikis gaxleCa), raTa xazi gaesva fsiqikis sferoebSi sqizisis, anu
gaxleCis mniSvnelobaze. misi azriT, Sizofreniuli aSlilobis
mimdinareobis manZilze gardauvlia fsiqikis rRveva. igi Sizofreniis
ZiriTad maxasiaTeblad miiCnevda oTx fundamentur simptoms, e.w. 4 a-s:
asociaciuri procesis aSliloba, afeqturi darRvevebi, autizmi (sakuTar
Sinagan samyaroSi daZirva (3)) da ambivalentoba (garkveuli movlenis, an
pirovnebis mimarT ori urTierTsapirispro impulsis Tanaarseboba (3)).
mogvianebiT, klinikuri diagnostirebisaTvis kurt Snaideris (Kurt Schneider) mier gamoyofil iqna Sizofreniis pirveli rangis da meore rangis
simptomebi. pirveli rangis simptomebad avtori miiCnevda Semdeg simptomebs:
azrTa gaxmovaneba; mokamaTe da makomentirebeli xmebi; fizikuri uZlurebis
(ususurobis) gancda; azrebis warTmeva da gadacema; bodviTi aRqma;
nebismieri sxva naZaladeobis gancda, romelic Seexeba nebiT aqtebs,
`gakeTebul~ afeqtsa da ltolvebs (3).
klasifikacia (93)
1996 wlidan saqarTveloSi fsiqikuri daavadebaTa diagnostireba da
samedicino dokumenatciis warmoeba xdeba ICD-10 klasifikaciis mixedviT
(ix. daavadebaTa saerTaSoriso klasifikacia. me-10 gadasinjva (fsiqiatria). jgufi `Sizofrenia da sxva fsiqozuri aSlilobani~ gaerTianebulia erT
kodSi (F20-F29), saxelwodebiT:
Sizofrenia, Sizotipuri da bodviTi aSlilobani
am paragrafSi ganxilulia Sizofrenia, rogorc am jgufis yvelaze ufro
mniSvnelovani daavadeba, Sizotipuri aSliloba, myari bodviTi
aSlilobani da ufro farTo jgufi mwvave da swrafad ganviTarebuli
aSlilobisa. miuxedavad misi sadaoobisa, Sizoafeqturi aSlilobanic am
TavSi rCeba.
F20 Sizofrenia
Sizofreniuli aSlilobebisaTvis zogadad damaxasiaTebelia aRqmisa da
azrovnebis sferoSi fundamentaluri darRvevebi, agreTve araadeqvaturi da
daClungebuli afeqti. cnobiereba da inteleqtualuri SesaZleblobebi
Senaxulia, Tumca droTa ganmavlobaSi SeiZleba Tavi iCinos garkveulma
kognitiurma deficitma. yvelaze ufro mniSvnelovan fsiqopaTologiur
gamovlinebebs warmoadgens eqo-azrebi, azrTa Cadeba an warTmeva,
gaxsniloba, zemoqmedebis bodva, pasiuri damorCileba da bodviTi aRqma,
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smeniTi halucinaciebi, xSirad makomentirebeli an gansjis Sinaarsis,
azrovnebis aSlilobani da negatiuri simptomebi. Sizofreniuli
aSlilobebis mimdinareoba uwyvetia an epizoduri, progresirebadi an myari
deficitiT. SeiZleba iyos erTi an ori epizodi mTliani an nawilobrivi
remisiiT. Sizofreniis diagnozi ar unda daisvas gamoxatuli depresiis an
maniakaluri sindromis dros, aseve ar unda daisvas cerebruli daavadebis,
wamliT intoqsikaciisa da abstinenciis dros. msgavsi aSlilobani,
romlebic viTardebian epilefsiis an sxva cerebruli daavadebis dros,
unda iqnes klasificirebuli F06.2-iT, fsiqoaqtiuri nivTierebebiT
gamowveuli - F10-F19-iT saerTo meoTxe niSniT 5. ar igulisxmeba: mwvave Sizofrenia (aradiferencirebuli) (F23.2),
cirkularuli Sizofrenia (F25.2), Sizofrenuli reaqciebi (F23.2), Sizotipuri aSlilobani (F21).
F20.0 paranoiduli Sizofrenia
paranoiduli Sizofreniis dros dominirebs SedarebiT myari, xSirad
paranoiduli bodvebi, upiratesad smeniTi halucinaciebiT, da SegrZnebaTa
aSlilobiT. afeqtis, nebelobis, metyvelebis darRvevebi, katatoniuri
simptomebi an ar arsebobs an SedarebiT sustia.
parafreniuli Sizofrenia
ar igulisxmeba: involuciur paranoiduli mdgomareoba (F22.8) paranoia (F22.0)
F20.1 hebefreniuli Sizofrenia
am formis dros, wina planzea upiratesad emociuri darRvevebi. bodviTi
ideebi da halucinaciebi aramyari da fragmentulia, qcevebi
upasuxismgeblo, ucnauri da manerulia. afeqti zedapiruli da
araadeqvaturia, azrovneba mouwesrigebeli da metyveleba inkoherentulia.
midrekilebaa ganmartoebisaken, qcevebi gancdis gareSe gamoiyureba.
“negatiuri” simptomebis swrafi ganviTarebis gamo prognozi cudia.
Sizofreniis es forma iwyeba mozard asakSi da zrdasrul axalgazrdebSi.
araorganizebuli Sizofrenia.
hebefrenia.
F20.2 katatonuri Sizofrenia
katatonuri Sizofreniis dros, wina planzea fsiqomotoruli darRvevebi,
romlebic iseT ukidures formebs Soris meryeobs, rogoricaa hiperkinezebi
da stupori, an avtomaturi damorCileba da negativizmi. iZulebiTi
moZraobebi da pozebi klinikur suraTSi SesaZlebelia SenarCundes didi
xnis ganmavlobaSi. niSandoblivia impulsuri agznebis epizodebi.
katatonur fenomenebs SeiZleba Tan sdevdes sizmrismagvari (oneiroiduli)
mdgomareobebi, mkafio, scenuri halucinaciebiT.
katatonuri stupori:
Sizofreniuli:
Sizofreniuli katalefsia
Sizofreniuli katatonia
cvilisebri moqniloba
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F20.3 aradiferencirebuli Sizofrenia
iseTi fsiqozuri mdgomareoba, romelic Sizofreniis zogad kriteriumebs
akmayofilebs, magram ar emTxveva F20.0-F20.2-Si aRweril formebs, romlebic
avlenen erTze met Sizoformul niSnebs, magram ZiriTadi diagnostikuri
simptomebis dominirebis gareSe.
atipiuri Sizofrenia
ar igulisxmeba: mwvave Sizofreniis msgavsi fsiqikuri aSliloba (F23.2) qronikuli aradiferencirebuli Sizofrenia (F20.5) postSizofreniuli depresia (F20.4)
F20.4 postSizoiduri depresia
saqme exeba xangrZliv depresiul epizods, romelic Sizofreniuli
daavadebis kvaldakval vlindeba. zogierTi “pozitiuri” an “negatiuri”
simptomi jer kidev saxezea, Tumca klinikur suraTSi ar dominirebs. es
depresiuli mdgomareoba xSirad TviTmkvlelobis gazrdil riskTan aris
dakavSirebuli. Tu pacients aRar aqvs Sizofreniuli simptomebi, maSin
depresiul epizods daesmis diagnozi (F32.-), Tu Sizofreniuli simptomebi
axali dawyebulia da wina planzea, maSin diagnozi daismeba, rogorc
Sizofreniis qvetipi (F20.0-F20.3).
F20.5 rezidualuri Sizofrenia
qronikuli stadia Sizofreniis mimdinareobaSi, romlis drosac SeimCneva
mkveTri gadasvla adreulidan momdevno stadiaze damaxasiaTebeli
xangrZlivad Senaxuli, Tumca araaucileblad Seuqcevadi "negatiuri"
simptomebiT, rogoricaa fsiqomotorikis Seneleba, aqtiurobis daqveiTeba,
emociuri gasadaveba, pasiuroba da uiniciativoba; metyvelebis rogorc
Sinaarsobrivi, aseve raodenobrivi gaRaribeba; araverbaluri
komunikaciebis siRaribe: mimikis, mzeris, xmis modulaciis da pozis;
TviTmomsaxurebis Cvevebis da socialuri saqmianobis ukmarisoba.
qronikuli aradiferencirebuli Sizofrenia.
narCeni mdgomareoba.
Sizofreniuli rezidualuri mdgomareoba.
F20.6 martivi Sizofrenia
saqme exeba mdgomareobas TandaTanobiTi, magram progresirebadi, ucnauri
qcevebiT, socialur moTxovnilebebTan SeusabamobiT, saerTo aqtiurobis
daqveiTebiT. rezidualuri SizofreniisaTvis damaxasiaTebeli negatiuri
simptomebi (mag: daClungebuli afeqti, motivaciis daqveiTeba) viTardeba
winamorbedi fsiqozuri simptomebis gareSe.
F20.8 Sizofreniis sxva formebi
senestopaTiuri Sizofrenia.
Sizofreniformebi:
aSliloba, romelic sxvagvarad ar aris dazustebuli
fsiqozebi, romelic sxvagvarad ar aris dazustebuli
ar igulisxmeba: xanmokle Sizofreniformuli aSlilobebi (F23.2).
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F20.9 dauzustebeli Sizofrenia
F21 Sizotopuri aSliloba
saqme exeba darRvevas, romlisTvisac damaxasiaTebelia eqscentriuli
qcevebi, azrovnebisa da guneba-ganwyobis sferos anomaliebi, romelic
axdens Sizofreniis STabeWdilebas, magram calsaxad tipiuri
Sizofreniuli simptomebi arasodes ar aRiniSneba, Tumca SeiZleba adgili
hqondes nebismier Semdegi saxis gamovlinebebs:
1. araadeqvaturi da garegnulad gamoumJRavnebeli afeqti
2. anhedonia
3. ucnauri da eqscentruli qcevebi
4. tendencia socialuri ukandaxevisadmi
5. paranoiduli an ucnauri ideebi, romelic namdvil bodvebamde ar
midis
6. akviatebuli azrebi
7. azrovnebisa da aRqmis moSla
8. epizoduri, gardamavali (tranzitoruli) kvazi-fsiqozuri epizodebi,
smeniTi an sxva halucinaciebiT, bodvismagvari ideebiT, romlebic ar
aris garegani mizezebiT gamowveuli. avadmyofobis calsaxad dadgena
SeuZlebelia da daavadebis mimdinareoba pirovnuli aSlilobis
xasiaTs atarebs.
latenturi Sizofreniuli reaqcia:
mosazRvre Sizofrenia,
latenturi Sizofrenia,
prefsiqozuri Sizofrenia,
prodromaluri Sizofrenia,
fsevdonevrozuli Sizofrenia,
fsevdofsiqopaTiuri Sizofrenia,
Sizotipuri pirovnuli aSliloba.
ar igulisxmeba: aspergeris sindromi (F84.5) pirovnebis Sizoiduri aSliloba (F60.1)
F22 xangrZlivi bodviTi aSlilobani
es jgufi moicavs aSlilobaTa rigs, romelTa drosac xangrZlivad
arsebuli bodva warmoadgens erTaderT an yvelaze TvalSisacem klinikur
maxasiaTebels da romelic ar SeiZleba klasificirebuli iqnes rogorc
organuli. Sizofreniuli an afeqturi aSliloba, bodviTi aSlilobebi,
romlebic mimdinareoben ramdenime Tveze ufro naklebi drois
ganmavlobaSi, SeiZleba klasificirebuli iqnes F23.-iT.
F22.0 bodviTi aSliloba
darRvevebis es jgufi xasiaTdeba erTi an erTmaneTTan dakavSirebuli
ramdenime bodviTi ideis ganviTarebiT, romlebic xangrZlivad, xandaxan ki
mTeli sicocxlis ganmavlobaSi arseboben. bodviTi sistemis Sinaarsi
Zalian gansxvavebulia. am diagnozTan SeuTavsebelia gamoxatuli da
xangrZlivi smeniTi halucinaciebi, Sizofreniuli simptomebi, rogoricaa:
devnis bodva, afeqtis daClungeba, agreTve Tavis tvinis mZime organuli
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daavadebebi. es diagnozi nawilobriv gamoricxuli ar aris xandazmulebSi.
im pirobiT, Tu Sizofreniul xasiaTs ar atarebs da klinikuri suraTis
erT mcire nawils Seadgens.
paranoia:
paranoiduli fsiqozi,
paranoiduli mdgomareoba.
mogvianebiTi parafrenia,
damokidebulebis senzitiuri bodva.
ar igulisxmeba: paranoiduli pirovnuli aSliloba,
fsiqogenuri paranoiduli fsiqozi (F23.3), paranoiduli reaqcia (F23.3), paranoiduli Sizofrenia (F20.0).
F22.8 sxva qronikuli bodviTi aSlilobani
am aSlilobebis dros, bodvas, an bodvebs Tan sdevs mdgradi
halucinaciuri xmebi an Sizofreniuli simptomebi, romlebic ar
Seesabamebian Sizofreniuli diagnozis (F20.-) kriteriumebs. bodviTi dismorfofobia,
paranoiis kverulanturi forma.
F22.9 dauzustebeli myari bodviTi aSliloba
F23 mwvave da gardamavali (tranzituli) fsiqozuri aSlilobani
aSlilobaTa heterogenuli jgufi, romelsac axasiaTebs mwvave dasawyisi
fsiqozuri simptomebiT (bodvebi, halucinaciebi, aRqmis aSlilobani) da
qcevis TvalsaCino moSla. mwvave dasawyisi gulisxmobs ori kviris an ufro
mcire drois ganmavlobaSi paTologiuri klinikuri suraTis ganviTarebas.
aRniSnul aSlilobaTa ganviTareba ar aris gamowveuli organuli
mizezebiT. organuli paTologiiT gamowveuli deliriumis (F05.-) damaxasiaTebeli simptomebis - dabneuloba, uxerxulobis grZnoba,
dezorientacia droSi, adgilsa da sakuTar TavSi ar aris sakmarisad
xangrZlivi da mwvave. sruli gamojansaReba SeiZleba moxdes ramdenime
TveSi, xSirad ramdenime kviraSi da dReebSic ki. Tu aSliloba myaria da
ufro didxans grZeldeba, maSin aucilebeli xdeba diagnozis gadaxedva.
aSliloba SesaZlebelia dakavSirebuli iyos an ar iyos mwvave stresTan,
romelic erTi an ori kviriT win uswrebda avadmyofobis dasawyiss.
F23.0 mwvave polimorfuli fsiqozuri aSliloba Sizofreniis simptomebis
gareSe
mwvave fsiqozuri aSliloba, romlis drosac saxeze gvaqvs halucinaciebi,
bodvebi da aRqmis darRvevebi da am simptomTa cvalebadoba SeiniSneba
dRiTi-dRe da zogjer saaTobrivadac ki. xSirad saxeze gvaqvs emociuri
Relva tranzitoruli bednierebis da eqstazis an SfoTvis da
gamRizianeblobis gancdiT. mTlianad klinikuri suraTisaTvis
damaxasiaTebelia polimorfizmi da arastabiluroba da fsiqozuri niSnebi
ar azusteben Sizofreniis diagnozs (F20.-). es aSlilobebi xSirad iwyeba
uecrad, viTardeba swrafad ramdenime dReSi da SesaZlebelia swrafadve
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gaqres ganmeorebis gareSe. Tu simptomebi grZeldeba, diagnozi unda
Seicvalos qronikul bodviT aSlilobaze (F22.-).
F23.1 mwvave polimorfuli fsiqozuri aSliloba Sizofreniis simptomebiT
mwvave fsiqozuri aSliloba, romlis drosac saxeze gvaqvs polimorfuli
da arastabiluri klinikuri suraTi, rogorc aRwerilia F23.0-Si. miuxedavad arastabilurobisa, umetesi periodis ganmavlobaSi, saxezea
SizofreniisaTvis damaxasiaTebeli simptomebi. Tu es simptomebi grZeldeba,
maSin unda klasificirdes rogorc Sizofrenia (F20.-), Bouffee delirante Sizofreniis simptomebiT,
cikloiduri fsiqozi Sizofreniis simptomebiT.
F23.2 mwvave Sizofreniismsgavsi fsiqozuri aSliloba
fsiqozuri simptomebi SedarebiT stabiluria da Seesabameba Sizofreniis
diagnozs, magram grZeldeba erT Tveze naklebi drois ganmavlobaSi.
polimorfuli arastabiluri niSnebi, rogorc aRwerilia F23.0-Si ar
arsebobs. Tu Sizofreniuli simptomebi grZeldeba, maSin unda
klasificirdes rogorc Sizofrenia (F20.-). mwvave (aradiferencirebuli) Sizofrenia,
xanmokle Sizofreniformuli aSliloba,
xanmokle Sizofreniformuli fsiqozi,
oneirofrenia,
Sizofreniuli reaqcia.
ar igulisxmeba: organuli bodviTi aSliloba (F06.2), Sizofreniformuli aSliloba, romelic sxvagvarad ar
aris dazustebuli (F20.8).
F23.3 sxva mwvave upiratesad bodviTi fsiqozuri aSlilobebi
klinikur suraTs warmoadgens SedarebiT stabiluri bodvebi an
halucinaciebi magram ar azustebs Sizofreniis diagnozs (F20.-). Tu
bodvebi grZeldeba, maSin unda klasificirdes, rogorc xangrZlivi
bodviTi aSliloba (F22.-). paranoiduli reaqcia,
fsiqogenuri paranoiduli fsiqozi.
F23.8 sxva mwvave gardamavali fsiqozuri aSlilobebi
Seicavs nebismier sxva specifikur fsiqozur aSlilobebs, romlis
gamomwvevi mizezi ar aris organuli da romelic ar azustebs F23.0-F23.3 klasifikacias.
F23.9 mwvave da gardamavali fsiqozuri aSliloba, araspecifikuri
xanmokle reaqtiuli fsiqozi, romelic sxvagvarad ar aris dazustebuli
reaqtiuli fsiqozi.
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F.24 inducirebuli bodviTi aSliloba
es aris ori an meti adamianis mier mWidro emociuri kavSiriT gaziarebuli
bodviTi aSliloba, mxolod erT-erT maTgans aqvs genuinuri fsiqozuri
aSliloba. bodvebiT inducirdeba sxva an sxvebi da Cveulebriv qreba,
rodesac es adamianebi gancalkevdebian.
wyvilTa fsiqoziT gamowveuli paranoiduli aSliloba,
wyvilTa fsiqoziT gamowveuli fsiqozuri aSliloba.
F25 Sizoafeqturi aSlilobani
saxezea rogorc afeqturi, aseve Sizofreniuli simptomebi, magram ar
azusteben Sizofreniul, depresiul da maniakalur epizodebs. sxva
SemTxvevebSi, rodesac afeqturi simptomebi emateba adre arsebul
Sizofreniul daavadebas, Tanaarsebobs an enacvleba sxva tipis bodviT
aSlilobebs, klasificirebulia F20-F29-iT. araadeqvaturi emociurobis
fsiqozuri simptomebi afeqturi aSlilobebis dros ar azustebs
Sizoafeqturi aSlilobis diagnozs.
F25.0 maniakaluri tipis Sizoafeqturi aSliloba
saxeze gvaqvs Sizofreniuli da maniakaluri simptomebi imdagvarad, rom
daavadebis epizodebi ar gvaZleven uflebas davsvaT Sizofreniis an
maniakaluri epizodis diagnozi. es kategoria unda iqnes gamoyenebuli
rogorc erTi epizodis, aseve rekurentuli aSlilobis dros, romlis
drosac umetesad saqme gvaqvs maniakaluri tipis Sizoafeqtur epizodebTan.
maniakaluri tipis Sizoafeqturi fsiqozi.
maniakaluri tipis Sizofreniformuli fsiqozi.
F25.1 depresiuli tipis Sizoafeqturi aSliloba
am aSlilobis dros saxeze gvaqvs rogorc Sizofreniuli, aseve
depresiuli simptomebi ise, rom daavadebis epizodi ar azustebs arc
Sizofreniuli da arc depresiuli epizodis diagnozs. es kategoria unda
iqnes gamoyenebuli, rogorc erTeuli epizodis, aseve rekurentuli
aSlilobis dros, rodesac umetesad sWarbobs depresiuli tipis
Sizoafeqturi epizodebi.
depresiuli tipis Sizoafeqturi fsiqozi,
depresiuli tipis Sizofreniformuli fsiqozi.
F25.2 Sereuli tipis Sizoafeqturi aSliloba
cirkularuli Sizofrenia,
Sereuli Sizofreniuli da afeqturi fsiqozi.
F25.8 sxva Sizoafeqturi aSlilobani
F25.9 dauzustebeli Sizoafeqturi aSliloba
11
F28.sxva araorganuli fsiqozuri aSlilobani
bodviTi an halucinaciuri aSlilobani, romelic ar gvaZlevs uflebas
davsvaT Sizofreniis diagnozi (F20.-), xangrZlivi bodviTi aSlilobani
(F22.-), mwvave da tranzitoruli fsiqozuri aSlilobani (F23.-), fsiqozuri tipis maniakaluri epizodi (F30.2) an mwvave depresiuli epizodi (F32.3). qronikuli halucinaciuri fsiqozi.
F.29 dauzustebeli araorganuli fsiqozi
fsiqozi, romelic sxvagvarad ar aris gamoricxuli
ar igulisxmeba: fsiqikuri aSliloba, romelic sxvagvarad ar aris
dazustebuli (F09).
dResdReobiT, saerTaSorisod aRirebulia ori, zemoaRniSnuli evropuli ICD-10 da amerikuli DSM-IV-TR
klasifikacia, romelic erTmaneTTan
SesabamisobaSia (5):
• Sizofrenia (ICD-10: F20.XX da DSM-IV TM: 295);
1. paranoiduli tipi ICD-10: F20.0X da DSM-IV TM: 295.30 (igive parafreniuli Sizofrenia _ Zveli klasifikaciebiT)
2. hebefreniuli (ICD-10: F20.1X) anu dezorganizebuli tipi
(DSM-IV TM: 295.10)
3. katatoniuri tipi (ICD-10: F20.2X da DSM-IV TM: 295.20)
4. aradiferencirebuli tipi (ICD-10: F20.3X da DSM-IV TM: 295.90)
5. postSizofreniuli depresia (ICD-10: F20.4X) anu depresiuli
aSliloba sxvagvarad dauzustebeli (DSM-IV TM: 311)
6. rezidualuri tipi (ICD-10: F20.5X da DSM-IV TM: 295.60)
7. martivi Sizofrenia (ICD-10: F20.6X, 295.90)
8. Sizofreniis sxva formebi (ICD-10: F20.8X)
mimdinareobas gansazRvravs kodis me-5 niSani (6):
0=uwyveti (aRiniSnos, Tuki upiratesad negatiuri simptomebi sWarbobs);
1= epizoduri, defeqtis progredientuli ganviTarebiT;
2=epizoduri, epizodebs Soris rezidualuri simptomebiT (aRiniSnos, Tuki
upiratesad negatiuri simptomebiTaa) anu epizoduri stabiluri defeqtiT;
3=epizoduri, epizodebs Soris rezidualuri simptomebis ararsebobiT;
4=erTaderTi epizodi arasruli remisiiT (aRiniSnos, Tuki upiratesad
negatiuri simptomebi sWarbobs);
5= erTaderTi epizodi sruli remisiiT;
8=sxva, araspecifiuri SemTxveva;
9=inicialuri aqtiuri fazis simptomebis dawyebidan 1 weliwadze naklebi
periodia.
12
• Sizotipuri aSliloba (ICD-10: F21), anu Sizotipuri pirovnuli
aSliloba (DSM-IV TM: 301.22); • qronikuli bodviTi aSlilobani (ICD-10: F22.0 da DSM-IV TM: 297.1) • mwvave da tranzitoruli fsiqozuri aSlilobani (ICD-10: F23.XX)
anu xanmokle fsiqozuri aSliloba (DSM-IV TM: 298.8) • inducirebuli fsiqozuri aSliloba (ICD-10: F24 da e.w. Folie a Deux
DSM-IV TM: 297.3) • Sizofreniismagvari (Sizofreniis sxva formebi) aSliloba (ICD-10:
F20.8 da DSM-IV TM: 295.40); • Sizoafeqturi aSliloba (ICD-10: F25.X da DSM-IV TM: 295.70) • sxva araorganuli fsiqozuri aSliloba (ICD-10: F28, DSM-IV-TM:298.9) • dauzustebeli (araspecifikuri) araorganuli fsiqozi (ICD-10: F29;
DSM-IV-TM:298.9 )
DSM-IV TM klasifikaciis mixedviT, garda zemoaRniSnulisa, (gansxvavebiT ICD-10-is F06.X), amave jgufSi Sedis: zogadi samedicino xasiaTis
problemiT gamowveuli fsiqozuri aSliloba (DSM-IV TM: 293.XX).
2. epidemiologia (7)
msoflioSi Sizofreniis gavrceleba saerTo populaciaSi Seadgens
saSualod mosaxleobis 1%-s, qalebsa da mamakacebSi maCvenebeli erTnairia.
WHO-s monacemebiT, am organizaciaSi gaerTianebul rva qveyanaSi,
yovelwliurad axali SemTxvevebis (incidence) saSualo maCvenebeli Seadgens
0,22-s 1000 sul mosaxleze. aRsaniSnavia, rom es maCvenebli sakmaod meryeobs
drois mixedviT sxvadasxva qveyanaSi kulturaluri Taviseburebebis da
mosaxleobis Semadgenlobis gaTvaliswinebT.
pacientTa 20-40%-s fsiqozuri simptomebis pirveli epizodi gadatanili
aqvs 20 wlamde asakSi. mamakacebisaTvis pirveli piki modis 15-25 welze,
xolo qalebisTvis 25-35 welze_pirveli piki da meore piki_40-45 welze,
uSualod menopauzis win.
Sizofreniis mqone pacientTa 80%-ze metis mSoblebSi Sizofrenia ar aris
diagnostirebuli. magram mainc udavoa genetikuri faqtoris, rogorc risk-
faqtoris roli am daavadebis ganviTarebaSi. Sizofrenia gvxvdeba im
pacientebis 13%-Si, romelTac hyavT SizofreniiT daavadebuli Tundac
erTi mSobeli da pacientTa 35-40%-Si, romelTa ded-mama SizofreniiTaa
daavadebuli. monozigotur tyupebSi Sizofrenia gvxvdeba SemTxvevaTa 50%-
Si, xolo dizigoturebSi 9%-Si, iseve rogorc sxva da-ZmebSi.
mravli, Tumca ara yvela kvleva adasturebs daavadebis ganviTarebasa da
samSobiaro garTulebebs Soris kavSirs, romelic nayofis Tavis tvinis
hipoqsiuri dazianebis Sedegia. pacientebs, romelTac Sizofrenia adreul
asakSi daewyoT, ufro xSirad aReniSnebodaT avadmyofobis istoriaSi
samSobiaro garTulebebi, vidre maT, visac mogvianebiT asakSi daewyoT
daavadeba.
aseve dadasturebulia kavSiri Sizofreniis simptomebis gamomJRavnebasa da
fsiqoaqtiuri nivTierebebis moxmarebas Soris. Sizofrenia iwyeba saSualod
ufro axalgazrda asakSi im pirebSi, romlebic moixmardnen fsiqoaqtiur
nivTierebebs, vidre im pirebSi, vinc ar moixmardnen.
13
daavadebis ganviTarebis risk-faqtorebs miekuTvneba, aseve, martoxeloba,
maRal urbanizebul garemoSi aRzrda, dabali socio-ekonomiuri
mdgomareoba, stresuli situaciebi, mamis xnieri asaki.
Sizofrenia warmoadgens yvelaze `ZviradRirebul~ fsiqikur aSlilobas,
romelzedac aSS-Si mTlianad jandacvaze gaweuli xarjebis 2,5% modis
(rac 1995 wlidan moyolebuli wliurad Seadgens 65 mlrd. aSS dolars,
zrdis tendenciiT). aRniSnuls emateba gverdiTi Tanxebi, romelic
ixarjeba pacintTa da maTi ojaxebis daxmarebebze. aseve
gasaTvaliswinebelia momvlelebisa da sazogadod sociumis socialuri Tu
sxva saxis mxardaWera.
3. etiopaTogenezi (8)
dResdReobiT aRiarebulia Sizofreniis etiopaTogenezis ramdenime Teoria,
maT Soris:
1. stress-mowyvladobis modeli;
2. neiro-biologiuri midgoma, romelsac safuZvlad udevs
Sizofreniis ganviTarebis:
• dofaminerguli hipoTeza; • neiropaTologiuri Taviseburebani, cns-s
radiografiuli kvlevis monacemebi, fsiqo-neiro-
endokrinologiis Taviseburebani.
3. genetikuri faqtorebis Teoria;
4. fsiqosocialuri faqtorebis Teoria:
• fsiqoanalitikuri Teoria;
• socialuri Teoria.
1. stress-mowyvladobis modeli
am modelis Tanaxmad, yvela adamians gaaCnia garkveuli mowyvldoba
biologiuri, fsiqo-socialuri da garemo faqtorebis mimarT, romlebic
stresogenul garemoSi moxvedrisas, mowyvlad pirovnebaSi ganapirobeben
Sizofreniuli simptomatikis ganviTarebas. zogadad, diaTezis/
mowyvladobis cnebaSi igulisxmeba biologiuri (mag. infeqcia, genetikuri
ganwyoba, fsiqoaqtiuri nivTierebebis moxmareba, fizikuri taravma),
fsiqologiuri (maRal-stresogenuli ojaxebi, aRzrdis Taviseburebani,
axlobeli adamianis gardacvaleba), an orive mowyvladoba erTad.
