ოქსფორდის სახელმძღვანელო ფსიქიატრიაში

, ,
Tavi 1 fsiqikuri
aSlilobis simptomebi da niSnebi
Tavis Sinaarsi
imisTvis, rom fisiqiatrs kargad hqondes ganviTare-
zogadi sakiTxebi
buli pacientis gamokvlevisTvis saWiro unar-Cvevebi,
fsiqopaTologia
man unda safuZvlianad icodes, Tu rogor xdeba simp-
aRweriT fiqopaTologiaSi gamoyenebuli tomebisa da niSnebis dadgena. aseTi codnis gareSe
terminebi da cnebebi fsiqiatrma SeiZleba fenomenebis araswori klasifika-
simptomebisa da niSnebis ganmarteba cia moaxdinos da, aqedan gamomdinare, mcdari diagnozi
guneb-ganwyobisa da emociuri sferos dasvas. swored amitom es Tavi fsiqikuri aSlilobis
paTologia ZiriTadi simptomebisa da niSnebis ganazRvras eZRvneba.
aRqmis paTologia pacientis simptomebisa da niSnebis dadgenisas fsiqi-
azrovnebis paTologia atrma unda gadawyvitos, Tu ramdenad kargad jdeba es
asociaciuri procesis darRvevebi fenomenebi sxva pacientebTan dadgenil paternebSi. sxva
depersonalizacia da derealizacia sityvebiT rom vTqvaT, man unda gadawyvitos, Seesabam-
motoruli simptomebi da niSnebi eba Tu ara konkretuli klinikuri niSnebi sayovelTaod
dadgenil sindroms. fsiqiatri amas akeTebs pacientis
sxeulis xatis darRvevebi
mocemul momentSi arsebuli mdgomareobis Seswavlisa
sakuTari `me~-s darRvevebi
da misi avadmyofobis istoriis Sesaxeb arsebuli in-
mexsierebis darRvevebi
formaciis Sejerebis safuZvelze. sindromis identifi-
cnobierebis darRvevebi kacia mniSvnelovania, radgan es prognozis gakeTebasa
yuradRebisa da koncentraciis darRvevebi da efeqturi mkurnalobis SerCevaSi gvexmareba. sin-
insaiTi dromebis identifikaciis dros fsiqiatris yuradReba
warmarTulia imaze, Tu ra aris msgavsi pacientebis
fsiqiatrebs ori garkveuli unaris qona moeTxovebaT. avadmyofobis mizezi, ra saxis mkurnaloba utardebaT
pirvelia anamnezis Sekrebisa da fsiqikuri mdgomareo- maT da ra Sedegebi mosdevs aseT mkurnalobas. diagnos-
bis gamokvlevis gziT klinikuri monacemebis obieqturi, tikisa da klasifikaciis sakiTxebi ganxilulia meore
zusti Segrovebisa da maTi sistematuri, dabalansebuli TavSi, romelic sxvadasva tipis fsiqikur aSliobebs eZ-
saxiT organizebis unari, meore ki _ TiToeuli paci- Rvneba. mesame TavSi ki saubaria imaze, Tu rogor unda
entis, rogorc calke individis, intuiciuri gagebis moxdes mocemul TavSi aRwerili simptomebis gamovlena
unari. pirveli unaris gamoyenebis dros fsiqiatri da interpretacia. garda amisa ganxilulia informaciis
eyrdnoba Tavis klinikur unar-Cvevebs da klinikuri integrireba sindromuli diagnozis dasadgenad, rac,
fenomenebis codnas, xolo meore unaris gamoyenebis Tavis mxriv daavadebis marTvisa da prognozisadmi ra-
SemTxvevaSi _ Tavis codnas adamianis bunebis Sesaxeb cionaluri midgomis safuZvels warmoadgens.
da wina pacientebTan muSaobisas SeZenil gamocdilebas, ramdenadac am Tavis umetesi nawili simptomebisa da
raTa Caswvdes im pacientis mdgomareobas, romelTanac niSnebis gansazRvrasa da aRweras eTmoba, SesaZloa is
is mocemul momentSi muSaobs. orive unaris ganviTareba ufro rTuli wasakiTxi aRmoCndes momdevno TavebTan
SesaZlebelia pacientis mosmenisa da ufro gamocdili SedarebiT. navaraudevia, rom mkiTxvels SeuZlia mo-
fsiqiatrisagan codnis miRebis meSveobiT. nebismier sax- cemuli Tavi or nawilad dayos: pirveli moicavs Sesa-
elmZRvanelos SeuZlia mogvawodos informacia da aR- val nawilsa da im fenomenebis zogad gagebas, rom-
weros is procedurebi, romlebic aucilebelia pirveli lebic ufro xSirad gvxvdeba. meore nawili ki foku-
unaris ganviTarebisTvis. is, rom am TavSi yuradReba sirebulia gansazRvrebebis detalebze da naklebad
swored am unarzea gamaxvilebuli, sulac ar gulisx- gavrcelebul simptomebsa da niSnebze. am nawilSi
mobs imas, rom intuiciuri gageba ar aris mniSvnelovani, mocemuli informaciis gamoyenebis saukeTeso gzas
aramed niSnavs mxolod imas, rom misi ganviTareba marto warmoadgens misi Sejereba pacientis interviuirebiT
saxelmZRvanelos daxmarebiT ar aris SesaZlebeli. miRebul monacemebTan.
_1_
1 fsiqikuri aSlilobis simptomebi da niSnebi
zogadi sakiTxebi levebidan. froidi anomaliuri fsiqikuri movlenebis

gamomwvev mizezebs pacientisTvis ucnobi (àracnob-
calkeuli fenomenebis aRweramde, sasurvelia ganvix-
ieri~) fsiqikuri procesebis terminebiT xsnida. mag.,
iloT zogierTi zogadi sakiTxi, romelic exeba simp-
is devnis bodviT ideebs ganmartavda, rogorc arac-
tomebisa da niSnebis Seswavlis meTodebs da im termi-
nobier fsiqikaSi mimdinare aqtivobis (represiisa da
nebs, romlebic maT aRsawerad gamoiyeneba.
proeqciis meqanizmebis muSaobis CaTvliT) cnobier
gamoxatulebas.
fsiqopaTologia
amgvarad, eqsperimentuli fsiqopaTologia foku-
fsiqopaTologia fsiqikis anomaliur mdgomareobas
sirebulia cnobier fsiqikur procesebze, romelTa
Seiswavlis da sakiTxis mimarT or gansxvavebul mid-
empiriuli gazomva da Semowmeba savsebiT SesaZlebe-
gomas moicavs: aRweriTs da eqsperimentuls. mocemu-
lia. igi iyenebs iseT eqsperimentul meTodebs, ro-
li Tavi TiTqmis mTlianad pirvels exeba. meore mid-
gorebicaa kognituri da bihevioruli fsiqologiisa
goma (romelic aseve am TavSia warmodgenili) ufro
da funqciuri neirovizualizaciis meTodebi. mag.,
dawvrilebiT momdevno TavebSi iqneba ganxiluli.
arsebobs kognituri Teoriebi bodviTi ideebis, pani-
aRweriTi fsiqopaTologia kis Setevis da depresiis warmoSobis Sesaxeb. miuxe-
davad imisa, rom eqsperimentuli fsiqopaTologia
aRweriTi fsiqopaTologia fsiqikis anomaliuri md-
dainteresebulia simptomebis gamomwvevi mizezebiT,
gomareobis obieqturi aRweraa. fsiqopaTologia
kvleva, Cveulebriv, tardeba im sindromebis konte-
cdilobs, SeZlebisdagvarad gaTavisufldes miker-
qstis gaTvaliswinebiT, romelSic es simptomebi iCens
Zoebuli ideebisa da Teoriebisagan da Semoifarglos
Tavs. amitom eqsperimentul fsiqopaTologiaSi Cat-
im cnobieri gamocdilebisa da TvalsaCino qcevebis
arebuli kvlevis Sedegebi ganxiluli iqneba im TavSi,
aRweriT, romlebze dakvirvebac SesaZlebelia. mas
romelSic Sesabamis aSlilobazea saubari.
zogjer fenomenologias an fenomenologiur fsiqopa-
Tologias uwodeben, Tumca, sinamdvileSi, es termine-
bi ar warmodgens sinonimebs da termins `fenomenolo- aRweriT fsiqopaTologiaSi gamoyenebuli
gia~ sxva mniSvnelobebic gaaCnia (Berrios, 1992). terminebi da cnebebi
aRweriTi fsiqopaTologiis mizania, naTeli moh- simptomebi da niSnebi
finos avadmyofuri fsiqikuri gamocdilebis arse- zogadi medicinis sferoSi arsebobs simptomebisa da
biT Taviseburebebs da gaigos, Tu ra saxiT ganicdeba niSnebis zusti ganmarteba da es cnebebi erTmaneTisa-
`sakuTari~ daavadeba TiToeuli pacientis mier. es gan mkafiod aris gamijnuli. gansxvavebuli mdgomareo-
moiTxovs fsiqikuri aSlilobis simptomebis gamovle- baa fsiqiatriaSi. aq, samedicino gagebiT Zalian cota
nis, identifikaciisa da interpretaciis unars, rac `niSani~ gvaqvs (katatonuri Sizofreniis, motoruli
klinikuri praqtikis ZiriTad elements warmoadgens darRvevebisa da nervuli anoreqsiis fizikuri mani-
da, rasakvirvelia, `fsiqiatris fundamentur profe- festaciebis gamoklebiT), xolo diagnostikuri Rire-
siul unar-Cvevad~ aris miCneuli (Sims, 2003). bulebis mqone informacia ZiriTadad pacientis avad-
aRweriTi fsiqopaTologiis yvelaze ufro Tval- myofobis istoriidan da mis garegnobasa da qcevaze
saCino warmomadgenelia germaneli fsiqiatri da fi- dakvirvebiT miiReba. amitomac, fsiqiatriaSi termini
losofosi karl iaspersi. misi klasikuri naSromi `niSani~ zusti mniSvnelobiT ar gamoiyeneba, aramed
Allgemeine Psychopathologie (zogadi fsiqopaTologia), ori Sinaarsi aqvs: erTis mixedviT is warmoadgens im
romelic pirvelad 1913 wels gamoqveynda, dResac am maxasiaTeblebs, romlebic dakvirvebas eqvemdebareba,
sferos yvelaze ufro srulyofil aRweras warmoad- da ara imas, rasac pacienti gveubneba (mag., pacientis
gens. xelmisawvdomia am naSromis meSvide gamocema, reaqcia halucinaciaze); meores mixedviT _ iseT simp-
romelic inglisur enaze hoenigis da hamiltonis mier tomTa jgufs, romelsac damkvirvebeli mTlianobaSi
aris naTargmni (Jaspers, 1963); simsis (Sims, 2003) mier ganixilavs, rogorc garkveuli darRvevisTvis damaxa-
SemoTavazebuli, wasakiTxad ufro ioli da Taname- siaTebel niSans. praqtikaSi `simptomebi da niSnebi~
drove, varianti da 1968 wels gamocemuli iaspersis xSirad `simptomebis~ magivrad gamoiyeneba (rogorc
Teoriis mokle Sesavali. es am TavSia mocemuli) da orive termini fsiqikuri
aSlilobis fenomenebze miuTiTebs).
eqsperimentuli fsiqopaTologia
eqsperimentuli fsiqopaTologia cdilobs, ara mar- subieqturi da obieqturi
to aRweros, aramed axsnas kidec anomaliuri fsiqi- zogadi medicinis sferoSi teminebi `subieqturi~ da
kuri fenomenebi. aseTi mcdelobis erT-erTi pirveli òbieqturi~ gamoiyeneba, rogorc simptomebisa da
magaliTia fsiqodinamikuri fsiqopaTologia, ro- niSnebis Sesabamisi cnebebi. obieqturad iTvleba is
melic saTaves iRebs froidis fsiqoanalitikuri kv- simptomebi da niSnebi, romlebze dakvirvebac eqims
_2_
zogadi sakiTxebi
uSualod SeuZlia (mag., meningialuri niSnebi, siyvi- lia, magram acnobierebdes, rom es sinamdviles ar See-
Tle). Tumca, ufro zusti mniSvnelobiT, esec subieq- sabameba. am SemTxvevaSi Sinaarsi igivea, rac pirvel
tur Sefasebas warmoadgens. magaliTSi (orive homoseqsualizms exeba), xolo for-
fsiqiatriaSi am terminebs TiTqmis iseTive mniSvn- ma ki gansxvavebulia.
elobiT iyeneben, rogorc zogad medicinaSi, Tumca diagnozis dasmisas formas xSirad gadamwyveti
fsiqiatriaSi maTi Sinaarsobrivi sazRvrebi ufro mniSvneloba aqvs. zemoT moyvanil pirvel or mag-
bundovania, iseve, rogorc simptomebisa da niSnebis. aliTSi, halucinaciis arseboba (gansazRvrebis mixed-
termini òbieqturi~ aRniSnavs im maxasiaTeblebs, viT) ama Tu im saxis fsiqozze miuTiTebs, maSin roca
romlebze dakvirvebac intervius mimdinareobis dros mesame magaliTSi, savaraudod, saqme gvaqvs obse-
xdeba (pacientis garegnoba da qceva) da Cveulebriv siur-kompulsur aSlilobasTan. diagnozis dasmisT-
maSin gamoiyeneba, rodesac fsiqiatrs unda sakuTari vis Sinaarsi nakleb yuradsaRebia, magram is SeiZleba
dakvirvebis Sedegad miRebuli informacia pacientis Zalian mniSvnelovani iyos daavadebis marTvis dros.
mier aRweril simptomebs Seadaros. mag., depresiis Se- mag., bodvis Sinaarsidan gamomdinare, SegviZlia vi-
fasebisas, iseTi Civilebi, rogorebicaa cud gunebaze varaudoT, rom pacienti SeiZleba Tavs daesxas ada-
yofna da tirilis survili subieqtur maxasiaTeblebs mians, romelic Tavisi mdevari hgonia. agreTve, unda
warmoadgens, maSin, rodesac susti mxedvelobiTi kon- gaviTvaliswinoT, rom is, rac pacients awuxebs, Si-
taqti, fsiqomotoruli Seneleba da tirili _ obieq- naarsia da ara forma. pirvel rigSi mas surs saubari
turi maxasiaTeblebia. Tu orive saxezea, fsiqiatrs im adamianze, romelic mas devnis, da ara imaze, rac
SeuZlia `depresiis subieqturi da obieqturi gamov- SeiZleba amas mohyves. pacienti SeiZleba gaaRizianos
linebebi~ daafiqsiros. subieqturi da obieqturi misi azriT uadgilo SekiTxvebma sakuTari warmod-
maxasiaTeblebis erToblivi mocemuloba ufro safuZ- genebis formis Sesaxeb. fsiqiatri sifrTxiliT unda
vliani daskvnis gakeTebis saSualebas iZleva, vidre moekidos formasa da Sinaarss Soris arsebul gansx-
TiToeuli maTganisa cal-calke. Tumca, Tu pacien- vavebebs da unda gadawyvitos, Tu romel maTganze
tis qceva da manerebi intervius mimdinareobis dros gaamaxvilos yuradReba.
savsebiT normaluria, miuxedavad subieqturi Civi-
pirveladi da meoradi
lebisa, fsiqiatri afiqsirebs, rom òbieqturi maxa-
siaTeblebis mixedviT, depresia ar aRiniSneba~. aseT terminebi `pirveladi~ da `meoradi~ xSirad gamoiy-
SemTxvevaSi fsiqiatrma unda gansazRvros Seusabamo- eneba simptomebTan dakavSirebiT, magram erTmaneTisa-
bis mizezebi da gadawyvitos, Tu rogori diagnosti- gan gansxvavebuli mniSvnelobiT. pirveli mniSvneloba
kuri daskvnebi gamoitanos. rogorc wesi, obieqtur simptomis gamovlenis droze amaxvilebs yuradRebas
niSnebs ufro didi mniSvneloba eniWebaT. mag., fsiqi- da ubralod miuTiTebs imaze, Tu romeli simptomi
atrs SeuZlia dasvas depresiuli aSlilobis diagnozi iCens Tavs pirvelad. meore ki kauzaluria. am mniSvn-
maSinac ki, rodesac pirovneba subieqturad ar ganic- elobis Tanaxmad, `pirveladi~ niSnavs ùSualod pa-
dis depresias, magram misi obieqturi maxasiaTeblebi Tologiuri procesidan aRmocenebuls~, xolo `meo-
sakmarisi xarisxiT aris warmodgenili, da piriqiT _ radi~ _ `reaqcias pirvelad simptomze~. es ori mniSvn-
fsiqiatrma SeiZleba saeWvod miiCnios pacientis Civi- eloba xSirad emTxveva erTmaneTs, radgan simptomebi,
lis (mag., uguneboba, ragind Zlieradac ar unda iyos romlebic uSualod fsiqopaTologiuri procesidan
es gamoxatuli) diagnostikuri Rirebuleba, Tu ar ar- aRmocendeba, Cveulebriv, pirveli iCens Tavs. Tumca,
sebobs am diagnozis obieqturi maxasiaTeblebi. aris SemTxvevebi, rodesac ufro gviandeli simptom-
ebi pirveladze sapasuxo reaqcias ki ar warmoadgns,
forma da Sinaarsi aramed isinic uSualod fsiqopaTologiuri proces-
fsiqiatriuli simptomebis aRweris Semdeg sasurve- ebidan arian aRmocenebuli. terminebs `pirveladi~ da
lia, ganvasxvaoT terminebi `forma~ da `Sinaarsi~, `meoradi~ ufro xSirad pirveli mniSvnelobiT iyene-
rasac yvelaze ukeT Semdegi magaliTi gviCvenebs: Tu ben, radgan maTi amgvari gaazreba Tavis TavSi ar Sei-
pacienti ambobs, rom marto yofnisas esmis xmebi, cavs kauzalur qveteqsts. miuxedavad amisa, bevr pa-
romlebic mas homoseqsuals uwodeben, aseTi gamoc- cients ar SeuZlia imis Tqma Tu rogori Tanmimdevro-
dilebis forma smeniTi halucinaciebia (ix. qvemoT), biT gamovlinda misi simptomebi. Tuki erTi simptomi
xolo Sinaarss warmoadgens azri, rom pacienti homo- meoreze gacemul reaqcias warmoadgens (mag., devnis
seqsualia. meore pacients SeiZleba Caesmodes xmebi, bodviTi idea aris reaqcia imaze, rom pirovnebas esmis
rom mas male moklaven. aseT SemTxvevaSic forma aris xmebi, romlebic mas adanaSauleben), mas, kauzaluri
smeniTi halucinaciebi, magram Sinaarsi pirvelisagan mniSvelobiT, meorad simptoms uwodeben. sindromebis
gansxvavebulia. mesame pirovnebas SeiZleba awuxebdes aRwerisas terminebi `pirveladi~ da `meoradi~ amgvari
ganmeorebadi intruziuli azri, rom is homoseqsua- mniSvnelobiTac gamoiyeneba.
_3_
gageba da axsna filebuli aqvs da im adamianze, romelsac warsulSi

bevri marcxi ganucdia, magram momavlis imedi aqvs. im-
simptomebze saubrisas iaspersi (Jaspers, 1913) erTma-
isTvis, rom fsiqiatrma naTeli warmodgena Seiqmnas pa-
neTisagan ganasxvavebda gagebis or formas. pirveli,
cientis fsiqikuri aSlilobis gamocdilebiTi aspeqtis
romelsac verstehen (gageba) ewodeba, warmoadgens paci-
Sesaxeb, igi iseve unda ecados pacientis pirovnebis
entis subieqturi gamocdilebis Sefasebis mcdelobas
gagebasa da Secnobas, rogorc amas biografebi akeTeben.
(rogor ganicdeba mis mier es grZnoba?). amgvari Se-
am saxis midgomas zogjer pirovnebis cxovrebis isto-
faseba fsiqiatrisagan intuiciasa da empaTiis unars
riaze damyarebul midgomas uwodeben da mis praqtikaSi
moiTxovs. meore formas ewodeba erklaren (axsna) da is
gamoyenebis dros saxelmZRvanelo naklebad gviwevs dax-
movlenebs garegani faqtorebis gaTvaliswinebiT ga-
marebas. pacientis gagebis saukeTeso gza misi mosmenaa.
nixilavs. mag., pacientis cud xasiaTze yofna SeiZleba
fsiqiatrs Zalian waadgeba iseTi biografiuli da lit-
àixsnas~ im faqtiT, rom is cota xnis win samsaxuri-
eraturuli nawarmoebebis kiTxva, romlebSic aRwer-
dan daiTxoves. àxsna~ etiologiis condas moiTxovs.
ilia, Tu rogor ayalibebs cxovrebiseuli gamocdileba
calkeuli simptomebis mniSvnelovnoba pirovnebas, rac, Tavis mxriv, daexmareba mas gaacnobie-
fsiqikuri aSlilobis diagnozis dasasmelad garkveu- ros, rom adamianebi gansxvavebulad reagireben erTsa
li simptomebis jgufis (sindromis) arsebobaa da imave movlenaze.
saWiro. calke aRebuli nebismieri simptomi SeiZleba
janmrTel adamianebsac aReniSnebodes. halucinacia-
kulturiT gapirobebuli gansxvavebebi
mac ki, romlis arseboba xSirad ganixileba rogorc fsiqopaTologiaSi
fsiqikuri aSlilobis ganmsazRvreli kriteriumi,
sruliad gansxvavebul kulturebSi simptomebi msgav-
SeiZleba xandaxan, xanmokle droiT, janmrTel adami-
sia Tavisi formis mixedviT. gansxvaveba vlindeba imaSi,
anebSic iCinos Tavi. saqme isaa, rom calkeuli (izoli-
Tu romel simptomebze saubroben pacientebi eqimebTan.
rebuli) bodviTi idea maSin iTvleba fsiqikuri aSli-
mag., indoeTSi mcxovrebi adamianebi, evropelebisagan
lobis maCveneblad, rodesac is mkveTrad gamoxatuli
gansxvavebiT, depresiuli aSlilobis dros iSviaTad
da persistentulia (ix. Tavi 13). sazogadod, mxolod
uCivian cud guneb-ganwyobas da ufro metad somatur
erTi simptomiT ver vimsjelebT fsiqikuri aSlilo-
simptomebze amaxvileben yuradRebas. kulturis mixed-
bis arsebobaze. aseTi simptomis arseboba mxolod
viT gansxvavebulia simptomebis Sinaarsic. mag., zogi-
imaze migvaniSnebs, rom unda Catardes safuZvliani
erTi afrikuli kulturis warmomadgenlebs SeiZleba
da, saWiroebis SemTxvevaSi, ganmeorebiTi gamokvl-
aReniSnebodeT bodva boroti sulebis Sesaxeb, rac ev-
eva fsiqikuri aSlilobis sxva simptomebisa da niS-
ropelebTan Zalian iSviaTad gvxvdeba. kulturologi-
nebis dasadgenad. rozenhanis gamokvlevaSi (Rosenhahn,
uri gansxvavebebi gavlenas axdens agreTve avadmyofo-
1973) naCvenebia, Tu ramdenad saxifaToa am prin-
bis subieqtur gancdaze da, aqedan gamomdinare, imaze,
cipis gauTvaliswinebloba. rva `pacients~, romlebic
Tu rogor aRiqvams da gaiazrebs pacienti Tavis avad-
acxadebdnen, rom esmodaT xmamaRla warmoTqmuli si-
myofobas (Fabrega, 2000). zogierT kulturaSi fsiqikuri
tyvebi _ `carieli, fuye~, dausves Sizofreniis di-
aSlilobis Sedegebi miewereba jadoqrobas _ rwmenas,
agnozi miuxedavad imisa, rom sxva simptomebi ar aR-
romelsac garkveuli wvlili Seaqvs pacientis mZime
eniSnebodaT da maTi qcevac savsebiT normaluri iyo.
mdgomareobis CamoyalibebaSi. zogierT kulturaSi ki
es gamokvleva imasac gviCvenebs, Tu ramdenad mniS-
fsiqikuri daavadebebi imdenad mZlavrad aris stigma-
vnelovania aRweriTi fsiqopaTologiis codna da san-
tizebuli, rom SeiZleba qorwinebisTvis dabrkolebad
do diagnostikuri kriteriumebis gamoyeneba (Tavi 2).
iqces. aseT kulturaSi fsiqikuri avadmyofobis gavlena
pacientis Sexedulebaze sakuTari Tavisa da momavlis
pacientis gamocdileba Sesaxeb Zalian gansxvavebuli iqneba im zegavlenisagan,
simptomebi da niSnebi fsiqopaTologiis sagnis mxolod romelsac fsiqikuri daavadebis mimarT tolerantul
nawils warmoadgens. fsiqopaTologia aseve moicavs pa- sazogadoebaSi mcxovrebi pacienti ganicdis.
cientis gamocdilebas, romelic mis daavadebasTan aris
dakavSirebuli da imas, Tu rogor cvlis fsiqikuri simptomebisa da niSnebis ganmarteba
aSliloba pacientis warmodgenas sakuTar Tavze, sa-
myaroze da momavalTan dakavSirebul imedebze. es aris guneb-ganwyobisa da emociuri sferos
erT-erTi magaliTi `gagebisa~, razec zemoT iyo saubari. paTologia
depresiulma aSlilobam SeiZleba Zalze gansxvavebuli
fsiqiatrias umeteswilad saqme aqvs paTologiur
gavlena iqonios im adamianze, romelic uproblemod,
emociur mdgomareobebTan, kerZod, guneb-ganwyobis
bednierad cxovrobs da ZiriTadi ambiciebic dakmayo-
_4_
simptomebis da niSnebis ganmarteba
darRvevebTan da emociuri sferos aSlilobasTan, intensivobis gazrdas Tan axlavs hiperaqtiuroba da
gansakuTrebiT ki SfoTvasTan. Sesabamisi simptom- kunTebis tonusis mateba; xolo depresias _ fsiqomo-
ebis aRweramde, gaugebrobis Tavidan asacileblad, toruli Seneleba da mZime sulieri mdgomareoba.
sasurvelia, moviyvanoT terminebis ganmarteba, miT
emociisa da guneb-ganwyobis cvlilebebi
umetes, rom droTa ganmavlobaSi maTi mniSvneloba
meryeobis mixedviT
sagrZnoblad Seicvala.
upirveles yovlisa, `guneb-ganwyoba~ SeiZleba emociebi da guneb-ganwyoba icvleba pirovnebis
gavigoT, rogorc farTo mniSvnelobis mqone termini, cxovrebiseul situaciasa da sazrunavTan erTad. pa-
romelic nebismier emocias moicavs (mag., SfoTviTi Tologiuri mdgomareobis dros isini SeiZleba, norm-
guneb-ganwyoba). Tumca, ufro viwro mniSvnelobiT, alurTan SedarebiT, metad an naklebad meryeobdes.
is iseT kontiniumze ganlagebuli emociebis aRsaniS- guneb-ganwyobis momatebul cvalebadobas guneb-gan-
navadac gamoiyeneba, romlis erT boloze depresiaa, wyobis labiloba anu sustsulovneba ewodeba, xolo
xolo meoreze _ mania. am terminis pirveli mniSvnelo- eqstremalur cvalebadobas zogjer emociur Seukave-
biT gamoyeneba SedarebiT iSviaTad xdeba. meore mniS- blobas uwodeben.
vneloba asaxavs im faqts, rom amJamindeli diagnosti- guneb-ganwyobis cvalebadobis Semcirebas siClunge
kuri sistemebis mixedviT guneb-ganwyobis (afeqturi) an gasadaveba ewodeba. am terminebs winaT odnav gansx-
aSlilobebi iseTi tipis darRvevebia, romelTa ganmsaz- vavebuli mniSvneloba hqondaT, magram axla maT erTi
Rvrel maxasiaTeblebs depresia da mania warmoadgens, da igive mniSvnelobiT iyeneben. cvalebadobis Semci-
xolo SfoTviTi xasiaTis da sxva saxis emociuri aSli- reba, Cveulebriv, gvxvdeba depresiisa da Sizofreniis
loba calke kategoriad moiazreba. am qveTavSi (sanam dros. srul ganurCevlobas apaTias uwodeben (SeniS-
SfoTvis, depresiisa da maniis specifikur maxasiaTe- vna: am SemTxvevaSi es termini gansxvavebuli mniSvelo-
blebs calke gamovyofdeT da ganvixilavdeT) aRwer- biT gamoiyeneba, vidre yoveldRiur metyvelebaSi).
ilia iseTi maxasiaTeblebi, romlebic saerToa rogorc emociis arakongruentuloba (Seusabamoba)
`guneb-ganwyobisTvis~, aseve `sxva emociebisTvis~.
emociur doneze momxdari cvlilebebi SeiZleba ar
meore nawilSi ganxilulia termini àfeqti~. dRes
Seesabamebodes
es sityva Cveulebriv termin `guneb-ganwyobis~ nacv
pacinetis azrebs da im viTarebas, romelSic is imy-
lad gamoiyeneba, am ukanasknelis ufro viwro mniSvne
ofeba.
lobiT. swored aqedan gamomdinare amboben: `misi
aseT emocias arakongruentuli anu Seusabamo ewo-
afeqturi mdgomareoba normaluria~ an `mas afeqturi
deba. mag., pacienti SeiZleba karg gunebaze gamoiy-
aSliloba aReniSneba~. Tumca, warsulSi am terminebs
urebodes an icinodes sakuTari dedis gardacvaleba-
odnav gansxvavebuli mniSvnelobiT iyenebdnen: `guneb-
ze saubrisas. aseTi arakongruentuloba gansxvavdeba
ganwyoba~ aRniSnavda dominantur da xangrZliv mdgo
`morcxvi~ sicilisagan, rac imis maCvenebelia, rom
mareobas, xolo àfeqti~ ukavSirdeboda calkeul
pirovneba uxerxulad grZnobs Tavs.
aspeqts an obieqts da SedarebiT xanmokle mdgo
mareobaze miuTiTebda. emociuri sferos aSlilobisa da guneb-
fsiqikuri aSlilobebis dros guneb-ganwyobis paTo- ganwyobis darRvevebis klinikuri gamoxatuleba
logia sami saxiTaa warmodgenili: emociuri sferos aSliloba da guneb-ganwyobis dar-
1. Secvlilia guneb-ganwyobis xasiaTi. Rvevebi arsebiTad nebismieri fsiqikuri aSlilo-
2. CveulebrivTan SedarebiT metad an naklebad merye- bis dros iCens Tavs. isini afeqturi da SfoTviTi
via. aSlilobis ZiriTadi maxasiaTeblebia. agreTve, Cveu-
lebriv, Tan axlavs kvebiT aSlilobas, wamalmoxmare-
3. ar Seesabameba pacientis azrebsa da qmedebebs an mis
biT gamowveul aSlilobas, deliriums, demenciasa da
amJamindel mdgomareobas.
Sizofrenias.
emociisa da guneb-ganwyobis cvlilebebi SfoTva

xasiaTis mixedviT raime saSiSroebis arsebobis dros SfoTvis aR-
es cvlilebebi SeiZleba gamoixatebodes SfoTvaSi, moceneba normaluri reaqciaa. SfoTva paTologiu-
depresiaSi, aweul guneb-ganwyobaSi, gaRizianebado- rad iTvvleba maSin, rodesac misi intensivoba arse-
basa da sibrazeSi. nebismieri es cvlileba SeiZleba buli saSiSroebis xarsxis araproporciulia an masze
dakavSirebuli iyos pacientis cxovrebaSi momxdar ufro didxans grZeldeba. SfoTviTi guneb-ganwyoba
movlenebTan, Tumca, SesaZloa yovelgvari TvalsaC- mWidrodaa dakavSirebuli somatur, vegetatiur da
ino mizezebis gareSec ganviTardes. maT Cveulebriv fsiqologiur komponentebTan. yvelaferi es SeiZleba
Tan sdevs sxva simptomebic da niSnebic. mag., SfoTvis ganxilul iqnes, rogorc ekvivalenti saSiSroebasTan
_5_
gasamklaveblad mzadebis, rasac sxva ZuZumwovrebSic sac is ubeduri SemTxvevis araproporciulia an zed-
vxvdebiT. mag., mtaceblisagan gaqcevisTvis mzadeba, metad didxans gastans. depresiuli guneb-ganwyoba
misgan Tavis arideba an masTan SebrZoleba. msubuqi mWidrod aris dakavSirebuli sxva cvlilebebTanac,
da zomieri intensivobis SfoTva umetes wilad aum- gansakuTrebiT TviTSefasebis daqveiTebasTan, pesi-
jobesebs sxvadasxva tipis aqtivobas, magram Zlieri mistur an negatiur azrebTan da siamovnebis gancdis
intensivobis SfoTva piriqiT _ aferxebs mas. SesustebasTan an dakargvasTan (anhedonia). depresi-
SfoTviTi reaqcia ufro safuZvlianad mecxre Tav- ul pirovnebas aqvs damaxasiaTebeli gamometyveleba
Sia ganxiluli. qvemoT misi mTavari komponentebia mo- da garegnuli ieri: qvemoT daweuli piris kuTxeebi,
cemuli: Sekruli warbebi da moxrili, daTrgunuli Sesaxed-
w fsiqologiuri komponenti. aJitacia da cudi wi- aoba. zogierT depresiul pacients agznebis done
naTgrZnoba, romelsac Tan axlavs mousvenroba, daqveiTebuli aqvs (fsiqomotoruli retardacia), ma-
wuxili, gaRizianebadoba, momatebuli sifxizle gram zogierTs piriqiT _ mousvenroba da aJitacia
(uZilobasTan erTad) da yuradRebis Seviwroveba aReniSneba. depresiis fsiqopaTologia ufro vrclad
(kerZod saSiSrebis wyaroze fokusireba). meTerTmete TavSia ganxiluli.
w somaturi komponenti. kunTebis daZabuloba da ga-
klinikuri gamoxatuleba
xSirebuli sunTqva. Tu am cvlilebebs Tan ar sdevs
fizikuri aqtivoba, isini SeiZleba ganicdebodes depresia SeiZleba dafiqsirdes nebismieri fsiqikuri
rogorc kunTebis daZabulobiT gamowveuli tremo- aSlilobis dros. is afeqturi aSlilobebis ganmsaz-
ri an rogorc hiperventilaciis efeqti (mag., Ta- Rvrel niSans warmoadgens da Cveulebriv Tavs iCens
vbrusxveva). Sizofreniis, SfoTvis, obsesiur-kompulsuri aSli-
lobebis, kvebiTi aSlilobis da fsiqoaqtiuri niv-
w avtonomiuri komponenti. guliscemis gaxSireba,
Tierebebis moxmarebiT gamowveuli aSlilobis dros.
momatebuli oflianoba da piris simSrale. aseve,
depresia SeiZleba organuli darRvevebis SemTxveva-
SesaZlebelia aRiniSnebodes Sardvis an defekaciis
Sic gamovlindes.
Zlieri moTxovnileba.
w saSiSroebisTvis Tavis arideba. fobia warmoadgens aweuli guneb-ganwyoba _ mania
konkretuli sagnis an movlenis gamudmebul, ira- depresiulTan SedarebiT, aweuli guneb-ganwyoba
cionalur SiSs. Cveulebriv, SeiniSneba saSiSi obi- ufro naklebadaa Seswavlili. maniakaluri mdgo-
eqtisTvis Tavis aridebis aSkara survili, magram mareoba warmoadgens aweuli guneb-ganwyobis eqs-
ara nebismier SemTxvevaSi (am ukanasknelis magaliTia tremalur xarisxs. igi, depresiis msgavsad, garkveul
ipoqondria _ avadmyofobis SiSi). aseTi SiSi obieq- cvlilebebTan aris dakavSirebuli: gazrdil TviT-
turad arsebuli safrTxis araadekvaturia, rasac dajerebulobasa da keTildReobis gancdasTan er-
Tavad pacientic acnobierebs. fobiebi SeiZleba Tad momatebulia aqtiuroba da sifxizlis done. es
ukavSirdebodes cocxal obieqtebs, bunebis movle- ukanaskneli, Cveulebriv, pacientisTvis sasiamovno
nebs an raime sxva situacias. fobiis mqone adamian- grZnobaa, Tumca zog SemTxveevaSi mis mier Semawuxeb-
ebi gancdian SfoTvas ara mxolod saSiSi obieqtis el mosvenrobad ganicdeba. aweuli guneb-ganwyoba
an situaciis realurad arsebobis SemTxvevaSi, ar- yvelaze xSiria maniisa da hipomaniis dros.
amed maTze fiqris drosac. (anticipatoruli SfoT-
gaRizianebadoba da sibraze
va). fobiebi ufro safuZvlianad ganxiluli iqneba
SfoTviT aSlilobaze saubrisas. gaRizianebadoba aris iseTi mdgomareoba, romelic
gabrazebis mzaobis aqtivacias warmoadgens. rogorc
klinikuri gamoxatuleba gaRizianebadobam, aseve sibrazem SeiZleba Tavi iCi-
fobiebi gavrcelebuli movlenaa janmrTel bavSvebSi, nos mravali sxvadasxva saxis darRvevis dros, ris ga-
xolo mozardebTan da zrdasrul adamianebTan ufro moc erTsac da meoresac diagnozis dasmisas mcire
naklebi sixSiriT iCens Tavs. fobiis simptomebi nebi- mniSvneloba eniWebaT. Tumca, gaRizianebadobasa da
smieri saxis SfoTviTi aSlilobis dros gvxvdeba, ma- sibrazes didi mniSvneloba aqvs riskis Sefasebisa da
gram isini ufro fobikuri aSlilobis mTavar maxasi- riskis marTvis dros, ramdenadac SesaZlebelia, rom
aTeblebs warmoadgens. maTi arseboba TviT pacientisTvis an sxva pirisT-
vis zianis miyenebis saSiSroebas Seicavdes (Tavi 3).
depresia gaRizianebadoba SeiZleba Tan axldes SfoTviT aSli-
depresia aris normaluri reaqcia raime danakarg- lobas, depresias, manias, demencias da medikamentur
ze an ubedurebaze. aseT SemTxvevaSi mas glovas an intoqsikacas.
dards uwodeben. depresia maSinaa anomaliuri, rode-
_6_
aRqmis paTologia uri ganaTebis pirobebSi (mag., deliriumis mqone ada-
specifikuri saxis aRqmis darRvevebi mZime fsiqikuri mianebTan). rogorc normaluri mdgomareobis, aseve
aSlilobis simptomebs warmoadgens. aqedan gamomdin- deliriumis drosac, iluziebis gaCenis albaToba
are, mniSvnelovania, SegveZlos am simptomebis iden- ufro maRalia maSin, rodesac pirovneba SfoTvas gan-
tificireba da maTi gamocalkeveba sxva, naklebad icdis. amitom bnel quCaSi buCqis konturs adamianad
mniSvnelovani da gavrcelebuli cvlilebebisagan, ufro SeSinebuli pirovneba aRiqvams, vidre mSvid md-
romlebic sensorul darRvevebSi vlindeba. swored gomareobaSi myofi.
amitom, aRqmiTi fenomenebi ufro detalurad iqneba halucinaciebi
aRwerili.
halucinacia uobieqto aRqmaa, romelic grZnobaTa
aRqma da xati organoebis mier iseTive xarisxiT ganicdeba, rogorc
aRqma aris grZnobaTa organoebis meSveobiT miRebuli realurad arsebuli obieqtis zemoqmedeba. iluziisa-
informaciis Secnobis procesi. magram igi ar aris gan gansxvavebiT igi aRiqmeba, rogorc gare samyaros
grZnobaTa organoebis mier mowodebuli monacemebis an pirovnebis sxeulidan (da ara warmosaxvidan) wa-
uSualo asaxva, radganac maTze zemoqmedebs kognitu- mosuli impulsi. halucinaciis gaqroba survilze ar
ri procesebi, romlebic axdens monacemTa konstru- aris damokidebuli.
irebas da qmnis sqemebs, romelTa mixedviTac xdeba halucinacia umetes SemTxvevaSi mniSvnelovan fsiqi-
obieqtis aRqma. Cven SegviZlia Tvalyuri vadevnoT an kur aSlilobaze miuTiTebs. rogorc amas qvemoT vnax-
ignorireba gavukeToT aRqmis process, magram nebi- avT, sxvadasxva tipis darRvevas specifikuri haluci-
syofis ZalisxmeviT misi Sewyveta SeuZlebelia. naciebi axasiaTebs. Tumca, halucinaciebma SeiZleba
xati aris aRqmis obieqtis asaxva, romelic gonebaSi janmrTel adamianebSic iCinos Tavi, rac, Cveulebriv,
warmoiqmneba. is SeiZleba gamoviwvioT an gavaqroT CaZinebisas (hipnogogiuri halucinaciebi) an gamoRvi-
nebisyofis ZalisxmeviT. xatebi, aRqmis obieqtebisa- Zebisas (hipnopompiuri halucinaciebi) xdeba. halu-
gan gansxvavebiT, ganicdeba rogorc iseTi ram, rac cinaciis es ori saxeoba SeiZleba mxedvelobiTic iyos
realur mniSvnelobas aris moklebuli. ase rom, da smeniTic. smeniTi halucinaciis dros adamians
janmrTel adamians SeuZlia xati aRqmis obieqtisa- zogjer iseTi gancda eufleba, rom mas viRac eZaxis.
gan ganasxvavos. zogierTi adamiani aRiqvams eidetur amgvari halucinaciebi gavrcelebulia narkolefsiis
xats. es aris vizualuri xati, romelic imdenad in- dros. zogierT adamians, romelmac axlaxan dakarga
tensiuri da detaluria, rom igi fotografiulad
asaxavs aRqmis obieqts, Tumca, sxva mxriv, misgan
cxrili 1.1 halucinaciebis aRwera
gansxvavdeba. Cveulebriv, xati aRqmis procesis daw-
yebisTanave qreba, magram zogjer is aRqmis obieqtis sirTulis mixedviT
paraleluradac ganagrZobs arsebobas (im SemTxvevaSi, w martivi
Tu obieqti susti da arastruqturirebulia). aseTi
w rTuli
tipis xats pareidolia ewodeba.
aRqmis Sinaarsi SeiZleba icvlebodes rogorc in- SegrZnebis modalobis mixedviT
tensivobis mixedviT, ise Tvisobrivadac. adamianebi, w smeniTi
romlebsac SfoTva axasiaTebT SegrZnebebs Cveu- w mxedvelobiTi (vizualuri)
lebrivze ufro mZafrad ganicdian. mag., pirovneba w ynosviTi da gemovnebiTi
SeiZleba uCveulod mgrZnobiare iyos xmauris mimarT. w somaturi (taqtiluri da visceraluri)
maniis dros aRqmis Sinaarsebi Cveulebrivze ufro
specialuri maxasiaTeblebis mixedviT
mkveTria, xolo depresiis dros ki SeiZleba, piriqiT
_ mkrTali da usicocxlo iyos. w smeniTi
w meore piris
iluziebi w mesame piris
iluzia garegani stimulis mcdar aRqmas warmoadgens. w Gedankenlautwerden
is aRmocendeba maSin, rodesac sensoruli stimula- w cho de la pense
ciis zogadi done daqveiTebulia da yuradReba ar w mxedvelobiTi
aris fokusirebuli relevantur sensorul modalo- w eqstrakampinuri
baze. mag., sibneleSi buCqis konturi Tavidan SeiZleba avtoskopiuri halucinacia
adamianad aRiqmebodes (Tu yuradReba ar aris kon-
refleqtoruli halucinacia
turze fokusirebuli). iluziebi SeiniSneba cno-
bierebis donis daqveiTebis drosac, Tundac normal- hipnogogiuri da hipnopompiuri halucinaciebi
_7_
axlobeli, gardacvlili pirovnebis halucinacia aR- autoskopiuri halucinaciis dros pacienti xan-
eniSneba. halucinaciebi SeiZleba dafiqsirdes senso- mokle drois manZilze Tavis sxeuls xedavs gare
ruli deprivaciis Semdeg; periferiuli warmoSobis sivrceSi proecirebulad, Cveulebriv, sakuTari Tavis
siyruis an sibrmavis mqone adamianebTan; nevrologi- win. sensoruli deprivaciis dros aseTi saxis gamoc-
uri darRvevebisas, romlebic gavlenas axdens mxedv- dilebas, xandaxan, janmrTeli adamianebic aRweren.
elobiTi gadacemis gzebze da, agreTve, epilefsiisa aseT gancdas sxeulis miRma yofnis gancdas uwode-
(Tavi 14) da Sarl bones sindromis dros. ben. autoskopiuri halucinaciebi adamianebs serio-
zuli avariis an guli Setevis Semdegac aReniSnebaT
halucinaciis tipebi
(orive SemTxvevaSi adamians iseTi gancda aqvs, TiTqos
halucinaciebi SeiZleba aRvweroT maTi sirTulisa da sikvdils TvalebSi Caxeda). iSviaT SemTxvevaSi, aseTi
sensoruli modalobebis mixedviT (cxrili 1.1). sir- gamocdilebis dros, pacienti SeiZleba darwmunebuli
Tulis mixedviT arsebobs martivi da rTuli haluci- iyos, rom mas oreuli hyavs (Doppelganger).
naciebi. martivi smeniTi halucinaciis dros, adamians refleqtoruli halucinaciebi iSviaTi fenomenia,
esmis xmauri (mag. jaxunis xmebi) an stvena, xolo rTu- romlis drosac erTi romelime modalobis stimuli
lis dros _ xmebi an musika; martivi mxedvelobiTi meore modalobaSi iwvevs halucinacias. mag., musikam
halucinaciis dros, adamiani xedavs sinaTlis gaelve- SeiZleba mxedvelobiTi halucinaciebi gamoiwvios.
bas, xolo rTuli dros _ adamianebis saxeebs an sx-
vadasxva scenebs. halucinaciebis klinikuri gamoxatuleba
smeniTi halucinaciebis dros adamians SeiZleba halucinaciebs vxvdebiT sxvadasxva saxis darRvevebi-
esmodes xmauri, musika an xmebi. xmebi SeiZleba iyos sas, gansakuTrebiT Sizofreniis, mwvave afeqturi
mkveTri an bundovani da mas sityvebis, frazebis an aSlilobis, organuli darRvevebisa da disociaciuri
winadadebebis forma hqondes. isini SeiZleba pirdapir mdgomareobebis dros. amitomac, halucinaciis ar-
pacients mimarTavdnen (meore piris halucinaciebi) sebobis dadgena TavisTavad didad ver dagvexmareba
an erTmaneTSi saubrobdnen da pacients mesame pirSi diagnozis dasmaSi. Tumca, halucinaciis tipebs, rom-
ixseniebdnen (mesame piris halucinaciebi). zogjer lebsac qvemoT ganvixilavT, didi mniSvneloba aqvs
pacienti ambobs, rom xmebma winaswar ician is, ris diagnostikisTvis:
gafiqrebasac is cota xnis Semdeg apirebs. zogjer w smeniTi halucinaciebi. diagnostikisTvis mniS-
xmebi pacientis fiqrebs paralelurad axmovaneben vnelovania mxolod naTlad gamoxatuli xmebi (da ara
(Gedankenlautwerden) an imeoreben imas, rac pacientma xmauri an musika). mesame piris halucinaciebi (ix. ze-
cota xnis win gaifiqra (cho de la pense). moT) mWidrod aris dakavSirebuli SizofreniasTan.
mxedvelobiTi halucinaciebi SeiZleba iyos martivi aseTi saxis xmebi SeiZleba ganicdebodes, rogorc
da rTuli, xolo halucinaciis obieqtis zomis mixed- pacientis ganzraxvaTa an qmedebaTa komentari (mag.,
viT _ normaluri an anomaliuri. iseT halucinacias, `mas unda am qalTan sqesobrivi kavSiris damyareba~
romlis drosac pirovnebas juja figurebi eCveneba, an ìs pirs ibans~). garda amisa, xmebs SeiZleba kri-
zogjer liliputurs uwodeben. xandaxan pacienti tikuli SeniSvnebis saxec hqondeT. meore piris smen-
aRwers mxedvelobiT halucinacias, romlis drosac iTi halucinaciebi (xmebi, romlebic Tavad pacients
is raimes an vinmes sakuTari mxedvelobis aris miRma, mimarTaven) ar miuTiTebs romeliRac konkretul
Cveulebriv, Tavs ukan xedavs (eqstrakampinuri halu- diagnozze, Tumca maTi Sinaarsi da pacientis reaq-
cinaciebi). cia SeiZleba garkveul miniSnebas iZleodes. ase mag.,
ynosviTi da gemovnebiTi halucinaciebi xSirad er- Seuracxmyofeli Sinaaris mqone xmebi (`Sen uiRblo
Tad ganicdeba. suni da gemo umetes SemTxvevaSi usia- xar, Sen garyvnili xar~) mZime depresiul darRvevaze
movnoa. miuTiTebs, gansakuTrebiT maSin, rodesac pacienti
taqtiluri halucinaciebis dros, romelsac am Sefasebebs samarTlianad miiCnevs. SizofreniiT
zogjer haptur halucinaciebs uwodeben, adamiani daavadebul pacientebSi aseTi komentarebi ufro
SeiZleba grZnobdes Sexebas, Cxvletas an daxrCobas. xSirad aRSfoTebas iwvevs. Sizofreniaze migvaniS-
zogjer SeiZleba iseTi SegrZneba hqondes, TiTqos mis nebs iseTi xmebic, romlebic winaswar ganWvrets, ba-
kanqveS raRac moZraobs, rasac pacienti tansacmlis Zavs an imeorebs pacientis azrebs.
qsovilSi damalul mwerebs, Wiebs an sxva mcire zomis
w mxedvelobiTi halucinaciebi yovelTvis zrdis or-
qmnilebebs miawers. visceraluri SegrZnebebis halu-
ganuli darRvevebis arsebobis albaTobas. Tumca,
cinaciebis dros SeiZleba pacients eCvenebodes, rom
gvxvdeba mwvave afeqturi aSlilobis, Sizofreniis
Sinagani organoebi gawelili an daberili aqvs. aseve
da disociaciuri aSlilobis drosac. vizualuri
SesaZloa, aReniSnebodes sasqeso organoebis stimu-
halucinaciis Sinaarsi arcTu ise mniSvnelovania di-
laciis an eleqtroSokis SegrZnebebi.
_8_
agnozis dasadgenad. autoskopiuri halucinaciebi azrovnebis paTologia
aseve miuTiTebs organuli darRvevebis (mag., safeTq- fsiqiatriaSi azrovnebisa da asociacuri procesis
lis wilis epilefsiis) arsebobis SesaZleblobaze. darRvevebi diagnostikuri TvalsazrisiT yvelaze
w ynosviTi da gemovnebiTi halucinaciebi iSviaTad ufro mniSvnelovan simptomebad aris miCneuli. ami-
gvxvdeba. isini SeiZleba aRiniSnebodes Sizofre- tom, aRqmis darRvevebis msgavsad, aRweriTi fsiqopa-
niis, mZime depresiuli darRvevebis da safeTqlis Tologiis es sferoc ufro detalurad ganxilvas
wilis epilefsiis dros. agreTve, iseTi simsivnis saWiroebs. aseTi darRvevebi ori tipis fenomenebs
SemTxvevaSi, romelic gemovnebiT receptorebze mo- ukavSirdeba. esenia:
qmedebs. 1. Tavad azrovnebis paTologia, rac warmoadgens
w taqtiluri da somaturi halucinaciebi Sizofre- cvlilebas calkeuli azrebis bunebaSi. bodvis ti-
niaze migvaniSnebs, gansakuTrebiT maSin, Tu maTi Si- pis gansazRvra gansakuTrebiT mniSvnelovania. az-
naarsi an interpretacia ucnaria. kanqveS mwerebis rovnebis paTologia mocemul TavSia ganxiluli.
cocvis SegrZneba (formikacia) aqvT adamianebs, 2. asociaciuri procesis darRvevebi, rac moicavs
romlebic borotad iyeneben kokains. azrovnebisa da sxvadasxva azrebis erTmaneTTan
dakavSirebis process. am dros SeiZleba dairRves
fsevdohalucinaciebi
calkeuli azrebis urTierTdakavSirebis siswrafe
es termini miuTiTebs gamocdilebaze, romelic halu- an forma. es fenomenebi momdevno TavSia ganxiluli.
cinaciebis msgavsia, magram ar akmayofilebs misi
definiciis yvela moTxovnas. am termins ori gansx- bodva
vavebuli mniSvneloba aqvs da arc erTi maTgani ar bodva aris myari rwmena, romelsac araadekvaturi
pasuxobs `namdvili~ halucinaciis kriteriumebs. safuZveli aqvs. masze ar zemoqmedebs racionaluri ar-
pirveli mniSvnelobis mixedviT, fsevdohalucinacia gumentebi da faqtebi, romlebic sapirispiro viTarebaze
aris sensoruli gamocdileba, romelic namdvili miuTiTebs. aseTi rwmena atipiuria mocemuli pirovnebi-
halucinaciisagan Semdegi niSniT gansxvavdeba: paci- sTvis, romelsac garkveuli saxis ganaTleba aqvs da
entisTvis halucinacia ar miekuTvneba gare sinamd- garkveuli kulturisa da religiis warmomadgenelia. am
viles anu is lokalizebulia gonebaSi da ara gare gansazRvrebis mizania ganvasxvavoT erTmaneTisagan bod-
samyaroSi. am mxriv fsevdohalucinaciebi hgavs war- viTi idea, romelic mZime fsiqikuri aSlilobis ZiriTad
mosaxviT xatebs, magram, maTgan gansxvavebiT, nebisyo- simptoms (konkretulad fsiqozis simptoms) warmoadgens,
fis ZalisxmeviT fsevdohalucinaciis gaqroba Seu- sxva tipis paTologiuri azrebisagan da im mtkiced dam-
Zlebelia. meore mniSvnelobis mixedviT, sensoruli kvidrebuli rwmenebisagan, romlebsac janmrTel ada-
gamocdileba TiTqos gare samyarodan momdinareobs, mianebTan vxvdebiT. garkveuli problemebis arsebobis
magram pacientma icis, rom is realobas ar Seesabam- miuxedavad (ix, boqsi 1.1), mocemuli gansazRvreba (ro-
eba. sakiTxis ufro detaluri ganxilva ixileT hares- gorc amosavali wertili) sakmarisia imisTvis, rom bod-
Tan da teilorTan (Hare 1973; Taylor, 1981). vis fenomeni ufro detalurad ganvixiloT.
klinikuri TvalsazrisiT rTulia fsevdohaluci- bodvis kidev erTi damaxasiaTebeli Tviseba (ro-
naciebis am orive ganmartebis gamoyeneba, radgan pa- melic ar Sedis mocemul ganmartebaSi) aris is, rom
cientebi TavianTi gamocdilebis detalurad aRweras igi, mtkiced dafiqsirebuli normaluri rwmenis ms-
iSviaTad axerxeben. miuxedavad amisa, Cveulebriv, gavsad, mniSvnelovnad zemoqmedebs pirovnebis grZno-
mainc SesaZlebelia imis garkveva, warmoadgens Tu ara bebsa da qcevaze. qceviTi reaqcia bodvaze SeiZleba
mocemuli perceptuli gamocdileba namdvil haluci- Tavad iyos Seusabamo da zogjer ucnauric ki. amis
nacias, ramdenadac mxolod es ukanaskneli aris diag- gamo, xSirad swored es qceviTi reaqciaa fisiqi-
nostikuri mniSvnelobis matarebeli. Tu gamocdileba atris yuradRebis upirvelesi sagani, radgan is bod-
halucinacias ar warmoadgens, is aucileblad unda vis gamovlenis saSualebas iZleva. mag., mamakacma,
iqnes aRwerili, magram misi, rogorc ama Tu im saxis romelsac hqonda bodviTi idea, rom mas akustikuri
fsevdohalucinaciis, identificireba ar aris saWiro. talRebiT asxiveben, Tavisi fanjara vercxlis fol-
giT dafara da Semosasvleli karebi Caxerga. Tumca,
aRqmis obieqtisTvis miwerili mniSvnelobis zogjer bodviTi ideebi mcire zegavlenas axdes emo-
anomaliuroba ciebsa da qcevebze. mag., pacients SeiZleba sjerodes,
bodviTi aRqma warmoadgens bodvas, romelic uSua- rom is samefo ojaxis wevria da amave dros kmayofili
lod gamomdinareobs aRqmuli obieqtisagan. zogjer iyos saerTo sacxovrebelSi cxovrebiT. amgvar gaore-
mas SecdomiT perceptul darRvevad miiCneven, Tumca bas ormagi orientacia ewodeba da is, Cveulebriv,
realurad is azrovnebis darRvevas warmoadgens da qronikuli Sizofreniis dros iCens Tavs.
amitom Semdeg qveTavSia ganxiluli.
_9_
boqsi 1.1 bodvis ganmartebasTan bodva ar warmoadgens rwmenas, romelsac imave kulturaSi
sxva warmomadgenlebic iziareben. es kriteriumi mniSv
dakavSirebuli problemebi nelovania maSin, rodesac pacienti romelime kulturis
an qvekulturis (religiuri jgufis CaTvliT) wevria,
bodva aris myari Sexeduleba, romelic ar eqvemdebareba
radganac aseT jgufebSi janmrTeli adamianebic SeiZleba
koreqcias da romlis mimarT adamiani ar aris kritikuli.
iziarebdnen iseT rwmenas, romelic am jgufis gareT
bodvis ganmasxvavebeli niSania, rom igi gamyarebulia rwmeniT,
ar aris miRebuli. bodvis msgavsad, aseTi kulturiT
romlis Secvlac sawinaaRmdego faqtebiT SeuZlebelia.
gapirobebuli rwmena Cveulebriv, Znelad icvleba
magaliTad, im pacientis gadarwmuneba, romelsac aqvs
sawinaaRmdego faqtebisa da safuZvliani argumentebis
bodva, rom mezobel saxlSi cxovroben adamianebi, romlebic
meSveobiT (magaliTad, rwmena boroti sulebis arsebobis
mas devnian, SeuZlebelia imis mtkicebiT, rom es saxli
Sesaxeb). amitom, sanam gadavwyvetT, warmoadgens Tu
carielia. amis sapasuxod man SeiZleba Tqvas, rom mdevrebma
ara romelime mosazreba bodvas, mniSvnelovania, jer
saxli manamde datoves, sanam mas Seamowmebdnen. bodvis es
davadginoT, iziareben Tu ara am Sexedulebas imave
kriteriumi imitomaa rTuli, rom normaluri adamianebis
kulturis sxva warmomadgenlebi.
zogierTi warmodgenac zustad aseve mdgradia sapirispiro
mtkicebulebis mimarT. magaliTad, mtkice spiritualistis bodva, rogorc mcdari Sexeduleba. bodvis zogierTi
rwmenebs ver Searyevs skeptikosis kontrargumentebi. Zlierad ganmarteba gviCvenebs, rom is mcdar rwmenas (Sexedulebas)
fiqsirebul arabodviT Sexedulebebs zeRirebulovani ideebi warmoadgens. Tumca, es kriteriumi ar Sedis zemoT
ewodeba (ix. qvemoT). mocemul ganmartebaSi, radgan gansakuTrebul viTarebebSi
bodvis ganmartebis kidev erTi problema parcialuri bodviTi ideebi SeiZleba simarTles Seesabamebodes an
bodvaa. miuxedavad imisa, rom, Cveulebriv, bodva SemdgomSi aRmoCndes swori. amis sayovelTaod cnobili
aRmocenebisTanave myari rwmenaa, zogjer mas Tavidan magaliTia paTologiuri eWvianoba. amgvarad, TviT
garkveuli eWvi axlavs. garda amisa, gamojanmrTelebis Sexedulebis simcdare ki ar aris imis kriteriumi,
procesSi pacienti arcTu ise iSviaTad gadis iseT warmoadgens Tu ara es Sexeduleba bodviT ideas, aramed
etaps, rodesac mas sul ufro da ufro metad epareba im fsiqikuri procesis xasiaTi, romelmac adamiani am
eWvi sakuTari bodviTi warmodgenis sisworeSi, sanam Sexedulebamde miiyvana (am debulebis sirTule aris is,
sabolood ganTavisufldeba misgan. termini `parcialuri rom Cven ar SegviZlia amgvari fsiqikuri procesebis
bodva~ eWvis am orive variantze miuTiTebs. es termini zustad gansazRvra). arsebobs `simcdaris~, rogorc
gamojanmrTelebis procesis konteqstSi mxolod maSin bodvis kriteriumis gamoyenebasTan dakavSirebulis,
gamoiyeneba, rodesac cnobilia, rom pacientis arsebul kidev erTi praqtikuli xasiaTis problema, rac imaSi
Sexedulebebs win myari bodviTi azrebi uZRoda. amasTan, mdgomareobs, rom am kriteriumis gamoyenebisas, Cven
am termins bodvis Camoyalibebis mimarT mxolod maSin SeiZleba vivaraudoT, rom mocemuli Sexeduleba mcdaria
viyenebT, rodesac retrospeqtulad cnobilia, rom misi Zalian dabali albaTobis gamo. am varauds susti
bodviTi ideebi mogvianebiT Camoyalibda. calke aRebuli safuZveli aqvs, radgan zogierTi, viTomda dabali
parcialuri bodva, fsevdohalucinaciebis msgavsad, albaTobis mqone istoria (mag., mezoblebis mxridan
diagnozis dasasmelad ar gamodgeba. adamianis devna), SeiZleba zogjer swori aRmoCndes da
am daskvnamde pirovneba zusti dakvirvebisa da logikuri
bodvas araadekvaturi safuZvli aqvs. bodva ar warmoadgens
azrovnebis gziT iyos misuli. amitom, pirovnebis ideebi
dakvirvebisa da logikis procesis Cveulebriv Sedegs.
da rwmeniTi warmodgenebi Zalian safuZvlianad unda
zogierTi bodva uecrad, saganze yovelgvari winaswari
SeviswavloT manam, sanam maT bodvad miviCnevT.
fiqris gareSe, iCens Tavs (pirveladi bodva, ix. qvemoT).
zogierTi bodva Tavs iCens, rogorc sxva, anomaluri
gamocdilebis axsnis mcdeloba. amis magaliTia bodva, es sakiTxebi Semdeg wyaroebSia ganxiluli: Spitzer, 1990;
romlis mixedviT xmebi, romelic pacients esmis, ekuTvnis Butler and Braff, 1991.
im adamianebs, romlebic mas uTvalTvaleben.
bodvis tipebi aRqma iyos (ix. qevemoT). radganac pacients uWirs ase-
Ti uCveulo da usiamovno fsiqikuri movlenis zusti
zogierTi tipis bodviTi ideebis amocnoba da katego-
Tanmimdevrobis damaxsovreba, xSirad Znelia darw-
rizacia maTi maxasiaTeblebisa da Tematikis mixedviT
munebiT iTqvas, Tu romeli gamocdileba iCens Tavs
xdeba (cxrili 1.2). bevri termini mxolod aRwerisT-
pirvelad. pirvelad bodvas didi mniSvneloba eniWeba
vis aris gamosadegi, Tumca zogierT maTgans gansa-
Sizofreniis diagnostirebisas da is mxolod maSin
kuTrebuli diagnostikuri mniSvneloba aqvs. damate-
unda dafiqsirdes werilobiT, rodesac danamdvile-
biTi informaciisTvis ixileT simsi (Sims, 2003).
biT SegviZlia misi arsebobis dadastureba.
pirveladi da meoradi bodva meoradi bodva aSkarad wina avadmyofuri gamoc-
pirveladi anu avtoqtonuri bodva yovelgvari winms- dilebidan momdinareobs da SeiZleba saxvadasxva sax-
wrebi fsiqikuri movlenis gareSe, uecrad da sruli is iyos. is SeiZleba moicavdes: halucinaciebs (mag.,
darwmunebulobiT iCens Tavs. mag., SizofreniiT daa- adamians, romelsac xmebi esmis, SeiZleba sjerodes,
vadebulma pacientma SeiZleba uecrad, yovelgvari rom mas devnian), daqveiTebul guneb-ganwobas (mag.,
winmswrebi mizezisa da fiqrebis gareSe, irwmunos, qals, romelsac Rrma depresia aqvs, SeiZleba sje-
rom mas sqesi Seecvala. pirveladi bodva yovelTvis rodes, rom adamianebi mas arafris maqnisad miiCneven)
azrebis gaCeniT ar iwyeba. zogjer pirveladi gamoc- an bodviT ideas (mag, adamians, romelic darwmunebu-
dileba SeiZleba bodviTi guneb-ganwyoba an bodviTi lia, rom irgvlivmyofebi mas usamarTlod amtyune-
_ 10 _
pacients mis winaTgrZnobas usabuTebs. germanulad
cxrili 1.2 bodvis aRwera am winmswreb guneb-ganwyobas Wahnstimmung ewodeba.
fiqsirebulobis mixedviT (ix. boqsi 1.1) es termini Cveulebriv, iTargmneba rogorc bodviTi
w sruli guneb-ganwyoba, Tumca, realurad, es aris guneb-ganw-
w parcialuri yoba, saidanac bodva aRmocendeba.
w sruli
w nawilobrivi bodviTi aRqma
aRmocenebis mixedviT
zogjer, kargad nacnobi aRqmis obieqtisTvis yovel-
w pirveladi gvari mizezis gareSe axali mniSvnelobis miniWeba
w meoradi pirvelad anomaliur gamocdilebas warmoadgens. mag.,
sawer magidaze werilebis ganlageba SeiZleba pacien-
sxva bodviTi gamocdilebebi
tis mier interpretirebuli iqnes rogorc niSani imi-
w bodviTi guneb-ganwyoba
sa, rom is male mokvdeba. aseT gamocdilebas bodviTi
w bodviTi aRqma
aRqma ewodeba. aRsaniSnavia, rom am dros Tavad aRqma
w bodviTi mexsiereba
normaluria. anomaliuri misi bodviTi interpreta-
Tematikis mixedviT ciaa.
w devnis (paranoiduli) bodva
w damokidebulebis bodva mcdari bodviTi identifikacia
w gandidebis (eqspansiuri) bodva es aris sakuTari Tavis an sxva adamianebis mcdari
w danaSaulis bodva bodviTi identifikacia. aRwerilia misi ramdenime
w nihilisturi eponimuri forma, romlebic simptomebad da sin-
w ipoqondriuli dromebad aris gamoyofili. mcdari bodviTi identi-
w religiuri
fikaciis aSliloba mecamete TavSi swored am pozi-
w eWvianobis
cidanaa ganxiluli.
w seqsualuri an siyvarulis
w zemoqmedebis bodva bodviTi mexsiereba
w bodva, romelic azrebis mikuTvnebulobas exeba
bodviTi mexsierebis dros bodviTi interpretacia
w azrebis Canergva
warsulSi momxdar movlenasTan aris dakavSirebuli.
w azrebis warTmeva
bodviTi mexsierebis ufro gavrcelebuli formis
w azrebis gaxmovaneba
SemTxvevaSi warsulSi momxdari faqti sinamdviles
sxva maxasiaTeblebis mixedviT Seesabameba, xolo sityva `bodviTi~ miuTiTebs im
w gaziarebuli/inducirebuli bodva mniSvnelobaze, romelic am faqts axla miewera. mag.,
pacients, romelsac sjera, rom amJamad viRac apir-
ben da gmoben, SeiZleba sjerodes, rom daapatimre- ebs mis mowamvlas, SeiZleba sworad axsovdes, rom mas
ben). zogierT meorad bodvas, rogorc Cans, gaaCnia pirRebineba hqonda sakvebis miRebis Semdeg (rac re-
integraciuli funqcia _ ufro naTeli gaxados pa- alurad moxda fsiqozis dawyebamde didi xniT adre),
cientisTvis misi pirveladi gamocdileba (rogorc xolo axla mcdarad askvnides, rom is ganzrax mowam-
es pirvel magaliTSia mocemuli). sxva tipis bodva ki les. amis sawinaaRmdegod, uecari (avtoqtonuri) bod-
piriqiT _ aZlierebs devnisa da marcxis gancdas, ro- vis dros pacienti ararsebul faqts warsulSi momx-
gorc es mesame magaliTSia mocemuli. meoradi bod- dar movlenad miiCnevs. es ukanaskneli SeiZleba gan-
viTi ideebi SeiZleba akumulirdes iqamde, sanam rTul vixiloT, rogorc WeSmariti bodviTi mexsiereba (anu,
da stabilur bodviT sistemad ar Camoyalibdeba. aseT Tavad mexsierebis Sinaarsi warmoadgens bodvas) maSin,
bodvas sistematizirebuls uwodeben. rodesac pirvel SemTxvevaSi mexsierebis Sinaarsi
normaluria, magram pacienti mis bodviT interpre-
bodviTi guneb-ganwyoba
tacias axdens.
rodesac bodviTi idea pirvelad iCens Tavs, pacien-
ti am faqtze emociurad reagirebs. mag., pirovneba, inducirebuli bodva
romelsac sjera, rom adamianebis jgufs misi mokvla rogorc wesi, adamianebi bodviT ideebs Secdomad
aqvs gadawyvetili, Cveulebriv SiSs ganicdis. zogjer aRiqvamen. isini ekamaTebian avadmyofs da cdiloben,
bodvas win uZRvis guneb-ganwyobis Secvla. aseTi gun- Seusworon mas. zogjer, pirovneba, romelic aseT
eb-ganwyoba xSirad imis winaswari gancdaa, rom male, pacientTan erTad cxovrobs, misi bodviTi ideebis
jer kidev daudgeneli, avismomaswavebeli ram mox- gaziarebas iwyebs. aseTi viTareba kvalificirdeba
deba. rodesac aseTi bodva aRmocendeba, is TiTqos rogorc inducirebuli bodva anu folie deux. erTad
_ 11 _
cxovrebis periodSi am pirovnebis bodviTi idea ise- amajerebeli istoriebi zogjer sinamdviles Seesabam-
Tive Zlieria, rogorc pacientis, magram xSirad, maTi eba. aseve, unda gvaxsovdes, rom zogierT kulturaSi
daSorebis Semdeg, swrafadve qreba. daSvebuli da savsebiT normaluria sakuTari ubedru-
rebisa da marcxis axsna sxva adamianis mier ganxor-
bodvis Sinaarsi
cielebuli boroti qmedebebiT _ mag., jadoqrobiT.
klinikuri muSaobis dros sasargebloa bodviTi
ideebis dajgufeba mTavari Temebis mixedviT, radgan damokidebulebis bodva
maT garkveuli diagnostikuri mniSvneloba gaaCniaT. damokidebulebis bodviTi ideebis arsebobisas pacienti
Tumca, kargi iqneba, Tu manamde termin `paranoiduls~ obieqtebs, movlenebs an adamianebs, romelTac masTan
ganvixilavT. miuxedavad imisa, rom am termins xSirad aranairi kavSiri ara aqvT, sakuTar Tavs ukavSirebs. mag.,
iyeneben, misi mniSvneloba yovelTvis naTeli ar aris pacients SeiZleba sjerodes, rom gazeTSi gamoqveynebu-
(boqsi 1.2). li statia an televiziiT gakeTebuli gancxadeba uSua-
lod mas exeba _ an Tavad mas atyobinebs raimes, an sxvebs
devnis bodva
awvdis informacias mis Sesaxeb. damokidebulebis bodvis-
devnis bodva yvelaze ufro xSirad ukavSirdeba as sxva adamianis qmedeba an misi Jestikulacia pacientis
pirovnebebs an organizaciebs, romlebic, avadmyofis mier sakuTari Tavis Sesaxeb Setyobinebad aRiqmeba. mag.,
azriT, cdiloben, raime avnon mas, Selaxon misi repu- pacientma SeiZleba CaTvalos, rom adamiani, romelic
tacia an daaavadon igi. aseTi tipis bodva sakmaod Tmaze xels ikidebs, signals aZlevs mas, rom igi qalad
gavrcelebulia, magram nakleb diagnostikuri mniSvn- gadaiqces. miuxedavad imisa, rom damokidebulebis bod-
eloba aqvs, vinaidan gvxvdeba rogorc Sizofreniis, vis umetesoba devnasTan aris dakavSirebuli, zogjer
aseve organuli mdgomareobebisa da afeqturi paTol- gandidebis an darwmunebis Temebsac CairTavs.
ogiebis drosac. miuxedavad amisa, diagnozis dasmisas
bodvis mimarT pacientis damokidebulebas SeiZleba gandidebis bodva
garkveuli mniSvneloba hqondes. depresiis dros pa- gandidebis bodva sakuTar Tavze gazviadebul war-
cientisTvis, romelsac devnis bodva aqvs, damaxasi- modgenas gulisxmobs. pacienti SeiZleba fiqrobdes,
aTebelia is, rom mas, mdevaris qmedebebi samarTli- rom is mdidari, uCveulo unarebiT dajildovebuli
anad miaCnia da Tvlis, rom man es sakuTari amoraluri da gamorCeuli adamiania. aseTi ideebi gasakuTrebiT
saqcieliT daimsaxura, maSin, roca Sizofreniis dros maniisa da Sizofreniis dros iCens Tavs.
pacienti aRSfoTebulia aseTi qmedebebiT da maT
ar amarTlebs. devnis bodviTi ideebis Sefasebisas, danaSaulis bodva
aucilebelia, gvaxsovdes zemoT miniSnebuli gafrTx- danaSaulis bodva yvelaze ufro xSirad depresiuli
ileba imis Seaxeb, rom devnasTan dakavSirebuli arad- daavadebebis dros gvxvdeba da amitom mas zogjer
depresiul bodvas uwodeben. aseTi bodvis tipiuri
Temebia: is mciredi ukanonoba, romelic pacientma
boqsi 1.2 termini `paranoiduli~ warsulSi Caidina, momavalSi gamoaSkarvdeba da mas
termins `paranoiduli~ xSirad devnis bodvis ekvivalentad saxels gautexs; an pacientis codvebisTvis misi ojax-
iyeneben. miuxedavad amisa, zusti ganmartebis Tanaxmad, is wevrebi daisjebian.
am termins ufro farTo mniSvneloba aqvs (Lewis,
1970). sityvas `paranoiduli~ Zveli berZnebi `Wkuidan
nihilisturi bodva
gadamcdaris~ ekvivalentad xmarobdnen. magaliTad, am
sityvas hipokrate iyenebda febriluri deliriumis mqone nihilisturi bodva warmoadgens imis rwmenas, rom zo-
pacientebis aRwerisas. mogvianebiT, mravali avtori am gierTma pirovnebam an raime sxva obieqtma ukve Sew-
termins mimarTavda gandidebis, erotikuli, eWvianobis da
religiuri bodvis daxasiaTebisas. miuxedavad imisa, rom yvita an Zalian male Sewyvets arsebobas. amis maga-
istoriuli mosazrebidan gamomdinare, umjobesi iqneboda liTia pacientis bodva iseT Temebze, rom mas ar aqvs
SegvenarCunebina am terminis ufro farTo gageba, axla fuli, rom misi kariera daingra an rom msoflio
mas, Cveulebriv, viwro mniSvnelobiT iyeneben, ra saxiTac
ganadgurebis pirasaa misuli. nihilisturi bodva
es paranoiduli pirovnuli aSlilobis diagnostikur
kategoriaSia mocemuli. radgan termins `paranoiduli~ Tavs iCens mZime depresiis dros. zogjer nihilis-
ori SesaZlo mniSvneloba aqvs, termini `devna~ umjobesia turi bodva sxeulis funqciis darRvevas exeba (mag.,
maSin gamoviyenoT, rodesac `paranoiduls~ viwro
pacients hgonia, rom misi nawlavebi blokirebulia).
mniSvnelobiT vxmarobT. yovelive es, agreTve, gavlenas
axdens am sityvis gamoyenebaze iseTi sindromebis amas xSirad kotaris sindroms uwodeben.
aRwerisas, romlebSic amgvari simptomebi dominireben.
Zveli termini `paranoiduli fsiqozi~ (an `paranoiduli
ipoqondriuli bodva
mdgomareoba~), nawilobriv gaurkvevlobebis Tavidan ipoqondriuli bodva avad yofnis usafuZvlo gancdaa.
acilebis mizniT, axla Secvala terminma `bodviTi
pacients, yovelgvari sawinaaRmdego samedicino mtkice-
aSlilobebi~ (ix. Tavi 13).
_ 12 _
bulebebis miuxedavad sjera, rom raRac sneulebiTaa rom es misi surviliT ar xdeba. Cveulebriv, Sizofre-
daavadebuli. aseTi bodva ufro gavrcelebulia xanSi niis dros sxva simptomebic aRiniSneba.
Sesul adamianebTan da am asakobriv jgufSi janmrTelo-
bis mimarT gazrdil yuradRebas asaxavs. sxva ipoqondri- bodva, romelic azrebis mikuTvnebulobas exeba
uli bodva simsivneebTan an seqsualuri gziT gadamcem TavisTavad cxadia, janmrTelma adamianebma ician,
daavadebebTan aris dakavSirebuli. agreTve, pacienti rom maTi azrebi maTve ekuTvniT; rom maTi azrebis
SeiZleba wuxdes imis Taobaze, Tu rogor gamoiyureba gageba sxva adamianebs mxolod maSin SeuZliaT, Tu
misi sxeulis romelime nawili, gansakuTrebiT cxviri. maT xmamaRla warmoTqvamen, daweren an saxis gamom-
ipoqondriuli bodva unda ganvasxvaoT wuxilisagan etyvelebiT, JestebiT an saqcieliT gamoxataven. bod-
janmrTelobis Taobaze, rasac ipoqondriis dros vx- vis mqone pacientebisTvis es ase ar aris. maT SemTx-
vdebiT da romelic bodvas ar warmoadgens. vevaSi azrebis `~kuTvnilebasTan~ dakavSirebuli sami
bodvidan erTi aRiniSneba. samive mWidrodaa dakav-
Razoianobis (col-qmruli Ralatis) bodva Sirebuli SizofreniasTan.
Razoianobis bodva ufro mamakacebSia gavrcelebuli, w azrebis `Canergva~ aris bodva, romlis drosac zo-
vidre qalebSi. eWvianoba yovelTvis bodva ar aris. eW- gierTi azri pacientis mier aRiqmeba ara rogorc sa-
vianobis naklebi intensivobis gancda da akviatebuli kuTari, aramed gareSe Zalis mier Canergili. xSiria
azrebi Cveulebriv movlenas warmoadgens. Razoianobis masTan asocirebuli ganmartebiTi xasiaTis bodva.
bodva mniSvnelovania imitom, rom man SeiZleba gamoi- mag., mdevari iyenebs radiotalRebs pacientisTvis
wvios agresiuli qmedeba im pirovnebis an pirovnebebis azrebis Casanergad. es gamocdileba ar unda agveri-
mimarT, romlebic, pacientis azriT, moRalateebi os obsesiis mqone pacientis gamocdilebasTan. obse-
arian. Razoianobis bodvis mqone pacienti ar dakmayo- siis mqone pacienti SeiZleba wuxdes iseTi azrebis
fildeba im faqtiT, rom man ver SeZlo Tavisi eWvis gamo, romlebic misi bunebisTvis ucxoa, Tumca, mas
damadasturebeli mtkicebulebis mopoveba da Ziebas arasodes epareba eWvi imaSi, rom es azrebi mas ekuT-
SemdgomSic ganagrZobs. es mniSvnelovani da potenciu- vnis. pacients, romelsac azrebis `Cadebis~ bodva
rad saSiSi fenomenebi mecamete TavSi iqneba aRwerili. aqvs, hgonia, rom es azrebi mas ki ar ekuTvnis, aramed
sxvis mieraa mis gonebaSi Canergili.
seqsualuri an siyvarulis bodva
w azrebis `warTmeva~ (miTviseba) aris bodva, romlis
aseTi tipis bodva iSviaTia da ufro xSirad qaleb- drosac pacients uCndeba gancda, rom mas sakuTar
Si gvxvdeba. seqsualuri bodva zogjer meoradia da azrebs arTmeven. aseT bodvas, Cveulebriv, Tan ax-
sasqeso organoebze dafiqsirebuli somaturi halu- lavs azrovnebis blokireba: pacientis azrovnebis
cinaciebis fonze aRmocendeba. sasiyvarulo bodvis procesSi xdeba uecari wyveta da is fiqrobs, rom
mqone pirovnebas sjera, rom is uyvars adamians, ro- `dakarguli~ azrebi gareSe Zalam miiTvisa. azris
melic realurad misTvis miuwvdomelia da romelsac `Cadebis~ bodvis msgavsad, zogjer, aqac vxvdebiT
xSirad ufro maRali socialuri statusi aqvs. umetes azrebis `warTmevsTan~ asocirebul ganmartebiTi
SemTxvevaSi, pacienti am adamians arc ki dalaparake- xasiaTis bodvas.
bia. siyvarulis (erotikuli) bodva klerambos sin-
w azrebis gaxmovaneba warmoadgens bodvas, romlis
dromis yvelaze ufro TvalsaCino maxasiaTebelia.
drosac pacients sjera, rom misi gamouTqmeli az-
zemoqmedebis bodva rebi SeiZleba cnobili gaxdes sxva adamianisTvis
pacienti, romelsac zemoqmedebis bodva aReniSneba, radiosa da telepatiis meSveobiT an raime sxva
darwmunebulia, rom misi qmedebebi, impulsebi da gziT. agreTve, zogierT pacients sjera, rom misi
azrebi garedan imarTeba. amas, agreTve, pasiurobis azrebi SeiZleba meore adamians esmodes. amgvari
fenomenebs uwodeben. radgan es simptomi didi alba- rwmena, aseve, Tan axlavs gancdas, romlis drosac
TobiT miuTiTebs Sizofreniis arsebobaze da mniS- pacients sjera, rom mis azrebs sxva axmovanebs (Ge-
vnelovania sasamarTlo medicinisTvis, igi werilo- dankenlautwerden), rac zemoT iyo aRwerili.
biT ar unda dafiqsirdes manam, sanam cxadad ar iCens
Tavs. amgvari simptomebi SesaZloa agverios impera- obsesiuri da kompulsuri simptomebi
tiuli halucinaciebisadmi morCilebaSi; religiur obsesiebi
mrwamsSi, rom RmerTi marTavs adamianis qmedebas, an obsesiebi warmoadgens periodulad ganmeorebad per-
nebis Tavisuflebis metaforul SefasebebSi. maTgan sistentul azrebs, impulsebs an xatebs, romlebic,
gansxvavebiT, pacients, romelsac zemoqmedebis bodva miuxedavad maTi SeCerebis mcdelobisa, mainc aRwven
aqvs, mtkiced sjera, rom misi moZraobebi an qmedebebi gonebaSi erT-erTi damaxasiaTebeli Tviseba aris brZo-
gareSe (magram araRvTaebrivi) ZaliT aris marTuli da lis subieqturi gancda _ pacienti winaaRmdegobas uw-
_ 13 _
evs akviatebas, romelic, miuxedavad amisa, mainc iWreba frazebi, romlebic religiur pirovnebas `mosdis
mis gonebaSi. garda amisa, pacienti darwmunebulia, rom TavSi~.
Tu raimeze fiqrob, mosalodnelia rom es realurad w obsesiuri àzrovnebiTi coxna aris ganmeorebadi
moxdes. obsesiuri azrebi sakuTar azrebad ganicdeba Semawuxebeli Temebi, romelTac ufro rTuli xasi-
da pirovneba ar Tvlis, rom isini sxvis mier aris Can- aTi aqvT. mag., azrebi qveynis dasasrulis Sesaxeb.
ergili (azrebis `Cadebis~ bodvisagan gansxvavebiT).
w obsesiuri eWvebi ganmeorebadi Temebia, romlebic
bodvisagan meore mniSvnelovani gansxvavebaa aseve is,
gamoxatavs daurwmuneblobas wina moqmedebasTan da-
rom pirovneba obsesiebs mcdarad da uazrod miiCnevs.
kavSirebiT (mag., gamorTo Tu ara eleqtroaparatu-
es, Cveulebriv, exeba iseT Temebs, razec pacienti wuxs
ra, romelmac SeiZleba xanZari gamoiwvios). rogor-
an rac misTvis usiamovnoa. maT xSirad (magram ara yov-
ic unda iyos eWvis xasiaTi, pirovneba acnobierebs,
elTvis) Tan sdevs kompulsiebi (ix. qvemoT).
rom daurwmuneblobis xarisxi da amiT gamowveuli
is faqti, rom pacienti winaaRmdegobas uwevs Tavis
wuxili arakeTilgonivrulia.
akviatebas, Zalze mniSvnelovania, radgan es, sxva niS-
w obsesiuri impulsebi aris garkveuli qmedebebis Ca-
nebTan erTad (ideis Sesaxeb mudmivi an sruli darw-
denis ganmeorebadi Zlieri survili. Cveulebriv,
munebulobis ararseboba), saSualebas gvaZlevs, obsesia
aseTi qmedebebi agresiuli, saSiSi an socialuri
bodvisagan ganvasxvaoT. Tumca, praqtikaSi maTi erTma-
TvalsazrisiT samarcxvinoa (mag., sxva adamianisTvis
neTisagan gansxvaveba SeiZleba ufro rTuli aRmoCndes,
danis Cartyma, avtobusis win gadaxtoma, eklesiaSi
radgan xangrZlivi obsesiis SemTxvevaSi winaaRmde-
uwmawuri sityvebis wamoZaxeba). rogoric ar unda
gobis gawevis Sesusteba SeiniSneba. garda amisa, rode-
iyos amgvari impulsi, pirovnebas ar aqvs misi ganx-
sac obsesiebi Zalian intensiuria, pacienti SeiZleba
orcielebis survili, Zlier winaaRmdegobas uwevs
naklebad iyos darwmunebuli maT simcdareSi. aqedan
mas da ltolva qmedebaSi ar gadadis.
gamomdinare, guldasmiT Sedgenili avadmyofobis is-
toria, romelic ara marto simptomebs, aramed sxva w obsesiuri fobiebi. es termini aRniSnavs obsesiur
saWiro maxasiaTeblebsac moicavs (mag., kompulsiebs, simptomebs, romlebic, iseve rogorc SfoTva, gan-
fsiqozis sxva gamovlinebebs), Tavidan agvaridebs ridebasTan aris dakavSirebuli. mag., adamianisT-
diagnostikasTan dakavSirebul sirTuleebs. aseve, vis daniT Wrilobis miyenebis obsesiurma impulsma
aucilebelia, ganvasxvaoT klinikuri TvalsazrisiT SeiZleba Sedegad gamoiwvios is, rom pirovnebam
mniSvnelovani obsesiebi da msgavsi azrebi, romle- saerTod Tavi aaridos danis gamoyenebas. zogjer
bic janmrTel adamianebTan iCens Tavs, gansakuTrebiT daavadebebis obsesiur SiSs avadmyofobis fobias
daRlilobis an stresul mdgomareobaSi yofnis dros. uwodeben.
klinikuri TvalsazrisiT mniSvnelovani obsesiis dasa- w obsesiuri Seneleba. pacientebi, romlebsac akviate-
dgenad unda aRiniSnebodes iseTi maCveneblebic, rog- bebi aqvT, xSirad nela moqmedeben, radgan maT kom-
orebicaa disfunqcia da obsesiuri rwmenis mudmivi ar- pulsur ritualebs an ganmeorebad eWvebs didi dro
seboba. obsesiuri simptomebi pirovnebis anankasturi miaqvs da xdeba yuradRebis mTavari miznidan sxva
aSlilobisTvisac aris damaxasiaTebeli. saganze gadatana. miuxedavad amisa, zogjer Senel-
obsesiebs SeiZleba sxvadasxva forma hqondes (cxri- eba araa meoradad am problemebiT gamowveuli, ar-
li 1.3) amed ucnobi warmoSobis pirvelad maxasiaTebels
w obsesiuri azrebi ganmeorebadi da momabezrebeli warmoadgens.
sityvebi an frazebia, romlebic Semawuxebelia paci- aseve mravalferovania obsesiebis Tematika,
entisTvis. mag., uxamsi an RvTis mgmobi, mkrexeluri romelTa umetesoba SegviZlia qvemoT mocemuli eqvsi
kategoriis mixedviT davajgufoT:
cxrili 1.3 obsesiuri da kompulsiuri 1. WuWyi da dabinZureba
simptomebi 2. agresia
obsesiebi 3. wesrigi
w azrebi 4. avadmyofoba
w azrovnebiTi coxna 5. seqsi
w eWvebi
6. religia
w impulsebi
w obsesiuri fobiebi bodvis Sinaarsi
kompulsiebi (ritualebi) azrebi WuWyisa da dabinZurebis Sesaxeb, Cveulebriv,
dakavSirebulia sxva adaminisTvis an sakuTari TavisT-
obsesiuri Seneleba
_ 14 _
vis avadmyofobis gavrcelebis gziT zianis miyenebis w dasufTavebis (gawmendis) rituali xSirad xelebis
ideasTan. agresiuli azrebi SeiZleba asaxavdes ada- ganmeorebiT banas ukavSirdeba, magram SeiZleba sax-
mianisTvis fizikuri Seuracxyofis miyenebas, sazoga- lis samuSaosac moicavdes.
doebaSi agresiulad yvirils an uwmawuri sityvebis w daTvlis rituali garkveuli wesiT daTvlas gu-
wamoZaxebas. wesrigTan dakavSirebuli azrebi sagnebis lisxmobs (mag., sameulebad Tvla). is xSirad daka-
wesrigSi moyvanas an samuSos organizebas exeba. azre- vSirebulia eWvis Semcvel azrebTan _ ramdenjerme
bi, romlebic avadmyofobas ukavSirdeba, Cveulebriv, daTvla aucilebelia raTa davrwmundeT, rom Tv-
SiSis Semcvelia (mag., simsivnis an veneriuli daa- lisas Secdoma ar dagviSvia. Cveulebriv, daTvla
vadebis Zlieri SiSi). obsesiuri ideebi seqsis Sesaxeb, xmamaRla ar xdeba, amitom meore adamianma SeiZleba
Cveulebriv, dakavSirebulia iseT qmedebebTan, rom- ar icodes am ritualis arsebobis Sesaxeb.
lebic pirovnebas samarcxvinod miaCnia. religiasTan
w Cacmis ritualis dros pirovneba alagebs an icvams
dakavSirebuli obsesiebi xSirad imaSi gamoixateba,
tansacmels garkveuli wesiT an TanmimdevrobiT. am
rom adamians uCndeba eWvi fundamentalur sakiTxebSi
rituals xSirad Tan axlavs eWvis Semcveli azrebi,
(mag., àrsebobs Tu ara RmerTi?~) an imis Taobaze, Tu
ris gamoc es qceva usasrulod meordeba.
ramdenad srulad moinania Tavisi codvebi (`sindisis
qenjna~). zeRirebulovani ideebi
kompulsiebi zeRirebulovani ideebi pirvelad 1900 wels, vernikes

mier iqna aRwerili. zeRirebulovani idea aris izoli-
kompulsiebi obsesiis sapasuxo ganmeorebadi, gare-
rebuli, `misaRebi, gasagebi idea, romelic pacients
gnulad mizanSewonili da stereotipuli (kompul-
misi aragonivruli Sinaarsis miuxedavad gaaCnia.~
suri qcevis alternatiuli saxelwodebaa) qcevebia.
(Sims, 2003, 143). mas SeiZleba mravali wlis manZlze
amis gamo maT zogjer kompulsur ritualebs uwo-
wamyvani adgili eWiros adamianis cxovrebaSi da gav-
deben. kompulsiebs yovelTvis Tan axlavs erTis
lenas axdendes mis qmedebebze. amitom zeRirebulo-
mxriv subieqturi gancda imisa, rom qceva aucile-
van ideas bodviTi ideebisTvis damaxasiaTebeli zogi-
blad unda ganxorcieldes da meores mxriv qcevis
erTi Tviseba gaaCnia. miuxedavad amisa, aucilebelia
ganxorcielebisTvis winaaRmdegobis gawevis Zlieri
am ori saxis ideis erTmaneTisagan gansxvaveba, radgan
survili. obsesiebis msgavsad, kompulsiebic uazro-
maT Zalze gansxvavebuli diagnostikuri mniSvneloba
bad aRiqmeba. kompulsia, Cveulebriv, azris Semcveli
gaaCniaT.
obsesiis Sinaarsis fonze xdeba. mag., xelebis xSirad
zeRirebulovani ideebi bodviTi ideebisagan sami
dabanis kompulsia gamowveulia obsesiuri azrebiT,
mTavari niSniT gansxvavdeba:
rom xelebi WuWyiania. zogjer obsesiuri ideebi exeba
im uaryofiT Sedegebs, romlebic kompulsias mohyveba w zeRirebulovani ideis Sinaarsi da safuZveli,
(mag., meore adamians raime ubedureba daemarTeba, Tu Cveulebriv, gasagebia, Tuki cnobilia pirovnebis
kompulsuri qceva àrasworad~ ganxorcielda). kom- cxovrebis istoria, maSin rodesac bodviT ideas
pulsiebma problemebi SeiZleba gamoiwvios ramdenime da mis pacientiseul ganmartebas Cvelebriv ucnau-
mizezis gamo: ri xasiaTi aqvs. mag., pirovneba, romlis jer deda,
xolo Semdeg da avTvisebiani simsivniT daavadda,
w uSualod gamoiwvios ziani (mag., dermatiti, xelis
SeiZleba mivides im daskvnamde, rom avTvisebiani
xSiri banis Sedegad).
simsivne gadamdebia (rac, Zneli gasagebi ar aris).
w xeli SeuSalos normalur cxovrebas, radgan maT-
w zeRirebulovani ideebis Tematika, Cveulebriv, im
Tvis garkveuli drois daTmoba xdeba saWiro.
kulturis warmomadgenlebisTvis, romelsac pa-
w miuxedavad imisa, rom kompulsuri qceva droe- cienti ganekuTvneba, misaRebia da maT mier gazi-
biT aqveiTebs obsesiasTan dakavSirebul SfoTvas, arebulia (mag., sxeulis formasTan dakavSirebuli
sinamdvileSi is xels uwyobs aseTi mdgomareobis zeRirebulovani ideebi, romlebic nervuli anoreq-
SenarCunebas. kompulsiebis Sesustebis strategiebs siisTvis aris damaxasiaTebeli).
centraluri adgili ukavia obsesiur-kompulsuri
w zeRirebulovani ideebis dros, pacients, Cveu-
aSlilobebis biheviorul mkurnalobaSi.
lebriv, gaaCnia survili, Cawvdes Tavisi Sexedule-
arsebobs sxvadasxva saxis kompulsuri qcevebi. maT- bebis bunebas da miiRos gansxvavebuli Tvalsazrisi,
gan, gansakuTrebiT, oTxia mniSvnelovani: Tumca aseTi survili sustia _ pacienti yovelTvis
w Semowmebis rituali, romelic xSirad usafrTxoe- ubrundeba Tavis pirvandel ideebs da inarCunebs
basTan aris dakavSirebuli. mag., araerTgzis Semow- maT.
meba imisa, rom eleqtro xelsawyo gamorTulia an zeRirebulovani ideebi obsesiebisganac unda gan-
kari daketilia. vasxvaoT. zeRirebulovani ideebis gansxvaveba obse-
_ 15 _
siisagan ufro advilia, vidre bodviTi ideebisagan, kvirvebeli pacientis metyvelebaSi uecar wyvetas
radgan am dros ideebi ar ganicdeba uazrod, cno- afiqsirebs. am tipis fenomenis susti gamoxatuleba
bierebaSi SemoWrilad da adamiani ar uwevs maT wi- Cveulebrivi movlenaa, gansakuTrebiT daRlilobis,
naaRmdegobas. zeRirebulovani ideebi imiT gansx- SfoTvis an dabneulobis dros. azrebis blokirebi-
vavdeba normaluri religiuri rwemenisagan, rom es sas momxdar wyvetas uecari, TvalSi sacemi da gan-
ukanaskneli ufro farTo jgufis mier aris gazi- meorebadi xasiaTi aqvs. is pacientis mier ganicdeba,
arebuli, religiuri swavlebidanaa aRmocenebuli da rogorc gonebis ucabedi da sruli dacarieleba. az-
periodulad daeWvebis sagans warmoadgens. rovnebis blokireba mniSvnelovani simptomia, radgan
am gansxvavebebis miuxedavad, xandaxan SeiZleba is Sizofreniaze miuTiTebs. diagnostikuri kavSiri
Zneli iyos zeRirebulovani ideis amocnoba da mkve- SizofreniasTan ufro myaria maSin, rodesac pacienti
Tri sxvaobis danaxva zeRirebulovan azrebs, bodviT amgvar gancdebs uCveulo axsnas uZebnis (mag., rode-
ideebs, akviatebasa da normalur ideas Soris. Tumca, sac ambobs, rom misi azrebi meore adamianma waiRo).
es iSviaTad iwvevs praqtikuli xasiaTis problemebs,
asociaciuri procesis darRvevebi formis mixed-
radgan diagnozis dasma erTze meti simptomis arsebo-
viT
ba-ararsebobazea damokidebuli.
asociaciuri procesis formis darRvevis dadgena
sxeulis formasa da wonasTan dakavSirebuli war-
Cveulebriv metyvelebisa da weris maCveneblebis
modgenebi, romlebsac nervuli anoreqsiis dros
mixedviT xdeba, Tumca zogjer is pacientis qceva-
vxvdebiT, albaT zeRirebulovani ideebis yvelaze
Sic aSkarad vlindeba. mag., pacients SeiZleba ar See-
ufro naTel magaliTs warmoadgens. makkenas Tanax-
Zlos dokumentebis dalageba Sesatyvis kategoriaTa
mad (McKenna, 1984), es termini aseve gamoiyeneba iseTi
dasaxelebebis mixedviT. azrovnebis formis darRve-
saxis anomaliuri ideebis mimarT, romlebic mraval
va ramdenime saxisaa (ix. qvemoT). TiToeuli maTgani
sxva viTarebaSic iCens Tavs (dismorfofobia, ipoqon-
garkveuli tipis fsiqikur aSlilobas ukavSirdeba,
dria, pirovnebis paranoiduli aSliloba da avadmyo-
magram calke aRebuli arc erTi ar aris sakmarisi di-
furi eWvianoba). Tumca, mniSvnelovania, xazi gavusvaT
agnozis dasasmelad.
imas, rom zeRirebulovani ideebis identificireba
xdeba ara Sinaarsis, aramed formis mixedviT da maT perseveracia
ar gaaCniaT calsaxa kavSiri romelime calke aRebul perseveracia aris erTi da imave azris mudmivad da
diagnostikur kategoriasTan. amgvarad, avadmyofo- uadgilod gameoreba. am darRvevis dadgena pirovnebis
basTan dakavSirebuli eWvianobis zogierTi SemTxveva metyvelebisa da qmedebebis SeswavliT xdeba. kerZod,
aSkarad bodviT xasiaTs atarebs, maSin roca ipoqon- martivi SekiTxvebis Tanmidevrulad dasmisas pacient-
driisa da dismorfofobiis dros aseT Sexedulebebs ma SeiZleba sworad upasuxos pirvel SekiTxvas, magram
xSirad obsesiis an wuxilis xasiaTi aqvs da ara zeRi- Semdgom kiTxvebze Seusabamod igive pasuxi gaimeoros.
rebulovani ideis. perseveracias vxvdebiT demenciisa da Sublis wilis
dazianebisas; Tumca, sxva daavadebebis drosac aRin-
asociaciuri procesis darRvevebi iSneba.
asociaciuri procesis darRvevebi tempis
mixedviT azrTa qariSxali
azris dinebis darRvevisas icvleba azrebis raodeno- azrTa qariSxalis dros azrebi da metyveleba swrafad
ba da siswrafe. azrebis moWarbebisas aRiniSneba mra- inacvlebs erTi Temidan meoreze. erTi azri bolomde
valferovani azrebis simravle. am dros aRmoceneb- ar aris dasrulebuli, rodesac pacienti meoreze ga-
uli azrebi swrafad miedineba. azrovnebis gaRari- dadis. Cveulebriv, azrebis normaluri, logikuri Tan-
bebis dros pacientis gonebaSi Cndeba ramdenime azri, mimdevroba SenarCunebulia, magram maTi erTmaneTTan
romlebic erTferovania da nela miedineba. azrebis dakavSireba SeiZleba garemodan Semosulma SemTxveviT-
moWarbeba Tavs iCens maniis dros, azrebis simwire ki ma stimulebma gamoiwvios; an kidev, pacientis mier war-
_ depresiuli aSlilobisas. orive maTgani SeiZleba moTqmulma sityvam SeiZleba Secvalos azrebis Tanmim-
dafiqsirdes Sizofreniis dros. radgan es fenomene- devroba. aralogikuri verbaluri kavSirebi SeiZleba
bi metyvelebaSi vlindeba, maT zogjer metyvelebis Semdegi saxisa iyos: bgeriTi asociaciebi (momdevno
moWarbebas da metyvelebis gaRaribebas uwodeben. sityva JReradobiT hgavs pirvels), sityvebis TamaSi
(momdevno sityva wina sityvis meoradi mniSvnelobidan
azrebis blokireba gamomdinareobs) da gariTmva. praqtikaSi Znelia gan-
zogjer azris nakadi SeiZleba uecrad Sewydes. pa- vasxvaoT azrTa qariSxali azrebs Soris kavSiris Ses-
cienti grZnobs, rom goneba ubneldeba, xolo dam- ustebisagan (ix. qvemoT), gansakuTrebiT maSin, rodesac
_ 16 _
pacienti swrafad laparakobs. aseT dros sasargebloa tyvebi an frazebi, romlebic xSirad gamoiyeneba avad-
pacientis metyvelebis Cawera. azrTa qariSxali mani- myofuri gamocdilebis aRsawerad. neologizmebi unda
isTvis aris damaxasiaTebeli. ganvasxvaoT sityvebis arasworad warmoTqmis, dabali
ganaTlebis mqone adamianebis mier sityvebis araswori
azrebs Soris kavSiris Sesusteba mniSvnelobiT xmarebis, dialeqtis, bundovani teqnikuri
azrebs Soris kavSiris Sesusteba azrovnebis normal- terminebisa da im SeTxzuli sityvebisagan, romlebsac
uri struqturis dakargvis maCvenebelia. pacientis zogierTi ojaxi gasarTobad igonebs. imis dasadgenad,
saubari abneulia, alogikuria da damatebiTi kiTxvebis warmoadgens Tu ara esa Tu is sityva neologizms, in-
dasmiT ufro naTeli ar xdeba. interviuerebma, saku- terviueri unda SeekiTxos pacients, Tu ra mniSvnelo-
Tari gamocdilebidan kargad ician, rom, rac ufro bas debs is am sityvaSi. neologizmebi yvelaze xSirad
metad cdiloben isini naTeli gaxadon pacientis az- qronikuli Sizofreniis dros gvxvdeba.
rebi (an rac ufro didxans ar awyvetineben pacients
saubars), miT ufro naklebad esmiT misi naTqvami. depersonalizacia da derealizacia
aRwerilia am tipis azrovnebis darRvevis ramdenime depersonalizacia warmoadgens `me-s cnobierebis Secv-
sfecifikuri niSan-Tviseba (ix. qvemoT), magram maTi las, romlis drosac pirovnebis mier sakuTari persona
dadgena sakmaod rTulia. klinicistisTvis yvelaze ganicdeba, rogorc ararealuri, mowyvetili sakuTar
metad TvalSi sacemi azrovnebis sicxadis naklebobaa. gamocdilebas. pacients ar SeuZlia emociis gancda. de-
am tipis azrovnebis aRweris saukeTeso gzaa pacientis realizacia igive saxis cvlilebaa, oRond is garemosTan
metyvelebis Cawera da imis dafiqsireba, Tu ra STabeW- aris dakavSirebuli. obieqtebi ararealurad gamoiy-
dilebas axdens is interviuerze. am SemTxvevaSi (azrebs ureba, xolo adamianebi _ rogorc usicocxlo, organ-
Soris kavSiris Sesustebis dros) pacientis araTanmim- zomilebiani figurebi. miuxedavad imisa, rom pacienti
devruli, aramkafio metyveleba gansxvavdeba iseTi uCivis emociaTa gancdis uunarobas, igi depersonal-
adamianis abneuli metyvelebisagan, romelic SfoTvas izaciasa da derealizacias aRwers, rogorc ukiduresad
ganicdis an romelsac dabali inteleqti aqvs. adamian- usiamovno gancdas. depersonalizaciisa da derealiza-
ebi, romlebic SfoTvas ganicdian, ufro Tanmimdevru- ciis am ZiriTad maxasiaTeblebs xSirad Tan sdevs sxva
lad metyveleben, Tuki maT mSvid atmosferos Sevuqm- avadmyofuri gancdebi: cvlilebebi drois aRqmaSi, sxe-
niT; xolo, dabali inteleqtis mqone adamianebi ki Ta- ulis xatTan dakavSirebuli cvlilebebi (mag., gancda,
vianT azrebs, Cveulebriv, ufro naTlad gamoxataven, rom kidurebi gaizarda an dapataravda an gansxvavebuli
rodesac interviueri SekiTxvebs umartivebs da ufro forma miiRo). zogjer adamians iseTi gancda eufleba,
met dros aZlevs pasuxis gasacemad. TiTqos is sxeulis gareT imyofeba da sakuTar qmedebebs
azrebs Soris kavSiris Sesustebis sami maxasiaTe- garedan (Cveulebriv, zemodan) uyurebs.
belia aRwerili. isini yvelaze xSirad Sizofreniis radganac pacientebs uWirT depersonalizaciasa da
dros gvxvdeba. am maxasiaTeblebis ganekuTvneba: derealizaciasTan dakavSirebuli gancdebis aRwera,
1. paralogia _ saTqmelis garSemo triali (Vorbeireden). isini xSirad mimarTaven metaforas, ris gamoc SeiZle-
raime Temaze saubrisas pacienti bolomde ver asru- ba depersonalizacia da bodviTi ideebi erTmaneTSi
lebs saTqmels da mudmivad trialebs mis garSemo. agverios. mag., pacientma SeiZleba Tqvas: ìseTi gancda
2. tangencialoba (mxedris svlis msgavsi azrovneba maqvs, TiTqos Cemi tvinis nawili ar muSaobs~ an ìs-
anu mTavari gzidan gadacdena) _ yovelgvari logi- eTi gancda maqvs, TiTqos adamianebi, romlebsac vxe-
kuri kavSirebisa da TvalsaCino asociaciebis gar- dav, usicocxlo qmnilebebi arian~. zogjer deperson-
eSe erTi Temidan meoreze gadasvla (rogorc wina- alizaciisa da bodvis erTmaneTisagan gansasxvaveblad
dadebebs Soris, aseve winadadebis SigniT). saguldagulo gamokiTxvis Catarebaa saWiro. `TiTqos~
gancda sasargeblo diskriminators warmoadgens.
3. verbigeracia _ bgerebis, sityvebis an frazebis
depersonalizacia da derealizacia janmrTel ada-
uazro gameoreba. amgvari anomalia Tavs iCens mZime
mianebTanac SeiniSneba. is, Cveulebriv, Tavs iCens
eqspresiuli afaziisa da zogjer Sizofreniis dros.
daRlilobisas da uecrad aRmocenebuli droebiTi
misi ukiduresi gamovlinebaa `sityvieri salaTi~.
fenomenia (Sedman, 1970). agreTve, misi simptomebi fiq-
azrovnebis sxva darRvevebi sirdeba uZilobisa da sensoruli deprivaciis dros
zeCarTva _ cnebaTa sazRvrebis gafarToeba, romlis da, aseve, halucinogenuri narkotikebis miRebisas.
dros pacienti erTad ajgufebs iseT sagnebsa da mov- depersonalizacia da derealizacia aRiniSneba gen-
lenebs, romlebic, Cveulebriv, erTmaneTTan mWidrod eralizirebuli da fobikuri SfoTviTi aSlilobebis,
ar aris dakavSirebuli. depresiuli aSlilobebis, Sizofreniisa da Sublis
neologizmebi _ pacientis mier gamogonili iseTi si- wilis epilefsiis dros. arsebobs, agreTve, iSviaTad
gamoyenebadi diagnostikuri kategoria _ deperson-
_ 17 _
alizacia-derealizaciis sindromi. w eqopraqsia _ pacientis mier interviueris moZra-
obebis avtomaturi gameoreba. pacienti aseT moZra-
motoruli simptomebi da niSnebi obebs maSinac imeorebs, rodesac mas sTxoven, rom
socialur qcevasTan, mimikasa da pozasTan dakavSire- Sewyvitos amis keTeba.
bul anomaliebs xSirad vxvdebiT nebismieri saxis w Mitgehen (raimes an vinmes miyola) _ agreTve, miu-
fsiqikuri aSlilobebis dros. motoruli simptom- TiTebs ukidures morCilebaze. am dros SegviZlia
ebi da niSnebi SeiZleba medikamenturi mkurnalobis pacientis kidurebi nebismieri saxiT vamoZraoT
gverdiT movlenasac warmoadgendes. isini ganxilulia msubuqi zewolis gziT.
mesame TavSi, sadac pacientis gamokvlevaa aRwerili. w ambitendencia _ pacienti monacvleobiT akeTebs
Senelebuli motorika da agznebuli mdgomareoba, neiroendokrinuli
erTmaneTis sapirispiro moZraobebs (mag., misasal-
romlebic depresiuli aSlilobis mniSvnelovani testebi
maxa- meblad xels xan win wevs xan ukan miaqvs), romlebsac
siaTeblebia, meTerTmete TavSia ganxiluli. tikebis Tan ramodenimejer imeorebs.
gamoklebiT, qvemoT CamoTvlili specifikuri simp-
tomebi umTavresad SizofreniT, kerZod ki, kataton- sxeulis xatis darRvevebi
uri SizofreniiT daavadebul pacientebs aReniSnebaT.
sxeulis xati anu sxeulis sqema aris pirovnebis su-
w tiki _ usistemo ganmeorebadi moZraobebi, romle- bieqturi warmodgena sakuTari sxeulis Sesaxeb. kli-
bic kunTebis garkveul jgufs CairTavs. mag., Tavis nicistisTvis mniSvnelovania imis codna, Tu ramdenad
gverduli moZraobebi an erT-erTi mxris aCeCva. mTliania pacientis sxeulis xati, rogor aris ganla-
w manerizmi _ ganmeorebadi moZraobebi, romelTac gebuli masSi sxeulis nawilebi da rogor moZraoben
garegnulad funqciuri mniSvneloba gaaCniaT (mag., isini. sxeulis xatisTvis damaxasiaTebeli anomaliebi
misalmeba). Tavs iCens nevrologiuri darRvevebisas. amis maga-
w stereotipuli moZraobebi _ ganmeorebadi moZrao- liTia fantomuri SegrZnebebi kiduris amputaciis
bebi, romelTac, tikisgan gansxvavebiT, regularu- Semdeg; pacientis uunaroba, gaacnobieros sakuTari
li xasiaTi aqvT, xolo manerizmisagan gansxvavebiT, sxeulis erT mxares momxdari cvlilebebi (Cveuleb-
garegnulad funqciuri mniSvneloba ar gaaCnia. riv, insultis Semdeg); hemisomatognozia (pirovneba
(mag., win da ukan rweva.) mcdarad ganicdis, rom kiduri ar aqvs) da anozog-
w katatonia _ mdgomareoba, romlis drosac momate- nozia (pacienti ver acnobierebs sxeulis funqciis
bulia kunTebis tonusi, rac gavlenas axdens gaSla- dakargvas, rac Cveulebriv hemiplegiis Semdeg xdeba).
sa da moxraze da wydeba mizanmimarTuli moZraobis es anomaliebi sxvadasxva nevrologiur saxelmZRvane-
Sedegad. loSi da liSmanTanaa aRwerili (Lishman, 1998).
sxeulis zomisa da formis damaxinjebul aRqmas xan-
w katalefsia (cvilisebri moqniloba) _ termini,
daxan janmrTel adamianebTanac vxvdebiT daRlilo-
romelic katatoniis tonuss aRwers. katalefsiis
bis an CaZinebis dros. gancda, rodesac pacients eCve-
dros pacientis kidurebis mdgomareoba SenarCune-
neba, rom misi kiduri diddeba, pataravdeba an sxva
bulia xangrZlivi drois manZilze, xolo kunTebis
saxis deformacias ganicdis, fiqsirdeba Sakikisa da
tonusi TandaTan izrdeba. aseve, am anomaliis mqone
epilefsiuri gulyris winmswrebi auris SemTxvevaSi,
pacientebs zogjer Tavi baliSis odnav zemoT uWi-
da, aseve, LSD-s miRebis Semdeg. am dros pirovneba
ravT (`fsiqologiuri baliSi~), rac Zalze moux-
acnobierebs, rom misi gancda ararealuria. sxeulis
erxebeli pozaa janmrTeli adamianisTvis. katalef-
nawilebis zomisa da formis Secvla aReniSneba Sizo-
sia ar unda agverios katafleqsiaSi.
freniiT daavadebul zogierT pacients. am SemTxveva-
w pozireba _ uCveulo pozis SenarCuneba didi xnis Si es simptomebi bodviTi an halucinatoruli xasia-
manZilze. pozas SeiZleba simboluri mniSvneloba Tisaa da maTi gacnobierebis xarisxi dabalia.
hqondes (mag., gaSlili xelebiT dgoma jvarcmis po- sxeulis xatis darRveva nervuli anoreqsiisTvis
zaSi), zogjer ki mas aranairi mniSvneloba ar gaaCnia aris damaxasiaTebeli. am dros pacienti amtkicebs,
(mag., cal fexze dgoma). rom msuqania, maSin rodesac sinamdvileSi Zalian ga-
w manWva _ iseTive mniSvneloba aqvs, rogorc yovel- mxdaria da zogjer gamofitvamdea misuli.
dRiur metyvelebaSi. gaorebis fenomenis dros adamiani sakuTar sxeuls
w Schauzkampf _ tuCebis cxvirTan axlos mitana. an xseulis romelime nawils gaorebulad ganicdis.
mag., pacients hgonia, rom ori marcxena xeli aqvs. Za-
w negativizmi _ pacienti akeTebs imis sapirispiros,
lian iSviaTad am tipis gamocdileba aRiniSneba Saki-
rasac sTxoven da aqtiurad ewinaaRmdegeba misi da-
kis, Sublis wilis epilefsiisa da Sizofreniis dros.
morCilebis nebismier mcdelobas.
msgavsi gamocdileba, aRwerili avtoskopiuri halu-
_ 18 _
cinaciisas, zemoT aris mocemuli. maT SeiZleba Tqvan, rom iseTi gancda euflebaT,
TiTqosda uCinardebian. halucinaciebi SeiZleba gan-
sakuTari `me~-s darRvevebi vixiloT iseT fenomenad, romlis drosac pirovneba
`me~-s gancdas ramodenime aspeqti gaaCnia. is ufro ver acnobierebs ra imyofeba `me~-s SigniT da ra _
metia, vidre mxolod sxeulis Secnoba. Cven gancdaSi mis gareT. igive tipis darRvevebi (rodesac adamians
gveZleva erTianoba `me~-s sxvadasxva aspeqtebs Soris; ar SeuZlia ganasxvaos, ra warmoadgens `me~-s nawils
viciT, rom Cveni qmedebebi Cvenve gvekuTvins; vxedavT da ra ara) Tavs iCens pasiurobis fenomenebis dros.
zRvars Cvensa da gare samyaros Soris da ganvicdiT am SemTxvevaSic pacienti misTvis sasurvel qmedebebs
uwyvetobas Cvens warsul `me~-sa da awmyo `me~-s Soris. garedan inicirebulad ganicdis.
`me~-s cneba nawilobriv faravs sxeulis xatis cnebas.
Tumca, Cveulebriv, sxeulis xati `me~-s nawilad ga- mexsierebis darRvevebi
nicdeba, misi gancda ufro obieqturadac SeiZleba mexsierebis darRvevis maxasiaTeblebi da misi Sefase-
(mag., rodesac vambobT `fexs stkiva~.) garkveuli ti- ba detalurad mesame da meToTxmete TavSia aRwerili.
pis fsiqikuri aSlilobis dros Secvlilia `me~-s zo- aq Cven mxolod zogierT ZiriTad terminebsa da cne-
gierTi aspeqti. es cvlilebebi xSirad sxva paTolo- bebs warmogidgenT.
giur fenomenebs ukavSirdeba, ris gamoc `me~-s anoma- mexsierebis dakargvas amnezia ewodeba. xandaxan ga-
liebis aRwera am Tavis sxvadasxva nawilSia mocemuli. moiyeneba misi monaTesave termini dismnezia. param-
nezia aris mexsierebis damaxinjeba. zogierTi tipis
qmedebasTan dakavSirebuli darRvevebi mexsierebis darRveva gvxvdeba fsiqikuri aSlilobis
CvenTvis TavisTavad cxadia, rom Cveni qmedebebi Cven- dros da, Cveulebriv, aRiwereba droiTi parametre-
ve gvekuTvnis (Tu amaSi metaforuli da religiuri bis gamoyenebiT, romlebic fsiqologiuri kvleviT
Sinaarsi ar aris Cadebuli). pacienti, romelsac ze- dadgenili sqemebis msgavsia. ufro detaluri infor-
moqmedebis bodva aqvs, amas ver acnobierebs. mas is- maciis moZieba SesaZlebelia neirofsiqologiur li-
eTi gancda aqvs, rom misi azrebi mas ar ekuTvnis da teraturaSi da liSmanis naSromSi (Lishman, 1998).
darwmunebulia, rom isini garedan aris `Canergili~. w uSualo mexsiereba gulisxmobs informaciis Senax-
zogierT pacients dakarguli aqvs imis gancda, rom vas xanmokle periodiT, romelic wuTebiT izomeba.
misi qmedebebi mas ekuTvnis da swams, rom is gareSe aseTi mexsierebis klinikuri Semowmeba Semdegnairad
ZaliT aris marTuli. xdeba: pacients sTxoven daimaxsovros romelime
romanis saTauri an raime misamarTi da ramodenime
`me~-s mTlianobis cnobierebasTan dakavSirebu-
wuTis Semdeg gaixsenos igi.
li darRvevebi
w axlo warsulis mexsiereba bolo ramodenime dRis
zog pacients dakarguli aqvs imis gancda, rom is erT
movlenebs exeba. aseTi mexsierebis klinikuri Semow-
mTlian arsebas warmoadgens. mravlobiTi pirovnuli
meba Semdegnairad xdeba: pacients ekiTxebian im mov-
aSlilobis mqone pacientebs iseTi gancda aqvT, rom
lenebis Sesaxeb, romlebic mis yoveldRiur cxov-
isini ori an ramdenime `me~-sagan Sedgebian, romlebic
rebaSi xdeba (mag., Tu ra Wama ramdenime dRis win)
sxvadasxva dros monacvleobiT iCenen Tavs. autosko-
an mis garemoSi momxdari movlenebis Sesaxeb (mag.,
piis an misi msgavsi gamocdilebis dros (Doppelganger)
kargad cnobili axali ambebi).
pirovneba erTdroulad or `me~-s ganicdis, magram is
darwmunebulia, rom isini misi sakuTari `me~-s nair- w xangrZlivi mexsiereba (Soreuli warsulis mexsie-
saxeobebia. reba) didi xnis winaT momxdar movlenebs exeba. am
dros, Semowmebis mizniT, pacientebs ekiTxebian is-
`me~-s mTlianobasTan dakavSirebuli darRvevebi eTi movlenebis Sesaxeb, romlebic mexsierebis dar-
Cven viciT, rom Tumca droTa ganmavlobaSi vicvle- Rvevamde xdeboda.
biT, mainc erTsa da imave adamianad vrCebiT. iSviaT mexsierebis nebismieri mdgomareobis Semowmebisas
SemTxvevebSi SizofreniiT daavadebul adamianebs da- unda ganvasxvaoT informaciis spontanuri gaxseneba
karguli aqvT amgvari uwyvetobis SegrZneba. pacient- da misi cnoba. zog SemTxvevaSi pacientebs, romlebsac
ma SeiZleba Tqvas, rom is axla sxva adamiania, vidre ar SeuZliaT informaciis gaxseneba, misi sworad
daavadebis dawyebamde iyo anu rom misi Zveli `me~ axa- amocnoba SeuZliaT.
li `me~-Ti Seicvala.
mexsierebis dakargva yvelaze ufro xSirad demen-
`me~-s sazRvrebTan dakavSirebuli darRvevebi ciisa da deliriumis dros gvxvdeba. aseT SemTxvevebSi
ufro rTulia bolo dros momxdari movlenebis gaxse-
am tipis darRvevebs vxvdebiT zogierT adamianTan
neba, vidre Soreul warsulSi momxdari faqtebisa. de-
LSD-s an sxva narkotikuli nivTierebis miRebis dros.
menciis dros mexsierebis dakargva, Cveulebriv, droSi
_ 19 _
progresirebs da TandaTanobiT uaresdeba, Tumca mex- mcdari mexsierebis sindromi
sierebis sruli dakargva iSviaTia. zogierTi organu-
is, Tu ramdenadaa SesaZlebeli, rom mogonebebi mTli-
li mdgomareoba iwvevs saintereso nawilobriv efeqts,
anad represirebul iqnes da mrvali wlis Semdeg isev
romelic amnezuri darRvevis saxeliTaa cnobili. ase-
aRdges mexsierebaSi, kamaTis sagans warmoadgens. es
Ti darRvevis dros pirovnebas ar axsovs is movlenebi,
kiTxva yvelaze ufro xSirad maSin Cndeba, rodesac
romlebic ramdenime wuTis win moxda, magram SeuZlia
fsiqoTerapiis procesSi pacienti saubrobs seqsual-
Soreul warsulSi momxdari faqtebis gaxseneba. mexsie-
uri Zaladobis faqtebze, romlebic manamde arasodes
rebis sruli dakargva an pirovnuli identobis seleq-
gaxsenebia da romelTac kategoriulad uaryofs is
tiuri dakargva fsiqogenur mizezebze (ix. qvemoT) an
piri, visac Zaladobis Cadena edeba bralad. bevri
simulaciaze miuTiTebs. zogierT pacients, romelsac
klinicisti miiCnevs, rom aseTi mogonebebi zedmetad
mexsierebis darRveva aReniSneba, miniSnebebis micemas-
skrupulozuri gamokiTxviTaa provocirebuli, zogi-
Tan erTad uumjobesdeba gaxsenebis procesi.
erTis azriT ki, es WeSmariti mogonebebia, romlebic
cnobierebis dakargvis Semdeg, drois garkveul mo- adreul periodSi srulad iqna represirebuli. isi-
nakveTSi (kerZod, aracnobieri mdgomareobidan gani, vinc meore mosazrebas uWeren mxars, miuTiTeben
mosvlisa da cnobierebis srulad aRdgenis momentebs im faqtze, rom movlenebi, bavSvobaSi gadatanil Za-
Soris arsebul periodSi), mexsiereba gauaresebulia. ladobasTan ar aris kavSirSi, zogjer SeiZleba sru-
aseT mdgomareobas anterograduli amnezia ewodeba. lad mieces daviwyebas, magram momavalSi kvlav moxdes
garda amisa, arsebobs mizezebi (mag., Tavis travma an maTi aRdgena. igive avtorebi im faqtzec miuTiTeben,
eleqtrokonvulsiuri Terapia), romlebic cnobierebe- rom zogierTi aRdgenili mogoneba bavSvobaSi gancdi-
bis dakargvamde momxdari movlenebis gaxsenebis uuna- li Zaladobis Sesaxeb, SemdgomSi obieqturi monace-
robas iwveevs, rasac retrograduli amnezia ewodeba. mebiT dasturdeba (Brewin, 2000). miuxedavad imisa,
rom amgvari faqtebis sandoobis xarisxi yovelTvis
cnobasTan dakavSirebuli darRvevebi
kiTxvis niSnis qveS dgas, mogonebebis sruli da xan-
cnobasTan dakavSirebuli darRvevebi zogjer aRiniS- grZlivi represiis arseboba mainc dasaSvebad aris
neba nevrologiuri da fsiqikuri aSlilobis dros. miCneuli. Tumca, savaraudod, àRdgenili mexsierebis
w Jamais vu _ adamiani ver cnobs adre momxdar movle- Sinaarsebis sindromis~ SemTxevevaTa mxolod mcire
nebs. nawils SeiZleba moeZebnos amgvari axsna.
w Dj vu _ adamiani darwmunebulia, rom meordeba is-
eTi movlena, romelic sinamdvileSi warsulSi ara- cnobierebis darRvevebi
sodes momxdara. Cven vsaubrobT sakuTari `me~-sa da garemos cno-
w konfabulacia _ pacienti ixsenebs momxdari bierebis Sesaxeb. cnobierebis xarisxi SeiZleba vari-
faqtebs, romlebsac is xan erT periods ukavSirebs, rebdes sifxizlesa da komatozur mdgomareobas So-
xan meores. garda amisa, is, rogorc momxdarze, sau- ris. cnobiereba SeiZleba Tvisobrivadac icvlebodes:
brobs iseT faqtebze, romlebic mas Tavs arasdros Zili, iseve rogorc stupori, gansxvavdeba aracnob-
gadaxdenia. konfabulacia damaxasiaTebelia amn- ieri mdgomareobisagan (ix. qvemoT).
ezuri sindromisTvis. w koma cnobierebis daqveiTebis ukiduresi formaa.
movlenebis gaxseneba SeiZleba icvlebodes guneb- am dros pacients garegnulad aranairi fsiqikuri
ganwyobis mixedviT. depresiuli aSlilobis dros aqtivoba ar aReniSneba; sunTqvis garda, SeiniSneba
ufro advilad ixseneben sevdian ambebs, rac, Tavis Zalin sustad gamoxatuli motoruli aqtivoba. pa-
mxriv, amZimebs pacientis isedac uaryofiT guneb-gan- cienti Zlier stimulzec ki ar iZleva reaqcias.
wyobas. komatozuri mdgomareobis ranJireba SesaZlebelia
SenarCunebuli refleqsuri reaqciebis xarisxisa da
fsiqogenuri amnezia eleqtroencefalogramis monacemebis mixedviT.
iTvleba, rom fsiqogenuri amnezia represiis aqtiuri w cnobierebis aSla aris mdgomareoba, romlis diapa-
procesis Sedegia. represia iseTi movlenebis gax- zonic meryeobs sustad gamoxatuli darRvevebidan
senebas uSlis xels, romlebmac SeiZleba usiamovno aSkarad gamoxatul somnolentur mdgomareobamde,
emociebi gamoiwvion. es mosazreba disociaciuri am- romlis drosac adamiani srulyofilad ver reagirebs
neziis Seswavlis Sedegad warmoiSva, magram igive faq- stimulebze. am dros sxvadasxsva xarisxiTaa daqveiTe-
torebi SeiZleba organuli amneziis zogierT SemTx- buli yuradReba, koncentracia da mexsiereba; aRiniS-
vevaSic monawileobdes. maTi meSveobiT naTeli xdeba, neba dezorientacia. azrovneba areulia da arasworad
Tu ratom rTuldeba zogierTi faqtis gaxseneba sxva xdeba faqtebis interpretacia. cnobierebis aSla de-
faqtebTan SedarebiT. liriumis specifikur niSans waramodgens.
_ 20 _
w stupors fsiqiatriaSi uwodeben iseT mdgomareo- ganuli darRvevebi). swored amitom yuradRebisa da
bas, romlis drosac pacienti aramobiluri, damun- koncentraciis darRvevebi ver gvexmareba diagnozis
jebuli da ureaqcioa, Tumca iseT STabeWdilebas dasmis dros. miuxedavad amisa, maT garkveuli mniSvn-
tovebs, TiTqos srul gonebazea, radgan, Cveu- eloba aqvT menejmentis (marTvis) TvalsazrisiT (mag.,
lebriv, Tvalebi gaxelili aqvs da mis garSemo myof isini zemoqmedebs pacientis unarze gasces da miiRos
sagnebs Tvals adevnebs. Tu pacients Tvalebi daxu- informacia intervius dros; an xels uSlis pacients
Wuli aqvs, Cvens mcdelobas, gavaxelinoT Tvali, is muSaobaSi, manaqanis marTvasa da Tavisufali drois
winaaRmdegobas uwevs. pacientis refleqsebi norm- gatarebaSi).
aluria da misi sxeuli mosvenebul mdgomareobaSia.
aseT viTarebas katatoniis dros vxvdebiT (SeniS- insaiTi
vna: nevrologiaSi es termini sxva mniSvnelobiT fsiqopaTologiaSi termini ìnsaiTi~ niSnavs paci-
gamoiyeneba da, Cveulebriv, cnobierebis xarisxis entis mier sakuTar TavSi momxdari avadmyofuri
daqveiTebas gulisxmobs). cvlilebebis gacnobierebas da maT mimarT swori
w abneva naTlad azrovnebis unaris arqonaa. is, Cveu- damokidebulebebis SemuSavebas, rac, zog SemTxveva-
lebriv, daqveiTebuli cnobierebis mdgomareobaSi Si imis gacnobierebasac gulisxmobs, rom es cvlile-
myof pacientebTan gvxvdeba, Tumca, SeiZleba norm- bebi fsiqikur darRvevaze miuTiTebs. es pacientisT-
aluri sicxadis cnobierebis mqone pacientebsac vis advili ar aris, radgan gulisxmobs garkveuli
aRniSnebodes. deliriumis SemTxvevaSi, abneva cno- xarisxiT imis codnasac, Tu sad gadis normaluri
bierebis nawilobriv dabindvasa da sxva gamoxat- fsiqikuri funqcionirebisa da fsiqikuri gamoc-
ulebebTan erTad fiqsirdeba. warsulSi deliriums dilebis sazRvrebi. garda amisa, insaiTis Sefaseba
abnevis mdgomareobas uwodebdnen. termini àbneva~ unda moxdes imis gaTvaliswinebiT, Tu ra icis pa-
aRniSnavda, rogorc cnobierebis daqveiTebas, ise cientma fsiqikuri darRvevis Sesaxeb da ras fiqrobs
azrovnebis darRvevas. is amis Taobaze. insaiTis miRweva ar gulisxmobs
sxva terminebi, romlebic cnobierebis daqveiTebis imas, rom pacienti savsebiT unda eTanxmebodes da
aRsaniSnad gamoiyeneba: iziarebdes eqimis pozicias. insaiTze, agreTve, kul-
turaluri faqtorebic axdens zegavlenas (Saravanan
w oneiroiduli mdgomareoba _ sizmris msgavsi mdgo-
et al., 2004).
mareoba, romlis drosac adamians realurad ar sZi-
miuxedavad imisa, rom adre insaiTis arseboba-
navs. Tu is xangrZlivia, mas SegviZlia bindiseburi
ararseboba fsiqozis (insaiTi ar aRiniSneba) da nev-
mdgomareoba vuwodoT.
rozis (insaiTi saxezea) ganmasxvavebel niSnad miiC-
w torpori _ mTvlemare mdgomareoba, romelic ad- neoda, dRes es gansxvaveba sandod da Rirebulebis
vilad gadadis ZilSi. am dros pacients aReniSneba mqoned aRar iTvleba. fsiqozis dros ìnsaiTis nak-
azrovnebis Seneleba da aRqmis velis Seviwroveba. leboba~ ukeT moiazreba iseTi terminebis meSveobiT,
garda zemoT aRniSnuli darRvevebisa, arsebobs rogorebicaa `realobis damaxinjeba~ da `realobis
Zil-RviZilis darRvevebi, romelTa drosac pirovne- darRveva~ (ix. Tavi 12).
bas cnobierebis donis daqveiTeba aReniSneba (mag., imis dafiqsireba aReniSneba Tu ara pacients in-
narkolepsiisas). am dros pacienti SeiZleba xSirad saiTi sakmarisi ar aris. insaiTs sxvadasxva aspeqtebi
da moulodnelad ecemodes, rasac kunTebis tonusis gaaCnia, romlebic pacientTan SeiZleba gansxvavebuli
daqveiTeba (katapleqsia) iwvevs. xarisxiT iyos warmodgenili. mag.:
yuradRebisa da koncentraciis darRvevebi w acnobierebs Tu ara pacienti sxvebisTvis TvalsaC-

ino movlenebs (mag., rom is uCveulod aqtiuri da
yuradReba raime saganze fokusirebis unaria, xolo
aJitirebulia)?
koncentracia fokusis SenarCunebis unars niSnavs.
fokusirebis unari informaciis garkveul nawilze, w gacnobierebis SemTxvevaSi, miiCnevs Tu ara igi am
romelic Tavis tvinamde aRwevs, Zalian mniSvnelovania movlenas anomaliurad (Tu Tvlis, rom uCveulo aq-
yoveldRiur cxovrebaSi, mag., xmaurian adgilas sau- tivoba da mxiaruleba mxolod karg gunebaze yof-
brisas. garda amisa adamians unda SeeZlos yuradRebis nis normaluri gamoxatulebaa)?
erTdroulad warmarTva informaciis ramdenime wy- w Tuki is fiqrobs, rom es movlena anomaliuria, mi-
aroze (mag., rodesac saWesTan zis da Tan saubrobs). iCnevs Tu ara igi mas fsiqikuri daavadebis gamoxat-
koncentraciisa da yuradRebis daqveiTeba mravali ulebad (Tu Tvlis, rom aseTi mdgomareoba ganapi-
saxis paTologiis dros gvxvdeba (depresiuli aSli- roba mag., raime fizikurma daavadebam an mtrebis
loba, mania, SfoTviTi aSliloba, Sizofrenia da or- mier misma mowamlvam)?
_ 21 _
w Tu pacienti am movlenis mizezs fsiqikur daa- damatebiTi literatura
vadebaSi xedavs, Tvlis Tu ara, rom mkurnalobas Berrios, GE (1996) The history of mental symptoms.Cambrige,
saWiroebs? Cambrige University Press. (aRweriTi fsiqopaTologiis
am kiTxvebze gacemuli pasuxebi ufro sando da istoria.)
informaciulia, vidre mxolod imis dafiqsireba Jamison, KR (1996) An unquiet minde. Knopf, New York. (naS-
aReniSneba Tu ara pacients insaiTi (David, 1990). in- romSi aRwerilia maniakalur-depresiuli aSlilo-
saitis xarisxis dadgena gvexmareba, ufro zustad bis mqone pirovnebis subieqturi gancdebi.)
ganvsazRvroT, Tu ramdenad daemorCileba pacienti
Jaspers, K (1963) General psychopathology (trans. from the 7th
mkurnalobas. fsiqoTerapiaSi termini ìnsaiTi~ gansx-
German edition by J. Hoening and M.W. Hamilton). Man-
vavebuli mniSvnelobiT ixmareba, vidre fsiqiatriaSi.
chester, Manchester university Press. (klasikuri naSromi
fsiqoTerapiaSi insaiTi miuTiTebs unarze gaigo saku-
zogadi fsiqopaTologis sakiTxebze. gansakuTrebiT
Tari motivebi da gaacnobiero fsiqikuri aqtivobis is
mniSvnelovania naSromis pirveli Tavi.)
mxareebi, romlebic adre ar gqonda gacnobierebuli.
termini inteleqtualuri insaiTi zogjer aRniSnavs Sims, A (2003) Symptoms in the mind, an introduction to de-
amgvari gageba/gacnobierebis formulirebis unars, scriptive psychopathology. 3rd edn, Elsevier Science, London.
xolo emociuri insaiTi _ unars, ganicado/SeigrZno (am Tanamdrove teqstSi mocemulia Temis detaluri
amgvari gacnobiereba da misce masze reaqcia. da farTo mimoxilva).
_ 22 _
Tavi 2 klasifikacia da
diagnostika
Tavis Sinaarsi
rac fsiqiatriaSi diagnostirebis safuZvels war
fsiqikuri daavadebis koncefciebi
moadgens. mocemul TavSi Cven ganvixilavT fsi
fsiqikuri daavadebis gansazRvreba qiatriuli diagnostirebisa da klasificirebis prin
biosamedicino da socialuri cipebs, ramdenadac isini qmnian CarCos, romlis Sig
koncefciebis urTierTmimarTeba niTac mimdinareobs klinikuri procesebi.
dazianeba, unarSezRuduloba fsiqiatriaSi klasifikaciis saWiroebas ramdenime
da invalidoba mizezi ganapirobebs, esenia:
diagnozi, daavadeba da aSliloba w eqimebs Soris komunikaciis xelSewyoba paciente
klasifikaciis kritika bisTvis dasmuli diagnozis Taobaze;
klasifikaciis istoria w diagnozis mniSvnelobis garkveva simptomebis, prog
Tanamedrove klasifikaciis maorganizebeli nozirebis, mkurnalobisa da etiologiis Tvalsaz
principebi risiT;
organuli da funqciuri w klinikuri kvlevis Sedegebis gaTvaliswineba paci
nevrozi da fsiqozi entebTan yoveldRiuri muSaobisas;
kategoriebi, ganzomilebebi da mraval w epidemiologiuri kvlevisa da sando statistikuri
RerZuli (multiaqsialuri) sistema informaciis mopovebis xelSewyoba;
diagnozTa ierarqia w cdis pirebis urTierTSedarebad jgufebTan kvlevis
komorbidoba Catarebis uzrunvelyofa.
sandooba da validuroba
aRniSnulTagan pirveli sami mizezi yvelaze
fsiqiatriuli diagnozis sandooba relevanturia klinikuri praqtikisTvis. marTlac,
fsiqiatriuli diagnozis validuroba Zneli warmosadgenia, Tu rogor ganxorcieldeboda
Tanamedrove fsiqiatriuli klasifikacia racionalur mtkicebulebaze dafuZnebuli fsiqiat
daavadebebis saerTaSoriso riuli praqtika im wesrigis gareSe, romelsac
klasifikacia (ICD), VTavi klasifikacia qmnis. klasifikacia iseTive funda
diagnostikuri da statistikuri menturi da mniSvnelovani komponentia fsiqiatri
saxelmZRvanelo (DSM) isTvis, rogorc medicinis sxva dargebisTvis. Tumca,
fsiqiatriuli klasifikaciis meore mxriv, fsiqiatriuli klasifikacia iwvevs
axlandeli da momavali sakiTxebi specifikur sirTuleebs da winaaRmdegobebs, rac,
kultura, rogorc faqtori umetesad, mravali saxis aSlilobis gaurkveveli
etiologiis Sedegia. aq ori saxis sirTulesTan gvaqvs
problemuri kategoriebi da
saqme. pirveli konceptualuri saxis sirTuleebia.
atipiuri aSlilobebi
isini kavSirSia fsiqikuri daavadebis bunebasTan da
qvezRurblovani aSlilobebi da maTi
imasTan, Tu ra unda daeqvemdebaros klasifikacias.
klinikuri mniSvneloba meore _ praqtikuli xasiaTisaa da kavSirSia imasTan,
mkvlevaris saWiroebebi Tu rogor ganisazRvreba da organizdeba kategoriebi
ICD-11-sa da DSM-V-is mimarTulebiT klasifikaciis sqemaSi. es Tavi, pirvel rigSi, moicavs
am wignSi gamoyenebuli klasifikaciebi konceptualur sakiTxebsa da kritikas, romelsac
mosdevs klasifikaciis istoriuli rakursi. SemdgomSi
wignis pirveli Tavi moicavs fsiqikuri aSlilobebis Cven aRvwerT da erTmaneTs SevadarebT amJamad or
simptomebsa da niSnebs. mesame TavSi mocemulia farTod gavrcelebul sqemas: ICD-10-is V Tavs, DSM-
fsiqiatriuli gamokvleva, romlis saSualebiTac xdeba IV-s da im maorganizebel principebs, romlebsac isini
simptomebisa da niSnebis gamovlena da interpretacia, efuZneba.
_ 23 _
2 klasifikacia da diagnostika
fsiqikuri daavadebis koncefciebi biosamedicino koncefcias warmoadgens (Scadding,

1967). sqedingi ar iZleva biologiuri naklis
yoveldRiur metyvelebaSi sityva `daavadeba~ Tavi
gansazRvrebas, magram fsiqiatriaSi is gulisxmobs
suflad gamoiyeneba. fsiqiatriul praqtikaSic termini
nayofierebis Semcirebas (reproduqciuli jan
`fsiqikuri daavadeba~ naklebi sizustiT ixmareba da,
mrTeloba) da sikvdilianobis zrdas. arsebobs kidev
xSirad, `fsiqikuri aSlilobis~ sinonims warmoadgens.
erTi koncefcia, romelic daavadebas ganixilavs,
fsiqikuri daavadebis sworad gansazRvra rTu
rogorc èvoluciur nakls ~ (Wakefield, 1992).
lia rogorc praqtikuli, ise filosofiuri Tval
sazrisiT. rutinul klinikur muSaobaSi es sirTule w
paTologiuri procesi. zogierTi radikaluri Teo
ZiriTadad mniSvnelovania eTikur da iuridiul retikosi (mag., Szasz, 1960), gamoTqvams mosazrebas,
sakiTxebTan mimarTebaSi (rogoric, mag., iZulebiTi rom daavadeba, rogorc aseTi, SeiZleba ganisazRvros
hospitalizaciaa). sasamarTlo fsiqiatriaSi fsiqikuri mxolod fizikuri paTologiis terminebSi. radganac
daavadebis iuridiuli gansazRvreba gansakuTrebiT umetesoba fsiqikuri daavadebis SemTxvevaSi ar
mniSvnelovania iseT sakiTxebTan mimarTebaSi, rogo aRiniSneba gamokveTili fizikuri paTologia, am
rebicaa kriminaluri pasuxismgebloba. TvalsazrisiT isini daavadebebs ar warmoadgenen.
fsiqikuri daavadebis koncefciebis ganxilva Semdeg am Teoriis avtori kidev ufro Sors midis da
avtorebTanaa mocemuli: Lazare, 1973; Kendell, 1975; amtkicebs, rom, fsiqikuri daavadebis umetesoba, ar
Hafner, 1987; Clare, 1997. warmoadgens eqimebis kompetencias. amgvari mosazreba
paTologiis ukiduresad viwro gagebas gulisxmobs.
fsiqikuri daavadebis gansazRvreba garda amisa, es Sexeduleba dausabuTebelia da
sruliad SeuTavsebelia informaciasTan fsiqikuri
fsiqikuri daavadebis dRes arsebuli gansazRvrebebi
aSlilobebis genetikuri da neirobiologiuri
arc damakmayofilebelia da arc sayovelTaod
safuZvlebis Sesaxeb. es Sexeduleba, agreTve, ar
miRebuli. erT-erTi midgoma SemdegSi mdgomareobs:
iTvaliswinebs am daavadebebTan dakavSirebuli
zogad medicinaSi dgindeba daavadebis koncefcia
avadobisa da sikvdilianobis maCveneblebs.
da xdeba misi identificireba fsiqikuri daavadebis
romelime analogTan. zogad medicinaSi arsebobs w
tanjvis gancda. am midgomas praqtikuli Rirebuleba
gansazRvrebis xuTi tipi: gaaCnia, radgan is gansazRvravs im adamianTa jgufs,
romelic, Cveulebriv, eqims mimarTavs. misi nakli
w
janmrTelobis arqona. am midgomas aqcenti jan
imaSi mdgomareobs, rom am terminis gamoyeneba ar
mrTelobaze gadaaqvs, magram amiT problema ar
SeiZleba yvelas mimarT, vinc Cveulebriv avadmyofad
wydeba, radgan Tavad janmrTelobis gansazRvreba
iTvleba. mag., maniiT daavadebuli pacientebi Se
bevrad rTulia. msoflio jandacvis organizaciam
iZleba Tavs araCveulebrivad kargad grZnobdnen
janmrTeloba gansazRvra, rogorc `sruli fizikuri,
da ar ganicdidnen tanjvas, Tumca adamianebis
fsiqikuri da socialuri keTildReoba da ara mxo
umetesoba maT fsiqikurad daavadebulad miiCnevs.
lod daavadebis an uZlurebis ararseboba~. erT-
erTi kritikosis azriT, `verc erTi gansazRvreba
biosamedicino da socialuri koncefciebis
ver iqneba amaze ufro yovlismomcveli an amaze
ufro uazro~ (Lewis, 1953). arsebobs kidev mravali urTierTmimarTeba
sxva gansazRvreba, magram arc erTi maTgani ar aris zemoTxsenebuli koncefciebi SeiZleba orad daiyos:
damakmayofilebeli. koncefcia, romelic fsiqikur daavadebas ganixilavs
w
daavadeba aris is, rasac eqimebi mkurnaloben. am wminda biosamedicino kuTxiT da koncefcia, romelic
gansazRvrebas aqvs simartivis xibli, magram is, Tvlis, rom fsiqikuri daavadeba socialuri feno
realurad, ver iZleva problemis gadawyvetas. mid menia da upiratesobas subieqtur Sefasebas ani
gomas, romlis Tanaxmad daavadeba aris is, risi Webs. debatebi am Temaze jer kidev grZeldeba da,
mkurnalobac eqimebs SeuZliaT, garkveulwilad nawilobriv, ganpirobebulia daavadebebis etio
meti Rirebulebis mqonea. gamocdileba gviCvenebs, logiaze arsebuli SexedulebebiT. Tumca, amJamad
rom rogorc ki SesaZlebeli xdeba janmrTelobis damkvidrebulia mosazreba, rom maSinac ki, rodesac
ama Tu im mdgomareobis samedicino mkurnaloba (mag., aSliloba biosamedicino poziciidan ganixileba,
alkoholizmis an Warbwonianobis), ufro metadaa diagnostirebaSi subieqturi Sefaseba monawileobs
mosalodneli, rom es mdgomareoba ganixilebodes, (Fulford, 1989). mag., azrebi da emociebi centralur
rogorc daavadeba (Campbell et al., 1979). rols TamaSobs bevr fsiqikur aSlilobaSi, magram is,
Tu rogoria es azri da emocia (`kargia Tu cudi~) da
w biologiuri nakli. daavadebis, rogorc biologiuri
ra diagnostikuri mniSvneloba aqvs maT, es subieqtur
naklis gansazRvreba, warmodgenilia sqedingis
Sefasebazea damokidebuli.
mier da daavadebis yvelaze ufro radikalur
_ 24 _
klasifikaciis kritika
dazianeba, unarSezRuduloba da fsiqiatriaSi samedicino mniSvnelobiT daavadebis
invalidoba mkafio kategoriebis naklebobam ganapiroba ufro
zogadi terminis àSliloba~, gamoyeneba. ICD-10-Si
medicinaSi da gansakuTrebiT fsiqiatriaSi mizan
aSliloba gansazRvrulia, rogorc:
Sewonilia aRiweros da dajgufdes aSlilobis Se
`klinikurad gamoxatuli qcevis an simptomebis
degebi. es midgoma dakavSirebulia daavadebis im
erToblioba, romelic umetes SemTxvevaSi aso
koncefciasTan, romlis Tanaxmad, daavadeba dis
cirebulia distresTan da gavlenas axdens pirovnebis
funqciis arsebobas gulisxmobs (Wakefield, 1992),
funqcionirebaze. socialuri deviacia an konfliqti
rogorc es ICD-10-sa da DSM-IV-Si Setanili fsiq
pirovnebis disfunqciis gareSe, am gansazRvrebis
ikuri aSlilobis gansazRvrebebSia mocemuli. qve
Tanaxmad, fsiqikur aSlilobad ar ganixileba.
moT motanili sami urTierTdakavSirebuli term
DSM-IV gansazRvreba ufro vrceli, magram pirvelis
ini samedicino sociologiidan da socialuri fsi
msgavsia:
qologiidan aris nasesxebi da aSlilobis saziano
`klinikurad mniSvnelovani qceva an fsiqologiuri
Sedegebis aRsawerad gamoiyeneba:
sindromi an paterni, romelic Tavs iCens individSi
1. dazianeba exeba paTologiur defeqts (mag., hemipa
da romelic dakavSirebulia arsebul distresTan
rezi insultis Semdeg).
(avadmyofur simptomTan, mag., tkivilTan), an unar
2. unarSezRuduloba _ fizikuri an fsiqologiuri SezRudulobasTan (funqcionirebis gauaresebasTan
funqciis SezRudva, romelic dazianebidan momdi erT an met mniSvnelovan sferoSi) an tkivilis, an
nareobs (mag., sakuTari Tavis movlasTan dakavSi invalidobis, an letalobis riskis mniSvnelovan
rebuli sirTuleebi, romlebic gamowveulia hemi zrdasTan amasTan, es sindromi anu paterni ar unda
pareziT). warmoadgendes ubralod mosalodnel reaqcias kon
3. invalidoba exeba socialur disfunqcias (mag., muS- kretul movlenaze, mag., Zvirfasi adamianis gar
aobis uunaroba hemiparezis Sedegad). dacvalebaze. rac unda iyos misi pirveladi mizezi, is
qmeduunaroba SeiZleba ganxilul iqnes, rogorc unda ganixilebodes individSi qcevis, fsiqologiuri
daavadebis sxva saziano Sedegi, Tumca termins Cveu- an biologiuri disfunqciis gamovlinebad. arc
lebriv iuridiuli datvirTva aqvs da exeba mkurnalo- deviaciuri qceva (politikuri, religiuri an
basTan dakavSirebuli gadawyvetilebebis miRebis un- seqsualuri) da arc konfliqti individsa da
arze daavadebis zegavlenas. (ix.Tavi 4). sazogadoebas Soris ar warmoadgens fsiqikur
aSlilobas, Tu deviacia an konfliqti araa individis
diagnozi, daavadeba da aSliloba disfunqciis simptomi, rogorc es zemoTaa aRwerili~.
miuxedavad msgavsebisa, am or gansazRvrebas Soris
termini `diagnozi~ ori ramdenadme gansxvavebuli
mniSvnelovani gansxvaveba SeiniSneba, romelic SeiZ
mniSvnelobiT ixmareba. èrTis meorisgan garCevas~
leba advilad darCes yuradRebis miRma. ICD-10-Si
zogadi mniSvneloba aqvs. Tumca, medicinaSi amas
gansazRvreba _ àdamianis funqcionirebisTvis xelis
specifikuri mniSvneloba eniWeba. kerZod, es im
SeSla~, exeba mxolod sxvaze zrunvas da pirovnebis
simptomebisa da niSnebis gamomwvevi mizezebis
uSualo garemos; is ar gulisxmobs samsaxureobrivi
codnaa, rasac pacienti uCivis. gamomwvevi
an sxva socialuri rolebis SesrulebisTvis xelis
mizezebi simptomebisgan gansxvavebuli terminebiT
SeSlas. DSM-IV-Si ki _ `funqcionirebis gauareseba erT
gamoixateba. mag., mwvave apendicitis simptomebi
an met mniSvnelovan sferoSi~, exeba funqcionirebis
sruliad gansxvavebuli terminiTaa gadmocemuli,
yvela tips.
vidre misi gamomwvevi mizezi, rac, eqimis azriT,
orive gansazRvreba gviCvenebs, rom fsiqikuri aS
peritoneumis gaRizianebaa, romelic apendiqsis
lilobebi dafuZnebulia ara Teoriul koncefciebs
anTebiTaa ganpirobebuli. am saxiT diagnozis dasmis
an prezumfciebze etiologiis Sesaxeb, aramed simpto
SesaZlebloba, damakmayofilebelia eqimisaTvis da
mebisa da qcevebis amocnobad jgufebze (Kendler,
sasargebloa pacientisTvis, radgan gansazRvravs,
1990). es gasagebs xdis mraval debats kategoriebis
Tu ra saxis gamokvlevebis da mkurnalobis Catarebaa
klasifikaciis sandoobasa da validurobaze, rac am
saWiro. aSkaraa, rom klasifikaciis praqtikuloba
TavSi iqneba ganxiluli.
sruliad zedmets xdis masTan dakavSirebul
filosofiur da Teoriul mosazrebebs. samwuxarod, am
saxiT diagnozis dasma fsiqiatriuli pacientebisTvis klasifikaciis kritika
iSviaTadaa SesaZlebeli. gamonakliss mxolod miuxedavad garkveuli upiratesobisa, fsiqiatriuli
òrganuli~ fsiqikuri aSlilobebi warmoadgens (ix. klasifikaciis gamoyenebas xandaxan akritikeben,
qvemoT). rogorc aramarTebuls an sazianos. amgvari kri
_ 25 _
boqsi 2.1 stigma w fsiqikuri daavadeba ar ikurneba

w adamianis janmrTeloba verasdros aRdgeba
adamianebis mier pirovnebis stigmatizacia maSin xdeba, roca
amgvari warmodgenebis gamo, adamianebi Tavs arideben
masze msjeloben ara pirovnuli Tvisebebis mixedviT, aramed
fsiqikuri aSlilobebis mqone pirebs da sxvebsac uSlian
im ìarliyis safuZvelze, romelic mas saSiS, arasasurvel
maTTan kontaqtis damyarebas. amis gamo, maT ar eZlevaT
jgufs miakuTvnebs. stigmatizaciis tendencias, rogorc
saSualeba gaacnobieron, rom maTi Tavdapirveli daskvnebi
Cans, Rrmad aqvs fesvebi gadgmuli adamianis bunebaSi. es
am adamianebze mcdari iyo. fsiqikurad daavadebul adamianTa
aris reagireba im adamianebze, romlebic gansxvavebulad
problemebs stigmatizaciis SiSic emateba. amitom, isini
gamoiyurebian an iqcevian. stigmatizacia emyareba SiSs, rom
ver bedaven avadmyofobis adreul etapze daxmarebis Ziebas
gansxvavebuli adamianebi, SeiZleba moiqcnen SemaSineblad
da sakuTari mZime mdgomareobis gaziarebas naTesavebisa da
da araprognozirebadni iyvnen; es SiSi mcirdeba, rodesac
megobrebisaTvis. stigmas ufro farTo socialuri efeqtic
naTeli xdeba, rom stigmatizebuli adamiani ar iqceva ise,
aqvs. magaliTad, fsiqikuri problemebis mqone pirebisTvis
rogorc amas misgan elian.
rTulia samsaxurSi mowyoba, daqorwineba da Svilebis yola.
stigma fsiqiatriaSi. adamianebs eSiniaT fsiqikuri daa zogierTi maTganisaTvis sakuTari mdgomareobis damalvis
vadebis da avadmyofi adamianebis stigmatizacias axdenen. mcdeloba, stigmis Tavidan acilebis mizniT, TiTqmis iseve
amis gamomwvevi mizezebi rTulia. erT-erTi maTgani imaSi mZimea, rogorc is tvirTi, romelic avadmyofobas moaqvs.
mdgomareobs, rom fsiqikuri daavadebis mqone adamianebs ar stigmatizaciam SeiZleba imoqmedos fsiqikuri daavadebis
SeuZliaT sakuTari qcevis marTva da SeiZleba ucnaurad, mqone adamianebis movlisaTvis saWiro resursebis gamo
araprognozirebadad da Zaladobrivadac ki iqceodnen. yofaze, rac SeiZleba imaSi gamoixatebodes, rom sazo
amgvarad, isini pirdapiri da, SesaZloa, arapirdapiri gadoebam ar mianiWos prioriteti am tipis adaminebis
safrTxis Semcvelad aRiqmebodnen, radgan maTi TviT momsaxurebas da maTTvis dafinansebis gamoyofas.
kontrolis nakleboba safrTxes uqmnis imis rwmenas, rom
stigmis Semcireba. araswori aRqmisa da crurwmenis Secvla,
Cven SegviZlia vmarToT sakuTari qmedebebi. rogori
rac safuZvlad udevs stigmas, sazogadoebis ganaTlebiT
fsiqologiuri meqanizmebic ar unda edos amas safuZvlad,
miiRweva. stigmatizaciaze mimarTuli kampania ZiriTadad
fsiqikuri daavadebis SiSi aiZulebs adamianebs, erTnairi
moicavs:
sifrTixiliT moeqcnen yvela fsiqikuri problemis mqone
pirs, rac xSirad pacientebisTvis arasasurveli formiT w informaciis miwodebas fsiqikuri daavadebis namdvili
xdeba da zrdis stigmatizaciis xarisxs. diagnozi, rogorc bunebisa da saxifaTo qcevis dabali sixSiris Sesaxeb
iarliyi, potenciurad stigmatizacias gulisxmobs (maga
liTad, keTri da Sidsi). varaudobdnen, rom fsiqikuri w warsulSi fsiqikuri daavadebis mqone, sazogadoebisaTvis
daavadebis stigma Semcirdeboda, Sizofreniasa da msgavs cnobili adamianebis dayoliebas sajaro gamosvlebze,
diagnozebze uaris Tqmis SemTxvevaSi, magram es winadadeba raTa maT sajarod isaubron TavianTi gamocdilebis
ar iTvaliswinebs imas, rom stigmis safuZveli SiSia da Sesaxeb
mxolod iarliyis moSoreba ar amcirebs SiSs. fsiqikuri w axalgazrdebze fokusirebas, radgan maTi damokide
daavadebis mqone adamianebi Tanamedrove sadiagnostiko bulebebi naklebad myaria, vidre ufrosi Taobisa.
terminebis Semotanamde bevrad ufro adre iyvnen
stigmatizebulni. adamianebi, romelTac fsiqikuri daa marTalia, stigmis Semcireba SesaZlebelia, magram es
vadebis eSiniaT, igoneben sakuTar iarliyebs (mag., martivad da swrafad ar xdeba. warsulSi stigmatizebulni
aranormaluri), romlebic diagnozTan SedarebiT bevrad iyvnen epilefsiiT daavadebuli adamianebi, magram maTi
ufro Zlieri stigmis matarebelia. stigmis SemcirebisTvis mdgomareobis Sesaxeb codnis gavrcelebasa da mkurnalobis
aucilebelia SiSis Semcireba, rac moiTxovs zust gaumjobesebasTan erTad, maTdami damokidebuleba Tan
informacias fsiqikuri daavadebis Sesaxeb da fsiqikuri daTanobiT Seicvala. amJamad, dadebiTi cvlilebebi ukve
daavadebis mqone adamianebis ukeTes gagebas. SeimCneva depresiuli aSlilobisa da alchaimeris daava-
saSiSroebis faqtori fsiqiatriuli stigmis mTavari debis mqone adamianebis stigmatizaciasTan dakavSirebiT,
komponentia. sxva mniSvnelovani komponentebi qvemoTaa Tumca es jer kidev ar vrceldeba SizofreniiT daavadebu-
CamoTvlili (Crisp et al., 2000) lebze. amgvarad, sazogadoebis saganamanaTleblo kampania,
romelic stigmis Tanmdevi SiSisa da gaugebrobis Semci-
w fsiqikuri daavadebis mqone adamianebi grZnoben, rom rebazea mimarTuli, mudmivi xasiaTisa unda iyos. krispis
Cvengan gansxvavebulni arian naSromSi (Crisp, 2004) mocemulia stigmis mravalmxrivi
w rTulia maTTan saubari ganxilva.
tika nawilobriv momdinareobs sxvadasxva winaaR mkurnalobis dros aucileblad unda iqnes gaT
mdegobebidan, romlebic zemoT iyo naxsenebi. Tu valiswinebuli. standartuli klasifikaciis kri
Tavad fsiqikuri aSlilobis koncefciaa sadavo, maSin tikosebma Tavad gamoiyenes idiosinkraziuli kla
klasifikaciac aseve sakamaTo iqneba. gansakuTrebiT sifikaciebi sakuTar teqnikur terminebTan erTad,
xSiri da mwvave kritika iyo gamoTqmuli. ànti- rogorc informaciis Sejamebis saSualeba.
fsiqiatriuli~ moZraobis mwvervalze 1950 da 1960-ian w
zogierTi sociologi asabuTebs, rom pirovnebis
wlebSi. is ZiriTadad sami saxisa iyo: mikuTvneba diagnostikuri kategoriisadmi calsaxad
w
pacientebis mikuTvneba diagnostikuri kategori imas niSnavs, rom am dros deviaciuri qcevisTvis
isTvis xels uSlis maTi unikaluri pirovnuli `daavadebis~ iarliyis miwebeba xdeba, rac mxolod da
sirTuleebis gagebas, Tumca, savsebiT SesaZlebelia mxolod zrdis pirovnebis sirTuleebs. eWvgareSea,
klasifikaciis gamoyeneba pacientis unikaluri rom terminebi èpilefsia~ da `Sizofrenia~ stigma
Tvisebebis gaTvaliswinebiTac moxdes. aseTi kom tizacias gulisxmobs (boqsi 2.1). Tumca, iseTi
binacia marTlac mniSvnelovania, radgan am Tvi aSlilobebi, romlebic iwvevs adamianis tanjvas da
sebebma SeiZleba Secvalos prognozi da, amitom, saWiroebs mkurnalobas, amiT naklebad realuri ar
_ 26 _
klasifikaciis kritika
xdeba. am poziciaSi ubralod isaa xazgasmuli, rom am gziT SesaZlebelia stigmatizaciis problemis
fsiqikuri daavadeba ar unda ganisazRvros, rogorc nawilobrivi movla, Tumca misi moxsna SeuZlebelia,
mxolod socialurad deviaciuri qceva. mag., xSirad radgan, rogorc aRiniSna, stigma mravali faqtoris
amtkiceben, rom Tu adamianma sastiki mkvleloba zemoqmedebis Sedegia.
Caidina, is udavod fsiqikurad daavadebuli an miuxedavad imisa, rom es kritika mniSvnelovania, is
àvadmyofia~. miuxedavad imisa, rom aseTi qceva Zalze mxolod da mxolod argumentia klasifikaciis mcdari
iSviaTia, SeuZlebelia misi fsiqikur daavadebasTan gamoyenebis winaaRmdeg. iseTi aSlilobebi, rogorebicaa
gaigiveba. am ukanasknelis arseboba calke unda epilefsia da Sizofrenia da maTi saziano Sedegebi ver
dadgindes fsiqiatriuli istoriis da fsiqikuri gaqreba imiT, Tu maT am saxelebiT aRar movixseniebT.
mdgomareobis gamokvlevis safuZvelze. ufro ICD-10-sa da DSM-IV-Si, romlebic SemdgomSia gan
metic, Tu fsiqikuri daavadebis arsebobis Sesaxeb xiluli, xazgasmulia is faqti, rom klasifikacia
daskvna gamogvaqvs mxolod da mxolod socialurad aris komunikaciis saSualeba da gzamkvlevi, romelic
deviaciuri qcevis arsebobis safuZvelze, aman gadawyvetilebis miRebaSi gvexmareba, magram, amave
SeiZleba politikur manipulaciebs Seuwyos xeli dros, isicaa gaTvaliswinebuli, rom klasifikacia
(ix. qvemoT). fsiqikuri daavadebis gansazRvrebidan droebiTi da arasrulyofili sqemaa. eqimebma da
da diagnostikuri kriteriumidan socialuri kri mkvlevarebma unda ixelmZRvanelon TavianTi ga
teriumis gamoricxvis mizezi aris is, rom mravali mocdilebiTa da saRi azriT da, agreTve, unda
qceva saxvadasxvagvarad fasdeba sxvadasxva qveyanaSi gaiTvaliswinon daavadebaTa is daxasiaTeba, romelic
da sxvadasxva dros. mag., homoseqsualoba 1970 klasifikaciaSia Setanili. garda amisa, klasifikaciis
wlamde fsiqikur aSlilobad ganixileboda. klinikuri upiratesobaa is, rom igi gvexmareba
w
adamianebi zustad arasodes ergebian dadgenil ka fsiqikuri problemebis mogvarebaSi danaSaulebrivi
tegoriebs. miuxedavad imisa, rom daavadebebis (an qcevis dros, gadawyvetilebis miRebaSi imis Taobaze,
pacientebis) mcire nawilis klasificireba ar aris Tu rogor davgegmoT racionalurad janmrTelobaze
SesaZlebeli, es ar warmoadgens imis safuZvels, rom zrunva da rogor ganvsazRvroT, Tu ramdenad sa
uari vTqvaT maTi umravlesobis klasifikaciaze. fuZvliania sadazRvevo moTxovnebi. agreTve, gvex
mareba politikuri miznebisTvis fsiqiatriis boro
cxadia, rom fsiqiatriaSi zogjer mimarTavdnen
tad gamoyenebis Temaze kompetenturi diskusiis war
klasifikaciiT manipulirebas politikuri, finansuri
marTvaSic.
da sxva mosazrebebis gamo. amis magaliTia sabWoTa
fsiqiatriaSi klasifikaciis gamoyenebis sxva saxis
kavSiri, sadac zogi fsiqiatri garigebaSi Sevida
kritika umetesad exeba detalebs da ara principebs
mTavrobasTan da gansxvavebuli politikuri Tval
(mag., aris Tu ara diagnostirebis kategoriebi sando
sazrisis arseboba fsiqikuri daavadebis gamoxa
da validuri). es sakiTxebi warmodgenilia mocemul
tulebad gamoacxada. aseTi faqtebi mkacrad iqna
TavSi da wignis sxva nawilebSi.
dagmobili, ris Sedegadac msoflio fsiqiatrTa
asociacia saTaveSi Caudga eTikuri wesebis SemuSavebas, klasifikaciis istoria
raTa momavalSi Seemcirebina amgvari SemTxvevebis
anomaliuri fsiqikuri mdgomareobis klasifikaciis
aRmocenebis riski.
mcdelobebs ukve antikur xanaSi vxvdebiT. erT-erTi
amJamad, sabednierod, naklebad arsebobs amgvari
mizezi, ris gamoc aq klasifikacia qronologiur
riski, Tumca, zemoT motanili SemTxvevebi imas
WrilSi ganixileba aris is, rom Tanamedrove fsiqi
miuTiTebs, rom pacientebis diagnostireba da kla
atriuli klasifikacia, nawilobriv, sxvadasxva is
sificireba ar aris neitraluri aqti da rom is eTikuri
toriuli Temisa da mosazrebis hibrids warmoadgens.
da sxva saxis datvirTvis matarebelia (Tavi 4). erT-
adreul berZnul samedicino CanawerebSi fsiqikuri
erTi eTikuri problema stigmatizacias ukavSirdeba.
aSlilobis sxvadasxva gamovlinebaa aRwerili (agzneba,
isic ki, vinc ar aRiarebs zogierTi problemis eTikur
depresia, abneuloba, mexsierebis dakargva). es martivi
mniSvnelobas, udavod iziarebs im mosazrebas, rom
klasifikacia damkvidrda romaul medicinaSi da
stigmatizacia Zalze seriozuli sakiTxia fsiqikuri
daixvewa berZeni mkurnalis _ galenis mier, romlis
janmrTelobis problemebis mqone pacientebisTvis
klsifikaciis sistemas me-18 saukunemde iyenebdnen.
(Byrne, 2000). boqs 2.1-Si ganxilulia stigmatizaciis
me-18 saukuneSi gaCnda interesi bunebis movlenebis
sakiTxi fsiqiatriis sferoSi. fsiqiatrebma da zo
klasifikaciis mimarT, rac, nawilobriv, ganapiroba
gadad yvelam, vinc fsiqiatriuli diagnostikis
lineis publikaciam mcenareTa klasifikaciis Sesaxeb.
terminebs iyenebs, ueWvelad unda miaqcios saTanado
linei samedicino kvalifikaciis mqone profesori
yuradReba maT koreqtul gamoyenebas, imas, Tu ra
botanikosi iyo, romelmac, agreTve, Seqmna daavadebaTa
daniSnulebiT da ra konteqstSi xdeba maTi xmareba.
naklebad cnobili klasifikacia, romelSic mTavari
_ 27 _
klasi _ fsiqikuri aSlilobebia. am periodSi mravali sistemis baziss warmoadgens.
tipis klasifikacia iyo SemoTavazebuli, romelTagan amave dros, nevrologiis damoukidebel dargad
aRsaniSnavia Sotlandieli mkurnalis _ uiliam Camoyalibebam Seasusta samedicino interesi `nervuli
kalenis mier 1772 wels gamocemuli klasifikacia. pacientebis~ mimarT. es termini, romelic gamoiyeneboda
kalenma erTad daajgufa fsiqikuri aSlilobebi me-19 saukuneSi britaneTsa da CrdiloeT amerikaSi
deliriumis garda, romelic man gaaerTiana feb (Bynum, 1985), aRniSnavda sxvadasxva Civilebis mqone
rilur mdgomareobebSi. am sqemaSi fsiqikuri aS pacientebis did jgufs. es Civilebi TandaTan moeqca
lilobebi Setanili iyo farTo klasSi, romelsac axali dargis _ fsiqiatriis kompetenciis sferoSi
kalenma `nevrozebi~ uwoda. es termini man gamoiyena ZiriTad fsiqikur daavadebebTan erTad. froidisa
im daavadebebis aRsaniSnavad, romlebic nervul da misi Tanamedroveebis naSromebma ganapiroba ner
sistemaze zemoqmedeben (Hunter and McAlpine, 1963). vuli simptomebisa da `nevrotuli~ aSlilobebis
kalenis klasifikacia eyrdnoboda etiologiur fsiqologiuri mizezebis ufro farTod aRiareba
princips (fsiqikuri daavadebebi nervuli sistemis da isteriisa da SfoTviTi aSlilobis Tanamedrove
aSlilobad iyo ganxiluli) da aRweriT princips, koncefciis Camoyalibeba. fsiqiatriaSi nozologiuri
romelic miznad isaxavda calkeuli klinikuri modelebis mimoxilva Semdeg wyaroSia mocemuli:
sindromebis urTierTgamoyofas nevrozebs SigniT. Pichot, 1994.
kalenis mier gamoyenebuli termini `nevrozi~ mo
icavda yvela fsiqikur aSlilobas, iseve, rogorc, Tanamedrove klasifikaciis
mraval nevrologiur daavadebas. am terminis ufro
maorganizebeli principebi
viwro mniSvneloba, romelic amJamad gamoiyeneba,
istoriuli wyaroebis garda, yuradRebas imsaxurebs
mogvianebiT Camoyalibda (ix. qvemoT).
Tanamedrove klasifikaciis ZiriTadi sakiTxebi, rom
me-19 saukunis adreul wlebSi ramdenime frangma
lebic klasifikaciis maorganizebel principebs exeba.
avtorma gamoaqveyna gavleniani klasifikacia. filip
pinelis klasifikaciaSi (Treatise on insanity), romelic
organuli da funqciuri
gamoica 1806 wels inglisur enaze, fsiqikuri
aSlilobebi Semdeg kategoriebadaa warmodgenili: pirveli sakiTxi ukavSirdeba fsiqiatriaSi damkvid
mania deliriumiT, mania deliriumis gareSe, melan rebul gansxvavebas organul da funqciur aSlilobebs
qolia, demencia da idiotia. pinelis erT-erTma Soris.
Tanamemamulem, eskirolma, dawera saxelmZRvanelo, organuli aSliloba warmoiSoba TvalsaCino cereb
romelic 1845 wels inglisur enaze gamoica da ruli an sistemuri paTologiuri procesis Sedegad.
romelsac mravali mkiTxveli gamouCnda. eskirolma ZiriTadi aSlilobebia demencia, deliriumi da sxva
Semoitana axali kategoria _ `monomania~ (`nawilobrivi neirofsiqiatriuli sindromebi (Lishman, 1998).
aSliloba~) anu mcdari ideebis Semcveli mdgomareoba, `funqciuri~ aris krebiTi termini, romelic yvela
romlis Secvla SeuZlebelia logikuri dasabuTebiT. sxva saxis fsiqikuri aSlilobis mimarT gamoiyeneba.
eskirolma monomania dayo qvejgufebad, romlebic klasifikaciis TvalsazrisiT, organul-funqciur da
moicavda inteleqtualur, erotikul, mwvave, homo yofas ori ZiriTadi aspeqti gaaCnia:
cidur da simTvraliT gamowveul monomanias. im 1. amgvari diferenciaciis dros yovelTvis dgeba
drois sxva fsiqiatrebis msgavsad, arc pineli da arc sxeulisa da sulis koncefciebis da filosofiuri
eskiroli ar ganixilavdnen nevrozebs (am terminis dualizmis sakiTxi. radikaluri Tvalsazrisis
Tanamedrove mniSvnelobiT) da qceviT darRvevebs, Tanaxmad, funqciur aSlilobebs ar gaaCniaT
radgan amas zogadad Terapevtebi mkurnalobdnen. biologiuri safuZveli, xolo fsiqologiuri da
amave periodSi, germaniaSi, kalbaumma Camoayaliba socialuri faqtorebi irelevanturia organuli
klasifikaciis kvlevisTvis saWiro ori moTxovna: aSlilobebis mimarT. aseTi polarizacia xels uwyobs
daavadebis gansazRvrisTvis ZiriTadi unda yofiliyo fsiqiatriaSi imgvari radikaluri Sexedulebebis
fsiqikuri daavadebis mimdinareoba da klasifikaciis damkvidrebas, romlebic srulad gamoricxaven erT
sistemis gansazRvrebebis formulirebisas gaTvalis SemTxvevaSi biologiuri, xolo, meore SemTxvevaSi,
winebuli unda yofiliyo sruli klinikuri suraTi. fsiqikuri faqtorebis monawileobas, nacvlad
es Sexeduleba gaiziara krepelinma, romelmac am imisa, rom gaiTvaliswinon orive rigis faqtorebis
midgomis safuZvelze ganasxvava maniakalur-dep wvlili daavadebis etiologiaSi (Eisenberg, 1986a;
resiuli fsiqozi (bipolaruli aSliloba) da Anonymous, 1994).
Sizofrenia (ix. boqsi 12.3). krepelinis wignis Semdegi 2. xsenebul diferenciacias praqtikuli aspeqti ga
gamocema safuZvlad daedo fsiqikuri daavadebis aCnia, ramdenadac òrganuli~ gansazRvravs aS
klasifikaciis Semdgom srulyofas, rac dRevandeli lilobebs etiologiuri TvalsazrisiT, maSin, roca
_ 28 _
Tanamedrove klasifikaciis maorganizebeli principebi
yvela sxva fsiqikuri aSliloba mxolod aRweriTia gvxvdeba. garda imisa, rom am terminebis srulyofil
da simptomebisa da niSnebis konstalacias emyareba. gansazRvras problemebi ukavSirdeba (ICD-10 Tavs
amas mivyavarT winaaRmdegobamde da sirTuleebamde aridebs `bodvis~ gansazRvras), iarliyi `fsiqozi~
am ori koncefciis gadakveTisas. aradamakmayofilebelia, radgan daavadebebs, rom
arsebobs saerTo SeTanxmeba, rom am da sxva mizezebis lebsac es termini moicavs, cota ram aqvT saerTo
gamo, organul-funqciuri diqotomia arc validuria da, Cveulebriv, ufro informatulia konkretuli
da arc sasargeblo, ris gamoc masze uari unda aSlilobis klasifikacia. am mizezebis gamo, gansxvaveba
iTqvas (Spitzer et al., 1992). Tumca, sxva alternativamde nevrozsa da fsiqozs Soris, romelic warmoadgenda
misvla ufro rTuli aRmoCnda. Tu rogor gadaWres fundamentur maorganizebel princips (ICD-9-
klasifikatorebma ICD-10 da DSM-IV es sakiTxi, mde), uaryofil iqna ICD-is da DSM-is amJamindel
ganxilulia am Tavis Semdeg nawilSi da me-14 TavSi. klasifikaciebSi.
miuxedavad imisa, rom fsiqozma dakarga kla
nevrozi da fsiqozi sifikatoris mniSvneloba, igi dRemde moxerxebuli
terminia im aSlilobebis aRsaniSnavad, romlebic
warsulSi fsiqozebisa da nevrozebis cnebebi mniSvne
Cveulebriv mZimea da xasiaTdeba bodviT, haluci
lovani iyo klasifikaciur sistemaTa umravlesobaSi.
naciebiT da uCveulo an ucnauri qceviT. am terminis
miuxedavad imisa, rom arc erTi maTgani ar gamoiyeneba,
gamoyeneba gansakuTrebiT maSinaa mosaxerxebeli,
rogorc maorganizebeli principi ICD-10 da DSM-IV
roca ufro zusti diagnozis dasma SeuZlebelia.
klsifikaciebSi, yoveldRiur klinikur praqtikaSi
zedsarTavis formiT is, agreTve, SemorCenilia
es terminebi dRemde ixmareba, rogorc zogadi des
ICD-10-sa da DSM-IV-is kategoriebSi, rogoricaa
kriptorebi, ris gamoc mniSvnelovania gavecnoT am
`daudgeneli saxis fsiqozuri aSlilobebi~, an kidev
cnebebis istorias.
iseT aRweriT terminebSi, rogorebicaa `fsiqozuri
fsiqozi simptomi~ da àntifsiqozuri medikamentebi~.
termini fsiqozi SemoTavazebuli iyo foixterslebenis
nevrozi
mier, romelmac 1845 wels gamosca wigni saTauriT `
rogorc iTqva, kalenma gamoiyena termini `nevrozi~
samedicino fsiqologiis principebi~. avtors Semoaqvs
nervuli sistemis daavadebebis aRsaniSnavad. TandaTan
termini `fsiqozi~ mZime fsiqikuri aSlilobebis aR
nevrozis kategoria daviwrovda jer garkveuli
saniSnavad. man, agreTve, SemoiRo termini `nevrozi~
nevropaTologiis mqone aSlilobebis gamocalkevebis
zogadad fsiqikuri aSlilobebisTvis. is werda: `yve
(rogoricaa epilefsia da insulti), xolo, Semdeg
la fsiqozi aris imavdroulad nevrozi, magram yvela
fsiqozis calke kategoriad Camoyalibebis Sedegad.
nevrozi ar aris fsiqozi~ (Hunter and MacAlpine, 1963).
terminebis `nervozisa~ da `fsiqozis~ gamoyenebis
nevrozis cnebis SeviwrovebasTan erTad, fsiqozebi
sawinaaRmdego argumenetebi erTmaneTis msgavsia
aRar ganixileboda nevrozebis qvejgufebad da da
da gasagebs xdis imas, Tu ratom moxda `nevrozis~,
moukidebeli daavadebis statusi SeiZina. mravali
rogorc maorganizebeli principis, uaryofa
sirTule, romelic dRes `fsiqozisa~ da `nevrozis~
arsebul klasifikaciaSi. pirvel rigSi, rTulia
gansazRvrebas ukavSirdeba, swored aqedan momdi
am cnebis gansazRvra (Gelder, 1986); meorec,
nareobs.
daavadebebs, romelTac nevrozi moicavs, cota rama
Tanamedrove mniSvnelobiT, termini `fsiqozi~
aqvT saerTo da, mesamec, ufro meti informaciis
aRniSnavs mZime fsiqikur aSlilobebs da moicavs
gadacemaa SesaZlebeli SedarebiT konkretuli da
Sizofrenias da zogierT organul da afeqtur
aRweriTi diagnozebis gamoyenebiT, rogoricaa, mag.,
aSlilobas. uamravi kriteriumi iqna SemoTavazebuli
SfoTviTi aSliloba. Semdegi argumenti is aris, rom
ufro zusti gansazRvrebis formulirebis mizniT,
fsiqodinamikur literaturaSi `nevrozi~ xSirad
magram yvela maTgans garkveuli problemebi ukav
etiologiuri mniSvnelobiT gamoiyeneba, magram,
Sirdeba. saerTo azris Tanaxmad, kriteriumad, daav
radgan amas sakmarisi mecnieruli dasabuTeba ar
adebis simZime unda iqnes gamoyenebuli, magram
aqvs, es termini Seuferebelia zogad fsiqiatriaSi
`fsiqozis~ kategoriaSi Semavali zogierTi SemTxveva
gamoyenebuli saerTaSoriso klasifikaciisTvis.
SedarebiT msubuqia (xolo zogierTi nevrozi mZi
`fsiqozis~ msgavsad, terminebi `nervozi~ da `nev
mea da damauZlurebeli). xSirad kriteriumad in
rotuli~ sasargeblo martivi deskriptorebia.
saiTis naklebobas iyeneben, magram Tavad ìnsaiTis~
isini aRniSnaven iseT aSlilobebs, romlebic, Cve
gansazRvra sakamaod rTulia (gv ??). ramdenadme
ulebriv, SedarebiT msubuqia da, rogorc wesi,
zusti kriteriumia subieqturi gamocdilebisa
asocirdeba SfoTvis zogierT formasTan an Sesam
da obieqturi realobis erTmaneTisgan garCevis
Cnev daZabulobasTan, gansakuTrebiT maSin, Tu
uunaroba, rac halucinaciisa da bodvis dros
_ 29 _
konkretuli aSliloba jer kidev ar aris dadgenili. mas eqneba maRali maCveneblebi nevrotizmis da
imis gamo, rom termini `nevrotuli~ nacnobia da eqstraversiis RerZebze da dabali maCvenebeli
gamosadegia, ICD-10-Si is gamoiyeneba zedsarTavis fsiqotizmis RerZze. aizenkis samganzomilebiani
formiT, rogorc aSlilobaTa erT-erTi jgufis sistema Camoyalibda multivariaciuli analizis
dasaxeleba (`nevrotuli, stresTan dakavSirebuli procedurebis gamoyenebiT, romelic Catarda didi
da somatoformuli aSlilobebi~), xolo DSM-Si, es raodenobis normaluri individebis monacemebze
termini zedsarTav saxeladac ki ar gamoiyeneba. da ara fsiqiatriuli pacientebisaze. sistemis
ganzomilebebi Teoriulad misaRebia, magram un
kategoriebi, ganzomilebebi da da gvaxsovdes, rom isini mniSvnelovnadaa damo
mravalRerZuli(multiaqsialuri) sistema kidebuli sawyis varaudebze, cdis pirebisa da
meTodebis SerCevaze. seriozul problemas qmnis
klasifikacia kategoriebis mixedviT
fsiqotizmisganzomileba, romelic nakleb kavSirSia
tradiciulad, fsiqikuri aSlilobebis klasifikacia
`fsiqozis~ cnebasTan misi axlandeli mniSvnelobiT.
xdeba maTi kategoriebad dayofiT, rodesac ka
mag., am ganzomilebis mixedviT, mxatvrebsa da
tegoriebi erTmaneTisagan gancalkevebul nozolo
patimrebs maRali qulebi eniWebaT.
giur erTeulebs warmoadgenen. rogorc aRiniSna,
ganzomilebis cneba axlaxan iqna ganxiluli epi
safuZvlad mdebare paTologiis arcodnisas, es
demiologiur gamokvlevebSi, romelTa Tanaxmad jan
kategoriebi SeiZleba mxolod simptomTa paternebisa
mrTeli mosaxleoba da fsiqikuri aSlilobis diagnozis
da daavadebis mimdinareobis terminebSi ganisazRvros.
mqone pirebi SeiZleba erT kontiniumze moTavsdnen. es
amgvari kategorizacia aadvilebs daavadebis mkur
mosazreba, sxvasTan erTad, fsiqozur simptomebsac
nalobisa da marTvis dros gadawyvetilebis miRebas,
exeba. motanilia argumentebi imis sasargeblod, rom
magram amas ori problema ukavSirdeba:
iseTi mZime aSlilobac ki, rogoric, mag., Sizofreniaa,
1. SesaZlebelia, mivaRwioT SeTanxmebas gansazRvrebasa faqtiurad ganzomilebiT konstruqts warmoadgens
da aRwerilobasTan dakavSirebiT (sandoobis gasa (Stefanis et al., 2002). fsiqikuri aSlilobis ganxilva
umjobeseblad, ix. qvemoT), magram es kriteriumebi mravalganzomilebiani TvalsazrisiT, SegviZlia Seva
xSirad dausabuTebelia. gaurkvevelia, Tu daroT hipertenziisa da sxva samedicino diagnozebis
ramdenad warmoadgens es kategoriebi gansxvavebul mimarT midgomas, romlebic normaluri ganawilebis
erTeulebs (validuroba, ix. qvemoT). ukidures formebad aris miCneuli, rac ufro
2. pacientebis mniSvnelovani nawili ar `Tavsdeba~ gamomwvevi mizezis genetikuri winaganwyobis bunebas
romelime erT kategoriaSi an akmayofilebs ori asaxavs (rogorc raodenobrivi Tviseba, ix. me-5 Tavi),
an meti kategoriis kriteriums (komorbidoba, ix. vidre daavadebis kategoriul xedvas. Tumca problema
qvemoT). imaSia, rom mravalganzomilebiani klasifikacia didi
yoveli maTgani mniSvnelovani argumentia da am Rirebulebis mqone ar aris klinikur praqtikaSi.
wignis sxva nawilebSia ganxiluli. Tumca, unda iTqvas, yovel pacientTan dakavSirebiT saWiroa `ki~ an àra~
rom jer-jerobiT ar Seqmnila sxva, praqtikuli gadawyvetilebis miReba, romelic, upirveles yovlisa,
TvalsazrisiT ufro damakmayofilebeli sistema. imas exeba, sWirdeba Tu ara pacients mkurnaloba.
amisTvis unda gairkves, aqvs Tu ara pacients fsiqikuri
mravalganzomilebiani sistema aSliloba, romelic saWiroebs mkurnalobas da, Tu
sivrculi klasifikacia ar iyenebs calkeul ka es asea, ra saxis mkurnaloba unda Cautardes mas.
tegoriebs, aramed axasiaTebs subieqts qulebiT es klinikuri imperativi upiratesobas aniWebs iseT
ori an meti ganzomilebis mixedviT. warsulSi klasifikaciis sistemas, romelic kategorizaciis
kreCmeri da ramdenime sxva fsiqiatri mxars uWerdnen principzea agebuli (ix. Van Os et al., 1999).
amgvar klasifikacias. mogvianebiT, is ganaviTara
mravalRerZuli (multiaqsialuri) sistema
fsiqologma aizenkma, radgan Tvlida, rom ar mo
iZebneba diskretuli kategoriebis arsebobis sis termini `mravalRerZuli~ gamoiyeneba iseTi
temuri, realuri mtkicebuleba. aizenkma (Eysenck, klasifikaciis sqemisTvis, romelSic kodirebulia
1970b) Semoitana samganzomilebiani sistema, romelSic informaciis ori an meti calkeuli jgufi
Sedioda fsiqotizmi, nevrotizmi da eqstraversia- (rogorebicaa simptomebi, etiologia an pirovnebis
introversia. am sistemis mixedviT, kiTxvarze pasuxis tipi). essen-mioleri iyo pirveli, vinc Semoitana
gacemis Semdeg pacientebs eniWebaT qulebi _ TiToeulze es sistema fsiqiatriaSi. is erT RerZs klinikuri
am sami RerZidan. mag., Tu pirovneba, kategoriaze sindromebisTvis iyenebda, meores ki _ etiologiisTvis
dafuZnebuli sistemis mixedviT, miekuTvneba diso (Essen-Moller, 1971). mravalRerZuli klasifikacia
ciaciuri aSlilobis kategorias, aizenkis sistemaSi axla DSM-is integraluri nawilia da, aseve, ICD-
_ 30 _
sandooba da validuroba
10-Sia gaTvaliswinebuli (ix. qvemoT). miuxedavad arsebul klasifikaciebSi gamoiyeneba (gansakuTrebiT
imisa, rom es sistema ramdenime mizezis gamo DSM-IV) xels uwyobs mravlobiTi diagnozis dasmas.
mimzidvelia, mravalRerZuli sqemebi Zalze rTulia gamoTqmulia mosazreba, rom zogierTi fsiqiatriuli
da did dros moiTxovs yoveldRiuri gamoyenebis komorbidoba faqtiurad amis artefaqtia (Maj, 2005).
dros, gansakuTrebiT maSin, Tu TiTeuli RerZis termini komorbidoba moicavs or gansxvavebul
klinikuri sargeblianoba (mag., daavadebis marTvasa garemoebas:
da mkurnalobis Sedegebze) ar aris naCvenebi. w aSlilobebs, romlebic amJamad ganixileba, rogorc
erTmaneTisagan gansxvavebuli, magram, savaraudod,
diagnozTa ierarqia mizezobrivad erTmaneTTan dakavSirebuli mdgo
kategoriaze damyarebul sistemebSi xSirad mareobebi. sxva sityvebiT rom vTqvaT, saqme gvaqvs
igulisxmeba kategoriebis ierarqia. Tu saxezea ori erTi daavadebis procesTan, romelic ori an meti
an meti aSliloba, Cveulebriv, igulisxmeba, rom klinikuri suraTiT vlindeba da codnis naklebobis
erT-erTi maTgani wamyvania da ufro mniSvnelovnad an klinikuri SeTanxmebis gamo erTmaneTisagan
ganixileba rogorc mkurnalobis, ise aRricxvis damoukidebel aSlilobebad ganixileba (mag., paci
TvalsazrisiT. mag., organul aSlilobas upiratesoba enti, romelsac depresiuli aSliloba da SfoTviTi
eniWeba SizofreniasTan SedarebiT, xolo Sizofrenia aSliloba aReniSneba). es komorbidobis yvelaze
wamyvania guneb-ganwyobis aSlilobasTan SedarebiT. gavrcelebuli formaa (Krueger 1999).
es varaudi gamarTlebulia, radgan gvaqvs klinikuri w aSlilobebs, romlebic mizezobrivad ar arian da
dasabuTeba ierarqiis arsebobisa aSlilobebs Soris. kavSirebuli. anu rodesac viTardeba ori erT
mag., SfoTvis simptomebi, Cveulebriv, gvxvdeba maneTisgan damoukidebeli aSliloba, mag., pirov
depresiis dros da zogjer pacientis Civili nebas, romelsac didi xania aReniSneba panikuri
swored am simptoembs exeba. Tu mkurnaloba SfoTvis aSliloba, uviTardeba preseniluri demencia.
moxsnaze iqneba mimarTuli, pacientis mdgomareoba
aRsaniSnavia, rom komorbidobaze mxolod maSin
ar gaumjobesdeba, magram depresiis mkurnalobiT
saubroben, roca dakmayofilebulia ori an meti
SeiZleba Sesustdes rogorc SfoTvis, ise depresiuli
aSlilobis kriteriumi. es termini ar gamoiyeneba
simptomebi. es Tvalsazrisi SeiZleba mniSvnelovani
im pacientebis mimarT, romlebic diagnostikur
iyos gadawyvetilebis miRebisTvis mkurnalobis
kategoriebSi ver Tavsdebian da ver akmayofileben
Tanmimdevrobis Sesaxeb da, aseve, imis Taobaze, Tu
verc erT diagnostikuri kategoriis kriteriums.
romeli aSliloba unda iqnes Setanili momsaxurebis
statistikaSi, Tu mxolod erTi daavadeba unda iyos
registrirebuli. nebismier SemTxvevaSi, pacientis sandooba da validuroba
istoriaSi unda mieTiTos yvela aSliloba da simptomi, fsiqiatriuli diagnozis sandooba
romelic mocemul SemTxvevaSia warmodgenili da,
rac ar unda iyos klasifikaciis maorganizebeli
agreTve is, Tu rogor icvlebian isini droTa
principebi, damakmayofilebeli sistemis mier klasi-
ganmavlobaSi da mkurnalobasTan erTad.
ficirebuli diagnozebis amocnoba sandoobis maRali
xarisxiT unda xdebodes (Kendell, 1975). amJamad kat-
komorbidoba
egoriebis umetesobis sandooba sakmaod damakmayo-
bolo xanebSi naklebi yuradReba eTmoba diagnozebis filebelia, Tumca adre ase ar iyo qvemoT aRwerili
ierarqias da didi mniSvneloba eniWeba komorbidobas, mizezebis gamo. 1950-ian da 1960-ian wlebSi Catareb-
romlesac, agreTve, ormag diagnozs uwodeben. amas ulma gamokvlevebma cxadyo, rom fsiqiatrebs Soris
aqvs sami mizezi; jer erTi, kvlevam aCvena, rom arsebobs aSkara uTanxmoeba diagnostirebis Taobaze,
komorbidoba Zalian gavrcelebulia (Kessler 2004); rac ori mTavari mizeziTaa gamowveuli (Kreitman, 1961).
mag., depresiuli pacientebis 50% amavdroulad
w interviurebis teqnika da fsiqiatrebis maxasiaTe-
akmayofilebs SfoTviTi aSlilobebis kriteriumebs;
blebi. es exeba imas, Tu rogor dgindeba simptom-
meorec, es midgoma exmareba eqims, Tanabrad dauTmos
ebi da niSnebi, rogor xdeba maTi interpretacia da
yuradReba mocemul momentSi warmodgenil yvela
maTTvis mniSvnelobis miniWeba. es, Tavis mxriv, asax-
aSlilobas da ar dauSvas, rom romelime maTgani
avs imas, Tu ra saxis profesiuli ganaTleba miiRo
ierarqiulad yvelaze maRla mdgomad CaiTvalos
klinicistma, rogoria misi profesiuli kultura
da amis gamo, mkurnalobis TvalsazrisiT, mas
da a.S. videofirze gadaRebuli interviu aCvenebs,
mianiWos prioriteti. zemoT naxsenebi klasifikaciis
rom amerikelma fsiqiatrebma daafiqsires bevrad
mravalRerZuli sistema nawilobriv asaxavs am
ufro meti simptomi, vidre britanelebma (Sandifer et
Tvalsazriss. mesame, diagnostikuri `wesebi~, romlebic
al., 1968).
_ 31 _
w diagnostikuri terminebisa da kriteriumebis sxva gamokvleva, organizebuli msoflio jandacvis or-
dasxvagvari gamoyeneba. ukanasknel periodamde ar ganizaciis mier. masSi cxra qveynis centrebma miiRes
arsebobda sakvanZo terminebis farTod miRebuli monawileoba (kolumbia (kali), Cexoslovakia (praRa),
leqsikoni an gansazRvrebebi. amdenad, ar arsebob- dania (orxusi), inglisi (londoni), indoeTi (agra),
da imis garantia, rom fsiqiatrebi simptomebisa da nigeria (ibadani), taivani (taibei), aSS (vaSingtoni)
sindromebisTvis erTsa da imave kriteriumebs iy- da ruseTi (moskovi). IPSS iyo pirveli gamokvleva,
enebdnen. stengelis mier Catarebulma ZiriTadma romelmac naTlad aCvena, rom struqturirebuli in-
gamokvlevam (Stengel 1959) aCvena, rom àrsebobs qao- terviu SesaZlebelia iTargmnos da gamoyenebul iqnes
si klasifikaciebis gamoyenebaSi~. man Tavi mouyara sxvadasxva kulturebSi, rac Seqmnis SesaZleblobas
sxvadasxva enaze warmodgenil 28 klasifikacias, cxrave qveyanaSi gamovavlinoT pacientebi tipiuri
romelTagan 11 iyo òficialuri, naxevradoficial- Sizofreniuli simptomebiT (msoflio jandacvis or-
uri an erovnuli klasifikacia~, xolo 17 ufro in- ganizacia, 1973). IPSS-iT miRebuli monacemebi ganxi-
dividualurad iyo Seqmnili, magram mainc misaRebad lulia me-12 TavSi.
iTvleboda. 28-dan erTsac ar axlda raime miTiTeba
standartizebuli intervius sqema
Semadgeneli terminebis mniSvnelobis Sesaxeb.
mniSvnelovan wingadadgmul nabijs diagnostikuri
filadelfiaSi Catarebuli kvlevidan, romelic am sandoobis gaumjobesebis TvalsazrisiT standarti-
faqtorebis mniSvnelobis ilustracias iZleva, gamom- zebuli intervius sqemis Camoyalibeba warmoadgenda,
dinareobs daskvna, rom diagnozebis garSemo arsebuli romelmac minimumamde daiyvana interviurebis teqni-
uTanxmoebis 62% warmoiSva diagnostikuri iarliyebis kasa da Sefasebis doneebSi fsiqiatrebs Soris arseb-
araadekvaturi gamoyenebis gamo, 32% _ intervius uli gansxvavebebi (ganxilulia me-3 TavSi). es miRweul
araadekvaturi teqnikis da mxolod 5% _ pacientebis iqna intervius Sinaarsisa da mimdevrobis dazustebiT
araTanmimdevrulobis gamo (Ward et al., 1962). da qulebis daangariSebis wesebis dadgeniT, romelTa
mixedvT fasdeba simptomebis arseboba da simZime.
fsiqiatriuli diagnostikuri kriteriumis
standartizebuli intervius sqemis Seqmna pirdapir
saerTaSoriso gamokvleva
iyo dakavSirebuli zemoT xsenebul saerTaSoriso
stengelis naSromma (Stengel, 959) da 1960-ian wlebSi
gamokvlevasTan. aSS-britaneTis diagnostikur gamokv-
arsebulma mzardma SeSfoTebam qveynebs Soris diag-
levaSi gamoiyenes amJamindeli statusis Sesafasebeli
nostikis garSemo Seqmnili uTanxmoebis gamo, moiTxo-
instrumenti (Present State Examination, PSE) - erT _
va saerTaSoriso kvlevebis Catareba, rac miznad
erTi pirveli struqturirebuli fsiqiatriuli in-
isaxavda diagnostikur praqtikaSi arsebuli gansx-
terviu (Wing et al., 1974).
vavebebis wyaros identificirebas da, Sesabamisad,
standartizebuli intervius sqemebs amJamad far-
sandoobis xarisxis gaumjobesebas. gaTvaliswinebul
Tod iyeneben. specialistebisa da araspecialistebi-
iqna filosofos hempelisis winadadeba imis Taobaze,
sTvis xelmisawvdomia formebi, romlebic sxvadasxva
rom aucilebeli iyo operaciuli gansazRvrebebis Se-
garemosa da populaciaSi gamoiyeneba. Semdgomi mag-
muSaveba, rac gulisxmobda kategoriis (mag., simpto-
aliTebi mocemulia me-3 TavSi.
mis) dazustebas CarTvisa da gamoricxvis zusti deb-
ulebebis saSualebiT. diagnostireba kompiuteriT
ZiriTad gamokvlevas warmoadgenda aSS-britaneTis IPSS- ma aCvena, rom miuxedavad imisa, rom fsiqiatrebis
(US-UK) diagnostikuri kvleva~ (Cooper et al., 1972), ro- mier simptomebis SefasebebSi arsebuli gansxvavebebis
melic mohyva imis demonstrirebas, rom maniakaluri didi nawili SeiZleba aRmoifxvras struqturirebu-
depresiisa da Sizofreniis diagnostikuri da hospi- li intervius saSualebiT, miRebul diagnozebs Soris
talizaciis maCveneblebi am or qveyanaSi mniSvnelovnad mainc SeiniSneba zogierTi gansxvaveba. amis mizezs
gansxvavdeboda. mag., britaneTSi maniakalur-depresiu- warmoadgenda simptomebisa da qcevebis gansxvavebuli
li daavadebis done aTjer ufro maRali iyo, vidre diagnostikuri interpretacia. yovelive aman ganapir-
aSS-is Sesabamis fsiqiatriul saavadmyofoebSi, maSin oba iseTi kompiuteruli programebis Seqmna, rogore-
rodesac aSS-Si dadgenili Sizofreniis done orjer bicaa DIAGNO (Spatzer and Endicott, 1968) da GATEGO
aRemateboda britaneTis maCvenebels (Kramer et al., (Wing et al., 1974). mocemuli programebi adgenen diag-
1969). Sedgomma kvlevam cxadyo, rom niu-iorki aratip- nozs simptomebis Sefasebis gamoyenebiT, rac gamor-
iur suraTs iZleoda da rom CrdiloeT amerikaSi diag- icxavs eqimis subieqturobas da sxva mizezebiT daS-
nostikuri praqtika britaneTis msgavsi iyo. vebul SemTxveviT Secdomebs. miuxedavad imisa, rom
amas mohyva Sizofreniisa saerTaSoriso piloturi kompiuteriT dasmuli diagnozi asaxavs programis
kvleva (IPSS). es iyo mniSvnelovani saerTaSoriso Semdgenlis Sexedulebas diagnozis dasmis Taobaze, am
_ 32 _
Tanamedrove fsiqiatriuli klasifikacia
saxis programebi mainc Rirebulia epidemiologiuri fsiqiatrias eZRvneba.
da sxva saxis gamokvlevebis Casatareblad.
ICD-is istoria
fsiqiatriuli diagnozis validuroba fsiqikuri aSlilobebi klasifikaciaSi pirvelad me-
eqvse gamocemaSi (ICD-6), 1948 wels Seitanes, magram
zemoT moyvanili diskursis centrSi moeqca diag-
arc ICD-6 da arc ICD-7 farTod ar gamoiyeneboda,
nozis sandooba, radgan sxvadasxva Semfaseblis mier
radgan isini moicavdnen mxolod dasaxelebebis sias
Catarebuli Sefasebis Sedegebis Sesabamisobis san-
da ricxviT kodebs, romelTa meSveobiT SesaZlebe-
doobis xarisxis gareSe SeuZlebelia Semowmdes vali-
li iyo hospitalizaciis nacionaluri statistikis
duria Tu ara cneba. validuroba gacilebiT ufro
cxrilebis Sedgena, magram maT ar axldaT Semadgeneli
rTuli cnebaa. zogadi gansazRvrebis mixedviT, is
terminebis mniSvnelobebis terminologiuri leqsiko-
miuTiTebs, Tu ra xarisxiT aRniSnavs cneba imas, rasac
ni. rogorc aRiniSna, stengelis 1959 wlis gamokvl-
unda aRniSnavdes. is, aseve, mWidro kavSirSia praqti-
eva, gaumjobesebis mimarTulebiT gadadgmul pirvel
kul gamoyenebasTan.
mniSvnelovan nabijs wrmoadgenda. man safuZveli
Cveulebriv ganixilaven validurobis sam formas:
moumzada msoflio jandacvis organizaciis gafar-
1. Sinaarsis validuroba: Sesabamisoba klinikur cne-
Toebul programas, romelic `saerTo enis~ miRwevaze
bebTan da deskripciebTan, romlebic amJamad dad-
iyo mimarTuli. es programa ukve ocdaaT welze met
genilia klinikur praqtikaSi. es sakmaod advili
xans xorcieldeba.
misaRwevia, Tu sworad gamoviyenebT terminolo-
1968 wels gamoica ICD-8. man garkveul progress
giis leqsikonsa da kriteriumebis nusxas (rac imas
miaRwia Zveli problemebis gadaWris mimarTulebiT.
gviCvenebs, rom sandooba da validuroba erTmane-
klasifikacias Tan axlda 1974 wels britaneTSi ga-
Tisagan srulad damoukidebelni ar arian).
mocemuli terminologiuri leqsikoni. miuxedavad
2. prognozuli validuroba gviCvenebs, Tu ra xarisxi- amisa, ICD-8 mainc ar warmoadgenda damakmayofilebel
Taa mosalodneli mkurnalobaze sapasuxo reaqcia sistemas, radgan Seicavda zedmetad bevr kategoriebs
da rogori iqneba daavadebis gamosavali; mas maRali da zogierTi sindromis alternatiuli kodirebis sa-
praqtikuli gamoyeneba aqvs. Sualebas iZleoda. 1978 wels gamoica ICD-9-is V Tavi.
3. konstruqciuli validuroba: es aris mesame, validu- zogadad is ICD-8-is msgavsi iyo, radgan msoflio
robis yvelaze Zireuli forma, romelic gviCvenebs jandacvis organizacia fiqrobda, rom nacionaluri
kavSirs daavadebasa da mis etio-paTogenezs Soris. mTavrobebi ar moisurvebdnen didi raodenobis cvli-
samwuxarod, fsiqikuri aSlilobebis umravlesobas lebebis miRebas, miuxedavad imisa, rom klasifikacias
aqvs ucnobi an umniSvnelo konstruqciuli vali- Tan axlda odnav ukeTesad damuSavebuli terminolo-
duroba, rac gamoixateba im aRwerilobiTi krite- giuri leqsikoni, romelic saerTaSoriso tendenciebs
riumebis arsebobaSi, romelic maT diagnostirebas asaxavda.
udevs safuZvlad.
ICD-10
dRemde, faqtobrivad, mcire progresi SeiniSneba
ICD-10-is SemuSavebamde cxadi gaxda, rom saerTaSor-
klasifikaciis arsebuli sqemebis validurobis dadge-
iso doneze TanamSromloba aucilebel process war-
nis mimarTulebiT. fsiqiatriaSi sandoobisa da vali-
moadgenda. am procesis miznebidan gamomdinare ICD-10-
durobis damatebiTi ganxilvisTvis ix. Kendell (1975),
is V Tavs unda daekmayofilebina Semdegi moTxovnebi:
Spitzer and Williams (1985), Jablensky and Kendell (2003).
w
is gamosadegi unda yofiliyo saerTaSoriso
komunikaciisTvis avadobisa da sikvdilianobis
Tanamedrove fsiqiatriuli
statistikis Sesaxeb.
klasifikacia
w
unda Seesrulebina standartis roli nacionalur
daavadebebis saerTaSoriso klasifikacia da sxva fsiqiatriul klasifikaciaSi.
(ICD), V Tavi w
unda yofiliyo misaRebi da sasargeblo farTo
daavadebebis saerTaSoriso klasifikacia (ICD) Camo- momxmareblisTvis sxvadasxva kulturaSi.
yalibebulia msoflio jandacvis organizaciis mier w
unda Seesrulebina saganmanaTleblo funqcia.
(WHO), rogorc daavadebis Sesaxeb saerTaSoriso xsenebuli procesi daiwyo 1982 wels. winaswari
statistikuri monacemebis Segrovebis damxmare sa- samuSaoebi Seasrules sxvadasxva qveynis eqspertebma.
Sualeba. sistemis gadasinjva xdeba sistematurad, savele gamocda Catarda 39 qveynis 112 centrSi, eqvs
ramdenime weliwadSi erTxel. amJamindeli gamocema enaze (Sartorius et al., 1993). savele gamocdiT dadginda
rigiT meaTea (ICD-10). ocdaerTi Tavidan, me-5 Tavi Sesabamisobis sando xarisxi sxvadasxva Semfaseblebis
_ 33 _
mier mowodebul Sefasebebs Soris anu ramdenad fsiqoaqtiuri nivTierebiT ganpirobebuli fsiqikuri
erTnairad afasebdnen isini erTsa da imave kategoriebs. da qceviTi aSliloba (F1x) da stresTan dakavSirebuli
garda amisa, savele gamocdas unda uzrunvelyo is, aSliloba (F4x).
rom pacientebs, romlebTanac praqtikosi fsiqiatrebi radgan ICD-10 ramdenime mizniT gamoiyeneba, igi
muSaobdnen, kargad `morgebodaT~ eqspertTa mier ramdenime formiT arsebobs (cxrili 2.2). TiToeuli
SemuSavebuli aRwerilobebi. saboloo versia saTa Tavsebadia ZiriTad versiasTan da misgan aris na
uriT _ `klinikuri aRwerebi da diagnostikuri sa warmoebi. pirveladi jandacvis versiaSi Sedis mxo
xelmZRvanelo principebi~ (Clinical Descriptions and lod 27 kategoria. yovel maTgans axlavs Sexseneba
Diagnostic Guidelines), 1992 wels gamoica msoflio jan Sesabamisi menejmentis da mkurnalobis Sesaxeb. es
dacvis organizaciis mier ICD-10 is saxiT (World Health versia, SesaZloa, erT-erT yvelaze metad farTod
Organization, 1992b). is moicavs klasifikaciaSi Semavali xmarebul versiad gadaiqces. kvlevis versia (ICD-
TiToeuli aSlilobis aRwerilobas ZiriTadad Txro 10) moicavs ufro specifikur diagnostikur kri
biTi formiT. diagnostikurma instruqciebma mom teriumebs, romlebic DSM-IV-is kriteriumebis msga
xmarebelTTvis cxadi gaxada, rom es klinicistebs vsia (ix. qvemoT) da, agreTve, `kulturisTvis spe
saSualebas aZlevs, msjeloba ufro farTo konteqstSi cifikuri~ aSlilobis nusxas da terminologiur
awarmoon. leqsikons. miuxedavad amisa, jer-jerobiT, kvle
yvela diagnostikuri kodi iwyeba aso-bgeriT F da, vebisTvis DSM-IV ufro farTod gamoiyeneba.
sxva Tavebis msgavsad, Sedgeba 10 ZiriTadi nawilisgan
(cxrili 2.1), romelTagan TiTeuli SeiZleba dai diagnostikuri da statistikuri
yos aTad da a.S. mag., F20 Sizofrenias SeiZleba saxelmZRvanelo (DSM)
mohyvebodes Semdegi nomeri am jgufSi Semavali sxva
DSM-is istoria
kategoriisTvis (mag., F20.1, hebefrenuli Sizofrenia).
1952 wels amerikis fsiqiatriulma asociaciam
saWiroebis SemTxvevaSi sxva kodebic gamoiyeneba.
(APA) pirvelad gamosca diagnostikuri da sta
miuxedavad imisa, rom ICD-10 ZiriTadad aRweriTi
tistikuri saxelmZRvanelo (DSM-I), rogorc farTod
klasifikaciaa, arsebuli codna da dadgenili kli
gakritikebuli ICD-6-is alternativa. DSM-I ZiriTadad
nikuri praqtika gulisxmobs, rom etiologia gan
asaxavda adolf meierisa da karl meningeris
msazRvreli kriteriumia zogierTi ZiriTadi kate
Sexedulebebs, xolo terminologiuri leqsikoni
goriisTvis. es gansakuTrebiT iseT kategoriebs
asaxavda fsiqoanalituri ideebis popularobas
exeba, rogorebicaa organuli daavadebebi (F0x),
aSS-Si. DSM-II gamoica 1968 wels, rogorc ICD-8-is
amerikuli nacionaluri leqsikoni. man gaaerTiana
cxrili 2.1 ICD-10-is VTavi (F). mTavari
kategoriebi fsiqoanalituri da krepeliniseuli ideebi.
F00-F09 organuli, simptomaturis CaTvliT,

fsiqikuri aSlilobebi cxrili 2.2 ICD-10-is Tavi V-is dokumentebi
standartuli ICD-10; klinikuri aRwerilobebi da
F10-F19 fsiqoaqtiuri nivTierebiT ganpirobebuli kvlevis saxelmZRvanelo principebi
fsiqikuri da qceviTi aSlilobebi (msoflio jandacvis organizacia, 1992b)
variantebi specialistebisTvis
F20-F29 Sizofrenia, Sizotipiuri da bodviTi
pirveladi jandacva
aSlilobebi
mravalRerZuli sistemebi zrdasrulTa zogadi
F30-F39 guneb-ganwyobis (afeqturi) aSlilobebi fsiqiatriisTvis
F40-F49 nevrotuli, stresTan dakavSirebuli da mravalRerZuli sistema bavSvTa fsiqiatriisTvis
somatoformuli aSlilobebi gonebrivi CamorCeniloba
kvlevis diagnostikuri kriteriumebi
F50-F59 fiziologiuri da fizikuri darRvevebiT
gamowveuli qcevis paTologia damatebiTi ganmartebebis, aRwerilobebisa da
gansazRvrebebis Semcveli dokumentebi
F60-F69 zrdasrulTa pirovnuli da qceviTi fsiqikuri janmrTelobis terminebis leqsikoni
darRvevebi fsiqikur janmrTelobaSi kroskulturaluri terminebis
leqsikoni
F70-F79 gonebrivi CamorCeniloba
alkoholisa da narkotikuli nivTierebis gamoyenebasTan
F80-F89 fsiqikuri ganviTarebis darRvevebi dakavSirebuli terminebis leqsikoni
F90-F99 bavSvTa da mozardTa asakSi dawyebuli ICD-10-is simptomebis Sesamowmebeli sia
qceviTi da emociuri aSlilobebi. swrafi instruqciebis jibis saxelmZRvanelo
_ 34 _
Tanamedrove fsiqiatriuli klasifikacia
DSM-III gamoica 1980 wels. es iyo mniSvnelovani SefasebisTvis.
wingadadgmuli nabiji (M. Wilson 1993). igi moicavda 1994 wels gavrcelda DSM-IV-is winaswari versia,
xuT mTavar inovacias: raTa mis publikaciamde Catarebuliyo diskusiebi
w
yoveli diagnozisTvis SemuSavebul iqna zusti da gamoTqmuliyo Sesabamisi komentarebi (amerikis
operaciuli kriteriumebi CarTvisa da gamoricxvis fsiqiatriuli asociacia, 1994). DSM-IV-is teqstobrivi
wesebTan erTad (Feighner et al., 1972; Endicott and Spitzer, Semowmeba (DSM-IV-TR) gamoica 2000 wels. is moicavs
1978). es iyo am saxiT momzadebuli pirveli sruli mcire teqstobriv cvlilebebs da ganaxlebul
klasifikacia da, aseve, pirveli klasifikacia, ro klasifikacias, rogorc ganaTlebis instruments,
melmac gaira savele testireba. magram ar moicavs diagnostikuri kriteriumebis
w
miRebul iqna mravalRerZuli klasifikacia xuTi mniSvnelovan cvlilebebs (amerikis fsiqiatriuli
RerZiT (cxrili 2.3). asociacia, 2000).
DSM-IV inarCunebs DSM-III-is (cxrili 2.3) mra
w
gadaisinja nomenklatura da gadajgufda zogierTi
valRerZovan bunebas. DSM-IV-is kategoriebi aq ar
sindromi. mag., nevrozisa da isteriis terminebi
aris naCvenebi, magram isini Sesabamis TavebSia war
gauqmda da guneb-ganwyobis yvela aSliloba erTad
modgenili.
dajgufda.
w
amoRebul iqna mravali fsiqodinamikuri cneba. ICD-10- isa da DSM-IV -is urTierTSedareba
w
zogierTi mdgomareobisTvis, avadmyofobis xan ICD-10 da DSM-IV paralelurad Camoyalibda da,
grZlivoba warmodgenili iyo, rogorc erT-erTi raTa zedmeti gansxvavebebi Tavidan aecilebinaT,
diagnostikuri kriteriumi. or dokumentze momuSave jgufebs Soris xSiri
DSM-III mniSvnelovani iyo ara mxolod imitom, rom konsultaciebi mimdinareobda. es Zalisxmeva didad
warmoadgenda win gadadgmul nabijs klasifikaciis warmatebuli aRmoCnda, radgan sistemebi iziarebdnen
meTodebisa da diagnostikuri kategoriebis Semu umTavres cnebebsa da kategoriebs, Tumca, maT
Savebis TvalsazrisiT, aramed imitomac, rom man ga Soris zogierTi gansxvaveba SeiniSneba (cxrili 2.4).
iTvaliswina Tanamedrove aRweriTi kvlevis saWi
roebebi. misi midgoma empiriuli xasiaTisa iyo wina cxrili 2.4 ICD-10-sa da DSM-IV Soris
versiisagan gansxvavebiT, romelic, ZiriTadad, asa arsebuli gansxvavebebi
xavda amerikuli fsiqiatriis klinikur da fsi
ICD-10 DSM-IV
qodinamikur mosazrebebs. 1987 wels DSM-III-R daeq
warmoSoba saerTaSoriso (WHO) amerikis
vemdebara Sualedur gadamuSavebas, ramac safuZveli
fsiqiatrTa
moumzada DSM-IV-is Seqmnas. asociacia
prezentacia sxvadasxva variantebi
klinikuri erTi dokumenti
DSM-IV
muSaobisaTvis,
DSM-IV-is Semdegi gadamuSaveba ganxorcielda cameti kvlevisa da
pirveladi
samuSao jgufis mier. am proceduram sami safexuri
jandacvisaTvis
gaiara:
enebi
xelmisawvdomia xelmisawvdomia
w
gamocemuli literaturis yovelmxrivi mimoxilva.
yvela farTod mxolod
w
ukve Tavmoyril monacemTa analizi. gavrcelebul enaze inglisur enaze
struqtura
w
savele gamokvlevebi SemoTavazebuli cvlilebebis moqceulia ICD-is mravalRerZulia
erTiani struqturis
farglebSi ;
erTRerZiania V
cxrili 2.3 DSM-III-isa da DSM-IV-is xuTi RerZi TavSi;
arsebobs
RerZi I klinikuri sindromebi da mdgomareobebi,
damoukidebeli
romlebic ar miekuTvnebian fsiqikur mravalRerZuli
aSlilobas da, romlebzec mimarTulia sistema
yuradReba da mkurnaloba. Sinaarsi diagnostikuri
saxelmZRvanelo kriteriumebi,
RerZi II pirovnuli aSlilobebi principebi da rogorc
RerZi III fizikuri aSlilobebi da mdgomareobebi kriteriumebi ar wesi, moicavs
moicavs aSlilobebis socialuri
RerZi IV fsiqosocialuri stresorebis simZime socialur Sedegebs funqciebis
mniSvnelovan
RerZi V bolo wlis adaptaciuri funqcionirebis
gauaresebas
umaRlesi done

