Sizofrenia da sxva fsiqozuri aSlilobani

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.

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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 èsmis~ 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


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 èqstrapiramiduli

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)


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.


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


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)


• 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)


• 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


• 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

èqstrapiramiduli 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


paTologiuri xasiaTi

sakamaToa


gamoxatuleba


gamoxatuleba



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


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


paTologiuri xasiaTi

sakamaToa


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


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


paTologiuri xasiaTi

sakamaToa


gamoxatuleba


gamoxatuleba



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


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



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?~;

ìcvli 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?~; ès

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?~; ùyurebT Tu ara

televizors?~; ùsmenT radios?~

0= normaluri

1= paTologiuri xasiaTi

sakamaToa


umniSvneloa


SesamCnevia


SesamCnevia TiToeuli

damkvirveblisaTvis


done

22. seqsualuri interesebi

fasdeba pacientis interesi da mzaoba

seqsualuri kontaqtebis mimarT.

0= normaluri


sakamaToa


umniSvneloa


SesamCnevia



damkvirveblisaTvis


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


sakamaToa


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


sakamaToa


umniSvneloa


SesamCnevia



damkvirveblisaTvis


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


gamoxatva

3= SesamCnevi paTologiuri

gamoxatva


yvela mkvlevarisaTvis

SesamCnevia


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 ìmarjvebs~.

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


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~.


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


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.


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.


gaTvaliswineba:




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.

86

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).


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):


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.


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.

91


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.


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.

92


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.

93

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


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.


am aSlilobis mkurnalobis strategia iseTivea, rogorc Sizofreniisa

(ix. Sizofreniis mkurnaloba). am ukanasknelisgan gansxvavebiT

pacientTa 75% (Sizofreniis dros _ 20%) eqvemdebareba antifsiqozur

mkurnalobas 8 dReSi.

95

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.


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.


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)

96



gaTvaliswineba:




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.

97

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.


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.

98


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.

99


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.


gaTvaliswineba:




100

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

101

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

1. The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines World Health Organization. p.p 78-79

2. Synopsis of psychiatry Behavioral science/Clinical psychiatry. 9-th edition Harold I. Kaplan, MD and Benjamin J. Sadock, MD p.134;

3. Synopsis of psychiatry Behavioral science/Clinical psychiatry. 8-th edition Harold I. Kaplan, MD and Benjamin J. Sadock, MD p.476; p.280, p.282.

4. Карманное руководство к МКБ-10. 5. Diagnostic and Statistical Manual of Mental Disorders. Forth Edition. American psychiatric

Association. ISBN 0-89042-061-0 pp. 835-836; p.839 6. ix. (1). p.79 7. Practice Guidelines for the treatment of Psychiatric Disorders. Compendium 2006

schizophrenia (second edition) pp. 626-627; 585-587; 590, 600. 8. ix. (2). pp.136-141 9. ix. (1). pp.78-79 10. ix. (3). p.483, 472. 11. ix. (2). p.141 12. ix. (1). pp. 82-83. 13. ix. (2). pp.148-149 14. ix. iqve pp. 157-159; 161-164 15. ix. (1). pp.84-85; 89 16. ix. (2). p.160 17. ix. iqve. pp. 162. 18. ix. (3). pp. 783-784. 19. ix. (1). p. 84 20. ix. (2). p.784 21. Морозов. Клиничесская Рсихиатрия 22. ix. (2). p. 155 23. ix. iqve p. 155-156 24. ix. iqve pp.155-157 25. ix. iqve pp.164-165.

110

26. ix. (1) pp.85-86. 27. ix. (2). pp.154-155 28. ix. iqve. p.166-167. 29. Treating schizophrenia. A Quick reference Guide. Based on Practice Guideline of Patients

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33. Lesem MD, Zajecka JM, Swift RH, Reeves KR, Harrigan EP: Intramuscular ziprasidone, 2 mg versus 10 mg, in the short-term management of agitated psychotic patients. J Clin Psychiatry 2001; 62:12-18 [A]

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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 àieti~-s

fsiqiatriis kaTedris asocirebuli profesori;

⇒ nato xoneliZe _ arasamTavrobo organizacia àsociacia 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.

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