2. neiro-biologiuri midgoma
sadReisod Sizofreniis uSualo mizezebi mecnierebisTvis cnobili ar
aris, miuxedavad imisa, rom literaturaSi sul ufro izrdeba im kvlevebis
ricxvi, romelic TvalsaCinos xdis paTofiziologiuri faqtoris rols
Tavis tvinis zogierT ubanSi, rgoricaa: a) limbiuri sistema, b) Sublis
wilis qerqi (frontal cortex), g) naTxemi (cerebellum) da d) qerqqveSa kvanZebi
(basal ganglia). TiToeul am ubanSi disfunqcia Semdgom vrceldeba sxva
wilebSic. aRniSnuli asaxvas poulobs Sizofreniis etiopaTogenezis
TeoriebSi.
14
- dofaminerguli hipoTeza gamartivebulad SemdegSi mdgomareobs:
Sizofreniis ganviTareba dakavSirebulia dofaminerguli gadacemis
siWarbesTan. hipoTeza eyrdnoba or mnSvnelovan faqtors:
1. umeteswilad, antifsiqozuri medikamentebis efeqturoba pirdapir
korelaciaSia maTi D2 receptorebisadmi antagonistur moqmedebasTan;
2. fsiqozis mastimulirebeli (maprovocirebeli) moqmedeba gaaCiaT
fsiqotropul saSualebebs, romlebic zrdian dofaminergiuli
gadacemis intensivobas (mag, amfetaminebi).
hipoTezis mixedviT, Znelia ganisazRvros, Tu konkretulad rasTanaa
dakavSirebuli dofaminergiuli gadacemis gazrda: sinafsur napralSi
dofaminis Warb gamonTavisuflebasTan, dofaminuri receptorebis
raodenobis siWarbesTan, arsebuli receptorebis hiperaqtiurobasTan, Tu am
faqtorebis kombinaciasTan.
aseve unda aRiniSnos sxva neirotransmiterebis gadacemis roli daavadebis
etiopaTogenezSi, kerZod serotoninergiuli, norepinefrinergiuli, GABA-ergiuli (gama-amino-erbos maJava). serotonin-dofaminergul antagonists
warmoadgenen antifsiqozuri medikamentebi, magaliTad rogoricaa
klozapini, risperidoni. aRsaniSnavia norepinefrinergiuli
(noradrenalinergiuli) gadacemis aqtivobis (locus ceruleus–Si) daqveiTeba
antifsiqozuri medikamentebiT xangrZlivi mkuranlobisas. agreTve,
SizofreniiT daavadebuli pacientebis (Tumca ara yvelas) hipokampSi
viTardeba GABA-ergiuli gadacemis deficiti.
amdenad, rigi neirotrnsmiteruli gadacemis disbalansi Sizofreniis
ganviTarebis mono-amniuri Teoriis safuZvels qmnis.
- neiropaTologiuri Taviseburebani Sizofreniis dros ZiriTadad
vlindeba Tavis tvinis sxvadasxva areSi neiropaTologiuri da
neiroqimiuri ZvrebiT. kerZod, limbur sistemasa da qerqqveSa kvanZebSi,
aseve, Tavis tvinis qerqSi, Talamussa (mxedvelobis borcvi) da tvinis
ReroSi. dadasturebulia Sizofreniis dros Tavis tvinis moculobis
Semcireba. es exeba Tavis tvinis zemoaRniSnul areebs.
vinaidan limburi sistema akontrolebs emociebs, hipoTezurad Sizofreniis
fsiqofiziologiuri bazisi es regionic aris. mravali paTanatomiuri
kvlevis Sedegebi adastureben amygdala, hippocampus da parahippocampal gyrus-is zomaSi Semcirebas SizofreniiT daavadebulebSi.
Sizofreniis mqone pacientebisaTvis damaxasiaTebelia Taviseburi siaruli
da saxis mimika (manerianoba), stereotipuli moZraobebi. amdenad,
savaraudoa qerqveSa kvanZebis daintereseba Sizofreniis dros, vinaidan es
regioni akontrolebs moZraobebs.
zemoaRniSnuli dasturdeba cns-is radiografiuli kvlevebiT, rogoricaa
kompiuteruli tomografia (CT), magnitur-birTvuli rezonansi (MRI). aseve, cns-is funqciuri kvlevis meTodebi: funqciuri MRI, PET, SPECT.
3. genetikuri faqtorebis Teoria
am Teorias adasturebs epidemiologiuri monacemebi (ix. epidemiologia).
molekuluri biologiis ganviTarebam saSualeba misca mecnierebs emsjelaT
Sizofreniis dros garkveuli qromosomebis dainteresebaze, esenia: me-5, -11,
15
18 qromosomebis grZeli mxari da me-19 da X qromosomebis mokle mxari,
aseve, me-6, -8 da 22 qromosomebis gansazRvruli wertilebi. dResdReobiT,
miRebulia Sizofreniis heterogenuli genetikuri (bazisis) Teoria.
4. fsiqosocialuri faqtorebis Teoria
- fsiqoanalitikuri Teoria
am Teoriis centralur hipoTezas warmoadgens z. froidis Sexeduleba,
romlis mixedviT Sizofrenis dros pirovnebis (ego) ZiriTadi dacviTi
meqanizmi frustraciasa da konfliqtze aris regresia (regression). agreTve
arsebobs sxva Teoriuli hipoTezebic (romlebic ar wamoadgens
mtkicebulebebze dayrdnobil faqtebs, esenia: daswavlis Teoria, ojaxuri
dinamika da sxva).
- socialuri Teoria
am Teoriis mixedviT, industrializacia da urbanizacia mniSvnelovan
zegavlenas axdens Sizofreniis dawyebaze da mimdinareobis simZimeze.
4. klinikuri simptomatika
simptomebis CamonaTvali (9)
Sizofreniis ZiriTad klinikur simptomebs wamoadgens:
a) eqo-azrebi, azrebis Cadeba an warTmeva, azrebis gadacema;
b) zemoqmedebis bodva (kontrolis/gakontrolebis), ideatoruli,
sensoruli da motoruli avtomatizmi, bodviT aRqmasTan erTad;
g) smeniTi halucinaciebi _ pacientis qcevis an azrebis persistentulad
makomentirebeli xmebi, an ori/an meti `dialogSi myofi xma~; an sxva tipis
xmebi, romelic pacients `esmis~ sxeulis sxvadasxva nawilidan;
d) sxvadasxva Sinaarsis persistentuli bodviTi ideebi, romelic eTno-
kulturulad savsebiT miuRebelia (mag, religiuri, politikuri an
msoflmxedvelobrivi Sexedulebebi);
e) nebismieri modalobis (intensivobis) halucinaciebi, romelTac Tan
axlavT erTeuli arasistematizebuli, Camouyalibebuli bodviTi ideebi,
TvalsaCino afeqturi datvirTvis gareSe, an persistiuli zeRirebulovani
ideebi, romlebic yoveldRiurad aRmocendeba kvireebis an Tveebis
manZilze;
v) wyvetili azrovneba an araTanamimdevruli asociaciebi, ris Sedegad
viTardeba inkoherentuloba, araarsebiTi metyveleba da neologizmebi;
z) katatoniuri qceva, agzneba, Sekaveba, cvilisebri moqniloba,
negativizmi an stupori;
T) e.w. negatiuri anu deficituri simptomebi, rogoricaa: apaTia,
metyvelebis raodenobrivi da Sinaarsobrivi gaRaribeba, emociuri
reagirebis daClungeba, gasadaveba an Seusabamoba, arakongruentuloba,
rasac Tan sdevs socialuri izolacia da socialuri funqcionirebis
daqveiTeba. mniSvnelovania imis aRniSvna, rom es ar aris neirolefsiuri
medikamentebis moqmedebis an depresiis Sedegi;
16
i) pirovnebis qcevis mniSvnelovnad myari Secvla vlindeba interesebis
daqveiTeba-SezRudvaSi, miznebisa da samomavlo gegmebis ararsebobaSi,
ideebis deficitSi, autizaciaSi da socialur izolaciaSi.
zemoT aRniSnul simptomebs, praqtikuli mosazrebebis gamo, aerTianeben
plius (anu pozitiur) da minus (anu deficitur simptomebad) (10).
"plius-simptomebi":
I. halucinaciebi
• smeniTi;
• makomentirebeli `xmebi~;
• dialogis saxiT ‘xmebi’;
• taqtilur-somaturi;
• ynosviTi;
• mxedvelobiTi.
II. bodva
• devnis (persekutoruli);
• Razoianobis;
• codvianobis da TviTbraldebis;
• gandidebis;
• religiuri Sinaarsis;
• ipoqondriuli (somaturi);
• damokidebulebis (bodviTi) azrebi;
• zemoqmedebis (gakontrolebis bodviTi) azrebi;
• gaxsnilobis (bodviTi) azrebi;
• azrTa gadacema;
• azrTa Cadeba;
• azrTa warTmeva.
III. ucnauri qceva
• ucnauri garegnuli ieri da Cacmuloba;
• ucnauri socialuri da seqsualuri qceva;
• agresiuli da aJitaciuri qceva;
• ganmeorebadi an stereotipuli qceva
IV. azrovnebis formis aSlis pozitiuri paTologia
• asociaciuri jaWvis gawyveta, dezorganizebuli azrovneba;
• tangencialoba (mizanze orientirebuli Tanamimdevruli
azrovnebis SeuZlebloba);
• inkoherentuloba;
• alogikuroba;
• detalizacia;
• `tyviamfrqvevisebri~ metyveleba;
• gafantuli, dabneuli metyveleba;
• verbigeracia (asociaciebi msgavsi JReradobis (da ara
Sinaarsis) mqone sityvebisa).
17
`minus-simptomebi~
I. emociuri gasadaveba da gaRaribeba
• saxis gaxevebuli gamometyveleba;
• spontanuri moZraobis Semcireba;
• gamomsaxvelobiT moZraobaTa siRaribe;
• mzeriTi kontaqtis simcire;
• afeqturi reagirebis ararseboba (afeqturi gasadaveba);
• Seusabamo afeti (paraTimia);
• vokaluri gamoxatvis unaris nakleboba (monotonuri
metyveleba).
II. (logikuri) metyvelebis SeuZlebloba da paralogia
• saubris gaRaribeba;
• metyvelebis Sinaarsobrivi gaRaribeba;
• azrebis gawyveta, blokireba;
• pasuxis latenturi drois gazrda.
III. abulia-apaTia
• Tavis movlis da higienis dacvis SeuZlebloba;
• samsaxurebis (an saswavleblebis) monacvleoba;
• fizikuri anergia.
IV. anhedonia, asocialuroba
• gasarTobi saqmianobebis Semcireba;
• seqsualuri interesebis daqveiTeba;
• siaxlovis, TanagrZnobis unaris daqveiTeba;
• damokidebuleba naTesavebTan, megobrebTan da TanatolebTan
(autizacia).
V. yuradReba • socialuri uyuradReboba;
• uyuradReboba fsiqikuri gamokvlevis mimdinareobisas.
(SANS da SAPS sruli versebi ix. danarTebSi #1 da #2)
18
5. daavadebis diagnozi
a) diagnostikuri kriteriumebi (11):
Sizofreniis diagnostikuri kriteriumebi ganisazRvreba klinikuri
simptomebiT, socialuri disfunqciT, daavadebis xangrZlivobiT, sxva
aSlilobebis da mdgomareoebebis gamoricxviT. amasTan, aRsaniSanavia, rom
mas ar gaaCnia klinikur-laboratiriuli kriteriumebi. Sizofreniis
diagnostikuri kriteriumebia:
A. damaxasiaTebeli simptomebi: qvemoT moyvanilidan ori (an meti),
romelTagan TiToeuli warmodgenilia mTeli erTi Tvis (an umetesi
periodis) ganmavlobaSi (SesaZloa naklebic, Tuki warmatebiTaa
namkurnalevi):
(1) bodva;
(2) halucinaciebi;
(3) dezorganizebuli metyveleba (asociaciebis gawyveta an
inkoherentuloba);
(4) uxeSad (mniSvnelovnad) dezorganizebuli an katatoniuri
qceva;
(5) negatiuri simptomebi, rogoricaa: emociuri gasadaveba,
metyvelebis gaRaribeba, an misi arqona (alogia) da
nebelobis daqveiTeba (hipobulia), an arqona (abulia).
SeniSvna: A. kriteriumis mxolod erTi simptomic sakmarisia, Tuki
bodvis Sinaarsi uaRresad ucnauri, eqscentriulia, an
halucianciebi Sedgeba pacientis qcevis an azrebis
persistentulad makomentirebeli xmebisgan, an ori/an meti
`dialogSi myofi xmisgan~.
B. socialuri disfunqcia: darRvevebis gamovlenidan moyolebuli,
mTeli drois (an mniSvnelovani periodis) ganmavlobaSi aRiniSneba
Cavardna funqcionirebis yvelaze mniSvnelovan erT an or sferoSi.
es Seexeba: samsaxurs, interpersonalur urTierTobebs, an sakuTari
Tavis movlas (Tuki daavadeba iwyeba bavSvobaSi an mozardobis
periodSi, warumatebloba/Cavardna Seexeba interpersonalur
urTierTobebs, mosalodnel akademiur miRwevebs da profesiul
saqmianobas).
C. xangrZlivoba: aRniSnuli darRvevebis niSnebi saxezea sul cota 6
Tvis ganmavlobaSi. es eqvsTviani periodi unda moicavdes mwvave
simptomebis arsebobas sul cota 1 Tvis manZilze (SesaZloa
naklebic, Tuki warmatebiTaa namkurnalevi), romelic Seesabameba A. kriteriums (anu aqtiuri fazis simptomebs) da aseve, SesaZloa
moicavdes prodromalur da rezidualur periodebsac. am
prodromaluri an rezidualuri periodebis ganmavlobaSi
darRvevebis niSnebi SesaZloa gamovlindes mxolod negatiuri
simptomebiT, an A. kriteriumSi CamoTvlili erTi an ori simptomis
Sesustebuli formiT (mag. odiozuri, ucnauri myari Sexedulebebi,
uCveulo percefciuli gancdebi).
D. Sizoafeqturi da guneb-ganwyobis aSlilobis gamoricxva:
Sizoafeqturi aSliloba da guneb-ganwyobis aSliloba fsiqozuri
simptomebiT gamoiricxeba, Tuki: (1) fsiqozis aqtiuri fazis
19
simptomebTan erTad ar aRmocendeba didi depresiuli, maniakaluri, an
Sereuli epizodi; an (2) guneb-ganwyobis aSlilobis epizodebi
aRmocendeba aqtiuri fazis simptomebTan erTad, magram maTi saerTo
xangrZlivoba gacilebiT xanmoklea aqtiuri da rezidualuri
periodebis xangrZlivobasTan SedarebiT.
E. fsiqoaqtiuri nivTierebebis gamoyenebiT/zogadsamedicino xasiaTis
mdgomareobiT gamowveuli fsiqozuri aSlilobis gamoricxva:
aSlilobis ganviTareba ar aris dakavSirebuli fsiqoaqtiuri
nivTierebebis (an sxva farmakologiuri saSualebebis) gamoyenebasTan
da zogadsamedicino problemiT gamowveul fsiqozur
mdgomareobasTan.
F. ganviTarebis aSlilobasTan kavSiri: Tuki pacientis istoriaSi
aRiniSneba bavSvTa autizmi an sxva ganviTarebis pervaziuli
aSliloba, damatebiTi diagnozi Sizofreniisa daismeba mxolod im
SemTxvevaSi, Tu gamoxatuli iqneba aseve bodvebi da/an halucinaciebi
sul cota erTi Tvis (an naklebi, Tuki warmatebiTaa namkurnalevi)
manZilze.
mimdinareobis klasifikacia: inicialuri aqtiuri fazis simptomebis
gamovlenidan mxolod 1 wlis gavlis Semdeg aris SesaZlebeli daerTos
diagnozs
(ix. klasifikacia mimdinareobis me-5 niSani).
Sizofreniis ZiriTadi tipebis diagnostikuri kriteriumebia:
1. paranoiduli wamoadgens Sizofreniis tips, romlis drosac:
A. adgili aqvs Tundac erT (an meti) bodviT azrebs an smeniT
(intensiuri) halucianciebs;
B. qvemoT moyvanilidan arc erTi ar aris wamyvani:
dezorganizebuli metyveleba, uxeSad dezorganizebuli an
katatoniuri qceva, Seusabamo afeqti an emociuri gasadaveba.
2. dezorganizebuli (anu hebefreniuli) wamoadgens Sizofreniis tips,
romlis drosac:
A. yvela qvemoT CamoTvlili wamyvania:
(1) dezorganizebuli metyveleba;
(2) uxeSad dezorganizebuli qceva;
(3) Seusabamo afeqti an emociuri gasadaveba.
B. kriteriumebi ar Seesabameba katatoniur tips.
3. katatoniuri wamoadgens Sizofreniis tips, romlis drosac:
A. klinkur suraTSi dominirebs sul cota ori niSani qvemoT
CamoTvlilidan:
(1) motoruli Sekaveba, katalefsiuri (cvilisebri
moqniloba) an stuporozuli;
(2) motoruli agzneba (romelic ar aris garemo
stimulze pasuxi da aSkarad umiznoa);
20
(3) ukiduresi negativizmi (yvela saxis instruqciisadmi
umotivo rezistentoba an rigidul pozaSi darCena,
miuxedavad misi amoZravebis mcdelobisa);
(4) specifikuri nebelobiTi moZraobebi, gamoxatuli
garkveuli poziT (ucnauri arabunebrivi pozis miReba),
stereotipuli moZraobebiT, TvalsaCino manerulobiT
an JestikulciiT;
(5) eqolalia da eqopraqsia.
4. aradiferencirebuli tipis Sizofreniis dros gvxvdeba A kriteriumis
simptomebi, romlebic ar akamyofilebs paranoiduli,
dezorganizebuli da katatoniuri tipis Sesabamis (A) kriteriums.
Sizofreniis danarCeni tipebis diagnostikuri kriteriumebi aris Semdegi
(12):
5. postSizofreniuli depresis diagnozi ismeba, Tuki:
a) bolo 12 Tvis manZilze saxeze iyo Sizofreniis simptomebi,
romelic akmayofilebda Sizofreniis ZiriTad kriteriumebs (ix.
Sizofreniis ZiriTadi diagnostikuri kriteriumebi), magram ara
amJamad;
b) kvlav saxezea zogierTi Sizofreniuli simptomi;
c) wina planzea pacientisaTvis distresuli depresiuli simptomebi,
romelic akmayofilebs depresiuli epizodis kriteriumebs (ix.
depresiuli epizodis diagnostikuri kriteriumi) da romelic
saxezea sul cota 2 kviris manZilze.
Tuki pacients saerTod aRar aReniSneba Sizofreniuli simptomebi,
maSin diagnostirdeba depresiuli epizodi; xolo im SemTxvevaSi, roca
Sizofreniuli simptomatika gaSlilia da dominirebs klinikur
suraTSi, daismeba Sizofreniis oTxi ZiriTadi tipidan erT-erTis
diagnozi.
6. rezidualuri Sizofreniis diagnozi ismeba, Tuki:
A. warsulSi, garkveuli drois maZilze saxeze iyo Sizofreniis
ZiriTadi kriteriumebi, magram amJamad aRar aris;
B. sul cota oTxi mainc qvemoT CamoTvlili `negatiuri
simptomebidan~ saxeze iyo bolo 12 Tvis manZilze:
1) fsiqomotoruli Seneleba an energiis daqveiTeba;
2) garkveulwilad emociebis gasadaveba;
3) pasiuroba da iniciativis nakleboba;
4) metyvelebis raodenobrivi da/an Sinaarsobrivi gaRaribeba;
5) cudi araverbaluri komunikacia saxis gaxevebuli
gamometyvelebis, mzeriTi kontaqtis simciris, vokaluri
gamoxatvis unaris naklebobis an Jestikulaciisa da
gamomsaxvelobiT moZraobaTa siRaribis gamo;
21
6) socialuri qcevis, Tavis movlisa da higienis dacvis
gauareseba.
7. martivi Sizofreniis diagnozi ismeba, Tuki:
A. sul cota erTi wlis manZilze nela, magram progresulad,
xdeba qvemoT CamoTvlili sami simptomis ganviTareba:
1) pirovnebis qcevis zogierTi aspeqtis mniSvnelovani da myari
Secvla, rac vlindeba survilebisa da interesebis
dakargvaSi; cxovrebis azris da miznis dakargvaSi; sakuTar
TavSi CaZirvaSi da socialur izolaciaSi;
2) `negatiuri simptomebis~ TandaTanobiTi aRmoceneba da
gaRrmaveba, rogoricaa TvalsaCino apaTia, metyvelebis
raodenobrivi gaRaribeba, aqtiurobis donis daqveiTeba,
emociuri gasadaveba, pasiuroba, iniciativis da araverbaluri
komunikaciis daqveiTeba (saxis gamometyvelebis gaxeveba,
mzeriTi kontaqtis, vokaluri gamoxatvis unaris,
Jestikulaciisa da gamomsaxvelobiT moZraobebis gaRaribeba);
3) socialuri, akademiuri da profesiuli funqcionirebis
TvalsaCino gauareseba.
b) diferencialuri diagnozis CamonaTvali (10, 13)
Sizofreniis diferencialuri diagnozi unda gatardes ori sxva jgufis
aSlilobasTan, kerZod, somato-nevrologiur da fsiqiatriul
aSlilobebTan:
somato-nevrologiuri aSlilobebi:
1. wamlebis gamoyenebiT inducirebuli:
• fsiqoaqtiuri nivTierebebis gamoyenebiT inducirebuli:
amfetaminiT, halucinogeniT, alkoholiT (alkoholuri
halucinozi) barbituratebis moxsniT, kokainiT;
• sxva mdgomareobebis samkurnalod gamoyenebuli (mag.
efedrini, Teofilini, steroidebi da sxva).
2. epilefsia _ ZiriTadad, safeTqlis wilis;
3. neoplaziebi, travma (limbiuri an Sublis wilis);
4. mdgomareobebi, dakavSirebuli cerebro-vaskularul
daavadebebTan (mag. alchaimeris daavadeba, vaskularuli
demenciebi, hantingtonis daavadeba, vilsonis daavadeba da sxva);
5. sxva mdgomareobebi, dakavSirebuli metabolur darRvevebTan,
infeqciur da qronikuli anTebiT mimdinare daavadebebTan (mag.
Sidsi; herpesuli encefaliti; neirosifilisi; vernike-
korsakovis sindromi; mwvave porfiria; sistemuri wiTeli
mglura; mZime metalebiT mowamvla; bazaluri gangliis
idiopaTiuri kalcifikacia da sxva).
22
fsiqiatriuli aSlilobebi:
1. sxva fsiqozuri aSlilobani, rogoricaa:
• Sizofreniismagvari aSliloba;
• xanmokle fsiqozuri aSliloba;
• Sizoafeqturi aSliloba;
• bodviTi aSlilobani;
2. guneb-ganwyobis aSlilobani;
3. obsesiur-kompulsiuri aSliloba;
4. specifiuri personologiuri darRvevebi. kerZod:
• Sizoiduri personologiuri aSliloba;
• emociurad arastabiluri (mosazRvre) personologiuri
aSliloba;
• anankasturi (obsesiur-kompulsiuri) personologiuri
aSliloba;
5. Sizotipuri aSliloba;
6. ganzrax ganviTarebuli aSliloba, dakavSirebuli fizikur an
fsiqologiur faqtorTan (simulacia).;
7. pubertatuli (gardatexis) krizi _ normaluri mozardis krizi.
23
6. gamokvlevis sqema (29)
Sizofreniis yvela tipis mkurnaloba warmoebs diferencirebulad, sam
etapad: mwvave faza, stabilizaciis faza da stabiluri faza. TiToeuli
fazis marTvisTvis saWiroa specifikuri midgoma. daavadebis
fsiqiatriuli marTvis erTiani sqema Semdegnairad gamoiyureba:
mwvave faza
1. pacientis mdgomareobis Sefaseba;
2. misi mdgomareobis fsiqiatriuli marTva;
3. antifsiqozuri medikamentebis gamoyeneba;
4. garda antifsiqozurisa, sxva fsiqotropuli medikamentebis
CarTva mkurnalobaSi;
5. eleqtro-krunCxviTi da sxva somaturi Terapiis gamoyeneba;
6. pirveli epizodis mkurnalobasTan dakavSirebuli sakiTxebis
gaTvaliswineba.
Sizofreniis fsqiatriuli marTva (menejmenti)
1. simptomebis Sefaseba da diagnozis dazusteba;
2. mkurnalobis gegmis ganxorcieleba;
3. pacientTan Terapiuli aliansis damyareba da mkurnalobis
Catarebis uzrunvelyofa;
4. pacientisa da misi ojaxis wevrebis gaTviTcnobiereba
daavadebis Sesaxeb da fsiqologiuri muSaobis Catareba
(fsiqoTerapia);
5. TandarTuli (komorbiduli) mdgomareobebis mkurnaloba;
6. pacientis socialur garemoze da mis funqcionirebaze zrunva;
7. sxvadasxva klinicistebis mier erToblivi mkurnalobis
Catareba;
8. mkurnalobis dokumentaciis detalurad warmoeba (vinaidan
SesaZloa, daavadebis mimdinareobis manZilze pacientebs
xvadasxva profesionalebTan mouwioT urTierToba).
24
stabilizaciis faza
stabiluri faza
1. pacientis mdgomareobis Sefaseba;
2. misi mdgomareobis fsiqosocialuri marTva;
3. antifsiqozuri medikamentebis gamoyeneba;
4. garda antifsiqozurisa, sxva fsiqotropuli medikamentebis
CrTva mkurnalobaSi;
5. eleqtro-krunCxviTi da sxva somaturi Terapiis gamoyeneba;
6. pacientebisa da maTi ojaxis wevrebis waxaliseba, maT mier
TviTdaxmarebis organizaciebis momsaxurebis gamoiyenebis
mizniT.
mkurnalobisadmi rezistetuli pacientebis movlasTan
dakavSirebuli sakiTxebi
deficituri (negatiuri) simptomebis mkurnaloba
samkurnalo dawesebulebis an sacxovreblis
(TavSesafris) SerCeva
25
7. mkurnalobis sqema (29)
Sizofreniis fsiqiatriuli marTva
1. simptomebis Sefaseba da diagnozis dazusteba
dadgindes zusti diagnozi: gatardes diferencialuri diagnozi
sxvadasxva fsiqikur aSlilobasTan, rac mniSvnelovan zegavlenas
iqoniebs xanmokle da xangrZlivi mkurnalobis dagegmvaze. roca
zusti diagnozis gansazRvra ar xerxdeba da pacients prodromSi
aReniSneba calkeuli simptomebi da fsiqozis ganviTarebis riski,
igi saWiroebs xelaxal Sefasebas.
pacientisa da misi simptomebis Sesaxeb axali informaciis
gaCenisTanave saWiroa xelaxla diagnozis dazusteba da
mkurnalobis gegmis ganaxleba.
ganisazRvros mkurnalobis calkeuli konkretuli miznebi.
mkurnalobis efeqtianobis gasazomad saWiroa gamosavlis obieqturi
Sefaseba, romelic warmatebuli mkurnalobis SemTxvevaSi
gaumjobesebis xarisxs realurad Seafasebs.
klinikuri mdgomareobis gasakontroleblad (monitoringisaTvis)
saWiroa Sefasebis obieqturi raodenobrivi skalebis gaTvaliswineba,
rogoricaa:
1. uneblie paTologiuri moZraobebis skala (AIMS);
2. fsiqiatriuli Sefasebis mokle skala (BPRS);
3. pozotiuri simptomebis Sefasebis skala (SAPS) da
4. negatiuri simptomebis Sefasebis skala (SANS).
(skalebis Semoklebuli da sruli variantebi ix. danarTebSi #1,
#2, #3, #4).
26
2. mkurnalobis gegmis Camoyalibeba da mkurnalobis uzrunvelyofa
3. Terapiuli aliansis damyareba da mkurnalobis gegmis zustad
Sesruleba
SeirCes specifikuri mkurnaloba da mkurnalobis Catarebis
Sesabamisi adgili (es procesi aris mravaljeradi da meordeba
pacientis klinicistTan urTierTobis mTeli periodis
ganmavlobaSi)
ganisazRvros pacientis survilebi, miznebi da moxdes maTi
dakavSireba mkurnalobis SedegTan, raTa uzrunvelyofil iqnas
mkurnalobis zustad Sesruleba.
Sefasdes is faqtorebi, romelic zegavlenas axdenen mkurnalobis
zustad Catarebaze, raTa moxdes swori marTva. es faqtorebia:
1. pacientis daqveiTebuli kritika (insaiTi) daavadebis an
medikamentebis miRebis mimarT;
2. pacientis naklebad informirebuloba mkurnalobis pozitiuri
(simptomebisgan ganTavisufleba) da negatiuri (usiamovno
gverdiTi efeqtebi, mkurnalobis procesTan dakavSirebuli
gansakuTrebuli reJimi) Sedegebis Sesaxeb;
3. kognituri deficiti (daqveiTeba);
4. Terapiuli aliansis darRveva;
5. finansur an/da transportirebis sakiTxebTan dakavSirebuli
problemebi;
6. eTnokulturuli rwmena-Sexedulebebi;
7. ojaxis an mxardamWeri socialuri garemos arqona.
im pacientebTan muSaobisas, romlebic sistematurad acdenen
klinicistTan gegmiur Sexvedrebs an zedmiwevniT zustad ar itareben
mkurnalobas, saWiroa socialuri samsaxurebis intensiuri Careva
(satelefono zarebi da/an ojaxSi monaxuleba)
27
4. pacientisa da misi ojaxis wevrebis gaTviTcnobiereba da maTi
fsiqologiuri mxadraWera (fsiqoTerapia)
5. TandarTuli (komorbiduli) mdgomareobebis mkurnaloba, rogoricaa:
mZime depresia, fsiqoaqtiuri nivTierebebis moxmareba da posttravmuli
stresuli aSliloba (ptsa)
6. pacientis funqcionirebisa da socialuri garemos Sefaseba da masze
zrunva
droulad iqnas amocnobili recidivis adreuli simptomebi, raTa ar
gaiSalos daavadebis gamwvavebis sruli klinikuri suraTi.
pacientis ojaxis wevrebs miewodoT informacia daavadebis bunebis da
misi daZlevis strategiebis Sesaxeb, raTa Semcirdes recidivebi da
gaumjobesdes pacientis cxovrebis xarisxi.
samuSao multidisciplinaruli (MDT) jgufis wevrebma unda
uzrunvelyon pacienti da misi ojaxi koordinirebuli
fsiqiatriuli momsamsaxurebiT da saWiroebis SemTxvevSi Tavad
mimarTon damatebiT samsaxurebsac.