_ 35 _
maTi umetesoba umniSvneloa da Sesabamis TavebSia kultura, rogorc faqtori
ganxiluli. ramdenime maTgani aRniSnulia qvemoT. miuxedavad imisa, rom ICD-10 da DSM-IV klasifikaciebi
w
Sizofreniis diagnostirebisTvis saWiroa gaviTva nakleb mniSvnelobas aniWebs nacionalur midgomebs
liswinoT simptomebis xangrZlivoba. miuxedavad (ix. boqsi 2.2), ramdenime TvalsazrisiT lokaluri
imisa, rom simptomebi Zalian msgavsia, ICD-10 da kulturaluri sakiTxebi klasifikaciisTvis mni
miuTiTebs, rom isini unda iyvnen warmodgenilni Svnelovani rCeba (Mezzich et al., 1999).
maqsimum erTi Tvis ganmavlobaSi, xolo DSM-IV- zogierTi qveynis fsiqiatrebi da eqimebi (indoeTi,
is mixedviT, isini unda iCendnen Tavs eqvsi Tvis pakistani da CineTi), sadac arsebobs SexedulebaTa
ganmavlobaSi, avadmyofobis winmswrebi periodis tradiciuli da farTo sistemebi janmrTelobisa
CaTvliT (me-12 Tavi). da daavadebis Sesaxeb, zogjer gamoTqvamen ukma
w
terminebi `nevrotuli~ da `nevrasTenia~ ar gamo yofilebas imis Taobaze, rom evropasa da CrdiloeT
iyeneba DSM-IV-Si. nevrasTenia Zalian gavrcelebuli amerikaSi Seqmnili klasifikaciebi zedmetad acal
diagnozia CineTSi (ix. qvemoT), xolo termini keveben erTmaneTisagan sxeulsa da fsiqikas. mag.,
`nevrozi~ mraval qveynaSi gamoiyeneba. amis gamo somatoformuli aSlilobebis koncefciis ukan dgas
isini, garkveuli sifrTxiliT, Setanilia ICD fsiqikisa da somatikis urTierTisagan gamijvna.
klasifikaciaSi (me-8 da me-10 Tavebi). aseTi midgoma iwvevs problemebs dasavleTis medi
cinaSi da yvelasTvis gasagebi ar aris. am sakiTxebis
DSM-IV-Si aSlilobebis socialuri Sedegebi Seta
w
gamokvleva rTulia, radgan gansxvavebuli kulturis
nilia (rogorc SesaZlebloba) aSlilobaTa ume
warmomadgenlebma SeiZleba ver dainaxon kulturaluri
tesobis kriteriumebis siaSi, maSin, roca ICD-
da adgilobrivi faqtorebis mniSvneloba, an kidev
10-Si isini ar ganixileba gamarTlebul maiden
gauWirdeT imis gageba, Tu ranairadaa aRwerili
tificirebel kriteriumebad. garda im SemTxvevebisa,
emociebi da qcevebi maTTvis ucnob enaze.
rodesac logikurad gamarTlebulia aSlilobis
`kulturisTvis specifikuri~aSlilobebis nus
socialuri Sedegebis Setana mis gamosavlen faq
xa, romelic ICD-10-sa da DSM-IV-is damatebas war
torTa ricxvSi. unda gaviTvaliswinoT is faqtic,
moadgens, saSualebas gvaZlevs SevamowmoT am sin
rom gansxvavebul garemoSi erTi da imave qcevis
dromebis sargeblianoba savele gamokvlevebis gziT.
mimarT sxvadasxva damokidebuleba arsebobs, ris
dReisTvis mopovebuli mwiri da usistemo informacia
gamoc globaluri moxmarebis klasifikaciaSi
gviCvenebs, rom am fsiqikur mdgomareobaTa umetesoba
kulturuli zegavlenis amsaxveli daskvnebi min
warmoadgens SfoTvis, depresiisa da Zaladobrivi
imumamde una iqnes dayvanili.
qcevis kulturiT gamowveul variaciebs da ara
mniSvnelovania imis gacnobiereba, rom es ori
sxvadasxva tipis aSlilobas.
klasifikacia ufro metad avsebs, vidre ewinaaRmdegeba
erTmaneTs. ICD-10 Seiqmna saerTaSoriso Zalisxmevis
problemuri kategoriebi da atipiuri
Sedegad da gankuTvnilia nebismieri qveynisTvis,
aSlilobebi
romelsac Tavisi kultura, specifikuri profesiuli
saWiroebebi da klinikuri tradiciebi gaaCnia. DSM-IV Tanamedrove klasifikaciis ramdenime nawili aRia
aris aSS-is nacionaluri klasifikacia, romelic asaxavs rebulia, rogorc gaurkveveli statusisa da mni
misi Semqmneli organizaciis _ amerikis fsiqiatrTa Svnelobis mqone da moicavs stresTan dakavSirebul
asociaciis (APA) profesiul, saganmanaTleblo da aSlilobebsa da somatoformul aSlilobebs (ix.
finansur prioritetebs. gansxvavebuli mosazrebebi Widiger and Clark, 2000; Mayou and Sharpe, 2004).
ICD-10-isa da DSM-IV-is urTierTmimarTebis Sesaxeb ramdenime kategoriaSi aSlilobebis zedmetad
Semdeg wyaroebSia mocemuli: Andrews et al., (1999); First didi nawili kodirebulia, rogorc àtipiuri~ an
and Pincus (1999). `dauzustebeli~. STambeWdavi magaliTia àtipiuri
kvebiTi aSliloba~, romelic ufro gavrcelebulia,
vidre tipiuri kvebiTi aSlilobebis sixSireTa er
fsiqiatriuli klasifikaciis Toblioba (me-15 Tavi).
axlandeli da momavali sakiTxebi
am TavSi ganxilulia mravali aqtualuri sakiTxi qvezRurblovani aSlilobebi da maTi
klasifikaciis Sesaxeb, rac aqtiuri debatebis sagnad klinikuri mniSvneloba
rCeba. aq wamoweulia zogierTi damatebiTi sakiTxic, mdgomareobebi, romlebic klasifikaciaSi Setanili
romelTac SeiZleba gavlena iqonion momaval pro aSlilobebis msgavsia, magram ar akmayofilebs yvela
cesebze. diagnostikur kriteriums (xSiria gansakuTrebiT Tem
sa da pirveladi jandacvis SemTxvevebSi). axlaxan
_ 36 _
am wignSi gamoyenebuli klasifikaciebi
aRniSnuli. es midgoma aadvilebs kvlevaSi monawile
boqsi 2.2 klasifikaciis sxva erovnuli
pacientebis maxasiaTeblebis dadgenas, magram igi
sistemebi
farTo ganzogadebis saSualebas ar iZleva, radgan
ICD-10-sa da DSM-IV-is farTo mimReblobam saerTaSoriso kvlevisas gamoiricxeba mosazRvre mdgomareobis
doneze Seamcira manamde arsebuli erovnuli diagnos
tikuri tradiciebis mniSvneloba. Tumca, isini, kvlav mqone individebi da àtipiuri SemTxvevebi~, maSin,
sainteresoa istoriuli TvalsazrisiT da,zogjer, roca am tipis pacientebi praqtikaSi xSirad gvxvdeba.
garkveul gavlenas axdens saganmanaTleblo programebze
(ix. Mezzich et al., 2000).
ICD-11-sa da DSM-V-is mimarTulebiT
krepelinisa da bleileris mier warmodgenilma aR
werilobiTma koncefciebma didi gavlena moipoves ICD-11-sa da DSM-V-Tan dakavSirebuli sawyisi
evropis qveynebis umravlesobaSi, kerZod germaniaSi, did diskusiebi am wignis mzadebis dros mimdinareobs.
britaneTsa da skandinaviis qveynebSi. skandinaviaSi agreTve
didi yuradReba daeTmo fsiqogenuri anu reaqtiuli msoflio jandacvis organizaciam uari Tqva ICD-
fsiqozebis koncefcias (Stromgren, 1985; Cooper, 1986). is yvela Tavis aT weliwadSi erTxel gadasinjvis
skandinavia aRniSvnis Rirsia imis gamoc, rom man adre programaze, ase rom momavali saqmianoba aRar iqneba
Semoitana mravalganzomilebiani diagnozis koncefcia.
am valdebulebiT datvirTuli. amerikis fsiqiatrTa
safrangeTSi krepelinis Sexedulebebi Sizofreniis Sesa
xeb naklebad damkvidrda, xolo fsiqozis ori diagnostikuri asociaciam (APA) gamoaqveyna DSM-V-is kvlevis gan
kategoria (bouffe dlirante da dlires chroniques), romlebic, rigi, romelic iTvaliswinebs am dokumentis ga
Cveulebriv, sxvagan ar gamoiyeneboda, aq kvlav SenarCunda.
moqveynebas 2010 wlis Semdeg.
Bouffe dlirante aRniSnavs bodviTi mdgomareobis uecar
ganviTarebas; mas Tan axlavs transis msgavsi SegrZnebebi, DSM-IV -Si Sesulia ramdenime àxali~diagnozi.
igi mcire xangrZlivobisaa da kargi prognozi ukavSirdeba. ganixileba DSM-V-Si maTi Setanis sakiTxi. esaa qala-
mocemuli aSliloba Sevida ICD-10-Si, rogorc mwvave tvinis travmis Semdgomi aSliloba da premenstrualuri
gardamavali fsiqozuri aSliloba (F23), romelic, agreTve,
aerTianebs reaqtiuli fsiqozis skandinaviuri koncefciis disforiuli aSliloba, Tumca, orive organizaciis
maxasiaTeblebs. Dlires chroniques aRniSnavs mdgomareobebs, (WHO da APA) politika iTvaliswinebs cvlilebebisa
romlebic ICD-10-Si klasificirebuli iqneboda, rogorc da damatebebis Setanas mxolod im SemTxvevaSi, Tu
myari bodviTi aSlilobebi. isini dayofilia or jgufad:
isini axali mtkicebulebebiT iqneba dadasturebuli.
arafokusirebuli, romelSic fsiqikuri aqtivobis
ramdenime sfero ziandeba da fokusirebuli _ romlis am adreul etapze mxolod imis Tqma SeiZleba,
drosac mxolod erTi bodviTi Sinaarsia wamyvani, magaliTad rom cvlilebebis Setana pirovnuli aSlilobebis
erotomania. es aSlilobebi ganxilulia me-13 TavSi.
nawilSia mosalodneli (Cooper, 2003). diagnostikuri
saerTaSoriso variaciis sxva magaliTia uaxlesi Cinuri
nacionaluri klasifikacia (Chinese classification of mental kategoriebis validurobis gasaumjobeseblad SeiZ
disorders, second edn revised-CCMD-2-R). miuxedavad imisa, leba epidemiologiuri kvleviT miRebuli Sedegebic
rom igi ZiriTadad efuZneba ICD-10-s, am klasifikaciidan gaiTvaliswinon (Robins, 2004).
amoRebulia TiTqmis yvela somatoformuli aSliloba.
gansakuTrebuli adgili ukavia nevrasTeniis kategorias,
romelic jer kidev erT-erTi yvelaze xSiri diagnozia am wignSi gamoyenebuli
Cinur fsiqiatriaSi (Kleinman, 1982).
klasifikaciebi
Catarebuli kvleva xazs usvams imas, rom populaciaSi am wignSi ganxilulia ICD-10 da DSM-IV klasifikaciebi.
dadgenili aSlilobebis maCvenebli gansxvavebuli iqneba iseve, rogorc sxva saxelmZRvaneloebSi, aSlilobebi
imisda mixedviT, moicavs Tu ara statistika `msubuq~ dajgufebulia Tavebis mixedviT, radgan wignis aseTi
SemTxvevebs (fsiqikuri janmrTelobis konsorciumi. WHO struqtura ufro mosaxerxebelia da xels uwyobs
World Mental Health Consortium, 2004). grZeldeba debatebi masalis ukeT gagebas. Tavebis saTaurebi yovelTvis
imis Taobaze, Tu sad unda moTavsdes qveda zRvruli zustad ar Seesabameba DSM-IV-sa da ICD-10-Si
mniSvneloba da ris safuZvelze (Pincus et, al 1999; Spitzer gamoyenebul terminebs, rac imiTaa gapirobebuli,
and Wakefield, 1999; Regier, 2000;Kessler et al., 2003). rom saTauri ukeT ajamebs ama Tu im Sinaarss.
mkvlevaris saWiroebebi damatebiTi literatura

miuxedavad imisa, rom eqimebsac da mkvlevarebsac American Psychiatric Association (2000) Diagnostic and
sWirdebaT sando klasifikacia, maTTvis odnav statistical manual of mental disorders _ text revision, 4th edn.
gansxvavebuli aspeqtebia mniSvnelovani. kvleva American Psychiatric Association, Washington, DC.
saWiroebs zust kriteriumebs im individebis
Kendell, RE (1975) The role of diagnosis in psychiatry.
SesarCevad, romelTa simptomebi da sxva maxasi
Blackwell Scientific Publications. Oxford.
aTeblebi garkveuli saxiT erTmaneTis msgavsia. es
mizani gaadvilda sxvadasxva SefasebiTi skalebis, World Health Organization (1992) The ICD-10 classification
intervius sqemebisa da kompiuteruli programebis of mental and behavioral disorders. Clinical descriptions and
Seqmnis Sedegad, rogorc es zemoT da me-3 TavSia diagnostic guidelines. World Health Organization, Geneva.
_ 37 _
Tavi 3 gamokvleva
Tavis Sinaarsi
fsiqiatriuli interviu ?? intervius Catareba zogad samedicino praq-
interviusTvis mzadeba ?? tikaSi da zogadi profilis saavadmyofoSi ??
intervius dawyeba ?? pacientis interviuireba binaze ??
intervius gagrZeleba da dasruleba ?? interviu pacientis ojaxTan ??
informatorebis interviuireba ?? ucxo kulturis pacientis interviuireba ??
pacientis maxasiaTebelebi, romlebmac SezRuduli inteleqtis mqone pacientis
SeiZleba zegavlena moaxdinon interviuze ?? interviuireba ??
avadmyofobis istoria?? bavSvebisa da xandazmulebis interviuireba ??
anamnezis Sekrebis sqema ?? informaciis integrireba da Sefaseba ??
anamnezis Sekreba ?? daskvnebis gamotana da
fsiqikuri statusis kvleva ?? gadawyvetilebis miReba ??
garegnoba da qceva ?? sxva sakiTxebi, romlebic gavlenas
metyveleba ?? axdens informaciis Sefasebaze ??
guneb-ganwyoba ?? Canaweris gakeTeba da informaciis gacvla??
azrebi ?? SemTxvevis Canawerebis mniSvneloba ??
aRqma ?? Canawerebis gakeTeba pacientis
kognituri funqciebi ?? saavadmyofoSi moTavsebisas ??
fsiqologiuri gamokvleva ?? Canawerebi daavadebis mimdinareobis Sesaxeb
insaiTi (kritika mdgomareobis mimarT) ?? ??
fsiqiatriuli gamokvlevis sxva epikrizi ??
komponentebi?? formulireba ??
fizikuri gamokvleva ?? problemebis CamonaTvali ??
laboratoriuli gamokvlevebi ?? werili zogadi profilis eqims ??
fsiqologiuri gamokvleva ?? pacientisTvis diagnozisa da daavadebis
riskis Sefaseba ?? marTvis gegmis axsna-ganmarteba ??
saWiroebaTa Sefaseba ?? Sefasebis standartuli meTodebi ??
fsiqiatriuli gamokvlevis gansakuTrebuli standartuli diagnostikuri Sefaseba ??
SemTxvevebi?? simptomebis gasazomi instrumentebi ??
intervius Catareba sagangebo viTarebaSi ?? danarTi??
fsiqiatriuli gamokvleva sami mizniT tardeba. esaa: da niSnebis (Tavi 1) gamovlenas da maTi diagnosti-
1. diagnozis dasma. miuxedavad imisa, rom diagnozs kuri mniSvnelobis Sefasebas.
Tavisi susti mxareebi aqvs (Tavi 2), is fsiqiatriuli 2. diagnozis konteqstis gageba. klinicistma kargad
praqtikis centraluri komponentia, radgan saSu- unda Seiswavlos pacientis cxovrebis istoria, amJa-
alebas aZlevs klinicists, SeimuSaos racionaluri mindeli mdgomareoba da pirovnuli Tvisebebi, raTa
da faqtebze damyarebuli midgoma mkurnalobisa da gaigos, Tu ratom ganuviTarda mas esa Tu is aSlilo-
prognozis mimarT. gamokvlevis ZiriTadi mizani, ba. Segrovili informacia gavlenas axdens mkurnalo-
gansakuTrebiT axali pacientebis SemTxvevaSi, dife- bis SerCevasa da daavadebis prognozzec. gamokvlevis
rencialuri diagnozi da diagnozis dasmaa. es, Tavis es aspeqtebi am TavSia mocemuli, xolo konkretuli
mxriv, moiTxovs fsiqikuri aSlilobis simptomebisa etiologiuri faqtorebi me-5 TavSia ganxiluli.
_ 38 _
fsiqiatriuli interviu
3. Terapiuli urTierTobis damyareba. diagnozis das- sinamdvileSi, gamokvleva aqtiuri, seleqtiuri

misTvis aucilebeli informaciis mopovebisas fsiq- procesia. fsiqiatri cdilobs im informaciis
iatrma unda izrunos imaze, rom pacienti ganewyos gamoyofas, romelsac, SeiZleba, diagnostikuri
mis mimarT da gauCndes sruli da zusti informa- mniSvneloba hqondes. is amowmebs hipoTezebs da
ciis miwodebis survili. Terapiuli urTierTobis cdilobs interviuirebis procesi konkretul
damyareba Zalian mniSvnelovania im SemTxvevaSic, viTarebas da konkretuli pacientis saWiroebebs
Tu pacienti daeTanxmeba eqimis mier SeTavazebul miusadagos. gamokvlevis am dinamikuri aspeqtis
mkurnalobis gegmas. daufleba mxolod praqtikuli gamocdilebiTaa
fsiqikuri gamokvlevis procesi SeiZleba ramdenime SesaZlebeli. es saWiroebs fsiqiatris mier ZiriTadi
etapad daiyos. es etapebia: sindromebis codnas da am codnis praqtikaSi
gamoyenebis unars, raTa man saTanado mniSvneloba
w mosamzadebeli periodi: am etapze klinicisti unda
mianiWos gamokvlevis procesSi dadgenil konkretul
flobdes intervius CatarebisTvis sakmarisad gan
simptomebs da anamnezis SekrebiT mopovebul
viTarebul unar-Cvevebs, raTa moaxerxos zemoT
informacias. swored amitom fsiqikuri aSlilobebis
xsenebuli amocanebis Sesruleba. am etapze aseve
klasifikacia wina TavSia Setanili.
unda gadawydes, kidev vis unda Cautardes interviu
igulisxmeba, rom mocemuli Tavis mkiTxvels Se
(mag., naTesavebs) da arsebobs Tu ara iseTi
uZlia fizikuri mdgomareobis gamokvlevis kvali
faqtorebi, romlebic modifikacias saWiroebs (mag.,
ficirebulad Catareba, amitom mas mxolod mokled
enobrivi sirTuleebi an drois deficiti).
SevexebiT. ufro detaluri informaciis miReba
w informaciis Segroveba: informaciis Segroveba xdeba samedicino saxelmZRvaneloebidanaa SesaZlebeli.
organizebulad, im sakiTxebis gaTvaliswinebiT, rac
saWiroa anamnezis Sesakrebad da fsiqikuri statusis
gamosavlenad.
w informaciis Sefaseba diagnozis an diferencialuri interviusTvis mzadeba
diagnozis dasmis mizniT: am etapis aRwera iseTi fsiqiatriuli interviu sxvadasxva tipis garemoSi
mkiTxvelisTvis, romelsac ar aqvs sakmarisi gamo tardeba. aq mocemuli rekomendaciebi im xarisxiT
cdileba fsiqiatriaSi, yvelaze rTulia, radgan unda davicvaT, ramdenadac es praqtikuladaa
informaciis Sefaseba iTxovs konkretuli sim SesaZlebeli. maTi srulad dacva yovelTvis ver
ptomebisa da simptomTa kombinaciebis diagnos xerxdeba. zogierTi tipis garemoSi es gansakuTrebiT
tikuri mniSvnelobis codnas. rTulia (mag., gadaudebeli da saswrafo momsaxurebis
w informaciis gamoyeneba: am etapze miRebuli mona ganyofileba). miuxedavad amisa, SeZlebisdagvarad
cemebis safuZvelze ganisazRvreba Sesabamisi mkur yvelaferi unda gakeTdes imisTvis, rom
naloba da keTdeba daavadebis prognozi. w pacientma komfortulad igrZnos Tavi;
w informaciisa da miRebuli daskvnebis dafiqsireba w daculi iyos saubris konfidencialoba;
da sxva specialistebisTvis gaziareba: klinicistma
w daculi iyos interviueris usafrTxoeba.
unda miawodos Sesabamisi informacia da das
kvnebi janmrTelobis sferoSi momuSave sxva intervius mimdinareobas xels araferi ar unda
profesionalebs, romlebic pacientTan amJamad uSlides (is ar unda wydebodes ama Tu im mizezis
muSaoben an momavalSi imuSaveben da, aseve, gamo). Sesabamisi zomebi unda iqnes miRebuli imisT-
miRebuli Sedegebi unda ganumartos pacientsa da vis, rom ucxo pirma pacientis da eqimis saubari Sem-
mis naTesavebs. TxveviT ar moisminos. pacienti komfortulad unda
grZnobdes Tavs. interviueri pacientis pirispir ar
mocemul TavSi, romelic exeba zogadi profilis
unda ijdes. misi skami pacientis mimarT kuTxiT unda
fsiqiatris mier sawyis etapze pacientis srul
iyos moTavsebuli. garda amisa, interviueri da paci-
gamokvlevas, yvela es Tema cal-calkea ganxiluli.
enti erT simaRleze (doneze) unda isxdnen.
am TavSi isicaa naCvenebi, Tu rogor xdeba am pro
sasurvelia, gamokiTxvis dros eqimma CainiSnos Ta-
cesis adaptacia konkretul viTarebebTan. Tavidan
visi STabeWdilebebi. intervius Semdeg Canawerebis
mocemulia fsiqiatriuli interviuirebis ZiriTadi
gakeTebas bevri dro miaqvs da es Canawerebi bolomde
procesis zogadi monaxazi. unda aRiniSnos, rom
zusti ar aris. ukeTesia, Canawerebis gakeTeba saubris
saxelmZRvaneloebSi (maT Soris, mocemul saxel
dawyebidan ramdenime wuTis Semdeg daviwyoT, rode-
mZRvaneloSi) aRwerili gamokvlevis procesi iseT
sac pacienti darwmundeba imaSi, rom mas yuradRebiT
STabeWdilebas tovebs, TiTqos is monacemTa Segro
usmenen. Tu interviueri cacia ar aris, pacienti mis-
vebis pasiuri, winaswar gansazRvruli procesia.
gan marcxniv unda ijdes. aseT poziciaSi mas saSuale-
_ 39 _
3 gamokvleva
ba eZleva yuradReba miaqcios pacients, SeinarCunos tardeba (mag., iuridiuli angariSi), es pacients
araoficialuri atmosfero da, amave dros, awarmoos naTlad unda ganvumartoT. pacients, aseve, unda
Canawerebi. zogjer, rodesac pacienti zedmetad Sfo- vacnoboT, Tu rogoria intervius zogadi struqtura
Tavs an aRelvebulia, ukeTesi iqneba, Tu STabeWdile- (mag., jer ganixileba amJamindeli movlenebi, Semdeg
bebs intervius dasrulebis Semdeg CaviniSnavT. ki warsulSi momxdari faqtebi) da ra dro daeTmoba
pacientebis Zalian mcire raodenobaa potenciurad intervius.
saSiSi. miuxedavad amisa, usafrTxoebis zomebi yoveli interviu Ria kiTxvebiT iwyeba (es is kiTxvebia,
intervius win unda iqnes miRebuli. Tuki arsebobs romlebzec SeuZlebelia `ki~ an àra~ pasuxis gacema).
Zaladobis saSiSroeba, interviuerma unda daicvas es kiTxvebi SeiZleba Semdegi saxis iyos: `momiyeviT
Semdegi pirobebi: Tqveni problemebis Sesaxeb~. mieciT pacients
w respondentma unda icodes, Tu sad Catardeba saSualeba, ramdenime wuTis ganmavlobaSi Tavisuflad
interviu da ramdeni xani gagrZeldeba igi. es isaubros, sanam mas Semdeg kiTxvas dausvamdeT.
gansakuTrebiT maSinaa mniSvnelovani, rodesac daakvirdiT pacients, Tu ra saxiT aRwers is
interviu samedicino dawesebulebaSi ar tardeba; sakuTar problemebs, rogoria misi pasuxebi da ra
Tumca, aseve mniSvnelovania saavadmyofoSi Cata maneriT pasuxobs is dasmul kiTxvebs (mag., pacienti
rebis drosac, gansakuTrebiT ki maSin, Tu interviu zedmetad sityvaZunwia Tu zedmetad bevrs saubrobs
samuSao dRis dasasruls aris daniSnuli, rodesac meorexarisxovan detalebze).
personali saavadmyofoSi aRar imyofeba; qvemoT SemoTavazebulia ramdenime teqnika,
romlebic aumjobesebs intervius xarisxs (Goldberg et
w interviuers nebismier momentSi unda SeeZlos
al., 1980):
daxmarebisTvis mimarTos mesame pirs. saavadmyofoSi
intervius Catarebisas SeamowmeT yvela Rilaki, w interviueri mosvenebul mdgomareobaSi unda imyo
romelic gansakuTrebul SemTxvevaSi gamoiyeneba. febodes. is iseT STabeWdilebas unda tovebdes,
Tu es SeuZlebelia, maSin im adgilis siaxloves, rom arsad eCqareba (drois deficitis pirobebSic
sadac tardeba interviu, aucileblad mesame piri ki);
unda imyofebodes; w mniSvnelovania pacientTan mzeriT kontaqtis dam
w interviuersa da oTaxidan gasasvlels Soris yareba. interviueri ar unda iyos zedmetad fok
arsebuli sivrce Tavisufali unda iyos, raTa xeli usirebuli Canawerebze;
ar SeuSalos mas, saWiroebis SemTxvevaSi, droulad w unda iyos yuradRebiT rogorc distresis gamom
datovos oTaxi. arc pacienti da arc raime sagani xatveli verbaluri da araverbaluri niSnebis, aseve
winaRobas ar unda qmnides; saubris faqtobrivi Sinaarsis mimarT;
w gaitaneT oTaxidan nebismieri sagani, romelic pa w interviuers unda SeeZlos araTanmimdevrulad an
cients SeuZlia iaraRad gamoiyenos. zedmetad molaparake pacientebTan saubris war
Tu riski maRalia, an Tu SeuZlebelia zemoT Ca marTva.
moTvlili pirobebis dacva, SesaZloa aucilebeli
gaxdes intervius gadadeba. intervius gagrZeleba da dasruleba
upirveles yovlisa, saWiroa naTeli informaciis
intervius dawyeba miReba pacientis problemebis Sesaxeb. mniSvnelovania,
interviueri esalmeba pacients, mimarTavs mas saxeliT, simptomebi ganvasxvavoT maTi Sedegebisagan da sxva
acnobs sakuTar Tavs (eubneba sakuTar saxelsa da cxovrebiseuli problemebisagan, romelTa ganxilva
statuss) da mokled ganumartavs, Tu ratom tardeba SeiZleba pacientma moisurvos. mag., pacienti SeiZle-
gamokvleva da ra mizans isaxavs igi. Tu pacients sxva ba ZiriTadad uCiodes ugunebobas, sirTuleebs seq-
eqimis TxovniT xvdebiT, es unda ecnobos mas. Tu sualur sferoSi an finansur problemebs. TiToeul
pacienti interviuze sxva pirebis TanxlebiT movida, SemTxvevaSi saerTo maCvenebeli depresiaa, magram amis
interviueri esalmeba maT da ganumartavs, Tu ramden dadgena Sefasebis Catarebas saWiroebs. upirveles
xans mouwevT maT lodini intervius dasrulebamde. yovlisa, yuradReba miaqcieT fsiqikuri aSlilobis
Tanmxleb pirebs unda ecnoboT, CautardebaT Tu simptomebsa da niSnebs, xolo danarCen problemebze
ara piradad maT interviu. Tu pacients SeuZlia muSaoba samomavlod gadadeT.
TqvenTvis saWiro informaciis mowodeba, jobs mas Tavidanve ifiqreT SesaZlo diagnozis Sesaxeb da
Tavidan calke SexvdeT. interviueri ganumartavs intervius msvlelobaSi iseTi kiTxvebi SearCieT,
pacients, rom intervius ganmavlobaSi gakeTdeba romlebic uaryofs an daadasturebs Tqvens mier na-
Canawerebi, romlebic konfidencialuri xasiaTisaa. varaudev diagnozs. mag., Tu pacienti ambobs, rom es-
Tu interviu romelime gareSe organizaciis dakveTiT mis xmebi, es pirvel rigSi, Sizoferniaze badebs eWvs.
_ 40 _
amis gamo, Sefasebis romelime etapze SeecadeT ga- Tu ramdenad misaRebi da efeqturi iyo es mkurnaloba
moavlinoT is ZiriTadi niSnebi, romlebic am daavade- pacientisTvis.
bas axasiaTebs da daadastureT maTi arseboba-ararse- interviueri avsebs intervius sqemis Sesabamis se-
boba. interviueri imasac iTvaliswinebs, Tu ra saxis qciebs. es sqema qvemoTaa motanili. drois defici-
informacia aris Sesatyvisi daavadebis prognozisa da tis pirobebSi jobs pacientis fsiqikuri mdgomareoba
mkurnalobisTvis. amgvarad, interviuireba rutinuli SeafasoT misi ZiriTadi Civilebis dadgenis Semdeg.
kiTxvebis dasmas rodi gulisxmobs. es aris dinami- es gagiadvilebT im sakvanZo momentebis gamoyo-
uri interaqtiuli procesi. am dros fsiqiatris yur- fas, romelTa Sesaxebac dasvamT kiTxvebs anamnezis
adReba warimarTeba hipoTeziT, romelic mopovebuli Sekrebis dros. sakmarisi drois arsebobis pirobebSi,
informaciis safuZvelzea Camoyalibebuli da modi- fsiqikur mdgomareobas, Cveulebriv, ikvleven inter-
ficirdeba damatebiTi informaciis mopovebis kvalo- vius dasaruls, fizikuri mdgomareobis gamokvlevas-
baze. intervius aqtiurad Catareba gansakuTrebiT Tan erTad.
mniSvnelovania drois deficitis pirobebSi, rode- saSualeba mieciT pacients, ramdenadac es Sesa-
sac saswrafod unda iqnes miRebuli gadawyvetileba Zlebelia, spontanurad aRweros Tavisi problemebi.
mkurnalobis Taobaze. fsiqiatriis sferoSi kompe- aman, SesaZloa, moulodnelad `gamoaaSkaravos~ iseTi
tenturobis zrdasa da sakuTar TavSi darwmunebu- masala, romelic, SesaZloa, ar gamovlindes kiTxve-
lobis SeZenasTan erTad, umjobesdeba SesaZlo di- bze pasuxis gacemisas. Tumca, SeiZleba, mainc gaxdes
agnozis moazreba da intervius imgvarad warmarTva, saWiro kiTxvebis dasma, raTa pacienti aseTi gadaxve-
rom ufro swrafad da damajereblad moxdes SesaZlo vis Semdeg Temas daubrundes da misgan konkretuli
diagnozis dadastureba an gamoricxva. informacia movipovoT (mag., informacia SeiZleba exe-
ecadeT daadginoT simptomebis xasiaTi manam, sanam bodes kavSirs stresul movlenasa da simptomebs So-
dasvamdeT kiTxvebs imis Taobaze, Tu rodis da ra sax- ris). sadac ki es SesaZlebelia, interviueri daxuru-
iT gamovlinda isini. Tu romelime simptomi saeWvod li an mimaniSnebeli kiTxvebis nacvlad Ria kiTxvebs
mogeCvenaT, sTxoveT pacients, moitanos Sesabamisi unda svamdes, radgan mimaniSnebel kiTxvebSi pasuxia
konkretuli magaliTebi. yvela ZiriTadi simptom- nagulisxmevi, xolo daxuruli kiTxvebi mxolod `ki~
is safuZvliani Seswavlis Semdeg, dasviT pirdapiri an àra~ pasuxis gacemis saSualebas iZleva. ase mag.,
kiTxvebi sxva simptomebis Sesaxeb, romlebic relevan- iseTi daxuruli kiTxvis nacvlad, rogoricaa _ `bed-
turia mocemuli SemTxvevebisTvis, magram romlebzec
jer ar yofila saubari. aseT dros, fsiqiatriul sin- boqsi 3.1 efeqturi fsiqiatriuli
dromebze arsebul informaciaze dayrdnobiT, inter- Sefasebisas gamoyenebuli zogierTi
teqnika
viueri gadawyvets, Tu ra saxis kiTxvebi unda dasvas
mocemul SemTxvevaSi. mag., pirovnebas, romelic am- w daexmareT pacients Tavisuflad isaubros. amas
gagiadvilebT Ria kiTxvebis dasma da iseTi miniSnebebis
bobs, rom depresiulad grZnobs Tavs, usvamen kiTx-
gamoyeneba, rogoricaa dasturis niSnad Tavis
vebs momavalTan da suicidTan dakavSirebuli azrebis daqneva, an imgvari gamoTqmebis gamoyeneba, rogoricaa
Sesaxeb. Tu dadasturda suiciduri azrebis arse- `ganagrZeT saubari~, an `kidev raime miTxariT amis
Sesaxeb.~
boba, dasviT damatebiTi konkretuli kiTxvebi. aseve
hkiTxeT pacients, Tu ra zegavlena iqonia am simp- w ecadeT, rom pacienti ar gadadiodes sxva Temaze. aqac
SegiZliaT gamoiyenoT araverbaluri signalebi. garda
tomebma mis cxovrebaze, raTa moipovoT funqciebis amisa, gamoiyeneT konkretuli saxis Careva (mag. àxla
daqveiTebis damadasturebeli faqtebi. minda damatebiTi SekiTxvebi dagisvaT imis Taobaze, Tu
amis Semdeg dgindeba, Tu rogor vlindeba da vi- rogor grZnobT Tavs. Cven SegviZlia Tqvens finansur
problemas mogvianebiT davubrundeT~).
Tardeba simptomebi Sesabamis stresul movlenasTan
w kiTxvebis dasma gegmis mixedviT unda xdebodes, magram
an fizikur daavadebasTan maTi kavSiris gaTval-
nu dasvamT imden kiTxvas, rom pacients xeli SeeSalos
iswinebiT. saWiroa didi gulmodgineba, raTa dadg- spontanurad ama Tu im Temis win wamowevaSi, romelic
indes simptomebis gamovlenisa da gamwvavebis zusti intervius dros ar yofila gaTvaliswinebuli.
TariRi. zogjer sasargebloa kiTxvebis dasma imis w SeamowmeT, Tu ramdenad sworad gesmiT pacientis
Taobze, Tu ra kavSirSia simptomebis aRmoceneba im naTqvami. darwmundiT imaSi, rom moicaviT pacientisTvis
mniSvnelovani yvela problema. amaSi dagexmarebaT
movlenasTan, romelic pacients SeiZleba axsovdes ukukavSiri, anu pacientisaTvis ZiriTadi punqtebis
(mag., mis dabadebis dResTan). yuradReba miaqcieT Sejameba. es nabiji agreTve dagexmarebaT CamoiyaliboT
imas, Tu rogor cdilobs pacienti simptomebTan gam- azri diagnozisa da daavadebis mizezebis Sesaxeb.
klavebas (mag., xom ar moixmars alkohols stresis mo- w Sefasebisas moqniloba gmarTebT. es exeba rogorc
Sefasebis xangrZlivobas, ise mis Tanmimdevrobas.
saxsnelad). Tu pacients ukve Cautarda mkurnaloba,
SearCieT kiTxvebi imisda mixedviT, Tu rogori
CainiSneT, Tu ra saxis mkurnaloba Cautarda mas, ra varaudebi gagiCndebaT diagnozTan, daavadebis
xnis manZilze da rogori iyo Sedegebi. aseve CainiSneT, mizezebTan da samoqmedo gegmasTan dakavSirebiT.
_ 41 _
3 gamokvleva
nierad grZnobT Tavs col-qmrul cxovrebaSi?~, das- an rodesac zrdasruli pacienti munjia an zedmetad
viT kiTxva: `rogor ewyobiT Tqven da Tqveni meuRle abneulia). sxva SemTxvevebSi, eqimma unda ganumartos
erTmaneTs?~. rodesac aucilebelia daxuruli kiTx- pacients, Tu ratom aris saWiro informatoris
vis dasma, pasuxis miRebis Semdeg sTxoveT pacients, interviuireba. am dros isic aRiniSneba, rom
Sesabamisi magaliTebi moiyvanos. intervius dasrule- informators ar gaumJRavneben pacientis mier
bamde kargi iqneba, Tu dasvamT Semdegi saxis zogad mowodebul konfidencialur informacias. Tu
kiTxvebs: `xom ar damaviwyda iseTi ramis kiTxva, rac, naTesavs unda mivawodoT raime saxis informacia
Tqveni azriT, CemTvis saintereso unda iyos?~ (mag., informacia mkurnalobis Sesaxeb), es pacientis
boqsSi 3.1 Sejamebulia efeqturi interviurebisT- nebarTvas saWiroebs. zustad aseTive midgoma
vis saWiro teqnika. gamoiyeneba naTesavebis mimarT.
Tavidan interviueri ganmartavs intervius
informatorebis interviuireba Catarebis mizans. mas, SesaZloa, informatoris
sadac ki es SesaZlebelia, pacientis avadmyofobis damSvideba daWirdes. pacientis naTesavs SeiZleba
istoria unda Seivsos informaciiT, romelsac SeeSindes imisa, rom interviueri mas miiCnevs
gvawvdis pacientis axlo naTesavi an romelime sxva pacientis problemebze pasuxismgebel adamianad,
piri, romelic kargad icnobs pacients. es bevrad an mas raime moTxovnebs wauyenebs. interviueri
mniSvnelovania fsiqiatriaSi, vidre medicinis sensitiuri unda iyos aseTi ideebis mimarT da,
sxva dargebSi, radgan fsiqikuri daavadebis mqone saWiroebis SemTxvevaSi, ganixilos kidec isini,
zogierTi pacienti ver acnobierebs Tavisi simptomebis magram is Rrmad ar unda SeiWras amgvar diskusiebSi
simZimes. zogi pacienti kargad acnobierebs Tavis da misi qceva ar unda imyofebodes konfliqtSi mis
problemas, magram ar surs misi gamJRavneba. mag., upirveles pasuxismgeblobasTan pacientis winaSe. Tu
adamianebi, romlebic borotad moixmaren alkohols, informators intervius pacientisagan damoukideblad
xSirad ar amxelen miRebuli alkoholis raodenobas. utareben, fsiqiatrma ar unda gaumJRavnos pacients
garda amisa, pacientebi da maTi naTesavebi SeiZleba intervius Sinaarsi informatoris nebarTvis
gansxvavebul informacias iZleodnen pacientis gareSe. am wesis dacva maSinacaa mniSvnelovani, Tu
pirovnul maxasiaTeblebze. interviu partniorTan informatorma interviuers iseTi ram uTxra, rac
an naTesavTan tardeba ara mxolod damatebiTi SemdgomSi pacientTan erTad unda iqnes ganxiluli
informaciis mosapoveblad, aramed pacientisa da (mag., acnoba interviuers pacientis mier alkoholis
daavadebisadmi maTi damokidebulebis gasarkvevad Warbad moxmarebis Sesaxeb).
da samkurnalo gegmaSi maTi CarTvis mizniT. garda zogjer, pacientis da misi daavadebis Sesaxeb
amisa, interviu saSualebas gaZlevT gaarkvioT, Tu damatebiTi informaciis Segrovebis mizniT,
ramdenad didi tvirTia pacientis avadmyofoba misi fsiqiatrs uwevs saubari pacientis damsaqmebelTan,
axloblebisTvis da rogor axerxeben isini Tavis megobrebTan, policiasTan an sxva pirebTan. aseTi ram
garTmevas. informatorisagan miRebuli informacia mxolod pacientis nebarTviT unda xdebodes, Tuki
maSinaa arsebiTi mniSvnelobis mqone, rodesac ar arsebobs ufro mniSvnelovani samarTlebrivi an
pacients ar SeuZlia Tavisi mdgomareobis zustad usafrTxoebasTan dakavSirebuli mizezebi (mag., Tu
aRwera, mag., daqveiTebuli mexsierebis gamo. da pacienti Tavisuflebis aRkveTis adgilas imyofeba an
bolos, Tu mniSvnelovania informaciis mopoveba Tu man SeiZleba ziani moutanos mesame mxares).
pacientis bavSvobis Sesaxeb, interviu mSobelTan
an ufros da-ZmasTan SeiZleba Zalze informatuli pacientis maxasiaTebelebi, romlebmac
aRmoCndes. SeiZleba zegavlena moaxdinon interviuze
informatorebs SegiZliaT SexvdeT calke, an isini intervius Catareba ramdenime mizezis gamo SesaZloa
pacientTan interviuze moiwvioT. es damokidebuli rTuli aRmoCndes. bevr mizezs ganapirobebs situacia
iqneba imaze, Tu Semfasebeli da pacienti ras (xmauriani garemo, drois deficiti), an interviueris
aniWeben upiratesobas. Tumca, orive SemTxvevaSi maxasiaTeblebi (mag., arasakmarisi gamocdileba, daR-
informatorTan dakavSireba pacientis nebarTviT liloba). zogi problema Tavad pacientis maxasiaTe-
xdeba. Tu pacienti ar rTavs informators nebas, blebiTaa ganpirobebuli da aq swored maTze iqneba
rom mas interviu CamoarTvan, gamoikvlieT amis saubari. gaxsovdeT, rom amgvari problemebi SeiZleba
mizezi da ganmarteT, Tu ra sirTuleebs gamoiwvevs sagulisxmo aRmoCndes diagnostirebis TvalsazrisiT
es Sefasebis procesis TvalsazrisiT. arsebobs (mag., pacienti SeiZleba sityvaZunwi iyos depresiis
ramdenime situacia, rodesac pacientis nebarTva ar gamo an Secvlili hqondes cnobiereba deliriumis
aris aucilebeli naTesavis an sxva informatoris gamo).
interviuirebis win (mag., rodesac pacienti bavSvia,
_ 42 _
SfoTviani pacienti viTarebaSi yvelaferi unda gakeTdes imisTvis, rom

informacia sxva informatorebisagan movipovoT.
miuxedavad imisa, rom SfoTva zog SemTxvevaSi paci-
entis fsiqikuri mdgomareobis erT-erTi maxasiaTebe- araTanamSromluri pacienti
lia, is, SeiZleba, interviuTi iyos gamowveuli. Tu pa-
zog pacients ar surs, rom mas interviu CamoarTvan da
cienti zedmetad SfoTviania, interviuerma SeiZleba
interviuze mesame mxaris (mag., meuRlis) daJinebuli
mas uTxras, rom uamravi adamiani ganicdis SfoTvas,
TxovniT Tanxmdeba. rodesac pacienti ar midis Tanam-
rodesac pirvelad iRebs monawileobas fsiqiatriul
Sromlobaze, interviuerma xelaxala unda ganixilos
interviuSi da ganagrZos imis garkveva, Tu ra awuxebs
is mizezebi, ris gamoc mas pacientma momarTa da unda
pacients.
daarwmunos igi, rom intervius Catareba mis interes-
sityvaZunwi pacienti Sic Sedis. gaxsovdeT, rom pacientis uari interviuer-
Tan TanamSromlobaze SeiZleba gamowveuli iyos imiT,
interviueri daexmareba sityvaZunw pacients, isau-
rom pacienti ver acnobierebs sakuTar avadmyofobas.
bros Tavisuflad, Tu igi mis mimarT interess araver-
mag., deliriumis, depresiisa da fsiqozebis SemTxveva-
balurad gamoxatavs (mag., skamze jdomisas odnav win
Si. aseT dros pacientis xelaxla gamokvlevamde Sei-
gadaixreba da interesis gamomxatvel gamometyvele-
Zleba saWiro gaxdes informatorTan gasaubreba.
bas miiRebs). zogadad, interviuerma unda gamoiyenos
yvela is araverbaluri niSani, romelic efeqtur in- ukontaqto pacienti
tervius ganapirobebs.
Tu pacients mutizmi an stuporozuli mdgomareoba
ybedi pacienti aqvs, aucilebelia informatoris interviuireba, ro-
melic mogvawodebs informacias mdgomareobis ganviTa-
advili ar aris iseTi pacientis moTokva, romelic
rebisa da mimdinareobis Sesaxeb. aseTi pacientis fsiqi-
zedmetad bevrs laparakobs. Tu fsiqiatri ver
kuri mdgomareobis Sefasebisas interviuers mxolod
axerxebs saWiro Temaze intervius warmarTvas, is
qcevaze dakvirveba SeuZlia, Tumca esec sakmaod infor-
unda daelodos im moments, rodesac pacienti bune-
matiulia. radgan stuporis dros sruliad umoZrao pa-
brivad gaakeTebs pauzas da auxsnas mas, rom, radganac
cients SeiZleba ucbad ganuviTardes Zlieri fsiqo-mo-
interviu droSia SezRuduli, mas mouwevs, drodadro
toruli agzneba Zaladobrivi qmedebebiT, aucilebelia
Seawyvetinos saubari. man isic unda aRniSnos, rom es
Sesabamisi usafrTxoebis zomebis miReba.
saWiroa iseT sakiTxebze koncentraciisTvis, romle-
manam dasvamT mutizmis diagnozs, mieciT pacients
bic aucilebelia mkurnalobis dasagegmad. Tu fsiq-
sakmarisi dro pasuxis gasacemad da mosinjeT ramden-
iatri amas taqtianad gaakeTebs, maSin yvelaze ybed
ime sasaubro Tema. Tu pacienti mainc ar gipasuxebT,
pacientsac ki daiyoliebs.
sTxoveT daweros pasuxi. qcevaze dakvirvebis garda,
hiperaqtiuri pacienti daakvirdiT Tvalebis moZraobas: Ria aqvs Tu daxuWu-
zogi pacienti imdenad aqtiuri da mousvenaria, rom li, fiqsirebulia erT wertilze, Tu umiznod acecebs
misi fsiqikuri mdgomareobis gamosavlenad mizan- aqeT-iqiT, ayolebs Tu ara Tvals sagnebs. Tu Tvalebi
mimarTuli intervius Catareba Zalian Znelia. aseT daxuWuli aqvs, sTxoveT gaaxilos. daakvirdiT, gaax-
SemTxvevaSi interviueri ramdenime, yvelaze mniS- els Tu ara, an roca sTxovT, xom ar ewinaaRmdegeba
vnelovani kiTxviT ifargleba da pacientis qcevazea Tvalebis gaxelas. aseT SemTxvevebSi aucilebelia
koncentrirebuli. Tu pacients mimReb ganyofile- fizikuri da nevrologiuri gamokvleva. garda amisa,
baSi vnaxulobT, misi zedmeti aqtiuroba SeiZleba mniSvnelovania katatonuri SizofreniisTvis damaxa-
warmoadgendes reaqcias sxvaTa mcdelobaze, Sez- siaTebeli niSnebis gamovlenac (gv. ??).
Rudon igi. Tu aseT dros inteviueri mSvidad da
sxva problemebi
TviTdajerebulad moiqceva, man SesaZloa moaxerxos
zogi pacienti cdilobs, Tavad warmarTos interviu.
pacientis damSvideba, rac sakmaris pirobas Seqmnis
es gansakuTrebiT maSin xdeba, rodesac interviueri
gamokvlevis Casatareblad.
masze axalgazrdaa. zogi pacienti zedmetad megobru-
abneuli pacienti lad iqceva, ris gamoc interviu SeiZleba Cveulebriv
rodesac avadmyofi Tavis istorias areulad yveba an saubrad gadaiqces. nebismier SemTxvevaSi, intervi-
dabneulia, interviuerma Tavidanve unda gamoikvlios uerma unda ganmartos, Tu ratom warmarTavs igi pa-
misi kognituri funqciebi. Tu saxezea cnobierebis cients swored garkveul Temebze sasaubrod. droTa
paTologia an kognituri daqveiTeba, interviuerma, ganmavlobaSi intervius warmarTva TviTdajerebuli
gamartivebuli intervius xelaxla daiwyebamde, unda da asertuli (magram ara dominanturi) maneriT inter-
daamSvidos igi da daexmaros mas orientirebaSi. aseT vius warmarTva agvaridebs amgvar problemebs.
_ 43 _
3 gamokvleva
avadmyofobis istoria anamnezis Sekrebis sqema

fsiqikuri gamokvlevis ZiriTadi nawilebia avadmyo- informacia jgufdeba Sesabamis Temebad, rogorc es
fobis istoria da fsiqikuri statusis kvleva. es naCvenebia cxrilSi 3.1. es Tavi Seicavs mokle saxiT
ukanaskneli intervius dros gamovlenili simptom- mocemul Canawerebs da sailustracio kiTxvebs.
ebisa da niSnebis dafiqsirebas gulisxmobs, xolo
informatori
avadmyofobis istoria moicavs yvelafer danarCens.
gamokvlevis dasasruls tardeba fizikuri mdgomare- w Cveulebriv, mTavari informatori pacientia. Tu es
obis gamokvleva, xolo xandaxan Semdgomi gamokvlevis ase ar aris, daasaxeleT mizezi.
Catarebac xdeba saWiro. am qveTavSi saubaria fsiqi- w sxva informatoris (informatorebis) vinaoba, misi
atriul istoriaze, romelsac mosdevs fsiqikuri md- kavSiri pacientTan, nacnobobis xangrZlivoba.
gomareobis kvleva da sxva saxis gamokvlevebi. w visganaa momarTva da momarTvis mizezi.
qvemoT motanilia anamnezis Sekrebis yvelaze
gavrcelebuli sqema, romelic, advilad aRsaqmeli amJamindeli mdgomareoba
rom iyos, Temebisa da maTSi Semavali punqtebis saxi-
w CamoTvaleT simptomebi, rodis iCina simptomebma Tavi,
Taa warmodgenili. ufro detaluri informacia Sem-
maTi xangrZlivoba da TiToeuli maTganis dinamika.
dgom CanawerebSi unda iqnes dafiqsirebuli. rogorc
w ikiTxeT im simptomebis Sesaxeb, romelTa gamovlena
zemoT iTqva, intervius udidesi nawili diagnosti-
mosalodneli iyo, magram romlebmac ar iCines
kuri simptomebis gamovlenasa da aRricxvazea mimar-
Tavi (mag., daqveiTebuli guneb-ganwyobis mqone
Tuli, magram, amas garda, interviueri sxva kiTxveb-
pirovnebas ar aReniSneba azrebi TviTmkvlelobis
sac svams, romlebic exeba pacientis cxovrebasa da im
Sesaxeb; bodvis mqone pacients ar aqvs Sizofreniis
viTarebas, romelSic is amJamad imyofeba. amave dros,
ZiriTadi simptomebi). aRricxeT isini.
mTlianad interviu raportis damyarebaze unda iyos
mimarTuli, rac, saboloo jamSi, zemoT xsenebul w droSi kavSiri simptomebsa da romelime fsiqikur
miznebs emsaxureba da safuZvels uqmnis Terapiuli aSlilobas, an romelime fsiqologiur, an socialur
urTierTobis Camoyalibebas. problemas Soris.
qvemoT motanili sqema sruli da Tanmimdevrulia, w simptomiT gamowveuli nebismieri fuqnciuri gau
radgan am tipis gamokvlevis Catareba Zalian mniS- aresebis buneba da xangrZlivoba;
vnelovania iqamde, sanam pacients mokle interviu w nebismieri saxis Catarebuli mkurnaloba; misi Se
Cautardebodes. miuxedavad imisa, rom TiToeul Sem- degebi da gverdiTi movlenebi.
TxvevaSi sruli anamnezis Sekreba arc SesaZlebelia
da arc aucilebeli, mopovebuli informacia yov- ojaxis anamnezi
elTvis Tanmimdevruli da standartuli wesiT unda w mSoblebi da da-Zma. amJamindeli asaki an ra asakis
aRiricxos. es daexmareba interviuers, gaixsenos yvela gardaicvala (gardacvalebis SemTxvevaSi daasaxeleT
savaraudod mniSvnelovani Tema da is SemdgomSi dam- mizezi); saqmianoba, pirovnuli Tvisebebi, pacientTan
atebiTi informaciiT Seavsos. es praqtika, agreTve, urTierTobis xarisxi, fsiqikuri an somaturi
saqmes uadvilebs im kolegebs, romlebic am Canawerebs
momavalSi gamoiyeneben. Canawerebis warmoebisas Segvi-
cxrili 3.2 cxovrebis anamnezis sqema
Zlia mivsdioT mocemul struqturas maSinac ki, rode-
sac SeuZlebelia sasurveli TanmimdevrobiT informa- dedis fexmZimoba da mSobiaroba
ciis Segroveba. CanawerebSi Semavali TiToeuli punqti adreuli ganviTareba

unda iqnes daTariRebuli da xelmowerili. ganSoreba bavSvobisas, emociuri xasiaTis problemebi,
avdmyofoba, ganaTleba
cxrili 3.1 avadmyofobis istoriis sqema SromiTi saqmianoba
pacientis saxeli da gvari, asaki da misasamrTi urTierTobebi
sxva informatoris vinaoba da misi kavSiri pacientTan Svilebi
amJamindeli mdgomareoba socialuri pirobebi
ojaxis anamnezi fsiqoaqtiuri nivTierebis moxmareba
cxovrebis anamnezi (ganvrcobilia cxrilSi 3.2) warsulSi gadatanili somaturi daavadebebi
gadatanili somaturi da fsiqikuri daavadebebi warsulSi gadatanili fsiqikuri daavadebebi
pirovnuli maxasiaTeblebi (ganvrcobilia cxrilSi 3.3) samarTaldarRvevebi
_ 44 _
avadmyofobis istoria
daavadebebis istoria.
cxrili 3.3 pirovnuli maxasiaTeblebi
w ojaxis socialuri mdgomareoba.
urTierTobebi
w im SemTxvevaSi, Tu ojaxis anamnezi rTuli da
relevanturia, SeadgineT sagvareulo xe. Tavisufali drois gatareba
dominanturi guneb-ganwyoba da emociebi

cxovrebis anamnezi (ix. cxrili 3.2)
xasiaTi
w orsuloba da dabadebis droindeli anomaliebi (mag.,
socialuri ganwyobebi da standartebi
infeqciebi, naadrevi mSobiaroba, mSobiarobasTan
dakavSirebuli problemebi). Cvevebi
w adreuli ganviTarebis ZiriTadi etapebi; siaruli,

w gadatanili fsiqikuri daavadebebi: TiToeuli
laparaki, spinqteris kontroli da sxva.
daavadebis xasiaTi da xangrZlivoba. aRricxeT
w bavSvoba: nebismieri xangrZlivi ganSoreba mSobelTan da
TviTdazianebis TiToeuli epizodi. mkurnalobis
masze pacientis reaqcia. nebismieri emociuri xasiaTis
TiToeuli SemTxvevis TariRi, xangrZlivoba, xa
problemebi (asaki, rodesac problemam iCina Tavi;
siaTi, adgili da Sedegi.
ra mcdeloba gakeTda mis mosavlelad). bavSvobisas
w romel preparatebs iRebs amJamad, kontraceptuli
gadatanili nebismieri seriozuli daavadeba.
preparatebis CaTvliT, preparatebi, romlebic re
w skola da umaRlesi ganaTleba: TiToeuli etapis
ceptis gareSe gaicema, sxva saSualebebi. nebismieri
dasawyisis da dasrulebis asaki. skolis, kolejis an
alergiuli an arasasurveli reaqcia.
universitetis tipi. akademiuri miRwevebi; sporti
w samarTaldarRvevebi: dakaveba, nasamarTleoba, pa
da sxva klasgareSe aqtivoba. urTierToba sxva
timroba. samarTaldarRvevis xasiaTi, gansakuTrebiT
moswavleebTan/studentebTan da maswavleblebTan.
saSiSroebis TvalsazrisiT.
bulingi.
w SromiTi saqmianoba: axlandeli samuSao _ TariRebi, pirovnuli maxasiaTeblebi
movaleobebi, Sesruleba, kmayofileba. CamoTvaleT w intervius am etapze pacientis mier Tavisi
pacienti sad muSobda manamde; ratom Seicvala istoriis aRwera da misi Txrobis manera garkveul
samuSao adgili. warmodgenas gviqmnis misi pirovnebis Sesaxeb. Tumca,
w axlandeli urTierTobebi: partnioris identoba da mniSvnelovania pacientis pirovnul maxasiaTeblebze
sqesi, urTierTobis xangrZlivoba, xasiaTi (mag., aris yuradRebis ufro metad gamaxvileba (cxrili 3.3).
Tu ara daqorwinebuli). partnioris janmrTeloba, pirovnuli maxasiaTeblebi da personologiuri
misi damokidebuleba pacientis avadmyofobis mi aSlilobebi me-7 TavSia ganxiluli.
marT da urTierTobis xarisxi. w urTierTobebi: megobrebi, ramdenime Tu bevri,
w sqesobrivi sfero: damokidebuleba seqsisadmi, hete zedapiruli Tu axlo urTierToba, sakuTar Tu
roseqsualuri da homoseqsualuri gamocdileba, sawinaaRmdego sqesTan, urTierToba TanamSrom
amJamindeli sqesobrivi cxovreba, kontraceptuli lebTan da ufrosebTan.
saSualebebis gamoyeneba. is, Tu ra saxiT da ramdenad w Tavisufali drois gatareba: hobi da interesebi.
Rrmad unda ganixilebodes seqsualur sferosTan da w dominanturi guneb-ganwyoba da emociebi. mag., pa-
kavSirebuli sakiTxebi, SemdgomSia ganxiluli (gv. ??). cienti SeiZleba iyos SfoTviani, daTrgunuli, op-
timisti an pesimisti, zedmetad TviTkritikuli an
w Svilebi: maTi vinaoba, abortebis an mkvdradSobis
Tavdajerebuli, stabiluri an cvalebadi xasiaTis.
SemTxvevebis raodenoba, temperamenti, emociuri
garda amisa, pacienti SeiZleba iyos TavSekavebuli
ganviTareba, fsiqikuri da fizikuri janmrTeloba.
an demonstraciuli.
w socialuri pirobebi: sacxovrebeli, ojaxis Semad w xasiaTis sxva Taviseburebani: perfeqcionisti, obse-
genloba da finansuri problemebi. siuri, ganmartoebuli, impulsuri, mgrZnobiare an
w alkoholis, Tambaqos da aralegaluri narkotikebis dominanturi.
moxmareba. w socialuri ganwyobebi da standartebi: moraluri
da religiuri standartebi, damokidebuleba janmr-
warsulSi gadatanili somaturi da
Telobisa da sxeulis mimarT.
fsiqikuri daavadebebi
w gadatanili somaturi daavadebebi: daavadebebi, anamnezis Sekreba
operaciebi, ubeduri SemTxvevebi, narkotikuli zemoT mocemul sqemaSi warmodgenilia is sakiTxebi,
nivTierebebis moxmarebis mkurnaloba. romlebic anamnezis Sekrebisas unda gaviTvaliswinoT.
_ 45 _
3 gamokvleva
Tumca, masSi araferia naTqvami imaze, Tu ratomaa es problemebs (mag., im faqtma, rom pacientis ufrosi da
sakiTxebi mniSvnelovani an ra sirTuleebs unda velo- an Zma Tavis tvinis simsivniT gardaicvala, SeiZleba
doT maTTan dakavSirebiT. isini ganixileba am nawil- nawilobriv agvixsnas, Tu ratom aris pacienti SeS-
Si, romelic motanili sqemis mixedviTaa dawerili. foTebuli Tavis tkivilis gamo).
momarTvis mizezebi pirovnebis ganviTarebis istoria

am SemTxvevaSi keTdeba mxolod mokle Canaweri; mag., orsuloba da mSobiaroba
`mZime depresia, ar reagirebs medikamentur mkurnalo-
orsulobasa da mSobiarobasTan dakavSirebuli gar-
baze. interviu, Cveulebriv (Tumca ara yovelTvis),
Tulebebi xSirad kavSirSia daswavlis darRvevasTan.
momarTvis mizezebzea fokusirebuli. SeamowmeT, asax-
aseve, isini zogierTi fsiqikuri aSlilobis risk-
elebs Tu ara pacienti momarTvis imave mizezebs. Tu
faqtors warmoadgenen. arasasurvel orsulobas Sesa-
es ase ar aris, es, TavisTavad, Rirebuli informa-
Zlebelia mohyves cudi urTierToba dedasa da Svils
ciaa. mag., pacienti SeiZleba ar gveTanxmebodes imaSi,
Soris.
rom depresiaSia da darwmunebuli iyos, rom mas avT-
visebiani simsivne aqvs. es, SesaZloa, diagnostikurad bavSvis ganviTareba
mniSvnelovani informacia iyos (mag., miuTiTebdes Zalian cota pacientma Tu icis, gaiara Tu ara man
ipoqondriis arsebobaze) da, aseve, zemoqmedeba moax- normalurad ganviTarebis yvela safexuri. es infor-
dinos pacientis survilze, Cautardes gamokvleva an macia ufro mniSvnelovania, Tu pacienti bavSvi an
Sesabamisi mkurnaloba. mozardia. aseT dros SegviZlia interviu mSoblebs
amJamindeli mdgomareoba CavutaroT. am tipis informacia aseve mniSvnelova-
nia daswavlis darRvevis mqone bavSvebTan muSaobisas.
istoriis es nawili SedarebiT vrcelia, radgan aq
dedasTan ganSorebis efeqti mniSvnelovnad cvaleba-
xSirad gvxvdeba ramdenime simptomi da TiToeulis
dobs imisda mixedviT, Tu ra asakSi moxda ganSoreba
srulyofil daxasiaTebas garkveuli dro sWirdeba.
da mis xangrZlivobasa da mizezebzea damokidebuli.
aRwereT TiToeuli simptomis simZime da xangrZlivoba
gamokiTxva bavSvis emociuri ganviTarebis Sesaxeb
(rogor aRmocenda da ganviTarda _ TandaTan an safex-
gvawvdis informacias bavSvis temperamentze adreul
ureobrivad, uwyvetia Tu Setevismagvari). daadgineT,
asakSi da misi pirovnebis Camoyalibebaze. ganviTare-
romeli simptomia Tanmdevi da romeli _ damoukide-
baSi Seferxeba an raime anomalia SeiZleba SemdgomSi
beli. aRnusxeT yvela Catarebuli mkurnaloba, misi
aRmocenebuli problemebis gamomwvev faqtors an
efeqturoba da gverdiTi movlenebi. Tu romelime
adreul niSans warmoadgendes. Tumca, bavSvis maxasi-
medikamenti araefeqturi gamodga, hkiTxeT pacients,
aTeblebi, Cveulebriv, ar gvaZlevs zrdasrul asakSi
regularulad da Sesabamisi dozebiT iRebda Tu ara
Camoyalibebuli darRvevebis zust prognozs, amitom
preparats.
maTi zedmiwevniTi ganxilva mxolod bavSvTa da mo-
ojaxis anamnezi zardTa gamokvlevis drosaa saWiro. bavSvTa fsiqi-
fsiqikuri aSlilobis ojaxis istoriam SesaZloa ga- atriaSi gamokvlevis Catareba 24-e TavSia aRwerili.
moavlinos genetikuri faqtorebi an garemos zegav-
ganaTleba
lena. zogierTi daavadeba genetikuri faqtoriT ukeT
skolis dokumentaciasTan gacnobiT vadgenT paci-
aixsneba. rac meti naTesavia daavadebuli, miT ufro
entis inteleqtis, miRwevebisa da socialuri ganvi-
safuZvliania genetikuri faqtoris gaTvaliswineba.
Tarebis dones. kiTxvebi unda daisvas imis Taobaze,
miuxedavad imisa, rom ojaxis istoriis konteqstSi
SeiZina Tu ara pacientma megobrebi da daamyara Tu
garemos faqtori nakleb mniSvnelovnad iTvleba ge-
ara kontaqti maswavleblebTan. aseve, unda gavarkvi-
netikurTan SedarebiT (Tavi me-5), pacientis prob-
oT, Tu ramdenad warmatebiT monawileobda bavSvi sx-
lemisa da misi warmoSobis gasarkvevad informacia
vadsaxva TamaSebsa da aqtivobebSi. Sesabamisi kiTxvebi
ojaxuri garemoebebis Sesaxeb kvlav ZiriTad infor-
unda davusvaT im pacientebsac, romlebic umaRles
maciadaa miCneuli. Sesabamisad, unda daisvas kiTxvebi
saswavlebelSi swavloben.
mSoblebisa da da-Zmis pirovnuli maxasiaTeblebis,
maTi urTierTobis da ojaxis socialuri da finans- SromiTi saqmianobis istoria
uri mdgomareobis Sesaxeb.
gamokiTxva amJamindeli samsaxuris Sesaxeb intervi-
ojaxis cxovrebaSi axlaxan momxdari ambebi, Sesa-
uers exmareba, gaarkvios pacientis socialuri da fi-
Zloa, pacientisTvis stresuli aRmoCndes (mag., seri-
nansuri mdgomareoba, rac SeiZleba stresis erT-erT
ozuli avadmyofoba an ganqorwineba). ojaxis cxovre-
potenciur mizezs warmoadgendes. pacientis pirovnu-
baSi momxdari faqtebi ufro gasagebs xdis avadmyofis
li Tvisebebis Sesafaseblad Zalian mniSvnelovania
_ 46 _
avadmyofobis istoria
gamovkiTxoT mas wina samsaxurisa da misi datovebis bic zogjer arasasurvel fsiqologiur reaqciebTan
mizezebis Sesaxeb. Tanamdebobrivi daqveiTeba SeiZle- asocirdeba. informacia pacientis Svilebis Sesaxeb
ba qronikuli daavadebis an alkoholis Warbi mox- kavSirSia pacientis problemebTan da misi ojaxuri
marebis mizezi gaxdes. samsaxuris xSiri gamocvla an cxovrebis wesTan. radgan mSoblebis avadmyofobam
samsaxuridan xSiri daTxovna SeiZleba asaxavdes per- SeiZleba Svilebze imoqmedos, mniSvnelovania vico-
sonologiur sirTuleebs. deT, uvlis Tu ara Cvil bavSvs mZime depresiaSi myo-
fi deda, an kidev, alkoholis momxmarebel agresiul
sqesobrivi sfero mamakacs hyavs Tu ara Svilebi, romlebic masTan er-
interviueri unda xelmZRvanelobdes saRi azriT imis Tad cxovroben. Tu stacionarSi iseTi pacienti unda
gansazRvrisas, Tu ramdenad detalurad unda Cau- moTavsdes, romelsac Svilebze zrunva akisria, mniS-
tardes gamokiTxva TiToeul pacients. es damokideb- vnelovania ganvsazRvroT maTi saWiroebebi da uzrun-
ulia imaze, Tu rogor pasuxobs pacienti sawyis kiTx- velvyoT bavSvebis movla-patronoba.
vebs da rogoria misi demografiuli maxasiaTeblebi.
agreTve, mniSvnelovania, Tu ra aris misi ZiriTadi gadatanili somaturi da fsiqikuri daavadebebi
Civilebi. mag., Tu pacienti gTxovT daxmarebas sqe- aucilebelia pacientis gamokiTxva warsulSi Catare-
sobriv sferoSi arsebuli siZneleebis gamo, Zalian buli Terapiuli da qirurgiuli mkurnalobis Sesaxeb.
mniSvnelovania detaluri gamokiTxva, Tumca, inter- gansakuTrebiT yuradRebiTaa Sesaswavli is fsiqi-
viuers xSirad isic ainteresebs, Tu ra saxis kavSiri kuri aSlilobebi, romlebic warsulSi aReniSneboda.
arsebobs pacientis sqesobriv cxovrebasa da mis am- pacientsa da mis naTesavebs SeuZliaT mogvawodon
Jamindel siZneleebs Soris anu sqesobrivi xasiaTis zogadi informacia warsulSi gadatanili avadmyofo-
problemebi pacientis sxva sirTuleebis mizezia, bisa da mkurnalobis Sesaxeb, magram mainc marTebulia
Sedegi, Tu Tanmdevi movlena. informacia miviRoT im pirebisagan, vinc uSualod
agreTve, unda gadawydes, Tu rodis unda daisvas mkurnalobda pacients.
kiTxvebi bavSvobisdroindeli seqsualuri Zaladobis
Sesaxeb da ramdenad detaluri unda iyos am tipis socialuri pirobebi
kiTxvebi. samwuxarod, am saxis warsuli gamocdileba pacientis socialuri garemoebebis SeswavlaSi gvex-
sakmaod gavrcelebulia, gansakuTrebiT qalebTan, mareba SekiTxvebi pacientis sacxovreblis, finansuri
ris gamoc fsiqiatrs uwevs Sesabamisi kiTxvebis in- mdgomareobis da ojaxis Semadgenlobis Sesaxeb. am
terviuSi Setana. miuxedavad amisa, mocemul Temaze dros xdeba pacientis resursebis (momvleli pirebis
saubris dawyeba pirvelive interviuze xSirad ar aris CaTvliT), problemebisa da stresis wyaros Sefaseba.
marTebuli, Tu iniciativa Tavad pacientisagan ar ar arsebobs zogadi kanoni imisa, Tu ramdenad deta-
modis. kiTxvebis dasmis Taobaze fsiqiatris gadaw- luri unda iyos am tipis informacia. amis dadgenaSi
yvetilebas ganapirobebs misi klinikuri gamocdile- saRi azri gvexmareba.
ba, kompetenturoba da interviusTvis gansazRvruli
fsiqoaqtiuri nivTierebebis gamoyeneba
drois xangrZlivoba. Tu intervius ganmavlobaSi ar
da maTi borotad moxmareba
iyo saubari seqsualuri Zaladobis Sesaxeb, Canawereb-
Si es faqtic unda aRiniSnos. seqsualur aSlilobas- es sakiTxi exeba alkoholisa da sxva nivTierebebis
Tan dakavSirebuli kiTxvebi me-19 TavSia ganxiluli. moxmarebas awmyosa da warsulSi. unda aRiweros im
wamlebis arasworad moxmareba, romlebic pacients
qorwinebis istoria gamouweres. pacienti SeiZleba Tavs aridebdes pasux-
aq igulisxmeba yvela saxis xangrZlivi intimuri urT- is gacemas an araswori pasuxebi gagvces, ris gamoc
ierToba. dasviT kiTxvebi amJamindeli da warsuli SeiZleba saWiro gaxdes maTi gadamowmeba rogorc sxva
xangrZlivi urTierTobebis Sesaxeb. kiTxvebi iseTi informatorebTan, ise sxva wyaroebis mixedviT (mag.,
saxiT unda daisvas, rom maTSi partnioris sqesi ar Sardisa da sisxlis analizi). ufro detaluri infor-
iyos nagulisxmevi. xSiri da wyvetili urTierTobebi, macia am sferoSi intervius Catarebis Sesaxeb me-18
SesaZloa, pirovnul anomaliaze miuTiTebdes. meuRl- TavSia mocemuli.
is saqmianoba, pirovnuli Tvisebebi da janmrTelobis
pirovnuli maxasiaTeblebis Sefaseba
mdgomareoba pacientis amJamindeli cxovrebiseuli
viTarebis mniSvnelovani ganmsazRvrelia. pirovnuli maxasiaTeblebis Sefaseba Semdeg monace-
mebs eyrdnoba: pacientis TviTSefasebis monacemebi,
Svilebi mis qcevaze dakvirveba da informaciis mopoveba imaT-
orsuloba, mSobiaroba da fexmZimobis bunebrivi gan, vinc pacients kargad icnobs. Tu pacientis TviT-
Sewyveta _ es is mniSvnelovani movlenebia, romle- Sefasebas zedmetad did mniSvnelobas mivaniWebT,
_ 47 _
3 gamokvleva
aman SeiZleba SecdomaSi Segviyvanos. zogi adamiani bis gamoxatuli meryeoba? Tu es asea, ramdenad xSiria
gadaWarbebulad dadebiTad afasebs sakuTar Tavs. da ra xangrZlivobisaa es cvlilebebi? aris Tu ara es
mag., antisocialurma pirovnebam SesaZloa ar gamoav- dakavSirebuli cxovrebiseul movlenebTan? informa-
linos Tavisi qcevis agresiuloba an sakuTari ara- ciam imis Sesaxeb, Tu rogoria pacientis guneb-ganwy-
keTilsindisiereba; an kidev, depresiuli adamianebi oba da rogor icvleba igi, SesaZlebelia migvaniSnos
xSirad sakuTar Tavs ganixilaven, rogorc agresiuls afeqtur aSlilobaze, romelic SegviZlia SemdgomSi
da kritikuls. amitom, Tuki es SesaZlebelia, infor- ufro Rrmad gamovikvlioT.
macia sxva pirebis gamokiTxviTac unda miviRoT.
pacientis pirovnebis dasaxasiaTeblad SegviZlia fsiqikuri statusis kvleva
vkiTxoT pacients, Tu rogor iqceva is konkretul
avadmyofobis istoriaSi mocemulia is simptomebi,
situaciaSi, gansakuTrebiT maSin, rodesac misi so-
romlebic iyo gasaubrebamde, xolo fsiqikuri statu-
cialuri roli icvleba (mag., samuSaos dawyeba, qor-
sis kvleva ki gulisxmobs avadmyofobis im simptomebze,
wineba, mSoblis rolis miReba).
niSnebsa da qceviT darRvevebze dakvirvebas, romlebic
qcevis mixedviT pacientis pirovnebis Sefasebisas,
gasaubrebis periodSi aRiniSneba. amgvari gamokvleva
mniSvnelovania gaviTvaliswinoT, rom interviuSi
warmoebs istoriis daweris Semdeg. miuxedavad imisa,
monawileoba SfoTvis gamomwvevia. garda amisa, in-
rom aseTi Tanmimdevroba tradiciulia da konceptua-
terviu fsiqikuri aSlilobis efeqtebis gamovlenis
lurad sasargeblo, praqtikaSi anamnezsa da fsiqikur
saSualebas unda iZleodes. pirovneba, romelic kon-
statuss Soris mkveTri sazRvris gavleba SeuZlebelia.
taqturia da, Cveulebriv, Tavs akontrolebs, depre-
kerZod, axlo warsulSi arsebuli niSnebi da simptom-
siis dros SesaZlebelia gaxdes gulCaTxrobili da
ebi (mag., ukanaskneli ramdenime saaTis manZilze smen-
sakuTar TavSi ar iyos darwmunebuli.
iTi halucinaciebis arseboba), Cveulebriv, aRwerilia
saRi azri da gamocdileba gvkarnaxobs, Tu ra siR-
fsiqikur statusSi, im SemTxvevaSic ki, Tu es fenomeni
rmeze unda Catardes gamokiTxva pacientis xasiaTis
uSualod interviuirebis dros ar vlindeba. fsiqikur
dasadgenad da raze unda iyos is fokusirebuli. Tu
statusSi mocemulia is niSnebic da simptomebic, rom-
pacients (an informators) uWirs Ria kiTxvebis gamoy-
lebic ama Tu im mizezis gamo manamde ar yofila aRwer-
enebiT aRweros sakuTari xasiaTi, dausviT mas Semdegi
ili (mag., informacia suicidis Sesaxeb). amitom mniS-
saxis kiTxvebi: `sakuTar Tavs pesimists uwodebT, Tu
vnelovania, rom fsiqikur statusSi miTiTebuli iyos
optimists?~, `sakuTar Tavs martosuls uwodebT, Tu
avadmyofobis niSnebisa da simptomebis aRmocenebis
kontaqtur adamians?~ aseT SemTxvevaSi ar unda gavamax-
dro da mimdinare momentisTvis maTi arseboba.
viloT yuradReba mxolod uaryofiT atributebze, ar-
Tu stacionars an TemSi pacients naxulobs medda
amed unda davsvaT kiTxvebi dadebiTi maxasiaTeblebis
an sxva samedicino personali, maSin fsiqikur md-
Sesaxebac (mag., SevekiTxoT pacients, ramdenad advilad
gomareobaze maTi dakvirvebis Sedegebi Zalian mniS-
itans is sirTuleebs). es mniSvnelovania ara mxolod
vnelovania da SeiZleba imaze metad informatiuli
pacientis Sesaxeb dabalansebuli suraTis misaRebad,
iyos, vidre fsiqikuri statusis kvlevisas pacientis
aramed imitomac, rom pirovnebis Zlieri mxareebi war-
qcevaze xanmokle dakvirvebiT miRebuli monacemebi.
moadgens ukeTes samiznes Terapiuli intervenciisTvis,
fsiqikuri mdgomareobis kvleva iTvaliswinebs fsiq-
Tuki pacienti Terapiuli Carevis saSualebas iZleva.
ikuri aSlilobis niSnebis arsebobis an ararsebo-
urTierTobebi bis Sesabamisi TanmimdevrobiT aRweras (cxrili 3.4).
simptomebi da niSnebi, romlebzec qvemoTaa saubari,
pirovneba morcxvia, Tu advilad SeuZlia megobruli
pirvel TavSia aRwerili da, mcire gamonaklisis gar-
urTierTobebis damyareba? SeuZlia mas adamianebTan
da, Cven maT specialurad aRar SevexebiT. fsiqikuri
axlo da xangrZlivi urTierTobis SenarCuneba? aseve,
statusis kvleva moiTxovs sagangebo unar-Cvevebs,
mniSvnelovania samsaxureobrivi urTierTobebi da
romlebic SemuSavdeba gamocdil interviuerze dak-
urTierTobebi megobrebTan da naTesavebTan. is, Tu ro-
virvebiT, profesionalis meTvalyureobis qveS mim-
gor atarebs adamiani Tavisufal dros, naTels hfens
dinare praqtikuli saqmianobiT da Sesabamisi lit-
mis pirovnul maxasiaTeblebs, asaxavs mis interesebs da
eraturis gacnobiT. fsiqikuri statusis gamokvle-
imas, Tu ras aniWebs igi upiratesobas (mag., martoobas
viT xdeba mniSvnelovani diagnostikuri informaciis
TuU sazogadoebaSi yofnas). es imasac gviCvenebs, Tu
mopoveba. amgvarad, fsiqikuri mdgomareobis zusti
ramdenad energiulia igi da ra resursebi gaaCnia mas.
da mravalmxrivi gamokvleva warmoadgens ZiriTad
guneb-ganwyoba unar-Cvevas, romelic aucilebelia fsiqiatrebisa da
SevekiTxoT pacients, Cveulebriv, mxiarulad aris fsiqikuri janmrTelobis sferoSi momuSave sxva pro-
xolme Tu ugunebod? aReniSneba Tu ara guneb-ganwyo- fesionalebisTvis.
_ 48 _
fsiqikuri statusis kvleva
Si moxrili jdoma; mas Tavi daxrili aqvs da mzera
cxrili 3.4 fsiqikuri statusis gamokvlevis sqema qveviTaa mimarTuli. SfoTvis mqone pacienti Se
garegnoba da qceva iZleba ijdes skamis kideze, skamis gverdebze
metyveleba xelebCaWidebuli. SfoTvis mqone pacients, romelic
imyofeba aJitirebuli depresiis mdgomareobaSi,
guneb-ganwyoba
axasiaTebs tremori, mousvenroba. igi xeliT exeba
azrovneba samkaulebs an awvalebs frCxilebs. maniakaluri
aRqma pacienti aris zeaqtiuri da mousvenari. moZraobis sxva
darRvevebi moicavs mogvianebiT diskinezias (gv. ??) da
kognituri funqciebi
motorul niSnebs, romelic ZiriTadad katatonuri
insaiTi SizofreniisTvisaa damaxasiaTebeli (gv. ??)
garegnoba da qceva socialuri qceva

zogadi STabeWdileba garegnobaze pacientis socialuri qceva da urTierTobebi
pacientis garegnobas udidesi diagnostikuri mniSv ganpirobebulia misi pirovnuli TvisebebiT da,
neloba aqvs. rogorc SemdgomSi vnaxavT, gamocdili rogorc es zemoT iyo aRniSnuli, intervius
klinicisti am informaciaze dayrdnobiT, xSirad, mimarT damokidebulebiT. garda amisa, qcevaze
winaswar diagnozs pacientTan Sexvedris pirvelive SeiZleba gavlenas axdendes fsiqikuri aSliloba
wuTebidan svams. pirovnebaze dakvirveba masTan Sex da, amdenad, igi mniSvnelovani diagnostikuri
vedrisTanave iwyeba: rogoria misi manerebi? rogor informaciis matarebelia. maniakaluri pacientebi
iqceva igi mosacdel oTaxSi yofnisas? wynarad zis, midrekilni arian zedmeti familiarobisa da
bolTas scems, Tu TavisTvis icinis? rogor pasuxobs TavSeukavlobisaken, xolo demenciis mqone pa
misalmebas? oTaxSi Semosvlisas aReniSneba Tu ara cientebi ise iqcevian, TiTqos isini samedicino
parkinsonizmis, ataqsiis an moZraoba-moqmedebebis interviuze ar imyofebodnen. Sizofreniis mqone
sxva darRvevebi? pacientis Cacmulobac garkveuli pacientebi, SesaZloa, sakuTar TavSi Caketilni da
informaciis matarebelia. WuWyiani, mouwesrigebeli TavianTi fiqrebiT moculebi iyvnen. antisocialuri
tansacmeli miuTiTebs sakuTari Tavis ugulebelyofaze. pirovnuli darRvevis mqone pacientebi SeiZleba
maniakalur pacientebs SeiZleba ecvaT Wreli an agresias avlendnen. Tu socialuri qceva Zalian
Seuferebeli tansacmeli. zogjer ucnauri Cacmuloba uCveuloa, zustad unda aRweroT, Tu ra aris
garkveul diagnozze mianiSnebs. mag., mSral amindSi masSi uCveulo, vidre gamoiyenoT zogadi frazebi,
sawvimaris tareba SeiZleba pacientis bodviTi azrebiT rogoricaa, mag., ùcnauri qceva~.
iyos ganpirobebuli, rom masze sxivebiT zemoqmedeben.
wonaSi mniSvnelovani klebis niSnebis arsebobisas eWvi metyveleba
unda mivitanoT depresiaze, nervul anoreqsias an miuxedavad imisa, rom pacientis azrebis gageba
somatur daavadebebze. mxolod metyvelebiTaa SesaZlebeli, fsiqikuri
statusis kvlevisas metyveleba da azrovneba cal-
saxis gamometyveleba da emociebis gamoxatva calke fasdeba. metyvelebis Sefasebisas yuradRebas
saxis gamometyveleba gvawvdis informacias guneb- vamaxvilebT saubris tempze, sisxarteze, sityvaTa
ganwyobis Sesaxeb. depresiis dros tuCis kuTxeebi maragze, JReradobasa da sityvis gamoTqmis sir
daweulia; warbebs Soris aRiniSneba vertikaluri Tuleebze, xolo metyvelebis SinaarsiT (mag.,
Rarebi. SfoTvis mqone pacients Sublze horizontaluri sikvdilze fiqri an gandidebis azrebi) vafasebT
Rarebi, Tvalis quTuToebs Soris gafarToebuli azrovnebas.
naprali da dilatirebuli gugebi aqvs. saxis ga
mometyveleba SeiZleba gamoxatavdes aweul guneb- metyvelebis tempi da raodenoba
ganwyobas, gaRizianebas da gabrazebas; `gaxevebuli~, metyveleba SeiZleba iyos uCveulod swrafi da
umetyvelo saxe preparatebis eqstrapiramiduli gver mravalsityviani maniakaluri mdgomareobis dros,
diTi efeqtebis Sedegs warmoadgendes. gamometyvelebis xolo depresiis SemTxvevaSi neli, gaRaribebuli da
Tavisebureba SeiZleba fizikur daavadebazec mig monotonuria. depresiis an demenciis arsebobisas
vaniSnebdes, mag., Tireotoqsikozze. SeiZleba mniSvnelovnad gaizardos kiTxvaze pasuxis
gacemis dro, rasac Semdeg mokle pasuxi mohyveba.
poza da moZraoba aseTi pacientebis metyveleba spontanurobasaa
poza da moZraoba aseve asaxavs guneb-ganwyobas. moklebuli. igive suraTi ixateba, Tu pirovneba
depresiuli pacientisTvis damaxasiaTebelia mxreb morcxvi an dabali inteleqtisaa.
_ 49 _
3 gamokvleva
metyvelebis sirTuleebi ris daqveiTeba depresiis dros. amitom fsiqikuri

mdgomareobis kvlevis es nawili sasurvelia gaR
Tu pacients aReniSneba problemebi Sesatyvisi sit
rmavdes kiTxvebiT, romlebic Seexeba guneb-gan
yvebis povnasa da gamoTqmaSi, SegviZlia vivaraudoT,
wyobis (afeqturi) aSlilobis diagnostikur niS
rom pacienti disfaziiT an dizarTriiT aris daava
nebs, da gamovlenili monacemebi, interviueris ga
debuli. ufro detaluri informacia mocemulia boqsSi
dawyvetilebiT, Sevides anamnezis an fsiqikuri sta
3.2 (gv. ??) da, aseve, nevrologiis saxelmZRvaneloSi.
tusis Sesabamis nawilSi.
neologizmebi
cvalebadi da Seusabamo guneb-ganwyoba
neologizmebi pacientis mier gamogonili sityvebia,
dominanturi guneb-ganwyobis Sefasebisas, inter
romlebsac is iyenebs Tavisi avadmyofuri gancdebis
viuerma unda gaarkvios, Tu rogor cvalebadobs
aRsawerad (gv. ??).
igi. Tu guneb-ganwyoba intensiurad cvalebadobs,
metyvelebis sisxarte mas labiluri ewodeba. mag., pacienti intervius
Seferxeba metyvelebaSi SeiZleba asaxavdes SfoT erT momentSi ugunebo an daTrgunulia, magram
vas, gafantulobas an dabal inteleqts. ufro mniSv misi guneb-ganwyoba swrafad icvleba normaluri
nelovania is, rom es anomaliebi SeiZleba asaxavdes an zedmetad mxiaruli ganwyobilebiT. emociuri
asociaciuri procesis aSlilobebs (gv. ??). mag., reaqciis nebismieri saxis daqveiTeba, romelsac
metyvelebis uecari wyveta SeiZleba miuTiTebdes emociur siClunges uwodeben (gv. ??), aseve unda iyos
azrebis blokirebaze, swrafi gadasvla erTi Temidan aRniSnuli.
meoreze _ ideaTa xtomaze. am anomaliebis analizis Cveulebriv, intervius dros guneb-ganwyoba gan
gasaumjobeseblad saWiroa metyvelebis nimuSis Cawera xiluli Temebis paralelurad cvalebadobs. pacients
da misi ganmeorebiTi mosmena. CainiSneT TvalsaCino sevda eufleba, rodesac arasasiamovno SemTxvevebs
magaliTebi. ganvixilavT; brazobs, rodesac aRvwerT misTvis ga
maRizianebel faqtebs da a.S. rodesac guneb-gan
guneb-ganwyoba wyoba ar Seesabameba konteqsts, mas Seusabamos
tradiciulad, qveTavi guneb-ganwyobis Sesaxeb moicavs (arakongruentuls) vuwodebT (gv. ??).
emociebisa da maTTan dakavSirebuli fenomenebis suiciduri azrebi
aRricxvas, suiciduri azrebis CaTvliT.
zogi gamoucdeli interviueri erideba gamokiTxvas
depresia da mania suicidis Sesaxeb im mosazrebiT, rom ar gauCinos
guneb-ganwyobis Sefaseba iwyeba qcevaze dakvirvebiT, pacients TviTmkvlelobasTan dakavSirebuli azrebi.
rac ukve zemoT ganvixileT. da grZeldeba pirdapiri faqtebi gveubneba, rom aseTi ram nakleb savaraudoa,
kiTxvebiT (mag., `rogor xasiaTze xar?~ an `rogor Tumca, kiTxvebi etapobrivad unda daisvas. sawyisi kiTxva
grZnobT Tavs?~). depresiis Sesafasebelad unda aseTi SeiZleba iyos: `gifiqriaT Tu ara, rom cxovreba
daisvas kiTxvebi imis Taobaze, aqvs Tu ara pacients uazroa?~ da, saWiroebis SemTxvevaSi, vikiTxoT: `xom ar
tirilis moTxovnileba (xSirad avadmyofi uaryofs gagCeniaT sikvdilis survili?~ an `xom ar gifiqriaT,
tirilis faqts), aris Tu ara misi azrebi awmyos Sesaxeb ra gziT SeiZleba daasruloT Tqveni sicocxle?~
pesimisturi da uyurebs Tu ara uimedod momavals; SesaZloa interviuerma ar icodes, Tu rogor
awuxebs Tu ara danaSaulis grZnoba warsulis moagvaros pacientis problema, Tu pacienti aRiarebs,
movlenebTan dakavSirebiT. Sesaferisi kiTxvebia: `ras rom mas hqonia suiciduri azrebi an ganuzraxavs
eliT momavalSi?~ an àdanaSaulebT Tu ara sakuTar TviTmkvleloba. treningis gavla TviTdazianebisa da
Tavs raimes gamo~? kiTxvebi aweuli guneb-ganwyobis TviTmkvlelobis sakiTxebze specialists daexmareba
Sesaxeb Seesabameba depresiis Taobaze dasmul am problemis gadaWraSi. kiTxvebi suicidis Taobaze
kiTxvebs (mag., `rogor gunebaze xarT?~) Tu amas SemdgomSia ganxiluli (gv. ??).
saWiroeba moiTxovs, gaarZeleT gamokiTxva pirdapiri SfoTva
kiTxvebis dasmiT (mag., `xarT Tu ara uCveulod karg
SfoTvis Sefaseba xdeba subieqturi SegrZnebebis,
gunebaze?~). aRsaniSnavia, rom maniis dros pacients
SfoTvasTan dakavSirebuli fizikuri simptomebisa da
SeiZleba axasiaTebdes gaRizianebadoba, iseve rogorc
kogniciis Sesaxeb kiTxvebis dasmiT. mag., interviuers
mxiaruli guneb-ganwyoba.
SeuZlia daiwyos gamokiTxva Semdegi zogadi xasiaTis
klinikurad gamoxatuli depresiisa da aweuli
SekiTxviT: ras grZnobT SfoTvisas?~ da amis mere
guneb-ganwyobis dros saxezea TiToeuli maTganisTvis
gadavides kiTxvebze, romlebic exeba gulis cemis
damaxasiaTebeli, gansxvavebuli niSan _ Tvisebebi,
aCqarebas, piris simSrales, kankals, avtonomiuri
mag., anhedonia, daRliloba da koncentraciis una
_ 50 _
nervuli sistemis moqmedebis sxva efeqtebsa da amitom saWiroa intensiuri gamokiTxvis Catareba,
kunTebis daZabulobas. SfoTvis Semcveli azrebis romelic pacientis mimarT TanagrZnobis gamoxatvis
dadgenis SemTxvevaSi, SegiZliaT pacients dausvaT fonze unda mimdinareobdes. iqamde, sanam CavTvliT,
Semdegi kiTxvebi: `ra azrebi mogdiT TavSi SfoTvisas?~ rom pacients obsesiebi axasiaTebs, unda davrwmundeT
SesaZlo pasuxebi moicavs fiqrebs gulis wasvlisa da imaSi, rom pacienti, am azrebs, rogorc sakuTars ise
TviTkontrolis dakargvis Sesaxeb. aq dasmuli bevri aRiqvams da ara rogorc garedan Canergils.
kiTxva emTxveva anamnezis Sekrebisas dasmul kiTxvebs.
kompulsiebi
depersonalizacia da derealizacia akviatebul azrebs xSirad Tan sdevs kompulsuri
Cveulebriv, depersonalizacia da derealizacia qceva (gv. ??). zogierT qcevaze dakvirveba uSualodaa
SfoTviT aSlilobas axasiaTebs. mniSvnelovania maTi SesaZlebeli (Tumca, iSviaTad intervius dros),
gamijvna fsiqozuri simptomebisgan. pacientebs, zogierTze dakvirveba ki SeuZlebelia (mag., frazebis
romlebsac ganucdiaT depersonalizacia da dere gunebaSi gameoreba). maTze mxolod is mianiSnebs,
alizacia, uWirT am mdgomareobebis aRwera, xolo rom pacientis saubari drodadro wydeba. am dros
is pacientebi, romlebsac es ar ganucdiaT, kiTxvis pacients Semdegi kiTxva unda davusvaT: ìZulebuli
arasworad gagebis gamo, SeiZleba dagveTanxmon, rom xom ara xarT, gadaamowmoT iseTi qmedebebi, romlebic
aqvT es simptomebi. amitom pacientebs unda vTxovoT namdvilad iciT rom daasruleT?~; `xom ar asrulebT
aRweron amis konkretuli magaliTebi. aseT dros gamudmebiT erTsa da imave moqmedebas, romelsac
sasargebloa Semdegi kiTxvebis dasma: `gqoniaT Tu ara adamianTa umetesoba mxolod erTxel asrulebs?~;
odesme iseTi SegrZneba, rom Tqvens garSemo myofi ìZulebuli xom ar xarT erTi da igive moqmedeba
obieqtebi ararealuria?~, `xom ar gqoniaT odesme mravaljer gaimeoroT?~. Tu pacientis pasuxi erT-
iseTi gancda, rom Tqven an Tqveni sxeulis romelime erT kiTxvaze mainc dadebiTia, interviuerma unda
nawili ararealuria?~ derealizaciis mqone pacientebi sTxovos mas, moiyvanos konkretuli magaliTebi.
garemoSi arsebul obieqtebs aRweren rogorc
bodva
xelovnurs da usicocxlos. depersonalizaciis mqone
pacientebi amboben, rom sakuTar Tavs gaucxovebulad bodvis Sesaxeb pirdapiri kiTxvebis dasma SeuZ
aRiqvamen da ar SeuZliaT emociebis gancda. maTi lebelia, radgan pacienti ver acnobierebs, rom is
TqmiT, Tavs ise grZnoben, TiTqos raRac rols gansxvavebulia misi sxva Sexedulebebisagan. radgan
asruleben. bodvas diagnostikuri mniSvneloba aqvs da is, amave
dros, sirTuleebs uqmnis interviuers, es aSliloba
azrebi ufro detalurad pirvel TavSi ganvixiloT. (gv. ??).
bodvis arsebobaze eWvi interviuers SeiZleba
klinicistma yuradReba unda miaqcios pacientis
gauCndes sxvebisagan miRebuli informaciis an
azrebis ZiriTad Sinaarss (mag., devna, kiTxvebze
pacientis cxovrebaSi momxdari faqtebis safuZvelze.
negatiuri an TviTdamamcirebeli pasuxebis gacema,
rodesac vcdilobT bodviTi ideebis gamovlenas,
mudmivi triali dietisa da sakuTari sxeulis garSemo).
Tavidanve davsvaT kiTxvebi imis Sesaxeb, Tu ra
es informacia, SesaZloa, gvamcnobdes bodviTi
SeiZleba iyos pacientis mier aRwerili simptomebisa
aSlilobis, depresiis, kvebiTi darRvevebis arsebobas
da usiamovno gamocdilebis mizezi. mag., pacienti,
da man SeiZleba migviTiTos, Tu ra mimarTulebiT
romelic ambobs, rom cxovrebam azri dakarga, SeiZleba
waviyvanoT Semdgomi gamokiTxva. Tumca, gamokiTxvis
darwmunebuli iyos, rom is saSinlad garyvnili
am nawilis ZiriTadi mizania pacientis azrebis
adamiania da rom mas ulpeba Sinagani organoebi.
xasiaTis gansazRvra, saxeldobr ki, obsesiuri da
zogi pacienti moxerxebulad malavs sakuTar
bodviTi azrebis gamovlena
bodviT ideebs. aseT dros interviurma yuradReba
obsesiebi unda miaqcios TemisTvis Tavis aridebis da Temis
obsesiebi aRwerilia ?? gverdze. obsesiebis gamo Secvlis faqtebs da nebismier sxva niSnebs, romlebic
savlenad svamen Semdeg kiTxvas: `Tqvens gonebaSi informaciis damalvaze miuTiTebs. magram, rogorc ki
mudmivad xom ar iWreba iseTi azrebi, romlebisganac moxdeba bodviTi ideebis gamoaSkaraveba, pacientebi
ver TavisufldebiT, miuxedavad imisa, rom Zalian xSirad iwyeben maTze saubars interviueris mxridan
cdilobT gandevnoT isini?~ Tu pacienti am yovelgvari Zalisxmevis gareSe.
kiTxvaze dadebiT pasuxs iZleva, vTxovoT, moiyvanos mas Semdeg, rac gamovavlenT iseT ideebs, romlebsac
konkretuli magaliTi. pacients SeiZleba rcxvenodes SeiZleba bodviTi xasiaTi hqondeT, interviuerma
imis aRiareba, rom mas akviatebuli azrebi aqvs, unda gadawyvitos, akmayofileben Tu ara isini
gansakuTrebiT Tu isini Zaladobas an seqss exeba. bodvis kriteriumebs (gv. ??). upirveles yovlisa,
_ 51 _
3 gamokvleva
gaarkvieT, ramdenad myaria es ideebi. fsiqiatrs es kiTxva exeba ùmarTav mdgomareobas~, romelic
sWirdeba sakmarisi moTmineba da taqti imisTvis, rom SeiZleba Zlierma SfoTvam gamoiwvios; zogis
am procesSi pacients ar daupirispirdes. pacienti dadebiTi pasuxi ki, faqtiurad, imas miuTiTebs, rom
unda grZnobdes, rom mas winaswari ganwyobis gareSe pacients aReniSneba smeniTi halucinacia, romelic
usmenen. Tu eqimi cdilobs pacientis bodviTi ideebis mas ubrZanebs, ganaxorcielos esa Tu is qmedeba.
simyaris dadgenas sawinaaRmdego Sexedulebebis aqedan gamomdinare, dadebiTi pasuxis miRebisas
gamoTqmis gziT, es unda xdebodes kiTxviTi formiT unda davsvaT damatebiTi kiTxvebi, raTa am saxis
da ara imgvari argumentaciiT, romelsac kamaTisas interpretaciebi gamovricxoT.
iyeneben. Semdeg safexurze unda gairkves pacientis da bolos, mkiTxvels unda SevaxsenoT bodvis sxva
azrebi kulturiT gapirobebuli rwmenebia, Tu dasxva kategoriebi, romlebic pirvel TavSia aR
bodviTi ideebi. am kiTxvaze pasuxis gacema rTulia, werili (gv. ??). agreTve, interviuers unda SeeZ
Tu pacienti iseT kulturas an religiur jgufs los erTmaneTisagan pirveladi da meoradi bodvis
miekuTvneba, romlis Sexedulebebi da ganwyobebi gansxvaveba da yuradRebis gamaxvileba bodviT
ucnobia interviuerisTvis. aseT SemTxvevaSi inter aRqmasa da bodviT guneb-ganwyobaze. am sakiTxebze
viuers daexmareba gasaubreba imave qveynis an reli fokusireba mxolod maSin xdeba, rodesac fsiqozis
giuri jgufis warmomadgenelTan, saidanac is Seit niSnebi aSkaradaa gamoxatuli. aseT SemTxvevaSi isini
yobs, gaziarebulia Tu ara am jgufis mier pacientis SegviZlia gamoviyenoT imisTvis, raTa ganvasxvavoT
Sexedulebebi. Sizofrenia sxva fsiqozuri aSlilobisagan.
bodvis zogierTi forma, romlebic Sizofrenias
axasiaTebs, Zneli amosacnobia. esenia: aRqma
w azrebis gaxmovanebis bodva. am tipis bodva unda iseve, rogorc bodvis SemTxvevaSi, kiTxvebis dasma
ganvasxvavoT Semdegi rwmenisagan: adamianebs halucinaciebis Sesaxeb taqtianad unda xdebodes,
SeuZliaT daaskvnan, Tu ras fiqrobs adamiani, misi raTa pacients gavuadviloT sakuTar gamocdilebaze
qcevidan da saxis gamometyvelebidan gamomdinare. saubari. kiTxvebis dasmamde SegiZliaT aseTi Sesavali
azrebis gaxmovanebis bodvis gamosavlenad dasviT fraza gamoiyenoT: `zogierTi adamiani Tvlis, rom,
Semdegi kiTxvebi: `rodesme xom ar geuflebaT rodesac is nerviulad aris, SeiZleba uCveulo
iseTi gancda, rom sxvebma ician Tqveni azrebis gancdebi daeuflos.~ am frazas SeiZleba mohyvebodes
Sesaxeb maSinac ki, rodesac amaze xmamaRla ar kiTxvebi imis Taobaze, xom ar esmis pacients xmebi an
saubrobT?~ Tu pacienti am kiTxvaze dadebiTad bgerebi maSin, rodesac axlos aravinaa. Tu anamnezi
pasuxobs, interviuerma unda dasvas kiTxva imis amis safuZvels iZleva, kiTxvebi unda daisvas
Taobaze, Tu ranairad aris es SesaZlebeli. zogi mxedvelobiTi da sxva saxis halucinaciebis Sesaxeb,
pacienti kiTxvaze dadebiTi pasuxis gacemisas imas romlebmac, SesaZloa, sxva modalobebSi iCinon Tavi.
gulisxmobs, rom azrebis Sesaxeb daskvnis gamotana da piriqiT, Tu winaswari gamokvleviT ar dadginda
saxis gamometyvelebidan aris SesaZlebeli. fsiqozis niSnebis arseboba, SeiZleba umjobesi iyos,
w azrebis `Canergvis~ bodva. am tipis bodvis gamo am tipis gamokiTxva saerTod ar CavataroT.
savlenad SegviZlia davsvaT Semdegi kiTxva:
smeniTi halucinaciebi
`rodesme xom ar gigrZvniaT, rom Tqvens gonebaSi
arsebuli azrebi Tqven ki ar gekuTvniT, aramed Tu pacienti aRwers smeniT halucinaciebs, saWiroa
garedanaaa Canergili?~ azrebis `warTmevis~ bodvis damatebiTi kiTxvebis dasma imis mixedviT, Tu
gamosavlenad Semdeg kiTxvas svamen: `rodesme xom ranairad ganicdeba isini pacientis mier, radgan es
ar gigrZvniaT, rom viRaca Tqveni Tavidan azrebs mniSvnelovania diagnostikuri TvalsazrisiT (gv. ??).
iRebs?~ dadebiTi pasuxis SemTxvevaSi, CaatareT gasarkvevia pacients erTi xma esmis, Tu ramdenime?
ufro detaluri gamokvleva. Tu mas ramdenime xma esmis, unda gavigoT es xmebi
pacients mimarTaven, Tu erTmaneTs esaubrebian
w zemoqmedebis bodva (azris pasiuroba) aseve rTuli
pacientis Sesaxeb, anu mas mesame pirSi moixsenieben?
gamosavlenia. SeekiTxeT pacients: `rodesme xom ar
es ukanaskneli unda ganvasxvavoT im SemTxvevisagan,
gigrZvniaT, rom Tqveni qmedebebi sxva adamianis an
rodesac pacients esmis adamianebs Soris realuri
gareSe Zalis mier imarTeba?~ zogierTi pacienti
saubari da darwmunebulia, rom isini masze saubroben
am kiTxvaze dadebiT pasuxs iZleva imitom, rom
(damokidebulebis bodva). Tu pacienti ambobs, rom
kiTxva arasworad aqvs gagebuli da, religiuri an
xmebi mas mimarTaven, interviuerma unda gaarkvios,
filosofiuri mrwamsidan gamomdinare, gulisxmobs,
Tu ras amboben es xmebi da, aseve, ganicdeba Tu ara
rom adamianis qmedebebs RmerTi an raime sxva
maT mier naTqvami pacientis mier rogorc brZaneba,
gareSe Zala marTavs. zogi pacienti fiqrobs, rom
romlis Sesruleba, pacientis azriT, aucilebelia.
_ 52 _
CainiSneT magaliTebis saxiT, Tu ra sityvebs sakuTari vinaobis Sesaxeb. autofsiqikuri cnobiereba
warmoTqvamen halucinatoruli xmebi. SenarCunebulia im SemTxvevebis garda, roca pacients
aReniSneba mZime demencia, disociaciuri aSliloba an,
mxedvelobiTi halucinaciebi
Tu saxezea simulacia.
mxedvelobiTi halucinaciebi unda ganvasxvavoT
mxedvelobiTi iluziebisagan. Tu halucinacia in yuradReba da koncentracia
tervius ganmavlobaSi ar iCens Tavs, es ori erT anamnezis Sekrebisas interviueri unda daakvirdes
maneTisagan Zneli gasarCevia, radgan maTi garCeva im monacemebs, romlebic pacientis yuradRebisa da
xdeba im vizualuri stimulis arseboba-ararsebobis koncentraciis unaris maCvenebelia. amdenad, fsiqikuri
mixedviT, romlis mcdar interpretaciasac pacienti statusis kvlevamde mas ukve garkveuli STabeWdileba
iZleva. imis dadgena, axlavs Tu ara vizualur xats Seeqmneba am unarebis Sesaxeb. standartuli testebiT
`TiTqosda~ gancda, an imis kiTxva _ ès xati gareT SesaZlebelia miviRoT damatebiTi informacia
imyofeba, Tu Tqvens gonebaSi~, SeiZleba dagvexmaros da raodenobrivi maxasiaTeblebi, rac saSualebas
diferencirebaSi. mogvcems SevadaroT sxvadasxva dros Catarebuli
amis garda, interviuerma unda ganasxvavos halu gamokvlevebis monacemebi. Sefasebas, Cveulebriv,
cinacia disociaciuri gancdebisagan. am ukanasknelis Svidianebis seriuli testiT iwyeben (serial sevens test).
dros pacienti ambobs, rom masTan sxva adamiani an pacients sTxoven, 100-s gamoaklos 7 da miRebul cifrs
suli imyofeba, romelTanac saubari SeuZlia. am kvlav gamoaklos Svidi da es gaimeoros imdenjer,
tipis gancdebi aRiniSneba pirovnebis isteriuli sanam sabolood miRebuli sxvaoba Svidze naklebi
aSlilobis dros an zogierTi religiuri jgufis aRmoCndeba. unda aRiricxos am amocanis Sesrulebis
warmomadgenlebSi. es gancdebi diagnostikurad mniSv dro da Secdomebis raodenoba. Tu pacienti ver
nelovani ar aris. asrulebs am amocanas ariTmetikis arcodnis gamo,
mas unda vTxovoT, Seasrulos gamoklebis ufro
kognituri funqciebi martivi operacia an daasaxelos weliwadis Tveebi
kognituri daqveiTebis niSnebi intervius adreul Sebrunebuli TanmimdevrobiT.
etapzeve SeiZleba gamovlindes. aseT SemTxvevaSi
mexsiereba
aucilebelia kognituri funqciebis saTanadod
anamnezis Sekrebisas interviuerma pacientis mier
Sefaseba, radgan imisda mixedviT, Tu ra Sedegebs
aRwerili warsulis movlenebi unda Seadaros sxva
miviRebT, interviuers, SesaZloa, mouwios intervius
informatoris mier mowodebul informacias da
Semokleba an gadadeba iqamde, sanam sxva informators
yuradReba miaqcios maT Soris arsebul gansxvavebas.
ipovides. fsiqikuri mdgomareobis mini-Sefasebis
Tu mexsierebis funqcia daqveiTebulia, unda da
tests (ix. am Tavis danarTSi) farTod iyeneben
fiqsirdes konfabulaciis nebismieri gamovlineba
kognituri funqciebis skriningis mizniT.
(gv. ??). fsiqikuri statusis kvlevisas Sesabamisi
demenciisa da sxva organuli aSlilobebis diag
testebiT afaseben xanmokle da xangrZliv mexsierebas
nostirebisas, kognituri funqciebis kvleva Sefasebis
da imas, Tu ramdenad axsovs pacients axlo warsulis
centralur komponents warmoadgens, amitom xSirad
movlenebi. vinaidan arc erTi amaTgani ar gvaZlevs
damatebiTi, ufro formaluri testebic gamoiyeneba
srul suraTs, miRebuli Sedegebi unda Sefasdes
(ix. Tavi 14). xolo, im SemTxvevaSi, Tu gamokiTxvis
mexsierebis Sesaxeb mopovebul sxva informaciasTan
dasrulebisTvis interviuers ar uCndeba eWvi imisa,
erTad. saWiroebis SemTxvevaSi gamoiyeneba stan
rom arsebobs kognituri deficiti, kognituri fun
dartuli fsiqologiuri testebi. aseve, Zalian mni
qciebi Zalian mokled unda Sefasdes. kognituri
Svnelovania mexsierebis daqveiTebaze obieqturi
Sefasebis mimoxilva mocemulia Semdeg wyaroSi: Kipps
monacemebis mopoveba da imis dadgena, Tu ra gavlenas
and Hodges, 2005.
axdens es yoveldRiur saqmianobaze (mag., yidva, Cacma
orientacia da sxva).
orientaciis Sefasebisas pacients usvamen kiTxvebs xanmokle mexsierebis Sesafaseblad pacients sTxo
imis dasadgenad, Tu ramdenad kargad icis man, Tu ra ven, daimaxsovros saxeli, gvari da martivi misamarTi,
droa axla, sad imyofeba igi an vin aris mis garSemo. dauyonebliv gaimeoros (raTa davrwmundeT, rom
Tavidan konkretuli kiTxvebi weliwads, Tvesa da is sworad dafiqsirda) da `Seinaxos mexsierebaSi~.
ricxvs exeba. pasuxebis Sefasebisas gaxsovdeT, rom gaxsenebis unaris Semowmebamde, momdevno 5 wuTis
bevrma janmrTelma adamianma zustad ar icis, Tu ra ganmavlobaSi interviueri agrZelebs sxva Temebze
dRea dRes an sad imyofeba konkretulad. Tu pacienti saubars da Semdeg sTxovs pacients, gaimeoros da
sworad ver gascems pasuxs dasmul kiTxvebs, hkiTxeT maxsovrebuli informacia. am amocanis Sesrulebisas
_ 53 _
3 gamokvleva
saSualo inteleqtis janmrTeli adamiani umniSvnelo gamoyeneba) an is, rac pirdapir kavSirSi ar aris
Secdomebs uSvebs. Tu damaxsovrebuli masalis aR diagnostikasa da pirvelad mkurnalobasTan (mag.,
dgena aradamakmayofileblad xdeba, interviuers Sefaseba fsiqoTerapiuli CarevisTvis).
SeuZlia pacients es procesi karnaxiT gauadvilos
(mag., uTxariT pacients `Rviis 35~ da igi gaixsenebs, fizikuri gamokvleva
rom es quCis dasaxelebaa). fizikuri gamokvleviT SeiZleba gamovlindes:
mexsiereba axlo warsulis movlenebze: axlo war
1. mniSvnelovani diagnostikuri niSnebi, mag., Ciyvi
sulis movlenebze mexsierebis Sesafaseblad pacients
an refleqsebis ar arseboba. es gansakuTrebiT
SegviZlia vkiTxoT, Tu ra moxda ukanaskneli xuTi
mniSvnelovania diferencialuri diagnozisTvis
dRis ganmavlobaSi.
an organuli darRvevebis gamosaricxad. saWiroa
xangrZlivi mexsierebis Sesafaseblad pacients
nevrologiuri (cerebrovaskuluris CaTvliT) da
sTxoven, gaixsenos, Tu gasul wlebSi ra moxda piradad
endokrinuli sistemebis gansakuTrebiT detalu
misTvis an zogadad mniSvnelovani. piradulidan
ri gamokvleva; Tumca, arc sxva sistemebis ugu
mas SeiZleba sTxovon, gaixsenos SviliSvilebis
lebelyofa SeiZleba. am sakiTxebTan dakavSirebiT
saxelebi an Svilebis dabadebis TariRi (ra Tqma
damatebiTi informaciis misaRebad mkiTxveli unda
unda, Tu interviurs SeuZlia amis gadamowmeba).
gaecnos Sesabamis saxelmZRvanelos (Kaufman, 2002).
zogadi xasiaTis Temebidan ki SegviZlia vkiTxoT
2. fsiqotropuli nivTierebebiT gamowveuli gverdiTi
warsulSi cnobili politikuri liderebis saxelebi
movlenebi, mag., hipertenzia, parkinsonizmi an gamo
da gvarebi. movlenaTa Tanmimdevrobis gaxseneba
nayari.
iseve mniSvnelovania, rogorc calkeuli faqtebis
gaxseneba. 3. fsiqikuri aSlilobis gavlena pacientis zogad
kognituri funqciebis gamokvleva detalurad gan janmrTelobaze, kvebis statussa da sakuTari Tavis
xilulia me-14 TavSi. movla-patronobaze.
am mizezTa gamo, somaturi gamokvleva fsiqiatriuli
insaiTi (kritika mdgomareobis mimarT) gamokvlevis aucilebeli Semadgeneli nawilia, Tumca,
praqtikaSi somaturi gamokvlevis xangrZlivoba
Canaweri _ `pacients insaiTi aReniSneba~ an `pacients
da masze pasuxismgeblobis xarisxi gansxvavebulia.
insaiTi ar aReniSneba~, nakleb Rirebulia. amis nacvlad
mag., mravali ambulatoriuli pacientis momarTva
interviuerma unda dasvas kiTxvebi insaiTis sxvadasxva
SeiZleba gaakeTos sxva eqimma, romelmac axlaxan
aspeqtis Sesaxeb, rac me-19 TavSia ganxiluli. es
Caatara misi somaturi gamokvleva. dRis samedicino
gulisxmobs pacientis mier sakuTari problemebisa
centrSi an stacionarSi avadmyofebi imyofebian
da perspeqtivis Sefasebas da imis garkvevas, Tu ras
fsiqiatris dakvirvebis qveS, romelic zogadad
miawers igi maT: avadmyofur mdgomareobas Tu raime
pasuxismgebelia pacientis fizikur da fsiqikur
sxva mizezs (mag. devnas). Tu pacienti acnobierebs
janmrTelobaze. saavadmyofoSi moxvedrilma yvela
rom avadaa, unda gavarkvioT, misi azriT es daavadeba
axalma pacientma unda gaiaros sruli fizikuri
fizikuria Tu fsiqikuri? Tvlis Tu ara, rom sWirdeba
gamokvleva. nebismier SemTxvevaSi, fsiqiatrma unda
mkurnaloba? Tu es asea, ras fiqrobs is medikamentebis
gadawyvitos, Tu ra tipis fizikuri gamokvleva un
miRebaze, stacionirebasa da fsiqoTerapiaze?
da Cautardes pacients da Tavad gamoikvlios an
interviuerma isic unda gaarkvios, miaCnia Tu ara
uzrunvelyos misi Catareba sxva eqimis mier. Tu sawyisi
pacients, rom stresulma cxovrebiseulma movlenam
gamokvlevis Sedegebi saeWvo an kompleqsuria, isini
an sakuTarma qmedebam garkveuli roli iTamaSa misi
ganxilul unda iqnes nevrologTan an sxva profilis
avadmyofobis gaCenaSi. pacientis Tvalsazrisi am
eqimTan erTad. zog SemTxvevaSi saWiroa umaRlesi
sakiTxebze migvaniSnebs, Tu ramdenad iTanamSromlebs
nevrologiuri funqciebis detaluri gamokvleva,
is mkurnalobis procesSi.
rogorc neirofsiqiatriuli gamokvlevis dros (ix.
boqsi 3.2). is SeiZleba win uZRodes standartul
fsiqiatriuli gamokvlevis sxva neirofsiqologiur an nevrologiur gamokvlevas,
komponentebi romelic, ZiriTadad, neirofsiqiatriuli darRvevebis
anamnezis Sekreba da fsiqikuri statusis kvleva gamovlenazea mimarTuli.
fsiqiatriuli Sefasebis ZiriTad nawils warmoadgens.
Tumca, SesaZlebelia, pacientis mdgomareobis `sruli~ laboratoriuli gamokvlevebi
SefasebisTvis, saWiro gaxdes sxva elementebis laboratoriuli gamokvlevebi gansxvavebulia dife
damatebac. am TavSi ar ganixileba Sefasebis sxva rencialuri diagnozis, pacientis janmrTelobis
specializebuli aspeqtebi (mag., Sefasebis skalebis zogadi mdgomareobisa da arsebuli resursebis Se
_ 54 _
fsiqiatriuli gamokvlevis sxva komponentebi
3.2 neirofsiqiatriuli gamokvleva ideomotoruli apraqsiis dasadgenad, avadmyofma unda

Seasrulos sul ufro da ufro rTuli davalebebi,
lingvisturi unarebi romlebic, Cveulebriv, samsafexuriani TanmimdevrobiT
sruldeba: (i) Seexos marjvena yurs (ii) marcxena xelis Sua
dizarTria ewodeba metyvelebis unaris darRvevas.
TiTiT, rodesac (iii) marjvena cera TiTi magidaze udevs.
disfazia aris qerquli warmoSobis lingvisturi funqciis
Tu avadmyofs ar SeuZlia gaamTelos geometriuli
nawilobrivi daqveiTeba. is SeiZleba iyos recepciuli
figuris marcxena nawili an Caicvas tansacmeli marcxena
an eqspresiuli. dizarTriis dasadgenad pacients unda
mxares, apraqsia miuTiTebs Txemis wilis ukana ubnis
vTxovoT, warmoTqvas romelime rTuli fraza an enis
marjvenamxriv dazianebaze. amasTan erTad, SeiZleba
gasatexi.
Segvxvdes sxva darRvevebi, romlebic imave ubanSia
recepciuli disfazia. recepciuli disfaziis dasadgenad lokalizebuli saxeldobr, sensoruli uyuradReboba
pacients unda wavakiTxoT Sesaferisi sirTulis teqsti. Tu da anozognozia.
pacienti amas ver moaxerxebs, sTxoveT calkeuli sityvebisa
agnozia esaa sensoruli stimulis Semecnebis uunaroba, im
an asoebis wakiTxva. Tu is moaxerxebs am monakveTis
SemTxvevaSi, rodesac grZnobaTa organoebi da gadacemis
wakiTxvas, sTxoveT, axsnas misi Sinaarsi. imis dasadgenad,
gzebi intaqturia. agnoziis diagnozis dasma xdeba mas
esmis Tu ara pacients zepiri metyveleba, moasmenineT mas
Semdeg, rac davrwmundebiT, rom pirovnebis sensoruli
teqstis monakveTi da sTxoveT, ganmartos igi (pirveli
aparati normalurad funqcionirebs da cnobiereba naTelia.
Semowmeba imisa, rom mexsiereba Senaxulia) an Seasrulos
martivi instruqcia (mag., miuTiTos dasaxelebul sagnebze). w astereognozia aris samganzomilebiani figurebis
identificirebis uunaroba. mis dasadgenad pacients
eqspresiuli disfaziis dasadgenad pacients unda vTxovoT,
xelSi dasaWerad aZleven sxvadasxva sagans _ gasaRebs,
daasaxelos yofiTi sagnebi, rogorebicaa saaTi, gasaRebi,
sxvadasxva zomis monetebs an qaRaldis samagrebs, xolo
kalmistari da maTi nawilebi (mag., saaTis ciferblati)
man, TvaldaxuWulma unda SeZlos maTi amocnoba.
an sxeulis nawili. aseve, unda vTxovoT, isaubros
spontanurad (mag., Tavisi hobis Sesaxeb) da daweros mokle w atopognozia aris sakuTari sxeulis kanze sagnis
teqsti, jer karnaxiT, xolo Semdeg spontanurad, misTvis mdebareobis gansazRvris uunaroba.
nacnob Temaze (mag., ojaxis wevrebis Sesaxeb). Tu pacienti
ver asrulebs am davalebas, vTxovoT, gadaiweros erTi w TiTebis agnoziis dros pacienti ver axerxebs, rom
mcire monakveTi. TvaldaxuWulma moaxdinos im TiTis identificireba,
romelsac exebian.
lingvisturi darRvevebi miuTiTebs marcxena hemisferoSi imisaTvis, rom gavigoT, xom ar ereva pacients
arsebul dazianebaze memarjvene pacientebSi. caciebSi erTmaneTSi marjvena da marcxena mxare, unda SevexoT mis
darRvevis lokalizacia ase zustad ver dgindeba, Tumca, xels an yurs da vkiTxoT, Tu romel mxares SevexeT.
ufro xSirad, is mainc marcxena hemisferos ukavSirdeba. w agrafognozia aris sxeulze `dawerili~ asoebis an ricxvebis
lingvisturi darRvevis tipi damatebiT miuTiTebs identificirebis uunaroba. agrafognoziis Sesamowmeblad
dazianebis lokalizaciaze. eqspresiuli disfazia pacients xelisgulze daxuruli kalmistriT an sxva msgavsi
gvafiqrebinebs wina dazianebaze, xolo recepciuli sagniT ricxvebis monaxazi `gamogvyavs~.
disfazia _ ukanaze, smeniTi disfazia _ safeTqlis wilis
dazianebaze, xolo mxedvelobiTi disfazia ufro ukana w anozognoziis dros pacienti ver aRiqvams avadmyofobiT
dazianebaze mianiSnebs. gamowveul funqciur darRvevebs. magaliTad, marjvena
Txemis wilis dazianebis Semdeg, pacienti ver acnobierebs
konstruirebis unari Tavisi sxeulis marcxena mxares ganviTarebul sisustes
apraqsia aris mizanmimarTuli moqmedebisa da moZraobis da aReniSneba sensoruli uyuradReboba.
darRveva, rodesac pirovnebas SenarCunebuli aqvs
agnoziis arseboba miuTiTebs asociaciuri areebis da
motoruli da sensoruli funqciebi. apraqsia SeiZleba
zianebaze pirveladi sensoruli receptuli aris garSemo.
sxvadasxvagvarad Semowmdes.
marjvena da marcxena Txemis wilis dazianeba iwvevs
w konstruqciuli apraqsiis dasadgenad, pacients unda kontrlateralur astereognozias, agrafognozias da
vTxovoT, daxatos martivi sagnebi (mag., velosipedi, atopognozias. sensoruli uyuradReboba da anozognozia
saxli an saaTis ciferblati). ufro xSirad gamowveulia marjvena Txemis wilis dazianebiT.
TiTebis agnoziasa da marjvena-marcxena mxaris dezorientaciis
w Cacmis apraqsiis dasadgenad, pacients unda vTxovoT, mizezad umetesad Txemis wilis dazianebaa miCneuli.
Caicvas tansacmeli.
sabamisad. erT SemTxvevaSi, aranairi kvleva saWiro fsiqologiuri gamokvleva

araa, xolo, meoreSi, SeiZleba aucilebeli gaxdes klinikuri da fsiqologiuri testireba sxvadasxva
neirovizualuri gamokvlevebi, genetikuri testireba saxiT avsebs fsiqiatriul gamokvlevas, miuxedavad
da bioqimiuri skriningi. gansakuTrebiT maSin, Tu imisa, rom misi Catareba, umetes SemTxvevaSi ar aris
eWvi gvaqvs iseT organul darRvevaze, romelic aucilebeli da zogjer naklebad xelmisawvdomicaa.
mkurnalobas emorCileba an genetikuri warmoSobisaa. amitom am Temas mokled mimovixilavT. qvemoT mo
ar arsebobs rutinuli gamokvlevebi, romelTa Ca cemulia fsiqologiuri gamokvlevis ZiriTadi for
tareba yvela SemTxvevaSia aucilebeli, Tumca, ru mebi da maTi mniSvneloba.
tinuli sisxlis testebi (sisxlis saerTo analizi,
eleqtrolitebi, RviZlisa da farisebri jirkvlis neirofsiqologiuri gamokvleva
funqciebi), Cveulebriv, tardeba pacientis klinikaSi arsebobs mravali fsiqometruli testi neiro
moTavsebisas. gamokvlevebis sqema, sindromebTan fsiqologiuri funqciebis sxvadasxva aspeqtis ga
erTad, ganxilulia Semdgom. sazomad. maTi saSualebiT SeiZleba ganisazRvros
_ 55 _
3 gamokvleva
zogadi inteleqtis done, mexsierebis konkretuli specialuri skala eqTnisTvis, romelic aCvenebs,
sferoebi da informaciis gadamuSavebis siswrafe. Tu ra xnis ganmavlobaSi iyo pacienti aqtiuri an
agreTve, arsebobs testebi, romlebiTac xdeba Ta raime saqmianobiT dakavebuli. aseTi skala SeiZleba
vis tvinis calkeuli nawilis funqciebis Sefaseba xuTsafexuriani iyos. masSi TiToTeuli Sefasebis
(Lezak et al., 2004). fsiqiatriaSi neirofsiqologiuri kriteriumi Seexeba qcevas (mag., sxvebTan saubari an
testireba upiratesad gamoiyeneba (Grant and Adams, kartis TamaSi), romelic relevanturia TiToeuli
1996; Powell, 2000): pacientis mimarT. garda imisa, rom aseTi skalebi
w daswavlis darRvevebis (gonebrivi CamorCenilobis) gvawvdis bazisur informacias, maTi meSveobiT
dros. aseT SemTxvevaSi mdgomareobis simZime in warmoebs daavadebis ganviTarebisa da mkurnalobis
teleqtis koeficientiT ganisazRvreba; efeqturobis monitoringi. amgvari informacia
avsebs fsiqikuri statusis kvleviTa da pacientze
w demenciis dros, roca testirebiT izomeba kog
dakvirvebis Sedegad miRebul Tvisobriv monacemebs.
nituri funqciebis gauaresebis xarisxi;
qcevis Sefaseba, aseve, gamoiyeneba aSlilobis
w roca savaraudoa premorbiduli kognituri fu komponentebis (mag., fobiis dros molodinis SfoTva,
nqcionirebis gauareseba. aseT SemTxvevaSi, Se acileba da daZlevis strategia (kopingi)), garemos
saZlebelia, iyos gansxvaveba verbalursa da ara stimulebTan maTi kavSiris (mag., adgilis simaRle),
verbalur inteleqts Soris; zogadi garemoebebis (mag., xalxmravali adgili) an
w daavadebis mimdinareobisas neirofsiqologiur de Sinagani signalebis (mag., guliscemis SegrZneba)
ficitze dinamikaSi dakvirvebisTvis. am SemTxvevaSi Sesafaseblad. qcevis Sefaseba bihevioristuli
testireba ganmeorebiT tardeba; Terapiis aucilebeli winapirobaa (gv. ??).
w funqciurad mniSvnelovani deficitis gamosavlenad,
pacientis pirovnuli Tvisebebis Sefaseba
romelic ar aris gamoxatuli da amitom SeiZleba
ugulebelyofil iqnes. mag., Sizofreniis dros warsulSi fsiqiatriuli Sefasebis ganuyofel
aRiniSneba mexsierebisa da yuradRebis daqveiTeba, nawils pacientis pirovnuli Tvisebebis testireba
rac, prognozuli TvalsazrisiT, cudi maCvenebelia. Seadgenda. amisaTvis, sxva meTodebTan erTad,
miuxedavad imisa, rom neirofsiqologiuri tes proeqciul meTodebs iyenebdnen (mag., rorSarxis
tireba, upirveles yovlisa, kvlevis iaraRs testi). dRes aseTi testebi farTod aRar gamoiyeneba,
warmoadgens, mas Semdeg, rac miRebuli monacemebi radgan maTi saSualebiT ver xerxdeba pirovnebis
ufro zusti da gasagebi gaxdeba, igi SeiZleba im aspeqtebis Seswavla, romlebic yvelaze metadaa
rutinuli klinikuri Sefasebis nawilad gadaiqces; dakavSirebuli fsiqikur aSlilobebTan da maT dabali
diagnostikuri da prognozuli Rirebuleba aqvT. amis
w Tu savaraudoa fsiqikuri aSlilobis organuli
nacvlad anamnezSi pirovnuli Taviseburebebis aRwera
mizezi. aseT SemTxvevaSi testirebis Sedegebi
keTdeba ise, rogorc es zemoT iyo ganxiluli, rasac,
SeiZleba dazianebis lokalizaciaze miuTiTebdes.
samecniero da diagnostikuri miznebidan gamomdinare,
Tumca, Tavis tvinis dazianebis lokalizaciis
SeiZleba daematos personologiuri aSlilobis
gamosavlenad warmoebuli neirofsiqologiuri tes
sqemebi, rogorebicaa pirovnuli aSlilobis kvlevis
tireba neirovizualurma meTodebma Caanacvla.
saerTaSoriso sqema (International Persoanlity Disorder
kognituri Sefaseba Examination) da pirovnebis Sefasebis sqema (Personality
zogjer termini `kognituri~ ixmareba `neiro Assessment Schedule. Reich and de Girolamo, 2000). es
fsiqologiuris~ sinonimad. mocemul konteqstSi sakiTxi, agreTve, ganxilulia me-7 TavSi.
`kognituri Sefaseba~ aRniSnavs pacientis kogniciis,
kerZod, azrebis, mosazrebebisa da azrovnebis
riskis Sefaseba
paternebis Sefasebas. es gvexmareba, ganvsazRvroT riskis Sefaseba fsiqiatriuli gamokvlevis arsebiTi
kognituri Terapiis Catarebis mizanSewoniloba da komponentia. am konteqstSi termini `riski~ moicavs sx-
mizani (Tavi 22 -e). vebTan da sakuTar TavTan dakavSirebul risks. pirvel
SemTxvevaSi es aris Zaladoba, meoreSi _ TviTmkvlelo-
qcevis Sefaseba ba, TviTdazianeba an sakuTari Tavis ugulebelyofa.
qcevaze dakvirveba da misi Sefaseba sasargebloa fsiqikuri aSlilobis mqone pirebis TviTmkvlelobis
gamoviyenoT yoveldRiur klinikur praqtikaSi, an maT mier mkvlelobis Cadenis SemTxvevaSi umetesad
gansakuTrebiT maSin, roca saqme stacionarul uaryofiTadaa Sefasebuli is faqti, rom speciali-
avadmyofebs exeba (Hall, 2000). Tu ar arsebobs stebis mier saTanadod ar iqna Camoyalibebuli da
klinicistisTvis saWiro skalebi, Sefasebis skalebi dokumentirebuli riskis saSiSroeba da, Sesabamisad,
specialurad iqmneba. mag., SeiZleba Seiqmnas SemuSavebuli riskis marTvis gegma. TviTdazianebisa
_ 56 _
individualuri
warsulSi Cadenili Zaladobrivi qcevis istoria
cxrili 3.5 sxvebisTvis zianis miyenebasTan momavali Zaladobis saukeTeso prediqtoria, ami
dakavSirebuli riski
tom masTan dakavSirebuli informaciis mopoveba
pirovnuli faqtorebi warmoebs ara mxolod pacientebisagan, aramed maTi
warsulSi sxvaze ganxorcielebuli Zaladoba* naTesavebisa da axloblebisagan, Zveli avadmyofobis
istoriis Canawerebidan da zogjer policiisaganac.
asocialuroba, impulsuroba, gaRizianebadoba
asocialuroba, impulsuroba da gaRizianebadoba
axalgazrda asaki da mamrobiTi sqesi iseTi pirovnuli maxasiaTeblebia, romlebic dam
axlaxans gadatanili cxovrebiseuli krizisi atebiT risk-faqtors warmoadgens. warsulSi Cadenili
Zaladobis dros arsebuli socialuri viTarebis
susti socialuri kavSirebi
garkveva dagvexmareba, gamovavlinoT maprovocirebeli
ganqorwineba an ganSoreba faqtorebi, romlebic unda gaviTvaliswinoT
umuSevroba amJamindel situaciaSi (ix. qvemoT). riskis xarisxs
socialuri arastabiluroba zrdis, agreTve, socialuri izolacia da axlad
gadatanili cxovrebiseuli krizisi. avadmyofobasTan
avadmyofobasTan dakavSirebuli faqtorebi
dakavSirebuli faqtorebidan mniSvnelovania fsi
fsiqozuri simptomebi * qozuri aSliloba da wamal da alkoholmoxmareba,
wamalmoxmareba* gansakuTrebiT maTi kombinacia. wamalmoxmarebis,
fsiqozisa da pirovnuli aSlilobis Tanaarseboba
mkurnalobis mimarT rezistentoba
Zaladobis yvelaze maRali riskis Semcvelia.
mkurnalobis reJimisadmi daumorCilebloba 3.5 cxrilSi CamoTvlili fsiqikur mdgomareobasTan
mkurnalobis Sewyveta dakavSirebuli faqtorebi gansakuTrebul yuradRebas
saWiroebs. sxvaze Zaladobis azrebi Zalian mniSv
fsiqikur mdgomareobasTan dakavSirebuli faqtorebi
nelovania, miT umetes, Tu es im pirovnebas exeba,
gaRizianebadoba, mtruli ganwyoba, brazi romelic pacientisTvis xelmisawvdomia. mZime (fsi
undobloba, eWvianoba qozuri) depresiis dros suicidur azrebTan erTad
SeiZleba gaCndes sxvebis, upiratesad ojaxis wevrebis,
sxvaze Zaladobis azrebi
daxocvis azric. avadmyofuri eWvianoba da sxva
im adamianebis mimarT muqara, romlebic pacientisTvis bodviTi aSlilobebi SeiZleba sxva riskebTanac
xelmisawvdomni arian *
iyos dakavSirebuli da warmosaxviTi mtris an
Zaladobrivi qmedebis dagegmva * konkurentisTvis zianis miyenebas gulisxmobdes (gv. ??).
devnis bodva Zalze mniSvnelovania situaciuri faqtorebi. pa
eWvianobis bodva
cientTan sxva pirebis realurma an warmosaxviTma
dapirispirebam, iseve, rogorc im situaciaSi dab
zemoqmedebis bodva
runebam, romlis drosac warsulSi Zaladoba moxda,
Zaladobrivi Sinaarsis imperatiuli halucinaciebi SeiZleba biZgi misces axal agresiul qcevas. yovel
suiciduri azrebi, romlebsac Tan axlavs mZime depresia calkeul SemTxvevaSi aucileblad unda gairkves,
aris Tu ara pacientisTvis iaraRi xelmisawvdomi.
cnobierebis paTologia
imisTvis, rom risk-faqtorebi mTlianobaSi Seva
daavadebisadmi insaiTis (kritikis) nakleboba fasoT, unda gamoviyenoT klinikuri gamocdileba
situaciuri faqtorebi da saR azrze dafuZnebuli msjeloba. saTanadod
SemuSavebuli riskis Sefasebis gegmis arsebobis miu
sxvebis mier pacientis provocireba da konfrontacia
xedavad, aucilebelia ganmeorebiTi da safuZvliani
warsulSi momxdar Zaladobriv aqtebTan asocirebuli klinikuri gamokvlevebi. riskis Sefaseba unda ga
situaciebi
keTdes im profesiuli gundis wevrebis mier, romlebic
iaraRis xelmisawvdomoba* mkurnaloben pacients, xolo, Tu pacients erTi eqimi
da TviTmkvlelobis riskebi ganxilulia me-17 TavSi. hyavs, man unda ganixilos riskis Sefasebis sakiTxebi
aq saubari iqneba sxvebze Zaladobis riskis Sefasebaze, sxva kolegebTan erTad. garkveul viTarebaSi
romlis drosac oTxi rigis faqtorebs iTvaliswineben: SeiZleba saWiro gaxdes Sefasebis Sedegebis gacnoba
pirovnuls, daavadebasTan dakavSirebuls, fsiqikur im pirisTvis, romelic riskis qveS imyofeba (gv. ??).
mdgomareobasTan dakavSirebulsa da situaciur faq- riskis Sefasebis Sedegebis ganxilva regularulad
torebs. es faqtorebi mocemulia cxrilSi 3.5. aqedan unda xdebodes da am dros klinicistTa gundis
yvelaze mniSvnelovani varskvlaviTaa moniSnuli. calkeuli wevrebisagan miRebuli informacia unda
_ 57 _
3 gamokvleva
urTierTSejerdes. am sakiTxs eZRvneba naSromebi: Seuferebel garemoSi. aq ganvixilavT, Tu rogor
Maden, 1996 and Mullen, 2000. modificirdeba intervius Catarebis procesi da
miuxedavad imisa, rom riskis SefasebiT miRebuli fsiqiatriuli gamokvleva aseT viTarebaSi.
informacia Zalian mniSvnelovania, aucilebelia
misi arsebul konteqstSi ganxilva. jer erTi, intervius Catareba sagangebo viTarebaSi
fsiqiatriuli pacientebis didi umravlesoba sagangebo viTarebaSi Catarebuli interviu unda
sxvebisTvis riskis Semcveli ar aris da ufro iyos xanmokle da sakvanZo sakiTxebze fokusirebuli,
savaraudoa, pacienti msxverplis rolSi aRmoCndes raTa, rac SeiZleba swrafad daisvas winaswari
da ara damnaSavis. mosazreba, rom mZime fsiqikuri diagnozi da Camoyalibdes samoqmedo gegma. aseTi
daavadebis (gansakuTrebiT Sizofreniis) mqone pa gamokvleva, Cveulebriv, tardeba mwvave aSlilobis
cienti potenciuri moZaladea, usafuZvloa. ase mqone, aseve, Zalian mZime mdgomareobaSi myof
Ti Sexedulebebi xels uwyobs fsiqiatriuli avad pacientebTan. interviu ufro xSirad tardeba iseT
myofebis stigmatizacias. meorec, riskis sruli rTul garemoSi, rogoricaa policiis ganyofileba
Sefasebac ki Zaladobis realur prognozze mxolod an palata, romelSic erTdroulad ramdenime
mcire informacias gvawvdis. mag., moZalade xSirad pacienti imyofeba. Cveulebriv, aseT pirobebSi
iseTi pirovneba aRmoCndeba, romelsac ar aqvs xdeba fsiqozis (Sizofrenia, mania, narkotikuli
Zaladobis istoria, xolo adamiani, romelsac mra nivTierebis moxmarebiT gamowveuli mdgomareobebi),
vali risk-faqtori aReniSneba, arasodes xdeba deliriumisa da Tavis tvinis organuli dazianebebis
moZalade. SeuZlebloba imisa, rom winaswar gani diagnostireba. interviueri unda dafiqrdes imaze, Tu
sazRvros Zaladoba, seriozuli argumentia nebis romeli kiTxvebia aqtualuri mocemuli momentisTvis
mieri sakanonmdeblo aqtis winaaRmdeg, romelic da romeli unda daisvas mogvianebiT. yvelaze mni
iTvaliswinebs maRali riskis mqone pirebis pro Svnelovania is Temebi, romlebic gvexmareba, swrafad
filaqtikuri mizniT dakavebas (Szmukler, 2001). miviRoT gadawyvetileba daavadebis marTvis Taobaze:
mizanSewonilia Tu ara pacientis hospitalizacia,
saWiroebaTa Sefaseba unda Cautardes Tu ara pacients laboratoriuli
mZime an xangrZlivi fsiqikuri daavadebis (gan gamokvleva da sWirdeba Tu ara mas medikamentebi.
sakuTerbiT fsiqozis) mqone pacientebis SemTxvevaSi, radgan gamokvleva SeiZleba garTuldes imis gamo,
sul ufro da ufro metad maxvildeba yuradReba rom pacients ar SeuZlia an ar aqvs survili bolomde
maT saWiroebebze (am sityvis farTo mniSvnelobiT). CaerTos intervius procesSi, ecadeT moipovoT
amgvari saWiroebebi SeiZleba ukavSirdebodes yovelgvari xelmisawvdomi informacia intervius
fizikur janmrTelobas, higienas, socialur izo dawyebamde. mag., hkiTxeT pacientis Tanmxleb pirs
lacias, saSinao saqmis SesrulebisTvis saWiro (vinc ar unda iyos igi), ra icis pacientis Sesaxeb
unar-Cvevebs da a.S. saWiroebebis aqcentirebas ga da im movlenebis Sesaxeb, romlebic axlaxan moxda
napirobebs im faqtis gacnobiereba, rom amgvari sa mis cxovrebaSi. pacientis kuTvnilma nivTebma
Wiroebebi xSirad ugulebelyofilia da ar aris SeiZleba miganiSnoT imaze, Tu riT iyo pacienti
dakmayofilebuli. pirvel etapze unda dadgindes adre daavadebuli an ra wamals iRebda igi. Tu
saWiroebebi. informaciis didi nawili unda pacients warsulSi hqonda fsiqiatriuli problemebi,
Segrovdes avadmyofobis istoriis daweris procesSi, maqsimalurad unda ecadoT, moipovoT istoriis
Tumca, es SeiZleba sakmarisi ar iyos da pacientis Canawerebi an daukavSirdeT im specialists, romelic
irgvliv arsebuli situacia damatebiT gamokvlevas monawileobda pacientis mkurnalobaSi. rodesac
moiTxovdes. arsebobs specialuri skalebi, romlebsac vgegmavT, Tu sad da ra saxiT CavatarebT intervius,
saWiroebebis dasadgenad iyeneben (Marshall et al., 1995). unda gaviTvaliswinoT pacientisa da mis garSemo myof
pirTa usafrTxoeba.
fsiqiatriuli gamokvlevis gadaudebel viTarebaSi gamokvlevis Catarebisas,
ecadeT, ramdenadac es SesaZlebelia, moipovoT
gansakuTrebuli SemTxvevebi
Semdegi ZiriTadi informacia:
am TavSi ganixileba sruli fsiqiatriuli gamo
w ra aris is mTavari fsiqikuri problema, romelic
kvleva, romelsac fsiqiatrebi atareben fsiqiatriul
unda aRiweros simptomebisa da qcevis TvalsazrisiT.
samsaxurebSi da aqvT gamokvlevisTvis sakmarisi
garda amisa, unda gairkves misi gaCenis dro,
dro. Tumca, gamokvlevaTa umetesoba ver akma
mimdinareoba da mocemul momentSi misi simZime.
yofilebs am kriteriumebs, radgan umeteswilad
tardeba araspecialistebis mier arafsiqiatriul w sxva relevanturi simptomebi (maTi aRmoceneba,
dawesebulebebSi, drois defecitis pirobebsa da mimdinareoba da simZime).
_ 58 _
fsiqiatriuli gamokvlevis gansakuTrebuli SemTxvevebi
w fsiqiatriuli an samedicino daavadebis istoria. 1.zogadi fsiqologiuri adaptacia: daRliloba,
w amJamindeli medikamenturi mkurnaloba. gaRizianebadoba, koncentraciis nakleboba, stresis
qveS yofnis SegrZneba;
w alkoholis an sxva nivTierebis moxmareba.
2.SfoTva da wuxili: SfoTvisa da daZabulobis fi
w stresuli viTareba simptomebis aRmocenebisas da
zikuri siptomebi, fobiebi da persistentuli mta
mocemuli momentisTvis.
njveli fiqrebi;
w ramodenime sakvanZo kiTxvis meSveobiT ojaxisa da
3.depresiis simptomebi: persistentuli depresiuli
piradi istoriis gacnoba.
guneb-ganwyoba, tirili, cremlianoba, uimedoba,
w socialuri viTareba da mxardaWeris gawevis Sesa-
TviTdadanaSauleba, azrebi imis Sesaxeb, rom
Zlebloba.
cxovreba gausaZlisia, suiciduri azrebi, diliT
w riskis Sefaseba, TviTdazianebisa da sxvebis usafr adre gaRviZeba, dRis ganmavlobaSi cvalebadi guneb-
Txoebis gaTvaliswineba. ganwyoba, wonaSi kleba da libidos daqveiTeba.
4.fsiqologiuri konteqsti: (anu pacientis pirovnuli
intervius Catareba zogad samedicino praq
maxasiaTeblebi da garemoebebi) miuxedavad imisa,
tikaSi da zogadi profilis saavadmyofoSi rom zogadi profilis eqimisTvis es yovelive
zogad samedicino praqtikaSi xSirad gvxvdeba fsiqi- wina kontaqtidanaa cnobili, mainc saWiroa am
kuri aSlilobis, gansakuTrebiT depresiisa da SfoT- parametrebis xelaxali ganxilva.
viTi aSlilobebis SemTxvevebi, aseve, wamalmoxmareba aqedan gamomdinare, skriningis mizniT, aSlilobebis
da somatoformuli aSliloba, romelic upiratesad Sesaxeb Seiqmna ufro formalizebuli kiTxvebi,
fizikuri Civilebis saxiT vlindeba (mag., qronikuli romlebic ufro Sesaferisi iqneboda pirveladi
tkivili, daRliloba). eqimma yovelTvis unda dauSvas, jandacvis dawesebulebaSi mokle intervius Casa
rom es simptomebi SeiZleba iyos fsiqikuri aSlilo- tareblad. es kiTxvebi iyo fokusirebuli iseT
bis gamoxatuleba. fizikuri da fsiqikuri faqtorebis aSlilobebze, romlebic ufro xSirad gvxvdeba aseT
urTierTkavSirze metyvelebs is faqti, rom standar- garemoSi. cxrilSi 3.6. warmodgenili kiTxvebi adap
tul SefasebasTan SedarebiT, fsiqikuri aSlilobis tirebulia Semdegi wyarodan: Spitzer et al., 1994.
diagnozs ufro zustad svamen zogadi profilis eq- Tu interviu tardeba CvenTvis saintereso kon
imebi, romlebmac kargad ician zogadi medicina (Gold- kretul fsiqologiur sakiTxTan dakavSirebiT
berg and Huxley, 1980). pirveladi jandacvis samsaxurs da swored misiTaa mkafiod warmarTuli, aseve,
akiTxaven iseTi pacientebic, romlebsac garkveuli
fsiqologiuri Civilebi aqvT, mag., daqveiTebuli gun-
cxrili 3.6 fsiqikuri aSlilobis gamosavleni
eb-ganwyoba an panikis Setevebi.
kiTxvebi
miuxedavad imisa, Tu ra saxis CiviliT gvakiTxavs
pacienti (fizikuriT Tu fsiqologiuriT), SezRudul ukanaskneli Tvis manZilze ra mizniT tardeba skriningi
droSi efeqturi fsiqiatriuli gamokvlevis Catareba 1. gaqvT daqveiTebuli gu depresia
yovelTvis rTulia. miznis misaRwevad ori moTxovna neb-ganwyoba?
unda iyos daculi: jer erTi, interviu iseTi saxiT 2. naklebad gsiamovnebT depresia
unda warimarTos, rom xeli Seewyos arsebuli fsiqi- imis keTeba, rac
kuri aSlilobis dadgenas (mag., yuradRebis miqceva warsulSi siamovnebas
ganiWebdaT?
yvela im niSnisa Tu informaciisTvis _ Canaweri isto-
riaSi, pacientis garegnoba da qceva _ romlebic aSli- 3. gaqvT zogadad SfoTvis nevrozi (SfoTva)
gancda?
lobaze miuTiTebs). meorec _ skriningis mizniT iseTi
kiTxvebis dasma, romelTa meSveobiTac SesaZlebelia 4. nerviulobT Tqveni jan nevrozi (SfoTva
mrTelobisa an sxva konk- janmrTelobis gamo)
ZiriTadi aSlilobis identificireba da im sferoe- retuli ambebis gamo?
bis gamovlena, romlebic ufro detalur Sefasebas
5. umarTavi gaxda Tqveni kvebiTi aSliloba
saWiroebs (cxrili 3.6). kvebiTi Cvevebi?
pirvel fundamentur naSromSi, romelic am
6. iRebT Tu ara alkoholis moxmarebasTan
sferoSi Seiqmna (Goldberg and Huxley, 1980), aRwerilia alkohols? (Tu es asea, dakavSirebuli problema
gamokvleva, romelic unda Cautardes zogadi upasuxeT CAGE kiTxvebs
profilis samedicino dawesebulebaSi moxvedril (gv. ??)
pacients. es iseTi pacientebia, romelTa Civilebi 7. miawodeT pacients sami demencia/deliriumi
fsiqologiuri mizezebis arsebobas gvafiqrebinebs. obieqti da sTxoveT, ga
ixsenos isini 2 wuTis
aseTi gamokvleva oTx sferos moicavs: Semdeg
_ 59 _
3 gamokvleva
Tu im kiTxvebis gamoyeneba, romlebic skrinings frustracias an Tavs damnaSaved grZnobdnen.
emsaxureba, sworad xdeba, maSin SesaZlebelia mravali interviuerma sifrTxile unda gamoiCinos, raTa ar
fsiqikuri aSlilobis identificireba 10-15 wuTis gauRrmaos maT es SegrZnebebi.
ganmavlobaSi. Cven SegviZlia SevadginoT winaswari interviuerma unda dasvas Semdegi kiTxvebi:
gegma da mogvianebiT xelaxla SevxvdeT pacients, raTa w rogor aisaxeba daavadeba ojaxis cxovrebaze da ro-
SevafasoT dasmuli diagnozi da ufro detalurad gor cdilobs igi gaumklavdes mas?
ganvixiloT misi daavadebis marTvis sakiTxebi.
w rogori urTierTobebi da aliansebia ojaxSi? aris
zemoT Tqmuli aseve miesadageba intervius Catarebas
Tu ara ojaxSi mniSvnelovani azrTa sxvadasxvaoba?
iseT garemoSi, rogoricaa gadaudebeli samedicino
w surT Tu ara ojaxis wevrebs, mosinjon pacientisT-
samsaxuris ganyofileba an iseTi palata, romelSic
vis daxmarebis gawevis axali saSualebebi?
erTdroulad bevri pacienti imyofeba. amave dros,
amgvar viTarebaSi gansakuTrebuli yuradReba unda damatebiTi informacia ojaxuri intervius Sesaxeb
mivaqcioT fizikur simptomebs, somatoformuli mocemulia Semdeg wyaroSi: Goldberg, 1997. ojaxis in-
aSlilobis Camoyalibebis SesaZleblobas da sui terviuireba ojaxis Terapiis konteqstSi 22-e TavSia
cidis riskis Sefasebas. garda amisa, Terapiul ganxiluli.
da qirurgiul pacientebs xSirad utareben fsi
qiatriul konsultacias, romelic deliriumTanaa ucxo kulturis pacientis interviuireba
dakavSirebuli. Tu pacienti da interviueri saubroben sxvadasxva
enaze, maT, cxadia, mTargmneli esaWiroebaT. Tumca,
pacientis interviuireba binaze mxolod zusti Targmani sakmarisi ar aris. intervi-
xSirad mizanSewonilia, movipovoT informacia imis ueri SeiZleba pacientis kulturas iseve ar icnobdes,
Sesaxeb, Tu ra viTarebaSi cxovrobs pacienti. amis rogorc mis enas. garda amisa, qal pacients, romelic
garkveva binaze vizitiTaa SesaZlebeli, rac SeiZleba sxva kulturis warmomadgenelia, Tu interviueri ma-
fsiqiatriuli gundis romelime sxva wevrma gaakeTos. makacia, SeiZleba ar hqondes masTan pirad sakiTxebze
am dros irkveva, Tu rogoria pacientis yofa saxlSi. saubris survili. im SemTxvevaSic ki, rodesac ze-
binaze viziti, aseve, gvawvdis ufro zust informacias moT Tqmuli problemas ar warmoadgens, mesame piris
imis Taobaze, Tu rogoria ojaxis wevrebs Soris (Tarjimnis) monawileoba da Targmnis procesi, zemo-
urTierToba. viziti binaze gansakuTrebiT maSinaa qmedebs interviuze da mniSvnelovnad axangrZlivebs
mniSvnelovani, rodesac saqme xandazmul pacientebs mas. sasurvelia, rom Tarjimani jandacvis sferos
exeba (gv. ??). warmomadgeneli iyos, radgan is Tavad SeZlebs monaw-
Tuki es SesaZlebelia, sasurvelia, vizitamde, ileobas pacientis gamokvlevaSi.
fsiqiatri gaesaubros zogadi profilis eqims, zogierTi faqti an movlena ucxo kulturis pacien-
romelsac uSualo kontaqti aqvs ojaxTan mravali tisTvis ufro stresulia, vidre im kulturis war-
wlis manZilze. vizitamde yovelTvis unda iqnes momadgenlisTvis, romelsac interviueri ekuTvnis.
gaTvaliswinebuli interviueris usafrTxoebis sa am SemTxvevaSi, fsiqikuri daavadebis stigmatizacia
kiTxi. interviueri darwmunebuli unda iyos, rom SeiZleba ufro Zlieri iyos. ojaxuri prioritetebi
jgufis romelime sxva wevrma icis vizitis droca SesaZloa gansxvavebuli iyos da mTlianad ojaxis
da adgilic. Tuki arsebobs raime potenciuri riski, keTildReoba ufro mniSvnelovan Rirebulebas war-
interviu orive specialistis mier erToblivad unda moadgendes, vidre misi calkeuli wevrisa. emociuri
Catardes. aSlilobebi SeiZleba ufro metad gamoxatuli iyos
fizikur simptomebSi, vidre fsiqikurSi. garda amisa,
interviu pacientis ojaxTan pacients SeiZleba eSinodes mkurnalobis imitom, rom
zogjer ojaxTan interviu tardeba ojaxis ramdenime igi ar endoba specialistebs. es maSin xdeba, rode-
wevrTan erTdroulad, raTa gavarkvioT maTi sac pacientis qveyanaSi samedicino momsaxureba ar
damokidebuleba pacientisa da misi avadmyofobis aris ganviTarebuli. qceva, romelic erT kulturaSi
mimarT, aseve, davadginoT ojaxSi arsebuli SesaZlo daavadebis arsebobis eWvs iwvevs, SesaZlebelia sxva
konfliqtis xasiaTi. interviu ojaxTan, Cveulebriv, kulturaSi mZime fsiqikuri mdgomareobis socialu-
bavSvisa da mozardTa fsiqiatriaSia saWiro. rad dasaSveb formas warmoadgendes (mag., ukiduresi
interviuers unda axsovdes, rom ojaxis wevrebi, formiT emociebis gamoxatva). sxvadasxva kulturaSi
rogorc wesi, cdiloben daexmaron pacients, magram warmodgenebi mizezobrivi kavSiris Sesaxeb SeiZleba
maTi mcdeloba, Cveulebriv, uSedegoa, ris gamos sruliad gansxvavebuli iyos. mag., mZime mdgomareoba
isini, SesaZloa, demoralizebulni iyvnen, ganicdidnen SesaZloa miCneul iqnes boroti sulebis moqmedebad.
aseve, Zneli dasadgenia, warmoadgens Tu ara mocemul
_ 60 _
informaciis integrireba da Sefaseba
kulturas an qvekulturaSi damkvidrebuli warmod- sasargeblo iqneba, agreTve, Semdeg kiTxvebze pasuxis
genebi bodvas Tu normas. kulturul gansxvavebaTa gacema:
zemoqmedeba diagnostikasa da klasifikaciaze ganxi- w rogoria diagnozi?
lulia me-2 TavSi.
w ra gavlena aqvs mas pacientis cxovrebaze?
SezRuduli inteleqtis mqone pacientis w aRiniSneba Tu ara uSualo riski, romelsac mogva-
reba sWirdeba?
interviuireba
w rogoria pacientis amJamindeli mdgomareoba?
SezRuduli inteleqtis mqone pacientebis (anu das-
wavlis darRvevis mqone pacientebis) intreviuirebis w ratom ganviTarda aSliloba?
procedurebi normaluri inteleqtis mqone pacien- w ra saxis mkurnalobaa naCvenebi?
tebis intreviuirebis procedurebis msgavsia, magram w rogoria prognozi?
garkveul momentebs mainc unda mieqces gansakuTreb-
w ra damatebiTi informaciaa saWiro am kiTxvebze pa-
uli yuradReba. kiTxvebi unda iyos mokle da martivi.
suxis gasacemad?
ar unda gamoviyenoT metaforuli gamoTqmebi. Sesa-
Zloa, daxurul kiTxvebs gverdi ver avuaroT, magram w ra codna sWirdeba pacients da risi codna surs mas?
maTi gamoyenebis SemTxvevaSi pasuxebi unda gadamowm- rogoria diagnozi?
des. Tu kiTxvaze _ `Tqven naRvliani xarT?~ pasuxia _
pirveli safexuria simptomebisa da niSnebis
`diax~, kiTxvaze _ `Tqven kargad grZnobT Tavs?~, pa-
meSveobiT miRebuli informaciis safuZvelze
suxi igive ar unda iyos. zogierTi pacienti imeorebs
diagnozis dasma. am informaciis mopoveba xdeba
interviueris bolo sityvas. aseTi pasuxi ar SeiZleba
anamnezis SegrovebiT, fsiqikuri statusisa da,
gadamowmebis gareSe dasturad CavTvaloT.
saWiroebis SemTxvevaSi, fizikuri mdgomareobis
daswavlis darRvevis mqone adamianebma SeiZleba ver
gamokvleviT da igi SemdegSi gamoiyeneba im
miuTiTon simptomis aRmocenebis dro an ver moax-
diagnozis dasasmelad, romelic dafuZnebuli
erxon imis aRwera, Tu ra TanmimdevrobiT gamovlinda
iqneba fsiqiatriul klasifikaciaze da TiToeul
simptomebi. da mainc, interviuerisTvis mniSvnelova-
diagnostikur kategoriasTan dakavSirebul
nia yvela am saxis informaciis mopoveba. yuradReba
kriteriumze. zogjer diagnozi SeiZleba iyis
unda gavamaxviloT imaze, Tu rogor aRwers pacienti
winaswari manam, sanam Semdgomi informacia ar
simptomebs da imazec, Tu ra awuxebs mas. ix. 25-e Tavi,
iqneba xelmisawvdomi. calkeuli tipis fsiqikuri
romelSic ganixileba daswavlis darRvevis gamokvleva.
aSlilobis diagnostireba momdevno TavebSia
ganxiluli. xolo aq SemovifarglebiT gamokvlevis
bavSvebisa da xandazmulebis interviuireba
mimarT zogadi midgomiT. diagnozs Tan axlavs
bavSvebisa da mozardebis interviuireba ganxilulia aSlilobis Sefaseba misi xarisxis mixedviT _
?? gverdze, xolo xandazmulebis _ ?? gverdze. msubuqi, zomieri da mZime.
informaciis integrireba da Sefaseba cxrili 3.7 Temebi, romlebic unda Sefasdes

aqamde gamokvlevis process ZiriTadad ganvixilavdiT
fsiqiatriuli gamokvlevis dros
monacemTa Segrovebis TvalsazrisiT. gamokiTxvis pacientis problemebi da maTi Sedegebi
mizani iyo hipoTezebis Semowmeba im maniSneblebis
w diagnozi
gaTvaliswinebiT, romlebic ama Tu im diagnozsa da
etiologiaze miuTiTebda. Semdeg nawilSi axsnilia, w gavlena sakuTar Tavsa da sxvebze (disfunqcia)
Tu, sferoSi arsebuli codnis sistemaSi, rogor xdeba w sakuTar TavTan da sxvebTan dakavSirebuli riski
fsiqiatriaSi faqtebis Sefaseba da maTi integracia.
rogoria pacientis amJamindeli mdgomareoba
daskvnebma pirdapir unda migviyvanos gadawyvetilebebTan
_ rogor vumkurnaloT. kidev erTxel vusvamT xazs w pacientis cxovrebis istoria
imas, rom praqtikaSi informaciis Sefaseba imave w amJamindeli viTareba
TanmimdevrobiT xdeba, rogorc misi mopoveba.
w pacientis pirovnuli maxasiaTeblebi
daskvnebis gamotana da gadawyvetilebis etiologia

miReba mkurnaloba
Temebi, romlebic unda Sefasdes fsiqiatriuli prognozi
gamokvlevis dros da romelTa mixedviTac unda iqnes
miRebuli gadawyvetileba, CamoTvlilia cxrilSi 3.7. ramdenad esmis pacients arsebuli problemebi
_ 61 _
3 gamokvleva
ra gavlena aqvs mas pacientis cxovrebaze? saSualebebs, romlebiTac pacienti cdilobs stresis
moxsnas (mag., SfoTvis gamomwvevi situaciebisTvis
sakuTari problemebis aRwerisas pacientebi sa
Tavis arideba an alkoholis borotad gamoyeneba).
ubroben rogorc simptomebze, ise sxva sakiTxebzec.
SemanarCunebeli faqtorebi mniSvnelovnad gansa
gamokvlevis mTavari mizania fsiqopaTologiis amo
zRvravs mkurnalobis formas.
cnoba da daxasiaTeba, radgan es gansazRvravs, Tu ra
etiologiaSi cxovrebis diagrama cxovrebiseuli
darRveva iqneba diagnostirebuli. aseve, aucilebelia,
movlenebis rolis Sefasebis airaRis warmoadgens
gavarkvioT, Tu ra gavlena aqvs am simptomebs
(Sharpe, 1990). misi meSveobiT xdeba fizikuri da
pacientis cxovrebaze, radgan diagnozis umetes
fsiqikuri aSlilobebis epizodebsa da potenciurad
SemTxvevaSi aRiniSneba gauaresebuli funqcionireba.
stresul movlenebs Soris droTa kavSiris damyareba.
amitom unda gairkves pacientis funqcionirebis
misi gamoyeneba sasargebloa xangrZlivi da rTuli
Cveuli done da is, Tu ramdenadaa igi gansxvavebuli
istoriebis SemTxvevaSi. diagramas aqvs sami sveti:
axlandeli donisagan.
erTi cxovrebiseuli movlenebisTvis da TiTo-TiTo
aRiniSneba Tu ara uSualo riski, romelsac _ fizikuri da fsiqikuri aSlilobebisTvis, xolo
mogvareba sWirdeba? mwkrivebSi mocemulia pacientis cxovrebis wlebi.
rogorc iTqva, riskis Sefaseba warmoadgens fsiqi- cxovrebis diagramis Sesavsebad unda davaTariRoT
atriuli gamokvlevis qvakuTxeds. riskis identi- TiToeuli movlena, radgan es gviCvenebs, Tu ra
ficirebis Semdeg unda moxdes misi marTva. mag., Tu kavSiria stresorebsa da avadmyofobis dawyebas
pacients aReniSneba TviTugulebelyofis an TviTda- Soris, aseve, fsiqikur da fizikur aSlilobebs Soris.
zianebis niSnebi, es imoqmedebs gadawyvetilebaze, am konteqstSi marTebulia visaubroT pirovnuli
movaTavsoT Tu ara pacienti stacionarSi misi nebis maxasiaTeblebis Sesaxeb. pacientis pirovnuli
gareSe. Tu arsebobs sxvisTvis zianis miyenebis saSiS- Tvisebebis dadgena misi cxovrebis istoriisa da
roeba, fsiqiatrma riskis qveS myofi piri unda gaaf- fsiqikuri aSlilobis srulad Secnobis nawilia.
rTxilos. amitom did mniSvnelobas vaniWebT gamokvlevis
procesSi sando da sruli informaciis Segrovebas
rogoria pacientis amJamindeli mdgomareoba? pacientis pirovnuli Tvisebebis Sesaxeb. garda imisa,
informacia pirovnebis sacxovrebeli pirobebis, fi- rom amgvari informacia dagvexmareba, davadginoT
nansuri mdgomareobis, interesebisa da urTierTo- daavadebis etiologia, is sasargebloa daavadebis
bebis Sesaxeb, gvexmareba daavadebis marTvasa da prog- marTvis dagegmvisa da prognozirebisTvis. mag.,
nozirebaSi. mag., usaxlkaro adamians gansaxvebuli komorbidul pirovnul aSlilobas, rogorc wesi,
mzrunveloba sWirdeba, vidre imave aSlilobis mqone cudi prognozi ukavSirdeba; garda amisa, is gavlenas
pacients, romelsac aqvs mudmivi sacxovrebeli da hy- axdens gadawyvetilebaze, Tu ra saxis fsiqologiuri
avs momvleli. arsebulma garemoebam SeiZleba imoqm- mkurnaloba Catardes.
edos pacientis avadmyofuri mdgomareobis SenarCu-
nebaze da Careva swored amaze unda iqnes mimarTuli. ra saxis mkurnalobaa naCvenebi?
mag., wuxili sacxovrebeli pirobebis gamo SeiZleba Tu pacients sWirdeba mkurnaloba, ZiriTadad
warmoadgendes stresors, romelic avadmyofs depre- gadasawyvetia is, Tu ra saxis mkurnaloba unda
siul mdgomareobas unarCunebs. Cautardes mas. gadawyvetileba mkurnalobis Cata
rebis Sesaxeb pacientTan erTad ganixileba; irCeva
ratom ganviTarda aSliloba? mkurnalobis sxvadasxva saxe da TiToeuli ganixileba
etiologiis sakiTxebi ganxilulia me-5 TavSi. aq misi efeqturobis, gverdiTi movlenebisa da sxva
SemovifarglebiT mxolod imiT, Tu rogor unda parametrebis TvalsazrisiT. es sakiTxebi ganxilulia
mivudgeT etiologiur faqtorebs TiToeuli Semdeg TavebSi.
pacientis SemTxvevaSi. mocemul wignSi gamoyenebulia
qronologiuri midgoma. daavadebis mizezebi iyofa rogoria prognozi?
sam kategoriad: predispoziciur, precipitatur prognozi ZiriTadad damokidebulia imaze, Tu ra
da SemanarCunebel faqtorebad. predispoziciuri saxis aSlilobasTan gvaqvs saqme; aseve, pacientis
faqtorebi SeiZleba iyos genetikuri xasiaTis, individualur maxasiaTeblebze (mag., mis asakze,
ukavSirdebodes temperaments an tvinis dazianebas simptomebis simZimeze, komorbidobaze da a. S.). Tu am
cxovrebis adreul etapze. precipitaturi faqtorebi saxis informacias srulad ver movipovebT, pirveladi
xSirad stresuli movlenebia. SemanarCunebeli Sefasebisas, mocemul etapze mainc SesaZlebelia
faqtorebi SeiZleba warmoadgendes xangrZlivi moklevadiani prognozis gakeTeba. pacients SegviZlia
zemoqmedebis stresorebs an ukavSirdebodes im vuTxraT, rom ufro zusti, grZelvadiani prognozis
_ 62 _
Canaweris gakeTeba da informaciis gacvla
gakeTeba SesaZlebeli iqneba ufro vrceli informaciis momuSave sxva specialistebi yuradRebas amaxvileben
mopovebis Semdeg. klinicisti akvirdeba aSlilobis am faqtorebidan erT-erTze, sakuTari specialobidan
dinamikas ramdenime kvirisa da Tvis manZilze. gamomdinare. mag., fsiqologi yuradRebas amaxvilebs
normidan gadaxraze, xolo socialuri muSaki _
ra damatebiTi informaciaa saWiro am kiTxvebze
arsebul garemoebebze pacientis reaqciaze. amgvarma
pasuxis gasacemad?
gansxvavebebma midgomebs Soris SeiZleba migviyvanos
pacientTa umravlesobis gamokvleva ar Semoifar- uTanxmoebamde multidisciplinaruli gamokvlevis
gleba erTi interviuTi, romelic bevr kiTxvaze ver dros. mniSvnelovania, rom fsiqiatrebma gaacnobieron
gagvcems damajerebel pasuxs. gamokvleva unda war- am potenciuri problemis arseboba da Seecadon mis
movidginoT, rogorc interaqtiuli procesi, romlis gadaWras.
drosac xdeba miRebuli Sexedulebebisa da daskvnebis
mudmivi gadasinjva da pacientisa da misi avadmyofo- Sefaseba gamocdili fsiqiatris mier
bis Sesaxeb damatebiTi informaciis mopoveba. mocemu- am TavSi saubaria sistemur da logikur midgomaze
li Tavi aRweriTi xasiaTisaa, masSi ganixileba gamokv- gamokvlevis mimarT, romlis drosac xdeba
levis diagnostikuri miznebi, magram praqtikaSi ar informaciis guldasmiT Segroveba da simptomebisa
arsebobs gansxvaveba gamokvlevis am da sxva miznebs da niSnebis gamoyofa diagnozis dasmis mizniT.
Soris (mag., riskis Sefaseba an reaqcia mkurnalo- nebismieri axalbeda fsiqiatri yovelTvis mkacrad
baze). fsiqiatrisa da pacientis TiToeuli Sexvedra unda icavdes am midgomis principebs. Tumca, rogorc
gamokvlevis, Sefasebisa da gadawyvetilebis miRebis irkveva, gamocdili fsiqiatrebi gamokvlevas sakmaod
procesia. amdenad, gamokvleva xangrZlivi procesia, gansxvavebulad atareben. isini swrafad svamen
romelic mimdinareobs rogorc mkurnalobis, aseve diagnozs, xSirad intervius pirvelive wuTebSi,
Semdegi periodis ganmavlobaSic. pacientis garegnobis, qcevisa da metyvelebis
safuZvelze (Gauron and Dickinson, 1966; Kendell, 1975).
ra codna sWirdeba pacients da risi codna surs
fsiqiatri SeiZleba ver acnobierebdes, Tu riT
mas?
xelmZRvanelobda diagnozis dasmisas. Svarci da
es sakiTxi konkretul aSlilobebsa da mkurnalobasTan
uiginsi am process `tipizacias~ (typification) uwodeben
mimarTebaSi ganxilulia ?? gverdze da, aseve,
(Schwartz and Wiggins, 1987). intervius danarCeni nawili
momdevno TavebSi.
diagnozis dadasturebasa da daxvewas emsaxureba.
mosalodnelia, rom, gamocdilebis SeZenasTan
sxva sakiTxebi, romlebic gavlenas axdens
erTad, fsiqiatrma gamokvlevis Catarebisas sul
informaciis Sefasebaze ufro xSirad gamoiyenos aseTi strategia. Tu eqimi
daavadeba da avadmyofoba kargad icnobs fsiqopaTologiasa da diagnostikur
es cnebebi, romlebic me-2 TavSi iyo Setanili, klasifikacias, mas SeuZlia `tipizaciis~ efeqturad
Sexsenebas saWiroebs. àvadmyofoba~ gulisxmobs gamoyeneba. amasTan, xazs vusvamT imasac, rom
pacientis gamocdilebas, xolo `daavadeba~ ki _ fsiqiatrma ar unda gamoiyenos aseTi midgoma
am gamocdilebis paTologiur mizezebs. pacienti manam, sanam is kargad ar aiTvisebs fsiqiatriul
SeiZleba iyos daavadebuli, magram ar ganicdides saxelmZRvaneloebSi ilustrirebul midgomas da
Tavs avadmyofad, an piriqiT _ avadmyofad ganicdides ar SeiZens sakmaris gamocdilebas. interviuerma
Tavs, magram ar aReniSnebodes raime daavadeba. arasodes ar unda gamoitanos naadrevi daskvna
zogad medicinaSi pacientebi uyvebian eqims TavianTi konkretuli SemTxvevis Taobaze, radgan man SeiZleba
avadmyofobis Sesaxeb, xolo eqimebi cdiloben ver SeniSnos saWiro informacia da ugulebelyos is
aRmoaCinon avadmyofobis gamomwvevi daavadeba, faqtebi, romlebic ar adasturebs mis Sexedulebas.
radgan amazea damokidebuli mkurnaloba. pacientebs
da maT axloblebs, aseve, surT gaigon, Tu ra aris Canaweris gakeTeba da informaciis
avadmyofobis mizezi da rogori iqneba mkurnaloba, gacvla
magram yovelTvis ar esmiT, rogor exmareba
gamokvlevis dasrulebis Semdeg aucilebelia mdgo
samedicino diagnozi amis garkvevas. fsiqiatrebic
mareobis aRwera da, SemTxvevis marTvis mizniT,
cdiloben daavadebis, rogorc avadmyofobis mizezis,
sxva specialistebisTvis am informaciis miwodeba.
dadgenas, magram, amasTan, yovelTvis sxva mizezebsac
miznidan da recipientidan gamomdinare, Canawerebis
iTvaliswineben; zogjer pacientis gamocdileba
gaformeba da gagzavna sxvadasxva formiT xdeba,
SeiZleba gagebul iqnes, rogorc normidan ukiduresi
Tumca, es procesi yovelTvis unda iTvaliswinebdes
gadaxra, zojer _ rogorc reaqcia garemoebebze, zogjer
Semdeg ZiriTad principebs:
ki, maTi kombinacia. fsiqikuri janmrTelobis sferoSi
_ 63 _
3 gamokvleva
w Canaweri unda iyos gasagebi da mokle. unda did daxmarebas gauwevs mokle, amomwuravi da kargad
Seicavdes informacias mniSvnelovani simptomebis struqturirebuli SemTxvevis Canaweri, romelic gas-
ararsebobis Sesaxeb (mag., `pacients ar aReniSneba agebi eniTaa dawerili.
suiciduri azrebi da tendenciebi~). moerideT im
informaciis gameorebas, romelic ukve cnobilia Canawerebis gakeTeba pacientis
recipientisTvis. gamoiyeneT iseTi saTaurebi saavadmyofoSi moTavsebisas
da qvesaTaurebi, romlebic sakvanZo sakiTxebs rodesac pacienti saswrafod unda moTavsdes saavad-
gamoavlens (mag., `diagnozi~, àmJamindeli medi myofoSi, eqimi droSia SezRuduli. swored am drosaa
kamenturi mkurnaloba~.) gansakuTrebiT mniSvnelovani, rom Canawerebi Sesabam-
w bevr qveyanaSi pacients ufleba aqvs waikiTxos, Tu is Temebs exebodes. Canawerebi, romlebic keTdeba pa-
ra weria mis Sesaxeb. es informacia, aseve, SeiZleba cientis saavadmyofoSi moTavsebisas, sul cota, Sem-
gamoyenebul iqnes iuridiuli mizniT. zog qveyanaSi, deg informacias unda Seicavdes:
maT Soris britaneTSi, iTvleba, rom pacients w saavadmyofoSi moTavsebis mizezi;
ufleba aqvs, gaecnos eqimebis im korespondencias,
w nebismieri informacia, romelic saWiroa, ra
romelic uSualod mas exeba, garda im SemTxvevebisa,
Ta miRebul iqnes gadawyvetileba saswrafo mkur
rodesac es informacia garkveuli mizezebis gamo
nalobis Sesaxeb;
konfidencialuria. darwmundiT, rom informacia
w nebismieri informacia, romelic mogvianebiT aRar
zustia da rom Tqveni mosazrebebi da daskvnebi
iqneba xelmisawvdomi. mag., detalebi fsiqikuri
gonivrulia. moerideT dausabuTebel an zedmetad
mdgomareobis Sesaxeb saavadmyofoSi moTavsebisas
subieqtur komentarebs. zogjer mizanSewonilia,
(wamlis miwodebamde) da informaciis miReba iseTi
gaesaubroT zogadi profilis eqims an janmrTelobis
informatorisagan, romelsac, SesaZloa, momavalSi
sferos sxva specialists, raTa ufro vrclad
veRar SexvdeT.
ganixiloT mocemuli SemTxvevis zogierTi detali.
pacients unda uTxraT, rom is miiRebs Canaweris sakmarisi drois pirobebSi, SeiZleba sistemuri
asls da eqneba TqvenTan dakavSirebis saSualeba im anamnezis damateba. gamoucdeli interviueri sas
SemTxvevaSi, Tu informacia gaugebari an mcdari wrafo gadawyvetilebis miRebisas xandaxan Zalian
aRmoCndeba. did dros kargavs meorexarisxovan detalebze da
ar aRricxavs fsiqikuri mdgomareobis im detalebs,
w nebismieri korespondencia unda iyos konfiden-
romlebic, SesaZloa, droebiTi xasiaTisaa, magram,
cialuri.
Zalian mniSvnelovania diagnostirebis TvalsazrisiT.
aq ganvixilavT gamokvleviT miRebuli informaciis
gamokvlevis danarCeni nawili SeiZleba mogvianebiT,
gaformebis sxvadasxva meTodebs, romelTa gaziareba
ramdenime dRis ganmavlobaSi Catardes. saavadmyofoSi
unda moxdes fsiqiatriuli jgufis wevrebs Soris,
moTavsebis Canaweri unda dasruldes saxeldaxelo
aseve, fsiqiatrsa da sxva eqimebs da fsiqiatrsa da
moqmedebis mokle gegmiT, romelic pacientze
pacients Soris.
mimagrebul ufros eqTanTan unda SevaTanxmoT.
SemTxvevis Canawerebis mniSvneloba

Canawerebi daavadebis mimdinareobis Sesaxeb
(CASE NOTES)
Canawerebi daavadebis mimdinareobis Sesaxeb unda
SemTxvevis Canawerebis saTanado warmoeba mniSvnelova- Seicavdes konkretul informacias, mxolod aseT
nia medicinis yvela dargSi. fsiqiatriaSi es sasicocx- SemTxvevaSi iqneba Rirebuli. nacvlad imisa, rom
lo mniSvnelobis mqonea, radgan didi raodenobis in- CanawerebSi iseTi zogadi frazebi CavweroT, ro
formacia sxvadasxva wyarodan miiReba. mniSvnelovania gorebicaa `pacienti ukeT grZnobs Tavs~, an `pacientis
informaciis Tavmoyra iseTi saxiT, rom adamianma, ro- qceva SedarebiT mowesrigda~, umjobesia, ganmartoT,
melic ar icnobs mocemul SemTxvevas an, mag., kole- ra mxriv grZnobs is ukeTesad Tavs (mag., naklebadaa
gam, romelic mowveulia gadaudebeli saWiroebis gamo Sepyrobili suiciduri azrebiT) an rogor mowesrigda
swrafad SeZlos ZiriTad momentebSi garkveva. SemTxve- misi qceva (naklebad mousvenaria da ukve SeuZlia
vis Canawerebi ara mxolod misi SemdgenlebisTvis aris sakvebis miRebisas magidasTan jdoma).
mniSvnelovani (radgan samaxsovro dokumentis fuqn- CanawerebSi, romlebic daavadebis mimdinareobis
cias asrulebs), aramed pacientTan kavSirSi myofi sxva Sesaxebaa, unda iyos aRwerili pacientis mkurnaloba.
pirebisTvisac. SemTxvevis Canawerebs, agreTve, samed- miuxedavad imisa, rom medikamenturi mkurnalobis
icino-samarTlebrivi mniSvneloba aqvs. Tu fsiqiatri detalebi daniSnulebaSia miTiTebuli, ufro mo
sakuTari qmedebebis gasamarTleblad an pacientis saxerxebelia es informacia davafiqsiroT nebis
Civilis SemTxvevaSi gamoZaxebulia sasamarTloSi, mas mier aramedikamentur mkurnalobasTan erTad, im
_ 64 _
Canawerebis gverdiT, romlebic asaxaven cvli epikrizi mniSvnelovani Canaweria, gansakuTrebiT maSin
lebebs fsiqikur mdgomareobasa da qcevaSi. ar Cans, rodesac pacienti kvlav avad xdeba da masze
aris aucilebeli fsiqoTerapiuli seansebisa da mzrunveloba specialistTa sxva jgufs ekisreba.
konsultaciebis mimdinareobis srulad Cawera, magram epikrizis zogierTi punqti komentars saWiroebs.
unda gakeTdes mTavari Temebis Canawerebi, pacientis kerZod, momarTvis mizezSi dasaxelebuli unda iyos
reaqciebze dakvirvebis Sesabamis monacemebTan erTad. problema da ara savaraudo diagnozi. mag., `napovnia
xSirad mizanSewonilia ramdenime seansis Semajamebeli agznebul mdgomareobaSi RamiT xetialis dros. yviroda
Canaweris gakeTeba, romelSic procesis dinamika iqneba da RmerTs da eSmaks axsenebda~ da ara `Sizofreniis
asaxuli. agreTve, unda Caiweros fsiqoTerapiuli samkurnalod~. am SemTxvevaSi mniSvnelovania pacientis
jgufis Sexvedrebze miRebuli daskvnebi. Tu paci pirovnebis daxasiaTeba. epikrizis Semdgeneli unda
entTan Sexvedrebi poliklinikaSi mimdinareobs, unda ecados, ipovos Sesabamisi sityvebi da frazebi,
dafiqsirdes ukanaskneli vizitis Semdgomi mTavari romlebic pirovnul maxasiaTeblebs gadmogvcems. Tu
cxovrebiseuli movlenebi da stresorebi. ar dadginda konkretuli paTologiis arseboba, unda
unda gakeTdes zusti Canaweri nebismieri infor mokled Sejamdes fsiqikuri gamokvlevis Sedegebi.
maciis an rCevis Taobaze, romelic pacientma an misma rodesac keTdeba Canaweri fsiqikuri mdgomareobis
naTesavebma eqimisagan miiRes. es sakmarisi unda iyos Sesaxeb, TiToeul saTaurTan dakavSirebiT saWiroa
imis dasadgenad, iyo Tu ara pacienti saTanadod komentari imis Taobaze, dadgenilia Tu ara raime
informirebuli, rodesac axal mkurnalobaze Tan paTologia. diagnozi unda daiweros ICD-10-isa da
xmobas acxadebda. aseve, nebismier pirs, romelic DSM-IV-is terminebis gamoyenebiT. Tu diagnozi
pacients mogvianebiT miscems rCevas, saSualeba unda dadgenili ar aris, unda CamovTvaloT alternativebi
hqondes gaarkvios, gansxvavdeba Tu ara misi rCeva imis miTiTebiT, Tu romeli maTgania ufro savaraudo.
adre micemulisagan, raTa, saWiroebis SemTxvevaSi, zogierT SemTxvevaSi, SeiZleba saWiro gaxdes erTze
warmoadginos aucilebeli axsna-ganmarteba. meti diagnozis dasma.
fsiqiatrebis garda, daavadebis mimdinareobas ak mkurnalobis epikrizi unda Seicavdes monacemebs
virdebian eqTnebi, okupaciuri Terapiisa da klinikuri yvela medikamentis dozirebasa da gamoyenebis
fsiqologiis specialistebi da socialuri muSakebi. xangrZlivobis Sesaxeb. prognozi unda iyos mokled,
xSirad isini awarmoeben damoukidebel Canawerebs, magram magram maqsimalurad zustad formulirebuli.
sasurvelia, rom informaciis mniSvnelovani punqtebi fraza _ `prognozi gaurkvevelia~, arafris mTqme
Setanil iqnes avadmyofobis istoriaSi. agreTve, unda lia. specialisti meti ZalisxmeviT unda miudges
gakeTdes fsiqoTerapiuli jgfis wevrebis oficialuri prognozirebis sakiTxebs, radgan sakuTari mosaz
diskusiebis Canawerebi. gansakuTrebiT mniSvnelovania, rebisa da realuri gamosavlis Sedareba daexmareba
mkafiod ganisazRvros pacientze Semdgomi zrunvis mas klinikuri codnis gaRrmavebaSi. epikrizis
gegma mas Semdeg, rac igi saavadmyofodan gaewereba. Semdgenelma unda miuTiTos, Tu ramdenad saeWvoa
garda amisa, unda dadgindes, im piris vinaoba, romelic prognozi da, aseve, ra aris daeWvebis mizezi
ZiriTadad iqneba amaze pasuxismgebeli. britaneTSi es (mag., eWvi imis Taobaze, rom pacienti ar daicavs
principebi pacientze zrunvis specialur programaSia mkurnalobis reJims). momavali mkurnalobis mokle
formulirebuli (gv. ??). CanawerSi unda iyos miTiTebuli ara mxolod is, Tu
ra unda gakeTdes, aramed isic, Tu vin unda gaakeTos.
epikrizi specialistTa gundisa da zogadi profilis eqimis
epikrizi, Cveulebriv, stacionaruli pacientebisTvis funqciebi mkafiod unda iyos gansazRvruli.
iwereba. saukeTeso SemTxvevaSi is ori nawilisagan
Sedgeba. pirveli nawili ivseba stacionarSi formulireba (epikrizis daskvniTi nawili)
moTavsebisTanave da masSi sawyisi monacemebia formulireba exmareba klinicists, cxadad gaiazros
Setanili; meore nawili _ gawerisas da masSi mocemulia diagnozi, etiologia, mkurnaloba da prognozi.
informacia mimdinare progresis Sesaxeb, Tumca, formulireba ar unda Seicavdes spekulaciebs,
praqtikaSi iwereba saboloo epikrizi, romelSic Tumca, SeiZleba Seicavdes iseT hipoTezebs, romelTa
Sedis avadmyofobis istoriis umTavresi momentebi. Semowmeba SeiZleba Semdgomi informaciis mopovebis
epikrizi unda iyos mokle, magram amomwuravi; gziT. sxvadasxva tipis avadmyofobis istoriis
dawerili telegrafuli stiliT da standartuli formulirebis daweris Sedegad, vswavlobT mocemul
formatis gamoyenebiT, raTa gareSe pirma advilad SemTxvevebSi arsebuli problemebis gaanalizebas.
moiZios informaciis calkeuli punqtebi. Sevsebuli dawerili formulireba didad exmareba gamocdil
epikrizi, Cveulebriv, erTi an erT-naxevari nabeWdi fsiqiatrs, gaerkves rTul SemTxvevebSi.
gverdia. nimuSi mocemulia boqsSi 3.3. Sevsebuli formulirebaSi Semavali saTaurebi CamoTvlilia
_ 65 _
3 gamokvleva
boqsi 3.3 epikrizis nimuSi gamokvlevis dros arsebuli fizikuri mdgomareoba:

paTologia ar aRiniSneba. fsiqikuri mdgomareoba:
pacienti: q-ni a.b., dabadebis TariRi: 7.2.71 / asaki _ 34. garegnulad mouwesrigebeli (dauvarcxneli), dabneuli.
metyveleba: neli, xangrZlivi dayovnebebiT, Tanmimdevruli.
konsultanti: eqimi g.; epikrizi Seavso eqimma d-m. 25.7.05
azrovneba: moculia fiqrebiT sakuTari mZime mdgomareobis
Semosvlis TariRi: 27.6.05 Sesaxeb da Relavs imis gamo, rom qmari da misi sayvareli
gaweris TariRi: 22.7.05 mis winaaRmdeg moqmedeben. natrobs sikvdils.
momarTvis mizezi _ mZime depresia da suiciduri azrebi mkafiod gamoxatuli suiciduri azrebi, romelTac ver
uwevs winaaRmdegobas. ar aReniSneba bodva da obsesiebi.
ojaxis anamnezi: guneb-ganwyoba: depresiuli, adanaSaulebs sakuTar Tavs,
mama _ 66 wlis. pensiaze gasuli mebaRe, kargi fizikuri uimedo. aRqma: warmoidgens gardacvlili bebiis saubars,
janmrTelobiT. aReniSneba guneb-ganwyobis meryeoba. romelic mas damamcirebeli toniT mimarTavs, magram es
pacientTan aqvs cudi urTierToba. ar aris halucinacia. kogniciebi: daqveiTebuli yuradReba
da koncentracia. mexsiereba: ar aris gamokvleuli.
deda _ 57 wlis; janmrTeli, myari spiritualisti; insaiTi: fiqrobs, rom avadaa da darwmunebulia, rom ver
pacientTan aqvs distanciuri urTierToba. gamojanmrTeldeba.
da _ joani. 38 wlis. ganqorwinebuli. janmrTeli. ojaxi specialuri gamokvleva: hemoglobini da eleqtrolitebi:
materialurad uzrunvelyofilia. ojaxis wevrebs Soris normis farglebSi
naklebi emociuri siaxlovea. fsiqikuri aSlilobebi: biZa
mamis mxridan _ oTxjer iwva saavadmyofoSi `maniakaluri mkurnaloba da daavadebis mimdinareoba: imyofeba mudmivi
depresiis~ diagnoziT. meTvalyureobis qveS. fluoqsetini Canacvlebulia
amitriptiliniT, romlis dozac TandaTanobiT
cxovrebis anamnezi: pacientis muclad yofnis periodi, izrdeba 175 miligramamde dReSi. aqtivobis gazrda.
dabadeba da adreuli ganviTareba _ normaluri. kargi erToblivi interviu qmarTan colqmruli urTierTobis
janmrTeloba bavSvobaSi. skola _ Sevida 6 wlis, daamTavra gasaumjobeseblad. qmrisaTvis rCevis micema finansebis
16 wlis asakSi. swavlis periodi _ gansakuTrebuli marTvasTan dakavSirebiT. guneb-ganwyobis TandaTanobiTi
movlenebis gareSe. hyavda megobrebi. 16-idan 22 wlamde gaumjobeseba da suiciduri azrebis gaqroba. saxlSi
muSaobda maRaziaSi gamyidvelad. hyavda ramdenime warmatebulad gatarebuli SabaT-kvira saavadmyofodan
partniori mamakaci. daqorwinda 22 wlis asakSi. qmari sabolood gaweramde.
2 wliT ufrosi, satvirTo manqanis mZRoli. gasul wels
hqonda mZime gancdebi meuRlis Ralatis gamo. Svilebi: mdgomareoba gawerisas: msubuqi rezidualuri depresiuli
jeini _ 7 wlis, janmrTeli; poli _ 4 wlis, epilefsiiT simptomebi. imedianadaa, magram wuxs colqmruli
daavadebuli. seqsualuri cxovreba _ ukanasknel wlamde urTierTobis momavalze.
damakmayofilebeli. garemoebebi: sacxovrebeli _ diagnozi: depresiuli aSliloba.
municipaluri. finansuri problemebi. prognozi: damokidebulia imaze, Tu rogor warimarTeba
gadatanili daavadebebi: 27 wlis asakSi (mSobiarobis ojaxuri urTierTobebi. Tu gaumjobesdeba, moklevadiani
Semdeg) depresiuli aSliloba. xangrZlivoba _ 8 kvira. prognozi kargia. grZelvadiani prognozi _ momavalSi
Sexvda konsultants. depresiuli aSlilobis riski.
premorbiduli pirovnuli Tvisebebi: cota megobari.
cvalebadi guneb-ganwyoba; advilad nerviuldeba. ar aris daavadebis Semdgomi marTva:
darwmunebuli sakuTar TavSi; ar aqvs obsesiuri niSnebi.
dedis msgavsad, sjera zebunebrivi Zalebis. iSviaTad iRebs w gagrZeldes amitriptiliniT mkurnaloba _ 175 mg dReSi
alkohols. ar eweva. uaryofs narkotikebis moxmarebas. 9 Tvis ganmavlobaSi xelaxal Semowmebamde. zogadi
profilis eqimis daniSnuleba.
amJamindeli daavadebis anamnezi: 6 kviris ganmavlobaSi, mas
Semdeg, rac Seityo meuRlis Ralatis Sesaxeb, gauuaresda w jo smiTi, Temis eqTani, fsiqiatri _ mTavari pasuxismge-
guneb-ganwyoba; xSirad tiris, adre iRviZebs, uyuradReboa beli piri. pacientTan vizitis TariRi: 27.7.05.
bavSvebis mimarT, dakarga mada, daqveiTebuli libido.
intensiuri suiciduri azrebi, rasac mohyva Tavis CamoxrCobis w pacients aqvs misi mkurnalobisa da movlis gegmis
mcdeloba stacionarSi moTavsebis Rames. mdgomareoba asli; man da misma meuRlem ician, Tu vis mimarTon
uaresdeba, miuxedavad imisa, rom 4 kviris ganmavlobaSi gansakuTrebul SemTxvevaSi.
yovel dRe regularulad iRebs 20 miligram fluoqsetins. w fsiqiatrTan ambulatoriuli viziti _ 4.8.05.
cxrilSi 3.8, xolo konkretuli magaliTi boqs TiToeulma maTganma ufro adreul faqtorebSi. amas
3.4-Sia mocemuli. mokle Sesavlis Semdeg iwereba mosdevs gansakuTrebuli problemebis sia da sxva
diferencialuri diagnozi, romelsac Tan axlavs saWiro informacia. Semdeg iwereba daavadebis marTvis
TiToTeul diagnozTan dakavSirebuli albaToba. mokle gegma da bolos _ Canaweri prognozis Sesaxeb.
isini ranJirebuli saxiTaa warmodgenili. TiToeul
alternativas Tan axlavs damamtkicebeli argu problemebis CamonaTvali
mentebi an kontr-argumentebi, rasac mosdevs problemebis CamonaTvali rTuli socialuri
daskvna yvelaze maRali albaTobis mqone diagnozis problemebis arsebobis dros gviwevs daxmarebas. misi
Sesaxeb. ètiologiis~ qveS iwereba predispoziciuri, meSveobiT ufro advilia pacientis dasaxmareblad
precipitatuli da SemanarCunebeli faqtorebi. gasatarebeli RonisZiebebis naTlad Camoyalibeba;
Semdeg, Cveulebriv, qronologiuri TanmimdevrobiT, mkurnalobis ukve SeTanxmebuli miznebis miRwevaSi
ganixileba TiToeuli predispoziciis dasaxelebis progresis monitoringi. xSirad mizanSewonilia siis
safuZveli imis saCveneblad, Tu ra wvlili Seitana Sedgena pacientTan erTad, radgan es exmareba mas,
_ 66 _
boqsi 3.4 formulirebis (epikrizis etiologia

daskvniTi nawilis) nimuSi rogorc Cans, simptomebi provocirebulia imiT, rom
pacientma Seityo qmris Ralatis Sesaxeb. a.b.-s meryevi,
(SeniSvna: es Canaweri boqsSi 3.3. ganxiluli hipoTeturi da eWviani bunebidan gamomdinare, aqvs winaganwyoba,
SemTxvevis Semoklebuli variantia. am ori midgomis rom usiamovno ambavTan dakavSirebiT ganuviTardes
SedarebiT mkiTxveli Seafasebs gansxvavebas sxvadasxva aseTi mZime sapasuxo reaqcia. stresul viTarebaSi igi,
formulirebebs Soris). SesaZloa, midrekili aRmoCndes depresiuli aSlilobis
q-ni a.b., 34 wlis, daqorwinebuli. 6 kviris ganmavlobaSi ganviTarebisken, radgan (a) pirveli Svilis dabadebis Semdeg
misi depresiuli mdgomareoba uaresdeboda. miuxedavad ganuviTarda depresia; (b) aqvs cvalebadi guneb-ganwyoba
ambulatoriuli mkurnalobisa antidepresantebiT, saxlis da aReniSneba (g) guneb-ganwyobis aSlilobis ojaxuri
pirobebSi ver SesZlo mdgomareobasTan gamklaveba. anamnezi, rac SeiZleba genetikur midrekilebas asaxavdes.
aSlilobis SenarCunebas xeli Seuwyo mudmivma colqmrulma
diagnozi uTanxmoebam da valze wuxilma. dis ganqorwinebisa da misi
depresiuli aSliloba. daqveiTebul guneb-ganwyobasTan mZime mdgomareobis gagebam gaaZliera q-ni a.b.-s dardi.
erTad, pacients eRviZeba Cveulebrivze ufro adre. Tavs
grZnobs uaresad dilis saaTebSi, aReniSneba madisa da mkurnaloba
libidos daqveiTeba. nakleb energiuli da uiniciativo. Tavs depresiuli aSlilobis simptomebis arseboba imaze mig
adanaSaulebs imaSi, rom cudi dedaa (rac sinamdviles ar vaniSnebs, rom, savaraudod, pacienti daemorCileba
Seesabameba) da darwmunebulia, rom ver gamojanmrTeldeba. aqvs antidepresantebis Sesabamisi dozebiT mkurnalobas.
mkafiod gamoxatuli suiciduri azrebi. arc erTi maxasiaTebeli miuxedavad imisa, rom serotoninis ukumitacebis
am diagnozis sawinaaRmdego mtkicebuleba ar aris. seleqciuri inhibitoris (SSRI) gamoyeneba uSedego aRmoCnda,
Sizofrenia Tu sxva fsiqozi. q-ni a.b. darwmunebulia, rom amitriptilini SeiZleba ufro efeqturi gamodges mZime
qmari mis winaaRmdeg moqmedebs, rom esaubreba gardacvlili depresiuli aSlilobis samkurnalod. erToblivma intervium
bebia. Tumca, es rwmena ar aris bodviTi xasiaTis da bebiis pacientTan da mis meuRlesTan SeiZleba gadaWras an
xma ar aris halucinacia. orive simptomi Seesabameba mis Seasustos colqmruli problemebi. qmars unda vurCioT, Tu
guneb-ganwyobas da mZime depresiul mdgomareobas. mas rogor miiRos konsultacia valis gadaxdasTan dakavSirebiT.
ar aReniSneba Sizofreniis pirveli rigis simptomebi da
inarCunebs insaiTis unars. prognozi
pirovnuli aSliloba. miuxedavad imisa, rom q-n a.b.-s Tu colqmruli problemebi nawilobriv mainc mogvardeba,
mravali wlis manZilze aReniSneba guneb-ganwyobis moklevadiani prognozi dadebiTi iqneba. Tumca, zemoT
cvalebadoba, es ar akmayofilebs cikloTimiuri pirovnuli aRniSnuli winaganwyobis faqtorebi imas miuTiTebs, rom
aSlilobis kriteriumebs. stresul situaciaSi pacients kvlav SeiZleba ganuviTardes
daskvna. depresiuli aSliloba. depresiuli aSliloba.
werili zogadi profilis eqims

cxrili 3.8 formulireba
zogadi profilis eqimisTvis werilis gagzavnisas,
problemis Camoyalibeba upirveles yovlisa, unda davfiqrdeT imaze, Tu ra
diferencialuri diagnozi icis man pacientis Sesaxeb da ra kiTxvebi dasva man
momarTvaSi. Tu eqimma momarTvis werilSi Cawera
etiologia
mocemuli SemTxvevis yvelaze mkafio detalebi, maSin
Semdgomi gamokvleva
pasuxSi maTi gameoreba aucilebeli ar aris. Tu zogadi
mkurnalobis gegma profilis eqimi pacients kargad ar icnobs, mas unda
prognozi mivawodoT ufro detaluri informacia. aseve, Tu
momarTvis werilSi mocemuli diagnozi sworia, maSin
gaiazros, Tu romeli problemis gadaWraa SesaZlebeli mxolod misi dadastureba iqneba saWiro, Tu ara _
da risi gakeTeba SeuZlia mas am TvalsazrisiT. Tqven mier dasmuli diagnozi unda dasabuTdes.
cxrili 3.9 gviCvenebs problemebis CamonaTvals, amis Semdeg, ganixileba mkurnaloba da prognozi.
romelic pirveli Sefasebis Semdeg SeiZleba gakeTdes, medikamenturi mkurnalobis aRwerisas unda dasaxeldes
iseT SemTxvevaze, rodesac qalbatonma miiRo preparatis doza, misi miRebis dro da xangrZlivoba.
wamlis gadaWarbebuli doza, mas aRmoaCnda SfoTvis agreTve, unda mivuTiToT momaval daniSnulebaze
simptomebi da, aseve, bevri socialuri problema. pasuxismgebeli pirebi. daasaxeleT pasuxismgebeli
siaSi Sesatan sakiTxebze muSaobis procesSi SegviZlia piri, Terapevti, nebismieri monawile samsaxuri
axali problemebis damateba, arsebuli problemebis da maTi konkretuli movaleobebi. unda aRiniSnos
modifikacia an zogierTis siidan amoReba. mag., pacientTan Semdegi Sexvedris TariRi da is, urCieT
SeiZleba aRmoCndes, rom qalis rTuli mdgomareoba Tu ara pacients, Sexvdes zogadi profilis eqims. es
seqsualur sferoSi col-qmars Soris wamoWrili detalebi, Tuki es SesaZlebelia, werilis daweris
problemis mizezia da ara Sedegi, rac imaze win telefoniT unda SevuTanxmoT zogadi profilis
mianiSnebs, rom mocemul SemTxvevaSi mizanSewonilia eqims, raTa man dagvidasturos isini. werilSi xazi
konsultaciis Catareba. amitom cxrilSi 3.9 unda unda gaesvas TanamSromlobiT midgomas, raTa aman
Seswordes punqti 4. waaxalisos zogadi profilis eqimi, daamyaros aqtiuri
_ 67 _
3 gamokvleva
cxrili 3.9 problemaTa CamonaTvali

problema qmedeba agenti gadasinjva
1. xSirad Cxubobs qmarTan erToblivi interviu eqimi 3 kvira
2. 3 wlis vaJiSvils aqvs metyvelebis CamorCena metyvelebis gamokvleva zogadi profilis 1 kvira
eqimis daxmarebiT
3. aradamakmayofilebeli sacxovrebeli pirobebi viziti binaTmowyobis pacienti 2 kvira

departamentis ofisSi
4. disfunqcia seqsualur sferoSi (#1-is gamo) gadavadeba
5. panikis Setevebi Sefaseba kognituri fsiqologi 6 kvira

Terapiis Catarebis
saWiroebis TvalsazrisiT
kontaqti. es saSualebas miscems mas, ukeT gaerkves boqsSi 3.5. Sejamebulia pacientTan da mis na
saorganizacio mxareSi da hqondes pacientis Taobaze TesavebTan gansaxilveli punqtebi.
sakuTari mosazrebis gamoTqmis saSualeba.
Sefasebis standartuli meTodebi
pacientisTvis diagnozisa da daavadebis
rogorc kvlevaSi, ise klinikur praqtikaSi, sasarge-
marTvis gegmis axsna-ganmarteba
bloa simptomebisa da sindromebis, sxvadasxva saxis
rodesac pacientTan da mis naTesavebTan erTad unarSezRudulobisa da fsiqikuri aSlilobis Sede-
ganixlavT gamokvlevis Sedegad miRebul daskvnebs, gebis Sefaseba standartuli meTodebis gamoyenebiT.
SesaZloa, sasargeblo iyos, Tavidan mokled SeajamoT es meTodebi uzrunvelyofs sandoobas da aadvilebs
sakvanZo sakiTxebi. es dagexmarebaT daadginoT, rom sxvadasxva fsiqiatrebis mier sxvadasxva dros miRe-
sworad gesmiT avadmyofobis istoria da rom ar buli Sedegebis urTierTSejerebas.
gamogrCaT iseTi ram, rac mniSvnelovania pacientisa Sefasebis standartuli meTodebi ZiriTadad sami
da misi naTesavebisTvis. agreTve, dagexmarebaT tipisaa:
imis demonstrirebaSi, rom Tqven CarTuli xarT
1. meTodebi, romelTa meSveobiT, diagnozis dasmis
mkurnalobis procesSi da empaTias ganicdiT pacientis
mizniT, fasdeba simptomebi. am meTodebs mniSvn-
mimarT, rac gzas gauxsnis diagnozis Sesaxeb diskusias
eloba hqonda Tanamedrove fsiqiatriuli klasifi-
da samomavlo gegemebis ganxilvas.
kaciebis Seqmnisas da isini me-2 TavSia warmodge-
diagnozze saubrisas ar gamoiyenoT samedicino
nili. fsiqikuri statusis Sefasebis mokle skala,
terminebi maTi axsnis gareSe. pacientma, SesaZloa,
romelic mocemuli Tavis danarTSia mocemuli, am
ver gaigos maTi mniSvneloba. axseniT, ras niSnavs
tipis meTodebis erT-erT magaliTs warmoadgens.
mocemuli diagnozi mizezebis da prognozis Tval
sazrisiT da ganumarteT pacients, Tu rogori 2. meTodebi, romelTa meSveobiT fasdeba simptomis an
samkurnalo saSualebebis gamoyenebaa SesaZlebeli simptomTa jgufis simZime.
mocemul SemTxvevaSi. 3. meTodebi, romelTa gamoyenebiT fasdeba fsiqi-
daavadebis marTvis gegmis SeTavazebisas, hkiTxeT kuri aSlilobis arsebobis zogadi indikatorebi da
pacients, Tu ra saxis mkurnalobas moelis igi da aqvs fsiqikuri aSlilobis efeqti. maT ewodeba global-
Tu ara mkafio damokidebuleba mkurnalobis mimarT uri Sefasebis skalebi da isini Seicaven cxovrebis
(mag., medikamenturi mkurnalobis mimarT). gegma din xarisxis maCveneblebs.
jad unda ganumartoT da dro da dro SeamowmoT, standartuli meTodebi da standartuli Sefasebi-
ramdenad esmis igi pacients. rogorc medikamenturi, sadmi arsebuli midgomebi mocemulia Semdeg wyaroe-
ise fsiqologiuri mkurnalobis dagegmvisas, ram bSi: Task Force for Psychiatric Measures (2000); Farmer et al.,
denime sakiTxia gansaxilveli (gv. ??, 22-e Tavi). mni (2002).
Svnelovania, rom intervius ganmavlobaSi am saxis
ganmartebebisTvis sakmarisi dro gamoyoT, rac gazrdis standartuli diagnostikuri Sefaseba
imis albaTobas, rom pacienti mkurnalobis gegmis arsebobs diagnostikuri Sefasebis mravali instru-
Sesatyvisad imoqmedebs. Tu sruli axsna-ganmartebis menti, romelTagan qvemoT mocemulia iseTebi, rom-
Semdeg pacientisTvis ar aris misaRebi gegmis romelime lebic yvelaze xSirad gamoiyeneba. specifikuri diag-
nawili, interviueri unda Seecados, rom pacientTan nozebis Sesafasebeli sxva meTodebi mocemulia TavSi,
erTad ganixilos misTvis misaRebi alternativa. romelic exeba calkeul sindromebs.
_ 68 _
axlandeli statusis Sefaseba (Present State

boqsi 3.5 komunikacia pacientTan da mis
Examination)
naTesavebTan
mocemuli nusxis saTanado SekiTxvebi dagexmarebaT, axlandeli statusis Sefasebis testze muSaoba 1950-
miiRoT gadawyvetileba, Tu ra informacia unda miawodoT iani wlebis dasasruls daiwyo. pirveli versiebi
pacientebs da maT naTesavebs. gamoiyeneboda mxolod avtoriseul gamokvlevebSi.
diagnozi mecxre gamocema (PSE 9) pirvelia, romelic sxva momx-
w rogoria fsiqiatriuli diagnozi? Tu is gaurkvevelia, mareblebisTvis gamoqveynda (Wing et al., 1974). testi
ra SeiZleba gakeTdes amasTan dakavSirebiT? sul cota 35 enazea gamoqveynebuli da farTod gamoi-
w dasmulia Tu ara fizikuri daavadebis diagnozi? yeneba bevr qveyanaSi. ZiriTadi principi imaSi mdgo-
w aris Tu ara saWiro damatebiTi informacia an spe mareobs, rom interviu, romelic aSkarad struqturi-
cialuri gamokvleva?
rebul xasiaTs atarebs, mainc inarCunebs klinikuri
w ras niSnavs es diagnozi pacientisaTvis?
gamokvlevis niSnebs. interviueri, romelsac fsiqi-
w ram gamoiwvia pacientis arsebuli mdgomareoba?
atriaSi treningi aqvs gavlili, cdilobs amoicnos
pacientis movlis gegema anomaliuri fenomenebi, romlebmac Tavi iCina drois
w rogoria mocemuli gegma da rogor daexmareba igi garkveul monakveTSi da daadginos maTi simZime.
pacientsa da mis ojaxs?
140 Sesafasebeli debuleba (punqti) detaluradaa
w arsebobs Tu ara samarTlebrivi berketebi, romelTa
gamoyenebac SesaZlebelia? Tu arsebobs, ratom aris
ganmartebuli terminologiur leqsikonSi. kompiut-
saWiro maTi gamoyeneba da ra Sedegebi mohyveba amas? eruli programebi iZleva simptomebis Sesafasebel
w ra unda icodnen pacientebma medikamenturi mkur qulebs, diagnozs (CAT _ EGO) da ara fsiqozuri simp-
nalobis Sesaxeb? tomebis simZimis sazoms, romelic klinikuri monace-
w ra unda icodnen pacientebma fsiqologiuri mkur mebis safuZvelzea dadgenili (the Index of Definition).
nalobis Sesaxeb?
vin ras akeTebs?

klinikuri Sefasebis instrumenti
neirofsiqiatriaSi (Schedule for Clinical Assessment
w vin aris mTavari pasuxismgebeli piri da ra evaleba mas?
in Neuropsychiatry)
w ra roli aqvs fsiqiatrs da ra sixSiriT unda inaxulos
man pacienti? PSE-is meaTe gamocema integrirebulia neirofsiqia-
w ra roli aqvT fsiqiatriuli gundis sxva wevrebs? triaSi klinikuri Sefasebis instrumentTan, romelic
w ra roli aqvs zogadi profilis eqims? ufro moculobiTia da gamoiyeneba ufro meti tipis
w risi gakeTeba SeuZlia ojaxs pacientis dasaxmareblad? aSlilobis diagnostirebisTvis (kvebiTi, somatofor-
gadaudebeli SemTxveva muli, fsiqoaqtiuri nivTierebis borotad moxmare-
w savaraudoa Tu ara aseTi SemTxvevebi da ra gziT SeiZ- biT gamowveuli aSlilobebi da kognituri darRvevebi
leba maTi Tavidan acileba? (WHO, 1992 a). mocemuli sistema eTanxmeba PSE 9-s da
w arsebobs Tu ara SesaZlo krizisis adreuli gamafrTxi- iTvaliswinebs ICD-10-Si, DDSM-III R-Si da DSM-IV-Si
lebeli niSnebi?
Setanil diagnozebs (Janca et al., 1994). kompiuteruli
w vis unda mivmarToT gadaudebeli SemTxvevis dros da
versia xelmisawvdomia.
rogor davukavSirdeT swrafad am pirebs?
mniSvnelovani gansxvavebaa im instrumentebs Soris,

struqturirebuli klinikuri interviu
diagnostikisTvis (Structured Clinical Interviw for
romlebic gankuTvnilia fsiqiatriaSi treninggav-
Diagnosis)
lili interviuerebisTvis da romlebic navaraudevia
im interviuerebisTvis, romelTac aseTi treningi ar mocemuli instrumenti (SCID) warmoadgens diagnosti-
gauvliaT. Tu interviuers fsiqiatriaSi treningi kuri Sefasebis proceduras, romelic Seqmnilia DSM
gavlili aqvs, sakmarisia mas gavacnoT simptomebis Se- diagnozebis dasasmelad. is pirvelad DSM-III TR-Tan
fasebis zogadi wesebi. axlandeli statusis Sefase- erTad gamoica. is klinicistma SeiZleba gamoiyenos
ba~ (Present State Examination) am tipis intervius war- rogorc gamokvlevis Cveuli proceduris nawili,
moadgens. boqsi 3.6-is zeda nawilSi mocemulia misi konkretuli diagnozis dasadastureblad; agreTve,
formatis ilustracia. instrumentebSi, romlebic gamokvlevis an skriningis Catarebisas, janmrTelobis
gankuTvnilia im interviuerebisTvis, romelTac ara sxvadasxva mdgomareobebis sistematuri SefasebisT-
aqvT miRebuli formaluri ganaTleba fsiqiatriaSi, vis (Spitzer et al., 1987). arsebobs SCID-is sxvadasxva
(rogorc es Cveulebriv xdeba farTomasStabiani epi- versia: pacientisTvis gankuTvnili versia gamoiyeneba
demiologiuri gamokvlevisas), gamoiyeneba simptom- im pirebTan, romlebic identificirebulni arian ro-
ebis aRricxvisa da sindromebis diagnostirebis ufro gorc fsiqiatriuli pacientebi, xolo meore gamocema
detaluri wesebi. boqsSi 3.6 am formatis nimuSicaa _ arapacientebisTvis _ epidemiologiur gamokvleveb-
mocemuli. Si. garda amisa, SCID-II gamoiyeneba DSM IV-is II aqsis
_ 69 _
3 gamokvleva
boqsi 3.6 standartuli Sefasebis gagviwios Semdegi kiTxvebis dasmam: `rodesac SeamCnieT
kiTxvebis nimuSebi fsiqozuri simptomebis arseboba, xom ar iRebdiT im
dros narkotikul nivTierebas an wamals? xom ar svamdiT
nimuSi 1. definicia PSE-Si. `bodva, rom Sens azrebs bevrs? fizikurad avadmyofobdiT?~ Tu pacienti ar
sxvebi kiTxuloben~ (ix. Wing et.al., 1974) . adasturebs fsiqozuri simptomebis arsebobas, gadadiT
Semdeg kiTxvaze: àxla minda dagisvaT kiTxva im uCveulo
es Cveulebrivi ganmartebiTi xasiaTis bodvaa. xSirad gancdebze, romlebic adamianebs uCndebaT xolme~.
is gvxvdeba damokidebulebis bodvasTan an mcdar Tu pacienti adasturebs fsiqozuri simptomebis
interpretaciasTan erTad, rac moiTxovs imis ganmartebas, arsebobas, interviu Semdegi saxiT gaagrZeleT: `Tqven
Tu saidan ician adamianebma pacientis momavali qmedebis miambeT amis (fsiqozuri gancdebis) Sesaxeb. axla vapireb
Sesaxeb. es azri SeiZleba iyos Sedegi iseTi gancdebisa, kidev ufro meti kiTxva dagisvaT msgavsi Temebis garSemo~.
rogorebicaa azrTa gaxmovaneba, azrebis Canergva, smeniTi
halucinaciebi, kontrolis, devnisa da zemoqmedebis bodva. es aris pirovnebis mcdari rwmena, romelic efuZneba
bodviTi ideebi. aseve, SeiZleba Tavi iCinos eqspansiur araswor daskvnebs gare realobis Sesaxeb. is myaria imisda
bodvasTan erTad (mag., pacients surs ganmartos, Tu rogor miuxedavad, Tu ras fiqroben sxva adamianebi da raze
mopara mas ainStainma originaluri ideebi). Sesabamisad, am metyvelebs utyuari da aSkara faqtebi. zeRirebulovani
simptoms ar aqvs diagnostikuri mniSvneloba. mTavaria, ideebi (aragonivruli mtkice rwmena), romelTa intensivoba
rom is SecdomiT ar unda CaiTvalos diagnostikurad ufro bodvaze sustia, unda iyos kodirebuli, rogorc `2~. SeniSvna:
mniSvnelovan simptomad, rogoric, magaliTad, azrebis bodva SeiZleba iyos kodirebuli, rogorc `3~, Tu pacienti
Canergva da gaxmovanebaa. dadebiTad pasuxobs Semdegi tipis erTze met kiTxvas:
Tu pacientisaTvis ubralod dasaSvebia, rom misi òdesme xom ar mogCvenebiaT, rom adamianebi Tqvens Sesaxeb
azri SeiZleba sxvam waikiTxos, magram ar aris amaSi saubroben an gansakuTrebul yuradRebas gaqceven?~...
darwmunebuli, SeafaseT es mdgomareoba quliT `1~, xolo damokidebulebis bodva, piraduli mniSvneloba, romelic
Tu is amaSi darwmunebulia, SeafaseT quliT `2~. gamoricxeT mcdarad miewereba garemos obieqtebsa da movlenebs.
is adamianebi, romlebic Tvlian, rom sxvebs SeuZliaT SekiTxva: `ras ityviT televiziidan, radiodan, gazeTidan
maTi azrebis wakiTxva, radgan isini miekuTvnebian jgufs, an garemodan gansakuTrebuli Setyobinebebis miRebis
romelsac aqvs àzrebis wakiTxvis~ praqtika. es SemTxveva Taobaze?~
Sefasdeba rogorc 1 an 2 #83 simptomze. (aRricxeT ?: 1: 2.: 3, sadac 1=SesaZlo/aSkarad organuli;
PSE-s nawili, romelic halucinaciebs exeba, grZeldeba 3=araorganuli).
kiTxvebiT mesame piris halucinaciebisa da araverbaluri devnis bodva. viRaca Tavs esxmis, ar asvenebs, atyuebs,
halucinaciebis Sesaxeb. devnis pacients an jgufs, romelsac is miekuTvneba,
an kidev SeTqmulebas awyobs mis winaaRmdeg. SekiTxva:
nimuSi 2. SCID kiTxvebi bodvis Sesaxeb (ix. Spitzer et.al., `daJinebiT xom ar cdilobs vinme, rom usiamovneba an
1987) tkivili mogayenoT?~ (aRricxeT ?: 1: 2: 3, sadac 1=SesaZlo/
fsiqozuri da asocirebuli simptomebi. es moduli aSkarad organuli; 3=araorganuli).
emsaxureba fsiqozuri da asocirebuli simptomebis gandidebis bodva. am bodvis Sinaarsia _ gazviadebuli
kodirebas, romlebmac Tavi iCina pacientis cxovrebis warmodgena sakuTari Zalauflebis, codnis an
romelime monakveTSi. mniSvnelobis. kiTxva: òdesme xom ar gigrZvniaT, rom Tqven
nebismieri fsiqozuri da asocirebuli simptomis gansakuTrebulad mniSvnelovani xarT an SegwevT unari,
dadgenisas, romelic kodirebulia, rogorc `3~, daadgineT, gaakeToT iseTi ram, rac sxvebs ar SeuZliaT?~ aRricxeT ?:
simptomi àraorganulia~, Tu pacients aReniSneba SesaZlo 1: 2: 3, sadac 1=SesaZlo/aSkarad organuli; 3=araorganuli).
an realuri òrganuli~ mizezi. Tu zogadma mimoxilvam SCID-is es monakveTi grZeldeba kiTxvebiT sxva saxis
ar mogvawoda saWiro informacia, SesaZloa, daxmareba bodvebis Sesaxeb (somaturi, nihilisturi da sxva).
aSlilobebis, kerZod, personologiuri aSlilobis melic aRiniSneboda ukanaskneli 2 kviris, an ukanaskne-

diagnostirebisTvis. li 1, 2, 6 an 12 Tvis manZilze.
diagnostikuri interviu (Diagnostic Interview Schedule) kompleqsuri saerTaSoriso diagnostikuri

instrumenti, romelic diagnostikuri interviusTvis interviu (Composite International Diagnostic
aris gankuTvnili, Seiqmna SeerTebul StatebSi, rogorc
Interview. CIDI)
im proeqtis nawili, romelic miznad isaxavda fsiqi- Sedgenili saerTaSoriso diagnostikuri interviu Se-
kuri daavadebis gavrcelebis Seswavlas (Epidemiological muSavda msoflio jandacvis organizaciisa da aSS-s
Catchemnt Rroject, ECA) (Robins et al., 1981). ara-klini- alkoholisa da narkotikuli nivTierebebis borotad
cistebisTvis Seiqmna srulad struqturirebuli in- gamoyenebisa da fsiqikuri janmrTelobis adminis-
terviu, romelic Seicavs diagnostikur kriteriumebs, traciuli departamentisTvis. es aris amomwuravi,
romlebsac klinicistebi iyeneben. DIS moicavs im di- standartuli interviu, romelic DIS-is safuZvel-
agnozebs, romlebic umetesad zrdasrul populaciaSi zea Seqmnili da gamoiyeneba fsiqikuri aSlilobebis
gvxvdeba. am diagnozebis dadgena SesaZlebelia mxolod Sesafaseblad da diagnozis dasasmelad ICD-is da
mocemuli intervius Sinaarsis SefasebiT (mag., masSi ar DSM-IV-is mixedviT. Targmnilia 16 enaze da Seqmnlia
Sedis neirogenuli bulimia). Tavidan diagnozs svamen klinicistebisa da araklinicistebisTvis, romlebic
cxovrebis mTeli ciklis safuZvelze. amis Semdeg in- sxvadasxva kulturaSi muSaoben. CIDI paketi Seicavs
terviueri kiTxulobs, Tu bolo dros rodis aReniSne- ZiriTad intervius mkvlevarisa da interviueris
boda pacients ukanaskneli simptomi. pacientis pasuxis versiebisTvis (interviueris versias Tan axlavs di-
safuZvelze, klinicisti afiqsirebs aSlilobas, ro- agnostikuri indeqsi, romelic iZleva saSualebas,
_ 70 _
rom konkretuli CIDI SekiTxvebi daukavSirdes ICD- zomavs depresiuli sindromis simZimes da ara depre-
10-is da DSM-IV-is konkretul diagnostikur krite- siis simptoms.
riumebs), damatebiT modulebs (romlebic exeba an-
tisocialur pirovnebas da posttravmuli stresiT
bekis depresiis skala (Beck Depression Scale)
gamowveul aSlilobas), treningis saxelmZRvaneloe- am skalaze izomeba 21 punqti da mas, Cveulebriv, pa-
bs da kompiuterul programebs. interviu Seicavs cienti avsebs. TiToeul punqts ukavSirdeba oTxi de-
SekiTxvebs cxovrebis nebismier periodSi aRmocenebu- buleba, pacienti ki irCevs, Tu romeli maTgani asaxavs
li simptomebisa da problemebis, aseve, mimdinare md- yvelaze ukeT mis gancdebs gasuli kviris manZilze.
gomareobis Sesaxeb (World Health Organization, 1989; Essau
montgomeri-asbergis depresiis Sefasebis skala
and Wittchen, 1993; Janca et al., 1994).
(Montgomery _ Asberg Depression Rating Scale)
simptomebis gasazomi instrumentebi mocemuli skala (MADRS; Montgomery and Asberg, 1797) 10
punqtisagan Sedgeba. TiToeuli punqti fasdeba oTxqu-
kvlevaSi da zogjer klinikaSic saWiroa ara marto
lian skalaze interviueris mier, romelic TiToeuli
imis dafiqsireba, saxezea Tu ara esa Tu is simptomi,
qulis Sesabamis definicias iyenebs. skalaze izomeba
aramed, aseve, maTi simZimis gazomva da imis Cveneba,
mxolod depresiis fsiqologiuri simptomebi.
Tu rogor icvlebian isini droTa ganmavlobaSi an
mkurnalobis Sedegad. zogi instrumenti zomavs cal- sxva simptomebis Sefaseba
keul simptoms an simptomTa viwro jgufs, zogi ki _
iel-braunis obsesiur-kompulsuri skala (Yale-
simptomTa farTo jgufs, rogorc aSlilobis simZi-
Brown Obsessive Compulsive Scale)
mis zogad maCvenebels.
mocemul skalaze (YBOCS) Sefasebas akeTebs klini-
SfoTvis simptomTa Sefaseba cisti. afasebs 10 simptoms 4 safexurian skalaze ob-
hamiltonis SfoTvis skala (Hamilton Anxiety Scale) sesiur-kompulsuri aSlilobis diagnozis mqone paci-
entebTan. skalaze ar keTdeba depresiuli da SfoT-
hamiltonis SfoTvis skala farTod gamoiyeneba (HAS;
viTi simptomebisa da obsesiuri pirovnuli niSnebis
Hamilton, 1959). interviueri afasebs xuTqulian skala-
Sefaseba.
ze camet punqts. TiToeuli maTganis Sefaseba mokle
aRweris safuZvelze keTdeba. is, Tu interviuirebis iangis maniis Sefasebis skala (Young mania rating
ra meTodi gamoiyenos, amas Tavad Semfasebeli gadaw- scale)
yvets. skalaze izomeba zogierTi depresiuli simpto-
iangis skalaze fasdeba maniis simptomebi (Young et al.,
mi, swored amitom es skala zomavs SfoTvis sindromis
1978), rogorc pacientis, ise klinicistis mier. es
simZimes da ara SfoTvis siptomebs.
aris 11 punqtiani skala, romelSic TiToeuli pun-
SfoTvis klinikuri skala (Clinical Anxiety Scale) qtis Sefaseba 0-dan 5-mde qulebiT keTdeba.
SfoTvis klinikuri skala Seiqmna (CAS; Snaith et al., motoruli simptomebis Sefaseba
1982) hamiltonis skalis safuZvelze, SfoTvis simp-
es simptomebi SeiZleba Sefasdes ramdenime skalis
tomebze fokusirebis mizniT. is ar gamoiyeneba mx-
gamoyenebiT, romlebic ukavSirdeba antifsiqozuri
olod da mxolod SfoTviTi aSlilobis diagnozis
medikamenturi mkurnalobis gverdiT movlenebs. maT-
mqone pacientebTan.
Si Sedis eqstrapiramiduli simptomebis Sefasebis
mdgomareoba _ niSan-Tvisebebis SfoTvis skala skala (ESRS; Chouinard et al., 1980) da barnis akatiziis
(The State _ Trait Anxiety Inventory). skala (Barnes, 1989).
es instrumenti (STAI; Spielberger et al., 1983) TviTSe- kognituri funqciebis daqveiTebisa da demenciis
fasebis skalaa, romelzec 20 debuleba fasdeba. ma- Sefasebis skala
Tze pasuxis gacema ori TvalsazrisiT xdeba: ras gan-
am Tavis danarTSi mocemuli fsiqikuri mdgomareobis
icdis pacienti skalis Sevsebisas (niSan-Tvisebebi) da
mini _ Sefasebis testi (MMSE; Folstein et al., 1975) ze-
ras ganicdis igi zogadad (mdgomareoba).
moT iyo naxsenebi. sxva skalebi, romlebsac iyeneben
depresiuli simptomebis Sefaseba kognituri funqciebis daqveiTebisa da demenciis qcev-
iTi simptomebis Sesafaseblad, me-14 TavSia ganxiluli.
depresiis Sefasebis hamiltonis skala (Hamilton
Rating Scale for Depression) Sizofreniis simptomebis Sefaseba
am skalas (HRSD; Hamilton, 1967) interviueri avsebs PSE iyo ganxiluli zemoT. sxva skalebi mocemulia
arastruqturirebuli intervius gamoyenebiT. is me-12 TavSi.
_ 71 _
3 gamokvleva
simptomebis farTo jgufebis Sefaseba cxovrebis xarisxis skalebi (Quality of life scales)
mzardi interesi SeiniSneba cxovrebis xarisxis mimarT,
zogadi janmrTelobis statusis kiTxvari (General
romelic medicinis sferoSi miRweuli Sedegebis Ziri-
Health Questionnaire)
Tad sazoms warmoadgens. amJamad arsebobs am tipis 100
am kiTxvaris Tavdapirveli versia (GHQ; Goldberg, skala. amaTgan fsiqiatriaSi xSirad gamoiyeneba EuroQoL.
1972) Seicavda 60 punqts, xolo Semdeg Seiqmna misi SF-36 da lankaSiris skala (Lancashire scale). zog skalas
Semoklebuli versia. es kiTxvari gamoiyeneba, ro- pacienti avsebs, zogs ki _ misi naTesavi an momvleli.
gorc skriningis instrumenti pirveladi jandacvis
sferoSi, zogad samedicino praqtikasa da TemSi Cat- janmrTelobis gasazomi erovnuli skala (Health of
arebul gamokvlevebSi. misi sruli versiac ki Ses- the Nation Outcome Scale)
aZlebelia 10 wuTSi Seivsos. simptomebis raodeno- es Tormetpunqtiani skalaa (HoNOS; Wing et al., 1998).
briv maCveneblebs emateba zogadi simZimis qula, ro- misi meSveobiT afaseben klinikur problemebs da so-
melic asaxavs fsiqiatris gadawyvetilebas, miiCnevs cialur funqcionirebas. is Seiqmna rogorc instru-
Tu ara igi am SemTxvevas fsiqiatriul problemad. menti, romelic zomavs im progress, romelsac bri-
arsebobs kidev erTi versia, romelSic Sedis soma- tanuli erovnuli janmrTelobis dacvis samsaxurma
turi simptomebis, SfoTvisa da uZilobis, depresii- dasaxuli miznebis ganxorcielebaSi miaRwia. am miznis
sa da socialuri disfunqciis skalebi (Goldberg and arsia fsiqikurad daavadebuli adamianebis janmrT-
Hillier, 1979). elobisa da socialuri funqcionirebis gaumjobese-
ba. samomavlod am skalis gamoyeneba yvela fsiqiatri-
swrafi fsiqiatriuli Sefasebis skala (Brief psy-
ul pacientTanaa gaTvaliswinebuli. mocemuli skalis
chiatric rating scale).
testireba sxva qveynebSic gakeTda. misi gamoyenebis
es skala (BPRS; Overall and Gorham, 1962) 16 puqntisgan mizniT, Catarda skalis adaptacia xandazmul popula-
Sedgeba; TiToeuli punqti Svidquliani skaliT fas- ciasTan da daswavlis darRvevis mqone pirebTan.
deba. Sefasebis dro ar aris dadgenili da Tavad Sem-
faseblis mier ganisazRvreba. es instrumenti gamoi-
yeneba mZime da ara msubuqi fsiqikuri aSlilobebis
damatebiTi literatura
Sesafaseblad. Blumenthal, S and Lavender, T (2000) Violence and mental
disorder: a critical aid to the assessment and management of
globaluri Sefasebis skalebi (Global rating scales)
risk. Zito Trust, London.
funqcionirebis zogadi Sefaseba (Global assessment Cooper, JE and Oates, M (2000) The principles of assessment
of functioning) in general psychiatry. In MG Gelder, JJ Lopez Ibor jr, and
mocemuli skala Setanilia DSM-IV-Si da global- NC Andreason (eds) The new Oxford textbook of psychiatry,
uri Sefasebis skalis gadamuSavebul versias war- Chapter 1.10.1. Osxford University Press, Oxford.
moadgens (Endicott et al., 1976). es aris 100- punqtiani Maguite, P and Pitceathly, C (2002) Key communication skills
skala, romelic zomavs pacientis zogadi funqcioni- and how to acquire them. BMJ 325: 697-700.
rebis dones. yovel aTbalian intervals Tan axlavs
Task Force for Psychiatric Measures (200) Handbook of psy-
fsiqologiuri, socialuri da profesiuli funq-
chiatric measures. American Psychiatric Association Press,
cionirebis mokle aRwera.
Washington, DC. (moicavs farTo informacias fsi-
zogadi klinikuri STabeWdileba (Clinical global im- qikuri daavadebis simptomebisa da sindromebis ga-
pression) mosavleni da gamzomi instrumentebis Sesaxeb)
am instrumentSi (CGI ; Guy, 1976) Sedis ori punqti. Taylor, MA (1999) Fundamentals of clinical neuropsychiatry,
ZiriTadi punqti _ `zogadi simZime~, klinicistisagan Osxford University Press, New York and Oxford. (ix. Tavi
moiTxovs pacientis daavadebis zogadi simZimis Se- 2 neirofsiqiatriuli gamokvlevis Sesaxeb da Tavi 4
fasebas intervius Catarebisas, imave diagnozis mqone kognituri da qceviTi nevrologiuri gamokvlevis
sxva pacientebTan SedarebiT. `zogadi cvlilebebis~ Sesaxeb)
indeqsiT xdeba cvlilebis xarisxis Sefaseba sawyis J.C. Anthony, L Le Resche, U. Niaz, M.R. von Korff, M.F. Fol-
mdgomareobasTan SedarebiT. es instrumenti xSirad stein (1982). Limits of the `Mini Mental State~ as a screen-
gamoiyeneba, rogorc efeqturobis sazomi samkurnalo ing test for dementia and delirium among hospital patients.
preparatebis gamocdis dros. Psychological Medicine 12.397-408.
_ 72 _
danarTi fsiqikuri mdgomareobis mini-Sefasebis testi

(daamateT qulebi TiToeuli swori pasuxis SemTxvevaSi) Sefaseba qula
orientacia
1 romeli welia? _ 1
sezoni? _ 1
ricxvi? _ 1
dRe? _ 1
Tve? _ 1
2 sad vimyofebiT? StatebSi? _ 1
sagrafoSi? _ 1
qalaqSi? _ 1
saavadmyofoSi? _ 1
iatakze? _ 1
aRricxva
3 daasaxeleT sami obieqti, romelTaganac TiToeulis Tqmas sWirdeba 1 wami. amis _ 3

Semdeg sTxoveT pacients, daasaxelos samive obieqti. mianiWeT TiToeul swor
pasuxs 1 qula. gaimeoreT pasuxi manam, sanam pacienti samive obieqts daiswavlis.
yuradReba da angariSi
4 seriuli Svidianebi. mianiWeT TiToeul swor pasuxs 1 qula. SewyviteT testi xuTi _ 5
pasuxis Semdeg.
alternatiuli testi: waikiTxeT sityva `samyaro~ (WORLD) ukuRma.
aRdgena
5 sTxoveT pacients, daasaxelos sami obieqti, romlebic kiTxva 3-Si daiswavla. _ 3

mianiWeT TiToeul swor pasuxs 1 qula.
ena
6 aCveneT fanqari an saaTi. sagnis miTiTebisas aTqmevineT pacients misi saxeli. _ 2
7 sTxoveT pacients ramdenjerme gaimeoros Semdegi: àraviTari `Tu~-ebi, `da~-ebi da _ 1

`magram~-ebi.
8 sTxoveT pacients, Seasrulos samsafexuriani instruqcia: `daiWireT qaRaldi _ 3

marjvena xelSi. mokeceT qaRaldi orad. dadeT qaRaldi iatakze.
9 waakiTxeT pacients Semdegi instruqcia da SeasrulebineT igi: daxuWeT Tvalebi _ 1