28
mwvave faza (29)
1. Sefaseba mwvave fazaSi
mkurnalobis miznebia:
1. fizikuri dazianebis prevencia;
2. dezorganizebuli qcevis marTva;
3. fsiqozuri simptomebis simZimis (xarixis) Semcireba (mag, aJitaciis,
agresiis, negatiuri simptomebis, afeqturi simptomebis);
4. mwvave epizodis ganviTarebis xelSemwyobi faqtorebis dadgena da
maTi marTva;
5. pacientis funqcionirebis optimalur mdgomareobaSi dabruneba;
6. pacintTan da mis ojaxTan (Terapiuli) aliansis damyareba;
7. xanmokle da xangrZlivi mkurnalobis gegmis SemuSaveba;
8. am fazis mkurnalobis Semdgom, pacientis Sesabamis reabilitaciur
samsaxurebTan dakavSireba.
mwvave fazaSi Sefasebis miznebia:
1. im mizezebis gansazRvra da Sefaseba, ris gamoc xelaxla
aRmocenda da/an gauaresda klinikuri simptomebi (mag. ar iqna
uzrunvelyofili adeqvaturi medikamenturi mkurnaloba);
2. pacientis diagnozis dadgena an dadastureba;
3. TandarTuli (komorbiduli) fsiqikuri Tu somaturi
mdgomareobis amocnoba, fsiqoaqtiuri nivTierebebis gamoyenebis
CaTvliT;
4. pacientis zogad somaturi janmrTelobis mdgomareobis
Sefaseba;
5. pacientis Zlieri da susti mxareebis (resursebis da
problemebis) gansazRvra;
6. pacientis CarTva Terapiul aliansSi.
pirveladi informaciis srulad mopoveba, raSic Sedis:
fsiqiatriuli da somaturi anamnezi, fizikuri da fsiqikuri
statusis Sefaseba.
29
2.
regularuli gasaubreba ojaxis wevrebTan (an sxva pirebTan, visac
aqvs informacia pacientis Sesaxeb), Tuki Tavad pacienti winaaRmdegi
ar aris.
gadaudebel sarisko situaciebSi dasaSvebia sxva pirebTan gasaubreba,
pacientis Tanxmobis gareSe.
laboratoriuli gamoklvevebis Catareba (SizofreniiT daavadebul
pacientTa SefasebisaTvis saWiro laboratoriul da sxva
diagnostikur gamokvlevaTa sruli sqema ix. cxrili #1.)
im pacientebisTvis, romelTac aReniSnebaT axlad ganviTarebuli
fsiqozis niSnebi (an fsiqozi atipiurad vlindeba), mxedvelobaSi
iqnas miRebuli damatebiTi diagnostikuri kvlevebis Sedegebi
(rogoricaa CT da MRI), riTac SeiZleba diagnozis dadastureba (mag.
Tavis tvinis parkuWebis gafarToeba, qerqis moculobis Semcireba).
suicidis risk-faqtorebis Sefaseba (rogoricaa warsulSi mcdelobebi,
depresiuli guneb-ganwyoba, suiciduri azrebi, imperatiuli
halucinaciebi, uimedoba, SfoTva, eqstrapiramiduli gverdiTi efeqtebi,
alkoholis an sxva fsiqoaqtiuri nivTierebebis gamoyeneba).
pacientis agresiuli qcevis Sefaseba, irgvlivmyofebis dazianebis
riskis CaTvliT.
30
cxrili #1
SizofreniiT daavdebul pacientTa fizikuri da laboratoriuli Sefasebis sqema (7,30)
Sefaseba sawyisi anu bazisuri Semdgomi (damatebiTi)
Sefasdes pacientis fizikuri
statusi da ganisazRvros (Tuki
aris) TandarTuli somaturi
daavadeba
organizmis somaturi mdgomareobis
ZiriTadi maCveneblebi (pulsi,
arteriuli sixlis wneva,
temperatura);
pulsi, sisxlis wneva, temperatura pulsi, sisxlis wneva,
temperatura, klinikuri
saWiroebis mixedviT, kerZod,
roca vumatebT medikamentis
dozebs.
sxeulis wona da simaRle sxeulis wona, simaRle da sxeulis
masis indeqsi (BMI)a sxeulis masis indeqsi (BMI) unda ganisazRvros yovel
vizitze pirveli 6 Tvis
ganmavlobaSi da SemdgomSi, sul
cota, kvartalurad (3 TveSi
erTxel)b
hematologia sisxlis saerTo analizi sisxlis saerTo analizi,
klinikuri saWiroebis mixedviT.
sisxlis qimiuri analizi 1. eleqtrolitebi,
2. Tirkmlis funqciuri analizi
(sisxlSi da SardSi
azotis/kreatininTan Sefardeba),
3. RviZlis funqciuri testi,
4. farisebri jirkvlis funqciuri
testi.
yovelwliurad da klinikuri
saWiroebis mixedviT
infeqciuri daavadebebi analizebi:
aTaSangze, C hepatitze da Sidsze,
klinikuri sWiroebis mixedviT
31
orsuloba orsulobis testebis Catareba
Svilosnobis asakSi myofi
qalebisTvis
toqsikologia narkologiuri testireba da,
klinikuri saWiroebis mixedviT,
mZime liTonebis skriningi
narkologiuri testireba
eeg/radiografiuli gamokvleva klinkuri saWiroebis mixedviT eeg,
Tavis tvinis radiografiuli
gamokvleva (CT da MRI)
mkurnalobis gverdiT efeqtebTan
dakavSirebuli (damatebiTi)
Sefasebag
diabetid diabetis risk-faqtorebis skriningie;
sisxlSi glukozisv done, uzmoze
uzmoze sisxlSi glukozis an
hemoglobin A1-is done axali
mkurnalobis dawyebidan sul
cota 4 TveSi da SemdgomSi
yovelwliuradv.
hiperlipidemia lipidebis donez sul cota 5 weliwadSi erTxel
Q_T intervalis gaxangrZliveba ekg da sisxlSi kaliumis donis
gansazRvra TioridaziniT, mezori-
daziniT, pimozidiTYmkurnalobis
dawyebamde; ekg ziprazidoniT
mkurnalobis dawyebamde, kardialuri
risk-faqtorebis arsebobis
SemTxvevaSiT
hiperprolaqtinemia hiperprolaqtinemiis
simptomebisaTvis skriningii
yovel vizitze hiperprolaq-
tinemiis simptomebis skriningi,
vidre ar miaRwevs stabilur
dones; SedgomSi _ yovel-
32
klinikuri saWiroebis mixedviT
prolaqtinis done
medikamentebiT, romlebic
prolaqtinis dones zrdiani
klinikuri saWiroebis mixedviT
prolaqtinis done
eqstrapiramiduli gverdiTi
efeqtebi, akaTiziis da mogvianebiTi
diskineziis CaTvliT
eqstrapiramiduli gverdiTi
efeqtebis klinikuri Sefaseba
yovel 6 TveSi erTxel
Sefasdes paTologiuri
uneblie moZraobebi, pirveli
Taobis antifsiqozuri
saSualebebiT mkurnalobisas,
xolo meore Taobis antifsiqo-
zuri medikamntebiT ki _ yovel
12 TveSi erTxel.
maRali riskis pacientebis
Sefaseba Sesabamisad moxdes 3
da 6 TveSi erTxelk.
a. sxeulis masis indeqsis (BMI) gamoangariSeba xdeba formuliT wona kg-Si/(simaRle m-ebSi). adamians, romlis 25 < (BMI) <30 zedmeti wona aqvs, xolo (BMI) > 30 simsuqne awuxebs.
b. (BMI) < 18,5 mqone pacientebis garda, (BMI)-is yoveli erTeuliT Secvlisas pacentebi saWiroeben ufro xSir
Sefasebas da antifsiqozuri mkurnalobis Secvlas.
g. sazogadod, pacientTa Tavdapirveli bazisuri Sefaseba damokidebulia pacientis fizikur mdgomareobaze da
medikmentebTan dakavSirebul specifikur gverdiT efeqtebze. aRniSnulis Sesaxeb informacia adaptirebulia
2002 wlis oqtomberSi Mount Sinai-Si Catarebuli konferenciis mier mowodebuli rekomendaciebidan, romelic
Seexeboda SizofreniiT daavadebul pacintTa janmrTelobis monitorings.
d. marTalia, Znelia zustad ganisazRvros yvela medikamentis hiperglikemiis da Saqriani diabetis ganviTarebis
risk-faqtorebi, Tumca epidemiologiuri kvlevebiT dadgenilia meore Taobis antifsiqozuri mdikamentebiT
gamowveuli hiperglikemiis da masTan asocirebuli ketoacidozis, hiperosmolaruli komis da letaluri
gamosavlis Tavidan asacileblad gadaudebeli mkurnaloba.
e. aradiagnostirebuli diabetis maRal risk-faqtorebs miekuTvneba (BMI) > 25, diabetis arseboba pirveli rigis
naTesavebSi, dabali fizikuri aqtivoba, hipertenzia, qolesterinis maRali done da Semdegi simptomebi: xSiri
33
Sardva, Zlieri wyurvilis da SimSilis grZnoba, wonis mniSvnelovani kargva, gamofitva, gaRizianebadoba,
mxedvelobis gauareseba.
v. sisxlSi uzmoze Saqris donis gansazRvra. am maCveneblebis paTologiuri Sedegebi (uzmoze sisxlSi Saqari >
110 mg/dl) miuTiTebs specialistis konsultaciis aucileblobaze.
z. pacientis SesaZlo lipiduri darRvevebis Sesaxeb damatebiTi konsultacia Sesabamis specialistTan.
T. kardialuri risk-fatorebia gul-sisxlZrTvTa daavadeba, sinkopes arseboba anamnezSi, uecari adreuli
gardacvalebis ojaxuri istoria da gaxangrZlivebuli Q_T-s intervali.
i. qalebSi: libidos, menstrualuri darRvevebi da galaqtorea. mamakacebSi: libidos, ereqciis da eakulaciis
disfunqcia.
k. uneblie paTologiuri moZraobebis ganviTarebis maRali risk-faqtirebs Seadgens: pacientTa xandazmuli asaki,
anamnezSi mwvave distonia, akatizia da sxva eqstrapiramiduli gverdiTi efeqtebi.
34
2. fsiqiatriuli marTva mwvave fazaSi
3. antifsiqozuri medikamentebis gamoyeneba mwvave fazaSi
mkurnalobis dawyebamde (Tuki es SesaZlebelia) pacientTan
medikamenturi mkurnalobis pozitiuri da SesaZlo negatiuri
Sedegebis (mkurnalobisas ganviTarebuli gverdiTi efeqtebi:
orTostatiuli hipotenzia, Tavbrus xveva, distonia, uZiloba,
sedacia) awon-dawonva; im simptomebis dakonkreteba, romlebic
mkurnalobis mizans warmoadgens (mag. SfoTva, cudi Zili,
halucinacia(ebi) da bodva(ebi)).
antifsiqozuri medikamenturi mkurnalobis droulad dawyeba.
zogjer umjobesia medikamenturi mkurnalobis gadavadeba im
pacientTaTvis, romelTac esaWiroebaT mravalmxrivi diagnostikuri
Sefaseba, uars amboben medikamentur mkurnalobaze, an roca fsiqozi
gamowveulia fsiqoaqtiuri nivTierebebis gamoyenebiT, an mwvave
stresze reaqciiT.
antifsiqozuri medikamentebiT mkurnalobisas ganviTarebuli
gverdiTi efeqtebis minimumamde dayvana, romelic SesaZloa
gamoiwvios farmakologiur mkurnalobaze _ wamlis miRebaze da/an
miRebis gagrZelebaze _ uari.
im simptomebisa da laboratoriuli monacemebis ZiriTadi (bazisuri)
maCveneblebis Sefaseba, romlebic antifsiqozuri mkurnalobis
efeqtianobis gasakontroleblad gamodgeba (ix. cxrili 1.)
35
* - saqarTveloSi registrirebuli preparati
medikamentebis amorCeva iseTi faqtorebis gaTvaliswinebiT,
rogoricaa:
• samizne simptomze upiratesi moqmedeba;
• am medikamentis(ebis) gamoyenebisas maTi moqmedebis
gverdiTi efeqtebis gamocdileba warsulSi;
• mosalodneli gverdiTi moqmedebis efeqtebi (ix. cxrili 4);
• ama Tu im medikamentisTvis pacientis mier upiratesobis
miniWeba, maTi miRebis gzis CaTvliT;
• medikmentebis (da maTi gamoSvebis formis) xelmisawvdomoba
(mag. swrafadxsnadi tabletebi, wveTebi, xanmokle da
xangrZlivi moqmedebis ineqciebi)
roca mwvave fsiqozuri pacienti sakuTari Tavis an
irgvlivmyofebis mimarT amJRavnebs agresiul qcevas, gadaudebeli
mkurnalobis dauyovnebliv Catareba.
• pacientTan gasaubreba misi damSvidebis mizniT (gasaubrebis
mcdeloba);
• dasaSvebia pacientis fizikurad SezRudvis meTodebis
gamoyeneba, romelic unda Catardes usafrTxod, trenirebul
specialistTa mier.
• pirveli da meore Taobis antifsiqozuri medikamntebis
parenteraluri formis gamoyeneba, benzodiazepinebis
parenteralur miRebasTan erTad, an maT gareSe.
• an (alternatiulad) meore Taobis medikmentebis
swrafadxsnadi oraluri formis gamoyeneba (mag.
olanzapinis*, risperidonis*) an aqtiuri nivTierebis maRali
Semcvelobis mqone (maRalkoncentrirebuli) oraluri
formebis (mag. risperidonis, haloperidolis*) gamoyeneba.
ix. cxrilebi 2 da 2-1, 3 da 3-1.
36
* - saqarTveloSi registrirebuli preparati
gaxangrZlivebuli moqmedebis antifsiqozuri medikamentebis
ineqciebis gamoyeneba im pacientebisaTvis, romelTa mkurnaloba ar
iqna uzrunvelyofili, ris gamoc viTardeba xSiri gamwvavebebi.
logikuria mkurnalobis dawyeba imave medikamentis tabletis
formiT (flufenazini*, haloperidoli, risperidoni)
(ix. cxrili 3. da 2-1.)
pirveli arCevis medikamentebad meore Taobis antifsiqozuri
saSualebebis gamoyeneba, eqstrapiramiduli gverdiTi efeqtebis da
mogvianebiTi diskineziis ganviTarebis dabali riskis gamo.
• im pacientTaTvis, romelTac gaaCniaT pirveli Taobis
medikamentebiT efeqtiani mkurnalobis warsuli gamocdileba,
an upiratesobas aniWeben maT, iyeneben imave wamlebs. agreTve,
zogierTi tipis pacientisaTvis pirveli Taobis wamlebi
warmoadgenen pirveli arCevis medikamentebs.
• garda klozapinisa* (romelic gamoiyeneba mkurnalobisadmi
rezistentuli simptomebis mqone pacientebisaTvis) pozitiuri
simptomebis mkurnalobisTvis antifsiqozuri medikamentebis
moqmedebis efeqtianoba praqtikulad erTnairia.
• zogad fsiqopaTologiur simptomatikaze, kognitur, negatiur
da guneb-ganwyobis aSlis simptomebze ufro xSirad ukeTesi
efeqti gaaCniaT meore Taobis antifsiqozur medikamentebs.
(ix. cxrili 3)
medikamentis dozis mateba Terapiul dozamde _ dasaSvebi drois
intervaliT (ZiriTadi gverdiT efeqtebi, rogoricaa sedacia,
orTostatiuli hipitenzia da taqikardia, zRudaven dozis matebas);
klinikuri mdgomareobis gakontroleba _ sul cota 2 _ 4 kviraSi,
rac arCeuli mkuranlobisadmi daqvemdebarebis dadgenis saSualebas
iZleva.
• pacientTa umravlesobisaTvis pirveli Taobis antifsiqozuri
medikamentebis optimaluri doza `eqstrapiramiduli
simptomebis~ (eps) zRurblTan axlosaa, da am (dozis) dros,
SesaZlebelia minimaluri rigidulobis ganviTareba;
• meore Taobis antifsiqozuri medikamentebisaTvis optimaluri
doza aris farmakofirmis mier gansazRvruli Terapiul
dozasa da anotaciaze (FDA-s mier damtkicebuli) miTiTebul
dozis sazRvrebSi.
37
roca pacientis mkurnaloba uzrunvelyofilia da medikamentis
plazmuri koncentaracia adeqvaturia, magram gaumjobesebas
adgili ara aqvs, dozis Semdgomi gazrda (Tuki, pacienti itans) an
sxva medikamentze gadasvla.
saWiroebis SemTxvevaSi, plazmaSi im medikamentebis
koncentraciis gansazRvra, romelTa plazmur
koncentraciasTanaa dakavSirebuli pacientis klinkuri
mdgomareobis gaumjobeseba (mag. haloperidoli, klozapini).
Tuki pacientis mdgomareoba ar umjobesdeba, mizezis dadgena, mag:
ar iqna uzrunvelyofili am medikamentiT zusti (sqemiT)
mkurnaloba, medikamenti swrafad metabolirdeba, an cudad
absorbirdeba.
38
cxrili #2,
ZiriTadi antifsiqozuri medikamentebi (7, 31, 32, 33, 34)
*- saqrTveloSi registrirebuli preparatebi
antifsiqozuri
medikamentebis
dasaxeleba
rekomendirebuli
dozebis
sazRvrebi
(mg/dR)a
qlorproma
zinis
ekvivalenti
(mg/dR) b
naxevar-
daSla
(sT-ebSi)
g
sisxlSi
Terapiuli
dozis
sazRvrebi
(ng/ml) (46)
pirveli Taobis:
fenoTiazinebi
qlorpromazini* 300–1000 100 6 30-100
flufenazini* 5–20 2 33 0.2-2.0
mezoridazini 150–400 50 36
perfenazini 16–64 10 10 0.8-2.4
Tioridazini 300–800 100 24 1-1.5
trifluoperazini* 15–50 5 24
levomepromazini
(44)
200-800
butirofenonebi
haloperidoli* 5–20 2 21 5-10
sxvebi
pimozidi (46) 1-10
loqsapini 30–100 10 4 30-100
molindoni 30–100 10 24
TioTiqseni 15–50 5 34 2-15
qlorprotiqseni
* (44) 10-600
sulpiridi* (45) 400-800-2400(max) (44)
meore Taobis:
aripiprazoli 10–30 75
klozapini* 150–600 12 >350
olanzapini* 10–30 33
quetiapini 300–800 6
risperidoni* 2–8 24
ziprazidoni 120–200 7
39
a rekomendirebuli dozebi adaptirebulia Semdegi gamocemebidan: 2003 Schizophrenia Patient Outcome Research Team recommendations (Lehman AF, Kreyenbuhl J, Buchanan RW, et al.: “The Schizophrenia Patient Outcomes Research Team (PORT): Updated Treatment Recommendations 2003.” Schizophr Bull [in press]).
b qlorpromazinis eqvivalenti daaxloebiT Seesabmeba 100 mg.
qlorpromazinis dozas. es eqvivalentebi SesabamisobaSi ar modis meore
Taobis antifsiqozur medikamentebTan, am SemTxvevaSi es maCvenebli ar
gamoiyeneba (Centorrino F, Eakin M, Bahk WM, et al.: “Inpatient Antipsychotic Drug Use in 1998, 1993, and 1989.” Am J Psychiatry 159:1932–1935, 2002).
g naxevardaSla aris drois periodi, romelic saWiroa plazmaSi wamlis
koncentraciis gasanaxevreblad; es maCvenebeli (naxevardaSlis periodi)
gamoiyeneba Sesabamisi dozirebis gansasazRvrad (Hardman JG, Limbird LE, Gilman AG (eds.): Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 10th ed. New York, McGraw-Hill Professional, 2001). wamlis naxevardaSlaSi ar Sedis misi
aqtiuri metabolitebis naxevardaSla.
40
cxrili #2-1
antifsiqozuri depo ineqciebi _ dozireba (45)
wamlis
dasaxeleba
dozebis
sazRvrebi
(mg/kvira)
ineqciebs Soris
intervali
(kvira)
komentarebi
flupentiqsol
dekanoati
12.5-400 2-4 SesaZloa,
gamoiwvios guneb-
ganwyobis aweva;
aJitacia
gaaZlieros.
flufenazin
dekanoati*
12.5-50 2-5 umjobesia depresiis
da eps-is dros
Tavis arideba.
haloperidol
dekanoati
12.5-75 4 xSirad iwvevs eps-s
da iSviTad _ Zlier
sedacias.
pipoTiazin
dekanoati
12.5-50 4 _
zuklopentiqsol-
dekanoati
100-600 2-4 gamoiyeneba
aJitaciis da
agresiis dros.
risperidonis
depo-ineqcia (75)
25-50 2 efeqtianoba
iseTivea, rogorc
tabletirebuli
formis 2-6 mg/dR
41
cxrili #3
Sizofreniis mwvave fazis mkurnalobis pirveli arCvevis
medikamntebi (7)
klinikuri suraTis
ganmsazRvreli niSnebi
jgufi 1:
pirveli
Taobis
medikame
ntebi
jgufi 2:
risperidoni*,
olanzapini*,
quetiapini,
ziprazidoni,
an aripiprazoli
jgufi
3:
kloza
pini*
jgufi 4:
antifsiqozuri
mediakmentebis
gaxangrZlivebu
li moqmedebis
ineqciebi
1. pirveli epizodi
2. myari (persistentuli)
suiciduri azrebi an
moqmedeba
3. myari (persistentuli)
agresiuloba
4. mogvianebiTi diskinezia
diax
diax
jgufi 2-is yvela
wamlis gamoyenebisas
mogvianebiTi
diskineziis
ganviTarebis riski
erTanairad dabali
ar aris
diax
diax
diax
5. midrekileba
eqstrapiramiduli
gverdiTi efeqtebis
ganviTarebisadmi.
6. midrekileba
prolaqtinis donis
momatebisadmi.
7. midrekileba wonis
momatebisadmi,
hiperglikemiisadmi,
hiperlipidemiisadmi.
roca SeuZlebelia farma-
kologiuri mkurnalobis
zusti sqemiT uzrunvel-
yofa (ganmeorebiTi)
diax.
garda risperidonis
Zalian maRali
dozebisa
diax.
garda
risperidonisa.
gamoiyeneba
ziprazidoni an
aripiprazoli
diax.
*- saqarTveloSi registrirebuli preparatebi
42
cxrili #3-1
antifsiqozuri medikamentebis da sxva wamlebis urTierTqmedeba
(romelTa umetesoba metabolirdeba citoqrom P450 2D6 sistemiT) (46)
*- saqarTveloSi registrirebuli preparatebi
alkoholi iwvevs damatebiT sedacias, koordianciis
darRvevas.
haloperidoli* zrdis alkoholis dones.
antikonvulsantebi (garda
valproatisa*)
amcireben antifsiqozuri medikamntebis dones
sisxlSi.
Tambaqo amcirebs antifsiqozuri medikamntebis dones
sisxlSi.
eriTromicini zrdis klozapinis* dones.
fluvoqsamini zrdis klozapinis dones.
serotoninis seleqtiuri
ukumutacebis inhobitorebi
(ssui)
zrdian neiroleptikebis dones da auareseben
eqstrapiramidul sindroms.
tricikluri antidepresantebi zogierTi neiroleptiki zrdis maT dones;
zrdian antifsiqozuri medikamntebis dones
sisxlSi
antiqolinergiulebi iwvevs damatebiT antiqolinergiul efeqts.
liTiumi SesaZloa gamoiwvios qlorpromazinis* donis
gazrda.
disulfirami amcirebs qlorpromazinis dones.
antiariTmiulebi
meTildopa
guaneTidini
propranololi
iwvevs hipotenzias da cnobierebis Secvlas;
iwvevs antihiperTenziul efeqts;
zrdis antifsiqozuri medikamentebis dones
sisxlSi.
43
cxrili #4
antifsiqozuri medikamentebis ZiriTadi gverdiTi efeqtebi (a) (7, 35-38)
medikamenti eqstrapiramid
uli
geverdiTi
efeqtebi/mogvi
anebiTi
diskinezia
prolaqtin
is
donis
mateba/ele
vacia
wonis
mateba
gluko
zis
donis
mateba
lipidebis
donis
mateba
Q-T interva
lis
gaxangrZ
liveba
sedacia hipoten
zia
antiqolin
ergiuli
gverdiTi
efeqti
Tioridazini + ++ + +? +? +++ ++ ++ ++
perfenazini ++ ++ + +? +? 0 + + 0
haloperidoli* +++ +++ + 0 0 0 ++ 0 0
klozapini* (b)
0 (c)
0 +++ +++ +++ 0 +++ +++ +++
risperidoni* + +++ ++ ++ ++ + + + 0
olanzapini* 0 (c)
0 +++ +++ +++ 0 + + ++
quetiapini (d)
0 (c)
0 ++ ++ ++ 0 ++ ++ 0
ziprazidoni 0 (c)
+ 0 0 0 ++ 0 0 0
aripiprazoli
(e)
0 (c)
0 0 0 0 0 + 0 0
qlorpromazini
*(45)
++ +++ _ _ _ _ +++ +++ +++
flupentiqsoli
(45)
++ +++ _ _ _ _ + + ++
metaboluri sindromi
44
a. 0 = gverdiTi efeqtebis ganviTarebis riski ar aris an Zalze iSviaTad viTardeba Terapiuli doziT. + = sustad
an iSviaTad iwvevs gverdiT efeqtebs Terapiuli doziT. ++ = zogjer iwvevs gverdiT efeqtebs Terapiuli
doziT. +++ = xSirad iwvevs gverdiT efeqtebs Terapiuli doziT. ?/_ = sarwmuno monacemebi ar aris.
adaptirebulia Semdegi gamocemidan: “Antipsychotic Agents,” in Current Psychotherapeutic Drugs, Second Edition. Edited by Quitkin FM, Adams DC, Bowden CL, et al. Philadelphia, PA, Current Medicine, 1998, pp. 120–154, with permission of Current Medicine, Inc. b. agreTve iwvevs agranulocitozs, krunCxvebs, miokarditebs.
g. gamonaklisis saxiT SesaZloa gamoiwvios akaTizia.
d. arsebobs kataraqtis ganviTarebis saSiSroeba.
e. SeiZleba gamoiwvios Rebineba da Tavis tkivili.
*- saqarTveloSi registrirebuli preparatebi
flufenazini*
(45)
+++ +++ _ _ _ _ + + ++
pimozidi (45) + +++ _ _ _ _ + + +
sulpiridi*
(45)
+ +++ _ _ _ _ 0 0 0
trifluoperaz
ini* (45)
+++ +++ _ _ _ _ + + +/_
zuklopentiqso
li (45)
++ +++ _ _ _ _ ++ + ++
45
4. damatebiTi medikamentebis gamoyeneba mwvave fazaSi
garda antifsiqozurisa sxva fsiqotropuli medikamentebis gamoyeneba:
• komorbiduli mdgomareobebis (mag. mZime depresiis, obsesiur-
kompulsiuri aSlilobis),
• fsiqozTan dakavSirebuli simptomebis (rogoricaa: aJitaciis,
agresiis, guneb-ganwyobis aSlis simptomebi)
• Zilis darRvevebis samkurnalod.
• aseve, antifsiqozuri medikamentebis gverdiTi efeqtebis
koregirebisaTvis.
mniSvnelovania imis gaTvaliswineba, rom zogierTi antidepresanti
(romelic kateqolaminebis ukumitacebis inhibitoria) zog SemTxvevaSi
fsiqozuri simptomebis gamwvavebas an SenarCunebas iwvevs.
mkurnalobis mwvave fazaSi benzodiazpinebis gamoyeneba efeqtiania
SfoTvisa da aJitaciis samarTavad.
guneb-ganwyobis stabilizatorebi da beta-blokatorebi
efeqtianad gamoiyeneba pacientis agresiis xarisxis
Sesamcireblad.
garda zemoaRniSnulisa, eqstrapiramiduli simptomebis
mkurnalobis sxva strategiaa antifsiqozuri medikamentis dozis
Semcireba, an sxva antifsiqozur medikamentze gadasvla.
(ix. cxrili 5; 5-1)
eqstrapiramiduli gverdiTi efeqtebis profilaqtikisa da
mkurnalobis dawyebamde mxedvelobaSi unda iqnes miRebuli
Semdegi faqtorebi:
• antifsiqozuri wamlis midrekileba eqstrapiramiduli
simptomebis gamowvevisadmi (ix. cxrili 4);
• pacientis mier upiratesobis miniWeba ama Tu im
medikamentisaTvis;
• pacientis warsuli istoria eqstrapiramiduli simptomebis
ganviTarebis Sesaxeb;
• eqstrapiramiduli simptomebis ganviTarebis sxva risk-
faqtorebis arseboba (konkretulad distoniis ganviTarebis
risk-faqtorebi);
• antiqolinergiuli gverdiTi efeqtebis ganviTarebis da
SesaZlo Sedegebis risk-faqtorebis arseboba.