(es sityvebi didi asoebiT dawereT).
10 daawerineT pacients winadadeba, romelic mas surs (winadadeba unda Seicavdes _ 1

subieqts da obieqts da azris Semcveli unda iyos. qulebis miwerisas ar
gaiTvaliswinoT marTlweris Secdomebi).
11 gaadideT qvemoT mocemuli naxazi 1.5 santimetramde da _ 1

sTxoveT pacients, gadaxazos igi (mianiWeT mas erTi qula,
Tu naxazSi mocemulia yvela gverdi da kuTxe da Tu
urTierTgadamkveTi gverdebi oTxkuTxeds qmnis).
_ sul =30
J.C. Anthony, L Le Resche, U. Niaz, M.R. von Korff, M.F. Folstein (1982). Limits of the Mini Mental State as a screening test for dementia and
delirium among hospital patients. Psychological Medicine 12.397-408.
_ 73 _
Tavi 4 eTika da
samoqalaqo samarTali
Tavis Sinaarsi
aspeqtebi zogadi xasiaTisaa, radgan kanonebi gansx-
zogadi sakiTxebi ??
vavebulia sxvadasxva qveyanaSi. aqedan gamomdinare,
eTikuri midgomebi ??
mkiTxvelebma unda moipovon informacia im qvey-
eTikuri principebi ?? nebSi arsebuli kanonmdeblobis Sesaxeb, romelSic
praqtikis kodeqsi ?? isini muSaoben, da, saWiroebis SemTxvevaSi, mimarTon
eTikuri problemebi fsiqiatriul praqtikaSi ?? eqsperts rCevisTvis kanonis detalebTan da mis gamo-
eqimisa da pacientis urTierToba ?? yenebasTan dakavSirebiT.
konfidencialoba ?? es Tavi dayofilia sam nawilad. masSi Sedis:
Tanxmoba mkurnalobaze ?? 1. zogadi sakiTxebi
fsiqikuri aSlilobis 2. eTikuri problemebi fsiqiatriaSi
aranebayoflobiTi mkurnaloba ??
3. fsiqiatriasTan dakavSirebuli samoqalaqo samarT-
kvlevis eTika ??
lis zogierTi aspeqti.
samoqalaqo samarTlis ramdenime aspeqti ??
mkiTxvelma unda gaiTvaliswinos, rom eTikis prob-
qmedunarianoba anderZis Sedgenisas ??
lemebze am wignis sxva TavebSicaa saubari. zogierTi
mindobiloba da qonebis marTva ?? problema, romelic specifikur sakiTxebs exeba, Sesa-
saojaxo samarTlis aspeqtebi ?? bamis TavebSia ganxiluli (ix. boqsi 4.1.)
samoqalaqo samarTlis normebis
darRveva da xelSekrulebebi ??
zogadi sakiTxebi
pirovnuli ziani ??
daskvna imis Sesaxeb, rom mocemuli qmedeba eTikurad
avtomanqanis marTvis ufleba ??
ufro gamarTlebulia sxva qmedebebTan SedarebiT,
unda iyos:
am TavSi saubaria fsiqikuri problemebis mqone pirebis
w dafuZnebuli SeTanxmebul eTikur midgomebze da
movlasTan dakavSirebul zogadi eTikis sakiTxebze,
principebze
romlebic exeba pirovnebis konfidencialobas, Tanx-
w logikurad dasabuTebuli
mobis micemasa da avtonomias. Cven vvaraudobT, rom
mkiTxvelebs ukve Seswavlili aqvT zogadi medicinis w urTierTSesabamis gadawyvetilebebze dafuZnebuli.
eTikuri aspeqtebi. vinc am principebs ar icnobs, Seu-
ZliaT gaecnon hopis da misi Tanaavtorebis naSroms eTikuri midgomebi
(Hope, Savalescu and Hendrick, 2003) an samedicino eTikis fsiqiatriaSi, iseve rogorc zogadad eTikaSi, arse-
sxva romelime saxelmZRvanelos. bobs ori farTo midgoma eTikuri problemebis mima-
eTikuri sakiTxebi Zalian mniSvnelovania medicinis rT: valdebulebaze dafuZnebuli da utilitaruli.
yvela sferoSi. fsiqiatriaSi am sakiTxebs damate- movaleobebze dafuZnebuli midgoma warmoadgens
biTi mniSvneloba eniWeba, radgan zogierT pacients klinicistebis valdebulebebTan dakavSirebuli wese-
ar SeuZlia gaacnobieros, rom mas mkurnaloba sWird- bis mTel rigs (mag., wesi, romlis Tanaxmad, eqimebs ar
eba. xSirad Cndeba kiTxvebi fsiqikuri daavadebis unda hqondeT seqsualuri urTierToba TavianT pa-
mkurnalobaze Tanxmobis gamoxTvis unarTan dakav- cientebTan). es wesebi Tavs iyris praqtikis kodeqsSi.
SirebiT. medicinis sxva dargis specialistebi zogjer radgan arsebobs aseTi wesebi, klinicistebma ician Ta-
mimarTaven fsiqiatrebs TavianTi pacientebis im un- vianTi valdebulebebis Sesaxeb. Tumca, es midgoma mou-
arTan dakavSirebiT, romelic fizikuri daavadebis qnelia da misi gamoyeneba Znelia rTul SemTxvevebSi.
mkurnalobaze Tanmxobis gamoxatvas exeba. utilitaruli midgoma exeba sargeblisa da zianis
am TavSi Cven aseve visaubrebT fsiqiatriasTan da- Sesaxeb mosazrebebis dabalansebas. zogadi wesebis
kavSirebuli kanonmdeblobis zogierT aspeqtze. es gamoyenebis nacvlad, TiToeuli SemTxveva fasdeba
_ 74 _
eTikuri problemebi fsiqiatriul praqtikaSi
individualurad da keTdeba daskvna, rom eTikurad boqsi 4.1 eTikuri problemebi, romlebic
swori qmedeba is aris, romelsac saukeTeso mosal- sxva TavebSia ganxiluli
odneli Sedegebi mohyveba. es midgoma met-naklebad
klasifikacia (Tavi 2)
iTvaliswinebs klinikur problemebTan dakavSirebul
diagnozi, romelic efuZneba moralur an politikur
sirTuleebs, magram is yovelTvis ar iZleva erTiani, Sexedulebebs
urTierTSeTanxmebuli daskvnis gamotanis saSualebas,
radgan sxvadasxva adamianma, SesaZloa, gansxvavebuli mtkicebulebaze dafuZnebuli fsiqiatria (Tavi 6)
wona mianiWos sargebelsa da zians mocemul, konkre- placeboTi kontrolirebadi klinikuri kvlevebi da
SemTxveviTi SerCeva
tul SemTxvevaSi.
praqtikaSi es ori midgoma erTmaneTs kveTs. val- personologiuri aSliloba (Tavi 7)
debulebaze dafuZnebuli midgoma SeiZleba gulisx- stigma da pacientis CarTuloba
mobdes iseTi qmedebis ganxorcielebis valdebulebas,
kvebiTi aSliloba (Tavi 15)
romelic saukeTeso Sedegs moitans, xolo utili-
anoreqsiis aranebayoflobiTi mkurnaloba
taruli midgomisas, saukeTeso Sedegi SeiZleba Sesa-
bamisi wesis gamoyenebis Sedegad miviRoT. fsiqiatria da medicina (Tavi 16)
pacientebi, romlebic uars amboben mkurnalobaze
eTikuri principebi genetikuri konsultireba (gv
samedicino eTikaSi farTod gamoiyeneba Semdegi sami aiv (HIV) (gv
principi (Beauchamp and Childress, 2001):
suicidi da ganzrax TviT dazianeba (Tavi 17)
1. pirovnebis avtonomiurobis pativiscema: paci- pacientebi, romlebic sakuTar Tavs vneben da uars
entebis CarTva janmrTelobasTan dakavSirebul amboben mkurnalobaze
gadawyvetilebebSi; pacientebis informireba, raTa
wamlebi da sxva somaturi mkurnaloba (Tavi 21)
maT SeZlon gadawyvetilebebis miReba; pacientebis
medikamenturi mkurnaloba (gv.
Sexedulebebis pativiscema.
eleqtrokonvulsiuri Terapia da fsiqoqirurgia (gv
2. gulmowyaleba (àr avno~): praqtikaSi es ZiriTadad
imis keTebas niSnavs, rac profesionalis azriT fsiqiatriuli servisebi (Tavi 23)
saukeTesoa. àr avno~ principi xandaxan winaaRmde- eTikuri problemebi fsiqiatriuli servisebis
uzrunvelyofaSi (gv
gobaSi modis àvtonomiurobasTan~ (mag., rodesac
pacienti uars ambobs mkurnalobaze, profesionali bavSvTa fsiqiatria (Tavi 24)
ki Tvlis, rom es aucilebelia; ix. qvemoT). interesTa konfliqti, konfidencialoba da Tanxmoba
3. samarTlianoba: samarTliani qmedeba da sxvadasxva daswavlis darRveva (Tavi 25)

adamianebis interesTa dabalanseba normalizacia avtonomia da interesTa konfliqti
Tanxmoba mkurnalobaze da Tanxmoba kvlevaze
praqtikis kodeqsi
praqtikis kodeqsi da saxelmZRvanelo principebi mzad- eTikuri problemebi fsiqiatriul
deba da kontroldeba profesiuli organizaciebis praqtikaSi
mier, rogorebicaa amerikis fsiqiatrTa asociacia
am Tavis momdevno nawilSi ganvixilavT eTikur prob-
(American Psychiatric Association) (1995), britaneTSi zog-
lemebs, romlebic exeba:
adi samedicino sabWo (General Medical Council) (2004) da
fsiqiatrTa samefo koleji (The Royal College of Psychia- w eqimisa da pacientis urTierTobas
trists) (2000). zogierT qveyanaSi eTikis kodeqsis praqti- w konfidencialobas
kaSi gatareba xdeba ara profesiuli organizaciebis, w Tanxmobas
aramed saxelmwifos mier, rac gamoiwvia britaneTSi w iZulebiT mkurnalobas
zogierTi profesiis mimarT ndobis dakargvam.
w kvlevas.
sxva profesiebis warmomadgenlebs, romlebic Car-
Tulni arian fsiqiatriul mkurnalobaSi (mag., saeqT- eTikuri problemebi, romlebic praqtikis speci-
no saqme da fsiqologia), sakuTari praqtikis kodeqsi fikuri aspeqtebidan momdinareobs, sxva TavebSia
aqvT da igi ar aris samedicino profesiis kodeqsis ganxiluli (ix. boqsi 4.1).
identuri. aseTma gansxvavebebma, SesaZloa, xandaxan
gaarTulos mkurnalobis eTikur aspeqtebTan dakav- eqimisa da pacientis urTierToba
Sirebuli gadawyvetilebebi, romlebic multidiscip- ndobiTi urTierToba eqimsa da pacients Soris
linurma gundma unda miiRos. eTikuri samedicino praqtikis safuZvelia. es urTi-
_ 75 _
4 eTika da samoqalaqo samarTali
erToba unda emsaxurebodes pacientis interesebs da aklisebi. es wesi Zalian Zvelia da hipokrates ficSia
unda eyrdnobodes zemoT aRniSnul principebis _ av- gacxadebuli:
tonomiis, gulmowyalebis (àr avno~) da samarTliano- `nebismier rames, rac kavSirSia an ar aris kavSirSi
bis pativiscemas. Cems profesiul praqtikasTan, rasac me davinaxav an
movismen adamianis pirad cxovrebaze, rac ar unda
urTierTobis borotad gamoyeneba
iTqvas sxvagan, me ar gavaxmovaneb, radgan CavTvli,
rac ufro intensiuria eqimisa da pacientis urTier- rom es yvelaferi saidumlod unda iqnes Senaxuli~.
Toba da rac ufro mowyvladia pacienti, miT ufro ad- es wesi Seicvala 1948 wels, Jenevis deklaraciaSi,
vilia am urTierTobis borotad gamoyeneba. swored ami- romelmac Semdegi mniSvnelovani punqti daamata: kon-
tom gansakuTrebiT unda gamaxvildes yuradReba imaze, fidencialobis valdebuleba grZeldeba pacientis
rom ar moxdes am urTierTobis borotad gamoyeneba sikvdilis Semdegac:
fsiqoTerapiis dros. Terapevtebi borotad iyeneben `me pativs vcem CemTvis gandobil saidumlos paci-
eqimisa da pacientis urTierTobas rodesac isini: entis sikvidilis Semdegac~.
Tavs axveven pacients sakuTar Rirebulebebsa da bevr qveyanaSi erovnuli profesiuli organizacie-
rwmenas, magaliTad, fexmZimobis Sewyvetis kon- bi aqveyneben saxelmZRvanelo principebs, romle-
sultaciisas. es zegavlena SeiZleba iyos Ria (mag., bic exeba zogad klinikur situaciebs, rogorebicaa
eqimi eubneba, rom fexmZimobis Seyveta moralurad Canawerebis dacva, informaciis gaziareba naTesavebi-
arasworia), an faruli (mag., rodesac eqimi pirda- sTvis, da informaciis gamJRavneba mesame mxarisTvis
pir ar gamoTqvams Tavis azrs, magram yuradRebas (ix. mag., General Medical Council, 2004 da internet gver-
amaxvilebs fexmZimobis Sewyvetis sawinaaRmdego, di www. gmc-uk.org). konfidencialoba, aseve, daculia
vidre mxardamWer argumentebze). msgavsi probleme- kanoniT da samuSao xelSekrulebiT da, Tumca, pro-
bi SeiZleba warmoiSvas ojaxuri Terapiisas, rode- fesiul saxelmZRvanelo principebs ar aqvT kanonis
sac Terapevtis Rirebulebebi xels uSlis mas ga- Zala, maT sasamarTlo seriozulad ekideba, rogorc
nixilos wyvilis daSoreba-ardaSorebis sakiTxi. zogadad aRiarebul standartebs.
mesame mxaris interesebs pacientTa interesebze maR- bevr qveyanas aqvs konfidencialobis dacvis kanone-
la ayeneben (mag., upiratesoba eniWeba ara pacientis, bi da, aseve, kanonebi, romlebic exeba dawerili da
aramed damsaqmeblis interesebs). Tumca, calkeuli eleqtronuli Canawerebis Senaxvis wesebs. kanonebi,
pacientis interesebi ver iqneba sxvebisgan izolire- aseve, iTvaliswinebs pacientis uflebebs, gaecnon Ta-
bulad gaTvaliswinebuli. mag., TemisTvis resursebis vianT pirad informacias. fsiqiatrebi unda icnobdnen
gamoyofisas, an potenciurad saSiSi pacientis im organizaciis eTikur da iuridiul moTxovnebs, sa-
mkurnalobaze gadawyvetilebis miRebisas, pacientTa dac isini muSaoben. britaneTSi Sesabamisi kanonebi mo-
interesebi unda dabalnsdes sxva adamianTa intere- nacemTa dacvis aqtSia asaxuli (Data Protection Act) (1998).
sebis Sesabamisad. es rTuli gadawyvetilebebi sxva inglisis samrTlebrivi sistemis poziciidan, ro-
TavSia ganxiluli (gv. ?? da gv. ??). gorc sazogadoeba, ise calkeuli individia daintere-
sebuli imaSi, rom pacientebi endobodnen eqimebs da
pacientebs seqsualur eqsploatacias uweven. praq-
hqondeT imis garantia, rom eqimebi daicaven konfi-
tikis samedicino kodeqsi kategoriulad krZalavs
dencialur informacias pacientebis Sesaxeb. aqedan
pacientTan seqsualuri urTierTobis damyarebas.
gamomdinare, rodis aris kanonieri eqimis mier konfi-
gansakuTrebuli sifrTxilea saWiro, rodesac in-
dencialobis darRveva da rodis ara, damokidebulia
tervius dros wamyvani Tema seqsualuri probleme-
ara piradi da sazogadoebrivi interesebis dabalan-
bia (mag., seqsologTan konsultaciisas).
sebaze, aramed ori konfliqturi sazogadoebrivi in-
pacientebs eqsploatacias uweven finansuri mogebis teresis dabalansebaze.
mizniT (mag., kerZo praqtikaSi mkurnalobis proce-
sis xelovnurad gaxangrZliveba). konfidencialobasTan dakavSirebuli eTikuri
principebi
konfidencialoba informaciis dacva
konfidencialoba Zalian mniSvnelovania pacientsa da piradi informacia unda iyos daculi da Canawere-
eqims Soris ndobis dasamyareblad. es gansakuTrebiT bi usafrTxod unda iyos Senaxuli. aseve, yuradRe-
mniSvnelovania fsiqiatriaSi, radgan informaciis ba unda gamaxvildes mobiluri telefonebisa da
mopoveba pirad da Zalian sensitiur sakiTxebs exe- eleqtronuli fostis usafrTxoebaze. imisaTvis,
ba. zogadi wesis mixedviT, informacia ar unda gam- rom ar moxdes informaciis SemTxveviTi gaJonva,
JRavndes pacientis Tanxmobis gareSe, Tumca, rogorc konsultaciebi unda Catardes iseT adgilas, sadac
es SemdgomSia ganxiluli, arsebobs garkveuli gamon- SeuZlebeli iqneba saubris mosmena mosaubris survi-
_ 76 _
lis gareSe (es zogjer rTulia, rodesac pacientebis gaices mxolod pacientis TanxmobiT. Tumca, rodesac
monaxuleba saxlSi an Terapiul ganyofilebaSi xdeba). pacients ar aqvs unari ganacxados Tanxmoba infor-
aseve, TanamSromlebma Tavi unda Seikavon diskusiebi- maciis gamJRavnebaze (mag., demenciis dros), infor-
sgan iseT adgilebSi, sadac sxvebma SeiZleba maT sau- maciis gamJRavneba SesaZlebelia, Tu es emsaxureba
bars mousminon. pacientis interesebs.
gamokvlevis Catareba mesame mxaris moTxovniT.
Tanxmoba informaciis gamJRavnebaze rodesac pacientebs utardebaT gamokvleva mesame
konfidencialoba ar irRveva, rodesac pacienti acxadebs mxaris moTxovniT (mag., samuSaosTvis vargisianobis
informirebul Tanxmobas informaciis gamJRavnebaze. am Sefaseba damsaqmeblis moTxovniT), aucilebelia pa-
konteqstSi informirebuli Tanxmoba gulisxmobs, rom cientma Tavidanve icodes Sefasebis mizani da, aseve,
pacienti srulad iazrebs gamJRavnebis mizezebs, imas, eqimis valdebulebebi mesame mxaris mimarT. am dros,
Tu ra gamJRavndeba da amis SesaZlo Sedegebs. konfi- pacientisgan, werilobiTi Tanxmoba unda iqnes miRe-
dencialobis principi ar irRveva, rodesac ver xdeba buli. sxvagvarad, informaciis gamJRavneba SeiZleba
pacientis identificireba, mag., SeniRbuli SemTxvevis moxdes mxolod sazogado interesebidan gamomdinare
angariSSi. Tumca zogadad, rogorc wesi, saregistra- (ix. qvemoT), sikvdilis an seriozuli zianis preven-
cio JurnalebSi Setanilia moTxovna, rom pacientebma ciis mizniT.
ganacxadon informirebuli, xelmowerili Tanxmoba maT Temze dafuZnebuli momsaxureba. pacientebma Ta-
Sesaxeb informaciis gamJRavnebaze, maSinac ki, roca vidanve unda icodnen, rom saWiroebis SemTxvevaSi
maTi identoba SeniRbulia. informacia gamJRavnebuli iqneba im jgufisTvis,
romelsac pacientze mzrunveloba akisria. jgu-
konfidencialoba bavSvTa mkurnalobisas
fis wevrebma unda daicvan konfidencialobis prin-
bavSvTa mkurnalobisas aRZruli es da sxva eTikuri cipebi. jgufis zogierT wevrs (mag., socialur mu-
problemebi ganxilulia 24-e TavSi. aq sakmarisia Sakebs) SeiZleba mouwios informaciis ganxilva Tavis
aRvniSnoT, rom dadgenilze ufrosi asakis bavSvebs zedamxedvelebTan an informaciis gacema sxva dawe-
(rogorc wesi, es zRvari 16 welia) konfidencialobas- sebulebebisTvis (mag., rodesac isini pacientebs ex-
Tan dakavSirebiT igive uflebebi aqvT, rac ufrosebs. marebian binaTmowyobis sakiTxebSi). rodesac dgeba
umcrosi asakis bavSvebis SemTxvevaSi, rogorc wesi, mkurnalobis gegmebi, mniSvnelovania, rom aseTi
mSoblebs acnoben klinikur informacias. mSoblebs sakiTxebi iqnes gaTvaliswinebuli da, aucileblobis
aqvT iuridiuli valdebuleba imoqmedon TavianTi SemTxvevaSi, am sakiTxebis ganxilva pacientTan erTad
Svilebis interesebidan gamomdinare da, amitom, saTa- unda moxdes. mezoblebma SeiZleba Seityon pacient-
nadod unda iyvnen informirebulni. Tan vizitis Sesaxeb. ufro metic, savele programebma
situaciebi, romelTa drosac SeiZleba gaCndes SeiZleba moiTxovos gamokiTxvis Catareba im maRali
konfidencialobasTan dakavSirebuli problemebi riskis mqone pacientebTan dakavSirebiT, romlebic ar
dadian daniSnul Sexvedrebze. am da msgavsi potenci-
sxvebisgan informaciis mopoveba. rogorc wesi, sx-
uri problemebis warmoSoba mosalodnelia da isini
vebisgan informaciis moZiebisTvis saWiroa pacientis
pacientTan erTad unda iqnes ganxiluli, misgan wi-
nebarTva. fsiqikuri aSlilobis dros, rodesac paci-
naswari saWiro Tanxmobis misaRebad. sagangebo situa-
enti ver axerxebs sakuTar Tavze informaciis miwo-
ciaSi, piradulobis dacvis ufleba unda dabalansdes
debas, xolo saTanado mkurnalobis Casatareblad es
pacientisTvis an sxvebisTvis zianis miyenebis riskTan.
informacia mniSvnelovania, fsiqiatrma unda gadaw-
Tu pacienti uars ambobs informaciis gamJRavnebaze
yvitos, moiZios Tu ara informacia pacientis Tanx-
miuxedavad imisa, rom mas naTlad auxsnes, Tu ra Sei-
mobis gareSe. saxelmZRvanelo principebis funqciaa,
Zleba moxdes informaciis gaumJRavneblobis SemTx-
daculi iqnes pacientebis interesebi da, ramdenadac
vevaSi, mis survils pativi unda vceT, Tu es sxvebs ar
es SesaZlebelia, informacia axlo naTesavebisgan
ayenebs riskis qveS da ar moaqvs maTTvis ziani.
iqnes mopovebuli.
jgufuri Terapia. jgufuri Terapia warmoSobs kon-
sxvebisTvis informaciis gamJRavneba. informacia
fidencialobasTan dakavSirebul specifikur prob-
unda gamJRavndes mxolod pacientis nebarTviT, gar-
lemebs, radgan pacienti uziarebs pirad informacias
da im specifikuri garemoebebisa, romlebic qvemoT
ara mxolod Terapevts, aramed jgufis sxva wevrebsac.
aris aRwerili. dasaSvebia mxolod im informaciis
sanam mkurnaloba daiwyeba, Terapevtma unda axsnas,
gamJRavneba, romelic konkretuli amocaniT aris gan-
rom aucilebelia yvela moekidos konfidencialobiT
pirobebuli. Tuki es SesaZlebelia, araidentifici-
sxvebis mier gamJRavnebul informacias. informaciis
rebadi monacemebi unda iqnes gamoyenebuli. xSir-
gamJRavnebaze Tanxmoba aucileblad unda iqnes miRe-
ad informacias naTesavebi iTxoven, magram is unda
buli jgufis yvela wevrisgan.
_ 77 _
wyvilTa Terapia. zogadad wyvilTa Terapias win uZ- genels SeuZlia waikiTxos klinikuri Canawerebi da
Rvis individualuri gasaubreba wyvilis TiToeul werilebi, romlebic pacientis Sesaxeb informacias
wevrTan. am saxiT miRebuli informacia ar unda gam- Seicavs, Tumca, SesaZloa arsebobdes garkveuli Sez-
JRavndes meore adamianTan pirvelis Tanxmobis gar- Rudvebi, Tuki arsebobs sxvebisTvis zianis miyenebis
eSe. erToblivi sesiebis dros, Tu es SesaZlebelia, albaToba (mag., garkveuli saxis informaciis gacnobi-
yvela relevanturi informacia unda gamJRavndes im sas, romelic informatorma saidumlod gasca).
adamianisgan, romelsac es informacia exeba. Tu Tera- damatebiTi informaciis misaRebad konfidencialo-
piis dawyebis Semdeg saWiro xdeba wyvilis erT-erT basTan dakavSirebul problemebze ix. Hope et al., (2004,
wevrTan individualuri Sexvedra, mag., depresiis Tavi 7).
simptomebis Sesafaseblad, SesaZloa ukeTesi iyos,
rom Terapevtma Tavis kolegas sTxovos amis gakeTe- Tanxmoba mkurnalobaze
ba. msgavsi problemebi SeiZleba warmoiSvas ojaxuri Tanxmoba mniSvnelovania zogadad samedicino praq-
Terapiis drosac. tikisTvis. Cven vvaraudobT, rom mkiTxvelebi icnoben
saTanado koncefciebs da procedurebs zogadi sa-
konfidencialobis wesis gamoyenebisas
medicino praqtikidan. maT, vinc ar icnobs am konce-
gamonaklisis daSveba
fciebsa da procedurebs, SeuZliaT gaecnon zogadi
gamonaklisis daSveba pacientis interesebidan ga-
medicinis sabWos uaxles saxelmZRvanelo principebs,
momdinare. gamonaklis situaciebSi eqimebma SeiZleba
Tu isini muSaoben britaneTSi (www.gmc-uk.org), an Ses-
gaumJRavnon informacia mesame mxares pacientis Tanx-
abamis dokuments sxva qveynebSi muSaobisas; agreTve,
mobis gareSe, rodesac es pacientis interesebs emsax-
SeuZliaT gaecnon eTikis saxelmZRvanelos (mag., Hope
ureba. mag., rodesac informacia pacientis Sesaxeb es-
et al., 2004).
aWiroeba meore eqims, romelic uwevs mas gadaudebel
daxmarebas reanimaciul ganyofilebaSi, xolo paci- Tanxmobis miReba
entisgan Tanxmobis miReba ver xerxdeba; an rodesac
1. pacients naTlad da amomwuravad unda esmodes daa-
pacients mZime fsiqikuri an fizikuri daavadebis gamo
vadebis buneba, arsebuli procedurebi da SesaZlo
ar SeuZlia informirebuli Tanxmobis micema, xolo
gverdiTi movlenebi;
informaciis gamJRavneba aucilebelia misi mkurnalo-
2. pacienti Tavisi nebiT unda daTanxmdes mkurna
bisTvis.
lobaze;
gamonaklisis daSveba sazogadoebis interesebidan
gamomdinare. miuxedavad imisa, rom eqimebs gaaCniaT 3. mas unda hqondes gadawyvetilebebis miRebis unari,
zogadi iuridiuli valdebulebebi (maT unda konfi- anu unda iyos qmedunariani am sityvis iuridiuli
dencialurad Seinaxon is, rasac pacientebi eubnebi- mniSvnelobiT (ix. qvemoT). gaiTvaliswineT, rom
an), arsebobs gansakuTrebuli garemoebebi, rodesac britaneTisgan gansxvavebiT, amerikis SeerTebul
eqimebi movaleni arian gaumJRavnon informacia mesame StatebSi sityva `qmedunarianoba~, zogadad, ixmareba
mxares, radgan es emsaxureba sazogadoebis, jgufis ufro klinikuri, vidre iuridiuli mniSvnelobiT.
an am jgufis wevrTa interesebs. arsebobs normatu-
Tanxmobis SenarCuneba
li valdebulebebi, romelTa Tanaxmadac informacia
zogierTi pacienti Tanxmdeba qronikuli daavadebis
unda gamJRavndes, Tu saqme exeba gadamdeb daavadebas,
mkurnalobaze, magram mogvianebiT veRar axerxebs
fsiqoaqtiuri wamlebis gamoyenebas, manqanis marTvis
Sesabamisi qcevis ganxorcielebas. aseT SemTxvevaSi,
uunarobas, da bavSvze Zaladobis eWvs. aseve, arsebobs
klinicisti unda ecados, rom xelaxla miiRos pacien-
valdebuleba, rom gamJRavndes informacia sasamarT-
tisgan Tanxmoba da aRadginos masTan TanamSromloba.
los moTxovniT an rodesac saxezea seriozuli dana-
amis misaRwevad gamarTlebulia damatebiTi daxmare-
Saulis Cadenis mtkicebuleba. es, Cveulebriv, exeba
bis SeTavazeba, magram araviTar SemTxvevaSi ar unda
iseT danaSauls, romelmac SeiZleba sxvas seriozuli
davemuqroT pacients, rom mas Seumcirdeba saWiro
ziani miayenos an sikvdilis riskis qveS daayenos (mag.,
daxmareba.
bavSvze Zaladoba). aseT SemTxvevaSi, yvela Rone unda
vixmaroT, raTa davarwmunoT pacienti, rom man gaam- rodis ar aris saWiro sityvieri Tanxmoba
JRavnos saWiro informacia. Tu pacienti amaze uars
aris situaciebi, rodesac sityvieri Tanxmoba ar aris
ambobs, mas unda avuxsnaT, Tu ra mizeziTaa aucile-
aucilebeli (es situaciebi damokidebulia adgilob-
beli amgvari informaciis gamJRavneba da es mizezebi
riv kanonze da konkretul precedentze):
werilobiT unda dafiqsirdes.
w nagulisxmevi Tanxmoba (mag., rodesac pacienti Tvi-
gamonaklisis daSveba iuridiuli warmomadgenlebi-
Ton wevs xels wnevis gasazomad).
sTvis. pacientis msgavsad, mis iuridiul warmomad-
w aucilebloba. es iseTi garemoebaa, rodesac Cau-
_ 78 _
revlobis SemTxvevaSi arsebobs seriozuli zianis mkurnalobaze, aqvs fsiqikuri aSliloba, rac xels uS-
an sikvdilis albaToba, xolo pacientis qmedunari- lis informirebuli Tanxmobis gancxadebaSi, saWiroa
anoba saeWvoa (ix. qvemoT). fsiqikuri aSlilobis mkurnaloba, aucilebelobis
w sagangebo situacia iseTi viTarebaa, rodesac SemTxvevaSi, iZulebiTi iuridiuli Zalis gamoyenebiT.
saWiroa saswrafod moxdes pacientis an sxva pirisT- inglisis kanonis Tanaxmad, dauSvebelia pacientis
vis seriozuli zianis miyenebis prevencia an, rode- nebis gareSe misi fizikuri daavadebis mkurnaloba,
sac unda aRikveTos danaSauli. magram dasaSvebia fsiqikuri aSlilobis mkurnaloba.
fsiqikuri aSlilobis warmatebuli mkurnalobis Sem-
uaris Tqma samedicino mkurnalobaze
deg, pacientma SeiZleba Tanxmoba ganacxados fizikuri
britaneTSi kanoni ganasxvavebs Tanxmobas samedici- daavadebis mkurnalobaze, razec adre uars ambobda.
no mkurnalobaze da fsiqiatriul mkurnalobaze. es
nawili exeba samedicino mkurnalobaze uaris Tqmas. Tanxmobis iuridiuli aspeqtebi
qmedunarian zrdasrul adamianebs ufleba aqvT, uari Tanxmobis gancxadebasTan dakavSirebuli qmedunari-
Tqvan samedicino mkurnalobaze maSinac ki, Tu uaris anobis iuridiuli koncefcia exeba pacientis unars
Tqmas sikvdili an samudamo fizikuri unarSezRudu- (a) gaiazros da axsovdes informacia mkurnalobis
loba mohyveba. Sesaxeb; (b) sjerodes am informaciis; (g) gamoiyenos es
Tu pacienti uars ambobs samedicino mkurnalobaze, informacia informirebuli arCevanis gasakeTeblad.
eqimma unda gaarkvios ori mniSvnelovani sakiTxi, sa- pacientebs, SesaZloa, akldeT qmedunarianoba, rom
nam daaskvnides, rom pacients aqvs uaris Tqmis ufle- ganacxadon informirebuli Tanxmoba Semdegi mizeze-
ba: (a) aris Tu ara pacienti qmedunariani (anu, aqvs bis gamo:
Tu ara mas iuridiulad miniWebuli qmeduunaroba, ix. 1. axalgazrda asaki _ mSoblebi iZlevian Tanxmobas
qvemoT), da Sesabamisad, aqvs Tu ara unari, daTanx- bavSvebisa da mozardebis nacvlad, Tu isini im
mdes mkurnalobaze an uari Tqvas masze fsiqikuri asakisani arian, rom kanoniT ar aqvT Tanxmobis mi-
daavadebis gamo? (b) xom ar imyofeba pacienti sxvisi cemis ufleba. Tanxmoba mkurnalobaze bavSvebsa da
zegavlenis qveS, anu misi uari xom ar aris iZulebiTi mozardebSi 24-e TavSia ganxiluli.
xasiaTis da sulac ar gamoxatavs pacientis nebas?
2. daswavlis darRvevebi
uaris Tqma qmedunariani pacientebis mier. aseTi
pacientebisgan miRebuli uari SeiZleba gamowveuli 3. fsiqikuri aSliloba. fsiqiatrebs, SesaZloa, mo
iyos gaugebrobiT an daavadebis da misi mkurnalo- uwioT im pacientebis gamokvleva, romlebic,
bis SiSiT. eqimebma garkveuli dro unda dauTmon savaraudod, am mesame jgufs ekuTvnian. amisaTvis
imis gagebas, Tu rogor aRiqvams pacienti sakuTar isini mimarTaven gamokiTxvas, romlis forma
mdgomareobas da ra awuxebs mas, sanam kidev erTxel mocemulia boqsSi 4.2.
auxsnian maT sxvadasxva samedicino sakiTxs. aseTi daskvna Tanxmobis iuridiuli qmedunarianobis Se
midgomis arCevis SemTxvevaSi, orive mxare Tanxmdeba saxeb yovelTvis exeba konkretul gadawyvetilebas.
mkurnalobis iseT gegmaze, romelic gamarTlebulia mwvave fsiqikuri aSlilobis mqone pacienti SeiZleba
samedicino TvalsazrisiT da, aseve, misaRebia paci- araqmedunariani iyos zogierT sakiTxSi, magram
entisTvis. zogierTi qmedunariani zrdasruli paci- hqondes unari, miiRos gadawyvetileba raime saxis
enti eqimTan erTad msjelobis Semdegac uars ambobs konkretul mkurnalobaze. mag., pacients, romelsac
mkurnalobaze da mas amis sruli ufleba aqvs. Sizofrenia da paranoiduli bodva aqvs, SeuZlia
uaris Tqma araqmedunariani pacientebis mier. bri- miiRos gadawyvetileba mkurnalobis Catarebaze
taneTSi da sxva qveynebSi pacientis mkurnal eqims gulis Setevis dros. (ix. Katz et al., 1995 _ Seexeba fsi-
ufleba aqvs imoqmedos pacientis interesebidan ga- qiatriuli konsultaciis Catarebas im pacientebTan,
momdinare da SeuZlia Caataros saswrafo mkurnalo- romlebic uars acxadeben samedicino mkurnalobaze).
ba sicocxlisTvis saSiS sgangebo situaciebSi maSin,
Tanxmobis gancxadeba ndobiT aRWurvili mxaris mier
roca pacients ar Seswevs Tanxmobis gancxadebis un-
ari. rodesac ki es SesaZlebelia, janmrTelobis sxva inglisis kanonmdeblobis mixedviT, Tu zrdasrul
specialistebTan unda Catardes konsultacia. unda adamians ar gaaCnia mkurnalobaze daTanxmebis unari
gakeTdes im mizezebis detaluri Canaweri, romelTa janmrTelobis mdgomareobis gamo, aravis SeuZlia
gamoc moxda konkretuli gadawyvetilebis miReba. eq- misi saxeliT Tanxmobis micema. zogierT iurisdiq-
imebi unda icnobdnen im qveynis kanonebs, romelSic ciaSi daSvebulia ndobiT aRWurvili piris mier Tanx-
muSaoben. Semdgomi diskusiisTvis ix. Hope et al., (2004). mobis gacemis garkveuli forma (mag., Sotlandiur
uaris Tqma fsiqikuri aSlilobis mqone pacientebis kanonmdeblobaSi meurvis daniSvna). im SemTxvevaSi,
mier. Tu pacients, romelic uars ambobs samedicino rodesac ndobiT aRWurvili piris Tanxmoba ar aris
_ 79 _
kanoniT gaTvaliswinebuli, xolo pacients winaswar
boqsi 4.2 zrdasruli pacientebis
ar gaukeTebia Sesabamisi miTiTebebi (ix. qvemoT), da am
qmedunarianobis Sefaseba
dros aucilebelia gadawyvetilebis miReba imis Tao-
baze, Cautardes Tu ara pacients mkurnaloba, paci- nabiji 1 daadgineT, Tu ra gadawyvetilebaa misaRebi da
ra informaciaa amisaTvis saWiro
entebis interesebidan gamomdinare, gadawyvetilebas
gadawyvetileba, romelic miRebul unda iqnes
iRebs pasuxismgebeli eqimi kolegebTan SeTanxmebiT.
alternatiuli, gonivruli gadawyvetilebebi
sasurvelia naTesavebTan konsultaciis gavla (Tum-
TiToeuli gonivruli gadawyvetilebis dadebiTi da
ca, inglisis kanonis mixedviT, dReisTvis, maT ar aqvT uaryofiTi mxareebi
Tanxmobis gamoxatvis an misgan Tavis Sekavebis ufle-
nabiji 2 SeafaseT pacientis kognituri unarebi
ba) da mocemuli SemTxvevis ganxilva sxva profesion-
SeafaseT, aqvs Tu ara adamians unari:
alebTan erTad. unda gakeTdes detaluri Canawerebi
gaigos informacia
im mizezebze, romelTa gamoc miRebul iqna konkret-
daimaxsovros informacia
uli gadawyvetileba da aseve, werilobiT unda dafiq-
Seafasos informacia da miiRos gadawyvetileba
sirdes gaweuli konsultaciebi.
nabiji 3 gaarkvieT daqveiTebuli kognituri
winaswari Tanxmoba SesaZleblobis savaraudo mizezebi
deliriumi
winaswari miTiTebebi, romlebsac xandaxan `sicocxlis
demencia
anderZs~ (`Living Will~) uwodeben, bevr qveyanaSia daS-
sxva nevrologiuri darRvevebi, romlebic SesaZloa
vebuli (magram ara inglissa da uelsSi). maTi arseboba uaryofiTad moqmedebdes kognitur funqciebze
gamarTlebulia imiT, rom adamianebs, romlebsac war- daswavlis darRvevebi
sulSi hqondaT gadawyvetilebis miRebis unari, magram
nabiji 4 SeafaseT sxva faqtorebi, romlebic SesaZloa
Semdeg dakarges igi (mag., demenciis gamo) ise umkurna-
xels uSlides qmedunarianobas
lon, rogorc maT es endomebodaT. imisaTvis, rom ada-
fsiqikuri daavadeba:
mianma gaakeTos winaswari miTiTebebi, igi unda iyos bodva
qmedunariani da kargad informirebuli. winaswari halucinacia
miTiTebebi pativs scems pirovnebis avtonomiurobas guneb-ganwyobis (afeqturi) aSliloba
da, zogadad, miCneulia, rom exmareba rogorc pacien- arasakmarisi simwife:
tebs, aseve eqimebs. Tumca, xandaxan Znelia janmrTel SeafaseT emociuri da kognituri simwife
mdgomareobaSi gamoTqmuli survilebis morgeba Sem-
dgomi situaciidan gamomdinare gadawyvetilebasTan.
doebas aqvs ufleba, iyos daculi.
zogierT iurisdiqciaSi (magram amJamad ara inglisSi)
umetes qveynebSi moqmedebs kanonebi, romlebic
naTesavebs da ndobiT aRWurvil pirebs SeiZleba hqon-
icavs fsiqikuri aSlilobis mqone adamianebs da icavs
deT uflebamosileba, miiRon gadawyvetileba araq-
sazogadoebas im Sedegebisgan, rac maT fsiqikur aSli-
medunariani pacientis magivrad, Tumca, es ar aris
lobas mohyveba, Tumca, sxvadasxva qveyanaSi fsiqikuri
savsebiT damakmayofilebeli imis gansasazRvrad, Tu
aSlilobis gansazRvreba da procedurebi gansxvave-
ra endomeboda Tavad pacients. adamians, romelic
bulia. skandinaviis zogierT qveyanaSi aranebayo-
iZleva miTiTebebs, unda esmodes, rom garemoeba
flobiTi mkurnalobis procedurebi martivia, xolo
SeiZleba Seicvalos da sxvebis interesebis gaTval-
amerikaSi, zogjer sasamarTlo mosmenis proceduraa
iswineba gaxdes saWiro. amitom, miTiTebebis ganxor-
saWiro. inglissa da uelsSi fsiqikuri janmrTelo-
cieleba SeiZleba ufro moqnilad Sesruldes, vidre
bis aqti (1983) Seicavs debulebas aranebayoflobiTi
mkacri instruqcia, romlis yvela detali nebismier
hospitalizaciisa da mkurnalobis Sesaxeb, Tumca, iq
situaciaSi unda iyos gaTvaliswinebuli.
axali kanonmdeblobis Seqmnaa dagegmili.
iZulebis xerxebi unda iyos gamoyenebuli mxolod
fsiqikuri aSlilobis aranebayoflobiTi
maSin, rodesac ar arsebobs sxva alternativa.
mkurnaloba gamocdil fsiqiatrs SeuZlia Tavi aaridos aseTi
arsebobs specialuri iuridiuli usafrTxoebis xerxebis gamoyenebas, Tu gamarTavs pacientTan
zomebi adamianebisTvis, romlebic safrTxes warmoad- da mis naTesavebTan mSvid da taqtian diskusias
genen sakuTari TavisTvis an sxvebisTvis fsiqikuri da ganixilavs im mizezebs, Tu ratom aris
aSlilobis gamo da, romlebic uars amboben saWiro hospitalizacia aucilebeli. Tu aman ver daarwmuna
mkurnalobaze, radgan ar aRiareben sakuTar fsiqi- pacienti da iZulebiTi mkurnaloba gamarTlebulia,
kur aSlilobas. aseT viTarebaSi warmoiSoba eTikuri Semdgomi saubari unda gagrZeldes ojaxis wevrebTan,
dilema: maT aqvT Tavisuflebis ufleba, magram, aseve, raTa mopovebul iqnes maTi mxardaWera iZulebiTi
saWiroeben mkurnalobasa da zrunvas, xolo sazoga- mkurnalobis Taobaze. ojaxis wevrebTan saubrisas
_ 80 _
boqsi 4.3 kvlevis eTikasTan dakavSirebuli Tanxmoba

ramdenime sakiTxis Sefaseba aris Tu ara cdis piri qmedunariani, raTa ganacxados
Tanxmoba?
SeniSvna: klinikur kvlevebSi monawileTa CarTvasTan da
klinikuri kvlevis CatarebasTan dakavSirebuli eTikuri miiReben Tu ara cdis pirebi mkafio da sakmaris
problemebi ganxilulia ( ??117e gv.) informacias?
eqnebaT Tu ara maT sakmarisi dro, raTa miiRon
mecnieruli Rirebuleba gadawyvetileba imis Taobaze, ganacxadon Tu ara
Tanxmoba an uari Tqvan Tanxmobis gancxadebaze aseTis
Rirebuli iqneba Sedegebi?
survilis SemTxvevaSi?
uzrunvelyofs Tu ara gamoyenebuli meTodebi da naTeli iqneba Tu ara cdis pirebisaTvis, rom uaris Tqma
monawile jgufebis zoma dasaxuli miznebis miRwevas? ar imoqmedebs mkurnalobis raodenobriv Tu Tvisobriv
parametrebze?
arsebobs Tu ara finansuri da sxva saxis resursebi da
aris Tu ara mosalodneli interesTa konfliqti? aris Tu ara urTierToba mkvlevarsa da cdis pirs
Soris iZulebiTi (mag., iseTi rogoricaa moswavlesa da
aris Tu ara mosalodneli, rom romelime mkvlevars maswavlebels Soris)?
Seeqmnas interesTa konfliqti?
SeiZleba Tu ara, rom pacientebis xarjebis dafarva
SeiZleba Tu ara igive miznebi miRweul iqnes ufro gaxdes stimuli pacientisgan Tanxmobis miRebisa?
eTikuri gziT? imyofeba Tu ara mkvlevari raime zemoqmedebis qveS
cdis pirebis mozidvisas (mag., Tanxis gadaxda sponsori
usafrTxoeba kompaniis mier)?
aris Tu ara procedurebi usafrTxo? riskis arsebobis
SemTxvevaSi, miRebulia Tu ara usafrTxoebis yvela konfidencialoba
zoma? Tanaxmani arian Tu ara cdis pirebi kvlevaSi
konfidencialuri informaciis gamoyenebaze?
misaRebia Tu ara riskis dadgenili xarisxi
mkvlevarebisaTvis, cdis pirebisa da maTi naTesavebisTvis? usafrTxod iqneba Tu ara Senaxuli kvlevis monacemebi?
adaptirebulia Hope et al., (2004 p 196) and Weingarten and
Leibovici (2004, p 1013)
eqimma unda gaiTvaliswinos, rom SesaZloa isini naTesavebisTvis an axloblebisTvis Zalian rTulia.
mRelvarebam Seipyros da Tavi damnaSaved igrZnon. aseTi konfliqti SeiZleba Semdegnairad gadawydes:
stacionarSi moTavsebis Semdeg, akrZalvebi mini pacientze pasuxismgebel fsiqiatrs SeuZlia awarmoos
maluri unda iyos. mxolos is akrZalvebia gamarTlebuli, dialogi zogadi profilis eqimTan an sxva special-
romlebic aucilebelia usafrTxoebisTvis da sak istTan, romelic angariSvaldebulia pacientis momv-
marisia mkurnalobis Casatareblad. Tu pacientis leli pirebis winaSe.
momvleli personali keTilganwyobili, momTmeni
usafrTxoebis zomebi
da mtkicea da, amave dros, aqvs lavirebis unari,
male pacientic da misi naTesavebic dainaxaven, rom nebismieri samarTlebrivi aqti iZulebiT hospital-
iZulebiT mkurnaloba mxolod odnav gansxvavdeba izaciasa da mkurnalobaze Seicavs debulebas, romlis
nebayoflobiTi mkurnalobisgan da daiwyeben maTTan Tanaxmad sawyisi gadawyvetileba apelacias eqvemde-
TanamSromlobas. Tu isini uars ityvian TanamSrom- bareba, rac usafrTxoebis garantias qmnis. sxvadasxva
lobaze da mkurnaloba unda gagrZeldes maTi Tanxmo- samarTlebriv sistemebSi sxvadasxva saapelacio pro-
bis gareSe, eqimma pacients da mis naTesavebs unda aux- cedurebia gaTvaliswinebuli da mkiTxvelebma Tavad
snas amis mizezebi da werilobiT daafiqsiros isini. unda gaarkvion, Tu ra regulaciebia im samarTlebriv
inglissa da uelsSi arsebobs damatebiTi iuridiuli sistemaSi, romlis farglebSic isini muSaoben.
moTxovnebi, rodesac saavadmyofoSi moTavsebul pa-
cients esaWiroeba eleqtro konvulsiuri Terapia (ECT) kvlevis eTika
da ar iZleva an ver iZleva gacnobierebul Tanxmobas. fsiqiatriul kvlevas, iseve rogorc yvela saxis sa-
fsiqiatrma es problema safuZvlianad unda ganixilos medicino kvlevas, warmarTavs eTikuri principebi,
naTesavebTan da, aseve, damoukidebeli fsiqiatrisgan romlebic eyrdnoba adamianebze kvlevis Catarebis
konsultacia unda miiRos. damoukidebelma fsiqiatrma saerTaSoriso doneze SeTanxmebul saxelmZRvanelo
unda gaiaros konsultacia sxva profesionalebTan, principebs. am principebis Camoyalibebas biZgi misca
romlebsac konkretuli pacientis mkurnaloba exebaT. nacistur germaniaSi Catarebuli samedicino kvlevis
aRmaSfoTebeli formebis gamoaSkaravebam. es princi-
interesTa konfliqti iZulebiTi mkurnalobis dros pebi Caiwera helsinkis deklaraciaSi, romelic pirve-
interesTa konfliqti warmoiSoba maSin, rodesac, lad gamoqveynda 1964 wels msoflio samedicino aso-
mag., pacienti uars ambobs hospitalizaciaze, xolo ciaciis mier (ix. World Medical Association, 2000). mas
saavadmyofos farglebs gareT masze zrunva misi Semdeg Seiqmna sxvadasxva erovnuli da saerTaSor-
_ 81 _
iso saxelmZRvanelo principebi, romelTa praqtikul mocemul kvlevaSi monawileobaze Tanxmoba ganacxa-
ganxorcielebas eTikis erovnuli da adgilobrivi dos?
sabWoebi uzrunvelyofen. Seicavs Tu ara mocemuli kvleva raime risks an dis-
fsiqiatriuli kvlevis eTikuri problemebi sxva komforts mocemuli adamianisTvis?
saxis samedicino kvlevis problemebis identuria (ix.
moaqvs Tu ara mas raime potenciuri sargebeli sxva
britaneTis saerTo samedicino sabWos saxelmZRvane-
adamianebisTvis, romlebsac msgavsi problemebi
lo principebi (www.gmc-uk.org) an britaneTis kvle-
aqvT da aseve araqmedunarianebi arian?
vis komitetis centraluri ofisis internet-gverdi
arsebobs Tu ara raime arapirdapiri miniSneba imaze,
www.corec.org.uk). magram am SemTxvevaSi gansakuTrebiT
rom adamiani uars ambobs kvlevaSi monawileobis
xazgasmulia is principebi, romlebic exeba Tanxmobis
miRebaze?
gancxadebas qmedunariani, magram mowyvladi zrdas-
ruli pirebis mier, romlebmac, advili SesaZlebelia sasurvelia konsultaciis gavla naTesavebTan an
Tanxmoba zewolis qveS ganacxadon; aseve, Tanxmobis sxva adamianebTan, romlebmac ician pacientis mdgo-
gancxadebas araqmedunariani adamianebis mier. mareoba. kvlevis moTxovnebidan gamomdinare, iuridi-
uli regulaciebi gansxvavdeba, amitom mkvlevari val-
informirebuli Tanxmobis gancxadeba kvlevaSi debulia gaecnos da zedmiwevniT Seasrulos adgilo-
monawileobaze brivi eTikuri da iuridiuli procedurebi.
kvlevis eTikurad CatarebisTvis Zalian mniSvnelova-
nia informirebuli Tanxmobis miReba. amasTan dakav-
samoqalaqo samarTlis ramdenime
SirebiT milerma (Miller, 2000) mniSvnelovani punqtebi
Camoayaliba:
aspeqti
samoqalaqo samarTali exeba individebis ufleba-
pacientebma Zalian kargad unda icodnen, rom kvl-
movaleobebs erTmaneTis mimarT, ojaxis kanonis CaT-
eva ar tardeba maTi piradi sargebelisTvis;
vliT, romelsac gansakuTrebuli mniSvneloba aqvs
pacientebze ar unda xdebodes zewola; bavSvTa fsiqiatrebisTvis. amiT igi gansxvavdeba sisx-
pacientebs aqvT ufleba nebismier dros uari Tqvan lis samarTlisgan, romelic exeba danaSaulis Cade-
kvlevaSi monawileobaze yovelgvari sasjelis gar- nas saxelmwifos an sxva adamianis mimarT (mag., mkv-
eSe; leloba). garda im sakiTxebisa, romlebic am TavSi
mkvlevaris garda, pacientis ojaxis wevri an sxva, iyo ganxiluli, samoqalaqo samarTali agvarebs iseT
am saqmisTvis Sesaferisi piri, unda akvirdebodes sakiTxebs, rogorebicaa sakuTreba, memkvidreoba da
pacientis mdgomareobas da Seatyobinos mkvlevars xelSekrulebis dadeba. sasamarTlos mimarTaven indi-
nebismieri problemis Sesaxeb; videbi an jgufebi, romlebic Tvlian, rom maT mimarT
placebo-kontrolirebad kvlevebSi pacientebma ukanonoba ganxorcielda. amisgan gansxvavebiT, sisx-
naTlad unda gaiazron placebos miRebis albaToba, lis samarTlis saqmeebis garCeva saxelmwifos sax-
is, rom amas SesaZloa ar mohyves maTi mdgomareobis eliT xdeba.
gaumjobeseba da rom maTi simptomebi SeiZleba gau- xandaxan, ama Tu im samoqalaqo saqmesTan dakavSire-
aresdes kidec (ix. aseve Lavori, 2000). biT, fsiqiatrebs sTxoven werilobiT angariSs pacien-
tis fsiqikuri mdgomareobis Sesaxeb. aseTi angariSebi
kvlevis Catareba im adamianebis monawileobiT, unda momzaddes pacientis mdgomareobis amomwuravi
romlebsac ar SeuZliaT informirebuli ganxilvis Semdeg da pacientis informirebuli Tanx-
Tanxmobis gancxadeba mobis safuZvelze, unda iyos mokle da faqtebs eyrd-
fsiqiatriuli pacientebis umravlesobas SeuZlia ga- nobodes. angariSis struqtura unda mihyvebodes
nacxados informirebuli Tanxmoba, magram zogierTs gegmas, romelic ?? gverdzea mocemuli. rac Seexe-
aqvs imgvari aSliloba, romelic gavlenas axdens az- ba Sinaarss, sasurvelia iuridiuli rCevis miReba im
rovnebis processa da gadawyvetilebis miRebis un- samarTlebriv aspeqtebTan dakavSirebiT, romlebic am
arze. Tu aseT pacientebs yvela tipis gamokvlevidan konkretul SemTxvevas exeba. am Tavis momdevno nawili
gamovricxavT, maT SeiZleba ver isargeblon im upi- iTvaliswinebs inglissa da uelsSi arsebul praqtikas,
ratesobiT, rac kvlevaSi monawile pacientebs aqvT. Tumca misi principebi ufro farTodac gamoiyeneba.
gadawyvetilebis miReba imis Taobaze _ CavrToT Tu
ara aseTi pacienti kvlevaSi, xdeba Semdegi konkre- qmedunarianoba anderZis Sedgenisas
tuli sakiTxebis gaTvaliswinebis Semdeg: es termini exeba sando da dasabuTebuli anderZis
Seicavs Tu ara mocemuli kvleva raime potenciur Sedgenis unars. Tu adamians aqvs fsiqikuri aSliloba
sargebels im adamianisTvis, romelsac sTxoven, rom anderZis weris procesSi, anderZis sandooba SeiZleba
_ 82 _
samoqalaqo samarTlis ramdenime aspeqti
eWvqveS dadges da masSi SeiZleba eWvi iqnes Setanili. gadacema martivi meTodia, romelic pacientisgan
anderZi SeiZleba iuridiulad sandod CaiTvalos, Tu moiTxovs uflebamosilebis werilobiT gadacemas
anderZis Semdgeneli piri `saR gonebaze~ iyo (ix. qve- sxva adamianisTvis, romelic imoqmedebs pacientis
moT) anderZis Sedgenis dros. fsiqiatrebs SeiZleba saxeliT misi avadmyofobis dros. uflebamosilebis
sTxovon, gamoTqvan TavianTi mosazreba Semdegi ori gadacemis xelmowerisas, pacients kargad unda es-
sakiTxis garSemo: modes, Tu ras akeTebs. mas SeuZlia uflebamosileba
1. qmedunarianoba anderZis Sedgenis dros; nebismier dros gaauqmos.
qonebis gankargva daniSnuli piris mier ufro
2. ramdenad SesaZlebelia, rom anderZis Semdgeni piri
formaluri proceduraa da ukeT emsaxureba pacien-
anderZis werisas imyofeboda sxvisi zegavlenis
tis interesebs. inglissa da uelsSi mimarTva keTdeba
qveS.
dacvis sasamarTloSi, romelmac SeiZleba gadawyvi-
imisaTvis, rom dadgindes, aris Tu ara anderZis Sem-
tos qonebis ganmkargavi piris daniSvna. es procedura
dgeni piri saR gonebaze, eqimma Semdeg kiTxvebs unda
ufro asakovan adamianebs exebaT. qonebis ganmkargavi
upasuxos:
piris daniSvnis sakiTxi gansakuTrebul pasuxismge-
esmis Tu ara anderZis Semdgen pirs, Tu ra aris an- blobas akisrebs fsiqiatrs. Tu hospitalizaciis pe-
derZi da ra Sedegebi mohyveba mis Sedgenas? riodSi pacients aqvs unari marTos Tavisi sakuTre-
icis Tu ara man, ra saxisa da odenobis sakuTrebas ba, magram mogvianebiT kargavs mas inteleqtualuri
flobs (Tumca, detalebis codna ar moeTxoveba)? funqciebis gauaresebis gamo, eqimis valdebulebaa,
icis Tu ara axlo naTesavebis saxelebi da gvarebi Seatyobinos naTesavebs mis sakuTrebasTan dakavSire-
da SeuZlia Tu ara gansazRvros maTi SesaZlo pre- buli riskis Sesaxeb. Tu naTesavebi arafers moimoq-
tenzia mis sakuTrebaze? medeben, maSin eqimi valdebulia, gaakeTos mimarTva
dacvis sasamarTloSi. eqims SeiZleba ar hqondes sa-
misi fsiqikuri mdgomareoba ar aris imdenad pa-
samrTlosTvis mimarTvis survili, magram yvela Sem-
Tologiuri, rom daarRvios misi logika da imoqm-
dgomi qmedeba ukve sasamarTlos pasuxismgeblobaa da
edos mis emociebze, ramac, Tavis mxriv, SeiZleba
ara eqimis.
zegavlena moaxdinos anderZis Sedgenaze (bodvebis
mqone adamiani uflebamosilia Seadginos anderZi,
saojaxo samarTlis aspeqtebi
Tu misi bodva ar axdens zegavlenas anderZis Sedge-
nis procesze). saqorwino kontraqti miiCneva aravalidurad, Tu qor-
winebis dros erT-erT mxares hqonda iseTi fsiqikuri
am sakiTxebis gadasawyvetad eqimi, pirvel rigSi,
aSliloba, rom ar esmoda kontraqtis arsi. Tu aseTi
pirispir unda gaesaubros anderZis Semdgenels, Sem-
xarisxis fsiqikuri aSlilobis dadastureba SesaZle-
deg ki mis naTesavebsa da axloblebs, raTa darw-
belia, qorwineba SeiZleba baTilad gamocxaddes gan-
mundes mis mier gamoTqmuli debulebebis faqtobriv
qorwinebis sasamarTlos mier. Tu wyvilidan erT-erTi
sisworeSi, rom Seamowmos faqtebi.
piri saR gonebaze ar aris da misi gankurneba SeuZle-
arasasurveli zegavlenis Sefaseba ufro rTulia
belia, qorwinebis Semdeg es SeiZleba ganqorwinebis
da moiTxovs anderZis Semdgenel pirsa da beneficia-
safuZvlad CaiTvalos da fsiqiatrs SeiZleba prog-
rs Soris arsebuli urTierTobis garkvevas, anderZis
nozis gakeTeba mosTxovon. fsiqiatrs, aseve, SeiZleba
Semdgeneli piris fsiqikuri mdgomareobis Semowmebas
sTxovon azris gamoTqma imis Taobaze, Tu ramdenad
da, agreTve, imis codnas, Tu ra hqonda mas adre gan-
qmedunariania mSobeli an meurve imisaTvis, rom saTa-
zraxuli.
nadod mouaros bavSvs.
mindobiloba da qonebis marTva

samoqalaqo samarTlis normebis darRveva da
Tu pacients ar SeuZlia gankargos Tavisi sakuTreba
xelSekrulebebi
fsiqikuri aSlilobis gamo, saWiroa alternatiuli
samoqalaqo samarTlis normebis darRvevisas pirovne-
zomebis miReba, gansakuTrebiT maSin, Tu misma araq-
bas ekisreba samoqalaqo samarTliT da ara sisxlis
medunarianobam SeiZleba did xans gastanos. aseTi
samarTliT gaTvaliswinebuli pasuxismgebloba. am
zomebis gatareba SeiZleba saWiro gaxdes, rogorc
tipis samarTaldarRvevebia gulgriloba, diskredit-
TemSi mcxovrebi, aseve hospitalizebuli pacientisT-
acia, ciliswameba, gadacdena da sxvisTvis zianis miy-
vis. inglisis kanoni iTvaliswinebs orgvari zomebis
eneba. Tu am saxis danaSauli Cadenilia saR gonebaze
miRebas _ ndobiT aRWurvili pirisTvis ufle-
armyofi adamianis mier, maSin sasamarTlos mier dawe-
bamosilebis gadacemas da qonebis marTvas daniSnuli
sebuli sasjeli, rogorc wesi, nominaluri xasiaTi-
piris mier.
saa. am konteqstSi arasaR gonebaze yofnis gansazRvra
ndobiT aRWurvili pirisTvis uflebamosilebis
_ 83 _
SezRudulia da, sasurvelia, fsiqiatrma am sakiTxze is, Tu ramdenad usafrTxoa pirovnebisTvis manqanis
konsultacia iuristisgan miiRos. marTva, aseve aqtualuri xdeba fsiqotropuli prepa-
Tu adamiani xels awers xelSekrulebas da mas, Sem- ratebis miRebisas, romlebsac axasiaTebT sedaciuri
dgomSi, uviTardeba fsiqikuri aSliloba, maSin kon- an sxva gverdiTi movlenebi (mag., trankvilizatorebis
traqtis dacva savaldebuloa. Tu adamiani arasaR an antifsiqozuri medikamentebis miReba).
gonebazea kontraqtis Sedgenisas, maSin, inglisis eqimebi unda icnobdnen da icavdnen avtomobi-
kanonis mixedviT, erTmaneTisgan imijneba cxovrebi- lis marTvis uflebis adgilobriv iuridiul stan-
seuli `saWiroebebi~ da ìs, rac aucilebel saWiroe- dartebs. es standartebi gansxvavdeba im SedarebiT
bas ar warmoadgens~. saWiroebebia saqoneli (an mom- mkacri moTxovnebisgan, romlebsac msubuqi avtoman-
saxureba), romelic `mocemuli adamianis cxovrebis am qanis da didi satvirTo manqanebis mZRolebs uyene-
konkretul momentSi misi realuri moTxovnebis Ses- ben. britaneTis marTvis mowmobis mflobels ekisreba
abamisia~ (Sale of Goods Act. 1893). yovel konkretul valdebuleba, Seatyobinos marTvisa da satransporto
SemTxvevaSi sasamarTlom unda gadawyvitos, am gansaz- licenzirebis saagentos (Driving and Vehicle Licensing
Rvrebis mixedviT, mocemuli saqoneli da momsaxureba Agency - DVLA), Tu aqvs raime daavadeba, romelmac
aucilebel saWiroebas warmoadgens, Tu ara. saWiroe- SeiZleba gavlena iqonios misi, rogorc mZRolis,
bebTan dakavSirebuli kontraqtis dacva yovelTvis usafrTxoebaze. eqimebma unda gaacnobierebinon paci-
aucilebelia. entebs maTi mdgomareoba da unda uzrunvelyon is,
rodesac arasaR gonebaze myofi piri kontraqts ad- rom pacientebs esmodeT, Tu ramdenad mniSvnelova-
gens iseT saqonelsa da momsaxurebasTan dakavSire- nia am faqtis gancxadeba. marTvis sakiTxis gadawyve-
biT, romelic aucilebel saWiroebas ar warmoadgens, tisas eqimi unda dafiqrdes imaze, SesaZlebelia Tu
kontraqtis dacva aucilebelia, Tu ar aris naCvenebi, ara pacientis mdgomareobam an misma mkurnalobam
rom mocemul pirovnebas kontraqtis Sedgenisas ar gamoiwvios TviTkontrolis dakargva, aRqmis gaua-
esmoda, ras akeTebda da, Tu meore pirma icoda misi reseba, koncentraciis daqveiTeba, an im motorul
qmeduunarobis Sesaxeb. funqciebze zemoqmedeba, romlebic manqanis marTvaSi
iReben monawileobas. Tu amomwuravi diskusiis Semdeg
pirovnuli ziani aseTi mdgomareobis mqone pacienti mainc agrZelebs
fsiqiatrebs SeiZleba sTxovon, warmoadginon weri- avtomanqanis marTvas, britaneTSi momuSave eqimma
lobiTi angariSi pacientebis mier wamoyenebul saTanado samedicino informacia unda miawodos sa-
moTxovnebTan dakavSirebiT, romlebic posttravmu- transporto licenzirebis saagentos mrCevels medi-
li stresuli aSlilobis an ubeduri SemTxvevebis cinis sakiTxebSi.
fsiqologiuri Sedegebis kompensacias exeba (ix. gv.
??). es angariSebi unda Seesabamebodes adgilobriv iu-
ridiul procedurebs da unda moicavdes Semdeg kom- damatebiTi literatura
ponentebs: (a) informaciis wyaro, (b) travmis istoria,
American Psychiatric Association (2001) Psychiatric ethics
(g) fsiqiatriuli da socialuri istoria, (d) ubeduri
primer. American Psychiatric Publishing Inc., Washington
SemTxvevis Semdgomi mimdinareoba. angariSebSi deta-
DC.
lurad unda iyos Sefasebuli mniSvneloba da kavSiri
travmasa da yvela Semdgom simptomsa da unarSez- Bloch, S, Chodoff, P and Green S (eds) (1999) Psychiatric eth-
Rudulobas Soris. ics, 3rd edn. Oxford University Press, Oxford.
Dickenson, D and Fulford, KWM (2000) In two minds: a case
avtomanqanis marTvis ufleba book of psychiatric etics. Oxford University Press, Oxford.
es sakiTxi SeiZleba daisvas bevri fsiqikuri aSlilobis Hope, T, Savelescu, J and Hendrick, J (2003) Medical ethics
dros. manqanis saxifaTod marTva SeiZleba gamowveu- and law: the core curriculum. Churchill Livingstone, London.
li iyos suiciduri midrekilebiT an maniakaluri ag- Montgomery, J (2000) Health care law, 2nd edn. Osxford Uni-
znebiT. manqanis panikuri an agresiuli marTva SeiZle- versity Press, Oxford.
ba ganpirobebuli iyos devnis bodviT; gaubedavi an
vebgverdi:
araakuratuli marTva SeiZleba demenciis Sedegi iyos.
National Reference Center for Bioethics Literature: WWW.geor-
manqanis marTvis dros koncentracia SeiZleba dair-
getown.edu/research/nrcbl
Rves SfoTviTi an depresiuli aSlilobebis dros.
_ 84 _
Tavi 5 etiologia
Tavis Sinaarsi
im fsiqikuri aSlilobis mizezebi, romelic ama Tu im
etiologiuri midgoma fsiqiatriaSi??
pacients aReniSneba. meorec, etiologiis sakiTxebis
etiologiis zogadi sakiTxebi??
farTo konteqstSi ganxilvisas, ainteresebT daavad
etiologia da intuiciuri gageba ??
ebebis etiologiis Sesaxeb arsebuli is monacemebi,
daavadebis gamomwvevi mizezebis
romlebic klinikuri, TemSi Catarebuli da labo
kompleqsuroba da sirTule ??
ratoriuli gamokvlevebidan miiReba. aqedan gamom
daavadebis gamomwvevi mizezebis klasifikacia ??
dinare, mocemuli Tavis pirvel nawilSi saubaria
stresis cneba ??
etiologiis im zogad sakiTxebze, romlebic dgeba
fsiqologiuri reaqciis cneba ??
konkretuli pacientebis gamokvlevisas, xolo me
gageba da axsna ??
ore nawilSi ganxiluli iqneba is mecnieruli dis
calkeuli SemTxvevis etiologia ??
ciplinebi, romlebic garkveul rols TamaSoben
etiologiuri modelebi??
etiologiis sakiTxebis garkvevaSi.
reduqcionistuli da
arareduqcionistuli modelebi ??
neiromecnieruli midgoma ?? etiologiis zogadi sakiTxebi
samedicino modeli ??
etiologia da intuiciuri gageba
qceviTi modeli ??
ganviTarebis modelebi ?? rodesac klinicisti calkeul pacients ikvlevs,
politikuri modelebi (àntifsiqiatria~) ?? igi eyrdnoba etiologiis Sesaxeb arsebul codnas,
fsiqikur aSlilobaTa etiologiaze arsebuli romelic mocemuli pacientis msgavs pacientebze
mosazrebebis istoriuli ganviTareba ?? dakvirvebis Sedegad aris miRebuli. magram, klinicisti
fsiqoanalizi ?? mxolod am saxis codniT ver ixelmZRvanelebs. man,
mecnieruli disciplinebis wvlili fsiqikuri aseve, unda gamoiyenos codna adamianis bunebis
daavadebebis etiologiis dadgenaSi?? Sesaxeb, rac yoveldRiuri praqtikiT miiRweva. ma
aRweriTi klinikuri gamokvlevebi ?? galiTad, depresiuli pacientis gamokvlevisas, kli
epidemiologia ?? nicistma aucileblad unda icodes, Tu rogori fsi
socialuri mecnierebebi ?? qologiuri da neiroqimiuri cvlilebebi axlavs Tan
eqsperimentuli da klinikuri fsiqologia ?? depresiul aSlilobas, ra aris cnobili stresis
eTologia da evoluciuri fsiqologia ?? gamomwvevi faqtorebis Sesaxeb mocemuli daavadebis
genetika ?? etiologiaSi da rogoria pacientis genetikuri pre
bioqimiuri gamokvlevebi ?? dispozicia depresiuli aSlilobis mimarT. ama
farmakologia ?? ve dros, mas kargi intuicia unda hqondes, raTa
endokrinologia ?? gaiTvaliswinos, rom mocemuli pacientis depresiis
fiziologia ?? mizezi misi meuRlis avadmyofobaa.
nevropaTologia ?? fsiqiatriaSi, daavadebis etiologiaze msjelobisas,
mocemuli qveTavis kavSiri im qveTavebTan, am tipis saRi azri mniSvnelovan rols TamaSobs,
romlebic fsiqikuri daavadebebis magram, am dros, didi sifrTxilecaa saWiro, raTa
sindromebs exeba ?? Tavidan aviciloT daavadebis gamartivebuli xedva.
etiologiis Sesaxeb daskvnis gamotana mxolod
maSinaa marTebuli, Tu kargad gvesmis garkveuli
etiologiuri midgoma fsiqiatriaSi konceptualuri xasiaTis problemebi. magaliTad:
fsiqiatriaSi daavadebis etiologiis mimarT orgvari 38 wlis gaTxovili qalis depresiuli mdgomareoba
midgoma arsebobs. pirveli is, rom yoveldRiur uaresdeboda 4 kviris ganmavlobaSi. masTan simp
klinikur praqtikaSi fsiqiatrebi cdiloben aRmoaCinon tomebma swrafad iCina Tavi, mas Semdeg, rac is
_ 85 _
5 etiologia
qmarma miatova da uTxra, rom marto cxovreba w es martivi SemTxveva fsiqiatriaSi ramodenime eti
erCivna. pacientis dedasac adre Turme orjer ologiuri sakiTxis mniSvnelobas usvams xazs. esenia:
dasWirvebia fsiqiatriuli mkurnaloba: erTxel mas daavadebis gamomwvevi mizezebis kompleqsuroba da
mZime depresiuli aSliloba daudginda, meored ki sirTule
_ mania, Tumca, mis cxovrebaSi araferi momxdara w daavadebis gamomwvevi mizezebis klasifikacia
iseTi, rasac SeeZlo gamoewvia es daavadebebi.
w stresis cneba
rodesac pacienti 14 wlis iyo, mamam ojaxi miatova
da sxva qalTan gadavida sacxovreblad, bavSvebi w fsiqologiuri reaqciis cneba
ki dedasTan datova. amis Semdeg, ramdenime wlis w intuiciisa da mecnieruli codnis roli daavadebis
manZilze pacienti uaryofilad da ubedurad etiologiis dadgenisas.
grZnobda Tavs, magram, sabolood, am gancdebisagan
gaTavisuflda. Semdeg is daojaxda da ori Svili daavadebis gamomwvevi mizezebis
gauCnda. rodesac igi avad gaxda, isini 10 da 13 kompleqsuroba da sirTule
wlisani iyvnen. pacienti qmarma miatova, magram ori fsiqiatriaSi daaavadebis gamomwvev mizezebs Soris
kviris Semdeg is ojaxs daubrunda. cols uTxra, urTierTkavSiris Seswavlas sami ZiriTadi problema
rom Secdoma dauSva da rom namdvilad uyvarda igi. arTulebs (msgavsi sirTuleebi, oRond naklebi xa
miuxedavad qmris dabrunebisa, pacients simptomebi risxiT, medicinis sxva dargebSic gvxvdeba). esenia:
SenuarCunda da kidev ufro gauZlierda. mas adre
eRviZeboda, Tavi daaneba Cveul saqmianobas da droiTi kavSirebis nakleboba
TviTmkvlelobazec laparakobda. xSirad mizezi Sedegisagan garkveuli droiTaa da
am pacientis simptomebis analizisas, klinicisti, Sorebuli. magaliTad, cnobilia, rom bavSvobis
upirveles yovlisa, ixsenebs daavadebis etiologiis droindeli gamocdileba nawilobriv gansazRvravs
Sesaxeb arsebul im informacias, romelic mecnieruli zrdasrul asakSi emociuri xasiaTis sirTuleebis
gamokvlevebidanaa cnobili. genetikuri analizi gvi arsebobas. am mosazrebis Semowmeba ar aris mar
Cvenebs, rom, Tu mSobels aReniSneba mania da dep tivi, radgan saWiro informaciis mopoveba SesaZ
resiuli aSliloba, mosalodnelia, rom Svils dep lebelia an bavSvebis gamokvleviT da maTze ka
resiuli aSlilobisaken midrekileba gadaeces. amitom, tamnestikuri dakvirvebis warmoebiT (rac rTuli
unda vivaraudoT, rom konkretul pacientsac amgvari gansaxorcielebelia), an zrdasruli adamianebis ga
midrekileba dedisagan memkvidreobiT gadaeca. mokiTxviT maTi bavSvobisdroindeli gamocdilebis
klinikuri gamokvleva gvawvdis garkveul infor Taobaze, rac arasando informaciaa.
macias imis Sesaxeb, Tu ra Sedegi aqvs bavSvebis
mizezi da Sedegi
mSoblebisagan ganSorebas. mocemul SemTxvevaSi ase
Ti informacia didad Rirebuli ar aris, radgan Semdegi problemaa is, rom erTma mizezma SeiZleba
exeba adamianebs, romlebic bevrad patara asakSi ramdenime SedegTan migviyvanos. magaliTad, iTvleba,
daSordnen mSoblebs, vidre es konkretuli pacienti. rom Tu bavSobaSi adamians mSoblis siyvaruli aklia,
mecnieruli TvalsazrisiT, ar gvaqvs safuZveli es mas antisocialuri qcevis, suicidis, depresiuli
imisa, rom gansakuTrebuli yuradReba gavamaxviloT aSlilobisa da sxva saxis darRvevebisaken ganawyobs.
pacientis mamis mier ojaxis mitovebaze, magram da piriqiT, ramdenime mizezema SeiZleba erTi
intuicia gvkarnaxobs, rom es mniSvnelovani movlena Sedegi gamoiwvios. amis ilustracia SesaZlebelia an
unda yofiliyo. cxovrebiseuli gamocdilebidan sxvadasxva adamianTan erTi Sedegis sxvadasxva mizezis
gamomdinare viciT, rom qalebi qmris ojaxidan wasvlas CvenebiT, an erT adamianTan erTi Sedegis ramdenime
ganicdian da isic gasagebia, rom qalis gancdebi ufro mizezis gamovleniT. magaliTad, daswavlis darRveva
mZimea, Tu msgavsi faqti ukve moxda mis bavSvobaSi. (erTi Sedegi) SeiZleba hqondes ramdenime bavSvs,
aqedan gamomdinare, klinicisti intuiciiT xvdeba magram TiToeuli bavSvis SemTxvevaSi mizezi SeiZleba
rom, savaraudod, pacientis depresiuli mdgomareoba gansxvavebuli genetikuri anomalia iyos. an kidev,
esaa reaqcia qmris mier ojaxis mitovebaze. klinicists erTi adamianis depresiuli aSliloba (erTi Sedegi)
intuicia imasac karnaxobs, rom pacientma, wesiT, ukeT SeiZleba mraval sxvadasxva mizezTa (genetikuri
unda igrZnos Tavi meuRlis Sin dabrunebis Semdeg. faqtorebi, bavSvobisdroindeli uaryofiTi gamoc
mocemul SemTxvevaSi pacientis mdgomareoba ar dileba, stresi zrdasrul cxovrebaSi) kombinaciiT
gaumjobesebula. pacientTan simptomebis arseboba im iyos ganpirobebuli.
periodSi, rodesac is meuRlis mier aris mitovebuli,
arapirdapiri meqanizmebi
gasagebia, magram gaugebaria Tu ratom narCundeba es
mesame problema isaa, rom etiologiuri faqtorebi
simptomebi meuRlis Sin dabrunebis Semdegac.
_ 86 _
etiologiis zogadi sakiTxebi
fsiqikuri aSlilobebis ganviTarebaze iSviaTad naTeli warmodgena Seeqmnas pacientis pirovnebaze.
axdens pirdapir gavlenas. magaliTad, depresiisadmi am tipis gamokvleva gvexmareba avxsnaT is, Tu ratom
genetikuri winaganwyoba gaSualebulia iseTi fsi misca pacientma reaqcia stresul movlenaze da ratom
qologiuri faqtorebiT, romlebic zrdis am pi hqonda mas swored aseTi da ara sxvagvari reaqcia.
rovnebis mowyvladobas uaryofiTi cxovrebiseuli TiToeuli pacientis SemTxvevaSi udavoa pirovnuli
gamocdilebisadmi. amgvarad, etiologiuri faqto Tvisebebis mniSvneloba, amitom gaugebaria, Tu ratom
rebis gavlena, Cveulebriv, rTuli meqanizmebiTaa aris am Temaze arsebuli mecnieruli literatura
gaSualebuli, romlebic Seswavlasa da gagebas sa ase mwiri. amgvarad, pacientis pirovnebis Sefasebisas
Wiroebs. Zalian mniSvnelovania klinikuri unar-Cvevebis SeZena
gamocdili kolegis zedamxedvelobis qveS.
daavadebis gamomwvevi mizezebis
precipitatuli faqtorebi
klasifikacia
arsebobs iseTi movlenebi, romlebic daavadebis
rogorc iTqva, calkeuli fsiqikuri aSliloba
dawyebamde cota xniT adre iCenen Tavs da romlebic
SeiZleba ramdenime mizeziT iyos gamowveuli, amitom
daavadebis gamomwvev mizezebs hgavs. es movlenebi
saWiroa mizezebis klasifikaciis sqemis Sedgena. erT-
SeiZleba, fizikuri, fsiqologiuri an socialuri
erTi mosaxerxebeli gza mizezebis qronologiuri
xasiaTis iyos. gamoiwvevs Tu ara es movlenebi raime
klasifikaciaa. am dros gamoiyofa sami rigis faq
aSlilobas da isic Tu ra saxis SeiZleba iyos maT
torebi: predispoziciuri, precipitatuli da Sema
mier gamowveuli aSliloba, rogorc es zemoT iTqva,
narCunebeli.
nawilobriv, pacientis konstituciur faqtorebzea
damokidebuli. fizikur precipitatul faqtorebs
predispoziciuri faqtorebi
SeiZleba warmoadgendes Tavis tvinis simsivne an wamlis
zogierTi faqtori cxovrebis adreul periodSive
miReba . fsiqologiuri precipitatuli faqtorebia
iwyebs moqmedebas da gansazRvravs pirovnebis
pirovnebis cxovrebaSi momxdari usiamovno faqtebi,
mowyvladobas im mizezebis mimarT, romlebic drois
magaliTad, samsaxuris dakargva da cxovrebis Cveuli
TvasazrisiT axlosaa avadmyofobis dawyebasTan. es
wesis Secvla (magaliTad, sacxovrebeli adgilis).
faqtorebia genetikuri memkvidreoba, Canasaxis garemo
zogjer erTi da igive faqtori ramdenime saxiT
da aseve, Cvilobasa da adreul asakSi pirovnebis
moqmedebs. magaliTad, qala-tvinis travmam SeiZleba
ganviTarebaze moqmedi fizikuri, fsiqologiuri da
gamoiwvios fsiqikuri aSliloba Tavis tvinSi
socialuri faqtorebi. xSirad, adamianis fizikuri
ganviTarebuli garkveuli cvlilebebis an im stresis
da fsiqologiuri maxasiaTeblebis aRsawerad (misi
gamo, romelic travmis miRebam gamoiwvia.
cxovrebis nebismier monakveTSi) gamoiyeneba termini
`konstitucia~. es maxasiaTeblebi icvleba droTa SemanarCunebeli faqtorebi
ganmavlobaSi Semdgomi fizikuri, fsiqologiuri da es faqtorebi axangrZlivebs fsiqikur aSlilobas
socialuri faqtorebis zemoqmedebis Sedegad. zo misi provocirebis Semdeg. mkurnalobis dagegmvisas
gierTi avtori termins `konstitucia~ ufro viwro gansakuTrebiT mniSvnelovania maTi gaTvaliswineba.
mniSvnelobiT xmarobs da gulisxmobs cxovrebis pacientTan kontaqtamde predispoziciuri da
dasawyisSi mocemul fizikur da fsiqologiur ma precipitatuli faqtorebis moqmedeba SesaZloa
xasiaTeblebs, zogi ki _ mogvianebiT SeZenils. mo ukve Sewyvetili iyos, magram SemanarCunebeli
cemul wignSi meore definiciaa nagulisxmevi. faqtorebis movla kvlavac SeiZlebodes. magaliTad,
konstituciis cnebaSi Cadebulia is azri, rom sawyis etapze mravali fsiqikuri aSliloba iwvevs
adamiani SesaZlebelia garkveuli aSlilobis an meorad demoralizacias da socialuri aqtivobis
darRvevisaken (mg., Sizofreniisaken) iyos midre Sewyvetas, rac, Tavis mxriv, xels uwyobs aSlilobis
kili, magram am aSlilobam SeiZleba arasodes gaxangrZlivebas. xSirad mizanSewonilia aseTi meoradi
iCinos Tavi. fsiqiatriuli daavadebebis etio faqtorebis marTva, miuxedavad imisa, tardeba Tu ara
logiis TvalsazrisiT, konstituciis erT-erTi raime sxva konkretuli RonisZiebebi. SemanarCunebel
umniSvnelovanesi Semadgenelia personologiuri faqtorebs, aseve, gamaxangrZlivebel faqtorebsac
maxasiaTeblebi. uwodeben.
individualur SemTxvevebSi etiologiis dadgenisas,
yovelTvis unda iyos gaTvaliswinebuli pirovnuli stresis cneba
maxasiaTeblebi, rogorc erT-erTi ZiriTadi elementi.
stresis cnebis garSemo gamarTuli diskusiebi xSirad
amitom, klinicistma sakmarisi dro unda dauTmos
sakmaod damabnevelia, radganac am termins ori
pacientTan da mis axloblebTan saubars, raTa mas
gansxvavebuli mniSvnelobiT iyeneben. erT SemTxvevaSi
_ 87 _
5 etiologia
is aRniSnavs ama Tu im movlenas an situacias (mag., w adamiani unda gamovides aseTi fsiqologiuri
mecadineobas gamocdis Casabareblad), romelsac mdgomareobidan Sesabamisi movlenis SewyvetasTan
SeiZleba adamianze arasasurveli zemoqmedeba hqondes. erTad (garda, ra Tqma unda,
meore SemTxvevaSi _ gamowveul negatiur efeqtebs, im SemTxvevisa, rodesac naTlad Cans, rom ga
romlebsac SeiZleba fsiqologiuri an fiziologiuri maxangrZlivebeli faqtorebi xels uwyobs mdgoma
zegavlena hqondes. etiologiis ganxilvisas sjobs, es reobis SenarCunebas).
ori mniSvneloba erTmaneTisagan gavmijnoT. es sami kriteriumi SeiZleba gamoviyenoT klinikur
pirveli rigis faqtorebs SegviZlia stresorebi praqtikaSi, magram SesaZlebelia es rTuli aRmoCndes,
vuwodoT. isini moicaven mraval fizikur, fsi gansakuTrebiT es exeba meore kriteriums.
qologiur da socialur faqtors, romelTac
SeuZliaT arasasurveli efeqtis gamowveva. zogjer gageba da axsna
am cnebas ufro farTo mniSvnelobiT iyeneben da
rogorc iTqva, konkretul pacientTan dakavSirebiT
masSi aerTianeben im movlenebs, romlebic imwuTas
gakeTebuli etiologiuri daskvna unda aerTianebdes
uaryofiTad ar ganicdeba, magram maT SeiZleba
erTi mxriv codnas, romelic pacientTa jgufze
Soreuli uaryofiTi efeqti hqondeT. magaliTad,
Catarebuli kvlevebiTaa miRebuli da meore mxriv
Sejibrebam SeiZleba im momentSi sasiamovno da
_ yoveldRiuri gamocdilebidan SeZenil intuiciur
Zabuloba gamoiwvios, magram iqonios arasasurveli
gagebas. fsiqikuri aSlilobis Taobaze daskvnis
grZelvadiani Sedegi.
gamotanis am or gzas iaspersi aRniSnavs Semdegi ori
adamianze aseTi movlenis zemoqmedebas, Cveulebriv,
terminiT: 'Erklaren' da 'Verstehen' (Jaspers 1963, p 302),
stresul reaqcias uwodeben da mas ganasxvaveben
rac germanulad àxsnas~ da `gagebas~ niSnavs da
maprovocirebeli movlenisagan. es reaqcia moicavs
iaspersis naSromebis inglisur TargmanSi swored
avtonomiuri nervuli sistemis reaqciebs (mag.,
asea warmodgenili. magram iaspersi maT gansxvavebuli
arteriuli wnevis momateba), endokrinul cvlilebebs
mniSvnelobiT xmarobda. terminiT _ Erklaren, is
(mag., adrenalinisa da noradrenalinis gamoyofa) da
aRniSnavda mizezobrivi kavSiris gamomxatvel de
fsiqologiur reaqcias (agznebis gancda). mravali
bulebas, romlis msgavsic sabunebismetyvelo mec
saxis neirobiologiuri gamokvleva Seiswavlis Tavis
nierebebSi gvxvdeba. magaliTad debuleba, rom
tvinze stresis zemoqmedebas, konkretulad ki imas,
pacientis agresiuli qceva Tavis tvinis simsivniTaa
Tu rogor zemoqmedebs stresi guneb-ganwyobis
gamowveuli. iaspersi termins _ Verstehen, iyenebda
regulaciasa da emociuri xasiaTis informaciis
fsiqologiuri gagebis aRsaniSnavad, rac gulisxmobs
gadamuSavebaSi monawile meqanizmebze.
pirovnebis cxovrebaSi momxdar movlenebsa da
mis fsiqologiur mdgomareobas Soris arsebuli
fsiqologiuri reaqciis cneba
bunebrivi kavSiris intuiciur wvdomas. sasaubro
rogorc iTqva, sayovelTaod aRiarebulia, rom mZime inglisurSi amas ewodeba `sxvis tyavSi CaZromis~ unari,
fsiqologiuri mdgomareoba SeiZleba iyos reaqcia ris sailustraciodac Semdegi naTqvami gamodgeba: `me
usiamovno faqtze. zogjer aseTi faqtis an movlenis mesmis ratom gabrazda pacienti, rodesac mis Svils
kavSiri distressTn TvalsaCinoa (mag., qals emarTeba mezobelma dauyvira~.
depresia meuRlis gardacvalebis Semdeg), zogjer ki zemoT aRwerili gansxvaveba sakmaod naTelia
Zneli gasarkvevia, fsiqologiuri aSliloba reaqciaa calkeul pacientze saubrisas, magram zogjer ga
konkretuli faqtis mimarT, Tu es ori ubralod ugebroba iqmneba individualuri SemTxvevis far
daemTxva erTmaneTs (mag., depresia Soreuli naTesavis To ganzogadebis dros, rodesac gageba da axsna
gardacvalebis Semdeg). SeiZleba erTmaneTSi agverios. iaspersi ambobda, rom
iaspersma (Jaspers 1963, p 392) SemogvTavaza sami zogierTi fsiqoanalitikuri idea intuiciuri gagebis
kriteriumi, romlebic gvexmareba imis dadgenaSi, gansakuTrebul saxes warmoadgens. es individebis
aris Tu ara fsiqologiuri mdgomareoba reaqcia detaluri SeswavliT miRebuli daskvnebis gene
konkretul faqtze. es kriteriumebia: ralizaciaa da ara axsna, romlis mecnieruli
w faqti/movlena iseTive simwvavis (simZimis) unda Semowmeba SesaZlebelia. es ideebi adamianis bunebaSi
iyos, rogoricaa fsiqologiuri mdgomareoba da wvdomis Sedegia, rac maRali donis literaturuli
droSi misgan daSorebuli ar unda iyos. nawarmoebebis kiTxviT miiRweva da adamianis bu
w unda arsebobdes naTeli kavSiri movlenis xasiaTsa nebis gagebisaTvis udidesi Rirebulebis mqonea.
da fsiqologiuri aSlilobis Sinaarss Soris (zemoT fsiqiatriaSi maTi ugulebelyofa araswori iqneboda,
mocemul magaliTSi, adamiani SeiZleba moculi iyos magram, aseve, ar iqneboda swori, Tu maT mecnieruli
Tavis Soreul naTesavze fiqriT). Rirebulebis mqone informaciad miviCnevdiT.
_ 88 _
etiologiuri modelebi
calkeuli SemTxvevis etiologia neiromecnieruli midgomis Camoyalibebas, romlis
me-3 TavSi saubaria imaze, Tu rogor gamoaqvT daskvna safuZvelze gamoTqmuli mosazrebebi mocemulia
daavadebis etiologiis Sesaxeb. mocemulia axalgazrda kendelis naSromSi (Kandel, 1998):
qalis magaliTi, romlis depresiuli mdgomareoba w yvela fsiqikuri procesi Tavis tvinis moqmedebis
TandaTanobiT uaresdeboda. Cven vnaxeT, Tu rogor xdeba Sedegia. Sesabamisad, yvela qceviTi darRveva, sa
etiologiuri faqtorebis dajgufeba predispociziur, bolood, tvinis funqciis darRvevaa, maSinac ki,
precipitatul da SemanarCunebel faqtorebad da rodesac sawyisi `mizezi~ aSkarad garemoSia mo
rogor akavSireben mecnieruli kvlevebis meSveobiT cemuli;
(am SemTxvevaSi genetikuriT) miRebul informacias w cilebis warmoqmnis gziT, genebi mniSvnelovnad
pirovnebis intuiciur gagebasa da im faqtebis codnasTan, zemoqmedebs tvinis funqciaze, Sesabamisad, mniSv
romlebic pacientze ojaxuri problemebis zemoqmedebas nelovnia maTi monawileoba qcevis marTvaSi;
exeba. mkiTxvelisaTvis SesaZloa sasargeblo iyos ??
w socialuri da qceviTi gamocdileba Tavis tvinze
gverdze mocemuli formulirebis gadakiTxva manam, sanam
gavlenas, nawilobriv, genebis eqspresiaSi momxdari
am Tavis Semdeg nawilze gadavidodes.
cvlilebebis meSveobiT axdens. genebis eqspresiaSi
momxdari cvlilebebi, Tavis mxriv, gansazRvravs
etiologiuri modelebi sinafsuri kavSirebis paternebs. swored es iZleva
sanam ganvixilavdeT etiologiuri faqtorebis Ses imis saSualebas, rom qceva fsiqoTerapiiTa da
wavlaSi calkeuli mecnieris mier Setanil wvlils, daswavlis gziT Seicvalos.
unda gavecnoT im etiologiur modelebs, romlebic es ukanaskneli mosazreba eyrdnoba im faqts, rom
fsiqiatriaSi gamoiyeneba. nebismieri modeli in garemos stimulebis did nawils SeuZlia genebis
formaciis mowesrigebis saSualebaa. iseve, rogorc eqspresiis modulireba genebis transkrifciis faq
Teoriis, modelis meSveobiT vcdilobT garkveuli torebSi cvlilebebis Setanis gziT. Tumca, kon
fenomenebis axsnas, magram modeli amas iseTi kretuli cilebis genuri kodireba Tandayolilia,
farTo, yovlismomcveli saxiT akeTebs, rom advili garemosa da ganviTarebis zemoqmedeba gansazRvravs
dasamtkicebeli ar aris, rom igi mcdaria. imas, moxdeba Tu ara konkretuli genebis eqspresia
da ra xarisxiT. es gvaZlevs sarwmuno meqanizms,
reduqcionistuli da romelic gviCvenebs, Tu rogor urTierTzemoqmedebs
arareduqcionistuli modelebi Tandayolili da SeZenili faqtorebi qceviTi fe
arsebobs ganmartebiTi modelis ori tipi. reduq notipis gansazRvrisas.
cionistuli modeli cdilobs mizezobrivi kavSirebis amgvarad, neiromecniereba cdilobs, qcevaSi so
axsnas ufro da ufro martiv etapebze ukusvlis cialuri, ojaxuri da pirovnuli faqtorebis rolis
gziT. qvemoT aRwerili `viwro~ samedicino modeli dadgenas, tvinis funqciebSi momxdar cvlilebebTan
da fsiqoanalitikuri modelebi reduqcionistuli maTi dakavSirebis gziT. magaliTad, Tu Cven gvinda
modelis ilustracias warmoadgens. aseTi tipis mo gavigoT, rogor zemoqmedebs ufrosebis gulgrili
delis magaliTia Semdegi debuleba: Sizofreniis mizezi damokidebuleba bavSvis depresiisadmi midrekilebis
tvinis garkveul ubanSi neirotransmisiis darRvevaa. Camoyalibebaze, mniSvnelovania gavarkvioT, Tu rogor
arareduqcionistuli modeli cdilobs problemebis cvlis bavSvobisdroindeli uaryofiTi gamocdileba
dakavSirebas ufro farTo sakiTxebTan. Cveulebriv, Tavis tvinis Sesabamis meqanizmebs (mag., endokrinul
am saxisaa sociologiaSi arsebuli axsniTi modelebi. reaqcias stresze) da rogor SeiZleba am anomaliam
fsiqiatriSi aseTi modelis ilustracias warmoadgens ganapirobos depresiisadmi midrekileba ukve zrda
debuleba, romlis Tanaxmad pacientis daavadebis srul asakSi sirTuleebTan dapirispirebisas. am
_ Sizofreniis, mizezi mis ojaxSi unda veZeboT. gvarad, miuxedavad imisa, rom neiromecniereba iT
pacienti yvelaze TvalSi sacemi elementia adamianebis valiswinebs socialuri da pirovnuli faqtorebis
mouwesrigebel jgufSi. zustad aseve SeiZleba iTqvas, mniSvnelobas, is cdilobs maTi zemoqmedebis Sedegebis
rom garkveuli depresiuli mdgomareoba socialuri gagebas reduqcionistuli TvalsazrisiT.
deprivaciisa da izolaciis maxasiaTeblebTan aris
dakavSirebuli da es faqtorebi am mdgomareobis samedicino modeli
gamomwvev mizezebad CaiTvalos. fsiqiatriul etiologiaSi gamoyenebuli modelebidan
yvelaze didi mniSvneloba samedicino models eniWeba.
neiromecnieruli midgoma is asaxavs kvlevis im zogad strategias, romelic karg
teqnikur-konceptualuri xasiaTis progresma xeli Sedegs iZleva medicinaSi, gansakuTrebiT infeqciuri
Seuwyo Tavis tvinis Semswavlel mecnierebebSi daavadebebis Seswavlisas. daavadeba, rogorc erTeuli,
_ 89 _
5 etiologia
identificirebulia simptomTa paternis, tipiuri negatiuri movlenebi da deprivacia, sabolood,
klinikuri mimdinareobis, konkretuli bioqimiuri uaryofiTad aisaxeba pirovnebis qcevaze. miuxedavad
monacemebisa da paTologiis Sesaxeb mopovebuli imisa, rom es ukanaskneli Tvalsazrisi Teoriulad
informaciis safuZvelze (ix. me-2 Tavi, romelSic validuria da zrdis samedicino modelis etiologiur
daavadebebis modelebia aRwerili). aseTi erTeulis Rirebulebas, mTavari gadawyvetileba, romelic unda
identificirebis Semdeg, iwyeba aucilebeli da miiRos klinicistma an sxva, gadawyvetilebis mimRebma
sakmarisi mizezebis Zieba. magaliTad, tuberkulozis pirma, exeba imas, Tu ra donezea yvelaze ukeT
SemTxvevaSi, tuberkulozis bacila daavadebis SesaZlebeli daavadebis gageba da marTva. magaliTad,
aucilebel, magram arasakmaris mizezs warmoadgens, problemebi, romlebic gamowveulia fsiqoaqtiuri
maSin roca, tuberkulozis bacilis arseboba, nivTierebis araswori moxmarebiT SegviZlia tvinis
Tu mas zed erTvis cudi kveba da daavadebisadmi damajildovebeli sistemis defeqtad ganvixiloT.
daqveiTebuli winaaRmdegoba, sakmarisi mizezia. es mowyvlad individebTan iwveves `normalur~
am tipis `viwro~ samedicino modelebis gamoyeneba eqsperimentirebas narkotikuli nivTierebiT, rasac,
fsiqiatriaSi kargi Sedegebis momcemi aRmoCnda, Tavis mxriv, mivyavarT, fsiqoaqtiuri nivTierebis
magram ara yvela SemTxvevaSi. isini aSkarad miesadageba arasworad moxmarebasTan da mis Tanmxleb pirov
iseT sindromebs, romelTac mkafiod gamoxatuli nul da socialur SedegebTan. garda amisa, sazoga
organuli etiologia aqvT (mag., fsiqikuri aSlilobis doebaSi narkotikuli nivTierebebis Warbad moxma
mdgomareobebs, romlebic aSkarad ukavSirdeba reba SegviZlia ganvixiloT, rogorc socialuri
cerebrul darRvevebs an janmrTelobis zogad deprivaciisa da ojaxis institutis ngrevis simptomi
statuss). isini, agreTve, miesadageba iseT mZime (ix. me-18 Tavi). orive saxis etiologia Tavsdeba ufro
fsiqikur aSlilobebs, rogorebicaa Sizofrenia farTo samedicino modelSi, magram TiToeuli maTgani
da bipolaruli aSliloba. bolo dromde aseT aS sxvadasxva saxis intervencias gulisxmobs.
lilobebs, organulisagan gansasxvaveblad funqciurs
uwodebdnen, radgan iTvleboda, rom aseT SemTxvevaSi qceviTi modeli
SeimCneoda Tavis tvinis disfunqcia, xolo tvinis rogorc zemoT iTqva, zogierTi fsiqikuri aSliloba,
paTologia (rasac imdroindeli meTodebiT adgen romelsac Cveulebriv anomaliur qcevas uwodeben,
dnen) ar aRiniSneboda. Sizofreniis etiologiis Se advilad ar Tavsdeba samedicino modelSi. am tipis
saxeb bolo drois gamokvlevebma gvaCvena, rom es qcevaSi moiazreba TviTdazianeba, narkotikuli niv
Tvalsazrisi, ZiriTadad, swori iyo (ix. me-12 Tavi). Tierebebisa da alkoholis moxmareba da danaSaulis
Tumca, socialuri da kulturaluri faqtorebi aseve Cadenis ganmeorebiTi SemTxvevebi. qceviTi modeli
TamaSoben garkveul rols daavadebis gamovlenasa da am saxis aSlilobaTa gagebis alternatiul gzas
mimdinareobaSi. warmoadgens. am modelis Tanaxmad, qceviTi darRveva
socialuri da kulturaluri faqtorebis roli ganixileba im faqtorebis TvalsazrisiT, romlebic
amJamad saTanadodaa aRiarebuli zogad medicinaSi. normalur qcevas ganapirobebs. esenia draivebi,
Sesabamisad, Tanamedrove samedicino modelebi ganmtkiceba, socialuri da kulturaluri zegavlena
bevrad ufro farToa, vidre modelebi, romlebic da Sinagani fsiqologiuri procesebi, rogorebicaa
infeqciuri daavadebis meqanizmis gamovlenaze iyo socialuri damokidebulebebi, rwmenebi da molo
dafuZnebuli. Tanamdrove samedicino modelebic dinebi. qceviTi modelis Tanaxmad ar arsebobs
adasturebs im faqts, rom bevri daavadeba xasiaTdeba mkveTri sxvaoba normalur da anomaliur qcevas
normidan raodenobrivi da ara Tvisobrivi gadaxriT Soris, gansxvaveba mxolod da mxolod xarisxobrivia.
(mag., maRali arteriuli wneva). es Tvalsazrisi sworia, amitom, es modeli gamodgeba mravali viTarebis
Tu mas gamoviyenebT garkveuli tipis fsiqikuri gasaanalizeblad, rasTanac fsiqiatrs aqvs Sexeba.
aSlilobebis mimarT (mag., SfoTvisa da ufro msubuqi miuxedavad imisa, rom qceviTi modeli ZiriTadad
depresiuli aSlilobis mimarT), romelTa Casma ufro fsiqologiur da socialur mizezebs iTvaliswinebs,
farTo samedicino modelSia SesaZlebeli. is ar gamoricxavs genetikuri, fiziologiuri da
samedicino modelebTan dakavSirebuli sirTuleebi bioqimiuri mizezebis moqmedebas. es imiT aixsneba,
gansakuTrebiT maSin iCens Tavs, rodesac saubaria rom qcevis normaluri paternebi nawilobriv gene
qcevis darRvevebsa da socialuri qcevis paTologiaze; tikuri faqtorebiTaa ganpirobebuli an imiT,
magaliTad, antisocialuri qceva, wamalmoxmareba rom fsiqologiur faqtorebs (mag., ganmtkicebas)
da a.S. rogorc zemoT iTqva, neiromecniereba cdi fiziologiuri da bioqimiuri meqanizmebi udevs
lobs, gaigos am tipis aSliloba tvinis Sesabamis safuZvlad. garda amisa, qceviTi modeli iyenebs,
sistemebSi momxdari cvlilebebis meSveobiT. Tavis rogorc reduqcionistul, ise ara-reduqcionistul
tvinis meqanizmebSi momxdari cvlilebebis Sedegad, axsna-ganmartebas. magaliTad, qceviTi anomaliis axsna
_ 90 _
xdeba anomaliuri ganpirobebis (reduqcionistuli li~ Tvalsazrisi ar uwyobs xels fsiqikuri daa
modeli) an socialur zemoqmedebaTa qselis cnebebis vadebis ukeT gagebas da, faqtiurad, sakmaod
gamoyenebiT. aradamakmayofileblad ganmartavs klinikuri fsi
qopaTologiis SemTxvevaTa umetesobas. magaliTad,
ganviTarebis modelebi is ver xsnis, Tu ratom arsebobs Sizofrenia yvela
samedicino da qceviTi modelebi iTvaliswinebs, saxis sazogadoebaSi (ix. me-12 Tavi). miuxedavad amisa,
rom arsebobs predispoziciuri da precipitatuli fsiqiatriis ganxilva politikuri TvalsazrisiT
mizezebi. igulisxmeba, rom SesaZlebelia warsulma mainc mniSvnelovania, radgan es gavlenas axdens
movlenebma gansazRvros, gamoiwvevs Tu ara amJamindeli imaze, Tu rogor epyrobian fsiqikurad daavadebul
mizezi aSlilobas. zogi modeli kidev ufro metad adamianebs da ra saxis momsaxurebas sTavazoben maT
amaxvilebs yuradRebas warsul movlenebze da met (ix. 23-e Tavi). garda amisa, udavoa, rom fsiqikurad
yvelebs gamocdilebaTa Tanmimdevrobaze, ramac am daavadebuli adamianebis politikuri miznebisaTvis
Jamindel aSlilobamde migviyvana. amas etiologiis gamoyenebis araerTi faqti arsebobs. amis magaliTia
mimarT `cxovrebis istoria~-ze dafuZnebuli mid mravali germaneli fsiqiatris monawileoba evTanaziis
goma ewodeba. misi erT-erTi magaliTia froidis programebSi, romlebic nacisturi reJimis dros
fsiqoanalizi; meore_ meieris fsiqobiologia. es xorcieldeboda (Dudley and Gale, 2002). miuxedavad
Tvalsazrisebi qvemoT iqneba ganxiluli. imisa, rom TanamSromlobis es Semzaravi magaliTi
ukiduresi xasiaTisaa, mainc xazgasasmelia is, rom
politikuri modelebi (àntifsiqiatria~) politikur konteqstSi fsiqiatriuli praqtikis
analizi miuTiTebs imaze, rom saWiroa pacientis
zemoT ganxiluli modelebi efuZneba mecnierul
uflebaTa dacva da rom aucilebelia misi gamocdileba
midgomas fsiqikuri daavadebis etiologiis mimarT,
pirad da socialur konteqstSi iyos moazrebuli.
rac imas niSnavs, rom fsiqikuri aSlilobis gageba
fsiqikuri daavadebis mimarT mecnieruli midgomis
da Seswavla SesaZlebelia obieqturi da empiriuli
susti mxareebi ganxilulia Tomasisa da breqenis
gziT, sabunebismetyvelo mecnierebebis meTodebis
naSromSi (Tomas and Bracken, 2004).
gamoyenebiT. fsiqiatriis istoriaSi am Tvalsazriss
xSirad aradamajereblad miiCnevdnen, ris gamoc Se
mohqondaT sxva konceptualuri modelebi. magaliTad,
fsiqikur aSlilobaTa etiologiaze
Sua saukuneebSi fsiqikur daavadebas demonuri arsebuli mosazrebebis istoriuli
ZalebiTa da jadoqrobiT xsnidnen (ix. qvemoT). uka ganviTareba
naskneli 50 wlis manZilze, etiologiis mimarT adreuli droidan moyolebuli, fsiqikuri aSlilobis
mecnieruli midgomis kritikisas, xSirad gamoTqvamden kauzaluri Teoriebis mier aRiarebuli iyo rogorc
mosazrebas, rom fsiqikuri daavadebis gansazRvra somaturi, ise fsiqologiuri zemoqmedebis arseboba.
socialuri da politikuri imperativebiT xdeba berZnul samedicino literaturaSi fsiqikuri
da rom amas, ukeTes SemTxvevaSi, safuZvlad udevs aSlilobis mizezebze saubari ZiriTadad hipokrates
kulturiT ganpirobebuli subieqturi Sefaseba, xolo naSromebSi gvxvdeba (IV s. Zv.w). seriozuli fsiqikuri
yvelaze uares SemTxvevaSi _ socialuri kontrolis daavadebebi ZiriTadad fizikur mizezebs miewereboda
borotad gamoyenebis survili. da, Sesabamisi Teoriis mixedviT, janmrTeloba da
am tipis argumentebi, romlebic pirvelad wamoayena mokidebuli iyo sxeulis oTxi siTxis swor Ta
frangma fsiqiatrma miSel fukom (1926_1984), nafardobaze (sisxli, lorwo, yviTeli naRveli, Savi
ganaviTara ronald leingma (1927_1989). is iyenebda naRveli). melanqoliis gamomwvev mizezad iTvleboda
fenomenologiur midgomas da amtkicebda, rom Savi naRvelis siWarbe. garda amisa, miaCndaT, rom
Sizofrenia aris individis gasagebi reaqcia eqs SedarebiT msubuqi fsiqikuri daavadebebi ze
pluatatorul da gaucxovebul kulturaze. agreTve, bunebrivi ZalebiT iyo gamowveuli da rom maTi
fsiqiatri Tomas sasi kritikulad afasebda fsiqikuri mkurnaloba mxolod reliigiis prerogativa iyo.
gamocdilebis mimarT mecnierul midgomas. àr gamonakliss warmoadgenda isteria, romlis mizezadac
arsebobs fsiqologia. arsebobs mxolod biografia da _ saSvilosnos mdebareobis Secvlas asaxelebdnen.
avtobiografia~ _ ambobda igi. am tipis Sexedulebebs dResdReobiT miiCneven, rom isteriis gamomwvevi
àntifsiqiatrias~ uwodeben, riTac xazs usvamen mizezebi, ZiriTadad fsiqologiuri xasiaTisaa.
imas, rom mocemuli Tvalsazrisi radikalurad romaelma mkurnalebma, berZnul medicinaSi
gansxvavdeba samedicino modelisagan, romelic damkvidrebuli kauzaluri Sexedulebebi gaiziares
tradiciul fsiqiatriaSi gamoiyeneba. da garkveuli saxiT ganaviTares. galenis azriT,
fsiqiatrTa umravlesobis azriT, àntifsiqiatriu melanqoliis gamomwvevi mizezi Savi naRvelis
_ 91 _
5 etiologia
siWarbea, rasac ganapirobebs an sisxlis gacieba an etiologia nozologiazea damokidebuli. manam,
yviTeli naRvelis zedmetad gaxureba. iTvleboda, sanam gavarkvevT, Tu ra kavSiria sxvadasxva fsiqikur
rom frenits, romelsac deliriumis TanmxlebiT mim daavadebebs Soris, cota ram unda vicodeT kauzaluri
dinare febrilur mdgomareobas uwodebdnen, yviTeli kavSiris Sesaxeb. italieli eqimi morgani, romelic
naRvelis moWarbeba iwvevda. akvirdeboda fsiqikuri aSlilobis mqone pacientebs,
Sua saukuneebSi zemoT xsenebuli warmodgenebi im daskvnamde mivida, rom arsebobs ara erTi, aramed
fsiqikuri daavadebis mizezebis Sesaxeb daviwyebas ramdenime saxis sigiJe (Morgagni, 1769). amas mohyva
mieca, Tumca, zogierTi mecnieris SromebSi aSlilobaTa klasifikaciis ramdenime mcdeloba, aqe
ganviTareba hpova (mag., barTolomeus anglikusi). dan yvelaze cnobilia uiliam kalenis klasifikacia,
am periodSi fsiqikuri daavadebebis mizezebi cod romelmac nevrozis kategoria Seitana im aSlilobebis
visa da borotebis Teologiuri cnebebiT iyo aRsaniSnavad, romlebic ar aris nervuli sistemis
formulirebuli, ris gamoc fsiqikuri daavadebis lokalizebuli daavadebiT gamowveuli.
mqone adamianebs sdevnidnen, rogorc jadoqrebs. mosazreba, rom adamianis fsiqikuri aSlilobebi
mxolod meTeqvsmete saukunis Sua wlebSi uaryves gamowveulia Tavis tvinis konkretuli ubnebis
rwmena, rom fsiqikuri aSlilobis mizezi zebunebivi dazianebiT, momdinareobs frenologiis Teoriidan,
Zalebi da jadoqrobaa. am mxriv, sagulisxmoa romlis avtorebi arian gali (1758-1828) da misi
flamandieli avtoris iohan veieris (1515-1588) wigni moswavle Spurchaimi (1776-1832). galis azriT, tvini
De praestigiis demonum, romelic 1563 wels gamoqveynda. aris fsiqikis organo, xolo fsiqika sxvadasxva
ufro adre, cnobilma mkurnalma paracelsusma (1491- konkretuli unarebisagan Sedgeba, romelTa safuZ
1541), xazi gausva im faqts, rom fsiqikur daavadebebs veli tvinis garkveuli ubnebia. gali imasac am
bunebrivi mizezebi warmoSobs. tkicebda, rom tvinis ubnebis zoma gansazRvravs
meCvidmete da meTvramete saukuneebSi Camoyalibda masSi arsebuli unarebis siZlieres da rom tvinis
ufro mecnieruli midgoma fsiqikuri daavadebebis ubnebis zoma aisaxeba Tavis qalis moyvanilobaSi.
mizezebis mimarT, rac gamoiwvia eqimebis dainteresebam Sesabamisad, Tavis forma asaxavs pirovnebis fsiqikur
fsiqikuri aSlilobebiT, gansakuTrebiT ki isteriiTa monacemebs. miuxedavad imisa, rom am logikuri
da melanqoliiT. ingliseli eqimi Tomas uilisi jaWvis ukanaskneli rgolis Semadgeneli msjeloba
melanqolias `gulis vnebas~ miawerda, magram, amave mcdaria, ideebma cerebruli lokalizaciis Sesaxeb
dros, Tvlida, rom sigiJe (avadmyofoba, romelsac Tan SemdgomSic hpova ganviTareba. mzard interess tvinis
axlavs azrovnebis darRvevebi, bodva da halucinaciebi) paTologiis mimarT mohyva iseTi Teoriebis Seqmna,
`tvinis defeqtiT~ iyo gamowveuli. uilisi acno romelTa mixedviTac fsiqikuri aSlilobis sxvadasxva
bierebda, rom es defeqti iyo ara TvalSisacemi formas Tavis tvinis sxvadasxva nawilis dazianeba
struqturuli dazianeba, aramed funqciuri anomalia. ukavSirdeboda.
im dros gamoyenebuli terminologiis Sesabamisad, mosazreba, rom seriozuli fsiqikuri daavdeba
is saubrobda `sasicocxlo sulebis~ aSlilobaze, ojaxis erT wevrze mets aReniSneba (anu, STamomavlobiT
romlebic, imxanad gavrcelebuli SexedulebiT, pasuxs gadadis), didi xnis manZilze arsebobda, magram
agebdnen nervul qmedebaze. uilisi imasac aRniSnavda, mecxramete saukuneSi man axali saxe miiRo. 1809 wels,
rom isteria ver iqneboda gamowveuli saSvilosnos frangma fsiqiatrma morelma wamoayena mosazreba,
gadaadgilebiT, radgan am organos mdebareoba menjis romelic, SemdgomSi, `degenraciis Teoriis~ saxeliT
RruSi myari iyo. gaxda cnobili. am Teoriis Tanaxmad, ara marto
meCvidmete saukunis kidev erTma ingliselma eqimma, zogierTi fsiqikuri daavadebaa Tandayolili, aramed
Tomas sidenhemma, uaryo Teoria, romlis Tanaxmad Tandayolili SeiZleba iyos garemos zegavlenis
isteria saSvilosnos funqciuri paTologiiT un Sedegebic. cud sacxovrebel pirobebs da alkoholis
da yofiliyo gamowveuli (`saSvilosnosmieri ga avadmoxmarebas SeuZlia gamoiwvios fizikuri cvli
gudva~), radgan man am fenomenis (isteriis) arseboba lebebi, romlebic Semdeg Taobas gadaecema. moreli
mamakacebTanac daadgina. miuxedavad eqimebis interesis ambobda, rom radganac TiToeul TaobaSi zemomqmed
ganaxlebisa fsiqikuri daavadebebis mizezebis mimarT, garemo faqtorebs STamomavlobiTi efeqti aqvT,
meCvidmete saukunis yvelaze avtoritetuli naSromi daavadebebi sul ufro mZime formiT vlindeba yovel
sasuliero pirs _ robert bertons, ekuTvnis. mis momdvno TaobaSi. es mosazreba gulisxmobs, rom
SromaSi The anatomy of melancholy (1621) (melanqoliis fsiqikuri daavadebebi erTmaneTisagan gansxvavdeba
anatomia) detaluradaa aRwerili fsiqologiuri da ara Tvisobrivad, aramed simZimis mixedviT. nevrozi,
socialuri mizezebi (siRaribe, SiSi da martooba), fsiqozi da fsiqikuri defeqti warmoadgens erTi
romlebic ukavSirdeba melanqolias da, rogorc Cans, da imave Tandayolili procesis sxvadasxva xarisxis
iwvevs mas. (simZimis) gamoxatulebas.
_ 92 _
radgan es ideebi Seesabameboda da adasturebda ~fsiqikuri daavadebis etiliogiis ufro yuradRebiT
farTod aRiarebul Teoriebs, romelTa Tnaxmadac, ganxilva gviCvenebs, rom umetes SemTxvevaSi daavadeba
SeZenili maxasiaTeblebi STamomavlobiT gadaecemoda, sabolood yalibdeba ara erTi konkretuli mizezis
amitom maT advilad moikides fexi. samwuxarod, aman zegavleniT, aramed ramdenime, xSirad mravali
ganapiroba pesimisturi damokidebulebis gaCena mizezis Sedegad, romlebic predispoziciuricaa
daavadebis mkurnalobis mimarT da, aseve, biZgi da gamomwvevic. Zalian xSirad daavadebis embrioni
misca evgenikuri moZraobis Camoyalibebas, romlis Casaxulia cxovrebis im adreul periodSi, rodesac
Tanaxmadac, saWiro iyo fsiqikurad daavadebuli iwyeba xasiaTis formireba. es embrioni izrdeba
adamianebis izolacia sazogadoebisagan, raTa isini ganaTlebisa da garemo faqtorebis zemoqmedebis
ar gamravlebuliyvnen. amgvari faqtebi kidev erTxel Sedegad.~
Segvaxsenebs imas, rom etiologiurma Teoriebma (Greisinger 1867, gv.130).
SeiZleba gansazRvros da ganapirobos pacientebze
mecxramete saukunis britaneTSi etiologiis Se
zrunvis mimarT arasasurveli damokidebulebis
saxeb gabatonebuli Sexedulebebi kargad aris
gaCena.
ilustrirebuli Semdeg naSromebSi: A Manual
mecxramete saukunis Sua wlebSi fsiqikur daava
of psychological medicine (Bucknill and Tuke, 1858)
debasTan dakavSirebul mizezobriv kavSirebze yve
(`fsiqologiuri medicinis saxelmZRvanelo~); The
laze srul warmodgenas gviqmnis frangi fsiqiatris,
pathology of mind (Henry Maudsley, 1879) (`gonebis
eskirolis, da germaneli fsiqiatris, grizingeris,
paTologia~). moudsli mizezebs grizengeris msgav
naSromebi. eskirols (Esquirol, 1945) ainteresebda
terminebiT aRwerda. is ambobda, rom fsiqikur
calkeuli pacientis avadmyofobis mizezebi da
daavadebebs mravlobiTi mizezi aqvs. dispoziciuri
naklebad _ etiologiis zogadi sakiTxebi. man
mizezebi (memkvidreobiToba da aRzrda) iseTive
daafiqsira fsiqologiuri da fizikuri faqtorebi,
mniSvnelovania, rogorc ufro TvalsaCino proq
romlebic, misi azriT, mniSvnelovania calkeuli
simaluri mizezebi. moudsli Tvlida, rom mizezebis
SemTxvevis etiologiaSi da ganasxvava erTmaneTisagan
gansazRvrisas daSvebuli Secdomebi xSirad imiTaa
predispoziciuri da precipitatuli mizezebi. is
ganpirobebuli, rom `calkeuli, TvalSisacemi faqti,
Tvlida, rom STamomavlobis faqtori yvelaze mni
romelic erT-erTia movlenaTa jaWvSi katastrofis
Svnelovania predispoziciur faqtorebs Soris, magram
gamomwvev sakvanZo mizezad ganixileba. WeSmariteba ki
imasac aRniSnavda, rom predispoziciur faqtorebze
isaa rom, umetes SemTxvevaSi, urTierTSeTanxmebulad
zemoqmedebs fsiqologiuri da socialuri (anu
`moqmedebs~ pirovnebis SigniT da gareT arsebuli
`moraluri~, rogorc maT im dros uwodebdnen) mi
ramdenime mizezi da ara erTi efeqturi mizezi~
zezebi, rogoricaa ojaxuri problemebi, imed
(Maudsley, 1879, p.83).
gacrueba siyvarulSi da bedis ukuRmarToba. fsi
miuxedavad imisa, rom mecxramete saukuneSi, amgvari
qikuri aSlilobis mniSvnelovan mizezebad miiC
fsiqiatriuli naSromebis avtorebi da fsiqiatriis
neoda epilefsia, alkoholis borotad gamoyeneba,
maswavleblebi xazs usvamdnen mravlobiTi mize
intensiuri masturbacia, mSobiaroba, laqtacia da
zebis arsebobas, bevri mkvlevari ufro viwro
menstrualuri ciklis xelovnuri Sewyveta. eskirolis
Tvalsazriszec idga da mxolod genetikur kvlevasa
dakvirvebiT, asaki zemoqmedebs daavadebis tipze.
da paTologiis Seswavlaze iyo fokusirebuli, rac
magaliTad, demencia ar gvxvdeba axalgazrdebSi,
ganapirobebda sakmaod pesimistur damokidebulebas
xolo mania ar aris tipiuri xandazmulTaTvis. is
mkurnalobis mimarT. Tumca, Sveicarieli fsiqiatri
aRiarebda, rom pirovnuli Tvisebebi xSirad asrulebs
adolf maieri (1866_1950), romelic StatebSi mu
dispoziciuri faqtoris rols.
Saobda, xazs usvamda fsiqologiuri da socialuri
naSromSi `fsiqikuri aSlilobis paTologia da
faqtorebis rols fsiqikuri aSlilobis etiologiaSi.
Terapia~ (Pathology and therapy of mental disorder`),
midgomas, romelic aSlilobis gamomwvevi mizezebis
romelic 1945 wels gamoqveynda, vilhelm grizingeri
dadgenisas iTvaliswinebs warsul gamocdilebas da
amtkicebda, rom fsiqikuri aSliloba warmoadgens
eyrdnoba saR azrs, maieri fsiqobiologias uwodebda.
tvinis fizikur darRvevas. man vrclad ganixila
is iTvaliswinebda memkvidreobiTobisa da tvinis
fsiqikuri daavadebis nevropaTologia, aseTive,
dazianebis mniSvnelobas, magram imasac aRniSnavda,
yuradReba miaqcia sxva mizezebs, maT Soris: mem
rom es faqtorebi modificirebulia cxovrebiseuli
kvidreobiT faqtors, alkoholis miRebis Cvevas,
gamocdilebiT, romelic xSirad gansazRvravs, iqneba
ojaxur usiamovnebebs, sasiyvarulo urTierTobebiT
Tu ara esa Tu is aSliloba klinikurad gamoxatuli.
miRebul travmasa da mSobiarobas. gansakuTrebiT
maieris midgomas dResac iTvaliswineben calkeuli
amaxvilebda yuradRebas mizezTa simravleze, rac
pacientis daavadebis etiologiis dadgenisas. gan
Semdegi citatidan Cans:
_ 93 _
5 etiologia
xiluli etiologiuri Teoriebi, umTavresad, exe aSlilobis mizezebis sirTules da isic kargad
boda ZiriTad fsiqikur daavadebebs. naklebad mZime esmodaT, rom arc etiologia da arc mkurnaloba ar
daavadebebs _ nevrozs, isterias, ipoqondrias da unda yofiliyo viwrod fokusirebuli imJamindel
msubuq depresias, ZiriTadad, zogadi profilis mecnierul ideebze, aramed unda yofiliyo farTo
eqimebi mkurnalobdnen. frangi nevrologi pier Jane da gaeTvaliswinebina nebismieri fsiqologiuri,
ikvlevda isteriis mqone pacientebs da maT reaqcias socialuri da biologiuri faqtorebi, romlebic
hipnozze. is Tvlida, rom isteria tvinis funqciuri yvelaze mniSvnelovania konkretul SemTxvevaSi.
darRvevis Sedegia da SeiZleba hipnoziT ganikurnos. Tanamedrove mecnierebi muSaoben neiromecnierebis
StatebSi ueir mitCelma gamoTqva mosazreba, rom swrafi ganviTarebis epoqaSi, magram maT unda
msubuqi qronikuli depresiis msgavs mdgomareobebs SeinarCunon farTo klinikuri midgoma etiologiis
iwvevs nervuli sistemis gamofitva, rasac man sakiTxebisadmi da, amave dros, gaiTvaliswinon
nevrasTenia uwoda. winamorbedTa Rirebuli miRwevebi.
avstriaSi nevrologma zigmund froidma sca
da nervuli daavadebebisaTvis ufro farTo gan fsiqoanalizi
marteba moeZebna (jer isteriis da mere sxva mdgo fsiqoanalizis kvlevis meTodi gansxvavdeba Semdgom
mareobebisaTvis). Tavidan froidi intress iCenda ganxiluli meTodebisagan, radgan fsiqoanalizi
fiziologiuri mizezebis mimarT. Semdeg man fsiqikuri aSlilobebis Seswavlidan aRmocenda, anu
gamoTqva mosazreba, rom es mizezebi TavianTi klinikuri gamocdilebidan da ara fundamenturi
bunebiT fsiqologiuria, oRond isini dafarulia mecnierebidan. fsiqoanalizs aqvs gansakuTrebiT
pacientisTvis, radgan misi fsiqikis aracnobierSi kargad damuSavebuli da farTo Teoria, romelic
imyofeba. froidi etiologias moiazrebda ganviTarebis exeba rogorc normalur, ise paTologiur fsiqikur
konteqstSi, radgan miaCnda, rom zrdasrulobaSi funqcionirebas. eqsperimentuli fsiqologiisagan
gamovlenili aSlilobis sawyisi bavSvis ganviTrebis gansxvavebiT, mas ufro fsiqikuri aqtivobis ira
procesSi iyo saZiebeli (ixileT qvemoT). safrangeTSi cionaluri aspeqti ainteresebs. fsiqoanalitikuri
pier Janem warmoadgina alternatiuli fsiqologiuri Teoria gvawvdis klinikuri fenomenebis mraval
modeli _ damyarebuli nervuli aqtivobis siZlieris ferovan axsna-ganmartebas da amitom gansakuTrebiT
cvalebadobasa da cnobierebis velis Seviwrovebaze. mimzidvelia. Tumca, is maxasiaTeblebi, romelTa gamoc
interesi fsiqologiuri axsna-ganmartebis mimarT maSin es Teoria amdenad mravlismomcvelia, arTulebs mis
gaCnda, rodesac nevropaTologiuri da genetikuri mecnierul Semowmebas.
gamokvlevebi veRar iZleoda axal mniSvnelovan fsiqoanalitikuri Teoria froididan momdina
informacias. froidma da misma mimdevrebma, fsiqozis reobs, magram masSi wvlili sxva avtorebmac Seitanes,
axsnis mizniT, scades nevrozis Teoriis gafarToeba. romelTaganac bevrma Seqmna alternatiuli Teoriebi.
miuxedavad imisa, rom Seiqmna fsiqologiuri Teoria, amjerad mxolod froidis Teoriaze iqneba saubari,
ver moxerxda axali obieqturi monacemebis miReba xolo sxvaTa Teoriebs wignis sxva nawilebSi gan
mZime fsiqikuri daavadebebis mizezebis Sesaxeb. Tumca, vixilavT. mocemuli Tavi exeba fsiqoanalizis ZiriTad
am Teoriebis mier SemoTavazebuli axsna-ganmarteba mosazrebebs, hipoTezebi konkretuli sindromebis
zogierTi fsiqiatrisaTvis ufro misaRebi gamodga, Sesaxeb sxva TavebSia warmodgenili.
vidre sakuTari uvicobis aRiareba. fsiqoanalizi fsiqoanalitikuri Teoria, ZiriTadad, eyrdnoba
sul ufro popularuli xdeboda, gansakuTrebiT fsiqoanalitikuri mkurnalobis procesSi miRebul
amerikul fsiqiatriaSi 1970-ian wlebmade. Semdeg monacemebs pacientis azrebis, fantaziebis, sizmrebisa
ganaxlda interesi fsiqikuri daavadebis genetikuri, da bavSvobisdroindeli gamocdilebis Sesaxeb. froidi
bioqimiuri da nevropaTologiuri mizezebis mimarT. Terapiis procesSi pasiur rolSi imyofeboda, raTa
am axal midgomas biologiuri fsiqiatria ewodeboda miRebuli masala pacientis Tavisufali asociaciebis
(Guze, 1989). gamomxatveli yofiliyo da ara froidis sakuTari,
albaT, fsiqikuri aSlilobis mizezebis dadgenis es winaswar Semzadebuli mosazrebebis.
mokle mimoxilva, pirvel rigSi, imas gveubneba, rom Tumca, froidi pacientis mier miwodebuli masa
yoveli Taoba Tavis etiologiur Teorias afuZnebda lis interpretirebasac axdenda da mis zogierT
Tavisi droisaTvis yvelaze aqtiur da damajerebel naSromSi Znelia mkafiod ganvasxvaoT froidiseuli
mecnierul midgomebze. zogjer fsiqologiuri interpretacia pacientis naTqvamisagan. aman gamoiwvia
ideebi xdeboda wamyvani, zogjer ki genetikur da azrTa sxvadasxvaoba imis Taobaze, Tu ra mniSvnelobis
nevropaTologiur mosazrebebs eniWebodaT upi matarebelia zrdasruli pacientis monaTxrobi bav
ratesoba. saukuneebis manZilze, dakvirvebuli Svobisdroindeli seqsualuri gamocdilebis Se
klinicistebi kargad acnobierebdnen fsiqikuri saxeb _ asaxavs is realur faqtebs, Tu aracnobier
_ 94 _
fantaziebs. gaugebrobas ZiriTadad ganapirobebda aracnobieri nawilis Sesaxeb. Tumca, froidma aseTi
froidis muSaobis specifikuri stili da is teqnika, ideebi originalurad daakavSira erTmaneTs. misi
romelsac is wlebis manZilze iyenebda aracnobieri koncefciis yvelaze mTavari aspeqti aracnobieri
masalis gamosaaSkaraveblad (ix. Esterson, 1998). fsiqikaa. froids miaCnda, rom yvela fsiqikuri
fsiqoanalizi farTo diapazonis mqone Teoriis procesi aracnobieridan iRebs saTaves. zogierT
nimuSia, romlis msgavsi sxva sferoebSic moiZebneba. process (magaliTad, SegrZnebebs) saSualeba eZleva
aseTi Teoriebis arseboba metad sasargebloa mec Tavisuflad SeaRwios cnobier fsiqikaSi, zogs _ ara
nierebisaTvis, radgan maTi meSveobiT iqmneba CarCo, (WeSmaritad aracnobier procesebs), zogi ki dro da
romlis SigniT mravalferovani ideebi yalibdeba. es dro SeaRwevs cnobierebaSi (mexsierebis SinaarsTa
Teoriebi ar unda Sefasdes mxolod imis mixedviT, umravlesoba, romelic `winacnobierSi~ imyofeba).
xdeba Tu ara maTSi `Semowmebadi~ hipoTezebis froidis Tanaxmad, aracnobier fsiqikas aqvs sami
formulireba. Tumca, imisaTvis, rom am Teoriebma maxasiaTebeli, romlebic mniSvnelovania nevrozis
imuSaos, maTSi unda moxdes dakvirvebaTa axali genezisis TvalsazrisiT:
Sedegebis integracia. amis magaliTia darvinis 1. aracnobieri gamocalkevebulia realobidan;
evoluciis Teoria, romelic imitom gadarCa, rom is
2. aracnobieri dinamikuria da Zlevamosil Zalebs
Seesabameba uaxles informacias, romelic genebisa
Secavs;
da geologiuri epoqebis ganamarxebuli organizmebis
SeswavliT miiReba. froidi fiqrobda, rom odesme 3. aracnobieri konfliqtSia cnobier fsiqikasTan.
moxdeboda misi mosazrebebis dasabuTeba Tavis es sami maxasiaTebeli cal-calke iqneba ganxiluli.
tvinis meqanizmebis gamoyenebiT, magram ukanasknel iTvleboda, rom aracnobieri fsiqika ramdenime
dromde mecnierebas tvinis Sesaxeb ar hqonda saxiTaa realobas mowyvetili. is Seicavs uzarmazar
sakmarisi konceptualuri da teqnikuri saSualebebi. winaaRmdegobebsa da paradoqsebs da azviadebs im
amJamad ukve SesaZlebelia zogierTi mniSvnelovani situaciebsa da fantaziebs, romlebic erTmaneTisagan
fsiqoanalitikuri cnebis neirobiologiuri safuZ droSia daSorebuli. froidis azriT, am Tvisebebs
vlebis gasagebad garkveuli cdebis gakeTeba (ixileT kargad gamokveTs sizmris analizi. mas miaCnda,
qvemoT). rom sizmris manifestirebuli Sinaarsis analiziT
rogorc ukve aRiniSna, fsiqiatriaSi erTmaneTisagan (Sinaarsi, romelic axsovs imas, vinc sizmars xe
ganasxvaveben movlenis gagebasa da axsnas. am Tval davs) SesaZlebelia misvla sizmris `latentur~
sazrisiT, fsiqoanalizi gagebis Zalian kargad SinaarsTan, romelic bavSvobisdroindel survils
damuSavebuli formaa, romelic cdilobs, uf warmoadgens. is, vinc xedavs sizmars, faqtiurad,
ro gasagebi gaxados, rogorc normaluri fsi sizmarSi asrulebs samuSaos, romelic warmoadgens
qikuri procesebis, ise fsiqikuri aSlilobis latenturi Sinaarsis manifestirebul Sinaarsad
buneba. fsiqonalizs ar mivyavarT iseT amxsnel gardaqmnas. gardaqmnisas gamoiyeneba sxvadasxva me
hipoTezasTan, romelic eqsperimentul Semowmebas qanizmi, rogorebicaa: SekumSva (ramdenime xatis
eqvemdebareba. miuxedavad amisa, mecnierebma scades erTSi gaerTianeba), grZnobebis gadanacvleba obi
misi ramdenime martivi hipoTezis Semowmeba. zemoT eqtis arsebiTi maxasiaTeblidan meorexarisxovan
ganvixileT fsiqologiuri gagebis Rirebuleba; aq maxasiaTebelze da meoradi damuSaveba, anu awyobili
kvlav SevCerdebiT am Temaze, sanam fsiqoanalitikuri elementebis gadawyoba. froidi did mniSvnelobas
Teoriis aRweraze gadavalT. fsiqoanalizs SeuZlia aniWebda sizmris am Teorias, radgan Tvlida, rom
ufro siRrmiseul doneze axsnas is, Tu ra xdeba nevrotuli simptomebis warmoqmna da sizmris
pacientis fsiqikaSi, Tumca, es sxva gzebiTac miiRweva. konstruireba erTnairi procesebia, oRond, meore
aq warmovadgenT froidis Teoriis ZiriTad aspeqtebs; SemTxvevaSi, ufro didia meoradi gadamuSavebis wili.
Cveneuli prezentacia bevrad moklea, vidre amas aracnobieri fsiqika dinamikuri struqturaa,
froidis Teoria imsaxurebs. dainteresebul mkiTxvels anu is Seicavs iseT impulsebs, romelTa balansis
SeuZlia gaecnos froidis originalur naSromebs SenarCuneba Semowmebisa da gawonasworebis mudmivi
(magaliTad `Sesavali leqciebi fsiqoanalizSi~ procesis meSveobiT xdeba. froidis adreuli
(Introductory Lectures on Psychoanalysis), romlebic axsna- naSromebis Tanaxmad, aracnobieri mxolod seqsualur
ganmartebis mkafio nimuSebia. impulsebs Seicavs. mogvianebiT, man ufro didi
aqcenti agresiul impulsebze gaakeTa. iTvleboda,
janmrTeli fsiqikis struqtura rom seqsualuri impulsebi adreul bavSvobaSic ki
froidis TeoriaSi Semavali mravali idea manamdec aqtiuria. maTi intensivoba klebulobs daaxloebiT
arsebobda sanam froidi Tavis fsiqologiur 4 wlis asakSi da latentur mdgomareobaSi im
kvlevas daiwyebda. magaliTad, idea fsiqikis yofeba pubertatul asakamde. froidis azriT,
_ 95 _
5 etiologia
fsiqoseqsualuri ganviTareba ara mxolod adre ganmartebis da arc rogorc praqtikuli saqmianobis
iwyeba, aramed is xangrZlivi da rTuli procesia. saxelmZRvanelo principis TvalsazrisiT. rac Seexeba
ganviTarebis pirveli faza oraluria, anu seqsualuri fsiqoanalitikur modgomas interpersonaluri ur
draivis aqtivacia xdeba wovisas piris stimulaciiT TierTobis mimarT, is kvlavac gamoiyeneba sxvadasxva
da tuCebiT Sexebis dros. meore faza analuria, saxis fsiqoTerapiaSi iseve, rogorc yoveldRiur
anu seqsualuri draivis aqtivacia xdeba fekaliebis fsiqiatriul praqtikaSi (22-e Tavi). garda amisa,
Sekavebis an gamonTavisuflebis gziT. genitaliebi fsiqoanalitikuri cnebebis meSveobiT SesaZlebelia
seqsualuri energiis pirvelad wyarod mxolod mesame ufro metis gageba aSlilobis etiologiis Sesaxeb.
fazaSi yalibdeba. zogjer sqesobrivi ganviTarebis am amJamad maTi kvleva neiromecnierebis gamoyenebiTaa
fazebis gavla ar xdeba umtkivneulod. libido, anu SesaZlebeli. arsebobs mravali magaliTi imisa, rom es
seqsualuri instinqtis energia, SeiZleba dafiqsirdes ori midgoma urTierTgadamkveTia (Tutte, 2004):
(anu datyvevebul iqnes) ganviTarebis erT-erT w is, rom mzrunvel pirze mijaWvuloba mniSvnelovania
adreul safexurze. aseT SemTxvevaSi, adamianis qceva bavSvis ganviTarebis TvalsazrisiT, mudmivad
infantiluri xdeba da stresis qveS misi qceviTi mtkicdeba cxovelebze dayenebuli eqsperimentebiTa
paternebi regress ganicdis. am mniSvnelobiT, da adamianebze Catarebuli gamokvlevebiT. mi
fiqsaciis adgili gansazRvravs im nevrozis xasiaTs, jaWvulobis wyvetas hopoTalamur hipofizarul
romelic Semdeg cxovrebaSi yalibdeba. adrenaluri sistemis funqcionirebaSi SeiZleba
libidos ganviTarebasa da sxvadasxva fazaSi mis Seuqcevadi Sedegebi mohyves, xolo zrdasrul asakSi
aqtivaciasTan erTad, icvleba is obieqtic, romelzec stresisadmi fiziologiuri da qceviTi adaptaciis
libidoa mimarTuli. sakuTari Tavis siyvaruls, gauareseba.
rogorc gogonebTan, ise vaJebTan, dedis siyvaruli
w mexsierebis proceduruli (implicituri, aracno
Caenacvleba. amis Semdeg, kvlav adreul bavSvobaSi,
bieri) sistemis formirebam, romelic muSaobs
biWebi ufro intensiurad warmarTaven dedaze TavianT
mexsierebis deklaraciul (eqsplicitur, cnobier)
seqsualur survilebs, xolo mamis mimarT mtruli
sistemasTan erTad, SeiZleba gansazRvros, Tu
damokidebuleba uCndebaT (oidiposis kompleqsi).
rogor imoqmedebs qcevaze travmuli gamocdileba
gogonebs sapirispiro saxis mijaWvuloba axasiaTebT,
aracnobieri meqanizmebis meSveobiT.
romelic qreba seqsualuri impulsebis represiis
w prefrontaluri korteqsis funqciaa aracnobieri
Sedegad. aqedan gamomdinare, Cndeba sircxvilisa da
masalis SerCeva eqsplicituri mexsierebis sacavidan
zizRis gancdis unari da bavSvi gadadis latentur
da operatiul mexsierebaSi misi Semotana cnobieri
fazaSi. da bolos, seqsualuri impulsebi kvlav iCens
Sefasebis, dagegmvisa da qmedebis uzrunvelsayofad.
Tavs pubertatul periodSi da warimarTeba sxva
amgvarad, prefrontaluri korteqsi SegviZlia
zrdasrul adamianebTan urTierTobebis damyarebis
ganvixiloT, rogorc tvinis iseTi ubani, romelic
mimarTulebiT.
egos `saSemsruleblo funqciasTan~ dakavSirebuli
aracnobieri fsiqikis mesame aspeqtia _ brZola
aqtivobebis koordinacias ganagebs.
cnobieri fsiqikis winaaRmdeg. es konfliqti
ganixileba iseTi SfoTvis wyarod, romelic SeiZleba
SenarCundes mTeli cxovrebis manZilze da romelmac mecnieruli disciplinebis wvlili
SesaZloa warmoSvas nevrotuli simptomebi. froidis fsiqikuri daavadebebis
erT-erTi mniSvnelovani ideaa is, rom SfoTva etiologiis dadgenaSi
SeiZleba Sesustdes sxvadasxva dacviTi meqanizmebis
cxrili 5.1 gviCvenebs disciplinaTa im jgufebis
gamoyenebiT, romlebic dro da dro janmrTeli
CamonaTvals, romelTac TavianTi wvlili Seitanes
adamianis qcevaSic iCens Tavs. es meqanizmebi
fsiqikuri daavadebebis etiologiis ganszaRvraSi.
ganxilulia ?? gverdze.
mocemul TavSi TiToeuli jgufi ganxilulia Tan
mimdevrulad da gacemulia pasuxebi Semdeg kiTxvebze:
fsiqoanalizi da fsiqiatria
w calkeulma disciplinam fsiqikur aSlilobaTa
froidis ideas Zalian didi gavlena hqonda fsiqiatriis
etiologiis ra problemebs SeiZleba gasces pasuxi?
sferoSi. misi mosazreba imis Sesaxeb, rom ganviTarebis
procesebi mniSvnelovan rols TamaSobs daavadebis w zogadad, ra saxiT cdilobs TiToeuli disciplina
etiologiaSi, farTodaa miRebuli. miuxedavad am kiTxvebze pasuxis gacemas?
amisa, froidis Teoriis mraval detals (mag., w Cndeba Tu ara konkretuli sirTuleebi, rodesac
aracnobieri homoseqsualizmis, rogorc paranoiduli am disciplinebis meTodebs viyenebT fsiqikuri
mdgomareobebis gamomwvevis mniSvneloba) ar mieca aSlilobebis etiologiis axsnisas?
mniSvneloba arc klinikuri sindromis etiologiuri
_ 96 _
mecnieruli disciplinebis wvlili fsiqikuri daavadebebis etiologiis dadgenaSi
ganxiluli, uaxlesi sabuTia imisa, Tu rogor
cxrili 5.1 mecnieruli disciplinebi, gviRrmavebs Semdgomi klinikuri dakvirveba codnas
romlebsac TavianTi wvlili SeaqvT fsiqkuri
SedarebiT msubuqi guneb-ganwyobis aSlilobisa
daavadebebis etiologiis dadgenaSi
da bipolaruli aSlilobis urTierTkavSiris Se
aRweriTi klinikuri gamokvlevebi saxeb. kargad Catarebuli klinikuri gamokvleva,
epidemiologia albaT, kidev didxans SeinarCunebs saTanado adgils
fsiqiatriul mecnierebaSi.
socialuri mecnierebebi
eqsperimentuli da klinikuri fsiqologia epidemiologia

genetika epidemiologia Seiswavlis konkretuli populaciis
bioqimiuri gamokvlevebi SigniT daavadebis ganawilebas drosa da sivrceSi da,
aseve, im faqtorebs, romlebic am saxis ganawilebaze
farmakologia
zemoqmedebs. misi interesebis sferoa adamianTa
endokrinologia
jgufebi da ara calkeuli individi.
fiziologia
epidemiologiis cnebebi da meTodebi
nevropaTologia
epidemiologiis ZiriTadi cneba aris sixSire (rate),
aRweriTi klinikuri gamokvlevebi anu mocemul populaciaSi SemTxvevaTa raodenobis
manam, sanam ganvixilavdeT ufro srulyofilad Tanafardoba adamianebis raodenobasTan. SemTxveva
damuSavebul mecnierul midgomebs etiologiis SeiZleba gavigoT, rogorc (1) daavadebis epizodi
mimarT, gvsurs mkiTxvelis yuradRebis mipyroba an (2) amJamad an warsulSi daavadebuli adamianebi.
martivi klinikuri gamokvlevis Rirebulebaze. fsi SegviZlia gamoviTvaloT an mocemul momentSi ar
qiatria swored aseT gamokvlevebs efuZneba. maga sebuli sixSire (point prevalence), an sixSire drois
liTad, Tvalsazrisi, rom Sizofreniasa da guneb- garkveul intervalSi (period prevalence).
ganwyobis aSlilobas, savaraudod, gansxvavebuli garda amisa, epidemiologiis sakvanZo cnebebia
mizezebi aqvs, ZiriTadad, emyareba fsiqiatrebis avadobis sixSire (ganisazRvreba im adamianebis ra
Zveli Taobis mier Catarebul skrupulozur aRweriT odenobiT, romlebic janmrTelni iyvnen garkveuli
gamokvlevebs da Semdgom dakvirvebebs. periodis dasawyisSi, xolo, Semdeg, imave periodSi
mas, visac eWvi epareba imaSi, Tu ramdenad Rirebulia daavadnen), da avadobis albaToba cxovrebis manZilze
aRweriTi klinikuri gamokvlevebi, vurCevT gaecnos (ganisazRvreba im adamianebis raodenobiT, romlebsac,
obri luisis naSroms melanqoliis Sesaxeb (Lewis, SesaZlebelia, cxovrebis manZilze ganuviTardeT gar
1934), romelSic warmodgenilia mZime depresiuli kveuli daavadeba). kohortul gamokvlevebSi ada
aSlilobis 61 SemTxveva da am aSlilobis niSnebisa da mianebis jgufs akvirdebian garkveuli periodis
simptomebis detaluri kvleva. esaa inglisur enaze manZilze, raTa daadginon konkretuli maxasiaTeblebis
dawerili yvelaze srulyofili aRweriTi gamokvleva, gaCena an Secvla potenciurad mniSvnelovani adreuli
yvelaze Rirebuli wyaro depresiuli aSlilobis im faqtoris zemoqmedebis pirobebSi an misi zemoqmedebis
klinikuri niSnebis Sesaxeb, romelTa mkurnaloba ver gareSe (magaliTad, moweva da filtvis avTvisebiani
xerxdeba Tanamedrove meTodebis gamoyenebiT. luisis simsivne).
dakvirvebebma mecnierTa yuradReba miapyro iseT epidemiologiaSi gansakuTrebiT mniSvnelovania Sem
gadauWrel problemebs, rogorebicaa fsiqomotoruli degi sami meTodologiuri aspeqti:
Sekaveba, depersonalizaciis kavSiri afeqtur 1. risk-jgufebis gansazRvra;
cvlilebebTan, maniakaluri simptomebis arseboba, 2. daavadebis gansazRvra;
reaqtiul da endogenur jgufebad depresiuli 3. daavadebis SemTxvevaTa gamovlena.
aSlilobis klasifikaciis validuroba. jer-jerobiT
Zalian mniSvnelovania risk-jgufebis zustad gan
verc erTi am problemis gadaWra ver moxerxda, magram
sazRvra. es populacia SeiZleba moicavdes garkveul
luisis analizi mniSvnelovania Tundac imitom, rom
teritoriaze mcxovreb yvela adamians (mag., qveyana,
is maTze amaxvilebs yuradRebas.
kunZuli an mikroraioni), an kidev qvejgufs, romelSic
miuxedavad imisa, rom xsenebuli problemebi mra
erTi da imave asakis, sqesis an sxva potenciurad mniS-
valmxriv da araerTgzis iyo gamokvleuli es ar niSnavs
vnelovani saerTo niSnebis mqone adamianebi Sedian.
imas, rom klinikurma gamokvlevam Tavisi Rirebuleba
fsiqiatriaSi daavadebis gansazRvra erT-erTi cen-
dakarga. magaliTad, judis da misi Tanaavtorebis
traluri epidemiologiuri problemaa. SedarebiT ad-
gamokvleva (Judd et al., 2002), romelic me-6 TavSia
vilia iseTi mdgomareobis dadgena, rogoricaa daunis
_ 97 _
5 etiologia
sindromi, magram fsiqiatriuli diagnozis sandooba da klinikur da socialur cvladebs Soris. aseTi
dRemde aradamakmayofilebelia. standartuli kiTx- kavSirebis codna, SesaZloa sasargeblo iyos klini-
varebis SemuSavebam, romelTa meSveobiTac xdeba fsiqkuri TvalsazrisiT. magaliTad, epidemiologiurma
ikuri daavadebebis gamovlena, identifikacia, kla- gamokvlevebma aCvena, rom suicidis riski gazrdilia
sifikacia da Sefaseba, didad gaaumjobesa viTareba garkveuli maxasiaTeblebis mqone xanSi Sesul mamaka-
epidemiologiuri kvlevis sandoobisa da validobis cebTan. am kategoriis mamakacebi, Cveulebriv, marto
TvalsazrisiT. cxovroben, borotad moixmaren narkotikebs an alko-
daavadebis SemTxvevebis gamosavlenad or meTods hols, aReniSnebaT fsiqikuri aSliloba da suicidis
iyeneben. pirveli gulisxmobs yvela im SemTxvevis ojaxuri anamnezi.
aRricxvas, romelic samedicino da sxva saxis orga-
nizaciebisaTvis aris cnobili (gancxadebuli SemTx- garemoSi arsebuli mizezebi
vevebi). hospitalizaciis SemTxvevaTa raodenoba sak- epidemiologiuri kvlevis obieqtia predispoziciuri
maod informaciulia im daavadebaTa sixSiris dasa- da precipitatuli faqtorebi, aseve, misi interesebis
dgenad, romlebic `did fsiqiatrias~ ganekuTvneba, sferoSi Sedis fsiqikuri daavadebis pirovnuli da
magram nakleb informaciulia afeqtur da SfoTviT socialuri korelatebis analizi. predispoziciuri
aSlilobaTa umetesobis sixSiris dasadgenad. garda faqtorebidan memkvidreobiTobis zegavlenas Seiswav-
amisa, hospitalizaciis SemTxvevaTa sixSireze mrava- lian ojaxebis, tyupebisa da naSvilebi pirebis kvlevis
li cvalebadi faqtori zemoqmedebs (mag., saavadmyo- meSveobiT, rac genetikisadmi miZRvnil qveTavSia gan-
foebis teritoriuli siaxlove, eqimebis damokideb- xiluli. imave rigis gamokvlevebSi Seiswavleba dedis
uleba stacionaruli mkurnalobis mimarT, hospital- asakis zegavlena daunis sindromiT daavadebis riskze
izaciasTan dakavSirebuli wesebi da kanonmdebloba, da adreul bavSvobaSi mSoblis dakargvis efeqti. pre-
romelic aregulirebs aranebayoflobiT hospital- cipitatuli faqtorebis Semswavleli gamokvlevebi
izacias). swavlobs cxovrebiseul movlenebs, rac ganxilulia
meore meTodi gulisxmobs gancxadebuli da ara- qveTavSi, romelic socialur mecnierebebs eZRvneba.
gancxadebuli SemTxvevebis dadgenas mocemul raionSi. etiologiis mimarT epidemiologiuri midgomis ma-
amgvar viTarebaSi yvelaze Sedegiania oretapiani galiTia gamokvlevebi, romlebic iZiebs korelacias
gamokvlevis Catareba. pirvel etapze tardeba winas- garemo faqtorebsa da fsiqikur aSlilobas Soris.
wari skriningi daavadebebis potenciuri SemTxvevebis magaliTad, cnobilia, rom Sizofrenia ufro gavrce-
aRsaricxavad. am dros gamoiyeneba iseTi TviTSe- lebulia qalaqSi (gansakuTrebiT qalaqis centralu-
fasebis formebi, rogoricaa janmrTelobis zogadi ri nawilis im raionebSi, sadac mdgomareoba naklebad
mdgomareobis sakvlevi kiTxvari (General health question- saxarbieloa). es faqti an etiologiuri Tvalsazri-
naire, Goldberg, 1972). pirvel etaps mosdevs potenci- siTaa mniSvnelovani, an warmoadgens imis Sedegs, rom
uri SemTxvevebis klinikuri gamokvleva standartuli Sizofreniis ganviTarebis adreul etapze adamianebi
fsiqiatriuli intervius gamoyenebiT. izolaciaSi yofnas amjobineben. am sakiTxTan dakavSi-
rebulma uaxlesma kvlevebma (van Os et al., 2003) daamt-
epidemiologiuri gamokvlevis miznebi kica, rom fsiqozis gavrcelebis xarisxi aCvenebs wr-
fsiqiatriaSi epidemiologiurma kvlevam pasuxi unda fiv korelacias urbanizaciis xarisxTan (Seusabamobis
gasces sam ZiriTad kiTxvas: saerTo koeficienti: 1.57, 95% CI 1.30_1.89). es mniSv-
1. rogoria fsiqikuri aSlilobis gavrcelebis six- nelovani efeqti ar Seamcira iseTi faqtorebis gaTva-
Sire mocemul risk-jgufSi? liswinebamac, rogorebicaa asaki, genderi, ganaTlebis
done, mSoblis fsiqikuri daavadebis istoria da daba-
2. romelia fsiqikuri aSlilobis klinikuri da soci-
debis adgili (qveyana).
aluri korelatebi?
rogorc es mosalodneli iyo, gamoikveTa kidev erTi
3. romeli faqtorebi SeiZleba iyos mniSvnelovani
Zlieri da damoukidebeli faqtori _ fsiqozis oja-
etiologiuri TvalsazrisiT?
xuri istoria, romelic zemoqmedebs fsiqozis ganvi-
daavadebis gavrcelebis sixSiris dadgena xdeba Te- Tarebis riskze (Seusabamobis koeficienti: 4.59, 95%
mis doneze SerCeuli populaciis, zogadi profilis CI 2.41_8.74). Semdgomma analizma aCvena, rom urbaniza-
eqimTa pacientebisa da stacionaruli pacientebis cia bevrad ufro metad zrdis fsiqozis ganviTarebis
raodenobis gaTvaliswinebis safuZvelze. etiolo- risks fsiqozis ojaxuri istoriis mqone individeb-
giuri monacemebis Segrovebas xels uwyobs daavadebis Tan, vidre im pirebTan, romlebsac aseTi istoria ara
gavrcelebis xarisxis dadgena sxvadasxva geografiul aqvT. es monacemebi genebsa da garemos Soris arsebul
teritoriebze, socialur jgufebsa da klasebSi. ima- mniSvnelovan urTierTkavSirebze miuTiTebs: urbani-
ve mizans emsaxureba kavSirebis dadgena daavadebasa zaciis uaryofiTi efeqti (garemos efeqti) gansakuT-
_ 98 _
rebiT aisaxeba im individebze, romelTac axasiaTebT etiologiuri TvalsazrisiT.
genetikuri predispozicia fsiqozis mimarT. sapirispirod amisa, depresiuli aSlilobis gavr
celebis xarisxi sxvadasxva kulturaSi sakmaod
socialuri mecnierebebi gansxvavebulia. krosnacionalurma TanamSromlobiTma
sociologebis mier gamoyenebuli mravali cneba re- jgufma (Weissman et al., 1996) daadgina, rom depresiis
levanturia fsiqiatriis mimarT (ix. cxrili 5.2). sa- gamovlenis sixSire 1.5%-ia taivanSi da 19% _ libanSi.
mwuxarod, am cnebaTagan zogierTi, romelic poten- garda amisa, depresiuli mdgomareobis klinikuri
ciurad Zalian sasargebloa, yovelgvari kritikis ga- suraTic metad mravalferovania. aSkarad gamoxatuli
reSe gamoiyeneba. magaliTad, iTvleba, rom fsiqikuri somaturi simptomebi ufro gavrcelebulia ara
daavadeba aris mxolod da mxolod iseTi iarliyi, dasavlur kulturebSi. amave dros, naRvliani gan
romelic socialuri gadaxris mqone adamianebis mi- wyoba, sixarulis gancdis Sesusteba, SfoTva da
marT ixmareba (`miTi fsiqikuri daavadebis Sesaxeb.~). energiis nakleboba yvela tipis sazogadoebis war
es imaze mianiSnebs, rom saWiroa iseTi sociologiuri momadgenelTaTvis saerTo simptomebia (Bhugra and
Teoriebis SemuSaveba, romlebic, sxva nebismieri Teo- Mastrogianni 2004).
riis msgavsad, unda Semowmdes (anu Sesabamisi monace-
cxovrebiseuli movlenebis Seswavla
mebis Segrovebis gziT).
socialur gamokvlevebSi epidemiologiur meTodebs
sociologiisa da socialuri fsiqologiis zogier-
iyeneben avadmyofobasa da pirovnebis cxovrebaSi
Ti cneba urTierTgadamkveTia (magaliTad, atribuciis
momxdar movlenebs Soris kavSiris dasadgenad.
Teoria, romelic exeba adamianis mier cxovrebiseul
adreul gamokvlevebSi, volfma (Wolff, 1962) ramdenime
movlenaTa mizezebis interpretaciasa da TviTSefase-
aseul adamianTan Seiswavla avadobis maCveneblebi.
bis cnebasTan dakavSirebuli mosazrebebs). sociolo-
am monacemebs igi mravali wlis manZilze agrovebda
giur kvlevaTa nawili, romelic Seiswavlis cxovre-
da aRmoaCina, rom avadmyofobis epizodebi emTxveva
biseul movlenebs, epidemiologiur meTodebs iyenebs
pirovnebis cxovrebaSi momxdar cvlilebaTa periods.
(ix. qvemoT).
holmsma da rahem (Holmes and Rahe, 1967) scades im
transkulturaluri kvlevebi Zalze subieqturi meTodebis gaumjobeseba, romelTac
sxvadasxva sazogadoebaSi Catarebuli gamokvlevebi volfi iyenebda. maT gaakeTes nusxa, romelSic 41
gvexmareba davadginoT etiologiuri TvalsazrisiT saxis cxovrebiseuli movlena Seitanes (mag., samuSao,
mniSvnelovani gansxvavebebi. fsiqikuri aSlilobis sacxovrebeli adgili, finansebi, ojaxuri kavSirebi)
biologiurad gansazRvruli maxasiaTeblebi, rogorc da TiToeuls, simZimisda mixedviT, garkveuli qu
Cans, msgavsia sxvadasxva kulturaSi, maSin, roca la mianiWes. magaliTad, 100 qula _ meuRlis gar
fsiqologiurad da socialurad gansazRvruli niS dacvalebas, xolo 13 qula _ samsaxuridan droebiT
nebi gansxvavebulia. ase magaliTad, Sizofreniis `Zi daTxovnas.
reuli~ simptomebis sixSire msgavsia gansxvavebul garda amisa, cxovrebiseuli movlenebis fsiqo
sazogadoebebSi, rac imas niSnavs, rom saerTo ne logiuri zemoqmedebis Seswavlis srulyofis mizniT,
irobiologiuri anomaliis arseboba mniSvnelovania mkvlevarebma garkveul zomebs mimarTes:
w raTa Tavidan aecilebinaT mexsierebiT gamowveuli
Secdomebi daadgines is periodi, romelTan dakav
cxrili 5.2 fsiqiatriis mimarT socialuri
Teoriis gamoyenebis zogierTi magaliTi SirebiTac moxdeboda movlenaTa gaxseneba;
w Seecadnen, daedginaT avadmyofobis dawyebis zusti
cneba gamoyeneba
TariRi;
socialuri klasi da fsiqoaqtiuri nivTierebis
avadm oxmarebis epidemiologia w Seecadnen, gamoericxaT iseTi movlenebi, romlebic
qvekultura
aSkarad ar iyo dakavSirebuli avadmyofobasTan (ma
stigma da iarliyis sirTuleebi, romelsac awyde galiTad, samuSaos dakargva cudad muSaobis gamo);
miwera bian mZime fsiqikuri daava
debis mqone adamianebi sazo w Seecadnen movlenaTa daxasiaTebas maTi bunebis
gadoebaSi cxovrebisas (magaliTad, danakargi an saSiSroeba) da simZimis
institucionalizacia hospitalizaciis uaryofiTi TvalsazrisiT;
qceviTi efeqti
w scades monacemebis Segroveba naxevrad struqturi-
socialuri deviacia danaSaulebrivi qceva rebuli intervius gamoyenebiT da maTi sandoobis
avadmyofobasTan dakav fizikuri daavadebis fsiqo maRal doneze Sefaseba.
Sirebuli qcevis anoma logiuri Sedegebi
miuxedavad imisa, rom calkeuli cxovrebiseuli
luroba movlenebis mniSvneloba aRiarebulia, sinamdvileSi,
_ 99 _
5 etiologia
maTi gavlena arc ise didia, rogorc es pirveli Sexed- im adamianisaTvis, romelsac bavSvobaSi ganucdia
viT Cans. magaliTad, erT-erTi gamokvlevis Tanaxmad, igive. amgvarad, uaryofiTma gamocdilebam, romelic
respondentis socialuri velidan axlobeli ada- droSia daSorebuli uaryofiTi cxovrebiseuli mov-
mianis gasvlis faqti (misi gardacvalebis an masTan lenisagan, SeiZleba ganawyos adamiani imisaken, rom
ganSorebis gamo) dafiqsirda depresiuli aSlilobis mas SemdgomSi ganuviTardes fsiqikuri aSliloba.
mqone pacientebis 25%-Tan da sakontrolo jgufis xolo, danarCeni ori mizezia is, rom garkveulma am-
mxolod 5%-Tan. es aSkarad STambeWdavi gansxvaveba Jamindelma faqtorebma SeiZleba gazardos pirovnebis
statistikurad mniSvnelovani gamodga 1%-is doneze. mowyvladoba cxovrebiseuli movlenebis mimarT an
Tumca, am monacemTa Rirebuleba feiqkelma (Paykel, daicvas igi maTgan. mosazrebebi am ori faqtoris Ses-
1978) Semdegnairi gamoTvlebis gziT eWvqveS daayena: axeb, ZiriTadad, eyrdnoba brounisa da harisis naS-
depresiuli aSlilobis sixSire zustad ar aris romebs (Brown and Harris, 1978). am avtorebis Tanax-
gansazRvuli, magram, Tu vivaraudebT, rom is Sead- mad, qalebTan mowyvladobis faqtorebia mcirewlovan
gens 6 Tvis manZilze gamovlenili axali SemTxvevebis bavSvze zrunvis valdebuleba da umuSevroba, xolo
2%-s, maSin 10 000 adamianisagan Semdgar hipoTetur dacvas uzrunvelyofs pirovneba, romelsac SeuZlia
populaciaSi, aseTi axali SemTxvevebis raodenoba 200 maTi problemebis gaziareba. damcavi faqtorebis cne-
iqneba. Tu socialuri velidan gasvlis faqti dadg- ba Semotanil iqna iseTi faqtis asaxsnelad, rodesac
inda im adamianebis 5%-Tan, romlebsac ar ganuviTar- zogierTi adamiani ar xdeba avad mZime viTarebaSi mox-
daT depresiuli aSliloba, hipoTetur populaciaSi, vedrisas. uaxlesi gamokvlevebis Tanaxmad, zogierT
velidan gasvlis faqti Segvxvdeboda 9800 adamianidan kulturaSi damcavma da mowyvladobis faqtorebma
490-Tan, romlebic ar warmoadgenen axal SemTxvevebs. SeiZleba Secvalos reqcia cxovrebiseul stresul
200 axali SemTxvevidan, velidan gasvla Segvxvdeboda movlenebze. magaliTad, zimbabveSi, urbanul teri-
25%-Tan, anu 50 adamianTan. amgvarad, im adamianTa er- toriebze mcxovreb qalebTan, ojaxis mxardaWeris
Toblioba, romlebmac gamocades socialuri velidan gamo, mniSvnelovnad Semcirda mZime cxovrebiseuli
gasvlis fenomeni, Seadgenda 490 + 50, anu 540, saidanac movlenebiT gamowveuli depresiis ganviTarebis riski
mxolod 50-s (anu 10-dan 1-ze naklebs) ganuviTarde- (Broadhead et al., 2001).
boda depresiuli aSliloba. Sesabamisad, depresiuli
ojaxuri mizezebi
aSlilobis gansazRvrisas gaCenili am gansxvavebis
didi nawili raime sxva faqtors unda mivaweroT, es arsebobs mosazreba, rom zogjer fsiqikuri aSli-
ki imas niSnavs, rom cxovrebiseuli movlenebi biZgs loba gamoxatavs ojaxSi arsebul emociur aSlilobas
aZlevs depresiis ganviTarebas, ZiriTadad, winaswari da ara mxolod im adamianisas, romelic mkurnalobas
dispoziciis mqone individebTan. saWiroebs (ìdentificirebuli pacienti~). miuxedavad
am mosazrebas logikurad mivyavarT mowyvladobisa imisa, rom ojaxuri problemebi xSirad aqvT fsiqikuri
da damcavi faqtorebis gaTvaliswinebis aucileblo- aSlilobis mqone adamianebs, maTi mniSvneloba daa-
basTan (ix. qvemoT). aq isic unda aRiniSnos, rom ge- vadebis etiologiaSi aSkarad gazviadebulia, radgan
netikuri epidemiologiis gamokvlevebma seriozuli ojaxis wevrebis emociuri xasiaTis sirTuleebi Sei-
wvlili Seitana cxovrebiseuli movlenebis Seswavlis Zleba pacientis problemebis Sedegs warmoadgendes
saqmeSi, aCvena ra, rom uaryofiTi cxovrebiseuli da ara mizezs. garda amisa, ar aris gamoricxuli,
movlenebis gancdis tendencia nawilobriv geneti- rom axlo naTesavebis emociuri xasiaTis sirTuleebi
kuri faqtoriTaa ganpirobebuli. magaliTad, adami- saerTo genetikuri memkvidreobiT iyos ganpirobe-
anebi genetikurad gansxvavdebian imiT, Tu ramdenad buli. magaliTad, Sizofreniis mqone bavSvebis mSo-
arian midrekilni àirCion~ is garemo, romelic maT blebs axasiaTebT Sizotipuri pirovnuli aSlilobis
uaryofiTi cxovrebiseuli movlenebis gancdis ufro gazrdili riski (gv. ??). savaraudoa, rom ojaxur sir-
maRali riskis qveS daayenebs. alabaT, es aris erT- Tuleebs SeuZlia ukve Camoyalibebuli aSlilobis
erTi midgoma, romliTac SeiZleba aixsnas genetikuri mimdinareobis Secvla. magaliTad, ojaxis wevrebTan
mowyvladoba depresiis mimarT (Kendler et al., 2004). `gamoxatuli emociebis~ maRali intensivoba zrdis
Sizofreniis mqone pacientebTan daavadebis xelaxa-
mowyvladobisa da damcavi faqtorebi li gamwvavebis risks (gv. ??). rac Seexeba imas, rom
adamianebi cxovrebiseul movlenebze gansxvavebul fsiqikur aSlilobaTa umetes SemTxvevaSi, aSlilobis
reaqcias sami mizeziT iZlevian. jer erTi, erTsa da gamomxatveli niSnebi ojaxis sxva wevrebsac aReniS-
imave movlenas sxvadasxva adamianisaTvis SeiZleba nebaT, tyupebze Catarebuli gamokvlevebi gviCvenebs,
gansxvavebuli mniSvneloba hqondes misi warsuli ga- rom saerTo (ojaxuri) garemo naklebad mniSvnelovani
mocdilebidan gamomdinare. magaliTad, ojaxis wevr- faqtoria, vidre saerTo genebi.
Tan ganSoreba SeiZleba ufro mtkivneuli aRmoCndes
_ 100 _
migracia w is aRiarebs uwyvetobas normasa da paTologias

sacxovreblad gadasvla sxva qveyanaSi an imave qveynis Soris. am Sexedulebas iseT kvlevasTan mivyavarT,
sxva teritoriaze iseTi cxovrebiseuli cvlilebaa, romelic cdilobs, fsiqiatriuli anomaliebi axsnas
romelic SeiZleba CaiTvalos fsiqikuri aSlilobebis normaluri qcevis ganmsazRvreli procesebiT.
gamomwvev mizezad. mecnierTa mier dadgenilia aseT w mas ainteresebs pirovnebisa da garemos urTierTq-
cvlilebebTan dakavSirebuli Semdegi meqanizmebi: medeba. fsiqologiuri midgoma imiT gansxvavdeba
w seleqciuri migracia. iseTi daavadebis adreul socialurisagan, rom mas naklebad ainteresebs
etapze, rogoricaa, magaliTad, Sizofrenia, mi- garemos cvladebi da ufro metadaa fokusirebuli
graciis mizezi SeiZleba iyos is, rom adamiani imaze, Tu rogor gadaamuSavebs adamiani garemodan
ver axerxebs sakuTar samSobloSi socialuri kon- da sakuTari sxeulidan momdinare informacias.
taqtebis SenarCunebas. w fsiqologia yuradRebas amaxvilebs im faqtore-
w migraciis procesi. migraciis procesTan dakavSire- bze, romlebic xels uwyobs paTologiuri qcevis
bulma movlenebma (fizikuri da emociuri travma, SenarCunebas. fsiqologebi ar ganixilaven qcevas,
molodinis gaxangrZlivebuli periodi, gamofitva, rogorc daavadebis Sinagani procesis Sedegs; isini
socialuri deprivacia, izolacia) SeiZleba gamoi- varaudoben, rom qcevis SenarCuneba xdeba daZle-
wvios stresTan dakavSirebuli ramdenime saxis vis anomaliuri meqanizmebis wyalobiT, rogoricaa,
aSliloba. magaliTad, SfoTvis Semcirebis mizniT ganridebis
strategiis gamoyeneba.
w migraciis Semdgomi faqtorebi. migraciis Semdeg
xdeba mravali faqtoris aqtivacia, ramac SeiZleba neirofsiqologia
zegavlena moaxdinos fsiqikuri aSlilobis ganvi- neirofsiqologiasa da biologiur fsiqiatrias saer-
Tarebis riskze. amgvari faqtorebia iseTi arasa- To safuZveli aqvs, radgan orive cdilobs fsiqolo-
surveli socialuri movlenebi, rogorebicaa ra- giuri fenomenebis neirobiologiuri substratebis
sobrivi diskriminacia da akulturacia. akultu- identificirebas. amisaTvis sxvadasxva meTodologia
raciis dros xdeba tradiciuli kulturaluri gamoiyeneba, magram, nebismier SemTxvevaSi, saboloo
struqturebis rRveva, rac iwvevs TviTSefasebis mizania fsiqopaTologiis neiromecnierebis konte-
daqveiTebas da socialuri mxardaWeris dakargvas. qstSi gageba. amis ganxorcieleba xdeba cxovelebze
aseve, stresi da depresia SeiZleba gamoiwvios gan- eqsperimentebis Catarebisa da adamianebis Seswavlis
sxvavebam aspiraciis donesa da realur miRwevas gziT, kerZod Tavis tvinis garkveuli dazianebisa da
Soris. da bolos, imigrantebi SeiZleba aRmoCndnen fsiqikuri aSlilobis mqone pacientebis gamokvleviT.
ucxo virusebis zemoqmedebis qveS, ramac, SesaZloa, magaliTad, cxovelebze Catarebuli eqsperiment-
Tavis mxriv, imoqmedos embrionis ganviTarebaze da ebi gviCvenebs, rom SiSis fenomenSi gadamwyvet rols
ganapirobos fsiqikuri aSlilobis aRmoceneba Sem- amigdala TamaSobs. radgan amigdala TalamusTan aris
deg TaobaSi. dakavSirebuli, mis aqtivacias axdens safrTxis Sem-
cnobilia, rom zogierT eTnikur jgufSi imigracia cveli stimuli. amigdalas SeuZlia SiSis avtonomi-
dakavSirebulia fsiqozis ufro maRal sixSiresTan, uri reaqciis gamowveva safrTxis gacnobierebamde.
magram amis meqanizmi ar aris cnobili (ix. me-12 Tavi). es sqema travmul gamocdilebasTan daakavSira le
imigraciis gavlena sxva fsiqikur aSlilobebze nakleb duqsma (LeDoux, 1998), risTvisac man dauSva orive
Tanmimdevrulia. zog jgufSi aRiniSneba fsiqikuri sistemaSi disbalansis arsebobis SesaZlebloba _ ro-
janmrTelobis gaumjobeseba, SedarebiT adgilobriv gorc emociuri mexsierebis implicitur (aracnobier)
populaciasTan. aSkaraa, rom ltolvilebSi, romleb- sistemaSi (romelic moicavs Talamussa da amigdalas),
mac devnas daaRwies Tavi, aRiniSneba ufro gamokveTi- ise mexsierebis eqsplicitur (cnobier) deklaraciul
li, strestTn dakavSirebuli simptomatologia. mra- sistemaSi (romelic safeTqlis wilsa da hipokampuss
val ltolvils aqvs posttravmuli stresuli aSli- moicavs) (ix. qvemoT).
lobis simptomebi. Tumca, mniSvnelovania, rom am simp- neirofsiqologiuri gamokvlevebi, cxovelebze
tomebis interpretireba iseTi saxiT gakeTdes, rom Catarebuli eqsperimentuli gamokvlevebis msgavsad,
gaTvaliswinebul iqnes mocemul kulturaSi travmul adamianebsac utardebaT. mniSvnelovani informaci-
gamocdilebasTan gamklavebis specifika (Bhugra, 2004). is mopoveba SesaZlebelia im individebis SeswavliT,
romelTac aReniSnebaT Tavis tvinis mkafiod lokali-
eqsperimentuli da klinikuri fsiqologia zebuli dazianeba. magaliTad, amigdalas bilateral-
fsiqikuri aSlilobebis etiologiis mimarT fsiqolo- uri dazianebis mqone pacientebs SeuZliaT adamianis
giuri midgoma Semdegi TaviseburebebiT xasiaTdeba: saxis amocnoba, magram isini ver cnoben SiSis amsaxvel
_ 101 _
5 etiologia
gamometyvelebas. es faqti amtkicebs im mosazrebas, amis ilustraciaa strupis testis modificirebuli
rom amigdala mniSvnelovan rols asrulebs SiSTan variantis gamoyeneba. testis Sesrulebisas cdis pirs
dakavSirebuli stimulebis gadamuSavebaSi. moeTxoveba, daasaxelos im fonis feri, romelzec si-
amJamindeli neirofsiqologiuri midgoma aqtiu- tyvebia dawerili. rodesac sityva safrTxis Semcvelia
rad iyenebs Tavis tvinis tomografias. es saSuale- (magaliTad, `mokvla~), cdis pirs meti dro sWirdeba,
bas iZleva movaxdinoT Tavis tvinis im regionebisa imisTvis, rom Tqvas, ra ferisaa foni. davalebis Ses-
da wredebis lokalizacia, romlebic monawileobs rulebas gansakuTrebiT met dros andomeben SfoTvis
konkretul fsiqologiur procesebSi da aadvilebs mqone cdis pirebi (Monk and Pine, 2004).
janmrTeli pacientebis Sedarebas maTTan, visTanac es Semdgom gamokvlevebSi ori, klinikurad mniS-
procesebi paTologiurad mimdinareobs. magaliTad, vnelovani Sedegi iqna miRebuli. jer erTi, is, rom
magnitur rezonansulma tomografiam aCvena, rom, yuradRebis Secdomebi SfoTviTi aSlilobis dros
rodesac depresiis mqone pacientebi uyureben su- gamowveuli unda iyos adamianis uuanrobiT mowyvitos
raTebs, romlebzec saxis SeSinebuli gamometyvelebaa yuradReba safrTxis Semcvel stimulebs da ara am
gamosaxuli, maT aReniSnebaT Tavis tvinis neironuli stimulebze zedmeti koncentraciiT. meorec, SfoT-
wredis ufro Zlieri aqtivacia, vidre sakontrolo vis mqone cdis pirebi ufro Zlier reaqcias iZlevian
jgufis wevrebs, rac ukavSirdeba SfoTvis aRmZvreli safrTxis Semcvel stimulebze, vidre sakontrolo
stimulebis gadamuSavebas, maT Soris, amigdalas mi- jgufis wevrebi, maSinac ki, rodesac stimuli `SeniR-
erac. aqtivaciis maRali xarisxi iklebs antidepresan- bulia~, anu misi `miReba~ aracnobierad xdeba. SeniR-
tebis zemoqmedebis Sedegad (Fu et al., 2004), rac Sei- bva niSnavs cdis pirisaTvis stimulis miwodebas xan-
Zleba imaze metyvelebdes, rom amigdalas gaZliereb- mokle drois manZilze (<40 milisekundi), rasac uSua-
uli aqtivoba, sxva faqtorebTan erTad, ganapirobebs lod mosdevs sxva stimulis (`niRbis~) miwodeba ufro
depresiul pacientTan SfoTvis dominantobas, xolo xangrZlivi droiT. is faqti, rom SeniRbuli stimuli
antidepresantebi aqveiTebs amigdalas funqcias. iwvevs ufro Zlier qceviT reaqcias SfoTvis mqone
cdis pirebTan, imaze miuTiTebs, rom SfoTvisas moq-
informaciis gadamuSaveba
medi yuradRebis anomaliuri meqanizmebi CairTavs xi-
informaciis Teoriaze dafuZnebuli midgomis Tanax- faTis gadamamuSavebel aracnobier saSualebebs, rom-
mad, fsiqologia ganixilavs Tavis tvins rogorc arxs, lebic dakavSirebulia amigdalasTan (Monk and Pine,
romlis mier xdeba SegrZnebis organoebis mier mowo- 2004). miuxedavad am Sedegebis mniSvnelobisa, unda
debuli informaciis miReba, gafiltvra, gadamuSaveba gvaxsovdes, rom es SeiZleba warmoadgendes SfoTviTi
da Senaxva, aseve, mexsierebidan amoReba. es midgoma aSlilobis Sedegs da ara mis mizezs; Tumca, maSinac
Tavis tvins adarebs kompiuters da gvawvdis aparats, ki, rodesac Sedegs warmoadgens, mainc xels uwyobs
romelic gvexmareba gavigoT fsiqikuri aSlilobis daavadebis simptomebis SenarCunebas.
zogierTi anomalia. informaciis gadamuSavebis sx-
vadasxva etapze sxvadasxva meqanizmia CarTuli. ami- mexsiereba
tom informaciis disfunqciurma gadamuSavebam, rac informaciis gadamuSavebis modeli gamosadegia mex-
biZgs aZlevs fsiqikuri aSlilobis ganviTarebas, Sei- sierebis Sesaswavladac. am modelis Tanaxmad, ar-
Zleba sxvadasxva momentSi iCinos Tavi. am procesebSi sebobs damaxsovrebuli masalis sxvadasxva sacavi _
ori meqanizmi monawileobs: mexsiereba da yuradReba. sensoruli, romelSic miRebuli informacia xanmokle
maTSi momxdari cvlilebebi ukavSirdeba fsiqiatri- drois manZilze inaxeba Semdgomi gadamuSavebis molo-
ul simptomatologias. dinSi; xanmokle sacavi, romelSic damaxsovrebuli ma-
sala mxolod 20 wuTis ganmavlobaSi inaxeba, Tu ar
yuradReba
moxda misi mudmivad ganmeoreba, da xangrZlivi sacavi,
yuradReba sensoruli stimulebis masidan seleqciis romelSic informacia ufro didi xniT inaxeba. arse-
aqtiuri procesia, romelic seleqciis dros mimdinare bobs meqanizmi, romlis meSveobiTac, saWiroebisamebr,
informaciis gadamuSavebis procesis relevanturia. xdeba informaciis amoReba xangrZlivi sacavidan. aR-
arsebobs imis mtkicebuleba, rom yuradRebis procesi saniSnavia, rom es meqanizmi SeiZleba maSinac moiSa-
darRveulia zogierTi fsiqikuri aSlilobis dros. mag- los, rodesac mexsierebis kvali SenarCunebulia. am
aliTad, SfoTvis mqone pacientebi, SfoTvis dabali do- modelma mkvlevarebi saintereso eqsperimentebTan
nis mqone adamianebTan SedarebiT, ufro metad aqceven miiyvana. magaliTad, amneziis mqone pacientebs (gv. ??)
yuradRebas safrTxis Semcvel stimulebs. es faqti, ro- ukeTesi maCveneblebi aqvT mexsierebis sakvlevi iseTi
gorc fsiqologiuri funqcionirebis Sewyveta, vlinde- testebis Sesrulebisas, romelTa moiTxovnaa ukve
ba eqsperimentSi, romlis drosac amocana moiTxovs nacnobi masalis amocnoba da ara misi gaxseneba dax-
safrTxesTan dakavSirebuli sityvebis ugulebelyofas. marebis gareSe. es monacemebi miuTiTebs mexsierebis
_ 102 _
sacavidan informaciis amoRebis uunarobasze da ara w zemoqmedebs informaciis gadamuSavebaze, cnobier
misi Senaxvis uunarobaze. azrovnebaze, emociebsa da qcevaze;
cnobilia, rom cudi guneb-ganwyoba xels uwyobs w miuxedavad imisa, rom rwmenebi (Sexedulebebi) ar
usiamovno movlenebis aRdgena-ganaxlebas, rasac eqvemdebareba uSualo introspeqcias, SesaZlebelia
adasturebs rogorc janmrTeli pirebis, romlebSic maTi Sinaarsis verbaluri rekonstruqcia (rasac
iwvevdnen uaryofiT guneb-ganwyobas, ise depresiuli uwodeben daSvebebs an rwmenebs);
pacientebis monacemebi (Clark and Teasdale, 1982). es
w fsiqikuri aSlilobis mqone pacientebSi, es rwmene-
fenomeni depresiul pacientebSi depresiuli guneb-
bi disfunqciuria, ewinaaRmdegeba uaryofas da
ganwyobis gamovlenaa, Tu amgvari ganwyobis mizezi
garkveul rols TamaSobs aSlilobis etiologiasa
bolomde gaugebaria. Tumca, is, SeiZleba, garkveul
da, aseve, mis SenarCunebaSi.
rols TamaSobdes depresiuli mdgomareobis SenarCu-
nebaSi. SedarebiT axali gamokvlevebi fokusirebulia zemoTxsenebuli ideebi gamoiyenes kognituri Terapi-
imaze, Tu rogor aRadgenen guneb-ganwyobis aSli- is Seqmnisas. kognitur TerapiaSi nacadia konkretul
lobis mqone pacientebi TavianT cxovrebiseul mov- aSlilobasTan dakavSirebuli disfunqciuri Sexed-
lenebs. magaliTad, rodesac maT sTxoven, gaixsenon ulebebis identifikacia da iseTi teqnikis gamoyeneba,
raime konkretuli SemTxveva, romelic asocirdeba romelic exmareba pacients, gadaafasos da Secvalos
sityvasTan `bednieri~, depresiuli pacientebi, Cveu- sakuTari Sexedulebebi. magaliTad, eqsperimentuli
lebriv, Zalze ganzogadebul pasuxebs iZlevian (mag- kvleviT dadginda, rom panikuri aSlilobis mqone pa-
aliTad: `rodesac me didxans vseirnobdi sxvisi dax- cientebs (gv. ??) aqvT molodini, rom sensoruli in-
marebis gareSe~), vidre janmrTeli pirebi, romelTa formacia aCqarebuli guliscemis Sesaxeb gulis Sete-
pasuxebi ufro konkretuli da specifikuria (mag- vis momaswavebelia. es molodini, amgvari sensoruli
aliTad: `rodesac, gasul kviras, leiTonis tyeSi informaciis miRebisas iwvevs SfoTvas, rasac, Tavis
vseirnobdi Cemi ojaxis wevrebTan erTad~). mogone- mxriv, mosdevs guliscemis aCqareba. pacientis SfoT-
baTa aRdgenis zedmetad ganzogadebuli stili dakav- va izrdeba da iqmneba Caketili wre. zemoT xsenebuli
Sirebulia uaryofiTi cxovrebiseuli movlenebis is- molodinebis Secvla asustebs panikis Setevas.
toriasTan, aseve, SesaZlebelia, problemis gadaWris
unaris daqveiTebasTan. depresiuli mdgomareobis eTologia da evoluciuri fsiqologia
ganviTarebaSi es SeiZleba asrulebdes precipitatu- mravali fsiqologiuri gamokvleva gulisxmobs qcev-
li faqtoris rols (Williams, 2000; van Vreeswijk and De aze raodenobrivi xasiaTis dakvirvebis warmoebas.
Wilde, 2004). zogi maTgani iyenebs im meTodebs, romlebic eTolo-
rogorc ukve aRiniSna, izrdeba interesi imis mi giis sferoSi Seiqmna. rTuli qceva iyofa ufro martiv
marT, Tu ra saxiT monawileobs eqsplicitur deklara- komponentebad da sistemtur daTvlas eqvemdebareba.
ciuli da implicitur emociuri mexsiereba travmuli aRiricxeba regularuli Tanmimdevrobebi da adami-
gamocdilebis gadamuSavebaSi. gamoTqmulia varaudi, anebis urTierTqmedeba (magaliTad, urTierTqmede-
rom Zlieri travmuli movlenebis dros, eqsplicitu- ba dedasa da Cvilobis asakSi myofi Svilis). amgvar
ri mexsiereba SedarebiT bundovania, xolo implici- meTodebs mimarTavdnen im efeqtis Sesaswavlad, rac
turi (aracnobieri emociuri mexsiereba) _ cxadi. mohyveboda primatebSi Cvilis dedasTan ganSorebas.
aman SeiZleba gamoiwvios avtomaturi intruziebi da Semdeg, primatebis am qcevas adarebdnen Cvili bavSvis
eqsplicituri mexsierebis daqveiTeba posttravmuli qcevas, romelic dedisagan iyo mowyvetili.
stresuli aSlilobis dros (Halligan et al., 2003). ufro gviandel eTologiur kvlevebSi gamoiyenes
evoluciuri fsiqologiis miRwevebi, raTa ganesaz-
rwmenebi (Sexedulebebi) da molodinebi RvraT normaluri da paTologiuri qceva evoluciis
informaciis gadamuSavebis modelis Tanaxmad, reaq- konteqstSi. amgvarad cdilobdnen zogierTi qcevis
cias informaciaze (emociuri saxis reaqciis CaTvliT) evoluciuri adaptaciiT axsnas. magaliTad, radgan
gansazRvravs rwmenebi da molodinebi. es Tvalsazrisi depresiuli mdgomareoba gavrcelebuli movlenaa
gulixmobs, rom yoveli individis qcevas warmarTavs adamianTa sazogadoebaSi, sakiTxavia, Tu ra aris misi
misi rwmenebi (Sexedulebebi) da rom fsiqopaTologia adaptaciuri funqcia. erT-erTi mosazrebis mixedviT,
esaa sakuTar TavTan da samyarosTan dakavSirebuli depresia SeiZleba asaxavdes subordinaciis formas
rwmenebis (Sexedulebebis) Sinaarsis Secvla. kogni- cxovelebSi, romelTac dakarges adgili socialur
turi fsiqologia amtkicebs, rom aseTi rwmenebi sqe- ierarqiaSi. brZolaSi CarTvis nacvlad, rac SeiZle-
mebad aris organizebuli. sxvadasxva saxis fsiqopa- ba marcxiT damTavrdes, depresiaSi myofi individi
TologiasTan mimarTebaSi sqemebi mniSvnelovan Tvise- ganerideba situacias da emociur resursebs samoma-
bebs avlens: vlod inaxavs.
_ 103 _
5 etiologia
am mosazrebis eqsperimentiT Semowmeba advili ar aseT gamokvlevebSi SerCeva mkacradaa ganszaRvru-
aris, magram mis safuZvelze SeiZleba warmoiSvas li. garda amisa, ar aris sakmarisi paTologiuri fsiq-
hipoTeza mocemul procesSi monawile cerebruli ikuri mdgomareobis dadgena naTesavebSi, radgan pop-
meqanizmebis Sesaxeb. erT-erTi Teoriuli sirTule ulaciis nawils es mdgomareoba SeiZleba cxovrebis
aris is, rom fsiqikuri aSlilobebi xSirad warmoad- ufro gviandel etapze ganuvaTardes. amitom mkvl-
gens araadaptaciur qcevas. volperts (Wolpert, 1999) evarebi mimarTaven maCveneblebis Sesabamis koreqcias,
analogiisTvis mohyavs avTvisebiani simsivnis mag- romelic cnobilia, rogorc molodinis koeficienti
aliTi, romlis drosac ujredebis paTologiuri (anu daavadebis riski). am tipis kvlevebiT miRebuli
gamravlebis Sedegebi aSkarad araadaptaciuri da sa- Sedegebis interpretaciisas, garkveuli mizezebis
zianoa individisaTvis. rogorc avTvisebiani simsivne gamo, sifrTxile unda gamoviCinoT, razec qvemoT
SeiZleba CaiTvalos ujredebis gayofis normaluri gveqneba saubari.
procesis darRvevad, ise depresiac SeiZleba miviC- ojaxis gamokvleva
nioT normaluri emociis darRvevad. am poziciidan ojaxis riskis Sefaseba farTod gamoiyeneba fsiqi-
gamomdinare, sakiTxi is ki ar aris, Tu raSi mdgo- atriaSi. amaze mimarTuli gamokvlevebi kargad ver
mareobs anomaliuri qcevis adaptaciuri Rirebuleba, ganasxvavebs memkvidreobiT efeqts ojaxisa da gare-
aramed is, Tu ra warmoadgens im normaluri qcevis mos gavlenis Sedegebisagan. Tumca, ama Tu im aSli-
adaptaciur Rirebulebas, romelTanac dakavSirebu- lobis SemTxvevaSi, ojaxuri kavSirebis arsebobis
lia paTologiuri mdgomareoba. es sakiTxi ganxilu- demonstrireba mniSvnelovani pirveli nabijia da
lia Semdeg wyaroSi: Nettle, 2004. miuTiTebs imaze, rom aucilebelia sxva tipis gamokv-
levebis Catareba.
genetika
tyupebis gamokvleva
genetikuri gamokvlevebi sami mimarTulebiT xor-
cieldeba: tyupebis kvleva Zalzed mniSvnelovania imis dasad-
genad, Tu ra wvlili Seaqvs genetikur informacias
1. genetikuri da garemo faqtorebis fardobiTi wv-
fenotipSi (anu dakvirvebad maxasiaTeblebSi, rogore-
lilis dadgena daavadebis etiologiaSi;
bicaa pirovnuli niSan-Tvisebebi an darRvevebi). tyu-
2. genetikuri daavadebebis memkvidreobiTobis Ta- pebis Seswavlisas mkvlevari cdilobs, erTmaneTisagan
viseburebis gansazRvra; ganacalkeos genetikuri da garemo faqtorebis zegav-
3. Sesabamisi genebis identifikacia, maTi mutacia da lena konkordantobis xarisxis urTierTSedarebiT,
polimorfizmi. anu imis dadgeniT, aRiniSneba Tu ara erTi da igive
fsiqiatriaSi SedarebiT meti codna pirveli sakiTx- darRveva monozigotur da dizigotur tyupebSi. Tu
is garSemo dagrovda. kvlevis genetikuri meTodebi, fsiqikuri aSlilobis konkordantobis maCvenebeli,
zogadad, sami saxisaa: populaciisa da ojaxis Ses- dizigoturTan SedarebiT, ufro maRalia monozigo-
wavla (genetikuri epidemiologia), citogenetika da tur tyupebSi igulisxmeba, rom es genetikuri kompo-
molekuluri genetika. populaciisa da ojaxis kvleva nentiTaa gansazRvruli. rac ufro didia gansxvaveba
ZiriTadad fokusirebulia genetikuri faqtorebis konkordantobis maCveneblebs Soris monozigotur da
wvlilze da imaze, Tu ra saxiT xdeba daavadebis mem- dizigotur tyupebSi, miT ufro Zlieria memkvidreo-
kvidreobiT gadacema. citogenetika da molekuluri biTi faqtori.
genetika gvawvdis informacias memkvidreobiTobis memkvidreobiToba aris populaciis SigniT fsiqi-
meqanizmis Sesaxeb. fsiqiatriuli genetikis cnebebi, kuri aSlilobisadmi midrekilebis proporcia, ro-
meTodebi da terminologia Zalian rTulia da aq mx- melic gansazRvrulia genetikuri faqtorebiT da igi
olod mokled ganvixilavT. ufro detaluri aRwera procentebSi gamoixateba. gavrcelebuli fsiqikuri
mocemulia ouenis saxelmZRvaneloSi (Owen et al., 2003). aSlilobebis uaxlesi monacemebi, romlebic tyupebis
kvlevas efuZneba, mocemulia cxrilSi (cxrili 5.3).
genetikuri faqtorebis monawileobis xarisxi memkvidreobiTobis maCveneblebi exeba konkretul
populaciuri genetikis meTodebs (genetikuri epide- populacias; igi SeiZleba varirebdes sxvadasxva popu-
miologia) iyeneben riskis Sesafaseblad da am Tvalsaz- laciaSi da sxvadasxva garemo faqtorebis zegavleniT;
risiT ikvleven sam jgufs: ojaxebs, tyupebsa da naS- garda amisa, es maCveneblebi ar miesadageba calkeul
vileb pirebs. ojaxuri riskis Seswavlisas mkvlevari individebs. fsiqikur aSlilobaTa umetesoba da qce-
gansazRvravs fsiqikuri daavadebis risks daavadebuli vis maxasiaTeblebi garkveuli xarisxiT memkvidreobi-
piris naTesavebSi da adarebs mosalodnel risks zogad Tia da maTgan bevri memkvidreobiTi faqtoris aSkara
populaciaSi. (daavadebis mqone pirs, Cveulebriv, uwo- monawileobas adasturebs. garda autosomuri domi-
deben indeqsur SemTxvevas an probands). nanturi demenciisa, sxva SemTxvevebSi memkvidreobi-
_ 104 _
cxrili 5.3 memkvidreobiTobis maCveneblebi boqsi 5.1 genetikur epidemiologiaSi

sxvadasxva fsiqikuri aSlilobisas tyupebze Catarebuli gamokvlevebis
Sefaseba
aSliloba memkvidreobiTobis
maCvenebeli (%) moxda Tu ara zigoturobis zustad gansazRvra?
igulisxmeba, rom monozigoturi tyupebi genetikurad
Sizofrenia 80 identurebi arian, magram es SeiZleba ase ar iyos
bipolaruli aSliloba 80 iseTi faqtorebis gamo, rogoric mitoqondriuli
memkvidreobiTobaa;
didi depresiuli aSliloba 40 iTvleba, rom rodesac tyupebi erTad izrdebian,
rogorc es Cvulebriv xdeba xolme, monozigotur da
generalizebuli SfoTviTi 30
dizigotur tyupebze saerTo garemo Tanabrad moqmedebs.
aSliloba
magram es yovelTvis ase ar aris, gansakuTrebiT maSin,
panikuri aSliloba 40 Tu prenataluri periodic iqneba gaTvaliswinebuli.
(logikis sawinaaRmdegod, is naklebad msgavsia
fobia 35 monozigituri, vidre dizigoturi tyupebis SemTxvevaSi).
alkoholTan dakavSirebuli 60 miuxedavad zemoTqmulisa, rodesac tyupebzea saubari,
problemebi an alkoholur daSvebis gakeTeba erTnairi garemos arsebobis Sesaxeb,
nivTierebaze damokidebuleba gamosadegia aSlilobaTa umetesobisTvis. garda amisa,
unda aRiniSnos, rom, genebisa da garemos zegavlena
Toba yovelTvis mniSvnelovnad naklebia 100 %-ze, rac erTmaneTze zemoqmedebs, anu maTi zegavlena krebiTi
ar aris. magaliTad, mSoblebma, romelTac aReniSnebaT
imaze miuTiTebs, rom genetikuri faqtori erTaderTi antisocialuri aSliloba, SeiZleba gadascen Svilebs
determinanti ar aris da garemo faqtorebi aseve unda iseTi genebi, romlebic SvilebTan zrdis qceviTi
iyos gaTvaliswinebuli (Bouchard and McGue, 2003). darRvevisadami midrekilebis risks. Tumca, aseTi
mSoblebi, SeiZleba, amave dros, qmnidnen iseT ojaxur
memkvidreobiToba ar unda agverios konkordan
atmosferos, romelic TavisTavad zrdis qceviTi
tobasa da penetrantobaSi. fenotipma SesaZlebelia darRvevebis risks.
gviCvenos konkordantobis maRali xarisxi mono tyupebze Catarebuli kvlevebis umetesi nawili
zigotur tyupebSi genetikuri faqtoris monawileobis populaciis SeswavliT xorcieldeba da ar aris
dafuZnebuli registrirebul fsiqiatriul istoriebze.
gareSe (magaliTad, saerTo religiuri rwmena, erTi
miuxedavad imisa, rom amiT mcirdeba am ukanaskneliT
da imave fexburTis gundis mxardaWera); amave dros, gamowveuli cdomilebebi, mainc aRsaniSnia, rom didi
konkordantobis SedarebiT dabali maCvenebeli mo zomis SerCevebSic ki aRiricxeba SedarebiT mcire
nozigotur tyupebSi SeiZleba memkvidreobiTi faq raodenobis Secdomebi, ris Sedegadac miRebul
Sefasebebs, zogjer farTo sandoobis intervali aqvT.
toris mniSvnelovan rolze miuTiTebdes. mocemul garda amisa, diagnozis sandooba SeiZleba nakleb
konteqstSi penetrantoba aRniSnavs maRal albaTobas sarwmuno iyos. da bolos, gamoTqmulia mosazreba,
imisas, rom pirovnebis fenotipSi SesaZloa gamovlindes rom tyupad yofna SeiZleba TavisTavad zemoqmedebdes
fisiqikuri aSlilobis ganviTarebis riskze, Tumca am
Sesabamisi genotipi. Tumca, es yovelTvis ase ar
mosazrebas sakmarisi mtkicebuleba ar gaaCnia.
xdeba, rac, albaT, asaxavs individze dacviTi xasiaTis
genetikuri da garemos faqtorebis zemoqmedebas. mniSvnelovania fsiqikuri daavadebis etiologiaSi
realurad, mxolod ramdenime mdgomareobaa srulad ojaxuri garemo.
penetrantuli. miuxedavad imisa, rom tyupebze Catarebul gamo
garda imisa, rom tyupebze Catarebuli Tanamedrove kvlevebs didi mniSvneloba eniWeba genetikur epi
gamokvlevebi gviCvenebs genetikuri faqtorebis mo demiologiaSi, maTi ukritikod miReba ar SeiZleba,
nawileobis xarisxs, amave dros, saSualebas gvaZ radgan es kvlevebi emyareba garkveul daSvebebs,
levs, garemos faqtorebis zemoqmedebaSi ori ka romelTa monaxazi mocemulia boqsSi 5.1.
tegoria gamovyoT: zemoqmedeba, romelic mxolod
naSvilebi pirebis gamokvleva
mocemul individze vrceldeba (anu ar aris sxva
sTan gaziarebuli) da zemoqmedeba, romelic sa am tipis kvlevebi genetikuri da garemos faqtorebis
erToa tyupebisaTvis da gaziarebulia maT mier. zemoqmedebis diferencirebisTvis metad sasargebloa.
garemos faqtorebis zemoqmedebis diferenciacia ZiriTadi meTodia biologiuri naTesavebisa da
miiRweva daxvewili statistikuri midgomiT, ra arabiologiuri naTesavebis urTierTSedareba fsi
sac struqturuli tolobiT modelireba ewo qikuri aSlilobis sixSiris TvalsazrisiT. amisaTvis
deba. fsiqikuri daavadebis fenotipSi saerTo (ga gamoiyeneba sami ZiriTadi sqema:
ziarebuli) garemos wvlili ufro dabalia, vid w naSvilebi pirebis gamokvleva: erTmaneTs udareben
re calkeuli specifikuri an memkvidreobiTi aSlilobis sixSires im bavSvebSi, romlebic fsi
faqtorebisa (gamonakliss warmoadgens Sizofrenia). qikuri aSlilobis mqone mSoblebis mier arian ga
amasTan dakavSirebiT ibadeba kiTxva, Tu ramdenad Svilebulebi da adareben fsiqikur aSlilobaTa
_ 105 _
5 etiologia
ganviTarebis sixSires im bavSvebSi, romlebic rogor xdeba memkvidreobiTi fsiqikuri
janmrTeli mSoblebis mier arian gaSvilebulebi; daavadebebis gadacema
w mSvilebeli ojaxis Seswavla: biologiuri naTe memkvidreobiTobis tipis gansazRvra, anu imis garkveva, Tu
savebisa da mSvilebeli ojaxis naTesavebis fsiqikur rogor xdeba memkvidreobiTi safuZvlis mqone daavadebis
aSlilobaTa sixSiris Sedareba; gadacema, Sualeduria etapia Semdeg or safexurs Soris:
w kros-ojaxuri kvlevebi: izomeba im naSvilebi pi ufro dabal safexurze igulisxmeba imis dadgena,
rebis aSlilobis xarisxi, romelTac hyavT da rom fsiqikuri aSliloba da sxva fenotipebi ojaxur
avadebuli biologiuri mSoblebi, magram janmrTeli konstelaciebs qmnis da memkvidreobiTi xasiaTisaa;
arabiologiuri mSoblebi; es monacemebi udardeba im xolo ufro maRal sfexurze gamoiyeneba molekuluri
pirebis maCveneblebs, romelTac hyavT janmrTeli meTodebi im genebis aRmosaCenad, romlebic aSlilobazea
biologiuri, magram daavadebuli arabiologiuri pasuxismgebeli. faqtiurad, sakiTxi exeba imas, aqvs Tu ara
mSoblebi. mocemul aSlilobas mendelianuri maxasiaTeblebi, anu aC
naSvilebi pirebis kvlevis Sedegebze mravali faq venebs Tu ara ojaxis istoria mendelis klasikur paterns:
tori axdens gavlenas, rogoricaa Svilad ayvanis dominantur, recesiul da X qromosomasTan dakavSirebul
mizezi, socio-ekonomikuri statusis mixedviT bav memkvidreobiTobas. Tu es asea, maSin SeiZleba davaskvnaT,
Svebis araSemTxveviTi ganawileba da mSvilebel mSob rom mocemuli aSliloba gamowveulia erTi ZiriTadi
lebze problemuri bavSvis aRzrdis zemoqmedeba. geniT, romlis dadgena yvelaze ukeT genTa SeWidulobiTaa
garda amisa, aseT kvlevebSi, Cveulebriv, mcire SesaZlebeli (ix. qvemoT).
moculobis SerCeva gamoiyeneba, rac imiTacaa gan fsiqiatriaSi, iseve rogorc medicinis sxva dargebSi,
pirobebuli, rom mraval qveyanaSi Svilad ayvana am tipis aSlilobebi kargadaa cnobili (mag., ojaxuri
sul ufro iSviaTad xdeba. kidev ufro seriozuli demenciis da daswavlis unaris daqveiTebis zogierTi
xarvezia is, rom naSvileb pirebze Catarebuli mizezi), magram es aSlilobebi pasuxs ageben mTeli
kvlevebi naklebad Seicavs informacias prenataluri daavadebis mxolod mcire segmentze. fsiqikuri
garemos Sesaxeb. amgvari informaca ki metad mni aSlilobebis umetesoba ar avlens memkvidreobiTobis
Svnelovania iseTi aSlilobebis Sesaswavlad, rom klasikur mendelianur paterns. iseve, rogorc zogad
lebic dakavSirebulia muclad yofnisas momqmed medicinaSi gavrcelebuli darRvevebis umetesobas,
faqtorebTan da mSobiarobis garTulebebTan. rogoricaa, magaliTad asTma an Saqriani diabeti,
fsiqikur aSlilobebsac ramdenime (an mravalri) genis
fenotipis sazRvrebi kombinirebuli moqmedeba ganpirobebs da am qmedebaSi
zemoT aRwerili genetikuri epidemiologiuri gamo TiToeuli geni zomieri an susti efeqtis mqonea. amas
kvlevebi gvexmareba im klinikuri fenotipis sazRvrebis ewodeba aramendelianuri, rTuli an mravalfaqtoriani
dadgenaSi, romelic dakavSirebulia calkeuli genebis genetikuri aSlilobebi. ar arsebobs iseTi erTi geni,
memkvidreobiTobasTan. magaliTad, dadginda, rom romelic aSlilobis gamowvevis aucilebeli an sakmarisi
genetikuri midrekileba Sizofreniis mimarT saerTo pirobaa. genebi ganixileba risk-faqtorebad da maT
mowyvladobis nawilia. am tipis faqtebma mecnierebi uwodeben mowyvladobis genebs, romlebic erTobliobaSi
miiyvana Sizofreniuli aSlilobis speqtris cnebasTan gansazRvraven mowyvladobis genetikur zRurbls. am
(gv. ??). magaliTad, did depresiul aSlilobas da saxis `genetikuri arqiteqturidan~ gasagebi Cans, Tu
generalizebul SfoTviT aSlilobas, rogorc Cans, ratom aris rTuli genebis da maTi Sida variantebis
saerTo genetikuri safuZveli aqvs (Kendler et al., 1992 a). identificireba (Owen et al., 2000). am problemas kidev ori
garda imisa, rom kvlevebSi aris diagnostikuri sakiTxi arTulebs. jer erTi, genebis mier gamowveuli
kategoriebis validobisa da sazRvrebis dadgenis efeqti SeiZleba aditiuri an interaqtiuli xasiaTis iyos
mcdeloba, isini sul ufro metadaa fokusirebuli (epistazi); amave tipis urTierToba SeiZleba arsebobdes
endofenotipebze (an Sualedur fenotipebze). es is genebsa da garemos faqtorebs Soris. meorec, genebis
maxasiaTeblebia, romlebic ufro mWidro kavSirSia regulireba TavisTavad memkvidreobiTi bunebisaa da ar
aSlilobis biologiur da genetikur safuZvlebTan, aris damokidebuli dnm-Si nukleotidebis mimdevrobaSi
vidre Tavad klinikuri sindromi. magaliTad, Tvalis momxdar cvlilebaze (epigenetika).
midevnebis disfuqncia da daqveiTebuli operatiuli
genebis lokalizaciis da identifikaciis
mexsiereba Sizofreniis endofenotipebia. amgvarad,
meTodebi
miiCneva, rom endofenotipebi ufro Zlieri faqtorebi
da ufro mniSvnelovani biologiuri konstruqtebia, citogenetikuri gamokvlevebi
vidre Tavad fenotipebi (anu sindromebi) (Gottesman citogenetika adgens qromosomebSi arsebul struq
and Gould, 2003). turul darRvevebs da maT daavadebas ukavSirebs. am
_ 106 _
Tu im qromosomis rolis Sesaxeb arsebuli varaudi
boqsi 5.2 genetikuri variaciebis
emyareba mis garegnul maxasiaTeblebs. qromosomuli
terminologia: polimorfizmi, alelebi
darRvevebi, Cveulebriv, dakavSirebulia daswavlis
da mutaciebi
darRvevasTan. klinicisti genetikosebi maT di
ar arsebobs ori iseTi adamini, romelsac zustad
agnostirebas SedarebiT advilad axerxeben, iyeneben
erTnairi genomi aqvs. es imas niSnavs, rom yoveli
ra kariotipirebis meTods, romelic qromosomebis adamianis dnm-s aqvs nukleotidebis unikaluri
vizualizaciis saSualebas iZleva. fsiqiatriaSi amis Tanmimdevroba (monozigoturi tyupebis garda). dnm-Si
naTeli ilustraciaa daunis sindromi. am SemTxvevaSi nukleotidebis TanmimdevrobaTa variantebs ewodeba
polimorfizmi an aleluri variantebi. isini gvxvdeba,
ori tipis paTologiaa dadgenili. ufro xSirad saSualod, yovel 10000 nukleotidze mTeli genomis
gvxvdeba 21-e qromosomis damatebiTi asli (trisomia gaswvriv, rogorc genebSi, ise maT Soris. konkretuli
21. es aris aneuploidiis magaliTi, rac qromosomebis polimorfizmi SeiZleba iSviaTad gvxvdebodes, an kidev
variantebi (alelebi) SeiZleba populaciaSi Tanabari
araswor raodenobaze miuTiTebs). meore SemTxvevaSi
sixSiriT iyos ganawilebuli.
21-e qromosomis segmenti gaicvleba sxva qromosomis
polimorfizmebis umetesoba moicavs cvlilebas
segmentSi, rasac translokacia ewodeba. sxva dar calkeul nukleotidSi, saidanac gamomdinareobs
RvevebSi monawileobs X da Y qromosomebi (mag., termini erTeuli nukleotiduri polimorfizmi, xolo
terneris sindromi (XO) da klainfelteris sindromi sxva polimorfizmebis dros xdeba dnm-is jaWvSi
nukleotidebis CarTva, amovardna an replikacia.
(XXY). dRes ukve SesaZlebelia im sustad gamoxatuli
polimorfizmTa umetesobis mniSvneloba ucnobia,
citogenetikuri darRvevebis dadgena, romlebic gansakuTrebiT Cumi an konservatoruli Canacvlebebis
zemoqmedebs qromosomebis mcire zomis segmentebze SemTxvevaSi (anu iseT SemTxvevaSi, rodesac maT ar
(myife X sindromi (gv.??) da velokardiofacialuri SeuZliaT Secvalon cilaSi kodirebuli aminomJavaTa
Tanmimdevroba, an isini warmoadgenen dnm-is
sindromi (VCFS), romlis drosac 22-e qromosomis aramakodirebel nawilebs, an kidev genetikuri kodis
grZeli mxris erTi aslis nawili waSlilia (gv.??). degeneraciis gamo). Tumca, zogierT polimorfizms
miuxedavad imisa, rom citogenetikuri anomaliebi aqvs funqciuri korelati, rogorc es SemdgomSi
iqneba ganxiluli. radgan yovel autosomur gens ori
iSviaTadaa daavadebis mizezi, maTi arseboba gvaZ asli aqvs (autosoma aris yvela qromosoma X da Y-is
levs sagulisxmo miniSnebas imaze, Tu sad SeiZleba garda), genomis nebismier adgilas ori aleli SeiZleba
iyos lokalizebuli mowyvladobis genebi. magaliTad, identuri iyos (homozigoturi) an gansxvavebuli
(heterozigotuli).
SeniSnulia, rom daunis sindromis dros xSirad gvxvdeba
alchaimeris daavadeba. aman ubiZga mkvlevarebs, termini mutacia SeiZleba polimorfizmis sinonimad
gamoviyenoT da vigulisxmoT nebismieri variacia dnm-
miekvliaT im genebis 21-e qromosomisaTvis, romlebmac,
is TanmimdevrobaSi. Tumca, xSirad, termini `mutacia~
SesaZloa, gamoiwvios es daavadeba trisomiis armqone ufro viwro mniSvnelobiT gamoiyeneba da saziano
individebSic ki. am gziT moxda amiloiduri prekursori cvlilebas gulisxmobs, Cveulebriv imitom, rom es
genis identificireba (APP, Tavi 14). es iyo pirveli cvlileba daavadebis gamomwvevia. am mxriv, mutacia
gansxvavdeba polimorfizmisagan, romelsac, rogorc
SemTxveva, rodesac daadgines fsiqikuri aSlilobis ukve aRiniSna, SesaZloa ar mosdevdes raime cvlilebebi;
gamomwvevi geni. amis msgavsad, fsiqozis sixSiris xolo cvlilebebis gamowvevis SemTxvevaSi, isini
mateba VCFS-is mqone pacientebSi daexmara mecnierebs dadebiTi, neitraluri an saziano SeiZleba iyos. garda
amisa, es efeqtebi gansamzRvreli ki ar aris, aramed,
am ubanSi lokalizebuli im sami genis identifikaciaSi, ubralod, cvlis konkretuli fenotipis albaTobas.
romlebic, SesaZloa, warmodganen zogadad fsiqozis Sesabamisad, termini `mutacia~ gamoiyeneba farTo
predispozicias (Tavi 12). mniSvnelobiT da mendelianuri tipis aSlilobaze
miuTiTebs.
molekuluri genetika
molekuluri genetikis gamokvlevebis mizania im kvidreobiT gadacema daavadebul ojaxSi. Tu qro-
genebis identificireba, romlebic gvixsnis fenotipis mosomis konkretuli ubani an adgili, Cveulebriv,
memkvidreobiTobas fsiqikuri aSlilobis dros. genebis segregirebulia daavadebasTan, maSin mosalodnelia,
identifikaciisaTvis ori midgoma gamoiyeneba: genebis rom es ubani Seicavdes daavadebis gamomwvev gens. Se-
SeWidulobisa (poziciuri klonireba) da asociaciuri sabamisad, amboben, rom arsebobs kavSiri am ubansa da
gamokvlevebi (Owen et al., 2003). boqsSi 5.2 mocemulia daavadebas Soris. mocemuli ubnis daavadebasTan kav-
genetikur variabilobasTan dakavSirebuli zogierTi Siris albaToba albaTobis logariTmis maCvenebliT
cneba da termini, romlebic gvexmareba, gavigoT da (LOD) gamoisaxeba. Tu es maCvenebeli 3-s aRemateba, es
SeviswavloT daavadebaTa genetikuri safuZveli. SeWidulobis sakmaris mtkicebulebad iTvleba. Tavi-
dan mkvlevarebi yovel jerze calkeul qromosomas
genebis SeWidulobis gamokvlevebi Seiswavlidnen, axla ki xdeba mTliani genomis SeWidu-
daavadebis gamomwvevi genis dasadgenad, Cveulebriv, lobis skanireba, romelSic yvela qromosoma Seiswav-
arkveven, Tu rogor xdeba dnm-is segmentebis mem- leba. ubani SeiZleba didi zomis iyos, moicavdes dnm-
_ 107 _
5 etiologia
is milionobiT fuZes da Seicavdes uamrav gens. mas limorfizmebs) da mutacias (mutaciebs), rac naTels
Semdeg, rac moxdeba adgilis identifikacia, gamoiy- hfens SeWidulobis signals.
eneba ufro natifi meTodebi manam, sanam ar ganisaz-
genetikuri asociaciebis Seswavla
Rvreba da ar gaiSifreba daavadebis gamomwvevi geni,
rac gamoamJRavnebs mutacias da ganasxvavebs daavade- asociaciuri gamokvlevebis safuZvelia polimor-
bulis dnm-s ojaxis janmrTeli wevrebis dnm-isagan. fizmi (boqsi 5.2.). aseTi tipis kvleva amJamad yvelaze
fsiqiatriaSi SeWidulobis strategiis gamoyenebis gavrcelebuli meTodia fsiqiatriul genetikaSi. ixi-
yvelaze warmatebuli magaliTia alchaimeris daa- leT salivanis naSromi (Sullivan et al., 2001), romelSic
vadebisas 21-e qromosomaSi APP genis identifikacia ganxilulia am gamokvlevebis Catarebis safuZveli da
da hanTingTonis daavadebisas me-4 qromosomaSi han- maTi struqtura.
TingTonis genis identifikacia (me-14 Tavi). yvelaze martivi saxis asociaciuri kvleva zoma-
Tumca, rogorc iTqva, genebis SeWidulobis strate- vs genetikuri polimorfizmis sixSires im jgufSi,
giam fsiqiatriaSi mainc da mainc warmatebulad ar romelsac axasiaTebs mkvlevarTaTvis saintereso
imuSava, Tu ar CavTvliT ojaxuri demenciisa da das- fenotipi da adarebs mas janmrTeli individebis sa-
wavlis darRvevis zogierTi mizezis gamokvlevas. kontrolo jgufs. Cveulebriv, xdeba Sesaswavli genis
es ramdenime faqtorma ganapiroba (Owen et al., 2000): SerCeva, radgan is kandidat genad iTvleba. es is genia,
yvelaze mniSvnelovania is, rom SeWidulobiT ukeT romelsac, savaraudod, Tavisi wvlili Seaqvs sakvlev
aixsneba mendelianuri darRvevebi, anu iseTi SemTx- fenotipSi; amave dros, SeirCeva im saxis polimor-
vevebi, rodesac darRveva gamowveulia calkeuli fizmi, romelic gavrcelebulia, advili gasazomia
geniT, romelic dominanturi an recesiuli genebiT an, wina monacemebis Tanaxmad, qmediTia. Tu polimor-
gadaicema da romelsac maRali genuri penetrantoba fizmis sixSire jgufebSi mniSvnelovan gansxvavebas
axasiaTebs. es meTodi ar gamodgeba susti efeqtis gvaZlevs (Cveulebriv, ganisazRvreba xi-kvadratis
mqone mravlobiTi genebis identifikaciisaTvis, rom- testiT), maSin miiCneva, rom mocemuli saxis polimor-
lebic, rogorc iTqva, monawileobs fsiqikur aSli- fizmi an aleli daavadebasTanaa dakavSirebuli da am
lobaTa umetesobaSi. es meTodi arc maSinaa gamosa- daavadebis risk-faqtors warmoadgens. Seusabamobis
degi, rodesac ojaxSi aRniSnuli aSliloba gamowveu- koeficientebisa da sarwmunoebis intervalebis Se-
lia ramdenime calkeuli genis urTierTSereviT (ge- faseba dadgenili wesiT xdeba.
netikuri heterogenoba) an sindromis aragenetikuri fsiqiatriaSi `SemTxveva-kontrolis~ asociaciuri
formebiT (fenokopiebi). genebis SeWidulobis meTo- kvlevebi (case control association study) Zalian bevria da
dis sust mxareTa minimumamde dayvana SesaZlebelia SedarebiT advili Casatarebelia, radgan aramonaTe-
sxvadasxva gziT; magaliTad, sxvadasxva memkvidreo- save individebis Sekreba ufro advilia, vidre Se-
biTi modelebis Semowmeba an fenotipis sxvadasxva Widulobis genetikis Sesaswavlad saWiro informa-
gansazRvrebis gamoyeneba da imis dadgenia, Tu rom- ciis matarebeli ojaxebis moZieba. amasTan, poli-
eli maTgani gvaZlevs yvelaze maRal LOD maCvenebels. morfizmis genotipireba sisxlidan an loyis nacxi-
Tumca, saboloo jamSi, am tipis manipulaciebs mcdar dan eqstragirebuli dnm-idan swrafad da martivad
dadebiT pasuxTan mivyavarT. SeiZleba. es meTodi efuZneba polimerazul jaWvur
ukeTes Sedegebs iZleva axlaxans danergili meta- reaqcias (PCR), romelic dnm-is TvalsaCino amplifi-
analizuri kvlevebi. gamomuSavebulia iseTi meTode- kacias gulisxmobs. zogierTi Sedegi dasabuTebulia,
bi, romelTa meSveobiT SegviZlia gavakeToT ama Tu rogoricaa, magaliTad, apoE4-is kavSiri alchaimeris
im aSlilobis dros genomis mravlobiTi skanirebiT daavadebasTan (ix. boqsi 5.3). Tumca, yvela Sedegze
miRebuli Sedegebis metaanalizi. aseTi analiziT amas ver vityviT, rac asociaciuri kvlevebis Semdeg
SesaZlebelia sarwmuno monacemebis miReba, maSinac sust mxareebze migviTiTebs:
ki, rodesac calkeuli kvlevebis Sedegebi unmiSvne- w SerCeva xSirad Zalian patara moculobisaa (mag., 50
loa (rac gamowveulia maTi arasakmarisi potenciiTa SemTxveva TiTo jgufSi), ris gamoc miiReba mcdari
da sxva zemoT xsenebuli mizezebiT). amas ganapiro- pozitiuri da mcdari negatiuri Sedegebi. mcdari
bebs is, rom metaanalizis dros xdeba sxvadasxva kv- pozitiuri Sedegebi ufro problemuria, radgan
levebiT miRebuli didi masalis erTiani damuSaveba. maT ufro xSirad aqveyneben.
metaanalizis gamoyeneba gansakuTrebiT sasargebloa w jgufebi msgavsi eTnikuri warmoSobisa unda iyos,
Sizofreniis dros. misi meSveobiT sarwmuno xarisx- radgan polimorfizmis sixSire SeiZleba mniS-
iT mJRavndeba daavadebis ramdenime Sesabamisi ubani vnelovnad varirebdes. magaliTad, populaciebSi
(gv. ??). sabolood, imis dasabuTeba, rom daavadebis fermenti katexol_0_meTiltransferazas (COMT)
lokusi namdvilad napovnia, eyrdnoba genebis identi- meT 158 aleli (ix. boqsi 5.3) cvalebadia 1%-dan
fikacias, Semdgom maTSi mimdinare polimorfizms (po- 60%-mde mTeli msoflios masStabiT. aman, SesaZloa,
_ 108 _
boqsi 5.3 polimorfizmebis magaliTebi Sualeduria. daSveba, romelic sxva aRmoCenebiT

fsiqiatriaSi dadasturda, imaSi mdgomareobs, rom (valin_COMT)
iwvevs dofaminis ufro dabal aqtivobas meTioninis
apolipoprotein E4-is roli alchaimeris daavadebaSi. formasTan SedarebiT. monacemebi gviCvenebs, rom
me-19 qromosomaSi apolipoprotein E4 arsebobs sami am polimorfizmiT aixsneba winafrontaluri qerqis
ZiriTadi formiT (alelebi): apo E2, apo E3, apo E4. 1993 funqcionirebis donis individualuri variabilobis
wlis Semdeg, aTasobiT adamianze Catarebulma mravalma 4%. eganisa da misi kolegebis (Egan et al., 2001) da sxva
gamokvlevam gvaCvena kavSiri apo E4-sa da alchaimeris mkvlevarebis mier dadginda valinis Semcveli alelis
daavadebas Soris. genis apo E4 varianti aRiniSneba maRali sixSire SizofreniiT daavadebul pacientebSi
pacientebis ufro did jgufTan, vidre igive asakobrivi janmrTel subieqtebTan SedarebiT. es Sedegi eTanxmeba im
jgufis janmrTel adamianebTan. amgvarad, iTvleba, rom faqtebs, romlebic am daavadebas akavSireben dofaminTan
apo E4 dakavSirebulia alchaimeris daavadebasTan da da prefrontalur qerqTan. sxva gamokvlevebi aCvenebs,
warmoadgens mis genetikur risk faqtors. individebSi, rom igive polimorfizmiT SesaZlebelia gakeTdes
romlebsac aqvT apo E4-is erTi asli (heterozigotebi), antifsiqozur medikamentebze reaqciis prognozi.
samjer ufro maRalia alchaimeris daavadebis COMTvalin1158 meTionini _ fermentis es forma
ganviTarebis albaToba. es riski TiTqmis aTjer izrdeba gviCvenebs, rom genetikurma polimorfizmma SeiZleba
homozigotebSi (rodesac genis orive asli aris apo E4). iqonios gavlena normaluri qcevis maxasiaTeblebze,
Tumca, TiTqmis 50%-is SemTxvevaSi alchaimeris daavadeba daavadebisadmi mowyvladobasa da imaze, Tu rogor
Tavs iCens iseT adamianebSi, romelTac ar aqvT apo E4 reagirebs pacienti medikamentur mkurnalobaze
aleli, xolo apo E4 - is mqone homozigotebSi, is SeiZleba (farmakogenetika).
saerTod ar ganviTardes. es imaze miuTiTebs, rom apo
5-HHT transporteri (5-HHTT) geni da SfoTva. 5-HHTT
E4, iseve rogorc fsiqikur aSlilobaze pasuxismgebeli
aris SSRI-is samizne da aregulirebs sinafsuri 5-HT-
genebis umravlesoba, warmoadgens polimorfizms,
is aqtivobas. es geni Seicavs polimorfizms, romelic
romelic moqmedebs, rogorc risk faqtori. me-14 TavSi
lokalizebulia mis promotorul (sakontrolo) ubanze.
saubaria imaze, Tu ra rols TamaSobs apo E4 alchaimeris
es polimorfizmi, zemoT aRwerili SemTxvevisgan Semdegi
daavadebaSi da rogor zrdis am daavadebis risks.
ori niSniT gansxvavdeba: (a) is ar aris makodirebeli,
COMT val158meT, winafrontaluri qerqis funqcionireba anu igi ver cvlis aminomJavaTa Tanmimdevrobas cilaSi;
da Sizofrenia. fermenti kateqol-O-meTiltransferaza (b) is aris ara erTeuli nukleotidis polimorfizmi,
(COMT) monawileobs monoaminebis, gansakuTrebiT ki aramed sigrZeebis polimorfizmi. misi ori alelidan
dofaminis, metabolizmSi. es fermenti funqcionirebs, erTs uwodeben mokles (S), meores ki _ grZels (L).
rogorc maRalaqtiuri, ise dabalaqtiuri formiT. evropul populaciebSi, grZeli alelis sixSire 50%-
aq sxvaoba aqtivobis xarisxSi ganpirobebulia ia. zogierT gamokvlevaSi naCvenebia (Lesch et al., 1996),
polimorfizmis kodirebiT genSi, rac cvlis fermentSi rom es aleli asocirdeba nevrotizmTan (trait anxiety.
erTeul aminomJavebs: maRalaqtiuri aleli CarTavs SfoTviTi gancdebisadmi midrekileba). kaspim da misma
valins (val_COMT), dabalaqtiuri ki meTionins kolegebma (Caspi et al, 2004) aRmoaCines, rom mocemuli
(meTionin_COMT). eganma da misma kolegebma (Egan et al., aleli warmoadgens predispozicias depresiisadmi,
2001) aCvenes, rom (valin_COMT)-is mqone subieqtebs, romelic mosdevs cxovrebis adreul etapze momxdar
axasiaTebT naklebaqtiuri prefrontaluri qerqi uaryofiT movlenebs. polimorfizms SeuZlia Tavisi
(vlindeba operaciuli mexsierebis amocanebis wvlili Seitanos imaSi, Tu ramdenad gansxvavebuli
Sesrulebisas), vidre (meTionin_COMT)-is mqone iqneba reaqcia mkurnalobaze. is, agreTve, nawilobriv
adamianebs. heterozigotebTan efeqturobis xarisxi ganapirobebs SSRI-is gverdiT movlenebs.
eTnikuri stratifikaciis Sedegad, mogvces arte- w individis mSoblebis sakontrolo mizniT gamoy-
faqtuli gansxvavebebi jgufebs Soris, risi aR- eneba, ramac unda aCvenos, gadaeca Tu ara mas mem-
ricxvac da Tavidan acileba Zalian Znelia. kvidreobiT mSoblis polimorfizmi ufro maRali
w genomSi daaxloebiT 30 000-mde genia da asobiT da xarisxiT, vidre es SemTxveviT moxdeboda. xSirad am
aTasobiT polimorfizmi. imis albaToba, rom rome- mizniT mimarTaven gadacemis uwonasworobis tests.
lime calkeuli geni an polimorfizmi namdvilad ojaxis struqturis gaTvaliswinebiT xdeba eTni-
aris dakavSirebuli gasazom fenotipTan, Zalian kur stratifikaciasTan dakavSirebuli problemis
dabalia, Tu ar arsebobs sakmarisi damajerebeli gadaWra.
mtkicebuleba romelime genis monawileobis Sesaxeb w erT genSi arsebuli ramdenime polimorfizmis
(rac fsiqiatriaSi sakmaod iSviaTia). gazomva, ramac mecnierebi miiyvana im daskvnamde,
ufro gviandeli periodis asociaciur kvlevebSi rom polimorfizmebi ramdenime aTas nukleotidSi
scades am sirTuleebis daZleva sxvadasxva gziT (Page SeiZleba erTdroulad gamovlindes, radgan maTi
et al., 2003): gancalkeveba meiozis dros rekombinaciis gziT
iSviaTad xdeba. amas ewodeba SeWidulobis uwonas-
w kvlevis Sedegebis xarisxis gaumjobeseba didi
woroba. rogorc ki moxdeba SeWiduli polimor-
moculobis SerCevis gamoyenebiT, rac moiTxovs
fizmebis blokis (haplotipis) identificireba, misi
statistikur sizustes, cdebis damoukidebel
`saxeldeba~ SesaZlebeli xdeba erT-erTi Semadgene-
gameorebas da biologiuri TvalsazrisiT sarwmuno
li polimorfizmis gazomviT.
monacemebis miRebas (ixileT qvemoT). asociaciuri
kvlevebi aseve eqvemdebareba metaanalizs. w asociaciuri kvlevebis dakavSireba SeWidulobis
_ 109 _
5 etiologia
kvlevebTan. am ori midgomis kombinaciiT moxerxda Weinberger, 2005).
neuregulin 1-is, rogorc Sizofreniis mimarT mow- bolos, unda aRiniSnos, rom genebis eqspresiis reg-
yvladi genis, identifikacia. ulireba nawilobriv memkvidreobiTia da damoukide-
w polimorfizmis analizi mTeli genomis gaswvriv. belia dnm-Si nukleotidebis TanmimdevrobaTa variac-
teqnikuri saSualebebis ganviTarebasTan erTad, iebisagan, rasac epigenetika ewodeba da mniSvnelovania
SesaZlebeli xdeba aseul aTasobiT polimorfizmis ori mizezis gamo. jer erTi, is arTulebs genetikuri
erTdrouli gazomva (erTeuli nukleotiduri poli- gamokvlevebis Sedegebis interpretacias da meorec,
morfizmis rukaze gamosxva anu haplotipuri rukis igi relevanturia ramdenime fsiqikuri aSlilobis
Seqmna). es gvexmareba im problemis daZlevaSi, ra- mimarT (Petronis, 2004). amis magaliTia iseTi SemTx-
sac iwvevs kandidati genebis simwire (es is genebia, veva, rodesac mamisagan (an dedisagan) memkvidreobiT
romlebzec unda moxdes dakvirveba) da saSualebas miRebuli genis mxolod aslis eqspresia xdeba, xolo
gvaZlevs miukerZoeblad veZioT is genebi, romlebic meore qromosomis asli inaqtiuria. amas ewodeba ge-
daavadebisadmi mowyvladobas ganapirobebs. nomuri imprintingi, romlis klasikuri ilustraciaa
prader-vilis da angelmanis sindromebi (25-e Tavi).
rogor zemoqmedebs genebi daavadebis riskze
genebi da genebis eqspresia
genetikurma variantma SeiZleba gamoiwvios daavadeba
ori mizezidan erT-erTis gamo. Tu varianti makodi- molekuluri genetikis meTodebis gamoyenebiT ad-
rebelia (anu cvlis cilaSi aminomJavaTa Tanmimdev- vilad Seiswavleba genebis eqspresia. Tavis tvinSi
robas, romlebic geniTaa kodirebuli), cilam, ro- SesaZlebelia mRNA-is aRmoCena da raodenobrivi
gorc am cvlilebis pirdapirma Sedegma, SeiZleba ga- gansazRvra, aseve, SemTxvevebisa da sakontrolo
moamJRavnos gansxvavebuli funqcionireba (1. rogorc maCveneblebis Sedareba iseTi meTodebis gamoyenebiT,
es naCvenebia boqs 5.3-is pirvel or magaliTSi; 2. ro- rogorebicaa in situ hibridizacia da reversuli tran-
gorc APP mutacia alchaimeris ojaxur SemTxveveb- skriptazas polimerazuli jaWvuri reaqcia (RT-PCR).
Si). es efeqti SeiZleba orgvari iyos: igi SeiZleba mgavsad amisa, SesaZlebelia SeviswavloT kodirebu-
warmoadgendes normalurad funqcionirebis uunaro- li cilebi imunocitoqimiuri an vestern blotingis
bas (funqciis dakargvis mutacia), an cila SeiZleba meTodebiT specifikuri antisxeulebis gamoyenebiT.
gaxdes toqsikuri (funqciis SeZenis mutacia). Tumca, amJamad aseve SesaZlebelia aTasobiT mRNA-is erT-
genetikuri variantebis umetesoba, romelTac amJamad drouli Seswavla dnm _ mikroCipebis meSveobiT. am
ukavSireben fsiqikur aSlilobas, ar aris makodire- sferos ewodeba transkriptomika. dResdReobiT iq
beli. aseT SemTxvevebSi, moqmedi meqanizmia is, rom mneba analogiuri midgoma cilebis mimarT (pro-
icvleba genis eqspresiuloba da, Sesabamisad, cilis teomika). aRniSnuli meTodebiT SegviZlia, agreTve,
sinTezi. am cvlilebam, SeiZleba, imoqmedos cilis SeviswavloT genis eqspresiaSi momxdari cvlilebebi,
raodenobaze, sinTezis droze da cilis specifikur romlebsac iwvevs dazianeba, farmakologiuri niv-
maxasiaTeblebze. magaliTad, maregulirebel re- Tierebebi, hormonebi da a.S. aseve, es midgoma Sei-
gionSi momxdarma polimorfizmma SeiZleba gazardos Zleba gamoviyenoT mRNA-is an iseTi cilis mimarT,
genis transkribcia, Sedegad gamoiwvios mRNA-s zrda romelic eqstragirebulia periferiuli sisxlidan
da Semdgom cilis gazrdili raodenobis sinTezi an ujredul kulturaSi imyofeba. SesaZlebelia sxva
(rogorc es ilustrirebulia boqsi 5.3-is bolo mag- eqsperimentuli paradigmebis gamoyenebac (Bunney et
aliTSi, romelSic 5-HTT-is mokle aleli asocirebu- al., 2993; Rohlff and Hollis, 2003).
lia 5-HT-is transporteris sinTezis daqveiTebasTan da bolos, transgenuri Tagvebis Seswavla kidev
da, Sesabamisad, naklebi 5-HT-is xelmeored Sewovas- erTi damatebiTi gzaa fsiqikur aSlilobaSi genebisa
Tan). sxva ara-makodirebeli polimorfizmebi zemoq- da genebis eqspresiis rolis kvlevisa. amJamad Sedar-
medebs mRNA-is precesingze, romelsac alternati- ebiT advilia genis mospoba, Semotana, an misi eqspre-
ul splaisings uwodeben. misi meSveobiT erTeulma siis donis regulireba RNA-is interferenciis gamoy-
genma SeiZleba warmoSvas cilis ori an meti varianti enebiT. transgenur cxovelebze Catarebuli gamokv-
(izoformebi). cilis izoformebs SeiZleba hqondes levebi metad mniSvnelovania iseTi daavadebebis
gansxvavebuli Tvisebebi. maTs TanafardobaSi momx- Sesaswavlad, romlebic erTeuli genis mutaciiTaa
dar cvlilebas SeiZleba mohyves fiziologiuri da gamowveuli (magaliTad, Tagvebs, romlebsac hqodaT
paTofiziologiuri Sedegebi. amJamad iTvleba, rom adamianis APP genis mutaciuri forma, ganuviTardaT
mowyvladobis genebis gazrdili raodenobis efeqti alchaimeris daavadeba. me-14 Tavi). genebiT manipuli-
SeiZleba realizebul iqnes genis eqspresiulobis reba cxovelebze modelirebis ZiriTadi formaa, ro-
modulirebiT da alternatiuli splaisingiT. Sizo- melic fsiqiatriaSi gamoiyeneba (Seong et al., 2002).
frenia erT-erT maTgans warmoadgens (Harrison and
_ 110 _
bioqimiuri gamokvlevebi orotransmiterTa da fermentebis koncentracias,
bioqimiuri kvlevebi SeiZleba mimarTuli iyos an daa- gardacvalebis Semdeg; metic, fsiqikuri aSliloba
vadebis gamomwvev mizezebze, an daavadebis gamovle- uSualod ar iwvevs sikvdils, aramed gardacvalebis
nis meqanizmebze. bioqimiuri gamokvlevis meTodebi saboloo mizezi ZiriTadad sxva paTologiaa (xSir-
sakmaod mravalricxovania da amdenad, SeuZleblad ad bronqopnevmonia an wamlis gadaWarbebuli doza),
migvaCnia yvela maTganis aq ganxilva vvaraudobT ra, romelmac, SesaZloa, gamoiwvios cvlilebebi Tavis
rom mkiTxveli sakmaod informirebulia maT Sesaxeb. tvinSi.
amjerad visaubrebT fsiqikur aSlilobaTa gamokvl- Tu am SesaZleblobas gamovricxavT, mainc dasaSve-
evaSi bioqimiuri meTodebis gamoyenebaze. bia, rom miRebuli qimiuri cvlilebebi mkurnalobis
zemoT Tqmulidan naTelia, rom molekulur geneti- Sedegia da ara daavadebis. magaliTad, dofaminis re-
kaSi Catarebuli gamokvlevebis masStabis gafarToebas ceptorebis gazrdili simkvrive SizofreniiT daa-
didad Seuwyo xeli bioqimur doneze garkveuli anom- vadebuli pacientebis Tavis tvinSi mdebare birTvebSi
aliebis arsebobam, rac ganasxvavebs erTmaneTisagan (nucleus accumbence-sa da caudate nucleus-Si) SeiZleba mi-
konkretuli fsiqikuri aSlilobis mqone pacientebs. viCnioT im hipoTezis mtkicebulebad, rom Sizofre-
aseTi anomaliebis mniSvneloba kidev ufro gaizrde- niis gamomwvevi mizezi aris dofaminis funqciis cv-
boda, Tuki isini daavadebis etiologiasa da paTo- lileba Tavis tvinis aRniSnul ubnebSi. meores mxriv,
fiziologiaSi mniSvnelovan rols Seasrulebdnen. da es SeiZleba iyos antifsiqozuri wamlebis xangrZlivi
mainc, fsiqikur aSlilobasTan dakavSirebuli bioqi- miRebis Sedegi, rac blokavs dofaminis receptorebs,
miuri cvlilebebi umetes SemTxvevaSi Seuswavlelia, ramac SeiZleba gamoiwvios receptorebis ricxvis
rac ori mizeziTaa gamowveuli: pirvelia informa- kompensatoruli gazrda.
ciis nakleboba Tavis tvinSi normis doneze mimdin- rogorc zemoT iyo aRniSnuli, molekuluri gene-
are rTuli bioqimiuri procesebis Sesaxeb; meore _ tikis meTodebis meSveobiT SeiZleba SevavsoT gvamur
cocxal Tavis tvinze bioqimiuri gamokvlevebis Cat- masalaze bioqimiuri kvlevis meTodebiT miRebuli
arebis sirTule. metic, radgan fsiqikur aSliloba- informacia. magaliTad, in situ hibridizacia gvawv-
Ta umetesoba ar iwvevs sikvdils (garda suicidisa), dis informacias gamosakvlev neorotransmiterTa
gvamuri masala Znelad mosapovebelia (gardacvlili receptorebis genebis eqspresiis Sesaxeb (mRNA). am
xandazmulebis gamoklebiT). amitom, mkvlevarebi iy- meTodebis gamoyenebiT dadginda, rom glutamatis
eneben mraval arapirdapir meTods, maT Soris, per- receptorTa mRNA Semcirebulia SizofreniiT daa-
iferiuli qsovilebis, Tavzurgtvinis siTxis, sisxlis vadebul pacientTa hipokampusSi. es Sedegebi avsebs
ujredebisa da Sardis gamokvlevas. es gamokvlevebi glutamatis receptorebis ligand-damakavSirebel
advili Casatarebelia, magram maTi interpretacia gamokvlevebs Tavis tvinis am ubanSi (Harrison, 2004).
xSirad rTulia (magaliTad, Tavzurgtvinis siTxeSi mniSvnelovani progresia miRweuli gvamuri masalis
neirotransmiterTa da metabolitebis koncentraciis SeswavlaSi ramdenime meTodis kombinirebuli gamoy-
kavSiri funqciurad aqtiur neirotransmiterebTan enebis wyalobiT (genebis eqspresia, neiroqimiuri da
Tavis tvinSi). Sesabamisad, neirotransmiterebis re- nevropaTologiuri meTodebi). yovelive es miznad
ceptorebi da maTi meoradi mesenjerebi sisxlis isaxavs nervuli funqciis darRvevaTa Seswavlas Ta-
trombocitebsa da limfocitebSi xSirad gansxvavebu- vis tvinis gansazRvrul ubnebSi.
lad Seesatyviseba maTive analogebs Tavis tvinSi. da Tavis tvinis bioqimia da vizualizacia
bolos, plazmisa da Sardis maCveneblebi Zlier eqve-
ukanasknel wlebSi Seiqmna cocxal Tavis tvinSi bioqi-
mebareba dietur da qceviT cvlilebebs (ix. qvemoT).
miuri procesebis Seswavlis efeqturi meTodebi, rom-
bioqimiuri gamokvlevebis Sedegebs mkiTxveli Sem-
lebic zogierTi fsiqikuri aSlilobis kvlevisaTvis
dgom TavebSi gaecnoba. es sakiTxebi ufro deta-
gamoiyeneba. esenia:
luradaa ganxiluli im qveTavebSi, romlebic guneb-
ganwyobis aSlilobebsa da Sizofrenias eZRvneba. am w magnitur rezonansuli tomografia (MRI)
etapze mimovixilavT ramodenime magaliTs sxvadasxva w erTeuli fotonis emisiis tomografia (SPET)
tipis kvlevebidan. w pozitronis emisiis tomografia (PET)
gardacvalebis Semdgomi kvlevebi aRniSnuli meTodebis gamoyeneba Tavis tvinis

struqturisa da sisxlis mimoqcevis Seswavlisas
Tavis tvinis gvamuri masalis gamokvleviT SesaZle-
qvemoT, Sesabamis TavebSi iqneba ganxiluli. Tumca,
belia Tavis tvinSi mimdinare qimiuri cvlilebebis
Tavis tvinis vizualizacias Tavis tvinis bioqimiis
pirdapiri aRwera. samwuxarod, rTulia am monacem-
zogierTi aspeqtis gansasazRvradac mimarTaven. ma
Ta interpretacia, radgan Zneli dasadgenia, mox-
galiTad, fsiqiatriuli pacientebis sxvadasxva jgu
da Tu ara nebismieri cvlileba, romelic exeba ne-
_ 111 _
5 etiologia
febSi SesaZlebelia receptorTan dakavSirebis in vivo hidroqsilazas inhibitori, -meTil-para-Tirozini
Seswavla pozitron niSandebuli ligandebis da PET-is (AMT). am modelebis gamoyeneba saSualebas gvaZlevs
da SPET-is gamoyenebiT (Seybil et al., 2004). davaskvnaT, rom dofaminis gamoyofa gazrdilia mw-
vave Sizofreniis mqone pacientebSi (gv. ??). mimdinare
receptorTan dakavSirebis Seswavla PET-isa da gamokvlevebis meSveobiT SegviZlia davadginoT, Tu
SPET-is gamoyenebiT rogor gamoviyenoT aRniSnuli meTodebi sxva neiro-
5-HT 1A receptors mniSvnelovani roli eniWeba neiro- transmiterTa gamoyofis Sesaswavlad.
transmiter 5-HT-is funqcionirebis regulaciaSi. igi,
aseve, antidepresantuli medikamenturi mkurnalo- magnitur rezonansuli tomografia (MRI)
bis mniSvnelovani samiznea. PET vizualizaciis gam- MRI-s upiratesoba PET da SPET meTodebTan Sedar-
oyenebiT pozitron niSandebul 5-HT 1A-sTan erTad, ebiT aris is, rom aRniSnuli gamokvlevis dros paci-
mkvlevarTa jgufma daadgina, rom didi depresiuli entebi ar imyofebian radiaciuli zemoqmedebis qveS.
aSlilobis mqone pacientebis Tavis tvinSi 5-HT 1A-is (MRI) efeqturia Tavis tvinis struqturuli vizual-
receptorTan dakavSireba sustdeba. ufro metic, es izaciisaTvis da, agreTve, Tavis tvinSi sisxlis mimo-
paTologia SenarCunebuli aqvT im pacientebsac, rom- qcevis Seswavlisas. Tumca, ar aris sakmarisad mgrZno-
lebic gamovidnen depresiuli mdgomareobidan da Sew- biare Tavis tvinSi bioqimiuri procesebis gamosakv-
yvites medikamenturi mkurnaloba. es imaze miuTiTebs, levad (magnitur rezonansuli speqtroskopia, MRS).
rom 5-HT 1A-is receptorTan susti dakavSireba SeiZleba miuxedavad amisa, MRS sul ufro farTod gamoiyeneba
warmoadgendes depresiis markers. meores mxriv, re- fsiqikuri aSlilobebis Sesaswavlad da samkurnalod
ceptorTan dakavSirebis Sesusteba, SesaZloa depre- (Lyoo and Renshaw, 2002).
siul mdgomarebaSi yofnis Sedegi iyos (Bhagwager et w proton (1H) MRS SegviZlia gamoviyenoT CvenTvis
al., 2004). saintereso neirobiologiuri funqciis mqone na
finansuri mizezebis gamo, gamokvlevebi PET-is gam- erTebis raodenobis dasadgenad, maT Soris, mni
oyenebiT tardeba mxolod mcirericxovan speciali- Svnelovani aminomJavuri neirotransmiterebis _
zebul sakvlev centrebSi. Tumca, SPET vizualizacia GABA-sa da glutamatis (cxrili 5.4).
ufro farTod gamoiyeneba da iqmneba receptoris
w aseve, MRS-s meSveobiT SegviZlia fosforis Sem
mimarT specifikuri, SPET gamokvlevisaTvis Sesaferi-
cveli naerTebis speqtris dadgena da, Sesabamisad,
si, sul ufro meti ligandi. magaliTad, ramodenime
informaciis miReba energiis metabolizmsa da
gamokvleva ukve iyenebs SPET-s specifikur dofaminis
intraujredul pH-ze.
receptor ligandebTan erTad dofaminis receptor-
Tan dakavSirebis Sesaswavlad, afeqturi aSlilobisa w fsiqotropuli preparatebis nawili (magaliTad,
da Sizofreniis dros. fluoqsetini) warmoqmnis fluorin atomebs, ro
melTa vizualizacia SesaZlebelia MRS-iT, rac
neirotransmiterebis gamoyofa in vivo gviCvenebs am preparatebis ganawilebas Tavis tvinSi
PET da SPET meTodebis gamoyeneba specifikur dofam- maT specifikur receptorTa saitebze.
inur receptorebTan ligandebis dakavSirebiT in vivo w aseve, MRS SegviZlia gamoviyenoT liTiumis ga
dofaminis gamoyofis Sefasebis SesaZleblobas iZl- mosavlenad adamianis Tavis tvinSi. cnobilia,
eva. pacientis skanireba or gansxvavebul SemTxveva- rom Tavis tvinSi liTiumis raodenoba Seesabameba
Si xdeba: (1) iseTi wamlis Seyvanis Semdeg, romelic sisxlis plazmaSi arsebuli liTiumis raodenobis
cvlis endogenuri dofaminis gamoyofas (mag., amfe- naxevars.
tamini); (2) placebos Semdeg. amfetamini zrdis do- protonuli magnitur rezonansuli speqtroskopiiT
faminis gamoyofas presinafsur ubanSi. endogenuri
dofaminis es gazrdili raodenoba konkurenciaSia
cxrili 5.4 MRS meTodiT gansazRvruli
treiseris ligandTan, raTa miaRwios postsinafsur
neirotransmiterebi da neironuli
receptoramde. Sesabamisad, treiseris specifikuri metabolitebi
bma Semcirebulia da skanirebis meSveobiT amfetamini-
1
H NMR 31
P-NMR
sa da placebos mier gamowveul tresieris signalebs
Soris gansxvavebis dadgena saSualebas gvaZlevs gan- N acetil aspartati (NAA) ATP
vsazRvroT, Tu ra raodenobiT gamoiyo dofamini am- kreatini fosfokreatini
fetaminis gavleniT.
mioinozitoli araorganuli fosfati
msgavsi midgoma SegviZlia gamoviyenoT im prepa-
ratebTan, romlebic amcirebs endogenuri dofami- GABA fosfodiesteri
nis gamoyofas, rogorebicaa, magaliTad, Tirozin- glutamati fosfomonoesteri
_ 112 _
miRebuli Sedegebi naTlad gviCvenebs, rom depresiuli periferiuli sisxlis ujredebi, rogorebicaa
avadmyofebis qerqSi GABA-s raodenoba Semcirebulia. Trombocitebi da limfocitebi, Seicaven neirotrans-
es axleburad warmoaCens im faqts, rom aTwleulebis miterTa receptorebs, romlebic xSirad Tavis tvinSi
manZilze etiologiuri hipoTezebis Camoyalibeba arsebuli analogiuri receptorebis damakavSirebeli
monoaminur Teorias eyrdnoboda. saitebis msgavsia. mravali gamokvlevaa Catarebuli
depresiuli pacientebis Trombocitebze, magram Se-
periferiuli gazomvebi degebi ar aris Tanmimdevruli da icvleba iseTi
didi xnis ganmavlobaSi arsebobda eWvi imis Sesaxeb, faqtorebis zemoqmedebiT, rogoricaa, magaliTad,
aisaxeba Tu ara Tavzurgtvinis siTxeSi (CSF) arsebul medikamenturi mkurnaloba. garda amisa, Znelia imis
neirotransmiterTa Semcveloba Tavis tvinSi mimdinare, mtkiceba, rom aRniSnul periferiul damakavSirebel
funqciurad mniSvnelovan cvlilebebze. arsebobs saitebze aRwerili cvlilebebi Tavis tvinSic unda
kavSiri Tavzurgtvinis siTxeSi 5-hidroqsindoleas mimdinareobdes. marTlac, im kvlevebiT, romelTa
mJavas (5-HIAA) dabal Semcvelobasa da impulsur- drosac dakvirveba mimdinareobda erToblivad
agresiul qcevas Soris adamianebsa da primatebSi periferiul receptorTan dakavSirebasa da in vivo re-
(Gerald et al., 2002). es gvafiqrebinebs, rom CSF ceptoris vizualizaciaze, ver daadgines maT Soris
5-HIAA korelaciaSia qcevis dadgenil aspeqtebTan. korelaciis arseboba (Yatham et al., 2002). msgavsi SeniS-
Tavzurgtvinis siTxis Seswavlis garkveuli susti vnebi SeiZleba gamoiTqvas im SemTxvevebTan dakavSire-
mxarea is, rom xSirad, rogorc eTikuri TvalsazrisiT, biTac, rodesac sisxlis ujredebs iyeneben neiro-
ise praqtikuladac Znelia CSF nimuSebis aReba transmiterebTan dakavSirebul meoreuli mesenjere-
fsiqiatriuli pacientebisagan. amasTan, SeuZlebelia bisa da ionTa gadaadgilebis procesebis Sesaswavlad
neirotransmiterTa metabolizmis droze damoki (mag., kalciumis ganvladoba).
debuli cvlilebebis monitoringi nimuSebis ganme
orebiTi Seswavlis gziT. farmakologia
im mizniT, rom sisxlSi sxvadasxva substanciebis Zalian xSirad, daavadebis warmatebuli mkurnalobis
gazomvis safuZvelze emsjelaT Tavis tvinSi mim Seswavla naTels hfens mis etiologias. im seriozu-
dinare bioqimiuri cvlilebebis Sesaxeb, sakmaod li problemebis gamo, rac Tan axlavs fsiqiatriaSi
seriozuli kvlevebi Catarda. magaliTad, cnobilia, Tavis tvinis uSualod Seswavlas, mecnierebi ikvleven
rom 5-HT-is sinTezi damokidebulia 5-HT-is efeqturi fsiqotropuli wamlebis zemoqmedebas, raTa
prekursoris _ triptofanis, koncentraciaze Tavis SemdgomSi daadginon daavadebis dros mimdinare bi-
tvinSi. ramdenime kvlevam aCvena, rom didi depresiis oqimiuri anomaliebi. ra Tqma unda, amgvari midgoma
mqone pacientebis sisxlis plazmaSi triptofanis did sifrTxiles moiTxovs. Tu efeqturad momqmedma
Semcveloba daqveiTebulia. es adasturebs im hi wamalma dabloka konkretuli transmiteruli sistema,
poTezas, rom depresiuli aSlilobis dros Tavis Cven ver davaskvniT, rom es daavadeba am neirotrans-
tvinSi 5-HT-is funqcia daqveiTebulia. Tumca, Se miteris Warbi raodenobiTaa gamowveuli. amis naTeli
uZlebelia davaskvnaT, rom plazmis triptofanis magaliTia parkinsonizmi; antiqolinerguli wamlebi
zomieri daqveiTeba aucileblad Tavis tvinSi 5-HT- cvlian simptomebs, magram daavadeba gamowveulia do-
is neirotransmisiis gauaresebas ukavSirdeba. ufro faminerguli transmisiis deficitiT da ara qoliner-
metic, sisxlis plazmis triptofanis koncentraciis guli transmisiis siWarbiT.
msgavsi daqveiTeba aReniSnebaT im janmrTel ada vgulisxmobT, rom neirofarmakologiis zogadi me-
mianebsac, romlebmac dietis meSveobiT daikles wo Todebi cnobilia mkiTxvelisaTvis, amitom yuradRe-
naSi. Sesabamisad, advili SesaZlebelia, rom plazmis bas SevaCerebT fsiqiatriaSi am meTodebis gamoyenebis
triptofanis donis daweva depresiul pacientebSi calkeul sirTuleebze. aq ori ZiriTadi problema
wonaSi klebiT iyos gamowveuli. gamoikveTeba: (1) fsiqotropul wamalTa umravlesobas
sazogadod, sisxlsa da SardSi bioqimiuri anoma- ara erTi zemoqmedeba aqvs da xSirad Zneli dasadgen-
liebis kvleva fsiqikuri aSlilobebis etiologiis ia, romeli maTgania relevanturi Terapiuli efeqtis
dasadgenad, arc ise produqtiuli aRmoCnda. amgvari misaRwevad. magaliTad, miuxedavad imisa, rom li-
kvlevebidan realuri Sedegebis miReba SesaZlebe- Tiumis karbonats aqvs mravali cnobili farmakolo-
lia daswavlis darRvevis sferoSi, sadac sisxlSi da giuri efeqti, aqamde SeuZlebeli iyo bipolaruli
SardSi calkeuli metabolitebis gazomvebi zogjer aSlilobis mqone pacientebis guneb-ganwyobaze misi
Tavis tvinSi arsebuli darRvevebis Sesaxeb gvawvdis mastabilizebeli zemoqmedebis axsna; (2) kidev erTi
informacias. am tipis gazomva, agreTve, sasargeblo sirTule Cndeba imis gamo, rom bevri fsiqotropuli
diagnostikur tests warmoadgens, risi magaliTicaa wamlis Terapiuli efeqti nela vlindeba, maSin rode-
fenilketonuria (gv. ??). sac laboratoriaSi maTi farmakologiuri efeqtis
_ 113 _
5 etiologia
dadgena swrafad xdeba. magaliTad, arsebobs varaudi, endokrinologia
rom antidepresiuli preparatebis dadebiTi efeqti sisxlSi hormonTa koncentraciis cvlilebebi mniS-
damokidebulia presinafsur neironSi maTi ukumita- vnelovnad zemoqmedebs guneb-ganwyobasa da qcevaze.
cebis cvlilebebze, rac ukumitacebis dros swrafad endokrinuli funqciis darRvevebi iwvevs zogierT
viTardeba, xolo Terapiuli efeqtis gamosavlenad, dadgenil klinikur sindroms, romelTaganac zogs
daaxloebiT, ori kviraa saWiro. es SeiZleba imas ni- aqvs damaxasiaTebeli neirofsiqiatriuli gamov-
Snavdes, rom klinikuri antidepresiuli mniSvneloba linebebi (magaliTad, depresia kuSingis daavadebis
antidepresantebze Tavis tvinis àdaptaciuri~ dros).
reaqciiTaa ganpirobebuli. wlebis manZilze Seswav- miuxedavad aseTi kavSirebis arsebobisa, fsiqiku-
lili iqna antidepresiuli preparatebis mravali gan- ri aSlilobis dros, hormonTa bazaluri plazmuri
sxvavebuli adaptaciuri reaqcia, magram verc erTma donis gazomvam, zogadad, ar aCvena Tanmimdevruli
ver migviyvana axali antidepresantis Seqmnamde. Tan- darRvevebi fsiqiatriul pacientebTan; amitom am
amedrove kvlevebi swavlobs antidepresantebis gav- faqtebma mniSvnelovani wvlili ar Seitana etiologi-
lenas genebis transkribciis faqtorebsa da neiro- is dadgenaSi. gamonakliss warmoadgens didi depresia.
tropinebze (rogoricaa Tavis tvinis SeZenili neiro- am aSlilobis mqone pacientTa mniSvnelovan nawils
tropuli faqtori _ BDNF), romlebic gansazRvravs kortizolis hipersekrecia aReniSneba. sul ufro
sinafsuri kavSirebis zrdasa da tvinis plastikuro- meti empiriuli masala adasturebs, rom depresiis
bas (Duman, 2004). mqone zogierTi pacientis sisxlSi momatebuli kor-
axali medikamentebis SemoReba, romlebic Sedgeba tizolis done SesaZloa TamaSobdes garkveul rols
tradiciuli komponentebisagan, magram gansxvavebuli depresiis paTofiziologiaSi (gv. ??).
farmakologiuri moqmedeba aqvT, gvexmareba SevimuSa-
voT hipoTezebi konkretuli aSlilobis warmatebuli hormonebi da genebis eqspresia
mkurnalobis meqanizmisa da paTofiziologiis Ses- arsebobs uaxlesi monacemebi imis Sesaxeb, Tu rogor
axeb. magaliTad, serotoninis ukumitacebis seleq- SeuZlia hormonebs Tavis tvinis funqcionirebis Secv-
tiuri inhibitorebis (SSRI) gacnobisas irkveva, rom la. es saSualebas gvaZlevs, davinaxoT paTofiziolo-
mxolod is antidepresantebi, romlebsac aqvT poten- giuri kavSirebi hormonTa sekreciis cvlilebasa da
ciuri 5-HT-is ukumitacebis inhibitoruli Tvisebebi, Tavis tvinis Sesabamisi meqanizmebis cvlilebebs So-
efeqturia obsesiur-kompulsuri aSlilobis farma- ris. hormonebs SeuZlia rogorc intraceluluri, ise
kologiuri mkurnalobisas. sayovelTaod miRebuli eqstraceluluri signalirebis Secvla, rac, Cveule-
tricikluri antiodepresantebis gamoyeneba ki, uSe- briv, genebis eqspresiis cvlilebiT xdeba.
degoa (garda klomipraminisa). rogorc Cans, obse- magaliTad, kortikosteriodebi moqmedebs ujred-
siur-kompulsuri aSlilobis paTofiziologia gan- Ta birTvebze da cvlis sxvadasxva neirotransmitere-
sxvavdeba didi depresiisagan, romlis samkurnalodac bis receptorTa eqspresias. cxovelebze Catarebuli
erTnairad efeqturia orive klasis naerTebi. eqsperimentebiT dadginda, rom 5-HT 1A receptorTa
kidev erTi medikamenti, romelmac stimuli misca simkvrive icvleba sisxlSi cirkulaciaSi myofi kor-
am mimarTulebiT kvlevis Catarebas, klozapinia. es tizolis doniT. SesaZloa, kortizolis Warbma sekre-
antifsiqozuri medikamenti efeqturad moqmedebs im ciam gamoiwvios depresiisadmi winaswari ganwyoba,
pacientebis umravlesobaze, romlebic ar reagireben rasac ganapirobebs 5-HT 1A receptorTa funqciis
tradiciul antifsiqozur wamlebze. cnobilia, rom daqveiTeba Tavis tvinis limbur ubanSi. cxovelebze
antifsiqozuri wamlebis umravlesobis samkurnalo Catarebulma cdebma aseve gviCvena, rom kortikos-
efeqti miiReba maT mier dofamin D2-is receptore- teroidebis zemoqmedeba iwvevs ujredebis raode-
bis blokirebiT, xolo klozapins aqvs susti mgrZno- nobis Semcirebas hipokampSi. mocemulma aRmoCenam
beloba am receptoris mimarT. klozapini ukavSirdeba migviyvana hipoTezamde, rom depresiis mqone xan-
5-HT receptoris qvetips, kerZod 5-HT 2A receptors. dazmul pacientebSi kognituri fuqnciis daqveiTeba
ase gaCnda axali àtipiuri~ antifsiqozuri wamleb- SesaZloa warmoadgendes kortizolis hipersekreciiT
is didi raodenoba, romlebsac axasiaTebT kombinire- gamowveuli neironebis dazianebis Sedegs (Holsboer and
buli 5-HT2-is da dofamin D2-is receptorebis antag- Kunzel, 2004; gv. ??).
onisturi Tvisebebi. miuxedavad imisa, rom am wamlebs
garkveuli upiratesoba aqvT sayovelTaod aRiarebul peptiduri rilizing faqtorebi
antifsiqozur preparatebTan SedarebiT, mkurnalo- Tiroid mastimulirebeli hormonisa (TSH) da
bisadmi rezistentuli pacientebis SemTxvevaSi klo- adrenokortikotropuli hormonis (ACTH) gamoyofa
zapinis msgavsi efeqti ar aqvT. regulirdeba peptiduri rilizing faqtorebis mier.
Tavis tvinis sxva regionebSi maT aqvT damatebiTi
_ 114 _
sasignalo funqcia, romelic xSirad emociaTa regu- mkurnaloba asustebs neirotransmisias 5-HT recep-
laciaSi monawileobs. es peptidebi xSirad gvxvdeba torTa specifikur subpopulaciaSi (am SemTxvevaSi
klasikur neirotransmirebTan erTad. magaliTad, Ti- 5-HT2c receptori). es gavlena SeiZleba dakavSirebu-
rotropin rilizing hormoni (TRH) lokalizebulia li iyos mis uCveulo Terapiul efeqtTan, an iseTi
5-HT-sTan erTad 5-HT neironebSi. sul ufro mzardia gverdiTi moqmedebis gamovlenasTan, rogoricaa wo-
interesi imis mimarT, rom Seiqmnas iseTi peptidebi nis Warbi momateba.
rolebic zemoqmedebs peptidur receptorebze. amis
magaliTia kortikotropuli rilizing hormonis fiziologia
(CRH) antagonistebis SesaZlo gamoyeneba depresiis fiziologiuri meTodebis gamoyeneba
dros (gv. ??).
daavadebis mdgomareobasTan dakavSirebuli cere-
neiroendokrinuli testebi bruli da periferiuli aSlilobebis gamosakvlevi
sisxlis plazmaSi hormonTa donis gansazRvra Segvi- fiziologiuri meTodebi:
Zlia gamoviyenoT Tavis tvinis neirotransmiterTa w fsiqofiziologiuri meTodebi, maT Soris, pulsis,
funqciuri aqtivobis monitoringisTvisac. hipofizis sisxlis wnevis, sisxlis mimoqcevis, kanis gamtaro-
hormonebis sekrecia sxvadasxva neirotransmiterebiT bisa da kunTis aqtivobis gansazRvra;
kontroldeba. garkveul viTarebaSi sisxlis plazmis w Tavis tvinis sisxlis mimoqcevis Seswavla;
hormonTa koncentraciis cvlilebebi SegviZlia gam-
w eleqtroencefalografia (EEC gamokvleva).
oviyenoT maT sekreciaSi monawile neirotransmiter-
Ta funqciis Sesafaseblad. magaliTad, specifikuri fsiqofiziologiuri gazomvebi
preparatebiT Tavis tvinis 5-HT-is funqciis stimu- fsiqofiziologiuri gazomvebis interpretacia mi
lireba iwvevs plazmis prolaqtinis donis amaRlebas. nimum ori saxisaa. pirveli interpretacia erT
Sesabamisad, prolaqtinis koncentraciis gazrdili mniSvnelovania. gazomvis monacemebi gamoiyeneba da
done, gamowveuli preparatis standartuli dozis avadebis dros periferiuli organoebis funqcionirebis
gamoyenebiT, saSualebas gvaZlevs, ganvsazRvroT dasadgenad (magaliTad, imis gaasarkvevad, imatebs
Tavis tvinis 5-HT-is metaboluri gzebis funqciuri Tu ara Tavis qalis kunTebis eleqtromiografiuli
mdgomareoba. (EMG) aqtivoba im pacientebSi, romlebic uCivian
neiroendokrinuli Celenj testebi warmoadgens maRali arteriuli wneviT gamowveul Tavis tkivils).
Tavis tvinis neirotransmiterTa metaboluri gzebis meore interpretacia gamomdinareobs varaudidan, rom
dinamikur funqciur gasazom saSualebas. garkveuli periferiuli gazomvebi SesaZlebelia gamoviyenoT
fsiqikuri aSlilobebis dros es testebi aCvenebs nei- agznebis mdgomareobaSi myofi centraluri nervuli
rotransmiterTa funqcionirebis daqveiTebis Tanmim- sistemis cvlilebebis dasadgenad. amgvarad, kanis
devrul suraTs. magaliTad, depresiul pacientebs gamtareblobis, pulsis sixSirisa da sisxlis wnevis
prolaqtinis reaqcia 5-HT-is stimulaciaze Senelebu- mateba centraluri nervuli sistemis momatebuli
li aqvT da aseve rCeba klinikuri gamojanmrTelebi- agznebis indikatoria.
sas.
es imaze miuTiTebs, rom depresiuli aSlilobebi Tavis tvinis metabolizmisa da sisxlis
dakavSirebulia Tavis tvinSi 5-HT-is neirotransmi- mimoqcevis gazomva
siis deficitTan. Tumca, iseve rogorc sxva biolo- Tavis tvinis tomografiis (vizualizaciis) meTodebis
giuri maCveneblebis SemTxvevaSi, aqac sifrTxile gaumjobesebis Sedegad, ufro zustad izomeba Tavis
unda gamoviCinoT da gavakontroloT sxva, gareSe tvinis sisxlis mimoqceva fsiqikuri aSlilobebis
faqtorebiT gamowveuli efeqtebi (rogoricaa wonis dros. PET-iT da SPET-iT Catarebul gamokvlevebaSi,
dakargva da Zilis funqciis darRveva) (Cowen, 2005). SedarebiT Zveli teqnika Caanacvles qsenonis inha-
neiroendokrinuli testebiT SesaZlebelia, laciis meTodiT, radgan tomografiis Semotana re-
aseve, Tavis tvinis neirotransmiterul funqci- gionuli sisxlis mimoqcevis samganzomilebiani Seaf-
aze fsiqotropul nivTierebaTa efeqtebis Seswavla. sebis saSualebas iZleva.
magaliTad, kortizolis reaqcia 5-HT2c agonist re-
funqciuri magnitur-rezonansuli tomografia
ceptorze, rogoricaa m- qlorofenilpiperazini,
iblokeba im pacientebTan, romlebic mkurnalobdnen wylis protonis signaliT magnitur-rezonansuli
atipiuri antifsiqozuri preparatiT _ klozapiniT tomografiis meTodi, sakmaod mgrZnobiarea imisa-
da ar iblokeba imaTTan, romlebic iRebdnen iseT Tvis, rom misi meSveobiT ganisazRvros Tavis tvinSi
tradiciul antifsiqozur preparats, rogoricaa regionaluri sisxlis mimoqcevis zrda, rac mosdevs
flufenazini. es gvafiqrebinebs, rom klozapiniT neironul aqtivobas. es meTodi mniSvnelovani miRw-
_ 115 _
5 etiologia
evaa da, Cveulebriv, moixsenieba, rogorc funqcuri fsiqikuri aSlilobebis dros funqciuri magnitur-
magnitur-rezonansuli tomografia (fMRI). funqciu- rezonansuli tomografiis gamoyenebis Seaxeb, moce-
ri magnitur-rezonansuli tomografiis ZiriTad me- mulia Semdeg wyaroSi: Seibyl et al., 2004.
Tods warmoadgens sisxlis oqsigenaciis doneze da-
PET
mokidebuli vizualizacia (BOLD). BOLD efuZneba
deoqsihemoglobinis paramagniturobas da, aqedan PET vizualizacia SegviZlia gamoviyenoT, rogorc
gamomdinare, Seesabameba im magnituri velis gamoyene- Tavis tvinis metabolizmis, ise Tavis tvinis sisxlis
bas, romelic adgilobriv magnitur vels aZlierebs. mimoqcevis gansazRvrisaTvis. Cveulebriv, es ori
amis sawinaaRmdegod, oqsihemoglobini gacilebiT nak- monacemi mWidro korelaciaSia erTmaneTTan. zrdas-
lebadaa diamagnituri da warmoqmnis velis lokalur ruli adamianis Tavis tvinSi fuqnciuri aqtivoba
sust cvlilebebs. mTlianadaa damokidebuli JangviT metabolizmze,
neironuli aqtivobis gazrda dakavSirebulia Tavis romelic moixmars glukozasa da Jangbads, rogorc
tvinis sisxlis mimoqcevis lokalur gazrdasTan, rac substratebs. Sesabamisad, metabolizmis done Sei-
iwveves deoqsihemoglobinis koncentraciis Semcire- Zleba ganisazRvros Jangbadis moxmarebis gazomviT an
bas. es xdeba imis gamo, rom aqtivaciis normalur deoqsiglukozas dagrovebiT. Tavis tvinSi regionu-
pirobebSi sisxlis mimoqceva Zlierdeba neironebis li sisxlis mimoqcevis gansazRvra SesaZlebelia Sesa-
mier Jangbadis moxmarebasTan SedarebiT. adgilo- bamisad moniSnuli CO2- inhalaciis dros akumulire-
brivi deoqsihemoglobinis doneTa cvlileba SeiZleba buli radioaqtivobis gansazRvriT (Seibyl et al., 2004).
gaizomos da moxdes misi vizualizacia. es gviCvenebs, SPET
rom funqciuri magnitur-rezonansuli tomografiis
SPET-is meSveobiT sisxlis mimoqcevis gansazRvrisas
gamoyenebiT SeiZleba gaizomos aqtivaciis cvlile-
gamoiyeneba lipofiluri moniSnuli (radioaqtiuri)
bebi, magram ara bazisuri lokaluri Tavis tvinis
atomebi, rogoricaa teqnecium _ heqsameTilpro-
sisxlis mimoqceva. Sesabamisad, is unda gamoviyenoT
pilenaminoqsimi (99mTc-HMPAO). intravenurad Seyvanis
aqtivaciis paradigmasTan erTad. Cveulebriv, aseTi
Semdeg, aRniSnuli naerTi ramdenime saaTiT akumu-
paradigmebi SeiZleba droTa ganmavlobaSi xelaxla
lirdeba Tavis tvinSi stabiluri formiT. es gvaZlevs
gamoviyenoT `CarTva_gamorTvis~ reJimSi. aseTia, ma-
maRalxarisxiani gamosaxulebis miRebis saSualebas
galiTad, kognituri funqciis Sesamowmebeli martivi
iseTi tradiciuli deteqtoris gamoyenebiT, rogori-
testi. fMRI-is upiratesoba isaa, rom mas axasiaTebs
caa mbrunavi gama-kamera. 99mTc-HMPAO-is STanTqma
ukeTesi droiTi da sivrciTi detalizacia vizual-
pirdapirproporciulia Tavis tvinSi sisxlis mi-
izaciis sxva meTdebTan SedarebiT da ar saWiroebs
wodebasTan. Tumca, PET-isagan gansxvavebiT, SPET-s ar
radioaqtivobis gamoyenebas.
SeuZlia Tavis tvinis regionuli sisxlis mimoqcevis
funqciuri magnitur-rezonansuli tomografia far-
absoluturi gazomva. amitom SPET-is gamoyenebiT
Tod gamoiyeneba janmrTel subieqtebSi fsiqologiu-
miRebuli Sedegebi xSirad gamoisaxeba Tavis tvinis
ri funqciebis neironuli reprezentaciebis gansas-
gamosakvlevi ubnis aqtivobis SedarebiT mTeli Tavis
azRvrad. am meTodma mravali saintereso Sedegi mogv-
tvinis an naTxemis aqtivobasTan.
ca. magaliTad, pantevma da misma kolegebma (Pantev et
al., 1998) SeZles imis Cveneba, rom trenirebul musiko- Tavis tvinis sisxliT momarageba fsiqikuri
sebSi musikaluri tonebi axdenen sensoruli qerqis aSlilobebis dros
gacilebiT didi farTobis aqtivacias, SedarebiT ar- fsiqikuri aSlilobebis dros Tavis tvinis sisxliT
amusikosebTan. es gamokvleva kargad gviCvenebs, Tu momaragebis Sesaswavlad bevri gamokvlevaaa Catare-
daswavlis procesSi rogor axdens Tavis tvinis qerqi buli, magram Sedegebi xSirad urTierTgamomricxavia.
TviTreorganizacias, savaraudod, genebis eqspresiis umetes SemTxvevaSi, azrTa sxvadasxvaobas iwvevs me-
cvlilebis gziT. am tipis efeqtebi SeiZleba mniS- Todologiuri sirTuleebi, rac exeba tomografiis
vnelovani aRmoCndes garkveuli fsiqikuri aSlilobe- Casatarebeli pirobebis standartizacias da, agreTve,
bis ganviTarebaSi. mogvianebiT, andersonma (Anderson et pacientTa populacias. SesaZloa, mosvenebiTi mdgo-
al., 2004) gamoiyena funqciuri magnitur-rezonansuli mareoba ar iyos idealuri imisTvis, rom davadginoT
tomografia imis demonstraciisaTvis, rom arasasur- pacientebsa da sakontrolo jgufs Soris arsebuli
veli mogonebebis aqtiuri daviwyeba dakavSirebulia gansxvaveba, radgan mosvenebiTi mdgomareoba memkvid-
prefrontaluri dorsolateraluri korteqsis gaaq- rulad fiziologiuria da fsiqologiurad cvale-
tivebasTan da hipokampusis aqtivobis daqveiTebasTan. badi.
aRniSnuli aRmoCenebi miuTiTebs represiis _ froidis miuxedavad am sirTuleebisa, uaxles, skrupuloz-
mier aRwerili erT-erTi ZiriTadi dacviTi meqaniz- urad Catarebul gamokvlevebSi im pacientebze, rom-
mis _ SesaZlo biologiur substratebze. diskusia
_ 116 _
lebic ar iReben medikamentebs, saTanado Sefasebisas eleqtroencefalografia
miRebul iqna SeTanxmebis sakmaod maRali xarisxi.
meTodebi
PET-isa da SPET-is meSveobiT obsesiur-kompulsuri
aSlilobis mqone pacientebTan gamovlinda gazrdili eleqtroencefalografiis meSveobiT (EEG) xdeba
metaboluri aqtivoba da gaaqtivebuli sisxlis mimo- Tavis tvinis qerqis neironuli aqtivobis gazomva
qceva frontalur korteqsSi, saxeldobr, orbifron- Tavis qalas gaswvriv potencialTa sxvaobis gan-
talur regionebSi (Saxena and Rausch, 2000). garda sazRvris gziT. eleqtroencefalografiis gansxvave-
amisa, meti informaciis mopovebaa SesaZlebeli Tavis buli meTodebi fsiqiatriul gamokvlevebSi eti-
tvinis regionaluri sisxlis mimoqcevisa da pacien- ologiis Sesaswavlad gamoiyeneba. es meTodebia:
tis fsiqopaTologiis korelirebiT skanirebis dros. w standartuli (analogiuri) eleqtroencefalogra
aseTma midgomam warmatebiT imuSava da mosaxerxebe- fia;
li aRmoCnda Sizofreniis mqone pacientebSi dadge- w raodenobrivi (digitaluri) eleqtroencefalogra
nil simptomTa erTobliobis dasakavSireblad Tavis fia;
tvinis konkretul ubnebTan (gv. ??).
w Zilis eleqtroencefalografia
aqtivaciis paradigmebi (polisomnografia);
rogorc es fMRI-is ganxilvisas aRiniSna, fsiqologiu- w magnitoencefalografia;
ri aqtivaciis paradigmebs, PET-is gamoyenebiT, xSirad w aRZruli potencialebi.
mimarTaven moxalise janmrTeli pirebis kvlevisas.
gamokvleva tardeba Tavis tvinis ubnebisa da maTSi standartuli eleqtroencefalografia
ganTavsebuli im neironebis wredebis aRsawerad, rom- standartuli klinikuri eleqtroencefalografiis
lebic monawileobs metyvelebisa da mexsierebis fun- dros keTdeba qaRaldze Cawerili gamosaxulebis
damentur procesebSi. aqtivaciis paradigmebs, aseve, xarisxobrivi Sefaseba, romelsac atarebs gamocdili
mimarTaven fsiqikuri aSlilobebis mqone paciente- specialisti vizualuri inspeqciiT. am xasiaTis
bis SemTxvevaSi. aseT dros, aqtivaciis paradigmebis Canaweri did daxmarebas gviwevs epilefisiasa da
gamoyenebam SeiZleba mogvces ufro Tanmimdevruli fisiqikur aSlilobebs Soris arsebuli kavSirebis
Sedegebi, vidre Tavis tvinis sisxliT momaragebis SeswavlaSi, magram is ver gvawvdis sakmaris
gamokvlevebma. informacias etiologiis Sesaxeb. fsiqiatriul
magaliTad, rodesac sakontrolo jgufis janmrTe pacientTa daaxloebiT 30%-s, romelTac CautardaT
li subieqtebi asruleben viskonsinis baraTebis dax- eleqtroencefalografiuli gamokvleva, aReniSne
arisxebis tests (Wisconsin Card Sort Test), prefron- bodaT anomaliuri Canawerebi, magram maTi
talur korteqsSi aRiniSneba sisxlis mimoqcevis relevanturoba mcdari aRmoCnda. wamlis miRebiT
gaZliereba. SizofreniiT daavadebuli pacientebi gamowveuli artefaqtebi, albaT, gavrcelebuli
ufro cudad asruleben am tests, vidre sakontrolo movlenaa. standartul eleqtroencefalografias
jgufis cdis pirebi da iZlevian sisxlis mimoqcevis gaaCnia kargi droiTi, magram SedarebiT susti
gansxvavebul suraTs qerqis Sesabamis midamoSi. es sivrciTi gamosaxuleba.
gviCvenebs, rom SizofreniiT daavadebul zogierT raodenobrivi eleqtroencefalografia
pacients, SesaZloa aReniSnebodes prefrontaluri eleqtroencefalografiis signalis gamokvleva, SesaZ
qerqis disfunqcia, rac ganapirobebs davalebaTa ar- lebelia, aseve, raodenobrivad, risTvisac gansxvavebuli
adamakmayofileblad Sesrulebas, es ki, Tavis mxriv, maTematikuri midgomebi gamoiyeneba. yvelaze farTod
dakavSirebulia Tavis tvinis am ubnis neioronuli gavrcelebuli meTodia signalTa simZlavris speq
aqtivobis gazrdasTan. uaxlesi gamokvlevebi aRniS- traluri analizi furies transformaciis gamoyenebiT.
nul cvlilebas da sisxlis mimoqcevis darRvevebs arsebobs garkveuli fsiqikuri aSlilobebis dama
ukavSirebs kateqol-O-meTiltransferazas genis po xasiaTebeli speqtraluri nimuSebi, Tumca, maTi kav
limorfizms. es fermenti monawileobs dofaminis Siri Tavis tvinis Sesabamis meqanizmebTan ar aris
metabolizmSi da misi Sesabamisi geni ganixileba, calsaxa. eleqtroencefalografiis Sedegebidan ar
rogorc Sizofreniis kandidati geni (ix. boqsi 5.3). tefaqtebis statistikuri amoReba aseve problemuria.
gamokvlevebi, romelTa meSveobiTac cdiloben gene- aqamde eleqtroencefalografias klinikur kvlevaSi,
tikuri polimorfizmis integrirebas kognitur fun- ZiriTadad, gansxvavebuli medikamentebis moqmedebis
qcionirebasa da Tavis tvinis sisxlis mimoqcevaSi analizisa da dadgenis mizniT mimarTavdnen. mimdinareobs
momxdar cvlilebebTan, xels uwyobs Sizofreniis muSaoba uaxles fsiqotropul naerTTa skriningis
ufro srulyofil gagebas (Berman and Myer _ Linden- obieqturi meTodis Seqmnaze (Saletu et al., 2002).
berg, 2004).
_ 117 _
5 etiologia
Zilis eleqtroencefalografia (polisomnograma) xdeba. aRZrul (an movlenebTan dakavSirebul) poten-

cialTa aRricxva SesaZlebelia kompiuterizirebuli
Zilis dros eleqtroencefalograma aCvenebs damaxa-
gamaSualebeli meTodebiT. isini talRovani formiT
siaTebel talRaTa ganmeorebad paternebs, romlebic
iCens Tavs konkretuli stimulis Semdeg, garkveuli
SeiZleba safexurebad daiyos. ZiriTadi sxvaoba
drois intervaliT. magaliTad, reaqcia P300 warmoad-
aRiniSneba swrafi Zilis fazasa (rodesac Tvalis kak-
gens dadebiT gadaxras, romelic Cndeba 300 msek-Si
lebi swrafad moZraobs, REM anu sizmriani Zili) da
mas Semdeg, rac subieqti axdens miznobrivi stimulis
Rrma Zilis fazas (non-REM anu mSvidi Zili) Soris.
identificirebas, romelic CarTulia ararelevantur
Zilis eleqtroencefalograma anu polisomnogra-
stimulTa seriaSi.
ma gviCvenebs sakmarisad Tanmimdevrul anomaliebs
P300 talRebi SesaZlebelia Seesabamebodes kog-
depresiul pacientebSi, kerZod, gaxangrZlivebuli
nitur process, romelic saWiroa konkretuli stimu-
swrafi Zilis fazas. zogierTi aseTi anomalia Sesa-
lis amocnobisaTvis, mexsierebidan aRdgenisa da Se-
Zlebelia gagrZeldes klinikuri remisiis drosac da
fasebisaTvis. SizofreniiT daavadebul pacientebSi
SeiZleba gaxdes guneb-ganwyobis aSlilobisadmi mowy-
P300 talRis amplituda daqveiTebulia. aRsaniSnavia,
vladobis indikatori.
rom igive anomalia aRmoaCndaT SizofreniiT daavade-
polisomnografiis erT-erTi susti mxare isaa,
bul pacientTa pirveli rigis naTesavebs da Sizo-
rom am gamokvlevis Catarebas esaWiroeba special-
tipur pirovnebebs.
uri pirobebi (`Zilis laboratoria~), Tumca saxlis
am individebSi, P300 reaqciaSi cvlilebebi, savar-
pirobebSic SesaZlebelia Zilis monitoringis Catare-
audod, gamomdinareobs informaciis gadamuSavebis
ba ambulatoriuli aRWurvilobis gamoyenebiT (Shar-
darRvevidan da warmoadgens Sizofreniis winaganwyo-
pley et al., 2000). polisomnografia aseve efeqturia
bis markers (vulnerability trait marker). Tumca, es cvli-
Zilis xarisxsa da struqturaze medikamentebis zemo-
lebebi araspecifikuria da maTi aRmoCena SesaZlebe-
qmedebis gansazRvrisas. polisomnografiis gamoyeneba
lia sxva darRvevebis drosac (magaliTad, alkoholis
fsiqiatriul kvlevebSi ganxilulia Semdeg wyaro-
Warbi moxmarebis dros) (Blackwood, 2000). garda amisa,
Si:Nishino et al., 2004.
aRZrul potencialTa interpretacia Tavis tvinis
magnitoencefalografia meqnizmebis TvalsazrisiT advili ar aris, radgan
magnitoencefalografia aris iseTi gamokvleva, rom- Tavis qalidan Cawerili potencialebi Sors imyofeba
liTac izomeba eqstrakranialuri magnituri velis maTi aRmocenebis wyarosagan da asaxavs paralelurad
cvlilebebi, raTa ganisazRvros ionTa nakadi Tavis momqmed gansxvavebul nervul sistemaTa aqtivobas
tvinis qerqis neironebSi. eleqtroencefalografiis (Grillon and Ameli, 2004).
msgavsad, magnitoencefalografiis saSualebiT Sesa-
Zleblia fiziologiuri signalebis cvlilebis dafiq- nevropaTologia
sireba drois milisekundebis intervaliT. eleqtro- nevropaTologiuri gamokvlevebis mizania, pasuxi
encefalografiasTan SedarebiT, magnitoencefalo- gasces kiTxvas, Tu ramdenad axlavs Tan Tavis tvinSi
grafia ukeT aRircxavs signalTa lokalizacias, ma- mimdinare struqturul cvlilebebs specifikuri xas-
gram yvelaze ufro sasargeblo informaciis miReba iaTis fsiqikuri aSliloba. dResdReobiT Tavis tvinis
SesaZlebelia meTodebis kombinaciiT, anu magni- struqturis Seswavla cocxali masalis gamoyenebiTaa
toencefalografiis kombinaciiT funqciur vizual- SesaZlebeli magnitur-rezonansuli tomogrfiis meS-
izaciasTan. am gziT SesaZlebelia miviRoT qerquli veobiT da, agreTve, gvamuri masalis tradiciuli
procesingis ukeTesi sivrciTi da droiTi detaluri pirdapiri gamokvleviT.
gamosaxuleba. arc magnitoencefalografia da arc nevropaTologias Zalian didi mniSvneloba eni-
eleqtroencefalografia ar aris efeqturi qerqqveSa Weba, rodesac laparakia demenciisa da im ramoden-
neironuli aqtivobis cvlilebebis dasadgenad. fsi- ime fsiqikuri aSlilobis bunebis gagebaze, rodesac
qiatriul avadmyofebze Catarebul zogierT gamokv- dazianebis keris dadgena da gazomvebis Catareba
levaSi magnitoencefalografia aRZruli potencial- advili da sarwmunoa. sxva fsiqikuri aSlilobebis
ebis gansazRvrisaTvis gamoiyeneba (fsiqiatriaSi mag- SemTxvevaSi, ar aris aRwerili dazianebis Sesabamisi
nitoencefalografiis gamoyenebis Sesaxeb ix. wyaro: diagnostikuri ekvivalentebis arseboba. swored es
Stern and Silbersweig, 2001). faqti ganapirobebs tradiciul mosazrebas, rom fsi-
qikur aSlilobaTa umravlseoba funqciuri xasiaTisaa
aRZruli potenciali da ar aqvs organuli safuZveli. Tumca, magnitur-re-
eleqtroencefalografiuli meTodis meSveobiT Sesa- zonasuli tomogrfiisa da sxva gaumjobesebuli nev-
Zlebelia Tavis tvinis eleqtruli aqtivobis cvlile- rologiuri meTodebis gamoyenebam aCvena, rom mraval
baTa aRricxva, romelic garemos stimulis sapasuxod fsiqikur aSlilobas aqvs struqturuli korelatebi.
_ 118 _
magaliTad, SizofreniiT daavdebuli adamianis Tavis da fsiqologiur aRwerasTan. Sesabamisad, sxvadasxva
tvini msubuqi da momcro zomisaa, rac am daavadebis midgomebi amdidrebs da warmarTavs erTmaneTs, raTa
damaxasiaTebeli ujreduli da sinafsuri kavSirebis sabolood Seiqmnas ufro integrirebuli Sexeduleba
cvlilebebis Sedegia (me-12 Tavi). msgavsi cvlilebebi fsiqikuri daavadebis etiologiis Sesaxeb.
Tavis tvinis limburi sistemis nawilTa moculobasa
mocemuli qveTavis kavSiri im qveTavebTan, rom
da citoarqiteqturaSi aRwerilia depresiebis dros
lebic fsiqikuri daavadebebis sindromebs exeba
(me-12 Tavi). miuxedavad imisa, rom arc erT am cvli-
lebas ar eniWeba diagnostikuri mniSvneloba, radgan am TavSi ganxiluli iyo ramdenime gansxvavebuli
aRiniSneba TiToeuli am parametris urTierTgada- midgoma etiologiis mimarT. mkiTxveli, albaT, ukeT
farva Sesadarebel subieqtebsa da diagnozebs Soris, dainaxavs am midgomebis mniSvnelobas calkeuli fsi-
isini mainc warmoadgens Zlier arguments funqciur- qikuri daavadebis sindromebis, gansakuTrebiT ki
organuli dixotomiis sawinaaRmdegod. guneb _ ganwyobis aSlilobebisa (gv. ??) da Sizofre-
kvlevis ganviTarebuli meTodebi Segvaxsenebs, rom niis (gv. ??), etiologiis gacnobisas, rac wignis sxva
konkretuli drois monakveTSi xelmisawvdomma me- qveTavebSia mocemuli.
Todebma SeiZleba ver SeZlos Sesabamisi biologiuri
anomaliebis dadgena maTi arsebobis SemTxvevaSic ki.
alois alchaimerma aTeuli weli moandoma Sizof-
reniis nevrologiur gamokvlevas, sanam gadaaw- damatebiTi literatura
yda preseniluri demenciis SemTxvevas da aRmoaCina Charney, DS, Nestler, EJ (2004) Neurobiology of mental illness,
dazianebuli kerebi, romelTa meSveobiT dRes xdeba 2nd edn. Oxford University Press, Oxford.
misi saxeliT cnobili daavadebis dadgena. mas Semdeg,
Freud, S (1916_17) Introductory lectures on psychoanalysis.
rac nevropaTologiuri gamokvlevebi molekulur
Reprinted in Penguin Freud Library, Vol. 1. Penguin, Har-
doneze tardeba, gansxvaveba `funqciur~ da `stru-
mondsworth.
qturul~ darRvevebs Soris TavisTavad gaxda piro-
biTi. da bolos, unda aRiniSnos, rom progresi fsi- Jaspers, K (1963) General psychopathology (trans. J Hoenig
qikur daavadebaTa etiologiis gansazRvraSi miRweul and MW Hamilton), PP 301-11, 355 - 64, 383-99. Manches-
iqna genetikur, paTologiur da bioqimiur gamokvl- ter University press, Manchester.
evaTa kombinaciiT da miRebuli Sedegebis SejerebiT Owen MJ. O~Donovan M, Gottesman II. (2003) Psychiatric
avadmyofis epidemiologiur, klinikur, socialur genetics and genomics. Oxford, Oxford University Press.
_ 119 _
Tavi 6 mtkicebulebaze
damyarebuli midgoma fsiqiatriaSi
Tavis Sinaarsi
w saukeTeso mtkicebulebis moZieba
ra aris mtkicebulebebze damyarebuli medicina
w mtkicebulebis validurobisa da sargeblianobis
mtkicebulebebze damyarebuli midgomis
kritikuli SefasebaSedegebis implementacia
istoria 33
ratom gvWirdeba mtkicebulebebze w Sesrulebis Sefaseba.
damyarebuli medicina? 33 mdm-is principebi gamoiyeneba sxvadasxva samedicino

mtkicebulebis saxeebi 33 procedurisTvis. fsiqiatriaSi mas ZiriTadad iyeneben
calkeuli kvlevebi mkurnalobis Sesaxeb Terapiuli intervenciebis Rirebulebis Sesafaseblad.
momdevno nawilebSi mdm-is gamoyeneba mkurnalobis
validuroba 33
Sesaxeb kvlevebTan iqneba dakavSirebuli. rac Seexeba
Sedegebis warmodgena 33
iseT sferoebs, rogoric aris diagnostireba da
intervenciebis klinikuri gamoyeneba 33
prognozi, mogvianebiT ganvixilavT.
Terapiuli kvlevebis eTikuri sakiTxebi 33 -
sistemuri mimoxilvebi .
validuroba 33 .
Sedegebis warmodgena 33 -
klinikuri gamoyeneba 33 .
meta-analizis problemebi 33 ,
gamoyenebadoba 33 , .
mdm-is implementacia
mdm-is implementacia calkeul pacientTan 33 mtkicebulebaze damyarebuli midgomis
mdm-is implementacia servisis doneze 33 istoria
klinikuri praqtikis gaidlaini 33 medicinis xangrZliv istoriaSi arsebobs mkurnalobis
mdm-is Sefaseba 33 kvlevis erTeuli SemTxvevebi, romlebsac SeiZleba
mdm-is sxva gamoyeneba `mtkicebulebaze damyarebuli midgomis~ magaliTebi
ewodos. 1747 wels sazRvao qirurgma jeims lindma
diagnozi 33
(James Lind, 1747) Seiswavla `SesaZleblobis farglebSi
prognozi 33
erTmaneTis msgavsi~ mezRvaurebis 6 wyvili, romlebic
xarisxobrivi kvlevebi
suravandiT iyvnen daavadebulni. mezRvaurebi, romlebic
rodis unda moxdes xarisxobrivi 33 iRebdnen forToxalsa da limons, gamojanmrTeldnen
meTodis gamoyeneba 33 ramdenime kviraSi, gansxvavebiT im mezRvaurebisgan,
xarisxobrivi kvlevis Sefaseba 33 romlebic igive pirobebSi imyofebodnen da Cveulebrivad
ikvebebodnen. lindis kvleva ar iyo `brma~. 1784 wels
benJamin franklinma (Benjamin Franklin, 1784) hipnotizmis
ra aris mtkicebulebaze monawileebi SearCia SemTxveviTi wesiT, man ar icoda,
damyarebuli medicina romeli maTgani iyo namkurnalebi . `brmad moqmedebam~
mtkicebulebaze damyarebuli medicina (mdm) aris kli uaryo hipnotizmis samkurnalo efeqti, anu gaCnda Zlieri
nikurad mniSvnelovani informaciis miRebis sistemuri mtkicebuleba, rom efeqti STagonebiT iyo gamowveuli
gza etiologiis, diagnozis, prognozisa da mkurnalobis (Devereaux, et al., 2002).
Sesaxeb. mtkicebulebaze damyarebuli midgoma aris Tanamedrove randomizebuli kvlevis meTodi
procesi, romelic moicavs Semdeg etapebs: medicinaSi gamoiyena ser austin bradford-hilma
w klinikuri kiTxvis formulireba, romelzec SesaZ (Sir Austin Bradford-Hill, 1897-1991), romelmac 1948 wels
lebelia pasuxis gacema Seqmna samedicino kvlevis saxelmwifo sabWosTvis tu
_ 120 _
ra aris mtkicebulebaze damyarebuli medicina
berkulozis mkurnalobaSi streptomicinis gamoyenebis xolo did britaneTSi iorkis universitetTan arse
kvlevis dizaini. mogvianebiT bradford-hilis ran buli mimoxilvebisa da diseminaciis centri (the Centre
domizebuli meTodiT isargebles fsiqiatriuli mkur For Reviews and Dissemination, University of York, UK) qmnis
nalobis Sesamowmeblad. pirveli fsiqiatriuli kvleva, jandacvis intervenciebis sistemuri mimoxilvebis
romelSic es meTodi gamoiyenes, 1955 wels Catarda bazas, romelic mudmivad axldeba.
moudslis klinikaSi (Maudsley Hospital) (londonSi),
devid devisis da miSel Seperdis (David Davies and Michael ratom gvWirdeba mtkicebulebaze
Shepherd, 1955) mier, romlebmac aCvenes, rom depresiisa damyarebuli medicina?
da SfoTvis SemTxvevaSi placebosTan SedarebiT, ufro mdm-is gamoyenebiT SesaZlebelia klinikur praqtikaSi
efeqturia rezerpinis gamoyeneba. ramdenime wlis Semdeg arsebuli ori ZiriTadi problemis gadaWra:
aknerma da oldhamma (Ackner and Oldham, 1962) gamoiyenes
w sirTuleebi, romelic dakavSirebulia Tanamedrove
ormagad brma randomizebuli meTodi insulinuri komis
klinikuri da mecnieruli miRwevebis codnis ganax
Terapiis uarsayofad. Semdeg, 1965 wels samedicino
lebasTan
kvlevebis saxelmwifo sabWom gamoaqveyna pirveli didi
multicentruli randomizebuli kontrolirebadi w praqtikosi specialistebis Taviseburad muSaobis
kvleva fsiqiatriaSi, romelmac aCvena, rom depresiis tendencia, romelic ar aris gamyarebuli arsebuli
mqone hospitalizebul pacientebSi imipramini da eleq mtkicebulebebiT.
trokonvulsiuri Terapia placeboze ufro efeqtur klinikuri da samecniero Jurnalebis mzardi ra
samkurnalo saSulebebs warmoadgens (Tansella, 2002). odenobis gamo, bejiTi klinicistic ki ver moaxerxebs
mtkicebulebaze damyarebuli midgomis SedarebiT yvela Tanamedrove sarwmuno statiis gacnobas (Tavis
axali formulireba ekuTvnis arCibald kokreins (Archibalt viwro specialobaSic ki). amisTvis mas yoveldRiurad
Cochrane, 1909-1988), epidemiologs da gavleniani wignis 20 statiis wakiTxva dasWirdeba (!) amitomac klinicists
efeqtianoba da efeqturoba: randomizeba jandacvis uwevs informaciis sxva wyaroebis gamoyeneba. is
servisebSi (1972w.) avtors. kokreinma xazgasmiT miu eyrdnoba eqspertul, arasistemur mimoxilvebs, ko
TiTa mkurnalobis dagegmvisTvis randomizebuli kon legebis mosazrebebs, farmakologiuri firmebis
trolirebadi kvlevebis, rogorc yvelaze sarwmuno warmomadgenlebis mier miwodebul informacias
mtkicebulebebis, gamoyenebis saWiroebaze. misi yve da sakuTar gamocdilebas an Sexedulebebs. es iw
laze xSirad citirebuli gamonaTqvamia (1979): `Cveni vevs praqtikis iseT mravalferovnebas, rogoric,
profesiis didi naklia, rom Cven ver movaxerxeT yvela magaliTad, eleqtrokonvulsiuri Terapiis gamoye
Rirebuli randomizebuli kontrolirebadi kvlevis nebisas iyo aRwerili (UK ECT Review Group, 2003).
kritikuli Sejameba specialobebis an qvespecialobebis
mixedviT, romelic, periodulad, adaptacias gaivlida~. mtkicebulebis saxeebi
kokreinis mosazreba farTod gavrcelda da ori mdm-is fundamenturi piroba imaSi mdgomareobs, rom
mimarTulebis ganviTarebam SesaZlebeli gaxada misi zogi mtkicebuleba sxvebTan SedarebiT ukeTesia,
Tvalsazrisis ganxorcieleba. jer erTi, konkretuli
Terapiuli sakiTxis garSemo mtkicebulebebis Se
cxrili 6.1 ierarqia kvlevebisTvis
sagroveblad daiwyes eleqtronuli bazis gamoyeneba mkurnalobis Sesaxeb
da kompiuteris meSveobiT yvela (an TiTqmis yvela) Ia mtkicebuleba randomizebuli kontrolirebadi
sarwmuno randomizebuli kvlevis moZieba. meorec, kvlevebis sistemuri mimoxilvidan
meta-analizis statistikurma teqnikam SesaZlebeli Ib mtkicebuleba sul mcire erTi randomizebuli
gaxada randomizebuli kvlevebis kombinireba, riTic kontrolirebadi kvlevidan
moxerxda mkurnalobis efeqtis sarwmuno gazomva.
IIa mtkicebuleba sul mcire erTi kontrolirebadi
aseTi meTodologiis gamoyenebiT warmoebuli
ararandomizebuli kvlevidan
kvlevebis Sedegebi `sistemuri mimoxilvis~ saxe
liTaa cnobili. kvlevis es Sedegebi emijneba Se IIb mtkicebuleba sul mcire erTi, sxva tipis
nawilobriv eqsperimentuli kvlevidan
darebiT ufro tradiciul, naklebad sarwmuno
àRwerilobiT mimoxilvis,meTods, sadac mTavaria III mtkicebuleba araeqsperimentuli aRwerilobiTi
avtorTa gadawyvetileba imis Taobaze, Tu romeli kvlevebidan, maT Soris SedarebiTi kvlevebidan,
mtkicebuleba unda iyos gaTvaliswinebuli an ra korelaciuri kvlevebidan da SemTxveva-kontrolis
wona unda mieniWos mas. kokreinis kolaboracia, kvlevebidan
romelic Camoyalibda 1993 wels, msoflios udidesi IV mtkicebuleba eqspertTa komitetis angariSidan
organizaciaa, igi CarTulia sistemuri mimoxilvebis an mosazrebidan da/an avtoritetuli wyaros
warmoebasa da mxardaWeraSi (http://www.cochrane.org), klinikuri gamocdilebidan
_ 121 _
6 mtkicebulebaze damyarebuli midgoma fsiqiatriaSi
anu ufro sarwmuno da klinikurad gamosayenebeli. Sansebis Tanafardoba mocemulia 95%-iani sarwmunoobis
es piroba gansakuTrebiT advilad SemuSavda kvle intervaliT (rac miuTiTebs sididis im diapazonze,
vebisTvis mkurnalobis Sesaxeb. ierarqia, romelsac romelSic WeSmariti sidide 95%-iani sarwmunoobiT
yvelaze xSirad iyeneben mocemulia cxrilSi 6.1. Tavsdeba). rac ufro mcirea sarwmunoobis intervali,
am ierarqiaSi randomizebuli kvleviT miRebuli miT ufro metia kvlevis sizuste.
mtkicebuleba iTvleba ufro validurad, vidre Tu Sansebis Tanafardoba iseTi movlenisTvis, rogoric
ararandomizebuli kvleviT miRebuli mtkicebuleba, stacionirebaa 1.0-ia, es niSnavs, rom xelaxali mimarTvis
xolo randomizebuli kvlevebis sistemuri mimoxilva sixSire sakontrolo da eqsperimentul jgufs Soris
iTvleba klinikur kiTxvebze pasuxis oqros stan ar aris gansxvavebuli. ase rom, Tu kvlevaSi Sansebis
dartad (Geddes and Harrison, 1997). es piroba saWiroebs Tanafardobis sarwmunoobis intervali moicavs 1.0-
sistematur gadamowmebas, radgan arsebobs mosazreba, s, es niSnavs, rom kvlevam ver aCvena eqsperimentul da
rom martivi, klinikurad relevanturi gamosavlis sakontrolo mkurnalobas Soris gansxvavdeba.
mqone msxvili kvlevebi SeiZleba ufro validuri iyos,
vidre meta-analizi (Fukukawa, 2004). mniSvnelovania, efeqtis sidide
rom sistemuri mimoxilvis Sedegebis klinikur bevri kvlevis Sedegi uwyveti cvladia, rogoricaa,
praqtikaSi gamoyenebamde klinicists SeeZlos maTi magaliTad, saSualo qula depresiis Sefasebis ha
kritikulad Sefaseba (ix. qvemoT da Collins, et al., 2003). miltonis skalaze. meta-analizSi SesaZlebelia sawyisi
parametris gamoyeneba, magram ufro xSirad isazRvreba
calkeuli kvlevebi efeqtis sidide, radgan is statistikurad ufro
mkurnalobis Sesaxeb damajerebelia.
efeqtis sidide miiReba eqsperimentuli da sakon
validuroba trolo jgufis Sedegebs Soris sxvaobis gayofiT maTi
mkurnalobis Sesaxeb kvlevebis validurobis sakvanZo sxvaobis standartul gadaxraze. efeqtis sididis
kriteriumi aris randomizacia. amasTan, klinicistma, klinikuri interpretacia qvemoTaa ganmartebuli.
romlis pacientic CarTulia Terapiul kvlevaSi,
ar unda icodes, ra saxis mkurnalobis jgufSia misi intervenciebis klinikuri gamoyeneba
pacienti ganawilebuli. amas, Cveulebriv, uwodeben
riskis Semcireba da mkurnalobisTvis saWiro
randomizaciis siis SeniRbvas. SeniRbuli randomizaciis
raodenoba
gareSe kvlevis validuroba saeWvoa da misi Sedegebic
SeiZleba mcdari iyos. mdm-is mniSvnelovan nawils warmoadgens pacientebis
kvlevis validurobis Sefaseba damatebiT moiTxovs jgufze Catarebuli randomizebuli kvlevebis Sedegebis
pasuxis gacemas Semdeg kiTxvebze: gamoyeneba konkretuli pacientisaTvis. mkurnalobis
Rirebulebis Sesafaseblad gamoiyeneba cneba
w kvlevebiT miRebul daskvnaSi gaTvaliswinebuli Tu
absoluturi riskis Semcireba. es cneba gulisxmobs,
iyo masSi monawile yvela pacienti?
rom pacientebi, romlebsac CautardaT eqsperimentuli
w pacientebis analizi im jgufebSi Tu moxda, sadac isini
mkurnaloba da gamouvlindaT klinikurad mniSvnelovani
gaanawiles (e.w. mkurnalobis ganzraxvis analizi)?
arasasurveli efeqtebi (magaliTad, klinikuri
w iyo Tu ara dafaruli pacientebisa da eqimebisaTvis recidivi) unda SevadaroT im pacientebs, romlebsac
Catarebuli mkurnaloba utardebodaT sxva saxis mkurnaloba. am or sidides
w CautardaT Tu ara jgufebs erTnairi mkurnaloba ewodeba eqsperimentul jgufSi movlenaTa sixSire
eqsperimentuli mkurnalobis garda? da sakontrolo jgufSi movlenaTa sixSire da isini
w ganapiroba Tu ara jgufebis identoba bazisur procentebSi gamoiTvleba. am or sidides Soris sxvaoba
doneze randomizaciis procesma? aris absoluturi riskis Semcireba.
absoluturi riskis Semcireba SeiZleba gardaiqmnas
Sedegebis warmodgena klinikurad ufro gamosayenebel sidided _ mkur
nalobisTvis saWiro raodenobad. mkurnalobisTvis
Sansebis Tanafardoba saWiro raodenoba aris absoluturi riskis Semcirebis
rodesac klinikuri kvlevis Sedegi aris movlena Seqceuli sidide da aRniSnavs pacientebis raodenobas,
(magaliTad hospitalSi mimarTva), efeqturobis Se romelsac unda Cautardes eqsperimentuli mkurnaloba,
fasebis yvelaze xSirad gamoyenebuli sazomia San rom miviRoT erTiT ufro meti dadebiTi Sedegis
sebis Tanafardoba (odds ratio). Sansebis Tanafardoba mqone movlena, vidre Sesadarebeli mkurnalobis (anu
warmoadgens eqsperimentul jgufSi movlenis Sanss mkurnalobis Cautareblobis) SemTxvevaSi (boqsi 6.1).
gayofils sakontrolo jgufSi misi arsebobis Sansze. Sansebis Tanafardobis msgavsad, mkurnalobisTvis
_ 122 _
calkeuli kvlevebi mkurnalobis Sesaxeb
saWiro raodenobac Cveulebriv mocemulia 95%-
cxrili 6.2 fsiqiatriaSi gamoyenebuli
iani sarwmunoobis intervalis farglebSi (Geddes and
intervenciebis Sesabamisi mkurnalobisTvis
Harrison, 1997).
saWiro raodenoba (msr)
magaliTi intervencia gamosavali msr
peikelma da misma kolegebma (Paykel, et al., 1999) Caatares
nervuli bulimiis
158 pacientis didi depresiuli epizodis Semdgomi remisia 2
kognituri Terapia
randomizacia. am pacientebis nawils klinikuri marTva
klinikuri reaqcia
Cautarda kognitur-bihevioruli Terapiis 18 seansiT, zamTris depresiis
(simptomebis qulis 2
nawils ki _ ara. momdevno 68 kviris ganmavlobaSi sinaTliT mkurnaloba
50%-iani kleba)
recidivebis sixSire im jgufSi, romelsac kognitur-
klinikuri reaqcia
bihevioruli Terapia Cautarda (29%) mniSvnelovnad rezistentuli depresiis
(simptomebis qulis 4
naklebi iyo maT sixSireze im jgufSi, romelsac kognitur- dros liTiumis damateba
50%-iani kleba)
bihevioruli Terapia ar Catarebia (47%; p=0.02).
am SemTxvevaSi, recidivis absoluturi riskis Sem Sizofreniis dros
recidivis prevencia 4
cireba kognitur-bihevioruli Terapiis gamoyenebisas qlorpromazini
aris 47-29=18%. mkurnalobisTvis saWiro raodenoba am
Sizofreniis dros recidivis SemTxvevebi
ricxvis Seqceuli sididea da daaxloebiT 6-is tolia 7
ojaxuri Terapia 1 wlis ganmavlobaSi
(mkurnalobisTvis saWiro raodenoba Cveulebriv
mrgvaldeba momdevno umaRles mTel ricxvamde). es mwvave depresiis dros mkurnalobis
33
niSnavs, rom erTi recidivis Tavidan asacileblad susi-is da tca-s Sedareba xangrZlivoba 6 kvira
kbT-iT mkurnaloba unda Cautardes rezidualuri susi serotoninis ukumitacebis seleqciuri
depresiuli simptomebis mqone 6 pacients. zogadad inhibitorebi; tca tricikluri antidepresantebi
iTvleba, rom Tu mkurnalobisTvis saWiro raodenoba
10-ze naklebia, aseTi mkurnaloba efeqturia. xSirad gamoyenebuli fsiqiatriuli mkurnalobis
mkurnalobisTvis saWiro raodenobis interpretireba Sesabamisi mkurnalobisTvis saWiro raodenoba mo
damokidebulia mkurnalobis tipze da gamovlenil cemulia cxrilSi 6.2.
Terapiul da arasasurvel moqmedebebze. zogierTi Tu intervenciis Sedegi ufro sasargeblo movlenaa
(rogoricaa gamojanmrTeleba), vidre arasasurveli
boqsi 6.1 klinikur praktikaSi kvlevis movlenis Tavidan acileba, intervenciis efeqti ga
Sedegebis gamoyenebis maCveneblebi moiTvleba absoluturi sargeblis momatebiT, rac
imave gziT xorcieldeba, rogorc absoluturi ris
eqsperimentis kontroli kis Semcirebis miReba mkurnalobisTvis saWiro
raodenobidan. mkurnalobisTvis saWiro raodenobasTan
X-mkurnaloba Y-mkurnaloba
dakavSirebuli sididea zianisaTvis saWiro raodenoba,
dadebiTi
a b romelic aRniSnavs konkretuli Terapiis arasasurveli
Sedegi
moqmedebis risks (magaliTad, antifsiqozuri wamlebis
uaryofiTi eqstrapiramiduli gverdiTi moqmedeba).
c d
Sedegi
sakontrolo jgufSi movlenis sixSire = b/(b+d) Sansebis Tanafardobidan mkurnalobisTvis
eqsperimentul jgufSi movlenis sixSire = a/(a+c) saWiro raodenobis (NNT) gamoangariSeba
absoluturi riskis Semcireba Tu kvleviT an meta-analiziT miRebulia Sansebis
sxvaoba X da Y mkurnalobebis dadebiTi Sedegebis Tanafardoba, SesaZlebelia klinikuri praqtikisa
Sefardebebs Soris = sakontrolo jgufSi da pacientisaTvis ufro gamosadegi sididis _ mkur
movlenis sixSire - eqsperimentul jgufSi
nalobisTvis saWiro raodenobis, gamoangariSeba.
movlenis sixSire
zemoT motanil magaliTSi (Paykel et al., 1999) reci
Sansebis Tanafardoba (ST) divi ganuviTarda 78-dan 35 adamians, romelsac
X da Y mkurnalobis dros dadebiTi Sedegis kognitur-bihevioruli Terapia ar Cautarda da 80-
Sansebis Tanafardoba = (a/c)/(b/d)=ad/bc dan 23 pacients, romelTanac mkurnaloba swored
mkurnalobisTvis saWiro raodenoba ramden am meTodiT Catarda. am ori tipis mkurnalobas
pacients unda Cautardes X mkurnaloba, rom
Soris recidivis riskis Sansebis Tanafardoba 0.49-
miviRoT Y mkurnalobaze erTiT meti dadebiTi
a. Sansebis Tanafardobidan mkurnalobisTvis saWiro
Sedegi (=1/absoluturi riskis Semcireba)
raodenobis gamoangariSebisTvis aucilebelia vi
Geddes, Harrison, 1997
_ 123 _
codeT an gamoviTvaloT sakontrolo jgufSi re denobad. magaliTad, antidepresantebiT mkurna
cidivis mosalodneli sixSire. am sidides ewodeba lobisas, Tu efeqtis zoma 0.2 Seesabameba (anu pla
pacientTan mosalodneli movlenis sixSire. pacientTan cebos jgufSi efeqtis sixSire _ 30%-ia, xolo
mosalodneli movlenis sixSire (pmms) da Sansebis eqsperimentul jgufSi _ 60%), maSin mkurnalobisTvis
Tanafardoba (ST) Semdeg formulaSia gaerTieanebuli: saWiro raodenoba 10-is tolia. xolo, roca efeqtis
mkurnalobisTvis saWiro raodenoba = [1-pmms(1-ST)]/ zoma 0.5-ia, mkurnalobisTvis saWiro raodenoba 5-mde
[(1-pmms)pmms(1-ST)] mcirdeba.
Tu moyvanili magaliTidan aviRebT recidivebis
ganviTarebis % maCvenebls (35X100/7845%) da for Terapiuli gamokvlevebis eTikuri sakiTxebi
mulaSi CavsvamT, maSin miviRebT:
randomizacia
mkurnalobisTvis saWiro raodenoba={1-[0.45X(1-0.49)]}
randomizacia aris mtkicebulebaze damyarebuli
/{(1-0.45)X0.45X(1-0.49)}
klinikuri kvlevis sakvanZo procesi, romlis
es ricxvi 6-is tolia. igive monacemi miviReT absoluturi
daxmarebiT SesaZlebelia SansiTa da SemTxveviTobiT
riskis Semcirebis sididis gamoyenebiTac. Tu adgilobrivi
gamowveuli cdomilebis Tavidan acileba. miuxedavad
auditis mixedviT viciT, rom Cvens servisSi gamwvavebis
amisa, klinicistisTvis randomizeba SeiZleba
% maCvenebeli rezidualuri depresiuli simptomebis
arakomfortulic aRmoCndes, magaliTad, imis gamo,
mqone pacientebisTvis (peikelis 45%-is nacvlad) (Paykel
rom mas Rrmad swams im mkurnalobis efeqturobis,
et al., 1999) 20%-ia, maSin mocemuli formulis gamoyenebiT
romlis Sefasebac xdeba. randomizacia eTikuria, roca
mkurnalobisTvis saWiro raodenoba daaxloebiT 11
namdvilad gaurkvevelia, Tu ra tipis mkurnalobaa
iqneba. es imas niSnavs, rom Cvens servisSi kognitur-
saukeTeso mocemuli individisaTvis. mdm varaudobs,
bihevioruli TerapiiT 11 pacients unda vumkurnaloT,
rom aseTi situacia ufro xSirad gvxvdeba, vidre es
rom erTiT naklebi recidivi miviRoT. amdenad, Sansebis
klinicists warmoudgenia, radgan bevri endoba gamoc
Tanafardobis gamoyenebiT SegviZlia mkurnalobisTvis
dilebaze damyarebul efeqturobas da ara sistemur
saWiro raodenobis lokalur klinikur pirobebze
mtkicebulebebs.
morgeba, rac intervenciis gamoyenebasTan dakavSirebiT
gadawyvetilebis miRebaSi dagvexmareba. placebos gamoyeneba
fsiqotropuli medikamentebis kvlevebSi mosazrebebi
efeqtis zomis klinikuri relevantoba
preparatis placebod gamoyenebis Sesaxeb araerT
Sansebis Tanafardobis msgavsad efeqtis zomis kli
gvarovania. amis miuxedavad, samkurnalwamlo li
nikuri interpretireba advili ar aris. misi gamoyeneba
cenzirebis saagentoebi antidepresantebis licenzi
sasargebloa sakontrolo da eqsperimentuli popu
rebisTvis am tipis kvlevebis Catarebas moiTxoven.
laciis monacemTa gadafarvis Sesafaseblad. aseTi gziT
antidepresantebis gamokvlevebSi placebos gamoyenebis
miRebuli sakontrolo jgufis qulebi eqsperimentuli
argumentacia Semdeg debulebebs efuZneba (ix. Miller,
jgufis qulebze ufro dabalia (uaryofiTi efeqtis
2000):
zoma martivad imas niSnavs, rom sakontrolo jgufis
w didi depresiis dros placeboze reaqcia vari
qulebi eqsperimentuli jgufis qulebze maRalia).
abiluri da araprognozirebadia da misi Terapiuli
magaliTad, nouelis da misi kolegebis mier Ca
efeqti, arc Tu ise iSviaTad, aqtiuri mkurnalobis
tarebuli kvlevis mixedviT, Zilis saerTo droze
ekvivalenturia;
benzodiazepinebisa da zolpidemis efeqtis Seswavlisas
placebos efeqtTan SedarebiTi, saerTo efeqtis w placebo saWiroa axali antidepresantebis efeq
zoma aRmoCnda 0.71. (Nowell et al., 1997). normaluri turobis dasadgenad. aqtiur mkurnalobasTan Sesa
ganawilebis mixedviT es imas niSnavs, rom sakontrolo dareblad gamoyenebuli meTodologia arasakmarisia,
pirebis 76%-is Zilis saerTo xangrZlivoba naklebi radgan antidepresantis moqmedebasTan `gansxvavebis
iyo, vidre im jgufisTvis, sadac saZile saSualebebi ararseboba~ SeiZleba imas niSnavdes, rom axal da
gamoiyenes. efeqtis zoma Semdegnairad ganawilda: ukve dadgenil mkurnalobas Tanabari efeqti aqvs an
arc erTi mkurnaloba ar aris efeqturi konkretul
w 0.2 _ mcire
gamokvlevaSi;
w 0.5 _ zomieri
w antidepresanti preparatebis Seqmnisas placebo-
w 0.8 _ gamoxatuli
kontrolirebadi kvlevis dizainis ararsebobam
antidepresantebis Sedegis zoma placebosTan Se SeiZleba gamoiwvios iseTi preparatebis gayidva,
darebiT 0.4-0.5-s Seadgens. furukavam (Furukawa, romlebic araefeqturia da, amiT, ziani miayenos
1999) Seqmna tabula, romeliTac SesaZlebelia efeq sazogadoebriv janmrTelobas.
tis zomis gardaqmna mkurnalobisTvis saWiro rao
_ 124 _
sistemuri mimoxilvebi
es argumentebi unda aiwonos imis gaTvaliswinebiT, kombinireba raodenobrivi wesiT. radgan meta-analizi
rom depresiis dros antidepresantebi placeboze iyenebs yvela xelmisawvdom validur monacems, misi
metad efeqturia. amitom, randomizebul kvlevaSi statistikuri Zala individualur gamokvlevebze
pacientis mier placebos miReba ar warmoadgens ufro didia. amitom, mas SeuZlia gamoaaSkaravos
saukeTeso mkurnalobas. amis gamarTleba SeiZleba zomieri, magram klinikurad mniSvnelovani samkurnalo
mxolod imiT, rom pacienti am periodSi imyofeba efeqti, romelic calkeul randomizebul kvlevebSi
mkacri klinikuri meTvalyureobis qveS da cudad ar gamomJRavnda.
yofnis SemTxvevaSi maSinve SeiZleba misi kvlevidan mkurnalobis Sesaxeb sistemuri mimoxilvebi, iseve
gamoTiSva. rogorc calkeuli Terapiuli gamokvleva, unda
Semowmdes validurobisa da xarisxis TvalsazrisiT.
informirebuli Tanxmoba
am SemTxvevaSi unda daisvas ramdenime kiTxva:
randomizebuli kontrolirebadi kvlevis eTikurad
w Sedgeba Tu ara sistemuri mimoxilva relevanturi
CatarebisTvis gadamwyvetia informirebuli Tanxmobis
da randomizebuli kvlevebisgan? mdm-is upirvelesi
roli. es sakiTxi sirTuleebs qmnis iseTi fsiqikuri
amocanaa pasuxi gasces naTlad formulirebul
aSlilobebis SemTxvevaSi, romelTa drosac pacientis
kiTxvebs, amitom aucilebelia ganisazRvros, aris
saRad azrovnebisa da gadawyvetilebis miRebis unari
Tu ara sistemuri mimoxilvis mizezi im Terapiuli
daqveiTebulia. milerma (Miller, 2000) gamoyo ramdenime
kiTxvis Sesabamisi, romelsac unda gavceT pasuxi.
mniSvnelovani faqtori:
Semdegi nabijia imis garkveva, Sedgeba Tu ara
w pacienti gansakuTrebiT unda iyos informirebuli mimoxilva mxolod randomizebuli kvlevebisgan. Tu
imis Sesaxeb, rom kvleva ar tardeba misi piradi sistemuri mimoxilva warmoadgens randomizebuli da
sargebelisaTvis; ararandomizebuli kvlevebis narevs, Sedegi mcdari
w placebo mkurnalobisas pacients aucileblad iqneba.
unda ganvumartoT, rom masTan SeiZleba gamoiyenon w aRweren Tu ara avtorebi im meTodebs, romelTa
placebo, rom SeiZleba ar moxdes mdgomareobis mixedviTac ganTavsda relevanturi kvlevebi?
gaumjobeseba da rom arsebobs misi mdgomareobis eleqtronuli ZiebiT gaiolebulia klinikuri
gauaresebis albaToba; kvlevebis identifikacia, magram relevanturi
w pacienti Tavisufali unda iyos iZulebisa da kvlevebis TiTqmis naxevari SeiZleba gamotovebuli
waqezebisgan; iyos araswori kodirebis gamo. amitom mni
w pacients ufleba aqvs gamoeTiSos kvlevas nebismier Svnelovania, rom avtorebma miuTiTon, gamoiyenes
dros dausjelad; Tu ara Sesabamisi Jurnalebis eleqtronuli Zieba
xeliT ZiebasTan erTad. SeiZleba, aseve, kvlevebis
w saWiroa ojaxis wevris an sxva Sesabamisi piris
avtorebTan an farmacevtuli industriis Sesabamis
CarTva, raTa mkvlevaris garda isic akontrolebdes
jgufebTan dakavSireba. saerTod, uaryofiTi
pacientis mdgomareobas da saWiroebis SemTxvevaSi
kvlevebi ufro naklebad qveyndeba, vidre da
Sesabamisi informacia miawodos mkvlevars.
debiTi, ramac SeiZleba gamoiwvios konkretuli
mniSvnelovania pacientisa da misi ojaxis Ria da mkurnalobis efeqturobisa da amtanobis Sesaxeb
eqsplicituri informireba da yvela zomis miReba, mcdari optimisturi daskvnis gamotana. magaliTad,
raTa placebo mkurnalobam ar miayenos ziani pi mozardebSi antidepresantebis gamoyenebis Sesa
rovnebas. yvelafris miuxedavad, mosazrebebi am xeb Catarebuli kvlevebis analiziT aRmoCnda,
sakiTxis Sesaxeb araerTgvarovani rCeba. rom serotoninis ukumitacebis seleqtiurma in
hibitorebma da venlafaqsinma SeiZleba gazardon
sistemuri mimoxilvebi suiciduri qcevis riski. es mniSvnelovani infor
macia mxolod gamoqveynebuli monacemebis analizis
validuroba
Sedegad gaxda cnobili (Whittington, et al., 2004).
sistemuri mimoxilvebis mizania yvela validuri
w ris mixedviT SearCies avtorebma sistemur mimoxilvaSi
mtkicebulebis mopoveba specifikuri proceduris
Sesatani gamokvlevebi? sistemuri mimoxilvisas avto
an intervenciis Sesaxeb da amiT misi efeqturobis
rebma unda gadawyviton, Tu romel kvlevebs Cautardeba
zusti raodenobrivi Sefaseba. sistemuri mimo
analizi. es niSnavs xarisxis zusti sazomis gansazRvras
xilvebis ganxorcielebas xeli Seuwyo orma faq
im faqtorebze dayrdnobiT, romlebic zemoT iyo
torma: pirveli, xelmisawvdomia monacemTa iseTi
CamoTvlili. radgan daskvnis gamotana nawilobriv
eleqtronuli baza, rogoricaa medlaini (Medline)
subieqturia, sasurvelia, minimum ori erTmaneTisgan
da embeizi (Embase); meore, axali statistikuri
damoukidebeli mkvlevaris monawileoba.
teqnikiT SesaZlebelia sxvadasxva kvlevis Sedegebis
_ 125 _
w ramdenad Tavsebadia Terapiuli intervenciebis Sesaxeb audini-londoni

arsebuli kvlevebis Sedegebi? xSirad Sedegis zoma bondi-Cikago 1
sxvadasxva kvlevaSi sxvadasxvaa. Tu Sedegebi Sereulia, lemani-baltimori
anu zogi kvlevis mixedviT klinikuri efeqti didia, bondi-indiana 1
xolo zogierTis mixedviT efeqti saerTod ar aris testi-viskonsini
miRebuli, aseTi kvlevebi heterogenulad iTvleba. Candleri-kalifornia
zogjer heterogenobis mizezi aris iseTi faqtorebi, gaerTianebuli Sansebis
Tanafardoba (fiqsirebuli Sedegi)
rogoricaa wamlis dabali doza an gansxvaveba monawile
gaerTianebuli Sansebis
pacientebis maxasiaTeblebSi. Tu heterogenobas Tanafardoba (SemTxveviTi Sedegi)
ganmarteba ar moeZebneba, maSin mimoxilvis Sedegebi
dausabuTebelad ver CaiTvleba.
suraTi 6.1 asertuli stacionargareSe Terapiis (asT) gavlena
stacionirebis sixSireze (Freementale and Geddes, 1998).
Sedegebis warmodgena
gafarToebas, rogorc gamokvlevebis jamuri SemTxve-
Sansebis Tanafardobebis kombinireba viTi efeqtis Sansebis Tanafardoba asT kvlevebSi. Tu
meta-analizis Sedegebi xSirad warmodgenilia kvlevebiT populaciis mkurnalobis erTaniri Sedege-
blobogramiT (Forest plot), sadac sxvadasxva kvlevis bia miRebuli (anu heterogenoba naklebia), mkurnalobis
monacemebi diagramis saxiTaa mocemuli (gamosaxuleba gaerTianebuli analizisTvis gamoyenebuli unda iyos
6.1). rogorc zemoT iyo miTiTebuli, im kvlevebSi, fiqsirebuli Sedegis modeli. aq sarwmunoobis interva-
sadac Sedegi movlenaa da Sansebis TanafardobiTaa li ufro mcirea, Tumca mniSvnelovani heterogenobis
warmodgenili, sarwmunoobis intervali 95%-ia. arsebobisas, man, SeiZleba, SecdomaSi Segviyvanos.
meta-analizis mizania mkurnalobis efeqturobis gamosaxuleba 6.1 aCvenebs kvlevebs Soris statisti-
jamuri Sefaseba, rac xdeba yvela gamokvlevis Sansebis kurad mniSvnelovan heterogenobas. amasTan, dadebiTi
Tanafardobis an Sedegebis zomis gaerTianebiT. es Sedegis ZiriTadi wvlili, arc Tu ise did, or kvle-
ar warmoadgens yvela Sansis Tanafardobis martiv vaze modis. efeqturobis randomizebuli da fiqsire-
gasaSualoebul maCvenebels, aramed igi Sewonili buli modelis gamoyenebiT, erTnairi zomieri efeqti
maCvenebelia. didi statistikuri informaciis Semcvel gamovlinda. amasTan randomizebuli kvleviT miRebuli
da maRali sizustis (sarwmunoobis viwro intervali) sarwmunoobis intervali ufro farToa da kveTs 1-s.
kvlevebs SedarebiT ufro didi wvlili SeaqvT saboloo kvlevebis heterogenobidan gamomdinare randomizebu-
SedegSi. gaerTianebuli Sansebis Tanafardobasac aqvs li kvlevis monacemebi ufro mniSvnelovania. amdenad, am
95%-iani sarwmunoobis intervali. Tu es intervali monacemebze dayrdnobiT, restacionirebaze asertuli
1.0-s kveTs, iTvleba, rom eqsperimentuli intervencia mkurnalobis efeqturobis analizi, manam aseTi gansxva-
ar gansxvavdeba sakontrolosgan. vebis sarwmuno axsna ar moiZebneba, Zalian frTxilad
gamosaxulebaze 6.1 mocemulia im kvlevebis Sedegebi, unda gakeTdes (ixileT (Freementale and Geddes, 1998
romliTac swavlobdnen ganmeorebiT stacionirebaze
asertuli mkurnalobis efeqts (asT _ asertuli efeqtis zoma
stacionargareSe Terapia). zogierTi kvleva gviCvenebs rogorc zemoT iyo aRniSnuli, iq sadac saboloo
asT-s efeqturobas ganmeorebiT stacionirebaze, zogi ki monacemi uwyveti cvladia, Sedegis gamosaTvlel
ara. ori kvlevis gaerTianebuli analizis interpretireba saukeTeso meTods efeqtis zoma warmoadgens. imisaTvis,
rTulia, radgan erT-erTis sarwmunoobis intervali rom uzrunvelvyoT jamuri Sefasebis maRali sizuste,
(fiqsirebuli efeqtis modeli) ar gadafaravs 1.0-s, Sansebis Tanafardobebis msgavsad SesaZlebelia
rac miuTiTebs TemSi Catarebuli asT mkurnalobis efeqtis zomebis kombinaciasac mivmarToT.
mniSvnelovan gansxvavebaze sakontrolosagan, xolo
meore kvlevaSi (SemTxveviTi Sedegis modeli) kveTs 1.0- klinikuri gamoyeneba
s, da amitomac statistikurad minimalurad sarwmunoa. meta-analizis klinikuri gamoyenebis Sefaseba iseve
meta-analizic heterogenobaze miuTiTebs. amis sta- xdeba, rogorc es calkeuli kvlevebis SemTxvevaSi
tistikurad testireba qsi-kvadratis (X2) testis modi- iyo aRwerili. meta-analizi xSirad iZleva mkur
ficirebiTaa SesaZlebeli. Tu heterogenoba mniSvnelo- nalobisTvis saWiro raodenobis diagramul gamo
vania, yvelaze Sesaferisi meta-analizuri teqnika iqneba saxulebas. miuxedavad amisa, rogorc zemoT iTqva,
jamuri SemTxveviTi efeqtis modeli. jamuri Sefasebisas mkurnalobisTvis saWiro raodenobis gamoTvla Se
aseTi modeli imas iTvaliswinebs, rom sxvadasxva gamo- saZlebelia meta-analizis iseT monacemebze dayr
kvleva SeiZleba mkurnalobis sxvadasxva Sedegs aCveneb- dnobiT, rogoric aris absoluturi riskis Semcireba
des. es xSirad iwvevs sarwmunoobis intervalis iseTive an Sansebis Tanafardoba.
_ 126 _
sistemuri mimoxilvebi
meta-analizis problemebi kvlevebSi, sadac ufro metia SesarCevi raodenoba. amdenad,
didi kvlevis efeqtis zomebi grafikulad Tavs iyris
mcdari daskvna
eqsperimentul da sakontrolo jgufebs Soris sxvaobis
mtkicebulebebis sistemuri dalagebis garda, meta- saerTo saSualo sididesTan. amis sapirispirod, mcire
analizis mizania ramdenime kvlevis monacemTa gamokvlevebis Sedegebi gafantulia saSualos garSemo. es
kombinireba mkurnalobis efeqtis erTi Sefasebis imas niSnavs, rom rodesac calkeuli kvlevis sizuste unda
misaRebad. arsebobs ramdenime mizezi, ris gamoc am gamoisaxos grafikulad Sansebis Tanafardobis an efeqtis
proceduram SeiZleba araswori Sedegi mogvces: zomis mixedviT, miRebuli mrudi emsgavseba simetriul
w gamocemis Secdoma _ mtkicebulebebi aCvenebs, rom amobrunebul Zabrs (Zabrisebri grafiki). statitikurad
ufro xSirad qveyndeba mkurnalobis dadebiTi mniSvnelovani gadaxra am grafikidan mianiSnebs meta-
Sedegebis mqone kvlevebi, vidre uaryofiTi analizis Secdomaze, romelsac sifrTxiliT unda
Sedegebis mqone kvlevebi. Tu meta-analizSi ar movekidoT (ix. Egger, et al., 1997).
iqneba Seyvanili uaryofiTi Sedegebis kvlevebic,
mkurnalobis efeqti SeiZleba gaberili aRmoCndes; msxvili randomizebuli kvlevebi
w gamocemis dublireba _ dadebiTi Sedegis mqone rogorc zemoT iyo aRniSnuli, meta-analizis
kvleva SeiZleba gamoqveyndes ramdenjerme sxvadasxva upiratesobaa calkeuli kvlevebis kombinirebiT
formiT da sxvadasxva avtorobiT (!) erTi da igive sakmarisi raodenobis pacientebis Sekreba da amis
kvlevis ramdenjerme gaTvaliswinebam SeiZleba safuZvelze saSualo zomis, magram klinikurad
mcdarad gazardos mkurnalobis efeqturoba; mniSvnelovani Terapiuli efeqtis dadgena. mkur
w kvlevebis heterogenoba _ rogorc zemoT iyo nalobis saSualo zomis efeqtis dadgenis kidev
aRniSnuli, calkeul kvlevebSi Sedegebi SeiZleba erTi gza calkeul gamokvlevaSi pacientebis Zalian
gansxvavebuli iyos kvlevis dizainis, xarisxisa da didi raodenobis randomizebaa. aseTi msxvili
pacientTa populaciis sul mcire sxvaobis gamo. randomizebuli (martivi) kvlevebi (anu mega-kvlevebi)
Tu aseTi heterogenoba meta-analizis warmoebisas meta-analizTan SedarebiT upiratesobis mqonea, radgan
ar iqna amocnobili da gaTvaliswinebuli, daskvna yvela pacienti kvlevis saerTo dizainSi Tavsdeba.
SeiZleba mcdari aRmoCndes. mega-kvlevis ganxorcielebas esaWiroeba mkvlevarTa
ramdenime jgufis TanamSromloba da Sesabamisad _
ramdenad zustia meta-analizi?
kvlevis martivi dizaini da naTeli saboloo gamosavali.
cnobilia ramdenime SemTxveva, rodesac meta-analiziT aseTi meTodologia warmatebiT gamoiyeneba me
miRebuli daskvna gaabaTila calkeulma, didi masStabis dicinis iseT dargebSi, rogoricaa, magaliTad,
randomizebulma gamokvlevam. magaliTad, miokardiumis kardiologia, sadac intervencia zogjer SeiZleba
infarqtis gamosavalze intravenuri magneziis da martivi iyos (magaliTad aspirinis erTi doza dReSi)
debiTi efeqti, romelic meta-analizis mier iyos da saboloo gamosavali _ naTlad gansazRvruli
dadasturebuli, gadaWriT iqna uaryofili erTi didi, (kardialuri infarqti an sikvdili). fsiqiatriuli
58000 pacientze Catarebuli randomizebuli gamokvlevis kvlevebis gamowvevas warmoadgens aseTi meTodologiis
mier. meta-analiziT miRebuli mcdari daskvnis mizezi adaptireba iseT mdgomareobebTan, romelTa drosac
mogvianebiT axsnes gamocemisas daSvebuli SecdomiT, intervencia SedarebiT ufro rTulia da saboloo
mcire zomis gamokvlevis meTodologiuri uxarisxobiT gamosavali - Znelad SesamCnevi (Rendell, et al., 2004).
da klinikuri heterogenobiT (Collins, et al., 2003).
am tipis kvlevebis ganxilvisas aRmoCnda, rom gamoyeneba
meta-analizis 80% Seesabameba erTi didi kvlevis randomizebuli kvlevebiTa da meta-analiziT miRebuli
Sedegebs mkurnalobis efeqtis TvalsazrisiT, magram mtkicebulebebis rutinul klinikur praqtikaSi
am ori meTodiT dadasturebuli efeqtis zoma da gamoyenebis sirTuleebi ZiriTadad ukavSirdeba im
statistikuri mniSvneloba xSirad gansxvavebulia. problemas, rom klinikuri kvlevebi xSirad tardeba
aseve, erTi da igive Terapiuli intervenciis sakmarisad idealur pirobebSi da mravali aspeqtiT
sxvadasxva meta-analizidan SeiZleba gansxvavebuli ar Seesabameba rutinuli klinikuri muSaobis pirobebs:
daskvna gamomdinareobdes (ix. Furukawa, 2004).
w pacientebis populacia _ kontrolirebad kvlevebSi
Zabriseburi grafiki CarTuli pacientebi rutinuli klinikuri paciente-
bisgan SeiZleba gansxvavdebodnen daavadebis simZi-
meta-analizis sandoobis gazrdis erT-erTi gza
misa da Tanmxlebi problemebis naklebobiT. Sesaba-
`Zabrisebri grafikis~ gamoyenebaa. Zabrisebri grafiki
misad, kvleva SeiZleba Catardes iseT pacientebze,
efuZneba im varauds, rom Sesafasebeli mkurnalobis
romlebic faqtiurad ar warmoadgenen pacientebis
efeqturobis sizuste (sarwmunoobis intervali) metia im
Cveulebriv populacias.
_ 127 _
w zedamxedvelobis done _ wamlebis moqmedebis Ses mdm-is implementacia

wavlisas xorcieldeba regularuli monitoringi
xSiri Semowmebisa da zedamxedvelobis saxiT. mdm-is implementacia calkeul pacientTan
amdenad mosalodnelia, rom pacientebi maSinac ki ar saukeTeso Terapiuli intervenciis mtkicebulebis,
gamoeTiSebian gamokvlevidan, rodesac preparatebis misi validurobisa da Terapiuli saWiroebis Sesaxeb
amtanoba kargi ar aris. monacemebis arsebobisas, aucilebelia gadawydes, Tu
w Terapevtebis cvalebadoba _ gansakuTrebiT fsiqo ramdenad gamoiyeneba is calkeul pacientTan. farTo
Terapiul kvlevebSi, mkurnalobas atarebs gamocdili gagebiT es imazea damokidebuli, Tu rogori pasuxi
da daxelovnebuli Terapevti, im dros rodesac gaecema qvemoT mocemul sakvanZo kiTxvebs:
yoveldRiur praqtikaSi mkurnaloba SeiZleba w ramdenad hgavs es pacienti randomizebul kvlevaSi
naklebad gamocdilma Terapevtmac Caataros. aseve, monawile sxva pacientebs?
mkurnalobis protokolis Sesrulebis Sesamowmeblad w SesaZlebelia Tu ara adgilobrivi servisiT am
Terapevtis saqmianoba xSirad monitorings eqvem intervenciis warmatebiT ganxorcieleba? (magaliTad,
debareba mTeli kvlevis ganmavlobaSi, xolo rutinul interpersonaluri Terapiis rekomendacia azrs
praqtikaSi ki protokols naklebad icaven. kargavs, Tu ar arsebobs Sesabamisi momzadebis mqone
Terapevti, romelic am tipis Terapias Caatarebs).
pragmatuli kvlevebi
implementaciis Sesaxeb gadawyvetilebis misaRebad
zemoT CamoTvlili sirTuleebis dasaZlevad
aucilebelia mkurnalobisTvis saWiro raodenobis
pragmatuli kvlevebis Catareba ufro Sesaferis
morgeba adgilobriv klinikur situaciaze da re
gzad CaiTvala zogierTi fsiqiatriuli intervenciis
levanturi informaciis floba (ix. zemoT). garda amisa,
efeqturobis dasadgenad. aseTi kvlevis mizania
klinikuri gadawyvetilebis miRebisas gaTvaliswinebuli
randomizebuli kvlevis `realur situaciaSi~ Catareba.
unda iyos `daxmarebisa an zianis albaTobis~ koncefcia.
kvlevis meTodologia waagavs im mega-kvlevebisas
Straussa da makalisters (Straus and McAlister, 2001)
gamoyenebul meTodologias, romelic zemoT iyo
mohyavT magaliTi, sadac eqimi da pacienti ganixilaven
aRwerili, xolo dizaini asaxavs pasuxs martiv
antiqolinesTeraza donepezilis gamoyenebas kognituri
da mniSvnelovan klinikur kiTxvaze. pragmatuli
funqciis daqveiTebis riskis Sesamcireblad. donepezilis
kvlevebi tardeba maqsimalurad rutinul klinikur
Cvenebis `gamoyenebis saWiro raodenoba~ (NNT) 6-is tolia,
garemoSi. am tipis kvlevebis sxva mniSvnelovan niSnebs
xolo donepezilis gverdiTi efeqtebis `zianisaTvis
miekuTvneba:
saWiro raodenoba~ (NNH) 11-is tolia. daxmarebisa an
w gansakuTrebiT didi raodenobis sakvlevi obieqtis
zianis albaToba gamoiTvleba TanafardobiT (1/ NNT):(1/
randomizacia, radgan warmatebulma mkurnalobam
NNH) anu 1/6:1/11, rac daaxloebiT (2/1)-s anu donepezilis
SeiZleba mogvces mxolod zomieri sididis Sedegis zoma.
sasargeblod 2-s udris. aseve SesaZlebelia mkur
brma meTodis gamoyeneba randomizaciasTan SedarebiT
nalobisTvis saWiro da zianis gamomwvevi raodenobebis
naklebad mniSvnelovnad iTvleba, gansakuTrebiT,
Sedareba im faqtorebTan, romlebic iTvaliswinebs
aqtiuri mkurnalobis saxeebis Sedarebisas.
pacientisTvis kognituri daqveiTebisa da gverdiTi
w pacientebis kvlevaSi CarTvis gamartiveba Sem efeqtebis ganviTarebis mniSvnelobas. aseTi gamoTvlebis
zRudavi kriteriumebis Tavidan acilebis gziT. sargebeli jerjerobiT dauzustebelia. mTavaria, rom
principuli kriteriumi is aris, rom arc eqimma moxdes randomizebuli kvlevis Sedegebis adaptireba
da arc pacientma ar unda icodes, Tu sacdeli TiToeuli pacientis gansxvavebul saWiroebebTan.
mkurnalobis saxeebidan romelia ufro efeqturi.
w Sefasebis imdenad gamartiveba, rom SesaZlebeli mdm-is implementacia servisis doneze
iyos misi rutinul klinikur praqtikaze morgeba. heinesma (Haynes, 1999) SemogvTavaza axali mkurnalobis
`bevr SemTxvevaSi kvlevas ufro maRali mecnieruli danergisTvis mniSvnelovani safexurebi:
Rirebuleba eqneboda, rom Segroviliyo 10-jer naklebi w qmediToba _ muSaobs Tu ara intervencia kon
monacemi 10-jer meti pacientisgan~ (Collins, et al., 2003). trolirebul (ìdealur~) garemoSi?
w Sedegis klinikurad relevanturi sazomis gamo w efeqturoba _ imoqmedebs Tu ara intervencia
yeneba. magaliTad, Sizofreniis dros Terapiuli Cveulebriv praqtikaSi?
intervenciis efeqturobis dasadgenad pacientisa da
w sargeblianoba _ rogoria intervenciis efeqturoba
ojaxis wevrebisagan Sefasebis miReba martivi skalis
resursebis moxmarebasTan SedarebiT (xarjT-
gamoyenebiT klinikurad ufro relevanturad iTvleba,
efeqturoba anu xarji/sargebeli)?
vidre qulobrivi Sefaseba standartizebuli skaliT.
idealur SemTxvevaSi, mdm-is srul danergvamde
_ 128 _
mdm-is sxvagvari gamoyeneba
ganxiluli unda iyos yvela safexuri da gada Seqmnisas gamoyenebuli zogi mtkicebuleba emyareba
wyvetileba intervenciis Sesaxeb samive kriteriums unda mcire raodenobis kvlevebs, romelTa relevantobac
akmayofilebdes. fsiqiatriul praqtikaSi gamoyenebuli realur garemoSi SeiZleba saeWvo iyos. miuxedavad
Terapiuli intervenciebis (wamlebiT mkurnaloba amisa, praqtikuli klinikuri saxelmZRvanelo unda
da kognitur-bihevioruli Terapia) qmediToba Seicavdes SedarebiT konkretul rCevebs. aman SeiZleba
damtkicebulia, magram dasazustebelia misi efeqturoba gamoiwvios subieqturi rekomendaciebis gamoyenebis
da ekonomikuri sargeblianoba. magaliTad, liTiumiT saSiSroeba da Seamciros axali, ufro informatiuli
mkurnaloba qmediTia bipolaruli aSlilobebis kvlvevebis Catarebis albaToba.
profilaqtikisTvis, magram misi efeqturoba imedebs ar
amarTlebs, radgan standartul klinikur viTarebaSi mdm-is Sefaseba
pacientebis mxolod mcire raodenoba iRebs stabilurad mdm saWiroebs Sefasebas efeqturobis randomizebuli
liTiums (ix. Goodwin, 1999). kvlevebiT, rogorc es zemoT iyo aRwerili depresiis
mkurnalobis saxelmZRvanelo principebze saubrisas.
klinikuri praqtikis saxelmZRvanelo calkeulma praqtikosma SeiZleba Semdegnairad
principebi Seafasos mdm-is gamoyeneba:
medicinis zogierT sferoSi arsebobs sxvadasxva saxis w Seafasos, klinikuri gadawyvetilebis ra nawilia
mtkicebulebis sakmarisi raodenoba, magram ar aris mtkicebulebebze damyarebuli;
cnobili, Tu romelia saukeTeso Terapiuli marTva.
w gaacnobieros praqtikaSi arsebuli xarvezi, ro
aseT situaciaSi Rirebulia klinikuri praqtikis iseTi
melic saWiroebs relevanturi mtkicebulebebis
saxelmZRvanelo principebis SemuSaveba, romlebic
moZiebasa da Sefasebas;
eqspliciturad iqneba mtkicebulebebze damyarebuli.
w Seamowmos mtkicebulebebze damyarebul praqtikaSi
aseTi saxelmZRvanelo principebis SemuSavebis
momxdari cvlilebis efeqturoba.
saukeTeso gza Semdeg komponentebs gulisxmobs:
am gziT mdm-is procesi SeiZleba iqces mudmivi
w saxelmZRvanelo principebis Semqmneli jgufi,
profesiuli ganviTarebisa da gadamowmebis ciklis
romelic Sedgeba multidisciplinuri jgufisgan
ganuyofel nawilad.
da pacientebis warmomadgenlebisgan, adgens im zust
klinikur kiTxvebs, romlebsac unda gaeces pasuxi;
w xelmisawvdomi mtkicebulebebi sistematurad un
mdm-is sxvagvari gamoyeneba
da gadaisinjos da klasificirdes cxrilSi 6.1 wina qveTavebi fokusirebuli iyo mdm-is gamoyenebaze
miTiTebuli ierarqiis mixedviT; fsiqiatriuli Terapiuli intervenciebis Sesa
faseblad. mdm-is gamoyeneba aseve SeiZleba di
w saxelmZRvanelo principebis Semqmneli jgufi iZ
agnostikasTan, prognozTan da etiologiasTan da
leva rekomendaciebs, romlebic naTlad aCvenebs
kavSirebuli mtkicebulebebis SefasebisTvis, rac
am rekomendaciebis kavSirs xelmisawvdom mtki
randomizebuli kvlevebis gansxvavebul meTodologias
cebulebebTan.
moiTxovs. etiologiis mimarT gamoyenebuli midgoma
klinikuri saxelmZRvanelo principebis gansazRvris
me-5 TavSia ganxiluli, xolo diagnozisa da prognozis
saukeTeso variantia maTi SemuSaveba erovnul do
sakiTxebi qvemoTaa mocemuli. rogorc mkurnalobis, ise
neze, Sesabamisi profesiuli organizaciebis mier,
nebismieri sxva sakiTxebis mimarT mdm-is gamoyenebisas,
magram, Cveulebriv, saWiro xdeba maTi modifikacia
pirvel rigSi xdeba kiTxvis formulireba, romelic:
adgilobrivi klinikuri viTarebis gaTvaliswinebiT.
w uSualod unda exebodes gamovlenil problemas da
saxelmZRvanelo principebi maSinaa efeqturi, ro
desac isini aqtiurad vrceldeba da inergeba. w ise unda iyos Camoyalibebuli, rom aiolebdes
did britaneTSi klinikuri daxelovnebis erovnuli zusti pasuxis moZebnas (Geddes 1999, cxrili 6.3)
instituti (National Institute for Clinical Excellence) asrulebs
gansakuTrebul funqcias Terapiuli intervenciebis diagnozi
Sesaxeb mtkicebulebebis Segrovebis, analizis da Tu vcdilobT SevafasoT im konkretuli kvlevis
erovnuli saxelmZRvanelo principebis Seqmnis saqmeSi Rirebuleba, romliTac fasdeba diagnostikuri
(http://www.nice.org.uk/). klinikur praqtikaze am procesis testi, praqtikos eqims mouwevs pasuxis gacema Semdeg
warmatebuli zegavlena sabolood dadgenili ar aris kiTxvebze (ix. Sackett, et al., 1997):
da SeiZleba damokidebuli iyos iseT faqtorebze, w moxda Tu ara testis damoukideblad, brmad
rogoricaa mtkicebulebebis siZliere da stabiluroba Sedareba diagnostikis oqros standartTan?
da xarjebis sidide (Freemantle, 2004). damatebiT
w moicavda Tu ara SerCeva imis msgavs pacientebs, rom
problemebs qmnis is faqti, rom rekomendaciebis
_ 129 _
lebTac testireba CautardebaT klinikur praqtikaSi? alkoholis
w rogoria testis sensitiuroba da specifikuroba? borotad
gamoyeneba an masze
w daexmareba Tu ara is Cemi pacientebis marTvas? damokidebuleba
diax ara
magaliTi
60 1
kiTxva: ramdenad gamosadegia CAGE-is kiTxvari dadebiTi 3 an 4 (WeSmariti+) (cru+) 61
alkoholis Warbi moxmarebis dasadgenad hospi pasuxebis a b a+b
talizebul Terapiul da qirurgiul pacientebSi?
raodenoba c d c+d
CAGE-is 2,1 an
57 400
CAGE-is kiTxvari aris martivi, oTx punqtiani, kiTxvariT arc
(cru+) (WeSmariti+) 457
erTi
Seqmnilia alkoholis borotad momxmarebeli pa
a+c b+d a+b+c+d
cxrili 6.3 klinikuri kiTxvebis 117 401 518
gavrcelebuli tipebi
kiTxvis forma kvlevis yvelaze sando sqema sensitiuroba=a/(a+c)=60/117=0.51 anu 51%
ramdenad SesaZlebelia, tardeba kros-seqciuri
specifikuroba=d/(b+d)=400/401=0.998 anu 99.8%
rom pacients, romelsac kvleva. pacientebis im
aqvs konkretuli simptomi, nawils, romelsac namdvilad suraTi 6.2. alkoholis borotad gamoyeneba/alkoholze
niSani an diagnozi, aqvs mocemuli aSliloba damokidebuleba CAGE-is kiTxvaris mixedviT. Sackett, 1996
mocemuli darRveva da testze dadebiTi pasuxi,
axasiaTebdes? adareben pacientebis im cientebis identificirebisTvis (Tavi 18, gverdi
nawils, romelsac ara aqvs ??). seketma (Sackett, 1996) aRwera bostonis Temze-
es aSliloba, magram testze dafuZnebul saswavlo hospitalSi Catarebuli ga
dadebiT pasuxs iZlevian
mokvleva, sadac 518 pacientTan CAGE-is kiTxvari
sasurveli Sedegis randomizebuli gamoiyenes. oqros standarti, romelTanac Seadares
misaRebad CvenTvis mtkicebuleba. pacientebi CAGE-is kiTxvari, dawvrilebiTi socialuri anamn
sainteresoa, mkurnalobaa SemTxveviTi wesiT ezi da klinikuri Sefaseba warmoadgenda, romelsac,
ufro efeqturi Tu ganTavsdebian jgufebSi. zog Cvenebis SemTxvevaSi, emateboda RviZlis biofsia.
alternatuli mkurnaloba jgufs CvenTvis saintereso
amdenad, sarwmunod SeiZleba iTqvas, rom am ga
(maT Soris mkurnalobis mkurnaloba utardeba, zogs
mokvlevaSi identificirebuli iyo alkoholis bo
Cautarebloba)? ki alternatuli (cxrili 6.1)
rotad moxmarebis yvela SemTxveva.
ramdenad maRalia imis kvleva, sadac sawyisi klinikuri monacemebis (òqros standartis~) sa
albaToba, rom mocemul kohortis pacientebi fuZvelze gamovlinda 117 pacienti, romlebic ak
pacientTan daavadebas imyofebian daavadebis
mayofilebdnen alkoholis borotad gamoyenebis an
swored aseTi gamosavali ganviTarebis saerTo
masze damokidebulebis kriteriumebs. im 61 pacientidan,
eqneba? stadiaze (gansakuTrebiT
romlebmac CAGE-is kiTxvariT miiRes dadebiTi
daavadebis debiutis
etapze) da eqvemdebarebian
Sefaseba (3 an 4 qula), 60-s daudginda alkoholis
meTvalyureobas Sesabamisi borotad gamoyeneba oqros standartis mtkicebulebis
drois manZilze mixedviT. amitom, CAGE-is kiTxvari Zalian
specifikuria (gamosaxuleba 6.2). miuxedavad amisa, ver
ram gamoiwvia darRveva (an kvlevaSi, zemoqmedebis
moxerxda alkoholis borotad gamoyenebis danarCeni 57
ramdenad mosalodnelia, sixSiris TvalsazrisiT,
rom konkretulma erTmaneTs adareben CvenTvis SemTxvevis CAGE-is kiTxvariT identificireba. ase rom,
intervenciam arasasurveli saintereso daavadebis CAGE-is kiTxvari zomierad sensitiuri instrumentia.
efeqti mogvces)? mqone pirebs (SemTxvevebi) im es Sedegebi imas mianiSnebs, rom CAGE-is kiTxvari
jgufTan, romelsac ara aqvs warmoadgens skriningis sasargeblo instruments, ro
es daavadeba (sakontrolo desac mas viyenebT zogadi profilis saavadmyofoSi
jgufi). kvleva SeiZleba alkoholis problemuri moxmarebis dasadgenad, radgan
sxvadasxva formiT dadebiTi pasuxis maRali xarisxi alkoholis problemuri
tardebodes (randomizebuli moxmarebis prognozs iZleva. testis gamoyenebisas
kontrolirebadi kvleva,
gasaTvaliswinebelia, rom uaryofiTi pasuxi ar gamoricxavs
SemTxveva-kontrolis kvleva
alkoholis borotad gamoyenebas, gansakuTrebiT iseT
an kohortuli kvleva)
SemTxvevaSi, rodesac arsebobs alkoholis borotad
Geddes, 1999. moxmarebis damadasturebeli sxva mtkicebulebac.
_ 130 _
Tvisobrivi kvleva
prognozi depresia an guneb-ganwyobis msubuqi aSliloba,
kvlevebi prognozis Sesaxeb Semdegnairad unda vidre didi depresia. pacientebis daaxloebiT 48%-s
Sefasdes (ix. Sackett, et al., 1997): aReniSneboda guneba-ganwyobis ciklurobis an Sereuli
afeqturi mdgomareobis sul mcire erTi kvira.
w iyvnen Tu ara nimuSad aRebuli jgufis pacientebi
am kvlevis Tanaxmad, bipolaruli aSlilobis
identificirebuli aSlilobis erTi da igive, sawyis
mqone pacientebs, romlebic guneb-ganwyobis aS
etapze?
lilobis epizodis gamo mimarTaven mesameuli
w iyo Tu ara meTvalyureoba sakmarisad xangrZlivi donis centrebs, ramdenime momdevno wlis manZilze
da sruli? umetesad aReniSnebaT guneb-ganwyobis aSlilobis
w iyo Tu ara gamosavlis obieqturi kriteriumebi br- simptomebi, romlebSic Warbobs depresiuli simp
mad gamoyenebuli? tomebi, kerZod ki msubuqi da qve-sindromuli dep
w ergeba Tu ara Semdgomi dakvirvebis monacemebi Cems resiuli mdgomareobebi. miuxedavad amisa, droTa
pacientebs? ganmavlobaSi pacientebs SeiZleba ganuviTardeT
prognozuli kvlevebis xSiri problema Semdgomi rogorc maniakaluri, ise depresiuli an Sereuli
srulyofili dakvirvebis naklebobaa. uxeSi gamoTvlis simptomebis meryeoba. am kvlevas aseve aqvs eti
mixedviT, idealuri SemTxvevaa, rodesac kvlevidan 5%-ze ologiuri mniSvnelobac, radgan gamoiTqva varaudi,
naklebi pacienti gamoiTiSeba, xolo rodesac kvlevidan rom bipolarul aSlilobas da sxva ufro msubuq
20%-ze meti gamoiTiSeba, es kvlevis validurobas depresiul da hipomaniakalur mdgomareobebs aqvT
eWvqveS ayenebs. am kvlevebis gamoyenebis SesaZlebloba gansxvavebuli gamovlineba, magram maT erTi saerTo
imazea damokidebuli, Tu ramdenad hgvanan erTmaneTs aSliloba udevT safuZvlad. kvlevaSi CarTuli pa
kvlevaSi monawile pacientebi da realuri pacientebi. cientebi warmoadgendnen mesameul doneze refe
rirebul pacientebs, ris gamoc SeuZlebelia pirvelad
magaliTi jandacvaSi am monacemebis gamoyeneba.
kiTxva: Semdgomi xangrZlivi dakvirvebis mixedviT,
ramden xans ugrZeldebaT bipolaruli aSlilobebis Tvisobrivi kvleva
mqone pacientebs afeqturi simptomebi da rogori iyo
Tvisobrivi kvlevis meTodi gamoiyeneba im monacemebis
am simptomebis paterni?
Segrovebisa da analizisTvis, romelTa gamoxatvac
judi Tavis kolegebTan erTad (Judd, et al., 2002)
ricxvebiT SeuZlebelia (ix. Brown and Lloyd, 2001). miuxedavad
akvirdeboda bipolaruli aSlilobis diagnozis mqone
imisa, rom Tanamedrove fsiqiatriaSi mtkicebulebebze
146 pacients, romlebmac guneb-ganwyobis aSlilobis
damyarebuli midgoma randomizebul kontrolirebul
mimdinare epizodis gamo mimarTes aSS-is mesameuli
kvlevebzea fokusirebuli, romelTa saboloo Sedegic
donis 5 centrs. Semdgomi dakvirveba warmoebda
ricxvebSi aisaxeba, Tvisobriv midgomas xangrZlivi istoria
interviuirebiT pirveli 5 wlis ganmavlobaSi, jer 6
aqvs. am tipis midgomas miekuTvneba krepelinis naSromi
TveSi erTxel, Semdeg weliwadSi erTxel. intervius
klasifikaciis Sesaxeb da froidiseuli SemTxvevebis
dros vlindeboda afeqturi simptomebi fsiqiatriuli
analizi. SemTxvevebis SedarebiT Tanamedrove seriac
statusis Sefasebis skaliT, romelic dakavSirebuli
(mag. raselis naSromebi, romlebSic nervuli bulimiaa
iyo kvlevis diagnostikur kriteriumebTan. afeqturi
aRwerili. Russell, 1979), eyrdnoba Tvisobriv midgomas.
simptomebi, romlebic ar akmayofilebdnen kvlevis
Tvisobrivi da raodenobrivi kvlevebis sakvanZo
diagnostikur kriteriumebs miewereboda depresiis
gansxvavebebi mocemulia cxrilSi 6.4.
an maniis qve-sindromul kategoriebs.
Semdgomi dakvirvebis saSualo periodi 14,2 weli
rodis gamoiyeneba Tvisobrivi meTodi?
iyo, pacientTa 93% or welze meti xani akvirdebodnen.
fsiqiatriul kvlevaSi da servisis ganviTarebis
maT simptomebi aReniSnebodaT mTeli periodis
sferoSi zogjer marTebulia Tvisobrivi meTodis
naxevarze meti xnis ganmavlobaSi. pacientebis 90%-
gamoyeneba (Brown and Lloyd, 2001):
s erTi an meti kviris ganmavlobaSi umJRavndeboda
depresiuli simptomebi, xolo daaxloebiT amave w kvlevis sawyis etapze, relevanturi kiTxvis kon
raodenobas (86%), sul mcire erTi kviris manZilze cefciisa da ganmartebis Camosayalibeblad da
- maniakaluri da hipomaniakaluri simptomebi. hipoTezis Sesaqmnelad
miuxedavad amisa, depresiuli simptomebi momdevno w servisis momxmareblebis, ganmxorcieleblebis da
periodis ganmavlobaSi (momdevno kvirebis 32%) 3-jer profesionalebis damokidebulebis, Sexedulebebisa
ufro xSiri iyo, vidre maniakaluri da hipomaniakaluri da gamocdilebis Sesagroveblad da Sesadareblad
simptomebi (9,3%). depresiuli mdgomareobebi ufro w Sesafasebeli instrumentebisa da Sesafasebeli ska
metad klasificirdeboda, rogorc qve-sindromuli lebis Sesaqmnelad
_ 131 _
cxrili 6.4 sakvanZo gansxvaveba Tvisobriv da raodenobriv kvlevebs Soris

raodenobrivi kvleva Tvisobrivi kvleva
ZiriTadi mizani obieqturoba, sandooba, mecnieruli gageba personaluri kontaqtiT da dakvirvebiT.

WeSmariteba `gamtaroba~
SerCeva SemTxveviTi SerCeva; dizani, romliTac `mizanmimarTuli~. obieqtebis SerCeva xdeba gamiznulad,
kvlevis obieqtebi warmoadgenen saerTo kvlevis kiTxvis relevanturi maxasiaTeblebis mocviT
populacias da cdomilebis Tavidan acileba
monacemTa standartizebuli, òbieqturi~; validuri dakvirveba da interviu, xSirad interaqtiuri da Ria

Segroveba skalebi, bioqimiurad gansazRvruli gamosavlis mqone. werilobiTi masalis sistemuri kvleviT
gamosavali da a.S.
monacemTa raodenobrivi, statistikuri, hipoTezis TxrobiTi; kategoriebisa da Temebis generireba; analizis

analizi testireba ganmeorebiT warmoeba monacemTa Segrovebis procesSi
w mtkicebulebebze damyarebuli intervenciebis praq w iteracia/gameoreba _ grZelvadiani dakvirvebis

tikaSi gamoyenebis, Sefasebisa da implementaciis safuZvelze xdeba Tu ara interpretaciebis ga
problemebis gasagebad. dasinjva da reformulireba? dasabuTeba _naTladaa
raodenobrivi da Tvisobrivi kvlevebi erTmaneTis warmodgenili procedurebi, romlebic dakvirvebis
sapirispiro kvlevebi ar aris, TiToeuls iyeneben interpretacias ukavSirdeba, da moyvanilia sailus
garkveul situaciebSi, konkretuli saxiT. magaliTad, tracio magaliTebi?
rojersma Tavis kolegebTan erTad (Rogers, 2004) w konteqsti _ aris Tu ara kvlevis Rirebuleba da
moaxerxa Tvisobrivi meTodologiis raodenobriv mkvlevaris molodini gancxadebuli? ganumartes Tu
randomizebul kvlevasTan kombinireba, rac Sizo ara monawileebs kvlevis kulturaluri konteqsti
freniis mqone pacientebisTvis antifsiqozuri wam da misi mniSvneloba?
lebis marTebulad gamoyenebaSi daexmara. Tvisobrivi
kvleva aCvenebda, rom kvlevis monawileebi advilad validuroba
ver ixsenebdnen intervenciis moqmedebis detalebs. Tvisobriv kvlevaSi validurobis cneba miuTiTebs
meores mxriv, isini Rirebulad Tvlidnen imas, ufro interpretaciis damajereblobaze, vidre
rom kvlevaSi monawileoba maT profesionalebTan obieqtur, garegan kriteriumebTan Sedarebaze. va
kontaqtisa da urTierTobis saSualebas aZlevda. lidurobac icvleba rolTan erTad. magaliTad,
es asocirebuli iyo TviTefeqturobis gazrdasa da gamokvlevis mkiTxvels ainteresebs, ramdenad Tan
klinikur gaumjobesebasTan. mimdevruli da Sinaganad Sekrulia masala, mo
nawiles ki ainteresebs, ramdenad zustad aris in
Tvisobrivi kvlevis Sefaseba terpretirebuli misi gancdebi. sabolood, avtorebma
raodenobrivi kvlevis msgavsad, Tvisobrivi kvlevac unda gaiTvaliswinon, rom kvlevis procesma SeiZleba
unda iyos relevanturi da validuri. igive principebi zegavlena moaxdinos Segrovebul monacemebze (`ref
gamoiyeneba monawileTa SerCevisas, rac imas niSnavs, leqsuroba~).
rom isini naTeli da gamarTlebuli unda iyos. Tvisobrivi kvleva yovelTvis calsaxad ar fasdeba
mniSvnelovania Tvisobrivi midgomis SerCevis mizezis da specialurma terminologiam SeiZleba diskomforti
ganmarteba da monacemTa Segrovebis da analizis Seuqmnas araprofesional mkiTxvels. braunma da lo
meTodebis naTeli aRwera. Tvisobrivi kvlevis idma (Brown and Lloyd, 2001) miuTiTes, rom iseTi kiT
konteqstSi mniSvnelovania gamtarobis cneba. rac xvarebi, romlis terminologia jandacvis servisebis
imas exeba, Tu ramdenad axdens gavlenas dakvirvebaze mkvlevarebisTvis gaugebaria, naklebad vargisia gamo
gageba. stailsma (Stiles, 1999) gamoyo faqtorebi, sayeneblad.
romlebic gavlenas axdenen kvlevis gamtarobaze:
w masalaSi CarTulobis xarisxi _ ramdenad pirdapiria damatebiTi literatura:
kontaqti, magaliTad interviuireba, bunebrivi 1.Sackett DL, Richardson WS, Rosenberg W and Haynes RB (1997)
dakvirveba da werilobiTi wyaroebis gacnoba? Evidence-based Medicine, Churchill Livingstone, New York.
_ 132 _
Tavi 7 pirovneba da
pirovnuli aSliloba
Tavis Sinaarsi
kaluri aSlilobis dros) da ufro rTuli dasanaxia,
pirovneba
rodesac qceva icvleba nela, ufro xangrZlivi drois
pirovnebis mniSvneloba
manZilze (mag., Sizofreniis adreuli gamovlenisas).
pirovnebis tipebi
pirovnebis Camoyalibeba
pirovnebis mniSvneloba
pirovnebis gamokvleva
pirovnuli Taviseburebebi mniSvnelovania, vinaidan
pirovnuli aSliloba
isini SeiZleba gansazRvravdnen fsiqikuri aSlilobe-
anomaliuri pirovnebis cneba
bisadmi winaganwyobas (predispozicias), fsiqikuri aS-
rogor Camoyalibda warmodgena
lilobis uCveulo maxasaiTeblebs (anu warmoadgenen
anomaliuri pirovnebis Sesaxeb
`paToplastikur~ faqtors) da, aseve, pacientis mkur-
anomaliuri pirovnebis klasifikacia
nalobis procesis mimarT damokidebulebas.
aRwera da diagnostikuri kriteriumebi
epidemiologia pirovneba, rogorc predispozicia
etiologia
pirovnulma maxasiaTeblebma SeiZleba ganawyos indi-
pirovnuli aSlilobis prognozi
vidi fsiqikuri aSlilobisadmi stresul movlenebze
mkurnaloba
reaqciis modifikaciis gziT. mag., uaryofiTi movle-
pirovnuli aSlilobis marTva
nebi SfoTviT aSlilobas ufro iseT adamianSi gamoi-
pirovnuli aSlilobis konkretuli
wvevs, romelic yovelTvis wuxs umniSvelo probleme-
tipebis marTva
bis gamo.
paranoiduli pirovnuli aSliloba
Sizoiduri pirovnuli aSliloba pirovneba, rogorc paToplastikuri faqtori
antisocialuri (disocialuri) individis pirovnuli Tvisebebi ganapirobebs aSlilo-
pirovnuli aSliloba bis uCveulo maxasiaTeblebs. es, Cveulebriv, avadmyo-
isteriuli pirovnuli aSliloba fobasTan asocirebuli stresuli movlenebis sapa-
mosazRvre pirovnuli aSliloba suxod pirovnuli Tvisebebis gamZafrebiT vlindeba.
obsesiuri pirovnuli aSliloba mag., isteriuli niSnebi, romlebic disociaciur aS-
acilebadi (SfoTviTi) lilobaze miuTiTebs, isteriuli pirovnuli Tvisebe-
pirovnuli aSliloba bidan momdinareobs. rodesac aseTi uCvelo niSnebi
sxvaze damokidebulebis aSlilba gamokveTil xasiaTs atarebs, diagnozi Zneli dasasme-
eTikuri problemebi lia, Tu fsiqiatrma ar Caatara pacientis pirovnebis
danarTi zusti gamokvleva.
pirovneba pirovneba da mkurnaloba

termini `pirovneba~ aRniSnavs adamianis myar Tvise- individis pirovnuli maxasiaTeblebi mniSvnelovnad
bebsa da qcevis paternebs, romlebsac individi gansx- gansazRvravs mis damokidebulebas mkurnalobis mi-
vavebul viTarebaSi avlens. amdenad, `personologia~ marT. mag., obsesiuri Tvisebebis mqone individi SeiZ-
gansxvavdeba fsiqikuri aSlilobisgan imiT, rom qce- leba gabrazdes, Tu mkurnaloba zustad ar emTxveva
vebi, romlebic gansazRvravs pirovnebas, misi mTeli mis molodins; SfoTvisadmi midrekili adamianebi zed-
zrdasruli cxovrebis manZilze vlindeba, xolo qce- metad frTxilebi arian, rodesac maT sTxoven ufro
vebi, romlebic gansazRvravs fsiqikur aSlilobas, meti Zalisxmeva gamoiCinon reabilitaciis dros; anti-
gansxvavdeba individis premorbiduli qcevisgan. es socialuri Tvisebebis mqone adamianebi ar emorCile-
gansxvaveba advili dasanaxia, rodesac qceva sagrZ- bian daniSnulebas an, SeiZleba agresia gamoxaton med-
noblad icvleba xanmokle drois manZilze (mag., mania- personalis mimarT. mZime personologiuri aSlilobis
_ 133 _
7 pirovneba da pirovnuli aSliloba
mqone adamianebs uWirT samedicino servisebisgan mom- qcevis inhibicia da qcevis SenarCuneba. kloningeris
saxurebis miReba, radgan klinicistebs ar aqvT maTTan mixedviT qcevis aqtivacia asocirebulia siaxlis Zie-
urTierTobis survili (Lewis and Appleby, 1988). bis bazisur temperamentTan, qcevis inhibicia _ zia-
nis aridebasTan, xolo qcevis SenarCuneba _ jildoze
pirovnebis tipebi damokidebulebasTan. meoTxe bazisuri temperamentia
pirovnebis gagebis pirveli etapi pirovnebis tipis Seupovroba. iTvleba, rom siaxlis Zieba dakavSirebu-
dadgenas gulisxmobs. Cveulebriv, klinicistebi gan- lia dofaminergul funqciasTan, xolo zianis arideba
szaRvraven pirovnebis tips klinikur gamocdilebaze _ serotoninergul funqciasTan. kloningeris sqema
dayrdnobiT, rac gulisxmobs iseTi zogadad aRiare- xasiaTis sam Tvisebas Seicavs. esenia mizanmimarTule-
buli ramdenime kategoriis gamoyenebas, rogoric aris ba, TanamSromloba da transcendenturoba. iTvleba,
komunikabeluri da megobruli tipi da ganmartoebis rom xasiaTis es Tvisebebi ufro metad momdinareobs
moyvaruli adamiani, romelic acnobierebs da akon- bavSvobisa da mozardobis droindeli gamocdilebi-
trolebs Tavis qcevas. fsiqologebma scades ufro dan da ara biologiurad ganpirobebuli qceviTi dis-
mecnieruli kategoriebis SemuSaveba pirovnebis gam- poziciebidan.
zomi testebis gamoyenebiT, romlebic zomavs piro- pirovnebisa da pirovnuli aSlilobis sxvadaxva ti-
vnebis sxvadasxva aspeqtebs (Tvisebebs). am testebiT pebi agebulia am oTxi ZiriTadi temperamentidan da
dadgenili Tvisebebi damuSavda statistikuri meTo- xasiaTis sami Tvisebidan. mag., siaxlis Zieba SeiZleba
debiT da gamoiyo urTierTdakavSirebuli Tvisebebis gamovlindes cnobismoyvareobiT, enTuziazmiT, ara-
jgufebi anu faqtorebi. pirovnuli Tvisebebia SfoT- standartuli qceviT, advilad mobezrebiT. klonin-
vianoba, energiuloba, moqniloba, mtruli damokide- geris sqema imiTaa sainterso, rom pirovnebisTvis da-
buleba, impulsuroba, guneb-ganwyobis cvalebadoba, maxasiaTebeli ZiriTadi qceviTi dispociziebis iden-
disciplinirebuloba, TviTdajerebuloba. sxvadsaxva tifikaciis mcdelobas warmoadgens. es dispoziciebi
mkvlevarebma am Tvisebebidan gamomdinare mogvces pi- ganapirobebs pirovnebisTvis specifikur dakvirvebad
rovnebis sxvadasxva tipis gansazRvreba. ketelma gaqcevas. garda amisa, kloningeris sqema iTvaliswinebs,
moyo xuTi faqtori (Cattel, 1963), xolo aizenkma Seqmna rogorc memkvidreobiTi faqtoriT ganpirobebul va-
sqema (Eysenck, 1970a), romelSic Tavidan Sedioda ori riaciebs Tavis tvinis funqcionirebaSi, ise gamocdi-
ganzomileba (anu maRali rigis faqtori), romlebsac lebis zegavlenas. am Svidi faqtoris Sesaswavlad Sei-
man eqstraversia-introversia da nevrotizmi uwoda. qmna temperamentisa da xasiaTis kiTxvari (Temperament
SemdgomSi aizenkma daamata mesame ganzomileba _ fsi- and Character Inventory. Brandstrom et al., 2003). ramdejer-
qotizmi (Eysenck and Eysenck, 1976). am terminiT is aR- me scades kiTxvarze miRebuli Sedegebis dakavSireba
niSnavda garkveuli Tvisebebis klasters, romelSic Tavis tvinis funqcionirebis maCveneblebTan, magram
Sedioda sicive, agresiuloba, sisastike da antiso- miRebuli Sedegebi saboloo daskvnis gamotanis saSu-
cialuri qcevisken midrekileba. alebas ar iZleva (Turner et al., 2003).
amJamad iTvleba, rom pirovnebis aRwera xuTi fa- am mecnieruli Sedegebis miuxedavad, kliniciste-
qtoriT aris SesaZlebeli. am faqtorebs sxvadasxva bi ganagrZoben yoveldRiuri metyvelebidan aRebuli
saxeliT aRniSnavdnen, magram maT, zogadad, SeiZle- sityvebis gamoyenebas normaluri pirovnebis dadebi-
ba ewodos Riaoba gamocdilebis mimarT (anu siaxlis Ti da uaryofiTi Tvisebebis aRsawerad. pozitiuri
Zieba), keTilsindisiereba, eqstraversia-introversia, Tvisebebia: megobruloba, Tavdajerebuloba, stabi-
ukonfliqto xasiaTi (afilacia) da nevrotizmi. am luroba, adaptirebuloba. uaryofiTi maxasiaTeble-
faqtorebis inglisuri saxelwodebebis pirveli asoe- bia: morcxvoba, gulCaTxrobiloba, daurwmunebloba,
bisagan iqmneba akronimi OCEAN. mgrZnobiaroba, eWvianoba, gaRizianebuloba, impulsu-
uidigerma da kostam (Widiger and Costa, 1994) Semogv- roba, ego-centruloba, sixiste da agresiuloba. gar-
Tavazes sqema, romelSic yoveli faqtori Sedgenilia da amisa, arseobobs kidev ori termini: obsesiuri niS-
eqvs Tvisebaze miniWebuli qulebisgan. am faqtorebis nebi da isteriuli niSnebi. isini moicaven garkveuli
gamosakvlevi instrumentebi SemuSavda pacientebisgan niSnebis erTobliobas, romlebic, xSirad, erTdrou-
da sxva respondentebisgan miRebuli informaciis sa- lad gvxvdeba.
fuZvelze (Costa, McCrae, 1992), iseve, rogorc naxev- obsesiuri niSnebi moicavs iseT dadebiT Tvisebebs,
rad struqturirebuli intervius meSveobiT (Trull and rogoricaa sando, Seupovari da sizustis moyvaru-
Widiger, 1997). kloningerma (Cloninger, 1986) kolegebTan li. aseTi Tvisebebis mqone adamianebi isaxaven maRal
erTad (Cloninger et al., 1993) SeimuSava alternatiuli standartebs, icaven socialur normebs da kanonmor-
sqema. am sqemaSi sami `ZiriTadi qceviTi dispozicia~ Cilni arian. rodesac es Tvisebebi ufro mkafiodaa
gamoxatulia oTxi temperamentiT (Svidfaqtoriani gamoxatuli, isini vlindeba iseT negatiur maxasiaTe-
modeli). es qceviTi dispoziciebia qcevis aqtivacia, blebSi, rogoricaa sijiute, umniSvnelo detalebze
_ 134 _
pirovneba
yuradRebis gamaxvileba, fanatizmi da iumoris grZ- SegviZlia davaskvnaT, rom nevrotizmisa da eqstra-
nobis arqona. versiis maxasiaTeblebis CamoyalibebaSi memkvidreo-
rodesac isteriuli niSnebi msubuqadaa gamoxatu- biTi faqtoris monawileoba 20-30 procents Seadgens
li, isini socialurad momgebiania. aseTi Tvisebebis (McGuffin and Thaper, 1992). msgavsi viTarebaa sxva maxa-
mqone adamianebTan urTierToba cocxali da momxibl- siaTeblebis SemTxvevaSi. aqac saerTo da gansxvavebu-
velia; isini kargi maspinZlebi da stumrebi arian, war- li garemo faqtorebi mcire efeqtis mqonea. miRebuli
matebiT TamaSoben moyvarulTa Teatralur dadgmebSi Sedegebi, SeiZleba, mxolod normaluri populaci-
da sajaro gamosvlisas SeuZliaT auditoriis dain- isTvis iyos marTebuli. tyupebis kvleva, romelSic
tereseba. magram, rodesac isteriuli niSnebi ufro DSM-III-R -is pirovnuli aSlilobis kriteriumebia
Zlierad aris gamoxatuli, isini aSkarad wamgebiani gamoyenebuli, memkvidreobiTi faqtoris umniSvnelo
xdeba. aseTi Tvisebebis mqone adamianebs advilad ere- monawileobaze miuTiTebs (Torgesen et al., 1993).
vaT cremli da axdenen situaciebis dramatizacias. SeWidulobis kvlevebi. molekuluri genetikis
isini, aseve, demonstratiulad reagireben avadmyofo- meTodebis gamoiyenebiT Seiswavles kavSiri siaxlis
baze (warsulSi amas ìsteriul safars~ uwodebdnen), Ziebasa da nevrotizaciis maCveneblebs Soris. kv-
rac arTulebs maTi gancdebis intensivobis Sefasebas. levebis Sedegad raodenobrivi maxasiaTeblebis ram-
pacientis rolSi yofnisas isini SeiZleba momTxovnebi denime lokusi gamovlinda, romlebic nevrotiza-
da keklucebi iyvnen. ciis Taviseburebaze axdenen gavlenas (Fullerton et al.,
2003). es da sxva monacemebi damatebiT dadasturebas
pirovnebis Camoyalibeba saWiroeben, Tumca erT-erTi kvleviT (Zohar et al.,
pirovnebis tipebis biologiuri safuZvlebi 2003) dadasturda kavSiri zianis acilebasa da 8p21-is
ubans Soris. marTalia, aseTi gamokvlevebis Catareba
genetikuri zegavlena Znelia, Tumca maTi saSualebiT, sabolood, SesaZle-
yoveldRiuri dakvirveba gviCvenebs, rom Svilebi beli gaxdeba pirovnuli maxasiaTeblebis biologiuri
xSirad pirovnulad hgvanan TavianT mSoblebs. aseTi safuZvlebis dadgena.
msgaveseba an Tandayolilia an daswavlili socialuri
bavSvobisdroindeli temperamenti da
urTierTobis procesSi. pirovnuli maxasiaTeblebis
zrdasruli pirovneba
memkvidreobiTobis sakiTxi sami tipis gamokvlevebis
meSveobiT Seiswavleba. Cvili bavSvebi gansxvavdebian erTmaneTisgan Zilisa
aRnagoba da pirovneba. zogi avtori miiCnevs, rom da RviZilis, axal situacebTan gamklavebis, emoci-
pirovnuli maxasiaTeblebi sxeulis aRnagobasTan aris uri reagirebisa da yuradRebis koncentraciis pa-
dakavSirebuli. Tu es asea, amgvari kavSiris mizezi ternebiT. es Taviseburebebi, romlebic 24-e TavSia
SeiZleba genetikuri iyos. kreCmerma (Kretschmer, 1936) ganxiluli, SesaZloa, qmnian im safuZvels, saidanac,
aRwera konstitutciis sami tipi: piknikuri (dabali SemdgomSi, unda ganviTardes personologiuri gan-
da momrgvalebuli formebis mqone), aTleturi da as- sxvavebebi. miuxedavad imisa, rom es Taviseburebebi
Teniuri (wvrili da gamxdari sxeulis mqone). kreCmeri mTeli bavSvobis manZilze narCundeba, maTi kavSiri
Tvlida, rom sxeulis piknikuri aRnagoba dakavSire- mozrdili pirovnebis specifikur maxasiaTeblebTan
bulia pirovnebis cikloTimur tipTan (kontaqturi, dadgenili ar aris (Berger, 1985).
cvalebadi guneb-ganwyobis mqone), xolo asTeniuri
bavSvobisdroindeli gamocdileba da
aRnagoba _ `Sizotipur~ niSnebTan (civi, distanciuri
pirovnebis ganviTareba
da TviTkmayofili). kreCmeris Sefasebebi subieqtur
yoveldRiuri gamocdileba imaze metyvelebs, rom
msjelobas emyareboda. Seldonma (Sheldon et al., 1940)
bavSvobisdroindeli gamocdileba ayalibebs pirovne-
gaimeora kreCmeris gamokvlevebi, magram gamoiyena ra-
bas. Tumca, advili ar aris am mosazrebis damadas-
odenobivi meTodebi fizikuri maxasiTeblebis Sesafa-
turebuli obieqturi mtkicebulebis Semowmeba. Se-
seblad da ufro obieqturad gansazRvra personolo-
sabamisi gamocdilebis raodenobrivi gamoxatva da
giuri maxasiaTeblebi. misma Sedegebma ar daadastura
sandod aRricxva sakmaod Znelia. garda amisa, Znelia
arc erTi martivi korelacia sxeulis aRnagobasa da
iseTi prospeqtuli gamokvlevis dagegmva, romelic
pirovnebis tips Soris (Sheldon et al., 1940).
dafaravs xangrZliv intervals bavSvobisdroindel
tyupebis kvlevebi. ufro pirdapiri mtkicebuleba
movlenebsa da zrdasrulobis periods Soris. retro-
pirovnuli niSnebis genetikuri safuZvelis Sesaxeb
speqtuli kvleva ufro advili Casatarebelia, magram
mopovebulia erTad da cal-calke aRzrdili identu-
mozrdili adamianebis mier bavSvobisdroindeli ga-
ri tyupebis personologiuri testebiT Seswavlisas
mocdilebis gaxsenebiT miRebuli informacia arasan-
miRebuli maCveneblebis SedarebiT. am da sxva kvleve-
doa. miuxedavad amisa, mainc arsebobs monacemebi am
biT miRebuli Sedegebis ganzogadebis safuZvelze
_ 135 _
sakiTxis Taobaze (ix. pirovnuli aSlilobis etio- eriksonis Teoria Tavisi arsiT froidis Teoriis
logia). qveviT ganxilulia froidis fsiqodinamiuri msgavsia, Tumca is gansxvavebul terminebs iyenebs.
Teoria da sxva avtorebis mosazrebebi. eriksoni oralur fazas uwodebda ndoba-undoblobis
froidis Teoria. pirovnebis ganviTarebis froidi- fazas (imis aRsaniSnad, rom am periodSi usafrTxoe-
seuli sqemis mixedviT sicocxlis pirveli xuTi weli bis grZnoba yalibdeba), analur fazas avtonomiuro-
yvelaze didi mniSvnelobis mqonea. imisTvis, rom ba-eWvis fazas (am dros bavSvi daiswavlis sazogadoe-
pirovnuli ganviTareba normalurad mimdinareobdes, bis wesebs, sakuTari Tavis marTvas da iZens sakuTar
adamianma warmatebiT unda gaiaros libidos ganviTa- TavSi darwmunebulobas), xolo genitaliur stadias
rebis ZiriTadi stadiebi (oraluri, analuri da geni- uwodebda iniciativa-danaSaulis gancdis fazas,
taliuri). Tu man marcxi ganicada romlime am safex- rodesac bavSvs uyalibdeba warmodgena sakuTari Ta-
urze, is, zrdasrul asakSi, garkveuli Tvisebebis vis, rogorc pirovnebis Sesaxeb. Tu bavSvi warmatebiT
matarebeli iqneba. mag., analur stadize sirTuleebis gaivlis am safexurebs, is sakuTar TavSi darwmunebu-
aRmoceneba ganapirobebs obsesiuri pirovnuli niS- li da iniciativiani xdeba. sawinaaRmdego SemTxvevaSi
nebis Camoyalibebas. am sqemis mixedviT, mogvianebiT is SeboWil da daucvel pirovnebad yalibdeba. erik-
asakSi, SesaZlebelia, mSoblebis garda sxva adamian- sonma froidisgan isesxa latenturi periodis cneba,
ebTan identifikaciis gziT pirovnebam garkveuli magram, misi azriT, es periodi mozardobis xanazec
modificireba ganicados. Tumca iTvleba, rom Semd- vrceldeba. am ukanasknel stadias man gulmodgineba-
gomi gavlena nakleb mniSvnelovania, vidre adreuli arasrulfasovneba uwoda. am etapze bavSvi swavlobs
gamocdileba. froidis sqema mravalmxrivi da moqnil- skolasa da ojaxs gareT mimdinare socialur urT-
ia. misi saSualebiT, adreuli gamocdilebis safuZ- ierTobebSi sakuTari miRwevebis mniSvnelobas. er-
velze, pirovnebis bevri Tvisebis axsnaa SesaZlebeli. iksonis sqemam zegavlena moaxdina mozardobis xanis
Tumca, swored amis gamo, Teoriis kompleqsurobidan Seswavlaze, albaT, ZiriTadad imis gamo, rom eriksoni
gamomdinare, rTulia misi mecnieruli dasabuTeba. cxovrebis am periods mniSvnelobas aniWebda im dros,
iungis Teoria. pirovnebis ganviTarebis Teoria rodesac froidi am periods nakleb mniSvnelovnad
froidis Teoriis msgavsia im azriT, rom isic aRi- Tvlida.
arebs cxovrebis adreul periodSi momxdari fsiqi-
kuri movlenebis mniSvnelobas. Tumca, froidisgan pirovnebis gamokvleva
gansxvavebiT, iungi Tvlida, rom pirovnebis ganvi- pirovnebis gamokvleva ganxilulia me-2 TavSi, ma-
Tarebis procesi mTeli cxovrebis manZilze grZel- gram aq gvsurs or sakiTxze gavamaxviloT yuradReba.
deba. cxovrebis ciklis pirvel etaps iungi `sakuTari pirveli is aris, rom saSualebebi, romlebsac, Cveu-
movaleobebis Sesrulebad~ ganixilavda da am termins lebriv, pirovnebis kvlevisas iyeneben, gamousadegar-
iyenebda iseTi movlenebis mimarT, rogoricaa mSo- ia klinikur praqtikaSi. ukanasknel SemTxvevaSi igu-
blebis ojaxidan wamosvla, meuRlis povna da saku- lisxmeba, rom pirovnebis amJamindeli qceva misTvis
Tari ojaxis Seqmna. iungis modeli imiT aris mniS- Cveul qcevas asaxavs (da, Sesabamisad, mis pirovnul
vnelovani, rom yuradRebas amaxvilebs pirovnuli Tvisebebsac). aseTi daskvna, zogadad, sworia. Tumca,
Tvisebebis cvlilebebze mTeli cxovrebis manZilze. igive daskvna SecdomaSi Semyvania pacientebis gamokv-
Tumca, iungis modeli arasodes yofila iseTive gav- levisas, radgan avadmyofi adamianis amJamindeli qce-
leniani, rogorc froidis Teoria. garda amisa, misi va asaxvs ara mxolod mis pirovnul Tvisebebs, aramed
mecnieruli Semowmeba, aseve, Zalian rTulia. misi daavadebis efeqtebsac. avadmyofi adamianis pi-
adleri da neofroidianelebi. adlerma uaryo froi- ovnuli maxasiaTeblebis Sesaxeb iformaciis mopoveba
dis ideebi libidos ganviTarebis Sesaxeb. misi konce- SeiZleba misi warsuli qcevis Sesaxeb sando monace-
fciis mixedviT pirovneba viTardeba mudmivi Zalisx- mebis miRebis safuZvelze, romlebic miiReba rogorc
mevis procesSi, romelic arasrulfasovnebis ganc- pacientisgan, ise sxva informatorebisgan.
dis kompensaciazea mimarTuli. neofroidianelebis pirovnebis tipebis Sesaxeb nawilSi (gv. ??) naxsenebi
Tanaxmad (fromi, horni da salivani) ganviTarebis iyo pirovnuli niSnebis gazomvis zogierTi instru-
procesze ufro metad socialuri faqtorebi zemoq- menti. Cven, SeiZleba, vivaraudoT, rom es instru-
medebs, vidre froidis modelis biologiurad deter- mentebi da msgavsi standartizebuli testebi ukeTes
minirebuli stadiebi. am saerTo poziciis miuxedavad, informacias gvawvdis pacientze, vidre klinicisti.
mocemuli avtorebi gansxvavdebodnen erTmaneTisgan pirovnebis gamzomi testebi sandoa, rodesac maTi
socialuri faqtorebis detalebis gansazRvris Tval- meSveobiT xdeba janmrTeli adamianebis gamokvleva,
sazrisiT. maTi konkretuli Teoriuli debulebebi ar magram maT Sedegebze SeiZleba gavlena moaxdinos
iqna farTod miRebuli, magram idea socialuri faq- fsiqikurma aSlilobam. garda amisa, maTi gamoyenebiT
torebis mniSvnelobis Sesaxeb, gavleniani gamodga. ver xerxdeba klinikuri praqtikisTvis mniSvnelovani
_ 136 _
pirovnuli aSliloba
pirovnul Tvisebebis gazomva. amitom, pirovnebis tes- blebiT gansxvavdeba. maTi gamyofi xazi ganisazRvreba
tebi, romlebic kvlevebSi farTod gamoiyeneba, nak- Sesabamisi maCvenebliT, romelic qulebis garkveul
lebad ixmareba klinikur praqtikaSi. raodenobaSi gamoixateba. aseTi sistema Zalian mim-
pirovnebis sakvlevi meTodebis mimoxilva mocemu zidvelia, radgan is Seesabameba meTods, romelsac
lia Semdeg wyaroebSi: Westen (1997); Clark, Harrison (2001). warmatebiT iyeneben inteleqtualur ganviTarebaSi
gadaxrebis gansasazRvrad. aseT meTods, kvlevisTvis
pirovnuli niSnebis gamokvlevis mniSvneloba
aSkara Rirebuleba gaaCnia, magram misi sargeblianoba
rogorc mocemuli Tavis SesavalSi aRvniSneT, perso- klinikur muSaobaSi jer-jerobiT ar yofila dadge-
nologiuri maxasiaTeblebis gamokvleva mniSvnelova- nili.
nia gadawyvetilebis misaRebad daavadebis etiolo- socialuri kriteriumis gamoyenebisas anomali-
giis dadgenis, misi diagnostirebisa da mkurnalobis uri pirovnuli Tvisebebi iwvevs Tavad am Tvisebebis
TvalsazrisiT. etiologiis sakiTxebis ganxilvisas, matarebeli adamianis an mis garSemo myofi pirebis
pirovnuli maxasiaTeblebis codna gasagebs xdis imas, tanjvas. mag., anomaliuri sensitiuroba da pesimizmi
Tu ratom aris zogierTi movlena pirovnebisTvis Tavad am Tvisebebis matarebeli piris tanjvis mizezia,
stresuli. diagnostirebis dros, pacientis pirovnu- xolo sicive da agresiuloba sxva adamianebis tanjvis
li Tvisebebis codna gvagebinebs, Tu ratom axasi- gamomwvevia. miuxedavad imisa, rom aseTi kriteriumebi
aTebs aSlilobas uCveulo niSnebi, ratom reagirebs subieqturia da maT aklia sizuste, romelic statis-
pacienti swored aseTi saxiT avadmoyofobasa da mis tikur midgomas axasiaTebs, isini Seesabameba klini-
mkurnalobaze. pirovnuli maxasiaTeblebi, agreTve, kuri praqtikis realiebs da, amis gamo, farTod aris
prognozze zemoqmedebs. personologiuri maxasiaTe- miRebuli.
blebis Sefaseba unda moxdes TiToeul SemTxvevaSi da Tu gaviTvaliswinebT am sferoSi konceptualuri
ara mxolod pirovnuli aSlilobis dros (anu normis- xasiaTis problemebis arsebobas, ar gagvikvirdeba,
gan ukiduresi gadaxris dros. ix. qvemoT). rom anomaliuri pirovnebis damakmayofilebeli defi-
gamokvlevis Sedegebis aRircxva yvelaze metad nicia rTuli SesamuSavebelia. ICD-9-Si pirovnuli
aRweriTi terminebis gamoyenebiTaa xelsayreli. es aSlilobebi asea aRwerili:
terminebi unda SevarCioT imis gaTvaliswinebiT, Tu es aris individis pirovnuli da qceviTi tenden-
ra Tvisebebi axasiaTebs anomaliur pirovnebas. amis ciebis darRveva, romelic uSualod ar momdinareobs
mizezi is aris, rom zemoT aRwerili pirovnuli faq- daavadebidan, Tavis tvinis dazianebidan an romelime
torebi zedmetad zogadia imisTvis, rom klinicists fsiqikuri aSlilobidan. is, Cveulebriv, moicavs
misTvis mniSvnelovani informacia miawodos. aRweri- pirovnebis ramdenime sferos da TiTqmis yovelTvis
Ti terminebis magaliTebia sensitiuri, sakuTar TavSi aris asocirebuli mniSvnelovani xarisxis distrest-
daurwmunebeli, midrekili usafuZvlo wuxilisaken, Tan da socialur disfunqciasTan. amgvari darRveva,
zedmetad agresiuli, ar axasiTebs sinanulis gancda, Cveulebriv, vlindeba bavSvobas an mozardobaSi da
ar aris gulisxmieri adamianebis mimarT. am tipis aR- zrdasrulobis asakSic narCundeba.
weriTi sityvebi sasargebloa TiToeul pacientze ICD-10-Si gansxvavebuli definiciaa gamoyenebuli
warmodgenis Sesaqmnelad, romelic misTvis unikal- qceviTi paternebis simyaris TvalsazrisiT, magram
uri Tvisebebis kombinaciaze iqneba damyarebuli. ICD-9-is definicia ufro lakonuria, da, Sesabamisad,
ase Seqmnili zogadi suraTi warmatebuli klinikuri ufro Rirebuli.
praqtikis erT-erT safuZevels warmoadgens. aRsaniSnavia, rom pirovnebis mier gancdili dis-
tresi, romelic ICD-9-Si aris naxsenebi, SeiZleba
pirovnuli aSliloba mxolod mogvianebiT gamovlindes (mag., xangrZlivi
mxardamWeri urTierTobis dakargvis Semdeg). garda
anomaliuri pirovnebis cneba
amisa, Cveulebriv (magram ara yovelTvis) aRiniSneba
zogierTi tipis pirovneba aSkarad anomaliuria. mag., profesiul da socialur qcevasTan dakavSirebuli
paranoidul pirovnebas axasiaTebs ukiduresi eWvi- mniSvnelovani problemebi.
anoba, sensitiuroba da undobloba. Tumca, Zalian miuxedavad imisa, rom definiciebi anomaliur Tvise-
Znelia normaluri da anomaliuri pirovnebis erTma- bebzea fokusirebuli, mniSvnelovania gvesmodes, rom
neTisgan mkafiod gamijvna. isic ki Zneli gadasawyve- anomaliuri niSnebis mqone adamianebs, Cveulebriv, ax-
tia, Tu ra kriteriumebi unda gamoviyenoT maT gas- asiaTebT rogorc dadebiTi, ise uaryofiTi Tvisebebi.
amijnad. am mizniT ori kriteriumi iqna Semotanili: klinicistma yovelTvis unda Seafasos orive tipis
statistikuri da socialuri. Tvisebebi, raTa, SesaZleblobis SemTxvevaSi, marTvis
statistikuri kriteriumis mixedviT anomaliuri gegma swored pacientis dadebiT Tvisebebze daafuZ-
pirovneba normalurisgan raodenobrivi maxasiaTe- nos.
_ 137 _
pirovnuli cvlilebebi lobas, mtrul damokidebulebas, advilad Riziandeba,
zogjer, zrdasruli cxovrebis manZilze, Tavs iCens socialurad izolirebulia, aqvs sicarielis, uim-
Rrma da xangrZlivi pirovnuli cvlilebebi, romle- edobisa da gaucxoebis gancda. igi ukidures zRvram-
bic gansxvavdeba stresis an avadmyofobis Tanmdevi dea misuli. es niSnebi ar gvxvdeba stresul gamoc-
droebiTi qceviTi cvlilebebisgan. aseTi xangrZlivi dilebamde. miuxedavad imisa, rom pirovnebis amgvari
cvlilebebi SeiZleba momdinareobdes: mdgomareoba SeiZleba mosdevdes posttravmul stre-
sul aSlilobas, is, mainc, misgan gansxvavebul mdgo-
w Tavis tvinis dazianebisgan an organuli daavadebis-
mareobas warmoadgens.
gan;
w mZime fsiqikuri aSlilobisgan (gansakuTrebiT, Si rogor Camoyalibda warmodgena anomaliuri
zofrenia); pirovnebis Sesaxeb
w gansakuTrebiT mZime stresuli gamocdilebidan fsiqiatriaSi anomaliuri pirovnebis cneba mecxramete
(gvxvdeba wamebis msxverpl patimrebSi an tyveobaSi saukunis dasawyisSi damkvidrda, rodesac frangma fsiq-
myof pirebSi). iatrma pinelma aRwera manie sans delire. man es termini
ICD-10-Si Setanilia kategoriebi TiToeuli am ti- gamoiyena im pacientebis mimarT, romlebsac axasiaTebda
pis cvlilebisTvis. Tavis tvinis organuli daavadeb- agresiisa da Zaladobrivi qcevis ucabedi Setevebi, ma-
iT gamowveuli pirovnuli cvlilebebi organuli gram ar aReniSnebodaT bodviTi ideebi. im dros bodvi-
fsiqikuri aSlilobebis jgufSia Setanili (F00), ro- Ti ideebi ganixileboda fsiqikuri aSlilobis specifi-
melic Seicavs Tavis tvinis daavadebiT, dazianebiTa kur niSnad (termini delire frangulad bodvas niSnavs).
da disfuqnciiT gamowveuli pirovnuli da qceviTi savaraudod, am jgufSi Sediodnen ara mxolod isini,
aSlilobebis kategorias. kerZod, es aris encefali- visac dRes pirovnebis antisocialuri aSlilobis diag-
tis da qala-tvinis travmiT gamowveuli pirovnuli nozi eqneboda, aramed sxva fsiqikuri aSlilobis mqone
cvlilebebi. DSM-IV-Si isini diagnostirebulia, ro- pirebi, romlebsac bodva ar aReniSnebodaT, mag., zogi
gorc zogadi samedicino mdgomareobiT gamowveuli maniakaluri pacientic (ix. Kavka, 1949. aq mocemulia
pirovnuli cvlilebebi. pinelis wignis meore gamocemis Sesabamisi monakveTis
pirovnuli cvlilebebis ori danarCeni forma ICD- Targmani. pirveli gamocema gamoqveynda 1801 wels).
10-is F60 rubrikaSia gaerTianebuli (zrdasruli ada- Tumca, sxva avtorebi (mag., amerikeli benjamen raSi;
mianis pirovnuli da qceviTi aSlilobebi). fsiqikuri Rush) dainteresebulebi iyvnen msgavsi klinikuri
daavadebis Semdgomi xangrZlivi pirovnuli aSlilo- problemebiT, Semdegi mniSvnelovani nabiji swored
bis diagnostirebisTvis pirovnuli aSliloba unda ingliselma eqimma gadadga. 1835 wels, priCardma
aRiniSnebodes minimum 2 wlis ganmavlobaSi, aSkarad (Prichard), bristolis saavadmyofos ufrosma eqimma,
unda iyos dakavSirebuli fisiqikur daavadebasTan gamoaqveyna `traqtati SeSlilobisa da fsiqikis sxva
da ar unda aRiniSnebodes am daavadebis gaCenamde. darRvevebis Sesaxeb~ (J.C. Prichard. À treatise on insanity
aseTi aSlilobis mqone pacienti SeiZleba iyos sxvaze and other disorders of the mind~). pinelis terminze (manie
damokidebuli, pasiuri da momTxovni, an arakomunik- sans delire) dayrdnobiT, man Semoitana axali termini:
abeluri da izolirebuli im (ara bodviTi) rwmenis moraluri SeSliloba, romelic gansazRvra, ro-
gamo, rom is Seicvala an stigmatizebulia. ICD-is av- gorc bunebrivi grZnobebis, emociuri mijaWvulobis,
torebi aRniSnaven, rom aseTi cvlileba gasagebi xde- midrekilebebis, xasiaTis, Cvevebis, ganwyobilebebisa
ba pirovnebis avadmyofobisdroindeli gamocdile- da bunebrivi impulsebis avadmyofuri damaxinjeba
bidan gamomdinare, iseve, rogorc misi adrindeli inteleqtis, msjelobis unaris da SemecnebiTi fun-
damokidebulebebis, Seguebis paternisa da cxovrebi- qciebis aSkarad gamoxatuli darRvevisa da defeqtis
seuli situaciis gaTvaliswinebis Semdeg. Tumca, iTv- gareSe, konkretulad ki avandmyofuri bodviTi idee-
leba, rom Sizofrenias SeuZlia Secvalos pirovnuli bis an halucinaciebis gareSe (Prichard, 1835, gv. 6).
Tvisebebi uSualod an arapirdapiri gziT. miuxedavad imisa, rom aseTi gansazRvreba miesad-
ICD-10-is mixedviT, katastrofuli gamocdilebis ageboda pinelis mier aRweril agresiul avadmyofebs,
Semdgomi xangrZlivi pirovnuli aSliloba, aseve unda priCardi aSkarad gulisxmobda ufro farTo jgufs,
aRiniSnebodes minimum 2 wlis ganmavlobaSi. stresu- radgan man dasZina, rom `midrekileba qurdobisken
li gamocdileba ukiduresad intensiuri unda iyos. zogjer warmoadgens moraluri SeSlilobis niSans,
am tipis gamocdilebaa bunebrivi katastrofa; xan- zogjer ki _ wamyvan Tu ara, mis erTaderT Tavise-
grZlivi tyveoba an sakoncentracio banakSi moxvedra, burebas~ (gv. 27).
rodesac pirovnebis sicocxles gardauvali safrTxe priCardis mier Semotanili moraluri SeSlilobis
emuqreba, an pirovneba terorizmis an wamebis msxver- kategoria, pinelis mier aRwerili manie sans delire-s
plia. aseTi gamocdilebis adamiani amJRavnebs undob- msgavsad moicavda afeqtur aSlilobasac. is werda:
_ 138 _
pirovnuli aSliloba
`moraluri SeSlilobis yvelaze RirsSesaniSnavi Sem- Tavi dauTmo. man daaxasiaTa ara mxolod antisocial-
Txvevebis umetesobis wamyvani niSania naRveli da dar- uri tipi, aramed, kidev eqvsi tipi: agznebadi, arastabi-
di~ (gv. 18). `naRvliani da melanqoliuri depresiis luri, maCxubari, eqscentriuli, matyuara da TaRliTi.
mdgomareoba zogjer adgils uTmobs arabunebrivi ag- kurt Snaiderma gaafarTova fsiqopaTiuri pirov
znebis sapirispiro mdgomareobas~ (gv. 19). nebis cneba. Tu krepelinis mixedviT fsiqopaTiuri
priCardis moraluri SeSliloba moicavda iseT pirovnebis Svidi tipi miesadageboda iseT adamianebs,
mdgomareobebs, romlebic dRes diagnostirebulia, romlebic sxvisTvis tanjvisa da usiamovnebis mom-
rogorc pirovnuli aSliloba. Tumca, is am termins tanni arian, Snaiderma am kategoriaSi is adamianebic
mxolod im adamianebis mimarT ar iyenebda, romlebic gaaerTiana, romlebic Tavadac ganicdian tanjvas. ase
yovelTvis amgvarad iqceodnen: mag., man am kategoriaSi gaaerTiana aSkarad depresiu-
`rodesac amgvari fenomenebi aRiniSneba Tavneba da li da daucveli xasiaTis mqone adamianebi. amgvarad,
Wirveul xasiaTTan, socialuri kontaqtebis darRvev- Snaideris mixedviT, fsiqopaTiur pirovnebaSi Sedis
asTan da warsulSi sayvareli axloblebisa da mego- mTeli rigi pirovnuli paTologiebi da ara mxolod
brebis mimarT antipaTiis gancdasTan erTad, anu in- antisocialuri pirovneba. aqedan gamomdinare, am
dividis moraluri Tvisebebis SecvalasTan erTad, es terminma ori mniSveneloba SeiZina: ufro farTo mniS-
mdgomareoba mkafiod gamoxatuli xdeba.~ vnelobiT, is aerTianebda yvela saxis pirovnul pa-
am nawyvetSi, xasiaTSi momxdari clileba imas Tologias, xolo viwro mniSvnelobiT, gulisxmobda
miuTiTebs, rom priCardi gulisxmobda, ara mxolod antisocialur pirovnebas.
dRevandel dRes pirovnul aSlilobad klasifici- gaurkvevloba fsiqopaTiuri pirovnebis terminTan
rebul mdgomareobebs, aramed fsiqikur aSlilobad dakavSirebiT ar dasrulebula Snaideriseuli far-
klasificirebul mdgomareobebsac. To gansazRvrebiT. am SemTxvevaSi mocemuli termi-
mogvianebiT, mecxramete saukuneSi, dadginda, rom nis ori aspeqti iqcevs yuradRebas. pirvelis avto-
fsiqikurma aSlilobam SeiZleba Tavi iCinos bodvis ria Sotlandieli fsiqiatri ser deivid hendersoni,
gareSe da moraluri SeSlilobis cnebis mniSvneloba romelmac 1939 wels gamoaqveyna gavleniani wigni
ufro daviwrovda. mag., henri moudsli am termins iy- `fsiqopaTiuri mdgomareobebi~ (D. Henderson, Psycho-
enebda iseTi adamianebis mimarT, romlebsac is Semde- pathic states). man gansazRvra fsiqopaTebi, rogorc
gnairad aRwerda: adamianebi, romlebic, miuxedavad imisa, rom maT ar
àr aqvs WeSmaritad moraluri grZnobebis ganc- aReniSnebaT gonebrivi daqveiTeba:
dis unari. yvela misi survili da impulsi, romelsac mTeli cxovrebis manZilze an SedarebiT dabali
is gauazreblad emoCileba _ egoisturia. misi qceva asakidan moyolebuli amJRavneben qceviT aSlilobas,
marTulia amoraluri motivebiT... da mas araviTari romelic antisocialuri an asocialuri bunebisaa da,
survili ar aqvs, gauwios maT winaaRmdegoba~ (Maudsley Cveulebriv, ganmeorebiT an epizodur saxes atarebs.
1885, p171). am adamianebze Znelia socialuri, sadamsjelo da sa-
moudslim gamoTqva sakuTari mosazreba im ukmayo- medicino meTodebiT zemoqmedeba da maT mosavlelad
filebasTan dakavSirebiT, romelsac iwvevda termini Cven ar mogveZebneba Sesabamisi profilaqtikuri da
`moraluri SeSliloba~. mas es termini esmoda, rogorc samkurnalo zomebi.
`fsiqikuri gaucxoebis forma, romelic imdenad hgavs marTalia, es definicia, kvlav, fsiqopaTiuri pi
borotebas an kriminals, rom mravali adamiani mas me- rovnebis adreul viwro gagebas Seesabameba, hender-
dikosebis usafuZvlo gamogonebad miiCnevs~ (gv 170). sonma gaafarTova Tavisi definicia imiT, rom gamoyo
Semdegi nabiji Tanamedrove warmodgenebis Camo- fsiqopaTebis sami jgufi:
yalibebis mimarTulebiT gadadga koxma (Koch, 1891), 1. upiratesad agresiuli pirovnebebi; ara mxolod
romelmac Semoitana termini fsiqopaTiuri arasrul- isini, vinc mudmivad agresias amJRavnebs, aramed
fasovneba. am terminiT is aRniSnavda adamianTa jgufs, isinic, vinc midrekilni arian suicidisken, wamal-
romelsac axasiTebs qcevis aSkarad gamoxatuli pa- damokidebulebisa da alkoholmoxmarebisaken;
Tologia fsiqikuri daavadebisa da inteleqtualuri
2. pasiuri da araadeqvaturi pirovnebebi, arastabi-
funqciis daqveiTebis gareSe. mogvianebiT, termini
luri, ipoqondriuli da sensitiuri pirovnebebis
arasrulfasovneba, Caanacvles sxva terminiT, raTa
CaTvliT, paTologiuri matyuarebi da Sizoiduri
gaeneitralebinaT SefasebiTi da kritikuli toni, ro-
bunebis mqone adamianebi;
melic sityva àrasrulfasovnebas~ axlavs Tan. Tavi-
3. kreatiuli fsiqopaTebi. es jgufi zedmetad farToa,
dan, krepelins ar hoqnda mkafio warmodgena imaze, Tu
ris gamoc is nakleb Rirebulia. hendersonma moitana
rogor moexdina am adamianebis klasifikacia. mxolod
mesame jgufSi Semavali adamianebis magaliTi. esenia
Tavisi saxelmZRvanelos merve gamocemaSi Semoitana man
t.e. lourensi da Jana d~arki. miuxedavad imisa, rom
termini `fsiqopaTiuri pirovneba~ da mas erTi vrceli
_ 139 _
orive maTgani kreatiuli pirovneba iyo, maT cota rodesac SemTxvevebis Seswavla xdeba an epidemio-
ram hqondaT saerTo. hendersonis wvlili, ZiriTa- logiuri kvlevis an klinikuri auditisTvis. Tumca,
dad, imaSi mdgomareobs, rom man yuradReba gaamax- SerCeuli kriteriumi, rogoricaa, sakuTari Tavis an
vila araadekvaturi pirovnebebis kategoriaze. sxvebis tanjva pirobiTi da arazustia. SemTxvevebi,
terminma `fsiqopaTiam~ axali mniSvneloba SeiZina romlebic am kategoriis miRma rCeba (qvezRurblovani
inglisisa da uelsis 1959 wlis fsiqikuri janmrT- SemTxvevebi) sakmaod xSiria da maTTvis igive klini-
elobis aqtSi. is igive mniSvnelobiT Sevida 1983 wlis kuri problemebia damaxasiaTebeli, rac gamoxatuli
aqtSi, sadac fsiqopaTuri aSliloba gansazRvru- aSlilobebis dros iCens Tavs.
lia 41(42) TavebSi, rogorc `fsiqikis persistentu-
komorbidoba
li aSliloba an darRveva (inteleqtis seriozuli
daqveiTebiT, an mis gareSe), rac Sedegad anomaliurad pirobiTi da arazustia gansxvaveba ara mxolod nor-
agresiul da upasuxismgeblo qcevas iwvevs.~ malur da anomaliur pirovnebas Soris, aramed sxva-
es definicia warmoadgens mobrunebas fsiqopaTiuri dasxva tipis pirovnebis aSlilobebs Sorisac. garda
pirovnebis viwro gansazRvrebisaken, romlis Tanax- amisa, mraval pacients axasiaTebs iseTi niSnebi, rom-
mad, pirovnebis agresiul da upasuxismgeblo qcevas lebic erTze meti pirovnuli aSlilobis kriteri-
moaqvs tanjva sxva adamianebisTvis. garda amisa, es umebs akmayofilebs (ix Fayer et al., 1988). termini ko-
definicia im SesaZleblobasac moicavs, rom tanjva, morbidoba maSin gamoiyeneba, rodesac erT pacients
SeiZleba, mxolod mocemul pirovnebas miadgebodes SegviZlia davusvaT erTze meti pirovnuli aSlilo-
xolme, ris gamoc is pirovnuli aSlilobis ufro bis diagnozi. es termini maSinac gamoiyeneba, rodesac
farTo diagnostikur speqtrs moicavs. mocemuli pacienti erTdroulad akmayofilebs, rogorc fsiqi-
aqti iTvaliswinebs mkurnalobis Catarebas (para- kuri aSlilobis, ise pirovnuli aSlilobis kriteri-
grafi 3 (2b)) iseT SemTxvveaSi `rodesac fsiqopaTiuri umebs. meore SemTxvevaSi iTvleba, rom saxezea ori
aSlilobis mkurnaloba amsubuqebs mdgomareobas an gansxvavebuli mdgomareobis erTdrouli arseboba,
xels uSlis mis gauaresebas~. xolo ori pirovnuli aSlilobis erTdrouli moce-
ar aris gasakviri, rom am definicias da mis dam- mulobisas igives ver vityviT aseTive damajereblo-
atebiT debulebas mravali sirTule ukavSirdeba. biT. am dros, rogorc Cans, pacients aqvs erTi pirov-
(mocemul saxelmZRvaneloze muSaobis periodSi mim- nuli aSliloba, romlis niSnebi erTdroulad akmayo-
dinareobs axali britanuli kanonmdeblobis ganxilva filebs ori rigis pirobiT kriteriumebs, romlebic
fsiqikuri janmrTelobis Sesaxeb). uaxlesi midgomaa arsebul diagnostikur sistemaSi gamoiyeneba.
iseTi terminis Semotana, rogoricaa saxifaTo da pirovnul aSlilobasTan dakavSirebuli mdgo-
mZime pirovnuli aSliloba. es termini, ZiriTadad, mareobebi, romlebic sxvaganac aris klasifici-
miuTiTebs antisocialuri aSlilobisa da Zalado- rebuli
brivi qcevis mqone mamakacebze da misi Semotanis
winaT, cikloTimia da Sizotipuri aSliloba klasifi-
mizani am populaciiT gamowveuli riskis Semcirebaa
cirebuli iyo, rogorc pirovnuli aSliloba, radgan
(Home Office, 1999). mocemul termins ufro politiku-
isini warmoadgens qcevis stabilur paternebs, rom-
ri datvirTva aqvs, vidre klinikuri da mecnieruli.
lebsac SeuZlia distresis gamowveva. ICD-10-Si orive
dRemde SemorCenilia fsiqopaTiuri pirovnebis ori
maTgani amoRebulia pirovnuli aSlilobis kategori-
gansazRvreba. farTo mniSvnelobiT is yvela saxis
idan da klasificirebulia fsiqikur aSlilobebTan
anomaliur pirovnebas moicavs, xolo viwro mniSvne-
erTad; cikloTimia afeqtur aSlilobasTan erTad,
lobiT _ antisocialur pirovnebas. radganac termini
xolo Sizotipuri aSliloba _ SizofreniasTan erTad.
fsiqopaTiuri pirovneba sakmaod bundovania, upira-
amgvari klasifikacia iTvaliswinebs im faqts, rom es
tesobas aniWeben terminebs pirovnuli aSliloba, ro-
ori mdgomareoba SeiZleba zrdasrul asakSi aRmocen-
melic definiciis farTo mniSvnelobas Seesabameba da
des (mas Semdeg, rac pirovneba savsebiT Camoyalibebu-
antisocialuri pirovnuli aSliloba, romelic defi-
lia). garda amisa, Sizotipuri aSlilobis SemTxvevaSi
niciis viwro mniSvnelobis Sesabamisia.
ojaxis gamokvlevebi gviCvenebs, rom is genetikurad
SizofreniasTan aris dakavSirebuli (gv. ??). DSM-IV-
anomaliuri pirovnebis klasifikacia
Si, cikloTimuri aSliloba klasificirebulia, ro-
zogadi sakiTxebi gorc guneb-ganwyobis aSliloba, xolo Sizotipuri
kategoriebis gamoyeneba aSliloba pirovnul aSlilobad aris kvalificire-
buli. orive klasifikaciaSi, mravlobiTi pirovnuli
pirovneba uwyveti cvladia, magram fsiqikuri aSli-
aSliloba klasificirebulia, rogorc disociaciuri
lobis klasifikaciis sistemebi iyeneben zRvruli
aSliloba (gv. ??).
mniSvnelobis kategoriebs. kategoriebi sasargebloa,
_ 140 _
pirovnuli aSliloba
pirovnuli aSlilobebis klasifikacia ICD-10-sa

cxrili 7.1 pirovnuli aSlilobebis klasifikacia
da DSM-IV-Si
ICD-10 DSM-IV
cxril 7-Si Sedarebulia pirovnuli aSlilobebis
klasifikacia ICD-10-sa da DSM-IV-Si. es ori sqe- paranoiduli paranoiduli
ma erTmaneTis msgavsia, Tumca maT Soris garkveuli Sizoiduri Sizoiduri
gansxvavebebic SeiniSneba.
Sizotipuri (ix. teqsti) Sizotipuri
II RerZis gamoyeneba disocialuri antisocialuri
DSM-IV-Si pirovnuli aSlilobebi da fsiqikuri aSli- emociurad arastabiluri: mosazRvre
lobebi sxvadasxva RerZzea klasificirebuli: pirov- impulsuri tipi
nuli aSlilobebi _ II RerZze, xolo fsiqikuri aSli- mosazRvre tipi
lobebi _ I RerZze. amgvari klasifikacia gulisxmobs,
isteriuli isteriuli
rom es ori diagnozi sxvadasxva bunebisaa da mkvle-
vars ubiZgebs pirovnuli aSlilobis dadgenisaken Ti- - narcisuli
Toeul SemTxvevaSi. ICD-10-Si gansxvavebuli midgomaa anankasturi (obsesiur- obsesiur-kompulsuri

gamoyenebuli. Tu ar dadginda pirovnuli aSlilobis kompulsuri)
arseboba, mainc unda moxdes normaluri pirovnebis SfoTviani (acilebadi) acilebadi
gamokvleva zemoTxsenebuli mizezebis gamo, xolo ga-
sxvaze damokidebuli sxvaze damokidebuli
mokvlevis Sedegebi unda iyos Setanili formulire-
baSi, miuxedavad imisa, rom isini ar iqneba diagnozSi - pasiur-agresiuli
gaTvaliswinebuli.
Setanilia DSM-IV-Si, magram ara ICD-10-Si
klasterebad dajgufeba w narcisuli pirovnuli aSliloba;
DSM-IV-Si (magram ara ICD-10-Si) pirovnuli aSlilo- w pasiur-agresiuli pirovnuli aSliloba (Setanilia,
bebi sam klasteradaa dajgufebuli: rogorc kategoria, romelic Semdgom Seswavlas
1. A klasteri _ paranoiduli, Sizoiduri, Sizoti- saWiroebs).
puri;
mdgomareobebi, romlebic gansxvavebulad aris
2. B klasteri _ antisocialuri, mosazRvre, isteriu-
klasificirebuli ICD-10-sa da DSM-IV-Si
li, narcisuli;
rogorc zemoTY aRvniSneT, Sizotipuri pirovnuli
3. C klasteri _ acilebadi, damokidebuli, obsesiur-
aSliloba klasificirebulia ICD-10-Si Sizofre
kompulsuri.
niasTan erTad da mas Sizotipuri aSliloba ewodeba.
mocemuli Tavis struqtura swored amgvar katego- DSM-IV-Si is klasificirebulia, rogorc pirovnuli
rizacias eyrdnoba. aSliloba.
erTi da igive pirovnuli aSlilobis gansxvavebu-

aRwera da diagnostikuri kriteriumebi
li saxelwodeba
am nawilSi aRwerilia anomaliuri pirovnebis tipebi,
w pirovnuli aSliloba, romlis mimarTac ICD-10-
romlebic ICD-10-sa da DSM-IV-Si aris Setanili (ix.
Si gamoiyeneba, termini disocialuri, DSM-IV-Si
cxrili 7.1). diagnostikuri kriteriumebi vrcelia
antisocialuris saxeliTaa cnobili;
da gansxvavdeba formulirebis TvalsazrisiT. garda
amisa, am or sisitemaSi isini erTi da igive aSlilobis
Si gamoiyeneba termini anankasturi, DSM-IV-Si Se
sxvadasxva aspeqtze amaxvilebs yuradRebas. qvemoT
sulia, rogorc obsesiur-kompulsuri aSliloba;
motanili aRwera exeba definiciaTa ori rigis saerTo
niSnebs. sadac ki es SesaZlebelia, kriteriumebi
Si gamoiyeneba termini SfoTviani, DSM-IV-Si mox
gamartivebuli saxiT aris warmodgenili, raTa
seniebulia, rogorc acilebadi.
mogawodoT ama Tu im pirovnuli aSlilobis ufro
Setanilia ICD-10-Si, magram ara DSM-IV-Si zogadi aRwera.
orive SemTxvevaSi arsebuli mdgomareoba unda
w emociurad arastabiluri impulsuri pirovnuli
pasuxobdes pirovnuli aSlilobis zogad kriteriumebs.
aSliloba;
aseTi zogadi kriteriumebis gansazRvris mizniT ICD-
w persistentuli pirovnuli cvlileba, romelic ar
10-is kriteriumebi Semdegi saxiTaa Sejamebuli:
miewereba Tavis tvinis disfunqcias an dazianebas
(ix. zemoT). w pirovnebis maxasiaTeblebi da qcevis stabiluri pa
_ 141 _
ternebi aSkarad gadaxrilia kulturuli normebidan.
garda amisa, amgvari deviaciebi aRiniSneba erTze met
cxrili 7.2 paranoiduli pirovnuli
aSlilobis niSnebi
kognitur sferoSi (mag. damokidebulebebi, aRqmisa
da interpretaciis stili), afeqtur sferoSi, im eWviania
pulsebis marTvisa da dakmayofilebis sferoSi da undoblobas iCens sxvebis mimarT
sxvebTan urTierTobebSi;
Suriania
w deviacia ar aris lokalizebuli; qceva _ mraval
sensitiuria
situaciaSi mouqneli, araadapturi da disfunqciu-
ria; aRSfoTebulia
w pirovnebas aReniSneba distresi an is garSemomyof gulRvarZliania

adamianebze uaryofiTad moqmedebs; sakuTari Tavi mniSvnelovan adamianad miaCnia
w deviacia, Cveulebriv, stabiluri da xangrZlivia.
is bavSvobis asakis miwuruls an mozardobis asakSi kreCmerma aRwera, Tu rogor iwvevs aseTi adamianebis
vlindeba; sensitiuroba damcirebasTan da eWvTan dakavSirebul
azrebs, romlebic imdenad Zlieria, rom devnis
w deviaciuri qceva ar aris gamowveuli sxva fsiqi-
bodvaSic ki SeiZleba agverios. es `sensitiurobis
kuri aSlilobiT;
ideebis damokidebulebis bodva~ me-13 TavSia gan
w deviaciuri qceva ar aris gamowveuli Tavis tvinis xiluli. garda amisa, aseTi adamianebi xSirad gamo
dazianebiT, daavadebiT an disfuqnciiT. xataven aRSfoTebas da boRmianebi (gulRrZoni) arian.
arsebobs ramdenime diagnostikuri instrumenti (ix. isini arasodes patioben sxvas wyenas, romelic an
mocemuli Tavis danarTi; gv. ??). es instrumentebi realuria an kidev maT mier aseTad aris aRqmuli.
Zalian sasargebloa kvlevis Catarebisas, magram maT maT aqvT sakuTari uflebebis gazviadebuli gancda.
SedarebiT naklebi klinikuri Rirebuleba gaaCniaT. xSirad Civian sasamarTloSi da daJinebiT cdiloben
moigon procesi, rasac, SeiZleba, wlebi dauTmon.
A klasteri
maT adgilas, sxvebi didi xnis win daanebebdnen Tavs
paranoiduli pirovnuli aSliloba saasamarTloSi davas.
am tipis pirovnuli aSlilobis adamiani eWviani da paranoidul pirovnebebs aqvT sakuTari Tavis mni
sensitiuria (ix, cxrili 7.2.). isini sakuTar Tavs Svnelovnebis SegrZnebis gamZafrebuli gancda. maT
Zalian mniSvnelovnad ganicdian, magram Zalian sjeraT, rom Zalian niWierebi arian da SeuZliaT
advilad euflebaT sircxvilis da damcirebis gancda. saocrad maRali miRwevebi hqondeT cxovrebaSi. es
isini eWvianebi arian, ris gamoc maTi yuradReba ararealisturi warmodgena ar icvleba umniSvnelo
mudmivad mimarTulia imaze, rom sxvebma ar moatyuon. miRwevebis miuxedavad. aseTi rwmenis SenarCuneba
amis Sedegad, sxvebi maT `rTul, mZime~ adamianebad maTTan imis gamoa SesaZlebeli, rom maTi azriT, sxva
Tvlian da miaCniaT, rom maTi qceva ar aris saRi azriT adamianebi xels uSlian sakuTari potenciis srulad
warmarTuli. aseT adamianebs undobloba axasiaTebT. ganxorcielebaSi.
maT eWvi SeaqvT adamianebis erTgulebaSi da amitom ar
endobian maT. xSirad axasiaTebT eWvianoba seqsualur Sizoiduri pirovnuli aSliloba
niadagze. isini advilad ar iCenen megobrebs da termini `Sizoiduri pirovnuli aSliloba~ kreCmers
naklebad erTiandebian sxvadasxva saxis jgufebSi. ekuTvnis (Krechmer, 1936). is Tvlida, rom am tipis pi-
maT zedmetad uyvarT yvelafris gasaidumloeba, rovnuli konstitucia SizofreniasTan aris dakavSi-
arapirdapiri da TviTkmayofilni arian. maT advilad rebuli, magram misi es mosazreba SemdgomSi ar dadas-
wyinT da xSirad ise aRiqvamen sxvis qcevas, TiTqos turda (Tavi 12). am tipis aSlilobis mqone adamianebi
sxvebi civad da uxeSad icileben maT. rodesac emoiciurad civi, ganze mdgomi da distancirebulia.
paranoiduli pirovnuli aSlilobis mqone pirebs maT naklebad aqvT ganviTrebuli iumoris grZnoba da
raimes sTavazoben, isini, pirvel rigSi, iwyeben imaze introspeqciisaken da fantaziisaken arian midrekilni
fiqrs, Tu ra saxiT SeiZleba am SemoTavazebam avnos (cxrili 7.3.).
maT interesebs. isini civi adamianebi arian. maT ar SeuZliaT nazi
aseTi adamianebi sensitiurebi (mgrZnobiareni) grZnobebisa da brazis gamoxatva. naklebad aintere-
arian civi mopyrobis mimarT. maTTan urTierToba sebT seqsualuri urTierToba. rodesac aSliloba
arakomfortulia; xSirad gadadian Cxubsa da kamaTze; ukiduresad intensiuria, isini ugrZnobi da civi ada-
iseT komentarebSic ki, romlebic sruliad uwyinaria, mianebis STabeWdilebas toveben. isini distanciurni
damamcirebel da muqaris Semcvel Sinaarss deben. arian da naklebad ainteresebT sxva adamianebis azri.
_ 142 _
pirovnuli aSliloba
cxrili 7.3 Sizoiduri pirovnuli aSlilobis cxrili 7.4 antisocialuri pirovnuli

niSnebi aSlilobis niSnebi
emoiciurad civi ugrZnobia
indiferentuli amyarebs droebiT urTierTobebs
distanciuri upasuxismgebloa
uWirs siamovnebis miReba impulsuria da advilad Riziandeba
introspeqtuli ar axasiaTebs danaSaulisa da sinanulis gancda
uWirs pasuxismgeblobis aReba

sazogadoebaSi yofnisas cudad grZnoben Tavs, ar
Sedian axlo kontaqtSi; ojaxuri cxovreba maTTvis ar isini ucnaurad icvamen, ar icaven qcevis normebs da
aris kmayofilebis momtani. maT uyvarT ganmartoeba, ucnauri socialuri qceva axasiaTebT.
marto mihyvebian cxovrebis gzas da iSviaTad qmnian
ojaxs. maT uWirT cxovrebisgan siamovnebis miReba, B klasteris pirovnuli aSlilobebi
naklebad axasiaTebT iumoris grZnoba da ver iReben antisocialuri (disocialuri) pirovnuli aSli-
siamovnebas iseTi aqtivobebisgan, romlebic adamianTa loba
umravlesobisTvis siamovnebis momtania. am Tvisebebis
termini àntisocialuri~ gamoiyeneba DSM-IV-Si,
gamo isini kidev ufro Sordebian garSemo myofT.
xolo termini `disocialuri~ _ ICD-10-Si. am wignSi,
aseTi adamianebi midrekilni arian introspeqciisa
upiratesoba eniWeba termins àntisocialuri~. am aS-
da fantaziisaken. ufro metad ainteresebT inteleq-
lilobis mqone adamianebs naklebad anaRvlebT sxve-
tualuri Temebi, vidre adamianebi. aqvT warmosaxvis
bis gancdebi da ugrZnobni arian maT mimarT. isini ar
rTuli Sinagani samyaro, magram emociebisgan daclili.
iTvaliswineben sxvebis uflebebs, iqcevian impulsu-
Sizotipuri pirovnuli aSliloba rad da ar axasiaTebT danaSaulis gancda, xolo ua-
ryofiTi gamocdileba maT arafers aswavlis (cxrili
Sizotipuri pirovnuli aSlilobis mqone adamianebs
7.4). xSirad maTi anomaliuri qceva alkoholisa da
axasiaTebT socialuri SfoTva. maTi kogniciebi
narkotikebis zemoqmedebiTaa damZimebuli. 1941 wels,
da percepcia darRveulia, metyveleba ucnauri,
kleklim safuZvlianad aRwera es aSliloba Tavis naS-
xolo afeqturi reaqciebi _ Seusabamo. maTi qceva
romSi (Cleklley, The mask of insanity, 1964).
eqscentrulia. rogorc Cans, mocemuli pirovnuli
am or klasifikaciaSi odnav gansxvavebuli diag-
aSliloba SizofreniasTan aris dakavSirebuli. ICD-
nostikuri kriteriumebia gamoyenebuli. qvemoT mot-
10-Si (magram ara DSM-IV-Si) is ar aris klasificire-
anili aRwera ICD-10-Si gamoyenebul aRweras Seesabam-
buli, rogorc pirovnuli aSliloba. is kategorize-
eba. DSM-IV-is kriteriumebis mixedviT, pirovnebas 15
bulia SizofreniasTan erTad da klasifikaciaSi
wlamde asakSi qceviTi aSliloba unda axasiaTebdes.
Sizotipuri aSlilobis saxeliT aris Setanili.
aseTi aSlilobis mqone adamianebi sxvebis mimarT
am tipis adamianebs socialuri SfoTva axasiaTebT.
gulqva da gulgrilebi arian. maTi seqsualuri aq-
isini sazogadoebaSi yofnisas SfoTvas ganicdian,
tivoba daclilia nazi grZnobebisgan. isini SeiZleba
ris gamoc maT uWirT urTierTobebis damyareba da
sastikad da damamcireblad eqceodnen sxva adaminebs,
cota megobari hyavT. isini Tavs sxvebisgan gansxvave-
seqsualuri partniorebisa da bavSvebis CaTvliT,
bulad ganicdian da Znelad ergebian maT. kognituri
da maTze seqsualur da fizikur Zaladobas axor-
darRvevebi moicavs damokidebulebisa da eWvianobis
cielebdnen. maTi urTierTobebi zedapiruli da xan-
ideebs (magram ara bodvas), ucnauri da fantastikuri
moklea, miuxedavad imisa, rom maT zedapiruli xibli
Sinaarsis azrebs (mag., naTelmxilveloba, telepatia
axasiaTebT. es adamianebi upasuxismgebloni arian da
da sxvaTa azrebis kiTxva). aseT adamianebs axasiaTebT
ar icaven socialur normebs. isini ar eqvemdebarebian
uCveulo perceptualuri gamocdileba (mag., viRacis
sazogadoebrivi cxovrebis wesebs da SeiZleba regu-
arseboba an halucinaciismagvari gancdebi), . aseT
larulad arRvevdnen kanons da xSirad seriozul
pirebs aReniSnebaT ucnauri metyveleba (uCveulo
kanondarRvevas axorcieleben. maTi arakanonieri qce-
enobrivi konstruqciebi, sityvebi da frazebi, bun-
va, Cveulebriv, mozardobis asakSi iwyeba.
dovani metyveleba da mTavari Temidan gadaxveva).
aseTi adamianebi impulsurebi arian. isini ar isax-
aseTi pirebis afeqturi reaqciebi uCveuloa. isini
aven miznebs, winaswar arafers gegmaven, Cveulebriv
xisti, ucnauri adamianebis STabeWdilebas stoveben,
aqvT arastabiluri samuSao da xSirad acdenen mas.
romlebsac Raribi emociuri sfero aqvT. maTi qceva
isini midian riskze, ar iTvaliswineben sakuTar an sx-
eqscentrulia da ucnauri manerizmiT xasiaTdeba.
vaTa usafrTxoebas. advilad brazdebian da Riziande-
_ 143 _
bian da Seuracxofas ayeneben sxvebs. am Tvisebebs Tan nakleb `mowifuli~ dacviTi meqanizmebis gamoyeneba,
axlavs is, rom isini iSviaTad ganicdian sinanulsa da rogoric proeqcia da uaryofaa; (4) difuzuri pi
danaSauls da ver cvlian sakuTar qcevas dasjis an rovnuli identoba.
raime uaryofiTi Sedegebis sapasuxod. isini icile- rodesac am tipis pirovnuli aSliloba Seitanes
ben pasuxismgeblobas, mimarTaven gadabralebas da klasifikaciis sistemebSi, SemuSavda ufro obieqturi
axdenen sakuTari marcxis racionalizacias. garda kriteriumebi, magram ufro rTuli gaxda misi
amisa, isini upatiosno da upasuxismgebloni arian fi- ZiriTadi niSnebis gamoyofa. garda amisa, DSM IV da
nansur sakiTxebSi. ICD 10 klasifikaciebSi maT gansxvavebuli saxeli
mieniWaT: mosazRvre pirovnuli aSliloba DSM-IV-Si
mosazRvre pirovnuli aSliloba da emociurad arastabiluri pirovnuli aSliloba
termini `mosazRvre pirovnuli aSliloba~ Tavidan ICD-10-Si. es ukanaskneli iyofa mosazRvre tipad da
aSkarad arastabiluri adamianebis aRsawerad impulsur tipad. DSM-IV-Si mosazRvre pirovnuli
gamoiyeneboda. amgvar arastabilurobas pirvelad aSliloba cxra niSniT xasiaTdeba, saidanac, sul
aRwerdnen fsiqodinamiuri cnebebis gamoyenebiT. cota, xuTi niSnis arsebobaa aucilebeli DSM-IV-is
amis magaliTia kernbergiseuli aRwera (Kernberg, mixedviT diagnozis dasasmelad. ICD-10-Si TiToeul
1975), romelic iyenebda terminebs (1) egos sisuste qvetips xuTi kriteriumi aqvs. pirovnebis mosazRvre
impulsebis cud kontrolTan erTad; (2) azrovneba tipis aSlilobis diagnozisTvis maTgan, sul cota,
`pirveladi procesebis~ doneze (anu iracionaluri oTxis arsebobaa savaldebulo. es kriteriumebi 7.5
azrovneba) realobis testirebis miuxedavad; (3) iseTi cxrilSi Semajamebeli terminebiT aris mocemuli
da ar warmoadgens gamoqveynebuli kriteriumebis
cxrili 7.5 emociurad arastabiluri sityvasityviT citirebas. cxrili 7.5. aCvenebs,
da mosazRvre pirovnuli aSlilobis rom DSM-IV-is mosazRvre pirovnuli aSlilobis
kriteriumebis Semoklebuli versia
kriteriumebs Soris ramdenime ICD-10-is impulsuri
ICD-10 DSM-IV tipis kriteriumic aris Sesuli.
emociurad arastabiluri mosazRvre pirovnuli mosazRvre pirovnuli aSlilobis gansazRvris am
pirovnuli aSliloba, aSliloba mcdelobebis miuxedavad, ar aris naTeli, arsebobs
mosazRvre tipi Tu ara igi, rogorc calke mdgomi mocemuloba.
mravali adamiani, romelic akmayofilebs mosazRvre
darRveuli an bundovani identobis darRveva
me-s xati pirovnuli aSlilobis DSM-IV-is kriteriumebs, ag
reTve akmayofilebs isteriuli, narcisuli da an
intensiuri da intensiuri da
tisocialuri pirovnuli aSlilobis kriteriumebs
arastabiluri arastabiluri
(Skodal, 2002a).
urTierTobebi urTierTobebi
Zalisxmeva, rom ar iyos Zalisxmeva, rom ar iyos impulsuri pirovnuli aSliloba

sxvebisgan mitovebuli sxvebisgan mitovebuli rogorc zemoT iTqva, es aSliloba ICD-10-Si
ganmeorebiTi muqara an ganmeorebiTi muqara an Setanilia, rogorc emociurad labiluri pirovnuli
TviTdazianebis aqtebi TviTdazianebis aqtebi aSlilobis tipi. is ar aris calke Setanili DSM-IV-
sicarielis mudmivi gancda sicarielis mudmivi Si, Tumca misi ramdenime niSani mosazRvre pirovnuli
gancda aSlilobis kriteriumebSia Setanili. diagnostikuri
kriteriumebi naCvenebia cxrilSi 7.5. diagnozis
- gardamavali stresTan
dasasmelad minimum sami kriteriumi unda iyos
dakavSirebuli
dakmayofilebuli. impulsuri pirovnuli aSlilobis
paranoiduli azrebi
mqone adamianebs ar SeuZliaT sakmarisi xarisxiT
impulsuri tipi sakuTari emociebis marTva. isini midrekilni arian
impulsuri impulsuri ucabedi, Seukavebeli sibrazis Semotevebisaken, rasac
mogvianebiT nanoben. amgvari afeTqebebi yovelTvis
midrekilia sibrazisa da uWirs brazis kontroli
sityvieri agresiiT ar ifargleba da SeiZleba
Zaladobisaken
moicavdes fizikur Zaladobas, romelsac droebiTi
arastabiluri, Wirveuli afeqturi arastabiluroba
seriozuli ziani moaqvs. antisocialuri pirovnuli
ganwyoba
aSlilobis mqone adamianebisgan gansxvavebiT,
maCxubara - romelTaTvisac aseve tipiuria brazis Setevebi,
uWirs moqmedebis kursis - impulsuri aSlilobis mqone adamianebs ar axasiaTebT
SenarCuneba sirTuleebi urTierTobebSi.
_ 144 _
pirovnuli aSliloba
isteriuli pirovnuli aSliloba fizikur mimzidvelobas. sxvebze zemoqmedebis mizniT,

Tumca isteriuli pirovnuli aSliloba Setanilia, isini did drosa da fuls uTmoben tansacmlis SeZenas,
rogorc ICD-10, ise DSM-IV klasifikaciaSi, am ori sakuTari Tavis movlas. isini zedmetad mZimed ganicdian
klasifikaciis mier gamoyenebuli kriteriumebi umniSvnelo kritikasac ki maTi garegnobis Taobaze.
erTgvarad urTierTgansxvavebulia. cxril 7.6- garda im Tvisebebisa, romlebic diagnostikur
Si naCvenebia is niSnebi, romlebic ICD-10-Si di kriterumebad gamoiyeneba, isteriul pirovnul aS
agnostikur kriteriumebad gamoiyeneba, amave dros, lilobas axasiaTebs kidev ori niSani, romelic
aq, agreTve, mocemulia is kriteriumebi, romlebic imsaxurebs yuradRebas. isteriuli pirovnuli aS
gansxvavebulia am or klasifikaciaSi. lilobis mqone adamianebi egocentrulni arian.
TviTdramatizacia am aSlilobis yvelaze TvalSi maT naklebad anaRvlebT sxva adamianebi da sakuTar
sacemi niSania. man SeiZleba SeiZinos emociuri interesebsa da siamovnebas upirveles mniSvnelobas
`SantaJis~ forma. pirovneba, SeiZleba, risxvisa da aniWeben. isini pativmoyvareni da momTxovni arian.
TviTmkvlelobis demonstrirebis scenebs awyobdes. naklebad iTvaliswineben sxva adamianebs. Zalian
aseTi adamianebi sugestiurni arian da advilad cdiloben, rom adamianebi iZulebiT sakuTar sur
eqcevian sxvaTa (gansakuTrebiT avtoritetuli vilebs moargon. garda amisa, maT aqvT sakuTari Tavis
figurebis) gavlenis qveS. isini ahyvebian xolme motyuebis unari. sjeraT Tavis mier naTqvami tyuilis,
sxvaTa Sexedulebebsa da gemovnebas da cdiloben rogori ararealuri da daujerebelic ar unda iyos
ar CamorCnen modas. isini eZieben yuradRebasa da is, maSinac ki, rodesac sxvebi kargad xedavan mas.
amaRelvebel gamocdilebas. maT swyuriaT axali qcevis aseTi paterni yvelaze mkafiod aRiniSneba
gamocdileba, advilad bezrdebaT xolme da xanmokle `paTologiuri matyuarebisa~ da TaRliTebis umrav
enTuziazmi axasiaTebT. lesobis SemTxvevaSi.
aseTi adamianebi zedapiruli da labiluri emociebiT radganac zogierTi zemoTxsenebuli Tviseba
gamoirCevian. isini dramatuli saxiT gamoxataven bavSvebis normaluri maxasiaTebelia (mag., droebiTi
emociebs da SeiZleba qanci gamoacalon garSemomyofT enTuziazmi, warmosaxulis dajereba da sxvisTvis misi
risxvis SetevebiTa da sasowarkveTilebis ukontrolo realuri faqtebis saxiT miwodeba), zogi fsiqiatri
gamoxatviT. emociebis aseTi mozRvaveba zedapirulia isteriuli pirvnuli aSlilobis mqone adamianebis
da pirovneba swrafad gamodis am mdgomareobidan. mimarT iyenebs termins ùmwifari~. Cveni azriT, unda
mas ukvirs, rom garSemo myofT ise advilad ar veridoT aseTi terminebis gamoyenebas, radganac isini
aviwydebaT es scenebi, rogorc Tavad mas. maT arazusti da damamcirebelia.
axasiaTebT keklucoba da cdiloben moxiblon
narcisuli pirovnuli aSliloba
sxvebi sruliad uadgilo viTarebaSi, magram maTi
es pirovnuli aSliloba mocemulia DSM IV-Si da ara
seqsualuri gancdebi, iseve rogorc sxva emociebi,
ICD-10-Si, sadac is warmodgenilia, rogorc erT-erTi
zedapirulia. maT, SeiZleba, ver miaRwion orgazms
aSliloba, romelic Setanilia narCen kategoriaSi
vnebis demonstrirebis miuxedavad.
`sxva specifikuri pirovnuli aSlilobebi~. DSM IV-is
aseTi adamianebi zedmetad did mniSvnelobas aniWeben
kriteriumebis perifrazi dajamebulia cxrilSi 7.7.
cxrili 7.6 isteriuli pirovnuli aSlilobis

niSnebi cxrili 7. 7 narcisuli pirovnuli aSlilobis
TviTdramatizacia niSnebi
sugestiuroba sakuTari grandiozulobisa da mniSvnelovnebis gancda
zedapiruli, labiluri afeqti fantaziebi sakuTari ganuzomeli warmatebisa da

Zalauflebis Sesaxeb da sxva
iTxovs yuradRebas da eZebs amaRelvebel gamocdilebas
gansakuTrebulobis SegrZneba
cdilobs moxiblos sxvebi uadgilo viTarebaSi
moiTxovs gansakuTrebul aRfrTovanebas
zedmetad did mniSvnelobas aniWebs fizikur
mimzidvelobas Tvlis, rom imsaxurebs gansakuTrebul privilegiebs da
rom sxvebi mas survilebs unda usrulebdnen
SeniSvna: DSM IV-Si gamoiyeneba ori damatebiTi
kriteriumi: eqspluatacias uwevs sxvebs
aklia empaTia
w metyveleba zedmetad impresiulia
Suriania; sjera, rom sxvebs SurT misi
w urTierTobas aRiqvams, rogorc ufro intimurs,
vidre is sinamdvileSia qedmaRalia
_ 145 _
am tipis adamianebs aRmatebuli warmodgena aqvT sa- zRudavs sircxvilisa da dacinvis SiSi. Sizoiduri
kuTar Tavze; isini mkvexara da pretenziulebi arian. pirovnebis mqone adamianebisgan gansxvavebiT, isini ar
isini mudmivad dakavebulni arian fantaziiT sakuTari arian emociurad civi. maT namdvilad didi survili
ganuzomeli warmatebis, Zalauflebisa da inteleq- aqvT daamyaron socialuri urTierTobebi, magram ver
tualuri brwyinvalebis Sesaxeb. isini Tvlian, rom axerxeben amis ganxorcielebas.
gansakuTrebulni arian, ris gamoc sxvebisgan elian
Tayvaniscemas da gansakuTrebul priviliegiebs. isini sxvaze damokidebulebis pirovnuli aSliloba
Tvlian, rom saukeTesos Rirsni arian da cdiloben cxrili 7.9. gviCvenebs, rom diagnostikur kriteri-
maRali statusis mqone adamianebTan dakavSirebas. isi- umebSi gamoyenebuli niSnebi DSM-IV-sa da ICD-10-Si
ni eqspluatacias uweven adamianebs da naklebad ain- odnav gansxvavebulia. am aSlilobis mqone adamianebi
teresebT maTi gancdebi. maT SurT sxvebis qonebisa da nebas rTaven sxvebs maT nacvlad aiRon pasuxismge-
miRwevebis da fiqroben, rom sxvebsac SurT maTi. isini bloba TavianTi cxovrebis mniSvnelovan gadawyveti-
qedmaRalni arian da sxvebs zevidan qveviT uyureben. lebebze. maT susti neba aqvT da zedmetad damyol-
ni arian. isini pirdapir moTxovnebs ar uyeneben sxva
C klasteris pirovnuli aSlilobebi adamianebs, magram amas arapirdapiri gziT akeTeben,
acilebadacilebadi pirovnebis (SfoTviTi) aSli- radgan iseT STabeWdilebas toveben, rom ar SeuZliaT
loba mouaron sakuTar Tavs. maT akliaT energia da Zala
da grZnoben, rom ar SeuZliaT mouaron sakuTar Tavs;
DSM-IV-Si termini àcilebadi~ am tipis pirovnuli
amavdroulad eSiniaT, rom amis gakeTeba mouwevT. maT
aSlilobis aRsawerad gamoiyeneba. ICD-10-Si upirate-
akliaT sakuTari Zalebis rwmena, eridebian pasuxism-
soba eniWeba termins `SfoTviani pirovneba~, xolo
geblobas da sWirdebaT aqtiuri daxmareba gadawyve-
termini àcilebadi~ mis erT-erT alternativas war-
tilebis miRebisas; xSirad ekiTxebian sxvas rCevas da
moadgens. rogorc cxrili 7.8 gviCvenebs, am or kla-
elian sxvisgan dasturis miRebas.
sifikaciaSi odnav gansxvavebuli niSnebi gamoiyeneba.
Tu aseTi aSlilobis mqone adamianebi daqorwine-
midrekileba daZabulobisaken kriteriumad mxolod
bulni arian, maTi pirovnuli TvisebebiT gamowveuli
ICD-10-Sia Setanili.
efeqtebi SeiZleba gawonaswordes ufro energiuli da
mocemuli aSlilobis mqone adamianebi mudmiv daZ-
gadawyvetilebis unaris mqone meuRlis mier, romels-
abulobas ganicdian. isini Tavs daucvelad grZnoben
ac surs gadawyvetilebebis miReba da aqtiuri pirov-
da dabali TviTSefaseba aqvT. isini Tavs ganicdian
nebaa. aseTi adamianebis sirTuleebi maSin gadaiqceva
socialurad arasrulyofilad, aramimzidvelad da
samedicino problemad, rodesac meuRle maT gverdiT
uunarod. maT mudmivad awuxebT is, rom SeiZleba
aRar imyofeba. sakuTari Tavis amara darCenili, zogi
sxvebis mier iyvnen uaryofilni da gakritikebulni;
maTgani warumatebeli xdeba sazogadoebriv cxovreba-
wuxan, rom SeiZleba Sercxvnen da sxvebma dascinon
Si, kargavs samuSaos da, zogjer, saxl-karsac ki. war-
maT. isini sifrTxiliT ekidebian axal gamocdilebas
sulSi aseTi tipis adamians asTeniur, araTviTkmars
da eridebian axali kontaqtebis damayarebas. isini
da pasiurs uwodebdnen.
eridebian risks, sazogadoebaSi yofnisas uxerxulad
grZnoben Tavs da ar monawileoben socialur aqtivo-
baSi. hyavT cota axlo megobari, axal intimur situa- cxrili 7.9 sxvaze damokidebulebis
ciebSi SeboWilni arian da maT intimur urTierTobas pirovnuli aSlilobis niSnebi
nebas rTavs sxvebs aiRon pasuxismgebloba
cxrili 7.8 acilebadi (SfoTviani) pirovnuli zedmetad damyolia

aSlilobis niSnebi ar surs gonivruli moTxovnebi wauyenos sxva
daZabulobis gancda * adamianebs*
Tavs socialurad arasrulyofilad ganicdis grZnobs, rom ar SeuZlia mouaros sakuTar Tavs
mudmivad awuxebs imis SiSi, rom uaryofili iqneba
eSinia, rom marto darCeba da Tavad mouwevs sakuTar
sxvebis mier
Tavze zrunva
erideba urTierTobebSi Sesvlas
erideba risks sWirdeba aqtiuri daxmareba gadawyvetilebis miRebis
erideba socialur aqtivobas dros
SeniSvna: DSM-IV Seicavs or damatebiT kriteriums: SeniSvna: DSM-IV Seicavs sam damatebiT kriteriums:
w SeboWilia intimur urTierTobaSi, radgan eSinia, rom w uWirs proeqtebis dawyeba
Searcxvenen da dascineben
w Zalian cdilobs mxardaWeris mopovebas
w SeboWilia axal intimur situaciebSi ukmarisobis
grZnobis gamo w mouTmenlad eZebs mxrdamWer urTierTobebs
*ar warmoadgens DSM-IV-is kriteriums *ar warmoadgens DSM-IV-is kriteriums
_ 146 _
pirovnuli aSliloba
moirCevian da ar uyvarT saCuqrebis miReba da gacema;
cxrili 7.10 obsesiur-kompulsuri ar uyvarT nivTebis gadagdeba da zogjer nivTebsa da
(anankasturi)
fuls imarageben xolme.
pirovnuli aSlilobis niSnebi isini pedanturebi arian da did mniSvnelobas aniWe-
zedmetad did yuradRebas uTmobs detalebsa da wesebs ben socialur normebsa da pirobiTobebs; zedmetad
frTxilebi arian da axasiaTebT orWofoba; uWirT ga-
amuxruWebs perfeqcionizmi
dawyvetilebis miReba; uWirT situaciis dadebiTi da
zedmetad keTilsindisieria da skrupulozuri uaryofiTi mxareebis awona; gvian iReben gadawyveti-
zedmetad did mniSvnelobas aniWebs produqtiulobas lebebs da xSirad iTxoven rCevas; eSiniaT Secdomebis
daSvebis da gadawyvetilebis miRebis Semdeg wuxan ima-
xistia da jiuti
ze, xom ar miiRes mcdari gadawyvetileba.
surs, rom sxvebic emorCilebodnen mis wesebs am tipis pirovnebas axasiaTebs kidev ori mniSvne-
zedmetad pedanturia da did mniSvnelobas aniWebs lovani Tviseba, romelic ar warmoadgens diagnosti-
socialur normebsa da pirobiTobebs* kur kriteriums. erTia mgrZnobeloba kritikis mi-
zedmetad frTxilia da axasiaTebs orWofoba* marT, rac gamoixateba imaSi, rom maT zedmetad mniSv-
nelovnad miaCniaT sxvisi azri da elian, rom Zalian
SeniSvna: DSM-IV Seicavs or damatebiT kriteriums:
mkacrad iqnebian gakritikebulebi. aseTi adamianebi
w uWirs Zveli da gamousadegari nivTebis gadagdeba naklebad amJRavneben emociebs. meorea gamouxatavi
w axasiaTebT siZunwe; agrovebs fuls brazisa da aRSfoTebis gancda. is xSirad mimarTulia
im adamianebze, romlebic xels uSlian maT rutinul
*ar Sedis DSM-IV-is krteriumebSi
cxovrebas. aseT gancdas SeiZleba Tan axldes agre-
siuli Sinaarsis azrebi da warmodgenebi.
obsesiur -kompulsuri pirovnuli aSliloba
termini obsesiur-kompulsuri pirovnuli aSliloba pasiur-agresiuli pirovnuli aSliloba
DSM-IV-Si gamoiyeneba. ICD-10-Si gamoiyeneba termini es termini miesadageba pirovnebas, romelic pasiuri
anankasturi aSliloba (am terminis avtoria Kahn, 1928), winaaRmdegobis reaqcias iZleva mis mimarT wayenebul
rac xazs usvams imas, rom am tipis pirovnuli Tvise- moTxovnaze qcevis adekvaturobasTan dakavSirebiT.
bebi ar aris uSualod obsesiur-ompulsur aSlilo- aseTi reaqciebi gamoixateba gasakeTebeli saqmis ga-
basTan dakavSirebuli (gv. ??). cxrili 7.10 gviCvenebs, dadebaSi, drois flangvaSi, sijiuteSi, saqmis ganzrax
rom DSM-IV-sa da ICD-10-Si diagnostikur kriteriume- uxarisxod SesrulebaSi, ganzrax gulmaviwyobaSi da
bad odnav gansxvavebuli niSnebia gamoyenebuli. Tanamdebobis pirebis usafuZvlo kritikaSi. es kat-
am aSlilobis mqone adamianebi zedmetad did yur- egoria ar aris Setanili DSM-IV-sa da ICD-10-Si, ro-
adRebas uTmoben detalebsa da wesebs, wesrigsa da gorc erT-erTi tipis pirovnuli aSliloba.
gegmebs. maT axasiaTebT damamuxruWebeli perfeq-
cionizmi, rac Cveulebriv samuSaos tvirTad aqcevs. afeqturi pirovnuli aSliloba
muSaobis procesSi pirovnebis azrovneba trivialu- zog adamians aReniSneba guneb-ganwyobis regulaciis
ri detalebiT aris warmarTuli. mas aklia warmosax- aSliloba mTeli cxovrebis manZilze. isini mudmivad
va da ver axerxebs Sansebis gamoyenebas. aqvs maRali mZime gunebaze arian (depresiuli pirovnuli aSlilo-
moraluri standartebi, rac gamoixateba Warb keTil- ba) an araadekvaturad aweul mdgomareobaSi imyofebi-
sindisierebasa da skrupulozurobaSi da SefasebiT an (hiperTimiuli pirovnuli aSliloba). mesame jgufi
damokidebulebaSi movlenebis mimarT. am Tvisebebis monacvleobs am or poluss Soris (cikloiduri an
gamo is ver axerxebs siamovnebis miRebas. mas aklia cikloTimuri pirovnuli aSliloba). pirovnuli aSli-
iumori da diskomforts ganicdis iseTi qmedebisas, lobis es tipebi mravali wlis win aRweres da maTi
romelic sxvebisTvis saxaliso da siamovnebis momta- amocnoba klinikur praqtikaSi advilad xdeba, Tumca
nia. misTvis zedmetad mniSvnelovania samuSao proce- isini ar aris Setanili DSM-IV-sa da ICD-10 klasifi-
sis produqtiuloba, rac urTierTobebis daTmobis kaciebSi. amis mizezi is aris, rom orive sistemaSi es
xarjze xdeba. aSlilobebi klasificirebulia, rogorc guneb-ganwy-
aseT adamianebs uWirT Segueba axal situaciebTan. obis aSliloba da ara rogorc pirovnuli aSliloba.
isini xisti da mouqnelebi arian, ar uyvarT cvlile- ICD-10 -Si isini klasificirebulia, rogorc `guneb-
bebi da upiratesobas aniWeben usafrTxo da nacnob ganwyobis (afeqturi) persistentuli mdgomareobebi ~
rutinul saqmianobas; jiutebi da direqtiulebi arian (cikloTimia an disTimia) da rogorc cikloTimia an
da surT, rom sxvebic emorCilebodnen maT wesebs. ase- disTimia DSM-IV-Si. miuxedavad amisa, isini aq mokled
Ti adamianebi uferulebi arian. zogjer siZunwiT ga- iqneba aRwerili.
_ 147 _
depresiuli pirovnuli aSlilobis dros aRiniSneba meore terminia umwifari pirovneba. mas bundovani
persistentuli daweuli guneb-ganwyoba, pesimisturi mniSvneloba aqvs da gamoiyeneba im Seusabamobis aR-
damokidebuleba cxovrebis mimarT da cudis molo- saniSnavad, romelic pirovnebis qcevas da mis qro-
dini. pirovneba dardobs Tavisi problemebis gamo da nologiur asaks Soris SeiniSneba. pacientis qceva
zedmetad nerviulobs. aseT adamianebs xSirad axasi- ufro dabali asakis adamianisTvis aris Sesaferisi,
aTebs mkveTrad gamoxatuli pasuxismgeblobis grZno- vidre pacientis asakis adamianebisTvis. imisTvis, rom
ba. maT naklebad SeuZliaT miiRon siamovneba da ga- aviciloT termin ùmwifaris~ bundovaneba, sjobs
moTqvamen ukmayofilebas sakuTari cxovrebiT. zogi davazustoT problemis xasiaTi (problema exeba so-
advilad Riziandeba da mZime xasiaTi aqvs. cialur urTierTobebs, emociaTa marTvas, mzaobas pa-
hipoTimuri pirovnuli aSlilobis mqone adamian- suximgeblobis aRebisadmi, Tu raime sxvas). pacientis
ebi, Cveulebriv, mxiarulebi da optimisturebi arian, problemis aseTnairi dazusteba ufro konstruqci-
gamoirCevian energiulobiT. Tu maT es Tvisebebi zomi- ul midgomasTan migviyvans, vidre pirovnebis monaT-
erad axasiaTebT, isini xSirad efeqtur da warmatebul vla umwifar adamianad. garda amisa, es termini iseTi
adamianebad gvevlinebian. Tu es Tvisebebi ukiduresad mizezis arsebobas gulisxmobs, romelic ar aris das-
iqna gamoxatuli, maSin qveiTdeba gansjis unari, aseT abuTebuli, anu mowiful pirovnebad Camoyalibebis
pirebs, SeuZliaT, ukritiko da usafuZvlo gadaw- uunarobas. amis gamo, mocemuli terminisTvis Tavis
yvetilebebis miReba. maTi Cveuli mxiaruleba xSirad arideba, aseT sirTulesac agvaridebs.
icvleba gaRizianebis periodebiT, gansakuTrebiT ma-
Sin, rodesac maTi miznebi ar xorcieldeba. warsulSi, epidemiologia
am jgufSi Semaval zedmetad kritikul da mokamaTe zogad populaciaSi pirovnuli aSlilobis epide-
adamianebs fsevdokverulantebs uwodebdnen. miologiuri gamokvleva daiwyo im standartizebu-
cikloiduri pirovnuli aSlilobis mqone adamian- li instrumenetebis SemuSavebis Semdeg, romlebic
ebi meryeoben ukiduresad depresiul da hiperTimur DSM-III-is kriteriumebze iyo dafuZnebuli. am tipis
mdgomareobebs Soris. guneb-ganwyobis aseTi arastabi- gamokvlevebi didi zomis SerCevebs moiTxovs, radgan
luroba bevrad ufro damangrevelia, vidre romelime zogierTi pirovnuli aSlilobis gavrcelebis sixSire
persistentuli mdgomareoba. aseTi aSlilobis mqone Zalin dabalia. garda amisa, Znelia pirovnuli aSli-
adamianebi periodulad ukiduresad mxiaruli, aqti- lobis identificireba Temze dafuZnebuli gamokv-
uri da produqtiulebi arian. aseT dros isini iReben levebis doneze. aseT gamokvlevebSi, interviuers
damatebiT pasuxismgeblobas samuSaosTan da socialur iSviaTad miuwvdeba xeli informantebis mier mowo-
cxovrebasTan dakavSirebiT. Semdeg maTi guneb-ganwy- debuli informaciaze. epidemiologiuri monacemebi,
oba icvleba. optimizmi icvleba uaryofiTi, uimedo ZiriTadad, miRebulia rva gamokvleviT, romlebic
damokidebulebiT cxovrebis mimarT. maTi energiis britaneTSi, aSS-sa da germaniaSi Catarda (Girolamo,
done dabla iwevs. Tu aweul mdgomareobaSi yofnisas Gotto, 2000).
isini xalisiT iReben sxvadasxva valdebulebebs, axla pirovnuli aSlilobis gavrcelebis sixSiris erTo-
yovelive es maTTvis mZime tvirTad iqceva. isini iRe- blivi monacemi (anu yvela tipis pirovnuli aSlilo-
ben araswor gadwyvetilebebs da uars amboben iseTi bis jami) am rva gamokvlevaSi 6-15%-s Seadgens. six-
SesaZleblobebis gamoyenebaze, romlebzec, sxva SemTx- Siris maCvenebeli ufro maRalia qalaqis dasaxlebebSi
vevaSi, uars ar ityodnen. sabolood isini ubrundebian soflis dasaxlebebTan SedarebiT (Casey, Tyrer, 1986).
normalur guneb-ganwyobas an aweul mdgomareobas. britaneTSi uaxlesi da yvelaze sando maCvenebeli
ufro dabalia da 4.4 procents Seadgens (Singleton et
terminebi, romelTa gamoyenebasac unda veridoT
al., 2000). pirvnuli aSlilobis sixSiris maCveneblebi
zemoT ukve aRiniSna, rom termini `fsiqopaTiuri ar gansxvavdeba mamakacebSi da qalebSi da iklebs asa-
pirovneba~ aradamakmayofilebelia (gv. ??). aseve, kis matebasTan erTad.
unda moveridoT Semdegi ori gavrcelebuli termi- pirovnuli aSlilobis ufro maRali zogadi maCvene-
nis xmarebas, romlebsac, upiratesad, maSin mimarTavs beli dadginda fsiqiatriuli simptomebis mqone paci-
interviueri, rodesac saTanadod ar aqvs Seswavlili entebTan, romlebic pirveladi jandacvis servisebs
Tavisi pacientis problemebi. aseTi terminia araadek- akiTxaven. maTTan es monacemi 30%-s Seadgens (Moran
vaturi pirovneba, romelsac damamcirebeli elferi et al., 2000). ambulatoriul da stacionarul fsiqi-
aqvs. am terminis nacvlad sjobs davazustoT ra saxiT atriul pacientebSi pirovnuli aSlilobis saerTo
aris pirovneba araTviTkmari cxovrebis moTxovnebTan maCvenebeli daaxloebiT 50%-ia (Girolamo, Gotto, 2000).
mimarTebaSi. es migviyvans ufro konstruqciul war- cxrilSi 7.11 naCvenebia sxvadasxva tipis pirovnuli
modgenasTan imis Sesaxeb, Tu ranairad davexmaroT mas aSlilobis gavrcelebis sixSire. am gamokvlevebSi
cxovrebasTan ukeTesad gamklavebaSi. SerCevis zoma meryeobs 200-dan 1600-mde. zogierTi
_ 148 _
pirovnuli aSliloba
maCveneblis meryeobis diapazoni farToa, rac, va-
riaciis sxva mizezebis garda, kvlevis gansxvavebuli
cxrili 7.11 epidemiologiur kvlevebSi
pirovnuli aSlilobis gavrcelebis sixSiris
instrumentebis gamoyenebas asaxavs. zogi aSlilobis
gasaSualoebuli maCvenebeli
maCvenebeli gansxvavebulia mamakacebSi da qalebSi.
mag., antisocialuri pirovnuli aSliloba ufro pirovnuli pirovnuli gamokvlevebis sixSire
metad mamakacebSia gavrcelebuli (Tanafardoba klasteri aSliloba raodeboba (procenti)
meryeobs 2.1 da 7.1 Soris). miuxedavad imisa, rom mo- klasteri A paranoiduli 8 0.6
sazRvre da isteriuli pirovnuli aSlilobebi ufro
Sizoiduri 9 0.4
xSirad qalebSia aRwerili, mocemul gamokvlevebSi es
kanonzomiereba calsaxad ar dadasturda. Sizotipuri 8 0.6
gavrcelebis sixSiris saintereso maCveneblebi
klasteri B antisocialuri 18 1.9
dadginda qveynebis mixedviT. mag., antisocialuri
mosazRvre 9 1.6
pirovnuli aSlilobis sakmaod dabali maCvnebeli
dadginda taivanSi. gavrcelebis sixSiris maCvene- isteriuli 8 2.0
blebis farTo variabiloba ar aris sakmarisad sarw-
munod axsnili. es exeba kargad dagegmil gamokvleveb- klasteri C obsesiur- 8 1.7
kompulsuri
sac, romlebic didi moculobis SerCevaze Catarda.
zogierTi pirovnuli aSlilobis gavrcelebis sixSire amridebluri 7 0.7
SeiZleba cvalebadobdes sxvadasxva kulturul gare-
damokidebuli 8 0.7
moSi. is, rogorc Cans, gaSualebulia bavSvobisdro-
indeli garemoTi (ix. qvemoT) da adgilobrivi gene- pasiur- 7 1.7
tikuri variaciebiT; is aseve SeiZleba warmoadgendes agresiuli
pirovnuli aSlilobis amJamindeli definiciis mier Girolamo, Dotto, 2000.
kulturuli normebis gaTvaliswinebis efeqts.
iyos zrdasrul asakSi dabal TviTSefasebasTan.
etiologia retrospeqtuli gamokvlevebi aSkara problemebs
warmoSobs, magram prospeqtuli gamokvlevis Catareba
zogadi sakiTxebi ufro perspeqtiulia. erT-erTi aseTi gamokvlevis
pirovnuli aSlilobis mizezebi ucnobia. zogi avtori Tanaxmad, damoukideblad dadgenili ukiduresi
asaxelebs genetikur faqtorebs sxvadasxva tipis adreul fizikuri ugulebelyofa, sastiki mopyroba da
cxovrebiseul gamocdilebasTan erTad. zogi pirovnuli seqsualuri Zaladoba asocirebulia zrdasrul
aSliloba etiologiurad aris urTierTdakavSirebuli asakSi klasterSi Semavali pirovnuli aSlilobebis
mis msgavs fsiqikur aSlilobasTan. aRmocenebis riskTan (Johnson et al., 1999).
qvemoT ganxilulia genetikuri mizezebi konkretuli Cven ukve ganvixileT kavSiri pirovnul aSlilobasa
pirovnuli aSlilobis etiologiis monaxazTan erTad. da fsiqikur aSlilobas Soris. msgavsebam cikloTimur
adreuli cxovrebiseuli gamocdilebis zegavlenis pirovnebasa da maniakalur-depresiul aSlilobas
Seswavla rTulia imis gamo, rom am gamocdilebasa Soris mkvlevarebi miiyvana daskvnamde maT Soris
da zrdasrul cxovrebaSi pirovnuli aSlilobis mizezobrivi kavSiris arsebobis Sesaxeb. es Tvalsazrisi
diagnozs Soris xangrZlivi droiTi intervalia. klasifikaciis sistemaSia asaxuli (gv. ??). agreTve,
bavSvobisdroindeli gamocdilebisa da pirovnebis gamoiTqva mosazreba, rom Sizoiduri pirovnuli
damakavSirebeli fsiqodinamiuri Teoriebi aq aSliloba Sizofreniis nawilobriv gamoxatulebas
naxsenebia im konteqstSi, sadac isini gavlenis mqonea. warmoadgens, magram es mosazreba ar dadasturda
miuxedavad imisa, Tu ramdenad aris klini saTanado mtkicebulebiT (gv. ??). Tumca, aseTi kavSiris
cistebisTvis misaRebi fsiqodinamiuri Teoria, arseboba dadginda Sizotipuri pirovnuli aSlilobis
maTi umravlesoba miiCnevs, rom bavSvobisdroindel SemTxvevaSi. aseve, ar dadasturda kavSri obsesiur
gamocdilebas, pirovnul maxasiaTeblebsa da pirovnul pirovnul aSlilobasa da obsesiur-kompulsur
aSlilobas Soris mizezobrivi kavSiri arsebobs. aSlilobas Soris (Pfhol, Blum, 1991).
praqtikaSi gamarTlebulia bavSvobisdroindeli gam imis gamo, rom sxvadasxva tipis pirovnul aS
ocdilebis Seswavla da saR azrze dafuZnebuli lilobas sxvadasxva mizeziT xsnian, isini qvemoT
msjelobis gamoyeneba imis dasadgenad, Tu ramdenad iqneba ganxiluli. Tavidan ganvixilavT antisocialur
SesaZloa ama Tu im gamocdilebas zegavlena moexdina pirovnul aSlilobas, radgan mas ufro meti kvleva
pirovnebis ganviTarebaze. mag., mSoblebis mier eZRvneba. sxva saxis aSlilobebi igive TanmimdevrobiT
bavSvis mudmivi uaryofa SeiZleba dakavSirebuli aris dalagebuli, rogorc am Tavis dasawyisSi.
_ 149 _
antisocialuri pirovnuli aSliloba wamalmoxmareba) zrdasruli pirebis antisocialuri

qcevis damoukidebel prediqtors warmoadgens.
genetikuri mizezebi
genebis SeWidulobis gamokvlevebi rTuli Casa
tyupebze Catarebuli gamokvlevebi. yvelaze xSi tarebelia. amJamad, am tipis kvlevebiT SeWidulobis
rad citirebuli gamokvlevebi langesa da roza faqtebi ar aris dadasturebuli.
nofs ekuTvnis (Lange, 193; Rosanoff et al., 1934). am
gamokvlevebSi Seiswavleboda probandebi _ ram cerebruli paTologia da centraluri nervuli
denjerme msjavrdebulni sisxlis samarTlis dana sistemis ganviTareba
Saulis gamo da ara antisocialuri pirovnuli erT-erTi dakvirvebis Tanaxmad, Tavis tvinis dazianebis
aSlilobis mqone adamianebi, ris gamoc am gamokvlevebis mqone zogierTi pacienti agresiul qcevas amJRavnebs,
Sedegebis relevantoba aseTi aSlilobis mqone ada rac imas gulixmobs, rom pirovnebis antisocialurobis
mianebis mimarT saeWvoa. tyupebze Catarebulma ufro mizezs SeiZleba Tavis tvinis umniSvnelo disfunqcia
gviandelma gamokvlevebma daadastura antisocialuri warmoadgendes. es mosazreba jer-jerobiT ar yo
qcevis memkvidreobiTi xasiaTi zrdasrul adamianebSi fila dadasturebuli. magnitur-rezonansuli tomo
da aCvena, rom genetikuri faqtorebi ufro grafia aCvenebs, rom antisocialuri pirovnuli
mniSvnelovania zrasrul pirebSi, vidre antisocialur aSlilobis mqone adamianebTan prefrontalur ubanSi
bavSvebsa da mozardebSi, romlebTanac saerTo garemo Semcirebulia ruxi nivTierebis simkvrive Tavis
faqtorebi ufro didi mniSvnelobis mqonea (Lyons et tvinis uxeSi dazianebis gareSe (Raine et al., 2000),
al., 1995). rac, SeiZleba, garkveuli saxis prefrontalur
naSvilebi pirebis gamokvleva. kadores mier Cata disfunqcias asaxavdes. sanam davadgendeT, Tu ram
rebul mniSvnelovan gamokvlevaSi (Cadoret, 1978) Se denad mniSvnelovania es monacemebi, unda moxdes
mdegi Sedegebi iqna miRebuli: naSvileb pirebs, maTi dadastureba. SedarebiT axali neirovizualuri
romlebic dabadebidanve daaSores persistentuli gamokvlevebiT dadginda amigdalas arasakmarisi
antisocialuri qcevis mqone mSobels, ufro reaqcia emociuri xasiaTis stimulebze. garda amisa,
xSirad aReniSnebodaT antisocialuri pirovnuli sociopaTiis mqone individebSi amigdalas moculoba
aSliloba, vidre im naSvileb pirebs, romelTa Semcirebulia. es monacemebi daukavSires im faqts,
mSobels antisocialuri qceva ar axasiTebda. ga rom sociopaTebs naklebad axasiaTebT empaTia
mokvleva iTvaliswinebda, Tu romel mSobels axa adamianebis mimarT (ix. Blair, 2003).
siaTebda antisocialuri qceva _ biologiur de
das Tu biologiur mamas. STamomavlobaSi, an 5-hidroqsitriptamini da agresia
tisocialuri pirovnuli aSliloba ufro xSirad impulsuri da agresiuli qcevis mqone pacientebTan
iyo diagnostirebuli mamakacebTan, vidre qalebTan, dadginda 5-hidroqsitriptaminis (5-HT) neirotrans
Tumca qalebTan ufro didi sixSiriT dafiqsirda misiis anomaliebi, Tumca ara konkretulad anti
aSlilobis tipi, romelsac im dros isterias socialur pirovnul aSlilobasTan mimarTebaSi.
uwodebdnen. kadore Tvlida, rom isteria qalebSi im pirebis cerebrospinalur siTxeSi, romlebmac
iseTive genetikuri datvirTvis gamoxatulebaa, rac Caidines Zaladobis aqti winaswari ganzraxvis ga
antisocialuri pirovnuli aSliloba mamakacebSi. reSe, dadginda 5-HT metabolitis _ 5-HIAA-is (5-
miuxedavad imisa, rom am gamokvlevas Tavisi si ideoqsindileacetikuri mJavis) dabali done (Linnoila,
susteebi axasiaTebda (30%-ma uari Tqva interviuSi Virkkunen, 1992). 5-HT-iT gaSualebuli prolaqtinis
monawileobis miRebaze), man mainc daamtkica manamde gamonTavisufleba SedarebiT mcire raodenobiT xde
miRebuli Sedegebi (Crowe, 1974). mcire masStabis ba impulsuri agresiulobis istoriis mqone pirebSi
gamokvlevam, romelic Seiswavlida antisocialuri (Coccaro et al., 1989). igive anomaliebi SeiZleba kavSirSi
qcevis mqone naSvilebi pirebis biologiur mSoblebs, imyofebodes im pirovnul aSlilobasTan, romelic
daadgina antisocialuri qcevis ufro maRali sixSire xasiTdeba impulsuri qceviT, gansakuTrebiT, pre
im bavSvebis biologiur mSoblebTan SedarebiT, frontaluri deficitis pirobebSi (Dolan et al., 2002;
romlebsac antisocialuri qceva ar axasiaTebdaT New et al., 2004).
(Schulsinger, 1982).
ganviTarebis Teoriebi
kadorem (Cadoret et al., 1995) Seiswavla naSvilebi
pirebis aRzrda da ojaxuri garemo. am SemTxvevaSic, mSobelTan ganSoreba. xSirad citirebul adreul
biologiuri mSoblebis antisocialuri pirovnuli gamokvlevaSi, boulbim (Bowlby, 1944) Seiswavla 44
aSliloba gamodga naSvilebi bavSvebis antisocialuri `mcirewlovani qurdi~. man daaskvna, rom bavSvis
qcevis prediqtori. Tumca, mSvilebeli ojaxis ganSoreba dedasTan iwvevs antisocialur qcevas
uaryofiTi faqtorebi (col-qmruli problemebi da da axlo urTierTobis Camoyalibebis uunarobas. am
_ 150 _
pirovnuli aSliloba
gamokvlevam biZgi misca sxva mravali gamokvlevis aSlilobas Soris (Robins, 1966). miuxedavad imisa,
Catarebas, romlebic Seiswavlida ganSorebis zrdasrul asakSi persistentuli antisocialuri
efeqts. Sedegebi bevrad ufro mravalferovani qceviT xasiaTdeboda mxolod Zalian mcire nawili im
aRmoCnda, vidre amas boulbi varaudobda. aRmoCnda adamianebisa, romlebsac bavSvobaSi antisocialuri
rom dedasTan ganSoreba yvela bavSvze uaryofiTad qceva aReniSnebodaT, antisocialuri pirovnuli
ar moqmedebs da rom ganSorebis efeqti mraval aSlilobis mqone mozrdili adamianebis umravlesobas
faqtorzea damokidebuli (bavSvis asaki, dedasTan da bavSvobaSi aReniSneboda qceviTi xasiaTis problemebi.
mamasTan winare urTierToba da ganSorebis mizezi). bavSvobisdroindeli problemebis gamovlena zrdasrul
mSoblebidan gamomdinare mizezebi. mSoblebTan asakSi ufro maSin iyo mosalodneli, rodesac bavSvobis
ganSoreba xSirad mosdevs mSoblebs Soris daZabulobisa periodSi pirovnebas erTze meti antisocialuri qceva
da usiamovnebis xangrZliv periods, ramac TavisTavad aReniSneboda da rodesac antisocialuri aqtebi
SeiZleba moaxdinos bavSvze uaryofiTi gavlena. ganmeorebiT xasiaTs atarebda. qurdobas biWebSi
erT-erT mniSvnelovan gamokvlevaSi (Rutter, 1972) da arakanonier seqsualur qmedebebs gogonebSi
dadasturda, rom uTanxmoeba col-qmars Soris gansakuTrebiT xSirad mohyveboda antisociluri qceva
nawilobriv ganapirobebs kavSirs ganSorebasa da zrdasrul asakSi. es adreuli monacemebi SemdgomSic
antisocialur aSlilobas Soris, romelic vaJebs dadasturda. agreTve, dadasturda, rom qceviTi
aReniSnebaT. radganac bavSvobisdroindeli an problemebi warmoadgens antisocialuri pirovnebis
tisocialuri qceva dakavSirebulia antisocialur prediqtors iseTi faqtorebis zemoqmedebisgan
qceviT aSlilobasTan zrdasrul asakSi (ix. qvemoT), damoukideblad, rogoric uaryofiTi ojaxuri da
es monacemebi miuTiTebs kavSirze mSoblebTan socialuri faqtorebis zegavlenaa (Hill, 2003).
asocirebul faqtorebsa da antisocialur pirovnul
aSlilobas Soris.
socialuri daswavla bavSvobaSi. mravali wlis cotaa cnobili am aSlilobis mizezebis Sesaxeb. zo
win, skotma (Scott, 1960) warmoadgina antisocialuri gierTi mkvlevaris Tanaxmad, paranoiduli pirovnuli
qcevis Camoyalibebis socialuri daswavlis modeli. aSliloba ufro xSirad gvxvdeba Sizofreniis
amgvari qcevis Camoyalibeba SeiZleba SemdegiT iyos mqone probandis pirveli rigis naTesavebSi zogad
ganpirobebuli: populaciasTan SedarebiT (Kendler et al., 1985a). Tum-
ca, zogierTma gamokvlevam ar daadastura es Sedegebi
1. bavSvi antisocialur ojaxSi izrdeba;
(Coryell and Zimmerman, 1989).
2. ojaxSi ar arsebobs Tanmimdevruli wesebi;
3. pirovnebam SeiZleba daiswavlos antisocialuri Sizoiduri pirovnuli aSliloba
qceva, rogorc sxva problemebTan gamklavebis am aSlilobis mizezi ar aris cnobili. rogorc iTqva,
saSualeba (mag., rogorc arasrulfasovnebis gan Sizoiduri pirovneba genetikurad mWidrod ar aris
cdis damalvis saSualeba); dakavSirebuli SizofreniasTan (Winokur, 1993). fsi-
4. yuradRebis koncentraciis uunaroba da sxva faq qoanalitikosebi gamoyofen am tipis pirovnebis uu-
torebi, romlebic xels uSlis daswavlas. narobas miiRos da gasces siyvaruli. aseTi uunaroba
iTvleba Tavdacvad, romelic Camoyalibda cxovrebis
arsebobs am faqtorebis moqmedebis garkveuli adreul etapze deda-Svilis arasrulyofili ur-
mtkicebuleba. mag., antisocialuri pirovnuli aSli TierTobis sapasuxod. klainma (Klein, 1952) gamoTqva
loba dakavSirebulia fizikur ZaladobasTan da mosazreba, rom yvela bavSvi ganviTarebis procesSi
Zaladobriv aRzrdasTan Tanmimdevruli wesebis gaivlis garkveul etaps, romelsac is `Sizoidur po-
dacvis gareSe (Pollock et al., 1990), inteleqtis da zicias~ uwodebda. am etapze bavSvi oralur da sadi-
bal koeficientTan da did ojaxSi aRzrdasTan stur impulsebs saxifaTod ganicdis da axdens maT
(Farrington et al., 1988). mocemuli sqemis Rirebuleba, proeqcias mSobelze. am Teoriis Tanaxmad, bavSvebis
ZiriTadad, imaSi mdgomareobs, rom is klinicists umravlesoba gaivlis am stadias, magram maTi mcire
awvdis sasargeblo sqemas antisocialuri pirovnebis raodenoba inarCunebs proeqciis dacviT meqanizms.
SesaZlo mizezebis gamosakvlevad. Tumca, es ideebi Sizoidur pirovnul aSlilobasTan
bavSvobisdroindeli qceviTi problemebi da anti dakavSirebiT araa gaTvaliswinebuli amJamindel dia-
socialuri pirovneba. erT-erTma mniSvnelovanma 30 gnostikur saxelmZRvaenloSi.
wlianma Semdgomma gamokvlevam, romelic bavSvTa
fsiqikuri janmrTelobis klinikaSi Catarda, daadgina Sizotipuri pirovnuli aSliloba
kavSiri bavSvobisdroindel qceviT problemebsa da Sizotipuri pirovnuli aSlilobis yvelaze maRali
zrdasrul asakSi gamovlenil antisocialur pirovnul maCvenebeli aRiniSneba am aSlilobis mqone probandis
_ 151 _
naTesavebSi, vidre janmrTeli tyupebis naTesavebs an qoanalizis mixedviT, mocemuli aSliloba dakavSire-
(Torgersen, 1984) sxva ojaxis wevrebSi (Baron et al., 1985), bulia an oidiposis (Fenichel, 1945), an kidev oraluri
rac am aSlilobis genetikur safuZvelze miuTiTebs. konfliqtis gadaWris uunarobasTan (Marmor, 1953).
Sizotipuri pirovnuli aSliloba, aseve, ufro xSirad
obsesiuri pirovnuli aSliloba
gvxvdeba Sizofreniis mqone probandis biologiur da,
naklebad, arabiologiur naTesavebSi an sakontrolo rogorc Cans, obsesiur pirovnul aSlilobas mniSvne-
pirebSi (Kendler et al., 1981). struqturuli vizualiza- lovani genetikuri safuZveli gaaCnia (Murray, Reveley,
ciiT Catarebuli 17 gamokvlevis mixedviT, romlebSic 1981), Tumca misi buneba ar aris cnobili. fsiqoana-
swavlobdnen mocemuli aSlilobis mqone pirebs, naxes, litikuri Teoriis mixedviT obsesiuri pirovnuli aS-
rom am aSlilobis dros gamovlenili Tavis tvinis liloba momdinareobs ganviTarebis analur stadiaze
anomaliebi garda safeTqlis wilisa da lateralu- aRmocenebuli problemebidan. am aSlilobis klini-
ri parkuWis anomaliebisa, Sizofreniis mqone pirebSi kuri niSnebi sxvadasxva dacviTi meqanizmis (regresia,
dadgenili paTologiis msgavsia (Dickey et al., 2002). es reaqciis formireba, izolacia; ix. gv 153) moqmedebis
monacemebi imaze miuTiTebs, rom Sizotipuri pirov- Sedegad iTvleba. arc erTi am ganmartebaTagani ar
nuli aSliloba SeiZleba warmoadgendes Sizofreniis aris mecnierulad dasabuTebuli.
ufro msubuq formas, an es ori paTologia SeiZleba
SfoTviTi (acilebadi) pirovnuli aSliloba
sxva saxiT iyos erTmaneTTan dakavSirebuli.
SfoTviT-acilebadi pirovnuli aSliloba ar Seuswav-
mosazRvre pirovnuli aSliloba liaT SfoTviTi aSlilobisgan damoukideblad. bekma
am SemTxvevaSi ar dadginda mniSvnelovani genetiku- da frimanma warmoadgines kognituri modeli (Beck and
ri faqtorebi. gamokvlevebi, romlebic Seiswavlida Freeman, 1990), romlis centraluri elementebia ua-
mosazRvre pirovnuli aSlilobis gavrcelebas ama- ryofis SiSi, TviTkritika, sxva adamianebis reaqciebis
ve aSlilobis mqone probandis naTesavebSi, winaaRm- araswori Sefaseba da maTgan gamomdinare sxva pirov-
degobriv Sedegebs iZleva. Tumca, maTTan aRiniSneba nuli Tvisebebi. mocemul Teorias ar moeZebneba empi-
afeqturi aSlilobis (Stone, 1987) da sxva tipis pirov- riuli dasabuTeba.
nuli aSlilobebis gazrdili maCveneblebi (Pope et al.,
sxvaze damokidebulebisa da pasiur-agresiuli
1983). albaT, ufro sasasrgeblo iqneba im Tvisebebis pirovnuli aSliloba
genetikuri safuZvlis Seswavla, romlebsac TavianTi
am pirovnuli aSlilobis mizezi ar aris cnobili. ar
wvlili SeaqvT saerTo klinikur suraTSi (mag., aseTi
momxdara genetikuri faqtorebis identificireba.
Tvisebebia afeqtis regulaciis uunaroba da impulse-
fsiqoanlitikuri interpretaciiT orive aSliloba
bis aradamakmayofilebeli marTva. (Siever et al., 2002).
momdinareobs ganviTarebis oralur stadiaze warmo-
fsiqoanalitikuri Teoriebi aSlilobis mizezs xedaven
qmnili problemebidan. sxvaze damokidebulebis pi-
deda-Svilis arasrulyofil urTierTobaSi bavSvis in-
rovnuli aSlilobis mqone adamianebi aRniSnaven, rom
dividualizaciis safexurze (Kernberg, 1975). am mosaz-
bavSvobisas mSoblebi zedmet mzrunvelobas iCendnen
rebas adasturebs is faqti, rom mosazRvre pirovnu-
maT mimarT (Head et al., 1991), magram, rogorc zemoT
li aSlilobis mqone adamianebi sakontrolo jgufTan
iTqva, amgvari informaciis sandooba dabalia.
SedarebiT ufro xSirad ganicdidnen bavSvobaSi seq-
sualur da fizikur Zaladobas (Berelowicz, Tarnopolsky,
pirovnuli aSlilobis prognozi
1993). 28 wlian Semdgom dakvirvebaSi helgelandma (Hel-
geland) daadgina kavSiri, erTi mxriv, bavSvis ugulebe- pirovnuli aSliloba aris mdgomareoba, romelic
lyofasa da masze Zaladobas da, meore mxriv, gviandel mTeli cxovrebis manZilze gastans, ase rom, droTa
periodSi mosazRvre pirovnuli aSlilobis ganviTare- ganmavlobaSi, ar aris raime cvlilebebi mosalodne-
bas Soris. artistuli da sxva tipis niWi da intele- li. pirovnuli aSlilobebis gamosavlis Sesaxeb ar
qtualuri unarebi dadebiTi efeqtis mqonea. moiZebneba sando informacia. cxra gamokvlevis mi-
moxilvam, romelTa drosac warmoebda Semdgomi dak-
isteriuli pirovnuli aSliloba virveba, aCvena, rom mxolod ori maTgani grZeldebo-
am tipis pirovnuli aSlilobis mizezebis Seswavlas da 4 welze met xans. es gamokvlevebi erTmaneTisgan
sul ramdenime obieqturi kvleva eZRvneba. isteriuli gansxvavdeboda SerCevis wesis da kvlevis meTodebis
pirovnuli aSlilobis genetikuri faqtori ar Seus- TvalsazrisiT; garda amisa, Seswavlili pirebis rao-
wavliaT standartizebuli meTodebis gamoyenebiT. denoba Zalin mcire iyo. mimdinare farTomasStabu-
arsebobs standartizebuli meTodebis gamoyenebiT ri gamokvleva, romelsac atarebs aSS-is fsiqikuri
Catarebuli ramdenime gamokvleva da isinic winaaRm- janmrTelobis erovnuli instituti, albaT ufro
degobriv Sedegebs iZleva (McGuffin, Thaper, 1992). fsi- xarisxian informacias mogvawodebs.
_ 152 _
pirovnuli aSliloba
agresiuli da antisocialuri pirovnuli aSliloba. ris, sakmaod gavrcelebul movlenas warmoadgens.