46
cxrili #5
eqstrapiramiduli gverdiTi efeqtebi (39-40, 46);
distonia (uneblie) akaTizia parkinsonizmi mogvianebiTi
diskinezia
simptomi:
aRwera
enis, kisris, zurgis
da Tvalis kunTebis
uneblie SekumSva
motoruli mousvenroba da
kunTebis daWimulobis
subieqturi gancda (rac
SeZleba gamoixatos: win
da ukan siarulSi, adgoma-
dajdomaSi).
rigiduloba, tremori,
bradikinezia. ar
agerioT negatiur
simptomebsa da
depresiaSi.
tuCebis, enis an zemo
kidurebis uneblie
qoreaformuli
moZraobebi,
romlebic
mogvianebiT
viTardeba
ganviTarebis
riski • 40 wlamde asaki;
• maRal-potenciuri
neiroleptikebis
gamoyeneba
• ZiriTadad,AmaRal-
potenciuri
neiroleptikebis
gamoyenebisas
• doza-damokidebulia
• ZiriTadad,AmaRal-
potenciuri
neiroleptikebis
gamoyenebisas
• doza-damokidebulia.
• moxucebulobis
asaki;
• maRal dozebSi
neiroleptikebis
gamoyeneba 6 Tveze
metxans;
• anamnezSi: a)
gverdiT efeqtad
parkinsonizmi; b)
diabeti; g) guneb-
ganwyobis aSlis
simptomebi.
ganviTarebis
sixSirea weliwadSi
4-5 %.
mkurnaloba • profilaqtikurad:
30 wlamde
pacientebma,
romelTa
1. neiroleptikis dozis
Semcireba;
2. atipiur antifsiqozur
medikamentze gadasvla;
1. neiroleptikis dozis
Semcireba;
2. atipiur antifsiqozur
• regularulad,
weliwadSi 2-jer
aranormaluri
uneblie moZraobebis
47
mkurnalobas iwyebT
maRalpotenciuri
neiroleptikebiT,
paralelurad unda
miiRon benztropini
1-2 mg/dR (2
jeradad) 10 dRe,
SemdgomSi dozis
nel-nela
SemcirebiT.
• mwvave ditoniis dros:
1. benztropini 1-2 mg peroralurad an
kunTebSi;
2. difenilhidramini
25-50 mg.
peroralurad an
kunTebSi;
3. an diazepami* 5 mg. venaSi nela
Seyvana. (Semdgom ix.
profilaqtika)
3. beta-blokerebi, mag.
propranololi 20 mg.
dReSi 4-jer;
4. antiqolinergiuli saS-
ba, mag: benztropini 1
mg. dReSi 2-jer;
5. an benzodiazepini (mag.
lorazepami 0.5 mg.
dReSi 3-jer).
medikamentze gadasvla;
3. antiqolinergiuli
saS-ba, mag: benztropini
1-2 mg. dReSi 2-jer,
moxucebSi iwyeba 0,25
mg-iT da xangrZlivad
ar gamoiyeneba;
4. an amantadini 100-200 mg. dReSi 2-jer
gakontroleba,
skalis (AIMS) gamoyenebiT;
• atipiur antifsiqozur saS-
ebze gadasvla;
• E vitamini (alfa-
tokoferoli) 800- 1
200 erT/dR. 5 dRis
ganmavlobaSi
*- saqarTveloSi registrirebuli preparatebi
48
cxrili #5_1
avTvisebiani neirolefsiuri sindromi (ans) (45)
avTvisebiani neirolefsiuri sindromi
(ans)
ganviTarebis
riski
mkurnaloba (47)
neirolefsiuri mkurnalobis iSviaTi,
sicocxlisaTvis saSiSi garTulebaa,
romelic iwyeba cnobierebis SecvliT
(dezorientacia, fluqtuacia) da
axasiaTebs:
• klinikuri gamovlineba:
1. kunTovani rigiduloba;
2. distonia; 3. akaTizia;
4. mutizmi; 5. aJitacia; 6. hiperTermia;
7. diaforezi (oflianoba);
8. disfagia (ylapvis gaZneleba);
9. pulsis momateba
10. wnevis momateba
• laboratoriuli maCveneblebi:
2. kreatinfosfokinazis (CPK) mateba; 3. plazmaSi mioglobinis momateba;
4. mioglobinuria;
5. leikocitozi;
6. RviZlis enzimebis mateba;
6. Tirkmlis mw. ukmarisoba.
• premorbidulad
fsiqo-
motoruli
aJitacia;
• drois mcire intervalebiT
neiroleptikebi
s dozis mateba;
• didi raodenobiT
kunTovani
ineqciebi;
• antifsiqozur medikamentebTan
erTad
liTiumis
gamoyeneba.
I etapi (fsiqiatriul ganyofilebaSi):
1. antidofaminergiuli antifsiqozuri medikamentis
dauyovnebliv Sewyveta;
2. temperaturis, pulsis da sisxlis wnevis
gakontroleba;
3. gagrileba.
II etapi (gadaudebeli Terapiis ganyofilebaSi):
1. vitaluri funqciebis gakontroleba (monitoringi):
• rehidratacia da eleqtrolitebis balansi;
• Sardis gamoyofa da Tirkmlis funqcia;
2. dentroleni (pirdapiri moqmedebis miorelaqsanti,
1-3 mg/kg/dR, dReSi 4-jer intravenurad da rogorc ki
SeZlebs per os miRebas)+bromokriptini (dofamin-agnonisti, 2,5-5-10 mg/dR. dReSi 3-jer)+sedacia
(bezodiazepiniT) +filtvebis xelovnuri
velntialacia, saWiroebis mixedviT.
fsiqozis samkurnalod ki gamoiyeneba L-dopa, karbamazepini da ekT, saWiroebis mixedviT.
III etapi:
ans-s amowurvis Semdgom kidev erTi kvira (10 dR.)
grZeldeba zemoaRniSnuli mkurnaloba da Semdgom
Zalze frTxilad (dabali dozebiT da nel-nela
vzrdiT dozas) viwyebT dabalpotenciuri antifsqozuri
medikamentis gamoyenebas (klozapini*, quetiapini) *- saqarTveloSi registrirebuli preparatebi
49
5. eleqtro-konvulsiuri da sxva somaturi Terapiebis gamoyeneba
mwvave fazaSi
eleqtrokonvulsiuri Terapia gamoiyeneba upiratesad katatoniuri
simptomatikis mqone pirebisaTvis, romlebic lorazepamiT mkurnalobaze ar
reagirebdnen (mag, 1-2 mg./kunTebSi an intravenurad an 2-4 mg. tab-Si, yovel
48-72 sT-Si ganmeorebiT, saWiroebis mixedviT)
Sizofreniis da Sizoafeqturi aSlilobis mqone pirebisaTvis (romelTac
aReniSnebaT mZime persistentuli fsiqozi an suiciduri ideebi, an/da
qmedeba da manamade mkuranalobas, klozapinis CaTvliT, Sedegi ar
mohyolia) mizanSewonilia eleqtrokonvulsiuri Terapiis saWiroebis
ganxilva, medikamntur mkurnalobasTan erTad.
aseve, eleqtrokonvulsiuri Terapia sasargeblo SeiZleba iyos
SizofreniiT da TandarTuli depresiiT daavadebuli pacientTaTvis, Tuki
depresiuli simptomebi mkurnalobisadmi rezistentulia, an saxezea iseTi
simptomebi, rogoricaa fizikuri gamofitva, an suiciduri ideebi, an
qmedeba/mcdeloba, romlebic saWiroebs dauyovnebliv mkurnalobas.
50
6. pirveli epizodis mkurnalobasTan dakavSirebuli sakiTxebi
mTeli periodis ganmavlobaSi avadmyofuri niSnebis, simptomebis
warmoSobasa da ganviTarebaze detaluri dakvirveba da maTi werilobiTi
dafiqsireba _ Sesabamisi samedicino dokumentaciis warmoeba (vinaidan
fsiqozis pirveli epizodi SesaZloa iyos Zalze polimorfuli da
gamolindes sxvadasxva specifikuri aSlilobebis klinikuri suraTiT (mag,
Sizofreniismagvari aSliloba, bipolaruli aSliloba, Sizoafeqturi
aSliloba).
ix. sqema
pacientTan erTad gamwvevebis maRali risk-faqtorebis da im pozitiuri
faqtorebis ganxilva, romelTac SuZliaT minimumamde daiyvanos
gamwvavebis riski.
kanabisis da fsiqostimulatorebis gamoyenebis gamoricxva,
stresis marTvis gaumjobeseba da
SemanarCunebeli antifsiqozuri mkurnaloba.
remisiaSi myofi pacientis gamwvavebis riskis minimumamde dayvana, rasac
didi zegavlena gaaCnia klinikur, socialur da profesiuli saqmianobis
sferoebze.
pirveli epizodis mqone pacientebis 70%-ze meti aRweven fsiqozuri
simptomebis srul remisias 3-dan 4 TveSi, xolo 80%-ze meti_stabilur
remisias 1 wlis bolos.
mkurnalobisadmi cudad daqvemdebarebis prediqtorebia:
• sqesi _ mamakaci;
• cns-s pre- an perinataluri dazianeba;
• intensiurad gamoxatuli halucinaciebi da bodva;
• yuradRebis gauareseba, daqveiTeba;
• pacientis funqcionirebis dabali done premorbidSi;
• aranamkurnalevi fsiqozis xangrZlivoba;
• eqstrapiramiduli gverdiTi efeqtebis ganviTareba;
• pacientisaTvis distresuli emociuri garemo (mag. negatiuri da
kritikuli damokidebuleba mis mimarT, gadaWarbebuli mzrunveloba
irgvlivmyofisgan, emociurobis maRali done).
51
sqema
Sizofreniis pirveli epizodis mkurnalobis algoriTmi (45)
*- saqarTveloSi registrirebuli preparatebi
• SeuTanxmeT pacients/mis axlobels
antifsiqozuri medikamentis arCevani,
• Tuki SeuZlebelia, daiwyeT atipiuri
antifsiqozuri medikamentiT mkunaloba.
gazardeT doza (axdenT titracias),
saWiroebis mixedviT, efeqtur
minimalur dozamde
daaregulireT doza, misi efeqtianobis da
mis mimarT amtanobis mixedviT
SeafaseT yovel 6-8 kviraSi
roca Sedegi
miiRweva, ganagrZeT
mkurnaloba
dadgenili
efeqturi doziT.
roca Sedegi ar
miiRweva, SecvaleT
medikmenti, zemoT
aRniSnuli miTiTebebis
mixedviT
roca Sedegi ar
miiRweva, gamoiyeneT
klozapini*
• roca mkurnalobis
uzrunvelyofa ar
xerxdeba, vinaidan
pacienti cudad
itans am
medikaments, masTan
erTad ganixileT
wamlis Secvlis
sakiTxi
• an roca mkurnalobis
uzrunvelyofa ar
xerxdeba sxva
faqtorebis gamo,
ganixileT depo-
preparatebis da/an
Tanxmobis
Terapiis
gamoyeneba.
• gaimeoreT zemoT
aRwerili procesi.
52
stabilizaciis faza (29)
mkurnalobis miznebia:
• pacientisTvis stresis minimumamde dayvana da misi mxardaWeris
uzrunvelyofa, recidivis ganviTarebis Tavidan acilebis
mizniT;
• pacientis sociumSi (TemSi) cxovrebis adaptaciis gaumjobeseba;
• simptomebis TandaTanobiT reducireba (minimumamde dayvana) da
remisiis gamyareba.
stabilizaciis fazaSi, adeqvaturi Terapiuli efeqtis miRwevis Semdeg
(minimaluri gverdiTi efeqtebiT), Semdgomi 6 Tvis manZilze, Catardes
mkurnaloba (imave medikamentebiT da imave doziT) da mdgomareobis
monitoringi.
mwvave fazidan moyolebuli uwyvetad Sefasdes farmakoTerapis
gverdiTi efeqtebi da igi minimumamde iqnas dayvanili.
gagrZeldes mxardamWeri fsiqoTerapiuli intervencia.
pacients miewodos informacia:
• daavadebis mimdinareobis,
• gamosavlis da
• mkurnalobis uzrunvelyofis mniSvnelobis Sesaxeb (gagrZeldes
ojaxis wevrebis informireba).
pacientis hospitlidan gaweramde momzaddes Temze dafuZnebuli
uwyveti mkurnalobis servisebi (41, 42).
xSirad sasargebloa, jer kidev hospitalizebuli pacientebisaTvis
ambulatoriuli samsaxuris fsiqiatrTan Sexvedris organizeba; xolo
gasawerad momzadebuli pacientebisaTvis _ Temze dafuZnebuli
fsiqiatriuli samsaxuris fsiqiatrTan viziti.
gaweris Semdgom daxmareba gaewios pacients ojaxsa da sociumSi/TemSi
cxovrebaSi adaptirebaSi da realuri miznebis dasaxvaSi, raTa zedmetad
ar ecados samsaxurSi da sociumSi gadaWarbebulad aqtiur
funqcionirebas.
53
stabiluri faza (29)
1. Sefaseba stabilur fazaSi
mkurnalobis miznebia:
• simptomebis Semcireba an mdgomareobis xangrZlivad
daregulireba;
• pacientis funqcionirebis da cxovrebis xarisxis SenarCuneba an
gaumjobeseba;
• simptomebisa da gamwvavebebis (mzardi) efeqtiani mkurnaloba;
• mkurnalobis gverdiTi efeqtebis gakontrolebis gagrZeleba.
mdgomareobis Sefaseba da monitoringi, raTa GganisazRvros,
saWiroebs Tu ara pcienti mkurnalobis sqemis Secvlas.
pacientebs (romlebic iReben antifsiqozuri medikamentebs)
CautardeT eqstrapiramiduli simptomebis klinikuri Sefaseba,
fsiqiatrTan yovel vizitze.
pacientebs, romlebic iReben pirveli Taobis antifsiqozur
saSualebebs, yovel 6 TveSi erTxel, xolo pacientebs, romlebic
iReben meore Taobis saSualebebs, 12 TveSi erTxel, CautardeT
paTologiuri uneblie moZraobebis klinikuri Sefaseba.
6 Tvis ganmavlobaSi yovel vizitze da Semdgom, 3 TveSi erTxel,
gakontroldes pacientis wona da sxeulis masis indeqsi (BMI). im
pacientebs, romelTa sxeulis masis indeqsi aris 25 da meti, gegmiurad
CautardeT Warb wonasTan dakavSirebuli somaturi problemebis
monitoringi (kerZod, ganisazRvros sisxlis wneva, sisxlSi lipidebis
done, diabetis klinikuri simptomebi).
stabiluri fazis dawyebidan 4 Tvis bolos da Semdgom yovelwliurad,
uzmoze ganisazRvros sisxlSi glukozis done; aseve yovelwliurad
ganisazRvros (an ufro xSirad klinikuri saWiroebis mixedviT) _
sisxlSi eleqtrolitebis done, Tirkmlis, RviZlis da Tireoiduli
funqciebi; klinikuri Cvenebis Sesabamisad, Catardes sisxlis
narkologiuri analizi.
54
2. fsiqosocialuri mkurnaloba stabilur fazaSi(29)
daniSnuli mkurnalobis specifikurobis gaTvliswinebiT, Catardes
sxva gamokvlevebi: somaturi mdgomareobis ZiriTadi maCveneblebi,
sisxlis saerTo analizi, ekg, hiperprolaqtinemiis simptomebis
(laboratoriuli) da ofTalmologiuri gamokvleva.
(ix. cxrili 1).
pacientis Tanaxmobis SemTxvevaSi viqonioT da SevinarCunoT mWidro
kavSiri im (mxardamWer) pirTan, vinc amCnevs calkeuli simptoms da
pacientisaTvis stresul movlenebs.
pacientis individualuri saWiroebis da socialuri garemos
Sesabamisad, Sesaferisi fsiqosocialuri mkurnalobis SerCeva.
mniSvnelovan mtkicebulebebze dafuZnebul efeqtian
fsiqosocialuri mkurnalobaSi Sedis:
1. Temze dafuZnebuli mkurnalobis programa (PACT); 2. ojaxuri intervencia;
3. kognitur-bihevioruli Terapia;
4. socialuri unar-Cvevebis gamomuSaveba (Treiningi).
ix. ganmartebebi qvemoT
Sizofreniis (da sxva fsiqozis) mqone pacientTa umetesoba
antifsiqozuri mkurnalobis Sewyvetis SemTxvevaSi, xelaxali
gamwvavebis maRali riskis qveS arian. am riskis gansazRvris zusti
indikatori ar arsebobs. Tu pacients anamnezSi aReniSneba
gamwvavebis mravali an 5 wlis manZilze Tundac 2 epizodi,
mizanSewonilia misi uwyvet, SemanarCunebel antifsiqozur
mkurnalobaze daTanxmeba.
Tu antifsiqozuri mkurnalobis fonze remisia grZeldeba sul
cota 1 weli mainc, SesaZloa erToblivad miRebul iqnas
gadawyvetileba antifsiqozuri wamlebis miRebis Sewyvetaze, rac
yovelTviurad nel-nela dozis 10 %-iT SemcirebiT unda moxdes (7).
55
ganmartebebi:
1. Temze dafuZnebuli mkurnalobis programa (51-63) gulisxmobs:
integrirebuli multidisciplinaruli gundis mier pacientis
mkurnalobaSi aqtiur Carevas da misi SemTxvevis marTvas. dasavleTSi es
profesiuli gundi muSaobs kviraSi 7 dRe, dRe-RameSi 24sT da
uzrunvelyofs pacientis daxmarebas saxlSi, TemSi (mikrosociumSi) da
samuSao adgilze. aRniSnuli programa individualurad afasebs
pacientis mier stresis damoukideblad daZlevis unaris deficits da
exmareba Tavisi moTxovnilebebis gansazRvrasa da dakmayofilebaSi; aseve
afasebs da exmareba iseTi yofiTi unar-Cvevebis gaumjobesebaSi,
rogoricaa: tansacmlis recxva, saxlis dalageba, sayidlebze siaruli,
sakvebis momzadeba, saxarjo fulis ganawileba, transportiT
sargebloba da a.S;
2. ojaxuri intervencia (47-53): aucilebelia pacientis ojaxis wevrebi
droulad iqnen CarTulni erToblivi mkurnalobis procesSi, rac
mniSvnelovnad aumjobesebs pacientis mdgomareobas, saboloo
gamosavalis CaTvliT. am momsaxurebam unda moaxdinos pacientisa da
misi ojaxis wevrebis fsiqoganaTleba (gaTviTcnobiereba), rac maT
daexmareba klinicistebTan erTad mkurnalobis dagegmvaSi, miznebis
dasaxvasa da momsaxurebis uzrunvelyofaSi. es programa aris mkacrad
struqturirebuli da grZeldeba 9 Tvidan 2-3 wlamde;
3. kognitur-bihevioruli Terapia (64-81): did britaneTsa da aSS-Si kbT
farTod gamoiyeneba SizofreniiT (da sxva fsiqozuri aSlilobebiT)
daavadebuli pacientebis mkurnalobaSi. kbT individualuri Terapiaa,
romlis mizani ar aris Teprapevtis mier fsiqozuri simptomebis
uaryofa, pacintis gadarwmuneba da fsiqozis iracionalur movlenad
Sefaseba. am dros Terapiuli intervenciis mizania simptomebis Sesaxeb
pacientis Sexedulebebis da miseuli daZlevis strategiebis gamovlena,
masTan erTad axali, ufro racionaluri da pacientisTvis nakleb
distresuli mosazrebebis SemuSaveba. es Terapia gulisxmobs: bodviTi
azrebis da halucienaciebis Sesaxeb pacientis rwmena-Sexedulebebis
Secvlas, `xmebis~ SemTxvevaSi maTze fokusirebas da warmoSobis wyaros
xelaxal reatribucias (mikuTvnebas), fsiqozuri gancdebis Sesaxeb
pacientis gaTviTcnobierebas. kognitur-bihevioruli Terapiis
saxelmZRvanelo xelmisawvdomia, magram Terapiis Casatareblad
saWiroeba specialistis trenireba da misi Semdgomi supervizia;
4. socialuri unar-Cvevebis treiningi (82-92): regularuli swavleba da
bihevioruli teqnikebis gamoyeneba daexmareba pacients SeiZinos da/an
gaaumjobesos komunikaciuri, sakuTari Tavis movlis da sociumSi
funqcionirebis unar-Cvevebi. Cveulebriv, es Treiningi tardeba pacientTa
mcire jgufSi (6-8 kaci) da moicavs erTdroulad ara yvela socialur
unar-Cvevas, aramed mizanmimarTulia garkveuli funqcionirebis
sferosken, igi mkacrad struqturirebulia da sistematiurad aswavlis
pacientebs: sakuTari simptomebis amocnobas da marTvas, antifsiqozuri
medikamentebis sworad miRebas, SesaZlo gamwvavebis gamafrTxilebeli
niSnebis amocnobas, socialur urTierTobebs, rogoricaa Tavisufali
komunikaciebi (garegnuli ieri, gamometyveleba, xmis tembri), sakuTari
moTxovnilebebis gamoxatvas da uflebebis dacvas, aseve, samuSaoze
misaRebad intervius sworad warmarTvas.
56
3. antifsiqozuri medikmentebis gamoyeneba stabilur
fazaSi(28)
antifsiqozuri saSualebebis gamoyenebiT SesaZlo gamwvavebis
riskis Semcireba.
pacientTa umravlesobas, romlebic pirveli Taobis antifsiqozuri
agentebiT mkurnaloben, medikamentebi daeniSnoT doziT, romelic
`eqstrapiramiduli simptomebis~ (eps) zRurblTan axlosaa (anu am
dros fizikuri gamokvleviT SesaZlebelia minimaluri
rigidulobis aRmoCena).
meore Taobis antifsiqozuri medikamentebis daniSvna SesaZlebelia
Terapiuli doziT, romelic ar iwvevs eqstrapiramidul gverdiT
efeqtebs.
uaRresad mniSvnelovania, fsiqiatrma kargad awonos erTis mxriv
antifsiqozuri medikamentebis dozis Semcireba `minimalur
efeqtur dozamde~ da meores mxriv, xSiri gamwvavebebis riski da
Sizofreniuli siptomatikis gauareseba.
Sefasdes, rezidualuri negatiuri simptomebi warmoadgens
parkisonizmis Tu aranamkurnalevi depresiis gamovlinebas da
daeiniSnos Sesabamisi mkurnaloba.
57
4. damatebiTi medikamentebis gamoyeneba stabilur fazaSi
5. eleqtro-konvulsiuri Terapiis (ekT) gamoyeneba stabilur
fazaSi
6. stabilur fazaSi pacientisa da misi ojaxis wevrebis
mxardaWera, raTa maT mimarTon TviTdaxmarebis samkurnalo
dawesebulebebs
stabilur fazaSi, garda antifsiqozurisa gamoiyeneba sxva
medikamentebic iseTi komorbiduli (Tanamdevi) mdgomareobebis
samkurnalod, rogiricaa agresia, SfoTva an guneb-ganwyobis aSlis
sxva simptomebi; isini aseve gamoiyeneba ZiriTadi medikamentebis
antifsiqozuri efeqtis gasaZliereblad da gverdiTi efeqtebis
sakoreqciod.
im pacientebisaTvis, romelTa mkurnloba mwvave fazaSi warimarTa
eleqtrokonvulsiuri TerapiiT, amasTan mxolod fsiqofarmako-
logiuri profilaqtika efeqtiani ar aris, an maT daqveiTebuli
aqvT amtanoba antifsiqozuri medikamentebis mimarT, sasargebloa
SemanarCunebli ekT.
58
mkurnalobisadmi rezistentuli pacientebis movlasTan
dakavSirebuli specialuri sakiTxebi(29)
detalurad da yuradRebiT Sefasdes, iRebs Tu ara pacienti
adeqvatur antifsiqozur mkurnalobas, maSasadame, unda gairkves,
medikamentebis dozireba adeqvaturia Tu ara da iRebs Tu ara maT
zustad daniSnulebis mixedviT.
im pacientTaTvis, romelTa mkurnaloba ori dasaxelebis
antifsiqozuri medikamentiT, (amaTgan, erTi mainc, meore Taobis
antifisqozuri medikamentia) araefeqtiani iyo da/an maTTvis,
romelTac aReniSnebaT persistiuli suiciduri azrebi (qmedeba)
unda vcadoT klozapinis gamoyeneba.
rezidualuri simptomebis Taviseburebidan gamomdinare (mag.
pozitiuri, negatiuri, kognituri da/an guneb-ganwyobis aSlis
simptomebi, agresiuli qceva), garda antifsiqozuri medikamentiebisa,
gamoiyeneba antikonvulsantebi da benzodiazepinebi, mkurnalobis
gaZlierebis mizniT.
damtkicebulia ekT-s efeqtianoba mkurnalobisadmi rezistentuli
SemTxvevebisas.
kognitur-bihevioruli Terapiis teqnikebis gamoyeneba
mniSvnelovnad uwyobs xels pozitiuri simptomebis reducirebas.
Cveulebriv, saWiroa 4-6 kvira, raTa dadgindes, pacientis
simptomebi daeqvemdebara Tu ara gansazRvrul mkurnalobas.
Semdgomi 6 Tvis manZilze, an zogjer ufro xangrZlivadac,
SesaZloa igive antifsiqozuri mkurnalobis fonze gagrZeldes
pacientis mdgomareobis gaumjobeseba.
59
deficituri simptomebis mkurnaloba
pacientis Sefaseba im faqtorebis gamosavlenad, romelTac
SeuZliaT xeli Seuwyon meoradi negatiuri simptomebis
ganviTarebas.
Tu negatiuri simptomebi aris meoradi, mkurnaloba sWirdeba maT
uSualo mizezs:
• fsiqozur simptomebs _ antifsiqozuri medikamentebiT;
• depresias _ antidepresiuli medikamentebiT;
• SfoTvas _ anqsiolizuri saSulebebiT;
• eqstrapiramidul gverdiT efeqtebs _ antiparkinsonuli
medikamentebiT an antifsiqozuri medikamentebi dozis
SemcirebiT.
pirveladi persistentuli negatiuri simptomebis SemTxvevaSi,
dResdReobiT ar arsebobs mtkicebulebebze dafuZnebuli efeqtiani
mkurnaloba, magram klozapinis da sxva meore Taobis antifsiqozuri
agentebis gamoyeneba iZleva garkveul Sedegs.
60
samkurnalo dawesebulebis an sacxovreblis (TavSesafris)
SerCeva(28)
hospitalizaciis Cvenebas ganapirobebs, Tu ramdenad
• aris pacienti saxifaTo sakuTari Tavis an irgvlivmyofebis
mimarT;
• SeuZlia sakuTari Tavis movla;
• saWiroebs mudmiv meTvalyureobas an daxmarebas.
hospitalizaciis sxva SesaZlo Cvenebas warmoadgens pacientis
saerTo somaturi mdgomareoba an fsiqiatriuli problema, romlis
mkurnaloba ambulatorul pirobebSi saxifaTo an araefeqtiania.
iZulebiTi hospitalizaciisaTvis Catarebul unda iqnas garkveuli
samarTlebrivi procedura, pacientis hospitaliziis dasabuTebis
mizniT.
im pacientebs, romelTa hospitalizacia savaldebulo ar aris,
magram maTi mdgomareobis simwvave saWiroebs ufro intensiur
movlas vidre es tipiur ambulatoriul pirobebSia SesaZlebeli,
unda miewodoT alternatiuli mkurnalobis sxvadasxva saxeebi:
• dRis stacionari;
• Sin movlis samsaxuri;
• ojaxSi krizis-Terapia;
• krizisis movlis samsaxuri, sacxovrebeli adgilis mixedviT;
• asertiuli mkurnalobis Temze dafuZnebuli samsaxuri.
gansazRvruli faqtorebis Sesabamisad pacientebi inacvleben
fsiqiatriuli momsaxurebis qselis erTi safexuridan momdevnoze.
61
danarTi #1
SANS (`minus-simptomatikis~ Sefasebis skala)
I afeqturi gasadaveba da gaRaribeba
afeqturi gasadaveba da siClunge manifestirdeba rogorc emociuri
gamoxatvis, emociuri reaqciis unaris da grZnobis damaxasiaTebeli
gaRaribeba.
qvemoTmoyvanili Temebi rom SevafasoT, Cveulebriv saWiroa vesaubroT
afeqturad mniSvnelovan Temebze.
1. saxis gaxevebuli gamometyveleba
pacientis saxe gamoiyureba gaxevebulad,
meqanikurad, gayinulad. saxis
gamometyveleba, saubris emociuri
Sinaarsis cvlilebis miuxedavad,
ucvlelia an odnav icvleba. radgan
neiroleptikebsac SeucliaT nawilobriv
aseTi efeqtis gamowveva, amitom zustad
unda davadginoT, iRebs Tu ara pacienti
neiroleptiks, magram ar unda SevecadoT,
rom es simptomi neiroleptikiT
gamowveul efeqtad CavTvaloT.
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= mciredi paTologiuri
gamoxatuleba
3= zomieri paTologiuri
gamoxatuleba
4= gamoxatuli paTologia
5= mZimed gamoxatuli
paTologia
(saxe gaxevebulia an
odnav icvleba, Tu
icvleba, intervius
ganmavlobaSi)
2. spontanuri moZraobis Semcireba
pacienti saubris procesSi wynarad zis
da ar/an TiTqmis ar moZraobs. is
normalurad mosalodnelTan SedarebiT
ar/an naklebad amoZravebs xel-fexs, ar
icvlis jdomis pozas.
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= mciredi paTologiuri
gamoxatuleba
3= zomieri paTologiuri
gamoxatuleba
4= gamoxatuli paTologia
5= mZimed gamoxatuli
paTologia (saxe
gaxevebulia an odnav
icvleba, Tu icvleba,
intervius ganmavlobaSi)
3. gamomsaxvelobiT moZraobaTa siRaribe
pacienti Tavis sxeuls, rogorc damxmare
saSualebas sakuTari Tavis gamosaxatavad
ver iyenebs. mag. rogoricaa xeliT
moZraobebi, skamidan win gadmoxra an
Tavisuflad ukan gadawola.
es aris damatebiT Sefaseba spontanuri
motorikis SemcirebasTan erTad.
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= msubuqi, odnavi
daqveiTeba
3= zomiari, pacienti iyenebs
sxeuls
eqspresiisaTvis 3-4-jer
4= gamoxatuli, sxeuls
iyenebs 1-2-jer
5= mZime, ar iyenebs sxeuls
62
4. mzerTi kontaqtis simcire
pacienti saubris dros Tavs aridebs
mzeriT kontaqts, an TvalebiT aranairi
eqspresia ar gamoixateba. igi TiTqos
sivrces misCerebia, maSinac ki, roca
laparakobs.
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= mciredi paTologiuri
gamoxatuleba
3= zomieri, naxevarjer mainc
4= Zalian iSviaTia
5= arasodes ar iyenebs
5. afeqturi reagirebis ararseboba
(afeqturi gasadaveba)
pacienti ar/an arasakmarisad reagirebs
iseTi Sinaarsis saubrebze, romlebic
Cveulebriv iwveven gamxiarulebas an
damwuxrebas. interviuerma SeiZleba
TviTon gaicinos da SeekiTxos `xom ar
dagaviwyda rogor unda gaicino?~ (Tu
uyureb mis sapasuxo reaqcias)
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= msubuqi, magram garkveuli
daqveiTeba
3= zomieri, zogjer TiTqos
ver pasuxobs
4= gamoxatuli, umetesad ver
pasuxobs
5= saerTod upasuxod
tovebs, provocirebis
SemTxvevaSic ki
6. Seusabamo afeti (paraTimia)
afeqturi reaqcia aris Seusabamo an
sawinaaRmdego. afeqturobis es aSliloba
imaSic gamoixateba, rom pacienti
seriozul an samwuxaro Temaze saubrisas
iRimeba, an iRebs miamitur (sulelur)
gamometyvelebas. uxerxulobis gamom-
xatveli Rimili ar unda Sefasdes
rogorc paraTimia.
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= mciredi paTologiuri
gamoxatuleba
3= zomieri paTologiuri
gamoxatuleba
4= gamoxatuli paTologia
5= mZimed gamoxatuli
paTologia
7. vokaluri gamoxatvis unaris nakleboba
(monotonuri metyveleba)
pacients laparakisas ar gamosdis, rom
xmis intonacia normaluri hqondes.
mniSvnelovani sityvebi ar xasiaTdeba
tonis simaRlisa da siZlieris
cvalebadobiT. samwuxaro an zogadad
saintereso Temebze saubrisas ar gvaqvs
bgeraTa siZlieris modulacia.
0= normaluri
1= SemCneuli fenomenis
paTologiuri xasiaTi
sakamaToa
2= msubuqi
3= zomieri, zogjer aris
gasadaveba
4= gamoxatuli, TvalnaTeli
daqveiTeba
5= metyveleba aris
monotonuri
8. subieqturi Civilebi sicarielis
grZnobaze an SegrZnebis unaris
dakargvaze
pacienti aCvenebs rom verafers veRar
SeigrZnobs; mas SeuZlia aseve Tavi
aRweros rogorc grZnobebisagan
`daclilma~.
0= sruliad ara, pacienti
ambobs, rom normalurad
SeigrZnobs
1= fenomenis paTologiuri
xasiaTi sakamaToa
2= subieqturi SegrZnebebis
msubuqi, magram WeSmariti
Semcireba
63
3= zomieri Semcireba
4= aSkara Semcireba
5= pacienti aRniSnavs
grZnobebis SegrZnebis
uunarobas
9. afeqturi Semcirebis globaluri
Sefaseba
globaluri Sefaseba unda eyrdnobodes
afeqturi gasadavebisa da afeturi
siClungis zogad simZimes.
gansakuTrebuli mniSvneloba unda
mieniWos iseT ZiriTad niSnebs,
rogorebicaa: nakluli reagireba,
araadeqvaturoba da emociuri
intensiurobis zogadi Semcireba.
0= normaluri afeqti
1= afeqturi Semcireba
sakamaToa
2= msubuqi afeqturi
Semcireba
3= zomieri afeqturi
Semcireba
4= aSkara afeqturi
Semcireba
5= mZime afeqturi gasadaveba
da afeqturi siClunge
II alogia da paralogia
alogia aRwers azrovnebis da aRqmis gaRaribebas, rogorc es gvxvdeba
SizofreniiT daavadebul pacientebSi (a - niSnavs ararsebobas, logos –
azrs). azrovnebis procesi carielia, mouwesrigebeli an Senelebuli. alogia
pirvel rigSi gamoixateba Rarib, cariel metyvelebaSi (metyvelebis
siRaribe), an Cveulebrivi siWarbis, magram cariel metyvelebaSi (saubris
gaRaribeba) da/an pasuxis latenturi drois gazrdaSi.
10. saubris gaRaribeba
metyvelebis raodenobrivi gaRaribeba,
rasac amavdroulad Tan axlavs
formaluri dialogis CenarCunebis
uunaroba, an/da uinteresoba mag.
erTsiytviani pasuxebi, an kiTxvebis
upasuxod datoveba
0= gaRaribeba ar gvaqvs
pasuxTa arsobrivi da
Sesabamisi raodenoba
Seicaven damatebiT
informacias
1= gaRaribeba sakamaToa
2= msubuqi gaRaribeba
3= saubris zomieri
gaRaribeba;
zogierTi pasuxi Seicavs
damatebiT gamosadeg
informacias, bevri pasuxi
erTmarcvliania da
Zalian mokle (mag. xo;
ara; albaT; bolo kviras
da a. S.)
4= gamoxatuli gaRaribeba,
pasuxebi iSviaTad aris
ramdenime sityvaze
grZeli
5= mZime gaRaribeba, pacienti
Zalian cotas ambobs da
xSirad ar pasuxobs
11. metyvelebis Sinaarsobrivi gaRaribeba
saubari SeiZleba raodenobrivad
adeqvaturi iyos, magram uSinaarsoa an
umniSvnelo Sinaarsi aqvs, formaluri
dialogis unari SenarCunebulia, Tumca
Sinaarsobrivad gaRaribebulia.
0= gaRaribeba ar aris
1= gaRaribeba sakamaToa
2= msubuqi gaRaribeba,
SemTxveviTi pasuxebi
metad bundovania
imisaTvis, rom gavigoT
64
gansxvavdeba gaWianurebuli azrovnebisa-
gan, sadac subieqti gvaZlevs bevr
detals.
3= zomieri gaRaribeba,
pasuxTa umetesoba
bundovania
4= mniSvnelovani gaRaribeba,
sul mcire intervius
naxevari
5= mZime, TiTqmis mTeli
saubari bundovania da/an
gaugebari
12. azrebis wyveta, blokireba
metyvelebis mimdinareobis gawyveta –
sanam azri an idea damTavrdebodes.
pauzis Semdeg subieqti ver ixsenebs ras
ambobda. blokirebis konstatireba xdeba
mxolod maSin, rodesac subieqti TviTon
aRniSnavs azris Sewyvetas (gawyvetas) –
spontanurad, an eqimis SekiTxvaze
pasuxad.
0= ar aris
1= sakamaToa
2= 15 wuTis manZilze
erTxel aRmocendeba
3= 15 wuTis manZilze orjer
aRmocendeba
4= 15 wuTis manZilze samjer
aRmocendeba
5= 15 wuTis manZilze samze
metjer aRmocendeba
13. pasuxis latenturi drois gazrda
pacients pasuxis gasacemad Seusabamod
didi dro sWirdeba. ganmeorebiT
SekiTxvisas naTeli xdeba, rom pacientma
kiTxva gaigo, magram uWirs sakuTari
azrebis ganviTareba.
0= ar aris
1= sakamaToa
2= pasuxis win zogjer
mokle pauzebia
3= gamoxatuli pauzebi
4= latenturi drois
TvalsaCino gazrda
5= grZeli pasuxebi TiTqmis
yvela pasuxis win, an
pacienti TiTqmis ver
pasuxobs
14. alogiis subieqturi Sefaseba
pacienti aRniSnavs azrovnebis gaZnelebas
da/an siZneleebs Tanmimdevruli
azrovnebis gaSlaSi
0= saerTod ara
1= sakamaToa
2= msubuqi Semcireba
3= zomieri Semcireba
4= gamoxatuli Semcireba
5= pacienti aRniSnavs, rom
misi azrovneba metwilad
carielia da uWirs
sakuTari azrebis
ganviTareba
15. alogiuri azrovnebis globaluri
Sefaseba
unda Sefasdes metyvelebis gaRaribeba
da/an saubris Sinaarsis gaRaribeba.
paralogiuri azrovneba aris logikuri
azrovnebis uunarobis, an azrTa
TanmimdevrobaSi determinirebuli
tendenciis Sesustebis zogadi
gamoxatuleba, ris gamoc azrTa
Tanmimdevroba darRveulia.
0= ar aris
1= sakamaToa
2= umniSvnelo paTologia
3= paTologiuri gamoxatva
SesamCnevia
4= gamokveTili gaRaribeba
5= mZime gaRaribeba
15.a paralogia
paralogiuri azrovnebis Sefaseba unda
0= ar aris
1= sakamaToa
65
moxdes 5 gansxvavebis povnis kiTxviT
da/an andaziT.
2= 1 Secdoma pasuxSi
3= 2 Secdoma pasuxSi
4= 3 Secdoma pasuxSi
5= mniSvnelovani gamoxatva,
3 Secdomaze meti
III abulia-apaTia abulia Tavs iCens rogorc energiis, miswrafebebisa da interesebis
damaxasiaTebeli naklovaneba. zogjer pacientebi garedan stimulirdebian,
magram gamRizianeblis gaqrobis Semdeg stimuli swrafad qreba.
16. Tavis movla da higiena
pacienti sakuTari Tavis movlas da
higienas nakleb yuradRebas uTmobs; mas
unda aiZulo sxeulis movla. subieqts
SeiZleba hqondes WuWyiani, dauvarcxneli
Tma, WuWyiani xelebi, kbilebi, suni
piridan.
kiTxvebi: `ra sixSiriT iban tans?~;
`icvli tanisamoss, sacvlebs?~
0= ar aris
1= sakamaToa
2= msubuqi, magram
uyuradRebobis
aSkara niSani
3= mouwesrigebeli
garegnoba, pacients unda
mieTiTos, rom Tavs
mouaros
4= aSkarad mouwesrigebeli
garegnoba, pacients
mudmivad sWirdeba
miTiTeba Tavis movlaze
5= eqstremalurad
mouwesrigebeli
da mouvleli
17. araTanamimdevruloba profesiasa da
ganaTlebaSi
pacients ara aqvs regularuli samuSao
da/an am mimarTulebiT avlens
upasuxismgeblobas. stacionaris
pacientTan: igi ZaliT unda CavrToT
Sroma- an ergoTerapiaSi, an uars ambobs
iq wasvlaze. subieqts SeiZleba hqondes
samuSaos an swavlis mimarT midrekilebis
nakleboba – mis asakTan da sqesTan
SefardebiT.
0= ar aris
1= sakamaToa
2= araTanamimdevrulobis
msubuqi niSnebi
3= zomieri niSnebi, pacients
amaze unda mieTiTos
4= SesamCnevi niSnebi,
pacients sistematurad
unda mieTiTos
5= pacients Sroma an
ergoTerapiis Sesruleba
Tanmimdevrulad ar
gamosdis
18. fizikuri anergia
pacients aqvs midrekileba sxeulebrivi
moSvebulobisadmi. is saaTobiT zis
skamze da ar iZleva spontanur
aqtiurobas. igi met dros uTmobs pasiur
saqmianobas, mag. televizoris yurebas, an
is umoqmedoa.
kiTxvebi: `yofila Tu ar, rom mTeli dRe
wevxarT an zixarT umoqmedod?~; `es
gagrZelebula Tu ara erT dReze met
xans?~
0= ar aris
1= sakamaToa
2= msubuqi energiis dakargva
3= zomieri, pacients
periodulad unda
vaiZuloT iyos aqtiuri
4= pacients periodulad
unda vaiZuloT iyos
aqtiuri
5= pacienti metwilad
sruliad pasiuria
19. subieqturi Civilebi abuliasa da
apaTiaze
0= ar aris
1= sakamaToa
66
aq unda Sefasdes mxolod subieqturi
Civilebi energiisa da stimulebis
ararsebobaze.
2= msubuqi, magram sarwmuno
Civilebi
3= zomieri Civilebi
4= aSkara Civilebi
5= mZime Civilebi
20. globaluri Sefaseba
globalurma Sefasebam unda asaxos
apaTia-abuliis zogadi simZime sadac
gaTvaliswinebul unda iqnas pacientis
socialuri statusi da warmomavloba.
0= norma
1= sakamaToa
2= gamoxatulia mciredi
paTologia
3= paTologiuri
gamoxatuleba SesamCnevia
4= paTologiuri
gamoxatuleba TiToeli
damkvirveblisaTvis
SesamCnevia
5= mniSvnelovani gamoxatvis
done
IV anhedonia – asocialuroba es simptomokompleqsi moicavs pacientis siZneles, SeigrZnos interesi da/an
siamovneba, es SeiZleba gamoxatos sasiamovno aqtiurobebis mimarT interesTa
dakargvaSi, da/an amgvari qmedebebis dros, siamovnebis SegrZnebis uunarobaSi
da/an sxvadasxva tipis socialur urTierTobaTa ugulvebelyofaSi.
21. garToba da aqtiurobebi
pacients aqvs Zalian cota an aranairi
interesebi, aqtiuroba an hobi. Tumca es
simptomi SeiZleba nel-nela daiwyos,
saerTo jamSi mainc SesamCnevia aSkara
interesis dakargva adreul aqtiurobaTa
mimarT. aq ar unda Sefasdes pirveladi
SesaZlebeli Sizoiduri pirovneba,
romelsac aqvs dezinteresi socialuri
urTierTobebisadmi.
kiTxvebi: `Tu gaqvT interesi im
saqmianobisadmi, romelic Cveulebrivad
siamovnebas ggvridaT?~; `uyurebT Tu ara
televizors?~; `usmenT radios?~
0= normaluri
1= paTologiuri xasiaTi
sakamaToa
2= paTologiuri gamoxatva
umniSvneloa
3= paTologiuri gamoxatva
SesamCnevia
4= paTologiuri gamoxatva
SesamCnevia TiToeuli
damkvirveblisaTvis
5= mniSvnelovani gamoxatvis
done
22. seqsualuri interesebi
fasdeba pacientis interesi da mzaoba
seqsualuri kontaqtebis mimarT.
0= normaluri
1= paTologiuri xasiaTi
sakamaToa
2= paTologiuri gamoxatva
umniSvneloa
3= paTologiuri gamoxatva
SesamCnevia
4= paTologiuri gamoxatva
SesamCnevia TiToeuli
damkvirveblisaTvis
5= mniSvnelovani gamoxatvis
done
67
23. unari, igrZnos intimuroba da siaxlove
Sefasdeba imis unari, rom garkveul
pirovnebasTan pirovnuli urTierToba
daamyaros da SeinarCunos.
kiTxvarebi: `xom ar gqoniaT problemebi
Tqveni ojaxis wevrTan an meuRlesTan?~;
`rogor grZnobT Tavs, roca xvdebiT
Tqvens ojaxs, meuRles da a. S?~
0= normaluri
1= paTologiuri xasiaTi
sakamaToa
2= paTologiuri gamoxatva
umniSvneloa
3= zomieri, siamovnebs,
magram TviTon ar iCens
iniciativas
4= SesasmCnevi, neitraluria
vizitebis mimarT
damkvirveblisaTvis
5= urCevnia ar hqondes
kontaqti, an aris
mtrulad ganwyobili
axloblebis mimarT
24. damokidebuleba naTesavebTan,
megobrebTan da TanatolebTan (autizmi)
fasdeba sakuTar socialur wreSi
kontaqtebis damyarebis unari. autisturi
pacientebi spontanur kontaqtebs ar
amyareben; Tu vinme mas amisken ubiZgebs,
isini aRniSnulze an gaRizianebiT
reagireben, an stimulis gaqrobis Semdeg
CaiZirebian Zvel mdgomareobaSi.
kiTxvebi: `Tu atarebT bevr dros Tqvens
megobrebTan?~; `Tu gsiamovnebT
martooba?~; `ra ufro gsiamovnebT,
martooba Tu megobrebTan urTierToba?~
0= normaluri
1= paTologiuri xasiaTi
sakamaToa
2= paTologiuri gamoxatva
umniSvneloa
3= paTologiuri gamoxatva
SesamCnevia
4= paTologiuri gamoxatva
SesamCnevia TiToeuli
damkvirveblisaTvis
5= mniSvnelovani gamoxatvis
done
25. anhedonia – asocialurobis subieqturi
gacnobiereba
pacienti TviTon aRwers, rom es Tvisebebi
dakarga.
0= ar aris
1= sakamaToa
2= msubuqi, magram sarwmuno
gacnobiereba
3= zomieri gacnobiereba
4= SesamCnevi gacnobiereba
5= mZime gacnobiereba
26. anhedonia – asocialurobis globaluri
Sefaseba
globalurma Sefasebam unda asaxos
zogadi simZime anhedonia –
asocialurobis kompleqsisa.
0= norma
1= sakamaToa
2= msubuqi
3= zomieri
4= gamoxatuli, SesamCnevia
yvelasaTvis
5= mZime gamoxatvis done
V yuradReba yuradReba SizofrenikebSi xSirad darRveulia. pacients uWirs yuradRebis
raime gansazRvrulze koncentrireba da/an mas mxolod is SeuZlia, rom
koncentrireba sporadulad an naxtomiseburad moaxdinos. TviT subieqts
SeiZleba hqondes an ar hqondes gacnobierebuli Tavisi yuradRebis
koncentraciis deficiti.
27. socialuri uyuradReboba
pacienti Tavis mxridan socialuri
aqtiurobebis mimarT araviTar interess
0= ar aris
1= sakamaToa
2= msubuqi, magram
68
ar amJRavnebs. es uyuradReboba SeiZleba
gamomJRavndes, mag. negatiur qcevebSi
da/an socialuri aqtiurobebisagan Tavis
aridebis mcdelobaSi, naklul
koncentrirebis unarSi – rodesac
kiTxulobs, TamaSobs, uyurebs
televizors.
uyuradRebobis
garkveuli niSnebi
3= zomieri, subieqts
drodadro gamorCeba Tu
ra xdeba garemoSi
4= gamoxatuli, subieqti
xSirad ver amCnevs Tu ra
xdeba garemoSi, aqvs
siZneleebi kiTxvis dros
5= mZime, subieqts ar ZaluZs
miiRos monawileoba
saubarSi, daimaxsovros
ras kiTxulobs, an
gaerkves satelevizio
gadacemis siuJetSi
28. uyuradReboba fsiqologiuri testirebis
mimdinareobisas
Skalis erTjeradi gamoyenebisas unda
Catardes MMS. es testi SeiZleba
ganmeordes 3-4 kviris Semdeg.
mravaljeradi gamoyenebisas da Terapiis
Sedegebis SefasebisaTvis Semdegnairad
unda moviqceT:
erTi kviris Semdeg gameorebisas
gamovaklebinoT 100-dan 7.
ori kviris Semdeg gameorebisas oTxniSna
ricxvi ukuRma.
sami kviris Semdeg gameorebisas
gamovaklebinoT 100-dan 9.
gamokvlevis damTavrebisas: MMS.
0= uSecdomo
1= sakamaTo (pacienti
davalebas yoymaniT
akeTebs da/an uSvebs erT
Secdomas, romelsac
maSinve asworebs)
2= erTi Secdoma
3= ori Secdoma
4= sami Secdoma
5= sam Secdomaze meti
29. subieqturi Civilebi uyuradRebobaze
pacienti SeniSnavs rom mas
koncentrirebisas garkveuli siZneleebi
aqvs da/an uWirs yuradReba mimarTos
raime garkveulze.
0= Civilebi ara aqvs
1= sakamaToa
2= msubuqi Civilebi
3= zomieri Civilebi
4= SesamCnevi Civilebi
5= mniSvnelovani Civilebi
30. globaluri Sefaseba
fasdeba yuradReba da koncertraciis
unari, romlis drosac yuradReba eqceva
rogorc klinikur suraTs, iseve
davalebaTa Sesrulebas.
0= norma
1= fenomenTa paTologiuri
xasiaTi sakamaToa
2= mciredi paTologiuri
gamoxatva
3= SesamCnevi paTologiuri
gamoxatva
4= paTologiuri gamoxatva
yvela mkvlevarisaTvis
SesamCnevia
5= mniSvnelovani gamoxatvis
done
69
danarTi #2
"SAPS" halucinaciebi
1) smenoTi halucinaciebi. pacients
esmis laparaki, sxva saxis xmebi, an
xmauri, romelic sxvas aravis esmis.
0 normaluri
1 SemCneuli fenomenis
paTologiuri xasiaTi sakamaToa
2 mciredi paTologiuri
gamoxatuleba
3 zomieri paTologiuri
gamoxatuleba
4 gamoxatuli paTologia
5 mZimed gamoxatuli paTologia
2) makomentirebeli xmebi. pacients esmis
xmebi, romlebic mis azrebs da qcevas
ukeTeben komentars.
0, 1, 2, 3, 4, 5
3) xmebi dialogis saxiT. pacients esmis
ori an meti erTmaneTSi mosaubere
xma.
0, 1, 2, 3, 4, 5
4) somaturi an taqtiluri
halucinaciebi. pacienti gadmogvcems
sxeulis sxvadasxva nawilebSi
subieqturi SegrZnebebis Sesaxeb.
0, 1, 2, 3, 4, 5
5) ynosviTi halucinaciebi. pacienti
gadmoqvcems arabunebrivi sunis
Sesaxeb.
0, 1, 2, 3, 4, 5
6) mxedvelobiTi halucinaciebi.
pacienti xedavs xalxs, sagnebs, an
raRac konturebs, Tumca obieqturad
aRniSnuli ar dasturdeba.
0, 1, 2, 3, 4, 5
7) halicinaciebis globaluri Sefaseba.
es Sefaseba unda eyrdnobodes
halucinaciebis simwvaves, xangrZli-
vobas, da pacientis cxovrebaze maT
zegavlenas.
0, 1, 2, 3, 4, 5
70
bodva
8) persekutoruli bodva. pacienti
darwmunebulia rom mas devnian an mis
winaaRmdeg SeTqmuleba mzaddeba.
0, 1, 2, 3, 4, 5
9) Razvianobis bodva. pacienti
darwmunebulia rom meuRle mas
Ralatobs meuRle.
0, 1, 2, 3, 4, 5
10) codvianobis da TviTdanaSaulis
bodva. pacienti darwmunebulia, rom
mas didi codva aqvs an raime
danaSauli miuZRvis.
0, 1, 2, 3, 4, 5
11) gandidebis bodva. pacienti darwmunebulia, rom is flobs did
Zalas, gansakuTrebul unars,
talants da simdidres.
0, 1, 2, 3, 4, 5
12) religiuri bodva. pacienti moculia
religiis arsis Sesaxeb mcdari
ideebiT.
0, 1, 2, 3, 4, 5
13) somaturi bodva. pacienti darwmunebulia, rom misi sxeuli
Secvlilia an daavadebuli.
0, 1, 2, 3, 4, 5
14) damokudebulebis bodva. pacienti
darwmunebulia, rom umniSvnelo
SeniSvna an raime movlena kavSirSia
masTan da gansakuTrebuli
mniSvneloba aqvs.
0, 1, 2, 3, 4, 5
15) zemoqmedebis (kontrolis) bodva.
pacienti darwmunebulia raRac
gareSe Zala mis emociebs da
moqmedebebs akontrolebs.
0, 1, 2, 3, 4, 5
16) gaxsnilobis bodva. pacienti grZnobs,
rom xalxi mis azrebs kiTxulobs.
0, 1, 2, 3, 4, 5
17) azrTa gadacema. pacienti
darwmunebelia, rom SesaZlebelia
distanciaze misi azrebis gadacema.
0, 1, 2, 3, 4, 5
18) azrTa Cadeba. pacienti
darwmunebulia, rom azrebi mas ki ar
ekuTvnis aramed gare Zalis mier aris
Cadebuli masSi.
0, 1, 2, 3, 4, 5
19) azrTa amoReba. pacienti
darwmenebulia, rom misi Tavidan
gareSe Zalis mier azrebi iqna
amoRebuli.
0, 1, 2, 3, 4, 5
20) bodviTi ideebis globaluri
Sefaseba unda eyrdnobodes bodvis
intensiobis da mdgradobis Sefasebas,
da maT gavlenas pacientis
cxovrebaze.
0, 1, 2, 3, 4, 5
71
ucnauri qceva
21) Cacmuloba da Sesaxedaoba. pacienti
Cacmulia ucnaur maneraSi, an
ucnaurad iqceva.
0, 1, 2, 3, 4, 5
22) socialuri da seqsualuri qceva.
pacients arsebuli
sociokulturaluri qceviTi
normebisgan mniSvnelovnad
gadaxril qcevebs avlens,
(magaliTad masturbacia xalxSi).
0, 1, 2, 3, 4, 5
23) agresiuli da aJitaciuri qceva.
pacienti iqceva
gauTvaliswineblad, agresiulad,
an SfoTvian-aJitaciur maneraSi.
0, 1, 2, 3, 4, 5
24) ganmeorebadi an stereotipuli
qceva. pacienti avlens erT wyeba,
ganmeorebad aqtiurobas an
rituals.
0, 1, 2, 3, 4, 5
25) qcevis ucnaurobis globaluri
Sefaseba. es Sefaseba asaxavs
qcevis tipis socialuri
normebidan gadaxris xarisxs.
0, 1, 2, 3, 4, 5
72
azrovnebis formis aSlis pozitiuri paTologia
26) metyvelebis katastrofiuli daSla.
metyvelebis paterni, romlis drosac
xdeba ideaTa mocureba, mosxleta, ris
gamoc saubari inacvlebs Temidan Temaze,
da xdeba daukavSirebeli.
0, 1, 2, 3, 4, 5
27) tangencialoba. SekiTxvaze gacemuli
mcdari, irelevanturi pasuxi.
0, 1, 2, 3, 4, 5
28) inkoherentuloba. metyvelebis paterni,
rodesac msjeloba arsebiTad gaugebaria.
0, 1, 2, 3, 4, 5
29) alogikuroba. metyvelebis magaliTi,
rodesac msjeloba alogikuria.
0, 1, 2, 3, 4, 5
30) detalizacia. metyvelebis magaliTi,
rodesac arsebiTi ideis gamoyofis gza
metismetad aramizanmimarTuli dawvril-
manebuli da arapirdapiria.
0, 1, 2, 3, 4, 5
31) aCqarebuli, SemWidrovebuli metyveleba.
pacientis metyveleba metad swrafia
Znelia misi SeCereba. metyvelebis
produqcia gacilebiT ufro didia vidre
amas norma saWiroebs.
0, 1, 2, 3, 4, 5
32) cvladi, dabneuli metyveleba. pacientis
metyveleba advilad gadadis axlomyofi
stimulis gavleniT erTi Temidan
meoreze.
0, 1, 2, 3, 4, 5
33) JReradoba. metyvelebis forma, rodesac
saubars warmarTavs ara misi Sinaarsi,
aramed xmovani msgavseba.
0, 1, 2, 3, 4, 5
34) azrovnebis formis aSlis pozitiuri
paTologiis globaluri Sefaseba. es
Sefaseba asaxavs azrovnebis normidan
gadaxris sixSires, xarisxs da im
zegavlenas, rasac es paTologia axdens
avadmyofis komunikaciis unarze.
0, 1, 2, 3, 4, 5
Seusabamo afeqti
35) Seusabamo afeqti. pacientis afeqti aris
Seusabamo, inkoherentuli, gasdavebuli da
blagvi.
0, 1, 2, 3, 4, 5
73
danarTi #3 uneblie paTologiuri moZraobebis skala* (AIMS)
pacientis saxeli, gvari ______________________________________;
gamokvlevis TariRi _____________________________;
daakvirdiT pacients gamokvlevamde an gamoklvevis Semdeg mosvenebis
mdgomareobaSi (mag., mosacdel oTaxSi).
skami, romelsac gasinjvisas gamoiyenebT, unda iyos magari da myari,
saxelurebis gareSe.
pacientis gamokvlevis damTavrebis Semdeg, TiToeuli simptomis simZime
unda Sefasdes skalaze 0 (ar aRiniSneba), 1 (minimaluria), 2 (saSualo
simZimisaa), 4 (mZimea).
SeekiTxeT pacients, raime xom ar udevs piris RruSi (kanfeti, an saReWi
rezini), Tu ki, sTxoveT, gamoiRos.
hkiTxeT pacients, rogoria misi kbilebis mdgomareoba: atarebs Tu ara
proTezs, amJamad Tu awuxebs kbilebi an proTezi?
hkiTxeT pacients, Tavad Tu uCivis piris, saxis, xelebis an fexebis uneblie
moZraobebs. Tu ki, maSin sTxoveT, aRweros - ramdenad awuxebs an uSlis
raime saxis saqmianobaSi.
sTxoveT pacients, dajdes skamze sworad, xelebi daiwyos muxlebze da
terfebiT daeyrdnos iataks (daakvirdiT am pozaSi mTlianad sxeulis
mdgomareobas).
pacients sTxoveT, xelebi CamouSvas, Tu mamakacia _ muxlebs Soris da
Tu qalia da kaba acvia, muxlebis gaswvriv (daakvirdiT xelebs da
sxeulis sxva nawilebs).
sTxoveT pacients, gaaRos piri (daakvirdiT enas mosvenebisas). es
gaakeTeT orjer.
sTxoveT pacients, ena gamoyos (daakvirdiT enis paTologiur
moZraobebs). es gaakeTeT orjer.
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
74
sTxoveT pacients, daakakunos jer marjvena, Semdeg marcxena xelis
ceriT, rac SeuZlia swrafad, 10-15 wm.-is ganmavlobaSi (daakvirdiT am
dros misi saxis gamometyvelebas da fexebis moZraobas).
moaxrevineT da gaaSlevineT marjvena da marcxena mklavi, rig-rigobiT.
sTxoveT pacients, adges (daakvirdiT mTel sxeuls profilSi).
sTxoveT pacients, mklavebi win ise gaiSviros, rom mtevnebi qvemoT
hqondes CaSvebuli (am dros daakvirdiT mis tans, fexebs da pirs)a.
sTxoveT pacients, gaiaros ramdenime nabiji, Semotrialdes da
dabrundes ukan skamisken (daakvirdiT mis siaruls da xelebs). gaakeTeT
es orjera.
a. moZraobis gaaqtiveba.