klinikuri dakvirvebidan gamomdinare, am SemTxvevaSi Zalian cota kvleva aCvenebs imas, rom mkurnalobis
SeiZleba umniSvnelo gaumjobesebas hqondes adgili, Semdgomi cvlilebebi pirovnuli aSlilobis gaumjo-
romelic nela mimdinareobs. es gansakuTrebiT agre- besebiTaa gamowveuli da ara komorbiduli mdgoma-
siul da antisocialur qcevas exeba. robinsis (Robins) reobis gaumjobesebiT. es gansakuTrebiT exeba mosaz-
zemoT xsenebul gamokvlevaSi, persistentuli anti- Rvre pirovnul aSlilobas, romlis drosac xSirad
socialuri qcevis mqone pirebis daaxloebiT erTi gvxvdeba guneb-ganwyobis aSliloba.
mesamedis mdgomareoba gaumjobesda cxovrebis gvi- idealur SemTxvevaSi unda Catardes ori saxis ga-
andel etapze, razec metyvelebs patimrobisa da so- mokvleva: (1) kvlevebi uSualod pirovnul aSlilobeb-
cialur saagentoebTan urTierTobis sixSiris maCve- ze, rom vaCvenoT mkurnalobis efeqturoba komorbidu-
neblebi. Tumca, am adamianebs mainc aReniSnebodaT li aSlilobebisgan damoukideblad da (2) pragmatuli
sirTuleebi urTierTobebSi, rac vlindeboda mtrul kvlevebi, calkeuli komorbiduli aSlilobebisTvis,
damokidebulebaSi colebisa da mezoblebis mimarT da rom vaCvenoT mkurnalobis efeqti, romelic mosalod-
suicidis maCveneblis zrdaSi. nelia klinikur praqtikaSi, im mdgomareobebisTvis,
mosazRvre pirovnuli aSliloba. am aSlilobis Sem- romlisTvisac komorbiduloba damaxasiaTebelia.
TxvevaSi mravalgvari gamosavalia dafiqsirebuli,
mkurnalobis xangrZlovoba da Semdgomi dak-
rac imas niSnavs, rom mosazRvre pirovnuli aSliloba
virveba
SeiZleba erT mocemulobas ar warmoadgendes (Skoda
et al., 2002b). mag., stounma (Stone et al.,) daadgina, rom klinikur kvlevaTa umravlesoba, pirovnuli aSlilo-
maRali socialuri klasis oTxi warmomadgenlidan, bebis mimdinareobasTan SedarebiT, Zalian xanmoklea,
romelsac es diagnozi 20-30 wlis asakSi dausves, mxo- taieri da devidsoni (Tyrer and Davidson) Tvlian, rom
lod erTi akmayofilebda mocemuli diagnozis kri- kvlevisTvis 2 weli aucilebel minimums warmoadgens.
teriumebs saSualo asakSi. Tumca, maTi umravlesoba
TanamSromloba da Cavardnebi
akmayofilebda sxva pirovnuli aSlilobis kriteri-
umebs (maT Soris, isteriuli, acilebadi da obsesiuri pirovnuli aSlilobis mqone pacientebi xSirad ar
tipis aSlilobis). is adamianebi, romlebsac kvlavac icaven mkurnalobis reJims, xolo kvlevebSi ki ise-
aReniSnebodaT sawyisi diagnozi, xSirad fsiqoaqti- Ti pirebis monawileobaa aucilebeli, vinc Tanxmaa
uri nivTierebis momxmareblebi an kriminalebi iyv- TanamSromlobaze. damyoli pacientis SemTxvevaSic,
nen. stounis mier Catarebul gamokvlevaSi dadginda Cavardnebis jamuri maCvenebeli arTulebs miRebuli
suicidis maRali procenti (8.5%) (Stone et al., 1987), Sedegebis ganzogadebas. am problemas isic emateba,
Tumca, es Sedegi yvela gamokvleviT ar dadasturda. rom Semdgomi dakvirvebis periodi sakmaod xangrZli-
Sizotipuri pirovnuli aSliloba. 3-5 wliani Semdgo- vi unda iyos (ix. zemoT).
mi dakvirvebiT dadginda, rom Sizotipuri pirovnuli gamosavali, rogorc sazomi
aSlilobis dros gamosavali uaresia, vidre mosazRvre
pirovnuli aSlilobis gamokvleva asaxavs rogorc
pirovnuli aSlilobis SemTxvevaSi (Melhum et al., 1991).
fsiqikur mdgomareobas, aseve pirovnul cvlilebebs
C klasterSi Semavali pirovnul aSlilobebs (gv.
(xolo fsiqikuri mdgomareobis cvlileba SeiZleba ga-
??) ukeTesi prognozi aqvT, vidre sxva klasterebSi
mowveuli iyos komorbiduli aSlilobiT. ix. zemoT).
Semaval aSlilobebs.
pirovnuli aSliloba ganisazRvreba, rogorc tanjvis
momtani sakuTari TavisTvis an sxvebisTvis, magram
mkurnaloba
aseTi cvladebiT pirovnuli cvlilebebis gazomva Za-
Zalian cotaa iseTi mtkicebuleba, romliTac kli-
lian Znelia. antisociluri pirovnebis mkuranlobis
nicisti ixelmZRvanelebda pirovnuli aSlilobis
efeqturobis dasadgenad ufro martivia ganmeoreba-
mkurnalobis dros. amas garda, Zalian cotaa iseTi
di kanondarRvevebis sixSiris maCveneblis gamoyeneba,
gamokvleva, romelic akmayofilebs randomizaciis,
Tumca aseT cvladebSi momxdari cvlilebebi SeiZleba
brma kvlevis da Sesabamisi sakontrolo mkurnalobis
gamowveuli iyos sxva faqtorebiT da ara pirovnuli
moTxovnebs. taierma da devidsonma (Tyer and Davidson,
cvlilebebiT.
2000) daadgines damatebiTi mizezebi, romlebic gvixs-
nis klinikurad relevanturi kvlevis simwires. medikamenturi mkurnaloba
garda imisa, rom medikamenturi mkurnaloba gavlenas
komorbidoba
axdens komorbidul guneb-ganwyobis aSlilobaze, mas
komorbidoba pirovnul aSlilobasa da sxva aSlilo-
SeuZlia imoqmedos pirovnuli aSlilobis biologi-
bebs, gansakuTrebiT guneb-ganwyobis aSlilobasa da
ur safuZvelze (ix. etiologia), an SeiZleba iqonios
fsiqoaqtiuri nivTierebis borotad moxmarebas So-
_ 153 _
araspecifikuri moqmedeba SfoTvaze, agresiasa da mcire, magram Rirebul progress aRweven ramdenime
sxva simptomebze. Tvis manZilze. Tumca, antisocialuri pirovnuli aS-
lilobis mqone pacientebs SeiZleba mxardaWera mra-
antifsiqozuri medikamentebi vali wlis manZilze dasWirdeT. am kategoriis paci-
tipiuri antifsiqozuri preparatebi gamoiyeneba mo- entebs mxardaWera SeuZlia aRmouCinos fsiqiatrTa
sazRvre da Sizotipuri pirovnuli aSlilobis sam- jgufis wevrma, xolo kanondarmRvev pacientebs _
kurnalod, magram klinikuri kvleva Sereul Sedegebs probaciis oficerma. probaciis orderi gamodgeba ga-
gviCvenebs (Tyrer and Bateman, 2004). atipiuri antifsiqo- regani kontrolis mizniT antisocialuri qcevis mqo-
zuri preparatebi, rogoricaa olanzapini da risperi- ne iseT pirebTan, romlebic Tavidan naklebad arian
doni asustebs mtrul damokidebulebas da qronikul motivirebulni Secvalon TavianTi qceva.
disforias mosazRvre pirovnuli aSlilobis dros (Bo-
genschutz et al., ; 2004; Zanarini et al., 2001). es preparatebi, konsultireba
aseve, efeqturia Sizotipuri pirovnuli aSlilobis problemis gadaWra (gv. ??) exmareba pacientebs iseT
dros (Keshaven et al., 2004; Koenigsberg et al., 2003). stresul viTarebasTan gamklavebaSi, romelic pro-
vocirebas ukeTebs anomaliur qcevas an mtkivneul
antidepresantebi gancdebs. savaraudod, konsultirebis sxva formeb-
amitriptilinis efeqti Seudares placebo efeqts mo- Tan SedarebiT, mocemuli midgoma iwvevs nakleb pro-
sazRvre pirovnuli aSlilobis dros (Soloff et al., 1986; blemebs damokidebulebisa da gadatanis (transferis)
Soloff, 1994). zogi pacienti daemorCila mkurnalobas, Camoyalibebis TvalsazrisiT C klasterSi Semavali
zogi ki ara. miRebuli Sedegebi SeiZleba aixsnas Tan- aSlilobis mqone pacientebSi. es midgoma B tipis aS-
mxleb depresiul aSlilobaze moqmedebiT. mosazRvre lilobis mqone pacientebTanac aris efeqturi masSi
pirovnuli aSlilobis mqone pacientebSi fluoqseti- gamoyenebuli safexurebrivi procedurebis gamo.
ni ufro efeqturad asustebs brazis emocias, vidre fsiqodinamiuri konsultacia erTmaneTTan akavSi-
placebo (Salzmann et al., 1995; Coccaro and Kavoussi, 1997). rebs warsul gamocdilebas da axlandel sirTuleebs.
Ria kvlevis dros venlafaqsinis gamoyenebam Seamcira pirovnuli aSlilobis dros es midgoma Zalian sele-
TviTdazianeba mosazRvre pirovnuli aSlilobis mqo- qciurad unda gamoviyenoT. is yvelaze efeqturia im
ne pacientebSi (Markowitz and Wagner, 1995). usafrTxo axalgazrdebTan, romlebsac akliaT Tavdajerebulo-
dozebis dacva gadamwyveti mniSvnelobis mqonea. es ba, uWirT urTierTobis dmayareba da kargad ar ician,
gansakuTrebiT exeba iseT pirebs, romlebsac hqoniaT Tu rogor warmarTon sakuTari cxovreba. isini moti-
wamlis Warbi doziT miRebis SemTxvevebi. virebulni unda iyvnen, rom ganixilon da gadaafason
TavianTi damokidebulebebi da emociebi. mosazRvre
guneb-ganwyobis stabilizatorebi
da antisocialur pirovnebebTan fsiqodinamiuri mid-
mosazRvre pirovnuli aSlilobis mqone pacientebTan goma, zogadad, nakleb efeqturia, vidre problemis
valproatis moqmedeba Seiswavles mciremasStabiani gadaWraze muSaoba.
randomizebuli kvlevis farglebSi. am preparats aR-
moaCnda dadebiTi zemoqmedeba agresiaze, depresiaze dinamiuri fsiqoTerapia
da zogad simptomatologiaze (Hollander et al., 2003). dinamiuri fsiqoTerapia moiTxovs, rom pirovneba
ganmeorebiTma kvlevam bolomde ar daadastura is fa- mzad iyos cvlilebisTvis da surdes TerapevtTan Ta-
qti, rom liTiumi asustebs brazis emocias da aqvei- namSromloba. maSinac ki, rodesac es moTxovnebi da-
Tebs impulsurobas antisocialur pirovnebebSi (Nils- culia, unda moxdes arsebuli teqnikis modifikacia:
son, 1993). nebismier SemTxvevaSi SeiniSneba praqtiku- naklebi aqcenti gakeTdes warsuli movlenebis rekon-
li xasiaTis Semdegi sirTule: agresiuli qcevis mqone struqciaze da meti yuradReba daeTmos sxva adami-
adamianebi ar icaven mkacr reJims, romelic liTiumis anebTan urTierTobas, sirTuleebTan gamklavebas da
miRebis dros eniSnebaT. pirovnuli aSlilobebis sa- sakuTari emociebis marTvas. mniSvnelovania gadatani-
marTavi erT-erTi preparatia karbamazepini, magram sa da ukugadatanis analizi urTierTobaSi arsebuli
misi efeqti zustad ar aris dadgenili. problemebis identifikaciis mizniT. SedarebiT axal
medikamenturi mkurnaloba pirovnuli aSlilobis modifikacias mentalizacia ewodeba. is exmareba pa-
dros ganxilulia Semdeg wyaroSi: Tyrer and Bateman, 2004. cients gaerkves Tavis grZnobebSi, rwmenebsa da sur-
vilebSi, iseve, rogorc Tavis reaqciebSi sxva adami-
fsiqologiuri mkurnaloba
anebis mimarT da maT reaqciebSi pacientis qcevaze
mxardamWeri Terapia (Bateman and Fonagy, 2004).
pirovnuli aSlilobis mqone adamianebTan, ZiriTadad, pirovnuli aSlilobis mkurnalobas dinamiuri fsi-
fsiqologiuri mxardaWera gamoiyeneba. zogierTTan qoTerapiis gamoyenebiT Zalian cota kontrolire-
_ 154 _
pirovnuli aSliloba
badi kvleva eZRvneba, ris gamoc rTuldeba daskvnis ris ganmavlobaSi, raTa davadginoT, Tu ra situaciebi
gamotana misi efeqturobis Sesaxeb (Bateman and Tyrer, aRZravs arasasurvel qcevas (mag. agresias). paciente-
2004a). erT-erT xSirad citirebul gamokvlevaSi erT- bi, Cveulebriv, xedaven aseTi praqtikuli midgomis
maneTs udarebdnen xanmokle dinamiur Terapias da efeqturobas da gamokvlevis procesSi TerapevtTan
adaptaciis gaumjobesebaze mimarTul xanmokle Tera- TanamSromloben. Tu kvlevam gamoavlina iseTi fa-
pias. orive maTgani met-naklebad Tanabrad efeqtu- qtorebi, romlebic kidev ufro auaresebs anomaliur
ri gamodga, Tumca sakontrolo jgufTan SedarebiT, qcevas, unda vecadoT maT Scvlas an maTTvis Tavis
ukeTesi Sedegebi aCvena (Winston et al., 1991). aridebas. zogjer gamokvlevis Sedegebi axali midgo-
mis gamoyenebis upiratesobaze miuTiTebs. mag., qale-
kognituri Terapia bis mimarT agresiuli mamakaci SeiZleba gabrazdes,
bekma da frimanma moaxdines kognituri Terapiis ad- Tu is uaryofili iqna qalis mier, xolo es uaryofa
aptacia mis mosargebad pirovnul aSlilobasTan SeiZleba provocirebuli iyos misi mouxeSavi midgo-
(Beck, Freeman, 1990). mkurnalobisas Terapevtebi miT qalis mimarT. konsultirebam da treningma so-
fokusirebulni arian azrovnebasa da rwmenebze, rom- cialuri unar-Cvevebis gaumjobesebaSi, romelic pa-
lebic axasiaTebs pirovnul aSlilobas da safuZvlad cientis mouxeSav qcevaze iqneba mimarTuli, SeiZleba
udevs problemur emociebsa da qcevas. isini cdilo- mas seriozuli daxmareba gauwios.
ben am kogniciebis Secvlas kognituri Terapiis teq-
nikis gamoyenebiT (gv. ??). am wesiT muSaobisas dade- marTvis zogadi miznebi
biTi Sedegebia miRebuli, magram es meTodebi mainc miuxedavad imisa, rom garkveuli progresi SeiniSneba
ar aris efeqturi. mag., saxelmZRvanelos daxmarebiT pirovnul aSlilobebze zemoqmedebis TvalsazrisiT,
Catarebuli kognituri Terapia ar gamodga efeqturi maTi marTva mainc imazea mimarTuli, rom adamianis
TviTdazianebis ganmeorebis Semcirebaze muSaobisas cxovrebis stili ar modiodes winaaRmdegobaSi mis
mosazRvre pirovnuli aSlilobis mqone adamianebTan xasiaTTan. ra mkurnalobasac unda viyenebdeT, dasa-
(Tyrer et al., 2004). xuli miznebi ar unda iyos ambiciuri da maT miRwevas
sakmarisi dro unda davuTmoT. mkurnalobis safuZve-
kognitur-analitikuri Terapia li ndobaze damyarebuli urTierTobaa, magram aseTi
es midgoma (gv. ??) gamoiyenes mosazRvre pirovnuli urTierToba ar unda gadaizardos Terapevtze damo-
aSlilobis mqone adamianebis mimarT (Ryle, 1997), ma- kidebul urTierTobaSi (rogorc, mag., iseTi pirov-
gram misi Rirebuleba ar dadgenila klinikuri kvle- nuli aSlilobisas, romlis drosac pacienti sxvebze
vebis meSveobiT. agreTve, gamoiyeneba sqemaze fokusi- xdeba damokidebuli). amisaTvis Tavis aridebis miz-
rebuli midgoma (Young, 1999), magram isic unda Sefas- niT, Terapevti ar unda xvdebodes pacients zedmetad
des kontrolirebadi kvlevis meSveobiT. xSirad da sifxizles unda iCendes masze damokidebu-
meta-analitikuri kvleva, romelSic Seiswavleboda lebis nebismieri signalis mimarT (gv. ??). jgufuri
pirovnuli aSlilobis mkurnaloba fsiqodinamikuri mkurnaloba zogjer amsubuqebs amgvar problemebs.
meTodiT (14 gamokvleva) da kognituri Terapiis meS- aseT pacientebze zrunvaSi xSirad erTze meti spe-
veobiT (11 gamokvleva) gviCvenebs, rom efeqtis sidide cialisti monawileobs, romlebic pasuxs ageben mkur-
fsiqodinamiuri Terapiis SemTxvevaSi aris 1.46, xolo nalobis farmakologiur, fsiqologiur da socialur
kognituri Terapiis SemTxvevaSi _ 1.00 (Leichsenring, aspeqtebze. specialistebi mWidrod unda TanamSrom-
Leibing; 2003). Tumca, am sidideebs uSualod ver Seva- lobdnen erTmaneTTan, raTa maTi taqtika Tanmimde-
darebT erTmaneTs pacientebis populaciaSi da sxva vruli iyos. am tipis pacientTa umravlesoba cudad
cvladebSi arsebuli gansxvavebebis gamo. reagirebs personalis Secvlaze, ramac SiZleba gaaR-
pirovnuli aSlilobis fsiqologiuri mkurnaloba viZos mtkivneuli mogonebebi warsulSi gancdili da-
ganxilulia Semdeg wyaroSi: (Bateman and Tyrer, 2004a). nakargis, uaryofisa da ganSorebis Ssaxeb.
zogadi gegma. pacients vexmarebiT, rom naklebad
pirovnuli aSlilobis marTva Sevides sirTuleebis Semcvel situaciebSi. misTvis
gamokvleva sasargebloa iseT situaciebSi Sesvla, romlebic avi-
diagnozis dasmis garda unda Sefasdes individis Tarebs pirovnebis Zlier mxareebs. pacientma aqtiuri
Zlieri da susti mxareebi. Zlieri mxareebis codna Za- monawileoba unda miiRos Tavisi samkurnalo gegmis
lian mniSvnelovania, radgan mkurnaloba swored ama- SemuSavebaSi. mas naTlad unda avuxsnaT miRebuli ga-
ze unda iyos dafuZnebuli da susti mxareebis modi- dawyvetilebebis mizezebi da srulad ganvixiloT isi-
fikaciaze mimarTuli. amis Semdeg ikvleven im viTare- ni. pacientma ar unda Seiqmnas damatebiTi sirTuleebi
bas, romelSic pacienti amJamad imyofeba. pacientze alkoholisa da narkotikuli nivTierebis moxmarebis
unda vawarmooT detaluri dakvirveba ramdenime kvi- gamo an arasasurvel urTierTobaSi monawileobiT.
_ 155 _
mas unda ganvuviTaroT Tavisfali drois gamoyenebis progresi
unarebi, xeli SevuwyoT mis Semdgom ganaTlebas da
progresi xSirad safexurebad, nabij-nabij miiRweva. am
socialuri urTierTobebis qselis gafarToebas. Tu
gziT pirovneba uaxlovdeba adaptaciis met-naklebad
sarTod ar SeiniSneba gaumjobeseba, unda vecadoT si-
misaReb xarisxs. Cveulebriv, xdeba ukan daxevac, magram
tuaciis stabilizacias iqamde, sanam raime bednieri
misi gamoyeneba konstruqtiuladaa SesaZlebeli, radgan
SemTxveva ar Secvlis pacientis cxovrebas da ar ga-
swored aseT dros arian adamianebi yvelaze mondome-
aumjobesebs mas.
bulebi gaumklavdnen problemebs. miuxedavad imisa,
fsiqoTerapiis SerCeva. zemoxsenebul procedurebs
rom Terapevti aqtiurad da did xans unda cdilobdes
SegviZlia davamatoT fsiqoTerapiuli Careva fsiqo-
daexmaros am kategoriis pirovnuli aSlilobis mqone
dinamiuri an kognituri Terapiis gamoyenebiT, Tu pa-
adamianebs, mas kargad unda esmodes, rom zogi adamianis
cienti sakmaod motivirebulia da sakmaod stabilu-
mdgomareoba SeiZleba saerTod ar gamoswordes.
rad grZnobs Tavs imisTvis, rom SeZlos mkurnalobaze
fokusireba. fsiqoTerpiuli midgomis SerCeva damoki-
debulia pirovnuli aSlilobis tipze (ix. qvemoT) da
pirovnuli aSlilobis konkretuli
imaze, Tu ras aniWebs Tavad pacienti upiratesobas. tipebis marTva
medikamentebis SerCeva. medikamentebi mcire adgils pirovnuli aSlilobis tipi yovelTvis ar gansaz-
ikavebs pirovnuli aSlilobis mkurnalobaSi. medika- Rvravs mkuranlobis saukeTeso meTods. miuxedavad
meneturi mkurnaloba upirveles saSualebas ar unda amisa, klinikuri gamocdilebis safuZvelze SesaZle-
warmoadgendes, aramed unda Sediodes mzrunvelobis belia garkveuli daskvnebis gamotana, romlebic qve-
ufro farTo gegmaSi, romelic fsiqologiur da so- moT iqneba ganxiluli.
cialur zrunvas moicavs. gansakuTrebuli sifrTxi-
liT unda gamoviyenoT anqsiolizuri medikamentebi paranoiduli pirovnuli aSliloba
maTze damokidebulebis ganviTarebis riskis gamo. anam aSlilobis mqone pacientebis CarTva mkurnalo-
tidepresentebs, ZiriTadad, asocirebuli guneb-ganwy- bis procesSi Zalian rTulia, maTi eWviani bunebisa
obis aSlilobis dros iyeneben, romelic gamoixateba da advilad gaRizianebis gamo. Tu es moxerxda, mxar-
pirovnul aSlilobasTan dakavSirebuli emociuri da damWerma mkurnalobam SeiZleba xeli SeuSalos iseTi
qceviTi problemebis gauaresebaSi (mosazRvre pirov- problemebis akumulirebas, romlebic sxva adamiane-
nuli aSlilobis dros antidepresentebis gamoyeneba bis mimarT pacientis eWviani da braziani damokiebu-
qvemoTaa ganxiluli). zogjer sasargebloa antifsiqo- lebiTaa gamowveuli.
zuri medikamentebis gamoyeneba agresiuli qcevis Se-
sasusteblad. maTi gamoyenebis es da sxva konkretuli Sizoiduri pirovnuli aSliloba
SemTxvevebi zemoT iyo ganxiluli (nawilSi mkurnalo- am tipis aSlilobis mqone adamianebi eridebian axlo
bis Sesaxeb). maTze qvemoTac iqneba saubari konkretu- urTierTobas da xSirad eTiSebian mkurnalobas ramde-
li pirovnuli aSlilobebis mkurnalobis konteqstSi. nime seansis Semdeg. Tu maT davarwmunebT gaagrZelon
servisebis organizeba. pirovnuli aSlilobis mqo- mkurnaloba, isini iwyeben sakuTari problemebis inte-
ne adamianebis mkurnaloba SeuZlia calkeul praqti- leqtualizacias da eWvis Setanas mkurnalobis Rire-
koss, romelic pasuxismgebeli iqneba mkurnalobis bulebaSi. Terapevti unda daexmaros aseT adamianebs
fsiqologiur, farmakologiur da socialur mxare- sakuTari problemebis gacnobierebaSi da maTze imgvar
ze da saWiroebis SemTxvevaSi daxmarebisTvis spe- reagirebaSi, romelic rac SiZleba nakleb sirTules ga-
cialists mimarTavs. es gauadvilebs mas pacientis moiwvevs. saukeTeso SemTxvevaSi mkurnalobis procesi
urTierTobebis gagebas da mis daxmarebas, radagan, nelia, xolo Sedegebi _ umniSvnelo. kvleviTi fsiqo-
pirovnebis problemebis nebismier mravalferovne- Terapia, savaraudod, warumatebeli unda iyos, xolo
bas, saboloo jamSi, erTi safuZveli gaaCnia. Tumca, medikamenturi mkurnaloba, zogadad, araefeqturia.
praqtikosisTvis SeiZleba gaZneldes aseTi wesiT mu-
Saoba, Tu pirovnuli aSliloba kidev ufro damZimda. antisocialuri (disocialuri) pirovnuli
aseT SemTxvevaSi, pacientze zrunvas kisrulobs Temis
aSliloba
doneze momuSave jgufi, romlis centraluri wevri
mkurnaloba, Cveulebriv, moicavs zemoT aRweril
koordinacias gauwevs jgufis wevrebis muSaobas. zog
zomebs. medikamentebi nakleb efeqturia, Tumca an-
adgilas moqmedebs specialistTa jgufebi, romelTa
tifsiqozurma preparatebma SeiZleba iqonios droe-
wevrebi damatebiT daxmarebas uweven pirovnuli aSli-
biTi damamSvidebeli zemoqmedeba agresiul qcevaze,
lobis mqone adamianebs. pirovnuli aSlilobis mqone
romelic Cndeba mzardi stresis sapasuxod, xolo
adamianebisTvis gankuTvnili servisebi ganxilulia
antidepresantebi, SeiZleba, saWiro gaxdes komorbi-
Semdeg wyaroSi: (Bateman and Tyrer, 2004b).
_ 156 _
pirovnuli aSlilobis konkretuli tipebis marTva
duli depresiuli aSlilobis dros. iTvleba, rom zo- isteriuli pirovnuli aSliloba
gierT pacientTan liTiumi asustebs agresiul qcevas aseTi pacientebi zedmetad maRal moTxovnebs uyene-
(gv. ??), Tumca is mxolod maSin unda dainiSnos, Tu ben TavianT momvlelebs. isini xSirad cdiloben Tavs
pacienti zustad daicavs dozas da usafrTxoebasTan moaxvion personals mkurnalobasTan dakavSirebuli
dakavSirebul moTxovnebs (gv. ??). unda veridoT an- arapraqtikuli pirobebi, iTxoven Seusabamo wamals
qsiolizuri preparatebis gamoyenebas, radgan isini da Seuferebel dros moiTxoven daxmarebas. sxva pro-
ganmuxruWebasa da damokidebulebas iwvevs. blemebia uadgilod momxibvleli qceva, TviTdazian-
Sesabamisi resursebis arsebobisas, SegviZlia gamo- ebis muqara da mcdeloba usafuZvlod gaaxangrZli-
viyenoT individualuri an jgufuri Terapia, magram vo interviu. mniSvenlovania am problemebis adreul
misi Sedegebi naTeli ar aris. antisocialuri (diso- etapze identificireba, radgan Tu isini damkvidrda,
cialuri) pirovnuli aSlilobis mkurnalobisas unda maTi marTva Zalian rTuli xdeba. am tipis qcevebi pa-
gaviTvaliswinoT Semdegi: cientTan erTad unda ganvixiloT. mas unda naTlad
individualuri fsiqoTerapia avuxsnaT, rom samedicino persanali mas aucileblad
gauwevs saWiro daxmarebas, magram misi zogierTi qce-
es aris dinamiuri fsiqoTerapiis modificirebuli
va arasodes CaiTvleba misaRebad. aseT pacientebTan
forma, romelic gulisxmobs pacientis ganmeorebiT
unda veridoT individualuri analizuri fsiqoTera-
dapirispirebas Tavisi anomaliuri qcevis SedegebTan.
piis gamoyenebas. mkurnaloba unda warimarTos stre-
individualuri fsiqoTerapia sakamaod efeqturia.
sul situaciebze adaptaciuri reaqciebis SemuSavebis
is momdinareobs Smidebergis (Schmideberg, 1947) naS-
mimarTulebiT. medikamentebi naklebad gamoiyeneba,
romidan da moiTxovs iseT Terapavets, romelic ne-
Tu ar gvaqvs saqme komorbidul depresiul aSlilo-
bisyofian da Zlier pirovnebas warmoadgens. am tipis
basTan.
Terapiis dadebiTi Sedegebi jer-jerobiT ar yofila
specialuri kvleviT dadasturebuli.
mosazRvre pirovnuli aSliloba
Terapia mcire jufebSi mosazRvre pirovnuli aSlilobis marTvasTan dakav-
antisocialuri pirovnuli aSlilobis dros mcire Sirebuli problemebi isteriuli pirovnuli aSli-
jufebSi Terapiis Catareba iSviaTad aris efeqturi. lobisTvis damaxasiaTebeli problemebis msgavsia.
pacientebi xSirad xels uSlian jgufis sxva wevre- Tumca, mosazRvre pirovnuli aSlilobis dros Tera-
bis muSaobas. mxolod antisocialuri pacientebisgan piuli meTodebis arCevani ufro farToa. zogjer, sa-
Sedgenili jgufi, zogjer, ufro konstruqciulia, ma- sargebloa problemis gadaWraze mimarTuli konsul-
gram misi muSaobis warmarTva rTulia. Terapevts unda tirebis gamoyeneba (gv. ??). antifsiqozuri preparate-
gaaCndes sakmaod safuZvliani zogadi xasiaTis fsiqo- bis mcire dozam SeiZleba xanmokle droiT Seasustos
Terapiuli unar-Cvevebi da sgangebod iyos gawrTvnili agresiuli qceva. SegviZlia gamoviyenoT serotoninis
aseTi Semadgenlobis jgufebTan muSaobaSi. ukumitacebis seleqciuri inhibitorebi, radgan isini
amcirebs zogierT pacientTan impulsur qcevas (gv.
Terapiuli Temi ??). unda veridoT anqsiolizuri medikamentebis ga-
zogierTi adre daarsebuli Terapiuli Temi (mag., hen- moyenebas, radgan maT SeiZleba ganmuxruWebisa da da-
dersonis saavadmyofo inglisSi) specializebulia an- mokidebulebis efeqti gamoiwvion. maTi daniSvnisas,
tisocialuri pirovnuli aSlilobis mkurnalobaSi. am medikamentis miReba ufro farTo samkurnalo gegmis
tipis mkurnalobis principebi mocemulia ?? gverdze. nawils unda warmoadgendes.
jer-jerobiT ar Catarebula Terapiul TemSi mkur- Sesabamisi resursebis arsebobisas SegviZlia mov-
nalobis kontrolirebadi Sefaseba, ris gamoc Znelia sinjoT ramdenime saxis fsiqologiuri mkurnaloba,
daskvnis gamotana misi efeqturobis Sesaxeb. miuxedavad imisa, rom arc erT maTgans ar axasiaTebs
mniSvnelovani da sando efeqti.
jgufuri Terapiis reJimi
inglisis grendonis sapyrobileSi jgufuri meTode- dinamiuri fisqoTerapia
bi gamoiyenes avtoritarul garemoSi mcxovrebi pi- mosazRvre pirovnuli aSlilobis mqone adamianebi
rovnuli aSlilobis mqone patimrebis mimarT maTi ar reagireben dinamiuri fsiqoTerapiis Ceulebriv
mkurnalobisa da reabilitaciis mizniT. am tipis pa- formebze, xolo araprofesiulma mkurnalobam SeiZ-
cientebTan ar gamodga efeqturi sxva tipis reJimSi leba gamoiwvios emociebis kontrolis Sesusteba da
muSaoba. mocemul SemTxvevaSi dadebiTi Sedegebi iqna impulsurobis zrda. kernbergma (Kernberg, 1993) aR-
miRebuli, Tumca, jer ar Catarebula kontrolire- wera alternatiuli midgoma aseTi pacientebis mi-
badi gamokvleva, romelic am Sedegebis efeqturobas marT, romlis gamoyenebisas nakleb savaraudoa ase-
daadasturebda. Ti uaryofiTi Sedegebis miReba, miuxedavad imisa,
_ 157 _
rom Terapiis procesi ZiriTad fsiqopaTologiaze obsesiuri pirovnuli aSliloba
moqmedebs. aseT midgomas ewodeba eqspresiuli fsi- am tipis pirovnuli aSlilobis mqone pirebisTvis
qoTerapia. iTvleba, rom is kargi Sedegebis momtania fsiqoTerapia ar aris efeqturi. araprofesiulma
(Stone et al., 1987), magram jer-jerobiT ar Catarebula mkurnalobam SeiZleba gamoiwvios intensiuri avad-
Sesabamisi randomizebuli kontrolirebadi kvleva. myofuri introspeqcia, rac namdvilad ar aumjobe-
dinamiuri fsiqoTerapiis gamoyeneba mosazRvre piro- sebs pacientis mdgomareobas. mkurnaloba mimarTuli
vnuli aSlilobisas ganxilulia Semdeg wyaroSi: Hig- unda iyos iseTi situaciebis acilebaze, romlebic
gitt, Fonagy, 1993. aRrmavebs pacientis sirTuleebs, da, agreTve, stre-
jgufuri fsiqoTerapia sul situaciebTan ukeTes gamklavebaze. pacientebi
xSirad iTxoven daxmarebas asocirebuli depresiuli
aseTi tipis mkurnalobas is upiratesoba aqvs, rom ga-
aSlilobis dro. Zalian mniSvnelovania am komorbidu-
datanis urTierToba Terapevtze fokusirebis nacv-
li mdgomareobis identifikacia da mkurnaloba.
lad jgufze nawildeba. jgufis komentarebi pacien-
tis mier qcevaSi emociebis gamotanis Sesaxeb SeiZleba
acilebadi (SfoTviTi) pirovnuli aSliloba
misTvis ufro misaRebi iyos, vidre Terapevtis ko-
mentarebi. Terapevts sWirdeba kargad ganviTarebuli aseT pacientebs, Cveulebriv, dabali TviTSefase-
profesiuli unar-Cvevebi mosazRvre pirovnuli aSli- ba aqvT da kritikis eSiniaT. maT daxmarebas gauwevs
lobis mqone pacientisTvis daxmarebis gasawevad, raTa iseTi Terapiuli urTierToba, romlis drosac isi-
aseT pacientebTan jgufuri muSaobisas jgufis sxva ni Rirebulad igrZnoben Tavs da SeZleben sakuTari
wevrebis mkurnalobis xarisxi ar gauaresdes. jgufSi, aRqmisa da sakuTari Tavis axleburad danaxvas. zogi
Cveulebriv, imyofeba mosazRvre pirovnuli aSlilo- pacienti Tavs anebebs mkurnalobas, radgan kritiki-
bis mqone mxolod erTi pacienti. mimoxilvisTvis ix. sa da uaryofis eSinia. Cven winaswar unda gaviTvals-
Clarkin et al., 1991. winoT aseTi gancdebis aRmocenebis SesaZlebloba
da konstruqciulad ganvixiloT pacientTan erTad,
dialeqtikuri bihevioruli Terapia rogorc ki Tavs iCenen. Terpavets ar unda gamorCes
am tipis Terapia ?? gverdzea aRwerili. es aris is iS- komorbiduli depresiuli aSliloba, romelic mkur-
viaTi SemTxveva, rodesac mkurnalobis meTodma gaia- nalobas saWiroebs.
ra Sefaseba kontrolirebadi kvlevis meSveobiT. kon-
trolirebadi kvleva Catarda mosazRvre pirovnuli sxvaze damokidebulebis aSliloba
aSlilobis mqone qalebze, romlebTanac dafiqsirda dinamiurma fsiqoTerapiam SeiZleba gaaZlieros pa-
suicidis ganmeorebiTi epizodebi. dialeqtikuri bi- cientis sxvaze damokidebuleba. aseT pacientebTan
hevioruli Terapia ufro efeqturi gamodga sakon- sjobs gamoviyenoT problemis gadaWraze orientire-
trolo mkurnalobasTan SedarebiT TviTdazianebis buli konsultireba, romelic xels uwyobs sakuTar
reduqciis dros, magram uSualod ar Sefasebula ze- Tavze ufro meti pasuximgeblobis aRebas. unda veri-
moqmedeba Tavad pirovnul aSlilobaze. ufro grZel- doT medikamentebis gamoyenebas, garda im SemTxvevisa,
vadianma Semdgomma gamokvlevam aCvena, rom Terapiis rodesac aRiniSneba asocirebuli depresiuli aSli-
procesSi miRebuli efeqtebis umetesoba xangrZlivi loba.
drois manZilze ar narCundeba (Linehan et al., 1991).
eTikuri problemebi
fsiqoanalitikuri orientaciis mqone dRis
mkurnaloba stigma da pacientis CarTuloba
am tipis mkurnaloba warmoadgens analitikuri jgu- moraluri SeSlilobis adreuli ideebidan moyole-
furi da fsiqoanalitikuri individualuri mkur- buli, pirovnuli aSlilobis cneba dakavSirebulia
nalobis kombinacias. misi mizania pacientis daxmareba moralur SefasebasTan. rodesac adamianebs pirov-
sxva adamianebis Sinagani mdgomareobis ukeT gagebaSi. nuli aSlilobis diagnozs usvamen, maT hgoniaT, rom
es mkurnaloba ganmtkicebulia mcire randomizebuli raRaca saxis ukmarisoba axasiaTebT. es problema ais-
kontrolirebadi kvleviT, romelic mosazRvre piro- axeba zogierTi profesionalis damokidebulebaSi da
vnuli aSlilobis mqone pacientebzea Catarebuli. pa- im sirTuleebSi, romelsac aseTi adamianebi awydebian
cientebi aCveneben gaumjobesebas yvela testirebul fsiqiatriuli da sxva saxis momsaxurebis miRebisas.
sferoSi mkurnalobidan 18 Tvis Semdeg (Bateman and pirovnuli aSlilobis diagnozi zemoqmedebs pacien-
Fonagy, 1999). mkurnalobis dadebiTi Sedegebi Senar- tis mimarT gaweul mzrunvelobaze da sxvaTa warmod-
Cunda an gaumjobesda 18-Tviani Semdgomi dakvirvebis genaze maT Sesaxeb. amis gamo, bevri klinicisti Tavs
periodSi (Bateman and Fonagy, 2001). ikavebs aseTi diagnozis dasmisgan. pacientebis mzar-
_ 158 _
danarTi
di CarTuloba servisis miwodebisa da kvlevis dagegm- danarTi
vaSi, romelic, nawilobriv, Terapiuli Temis moZrao-
bidan momdinareobs, SeiZleba am uaryofiTi mxareebis boqsi 7.1 pirovnuli aSlilobis
SesustebaSi dagvexmaros. gansakuTrebiT mniSvnelova- diagnostirebis zogierTi instrumenti
nia wavaqezoT pacienti, rom man monawileoba miiRos
pirovnuli aSlilobis saerTaSoriso kvleva (International
Tavis movlasaTan dakavSirebuli gadawyvetilebe- Personality Disorders Examination. Laranger et al., 1994)
bis miRebaSi. es fsiqikuri aSlilobis Tanamedrove
w ikvlevs DSM-IV-Si da/an ICD-10-Si Semaval pirovnul
marTvis mTavari elementia da misi mniSvneloba kidev aSlilobebs kategoriebis da/an ganzomilebebis mixe
ufro izrdeba pirovnuli aSlilobis marTvisas. dviT;
w naxevrad struqturirebuli klinikuri intervius
damatebiTi literatura ori versia: DSM-IV-is versia, romelic Sedgeba 99
kiTxvisgan da ICD-10-is versia, romelSic 67 kiTxva
Gelder, MG, Lopez-Ibor, JJ Jr and AndreasenNC (eds) (2000).
Sedis. TiTo versiaSi Sedis kiTxvari skriningisaTvis.
The new Oxford textbook of psychiatry, Section 4.12: Person-
maT iyeneben iseTi pirebis identificirebisaTvis,
ality disorder. Oxford University Press, Oxford. (wignis am romlebsac nakleb savaraudoa, rom aReniSnebodeT
nawilis Svid TavSi mocemulia pirovnuli aSlilo- pirovnuli aSliloba.
bis farTo mimoxilva)
struqturirebuli klinikuri interviu DSM-IV-is II
Gunderson, JG and Hoffman, PD (eds) (2005) Understand-
RerZSi Semavali pirovnuli aSlilobebisaTvis (Structured
ing and treating borderline personality disorder; a guide for
Clinical Interview for DSM-IV Axis II P Personality Disorders
professional and families. American Psychiatric Publishing,
(SCID-II) (First et al., 1995)
Washington DC.
w ikvlevs DSM-IV-Si pirovnul aSlilobebs kategoriebis
Schneider, K (1950) Psychopathic personalities (trans. MW da/an ganzomilebebis mixedviT;
Hamilton). Cassell, London. (es aris ganuzomlad didi
w naxevrad struqturirebuli klinikuri interviu,
mniSvnelobis mqone klasikuri teqsti pirovnul romelSic Sedis 119 kiTxva. masSi Sedis kiTxvebi
aSlilobasTan dakavSirebuli mosazrebebis ganvi- skriningisaTvis. maT iyeneben iseTi pirebis iden
Tarebis Sesaxeb). tificirebisaTvis, romlebsac nakleb savaraudoa, rom
Tyrer, P (ed.) (2000) Personality disorders, disagnosis, manage- aReniSnebodeT pirovnuli aSliloba.
ment and course, 2nd edn. Butterworth _ Heinemann, Oxford.
struqturirebuli klinikuri interviu DSM-IV-Si
(am wignSi warmodgenilia mocemuli Temis sistem-
Semavali pirovnuli aSlilobebisaTvis (Structured Clinical
uri mimoxilva da gamomcemlis mier mowodebuli Interview for DSM-IV Personality (SIDP - IV) (Pfohl Et al, 1997)
pirovnebis kvlevis sqema).
w ikvlevs DSM-IV-Si da ICD-10-Si Semaval pirovnul aS
lilobebs kategoriebis an ganzomilebebis mixedviT;
w naxevrad struqturirebuli klinikuri interviu, ro
melSic Sedis 101 kiTxva Tematur versiaSi da 107 kiTxva
aSlilobebis mixedviT dalagebul versiaSi.
damatebiTi informacia pirovnuli aSlilobis sakvlevi
am da sxva instrumentebis Sesaxeb mocemulia Semdeg
wyaroSi: Task Force for Psychiatric Measures (2000). Chapter 32.
_ 159 _
Tavi 8 reaqcia stresul
gamocdilebaze
Tavis Sinaarsi
reaqcia stresul movlenebze etiologia
emociuri da somaturi reaqciebi gamokvleva
daZlevis strategiebi mkurnaloba
dacviTi meqanizmebi reagireba gansakuTrebuli
amJamindeli viTareba, warsuli gamocdileba tipis mZime stresze
da reaqcia stresul movlenebze gaupatiureba da fizikuri Zaladoba
stresul movlenebze sapasuxo omi da sxva saxis SeiaraRebuli konfliqti
reaqciebis klasifikacia ltolvilebTan da wamebis
mwvave reaqcia stresze msxverplTan dakavSirebuli problemebi
posttravmuli stresuli aSliloba adaptaciis aSliloba
adaptaciis aSliloba klinikuri suraTi
mwvave stresuli reaqcia da diagnostikuri kategoriebi
mwvave stresuli aSliloba ICD-10-isa da DSM-IV-is mixedviT
klinikuri suraTi epidemiologia
diagnostika ori klasifikaciis mixedviT etiologia
epidemiologia prognozi
etiologia mkurnaloba
mkurnaloba gansakuTrebuli tipis adaptacia
marTva fizikur daavadebasa da
posttravmuli stresuli aSliloba fizikur defeqtTan adaptacia
sxva saxis reaqciebi mwvave stresze adaptacia fizikuri daavadebis debiutTan
posttravmuli stresuli adaptacia letalur daavadebasTan
aSlilobis klinikuri suraTi glova da mZime danakargTan adaptacia
diagnozi xangrZlivi adaptacia bavSvobaSi
epidemiologia gadatanil seqsualur ZaladobasTan
stresuli movlenebi xSirad iwvevs fsiqikur aSli- moicavs. Semdeg ganxilulia reaqciebi stresul mov-
lobas. maT, agreTve, SeiZleba gamoiwvion uaryofiTi lenebze, sxvadasxva sindromebi, romlebSic Sedis mw-
emociuri reaqciebi, romelic, TavianTi xasiaTidan vave stresuli reaqciebi, posttravmuli stresuli
da simZimidan gamomdinare, ar iZleva imis sakmaris aSliloba, mZime stresze reagirebis gansakuTrebuli
safuZvels, rom daisvas SfoTviTi aSlilobis an gun- formebi da adaptaciis darRvevebi. bolos ganxilu-
eb-ganwyobis aSlilobis diagnozi. msgavsi, naklebad lia gansakuTrebuli tipis adaptaciuri reaqciebi,
mwvave reaqciebi, posttravmul stresul aSlilobas- romlebic moicavs adaptacias mZime danakargTan da
Tan erTad (romelic intensiuri da xangrZlivi reaq- letalur daavadebebTan; aseve, im zrdasruli adami-
ciaa mwvave stresorze) mocemul TavSia ganxiluli. am anebis problemebi, romelTac bavSvobaSi seqsualuri
TavSi aRwerili yvela fsiqikuri mdgomareoba, garda Zaladoba gadaitanes.
normaluri glovis reaqciisa, kategorizirebulia
DCM-IV-sa da ICD-10-is klasifikaciebSi, rogorc reaqcia stresul movlenebze
fsiqikuri aSliloba.
reaqcia stresul movlenebze sami komponentisgan
mocemuli Tavi iwyeba stresul movlenebze sapasuxo
Sedgeba:
reaqciis zogierTi komponentis aRweriT, romlebic
daZlevis strategiasa (kopingi) da dacviT meqanizmebs 1. emociuri xasiaTis reaqcia, romelsac Tan axlavs
somaturi cvlilebebi;
_ 160 _
reaqcia stresul movlenaze
2. daZlevis strategia; sxva adamianTan saubari da emociis gamoxatva.
3. dacviTi meqanizmi. w problemis Sefaseba _ imis dadgena, Tu ra SeiZleba
daZlevis strategiisa da dacviTi meqanizmebis Seicvalos da ra _ ara. SesaZlebeli cvlilebebis
cnebebi nawilobriv gadafaravs erTmaneTs, magram, ganxorcielebis mcdeloba problemis gadaWris gziT
radgan sxvadasxva Teorias miekuTvneba, cal-calke da Segueba imasTan, risi Secvlac SeuZlebelia.
iqneba ganxiluli. w problemis pozitiuri gadafaseba _ imis gacnobiere-
ba, rom problema SeiZleba raime sasikeTos momtani
emociuri da somaturi reaqciebi iyos. mag., samsaxuris dakargvam SeiZleba SesaZle-
arsebobs ori tipis sapasuxo reaqcia: SfoTviTi, bloba mogvces, ukeTes saqmianobas movkidoT xeli.
romelsac Tan axlavs vegetatiuri nervuli siste- w problemis Tavidan acileba _ problemis Sesaxeb
mis agzneba, rac iwvevs mosalodneli saSiSroebis fiqrze uaris Tqma; problemis gamomwvevi adamian-
gancdas, gaRizianebadobas, taqikardias, kunTebis ebisTvis Tavis arideba; an im situaciebisTvis, rom-
tonusis matebas da piris simSrales; da depresiuli lebmac SesaZloa gamoiwvion problemis gaxseneba.
reaqcia, romelsac Tan axlavs pesimisturi azrebi da daZlevis strategiebi, Cveulebriv, sasargebloa
fizikuri aqtivobis daqveiTeba. SfoTviTi reaqcia, problemis gadasaWrelad an emociuri reaqciis Sesa-
Cveulebriv, xifaTis Semcvel movlenebTan aris daka- susteblad. miuxedavad amisa, is yovelTvis ar asru-
vSirebuli, maSin, rodesac depresiuli reaqcia daka- lebs adaptaciur funqcias. mag., adreul stadiaze
vSirebulia iseT movlenebTan, rogoricaa ganSoreba somaturi daavadebis ugulvebelyofa ver iqneba adap-
an danakargi. am reaqciebis maxasiaTeblebi igivea, rac taciuri, vinaidan aman SeiZleba Seaferxos Sesabamisi
SfoTviTi da depresiuli aSlilobis simptomebi (aR- mkurnalobis droulad dawyeba. aqedan gamomdinare,
werilia mecxre da meTerTmete TavebSi), magram, isini pirovnebam unda SeZlos ara mxolod daZlevis strat-
nakleb intensiuria. egiebis gamoyeneba, aramed imis daadgenac, Tu romeli
strategia Seesabameba mocemul viTarebas.
daZlevis strategiebi
daZlevis strategiebi stresuli movlenebis zemo- gamklavebis araadaptaciuri strategiebi
qmedebis Sesustebas emsaxureba; arbilebs emociur aseTi strategiebi droebiT asustebs stresul mov-
da somatur reaqciebs da met-naklebad aadvilebs lenebze emociur reaqcias, magram SemdgomSi ufro
normalur funqcionirebas (Tumca, ara grZelvadian did sirTuleebamde mivyavarT.
perspeqtivaSi, ix. qvemoT). termini `daZlevis strat- gamklavebis araadaptaciuri strategiebia:
egiebi~ socialur fsiqologiaSi Catarebuli kvlevis w alkoholis an medikamentebis gamoyeneba (romle-
Sedegad warmoiqmna da pirovnebis gacnobierebul bic eqimis mier ar aris daniSnuli) emociuri reaq-
aqtivobas gulisxmobs (mag., stresorisTvis Segnebu- ciis Sesasusteblad an stresuli viTarebis gac-
lad Tavis arideba). pirovnebis aracnobier reaqciebs, nobierebis Sesamcireblad.
romlebic qvemoT iqneba ganxiluli, dacviTi meqa- w ganzrax TviTdazianeba wamlis dozis gadaWarbebis
nizmebi ewodeba. an sxeulis dazianebis gziT. zogi adamiani, imisaT-
daZlevis strategiebi ori tipisaa: problemis vis, rom daZabuloba Seimsubuqos, basri instrumen-
gadaWraze mimarTuli strategiebi, romelTa moq- tiT iseravs kans da amiT iwvevs tkivilsa da sisx-
medebis Sedegad araxelsayreli viTareba naklebad ldenas. zogi wamlis gadaWarbebul dozas iRebs,
stresuli xdeba da emociis Sesustebis strategiebi, raTa situacias Tavi daaRwios an gaagebinos sxvebs,
romlebic aqveiTebs stresoris sapasuxo emociur rom daxmareba sWirdeba.
reaqciebs.
w emociebis TavSeukaveblad gamoxatvas SeuZlia daZ-
problemis gadaWris strategiebia:
abulobis Sesusteba. zog sazogadoebaSi aseTi qceva
w daxmarebis Zieba; sruliad misaRebia garkveuli garemoebebis dros
w iseTi informaciisa da rCevebis moZieba, romlebic (mag., glovis dros). imave qcevam gansxvavebul viTa-
problemis gadawyvetaSi dagvexmareba; rebaSi SeiZleba gaafuWos urTierToba iseT adami-
w problemebis gadaWra _ problemis gadasaWreli geg- anTan, romelic sxva SemTxvevaSi daxmarebis aRmoCe-
mebis SemuSaveba da ganxorcieleba; nas moisurvebda.
w konfrontacia _ sakuTari uflebebis dacva da sxva w agresiuli qceva sibrazis gancdis myisier Sesuste-
adamianebis darwmuneba, Secvalon sakuTari qceva. bas iwvevs, magram mis gamo pirovneba SeiZleba moma-
emociis Sesustebis strategiebia: valSi ufro meti sirTuleebs waawydes da urTier-
Tobebi gaufuWdes.
w emociebisgan gantvirTva, èmociuri ventilacia~ _
_ 161 _
8 reaqcia stresul gamocdilebaze
daZlevis stili siis, uaryofis, gadatanis, proeqciisa da regresiis

meqanizmebs iyeneben. dacviTi meqanizmebi aracnobieri
rodesac erTi da igive adamiani sxvadasxva situaci-
procesebia, rac imas niSnavs, rom maTi gamoyeneba
aSi erTsa da imave daZlevis meqanizms iyenebs, iTv-
ganzrax ar xdeba da gamoyenebis realuri motive-
leba, rom mas daZlevis (kopingis) garkveuli stili
bi ar aris gacnobierebuli. miuxedavad amisa, isini
aqvs Camoyalibebuli. zogierTi adamiani gamklavebis
SeiZleba mogvianebiT gacnobierdes introspeqciis
strategiebs viTarebis mixedviT cvlis. mag., samsax-
gziT an sxvaTa axsna-ganmartebis Sedegad. naSromSi
urSi iyenebs problemis gadaWris strategias, magram,
`yoveldRiuri cxovrebis fsiqopaTologia~, froidma
rodesac cudad grZnobs Tavs, ganridebis strategias
mogvca dacviTi meqanizmebis gansazRvreba. es ter-
mimarTavs. zogi adamiani, Cveulebriv, gamklavebis
mini man gamoiyena mexsierebaSi uecari Cavardnebisa
araadaptaciur strategiebs iyenebs (mag., stresis
da wamocdenebis mimarT. dacviTi meqanizmebis cnebis
dros Warbad miiRebs wamals an alkohols). daZlevis
gamoyeneba sasargeblo aRmoCnda stresSi myofi ada-
strategiebi ganxiluli aqvs lazaruss (Lazarus, 1993).
mianebis yoveldRiuri qcevis sxvadasxva aspeqtis gas-
mogvianebiT mecnierebma ganasxvaves erTmaneTisgan
agebad, gansakuTrebiT ki iseTi adamianebis, romleb-
`daZlevis stili~, romelic ganixileba, rogorc qce-
sac fizikuri an fsiqikuri daavadeba aqvT. am cnebas
vis SedarebiT mdgradi maxasiaTebeli da `daZlevis
froidi iyenebda agreTve fsiqikuri aSlilobis eti-
reaqcia~, romelic specifikuri xasiaTis reaqciaa
ologiis asaxsnelad, magram am SemTxvevaSi is nak-
konkretul stresul viTarebaze (Beutler et al., 2003).
lebad sasargeblo aRmoCnda.
dacviTi meqanizmebi ZiriTadi dacviTi meqanizmebi ganmartebulia boqsSi 8.1.
dacviTi meqanizmebi (boqsi 8.1) esaa aracnobieri reaq-

cia gare stresorze an SfoTvaze, romelic Sinagani
amJamindeli viTareba, warsuli gamocdileba
konfliqtiT aris gamowveuli. pirvelad es meqanizme- da reaqcia stresul movlenebze
bi zigmund froidma aRwera, xolo mogvianebiT, ufro braunma da harisma (Brown and Harris 1978) gvaCvenes, rom
detalurad, misma qaliSvilma _ ana froidma (A. Freud, cxovrebiseul stresul movlenebze reagireba modi-
1936). stresze reaqciis dros yvelaze xSirad repre- ficirdeba amJamindeli viTarebisa da warsuli gamoc-
regresia aris iseTi qcevebis gaTaviseba, romlebic

boqsi 8.1 dacviTi meqanizmebi ganviTarebis ufro adreuli periodisaTvis aris
represia gulisxmobs iseTi impulsebis, emociebis Sesaferisi (magaliTad, sxvebze damokidebuleba). regresias
an mogonebebis cnobierebidan gandevnas, romlebic xSirad vxvdebiT fizikurad daavadebul adamianebTan.
potenciurad uaryofiTi gancdebis gamomwvevia. daavadebis gamwvavebis dros mas SeiZleba adaptaciuri
magaliTad, gansakuTrebiT mtkivneuli mogonebebi funqcia hqondes, radgan pacienti ufro damyoli xdeba
bavSvobaSi gadatanili seqsualuri Zaladobis Sesaxeb medikamentur an sxva saxis mkurnalobaze. rodesac regresia
SeiZleba cnobierebidan didi xniT ganidevnos. gamojanmrTelebis an reabilitaciis stadiazec grZeldeba,
is SeiZleba araadaptaciuri gaxdes, radgan asustebs
uaryofa represiasTan dakavSirebuli cnebaa. uaryofis pacientis Zalisxmevas, daexmaros sakuTar Tavs.
dros pirovneba ise iqceva, TiTqos man araferi icis imis
Sesaxeb, rac, wesiT, unda icodes. magaliTad, man icis, rom reaqciis formireba iseTi aracnobieri qcevaa, romlis
avTvisebiani simsivnisagan iRupeba, magram ise agrZelebs drosac adamiani sakuTari moqmedebiT Tavis grZnobebsa
cxovrebas, TiTqos arc ki gaugia Tavisi diagnozi. da gancdebs srulad ewinaaRmdegeba. magaliTad, seqsis
mocemul situaciaSi uaryofas adaptaciuri funqcia aqvs, mimarT gadametebuli mgrZnobeloba zogjer (magram ara
radgan man SeiZleba depresiis Sesustebas Seuwyos xeli, yovelTvis) warmoadgens pirovnebis reaqcias sakuTar,
magram avadmyofobis adreul stadiaze uaryofam SesaZloa misTvis miuRebel, seqsualur impulsebze.
ganapirobos is, rom adamianma uari Tqvas aucilebeli
gamokvlevebisa da mkurnalobis Catarebaze. am SemTxvevaSi racionalizacia aris miuRebeli qcevisaTvis mcdari,
uaryofa araadaptaciuri iqneba. magram pirovnebisTvis misaRebi axsnis aracnobierad
moZieba. magaliTad, qmars ar dahyavs coli wveulebebze,
gadatana - pirovnebasTan, obieqtsa an situaciasTan radgan ar siamovnebs misi sazogadoeba, magram arwmunebs
dakavSirebuli emociis gadatanaa sxva wyaroze. magaliTad, sakuTar Tavs imaSi, rom misi coli morcxvia da Tavad ar
mamakacma, romelsac coli axlaxans gardaecvala, SeiZleba siamovnebs gareT gasvla.
eqimi mkurnalobis arasworad warmarTvaSi daadanaSaulos,
raTa Tavidan aicilos sakuTari Tavis dadanaSauleba imis sublimacia aris miuRebeli impulsebis aracnobieri
gamo, rom bolo erTi Tvis ganmavlobaSi, colis movlaze gardaqmna iseT impulsebad, romlebic ufro misaRebia
ufro win sakuTar saqmes ayenebda. pirovnebisTvis. amis magaliTia organizaciaSi sxvebze
mbrZaneblobis survilis Canacvleba saqvelmoqmedo
proeqcia aris sakuTari azrebis an gancdebis sxva saqmianobiT (Tumca, ra Tqma unda, saqvelmoqmedo
adamianisaTvis miwera, raTa isini ufro misaRebi gaxdes. saqmianobis bevri sxva motivic arsebobs).
magaliTad, pirovneba, romelsac ar moswons Tavisi kolega,
sakuTar uaryofiT emociebs mas miawers. amis Semdeg ufro identifikacia aris sxva adamianis Tvisebebis an qmedebebis
ioli xdeba kolegis mimarT uaryofiTi damokidebulebis aracnobieri gaTaviseba, rac xSirad am adamianTan ganSorebis
gamarTleba. an misi dakargvis gamo gamowveuli tkivilis Semcirebas
emsaxureba. magaliTad, qvrivma SeiZleba xeli mokidos
saqvelmoqmedo saqmianobas, romelsac misi meuRle eweoda.
_ 162 _
stresul movlenaze sapasuxo reaqciebis klasifikacia
dilebis Sedegad. zogi garemoeba pirovnebas cxovreb-
cxrili 8.1 stresul movlenebze sapasuxo
iseuli stresuli movlenebis mimarT mowyvlads reaqciebis klasifikacia
xdis, mag., erTguli adamianis ararseboba, romelsac
ICD-10 DSM-IV
pirovneba Tavis problemebs gauziarebda. aseT viTa-
mwvave stresuli reaqcia mwvave stresuli aSliloba
rebebs mowyvladobis faqtorebi ewodeba. warsul ga-
posttravmuli stresuli posttravmuli stresuli
mocdilebas aseve SeuZlia mowyvladobis gazrda. mag., reaqcia aSliloba
bavSvobaSi mSoblebis dakargvam SeiZleba pirovneba adaptaciis aSliloba adaptaciis aSliloba
zrdasrul asakSi ufro mgrZnobiare gaxados im stre- w xanmokle depresiuli w romelsac depresiuli
suli movlenebis mimarT, romlebic danakargTan aris reaqcia guneb-ganwyoba axlavs Tan
dakavSirebuli. Tumca, droSi daSorebul movlenebs w Sereuli SfoTviTi da w romelsac Sereuli
depresiuli reaqcia SfoTviTi da depresiuli
Soris urTierTkavSiris mecnieruli Seswavla Znelia guneb-ganwyoba axlavs Tan
(cxovrebiseuli movlenebi da mowyvladobis faqtore- w romelsac SfoTva axlavs
w upiratesad, sxva
bi mogvianebiT iqneba ganxiluli, gv. ??). emociuri aSliloba Tan
w upiratesad, qcevis upira w romelsac qceviTi
tesi (predominant) aSliloba aSliloba axlavs Tan
stresul movlenebze sapasuxo w romelsac emociisa da
w emociisa da qcevis
reaqciebis klasifikacia Sereuli aSliloba qcevis Sereuli aSliloba
axlavs Tan
nebismieri reaqcia, romelic stresuli movlenis
w sxva reaqciebi mwvave w dauzustebeli.
dros iCens Tavs (da daavadebebis klasifikaciebSia stresze
warmodgenili), yovelTvis ar aris paTologiuri. qvejgufebis Tanmimdevroba Secvlilia, raTa naTlad gamo
glova normalur reaqcias warmoadgens mZime dana- Cndes msgavseba da gansxvaveba am or klasifikacias Soris.
kargis dros da mxolod adamianTa umciresoba iZleva
Zalian mZime an paTologiurad xangrZliv reaqcias. Tu igi iwyeba stresoris aRmocenebidan erTi saaTis
aseve, arsebobs bunebrivi sapasuxo reaqciis pater- ganmavlobaSi da sustdeba araumetes 48 saaTis Sem-
nebi saSiS an travmul movlenebze, rogoricaa, mag., deg. DSM-IV-is ganmartebis mixedviT, mwvave stresuli
saavtomobilo katastrofa. adamianebis umravlesobas aSliloba uaryofiTi movlenis gancdis dros an mis
uCndeba Zlieri SfoTvis myisieri gancda. ramodenime Semdeg unda gamovlindes da es mdgomareoba minimum
saaTis ganmavlobaSi isini gaognebulebi da agzneb- or dResa da maqsimum 4 kviras unda grZeldebodes.
ulebi arian. Semdeg ki maTi mdgomareoba TandaTan es ori gansazRvreba moicavs SfoTviTi reaqciis gan-
umjobesdeba. Zalian cota adamians aqvs ufro mZime sxvavebul fazebs, rac Semdeg terminologiur gan-
da xangrZlivi simptomebi, anu paTologiuri reaqcia. sxvavebaSi aisaxeba: reaqcia da aSliloba. ICD-10-Si
simZimisa da xangrZlivobis mixedviT Zneli dasadge- ufro xanmokle, normaluri sapasuxo reaqciebi moi-
nia, Tu sad gadis zRvari stresul movlenaze norm- azreba, xolo DSM-IV ufro gaxangrZlivebul, nakle-
alur da paTologiur reaqciebs Soris. praqtikaSi bad gavrcelebul reaqciebs moicavs. orive diagnos-
aseTi dayofa subieqtur xasiaTs atarebs. igive md- tikuri sistemis mixedviT, stresori gansakuTrebuli
gomareobaa im pacientebis SemTxvevaSi, romlebic saa- xasiaTis unda iyos. DSM-IV-is mixedviT, unda aRin-
vadmyofoSi medikamentur an qirurgiul mkurnalobas iSnebodes TviTdazianebis an sxvebisTvis zianis miy-
gadian. maTi umravlesoba SfoTavs, magram mxolod enebis qmedeba an amis saSiSroeba.
ramdenimes aReniSneba iseTi simwvavis SfoTva, rom-
lis drosac vlindeba uaryofis an sxva dacviTi meqa- posttravmuli stresuli aSliloba
nizmebi, romlebic xels uSlian pacientis CarTulo- es aris xangrZlivi da paTologiuri reaqcia gansa-
bas mkurnalobis procesSi. kuTrebuli intensivobis mqone stresul viTarebaze,
stresul gamocdilebaze arsebuli reaqciebi ICD- rogoricaa, mag., bunebrivi katastrofa da seqsual-
10-is da DSM-IV-is mixedviT sam jgufad klasi- uri an fizikuri Zaladoba.
ficirdeba (cxrili 8.1).
adaptaciis aSliloba
mwvave reaqcia stresze adaptaciis darRvevebi safexureobrivi da gaxan-
am kategorias ganekuTvneba uecrad aRmocenebul in- grZlivebuli reaqciaa pirovnebis cxovrebaSi momxdar
tensiur stresorze myisieri da xanmokle reaqcia. stresis Semcvel cvlilebebze. rogorc ICD-10-Si, aseve
amave dros, pirovnebas, romelic amgvar reaqcias iZl- DSM-IV-Si adaptaciis aSliloba, wamyvani simptomebis
eva, mocemuli momentisTvis ar unda aReniSnebodes mixedviT, dayofilia depresiul, Sereul SfoTviT
raime sxva fsiqikuri aSliloba. ICD-10-is gansazRvre- aSlilobad; depresiul aSlilobad, romelsac qceviTi
bis mixedviT, mwvave stresul reaqcias maSin vxedavT, aSliloba axlavs Tan; da emociisa da qcevis Sereul
_ 163 _
aSlilobad. DSM-IV-Si Setanilia damatebiTi katego- iRupeba. stresze reaqciis sxva simptomebia: gaSeSeba,
ria _ adaptaciis aSliloba, romelsac SfoTva axlavs gaogneba da mgrZnobelobis daqveiTeba, travmuli mov-
Tan, xolo ICD-10-Si Setanilia damatebiTi kategoria lenebis zusti TanmimdevrobiT gaxsenebis uunaroba,
_ upiratesi sxva emociuri aSliloba, romelSic Se- uZiloba, mousvenroba, koncentraciis gaZneleba da
dis ara mxolod SfoTvis TanxlebiT mimdinare adapta- vegetatiuri reaqciebi: oflianoba, gaxSirebuli gu-
ciis aSliloba, aramed iseTi adaptaciis aSlilobac, liscema da tremori. SesaZlebelia iyos mrisxaneba da
romelsac risxva axlavs Tan. isteriuli qcevac. zogjer aRiniSneba gaqcevis reaq-
ICD-10-Si stresul gamocdilebaze sami tipis reaqcia (mag., roca mZRoli garbis sagzao katastrofis
cia gaerTianebulia kategoriaSi `reaqcia stresze da adgilidan).
adaptaciis darRvevebi~ da Sedis TavSi F4, romelsac daZlevis strategia da dacviTi meqanizmebi aseve
ewodeba `nevrozuli, stresTan dakavSirebuli da so- warmoadgens stresul movlenebze mwvave reaqci-
matoformuli aSlilobebi~. am jgufSi Semavali aSli- is Semadgenel nawils. amridebloba yvelaze ufro
lobebis ganmsazRvreli maxasiaTeblebia: gavrcelebuli daZlevis strategiaa. pirovneba
w es aSlilobebi mwvave stresis an gaxangrZlivebuli, aridebs Tavs stresul movlenaze fiqrs da saubars
arasasurveli viTarebis uSualo Sedegia; da gaurbis yvelafers, rac ki am movlenas axsenebs.
yvelaze gavrcelebuli dacviTi meqanizmia uaryofa.
w am faqtorebis gareSe es aSlilobebi ar viTardeba.
Cveulebriv, amridebloba da uaryofa SfoTvis Ses-
DSM-IV gansxvavebul maorganizebel princips iy- ustebasTan erTad klebulobs. adamiani ufro ad-
enebs: mwvave stresuli aSliloba da posttravmuli vilad ixsenebs stresul movlenasTan dakavSirebul
stresuli aSliloba klasificirebulia, rogorc faqtebs da naklebad uWirs maTze fiqri da saubari.
SfoTviTi aSlilobebi, maSin, roca adaptaciis dar- aseTi dinamika saSualebasiZleva, rom adamianma moax-
Rvevebs calke adgili aqvT miCenili klasifikaciaSi erxos stresuli gamocdilebis `gadaxarSva~ da misi
da ar aris SfoTviT aSlilobasTan dakavSirebuli. miReba. Tumca, zogjer adamians uWirs Zlieri stre-
ICD-10-Si mocemuli damatebiTi kodebi suli movlenis detalebis gaxseneba.
Tu am reaqciebidan romelimes Tan sdevs ganzrax klinikur suraTSi arsebuli variaciebi

TviTdazianeba, am faqtis dasafiqsireblad SeiZleba mwvave stresze adaptaciuri reaqciis dros adamiani
sxva kodi iqnes damatebuli (kodi X60-X82). es kodi iyenebs daZlevis strategiebsa da dacviT meqanizmebs
Seicavs TviTdazianebis 23 meTods. agreTve, SesaZle- manam (rac mas normaluri funqcionirebis saSuale-
belia garkveuli tipis stresuli movlenis dazusteba bas aZlevs), sanam SfoTva da depresia Sesustdeba.
misTvis Tavi Z-dan aRebuli kodis miniWebiT (mag., Z58- amis Semdeg is wyvets maT gamoyenebas, raTa SeZlos
is gamoyeneba dasaqmebasTan, xolo Z63-is _ ojaxur vi- stresuli gamocdilebis `gadamuSaveba~. magram mwvave
TarebasTan dakavSirebuli problemebisTvis). stresze sapasuxo yvela reaqcias ar aqvs aseTi din-
glovis reaqciebis kodireba amika da yvela daZlevis strategia ar aris adaptaci-
uri. amis magaliTia distresis Sesasusteblad alko-
ICD-10-Si paTologiuri glova Sedis adaptaciur
holisa da narkotikuli nivTierebebis gadaWarbebuli
darRvevebSi. reaqciebi mZime danakargze, romlebic
miReba. zogierTi dacviTi meqanizmic naklebad adap-
damaxasiaTebelia mocemuli kulturisTvis, saerTod
taciuria (mag., regresia da gadatana). zogjer dacvi-
ar aris am klasifikaciaSi Setanili. Tu marTebuli
Ti meqanizmebis gamoyeneba zedmetad didxans grZel-
iqneba maTi, rogorc pacientis mdgomareobis aRweris
deba. aseT dros isini adaptaciur funqcias aRar
Semadgeneli nawilis kodireba, SegviZlia gamoviyenoT
asruleben. mag., uaryofa SeiZleba imdenad didxans
kodi Z63.4 (ojaxis wevris gardacvaleba).
gagrZeldes, rom gamoiwvios stresuli gamocdilebis
gadamuSavebis gadavadeba. zogjer stresuli movle-
mwvave stresuli reaqcia da mwvave nebis cxadi mogonebebi cnobierebaSi xatebis, fleS-
stresuli aSliloba bekis an Semawuxebeli sizmrebis saxiT iWreba. didxans
gagrZelebul aseT mdgomareobas posttravmul stre-
klinikuri suraTistresze mwvave fsiqologiuri reaq-
sul aSlilobas uwodeben.
ciis ZiriTadi simptomebi aris SfoTva da depresia.
SfoTva _ esaa reaqcia saSiSroebis Semcvel gamoc-
diagnostika ori klasifikaciis mixedviT
dilebaze, xolo depresia _ danakargze. SfoTva da
depresia xSirad erTdroulad gvxvdeba, radganac rogorc zemoT aRiniSna, `mwvave stresuli reaqciebi~
stresuli movlena xSirad saSiSroebisa da danakar- ICD-10-Si da `mwvave stresuli aSliloba~ DSM-IV-Si
gis nazavs warmoadgens. amis yvelaze kargi magaliTia stresze fsiqologiuri reaqciis sxvadasxva fazas
sagzao SemTxveva, romlis drosac erT-erTi mgzavri moicavs (gv. ??). DSM-Si mocemuli gansazRvreba, ro-
_ 164 _
mwvave stresuli reaqcia da mwvave stresuli aSliloba
melic farTod gamoiyeneba, exeba klinikuri Tval- stresuli aSliloba~ mxolod maSin gamoiyeneba, Tu
sazrisiT ufro mniSvnelovan SemTxvevebs. adamianebs, pirovnebas uSualod stresuli movlenis zemoqmede-
romlebsac mwvave stresuli aSliloba axasiaTebT, bamde ar aReniSneboda aseTi simptomebi. sxva SemTx-
ufro meti albaToba aqvT imisa, rom mogvianebiT vevaSi reaqcia miiCneva manamde arsebuli fsiqikuri
posttravmuli stresuli aSliloba ganuviTardeT aSlilobis gamwvavebad.
(Brewin et al., 2003). ra Tqma unda, posttravmul stre-
sul aSlilobas iseTive simptomebi axasiaTebs, rac epidemiologia
mwvave stresul aSlilobas. mTavari gansxvaveba simp- populaciaSi mwvave stresuli aSlilobis gavrcelebis
tomebis gamovlenis drosa da xangrZlivobaSia. miuxe- sixSire ucnobia. mwvave stresuli aSliloba dafiq-
davad amisa, im adamianebis 50%-s, romlebsac trav- sirebulia sagzao-satransporto SemTxvevebis dros
mis Sedegad sabolood uviTardebaT posttravmuli gadarCenil adamianTa 13%-Si (Harvey and Bryant, 1998),
stresuli aSliloba, travmis Semdeg maSinve ar aRe- Zaladobis msxverplTa 19%-Si (Brewin et al., 1999) da
niSnebaT yvela is simptomi, romlebic mwvave stresul masobrivi mkvlelobebis TviTmxilvelebis 33%-Si
aSlilobas axasiaTebs (McNally et al., 2003). (Classen et al., 1998).
klasifikaciis orive sistema am aSlilobis tipiur
simptomebs aRwers. DSM-IV-is Tanaxmad, imisaTvis, rom etiologia
davsvaT mwvave stresuli aSlilobis diagnozi, saxeze stresze mwvave reaqcia SeiZleba mravali saxis movle-
unda iyos SfoTvis aSkara simptomebi an Zlieri agzne- nam gamoiwvios. aseTia mniSvnelovani, magram xanmokle
ba, movlenis xelaxali gancda da qvemoT CamoTvlili movlenebi (mag., saavtomobilo katastrofa, xanZari)
xuTi disociaciuri simptomidan sami. es simptomebia: da movlenebi, romlebic iwvevs realur dazianebas an
1. gaSeSeba da gansvla garemo situaciidan; Seicavs amgvar xifaTs (fizikuri Seuracxyofa, gaupa-
2. cnobierebis Seviwroeba (`gabruebul mdgomareo- tiureba an seriozuli daavadebis uecrad aRmoCena).
baSi yofna~); zogierTi aseTi stresuli movlena iwvevs cxovrebi-
3. derealizacia; seul cvlilebebs, romlebic adaptacias saWiroebs
(mag., ubeduri SemTxveva, romlis drosac pirovnebas-
4. depersonalizacia;
Tan erTad myofi axlo megobari seriozulad daSavda).
5. disociaciuri amnezia. erTsa da imave stresul situaciaze adamianebi erT-
agreTve, SeiZleba aRiniSnebodes Tavis arideba is- nairad ar reagireben (ix. epidemiologia). reaqciebis
eTi stimulebisTvis, romlebic travmis gaxsenebas, mravalferovneba gvafiqrebinebs, rom konstituciuri
mniSvnelovan distress an socialuri funqcionirebis gansxvavebebi, warsuli gamocdileba da gamklavebis
gauaresebas iwvevs. ICD-10-is mixedviT, aseve aucile- stili etiologiaSi garkveul rols TamaSobs. Tumca,
belia generalizebuli SfoTviTi aSlilobisTvis dam- amis Sesaxeb Zalze mcire faqtobrivi informacia ar-
axasiaTebeli yvela simptomis arseboba. sebobs, radgan, Cveulebriv, yuradReba eTmoba ufro
ICD-10-is Tanaxmad, msubuqi aSlilobis diagnozis mZime da xangrZlivi posttravmuli stresuli aSli-
dasadgenad ar aris aucilebeli disociaciuri da sxva lobis gamokvlevas.
saxis simptomebis arseboba (F43.00). zomieri aSlilo-
bis (F43.01) diagnozis dasadgenad, qvemoT CamoTvli- mkurnaloba
li simptomebidan, aucilebelia iyos ori simptomi, katastrofisTvis mzadeba
xolo mZime formis dasadgenad (F43.02) _ oTxi. es
katastrofis fsiqologiur Sedegebze myisieri da
simptomebia:
Sesatyvisi reagirebis uzrunvelsayofad saWiroa
w mosalodneli socialuri urTierTobebis mimarT garkveuli gegmis SemuSaveba. am tipis reagireba Sei-
amridebloba Zleba miRweul iqnes im pirebis mozidviTa da swavle-
w yuradRebis velis Seviwroeba biT, romlebic mzad arian daxmareba gauwion msxver-
w dezorientaciis gamovlineba pls nebismier momentSi. maTTan dakavSirebis proce-
w sityvieri agresia da sibraze durebi Tavidanve iyos garkveuli. katastrofis dros
prioritetebi unda dadgindes msxverplisa da misi
w uimedoba an sasowarkveTileba
naTesavebis (bavSvebis CaTvliT) saWiroebebis gaTval-
w araadekvaturi an umizno hiperaqtiuroba iswinebiT. agreTve, gasaTvaliswinebelia gadaudebeli
w arakontrolirebadi da Zalze Rrma dardi (glovis daxmarebis samsaxuris TanamSromlebis saWiroebebi,
fenomeni ganixileba kulturul standartebTan Se- romlebzec katastrofis Sedegebma SeiZleba Zlieri
sabamisobaSi) zegavlena moaxdinon. katastrofis msxverplisTvis
terminebi `mwvave stresuli reaqcia da mwvave fsiqologiuri daxmarebis gawevis aucilebeli ele-
_ 165 _
gaagrZelos konsultantTan Sexvedrebi daaxloebiT
boqsi 8.2 gadaudebeli fsiqologiuri
erTi Tvis ganmavlobaSi. amgvari Sexvedrebi saWiroa
daxmarebis ZiriTadi komponentebi
im pirebis gamosavlenad, romelTac droTa ganmav-
w komforti da nugeSiscema lobaSi ar SeusustdaT stresuli simptomebi da amis
w Semdgomi saSiSroebisa da stresisgan dacva gamo SeiZleba posttravmuli stresuli aSlilobis
w dauyovnebeli fizikuri mzrunvelobis gaweva ganviTarebis maRali riskis qveS imyofebodnen.
w axlobeli adamianebis xelaxali dakavSireba erTmaneTTan
Tu ar moiZebneba megobari an profesionali,
w gamocdilebis urTierTgaziareba (magram ara iZulebiT)
romelsac pirovnebisTvis daxmarebis gaweva SeuZlia,
w gadarCenili pirebis dakavSireba im adamianebTan,
romlebsac maTTvis daxmarebis gaweva SeuZliaT
Tu misTvis ar aris ioli stresuli garemoebis mego-
w daxmarebis gaweva, rom SeZlon TviTkontrolis SenarCuneba brebTan an naTesavTan ganxilva (mag., gaupatiurebis
w im adamianebis gamovlena, romelTac Semdgomi zogierTi SemTxveva) an Tu stresze reaqcia mZime da
daxmareba sWirdebaT (SerCeva) xangrZlivia, SeiZleba saWiro gaxdes ufro formal-
uri fsiqoTerapiis gamoyeneba. msxverpls unda avux-
mentebi aRwerilia aleqsanderis mier (Alexander, 2005) snaT, rom misi mdgomareoba bunebrivia da rom es
(boqsi 8.2). swrafad gaivlis. SesaZloa dagvWirdes misTvis rCevis
micema, Tu rogor gaumklavdes travmuli movlenebis
debrifingi
Sedegebs. Tu aRiniSneba Zlieri SfoTva, pirovnebas
incidentis Semdeg konsultacia xSirad debrifingis SeiZleba erTi an ori dRiT anqsiolizuri saSualeba
an `kritikul incidentTan dakavSirebuli stresis~ daeniSnos, xolo Zilis seriozuli darRvevebisas,
debrifingis formiT tardeba. amgvari konsultacia erTi an ori dRis ganmavlobaSi _ saZile saSualeba.
SeiZleba iyos individualuri an jgufuri. debrifin- SesaZloa, pacienti fsiqoTerapiis Catarebas saWiroe-
gis dros, mas Semdeg, rac konsultanti proceduras bdes. rogorc irkveva, fokusirebuli da xanmokle
ganmartavs, msxverpli Semdeg safexurebs gaivlis: kognitur-bihevioruli Terapia ufro efeqturia, vi-
w faqtebi _ msxverpli yveba momxdaris Sesaxeb; dre mxardamWeri konsultaciebi. kognitur-bihevior-
w azrebi _ msxverpli yveba, Tu ra azrebi gauCnda mas ulma Terapiam SeiZleba SemdgomSi Tavidan agvacilos
uSualod incidentis Semdeg; posttravmuli stresuli aSlilobis Camoyalibeba
w gancdebi _ msxverpli ixsenebs incidentTan dakav- (Bryant et al., 1998; McNally et al., 2003).
Sirebul emociebs;
w Sefaseba _ msxverpli xelaxla afasebs Tavis reaq- posttravmuli stresuli aSliloba
cias; es termini aRniSnavs intensiur, xangrZliv da zogjer
w gaTviTcnobiereba _ konsultanti sTavazobs msx- droSi gadavadebul reaqcias Zlier stresul mov-
verpls informacias stresze reaqciisa da stresis lenaze. posttravmuli stresuli reaqciis aucileb-
marTvis Sesaxeb. el maxasiaTeblebs warmoadgens:
debrifingi farTod gamoiyeneba. monacemebi gviC 1. zesifxizle

venebs, rom Tu debrifingi Catarda, rogorc erTjera- 2. stresuli movlenis ganmeorebadi gancda
di, `calke aRebuli~ procedura, is ar gamodgeba 3. travmasTan asocirebuli stimulebisTvis Tavis
fsiqologiuri distresis Sesasusteblad da SeiZleba arideba
sazianoc ki aRmoCndes (metaanalizis Tema ganxilulia
amgvari aSlilobis gamomwvevi eqstremaluri
Semdeg wyaroSi: Rose et al., 2003). gaurkveveli rCeba
stresorebia bunebrivi katastrofebi (mag., wyal-
sakiTxi, Tu romelia ufro efeqturi _ debrifingi,
didoba an miwisZvra), adamianis mier gamowveuli
rogorc koordinirebuli mkurnalobis programis
katastrofebi (mag., xanZari, seriozuli sagzao-sa-
nawili, Tu rogorc jgufuri procedura.
transporto avaria, saomari viTareba, gaupatiure-
ba an pirovnebisTvis seriozuli fizikuri Seura-
marTva
cxyofis miyeneba). Tavisi pirvandeli mniSvnelobiT
travmuli movlenis Semdeg bevri adamiani mis mimarT cneba `posttravmuli stresuli aSliloba~ miuTiTeb-
TanagrZnobiT ganwyobil naTesavebTan, megobrebTan da reaqcias iseT eqstremalur stresorze, romelic
an profesionalebTan saubrobs incidentis Sedegad nebismier adamianze moaxdens zemoqmedebas. epidemi-
miRebuli fizikuri zianis Sesaxeb. radgan umetes ologiurma gamokvlevebma aCvena, rom erTsa da imave
SemTxvevaSi stresuli reaqciebi droTa ganmavloba- eqstremalur stresorze yvela adamians ar uyalib-
Si TavisTavad sustdeba da qreba, xelsayrelia lo- deba posttravmuli stresuli aSliloba da rom amaSi
dinisa da dakvirvebis strategiis gamoyeneba. miuxe- garkveul rols pirovnuli midrekileba TamaSobs.
davad amisa, kargi iqneba, Tu pirovnebas SevTavazebT
_ 166 _
posttravmuli stresuli aSliloba
ubeduri SemTxvevebis dros xSirad msxverpli ara mx- li. omis veteranebs, am aSlilobis garda, xSirad aqvT
olod fsiqologiur distress ganicdis, aramed fizi- depresia, somatizirebuli aSliloba da alkoholisa
kur dazianebasac iRebs, ramac SeiZleba gazardos da fsiqoaqtiuri nivTierebebis borotad gamoyenebis
posttravmuli stresuli aSlilobis albaToba. sxva mimarT midrekileba. sagzao avariis Semdeg ufro xSi-
predispoziciuri faqtorebi ganxilulia qveTavSi, rad aRiniSneba sxvadasxva saxis SfoTviTi aSliloba,
romelic etiologiis sakiTxebs eZRvneba. vidre posttravmuli stresuli aSliloba. sakon-
mdgomareoba, romelic amJamad posttravmuli stre- centracio banakSi namyof adamianebs SeiZleba ganuvi-
suli aSlilobis saxeliTaa cnobili, mravali wlis TardeT posttravmuli stresuli aSliloba, Tumca,
winaT iyo identificirebuli, Tumca, axla mas sxva maT SeiZleba aseve aReniSnebodeT mudmivi gaRiziane-
saxelwodebiT icnoben. es termini gaCnda amerikaSi badoba da mexsierebis daqveiTeba. ICD-10-Si Setanilia
vietnamis omidan dabrunebuli samxedro mosamsaxuree- `katastrofis Semdgomi xangrZlivi pirovnuli cvli-
bis Seswavlis Sedegad. posttravmuli stresuli aSli- lebebis~ kategoria (boqsi 8.3). am tipis mdgomareo-
lobis diagnozi miuTiTebda, rom dazaralebul samx- bebi SesaZloa aRmocendes posttravmuli stresuli
edro mosamsaxureebs ar aReniSnebodaT sxva fsiqikuri aSlilobis nacvlad an masTan erTad. mag., vietnamis
aSliloba da maT ubralod samedicino da socialuri omis veteranebis 43%-s, romelic akmayofilebs post-
daxmareba unda mieRoT. msgavsi fsiqologiuri efeq- travmuli stresuli aSlilobis yvela diagnostikur
ti dafiqsirebuli iyo (sxva saxelwodebiT) samxedro kriteriums, damatebiT aqvs sul cota erTi saxis aS-
mosamsaxureebTan orive msoflio omis dros, aseve, liloba. am dros yvelaze xSiria atipiuri depresia,
1942 wels, bostonis erT-erT Ramis klubSi momxdari alkoholze damokidebuleba, SfoTviTi aSliloba,
Zlieri xanZris TviTmxilvelebTan (Adler, 1943). (post- fsiqoaqtiuri nivTierebebis borotad gamoyeneba da
travmuli stresuli aSlilobis istoriuli mimoxilva somatizirebuli aSliloba (MacFarlane, 1985).
mocemulia Semdeg wyaroSi: Jones et al., 2003).
posttravmuli stresuli aSlilobis
sxva saxis reaqciebi mwvave stresze klinikuri suraTi
posttravmuli stresuli aSliloba gvxvdeba mxo- posttravmuli stresuli aSlilobis klinikuri maxa-
lod gansakuTrebuli stresuli movlenebis Semdeg, siaTeblebi SeiZleba sam jgufad daiyos (cxrili 8.2).
magram aseT movlenebze nebismieri saxis reaqcia ar simptomebis pirveli jgufi zesifxizleze miuTiTebs
aris posttravmuli stresuli aSlilobis maniSnebe- da moicavs persistentul SfoTvas, gaRizianebadobas,
uZilobas da koncentraciis daqveiTebas. simptomebis
boqsi 8.3 `katastrofis meore jgufi ukavSirdeba intruzias (anu cnobiere-
Semdgomi xangrZlivi pirovnuli baSi SeWras) da Seicavs momxdari movlenebis inten-
cvlilebebis kriteriumebi ICD-10-
is mixedviT cxrili 8.2 posttravmuli stresuli
(A) qvemoT CamoTvlili kriteriumebidan saxeze unda iyos aSlilobis ZiriTadi simptomebi
minimum ori kriteriumi. esenia:
zesifxizle
w garSemomyofTa mimarT permanentulad mtruli
damokidebuleba an undobloba w persistentuli SfoTva
w socialuri izolacia w gaRizianebadoba
w sicarielis an uimedobis mudmivi gancda w uZiloba
w sasowarkveTis xangrZlivi gancda an saSiSroebis w koncentraciis daqveiTeba
gancda realuri, obieqturi mizezis gareSe
w permanentuli gancda imisa, rom icvlebi an sxva intruziebi
adamianebisgan gansxvavebuli xar.
w intensiuri intruziuli xatebi
(B) amgvari cvlileba iwvevs mniSvnelovan distress w `fleSbeki~
da sagrZnoblad uSlis xels pirovnul an socialur
funqcionirebas. w ganmeorebadi distresuli sizmrebi
(C) pirovnuli cvlileba yalibdeba katastrofuli ganrideba

movlenis Semdeg; pirovnebas ar aReniSneba personologiuri
aSliloba im movlenamde, romliTac SeiZleba aixsnas misi w stresuli movlenebis sakuTari nebiT gaxsenebasTan
amJamindeli Tvisebebi. dakavSirebuli sirTuleebi
w im movlenebisaTvis Tavis arideba, romlebic stresuli
(D) pirovnuli cvlilebebi unda aRiniSnebodes sul gamocdilebis gaxsenebas iwvevs
cota ori wlis manZilze da ar unda iyos dakavSirebuli
romelime sxva saxis fsiqikuri aSlilobis epizodTan (garda w gaucxoeba
posttravmuli stresuli aSlilobisa), tvinis dazianebasa w emociebis gancdis uunaroba (èmociuri siClunge~)
an raime sxva daavadebasTan. w sxvadasxva saxis aqtivobebis mimarT interesis dakargva.
_ 167 _
siur intruziul xatebs, uecar `fleSbekebs~ da gan- diagnozi
meorebad distresul sizmrebs. mesame jgufis simp- ICD-10-sa da DSM-IV-Si mocemuli diagnostikuri kri-
tomebi ganridebasTan aris dakavSirebuli da moicavs teriumebi erTmaneTis msgavia, Tumca, am ukanasknelSi
stresuli movlenebis sakuTari nebiT gaxsenebasTan emociur gasadavebas bevrad ufro didi mniSvneloba
dakavSirebul sirTuleebs, Tavis aridebas imisaTvis, eniWeba. DSM-IV-Si mocemulia ori kriteriumi, romle-
rac stresuli movlenis gaxsenebas iwvevs, gaucxoe- bic ar aris warmodgenili ICD-10-Si. kerZod: simptom-
bis gancdas, emociebis gancdis uunarobas (~emociuri ebi unda vlindebodes aranakleb erTi Tvis manZilze
siClunge, emociuri gasadaveba) da aqtivobis mimarT da aman mniSvnelovani distresi an socialuri funq-
interesis dakargvas. yvelaze xSirad vxvdebiT Semdeg cionirebis daqveiTeba unda gamoiwvios. ori klasifi-
simptomebs: fleSbeki, Ramis koSmari da intruziuli kaciis kriteriumebis mixedviT posttravmuli stre-
xatebi. zogjer am simptomebs saerTo saxels simptom- suli aSlilobis diagnozis dasmisas, am gansxvavebis
ebis ganmeorebad gancdas uwodeben. gamklavebis ara- gamo, Tanxvedra mxolod 35%-s Seadgens (Andrews et
adaptaciurma reaqciebma SeiZleba Tavi iCinos per- al., 1999). SeTanxmebis Tanaxmad, konvenciis mixedviT,
sistentuli agresiuli qcevis, alkoholisa da nar- posttravmuli stresuli aSlilobis diagnozis dasma
kotikuli nivTierebebis gadaWarbebulad moxmarebis, SeiZleba im adamianebisTvisac, romlebsac, stresul
winaswar ganzraxuli TviTdazianebisa da suicidis movlenamde fsiqikuri aSliloba aReniSnebodaT.
saxiT (Hendin and Haas, 1991). diferencialuri diagnozi unda daisvas Semdegi md-
sxva maxasiaTeblebi gomareobebis dros:
am tipis aSlilobisTvis depresiuli simptomebi Cveu- w ukve arsebuli SfoTviTi da guneb-ganwyobis aSli-
lebrivi movlenaa. katastrofis dros gadarCenili lobebis stresiT gamowveuli gamwvaveba;
adamianebi xSirad ganicdian danaSaulis grZnobas. w mwvave stresuli aSlilobebi, romlebic mimdinare-
zogierTi travmuli movlenis Semdeg xdeba cxovrebis obis xangrZlivobiT gansxvavdeba;
sazrisisa da daniSnulebis gadafaseba, rac sakmaod w adaptaciis darRvevebi, romlebsac gansxvavebuli
mtkivneuli procesia (Janoff-Bulman, 1985). arsebobs simptomebi axasiaTebs;
mosazreba, rom disociaciuri simptomebi da deper-
w katastrofis Semdgom gaxangrZlivebuli pirovnuli
sonalizacia posttravmuli stresuli aSlilobis
cvlilebebi.
mniSvnelovan simptomebs warmoadgens (Foa at al., 1995).
posttravmuli stresuli aSliloba SeiZleba gamo
posttravmuli stresuli aSlilobis dasawyisi xatuli iyos ganzrax TviTdazianebis an fsiqoaqti-
da mimdinareoba uri nivTierebebis borotad gamoyenebis saxiT. orive
posttravmuli stresuli aSlilobis simptomebi _ araadaptaciuri daZlevis strategiaa (ix. zemoT).
SeiZleba stresuli movlenis Semdeg Zalian male an
ramodenime dReSi gamovlindes; zogjer ramodenime epidemiologia
Tvis, iSviaTad eqvsi Tvis Semdegac ki (McFarlane, 1988). zogad populaciaSi posttravmuli stresuli aSli-
DSM-IV-is mixedviT, am tipis aSlilobis diagnozi lobis Sesaxeb arsebuli monacemebi ZiriTadad aSS-dan
SeiZleba daisvas mxolod maSin, rodesac simptomebi aris miRebuli. sxva qveynebis monacemebi gansxvave-
aranakleb erTi Tvis manZilze grZeldeba. Tu ufro bulia, rac bunebrivi da xelovnuri katastrofebis
nakleb xans gastans, aseTi mdgomareoba SeiZleba Se- sixSiriTaa ganpirobebuli. aSS-Si mosaxleobis did
fasdes, rogorc mwvave stresuli aSliloba. aseTi nawilze Catarebuli kvlevis Sedegebis safuZvel-
midgomisas, stresTan dakavSirebuli aSlilobisa da ze keslerma da misma kolegebma (Kessler er al., 2001)
posttravmuli stresuli aSlilobis diagnozebi na- daadgines, rom DSM-III-R-is kriteriumebis mixedviT
klebad asaxavs erTmaneTisgan gansxvavebul or md- 7.8%-s posttravmuli stresuli aSliloba mTeli
gomareobas (Brewin et al., 2003). Tu pirovneba ganic- cxovrebis manZilze aReniSneboda (qalebi _ 10.4%; ma-
dis kidev erT, axal travmul movlenas, simptomebma makacebi _ 5.0%). Tormeti Tvis ganmavlobaSi post-
SeiZleba ganmeorebiT iCinos Tavi maSinac ki, rode- travmuli stresuli aSlilobis gavrcelebis maCvene-
sac es movlena, pirvelTan SedarebiT, ufro sustia. beli 1.3%-dan (avstralia) (Creamer et al., 2001) 3.6%-
umeteswilad amgvar aSlilobas persistentuli xasi- mde (aSS) (Narrow et al., 2002) meryeobda.
aTi aqvs. pacientebis daaxloebiT naxevari erTi wlis
manZilze ikurneba, magram maTi mesamedis gankurneba etiologia
mravali wlis manZilzec ki SeuZlebelia. (Kessler et al.,
stresori
1995).
posttravmuli stresuli aSlilobis ganviTarebis
aucilebeli mizezia gansakuTrebuli stresuli mov-
_ 168 _
lena. ar aris aucilebeli, rom pirovneba Tavad dazi- sabrZolo moqmedebebSi CarTulobis xarisxi, gairkva,
andes an piradad mas emuqrebodes saSiSroeba. am ti- rom genetikuri faqtori ganapirobebda erT mesa-
pis aSliloba adamians SeiZleba sxva mizezebis gamoc meds im gansxvavebebisas, romlebic SeiniSneboda
ganuviTardes. mag., posttravmuli stresuli aSli- mowyvladobaSi posttravmuli stresuli aSlilobis
loba SeiZleba ganuviTardes matareblis mZRols, mimarT. garemos, romelSic bavSvi an mozardi izrde-
romelsac TviTmkvlelobis mizniT adamiani gadauxta ba, ar Seaqvs mniSvnelovani wvlili am gansxvavebaSi.
liandagze an adamians, romelic ubeduri SemTxvevis posttravmuli stresuli aSlilobis riski matulobs
TviTmxilveli gaxda. DSM-IV-is avtorebis Tanaxmad, fsiqikuri aSlilobis ojaxuri anamnezis arsebobi-
aseTi movlenebi moicavs sikvdilis faqts an Tavad sas, rac genetikuri faqtoris moqmedebis amsaxvelia
pirovnebis da/an sxvebis sikvdilis, dasaxiCrebis an (Koenen et al., 2002).
sxeulis dazianebis seriozul safrTxes; vulkanis
predispoziciuri sxva faqtorebi
amofrqvevis Semdeg dazaralebuli mosaxleobis
gamokvlevam aCvena, rom posttravmuli stresuli ozerma (Ozer et al., 2003) Seajama individualuri faq-
aSliloba yvelaze maRali sixSiriT gamovlinda im torebi, romlebic zrdis mowyvladobas posttravmu-
pirebSi, romlebic ufro Zlieri zemoqmedebis velSi li stresuli aSlilobis Camoyalibebis mimarT. esenia:
imyofebodnen (Shore et al., 1989). Tumca, maT Soris yve- w guneb-ganwyobisa da SfoTviTi aSlilobis anamnezi;
las ar ganuviTarda posttravmuli stresuli aSli- w travmis preistoria;
loba. es monacemebi imaze metyvelebs, rom mocemul
w mdedrobiTi sqesi;
SemTxvevaSi garkveul rols pirovnuli mowyvladoba
TamaSobs. mas SeiZleba genetikuri an SeZenili xasiaTi w nevrotizmi;
hqondes. epidemiologiurma gamokvlevebma (Kessler et w dabali inteleqti;
al., 1995; Stein et al., 1997 and Creamer et al., 1992) gviCvena, w socialuri mxardaWeris nakleboba.
rom:
neirobiologiuri faqtorebi
w adamianebis umravlesoba mTeli Tavisi cxovrebis
manZilze erT travmul movlenas mainc ganicdis; dResdReobiT, posttravmuli stresuli aSlilobis
neirobiologiuri kvleva monoaminur neirotransmi-
w gamiznuli interpersonaluri Zaladobivi qmede-
terebze da HPA RerZzea fokusirebuli (orive stre-
bebis, gansakuTrebiT seqsualuri Zaladobis an sao-
sul movlenebze dacviTi reaqciebis mediatoria).
mari moqmedebebis dros, ufro metia posttravmuli
garda amisa, gamokvlevebma, romlebSic gamoiyeneba
stresuli aSlilobis ganviTarebis albaToba, vidre
Tavis tvinis vizualizacia, aCvena cvlilebebi hipo-
avariis an ubeduri SemTxvevis dros;
kampSi _ tvinis nawilSi, romelic mniSvnelovan rols
w qalebTan SedarebiT, mamakacebis cxovrebaSi ufro asrulebs mexsierebis formirebaSi da amigdalaSi,
xSiria travmuli movlenebi, magram qalebis cxovre- romelic monawileobs aracnobieri emociuri stim-
baSi ufro xSirad xdeba iseTi travmuli movlene- ulebis gadamuSavebaSi (boqsi 8.4) es faqtebi imaze me-
bi, romlebmac SeiZleba posttravmuli stresuli
aSliloba gamoiwvios (mag., bavSvobaSi gadatanili
boqsi 8.4 neirobiologiuri anomaliebi
seqsualuri Zaladoba, gaupatiureba an ojaxuri Za-
posttravmuli stresuli aSlilobis dros
ladoba).
HPA (hypothalamic-pituitary-adrenal axis) hipoTalamur-
w mamakacebTan SedarebiT, qalebTan ufro maRalia
hipofizarul-adrenaluri sistema:aRiniSneba sisxlis
imis albaToba, rom maT travmuli movlenebis sapa- plazmaSi kortizolis dabali done da aweuli mgrZnobeloba
suxod posttravmuli stresuli aSliloba ganuvi- deqsametazonis supresiis mimarT. Tavzurgtvinis siTxeSi
aRiniSneba kortikotropin-rilizing hormonis CHR-
TardeT. es gazrdili riski ver aixsneba imiT, rom is maRali done. grZelvadiani kvlevebiT dadginda
qalebisa da mamakacebis cxovrebaSi sxvadasxva tipis HPA sistemis disregulacia, rac garemo stresuli
travmuli movlenebi xdeba. movlenebisadmi zogadi labilobiT vlindeba.
noradrenalinis gavleniT aqtiurdeba simpaTikuri nervuli
genetikuri faqtorebi sistema, aRmocendeba gangaSis reaqcia, anu start-refleqsi.
Tavzurgtvinis siTxeSi momatebulia noradrenalinis
tyupebze Catarebuli gamokvlevebi imaze metyvelebs,
metabolitis (3-Methoxy-4-hydroxyphenylglycol - MHPG)-
rom gansxvaveba mowyvladobis TvalsazrisiT nawilo- done. noradrenalinis gaaqtiureba aZlierebs SfoTviT
briv genetikur xasiaTs atarebs. Trum da misma ko- reaqciebs (ODonnel et al., 2004).
legebma (True et al., 1993) Seiswavles 2224 monozigo- Tavis tvinis neirovizualuri kvlevebi (brain imaging) avlens
turi da 1818 dizigoturi tyupi (mamakacebi), rom- hipokampis mcire moculobas (rac, SeiZleba, mowyvladobis
faqtors warmoadgendes) da travmuli fsiqologiuri
lebic vietnamis omis dros aSS-is samxedro ZalebSi stimulis sapasuxod amigdalas hiperaqtivobas. (Nutt and
msaxurobdnen. mas Semdeg, rac gaTvaliswinebul iqna Malizia, 2004).
_ 169 _
tyvelebs, rom hipokampuri disfunqcia xels uSlis situaciebis gaxsenebas iwvevs (es xels uSlis refleq-
mexsierebis process, xolo amigdalaSi noradrener- sis Caqrobas da kognitur gadafasebas). cnobilia,
guli inervaciis gaZliereba iwvevs zesifxizles da rom intruziuli mogonebebis daTrgunva maT xelaxal
xels uwyobs travmuli mogonebebis avtomatur kodi- aRmocenebas uwyobs xels (Murray et al., 2002).
rebas da gaxsenebas (O~Donnell et al., 2004).
gamokvleva
fsiqologiuri faqtorebi
gamokvleva gulisxmobs monacemebis Segrovebas simp-
SiSis refleqsi tomebis bunebisa da xangrZlivobis, pacientis adrin-
posttravmuli stresuli aSlilobis mqone zogi- deli pirovnuli Tvisebebisa da fsiqikuri aSlilo-
erT pacients sensoruli stimuli, rogoricaa, mag., bis istoriis Sesaxeb. Tavis travmuli dazianebis
stresul situaciasTan dakavSirebuli suni an xmebi, dros (Tavdasxma, avaria) unda Catardes nevrologi-
travmuli movlenis cocxal mogonebebs uRviZebs. amis uri gamokvleva. sibraze da TviTdazianebis azrebi
safuZvelze SegviZlia vivaraudoT, rom am procesSi gavrcelebuli movlenaa posttravmuli stresuli
pirobiTi refleqsebi monawileoben. aSlilobis dros. aseT SemTxvevebSi saWiroa riskis
saTanado Sefaseba. meorad garTulebebs, rogoricaa,
kognituri Teoriebi mag., fsiqoaqtiuri nivTierebebis borotad gamoyene-
kognituri Teoriis warmomadgenlebi varaudoben, ba, SeiZleba dasWirdes damoukidebuli mkurnaloba
rom posttravmuli stresuli aSliloba aris maSin, (ix. meTvramete Tavi).
rodesac emociurad datvirTuli informaciis norm-
aluri gadamuSaveba Seferxebulia, ris gamoc mo- mkurnaloba
gonebebi gadaumuSavebeli rCeba da is amgvari for-
konsultacia
miT iWreba cnobierebaSi. am mosazrebas adasturebs
posttravmuli stresuli aSlilobis mkurnaloba
is faqti, rom posttravmuli stresuli aSlilobis
SesaZloa Zneli aRmoCndes, gansakuTrebiT maSin,
mqone pacientebi travmul movlenebs xSirad arasru-
rodesac misi simptomebis gamovlenidan erT wel-
lad da qaoturad ixseneben (Van Kolk and Fisler, 1995). am
ze metia gasuli. zogadi midgoma im SemTxvevebis
Teoriis Tanaxmad, erTsa da imave travmul movlenaze
mimarT, romelTa Camoyalibebidan SedarebiT nakle-
reaqciebs Soris arsebuli individualuri gansxvave-
bi droa gasuli, gulisxmobs emociuri mxardaWeris
bebi travmisa da misi zegavlenis Sefasebebs Soris
uzrunvelyofas, travmuli movlenebis gaxsenebis
arsebuli gansxvavebiTaa ganpirobebuli. analogiu-
xelSewyobas (raTa moxdes maTi integrireba paci-
rad, adreuli simptomebis SefasebaSi arsebuli gan-
entis gamocdilebasTan) da aseT movlenebTan daka-
sxvavebiT SeiZleba aixsnas, Tu ratom aReniSneba zo-
vSirebuli emociebis gadamuSavebis procesis gaad-
gierT adamians simptomebi ufro xangrZlivi drois
vilebas. mkunaloba agreTve mimarTulia danaSaulis
manZilze. sagzao avariis Semdeg intruziuli azrebis
gancdaze (kerZod, danaSaulis gancdaze, romelic
negatiuri interpretacia (mag., `me vgiJdebi~) imis mo-
gamowveulia stresul movlenaze àraswori~ reaq-
maswavebelia, rom pacients posttravmuli stresuli
ciiT da imiT, rom pacienti gadarCa, xolo misi ax-
aSliloba erTi wlis Semdegac aReniSneba (Ehlers et al.,
loblebi daiRupnen) da dardis gancdaze. pirovneba
l., 1998). posttravmuli stresuli aSlilobis kogni-
SeiZleba moculi iyos sicocxlisa da sikvdilis
turi modeli ganxilulia ehlersisa da klarkis mier
sazrisze fiqriT (Horowitz, 1986). adamians, romelic
(Ehlers and Clark, 2000).
pirovnuli Seuracxyofis an gaupatiurebis msxver-
fsiqodinamiuri Teoriebi plia, damatebiTi problemebi aqvs.
am Teoriebis Tanaxmad, emociuri ganviTareba ganapi- kognitur-bihevioruli mkurnaloba
robebs mZime stresul movlenebze reaqciebs Soris
rodesac simptomebi mZime an xangrZlivia, kognitur-
arsebul individualur gansxvavebebs (Horowitz, 1986).
bihevioruli Terapia yvelaze ufro Sesaferisi meTo-
aseTi midgoma damajerebelia, magram ar aris mecni-
dia. amgvari mkurnaloba ramodenime komponentisgan
eruli mtkicebulebiT gamyarebuli.
Sedgeba:
SemanarCunebeli faqtorebi w informaciis miwodeba, Tu rogori unda iyos Zlier
rogorc zemoT iTqva, adreuli simptomebis negatiur- stresze normaluri reaqcia da imis axsna, Tu ram-
ma Sefasebam SeiZleba nawilobriv xeli Seuwyos post- denad mniSvnelovania travmul movlenebTan dakav-
travmuli stresuli aSlilobis simptomebis Senar- Sirebuli situaciebisa da mogonebebisTvis Tvalis
Cunebas. sxva, savaraudo xelSemwyobi faqtorebia im gasworeba;
movlenebisTvis Tavis arideba, romelic travmuli w simptomebis TviT-monitoringi;
_ 170 _
w im situaciebSi CarTva, romlebsac pirovneba gaurbis;
boqsi 8.5 posttravmuli stresuli
w travmuli movlenebis mexsierebaSi aRdgena, raTa aSlilobisa da masTan dakavSirebuli
moxdes maTi integracia pacientis sxva saxis gamoc- travmuli sindromebis marTvis
dilebasTan. rodesac am xatebis mexsierebaSi aRd- saxelmZRvanelo principebi
gena pirvelad xdeba, xSirad isini fragmentuli xa- 1. katastrofaSi moxvedril nebismier adamians
siaTisaa da maT ara aqvT mkafio kavSiri mexsierebis posttravmuli aSlilobis dasadgenad unda Cautardes
sxva SinaarsebTan. mokle skriningi. es rutinuli xasiaTis procedura unda
Catardes incidentidan erTi Tvis Semdeg.
w kognituri restruqturizacia faqtebze msjelobis 2. rodesac simptomebi sustia da travmis Semdeg oTx
meSveobiT _ pirovneba afasebs faqtebs da ganixi- kviraze met xans ar rCeba, medicinis muSakebma momlodine
lavs maT dadebiT da uaryofiT mxareebs. pozicia unda daikavon da daakvirdnen pacients. amgvari
pozicia saSualebas aZlevs maT, marTon pacientis
w sibrazis marTva im adamianebTan, romlebsac jer problemebi. es midgoma janmrTelobis sferoSi momuSave
kidev aqvT sibrazis gancda travmul movlenebsa da yvela profesionalma unda gaiTvaliswinos. Semdegi
kontaqti pacientsa da medicinis muSaks Soris erTi Tvis
maT mizezebTan dakavSirebiT. ganmavlobaSi unda Sedges.
posttravmuli stresuli aSlilobis fsiqoTera- 3. im pacientebs, romlebsac travmuli movlenis Semdeg
piuli kvlevis metaanalizma aCvena, rom kognitur- erTi Tvis manZilze mZime posttravmuli simptomebi
aReniSnebaT, unda CautardeT travmaze fokusirebuli
bihevioruli mkurnalobis Terapiuli efeqti sakon- kognitur-bihevioruli Terapia. yvela adamians,
trolo jgufTan SedarebiT aris 1.65 da relaqsa- visac amgvari aSliloba aqvs, unda SevTavazoT
travmaze fokusirebuli fsiqologiuri mkurnalobis
ciasa da mxardamWer TerapiasTan SedarebiT 1.01.
kursi. Cveulebriv, aseTi saxis mkurnaloba tardeba
rodesac efeqtis sidide 1-is tolia, es mocemuli individualurad, ambulatoriul pirobebSi.
simptomebis erTeuli standartuli deviaciiT 4. posttravmuli stresuli aSlilobis mqone pacientebTan
gaumjobesebis Sesabamisia, xolo, rodesac efeqtis medikamenturi mkunaloba wamyvani ar unda iyos. aseT
dros upiratesoba eniWeba travmaze fokusirebul
sidide 1-ze metia, es mkurnalobis mniSvnelovan fsiqoTerapias.
efeqturobaze miuTiTebs (gv. ??). fsiqologiuri 5. medikamenturi mkurnaloba (paroqsetini, tricikluri
mkurnalobis dasasruls pacientebis daaxloebiT 55% antidepresantebi an mirtazapini) unda Catardes im
aRar pasuxobs posttravmuli stresuli aSlilobis SemTxvevaSi, rodesac pacienti uars acxadebs travmaze
fokusirebul fsiqologiur mkurnalobaze.
kriteriumebs, Tumca, bevr maTgans kvlav aReniSneba
garkveuli simptomebi. miuxedavad imisa, rom Sede- National Institute of Clinical Excellence (2005)
gebi damaimedebelia, saWiroa kvlevebis gagrZeleba,
raTa dadgindes, ramdenadaa SesaZlebeli yovel- aRmoCnda ramodenime antidepresanti, maT Soris se-
dRiur klinikur praqtikaSi aseTi Sedegebis miRweva rotoninis ukumitacebis seleqtiuri inhibitorebi
(Bradley et al., 2005). (SSRI), tricikliuri antidepresantebi (TCA) da mono-
Tvalebis moZraobis desensitizacia da reprocesia. aminoqsidazis inhibitorebi (MAOI). aseve arsebobs
es teqnologiebi posttravmuli stresuli aSlilobis winaswari monacemebi, romlebic mirtazapinis efeq-
samkurnalod SemuSavda. aseTi aSlilobis mqone ada- turobaze miuTiTebs (Davidson, 2003). miuxedavad amisa,
mianebis mkurnalobam aRniSnuli teqnologiebis gam- klinikuri daxelovnebis erovnuli institutis mier
oyenebiT imave sididis efeqti aCvena, rac kognitur- (National Institute of Clinical Excellence, NICE) Catarebul-
biheviorulma Terapiam, magram amis damamtkicebeli ma metaanalizma aCvena, rom posttravmuli stresuli
faqtebi SedarebiT naklebia (Bradley et al., 2005). zogi aSlilobis medikamentur mkurnalobas ufro susti
avtori eWvqveS ayenebs imas, Tu Tvalebis moZraobis efeqti aqvs, vidre struqturirebul fsiqoTerapias.
meTodi ramdenad iZleva specifikur informacias ga- amitom, is mocemuli aSlilobis dros ar miiCneva wa-
momwvev mizezebze (Davidson and Parker, 2001). myvan mkurnalobad garda im SemTxvevebisa, rodesac
rac Seexeba sxva saxis fsiqoTerapias (mag., fsiqo- Tavad pacienti aniWebs mas upiratesobas, an rode-
dinamikuri Terapia da hipnoTerapia), maT efeqturo- sac fsiqoTerapiis Catareba SeuZlebelia. miuxedavad
bas Zalian cota faqti adasturebs (am sakiTxze in- amisa, rodesac posttravmuli stresuli aSlilobis
formaciis misaRebad ix. National Insitute of Clinical Excel- mqone pacients komorbiduli depresiuli aSliloba
lence 2005). aReniSneba, fsiqoTerapiis paralelurad SegviZlia
CavataroT antidepresantebiT mkurnalobac. post-
medikamenturi mkurnaloba travmuli stresuli aSlilobis mkurnalobis mimox-
posttravmuli stresuli aSlilobis mkurnalobis ilva mocemulia Semdeg wyaroebSi: Ehlers (2000), Na-
dros unda veridoT anqsiolizuri preparatebis tional Institute of Clinical Excellence (2005), (boqsi 8.5) da
daniSvnas, radgan maTi xangrZlivi gamoyeneba iwvevs Bradley et al., (2005).
damokidebulebas. klinikuri gamocdisas efeqturi
_ 171 _
reagireba gansakuTrebuli tipis sxva tipis posttravmuli stresuli aSlilobis dros

mZime stresze da gulisxmobs travmuli movlenebis warmosaxvisa da
xelaxali gancdis gziT mtkivneuli gamocdilebisT-
gaupatiureba da fizikuri Zaladoba vis Tvalis gasworebas. garda amisa, yuradReba gamax-
gaupatiurebisa da fizikuri Zaladobis msxverpli sx- vilebulia mowyvladobisa da sakuTari Tavis dadana-
vadasxva reaqcias iZleva. es SeiZleba iyos stresze Saulebis daZlevaze (Jaycox et al., 2003). sxvadasxva ti-
mwvave reaqcia, posttravmuli stresuli aSliloba, pis fsiqoTerapia, romelic aqcents kognitur proce-
SfoTviTi aSliloba, depresiuli aSliloba da fsiqo- sebze akeTebs, iseTive efeqturi aRmoCnda, rogoric
seqsualuri disfunqcia. aqedan yvelaze xSirad post- eqspoziciuri Terapia (Resick et al., 2002).
travmuli stresuli aSliloba gvxvdeba. erT-erTi
gamokvlevis Sedegad dadginda, rom im qalebis 94%- omi da sxva saxis SeiaraRebuli konfliqti
s, romlebic gaupatiurebis msxverplni gaxdnen, mw- saomari moqmedebebis dros miRebuli fsiqikuri trav-
vave stresuli aSliloba CamouyalibdaT da maTgan ma da stresi an omis nevrozi _ es iseTi terminebia,
47%-s es simptomebi Tavdasxmidan sami Tvis Semdeg romlebic pirveli msoflio omis dros damkvidrda. is
ganuviTarda (Rothbaum et al., 1992). meore gamokvlevis im fsiqologiuri reaqciebis aRwerisTvis gamoiyene-
Sedegad aRmoCnda, rom amgvari gamocdilebis mqone boda, romlebic britanel da amerikel samxedroebSi
qalebis or mesameds Tavdasxmis Semdeg seqsualuri saomari moqmedebebis dros iCenda Tavs. am reaqciebis
aqtivoba dauqveiTda. maTgan 40%-ma gaupatiurebis umravlesoba amJamad diagnostirdeba, rogorc post-
Semdeg uari Tqva seqsualur urTierTobebze an maT travmuli stresuli aSliloba. danarCeni reaqciebi,
SeumcirdaT orgazmi eqvsi Tvis manZilze (Burgess and rogorc Cans, hgavs panikur da depresiul aSlilobas.
Holmstrom, 1979). SemTxvevebi, romelTa drosac xdeba panikis Semoteva
posttravmuli stresuli aSlilobis simptom- an aris gulTan dakavSirebuli Civilebi da romlebic
ebis garda, gaupatiurebisa da fizikuri Zaladobis amJamad diagnostirdeba, rogorc panikuri aSliloba,
msxverpli ganicdis damcirebas, sircxvils da mow- winaT cnobili iyo, rogorc dakostas sindromi anu
yvladia Semdgomi Tavdasxmis mimarT. igi aRar aris gulis funqciis moSla. samxedro fsiqiatrebis sim-
TviTdajerebuli, mas uqveiTdeba TviTSefaseba, uCn ciris gamo SeuZlebeli iyo im mravalricxovan Sem-
deba kiTxvebi imis Taobaze, Tu ratom mainc da mainc TxvevebTan gamklaveba, romlebsac omis dros awyde-
is aRmoCnda msxverplis rolSi da sakuTar Tavs ad- bodnen eqimebi. gamocdileba, romelsac isini fsiqi-
anaSaulebs imaSi, rom yovelgvari aucileblobis ga- atriul hospitalSi mZimed daavadebul pacientebTan
reSe Tavi safrTxeSi Caigdo (Janoff-Bulman and Frieze, muSaobis Sedegad iZendnen, ar iyo sakmarisi saomari
1983). rodesac amgvari Zaladobis Camdeni ojaxis moqmedebebis dros aRmocenebuli reaqciebis sam-
wevri an megobaria, zemoTxsenebul problemebs emate- kurnalod. amitom, saomari moqmedebebis dros miRe-
ba Ralatsa da konspiraciasTan dakavSirebuli prob- buli fsiqikuri travmis mqone pacientebs umTavresad
lemebi. msxverpls SeiZleba gauCndes undoblobis nevropaTologebi da fsiqologebi mkurnalobdnen.
grZnoba, qronikuli sibraze, gaRizianebadoba da sx- mag., v.h. riversi, viliam brauni da viliam makdaugo-
vebze gadaWarbebuli damokidebuleba. amgvari prob- li, britaneli fsiqologebi, romlebic pirveli
lemebi pirvelad qalebTan dafiqsirda, Tumca, igive msoflio omis dros amgvari fsiqikuri travmis mqone
siZneleebi aRiniSneba mamakacebTanac, romlebmac se- adamianebs mkurnalobdnen. maT omis Semdgom wlebSi,
qsualuri Zaladoba gadaitanes (Mezey and King, 1989). TavianTi gamocdilebis safuZvelze, mniSvnelovani
problemebi ufro didi xnis ganmavlobaSi Senar- naSromebi Seqmnes samedicino fsiqologiaSi (Rivers,
Cundeba, Tu adamianis sicocxles realuri an warmo- 1920; McDougall, 1926; Brown, 1934).
saxuli safrTxe emuqreba, an Tu warsulSi mas hqonda
fsiqologiuri da socialuri xasiaTis problemebi, mkurnaloba
viqtimizacia (gansakuTrebiT, bavSvobaSi gadatanili Tavdapirvelad saomari moqmedebis dros miRebul
Zaladoba), fsiqikuri avadmyofoba, borotad iyenebda fsiqikur travmas mkurnalobdnen imave meTodebiT,
fsiqoaqtiur nivTierebebs an aklda socialuri mx- rogoriTac nevrasTenias (dasveneba, izolacia, masaJi,
ardaWera (Mezey and Robbins, 2000). dieta, ix. gv. ??), magram es warumatebeli aRmoCnda.
hipnozis meSveobiT STambeWdavi Sedegebi iqna miRweu-
mkurnaloba li, magram es teqnika zogadad ar gamodga efeqturi.
socialuri mxardaWera mniSvnelovania imisaTvis, rom eqimi fsiqologebi iyenebdnen fsiqoTerapiul meTo-
saSualeba mivceT msxverpls ilaparakos arsebuli debs, romlebic froidma SeimuSava, kerZod, stresu-
problemis Sesaxeb da amiT daibrunos sakuTari Tavis li movlenebis gaxseneba, raTa momxdariyo represiis
mimarT pativiscema. aseT dros mkurnaloba igivea, rac daZleva da stresul movlenebTan dakavSirebuli emo-
_ 172 _
reagireba gansakuTrebuli tipis mZime stresze
ciebis gamoxatva. aqcenti gadatanili iyo aSlilobis da misma kolegebma (Fazel et al., 2005) sistematuri dak-
mkurnalobaze adreul stadiaSi. naTeli gaxda, rom virvebis Sedegad daadgines, rom evropaSi gadasaxle-
zogadi fizikuri janmrTelobisa da sabrZolo su- buli ltolvilebis daaxloebiT 10%-s posttravmuli
liskveTebis SesanarCuneblad fsiqoTerapia samxedro stresuli aSlilobis simptomebi aqvs, 5%-s aReniSneba
swavlebasTan erTad unda Catarebuliyo. aseTi kom- didi depresia, xolo 4%-s _ generalizebuli SfoT-
binirebuli Terapia ufro warmatebuli aRmoCnda. viTi aSliloba. bevr SemTxvevaSi es aSlilobebi erT-
avadmyofobis adreul stadiaze mkurnalobis, maneTs gadafaravs.
abreaqciis, fizikuri janmrTelobisa da sabrZolo
mkurnaloba
suliskveTebis SenarCunebis es zogadi principebi
SemdgomSi meore msoflio omisa da sxva samxedro mkurnaloba unda moicavdes rogorc fizikur, ise
konfliqtebis dros gamoiyenes. meore msoflio omis fsiqiatriul aspeqtebs. fsiqiatriuli mkurnaloba
dros xSirad mimarTavdnen anqsiolizur samkurnalo didi sifrTxiliT unda daviwyoT, radgan mas, ro-
saSualebebs abreaqciasTan erTad (Sargant and Slater, gorc stigmatizaciis gamomwvevs, SeiZleba mohyves wi-
1991). Semdgomi samxedro konfliqtebis dros dadgin- naaRmdegoba, rogorc ltolvilis, ise damxmare piris
da, rom gadaudebeli konsultaciebis Sedegad (emoci- mxridan. gansakuTrebuli yuradReba unda mieqces
uri daZabulobis medikamentebiT moxsnis gareSe) `sa- ndobaze damyarebuli urTierTobis Camoyalibebas.
brZolo Sokis~ mqone personalis daaxloebiT 70 pro- xSirad, kontaqtSi Sesvlamde aucilebelia praqtiku-
cents SeeZlo xuT dReSi dabruneboda Tavis samxedro li daxmarebis gaweva. bevr ltolvils ganSorebasTan,
nawils (Brandon, 1991). britaneTis armiaSi pirveli mZime danaklissa da qonebis dakargvasTan dakavSire-
msoflio omis dros miRebuli fsiqikuri travmebis buli problemebi aqvs. amitom, mniSvnelovania, rom
mkurnaloba aRwerili aqvs stouns (Stone, 1985). ar moxdes fiqsacia mxolod posttravmul stresul
aSlilobaze. wamebis msxverpls SeiZleba damatebiTi
ltolvilebTan da wamebis msxverplTan daxmareba dasWirdes, raTa SeZlos pirad Seuracxyo-
dakavSirebuli problemebi fasTan da sxva dazaralebulebis mimarT sindisis qen-
jnasTan gamklaveba. Tu eqimi da ltolvili sxvadasxva
ltolvilebs, Cveulebriv, mTeli rigi travmuli mov-
kulturis wamomadgenlebi arian, maT SesaZloa gansx-
lenebi aqvT gadatanili. magaliTad:
w saomari mdgomareoba
boqsi 8.6 ltolvilebisaTvis tipiuri
w naTesavebisa da megobrebis sikvdili an maTTan zogierTi stresori
ganSoreba
mizezebi
w sacxovreblisa da qonebis dakargva
omi
w fizikuri dazianeba (tvinis dazianebis CaTvliT), adamianis uflebebis darRveva
romlis mizezic SeiZleba iyos saomari moqmede- devna politikur, religiur, genderul an eTnikur niadagze
ba an Tavdasxma, gaupatiureba an wameba. agreTve,
ltolvili SeiZleba aRmoCndes sxvaze ganxorciele- danakargebi
buli Zaladobis TviTmxilveli. samSoblo
aseTma stresulma movlenebma SeiZleba nebismieri kultura
saxis reaqcia gamoiwvion, gansakuTrebiT ki post- ojaxi
travmuli stresuli da depresiuli aSliloba profesia
(Turner et al., 2003). am tipis aSlilobebi dafiqsirda ena
ltolvilebTan, romlebic sxvadasxva kulturas mi megobrebi
ekuTvnebian. miuxedavad amisa, mniSvnelovania gvax qoneba
sovdes, rom sxvadasxva kulturis warmomadgenlebis samomavlo gegmebi
ZiriTadi Civilebi SeiZleba garkveulwilad gansx-
vavdebodes erTmaneTisgan. mag., araevropelebi fizi- maspinZel qveyanasTan dakavSirebuli problemebi
kur simptomebze ufro amaxvileben yuradRebas, vidre fsiqologiuri da praqtikuli adaptacia
fsiqologiurze. identur movlenebze wamebis msxver- gaurkveveli momavali

travmuli cxovrebiseuli movlenebi
plT fizikuri dazianebis garda xSirad posttravmu-
socialuri gariyuloba da siRatake
li stresuli aSlilobac aReniSnebaT. agreTve, mniS-
rasizmi
vnelovania gvaxsovdes, rom ltolvilebisTvis amJa-
maspinZel qveyanaSi gabatonebuli stereotipebi
mindel stresorebTan gamklaveba SeiZleba iseTive
ucnobi kulturuli tradiciebi
rTuli iyos, rogorc im stresorebTan, romelTa ga-
moc saxlis datoveba mouxdaT (boqsi 8.6). feizelma Tribe 2002
_ 173 _
vavebuli warmodgena hqondeT imaze, Tu ras niSnavs (Casey et al., 2001).
janmrTeloba da rogori unda iyos stresze `norm- cxovrebiseulma stresulma movlenebma SeiZleba
aluri~ fsiqologiuri reaqcia. amitom, TiToeuli depresiis, SfoTvis, Sizofreniisa da sxva fsiqikuri
pacientis SemTxvevaSi unda gaviTvaliswinoT, Tu ram- aSlilobis provocireba gamoiwvios. amitom, adapta-
denad mizanSewonilia masTan formaluri fsiqoTera- ciis aSlilobis diagnozs ar svamen maSin, rodesac
piis Catareba da ramdenad marTebulia fsiqikuri daa- saxezea sxva fsiqikuri aSlilobebi. praqtikaSi am
vadebebisa da travmebis aRmniSvneli terminologiis aSlilobis diagnostireba faqtobrivad SfoTviTi da
gamoyeneba fsiqoTerapiis dros (Tribe, 2002). depresiuli aSlilobis gamoricxviT xdeba. garda ami-
gansakuTrebuli sifrTxile unda gamoviCinoT iseT sa, erT-erTi diagnostikuri pirobaa is, rom aSlilo-
SemTxvevebSi, rodesac ltolvilebTan muSaoba Tar- bam cxovrebiseuli cvlilebebis Semdeg maleve unda
jimnis meSveobiT gvixdeba. Tu es SesaZlebelia, Tar- iCinos Tavi. ICD-10-isa da DSM-IV-is moTxovnebis
jimnis funqcia ar unda Seasrulon ojaxis wevrebma, Tanaxmad, adaptaciis aSliloba stresuli movleni-
Temis uxucesebma an sxva pirebma, romelTa Tandas- dan sami Tvis ganmavlobaSi unda gamovlindes (ICD-
wrebiTac ltolvils ar siamovnebs sakuTar samarcx- 10-is mixedviT, Cveulebriv, erTi Tvis ganmavlobaSi).
vino gamocdilebaze saubari. es gansakuTrebiT mniS- mniSvnelovani aris is, rom pacientis adreuli ga-
vnelovania maSin, rodesac qalebs seqsualuri Seura- mocdilebisa da misi pirovnuli Tvisebebis Sesaxeb
cxyofa aqvT gadatanili, rac SeiZleba mTeli ojax- informaciis mopovebis Semdeg, naTeli unda gaxdes,
isTvis samarcxvino iyos. idealuri iqneba, Tu amgvar rom amgvari reaqcia uSualod aris dakavSirebuli
problemebze imuSavebs qali fsiqiatri, romelmac stresul gamocdilebasTan da misi proporciulia.
icis pacientis ena da kultura, Tumca, praqtikulad
es Zneli gansaxorcielebelia. diagnostikuri kategoriebi ICD-10-isa da
ltolvilebTan dakavSirebuli fsiqologiuri pro DSM-IV-is mixedviT
blemebis Sesaxeb informaciis misaRebad ix. Mollica rogorc zemoT ukve aRvniSneT (gv. ??), ICD-10-is
(2000) da Lustig et al., (2004). mixedviT adaptaciis aSliloba dayofilia: depre-
siul reaqciebad; SfoTvisa da depresiis Sereul
adaptaciis aSliloba reaqciebad; reaqciebad, romlebsac sxva emociuri
es termini aRniSnavs fsiqologiur reaqciebs, ro- aSliloba axlavs Tan da reaqciebad, romelsac qcev-
melic axal garemoebebTan Seguebis dros aRmocende- iTi aSliloba axlavs Tan (qceviT aSlilobas, Tavis
ba. aseTi garemoebebia: ganqorwineba da ganSoreba, is- mxriv, SeiZleba axldes an ar axldes emociuri aSli-
eTi radikaluri cvlilebebi, rogoricaa, mag., samuS- loba). DSM-IV-Si mocemulia eqvsi tipis adaptaciis
aos Secvla, skolidan universitetSi gadasvla, migra- aSliloba (ix. cxrili 8.2).
cia an fizikuri defeqtis mqone Svilis dabadeba. rac
Seexeba iseT SemTxvevebs, rogoricaa mZime danakargi, epidemiologia
letaluri daavadebis bolo stadia da seqsualuri zogadad, populaciaSi adaptaciis aSlilobis
Zaladoba, es moiTxovs specialuri saxis adaptacias, gavrcelebis xarisxi ucnobia. savaraudod, zogierT
ris Sesaxebac qvemoT gveqneba saubari. garemoSi, mag., zogadi profilis saavadmyofoebsa da
pirveladi jandacvis dawesebulebebSi, am aSlilobis
klinikuri maxasiaTeblebi gavrcelebis sixSire metia. sakmaod bevri Terapiuli
adaptaciis aSlilobis simptomebia SfoTva, wuxili, pacientis fsiqiatriuli Semowmebis Sedegad dadgin-
daqveiTebuli koncentracia, depresia da gaRizianeba- da, rom maTgan 12%-s aReniSneboda adaptaciis aSli-
doba. amas Tan axlavs vegetatiuri nervuli sistemis loba; aseve, insultis mqone pacientebis 27%-s (Strain
agznebiT gamowveuli iseTi fizikuri simptomebi, ro- et al., 1998).
goricaa gaxSirebuli guliscema da tremori. SeiZle-
ba, agreTve, vxedavdeT dramatul an agresiul qcevas, etiologia
TviTdaSavebis erTjerad an ganmeorebad epizodebs adaptaciis aSlilobis gamomwvevi aucilebeli piro-
da alkoholis an narkotikuli nivTierebebis boro- baa stresuli viTareba. Tumca, aseve mniSvnelovania
tad gamoyenebas. adaptaciis aSlilobis debiuti, mw- individualuri mowyvladoba, radgan erTsa da imave
vave stresul reaqciebTan SedarebiT, TandaTanobi- stresul viTarebaSi yvela adamians ar uviTardeba
Tia da misi mimdinareoba ufro xangrZlivia. xSirad adaptaciis aSliloba. am tipis mowyvladobis buneba
uaresdeba socialuri funqcionireba, rac distresis ucnobia; savaraudod, es gansxvaveba damokidebulia
intensivobis xarisxTan erTad adaptaciis aSlilobas individualur maxasiaTeblebze da, SesaZloa, nawilo-
normaluri adaptaciuri reaqciebisgan ganasxvavebs briv warsul gamocdilebasTan iyos dakavSirebuli.
_ 174 _
gansakuTrebuli tipis adaptacia
prognozi tebs sakuTar daavadebaze da ra zegavlenas axdens is
klinikuri gamocdileba gviCvenebs, rom adaptaciis maT cxovrebaze, anu, rogor afaseben isini TavianT
aSlilobaTa umravlesoba ramodenime Tve grZeldeba avadmyofobas. pacientebis da maTi mkurnali eqimebis
da mxolod mcire nawili SeiZleba gagrZeldes wlebis Sefaseba SeiZleba erTmaneTs emTxveodes an Zalian gan-
manZilze. adaptaciis aSlilobis mqone pacientebze sxvavdebodes, radgan pacientebis Sefaseba SeiZleba
Semdgomi sistemuri dakvirveba mwir informacias iZl- emyarebodes mcdar informacias, emociebs da ara obieq-
eva. zogierTi gamokvleva aCvenebs (Andreasen and Hoenck tur faqtebs; an, SesaZloa, es Sefaseba kulturaSi ga-
1982), rom zrdasrulebTan adaptaciur aSlilobas kargi batonebuli Sexedulebebis zegavleniT iyos Camoyali-
prognozi ukavSirdeba, zogierT mozards ki _ SeiZleba bebuli. amgvari Sefaseba SeiZleba ganamtkicon ojaxis
zrdasrul asakSi fsiqikuri aSliloba ganuviTardes. wevrebma, romlebic iziareben pacientis Sexedulebebs;
aseve, ojaxis wevrebi SeiZleba ewinaaRmdegebodnen paci-
mkurnaloba entis Tvalsazriss, rac kidev ufro daamZimebs mis md-
gomareobas. fizikur daavadebasa da fizikur defeqt-
mkurnaloba gulisxmobs pacientis stresuli prob-
Tan adaptaciaze msjelobisas yvelaze ufro xSirad iy-
lemebis gadaWras da xels uwyobs adaptaciis bune-
eneben or termins: avadmyofobiT ganpirobebuli qceva
briv process. adaptaciis bunebrivi procesi imazea
da avadmyofis roli. ganvixiloT es terminebi:
mimarTuli, rom pacientma naklebad gamoiyenos stre-
suli movlenebis uaryofisa da aridebis meqanizmebi. avadmyofobiT ganpirobebuli qceva
agreTve, pacients xeli unda SevuwyoT imaSi, rom man meqeinikis (Mechanic, 1978) mier termini àvadmyofobiT
gadaWras problemebi da winaaRmdegoba gauwios gam- ganpirobebuli qceva~ SemoTavazebul iqna im qcevis
klavebis araadaptur reaqciebs. SfoTva, Cveulebriv, aRsaniSnad, romelic fizikur an fsiqikur aSlilo-
mcirdeba, Tu pacients wavaxalisebT, isaubros arse- basTan adaptaciur an araadaptaciur Seguebas ukav-
bul problemebze da gamoxatos sakuTari gancdebi. Sirdeba. am tipis qceva moicavs: eqimTan konsulta-
zogjer saWiroa, rom pacientma ramdenime dRis ganma- cias, medikamentebis miRebas, naTesavebisa da mego-
vlobaSi anqsiolizuri da saZile saSualebebi miiRos. brebisgan daxmarebis Ziebas da uaris Tqmas araSesa-
problemis gadaWraze mimarTuli konsultaciebi tyvisi aqtivobebis ganxorcielebaze. amgvari qcevebi
(gv. ??) stimuls aZlevs pacients moZebnos stresu- adaptaciuria avadmyofobis adreul stadiaze, magram
li problemebis gadaWris gzebi da ganixilos is, Tu SeiZleba araadaptaciuri gaxdes, Tu SenarCundeba
ramdenad xelsayrelia ama Tu im saxis qmedebis ganx- gamojanmrTelebis stadiazec, rodesac adamiani da-
orcieleba. samomavlod es saSualebas miscems mas, moukidebeli unda gaxdes. qcevis am tips ganapirobebs
amoirCios da ganaxorcielos iseTi tipis aqtivoba, pacientis rwmena, rom is avad aris da ara obieqtu-
romelic problemis gadaWraSi daexmareba. Tu es aq- rad arsebuli daavadeba. avadmyofobiT ganpirobe-
tivoba warmatebuli aRmoCndeba, pacienti Semdegi buli qceva SeiZleba Camoyalibdes maSinac, rodesac
problemis ganxilvaze gadava. warumateblobis SemTx- daavadeba saerTod ar aRiniSneba. zogad praqtikaSi
vevaSi ki daubrundeba pirvel problemas da axlebur pacientis amgvari qceva, romelic daavadebis ararse-
midgomas mosinjavs. Tu problemis gadaWra ver xe- bobisas mJRavndeba, mniSvnelovan problemas warmoad-
rxdeba, pacients unda vurCioT Seeguos mas. maina da gens, radgan, Tu Camoyalibda, Zneli aRmosafxvrelia.
misi kolegebi amtkiceben (Maina et al., 2005), rom adap- marTalia, avadmyofobiT ganpirobebuli qcevis cneba
taciis aSlilobis mqone pacientebTan ufro efeqtu- nawilobriv gadafaravs avadmyofis rolis cnebas (ix.
ria xanmokle dinamiuri da mxardamWeri fsiqoTerapi- qvemoT), magram mocemul wignSi cal-calkea aRweri-
is gamoyeneba, vidre mkurnalobis dawyebis dayovneba li, radgan sxvadasxva warmoSobisaa.
da intervenciis mxolod maSin ganxorcieleba, rode-
sac raime problema iCens Tavs. avadmyofis roli
sazogadoeba avadmyof adamianebs gansxvavebulad epy-
gansakuTrebuli tipis adaptacia roba, rasac parsonsi (Parsons, 1951) avadmyofis rols
uwodebs. avadmyofis roli ori privilegiisa da ori
fizikur daavadebasa da fizikur defeqtTan valdebulebisgan Sedgeba. esenia:
adaptacia
w zogierTi socialuri pasuxismgeblobisgan gaTavi-
avadmyofobis Sefaseba sufleba;
avadmyofobasTan adaptacia ar SeiZleba gaazrebul w sxva adamianebisgan daxmarebisa da zrunvis molodi-
iqnes mxolod daavadebis Sesaxeb arsebuli faqtebisa nis ufleba;
da misi obieqturi Sedegebis TvalsazrisiT. adaptacia
w mkurnalobis Catarebisa da eqimTan TanamSromlobis
damokidebulia imaze, Tu ra warmodgena aqvT pacien-
valdebuleba;
_ 175 _
w gamojanmrTelebis survili. pacientis guneb-ganwyobaze, qcevasa da cnobierebaze.
sanam pirovneba avad aris, avadmyofis roli misTvis amgvari efeqtis gamomwvevi medikamentebi meTeqvsmete
adaptaciuria. Tu igi avadmyofobis Semdegac agrZe- TavSia CamoTvlili (cxrili 16.6).
lebs am rolSi yofnas, xdeba gamojanmrTelebis gada-
adaptacia somatur daavadebasTan
vadeba, radgan is Tavs aridebs pasuxismgeblobas da
sxvebze damokidebuli rCeba. adamianebis umravlesoba kargad adaptirdeba fizikur
daavadebasTan, magram, rodesac adaptacia nela da
adaptacia fizikuri daavadebis debiutTan arasrulyofilad mimdinareobs, SeiZleba fsiqologi-
uri mkurnaloba gaxdes saWiro. amgvari mkurnaloba
rodesac adamianebi fizikurad avaddebian, SeiZleba
ar unda iyos rTuli da somaturi daavadebebis mkur-
SfoTvas, depresias an sibrazes ganicdidnen. Cveu-
nali zogadi profilis praqtikosebi, saavadmyofos
lebriv, aseTi emociuri reaqciebi droebiTia da
eqimebi da meddebi, Cveulebriv, warmatebiT arTmeven
maleve sustdeba, radgan pacients axali situaciis
mas Tavs. rogorc wesi, fsiqiatri pacients yvelaze
mimarT mimRebloba uviTardeba. iseve, rogorc sxva
mZime problemebis daZlevaSi exmareba; aseve, daxmare-
saxis adaptaciuri reaqciebis dros, uaryofam an mini-
bas uwevs eqimebsa da eqTnebs. upirveles yovlisa,
mizaciam SeiZleba daicvas pacienti Zlieri SfoTvis-
xdeba cudi adaptaciis mqone pacientebis identifi-
gan, romelic mas diagnozis gagebisas uCndeba. miuxe-
kacia, romlebic ver umklavdebian daavadebas. amas,
davad amisa, uaryofa, romelic am mxriv sasargebloa,
Cveulebriv, akeTebs profesionalTa jgufi, romelic
SeiZleba araadaptaciuric iyos, radgan man SeiZleba
somatur daavadebebze muSaobs. cudi adaptaciis
SeuSalos xeli avadmyofobis adreul stadiaze dax-
mqoned iseTi pacientebi iTvlebian, romelTa gamo-
marebis droul moZiebas, xolo gviandel safexurze
janmrTelebis procesi ufro nela mimdinareobs, vi-
pacienti mkurnalobis mimarT naklebad damyoli gaxa-
dre es mosalodnelia daavadebis simZimidan gamomdi-
dos. gamklavebis sxva strategiebi SeiZleba daiyos
nare. guneb-ganwyobis aSlilobebi amgvari progresis
or jgufad: emociis Sesustebasa da problemis gadaw-
Senelebis gavrcelebul mizezs warmoadgens (aRsan-
yvetaze mimarTul strategiebad (gv. ??). daZlevis
iSnavia, rom gamojanmrTelebis Senelebuli procesi
strategiebi, romlebic emociis Sesustebas iwvevs,
zog SemTxvevaSi normalur reaqciad aris miCneuli).
xSirad Sesabamisia avadmyofobis adreuli stadiebi-
pacientebis am jgufTan guneb-ganwyobis aSlilobebis
sTvis, magram Semdeg etapze maT adgili unda dauTmon
dasadgenad SeiZleba gamoviyenoT kiTxvarebi skrinin-
problemis gadaWraze mimarTul gamklavebis strate-
gisTvis, magram miRebuli rezultatebi, sul cota,
giebs. gamklavebis strategiebma SeiZleba marcxi gani-
mokle intervius meSveobiT mainc unda gadamowmdes.
cadon, rodesac moTxovnebi Zalian maRalia, an rode-
mokle interviu unda Catardes iseT garemoSi, sadac
sac gamklavebis resursebi SezRudulia. amas SeiZle-
daculi iqneba konfidencialoba. Cveulebriv, pacien-
ba sxvadasxva mizezi hqondes: droTa ganmavlobaSi
tis ojaxis erT-ori wevrisgan unda movipivoT infor-
resursebis ganleva, Tavis tvinis daavadeba an travma.
macia problemebTan da avadmyofobasTan pacientis
somaturi daavadeba, rogorc fsiqiatriuli adaptaciis Sesaxeb da, agreTve, gavarkvioT, Tu ras
simptomebis uSualo gamomwvevi mizezi fiqroben ojaxis wevrebi pacientis avadmyofobaze.
somaturma daavadebam, rogorc stresorma, SeiZleba zogierTi pacienti medikamentur mkurnalobas
fsiqiatriuli simptomebis aRmoceneba gamoiwvios. saWiroebs, magram umravlesobisTvis ufro mizanSe-
SfoTva, depresia, daRliloba, sisuste, wonaSi dak- wonilia konsultaciis Catareba (gv. ??), risTvisac
leba da paTologiuri qceva SeiZleba uSualod so- saWiroa, rom pacientsa da eqims Soris ndoba damyard-
maturi darRvevebiT iyos gamowveuli. SedarebiT es, rac, Tavis mxriv, interviusTvis Sesabamisi drois
gavrcelebuli SemTxvevebi meTeqvsmete TavSia moce- daTmobas moiTxovs. konsultacia iwyeba pacientisTvis
muli (cxrili 16.5). zustad aseve, seqsualuri dis- daavadebis bunebisa da misi Sesabamisi mkurnalobis axs-
funqcia SeiZleba gauaresdes somaturi daavadebis an na-ganmartebiT. amis Semdeg, pacients unda davexmaroT,
misi mkurnalobis Sedegad (gv. ??). nebismieri amgvari rom misTvis diagnozi misaRebi gaxdes, rom is Seeguos
simptomis arsebobisas pirovnebam SeiZleba eqims mim- avadmyofobas da uari Tqvas araadaptaciur qcevebze
arTos. fsiqiatrma sifxizle unda gamoiCinos, raTa (mag., arasakmarisi damoukidebloba da mkurnalobis
ar gamorCes pacientis somaturi daavadeba. aucileblobis uaryofa). zogierT SemTxvevaSi, SeiZle-
ba sasargeblo aRmoCndes iseTi teqnologiebis gamoy-
somaturi daavadebis mkurnalobiT gamowveuli eneba, rogoricaa safexureobrivi aqtivobebi, moti-
fsiqiatriuli simptomebi vaciuri interviuireba da brazis marTva.
zogierTma medikamentma, romelic fizikuri daa- Tu pacienti somatur daavadebaze SfoTviT an
vadebis samkurnalod gamoiyeneba, SeiZleba imoqmedos depresiuli aSlilobiT reagirebs, am aSlilobebis
_ 176 _
Sesabamisi mkurnalobaa Casatarebeli (ix. mecxre da uCndeba. Tavidan man SeiZleba ar daijeros es faq-
meTerTmete Tavebi). ti da mSvid cxovrebas daubrundes. uaryofa Tan-
daTanobiT mcirdeba, rodesac adamiani urigdeba
adaptacia letalur daavadebasTan Tavis avadmyofobas, magram daavadebis progresire-
daaxloebiT naxevars im avadmyofebisas, romlebic basTan erTad SeiZleba xelmeored iCinos Tavi. am
saavadmyofoSi kvdebian, SfoTvis, depresiis, sibrazis dros pacienti kvlav ise iqceva, TiTqos araferi
an danaSaulis gancdis emociuri simptomebi aReniSne- icis sakuTari daavadebis bunebis Sesaxeb.
baT (Meyer at al., 2003). emociuri reaqciebis ganmsaz- w sxvebze damokidebuleba adaptaciuria mZime fizikuri
Rvreli faqtorebia pacientis personologiuri maxa- avadmyofobis adreul stadiaze, rodesac saWiroa,
siaTeblebi da im mxardaWeris siZliere da xarisxi, rom pacienti pasiurad daemorCilos mkurnalobas.
romelsac is ojaxis wevrebisgan, megobrebis an momv- gadaWarbebuli da xangrZlivi sxvebze damokideb-
lelebisgan iRebs. cxadia, emociuri reaqciebi ufro uleba ufro arTulebs Semdgom mkurnalobas da zr-
damaxasiaTebelia axalgazrda momakvdavi pacientebi- dis ojaxis wevrebis datvirTvas. rodesac pacienti
sTvis, vidre xandazmulebisTvis. amgvar reaqciebs sikvdilis piras imyofeba, sxvebze damokidebuleba
ufro iSviaTad vxvdebiT im pacientebTan, romelTac SeiZleba kvlav adekvaturi gaxdes.
swamT imqveyniuri cxovrebis. w gadatana _ xSirad esaa sibraze, romelic SeiZleba
SfoTva mimarTuli iyos samedicino personalis an naTe-
savebis mimarT. maTTvis amgvari reaqcia SeiZleba
SfoTvas SeiZleba iwvevdes Zlieri tkivili, fizikuri
gaugebari aRmoCndes da moTmineba dakargon pa-
damaxinjebis an Seukaveblobis (Sardvisa da defeka-
cientTan urTierTobisas. amis gamo maT SeiZleba
ciis) ganviTarebis molodini; agreTve, sikvdilis
naklebi dro dauTmon pacients, rac gaaZlierebs
SiSi da ojaxis momavalze wuxili. ojaxis wevrebi da
mis sasowarkveTas.
momvlelebi, pacientis SfoTvis Semsubuqebis mizniT,
zogjer malaven mis realur mdgomareobas. radgan uaryofas, sxvebze damokidebulebasa da gadatanas
maTma umravlesobam icis sakuTari diagnozi, misi da- Cveulebriv mosdevs mimRebloba. eqimis mizania dae-
malvis mcdeloba mxolod aZlierebs SiSs (rogoricaa, xmaros pacients sakuTari mdgomareobis `miiReba-
mag., tkivilis an Seukaveblobis SiSi). Si~, sanam avadmyofoba bolo stadiaSi gadaizrdeba.
am miznis miRweva ufro advilia maSin, rodesac pa-
depresia cients, samedicino personalsa da naTesavebs Soris
depresia SeiZleba gamoiwvios ojaxTan da megobrebT- kargi urTierTobaa damyarebuli.
an ganSorebis perspeqtivam, an iman, rom pacienti ve-
fsiqologiuri simptomebi
Rar Seasrulebs misTvis Rirebul saqmianobas. garda
amisa, uaryofiTi guneb-ganwyobis mizezebia avadmyo- pacientis distress SeiZleba daematos daavadebiTa
fobiT gamowveuli garegnuli cvlilebebi, operaciis da misi mkurnalobiT gamowveuli fsiqologiuri simp-
Sedegebi da radioTerapiiT gamowveuli sisuste. tomebi. kavSirebi, romlebic xSirad gvxvdeba daavade-
basa da fsiqologiur simptomebs Soris, Sejamebulia
danaSaulis grZnoba da sibraze cxrilSi 16.5. gansakuTrebiT Zlieri kavSiri arsebobs
zogierT pacients aqvs danaSaulis grZnoba, radgan dispnoesa da SfoTvas Soris. medikamentur mkurnalo-
Tvlis, rom gadaWarbebul moTxovnebs uyenebs naTe- basa da fsiqologiur simptomebs Soris dadgenili ka-
savebsa da megobrebs. religiur pacientebs SeiZleba vSirebi Sejamebulia cxrilSi 16.6.
sjerodeT, rom avadmyofoba sasjelia, romelic war-
mkurnaloba
sulSi Cadenili araswori qmedebebisTvis daimsaxures.
pacienti moaxloebuli sikvdilis usamarTlobis gamo Cveulebriv, momakvdav pacients adaptaciaSi exmareba
SeiZleba sibrazes ganicdides. es gancda man SeiZleba samedicino personali, romelic mis somatur daavade-
eqimebze, meddebsa da naTesavebze gadaitanos, ramac, bas mkurnalobs. fsiqiatrs mxolod maSin iZaxeben,
SesaZloa, gaarTulos pacientis movla (ix. qvemoT). rodesac aRiniSneba gansakuTrebuli problemebi (ix.
qvemoT) an saWiroa personalisTvis daxmarebis gaweva
dacviTi meqanizmebi da treningis Catareba.
uaryofa, sxvebze damokidebuleba da gadatana is
mkurnalobis miznebi
dacviTi meqanizmebia, romlebsac yvelaze ufro xSir-
ad vxvdebiT momakvdav pacientebTan. heqeTisa da vaismanis mixedviT (Hackett and Weisman,
1962), momakvdavi pacientebis mkurnalobis mizani
w uaryofa, Cveulebriv, pirveli reaqciaa, romelic
unda iyos `Sesaferisi sikvdili~, raSic avtorebi Sem-
pirovnebas fataluri avadmyofobis gagebis Semdeg
degs gulisxmoben:
_ 177 _
ramdenadac es SesaZlebelia, pirovneba ar unda lemebis Sesaxeb srul informacias flobdes, maSin,
grZnobdes tkivils; efeqturad unda funqcioni- Cveulebriv, ukeTesia am informaciis miwodeba moma-
rebdes im xarisxiT, ra xarisxiTac SeuZlia; unda vlisTvis gadavdoT. Sesabamis stadiaze pacients unda
gaacnobieros da gadaWras arsebuli konfliqtebi; vuTxraT, Tu ra SeiZleba gakeTdes imisaTvis, rom misi
SeZlebisdagvarad unda daikmayofilos yvela dar- darCenili cxovreba SeZlebisdagvarad komfortuli
Cenili survili; unda miandos sakuTari Tavis mar- iyos. daavadebis Sesaxeb sruli informacia simarTles
Tva imaT, visac endoba. unda Seesabamebodes, magram gadawyvetilebis miReba
imis Taobaze, Tu TiToeul SemTxvevaSi informaciis
am miznebis gansxvavebul formulirebas gvTavazobs
ra nawili gavumJRavnoT, damokidebulia pacientis
kubler-rosi (Kubler-Ross, 1969). igi sikvdilTan
reaqciebze da mis mier dasmul SekiTxvebze. aucile-
fsiqologiuri adaptaciis xuT fazas gamoyofs,
blobis SemTxvevaSi, eqimi unda miubrundes problemis
romelTa Tanmimdevroba yovelTvis erTi da igive ar
ufro Rrma ganxilvas maSin, rodesac pacienti amisT-
aris _ zogi SeiZleba saerTod àmovardnili~ iyos. am
vis mzad iqneba. mniSvnelovania yovelTvis gvaxsovdes,
fazebis codna sasargebloa im profesionalebisTvis,
rom momakvdavi pacientebis umravlesoba acnobierebs
romlebic momakvdav pacientebs uweven daxmarebas. es
sakuTari avadmyofobis prognozs (miuxedavad imisa,
fazebia:
arian Tu ara amis Sesaxeb uSualod informirebulni),
w uaryofa da izolacia; momvlelebis qcevaze dakvirvebiT maT SeuZliaT swori
w sibraze; daskvnebis gamotana. isini xvdebian, rom adamianebi maT
w nawilobrivi mimRebloba (`vaWroba drois mogebis mier dasmul SekiTxvebze pasuxis gacemas da maTTan
mizniT~); laparaks eridebian. pacientebs, romlebic SfoTvas,
w depresia; sibrazes an sasowarkveTilebas ganicdian, saSualeba
unda mieceT, gamoxaton TavianTi gancdebi da maTi ga-
w sruli mimRebloba.
momwvevi azrebis Sesaxeb imsjelon.
simptomebis Sesusteba
personalisTvis informaciis miwodeba
gansakuTrebiT mniSvnelovania tkivilisa da gaZnele-
mTelma samedicino personalma unda icodes, Tu ra in-
buli sunTqvis adekvaturi kontroli da deliri-
formacias flobs pacienti. sxva SemTxvevaSi maT Sei-
umiT gamowveuli dabneulobis Semcireba. SfoTva da
Zleba urTierTgamomricxavi rCevebi miscen pacients
depresia SeiZleba Semcirdes tkivilisa da gaZneleb-
da misi TandaswrebiT urTierTsawinaaRmdego mosazre-
uli sunTqvis gakontrolebis Semdeg. deliriumis ga-
bebi gamoTqvan. Tu procesis yvela monawilem icis, Tu
momwvevi mizezebi mocemulia ?? gverdze. momakvdavi
ra aris pacientisTvis cnobili, es maT urTierTobas
pacientebis movlisas SesaZlebelia zogierTi mniS-
gauadvilebs. winaaRmdeg SemTxvevaSi, maTsa da pacients
vnelovani simptomis mkurnaloba. esenia: dehidrata-
Soris gaCndeba distancia, rac izolaciaSi moaqcevs
cia, samkurnalo saSualebebis gverdiTi movlenebi,
avadmyofs da gaarTulebs adaptaciis process.
meoradi infeqciebi, kardialuri an respiratoruli
dekompensacia da hiperkalcemia. naTesavebisTvis informaciis miwodeba da mxarSi
amodgoma
pacientisTvis adaptaciaSi daxmarebis gaweva
naTesavebma unda icodnen, Tu ra informacias flobs
aucilebelia pacientTan kargi urTierTobis da-
pacienti. aseT SemTxvevaSi isini naklebad uxerxulad
myareba, raTa man SeZlos sakuTari problemebis Ses-
igrZnoben Tavs masTan saubrisas. naTesavebs iseve
axeb saubari da kiTxvebis dasma. avadmyofobis xasiaTi
sWirdebaT daxmareba, rogorc pacientebs. maT Sei-
mas gulwrfelad da martiv enaze unda ganvumartoT.
Zleba SfoTva da depresia ganuviTardeT da pacientis
zogjer eqimebi SiSoben, rom aseTi axsna avadmyofis
avadmyofobis mimarT uaryofiTi, agresiuli reaqcia
mdgomareobas kidev ufro daamZimebs. miuxedavad imisa,
gauCndeT. maT SeiZleba gauCndeT danaSaulis ganc-
rom detalebis mSralad miwodebam SeiZleba gamoiwvios
dac. aseTi reaqciebi xels SeuSlis maT, daamyaron
amgvari efeqti, umetes SemTxvevaSi ar aris Zneli ga-
normaluri urTierToba pacientTan da samedicino
dasawyveti is, Tu ra saxis informacia unda mivawodoT
personalTan. naTesavebs sWirdebaT informacia pa-
pacients diagnozisa da prognozis Sesaxeb. aucile-
cientis mdgomareobis Sesaxeb. maT unda mieceT Ses-
belia, rom pacients hqondes saSualeba, warmarTos
aZlebloba, isaubron TavianT gancdebze da moemza-
diskusia da gamoxatos Tavisi wuxili da survilebi.
don gardauvali, mZime danakargisTvis. winaaRmdeg
Tu mas ainteresebs, rogoria avadmyofobis prognozi,
SemTxvevaSi, pacientsa da mis ojaxis wevrebs Soris
simarTle ar unda davumaloT, radgan mikibul-mokib-
distancia SeiZleba gaizardos da isini gaucxovdnen
uli pasuxebi aryevs momvlelebis mimarT pacientis
erTmaneTisgan.
ndobas. xolo Tu mas ar aqvs survili sakuTari prob-
_ 178 _
specialuri momsaxureba SevamciroT, an is sxva preparatiT unda CavanacvloT.

avTvisebiani simsivnis ganviTarebis gviandel stadiaze
bevr saavadmyofoSi momakvdavi adamianebis mosavle-
sakmaod Znelia depresiuli aSlilobis zogierTi
lad ojaxis eqimTan da saavadmyofos personalTan
simptomis Sefaseba. mag., wonaSi kleba, anoreqsia,
specialisti eqTnebi TanamSromloben. aseT eqTnebs
uZiloba, interesis dakargva da daRliloba _
gavlili aqvT treningi momakvdavi pacientis ro-
yvelaferi es SeiZleba fizikuri daavadebiT iyos
gorc fsiqologiuri, aseve fizikuri movlis Tval-
gamowveuli. xolo dilas adre gaRviZeba, ukiduresi
sazrisiT. zogjer amgvar avadmyofebs uvlian pali-
sasowarkveTileba da sakuTari Tavis dadanaSauleba
atiuri mzrunvelobis klinikaSi (e.w. hospisSi), sa-
_ ufro zust miniSnebas gvaZlevs diagnozis Sesaxeb.
dac SesaZlebelia yuradReba gamaxvildes iseT de-
sifrTxile unda gamoviCinoT suiciduri azrebis
talebze, romlebic momakvdavi adamianis cxovrebis
Sefasebisas: Tu konsultaciebi da daavadebis marTvis
xarisxs gaaumjobesebs. aseT hospisebSi pacientebs
gaumjobeseba ar iwvevs guneb-ganwyobis gamosworebas,
maSin aTavseben, rodesac maTi movla saxlis piro-
maSin pacients unda davuniSnoT antidepresantebi
bebSi arapraqtikulia. aseTi klinikis TanamSromlebi
da yuradRebiT mivadevnoT Tvali mkurnalobis
uzrunvelyofen pacientis droebiT movlas da amiT
process. sawyisi doza mcire unda iyos da, saWiroebis
umsubuqeben tvirTs im adamianebs, romlebic saxlis
SemTxvevaSi, Seicvalos sxva antidepresantiT, raTa
pirobebSi uvlian avadmyofs.
mivakvlioT iseT medikaments, romlis mimarTac
fsiqiatrTan pacientis gadamisamarTeba pacienti ufro tolerantulia (Dein, 2003).
fsiqiatrTan pacientis gadamisamarTeba xdeba maSin,
kontaqti eqimebsa da eqTnebTan
rodesac saxezea mZime xasiaTis fsiqiatriuli simp-
kontaqti eqimebsa da eqTnebTan Zalze mniSvnelovania.
tomebi an qceviTi darRvevebi (Lyness, 2004). es xdeba
mas Semdeg, rac fsiqiatri mkurnalobis gegmas
Semdegi tipis pacientebis gamokvlevisa da marTvis
Seadgens, xSirad mkurnalobis process swored es
mizniT:
personali warmarTavs. momakvdavi pacientis movlis
w depresiuli pacientebis, raTa dadgindes depresiis
Sesaxeb ix. Billings, 2000.
mizezi da gadawydes Tu romeli tipis mkurnalo-
bis Catarebaa ukeTesi _ medikamenturis Tu struq-
glova da mZime danakargTan adaptacia
turirebuli fsiqoTerapiis.
sityvebi: mZime danakargi, glova da dardi _ zogjer
w arakomunikabeluri pacientebis, romlebsac ar
sinonimuria, magram maT sxvadasxva datvirTva aqvT,
surT saubari TavianT avadmyofobaze.
rac mniSvnelovania fsiqiatriisTvis.
w pacientebis, romlebic uars amboben TanamSromlo-
w mZime danakargi sayvareli adamianis sikvdils
baze. aseTi pacientebi ar iReben avadmyofobis gamo
ukavSirdeba.
Tavsmoxveul socialur SezRudvebs, ar adgenen
w glova aris mZime danaklisze uneblie emociuri da
saWiro gegmebs da ar iReben aucilebel gadaw-
qceviTi reaqcia.
yvetilebebs.
w trauri _ esaa im qcevebisa da ritualebis Segnebuli
garda amisa, fsiqiatrTan pacientis momarTva
Sesruleba, romlebic mZime danakargze socialurad
mizanSewonilia:
dadgenil reaqcias warmoadgens. es qcevebi da
w xangrZlivi problemebis dros, romlebsac amZimebs
ritualebi TavianTi formiTa da xangrZlivobiT
daavadeba da romlebic ukavSirdeba pacientis
gansxvavebulia sxvadasxva socialur da religiur
pirovnul Tvisebebsa da ojaxur konfliqts.
jgufSi.
w sxva simptomebis arsebobisas. aseTi pacientebisTvis
klasifikaciis sistemebi yovelTvis erTnairad ar
SfoTva da deliriumi Cveulebrivi movlenaa,
asaxavs am gansxvavebebs. ICD-10-Si mZime danakargi
ris movlasac samedicino personali fsiqiatris
gansazRvrulia, rogorc Z63.4, anu ganekuTvneba
daxmarebis gareSec axerxebs. gamonakliss war
kategorias `faqtorebi, romlebic gavlenas axdens
moadgens deliriumi fsiqozuri simptomebiT.
janmrTelobis statusze da jandacvis samsaxurebTan
depresiuli aSlilobis marTva kontaqtze~. DSM-IV-Si ki rogorc `mdgomareoba,
romelzec SeiZleba klinicistis yuradReba iqnes
depresiuli aSliloba SeiZleba gamoiwvios iseTma
fokusirebuli~. amgvarad, am termins ufro mZime
simptomebma, rogorebicaa tkivili da sunTqvis
danakargze reaqciis aRsaniSnad iyeneben, vidre Tavad
garTuleba. aucilebelia am simptomebis Sesabamisi
faqtis. ICD-10-Si dardi kodirebulia, rogorc
mkurnaloba. Tu medikamenti potenciurad depresiis
adaptaciis aSliloba, magram gamoyenebulia termini
gamomwvevia (ix. cxrili 16.6), misi doza an unda
`glovis reaqcia~. trauri, romelic socialuri
_ 179 _
qcevis formas warmoadgens, ar aris aSliloba da,
Sesabamisad, ar aris Setanili arc erTi klasifikaciis
cxrili 8.3 normaluri glovis reaqciebi
indeqsSi. am TavSi terminiT `reaqcia danakargze~ safexuri I: ramdenime saaTidan - ramdenime dRemde
aRiniSneba mZime danakargze nebismieri tipis reaqcia momxdaris uaryofa da miuRebloba
(rogorc normaluri, aseve paTologiuri). normalur èmociuri siClunge~
reaqciebs `glova~ ewodeba, xolo paTologiuri glova
safexuri II: ramdenime kviridan - 6 Tvemde
da depresiuli aSlilobebi anomaliuri reaqciebia.
wuxili, tirili, dardis Semotevebi
glova SfoTvis somaturi simptomebi
glova uwyveti procesia, magram meti sicxadisTvis is mousvenroba
SeiZleba sam safexurad daiyos (cxrili 8.3). cudi Zili
pirveli safexuris xangrZlivoba ramdenime saaTi umadoba
an ramdenime dRe SeiZleba iyos. am dros vxedavT danaSaulis gancda, sxvebis dadanaSauleba da sxv.
uaryofas, rac vlindeba emociuri reaqciis sisusteSi gancda, TiTqos gardacvlili adamiani gverdiT imyofeba
(èmociuri siClunge~). mas xSirad Tan axlavs arar- iluziebi, cocxali xatebi
ealurobis gancda. pirovneba bolomde ver aRiqvams smeniTi halucinaciebi (esmis gardacvlili adamianis xma)
axlobeli adamianis gardacvalebas. is SeiZleba mous- pirovneba moculia gardacvlili adamianis mogonebebiT
socialuri cxovrebidan gandgoma
venrad iyos da iseT STabeWdilebas tovebdes, TiTqos
gardacvlil adamians eZebs. safexuri III: ramdenime kviridan - ramdenime Tvemde
meore safexuri ramodenime kviridan daaxloebiT
simptomebis moxsna
6 Tvemde grZeldeba, Tumca, SeiZleba bevrad ufro socialuri aqtivobebis aRdgena
didxans gastanos. am dros adamiani wuxs, tiris, mas pozitiuri mogonebebi
eufleba martoobis gancda da periodulad gar-
(simptomebi SeiZleba ganmeordes garkveuli TariRebis
dacvlili adamiani Zlier enatreba. am safexurze
dros)
SfoTva Cveulebrivi movlenaa. pirovneba, romelmac
danaklisi ganicada, SfoTviani da mousvenaria, aqvs reaqciebi ar aris yovelTvis erTnairi da arc erTi
cudi Zili, uCivis umadobas da SeiZleba panikis Sete- maxasiaTebeli ar aris universaluri (Schuchter and
vebi hqondes. bevr adamians aqvs danaSaulis gancda Zisook, 1993).
imis gamo, rom gardacvlils sakmarisad kargad ver
mouara. zogierTi adamiani ganicdis sibrazes da sa- anomaliuri anu paTologiuri glova
kuTari danaSaulis gancdis proeqcias axdens (mag., glova anomaliuria, Tu is uCveulod intensiuria,
adanaSaulebs eqimebs an sxva adamianebs imaSi, rom maT gaxangrZlivebulia, droSi gadavadebuli an saxe
maqsimalurad kargad ar mouares gardacvlils). bevr Secvlilia. paTologiuri intensivobis kriteriumebi
maTgans agreTve iseTi gancda eufleba, TiTqos gar- igivea, rac depresiuli aSlilobis simptomebisa.
dacvlili adamiani maT gverdiTaa. daaxloebiT aTi- miiCneva, rom reaqcia paTologiuri xangrZlivobisaa,
dan erTs SeiZleba xanmokle halucinaciebic hqondes Tu is eqvs Tveze met xans grZeldeba. reaqcia
(Clayton, 1979). pirovneba gamudmebiT igonebs gardacv- dagvianebulad miiCneva, Tu adamiani ar gaivlis dardis
lil adamians da xandaxan am mogonebebs akviatebuli pirvel etaps sayvareli adamianis gardacvalebidan
xatebis saxe aqvs. xSiria socialuri urTierTobebi- ori kviris manZilze. dardis yvela formisTvis
sTvis Tavis arideba. gavrcelebul movlenas warmoad- damaxasiaTebelia im situaciebisa da viTarebebisTvis
gens fizikuri xasiaTis Civilebi (Parkes and Brown, mudmivad Tavis arideba, romlebic sikvdils ukav
1972). daqvrivebuli qalebi ufro xSirad iTxoven sa- Sirdeba.
medicino daxmarebas, vidre isini, visac danakargi ar paTologiuri intensivobis dardi. xSirad dep
ganucdia (Stein and Susser, 1969). resiuli simptomebi normaluri dardis komponentebia.
mesame safexurze es simptomebi sustdeba da ada- im adamianebis 35%-s, romlebmac mZime danakargi
miani yoveldRiur saqmianobas ubrundeba. pirovneba ganicades, glovis romelime etapze uviTardeba
TandaTanobiT urigdeba danakargs da ixsenebs im sa- depresiuli aSlilobis simptomebi (Schuchter and Zisook,
siamovno wuTebs, romlebic gardacvlil adamianTan 1993). umetes SemTxvevaSi depresiuli aSliloba eqvsi
erTad gautarebia. xSirad simptomebi xelaxla iCens Tvis mere aRar aRiniSneba, magram daaxloebiT 20%-
Tavs, rac garkveul TariRebTan aris dakavSirebuli s is didi xnis manZilze SeiZleba SeunarCundes. Tu
(mag., gardacvalebis dRe). im adamianebis erT mesameds, romelmac danakargi
marTalia, am safexurebis codna sasargebloa, ma- ganicada, romeliRac etapze depresiuli aSlilobis
gram isic gasaTvaliswinebelia, rom individualuri simptomebi aReniSneba, es SeiZleba imas niSnavdes,
_ 180 _
rom dadgenili zRvari zedmetad dabalia. Tumca, loa an Tavisi xarisxis (mag., aSkarad gamoxatuli
depresiuli aSlilobis simptomebis mqone adamianebis mtruli damokidebuleba, zeaqtiuroba da ukiduresi
SemTxvevaSi ufro metia imis albaToba, rom maT socialuri TviTizolacia) an Tavisi xasiaTis mixedviT
hqondeT cudi socialuri adaptacia, rom xSirad (mag., iseTi fizikuri simptomebis arseboba, romlebic
dadiodnen eqimebTan da borotad moixmardnen al gardacvlil adamians ukanaskneli avadmyofobis dros
kohols (Schuchter and Zisook, 1993). amitom, am hqonda). es deformirebuli gamovlinebebi aRwerili
kriteriumebis gamoyenebasa da depresiuli aSlilobis aqvs lindermans (Lindemann, 1944) Tavis gamokvlevaSi,
damatebiTi diagnozis dasmas praqtikuli mniSvneloba romelic Ramis klubSi gaCenili xanZris dros
aqvs. rodesac arsebobs eWvi depresiul aSlilobaze, gadarCenil adamianebs exeba.
gansakuTrebuli yuradReba unda mivaqcioT retar am formis nebismieri glovis dros Cveulebriv
daciisa da TviTSefasebis zogadi daqveiTebis SeiniSneba mudmivi Tavis arideba im situaciebisa da
simptomebs, radganac es maxasiaTeblebi iSviaTad viTarebebisTvis, romelic sikvdilTan dakavSirebul
gvxvdeba Cveulebrivi glovis dros (Jacobs et al., 1989). mogonebebs iwvevs.
suiciduri azrebi gvxvdeba intensiuri dardis
dros. mZime danakargis Semdeg suicidis procentuli paTologiuri glovis gamomwvevi mizezebi
maCvenebeli izrdeba erTi wlis manZilze, Tumca, Cveulebriv iTvleba, rom paTologiuri glovis
meuRlis an mSoblebis gardacvalebis SemTxvevaSi, is albaToba ufro maRalia maSin, rodesac:
maRalia xuTi wlis ganmavlobaSi. axalgazrda qvrivi w sikvdili uecari da moulodnelia;
qalebi da xandazmuli qvrivi mamakacebi suicidis w pirovnebas Zalian axlo an ambivalenturi urTier-
ufro maRali riskis qveS imyofebian, vidre sxva Toba hqonda gardacvlil adamianTan an masze iyo
adamianebi, romlebmac mZime danakargi ganicades damokidebuli;
(Bunch, 1972). suiciduri azrebis arsebobis dros
w pirovneba daucvelia, uWirs sakuTari gancdebis
aucilebelia suicidis riskis dauyovnebliv Sefaseba
gamovlena an adre aReniSneboda fsiqikuri aSli-
(gv. ??).
loba;
gaxangrZlivebuli glova. rogorc zemoT iTqva,
gaxangrZlivebul (qronikul) glovas xSirad gan w pirovneba valdebulia mouaros bavSvebs da amitom
martaven, rogorc glovas, romelic eqvs Tveze met iolad ver avlens dards.
xans grZeldeba. am dros normaluri procesis gavlis morbiduloba mZime danakargis Semdeg
nacvlad, pirveli da meore safexurebis simptomebi
zogierTma gamokvlevam (Stroebe and Stroebe, 1993)
didi xnis manZilzea SenarCunebuli. miuxedavad amisa,
uCvena, rom gansakuTrebiT mZime danakargis SemTx-
normaluri glovis zusti limitis dadgena Znelia da
vevaSi, momxdari faqtidan pirveli eqvsi Tvis ganma-
mdgomareobidan srul gamosvlas SeiZleba gacilebiT
vlobaSi gazrdilia meuRleebis an sxva axlo naTe-
meti dro dasWirdes. erT-erTi gamokvlevis Sedegad
savebis sikvdilianobis procentuli maCvenebeli, risi
aRmoCnda, rom daqvrivebuli qalebis mxolod mcire
mizezicaa gulis daavadebebi, avTvisebiani simsivne,
nawili aRar dardobs meuRlis gardacvalebas
RviZlis cirozi, suicidi da ubeduri SemTxveva. ra
erTi wlis Semdeg (Parkes, 1971). gaxangrZlivebuli
ganapirobebs aseT kavSirebs, zustad ar aris dadge-
glova SeiZleba dakavSirebuli iyos depresiul
nili; savaraudod, mizezi gansxvavebulia sxvadasxva
aSlilobasTan, magram SesaZloa mis gareSec iCinos
viTarebebSi. am dros xSiria suicidis SemTxvevebi
Tavi. gaxangrZlivebul dards `travmul glovasac~
(Bunch, 1972), ekonomiuri mdgomareobis gauareseba da
uwodeben, romlis drosac subieqtebi mudmivad
gazrdilia fsiqologiuri morbiduloba (Valdimarsdot-
èZeben~ gardacvlil adamians, aqvT Zlieri monatrebis
tir, 2003).
gancda, ar eguebian sikvdilis faqts da moculebi
arian gardacvlilze fiqriT (Boelen et al., 2003). dardis marTva
gadavadebuli glova. gadavadebuli glovis dros
dardi _ es normaluri reaqciaa. adamianebis umete-
pirveli safexuri Tavs iCens gardacvalebidan
soba dards ojaxis wevrebis, megobrebis, moZRvris da
mxolod ori kviris (an ufro didi xnis) Semdeg. amgvari
glovis ritualebis daxmarebiT umklavdeba. zogierT
dardi da glova ufro xSiria uecari, travmuli an
dasavlur sazogadoebaSi bevr adamians ar aqvs kav-
moulodneli sikvdilis dros (Jacobs 1993, p. 175).
Siri religiasTan; maTi glovis ritualebi SeiZleba
Sekavebuli da deformirebuli glova. termini
ar iyos mkveTrad gamoxatuli da ojaxis wevrebi
`Sekavebuli glova~ miuTiTebs iseT reaqciaze, ro
SeiZleba maTgan Sors imyofebodnen. am da kidev sxva
melsac zogierTi normaluri maxasiaTebeli aklia.
mizezTa gamo ojaxis eqimi TamaSobs mniSvnelovan
deformirebul dards aqvs depresiuli simptomebisgan
rols im adamianebis cxovrebaSi, romlebmac mZime da-
gansxvavebuli iseTi niSan-Tvisebebi, romlebic uCveu
_ 181 _
nakargi ganicades. paTologiuri glovis SemTxvevaSi CioT, daarqvan gardacvlil bavSvs saxeli da naxon
adamianebma SeiZleba fsiqiatrsac mimarTon. misi cxedari. Tu isini grZnoben, rom amisTvis mzad
zogierTi saerTo problemis garda, am adamianebs ar arian, moviZioT gardacvlili bavSvis foto, rom-
individualuri xasiaTis problemebic aqvT. mag., ax- lis Sexedvasac mSoblebi SeZleben, Tu momavalSi amis
algazrda qvriv mamakacs, romelsac mcirewlovani survili eqnebaT. amgvari zomebis miReba konsulta-
Svilebi hyavs, bevri iseTi sirTule eqmneba, ro- ciebTan erTad Seamcirebs mkvdradSobili bavSvis
melic xanSiSesuli qvrivi mamakacis winaSe ar dgeba, dedis mZime mdgomareobas im mSoblebTan SedarebiT,
radgan ukve zrdasruli Svilebi hyavs da isini Tavad visac aseTi daxmareba ar miuRia (Forrest and Standish,
exmarebian mas. agreTve, dedas, romelic mkvdradSo- 1984).
bil Svilze dardobs, gansakuTrebuli problemebi
awuxebs (ix. qvemoT). marTvis dagegmvisas, zogadi medikamenturi mkurnaloba
mimarTulebis garda (razec qvemoT iqneba yuradReba medikamenturi mkurnalobiT normaluri dardiT
gamaxvilebuli), mniSvnelovania pacientis individu- gamowveuli distresis Tavidan acileba ver xerxde-
aluri viTarebebis gaTvaliswinebac. ba, magram aseTi mkurnalobis Catareba SeiZleba gan-
sakuTrebul viTarebebSi aucilebeli iyos. dardis
konsultacia pirvel safexurze Zilis mosawesrigeblad an Zl-
am dros imave tipis konsultaciebi tardeba, rogor- ieri SfoTvis Sesasusteblad SeiZleba saWiro gaxdes
ic sxva saxis adaptaciuri reaqciebis dros. adamianma, ramodenime dRis ganmavlobaSi saZile da anqsiol-
romelmac mZime danakargi ganicada, unda ilaparakos ituri medikamentebis gamoyeneba. meore safexurze,
Tavisi danakargis Sesaxeb, gamoxatos mwuxareba, dana- depresiuli aSlilobis simptomebis SemTxvevaSi, Sei-
Saulis grZnoba an sibraze da gaacnobieros glovis Zleba mizanSewonili iyos antidepresantebis miReba,
normaluri mimdinareobis procesi. unda icodes, rom Tumca, mocemul jgufSi maTi gamoyenebis efeqturoba
mas SeiZleba gauCndes uCveulo gancdebi _ iluziebi, ar aris sakmarisad Seswavlili. meore safexurze, imi-
halucinaciebi an gancda imisa, TiTqos gardacvlili saTvis, rom Sesustdes Zlieri SfoTva, SeiZleba mar-
adamiani mis gverdiT imyofeba. winaaRmdeg SemTxvevaSi Tebuli iyos xanmokle medikamenturi mkurnalobis
aseTma gamocdilebam SeiZleba pirovnebis SeSfoTeba Catareba.
gamoiwvios. adamians SeiZleba dasWirdes daxmareba,
raTa: mxardamWeri jgufebi
w aRiaros, rom danakargi realobaa; mxardamWeri jgufebi iqmneba im adamianebis dasaxmare-

blad, romlebmac axlaxan ganicades mZime danakargi
w gaiaros dardis safexurebi;
(kerZod, axalgazrda qvrivi qalebis mxardasaWerad).
w Seeguos gardacvlili adamianis gareSe cxovrebas. erT-erTi amgvari organizacia britaneTSi CRUSE-is
aseve, raTa gadalaxos dardis pirveli safexuri saxeliT aris cnobili. sakuTari gamocdilebis ga-
(danakargis uaryofa) da mivides realobis mimRe- ziarebiT maTTvis, vinc warmatebiT gaumklavda mZime
blobamde. gardacvlili adamianis sxeulis yureba danakargs, adamianebs SeuZliaT TavianTi dardis sx-
da misi nivTebis dalageba exmareba am process, ami- vebisTvis gandoba, praqtikuli rCevebis miReba da
tom pirovnebas xeli unda SevuwyoT, raTa man ganax- gamklavebis gzebze msjeloba (Clark, 2004).
orcielos amgvari aqtivobebi. ganxiluli unda iqnes
iseTi praqtikuli xasiaTis problemebi, rogorebicaa, fsiqoTerapia
mag., dakrZalvis organizeba da finansuri sirTulee- fsiqoTerapiis Catareba yvela im adamianTan, vinc
bi. axalgazrda qvrivs SeiZleba davexmaroT patara mZime danakargi ganicada, ar aris mizanSewonili.
bavSvebis movla-patronobaSi da imaSi, rom bavSvebis garda amisa, ar aris damtkicebuli, rom maTTvis
TandaswrebiT zedmetad ar Seikavos Tavi dardis fsiqoTerapiis Catareba sasargebloa. ramodenime
gamoxatvisgan. garkveuli drois Semdeg, pirovnebas faqti metyvelebs imaze, rom krizisuli intervencia
unda davexmaroT, rom man SeZlos aRadginos social- SeiZleba sasargeblo iyos im adamianebisTvis, rom-
uri kontaqtebi, isaubros sxva adamianebTan sakuTari lebic paTologiuri dardis reaqciis ganviTarebis
danakargis Sesaxeb, gaixsenos gardacvlil adamianTan maRali riskis qveS imyofebian (Raphael, 1977), magram
erTad gatarebuli bednieri momentebi da ifiqros im misi gamoyeneba yvela im pirTan, romelic ganicdis
pozitiur aqtivobebze, romelTa ganxorcielebasac dards mZime danakargis gamo, ar aris mizanSewonili.
gardacvlili adamiani misTvis moisurvebda (informa- marmarma da misma kolegebma Seiswavles dinamikuri
ciisTvis ix. Klark, 2004). fsiqoTerapiis xanmokle kursis efeqti da daadgines,
mSoblebs, romlebic mkvdradSobil bavSvze dardo- rom es meTodi ar aris ufro qmediTi, vidre urT-
ben, specialuri daxmareba sWirdebaT. maT unda vur- ierTmxardamWeri jgufebis gamoyeneba (Marmar et al.,
_ 182 _
1988). fsiqoTerapiis Catarebam im adamianebis jguf- aRdgenili mogonebebi da cru mogonebebi
Tan, romlebsac meuRleebi gardaecvalaT, ar aCvena
bevr adamians, romlebsac seqsualuri Zaladoba an
ukeTesi Sedegebi sakontrolo jgufTan SedarebiT,
sxva mZime stresuli movlena aqvT gadatanili, aR-
romelsac Terapia ar Catarebia (Lieberman and Ya-
eniSneba nawilobrivi (parcialuri) amnezia, romelic
lom, 1992). paTologiuri dardis dros dinamikuri
movlenis yvelaze ufro stresul monakveTs ukav-
fsiqoTerapiis gamoyeneba seriozul argumentebs
Sirdeba. amgvari amnezia Tavs iCens maSinac, rodesac
efuZneba, magram misi efeqturoba jer-jerobiT ar
pirovnebas ar miuRia qala-tvinis travma, rasac See-
aris Seswavlili (Clark, 2004).
Zlo travmis Semdgomi amnezia gamoewvia. nawilobrivi
glovis warmarTva (parcialuri) amnezia posttravmuli stresuli aSli-
lobis klinikuri suraTis nawils warmoadgens. sruli
`glovis warmarTva~ ewodeba procedurebs, romlebic
amnezia ufro iSviaTia. fsiqiatrTa umravlesobas
asustebs dardis ganmaxangrZlivebel ganridebis qcev-
ganmeorebadi stresuli movlenis, romlis gaxsenebac
ebs. pirovnebas, romelmac mZime danakargi ganicada,
SemdgomSi xdeba, sruli amnezia aradamajereblad mi-
exmarebian imaSi, rom man Tvali gausworos mogonebebs
aCnia. miT ufro, Tu am movlenis arsebobis sxva dama-
gardacvlili adamianis Sesaxeb da ar ganeridos iseT
mtkicebeli sabuTebi ar arsebobs. am faqtebs kidev
situaciebs, romlebic am mogonebebs aRZravs, rac
ufro saeWvos xdis is, rom adamianebis erT meoTxeds
eqspoziciuri Terapiis formas warmoadgens (gv. ??).
bavSvobis movlenebis `gaxseneba~, romlebic ar aris
kontrolirebadi kvlevebis dros amgvarma midgomam
dakavSirebuli ZaladobasTan, SeiZleba STagonebis
susti efeqti aCvena (Foa et al., 1991). paTologiuri
meSveobiT hqondes Canergili (Brewin, 2000; McNally,
dardis fsiqologiuri mkurnalobis Sesaxeb informa-
2003).
ciis mosapoveblad ix. klarki (Clark, 2004).
faqtebi, romelTa Tanaxmad, WeSmariti mogonebebi
SeiZleba mravali wlis ganmavlobaSi miviwyebul iqnes,
xangrZlivi adaptacia bavSvobaSi gadatanil
xolo Semdeg amotivtivdes cnobierebaSi, umTavresad
seqsualur ZaladobasTan
klinikuri angariSebidanaa cnobili (Brewin, 2000). am
seqsualuri Zaladobis dros bavSvebi SeiZleba ganic- angariSebis mixedviT, adamianebis 25%-50%, romelic
didnen SfoTvas, depresias da posttravmul stresul afiqsirebs, rom bavSvobaSi seqsualuri Zaladoba aqvs
aSlilobas (gv ??). Cveulebriv, bavSvobis periodSi gadatanili, aRwers cxovrebis xangrZliv periodebs,
aRniSnuli efeqtebi sustdeba, magram adamianebi, rodesac ar axsovda es faqti. klinicistebi, agreTve,
romlebsac bavSvobaSi seqsualuri Zaladoba aqvT ga- amtkiceben, rom Terapiis procesSi aRdgenili mo-
datanili, zrdasrul asakSi sxvebze ufro mowyvlad- gonebebis 40%-mde sxva faqtebiTac aris gamyarebuli.
ni xdebian fsiqikuri aSlilobis mimarT. garda amisa, konsultaciis an fsiqoTerapiis dros amotivtive-
bavSvobaSi gadatanili seqsualuri Zaladoba ganapi- bul mogonebebze sxva sarwmuno faqtebis ararsebobis
robebs dabal TviTSefasebas da fsiqoseqsualuri xa- SemTxvevaSi, klinicistma unda
siaTis sirTuleebs, imisda miuxedavad, ganviTardeba
w gamoiCinos gansakuTrebuli sifrTxile, raTa ar
Tu ara fsiqikuri aSliloba.
Caagonos, Tavs ar moaxvios pirovnebas seqsualuri
zogierT zrdasrul adamians, romelmac ar icis,
Zaladobis mogonebebi;
rom bavSvobaSi seqsualuri Zaladoba aqvs gadat-
anili, uecrad, mTeli sicxadiT axsendeba es faqti. w gansakuTrebuli yuradRebiT ganixilos Terapiis
zogjer amgvar gaxsenebas spontanuri xasiaTi aqvs (es porcesSi `pirvelad aRdgenili mogonebebi~, sanam
Cveulebriv maSin xdeba, rodesac adamians amas raime daaskvnis, rom isini realuri movlenebis WeSmariti
situacia an movlena Seaxsenebs). spontanuri gaxsene- mogonebebia.
ba SeiZleba moxdes konsultaciis an fsiqoTerapiis savaraudoa, rom mravali e.w. àRdgenili mogoneba~,
dros, bavSvobisdroindel gamocdilebaze saubri- romelsac mieniWa `mexsierebis aRdgenili Sinaarsis~
sas. zogierTi aseTi mogonebis siswore sxva faqte- statusi, gansakuTrebuli frTxili analizis gareSe
biTac dasturdeba, magram maT, Cveulebriv, gadaWriT SeiZleba mcdari aRmoCndes. garda amisa, safiqre-
uaryofs savaraudo moZalade, romelic xSirad erT- belia, rom àRdgenili mexsierebis Sinaarsebi~ mra-
erTi mSobelia. varaudoben, rom xSirad aseTi, mt- valjeradi seqsualuri Zaladobis Sesaxeb iSviaTad
kicebulebebs moklebuli Zaladobis faqtebi mcdar Seesabameba sinamdviles.
mogonebebs warmoadgens da SesaZloa Terapevtis mier
epidemiologia
dasmuli SekiTxvebiT an interpretaciiT iyos provo-
cirebuli. am fenomens mcdari mogonebebis sindromi adamianebs, romlebic acxadeben, rom bavSvobaSi seq-
ewodeba (McNally, 2003). sualuri Zaladoba aqvT gadatanili, zrdasrul asak-
Si maRali fsiqikuri aSlilobis procentuli maCvene-
_ 183 _
beli aReniSnebaT (Mullen et al., 1993; Kendler et al., 2000). seqsualuri Zaladobis faqtebs, umetes SemTxvevaSi,
Catarebuli kvlevebis umravlesoba retrospeqtuli fsiqikuri aSlilobis mqone qalebi ixseneben, ar aris
xasiaTisaa da upiratesad qalebs Seiswavlis. fsiqi- damajerebeli, radgan TemSi Catarebuli gamokvleve-
atriul stacionarebSi myofni ufro xSirad afiq- biTac dadasturda, rom arsebobs kavSiri bavSvo-
sireben bavSvobaSi seqsualuri Zaladobis faqtebs, baSi seqsualuri Zaladobis gadatanasa da fsiqikuri
vidre janmrTeli kontrolebi. aseT gancxadebebs aSlilobis simptomebis arsebobas Soris (Bushnell et
gansakuTrebiT xSirad iseTi pacientebi akeTeben, al., 1993). garda amisa, rogorc zemoT ukve aRvniSneT,
romlebsac aReniSnebaT somatizirebuli aSliloba, arsebobs prospeqtuli monacemebi, romelTa Tanax-
disociaciuri da mosazRvre personologiuri aSli- mad, bavSvobaSi gadatanili seqsualuri Zaladoba nam-
lobebi (Sar et al., 2004). ar aris naTeli, bavSvobaSi dvilad aris dakavSirebuli fsiqikur aSlilobasTan
seqsualuri Zaladobis msxverpli qalebis ra pro- zrdasrul asakSi (Spataro et al., 2004).
cents uviTardeba amgvari aSlilobebi zrdasrul is, Tu ramdenadaa Tavad seqsualuri Zaladoba zr-
asakSi. spatarom da misma kolegebma (Spataro et al., 2004) dasrul asakSi fsiqikuri aSlilobis uSualo gamom-
Caatares prospeqtuli gamokvleva Zaladobis msxver- wvevi mizezi, daudgenelia. mag., kavSiri bavSvobaSi
pl 1600 bavSvze. gamokvlevis Sedegad dadginda, rom gadatanil Zaladobasa da zrdasrul asakSi gaCenil
Zaladobis msxverplTa 12, 4 procents mogvianebiT fsiqikur aSlilobas Soris SeiZleba nawilobriv aix-
Cautarda fsiqiatriuli mkurnaloba, im dros, rode- snas imiT, rom ojaxis wevrebs Soris cudi urTier-
sac sakontrolo jgufSi aseTi mkurnaloba mxolod Toba iyo (Neumann et al., 1996). adamianebi, romlebsac
3.6 procents dasWirda. biWebTan mniSvnelovnad ufro bavSvobaSi Zaladoba aqvT gadatanili, ufro xSirad
maRali iyo fsiqiatriuli mkurnalobis Catarebis acxadeben, rom mSoblebi maT mimarT mzrunvelobas ar
albaToba, vidre gogonebTan. Zaladobis msxverpls iCendnen an maTgan emociurad iyvnen distancirebulni
ufro xSirad aReniSneboda ramodenime saxis fsiqi- (Alexander and Lupfer, 1987). mulenma da misma kolegebma
atriuli aSliloba, romlebic moicavda, rogorc (Mullen et al., 1993) daadgines, rom Zaladobis naklebad
mTel rig bavSvTa asakis fsiqikur aSlilobebs, aseve mZime formis dros urTierTkavSiri Zaladobasa da
zrdasruli asakisTvis damaxasiaTebelsac, rogorebi- SemdgomSi ganviTarebul aSlilobas Soris SeiZleba
caa guneb-ganwyobis, somatoformuli, stresuli da aixsnas mxolod ojaxuri faqtorebiT, xolo mZime
personologiuri aSlilobebi, aseve fsiqoaqtiuri formis Zaladobas ki damoukidebeli da pirdapiri
nivTierebebis moxmarebiT gamowveuli aSlilobebi. efeqti aqvs.
Cveulebriv, fsiqikuri aSliloba gansakuTrebiT ma-
mkurnaloba
Sin viTardeba, rodesac moZalade pirovneba mSobe-
lia, rodesac Zaladobas mravaljeradi xasiaTi aqvs bavSvobaSi gadatanili Zaladobis gviandel Sedegebs
an didi xnis manZilze grZeldeba (Steel et al., 2004). mkurnaloben konsultaciebiT, dinamikuri fsiqoTer-
apiiT, kognituri TerapiiTa da jgufuri mkurnalo-
etiologia biT. sxvadasxva tipis am mkurnalobas ramodenime
bavSvobaSi seqsualuri Zaladobis gadatanis Sesaxeb saerTo maxasiaTebeli aqvs:
gakeTebul gancxadebebsa da zrdasrul asakSi gaCenil w mTavari mizania davexmaroT pacients gaacnobie-
fsiqikuri aSlilobis simptomebs Soris arsebul kav- ros adreuli gamocdileba da is, Tu ra zegavle-
Sirs SeiZleba sami tipis axsna moeZebnos: nas axdens amgvari gamocdileba mis cxovrebaze. es
1. sakontrolo pirebTan SedarebiT, fsiqikuri aSli- saWiroa imisTvis, rom gaumjobesdes pacientis amJa-
lobis mqone adamianebma SeiZleba ufro xSirad is- mindeli adaptacia.
aubron bavSvobaSi gadatanili Zaladobis Sesaxeb, w Terapiul urTierTobas iyeneben imisaTvis, rom pa-
radgan fsiqiatriuli gamokvlevis dros maT usva- cientma igrZnos, rom misi esmiT, rom mas endobian
men kiTxvebs maTi bavSvobis Sesaxeb. da pativs scemen; agreTve, TviTSefasebis gasaum-
2. bavSvobaSi gadatanilma seqsualurma Zaladobam Sei- jobeseblad.
Zleba uSualod gamoiwvios zrdasrul asakSi mowyv- w Terapiis procesSi pacients ufleba aqvs Tavad
ladoba fsiqikuri daavadebebis mimarT. gansazRvros, Tu ra dros isaubrebs bavSvobaSi ga-
3. seqsualuri Zaladoba SeiZleba zogierT sxva faq- datanili Zaladobrivi gamocdilebis Sesaxeb (sxva
torze mianiSnebdes (mag., cudi urTierTobebi ojax- SemTxvevaSi, is SeiZleba imdenad moicvas Zaladobis
is wevrebs Soris, rac zrdasrul asakSi fsiqikuri faqtis gaxsenebisas aRZrulma eqstremalurma emo-
aSlilobis realur mizezs warmoadgens). ciebma, rom aman uaryofiTad imoqmedos mis CarTu-
es sami SesaZlo mizezi rig-rigobiT iqneba ganxiluli. lobaze mkurnalobis procesSi).
zemoTxsenebuli kavSiris axsna mxolod imiT, rom w amJamad arsebuli adaptaciis problemebis identi-
_ 184 _
ficireba. am mxriv gansakuTrebiT mniSvnelovania am- damatebiTi literatura
ridebloba da brazis gamoxatva. pacients daxmareba
Golder, MG, Lpez-Ibor, Jr, and Andreasen, NC (eds) (2000)
unda gaewios, raTa man SeZlos amgvari siZneleebis
The new Oxford textbook of psychiatry, Section 4.6: Stress-
gadalaxva.
related and adjustment disorders. Oxford University Press,
w zogierT pacients daxmareba sWirdeba, raTa man mo-
Oxford (am nawilis oTx TavSi mocemulia ramdenime
agvaros fsiqoseqsualuri xasiaTis problemebi.
Temis sistemuri mimoxilva. esenia: mwvave reaqcia
mTavari gansxvaveba dinamikur da kognitur-bihevi- stresze, posttravmuli stresuli aSliloba, aRd-
orul midgomebs Soris Semdegia: dinamikuri midgoma genili mogonebebi da cru mogonebebi, adaptaciis
ufro did mniSvnelobas aniWebs imis gagebas, Tu ra aSliloba)
gavlenas axdens travma TviTSefasebasa da emociebis
Parkes, CM (1996) Bereavement: studies of grief in adult life,
gamoxatvaze, xolo kognitur-bihevioruli midgoma
3rd edn. Penguin Books, Harmondsworth (am wignSi moce-
cdilobs imis dadgenas, Tu rogor moqmedebs az-
mulia Temis mokle, magram detaluri mimoxilva. is
rovnebis arsebuli paternebi pirovnebis amJamindel
Seicavs profesionalebisTvis sasargeblo informa-
qcevaze.
cias. wigns Tan axlavs danarTi).
seqsualuri Zaladobis grZelvadiani Sedegebis fsi
McNally, RJ (2003) Remembering trauma. Harvard University
qologiuri mkurnalobis Sesaxeb damatebiTi informa-
Press, Cambrige, MA (mexsierebaze travmis zegavlenis
ciis mosapoveblad ixileT Semdegi wyaroebi: Kessler et
safuZvliani da kritikuli analizi).
al., (2003); Callahan et al., (2004).
_ 185 _
Tavi 9 SfoTviTi da
obsesiur-kompulsuri aSlilobebi
Tavis Sinaarsi
Cven DSM-IV klasifikaciiT vixelmZRvaneleT, ris ga-
terminologia da klasifikacia
moc obsesiuri aSlilobebi mocemul TavSi SevitaneT.
SfoTviTi aSlilobebi
SfoTviTi aSlilobebis Sesaxeb
arsebuli mosazrebebis ganviTareba SfoTviTi aSlilobebi
SfoTviTi aSlilobebis klasifikacia SfoTviTi aSliloba aris anomaliuri mdgomareba.
generalizebuli SfoTviTi aSlilobebi mis ZiriTad niSan-Tvisebas SfoTvis iseTi fsiqikuri
SfoTviT-fobiuri aSlilobebi da fizikuri simptomebi warmodgens, romlebic Tavs
fobikuri aSlilobebis klasifikacia iCens Tavis tvinis organuli daavadebis an sxva fsiqi-
specifikuri fobia kuri aSlilobis gareSe. SfoTviTi simptomebi aRweri-
socialuri fobia lia ?? gverdze, xolo maTi CamonaTvali 9.1 cxrilSia
agorafobia mocemuli. miuxedavad imisa, rom amgvari simptomebi
panikuri aSliloba nebismieri SfoTviTi aSlilobis dros SeiZleba aR-
klinikuri maxasiaTeblebi mocendes, TiToeuli tipis aSlilobas gaaCnia damaxa-
diagnostikuri kriteriumebi siaTebeli paterni, romelic mogvianebiT iqneba aRwe-
diferencialuri diagnozi rili. klinikuri suraTisa da etiologiis Tvalsazri-
epidemiologia siT SfoTviT aSlilobebs bevri saerTo maxasiaTebeli
etiologia gaaCniaT, magram maT Soris garkveuli gansxvavebebic
mimdinareoba da prognozi SeiniSneba:
mkurnaloba w generalizebuli SfoTviTi aSlilobis dros SfoT-
marTva vas persistentuli xasiaTi aqvs, Tumca is SeiZleba
Sereuli SfoTviT-depresiuli aSliloba cvalebadobdes intensivobis mixedviT.
diagnostikis sakiTxebi w SfoTviT-fobikuri aSlilobisas SfoTvas periodu-
etiologia li xasiaTi aqvs da garkveul viTarebebSi aRmocen-
mkurnaloba deba.
obsesiur-kompulsuri aSliloba
w panikuri aSlilobisas SfoTvas perioduli xasiaTi
klinikuri suraTi
aqvs, magram misi aRmoceneba ar aris dakavSirebuli
diferencialuri diagnozi
raime konkretul viTarebasTan.
epidemiologia
etiologia es gansxvavebebi (da aseve zogierTi gamonaklisi
prognozi SemTxveeva), ganxiluli iqneba mogvianebiT, sxvadasxva
mkurnaloba tipis SfoTviTi aSlilobebis aRwerasTan erTad.
SfoTviTi aSlilobebis Sesaxeb arsebuli

terminologia da klasifikacia mosazrebebis ganviTareba
SfoTviTi simptomi mravali aSlilobis dros iCens
cnobilia, rom SfoTva bevri fsiqikuri aSlilobis
Tavs. SfoTviTi aSlilobebisas is yvelaze ufro mZime
erT-erT mkveTrad gamoxatul simptoms warmoadgens.
da aSkarad gamoxatuli niSania. SfoTva obsesiuri aS-
SfoTva da depresia xSirad erTad iCens Tavs. amitom
lilobebis drosac sakmaod mkveTrad aris gamoxatu-
mecxramete saukunis meore naxevramde SfoTviTi aS-
li, Tumca, obsesiuri aSlilobebis dros mainc yvela-
lilobebi ar iyo calke klasificirebuli da guneb-
ze TvalSisacemi specifikuri obsesiuri simptomebia.
ganwobis aSlilobebs miekuTvneboda. froidma (1895b)
DSM-IV-Si obsesiuri aSlilobebi klasificirebulia,
pirvelma gamoTqva Semdegi mosazreba: SemTxvevebi,
rogorc SfoTviTi aSlilobis erT-erTi tipi, magram
romelTa drosac SfoTva wamyvan da ZiriTad simptoms
ICD-10-Si isini calke kategoriad aris gamoyofili.
_ 186 _
SfoTviTi aSlilobebi
warmoadgens, calke kategoriad unda iyos gamoyofi-
li `SfoTviTi nevrozebis~ saxelwodebiT.
cxrili 9.1 SfoTvis simptomebi
Tavdapirvelad, froidi SfoTviTi nevrozebis ka- fsiqologiuri agzneba
tegoriaSi fobiebisa da panikis Setevebis mqone pa- saSiSroebis molodini
cientebs aerTianebda, magram, mogvianebiT, man es ka- gaRizianebadoba
tegoria or jgufad dayo. pirvel jgufs, romelsac sensitiuroba xmauris mimarT
igive saxelwodeba SeunarCunda (SfoTviTi nevrozebi) mousvenroba
miekuTvneboda iseTi SemTxvevebi, romelTa drosac cudi koncentracia
pacientebs, ZiriTadad, SfoTvis fsiqologiuri simp- Semawuxebeli azrebi
tomebi aReniSnebodaT. meore jgufs, romelsac man vegetatiuri agzneba
`SfoTviTi isteria~ uwoda, ki iseTi SemTxvevebi, ro-
gastrointestinuri
melTa drosac pacientebs, ZiriTadad, SfoTvis fizi-
piris simSrale
kuri simptomebi da fobiebi aReniSnebodaT. amgvarad,
ylapvis gaZneleba
SfoTviT isteriSi Sedioda SemTxvevebi, romlebic
epigastruli diskomforti
CvenTvis agorafobiis diagnozis saxeliT aris cnobi- meteorizmi
li. Tavdapirvelad froidi varaudobda, rom SfoTvi- faRaraTi anu gaxSirebuli peristaltika
Ti nevrozebi da SfoTviTi isteria seqsualuri kon- respiratoruli
fliqtebiT iyo gamowveuli, Tumca, mogvianebiT, man moWeris SegrZneba gulmkerdis areSi
maTi gamomwvevi sxva mizezebis arsebobis SesaZleb- CasunTqvis gaZneleba
lobac dauSva. 1930-ian wlebSi fsiqiatrebis umrav- kardiovaskuluri
lesoba Tvlida, rom SfoTviTi nevrozebis gamowveva gaZlierebuli guliscema
mraval sxvadasxva saxis stresul problemebs SeeZlo diskomforti gulmkerdis areSi
majis amovardnis SegrZneba
(mag., Henderson and Gillespie, 1930, gv. 416-17).
genito-urinuli
fobikuri aSlilobebi antikuri xanidan aris cnobi-
xSiri Sardva an Sardis urgentuli Seukavebloba
li, magram am mdgomareobebis sistemuri samedicino
ereqciis darRveva
gamokvleva pirvelad, meTvramete saukuneSi, le ka-
menstrualuri diskomforti
mium (Le Camus) Caatara (Errera, 1962). mecxramete sau- amenorea
kunis pirvel naxevarSi arsebuli klasifikaciebis
kunTebis daZabuloba
mixedviT, fobiebi monomaniebis jgufs miekuTvne-
boda, romlebic ufro azrovnebis darRvevebs war- tremori
moadgendnen, vidre emociur aSlilobebs. Tumca, Tavis tkivili
rodesac vestfalma (Westphal, 1872) pirvelad aRwera kunTebis tkivili
agorafobia, man xazi gausva am tipis fobiaSi SfoT- hiperventilacia
vis mniSvnelovnebas. mogvianebiT, 1895 wels, froid-
Tavbrusxveva
ma fobiebi or jgufad dayo: zogad da specifikur
kidurebSi Cxvletis SegrZneba
fobiebad. pirvel SemTxvevaSi, pirovnebas aReniSneba sunTqvis gaZneleba
iseTi movlenebis, situaciebisa da arsebebis gazvia-
Zilis darRveva
debuli SiSi, romlebic, Cveulebriv, saSiSad aRiqmeba
(mag., sibnelis an simaRlis SiSi); meore SemTxvevaSi pa- uZiloba
cients eSinia iseTi movlenebis, romlebic janmrTeli Ramis SiSebi
adamianisaTvis realur saSiSroebas ar warmoadgens.
mag., gaSlili sivrcis SiSi (Freud 1895a, gv. 135-6). ter- xolo agorafobia _ zrdasruli cxovrebis adreul
mins `specificikuri fobia~ dResdReobiT ramdenadme etapze). daaxloebiT igive periodSi dadginda, rom
gansxvavebuli mniSvneloba gaaCnia, razec mogvianebiT rodesac fobiebs Tan axlavs mkveTrad gamoxatuli
gveqneba saubari. panikis Setevebi, isini naklebad eqvemdebareba bihe-
imis gamo, rom garkveuli tipis fobiebi sxvadas- viorul Terapias, ris gamoc am dros umjobesia imip-
xvagvarad emorCileboda bihevioruli meTodebiT raminiT mkurnaloba (Klein, 1964). mogvianebiT, aseTi
mkurnalobas, 1960-ian wlebSi gamoiTqva mosazreba, SemTxvevebi calke jgufad, panikur aSlilobebad,
rom fobiebi dajgufebuliyo martiv fobiebad, so- iqna klasificirebuli. amgvarma miRwevebma dRevan-
cialur fobiebad da agorafobiad. aRmoCnda, rom es del klasifikaciamde migviyvana, romlis mixedvi-
jgufebi gansxvavdeba erTmaneTisagan debiutis asakis Tac arsebobs generalizebuli SfoTviTi aSliloba,
mixedviTac (martivi fobiebi, Cveulebriv, bavSvobaSi SfoTviT-fobikuri aSliloba (martivi, socialuri da
viTardeba, socialuri fobia _ mozardobis xanaSi, agorafobia) da panikuri aSliloba.
_ 187 _
9 SfoTviTi da obsesiur-kompulsuri aSlilobebi
urTierTkavSiri obsesiur-kompulsur aSlilobebsa
da SfoTviT aSlilobebs Soris kvlavac gaurkveveli
cxrili 9.2 SfoTviTi aSlilobebis klasifikacia
rCeba. froidi Tavdapirvelad fiqrobda, rom fo- ICD-10 DSM-IV
biebsa da obsesiebs Soris mWidro kavSiri arsebobs F4 SfoTviTi aSlilobebi SfoTviTi aSlilobebi*
(Freud, 1895a). mogvianebiT, man gamoTqva varaudi, rom
F40 SfoTviT-fobikuri
SfoTva ZiriTad problemas warmoadgens rogorc aSliloba
SfoTviTi, aseve obsesiur-kompulsuri aSlilobis
agorafobia agorafobia
dros da damaxasiaTebeli simptomebi (fobiebi da
obsesiebi) SfoTvis sawinaaRmdego sxvadasxva tipis panikuri aSlilobis panikuri aSlilobis
dacviTi meqanizmebiTaa gamowveuli. sxva meciniere- gareSe anamnezis gareSe
bis azriT, obsesiuri aSlilobebi nevrozebis calke panikur panikuri aSliloba
jgufs ganekuTvneba, romlis etiologiac daudgen- aSlilobasTan erTad agorafobiasTan erTad
elia. rogorc zemoT aRvniSneT, SexedulebaTa amgva- socialuri fobia socialuri fobia
ri dayofa dResdReobiT or ZiriTad klasifikaciaSia
specifiuri fobia specifiuri fobia
asaxuli: DSM-IV-Si obsesiur-kompulsuri aSlilobe-
bi klasificirebulia, rogorc SfoTviTi aSlilobe- F41 sxva SfoTviTi
aSlilobebi
bis qvejgufi, xolo ICD-10-Si isini calke kategoriad
aris gamoyofili. panikuri aSliloba panikuri aSliloba
agorafobiis gareSe
SfoTviTi aSlilobebis klasifikacia generalizebuli generalizebuli SfoTviTi