* Synopsis of psychiatry Behavioral science/Clinical psychiatry. 9-th edition Harold I. Kaplan, MD and Benjamin J. Sadock, MD p.424.
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
75
danarTi #4
pacientis saxeli da gvari _______________________________________;
gamokvlevis TariRi _______________________;
fsiqiatriuli Sefasebis mokle skala (BPRS)
SeitaneT qula, romelic yvelaze saukeTesod Seesabameba pacientis
mdgomareobis aRweras: 0=ar aRiniSneba, 1=Zlier susti, 2=susti, 3=saSualo,
4=zomieri siRrmis, 5=Rrma, 6=ukiduresad Rrma.
1. somaturi Civilebi
pacientis fizikur janmrTelobasTan dakavSirebuli ipoqondriuli
Civilebi. SeafaseT sakuTar fizikur janmrTelobaze pacientis Sexeduleba,
miuxedavad imisa, arsebobs Tu ara am Civilebis realuri safuZvli.
2. SfoTva
pacientis gadaWarbebuli Relva, wuxili an SiSi awmyosa da/an momavalze.
SeafaseT pacientis gancdebi mxolod misi naTqvamis safuZvelze. daskvna ar
gaakeToT SfoTvis fizikuri niSnebis, an nevrotuli dacviTi meqanizmebis
safuZvelze.
3. emociuri deficiti
pacientis emociuri deficiti garemos, intervius an interviueris mimarT.
pacientis susti emociuri kavSiris mixedviT SeafaseT izolacia.
4. konceptualuri dezorganizacia
pacientis wyvetili azrovneba da/an dezorganizaciis xarisxi. Sefaseba
moaxdineT pacientis metyvelebiTi produqciis safuZvelze. misi
funqcionirebis xarisxze daskvnas nu gaakeTebT pacientis Sexedulebis
mixedviT.
5. braleulobis gancda
pacientis gadaWarbebuli wuxili an sinanulis gancda warsulSi Cadenili
saqcielis gamo. SeafaseT pacientis braleulobis subieqturi gancda,
romelsac is emociurad gadmogvcems. daskvnas nu gaakeTebT pacientis
depresiis, SfoTvis an nevrotuli dacviTi qcevis mixedviT.
6. daZabuloba
pacientis ‘nevrotuli’ daZabuloba, romelic fizikurad vlindeba sxeulis
poziT, gamometyvelebiT, mousvenrobiT an sxvadasxva moZraobiT.
daZabuloba fasdeba mxolod fizikuri niSnebis da motoruli qcevis
safuZvelze da ara daZabulobis subieqturi gancdiT, romelsac Tavad
pacienti aRniSnavs.
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
76
7. maneruloba da poza
fsiqikuri problemis mqone zogierTi pacientis arabunebrivi poza da
uCveulo motoruli aqtivoba, riTac igi normaluri adamianisgan
gansxvavdeba. SeafaseT mxolod paTologiuri moZraobebi. aq ar SeafasoT
motoruli aqtivobis raodenobrivi mateba.
8. grandiozulobis (gandidebis) gancda
pacientis gadaWarbebuli TviTSefaseba, misi rwmena sakuTar gansakuTrebul
SesaZleblobebsa an ZalauflebaSi. SeafaseT sakuTar Tavze pacentis
gamonaTqvamebis da ara imis mixedviT, Tu rogor uWiravs mas Tavi
intervius procesSi.
9. depresiuli guneb-ganwyoba
pacientis sevdianoba, sasowarkveTileba. SeafaseT misi pesimisturi
gamonaTqvamebis da ara pacientis moZraobebis Senelebis, an
depresiuli/somaturi Civilebis mixedviT.
10. negatiuri ganwyobileba
pacientis gaboroteba, siZulvili, agresiuloba, zizRi sxva adamianebis
mimarT. SeafaseT mxolod pacientis gamonaTqvamebi imis Sesaxeb, Tu ras
gZnobs is, an rogor eqceva sxvebs. ar gaakeToT daskvna pacientis
negatiuri ganwyobis Sesaxeb misi nevrotuli qcevebis, SfoTvis an somaturi
Civilebis safuZvelze. (interviueris mimarT damokidebuleba SeafaseT
grafaSi `TanamSromlobis arqona~).
11. eWvianoba
pacientis (bodviTi) azrebi, rom sxvebs mis mimarT cudi ganzraxva an
boroti Canafiqri aqvT (an warsulSi hqoniaT). SeafaseT mxolod pacientis
mier gamoTqmuli eWvebi da ara misi wuxili warsuli an amJamindeli
situaciis gamo.
12. halucunaciuri qceva
aRqma, romelic ar Seesabameba realurad arsebul gareTa (eqsternalur)
stimuls. SeafaseT mxolod is gancda, romelsac pacienti aRwers
normaluri adamianebis warmosaxvisgan aSkarad gansxvavebul fenomenad,
romelic mas bolo kviris ganmavlobaSi aReniSneba.
13. motoruli Seferxeba
pacientis energiis daqveiTeba, rac vlindeba mis Senelebul qcevaSi.
SeafaseT mxolod pacientze dakvirvebis da ara pacientis sakuTari
energiis donis Sesaxeb Sexedulebis safuZvelze.
14. TanamSromlobis arqona
1; 2; 3;4;5;6;
1; 2; 3;4;5;6;
1; 2; 3; 4;5;6;
1; 2; 3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
77
pacientis SewinaaRmdegeba, gaRizianeba, ganawyeneba interviuerisadmi da
TanamSromlobis nakleboba. SeafaseT interviusadmi pacientis
damokidebulebis da misi pasuxebis safuZvelze; ar SeafasoT intervius
gareT gamRizianebloba da TanamSromlobis arqona.
15. uCveulo azrebi
pacientis uCveulo, odiozuri, ucnauri an eqscentruli azrebi. SeafaseT
mxolod ucnaurobis xarsixi da ara azrovnebis procesis dezorganizaciis
xarisxi.
16. emociuri gasadaveba
pacientis emociuri gamoxatulebis daqveiTeba, adekvaturi emociurobis da
emociuri urTierTobebis TvalsaCino deficiti.
17. agzneba
pacientis aweuli gamRizianebloba, aJitacia, momatebuli reagireba garegan
faqtorebze.
18 dezorientacia
pacientis adekvaturi orientaciis arqona adgilSi, droSi, garemoSi da
sakuTar vinaobaSi.
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
1; 2;3;4;5;6;
78
II. qronikuli bodviTi aSlilobani (14)
1. definicia
qronikuli bodviTi aSliloba ewodeba iseT aSlilobas, roca pirovnebas
aReniSneba xangrZlivad arsebuli myari araeqscentriuli Sinaarsis bodva,
romelic ar miekuTvneba sxva fsiqiatriul aSlilobas, xolo xangrZlivoba
sul cota, erTi Tve mainc aris. am aSlilobis Zveli saxelwodebaa
paranoia anu paranoiduli aSliloba (15).
2. epidemiologia
amerikis SeerTebuli Statebis magaliTze bodviTi aSlilobebis
gavrceleba (prevalence) amJamad Seadgens 0.025-0.03%-s. amdenad, bodviTi
aSlilobebi gvxvdeba SizofreniasTan SedarebiT gacilebiT iSvaTad.
yovelwliurad axali SemTxvevebis (incidence) saSualo maCvenebeli Seadgens
1-dan 3 axal SemTxvevamde 100 000 sul mosaxleze. DSM-IV-TR klasifikaciis
mixedviT, qronikuli bodviTi aSlilobebis mizeziT hospitalizaciis
raodenoba Seadgens saerTod fsiqikuri aSlilobebis gamo stacionirebis
mxolod 1-2%-s. es aSliloba SesaZloa ganviTardes mozardobidan
dawyebuli moxucebulobis asakmde (18-80 w.w.), Tumca, umetesad iwyeba Sua
asakSi (40-45 w.w.)
3. etiopaTogenezi
bodviTi aSlilobebis zusti etiologia cnobili ar aris. es aSliloba
iwyeba mogvianebiT asakSi, gvxvdeba upiratesad qalebSi, Tumca gansxvaveba
genderuli Tanafardobis mxriv gacilebiT naklebia, vidre guneb-ganwyobis
aSlilobebis dros. qronikuli bodviTi aSlilobebis mqone pacientebze
xangrZlivma dakvirvebam naTelhyo am diagnozis stabiluroba. mxolod erT
meoTxedze naklebi SemTxvevis (1/4) diagnozi Seicvala SizofreniiT,
meaTedi (1/10) ki _ guneb-ganwyobis aSlilobiT.
qronikuli bodviTi aSlilobis etiopaTogenezSi mniSvenlovani adgili
uWiravs biologiur faqtorebs, vinaidan mTeli rigi nevrologiuri
darRvevebis dros (Tumca ara Tavis tvinis yvela saxis simsivenis dros),
roca ziandeba limburi sistema da qerqqveSa kvanZebi (basal ganiglia), viTardeba es aSliloba.
fsiqodinamiuri faqtorebi Taviseburad xsnis aSlilobis ganviTarebas.
qronikuli bodviTi aSlilobis mqone adamianebi ZiriTad dacviT meqanizmad
iyeneben sapasuxo reagirebas (reacrion formation), proecirebas (projection) da
uaryofas (denial). aseve miRebulia qronikuli bodviTi aSlilobis
ganviTarebis erik eriqsonis koncefcia, romlis mixedviT pirovnebis
ganviTarebis adreul stadiaze (0-12 Tve) yalibdeba ndoba undoblobis
sapirispirod (trust vs. mistrust), gansxvavebiT qronikuli bodviTi aSlilobis
mqone adaminebisa, roca undobloba `imarjvebs~.
79
4. klinikuri simptomatika (15)
a) simptomebis CamonaTvali
qronikuli bodviTi aSlilobebis es jgufi xasiaTdeba xangrZlivad
arsebuli myari bodviT, romlis klinikuri niSnebis klasifikacia ar
xerxdeba organul, Sizofreniul an guneb-ganwyobis aSlilobebis jgufSi.
savaraudod, igi heterogenuli warmoSobisaa da misi kavSiri
SizofreniasTan sakmaod sadaoa. SedarebiT mnSvnelovania genetikuri
faqtorebi, pirovnuli Taviseburebani da cxovrebiseuli garemoebebi, Tumca
maTi roli aSlilobis ganviTarebaSi cvalebadi da dauzustebelia.
bodviTi aSlilobis dros klinikur suraTSi saxezea monoTematuri bodva
an urTierTdakavSirebuli bodviTi azrebis erToblioba, romelic
arsebobs xangrZlivad, SesaZloa, mTeli sicocxlis ganmavlobaSi. es
bodvebi Zlier variabeluria da xSirad warmodgenilia devnis,
ipoqondriuli da gandidebis saxiT. aseve, bodviTi azrebis Sinaarsi
SesaZloa iyos pirovnebis Razoianobis, sakuTari sxeulis formis Secvlis
(dismorfofobia) da sxvebis mier misi negetiurad (mag, homoseqsualuri
orientaciis an specifikuri sunis mqone adamianad) Sefasebis ideebi. am
aSlilobis dros sxva fsiqopaTologiuri simptomebi ar aRiniSneba, garda
periodulad ganviTarebuli depresiisa da erTeul SemTxvevebSi
aRmocenebuli ynosviTi (olfaqtoruli) da taqtiluri halucinaciebisa.
iSviaTad, ZiriTadad moxucebSi, aseve SesaZloa erTeuli `xmebis~ arseboba.
es aSliloba ZiriTadad iwyeba Sua xnis asakSi, Tumca zog SemTxvevaSi,
saxeldobr dismorfofobiis dros, adreul asakSic SeiZleba daiwyos.
xSirad bodvis Sinaarsi da misi aRmocenebis dro dakavSirebulia garkveul
cxovrebiseul situaciasTan, mag. devnis bodva arcTu iSviaTad gvxvdeba
eTnikuri (an sxva) umciresobis wevrebSi. Tuki ar Seexeba bodviT azrebs,
pirovnebis emociuri sfero, metyveleba da qceva normis farglebSia.
5. daavadebis diagnozi (16)
a) diagnostikuri kriteriumebi
qronikuli bodviTi aSlilobebis diagnostikuri kriteriumebia:
araeqscentriuli Sinaarsis bodva (amaSi Sedis realuri cxovrebiseuli
situaciebi, agreTve devnis, mowamvlis, erotomaniuli anu siyvarulis,
Razoianobis, ipoqondriuli bodva), romlis xangrZlivoba sul cota, 1
Tvea;
A. arasodes aRiniSneba Sizofreniis A kriteriumi. SeniSvna: SesaZloa
ynovis (olfaqtoruli) an taqtiluri halucinaciebis arseboba, Tuki
isini dakavSirebuli arian bodvis TematikasTan;
B. Tu es ar Seexeba bodvis Tematikas, pacientis funqcionireba
mniSvnelovanad ar irRveva da misi qceva TvalsaCinod odiozuri an
eqscentriuli ar aris;
C. Tu bodvasTan erTdroulad guneb-ganwyobis darRvevis epizodi
aRmocenda, igi ufro xanmoklea, vidre bodvis periodis
xangrZlivoba;
80
D. aSlilobis ganviTareba ar aris dakavSirebuli fsiqoaqtiuri
nivTierebebis (an sxva farmakologiuri saSualebebis) gamoyenebasTan
an/da zogadsamedicino problemiT gamowveul mdgomareobasTan.
dasazustebelia tipi (bodvis dominanturi Tematikis mixedviT Semdegi
tipebi arsebobs):
erotomaniuli tipi: bodva, rom viRacis, ZiriTadad masze maRali statusis
pirovnebis siyvarulis obieqtia;
gandidebis tipi: bodva, rom aris gansakuTrebuli Rirsebis,
individualobis, Zalauflebis, codnis mqone; aqvs piradi urTierToba
RmerTTan an saxelganTqmul adamianTan(ebTan);
Razoianobis tipi: bodva, rom misi seqsualuri partniori Ralatobs;
devnis tipi: bodva, rom mas (an mis uaxloes adamians) devnian;
somaturi tipi: bodva, rom mas aqvs raRac fizikuri defeqti/nakli, an
raRac avadmyofobiT aris daavadebuli;
Sereuli tipi: ar aris dominanturi bodvis mxolod erTi romelime tipi,
aramed ramdenime tipia Sereuli;
dauzustebeli tipi.
b) diferencialuri diagnozis CamonaTvali (17)
qronikuli bodviTi da inducirebuli fsiqozuri aSlilobis
diferencialuri diagnozi unda gatardes Semdeg aSlilobebTan:
I. organuli bunebis aSlilobani, simptomatur aSlilobaTa CaTvliT:
• sxvadasxva saxis demencia;
• deliriumi, romelic ar aris ganpirobebuli alkoholuri an
sxva nivTierebebiT;
• tvinis dazianebiTa da disfunqciiT, agreTve sxva fizikuri
daavadebebiT gamowveuli fsiqikuri aSlilobani.
II. fsiqoaqtiuri nivTierebebiT ganpirobebuli fsiqikuri da qceviTi
aSlilobani;
III. ganzrax ganviTarebuli aSliloba, dakavSirebuli fizikur an
fsiqologiur faqtorTan (simulacia anu xelovnuri) aSlilobebi;
IV. Sizofrenia;
V. guneb-ganwyobis aSlilobani;
VI. obsesiur-kompulsiuri aSliloba;
VII. somatoformuli aSlilobani.
VIII. paranoiduli personologiuri aSliloba
IX. didi depresiuli epizodi;
81
6. gamokvlevis da 7. mkurnalobis sqema (14)
efeqtiani mkurnalobisTvis mniSvnelovania Semdegis
gaTvaliswineba:
1. diagnozis dazusteba;
2. Sesaferisi intervenciis Sesaxeb gadawyvetilebis miReba;
3. SesaZlo garTulebebis marTva.
Cveulebriv, qronikuli bodviTi aSlilobis mqone pacientTa
mkurnaloba tardeba dispanserulad. magram arsebobs ramdenime
mizezi, roca hospitalizacia aucilebelia:
1. sruli samedicino gamokvlevis mizniT (gansakuTrebiT
nevrologiuri da somaturi mizezebi);
2. pacientis agresiuli qceva (suiciduri an homociduri
qcevis impulsebi);
3. pacientis gamoxatuli disfunqciuri qceva ojaxSi da
samsaxurSi, rac bodvis SinaarsTan aris dakavSirebuli. am
dros socialuri da samsaxureobrivi urTierTobebis
stabilizaciisaTvis saWiroa profesiuli Careva.
gadaudebeli Terapiis ganyofilebSi gamoxatuli agznebis mqone
pacients gaukeTdes antifsiqozuri medikamentis ineqcia.
mkurnalobis miznis misaRwevad aucilebelia eqim-pacientis
Terapiuli aliansis Camoyalibeba, romelic am SemTxvevaSi
seriozul sirTules warmoadgens. amisaTvis efeqtiania iseTi
individualuri (da ara jgufuri) iseTi fsiqoTerapiuli meTodebis
gamoyeneba, rogoricaa:
• insaiTze orientirebuli mxardamWeri Terapia,
• kognituri da
• qceviTi Terapiebi.
Tavidan Terapia mimarTulia pacientis motivaciis asamaRlebel
mkurnalobaze. am dros mis bodviT ideebze msjelobis nacvlad
Terapevti unda ecados daexmaros pacients SfoTvis an
gamRizianeblobis daZlevaSi.
82
* - saqarTveloSi registrirebuli preparati
antifsiqozuri medikameturi mkurnaloba:
• wamlis arCeva ganpiroebebulia warsulSi simptomebis ama Tu
im preparatisadmi karg daqvemdebarebaze;
• mkurnaloba unda daiwyos nel-nela, mzardi dabali doziT
(mag. 2 mg. haloperidoli);
• SesaZloa, efeqturi iyos pimozidi, gansakuTrebiT somaturi
bodvis dros;
• antifsiqozur mkurnalobisadmi daqvemdebarebis dros
SemanarCunebeli dozebi Terapiulze dabali unda iyos;
• antifsiqozuri medikamentebis araefeqtianobis SemTxvevvaSi
mkurnalobis unda Sewydes;
• am dros SesaZloa efeqtiani iyos antidepresantebis, liTiumis
da antikonvulsantebis (karbamazepini* da valproati*)
gamoyeneba, gansakuTrebiT maSin, roca pacients aqvs guneb-
ganwyobis aSlilobis simptomebi an guneb-ganwyobis
aSlilobis ojaxuri istoria.
83
III. Sizotipuri aSliloba (18)
1. definicia
Sizotipuri aSliloba xasiaTdeba eqscentriuli qceviT, azrovnebis da
emociuri sferos Sizofreniis msgavsi darRvevebiT, romlebic SesaZloa
nebismier stadiaze ganviTardes. am aSliloisTvis aseve damaxasiaTebelia
e.w. ‘meeqvse grZnobis’ arseboba, zogjer damokidebulebis azrebi, iluziebi,
iSviTad derealizaciis epizodebi.
2. epidemiologia
Sizotipuri aSliloba viTardeba saerTo populaciis 3%-Si. SizofreniiT
daavadebulTa biologiur naTesavebSi yvelaze xSirad, sxva fsiqozebTan
SedarebiT, es aSliloba gvxdeba.
3. etiopaTogenezi
Sizotipuri aSliloba etiopaTogenezurad axlos dgas SizofreniasTan da
misi msgavsia. am aSlilobis ganviTarebis biologiuri faqtorebidan
niSandoblivia TrombocitebSi monoaminoqsidazis (MAO) dabali done
(romelic Sizotipuri aSlilobis mqone zogierT pacientSi gvxvdeba). aseve
aRsaniSnavia, rom aSlilobis mqone pirebs saganze Tvalis Tanabari
midevnebis nacvlad, aReniSnebaT Tvalis kaklis sakaduri moZraobebi
(swrafi monacvleoba erTi fokusidan meoreze), rac tipiuria
introvertebisa da dabali TviTSefasebis mqone pirebisaTvis, aseve xSiria
SizofreniiT daavadebulebSic. Sizotipuri aSliloba arcTu iSviaTad
gvxvdeba SizofreniiT daavadebulTa axlo naTesavebSi da sazogadod,
iTvleba Sizofreniis `genetikur formad~.
4. klinikuri simptomatika (19)
simptomebis CamonaTvali
Sizotipuri aSliloba xasiaTdeba eqscentruli qceviT, azrovnebisa da
emociur sferoebSi darRvevebiT (romelic msgavsia Sizofreniulisa),
kerZod: emociuri indiferntuloba an araadeqvaturoba, anhedonia,
socialuri izolaciisadmi midrekileba, paranoiduli an ucnauri azrebi,
romlebic bodvis xarisxs ar aRweven, akviatebuli azrebi, azrovnebiTi
coxna (умственная жвачка), aRqmis sferos darRvevebi, ZiriTadad iluzoruli,
SesaZloaHsmeniTi an sxva saxis halucinaciebis ganviTarebac. aSlilobis
dawyebis zusti drois gansazRvra Zalze rTulia, xolo mimdinareoba
iseTivea, rogoric pirovnuli aSlilobebis dros. aRniSnulis dasturia is
faqtic, rom DSM-IV-TR klasifikaciaSi es aSliloba Setanilia Sizotipuri
pirovnuli aSlilobis saxeliT, pirovnuli aSlilobebis jgufSi (A cluster).
84
5. daavadebis diagnozi
a) diagnostikuri kriteriumebi (19):
Sizotipuri aSliloba xasiaTdeba eqscentriuli qceviT, azrovnebis da
emociuri sferos Sizofreniismagvari darRvevebiT, romlebic SesaZloa
nebismier stadiaze ganviTardes. simptomebi ar aris am aSlilobisTvis
tipiuri an dominanturi, Tumca qvemoT CamoTvlili simptomebidan SesaZloa
ganviTardes yvela maTgani:
1. Seusabamo an Sekavebuli emociuri reagireba (emociuri `sicive~ da
indiferentuloba);
2. ucnauri, eqscentriuli an Taviseburi garegnoba da qceva;
3. irgvlivmyofebTan urTierTobis damyarebisa da SenarCunebis unaris
gauareseba da socialuri izolaciisadmi midrekileba;
4. ucnauri (odiozuri) myari Sexedulebebi an rwmena, romelic
gavlenas axdens pirovnebis qcevaze da ar Seesabameba eTnokulturul
normebs;
5. iWvneuloba an paranoiduli ideebi;
6. Sinagani winaaRmdegobis gareSe dismorfofobiuli, seqsualuri an
agresiuli Sinaarsis azrebis akviateba;
7. uCveulo somatosensoruli percefciuli gancdebi an sxva iluziebi,
depersonalizacia da derealizacia;
8. bundovani, metaforuli, detalur-skrupulozuri, an stereotipuli
azrovneba, rac vlindeba ucnauri metyvelebiT, Tumca aSkara
alogikuroba ar aRiniSneba;
9. epizoduri tranzitoruli (kvazi)fsiqozuri epizodebi _ intensiuri
iluziebis, smeniTi an sxva halucinaciebis, bodvismagvari ideebisa,
romlebic umetesad garegani trigeris (biZgi) gareSe aRmocendebian.
Sizotipur aSlilobas axasiaTebs qronikuli mimdinareobis da gamwvavebis
epizodebis fluqtuacia.
b) diferencialuri diagnozis CamonaTvali (20)
Sizotipuri aSlilobis diferencialuri diagnozi unda gatardes Semdeg
aSlilobebTan:
I. qronikuli bodviTi aSliloba;
II. Sizofrenia;
III. guneb-ganwyobis aSlilobani;
IV. tvinis dazianebiTa da disfunqciiT, agreTve sxva fizikuri
daavadebiT gamowveuli fsiqikuri aSlilobani;
V. fsiqoaqtiuri nivTierebebiT ganpirobebuli fsiqikuri da qceviTi
aSlilobani;
VI. paranoidul-personologiuri aSliloba;
VII. Sizoiduri personologiuri aSliloba;
VIII. sxva specifiuri personologiuri aSliloba;
IX. SfoTviTi personologiuri aSliloba;
X. emociurad arastabiluri (mosazRvre) personologiuri aSliloba.
85
6. gamokvlevis da 7. mkurnalobis sqema
efeqtiani mkurnalobisaTvis erTdroulad gamoiyeneba farmakoTerapia
(ix. Sizofreniis mkurnaloba) da fsiqoTerapia. medikamentebidan
iyeneben:
1. antifsiqozur medikamentebs, roca pacients aReniSneba
damokidebulebis azrebi, iluziebi da sxva fsiqozuri
simptomebi;
2. antidepresantebs, roca saxezea depresiuli simptomatika.
efeqtiani mkurnalobisTvis mniSvnelovania Semdegis
gaTvaliswineba:
1. diagnozis dazusteba;
2. Sesaferisi intervenciis Sesaxeb gadawyvetilebis miReba;
3. SesaZlo garTulebebis marTva.
ZiriTadad gamoiyeneba individualuri fsiqoTerapia. am dros
dasaZlevia iseTi seriozuli problema, rogoricaa pacientis
undobloba, ris gamoc udidesi mniSvneloba aqvs Terapevtis
profesionalizms da moTminebas (tolerantobas);
Sizotipuri aSlilobis mqone pacientebs uWirT jgufur
fsiqoTerapiaSi CarTva. Tumca, pacientis socialuri unar-Cvevebis
gasavarjiSeblad da misi iWvneulobis Sesamcireblad (roluri
TamaSebis gamoyenebiT) igi efeqtiania.
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IV. Sizoafeqturi aSliloba
1. definicia (21, 22)
saxelwodebis Sesabamisad, Sizoafeqtur aSlilobas axasiaTebs rogorc
Sizofreniis, aseve guneb-ganwyobis aSlilobis damaxasiaTebli niSnebi. igi
warmoadgens Setevebis saxiT ganviTarebul aSlilobas, roca klinikur
suraTSi erTdrouladaa saxeze guneb-ganwyobis aSlis da Sizofreniuli
simptomebi. Sizoafeqturi aSlilobis Setevebi xasiaTdeba simwvaviT,
cvalebadobiT da didi polimorfizmiT. amasTan, klinikur suraTSi
yovelTvis mniSvnelovani adgili uWiravs afeqtur darRvevebs.
2. epidemiologia (23)
ZiriTad populaciaSi Sizoafeqturi aSlilobis gavrceleba (lifetime prevalence) 1%^-ze naklebia (0.5 _ 0.8%). klinikur praqtikaSi winaswar
diagnozad gamoiyeneba Sizoafeqturi aSlilobis diagnozi, roca
aSlilobis saxe jer kidev dauzustebelia. Sizoafeqturi aSlilobis
depresiuli tipi ufro xSiria moxucebSi, vidre axalgazrdebSi, xolo
bipilaruli ki _ piriqiT. aSlilobis gavrceleba qalebSi (upiratesad,
gaTxovil qalebSi) ufro maRalia, vidre mamakacebSi. am ukanasknelebSi
aSliloba iwyeba ufro adreul asakSi, vidre qalebSi (msgavsad
Sizofreniisa).
bipolaruli tipis Sizoafeqturi aSlilobis mqone probandebis
biologiur naTesavebSi Sizofreniis SemTxvevebi TiTqmis imave sixSiriT
gvxvdeba, rogorc guneb-ganwyobis aSlilobis dros, maSin roca
depresiuli tipis dros Sizofreniis ganviTarebis riski ufro maRalia,
vidre guneb-ganwyobis aSlilobisa.
3. etiopaTogenezi (23)
Sizoafeqturi aSlilobis mizezi cnobili ar aris. dResdReobiT arsebobs
oTxi ZiriTadi modeli, romelTa mixedviT Sizoafeqturi aSliloba
warmoadgens: 1) an Sizofreniis, an guneb-ganwyobis aSlilobebis erT-erT
tips; 2) erTdroulad, Sizofreniis da guneb-ganwyobis aSlilobebis
gamovlinebas; 3) orivesgan gansxvavebul, mesame tipis fsiqozs; 4)
aSlilobebis heterogenul jgufs, romelic moicavs samive zemoCamoTvlil
SesaZleblobas (rac yvelaze savaraudoa).
4. klinikuri simptomatika (24)
simptomebis CamonaTvali
Sizoafeqturi aSliloba warmoadgens Setevebis saxiT ganviTarebul
aSlilobas, roca klinikur suraTSi erTdroulad wina planzea guneb-
ganwyobis aSlis da Sizofreniuli simptomebi, amasTan, TiToeuli maTgani
sul cota ramdenime dRe mainc grZeldeba. vinaidan, es aSliloba ar
warmoadgens guneb-ganwyobis tipiur aSlilobas da Sizofrenias,
87
ganixileba damoukidebel kategoriad, sakmaod xSirad gvxvdeba da misi
diagnostikuri ignorireba ar SeiZleba.
sxva mdgomareobebi, romlis drosac guneb-ganwyobis aSlis simptomebi: a)
gadafarulia an warmoadgens nawils klinikur suraTSi ukve arsebuli
Sizofreniuli daavadebisa; b) Tanaarsebobs an monacvleobs sxva tipis
persistiul (myar) bodviT aSlilobasTan, Sesabamis kategoriaSi, anu
`Sizofrenia da Sizotipuri aSliloba~-Si klasificirdeba.
aseve, guneb-ganwyobis arakongruentuli bodva(ebi) an halucinaciebi,
TavisTavad, ar gulisxmobs Sizoafeqturi aSlilobis diagnozs. guneb-
ganwyobis am aSlilobebs miekuTvneba: a) mania fsiqozuri simptomebiT; b)
bipolaruli afeqturi aSliloba mimdinare epizodSi maniiT, fsiqozuri
simptomebiT; g) bipolaruli afeqturi aSliloba mimdinare epizodSi mZime
depresiiT, fsiqozuri simptomebiT; d) mZime depersiuli epizodi fsiqozuri
simptomebiT; e) rekurentuli depresiuli aSliloba mimdinare epizodSi
mZime fsiqozuri simptomebiT.
pacientebi, romelTac aReniSnebaT rekurentuli Sizoafeqturi aSlilobis
epizodebi, upiratesad maniis tipiT (naklebad depresiuli tipi),
Cveulebriv srul remisias aRweven da Zalze iSviaTad uviTardebaT
defeqti.
5. daavadebis diagnozi (24):
a) diagnostikuri kriteriumebi
Sizoafeqturi aSlilobis diagnostikuri kriteriumebia:
A. daavadebis periodis ganmavlobaSi uwyvetad saxezea, xan didi
depresiuli epizodi, xan maniis epizodi, an Sereuli epizodi,
fsiqozur simptomebTan erTad, romlebic Seesamabeba
Sizofeniis A kriteriums;
SeniSvna: didi depresiuli epizodi unda moicavdes A1 kriteriums: pacienti (an irgvlivmyofebi) aRniSnavs depresiul
guneb-ganwyobas (sevdas, sicarielis grZnobas) mTeli dRis, an
dRis umetesi nawilis ganmavlobaSi).
B. daavadebis garkveuli periodis ganmavlobaSi, sul cota, 2
kviris manZilze mainc, aRiniSneba bodva an halucinaciebi,
TvalsaCinod gamoxatuli guneb-ganwyobis aSlis simptomebis
gareSe;
C. TiTqmis mTeli daavadebis aqtiuri da rezidualuri
periodebis ganmavlobaSi saxezea simptomebi, romlebic
Seesabameba guneb-ganwyobis aSlis epizodis simptomebs;
D. aSlilobis ganviTareba ar aris dakavSirebuli fsiqoaqtiuri
nivTierebebis (an sxva farmakologiuri saSualebebis)
gamoyenebasTan an/da zogadsamedicino problemiT gamowveul
mdgomareobasTan.
88
dasazustebelia tipi:
bipolaruli tipi: roca aSliloba moicavs maniis an Sereul epizods
(an maniis an Sereul epizods da did depresiul epizods);
depresiuli tipi: roca aSliloba moicavs did depresiul epizods.
b) diferenciluri diagnozis CamonaTvali (24)
Sizoafeqturi aSlilobis diferencialuri diagnozi unda gatardes Semdeg
aSlilobebTan:
I. Sizofrenia;
II. guneb-ganwyobis aSlilobebi;
III. tvinis dazianebiTa da disfunqciiT, agreTve sxva fizikuri
daavadebiT gamowveuli fsiqikuri aSlilobani;
IV. fsiqoaqtiuri nivTierebebiT ganpirobebuli fsiqikuri da qceviTi
aSlilobani.
6. gamokvlevis da 7. mkurnalobis sqema (23, 24)
diagnozis dazusteba da aSlilobis mimdinareobaze dakvirveba,
razedac iqneba damokidebuli mkurnalobis strategia.
Sizoafeqturi aSlilobis simptomatika SeiZleba ufro msgavsi
iyos:
1. guneb-ganwyobis aSlis epizodis;
2. Sizofreniis;
3. orivesi erTnairad.
89
farmakoTerapia:
1. guneb-ganwyobis stabilizatorebi (ix. guneb-ganwyobis
aSlilobis mkurnaloba) _ gamoiyeneba maniis epizodis
samkurnalod. guneb-ganwyobis aSlilobis bipilaruli tipis
mkurnalobisas liTiumisa da karbamazepinis efeqtianoba
erTnairia, maSin roca Sizoafeqturi aSlilobis depresiuli
tipis dros karbamazepinis efeqtianoba aRemateba liTiumisas.
SemanarCunebeli Terapiisas, gverdiTi efeqtebis (Tireoidul
jirkvalze da Tirkmelebze potenciuri moqmedebis) Tavidan
asacileblad, dozebi nel-nela mcirdeba. amave mizniT,
periodulad xdeba monotoringi: plazmaSi wamlis
koncentraciis, sisxlis, Tireoiduli jirkvlis da Tirkmlis
funqciis laboratoriuli gamoklvevebi.
2. antidepresantebi (ix. depresiis mkurnaloba) gamoiyeneba
depresiuli epizodis samkurnalod zustad ise, rogorc
bipolaruli depresiis dros. medikamentis amorCeva xdeba
winandeli mkurnalobis Sedegebis gaTvaliswinebiT. Cveulebriv,
pirveli arCevis medikamentebia serotoninis ukumitacebis
seleqtiuri inhibitorebi (SSRI), Tumca, agznebisa da uZilobis
SemTxvevaSi efeqtiania gamoiyeneba tricikluri
antidepresantebi.
3. antifsiqozuri medikamntebi gamoiyeneba fsiqozuri simptomebis
koregirebisaTvis (ix. Sizofreniis mkurnaloba)
eleqtrokonvulsiuri Terapia efeqtiania: maniisTvis da
depresiisTvis, roca medikamentozur mkurnalobas Sedegi ara
aqvs.
fsiqosocialuri mkurnaloba mniSvnelovnad aumjobesebs am
aSlilobis gamosavals. gamoiyeneba Semdegi meTodebi:
1. ojaxuri Terapia;
2. socialuri unar-Cvevebis gamomuSaveba (treningi).
3. kognituri reabilitacia.
90
V. mwvave da tranzitoruli fsiqozuri aSlilobani (25)
1. definicia
mwvave da tranzitoruli fsiqozuri aSliloba ewodeba iseT aSlilobas,
roca pirovnebas garkveuli fsiqo-socialuri stresoris(ebis) sapasuxod
uviTardeba Sizofreniis msgavsi simptomebi _ bodva(ebi) da halucinaciebi,
romelTa xangrZlivoba erTi dRidan erT Tvemdea.
2. epidemiologia
mwvave da tranzitoruli fsiqozuri aSlilobani ufro xSirad gvxvdeba
axalgazrda asakSi (20-30 w.w.), vidre asakovnebSi. aseve, cnobilia rigi
kvlevebi, romlebic adastureben am aSlilobis gavrcelebis maRal
sixSires dabal socio-ekonomikur fenebSi da im populaciaSi, romelTac
gadaitanes kataklizmebi (mag, miwisZvra) da kulturaluri Zvrebi (mag,
emigrantebSi).
3. etiopaTogenezi
mwvave da tranzitoruli fsiqozuri aSlilobis mizezi cnobili ar aris.
garkveul stresul garemoSi fsiqozuri simptomebi uviTardebaT ZiriTadad
biologiuri da fsiqologiuri mowyvladobis mqone adamianebs, romelTac
aReniSnebaT personologiuri darRvevebi, rogoracaa paranoiduli,
Sizoiduri, Sizotipuri da emociurad arastabiluri personologiuri
aSliloba. arsebobs zogierTi monacemi, romelic adasturebs Sizofreniisa
da guneb-ganwyobis aSlilobis anamnezs probandTa naTesavebSi.
fsiqodinamiuri TvalsazrisiT, xanmokle fsiqozuri aSliloba
uviTardebaT maT, visac ar gaaCniaT problemebTan adeqvaturi Tavis
garTmevis meqanizmebi da am aSlilobiT iRebs meorad sargebels. am dros
agreTve mniSvnelovania pacientis Tavdacva akrZaluli fantaziebisgan,
survilebis (ausrulebeli) asruleba, an distresuli fsiqologiuri
situaciisgan gaqceva.
4. klinikuri simptomatika
simptomebis CamonaTvali (26)
mwvave da tranzitoruli fsiqozuri aSlilobis dros adgili aqvs iseTi
mwvave fsiqozuri simptomebis uecrad dawyebasa da ganviTarebas,
rogoricaa bodva(ebi), halucinaciebi, gaugebari an inkoherentuli
metyveleba, an aRniSnul simptomTa nebismieri kombinacia. pirveli
fsiqozuri gamovlinebis dawyebasa da klinikuri suraTis srul gaSlas
Soris drois intervali 2 kviras ar aRemateba. niSandoblivia am
aSlilobis xSiri kavSiri mwvave stresTan, romelsac aqvs adgili pirvel
fsiqozur gamovlinebamde 2 kviriT (an naklebi droiT) adre. fsiqozuri
epizodis xangrZlivoba meryeobs 1 dRidan 1 Tvemde da sabolood
premorbiduli funqcionirebis donis aRdgeniT sruldeba.
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5. daavadebis diagnozi
a) diagnostikuri kriteriumebi (25)
mwvave da tranzitoruli fsiqozuri aSlilobebis diagnozi ismeba,
roca:
A. saxezea Tundac erTi Semdegi simptomebidan:
(1) bodva;
(2) halucinaciebi;
(3) dezorganizebuli metyveleba (asociaciebis kargva/wyveta an
inkoherentuloba);
(4) mniSvnelovnad/uxeSad dezorganizebuli an katatoniuri
qceva.
SeniSvna: simptomebSi ar Seva subkulturulad miRebuli
qcevis tipi.
B. aSlilobis xangrZlivoba aranakleb erTi dRe da ara umetes
erTi Tvea da premorbiduli funqcionirebis donis sruli
aRdgeniT mTavrdeba.
C. aSliloba zustad ar Seesabameba guneb-ganwyobis aSlilobas
fsiqozuri simptomebiT, Sizoafeqtur aSlilobas, an
Sizofrenias da ar aris dakavSirebuli fsiqoaqtiuri
nivTierebebis (an sxva farmakologiuri saSualebebis)
gamoyenebasTan an/da zogadsamedicino problemiT gamowveul
mdgomareobasTan.
dasazustebelia, Tuki dawyeba:
ukavSirdeba TvalaCino stresors(ebs) (xanmokle reaqtiuli fsiqozi);
ar ukavSirdeba TvalsaCino stresors(ebs);
ukavSirdeba mSobiarobis Semdgom periods.
b) diferencialuri diagnozis CamonaTvali (25)
mwvave da tranzitoruli fsiqozuri aSlilobis diferencialuri diagnozi
unda gatardes Semdeg aSlilobebTan:
I. Sizofreniismagvari aSliloba;
II. Sizoafeqturi aSliloba;
III. Sizofrenia;
IV. guneb-ganwyobis aSlilobani, fsiqozuri simptomebiT;
V. bodviTi aSliloba;
VI. sxva araorganuli fsiqozuri aSliloba;
VII. ganzrax ganviTarebuli aSliloba, dakavSirebuli fizikur an
fsiqologiur faqtorTan (simulacia, anu xelovnuri aSlilobebi);
VIII. meoradi fsiqozuri aSlilobebi;
IX. sxva disociaciuri (konversiuli) aSliloba, mravlobiTi
pirovneba;
X. emociurad arastabiluri (mosazRvre) personologiuri aSliloba;
XI. Sizotipuri aSliloba.
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6. gamokvlevis da 7. mkurnalobis sqema (23, 24)
mkurnalobis strategiebi:
1. hospitalizacia;
2. farmakoTerapia;
3. fsiqoTerapia.
mwavave tranzitoruli fsiqozis mqone pacientebis
hospitalizaciis mizania Sefaseba da gakontroleba:
1. fsiqozuri simptomebis da
2. agresiuli qcevis (suiciduri an homociduri qcevis
impulsebi)
farmakoTerapiisTvis gamoiyeneba fsiqotropuli medikamentebis
ori ZiriTadi jgufi:
1. antifsiqozuri (mag. haloperidoli, risperidoni, Terapiul
dozebSi) da
2. anqsiolizuri (benzodiazepinebi). gasaTvaliswinebelia, rom
maT gamoyenebasTan dakavSirebulia iSviaTad pacientis
agzneba da ufro iSviaTad, xanagrZlivad maRali dozebiT
mkurnalobis Semdeg, wamlis moxsnisas ganviTarebuli
krunCxvebi. medkamentozuri mkurnalobis ZiriTadi startegiaa xanmokle
Careva. maSin, roca saWiro xdeba SemanarCunebeli Terapia,
mizanSewonilia diagnozis gadaxedva.
fsiqoTerapia (kognituri Terapia) warmoadgens xangrZlivi Carevis
ZiriTad strategias, romelic fokusirdeba iseTi sakiTxebze,
rogoricaa:
1. stresorebi (fsiqozis maprovocirebeli matravmirebeli
situacia),
2. fsiqozuri epizodi,
3. stresis daZlevis strategiebi,
4. pacientis TviTSefaebis gaumjobeseba.
agreTve, Zalze mniSvnelovania ojaxis wevrebis CarTva pacientis
mkurnalobis procesSi.
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VI. Sizofreniismagvari aSliloba (27)
1. definicia
saxelwodeba _ Sizofreniismagvari (schizofreniform) aSliloba pirvelad
Semoitana norvegielma fsiqiatrma Gabriel Langfeld-ma 1939 w. misi gamovlineba
Sizofreniis msgavsia da grZeldeba aranakleb erTi Tve da araumetes eqvsi
Tvisa. am aSlilobis mqone pacientebi (gansxvavebiT SizofreniiT
daavadebuli pacientebisgan) epizodis amowurvis Semdgom ubrundebian
funqcionirebis premorbidul dones.
2. epidemiologia
Sizofreniismagvari aSliloba yvelaze xSirad gvxvdeba gvian mozardobis
da adreuli mozrdilobis asakSi.
3. etiopaTogenezi
Sizofreniismagvari aSlilobis etiologia Tumca Sizoferniis da guneb-
ganwyobis aSlilobebis msgavsia, magram zustad cnobili ar aris.
cnobilia mTeli rigi kvlevebi, romelTa mixedviT am aSlilobis
SemTxvevaTa 60-80% SemdgomSi diagnostirdeba Sizofreniad, xolo
danarCeni 20-40 % -is Sesaxeb faqtebze damyarebuli kvlevebi literaturaSi
dResdReobiT ar aris. aseve cnobilia, rom pacientebis Zalze mcire
procentSi (dauzustebelia ramdenSi) adgili aqvs mxolod erTi epizodis
aRmocenebas da SemdgomSi cxovrebis Cveuli riTmiT gagrZelebas.
4. klinikuri simptomatika da 5. daavadebis diagnozi
a) diagnostikuri kriteriumebi
Sizofreniismagvari (Sizofreniis sxva formebi) aSliloba
A. saxezea Sizofreniis A, D, E kriteriumebi (ix. Sizofreniis
diagnostikuri kriteriumebi).
B. aSlilobis epizodi (prodromuli, aqtiuri da rezidualuri
fazebis CaTvliT) grZeldeba sul cota, 1 da maqsimum 6 Tve
(roca saWiroa diagnozis dasma pacientis gamojanmrTelebamde,
kvalificirdeba `winaswar diagnozad~).
ganisazRvros, roca aris keTilsaimedo prognozuli niSnebi:
1) normaluri qcevis da funqcionirebis Secvlis pirveli
gamovlinebidan 4 kviris ganmavlobaSi viTardeba dominanturi
fsiqozuri simptomi(ebi);
2) abneva (an cnobierebis sxva Secvla) fsiqozuri epizodis pikze;
94
3) socialuri da okupaciuri funqcionirebis maRali premorbiduli
xarisxi;
4) guneb-ganwyobis daClungebis an gasadavebis ararseboba.
b) diferencialuri diagnozis CamonaTvali
Sizofreniismagvari aSlilobis diferencialuri diagnozi unda gatardes
Semdeg aSlilobebTan (27):
I. Sizofrenia;
II. mwvave da tranzitoruli fsiqozuri aSlilobani;
III. guneb-ganwyobis aSilobani, fsiqozuri simptomebiT;
IV. ganzrax ganviTarebuli aSliloba, dakavSirebuli fizikur an
fsiqologiur faqtorTan (simulacia anu xelovnuri) aSlilobebi;
V. fsiqoaqtiuri nivTierebebiT ganpirobebuli fsiqikuri da qceviTi
aSlilobani;
V. zogad samedicino xasiaTis problemiT gamowveuli fsiqozuri
aSliloba.
6. gamokvlevis da 7. mkurnalobis sqema (23, 24)
am aSlilobis mkurnalobis strategia iseTivea, rogorc Sizofreniisa
(ix. Sizofreniis mkurnaloba). am ukanasknelisgan gansxvavebiT
pacientTa 75% (Sizofreniis dros _ 20%) eqvemdebareba antifsiqozur
mkurnalobas 8 dReSi.
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VII. inducirebuli fsiqozuri aSliloba
1. definicia 2. epidemiologia da 3. etiopaTogenezi (14)
inducirebuli fsiqozuri aSliloba warmoadgens iseT aSlilobas,
romelic aReniSneba emociurad mWidro kavSiriSi myof or (an met) adamians.
am dros mxolod erT maTgania daavadebuli genuinuri fsiqoziT, xolo
meore piri inducirebulia. am aSlilobis SemTxvevebis 95 % erTi ojaxis
or wevrs moicavs, roca erT-erTi maTgani dominanturia da avadaa
SizofreniiT (an sxva fsiqozuri aSlilobiT), xolo meore mimRebia da
xSirad Tavad aris fizikurad araSromisunariani (mag, smenadaqveiTebuli,
aqvs cerebrovaskularuli aSliloba an sxva mizeziTaa damokidebuli
dominantur pirovnebaze). ufro xSirad gvxvdeba dabal socio-ekonomikur
fenebSi da umetesad qalebSi.
4. klinikuri simptomatika (15)
am aSlilobis mqone pirovnebis(ebebis) uaxloesi adamiani, mag. ojaxis
wevri, daaavadebulia SizofreniiT, Sizotipuri aSlilobiT, qronikuli
bodviTi aSlilobiT, mwvave an tranzitoruli fsiqozuri aSlilobiT,
romelTanac mWidro kavSiriSi imyofeba es pirovneba (mimRebi).
imavdroulad igi izolirebulia sxva adamianebisgan. Cveulebriv,
inducirebuli fsiqozuri aSliloba reducirdeba, rogorc ki e.w. mimRebi
piri gancalkevdeba dominanturi genuinuri fsiqozuri aSlilobis mqone
pirisgan.
5. daavadebis diagnozi
a) diagnostikuri kriteriumi (15):
inducirebuli fsiqozuri aSlilobis kriteriumebia:
A. pirovnebas bodva uviTardeba iseT situaciaSi, roca mas aqvs mWidro
kavSiri meore pirovnebasTan, xolo am ukanasknels aReniSneba
Camoyalibebuli bodva;
B. SinaarsiT bodva msgavsia im pirovnebis bodvisa, romelsac ukve
Camoyalibebuli bodva aqvs;
C. aSliloba zustad ar Seesabmeba sxva fsiqozur aSlilobas (mag.
Sizofrenias) an guneb-ganwyobis aSlilobas fsiqozuri simptomebiT da
ar aris dakavSirebuli fsiqoaqtiuri nivTierebebis (an sxva
farmakologiuri saSualebebis) gamoyenebasTan an/da zogadsamedicino
problemiT gamowveul mdgomareobasTan.
b) diferencialuri diagnozis CamonaTvali (ix. dif. diagnozi qronikuli
bodviTi aSlilobisTvis)
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6. gamokvlevis da 7. mkurnalobis sqema (23, 24)
efeqtiani mkurnalobisTvis mniSvnelovania Semdegis
gaTvaliswineba:
1. diagnozis dazusteba;
2. Sesaferisi intervenciis Sesaxeb gadawyvetilebis miReba;
3. SesaZlo garTulebebis marTva.
mkurnalobis ZiriTadi strategia:
• pacientis (mimRebis) gancalkeveba dominanturi (genuinuri
fsiqozis mqone) pirisgan;
• Tuki aucilebelia hospitalizacia, maTi moTavseba xdeba
sxvadasxva ganyofilebaSi;
• Cveulebriv, pacientis (mimRebis) bodviTi azrebi
reducirdeba antifsiqozuri medikamenturi Carevis gareSe.
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VIII. sxva araorganuli fsiqozuri aSliloba da dauzustebeli (araspecifikuri) araorganuli
fsiqozi (28)
1. definicia, 2. epidemiologia da 3. etiopaTogenezi
am saxelwodebis qveS aerTianeben fsiqozur simptomebs (halucinaciebs,
bodvas(ebs), dezorganizebul metyvelebas da qcevas), romelic ar
akamyofilebs sxva romelime fsiqozuri aSlilobis diagnostikur
kriteriumebs.
am aSlilobebis erT-erTi tipis, autoskopiuri fsiqozis mizezi cnobili
ar aris. etiologiiis biologiuri hipoTezis mixedviT, Tavis tvinis
safeTqel-Txemis wilebSi paTologiuri cvlilebebi (romelic
pasuxismgebelia TviTSegZnebaze), romelic kombinaciaSia mxedvelobis
qerqis paTologiur aqtivobasTan, ganapirobeben am aSlilobis ganviTrebas.
es, fsiqologiuri TvalsazrisiT, dakavSirebulia personologiur
aSlilobebTan (ZiriTadad, narcistul personologiur aSlilobasTan).
swored aseT adamianebs, romelTac axasiaTebT warmosaxva da vizualuri
sensitiuroba, maTTvis stresul periodebSi aReniSnebaT autoskopiuri
halucinaciebis epizodebi.
am aSlilobebis sxva tips warmoadgens mSobiarobisSemdgomi fsiqozi
(zogjer samSobiaro fsiqozs uwodeben), romelic uviTardebaT
axladnamSobiarev qalebs. misi gavrceleba udris daaxloebiT 1-s 1000
axladnamSobiarevze. aSlilobis mqone qalTa daaxloebiT 5-60%-s fsiqozi
uviTardebaT pirveli Svilis yolis Semdeg, aseve 50%-s aReniSnebaT
perinataluri arafsiqiatriuli garTulebebi, rogoricaa infeqcia,
intoqsikacia (mag, skopolaminiT), toqsemia da didi raodenobiT sisxlis
dakargva. mTeli rigi monacemebis mixedviT, mSobiarobisSemdgomi fsiqozi
warmoadgens guneb-ganwyobis aSlilobis epizods.
4. klinikuri simptomatika
sxva araorganuli fsiqozuri aSlilobis da dauzustebeli
(araspecifikuri) araorganuli fsiqozis klinikuri simptomebia:
fsiqozuri simptomebi: bodva(ebi) da halucinaciebi), an maTi kombinacia
(bodva plus katatonia), dezorganizebuli metyveleba da qceva, romelic
arcerTi fsiqozuri aSlilobis diagnostikur kriteriumSi ar jdeba, sxva
araorganul fsiqozur aSlilobebSi aerTianeben (mag. qronikuli
halucinaciuri fsiqozi). garda aRniSnulisa, mSobiarobisSemdgomi
fsiqozis klinikur suraTSi wamyvani bodviTi azrebi gulisxmobs sakuTari
Tavis an axalSobilis dazianebis ideebs.
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5. daavadebis diagnozi
a) diagnostikuri kriteriumi
es kategoria moicavs fsiqozur simptomatikas: bodvas, haluciancias,
dezorganizebul metyvelebas, uxeSad dezorganizebul an katatoniur
qcevas, roca garkveuli diagnozis dasasmelad ar aris sakmarisi (an aris
urTierTgamomricxvi) informacia an/da ar akmayofilebs romelime
fsiqozuri aSlilobis kriteriumebs.
magaliTebia:
1. mSobiarobis Semdgomi fsiqozi, romelic ar Seesabmeba guneb-
ganwyobis aSlilobas fsiqozuri simptomebiT, xanmokle fsiqozur
aSlilobas da ar aris dakavSirebuli fsiqoaqtiuri nivTierebebis
(an sxva farmakologiuri saSualebebis) gamoyenebasTan an/da
zogadsamedicino problemiT gamowveul mdgomareobasTan;
2. fsiqozi, romelic grZeldeba 1 Tveze nakleb xans, magram jer
gaumjobesebas adgili ara aqvs;
3. persistentuli smeniTi halucinaciebi, sxva simptomebis gareSe;
4. persistentuli araeqscentriuli, mcire gaqanebis yofiTi Sinaarsis
bodva(ebi), romelic faravs bodviTi aSlilobis ZiriTadi
periodis ganmavlobaSi arsebul guneb-ganwyobis aSlis epizodebs;
5. situaciebi, roca klinicistisTvis naTelia, rom saxezea fsiqozi,
magram ver gansazRvravs es pirveladia, Tu dakavSirebulia
fsiqoaqtiuri nivTierebebis (an sxva farmakologiuri
saSualebebis) gamoyenebasTan an/da zogadsamedicino problemiT
gamowveul mdgomareobasTan.
b) diferencialuri diagnozis CamonaTvali
am aSlilobis diferencialuri diagnozi ismeba yvela zemoTCamoTvlili
aSlilobis gamoricxvis Sedegad.
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6. gamokvlevis da 7. mkurnalobis sqema (23, 24)
Cveulebriv, mkurnaloba simptomaturia.
mag. mSobiarobis Semdgomi fsiqozis dros
fsiqofarmakoTerapiisTvis (romlis dawyebamde axalSobilis
ZuZuTi kveba unda Sewydes) gamoiyeneba:
1. antidepresantebi da liTiumi,
2. antifsiqozuri medikamentebi.
roca aucilebelia hospitalizacia (pacienti amJRavnebs suicidur
an homocidur agresiul qcevas bavSvis mimarT),
gasaTvaliswinebelia misi bavSvis naxvis survili, magram vizitis
dros savaldebuloa mkacri kontroli.
mwvave fsiqozis amowurvis Semdeg gamoiyeneba fsiqoTerapia,
romelic mimarTulia pacientis mier axali socialuri _ dedis
rolis gaTavisebisken da ojaxis wevrebis (meuRlis) mier
mxardaWeris gaZlierebisken.
efeqtiani mkurnalobisTvis mniSvnelovania Semdegis
gaTvaliswineba:
1. diagnozis dazusteba;
2. Sesaferisi intervenciis Sesaxeb gadawyvetilebis miReba;
3. SesaZlo garTulebebis marTva.
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8. eTikisa da samarTlis sakiTxebi fsiqiatriaSi
fsiqiatriaSi eTikisa da samarTlis sakiTxebi SemuSavebulia klinikuri
praqtikis nacionaluri rekomendaciebis moTxovnebis farglebSi da miznad
isaxavs, daexmaros eqims fsiqiatriuli daxmarebis aRmoCenisas imoqmedos
eTikur-samarTlebrivi principebiT.
sazogadoebis ganviTarebis Tanamedrove etapze, eqimis pasuxismgeblobisa
da pacientis uflebebis mzardi gacnobierebis pirobebSi, igrZnoba eqimis
ufleba-movalebebisa da samedicino saqmianobis eTikuri principebis
mkveTri Camoyalibebis saWiroeba. samedicino momsaxurebis sferoSi
saqarTveloSi moqmedi kanonmdebloba gansazRvravs erTi mxriv pacientis
uflebebs, xolo meore mxriv –samedicino momsaxurebis gamwevis
movaleobebs saerTaSoriso standartebis Sesabamisad.
“fsiqiatriuli daxmarebis Sesaxeb” kanonis Tanaxmad, eqimi fsiqiatri
moqalaqes fsiqiatriul daxmarebas uwevs aucilebeli samedicino Cvenebis,
agreTve profesiuli eTikisa da saqarTvelos kanonmdeblobis Sesabamisad
(muxli 8). fsiqitriuli daxmarebis safuZvlebia:
• kanoniF“fsiqiatriuli daxmarebis Sesaxeb” –2006 w
• kanoni “pacientis uflebebis dacvis Sesaxeb” - 2001 w
• kanoniF “janmrTelobis dacvis Sesaxeb” - 1997 w
• kanoni “saeqimo saqmianobis Sesaxeb” – 2001 w
• saqarTvelos saerTaSoriso xelSekrulebebi da SeTanxmebebi
mniSvnelovania aseve gaerosa da evrosabWos mier SemuSavebuli
rekomendaciebi, romlebic exeba fsiqikuri aSlilobis mqone pirTa
uflebebis dacvasa da fsiqiatriuli momsaxurebis eTikur principebs.
mocemul TavSi ganxilulia Tu rogor regulirdeba samarTlebrivad
eqimisa da pacientis urTierTobasTan dakavSirebuli zogadi eTikuri
principebi, rogoricaa konfidencialoba, informaciis miRebis ufleba,
mkurnalobaze Tanxmoba, aseve pacientis aranebayoflobiTi stacionaruli
mkurnalobisa da zogierTi sxva aqtualuri sakiTxi.
eTikis sakiTxebi
qveynebi gansxvavdebian im moTxovnebis mixedviT, rasac profesionalebs
uyeneben eTikuri kodeqsiT an profesiuli standartebiT. isini SeiZleba
iTvaliswinebdnen saerTaSoriso rekomendaciebs, rogoricaa hipokrates
fici an Jenevis deklaracia. amve dros adamianis uflebebis evropis
konvencia CarTulia evrokavSiris yvela wevri qveynis nacionalur
kanonmdeblobaSi.
eqimi/pacientis urTierTobis problemebi
eqim-pacientis urTierTobis eTikur problemas warmoadgens pacientis
avtonomiurobis sakiTxi, rac niSnavs pacientis uflebas gaakeTos
sakuTari arCevani sakuTari rwmenebisa da pasuximgeblobis mixedviT. es
principi moiTxovs eqimisagan daexmaros pacients gadawyvetilebis miRebaSi
da misdios mas. am dros eqimsa da pacients Soris yalibdeba partnioruli
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urTierToba. rodesac eqimis moqmedeba pacientis sakeTildReod gadafaravs
pacientis avtonomiurobis uflebas Sedegad vRebulobT paternalistur
damokidebulebas. paternalizmi gulisxmobs, rom fsiqitri karnaxobs
pacients Tu rogor unda moiqces igi cxovrebaSi.
eqimis movaleobaa pativi sces pacientis survilebsa da interesebs.
samwuxarod, fsiqiatrebi zogjer pirovnul sargebels naxuloben maTi
pacientebisagan sxvadasxva gzebiT. es SeiZleba iyos urTierTobis
gamoyeneba eqimis fsiqologiuri moTxovnilebebis an TviTSefasebis
dakmayofilebisTvis.
fsiqiatriis araswori da Zaladobrivi gamoyeneba
meoce saukunis ganmavlobaSi fsiqiatria araerTxel iqna gamoyenebuli
arasworad an, ufro metic, Zaladobrivad politikuri da komerciuli
miznebisaTvis calkeuli fsiqiatris an maTi damqiravebeli instituciebis
mier. gansakuTrebiT xSiri iyi aseTi faqtebi yofil sabWoTa kavSirSi,
sadac zogierTi fsiqiatri politikur disidentobas fsiqikuri daavadebis
kvalifikacias aZlevda. am movlenis sayovelTao gakicxvam daayena sakiTxi
msoflio fsiqiatrTa asociaciis rolisa eTikuri wesebis CamoyalibebaSi
mTeli msofliosaTvis, raTa SemdgomSi Semcirebuliyo fsiqiatriis
Zaladobrivi gamoyenebis riski.
eTikuri sakiTxebi ufro xSirad moralur-zneobriv sferos miekuTvneba da
maTi darRveva ar iwvevs adnministraciul an sisxlis samarTlis
pauxismgeblobas. Tumca aris eTikuri normebi, romelTa darRveva isjeba
saqarTvelos kanonmdeblobiT.
konfidencialoba
mkurnalobis procesSi eqims gaaCnia rogorc iuridiuli aseve eTikuri
valdebuleba daicvas samedicino saidumloeba. konfidencialoba
fsiqiatriaSi gansakuTrebuli mniSvneloba aqvs, radgan eqimis mier
mopovebuli informacia piradulia da xSirad pacientisaTvis metad
mtkivneul sakiTxebs exeba.
zogadad fsiqiatri ar unda agrovebdes informacias sxva pirebisagan
pacientis Tanxmobis gareSe. garda im SemTxvevebisa, rodesac pacients
fsiqikuri aSlilobis gamo ar aqvs unari miawodos informacia, am
informacias ki didi mniSvneloba aqvs daavadebis Sefasebisa da
menejmentisaTvis. am dros eqimi maqsimalurad unda moqmedebdes pacientis
interesebis dacviT da ecados informaciis miRebas pacientis uaxloesi
garemocvisagan. igive principi moqmedebs, roca eqimi informacias gascems
mesame pirze pacientis Sesaxeb, romelsac ara aqvs Tanxmobis micemis unari.
damkvidrebuli tradiciis Sesabamisad, samedicino dawesebulebaSi
pacientis yoveli mnaxveli sTxovs eqims dawvrilebiT informacias
pacientis janmrTelobis mdgomareobis Sesaxeb. rogorc wesi, aseT
SemTxvevvebSi pacients aravin ekiTxeba surs Tu ara mas am informaciis
gamJRavneba, xom ar Tvlis amas igi Tavisi Rirsebisa da pativis
Seuracxmyofelad. imavdroulad, eqims uamravi dro da energia exarjeba
sxvaTa cnobismoyvareobis dasakmayofileblad.