SfoTviTi aSlilobebis klasifikacia DSM-IV-isa da SfoTviTi aSliloba aSliloba
ICD-10-is mixedviT 9.2 cxrilSia mocemuli. miuxedavad Sereuli SfoTviT- _
imisa, rom umetes SemTxvevaSi isini erTmaneTs em depresiuli aSliloba
Txveva, maT Soris SeiniSneba oTxi mniSvnelovani * sqemebis Sedarebis gasaioleblad kategoriebis
gansxvaveba: Tanmimdevroba Secvlilia.
w ICD-10-Si SfoTviTi aSlilobebi dayofilia or
qvejgufad: (a) SfoTviT-fobikur aSlilobad (F40) w wuxili da cudi winaTgrZnoba, romelic ufro xan-
da (b) sxva SfoTviT aSlilobad (F41), romelSic grZlivia, vidre es janmrTeli adamianisTvis aris
Sedis panikuri aSliloba da generalizebuli damaxasiaTebeli. wuxils yovlismomcveli xasiaTi
SfoTviTi aSliloba; aqvs da ar aris fokusirebuli raime konkretul
sakiTxze, rogorc es panikuri aSlilobis (panikis
w panikuri aSliloba am or sqemaSi gansxvavebulad
Seteva), socialuri fobiis (sircxvilis gancda)
aris klasificirebuli (amis mizezi ?? gverdzea gan-
an obsesiur-kompulsuri aSlilobis (dabinZureba)
martebuli);
dros xdeba. pirovneba grZnobs, rom es yovlismom-
w DSM-IV-Si obsesiur-kompulsuri aSliloba klasi- cveli wuxili Zneli gasakontrolebelia.
ficirebulia, rogorc erT-erTi SfoTviTi aS
w fsiqologiuri agzneba, romelic SeiZleba gamoix-
liloba, xolo ICD-10-Si is calke kategoriad aris
atebodes gaRizianebadobaSi, sust koncentraciasa
gamoyofili;
da xmauris mimarT sensitiurobaSi. zogierTi pa-
w ICD-10-Si mocemulia Sereuli SfoTviT-depresiuli cienti mexsierebis gauaresebas uCivis, rac sinamd-
aSlilobis kategoria, romelic DSM-IV-Si ar aris vileSi yuradRebis susti koncentraciiT aris gan-
warmodgenili. pirobebuli. Tu mexsierebis gauaresebas realurad
aqvs adgili, aucilebelia misi gamomwvevi mizezebis
generalizebuli SfoTviTi aSlilobebi (SfoTvisgan gansxvavebuli mizezebis) guldasmiT
klinikuri suraTi gamokvleva.
generalizebuli SfoTviTi aSlilobis simptomebi w vegetaturi hiperaqtiuroba, romlis yvelaze ufro
(cxrili 9.3) persistentulia da, SfoTviT-fobikuri xSiri somaturi simptomebia oflianoba, gulis
aSlilobebisagan gansxvavebiT, maTi gamovlena an in- cemis aCqareba, piris simSrale, epigastruli dis-
tensifikacia ar aris asocirebuli raime konkretul komforti da Tavbrusxveva. Tumca, pacienti Sei-
viTarebasTan. generalizebuli SfoTviTi aSlilobis Zleba 9.1 cxrilSi CamoTvlil nebismier simptoms
dros pacients SeiZleba nebismieri SfoTviTi simptomi uCiodes. zogierTi pacienti, romelic am simptom-
aReniSnebodes (cxrili 9.1), magram misTvis damaxasiaTe- ebis arsebobisas eqims mimarTavs, damoukideblad
belia paterni, romelic Semdeg niSan-Tvisebebs moicavs: ver ixsenebs SfoTvis fsiqologiur simptomebs.
_ 188 _
SfoTviTi aSlilobebi
w kunTebis daZabuloba, romelic SeiZleba ganicde- isini gansxvavdebian, rogorc simptomebis raodenobis,
bodes, rogorc mousvenroba, kankali, modunebis aseve maTi xangrZlivobis mixedviT. raodenobisa da
uunaroba da, aseve, mxrebis, zurgisa da Tavis xangrZlivobis diagnostikuri kriteriumebi ar aris
tkivili (Cveulebriv bilateralur da frontalur mkacrad gansazRvruli da DSM-IV-sa da ICD-10-Si
an osipitalur nawilSi). ramdenime niSniT gansxvavdebian erTmaneTisagan. rac
w hiperventilacia, romelmac SeiZleba gamoiwvios Seexeba simptomebis raodenobas, rogorc DSM-IV-is,
Tavbrusxveva, kidurebSi Cxvletis SegrZneba da (rac ise ICD-10-is sakvlevi versiis mixedviT, aucilebelia,
ar unda paradoqsuli iyos) sunTqvis gaZnelebis anu rom pacients arsebuli CamonaTvalidan minimaluri
qoSinis SegrZneba. raodenobis simptomebi aReniSnebodes. Tumca, ICD-10-
is CamonaTvali Seicavs SfoTvis 22 fizikur simptoms,
w Zilis darRvevebi, romlebic moicavs CaZinebas-
maSin roca DSM-IV-isa _ mxolod eqvss. garda amisa,
Tan dakavSirebul problemebs da persistentul
ICD-sagan gansxvavebiT, DSM-Si ZiriTad simptoms Relva
Semawuxebel fiqrebs. Zils xSirad wyvetili, araja-
(nerviuloba) warmoadgens.
nsaRi xasiaTi aqvs da usiamovno sizmrebi sdevs Tan.
rac Seexeba simtomebis xangrZlivobas, rogorc DSM-
zogierT pacientebs awuxebs Ramis SiSebi, romelTa
IV-is, ise ICD-10-is sakvlevi versiis mixedviT, pacients
drosac maT uecrad, Zlieri SfoTvis SegrZnebiT
simptomebi minimum eqvsi Tvis manZilze unda aReniSne-
eRviZebaT. diliT adre gaRviZeba ar aris damaxasi-
bodes. Tumca ICD-10-is kriteriumebi klinikuri praq-
aTebeli generalizebuli SfoTviTi aSilobisaTvis
tikisaTvis ufro moqnilia: simptomebi unda aRiniS-
da ufro depresiul aSlilobaze miuTiTebs.
nebodes `TiTqmis yovel dRe, sul cota ramdenime
w sxva niSan-Tvisebebs ganekuTvneba daRliloba, kviris, Cveulebriv ki, ramdenime Tvis ganmavlobaSi.
depresiuli simptomebi, obsesiuri simptomebi da
depersonalizacia. isini ar warmoadgens generali- komorbidoba
zebuli SfoTviTi aSlilobis yvelaze ufro mkve- SfoTva da depresia
Trad gamoxatul simptomebs. Tu isini mkveTrad
mocemuli klasifikaciebi gansxvavdebian erTman-
aris gamoxatuli, maSin unda ganvixiloT sxva daa-
eTisagan im SemTxvevebisadmi midgomis TvalsazrisiT,
vadebis arsebobis SesaZlebloba (ix. qvemoT dife-
romlebic akmayofileben rogorc generalizebuli
rencialuri diagnozi).
SfoTviTi aSlilobis, aseve depresiuli aSlilo-
klinikuri niSnebi bis diagnostikur kriteriumebs. ICD-10-Si aseTi
SemTxvevebi calke kategoriadaa gamoyofili da maT
generalizebuli SfoTviTi aSlilobis dros adamians
Sereuli SfoTviT-depresiuli aSliloba ewodeba. es
saxe daZabuli aqvs, Subli SeWmuxnuli da mTlianad
kategoria ar aris warmodgenili DSM-IV-Si (Tumca,
pozac daZabulia. adamiani mousvenrad grZnobs Tavs
Sedis rubrikaSi _ `kriteriumebis jgufi, romlebic
da SeiZleba kankalebdes. damaxasiaTebelia kanis si-
Semdgom Seswavlas saWiroebs~) da, aqedan gamomdinare,
fermkrTale da oflianoba (gansakuTrebiT xelebis,
orive diagnozi SeiZleba daisvas. aseTi mdgomareobe-
fexebisa da iRliebis). cremlianoba, romelic Tavda-
bi ?? gverdze da meTerTmete TavSi iqneba ganxiluli.
pirvelad SeiZleba depresias mivaweroT, zogadad
cudi winaTgrZnobis gamomxatvelia. generalizebuli SfoTviTi aSliloba da sxva
diagnostikuri kriteriumebi SfoTviTi aSlilobebi
ar arsebobs mkveTri gansxvaveba generalizebul SfoTviT am ori aSlilobis diagnostikuri kriteriumebi gan-
aSlilobasa da Cveulebriv SfoTviT aSlilobas Soris. sxvavebulia DSM-IV-sa da ICD-10 klasifikaciebSi:
w ICD-10-is mixedviT, generalizebuli SfoTviTi
cxrili 9.3 generalizebuli SfoTviTi aSlilobis diagnozis dasma ar xdeba maSin, rode-
aSlilobis simptomebi sac simptomebi SfoTviT-fobikuri aSlilobis (F40),
wuxili da cudi winaTgrZnoba panikuri aSlilobis (F41) an obsesiur-kompulsuri
kunTuri daZabuloba* aSlilobis (F42) diagnostikur kriteriumebs akmay-
vegetatiuri hiperaqtiuroba*
fsiqologiuri agzneba*
ofileben.
Zilis darRveva* w DSM-IV-Si generalizebuli SfoTviTi aSlilo-
sxva maxasiaTeblebi bis dros aqcenti keTdeba wuxilze. es saSualebas
iZleva misi arsebobisas daisvas generalizebuli
depresia
obsesiebi SfoTviTi aSlilobis diagnozi maSinac ki, rodesac
depersonalizacia pacients zemoT CamoTvlili sami sxva aSlilobidan
erT-erTis simptomebi aReniSneba. Tu am kriteri-
* ixileT cxrili 9.1.
_ 189 _
umebiT vixelmZRvanelebT, komorbidoba gener- vadebisaTvis damaxasiaTebeli mexsierebis gauareseba
alizebul SfoTviT aSlilobasa da sxva SfoTviT an SecdomiT CaTvalos, rom es yuradRebis cudi kon-
aSlilobebs Soris xSiria: generalizebuli SfoTvi- cetraciiT aris gamowveuli. amitom, saSualo asakisa
Ti aSlilobis mqone pacientebis 23%-s socialuri da xanSiSesul pacientebs, romlebic SfoTvas uCivian,
fobia aReniSneba, 21%-s _ martivi fobia, xolo 11%- aucileblad unda SevumowmoT mexsiereba.
s _ panikuri aSliloba (Brawnam-Mintzer et al., 1993)
fsiqoaqtiuri nivTierebebis araswori moxmareba
diferencialuri diagnozi zogierTi adamiani SfoTvis Sesamsubuqeblad narko-
generalizebuli SfoTviTi aSliloba unda ganvasxva- tikul nivTierebas an alkohols moixmars. alkohol-
voT ara marto sxva fsiqikuri aSlilobebisagan, ar- damokidebulebis an wamaldamokidebulebis mqone
amed zogierTi somaturi daavadebisaganac. SfoTvis zogierT pacients aRkveTis simptomebi SfoTvis
simptomebi TiTqmis yvela fsiqikuri aSlilobis dros simptomebSi ereva da amitom, maT gasakontrole-
SeiZleba aRmocendes, magram zogierT SemTxvevaSi isini blad, anqsiolizur preparatebs iyenebs. klinicisti
gansakuTrebul diagnostikur sirTuleebs warmoSobs. sifxizles unda iCendes aseTi SemTxvevebis mima-
rT gansakuTrebiT maSin, rodesac pacients SfoTva
depresiuli aSliloba
diliT, gaRviZebisas uZlierdeba, radgan fsiqoaq-
depresiuli aSlilobis dros SfoTva tipiur simptoms tiuri nivTierebebis aRkveTis simptomebi yvelaze
warmoadgens, xolo generalizebuli SfoTviTi ufro xSirad swored am dros iCens Tavs (dRis am
aSlilobisas xSiria zogierTi depresiuli simptomi. monakveTSi SfoTvis gaZliereba SeiZleba depresiul
Cveulebriv, diagnozis dasma xdeba imis safuZvelze, aSlilobazec miuTiTebdes _ ix. zemoT).
Tu am ori tipis simptomidan romelia ufro mZimea da
ra TanmimdevrobiT iCens Tavs. informacia amis Ses- somaturi daavadebebi
axeb unda movipovoT pacientisagan, pacientis naTe- zogierTi somaturi daavadebis simptomebi SeiZleba
savebisgan, da, Tu SesaZlebelia, sxva informatorebi- SfoTviTi aSlilobis simptomebSi agverios. aseTi
sagan. upirveles yovlisa, yuradReba unda mivaqcioT SesaZlebloba nebismieri SemTxvevis dros unda iyos
im tipis simptomebs, romlebmac pirvelad iCina Tavi gaTvaliswinebuli, gansakuTrebiT ki maSin, rode-
da yvelaze ufro mwvaved aris gamoxatuli. erT-erT sac ar arsebobs SfoTvis gamomwevevi TvalsaCino
seriozul diagnostikur Secdomas warmoadgens iseTi fsiqologiuri mizezebi an pacients warsulSi (avadmy-
SemTxvevebi, rodesac aJitaciuri tipis mZime depre- ofobis istoriis mixedviT) ar aReniSneboda SfoTvis
siuli aSliloba generalizebul SfoTviT aSlilo- simptomebi. am mxriv gansakuTrebiT mniSvnelovania:
baSi erevaT. aseT Secdomebs iSviaTad davuSvebT, Tu w Tireotoqsikozi, romlis drosac pacients SeiZleba
SfoTvis mqone pacientebs yovelTvis gamovkiTxavT tremorTan da taqikardiasTan erTad gaRizianebado-
depresiuli aSlilobis simptomebis Sesaxeb (depre- ba da mousvenroba aReniSnebodes. pacientis fiziku-
siuli da suiciduri azrebis CaTvliT). xSirad, ri janmrTelobis Semowmebam SeiZleba gamoavlinos
depresiuli aSlilobis dros, pacientis mdgomareoba TireotoqsikozisaTvis damaxasiaTebeli niSnebi,
yvelaze mZime diliTaa da Tu SfoTva, am periodSi, rogoricaa mag., farisebri jirkvlis gadideba, atri-
ufro Zlierad aris gamoxatuli, es, savaraudod, aluri fibrilacia da egzoftalmi. Tireotoqsikozze
depresiul aSlilobaze miuTiTebs. eWvis gaCenis SemTxvevaSi aucilebelia farisebri
jirkvlis funqciis Semowmeba.
Sizofrenia
w feoqromocitoma da hipoglikemia, romlis drosac
SizofreniiT daavadebuli adamianebi, sxva simptome-
SfoTviT simptomebs, Cveulebriv, epizoduri xasiaTi
bis gamovlenamde, xSirad SfoTvas uCivian. diagnos-
aqvs da amitom ufro fobikur an panikur aSlilobas
tikuri Secdomis Tavidan asacileblad unda SevekiTx-
mogvagonebs. Tumca, isini, aseve, ganxiluli unda
oT SfoTvis mqone pacients, Tu misi azriT, ra aris
iyos rogorc generalizebuli SfoTviTi aSlilobis
arsebuli simptomebis gamomwvevi mizezi. Sizofre-
diferencialuri diagnozi. feoqromocitomasa da
niiT daavadebulma pacientma am kiTxvaze SeiZleba
hiperglikemiaze eWvis gaCenis SemTxvevaSi pacients
uCveulo pasuxi gagvces, rac manamde gamouvleneli
Sesabamisi fizikuri Semowmeba da laboratoriuli
bodviTi ideebis dadgenaSi dagvexmareba.
testireba unda Cautardes.
demencia
meoradi SfoTva somaturi daavadebebis
preseniluri da seniluri demenciis dros pacien-
simptomebis mimarT
ti, SeiZleba, pirvel rigSi, SfoTvas uCiodes. aseTi
zogjer somaturi daavadebis mqone pacienti, pirvel
SemTxvevebisas klinicists SeiZleba gamorCes am daa-
rigSi, uCivis SfoTvas, romelic gamowveulia RelviT
_ 190 _
SfoTviTi aSlilobebi
imis Taobaze, rom garkveuli fizikuri simptomebi seri- etiologia
ozuli somaturi daavadebebis momaswavebelia. rodesac
rogorc Cans, generalizebul SfoTviT aSlilo
fizikur simptomebs araspecifikuri xasiaTi aqvT, isini
bas iwvevs stresorebis zemoqmedeba iseT pirov
SeiZleba, SecdomiT, SfoTvas mivaweroT. garda amisa,
nebaze, romelsac genetikuri faqtorebisa da bav
zogierTi pacienti ar saubrobs garkveul fizikur
Svobisdroindeli garemos zegavlenis Sedegad Se
simptomebze, Tu eqmimma maT Sesaxeb kiTxva ar dausva.
sabamisi predispozicia aqvs Camoyalibebuli. Tumca,
es gansakuTrebiT maSin xdeba, rodesac pacientis SiSi
am mizezebis buneba da mniSvneloba bolomde ar aris
seriozuli daavadebis Taobaze konkretuli mizeziTaa
dadgenili.
gamowveuli. mag., Tu misi naTesavi an megobari avTvise-
biani simsimvniT gardaicvala, mas, SemdgomSi, SeiZleba stresuli movlenebi
igive simptomebi ganuviTardes. amitom pacients yov- klinikuri dakvirvebebi gviCvenebs, rom generalize-
elTvis unda davusvaT kiTxva imis Sesaxeb, xom ar aRen- buli SfoTviTi aSlilobebis ganviTareba stresul
iSneba mis romelime nacnobs analogiuri simptomebi. movlenebTan aris dakavSirebuli da stresis Semcveli
problemebis mougvareblobis SemTxvevaSi, SfoTviT-
somaturi daavadebis mcdari diagnostireba
ma aSlilobam SeiZleba qronikuli xasiaTi SeiZinos.
generalizebuli SfoTviTi aSlilobis nacvlad
SfoTviT aSlilobasTan ufro metad dakavSirebulia
aseT SemTxvevaSi pacients SeiZleba sxvadasxva saxis
saSiSroebis Semcveli stresuli movlenebi, xolo
gamokvleva Cautaron, rac kidev ufro aZlierebs mis
depresias ufro danakargTan dakavSirebuli movle-
SfoTvas. somaturi daavadebis arsebobis SesaZle-
nebi iwvevs (Finlay-Jones and Brown, 1981). erT-erTi ga-
bloba nebismier SemTxvevaSi unda davuSvaT, Tum-
mokvlevis mixedviT (Epidemilolgical Catchment Area Stu-
ca, aseve mniSvnelovania gvaxsovdes, rom SfoTvis
dy) mamakacebSi, romlebmac wina wels oTxi an oTxze
simptomebi mravalferovnebiT xasiaTdeba. pulsis aC-
meti stresuli movlena gadaitanes, rvajer ufro
qareba, Tavis tkivili, xSiri Sardva da abdominaluri
xSirad vxvdebiT DSM-IIIR-Si arsebuli kriteriumebis
diskomforti SeiZleba SfoTvis mqone pacientis pir-
Sesabamis generalizebul SfoTviT aSlilobas, vidre
velad Civilebs warmoadgendes. swori diagnozis dasma
maTTan, vinc igive periodSi sami an naklebi stresuli
damokidebulia generalizebuli SfoTviTi aSlilo-
movlena gadaitana (Blazer et al., 1991).
bis sxva simptomebis dadgenaze. aseve, aucilebelia,
gamovkiTxoT pacients, Tu rogori TanmimdevrobiT genetikuri mizezebi
iCines Tavi simptomebma daavadebis ganviTarebisas. ojaxis gamokvleva. generalizebuli SfoTviTi aS-
epidemiologia liloba ufro xSirad gvxvdeba am aSlilobis mqone
probandebis pirveli rigis naTesavebTan, vidre sakon-
monacemebi zemoT xsenebuli daavadebis gavrcelebis
trolo jgufis wevrebis pirveli rigis naTesavebTan.
sixSiris Sesaxeb cvalebadobs kvlevebSi gamoyenebuli
tyupebis Seswavla. tyupebze Catarebuli adreuli
diagnostikuri kriteriumebis mixedviT. aseve, gasa-
gamokvlevebis mixedviT (mag., Slater and Shields, 1969)
Tvaliswinebelia, gamoyenebulia, Tu ara, klinikuri
SfoTviTi aSlilobis konkordantoba ufro maRalia
mniSvnelobis mqone kriteriumi. SfoTviTi aSlilobis
monozigotur tyupebSi dizigoturTan SedarebiT, rac
gavrcelebis sixSire erTi wlis manZilze, daaxloebiT,
imas gulisxmobs, rom ojaxur kavSirebs genetikuri mi-
3%-s Seadgens, xolo mTeli cxovrebis manZilze _ 4-5%-
zezebi gaaCniaT. Tumca, unda aRiniSnos, rom am gamokv-
s. garda amisa, dadginda, rom is ufro qalebTan aris
levis dros sxvadasxva tipis SfoTviTi aSlilobebi ar
gavrcelebuli, vidre mamakacebTan. erT-erTi kvlevis
iyo erTmaneTisagan gamijnuli. meta-analizma aCvena,
mixedviT (US Epidemiological Catchment Area Study)
rom ojaxuri agregacia mniSvnelovanwilad aixsneba ge-
generalizebuli SfoTviTi aSlilobis maCvenebeli
netikuri faqtorebiT. aseve, mniSvnelovania is garemo
erTi wlis manZilze DSM-IV-is kriteriumebis mi
faqtorebi, romlebic tyupebisaTvis ar aris saerTo.
xedviT 3.8%-s Seadgenda (Brazer et al., 1991), xolo me
rac Seexeba ojaxur garemos _ misi roli daudgenelia
ore kvlevis mixedviT (US National Comorbidity Study),
(Hettema et al., 2001). genetikuri mowyvladoba, rogorc
romlis drosac klinkuri mniSvnelobis mqone kri
Cans, afeqturi aSlilobebisadmi midrekilebasac ga-
teriumi iyo gamoyenebuli _ 2.8%-s (Narrow et al.,
napirobebs. rac imas niSnavs, rom garemos faqtorebi
2002). afrikaSi Catarebuli gamokvlevis mixedviT,
raRac saxiT gansazRvraven imas, Tu rogor gamovlin-
romelSic DSM-IV-is kriteriumebi iyo gamoyenebuli,
deba Tandayolili mowyvladoba (Roy et al., 1995).
gavrcelebis saSualo maCvenebeli 3.7 procents Sead
genda (Bhagwanjee et al., 1998). generalizebuli Sfo adreuli gamocdileba
TviTi aSlilobis epidemiologiis Sesaxeb Semdgomi SfoTvis mqone pacientebisagan miRebuli informacia,
informaciis mosapoveblad ix. Kessler et al., (2001). bavSvobisdroindeli gamocdilebis Sesaxeb, imaze me-
_ 191 _
tyvelebs, rom generalizebul SfoTviT aSlilobas iyo, rom ganviTarebis am etapze gancdili marcxi
iwvevs adreuli asakis uaryofiTi gamocdileba. aseT- zrdasrul asakSi SfoTvis mimaT mowyvladobis kidev
ma informaciam obieqtur kvlevebsa da fsiqoanaliti- erT mizezs warmoadgens. fsiqoanalitikuri Teoriebi
kur Teoriebs misca dasabami. ar aris dadasturebuli mecnieruli kvleviT.
obieqturi kvlevebi. braunma da harisma (Brown and
Harris, 1993) ikvlies urTierTkavSiri bavSvobisdro- kognitur-bihevioruli Teoriebi
indel uaryofiT gamocdilebasa da zrdasrulobis ganpirobebis Teoriebis mixedviT generalizebuli
periodSi SfoTviTi aSlilobis ganviTarebas Soris. SfoTviTi aSliloba maSin aRmocendeba, rodesac
gamokvleva Catarda 404 qalze, romlebic muSaTa pirovnebas axasiaTebs Tandayolili predispozicia
klass miekuTvnebodnen da didi qalaqis SedarebiT reaqciisas vegetaturi nervuli sistemis zedmetad
Rarib nawilSi cxovrobdnen. adreuli uaryofiTi aqtivaciisadmi da rodesac xdeba reaqciis gene
gamocdilebis Sefaseba xdeboda mSoblebis gulgrili ralizacia. reaqciis generalizaciis safuZvelia war
damokidebulebisa da fizikuri an seqsualuri Zala- sulSi neitraluri xasiaTis stimulebis SfoTvasTan
dobis faqtebis Sesaxeb pacientebis mier mowodebuli asocireba ganpirobebis meqanizmis meSveobiT. es Teoria
informaciis safuZvelze. aseTi gamocdilebis mqone obieqturi mtikicebulebebiT ar aris gamyarebuli.
qalebSi gazrdili iyo generalizebuli SfoTviTi aS- kognituri Teoriis mixedviT, generalizebuli
lilobis (aseve, agorafobiisa da depresiuli aSli- SfoTviTi aSliloba aRmocendeba problemebze ara
lobis, magram ara martivi fobiebis) sixSiris maCve- sagnobrivi wuxilisa da potenciurad saSiSroebis
nebeli. kendlerma da misma kolegebma (Kendler et al., Semcvel viTarebebze yuradRebis fokusirebisaken
1002b) aseve aRmoaCines, rom SfoTviTi aSlilobis (da midrekilebis safuZvelze. es Teoria gamyarebulia,
zogierTi sxva fsiqikuri aSlilobis) sixSiris maCve- rogorc SfoTvis mqone pacientebisa da sakontroli
nebeli ufro maRalia iseT qalebSi, romlebic 17 jgufis wevrebis azrovnebis SeswavliT miRebuli
wlamde udedod izrdebodnen. uSualo monacemebiT, ise kognitur-bihevioruli mkur
fsiqoanalitikuri Teoriebi. fsiqoanalitikuri Teo- nalobis efeqturobis analiziT, rac mtkicebulebebis
riebis mixedviT SfoTva intrafsiqikuri konfliqtiTaa mopovebis arapirdapir meTods warmoadgens (gv. ??).
gamowveuli. SfoTva maSin aRmocendeba, rodesac ego generalizebuli SfoTviTi aSlilobis kognituri
agznebiTaa moculi. amis mizezi SeiZleba iyos: aspeqtebis kvlevis Sesaxeb informaciis misaRebad ix.
w gare samyaro (realisturi SfoTva) Wells and Butler, 1997.
w id-is instinqtebi, siyvarulis, sibrazisa da seqsis pirovneba

instinqtebis CaTvliT (nevrotuli SfoTva) pirovnuli Tvisebebi. SfoTvis simptomi nevrotizm-
w superego (moraluri SfoTva) Tan aris dakavSirebuli. tyupebis Seswavlam aCvena,
fsiqoanalitikuri Teoriis mixedviT, generali rom nevrotizmTan da generalizebul SfoTviT aSli-
zebuli SfoTviTi aSlilobisas SfoTva uSualod lobasTan dakavSirebuli genetikuri faqtorebi, gar
ganicdeba da ar aris modificirebuli dacviTi kveulwilad, emTxveva erTmaneTs (Hettema et al., 2004).
meqanizmebiT, romlebic, savaraudod, fobiebis an pirovnuli aSliloba. generalizebuli SfoTviTi
obsesiebis safuZvels warmoadgenen (gv. ?? da ??). am aSliloba Tavs iCens, rogorc SfoTviT-acilebadi
Teoriis mimdevrebis azriT, generalizebuli SfoTviTi pirovnuli aSlilobis, aseve sxva saxis pirovnuli
aSlilobisas, ego iolad iTrguneba, radganac is aSlilobis mqone adamianebSi.
dasustebulia bavSvobis periodSi ganviTarebis
neirobiologiuri meqanizmebi
procesis araswori mimdinareobiT. am marcxis
gamomwvevi mizezebidan gansakuTrebiT mniSvnelovani zogad SfoTviT aSlilobaSi, savaraudod, monawileo-
ganSoreba da danakargia (Bowlby, 1969). normalur ben is neirobiologiuri meqanizmebi, romlebic axor-
viTarebaSi bavSvebi SfoTvis daZlevas moyvarul cieleben normaluri SfoTvis mediacias. aseTi meqa-
mSoblebTan usafrTxo urTierTobebis meSveobiT nizmebi kompleqsuria da Tavis tvinis zogierT sis-
axerxeben. Tu bavSvi usafrTxo garemoSi ar izrdeba, temebsa da neirotransmiterebs CairTavs. cxovelebze
is, zrdasrul asakSi, adamianebTan ganSorebisas Catarebuli kvlevebis Sedegad dadginda amigdalas
SfoTvisaken iqneba midrekili. froidi varaudobda, gansakuTrebuli roli, romelic sensorul informa-
rom bavSvobis ufro gviandel etapze SfoTva cias iRebs rogorc uSualod Talamusidan, ise ufro
mamis mimarT metoqeobriv damokidebulebasTanaa grZeli gzebidan, romlebic moicavs somatosenso-
asocirebuli. man gamoiyena termini kastraciis rul korteqss da qerqis sartylisebri xveulis wina
SfoTva da mamasTan metoqeoba aRwera, rogorc nawils (ix. le Doux, 2000). garda amisa, iTvleba, rom
oidiposis konfliqti (gv. ??). froidi darwmunebuli SfoTvis regulaciaSi hipoTalamusic mniSvnelovan
_ 192 _
SfoTviTi aSlilobebi
rols asrulebs, radganac is akavSirebs SiSis Semcvel li aSlilobis sixSire ar aris gazrdili. SfoTvasa
mogonebebs relevantur awmyo konteqstTan. am meqa- da depresias Soris arsebuli kavSiri mogvianebiT, ??
nizmis funqcionirebis moSlas SeuZlia gamoiwvios gverdze iqneba ganxiluli.
SiSis zegeneralizacia iseTi stimulebis sapasuxod,
mkurnaloba
romlebic saSiSroebas ar Seicaven.
cxovelebis Seswavlam, aseve, gasagebi gaxada, Tu konsultaciebi
rogor xdeba Tavis tvinSi SfoTvis regulacia neiro- rodesac kargad organizebuli kontrolirebadi kv-
transmiterebisa da neiromodulatorebis meSveobiT. levis Sedegad miRebuli monacemebi ar aris sakma-
noradrenerguli neironebi, romlebic lurji laqi- risi, mkurnaloba klinikuri gamocdilebis safuZ-
danaa (locus ceruleus _ laT.) aRmocenebuli, aZlierebs velze unda warimarTos. generalizebuli SfoTviTi
agznebasa da SfoTvas. serotonerguli neironebi, aSlilobis adreul stadiaze (sanam jer kidev ar Cam-
romlebic nakeris birTvSi (nuclei raphe _ laT.) war- oyalibebula simptomebi, romlebic DSM-IV-is diag-
moiqmneba, kompleqsuri efeqtis mqonea. zogs Semakave- nostikuri kriteriumis Tanaxmad eqvsi Tvis manZlze
beli efeqti aqvs, zogs ki anqsiogenuri. gama-amonoer- unda aRiniSnebodes) konsultaciebi, xSirad, dadebiT
bo mJavis receptorebi, romlebic Tavis tvinSi far- efeqts iZleva. zogjer, ufro persistentuli xasi-
Todaa warmodgenili, inhibiciuri funqciis mqonea, aTis generalizebuli SfoTviTi aSlilobis mqone pa-
iseve, rogorc misi benzodiazepinis mierTebis ubani. cientebic dadebiTad reagireben konsultaciebze,
rogorc Cans, kortikotropinis relizeri hormo- Tumca, isini, ufro xSirad, kognitur-biheviorul
nic, agreTve, mniSvnelovan rols TamaSobs. es hor- Terapias an medikamentur mkurnalobas saWiroeben
moni aZlierebs SfoTvasTan dakavSirebul qcevas da (orive mogvianebiT iqneba aRwerili). generalizebuli
amigdalaSi maRali koncentraciiTaa warmodgenili SfoTviTi aSlilobis dros konsultaciebi zogadi
(ix. Charney and Bremner, 2004). princpebis mixedviT tardeba (aRwerilia ?? gverdze)
savaraudod, es meqanizmebi generalizebul SfoT- da yuradReba Semdeg momentebzea gamaxvilebuli:
viTi aSlilobis drosac asrulebs garkveul funq-
w marTvis gegmis detalurad SemuSaveba, romelic
cias, magram aseTi daskvnis gamotana rTulia, radgan
pacientTan, da, saWiroebis SemTxvevaSi, mis naTe-
adamianebze Zalian cota relevanturi kvlevaa Cat-
savTan an partniorTan unda SevaTanxmoT.
arebuli. Tavis tvinis funqciurma skanirebam aCvena,
rom generalizebuli SfoTviTi aSlilobis mqone pa- w pacientisaTvis aSlilobis bunebis Sesaxeb infor-
cientebSi gazrdilia Tavis tvinis qerqis aqtivoba da maciis miwodeba da misi darwmuneba, rom SfoTvis
Sesustebulia bazaluri gangliebis aqtivoba, magram fizikuri simptomebi yovelTvis somaturi daa-
am cvlilebebis funqciuri mniSvneloba gaurkvevelia. vadebiT ar aris gamowveuli (radgan SfoTvis mqone
neirobiologiuri cvlilebebi, romlebic generali- adaimanebs xSirad axasiaTebT cudi koncentracia,
zebuli SfoTviTi aSlilobis dros aRiniSneba, ganxi- sasargebloa maTTvis am Temaze sainformacio bro-
lulia Semdeg wyaroSi: Nutt (2001). Surebis miwodeba).
w problemebis gadaWraSi an maTTan adaptaciaSi paci-
prognozi entisaTvis daxmarebis gaweva.
DSM-IV-is erT-erTi kriteriumis mixedviT, gener- w rCevis micema kofeinis miRebis Taobaze. gener-
alizebuli SfoTviTi aSlilobis simptomebi pacients alizebuli SfoTviTi aSlilobis mqone pacientebi
eqvsi Tvis manZilze unda aReniSnebodes. am kriteriu- janmrTel adamianebze ufro sensitiurebi arian ko-
mis erT-erT safuZvels is warmoadgens, rom SfoTviT feinis anqsiogenuri efeqtebis mimarT (Bruce et al.,
aSlilobebs, romlebic eqvs Tveze didxans grZeldeba, 1992). bevri pacienti amas Tavadve xvdeba da amci-
cudi prognozi ukavSirdeba. mag., erT-erTi gamokv- rebs mis moxmarebas. wianaaRmdeg SemTxvevaSi, eqimma
levis mixedviT, aseTi pacientebis 80%-s SfoTviTi unda urCios pacients, rom man Tavi Seikavos kofei-
aSliloba sami wlis Semdegac aReniSnebodaT (Abelson nis gadaWarbebuli moxmarebisagan.
et al., 1991). Znelia imis prognozireba, Tu ra moxdeba
sami wlis Semdeg, Tumca, SfoTviTi aSlilobis mqone relaqsaciis treningi
pacientebis Seswavlam aCvena, rom eqvsi wlis ganma- vinaidan generalizebuli SfoTviTi aSlilobis di-
vlobaSi maTi ori mesamedi ganikurna an maTi mdgo- agnozis mqone pacientebze ar Catarebula sakmari-
mareoba sagrZnoblad gaumjobesda (Yonkers et al., 1996). si raodenobis kontrolirebadi kvlevebi, maTTvis
generalizebuli SfoTviTi aSlilobis (iseve, ro- rCevis micema klinikur gamocdilebas unda efuZne-
gorc sxva saxis SfoTviTi aSlilobis) mqone pacien- bodes. naklebad mZime SemTxvevebSi, regularulma
tebSi gazrdilia didi depresiis ganviTarebis riski relaqsaciurma varjiSebma SeiZleba SfoTvis Sesuste-
(Bittner et al., 2004), Tumca, Sizofreniisa da bipolaru- ba gamoiwvios. Tumca, mravali pacienti relaqsaciur
_ 193 _
varjiSebs regularulad ar akeTebs. pacientis moti- bas, magram ufro neli moqmedeba axasiaTebs. rodesac
vacia SeiZleba gaizardos, Tu relaqsaciur trenings SfoTvasTan erTad Zlieri palpitaciac aRiniSneba,
jgufurad CavatarebT. zogierTi adamiani ufro sxva saxis mkurnalobis araefeqturobis SemTxveva-
CarTulia mkurnalobis procesSi, rodesac pacients Si, zogjer betaadrenergul antagonistebs niSnaven
relaqsacias aswavlian iogas varjiSebTan erTad. (gv. ??), Tumca, isini ufro xSirad sajaro gamosvlis
SiSiT gamowveuli SfoTvis Sesamsubuqeblad gamoiy-
kognitur-bihevioruli Terapia eneba (gv. ??), vidre generalizebuli SfoTviTi aSli-
amgvari mkurnaloba warmoadgens relaqsaciisa da lobis dros. am medikamentebis daniSvnisas sifrTxile
kognituri procedurebis nazavs da pacients wuxi- unda gamoviCinoT da gaviTvaliswinoT is ukuCvenebe-
lis Semcveli azrebis gakontrolebaSi exmareba. kog- bi, romlebic maT axasiaTebT. aseve, unda mivdioT im
nitur-bihevioruli mkunalobis meTodi ?? gverdzea rekomendaciebs, romlebic ?? gverdze da mwarmoeb-
aRwerili. am meTodiT mkurnalobisas pacientebi bev- lis anotaciaSi aris mocemuli.
rad ufro kargad grZnoben Tavs, vidre im SemTxvevaSi, grZelvadiani mkurnaloba. generalizebuli SfoT-
rodesac maT araspecifikuri mkunaloba utardebad viTi aSlilobebi xSirad saWiroebs xangrZliv
an saerTod ar utardebaT mkurnaloba (Borkovec and mkurnalobas, romlis drosac benzodiazepinebis
Ruscio, 2000). aseT dros pacientebis 50%-s simptomebi gamoyeneba ar aris mizanSewonili (ix. zemoT). garda
umsubuqdeba da maT ufro xSirad mihyavT mkurnalo- amisa, depresiuli aSlilobebi xSirad mkurnalobis
bis kursi bolomde (Barlow et al., 1997). kognitur-bi- Semdgom periodSi viTardeba. amitom, grZelvadiani
hevioruli Terapiis efeqtebi sul cota, ori wlis mkurnalobisas, Cveulebriv, romelime anqsiolizur
manZilze narCundeba (Borkovec et al., 2002) da SeiZleba antidepresants iyeneben (ix. 21-e Tavi). am miznisaT-
bevrad ufro didi xanic gastanos (Durham et al., 2003). vis SeiZleba rogorc tricikluri antidepresantebis,
Tumca, ar aris cnobili mTliani proceduris Cat- aseve, serotoninis gamonTavisuflebis inhibitorebis
areba ufro efeqturia, Tu cal-calke relaqsaciis gamoyeneba. pacients, aseve, SeiZleba mcire doziT da-
an kognituri Terapiis Catareba (Borkovec et al., 2002). vuniSnoT antifsiqozuri preparatebi, magram, Cveu-
lebriv, mxolod im SemTxvevaSi, rodesac pirovneba
medikamenturi mkurnaloba
agresiulia an sxva medikamentebis mimarT damokideb-
anqsiolizuri preparatebi ?? gverdzea aRwerili. uleba aqvs Camoyalibebuli.
aq Cven SevexebiT zogierT specialur sakiTxs, rom- miuxedavad imisa, rom xSirad grZelvadiani
lebic generalizebuli SfoTviTi aSlilobis dros mkurnalobis Catarebaa saWiro, antidepresantebis
anqsiolitikebis gamoyenebas exeba. medikamenturi klinikuri testireba SfoTviTi aSlilobebisaTvis
mkurnaloba ufro swrafad zemoqmedebs simptom- or an sam Tveze didxans iSviaTad grZeldeba. amitom
ebze, vidre fsiqologiuri. aseTi mkurnaloba maSin aucilebeli xdeba depresiuli aSlilobis grZelvadi-
gamoiyeneba, rodesac fsiqologiuri mkurnaloba ani medikamenturi mkurnalobis farTo gamocdilebis
araefeqturia. miuxedavad amisa, eqimebi pacientebs eqstrapolacia. aseTi gamocdileba gviCvenebs, rom
medikamentur mkurnlaobas zedmetad ìolad~ da mkurnaloba SeiZleba mravali Tvis manZilze uvneblad
zedmetad xangrZlivi droiT uniSnaven. medikamentis da efeqturad grZeldebodes. xelmisawvdom prepa-
daniSvnamde unda gavixsenoT, rom generalizebuli ratebs Soris yvelaze xangrZlivi drois manZilze
SfoTviTi aSlilobisas placeboze reagirebis pro- Catarda venlafaqsinisa da paroqsetinis testireba.
centuli maCvenebeli daaxloebiT 40%-s Seadgens (Fos- aRmoCnda, rom isini ufro efeqturi arian grZelvadi-
sey and Lydiard, 1990), rac imaze miuTiTebs, rom pacien- ani mkurnalobisas, vidre sxva preparatebi (ix. Rouillon,
tis mdgomareobis gaumjobeseba xSirad medikamenturi 2004). SfoTviTi aSlilobebis samkurnalod pirvelad
mkurnalobis gareSecaa SesaZlebeli. monoamin oqsidazas inhibitorebi gamoiyenes (Sargant
moklevadiani mkurnaloba. generalizebuli SfoT- and Dally, 1962), magram maT am mizniT dRes iSviaTad iy-
viTi aSlilobis mkunalobisas, mizanSewonili, xan- eneben, radgan isini ufro xSirad Sedian reaqciaSi sxva
grZlivi zemoqmedebis mqone benzodiazepinebis (mag., preparatebTan da sakveb produqebTan (gv. ??).
diazepamis) gamoyeneba: 5mg orjer dReSi msubuqi Sem- generalizebuli SfoTviTi aSlilobebis dros anti-
Txvevebis dros da 10 mg samjer dReSi yvelaze mZime depresantebis gamoyenebis kokreiniseuli mimoxilva
SemTxvevebis dros. anqsiolizuri preparatebis dan- Semdeg wyaroSia mocemuli: Kapczinski et al., (2003).
iSvna sam kviraze ufro xangrZlivi vadiT iSviaTad
xdeba, radgan aman SeiZleba maTze damokidebuleba marTva
gamoiwvios. generalizebuli SfoTviTi aSlilobis pirveeladi daxmarebis gawevisas, generalizebuli
moklevadiani mkunalobisas, aseve, efeqturia buspi- SfoTviTi aSlilobis diagnozis formalurad dadge-
roni (gv. ??), romelic naklebad iwvevs damokidebule- namde, bevr pacients SfoTviTi aSlilobis adreuli
_ 194 _
SfoTviT-fobikuri aSlilobebi
stadia aReniSneba. rogorc zemoT ukve aRvniSneT, am gegmis SemuSavebisas unda gaviTvaliswinoT, rom
stadiaze xSirad konsultaciebis Catarebac sakmari- generalizebuli SfoTviTi aSliloba xSirad xan
sia. Zlieri SfoTvisas benzodiazepiniT mkurnalobis grZliv problemas warmoadgens.
mokle kursma SeiZleba swrafad Seumsubuqos pacients
mdgomareoba. fsiqiatrebs SfoTviTi aSlilobebis SfoTviT-fobikuri aSlilobebi
ukve Camoyalibebul formebTan aqvT saqme. aseTi pa-
SfoTviT-fobikur aSlilobas, ZiriTadaT, igive
cientiebis marTvis safexurebia:
simptomebi gaaCnia, rac generalizebul SfoTviT
w diagonizisa da komorbidobis Semowmeba gansakuTrebiT aSlilobas, magram es simptomebi mxolod garkveul
aucilebelia depresiuli aSlilobis, fsiqoaqtiuri viTarebaSi iCens Tavs. zogierTi fobikuri
nivTierebebis borotad moxmarebis an iseTi somaturi aSlilobisas aseTi viTarebebi iSviaTia da pacienti
mizezis arsebobisas, rogoricaa Tireotoqsikozi. umetesad ar ganicdis SfoTvas. sxva fobikuri
Tu pacients romelime maTgani daudginda, saWiroa aSlilobebisas, arsebobs SfoTvis gamomwvevi mravali
Sesatyvisi mkurnalobis Catareba. viTareba da, Sesabamisad, SfoTvac ufro xSirad iCens
w xelSemwyobi fsiqosocialuri faqtorebis Sefaseba, Tavs, Tumca, aseT SemTxvevebSic ki, pacienti, zogierT
rogoricaa mag., persistentuli socialuri prob situaciaSi saerTod ar ganicdis SfoTvas. fobikur
lemebi, colqmruli konfliqtebi an wuxili imis aSlilobas kidev ori damaxasiaTebeli Tviseba gaaCnia:
Taobaze, rom SfoTvis fizikuri simptomebi seri adamiani Tavs aridebs viTarebebs, romlebic SfoTvis
ozuli somaturi daavadebis maCvenebelia. provocirebas iwvevs da ganicdis anticipatorul
w gamokvlevis Sedegebis axsna da savaraudo mkur SfoTvas, rodesac arsebobs aseT viTarebaSi aRmoCenis
nalobis ganmarteba. gansakuTrebiT mniSvelovania perspeqtiva. SfoTvis gamomwvevi viTarebebi SeiZleba
avuxsnaT pacients, Tu ra iwvevs SfoTvis fizikur dajgufdes situaciebad (mag., xalxmravali adgilebi),
simptomebs. aseve, masTan erTad unda ganvixiloT, òbieqtebad~ (cocxali arsebebi; mag., obobebi) da
Tu rogor auxsnis igi sakuTar mdgomareobas Tavis bunebriv movlenebad (mag., Weqa-quxili). klinikuri
damsaqmeblebs, megobrebsa da ojaxis wevrebs. TvalsazrisiT erTmaneTisagan ganansxvaveben sam
garda amisa, pacients unda mivawodoT wignebi ZiriTad fobikur sindroms. esenia specifikuri fobia,
TviTdaxmarebis Sesaxeb (mag., Kennerley, 1997), mivceT socialuri fobia da agorafobia. es sindromebi
safuZvliani axsna-ganmartebebi da aRvuweroT mar mogvianebiT iqneba ganxiluli.
tivi kognitur-bihevioruli teqnikebi, romlebic
SeuZliaT gamoiyenon damoukideblad, an, rogorc fobikuri aSlilobebis klasifikacia
mkurnalobis ufro farTo gegmis nawili. DSM-IV-sa da ICD-10-Si fobikuri aSlilobebi da
w fsiqologiuri an socialuri daxmarebis SeTavazeba. yofilia specifikur fobiad, socialur fobiad
daxmareba SeiZleba ganxorcieldes konsultaciebis da agorafobiad. Tumca DSM-IV-Si (ICD-10-sgan gan
formiT (rogorc es zemoT iyo aRwerili), socialuri sxvavebiT) agorafobiis mqone pacientebi, romlebsac
problemis mogvarebaSi praqtikuli daxmarebis gaweviT panikis regularuli Setevebi axasiaTebT (mag., oTxze
an kognitur-bihevioruli Terapiis meSveobiT. meti Seteva oTxi kviris manZilze an erTi Seteva,
romelsac mTeli Tvis manZilze Setevis gameorebis
w medikamenturi mkurnaloba. aseTi mkurnalobis
persistentuli SiSi sdevs Tan) panikuri aSlilobis
saWiroebis SemTxvevaSi sawyis etapze Zlieri Sfo
kategorias miekuTvnebian. amgvari klasifikaciis
Tvis Sesamcireblad pacients, SeiZleba, ben
safuZveli ?? gverdzea ganmartebuli.
zodiazepinebiT mkurnalobis xanmokle kursi
daeniSnos, magram is iSviaTad unda gagrZeldes
specifikuri fobia
sam kviraze met xans. fsiqologiuri mkurnalobis
dawyebamde an iseT SemTxvevebSi, rodesac aseTma klinikuri suraTi
mkurnalobam Sedegi ar gamoiRo, SfoTvis ufro specifikuri fobiis mqone adamiani garkveuli obi
xangrZlivi droiT gasakontroleblad gamoiyeneba eqtebis danaxvisas an garkveul situaciebSi mo
antidepresantebis mcire doza. aseve, unda iqnes xvedrisas araadekvatur SfoTvas ganicdis. aseT
ganxiluli medikamentebis ZiriTadi da gverdiTi dros pirovnebas aReniSneba SfoTviTi simptomebi,
efeqtebi, rogorc es depresiis igive preparatebiT romlebic zemoT, 9.1 cxrilSia CamoTvlili. spe
mkurnalobis dros xdeba (gv. ??). cifikuri fobiis dros anticipatoruli SfoTva
w mkurnalobis gegmis ganxilva pacientTan, zogadi gavrcelebul movlenas warmoadgens da pirovneba,
praqtikis eqimTan da Temze dafuZnebul servisebSi Cveulebriv, cdilobs gaeqces da Tavi aaridos
momuSave personalTan, raTa saTanadod moxdes misTvis saSiS situaciebs. specifikur fobiebs, maTi
amocanebisa da pasuxismgeblobebis gansazRvra. ufro detaluri daxasiaTebis mizniT, win SegviZlia
_ 195 _
Sesabamisi stimulis saxeli davurToT (mag., obobebis isi stimulebis (sisxli, fizikuri dazianeba) ararsebo-
fobia). winaT xSirad iyenebdnen iseT terminebs, bis SemTxvevaSc (Accurso et al., 2001). aqedan gamomdinare,
rogoricaa araqnofobia, (obobebis fobiis nacvlad) kunTebis daZabvam SeiZleba sinkopes prevencias Seu-
an akrofobia (simaRlis fobiis nacvlad), magram aseTi wyos xeli. aseTi mdgomareoba Zalze gavrcelebulia
midgoma arc ise praqtikuli aris. avadmyofis pirveli rigis naTesavebTan. Semdgomi in-
DSM-IV-is mixedviT arsebobs oTxi tipis specifi- formaciis mosapoveblad ix. Marks (1988).
kuri fobia, romlebic dakavSirebulia:
gagudvis fobia
1. cxovelebTan
am tipis fobiis dros adamianebs aqvT ylapvis pro-
2. bunebriv movlenebTan
cesSi gagudvis Zlieri SiSi. maT gaZlierebuli aqvT
3. sisxlTan, ineqciasTan da fizikur dazianebasTan gulisrevis refleqsi da gadaylapvis mcdelobisas
4. situaciebTan da sxva maprovocirebel faqtorebTan. intensiur SfoTvas ganicdian. es fobia SeiZleba
am jgufs miekuTvneba stomatologiuri da same aRmocendes bavSvobaSi an zrdasrul asakSi sakvebis
dicino situaciebis SiSi da, agreTve, gagudvis SiSi. gadacdenis Semdeg. gagudvis fobiis mqone zogierT
mokled ganvixiloT zogierTi specifikuri fobia. adamians stomatologiuri mkurnalobisac eSinia,
xolo zogierTi Tavs aridebs sazogadoebriv adgi-
stomatologiuri mkurnalobis fobia lebSi Wamas. mkurnaloba desensitizaciis meSveobiT
zrdasruli adamianebis daaxloebiT 5%-s eSinia sto- xorcieldeba. Semdgomi informaciis mosapoveblaT
matologiuri mkurnalobis. amgvari SiSi SeiZleba is- ix. McNally (1999).
eTi Zlieri iyos, rom pirovnebam Tavi aaridos nebi-
avadmyofobis fobia
smier stomatologiur mkurnalobas. bihevioruli
mkurnalobis efeqturobis Semswavleli 38 gamokvle- aseTi fobiis dros adamians xSirad awuxebs SemaS-
vis meta-analiziT dadginda, rom mkurnalobis Cat- foTebeli azrebi imis Taobaze, rom SeiZleba avTvise-
arebidan oTxi wlis Semdeg individebis saSualod biani simsivne, veneriuli daavadeba an sxva seriozuli
77%-s mniSvnelovnad uqveiTdeba stomatologiuri avadmoyofoba hqondes. bodviTi ideebis mqone adami-
mkurnalobis SiSi (Kvale et al., 2004). anebisagan gansxvavebiT avadmyofobis fobiis mqone
adamianebi acnobiereben, rom maTi azrebi iraciona-
sahaero transportiT frenis fobia luria (yovel SemTxvevaSi maSin, rodesac uSualod
TviTmfrinaviT mgzavrobisas SfoTva gavrcelebul avadmyofobaze ar fiqroben). ufro metic, isini ar
movlenas warmoadgens, magram zogierTi adamiani iseT uweven winaaRmdegobas aseT azrebs, rogorc es ob-
Zlier SfoTvas ganicdis, rom misTvis TviTmfrinaviT sesiuri azrebis aRmocenebisas xdeba. zogierTi ada-
mgzavroba SeuZlebeli xdeba. zogi Tavad gamoTq- miani SeiZleba Tavs aridebdes saavadmyofoSi moxve-
vams mkurnalobis survils. xandaxan am tipis SiSi im dras, magram, sxva mxriv, maTi SiSi ar aris romelime
mfrinavebsac aReniSnebaT, romlebmac warsulSi avi- konkretul situaciasTan dakavSrebuli. Tu pacienti
akatastrofa ganicades. arsebobs aviaxazebi, romle- darwmunebulia, rom mas raime daavadeba aqvs, aseTi
bic atarebs desensitizaciiT mkurnalobas (gv. ??). mdgomareoba klasificirdeba, rogorc ipoqondria
garda amisa, SegviZlia gamoviyenoT wignebi TviTdax- (gv. ??), xolo Tu is Tvlis, rom misi azrebi iracio-
marebis Sesaxeb da virtualuri realobis programebi, naluria da winaaRmdegobas uwevs maT _ rogorc obse-
romlebSic realuri da warmosaxviTi eqspoziciebi siur-kompulsuri aSliloba.
gamoiyeneba. arsebobs monacemebi aseTi meTodebis
epidemiologia
efeqturobis Sesaxeb (Rothbaum et al., 2002), Tumca,
isini mecnierulad ar aris dadasturebuli (Maltby et DSM-IIIR-is kriteriumebis gamoyenebiT zrdasrul
al., 2002). adamianebTan cxovrebis manZilze specifikuri fo-
biebis gavrcelebis sixSire Sefasda, rogorc 4% ma-
sisxlisa da fizikuri dazianebis fobia makacebTan da 13% qalebTan (Kessler et al., 1994). klini-
aseTi fobiis dros sisxlis an fizikuri dazianebis da- kuri TvalsazrisiT mniSvnelovani kriteriumebis gam-
naxva SfoTvas iwvevs. Tumca, mas sxva fobikuri aSli- oyenebis dros, erTi wlis manZilze amgvari fobiebis
lobebisagan gansxvavebuli vegetaturi reaqcia axlavs gavrcelebis saerTo maCvenebeli 4.4%-s Seadgens
Tan. pirvelad taqikardias mosdevs iseTi vazovagal- (Narrow et al., 2002). specifikuri fobiebis umeteso-
uri reaqciebi, rogoricaa bradikardia, gafiTreba, baSi debiutis asaki bavSvobis xanaze modis: cxoveli-
Tavbrusxveva, gulisrevis SegrZneba da zogjer gulis bis fobia daaxloebiT 7 wlis asakSi viTardeba, sisx-
wasvla. am tipis fobiis mqone adamianebi midrekilni lis fobia _ 9 wlis asakSi, xolo stomatologiuri
arian vazovagaluri sinkopes ganviTarebisaken Sesabam- mkurnalobis fobia _ 12 wlis asakSi (Ost, 1987a).
_ 196 _
etiologia aris dadgenili, gansazRvravs Tu ara igive procesi

bavSvTan specifikuri fobiis ganviTarebas.
bavSvuri SiSebis persistentuloba
zrdasruli asakis specifikuri fobiebis umetesoba cerebruli lokalizacia
bavSvobaSi SeZenil fobiebs warmoadgens. amgvari fo- specifikuri fobiis mqone adamianebSi SiSis Semcveli
biebi bavSvobis asakSi Zalze gavrcelebulia (Fyer et al., stimulebis zemoqmedebisas sisxlis mimoqcevaSi momx-
1995). mozardobis periodis dasawyisisaTvis bavSvuri dari cvlilebebis Sesaswavlad pozitronul-emisiuri
SiSebis umravlesoba qreba, magram zogierTi maTgani tomografia gamoiyeneba. rodesac specifikuri fo-
zrdasrul periodSic narCundeba. amgvari persisten- biis mqone adamianebi fobiis Sesatyvisi stimulebis
tobis mizezi daudgenelia. savaraudod, yvelaze Zl- zemoqmedebas ganicdian, maT Zlieri SiSis reaqcia
ieri fobiebi yvelaze ufro didxans narCundeba. uCndebaT, romelsac Tan sdevs amigdalas, hipokampu-
sis ubnis da wina sartylisebri qerqis aqtivaciis gaz-
genetikuri faqtorebi
rda (Pissiota et al., 2003; Frederickson and Furmark, 2003).
erT-erTi gamokvlevis mixedviT specifikuri fobiis
mqone adamianebis pirveli rigis naTesavebis 31%- diferencialuri diagnozi
s specifikuri fobiebi aReniSneba (Fyer et al., 1995). specifikuri fobiis diferencialuri diagnostika iS-
specifikuri fobiis mqone mdedrobiTi sqesis tyu- viaTad aris sirTuleebTan dakavSirebuli. yovelTvis
pebis Seswavlis Sedegebi Seesabameba etiologiur unda gvaxsovdes, rom aseT fobias SeiZleba safuZv-
models, romelSic zomieri genetikuri mowyvladoba lad udevs depresiuli aSliloba, radgan zogierTi
kombinirebulia fobiasTan dakavSirebul stresul pacienti xangrZlivi specifikuri fobiis dros dasax-
movlenasTan (Kendler et al., 1992a). genetikuri mowyv- mareblad eqims swored maSin mimarTavs, rodesac
ladoba SeiZleba gulisxmobdes gansxvavebebs SiSis depresiuli aSlilobis gamo naklebad tolerantuli
ganpirobebis siZliereSi, romelTan dakavSirebiT- xdeba fobikuri simptomebis mimarT. obsesiuri aSli-
ac memkvidreobiTobis faqtori daaxloebiT 40%-s lobebis dros, zogjer, pacienti ganicdis SiSs da
gansazRvravs (Hettema et al., 2003). Tavs aridebs iseT sagnebs, rogoric aris mag., dana
(gv. ??). aseT SemTxveevebSi pacientis avadmyofobis
fsiqoanalitikuri Teoriebi istoriis sistematiuri Segroveba da misi fsiqikuri
fsiqoanalitikuri Teoriebis mixedviT fobiebi daka- mdgomareobis Semowmeba Sesabamisi obsesiuri azrebis
vSirebulia ara TvalsaCino gare stimulTan, aramed (mag., azrebi adamianisaTvis daniT zianis miyenebis
SfoTvis Sinagan wyarosTan, romelic gandevnilia Sesaxeb) dadgenaSi dagvexmareba.
cnobierebidan represiis gziT da mibmulia gare obi-
eqtze Canacvlebis meSveobiT. fsiqoanalitikuri Teo- prognozi
ria ar aris gamyarebuli obieqturi mtkicebulebebiT. zrdasrul cxovrebaSi specifikuri fobiebis prog-
nozi sistemurad ar aris Seswavlili. klinikuri
ganpirobebis Teoria da kognituri Teoria gamocdilebis Tanaxmad, bavSvobaSi aRmocenebuli
ganpirobebis Teoriis mixedviT specifikuri fobiebi specifikuri fobiebi mravali wlis manZilze nar-
asociaciuri daswavlis Sedegad aRmocendeba. zrdas- Cundeba, xolo zrdasrul asakSi stresuli situa-
rul cxovrebaSi am gziT fobiebis aRmoceneba iSviaTia ciebiT gamowveul specifikur fobiebs ukeTesi prog-
da, ZiriTadad, Zlieri stresuli gamocdilebiT aris nozi ukavSirdeba.
ganpirobebuli. mag., cxenTan dakavSirebuli saxifaTo
incidentis Semdeg adamians SeiZleba cxenis SiSi ganu- mkurnaloba
viTardes. zogierTi specifikuri fobia SeiZleba sxvis ZiriTadi mkurnalobisaTvis bihevioruli Terapiis
reaqciebze dakvirvebis Sedegad iqnes daswavlili: bavSvi eqspoziciuri forma gamoiyeneba (gv. ??). Cveulebriv,
akvirdeba sxva adamianis SiSis reaqciebs da igive stim- amgvari mkurnalobis Sedegad fobiis intensivoba da
ulebis mimarT SiSs daiswavlis. kognituri faqtorebi socialuri funqcionirebis uunaroba (social disability)
xels uwyobs SiSis SenarCunebas, gansakuTrebiT, fobi- klebulobs. Tumca, fobiis sruli gankurneba iSvia-
kuri stimulebisaTvis seleqciurad yuradRebis miqcevas Tad xdeba. mkurnalobis Sedegi mniSvnelovnad aris
da aseTi stimulebis SiSis Semcvel anticipacias. damokidebuli mravaljerad da xangrZliv eqspozi-
ciaze. dadgenilia, rom aseTi pacientebis 50%-s bo-
daswavlisTvis mzaoba lomde ar mihyavs mkurnaloba (Schneier et al., 1995).
es termini aRniSnavs garkveul stimulebze persis- zogierTi pacienti eqimebs dasaxmareblad mxolod
tentuli SiSis reaqciebis ganviTarebis Tandayolil maSin mimarTavs, rodesac mas fobia mnivnelovani saq-
predispozicias. zogierT mcirewlovan primats aqvs mis ganxorcielebaSi uSlis xels. aseT SemTxvevebSi,
gvelis mimarT SiSis Camoyalibebis mzaoba, magram ar mkurnalobis dawyebamde pacients fobikuri SfoTvis
_ 197 _
Sesasusteblad mcire doziT benzodiazepins uniS-
naven. eqspoziciis seansi, Cveulebriv, erTi saaTi
cxrili 9.4 socialuri fobiis diagnostikuri
kriteriumebi ICD-10-sa da DSM-IV-is mixedviT*
grZeldeba. eqspoziciis seansi ramdenjerme tardeba,
(Semoklebuli versia)
Tumca, aseve, SeiZleba Catardes erTi, xangrZlivi da
intensiuri seansi, romelic ramodenime saaTs gastans ICD-10 DSM-IV
(Ost et al., 2001). socialur situaciebSi ucnobi adamianebis winaSe

yuradRebis centrSi wardgomisas an maTi
moxvedris an uxerxuli yuradRebis centrSi
socialuri fobia da samarcxvino qcevis yofnisas samarcxvino
klinikuri suraTi ganxorcielebis mkveTrad qcevis ganxorcielebis
gamoxatuli SiSi; an amgvari SiSi; an amgvari
amgvari aSlilobisas pirovnebas socialur situa- situaciebisTvis Tavis ar situaciebisaTvis Tavis
ciebSi araadekvaturi SfoTva eufleba. mas iseTi deba. arideba
gancda aqvs, rom sxvebi akvirdebian da akritikeben mas. SiSis gamomwvev situaciebSi _
socialuri fobiis mqone adamianebi cdiloben Tavi SfoTvis ori simptomisa
da damatebiT, socialuri
aaridon aseT situaciebs da Tu amas ver axerxeben, fobiis sul cota erTi
bolomde ar erTvebian situaciaSi (mag., Tavs aride- romelime simptomis
(gawiTleba/tremori,
ben saubarSi monawileobas an iseT adgilas jdebian,
gulisrevis SiSi, Sardvis an
sadac naklebad miiqceven yuradRebas). amgvar situa- defekaciis SiSi) arseboba.
ciebSi aRmoCenis perspeqtivamac ki SeiZleba pirovne-
mkveTrad gamoxatuli pirovneba acnobierebs, rom
baSi sakmaod Zlieri SfoTva gamoiwvios. emociuri distresi. SiSi gadaWarbebuli an usa
SfoTvis gamomwvev situaciebs miekuTvneba restor- pirovneba acnobierebs, rom fuZvloa.
distresi gadaWarbebuli an gavlenas axdens
nebi, sasadiloebi, wveulebebi, seminarebi, sxdome-
usafuZvloa funqcionirebaze an iwvevs
bi da sxva RonisZiebebi. aseT situaciebSi yofnisas mkveTrad gamoxatul
pirovnebas iseTi gancda uCndeba, rom mas akvirdebi- distress
an. zogierTi pacienti SfoTvas mraval gansxvavebul simptomebi, romlebic _
situaciaSi ganicdis (generalizebuli socialuri Tavs iCens an prevalirebs
mxolod pirovnebisaTvis
fobia), xolo zogierT maTgans SfoTva mxolod rome-
saSiS situaciebSi an maTi
lime konkretul situaciaSi eufleba (mag., sxvebis warmodgenisas
TandaswrebiT werisas, sazogadoebis winaSe sityviT
socialuri fobia ar aris socialuri fobia ar aris
gamosvlisas an musikalur isntrumentze dakvrisas). gamowveuli sxva fsiqikuri aris gamowveuli sxva
DSM-IV-Si es gansxvavebuli socialuri fobiebi cal- aSlilobiT fsiqikuri aSlilobiT
calkea klasificirebuli (magram ara ICD-10-Si).
18 welze ufro axalgazrda
simptomebi. socialuri fobiis mqone adamianebs asakis pirovnebasTan
SeiZleba aReniSnebodes 9.3 cxrilSi mocemuli SfoT- simptomebi sul cota
eqvsi Tvis manZilze unda
vis nebismieri simptomi, magram gansakuTrebiT xSirad
grZeldebodes.
pacientebi uxerxulobisagan gamowveul gawiTlebasa
*
ICD-10-sa da DSM-IV-Si mocemuli kriteriumebis Sedarebis
da tremors uCivian. isini xSirad Sepyrobilni arian
gasaioleblad formulirebebi perefrazirebulia, xolo
ideiT, rom sxva adamianebi maT kritikuli TvaliT zogierTi punqtebis Tanmimdevroba _ Secvlili.
akvirdebian, Tumca acnobiereben amgvari mosazrebis
usafuZvlobas. debiuti da ganviTareba. socialuri fobia, Cveu-
kogniciebi koncentrirebulia SiSze, romelic sx- lebriv, mozardobis adreul periodSi iwyeba. pirveli
vaTa mier kritikuli Sefasebis SesaZleblobiT aris epizodi Tavs iCens sazogadoebriv adgilas yofnisas,
gamowveuli. amgvari kogniciebi mogvianebiT, etiolo- umetes SemTxvevaSi, yovelgvari TvalsaCino mizezis
giis ganxilvisas, iqneba aRwerili. gareSe. mogvianebiT SfoTva amis msgavs situaciebSic
sxva problemebi. zogierTi pacienti SfoTviTi simp- aRmocendeba. SfoTvis gancdis epizodebi TandaTano-
tomebis Sesasusteblad alkohols moixmars. alko- biT ufro mwvavdeba da pirovneba sul ufro xSirad
holis borotad gamoyeneba sxva fobiebze ufro so- aridebs Tavs amgvar situaciebs.
cialuri fobiis dros aris gavrcelebuli. social- arsebobs ori, erTmaneTisagan gansxvavebuli, so-
uri fobia, agreTve, alkoholis borotad gamoyenebis cialuri fobia, romelic calke ganxilvas saWiroebs.
prediqtors warmoadgens (Zimmermann et al., 2003). mas esenia:
xSirad Tan axlavs depresiuli aSliloba. suicidis w eqskreciis fobia. aseTi fobiis dros adamianebs
mcdeloba am tipis fobiis mqone pacientebTan ufro sazogadoebriv tualetSi SfoTva ewyebaT da amis
xSiria, vidre zogad populaciaSi (Schneier et al., 1992). gamo ver axerxeben moSardvas, an moSardvis xSiri
_ 198 _
moTxovnilebis gamo Sardis Seukaveblobis SiSi gan, romlis drosac adamians mTeli cxovrebis man-
uCndebaT. eqskreciis fobiis mqone adamianebi cdi- Zilze simorcxve da sakuTar TavSi daurwmunebloba
loben tualetisagan axlos imyofebodnen. defeka- axasiaTebs. socialur fobias mkveTrad gansazRvruli
ciasTan dakavSirebuli analogiuri simptomebi debiuti da xanmokle avadmyofobis istoria gaaCnia,
ufro iSviaTad gvxvdeba. Tumca praqtikaSi gansxvavebis dadgena SeiZleba Zneli
w gulisrevis fobia. zogierT pacients eSinia, rom aRmoCndes, radganac socialuri fobia, Cveulebriv,
SeiZleba sazogadoebriv adgilas guli aerios (mag., mozardobis xanaSi iCens Tavs da, amitom, pacientma,
avtobusSi an matarebelSi). aseT adgilas yofnisas SeiZleba zustad ver gaixsenos, Tu rodis gamouv-
isini gulisrevis SegrZnebasa da SfoTvas ganicdian. linda pirvelad igi. bevr adamians aReniSneba iseTi
zogierT maTgans aqvs gamudmebuli SiSi, rom sxvebs, simptomebi, romlebic orive aSlilobis diagnosti-
misi TandaswrebiT, guli aerevaT, Tumca, aseTi Sem- kur kriteriumebs akmayofilebs (Schneier et al., 1992).
Txvevea ufro iSviaTad gvxvdeba. socialuri unar-Cvevebis nakleboba. aseT dros so-
cialuri unar-Cvevebis nakleboba pirveladia, xolo
diagnostikuri kriteriumebi SfoTva _ meoradi. igi warmoadgens ara socialur
9.4 cxrilSi mokled aris Sejamebuli ICD-10-sa da fobias, aramed garkveuli tipis qcevas, romelic Tavs
DSM-IV-Si mocemuli socialuri fobiis diagnosti- iCens pirovnuli aSlilobebis, Sizofreniis da dab-
kuri kriteriumebi. orive klasifikacias analogiuri ali inteleqtis mqone adamianebTan. ganuviTarebeli
kriteriumebi aqvT, Tumca ICD-10-Si yuradReba ufro socialuri unar-Cvevebis mqone adamianisaTvis damaxa-
SfoTviT simptomebzea gamaxvilebuli (saxeze unda siaTebelia enis borZiki, monotonuri da gaurkveveli
iyos SfoTvis ori zogadi simptomi da socialur fo- diqcia. aseve, araadekvaturi saxis gamometyveleba
biasTan dakavSirebuli sami simptomidan erT-erTi). da Jestikulacia. aseTi pirovneba saubrisas, Cveu-
DSM-IV-Si damatebiT mocemulia kidev erTi krite- lebriv, Tvals aridebs mosaubres.
riumi, romlis mixedviTac 18 wlamde asakis adamians normaluri simorcxve. zogierTi adamiani, romelsac
simptomebi, sul cota, eqvsi Tvis manZilze unda aR- arc erTi zemoT CamoTvlili aSliloba ar aReniS-
eniSnebodes. neba, ubralod morcxvia da sazogadoebaSi uxerxu-
lad grZnobs Tavs. socialuri fobiis diagnostikuri
diferencialuri diagnozi kriteriumebi adgens simptomebis simwvavis zRurbls,
agorafobia da panikuri aSliloba. socialuri fobiis rac, aseT adamianebTan, socialuri fobiis mcdari di-
simptomma SeiZleba Tavi iCinos rogorc agorafobi- agnozis dasmas gamoricxavs.
is, ise panikuri aSlilobis dros. aseT SemTxvevebSi
epidemiologia
orive diagnozis dasma aris SesaZlebeli, Tumca,
Cveulebriv, ufro mizanSewonilia klinicistma Tavad SeerTebul StatebSi Catarebuli erT-erTi gamokvle-
gadawyvitos, Tu romel sindroms mianiWos upirate- vis mixedviT (US Study), erTi wlis manZilze social-
soba. uri fobiis gavrcelebis sixSire 7.4%-s Seadgenda.
generalizebuli SfoTviTi aSliloba da depresi- klinikurad mniSvnelovani kriteriumis gamoyenebi-
uli aSliloba. socialuri fobia unda ganvasxvavoT sas am maCvenebelma 18-54 wlis adamianebTan 3.7%-mde
generalizebuli SfoTviTi aSlilobisagan im situa- iklo. socialuri fobiebis gavrcelebis sixSire im
ciebis dadgeniT, romlebSic SfoTva iCens Tavs, xolo mamakacebTan da qalebTan, romlebic samedicino dax-
depresiuli aSlilobisagan _ anamnezisa da fsiqikuri marebisaTvis eqimebs mimarTaven, TiTqmis erTnairia,
statusis mixedviT. Tumca, sazogadoebrivi gamokiTxvebisas is qalebTan
Sizofrenia. SizofreniiT daavadebuli zogierTi odnav ufro xSirad fiqsirdeba, vidre mamakacebTan
pacienti socialur situaciebs aridebs Tavs devnis (Kessler et al., 1994). rogorc zemoT ukve aRvniSneT, so-
bodviTi ideebis gamo. maTgan gansxvavebiT, social- cialuri fobia depresiasTan da alkoholizmTan aris
uri fobiis mqone adamianebi (Tu isini SiSis gamomwvev asocirebuli.
situaciebSi ar imyofebian) acnobiereben, rom maTi
etiologia
Sexedulebebi simarTles ar Seesabameba.
sxeulis dismorfuli aSliloba. amgvari aSlilobis genetikuri faqtorebi
mqone adamianebi SeiZleba Tavs aridebdnen socialur aRmoCnda, rom socialuri fobia (magram ara sxva
situaciebs. aseT SemTxvevebSi swori diagnozis dad- SfoTviTi aSlilobebi) ufro xSirad gvxvdeba
gena Cveulebriv pacientis mier dafiqsirebuli prob- aseTi fobiis mqone adamianebis naTesavebTan, vidre
lemebis safuZvelze xdeba. zogad populaciaSi. es imaze miuTiTebs, rom mis
acilebadi pirovnuli aSliloba. socialuri fo- CamoyalibebaSi, savaraudoT, genetikuri faqtorebi
bia unda ganvasxvavoT iseTi pirovnuli aSlilobisa- monawileobs (Fyer et al., 1993). socialuri fobia
_ 199 _
ufro xSiria generalizebuli socialuri fobiis funqcionuri mniSvneloba SeiZleba imaSi mdgo-
mqone probandebis pirveli rigis naTesavebTan, mareobdes, rom amigdala warmoadgens Tavis tvinis
vidre arageneralizebuli socialuri fobiis mqone ubans, romelic monawileobs safrTxeze reagirebaSi.
probandebis pirveli rigis naTesavebTan (Stein et al., citalopramiT an kognitur-bihevioruli TerapiiT
1998a). 2000-ze meti mdedrobiTi sqesis tyupebis mkurnaloba aqveiTebs sisxlis mimoqcevas amigdalaSi
populaciidan miRebul SerCevaSi socialuri fobiis da masTan dakavSirebul Tavis tvinis ubnebSi (Furmark
mqone probandebTan dadgenili Sedegebi Seesabameba et al., 2002).
garkveul models. am modelSi zomieri genetikuri
mimdinareoba da prognozi
zegavlena, romelic variabelobis erT mesamedze nak
lebs ganapirobebs, urTierTqmedebaSi imyofeba ara adamianebs, romlebsac socialuri fobia daudgindaT
specifikur garemo faqtorebTan (Kendler et al., 1992a). sazogadoebaSi Catarebuli gamokiTxvis safuZvelze,
simptomebi, saSualod, 20-25 wlis ganmavlobaSi aR-
ganpirobeba eniSnebodaT (Davidson et al., 1993). rogorc ukve iTqva,
socialuri fobiebis umravlesoba iwyeba SfoTvis alkoholizmi da depresia Semdgomi dakvirvebis pro-
uecari epizodiT iseT viTarebebSi, romlebic fo cesSi iCens Tavs. miuxedavad imisa, rom aseT paci-
biis gamomwvebi viTarebebis msgavsia. savsebiT SesaZ entebTan dafiqsirebulia ganzrax TviT-dazianebis
lebelia, rom fobikuri simptomebis Semdgomi gan maRali procentuli maCvenebeli, rogorc Cans, aseTi
viTareba, nawilobriv, ganpirobebis meSveobiT xdeba. qceva gvxvdeba mxolod komorbiduli mdgomareo-
bis dros (mag., depresiuli aSliloba da alkoholis
kognituri faqtorebi araswori moxmareba). (Schneier et al., 1992).
socialuri fobiis etiologiaSi ZiriTad kognitur
faqtors warmoadgens pirovnebis gazviadebuli wu
mkurnaloba
xili imis Taobaze, rom socialur situaciebSi sxva fsiqologiuri mkurnaloba
adamianebis mier iqneba gakritikebuli (xSirad amas kognitur-bihevioruli Terapia warmoadgens fsiqo
`negatiuri Sefasebis SiSs~ uwodeben). aseT wuxils logiur mkurnalobas. mas upiratesobas aniWeben
Tan axlavs azrovnebis garkveuli stili: socialuri fobiis dros (aRwerilia ?? gverdze).
w socialuri qcevis metismetad maRali standartebi Tavdapirvelad, kognituri meTodika efuZneboda
w uaryofiTi Sexeduleba sakuTar Tavze. mag., `me mo iseT procedurebs, romlebsac warmatebiT iyenebdnen
sawyeni adamiani var.~ agorafobiisa da panikuri aSlilobis samkurnalod.
SemdgomSi aRmoCnda, rom am procedurebis gamoyene-
w socialur situaciebSi sakuTari qcevis gadaWar
ba eqspoziciis teqnikasTan erTad mniSvnelovnad ar
bebuli kontroli
aumjobesebs mkurnalobis efeqturobas (Gould et al.,
w `me~-s Sesaxeb intruziuli, negatiuri warmodgenebi,
1997; Taylor, 1996). rogorc Cans, socialuri fobiis
romlebsac adamiani sxvas miawerss.
mkurnalobisas ufro efeqturia kognitur-bihevior-
socialuri fobiis mqone adamianebi xSirad iTvise- uli Terapiis modificirebuli formis gamoyeneba (ix.
ben ùsafrTxo qcevebs~ (gv. ??), rogoricaa, mag., mxed- Clark 2000, Clark et al., 2003). aseTi modificirebuli
velobiTi kontaqtis Tavidan arideba, rac arTulebs mkurnaloba iTvaliswinebs sfecifikur kognitur
maT normalur urTierTobas sxva adamianebTan. (so- anomaliebs, romelebsac socialuri fobiis dros vx-
cialuri fobiis kognituri modelis Sesaxeb informa- vdebiT (ix. zemoT, etiologiisadmi miZRvnil qveTav-
ciis mosapoveblad ix. Clark, 2001. Si). am dros paralelurad tardeba zomebi, romlebic
ùsafrTxoebis qcevebis~ Semcirebazea mimarTuli (gv.
nevrologiuri meqanizmebi
??) da, agrTve, gamoiyeneba video da audio ukukav-
socialuri fobiis mqone pacientebis PET-iT Seswav- Siri. kognitur-bihevioruli Terapia SeiZleba jgu-
lis Sedagad dadginda, rom maTTan, anticipatoruli furadac Catardes, magram Terapiis jgufuri forma
SfoTvis dros, gaZlierebulia sisxlis mimoqceva mar- SesaZloa ar iyos iseTive efeqturi, rogorc indi-
jvena dorsolateralur prefrontalur korteqstSi, vidualuri mkurnaloba (Stangier et al., 2003).
marcxena qveda safeTqlis wilis qerqSi da marcxena treningi relaqsaciaSi. rogorc Cans, socialuri
hipokampisa da amigdalas ubanSi. aqtivaciis es pater- fobiis mkurnalobisas, mxolod relaqsaciaSi trenin-
ni igivea, rac jansaR adamianTan molodinis SfoTvis gis gamoyeneba ar aris efeqturi (Alstrom et al., 1984).
dros dadgenili paterni, im gansxvavebiT, rom: a) jan- mkurnalobis Sedegebi SeiZleba gaumjobesdes, Tu mas
saR adamianTan aseT dros amigdala ar aris aqtivire- eqspoziciis teqnikasTan erTad gamoviyenebT. Tumca,
buli da b) socialuri fobiis dros aqtivacia ufro savaraudod, treningi relaqsaciaSi nakleb efeqtu-
did ubans moicavs (Tilfors et al., 2001). am aRmoCenebis ria, vidre kognituri Terapia (Jerremalm et al., 1986).
_ 200 _
dinamiuri fsiqoTerapia. klinikuri gamocdilebis tacia, romlebic yvelaze xelisSemSleli simptom-

Tanaxmad, aseTi mkurnaloba SeiZleba sasargeblo iyos ebia specifikuri socialuri fobiebis dros (mag.,
zogierTi pacientisaTvis, gansakuTrebiT ki imaT- musikosebisTvis, nawarmoebis sajarod SesrulebiT
Tvis, visTanac socialuri fobiis aRmoceneba pirad gamowveuli SfoTvisas). Tumca, zogadad, social-
urTierTobebSi manamde arsebul problemebTan aris uri fobiis dros beta-adrenerguli blokatorebis
dakavSirebuli. Tumca, am mosazrebis Sesamowmeblad efeqti mniSvnilovnad ar aRemateba placebos efeqts
kontrolirebadi kvleva ar yofila Catarebuli. (Turner et al., 1994).
socialuri fobiis mkurnaloba ganxilulia Semdeg
medikamenturi mkurnaloba wyaroSi: Veale (2003).
arCevani, pirvel rigSi, serotoninis ukumitacebis
seleqciur inhibitorebze keTdeba. kontrolirebadma
marTva
kvlevebma aCvena, rom fluvoqsamini (van Vliet et al., ra unda icodes pacientma. pacientebs unda esmodeT,
1994), paroqsetini (Stein et al., 1998b) da sertrali- rom miuxedavad konstituciuri faqtorebis moq-
ni (Katzelnick et al., 1995) efeqturia socialuri fo- medebisa, socialuri SfoTvis xarisxi da simZime um-
biis samkurnalod. fluoqsetinic SeiZleba efeqtu- Tavresad gamowveulia SfoTvis aRmZvrel situaciebSi
ri gamodges (Davidson et al., 2004). nebismieri zemoT maT mier aTvisebuli araadapturi azrovnebisa da qce-
CamoTvlili medikamentis ZalaSi Sesvlas SeiZleba 6 vis stiliT. amgvari paternebis Secvla SesaZlebelia
kvira dasWirdes. medikamenturi mkurnaloba, Cveu- fsiqologiuri da medikamenturi mkurnalobis meS-
lebriv, cxra Tvidan erT wlamde grZeldeba, radgan veobiT. garda amisa, Semdgomi daxmarebis miRebamde,
mkurnalobis naadrevad Sewyvetis SemTxvevaSi pacien- pacienti SegviZlia uzrunvelvyoT TviTdaxmarebis
tebis daaxloebiT naxevars recidivi aReniSneba (mag., wignebiT (mag., Butler, 1999), romlebic maT miawodebs
Haug et al., 2003). medikamentebis dozis Semcireba Tan- saWiro informacias da daexmareba martivi kognitur-
daTanobiT unda moxdes. bihevioruli midgomebis gamoyenebaSi.
monoamin oqsidazas inhibitorebi. socialuri fo- mkurnalobis SerCeva. medikamentur da fsiqolo-
biis mkurnalobisas, placebosTan (Liebowitz et al., giur mkurnalobas Soris arCevanis gakeTebaSi pa-
1988) da atenololTan (Liebowitz et al., 1992) SedarebiT cientmac unda miiRos monawileoba. amisaTvis pa-
ufro efeqturi gamodga fenelzini. pacients, aseve, cients unda mivawodoT informacia medikamentebis
SeiZleba daeniSnos moklobemidi (monoamin oqsidazas gverdiTi efeqtebisa da ramdenime Tvis ganmav-
Seqcevadi inhibitori), magram miRebuli Sedegebi sak- lobaSi maTi miRebis saWiroebis Sesaxeb. aseve, unda
maod gansxvavebulia. mwarmoeblebis mier dafinanse- avuxnaT, rom fsiqologiuri mkurnaloba seanse-
buli gamokvlevis mixedviT, pacientebis 47%-s am pre- bze regularul daswrebasa da aqtiur CarTulobas
paratiT mkurnalobisas mniSvnelovani gaumjobeseba moiTxovs. bevr samedicino servisebSi fsiqologiuri
aReniSneba (International Multicenter Clinical Trial Group on mkurnalobis Casatareblad pacients SeiZleba didi
Moclobemide in Social Phobia, 1997); meore, mciremasSta- xnis lodini dasWirdes, maSin, roca medikamenturi
biani gamokvlevis mixedviT, aseTi mkurnaloba mx- mkunalobis Catareba dauyovnebliv aris SesaZlebe-
olod 17, 5%-Tanaa efeqturi (Schneier et al., 1998). Tu li.
serotoninis ukumitacebis seleqciuri inhibitore- medikamentis SerCeva. benzodiazepinebi SegviZlia
biT uSedego mkurnalobis Semdeg monoamin oqsida- gamoviyenoTY simptomebis xanmokle vadiT Sesamsub-
zas inhibitorebs gamoviyenebT, unda gvaxsovdes, rom uqeblad manam, sanam sxva saxis mkurnaloba Sedegs
aucilebelia davicvaT minimum orkviriani intervali, gamoiRebdes. Tu socialuri fobiis mqone pacienti
xolo fluoqsetinis gamoyenebisas _ xuTkviriani in- fsiqoaqtiuri nivTierebebis momxmarebelicaa, ben-
tervali (gv. ??). zodiazepinebis gamoyeneba ar aris rekomendebuli.
benzodiazepinebi SegviZlia gamoviyenoT simptom- serotoninis ukumitacebis seleqciur inhibitorsa
ebis xanmokle vadiT Sesamsubuqeblad, magram pacien- da monoamin oqsidazas inhibitors Soris arCevanis
tisaTvis maTi didi xniT daniSvna, damokidebulebis gakeTebisas, Cveulebriv, upiratesoba serotoni-
ganviTarebis riskis gamo, ar aris rekomendebuli (gv. nis ukumitacebis seleqciur inhibitorebs eniWeba.
??). benzodiazepinebs, ZiriTadad, im mizniT niSnaven, fsiqologiuri mkurnalobis saxeebs Soris yvelaze
rom daexmaron pacients socialuri valdebulebebis ufro efeqturad kognitur-bihevioruli Terapia iT-
SesrulebaSi iqamde, sanam sxva tipis mkurnaloba vleba. fsiqodinamiuri mkurnaloba SeiZleba sasarge-
gamoiRebdes Sedegs. blo gamodges zogierTi pacientebisaTvis, magram misi
beta-adrenerguli blokatorebi. beta-andrener- gamoyeneba (kognitur-bihevioruli Terapiisagan gan-
gulma blokatorebma (mag., atenololma) SeiZleba sxvavebiT) ar emyareba klinikuri kvlevebis Sedegad
xanmokle vadiT daareguliron tremori da palpi- miRebul monacemebs.
_ 201 _
agorafobia mier maTi gazviadeba xdeba.
klinikuri maxasiaTeblebi
anticipatoruli SfoTva (molodinis SfoTva)
agorafobiis dros pacientebi ganicdian SfoTvas sax-
molodinis SfoTva gavrcelebul movlenas warmoad-
lisgan moSorebiT yofnisas, xalxmraval adgilas an
gens. mZime SemTxvevebSi, pirovnebas SfoTva ramdenime
iseT situaciaSi aRmoCenisas, romelsac Tavs iolad
saaTiT adre ewyeba, vidre igi misTvis safrTxis Sem-
ver daaRweven. isini Tavs arideben aseT viTarebebs da
cvel situaciaSi moxvdeba. es kidev ufro aZlierebs
maTi anticipaciisas SfoTva an sxva saxis simptomebi
pacientis distress da zogjer SeiZleba gvafiqrebi-
aReniSnebaT. agorafobiis maxasiaTebeli cal-calke
nos, rom SfoTvas ufro generalizebuli xasiaTi aqvs,
iqneba ganxiluli.
vidre fobikuri.
SfoTva
sxva simptomebi
fobikur situaciebSi agorafobiis mqone pacientebs
anticipatoruli SfoTvis dros pacientebs xSirad
sxva SfoTviTi aSlilobisTvis damaxasiaTebeli SfoT-
aReniSnebaT depresiuli simptomebi. aseTi simptom-
viTi simptomebi aReniSnebaT (ix. 9.1 cxrili), Tumca
ebi zogjer SfoTvisa da ganridebis gamo normaluri
ori maTgani gansakuTrebiT mniSvnelovania:
cxovrebis wesis SezRudviT aris gamowveuli, zog Sem-
1. panikis Setevebi, romlebic aRmocendeba spontanu-
TxvevaSi ki Tavad aSlilobis Semadgenel nawils war-
rad an rogorc reaqcia gare stimulebze.
moadgens (iseve, rogorc sxva SfoTviTi aSlilobebis
2. SfoTvis gamomwvevi kogniciebi gulis wasvlis an sa-
dros). am dros pacientebs SeiZleba mZime deperson-
kuTar Tavze kontrolis dakargvis Sesaxeb.
alizaciac aReniSnebodeT.
iseTi SemTxvevebi, rodesac pacients oTxi kviris
ganmavlobaSi oTxze meti panikis Seteva aReniSneba, debiuti da mimdinareoba
DSM-IV-Si klasificirebulia ara rogorc agorafo- agorafobias sxva fobikuri aSlilobebisagan ramde-
bia, aramed rogorc panikuri aSliloba agorafobiis nadme gansxvavebuli debiuti da mimdinareoba gaaCnia.
meoradi simptomebiT. aseTi klasifikaciis mizezebi debiutis asaki. umetes SemTxvevebSi agorafobia 20-
?? gverdzea ganxiluli. dan 25 wlamde asakSi iwyeba. aseve xSiria misi gamovle-
na 35 wlis asakSi. anu, is ufro gvian viTardeba vidre
situaciebi
martivi fobiebi (bavSvobaSi) an socialuri fobiebi
SfoTvisa da ganridebis reaqciis provocirebas mra- (umetesad mozardobis periodSi).
vali situacia iwvevs. erTi SexedviT maT cota ram ra viTarebaSi iCens Tavs agorafobia. pirveli epizo-
aqvT saerTo, magram realurad isini sami ZiriTadi di, Cveulebriv, Tavs iCens maSin, rodesac pirovneba
Temis garSemo erTiandeba: saxlisagan moSorebiT yof- (umetes SemTxvevaSi qali, ix. qvemoT) sazogadoebriv
na, xalxmravali adgilebi da adgilebi, sadac gadaadg- transports elodeba an xalxmraval savaWro centrSi
ileba SezRudulia. aseT situaciebs ganekuTvneba sayidlebze imyofeba. uecrad, misTvis gaurkveveli
sazogadoebrivi transporti, matareblebi, maRaz- mizezis gamo, mas Zlieri SfoTva ewyeba, rasac gulis
iebi, supermarketebi da, aseve, adgilebi, romelTa wasvlis SegrZneba da gaxSirebuli guliscema axlavs
swrafad datoveba sxvaTa yuradRebis miqcevis gareSe, Tan. is maSinve tovebs am adgils da saxlSi an saavad-
SeuZlebelia (mag., savarZeli saparikmaxeroSi an Sua myofoSi midis, sadac swrafadve gamodis mdgomareo-
adgili sakoncerto darbazSi). radganac pacientis bidan. garkveuli drois Semdeg, igive an msgavs viTa-
mdgomareoba TandaTanobiT uaresdeba, is sul ufro rebaSi aRmoCenisas, mas isev ewyeba SfoTva da kvlav
da ufro met situaciebs aridebs Tavs da sabolood, gaqceviT Svelis Tavs. miuxedavad amisa, zogierTi
mZime SemTxvevebis dros, met-naklebad mijaWvuli pacienti sakuTari mdgomareobis aRwerisas ar afiq-
xdeba sakuTar saxlze (aseT mdgomareobas zogjer sirebs im faqts, rom SfoTva panikis auxsneli Sete-
`diasaxlisis saxlze mijaWvulobis sindroms~ uwode- viT daewyo. iseTi Zlieri stresis dadgena, romelsac
ben). am paternis sxvadasxva variaciebi, Cveulebriv, uSualod SeuZlia pirveli panikuri Setevis gamowveva,
ganpirobebulia iseTi faqtorebiT, romlebsac, iSviaTad aris SesaZlebeli, Tumca zogierT pacients
garkveuli droiT, simptomebis Sesusteba SeuZliaT. mizezad seriozuli problemebi mohyavs (mag., Svilis
mag., pacientebis umravlesoba naklebad SfoTavs, avadmyofobaze nerviuloba). aris SemTxvevebi, rode-
rodesac iseT adamianTan erTad imyofeba, romelsac sac pacientebs simptomebi somaturi daavadebebis an
endoba, xolo zogierTisaTvis SfoTvis Sesasuste- mSobiarobis Semdeg maleve uvlindebaT.
blad bavSvTan an Sinaur cxovelTan (mag., ZaRlTan) Semdgomi mimdinareoba. pirveli epizodis Semdeg
erTad yofnac ki sakmarisia. SfoTvis intensivobis SfoTva da ganrideba kvirebisa da Tveebis manZilze
amgvarma cvalebadobam SeiZleba SecdomiT gvafiqre- meordeba. panikis Setevebi sul ufro met viTarebaSi
binos, rom Zlieri simptomebis arsebobisas pacientis
_ 202 _
iCens Tavs da, TandaTanobiT, pirovnebas ganridebis
Cveva uyalibdeba.
cxrili 9.5 ICD-10-is (agorafobia) da DSM-
IV-is (agorafobia panikis Setevebis gareSe)
ojaxze zegavlena. mdgomareobis progresirebasTan
diagnostikuri kriteriumebi (Semoklebuli
erTad, agorafobiis mqone pacienti sul ufro da
versia)
ufro damokidebuli xdeba meuRleze an ojaxis sxva
ICD-10 DSM-IV
wevrebze, radgan isini exmarebian mas im saqmianobis
SesrulebaSi, romelic pacientSi SfoTvas iwvevs (mag., pacients aReniSneba pirovneba ganicdis
wayvnen maRaziaSi sayidlebze). moTxovnebi, romleb- mkveTrad gamoxatuli, SfoTvas iseT situaciebSi
permanentuli SiSi an aRmoCenisas, saidan
sac pacienti amis gamo meuRles uyenebs xSirad maT ganridebis reaqcia minimum gaqceva an panikis Setevis
Soris davasa da kamaTs iwvevs, Tumca agorafobiis ori saxis situaciaSi. SemTxvevaSi daxmarebis
amgvar situaciebs miReba Zneli iqneba.
mqone pirebis SemTxvevaSi seriozuli col-qmruli
ganekuTvneba xalxmravali magaliTad: saxls gareT,
problemebi ar aris ufro xSiri, vidre igive social- da sazogadoebrvi xalxmraval adgilebSi,
uri wris sxva warmomadgenlebSi (Buglass et al., 1977). adgilebi, saxlidan mogzaurobis dros an
moSorebiT yofna an marto xidze yofnisas
diagnostikuri kriteriumebi mogzauroba
agorafobiis mqone pacientebis umravlesobas aReniS- pirovneba ganicdis pirovneba aseT

mniSvnelovan distress, situaciebSi aRmoCenisas
neba panikis Setevebi, romlebsac SeiZleba situaci- romelic gamowveulia ganicdis distress an Tavs
uri an spontanuri xasiaTi hqondeT. aseTi pacien- ganridebiT an SfoTviT. aridebs maT
tebis umravlesoba akmayofilebs rogorc agorafo- am dros SfoTva
gadaWarbebuli an
biis, ise panikuri aSlilobis kriteriumebs. ICD-10- usafuZvloa
is mixedviT, mdgomareobebi, romelTa drosac orive
saSiSroebis Semcvel pacientebi ar
jgufis kriteriumebia wamodgenili, diagnostirdeba situciaSi pirovnebas akmayofileben panikuri
rogorc agorafobia, DSM-IV-Si ki aseTi mdgomareo- aReniSneba vegetatiuri aSlilobis kriteriumebs
bebi diagnostirebulia, rogorc panikuri aSliloba agznebis sul cota erTi
simptomi da damatebiT,
agorafobiasTan erTad. Sesabamisad, am klasifika- SfoTvis erT-erTi
ciaSi gamoyofilia calke kategoria _ agorafobia simptomi
panikis Setevebis gareSe. kidev erTi gansxvaveba imaSi simptomebi Tavs iCens an
mdgomareobs, rom ICD-10-is kriteriumebis mixedviT dominirebs mxolod iseT
gadamwyveti mniSveloba SfoTvis simptomebis arse- situaciebSi, romelic
aSinebs pacients; an aseTi
bobas eniWeba. (ix. cxrili 9.1). (DSM-IV-Si mocemuli situaciebis warmodgenisas
panikuri aSlilobis diagnostikuri kriteriumebi ??
simptomebi ar aris gamo simptomebi ar aixsneba ro
gverdzea ganxiluli). wveuli sxva aSlilobiT an melime sxva aSlilobiT
pacientis kulturisaTvis
diferencialuri diagnozi damaxasiaTebeli rwmenebiT
socialuri fobia * Sedarebis gasaioleblad ICD-10-sa da DSM-IV-is krite-

riumebi Semoklebuli da perefrazirebulia, xolo zogi-
agorafobiis mqone zogierTi pacienti, socialur
erTi punqtebis Tanmimdevroba _ Secvlili.
situaciebSi moxvedrisas SfoTvas ganicdis, xolo
socialuri fobiis mqone zogierTi pacienti Tavs panikuri aSliloba
aridebs xalxiT gadaWedil sazogadoebriv trans- agorafobiis dros pacientebs xSirad panikis Setevebi
ports an maRaziebs, sadac iseTi gancda uCndebaT, aReniSnebaT. am or aSlilobas Soris arsebuli gansx-
rom adamianebi kritikuli TvaliT uyureben maT. vavebebis Sesaxeb zemoT ukve gvqonda saubari.
swori diagnozis dasadgenad saWiroa ganridebis am-
Jamad arsebuli paternisa da orive aSlilobisaTvis depresiuli aSliloba
damaxasiaTebeli simptomebis ganviTarebis dinamikis depresiuli aSlilobis dros SeiZleba Tavi iCinos
detaluri Seswavla. agorafobiis simptomebma, xolo agorafobiis mqone
pacientebs xSirad depresiuli simptomebi aReniSne-
generalizebuli SfoTviTi aSliloba baT. imis dadgena, Tu rogori TanmimdevrobiT ganvi-
mZime agorafobiis dros SfoTva SeiZleba imdenad Tarda pacientTan simptomebi, swori diagnozis das-
bevr situaciaSi aRmocendes, rom Zneli gaxdes misi maSi dagvexmareba. xandaxan pacientebs depresiuli
gansxvaveba generalizebuli SfoTviTi aSlilobisa- aSliloba xangrZlivi agorafobiis fonze uviTarde-
gan. aseT dros aSlilobis ganviTarebis istoriis baT. mniSvnelovania davadginoT aseTi SemTxvevebi
Seswavla, Cveulebriv, swori diagnozis dasmaSi gvex- da pacients depresiuli aSlilobisaTvis Sesatyvisi
mareba. mkunaloba CavutaroT (ix. qvemoT).
_ 203 _
paranoiduli aSlilobebi vad imisa, rom fsiqoanalituri Teoria warsulSi

farTod iyo gavrcelebuli, igi ar aris empiriuli
xandaxan pacienti, romelsac paranoiduli bodva axa-
masaliT ganmtkicebuli.
siaTebs (aRmocendeba bodviTi aSlilobis dros an
Sizofreniis adreul stadiebze), Tavs aridebs saxli- gavrcelebisa da SenarCunebis Teoriebi
dan gasvlas da xalxmraval adgilebSi yofnas. aseT
daswavlis Teoriebi. SfoTvis aRmoceneba sul ufro
SemTxvevebSi swori diagnozis dasasmelad saWiroa pa-
met situaciaSi SeiZleba aixsnas ganpirobebiT, xolo
cientis fsiqikuri mdgomareobis Seswavla, rac Cveu-
SemdgomSi aseTi situaciebisaTvis Tavis arideba _
lebriv devnis an damokidebulebis bodviTi ideebis
ganridebis qcevis daswavliT. miuxedavad imisa, rom
gamovlenas uwyobs xels.
amgvari axsna damajereblad da logikurad gamoiy-
epidemiologia ureba, cxovelebTan daswavlis procesze dakvirvebiT
erT-erTi gamokvlevis mixedviT, romlis drosac DSM- am Teoriis mxardamWeri pirdapiri mtkicebulebebi ar
IIIR-is kriteriumebi gamoiyenes, agorafobiis (panikis iqna mopovebuli.
Setevebis gareSe) gavrcelebis procentuli maCvenebe- pirovnuli Tvisebebi. agorafobiis mqone pacientebs
li erTi wlis manZilze Seadgenda mamakacebTan 1.7%-s xSirad aRweren, rogorc sxvebze damokidebul ad-
da qalebTan 3.8%-s (Kessler et al., 1994), xolo mTeli aminebs, romlebic midrekilni arian Tavidan aicilon
cxovrebis manZilze _ daaxloebiT 6-10%-s (Weissman problemebi, nacvlad imisa, rom gaumklavdnen maT. sx-
and Merikangas, 1986). vebze damokidebuleba SeiZleba gamowveuli iyos bavS-
vobaSi ufrosebis mxridan gadametebuli mzrunvelo-
etiologia biT, romlis Sesaxebac isini ufro xSirad saubroben,
agorafobiis etiologiurma Teoriebma unda agvixsnan, vidre sakontrolo jgufis wevrebi. Tumca, am retro-
Tu ratom iCina Tavi SfoTvis Tavdapirvelma Sete- speqtuli Setyobinebebis miuxedavad, ar aris naTeli,
vebma da ratom xdeba maTi gavrceleba da gameoreba. iyvnen Tu ara es adamianebi sxvebze damokidebulni
orive es problema rig-rigobiT iqneba ganxiluli. agorafobiis ganviTarebamde.
ojaxis gavlena. agorafobiis SenarCunebas SeiZleba
debiutis Teoriebi xels uwyobdes ojaxuri problemebi, Tumca, erT-
agorafobia, iseve rogorc panikuri Seteva, Cveu- erTi kargad kontrolirebadi gamokvlevis (Buglass
lebriv (magram ara yovelTvis) sazogadoebriv adgi- et al., 1997) mixedviT, agorafobiis mqone pacientebs
lebSi SfoTvis aRmocenebiT iwyeba. inicialuri ara aqvT ufro meti ojaxuri problema, vidre sa-
SfoTvis aRmoceneba samgvarad aixsneba: kontrolo jgufis warmomadgenlebs. klinikuri da-
1. kognituri hipoTezis Tanaxmad SfoTva maSin vi- kvirvebis Sedegebi saSualebas gvaZlevs vivaraudoT,
Tardeba, rodesac pirovnebas usafuZvlod eSinia rom zogjer simptomebi SeiZleba SenarCundes pacien-
situaciis zogierTi aspeqtis an garkveuli somaturi tis mimarT ojaxis gadametebuli mzrunvelobis gamo.
simptomebis, romlebic am situaciaSi uCndeba (ix. ?? Tumca, ojaxis wevrebis mxridan pacientisadmi aseTi
gverdze qveTavi panikuri aSlilobis Sesaxeb). miuxe- damokidebuleba yovelTvis ar fiqsirdeba.
davad imisa, rom usafuZvlo SiSi agorafobiis diag-
prognozi
nozis mqone adamianebisaTvis aris damaxasiaTebeli,
zogadi samedicino praqtika gviCvenebs, rom zogjer
daudgenelia, hqondaT Tu ara maT amgvari SiSebi ad-
agorafobia maleve ikurneba, Tumca, Tu is erTi wlis
rec, iqamde, sanam aSliloba ganuviTardebodaT.
manZilze SenarCunda, Cveulebriv, Semdegi xuTi wlis
2. biologiuri Teoriis Tanaxmad inicialuri SfoTvis
manZilzec ganagrZobs arsebobas (Marks, 1969). qroni-
Seteva gamowveulia moulodneli gare stimulebiT,
kuli agorafobiis dros xSiria depresiis epizodebi.
romelebic zemoqmedebs gadametebuli SfoTviTi
klinikuri gamocdileba gveubneba, rom adamianebi eq-
reaqciis mimarT konstituciuri predispoziciis
ims daxmarebisaTvis yvelaze ufro xSirad swored am
mqone adamianze. arsebobs mtkicebulebebi, romelTa
epizodebis dros mimarTaven.
mixedviTac aseTi predispozicia genetikur kompo-
nents Seicavs. mkurnaloba
3. fsiqoanalitikuri Teoriis Tanaxmad inicialuri fsiqologiuri mkurnaloba
SfoTva gamowveulia aracnobieri fsiqikuri kon-
eqspoziciuri Terapia erT-erTi pirveli bihevior-
fliqtebiT, romlebic pirovnebisaTvis miuRebel
uli meTodia, romelic agorafobiis samkurnalod
seqsualur an agresiul impulsebTan aris dakav-
gamoiyenes. aRmoCnda, rom eqspoziciuri mkurnaloba
Sirebuli. aseTi impulsebis aRmocenebas arapirda-
ufro efeqturia, rodesac misi gamoyeneba SfoTvis
piri gziT biZgs aZlevs sawyisi situacia. miuxeda-
marTvasTan erTad xdeba (gv. ??; aseve Cohen et al., 1984).
_ 204 _
aseTi mkurnalobis dros prognozi ukeTesia im ada- miRebuli xanmokle efeqti TiTqmis orjer ufro sus-
mianebTan, romlebsac mkurnalobis dawyebamde kargi tia eqspoziciur mkurnalobasTan SedarebiT; recidi-
col-qmruli urTerToba hqondaT (Monteiro et al., 1985) vis SemTxvevebic ufro xSiria. Tumca, am gamokvlevis
vidre imaTTan, vinc cxovrebiseul stress qroniku- dros gamoyenebuli meTodologia mogvianebiT iqna
lad ganicdis (Wade et al., 1993). gakritikebuli.
kognitur-bihevioruli mkurnaloba panikuri aSli- antidepresantebi. agorafobiis dros antidepre-
lobisa da agorofobiis dros ?? gverdzea aRweriali. santebi misi Tanmxlebi depresiuli aSlilobis sam-
klinikuri kvlevebis Sedegad (ganxilulia ?? gverdze, kurnalod gamoiyeneba. isini, aseve, im pacientebTanaa
qveTavSi panikuri aSlilobis Sesaxeb) dadginda, rom efeqturi, romlebsac depresia ar aReniSnebaT, ma-
moklevadiani mkurnalobisas kognituri Terapia daax- gram panikis xSiri Setevebi axasiaTebT. yvelaze ufro
loebiT iseTive efeqturia, rogorc medikamenturi detalurad imipraminis zemoqmedebaa Seswavlili.
mkurnaloba, xolo grZelvadiani mkuranlobisas _ dadginda, rom klomipramins igive efeqtebi axasi-
ufro efeqturi. aTebs (Gentil et al., 1993). aRsaniSnavia, rom imipraminiT
mkurnalobis Sewyvetisas xSiria recidivis SemTxveebi.
medikamenturi mkurnaloba antidepresantebiT agorafobiis mkurnalobis reJimi
agorafobiis dros iseTive medikamentur mkurnalo- igivea, rac panikuri aSlilobis dros (gv. ??).
bas iyeneben, rasac panikuri aSlilobisas (gv. ??). serotoninis ukumitacebis seleqciuri inhibitore-
gansxvaveba imaSi mdgomareobs, rom agorafobiis bi. panikuri aSlilobis (rogorc agorafobiasTan
dros medikamentur mkurnalobasTan erTad pacienti erTad, aseve mis gareSe) mkurnalobisas efeqturia
ganmeorebiT SeyavT situaciebSi, romlebic misTvis serotoninis ukumitacebis zogierTi seleqciuri in-
saSiSroebis Semcvelia, ris gamoc is Tavs aridebs hibitoris gamoyeneba (gv. ??). erT-erTi meta-analizis
maT. aseTma eqspoziciam SeiZleba garkveuli Tval- Sedegad aRmoCnda, rom panikuri aSlilobisas ufro
saCino cvlilebebi gamoiwvios. radgan medikamenturi mizanSewonilia am preparatebiT mkurnaloba, vidre
mkurnalobis efeqturobis Semswavleli gamokvlevebis imipraminis an alprazolamis gamoyeneba (Boyer, 1995).
umravlesoba orive aSlilobis mqone pacientebze monoamin oqsidazas inhibitorebi ganekuTvneba im
erTdrouladaa Catarebuli, rTulia erTmaneTisa- preparatebs, romlebsac, Tavdapirvelad, agorafobi-
gan gavmijnoT pacientis reaqciebi am ori aSlilobis is medikamenturi mkurnalobisas mimarTavdnen. dRes,
mkurnalobaze. amitom mizanSewonilia, rom Semdgomi zogierT medikamentTan da sakvebTan reaqciaSi Sesv-
qveTavebis wakiTxvisas panikuri aSlilobis medikamen- lis gamo, maT ufro iSviaTad iyeneben (gv. ??). garda
tur mkurnalobasac gavecnoT (gv. ??). amisa, mravali Tvis manZilze mkurnalobis Semdegac
anqsiolizuri preparatebi SegviZlia gamoviyenoT ki, am preparatebis Sewyveta pacientTan xSirad re-
mxolod konkretuli, moklevadiani miznisaTvis _ cidivs iwvevs.
mag., imisTvis, rom davexmaroT pacients Tavi gaarTvas
misTvis mniSvnelovan valdebulebebs manam, sanam sxva marTva
saxis mkurnaloba Sedegs gamoiRebdes. anqsiolizuri ra unda icodes pacientma. agorafobiis mqone pacien-
saSulebebis daniSvna sam kviraze uforo xangrZlivi tebsa da maT axloblebs xSirad uWirT am daavadebis
vadiT ar aris rekomendebuli, radgan aman SeiZleba bunebis gageba. isini SeiZleba fiqrobdnen, rom ago-
damokidebuleba gamoiwvios (gv. ??). zogierT qveya- rafobia normaluri SfoTvis daZlevis arasakmarisi
naSi agorafobiis samkurnalod, romlis drosac xSi- motivaciiT aris gamowveuli. am dros, umjobesia
ria panikuri Setevebi (DSM-IV-is mixedviT _ panikuri maT informacia or etapad mivawodoT. pirvel rigSi,
aSliloba agorafobiasTan erTad) Zlieri moqmedebis unda avuxsnaT panikis Setevebis buneba. panikis Seteva
benzodiazepinsa da alprazolams iyeneben. Tumca, SeiZleba SevadaroT mcdar gangaSs iseT SemTxevebSi,
britaneTSi amgvari praqtika iSviaTia. anqsiolizuri rodesac dacviTi sistema zedmetad mgrZnobiarea. imis
saSualebebiT mkurnaloba aRwerilia mogvianebiT, mixedviT, Tu rogoria pacientis avadmyofobis isto-
panikuri aSlilobis ganxilvisas (gv. ??). alprazola- ria, gadaWarbebuli mgrZnobeloba SeiZleba aixsnas an
mis efeqturobis dasadgeni klinikuri cdebis umrav- fsiqologiuri konstituciiT an qronikuli stresiT,
lesoba Catarebul iqna rogorc panikuri aSlilobis, xolo garkveuli situaciebisaTvis Tavis arideba
ise agorafobiis (kerZod, agorafobiis panikasTan _ ganpirobebiT (am dros mag., SegviZlia moviyvanoT
erTad) mqone pacientebTan. gamonakliss warmoad- iseTi persistentuli SfoTva, romelic adamians ve-
gens marqsisa da misi kolegebis (Marks et al., 1993a, losipedidan gadmovardnis an avtokatastrofaSi mox-
b) klinikuri gamokvleva, romelic mxolod agorafo- vedris Semdeg uviTardeba). pacientis meuRles, mego-
biis mqone pacientebze Catarda. am gamokvlevis Sede- brebsa da naTesavebs, Cveulebriv, kargad esmiT, Tu
gad dadginda, rom alprazolamiT mkurnalobis dros raSi mdgomareobs bihevioruli Terapiis principebi,
_ 205 _
magram isini SeiZleba uaryofiTad iyvnen ganwyobilni moxdes alprazolamis dozis Semcireba.
medikamenturi mkurnalobis mimarT. amitom, pacien- medikamenturi mkurnalobis Semdgomi recidi-
tisaTvis SfoTvis sawinaaRmdegoT antidepresantebis vis SemTxvevaSi, pacientebs SegviZlia bihevioruli
daniSvnam, SesaZlebelia, maTSi gakvirveba da dabneu- mkunaloba SevTavazoT, Tumca kontrolirebadi kv-
loba gamoiwvios. pacientebs unda avuxsnaT, rom me- leva konkretulad aseT pacientebze ar Catarebula.
dikamenturi mkurnaloba `dacviTi sistemis~ sensiti- mkurnalobis Semdeg pacientebis umravlesoba ukeT
urobis dasaqveiTeblad aris saWiro da rom zogierTi grZnobs Tavs, magram mxolod mcire nawilTan xdeba
antidepresanti swored amas emsaxureba. simptomebisagan sabolood gaTavisufleba. agorafo-
garda amisa, pacientebma unda icodnen, rom medika- biis dros xSiria recidivebi, amitom rekomendebulia,
menturi mkurnaloba mxolod maSin iqneba efeqturi, rom pacientebma daxmarebisaTvis eqims adreul sta-
Tu isini gamudmebiT da daJinebiT ecdebian maTTvis diaze mimarTon.
saSiSroebis Semcveli situaciebisaTvis Tavis aridebis
tendenciis daZlevas. Terapevtma unda auxsnas pacien- panikuri aSliloba
tebs, Tu ra gziT SeiZleba amis miRweva da yuradReba
miuxedavad imisa, rom panikuri aSlilobis diagnozi
gaamaxvilos imaze, rom rezultati maT Zalisxmevazea
pirvelad gaCnda 1980 wels, rodesac is erT-erTi diag-
damokidebuli. TviTdaxmarebis wignebi (ix. qveviT)
nostikuri kategoriis saxiT DSM-IIIR klasifikaciaSi
aseve sasargebloa agorafobiisa da sakuTari TavisaT-
Seitanes, ukve asze meti welia, rac mecnierebi msgavs
vis daxmarebis gawevis Sesaxeb informaciis mosapove-
SemTxvevebs sxvadasxva saxeliT aRweren. am aSlilobis
blad. Tu es SesaZlebelia, sasurvelia, rom qveyanaSi
ZiriTad niSan-Tvisebas panikis Setevebi waroadgens,
arc Tu ise didi xnis win Camosul emigrantebs (rom-
anu SfoTvis uecari Setevebi, romlis drosac domini-
lebsac cudaT esmiT inglisuri ena) sainfonrmacio
rebs somaturi simptomebi. somatur simptomebs Tan ax-
bukletebi maTTvis gasageb enaze mivawodoT.
lavs janmrTelobis seriozuli garTulebis SiSi (mag.,
bihevioruli marTva. avadmyofobis adreul sta-
gulis Setevis SiSi). warsulSi aseT simptomebs kar-
diaze pacientebi yovelmxir unda wavaxalisoT, raTa
dionevrozs, da kosta~s sindroms (Da Costa~s syndrome),
isini Sevidnen situaciebSi, romlebsac SiSis gamo
neirocirkularul asTenias, gulis funqcionirebis
gaurbian. rodesac aSliloba myarad aris Camoyalibe-
darRvevas an gadaRlis sindroms uwodebdnen. aqedan
buli, mkurnalobisas upiratesobas aniWeben bihevior-
gamomdinare iTvleboda, rom pacineti sworia, rodesac
uli Terapiis eqspoziciur formas (pacientze fobiis
gulis funqcionirebis darRvevis eSinia. mogvianebiT,
gamomwvevi situaciebiT zemoqmedeba) kognitur Tera-
zogierTma avtorma gamoTqva mosazreba, rom pacien-
piasTan (panikis Setevebis daZleva) erTad (gv. ??). Tu
tebis mdgomareoba SeiZleba fsiqologiuri mizezebiT
kognituri Terapiis Catareba mocemul momentSi ar
yofiliyo gamowveuli. Tumca, mxolod meore msoflio
aris SesaZlebeli, pacients utardeba eqspoziciuri
omis dros (rodesac panikis Setevebis mimarT interesi
mkurnaloba, romelic klinicistis zedamxedvelobis
kvlav ganaxlda) vudma (Wood, 1941) daasabuTa, rom ase-
qveS unda mimdinareobdes. gamocemulia ramdenime
Ti mdgomareoba SfoTviTi aSlilobis erT-erT for-
TviTdaxmarebis saxelmZRvanelo, romlebic Terape-
mas warmoadgens. mas Semdeg, 1980 wlamde, panikis Sete-
vtebs amgvari zedamxedvelobis gawevaSi daexmareba
vebis mqone pacientebs generalizebuli an fobikuri
(mag., Andrews et al., 1994).
aSlilobis diagnozs usvamdnen. 1980 wels DSM-IIIR-is
medikamenturi mkurnaloba, pirvel rigSi, iseT pa-
avtorebma Semoitanes axali diangonstikuri katego-
cientebs unda SevTavazoT, romlebsac xSiri da/an
ria _ panikuri aSliloba. panikuri aSlilobis kate-
Zlieri panikis Setevebi axasiaTebT. Tumca, amis para-
gorias miakuTvnebdnen iseT pacientebs, romlebTanac
lelurad, aucilebelia pacienti ganmeorebiT movax-
panikis Setevebi generalizebul SfoTvasTan erTad an
vedroT iseT situaciebSi, romlebic winaT misTvis
mis gareSe iCenda Tavs. pacientebi, romlebsac panikis
saSiSroebis Semcveli iyo, ris gamo is gaurboda maT.
Setevebi agorafobiis fonze uviTardebodaT, am kat-
britaneTSi medikamenturi mkurnalobisas Cveulebriv
egoriSi ar Sediodnen. DSM-IV-is mixedviT, pacientebi,
antidepresantebs _ umetesad imipraminis an sero-
romlebsac xSirad aqvT panikis Setevebi (imisda miuxe-
toninis ukumitacebis seleqciur inhibitorebs _ iy-
davad, aqvT Tu ara agorafobia) panikuri aSlilobis
eneben. zogierT qveyanaSi upiratesobas alprazolams
kategoriaSi erTiandebian. (agorafobia panikis Sete-
aniWeben. medikamenturi mkurnalobis xangrZlivoba
vebis gareSe calke aris gamoyofili _ ix. gv. ??). pani-
zustad ar aris gansazRvruli, magram, depresiuli
kuri aSlilobis kategoria ICD-10-Sic aris mocemuli,
aSlilobis msgavsad, am SemTxvevaSic pacientebs an-
magram DSM-IV-isgan gansxvavebiT panikuri aSlilobis
tidepresantebi xSirad cxra Tvidan erT wlamde
diagnostireba ar xdeba iseT pacientebTan, romlebsac
eniSnebaT. nebismieri medikamenturi mkurnaloba Tan-
panikis SetevebTan erTad agorafobiac aReniSnebaT.
daTanobiT unda Sewydes. gansakuTrebiT nela unda
_ 206 _
panikuri aSliloba
cxrili 9.6 hiperventilaciiT gamowveuli cxrili 9.7 panikis Setevis simptomebi (DSM-IV)
simptomebi qoSini, romelsac Tans sdevs sunTqvis ukamrisobis
Tavbrusxveva usiamovno SegrZneba
yurebSi xmauri gagudvis SegrZneba
gaxSirebuli guliscema
Tavis tkivili
diskomforti an tkivili gulmkerdis areSi
sisustis SegrZneba oflianoba
gulis wasvlis SegrZneba Tavbrusxveva an gulis wasvlis SegrZneba
mgrZnobelobis dakargva gulisrevis SegrZneba an abdominaluri diskomforti
depersonalizacia an derealizacia
saxis, xelebis da fexebis areSi Cxvletis SegrZneba
mgrZnobelobis dakargva an Cxvletis SegrZneba
karpopedaluri spazmebi (mtevnisa da terfis kunTebis SekumSva)
saxis uecari siwiTle an Semcivneba
prekordialuri diskomforti kankali
sunTqvis ukamrisobis SegrZneba sikvdilis SiSi
gagiJebis an arakontrolirebuli qmedebis ganxorcielebis SiSi
panikis Setevis simptomebi 9.7 cxrilSia mocemuli. kviris ganmavlobaSi panikis Seteva oTxze metjer me-
ar aris aucilebeli, rom pacients yvela simptomi ordeba an erT panikur Setevas oTxi kviris manZilze
erTdroulad aReniSnebodes. DSM-IV-is mixedviT, Tan sdevs misi ganmeorebis an garTulebis (mag., gulis
diagnozis dasasmelad sakmarisia minimum oTxi Setevis) persistentuli SiSi. ICD-10-s msgavsi kvlevi-
simptomis arseboba. panikis Setevebis mniSvnelovan Ti kriteriumebi gaaCnia, Tumca, arsebobs gansxvavebe-
damaxasiaTebel niSanTvisebas warmoadgens is, rom: bi im kriteriumebSi, romlebic Setevebis mimdinareo-
w SfoTva swrafad aRmocendeba bas exeba. kerZod, ICD-10-Si isini naklebad zustad
w simpomebi mZimea aris gansazRvruli: Setevebi periodulad unda me-
w pirovnebas aqvs katastrofuli Sedegebis SiSi ordebodes da ar unda iyos mudmivad dakavSirebuli
fobiis gamomwvev situaciasTan/obieqtTan, mkveTrad
zogierTi pacientisaTvis, sxva simptomebTan erTad
gamoxatul daZabulobasTan an sicocxlisaTvis saSiS
damaxasiaTebelia hiperventilaciac, romelic, Tavis
situaciebSi aRmoCenasTan.
mxriv, zemoqmedebs sxva simptomebze.
hiperventilacia aris xSiri da zedapiruli sunTq-
va, romelsac sisxlSi narxSirorJangis koncentraciis
daqveiTeba mosdevs. hipokapniam, Tavis mxriv, SeiZle- panikis Setevebs adgili aqvs generalizebuli SfoT-
ba 9.6 crilSi CamoTvlili simptomebi gamoiwvios. viTi aSlilobis, SfoTviT-fobikuri aSlilobis (gana-
cxrilSi moyvanili ukanaskneli simptomi _ sunTqvis sakuTrebiT agorafobiis), depresiuli aSlilobis da
ukmarisobis SegrZneba _ paradoqsuli xasiaTisaa, mZime organuli darRvevebis dros. DSM-IV-Si mocemu-
radgan pirovneba am dros zedmetad xSirad sunTqavs. lia ori kriteriumi, romelic dagvexmareba ganvasx-
es simptomi mniSvnelovania, radgan aseTi SegrZneba vavoT amgvari meoradi Setevebi panikuri aSlilobebi-
sunTqvis gaxSirebas iwvevs, rac auaresebs pacientis sagan: panikuri aSlilobis mqone pacientisaTvis dam-
mdgomareobas. yovelTvis unda gvaxsovdes, rom hi- axasiaTebelia mkveTrad gamoxatuli, persistentuli
perventilacia SeiZleba auxsneli fizikuri simptome- wuxili, romelic Setevis xelmeored ganmeorebasTan
bis mizezs warmoadgendes. misi dadgena, Cveulebriv, da SeteviT gamowveul SesaZlo SedegebTan aris daka-
xdeba pacientis sunTqvis paternze dakvirvebiT im vSirebuli.
dros, rodesac pacients es simptomebi aReniSneba. hi-
perventilaciaze eWvis gaCenis SemTxvevaSi, pacients epidemiologia
unda arteriuli sisxlis airebis analizi (ABG) Cau- DSM-IIIR-is kriteriumebis mixedviT Catarebuli epi-
tardes, Tumca, qronikuli SemTxvevebisas analizis demiologiuri gamokvlevebis Tanaxmad, erTi wlis
rezultatebi SeiZleba normaluri aRmoCndes. manZilze zogad populaciaSi panikuri aSlilobis
gavrcelebis sixSire 1000 adamianSi daaxloebiT 14
diagnostikuri kriteriumebi SemTxvevas (Narrow et al., 2002) Seadgens. am SemTxveveb-
DSM-IV-is mixedviT, panikuri aSlilobis diagnozis Si Sedis panikuri aSliloba agorafobiasTan erTad
dasma SesaZlebelia maSin, rodesac: (a) panikis Seteve- (zogad populaciaSi SemTxvevebis daaxloebiT naxeva-
bi moulodnelad iwyeba (mag., ar warmoadgens reaqcias ri swored amgvar aSlilobas ganekuTvneba). umetesi
identificirebul fobikur stimulebze); (b) oTxi gamokvlevebis mixedviT qalebSi panikuri aSliloba
TiTqmis orjer ufro xSiria, vidre mamakacebSi. ro-
_ 207 _
gorc zemoT ukve aRvniSneT, diagnostikuri krite- kis Setevebi SeiZleba 5-HT-s an benzodiazepinis
riumebi iTvaliswinebs panikis Setevebis sixSirisa receptorebis funqcionirebis darRveviTac iyos
da siZlieris zRurbls, Tumca, gamokvlevebma aCvena, gamowveuli. ukanaskneli mosazrebis sasargeblod
rom panikis Setevebis raodenoba gamudmebiT cvaleba- metyvelebs Tavis tvinis funqciuri neirovizual-
dobs. amis gamo Catarda gamokvlevebi iseT paciente- uri meTodebiT Catarebuli gamokvlevebis Sedegebi,
bze, romelTa panikuri Setevebic, Tavisi sixSirisa da romlebmac aCvena, rom panikuri aSlilobis mqone
simZimis mixedviT, ar akmayofilebda panikuri aSli- pacientebSi Semcirebulia benzodiazepinuri recep-
lobis kriteriumebs. aRmoCnda, rom aseTi panikuri torebis SeerTebis ubnebi (Malizia et al., 1998).
Setevebis gavrcelebis sixSire eqvsi Tvis manZilze w panikuri Setevebis reduqcia. panikis Setevebis Sem-
1000 adamianSi daaxloebiT 30 SemTxvevas (Von Kofrr et cirebas iwvevs imipramini (zemoqmedebs 5-HT-isa da
al., 1985) Seadgenda, xolo mTeli cxovrebis manZilze noradrenergul sistemebze), klomipramini da flu-
_ 1000 adamianSi 56 SemTxvevas (Katernbahl, 1993). voqsamini (ZiriTadad, zemoqmedeben 5-HT-is trans-
misiaze), magram ara maproTilini, romelic seleqci-
etiologia uri noradrenerguli ukumitacebis blokators war-
genetika moadgens (Den Boer and Westerberg, 1988). klomipramini,
panikuri aSliloba xSirad gvxvdeba pacientis ojaxis rogorc panikis sawinaaRmdego saSualeba, savarau-
sxva wevrebTanac (mag., Mendelwicz et al., 1993). misi six- dod, ufro efeqturia, vidre imipramini. es SeiZleba
Sire monozigotur tyupebSi ufro maRalia dizigo- imiT iyos gamowveuli, rom imipramini 5-HT-is ukumi-
tur tyupebTan SedarebiT, rac imaze miuTiTebs, rom tacebis SedarebiT ufro susti blokatoria.
aSlilobis ojaxuri agregacia nawilobriv mainc ge- panikuri aSlilobis etiologiasTan dakavSirebuli
netikuri faqtorebiT aris ganpirobebuli (Skre et biologiuri Teoriebi ganxilulia Semdeg wyaroSi:
al., 1993), sadac memkvidreobiToba 30-40%-s Seadgens Ballenger, 2000.
(Kendler et al., 1993e). am sakiTxTan dakavSirebiT mrav- kognituri hipoTeza dafuZnebulia dakvirvebis
alricvxovani gamokvleva Catarda genebis SeWidulo- Sedegad miRebul monacemebze, romelTa mixedvidac
baze. am gamokvlevebiT dadginda, rom qromosomebis seriozuli somaturi da fsiqikuri daavadebebis SiSi
SeWiduloba 7, 9q da 13q Seadgens. Tumca, sarwmuno ufro xSiria panikis Setevebis mqone pacientebSi,
dadebiTi rezultatebi arc erTi gamokvlevis Sede- vidre SfoTviTi aSlilobis mqone iseT pacietebSi,
gad ar iqna miRebuli. romlebsac panikuri Setevebi ar aReniSnebaT. am hipo-
arsebobs ori ZiriTadi hipoTeza panikuri aSli- Tezis mixedviT panikuri aSlilobis dros SfoTva
lobis sxva gamomwvevi mizezebis Sesaxeb: bioqimiuri spiralurad viTardeba: SfoTvis somaturi simptom-
da kognituri. pirveli hipoTezis mixedviT panikuri ebi iwvevs avadmyofobis SiSs, rac, Tavis mxriv, kidev
aSliloba SeiZleba bioqimiuri darRvevebiT iyos ufro aZlierebs SfoTvas (Clark, 1986). amgvari monace-
gamowveuli, xolo meore hipoTezis mixedviT _ kogni- mebi saSualebas gvaZlevs vivaraudoT, rom kognituri
turi procesebis darRvevebiT. Terapia efeqturia panikuri aSlilobis mkurnalobi-
bioqimiuri hipoTeza ori rigis dakvirvebebs efuZ sas (ix. qveviT).
neba:
hiperventilacia, rogorc panikuri aSlilobis
w panikis Setevebis induqcia. qimiur agentebs panikis mizezi
Setevebis gamowveva ufro iolad SeuZlaT panikuri
arsebobs meoradi hipoTeza, romlis Tanaxmadac
aSlilobis mqone pacientebSi, vidre janmrTel ada-
panikuri aSliloba hiperventilaciiT aris gamowveu-
mianebSi (gansakuTrebiT natriumis laqtats [Pitts
li. eWvgareSea, rom Segnebul hiperventilacias (xSir
and McClure, 1967)] ioximbins [Charney et al., 1984],
sunTqvas) panikis Setevis gamowveva SeuZlia. Tumca,
flumazenils [benzodiazepinis receptorebis an-
ar aris dadgenili, rom uneblie hiperventilaciac
tagonisti], qolecistokinins da mCCP-s [5-HT re-
panikuri aSlilobis mizezs warmoadgens.
ceptorebis agonisti]). qimiuri agentebis simravle,
romelebsac aseT pacientebTan panikis Setevebis
provocireba SeuZliaT, arTulebs erTi zogadi
kauzaluri meqanizmis dadgenas. arsebobs mosazre- Cveulebriv, Semdgomi dakvirvebebi tardeba rogorc
ba, rom panikis Setevebi SeiZleba gamowveuli iyos im pacientebze, romlebsac erTdroulad panikis Sete-
anomaliebiT presinafsur adrenoreceptorebSi, vebi da agorafobia aReniSnebaT, ise mxolod panikuri
romlebic normaluri funqcionirebisas zRudaven aSlilobis mqone pacientebze. adreuli gamokvleve-
presinafsuri neironebis aqtivobas SfoTvis kon- biT, romlebic gadaRlis sindromis termins iyenebda,
trolTan dakavSirebul Tavis tvinis ubnebSi. pani- dadginda, rom pacientebis umravlesobas simptomebi
_ 208 _
panikuri aSliloba
20 wlis Semdegac aReniSneboda, Tumca, umetesobisaT- sneba simptomebi, doza SegviZlia maqsimum 175-225mg-
vis socialur situaciebSi yofna nakleb problematu- mde gavzardoT (yovel jerze 25mg-iT) imis gaTval-
ri gaxda (mag., Wheeler et al., 1950). garda amisa, panikuri iswinebiT, Tu rogoria pacientis fizikuri janmr-
aSlilobis diagnozis mqone pacientebze Catarebulma Telobis mdgomareoba. Tu arsebobs raime eWvi kar-
gamokvlevebma aCvena, rom avadmyofoba xangrZlivad, diologiuri problemebis Taobaze, imipraminis didi
SfoTvisa da depresiis monacvleobiT mimdinareobs doziT daniSvnamde, pacinets eleqtrokardiograma
(Roy-Byrne and Cowely, 1995). arabunebrivi mizezebiT unda gadavuRoT. maqsimaluri doziT mkurnalo-
gamowveuli sikvdilianobis sixSire, mamakacebSi karba 3-6 Tvis manZilze unda gagrZeldes. imipraminiT
diovaskuluri darRvevebiT gamowveuli sikvdiliano- mkurnalobis Sewyvetis Semdeg recidivis sixSire 30%-
bis CaTvliT, saSualoze maRalia (Coryell et al., 1982). s aRwevs (Zitrin et al., 1978), Tumca es maCvenebeli Sei-
Zleba Semcirdes, Tu dozis dakleba ufro nela, eqvs
mkurnaloba Tveze didxans gastans (Mavissakalian and Perel, 1992).
panikuri aSlilobisas, pacientebs mxardaWerisa da klomipramini. klomipramins imipraminis msgavsi
cxovrebiseuli problemebis gadawyvetaSi daxmarebis efeqti gaaCnia (Cassano et al., 1998).
garda, medikamenturi an kognituri Terapia sWird-
serotoninis ukumitacebis seleqciuri
ebaT. am dros SegviZlia sami saxis medikamenturi inhibitorebi
mkurnaloba gamoviyenoT.
panikuri aSlilobis mkurnalobisas efeqturia se-
benzodiazepinebi rotoninis ukumitacebis zogierTi seleqciuri in-
didi doziT miRebisas benzodiazepinebs panikis Sete- hibitoris gamoyeneba, romelsac, imipraminisagan gan-
vebis kontroli SeuZliaT, magram maT umravlesobas, sxvavebiT, kardialuri xasiaTis gverdiTi efeqtebi
aseTi doziT gamoyenebisas sedaciuri efeqti gaaCnia. ar gaaCnia. am preparatebs ganekuTvneba fluvoqsamini
gamonakliss warmoadgens alprazolami, romelic Zl- (Bakish et al., 1996), paroqsetini (Ochberg et al., 1995),
ieri moqmedebis preparats warmoadgens. amis gamo mas sertralini (ix. Ballenger, 2000) da fluoqsetini (Mi-
panikuri aSlilobis samkurnalod iyeneben. kontroli- chelson et al., 2001).
rebadma kvlevam aCvena, rom is ufro efeqturia place- kognituri Terapia
bosTan SedarebiT (ix. Ballenger, 2000). mkurnalobis bolo
kognituri Terapia asustebs SfoTvis somaturi
etapze, aRkveTis simptomebis Tavidan asacileblad,
efeqtebiT gamowveul SiSs. iTvleba, rom amgvari SiSi
alprazolamis dozis Semcireba Zalian nela da Tan-
panikis Setevebis provocirebas axdens da xels uwy-
daTanobiT unda xdebodes. maSinac ki, rodesac dozis
obs maT SenarCunebas. Cveulebriv, pacientebs eSini-
Semcireba 30 dRis manZilze mimdinareobs, pacientebis
aT, rom gaxSirebul guliscemas aucileblad gulis
erT mesameds mkveTrad gamoxatuli aRkveTis simptomebi
Seteva mohyveba, xolo Tavbrusxvevas _ cnobierebis
aReniSneba (Cross-National Collaborative Tanic Study, 1992). al-
dakargva. mkurnalobis procesSi hiperventilaciis an
prazolamiT mkurnaloba SeerTebul StatebSi daiwyes,
varjiSis meSveobiT xdeba iseTi fizikuri simptomebis
xolo britaneTSi am meTods naklebad iyenebdnen. dRes,
gamowveva, romlisac pacients eSinia. Terapevtma pa-
britaneTSi, panikuri aSlilobis benzodiazepinebiT
cientis yuradReba maTi aRmocenebis Tanmimdevroba-
mkurnaloba NHS-is mier (National Institute for Clinical Excel-
ze unda gaamaxvilos da auxsnas mas, rom panikis Sete-
lence, 2004a) ar aris rekomendebuli.
vis adreul etapzec SiSis gamowveva swored aseTi
imipramini da klomipramini TanmimdevrobiT xdeba. es procedura mogvianebiT, ??
imipramini iyo pirveli antidepresanti, romelic gverdzea aRwerili.
efeqturi aRmoCnda panikuri aSlilobis mkurnalo- kontrolirebadma gamokvlevebma aCvena, rom pani-
bisas (Klein, 1964). xSirad am preparatis pirvelad kuri aSlilobis dros kognituri Terapia minimum
miRebisas pacients uZiloba da gulis cemis gaxSireba iseTive efeqturia, rogorc imipraminiT mkurnaloba
aReniSneba. garda amisa, mas mosalodneli saSiSroebis (Clark et al., 1994; Barow et at., 2000). garda amisa, aR-
usiamovno winaTgrZnoba uCndeba. amis gamo imiprami- moCnda, rom imipraminiT mkurnalobis damTavrebis
nis sawyisi doza mcire unda iyos. mag., pirveli sami Semdeg adreuli recidivis aRmocenebis albaToba
dRis manZilze pacients dReSi 10mg imipramins uniS- ufro didia, vidre kognitur-bihevioruli Terapiis
naven. Semdeg, yovel sam dReSi erTxel, dozas 10mg-iT Semdeg. ramdenime gamokvlevis mixedviT grZelvadiani
zrdian, sanam yovedRiuri doza 50mg-s ar miaRwevs. kognitur-bihevioruli Terapia odnav ufro efeqtu-
amis Semdeg doza kviraSi erTxel 25mg-iT izrdeba ria, vidre grZelvadiani medikamenturi mkunaloba
da, sabolood, dReSi 150mg-mde adis. Tu pacients, (Nadiga et al., 2003). barlous (Barlow) mier Catarebuli
amgvari sqemiT mkurnalobis miuxedavad, mainc ar ex- gamokvlevis Tanaxmad, imipraminiT mkurnalobisa da
_ 209 _
kognitur-bihevioruli Terapiis erTdrouli gamoy- et al., 1989] mier fsiqiatriul pacientebze Catareb-
eneba ar zrdis mkurnalobis efeqturobas. uli gamokvlevis Tanaxmad avadmyofebis 52%-Tan) da
ufro iSviaTad, rodesac isini sakmarisad mwvavea im-
marTva isTvis, rom fsiqikuri aSlilobis diagnozi daisvas
ra unda icodes pacinetma. iseve, rogorc agorafobiis (igive gamokvlevis mixedviT avadmyofebis 29%-Tan).
SemTxvevaSi (gv. ??), pacientebs unda SeeZloT panikuri msgavsi Sedegebi iqna miRebuli im adamianebze Catare-
aSlilobis mdgomareobis axsna naTesavebisa da mego- buli saTemo epidemiologiuri gamokvlevis Sedegad,
brebisTvis. eqimma unda ganumartos pacients, rom romlebic SfoTviTi aSlilobis diagnostikur krite-
garkveuli tipis azrebi da qcevebi aZlierebs da ax- riumebs akmayofilebdnen: 28% akmayofilebda mcire
angrZlivebs panikur aSlilobas (ix. zemoT kognituri depresiis kriteriumebs, xolo 21% _ didi depresiis
Terapia). kargi iqneba, Tu pacienti gaecnoba Sesabamis kriteriumebs (Angst and Dobler-Mikola, 1985).
literaturas (mag., Rachman and De Silver, 1998). sasurve-
lia, rom qveyanaSi arc Tu ise didi xnis win Camosul diagnostikis sakiTxebi
migrantebs (romlebsac cudaT esmiT inglisuri ena) aris SemTxvevebi, rodesac diagnostikuri krite-
literatura maTTvis gasageb enaze mivawodoT. riumebis dasakmayofileblad SfoTvis an depresiis
mkurnalobis SerCeva. radgan kognitur da medikamen- simptomebi ar aris sakmarisad Zlieri. aseT mdgo-
tur mkunalobas daaxloebiT erTnairi efeqti gaaCnia mareobas, zogjer, mcire afeqtur aSlilobas (ix. me-
da maTi erTdrouli gamoyeneba mniSvnelovnad ar zr- TerTmete Tavi) an koTimias uwodeben. sxva diagnos-
dis Terapiul efeqts, mkurnalobis SerCeva damokide- tikuri terminebia:
bulia pacientis survilze da kognituri Terapiis w Sereuli SfoTviT-depresiuli aSliloba. es kate
Catarebis SesaZleblobaze. aseve, unda gaviTvaliswin- goria mocemulia ICD-10-Si, magram ar figurirebs
oT mkurnalobasTan dakavSirebuli xarjebi da misi DSM-IV-is ZiriTad klasifikaciaSi, Tumca, Seta
grZelvadiani Sedegebi (kognituri Terapia ufro Zvi- nilia im mdgomareobebis CamonaTvalSi, romelebic
rad Rirebulia, magram mas SeiZleba ufro xangrZlivi Semdgom Seswavlas saWiroebs.
efeqti hqondes). medikamenturi mkurnalobis arCevi-
w adaptaciis aSliloba. adaptaciis aSlilobis diag
sas imipraminTan SedarebiT upiratesobas serotoni-
nozis dasma xdeba maSin, rodesac sustad gamoxatuli
nis ukumitacebis seleqciur inhibitorebs aniWeben,
SfoTvisa da depresiis simptomebi cxovrebiseuli
radgan maT naklebi gverdiTi efeqtebi gaaCniaT. zo-
garemoebebis SecvlasTan aris dakavSirebuli.
gierT qveyanaSi iyeneben alprazolams, magram brita-
neTSi am preparatis gamoyeneba ar aris rekomendebuli
etiologia
(ix. zemoT). rodesac igive medikamenti pacients sxva
arsebobs sami mizezi, ris gamoc SfoTvam da depresiam
mizezebis gamo eniSneba, mas am preparatis ZiriTadi
SeiZleba erTad iCinos Tavi:
da gverdiTi efeqtebis Sesaxeb garkveuli informa-
cia unda mivawodoT. mag., unda avuxsanT, rom medi- 1. maT SeiZleba erTi da igive predispoziciuri mizezebi
kamenti garkveuli drois Semdeg iwyebs moqmedebas, hqondeT. mecnierebma (Brown and Harris, 1993) aRmoaCines,
rom arsebobs hiperdozirebis saSiSroeba da rom misi rom bavSvobisdroindeli uaryofiTi gamocdileba
Sewyveta erTbaSad ar unda moxdes. Tu pacientis mdgo- zrdasrul cxovrebaSi rogorc SfoTviT, ise
mareoba daaxloebiT 12 kviris Semdeg ar gaumjobesda, depresiul aSlilobasTan aris dakavSirebuli.
mkurnaloba sxva klasis antidepresantiT unda ga- 2. zogierTi stresuli movlenebi danakargisa da sa
vagrZeloT an daviwyoT kognituri TerapiiT muSaoba. SiSroebis elementebs Seicavs. pirveli depresiasTan
panikur aSlilobas xSirad garkveuli donis agora- aris dakavSirebuli, xolo meore _ SfoTvasTan.
fobiuli ganrideba axlavs Tan. aseT dros medikamen- 3. persistentuli SfoTva meorad depresias iwvevs.
tur an kognitur-biheviorul mkurnalobasTan erTad Semdgomma dakvirvebebma aCvena, rom persistentuli
eqspoziciuri teqnikac unda gamoviyenoT (agorafo- SfoTvis mqone adamianebs ufro xSirad uviTardebaT
biis mkurnaloba ix. ?? gverdze). depresia, vidre persistentuli depresiis mqone
adamianebs _ SfoTva.
Sereuli SfoTviT-depresiuli Sereuli SfoTviT-depresiuli aSlilobis prognozi
aSliloba ar aris zustad dadgenili.
rogorc zemoT aRvniSneT (gv. ??), SfoTviTi da depre-
siuli simptomebi xSirad erTdroulad iCens Tavs. mkurnaloba
es xdeba ufro maSin, rodesac simptomebi sustad mkurnalobis dros. Cveulebriv. iyeneben erT-erT
aris gamoxatuli (hilerisa da misi kolegebis [Hiller antidepresants, romelsac rogorc anqsiolizuri,
_ 210 _
aseve antidepresiuli efeqtebi gaaCnia (meTerTmete lebTan (upirveles yovlisa, iaponelebTan), sadac
Tavi). arCevani SeiZleba triciklur antidepresantebze is taifin-kyofu-sho-s anu interpersonaluri urTi
SeCerdes. Tu am preparatis mkurnalobam Sedegi ar erTobebis SiSis saxeliT aris cnobili. aseTi
gamoiRo, maSin monoamin oqsidazas inhibitorebs fobiis dros, socialur situaciebSi yofnisas,
iyeneben, magram aseT SemTxveevaSi sifrxile unda pirovneba ganicdis intensiur SfoTvas da (TiTqmis
gamoviCinoT gverdiTi movlenebis an maTi sxva bodvis doneze) darwmunebulia, rom sxva adamianebi
preparatebTan urTierTqmedebis Tavidan asacileblad mis mimarT uaryofiTad arian ganwyobilni. garda
(gv. ??). garda amisa, pacientebs serotoninis uku amisa, pacientebs sxva simptomebic aReniSnebaT. mag.,
mitacebis seleqciur inhibitorebsac uniSnaven, Tumca arasasiamovno sxeulebrivi sunis gavrcelebis SiSi,
maT SeiZleba, Tavdapirvelad, SfoTvis gaZliereba dismorfofobia da aversia mxedvelobiTi kontaqtis
gamoiwvion. mimarT (Tseng et al., 1992).
am sakiTxTan dakavSirebiT Semdgomi informaciis
mosapoveblad ix. gv. ?? da Tyrer et al., (2003). obsesiur-kompulsuri aSliloba
obsesiur-kompulsuri aSlilobis mokle aRwera
SfoTviTi aSlilobis ICD-9-Sia mocemuli. am aRweris mixedviT, obsesiur-
transkulturaluri saxesxvaobebi kompulsuri aSliloba aris mdgomareoba, romlis
zogierT kulturaSi SfoTviTi aSlilobis sim drosac:
ptomebs ufro xSirad somaturi xasiaTi aqvT, vid wamyvan simptoms warmoadgens subieqturi kompul
re fsiqologiuri. lefma (Leff, 1981) yuradReba siis gancda, romelsac pirovneba uwevs winaaRmdegobas.
miaqcia im faqts, rom es gansxvavebebi Seesatyviseba kompulsia SeiZleba exebodes raime qmedebis gan
gansxvavebebs im sityvebSi, romlebsac Sesabamis xorcielebas, romelime ideaze yuradRebis dafiq
kulturaSi SfoTvis aRsawerad iyeneben. ase mag., sirebas, garkveuli gamocdilebis gaxsenebas an
zogierT afrikul da aziur enebSi (da aseve amerikis raime abstraqtul Temaze fiqrs. arasasurveli
indielebis enaze) ar arsebobs sityva `SfoTva~. mis fiqrebi SeiZleba sxvadasxva saxiT iyos warmodgenili
nacvlad ixmareba gamoTqma, romelic sxeulebriv (intruziuli sityvebi, azrebis Tanmimdevroba,
SegrZnebas gamoxatavs (mag., iorubas enaze (afrika) azrovnebiTi coxna) da pirovnebis mier ganicdeba,
_ `guli wynarad ar aris~). garda amisa, mecnierebis rogorc araadekvaturi an uazro. obsesiuri impulsi
mier aRwerilia ramdenime mdgomareoba, romlebic, an idea aRiqmeba, rogorc pirovnebisaTvis ucxo,
SeiZleba, SfoTviTi aSlilobis transkulturalur magram misi Sinagani mdgomareobidan aRmocenebuli.
saxesxvaobas warmoadgendes, Tumca, maTi kavSiri obsesiuri qmedebebi SeiZleba gamoixatebodes
SfoTviT aSlilobebTan ar aris zustad dadgenili. kvazi ritualebis SesrulebaSi, romlebic SfoTvis
koro aris panikuri aSlilobis msgavsi mdgomareoba, Semsubuqebas emsaxureba (mag., xelebis xSiri dabana,
romelsac aziel, ufro xSirad ki, Cinel mamakacebTan dabinZurebis Tavidan acilebis mizniT). arasasurveli
vxvdebiT. guanCJous (CineTi) mcxovrebni mas suk-yeong-s azrebisa da impulsebis Tavidan acilebis mcdelobam
uwodeben, rac penisis dapataravebas niSnavs. pirovneba SeiZleba Zlieri Sinagani konfliqti gamoiwvios,
30 wuTis an 1-2 dRis ganmavlobaSi ganicdis Zlier rasac intensiuri SfoTva sdevs Tan.
SfoTvas, romlis drosac is gaxSirebul guliscemas,
oflianobas, perikardialur diskomfortsa da kankals klinikuri suraTi
uCivis. amavdroulad, pirovneba darwmunebulia, rom obsesiur-kompulsuri aSlilobisaTvis damaxasiaTebe
misi penisi TandaTanobiT muclis RruSi Sedis da rom lia obsesiuri azrovneba, kompulsuri qceva, sxvadasxva
igi am procesis dasrulebisTanave mokvdeba. koros intensivobis SfoTva, depresia da depersonalizacia.
epizodebi umTavresad RamiT, zogjer ki sqesobrivi obsesiuri da kompulsuri simptomebi 9.8 cxrilSia
aqtivobis Semdeg iCens Tavs. SiSis gamo pacientma mocemuli. miuxedavad imisa, rom isini ?? gverdzea
SeiZleba penisi raime sagans miamagros an sxva adamians aRwerili, mkiTxvelisaTvis sasargeblo iqneba maTi
sTxovos misi daWera. aseTi rwmena panikis Setevis ZiriTadi maxasiaTeblebis Sexseneba.
dros gancdili SiSis analogiuria, romlis drosac obsesiuri azrebi warmoadgenen sityvebs, ideebsa da
pacienti darwmunebulia, rom mas guli dauziandeba rwmenebs, romlebic pacientis nebisagan damoukideblad,
da amis gamo mokvdeba. koros epidemiebi aRwerilia naZaladevad iWreba cnobierebaSi, Tumca, mis mier aRiqmeba,
im adamianebTan, romlebTanac SfoTva socialuri rogorc sakuTari. obsesiuri azrebi, Cveulebriv,
stresorebiT an crurwmenebiT aris gamowveuli (Tseng usiamovnoa da amitom pacienti cdilobs win aRudges
et al., 1988). maT. obsesiuri simptomebisTvis damaxasiaTebelia
socialuri fobiis saxesxvaobebi aRwerilia azie erTdroulad naZaladeobis Sinagani gancdisa da
_ 211 _
misTvis winaaRmdegobis gawevis Zalisxmevis arseboba,

cxrili 9.8 obsesiur-kompulsuri aSlilobis
Tumca winaaRmdegobis gawevis Zalisxmeva am ors Soris
ZiriTadi maxasiaTeblebi
ufro Zlieria. obsesiur azrebs SeiZleba calkeuli
sityvebis, frazebis an gariTmuli leqsis forma obsesiuri simptomebi
azrebi
hqondes. Cveulebriv, isini pacietisaTvis usiamovno
azrovnebiTi coxna
an Sokis momgvrelia da SeiZleba uxamsi an mkrexeluri
impulsebi
xasiaTi hqondes. obsesiuri xatebi warmoadgens naTlad
`fobiebi~
warmosaxul scenebs, romlebsac xSirad Zaladobrivi
kompulsuri ritualebi
an zizRismomgvreli Sinaarsi aqvT (mag., paTologiuri paTologiuri sinele
seqsualuri aqtivobis Semcveli scenebi). SfoTva
azrovnebiTi coxna wamoadgens Sinagan debatebs, depresia
romelTa drosac dausruleblad xdeba argumentebis depersonalizacia
awon-dawonva, rac yoveldRiur umartives qmedebebzec
vrceldeba. zogierTi obsesiuri eWvi dakavSirebulia simptomebTan SedarebiT, gacilebiT ufro mkveTrad
qmedebebTan, romlebic SeiZleba arasworad iyos aris gamoxatuli.
Sesrulebuli an ar iyos dasrulebuli (mag., gazquris obsesiuri fobiebi. pacients SeiZleba obsesiuri
gamorTva an karis Caketva), zogi ki qmedebebTan, azrebi da kompulsuri ritualebi gansakuTrebiT
romlebmac SeiZleba adamianebs ziani miayenos (mag., gauZlierdes garkveul situaciebSi aRmoCenisas. mag.,
velosipedists Tu manqaniT gverdze CauvliT, is pacients sxva adamianebisaTvis zianis miyenebasTan
SeiZleba velosipedidan gadmovardes). aris SemTxvevebi, dakavSirebuli obsesiuri azrebi SeiZleba gauZ
rodesac obsesiuri eWvebi religiuri kanonebisa da lierdes samzareuloSi an iseT adgilas yofnisas,
ritualebis SesaZlo darRvevasTan aris dakavSirebuli sadac danebi inaxeba. distresis gamo, pirovnebam
(`sindisis qenjna~), rac kargad aris cnobili im (fobikuri aSlilobis mqone adamianebis msgavsad)
adaminebisaTvis, romlebic aRsarebas ismenen. SeiZleba Tavi aaridos amgvar situaciebs, ris gamoc
obsesiuri impulsebi warmoadgens ltolvas ise aseT mdgomareobas obsesiuri fobia ewodeba.
Ti qmedebebis ganxorcielebisaken, romlebsac, Cve SfoTva obsesiur-kompulsuri aSlilobis mniSvne
ulebriv, Zaladobrivi an samarcxvino xasiaTi aqvs lovan Semadgenel nawils warmoadgens. zogierTi
(mag., manqanis win Caxtoma, bavSvisaTvis zianis miyeneba rituali asustebs SfoTvas, zogi ki _ aZlierebs mas.
an eklesiaSi xmamaRla RvTisgmoba). depresia. obsesiebis mqone pacientebi xSirad dep
obsesiur ritualebs ganekuTvneba rogorc fsi resiulebi arian. zogierT SemTxevaSi depresia
qikuri aqtivobebi (mag., gansakuTrebuli xerxiT obsesiur simptomebze gacemul reaqcias warmoadgens.
Tvla an garkveuli sityvebis warmoTqma, romlebsac Tumca, arsebobs SemTxvevebi, rodesc depresia maTgan
pirovneba gamudmebiT imeorebs), aseve ganmeorebadi, damoukidebelad viTardeba.
uazro qcevebi (mag., dReSi ocjer an metjer xelis depersonalizacia. obsesiebis mqone zogierT paci
dabana). zogierTi ritualis kavSiri mis winmswreb ents depersonalizacia aReniSneba. urTierTkavSiri
obsesiur azrebTan savsebiT gasagebia (mag., xelebis aseT distresul simptomsa da obseisiur-kompulsur
xSiri dabana daimficirebis SiSis Semcveli azrebidan aSlilobis sxva maxasiaTeblebs Soris ar aris
momdinareobs), Tumca, arsebobs ritualebi, romlebSic dadgenili.
aseTi kavSirebi naTeli ar aris (mag., sagnebis dalageba kavSiri obsesiur pirovnebasTan. obsesiuri pirov
raime gansakuTrebuli pricnipis mixedviT). pirovneba neba meSvide TavSia aRwerili. miuxedavad imisa, rom
ganicdis Zlier survils gaimeoros aseTi qmedebebi obsesiuri pirovnuli Tvisebebi xSirad gvxvdeba
da Tu maTi Tanmimdevroba dairRva, iZulebuli obsesiur-kompulsuri aSlilobis mqone adamianebTan,
xdeba yvelaferi Tavidan daiwyos. obsesiuri ri maT Soris pirdapiri, erTmniSvnelovani kavSiri ar
tualebis mqone pacienti yovelTvis acnobierebs arsebobs. obsesiebis mqone pacientebis daaxloebiT erT
maT alogikurobas da, Cveulebriv, cdilobs ar mesameds sxva tipis pirovnuli maxasiaTeblebi gaaCniaT
gamomaJRavnos isini. zogierT maTgans eSinia, rom (Lewis, 1936). garda amisa, aseTi pirovnuli Tvisebebis
aseTi simptomebi gagiJebis momaswavebelia. amitom, mqone adamianebTan ufro didia depresiis ganviTarebis
aucilebelia, davarwmunoT pacientebi, rom es ase ar albaToba, vidre obseisiur-kompulsuri aSlilobisa.
aris da rom maTi SiSi usafuZvloa.
obsesiuri sinele. obsesiuri azrebi da ritualebi, diferencialuri diagnozi
nebismier SemTxvevaSi, iwvevs pirovnebis aqtivobis obsesiur-kompulsuri aSliloba unda ganvasxvavoT
Senelebas. Tumca, obsesiebis mqone zogierT paci sxva aSlilobebisagan, romelTa drosac obsesiuri
entTan amas gansakuTrebiT mZime xasiaTi aqvs da, sxva simptomebi iCens Tavs.
_ 212 _
SfoTviTi aSlilobebi etiologia

pacientis anamnezisa da misi fsiqikuri mdgomareobis seqsualuri, agresiuli an sxva Sinaarsis intruziuli
yuradRebiTa da safuZvilanad Seswavlis SemTxvevaSi azrebi, romlebic obsesiis mqone pacientebisaTvis
generalizebul SfoTviT aSlilobas, panikur aris damaxasiaTebeli, drogamoSvebiT janmrTel
aSlilobas da fobikur aSlilobas Soris gansxvavebebis adamianebTanac iCens Tavs (Rachman and Hodgson, 1980).
dadgena iSviaTadaa sirTuleebTan dakavSirebuli. obsesiuri fenomenebis sixSire, intensivoba da, rac
mTavaria, persistentoba Semdgom Seswavlasa da axsnas
depresiuli aSliloba saWiroebs.
obsesiur-kompulsuri aSlilobis mimdinareobas
xSirad enacvleba depresiuli periodebi, romelTa genetika
drosac gansakuTrebiT Zlierdeba obsesiuri simp adreuli gamokvlevebis mixedviT, obsesiur-
tomebi. aseT dros SeiZleba Zneli iyos depresiuli kompulsuri aSlilobis mqone pacientebis mSoblebis
aSlilobis dafiqsireba. agreTve, arsebobs SemTxve 5-7 procents igive diagnozi daudgingaT (Brown, 1942;
vebi, rodesac pirveladi depresiuli aSlilobis Rdin, 1953). es maCvenebeli maRalia zogad populaciaSi
mimdinareobisas obsesiuri simptomebi iCens Tavs. dafiqsirebul gavrcelebis maCvenebelTan SedarebiT
(ix. zemoT). tyupebze Catarebuli ramdenime gamo
Sizofrenia kvlevis Tanaxmad, konkordantoba monozigotur tyu
xandaxan obsesiur-kompulsuri aSliloba bodviT pebSi ufro maRalia dizigotur tyupebTan SedarebiT
ideebs waagavs, ris gamoc is SeiZleba SizofreniaSi (Rasmussen and Tsuang, 1986), rac imaze miuTiTebs, rom
agverios. es gansakuTrebiT maSin xdeba, rodesac obsesiur-kompulsur aSlilobaSi memkvidreobiToba
obseisuri azrebis Sinaarsi ucnauria an ritualebi garkveul rols TamaSobs. molekuluri genetikis
gansakuTrebuli eqscentrulobiT gamoirCeva da maT sferoSi Catarebuli kvlevebis mixedviT, arsebobs
mimarT rezistentoba sustia. aseTi SemTxvevebis dros mTeli rigi asociaciebi obsesiur-kompulsur aSli
swori diagnozis dasasmelad aucilebelia pacientis lobasa da garkveuli tipis genebs Soris, romlebic
avadmyofobis istoriis dawvrilebiT moZieba da axdenen 5-HT receptorebis (mag., 5-HT 1D receptoris)
masTan Sizofreniis sxva simptomebis dakvirvebiT kodirebas, Tumca es monacemebi jer ar aris bolomde
gamokvleva. dadasturebuli (Mundo et al., 2002).
organuli aSlilobebi monacemebi Tavis tvinSi arsebuli darRvevebis

obsesiuri simptomebi zogjer organuli cerebruli Sesaxeb
darRvebebis mqone pacientebsac aReniSnebaT. ase obsesiur-kompulsuri aSlilobis dros Tavis tvinis
Ti SemTxvevebi gavrcelebuli iyo 1920-ian wlebSi funqcionirebis darRvevaze ori tipis monacemebi
qronikuli leTargiuli encefalitis mqone paci miuTiTeTebs: asociaciebi im mdgomareobebTan, ro
entebs Soris am daavadebis epidemiis Semdeg. melTa zemoqmedeba Tavis tvinis funqcionirebaze
kargad aris cnobili da Tavis tvinis skanirebis
epidemiologia rezultatebi.
erTi wlis manZilze obsesiur-kompulsuri asociaciebi Tavis tvinis sxva saxis darRvevebTan.
aSlilobis gavrcelebis maCvenebeli 2.1%-s Seadgens. rogorc zemoT aRvniSneT, obsesiuri simptomebi
iseTi obsesiur-kompulsuri aSlilobis gavrcelebis gavrcelebuli iyo 1920-ian wlebSi leTargiuli
maCvenebeli, romelic ar aris komorbiduli sxva encefalitis epidemiis Semdeg. garda amisa, Jil de la
SfoTviT aSlilobasTan _ 1.2 procentia (Narrow et turetma Seitana obsesiuri simptomebi im aSlilobis
al., 2002). originalur aRweraSi, romelic axla mis saxels
zogad populaciaSi qalebis Tanafardoba mamaka atarebs (Gilles de la Tourette, 1885). mis mier gakeTebuli
cebTan cxovrebis manZilze gavrcelebis sixSiris daskvnebi mogvianebiT Catarebuli kvlevebiTac
TvalsazrisT cvalebadobs 1.2-dan (puertoriko) dasturdeba (mag., Cummings and Frankel, 1985;
3.8-mde (axali zelandia). Tumca, hospitalizebul Robertson et al., 1988). bavSvobis periodSi sidenhamis
pacientebSi Tanafardoba Cveulebriv erTi erTzea. qoreis gadatanisas, romelic zemoqmedebs kudian
Temis doneze Catarebul SerCevaSi SemTxvevebis 20- birTvebze, pacientebis 70%-s obseisiur-kompulsuri
60-Si mxolod obsesiebi iqna dafiqsirebuli, maSin simptomebi aReniSneba. zogierT bavSvSi obsesiur-
rodesac stacionaruli pacientebis 70 procentSi kompulsuri aSlilobis ganviTareba A jgufis
dafiqsirda obsesiebisa da kompulsiebis erTdrouli streptokokul infeqciebTan aris dakavSirebuli
arseboba (Weissman et al., 1994). (Snider and Swedo, 2004). es mdgomareoba, romelic
PANDAS saxelwodebiT aris cnobili (pediatriuli
_ 213 _
vegetaturi neirofsiqiatriuli aSliloba, romelic 2003). am kvlevebis Sedegebi urTierTgamomricxavia,
streptokokul infeqciebTan aris dakavSirebuli), ris gamoc Znelia erTmniSvnelovani daskvnebis gamo
mogvianebiT, ?? gverdze iqneba ganxiluli. tana. sxva gamokvlevebSi Seiswavlidnen obsesiur-
Tavis tvinis funqciuri neirovizualuri meTo kompulsur simptomebze iseTi nivTierebebis moqme
debiT Catarebuli kvlevebi. kompiuteruli da mag debas, romlebsac garkveuli tipis 5-HT receptorebis
nitur-rezonansuli tomografiis meTodebiT ar mimarT specifikuri efeqti gaaCnia. zogierTi
aris dadgenili Tavis tvinis raime struqturuli gamokvleva 5-HT1D da 5-HT2C receptorebze miuTiTebda,
paTologiis arseboba, romelic uSualod obsesiur- Tumca, am SemTxvevaSic urTierTgamomricxavi Sedegebi
kompulsuri daavadebis mqone pancientebisaTvis iqna miRebuli (Zohar et al., 2004).
iqneboda damaxasiaTebeli (Sexena et al., 1998). Tumca,
adreuli gamocdileba
SPET-iTa da PET-iT Catarebulma gamokvlevebma
am aSlilobis dros Tavis tvinis funqciuri zustad ar aris dadgenili, TamaSobs Tu ara raime
anomaliebi aCvena. kerZod, momatebulia aqtivoba rols adreuli gamocdileba obsesiur-kompulsuri
orbitofrontalur qerqSi, sartyelisebr xveulSi, aSlilobis etiologiaSi. bavSvs SeuZlia obsesiur-
kudian birTvSi da Talamusis nawilebSi (Sexena kompulsuri simptomebi dedisagan, imitaciuri
et al., 2001), rac miuTiTebs im neironuli gzebis daswavlis gziT, gadaiRos. Tumca, adreuli gamo
paTologiur aqtivobaze, romlebic am struqturebs kvlevebiT dadginda, rom aseTi aSlilobis mqone
CairTavs. rogorc Cans, am anomaliebidan mkurnalobas pacientebis SvilebTan maRalia araspecifikuri
mxolod zogierTi maTgani emorCileba (Saxena nevrotuli simptomebis da araobsesiuri simptomebis
et al., 2002). im pacientebSi, visac kompulsuri ganviTarebis riski (Cowie, 1961).
Semgrovebloba axasiaTebs, aqtivobis gansxvavebuli
fsiqoanalitikuri Teoriebi
paternia dafiqsirebuli, rac saSualebas gvaZlevs
miuxedavad imisa, rom fsiqoanalitikuri Teoriebi ar
vivaraudoT, rom es iSviaTi mdgomareoba Tavisi
aris mtkicebulebiT gamyarebuli, isini am qveTavSi
paTofiziologiiT gasxvavdeba sxva obsesiur-
TavianTi istoriuli mniSvnelobis gamoa Setanili.
kompulsuri aSlilobebisgan (Sexena et al., 2003).
Tavdapirvelad froidi (Freud, 1895b) Tvlida, rom
paTologiuri serotonerguli funqcia obsesiuri simptomebi agresuli an seqsualuri
garkveuli monacemebi gviCvenebs, rom obsesiur- xasiaTis aracnobieri impulsebiT aris gamowveuli.
kompulsuri simptomebi reagirebs iseT preparatebze, is miiCnevda, rom aseT stimulebs ukiduresad Zlieri
romlebic zemoqmedebs 5-HT-is funqciaze. aqedan SfoTvis gamowveva SeuZliaT, magram misi Sesusteba
gamomdinare, SeiZleba davaskvnaT, rom obsesiur- represiis dacviTi meqanizmis moqmedebiT da reaqciis
kompulsuri aSlilobis dros 5-HT-is funqcia ano formirebiT xdeba. es idea asaxavs obsesiebis mqone
maliuria. obsesiur-kompulsur simptomebze 5-HT-is mravali pacientis seqsualur da agresiul fantaziebs
ukumitacebis inhibitorebiT zemoqmedebas ramdenime da maT mier seqsualuri da agresiuli impulsebis
kvira sWirdeba, ris gamoc wamlis moqmedebis efeqts Sekavebis faqts. froidi, aseve, varaudobda, rom
SedarebiT gvian unda velodoT. Tumca, aseT gviandel obsesiuri simptomebi maSin iCens Tavs, rodesac xdeba
efeqtebs kompleqsuri xasiaTi aqvs da Zneli saTqmelia, regresia ganviTarebis analur stadiaze. regresiis
Tu romeli efeqtia ufro mniSvnelovani. nebismier meSveobiT adamiani Tavidan icilebs iseT impulsebs,
SemTxvevaSi, obsesiur-kompulsuri simptomebis rea romlebic ganviTarebis Semdgom stadiebze, kerZod
gireba iseT preparatebze, romlebic zemoqmedebs 5-HT- ki, genitaliur stadiaze da oidiposis kompleqsis
is funqciaze, ar adasturebs obsesiur-kompulsuri arsebobisas aRmocendeba. es idea asaxavs obsesiebis
aSlilobis dros 5-HT-is funqciis anomaliurobas. mqone pacientebis eqskretorul funqcionirebasa da
es mogvagonebs parkinsonizmis SemTxvevas, romlis dabinZurebaze fiqsacias.
drosac antiqolinerguli preparatebi, normalur
daswavlis Teoria
qolinergul sistemebze zemoqmedebis meSveobiT,
daswavlis Teoriis mixedviT obsesiur-kompulsuri
akontroleben simptomebs iseT pacientebSi, visTanac
aSliloba anomaliuri daswavlis Sedegad viTardeba.
aSliloba paTologiuri dofaminerguli funqciiT
magaliTad, obsesiuri ritualebi ganridebis re
aris gamowveuli.
aqciebis erT-erT formas warmoadgenen. miuxedavad
obsesiur-kompulsuri aSliobis dros 5-HT-is
imisa, rom amgvari meqanizmebiT SesaZlebelia
funqcis Sefasebisas iyeneben rogorc neiro-en
obsesiuri simptomebis zogierTi aspeqtis axsna,
dokrinul testebs (Barr et al., 1992; Hollander et al., 1992),
isini, zogadad, obsesiur-kompulsuri aSlilobis
ise serotoninis transportirebis gazomvas PET-isa
asaxsnelad ar gamodgeba.
da SPET-is meSveobiT (Pogarell et al., 2003; Simpson et al.,
_ 214 _
kognituri Teoria Sesasusteblad am preparatis didi doziT daniSvna

(200-250mg dReSi) ufro efeqturia, vidre placebo
kognituri Teoriis winapirobas warmoadgens is mo
(Clomipramine Collaborative Study Group, 1991).
sazreba, rom axsnas saWiroebs ara Tavad akviatebuli
pacientebis umetesoba tolerantulia klomipraminiT
azrebis arseboba (amgvari azrebi drogamoSvebiT
mkurnalobis mimarT, magram didi dozis gamoyenebisas
janmrTel adamianebsac axasiaTebT _ ix. zemoT),
xSirad Tavs iCens antiqolinergiuli gverdiTi
aramed obsesiebis mqone pacientis uunaroba akon
efeqtebi; zogerT pacients ki SeiZleba gulyra
trolos aseTi azrebi. salkovskisi (Salkovskis,
ganuviTardes. klinikuri TavalsazrisiT dadebiTma
1997) varaudobda, rom obsesiuri aSlilobis mqone
efeqtebma SeiZleba mkurnalobis dawyebidan
adamianebi akviatebul azrebze ise reagireben, TiTqos
daaxloebiT 6 kviris Semdeg iCinos Tavi, xolo
piradad arian pasuxismgebelni maT SesaZlo Sedegebze
pacientis mdgomareobis Semdgom gaumjobesebas
(mag., pasuxismgebloba sxva adamianisaTvis zianis
kidev eqvsi kvira dasWirdes. preparatis Sewyvetis
miyenebaze). aseT pasuxismgeblobis grZnobas adamiani
Semdeg ramdenime kviris manZilze, xSiria recidivis
mihyavs gamudmebul da gadaWarbebul mcdelobamde
SemTxvevebi (Pato et al., 1988). recidivi ufro
Tavidan aicilos akviatebuli azrebi da maTi SesaZlo
iSviaTia, rodesac klomipraminTan erTad pacients
Sedegebi. amisaTvis igi iTvisebs kompulsur qcevebs,
eqspoziciur Terapiasac utareben (Simpson et al.,
daiswavlis ganridebas da gamudmebiT iTxovs sxvisgan
2004). obsesiur-kompulsuri aSlilobis dros
damSvidebas. miuxedavad imisa, rom kognituri Teoria
sxva tricikluri antidepresantebis gamoyenebas,
ar aris mecnierulad dasabuTebuli, mniSvnelovania,
romelTac 5-HT ukumitacebis ufro susti
rom is, aSkarad gamoxatuli obsesiebisa da kom
mablokirebeli efeqtebi gaaCnia, aseTi Terapiuli
pulsiebis nacvlad, yuradRebas obsesiur-kompulsuri
zemoqmedeba ar axasiaTebs (Foa et al., 1987).
aSlilobis sxva aspeqtebze amaxvilebs.
serotoninis ukumitacebis specifikuri inhibi
prognozi torebi, maT Soris fluoqsetini, fluvoksamini,
paroqsetini da sertralini efeqturad zemoqmedebs
pacientebis daaxloebiT or mesameds erTi wlis
obsesiuri simptomebis Sesustebaze (Goodman et al.,
Tavze garkveuli gaumjobeseba aReniSneba. im
1989b; Jenike et al., 1990). meta-analizis Sedegad dadginda,
SemTxvevebidan, romlebic erT welze didxans
rom am preparatebze gacilebiT ufro efeqturia
gastans, zogierTis mimdinareobas fluqtuaciuri
klomipramini (Ackerman and Greenland, 2002), Tumca,
xasiaTi aqvs, xolo zogierTisas _ qronikuli.
isic gasaTvaliswinebelia, rom klomipraminisagan
(Ravizza et al., 1997). prognozi ukeTesia maSin,
gansxvavebiT, maT antiqolinergiuli gverdiTi
rodesac: (a) adgili aqvs precipitatorul,
efeqtebi ar gaaCniaT. radgan mkurnalobis Catarebis
maprovocirebel movlenas (b) pirovnebas kargi
Semdeg mniSvnelovani gaumjobeseba pacientebis
socialuri da profesiuli adaptacia axasiaTebs,
daaxloebiT naxevars aReniSneba, Sedegebis
da (g) simptomebs epizoduri xasiaTi aqvs.
gasaumjobeseblad saWiroa serotoninis ukumitacebis
prognozi uaresia, rodesac: a) saxezea pirovnuli
seleqciur inhibitorebTan erTdroulad sxva
aSliloba, da b) obsesiur-kompulsuri aSliloba
preparatebic dainiSnos. rac Seexeba damatebiT
bavSvobis peridSi ganviTarda (Iancu et al., 2000).
preparatebs, erTaderTi medikamenti, romelic
mZime SemTxvevebs SeiZleba gansakuTrebuli
mudmivad gvaZlevs dadebiT, Tumca sust Terapiul
persistentoba axasiaTebdes. mag., obsesiebis mqone
efeqts, antifsiqozuri preparatebia. maT, Cveulebriv,
hospitalizebul pacientebze Catarebuli erT-
mcire doziT iyeneben. dadebiTi efeqtebi dafiqsirda,
erTi gamokvlevis mixedviT (Kringlen, 1965), aseTi
rogorc tipiuri, ise atipiuri antifsiqotikis
pacientebis sam meoTxeds simptomebi 13-20 wlis
gamoyenebisas, Tumca, ukanaskneli pacientebs ufro
Semdegac ucvleli saxiT SeunarCunda, xolo kidev
kargad gadaaqvT (Sareen et al., 2004). klomipraminis
erTi gamokvlevis mixedviT pacientebis TiTqmis
msgavsad, serotoninis ukumitacebis seleqciuri
naxevarTan obsesiur-kompulsuri aSliloba 50
inhibitorebis Sewyvetis Semdeg, ramdenime kviris
welze didxans grZeldeboda (Skoog and Skoog, 1999).
manZilze xSiria recidivis SemTxvevebi.
anqsiolizuri preparatebi, garkveulwilad, xan
mkurnaloba
mokle vadiT, amsubuqebs simptomebs, magram paci
medikamenturi mkurnaloba entisaTvis maTi sam kviraze didi xniT daniSvna
klomipramini aris tricikluri antidepresanti, ar aris rekomendebuli. Tu aucilebelia, rom
romelsac 5-HT ukumitacebis Zlieri mablokirebeli anqsiolitikebiT mkurnaloba ufro didxans ga
efeqti gaaCnia. obsesiur-kompulsuri aSlilobis grZeldes, SeiZleba tricikluri antidepresantis an
mqone pacientisaTvis obsesiuri simptomebis antifsiqotikis mcire doziT gamoyeneba.
_ 215 _
kognitur-bihevioruli Terapia dinamiuri fsiqoTerapia

reaqciis prevencia obsesiebis gamomwvevi mizezebis kvlevis meTodika
da interpretaciuli fsiqoTerapia iSviaTad aris
obsesiuri ritualebis dros, pacientis mdgomareobas,
efeqturi obsesiebis mqone pacientebTan. maT, zogjer,
Cveulebriv, ori meTodis erTdrouli gamoyenebiT
SeiZleba gaauareson pacientis mdgomareoba, radgan
aumjobeseben. es meTodebia reaqciis prevencia (gv. ??)
aseTi procedurebi pacientSi iwvevs mtkivneul da
da pacientze iseTi garegani stimulebiT zemoqmedeba,
araproduqtiul akviatebul msjelobas (àzrovnebiT
romlebic arsebul simptomebs aZlierebs (eqspozicia).
coxnas~) iseTi sakiTxebis Sesaxeb, romelTa ganxilvac
SegviZlia vivaraudoT, rom aseTi mkurnalobis
mkurnalobis procesSi xdeba.
Sedegad saSualo simZimis ritualebis mqone pa
cientebis daaxloebiT ori mesamedis mdgomareoba neiroqirurgia
mniSvnelovnad gaumjobesdeba, Tumca, sruli gamo
mZime obsesiur-kompulsuri aSlilobis dros neiro
janmrTeleba ar aris mosalodneli (Rachman and
qirurgiuli Carevis uSualo rezultats, xSirad,
Hodgson, 1980). Tu kompulsuri ritualebi mkurnalobas
daZabulobisa da distresis gansacvifreblad swrafi
eqvemdebareba, maTi Tanmxlebi obsesiuri azrebic,
Semcireba warmoadgens. Tumca, daudgenelia, Tu
Cveulebriv, klebulobs. aseTi mkurnlobis Sedegebi,
ramdenad grZelvadiania aseTi Sedegebi, radgan
klomipraminiTa da serotoninis ukumitacebis seleq
amasTan dakavSirebiT kontrolirebadi kvleva jer ar
ciuri inhibitorebiT miRweuli rezultatebis
Catarebula. Catarda aTwliani Semdgomi gamokvleva
msgavsia (Cox et al., 1993; van Bolkom et al., 1998).
(Tan et al., 1971), romelSic Seiswavles obsesiur-
bihevioruli Terapia bevrad ufro nakleb
kompulsuri aSlilobis mqone 26 pacienti. am
efeqturia im pacientebTan, romlebTanac obsesiuri
pacientebs aReniSnebodaT dazianeba orbitomedialur
azrebi ritualebis gareSe iCens Tavs. mravali wlis
an sartyelisebr ubnebSi, an erTdroulad oriveSi.
manZilze iyenebdnen àzris SeCerebis~ meTods, Tumca
18 gamokiTxuli pacientidan rvas meored gaukeTda
zustad ar aris dadgenili, gaaCnia Tu ara mas raime
operacia, orma sicocxle TviTmkvlelobiT daasrula,
specifikuri efeqti. sternma da misma kolegebma
xolo daaxloebiT erTi mesamedi ukeT grZnobda Tavs.
(Stern et al., 1973) aRmoaCines, rom àzris SeCerebis~
ganmeorebiTi operaciebis sixSire da avadmyofis
meTodi marto irelevanturi azrebis SeCerebaze ar
mdgomareobis gaumjobesebis dabali maCvenebeli imaze
moqmedebs.
miuTiTebs, rom amgvari mkurnaloba SezRudulad
kognituri Terapia mimarTulia obsesiuri az
unda gamoviyenoT. am sakiTxis gansaxilvelad ix.
rebis CaxSobisa da Tavidan aridebis mcdelobebis
Christmas et al., (2004).
Sesustebaze, radgan amgvari mcdeloba ufro metad
obsesiur-kompulsuri aSlilobisas neiroqirurgi
zrdis maT sixSires. pacients sTxoven aRricxos
uli Careva mizanSewonilia mxolod iseTi qronikuli
da Semdeg Seadaros erTmaneTs obsesiuri azrebis
SemTxvevebis dros, romlebic wlebis manZilze
aRmocenebis sixSire Cveulebriv pirobebSi da
ar eqvemdebareba sxva saxis mkurnalobas. amitom,
CaxSobisa da yuradRebis gadatanis meTodebis
operaciis Sesaxeb gadawyvetilebis miRebamde, pa
gamoyenebisas. CaxSoba da ganrideba, savaraudod,
cients saavadmyofoSi an dRis stacionarSi mini
gamowveulia im rwmeniT, rom raime movlenaze fiqriT
mum erTwliani intensiuri mkurnalobis kursi un
xdeba am movlenis realurad gamowveva. amitom, aseTi
da Cautardes (medikameturi mkurnalobisa da bi
rwmenis Sesasusteblad, pacientTan erTad iseTi
hevioruli Terapiis CaTvliT).
faqtebis gaanalizebac xdeba, romlebic am rwmenis
sasargeblod an sawinaaRmdegod metyvelebs. aseTi marTva
teqnikis paralelurad SegviZlia magnitofirze mkurnalobis dros aucilebelia gvaxsovdes, rom
CaviweroT pacientis is azrebi, romlebsac is obsesiur-kompulsuri aSlilobis mimdinareoba
mudmivad imeorebs da Semdeg movasmeninoT isini mas fluqtuaciiT xasiaTdeba. mas axasiaTebs remisi
(eqspozicia); an kongituri Terapiis ZiriTadi kursis is xangrZlivi periodebi. garda amisa, unda gvax
Catarebis procesSi pacientTan erTad sxva kognituri sovdes, rom obsesiur-kompulsuri aSlilobis
xasiaTis darRvevebic ganvixiloT (gv. ??). mocemuli mqone pacientebs xSirad depresiuli aSlilobac
momentisaTvis ar arsebobs kognituri Terapiis aReniSnebaT. aseTi SemTxvevebis dros, depresiuli
grZelvadiani efeqturobis damadasturebeli sakma aSlilobis efeqturi mkurnaloba, xSirad, obsesiuri
risi mtkicebulebebi. obsesiur-kompulsuri aSli simptomebis Sesustebas iwvevs. swored amitom, dep
lobis samkurnalod kognituri Terapiis Sefasebis resiuli aSlilobis dasadgenad, TiToeuli pacienti
Sesaxeb informaciis mosapoveblad ix. Salkovskis, 1997. safuZvlianad unda iqnes gamokvleuli.
ra unda icodes pacientma. mkurnaloba pacien
_ 216 _
tisaTvis simptomebis axsniT unda daviwyoT. obsesiur-kompulsuri aSliloba ganxilulia Semdeg
saWiroebis SemTxvevaSi unda davarwmunoT pacienti, wyaroSi: Jenicke (2004).
rom simptomebi ar aris sigiJis momaswavebeli
(rac obsesiebis mqone pacientebs xSirad awuxebT). damatebiTi literatura
pacientis Tanxmobis SemTxvevaSi, SegviZlia mi
si meuRle an axlo naTesavebi davaswroT sagan Gelder, MG, Lpez-Ibor, JJ Jr and Andreasen. NC (eds) (2000)
manaTleblo sesiebze, sadac isini miiReben infor The new Oxford textbook of psychiatry. Oxford University
macias aSlilobis bunebisa da misi mkurnalobis Press, Oxford. (ix. nawili 4.7: SfoTviTi aSlilobebi:
Sesaxeb. pacientebisa da maTi ojaxis wevrebisaTvis, generalizebuli SfoTviTi aSlilobebi, social-
aseve, sasargebloa obsesiur-kompulsuri aSlilobis uri da specifikuri fobiebi, panikuri aSliloba
Sesaxeb arsebuli literaturis gacnoba. obsesiebis da agorafobia. ix. agreTve, nawili 4.8: obsesiuri
mqone pacienti SeiZleba sakuTar ritualebSi aSlilobebi.)
ojaxis wevrebis CaTrevas Seecados. aseT dros unda Menzies, R and de Silva, P (eda) (2003) Obsessive compul-
davexmaroT ojaxis wevrebs iseTi gzebis gamonaxvaSi, sive disorders: theory, research and treatment. John Wiley,
romelTa meSveobiTac isini winaaRmdegobas gauweven Chicester. (mocemulia Sesabamisi sakiTxebis farTo
pacietis amgvar moTxovnebs da, mis mimarT saTanado mimoxilva)
TanagrZnobasTan erTad. simtkicesac gamoiCenen. Nathan, PE and Gorman, JM (eds) (2002) A guide to treat-
mkurnalobis SerCeva. rogorc zemoT aRvniSneT, xSir ments that work, 2nd edn. Oxford University Press, New
SemTxvevaSi, medikamentur mkurnalobas simptomebis york. (ix. Tavebi panikuri aSlilobis, fobias, gen-
gakontroleba SeuZlia, magram misi Sewyvetis eralizebuli SfoTviTi aSlilobebis da obsesiur-
Semdeg xSiria recidivis SemTxvevebi. eqspoziciuri kompulsuri aSlilobebis fsiqosocialuri da far-
Terapia, reaqciis prevenciasTan erTad, savaraudod, makologiuri mkurnalobis Sesaxeb).
ukeTes grZelvadian rezultatebs iZleva, magram National Insitute for Clinical Excellence (2004) Anxiety: man-
Zlieri simptomebis arsebobisas reaqciis prevenciis agement of anxiety (panic disorder, with and without agora-
miRweva rTulia. amis gamo am meTods xSirad phobia, and generalized anxiety disorder) in adults in primary,
medikamentur mkurnalobasTan erTad iyeneben (garda secondary and community care. National Institute for Clini-
im SemTxvevebisa, rodesac pacienti medikamenturi cal Exellence Guideline 22. (periodulad ganaxlebadi
mkurnalobis winaaRmdegia). Tu bihevioruli Terapiis safuZvliani mimoxilva. ix. www.nice.org.uk.)
Catareba mocemuli momentisaTvis ver xerxdeba,
mkurnaloba SeiZleba medikamentebiT daviwyoT.
_ 217 _
Tavi 10 somatoformuli
da disociaciuri aSlilobebi
Tavis Sinaarsi
klasifikacia klasifikacia
somatoformuli aSliloba DSM-IV-Si zogadi termini `somatoformuli aSlilo-
klasifikacia DSM-IV-sa da ba~ gamoiyeneba iseTi somaturi simptomebiT mimdina-
ICD-10-is mixedviT re mdgomareobebis SemTxvevaSi, romlebsac Sesabamisi
konversiuli aSliloba fizikuri mizezebi ar gaaCniaT (cxrili 10.1). ICD-10-Si
somatizebuli aSliloba es aSlilobebi calke kategoriad gamoyofili ar aris
aradiferencirebuli da klasificirebulia `nevrotuli, stresTan dakavSi-
somatoformuli aSliloba rebuli da somatoformuli aSlilobebis~ jgufSi.
ipoqondria am or klasifikacias isic ganasxvavebs, rom ICD-10-
sxeulis dismorfuli aSliloba Si miTiTebuli mdgomareoba, romelsac konversiuli
somatoformuli aSliloba, romelic aSliloba ewodeba, DSM-Si gaerTianebulia `disocia-
sxvagvarad ar aris dazustebuli ciuri aSlilobebis~ jgufSi, maSin, rodesac DSM-IV-
tkivilis aSliloba Si, konversiuli aSliloba klasificirebulia, ro-
tkivilis zogierTi specifiuri sindromi gorc somatoformuli aSliloba. mocemul TavSi Cven
disociaciuri aSlilobebi DSM-IV-iT vixelmZRvanelebT.
disociaciuri aSlilobis tipebi
disociaciuri amnezia somatoformuli aSliloba
disociaciuri fuga am TavSi mocemuli masalis ganxilva unda moxdes
identobis disociaciuri aSlioba me-16 TavSi Semaval, auxsneli somaturi simptomebis
depersonalizaciuri aSliloba
ICD-10-Si mocemuli sxva disociaciuri boqsi 10.1 zogierTi ganmarteba
aSlilobebi (romlebic DSM-IV-Si somatoformuli aSlilobebi. es zogadi termini DSM-IV-
ar aris miTiTebuli). Si gamoyenebulia iseTi aSlilobebis jgufis aRsaniSnad,
romlis damaxasiaTebeli somaturi simptomebi organuli
faqtorebiT ver aixsneba.
mocemuli Tavi ZiriTadad exeba somatur simptomebs,
somatizacia. procesi, rodesac xdeba somaturi simptomebis
romlebsac aSkara fizikuri mizezebi ar gaaCniaT da aRmoceneba maTTvis adekvaturi organuli mizezebis ga
ufro fsiqologiuri mizezebiTaa ganpirobebuli. reSe.
aseT aSlilobebs somatoformuli aSlilobebi ewo- somatizebuli aSliliba. Sesabamisi fizikuri mizezebis
deba. aseve ganxiluli iqneba aSlilobebi, romelTac gareSe aRmocenebuli mravlobiTi somaturi simptomiT
mimdinare xangrZlivi mdgomareoba.
cnobierebis an identobis darRvevebi axasiaTebs, mag.,
amnezia da mravlobiTi pirovnuli aSliloba (diso- disociacia hipoTeturi meqanizmia. disociaciis dros
cnobierebasTan dakavSirebuli fsiqologiuri pro
ciaciuri aSlilobebi). romlebic, aseve, ar arian cesebi danawevrebuli da fragmentulia. disociacia
somaturi mizezebiT gamowveuli. DSM-IV-Si somato- ufro dawvrilebiT ganxilulia me-8 TavSi, stresTan
formuli da disociaciuri aSlilobebi erT TavSia dakavSirebul aSlilobebze saubrisas.
klasificirebuli da Cvenc maT erTad ganvixilavT. disociaciuri simptomebi. simptomebi, romlebic, savara
udod, disociaciis meqanizmis meSveobiT aRmocendeba.
Tumca, es aSlilobebi erTmaneTTan mWidrod dakavSi-
rebuli araa. amitom, am TavSi mocemuli masala etio- konversia. froidis mier SemoRebuli termini iseTi
hipoTeturi meqanizmis aRsaniSnad, romlis meSveobiT xdeba
logiuri TvalsazrisiT nakleb Tanmimdevruli da ar- fsiqologiuri stresis somatur simptomebad gardaqmna
gumentirebulia. (fsiqologiuri stresi iwvevs somatur simptomebs) (anu).
zogierTi termini, romelic am TavSi iqneba gamoyene- konversiuli aSliloba. es termini iseT mdgomareobebs
buli, 10.1 boqsSia ganmartebuli. aRniSnavs, romlebic, SeiZleba, konversiiT iyos ga
mowveuli. aseTi mdgomareobebi warsulSi isteriis saxeliT
iyo cnobili.
_ 218 _
somatoformuli aSlilobebi
qveTavTan erTad. aq visaubrebT iseT auxsnel fizikur

cxrili 10.1 somatoformuli aSlilobebis
simptomebze, romlebic somatoformul daavadebebSia
kategoriebi ICD-10-sa da DSM-IV-is mixedviT
klasificirebuli. somatoformuli aSliloba, ro
gorc pirobiTi diagnostikuri kategoria, mravali ICD-10 DSM-IV
wlis win iqna Setanili DSM-III-Si, Tumca am kate somatizebuli aSliloba somatizebuli aSliloba
goriis Rirebuleba dRemde gaurkveveli rCeba. aradiferencirebuli aradiferencirebuli
somatoformuli aSlilobis ganmsazRvrel niSan- somatoformuli aSliloba somatoformuli aSliloba
Tvisebas warmoadgens:
ipoqondriuli aSliloba ipoqondria
somaturi daavadebisTvis damaxasiaTebeli fizikuri
somatoformuli kategoriis gareSe
simptomebis arseboba, romlebsac TvalsaCino or
avtonomiuri vegetatiuri
ganuli mizezebi ar gaaCniaT. amasTan, arsebobs myari disfunqcia
mtkicebuleba, rom es simptomebi fsiqologiur
qronikuli tkivilis aSliloba, romelic
faqtorebTan an konfliqtTan arian dakavSirebulni. somatoformuli tkivili fsiqologiur faqtorebTan
eWvgareSea, rom es simptomebi, romlebic mniSvnelovan (da zogad somatur
mdgomareobasTan) aris
distressa da unarebis SezRudvas iwveven, bevr
dakavSirebuli
adamians aReniSneba (Bass et al., 2001). Tumca, ramdenad
mizanSewonilia iseTi mdgomareobebis erT jgufSi sxva somatoformuli somatoformuli aSlilobebi,
aSlilobebi romlebic sxvagvarad ar
gaerTianeba, romlebic mravali niSniT gansxvavdebian aris dazustebuli
erTmaneTisgan da, amasTan, garkveulwilad gada
kategoriis gareSe sxeulis dismorfuli
faraven SfoTviT da depresiul aSlilobebs (maRa aSliloba
li komorbidoba), dRemde ar aris saTanadod da
kategoriis gareSe konversiuli aSliloba
sabuTebuli. amasTan, ipoqondria da somatizebuli
aSliloba imdenad mdgradi mdgomareobebia, rom zogi nevrasTenia kategoriis gareSe
mecnieris azriT, personologiuri aSlilobis jgufSi
unda gaerTiandes. (somatoformuli aSlilobis cne riumebi SemuSavebulia stacionarul pacientebze
bis kritika mocemulia Semdeg wyaroSi: Sharpe and dakvirvebis Sedegad da naklebad miesadageba mo-
Mayou (2004). saxleobaSi gavrcelebul auxsnel somatur mdgo-
mareobebs.
klasifikacia DSM-IV-isa da ICD-10-is mixedviT w mosaxleobaSi gavrcelebuli mravali SemTxveva ar
DSM-IV-sa da ICD-10-Si somatoformuli aSlilobebis akmayofilebs somatoformuli aSlilobis diagnos-
kategoriebs Soris mravali msgavsebis miuxedavad ori tikur kriteriumebs. aseTi SemTxvevebi ori ara-
mniSvnelovani gansxvaveba aRiniSneba: specifikuri kategoriidan erT-erTs unda mivakuT-
w nevrasTenia ar aris mocemuli DSM-IV-Si, radgan vnoT. esenia: aradiferencirebuli somatoformuli
es kategoria SeerTebul StatebSi iSviaTad gamoiy- aSliloba da sxva somatoformuli aSlilobebi.
eneba. ICD-10-Si ki, rogorc saerTaSoriso klasifi- es rezidualuri kategoriebi naklebad aris Ses-
kaciur sistemaSi, nevrasTeniis kategoria Seta- wavlili da imdenad vrcelia maTi diagnostikuri
nilia, radgan mas zogierT Soreul aRmosavleTis kriteriumebi, rom SeiZleba moicvas TiTqmis yvela
qveyanaSi iyeneben. persistentuli auxsneli somaturi simptomi.
w konversiuli aSliloba warmoadgens somatofor- w DSM-IV-isa da ICD-10-is kriteriumebs Soris erTi

mul aSlilobas DSM-IV-is mixedviT, magram ara ICD- SexedviT umniSvnelo gansxvavebebi somatoformuli
10-is mixedviT (ix. zemoT). aSlilobis da misi subkategoriebis gavrcelebis
SefasebaSi seriozul gansxvavebebs iZleva (Simon,
w sxeulis dismorfuli aSliloba ICD-10-Si calke
2000).
kategoriad ar aris gamoyofili, igi ipoqondriuli
Cven ar vflobT sakmaris informacias klasifikaci-
aSlilobis diagnostikur kriteriumebSia Setanili.
is am nawilis safuZvlianad ganaxlebisTvis da amitom
garda amisa, arsebobs orive klasifikaciisTvis vTvliT, rom mcire cvlilebebis Setanas, arc Tu ise
saerTo problemebi: didi mniSvneloba aqvs. amis magivrad SeiZleba ufro
w jgufs SigniT arsebuli diagnostikuri kriteri- sasargeblo iyos somatoformuli aSlilobebis mra-
umebi araerTgvarovan principebzea dafuZnebuli valganzomilebiani aRwera (klinikuri sindromi, xan-
(etiologia, simptomebis raodenoba, konsultacie- grZlivoba, simptomebis raodenoba, kogniciebi da am
bi, somatur mkurnalobaze sapasuxo reaqcia). kategoriasTan dakavSirebuli fsiqikuri aSlilobi)
w ipoqondriuli aSlilobebis diagnostikuri krite- (ix. Sharpe and Mayou 2004).
_ 219 _
10 somatoformuli da disociaciuri aSlilobebi
boqsi 10.2 isteriis mokle istoria didi STabeWdileba moaxdina pacientebis sugestiurobam
hipnozis mimarT (ix. Sulloway, 1979). venaSi dabrunebis Semdeg,
isteriis aRwera jer kidev Zvel berZnul samedicino froidma da misma kolegam bruerma (Breuer) Seiswavles
teqstebSi gvxvdeba. im dros iTvleboda, rom isteria isteriuli pacientebi da TavianTi kvlevis Sedegebi
saSvilosnos mdebareobis an funqciis paTologiiT iyo pirvelad gamoaqveynes fundamentur naSromSi ìsteriis
gamowveuli. amgvari Sexeduleba meCvidmete saukunemde fenomenebis fsiqikuri meqanizmebis Sesaxeb~) (On the psychical
iyo gabatonebuli. SemdgomSi, TandaTanobiT, damkvidrda mechanisms of hysterical phenomena, 1893), xolo mogvianebiT
mosazreba, rom isteria Tavis tvinis darRvevas monografiaSi gamokvlevebi isteriis Sesaxeb (Studies on
warmoadgenda. mecxramete saukuneSi daadgines, rom Hysteria, 1893-5). isini Tvlidnen, rom isteria gamowveulia
tvinis am darRvevis dros mniSvnelovan rols TamaSobs emociurad datvirTuli (Cveulebriv, seqsualuri
predispoziciuri konstituciuri da organuli xasiaTis) ideebiT, romlebic garkveuli saxis warsuli
faqtorebi. garda amisa, isteriis maprovocirebel gamocdilebis gamo cnobierebidan represiis meSveobiT
mizezad Zlieri emocia iqna miCneuli. aracnobierSia gandevnili. (ix. gv. ???). froidma termini
mecxramete saukunis meore naxevarSi gansakuTrebuli `konversia~ gamoiyena im hipoTeturi procesis aRsaniSnad,
popularobiT sargeblobda frangi nevrologis, Sarkos romlis meSveobiTac aseTi faruli, gamoumJRavnebeli
naSromebi isteriis Sesaxeb. Sarko parizis erT-erT emocia fizikur simptomebad gardaiqmneba. bruerma da
saavadmyofoSi (Salptrire Hospital) muSaobda. Tavdapirvelad froidma es idea Semdegi fraziT gamoxates: ìsteriuli
is darwmunebuli iyo, rom isteriis simptomebi gamowveuli adamianebi, ZiriTadad, mogonebebiT itanjebian~.
iyo Tavis tvinis disfunqciiT da rom aseTi darRvevebi momdevno wlebSi froidi mivida im daskvnamde, rom es
pacinets hipnozisadmi gansakuTrebiT mgrZnobiares Tavdapirveli formulireba ar iyo swori da sugestiuri
xdida. pacientebis mier gamogonil, yalb monaTxrobs efuZneboda.
Sarko Tvlida, rom momatebuli mgrZnobelobis amis Semdeg mas isteriis Sesaxeb araferi dauweria. sxva
gamo pacientTan sugestiis meSveobiT SesaZlebeli iyo mecnierebi isteriis mimarT nakleb interess iCendnen
axali simptomebis gamowveva da arsebuli simptomebis da amis gamo am fenomenis dazustebaSi mniSvnelovani
modificireba. mogvianebiT, Sarko dainteresda Tavisi progresi ar yofila miRweuli. ganviTarebul qveyenebSi
yofili moswavlis, pier Janes ideiT imis Taobaze, rom isteria seriozul problemad ar iTvleboda. arsebobda
isteriis dros, ZiriTad darRvevas warmoadgens ara mosazreba, rom bevri aSkarad gamoxatuli SemTxveva,
sugestiuroba, aramed midrekileba disociaciisaken. sinamdvileSi, daudgenel organul daavadebas
kerZod, Jane imas gulisxmobda, rom isteriis dros warmoadgenda. am Sexedulebas gansakuTrebiT uWerda
darRveulia fsiqikur funqciebs Soris normaluri mxars sleiteri (Slater, 1965), romelic isteriis diagnozis
integracia (ix. agreTve, gv. ???). igi miiCnevda, rom aseTi mqone 85 pacients Svidi wlis ganmavlobaSi akvirdeboda.
disociacia iwvevs fsiqikuri funqcionirebis garkveuli dakvirvebis Sedegad 30 pacients organuli daavadeba
aspeqtebis gacnobierebis uunarobas. garkveuli periodis daudginda, xolo 34-s _ isteriisagan gansxvavebuli
manZilze Janes ideebi Zalze popularuli iyo, Tumca fsiqikuri aSliloba. mogvianebiT, isteriis Sesaxeb
isini arasodes yofila iseTi gavleniani, rogorc arsebulma Sexedulebam cvilebebi ganicada, razec ???
froidis ideebi. isteriis Sesaxeb Janes ideebis mimoxilva gverdze iqneba saubari.
mocemulia Semdeg wyaroSi: van der Kolk and van der Hart (1989). (isteriis istoriis Sesaxeb informaciis mosapoveblad
1895-96 wlis zamTarSi froidma Sarko moinaxula. masze ixileT Shorter (1992), xolo konversiis cnebis istoriis
Sesaxeb informaciis mosapoveblad _ Mace (2001).
konversiuli aSliloba 1. konversiuli aSliloba motoruli darRvevebiTa

termini `konversiuli aSliloba~ DSM-IV-Si moZ da motoruli simptomebiT. am qvetipSi Sedis iseTi
velebuli terminis ìsteriis~ magivrad gamoiyeneba. simptomebi, rogoricaa koordinaciis an balansis
ICD-10-Si is disociaciuri (konversiuli) aSlilobis darRveva; paralizi (dambla) an lokaluri sisuste;
ekvivalenturia da miuTiTebs iseT mdgomareobaze, ylapvis gaZneleba an `yelSi burTis gaCxeris~ Seg-
romlis drosac pacients aReniSneba calkeuli rZneba; afonia da Sardis Sekaveba.
nevrologiuri simptomebi, romelTa axsnac romelime 2. konversiuli aSliloba sensoruli darRvevebiTa
cnobili paTologiuri meqanizmiT ver xerxdeba; garda da sensoruli simptomebiT. am qvetipSi Sedis is-
amisa, am dros arsebobs mniSvnelovani fsiqologiuri eTi simptomebi, rogoricaa Sexebis an tkivilis Seg-
stresori. aseTi simptomebis Seswavlas xangrZlivi rZnebis dakargva, mxedvelobis gaoreba, sibrmave,
istoria aqvs da misi conda aucilebelia konversiuli siyrue da halucinaciebi.
aSlilobis cnebis dRevandeli statusis gasagebad. 10.2 3. konversiuli aSliloba gulyrebiT an kon-
boqsSi mocemuli aRwera ufro vrcelia, vidre es am vulsiebiT. am qvetipSi Sedis gulyrebi an kon-
miznisTvis aris saWiro, magram isteriis Sesaxeb warsulSi vulsiebi, romelTac nebelobiTi motoruli an sen-
arsebuli mosazrebebis codna aseve mniSvnelovania soruli komponentebi axlavs Tan.
froidis ideebis gagebisTvis, romlebmac Zalze didi
4. Sereuli konversiuli aSliloba. am qvetips iyene-
gavlena moaxdines meoce saukunis fsiqiatriaze.
ben maSin, rodesac pacients erTze meti kategoriis
klinikuri maxasiaTeblebi simptomi aReniSneba.
DSM-IV-Si konversiuli aSliloba oTx qvetipad aris Cveulebriv, konversiuli simptomebi ar asaxaven
dayofili: iseT fiziologiur an paTologiur meqanizmebs, rom-
_ 220 _
lebic sxva nevrologiur dazianebebSi aisaxeba. kon- w neirofiziologiuri meqanizmebi: Tavis tvinis fun-
versiuli simptomebi, aseve, Zalian mgrZnobiarea sug- qciuri neirovizualuri gamokvlevebiT miRebuli
estiis mimarT da SeiZleba mniSvnelovnad Seicvalon Sedegebi esadageba mosazrebas, rom Seferxebulia
sxva adamianebis, gansakuTrebiT ki eqimebis, komen- informaciis gadacema moZraobis intenciasa da moZ-
tarebis Sedegad. mag., pacients, romelsac siaruli raobis iniciaciasTan dakavSirebul Tavis tvinis
uWirs, SeiZleba simptomebi `gauZlierdes~ Tu mas in- ubnebs Soris (Athwal et al., 2001).
validis etls SevTavazebT. garda amisa, konversiuli w kognituri axsna. brauni (Brown, 2002) Tvlida, rom
aSlilobebis mqone adamiani SeiZleba naklebad wuxdes konversiuli simptomebi warmoadgenen mexsierebaSi
Tavisi simptomebisa da maTi Sedegebis gamo. am Tvise- Senaxuli simptomebis qronikuli aqtivaciis Sedegs.
bas zogjer la belle indifference (~lamaz gulgrilobas~) es ki ganpirobebulia am simptomebis gamovlinebebis
uwodeben (es termini mecxramete saukunis frangi mw- mimarT gadaWarbebuli yuradRebiT.
erlebisganaa nasesxebi).
w kulturologiuri axsna. zogierTi fenomeni, ro-
xSirad Tvlian, rom konversiuli aSlilobis mqone
melic dasavlur qveynebSi klasificirebulia, ro-
adamianebisTvis maT simptomebs meoradi gamorCena
gorc konversiuli aSliloba, SeiZleba sxva qvey-
aqvT, rac garkveul privilegiebsa da maTTvis arasa-
nebis kulturaSi Sepyrobilobis mdgomareobad iyos
surveli pasuxismgeblobebis Tavidan acilebaSi md-
miCneuli (ix. transi da Sepyrobilobis mdgomareo-
gomareobs (termini `pirveladi gamorCena~ imaze
ba, gv. ??).
miuTiTiTebs, rom fsiqikuri distresis gardaqmna
fizikur simptomebad anu konversia pacientisTvis etiologiasTan dakavSirebuli Teoriebis gansaxil-
Svebis momtania). meoradi gamorCenis dadgena zogjer velad ix. Halligan et al., (2001).
SeuZlebelia. garda amisa, meoradi gamorCeniT sxva prognozi
fsiqikuri an somaturi darRvevebis mqone paciente-
mogvianebiT ganviTarebuli nevrologiuri aSlilo-
bic sargebloben.
bebis prognozi. zogad praqtikaSi da saavadmyofos
epidemiologia saswrafo daxmarebis ganyofilebis pacientebze dak-
zogad populaciaSi rTulia konversiuli aSlilobis virvebis Sedegad dadginda, rom konversiuli aSli-
gavrcelebis sixSiris dadgena. monacemebi cvaleba- lobebi swrafad ikurneba adreul stadiaze. aSli-
dobs gamoyenebuli kriteriumebisa da demografiuli lobebi, romlebic erT welze didxans mimdinareobs,
kvlevebis tipis mixedviT. xuTi gamokvlevis Sedegebis savaraudod, mravali wlis manZilze grZeldeba. erT-
ganxilvisas aRmoCnda, rom am aSlilobis gavrcelebis erT sayovelTaod cnobil grZelvadian kvlevaSi, ro-
sixSire weliwadSi 100 000-dan 5-12 SemTxvevas Sead- melzec zemoT ukve gvqonda saubari, sleiteri (Slater,
gens. yvelaze dabali maCvenebeli fsiqiatriul praq- 1965) aRniSnavs, rom pacientebis did nawils, droTa
tikaSi dadginda, radgan konversiuli aSlilobis ganmavlobaSi, somaturi da fsiqikuri aSliloba uvi-
mqone bevri pacienti ar mimarTavs fsiqiatrs. monace- TardebaT. amJamad iTvleba, rom aseTi Sedegi atipiuri
mebi SeiZleba ufro metadac varirebdes, magram Cveu- SerCeviT iyo gamowveuli. kerZod, sleiteris SerCevaSi
lebriv 100 000-dan 50 SemTxvevas ar aRemateba (mag., Sediodnen is nevrologiuri pacientebi, romlebic spe-
Singh and Lee, 1997). mcirericxovanma gamokvlevebma, cializirebul stacionarSi gadiodnen mkurnalobas.
romlebiTac xdeboda konversiuli aSlilobis Sem- igive stacionarSi, mogvianebiT Catarebulma kvlevam
Txvevebis grZelvadiani monitoringi, ar daadastura im pacientebze, romelTa simptomebis axsnac arsebuli
Sexeduleba, rom konversiuli aSlilobebi SeiZleba kvlevis meTodebiT SeuZlebeli iyo, gamovlina, rom am
savsebiT ganikurnos (Akagi and House, 2002). pacientebis mxolod Zalian mcire nawils aReniSneboda
sxva fsiqikuri aSlilobebi an somaturi daavadebebi,
etiologia romliTac SesaZlebeli gaxdeboda am simptomebis axsna
konversiuli aSlilobebis etiologia ucnobia. arse- (Crimlisk et al., 1998). amasTan, konversiuli aSlilobis
bobs ramdenime etiologiuri Teoria, Tumca maT mci- diagnozis SemTxvevaSi, es mdgomareoba, droTa ganmav-
redi mtkicebuleba gaaCniaT. lobaSi, sakmaod stabiluri iyo.
w fsiqodinamiuri TeoriiT konversia ganmartebiTi mogvianebiT ganviTarebuli fsiqikuri aSlilobis
cnebaa, romelic miuTiTebs emociuri distresis prognozi. aseT pacientebTan mogvianebiT ganviTare-
gardaqmnaze simboluri mniSvnelobis somatur simp- buli nevrologiuri aSlilobebi iSviaTad iCens Tavs,
tomebad. Tumca maRalia fsiqiatriuli avadoba. Cveulebriv
fsiqikuri aSlilobis simptomebi eqimTan pirvelive
w socialuri faqtorebi konversiuli simptomebis aR-
vizitze vlindeba da ara mogvianebiT, ramdenime wlis
mocenebisa da ganviTarebis mTavar determinantebs
Semdeg.
warmoadgenen.
_ 221 _
prognozis prediqtorebi. dadebiTi gamosavalis avadmyofis mimarT damokidebuleba gulisximieri da

prediqtorebs warmoadgens avadmyofobis xanmokle mxardamWeri unda iyos. arc erT SemTxvevaSi ar SeiZ-
istoria da pacientis axalgazrda asaki. arasasurveli leba uyuradRebobis gamoCena an raime sadamsjelo
gamosavalis prediqtorebs warmoadgens avadmyofobis zomebis miReba. am miznebis misaRwevad aucilebelia
xangrZlivi istoria, personologiuri aSliloba da detaluri gegmis SemuSaveba, romelsac medpersonali
invalidobis daxmarebis miReba an sasamarTlo davaSi Tanmimdevrulad ganaxorcielebs pacientTan urTier-
monawileoba (Ron, 2001). Tobis prcesSi.
konversiuli aSlilobebis dros medikamenturi
mkurnaloba mkurnaloba naleb efeqturia. Tumca, Tu mdgomareoba
pirveladi da gadaudebeli daxmarebis dawesebule- depresiuli an SfoTviTi aSlilobis fonze, meoradad
bebSi pacientebze dakvirvebis Sedegad dadginda, rom viTardeba, saWiroa ZiriTadi aSlilobis mkurnalo-
mwvave konversiuli aSlilobebis dros saWiroa daba. pirveladi mdgomareobis mkurnaloba, Cveulebriv,
vamSvidoT pacienti, gamoviyenoT STagoneba da dau- meoradi simptomebis Sesustebas iwvevs. kognitur-bi-
yovnebliv miviRoT zomebi im stresuli situaciebis hevioruli Terapia nakleb efeqturia, Tumca is Seg-
mosagvareblad, romlebmac gamoiwvia pacientis reaq- viZlia gamoviyenoT, rogorc araspecifikuri damxma-
ciis provocireba (boqsi 10.3). eqimma pacientis mimarT re saSualeba, romelic pacientis gamojanmrTelebas
unda gamoamJRavnos TanagrZnoba da pozitiuri damo- Seuwyobs xels.
kidebuleba. is unda ecados, rom pacienti swrafad Zalze mniSvnelovania, rom simptomebis Sesasuste-
daubrundes normalur fizikur funqcionirebas (mag., blad gatarebuli zomebis paralelurad, pacients
uzrunvelyos, fizioTerapiis mokle kursis Catare- gaewios daxmareba aSlilobasTan dakavSirebuli ne-
ba). pacienti unda grZnobdes, rom eqimi mis problemas bismieri piradi da socialuri problemebis daZle-
seriozulad ekideba, rom misi mdgomareoba gavrce- vaSi. am mxriv sasargeblo iqneba xanmokle da foku-
lebul movlenas warmoadgens da rom gamojanmrTe- sirebuli fsiqologiuri mkurnalobis Catareba, ma-
leba namdvilad SesaZlebelia. Terapevtma unda gani- gram ufro intensiurma Terapiam SeiZleba pacientTan
xilos pacientis nebismieri pirovnuli problema da gadatanis (transferis) reaqcia gamoiwvios, romlis
CaTvalos, rom is TavisTavad imsaxurebs yuradRebas. marTvac sakmaod rTulia.
Tu simptomebi erT kviraze didxans gagrZelda, saWi- pacientebi, romlebsac mkurnalobis Sedegad gaum-
roa ufro aqtiuri mkurnalobis Catareba. am dros jobeseba ar aReniSnebaT, safuZvlianad unda gamo-
intervencia mimarTulia normaluri qcevis waxali- vikvlioT somaturi daavadebis gamovlenis mizniT.
sebaze da im faqtorebis aRmofxvraze, romlebic nebismier pacientze (ganurCevlad imisa, aReniSneba
aZliereben pacientis simptomebsa da disfunqcias. Tu ara mas gaumjobeseba), unda vawarmooT xangrZlivi
eqimma unda ganumartos mas, rom misi simptomebi da dakvirveba, raTa gamovricxoT raime organuli daa-
unarebis SezRudva (mag., damaxsovrebis an xelis moZ- vadeba, romelic SeiZleba Tavdapirveli gamokvlevis
raobis unaris dakargva) gamowveulia ara somaturi dros gamogvrCes.
daavadebiT, aramed intenciis qmedebaSi gardaqmnis
uunarobiT. mas, aseve, unda avuxsnaT, rom sensoru- èpidemiuri isteria~
li problemebi gamowveulia sensoruli informaciis xandaxan disociaciuri (konversiuli) aSliloba adami-
Secnobis uunarobiT da ara sensoruli gzebis dazia- anebis garkveul jgufSi èpidemiis~ msgavsad vrcel-
nebiT, anu gamowveulia fsiqologiuri faqtorebiT. deba. yvelaze xSirad, es movlena qalTa daxurul jgu-
eqimma unda gaamxnevos pacienti da uTxras, rom mas febSi aRiniSneba (mag., qalTa skolaSi, moxucebulTa
SeuZlia darRveul funqciaze kontrolis aRdgena. TavSesafarSi an qalTa monasterSi). rodesac jgufs
garda amisa, saWiroebis SemTxvevaSi, unda SesTavazos raime saSiSroeba emuqreba (mag., regionSi gavrcele-
samedicino daxmareba, rac, Cveulebriv, fizioTera- buli mZime somaturi daavadebiT dasnebovnebis riski),
piis kursis Catarebas gulisxmobs. jgufis wevrebSi SfoTva TandaTanobiT Zlierdeba.
mkurnalobis procesSi yuradReba gadaaqvT simp- rogorc wesi, epidemia erTi adamianidan iwyeba, ro-
tomebidan im problemebze, romlebmac aSlilobis melic jgufis wevrebis yuradRebis centrSi imyofeba
provocireba gamoiwvies. saavadmyofos personalma da gansakuTrebuli sugestiurobiTa da isteriulo-
mzrunveloba unda gamoiCinos pacientis mimarT, ma- biT gamoirCeva. es pirveli SemTxveva SeiZleba provo-
gram, amavdroulad, is TviTdaxmarebisaken unda waaxa- cirebuli iyos somaturi daavadebis saSiSroebasTan
lisos. Zalze mniSvnelovania, rom personali, pacien- dakavSirebuli zogadi winaTgrZnobiT an konkretuli
tis unarSezRudulobis gamo, ar wavides zedmet daT- adamianis (nacnobis) avadmyofobaze wuxiliT. Tanda-
mobebze. mag., pacientisTvis, romelsac siaruli ar TanobiT jgufSi sxva SemTxvevebic iCens Tavs: pirve-
SeuZlia, ar aris saWiro invalidis etlis SeTavazeba. lad im adamianebTan, romlebic ufro sugestiurebi
_ 222 _
arian, xolo Semdeg, SfoTvis gaZlierebasTan erTad, _ 1%-dan 2%-mde meryeobs. somatizebuli aSliloba
maT Sorisac, visac naklebi predispozicia gaaCnia. qalebTan orjer ufro xSiria, vidre _mamakacebTan.
simptomebi sxvadasxvagvaria, magram maTSi yvelaze mas mniSvnelovani komorbidoba gaaCnia sxva fsiqikur
ufro gavrcelebuli Tavbrusxveva da gulis wasvlaa. aSlilobebTan, mag., did depresiasTan. somatizebu-
isteriis epidemiuri afeTqebebi dafiqsirebuli iyo li aSliloba bevrad ufro naklebad stabiluria,
skolis moswavleebTan. zogierTi avtori Tvlis, rom vidre es sindromis Tavdapirveli aRweris dros iyo
Sua saukuneebSi gavrcelebuli qoreomania (`dancing navaraudevi. am sakiTxTan dakavSirebiT informaciis
manias~) savaraudod isteriul epidemias warmoadgen- mosapoveblad ix. Simon (2000); Fink (2000).
da, romelic religiuri aRtkinebiT iyo gamowveuli
etiologia
(ix. Wessely, 1987).
sent-luiselma mecnierebma daafiqsires memkvidreo-
somatizebuli aSliloba biTi kavSirebis arseboba somatizebuli aSlilobis
mqone qalebsa da maTi mamrobiTi sqesis naTesavebs
somatizebuli aSlilobis ZiriTad niSan-Tvisebas war-
Soris, romlebsac sociopaTia an alkoholizmi aRe-
moadgens xangrZlivi, mravlobiTi somaturi Civile-
niSnebodaT. maT, aseve, daaskvnes, rom katamnestiku-
bi, romlebic 30 wlamde vlindeba. 1962 wels sent-
ri dakvirvebebisa da ojaxis gamokvlevebis mixedviT,
luiselma fsiqiatrebma (Perley and Guze, 1962) aRweres
somatizebuli aSliloba warmoadgens unitarul sin-
qronikuli mravlobiTi somaturi Civilebi, romel-
droms, romelic droTa ganmavlobaSi stabiluria.
Ta organuli mizezebic daudgeneli iyo. maT aseTi
aseTi Sexeduleba SemdgomSi ar iqna dadasturebuli.
mdgomareoba isteriis erT-erT formad miiCnies da
vinaidan somatizebuli aSlilobis diagnostirebisT-
mas brikes sindromi uwodes. es saxelwodeba momdi-
vis xangrZlivi droa saWiro, gamoTqmulia mosazreba,
nareobs mecxramete saukunis frangi eqimisgan, ro-
rom umjobesia is personologiur aSlilobad CavTva-
melsac isteriis Sesaxeb monografia aqvs dawerili.
loT. Tumca, amgvari mosazreba ar aiolebs am mdgo-
sinamdvileSi brikes ar aqvs aRwerili is sindromi,
mareobis gamomwvevi mizezebis gagebas. auxsneli soma-
romelsac dRes misi saxeli hqvia da mis mier aRweri-
turi simptomebis gamomwvevi mizezebi mogvianebiT, me
li simptomebi ar Seesatyviseba isteriis Sesaxeb amJa-
-16 TavSia ganxiluli.
mad gavrcelebul warmodgenas.
msgavsi sindromi DSM-III-Si iyo Setanili. misi dia- mkurnaloba
gnostikuri kriteriumebi imdenad iyo SezRuduli,
somatizebuli aSlilobis mkurnaloba rTulia da xSi-
rom bevri adamiani, romelsac mravlobiTi somaturi
rad did xarjebTan aris dakavSirebuli. kargi iqne-
Civilebi aReniSneboda, ar esadageboda am katego-
ba, Tu mkurnalobas warmarTavs erTi eqimi, romelic
rias, ris gamoc, am adamianebs aradiferencirebuli
pacientis mimarT mudmiv mzrunvelobas gamoiCens da
somatoformuli aSlilobis rezidualur kagegorias
mxolod aucilebel gamokvlevebs Cautarebs. aseTma
miakuTvnebdnen. DSM-IV-is diagnostikuri kriteri-
midgomam SeiZleba Seamciros imis saWiroeba, rom pa-
umebi naklebad SezRudulia. aucilebelia oTxi tki-
cientebma janmrTelobis dacvis samsaxurebs mimar-
vilis simptomis _ ori gastrointenstinuri simpto-
Ton. es, agreTve, gaaumjobesebs maTi funqcionirebis
mis, erTi seqsualuri da erTi fsevdonevrologiuri
xarisxs (Smith et al., 1986; G. R. Smith, 1995). fsiqia-
simptomis arseboba, saidanac arc erTi bolomde ar
triuli gamokvleva dagvexmareba gaverkveT avadmyo-
aixsneba somaturi daavadebiT. ICD-10-is diagnosti-
fobis rTul istoriaSi, SevimuSavoT pacientis mov-
kuri kriteriumebis mixedviT dadgenili ToTxmeti
lis gamartivebuli gegma da mkurnalobis miznebi pa-
simptomidan aucilebelia sul cota eqvsi simptomis
cientTan da mis ojaxis wevrebTan da isini pacientis
arseboba, romlebic minimum or organoTa sistemasTan
fizikur janmrTelobaze pasuxismgebel eqimTan Seva-
iqneba dakavSirebuli. simptomebis CamonaTvali oTx
TanxmoT. xSirad mkurnalobis mizans, avadmyofobis
jgufadaa dayofili _ gastrointenstinuri, kardio-
Semdgomi ganviTarebis SeCereba ufro warmoadgens,
vaskuluri, neirogenitaluri da kanis an tkivilis
vidre pacientis sruli gankurneba. mkurnalobis Se-
simptomebi.
saxeb informaciis mosapoveblad ix. Fink (2000).
epidemiologia
aradiferencirebuli somatoformuli
somatizebuli aSlilobis gavrcelebis maCvenebeli
damokidebulia kvlevis dros gamoyenebul meTodeb- aSliloba
zea. sazogadoebrivi gamokiTxvis Sedegad miRebuli aradiferencirebuli somatoformuli aSliloba war-
monacemebis mixedviT, maTi gavrcelebis sixSire 1%- moadgens rezidualur kategorias iseTi auxsneli so-
ze naklebia, maSin, roca pirveladi samedicino daxma- maturi simptomebis klasifikaciisTvis, romlebic mi-
rebis dawesebulebebSi Catarebuli kvlevis mixedviT nimum eqvsi Tvis manZilze grZeldeba da ar aris sakma-
_ 223 _
risi somatizebuli aSlilobis diagnozis dasasmelad. genas arTulebs Sefasebis aprobirebuli standarti-
somatizebul aSlilobasTan SedarebiT ufro gavrce- zebuli meTodebis ararseboba. pirveladi samedicino
lebuli mdgomareobaa aradiferencirebuli somato- daxmarebis dawesebulebebSi Catarebuli zogierTi
formuli aSliloba. auxsneli simptomebis raodeno- kvlevis mixedviT am aSlilobis gavrcelebis sixSire
bisa da gavrcelebis Sesaxeb arsebuli monacemebi ar daaxloebiT 5%-s udris, xolo jandacvis msoflio
iZleva am ori aSlilobis mkveTrad urTierTgamijvnis organizaciis mier pirveladi jandacvis doneze Cata-
saSualebas. aqedan gamomdinare, gamoiTqva mosazreba, rebuli multicentruli gamokvlevis mixedviT _ mxo-
rom somatizebuli aSlilobis kriteriumebi nakle- lod 0.8%-s (Gureje et.al., 1997a). naklebad mkacri defi-
bad SemzRudavi unda iyos. (mag., Escobar et al., 1998). niciis gamoyenebisas gavrcelebis sixSirem 2.2% Sead-
es problema dRemde gadauWrelia, sindromis subie- gina. aseTi definicia ar iTvaliswinebs kriteriums _
qturad, auxsneli somaturi simptomebis raodenobis `sawinaaRmdego samedicino mtkicebulebebis mudmivi
mixedviT gansazRvra, miCneuli dausabuTeblad, vin- uaryofa~, magram masSi SenarCunebulia triada: wuxi-
aidan kvlevebiT Sedegad aseTi mdgomareobebis spe- li avadmyofobis gamo, masTan dakavSrebuli distresi
qtria gamovlenili. da eqimebTan ganmeorebiTi vizitebi. ipoqondriuli
aSlilobis dros xSiria komorbidoba depresiul da
ipoqondria SfoTviT aSlilobebTan. epidemiologiis Sesaxeb in-
termini ipoqondria erT-erT uZveles samedicino formaciis mosapoveblad ix. Simon (2000).
termins warmoadgens. mas Tavdapirvelad iyenebdnen
prognozi
iseTi aSlilobebis aRsawerad, romlebic, rogorc es
barskis da misi kolegebis mier Catarebuli (Barsky et
maSin iTvleboda, gamowveulia neknqveSa areSi mdebare
al., 1998) 4-5 wliani dakvirvebebis Sedegad aRmoCnda,
organoebis daavadebiT. mas Semdeg am termins sxva-
rom ipoqondria, xSirad, mTeli am periodis ganmav-
dasxva mniSvnelobiT iyenebdnen. dRes, DSM-IV-sa da
lobaSi narCundeba.
ICD-10-Si ipoqondria gansazRvrulia, rogorc mdgo-
mareoba, romlis drosac pirovneba darwmunebulia, etiologia
rom is garkveuli daavadebiT aris dasnebovnebuli
ipoqondriis gamomwvevi mizezebi ucnobia. ipoqondri-
(da, amis gamo, SiSiTaa Sepyrobili), rac saTanado sa-
is dros adgili aqvs normaluri sxeulebrivi SegrZne-
medicino gamokvlevebiT ar dasturdeba. DSM-IV-Si
bebis mcdar Sefasebas, rac pirovnebis mier daavade-
ipoqondria aRwerilia rogorc:
bis niSnebad aRiqmeba. amgvari mcdari interpretaciis
mdgomareoba, romlis drosac pacienti Sepyrobilia SenarCunebas xels uwyobs iseTi qcevebi, rogoricaa
SiSiT an darwmunebulia, rom seriozuli daavadeba pacientis mxridan daavadebis damamtkicebeli ar-
sWirs. pacientis mdgomareoba imiTaa gamowveuli, gumentebis mudmivi Zieba da sxeulze warmosaxviTi
rom is SegrZnebebis fizikur niSnebs somatur daa- dazianebis Tvaliereba an damuSaveba. auxsneli simp-
vadebas miawers. pacientis fizikuri janmrTelobis tomebis etiologia mogvianebiT, me-16 TavSi aris gan-
saTanado gamokvleva ar adasturebs iseTi somaturi xiluli.
daavadebis arsebobas, romliTac SeiZleba aixsnas es
mkurnaloba
fizikuri niSnebi da SegrZnebebi da pacientis mier
maTi araadekvaturi interpretacia. amgvari SiSi da radganac ipoqondria qronikuli an periodulad gan-
rwmena myaria miuxedavad sawinaaRmdego samedicino meorebadi aSlilobaa, misi marTva rTulia. eqimis
mtkicebulebebisa. mier pacientis mudmivi damSvideba usargebloa da,
SeiZleba, xelic ki Seuwyos pacientis wuxilis ga-
ipoqondriis diagnostikuri kriteriumebi isea Ser-
xangrZlivebas. aseT dros unda Catardes mxolod is
Ceuli, rom gamoricxavs panikuri aSlilobisa da bod-
gamokvlevebi, romlebic samedicino TvalsazrisiTaa
viTi ideebis arsebobas. am kriteriumebis mixedviT,
prioritetuli. pacientis sxva Civiliebis dasakmayo-
pirovnebas simptomebi minimum eqvsi Tvis manZilze
fileblad gamokvlevebis Catareba ar aris mizanSewo-
unda aReniSnebodes. arsebobs erTgvari gaurkvevlo-
nili. pacientebs daxmareba unda gavuwioT sxeulebri-
ba iseTi mdgomareobebis SemTxvevaSi, romlebic eqvs
vi SegrZnebebis mcdari interpretaciis koreqciaSi da
Tveze naklebi xangrZlivobisaa; an ipoqondriuli pi-
simptomebTan gamklavebis konstruqciuli gzebis Zie-
rovnuli aSlilobis diferencirebisas; an imasTan da-
baSi. gamokvlevebma aCvena, rom ipoqondriuli simp-
kavSirebiT, unda Sediodes Tu ara avadmyofobis SiSi
tomebis dros ufro efeqturia kognitur-bihevioru-
(nozofobia) mocemul kategoriaSi.
li mkurnaloba, vidre stresis bihevioruli marTva,
epidemiologia intervenciisgan Tavis Sekaveba (Clark et al., 1998), an
Cveulebrivi samedicino daxmarebis gaweva (Barsky and
ipoqondriuli aSlilobis gavrcelebis sixSiris dad-
_ 224 _
Aherne, 2004). ufro mZime fsiqopaTologiisa da so- pacientis mdgomareoba droTa ganmavlobaSi, gark-
cialuri funqcinirebis daqveiTebis SemTxvevaSi pro- veulwilad, gaumjobesdes, Tumca am sakiTxTan dakav-
gnozi naklebad saxarbieloa (Hiller et al., 2004). SirebiT grZelvadiani prospeqtuli gamokvlevebi ar
ipoqondriis zogadi mimoxilvisTvis ix. Noyes (2000). Catarebula.
fsiqiatriul literaturaSi mZime SemTxvevebi iS-
sxeulis dismorfuli aSliloba viaTad aris aRwerili. ufro gavrcelebulia dis-
sxeulis dismorfuli aSliloba warmoadgens termins, morfofobiis SedarebiT msubuqi SemTxvevebi, gansa-
romelic DSM-Si dismorfofobiis ufro farTo, ma- kuTrebiT im adamianebTan, romlebsac plastikuri
gram bundovani sindromis qvejgufis aRsaniSnad ga- operaciis gakeTebis survili aqvT an xSirad akiTxaven
moiyeneba. dismorfofobiis pirveli gansazRvreba dermatologs. rogorc mZime, ise SedarebiT msubu-
morselis ekuTvnis (Morselli, 1886). misi ganmartebiT, qi formis dismorfofobiis mqone pacienti, zogjer,
es aris ìm simaxinjisa da fizikuri defeqtis subie- sxva aSlilobebis diagnostikur kriteriumebsac ak-
qturi aRwera, romelsac, pacientis azriT, sxva adami- mayofilebs.
anebic amCneven~. DSM-Si termini `sxeulis dismorfu-
gamokvleva
li aSliloba~ miuTiTebs iseT dismorfofobiaze, ro-
gamokvlevis dros unda davadginoT, Tu rogoria sa-
melic ar erTiandeba sxva fsiqikuri aSlilobis kate-
kuTar garegnobasTan dakavSirebiT pacientis wuxilis
goriaSi. Cveulebriv, warmosaxul garegnul defeqtze
xasiaTi da ra saxiT uSlis es xels mis pirad da sazo-
wuxili zeRirebulovan ideas warmoadgens, magram,
gadoebriv cxovrebas. diagnozis dasma SeiZleba rTu-
aseTi mdgomareobis dros, individs, SeiZleba damate-
li aRmoCndes, radgan zogierTi pacienti, simorcx-
biT bodviTi aSlilobis (somaturi Sinaarsis) diagno-
vis gamo, ar amJRavnebs Tavisi simptomebis WeSmarit
zi daudgindes. es sindromi, nawilobriv, gadafaravs
bunebas. aqedan gamomdinare, klinicistma SeiZleba
bodviT aSlilobas, ipoqondriasa da obsesiur-kom-
SecdomiT socialuri fobiis, panikuri aSlilobis an
pulsur aSlilobas. ICD-10-Si aseTi mdgomareoba ipo-
obsesiur-kompulsuri aSlilobis diagnozi dasvas.
qondriis farTo kategoriis qvejgufs warmoadgens.
dismorfofobiis mqone pacientebi darwmunebul- mkurnaloba
ni arian, rom maTi sxeulis zogierTi nawili zedme-
dismorfuli aSliloba SeiZleba ganviTardes meoradi
tad didi, zedmetad patara an deformirebulia. sxva
fsiqikuri aSlilobis an depresiis fonze. aseT SemTx-
adamianebi Tvlian, rom maTi garegnoba normaluria an
vevebSi unda Catardes pirveladi aSlilobis Sesabami-
umniSvnelo anomaliiT xasiaTdeba. umniSvnelo anoma-
si mkurnaloba. im SemTxvevaSi, rodesac sxeulis dis-
liis arsebobis dros Zneli dasadgenia, Tu ramdenad
morfuli aSliloba pirveladia, misi mkurnaloba, xSi-
gazviadebulia pirovnebis wuxili sakuTari garegno-
rad, sirTuleebTan aris dakavSirebuli. mkurnalobis
bis Taobaze. pacientis fizikuri arasrulfasovne-
dros aucilebelia pacientTan TanamSromlobiTi
bis gancda yvelaze xSirad dakavSirebulia cxvirTan,
urTierTobebis damyareba. pacienti unda grZnobdes,
yurebTan, pirTan, mkerdTan, dundulebTan da peni-
rom fsiqiatri mis mimarT TanagrZnobiT aris ganwy-
sTan, Tumca SeiZleba sxeulis nebismier sxva nawilsac
obili, acnobierebs problemebis sirTules da mzad
exebodes. pacienti, SeiZleba, mudmivad moculi iyos
aris aRmouCinos daxmareba. radganac pacientebi xSi-
Tavisi mcdari warmodgenebiT da maTgan itanjebo-
rad qirurgiul Carevas moiTxoven, mniSvnelovania
des. pacients hgonia, rom sxvebi amCneven mis `fizi-
maT avuxsnaT, rom amgvari midgoma ar aris warmate-
kur nakls~ da laparakoben amis Sesaxeb. man SeiZleba
bis momtani da arsebobs mkurnalobis ufro efeqtu-
nebismieri problema sakuTar fizikur arasrulf-
ri saSualebebi. sxeulis dismorfuli aSlilobisTvis
sovnebas miaweros (mag., CaTvalos, rom ufro lamazi
damaxasiaTebeli nebismieri saxis profesiuli, so-
cxviri rom hqonoda, ufro met warmatebas miaRwevda
cialuri an seqsualuri problemebis arsebobisas, pa-
samsaxurSi, sazogadoebriv cxovrebaSi da seqsualur
cientebs unda CavutaroT konsultacia da gavuwioT
urTierTobebSi). dismorfofobiis mqone paciente-
praqtikuli daxmareba. mudmiv mxardaWerasTan erTad,
bi xSirad did dros uTmoben sakuTari sxeulis na-
aseTi midgoma zogi pacientisTvis, efeqturia, Tumca
wilebis Seswavlas, maT srulyofas da `defeqtebis~
ara yvela SemTxvevaSi. kosmetikuri qirurgia. kosme-
damalvas. maT, aseve, socialuri funqcionirebis
tikuri qirurgia, xSirad, warmatebulia im pacienteb-
mniSvenlovani gauareseba aReniSnebaT. dismorfofo-
Tan, romlebsac ar aReniSnebaT dismorfofobia. qir-
biis dros xSiria Tanmxlebi fsiqikuri aSlilobebi,
urgiuli Careva dismorfofobiis mqone pacientebTan,
rogoricaa depresia da socialuri fobia. dismor-
Cveulebriv, ar aris rekomendebuli, radganac maTi
fofobia, Cveulebriv, mozardobis asakSi iwyeba. es
umravlesoba ukmayofilo rCeba operaciis SedegebiT.
qronikuli mdgomareobaa, Tumca droTa ganmavlobaSi
amitom, operaciisTvis pacientebis SerCevisas gul-
fluqtuacia axasiaTebs. savsebiT SesaZlebelia, rom
_ 225 _
dasmiT unda gamovikvlioT maTi molodinebi. im paci- bunebis tkivilis mimarT pirovnebis subieqtur rea-
entebTan, romlebsac ararealisturi warmodgena aqvT qciaze fsiqologiuri faqtorebi axdenen gavlenas.
operaciis Sedegebze, qirurgul Carevas, Cveulebriv, zogad samedicino praqtikaSi, emociuri problemebis
dadebiTi Sedegebi ar mohyveba. plastikuri operaciis dros, tkivili gavrcelebul simptoms warmoadgens.
mizanSewoniloba qirurgis, fsiqiatris da fsiqolo- fsiqiatriul praqtikaSi stacionaruli avadmyofe-
gis saerTo gadawyvetilebazea damokidebuli. bis erTi mexuTedi da ambulatoruli pacientebis
antidepresantebi. dadgenilia, rom antidepresante- naxevarze meti tkivils uCivis. tkivilis simptomebi
biT, gansakuTrebiT ki serotoninis ukumitacebis sele- gansakuTrebiT xSiria depresiuli, SfoTviTi, paniku-
qciuri inhibitorebiT mkurnaloba dadebiT efeqtebs ri da somatoformuli aSlilobebis dros. fsiqikuri
iZleva. aseTi mkurnaloba efeqturia ara mxolod gamo- aSlilobis albaToba gansakuTrebiT maRalia im paci-
xatuli depresiuli simptomebis mqone pacientebisTvis. entebTan, romlebsac mravlobiTi tkivili aReniSne-
nebismieri tipis mkurnalobis dros aucilebelia baT (Gureje et al., 1998).
pacienti grZnobdes, rom mas yuradRebiT usmenen da
etiologia
mis azrs iTvaliswineben. qirurgebis an fsiqiatre-
bis mxridan pacientisTvis uneblied kategoriuli qronikuli tkivili bevri mdgomareobisTvis aris dama-
winaaRmdegobis gawevam SeiZleba gaarTulos aSli- xasiaTebeli (nevrologiuri da Zval-kunTovani siste-
lobis marTva. dismorfofobiis Sesaxeb informaciis mis darRvevebis CaTvliT). mas xSirad gaaCnia rogorc
mosapoveblad ixilieT Phillips (2000). fizikuri, ise fsiqologiuri mizezebi. tkivilis mqo-
ne zogierT pacients (miuxedavad imisa, aReniSneba, Tu
somatoformuli aSliloba, romelic ara fizikuri paTologia), depresiuli aSliloba aqvs.
sxvagvarad ar aris dazustebuli warsulSi varaudobdnen, rom arsebobs `tkivilisaken
midrekilebis aSliloba~ (`pain-prone disorder~), romelic
es rezidualuri kategoria aerTianebs somatoformu-
depresiuli aSlilobis erT-erT saxeobas warmoadgens,
li simptomebis farTo speqtrs, romelic ar akmayo-
Tumca am mosazrebas arc Tu ise bevri mtkicebuleba
filebs aqamde ganxiluli specifikuri somatofor-
gaaCnia (Von Koff and Simon, 1996). aseT dros tkivili,
muli kategoriebis an fizikuri CivilebiT mimdinare
savaraudod, pirovnuli an socialuri faqtorebiTaa
adaptaciis darRvevebis kriteriumebs.
gamowveuli da pacientis warmodgena tkivilis Sesa-
xeb mniSvnelovnad gansazRvravs misi persistentobis
tkivilis aSliloba
xarisxs (Linton, 2000). qronikuli tkivili SeiZleba mZi-
am aSlilobis mqone pacientebisTvis damaxasiaTebe-
me tvirTad daawves pacientis ojaxis wevrebs. garda
lia qronikuli tkivili, romelic ar aris gamowveuli
amisa, tkivilis aRqmaze, mis mimdinarobasa da mkurnal-
romelime somaturi daavadebiT an sxva fsiqikuri aS-
obaze SeiZleba zegavlena moaxdinos pacientis ojaxis
lilobiT. DSM-IV-Si aRniSnulia, rom am aSlilobis
wevrebisa da momvlelebis damokidebulebam.
arsebiT niSans warmoadgens tkivili, romelic klini-
kurad mkveTradaa gamovlenili da sakmarisad Zlieria gamokvleva
imisTvis, rom distresi an pirovnebis funqcionirebis im pacientebis gamosakvlevad, romlebic gaurkveveli
gauareseba gamoiwvios. amgvari tkivilis gamomwvevi mizezebiT gamowveul tkivils uCivian saWiroa:
organuli paTologia da paTofiziologiuri meqaniz-
w SesaZlo somaturi mizezebis safuZvliani gamokvle-
mi an daudgenelia an kidev organul paTologiasTan
va. Tu gamokvlevis Sedegebi uaryofiTia, unda gvax-
gvaqvs saqme, magram tkiviliT gamowveuli socialu-
sovdes, rom tkivili SeiZleba warmoadgendes iseTi
ri an profesiuli funqcionirebis gauareseba bevrad
somaturi daavadebis pirvel simptoms, romlis dad-
ufro mZimea, vidre es pacientis fizikuri mdgoma-
genac adreul stadiaze ver xerxdeba.
reobis Semowmebis Sedegad aris mosalodneli.
w tkivilis da im garemoebebis sruli aRwera, romlis
epidemiologia drosac tkivili iCens Tavs.
zogad populaciaSi Catarebuli gamokiTxebis mixed- w im simptomebis dadgena, romlebic depresiuli an
viT tkivili farTod gavrcelebul movlenas war- sxva fsiqikuri aSlilobisTvis aris damaxasiaTebe-
moadgens. adamianebis umetesoba afiqsirebs, rom maT li.
gardamavali xasiaTis tkivili ganucdiaT, magram Zal- w tkivilTan dakavSirebuli qcevebis aRwera. mag.,
ze cota adamiani aRwers persistentul an ganmeore- simptomebis gamovlenis, pacientis mier medikamen-
bad tkivils, romelic SesaZleblobebis SezRudvas tebis moTxovnisa da tkivilze reaqciis aRwera.
iwvevs (Gureje et al., 1998). pacientebis umravlesoba
w imis garkveva, Tu rogori warmodgena aqvs pacients
eqimebs tkivilis gamo mimarTavs. mwvave tkivili, Cveu-
tkivilis gamomwvev mizezebsa da mis Sedegebze.
lebriv, organuli mizeziTaa gamowveuli. nebismieri
_ 226 _
mkurnaloba (arakardialuri tkivili gulmkerdis areSi (gv. ??),