102
”fsiqiatriuli daxmarebis Sesaxeb”kanonis Sesabamisad (muxli 26) pacientis
Sesaxeb informaciis gamJRavneba mesame pirisaTvis dasaSvebia:
• pacientis/kanonieri warmomadgenelis TanxmobiT;
• misi mkurnalobisa da samecniero kvlevis procesSi uSualod
CarTuli pirebisaTvis;
• sasamarTlo gadawyvetilebiT;
• rodesac safrTxe eqmneba pacientis an mesame piris sicocxles an
janmrTelobas.
gansakuTrebuli sifrTxilea saWiro bavSvebze Zaladobis arsebobis
SemTxvevaSi. am dros informaciis gamJRavneba xels uwyobs seriozuli
danaSaulis prevencias, gamovlenas an aRkveTas. am SemTxvevaSi informacia
miewodeba pacientis kanonier warmomadgenels an naTesavs.
Tu pacientis aranebayoflobiTi stacionirebis mizezi sxva piris mimarT
gamoCenili Zaladobaa, eqims SeuZlia, sadac SesaZlebelia, msxverpls
miawodos garkveuli informacia pacientis mdgomareobis gaumjobesebis
Sesaxeb. aucilebelia am nabijis SeTanxmeba pacientTan.
pacientis Sesaxeb informacia konfidencialuria rogorc pacientis
sicocxleSi, aseve misi sikvdilis Semdeg (kanoni ”pacientis uflebebis
Sesaxeb” muxli, 27). ”fsiqiatriuli daxmarebis Sesaxeb” kanonis Tanaxmad
(muxli 26) eqimis mier am informaciis ganzrax an gaufrTxileblobiT
gamoyeneba pacientis an mesame piris sazianod isjeba saqarTvelos
kanonmdeblobiT.
personaluri informaciis uneburad gamJRavnebis SemcirebisaTvis Tavidan
unda iyos acilebuli ganxilvebi, romlis mosmenac SemTxveviT pirs
SeeZleba. amitom konsultacia unda tardebodes izolirebulad da
samedicino dokumentacia unda inaxebodes dacul adgilas. Tu saWiro
aRmoCnda, informacia unda gauziaron fsiqiatriuli daxmarebis procesSi
CarTul pirebs da yvelas gacnobierebuli unda hqondes konfidencialobis
principebi. informacias Cveulebriv uziareben naTesavebs mxolod pacientis
TanxmobiT, Tumca zog garemoebaSi, mag. demenciis dros, pacientis
saukeTeso interesebis dacvis mixedviT moqmedeben.
saswavlo an samecniero mizniT pacientis Sesaxeb informaciis
gamoyenebisas, monacemebi ise unda iyos warmodgenili, rom SeuZlebeli
gaxdes pirovnebis identifikacia (kanoni ”pacientis uflebebis Sesaxeb”
muxli, 28).
pacientisaTvis misi janmrTelobis mdgomareobasTan dakavSirebuli
informaciis miwodebis aucileblobis dakanoneba ukanaskneli wlebis
monapovaria. CvenSi moqmedebda da mniSvnelovnadwilad dResac ZalaSia
dauwereli kanoni avadmyofobis istoriis pacientisaTvis gacnobis
dauSveblobis Sesaxeb.
saqarTvelos kanonebis ”fsiqiatriuli daxmarebis Sesaxeb” (muxli 5) da
”pacientTa uflebebis Sesaxeb” (muxli 16, 17,) Tanaxmad, pacients ufleba
aqvs miiRos sruli, obieqturi, gasagebi informacia Tavisi daavadebisa da
ganzraxuli fsiqiatriuli daxmarebis Sesaxeb. Tu pacienti qmeduunaroa an
mas ara aqvs gacnobierebuli gadawyvetilebis miRebis unari, informacia
miewodeba mis kanonier warmomadgenels an naTesavs.
pacients aseve ufleba aqvs gaecnos mis Sesaxeb arsebul samedicino
dokumentacias. amasTan eqimi gansazRvravs informaciis miwodebis
103
moculobasa da formas. eqims SeuZlia SezRudos pacientisaTvis
misawodebeli informacia im SemTxvevaSi, Tu igi Seicavs faqtebs,
romelTac SeiZleba gaarTulos urTierToba ojaxSi, uaryofiTad
Secvalos pacientis damokidebuleba axloblebTan an daamZimos misi
fsiqikuri mdgomareoba. informaciis moculobis SezRudvaze dasabuTebuli
gadawyvetileba fiqsirdeba pacientis samedicino dokumentaciaSi (kanoni
”pacientTa uflebebis Sesaxeb” muxli 18).
pacientis damcvels/kanonier warmomadgenels ufleba aqvs gaecnos
pacientis Sesaxeb arsebul nebismier dokumentacias an moiTxovos misi
aslebi.
amasTan, evropis sabWos konvencia “adamianis uflebebisa da biomedicinis
Sesaxeb” ganmartavs, rom ”gaTvaliswinebuli unda iqnas pirovnebis
survili, ar miiRos informacia” (muxli 10). fsiqiatrma unda
gaiTvaliswinos es aspeqtic, rodesac pacienti TviTSefasebis SenarCunebis
an sxva raime motiviT ar interesdeba, magaliTad, Tavisi diagnozis
formulirebiT.
informirebuli Tanxmoba
moqmedi kanonmdeblobis Tanaxmad, informirebuli Tanxmoba mkurnalobaze
pacientis avtonomiis uzrunvelyofis erT-erTi ZiriTadi instrumentia.
informirebuli Tanxmoba gulisxmobs pacientis Tanamonawileobas saboloo
gadawyvetilebis miRebis procesSi misTvis daavadebisa da samedicino
Carevis Sesaxeb sruli, obieqturi, drouli da gasagebi informaciis
miwodebis Semdeg (kanoni ”fsiqiatriuli daxmarebis Sesaxeb” muxli 1).
mkurnalobis daniSvnisas eqimma unda auxsnas pacients mkurnalobis arsi da
SesaZlo gverdiTi movlenebi informirebuli Tanxmobis miRebis mizniT
(kanoni ”saeqimo saqmianobis Sesaxeb” muxli 39; kanoni ”pacientTa uflebebis
Sesaxeb” muxli 18).
amrigad, informirebuli Tanxmoba ori ZiriTadi komponentiTaa
warmodgenili:
• daavadebisa da samedicino Carevis Sesaxeb pacientisaTvis/kanonieri
warmomadgenelisaTvis sruli informaciis miwodeba;
• samedicino Carevaze pacientis/kanonieri warmomadgenlis Tanxmobis
miReba.
”fsiqiatriuli daxmarebis Sesaxeb” kanonis mixedviT, qmeduunaro an 16
wlamde pirisaTvis fsiqiatriuli daxmarebis aRmoCenisas informirebuli
Tanxmoba miiReba misi kanonieri warmomadgenelisagan, magram am
SemTxvevaSic pacients unda miewodos informacia misi asakisa da
fsiqikuri mdgomareobis gaTvaliswinebiT (muxli 8).
informaciis miwodeba gasageb enaze gulisxmobs, rom eqimma naklebad unda
gamoiyenos samedicino an pacientisaTvis gaugebari terminebi da
gaiTvaliswinos pacientis gagebis unari.
pacientis an misi kanonieri warmomadgenlis informirebuli Tanxmoba
fiqsirdeba samedicino dokumentaciaSi da dasturdeba xelmoweriT. Tu ar
arsebobs aranebayoflobiTi stacionirebis kriteriumebi, pacients an mis
kanonier warmomadgenels ufleba aqvs informaciis miwodebis Semdeg uari
ganacxados SeTavazebul fsiqiatriul daxmarebaze, rac aseve fiqsirdeba
104
samedicino dokumentaciaSi (kanoni ”fsiqiatriuli daxmarebis Sesaxeb”
muxli 10).
zogadad pirovnebas, romelsac aqvs informirebuli Tanxmobis micemis
unari, ufleba aqvs uari ganacxados samedicino mkurnalobaze, Tundac
uaris Tqma iwvevdes sikvdils an myar invalidobas. magram eqims mudmivad
unda axsovdes, rom uaris Tqma xSirad efuZneba daavadebisa da
mkurnalobis araswor gagebas. man yovelTvis imdeni dro unda daxarjos,
ramdenic saWiroa, raTa gaerkves pacientis rwmenebsa da SiSebSi
fsiqiatriul daxmarebasTan dakavSirebiT. problemis sruli, mSvidi
ganxilviT SesaZloa iseTi samkurnalo gegmis SemuSaveba, romelic
samedicino kuTxiT Sesaferisia da pacientisaTvisac misaRebi.
informirebuli Tanxmobis micemis unari calkeuli gadawyvetilebebis
mimarT gansxvavebulia. mZime fsiqikuri aSlilobis mqone pacienti SeiZleba
arakompetenturi iyos sxva aspeqtebSi, magram garkveuli mkurnalobis
mimarT iyos kompetenturi. magaliTad, SizofreniiT daavadebul pacients
paranoiduli ideebiT, SeuZlia miiRos gadawyvetileba mkurnalobis Sesaxeb
gulis Setevis dros.
aranebayoflobiTi stacionireba da mkurnaloba
fsiqiatriuli daxmarebis nebayoflobiTi principi gamomdinareobs
adamianis Uuflebebis, Tavisuflebis da avtonomiis eTikuri koncepciidan
da asaxulia TiTqmis yvela qveynis kanonmdeblobaSi, gansakuTrebiT
dasavluri demokratiis qveynebSi.
pacientis uflebaa ara marto Tavisuflebis ufleba, aramed mkurnalobis
uflebac. amitom specialuri sakanonmdeblo regulireba moqmedebs im
pirebisaTvis, romlebic warmoadgenen saSiSroebas sakuTari Tavis an
sxvebisaTvis fsiqikuri aSlilobis gamo da romlebic maTTvis saWiro
mkurnalobaze uars acxadeben. am pirebs Cveulebriv sakuTari fsiqikuri
mdgomareobis gageba da adeqvaturi TviTSefasebis unari arasakmarisi an
saerTod ara aqvT. am SemTxvevaSi eqimi dgeba eTikuri dilemis winaSe:
pacients aqvs Tavisuflebis ufleba, magram amasTan saWiroebs movlasa da
mkurnalobas, da sazogadoebasac aqvs ufleba iyos daculi.
aranebayoflobiTi hospitalizacia is kritikuli zRvaria sadac advilad
SeiZleba dairRves adamianis uflebebi. aq gansakuTrebiT rTulia
SeinarCuno balansi pacientis uflebas Soris iyos Tavisufali da
saxelmwifos valdebulebas - daicvas moqalaqeTa janmrTeloba da
usafrTxoeba.
evrosabWos rekomendaciis Sesabamisad “aranebayoflobiTi mkurnalobis
SemTxvevaSi unda arsebobdes procedura pacientis uflebebis dacvisa da
Zalauflebis borotad gamoyenebis winaaRmdeg. es procedura gulisxmobs
sxva eqimis azris gaTvaliswinebas, damoukidebeli organosgan nebarTvis
miRebas, pacients unda hqondes ufleba gadawyvetilebis gaprotestebisa da
unda arsebobdes gadawyvetilebis perioduli gadaxedvis meqanizmebi.”
sxvadasxva qveyanaSi moqmedi kanonmdebloba avaldebulebs profesionals
daumtkicos damoukidebel organos, rom pacientis Tavisuflebis SezRudva
nebis gareSe gamarTlebulia da ar arsebobs sxva alternativa.
miukerZoebeli ganxilvisaTvis SesaZlebelia mowmeebis gamoZaxeba, raTa
jvaredini dakiTxviT Seamowmdes mocemuli informacia.
105
“fsiqiatriuli daxmarebis Sesaxeb” kanonis mixedviT, saqarTveloSi
aranebayoflobiTi stacionaruli fsiqiatriuli daxmareba tardeba im
SemTxvevaSi, Tu pirs ar gaaCnia gacnobierebuli gadawyvetilebis miRebis
unari da fsiqiatriuli daxmarebis gaweva SeuZlebelia stacionirebis
gareSe; greTve, Tu pacienti safrTxes uqmnis sakuTar an sxvis
janmrTelobas, sicocxles an qonebas (muxli 18).
saqarTvelos konstituciiT, adamianis Tavisuflebis SezRudva sasamarTlo
gadawyvetilebis gareSe dasaSvebia mxolod 72 saaTis ganmavlobaSi (muxli
18), vinaidan, pacientis aranebayoflobiTi moTavseba stacionarSi aris
piris Tavisuflebis SezRudva, mxolod saasamarTlo SeiZleba iyos
gadawyvetilebis mimRebi organo. kanonSi konstituciis Sesabamisadaa
gawerili aseve sasamarTlos gadawyvetilebis miRebis vadac.
“fsiqitriuli daxmarebis Sesaxeb” kanoni aSkarad liberaluria pacientis
Tavisuflebis mimarT (aranebayoflobiT stacionirebisas sasamarTlo
dagenilebis aucilebloba, pacientis gawera ki sasamarTlos
gadawyvetilebis gareSe). magram am kanons ar udevs safuZvlad adamianis
ufleba iyos avadmyofur mdgomareobaSi da darCes mkurnalobis gareSe.
piriqiT, kanoni uflebas aZlevs eqims umkurnalos TiTqmis yvela saWiro
SemTxvevaSi. rodesac pacients ar aqvs gacnobierebis unari, eqimi moqmedebs
pacientis interesebidan gamomdinare. es gamonaklisi mniSvnelovania, magram
ar cvlis ZiriTad princips, rom saeqimo Carevisas aucilebelia pacientis
Tanxmoba.
gamocdil fsiqiatrs xSirad SeuZlia Tavidan aicilos aranebayoflobiTi
stacionireba, Tu moTminebiTa da taqtianad daarwmunebs pacientsa da mis
ojaxs stacionaruli mkurnalobis aucileblobaSi. Tu aman Sedegi ar
gamoiRo da aranebayoflobiTi mkurnaloba gardauvalia, saWiroa Semdgomi
saubrebi ojaxis wevrebTan pacientis stacionirSi moTavsebisas maTi
mxardaWerisaTvis. eqimma unda auxsnas situacia da yvela Rone ixmaros, rom
Seamciros ojaxis wevrTa SfoTva da danaSaulis gancda.
roca pacienti saavadmyofoSi imyofeba, usafrTxoebisa da adeqvaturi
mkurnalobisaTvis aucilebeli SezRudvebi minimaluri unda iyos.
”fsiqiatriuli daxmarebis Sesaxeb” kanonis mixedviT fsiqiatrs ufleba
aqvs pacientis mimarT gamoiyenos fizikuri SezRudvis meTodebi, Tu
arsebobs pacientis an garSemomyofTa dazianebis realuri safrTxe,
romlis Tavidan acileba sxvagvarad SeuZlebelia (muxli 16). SezRudvis
meTodebs, xangrZlivobasa da Sesabamisi Canawerebis gakeTebis
aucileblobac amave muxlSi da Sesabamis kanonqvemdebare aqtebSia
mocemuli.
“fsiqiatriuli daxmarebis Sesaxeb” kanonis Tanaxmad pacientis stacionarSi
aranebayoflobiT moTavseba iTvleba aranebayoflobiTi mkurnalobis
dasawyisad (muxli 18). aranebayoflobiTi mkurnalobis dros ar aris
aucilebeli pacientis kanonieri warmomadgenlis an naTesavis Tanxmoba.
Cveulebriv, pacienti da misi ojaxi male rwmundeba, rom aranebayoflobiTi
stacionaruli mkurnalobis meTodebi praqtikulad ar gansxvavdeba
nebayoflobiTi mkurnalobisagan da maT SeiZleba Svebac igrZnon
mkurnalobis dawyebis gamo. Tu saavadmyofos personali momTmeni da
yuradRebiania. Cveulebriv SesaZlebelia efeqturi Terapiuli
urTierTobis damyareba personals, pacientsa da naTesavebs Soris.
106
im SemTxvevaSi, Tu nebayoflobiT stacionirebuli pacienti uars acxadebs
mkurnalobis gagrZelebaze da fsiqiatri miiCnevs, rom misi mdgomareobidan
gamomdinare es mkurnaloba aucilebelia, mkurnaloba SesaZlebelia
gagrZeldes pacientis/kanonieri warmomadgenlis Tanxmobis gareSe. am dros
unda arsebobdes aranebayoflobiTi fsiqiatriuli daxmarebis kriteriumebi
(“fsiqiatriuli daxmarebis Sesaxeb”kanoni muxli 17).
mniSvnelovania, rom aranebayoflobiTi mkurnaloba grZeldeba manam, sanam
arsebobs amis aucilebloba. rogorc ki aranebayoflobiTi fsiqiatriuli
daxmarebis kriteriumebi amoiwureba, pacienti unda gaeweros stacionaridan
an mkurnaloba SeiZleba gagrZeldes mxolod pacientis/kanonieri
warmomadgenlis TanxmobiT (muxli 18).
amasTan, ”fsiqiatriuli daxmarebis Sesaxeb” kanonis me-15 muxlis Tanaxmad
akrZalulia pacientis stacionarSi dayovneba imaze meti xniT, vidre es
saWiroa misi gamokvlevisa da mkurnalobisaTvis. aranebayoflobiTi
stacionirebis Sesaxeb dawvrilebiTi procedura aRwerilia kanonSi
“fsiqiatriuli daxmarebis Sesaxeb”, administraciul saproceso kodeqsSi
da Sesabamis kanonqvemdebare aqtebSi.
aranebayoflobiTi stacionirebis sakiTxis gadawyvetis algoriTmi ixileT
danarTi 5-Si.
stacionaris gareT pacientis movlis sakiTxebi
stacionaridan gawerisas fsiqiatri Sesabamis informacias agzavnis
ambulatoriul fsiqiatriul dawesebulebaSi pacientis sacxovrebeli
adgilis mixedviT (”fsiqiatriuli daxmarebis Sesaxeb” kanoni, muxli 15). am
informaciis drouli miwodeba uzrunvelyofs pacientis movlis
uwyvetobas.
ambulatoriul fsiqiatriul dawesebulebaSi pacientis movlas
aregulirebs kanonqvemdebare aqti ”fsiqikuri aSlilobis mqone pacientebis
ambulatoriul dawesebulebaSi aRricxvisa da aRricxvidan moxsnis, maTze
meTvalyureobis wesis Sesaxeb”.
fsiqiatris profesiuli pasuxismgebloba da pacientisaTvis miyenebuli
zianis kompensacia
fsiqiatria, iseve rogorc zogierTi sxva saeqimo saqmianoba, maRali riskis
profesias ganekuTvneba. saqarTvelos kanonmdebloba iTvaliswinebs eqimis
Secdomis faqtze reagirebasa da pacientisaTvis zianis miyenebis riskis
Semcirebas.
fsiqiatrma unda icodes, ras niSnavs saeqimo Secdoma, romelsac kanoni
“janmrTelobis dacvis Sesaxeb” (muxli 3) ganmartavs, rogorc eqimis mier
uneblied pacientis mdgomareobisaTvis Seusabamo sadiagnozo da/an
samkurnalo RonisZiebebis Catarebas, rac miyenebuli zianis uSualo mizezi
gaxda. kanonSi “saeqimo saqmianobis Sesaxeb” saeqimo Secdomis nacvlad
gamoyenebulia termini “profesiuli Secdoma” (muxli 97). saeqimo SecdomaSi
igulisxmeba eqimis mier qveyanaSi aRiarebuli samedicino da eTikuri
standartebis, kanonmdeblobiT gansazRvruli wesebis darRveva, ramac
gamoiwvia pacientisaTvis zianis miyeneba.
107
kanonmdebloba iTvaliswinebs eqimis pasuxismgeblobis dayenebis saxes,
romelic “saeqimo saqmianobis Sesaxeb” kanonis 74-e muxlSia CamoTvlili da
moicavs werilobiT gafrTxilebas, saxelmwifo serTifikatis SeCerebas an
gauqmebas, fsiqotropuli medikamentebis gamoweris SezRudvas (Tu
dafiqsirda am rigis preparatebis aradaniSnulebisamebr gamoyeneba) da sxva
zomebs.
yvela aRniSnuli zomis gamoyeneba SeuZlia saxelmwifo serTifikatis
mimniWebel sabWos. fsiqiatrs SeuZlia gaasaCivros mis mimarT gamotanili
gadawyvetileba sasamarTloSi.
rac Seexeba pacientisaTvis miyenebuli zianis anazRaurebas, igi
regulirdeba kanoniT “pacientis uflebebis Sesaxeb” (me-10 muxli), romlis
mixedviTac pacienti mimarTavs sasamarTlos. eqimis profesiuli
pasuxismgeblobis sakiTxis ganxilvisas obieqturobis mniSnelovani
garantiaa profesiuli asociaciebis monawileoba saCivris ganxilvisa da
gadawyvetilebis miRebis procesSi. am SesaZleblobas iTvaliswinebs kanoni
“saeqimo saqmianobis Sesaxeb” (muxli 86).
fsiqiatriuli daxmareba arasrulwlovani pirebisaTvis
bavSvebisaTvis zogadi eTikuri principebisa da kanonmdeblobis gamoyeneba
moiTxovs balansis dacvas bavSvis avtonomiurobas, mSoblebis uflebasa da
saxelmwifos mier bavSvebis dacvis movaleobas Soris. es sakiTxebi kidev
ufro rTuldeba, rac ufro uaxlovdeba bavSvi mozrdilobis asaks.
zogierT SemTxvevaSi gasaTvaliswinebelia bavSvisa da mSoblis interesebsA
Soris wamoWrili konfliqti. zogadad bavSvis interesebs upiratesoba
eniWeba maTi mSoblebis interesebTan SedarebiT. es principi aSkaraa
bavSvze Zaladobis dros. sxva SemTxvevebSi gadawyvetilebis miReba ufro
gaZnelebulia. magaliTad, roca depresiuli deda ver zrunavs Svilebze da
mosalodnelia depresiis kidev ufro gaRrmaveba. am dros saWiro xdeba
fsiqiatris konsultacia da problemis gadaWra mSoblebsa da
profesionalebs Soris molaparakebebis gziT.
bavSvze fsiqiatriuli movlis ganxorcielebis dros, rogorc wesi, saWiro
xdeba rogroc samedicino ise socialuri samsaxurebis da zogjer
pedagogebis urTierTTanamSromloba. aseT SemTxvevebSi bavSvebsac
(dadgenili asakis zemoT) konfidenciurobis igive uflebebi aqvT, rogorc
mozrdilebs. ufro patara bavSvebis Sesaxeb informacias eqimi atyobinebs
mSoblebs.
saqarTveloSi 16 wlamde bavSvebis kanonieri warmomadgeneli mSobelia.
kanoniT “fsiqiatriuli daxmarebis Sesaxeb” pirveladi fsiqiatriuli
gamokvleva 16 wlamde asakis bavSvebis kanonieri warmomadgenlis TxovniT
tardeba (muxli 12), amave asakis pirebis saxeliT mkurnalobaze Tanxmobasac
maTi mSoblebi iZlevian (muxli 8). Tumca sasurvelia, fsiqiatri Seecados
Tanxmoba miiRos bavSvis mxridanac, rac dadebiTad imoqmedebs ganzraxul
fsiqiatriul daxmarebaze. mSobelma SeiZleba 16 wlamde asakis bavSvis
fsiqiatriul mkurnalobaze uari ganacxados. am dros fsiqiatri
gadawyvetilebas iRebs bavSvis fsiqikuri mdgomareobidan gamomdinare.
108
danarTi 5
pacientis aranebayoflobiTi fsiqiatriuli stacionirebis gadasawyvetad
algoriTmi
pacientisa da misi kanonieri warmomadgenlis
Tanxmoba ar aris aucilebeli
ki
xdeba pacientis aranebayoflobiTi stacionireba
ki
pacients ara aqvs gacnobierebuli gadawyvetilebis miRebis unari da
daxmarebis gaweva SeuZlebelia stacionirebis gareSe ara
ki
daxmarebis dayovneba safrTxes
Seuqmnis pacientis an sxvis
sicocxles an/da janmrTelobas
pacientma sakuTari moqmedebiT SeiZleba
miiRos an sxvas miayenos mniSvnelovani
materialuri zarali
pacients aReniSneba fsiqikuri aSliloba
ara ara ki
pacientis stacionireba
ar xdeba pacientis stacionireba
ar xdeba
pacientis stacionireba
ar xdeba
moTxovna pacientis aranebayoflobiT
stacionirebaze igzavneba sasamarTloSi
109
9. gaidlainis gadasinjvisa da ganaxlebis vada – 3 weli
10. gaidlainis miRebis xerxi/wyaro
1. The Maudsley Prescribing Guideline 2005 –2006 8-th edition; 2. Practice Guidelines for the treatment of Psychiatric Disorders. Compendium 2006 schizophrenia (second edition); 3. Treating schizophrenia. A Quick reference Guide. Based on Practice Guideline of Patients With Schizophrenia, second edition. Psychiatric Practice section of the APA web site at www.psych.org. SemuSavda arsebuli rekomendaciebis adaptirebuli varianti, romelic
erTis mxriv pasuxobs saerTaSoriso moTxovnebs, xolo meore mxriv
iTvaliswinebs saqarTvelos samedicino dawesebulebaTa rogorc
adamianur, ise teqnikur resursebs.
11. alternatiuli gaidlaini ar arsebobs
12. gamoyenebuli literatura
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93. daavadebaTa saerTaSoriso klasifikacia. me-10 gadasinjva (fsiqiatria); 94. saqarTvelos kanoni “fsiqiatriuli daxmarebis Sesaxeb”, 2006w; 95. g. kiknaZe, g. javaSvili - eqimis profesiuli saqmianobis samarTlebrivi
safuZvlebi, 2002w; 96. kanoni “pacientis uflebebis dacvis Sesaxeb” – 2001; 97. kanoni “saeqimo saqmianobis Sesaxeb” – 2001 w; 98. kanoniF “janmrTelobis dacvis Sesaxeb” - 1997 w; 99. Code of practice, Mental Health Act 1983 - 1999, London; 100. M. Gelder, R. Mayou, P. Cowen - Oxford Textbook of Psychiatry – 2001. 13. avtorTa jgufi: saqarTvelos fsiqikuri janmrTelobis asociacia
⇒ jgufis xelmZRvaneli _ manana bokuCava _ md, fsiqiatriis s/k
institutis konsultanti;
⇒ qeTevan abduSeliSvili _ md, umaRlesi samedicino skola `aieti~-s
fsiqiatriis kaTedris asocirebuli profesori;
⇒ nato xoneliZe _ arasamTavrobo organizacia `asociacia anti-
stigma~-s aRmasrulebeli direqtori.
eqspertebi:
⇒ Temur silagaZe _ Tssu neiromedicinis departamentis fsiqiatriis
mimarTulebis xelmZRvaneli, asocirebuli profesori;
⇒ i. suluxia _ profesori, m. asaTianis sax. samecniero-kvleviTi
institutis klinikuri ganyofilebis mecnieruli xelmZRvaneli;
114
⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros janmrTelobis dacvis
departamenti;
⇒ Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros janmrTelobis dacvis
departamenti.