abdominaluri tkivili (gv. ??), kidurebis fantomuri
qronikuli tkivilis marTva unda iyos individulu-
tkivili (gv. ??) da fibromialgia (gv. ??).
rad dagegmili da kompleqsuri. saWiroa, rom mkur-
nalobis procesSi pacientis ojaxis wevrebic iyvnen Tavis tkivili
CarTulni. klinicistma unda SeZlos TanamSromlo-
zogjer qronikuli an periodulad ganmeorebadi
biTi urTierTobebis damyareba pacientebTan, rom-
Tavis tkivilis mqone pacientebis gadamisamarTeba
lebsac ar surT fsiqologiuri meTodebis gamoyene-
fsiqiatrTan xdeba. arsebobs Tavis tkivilis gamomwvevi
biT mkurnalobis Catareba. tkivilTan dakavSirebuli
mravali somaturi mizezi, gansakuTrebiT ki Sakiki,
nebismieri somaturi darRvevis dros pacients unda
romelic cxovrebis garkveul periodSi, daaxloebiT,
Cautardes adekvaturi mkurnaloba da Sesaferisi
aTidan erT adamians aReniSneba. bevr pacients,
analgetikebi daeniSnos. Tu tkivili fsiqikur aSli-
romelic nevrologiur klinikaSi gadis mkurnalobas,
lobasTan aris dakavSirebuli, saWiroa am pirveladi
awuxebs Tavis tkivili, romlis somaturi mizezebic
mdgomareobis mkurnaloba.
daudgenelia. maT Soris yvelaze ufro gavrcelebulia
fsiqologiuri daxmarebisas unda Sefasdes:
`daZabvis~ Tavis tkivili, romlis drosac pacients
w nebismieri fsiqikuri aSlilobis arseboba: Sefaseba iseTi SegrZneba aqvs, TiTqos Tavze marwuxebs uWeren.
unda moxdes fsiqikuri aSlilobis arsebiTi niSnebis aseTi tkivili Cveulebriv xanmoklea da analgeziis
gamovleniT da ara mxolod iqidan gamomdinare, an kargi Ramis Zilis Semdeg swrafadve gadis,
rom ver moxerxda tkivilis gamomwvevi raime Tumca, xandaxan, SeiZleba mudmivi xasiaTic hqondes.
konkretuli somaturi mizezis dadgena. depresiuli zogierT pacients aReniSneba depresiuli simptomebi
daavadebis SemTxvevaSi pacients aucileblad unda an SfoTva, romelic cxovrebiseul stresTan aris
Cautardes Sesabamisi safuZvliani mkurnaloba. dakavSirebuli. fsiqologiuri faqtorebi, rogorc
zogjer antidepresantebiT mkurnaloba efeqturia Cans, Tavis tkivilis erT-erT gamomwvev faqtors
qronikuli tkivilebis mqone iseT pacientebisTvisac, warmoadgens. ar arsebobs imis damadasturebeli
romlebsac depresiuli aSliloba ar aReniSnebaT faqtebi, rom Tavis tkivili kunTTa daZabulobis
(O~Malley et al., 1999). zrdiT aris gamowveuli. ufro misaRebia Sexeduleba,
w fsiqologiuri Terapiis mizanSewoniloba: tkivilis romlis mixedviTac Tavis tkivilis mizezs vaskuluri
Sesasusteblad an masTan dakavSirebuli qcevebis meqanizmebi warmoadgens.
Sesacvlelad. kognitur-bihevioruli midgoma iT aris SemTxvevebi, rodesac pacientebs Tavis tkivilis
valiswinebs yuradRebis gadatanis, relaqsaciis gamomwvevi somaturi mizezebi ar udgindebaT. aseTi
da sxva saxis meTodebis gamoyenebas, romlebic pacientebis umravlesobis damSvideba SesaZlebelia,
pacients tkivilis daZlevaSi daexmareba. garda Tu maT avuxsniT, rom Catarebulma gamokvlevebma
amisa, misi mizania tkivilTan dakavSirebuli qcevis uaryofiTi Sedegebi aCvena. antidepresantebiT mkur
socialuri ganmtkicebis Sesusteba. meta-analizuri naloba da stresis marTvis teqnikis gamoyeneba,
kvleviT erTmaneTs Seadares sami sxvadasxva jgufi: garkveulwilad, aumjobesebs maT mdgomareobas
pacientebi, romlebsac CautardaT kognitur-bihe (Holroyd et al., 2001).
vioruli Terapia, sakontrolo jgufi da pacientebi,
saxis tkivili
romelTac alternatiuli mkurnaloba CautardaT.
aRmoCnda, rom kognitur-bihevioruli mkurnalobas saxis tkivils bevri somaturi mizezi gaaCnia. Tumca,
upiratesi, Tumca zomieri efeqti gaaCnia (Morley et arsebobs minimum ori forma, romlis drosac
al., 1999). mniSvnelovan rols, savaraudod, fsiqologiuri
faqtorebi asruleben. maTgan ufro xSiria tem
tkivilze momuSave mravalprofilian klinikebSi
poromandibuluri saxsris sindromi (kostenis
Tavmoyrilia mTeli gamocdileba dakavSirebuli
sindromi an facialuri arTralgia), romlis drosac
tkivilis mkurnalobis somatur da fsiqologiur
pacients safeTqel-qveda ybis saxsris irgvliv yru
meTodebTan. qronikuli tkivilis mkurnalobis fsi
tkivili aReniSneba. aseTi CivilebiT Cveulebriv
qologiuri midgomebis Sesaxeb informaciis mo
stomatologs mimarTaven. àtipiuri~ saxis tkivilis
sapoveblad ix. Bass and Jack (2002).
dros pacients ufro Rrma an pulsaciuri tkivili
awuxebs da, savaraudod, ufro nevrologis Care
tkivilis zogierTi specifikuri sindromi
vas saWiroebs. xSirad, aseTi simptomebis mqone
miuxedavad imisa, rom aRwerilia tkivilis bevri
pacientebs ar surT mimarTon fsiqiatrs. Tumca,
sxvadasxva tipi, am qveTavSi ganxilulia Tavis, saxis,
zogierTi gamokvlevis mixedviT, garkveuli tipis
zurgisa da menjis tkivili. tkivilis zogierTi
antidepresantebma SeiZleba simptomebis Semsubuqeba
sxva specifikuri sindromi me-16 TavSia ganxiluli
_ 227 _
gamoiwvion maSinac ki, rodesac pacients depresiuli disociaciuri aSlilobebi
aSliloba ar aReniSneba. aseve aRmoCnda, rom
DSM-IV-is mixedviT, disociaciuri aSlilobebis
temporomandibuluri darRvevebis dros kognitur-
ZiriTad niSan-Tvisebas cnobierebis, mexsierebis,
bihevioruli Terapia aZlierebs stomatologiuri
identobis da aRqmis funqciebis integraciis dar
mkurnalobis efeqts (Dworkin et al., 2002).
Rveva warmoadgens. aseTi darRveva SeiZleba uecrad
saxis tkivilis fsiqologiuri aspeqtebis Semdeg
an TandaTanobiT ganviTardes da perioduli an
wyaroSia ganxiluli: Feinmann (1999).
qronikuli saxe miiRos.
zurgis tkivili termini `disociaciis~ mokle istoria 10.4 boqsSia
aRwerili.
zurgis tkivili erT-erTi yvelaze ufro gavr
celebuli Civilia, romliTac pacientebi pirveladi
disociaciuri aSlilobis tipebi
daxmarebisTvis eqimebs mimarTaven da romelic
pirovnebis daqveiTebuli funqcionirebis mTavar cxrilSi 10.3 CamoTvlilia disociaciuri aSlilobis
mizezs warmoadgens. gansakuTrebulad Zlieri tipebi DSM-IV-is mixedviT da maTi ekvivalentebi ICD-
tkivili, umetes SemTxvevaSi, droebiTia, Tumca 10-Si. ICD-10-Si am jgufis aSlilobebis dasaxelebaSi
pacientebis daaxloebiT erT mexuTeds eqvs Tve mocemulia termini konversia, romelic frCxilebSia
ze met xans unarCundeba. zurgis tkivilis Casmuli. es imaze miuTiTebs, rom ufro adreuli SeT-
aRmocenebis sawyis etapze fsiqologiuri da qceviTi nxmebis mixedviT, aseTi mdgomareobebi konversiul
xasiaTis problemebis arseboba cudi gamosavalis aSlilobebTan erTad unda yofiliyo klasificire-
momaswavebelia (Linton, 2000). mkurnaloba Seicavs buli.
pacientisTvis tkivilis gamomwvevi mizezebisa da misi zogierTi avtori miiCnevs, rom disociaciuri aSli-
mdgomareobis prognozis Sesaxeb zusti informaciis lobebis arseboba kargad aris dasabuTebuli da aseTi
miwodebas, analgetikebis SezRuduli raodenobiT mdgomareobebi sakmaod gavrcelebulia (mag., Coons,
gamoyenebas da pacientis aqtivobis etapobrivad 1998), zogi ki saeWvod miiCnevs im mtkicebulebaTa ba-
gazrdas. zogierTi mkvlevaris azriT (Von Korff et al., zas, romelic, rogorc mTlianad kategoriis, ise misi
1994), pirveladi daxmarebis gawevisas pacientisTvis Semadgeneli komponentebis klasifikaciisTvis gamoi-
TviTdaxmarebis Taobaze rCevebis regularulad micema yeneba (mag., Merskey, 2000).
iseTive dadebiT Sedegs iZleva, rogorc analgezia an
woliTi reJimi. garda amisa, amgvari midgoma iafia boqsi 10.4 disociaciis mokle istoria
da ufro Seesabameba pacientis moTxovnilebebs. termini `disociacia~ frangi filosofosisa da fsiqiatris
kokreinis meTodologiiT Catarebuli mimoxilvis pier Janes saxelTan aris dakavSirebuli (Pierre Janet, 1859-
1947). is garkveuli periodi SarkosTan erTad parizis
Sedegebma aCvena, rom bihevioruli mkurnaloba ufro
erT-erT saavadmyofoSi (Salptrire Hospital) muSaobda. Jane
efeqturia, vidre intervenciisgan Tavis Sekaveba, ikvlevda fsiqikuri integraciisa da sensoruli aRqmis
Tumca is mniSvnelovnad ar aumjobesebs im samkurnalo aspeqtebs isteriisa da sxva saxis nevrozebis dros. aseTi
integraciis darRvevis aRsawerad Jane iyenebda termins
programebis efeqturobas, romlebsac, Cveulebriv,
dsagregation psychologique (iTargmneba rogorc disociacia).
welis qronikuli tkivilebis dros iyeneben (van garkveuli periodis manZilze Janes ideebi Zalze
Tulder et al., 2002). kidev erTi metaanalizuri kvleviT gavrcelebuli iyo (ix. van der Kolk and van der Hart, 1989),
dadginda, rom zurgis tkivilis Sesamcireblad magram SemdgomSi misi Teoria froidis ideebma daCrdila.
1970-ian wlebSi kvlav ganaxlda interesi disociaciis
antidepresantebi ufro efeqturia, vidre placebo, mimarT. es gamowveuli iyo fsiqologiuri travmis
Tumca ver aumjobesebs pacientis funqcionirebas efeqtebis SeswavliT, romelic gansakuTrebiT vietnamis
(Salerno et al., 2002). omis veteranebs aReniSnebodaT. gamokvlevebis Sedegad
dafiqsirda iseTi simptomebi, romlebic aRmocendeba
menjis qronikuli tkivili travmuli movlenebis sapasuxod da dadginda, rom maT
saerTo safuZveli (kerZod, disociaciuri meqanizmi)
qalebis umravlesobas, vinc ginekologiur klin gaaCniaT. garda amisa, daadgines disociaciuri simptomebi
ikebs mimarTavs menjis tkivili aReniSneba. xSirad, (ix. cxrili 10.2) da disociaciuri aSlilobebis axali
diagnostikuri kategoria.
aseT tkivils, gamokvlevebis uaryofiTi Sedegebis
miuxedavad, persistentuli xasiaTi aqvs. menjis
tkivili, mniSvnelovanwilad, fsiqologiuri faqto cxrili 10.2 disociaciuri simptomebi
rebiT aris gamowveuli da pirovnebis funqcionirebis
subieqturi sicarielis gancda
daqveiTebis erT-erT ZiriTad mizezs warmoadgens.
realobidan gansvla
zogjer, SeiZleba, efeqturi gamodges kognitur-
garemos srulyofilad aRqmis unaris daqveiTeba
bihevioruli intervencia (Glover and Pearce, 1995).
mexsierebis fragmentacia an dakargva
derealizacia da depersonalizacia
_ 228 _
disociaciuri aSlilobebi
mocvidan gaqceva. rogorc wesi, pacientebi amboben,
cxrili 10.3 disociaciuri aSlilobebis rom ar axsovT sad imyofebodnen xetialis dros da,
klasifikacia DSM-IV-is mixedviT da maTi
zogierT maTgans, pirovnuli identoba aqvs darRveu-
ekvivalentebi ICD-10-Si
li (ar icis TviTon vin aris). aseT SemTxvevebze mra-
DSM-IV ICD-10 vali dramatuli istoriaa gamoqveynebuli (ix. Hacking,
disociaciuri aSliloba F44 disociaciuri 1998). disociaciuri fuga unda ganvasxvavoT organu-
(konversiuli) aSliloba li darRvevebisgan, epilefsiisa da fsiqoaqtiuri niv-
disociaciuri amnezia disociaciuri amnezia TierebebiT gamowveuli intoqsikaciis CaTvliT.
dosociaciuri fuga disociaciuri fuga
identobis disociaciuri aSliloba
identobis disociaciuri mravlobiTi pirovnuli
aSliloba aSliloba aseTi aSlilobis dros (aseve cnobilia, rogorc ICD-
(klasificirebulia 10-is termini _ `mravlobiTi pirovnuli aSliloba~)
depersonalizaciuri
aSliloba F. 48.1-Si) pacientisTvis damaxasiaTebelia qcevis ori paternis
uecari monacvleoba, romelTagan mas mxolod erTi
disociaciuri aSliloba, disociaciuri (konversiuli)
romelic sxvagvarad ar aris aSliloba, romelic (mocemul momentSi arsebuli) axsovs, xolo meore avi-
dazustebuli sxvagavarad ar aris wdeba. am paternebidan erTi asaxavs adamianis realur
dazustebuli
pirovnebas, xolo meore `pirovneba~ warmoadgnes emo-
disociaciuri stupori ciuri reaqciebis, damokidebulebebis, mogonebebis
transi da Sepyrobilobis da socialuri qcevebis integrirebul erTobliobas,
mdgomareoba romelic xSirad kontrastulad gansxvavdeba real-
ganzeris sindromi urisgan. zogjer adamianSi orze meti `pirovnebaa~.
SeniSvna: ICD-10-Si aseve mocemulia sensoruli da 10.4 boqsSi mocemulia am aSlilobis diagnostikuri
motoruli darRvevebis kategoriebi, romlebic DSM-IV- kriteriumebi DSM-IV-is mixedviT. identobis disoci-
Si somatoformul aSlilobebSi, kerZod konversiuli aciuri aSliloba iSviaTad gvxvdeba, magram garkveul
aSlilobis qvekategoriaSia klasificirebuli.
periodebSi, gansakuTrebiT mecxramete saukunis miwu-
disociaciuri amnezia ruls, is ufro xSirad iyo dafiqsirebuli. es faqti,
albaT, ufro am aSlilobis mimarT eqimebis interesis
disociaciuri amneziis mTavar damaxasiaTebel ni
cvalebadobaze miuTiTebs, vidre misi gavrcelebis
Sans warmoadgens pirovnebis uunaroba gaixsenos
sixSireze. bolo ormoci wlis ganmavlobaSi idento-
mniSvnelovani (Cveulebriv stresTan dakavSirebuli)
bis disociaciuri aSlilobis daregistrirebuli Sem-
periodebi Tavisi piradi cxovrebidan, rac normaluri
Txvevebis raodenoba kvlav gaizarda (gansakuTrebiT
gulmaviwyobis farglebs scildeba. disociaciuri
SeerTebul StatebSi), magram ar aris dadgenili, asax-
amnezia SeiZleba aRmocendes calke an sxva disociaciur
avs Tu ara es realur viTarebas. epidemiologiuri
aSlilobebTan erTad; aseve, posttravmuli stre
gamokvlevebi ar iZleva pasuxs imis Taobaze, Tu riT
suli aSlilobis, mwvave stresuli aSlilobis da
SeiZleba aixnsas aseTi gansxvavebebi gavrcelebis six-
somatizirebuli aSlilobis dros. disociaciuri amn
Siris maCvenebelebSi.
eziis ismeba mxolod maSin, rodesac pacients sxva,
pacientebTan, romlebic 10.5 boqsSi aRweril krite-
zemoT CamoTvlili aSlilobebi ar aReniSneba.
riumebs akmayofileben, xSirad vxvdebiT sxva aSlilo-
disociaciuri amnezia unda ganvasxvavoT iseTi
bebis, mag., Sizofreniis, personologiuri aSlilobis
amneziisgan, romelsac somaturi mizezebi gaaCnia. is
da fsiqoaqtiuri nivTierebebis borotad gamoyenebis
ori formiT aris aRwerili:
diagnostikur kriteriumebs. bevr pacients, aseve,
1. fsiqogenuri amnezia, romelic erT, axlaxan momx- SfoTvisa da depresiis simptomebi aReniSneba. iden-
dar travmul movlenas exeba. tobis disociaciur aSlilobasa da am mdgomareobebs
2. bavSvobis xangrZlivi periodebis gaxsenebis uun- Soris urTierTkavSiri grZelvadiani kvlevebiT unda
aroba. aseTi SemTxvevebis dros zogierT pacients dadgindes, Tumca, aseTi meToduri kvlevebi Catare-
paralelurad organuli daavadebac aReniSneba. buli araa.
am sakiTxze informaciis mosapoveblad ix. Coons identobis disociaciuri aSlilobis etiologiis
(1998). ganxilvisas ori sakiTxi gansakuTrebiT iqcevs yur-
adRebas:
disociaciuri fuga 1. mZime travmis roli. klinikuri gamocdileba da
disociaciuri fuga Zalze iSviaTad gvxvdeba. aseTi kvlevebi aCvenebs, rom aseTi aSlilobis mqone pa-
aSlilobis mqone pacientebs axasiaTebs ara mxolod cientebis umravlesoba bavSvobaSi mZime fizikuri
mexsierebis dakargva, aramed maTTvis Cveuli gare- an seqsualuri Zaladobis msxverpli iyo. arsebuli
_ 229 _
ba, zustad ar aris dadgenili, warmoadgens Tu ara
boqsi 10.5 identobis disociaciuri
disociacia depersonalizaciuri aSlilobis gamomwvev
aSlilobis diagnostikuri kriteriumebi
meqanizms (ix. qveviT, etiologia). ICD-10-Si amgvari
DSM-IV-is mixedviT
gaurkvevloba gaTvaliswinebulia da depersonalizaciur
a. ori an ufro meti gansxvavebuli identobis an aSlilobas calke adgili aqvs miCenili.
pirovnuli mdgomareobis arseboba. TiToeul maTgans
gare samyarosa da sakuTari Tavis aRqmis, gaazrebisa da
klinikuri suraTi
maTTan urTierTdamokidebulebis met-naklebad myari
paterni axasiaTebs. mTavar niSans warmoadgens sakuTari Tavisa da aRqmuli
b. arsebuli identobidan an pirovnuli mdgomarebidan samyaros ararealurobis SegrZneba. pacients iseTi
minimum ori, perioduli monacvleobiT, akontrolebs
gancda aqvs, rom misi emociebi daClungebulia, xolo
pirovnebis qcevas.
g. mniSvnelovani piradi informaciis gaxsenebis uunaroba, qmedebebi _ meqanikuri, rac misTvis (rac ar unda
rac normaluri gulmaviwyobis sazRvrebs scildeba. ucnauri iyos es) ukiduresad usiamovnoa. pacients
d. darRvevebi ar aris ganpirobebuli fsiqoaqtiuri SenarCunebuli aqvs sakuTari gancdebis subieqturi
nivTierebebis uSualo fiziologiuri efeqtebiT
gacnobierebis unari. aseTi simptomebi SeiZleba
(mag. alkoholuri intoqsikaciisas gonebis dabindva
an qaoturi qceva) an somaturi daavadebiT (mag., intensiuri iyos da Tan axldes dj vu da cvlilebebi
kompleqsuri parcialuri gulyra). drois aRqmaSi. zogierTi pacienti uCivis sensorul
SeniSvna: am aSlilobis simptomebi ar unda davukavSiroT darRvevebs sxeulis erT romelime nawilSi (mag.,
bavSvebSi warmosaxviT megobrebTan TamaSs an sxva saxis Tavis, cxviris an kiduris deformacias). mas iseTi
TamaSebs, romlebSic fantazia monawileobs.
gancda aqvs, TiTqos sxeulis es nawili bambisganaa
gakeTebuli.
mosazrebis Tanaxmad, disociacia aRmocendeba, ro-
pacientebis ori mesamedi mdedrobiTi sqesis war
gorc fsiqologiuri dacviTi meqanizmi, romelic,
momadgenelia. avadmoyofoba xSirad mozardobis
pirveladi travmis miRebisas distresis Semcirebas
periodSi an zrdasruli cxovrebis adreul wlebSi
iwvevs, magram, SemdgomSi, mas xangrZlivi savalalo
iwyeba. SemTxvevebis daaxloebiT naxevari 30 wlis
Sedegebi mohyveba.
asakamde iCens Tavs. simptomebi, Cveulebriv, uecrad
2. iatrogenuli faqtorebi. avtorTa jgufi Tvlis, rom vlindeba _ zogjer maSin, rodesac pirovneba aqtiuria,
garkveul SemTxvevebSi, identobis disociaciuri zogjer ki _ daZabuli fizikuri varjiSis Semdeg
aSlilobis diagnozis dasmas ganapirobebs cnobili relaqsaciis mdgomareobis dros (Shorvon et al., 1946).
SemTxvevebi pirovnebis mravlobiTi gaorebis Sesaxeb, depersonalizaciuri aSliloba, xSirad, mravali wlis
diagnozis dasma sakmarisi mtkicebulebis gareSe da manZilze grZeldeba, Tumca mas nawilobrivi an sruli
hipnozis gamoyeneba. am sakiTxis mimoxilva Semdeg wy- remisiis periodebi axlavs Tan.
aroSia mocemuli: Putnam and Loewenstein (2000). zogi
avtori, identobis disociaciur aSlilobas iatro- diferencialuri diagnozi
genul avadmyofobad ganixilavs (Merskey, 000). depersonalizaciuri aSlilobis diagnozis dasmam
de aucilebelia gamovricxoT pirveladi aSlilobis
depersonalizaciuri aSliloba arseboba, gansakuTrebiT Sublis wilis epilefsia,
depersonalizaciuri aSlilobisTvis damaxasiaTe Sizofrenia, depresiuli aSliloba, obsesiuri aSli
belia usiamovno mdgomareoba, romlis drosac loba, konversiuli aSliloba, sxva disociaciuri
pirovneba gareT arsebul sagnebs an sxeulis nawilebs aSliloba, generalizebuli da SfoTviT-fobiku
deformirebulad aRiqvams da iseTi gancda aqvs, ri aSlilobebi da panikuri aSliloba. deperso
TiTqos isini ararealuri an misgan distancirebulia. nalizaciuri aSliloba aseve dakavSirebulia Sa
depersonalizaciis xanmokle simptomebi, rogorc kikTan, epilefsiasTan (Lambert et al., 2002) da
meorexarisxovani niSnebi, sakmaod xSirad gvxvedeba wamalmoxmarebasTan (Medford et al., 2003). mZime da
sxva sindromebis dros da am aSlilobis simptomebi persistentuli depersonalizacia zogjer SeiZleba
xandaxan sxva fsiqikuri aSlilobis drosac iCens Sizoiduri pirovnuli aSlilobis mqone adamianebsac
Tavs (ix. diferencialuri diagnozi). pirveladi aReniSnebodes.
depersonalizaciuri aSliloba iSviaTia. misi gavr depersonalizaciis pirveladi sindromi iSviaTia
celebis sixSire ar aris zustad dadgenili, rad da pacientebis umravlesoba romelime zemoT
gan arsebuli monacemebi imdenad gansxvavdeba erT CamoTvlili aSlilobiT aris daavadebuli.
maneTisgan, rom calsaxa daskvnis gakeTebis saSualebas
etiologia
ar iZleva (ix. Hunter et al., 2004).
miuxedavad imisa, rom DSM-IV-Si aseTi mdgomareobebi pirveladi depersonalizaciuri aSlilobis gamomwvevi
klasificirebulia, rogorc disociaciuri aSlilo mizezebi ucnobia. Sizoidur pirovnul aSlilobasTan
_ 230 _
disociaciuri aSlilobebi
misi SesaZlo kavSiris garda zustad gansazRvruli arsebobis SemTxvevaSic, pacients funqcionirebis
konstituciuri faqtroebi ar aris dadgenili. sieram normalizebaSi daexmareba. aseve, aucilebelia,
da misma kolegebma (Sierra et al., 2002) daadgines, rom SeZlebisdagvarad, SevamciroT pacientis cxovrebaSi
depersonalizaciuri aSlilobis mqone pacientebi arsebuli stresorebi. lamotrijiniT mkurnaloba, rac
moulodnel xmebze ufro adre reagireben, vidre glutamatis gamo Tavisuflebis Semcirebas iwvevs, ar
sakontrolo jgufis wevrebi, rac saSiSroebis mimarT gamodga efeqturi (Sierra et al., 2003). aseve araefeqturia
maT momatebul sifxizleze miuTiTebs. amavdroulad kognitur-bihevioruli mkurnaloba da dinamiuri
aRmoCnda, rom maT daqveiTebuli aqvT vegetatiuri fsiqoTerapia (ix. Simeon et al., 2003). mniSvnelovania,
reaqciebi usiamovno stimulebze, rac, savaraudod, rom Znelad gankurnebadi mdgomareobebis SemTxvevaSi
emociebis gadamuSavebis procesis seleqciuri ar gamoviyenoT mkunalobis araefeqturi meTodebi.
inhibiciiT aris gamowveuli. funqciuri magnitur- umjobesi iqneba, Tu maT nacvlad mxardaWeris
rezonansuli tomografiiis gamoyenebiT (Phillips et meTodebs davuTmobT sakmaris dros.
al., 2001), erTmaneTs Seadares depersonalizaciuri depersonalizaciis sindromis Sesaxeb informaciis
aSlilobis mqone pacientebis, obsesiur-kompulsuri mosapoveblad ix. de Pauw (2000).
aSlilobis mqone pacientebisa da janmrTeli
adamianebisgan Semdgari sakontrolo jgufis reaqciebi ICD-10-Si mocemuli sxva disociaciuri
emociurad datvirTul stimulebze. aRmoCnda, rom aSlilobebi (romlebic DSM-IV-Si ar aris
depersonalizaciuri aSlilobis mqone pacientebs miTiTebuli).
insulasa da safeTqel-kefis qerqSi Sesustebuli,
xolo marjvena ventralur prefrontalur korteqsSi disociaciuri stupori
gaZlierebuli aqtivoba aReniSnebodaT. kvlevis disociaciuri stuporis dros pacients stuporisTvis
aseTi Sedegebi (Tu isini Semdgomi gamokvlevebiT damaxasiaTebeli niSnebi aReniSneba. isini ar moZraoben,
dadasturda) SeiZleba interpretirebul iqnas, metyveleben da gare gamRizianeblebze ar reagireben,
rogorc reaqciis daqveiTeba Tavis tvinis im Tumca acnobiereben irgvliv mimdinare movlenebs.
ubnebSi, romlebic emociis reprezentaciasTan aris disociaciuri stupori iSviaTia da diagnozis
dakavSirebuli da reaqciis gaZliereba im ubnebSi, dasmamde aucilebelia sxva SesaZlo mdgomareobebis,
romlebic emociis regulacias ukavSirdeba. es kidev kerZod, Sizofreniis, depresiuli aSlilobis, maniis
erTxel miuTiTebs imaze, rom depesonalizaciuri da Tavis tvinis organuli daavadebebis gamoricxva.
aSlilobis dros xdeba emociuri reaqciebis inhibicia.
Tumca, mocemuli kvlevis Sedegebi ver gvixsnis imas, ganzeris sindromi
Tu ratom aRiniSneba depersonalizacia adamianebis ganzeris sindromi iSviaTi mdgomareobaa. mas oTxi
umravlesobasTan xanmokle periodis manZilze, maSin ZiriTadi damaxasiTebeli niSani aqvs:
rodesac pacientebis mcire nawilTan is stabilur 1. inteleqtis kvlevisas kiTxvebze `miaxloebiTi pasu
depersonalizaciur aSlilobad yalibdeba. xebis~ gacema (ix. qvemoT);
prognozi 2. fsiqogenuri somaturi simptomebis arseboba;
meoradi, sxva fsiqikuri aSlilobebis fonze, 3. halucinaciebi;

ganviTarebuli SemTxvevebis prognozi pirveladi 4. cnobierebis gamoxatuli darRvevebi.
aSlilobebis gamosavalzea damokidebuli. pirveladi ganzeris sindromi pirvelad patimrebTan iqna
depesonalizaciuri aSlilobis grZelvadiani kvlevebi aRwerili (Ganser, 1898), Tumca es sindromi mxolod
ar Catarebula. klinikuri gamocdileba gviCvenebs, maTTvis ar aris damaxasiaTebeli. termini `miaxloebiTi
rom SemTxvevebs, romlebic erT welze didxans pasuxi~ gulisxmobs iseT pasuxs (martiv SekiTxvaze),
grZeldeba, qronikuli mimdinareoba axasiaTebs. romelic TvalsaCinod arasworia, Tumca aSkaraa
misi kavSiri swor pasuxTan, rac gvafiqrebinebs,
mkurnaloba
rom pirovnebam icis swori pasuxi. mag., SekiTxvaze
sxva aSlilobebis Sedegad meoradad ganviTarebuli
`ramdenia ors mivumatoT ori?~ pacientma SeiZleba
depersonalizaciis dros, pirvel rigSi, ZiriTad
gvipasuxos `xuTi~, xolo SekiTxvaze `ramdenia sams
aSlilobas unda vumkurnaloT. pirveladi deper
mivumatoT sami?~ gvipasuxos _ `Svidi~. anu yovelTvis
sonalizaciuri aSlilobis dros anqsiolizurma
pasuxi erTiT metia swor pasuxze. ZiriTadad, adgili
preparatebma SeiZleba xanmokle droiT Seamsubuqon
aqvs vizualur halucinaciebs, romlebic xSirad
pacientis mdgomareoba, magram maTi xangrZlivi vadiT
gazviadebuli an gamogonilia. aseTi mdgomareobiT
daniSvna, damokidebulebis riskis gamo, ar aris
miRebuli aSkara gamorCena, miaxloebul pasuxebTan
rekomendebuli. mxardamWeri interviu, simptomebis
erTad, utifari simulaciis STabeWdilebas qmnis.
_ 231 _
Tumca, aseTi mdgomareba imdenad Tanmimdevruli da da qronikuli daRlilobis sindromi). kulturisTvis
persistentulia, rom masSi, savaraudod, aracnobieri specifikuri sindromis magaliTebia:
fsiqikuri meqanizmebi monawileoben. diagnozis das w lata. sindromi, romlis SemTxvevebic malaiel qa-
mis dros aucilebelia gamovricxoT Sizofrenia an lebze iyo aRwerili. misi damaxasiaTebeli niSnebia
Tavis tvinis organuli daavadeba. es ukanaskneli eqolalia, eqopraqsia da paTologiurad damyoli
gansakuTrebiT yuradRebiT unda iqnas gamokvleuli qceva. aseTi mdgomareoba, Cvelebriv, Tavs iCens Si-
maSin, rodesac klinikuri suraTi aRreul azrovnebasa Sis gancdis Semdeg.
da mxedvelobiT halucinaciebze miuTiTebs.
w amoki. amokis SemTxvevebi aRwerilia indoneziasa
ganzeris sindromis Sesaxeb informaciis mosapoveb-
da malaiaSi mcxovreb mamakacebze. (Van Loon, 1927).
lad ixilieT Dwyer and Reid (2004).
Tavdapirvelad adamiani mZime fiqrebSi iZireba, ra-
transi da Sepyrobilobis mdgomareoba sac Semdgom agresiuli qceva da zogjer iaraRis
saxifaTo gamoyeneba moyveba. Cveulebriv, mdgoma-
ICD-10-is mixedviT transi da Sepyrobilobis mdgo-
rebidan gamosvlis Semdeg, adamians araferi axsovs.
mareoba disociaciur (konvresiul) aSlilobebs gan-
naklebad sarwmunoa, rom aseTi qcevis paternis mqone
ekuTvneba. DSM-IV-Si, is Setanilia B danarTis Camo-
yvela pacienti disociaciuri aSlilobiT iyos daava-
naTvalSi (`kriteriumebi da aqsisebi, romlebic Semd-
debuli. zogierT maTgans SeiZleba mania, Sizofrenia
gom Seswavlas saWiroebs~).
an post-epilefsiuri mdgomareoba aReniSnebodes.
transisa da Sepyrobilobis mdgomareobisTvis dama-
xasiaTebelia pirovnuli identobis gancdisa da gare w arqtikuli isteria. sindromi, romelic eskimoseb-
samyaros gacnobierebis unaris droebiTi dakargva. Tan, ufro metad qalebs Siris gvxvdeba. am mdgoma-
aseTi mdgomareoba SeiZleba gamoiwvios pirovnebis reobis dros adamiani iglejs tansacmels, yviris,
religiur an sxva saxis ceremoniebSi monawileobam. tiris, gaSmagebuli darbis aqeT-iqiT da SeiZleba
am SemTxvevebSi msgavsi movlena aSlilobad ar gani- gaciebis gamo sakuTar sicocxles saSiSroeba Seu-
xileba. DSM-IV-is mixedviT, transi aris uneblie md- qmnas. zogjer aseT mdgomareobaSi myofi adamianebi
gomareoba, romelic ar aris pirovnebis kulturis agresias avlenen. am mdomareobis kavSiri disocia-
an religiisTvis damaxasiaTebeli da masSi klinikuri ciur aSlilobasTan ar aris zustad dadgenili da
TvalsazrisiT mniSvnelovan distress an funqcioni- is, SeiZleba, sxvadasxva mizeziT iyos gamowveuli.
rebis gauaresebas iwvevs.
aRdgenili mogonebebi da mcdari mogonebebis
zogierTi SemTxveva mravlobiT pirovnul aSli-
sindromi
lobas hgavs, radganac adamiani ise iqceva, TiTqos
aseTi mdgomareobebi ?? gverdzea aRwerili.
xanmokle droiT sxva pirovnebad aris gardaqmnili.
rodesac aseTi mdgomareba religiuri ritualebiT disociaciuri identobis imitaciuri aSliloba
aris gamowveuli, pirovnebas SeiZleba iseTi gancda
arsebobs sruli Tanxmoba imis Taobaze (im mecnierebs
hqondes, rom is romelime RvTaebiT an suliT aris
Sorisac ki, romlebic Tvlian, rom disociaciuri
Sepyrobili. am dros yuradReba Seviwrovebulia da
identobis aSliloba gavrcelebuli movlenaa), rom si-
mxolod uaxloesi garemocvis ramdenime aspeqtzea
mulaciuri da imitaciuri gamovlinebebi gavrcelebul
fokusirebuli (mag., sasuliero piris mier religi-
(Cveulebriv) movlenas warmoadgens (ix. Coons, 1998).
uri ritualis Catarebaze). transSi myofi pirovneba
SeiZleba gamudmebiT erTi da igive moZraobebs imeo-
rebdes, erTi da igive frazebs warmoTqvamdes an gark-
veul pozebs iRebdes. damatebiTi literatura
kulturisTvis specifikuri sindromebi Gelder, MG, Lpez-Ibor JJ Jr and Andreasen. NC (eds) (2000)
New Oxford texbook of psychiatry. Oxford, Oxford University
arsebobs mosazreba, romlis Tanaxmadac uCveulo
Press. (See setions 4.6.3; 4.9; 5.2.)
qcevis zogierTi paterni, romelic mxolod garkveu-
li kulturisTvis aris damaxasiaTebeli, disociaciis Halligan, PW, Bass, C and Marshall, JC (eds) (2001) Con-
fsiqologiur meqanizmebs asaxavs. zogierTi aseTi temporary approaches to the study of hysteria: clinical and
qceva SeiZleba klasificirebul iqnas, rogorc kul- theoretical perspectives. Oxford, Oxford University Press. (es
turisTvis specifikuri sindromi (es termini gaakri- aris sasargeblo wigni, romelSic ganxilulia moce-
tikes, radganac is mxolod aradasavlur kulturaSi mul TavSi aRwerili mdgomareobebis yvela aspeqti.)
arsebuli sindromebis aRsawerad gamoiyeneboda da ar Manu, P (ed.) (1998) Functional somatic syndromes. Cambridge,
miesadageboda iseT sindromebs, romlebic dasavluri Cambridge University Press. (ganxilulia gavrcelebuli
kulturisTvis iyo tipiuri (mag., kvebiTi aSliloba funqciuri sindromebi.)
_ 232 _
Tavi 11 guneb -ganwyobis
(afeqturi) aSlilobebi
Tavis Sinaarsi
Sesavali precipitatuli faqtorebi
depresia etiologiis fsiqologiuri axsna
mania etiologiis neirobiologiuri axsna
klinikuri niSnebi etiologia _ daskvna
depresiuli sindromi mimdinareoba da prognozi
mania sikvdilianoba afeqturi aSlilobebis dros
transkulturaluri faqtorebi prognozuli faqtorebi
guneb-ganwyobis (afeqturi) aSlilobebis depresiis mkurnaloba mwvave fazaSi
klasifikacia antidepresantebi
depresiis klasifikacia antikonvulsantebi
klasifikacia savaraudo etiologiuri eleqtrokrunCxviTi Terapia
faqtorebis mixedviT fsiqologiuri mkurnaloba
klasifikacia klinikuri suraTis mixedviT sxva mkurnaloba
klasifikacia mimdinareobis mixedviT maniis mkurnaloba mwvave fazaSi
ICD-10 da DSM-IV klasifikaciebi medikamentebi
bipolaruli aSlilobebi eleqtrokrunCxviTi Terapia
klasifikacia da aRwera yoveldRiur afeqturi aSlilobebis
praqtikaSi xangrZlivi mkurnaloba
diferencialuri diagnozi recidivebis da gamwvavebebis prevencia
depresia fsiqoTerapia
mania depresiis Sefaseba
afeqturi aSlilobebis epidemiologia depresiis marTva
bipolaruli aSlilobebi antidepresantebis SerCeva da gamoyeneba
depresia eleqtrokrunCxviTi Terapiis gamoyeneba
disTimia da rekurentuli aqtivobebi
xanmokle depresia fsiqoTerapia
msubuqi afeqturi aSlilobebi araefeqturi inicialuri mkurnaloba
afeqturi aSlilobebis etiologia recidivebisa da gamwvavebebis prevencia
genetikuri mizezebi maniis Sefaseba
pirovnuli Tvisebebi mwvave epizodi
garemo faqtorebi adreul asakSi recidivebisa da gamwvavebebis prevencia
Sesavali xSirad àfeqtur aSlilobebsac~ uwodebdnen da am

termins dResac farTod gamoiyeneben.
saxelwodeba guneb-ganwyobis aSlilobebi momdin-
areobs iqidan, rom maTi erT-erTi ZiriTadi maxasi-
aTebeli guneb-ganwyobis paTologiaa. dResdReobiT depresia
am terminis mniSvneloba iseTi darRvevebiT Semoi- ubedurebis dros dardi normaluri cxovrebiseuli
fargleba, rogorebicaa guneb-ganwyobis daqveiTeba emociaa. depresiuli gancda xSirad Tan axlavs ro-
an aweuli guneb-ganwyoba, Tumca warsulSi zogierTi gorc fsiqikur aSlilobebs, aseve fizikur daavade-
avtori am jgufSi SfoTviT aSlilobebsac aerTianeb- bebsac mag., iseT infeqciebs, rogorebicaa hepatiti an
da. SfoTviTi aSlilobebi mocemuli wignis me-9 Tav- nevrologiuri daavadebebi. am TavSi ganvixilavT ara
Sia aRwerili. guneb-ganwyobis aSlilobebs warsulSi Cveulebriv dards an sxva daavadebis Tanmxleb depre-
_ 233 _
11 guneb-ganwyobis (afeqturi) aSlilobebi
siul ganwyobas, aramed sindroms, romelic depresiam sindroms mania ewodeba. zogierTi diagnostikuri
ul aSlilobadaa cnobili. klasifikaciis mixedviT gamoyofilia maniis msubuqi
am sindromis ZiriTadi maxasiaTeblebia: forma _ hipomania (ix. qvemoT).
w guneb-ganwyobis daqveiTeba
w negatiuri azrebi klinikuri niSnebi
w interesebisa da siamovnebis miRebis unaris dakargva depresiuli sindromi
w energiis daqveiTeba depresiuli epizodis klinikuri maxasiaTeblebi gan
w Seneleba. sxvebulia da maTi dayofa sxvadasxvagvaradaa SesaZ
CamoTvlili niSnebidan, guneb-ganwyobis daqveiTeba lebeli. am TavSi aSlilobebi dajgufebulia maTi
yvelaze xSiri simtomia. simwvavis mixedviT. Tavdapirvelad ganvixilavT zo
mierad gamoxatul depresias, Semdeg ufro mZime
mania aSlilobebs, romlebic garkveuli klinikuri niSne
bis mixedviTaa dajgufebuli. xolo, sul bolos,
analogiuri mdgomareobaa aweuli guneb-ganwyobis Sem
ganxilulia msubuqi depresiuli aSlilobis damaxa
TxvevaSic. garkveuli xarisxiT aweuli guneb-ganwyoba
siaTebeli niSan-Tvisebebi. is, Tu ra warmoadgens
Cveulebrivi movlenaa bednierebis Jams, magram igi,
klinikuri depresiis èpizods~, garkveulwilad,
rogorc simptomi, SesaZloa gamovlindes sxvadasxva
sakamaTo sakiTxia. `depresiuli epizodis~ ICD-
fsiqikuri aSlilobebis drosac, Tumca, Cveulebriv,
10 klasifikaciis diagnostikuri kriteriumebi da
ufro iSviaTia, vidre depresia. am TavSi SevexebiT
simwvavis sxvadasxva doneebi mocemulia cxrilSi 11.1.
sindroms, romlis ZiriTadi maxasiaTeblebic aris:
cxrili 11.2 gviCvenebs `depresiuli epizodis~ DSM-
w momatebuli aqtivoba IV-klasifikaciis kriteriumebs.
w aweuli an gaRizianebuli guneb-ganwyoba
zomierad gamoxatuli depresiuli epizodi
w sakuTari SesaZleblobebis gadafaseba
zomieri depresiis ZiriTadi maxasiaTeblebia guneb-
ganwyobis daqveiTeba, interesebisa da siamovnebis
cxrili 11.1 `depresiuli epizodis~ miRebis unaris dakargva, pesimisturi fiqrebi da
diagnostikuri kriteriumebi ICD-10 fizikuri sisuste. yovelive es iwvevs socialuri da
klasifikaciis mixedviT profesiuli funqcionirebis gauaresebas.
A
garegnoba
w guneb-ganwyobis daqveiTeba
avadmyofs damaxasiaTebeli garegnoba aqvs. Cacmuloba
w interesebisa da siamovnebis miRebis unaris dakargva da varcxniloba SesaZloa ugulebelyofil iqnes. rac
w energiis daqveiTeba da aqtivobebis Semcireba Seexeba saxis nakvTebs, damaxasiaTebelia Camoweuli
tuCis kuTxeebi da vertikaluri naoWi warbebs Soris
B
(Subli SeWmuxnulia). Tvalebis xamxami SesaZloa
w yuradRebis koncentraciis daqveiTeba Semcirebuli iyos. mxrebi Camovardnilia da Tavi
w TviTrwmenisa da TviTSefasebis daqveiTeba isea daxrili, rom mzera qvemoT aris mimarTuli
w TviTbraldebisa da TviTdamcirebis ideebi (TavCaqindruli da Tvalebdaxrilia). Jestikulacia
minimumamdea dayvanili. mniSvnelovania imis aRniSvna,
w pesimisturi fiqrebi
rom, miuxedavad Rrma depresiisa, zogierTi pacienti
w TviTdazianebis ideebi
saxeze Rimils mainc inarCunebs.
w Zilis darRveva
w madis daqveiTeba.
guneb-ganwyoba
avadmyofi sakmaod sevdian guneb-ganwyobazea. ganwyoba
msubuqi depresiuli epizodi: klinikur suraTSi
warmodgenili unda iyos minimum ori A da ori B simptomi mniSvnelovnad ar umjobesdeba arc iseT garemoebaSi,
rodesac wuxili SeiZleba Semsubuqdes, mag., sasiamovno
zomieri (saSualo simZimis) depresiuli epizodi: klinikur
suraTSi warmodgenili unda iyos minimum ori A da sami B sazogadoebaSi yofna an kargi ambis gageba. ufro
simptomi metic, xSir SemTxvevaSi guneb-ganwyoba Cveulebrivi
mZime depresiuli epizodi: klinikur suraTSi warmodgenili mowyenilobisagan gansxvavebulad ganicdeba. zogjer
unda iyos yvela A da minimum oTxi B simptomi. avadmyofebi saubroben Sav Rrubelze, romelic Tan
klasifikaciaSi aseve gaTvaliswinebulia simptomebis axlavs yvela gonebriv aqtivobas. zogierT avadmyofs
simwvave da funqciuri gauareseba . aqvs unari, drois garkveul monakveTSi mainc SeniRbos
_ 234 _
klinikuri niSnebi
uvargisad miiCneven mas. mas aklia Tavdajerebuloba
cxrili 11.2 didi depresiuli epizodis da ugulebelyofs nebismier warmatebas, radgan
diagnostikuri kriteriumebi - DSM-IV
mis miRwevaSi sakuTar damsaxurebas ver xedavs.
aranakleb ori kviris ganmavlobaSi warmodgenili unda iyos pesimisturi fiqrebi exeba samomavlo gegmebs. pacienti
qvemoT mocemuli xuTi (an meti) simptomi da unda aRiniSnos
cvlilebebi adreul funqcionirebasTan SedarebiT.
yvelaze uaress moelis. igi momavalSi xedavs mxolod
aucilebelia oridan erT-erTis arseboba: a) daqveiTebuli warumateblobas samsaxurSi, finansur kriziss,
guneb-ganwyoba an b) interesebis an siamovnebis miRebis ubedurebas ojaxSi da sakuTari janmrTelobis gar
unaris dakargva
dauval gauaresebas. am tipis uimedobis gancdas
1. daqveiTebuli guneb-ganwyoba mTeli dRis ganmavlobaSi, Tan axlavs fiqri, rom sicocxle arafrad ar Rirs
TiTqmis yoveldRe, rac pacientis piradi CiviliT
(sicarielis, sevdis SegrZneba) an garSemomyofTa
da sikvdili mxolod Svebis momgvreli iqneba. aman
obieqturi dakvirvebiT (mag., movida cremliani pirovneba SeiZleba suicidur azrebamde an gegmebamdec
TvalebiT) vlindeba ki miiyvanos. amitom yvela SemTxvevaSi mniSvnelovania
2. interesebis SezRudva da siamovnebis miRebis unaris pacienti gamovkiTxoT, raTa davadginoT am azrebis
daqveiTeba yvela an TiTqmis yvela saqmianobisas, arseboba (suicidis riskis Sefaseba detalurad
mTeli dRis ganmavlobaSi, TiTqmis yoveldRe (rac
vlindeba, rogorc subieqturi CiviliT, aseve sxvebis ganxilulia me-17 TavSi).
dakvirvebiTac) TviTbraldeba xSirad gazviadebuli, mizezTan
3. wonis mniSvnelovani kleba dietis gareSe an wonaSi
Seusabamo danaSaulis gancdaa mag,. pacients SesaZloa
mateba (mag., saerTo wonis 5%-ze metis cvlileba Tvis danaSaulis grZnoba gauCndes mis mier warsulSi
ganmavlobaSi); madis momateba an daqveiTeba TiTqmis vinmes motyuebis an ganawyenebis gamo. Cveulebriv,
yoveldRe.
pacientebs msgavsi ambebi ar axsovT wlebis manZilze
4. insomnia an hipersomnia TiTqmis yoveldRe da axsendebaT mxolod depresiis dros, rasac Tan
5. fsiqomotoruli Sekaveba an piriqiT _ aJitacia. axlavs intensiuri emocia. aseTi viTareba pirdapir
(mousvenrobis an Senelebis ara mxolod subieqturi migviTiTebs depresiul mdgomareobaze. zogierT
SegrZnebaa, aramed TvalsaCinoa garSemo myofTaTvisac)
pacients SesaZloa hqondes braleulobis gancda
6. advilad daRla da anergia TiTqmis yoveldRe warsulSi momxdari konkretuli movlenis arsebobis
7. TviTSefasebis daqveiTeba an Seusabamo, an gazviadebuli gareSe. sxva tipis mogonebebi ukavSirdeba uiRblo/
TviTbraldebis gancda (SeiZleba iyos bodviTi ideebic) ubedur faqtebs; pacienti ixsenebs sevdiani Sem
TiTqmis yoveldRe (ara ubralod TviTbraldeba an
Txvevebs, rodesac ar gaamarTla sxvisi molodini
avadmyofobis gamo sakuTari Tavis dadanaSauleba)
an, roca iRbalma umtyuna. depresiis gaRrmavebis
8. yuradRebisa da koncentraciis unaris an TviTrwmenis paralelurad sevdiani mogonebebi sul ufro xSiri
daqveiTeba TiTqmis yoveldRe (subieqturi Civili an
garSemomyofTa dakvirvebis safuZvelze) xdeba. pacienti Tavs idanaSaulebs daTrgunulobisa
da uunarobis gamo da amas pirovnul naklovanebebsa
9. perioduli fiqrebi sikvdilze (ara ubralod sikvdilis
SiSi), ganmeorebadi suiciduri azrebi konkretuli da moralur sisustes miawers (xSir SemTxvevaSi am
gegmisa an mcdelobis gareSe, an dagegmili suicidi azrs sxvebi ar iziareben).
ganwyobis cvlileba garSemomyofTaTvis. zogierTi

mizanmimarTuli saqcieli
uxasiaTobas eqimTan gasaubrebis drosac ostaturad interesTa sferos SezRudva da siamovnebis gan
malavs, rac diagnozis dasmas kidev ufro arTulebs. cdis unaris daqveiTeba (cnobilia, rogorc anhe
guneb-ganwyoba dilas ufro daqveiTebulia, rodesac donia) damaxasiaTebelia depresiisTvis, Tumca pa
avadmyofi iRviZebs, xolo Semdeg, dRis ganmavlobaSi, cienti yovelTvis ar amJRavnebs am Civilebs. mas
is garkveulwilad, umjobesdeba. aRniSnul movlenas ar aqvs enTuziazmi gaakeTos is, rac Cveulebriv
guneb-ganwyobis dReRamuri meryeoba ewodeba. moswonda. igi kargavs cxovrebisa da yoveldRiuri
saqmianobisadmi interessa da xaliss. xSir SemTxvevaSi
depresiuli Semecneba cdilobs, ganeridos sazogadoebas. energiis Sem
negatiuri fiqrebi (`depresiuli Semecneba~) mniSvne cirebac, Cveulebriv, damaxasiaTebeli niSania (Tumca
lovani simptomebia, romelTa dayofa SesaZlebelia xandaxan gamoixateba fizikuri mousvenrobiT da
sam jgufad : SecdomaSi Sehyavs damkvirvebeli). pacienti xdeba
1. uRirsobis gancda, leTargiuli, didi Zalisxmeva sWirdeba nebismieri
saqmis gasakeTeblad da uWirs dawyebuli samuSaos
2. pesimizmi,
dasruleba. magaliTad, Cveulebriv, sisufTavis
3. TviTbraldeba da TviTdadanaSauleba. moyvaruli pirovneba am dros ar alagebs sawols
uRirsobis gancdis dros pacients miaCnia, rom, an WuWyian TefSebs tovebs magidaze. saxlis gareT
rasac akeTebs, araferi gamosdis da rom sxvebic muSaoba sul ufro da ufro SeuZlebeli xdeba.
_ 235 _
gasagebia, rom bevri pacienti aseT mdgomareobas wonaSi kleba ufro metia, vidre depresiuli
fizikur avadmyofobas ukavSirebs. mdgomareobiT ganpirobebulma madis daqveiTebam
SeiZleba gamoiwvios. zog SemTxvevaSi viTareba
fsiqomotoruli darRvevebi
sapirispiroa _ pacientebs uZlierdebaT mada da
fsiqomotoruli Seneleba, aseve, Cveulebrivi mov wonaSic sagrZnoblad imateben. xSirad sakvebis miReba
lenaa (Tumca, rogorc Semdgom iqneba aRwerili, droebiT ayuCebs dards.
zogierTi pacienti Tavs ufro aJitirebulad grZnobs, depresiuli aSlilobis dros xSiria somaturi Ci
vidre Senelebulad). Senelebuli pacienti moZraobs vilebic. fizikuri simptomebi mravalgvaria, Tum
da moqmedebs nela. pacientTan saubrisas aSkarad Cans ca gansakuTrebiT damaxasiaTebelia: yabzoba, advi
azrovnebis Seneleba; kiTxvaze pasuxis gacemis dro lad daRla da tkivilis SegrZneba sxeulis sxva
gaxangrZlivebulia, saubrisas akeTebs arabunebrivad dasxva nawilSi. matulobs ukve arsebul fizikur
gawelil pauzebs. aJitacia aris pacientis mousvenari daavadebasTan dakavSirebuli Civilebi da Tavs iCens
mdgomareoba, rasac iwvevs modunebis uunaroba da hipoqondriuli fiqrebi.
garSemomyofTa mier aRiqmeba, rogorc mousvenroba.
msubuqi forma vlindeba imiT, rom pacienti sxva niSnebi
mousvenrad aTamaSebs TiTebs an ver aCerebs fexebs. depresiuli aSlilobis dros SesaZloa, ramdenime
mwvave SemTxvevebSi pacients ar SeuZlia erT adgilze sxva simptommac iCinos Tavi da ZiriTad klinikur
didxans jdoma da dadis win da ukan. suraTSi erT-erTi maTgani dominirebdes. esenia:
saSualo simZimis depresiis dros SfoTva xSiria, depersonalizacia, akviatebuli azrebi, panikuri
magram ara mudmivi (rogorc Semdgom iqneba aRwerili, Seteva da disociaciuri aSlilobebis simptomebi,
is ufro msubuqi depresiuli aSlilobebisaTvisaa rogoricaa: fuga an parezi da kidurebSi
damaxasiaTebeli). momdevno, aseve xSiri simptomi, mgrZnobelobis dakargva. xSiria Civilebi mexsierebis
aris gaRizianebadoba, rac gamoixateba imaSi, rom daqveiTebazec; depresiuli pacientebi, rogorc
nebismier umniSvnelo Txovnas pacienti zomagadasuli wesi, neirofsiqologiur testebs cudad asruleben,
gabrazebiT da gaRizianebiT pasuxobs. magram gansakuTrebiT TvalsaCinoa is, rom axlo
warsulSi daswavlili masalis aRdgena da gaxseneba
biologiuri simptomebi
uWirT. zogjer depresiuli pacientis mexsiereba
Zalian mniSvnelovania simptomTa jgufi, romlebsac imdenadaa daqveiTebuli, rom klinikuri suraTi
xSirad `biologiurs~ (aseve `melanqoliur~, `so demencias emsgavseba. aseT mdgomareobas, romelic
maturs~ da `vegetaturs~) uwodeben. es simptomebi ufro xandazmul pacientebSi gvxvdeba, depresiul
moicavs: Zilis darRvevebs, guneb-ganwyobis dRe fsevdodemenciasac uwodeben (gv. 511 ??).
Ramur meryeobas, madis dakargvas, wonaSi klebas,
yabzobas, libidos daqveiTebas da qalebSi amenoreas mZime depresiuli epizodi da fsiqozuri
(sqesobrivad momwifebul qalebSi ciklis arqonas). depresia
zemoT CamoTvlili simptomebi xSiria, oRond, gar rodesac depresiuli aSliloba mwvavdeba, yvela da
damavali xasiaTis saSualo simZimis depresiuli maxasiaTebeli simptomi ufro intensiurad vlindeba.
aSlilobis dros. naklebad savaraudoa, rom pacienti SeZlebs socialuri
Zilis darRveva depresiis dros SesaZloa ramdenime an samsaxurebrivi movaleobebis Sesrulebas. higienis
tipis iyos. yvelaze saxasiaTo diliT adre gaRviZebaa, elementaruli wesebisa da kvebis ugulebelyofa
magram SeiZleba aRiniSnebodes CaZinebis gaZneleba eWvqveS ayenebs pacientis keTildReobas. fsiqomo
da Ramis ganmavlobaSi xSirad gaRviZebac. diliT torulma Senelebam SesaZlebelia pacientTan interviu
adre gaRviZeba gulisxmobs, rom pacienti xSirad gaarTulos an saerTod SeuZlebeli gaxados. zogjer
iRviZebs gamTeniisas, Cveulebrivze 2-3 saaTiT viTardeba bodviTi azrebic da halucinaciebic.
adre. amis Semdeg ukve aRar eZineba, wevs fxizlad, aseTi mdgomareoba fsiqozuri depresiis saxeliTaa
aqvs SfoTvis, mousvenrobisa da gamouZineblobis cnobili.
gancda. igi gaTenebuli dRis mimarT pesimisturadaa mwvave depresiuli epizodis dros ganviTarebuli
ganwyobili, danaRvlianebulia warsulSi gancdili bodviTi ideebi imave xasiaTisaa, rac saSualo simZimis
warumateblobebis gamo da momavals damwuxrebuli depresiuli azrebi. amitom maT guneb-ganwyobis
elis. diagnozis dasmisas swored es kombinacia aris kongruentuli bodviTi azrebi ewodeba. esenia:
mniSvnelovani _ adre gaRviZeba depresiul fiqrebTan TviTdamcireba, TviTbraldeba, azrebi avadmyofobisa
erTobliobaSi. aRsaniSnia isic, rom zogi depresiaSi da, ufro iSviaTad, qonebis dakargvis Sesaxeb. es
myofi pacienti zedmeti Zilis SemTxvevaSic Tavs bodvebi ZiriTadad pirvel TavSia aRwerili, xolo
gamouZineblad grZobs. aq ramdenime maTgans ganvixilavT: TviTbraldebis
_ 236 _
klinikuri niSnebi
bodvis dros pacients SesaZloa sjerodes, rom mniSvneloba aqvs. misi ukiduresi gamovlinebaa
umniSvnelo TaRliTobis gamo, magaliTad, pira depresiuli stupori.
di Semosavlebis deklarirebisas informaciis
depresiuli stupori
mcire uzustobisTvis, mas sastikad dasjian da
daamcireben. miaCnia, rom msgavsi sasjeli namdvilad mZime depresiuli epizodis dros moZraobis Seneleba
daimsaxura. hipoqondriuli bodvebis mqone pacienti da metyvelebis gaRaribeba SeiZleba ise gamwvavdes,
darwmunebulia, rom simsivne an veneriuli daavadeba rom pacienti gaxdes umoZrao da damunjdes.
aqvs. gaRatakebis bodvisas pacients miaCnia, rom dRevandel dRes, ramdenadac aqtiuri mkurnaloba
mTeli fuli dakarga raime bizneswamowyebaSi (rac xelmisawvdomia, msgavsi tipis mwvave depresiuli
ar aris adekvaturi). SesaZloa, Tavi iCinos devnis stupori iSviaTad gvxvdeba. swored amitom krepelinis
bodvamac. pacients miaCnia, rom garSemomyofebi (1921, gv. 80) aRwera gansakuTrebul interess iwvevs:
masze damamcireblad saubroben an masze SurisZieba `pacientebi utyvad wvanan loginSi, SekiTxvebze pasuxs
surT. rodesac devnis bodva depresiuli sindromis ar gvcemen, xSir SemTxvevaSi cdiloben Tavi aaridon
farglebSia, pacienti ZiriTadad sakuTar Tavs mi Sexebas, magram ZiriTadad ar reagireben qinZisTavis
iCnevs damnaSaved da miiCnevs, rom is imsaxurebs Cxvletaze (Tavs ar icaven). isini umweod da ususurad
aseT damokidebulebas. zogierTi pacientis bod sxedan, Sescqerian sakvebs da winaaRmdegobas ar uweven
va da halucinaciebi aSkara kavSirSi ar aris dep sxvas kovziT kvebisas (da gvemorCilebian, rodesac
resiul guneb-ganwyobasTan, anu guneb-ganwyobis ara vaWmevT)~.
kongruentuli fsiqozuri simptomebia, rac metad krepelinis SeniSvniT, gamojanmrTelebul pacien
arTulebs daavadebis prognozirebas. tebs uWirdaT stuporis dros gancdili movlenebis
gansakuTrebiT mZime depresiuli bodvebi damaxa mogoneba. dRes arsebuli zogadi mosazrebis mixed
siaTebelia kotaris sindromisaTvis (Cotard's syndrome), viT, gankurnebul pacientebs metnaklebi sizustiT
romelic frangma fsiqiatrma kotarma aRwera 1882 wels. axsovT stuporis dros momxdari yvela SemTxveva.
am sindromis damaxasiaTebeli Tvisebaa ukiduresad SesaZloa, krepelinis pacientebs hqondaT cnobierebis
nihilisturi bodvebi. magaliTad, zogierTi pacienti paTologia (es SeiZleba siTxis arasakmarisi rao
SeiZleba Ciodes, rom ganadgurebuli aqvs nawlavebi denobiT miRebas ukavSirdebodes, rac xSiria msgavs
ise, rom verasdros SesZlebs eqskrementis gamoyofas. pacientebSi). depresiuli stuporis SemTxvevaSi pa
zogierTma SesaZloa amtkicos, rom Ratakia da cientebs SesaZloa ganuviTardeT motoruli sferos
veRarasdros SesZlebs momavalSi fulis Sovnas. zogs katatonuri darRvevebi (gv. 16).
ki Rrmad sjera, rom ojaxi amouwyda da TviTonac atipiuri depresia
gardacvlilia. miuxedavad imisa, rom am simptomebis termini atipiuri depresia zogadad saSualo sim
ukiduresi simZime SeSfoTebas iwvevs, aseTi SemTxvevebi Zimis darRvevebis SemTxvevaSi gamoiyeneba. wlidan
mniSvnelovnad ar gansxvavdeba sxva mZime depresiuli wlamde misi mniSvneloba icvleboda da amJamad ix
aSlilobebisagan. mareba Semdegi tipis daRvevebis aRsaniSnad:
w cvalebadi depresiuli ganwyoba, guneb-ganwyoba
zomieri da mZime depresiis sxva klinikuri
reagirebs pozitiur movlenebze;
suraTebi
w sakvebis gadaWarbebulad miReba da didxans Zili;
aJitaciuri depresia
w ukiduresi sisuste da simZimis SegrZneba kidurebSi
es termini asaxavs depresiuli aSlilobis iseT (tyviis dambla);
SemTxvevebs, roca gamoxatulia aJitacia. rogorc ukve
w gamoxatuli SfoTva.
aRiniSna, aJitacia Tan sdevs bevr mZime depresiul
aSlilobas, magram aJitaciuri depresiis SemTxvevaSi, am klinikuri niSnebis mqone pacientebs aqvT ten
is gansakuTrebiT mwvavea. aJitaciuri depresia ufro dencia, gaazviadon mosalodneli an savaraudo uari
xSiria saSualo asakisa da xandazmul pacientebSi da (uaris mimarT sensitiuroba). atipiuri depresiis
iSviaTia _ axalgazrdebSi. amocnoba mniSvnelovania, radgan interpersonaluri
sensitiurobis gamo, pacientebi rTulad samarTavebi
retardirebuli depresia xdebian. maT ufro `rTuli~ xasiaTis adamianebad
es termini gamoiyeneba iseTi depresiuli aSli miiCneven. miiCneva, rom atipiuri depresia naklebad
lobebis aRsaniSnavad, romelTa TvalsaCino niSania emorCileba tricikluri antidepresantebiT mkur
fsiqomotoruli Sekaveba. ar arsebobs monacemebi nalobas da am SemTxvevaSi ufro efeqturia mono
imisa, rom es damoukidebeli sindormia, Tumca, Sekaveba aminoqsidazasa (MAOIs) da serotoninis seleqciuri
prognozulad kargi simptomia eleqtrokrunCxviTi ukumitacebis inhibitorebia (SSRIs) (Quitkin et al., 1993.
TerapiisTvis. am termins ufro aRwerilobiTi Joyce et al., 2004).
_ 237 _
msubuqi depresiuli epizodi 2002); es ki imas niSnavs, rom zog SemTxvevaSi msubuqi
simptomebi SesaZloa mxolod reducirebulad
SeiZleba vivaraudoT, rom msubuqi depresiuli
gamoxatavdes guneb-ganwyobis mZime darRvevebs.
aSlilobisTvis igive, oRond naklebi intensivobis
simptomebia damaxasiaTebeli, rac zemoT aRwerili guneb-ganwyobis msubuqi aSlilobebi
mZime formebis SemTxvevaSi gvqonda. nawilobriv
Cven ukve vnaxeT, rom SfoTvisa da depresiis
es asea, Tumca msubuqi depresiisas sxva damatebiTi
simptomebi xSirad erTdroulad iCens Tavs. marTlac,
simptomebic viTardeba, romlebic naklebadaa gamo
Zveli saxelmZRvaneloebis avtorebs (ix. Lewis, 1956)
xatuli mwvave mdgomareobis dros. aseTi simptomebi
miaCndaT, rom SfoTvisa da depresiuli darRvevebis
warsulSi aRweres, rogorc `nevrozuli~ da maT
mkafio gamijvna stacionirebuli pacientebis Sem
miekuTvneba: SfoTva, fobiebi (SiSi), obsesiuri sim
TxvevaSic rTuli iyo. Tumca, Tanamedrove fsiqi
ptomebi da, ufro iSviaTad, disociaciuri simptomebi.
atrebi Tanxmdebian mosazrebaze, rom simptomebis
orive DSM-IV da ICD-10 klasifikaciebSi Sedis
diferencireba SesaZlebelia ufro fsiqiatriul
msubuqi depresiis kategoria, romelic depresiuli
dawesebulebebSi myofi mwvave pacientebis SemTxvevaSi,
epizodis kriteriumebSi jdeba, magram am SemTxvevaSi
vidre pirveladi jandacvis rgolSi warmodgenili
depresiuli simptomebi raodenobrivadac cotaa da
msubuqi afeqturi aSlilobebis dros.
simwvaviTac naklebi (ix. cxrili 11.1).
`nevrozuli~ simptomebis garda, romlebic Tan klasifikacia
axlavs zogierT SemTxvevas, msubuqi depresiuli fsiqiatrebs mWidro TanamSromloba uxdebaT zogadi
aSlilobebisaTvis damaxasiaTebelia cud gunebaze profilis eqimebTan; Sesabamisad, msubuqi SfoTviTi
yofna, advilad daRla, interesebis daqveiTeba depresiis mniSvnelobis aRqma adekvaturia, Tumca,
da gaRizianebadoba. darRveulia Zilic, Tumca SeTanxmeba ar aris miRweuli klasifikaciis sakiTxebze.
damaxasiaTebelia ara diliT adre gaRviZeba, rogorc ICD-10 moicavs kategorias _ `Sereuli SfoTviTi
es mZime depresiis dros xdeba, aramed ufro xSiria da depresiuli aSliloba~, romelic im SemTxvevaSi
CaZinebis garTuleba da Rame xSiri gamoRviZeba, gamoiyeneba, roca SfoTvisa da depresiis simptomebi
rasac ZiriTadad Zili mxolod gamTeniisas moh ar aris imdenad Zlieri, rom SfoTviTi aSlilobis
yveba. `biologiuri~ niSnebi (umadoba, wonis kleba an depresiuli aSlilobis diagnozi daisvas da,
da libidos daqveiTeba) xSir SemTxvevaSi ar Sei roca simptomebi mWidrod ar ukavSirdeba stresul
niSneba. Tumca, guneb-ganwyoba dRis ganmavlobaSi movlenebs an seriozul cvlilebebs cxovrebaSi, rac
ramdenjerme icvleba _ dilasTan SedarebiT saRamos aucilebeli pirobaa mwvave stresuli reaqciebis an
ufro mZimdeba. pacients garegnulad SesaZloa arc adaptaciuri aSlilobebisTvis.
etyobodes daTrgunuloba an moZraobis Seneleba. ICD-10-is mixedviT, msgavsi mdgomareobis mqone
bodvebi da halucinaciebi ar aRiniSneba. pirebi xSirad pirveladi daxmarebis dawesebulebebSi
yvelaze iol formebSi es SemTxvevebi iZens msu xvdebian, Tumca, Zalian bevria iseTi, visac gamokvleva
buqi afeqturi aSlilobebis formas, romelTa aR saerTod ar Catarebia. ICD-10-Si es diagnozi SfoTviT
werac qvemoT aris mocemuli. rogorc Semdom iqneba aSlilobebSia moqceuli, magram, zogierTi fsiqiatris
naCvenebi, maTi klasifikacia sakmaod rTulia. msubuqi azriT, igi ufro guneb-ganwyobis aSlilobebs ukav
aSlilobebis umravlesoba sakmaod xanmoklea; dawyebas Sirdeba; am Sexedulebas asaxavs alternatiuli
ganapirobebs pirovnuli warumatebloba , xolo, termini `msubuqi afeqturi aSlilobebi~.
roca situacia icvleba, maSinve iklebs an xdeba axal DCM-IV-is klasifikaciaSi amis Sesatyvisi diag
garemoebebTan Segueba. Tumca, aris SemTxvevebi, nozebi mocemuli araa. klasifikaciis danarTSi
rodesac aRniSnuli mdgomareoba grZeldeba TveobiT an aris winaswari diagnozis ori varianti, romlebic
wlobiT da iwvevs mniSvnelovan problemebs, miuxedavad SeiZleba gamoviyenoT, roca gvaqvs Sereuli SfoTviTi
imisa, rom simptomatika ar uaresdeba. am qronikul da depresiuli aSliloba da msubuqi depresiuli
depresiul mdgomareobas disTimia ewodeba. terminiT aSliloba. miCneulia, rom faqtobrivi informacia ar
cikloTimiuri darRveva aRniSnaven guneb-ganwyobis aris sakmarisi, raTa romelime maTgani klasifikaciaSi
xangrZliv arastabilurobas, roca xSiria msubuqi movaTavsoT. miuxedavad imisa, rom cota ram aris
depresiisa da aRtacebis epizodebi. miCneulia, rom igi cnobili am mdgomareobebisa da sxva darRvevebTan maTi
bipolaruli aSlilobis msubuqi variantia. ufro mZime kavSiris Sesaxeb, am aSlilobis mqone pacientebi mainc
guneb-ganwyobis darRvevebis dros, arcTu ise iSviaTia mimarTaven eqims. maSinac ki, rodesac diagnozis zusti
SemTxvevebi, roca disTimiisa da cikloTimiuri kriteriumebis Camoyalibeba TiTqmis SeuZlebelia,
aSlilobis mqone adamianebs uviTardebaT ufro saWiroa arsebobdes mdgomareobis ganmsazRvreli
seriozuli darRvevebi an piriqiT (Judd et al., 1998, Sesabamisi kategoria.
_ 238 _
klinikuri niSnebi
advilad daRla
Zilis problemebi
gaRizianebadoba
dardi
suraTi. 11.1 randomizebulad depresia
gamokvleuli 10 000 mozrdi
depresiuli ideebi
lis klinikuri interviurebiT
SfoTva
gamovlenili nevrozuli sim
ptomebis maCveneblebi. yvela obsesia
simptomi ufro xSirad vlin koncentraciis unaris daqveiTeba
deba qalebSi (Ria Seferilobis somaturi simptomebi
mxare), vidre mamakacebSi (muqi
akviateba
Seferilobis mxare). yvelaze
gavrcelebuli simptomia àd fobiebi
vilad daRlis~ SegrZneba, ro fizikur janmrTelobasTan
dakavSirebuli wuxili
melic gamokiTxulTa 27%-s ga
panika
mouvlinda (Jenkins et al., 1997 w.).
40 30 20 10 0 10 20 30 40
monacemebi procentebSi
klinikuri suraTi sakuTari SesaZleblobis gadafaseba.

msubuqi afeqturi aSlilobis erT-erTi yvelaze
guneb-ganwyoba
saukeTeso ganmarteba mogvca goldbergma da sxv.
roca guneb-ganwyoba amaRlebulia, pacienti op
(Goldberg et al., 1976), romelmac 88 pacienti Seiswavla
timisturadaa ganwyobili da mxiarulia. aseT
filadelfiaSi. yvelaze xSiri simptomebi iyo:
mdgomareobas adreul SromebSi uwodebdnen `gadamdeb
w daRliloba
simxiarules~, Tumca, zogjer pacienti ufro ga
w depresia Rizianebulia, vidre eiforiuli da es gaRizianeba
w gaRizianebadoba sibrazeSi martivad gadadis. damaxasiaTebelia guneb-
w koncentraciis unaris daqveiTeba ganwyobis dReRamuri meryeoba regularuli ritmis
gareSe, gansakuTrebiT, mZime depresiuli aSlilobebis
w uZiloba
SemTxvevaSi. aweul guneb-ganwyobas, rogorc wesi,
w somaturi da dismorfuli simptomebi. depresiis msubuqi epizodebi mohyveba.
msgavsi simtomebia mocemuli National Psychiatric
Morbidity Household Survey-Si (Jenkins et al., 1997), garegnoba da qceva
romelic Seiswavlida `nevrozuli~ simptomatikis pacientis garegnoba xSirad pirdapir asaxavs mis guneb-
sixSires konkretul TemSi (suraTi 11.1). ganwyobas. mas SeiZleba ecvas kaSkaSa feris da cudad
msubuqi afeqturi aSlilobis mqone pacientebi Sexamebuli tansacmeli. ufro mwvave mgomareobaSi
eqimTan gamoxatuli somaturi CivilebiT midian. amis myofi ki SeiZleba usufTao da dauvarcxneli iyos.
mizezi gaurkvevelia; zogierTi simptomi avtomaturad maniakaluri pacientebi hiperaqtiurebi arian, rac
axlavs Tan SfoTvas da, SesaZloa, pacientebi ufro met xSirad fizikur gamofitvas iwvevs. pacientebi
yuradRebas somatur Civilebs uTmoben, vidre emociur erTdroulad bevr sxvadasxva saqmes iwyeben, magram
problemebs. meores mxriv, msubuqi afeqturi aSliloba verc erTs ver asruleben. mada momatebulia da
SesaZloa gaxangrZlivdes da zogierT SemTxvevaSi pacientebi sakvebs yovelgvari etiketis dacvis gareSe
gamoiwvios pirovnuli da profesiuli funqcionirebis iReben. seqsualuri moTxovnilebebi gazrdilia,
moSla. amgvarad, termini `msubuqi~ ar moiazrebs pacienti misTvis uCveulod ganmuxruWebulia da
darRvevis seriozul Sedegebs individisaTvis. rogorc misi qceva zedmetad Tavisufalia. Sobadobis asakSi
zemoT aRiniSna, zog SemTxvevaSi msubuqi afeqturi myofi qalebi orsulobis Tavidan acilebisTvis
aSliloba SesaZloa iyos guneb-ganwyobis mZime saWiro usafrTxoebis zomebis dacvas xSirad ugu
aSlilobis rezidualuri forma (Judd et al., 1998, 2002). lebelyofdnen, rasac saTanado yuradReba unda
mieqces. Zilis moTxovnileba daqveiTebulia. paci
mania entebi dgebian adre da, garSemomyofebis gasakvirad,
rogorc zemoT iTqva, maniis ZiriTadi maxasiaTeblebia energiulad da xmaurianad iwyeben saqmianobas.
_ aweuli guneb-ganwyoba, momatebuli aqtivoba da
_ 239 _
metyveleba da azrovneba informaciis sxva pirebisganac mopoveba. henri mo

udslim (1879, gv. 398) Semdegnairad aRwera es prob
maniis dros metyveleba aCqarebuli da mravalsit
lema:
yviania, radgan fiqrebi da azrebi swrafad enacvlebian
ìseve, rogorc araRrma Trobisas, naklebad gamo
erTmaneTs. am dros xdeba asociaciuri procesis aC
xatuli maniakaluri mdgomareobis dros, pirovnebas
qareba _ ideaTa xtoma (gv. 15??), anu imdenad swra
SeuZlia, daZabos goneba, Tavi mouyaros azrebs,
fad xdeba erTi Temidan meoreze gadasvla, rom
gaakontrolos Tavisi qceva da mcire drois manZilze
Znelia miyve asociaciaTa jaWvs. Tumca maT Soris
isaubros mSvidad da gonivrulad ise, rom SecdomaSi
kavSiris gageba rTuli araa, gansakuTrebiT, Tu sa
Seiyvanos gamoucdeli mosaubre~.
ubars CaviwerT da Semdeg gavSifravT. es movlena
DSM-IV-is mixedviT, maniakaluri epizodis diag
gansxvavdeba SizofreniisTvis damaxasiaTebeli azrov
nostikuri kriteriumebi mocemulia cxrilSi 11.3.
nebis darRvevebisagan, rodesac Canaweris Seswavlis
ICD-10-is mixedviT, es kriteriumebi msgavsia, Tumca,
Semdegac asociaciebs Soris kavSiris dadgena SeuZ
zustad ar aris miTiTebuli diagnozis dasmisTvis
lebelia.
aucilebeli simtomebis raodenoba.
xSiria eqspansiuri/gandidebis ideebi. pacientebs
sjeraT, rom maTi azrebi originaluri da mniSvne
lovania da rom maT mier Sesrulebuli samuSao
gamorCeuli xarisxisaa. bevri pacienti xdeba eqstra cxrili 11.3 maniakaluri epizodis
vaganturi, iwyebs fulis flangvas. xarjavs imaze diagnostikuri kriteriumebi - DSM-IV
mets, vidre SeuZlia. yidulobs Zvirian manqanasa A. calkeuli, minimum, 1-kviriani periodi (nebismieri
da samkaulebs, Tavs anebebs karg samsaxurs, ebmeba xangrZlivoba hospitalizaciis SemTxvevaSi), romlis
drosac vxedavT uCveulod, mudmivad aweul,
ugunur da sarisko biznes wamowyebebSi. eqspansiur guneb-ganwyobas an gaRizianebadobas
xandaxan gandidebis azrebs Tan axlavs gandidebis
B. guneb-ganwyobis aSlilobis periodSi qvemoT
bodva. zogierTma pacientma SesaZloa irwmunos, CamoTvlilTagan warmodgenili unda iyos, minimum,
rom aris mesia, an saxelmwifo moRvaweebis mrCeveli 3 simptomi (xolo gaRizianebadobis SemTxvevaSi _ 4
mniSvnelovan sakiTxebSi. SeiZleba ganviTardes devnis simptomi):
bodvac, rodesac pacients sjera, rom gansakuTrebuli 1. gadaWarbebuli TviTSefaseba an sakuTari Tavis
gandideba;
misiis gamo devnian. aseve, gvxvdeba damokidebulebisa
2. Zilis daqveiTebuli moTxovnileba (mag: 3 saaTi Zilic
da zemoqedebis bodviTi ideebic. Snaideris (ix. Tavi ki sakmarisia imisaTvis, rom Tavi dasvenebulad
me-12, cxrili 12.4) pirveli rigis simptomebi aRe igrZnos);
niSneba pacientTa 10-20 procents. bodvebi da pirveli 3. pacienti Cveulebrivze ufro mravalsityviania, aqvs
laparakis mudmivi moTxovnileba;
rigis simptomebi ar aris xangrZlivi _ maTi umetesoba
4. ideaTa xtoma an azrebis mozRvavebis subieqturi
nivelirdeba an ramdenime dReSi Sinaarsobrivad SegrZneba;
icvleba. 5. yuradRebis advilad gadanacvleba (pacientis
yuradReba advilad inacvlebs erTi gamRizianebli-
aRqmis paTologia dan meoreze);
maniis dros xSiria halucinaciebic, romlebic upi 6. gazrdili mizanmimarTuli aqtivoba (socialuri, sa-
muSao/saswavlo an seqsualuri kuTxiT) an fsiqomo-
ratesad guneb-ganwyobis fonis Sesamabisia. maga toruli aJitacia;
liTad, xma, romelic arwmunebs pacients, rom mas 7. siamovnebis momniWebel, magram potenciurad
gansakuTrebuli unari aqvs an religiuri Sinaarsis mtkivneul da sarisko aqtivobebSi monawileoba (mag.,
xilvebi. TavSeukavebeli xarjva, SemTxveviTi seqsualuri
kontaqtebis damyareba, sarisko biznes-garigebebSi
monawileoba).
sxva damaxasiaTebeli niSnebi
C. simptomebi ar emTxveva Sereuli epizodis diagnostikur
mwvave maniakalur mdgomareobaSi sakuTari mdgoma
kriteriumebs.
reobis mimarT kritika mniSvnelovnadaa daqveiTebuli.
pacients ar esmis, ratom unda Seikavos Tavi D. guneb-ganwyobis darRveva imdenad mZimea, rom SeuZlia
gamoiwvios mniSvnelovani gauareseba samsaxureobriv
grandiozuli gegmebisagan an Seamciros xarjebi da saqmianobaSi, socialur aqtivobebsa da urTierTobebSi
uari Tqvas eqstravaganturi nivTebis SeZenaze. igi an saWiroebs hospitalizacias, raTa Tavidan iqnes
acilebuli TviTdazianeba an sxvebisTvis zianis
iSviaTad miiCnevs Tavs avadmyofad an Tvlis, rom
miyeneba an saxezea fsiqozuri simptomatika.
sWirdeba mkurnaloba.
pacientebis umravlesobas SeuZlia Tavisi mdgoma E. guneb-ganwyobis darRveva araa dakavSirebuli raime
nivTierebis (narkotikuli nivTierebis da samkurnalo
reobis gakontroleba da disimulacia, gansakuTrebiT medikamentebis miRebasa an sxva mkurnalobasTan) mi-
maSin, rodesac maTi mkurnalobis sakiTxi ganixileba; Rebasa an sxva somatur mdgomareobebTan (magaliTad,
hiperTiroidizmi).
amitom, Tu ki amis saSualeba arsebobs, mniSvnelovania
_ 240 _
guneb-ganwyobis (afeqturi) aSlilobebi
Sereuli afeqturi mdgomareobebi gvxvdeba. amdenad, krepelinis aRwera (1921, gv. 106)
gansakuTrebiT yuradsaRebia:
depresiuli da maniakaluri simptomebi zogjer erT
`pacienti, Cveulebriv, miuwvdomelia, gulgrilia
droulad aRmocendeba. pacients, romelsac aReniSneba
irgvliv mimdinare movlenebis mimarT, SekiTxvebze
Warbsityvianoba da energiis mozRvaveba, SesaZloa,
pasuxs ar gvcems an saubrobs Cumad... icinis umizezod,
hqondes gamoxatuli depresiuli azrebi. zogierTi
mowesrigebuli tansacmliT utyvad wevs sufTa loginSi,
pacientis SemTxvevaSi mania da depresia swrafad
eqstraordinalurad aris morTuli da es yvelaferi
enacvleba erTmaneTs; mag., maniakaluri pacienti Se
Sinagani aRelvebis yovelgvari niSnis gareSea~.
saZloa ramdenime saaTiT gaxdes ukiduresad dep
gamojanmrTelebul pacientebs axsovT stuporis
resiuli da Semdeg swrafad daubrundes maniakalur
dros gancdili movlenebi. es mdgomareoba SesaZloa,
mdgomareobas, rac aRwerilia grizingeris (Griesinger,
ganviTardes maniakaluri epizodis an depresiuli
1867) adreul naSromebSi maniakaluri mdgomareobebis
epizodidan maniakalur mdgomareobaSi gadasvlis
Sesaxeb. bolo wlebSi sakiTxi kvlav aqtualuri
etapze.
gaxda, vinaidan aseTi mdgomareobebis samkurnalod,
sxva guneb-ganwyobis stabilizatorebTan SedarebiT,
yvelaze efeqturad valproati gamoiyeneba. transkulturaluri faqtorebi
mania gvxvdeba yvela kulturaSi. mniSvnelovania
swrafad cirkulirebadi aSlilobebi
distresis gamoxatvis kulturaluri Taviseburebebis
zogierTi bipolaruli aSliloba regularulad gaTvaliswineba, vinaidan, zog SemTxvevaSi, es mdgo
meordeba epizodebs Soris ramdenime dRiani an mareoba SesaZloa SecdomiT maniad iqnes miCneuli
kviriani intervaliT. me-19 saukuneSi ganmeorebadi (Kirmayer and Groleau, 2001). depresiuli epizodis
aSlilobebi frangma fsiqiatrma farlem (1854) aR klinikuri maxasiaTeblebi sxvadasxva kulturaSi
wera, rogorc cirkularuli SeSliloba. dRevandel gansxvavebulia, amasTan, bevr qveyanaSi misi diag
dRes bipolaruli aSlilobis mqone pacientebSi nostireba arasaTanadod xdeba, gansakuTrebiT, pir
guneb-ganwyobis xSir rekurentulobas, Cveulebriv, veladi jandacvis qselSi. somaturi simptomebi yvela
swrafad cirkulirebad aSlilobebs uwodeben. reku sazogadoebisTvisaa damaxasiaTebeli, Tumca ufro
rentuli epizodebi SesaZloa iyos depresiuli, xSiri da gavrcelebulia aradasavlur kulturebSi.
maniakaluri an Sereuli. swrafad cirkulirebadi emociuri mdgomareobis ganxilvisas, mniSvnelovania,
aSlilobebis Taviseburebebia: xSiri rekurentuloba somatizacia ganvasxvavoT somaturi metaforebisagan
(minimum, oTxi mkafiod gamoxatuli epizodi wlis (ix. me-10 Tavi). magaliTad, londonSi mcxovrebi
manZilze), epizodebs Soris xanmokle remisia an samxreT azieli qalebi TavianTi, sruliad gacno
erTi epizodidan sapirispiroze gadasvla. swra bierebuli emociuri gancdebis aRsawerad xmaroben
fad cirkulirebadi aSlilobebis marTvisa da pre iseT gamonaTqvamebs, rogorebicaa: `gulze simZime
venciisTvis gansakuTrebiT mniSvnelovania Semdegi mawevs~ àn sxeuli mixurs~. guneb-ganwyobisa da
klinikuri maxasiaTeblebi: energiis daqveiTeba, saimovnebis miRebis uunaroba da
w ufro xSiria qalebSi; SfoTva yvela kulturaSi depresiis ZiriTadi niSnebia
w xSirad Tan axlavs hipoTireozi; (ix. Bhugra and Mastrogianni, 2004).
w SesaZloa gamowveuli iyos antidepresantebis miRe
biT;
w misi mkurnalobisaTvis liTiumi naklebad efeq
guneb-ganwyobis (afeqturi)
turia. aSlilobebi
swrafad cirkulirebadi aSlilobebis klinikuri guneb-ganwyobis (afeqturi) aSlilobebis klasifi
maxasiaTeblebisa da mkurnalobis Sesaxeb damatebiTi kaciebSi fundamenturi klinikuri gansxvaveba aris
informaciis misaRebad ix. makini da iangi (Macking and depresiasa da manias Soris. arsebobs depresiuli
Young, 2004). epizodebis mravalgvari dayofa (ix. qvemoT), Tumca am
mimarTulebiT Catarebuli kvlevebis Sedegebi naklebad
maniakaluri stupori mniSvnelovania. gansakuTrebiT yuradsaRebia guneb-
am iSviaT aSlilobas axasiaTebs sruli umoZraoba ganwyobis aSlilobebis mimdinareobaze xangrZlivi
da damunjeba (mutizmi), pacientebs mxiaruli saxis dakvirvebis Sedegebi, romelTa Tanaxmadac arsebobs
gamometyveleba aqvT, rac aweul guneb-ganwyobas gamoxatuli klinikuri sxvaoba im mdgomareobebs
gamoxtavs, xolo mdgomareobidan gamosvlis Semdeg, Soris, rodesac mxolod depresiuli epizodebi
aRweren gadatanil, maniisTvis damaxasiaTebel, ideaTa viTardeba (rekurentuli depresiuli aSliloba) da
xtomis gancdas. dRes, radgan aqtiuri mkurnaloba rodesac depresiis garda aRiniSneba maniakaluri da/an
xelmisawvdomi gaxda, msgavsi mdgomareoba iSviaTad hipomaniakaluri epizodebic (bipolaruli aSliloba).
_ 241 _
da imave pacientis SemTxvevaSic da pacientebs So
cxrili 11.4 melanqoliuri da somaturi risac gansxvavebulia. depresiis klinikuri niS
depresiis klinikuri niSnebi
nebis Seswavlisas gamovlinda, rom zogi depresiuli
melanqoliuri niSnebi (DSM-IV) mdgomareobisTvis damaxasiaTebelia e.w. `biologiuri~
interesTa sferos SezRudva da siamovnebis miRebis uu- simptomebi, rogorebicaa: umadoba, fsiqomotoruli
naroba* cvlilebebi, wonaSi kleba, yabzoba, libidos daqveiTeba,
sasiamovno stimulebze sapasuxo reaqciis nakleboba amenorea da diliT adre gaRviZeba. am simptomebs xSirad
da, damatebiT, qvemoT CamoTvlilTagan sul cota, sami melanqoliursac uwodeben; isini qmnian depresiuli
simptomi: aSlilobebis specifikur qvejgufs, romelic DSM-IV-
siamovnebis miRebis unaris daqveiTeba (gansxvavebuli Si mocemulia saxelwodebiT _ `depresia melanqoliiT~,
Cveulebrivi mowyenilobisgan)
xolo ICD-10-Si _ `depresiuli epizodi `somaturi
xasiaTis damZimeba diliT*
simptomebiT~ (cxrili 11.4).
fsiqomotoruli Sekaveba an aJitacia*
anoreqsia an wonis mniSvnelovani kleba*
klasifikaciis meSveobiT diagnozis dasma rTulia,
braleulobis gadaWarbebuli gancda radgan pacientebis umravlesobas aqvs melanqoliis
libidos sagrZnobi daqveiTeba (mxolod ICD-10) esa Tu is niSani, romlis gamovlenas yuradRebiT
gamokvleva sWirdeba. Sesabamisad, melanqoliuri dep
*ICD-10-Si depresiis somaturi simptomebi (minimum oTxis
arsebobaa aucilebeli diagnozis dasasmelad). resiis diagnozis dasasmelad aucilebeli simptomebis
raodenoba, garkveulwilad, sakamaToa. miuxedavad
depresiis klasifikacia amisa, zogadad miRebulia, rom gamoxatuli melan-
zogadi SeTanxmeba depresiuli aSlilobebis klasi qoliuri depresia asocirdeba rig saerTo klinikur
fikaciis saukeTeso meTodze jer-jerobiT miRweuli maxasiaTebelTan:
ar aris. arsebobs ramdenime midgoma: w ufro mwvave simptomatika
w klasifikacia savaraudo etiologiuri faqtorebis w susti pasuxi placebo-mkurnalobaze
mixedviT;
w eleqtrokonvulsiuri Terapiis efeqturoba (ECT)
w klasifikacia klinikuri suraTis mixedviT;
w klasifikacia mimdinareobis mixedviT. w neirobiologiuri paTologiebis meti mtkicebuleba
(swrafi Zilis fazaSi Semcirebuli latenturi
klasifikacia savaraudo etiologiuri periodi, kortizolis hipersekrecia).
faqtorebis mixedviT dRemde gaurkvevelia, aris Tu ara melanqoliuri
isotriulad ganasxvavebdnen ori saxis depresiul depresia damoukidebeli aSliloba, Tu igi depresiul
aSlilobas. iTvleboda, rom erT SemTxvevaSi simp aSlilobaTa kontinuumis simwvaviT gansxvavebul
tomebi mxolod Sinagani, gare faqtorebisgan damo mdgomareobas warmoadgens.
ukidebeli mizezebiT iyo ganpirobebuli (endogenuri kendlerma (Kendler, 1997) am kiTxvaze pasuxis gasacemad
depresia), xolo meore SemTxvevaSi, simptomebi gare gamoikvlia tyupebi. man daadgina, rom melanqoliuri
stresorze sapasuxod viTardeboda (reaqtiuli depresia warmoadgens depresiis validur qvejgufs,
depresia). mravali wlis ganmavlobaSi aseTi dayofa romelic viTardeba depresiisadmi maRali genetikuri
aradamakmayofileblad iyo miCneuli. magaliTad, winaganwyobis mqone individebSi. amasTan, melanqoliis
luisi (Lewis, 1934) werda: diagnozi miuTiTebda raodenobrivad gansxvavebul
ufro mwvave formis arsebobaze, vidre gansxvavebul
`yvela daavadeba ori faqtoris Sedegia _ garemo
etiologiur qvejgufze.
zemoqmedebas axdens organizmze. konstituciuri
fsiqozuri depresia _ rogorc zemoT aRiniSna,
faqtorebia wamyvani, Tu garemo faqtorebi, es
mZime depresiis dros SesaZloa ganviTardes
verasodes gaxdeba gansjis sagani~.
fsiqozuri simptomatika (depresiul fsiqozs TiTqmis
rogorc me-5 TavSia aRniSnuli, depresiis indi mudmivad axlavs melanqoliis niSnebi). fsiqozuri
vidualuri SemTxvevebis ganxilvisas, saWiroa sxva simptomatikis arseboba miuTiTebs imaze, rom mxolod
dasxva etiologiuri faqtorebis xvedriTi wi antidepresantebiT mkurnaloba ar aris sakmarisi
lis gaTvaliswineba. arc ICD-10 da arc DSM-IV da saWiroa maTi antifsiqozur medikamentebTan
klasifikaciebSi reaqtiuli da endogenuri depresiis kombinacia (ix. Cowen, 2005).
kategoriebi ar aris Sesuli. aramelanqoliuri depresia _ simptomatikis profi
lis mixedviT, depresia (ara-melanqoliuri depresia)
klasifikacia klinikuri suraTis mixedviT moicavs sxvadasxva tipis klinikur aSlilobebs, maT
melanqoliuri depresia _ cnobilia, rom depresiuli Sorisaa: msubuqi depresiuli epizodi, atipiuri
epizodis dros ganviTarebuli simptomebi erTi depresia da disTimia. am tipis depresiuli aS
_ 242 _
ICD-10 da DSM- IV klasifikaciebi
lilobebis mqone pacienti arakeTilganwyobilia, depresiuli xdeba weliwadis erTsa da imave dros,
SfoTavs, aReniSneba fobiebi da obsesiebi. Camo upiratesad, Semodgomasa da zamTarSi. sezonuri
Tvlili simptomebis gamo, aramelanqoliur dep afeqturi aSlilobis ganviTarebas SesaZloa, xeli
resias `nevrozul depresias~ uwodeben, Tumca, es Seuwyos cxovrebiseulma problemebmac, Tumca, xSirad
termini Tanamedrove diagnostikur kriteriumebSi sruliad umizezodac iCens Tavs. amdenad, varaudoben,
aRar gvxvdeba. rogorc zemoT aRiniSna (gv. 221), rom sezonuri afeqturi aSliloba weliwadis droebis
atipiur depresias aqvs damaxasiaTebeli klinikuri cvlilebas, magaliTad, dRis sinaTlis xangrZlivobas
simptomatika da pasuxi mkurnalobaze; amitomac igi ukavSirdeba. sezonuri afeqturi aSlilobebis Ziri
aramelanqoliur depresiebs Soris gamoyofilia Tadi maxasiaTebeli maTi sezonuroba; amasTan, guneb-
damoukidebel kategoriad. ganwyobis sxva aSlilobebTan SedarebiT, am dros
ufro xSiria Semdegi simptomebi:
klasifikacia mimdinareobis mixedviT w hipersomnia;
unipolaruli da bipolaruli aSlilobebi _ guneb- w madis momateba _ naxSirwylebis miRebis dauokebeli
ganwyobis aSlilobebs, rogorc wesi, rekurentuloba survili;
axasiaTebs da krepelini swored mimdinareobiT
w saRamoobiT energiis daqveiTeba.
xelmZRvanelobda, roca mania da depresia erT
daavadebad gaaerTiana. man aRmoaCina, rom daavadeba Seteva, rogorc wesi, Semodgomaze, an zamTarSi
ZiriTadad erTnairad mimdinareobda, miuxedavad viTardeba. aqedan gamomdinare, mas `zamTris dep
imisa, sawyisi epizodi mania iyo, Tu depresia. resiasac~ uwodeben. zog pacients zafxulis peri
swored amitom, man es ori mdgomareoba maniakalur- odSi SeiZleba mania an hipomania ganuviTardes,
depresiuli fsiqozis kategoriaSi gaaerTiana. rac bipolarul sezonur aSlilobaze miuTiTebs.
es Sexeduleba, sazogadod, miRebuli iyo 1962 amdenad, SegviZlia vivaraudoT, rom dRis sinaTlis
wlamde, sanam leonhardma (Leonhard et al.) ar Semo Semcireba mniSvnelovani faqtoria depresiis paTo
gvTavaza dayofa Semdeg sam jgufad: fiziologiisTvis, amitom mkurnalobis meTodebi unda
iTvaliswinebdes dabnelebisas xelovnur sinaTleze
w pacientebi, romelTac mxolod depresiuli aSli
yofnas (Eagles, 2004). (sinaTliT mkurnalobis Sesaxeb
loba aqvT _ unipolaruli depresia;
informaciis misaRebad ix. gv. 572).
w pacientebi, romlebsac mxolod maniakaluri aSli xanmokle rekurentuli depresia _ zog SemTxvevaSi
loba aqvT _ unipolaruli mania; rekurentuli depresia mxolod mcire drois manZilze,
w pacientebi, romlebsac rogorc depresiuli, ise 2-dan 7 dRemde, iCens Tavs. xanmokle periodis gamo
maniakaluri aSliloba aqvT_ bipolaruli. mdgomareoba ar akmayofilebs arc didi depresiisa
Cvens droSi, rogorc wesi, ar ixmareba termini da arc depresiuli epizodis kriteriumebs. epi
ùnipolaruli mania~ da maniis yvela SemTxveva zodebi meordeba garkveuli sixSiriT (saSualod,
erTiandeba bipolarul jgufSi, rasac ganapirobebs TveSi erTxel). qalebTan raime TvalsaCino kavSiri
is, rom, maniakalur pacientebs TiTqmis yovelTvis menstrualur ciklTan ar aRiniSneba. miuxedavad imisa,
uviTardebaT depresiuli aSlilobac. rom depresiuli epizodebi xanmoklea, isini iseTive
raTa xazi gaesva unipolarul da bipolarul mwvavea, rogorc mZime depresiuli aSlilobebis
aSlilobebs Soris arsebul gansxvavebaze, leonhardma SemTxvevaSi da, SesaZlebelia, TviTmkvlelobasac
(Leonhard et al., 1962) aRwera am jgufebis memkvidreobiTi ukavSirdebodes. xanmokle rekurentuli aSliloba
sxvaobac, rac Semdgomi kvlevebiTac dadasturda asocirebulia pirovnul distresTan da socialuri
(gv. 232 ??). sazogadod, Tanxmdebian, rom depresiis da profesiuli funqcionirebis gauaresebasTan.
dros am ori jgufis simptomebi ZiriTadad msgavsia. komorbidoba maniakalur aSlilobas an disTimiasTan
unda arsebobdes garkveuli gadafarva jgufebs nakleb savaraudoa. xanmokle rekurentuli depresiis
Soris, radgan pacientebs, romlebsac unipolaruli SemTxvevebSi pacientebi iReben antidepresantebs, Tumca
depresiis diagnozi aqvT, SeiZleba mogvianebiT sakamaToa, ramdenad efeqturia isini (ix. Baldwin, 2003).
maniakaluri simptomebic ganuviTardeT. anu, sxva
gvarad rom vTqvaT, unipolaruli mdgomareobebi
ICD-10 da DSM- IV klasifikaciebi
aucileblad moicavs bipolarul SemTxvevebs, rom
lebic jer ar gamovlenila. am SezRudvis miuxedavad, guneb-ganwyobis aSlilobebis ZiriTadi kategoriebi
dayofa unipolarul da bipolarul aSlilobebad DSM-IV-isa da ICD-10-is mixedviT, mocemulia cxrilebSi
mkurnalobis TvalsazrisiT Zalian mosaxerxebelia 11.4 da 11.5. aq naTlad Cans am or klasifikacias Soris
(gv. 246-65??). mniSvnelovani msgavseba da garkveuli gansxvavebebic.
sezonuri afeqturi aSliloba. zogierTi pacienti pirveli msgavsebaa is, rom oriveSi Sesulia guneb-
_ 243 _
cxrili 11.5 bipolaruli aSlilobebis cxrili 11.6 depresiul aSlilobaTa

klasifikacia klasifikacia
ICD-10 DSM IV ICD-10 DSM-IV
maniakaluri epizodi hipomaniakaluri epizodi depresiuli epizodi didi depresiuli epizodi
msubuqi msubuqi
hipomania maniakaluri epizodi
saSualo saSualo
mania msubuqi
mZime mZime
mania fsiqozuri saSualo mZime fsiqoziT mZime fsiqoziT
simptomebiT
sxva depresiuli epizodebi
mwvave
atipiuri depresia
mwvave fsiqozuri
simptomebiT rekurentuli depresiuli didi depresiuli aSliloba
aSliloba rekurentuli
bipolaruli afeqturi bipolaruli I da
aSliloba bipolaruli II aSlilobebi mimdinare epizodSi msubuqi
mimdinare epizodSi mimdinare (an ukanaskneli
hipomaniiT epizodi) mimdinare epizodSi
zomieri
mimdinare epizodSi maniiT hipomania
mimdinare epizodSi mZime
mimdinare epizodSi mania*
mimdinare epizodSi mZime
depresiiT
depresiuli rekurentuli
mimdinare epizodSi depresia aSliloba fsiqozuri
Sereuli aSlilobiT simptomebiT
bipolaruli aSliloba Sereuli rekurentuli depresiuli

remisiis mgomareobaSi aSliloba remisiis
mdgomareobaSi
cikloTimia cikloTimia
guneb-ganwyobis xangrZlivi disTimiuri aSlilobebi
aSlilobebi
*gamoricxavs bipolarul II aSlilobas
cikloTimia
ganwyobis erTaderTi epizodi da rekurentuli
disTimia
epizodebi. aseve, orive aRwers qronikul msubuq
guneb-ganwyobis aSlilobebs, rodesac aRiniSneba guneb-ganwyobis sxva sxva mxriv dauzustebeli
aweuli guneb-ganwyobidan daqveiTebamde perioduli aSlilobani guneb-ganwyobis aSliloba
meryeoba (cikloTimia), an xangrZlivi daqveiTebuli xanmokle rekurentuli xanmokle rekurentuli
guneb-ganwyoba (disTimia). aRniSnul SemTxvevebSi depresia depresia
guneb-ganwyobis aSlilobebi ar aris imdenad mwvave,
sakmarisia bipolaruli aSlilobis kriteriumebis
rom daakmayofilos hipomaniakaluri an depresiuli
dasakmayofileblad. ICD-10-is Tanaxmad ki, am
epizodis kriteriumebi. DSM-IV-is klasifikaciaSi
diagnozis dasasmelad, saxeze unda iyos minimum
zogadi samedicino mdgomareobebiT gamowveuli
ori epizodi. DSM-IV klasifikacia bipolarul aS
guneb-ganwyobis aSlilobebi Sedis guneb-ganwyobis
lilobebs or nawilad yofs:
aSlilobaTa qvejgufSi, xolo ICD-10-Si ki _ organuli
fsiqikuri aSlilobebis kategoriaSi. w bipolaruli I aSliloba (sakmarisia minimum erTi
maniakaluri epizodis arseboba);
bipolaruli aSlilobebi w bipolaruli II aSliloba (rodesac iyo hipomania da
orive klasifikaciaSi manias hipomaniisgan gana ara mania).
sxvavebs simptomebis xangrZlivoba, fsiqozuri niS bipolaruli II aSlilobis diagnozi yuradRebas
nebis arseboba, socialuri da samsaxureobrivi amaxvilebs msubuqi hipomaniakaluri epizodis mni
funqcionirebis gauareseba. simwvavisa da fsiqozuri Svnelobaze iseT SemTxvevebSi, rodesac SesaZlebelia
simptomebis arsebobis an ararsebobis mixedviT, daisvas rekurentuli depresiis diagnozi. aseTi
maniakaluri epizodi SesaZlebelia daiyos qvejgu epizodebis arseboba gavlenas axdens mkurnalobis
febad; DSM-IV klasifikaciis mixedviT maniis an strategiazec. DSM-IV miTiTebulia, rom Tu mania
hipomaniis erTi konkretuli epizodis arseboba an hipomania gamowveulia somaturi mkurnalobiT,
_ 244 _
magaliTad, antidepresantebis miRebiT, maSin ver
davsvamT bipolaruli I an bipolaruli II aSlilobebis
cxrili 11.7 guneb-ganwyobis aSlilobebis
klinikuri aRweris sistemuri sqema
diagnozs. Tumca, ukanasknel wlebSi Catarebul
kvlevaTa Sedegebis safuZvelze dagrovda mzardi epizodi msubuqi, saSualo, mZime
mtkicebulebebi imisa, rom antidepresantebiT ga simwvave depresiuli, maniakaluri,
mowveuli mania an hipomania unda miviCnioT bi Sereuli
polaruli aSlilobebis maCveneblad (Goodwin, 2003). tipi melanqoliuri simptomebiT
atipiuri simptomebiT
klasifikacia da aRwera yoveldRiur
praqtikaSi damaxasiaTebeli gamokveTili SfoTviT
simptomebi
miuxedavad imisa, rom arc DSM-IV da arc ICD-10
klasifikaciebi ar aris bolomde damakmayofilebeli, fsiqozuri simptomebiT
nakleb savaraudoa, rom aRwerilobiTi kategoriebis
aJitaciiT, retardaciiT
momavalma gadajgufebam ukeTesi Sedegi gamoiRos. an stuporiT
realurad, sakiTxi maSin gadaiWreba, rodesac
mimdinareobis tipi unipolaruli an
moxerxdeba aSlilobaTa etiologiis ukeT gaazreba. bipolaruli
Tumca, orive klasifikacia, ICD-10 da DSM-IV
etiologiuri faqtorebi organuli
vargisia statistikuri monacemebisTvis. klinikuri
miznebis umravlesobisTvis ki umjobesia aSlilobaTa guneb-ganwyobis
aSlilobebis ojaxis
sistemuri aRwera, vidre maTi klasifikacia. istoria
yvela SemTxvevaSi, mdgomareobis Sefaseba unda
guneb-ganwyobis
moxdes simwvavis, gamoxatuli simptomebis, mimdi aSlilobebis piradi
nareobis tipisa da etiologiuri faqtorebis gaT istoria
valiswinebiT (cxrili 11.7). Cveulebriv, yvela ma bavSvobis droindeli
niakaluri epizodi, depresiuli epizodis ganvi gamocdileba
Tarebis gareSec, bipolarul aSlilobad ganixileba, pirovnuli Tvisebebi/
vinaidan maniakaluri pacientebis umetesobas sabo xasiaTis Taviseburebebi
lood mainc uviTardeba depresia. amasTan, ma
socialuri mxardaWera
niakaluri pacientebi ramdenime maxasiaTebliT gvanan
bipolaruli aSlilobis mqone pirebs. aRniSnul cxovrebiseuli movlenebi
sakiTxebze msjeloba gagrZeldeba Semdeg TavebSi.
sizuste damokidebulia depresiuli da SfoTviTi
diferencialuri diagnozi simptomebis simwvavis SedarebiT Sefasebasa da am
simptomebis ganviTarebis Tanmimdevrobaze. msgavsi
depresia problemebi iCens Tavs gamoxatuli fobikuri an
depresiuli aSlilobebi unda ganvasxvavoT: obsesiuri simptomebis an disociaciuri aSli
w Cveulebrivi dardisagan; lobebis SemTxvevaSic (Teatraluri qceviTi dar
Rvevebis arsebobis an ararsebobisas). yvela aseTi
w SfoTviTi aSlilobebisagan;
mdgomareobis dros klinicistma SeiZleba ver ga
w Sizofreniisagan;
moavlinos depresiuli simptomebi da daniSnos
w tvinis organuli sindromisagan. araswori mkurnaloba.
depresiisa da Cveulebrivi dardis diferencireba
Sizofrenia
xdeba depresiuli sindromisTvis damaxasiaTebeli
simptomebis arsebobis gaTvaliswinebiT (gv. 218??). Sizofrenis SemTxvevaSi diferencialuri diagnozis
depresiuli aSliloba maRali komorbidobiT gamo sizuste damokidebulia am mdgomareobisTvis dama
irCeva. xSiria Tanmxlebi SfoTviTi, kvebiTi da per xasiaTebeli simptomebis gamovlenaze (me-12 Tavi).
sonologiuri aSlilobebi an wamalmoxmareba. yvela diferencirebis problemebi SesaZloa gaCndes dep
am SemTxvevaSi mniSvnelovania depresiis amocnoba da resiuli fsiqozis dros, Tumca, am SemTxvevaSic,
saTanado mkurnalobis Catareba. saWiroa fsiqikuri mdgomareobis saguldagulod
Seswavla, damaxasiaTebeli simptomebisa da maTi
SfoTviTi aSlilobebi ganviTarebis Tanmimdevrobis gamovlena. yuradsaRebia
msubuqi depresiuli aSlilobebis garCeva SfoTviTi warsuli fsiqiatriuli istoriac. gansakuTrebiT
aSlilobebisagan zogjer sakmaod rTulia. diagnozis rTulia iseTi mdgomareobebis diferencireba, rodesac
_ 245 _
depresiuli da Sizofreniuli simptomebi Tanabradaa Tavis tvinis SesaZlo paTologia, gansakuTrebiT
warmodgenili. aseTi mdgomareobebi, e.w. Sizoafeqturi maSin, Tu anamnezurad guneb-ganwyobis aSliloba ar
aSlilobebi, ganxilulia 278??-e gverdze. aRiniSneba. gamoxatuli afeqturi mdgomareobis gareSe
ukiduresi socialuri ganmuxruWeba (magaliTad,
demencia da sxva organuli mdgomareobebi
sazogadoebaSi moSardva) miuTiTebs Sublis wilis
Sua an xanSiSesuli asakis pacientebSi depresiuli paTologiaze. aseT dros aucilebelia nevrologiuri
aSlilobis gansxvaveba demenciisagan sakmaod rTulia, gamokvlevis Catareba. axalgazrda asakSi maniakaluri
vinaidan maT umetesobas mexsierebis problemebi mdgomareobis ganviTarebas SeiZleba xeli Seuwyos aiv
aReniSneba. mZime depresiuli aSlilobebis dros infeqciam an Tavis tvinis travmam.
kognituri testebis Sesruleba gaZnelebulia, amitom maniasa da narkotikebis moxmarebiT gamowveul
am mdgomareobebis diferencireba mxolod kognituri agznebas Soris diferencialuri diagnozis dasa
daqveiTebis maCveneblebiT faqtobrivad SeuZlebelia. smelad mniSvnelovania pirovnebis istoriis Seswavla
amgvar viTarebaSi gansakuTrebiT mniSvnelovania da narkotikebis Semcvelobaze Sardis gamokvleva.
depresiuli simptomebis gamovlena. depresiis dama pacientis stacionirebis SemTxvevaSi narkotikebiT
dasturebeli iqneba isic, Tu guneb-ganwyobis nor gamowveuli mdgomareoba swrafad swordeba. Tumca,
malizebasTan erTad, moxdeba mexsierebis gaum aucileblad unda gvaxsovdes, rom bipolaruli
jobeseba. depresia SeiZleba ganviTardes Zalian aSlilobis mqone pirebi maRali sixSiriT moixmaren
bevr zogad-samedicino mdgomareobis fonze (gverdi alkoholsa da narkotikul nivTierebebs.
382??). diagnozisTvis gansakuTrebiT mniSvnelovania
avadmyofobis istoriis codna, sruli fizikuri
afeqturi aSlilobebis
gamokvlevis Catareba da, ramdenadac es SesaZlebelia,
damatebiTi monacemebis moZieba.
epidemiologia
depresiis gavrcelebis maCveneblis dadgena rTulia,
mania rac, nawilobriv, ukavSirdeba sxvadasxva kvlevebSi
gansxvavebuli diagnostikuri meTodebis gamoyenebas.
maniakaluri aSlilobebi unda ganvasxvavoT:
Tanamedrove mkvlevarebi ufro xSirad mimarTaven
w Sizofreniisagan;
struqturirebul diagnostikur intervius, rome
w Tavis tvinis organuli daavadebebisagan, romlebic lic moicavs Semdeg standartul diagnostikur
Sublis wils moicaven (magaliTad, simsivne an aiv instrumentebs: diagnostikuri intervius sqema (DIS),
infeqcia); Sedgenili saerTaSoriso diagnostikuri interviu
w amfetaminebis an sxva narkotikuli nivTierebebis (CIDI) da neirofsiqiatriaSi klinikuri Sefasebis
miRebiT gamowveuli agznebis xanmokle epizodebi- sqema (SCAN), romlebSic gamoyenebulia mimdinare
sagan mdgomareobis kvlevis me-10 gamocema (PSE) (gv. 62
??). radgan maniis dadgena da diagnostika SedarebiT
Sizofrenia
martivia, guneb-ganwyobis aSlilobebs Soris bipo
yvelaze rTulia maniakaluri mdgomareobis dife laruli SemTxvevebis gamovlena ufro sandoa.
rencireba Sizofreniisagan. maniakaluri aSli
lobis SemTxvevaSic SesaZloa, ganviTardes sme bipolaruli aSlilobebi
niTi halucinaciebi da bodvebi, maT Soris, Si
industriul qveynebSi mosaxleobis ukanasknelma
zofreniisaTvis damaxasiaTebeli simptomebic, magal
gamokiTxvebma (Kessler et al., 1997) aCvena, rom:
iTad, damokidebulebis bodva. Tumca, es simptomebi
w sicocxlis manZilze bipolaruli aSlilobis
swrafad icvlis Sinaars da iSviaTad grZeldeba
ganviTarebis riski meryeobs 0, 3-dan 1.5 procentamde;
momatebuli aqtivobis fazis Semdegac. Tu orive
aSlilobisTvis damaxasiaTebeli simptomebi Tanabradaa w 6 TveSi gamovlenili bipolaruli aSlilobebis
warmodgenili, aseT mdgomareobas Sizoafeqturi SemTxvevaTa ricxvi mniSvnelovnad ar gansxvavdeba
aSliloba ewodeba da igi ufro detalurad me-12 sicocxlis manZilze daavadebis ganviTarebis six
TavSia ganxiluli. diagnostikisaTvis damatebiTi Sirisgan, rac aSlilobis qronikul xasiaTze miu
informaciis mosaZieblad saWiroa pacientis ojaxisa TiTebs;
da misi piradi istoriis guldasmiT Seswavla. w bipolaruli aSlilobis gavrceleba qalebsa da ma
makacebSi Tanabaria;
Tavis tvinis organuli daavadeba da
narkotikuli nivTierebebis moxmareba w mosaxleobaSi Catarebuli kvlevebis Sedegebis Tana
xmad daavadebis sawyisi asakia daaxloebiT 17 weli;
saSualo an xandazmuli asakis eqspansiuri qcevis
pacientebis emTxvevaSi yovelTvis unda gamoiricxos w bipolaruli aSliloba maRali komorbidulobiT
_ 246 _
afeqturi aSlilobebis etiologia
xasiaTdeba, gansakuTrebiT xSiria SfoTviTi aSli wels da Semdgom dabadebuli pacientebis kvlevam
lobebi da wamalmoxmareba. industriul qveynebSi gamoavlina am populaciaSi
cxovrebis manZilze depresiis ganviTarebis moma
depresia tebuli riski da pirveli epizodis ganviTarebis
mosaxleobis kvlevisas depresiuli epizodis zusti ufro axalgazrda asaki. es kvlevebi ZiriTadad
sazRvrebis dadgena rTulia, Tumca, ukanaskneli retrospeqtulia da, SesaZloa, axalgazrdebTan Seda
kvlevebiT, romlebSic DSM-IV-is kriteriumebi ga rebiT, asakovan pacientebTan depresiuli epizodebis
moiyenes, ganviTarebul qveynebSi Semdegi Sedegebi SemTxvevebSi naklebia, radgan maT daqveiTebuli
miiRes (Alonso et al., 2004): aqvT mexsiereba, an warsulSi gadatanili depresiuli
mdgomareobis gamJRavneba ar surT (Paykel, 2000).
w mosaxleobaSi didi depresiis 12-Tviani gavrcelebis
sixSire 2-5% -ia;
disTimia da rekurentuli xanmokle
w sicocxlis manZilze depresiis gamovlenis maCve
depresia
nebeli sxvadasxva kvlevebSi mniSvnelovnad gan
cxovrebis manZilze disTimiis riski daaxloebiT 4
sxvavdeba (4-30%). zusti cifri, savaraudod, 10-
procentia (Alonso et al., 2004). disTimiis maCvenebeli
20%-s Soris meryeobs;
ufro maRalia qalebsa da ganqorwinebulebSi. xan
w daavadebis sawyisi asakia daaxloebiT 27 weli;
mokle rekurentuli depresiis epidemiologiaze
w gansxvavebul kulturebSic depresia TiTqmis or arsebuli monacemebi metad mwiria. ciurixSi Cata
jer metia qalebSi, vidre _ mamakakacebSi; rebuli kvlevebis Tanaxmad, xanmokle depresiuli
w 1945 welsa da Semdgom dabadebul adamianebs dep aSlilobisaTvis 12-Tviani gavrcelebis sixSirea daax
resiis maCvenebeli SesaZloa gazrdili hqondeT; loebiT 2.6%, xolo disTimiisTvis _ 2, 3% (Pezawas et
depresiis maCvenebeli ufro maRali aqvT umuSevar al., 2003).
da ganqorwinebul pirebs;
w didi depresiis dros xSiria komorbiduloba, gan msubuqi afeqturi aSlilobebi
sakuTrebiT, SfoTviTi aSlilobebisa da wamal msubuqi afeqturi aSlilobebis sixSire Zalian va
moxmarebis. riabeluria, vinaidan sxvadasxva kvlevebSi gan
mizezi imisa, Tu ratomaa qalebs Soris maRali sxvavebuli midgomebia gamoyenebuli. es aSlilobebi
maCvenebli, dadgenili araa. sixSire izrdeba sqesobrivi yvelaze ufro gavrcelebulia mosaxleobaSi. ma
momwifebis asakSi da, SesaZloa, garkveulwilad, galiTad, erovnuli fsiqiatriuli avadobis sayo
qalebSi depresiuli simptomebisadmi momatebuli facxovrebo kvlevis (National Psychiatric Morbidity
mzaobis mizezs warmoadgendes. Tumca, aseTi àrCeviTi~ Household Survey) mixedviT, nevrozuli aSlilobis
axsna ver iqneba sakmarisi mtkicebuleba. depresiis erTkviriani gavrcelebis sixSire saSualod 16%-
mqone mamakacebs, romlebic xSirad alkoholis didi ia (12.3% _ kacebSi da 19.5% _ qalebSi). am sakvlevi
odenodiT momxmareblebi arian, rac niRbavs depresiul jgufidan TiTqmis naxevari akmayofilebda Sereuli
simptomatikas, SesaZlebelia swored amitom, upi SfoTviTi aSlilobis ICD-10-is kriteriumebs (Jenkins
ratesad, alkoholTan dakavSirebuli problemebi et al., 1997). msubuqi depresiis (DSM-IV-is mixedviT)
aReniSnebaT. Tumca, arc es mosazreba iZleva srul epidemiologiurma kvlevebma aCvena, rom misi
yofil axsnas sqesTan dakavSirebuli gansxvavebis gavrcelebis sixSire 55 da meti asakis pirebSi 9.8%-ia
Taobaze. sqesTan dakavSirebuli neirobiologiuri (Beekman, et al., 1999). saocrad msgavsi Sedegebi iqna
gansxvavebebi (magaliTad, serotoninuli centraluri miRebuli mozardebsa da axalgazrdebze Catarebul
gadacemis gzis organizeba) ramdenad ganapirobebs kvlevebSic (9.9%) (Kessler and Walters, 1998).
depresiisadmi winaganwyobas, momavali kvlevis saga
nia. gasaTvaliswinebelia, rom zog kulturaSi afeqturi aSlilobebis etiologia
qalebi socialuri Cagvrisa da diskriminaciis afeqturi aSlilobebis etiologiasTan dakavSirebiT
obieqts warmoadgenen. isini ufro xSirad ganicdian sxvadasxva Teoria arsebobs. safuZvlianadaa Ses
seqsualur da fizikur Zaladobas, vidre mamakacebi. wavlili depresiis genetikuri epidemiologia da
amdenad, msgavsi faqtorebic SesaZloa ganapirobeben is bavSvobisdroindeli gamocdileba, romelic pi
qalebis momatebul depresiulobas. rovnebas zrdasrul asakSi ufro mowyvlads xdis
adre iTvleboda, rom depresiuli aSlilobebis depresiisadmi. aseve, dagrovilia mniSvnelovani cod
ganviTarebis riski asakTan erTad matulobs, Tumca na imis Sesaxeb, Tu ra mniSvneloba aqvs depresiisadmi
ukanasknelma kvlevebma aCvena, rom depresia yvelaze midrekili individebisTvis cxovrebiseul sirTu
metad gavrcelebulia 18-44 asakobriv jguSi. 1945 leebsa da stress, rogorc maprovocirebel faqtorebs.
_ 247 _
cxrili 11.8 boqsi 11.1 guneb-ganwyobis aSlilobebis

mravalfaqtoruli buneba
kvlevis sagani Sesabamisi kvleva
w guneb-ganwyobis aSlilobebis genetikur safuZvels
genetikuri genetikuri epidemiologia qmnis mravali genis individualuri Tvisebebis
molekuluri genetika erToblioba. calkeuli genis Tavisebureba SeiZleba
gamovlindes uSualod kortikuli meqanizmebis
pirovnuli temperamenti modifikaciiT, an iribad aisaxos pirovnul Tvisebebsa
kognituri Taviseburebebi da fsiqologiuri daZlevis meqanizmebze.
bavSvobis mSoblebis deprivacia w bavSvobis droindeli uaryofiTi gamocdileba
droindeli arasasurveli garemo da Zaladoba gavlenas axdens pirovnul Tvisebebze da, Sesabamisad,
garemo bavSvobaSi qveiTdeba misi mijaWvulobisa da socialuri
mxardaWeris miRebis unari. negatiuri garemo pirobebi
socialuri garemo cxovrebiseuli movlenebi moqmedebs hipoTalamur-hipofizarul-adrenaluri
qronikuli sirTuleebi sist
emis ganviTarebasa da mozardobaSi stresze
neirobiologiuri pasuxis Taviseburebaze.
fsiqologiuri fsiqodinamiuri
kognituri w guneb-ganwyobis aSlilobebi xSirad provocirebulia
mimdinare movlenebiT, gansakuTrebiT maSin, rodesac
biologiuri monoaminebi pirovnebas arasakmarisi socialuri mxardaWera aqvs.
hipoTalamur-hipofizarul- cxovrebiseuli sirTuleebis gavlena modificirdeba
adrenaluri sistema bavSvobis droindeli gamocdilebiT, piradi Tvi
neirofsiqologia sebebiTa da genetikuri winaganwyobiT. am sami faqtoris
neirovizualizacia erToblioba gansazRvravs individis mdgradobas
nevropaTologia an mowyvladobas uaryofiTi movlenebis mimarT da,
Sesabamisad, guneb-ganwyobis aSlilobis ganviTarebis
bevrad naklebia cnobili im meqanizmebze, romlebic risks.
monawileoben gamomwvevi da maprovocirebeli faq w guneb-ganwyobis aSlilobebis neirobiologia ukav

Sirdeba aqtivobis cvlilebas monoaminur neironebsa
torebis klinikur simptomebad `gadaTargmnaSi~.
da hipoTalamur-hipofizarul-adrenalur sistemaSi,
am meqanizmebis Seswavlisas (rac, bunebrivia, mni romelTa erToblivi moqmedeba ganapirobebs guneb-
Svnelovania mkurnalobisaTvis) iyeneben or ZiriTad ganwyobaSi monawile neironuli qselis Secvlil
muSaobas.
konceptualur midgomas, romlebic, zogadad, `fsi
qologiur~ da `biologiur~ meqanizmebad SeiZleba w guneb-ganwyobis aSlilobebis dros tvinis zogierTi
struqturuli paTologia migviTiTebs qronikul bi
daiyos. ologiur mowyvladobaze, rac, savaraudod, genetikuri
an neiroganviTarebis faqtorebiTaa ganpirobebuli.
genetikuri mizezebi
lod 20%-mdea. unipolaruli depresiis drosac
ojaxisa da tyupebis kvleva
konkordantoba ufro maRalia monozigoturi (46%),
ojaxuri kvlevebi vidre dizigoturi tyupebis SemTxvevaSi (20%). zo
guneb-ganwyobis aSlilobebis riski maRalia, rogorc gadad, SeiZleba iTqvas, rom genetikis gavlena ufro
bipolaruli, ise unipolaruli pirveli rigis na didia bipolaruli aSlilobebis SemTxvevaSi, vidre
TesavebSi. es riski orjer metia bipolaruli aSli unipolarulis (ix. McGuffin et al., 1996).
lobebis SemTxvevaSi (cxrili 11.9). bipolaruli
probandebis naTesavebs aqvT rogorc unipolaruli cxrili 11.9 bipolaruli aSlilobebisa da
depresiisa da Sizoafeqturi aSlilobebis, aseve didi depresiis genetikuri epidemiologia
bipolaruli aSlilobis ganviTarebis momatebuli bipolaruli unipolaruli
riski. amis sapirispirod, unipolaruli depresiis aSliloba aSliloba
dros bipolaruli da Sizoafeqturi aSlilobebis riski cxovrebis manZilze 1% 1020%
ganviTarebis gazrdili maCveneblebi ar aRiniSneba.
sqesis mixedviT 1:1 1:2
ganawileba (mamrobiTi:
tyupebis kvleva mdedrobiTi)
tyupebis Seswavlam aCvena, rom ojaxSi guneb- pirveli rigis naTesavebi
ganwyobis aSlilobaTa SemTxvevebs genetikuri
faqtorebi ganapirobebs; konkordantoba ufro bipolaruli aSlilobebis 10% 2%
riski cxovrebis manZilze
maRalia monozigotur, vidre _ dizigotur tyupebSi,
rogorc bipolaruli, ise unipolaruli aSlilobebis unipolaruli 2030% 2030%
aSlilobebis riski
dros. magaliTad, bipolaruli aSlilobebisTvis cxovrebis manZilze
konkordantobis maCvenebeli monozigotur tyupebSi
daavadebis dawyebis 21 27
60-dan 70%-mde, xolo dizigotur tyupebSi mxo
saSualo asaki
_ 248 _
guneb-ganwyobis aSlilobebis klasifikaciis ge- receptorebis Sesaxeb, SeiZleba gansazRvros afeqtu-

netikuri safuZveli ri aSlilobebis ganviTarebis riski. uamravi kvlevaa
Catarebuli kandidati genebis gamosavlenad, magram
genetikuri kvlevebi gvexmareba ukeT gavigoT guneb-
jer-jerobiT damakmayofilebeli monacemebi ar ar-
ganwyobis aSlilobebis sxvadasxva qvejgufebs Soris
sebobs (Fanous and Kendler, 2004). serotoninis trans-
arsebuli etiologiuri kavSirebi, magaliTad, tyupebis
porteris gens aleluri variabeloba axasiaTebs, rom-
kvlevisas, karkovski da kendleri (Karkowski andKendler, 1997)
lidanac erT-erTi transporteris ubnis eqspresias
mividnen im daskvnamde, rom unipolaruli da bipolaruli
gansazRvravs. aseTi polimorfizmis damadasture-
depresiebis genetikuri winaganwyoba ufro simwvaviT,
beli monacemebi depresiul pacientebze Catarebuli
da ara etiologiiT, ganasxvavebs am or mdgomareobas
kvlevebis CvenebiT araerTgvarovania (Anguelova et al.,
erTmaneTisagan. makgafinma (McGuffin et al., 2003) ki
2003). prospeqtuli kvlevis safuZvelze kaspim (Caspi
aCvena, rom genetikuri mowyvladoba maniisadmi ufro
et al., 2003) daadgina, rom serotoninis transport-
specifikuria da, rogorc sCans, ar warmoadgens mxolod
eris garkveuli alelis matarebel pirebs uaryofiTi
simwvaviT gansxvavebul guneb-ganwyobis aSlilobas.
cxovrebiseuli movlenebis dros ufro xSirad uvi-
tyupebis kvelvam gamoavlina, rom genetikuri mo
TardebaT depresia. es SesaZloa iyos arasasurveli
wyvladoba depresiisa da SfoTviTi aSlilobebis
garemosa da genetikuri winaganwyobis faqtorebis
mimarT erTi da imave genebiT, magram gansxvavebuli
urTierTkavSiris saintereso magaliTi.
garemo risk-faqtorebiTaa ganpirobebuli (Kendler,
1996). amasTan, depresiis mowyvladobaze garemo
pirovnuli Tvisebebi
faqtorebis efeqti ufro metad moicavs pirovnebis
individualur gamocdilebas, vidre gaziarebul garkveuli pirovnuli Tvisebebi warmoadgens guneb-
(ojaxis) gamocdilebas. ganwyobis aSlilobaTa winaganwyobas. magaliTad,
klinikurad vlindeba, rom depresiul pacients pre-
memkvidreobis tipi morbidSi xSirad SfoTvis maRali done aReniSneba.
guneb-ganwyobis aSlilobaTa ojaxuri ganawileba ar pirovnuli Tvisebebis Tavisebureba guneb-ganwyobis
eqvemdebareba mendelis martiv kanonebs. cnobilia, rom aSlilobebTan Semdegnairad asocirdeba:
qali ufro midrekilia depresiisadmi, vidre _ mamakaci. 1. pirovnul Tvisebad miCneuli maxasiaTebeli Sesa
SesaZlebelia, genetikuri faqtorebi qalebSi ufro Zloa daavadebis msubuq formas warmoadgendes. ma
mniSvnelovan rols asrulebs, gansakuTrebiT maSin, Tu galiTad: krepelini (Kraepelin, 1921) varaudobda,
afeqturi aSlilobebis ufro farTo diagnostikuri rom cikloTimiuri temperamentis mqone adamianebi
kriteriumebia gamoyenebuli (Kendler et al., 2001). amdenad, (e.i. ganmeorebadi da xangrZlivi guneb-ganwyobis
genetikuri SeWidulobisa da kavSirebis kvlevisas cvlilebebiT) ufro metad iyvnen midrekilni mani
mniSvnelovania mamakacebsa da qalebSi sxvadasxva akalur-depresiuli aSlilobisadmi. Cvens droSi am
lokusebis depresiisadmi winaganwyobaze gavlenis cal- tipis temperamenti klasificirdeba guneb-ganwyobis
calke Seswavla. zogadad, savaraudoa, rom genetikuri aSlilobad (cikloTimiuri aSliloba) da miCneulia
winaganwyoba afeqturi aSlilobebisadmi ganpirobebulia bipolaruli aSlilobebis msubuq formad.
mravali genis mcire efeqtis erToblivi moqmedebiT,
2. zogierTi pirovnuli Tviseba gavlenas axdens ada
e.w. poligenuri memkvidreobiT.
mianebis qcevaze arasasurvel garemoSi moxvedrisas
molekuluri genetika da, Sesabamisad, zrdis depresiuli aSlilobis
risks. magaliTad: kognituri Tavisebureba, ro
guneb-ganwyobis aSlilobebis molekuluri kavSirebis
goricaa `sociotropoba (mowonebis Zlieri moT
Seswavlam mniSvnelovani veraferi gamoavlina, risi
xovnileba) asocirdeba depresiis gazrdil riskTan
mizezic aris calkeuli genis mcire efeqti da genetikuri
cxovrebiseuli sirTuleebis gadatanis Semdeg
heterogenoba. marTalia, miRebulia garkveuli
(Mazure and Maciejewski, 2003).
pozitiuri monacemebic, magram maTi dublireba Zalian
Znelia, magaliTad, bipolaruli aSlilobis SedarebiT 3. garkveuli tipis personologiur ganviTarebasa da
axalma kvlevebma gamoavlina mniSvnelovani kavSirebi fsiqikur aSlilobebs SesaZloa saerTo genetikuri
13q da 22q qromosomebTan (ix. Badner and Gershon, 2003), safuZveli hqondes, magaliTad: nevrotizmi, rac
Tumca aucilebelia am Sedegis gameoreba. aizenkis pirovnebis tipis gamosavleni testiT izomeba,
depresiis winaganwyobas warmoadgens. tyupebis kvleva
genetikuri kavSirebis Seswavla ki gviCvenebs, rom nevrotizmsa da depresias saerTo
depresiis monoaminuri Teoriis Tanaxmad, alelebis genebi aqvs (ix. Fanous and Kendler, 2004).
genetikurma variaciam, romelic Seicavs informacias amrigad, Tanamedrove monacemebi gviCvenebs, rom
monoaminebis sinTezis, metabolizmis an specifikuri depresiis genetikuri riski nawilobriv xasiaTis
_ 249 _
garkveuli tipisa da kognituri Taviseburebis mem iwvevs. Tumca, sanam davaskvniT, rom stresuli
kvidreobiTobaSi vlindeba, rac, SesaZloa, aqveiTebdes garemo ganapirobebs depresiul aSlilobebs, saWiroa
stresTan gamklavebis unars (ix. Goodyer, 2002). gaviTvaliswinoT sxva faqtorebic. pirvel rigSi,
kavSiri SeiZleba iyos SemTxveviTi. meorec, kavSiri
garemo faqtorebi adreul asakSi SeiZleba iyos araspecifikuri; ar aris gamoricxuli,
mSoblis deprivacia rom sxva tipis daavadebebs zustad aseTive stresuli
movlena uZRodes win. mesamec, SesaZlebelia, is iyos
fsiqoanalitikosebis azriT, bavSvobaSi dedobrivi
yalbi; pacienti stresulad aRiqvams movlenebs,
siyvarulis nakleboba, gamowveuli mSoblis da
roca cdilobs retrospeqtulad axsnas daavadebis
kargviT an masTan ganSorebiT, zrdis depresiuli
mizezi, an imitom, rom ukve depresiulia. dabolos,
aSlilobebisadmi mowyvladobas zrdasrul asakSi.
SesaZlebelia, rom Tavad depresia iyos cxovrebiseuli
Tumca, epidemiologiuri kvlevebiT ar dasturdeba
movlenis gamomwvevi.
zrdasrulobaSi depresiuli aSlilobis riskis
mkvlevarebi cdiloben am meTodologiuri sir
mateba, ganSorebis mizezi Tu mSoblis gardacvalebaa.
Tuleebis gadaWras. pirveli ori problemis Sesas
zogadad, meti mxardamWeri hyavs mosazrebas, rom
wavlad, kerZod, imis gamosavlenad, aris es movlenebi
depresiuli aSliloba mowiful asakSi ukavSirdeba
SemTxveviTi Tu specifikuri, saWiroa janmrTeli
mSoblebis daSorebas, ufro konkretulad ki _
mosaxleobidan da sxva daavadebebis mqone pirebidan
ganqorwinebas. am SemTxvevaSi gadamwyvet rols
sakontrolo jgufebis saTanadod SerCeva. xolo,
mSoblebis mxridan yuradRebis nakleboba da maT
yalbi kavSiris gamosavlenad ori gansxvavebuli mi
Soris arsebuli uTanxmoeba ufro TamaSobs, vidre
dgoma gamoiyeneba: pirveli gulisxmobs daavadebisagan
konkretuli danaklisi. marTlac, uTanxmoeba ojaxSi
sruliad damoukidebeli movlenebis (magaliTad,
da adekvaturi zrunvis nakleboba depresiisaken
samsaxuridan daTxovna sawarmos daxurvis gamo)
midrekilebas im ojaxebSic zrdis, sadac ganqorwineba
gamijvnas iseTi movlenebisgan, romlebic SeiZleba
ar momxdara (ix. Harris, 2001).
daavadebis Sedegs warmoadgendes (rogoricaa sam
urTierToba mSoblebTan saxuridan mxolod am pirovnebis daTxovna). meore
naTelia, rom mSoblis Zaladobrivi damokidebuleba, midgoma gulisxmobs, janmrTeli pirebis SeTanxmebul
magaliTad fizikuri an seqsualuri Zaladoba, mosazrebaze dayrdnobiT, movlenis stresis xarisxis
zrdasrul asakSi sxvadasxva fsiqikuri aSlilobebis, gansazRvras.
maT Soris didi depresiis ganviTarebis risk- miRebuli Sedegebi:
faqtoria (Harris, 2001). naklebadaa cnobili aRzrdis
meTodologiurad sando kvlevebma aCvena, rom:
gansxvavebuli tipis gavlena depresiis winaganwyobaze.
erT-erT sirTules warmoadgens mSoblebTan urTi w depresiuli epizodis ganviTarebis wina TveebSi
erTobis tipis retrospeqtulad gansazRvra. pacientis uaryofiTi cxovrebiseuli movlenebis ricxvi eqvs
mogonebebs SesaZloa, aferxebdes sxvadasxva faqtori, jer metia;
maT Soris, depresiuli aSlilobac. Tumca, savaraudoa, w SfoTviTi aSlilobebisa da Sizofreniis ganvi
rom, rogorc uyuradReboba, ise gadametebuli Tarebas da TviTmkvlelobis mcdelobebs bevri
zrunva, Tanabrad ukavSirdeba aramelanqoliuri stresuli movlena uZRvis win;
depresiis ganviTarebis risks zrdasrul asakSi; am w zogadad, `danaklisi~ ukavSirdeba depresias, xolo
kavSiris meqanizmis dadgena Semdgom Seswavlas mo `safrTxis Semcveli movlenebi~ _ SfoTvas;
iTxovs (Enns, 2000). postnataluri depresiis mqone
w depresiis ganviTarebis TvalsazrisiT, didi mniSvn
dedisTvis damaxasiaTebelia ugulebelyofa da
eloba aqvs cxovrebiseul movlenebs, magram maTi
emociuri indiferentuloba axalSobilis mimarT.
gavlena naklebia melanqoliuri tipis aSlilobebisa
zrunvis aseTma stilma SesaZloa grZelvadiani
da Zlieri ojaxuri istoriis arsebobis SemTxvevaSi.
uaryofiTi gavlena iqonios bavSvis TviTSefasebasa da
ukanaskneli kvlevebi gviCvenebs, rom depresiis
mijaWvulobis unarze, rac Semdgom TaobebSi gazrdis
ganviTareba ufro metad Rirsebis Semlaxvel da
depresiis ganviTarebis risks.
pirovnebisTvis Seuracxmyofel movlenebTanaa da
precipitatuli faqtorebi kavSirebuli. xolo, depresiis remisia xSirad aso
cirebulia àxali cxovrebis dawyebasTan~ (axa
cxovrebiseuli movlenebi li nacnoboba an swavlis dawyeba) (Harris, 2001).
meTodologiuri midgomebi mniSvnelovania genetikuri faqtorebis roli cxov
yoveldRiuri klinikuri praqtika gviCvenebs, rom rebiseuli sirTuleebis daZlevaSi. magaliTad, gar
depresiul aSlilobebs xSirad stresuli movlenebi kveuli tipis individebs axasiaTebs swrafva riskis
_ 250 _
Semcvel garemosken; aseve, genetikuri faqtorebi, efeqti. braunma da harisma am tipis garemoebebs
pirovnuli Taviseburebebidan gamomdinare, ganapi xangrZlivi sirTuleebi uwodes.
robebs konkretuli individis mier cxovrebiseuli meore tipi ki Tavad ar axdens gavlenas depresiaze,
movlenebis aRqmas (Kendler et al., 1999). aramed mxolod aZlierebs xanmokle cxovrebiseuli
zogadad, depresiuli epizodebis ricxvis zrdasTan movlenebis zemoqmedebas. aseT garemoebebs uwodeben
erTad, klebulobs cxovrebiseuli movlenebis mowyvladobis faqtors. am or tips Soris arsebuli
mniSvnelobac. es niSnavs, rom didi depresiuli gansxvaveba ar aris naTlad Camoyalibebuli. magaliTad,
aSlilobis Camoyalibebis Semdeg, depresiuli epizodi colqmrul urTierTobaSi grZelvadiani problemebi
SeiZleba stresuli movlenebis gareSec ganviTardes. (xangrZlivi sirTule) SesaZloa ukavSirdebodes
aseTi urTierTkavSiri naklebad TvalsaCinoa dep intimuri urTierTobis problemebs, xolo braunis
resiuli aSlilobis ojaxuri istoriis SemTxvevaSi. mixedviT, es ukanaskneli mowyvladobis faqtors
SesaZloa, rom depresiis ojaxuri istoria akninebs warmoadgens.
depresiuli epizodis ganviTarebisas garemo faqt kvlevebi gviCvenebs, rom depresiuli epizodebis
orebis mniSvnelobas, riTac SeiZleba aixsnas aseT ganviTarebis riski izrdeba Semdegi cxovrebiseuli
ojaxebSi depresiis gazrdili riski (Kendler et al., movlenebis Sedegad, rodesac pirovneba:
2011). w uvlis bavSvebs;
w muSaobs saxlidan gausvlelad;
mania w ar hyavs axlobeli adamiani
darwmunebiT Znelia imis Tqma, iwvevs Tu ara manias zogadad, cnobilia, rom sazogadoebrivi mxar
cxovrebiseuli movlenebi. warsulSi iTvleboda, rom daWerisa da Tanadgomis nakleboba an socialuri
mania mxolod endogenuri (Sinagani) daavadebaa, Tumca, gaucxoeba xels uwyobs depresiis ganviTarebas. es
klinikuri gamocdileba gviCvenebs, rom garkveul meqanizmi bolomde Seswavlili araa, amitom sxvadasxva
SemTxvevebSi iseTi cxovrebiseuli gamocdileba, interpretaciiT cdiloben mis axsnas: (1) SesaZlebelia
romelic depresias unda iwvevdes, SeiZleba maniis pirovneba depresiisadmi ufro mowyvladia, rodesac
mizezic gaxdes, magaliTad, mZime danaklisi. sando adamiani gverdSi ar udgas, an (2) depresia Tavad
iseve rogorc rekurentuli depresiis SemTxvevaSi, cvlis sxva adamianebTan urTierTobis unars, an (3)
cxovrebiseuli movlenebis gavlena ufro Zlieria garkveuli pirovnuli Tvisebebis gamo individi ver
maniakalur-depresiuli aSlilobis sawyis etapze, axerxebs saimedo urTierTobebis damyarebas sxvebTan,
xolo aSlilobis Camoyalibebis Semdeg, gare faq rac depresiis ganviTarebas ganapirobebs (Harris, 2001).
torebi kargavs Tavis mniSnvelobas. Tumca, uar am Temaze damatebiTi informaciis misaRebad ix. gv. 94.
yofiTi cxovrebiseuli movlenebi gavlenas axdens
bipolaruli aSlilobis, gansakuTrebiT, depresiuli fizikuri avadmyofobis Sedegebi
epizodis simptomebze. sainteresoa, rom maniakaluri yvela tipis daavadebas an maT mkurnalobas, roorc
simptomebi SeiZleba gamoiwvios mniSvnelovani araspecifikur stresors, SeuZlia depresiisadmi mid
miznis miRwevam, anu sixarulisa da kargad yofnis rekil individebSi gamoiwvios afeqturi aSlilobebi.
`Cveulebrivi~ SegrZneba, Sesabamisi winaganwyobis Tumca, zogierT SemTxvevaSi, somatur daavadebebs
mqone pirovnebebis SemTxvevaSi, SesaZloa maniakalur guneb-ganwyobis aSlilobebis ganviTarebaze uSualo
aSlilobaSi gadaizardos (ix. Rush, 2003). gavlenis moxdenac SeuZliaT. magaliTad, Tavis tvinis
simsivne, konkretuli infeqciebi _ aiv Sidsis CaTvliT,
mowyvladobis faqtorebi da cxovrebiseuli
da endokrinuli daavadebebi. aseT Tanmxleb afeqtur
sirTuleebi
aSlilobebs organul guneb-ganwyobis aSilobebs
zogadi klinikuri dakvirvebis safuZvelze, SeiZleba uwodeben. maTze damatebiTi informacia mocemulia
iTqvas, rom zemoqmedebs is movlenebi, romlebic me-16 TavSi.
uSualod win uZRvian depresiul aSlilobebs. unda vaRiaroT, rom zemoT aRniSnuli dayofa
faqtiurad, esaa ùkanaskneli wveTi~ im adamianisTvis, pirobiTia. magaliTad, kuSingis daavadebis dros,
romelic xangrZlivi uaryofiTi garemo faqtorebis pacientTa mxolod naxevars aReniSneba Tanmxlebi
gavlenas ganicdis. magaliTad, uiRblo qorwineba, depresiuli mdgomareoba. radgan yvela pacients
problemebi samsaxurSi an mZime sacxovrebeli pi ar aqvs depresia, es niSnavs, rom depresiis
robebi. braunma da harisma (1978) winaganwyobis ganviTarebisTvis plazmaSi kortizolis gazrdili
movlenebi or tipad dayves. pirvel tips miekuTvneba donis garda, sxva faqtorebic mniSvnelovania.
xangrZlivi stresuli garemoebebi, rolebsac Se Tumca, gasaTvaliswinebelia, rom organul afeqtur
uZliaT rogorc Tavad ganapirobon depresia, aseve aSlilobebs SeuZliaT meti informacia mogvcen guneb-
gaaZlieron xanmokle cxovrebiseuli movlenebis ganwyobis aSlilobaTa etiologiaze, magaliTad:
_ 251 _
kuSingis daavadebis dros depresiuli mdgomareoba erTdrouladaa gamoxatuli (erTmaneTis sapirispiro
umjobesdeba kortizolis donis normalizebiT. grZnobebi). roca sayvareli òbieqti~ ikargeba,
swored am aRmoCenam migviyvana im daskvnamde, rom pacienti sasowarkveTilia; amavdroulad, nebismieri
kortizolis Warbi gamoyofa mniSvnelovan rols agresiuli grZnobebi, rac am òbieqts~ ukavSirdeba,
TamaSobs depresiis paTofsiqologiaSi (gv. 241). TviTbraldebis grZnobebis saxiT, gadamisamrTdeba
aRsaniSnavia isic, rom puerperiumi (romelic ar aris pacientze.
daavadeba) aseve ukavSirdeba afeqturi aSlilobebis froidis azrebi mogvianebiT melani klainma (1882-
gazrdil risks (gv. 402). 1960) ganaviTara; mas sjeroda, rom bavSvis ZuZudan
mocileba (rZis arqonis gamo) umniSvnelovanesi
etiologiis fsiqologiuri axsna simboluri danaklisia CvilisTvis, romelsac
fsiqologiuri Teoriebis Tanaxmad, uaxlesma da `kargi obieqtis~ gaqrobis gamo sindisis qenjna da
warsulma cxovrebiseulma gamocdilebam SeiZleba danaSaulis grZnoba uCndeba. normaluri ganviTarebis
gamoiwvios depresiuli aSlilobebi. am Temaze ar SemTxvevaSi, `depresiuli SfoTva~ ganapirobebs
sebuli literaturis did nawilSi ver xerxdeba zaralis anazRaurebisa da sxvaze zrunvis survils.
depresiuli simptomisa da depresiuli aSlilobis marcxi am procesis marTvaSi iwvevs depresiul
adekvaturi gamijvna. am problemisadmi ZiriTadi reaqciebs momavali danaklisis saxiT. klaini nakleb
midgomebi momdinareobs fsiqoanalizuri da kogni yuradRebas uTmobda dedis saqciels am procesSi,
tur-bihevioruli Teoriebidan. savaraudod imitom, rom gadamwyvet faqtorad Cvilis
Sinagan impulss miiCnevda. Tumca, jon boulbis
fsiqoanalitikuri Teoria naSromma (1907-1990) gviCvena, rom aRmzrdelis
depresiis fsiqoanalitikur Teorias dasabami misca unar-Cvevebi (dasavlur kulturaSi, ZiriTadad, de
statiam, romelic abrahamma gamoaqveyna 1911 wels. da) Cvilis usafrTxo, emociuri `mijaWvulobis~
SemdgomSi igi ganaviTara froidma Tavis naSromSi ganviTarebisTvis Zalian mniSvnelovania da mas
`glova da melanqolia~ (1917). man yuradReba udidesi roli eniWeba samomavlod interpersonaluri
gaamaxvila im gansxvavebaze, romelic glovis fe urTierTobebis Camoyalibebis procesSi. arasaimedo
nomensa da depresiuli aSlilobis simptomebs mijaWvulobas SeuZlia gazardos sxvadasxva tipis
Soris arsebobs da daaskvna, rom maTi gamomwvevi fsiqopaTologiuri mdgomareobebis, maT Soris
mizezebi SesaZloa msgavsi iyos. Tumca, mocemuli da depresiis, ganviTarebis riski. aseT pirovnebas
Semdgomi SemuSavebuli Teoriebi ar aris gamyarebuli zrdasrul asakSi cxovrebiseuli sirTuleebis dros
mtkicebulebebiT. maTi ganxilva mniSvnelovania uWirs emociuri mxardaWeris miReba (ix. Gabbard, 2000).
imdenad, ramdenadac vecnobiT depresiis Sesaxeb
arsebul mosazrebaTa ganviTarebis istorias.
kognituri Teoriebi
unda aRiniSnos, rom froidi ar miiCnevda, rom depresiul pacientebs rekurentuli da invaziuri
mwvave depresiuli aSlilobis safuZveli yovelTvis negatiuri fiqrebi (àvtomaturi fiqrebi~) axasiaTebT.
erTi da igive mizezi iyo. igi fiqrobda, rom zogi bekma (1967) gamoTqva mosazreba, rom depresiuli
aSliloba ùfro somaturi da ara fsiqogenuria~. Semecnebis dros pirovneba negatiurad aRiqvams
Tumca, es midgoma mxolod im SemTxvevaSi miaCnda sakuTar Tavs, samyarosa da momavals (xSirad,
gamarTlebulad, rodesac `fsiqogenuri buneba eWvs Tavis warsulsac). aRniSnuli avtomaturi fiqrebi
ar iwvevda~ (Freud, 1917, gv. 243). froidi Tvlida, alogikuri azrovnebis gamo sakmaod myaria (rasac
rom, rogorc glovis mizezi SeiZleboda yofiliyo beki kognitur damaxinjebas uwodebda). esenia:
sikvdiliT gamowveuli danakargi, ise melanqoliac _ w subieqturi daskvnebi (daskvnis gamotana dausa
sxva tipis danakargis Sedegi. radgan aSkara iyo, rom buTeblad an sapirispiro mtkicebulebis safuZ
yvela depresiul pacients ar hqonda konkretuli velze);
danakargi, aucilebeli gaxda danakargis `garkveuli w SerCeviTi abstraqcia (aqcentis gakeTeba erT de
abstraqciis~ an misi Sinagani warmodgenebis pos talze da mdgomareobis ufro mniSvnelovani
tulireba, an, froidis sityvebiT rom vTqvaT maxasiaTeblebis ignorireba);
òbieqtis~ dakargva.
w zedmetad ganzogadeba (zogadi daskvnis gakeTeba
froidi aRniSnavda, rom depresiuli pacientebi
erTi SemTxvevis safuZvelze);
xSirad TviTkritikulebi arian da misi azriT,
TviTbraldebas udavod iwvevs im adamianis faruli w personalizacia (sruliad Seusabamod gare movle
dadanaSauleba, vis mimarTac pacienti gulgrili nebis sakuTar TavTan dakavSireba).
ar aris. sxva sityvebiT rom vTqvaT, depresia fsiqiatrTa umetesoba guneb-ganwyobis aSlilo
maSin Cndeba, roca siyvaruli da siZulvili bebis ganviTarebisaTvis am depresiul kognicias
_ 252 _
meorexarisxovnad miiCnevda. bekma (Beck, 1967), daqveiTebam SeiZleba gaaaqtiuros yvela warmodgena
Camoayaliba Tavisi mosazreba da SemogvTavaza gan da mosazreba, rac klinikur depresiasTan asocirdeba.
sxvavebuli xedva, romlis Tanaxmadac, depresiuli daweuli guneb-ganwyobisa da negatiuri azrovnebis
kognicia win uswrebda depresias da ganapirobebda interaqtiuri cikli mocemulia suraTze 11.2 (Abela
pirovnebis depresiisadmi midrekilebas da maT dis and D~Alessandro, 2002).
funqciuri azrebi uwoda. aseTi azria, magaliTad: `me kognituri Teoriis erT-erTi mosazrebis mixedviT,
Tu yvelaferSi warmatebuli ar var, maSin araraoba guneb-ganwyobasTan dakavSirebuli kognituri pro
var~. sakiTxis ase dayeneba gavlenas axdens pirovnebis cesebi asaxavs cvlilebebs fsiqikur modelebSi,
unarze daZlios stresi da sirTuleebi. magaliTad, romlebsac Cven Cveni gamocdilebis gasaazreblad
warumateblobam samsaxurSi SesaZlebelia ufro im viyenebT. aman ganapiroba `metakognituri cnobie
adamianisTvis iyos depresiis gamomwvevi mizezi, visac rebis~ dakargvis koncefciis ganviTareba, rac imaSi
msgavsi ideebi aqvs. sxva kvlevebiT daadgines, rom mdgomareobs, rom negatiuri fiqrebi da grZnobebi
depresiis dros pirovnebas ufro metad uaryofiTi aRiqmeba rogorc fsiqikuri movlena da ara obieqturi
movlenebi amaxsovrdeba (Clark and Teasdale, 1982). simarTle sakuTari Tavis Sesaxeb. `meditaciaze
aseTi seleqciuri mogonebebi amZimebs depresiul (mindfulness) dafuZnebuli~ kognituri Terapia miznad
mdgomareobas da ufro rTuli xdeba masTan gamklaveba. isaxavs metakognituri cnobierebis gazrdas da,
kognitur modelTan dakavSirebuli ZiriTadi Sesabamisad, depresiis recidivis Tavidan acilebas
problemaa is, rom disfunqciuri azrebi da da (ix. Teasdale et al., 2002).
mokidebulebebi, iseve, rogorc uaryofiTi Sinaarsis
movlenebisadmi arCeviTi interesi, depresiuli mdgo etiologiis neirobiologiuri axsna
mareobidan gamosvlis Semdeg qreba. Tanamedrove nebismier SemTxvevaSi, rogoric ar unda iyos
kognituri Teoriis mixedviT, (`latenturi~) dis depresiis etiologia, misi klinikuri gamovlinebebi
funqciuri azrebi SeiZleba arsebobdes, magram maTi Tavis tvinSi arsebuli neiroqimiuri cvlilebebiTa
gamovlena rTulia manam, sanam Sesabamisi stresori da emociebis regulaciis rkalSi mimdinare pro
an guneb-ganwyobis cvlileba (normis farglebSi) cesebiTaa ganpirobebuli. depresiuli pacientebis
ar moaxdens maT aqtivacias. am modelis mixedviT, bioqimiuri gamokvlevebi ZiriTadad mimarTuli iyo
guneb-ganwyobis (normis farglebSi) umniSvnelo monoaminis neirotransmiterebze, radgan efeqturi
antidepresantebis moqmedebaSi monoaminuri gzebi
mniSvnelovan rols TamaSobs (ix. qvemoT). bunebrivia,
(adreuli) gamocdileba
antidepresantebi ver moaxdens gavlenas depresiis
gamomwvev mizezebze, magram maT SeuZliaT imoqmedon
disfunqciuri azrebis formireba daavadebis simptomebze. garda amisa, monoaminebis
Seswavlas sxva mizezic aqvs. maT stresuli mov
lenebis mimarT adaptaciuri reaqciis formirebaSi
kritikuli/gadamwyveti movlena mniSvnelovani adgili ukaviaT.
monoaminuri gzebi, ufro konkretulad _ nora
drenalini da serotonini, iwvevs tvinis im kortikuli
varaudebis gaaqtiureba
da subkortikuli struqturebis agznebas, romlebic,
iTvleba, rom guneb-ganwyobis regulirebaSi mona
wileoben. Tanamedrove neirovizualuri da struq
avtomaturi negatiuri azrebi
turuli kvlevebiT swavloben Tavis tvinSi mimdinare
cvlilebebs, romlebic afeqturi simptomatikis
klinikur gamovlinebebs udevs safuZvlad. amis
Tanxvedria is mosazreba, rom afeqturi aSlilobebi,
depresiis simptomebi klinikuri mimdinareobis Taviseburebis miuxedavad,
romlesac axasiaTebs simptomebis meryeoba da sru
qceviTi somaturi li alagmva, mainc Tavis tvinis Sesabamis ubnebSi
motivaciuri kognituri garkveul neiropaTologiur cvlilebebTanaa da
afeqturi kavSirebuli. am cvlilebebis nawili SesaZloa
ganviTarebis procesTan iyos asocirebuli da, sa
suraTi 11.2 kognituri modeli gviCvenebs, Tu rogor xdeba
latenturi disfunqciuri azrebis gaaqtiureba kritikuli varaudod, genetikuri mowyvladobis an bavSvobaSi
SemTxvevis Sedegad, rac, Tavis mxriv, qmnis depresiuli guneb- cudi mopyrobis Sedegs warmoadgendes. dResdReobiT,
ganwyobisa da negatiuri fiqrebis mankier wres (Fennell, 1993 ). mravali kvleva Seiswavlis cxovelebsac da ada
_ 253 _
informacia antidepresantebis bioqimiuri efeq
boqsi 11.2 monoaminuri neirotransmisiis
tis Sesaxeb mocemulia 21-e TavSi, romelic exeba
darRvevebi depresiis dros
monoaminis neirotransmiterebis darRvevebis ga
serotonini movlinebas im pacientebSi, romlebic ar gadian
triftofanis daqveiTeba plazmaSi mkurnalobis kurss (boqsi 11.2). am kuTxiT gacilebiT
serotoninis neiroendokrinuli pasuxis Sesusteba naklebi samuSaoa gaweuli maniis mimarTulebiT,
tvinSi 5-HT1A receptoruli SeboWvis daqveiTeba
amitom mocemuli ganxilva Semoifargleba ZiriTadad
(pozitronul emisiuri tomografia _ PET)
serotoninis transporteris aqtivobis Sesusteba
depresiuli aSlilobebiT, Tumca, yuradReba aseve
triftofanis Semcirebisas recidivis ganviTareba gamaxvilebuli iqneba maniis dofaminis hipoTezazec.
noradrenalini serotoninis funqcia

noradrenalinis mediatoruli zrdis hormonis plazmis triftofani. serotoninis sinTezi tvinSi,
gamotyorcnis daqveiTeba
damokidebulia misi prekursoris _ amino mJavis,
klinikuri gamwvaveba AMPT-s Semdeg (Alpha-methyl-para-
tyrosine - alfa-meTil-para-Tirozini) L-triftofanis, saTanado raodenobis arsebobaze.
sisxlis plazmaSi triftofanis done daweuli aqvT
dofamini
im pacientebs, romlebic ar ganicdian mkurnalobas,
homovaniluri mJavis (HVA) donis daweva Tavzurgtvinis
siTxeSi gansakuTrebiT, melanqoliuri depresiis mqone
dofamin D2-is receptorebis SeboWvis gaZliereba (PET/SPET) pacientebs. janmrTeli pirebis gamokvlevam aCvena,
klinikuri gamwvaveba AMPT-s Semdeg. rom dietis meSveobiT wonis klebam SesaZloa dawios
triftofanis done. am faqtoriT nawilobriv, magram
mianebsac imis Sesafaseblad, Tu ra gavlenas axdens ara srulad, SesaZlebelia aixsnas depresiis dros
adreuli ganviTarebis travmuli gamocdileba hi sisxlis plazmaSi triftofanis Semcireba. plazmuri
poTalamur-hipofizarul-adrenalur sistemaze, ro triftofanis donis daqveiTeba gavlenas axdens
melic TavisTavad monawileobs stresze sapasuxo Tavis tvinSi serotoninis funqciis gauaresebaze,
reaqciis formirebaSi. da bolos, aucileblad unda magram, savaraudod, es ar unda iyos mniSvnelovani
aRiniSnos, rom rac metia epizodebis ricxvi, afeqturi mizezobrivi faqtori (ix. Cowen, 2005).
aSlilobis gamosavalic ufro cudia. SesaZlebelia, Tavzurgtvinis siTxis kvleva. depresiuli paci
aseT Sedegs guneb-ganwyobis aSlilobebis simwvavesa entebis Tavzurgtivinis siTxis Seswavlisas xdeboda
da cud prognozs Soris kavSiri ganapirobebdes, depresiis dros tvinSi 5-HT funqciis iribad Se
Tumca, arc isaa gamoricxuli, rom guneb-ganwyobis faseba. amasTan dakavSirebiT mravali kvleva Catarda
aSlilobebis mwvave epizodebi Tavad gansazRvravdes depresiis mqone aranamkurnaleb pirebze, magram
neirobiologiur efeqts da auaresebdes prognozs sabolood ar dadasturda cerebrospinalur siTxeSi
(e.w. `naiarevis~ fenomeni). 5-hidroqsiindolaceturi mJavis (5-HIAA), romelic
5-HT ZiriTadi metabolitia, koncentraciis Sesabamisi
monoaminis hipoTeza
daqveiTeba. Tumca, arsebobs ufro myari monacemebi
monoaminis hipoTezis mixedviT, depresiul aSlilobas imisa, rom suicidur pacientebs Tavzurgtvinis siTxeSi
ganapirobebs monoaminis neirotransmiteruli sis 5-HIAA-s stabilurad dabali done aReniSnebaT. es
temis darRvevebi tvinis erT an ramdenime ubanSi. ar aris damaxasiaTebeli mxolod depresiuli pa
adre arsebuli hipoTezis Tanaxmad, amas iwvevda cientebisTvis. msgavsi daqveiTeba gvxvdeba per
monoaminebis miwodebis Seferxeba; uaxlesi Teoriebis sonologiuri aSlilobebis an Sizofreniis drosac
mixedviT ki, gvaqvs rogorc aminebis koncentraciis, im pirebSi, romlebsac sxvebis mimarT agresiuli
aseve receptorebis cvlilebebic. am procesebTan qmedebebi axasiaTebT. aqedan gamomdinare, gamoiTqva
dakavSirebiT sami monoaminis transmiteri aris ga mosazreba, rom cerebrospinalur siTxeSi 5-HIAA-s
movlenili: serotonini (5-hidroqsitriftamini, dabali done ganapirobebs cxovrebiseul sirTuleebze
5-HT), noradrenalini da dofamini. bolo or nei individis impulsur pasuxs (Placidi et al., 2001).
rotransmiters kateqolaminebsac uwodeben. tvinis autofsiis Semdgomi kvleva. gardacvlil
hipoTeza sam fenomenze dakvirvebiT Semowmda: depresiul pacientebs (ZiriTadad, TviTmkvlelobiT)
w afeqturi aSlilobis mqone pacientebis neiro CautardaT tvinSi serotoninisa da 5-HIAA-s ga
transmiterebis bioqimiuri monacemi; mokvleva. miuxedavad imisa, rom es monoaminuri
w SerCeviTi preparatebis efeqti monoaminuri sis hipoTezis ufro pirdapiri testia, Sedegebis in
temis funqcionirebis gazomvad indeqsebze (Zi terpretacia problemuria ori mizezis gamo: (1)
riTadad, neiroendokrinuli indeqsebi); aRmoCenili cvlilebebi SesaZlo, sikvdilis Sem
w antidepresantebis saerTo farmakologiuri Tvisebebi. dgom iyos ganviTarebuli. (2) cvlilebebi SesaZ
_ 254 _
loa sikvdilamdec iyo, magram ganpirobebuli aris Tu ara es cvlilebebi paTofiziologiisTvis
ara depresiuli aSlilobiT, aramed sxva iseTi centraluri, Tu Tanmdevi fenomenebia e.w. epife
mizezebiT, rogorebicaa: anoreqsia an samkurnalod nomenebia. amis Sesaswavlad saWiroa 5-HT-s daq
an TviTmkvlelobis mizniT miRebuli wamlebi. mTli veiTebuli funqciiT gamowveuli mdgomareobebis
anobaSi, mtkicebulebebi imisa, rom depresiuli kvleva rogorc janmrTel, ise depresis momatebuli
pacientis tvinSi bunebrivi sikvdilisa Tu riskis mqone individebSi.
TviTmkvlelobis Semdeg serotoninisa da 5-HIAA-s rogorc zemoT aRvniSneT, tvinSi serotoninis sin
daweuli koncentracia aRiniSneba, Zalian ususuria. Tezi damokidebulia Tavis tvinSi misi prekursoris,
Tanamedrove kvlevebma, romlis drosac iyeneben L-triftofanis, xelmisawvdomobaze. organizmSi tri
receptoris avtoradiografiul da mRNA gamo ftofans moklebuli aminomJavebis nazavis SeyvaniT
saxulebis teqnikas, aCvena, rom TviTmkvlelebs 5-HT2A SesaZlebelia plazmis triftofanis donisa da Tavis
eqspresiis momateba da prefrontalur nawilSi tvinSi 5-HT moqmedebis, mcire xniT daqveiTeba.
serotoninis transporteris aqtivobis Sesusteba am proceduras triftofanis deplecia ewodeba.
aReniSnebaT (ix. Stockmeier, 2003). triftofanis deplecias umniSvnelo efeqtis mox
tvinis neiroqimiuri kvlevis meTodebi _ tvinis dena SeuZlia im pirebis guneb-ganwyobaze, rom
Seswavlis neirovizualuri meTodebis daxvewam, lebsac ara aqvT afeqturi aSlilobebis piradi an
rac SerCeviTi ligandebis markirebis gamoyenebas ojaxuri istoria da, bunebrivia, igi ar warmoSobs
gulisxmobs, SesaZlebeli gaxada tvinSi serotoninis mniSvnelovan klinikur depresiul simptomatikas. amis
receptorebis garkveuli qvetipebis in vivo Sefaseba. sapirispirod, mkurnalobis gareSe myof euTimiur
damtkicebulia, rom kortikul da subkortikul pacientebs, romlebsac afeqturi aSlilobebis
ubnebSi 5-HT1A-s receptorebis SeboWvis unari zo anamnezi aqvT, triftofanis depleciis Sedegad
mierad daqveiTebulia (Sargent et al., 2000). aseve, Zalian swrafad, magram xanmokle droiT, depresiuli
aRiniSneba 5-HT transporteris aqtivobis Sesusteba epizodi uviTardebaT. aqedan Semdegi daskvnebis
da 5-HT ujredebis sxeulebis simkvrivis Semcireba. gamotana SegviZlia:
Tumca, msgavsi cvlilebebi ar SeiniSneba kortikul w tvinSi serotoninis funqciis gauareseba depresiis
ubnebSi (Meyer et al., 2004). ganviTarebisTvis ar aris sakmarisi piroba, radgan
neiroendokrinuli testebi. tvinSi serotoninis triftofanis deplecia ver axdens gavlenas im
sistemis funqciuri aqtivobis Sesamowmeblad pirebis guneb-ganwyobaze, romlebic midrekilni ar
gamoiyeneba iseTi nivTierebebi, romlebic iwveven arin afeqturi aSlilobebisadmi;
5-HT funqciis stimulirebas; aseve, zomaven
w afeqturi aSlilobebisadmi mowyvladi pirebis
endokrinul pasuxs, romelic 5-HT gzebiT kon
SemTxvevaSi serotoninis funqciis gauareseba iwvevs
troldeba, rac ZiriTadad prolaqtinis, zrdis
klinikurad gamoxatul depresiul simptomatikas;
hormonis an kortizolis gamoyofas gulisxmobs.
neiroendokrinuli testebiT SesaZlebelia tvinSi w tvinSi serotoninis funqciis gauareseba gavlenas
serotoninis funqciis gazomva. Tumca, am procesebSi axdens sxva mowyvlad faqtorebze da riskis mqone
monawile 5-HT sinafsebi, savaraudod, hipoTalamusSia individebSi iwvevs depresiul aSlilobas.
ganlagebuli, ris gamoc Tavis tvinis sxva ubnebSi sxva mowyvladi faqtorebis buneba gaurkveveli
mimdinare cvlilebebi, SesaZloa, yuradRebis miRma rCeba. ar aris gamoricxuli, rom depresiisadmi mid
darCes. neiroendokrinuli testirebisTvis 5-HT rekili individebi gansxvavebulad reagirebdnen pre
moqmedebis gasaZliereblad sxvadasxva wamlebs kursoris deficitze. aseve, SeiZleba davuSvaT isic,
iyeneben. rom centraluri guneb-ganwyobis maregulirebel
aranamkurnalebi depresiuli pacientebis kvle sistemaSi deficiti winaswar arsebobs da Tavs iCens
vam aCvena, rom 5-HT-Ti regulirebuli endokri 5-HT_s funqciis daqveiTebis dros (Smith et al., 1999).
nuli reaqcia stabilurad daqveiTebulia. rigi
am darRvevebisa SenarCunebulia klinikuri ga
noradrenalinis fuqncia
mojanmrTelebis Semdegac, rac depresiis riskis metabolizmi da receptorebi. ar arsebobs Tanmim
mqone pacientebSi serotoninis funqciis garkveuli devruli monacemebi depresiuli pacientebis tvinSi
aspeqtebis qronikul disfunqciaze miuTiTebs (ix. an cerebrospinalur siTxeSi noradrenalinis an
Cowen, 2005 w). misi ZiriTadi metabolitis 3-metoqsi-4-hidroqsi-
triftofanis deplecia. arsebuli monacemebi fenilglikolis (MHPG) cvlilebis Sesaxeb (ix.
aSkarad migvaniSnebs depresiis mqone pacientebis Anand and Charney, 2000). iseve, rogorc serotoninis
tvinSi serotoninis neirotransmisiis darRvevebze. receptorebi, noradrenalinis receptorebic SeiZ
Tumca, maTze dayrdnobiT Znelia imis gansazRvra, leba daiyos qveklasebad. arsebobs monacemebi,
_ 255 _
rom im pacientebis Tavis tvinis zogierT ubanSi, nebic monawileobs depresiuli mdgomareobis paTo
romlebmac sicocxle TviTmkvlelobiT daasrules, fiziologiaSi:
2-adrenoceptoris SeboWvis gaZlierebuli eqspresia w mezolimbur sistemaSi, mastimulirebeli qcevisa da
aRiniSneba (ix. Escriba et al., 2004). dajildovebis procesebSi, dofaminuri neironebi
neiroendokrinuli testebi. tvinSi noradrena umniSvnelovanes rols asrulebs; es procesebi
linis funqciis gaZliereba zrdis plazmaSi adre depresiis, gansakuTrebiT ki melanqoliuri mdgo
nokortikotropuli hormonis (ACTH), kortizolisa mareobis dros, darRveulia;
da zrdis hormonis koncentracias. arsebobs kargad
w cxovelebis antidepresantebiT mkurnalobis Sede
dasabuTebuli mosazreba, rom melanqoliuri dep
gad izrdeba dofaminis receptorebis eqspresia
resiis SemTxvevaSi, zrdis hormonis sapasuxo re
nucleus accumbens_Si;
aqcia, rogorc noradrenalinis ukumitacebis inhi
garkveuli mtkicebulebebis safuZvleze arsebobs
bitoris _ dezipraminis, aseve noradrenalinis re
mosazrebebi, rom dofaminis funqcia darRveulia
ceptoris agonistis _ klonidinis mimarT, Sesus
depresiis dros:
tebulia. klonidini hipoTalamusSi uSualod
zemoqmedebs postsinafsur 2-adrenoceptorze da w cerebrospinalur siTxeSi dofaminis metabolitis
iwvevs plazmaSi zrdis hormonis donis momatebas. homovanilinuri mJavis (HVA) done mudmivad dabalia
amdenad, Sesustebuli neiroendokrinuli pasuxi depresiuli pacientebis SemTxvevaSi;
depresiul pacientebSi migviTiTebs hipoTalamusSi w depresiuli pacientebis tvinis neirovizualurma
postsinafsur 2-adrenoceptorebis daqveiTebul kvlevebma aCvenes striatumSi D2/D3 receptorebis
mgrZnobelobaze (Anand and Charney, 2000). es migneba momatebuli SeboWva, rac presinafsuri dofaminis
aSkarad ewinaaRmdegeba zemoT aRniSnul faqts, gamoyofis daqveiTebis Sedegia (ix.Verhoeff, 1999).
rom kortikul SreSi 2-adrenoceptoris eqspresia aRniSnuli monacemebi da is faqti, rom AMPT_
gaZlierebulia. Ti SesaZlebelia gamojanmrTelebul depresiul
kateqolaminebis deplecia. kateqolaminebis sin pacientebSi recidivis gamowveva, gviCvenebs, rom
Tezis Sesusteba enzimis Tirozin-hidroqsilazas dofaminis funqciis Sesustebam, SesaZloa garkveuli
inhibaciiTaa SesaZlebeli, romelic, Tavis xmriv, roli iTamaSos depresiuli simptomebis ganviTarebasa
akatalizebs amino-mJavis, Tirozinis, gardaqmnas da antidepresiuli medikamentebis moqmedebis
nordarenalinisa da dofaminis prekursorad _ efeqturobaSi.
L-dofad. am efeqtis miRweva SesaZlebelia medikamentis mania. Sizofreniis paTofiziologiaSi dofaminis
_ alfa-meTil-para-Tirozinis (AMPT) miRebiT. hiperaqtivobis hipoTezas gansakuTrebuli adgili
janrmTel pirebSi AMPT iwvevs sedacias, magram ara ukavia (gv. 288 ??). arsebobs varaudi, rom maniakaluri
depresiis gamoxatul simptomebs. iseve, rogorc mdgomareobac dofaminis gaZlierebul aqtivobasTanaa
triftofanis depleciis dros, gamojanmrTelebuli dakavSirebuli (Silverstone and Cookson, 1982). dofaminis
depresiuli pacientebis SemTxvevaSi, romlebic moqmedebisa da misi metabolizmis Seswavla amis
medikamentebs ar iReben, kateqolaminebis deplecia uSualo mtkicebulebebs ar gvaZlevs. Tumca, kargadaa
ganapirobebs depresiuli mdgomareobis TvalsaCino cnobili, rom maniis gamowveva dofaminis agonists _
klinikur gamwvavebas (Berman et al., 1999). amas SeiZleba bromokriptins SeuZlia. xolo, fsiqostimulatorebi _
iwvevdes dofaminisa da noradrenalinis funqciis amfetamini da kokaini, eiforiasa da zedmet sifxizles
gauareseba an aRniSnuli neirotransmiterebis kom iwvevs. amasTan, dofaminis receptorebis antagonisti
binirebuli inhibacia. medikamentebi, magaliTad, haloperidoli, efeqturad
es monacemebi gviCvenebs, rom afeqturi aSlilobebis gamoiyeneba maniis samkurnalod.
maRali riskis mqone pirebi mowyvladni arian rogorc bipolaruli aSlilobis mqone, intermisiaSi myof
serotoninis, aseve kateqolaminebis neirotransmisiis pacientebs amfetaminis intravenurad Seyvanisas ga
mimarT. es Tanmxvedria im klinikuri mtkicebulebisa, moxatuli fsiqopaTologiuri simptomebi ganu
rom medikamentebi, romlebic seleqciurad moqmedeben viTardaT. amasTan (rogorc moniSnul raklopridze
adrenalinisa da serotoninis receptorebze, efeq dakvirvebis teqnikam aCvena) ar gaZlierebula pre
turi antidepresantebi arian. sinafsuri dofaminis gamoyof (gv. 288 ??). amis
safuZvelze, SegviZlia davaskvnaT, rom maniis riskis
dofaminis funqcia
mqone pirebs dofaminis neirotransmisiis gaZlierebis
depresiis dros dofaminis moqmedeba, serotoninis
mimarT momatebuli mgrZnobeloba aqvT, Tumca,
an noradrenalinis funqciebTan SedarebiT, nakle
nakleb savaraudoa, rom es dofaminis presinafsuri
badaa Seswavlili, magram garkveuli mizezebi gva
gamoyofis gaZlierebis Sedegi iyos (Yatham et al., 2002).
Zlevs safuZvels vifiqroT, rom dofaminis neiro
_ 256 _
monoaminebis roli meore kiTxvasTan dakavSirebuli informacia Se

dReisaTvis sakmaod myari monacemebi arsebobs iswavles emociuri informaciis gadamuSavebis
imisa, rom aranamkurnaleb depresiul pacientebs procesze monoaminebis moqmedebis manipulaciis gziT.
monoaminuri funqciebis mniSvnelovani darRvevebi naxes, rom orive jgufis (rogorc serotoninerguli,
aReniSnebaT. Tumca, es darRvevebi gansxvavebulia aseve noradrenerguli) antidepresantebi, socialuri
sxvadasxva SemTxvevaSi da gamowveuli cvlilebebi ar percefciisa da emociuri mexsierebis Semswavleli
aris imdenad gamoxatuli da sakmarisad sensitiuri, testebis Sesrulebisas, amcirebs negatiur damo
rom moxerxdes maTi diagnostika. kidebulebas da aZlierebs pozitiur xedvas. es
yvelaze sarwmuno kvlevebi, romlebic depresiis migviTiTebs, rom monoaminebis aqtivobis cvlilebiT
paTofiziologiaSi moniaminebis umniSvnelovanes rol SesaZlebelia kogniciis modificireba, rasac,
ze migviTiTeben, 5-HT_isa da kateqolaminebis depleciis rogorc cnobilia, gansakuTrebuli mniSvneloba aqvs
paradigmebia. ukve dadasturebulia, rom afeqturi depresiis ganviTarebisa da gaxangrZlivebis procesSi.
aSlilobebisadmi midrekil individebSi klinikuri
endokrinuli darRvevebi
depresiis gamowvevisTvis sakmarisia serotoninis,
noradrenalinisa da dofaminis funqciebis Sesusteba. endokrinuli darRvevebi, SeiZleba ori mizeziT iyos
aRniSnulidan gamomdinare, ibadeba ori kiTxva: saintereso etiologiisaTvis:
1. zogierTi endokrinuli darRveva, ufro xSirad,
1. ra gavlenas axdens monoaminebis funqciebis cvli
afeqturi aSlilobebis Semdeg viTardeba, rac
lebebi guneb-ganwyobis regulirebaSi CarTul
garkveul mizez-Sedegobriv kavSirze migviTiTebs;
kortikul Sreze?
2. depresiis dros ganviTarebuli endokrinuli dar
2. ra gavlenas axdens monoaminebis funqciebis cvli Rvevebi migvaniSneben, rom SesaZloa adgili hqondes
lebebi depresiis klinikur niSnebze? hipoTalamusis centrebis darRvevebs, romlebic
pirvel kiTxvaze pasuxis gasacemad aucilebelia endokrinul sistemas uweven kontrols.
ukeT gavecnoT monoaminis moqmedebas ujredul
doneze. amJamad arsebobs mzardi monacemebi meorad endokrinuli darRvevebi da depresia
mesenjerebsa da nervul ujredebs Soris signalebis kuSingis sindromis mqone pacientTa naxevarze
gadacemaze monoaminebis moqmedebis Sesaxeb. cxovelebze mets aReniSneba depresia, romelic, rogorc we
Catarebuli Tanamedrove eqsperimentuli kvlevebi si, kortizolis donis regulirebasTan erTad um
gviCvenebs, rom cikluri adenozin monofosfatis jobesdeba. depresia Tavs iCens adisonis daavadebis,
(AMP) stimulirebas mivyavarT specifikuri samiz hipoTiroidizmis da hiperparaTiroidizmis dros.
ne genebis eqspresiis cvlilebamde, romlebic nei SesaZloa, premenstrualur, menopauzisa da mSo
rotropinis _ tvinis neirotropuli faqtoris biarobis Semdgom periodebSi depresiis ganviTareba
(BDNF), gamomuSavebis procesSi monawileoben. es endokrinuli cvlilebebiT iyos ganpirobebuli.
neirotropinebi aucilebelia centraluri ner aRniSnuli klinikuri kavSirebi ufro detalurad me-
vuli sistemis neironebis funqcionirebisa da ga 16 TavSia ganxiluli.
darCenisTvis. maSasadame, monoaminebis funqciis
hipoTalamur-hipofizarul-adrenaluri sistema
cvlileba, SesaZloa, gansazRvravs guneb-ganwyobis
regulirebaSi CarTuli kortikuli neironebis uamravi kvlevaa Catarebuli imisaTvis, rom gan
funqcionirebasa da sicocxlisunarianobas. sazRvruliyo depresiis dros kortizolis done. ukve
eqsperimentul cxovelebSi BDNF-is eqspresia zomierad mwvave depresiis SemTxvevaSic, pacientebis
stresis fonze sustdeba, xolo antidepresantebiT naxevarze mets, 24 saaTiani ciklis manZilze, plazmaSi
mkurnalobisas Zlierdeba. aman xeli Seuwyo Sem kortizolis done momatebuli aqvs. kortizolis
degi hipoTezis ganviTarebas: stresiT induci sekreciis momateba asocirebulia Tirkmelzeda
rebuli afeqturi aSlilobebis ganviTareba da jirkvlis gadidebasa da kortikotropinis (adre
monoaminebis Terapiuli efeqti dakavSirebulia im nokortikotropuli hormoni _ ACTH) momatebul
ujredTSorisi meqanizmebis cvlilebebTan, romlebic aqtivobasTan.
neirotropinebis warmoqmnaze arian pasuxismgeblebi depresiis mqone pacientebTan deqsametazonis
(ix. Duman, 2004). am mosazrebis safuZvelze SeiZleba supresiis testis gamoyenebam saintereso Sedegebi
aixsnas isic, Tu rogor axdens gavlenas cxovrebiseuli aCvena. am dros pacientis organizmSi 1 mg sinTezuri
usiamovnebebi neironebis sicocxlisunarianobaze da, kortikosteroiduli deqsametazonis SeyvaniT, ro
SesaZloa, guneb-ganwyobis regulaciaSi monawile melic glukokortikoidul receptorebze moq
Tavis tvinis ubnebis anatomiur struqturazec (ix. medebs, xdeba hipofizarul doneze ACTH inhibacia
qvemoT). da, Sesabamisad, kortizolis donis supresia. sta
_ 257 _
cionaruli pacientebis daaxloebiT 50%-s kor migviTiTebdes neirobiologiur meqanizmze, romlis
tizolis sekreciis normaluri supresia ar aReniSneba. meSveobiTac, savaraudod, xdeba bavSvobaSi miRebuli
deqsametazoniT supresia, ufro xSirad, ar xdeba fsiqologiuri tramvis Sedegebis guneb-ganwyobis
melanqoliuri depresiis dros. Tumca, specifikuri aSlilobebisadmi midrekilebad `gadaTargmna~. Tana
kavSiri sxva fsiqopaTologiur maxasiaTebelTan medrove kvlevebi adasturebs, rom zrdasrul pirebs,
ar aRiniSneba. deqsametazonis supresiis testi ar romlebic bavSvobaSi Zaladobas ganicdidnen, stresze
aris specifikurad Secvlili mxolod afeqturi hipoTalamur-hipofizarul-adrenaluri sistemis
aSlilobebis dros; msgavsi Sedegebi miRweulia maniis, reaqcia momatebuli aqvT (Heim and Nemeroff, 2000).
qronikuli Sizofreniisa da demenciis SemTxvevebSic. CRH da depresia. garda imisa, rom gavlenas axdens
aqedan gamomdinare, melanqoliuri depresiis diag kortizolis sekreciaze, depresiis etiologiaSi
nostikis mizniT deqsametazonis supresiis testis CRH uSualod monawileobs. cnobilia, rom CRH
gamoyenebam dakarga Tavisi mniSvneloba. tvinis limbur sistemaSi neorotransmiteris rols
Semdegi meTodologia, romelic gamoiyenes dep asrulebs, sadac igi stresze bioqimiuri da qceviTi
resiis dros, gulisxmobda saRamos deqsametazonis pasuxis regulirebaSia CarTuli. cxovelebSi CRH-
micemas, xolo momdevno dRes ki kortikotropinis micema iwvevs neiroendokrinuli regulaciis,
rilizing-hormonis Seyvanas (CRH-kortikotropin- Zilisa da madis cvlilebebs, rac depresiisaTvisac
rilizing-hormoni, romelic aZlierebs hipofizSi damaxasiaTebelia. garda amisa, kortizol_rilizing
adrenokortikotropuli hormonis _ ACTH-s sek faqtoris done Tavzurgtvinis siTxeSi SeiZleba
recias). janmrTel pirebSi deqsametazonis Seyvana momatebuli iyos. Sesabamisad, savaraudoa, rom
aneitralebs ACTH-sa da kortizolis reaqcias kortikotropin-rilizing hormonis hipersekrecia
CRH-ze; depresiul pacientebs ki ACTH-is monawileobs depresiis paTofiziologiaSi da, SesaZ
moqmedebac da kortizolis reaqciac gamoxatuli loa, CRH receptorebis arapeptidur antagonistebs
aqvT. es kidev erTxel cxadhyofs, rom depresiuli antidepresiuli moqmedeba hqondeT (ix. Heim and
pacientebis SemTxvevaSi deqsametazoni ar axdens Nemeroff, 2000).
gavlenas ACTH-is sekreciaze. amis safuZvelze kortizoli, monoaminebis funqcia da neironuli
ganviTarda `glukokortikoiduli receptorebis hi toqsikuroba. Tanamedrove kvlevebma aCvena, rom
poTeza~, romlis Tanaxmadac, hipoTalamur-hipo kortikosteroidebi axdens mTeli rigi mono
fizarul-adrenaluri sistemis disfunqcia da aminuri receptorebis genomuri eqspresiisa da
mis Sedegad ganviTarebuli depresiuli sindromi funqcionirebis regulirebas Tavis tvinSi. ma
dakavSirebulia glukokortikoiduli receptorebis galiTad, kortikosteroidebs SeuZliaT, Seasus
genetikur an SeZenil defeqtTan. es monacemebi da ton postsinapturi 5-HT1A receptorebis eqspre
cxovelebze Catarebuli eqsperimentuli kvlevebiT sia hipokampSi. amis safuZvelze gaCnda mosa
gvaCvenebs, rom antidepresantebiT mkurnaloba aZ zreba, rom kortizolis Warbi gamoyofa, 5-HT ne
lierebs glukokortikoiduli receptorebis eqs irotransmisiis Sesustebis gamo, qmnis depresiis
presias. amdenad, antidepresantebis moqmedebis ganviTarebis winapirobas. cxovelebze Catarebulma
erTierTi Terapiuli Tviseba, glukokortikoiduli eqsperimentulma kvlevebma gamoavlina kavSiri kor
receptorebis maregulirebeli efeqtis gaumjo tizolis gazrdil sekreciasa da hipokampSi nei
besebiT, hipoTalamur-hipofizarul-adrenaluri sis ronebis dazianebas Soris. Sesabamisad, arsebobs
temis normalizeba unda iyos (ix. Holsboer and Kunzel, mosazreba, rom kortizolis qronikuli hipersekrecia
2004). ukavSirdeba kognitur gauaresebas, rac qronikuli
zogadad, depresiul pacientebSi hipoTalamur- depresiisTvis damaxasiaTebelia (mimoxilva ix.
hipofizarul-adrenaluri sistemis cvlilebebi Holsboer and Kunzel, 2004).
mdgomareobis darRvevebad miiCneva, rac gulisxmobs,
rom mdgomareobidan gamosvlis Semdeg es deficiti farisebri jirkvlis funqcia
aRar aRiniSneba. Tumca, arsebobs monacemebi, rom depresiis dros plazmaSi Tavisufali Tiroqsinis
gamojanmrTelebis Semdegac umniSvnelo cvlilebebi koncentracia normis farglebSia, Tumca, SesaZlebelia
isev rCeba. es niSnavs, rom depresiisadmi midrekil Semcirebuli iyos Tavisufali triiodoTironinis
pirebs SesaZloa, hqondeT hipoTalamur-hipofizarul- koncentracia. depresiuli pacientebis daaxloebiT
adrenaluri sistemis sakmaod stabiluri darRvevebi. erT meoTxeds Tirotropin-rilizing hormonis (TRH)
eqsperimentuli cxovelebis magaliTze naCvenebia, intravenurad Seyvanisas Tiroidmastimulirebeli
rom adreuli uaryofiTi movlenebi ganapirobebs hormonis gasadavebuli pasuxi (TSH) aReniSneba; es
xangrZliv cvlilebebs hipoTalamur-hipofizarul- darRvevebi ar aris depresiisTvis specifikuri,
adrenaluri sistemis regulirebaSi. es SesaZloa, maT alkoholizmisa da panikuri aSlilobebis
_ 258 _
drosac vxvdebiT. iseve rogorc CRH, TRH-sac w Zilis mimdinareobisa da xangrZlivobis darRvevebi;
tvinis neirotransmisiaSi sakuTari roli aqvs w Rrma Zilis fazis Semcireba (me-3 da me-4 etapi);
da aRmoCenilia tvinis neironebSi klasikuri mo
w REM Zilis CaZinebis fazis Semcireba;
noaminuri neirotransmiterebis, magaliTad, 5-HT_s
gverdiT. amdenad, SesaZlebelia, rom depresiis dros w Ramis pirvel nawilSi REM Zilis fazis gaxangrZli-
farisebri jirkvlis funqciis darRvevebi TRH-is veba.
Secvlil moqmedebas ukavSirdebodes (ix. Holsboer and did interess iwvevs REM Zilis CaZinebis fazis
Kunzel, 2004). Semcireba, misi etiologiasTan kavSiris gamo. arsebobs
garkveuli monacemebi, rom gamojanmrTelebis Semdegac
depresia da imunuri sistema CaZinebis faza Secvlilia da, SesaZloa, gamwvavebis
arsebobs mzardi monacemebi imisa, rom depresiis dros niSanic ki iyos. Zilis REM fazasa da depresiis kavSirze
imunuri sistemis sxvadasxva tipis darRvevebi iCens isic metyvelebs, rom antidepresantebis umravlesoba
Tavs. adre Catarebulma kvlevebma aCvena ujreduli zrdis REM Zilis CaZinebis fazas da amoklebs REM
imunuri pasuxis daqveiTeba (Herbert and Cohen, 1993). Zilis fazas. garda amisa, rogorc zogadad Zilis, aseve
amave dros, Tanamedrove kvlevebiT fiqsirdeba REM Zilis deprivaciac iwvevs depresiuli simptomebis
imunuri aqtivacia, kerZod ki, garkveuli citokinebis droebiT Semsubuqebas (damatebiTi informacia ix.
gamoyofis gaZliereba (boqsi 11.3). cnobilia, rom Nishino et al., 2004).
citokinebi iwvevs hipoTalamur-hipofizarul-adre ar aris cnobili amis neiroqimiuri meqanizmebi. REM
naluri sistemis gaaqtiurebas. amdenad, depresiis Zilis cvlilebebi SesaZlebelia dakavSirebuli iyos
dros imunuri regulaciis cvlilebebs hipoTalamur- muskarinuli qolinerguli receptorebis momatebul
hipofizarul-adrenaluri sistemis disfunqciazec sensitiurobasTan (Perlis et al., 2002).
SeuZliaT garkveuli gavlenis moxdena SeuZliaT.
SesaZlebelia isic, rom imunur sistemaSi ar tvinis neirovizualuri gamokvlevebi afeqturi
sebuli cvlilebebi depresiuli mdgomareobis Se
aSlilobebis dros
degad viTardebodes. magaliTad, sakvebis mcire struqturuli neirovizualuri gamokvlevebi
raodenobiT miReba an sakuTari Tavis movlis ugu tvinis moculoba. depresiis mqone pacientebis
lebelyofa. Tumca, cnobilia, rom organizmSi kompiuteruli tomografiiTa (CT) da magnitur-
zogierTi citokinis (magaliTad, interferoni rezonansuli kvlevebiT (MRI) Seswavlis Sedegad
an simsivnis nekrozis faqtori) Seyvanam SeiZleba mTeli rigi cvlilebebi gamovlinda. gansakuTrebiT
gamoxatuli depresiuli simptomebis ganviTareba TvalsaCino cvlilebebi aRiniSneba mZime da xan
ganapirobos. es faqti metyvelebs imaze, rom imunuri grZlivad mimdinare depresiuli mdgomareobebis
sistemis darRvevebi, savaraudod, uSualo gavlenas dros. yvelaze xSirad gvxvdeba Semdegi cvlilebebi:
axdes depresiuli mdgomareobis ganviTarebaze.
w lateraluri parkuWis gadideba (gansakuTrebiT,
Tanamedrove Sexedulebebis Tanaxmad, citokinebs
xandazmuli pacientebis SemTxvevaSi, depresiis
SeuZlia triftofanis metabolizmSi monawile enzimis
mogvianebiT asakSi ganviTarebis dros);
_ triftofan oqsigenazas gaaqtiureba. es iwvevs
triftofanis donis daqveiTebas, rac depresiisadmi w hipokampis zomaSi Semcireba (ufro unipolaruli,
midrekili pirebisTvis depresiis mniSvnelovan risk_ vidre bipolaruli depresiis dros);
faqtors warmoadgens (ix. Capuron and Miller, 2004). w bazaluri birTvebis moculobis Semcireba (uni
polaruli, magram ara bipolaruli depresiis dros);
Zilis darRvevebi depresiis dros
depresiisaTvis damaxasiaTebeli Zilis darRvevebi
boqsi 11.4 afeqturi aSlilobebis mqone
depresiuli pacientebis Zilis eeg-s (polisomnograma) pacientebisTvis damaxasiaTebeli
CanawerebiT registrirebulia Semdegi tipisa: zogierTi paTologiuri ujreduli
cvlileba
boqsi 11.3 imunuri sistemis cvlilebebi 1. gliuri ujredebis raodenobis Semcireba (qerqis
depresiis dros sartylisebri xveulis wina nawilSi
2. neironebis zomisa da sixSiris daqveiTeba
mitogenze limfocitebis proliferaciuli pasuxis
(prefrontalur korteqsa da qerqis sartylisebri
daqveiTeba
xveulis wina nawilSi)
bunebrivi kilerebis aqtivobis Sesusteba
3. sinafsuri markerebis daqveiTeba (prefrontalur
mwvave fazis cilis zrda korteqsSi)
citokinebis donis momateba (magaliTad, IL-1, IL-6). Harrison, 2002
_ 259 _
w ruxi nivTierebis moculobis Semcireba prefron aSliloba, savaraudod, vaskuluri daavadebiTaa
talur nawilSi; gamowveuli, romelic Tavis mxriv azianebs guneb-
w amigdalas moculobis gazrda (bipolaruli subi ganwyobis maregulirebeli gzebis funqcionirebas (ix.
eqtebi). Drevets et al., 2004). TeTri nivTierebis hiperintensivoba
nanaxia bipolaruli aSlilobis mqone rogorc
am struqturuli darRvevebis warmoSoba ucnobia,
axalgazrda, ise xandazmul pirebSic, Tumca, am
magram is, SesaZloa, kavSirSi iyos ujredul nev
darRvevebis mniSvneloba dRemde naTeli ar aris.
ropaTologiur darRvevebTan, rasac sul ufro da
ufro xSirad aRweren depresiis dros (boqsi 11.4). cerebruli sisxlis mimoqceva da metabolizmi
depresiis neirotropuli hipoTeza gulisxmobs, rom
cerebruli sisxlis mimoqcevis gazomva sxvadasxva
stresi (savaraudod, kortizolis hipersekreciis
gziT xdeba: fotonuri emisiuri tomografiiT
xelSewyobiT) SesaZloa, win uZRodes neironebis
(SPET), pozitronuli emisiuri tomografiiTa
atrofias an kvdomas, xolo mozrdil pirebSi _
(PET) an magnitur-rezonansuli gamokvlevebiT
neirogenezis Sesustebul regulacias, gansakuTrebiT
(MRI). am ukanasknels cerebruli metabolizmis ga
hipokamSi (ix. Duman, 2004). savaraudoa, rom am tipis
zomvac SeuZlia. cerebruli sisxlis mimoqceva da
procesebi ganapirobebs boqsSi 11.4 CamoTvlil
metabolizmi, Cveulebriv, mWidro urTierTkavSirSia.
struqturul cvlilebebs.
mravali kvlevaa Catarebuli depresiuli pacien
TeTri nivTierebis hiperintensivoba. magnitur-
tebis cerebruli sisxlis mimoqcevisa da meta
rezonansuli kvlevebis meSveobiT gamovlinda Tavis
bolizmis Sesaswavlad. miRebuli monacemebi zog
tvinis zogierT ubanSi (gansakuTrebiT periventrikul
jer urTierTgamomricxavia. arsebobs uamravi me
ubanSi) TeTri nivTierebis hiperintensivoba rogorc
Todologiuri faqtori _ pacientebis SerCeva,
xandazmul pirebSi, ise depresiis mqone pacientebSi.
Catarebuli mkurnaloba da neirovizualuri teqnika,
TeTri nivTierebis es hiperaqtivoba asocirebulia:
rac Sedegebis Seusabamobas ganapirobebs. miuxedavad
w mogvianebiT asakSi ganviTarebul depresiasTan; amisa, mecnierebi Tanxmdebian, rom depresiis dros
w daavadebis simZimesa da medikamentur mkurnalobaze sisxlis mimoqceva da metabolizmi Semdeg ubnebSia
cud pasuxTan; Secvlili:
w apaTiasa da fsiqomotorul SenelebasTan; w prefrontaluri qerqi (orbitofrontaluri,
w vaskuluri risk-faqtorebis arsebobasTan. dorsolateraluri da dorsomedialuri qerqi);
arsebobs mosazreba, rom aseTi klinikuri da w qerqis sartylisebri xveulis wina nawili;
radiologiuri maxasiaTeblebis mqone depresiuli w amigdala da Talamusi;
w kudiani birTvi.
boqsi 11.5 neirofsiqologiuri
funqciuri kvlevebiT miRebuli monacemebi
korelatebi depresiis dros
adasturebs mosazrebas, rom afeqturi aSlilobebis
dorsolateraluri da dorsomedialuri dros gvaqvs Tavis tvinis sxvadasxva ubnebs Soris
prefrontaluri qerqi
urTierTqmedebis darRvevebi da ara erTi romelime
w kognituri disfunqcia (kerZod, aRmasrulebeli
struqturis cvlilebebi. am procesSi CarTulia
funciebis darRvevebi) da kognituri Seneleba
Sublisa da safeTqlis wilebSi da maTTan dakavSrebul
orbitaluri da lateraluri prefrontaluri qerqi bazalur gangliasa da TalamusSi moTavsebuli
Sesabamisi ubnebi (ix. Drevets et al., 2004). tvinis
w Secvlili emociuri procesebi
am ubnebsa da depresiis klinikur niSnebs Soris
w perseveraciuli azrovneba
korelaciis Sesaxeb arsebuli informacia mocemulia
boqsSi 11.5.
qerqis sartylisebri xveulis wina nawili
w yuradRebis daqveiTeba neirofsiqologiuri cvlilebebi afeqturi
w Secvlili emociuri procesebi aSlilobebis dros
sxvadasxva neirofsiqologiuri testebis Sesrule
amigdala
bisas, depresiisa da maniis mqone pacientebs dabali
w Secvlili emociuri procesebi maCveneblebi aReniSnebaT. gansakuTrebiT Tval
saCinoa yuradRebis, daswavlis, mexsierebisa da
bazaluri ganglia
aRmasrulebeli funqciebis deficiti. dRemde ar aris
w fsiqomotoruli darRvevebi dazustebuli, es kognituri gauareseba zogadi da
w qcevis stimulirebis darRvevebi difuzuri defeqtia, Tu garkveuli specifikurobiT
_ 260 _
xasiaTdeba. magaliTad, arsebobs mosazreba, rom es meqanizmebi ar gamoricxavs erTi meores da,
aRmasrulebeli funqciis deficiti SesaZloa, SesaZloa, erTiani paTologiuri procesis sxvadasxva
prefrontalur ubnebSi neirovizualuri kvlevebiT dones warmoadgendes. fsiqologiuri kvlevebi jer
dafiqsirebul cvlilebebs Seesabamebodes. sawyis etapzea. depresiul pacientebs aReniSnebaT
kognituri deficiti depresiuli mdgomareobis azrovnebis procesis darRvevebi, rac depresiuli
gaumjobesebasTan erTad mcirdeba. Tumca, Tana mdgomareobis gaxangrZlivebis TvalsazrisiT,
medrove monacemebis safuZvelze miiCneven, rom savaraudod, mniSvnelovan rols asrulebs. Tumca,
zomieri kognituri gauareseba epizodis amowurvis amis damadasturebeli sakmarisi mtkicebulebebi ar
Semdegac rCeba (Chamberlain and Sahakian, 2004). arsebobs.
kognituri daqveiTeba gansakuTrebiT TvalsaCinoa SeiZleba gamoviyenoT sxvadasxva bioqimiuri Teoriebi
xandazmul pacientebSi. SesaZloa, am SemTxvevaSi imisaTvis, rom avxsnaT, Tu rogor xdeba depresiis
es darRvevebi ukavSirdeba hipokampis moculobis gamomwvevi stresisa da cxovrebiseuli sirTuleebis
Semcirebas (O'Brien et al., 2004). neiroqimiur cvlilebebad `gadaTargmna~. monoaminuri
neirotransmiterebi monawileobs stresze reaqciis
daskvna regulirebasa da im qcevebis modificirebaSi, rom
maniis an mwvave depresiuli aSlilobis ganviTa lebic darRveulia afeqturi aSlilobebis dros.
rebisadmi winaganwyoba (predispozicia) mniSvnelovnad savaraudod, rogorc gare movlenebi, aseve genetikuri
aris damokidebuli genetikur mowyvladobaze. ge faqtorebi erToblivad ganapirobebs depresiisTvis
netikuri faqtorebis gavlena bolomde naTeli damaxasiaTebel monoaminebis funqciebis cvlilebebs.
ar aris. isini SeiZleba moqmedebdnen rogorc mowyvladi pirebis SemTxvevaSi, monoaminebis
monoaminebis neirotransmiterebis regulirebaze, transmisiis daqveiTeba depresiis klinikuri suraTis
aseve sxva faqtorebzec, rogorebicaa temperamenti ganviTarebas iwvevs.
da cxovrebiseul stresul movlenebze reagirebis depresiuli mdgomareoba asocirebulia prefron
unari. uaryofiTi adreuli gamocdileba, rogoricaa talur korteqsSi aqtivobis darRvevebTan. zogjer,
mSoblebs Soris uTanxmoeba an fizikuri da sxva gansakuTrebiT cudi prognozis SemTxvevaSi, ar
saxis Zaladoba, garkveul rols TamaSobs pirovnuli sebobs monacemebi neropaTologiuri cvlilebebis
Tvisebebis CamoyalibebaSi, rac, Tavis mxriv, gan Sesaxeb, romlebic moqmedeben, rogorc Semdgomi
sazRvravs mZime viTarebaSi individis mier emociuri predispoziciuri faqtorebi (gamartivebuli neiro
mxardaWeris miRebisa da stresTan gamklavebis unars. bavSvobisdroindeli
amasTan, adreul uaryofiT gamocdilebas SeuZlia uaryofiTi gamocdileba
stresze hipoTalamur-hipofizarul-adrenaluri sis
temis iseTi pasuxis Camoyalibeba, romelic afeqturi hipoTalamur-hipofizarul-adrenaluri sistema (HPA)
aSlilobebis ganviTarebis winapirobas Seqmnis. amJamindeli stresi
arasasurveli cxovrebiseuli movlenebi da
kortizoli
sxvadasxva somaturi daavadebebi depresiis pre
cipitatul faqtorebs warmoadgens. miRweulia genetikuri faqtorebi
garkveuli progresi aseTi stresuli SemTxvevebis
NA-s funqcia 5-HT-s funqcia
gamovlenasa da maTi zemoqmedebis xarisxis Se
fasebaSi. aseTi kvlevebiT dadginda, rom danaklisi
SesaZloa iyos mniSvnelovani, magram ara erTaderTi, prefrontaluri korteqsi
precipitatuli faqtori. SesaZloa, konkretuli hipokampi
warsuli
movlenis efeqti sxvadasxva faqtorebis zegavleniT
depresiuli epizodi
gaZlierdes (magaliTad, ramdenime mcirewlovani depresiuli
bavSvis movla an socialuri izolacia), rac zrdis sindromi
pirovnebis midrekilebas depresiisadmi. rogorc
ukve aRvniSneT, stresuli movlenis zemoqmedebis suraTi 11.3 depresiis paTofiziologiis gamartivebuli
neirobiologiuri modeli. bavSvobaSi miRebul uaryofiTi
xarisxi, aseve, damokidebulia adreul cxovrebiseul gamocdileba gavlenas axdens HPA sistemis funqcionirebaze,
gamocdilebaze, pirovnul Tvisebebsa da genetikur romelic stresuli cxovrebiseuli movlenebis Sesabamisad
mowyvladobaze. SemdgomSic icvleba (mgrZnobeloba, romelic genetikuri
faqtorebiTaa ganpirobebuli). kortizolis sekreciis
raTa aixsnas precipitatuli movlenebis Sedegad darRvevebi aqveiTebs noradrenalinisa (NA) da serotoninis
depresiuli aSlilobebis ganviTareba, ori tipis (5-HT) funqciebs, rac, Tavis mxriv, prefrontalur qerqsa da
paTofsiqologiuri meqanizmia gamoyenebuli: pirveli hipokamSi Tandayolili an SeZenili darRvevebis arsebobisas,
depresiis klinikuri suraTis ganviTarebas iwvevs.
_ fsiqologiuri, xolo meore _ neirobiologiuri.
_ 261 _
biologiuri modeli mocemulia suraTze 11.3). sabolood maniakaluri epizodi uviTardeba. aseT
Tanamedrove kvlevebSi depresiis sxvadasxva risk_ pacientebs, meti albaTobiT, maniis ojaxuri istoria
faqtorebis Tvisobrivi maCveneblebis Sesafaseblad an antidepresantebiT mkurnalobisas guneb-ganwyobis
rTul statistikur gamoTvlebs iyeneben. magaliTad, xanmokle da msubuqi aweva aReniSnebaT. stacionarul
kedlerma (Kendler et al., 2002) 1 942 mdedrobiTi da zogad populaciaSi Catarebuli Tanamedrove
sqesis tyupebis prospeqtuli kvlevis safuZvelze kvlevebis safuZvelze SesaZlebelia Semdegi zogadi
gamoTvala, rom naxevarze met SemTxvevaSi dep daskvnebis gakeTeba (ix. Angst, 2000):
resiisadmi midrekileba Semdegi faqtorebiT iyo
bipolaruli aSlilobebi
ganpirobebuli (faqtorebi dalagebulia maTi mni
Svnelovnebis mixedviT): w stacionarSi Catarebuli kvlevebis Tanaxmad,
bipolaruli aSlilobebi, Cveulebriv, 21 wlis
w ukanaskneli periodis stresuli movlenebi da sir
asakidan iwyeba, Tumca, zogadi populaciis kvlevebma
Tuleebi;
ufro adreuli asaki (daaxloebiT 17 weli) aCvena.
w mozardobis periodis risk-faqtorebi (nevrotizmi,
bipolaruli aSlilobebis gviani dasawyisi iSviaTia
adre ganviTarebuli SfoTviTi aSlilobebi da
da ufro xSirad tvinis organuli daavadebebiTaa
qcevis darRvevebi);
gamowveuli;
w genetikuri riski; w maniakaluri epizodis (mkurnalobis an mkurnalobis
w depresiis anamnezi. arCatarebis SemTxvevaSic) saSualo xangrZlivoba
imave kvleviT gamovlinda, rom bavSvobisdroindeli daaxloebiT 6 Tvea;
uaryofiTi gamocdilebac, iribad (kerZod, cxov w maniakaluri epizodis mqone pacientTa 90%-s guneb-
rebiseuli sirTuleebis gazrdili riskisa da ganwyobis darRvevebis sxva epizodebi SemdgomSic
arasakmarisi socialuri mxardaWeris gamo) gav uviTardebaT;
lenas axdens SemdgomSi depresiis ganviTarebis w bipolarul pacientebs 25-wliani dakvirvebis peri
riskze. sainteresoa, rom genetikuri faqtorebis odSi guneb-ganwyobis saSualod 10 epizodi ganu
zogierTi efeqti adreuli uaryofiTi gamocdilebis viTardaT;
gazrdil riskTanaa asocirebuli. savaraudoa, rom w epizodebs Soris intervali, asakisa da epizodebis
depresiisadmi genetikuri mowyvladoba, ufro didi raodenobis zrdasTan erTad, progresulad mcir
albaTobiT, negatiur ojaxur garmeoSi iCens Tavs. es deba.
SeiZleba mSoblebisa da Svilebis xasiaTTanac iyos w TiTqmis yvela mwvave afeqturi epizodis Semdeg
dakavSirebuli. pacienti gamodis mdgomareobidan, Tumca, daava
Tanamedrove kvlevebis safuZvelze SeiZleba debis saboloo gamosavlis prognozireba rTulia.
davaskvnaT, rom depresia aris daavadeba, romelic bipolaruli pacientebis daaxloebiT 20%-s 5
genetikuri, garemo da interpersonaluri faqto wlis manZilze kargi socialuri da profesiuli
rebiTaa determinirebuli. es faqtorebi erTmaneTTan funqcionireba da klinikuri stabiluroba aReniS
rTul urTierTqmedebaSia da pirdapir an iribad neba. bipolaruli II tipis aSlilobis SemTxvevaSi
gavlenas axdens erTmaneTze. mocemuli formulireba, gamosavali ufro keTilsaimedoa, magram epizodebis
erTis mxriv, arTulebs depresiis etiologiis swrafi monacvleoba prognozs auaresebs.
asaxsnelad martivi modelebis gamoyenebas, magram,
meores mxriv, Seesabameba klinikur gamocdilebas. unipolaruli depresia
amasTan, SegviZlia gamovyoT sxvadasxva saxis (rekurentuli didi depresia)
intervenciebi, romelTa meSveobiTac SesaZlebelia w unipolaruli depresia SeiZleba sxvadasxva asakSi
depresiis ganviTarebis riskis Semcireba. gamovlindes. zogadad, iTvleba, rom, ufro
gvian iwyeba, vidre bipolaruli aSlilobebi. si
mimdinareoba da prognozi cocxlis manZilze praqtikulad identuri epi
radgan afeqtur aSlilobebs gansxvavebuli mim zodebi viTardeba. adreul da mogvianebiT asakSi
dinareoba da prognozi aqvs, mizanSewonilia, bi dawyebuli aSlilobebis ganviTarebaze, savaraudod,
polaruli da unipolaruli aSlilobebis cal-calke gansxvavebuli etiologiuri faqtorebi axdens
ganxilva. amasTan, unda gvaxsovdes, rom unipolaruli gavlenas.
depresiis mqone pacientebis garkveul nawils w epizodis xangrZlivoba saSualod 6 Tvea; pacientTa
is pirebi warmoadgenen, romlebsac bipolaruli 25%-s depresia, SesaZloa, erT wlamde (da metic)
aSlilobebi jer ar CamouyalibdaT. miCneulia, gaugrZeldes, xolo 10-20%-s qronikuli uwyveti
rom depresiis mqone pirebis daaxloebiT 10%-s mimdinareoba aReniSneba.
_ 262 _
w depresiis pirveli epizodis Semdeg, pacientTa 80%-
boqsi 11.6. sikvdilianobis standartuli maCve
s Semdgomi epizodebi uviTardeba (anu rekurentuli nebeli sxvadasxva depresiuli aSlilobebis dros
depresia uviTardeba).
w didi depresia 20.35
w 25-wliani dakvirvebis periodSi, rekurentuli
w bipolaruli aSliloba 15.05
depresiis pacientebs saSualod xuTi depresiuli w disTimia 12.12
epizodi ganuviTardaT. (Harris da Barraclough, 1997)
w iseve, rogorc bipolaruli aSlilobis mqone pa
lianobis standartuli maCvenebeli orjer metia,
cientebis SemTxvevaSi, epizodebs Soris intervali,
vidre zogad populaciaSi. amgvar viTarebas, TviT
asakisa da epizodebis raodenobis zrdasTan erTad,
mkvlelobis garda, ganapirobebs sxvadasxva ube
progresulad mcirdeba.
duri SemTxveva, kardiovaskuluri daavadebebi da
w depresiuli pacientebis didi nawili (daaxloebiT komorbiduli wamal da alkoholmoxmareba. epide
erTi mesamedi) epizodebs Soris sruli remisiis miologiurma kvlevebma aCvena, rom afeqturi aS
mdgomareobas ver aRwevs. lilobebis mkurnaloba sikvdilianobis SemTxvevebs
w zogadad, rekurentuli depresiis grZelvadiani ga amcirebs (ix. Angst et al., 2002).
mosavali, bipolarul aSlilobebTan SedarebiT, afeqturi aSlilobebis dros TviTmkvlelobis maC
keTilsaimedoa, Tumca, bevrad ukeTesi araa. pa venebeli 12-jer ufro maRalia, vidre zogad po
cientebis mxolod 25% xuTi wlis manZilze inar pulaciaSi (Harris da Barraclough, 1997). riski sxvadasxva
Cunebs klinikur stabilurobas da kargi socialuri diagnostikuri qvekategoriebis mixedviT, magram
da profesiuli funqcionirebis unars. yvelaze metia didi depresiis SemTxvevaSi (boqsi 11.6).
depresiul pacientebze xangrZlivi dakvirvebis
disTimia
Sedegad sicocxlis manZilze TviTmkvlelobis riskis
ganmartebis mixedviT, disTimia aris xangrZlivad gansxvavebuli maCveneblebi gamovlinda. mZime depresiis
mimdinare qronikuli afeqturi aSliloba, romlis mqone da stacionirebuli pacientebis SemTxvevaSi
drosac, mosaxleobaze Catarebuli kvlevebis Ta suicidis riski TiTqmis 15%-ia. Tumca, zogadad,
naxmad, spontanuri gamojanmrTelebis SemTxvevebi mosaxleobaSi Catarebuli kvlevebis Tanaxmad, ufro
iSviaTia. disTimiis mqone zogierT pacients sicocxlis msubuqi formebis dros riski mniSvnelovnad dabalia.
manZilze SeiZleba didi depresia (e.w. ormagi depresia) droTa ganmavlobaSi, daavadebis ganviTarebasTan
ganuviTards, an didi depresiis mqone pirebs _ erTad, suicidis SemTxvevebi klebulobs da sikv
disTimia. maniakaluri epizodebi iSviaTiad viTardeba. dilianobis maCvenebelSi misi xvedriTi wili
msubuqi afeqturi aSliloba mcirdeba. SeiZleba es avxsnaT imiT, rom mogvianebiT
periodSi izrdeba bunebrivi mizezebiT grdacvalebis
msubuq depresiasTan dakavSirebiT yvelaze meti
SemTxvevebi an, SesaZloa, TviTmkvlelobis riski
informacia arsebobs, romlis Tanaxmadac, msubuqi
daavadebis sawyis etapze gansakuTrebiT maRalia.
depresiisa da didi depresiis rekurentuloba Ti
Tqmis msgavsia. pacientebs, romlebsac aqvT msubuqi
prognozuli faqtorebi
depresiis diagnozi, SeiZleba mogvianebiT didi
aSlilobebis samomavlo prognozis saukeTeso maC
depresia ganuviTardeT da piriqiT. amgvarad, msubuqi
venebelia wina epizodebis istoria. cxadia, rom
depresia, disTimiis msgavsad, SesaZloa, warmoadgendes
ramdenime wina epizodis arsebobis recidivis gan
didi depresiis risk-faqtors an rezidualur
viTarebis riski gacilebiT maRalia. momavalSi epi
mdgomareobas, romelic didi depresiis Semdgomi
zodebis ganviTarebis momaswavebeli faqtorebia:
remisiis periodSi aRiniSneba. zogadad, xangrZlivi
kvlevebis monacemebze dayrdnobiT miCneulia, rom w simptomebis arasruli remisia;
didi da msubuqi depresia da disTimia warmoadgens w bipolaruli aSlilobebi;
ara damoukidebel aSlilobebs, aramed depresiuli w daavadebis dawyeba adreul asakSi;
aSlilobebis speqtris sxvadasxva mdgomareobebs (ix.
w cudi socialuri mxardaWera;
Hermens et al., 2004).
w susti fizikuri janmrTeloba;
sikvdilianoba afeqturi aSlilobebis dros w Tanmxlebi personologiuri aSlilobebi;
afeqturi aSlilobebis mqone pacientebis SemTxve w Tanmxlebi wamal da alkoholmoxmareba.
vaSi sikvdilianobis maCvenebeli, ZiriTadad, TviT recidivebis ganviTarebis sxvadasxva risk-faqto
mkvlelobis (magram ara mxolod) gamo, mniSvnelovnad rebis arseboba, gadatanili epizodebis paternebi
gazrdilia. afeqturi aSlilobebis dros sikvdi da amJamindeli remisiis xarisxi mniSvnelovani maC
_ 263 _
venebelia, romelTa safuZvelzec xangrZlivi mkur kvlevebiT bevrjer Seudares placebos da naxes,
naloba unda Catardes (ix. qvemoT). afeqturi aSlilobis rom yvela, gansakuTrebiT ki mZime depresiis mqo
mqone bevri pacienti miiCnevs, rom mas aqvs qronikuli ne pacientebis SemTxvevaSi, triciklur antid
rekurentuli mdgomareoba, romelic xangrZliv epresantebs, placebosTan SedarebiT, aSkara upira
kompleqsur mkurnalobas saWiroebs (ix. Young, 2001). tesoba aqvs (Morris da Beck, 1974). informacia
imis Sesaxeb, Tu ramdenad gansxvavdeba klinikuri
depresiis mkurnaloba mwvave fazaSi efeqturobis TvalsazrisiT sxvadasxva tricikluri
aq ganvixilavT depresiis mwvave fazis dros sxvadasxva antidepresantebi, Zalian mwiria, amasTan, maT gan
tipis mkurnalobis efeqturobas. am nawilis wa sxvavebuli gverdiTi movlenebi aqvT (ix. 21-e Tavi).
kiTxvamde dagWirdebaT 21-e Tavis gadaxedva, ro lofepramini SedarebiT usafrTxoa zedozirebis Sem
melSic mocemulia antidepresiul medikamentebsa TxvevaSi. antidepresantebis sxva jgufebTan Seda
da eleqtrokrunCxviT TerapiasTan dakavSirebuli rebiT, triciklurebi yvelaze efeqturia, Tumca,
detaluri informacia. afeqturi aSlilobebis mqone calkeul SemTxvevebSi sasurveli Sedegis miRweva
pacientebisTvis mkurnalobis SerCevis, maTi movlisa sxva jgufis antidepresantebiTacaa SesaZlebeli (ix.
da zrunvis sakiTxebi ganxilulia TavSi, romelic qvemoT).
daavadebis marTvas exeba.
pasuxi mkurnalobaze sxvadasxva klinikur qve-
jgufebSi
antidepresantebi
tricikluri antidepresantebi naklebad efeqturia
antidepresantebs efeqturad iyeneben didi depresiis
Semdegi diagnozis dros:
mwvave fazis samkurnalod. placebosTan SedarebiT,
antidepresantebi yvelaze efeqturia im depresiuli w depresia fsiqozuri simptomebiT (rogorc mono
pacientebisTvis, romlebsac, sul mcire, zomieri Terapia);
depresia aReniSnebaT. kontrolirebadi kvlevebis w SedarebiT msubuqi depresiuli mdgomareoba (ham-
Tanaxmad, xanmokle dadebiTi pasuxi aqtiur mkur iltonis depresiis Sefasebis skaliT 14-ze naklebi
nalobaze myofi pacientebis 60%-s, xolo placebos qula);
jgufSi _ 30%-s aReniSneba (mkurnalobisTvis sa w atipiuri depresia.
Wiro raodenoba [NNT] = 4-5) (ix. Anderson et al.,
2003). efeqturobis TvalsazrisiT, sxvadasxva anti monoaminooqsidazas inhibitorebi
depresantebs Soris arCevanis gakeTeba Znelia, arsebobs azrTa sxvadasxvaoba imasTan dakavSirebiT, Tu
Tumca, garkveul situaciaSi romelimes gamoyeneba, ramdenad efeqturia didi depresiis (gansakuTrebiT,
SesaZlebelia, ufro mizanSewonili iyos (ix. qvemoT). melanqoliuri depresiis) monoaminoqsidazas inhi
disTimiis SemTxvevaSic msgavsi klinikuri monacemebi bitorebiT (mao-s inhibitorebi) mkurnaloba. pla
miiRes. naxes, rom disTimiis drosac sxvadasxva jgufis cebo-kontrolirebadma kvlevebma gviCvena, rom
antidepresantebi _ rogorc tricikluri, aseve mao-s inhibitorebi efeqturi antidepresantebia
serotoninis ukumitacebis seleqciuri inhibitorebi da saSualo da mZime depresiis dros tricikluri
(susi-ebi), efeqturad moqmedebs. Catarebuli meta- antidepresantebis msgavsi Terapiuli efeqti aqvs.
analizis, aqtiur mkurnalobaze myofi pirebis 55%-s, Tumca, gasaTvaliswinebelia, rom mao-s inhibitorebi
xolo placebos miRebisas _ 30%-s dadebiTi pasuxi bevr wamalsa da sakvebTan SeuTavsebelia da, SesaZloa,
aReniSna (NNT = 4) (Lima et al., 1999). mZime garTulebebi gamoiwvios. amitom, isini ar
ar aris dadgenili, Tu ramdenad mizanSewonilia warmoadgenen pirveli arCevis antidepresantebs.
ioli formis depresiuli aSlilobebis dros, ro kontrolirebadi kvlevebis Tanaxmad mao-s inhi
goricaa msubuqi depresia an Sereuli SfoTviT- bitorebs, triciklur antidepresantebTan SedarebiT,
depresiuli mdgomareoba, antidepresantebis gamo garkveuli upiratesoba eniWebaT Semdegi mdgomarebis
yeneba. zogadad miiCneven, rom am tipis darRvevebis dros:
dros tricikluri antidepresantebis gamoyeneba w atipiuri depresia;
SedarebiT araefeqturia. SesaZloa, rom serotoninis
w asTeniuri bipolaruli depresia (Semdegi maxasi
ukumitacebis seleqciuri inhibitorebiT mkurnaloba
aTeblebiT: daRliloba, retardacia, momatebuli
ufro Sedegiani iyos, Tumca, maTi klinikuri mni
mada da Zili);
Svneloba Seswavlili ar aris (Judd et al., 2004).
w tca-sa da susi-ebis mimarT rezistentuli depresia.
tricikluri antidepresantebi mao-s Seqcevadi A-tipis inhibitori _ maklobemidi,
tricikluri antidepresantebi, rogorc stacio garkveuli upiratesobiT gamoirCeva. misi daniSvnisas
narul, ise ambulatoriul pacientebze Catarebuli ar aris saWiro Tiraminis dabali Semcvelobis dietis
_ 264 _
depresiis mkurnaloba mwvave fazaSi
daniSvna. Tumca, sxva wamlebTan urTierTqmedebisas Anderson et al., 2000). amasTan, susi-ebis gadaWarbebuli
SesaZloa garTulebebis ganviTareba (gv. 552). kon doziT (magaliTad, TviTmkvlelobis mizniT) miReba
trolirebadi kvlevebiT dadginda, rom, placebosTan SedarebiT usafrTxoa. gasaTvaliswinebelia isic,
SedarebiT, maklobemidi efeqturia garTulebebis rom zedozirebisas venlafaqsini susi-ebze naklebad
gareSe mimdinare didi depresiis SemTxvevaSi. usafrTxoa (Cheeta et al., 2004).
dReisaTvis ar aris damtkicebuli, rom maklobemidis
sxva antidepresantebi
standartuli dozebiT gamoyeneba iseTive efeqturia,
rogorc tipuri maoi-ebisa iseTi depresiis dros, amJamad xelmisawvdomia antidepresantebis farTo
romelic rezistentulia tca-sa da susi-ebis mimarT speqtri (ix. 21-e Tavi). yvela maTganis efeqturoba,
(ix. Cowen, 2005). placebosTan SedarebiT, kargadaa Seswavlili. medi
kamentebs Soris ZiriTad sxvaobas maTi ramdenime
mao-s inhibitorebisa da tricikluri antidepre- gverdiTi efeqti gvaZlevs (cxrili 11.10). reboqsetinis
santebis kombinacia garda, antiqolinerguli gverdiTi movlenebi an
arsebobs garkveuli monacemebi, rom mao-s inhi tidepresantebs iSviaTad axlavs. trazodoni da
bitorebiTa da tricikluri antidepresantebiT mirtazapini meti sedaciurobiT gamoirCeva. sero
mkurnalobis mimarT rezistentul SemTxvevebSi, am toninisa da noradrenalinis ukumitacebis inhibitors
ori medikamentis kombinacia ufro Sedegis momcemia, _ duloqsetins, susi-ebis msgavsi gverdiTi movlenebi
vidre Sesabamisi dozebiT maTi cal-calke miReba. es aqvs. zedozirebis SemTxvevaSi yvela CamoTvlili
varaudi ar aris dadasturebuli; orjer Catarebuli antidepresanti, triciklurebTan SedarebiT, ufro
klinikuri cdiT amis damtkiceba ver moxerxda (ix. usafrTxoa.
Cowen, 2005). Tumca, SesaZloa, es imitom moxda, rom
klevebi ar Catarda romelime preparatis mimarT liTiumi
rezistentul pacientebze (anu pacientTa im jgufze, liTiumi, rogorc monoTerapia
romelTac kombinirebuli mkurnaloba ufro xSirad
am nawilSi ganvixilavT liTiumis gamoyenebas de
eniSnebaT).
presiuli darRvevebis dros, xolo maniisa da
serotoninis ukumitacebis seleqciuri inhi afeqturi aSlilobebis mkurnalobisas misi xma
bitorebi (susi-ebi) da serotoninisa da norad rebis wesebs mogvianebiT SevexebiT. placebo-
renalinis ukumitacebis inhibitorebi (snusi-ebi) kontrolirebadma kvlevebma aCvena, rom bipolaruli
serotoninis ukumitacebis seleqciuri inhibitorebi depresiis SemTxvevaSi liTiums antidepresiuli
(susi-ebi) safuZvlianad Seiswavles placebosa da sxva moqmedeba axasiaTebs. magram unipolaruli depresiis
antidepresantebTan Sedarebis gziT. dadasturebulia, samkurnalod liTiumis monoTerapiis saxiT gamoyeneba
rom umetes wilad maT triciklurebis msgavsi efeqti nakleb efeqturia (Goodwin, 2003).
aqvT, magram ara stacionaruli pacientebisTvis.
liTiumiT augmentacia
venlafaqsini, romelic serotoninisa da noradr
miuxedavad imisa, rom liTiumi monoTerapiis saxiT
enalinis ukumitacebis inhibitoria, mZime depresiis
iSviaTad gamoiyeneba depresiis samkurnalod, rezis
dros susi-ebze ufro efeqturia (Smith et al., 2002).
tentul SemTxvevebSi misi antidepresantebTan erTad
obsesiur-kompulsuri darRvevebis Tanmxlebi dep
daniSvna karg Sedegs iZleva (liTiumiT augmentacia).
resiis samkurnalod sus-ebi, triciklur anti
metaanalizurma kvlevam aCvena, rom liTiumiT au
depresantebTan (qloropaminis garda) SedarebiT,
gmentaciis SemTxvevaSi dadebiTi pasuxi hqonda
gacilebiT ukeTesia (ix. Anderson et al., 2000).
depresiuli pacientebis 50%-s, xolo placebos
triciklur antidepresantebTan dakavSirebuli jgufSi, mxolod 20%-s (NNT=3-4) (Bauer and Dpfmer,
tolerantoba 1999).
xanmokle klinikuri kvlevebis meSveobiT dadginda, marTalia, ramdenime kvlevam aCvena, rom liTiumis
rom triciklur antidepresantebs, maTi gamoxatuli damatebis Sedegad mdgomareoba swrafad (48 saaTis
gverdiTi movlenebis gamo, Tavs ufro meti pacienti ganmavlobaSi) umjobesdeba, magram, ZiriTadad,
anebebs, vidre es xdeba susi-ebis SemTxvevaSi simptomebis alagmva TandaTanobiT, daaxloebiT 2-3
(gverdiTi movlenebiT ganpirobebuli mkurnalobidan kviris manZilze, xdeba. unipolaruli depresiis dros
àmovardnis~ riskis SedarebiTi maCvenebelia: liTiumis damateba iseTive efeqturia, rogoric
0.73, NNT=33). rutinul klinikur situaciebSi, bipolaruli aSlilobebis SemTxvevaSi. dRemde ar
gansakuTrebiT or kviraze meti mkurnalobis dros, arsebobs sarwmuno klinikuri an bioqimiuri maC
monacemebi susi-ebis sasargeblod izrdeba (ix. veneblebi, romelTa meSveobiTac SeiZleba gani
sazRvros, Tu romeli pacientebisTvis iqneba aseTi
_ 265 _
cxrili 11.10 zogierTi antidepresantis klinikuri maxasiaTeblebi

antiqolinerguli sedaciuri wonis mateba seqsualuri toqsikuroba zedozirebis
disfunqcia SemTxvevaSi
amitriptilini +++ +++ +++ + +++
lofepramini + 0 0 + 0
susi-ebi 0 0 + +++ 0*
venlafaqsini 0 0 + +++ ++
duloqsetini 0 0 + +++ ?
trazodoni 0 +++ + 0 ++
reboqsetini + 0 0 + 0
mirtazapini 0 +++ +++ 0 0
0, aranairi, +, msubuqi ++, saSualo +++, markirebuli

*citaloprami SesaZloa ufro toqsikuri iyos, vidre sxva susi-ebi.
mkurnaloba efeqturi. liTiumiT augmentaciis efeqti, Sedareba mkurnalobis sxva tipebTan

rogorc Cans, ar aris SezRuduli antidepresantebis
ramdenime kvlevis meSveobiT stacionaruli pacientebi,
romelime specifikuri jgufisTvis.
romlebic ekT-iT mkurnalobdnen, Seadares pacientebs,
romlebic antidepresantebs iRebdnen. triciklur an-
antikonvulsantebi
tidepresantebTan Sedarebisas, cxra kvlevidan eqvsSi
iseTi antikonvulsantebi, rogorebicaa karbamazepini, ekT-is aSkara upiratesoba gamovlinda, xolo danar-
valproati da lamotrijini, warmatebiT gamoiyeneba CenebSi msgavsi Sedegebi miiRes. mao-s inhibitorebTan
bipolaruli aSlilobebis marTvis procesSi da xels Sedarebisas, yvela Catarebulma (xuTma) kvlevam aCvena,
uwyobs depresiuli epizodebis prevencias. ar aris rom ekT-s ufro swrafi da gamoxatul efeqti hqonda.
damtkicebuli, ramdenad efeqturia es wamlebi depresiis es monacemebi gviCvenebs, rom stacionirebuli mZime
mwvave fazaSi. Tumca, placebo-kontrolirebadi depresiis mqone pacientebis SemTxvevaSi ek-Terapia
kvlevebis Tanaxmad, bipolaruli depresiis mqone ufro Sedegiania (yovel SemTxvevaSi, xanmokle perio-
pacientebis efeqti saxezea (Calabrese et al., 1999). dis ganmavlobaSi), vidre antidepresantebiT mkurna-
loba (UK ECT Review Group, 2003, boqsi 21.12).
eleqtrokrunCxviTi Terapia (ekT)
ekT-is gamoyenebis Cvenebebi
ekT mkurnaloba aRwerilia 21-e TavSi, romelSic
yuradReba gverdiT movlenebsac eTmoba. am nawilSi klinicistebi, rogorc wesi, Tanxmdebian, rom ekT-iT
ki ganvixilavT depresiis dros eleqtrokrunCxviTi mkurnaloba yvelaze efeqturia mZime depresiis dros,
Terapiis efeqturobasTan dakavSirebul monacemebs. gansakuTrebiT maSin, roca wonis sagrZnobi kleba,
diliT adre gaRviZeba, Sekaveba da bodva aRiniSneba.
simulirebuli ekT kvlevebi kvlevebma, romlis drosac moxda sruli ekT-s Seda-
didi depresiis mqone pacientebze eqvsi ormagi brma reba simulirebul ekT-sTan, gviCvena, rom bodva da
meTodiT Catarebuli kontrolirebadi kvleviT (ufro naklebad) retardacia is simptomebia, romlebic
erTmaneTs Seudarda ekT-sa da simulirebuli ekT-s ganasxvavebs srul da simulirebul ekT-ze dadebiTi
(pacients utardeba anesTezia, magram eleqtrodSi pasuxis mqone pacientebs (UK ECT Review Group, 2003).
dens ar atareben) efeqturoba. xuTi kvlevis Tanaxmad sxva kvlevebiT daadgines, rom fsiqozuri simptome-
sruli ek-Terapia simulaciaze bevrad ufro efeqturi bis SemTxvevaSi ekT-s gamoyeneba ufro efeqturia,
aRmoCnda. kvlevaSi, romelSic sruli proceduris vidre cal-calke tricikluri antidepresantebiTa an
upiratesoba ar gamovlinda, ekT procedurisTvis antifsiqozuri medikamentebiT mkurnaloba. Tumca, am
gamoiyenes dabali dozebiT unilateraluri ekT preparatebis kombinacia SesaZloa iseTive Sedegiani
(rac, zogadad, sxvadasxva mosazrebiT naklebad iyos, rogorc ek_Terapia (uSualod amis Sesaswavlad
efeqturia). saerTo monacemebis mixedviT. sruli pirdapiri kvlevebi ar Catarebula) (ix. Cowen, 2005).
ekT-is efeqturoba _ 70%-Si, xolo simulaciuris _ ekT_s praqtikuli mniSvneloba aris is, rom misi gamoye-
40%-Si gamovlinda (NNT 3-4) (ix. UK ECT Review Group, neba iZleva Sedegs maSin, rodesac (fsiqozuri niSnebis
2003, Tavi 21-e). arsebobisa Tu ararsebobis miuxedavad) sruli kursiT
_ 266 _
depresiis mkurnaloba mwvave fazaSi
Catarebuli mkurnalobiT saTanado Sedegi miRweuli daZlevis, rodesac eqimi da pacienti erTad akeTeben
araa. Tumca, aseT SemTxvevebSi maRalia recidivebis problemebis identificirebas da maT gadasaWrelad
sixSire (Sackheim et al., 1990). (ix. moqmedi NICE-is gai- realistur gegmebs saxaven. randomizebulma kvlevebma
dlaini; ekT-s gamoyenebis Sesaxeb ix. gv. 565). aCvenes, rom zomieri depresiis mqone pacientis
mkurnalobisas problemis daZlevaze mimarTuli
fsiqologiuri mkurnaloba Terapia ufro efeqturia, vidre jandacvis pirvelad
yvela depresiul pacients, ra mkurnalobasac ar unda rgolSi gamoyenebuli Cveuli mkurnaloba. ramdenad
gadiodes, esaWiroeba fsiqoTerapia, misi zogadi ga- efeqturis is medikamentur mkurnalobasTan Seda
gebiT, rac gulisxmobs pacientis fsiqoganaTlebasa rebiT, Seswavlili ar aris (National Institute for Clinical
da gamxnevebas. aseTma damokidebulebam (`klinikuri Excellence, 2004).
menejmenti~), SesaZloa, ganapirobos garkveuli simp-
kognitur-bihevioruli Terapia
tomaturi gaumjobeseba da xeli Seuwyos pacientis
mier mkurnalobis reJimis saTanadod dacvas. fsiqo- depresiis dros, kognitur-bihevioruli Terapiis Zi
ganaTleba da gamxneveba pacientis mewyviles, ojaxis riTadi mizania daexmaros pacientebs Secvalon Ta
wevrebsa da mis zrunvaSi CarTul sxva pirebsac sWir- vianTi azrovneba da qceva cxovrebiseuli movlenebisa
debaT. da depresiuli simptomebis mimarT, Tavisi azrovnebisa
fsiqologiuri mkurnaloba, romelsac depresiis da qcevis SecvlaSi (damatebiTi informacia ix. gv. 588
dros iyeneben, moicavs sxvadasxva saxis Terapias: ??). mravali kvlevaa Catarebuli imis Sesaswavlad. Tu
ramdenad efeqturia kognitur-bihevioruli Terapia
w mxardaWeris fsiqoTerapia;
mwvave depresiuli epizodebis mqone pacientebis
w kognitur-bihevioruli Terapia; mkurnalobisas (National Institute for Clinical Excellence,
w interpersonaluri fsiqoTerapia; 2004d). maT safuZvelze SesaZlebelia Semdegi daskv
w wyvilebis Terapia; nebis gakeTeba:
w dinamiuri fsiqoTerapia. w arsebobs myari mtkicebulebebi imisa, rom depresiis
simptomebis gasaumjobeseblad, kognitur-bihevi
fsiqoTerapiis aRniSnuli tipebi SeiZleba gamo
orul Terapias (sakontrolo jgufTan SedarebiT,
viyenoT rogorc antidepresantebis alternatiuli
romelsac ar utardeboda mkurnaloba) garkveuli
mkurnaloba an rogorc damxmare saSualeba. ram
upiratesoba aqvs;
denadaa efeqturi fsiqoTerapia didi depresiis
dros antidepresantebTan SedarebiT, es naklebadaa w depresiuli mdgomareobebis samkurnalod kogni
Seswavlili. SedarebiT meti da sarwmuno informacia tur-bihevioruli Terapiis upiratesoba, SedarebiT
arsebobs kognitur-biheviorul Terapiaze. zoga placebo_medikamentTan, klinikur menejmentsa da
dad, msubuqi da saSualo simZimis depresiis Sem pirvelad rgolSi Catarebul Cveul mkurnalobasTan,
TxvevaSi, fsiqoTerapia garkveulwilad ufro arasakmarisadaa Seswavlili;
efeqturia, vidre pirvelad jandacvaSi gamoyenebuli w depresiuli mdgomareobebis samkurnalod kogni
Cveuli mkurnaloba. jandacvis pirvelad rgolSi tur-bihevioruli Terapiis upiratesoba, SedarebiT
struqturirebul midgomas, rogoricaa kognitur- sxva fsiqoTerapiebTan (iqneba es struqturirebuli,
bihevioruli Terapia, sxva saxis TerapasTan SedarebiT Tu arastruqturirebuli), ar aris saTanadod
(magaliTad, arapirdapiri konsultireba), aranairi dasabuTebuli.
upiratesoba ar aqvs (Wampold et al., 2002), rac imas antidepresantebTan SedarebiT, kognitur-bihevio
niSnavs, rom imisaTvis, rom mkurnaloba efeqturi rulma Terapiam garkveulwilad ukeTesi Sedegi
iyos, mniSvnelovania sxvadasxva fsiqoTerapiisTvis gviCvena. magaliTad, antidepresiuli efeqtis mxriv,
damaxasiaTebeli saerTo faqtorebi (gv. 583 ??). ran gansxvaveba kognitur-biheviorul Terapiasa da an
domizebulma kvlevebma aCvena, rom zomieri depresiis tidepresantebs Soris ar gamovlinda; amasTan,
dros fsiqoTerapia, xSirad, iseTive Sedegiania, depresiul simptomebze kognituri Terapiis gavlena
rogorc medikamenturi mkurnaloba (National Instutute ufro xangrZlivi da myari aRmoCnda (Evans et al.,
for Clinical Excellence, 2004). 1992). zomieri da mZime depresiis dros kognitur-
mxardaWera da problemebis daZleva bihevioruli Terapiisa da antidepresantebiT mkur
nalobis kombinacia bevrad ufro efeqturia, vidre
mxardaWeriTi fsiqoTerapia scdeba klinikur menej
mxolod medikamenturi mkurnaloba (National Institute for
ments da iTvaliswinebs mimdinare cxovrebiseuli
Clinical Excellence, 2004d). klinicistebis azriT, mZime
sirTuleebis gamovlenasa da maT dasaZlevad
depresiis mqone pacientebisTvis mxolod kognitur-
pacientis Zlieri mxareebisa da arsebuli resursebis
bihevioruli Terapiis Catareba ar aris Sedegiani
gamoyenebas. es midgoma gulisxmobs problemebis
_ 267 _
(Thase and Friedman, 1999), Tumca, es dakvirveba dinamikuri fsiqoTerapia
kvlevebiT ar dasturdeba (National Institute for Clinical
dinamikur fsiqoTerapias gansxvavebuli mizani aqvs,
Excellence, 2004d). aseTi Seusabamoba, SesaZloa, ter
vidre ukve aRwerili Terapiebs, gansxvavebuli
mini `simwvave~, gansxvavebul ganmartebasTan an
mizani aqvs. igi cdilobs gadaWras is Sinagani
randomizebuli kvlevebis pirdapir praqtikaSi
pirovnuli konfliqtebi da maT mier gamowveuli
gadmotanis problemebTan iyos dakavSirebuli.
cxovrebiseuli sirTuleebi, romlebic depresiis
mniSvnelovania praqtikosi eqimis gamocdilebac (De
ganviTarebasa da gaxangrZlivebas ganapirobeben.
Rubies et al., 2005). msubuqi depresiuli mdgomareobebis
misi samkurnalo Rirebulebis Sesaxeb arsebuli
dros, SesaZloa, dadebiTi Sedegi mogvces
mosazrebebi gansxvavebulia. sul ramdenime kvlevaa
kompiuteruli kognitur-bihevioruli Terapiis an
Catarebuli, romelTa meSveobiTac cdilobdnen di
TviTdaxmarebis saxelmZRvanelos gamoyenebam (National
namikuri fsiqoTerapiis Sefasebas, Tumca, upiratesad
Institute for Clinical Excellence, 2004d).
Seiswavles xanmokle da jgufuri Terapiis SemTxvevebi.
interpersonaluri fsiqoTerapia depresiis dros am Terapiis efeqturoba, kognitur-
biheviorul Terapiasa da antidepresantebiT mkur
interpersonaluri fsiqoTerapia aris personolo
nalobasTan SedarebiT, nakleb Sedegiani aRmoCnda
giuri urTierTobebisa da cxovrebiseuli proble
(National Institute for Clinical Excellemce, 2004d).
mebisadmi sistemuri da standartizebuli Terapiuli
midgoma (gv. 587??). misi moqmedeba depresiis dros
sxva mkurnaloba
naklebadaa Seswavlili, vidre kognitur-bihevioruli
Terapia, magram, zogadad, miiCneven, rom efeqturia Zilis deprivacia
(Weisman et al., 1979; Elkin et al., 1989). klinikuri ramdenime kvlevam aCvena, rom zogierTi depresiuli
daxelovnebis erovnuli institutis (National Institute aSlilobis dros guneb-ganwyobaSi xanmokle cvli
for Clinical Excellence, 2004d) monacemebis mixedviT, lebebis gaumjobeseba Zilis deprivaciiT miiRweva.
ineterpersonaluri Terapia: depresiuli simptomebis gaumjobeseba sruli uZilobis
w ufro efeqturia, vidre placebo-mkurnaloba, SemTxvevaSi, TiTqmis yovelTvis droebiTia; es efeqti
klinikuri menejmenti da zogadi praqtikis eqimis qreba momdevno Ramis Zilis Semdeg, an, SesaZloa,
Cveuli mkurnaloba; uZilo Ramis Semdeg dRisiT CaTvlemis SemTxvevaSic
w iseTive efeqturia, rogorc antidepresantebiT ki. Zilis deprivaciis antidepresiuli efeqti did
mkurnaloba; Teoriul interess iwvevs, Tumca, xanmokle efeqti
mas praqtikul mniSvnelobas ukargavs. miuxedavad
w ufro efeqturia antidepresantebTan kombinaciaSi,
amisa, arsebobs garkveuli monacemebi, rom Zilis
vidre mxolod medikamentebis miReba. Tumca, ucnobia
deprivaciam SeiZleba daaCqaros antidepresantebis
mwvave mdgomareobis dros ra ufro efeqturia _
moqmedeba an, rom zogierTi farmakologiuri CareviT,
interpersonaluri Terapiisa da antidepresantebis
SesaZloa, Zilis deprivaciis efeqtis gaxangrZliveba
kombinacia, Tu marto antidepresantebi.
(ix. Berger et al., 2003).
wyvilebis Terapia
sinaTliT mkurnaloba
wyvilebis Terapias iyeneben iseT depresiul paci
rekurentuli zamTris depresiis mqone pacientebis
entebTan, romlebTanac partniorTan urTierToba
50%-s sinaTliT (daaxloebiT, 10 000 luqsi) mkur
iwvevs an amwvavebs depresias. intervenciis mizania
nalobaze dadebiTi Sedegi aqvs. mkurnaloba, rogorc
am urTierTobebis bunebis gansazRvra-dadgena da
wesi, diliT, erTi an ori saaTis ganmavlobaSi
misi imdagvari modificireba, rom orivesTvis mi
tardeba; Tumca, es ar aris yovelTvis savaldebulo
saRebi iyos. am Terapiis Sesafaseblad mxolod
da proceduris an SuadRiT Catareba, SeiZleba,
ramdenime randomizebuli kvlevaa Catarebuli da
iseTive efeqturi iyos. proceduris xangrZlivoba,
naCvenebia misi upiratesoba im sakontrolo jgufTan
Cveulebriv, 1-2 saaTia (gv. 572).
SedarebiT, romelsac mkurnaloba ar utardeba.
zamTris depresiis mqone pacientebze sinaTliT
Tumca, sakmarisi monacemebi wyvilebis Terapiis
mkurnalobis placebo-kontrolirebadi kvlevis Cata
SedarebiTi efeqturobis Sesaxeb, sxva fsiqoTerapiebs
reba problemuria, radgan pacientebis umravlesobas,
an medikamentur mkurnalobasTan, ar arsebobs
mkurnalobis dawyebamde mtkiced swams, rom sinaTliT
(National Institute for Clinical Excellence, 2004d). praqtikaSi
Terapia mkurnalobis Zalian mniSvnelovani meTodia.
antidepresantebiT mkurnaloba da wyvilebis Terapia
am SezRudvis gaTvaliswinebiT, kvlevebis umetesobam
erTad gamoiyeneba, magram aRniSnuli kombinacia
daadastura kaSkaSa Suqis upiratesoba mkrTal SuqTan
saTanadod Sefasebuli ar aris.
SedarebiT. Cveulebriv, antidepresiuli efeqti
_ 268 _
maniis mkurnaloba mwvave fazaSi
miiReba sinaTliT mkurnalobis dawyebidan 2-5 dReSi, haloperidoli. placebo-kontrolirebadi kvlevebi
magram zogierT pacients mkurnalobis Catareba ufro adasturebs, aseve, rom maniis dros efeqturia
xangrZlivi xangrZlivi droiT sWirdeba. sinaTliT kvetiapini, aripirazoli da risperidoni (Schatzberg,
Terapia gansakuTrebiT Sedegiania àtipiuri~ niSnebiT 2004). mniSvnelovania aRiniSnos, rom darRvevis ufro
mimdinare depresiis dros, rodesac aRiniSneba mwvave formis mqone pacientebi, SesaZloa saerTod ar
sakvebis gadaWarbebulad miReba da didxans Zili. raTa iyvnen CarTulni placebo-kontrolirebad kvlevebSi,
Tavidan aviciloT gamwvavebebi, sinaTliT Terapia rac zRudavs kvleviT miRebuli monacemebis gan
unda gagrZeldes bunebrivi remisiis periodamde, anu zogadebis saSualebas.
adre gazafxulamde (informacia sinaTliT Terapiasa
guneb-ganwyobis stabilizatorebi
da zamTris depresiaze ix. Eagles, 2004; Golden et al.,
(normoTimikebi)
2005; gv. 572).
liTiumi
maniis mkurnaloba mwvave fazaSi is, rom liTiumi efeqturia maniis mwvave fazis
maniis mkurnaloba mniSvnelovani klinikuri gamowvevaa samkurnalod, xuTi placebo-kontrolirebadi kvlev
da xSirad fsiqiatriuli gundis marTvis unar-Cvevebis iTaa dadasturebuli. erTma kvlevam, romelSic
seriozul gamocdas warmoadgens. maniis marTvaSi Seadares liTiumi rogorc placebos, ise sxva
ZiriTadi da mTavari medikamentebiT mkurnalobaa. normoTimikebs (Bowden et al., 1994), aCvena, rom dadebiTi
maniis mkurnaloba miznad isaxavs: momatebuli pasuxi liTiumis SemTxvevaSi 49%, valproatze _ 48%,
fizikuri da fsiqikuri aqtivobis Semcirebas, fsiqozis xolo placeboze _ 25% iyo. metaanalizma gviCvena,
niSnebis Semsubuqebas, gadaRlis, Zilis naklebobisa rom liTiumi maniis dros, saSualod, 2-jer ufro
da, mcire raodenobis siTxis miRebis gamo, somaturi efeqturia, vidre placebo (NNT = 5) (Poolsup et al.,
gauaresebis prevencias. mniSvnelovania aRiniSnos, 2000). gamoxatuli depresiuli epizodebis, fsiqozuri
rom Tanamedrove medikamenturi mkurnalobis da simptomebisa da swrafad cirkulirebadi afeqturi
nergvamde, maniiT gardacvalebis maCvenebeli sta aSlilobebis SemTxvevaSi, liTiumiT monoTerapia
cionarSi 20%-s aRemateboda; pacientTa TiTqmis nakleb Sedegiania (Goodwin, 2003).
naxevari gamofitvisgan kvdeboda (Derby, 1933).
karbamazepini
Tu ramdenad efeqturia maniis mkurnalobisas
medikamentebi
mwvave fazaSi karbamazepini, kvlevis dizainTan
antifsiqozuri saSualebebi dakavSirebuli problemebis gamo (kvlevebis mcire
tipiuri antifsiqozuri saSualebebi raodenoba, damatebiTi medikamentebis gamoyenebis
SemTxvevebi da diagnostikurad araerTgvarovani
ramdenime randomizebulma kontrolirebadma kvle
jgufebis monawileoba), saTanadod araa Sefasebuli.
vam aCvena, rom maniis mkurnalobisas efeqturia
Tumca, axali, 200 pacientze Catarebuli placebo-
qlorpromazini da haloperidoli, miuxedavad imisa,
kontrolirebadi kvlevis Tanaxmad, karbamazepinze
aqvT Tu ara pacientebs gamokveTili fsiqozuri niSnebi
(42%) dadebiTi pasuxi gacilebiT maRali aRmoCnda,
(Chou et al., 2000). Tumca, tipiuri antifsiqozuri
vidre placeboze (21%). zogadad, maniis mwvave fazaSi
medikamentebi zomierad unda gamoviyenoT; maniakalur
mkurnalobis dros karbamazepins, efeqturobis
pacientebs es medikamentebi xSirad maRali doziT
TvalsazrisiT antifsiqozuri medikamentebis ekvi
eniSnebaT, rac eqstrapiramiduli gverdiTi mov
valenturi moqmedeba aqvs; Tumca, SesaZloa, li
lenebis riskis zrdas uwyobs xels. garda amisa,
TiumTan da valpoatTan SedarebiT, nakleb efeqturi
standartuli antifsiqozuri medikamentebiT ver
iyos (Grunze et al., 2003). rogorc liTiumis, aseve
xerxdeba depresiuli epizodis prevencia, romelic
karbamazepinis daniSvnisas, gverdiTi movlenebis
mosalodnelia. rom maniakaluri epizodis amowurvis
Tavidan acilebis mizniT, aucilebelia dozebis
Semdeg ganviTardes.
mzardi titracia. garda amisa, karbamazepini axdens
atipiuri antifsiqozuri saSualebebi RviZlis metaboluri enzimebis stimulacias, ra
maniis samkurnalod atipiuri antifsiqozuri medi mac SesaZlebelia, gamoiwvios karbamazepinTan
kamentebi sul ufro xSirad gamoiyeneba maTi ukeTesi erTad daniSnuli sxva medikamentebis plazmuri
amtanobis gamo. sistemuri mimoxilviT (Rendell et al., koncentraciis daqveiTeba.
2003) dadginda, rom maniis mkurnalobisas mwvave
valproati
fazaSi olanzapini ufro efeqturia, vidre placebo
mTeli rigi randomizebuli kontrolirebadi kvle
da valproati, magram ara imdenad, ramdenadac
vebiT dadgenilia, rom maniis mkurnalobisas val
_ 269 _
proats liTiumis ekvivalenturi, xolo placebosTan Ti antifsiqozuri preparatiT mkurnalobis mi
SedarebiT gacilebiT Zlieri efeqti aqvs. gamokveTili marT. dadebiTi pasuxi ekT mkurnalobaze (22-dan
disforiuli simptomebisa da swrafad cirkulirebadi 13) mniSvnelovnad aRemateboda kombinirebuli
afeqturi aSlilobebis mqone pacientebis qvejgufSi mkurnalobis efeqturobas (arcerTi 5-dan). uni
valproati SesaZloa liTiumze efeqturi iyos. lateraluri da bilateraluri ekT-s Sedegebs Soris
arsebuli monacemebis mixedviT, maniis mwvave sxvaoba ar dafiqsirebula (Mukherjee et al., 1988)
fazis mkurnalobisas valproati TiTqos naklebad retrospeqtulma kvlevam gviCvena, rom maniis
efeqturia, vidre olanzapini, magram, meores mxriv, mwvave fazis mkurnalobisas ekT-s efeqturobis
igi naklebad sedaciuria da ar iwvevs wonaSi matebas saerTo maCvenebeli daaxloebiT 80%-ia. am kvle
(ix. Macritchie et al., 2003). vaSi monawile bevri pacienti medikamenturi
valproatis upiratesoba aris is, rom igi ufro mkurnalobis mimarT rezistentuli iyo (Mukherjee
swrafad iwyebs moqmedebas, vidre guneb-ganwyobis sxva et al., 2004). klinikur praqtikaSi medikamentebisadmi
stabilizatorebi. magaliTad, valproatis (20mg/kg/ rezistentuli an sicocxlisaTvis saSiSi (ukiduresi
dReSi) miRebis dros misi moqmedebis Sedegi, SesaZloa, hiperaqtivobis an fizikuri gamofitvis dros)
1-4 dReSi gamovlindes. amas albaT ganapirobebs is, rom maniakaluri mdgomareobebis samkurnalod ekT-s
valproatis amtanoba dozis swrafi matebis saSualebas gamoyenebis mzardi tendencia SeiniSneba. depresiis
iZleva; liTiumisa da karbamazepiniT mkurnalobis mkurnalobasTan SedarebiT, maniis SemTxvevaSi ekT
SemTxvevaSi ki dozis mateba TandaTanobiT xdeba mokle intervalebiT tardeba. Tumca, ramdenad
(Goodwin, 2003). Catarebuli kvlevebis mixedviT, maniis aumjobesebs an aCqarebs mkurnalobis Sedegs aseTi
mkurnalobis dros valproatis efeqturoba vlindeba reJimi, cnobili araa. maniakaluri mdgomareobebis
plazmaSi misi 50 mkg/ml-isa da meti koncentraciis samkurnalod bilateraluri da unilateraluri
SemTxvevaSi (ix. Hirschfeld et al., 1999). ekT-s upiratesi efeqturobac, dReisaTvis ar aris
saTanadod Seswavlili (damatebiTi informacia ix.
benzodiazepini
Mukherjee et al, 2004).
benzodiazepinebi maniis mkurnalobisTvis saWiro
damatebiTi medikamentebia. maT swrafad SeuZliaT
afeqturi aSlilobebis xangrZlivi
momatebuli aqtivobisa da uZilobis daregulireba.
maniis dros benzodiazepinebis monoTerapiis saxiT
mkurnaloba
gamoyeneba ar aris mizanSewonili, vinaidan izrdeba xangrZlivi kvlevebis meSveobiT dadginda, rom xSiri
ganmuxruWebis riski. benzodiazepinebi yvelaze efeq gamwvavebebisa da aranamkurnalebi SemTxvevebis
turia guneb-ganwyobis stabilizatorebTan kom dros daavadebis prognozi mniSvnelovnad uaresia;
binaciaSi xmarebisas, radgan mxolod normoTimikebiT amitom sul ufro meti yuradReba eTmoba daavadebis
mkurnalobis dros Sesabamisi efeqti mogvianebiT grZelvadian marTvas.
miiRweva. benzodiazepinebi, aseve, efeqturia anti
fsiqozur medikamentebTan erTad. maTi miReba recidivebisa da rekurentulobis prevencia
amcirebs antifsiqozuri preparatis dozas, romelic sityvaSi _ recidivi igulisxmeba mocemuli epizodis
saWiroa agznebuli da momatebuli aqtivobis mqone inicialuri mkurnalobiT miRweuli dadebiTi efeqtis
pacientis dasamSvideblad. Cveulebriv, iniSneba iseTi Semdeg simptomebis gauareseba. xolo rekurentuloba
maRalpotenciuri benzodiazepinebi, rogorebicaa niSnavs erTi epizodis sruli amowurvis Semdeg
lorazepami da klonazepami. isini unda dainiSnos axali epizodis ganviTarebas. recidivis prevenciul
àucileblobis~ SemTxvevaSi da xanmokle droiT, rom mkurnalobas _ xangrZlivi, xolo rekurentulobis
ar ganviTardes tolerantoba da damokidebuleba prevenciul mkurnalobas _ profilaqtikuri/Se
(Grunze et al., 2004). manarCunebeli mkurnaloba ewodeba. Tumca, praq
tikaSi yovelTvis ar aris advili maTi gamijvna,
eleqtrokrunCxviTi Terapia radgan Tavdapirvelad mkurnaloba SeiZleba dainiS
ekT-s farTod iyeneben maniiis samkurnalod, Tumca, nos gamwvavebis profilaqtikisTvis, Semdeg _ reku
amasTan dakavSirebiT mxolod ori kontrolirebadi rentulobis prevenciisTvis.
kvlevaa Catarebuli. erTi kvleviT dadginda,
unipolaruli depresiis medikamenturi
rom ormxrivi ekT liTiumze efeqturia (Small et mkurnaloba
al., 1988). meore kvlevaSi bilateraluri da uni
lateraluri ekT_s efeqturoba Seadares liTiumisa xangrZlivi mkurnaloba
da haloperidolis kombinacias iseTi pacientebis dadgenilia, rom dadebiTi efeqtis miRwevis
SemTxvevaSi, romlebic rezistentulebi arian er SemTxvevaSic ki antidepresantebis moxsna recidivis
_ 270 _
afeqturi aSlilobebis xangrZlivi mkurnaloba
maRal risks ganapirobebs. pacientTa daaxloebiT Tidan or wlamde gaxangrZlivebam recidivis maCvene-
erT mesameds medikamentebis moxsnis Semdeg erTi beli 18%-mde, xolo placebos SemTxvevaSi ki mxolod
wlis ganmavlobaSi uviTardebaT recidivi, romelTa 41%-mde Seamcira. xangrZlivi mkurnalobis dros
umetesoba pirveli 6 Tvis manZilze iCens Tavs. pla miRebuli praqtikaa medikamentebis, gansakuTrebiT
cebo-kontrolirebadi kvlevebis safuZvelze xan tricikluri antidepresantebis, `SemanarCunebel~
grZlivi Terapiis rolis Sesaxeb Semdegi daskvnebis dozamde Semcireba. aman, SesaZloa, arasaTanado moni-
gakeTeba SeiZleba (ix. Anderson et al., 2000): toringis SemTxvevaSi, Seasustos prevenciuli efeq-
w remisiis miRwevis Semdeg, antidepresantiT murna ti. profilaqtikuri mkurnalobis zogadi principia:
lobis gagrZeleba 6 Tvis manZilze anaxevrebs re `rac mdgomareobas aumjobesebs, is mdgomareobas kar-
cidivis maCvenebels; gad inarCunebs~ (Anderson et al., 2000).
liTiumi xSirad gamoiyeneba rekurentuli unipo-
w Tuki es SesaZlebelia, mkurnaloba unda gagrZeldes
laruli depresiis prevenciisaTvisac, Tumca, arsebu-
Tavdapirveli efeqturi doziT;
li monacemebiT, misi efeqturoba bevrad ufro Tval-
w rekurentulobis dabali riskis mqone pacientebi- saCinoa bipolaruli aSlilobebis dros (ix. Burges et
saTvis naklebad efeqturia antidepresantebiT al., 2001). gamomdinare iqidan, rom liTiumiT SesaZle-
mkurnalobis 6 Tveze meti droiT gagrZeleba. gam- belia maniakaluri epizodis prevencia, misi daniSvna
onakliss warmoadgenen asakovani pacientebi, rom- mizanSewonilia depresiis mqone iseTi pacientebisT-
lebisTvisac rekomendebulia mkurnalobis 12 TviT vis, romlebsac aweuli guneb-ganwyobis nebismieri
gaxangrZliveba. simptomi aReniSnebaT (ix. qvemoT).
profilaqtikuri/SemanarCunebeli mkurnaloba bipolaruli depresiis medikamenturi
rekurentuli depresiis mqone pacientebis (Cveu- mkurnaloba
lebriv, igulisxmeba, sul mcire, sami epizodi gasu-
li 5 wlis ganmavlobaSi) kontrolirebadma gamokvl-
xangrZlivi mkurnaloba
evam gviCvena, rom profilaqtikuri antidepresiuli naklebadaa Seswavlili, Tu ra roli eniWeba maniakal-
mkurnaloba mniSvnelovnad amcirebs recidivebis gan- uri epizodis Semdgom xangrZliv mkurnalobas bipo-
viTarebis risks. magaliTad, 128 pacientze Catarebu- laruli aSlilobebis dros. Tumca, arsebobs zogadi
li samwliani kvleviT (Frank et al., 1990) daadgines 22%- klinikuri gamocdileba, rom medikamentebis dozis
iani recidivis maCvenebeli im pacientebSi, romlebic swrafma klebam SesaZloa, ganapirobos efeqturad
imipramins iRebdnen da 78% _ placebos SemTxvevaSi. namkurnalebi maniakaluri mdgomareobis uecari gamw-
sistemurma mimoxilvam (Geddes et al., 2003) daadastura vaveba. cnobilia, rom maniakaluri epizodis saSualo
grZelvadiani SemanarCunebeli mkurnalobis mniSvn- xangrZlivoba 6 Tvea, amdenad, mizanSewonilia, sul mc-
eloba. am kvlevis mixedviT, aqtiuri mkurnalobis er- ire, am periodis ganmavlobaSi mkurnalobis gagrZele-
SemTxvevebi/pacientebi antidepresantuli SemTxvevebi

Sansebis Tanafardoba
cdebis Seswavlili koreqtirebuli dispersia gansxvaveba (95% CI) sarwmunoebis intervali Semcireba
raodenoba antidepresanti placeboTi O-E O-E-Si koreqtirebuli placeboTi (SE)
noradrenalinis
ukumitacebis seleqciuri 2 169/912 313/889 57.5 (60.7)
inhibitori nusi
(19%) (35%)
monoaminoqsidazas
inhibitori _ maoi 4 13/61 57/66 15.7 (6.0)
(21%) (86%)
triciklurebi 15 113/449 248/432 70.7 (50.5)
serotoninis
(25%) (57%)
ukumitacebis seleqciuri 10 156/1034 385/1046 94.9 (80.7)
inhibitorebi _susi
(15%) (37%)
sxva 1 14/71 28/72 6.9 (7.5)
(20%) (39%)
sul 32 465/ 1031/ 245.7 (205.4) 70% (4)

2527 2505 2p<0.00001
(18%) (41%)
99% an 95% konfidencialobis intervali
0 0.5 1.0 1.5 2.0
heterogenoba xuTi kategoriis mixedviT : x2=18.6; p=0.001 antidepresanti ukeTesia antidepresanti uaresia
4
mkurnalobis efeqti 2p<0.00001
suraTi 11.4 depresiuli epizodebis recidivebis sixSiris metaanalizi randomizebulad SerCeuli pacientebis SemTxvevaSi,
romlebsac antidepresantebiT grZelvadiani mkuraloba (daaxloebiT erTi weli) utardebodaT (Geddes et al., 2003).
_ 271 _
ba. mwvave mdgomareobaSi myofma pacientebma SeiZleba SemTxvevebi gvaqvs. karbamazepini SeiZleba dainiSnos
miiRon rogorc guneb-ganwyobis stabilizatorebi, monoTerapiis saxiT an liTiumTan kombinaciaSi.
aseve antifsiqozuri preparatebi. antifsiqozuri me- valproati _ valproati sul ufro xSirad
dikamentebis gamoxatuli gverdiTi movlenebis gamo gamoiyeneba mwvave maniis samkurnalod da, Sesabamisad,
sasurvelia jer maTi dozebis TandaTanobiT Semci- aucilebelia misi xangrZlivi profilaqtikuri
reba da mere moxsna. efeqtis dadgena. 372 pacientze Catarebuli ran
domizebuli kvlevis meSveobiT Seadares erTi wlis
profilaqtikuri/SemanarCunebeli mkurnaloba ganmavlobaSi valproatiT, liTiumiTa da place
liTiumi _ safuZvlianadaa damtkicebuli, rom boTi Catarebuli SemanarCunebeli mkurnalobis
rekurentuli bipolaruli aSlilobis mqone pacien- profilaqtikuri efeqti (Bowden et al., 2000). am pe
tebTan efeqturia profilaqtikuri mizniT liTiumis riodis farglebSi axali epizodebis ganviTarebis
gamoyeneba. sistemurma momoxilvam (Geddes et al., 2004) sixSiriT es jgufebi erTmaneTisgan mniSvnelovnad ar
aCvena, rom yvela tipis afeqturi aSlilobis dros gansxvavdebodnen. Tumca, im pacientebis raodenoba,
recidivis prevenciisTvis liTiumi gacilebiT ukeTe- romlebic axali afeqturi epizodis ganviTarebis
sia, vidre placebo (saSualo fardobiTi riski 0.65, gamo kvlevidan àmovardnen~, gacilebiT meti iyo
95% CI = 0.5-0.84). maniakaluri epizodebis profilaq- placebos jgufSi. pacientebs, romlebic iRebdnen
tikisTvis liTiumi aSkarad efeqturia, magram, ramde- valproats (placebosTan SedarebiT), ufro xSirad
nad mniSvnelovania misi roli depresiuli epizodebis aReniSnebodaT tremori, alopecia da wonis mateba.
prevenciisTvis, naklebadaa dadasturebuli (saSualo dReisTvis valproatiT xangrZlivi mkurnalobis
fardobiTi riski 0.72, 95% CI = 0.5-0.84). profilaqtikuri efeqtis damadasturebeli masala
zogadad, liTiumiT mkurnalobisas bipolaruli pa- mwiria da liTiumze arsebul monacemebTan SedarebiT
cientebis daaxloebiT 50%-s dadebiTi Sedegi aReniS- bevrad naklebi.
neba. profilaqtikis mizniT, liTiumiT mkurnalobis rezistentuli bipolaruli aSlilobebis uamravi
SedarebiT cud Sedegs moaswavebs Semdegi faqtorebi: klinikuri SemTxvevis magaliTze naCvenebia, rom
w swrafad cirkulirebadi darRvevebi da qronikuli valproats dadebiTi profilaqtikuri efeqti aqvsi
depresia; iseTi mdgomareobebis dros, rodesac karbamazepiniTa
w Sereuli afeqturi mdgomareoba; da liTiumiT mkurnaloba ar aris Sedegiani. am
kvlevebSi valproats xSirad liTiumTan an guneb-
w guneb-ganwyobis arakongruentuli fsiqozuri
ganwyobis sxva stabilizatorebTan kombinaciaSi
niSnebi.
iyenebdnen (Goodwin, 2003).
aseve, dadasturebulia, rom rekurentuli afeqturi lamotrijini _ ori prospeqtuli placebo-kon
aSlilobebis dros liTiumis gamoyeneba iwvevs trolirebadi kvleviT naCvenebia bipolaruli aSli
TviTmkvlelobis gamo sikvdilianobis maCveneblis lobebis mqone pacientebis SemTxvevaSi lamotrijinis
mniSvnelovan klebas (Caprian et al., 2005). am efeqts profilaqtikuri efeqti. lamotrijini umniSvnelo
yvelaze xSirad liTiumisadmi miZRvnili kvlevebi gavlenas axdens maniis prevenciaze, Tumca, depresiis
aCvenebs, amitom aseTi damokidebulebis meqanizmi da profilaqtikis TvalsazrisiT mas gamoxatuli efeqti
specifika damatebiT Seswavlas moiTxovs. nebismier aqvs. am TvisebiT igi gansxvavdeba liTiumisa da
SemTxvevaSi, klinikuri TvalsazrisiT Zalian mniSv valproatisgan, romlebic ufro efeqturia maniis
nelovania is, rom liTiumi amcirebs suiciduri prevenciisTvis (Goodwin, 2003). amasTan, britaneTSi
qcevis risks. aseTi efeqti ar aris aucilebeli guneb- afeqturi aSlilobebis samkurnalod lamotrijini ar
ganwyobis sxva stabilizatorebsac axasiaTebdes aris licenzirebuli.
(Muller_Oerlinghausen et al., 2003). antifsiqozuri medikamentebi _ bipolaruli aSli
karbamazepini _ randomizebuli kontrolirebadi lobebis dros stabiluri mdgomareobis Sesanar
kvlevebi, romlebic Catarebulia imis Sesaswavlad, Cuneblad zogjer tipiuri antifsiqozuri medi
Tu ramdenad efeqturia karbamazepini bipolaruli kamentebi gamoiyeneba. maT, ZiriTadad, guneb-ganwyobis
aSlilobebis profilaqtikis TvalsazrisiT, paci stabilizatorebTan erTad niSnaven. zogadad, Tuki
entTa SedarebiT mcire ricxvs moicavs. zogadad, es SesaZlebelia, mizanSewonilia am preparatebis
bipolaruli aSlilobebis profilaqtikisTvis karba Semcireba an moxsna, vinaidan ar xdeba depresiis
mazepinis gamoyeneba karg Sedegs gvaZlevs, Tumca, profilaqtika da maRalia tardiuli (mogvianebiTi)
`klasikuri~ bipolaruli aSlilobebis dros liTiumze diskineziis ganviTarebis riski.
nakleb efeqturia (Goodwin, 2003). gamomdinare aqedan, bipolaruli aSlilobebis xangrZlivi Semanar
karbamazepinis daniSvnaze unda vifiqroT maSin, Tu Cunebeli mkurnalobis dros atipiuri antifsiqozuri
liTiumze cudi pasuxi an swrafad cirkulirebadi medikamentebi calke an guneb-ganwyobis stabili
_ 272 _
depresiuli aSlilobebis Sefaseba
zatorebTan kombinaciaSi iniSneba. aseTi SemTxvevebis
dros sakmaod kargadaa dasabuTebuli olanzapinis
cxrili 11.11 nortriptilinis da interperso-
naluri Terapiis (ipT) gavlena bolo sami wlis
efeqturoba, rac, mTlianobaSi, liTiumis efeq
ganmavlobaSi ganviTarebuli recidivebis six-
turobas utoldeba (McCormack and Wiseman, 2004).
Sireze, 60-is da meti asakis mqone pacientebSi
atipiuri antifsiqozuri preparatebi naklebad iwvevs
eqstrapiramidul aSlilobebs, magram maT metaboluri mkurnaloba raodenoba recidivis
koeficienti (95% CI)
gverdiTi movlenebi axasiaTebT, rogoricaa wonaSi
mateba da diabeti. bipolaruli aSlilobebis dros nortriptilini + ipT 22 20% (4-36)
atipiuri antifsiqozuri preparatebis xangrZlivi nortriptilini 24 43% (25-61)
gamoyeneba sifrTxilesa da mkacr meTvalyureobas
ipT da placebo 21 64% (45-83)
moiTxovs.
placebo 29 90% (79-100)
fsiqoTerapia
ar aris saTanadod gaTvaliswinebuli mkurnalobis
kognituri Terapia araspecifikuri efeqti) (Jones, 2004). raTa moxdes
unipolaruli depresia specifikuri Terapiuli meqanizmebis saTanadod Ses
wavla da Sefaseba, aucilebelia, ukeTesi kontro
rogorc zemoT aRvniSneT, cnobilia, rom depresiis
lirebadi kvlevis Catareba.
mwvave fazaSi kognituri Terapiis Catareba
xangrZlivi drois manZilze aumjobesebs depresiul interpersonaluri Terapia
simptomatikas da amcirebs recidivis risks (Hollon rekurentuli depresiuli epizodebis mqone paci
et al., 2005). kognituri Terapiis profilaqtikuri entebisTvis interpersonaluri Terapiis TveSi
da SemanarCunebeli mkurnalobis mizniT gamoyeneba erTxel Catareba ayovnebs depresiuli epizodis
sul ufro met interess iwvevs. gansakuTrebiT iseTi ganviTarebas, magram ar axdens mis prevencias,
pacientebisTvis, visac depresiis rezidualuri rogorc es standartuli klinikuri menejmentis dros
simptomebi da, Sesabamisad, recidivis ganviTarebis xdeba. imave kvlevis mixedviT, interpersonaluri
maRali riski aqvT. Seiswavles 158 pacienti, rom Terapia naklebad efeqturia, vidre imipraminiT
lebsac didi depresiis epizodis mkurnalobis profilaqtikuri mkurnaloba; arc fsiqoTerapiiTa da
Semdgomi rezidualuri simptomebi aReniSnebodaT imipraminiT erTobliv mkurnalobas hqonda ukeTesi
(Paykel et al., 1999). yvela pacienti fsiqoganaTlebasa Sedegi, vidre mxolod imipraminis gamoyenebas
da gamxnevebasTan (`klinikur menejmentTan~) erTad, (Frank et al., 1990). Tumca, bolodroindelma kvlevam
xangrZlivi drois manZilze iRebda antidepresantebs. cxadyo, rom ukanaskneli sami wlis manZilze
maT naxevars damatebiT Cautarda kognituri Terapiis depresiuli recidivis prevenciis mizniT, ufrosi
16 sesia. Semdgomi 16 Tvis manZilze im pacientebis asakis depresiuli pacientebis nortriptiliniT da
jgufSi, romlebmac kognituri Terapiis kursi ga interpersonaluri TerapiiT kombinirebuli mkur
iares, recidivebis sixSire 29% iyo, xolo im jgufSi, naloba ufro efeqturia, vidre nortriptiliniT da
romelsac mxolod klinikuri menejmenti Cautarda _ klinikuri menejmentiT (Reynolds st al, 1999) (boqsi 11.7).
47%.
bipolaruli aSlilobebi depresiuli aSlilobebis Sefaseba

ramdenad efeqturia fsiqoTerapia bipolaruli Sefasebis safexurebia:
pacientebis SemTxvevaSi, naklebadaa Seswavlili; w depresiuli aSlilobis diagnozis dadgena;
Tumca, kognituri Terapia SesaZlebelia ufro w aSlilobis simwvavis gansazRvra, suicidis riskis
Sedegiani iyos, radgan igi exmareba pacientebs CaTvliT;
TavianTi daavadebis xasiaTisa da mkurnalobis
w gamomwvevi mizezebis Sesaxeb azris Camoyalibeba;
aucileblobis gaazrebaSi. randomizebuli kvlevis
Sedegad dadgenilia, rom pacientisTvis recidivis w pacientis socialuri resursebis Sefaseba;
adreuli niSnebis Sesaxeb informaciis miwodeba w sxva adamianebze am aSlilobis gavlenis Sefaseba.
maniakaluri epizodebis ganviTarebis risks 18 Tvis diagnozi damokidebulia pacientis istoriis de
ganmavlobaSi 30%-iT amcirebs (Perry et al., 1999). aseve, talur aRwerasa da misi fizikuri da fsiqikuri
Sedegiani aRmoCnda ufro specifikuri, kognitur- mdgomareobis Sefasebaze. aRniSnuli sakiTxi mocemuli
bihevioruli Terapiis gamoyeneba, romelic dadebiTad Tavis dasawyisSia ganxiluli. gansakuTrebuli yu
moqmedebs afeqtur simptomebze da aumjobesebs radRebaa saWiro, raTa ar gamogveparos im pacientebis
socialur funqcionirebas (Tumca, aseT kvlevebSi depresiuli aSliloba, romlebic Tavad ar uCivian
_ 273 _
depresiul mdgomareobaSi yofnas (`SeniRbuli dep
boqsi 11.7 risi codna surT pacientebs da
resia~). Zalian mniSvnelovania, rom depresiuli
maTi ojaxis wevrebs
aSlilobis diagnozi ar dadgindes mxolod Tval
Sisacemi depresiuli simptomebis safuZvelze. amis qvemoT mocemuli kiTxvebi gansakuTrebiT mniSvnelovania
mwvave depresiis pirveli epizodis mqone pacientebisTvis:
mizezi SeiZleba iyos sxva daavadebebi, magaliTad,
1. ra mWirs?
zogadi samedicino mdgomareoba. unda gvaxsovdes,
rom garkveul nivTierebebs _ rogorc legalurs, 2. gamovjanmrTeldebi?
aseve aralegalurs, SeuZlia depresiis gamowveva (gv. 3. ra saxis mkurnaloba mWirdeba?
302 ?? da Tavi 18). 4. rogor SevZleb mdgomareobis gaumjobesebas?
raTa SevZloT mdgomareobis Sefaseba, mniSvne
5. SesaZlebelia Tu ara, rom daxmareba gauwion Cems
lovania vicodeT guneb-ganwyobis aSlilobis wi ojaxs?
na epizod(eb)i. zogierT pacients aReniSneba gu
am kiTxvebze pasuxis gacema pacientisa da misi
neb-ganwyobis rekurentuli epizodebi. maTze mopo mdgomareobis safuZvlian codnas moiTxovs. Tavis mxriv,
vebuli informacia gvexmareba mimdinare epizodis pacientebi gagebiT moekidebian da mxedvelobaSi miiReben
imas, rom yuradRebian eqims garkveuli informaciis
prognozirebasa da mkurnalobaze pasuxis sworad
moZieba sWirdeba imisTvis, rom am mniSvnelovan kiTxvebze
gansazRvraSi. gansakuTrebiT mniSvnelovania, gamo pasuxi gasces.
vikiTxoT maniisa da hipomaniis wina epizodebi, qvemoT mocemulia ramdenime zogadi xasiaTis rCeva:
maSinac ki, Tu es epizodebi msubuqi da xanmokle iyo.
w depresia samedicino mdgomareobaa da amaSi pirovneba
im SemTxvevaSi, Tu arsebobs maniis istoria, guneb- ar aris damnaSave. braleulobis gancda ganzogadebulia
ganwyobis aSliloba bipolarulia. naTesavebisa da da ganixileba, rogorc arsebuli mdgomareobis nawili;
axlo megobrebis gamokiTxva dagvexmareba davadginoT, w depresiuli epizodebis prognozi kargia, Tumca,
aseTi epizodebis arseboba warsulSi. depresiuli adamianebi, Cveulebriv, prognozis mimarT
pesimisturad arian ganwyobilni;
aSlilobis simwvave ganisazRvreba arsebuli sim
ptomatikiT. mdgomareobis seriozul gamwvavebaze w mkurnaloba iTvaliswinebs fsiqologiur daxmarebasa
da, saWiroebis SemTxvevaSi, medikamentur mkurnalobas.
metyvelebs `biologiuri~, halucinaciuri da bod
mkurnalobis gegma klinikuri gundisa da pacientis
viTi simptomebi (gansakuTrebiT mniSvnelovania erToblivi muSaobis Sedegad unda SemuSavdes. aucilebelia
ukanaskneli ori). aseve, mniSvnelovania imis dadgena, pacientis uflebebisa da arCevanis gaTvaliswineba;
Tu ra gavlenas axdens depresiuli aSliloba w mkurnalobis gegmis nawili moicavs pacientis
pacientis Sromisunarianobas an mis CarTulobaze mdgomareobisTvis yvelaze Sesaferisi profesiuli
da socialuri aqtivobebis dadgenas. klinikuri
ojaxur da socialur aqtivobebSi. Sefasebis dros mdgomareobis Sesabamisi adaptaciis uzrunvelsayofad
unda gaviTvaliswinoT rogorc arsebuli simptomebis saWiroa amis xSiri gadamowmeba;
simwvave, aseve mdgomareobis xangrZlivoba da w Zalian mniSvnelovania, rom daavadebis bunebis
mimdinareoba. daavadebis xangrZlivoba ara marto ganxilvasa da mkurnalobis gegmis SemuSavebaSi
monawileobdes ojaxi; misi mxardaWera fasdaudebelia.
prognozis TvalsazrisiTaa mniSvnelovani, aramed
depresiuli adamianebis mimarT kritikulma SeniSvnebma
gviCvenebs pacientis distresTan gamklavebis unarsac. SesaZloa maTi demoralizeba gamoiwvios. ojaxis
gaxangrZlivebul, Tundac aramwvave aSlilobas, CarTvis erT-erTi mizania urTierTobis gaumjobeseba
da mxardaWeris gazrda.
pacientis sasowarkveTamde miyvana SeuZlia. auci
lebelia yovelTvis Sefasdes suicidis riski iyos uaxlesi da mwvave problemebi an qronikuli
(Sefasebis meTodebi aRwerilia ?? 414-e gverdze). sirTuleebi (magaliTad, mudmivi colqmruli usi
Semdeg etapze xdeba etiologiis Sefaseba: pre amovnebebi, bavSvebTan dakavSirebuli sirTuleebi da
cipitatuli, maprovocirebeli da SemanarCunebeli finansuri problemebi).
faqtorebis gamovlena. mdgomareoba unda Sefasdes ara Semdegi safexuria pacientis socialuri resursebis
rogorc èndogenuri~ an `reaqtiuli~, aramed yovel ganxilva. gamokiTxvam unda moicvas ojaxi, megobrebi
konkretul SemTxvevaSi saWiroa yvela relevanturi da samuSao. depresiuli aSlilobis periodSi misi
risk-faqtoris saTanadod Sefaseba. yvarule ojaxma SesaZloa, daxmareba gauwios pacients
maprovocirebeli mizezebi SeiZleba iyos fsi da Seuqmnas megobruli garemo, waaxalisos maSin,
qologiuri da socialuri (am TavSi ukve ganvix. roca mas dakarguli aqvs rwmena da xeli Seuwyos
cxovrebiseuli movlenebi), an fizikuri daavadeba da mis CarTvas Sesaferis aqtivobebSi. zogierTi pa
misi mkurnaloba. msgavsi SemTxvevebis Sesafaseblad cientisTvis samuSao aris Rirseuli socialuri
kargi praqtikaa pacientis samuSaos, finansuri mdgo resursi, romelic uzrunvelyofs relaqsacias da
mareobis, ojaxuri cxovrebis, socialuri aqtivobebis, megobrul urTierTobebs. zogisTvis samuSao stresis
cxovrebis pirobebisa da fizikuri janmrTelobis gamowvevi mizezia. yoveli calkeuli SemTxvevis
Sesaxeb rutinuli gamokiTxvis Catareba. SesaZloa Sefasebisas didi yuradRebaa saWiro.
_ 274 _
depresiuli aSlilobis marTva
mowodebiT. pirveli kiTxvaa, sWirdebaT Tu ara
boqsi 11.8 depresiis marTva
pacientebs stacionarSi an dRis stacionarSi
1. msubuqi depresiis mqone pacientebs, romlebic SesaZloa mkurnaloba. pasuxi damokidebulia mdgomareobis
mkurnalobis gareSec swrafad gamojanmrTeldnen,
xanmokle periodebis intervaliT unda CautardeT simwvavesa da pacientis socialur resursebze.
Semowmeba (fxizeli molodini). simwvavis ganxilvisas, gansakuTrebuli yuradReba
2. msubuqi depresiis mqone pacientebisaTvis anti unda mieqces suicidis risks (an sxva nebismier risks,
depresantebis daniSvna ar aris rekomendebuli. ris winaSec SeiZleba aRmoCndes ojaxis wevrebis
3. xangrZlivi msubuqi depresiis mqone pacientebisaTvis sicocxle an keTildReoba, gansakuTrebiT, bavSvebi)
rekomendebulia marTuli TviTdaxmarebis programaSi
da, aseve, imas, rom pacientma ar SeWamos an ar dalios
CarTva, romelic efuZneba kognitur-biheviorul
Terapias. am dros rekomendebulia savarjiSo programa iseTi ram, rac safrTxes Seuqmnis mis sicocxles. Tu
da Zilis higiena. yovelive amas gamovricxavT, pacientebis umetesobas,
4. rogorc msubuqi, aseve zomieri depresiis dros, unda romlebsac ojaxis mxardaWera aqvT, Zalian mwvave
vifiqroT depresiaze fokusirebuli fsiqologiuri depresiis drosac ki SeiZleba mkurnaloba saxlSi
mkurnalobis (rogoricaa: problemebis gadaWra,
kognitur-bihevioruli moklevadiani Terapia da Cautardes. pacientebma, romlebic marto cxovroben
konsultacia) Catarebaze. an romelTa ojaxebsac ar aqvT SesaZlebloba dRis
5. zomieri depresiis dros, antidepresantebis gamoye ganmavlobaSi maTi movlis, im SemTxvevaSi, Tu Temze
nebis saWiroebis SemTxvevaSi, rogorc wesi, unda dafuZnebuli intensiuri mkurnaloba xelmisawvdomi
davniSnoT serotoninis seleqciuri ukumitacebis
ar aris, stacionarSi an dRis stacionarSi unda
inhibitorebi.
imkurnalon. aucilebelia, rom marTvis mniSvnelovani
6. mZime depresiis mqone pacientebs unda daeniSnoT
kognituri Terapia antidepresantebTan kombinaciaSi. gadawyvetilebebi, iseve rogorc Semdgomi mkurnalobis
gegmebi, miRebul iqnes pacientTan erTad, masTan
7. pacientebs, romlebsac uaxloes warsulSi ori an meti
depresiuli epizodi hqondaT, antidepresantebiT TanamSromlobis gziT. ojaxis CarTulobac, Tuki
mkurnaloba ori wlis ganmavlobaSi unda CautardeT. es SesaZlebeli iqneba, savaraudod, ukeTesi Sedegis
8. rezistentuli depresiis mqone pacientebis SemTxvevaSi miRebas Seuwyobs xels (boqsi 11.7).
antidepresantebiTa da kognitur-bihevioruli Tera Tu pacients ar sWirdeba klinikaSi moTavseba,
piiT kombinirebuli mkurnaloba unda ganvixiloT.
dgeba sakiTxi imisa, gaagrZelos Tu ara man muSaoba.
9. rekurentuli depresiis mqone pirebs, antidepre msubuqi aSlilobis SemTxvevaSi, samsaxuri daexmareba
santebiT mkurnalobis miuxedavad, xSiri gamwvavebebi
aReniSnebaT, an im pacientebs, romlebic upiratesobas pacients ganTavisufldes depresiuli azrebisagan;
fsiqologiur intervencias aniWeben, kognitur-bi aseve, es kargi iqneba urTierTobebisTvisac. rodesac
hevioruli Terapia unda CutardeT. aSliloba ufro mwvavea, am dros gamoxatuli
(NICE 2004d) Senelebuli moZraobebi, cudi koncentracia, manqanis
marTvis unarisa da samsaxurSi Sromisunarianobis
gansakuTrebuli yuradReba unda mivaqcioT imas,
daqveiTeba kidev ufro umZafrebs pacients uimedobis
Tu ra gavlenas axdens pacientis mdgomareoba da
gancdas. im SemTxvevaSi, Tu mwvave aSlilobis mqone
misi aSliloba sxva adamianebze. yvelaze TvalsaCino
pacienti samsaxurSi siaruls agrZelebs, SesaZloa,
problemebi warmoiqmneba maSin, rodesac pacienti
sxva adamianebi safrTxis winaSe aRmoCndnen.
masze damokidebuli patara bavSvebis dedaa. obi
am dros yuradReba unda gamaxvildes antidepresantebiT
eqturi kvlevebiTaa dadasturebuli klinikuri da
mkurnalobaze. mkurnaloba eniSneba didi depresiis
kvirvebis Sedegebi, rom romelime mSoblis dep
mqone pacientebis umravlesobas, romlebsac, sul cota,
resiuli aSliloba asocirebulia maT SvilebSi
zomieri depresia aqvT. gansakuTrebiT, gamoxatuli
afeqturi aSlilobebis ganviTarebasTan (Cooper and
melanqoliuri simptomebis dros. sxva Cveneba moicavs
Murray, 1998). mniSvnelovania imis gaTvaliswineba, Tu
ojaxis istoriasa da pacientis depresiis personalur
ramdenad usafrTxoa irgvlivmyofebisTvis pacientis
istorias, gansakuTrebiT maSin, roca medikamentur
samsaxurSi yofna (magaliTad, avtobusis mZRolad
mkurnalobas kargi Sedegi mohyveba. disTimiis dros
muSaoba). depresiuli bodviTi azrebis arsebobisas
aseve iniSneba antidepresantebi, Tumca, ramdenad
unda ganvsazRvroT, Tu ra SeiZleba moimoqmedos
efeqturia isini msubuqi depresiuli aSlilobebis
pacientma. magaliTad, mwvave mdgomareobaSi myofma
samkurnalod, Seswavlili ar aris. antidepresantebis
depresiulma dedam SeiZleba moklas Svili, radgan mas
daniSvna SesaZlebelia maSinac, rodesac didi depresiis
sjera, rom sicocxleSi is tanjvisTvisaa ganwiruli.
mqone pacients Semdgom uviTardeba msubuqi depresiis
simptomebi. depresiis marTvis etapobrivi mkurnalobis
depresiuli aSlilobis marTva Sesaxeb instruqciebi SemuSavebulia britaneTis
am nawils viwyebT zomieri da mZime depresiis mqone janmrTelobisa da klinikuri daxelovnebis erovnuli
pacientebis marTvis Sesaxeb arsebuli informaciis institutis mier (2004d) (boqsi 11.8).
_ 275 _
antidepresantebis SerCeva da gamoyeneba eleqtrokrunCxviTi Terapiis (ekT)
arsebobs antidepresantebiT mkurnalobis ramdenime gamoyeneba
meTodi da maTi SerCeva pacientTan SeTanxmebiT unda eleqtrokrunCxviTi Terapia (ekT) iSviaTad SeiZle-
moxdes; Tanac yuradReba unda gavamaxviloT wamlis ba iyos depresiis pirveli arCevis mkurnaloba. igi,
mosalodnel ukuCvenebebze. es yovelive aRwerilia Cveulebriv, mxolod klinikaSi myof pacientebs
21-e TavSi. utardebaT. ekT, rogorc pirveli rigis RonisZieba,
w serotoninis ukumitacebis seleqciuri inhibitorebi maSin unda Catardes, rodesac saWiroa mdgomareobis
(susi), Cveulebriv, pirveli arCevis antidepresantebia swrafad gaumjobeseba. praqtikaSi mas iyeneben pacien-
zomieri depresiis mqone pacientebisTvis im SemTxvevaSi, tebis or ZiriTad jgufTan:
Tu pacienti ar Tvlis, rom adre gamoyenebul sxva wamals w maTTan, vinc uars ambobs sakmarisi raodenobis siTx-
ukeTesi moqmedeba hqonda. lofepramini _ tricikluri is miRebaze, rac aucilebelia Sardis adekvaturi ra-
antidepresanti, romelic zedozirebis SemTxvevaSi odenobiT gamoyofis uzrunvelsayofad (depresiuli
SedarebiT usafrTxoa, aris sxva tipis arasedaciuri stuporis iSviaTi SemTxvevebis CaTvliT);
Semadgenlobis mqone gansxvavebuli ukuCvenebebis w pacientebTan, romlebsac suicidis maRali riski aqvT.
profilis medikamenti (boqsi 11.8).
zogjer ekT eniSneba pacients, romelic ukidures-
w mirtazapini SeiZleba dainiSnos, Tu pacients sWird- ad daTrgunulia da, amdenad, gamarTlebulia swrafi
eba damxmare sedaciuri saSualeba. Terapiis kursis Catareba. aseTi SemTxvevebi iSviaTia.
w tricikluri antidepresantebi, rogoricaa amitrip- unda gvaxsovdes, rom garda im SemTxvevebisa, rodesac
tilini, SeiZleba iyos pirveli arCevani mZime depre- pacientebi rezistentulebi arian antidepresantebiT
siis mqone, gansakuTrebiT, stacionaruli depre- mkurnalobis mimarT, ekT antidepresantebisagan mx-
siuli pacientebisTvis. mwvave darRvevis mqone pa- olod swrafi efeqtiT da ara saboloo Terapiuli
cientebs, romlebic ver uZleben triciklur pre- SedegiT gansxvavdeba. fsiqozuri simptomebiT mimdi-
paratebs an medikamentebi maTTvis ukunaCvenebia, nare depresiis dros ekT-Ti mkurnaloba gacilebiT
arsebobs venlafaqsinis alternativa (Tumca eq- efeqturia, vidre mxolod antidepresantebis miReba;
imebma unda icodnen, rom britaneTis samedicino magram, savaraudod, antidepresantisa da antifsiqo-
usafrTxoebis komisiis mier venlafaqsinis gamoy- zuri medikamentis kombinirebuli gamoyeneba, Sedar-
enebaze bolo dros SezRudvebia dawesebuli, gv. 555 ebiT nela, magram imave efeqts iZleva.
??). orive medikamenti _ amitriptilini da venla-
faqsini. naklebad usafrTxoa, vidre aq CamoTvlili aqtivobebi
sxva Semadgenlobis mqone medikamentebi. yoveli pacientisTvis saWiroa Sesaferisi aqtivobis
am medikamentebis dozirebis, usafrTxoebis zomebis gaTvaliswineba. depresiis mqone pacientebi uars am-
dacvisa da pacientebisaTvis misacemi instruqciebis boben sxvadasxva saqmianobebze da sxvebisgan izolire-
Sesaxeb arsebuli informacia mocemulia 21-e TavSi. bas amjobineben. amitom isini socialuri mxardaWer-
aucilebelia, rom daniSnulebis micemis dros, pa- isa da waxalisebis gareSe rCebian, rac auaresebs
cients kidev erTxel gavumaxviloT yuradReba imaze, depresiul mdgomareobas. aucilebelia davrwmundeT
rom gverdiTi movlenebi maleve gamovlindeba, Tera- imaSi, rom pacienti adekvaturadaa dasaqmebuli. mas
piuli efeqti ki, savaraudod, 2 kviris Semdeg iCens ar unda SevTavazoT iseTi saqme, romelsac koncen-
Tavs; xolo maqsimaluri gaumjobeseba 6-12 kviris traciis daqveiTebisa da Senelebuli moZraobebis
Semdeg gveqneba. am drois ganmavlobaSi saWiroa pa- gamo Tavs ver gaarTmeves. amitomaa, rom depresiuli
cientebis regularulad Semowmeba, raTa moxdes maTi pacientebisTvis SeTavazebuli aqtivobebis CamonaT-
Sesaferisi klinikuri marTvis uzrunvelyofa (ix. vali sakmaod SezRudulia; Tumca, mdgomareobis cv-
zemoT); am periodis ganmavlobaSi mZime aSlilobis lilebasTan, erTad maTi ricxvic icvleba. pacientis
mqone pacientebma Semowmeba yovel 2-3 dReSi erTx- saxlSi mkurnalobis SemTxvevaSi, aucilebelia ojaxis
el unda gaiaron, xolo sxva mdgomareobebis dros wevrebTan imis garkveva, Tu ramdenad iqnebian isini
_ kviraSi erTxel. mniSvnelovania davrwmundeT, Tu CarTulni mis movlaSi. stacionaruli pacientebis
ramdenad icavs pacienti daniSnul dozas. pacientebi sakiTxi klinikaSi momuSave multidisciplinurma
unda gavafrTxiloT, Tu ra Sedegi SeiZleba mohyves gundma unda gadawyvitos.
alkoholis miRebas. maT unda gaewioT konsultacia
manqanis marTvasTan dakavSirebiT; kerZod, maT unda fsiqoTerapia
aekrZaloT manqanis marTva, Tu aReniSnebaT sedaci- Sesaferisi fsiqologiuri mkurnalobis forma yovel
uri gverdiTi movlenebi an sxva zemoqmedeba, rac calkeul SemTxvevaSi individualurad unda ganisaz-
Seaferxebs maT moqmedebas kritikul viTarebaSi. Rvros. ukve aRvniSneT, rom yvela pacients sWirdeba
_ 276 _
gadametebulma saubarma SesaZloa, gaaRrmavos paci-
boqsi 11.9 rezistentuli depresiis
entis uimedobis gancda. TviTanalizze mimarTuli
farmakologiuri mkurnaloba
Terapia kidev ufro auaresebs mdgomareobas. aseTi
w gazardeT antidepresantis doza maqsimalurad mkurnalobis Catareba SesaZlebelia gamwvavebebs So-
tolerantul dozamde; gazomeT tricikluri
antidepresantebis plazmuri koncentracia; im ris intervalSi. gansakuTebiT, iseT SemTxvevebSi,
SemTxvevaSi, Tu pacients fsiqozuri simptomebi rodesac daavadebis rekurentulobas mniSvnelovnad
aReniSneba, daniSneT antifsiqozuri medikamenti; ganapirobebs cxovrebiseul movlenebze pacientis re-
gamoiyeneT sxva klasis antidepresantebi ven
lafaqsinisa da triciklurebis CaTvliT; agirebis Tavisebureba.
w gamoiyeneT antidepresantebis kombinacia (mag., susi-ebi
an venlafaqsini mirtazapinTan erTad); uSedego inicialuri mkurnaloba
w antidepresantebTan erTad daniSneT liTiumi;
uSedego inicialuri mkurnalobis dros, rodesac
w susi-ebs an venlafaqsins daumateT antifsiqozuri
medikamenti;
depresiuli epizodis SemTxvevaSi antidepresante-
w triciklur antidepresantebs daumateT triiod biTa da fsiqologiuri TerapiiT kombinirebuli
Tironini; mkurnaloba gonivrul vadaSi Sedegs ar gvaZlevs,
w gamoiyeneT mao inhibitorebi (SeiZleba efeqturi iyos saWiroa mkurnalobis gegmis gadaxedva. pirvel rigSi,
liTiumTan erTad); unda gadamowmdes, iRebda Tu ara pacienti daniSnul
w ekT.
medikamentebs. im SemTxvevaSi, Tu pasuxi uaryofiTia,
saWiroa mizezebis gaanalizeba. SesaZloa, pacienti
mxardaWera, gamxneveba da fsiqoganaTleba. maT unda darwmunebulia imaSi, rom mkurnaloba mas ver uSve-
icodnen, rom depresia avadmyofobaa da ara maTi lis, an Sewuxebulia gverdiTi movlenebis gamo. yur-
pirovnuli sisuste. msgavsi konsultaciebi pacien- adRebiT unda gadaixedos diagnozic da gadamowmdes,
tebis ojaxis wevrebTanac da partniorebTanac Zalian aris Tu ara gamovlenili yvela mniSvnelovani stre-
sasargebloa. suli movlena an gaxangrZlivebuli sirTule.
sxvadasxva SemTxvevaSi zemoT ganxiluli specifi- Tu am mxriv aranairi siaxle ar aris, maSin SeZlebi-
kuri fsiqologiuri Terapiebidan erT-erTi unda sdagvarad unda gaizardos antidepresantebis doza.
gamoviyenoT. msubuqi da zomieri depresiis dros Sei- tricikluri antidepresantebis SemTxvevaSi, gansa-
Zleba mivmarToT monoTerapias, gansakuTrebiT maSin, kuTrebiT, Tu dRiuri doza 150 mg-ia, rekomendebu-
rodesac pacients ar aqvs melanqoliuri niSnebi an ar lia plazmaSi preparatis koncentraciis Semowmeba (gv.
surs medikamenturi mkurnaloba (britaneTis janmr- 542). zogadad, optimaluri Terapiuli dozebi sero-
Telobisa da klinikuri daxelovnebis erovnuli in- toninis ukumitacebis seleqciuri inhibitorebisT-
stituti, 2004d). fsiqologiuri mkurnalobis SerCeva vis ar aris dadgenili. zogi pacienti, SesaZlebelia,
damokidebulia Sesabamisi kvalifikaciis mqone Tera- ufro maRal dozas saWiroebs, gansakuTrebiT iseT
pevtis arsebobasa da pacientis arCevanze. Tumca, aqve SemTxvevebSi, Tu standartul dozaze nawilobrivi
aRvniSnavT, rom zomieri depresiis samkurnalod ram- pasuxi SeimCneva. mkurnalobisadmi rezistentuli pa-
denad efeqturia struqturuli Terapiebi (rogori- cientebisaTvis, savaraudod, venlafaqsinis maRali
caa interpersonaluri Terapia da kognituri Tera- dozebi ufro efeqturi iqneba (ix. Cowen, 2005). im Sem-
pia), ufro kargadaa Seswavlili. antidepresantebis TxvevaSi, Tu pacientis mdgomareoba ar umjobesdeba,
miRebisas Terapiuli pasuxi, Cveulebriv, ufro swra- saWiroa Semdegi RonisZiebebis gatareba (boqsi 11.9):
fia, vidre fsiqoTerapiis SemTxvevaSi.
amJamindeli rekomendaciebis Tanaxmad, mwvave antidepresantebis Secvla
depresiis mqone pacientebisTvis mizanSewonilia an- im SemTxvevaSi, Tu pacients daniSnul antidepresantze
tidepresantebTan erTad kognitur-bihevioruli saTanado pasuxi ar aReniSneba, saWiroa am preparatis
Terapiis daniSvna (britaneTis janmrTelobisa da Sewyveta da axali medikamentis daniSvna. am sakiTxTan
klinikuri daxelovnebis erovnuli instituti, 2004d). dakavSirebiT gamoqveynebuli kvlevebis umetesoba
praqtikaSi, kognitur-bihevioruli Terapiis organi- Ria kvlevebia da, Sesabamisad, Znelia gamoiricxos
zebisTvis garkveuli droa saWiro. nebismier SemTx- iseTi SemTxvevebi, rodesac iyo placebo efeqti an
vevaSi, mdgomareobis antidepresantebiT inicialuri spontanuri gamojanmrTeleba. miuxedavad amisa,
gaumjobeseba xels uwyobs fsiqologiuri mkurnalo- arsebobs sakmarisi monacemebi imis dasamtkiceblad,
biT maqsimaluri Sedegis miRebas (ix. Wolpert, 1999). rom inicialur mkurnalobaze rezistentuli pa
aseve mniSvnelovania mogvardes is fsiqologiuri cientebis daaxloebiT 50% antidepresantis cvli
problemebi, romlebic xels uwyoben depresiis ganvi- lebis SemTxvevaSi dadebiT Sedegs gvaZlevs (ix. Nelson,
Tarebasa da gaxangrZlivebas. 2003).
mZime depresiis dros, sawyis etapze, problemebze maSin, roca pacienti rezistentulia erTi romelime
_ 277 _
antidepresantis mimarT, logikuria gansxvavebuli entebis SemTxvevaSi, pirvel rigSi, antidepresantebTan
farmakologiuri profilis antidepresantze gada erTad unda davniSnoT sxva preparati, anu gamo
svla. Tumca, gasaTvaliswinebelia, rom Ria kvlevebis viyenoT àugmentacia~. unda gaviTvaliswinoT, rom
Tanaxmad, erTi susi_dan am jgufis meore preparatze augmentaciis dros izrdeba medikamentebis urTi
gadasvla aseve efeqturia aRmoCnda. susi_ebis erTqmedebiT gamowveuli gverdiTi efeqtebis riski.
daniSvnis SemTxvevaSi, rodesac erT serotoninergul
preparats vanacvlebT amave jgufis meore medi liTiumis augmentacia
kamentiT, gansakuTrebuli sifrTxilea saWiro, raTa randomizebuli kvlevebis monacemebiT, liTiumis
Tavidan aviciloT serotonuli sindromi. praqtikaSi gamoyeneba SesaZloa, efeqturi iyos rezistentuli
es gulisxmobs erTi preparatis Semcirebasa da depresiis mkurnalobisas. antidepresantebis augmen
srul moxsnas da amis Semdeg meore antidepresantis tacia liTiumiT, Cveulebriv, usafrTxo da iolad
naxevari an naklebi doziT dawyebas. fluoqsetinis asatania, Tu sxva ukuCvenebebi ar arsebobs (gv. 560
gamoyenebisas (misi xangrZlivi naxevardaSlis peri ??). depresiuli pacientebis daaxloebiT naxevars
odis gamo) misi moxsnis Semdeg, sul cota, erTi dadebiTi pasuxi ukve 1-3 kviraSi aReniSneba. liTiumi
kvira unda gavides, rom meore susi dainiSnos. SegviZlia davniSnoT kargi efeqtis mqone nebismier
Tumca, roca vcvliT sxvadasxva farmakologiuri pirvelad arCeul antidepresantTan erTad. Tumca,
Tvisebis mqone agentebs (magaliTad, citalopramis susi-ebTan da venlafaqsinTan augmentaciisas, sa
Secvla mirtazapiniT an reboqsetiniT), SeiZleba Wiroa sifrTxilis gamoCena, raTa ar ganviTardes
erTi preparatis dozis Semcirebis paralelurad serotoninuli neirotoqsikuroba (gv. 551). aseT
gavzardoT meoris doza (detaluri informaciisTvis SemTxvevebSi umjobesia liTiumis dabali dozebiT
SegiZliaT ixiloT Maudsley Prescribing Guideline, Taylor dawyeba (200 mg dReSi) da kviraSi maqsimum 200 mg-iT
et al., 2003). gazrda. augmentaciis dros ZiriTadi mizania liTiumis
amitriptilini (Barbui and Hotopf, 2001) da ven profilaqtikur doneze SenarCuneba (0.5-0.8 mmoli/l);
lafaqsini (Smith et al., 2002) ufro efeqturi sasurvelia liTiumis plazmuri koncentraciis da
antidepresantebia, vidre susi-ebi; Sesabamisad, maTi bali maCvenebeli susi-ebTan kombinaciis dros. ar
daniSvna mizanSewonilia im SemTxvevebSi, rodesac sebobs mosazreba, rom liTiumis SeTavseba mao
inicialuri mkurnaloba uSedegoa. igive SeiZleba inhibitorebTan an klomipraminTan (zogjer trif
iTqvas mao inhibitorebis Sesaxebac, romlebsac tofanis damatebiT) SeiZleba efeqturi iyos iseTi
rezistentuli depresiis zogierT SemTxvevaSi Tval depresiuli mdgomareobebis dros, romlebic Znelad
saCino pozitiuri efeqti aqvT (Nolen et al., 1988). Tumca, emorCilebian mkurnalobas (ix. Cowen, 2005).
sxva wamlebTan da zog produqtTan urTierTqmedebis
antifsiqozuri medikamentebi
gamo, maTi daniSvna SezRudulia. dasawyisSive re
zistentuli depresiis samkurnalod maT iSviaTad fsiqozuri simptomebiT mimdinare depresiis Sem
iyeneben, garda im SemTxvevebisa, rodesac warsulSi TxvevaSi saukeTeso Sedegs iZleva antidepresantiT
inhibitorebiT mkurnalobaze pacients kargi Sedegi da antifsiqozuri medikamentiT kombinirebuli
hqonia. mkurnaloba (ix. zemoT). arafsiqozuri rezistentuli
depresiis dros tipiuri antifsiqozuri medikamentis
antidepresiuli medikamenturi mkurnalobis daniSvna nakleb efeqturia, garda im SemTxvevebisa,
augmentacia rodesac agznebisa da distresis Semcireba mcire
antidepresiuli preparatebis cvlilebis dros prob dozebiT xdeba. atipiur antifsiqozur preparatebTan
lemaa is, rom pirveli preparatis moxsnam SeiZleba dakavSirebiT arsebobs pirveladi monacemebi imisa,
mdgomareoba gaauaresos. inicialuri mkurnalobiT rom maT, arafsiqozuri depresiis mkurnalobisas,
SesaZlebelia mcire gaumjobesebis miRweva, maga susi-ebTan kombinaciaSi antidepresiuli efeqti axa
liTad: SedarebiT mowesrigdes Zili an Semcirdes siaTebT. randomizebulma kontrolirebadma kvle
daZabuloba. Tu movxsniT preparats, es mcire efeqtic vam (Shelton et al., 2001) aCvena, rom fluqsetiniT
daikargeba. aseve, arsebobs riski, rom pirveladi mkurnalobis mimarT rezistentul SemTxvevebSi
mkurnalobis swrafad Sewyvetam SesaZlebelia moxsnis olanzapinis damatebam (5-20mg) mniSvnelovnad gaa
mdgomareoba gamoiwvios (ix. 21-e Tavi); amasTan, dozis umjobesa Sedegi, vidre placebos damatebam an
TandaTanobiTi Semcireba axangrZlivebs preparatis olanzapiniT monoTerapiam. aseve, Ria kvlevebi adas
Secvlis process, risi gadatanac depresiuli da turebs risperidonis dabali doziT augmentaciis
uimedo pacientisTvis advili araa. efeqturobas susi-sadmi rezistentul SemTxvevebSi
aqedan gamomdinare, inicialuri mkurnalobisadmi (ix. Cowen, 2005).
nawilobrivi pasuxis mqone an rezistentuli paci susi-ebis augmentaciisaTvis atipiur antifsiqozur
_ 278 _
preparatebs ufro dabali dozebiT iueneben, vidre araefeqturi mkurnalobis SemTxvevebSi mirtazapinis
Sizofreniis samkurnalodaa saWiro. savaraudod, an misi winamorbedis _ mianserinis, damatebiT
amis mTavari farmakologiuri meqanizmi ufro 5-HT2 daniSvnis Sedegebi. farTo randomizebulma kvlevam,
receptoris, da naklebad, dofamin D2 receptoris rezistentuli depresiis SemTxvevebSi, sertralinisa
blokirebasTanaa dakavSirebuli. miuxedavad amisa, da mianserinis kombinirebuli mkurnalobis upi
olanzapinis mcire dozac iwvevs Semawuxebel sedaciasa ratesoba, mianseriniT monoTerapiasTan SedarebiT,
da wonaSi matebas. risperidonis miRebasac, aseve, Tan ar daadastura (ix. Cowen, 2005). triciklurebis
axlavs wonaSi mateba da hiperprolaqtinemia. koncentraciis momatebis gamo, yuradRebiT unda
movekidoT triciklurebisa da susi-ebis kombinacias
triiodTironini (T3) (gv. 547 ??).
zogierTi Ria da kontrolirebadi kvlevis Tanaxmad,
tricikluri antidepresantebiT araefeqturi mkur ekT-s gamoyeneba rezistentuli depresiis dros
nalobis SemTxvevaSi, triiodTironinis (T3) 20-40 ekT-Ti mkurnalobis sakiTxi mZime depresiebis
mkg dRiuri dozis damateba sasurvel klinikur SemTxvevaSi unda ganvixiloT. ekT karg Sedegs iZleva,
Sedegs gvaZlevs. Tumca, gamoqveynebuli oTxi ran roca pacienti medikamenturi mkurnalobis mimarT
domizebuli kvlevis meta-analiziT, romliTac rezistentulia. ekT medikamentebze ufro efeqturia
Sefasda tricikluri antidepresantebis mimarT mZime depresiisa da fsiqozuri simptomebiT mimdinare
rezistentuli SemTxvevebisTvis T3-iT augmentaciis depresiis dros. kvlevebi gviCvenebs, rom ekT-s
efeqturoba, ar aris miRebuli saimedo Sedegebi efeqturoba medikamentebisadmi rezistentuli dep
(Aronson et al., 1996). unda aRiniSnos, rom T3-iT susi- resiuli pacientebis mkurnalobisas mosalodnel
ebis augmentacia ar aris Seswavlili kontrolirebadi ze ufro dabalia (daaxloebiT 50%), vidre ara
kvlevebiT. miuxedavad arasakmarisi monacemebisa, rezistentuli pacientebis SemTxvevaSi (daaxloebiT
zogierTi depresiuli pacientisTvis T3-is damateba 80%) (Prudic et al., 1990).
SeiZleba Sedegiani iyos. aseT SemTxvevebSi T3 iniSneba unda aRiniSnos, rom antidepresantebis (sruli
10 mkg dRiuri doziT da, Tu amtanobac kargia, erTi dozebiT mkurnalobis) mimarT rezistentul Sem
kviris Semdeg 20 mkg-mde izrdeba. am dozaze gverdiTi TxvevebSi ekT-iT mkurnalobis Semdeg momdevno
movlenebi, Cveulebriv, umniSvneloa, Tumca, SesaZloa, wlis ganmavlobaSi, recidivis riski 50%-ia. amis
tremorisa da oflianobis ganviTareba. gonivrulia, mizezi SeiZleba iyos is, rom pacientebi xSirad im
Tu kardiovaskularuli daavadebis dros T3-iT antidepresants iReben, romelic warsulSi ara
augmentacias ar gamoviyenebT. efeqturi iyo (Sackheim et al., 1990). aseT SemTxvevebSi
logikuria ekT-iT mkurnalobis Semdeg xangrZlivi
antidepresantebiT kombinirebuli mkurnaloba mkurnalobisTvis sxva jgufis antidepresantis an
antidepresantebis kombinacia gulisxmobs araefeqtur liTiumis gamoyeneba. Tumca, dReisTvis monacemebi
an nawilobriv efeqtur antidepresantTan erTad imis Sesaxeb, rom aseTi midgoma amcirebs recidivebis
meore antidepresantis daniSvnas. aseTi midgoma sixSires, ar arsebobs.
SeiZleba ganvixiloT, rogorc efeqtis gaZlierebis
strategia. Tumca, Tu pacientis mdgomareoba um sxva mniSvnelovani sakiTxebi
jobesdeba, Znelia imis garkveva, es efqti ori aucilebelia mkurnalobisadmi rezistentuli pa
antidepresantis kombinirebuli moqmedebis Sedegia, cientebis mxardaWera. im SemTxvevaSi, Tu mdgo
Tu meore antidepresantis damoukidebeli aqtivobis. mareoba ar umjobesdeba, pacientebSi matulobs
aseTi kombinacia farmakologiurad mizanSewonilia pesimisturi ganwyobilebebi. amitom mniSvnelovania,
imdenad, ramdenadac ori preparatiT monoaminur pacients avuxsnaT, rom, sabolood, depresiuli
gzebze ufro aqtiuri zemoqmedebaa SesaZlebeli, mdgomareobidan gamosvlis didi Sansi arsebobs,
vidre erTi medikamentis gamoyenebisas. praqtikaSi miuxedavad imisa, SesaZlebelia Tu ara mkurnalobiT
es niSnavs, rom susi-ebi an venlafaqsini xSirad gamojanmrTelebis procesis daCqareba. Tu pacienti
noradrenergul preparatebTan, kerZod, triciklur ar aris Zalian depresiuli, unda vesaubroT yvela
antidepresantebTan, reboqsetinTan an mirtazapinTan im problemaze, romlebic, SesaZloa, xels uwyoben
(romelic 2 -adrenoceptoris blokirebiT zrdis depresiuli mdgomareobis ganviTarebas. kognituri
noradrenalinis funqcias) erTad iniSneba. Terapiis meSveobiT SeiZleba pacients davexmaroT
aseTi strategiis damadasturebeli mtkicebulebebi imaSi, rom man SeZlos Secvlili azrovnebisa da
Zalian mwiria. Tumca, am midgomis sasargeblod msjelobis gaumjobeseba. rezistentul SemTxvevebSi
ramdenime kvleva da eqspertTa mosazrebebi met gansakuTrebiT mniSvnelovania suicidis riskis
yvelebs. yvelaze ukeTesad Seswavlilia susi-ebiT saTanadod Sefaseba.
_ 279 _
recidivebisa da rekurentulobis prevencia mkurnaloba gagrZeldes imave medikamentiT da,
ramdenadac SesaZlebelia, imave doziT. xangrZlivad
medikamentebiT mkurnaloba
miRebisas, ukeTesi amtanobis gamo, SemanarCunebeli
xangrZlivi mkurnaloba mkurnalobisTvis umjobesia axali antidepresantebis
gamojanmrTelebis Semdeg, pacients ramdenime gamoyeneba. Tu arasasurveli efeqtis mizeziT
Tvis ganmavlobaSi meTvalyureoba unda gauwios saWiroa medikamentis Secvla (magaliTad, seqsualuri
fsiqiatriulma gundma an zogadi profilis eqimma. disfunqcia susi-ebis gamoyenebisas), alternatiuli
im SemTxvevaSi, Tu antidepresantebiT mkurnalobis preparatis daniSvnisas, saWiroa am gverdiTi
Sedegad mdgomareoba gaumjobesda, maSin maTi miReba movlenebis gaTvaliswineba.
unda gaxangrZlivdes daaxloebiT 6 Tvis ganmavlobaSi. SesaZloa, liTiumi efeqturi iyos rekurentuli
Semdeg, ramdenime kviris manZilze, TandaTanobiT depresiis xangrZlivi profilaqtikisTvis. Tumca,
unda SevamciroT doza da movxsnaT preparati. radgan misTvis damaxasiaTebelia gverdiTi movlenebi
rezidualuri simptomebis arsebobisas, medikamentis da aucilebelia plazmuri koncentraciis monitoringi,
moxsna ar aris sasurveli. dozebis Semcirebisa da xSir SemTxvevaSi, liTiumi ver iqneba pirveli arCevis
preparatis moxsnis periodSi saTanado yuradReba medikamenti. Tumca, anamnezSi maniakaluri (Tundac
unda mivaqcioT moxsnis mdgomareobis an recidivis msubuqi an xanmokle) epizodis arsebobisas, unda
ganviTarebis risks. gamwvavebis adreuli niSnebis gaviTvaliswinoT misi gamoyenebis SesaZlebloba.
pacientTan ganxilva da aseTi mdgomareobisTvis liTiumi SeiZleba efeqturi iyos antidepresantebis
samoqmedo gegmis SemuSaveba mniSvnelovnad exmareba mimarT rezistentuli, rekurentuli depresiis mqone
mas. Tu pacienti Tanaxmaa, sasurvelia, rom gegmis pacientebis SemTxvevaSic.
SemuSavebis procesSi monawileoba miiRon, sasurvelia,
sxva mniSvnelovani sakiTxebi
ojaxis wevrebma an axloblebma.
Tuki depresia dakavSirebulia Tavad pirovnebis mier
profilaqtikuri mkurnaloba provocirebul stresebTan, magaliTad, ukidures
didi depresia xSirad rekurentulia da, SesaZloa, gadaRlas an rTul socialur urTierTobebTan,
saWiro gaxdes xangrZlivi profilaqtikuri mkur maSin saWiroa davexmaroT pacients, raTa man SeZlos
nalobis Catareba. rekurentulobis risk-faqto cxovrebis wesis Secvla da Semdgomi gauaresebis
rebze ukve visaubreT (gv. 246 ??). klinicistma un Tavidan acileba. amis miRweva SesaZlebelia fsi
da gaiTvaliswinos damatebiTi individualuri faq qoTerapiiT. fsiqoTerapiis Catareba SeiZleba jgu
torebi: furad, individualurad an wyvilebSi. ukve aRvniSneT,
rom kognitur-bihevioruli fsiqoTerapiiT SeiZleba,
w rekurentulobis SesaZlo gavlena pacientis cxov
rezidualuri simptomebis mqone pacientebis Sem
rebaze;
TxvevaSi, recidivebis ricxvis Semcireba. TemSi momuSave
w medikamenturi mkurnalobis warsuli gamocdileba;
fsiqiatriul eqTans an Terapevts aseT mkurnalobaSi
w pacientis damokidebuleba xangrZlivi mkurnalobis mniSvnelovani rolis Sesruleba SeuZliaT.
mimarT. mniSvnelovania ojaxis eqimis monawileoba pacientis
dadgenilia, rom sami didi depresiuli epizodis mdgomareobis grZelvadian monitoringSi. igi, aseve,
mqone pacientebs axali epizodis ganviTarebis CarTuli unda iyos mkurnalobis gegmis SemuSavebis
90%-iani riski aqvT. zogadi rekomendaciiT, pro procesSi. misi monawileoba, SesaZloa, gansakuTrebiT
filaqtikur mkurnalobas saWiroeben is pacientebi, sasargeblo aRmoCndes interkurentuli mdgoma
romlebsac 5 wlis manZilze orjer ganuviTardaT reobebis dros.
depresiuli epizodi. gansakuTrebiT, rekurentuli
didi depresiis ojaxuri istoriis an gamwvavebis maniis Sefaseba
xelSemwyobi pirovnuli da socialuri faqtorebis
maniis Sefaseba moicavs imave safexurebs, rac dep
arsebobis SemTxvevaSi (Anderson et al., 2000b). qro
resiis SemTxvevaSi aRvwereT:
nikuli rezidualuri simptomebis arseboba, aseve,
profilaqtikuri mkurnalobis aucileblobaze miu w diagnozis dadgena;
TiTebs. w aSlilobis simwvavis gansazRvra;
w gamomwvevi mizezebis Sesaxeb azris Camoyalibeba;
medikamentis SerCeva
w pacientis socialuri resursebis Sefaseba;
umetes SemTxvevaSi, antidepresanti unda SeirCes
w mocemuli aSlilobis sxva adamianebze gavlenis
mkurnalobis mwvave da profilaqtikur fazaSi, masze
Sefaseba.
sapasuxo reaqciis gaTvaliswinebiT. sasurvelia
_ 280 _
maniis marTva
diagnozis dadgena damokidebulia pacientis kavSiris damyareba maniiT daavadebul pacientTan.

avadmyofobis istoriis safuZvlianad Seswavlasa da Tumca, daavadebis mimarT arakritikulma damoki
mdgomareobis Sefasebaze. anamnezis Sekrebisas, Tu debulebam da iZulebiTi stacionirebiT gamowveulma
es SesaZlebelia, unda mivmarToT naTesavebs, radgan gaRizianebam, SesaZloa, es mcdeloba Zalian ga
pacienti SeiZleba ver acnobierebdes avadmyofurad arTulos. konfrontaciis Tavidan asacileblad,
Secvlil qcevas. am TavSi ukve ganvix. diferencialuri umjobesia, gagebiT movekidoT pacients, Tumca,
diagnozi. unda gvaxsovdes, rom msubuqi ganmuxruWeba, amasTan, saWiroa simtkicis gamoCena. maniis mqone
SesaZloa, maniis garda, tvinis frontaluri qerqis pacientTan urTierTobisas, SegviZlia visar
dazianebiT (rogoricaa simsivne) iyos gamowveuli. gebloT misi mdgomareobisTvis damaxasiaTebeli
fsiqoaqtiuri nivTierebebis gamosavlenad SesaZ yuradRebis gafantulobiT da Tavi avaridoT
lebelia Sardis analizi gaxdes saWiro. kamaTs. winaaRmdegobis gawevis nacvlad, umjobesia
Semdegi safexuria simwvavis gansazRvra. am mizniT davelodoT, rodis gadavlen sxva Temaze da mivyveT
mniSvnelovania rogorc pacientis, aseve informaciis maT. klinikaSi maTi movla ZiriTadad ekisrebaT
momwodeblis gamokiTxva. maniiT daavadebuli pa eqTnebs da eqTnis TanaSemweebs. isini uzrunvelyofen
cientebi cdiloben eqimTan saubrisas Tavis Se pacientis mSvid da naklebad mastimulirebel garemos,
kavebas da qcevebis gakontrolebas. aseT daZabul rac amcirebs konfliqtebisa da arakeTilgonivruli
mdgomareobas, SesaZloa, dauyovnebliv mohyves Tav seqsualuri kavSirebis damyarebis SesaZleblobas.
Seukavebeloba da ganmuxruWeba. maniis sawyis stadiaze damxmare, realobaze orientirebuli, fsiqoTerapia
eqimi SeiZleba advilad Secdes da xelidan gauSvas mkurnalobis mniSvnelovani nawilia, romelSic,
pacientis klinikaSi moTavsebis SesaZlebloba manam, SesaZloa, saWiro gaxdes axloblebisa da ojaxis
sanam igi araadekvaturi azrovnebisa da aragonivruli wevrebis CarTva, romlebic Tavadac ganicdian
gadawyvetilebebis gamo Tavis Tavs problemebs ar daZabulobas maniis ganviTarebuli epizodis gamo.
Seuqmnis. Zalian mniSvnelovania identificireba im saganmanaTleblo sesiebi unda Catardes mas Semdeg,
cxovrebiseuli movlenebisa, romlebic maniakaluri rodesac pacienti SedarebiT damSviddeba. pacients,
mdgomareobis provocirebas axdenen. mania zogjer SesaZloa, meti praqtikuli daxmareba dasWirdes,
viTardeba sxvadasxva somaturi daavadebis fonze, raTa Semcirdes daavadebis finansuri, iuridiuli da
an medikamentebis (gansakuTrebiT, steroidebis an profesiuli xasiaTis uaryofiTi Sedegebi.
antidepresantebis) miRebisas, an operaciis Semdeg. Tu
medikamentebi
adamiani emociuria, mania SesaZloa, Zilis deprivaciam
gamoiwvios. medikamentebi Zalian did rols asrulebs maniis
maniakaluri mdgomareobebis gavlena sxva pirebze mwvave fazis marTvaSi. Tumca, moqmedebisa da
iseve unda SevafasoT, rogorc depresiis SemTxvevaSi. amtanobis TvalsazrisiT, medikamentebiT mkur
Zalian megobruli da mzrunveli ojaxisTvisac Znelia nalobas mainc aqvs SezRudvebi. britaneTSi maniis
ojaxis pirobebSi maniakaluri pacientis movla. mwvave fazis samkurnalod, Cveulebriv, Tavidanve
yovelTvis saTanadod unda Sefasdes pacientis antifsiqozur preparatebs iyeneben. guneb-ganwyobis
pasuxismgebloba masze damokidebuli bavSvebis movlas stabilizatorebi, antifsiqozur prepartebTan
an samsaxureobriv saqmeebTan dakavSirebiT. erTad, iniSneba grZelvadiani profilaqtikis mizniT
an maSin, roca antifsiqozuri medikamentebiT
mkurnaloba aradamakmayofilebelia. im SemTxvevebSi,
maniis marTva rodesac pacientebi jer ar iReben guneb-ganwyobis
mwvave epizodebi stabilizatorebs, medikamenturi marTva SeiZleba
pirvel rigSi unda gadawydes, movaTavsoT Tu Semdegnairad SevajamoT:
ara pacienti klinikaSi. yvela SemTxvevaSi, garda w mkurnaloba unda daviwyoT atipiuri antifsiqozuri
msubuqi formebisa, sasurvelia pacientis klinikaSi medikamentebiT (haloperidolis zomieri dozebiT);
moTavseba, raTa is, misive qcevidan gamomdinare, w imisTvis, rom SevamciroT antifsiqozuri pre
mosalodneli Sedegebisgan davicvaT. Tu aSliloba paratebis saWiro doza da, saWiroebis SemTxvevaSi,
ar aris Zalian mwvave, klinikaSi gadayvanis Taobaze uzrunvelvyoT damakmayofilebeli Zili, unda
misi darwmunebis Semdeg, pacienti eTanxmeba am gamoviyenoT maRali aqtivobis benzodiazepinebi
gadawyvetilebas. rodesac aSliloba Zalian mwvavea, (magaliTad, lorazepami an klonazepami);
klinikaSi moTavsebis aucilebloba gardauvalia.
w Tu aRniSnuli mkurnalobiT Sedegs ver mivaRwevT,
klinikuri marTva damatebiT unda davniSnoT guneb-ganwyobis sta
bilizatori (liTiumi _ `klasikuri~ maniis dros
mkurnalobis mniSvnelovani mizania Terapiuli
_ 281 _
da valproati _ gamoxatuli disforuli maniis an bipolaruli depresiis mkurnaloba
Sereuli mdgomarebis, dros an rodesac liTiumi bipolaruli aSlilobebisTvis damaxasiaTebelia dep
ukunaCvenebia). resiuli epizodebi. depresiis mkurnaloba bipolaruli
im SemTxvevaSi, rodesac gadawyvetilia inicialur aSlilobis dros, SesaZloa, problematuri iyos,
periodSi guneb-ganwyobis stabilizatorebis daniSvna, radgan standartuli antidepresantebiT mkurnalobas
arCevani unda gakeTdes liTiumsa da valproats Soris. Tan axlavs mTeli rigi sirTuleebi:
valproati ufro advili gamosayenebelia da swrafad w unipolarul depresiasTan SedarebiT, bevrad
moqmedebs. benzodiazepinebi iniSneba damatebiTi naklebi efeqturoba;
hiperaqtivobis prevenciis mizniT da normaluri Zilis w maniis stimulirebis riski;
uzrunvelsayofad. antifsiqozuri medikamentebis miReba
w swrafi cirkulirebis stimulirebis riski.
unda gaagrZelon im pacientebma, romlebsac Catarebul
mkurnalobaze arasakmarisi pasuxi aReniSnebaT. Tu bipolaruli pacientebisTvis liTiumi SeiZleba
pacients maniakaluri epizodi aqvs da is iRebs guneb- Sesaferisi antidepresanti iyos da ar gamoiwvios mania.
ganwyobis stabilizators, pirvel etapze unda meores mxriv, umetes SemTxvevaSi, is araefeqturia
gavzardoT wamlis doza. mniSvnelovania daniSnulebis da bevria iseTi bipolaruli pacienti, romelic,
mkacrad dacvis uzrunvelyofa. Semdgom, SesaZlebelia, miuxedavad liTiumiT mkurnalobisa, depresiulia.
saWiro gaxdes antifsiqozuri medikamentebis aseT viTarebaSi antidepresantebis gamoyeneba
damateba. rezistentul SemTxvevebSi SeiZleba meore Cveulebrivi movlenaa da, miuxedavad zemoTaRniSnuli
stabilizatoris damatebac (Goodwin, 2003). problemebisa, bolodroindeli sistemuri kvlevebis
maniakaluri epizodis gaumjobesebis Sefaseba Se Tanaxmad (Gijsman et al., 2004), bipolaruli depresiis
saZlebelia ara marto fsiqikuri mdgomareobis mkurnalobis dros antidepresantebis miReba efeq
da zogadi qcevis, aramed Zilis paternebisa da turia. Tumca, gasaTvaliswinebelia isic, rom
daavadebis dros dakarguli wonis aRdgenis mixed tricikluri antidepresantebis (10%) miRebisas,
viTac. Tu mdgomareoba gaumjobesda, antifsiqozuri maniaSi gadasvlis riski ufro maRalia, vidre susi-
medikamentebiT mkurnaloba TandaTan unda Sevam ebisa (3.2%) da placebos (4%) SemTxvevaSi, rac
ciroT. mniSvnelovania, rom medikamenti Zalian imas mowmobs, rom susi-ebi am TvasazrisiT ufro
swrafad ar SevwyvitoT; winaaRmdeg SemTxvevaSi Se usafrTxo antidepresantebia. bipolaruli depresiis
saZloa, ganviTardes recidivi da ganaxldes mar antidepresantebiT mkurnalobisas, Cveulebriv, guneb-
TvasTan dakavSirebuli problemebi. ganwyobis stabilizatorebi iniSneba, rac, savaraudod,
ekT-s iyenebdnen maniis sankurnalod manam, sanam amcirebs maniis ganviTarebis risks (Goodwin, 2003).
SemoiRebdnen antifsiqozur medikamentebs, magram bipolaruli depresiis marTvisas mwvave fazaSi,
misi efeqturobis damadasturebeli cnobebi jer SesaZloa, lamotrijinic efeqturi iyos (Calabrese
kidev sakmarisi ar aris (ix. zemoT). ekT-iT mkurnaloba et al., 1999); savaraudod, igi ar warmoqmnis maniis
unda ganvixiloT iseT SemTxvevebSi, rodesac stimulirebis an swrafi cirkulirebis risks. aseve,
maqsimaluri dozebiT mkurnalobac ki uSedegoa. Seswavlilia atipiuri antifsiqozuri medikamentebis
klinikuri gamocdilebis Tanaxmad, msgavs SemTxvevebSi moqmedeba. randomizebuli kvleviT Seadares ori
ekT mkurnalobas xSirad mohyveba simptomebis jgufi (Tohen et al., 2003). erT jgufs utardeboda
mniSvnelovani gaumjobeseba, rac mkurnalobis mkurnaloba olanzapiniT, xolo meores _ olanzapiniTa
medikamentebiT gagrZelebis saSualebas iZleva. ekT-s da fluoqsetiniT. Seiswavles bipolaruli depresiis
gamoyeneba SeiZleba efeqturi iyos Sereuli afeqturi mqone 833 pacienti da naxes, rom remisiis saukeTeso
mdgomareobis dros, rodesac depresiuli simptomebi maCvenebeli olanzapin-fluoqsetinis jgufSi
mkveTradaa gamoxatuli. dafiqsirda (48.8%). mxolod olanzapiniT mkurnalobisas
depresiuli aSlilobis simptomebze dakvirveba remisia _ 32.8%-Si, xolo placebos SemTxvevaSi _ 24,
nebismieri saxis mkurnalobisas unda gagrZeldes. 5%-Si iqna miRweuli. maniakaluri mdgomareobebis
unda gvaxsovdes, rom gardamavali, magram, amave dros, ganviTarebis sixSiriT es jgufebi erTmaneTisgan ar
Rrma depresiuli guneb-ganwyoba, rasac Tan axlavs gansxvavdebodnen (bipolaruli depresiis mkurnalobis
depresiuli ideebi, maniakaluri mdgomareobebis dros Sesaxeb informaciis misaRebad ix. Frangou, 2005).
Cveulebrivi movlenaa (ix. Sereuli mdgomareobebi, gv.
224 ??). klinikuri suraTi SeiZleba swrafad Seicvalos recidivebisa da rekurentulobis prevencia
da ganviTardes xangrZlivi depresiuli epizodi. xangrZlivi mkurnaloba
aseT dros ar aris gamoricxuli suiciduri ideebis maniakaluri epizodi, SesaZloa, ramdenime Tve
ganviTareba. Tuki ganviTarda depresiuli mdgomareoba, gagrZeldes; amitom iseve, rogorc depresiis
aucilebelia saTanado mkurnalobis Catareba.
_ 282 _
maniis marTva
SemTxvevaSi, sasurvelia mkurnalobis xangrZlivad, arsebobs Cveneba, rom bipolaruli darRvevis dros
sul mcire 6 Tvis manZilze Catareba. mkurnaloba liTiumis gamoyeneba amcirebs suicidis risks.
unda Semcirdes da Sewydes mxolod mas Semdeg, Tuki liTiumis gamoyeneba Semdgomi epizodebis pre
8 kviris ganmavlobaSi pirovnebas maniakaluri niSnebi venciis mizniT ganxilulia 560-e ?? gverdze.
aRar aReniSneba. gansakuTrebuli sifrTxiliT unda liTiumiT mkurnlobisas gasaTvaliswinebelia ori
Sewydes liTiumis miReba (magaliTad, kviraSi ara mniSvnelovani sakiTxi: pirveli _ unda gaisinjos
umetes 100 mg-isa), radgan ucbad Sewyvetam SesaZloa pacienti da regularuli intervalebiT Semowmdes
maniis `ganaxleba~ gamoiwvios (Goodwin, 2003). plazmaSi liTiumis, Tirkmlisa da farisebri jirkvlis
funqciebi; meore _ zogierTi pacienti Tavad wyvets
profilaqtikuri mkurnaloba
liTiumis miRebas, radgan eSinia misi xangrZlivi
medikamentebi miRebiT gamowveuli gverdiTi movlenebis da aqvs
rogorc vnaxeT, bipolarul aSlilobebs upiratesad `gasadavebis~ subieqturi gancda. liTiumis miRebis
rekurentuli mimdinareoba axasiaTebs. pacientebs swrafi Sewyveta zrdis recidivis ganviTarebis risks.
aReniSnebaT depresiuli da maniakaluri epizodebi, amitom, pacientebs unda avuxsnaT, rom liTiumis
Tumca, calkeul SemTxvevebs gansxvavebuli paternebi Sewyveta unda moxdes TandaTanobiT da mkacri
axasiaTebs. profilaqtikuri mkurnalobis Catareba monitoringis qveS. dispanseruli dakvirvebisa da
rekomendebulia im pacientebisTvis, romlebsac 5 profilaqtikuri mkurnalobis meSveobiT recidivis
wlis manZilze (an nakleb droSi) ori an orze meti riski SeiZleba sagrZnoblad Semcirdes, Tumca,
epizodi ganuviTardaT. gansakuTrebiT maSin, rodesac guneb-ganwyobis meryeoba mainc aRiniSneba. aseTi
avadmyofuri mdgomareoba pirovnebisTvis saSiSi da meryeoba xSirad moiTxovs antidepresantebiTa an
safrTxis Semcvelia. es, Cveulebriv, guneb-ganwyobis antifsiqozuri medikamentiT damatebiT mkurnalobas.
stabilizatorebiT grZelvadian mkurnalobas guli liTiumze arasakmarisi pasuxis SemTxvevaSi, SeiZleba
sxmobs. guneb-ganwyobis stabilizatorebis daniSvna. miuxe
bipolaruli aSlilobis mqone pirebi xSirad davad imisa, rom gverdiTi movlenebis riski Se
uars amboben medikamentebis xangrZlivad miRebaze. iZleba gaizardos, dasaSvebia guneb-ganwyobis sta
amis bevri mizezi arsebobs, amitom mniSvnelovania bilizatorebis kombinaciis gamoyenebac.
pacientTan saubari da misi mosazrebebisa da swrafad cirkulirebadi aSliloba. bipolaruli
Sexedulebebis gaTvaliswineba. sayuradRebo piradi aSlilobis mqone zogierT pacients uviTardeba
gamocdileba gagviziara jamisonma (2003). misi azriT, swrafad cirkulirebadi guneb-ganwyobis aSliloba (gv.
uaris Tqmis mizezi SeiZleba iyos is, rom: 224 ??). zogjer am aSlilobas aSkarad antidepresantebi
iwvevs; am dros umjobesia antidepresantis Sewyveta.
w pacientebs uWirT qronikuli daavadebis diagnozisa
swrafad cirkulirebadi aSliloba xSirad moiTxovs
da xangrZlivi mkurnalobis aucileblobis aRiareba.
guneb-ganwyobis stabilizatorebiT kombinirebul
Zalian mniSvnelovania stigmasTan dakavSirebuli
mkurnalobas da drodadro atipiuri antifsiqozuri
sakiTxebi.
medikamentebis daniSvnas. iTvleba, rom rezistentul
w arsebuli mosazreba imis Taobaze, rom pirovnebas SemTxvevebSi efeqturia triiodTironinis maRali
wamlebis gareSec SeuZlia Tavisi guneb-ganwyobis doziT daniSvna (damatebiTi informacia ix. Mackin and
marTva da am mizniT medikamentebis gamoyeneba Young, 2004).
mxolod pirovnul sisusteze mianiSnebs.
w pacientebs eSiniaT, rom medikamentebi gamoiwvevs fsiqo-socialuri midgomebi
emociur gasadavebas. zog SemTxvevaSi guneb- bipolaruli aSliloba xSir SemTxvevaSi xasiaTdeba
ganwyobis stabilizatorebi garkveulad aqveiTebs qronikuli mimdinareobiTa da avadobis maCvenebliT.
sixarulis gancdasa da SemoqmedebiT unars. es fsiqo-socialur funqciebTan dakavSirebuli prob
ukanaskneli, hipomaniis SemTxvevaSi, medikamenturi lemebi bevr sferoSi iCens Tavs:
mkurnalobiT qveiTdeba, rasac pacienti ise w diagnozTan da, aqedan gamomdinare, cxovrebis axal
aRiqvams, rogorc mniSvnelovan danakargs. amitom wesTan Segueba;
mniSvnelovania mdgomareobis dabalanseba da dep
w interpersonaluri da colqmrul urTierTobaTa
resiuli epizodis prevencia.
sirTuleebi;
britaneTSi liTiumi ganixileba guneb-ganwyobis
w profesiuli saqmianobis problemebi;
pirvel stabilizatorad, Tumca, amerikaSi, misi
w fsiqoaqtiuri nivTierebebis borotad gamoyeneba;
amtanobis gamo, valproati ufro popularulia.
miuxedavad amisa, ar aris sakmarisad dasabuTebuli w medikamentebis miRebasTan dakavSirebuli prob
misi xangrZlivi profilaqtikuri efeqti. amasTan, lemebi.
_ 283 _
boqsi 11.10 fsiqologiuri midgomebi damatebiTi literatura

bipolaruli aSlilobebis dros Griez EJ, Faravelli C, Nutt DJ, Zohar J (2005) Mood disorders:
w cxovrebis wesis Sesaxeb rCevis micema (mniSvnelovania clinical management and research issues. John Wiley,
Zilis reJimis dacva; dauSvebelia fsiqoaqtiuri Chichester. (saxelmZRvanelo klinikuri kvlevebisa da
nivTierebebis moxmareba);
guneb-ganwyobis aSlilobis marTvis kompleqsuri
w recidivis gamomwvevi mizezebis droulad gamovlena
midgomebiT)
da profilaqtika (magaliTad, Zilis darRvevebis
ganviTareba, fsiqoaqtiuri nivTierebebis moxmareba); Kraepelin, E (1921) Manic-depressive insanity and paranoia
w recidivis adreuli subieqturi niSnebis amocnoba (transl. R. M. Barclay), Churchill Livingstone, Edinburgh,
(magaliTad, mousvenrobis gancda, Zilis darRvevebi)
da Sesabamisi moqmedebis gegmis SemuSaveba;
pp. 1_164. Reprinted in 1976 by Arno Press, New York. (kla-
sikuri angariSi. gansakuTrebiT sayuradReboa aR-
w fsiqoganaTleba mkurnalobis mniSvnelobis Taobaze.
preparatebis gverdiTi movlenebis mimarT Sesabamisi wera ganukurnebeli maniisa, romelic dRes iSvia-
yuradRebis miqceva da maTi Sesamcireblad aqtiuri Tiad gvxvdeba).
zomebis miReba.
Jamison, KR (1997) An unquiet mind. Picador, London.
am problemebis mogvarebaSi gvexmareba fsiqolo (araCveulebrivi avtobiografia bipolaruli mdgo-
giuri mkurnalobis meTodebi. romlebic iyeneben mTel mareobisa da misi mkurnalobis gamocdilebis aR-
rig Teoriul midgomebs. maTi simravlis miuxedavad, weriT)
yvela Terapia iTvaliswinebs fsiqoganaTlebas Lewis, AJ (1934) Melancholia: a clinical survey of depressive
da sakuTari Tavis marTvis unarebis gaZlierebas states. Journal of Mental Science 80, 277_378. Reprinted
(Goodwin, 2003) (boqsi 11.11). in Lewis, AJ (1967) Inquiries in Psychiatry, Routledge and
miuxedavad imisa, rom arsebobs bipolaruli Kegan Paul, London, pp. 30_117. (es SesaniSnavi kvleva
aSlilobebis efeqturi medikamenturi mkurnaloba, Seicavs depresiuli aSlilobis klinikuri suraTis
klinikuri praqtikis Sedegebi yovelTvis damaimedebeli detalur aRweras)
ar aris. fsiqo-socialuri meTodebis gamoyenebam,
savaraudod, unda gaaumjobesos mkurnalobis saerTo
done. imedismomcemia am mimarTulebiT Catarebuli
winaswari randomizebuli kvlevebi (Goodwin, 2003).
_ 284 _
Tavi 12 Sizofrenia
Tavis Sinaarsi
klinikuri niSnebi Tanamedrove etiologiuri
mwvave sindromi hipoTezebi Sizofreniis Sesaxeb
qronikuli sindromi mimdinareoba da prognozi
Sizofreniis tipebi mkurnaloba
klinikuri sindromis sxva aspeqtebi antifsiqozuri preparatebi
diagnostika da klasifikacia antidepresantebi da guneb-ganwyobis
Sizofreniis Sesaxeb arsebuli stabilizatorebi (normoTimikebi)
mosazrebebis istoriuli mimoxilva eleqtrokrunCxviTi Terapia
Sizofrenia fsiqosocialuri midgomebi
Sizofreniis klasifikacia daavadebis marTva
ICD-10-isa da DSM-IV-is mixedviT mwvave mdgomareoba
Sizofreniismagvari aSlilobebi antifsiqozuri preparatebis arCeva
diferencialuri diagnozi Semdgomi movla `kargi prognozis~
epidemiologia SemTxvevaSi
etiologia gamoxatuli daqveiTebis mqone cudi
mimoxilva prognozis pacientebis Semdgomi movla
genetika pacientebi `cudi prognoziT~
garemo risk-faqtorebi da gamoxatuli daqveiTebiT
Tavis tvinis struqturuli cvlilebebi daavadebis marTvis sxva sakiTxebi
cerebruli sisxlis nakadi sxva sakiTxebi
neiroqimiuri monacemebi qalebi da Sizofrenia
neirofiziologiuri monacemebi rasobrivi gansxvaveba da Sizofrenia
socialuri da fsiqosocialuri faqtorebi Sizofreniis Sesaxeb saubari
fsiqologiuri faqtorebi pacientebTan da maT axloblebTan
fsiqozuri aSlilobebidan yvelaze rTulia Sizofre- tomebia: bodva, halucinacia da ideatoruli avtoma-
niis gansazRvra da aRwera. amas, ZiriTadad, ganapi- tizmi (ix. cxrili 12.1). am simptomebs xSirad poziti-
robebs is faqti, rom 100 wlis manZilze sxvadasxva ur simptomebs uwodeben. zogi pacienti gamodis am mw-
qveyanaSi sxvadasxva fsiqiatris mier sruliad gansxvave mdgomareobidan an daavadeba gadadis qronikul
vavebuli koncefciebi iyo Seqmnili da SemoTavazeb- formaSi. qronikuli formisTvis damaxasiaTebeli
uli. dRes ZiriTad sakiTxebze SeTanxmeba miRweulia, simptomebi Zalian gansxvavebulia: apaTia, motivaciisa
Tumca, garkveuli uzustobebi bevr problemasTan dada interesebis nakleboba, socialuri izolacia. am
kavSirebiT mainc arsebobs. Sizofrenia kvlav rCeba im simptomebs negatiur simptomebs uwodeben da maTi
fundamentur sakiTxTa krebulad, romelTa gadaWra- ganviTarebis Semdeg pacientTa Zalian mcire nawili
sac fsiqiatrebi dRemde cdiloben: daavadebis konce- gamodis mdgomareobidan. daavadebis orive fazaSi
fcia, klasifikacia da etiologia. SesaZlebelia afeqturi da sxva simptomebis ganviTa-
sirTulidan gamomdinare, saubars daviwyebT ori rebac (gv. 271).
bazisuri koncefciis ganxilviT _ mwvave Sizofre-
nia da qronikuli Sizofrenia. unda gvaxsovdes, rom klinikuri niSnebi
es idealuri aRwera da ganmartebaa, Tumca sakiTxis
am wignis mkiTxvels, savaraudod, wakiTxuli unda
amgvarad gamartiveba dagvexmareba ukeT gavigoT gan-
hqondes pirveli da mesame Tavebi, romlebSic mocemu-
sxvavebuli mosazrebebi.
lia SizofreniisTvis damaxasiaTebeli kardinaluri
mwvave Sizofreniis ZiriTadi damaxasiaTebeli simp-
niSnebisa da simptomebis ganmarteba.
_ 285 _
12 Sizofrenia
cxrili 12.1 mwvave SizofreniisTvis boqsi 12.1 amonaridi mwvave Sizofreniis

damaxasiaTebeli yvelaze xSiri simptomebi mqone pacientis istoriidan
simptomi sixSire (%) 20 wlis axalgazrda, manamde janmrTeli mamakaci,

ucnaurad iqceva. periodulad brazdeba da eubneba
kritikuli damokidebulebis (insaiTis) ar qona 97 megobrebs, rom dasdeven. zogjer TavisTvis umizezod
icinis. ramdenime Tvea moculia mzardi intensivobis
smeniTi halucinaciebi 74 gancdebiT. misi akademiuri moswreba dabalia. eqimTan
damokidebulebis azrebi 70 saubrisas mousvenari da dabneulia. ambobs, rom esmis
komentaris Semcveli da Seuracxmyofeli xmebi. mas
undobloba 66 sjera, rom policia da universitetis pedagogebi mis
winaaRmdeg awyoben SeTqmulebas da surT, rom momwamlavi
emociuri gasadaveba 66 airiT imoqmedon mis tvinze da amouRon azrebi. igi, aseve,
darwmunebulia, rom sxvebs SeuZliaT misi azrebis kiTxva.
xmebi, romlebic pacients esaubrebian 65
bodviTi gunebganwyoba 64 ZliaT misi (pacientis) fsiqozebis gageba-amocnoba.

devnis bodva 64
garegnoba da qceva SizofreniiT daavadebul zo-
gierTi pirs SeiZleba sruliad Cveulebrivi hqondes,
azrTa gaucxoeba 52
pacientTa nawili ki iyos Secvlili, Tumca, SeiZleba
xmamaRali azrebi 50 garegnoba yovelTvis ar miuTiTebdes fsiqozze. isi-
wyaro: msoflio jandacvis organizacia (1973) ni, SesaZloa, moculni iyvnen TavianTi garegnobasa da
janmrTelobaze zrunviT, religiuri ideebiT an sxva
mwvave sindromi intensiuri gancdebiT. socialuri izolacia vlinde-
boqsSi 12.1 mocemulia informacia mwvave Sizofre- ba, magaliTad, imiT, rom pirovneba sakuTar oTaxSia
niisTvis damaxasiaTebeli ramdenime niSnis Sesaxeb: Caketili an, zogjer, gaunZrevlad wevs sawolSi. zogi
gamoxatuli devnis bodva, romelsac Tan axlavs halu- pacienti umizezod icinis an tiris. zogierTi TiTqos
cinaciebi, TandaTanobiT ganviTarebuli socialuri mudmivad Secbunebuli da gaognebulia, zogi _ mous-
izolacia, samsaxureobrivi movaleobebis Sesrulebis venari da xmauriani, zogi pacienti SeiZleba moulod-
gauareseba da ucnauri azrebi, rom sxva adamianebs Seu- nelad araadekvaturad moiqces.
azrovnebisa da asociaciuri procesis darRvevebi
aisaxeba metyvelebaSi. adreul stadiaze pacientis
cxrili 12.2 qronikuli SizofreniisTvis
metyveleba bundovania da xSirad Znelia naTqvamidan
damaxasiaTebeli niSnebis sixSire
saerTo azris gamotana. zogs uWirs abstraqtuli az-
niSnebi sixSire (%) rovneba. zogi pacienti moculia fsevdomecnieruli
socialuri izolacia 74 an mistikuri azrebiT. azrovnebis darRvevebis gamw-
vavebisas asociaciuri procesis ori damaxasiaTebeli
daqveiTebuli aqtivoba 56
paTologia vlindeba: asociaciuri nakadis darRveve-
saubris iSviaTad warmarTva 54 bi SenelebiT, aCqarebiTa an blokirebiT, (rac me-15
interesTa sferos SezRudva 50 gverdzea aRwerili), an daukavSirebeli asociacie-
Seneleba 48
bi. am dros aRiniSneba alogia (magaliTad, `mxedris
svla~) an kiTxvis sibrtyeSi saubari (Vorbeireden). Za-
zedemti aqtivoba 41
lian mwvave SemTxvevebSi darRveulia metyvelebis
ucnauri azrebi 34 Tanmimdevrobac da struqturac (sityvieri salaTi,
depresia 34 verbigeracia). pacientebi sityvebSi xSirad sxva Si-
naarss deben (metonimia an parafazia), SesaZlebelia
ucnauri qceva 34
axali sityvebis warmoqmnac (neologizmi).
garegnobis ugulebelyofa 30 xSiria guneb-ganwyobis aSlilobebi da ZiriTadad
ucnauri poza da moZraobebi 25 sami saxiT vlindeba: (1) aRiniSneba gamoxatuli dar-
Rvevebi SfoTvis, depresiis, gaRizianebis an eiforiis
Zaladobis saSiSroeba 25
saxiT; (2) emociuri gasadaveba, rodesac dominirebs
kvebiTi Cvevebis gauareseba 13
emociuri indiferentuloba an daqveiTebulia emoci-
socialurad miuRebeli qceva 8 uri pasuxi (gv. 5); (3) afeqtis inkongruentuloba (Seu-
ucnauri seqsualuri qceva 8 sabamo afeqti), rodesac pacientis emociebi ar See-
sabameba situacias an Tavad pacientis gancdebs (gv. 5).
suicidis mcdeloba 4
yvelaze xSiri damaxasiaTebeli simptomebia smeniTi
Seukavebloba 4 halucinaciebi. pacients esmis xmauri, musika, calkeu-
_ 286 _
klinikuri niSnebi
li sityvebi, mokle frazebi an mTeli saubari. xmebma
boqsi 12.2 amonaridi qronikuli
SesaZloa ar Seawuxos pacienti an SeiZleba gamoiwvi-
Sizofreniis mqone pacientis istoriidan
os Zlieri distresi. zogjer pacients esmis xmamaRla
saSualo asakis mamakaci cxovrobs usaxlkaroTa TavSe-
naTqvami sakuTari azrebi gafiqrebisTanave (Gedanken-
safarSi da dadis TavSesafris saxelosnoSi. ZiriTadad
lautwerden) an uSualod gafiqrebis Semdeg (echo de la ganmartoebulia, dauvarcxneli da gauparsavia.
pensee). zogjer xma mesame pirTan erTad msjelobs da Tavs mxolod sxvebis miTiTebiT iwesrigebs. misi
komentars ukeTebs pacientis qcevas. Semdgom naCvene- socialuri qceva ucnauri da arabunebrivia. metyveleba
Senelebulia, azrebi bundovani da daukavSirebeli.
bi iqneba, rom bolo sami simptomi gansakuTrebiT emociurad gasadavebulia. ramdenime wlis manZilze
mniSvnelovania diagnostikuri TvalsazrisiT. mxed- pacientis mdgomareoba praqtikulad ucvlelia, garda
velobiTi halucinaciebi iSviaTia da, upiratesad, xanmokle mwvave periodebisa, romlis drosac igi arRvevs
sacxovreblis mSvid garemosa da mcxovrebTa simyudroves.
aRmocendeba sxva saxis halucinaciebTan erTad. zog
pacients aReniSneba taqtiluri, ynosviTi, gemovnebi- daqveiTeba, rac vlindeba imaSi, rom izRudeba moti-
Ti da somaturi halucinaciebi. maTi interpretacia vaciisa da interesTa sfero. Tavis nebaze mitovebuli
xSirad bodviTia. magaliTad, usiamovno halucinaci- pacienti xangrZlivi drois ganmavlobaSi SeiZleba sru-
uri SegrZnebebi mcire menjSi, SeiZleba aRqmul iqnes liad umoqmedo iyos an akeTebdes ganmeorebad, umizno
mdevnelis seqsualur zemoqmedebad. saqmes. igi, upiratesad, ganmartoebulia, rac ise auare-
SizofreniisTvis damaxasiaTebelia bodvebi. pirve- sebs mis socialur qcevas, rom xSirad iwvevs irgvliv-
ladi bodva (gv. 10) naklebad gvxvdeba da Znelia maTi myofebis gaognebas. pacienti SeiZleba saTanadod ver
gamovlena. bodva SeiZleba aRmocendes e.w. pirveladi uvlides Tavs. Cacmuloba, gansakuTrebiT qalebis, Sei-
bodviTi guneb-ganwyobis (Wahnstimmung, gv. 10) niadagze. Zleba iyos saguldagulod SerCeuli, magram raRaciT
xSiria devnis bodva, magram igi araspecifikuria Sizo- uCveulo. zogi pacienti agrovebs da imaragebs nivTebs,
freniisTvis. marTalia, naklebi sixSiriT gvxvdeba, ma- ris gamoc maTi sacxovrebeli adgili gadatenili da
gram gansakuTrebuli diagnostikuri mniSvneloba aqvs binZuria. sxvebi arRveven sazogadoebis myudroebas
damokidebulebisa da kontrolis bodvasa da azrebis ucxo pirTan intimuri saubris gabmiTa an xmamaRali yvi-
mikuTvnebis bodvas; am ukanasknels SeiZleba mivakuT- riliT. aseTi qceva SeiZleba gauuaresdes moxucebul
vnoT azrebis Canergva, amoReba an gadacema (gv. 12). pacientebs kognituri daqveiTebis Sedegad.
insaiTi (krtikuli damokidebuleba daavadebis metyveleba darRveulia da asaxavs azrovnebis pa-
mimarT), rogorc wesi, darRveulia. pacientebis um- Tologias, rac mwvave mdgomareobaSic vlindeba. emo-
ravlesoba uaryofs, rom maTi gancdebi daavadebis ciebi, Cveulebriv, gasadavebulia, xolo emociis ar-
Sedegia. miaCniaT, rom maT mdgomareobas arakeTilmo- sebobisas, upiratesad, aRiniSneba inkongruentuloba
surne adamianebis qmedebebi iwveven. (Seusabamoba). xSiria, Tumca yovelTvis ar gvxvdeba,
orientacia, Cveulebriv, Senaxulia. Tumca, az- halucinaciebi da bodvebi. am simptomebis arsebobisas
rovnebis procesis gamoxatuli aSlilobis dros an, pacients maT mimarT umniSvnelo emociuri damokideb-
rodesac pacienti mTlianad moculia Tavisi fsiqo- uleba aqvs. magaliTad, pacienti darwmunebulia, rom
zuri gancdebiT da ver mihyveba interviueris kiTx- devnian, magram arc eSinia da arc brazobs.
vebs, Znelia amis gansazRvra. viTardeba sxvadasxva motoruli darRvevebi: ste-
Cven vaCveneT, Tu raoden mravalferovani SeiZleba reotipia, manerizmi an sxva katatonuri simptomebi
iyos klinikuri suraTi. Zalian iSviaTad aRiniSneba da diskineziebi (gv. 16, Hamilton, 1984). diskineziebi
yvela es simptomi. zog pacients daavadebis sawyis upiratesad, magram ara yovelTvis, antifsiqozuri
etapzec SeiZleba ganuviTardes negatiuri simptoma- preparatebis xangrZlivi miRebis Sedegad viTardeba
tikac. diagnozis dasmisas mxedvelobaSi unda mivi- (gv. 534).
RoT daavadebis paternebi, xangrZlivoba da Tavise- qronikuli Sizofreniis dros iseve, rogorc mwvave
burebebi, rac momdevno TavSi iqneba ganxiluli. Sizofreniis SemTxvevaSi, simptomebi da daavadebis
niSnebi didi mravalferovnebiT gamoirCeva. nebis-
qronikuli sindromi mier safexurze SeiZleba ganviTardes an gamwvavdes
mwvave sindormis `pozitiuri~ simptomebisgan gansx- pozitiuri simptomatika, risi mizezic SeiZleba iyos
vavebiT, qronikul sindroms axasiaTebs `negatiuri~ mkurnalobis Sewyveta an cxovrebiseuli movlenebi.
simptomebi, rogorebicaa daqveiTebuli aqtivoba, mo-
tivaciisa da interesebis nakleboba, emociuri gasa- Sizofreniis tipebi
daveba da azrovnebis darRvevebi (boqsi 12.2). ZiriTadi klinikuri suraTis mixedviT, Sizofrenia
es CamonaTvali moicavs zogierT negatiur simptoms, ramdenime qvetipad iyofa:
romelsac xSirad `defeqtur mdgomareobad~ moixse- w paranoiduli Sizofrenia yvelaze gavrcelebuli
nieben. yvelaze gamoxatuli Taviseburebaa nebelobis
_ 287 _
12 Sizofrenia
formaa. misTvis, umetesad, damaxasiaTebelia sis aTeblebis mixedviT Sizofreniis sxvadasxva tipebad
tematizebuli devnis bodva Sesabamisi Sinaarsis dayofis mcdeloba. ori TvalsaCino magaliTi qvemo-
smeniTi halucinaciebiT. asociaciuri procesis Taa moyvanili.
aSliloba, afeqturi, katatonuri da negatiuri sim
Sizofrenia _ tipi I da tipi II
ptomebi ar aris gamoxatuli. pirovneba SedarebiT
kargad gamoiyureba. daavadeba iwyeba gviandel qroum (Crow, 1985) klinikur da neirobiologiur maxa-
asakSi da ukeTesi prognozi aqvs, vidre sxva tipis siaTeblebze dayrdnobiT Sizofreniis ori sindromi
Sizofrenias. aRwera. pirvel tips axasiaTebs mwvave dasawyisi, upi-
ratesad, pozitiuri simptomebi da Senaxuli social-
w hebefrenuli Sizofrenia aseve cnobilia dezor
uri funqcionireba remisiis periodSi. damaxasiaTe-
ganizebuli Sizofreniis saxelwodebiT. am for
belia antifsiqozur mkurnalobaze dadebiTi pasuxi
misTvis damaxasiaTebelia azrovnebisa da emociuri
da bioqimiurad dadasturebuli dofaminis hiperaq-
sferos paTologia. guneb-ganwyoba cvalebadia,
tivoba. amis sapirispirod, meore tipis Sizofrenia
xolo qcevebi umetesad moulodneli da aSkarad
iwyeba TandaTanobiT, upiratesad, negatiuri simptom-
`suleluri~. bodvebi da halucinaciebi perioduli
ebiT. antifsiqozuri mkurnaloba xSirad araefeqtu-
da arsistematizebulia. xSiria maneruloba, met
ria. dofaminis hiperaqtivoba ar dasturdeba, Tumca
yveleba qaoturi da daukavSirebelia. negatiuri
aris struqturuli cvlilebebi Tavis tvinSi (gansa-
simptomebi adre iCens Tavs da ganapirobebs cud
kuTrebiT parkuWepis dilatacia). klinikuri praqtika
prognozs.
gviCvenebs, rom zogi pacienti SeiZleba mivakuTvnoT
w katatonuri Sizofreniis yvelaze TvalsaCino Tavi
pirvel tips, meore tipis SemTxvevebi SedarebiT na-
seburebaa motoruli simptomebi (gv. 16). motoruli
klebia, xolo umetesobas Sereuli niSnebi aqvs. Sem-
aqtivoba icvleba agznebidan stuporamde. SesaZ
dgomi kvlevebi naklebad amyarebs am modeliT Semo-
lebelia sizmrisebri (oneroiduli) mdgomareobis
Tavazebul neirobiologiuri dayofis principsa da
ganviTarebac. Sizofreniis es forma gavrcelebuli
korelaciebs. miuxedavad amisa, Tavis droze es mosaz-
iyo warsulSi; dRes ganviTarebul qveynebSi Seda
reba Zalian mniSvnelovani iyo, Sizofreniis neirobi-
rebiT iSviaTia, rac SeiZleba aixsnas daavadebis
ologiur aspeqtebze yuradRebis mipyrobis Tvalsaz-
bunebis SecvliT, mkurnalobis gaumjobesebiT an
risiT.
warsulSi organuli katatoniis araswori diag
nostikiT. sami klinikuri sindromi
w martivi Sizofrenia iwyeba `Semparavad~ da axasiaTebs bolo drois kvlevebi gvTavazobs fsiqopaTologiis
ucnauri qceva, socialuri izolacia da Sromis ufro kompleqsur gansazRvrebasa da korelatebs.
unaris daqveiTeba. bodvebi da halucinaciebi ga yvelaze TvalsaCino am mxriv lidlis (Liddle, 1987) kv-
moxatuli ar aris. radgan am formis dros Si levaa. igi swavlobda qronikuli Sizofreniis mqone
zofreniisTvis damaxasiaTebeli simptomebis gamov pirebs da gamoavlina urTierTgadamfaravi sami
lena Zalian rTulia, es diagnozi iSviaTad daismis. klinikuri sindromi, romlebsac uwoda realobis dam-
w aradiferencirebuli Sizofrenia aRniSnavs iseT axinjeba, dezorganizacia da fsiqomotoruli gaRari-
SemTxvevebs, romelTac arc beba (cxrili 12.3). Tanamedrove kvlevebi adasturebs
am monacemebs. lidlim miusadaga simptomTa es klas-
erTi diagnozi ar miesadageba an romelTa drosac
terebi neirofsiqologiuri deficitis paternebs da
yvela formisTvis damaxasiaTebeli niSnebi Tabnabrad-
regionalur cerebrul sisxlis nakads (Liddle et al.,
aa gamoxatuli. momdevno ori kategoria axlaxans gam-
1992). yvelaze xSiri dublirebuli aRmoCenaa kavSiri
oyves. rezidualuri Sizofreniis diagnozi daismis
fsiqomotorul gaRaribebas, Sublis wilis amocanebis
maSin, rodesac, sul cota, erTi wlis manZilze, pa-
gauaresebul Sesrulebasa da frontaluri sisxlis
cients aReniSneba mxolod negatiuri simptomebi da
nakadis Semcirebas Soris.
pozitiuri simptomebis recidivebi ar aRiniSneba.
deficituri sindromi ewodeba Sizofreniis qvetips,
klinikuri sindormis sxva aspeqtebi
romelsac axasiaTebs adre ganviTarebuli, gamoxatu-
li da persistentuli negatiuri simptomebi (Carpenter depresiuli simptomebi
et al., 1988). krepelinis droidan cnobilia, rom depresia SeiZle-
yvela es forma ufro aRwerilobiTia da ar ganasx- ba Sizofreniis nebismier stadiaze ganviTardes. igi
vavebs realurad Sizofreniis sxvadasxva sindroms, SeiZleba win uZRodes gamoxatuli pozitiuri simp-
Tumca paranoidul Sizofrenias SeiZleba marTlac tomebis ganviTarebas. amasTan, pacientTa daaxloe-
hqondes gansxvavebuli (da naklebi) genetikuri dat- biT meoTxeds aReniSneba persistentuli depresia,
virTva. arsebobs Sizofreniis biologiuri maxasi- romelsac postSizofreniuli depresia ewodeba.
_ 288 _
klinikuri niSnebi
cxrili 12.3 simptomTa sami klasteris cerebruli da fsiqologiuri korelatebi

sindromi simptomi regionaluri cerebruli sisxlis fsiqologiuri testis
nakadis korelacia Sesrulebis deficiti
sinamdvilis bodva, halucinacia marcxena medialur temporaluri wili, TviTmonitoringis

damaxinjeba sartylisebri xveulis qerqi darRvevebi
dezorganizacia asociaciuri procesis sartylisebri xveulis wina nawili, seleqciuri yuradRebis

aSliloba, Seusabamo afeqti, marjvena ventralur frontaluri daqveiTeba
ucnauri qceva korteqsi, bilateraluri
parietaluri ubani
fsiqomotoruli gasadavebuli afeqti, sponta frontaluri korteqsSi daqveiTebuli sityvebis ganzogadebis

gaRaribeba nuri moZraobebis Semcireba aqtivoba testi dagegmvis testebi
Sizofreniisa da depresiis kavSiris ramdenime veiTebuli inteleqtualuri maCvenebeli. daavadebis

mizezi arsebobs: ganviTarebas mosdevs Semdgomi kognituri gauareseba,
w depresia SeiZleba iyos Sizofreniis integrirebuli romelic nawilobriv aRdgeba mwvave epizodidan
nawili. amas adasturebs is faqti, rom pacientTa gamosvlis Semdeg. kognituri funqciebis deficiti
50%-s mwvave mdgomareobaSi aReniSneba gamoxatuli ufro winaganwyobis (trait) markeria da ara mdgomareobis
depresiuli simptomebi; fsiqozis CaTavebasTan er- (state) da mniSvnelovnad damoukidebelia sxva, daa
Tad mdgomareoba umjobesdeba; vadebisTvis damaxasiaTebeli simptomebisagan. 70
wlisTvis pacientTa garkveul nawils aReniSneba Rrma
w postfsiqozur fazaSi depresiul simptomebs Sei-
kognituri darRvevebi, bunebiT alchaimeris demenciis
Zleba ganapirobebdes insaiTis gaumjobeseba, rode-
msgavsi, magram damaxasiaTebeli nevropaTologiuri
sac pacienti acnobierebs daavadebis bunebasa da
niSnebi ar aris gamovlenili.
masTan dakavSirebul sirTuleebs. aseTi mdgomareo-
sxva niSnebis msgavsad, kognituri deficiti, oRond
bac droebiTia da ganzogadebisTvis ver gamodgeba;
naklebi xarisxiT, pacientis janmrTel naTesavebsac
w depresia SeiZleba warmoadgemdes antifsiqozuri aReniSnebaT, rac genetikur winaganwyobaze miuTi
mkurnalobis gverdiT efeqts. esec ver iqneba Tebs.
erTaderTi axsna, vinaidan depresia SeiZleba ganvi- ukanasknel dros kognituri darRvevebi aqtualuri
Tardes aranamkurnaleb pacientebSic. Semdegi mizezebis gamo gaxda: (1) cudi prognozis
Sizofreniis dros arsebuli depresiuli simptom- ZiriTadi ganmsazRvreli kognituri darRvevebia
ebi ar unda agverios motorul gverdiT movlenebSi (Green et al., 2000); (2) amJamad Sizofreniis mkurnalobis
an negatiur simptomebSi. maT Soris gansxvaveba mniS- ZiriTad samiznes warmoadgens (gv. 300); 3.arsebobs
vnelovani, magram Znelad dasadgenia. depresiasa da mzardi monacemebi imis Sesaxeb, rom kognituri
Sizofrenias Soris urTierTkavSiris mimoxilva ix. Taviseburebebi Sizofreniis ZiriTadi, bazisuri
malholandisa da kuperis naSromi (Malholland and Coo- simptomebi an endofenotipia (gv. 284). kognituri
per, 2000) darRvevebis mniSvnelobidan gamomdinare, SemuSavda
kvlevis meTodebi, romlebic yoveldRiur praqtikaSi
kognituri niSnebi
maTi swrfad Sefasebis saSualebas iZleva (magaliTad,
kognituri darRvevebi Sizofreniis mniSvnelovani, neirofsiqologiuri statusis Sefasebis ganmeorebadi
magram ugulebelyofili komponentia (Sharma and batarea RBANS; Gold et al., 1999).
Harvey, 2000, Goldberg et al., 2003). kognituri darRvevebi
mexsierebisa da daswavlis yvela aspeqtSi vlindeba. nevrologiuri niSnebi
gansakuTrebiT gamoxatulia semantikuri mexsierebis, fsiqiatriis mier aseve ugulebelyofilia Sizo
muSa mexsirebisa da yuradRebis deficiti, romelic, freniis dros nevrologiuri niSnebis arseboba
daaxloebiT 1-2 standartuli deviaciiT ganasxvavebs (Hainrichs and Buchanan, 1988). maT uwodeben `rbil
pacientebs janmrTeli individebisgan. arCveviTad ga niSnebs~, radgan isini ar gansazRvraven konkretul
uaresebuli muSa mexsiereba dafiqsirebulia sxvamxriv traqtSi an birTvSi lokalizebul paTologias. isini
intaqturi neirofsiqologiuri Sesrulebis mqone aerTianeben sensoruli integraciis, koordinaciisa
pacientebSic. da kompleqsuri motoruli aqtebis darRvevebs. aseve,
Sizofreniis dros neirofsiqologiuri maCvene am kategoriaSi SeiZleba gaerTiandes katatonia da
blebis droSi cvalebadoba rTulia da ar aris diskineziebi. nevrologiuri aSlilobebi aRiniSneba
bolomde Seswavlili. im pirebs, romlebsac uviTa aranamkurnaleb, pirvelad pacientebSi (amiT gamij
rdebaT Sizofrenia, ukve skolaSi aReniSnebaT daq nulia antifsiqozuri preparatebis moqmedebis
_ 289 _
12 Sizofrenia
gavlena), Tumca ufro qronikuli SizofreniisTvisaa aTebeli xdeba paranoiduli simptomatika ukeT orga-
damaxasiaTebeli. nevrologiuri niSnebi korelaciaSia nizebuli bodvebiT.
kognitur darRvevebTan, rac miuTiTebs Tavis tvinis inteleqtsac aqvs garkveuli gavlena klinikur
difuzur paTologiasa da ganviTarebis anomaliaze. suraTze. daswavlis darRvevebis dros pacients Se-
es faqti miCneulia imis dasturad, rom Sizofrenia darebiT martivi simptomatika aReniSneba. aseT md-
neiroganviTarebis daavadebaa. Sizofreniis dros nev gomareobas zogjer moixsenieben profSizofreniis
rologiuri simptomebis Sefaseba SeiZleba gakeTdes (pfropfschizophrenie) saxelwodebiT. amis sawinaaRmde-
nevrologiuri Sefasebis SkaliT (Buchanan and god, maRali inteleqtis pirebi Zalian rTul bodviT
Heinrichs, 1989). Temis ufro safuZvliani mimoxilva ix. sistemebs qmnian da bevrad ukeTesad SeuZliaT Tavi-
bombinis naSromi (Bombin et al., 2005). anTi azrebis gadmocema da sxvebis darwmuneba.
klinikur suraTze mniSvnelovani gavlenis mox-
ynosviTi disfunqcia
dena SeuZlia socialuri stimulacii intensivobas.
Sizofreniis mqone pacientebs aqvT ynosviTi funq- arasakmarisi stimulireba negatiur simptomatikas
ciis deficiti, rac sunis identificirebis, sunis aRrmavebs, xolo zedmeti stimulireba xels uwyobs
mimarT mgrZnobelobisa da sunze mexsierebis defi- pozitiuri simptomebis ganviTarebas. Tanamedrove
citiT vlindeba (Moberg et al., 1999). es darRvevebi fsiqosocialuri midgomebi dagegmilia imgvarad, rom
ar aris dakavSirebuli antifsiqozur mkurnalobasa orive ukiduresoba Tavidan iqnes acilebuli. arasak-
da Tambaqos wevasTan. isini ufro TvalsaCinoa def- marisi stimulireba dakavSirebulia institucional-
icitaruli sindromis mqone pacientebTan da ufro izaciasTan, xolo zedmeti stimulireba _ emociebis
gamoxatulia marcxena, vidre marjvena nestoSi, rac gadaWarbebul eqspresiasTan.
miuTiTebs Sizofreniis dros paTologiis lateral-
izaciaze (gv. 284). am niSnis klinikuri mniSvnelobaa
diagnostika da klasifikacia
is, rom es darRvevebi SeiZleba socialuri intere-
sebis naklebobasTan iyos asocirebuli (Malaspina and am nawilSi upiratesad SevexebiT Sizofreniis diag-
Coleman, 2003). nostikur kriteriumebs da Sizofreniis klasifi-
kacias, rogorc es ICD-10 da DSM IV-Sia mocemuli.
wyliT intoqsikacia Tumca, Tanamedrove midgomebisa da problemebis ukeT
Sizofreniis mqone zogi pacienti svams didi raodebiT gageba istoriuli perspeqtivis gaTvaliswinebiTaa
wyals, rac iwvevs wyliT intoqsikaciisTvis damaxasi- SesaZlebeli.
aTebel mdogmareobas poliuriasa da hiponatriemiis
saxiT. mwvave SemTxvevebSi SeiZleba ganviTardes tvi- Sizofreniis Sesaxeb arsebuli mosazrebebis
nis SeSupeba, koma, aseve, ar aris gamoricxuli avad- istoriuli mimoxilva
myofis sikvdilic. wyurvilis mosaklavad pacienti Sizofreniis Sesaxeb arsebul mosazrebaTa ganviTarebis
SeiZleba iyenebdes uvargis wyalsac. am qcevis mizezi istoria mocemulia boqsSi 12.3. farTo gagebiT, masSi
Seswavlili araa. SesaZlo meqanizmebia: saerTo gene- fsiqikuri aSlilobebis ganviTarebis mTeli istoria
tikuri faqtorebi, bodviTi ideebi an hipoTalamusSi aisaxeba, saidanac Cans, rom gasuli saukunis manZilze
mimdinare cvlilebebi, romlebic gavlenas axdenen an- fsiqiatriaSi Sizofreniis Seswavlas centraluri
tidiurezuli hormonis gamoyofaze (ix. Merceir-Guidez adgili ukavia. (ix. Berrios, 2000).
and Loas, 1998). samocian wlebSi gamoiTqva mosazreba, rom terminis _
`Sizofrenia~, xmarebasTan dakavSirebiT gansxvavebuli
faqtorebi, romlebsac aqvT gavlena klinikur
midgomebi arsebobda. es savsebiT gasagebia, im is
Taviseburebebze
toriuli Sexedulebebisa da tradiciebidan ga
socialurma da kulturalurma faqtorebma SeiZleba
momdinare, romlebic 12.3 boqsSia Sejamebuli. ma
gavlena iqonios simptomebis Sinaarsze. magaliTad,
galiTad, inglissa da evropaSi Sizofreniis, da
dRes religiuri Sinaarsis bodviTi ideebi wina sau-
avadebaTa am viwro jgufis, diagnostikisTvis
kunesTan SedarebiT iSviaTia. ufro xSiria kloni-
Snaideris pirveli rigis simptomebi gamoiyeneboda.
rebasTan, kosmosTan da aiv infeqciasTan dakavSire-
aSS-Si, fsiqodinamiuri procesebis mimarT arsebuli
buli bodvebi. asakic, rogorc Cans, gavlenas axdens
interesebidan gamomdinare, diagnozi fsiqikuri
Sizofreniis Taviseburebaze. mozardebsa da axalgaz-
meqanizmebis gaTvaliswinebiT ismeboda da ufro
rdebSi klinikuri niSnebi ufro xSirad vlindeba az-
met SemTxvevebs moicavda. pirveli stacionirebis
rovnebis paTologiiT, guneb-ganwyobis aSlilobebiT,
sixSirec ufro maRali iyo aSS-Si, vidre inglisSi.
avtomatizmebiT, azrTa CanergviTa da socialuri
aseTi gansxvavebis arsebobam ganapiroba ori mniS
izolaciiT. asakis matebasTan erTad, ufro damaxasi-
vnelovani kroskulturaluri kvlevis Catareba
_ 290 _
boqsi 12.3 SizofreniasTan dakavSirebuli kurt Snaideri (Kurt Schneider, 1887-1967) ar unda
koncefciebisa da terminologiis agverios karl SnaiderSi, romelsac ekuTvnis azrovnebis
paTologiis klasifikacia. kurt Snaideri cdilobda
ganviTareba gamoeyo SizofreniisTvis damaxasiaTebeli simptomebi, rac
diagnozis ufro zustad dasmis da misi sxva aSlilobebisagan
me19 saukuneSi arsebobda mosazreba, rom yvela gamorCevis saSualebas mogvcemda. Snaideris pirveli rigis
fsiqikuri aSliloba erTi mTlianobis gamovelnaa, romelsac simptomebi (cxrili 12.4) wamyvania Sizofreniis dRes
grizingerma (Griesinger) erTiani fsiqozi (Einheitpsychose) arsebul diagnostikur kriteriumebSi. Tumca, bleileris
uwoda. amis sapirospirod, morelma (Morel) ganacxada, fundamenturi simptomebis msgavsad, am niSnebsac,
rom SesaZlebelia fsiqikuri aSlilobebis gancalkeveba savaraudod, ar aqvT centraluri fsiqopaTologiuri
da klasifikacia. moreli cdilobda gamoeyo calkeuli mniSvneloba. garda amisa, Snaideri miuTiTebda, rom am
jgufebi da, gamomwvev mizezebze, simptomebsa da gamosavalze simptomebis arseboba ar aris aucilebeli da sakmarisi
dayrdnobiT, Seeqmna klasifikacia. 1852 wels man aRwera piroba diagnozisTvis: SizofreniisTvis damaxasiaTebeli
daavadeba demence precoce, romelic iwyeboda mozardobis mravali paTologiuri modelidan, arsebobs ramdenime,
asakSi da iwvevda jer socialur izolacias, ucnaur, romlebic miesadagebian pirveli rigis mniSvnelobis
manerul qcevebsa da sakuTari Tavis ugulebelyofas, xolo darRvevebs, imitom ki ara, rom Cven maT bazisur niSnebs
sabolood, mTavrdeboda inteleqtualuri daqveiTebiT. mivakuTvnebT, aramed imitom, rom maT gansakuTrebuli
cota xnis Semdeg, kalbaumma (Kahlbaum, 1863) aRwera katatonia, mniSvneloba aqvT Sizofreniis gansazRvrasa da
xolo hekerma (Hecker, 1871) _ hebefrenia. emil krepelinma diagnostikaSi. maSin, rodesac saxezea aseTi modelis
(Emil Kraepelin, 1855-1926) avadmyofobis mimdinareobasa arseboba da bazisuri somaturi avadmyofoba ar aRiniSneba,
da simptomebze dakvirvebis Sedegad Camoayaliba Tavisi Cven SegviZlia davsvaT Sizofreniis diagnozi. ... diagnozis
Sexedulebebi. igi uaryofda erTiani fsiqozis ideas da dasmisaTvis yovelTvis ar aris saWiro pirveli rigis
SemogvTavaza daavadebebis ori jgufi: dementia praecox da simptomebis arseboba (Schneider, 1959).
maniakalur-depresiuli fsiqozi. dementia praecox-is jgufSi ramdenime germanelma fsiqiatrma scada Sizofreniis
man Seiyvana manamde damoukideblad miCneuli mdgomareobebi qvejgufebis gamoyofa. vernikes (Wernicke) moswavle karl
_ katatonia da hebefrenia (sityviT demencia krepelinma klaisti (Karl Kleist) swavlobda asociacias daavadebis
xazi gausva am daavadebisTvis damaxasiaTebel kognitur sxvadasxva tipebsa da Tavis tvinis paTologias Soris.
daqveiTebas, romelic ??? gverdzea aRwerili). dementia misTvis misaRebi iyo krepelinis ZiriTadi diagnostikuri
praecox-is pirveli aRwera krepelinma gamoaqveyna Tavis midgomebi, magram cdilobda, klinikuri suraTis guldasmiT
fsiqiatriis saxelmZRvanelos meoTxe gamocemaSi 1893 wels Seswavlis safuZvelze, gaemijna Sizofreniis qvetipebi da
da ganavrco Semdgom gamocemebSi. igi daavadebas aRwerda, atipiuri formebi. misi mcdeloba ganesazRvra Sizofreniis
rogorc naTeli cnobierebis fonze ganviTarebuli qvetipebi Tavis tvinSi arsebuli paTologiebis mixedviT
mdgomareobebis serias, saerTo damaxasiaTebeli niSniT, Zalian saintereso, magram warumatebeli aRmoCnda.
rogoricaa Sinagani kavSirebis ucnauri rRveva (Kraepelin, leonhardma gaagrZela klinikuri suraTis Seswavla
1919). man Tavidan gamoyo sami mdgomareoba (paranoiduli, da gamoaqveyna sakmaod rTuli klasifikacia, romelic
hebefrenuli da katatonuri) da Semdgom daamata meoTxe ganasxvavebda Sizofrenias cikloduri kargi gamosavlis
(martivi). parafrenia gamijna dementia praecoxgan imis mqone araafeqturi fsiqozebisagan (Leonhard, 1957). man, aseve,
safuZvelze, rom es mdgomareoba iwyeba saSualo asakSi da gamoyo Sizofreniis ori jgufi. pirveli, anu sistemuri jgufi,
ar axasiaTebs iseTive emociuri da nebelobiTi cvlilebebi, xasiaTdeboda progresuli mimdinareobiT da aerTianebda
rogorc dementia praecoxs. krepelini ganixilavda dementia katatonias, parafrenias da hebefrenias. meore, arasistemur
praecoxs, rogorc progresirebad qronikul mdgomareobas, jgufSi, Sedioda parafrenia afeqturi aSlilobebiT,
romelic uciloblad iwvevs pirovnebis daqveiTebas. Sizofazia da perioduli katatonia. afeqturi parafreniis
aRsaniSnavia, rom krepelinis mier klinikuri SemTxvevebis dros pacients aReniSneboda afeqturad Seferadebuli
13% mTavrdeboda sruli gamojanmrTelebiT (Tumca, zog paranoiduli bodvebi. Sizofaziis dros gamoxatuli iyo
SemTxvevaSi Semdgomi recidivebiT), xolo pacientTa 17% asociaciuri procesis darRvevebi, praqtikulad gaugebari
cxovrobda damoukideblad da axerxebda muSobas. metyvelebiT. perioduli katatoniisTvis damaxasiaTebeli
eugen bleilerma (Eugen Bleuler, 1857 -1959) krepelinis iyo katatonur simptomebs Soris regularuli remisiebi.
Sromebze dayrdnobiT gamosca wigni, romelSic werda: katatonur simptomebs adgenda Sekaveba da uecari agzneba.
idea naadrevi Wkuasustobis Sesaxeb ekuTvnis krepelins skandinavieli fsiqiatrebi imyofebodnen iaspersis (Jaspers)
(Bleuler, 1911). igi, aseve, madlobas uxdida Tavis axalgazrda gavlenis qveS, romelmac gamoyo Sizofrenia da reaqtiuli
kolegas karl iungs (Carl Jung), romelmac naadrevi fsiqozebi. 1930 wels langfeldma (Langfeldt) gamijna
Wkuasustobis koncefcia froidiseuli mosazrebebiT erTmaneTisagan WeSmariti Sizofrenia (cudi gamosavlis mqone
gaamdidra. krepelinisgan gansxvavebiT, bleileri naklebad mdgomareoba) da Sizofreniismagvari mdgomareobebi (kargi
amaxvilebda yuradRebas prognozze. igi ufro metad gamosavlis mqone) (Langfeldt, 1961). WeSmariti Sizofreniis
dainteresebuli iyo simptomTa formirebis meqanizmebiT. ganmarteba axlos idga dementia praecoxis krepeliniseul
bleilerma gamoiyena termini Sizofrenia, raTa aReniSna koncefciasTan. Sizofreniismagvar mdgomareobas aRwerda,
fsiqikuri funqciebis gaxleCiloba, rac misi azriT am rogorc stresiT gamowveul mdgomareobas, gamoxatuls
daavadebis centralur niSans warmoadgenda. bleilers dabneulobiTa da afeqturi simptomatikiT. langfeldis
sjeroda, rom arsebobda fundamenturi da damatebiTi mosazrebam karg da cud prognozze Zalian didi gavlena iqonia,
niSnebi. misi azriT, fundamentur simptomebs warmodgendnen: magram kvlevebma am kriteriumebis prognozuli mniSvneloba
asociaciaTa procesis aSlilobebi, emociuri reaqciis ar daadastura. Tanamedrove kriteriumebis Tanaxmad,
cvlilebebi da autizmi (realuri samyarodan izolacia da langfeldiseuli Sizofreniismagvari mdgomareobebis
sakuTari samyaros Seqmna). sainteresoa, rom SizofreniisTvis umetesoba moxvdeboda afeqturi aSlilobebis jgufSi
damaxasiaTebeli yvelaze xSiri simptomebi (halucinacia, (Bergen et al., 1990). xazi unda gaesvas imas, rom DSM-IV Si
bodva, katatonia, ucnauri qcevebi) man damatebiT niSnebad termini Sizofreniismagvari aSlilobebi sruliad sxva
miiCnia. bleilers Sizofreniuli SemTxvevebis fsiqologiuri mniSvnelobiT ixmareba (gv 278 ??).
mxare ainteresebda, Tumca, ar uaryofda neirofiziologiuri daniasa da norvegiaSi gansakuTrebul interess iwvevda
mizezebis arsebobasac. radgan bleileri yuradRebas ufro stresis Semdgom ganviTarebuli mdgomareobebi. terminebs
metad fsiqopaTologiur meqanizmebze amaxvilebda, amitom - reaqtiuli fsiqozi da fsiqogenuri fsiqozebi,
misi diagnostikuri midgomebi, krepelinTan SedarebiT, xSirad iyeneben stresiT gamowveuli mdgomareobebis
nakleb specifikuri iyo. bleilers ufro optimisturi aRsaniSnad, romelTa niSnebi, garkveulwilad, gasagebia da
prognozi hqonda, Tumca, iqve aRniSnavda: vsaubrobT ara kargi gamosavali axasiaTebT. Tanamedrove klasifikaciis
gamojanmrTelebaze, aramed xangrZliv gaumjobesebaze. mixedviT, es darRvevebi SeiZleba gaerTiandes xanmokle
igi aseve werda: Tu pacients arasdros gamouvlenia gardamaval an Sizofreniformul aSlilobebSi (xanmokle
Sizofreniis niSnebi da kvlavac ar aReniSneba daavadebisTvis fsiqozebis istoriuli mimoxilva ixileT Garrabe & Cousin,
damaxasiaTebeli simptomebi, rCeba mxolod Zalian mcire 2000 ).
SemTxvevebi, rodesac unda veZeboT es niSnebi (Bleuler, 1911).
_ 291 _
12 Sizofrenia
(romelic ganxilulia me-2 TavSi), romlebmac udi afeqturi aSlilobebisa da Sizofreniis kiTxvari
desi gavlena moaxdines ara marto Sizofreniis, (Schedule of Affective Disorders and Schizophrenia _ SADS).
aramed mTeli diagnostikuri kriteriumebisa da daskvnis saxiT, SeiZleba iTqvas, rom krepelinisa da
klasifikatoruli sistemebis Seqmnaze. britanul- bleileris mier daavadebis koncefciis gansazRvris
amerikulma diagnostikurma proeqtma aCvena, rom niu- Semdeg, SizofreniasTan dakavSirebiT mravali Sexe
iorkSi termini `Sizofrenia~, ufro farTod esmodaT, duleba da mosazreba gamoiTqva. Tanamedrove kla
vidre inglisSi. niu-iorkSi Sizofreniis diagnozi sifikaciebze dayrdnobiT, es termini amJamad gan
hqondaT dasmuli iseT pacientebs, romlebsac inglisSi sazRvravs sindroms, romlis diagnostireba maRali
guneb-ganwyobis an personologiuri aSlilobebis sizustiTaa SesaZlebeli. amas gadamwyveti mniSvneloba
diagnozs daudgendnen. cxra qveyanaSi Sizofreniaze aqvs klinikur praqtikaSi. Tumca, rogorc me-3 TavSi
Catarebulma saerTaSoriso piloturma kvlevam iyo aRniSnuli, sarwmuno diagnozi sakmarisi ar aris.
(msoflio jandacvis organizacia, 1973), romelic magaliTad, Snaideris pirveli rigis simptomebis
exeboda diagnostikis sakiTxebs, gamoavlina, rom gamoyeneba zrdis daavadebis diagnostirebis sar
erTnairi kriteriumebi gamoiyeneboda kolumbiaSi, wmunoebas, magram prognozuli mniSvneloba ar
CexoslovakiaSi, daniaSi, indoeTSi, nigeriaSi, tai gaaCnia. aseve, am simptomebs ar axasiaTebs Tval
vansa da britaneTSi. sabWoTa kavSirsa da aSS-Si am saCino memkvidreobiToba, rasac etiologiurad
kriteriumebis sazRvrebi gafarToebuli iyo. SizofreniisTvis didi mniSvneloba aqvs (McGuffin et
am aRmoCenam cxadyo, rom aucilebeli iyo SeTan al., 1984). radgan saTanadod ar viciT Sizofreniis
xmebuli diagnostikuri kriteriumebis Seqmna. saWiro gamomwvevi mizezebi, am sindromis validuroba
iyo standartuli meTodebis SemuSaveba, romelTa kvlav sakamaTo rCeba. sanam ZiriTad kiTxvas pasuxi
mixedviTac gansaxRvravdnen da gamoavlendnen daa ar gaecema, manamde diskusiebi diagnostikur saz
vadebas. aq mokled ganvixilavT sam meTods, ro Rvrebze, damaxasiaTebel niSnebsa da qvetipebze kvlav
melTa danergvam xeli Seuwyo Tanamedrove klasi gagrZeldeba.
fikaciebis ganviTarebas (ICD-10-sa da DSM-IV-s). (1)
CATEGO _ es aris kompiuteruli programa, romelic Sizofreniis klasifikacia ICD-10-isa da
Seqmnilia standartuli intervius Sedegad miRebuli DSM-IV -is mixedviT
informaciis aRsaricxad, rogorc es xdeba fsiqikuri Sizofreniisa da Sizofreniismagvari aSlilobebis
statusis kvlevis SemTxvevaSi (gv. 63). yvelaze viwro klasifikacia ICD-10-isa da DSM- IV-is mixedviT
gagebiT, es sindromi moicavda Semdeg simptomebs: mocemulia da Sedarebulia cxrilSi 12.5, saidanac Cans,
(1) azrTa Canergva, gadacema an amoReba, kontrolis rom mocemuli klasifikaciebi ZiriTadad msgavsia.
bodva da smeniTi halucinaciebsi, rodesac mesame piri
komentars ukeTebs pirovnebis qcevebs. (2) faineris DSM-IV
(Feighner et al., 1972) kriteriumebi SeimuSaves sent DSM-IV klasifikaciaSi Sizofrenia gansazRvrulia
luisSi (St, Louis), raTa gamoeyoT cudi prognozis mwvave fazis simptomebisa da daavadebis niSnebis
mqone pacientebi. maT daamates iseTi kriteriumebi, xangrZlivobis mixedviT, rac unda grZeldebodes sul
romlebic naklebi sizustiT gamoirCeoda, vidre cota 6 Tvis manZilze (cxrili 12.6). mwvave simptomebi
CATEGO; gamoikvlies iseTi mdgomareobebi, rodesac (A kriteriumebi) moicavs: bodvebs, halucinaciebs,
daavadeba uwyvetad mimdinareobda 6 Tvis manZilze dezorganizebul metyvelebasa da qcevas, aseve,
da gamoricxes iseTi SemTxvevebi, rodesac pacients negatiur simptomebs. CamoTvlili simptomebidan
aReniSneboda guneb-ganwyobis aSlilobebi da alkohol aranakleb ori, erTi Tvis (SesaZlebelia, warmatebuli
an wamalmoxmareba. es kriteriumebi validuri, mag mkurnalobis SemTxvevaSi, drois nakleb monakveTSic)
ram Zalian SezRuduli iyo. aseTi kriteriumebis manZilze unda aRiniSnebodes. im SemTxvevebSi, ro
gamoyenebis Sedegad bevri SemTxveva diagnozis dasmis
gareSe darCa, Tumca prognozulad cudi SemTxvevebis cxrili 12.4 Snaideris pirveli rigis simptomebi
gamovlena kargad moxerxda (savaraudod, im ZiriTadi esmiT xmamaRla naTqvami azrebi
kriteriumis gamo, rom daavadeba 6 Tvis manZilze mesame piris halucinaciebi
uwyvetad mimdinareobda). (3) spiTzerma (Spitzer et al.,
makomentirebeli halucinaciebi
1978) faineris kriteriumebis gamoyenebiT SeimuSava
samecniero-diagnostikuri kriteriumebi (Research somaturi halucinaciebi
Diagnostic Criteria _ RDC). erTaderTi gansxvaveba iyo azrebis amoReba an Canergva
is, rom orkviriani anamnezi diagnozisTvis ar iyo
bodviTi aRqma
sakmarisi. samecniero-diagnostikuri kriteriumebis
(RDC) struqturirebuli gamokiTxvisTvis Seiqmna sxva Zalis mier gamowveuli grZnobebi an qcevebi
_ 292 _
rodesac mwvave simptomebi ar aris gamoxatuli. Tu
cxrili 12.5 Sizofreniis da Sizofreniisma simptomebi grZeldeba 6 Tveze naklebi dro, unda
gvari aSlilobebis klasifikacia ICD-10-sa da
daisvas Sizofreniformuli an mwvave da gardamavali
DSM-IV-Si
fsiqozuri aSlilobis diagnozi.
ICD-10 DSM-IV wamyvani simptomebis mixedviT, DSM-IV-Si Sizof
Sizofrenia Sizofrenia reniis ramdenime qvetipia gamoyofili. mwvave sim
ptomebis gamovlenidan erTi wlis Semdeg, kla
paranoiduli paranoiduli
sifikaciis mixedviT, SeiZleba gamoviyenoT xan
hebefrenuli dezorganizebuli grZlivi mimdinareobis gansazRvreba da mivuTiToT
katatonuri katatonuri gamwvavebebisa da remisiis Taviseburebebze.
DSM-IV-Si Sizofrenia gamoyofilia Semdegi ori
aradiferencirebuli aradiferencirebuli
ZiriTadi kategoriisagan: bodviTi aSlilobebi (Ta
rezidualuri rezidualuri
vi me-13) da sxvagvarad dauzustebeli fsiqozuri
martivi Sizofrenia aSlilobebi.
postSizofreniuli depresia ICD-10

sxva Sizofrenia ICD-10-Si DSM-IV-Tan SedarebiT Sizofreniis diag
nozis dasmisTvis pirveli rigis simptomebze meti
dauzustebeli Sizofrenia
aqcentia gakeTebuli (cxrili 1.7) da erTi Tvis
Sizotipuri aSliloba manZilze simptomebis arseboba sakmarisadaa miCneuli.
ICD-10-Si Sizofreniis ufro meti tipia gamoyofili,
Sizoafeqturi aSliloba Sizoafeqturi aSliloba rac yvelaze TvalsaCinod ganasxvavebs am or kla
xangrZlivi bodviTi bodviTi aSlilobani sifikacias erTmaneTisagan. DSM-IV-Si ar aris
aSlilobani Setanili martivi Sizofrenia da postSizofreniuli
bodviTi aSliloba
depresia. orive klasifikaciaSi is SemTxvevebi, ro
sxva qronikuli bodviTi
aSlilobani desac Sizofreniul simptmebTan erTad gvxvdeba
gamoxatuli afeqturi epizodebi, Sizoafeqtur aS
mwvave da gardamavali xanmokle fsiqozuri
fsiqozuri aSlilobani aSlilobani lilobebSi klasificirdeba.
garkveuli pirovnuli aspeqtebi genetikuradaa
mwvave Sizofreniismagvari Sizofreniformuli
dakavSirebuli SizofreniasTan. Sizotipuri aSliloba
fsiqozuri aSliloba aSlilobani ICD-10-Si Sesulia Sizofreniis jgufSi, xolo DSM-IV
klasifikaciaSi ki ganxilulia personologiur aS
mwvave polimorfuli
fsiqozuri aSliloba lilobebTan erTad. Sizotipuri aSlilobisTvis da
maxasiaTebelia socialuri izolacia, gasadavebuli
sxva mwvave fsiqozuri
aSliloba afeqti, aseve, aRiniSneba perceptualuri, azrovnebisa
da metyvelebis darRvevebi, ucnauri da eqscentruli
inducirebuli bodviTi gaziarebuli fsiqozuri
aSliloba aSliloba qcevebi.
orive klasifikaciaSi bodviTi aSlilobebi gamo
sxva araorganuli fsiqozuri
yofilia Sizofreniisgan (ix. me-13 Tavi). aseve, gamij
aSlilobani
nulia mwvave da gardamavali fsiqozebi, romlebic
dauzustebeli araorganuli sxvagvarad mwvaved iwyeba da 2-3 TveSi sruliad amoiwureba.
fsiqozi dauzustebeli
fsiqozuri aSliloba
DSM-IV-isa da ICD-10 klasifikaciebis
gansxvavebaTa Sejameba
desac mwvave simptomebTan erTad gamoxatulia guneb-
DSM-IV-sa da ICD-10 klasifikaciebs Soris ZiriTadi
ganwyobis aSlilobebis epizodebi, unda daisvas
gansxvaveba diagnostikur midgomebSia:
Sizoafeqturi an fsiqozuri epizodiT mimdinare
afeqturi aSlilobebis diagnozi. DSM-IV-is mixedviT, w ICD-10-Si Snaideris pirveli rigis simptomebze
Sizofreniis momdevno diagnostikuri kriteriumia _ meti aqcentia gakeTebuli. DSM-IV yuradRebas
daavadebis dawyebis Semdeg pirovnebisTvis Sesabamisi amaxvilebs daavadebis mimdinareobasa da funqciur
okupaciuri, akademiuri da socialuri funqcionirebis gauaresebaze;
gauareseba. rogorc zemoT aRvniSneT, darRvevebi w ICD-10-is Tanaxmad, sakmarisia simptomebis arseboba
unda vlindebodes 6 Tvis manZilze da SeiZleba erTi Tvis manZilze, xolo DSM-IV-is mixedviT,
moicavdes prodromul da rezidualur periodebsac, daavadebis niSnebi unda aRiniSnebodes (prodromuli
_ 293 _
12 Sizofrenia
cxrili 12.6 Sizofreniis kriteriumebi DSM-IV-is mixedviT

A. aqtiuri fazisTvis damaxasiaTebeli kriteriumebi D. Sizoafeqturi da guneb-ganwyobis
ori (an meti) Semdegi simptomi aRiniSneba drois umetes periodebSi 1 aSlilobebis gamoricxva
Tvis ganmavlobaSi (an, warmatebuli mkurnalobis SemTxvevaSi, naklebi Sizoafeqturi da guneb-ganwyobis aS
drois ganmavlobaSi) lilobebi unda gamoiricxos Semdegi
1. bodvebi ori niSniT: (1) didi depresiis, maniis an
2. halucinaciebi Sereuli epizodebi ar unda gamovlindes
3. dezorganizebuli metyveleba (xSiria Temidan gadaxveva an inko aqtiuri fazis simptomebTan erTad, an (2)
herencia) aqtiuri fazis SemTxvevaSi ganviTarebuli
4. gamoxatuli dezorganizebuli an katatonuri qceva aseTi epizodebi unda iyos aqtiur da
5. negatiuri simptomebi, e.i. gasadavebuli afeqti, aligia an abulia rezidualur fazebze xanmokle.
B. socialuri/okupaciuri disfunqcia E. wamlebis/zogadi somaturi problemebis

daavadebis dawyebidan, drois ZiriTad periodSi, manamde arsebul gamoricxva
donesTan SedarebiT, gauaresebulia funqcionireba Semdeg ZiriTad aSliloba ar aris gamowveuli nivTie
sferoebSi: samsaxuri, interpersonaluri urTierTobebi an sakuTari rebebis (narkotikuli saSualebebi, sam
Tavis movla (Tu daavadeba iwyeba adreul asakSi, interpersonaluri, kurnalo preparatebi) uSualo moqmedebiT
akademiuri da okupaciuri unarebi Sesabamis doneze ar ganviTardeba). an zogadi samedicino problemebiT.
C. mimdinareoba F. kavSiri ganviTarebis zogad aSlilobebTan

daavadebis niSnebi unda grZeldebodes aranakleb 6 Tve (an naklebi Tu aris autizmis an sxva ganviTarebis
xangrZlivobiT, warmatebuli mkurnalobis SemTxvevaSi). am 6 Tvis zogadi aSlilobebi, Sizofreniis diag
manZilze, sul cota, erTi Tvis ganmavlobaSi unda aRiniSnebodes A nozi ismeba maSin, rodesac aranakleb
kriteriumebSi mocemuli simptomebi (aqtiuri fazis simptomebi) da erTi Tvis manZilze (an, warmatebuli
SeiZleba moicavdes: prodromuls an rezidualurs; SesaZloa iyos mkurnalobis SemTxvevaSi, drois nakleb
mxolod negatiuri simptomebi ori an meti naklebi intensivobis A monakveTSi) gamoxatulia bodvebi da
kriteriumebSi warmodgenili simptomebi (ucnauri azrebi, uCveulo halucinaciebi.
perceptualuri gancdebi)
cxrili 12.7 Sizofreniis kriteriumebi ICD-10-is mixedviT

Sizofreniis diagnozis dasasmelad unda aRiniSnebodes e. nebismieri modalobis myari halucinaciebi, romlebsac
minimum ori aSkara (an, Cveulebriv, orze meti, naklebad axlavs gardamavali an naklebad formirebuli bodviTi
gamoxatuli simptomebis SemTxvevaSi) simptomi romelime ideebi, Camoyalibebuli afeqturi Sinaarsis gareSe, an
erTi jgufidan, romelic mocemulia (a) (d) CamonaTvalSi zeRirebulovani ideebi, romlebic vlindeba yovel dRe
an simptomebi aranakleb ori jgufidan, romelic kvirebisa da Tveebis manZilze
mocemulia (e) (h) CamonaTvalSi erTi Tvis an meti xnis v. asociaciuri nakadis darRvevebi, rac iwvevs inkohe
manZilze ZiriTadi drois ganmavlobaSi. rencias, Seusabamo metyvelebasa an neologizmebs
a. eqo azrebi, azrebis Canergva an amoReba, an azrebis z. katatonuri qceva, rogoricaa agzneba, maneruloba,
gadacema cvilisebri moqniloba, negativizmi, mutizmi da stupori
b. kontrolis, zemoqmedebis an pasiurobis bodva, romelic T. negatiuri simptomebi, rogorebicaa gamoxatuli apa
exeba konkretul azrebs, moqmedebebs, SegrZnebebsa an Tia, metyvelebis gaRaribeba, emociuri gasadaveba
sxeulis, an kidurebis moZraobas. bodviTi aRqma an Seusabamo afeqti, romelic, Cveulebriv, iwvevs
g. komentaris Semcveli smeniTi halucinaciebi. xmebi, socialur izolacias da socialuri funqcionirebis
romlebic komentars ukeTeben pirovnebis qcevas an daqveiTebas. aseTi mdgomareoba ar unda iyos depresiis
erTmaneTSi saubroben masze, an xmebi, romlebic pacients an neirolefsiuri preparatebis Sedegi
sxeulis sxvadasxva nawilidan esmis i. mniSvnelovani da myari xarisxobrivi cvlilebebi qcevaSi,
d. myari bodviTi ideebi, romlebic kulturalurad Seu rac gamoixateba interesebis SezRudviT, motivaciis
sabamo da ucnauria arqoniT, usaqmurobiT, sakuTar TavSi CaketviTa da
socialuri izolaciiT
da rezidualuri periodebis CaTvliT) aranakleb 6 Sizofreniismagvari aSlilobebi

Tvis manZilze; Sizofreniis nebismieri ganmartebis SemTxvevaSi, yo
w Sizotipuri aSliloba Sesulia orive klasifi velTvis aris iseTi mdgomareobebi, romlebic hgvanan
kaciaSi, magram DSM-IV-Si personologiur aSli Sizofrenias, magram bolomde ver akmayofileben
lobadaa klasificirebuli; daavadebis diagnostikur kriteriumebs. ICD-10 da
w ICD-10-Si mocemulia Sizofreniis damatebiTi qve DSM-IV klasifikaciebSi aseTi aSlilobebi oTx
tipebi: martivi Sizofrenia da postSizofreniuli jgufadaa dayofili:
depresia; 1. bodviTi aSlilobebi (paranoiduli fsiqozebi);
w dezorganizebuli Sizofrenia, mocemuli DSM-IV-Si, 2. xanmokle fsiqozebi;
ICD-10-Si warmodgenilia hebefrenul Sizofreniad. 3. gamoxatuli aSlilobebi afeqturi simptomebiT;
_ 294 _
4. aSlilobebi SizofreniisTvis aucilebeli yvela rom orive klasifikaciaSi aseTi mdgomareobebi Si
kriteriumis gareSe. zoafeqtur aSlilobebad klasificirdeba.
termins `Sizoafeqturi aSliloba~ sxvadasxva mni
xanmokle fsiqozebi
SvnelobiT iyenebdnen. pirvelad igi SemoiRo ka
DSM IV klasifikaciaSi termini `xanmokle fsiqozuri zaninma (Kasanin) 1933 wels. man aRwera mwvave
aSliloba~, ixmareba iseTi mdgomareobebis aRsaniSnad, fsiqikuri aSlilobis mqone axalgazrda pacientebis
romlis drosac cxrilSi 12.6 CamoTvlili mwvave mcire jgufi, romlebsac daavadeba mwvaved daewyoT
simptomebidan, sul cota, erTi mainc mdgomareoba da aReniSnebodaT TvalsaCino afeqturi simptomebi.
SeiZleba gagrZeldes erTi dRe, magram ar aRemateba mdgomareoba ramdenime kvira grZeldeboda da dam
erT Tves. am xnis ganmavlobaSi unda moxdes sruli Tavrda sruli gamojanmrTelebiT.
gamojanmrTeleba. aSlilobebi SeiZleba (magram ara am terminis Tanamedrove ganmarteba mniSvnelovnad
aucileblad) gamowveuli iyos stresoriT, magram ar gansxvavdeba misi Tavdapirveli definiciisgan. DSM-
unda iyos wamlebis an somaturi daavadebis uSualo IV-is mixedviT, aucilebelia daavadebis uwyveti
Sedegi. Sizofreniformuli fsiqozebi Sizofreniis periodis arseboba, romlis drosac erTsa da imave
msgavsi aSlilobebia (axasiaTebs A kriteriumebi), ro periodSi aRiniSneba rogorc depresiuli, maniakaluri
melTa xangrZlivoba 1 Tveze metia (amitomac ver iq an Sereuli epizodi, ise Sizofreniis A kriteriumebic.
neba klasificirebuli, rogorc xanmokle fsiqozuri amasTan, daavadebis am uwyveti mimdinareobis dros
aSliloba), magram ar aRemateba 6 Tves (rac saWiroa mwvave fazis fsiqozuri simptomebi, sul cota, 2 kviris
Sizofreniis diagnozisTvis). diagnozis dasmisTvis ganmavlobaSi unda gagrZeldes, gamoxatuli afeqturi
socialuri da okupaciuri disfunqcia saWiro ar aSlilobebis gareSe (winaaRmdeg SemTxvevaSi, daismeba
aris. guneb-ganwyobis (afeqturi) aSlilobebis diagnozi).
ICD-10 klasifikaciaSi Setanilia mwvave da gar guneb-ganwyobis aSlilobebi unda TvalsaCino iyos
damavali fsiqozuri aSlilobebis jgufi. maTTvis daavadebis mTeli mimdinareobis manZilze. ICD-10-
damaxasiaTebelia mwvave dasawyisi da sruli gamo Si Sizoafeqturi aSlilobis diagnostikuri kri
janmrTeleba 2-3 Tvis manZilze. aSliloba SeiZleba teriumebi msgavsia. aq miTiTebulia, rom diagnozis
(Tumca ara yovelTvis) gamowveuli iyos stresuli dasma SeiZleba mxolod im SemTxvevaSi, rodesac
cxovrebiseuli situaciiT. es kategoria dayofilia daavadebis suraTSi Sizofreniuli da afeqturi
ramdenime urTierTgadamfarav da am mxriv gaugebar simptomebi Tanabradaa gamoxatuli da erTdrouladaa
qvetipebad. pirveli oris SemTxvevaSi _ mwvave po (an ramdenime dRis intervaliTaa) warmodgenili. (es
limorfuli fsiqozuri aSliloba SizofreniisTvis mniSvnelovani kriteriumia: termini `Sizoafeqturi~,
damaxasiaTebeli simptomebiT an damaxasiaTebeli ar gamodgeba, Tu simptomebi izolirebuladaa an
simptomebis gareSe, halucinaciebi, bodviTi ideebi arsebobs ori damoukidebeli diagnozis, an, rodesac
da perceptuli darRvevebi TvalsaCino, magram Tavisi pirveladi diagnozis gamosavlenad mdgomareoba
bunebiTa da simwvaviT cvalebadia. xSiria TandarTuli sakmarisad detalurad araa Seswavlili).
guneb-ganwyobisa da motoruli darRvevebi. Bouffee ICD-10-Si gamoyofilia Sizoafeqturi aSlilobebi
delirante da cikloiduri fsiqozebi (boqsi 12.3) am depresiuli, maniakaluri da Sereuli epizodebiT.
aSlilobebis sinonimebadaa gamoyenebuli, miuxedavad DSM-IV-Si mocemulia depresiuli tipi da bipolaruli
imisa, rom skandinaviuri fsiqiatriuli skola maT tipi.
damoukidebel aSlilobebad miiCnevs da mocemul ojaxuri kvlevebi gviCvenebs, rom Sizoafeqturi
formulirebas ar eTanxmeba. aSlilobis SemTxvevaSi gazrdilia rogorc afeqturi
Semdegi, mesame tipi _ mwvave Sizofreniismagvari aSlilobebis, aseve Sizofreniis ganviTarebis ris
fsiqozuri aSliloba, iseTi mdgomareobaa, rodesac ki. iTvleba, rom Sizoafeqturi aSlilobis dros
saxezea SizofreniisTvis damaxasiaTebeli niSnebi, gamosavali, zogadad, ufro keTilsaimedoa, vidre
magram erT Tveze naklebi xangrZlivobisaa. danarCeni Sizofreniis SemTxvevaSi. iSviaTia negatiuri sim
SemTxvevebi, romlebic ver akmayofileben am qvetipis ptomebis ganviTareba (Tsuang et al., 2000).
kriteriumebs, Sesulia sxva mwvave da gardamavali Sizofreniis dros ar aris iSviaTi fsiqozisgan
fsiqozebis kategoriaSi. ICD-10-Si mocemuli am aS damoukideblad depresiis ganviTareba (rogorc ze
lilobaTa jgufebi gamosavlis mixedviT araerT viT aRvniSneT). ICD-10-Si aseTi mdgomareobebi Se
gvarovania (Singh et al., 2004). tanilia postSizofreniul aSlilobebSi. diagnozi
ismeba im SemTxvevaSi, rodesac saxezea Sizofreniuli
gamoxatuli aSlilobebi afeqturi simptomebiT
simptomebi (pozitiuri an negatiuri), xolo dep
zog pacients metad an naklebad aReniSneba Tanabari
resiuli simptomatika aRiniSneba, sul cota, ori
Sizofreniuli da afeqturi simptomebi. ukve aRvniSneT,
kviris manZilze.
_ 295 _
12 Sizofrenia
qronikuli aSlilobebi SizofreniisTvis da, garkveulwilad, subieqturia. aseve, ar arsebobs

arasakmarisi simptomebiT mkafio gansxvaveba Sizofreniis variantebad miCneul
rTul problemas warmoadgens mdgomareobebi, ro aSlilobebs Soris (Adler and Strakovski, 2003). zogi
melTac qronikuli mimdinareoba aqvT, magram ver aSliloba ICD-10-sa da DSM-IV klasifikaciebSi erTi
akmayofileben Sizofreniis kriteriumebs. maTSi oTxi da imave kategoriaSi erTiandeba, magaliTad, bodviTi
jgufia gaerTianebuli: aSlilobebi; xolo Sizotipuri aSliloba ICD-10-
Si SizofreniaSi, xolo DSM-IV-Si personologiur
1. pacientebi, romlebsac warsulSi ganuviTardaT
aSlilobebSi moiazreba. aseTi sirTuleebi miuTiTebs
sruli Sizofreniuli simptomatika, magram am
sindrom(eb)is ucnob validobaze da, savaraudod,
Jamad diagnozisTvis saWiro yvela kriteriumi ar
sakiTxis gadawyveta mxolod maSin gaxdeba SesaZlebeli,
aRiniSnebaT. es SemTxvevebi ICD-10-sa da DSM-IV-Si
rodesac klasifikacia etiologiur an empiriulad
klasificirebulia, rogorc rezidualuri Sizofrenia;
validur markerebze dayrdnobiT gadakeTdeba.
2. pirebi, romlebic bavSvobidan gamoirCeodnen uc amis gaTvaliswinebiT, Tanamedrove klinikuri
nauri qceviT da hqondaT SizofreniisTvis dama praqtika moiTxovs Sizofreniis diferencirebas sxva
xasiaTebeli niSnebi, magaliTad, damokidebulebisa aSlilobebisagan:
da devnis ideebi, ucnauri msjeloba. gaxangrZ
w organuli sindromi: mwvave Sizofrenia SeiZleba
livebuli mdgomareobis dros, DSM-IV-Si ase
SemTxveviT deliriumad miviCnioT, gansakuTrebiT
Ti SemTxvevebi klasificirdeba, rogorc perso
maSin, Tu gamoxatulia azrovnebis paTologia da
nologiuri aSlilobebi (Sizotipuri persono
guneb-ganwyobis aSlilobebi. aseT dros, guldasmiT
logiuri aSliloba), xolo ICD-10-Si _ rogorc
unda Sefasdes cnobiereba, dezorientacia da
Sizofrenia (Sizotipuri aSliloba). am aSlilobis
deliriumis sxva damaxasiaTebeli simptomebi (Tavi
SizofreniasTan mWidro kavSiris gamo mas xSirad
me-14). Sizofreniismagvari aSlilobebi SeiZleba
latentur Sizofrenias uwodeben, an Sizofreniis
ganviTardes naTeli cnobierebis fonzec sxvadasxva
speqtris aSlilobad miiCneven.
nevrologiuri da somaturi daavadebebis Sedegad.
3. pirebi, romlebsac aReniSnebaT socialuri izolacia, DSM-IV klasifikaciis mixedviT, aseT mdgomareobebs
ucnauri qceva, gasadavebuli afeqti, motivaciis ewodeba zogadi samedicino mdgomareobebis Sedegad
nakleboba, xolo pozitiuri simptomebi arasdros ganviTarebuli fsiqozuri aSlilobebi, xolo ICD-
hqoniaT. aseTi mdgomareobebis aRsaniSnavad sxvasdaxva 10-is mixedviT _ organuli bodviTi aSlilobebi.
termini iyo SemoTavazebuli, maT Soris, martivi klasikuri magaliTebia Sublis wilis epilefsia
Sizofrenia (gv. 270), Sizoiduri personologiuri (rTuli parcialuri krunCxvebiT), progresuli dam
aSliloba (gv. 135) da aspergeris sindromi (gv. 671). bla da metaqromuli leikodistrofia (Tavi me-14).
4. da bolos, kvlav gamovyofT iseT SemTxvevebs, organuli aSlilobebisTvis ufro damaxasiaTebelia
romelTa drosac saxezea myari bodviTi aSlilobebi, mxedvelobiTi halucinaciebi. organuli fsiqozebis
magram SizofreniisTvis damaxasiaTebeli sxva arseboba miuTiTebs fsiqozis dros samedicino
niSnebi ar aRiniSneba (Tavi me-13). istoriisa da fizikuri mdgomareobis Rrmad da
guldasmiT Seswavlis mniSvnelobaze. londonSi
jesingis (Gjessing~s) sindromi
Catarebulma erT-erTma kvlevam aCvena, rom Si
jesingma 1947 wels aRwera Sizofreniismagvari mdgo zofreniis pirveli epizodis diagnozis 268 Sem
mareoba, romlis drosac katatonuri simptomatika Txvevidan 10 (3, 7%) organuli mizezebiT (ara
periodulad viTardeboda da am periodebSi (Tumca, alkoholiT an fsiqoaqtiuri nivTierebebiT) iyo
ara yovelTvis) aRiniSneboda azotis balansis gamowveuli (Johnstone et al., 1987);
cvlilebebi. jesings miaCnda, rom am mdgomareobas
w preparatebis miRebiT inducirebuli mdgomareobebi
ganapirobebda farisebri jirkvlis disfunqcia
(fsiqoaqtiuri nivTierebebis avadmoxmarebis CaTv
da misi warmatebuli mkurnaloba TiroqsiniT iyo
liT).
SesaZlebeli. Tu es mdgomareoba marTlac arsebobs,
igi Zalian iSviaTia da SesaZloa fazebis swrafi w samkurnalo mizniT daniSnuli preparatebi, gansa
monacvleobiT mimdinare bipolaruli aSlilobis kuTrebiT steroidebi da dofaminis agonistebi,
variants warmoadgendes. rig SemTxvevebSi, gamoxatul fsiqozur simptomebs
iwveven. Sizofreniismagvari fsiqozuri simptomebis
diferencialuri diagnozi gamovlenisas fsiqoaqtiuri preparatebis, kerZod,
Cven ukve ganvix. Sizofreniisa da Sizofreniismagvari fsiqostimulatorebis an fenciklidinis Warbi
aSlilobebis Tanamedrove klasifikacia da vnaxeT, rom dozebiT miReba da, aseve, alkoholis avadmoxmareba
sazRvrebi am aSlilobebs Soris sakmaod gaurkveveli yovelTvis unda gamoiricxos. swori diagnozis
_ 296 _
etiologia
dasmaSi Sardis an Tmis Reris analizi dagvexmareba. 4-4, 6-ia da erTnairia sxvadasxva qveyanaSi (Jablensky,
aseve, yuradsaRebia kavSiri wamlis miRebasa da 2003). magaliTad, britaneTis erovnuli avadobis
simptomebs Soris. axalgazrdebis mier rekriaciuli kvlevam gamoavlina, rom `funqciuri fsiqozebis~
wamlebis maRali sixSiriT gamoyeneba mniSvnelovnad wliuri gavrcelebis maCvenebeli 1000 sul mo
arTulebs wamliT inducirebuli fsiqozisa da saxleze 4 SemTxvevaa (Jenkins et al., 1998). arsebobs
Sizofreniis erTmaneTisgan diferencirebas. gamonaklisebic, magaliTad, maRali maCveneblebi
w guneb-ganwyobis aSlilobebi fsiqozuri simpto Sveciasa da fineTis garkveulad izolirebul Tem
mebiT: gansxvaveba Sizofrenias, Sizoafeqtur aSli Si da britaneTSi mcxovreb karibul-afrikul popu
lobebsa da guneb-ganwyobis aSlilobebs Soris laciaSi (gv. 290). amis sapirispirod, stabilurad
ganisazRvreba afeqturi simptomebis gamoxTvis dabali maCvenebeli (1, 2_1000-ze) aRiniSneba aSS-Si
xarisxiTa da xangrZlivobiT, halucinaciur da hateritebisa da anabaptistebis seqtebis mimdevrebSi
bodviT simptomebsa da afeqtur simptomebs Soris (Nimgaonkar et al., 2000). aseT Sedegebs SeiZleba
urTierTkavSiriTa da wina epizodebSi ganviTarebuli ganapirobebdes gansxvavebuli diagnostikuri krit
simptomebis bunebiT. axalgazrdebSi maniakaluri eriumebi, genetikuri winaganwyoba an migracia. zogi
mdgomareobis diferencireba gansakuTrebiT Zne kvlevis mixedviT, industriul qveynebSi Sizofreniis
lia da zogjer diagnozis dasmisTvis saWiroa da axali SemTxvevebis ricxvi Semcirebulia. magaliTad,
avadebis mimdinareobaze xangrZlivi dakvirveba. SotlandiaSi (Eagles andWhalley, 1985) 1969-dan 1978
mniSvnelovania afeqturi aSlilobebis ojaxuri wlamde 40%-iT Semcirda SizofreniiT pirveli
anamnezis gamokiTxva. stacionirebis SemTxvevebi. es monacemebi SemdgomSi
ramdenime, (magram ara yvela) kvleviT dadasturda.
w bodviTi aSlilobebi: es aSlilobebi xasiaTdeba
amdenad, ramdenad asaxavs es monacemebi Sizofreniis
qronikuli, sistematizebuli paranoiduli bodve
SemTxvevaTa realur Semcirebas, Zneli saTqmelia.
biTa da periodulad aRmocenebuli halucinaciebiT.
magaliTad, kendelma (Kendel et al., 1993) aCvena, rom
am aSlilobebis dros ar vxvdebiT SizofreniisTvis
SotlandiaSi Sizofreniis SemTxvevaTa ricxvis Sem
damaxasiaTebel sxva simptomebs da fsiqikuri
cireba dakavSirebuli iyo diagnostikuri krite
mdgomareoba, sxvamxriv, TiTqmis ucvlelia.
riumebis Secvlasa da pirveli stacionirebis ara
w personologiuri aSlilobebi: diferencialuri zust dokumentirebasTan. arsebobs sapirispiro
diagnozis dasma paranoiduli, Sizotipuri da monacemebic, rom Sizofreniis pirveladi SemTxvevebis
Sizoidur personologiuri aSlilobebis dros ricxvi gazrdilia (Jablensky, 2003).
gansakuTrebiT Znelia axalgazrda pacientebis Sizofrenia, Cveulebriv, iwyeba 15-45 wlis asakSi.
SemTxvevaSi, Tu daavadeba TandaTanobiT iwyeba daavadebis dawyebis asakis, SemTxvevaTa sixSirisa da
an, rodesac saxezea paranoiduli bodviTi ide sikvdilianobis TvalsazrisiT, qalebsa da kacebs
ebi. SesaZloa, sxva fsiqozuri niSnebisa da Si Soris umniSvnelo gansxvavebaa. gviandel asakSi gan
zofreniisTvis damaxasiaTebeli simptomebis gamo viTarebuli Sizofrenia ganxilulia me-20 TavSi.
savlenad saWiro gaxdes xangrZlivi dakvirveba.
mosazRvre personologiuri aSlilobis SemTxve
vaSic, SesaZloa fsiqozuri simptomebis ganviTareba,
etiologia
Tumca, afeqturi arastabiluroba da am aSlilobis zogadi mimoxilva
sxva Taviseburebebi iZleva Sizofreniisgan mosazrebebi Sizofreniis etiologiis Sesaxeb
diferencirebis saSualebas. uSualodaa dakavSirebuli am daavadebis klasifikaciasa
da bunebaze arsebul azrTa sxvadasxvaobasTan (me-3
epidemiologia Tavi da gv. 273). amitom SizofreniaSi gaerTianebulia
Sizofrenia xasiaTdeba axali SemTxvevebis SedarebiT mTeli speqtri im biologiuri, fsiqologiuri
dabali sixSiriT, magram gavrcelebisa da xarjebis da socialuri faqtorebisa, romlebic zogadad
maRali maCveneblebiT (Knapp et al., 2004), rac daavadebis fsiqikuri aSlilobebisTvis mniSvnelovnadaa miCneuli
qronikul xasiaTze miuTiTebs. gavrcelebisa da (me-5 Tavi da cxrili 12.8) da is meTodebi, romlebic
SemTxvevaTa gamovlenis sixSire damokidebulia maT Sesaswavlad gamoiyeneba. winamdebare TavSi
diagnostikur kriteriumebze da gamokvleul popu Sejamebulia TiToeul faqtorTan dakavSirebuli
laciaze. yovelwliurad axali SemTxvevebis ricxvi Tanamedrove codna da Teoriebi, aseve, moyvanilia
Tanamedrove diagnostikuri kriteriumebiT, 1000 moZvelebuli, magram mainc didi avtoritrtis
sul mosaxleze 0.16-dan 0, 54-mde meryeobs. es ricxvi mqone Sexedulebebi. am TavSi etiologia moiazreba
daaxloebiT 2-3-jer naklebia gavrcelebis sixSireze farTo mniSvnelobiT da masSi paTogenezuri da
(Jablensky, 2003). romelic 1000 sul mosaxleze 1, paTofiziologiuri sakiTxebicaa gaerTianebuli.
_ 297 _
12 Sizofrenia
Sizofreniis etiologiis Taobaze arsebuli ZiriTadi
Tanamedrove midgomebi, romlebTan dakavSirebiTac
cxrili 12.8 Sizofreniis etiologiuri
faqtorebi da Teoriebi
SeTanxmeba miRweulia, Semdegnairad SeiZleba Sejamdes:
yvelaze ufro mniSvnelovania genetika, Sizofreniis kategoria magaliTi
riskis daaxloebiT 80% memkvidreobiT gadadis. genebi niuregulini
memkvidreobiToba rTuli da kompleqsuria. genebi, disbindini
romlebic ukanaskneli periodis manZilze gamoyves, garemo mSobiarobis garTulebebi
daavadebas ki ar gansazRvravs, aramed daavadebis gripi orsulobis dros
risk-faqtorebia. mniSvnelovania garemos gavlenac. zamTarSi dabadeba
haSiSis moxmareba adreul asakSi
sxvadasxva garemo faqtorebi moqmedebs mucladyofnis mamis asaki
periodidan da Semdgomac da, genetikur winaganwyobasTan
socialuri migracia
erTad, ganapirobebs neiroganviTarebis Seferxebas, rac urbanul garemoSi dabadeba da
daavadebis simptomebis ganviTarebis uSualo mizezadaa gazrda
miCneuli. premorbidulad igi vlindeba mTeli rigi cxovrebiseuli movlenebi
inteleqtualuri, qceviTi da neiroanatomiuri Ta struqturuli Tavis tvinis Semcirebuli zoma

viseburebebiT. Sizofreniis dros Tavis tvinis mo sinafsuri markerebis simcire
culoba normasTan SedarebiT mcirea da aRiniSneba funqciuri hipofrontaloba

lokaluri struqturuli da funqciuri gansxvavebebi. neirovizualizacia
aqedan gamomdinare, arsebobs mosazreba, rom am neirofiziologiuri Tvalis gayolebis disfunqcia
sindroms gansazRvravs Tavis tvinis sxvadasxva ubans Secvlili sensoruli gamowveuli
potencialebi
Soris da ubnebs SigniT kavSirebis darRvevebi. mwvave
simptomebi asocirebulia dofaminis momatebul nei fsiqologiuri kognituri darRvevebi
pirovnuli faqtorebi
rotransmisiasTan, xolo kognituri daqveiTeba pre fsiqodinamiuri Teoriebi
frontalur qerqSi dofaminis deficitur aqtivobasTan. ojaxis dinamika da
orive darRveva SeiZleba iyos meoradi da gamowveuli urTierTobebi
glutamaturi sistemis araswori funqcionirebiT. hipoTezebi neiroganviTareba
miuxedavad imisa, rom fsiqosocialuri faqtorebi stresmowyvladoba
aberantuli kavSirebi
udides gavlenas axdens daavadebis dawyebasa da
mimdinareobaze, axlo warsulamde maT, garkveulwilad, riski, garkveulwilad, damokidebulia fenotipis
ugulebelyofdnen. daskvnis saxiT SeiZleba vTqvaT, rom definiciaze. magaliTad, prospeqtuli kvlevebis
Sizofreniis etiologiasTan dakavSirebiT arsebobs dros, rodesac Seiswavles SizofreniiT daavadebuli
mxolod ramdenime dasabuTebuli mosazreba. maSinac dedebis 200-ze meti bavSvi (Parnas et al., 1993), aRmoCnda,
ki, rodesac gvaqvs myari faqtebi, maTi interpretacia rom ufro xSiri iyo ara marto Sizofreniis (16.2%
xSirad sakmaod bundovania. sakontrolo jgufis 1.9%-Tan SedarebiT), ara
med Sizoiduri, paranoiduli da Sizotipuri per
genetika sonologiuri aSlilobebis SemTxvevebic (21.3%
mexuTe TavSi aRvniSneT, rom genetikuri winaganwyobis sakontrolo jgufis 5%-Tan SedarebiT). Sizofreniis
gamosavlenad ikvleven ojaxs, tyupebsa da naSvileb mqone pacientebis pirveli rigis naTesavebis Seswavlis
pirebs. Sizofreniis SemTxvevaSi samive amgvari gamo safuZvelze kendlermac msgavsi Sedegebi miiRo
kvleva intensiuradaa Catarebuli (ix. Gottesman, 1991). (Kendler et al., 1993) (cxrili 12.9). ojaxis kvlevebis
erTiani analizi naTlad adasturebs daavadebis
ojaxis kvlevebi
etiologiaSi ojaxuri anamnezis mniSvnelobas, Tumca,
ojaxis pirveli sistemuri kvleva krepelinis kli am kvlevebiT ver xerxdeba genetikuri da ojaxuri
nikaSi Caatara ernst rudinma (Ernst Rudin), ro garemo faqtorebis gamijvna.
melmac aCvena, rom Sizofreniis SemTxvevebi ufro ojaxis kvlevebi mniSvnelovania imis dasadgenadac,
xSiria avadmyofTa probandebSi, vidre zogad popu Tu ramdenad damoukideblad gadaecema mowyvladoba
laciaSi. Tanamedrove kvlevebSi naTesavebisa da Sizofreniisa da guneb-ganwyobis aSlilobebis mi
probandebisTvis diagnostikis ufro zusti kri marT. im SemTxvevaSi, Tu saqme gvaqvs or damo
teriumebia gamoyenebuli da probandebic ukeTesadaa ukidebel sindormTan, sakmaod TvalsaCino pater
SerCeuli. aseTi gaumjobesebuli kvlevebiT miRebuli nebi unda gamovlindes. miRebuli Sedegebi urTi
Sedegebi gviCvenebs, rom cxovrebis manZilze daava erTgamomricxavia. zogi avtori am sindromebis mimarT
debis riski pirveli rigis naTesavebSi 5-10%-ia, xolo damoukidebel mowyvladobaze saubrobs, xolo sxvebi
janmrTel populaciaSi mxolod 0.2-0.6% (cxrili 12.9). amtkiceben, rom memkvidreobiToba gansazRvravs
_ 298 _
etiologia
tyupebis kvleva
cxrili 12.9 Sizofreniis mqone pacientebis
naTesavebSi cxovrebis manZilze Sizofreniis tyuebis kvlevebis mizanSewoniloba, meTodebi da
ganviTarebis riski problemebi ganxilulia 98-e gverdze. am kvlevebs
SizofreniisTvis gansakuTrebuli mniSvneloba aqvT,
riski %-Si
vinaidan maTi meSveobiT mudmivad dasturdeba Sizo-
naTesauri kavSiri gamovlenili gamovlenili freniis memkvidruli xasiaTi.
SemTxvevebi da savaraudo
SemTxvevebi
tyupebis pirveli safuZvliani kvleva miunx-
enSi Caatara luqsenbergerma (Luxenberger, 1928). man
mSoblebi 4.4 5.5
monozigoturi tyupebis 19 wyvilidan konkordantoba
yvela saxis daZma 8.5 10.2 11-s aRmouCina, xolo dizigoturi tyupebis 13 wyvi-
daZma (saerTo 13.8 17.2 lidan _ arcerTs. marTalia, Semdgomma kvlevebma es
daavadebuli mSobliT) gansxvavebuli Sefardeba aCvena, magram yvela Tanx-
Svilebi 12.3 13.9
mdeba imaSi, rom konkordantoba identur tyupebSi
mniSvnelovnad maRalia araidentur tyupebTan Sedar-
Svilebi (orive 36.6 46.3
ebiT, rac aSkara memkvidrul komponentze miuTiTebs.
daavadebuli mSobliT)
arsebuli monacemebiT, monozigotur tyupebSi kon-
naxevar daZma 3.2 3.5
kordantoba daaxloebiT 50%, xolo dizigoturebSi
Zmis an diswulebi 2.2 2.6 10%-ia (Cardno and Gottesman, 2000). moudslis (Mouds-
Shields (1980) ley) fsiqiatriis institutis mier Catarebul kvleva-
Si, romlis drosac tyupebis 108 wyvili Seiswavles
ICD-10 kriteriumebis mixedviT, Sizofreniis sixSire
ara romelime daavadebis ganviTarebas, aramed zo
identur tyupebSi _ 42%, xolo araidenturebSi 1.7%
gad winaganwyobas fsiqikuri aSlilobebis mimarT
dafiqsirda.
(Crow, 1994). Tanamedrove kvlevebze dayrdnobiT,
tyupebis Tanamedrove kvlevebi, romelTa meSveo-
SesaZlebelia Semdegi daskvnebis gakeTeba:
biTac fasdeba memkvidreobis xarisxi, (mosaxleobaSi
w Sizofreniis, Sizoafeqturi aSlilobisa da guneb-
Sizofreniisadmi winaganwyobis sixSiris gamovlena
ganwyobis aSlilobebis ganviTarebis riski maRalia
SeiZleba genebs mivaweroT, gv. 98) iZleva garemo faq-
Sizofreniis mqone pacientebis pirveli rigis na
torebis individualur (mxolod erT pirze moqmedi
TesavebSi;
faqtorebi) da gaziarebul (tyupebisTvis saerTo anu
w Sizofreniisa da guneb-ganwyobis aSlilobebis gan Tanafaqtorebi) faqtorebad dayofis saSualebas.
viTarebis riski maRalia Sizoafeqturi aSlilobis metaanalizurma kvlevam (Sullivan et al., 2003) daadas-
mqone pacientebis pirveli rigis naTesavebSi; tura, rom Sizofrenias aqvs gamoxatuli memkvidruli
w bipolaruli aSlilobebis ganviTarebis riski ar buneba (81%; 95%-iani ndobis inervaliT 73-90%). mar-
aris maRali Sizofreniis mqone pacientebis pirveli Talia, monacemTa interpretaciasTan dakavSirebiT
rigis naTesavebSi (Kendler et al., 1993 a, b, c, d; Maier azrTa sxvadasxvaobaa, magram, amasTanave, dagrovili
et al., 1993; Parnas et al., 1993). monacemebi araorazrovnad miuTiTebs Sizofreniis
cxrili 12.10 cxovrebis manZilze fsiqikuri aSlilobebis ganviTarebis riski

Sizofreniisa da Sizoafeqturi aSlilobisa probandebsa da janmrTeli
kontrolebis pirveli rigis naTesavebSi
probandis diagnozi
daavadeba
Sizofrenia (%) Sizoafeqturi (%) janmrTeli kontrolebi (%)
Sizofrenia 6.5 6.7 0.5
Sizotipuri aSliloba 6.9 2.8 1.4
Sizoafeqturi aSliloba 2.3 1.8 0.7
yvela saxis afeqturi aSliloba 24.9 49.7 22.8
fsiqozuri afeqturi aSlilobebi 8.3 12.4 2.6
bipolaruli aSlilobebi 1.2 4.8 1.4
Kendler et al., (1993 b,c,d).
_ 299 _
12 Sizofrenia
risk-faqtorebs Soris genebis upirates mniSvnelo- naTesavebSi Sizofreniisa da sxva Sizofreniuli speq-
baze. metaanalizuri kvlevebiT, aseve, dadginda, rom tris aSlilobebis ganviTarebis riski aTjer ufro
garemo faqtorebidan meti wvlili miuZRvis gaziare- maRalia (Kety et al., 1994).
bul da ara individualur-specifikur faqtorebs Svilad ayvanis gamokvlevaTa monacemebi srulad
(11%; 95%-iani ndobis intervaliT 3-19%). gaziare- amyarebs mosazrebas, rom Sizofreniis ojaxuri Sem-
bul faqtorebSi adreuli fsiqodinamiuri Teoriebis Txvevebi genetikuri faqtorebiTaa ganpirobebuli.
Tanaxmad, Sedis ojaxuri garemo, Tumca, aranakleb yuradsaRebia is, rom am kvlevebSi ver xerxdeba prena-
mniSvnelovania biologiuri faqtorebic, magaliTad, taluri garemos gaTvaliswineba, rasac sxva kvlevebi
virusuli infeqciebi an kveba, rac Tanamedrove epi- did mniSvnelobas aniWeben. aseve, Znelia genetikuri
demiologiuri kvlevebiTaa Seswavlili (gv. 285). faqtorebisa da mimRebi ojaxis garemo pirobebis
monozigoturi tyupebi identuri genetikuri in- urTierTgavlenis gamoricxvac. miRebuli monacemebis
formaciis matareblebi arian. rogorc daavadebul, Tanaxmad, Sizofreniis maRali riskis mqone gaSvileb-
ise janmrTel tyupiscalsac daavadebis ganviTarebis uli pirebi metad mgrZnobiareni arian aRzrdis arasa-
Tanabari genetikuri riski aqvs, magram Sizofrenia, ra- surveli pirobebis mimarT (Tienari et al., 2004).
Rac mizezis gamo, fenotipurad yovelTvis ar vlinde-
memkvidreobis tipi
ba (e.w. `SemTxveviTi procesi~ albaTobis TeoriaSi).
Sizofreniis mqone pacientebis naTesavebSi daavadebis
Svilad ayvanis kvlevebi ganviTarebis sixSire ar eqvemdebareba martiv mende-
hestonma (Heston, 1966) Seiswavla 46 mozrdili adami- lianuri ganawilebis princips, rodesac niSan-Tviseba
ani, romlebic dabadebidan 3 dRis vadaSi gaaSviles da erTi dominanturi an recesiuli geniT gadaecema. aseTi
romlebsac SizofreniiT daavadebuli dedebi hyavdaT. genis arseboba SesaZlebelia, magram igi cvalebadi pen-
isini gansxvavebul garemoSi, Tumca, ara avadmyof de- etrantobiT unda xasiaTdebodes. genetikuri kvlevebis
dasTan izrdebodnen. kvlevis dros maTi saSualo asaki Sedegebi praqtikulad gamoricxavs im mosazrebas, rom
36 weli iyo. hestonma Sesadareblad SearCia aRzrdis Sizofrenia sxvadasxva modifikaciisa da ZiriTadi
pirobebis TvalsazrisiT dabalansebuli sakontrolo efeqtis mqone erTi geniT gamowveuli daavadebaa.
jgufi, romlis wevrebsac janmrTeli dedebi hyavdaT. arsebobs ori alternatiuli (SesaZloa, orive swori)
avadmyofi dedis Svilebidan xuTs daudasturda Sizo- midgoma:
freniis diagnozi, sakontrolo jgufSi ki _ arcerTs. 1. Sizofrenia aris mravali genis jamuri efeqtis
Sizofreniis ganviTarebis sixSiris maCvenebeli gaS- Sedegi, e.w. kompleqsuri anu aramendelianuri
vilebul bavSvebSi daaxloebiT iseTive iyo, rogoric genetikuri daavadeba. Sizofreniisadmi midrekileba
avadmyof mSobelTan darCenilebSi. mosaxleobaSi sxvadasxva xarisxiT arsebobs, magram
1965 wels danieli da amerikeli mecnierebis mier gamovlena xdeba maSin, rodesac Sizofreniisadmi
Catarebuli kvlevebis safuZvelze dagrovda dam- winaganwyoba genetikuri mowyvladobis zRurbls
atebiTi Sedegebi. am kvlevebSi gamoiyenes fsiqikuri gadaaWarbebs. arc erTi calke aRebuli geni ar
aSlilobebisa da Svilad ayvanis SemTxvevebis daniis aris sakmarisi da aucilebeli daavadebis gan
erovnuli aRricxvis monacemebi. erT-erT ZiriTad viTarebisTvis, aramed mxolod Sizofreniis risk-
proeqtSi (Kety et al., 1975) Svilad ayvanili bavSvebis faqtors warmoadgens. Sizofrenia aris poli
ori jgufi gamoyves: 33 bavSvi, romlebsac hyavdaT morfizmis da ara mutaciis Sedegi (gv. 101).
Sizofreniis mqone deda da sakontrolo jgufi, rom-
2. Sizofrenia aris sxvadasxva daavadebaTa jgufi,
lis wevrebsac ar hyavdaT avadmyofi deda. orive jgu-
romlebsac gansxvavebuli genetikuri da ara
fisTvis Seadares Sizofreniis ganviTarebis sixSire
genetikuri safuZvlebi aqvT. sxva sityvebiT rom
biologiur da mimReb ojaxebSi. daavadebis SemTxve-
vTqvaT, Sizofrenia heterogenuli daavadebaa.
vaTa sixSire meti iyo Sizofreniis mqone naSvilebi
pirebis biologiur naTesavebSi, vidre kontrolebi- Sizofreniis ganviTarebaSi monawile ramdenime genis
saSi, rac aSkarad genetikur winaganwyobaze miuTiTeb- gamovlena (ix. qveviT) pirveli mosazrebis sasargeblod
da. amasTan, mimRebi ojaxis wyvilebSi, romlebic metyvelebs. jer-jerobiT ar aris Seswavlili
arajanmrTeli dedisgan naSvileb bavSvs zrdidnen, calkeuli genis sxvadasxva qvejgufebTan kavSiri, rac
Sizofreniis SemTxvevaTa raodenoba momatebuli ar meore (heterogenobis) Teoriasac gaamyarebda.
iyo, rac, savaraudod, imas adasturebs, rom garemo qrous (Crow) lateralizaciis hipoTeza
faqtorebs arsebiTi mniSvneloba ar unda hqondes.
Sizofreniis etiologiasTan dakavSirebiT sruliad
daniaSi Catarebulma Semdgomi Sefasebis kvlevebma,
gansxvavebuli Teoria SemogvTavaza qroum (Crow,
gaSvilebulTa erovnuli monacemebis safuZvelze
2002). man gamoTqva mosazreba, rom Sizofrenia erTi
gamoavlina, rom daavadebuli pirebis pirveli rigis
genis daavadebaa, romelic, aseve, pasuxismgebelia
_ 300 _
etiologia
adamianis Tavis tvinis or umniSvnelovanes Tvisebaze: SemTxvevebis 1%), magram gviCvenebs, Tu ra mniSvneloba
cerebrul asimetriasa da metyvelebaze. aranairi aqvs Sizofreniis ganviTarebisTvis 22q11 qromosomas.
sxva genetikuri Tu garemo faqtorebi saWiro
Sizofreniis ganmsazRvreli genebi
araa. sxvadasxva mosazrebidan gamomdinare, es geni
sasqeso qromosomis garkveul ubanSi mdebareobs. Sizofreniis maRali memkvidreobiTobisa da Cata
SizofreniasTan dakavSirebuli sxva aspeqtebi, men rebuli mravali kvlevis miuxedavad, Zalian rTu
delianuri paternebis ararsebobis CaTvliT, rac li aRmoCnda Sizofreniis genis qromosomuli lo
mosalodnelia erTi genis daavadebebis SemTxvevaSi, kalizebis dadgena, rom araferi vTqvaT Tavad genebis
epigenuri faqtorebiTaa axsnili (gv. 103). es midgoma gansazRvraze. am sirTuleebs ganapirobebs zeviT
sakmaod originaluria da yuradRebas amaxvilebs CamoTvlili mravali problema, kerZod, fenotipis
SizofreniisTvis damaxasiaTebeli cerebruli asi memkvidrul xasiaTTan dakavSirebuli gaurkvevloba
metriis Sesustebaze (Sommer et al., 2001), magram ar da mravali mcire, Znelad gasazomi efeqtis mqone
arsebobs pirdapiri mtkicebulebebi am konkretuli genis arseboba. Tumca, am mxriv, ukanasknel wlebSi
genis Sesaxeb da arc im meqanizmebis axsna, rac ga mniSvnelovan progress miaRwies (ix. Owen et al., 2004).
napirobebda aseTi farTo speqtris normalur da ori metaanalizuri kvlevis meSveobiT moxerxda Si
paTologiur gamovlinebebs. zofreniasTan dakavSirebuli qromosomuli lo
kusis gansazRvra, kerZod, maRali da Zalian ma
ra aris memkvidruli? Rali albaTobiT gamovlinda 2p, 8p, 13q da 22q
daavadebis genis gamovlena ufro advilia, rodesac (p-qromosomis mokle da q-qromosomis grZel mxares).
dadgenilia memkvidruli fenotipis sazRvrebi. ukve gamoiyo SizofreniasTan asocirebuli ramdenime geni
visaubreT Sizofreniuli speqtris daavadebebisa (monacemebi ix. cxrilSi 12.11). naCvenebia, rom arc
da guneb-ganwyobis aSlilobebisagan Sizofreniis erTi geni ar iwvevs Sizofrenias (rogorc es xdeba
sazRvrebis dadgenasTan dakavSirebul sirTuleebze. mendelianuri genuri daavadebebis SemTxvevaSi),
sxvagvari midgomiT SesaZlebelia iseTi konkretuli magram TiToeuli genis variaciebi (polimorfizmi)
komponentis an masTan dakavSirebuli im Tvisebebis dakavSirebulia daavadebis riskis zomier (naklebad,
gamovlena, romlebic memkvidreobiT gadaecema. vidre 3-jer) gazrdasTan.
mravali mtkicebulebiT dadgenilia, rom aseTi saukeTeso Sedegebia miRebuli niuregulinisa
niSnebia endofenotipebi anu Sualeduri fenotipebi. da disbindinis SemTxvevaSi. monacemebi sakmarisad
fenotipi ufro axlosaa genebTan da etiologiurad myaria, vinaidan ramdenjerme gadamowmda sxvadasxva
meti validobiT gamoirCeva. Sizofreniis endofe populaciaSi. orive geni sakmaod kompleqsuria;
notipebia: gamowveuli potencialebi, muSa mexsiereba, amasTan, maTi biologia da funqciebi ar aris
tvinis struqtura, Tvalis gayolebis disfunqcia
da a.S. (gv. 298-90). SesaZlebelia, rom sxvadasxva cxrili 12.11 SizofreniaSi monawile genebi da
endofenotips sxvadasxva geni gansazRvravdes. maTi qromosomuli lokalizeba
imis dasadgenad Tu, ramdenadaa mocemuli endo
genis
fenotipi Sizofreniis ganmsazRvreli nawili, unda alternatiuli dasaxeleba lokusi
saxelwodeba
dadasturdes misi genetikuri safuZveli da gakeTdes
niuregulini NRG1 8p
imis demonstrirebac, rom igi saimedo da sasargebloa,
magaliTad, daavadebis gamosavlis an mkurnalobis disbindini DTNBP1 6p
efeqturobis gansazRvrisas. G72 D-amino mJava oqsidazas 13q
aqtivatori
velokardiofacialuri sindromi
RGS-4 G proteinis impulsis 1q
velokardiofacialuri sindromi anu di jorjis gadacemis regulatori
sindromi (di George syndrome) gamowveulia 22q11
DISC-1 dazianebuli Sizofreniis 1q
qromosomis deleciiT (aqedanaa misi alternatiuli dros 1
dasaxeleba _ 22q11 qromosomis deleciis sindromi).
GRM3 metabotropuli glutamaturi 7q
es sindromi SedarebiT gavrcelebuli citogenuri receptori 3
anomaliaa (1 SemTxveva 4000 sul mosaxleze) da iwvevs
COMT kateqolOmeTil 22q
mTel rig fizikur da kognitur darRvevebs (Marphy, transferaza
2002). SemTxvevaTa daaxloebiT 30%-Si viTardeba
DAAO DaminomJava oqsidaza 12q
sxvadasxva saxis fsiqikuri aSliloba (rogorc
Sizofreniismagvari, aseve guneb-ganwyobis). marTalia, HTR2A 5-HT2A receptori 13q
es sindromi Sizofreniis iSviaTi mizezia (mTeli DRD3 dofaminis D3 receptori 3q
_ 301 _
12 Sizofrenia
saTanadod Seswavlili. niuregulini gansazRvravs gamo); (2) samSobiaro garTuleba SeiZleba gamowveuli
gliuri ujredebis zrdisa da sinafsuri plas iyos nayofis anomaliurobiT an misi genetikuri
tikurobis mraval aspeqts. disbindini ki mona TaviseburebebiT; (3) asaxavdes orsulobis periodSi
wileobs sinafsuri kavSirebis funqciurobasa da dedis janmrTelobis mdgomareobas.
impulsebis gadacemaSi. sxva genebze miRebuli Se
orsulobaSi gadatanili gripi
degebi naklebad damajerebelia, xolo zogi, sa
erTodac, cru-pozitiuri aRmoCnda. momavalSi mo ramdenime kvlevam aCvena, rom mesame trimestris
salodnelia ufro meti genis (magaliTad, me-2 qro dros nayofze gripis virusis (gansakuTrebiT 1957
mosomaSi lokalizebuli genebis) identificireba. wlis pandemiuri A2 gripis virusis) zemoqmedeba
Sizofreniis yvela savaraudo genis dasaxeleba an zrdis Sizofreniis ganviTarebis risks. amis bio
maTi mniSvnelobis, moqmedebis da urTierTgavlenis logiuri dadastureba cxovelebze Catarebulma
gansazRvra amJamad SeuZlebelia. magaliTad, ni kvlevebma mogvca, romelTa meSveobiTac gairkva, rom
uregulinisa da disbindinis SizofreniasTan da prenataluri gripi uaryofiTad moqmedebs tvinis
kavSirebuli polimorfizmi sxvadasxva kvlevis mi ganviTarebaze. amave dros kvlevebis umravlesoba
xedviT gansxvavebulia. amasTan, moniSnuli cilebis negatiur Sedegebs gvaZlevs da kavSiri Sizofreniasa
aminomJavebSi cvlilebebi ar dadasturda. erT-erTi da grips Soris Znelad dasadgenia. amas damatebiT
SesaZlo variantia, rom Sizofreniis dros gvaqvs adasturebs axali kvlevebiT miRebuli Sedegebi,
genis eqspresiis darRvevebi da geni gansazRvravs romelTa mixedviTac orsulobis adreul periodSi
Tavis tvinSi glutamatur da dofaminur gadacemas, gripze dadebiTi serologiuri reqciis SemTxvevaSi,
romelTa mniSvnelobac SizofreniisTvis, arsebuli SizofreniiT daavadebis riski 7-jeraa gazrdili
Teoriebi Tanaxmad, dadasturebulia (Harrison (Brown et al., 2004).
andWeinberger, 2005). dedisa da bavSvis sxva infeqciebic SeiZleba da
kavSirebuli iyos SizofreniasTan, magaliTad, toq
garemo risk-faqtorebi soplazmozi, poliomieliti, wiTela da Cutyvavila
(Buka et al., 2001), magram es damtkicebuli araa.
tyupebis kvleva, rac ukve ganvix., gviCvenebs, rom
Sizofreniis ganviTarebaze garemo faqtorebis mcire, sxva prenataluri faqtorebi
magram aSkara gavlena arsebobs. am mimarTulebiT
Sizofreniis ganviTarebasTan dakavSirebuli orsu
mTeli rigi, gansakuTrebiT pre- da postnataluri,
lobis periodis sxva garTulebebia rezus Seu
faqtorebia Seswavlili. am TavSi aRwerilia ZiriTadi
Tavsebloba, kvebis Raribi racioni da stresi (McGrath
biologiuri faqtorebi, xolo socialuri sakiTxebi
and Murray, 2003; Neugebauer, 2005).
momdevno nawilSia mocemuli (Sizofreniis risk-
faqtorebis mimoxilva ix. McGrath and Murray, 2003). zamTris bavSvebi
Sizofreniis SemTxvevebi umniSvnelod metia zamTarSi
samSobiaro garTulebebi
dabadebul bavSvebSi, zafxulSi dabadebulebTan Se
retrospeqtuli kvlevebi gviCvenebs, rom Sizofreniis
darebiT (Davies et al., 2003). aseve, erTnairad gamovlinda
mqone pacientebs meti samSobiaro garTulebebi
rogorc CrdiloeT, ise samxreT naxevarsferoebsa
aReniSnebaT, vidre maT janmrTel da-Zmas. meta-
da, meti intensivobiT, zeda ganedebze. SizofreniiT
analizur kvlevebSi Sansebis Sefardeba TiTqmis 2-s
daavadebuli pirebi, ojaxuri anamnezis gareSe, ufro
udris (Gedes et al., 1999). Tumca, am mimarTulebiT
xSirad zamTarSi arian dabadebulebi. amis axsna
Catarebuli ramdenime, maT Soris, prospeqtuli
SesaZlebelia zamTris dasawyisSi gripis gazrdili
kvlevis Sedegebi uaryofiTi aRmoCnda. SesaZloa,
sixSiriT an mzisa da D vitaminis naklebobiT; aseve,
genetikuri garTulebebi Sizofreniis mimarT wina
SeiZleba dakavSirebuli iyos Casaxvis periodTan da
ganwyobis mqone pirebis SemTxvevaSi metad mniSvlovania
genuri informaciis sezonur fluqtuaciasTan.
(McNeil et al., 2000). jer-jerobiT ucnobia, romeli
samSobiaro garTulebaa yvelaze metad dakavSirebuli bavSvis ganviTareba
SizofreniasTan; gedesma (Geddes et al., 1999) naxa, rom parnasma (Parnas et al., 1982) gamosca naSromi, romelSic
amnionuri membranis naadrevi darRveva, 37 kviramde Sizofreniis mqone 207 dedis Svilebis Seswavlis
mSobiaroba, reanimaciis an inkubatoris saWiroeba monacemebi gamoaqveyna. isini pirvelad 8-12 wlis asakSi
da nayofis mcire wona aSkarad moqmedebs daavadebis Seafases, mere ki _ 18 wlis Semdeg. am droisTvis 13-s
ganviTarebaze. samSobiaro garTulebasa da Sizo hqonda Sizofreniis diagnozi da 29-s aReniSneboda
frenias Soris kavSirs ramdenime SesaZlo axsna aqvs: `Sizofreniis mosazRvre mdgomareoba~. pirveli Se
(1) samSobiaro garTuleba SeiZleba daavadebis uSualo fasebisas miRebuli monacemebiT, prognozulad
mizezs warmoadgendes (magaliTad, nayofis hipoqsiis mniSvnelovani iyo:
_ 302 _
etiologia
w interviurebisas susti urTierTkavSiri; unda daisvas ara Sizofreniis, aramed Sesabamisi
w Tanatolebisgan socialuri izolacia; fsiqikuri aSlilobis daignozi (Tavi me-18). Tumca,
arsebobs monacemebi, rom zogierTi nivTierebis
w mSoblebis gancxadeba, rom pacienti bavSvobidanve
gamoyeneba zrdis Sizofreniis ganviTarebis risks,
pasiuria.
gansakuTrebiT haSiSis. andreasenma (Andreasson et al.,
mogvianebiT, donma (Done et al., 1994) 16 000-ze me 1987) gamoikvlia 45 000 Svedi wvevamdeli, romlebic
ti cdis piris 16-wliani kohortuli kvlevis Se ganmeorebiT Seafasa 15 wlis Semdeg. man aCvena, rom
degad aCvena, rom Sizofreniis ganviTarebis prog haSiSis momxmareblebSi Sizofreniis ganviTarebis
nozireba SesaZlebelia ukve 11 wlis asakSi (an riski 2.5-jer, xolo intensiur momxmareblebSi
ufro adrec). aseT bavSvebs ufrosebis mimarT aqvT 6-jeraa gazrdili. es monacemebi SeiZleba orgvarad
mtruli damokidebuleba da werisa da metyvelebis aixsnas: (1) haSiSis moxmareba Sizofreniis ganviTarebis
sirTuleebi aReniSnebaT. msgavsi gansxvaveba aCvena risk-faqtoria an (2) Sizofreniisadmi winaganwyobis
im jgufebis Sedarebamac, romlebSic gamoikvlies mqone pirebs (an Sizofreniis prodromSi) aqvT
nevrologiuri daavadebebis mqone bavSvebi da midrekileba haSiSis mimarT. ukanaskneli kvlevebi
isinic, romlebsac nevrologiuri problemebi miuTiTebs haSiSis WeSmarit kauzalur mniSvnelobaze.
ar aReniSnebodaT. analogiuri kvleva Caatara riski gansakuTrebiT maRalia haSiSis adreuli
jonsmac (Jones et al., 1994) da naxa, rom bavSvebi, asakidan moxmarebis SemTxvevaSi (Arsenault et al., 2004).
romlebsac mogvianebiT uviTardebaT Sizofrenia, amasTan, Sizofreniis ganviTarebis safrTxe, raime
Tanatolebs ramdenadme CamorCebian ganviTarebaSi; sxva mizezis gamo fsiqozisadmi mowyvlad pirebSi,
maT aReniSnebaT metyvelebis problemebi, aqvT TvalsaCinod momatebulia (Henquet et al., 2005). maT
dabali maCveneblebi saswavlo testebSi da nak Soris, mniSvnelovania genetikuri faqtorebic (Caspi
lebad interesdebian socialuri TamaSebiT. is, et al., 2005).
rom arsebobs kavSiri ganviTarebis CamorCenasa
(magaliTad siarulis dawyeba) da Sizofrenias Soris, sxva risk-faqtorebi
dadasturda daniaSi adgilobriv mosaxleobaze Cata Sizofreniis SemTxvevebs ufro xSirad vxvdebiT
rebuli kvlevebiT. devidsonma (Davidson et al., 1999) epilefsiis mqone pacientebsa (me-14 Tavi) da dabali
naxa, rom mamrobiTi sqesis bavSvebi, romlebsac inteleqtis mqone pirebSi (25-e Tavi). ojaxuri
sabolood Sizofrenia ganuviTardaT, gamoirCeodnen anamnezis ararsebobis dros Sizofrenia mamis asak
socialuri funqcionirebis, organizaciuli una Tanaa asocirebuli (Sipos et al., 2004), rasac, Se
risa da inteleqtualuri aqtivobis deficitiT. saZloa, ganapirobebdes asakTan erTad spermaSi de
uolkerma (Walker et al) kolegebTan erTan Seiswavla novo genetikuri mutaciis sixSiris mateba. Zveli
axalSobilebis qceva da motoruli aqtivoba (ojaxuri kvlevebis Tanaxmad, qala-tvinis travma warmoadgens
videoCanawerebis saSualebiT) da daaskvna, rom am Sizofreniisa da sxva fsiqozebis ganviTarebis
monacemebis safuZvelze SesaZlebelia Sizofreniis risk-faqtors, Tumca monacemebi arasakmarisi da
adreuli prognozireba (Schiffman et al., 2004). dausabuTebelia (David and Prince., 2005).
amdenad, arsebobs sakmarisi mtkicebulebebi imi
sa, rom Sizofreniis mqone pirebs bavSvobaSi inte Tavis tvinis struqturuli cvlilebebi
leqtualuri da motoruli disfunqcia da socialuri mravali saukunea mimdinareobs dava Sizofreniis
deficiti aReniSnebaT. Tumca, bolomde naTeli ar aris, dros nevropaTologiuri cvlilebebis arsebobis
ramdenad specifikuria es cvlilebebi an ra kavSirSia Taobaze. pirvelad amis damtkiceba scada alchaimerma,
momavalSi Sizofreniis ganviTarebasTan. bavSvebis romelmac ramdenime aTeuli weli miuZRvna dementia
umetesobas, romlebsac SemdgomSi ganuviTardaT praecox-is Seswavlas da bolos gamoaqveyna naSromi
Sizofrenia, kvlevis periodSi klinikuri anomalia preseniluri demenciis Sesaxeb, romelic misi
ar gamouvlinda, xolo bevr bavSvs, romlebsac saxeliTaa cnobili. alchaimerma da sxva mkvlevarebma
aReniSnebodaT deficituri maCveneblebi, Sizofrenia ver SeZles Tavis tvinSi damaxasiaTebeli da sarwmuno
ar ganuviTarda. miuxedavad amisa, es kvlevebi amyarebs cvlilebebis aRmoCena, amitom CaTvales, rom
mosazrebas imis Taobaze, Tu ra mniSvneloba aqvs Sizofrenia funqciuri da ara organuli daavadebaa.
SizofreniisTvis adreul neiroganviTarebas. ukanaskneli ocdaaTi wlis manZilze neirovizualuri
wamalmoxmareba meTodebisa da gakveTis meSveobiT miRebuli
monacemebi erTmniSvnelovnad iZleva imis mtkicebis
sadavoa urTierTkavSiri alkoholis an fsiqoaqtiuri
saSualebas, rom Sizofrenia `tvinis daavadebaa~
nivTierebebis moxmarebasa da Sizofrenias Soris.
(Weinberger, 1995), Tumca daavadebis nevropaTologia
radgan wamalmoxmareba fsiqozis uSualo gamomwvevia,
dRemde ar aris saTanadod Seswavlili da gagebuli.
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12 Sizofrenia
aranamkurnaleb pacientebSic, rac imaze miuTiTebs,
cxrili 12.12 tvinis struqturuli
rom isini mkurnalobiT ar aris gamowveuli. es
cvlilebebis monacemebi Sizofreniis dros
cvlilebebi zomieria (magaliTad, tvinis moculobis
tvinis neirovizualuri kvlevebi cvlileba mxolod 3%-ia), aRiniSneba kontrolebisa
Semcirebulia tvinis moculoba da pacientebis monacemebis urTierTgadafarvac.
amasTan, maT ar aqvT diagnostikurad specifikuri
gafarToebulia lateraluri parkuWebi
mniSvneloba. magaliTad, gafarToebuli parkuWebi da
gafarToebulia mesame parkuWi cerebruli atrofia damaxasiaTebelia alchaimeris
Semcirebulia medialuri temporaluri wili daavadebisTvisac, xolo SeWmuxnili hipokampi gvxvdeba
guneb-ganwyobis aSlilobebis drosac. arsebobs
Semcirebulia qerqis ruxi nivTiereba
mxolod ramdenime klinikopaTologiuri kavSiri;
Sesustebulia cerebruli asimetria
zogierTi struqturuli cvlileba asocirebulia
nevropaTologia garkveul kognitur deficitTan, magaliTad, az
rovnebis darRvevebi _ safeTqlis wina xveulasTan.
Semcirebulia tvinis masa
axali kvlevebis meSveobiT mecnierebi cdilobdnen
neirodegeneraciuli cvlilebebis ararseboba
daedginaT Tavis tvinis struqturuli cvlilebebis
gliozis ararseboba ganviTareba daavadebis msvlelobis periodSi. miRe
Semcirebulia presinafsuri markerebi buli Sedegebi Zalian kompleqsuri da, xSir SemTxvevaSi,
urTierTgamomricxavia (Weinberger and McClure, 2002).
Semcirebulia dendritis markerebi
zogi cvlileba simptomebis gamovlenamde arsebobs,
Semcirebulia oligodendroglia xolo zogierTi pirveli epizodis periodSi vlindeba
tvinis zogierT ubanSi Semcirebulia piramiduli neironebi (Pantelis et al., 2003). darRvevebis umetesoba ar
progresirebs, Tumca ramdenime kvlevam aCvena, rom
Semcirebulia Talamuri neironebi
damatebiTi cvlilebebis ganviTareba xdeba pacientTa
dReisTvis arsebuli ZiriTadi Sedegebi Sejamebulia garkveul jgufSi an daavadebis garkveul etapze.
cxrilSi (cxrili 12.12) pacientebis pirveli rigis naTesavebsac aReniSnebaT
tvinis moculobis Semcirebis tendencia da maTi
struqturuli neirovizualuri gamokvlevebi
monacemebi moqceulia pacientebisa da janmrTeli
erT-erT pirvel kvlevaSi jonstounma (Jonstone et kontrolebis maxasiaTeblebs Sorisa (Lawrie et al.,
al., 1976) Tanamedrove kompiuteruli tomografiuli 1999). es metyvelebs imaze, rom tvinis anomalia
teqnikis gamoyenebiT gamoikvlia samocdaaTi xan genetikuri faqtorebiTaa ganpirobebuli.
dazmuli Sizofreniuli pacienti da rva janmrTeli
kontroli. man naxa, rom pacientebs janmrTelebTan nevropaTologia
SedarebiT Tavis tvinis parkuWebis mniSvnelovani gakveTiT miRebuli monacemebis safuZvelze SesaZ
gafarToeba aReniSnebodaT. Sizofreniis dros la lebelia neirovizualuri gamokvlevebiT gamovlenili
teraluri parkuWis gafarToeba jer kidev ramdenime Sedegebis ujredul da molekulur doneze Seswavla
aTeuli wlis win daadgines pnevmoencefalografiuli (Harrison, et al., 1999) (ix. cxrili 12.12).
gamokvlevebiT, magram swored jonstounis mier dReisTvis cnobilia, rom:
Catarebulma kvlevam gaaZliera interesi am faqtis w tvinis masa Semcirebulia;
mimarT. SemdgomSi Catarebuli mravali, upiratesad
w mtkicebuleba neirodegeneraciuli cvlilebebis
magnitur-rezonansuli, gamokvlevebiT es aRmoCena
Sesaxeb ar arsebobs, rac miuTiTebs paTologiis
dadasturda da axali monacemebiT gamdidrda (ix.
neiroganviTarebis bunebaze da gviCvenebs, rom
Shenton et al., 2001).
daavadebis manZilze progresirebadi cvlilebebi,
Tanamedrove metaanalizuri kvlevebiT dadgenilia,
romlebic ramdenime magnitur-rezonansuli kvle
rom Sizofreniis dros tvinis saerTo moculoba,
viT gamovlinda, ar aris neirotoqsikuri an
lateraluri da mesame parkuWebi da hipokampi mni
neirodegeneraciuli xasiaTis.
Svnelovnada da namdvilad Secvlilia (Wright et al.,
2000). parkuWebis dilatacia da, savaraudod, sxva w dafiqsirebulia sinafsuri da dendrituli mar
cvlilebebic yvela pacientisTvis unimodaluria, kerebis, gliisa da specifikuri populaciis ne
rac imis maniSnebelia, rom es anomaliebi mxo ironebis simkvrivis cvlilebebi. es darRvevebi
lod òrganuli~ SizofreniisTvis ara aris dama lokalizebulia cerebrul korteqsSi, hipokampsa
xasiaTebeli. aSkara kavSiri sqesTan ar arsebobs. es da TalamusSi da miuTiTebs sinafsuri kavSirebis
darRvevebi Tavdapirveladve vlindeba da, aseve, deficitze, rac Sizofreniis àberantuli kav
_ 304 _
etiologia
Sirebis~ hipoTezas amyarebs. testis) Sesrulebisas (Liddle and Pantelis., 2003).
w bevrma kvlevam aCvena, rom neironebis garkveul am cvlilebebaTa monacemebis analizi sakmaod
jgufs zog ubanSi, gansakuTrebiT, entorinalur rTulia, vinaidan pacientebi, zogadad, cudad
qerqs an TeTr nivTierebaSi, Secvlili aqvs mde asruleben kognitur operaciebs da SesaZlebelia,
bareoba. es aRmoCena mWidrodaa dakavSirebuli rom daqveiTebuli aqtivoba, ubralod, testis cud
prenataluri neironuli migraciis darRvevebis Sesrulebas an amocanaSi warumateblad CarTvas
Sesaxeb arsebul mosazrebasTan. Tumca, es monacemebi asaxavdes. zogi monacemiT, pacientebs, kontrolebis
ar aris sakmarisad dublirebuli. msgavsad, kognituri amocanis SesrulebisTvis fron
taluri korteqsis ufro metad gaaqtiureba esa
w genebis eqspresiis kvlevisas, gamovlenilia cvli
WiroebaT, rac, SesaZloa, qerqSi mimdinare procesebis
lebebi im genebSi, romlebic gansazRvraven nervuli
èfeqturobis~ Semcirebaze mianiSnebdes (Callicot et al.,
da oligodendrogliuri ujredebis monawileobas
2003). aseTi darRvevebi dakavSirebulia àberantuli
SizofreniaSi. kavSiri molekulur, struqturul
kavSirebisa~ da dofaminis TeoriebTan, romlebic
da genetikur faqtorebs Soris naTeli araa (ix.
qvemoTaa ganxiluli.
Harrison and Weinberger, 2005).
kvlevebis nawili swavlobs specifikuri simptomebis
cerebrul korelatebs. magaliTad, funqciurma mag
cerebruli sisxlis nakadi
nitur-rezonansulma gamokvlevebma aCvena, rom au
sxvadasxva teqnikis meSveobiT, kerZod. pozitronul-
ditoruli halucinaciebis arsebobisas aRiniSneba
emisiuri tomografiiT (PET), funqciuri magnitur-
safeTqlis wilis im regionis susti aqtivoba, romelSic
rezonansuli gamokvlevebiT (FMRI), erT-fotonuri
xdeba garedan miRebuli sityvieri informaciis ga
emisiuri tomografiiT (SPET) SesaZlebelia Sizo
damuSaveba. unda vivaraudoT, rom saerTo nervul
freniis dros gamovikvlioT cerebruli sisxlis
substratze mimdinareobs konkurencia (ix. David and
nakadisa da metaboluri aqtivoba (ix. me-5 Tavi).
Busatto, 1999).
Sizofreniis dros kvlevebi, ZiriTadad, Semdegi sami
mimarTulebiT xorcieldeba:
neiroqimiuri monacemebi
1. mosvenebul mdgomareobaSi cerebruli sisxlis na
dReisTvis Seswavlilia mravali neirotransmiteri,
kadis Seswavla;
maTi receptorebi, enzimebi da metabolitebi da
2. specifikuri kognituri amocanebis Sesrulebisas aRnusxulia maTi cvlilebebi Sizofreniis dros.
cerebruli aqtivaciisa da deaqtivaciis paternebis mkvlevarebi amJamad iyeneben Zalian kargad damu
dadgena; Savebul da sensitiur meTodebs, raTa SeZlon ne
3. specifikur simptomebsa da regionaluri cerebruli iroqimiuri da neiroanatomiuri cvlilebebis dakav
sisxlis nakadis paternebs Soris korelaciis ga Sireba da SizofreniisTvis `neiroqimiuri anatomiis~
movlena. erTiani suraTis Seqmna (Fallon et al., 2003). aseve, didi
pirveli gamokvleva Caatares ingvarma da franzerma Zalisxmevaa mimarTuli iqiTken, rom gaerTiandes
(Ingvar andFranzen., 1974). maT Seiswavles cerebruli gakveTiTa da in vivo neirovizualuri meTodebiT
sisxlis nakadi qronikuli Sizofreniis mqone nam miRebuli informaciisa da, ukanasknel wlebSi,
kurnaleb pacientebSi. kvlevisad gamoiyenes ra neiroqimiuri da genetikuri kvlevebiT miRebuli
dioaqtiuri qsenonis ineqcia da naxes, rom sisxlis Sedegebi. Tumca, am TavSi aRwerili bevri monacemis
nakadi Tavis tvinis frontalur korteqsSi, sxva mniSvneloba Sizofreniis etiologiisTvis yovelTvis
ubnebTan SedarebiT, daqveiTebuli iyo. mas Sem ar aris naTeli. Znelia am darRvevebidan im cvli
deg `hipofrontaloba~iTvleba Sizofreniis dama lebebis gamoyofa, romlebic daavadebaze tvinis
xasiaTebel Taviseburebad. marTalia, bevrma kvle adaptaciuri an araadaptaciuri reaqciis nawils an
vam msgavsi Sedegi aRar aCvena, magram uaxlesi medikamentebis Sedegs warmoadgenen.
metaanaliziT am mosazrebis siswore kvlav dadas dofamini
turda (Hill et al., 2004). aRsaniSnavia, rom kavSiri
ukanaskneli ocdaaTi wlis ganmavlobaSi Catarebuli
Sizofreniasa da hipofrontalobas Soris maSinaa
kvlevebis ori ZiriTadi jgufi SizofreniisTvis
ufro gamoxatuli, roca gaTvaliswinebulia sim
dofaminis gansakuTrebul mniSvnelobaze miuTiTebs
ptomebis Tavisebureba da daavadebis faza, maga
(Seeman., 1987). pirveli jgufi ganixilavs amfetaminebis
liTad, fsiqomotoruli gaRaribebis dros (cxrili
efeqts, romlebic, sxva moqmedebasTan erTad, iwveven
12.3). frontaluri perfuziisa da aqtivobis dar
centralur sinafsebSi dofaminis gamoTavisuflebas.
Rvevebi ufro TvalsaCinoa kognituri amocanebis
janmrTeli adamianis mier amfetaminebis maRali
(magaliTad, viskonzinis kartebis daxarisxebis
doziT ganmeorebadi miReba iwvevs mwvave Sizofreniis
_ 305 _
12 Sizofrenia
msgavs mdgomareobas. amasTan, Sizofreniuli paci disregulacia meoradad, glutamaturi darRvevebiTaa
entebisTvis amfetaminebis daniSvna auaresebs fsi ganpirobebuli (ix. qvemoT). dofaminTan dakavSirebiT
qozur simptomebs. meore mimarTuleba efuZneba kapurma (Kapur, 2003) fenomenologiuri midgoma
im aRmoCenas, rom yvela antifsiqozuri preparati SemogvTavaza. misi mosazrebiT, is faqti, rom dofamini
dofaminis receptorebis antagonistia da maTi moq monawileobs kognitur da qceviT aqtivobebSi, met
medeba D2 receptorze yvelaze ukeTesad gansazRvravs yvelebs imaze, rom dofamini gare impulsebis Sinagan
maT antifsiqozur efeqturobas (gv. 530). warmodgenebad `gardaqmnis~ mediatoria . Sizofreniis
sakmaod myari monacemebi gvaqvs antifsiqozuri dros dofaminerguli darRvevebi iwvevs stimulebisa
preparatebis moqmedebaSi dofaminis centralur da maTi mniSvnelobis araswor gagebas, xolo bodvebi,
rolze, magram mtkicebulebebi SizofreniaSi do halucinaciebi da pacientis survili _ gaerkvios
faminis neirotransmisiis monawileobis Sesaxeb, maTSi, am gamocdilebis Sedegia.
ukanasknel dromde, naklebad myari iyo. es gamo
glutamati
wveulia daavadebisa da wamlis moqmedebis efeqtis
erTmaneTisgan gamijvnis sirTuliT. uaxlesi neiro ukanasknel wlebSi gaizarda interesi imis mimarT,
vizualuri (PET da SPET) kvlevebiT SesaZlebeli gaxda Tu ra mniSvneloba aqvs SizofreniisTvis aminomJava
aranamkurnaleb pacientebSi moniSnuli radioaqtiuri neirotransmiteris glutamats. es ganapiroba im
ligandebiT Tavis tvinSi dofaminis receptorebisa da sakvanZo aRmoCenam, rom N-meTil-D-aspartatis
dofaminis sinTezis Seswavla. kvlevaTa umravlesobam (NMDA) tipis glutamaturi receptorebis anta
ver gamoavlina ubralo gansxvaveba dofaminis gonistebs (fenciklidini da ketamini) SeuZliaT
receptorebis raodenobaSi. Tumca, iq, sadac ufro Sizofreniismagvari mgomareobebis kupireba. amas
kompleqsuri paradigmebi gamoiyenes, dofaminerguli daemata axali monacemebi NMDA receptorebis
darRvevebis damajerebeli monacemebi miiRes (Harrison, modulatorebis (magaliTad, glicinis) antifsiqozuri
2000). me-5 TavSi aRwerili iyo, Tu rogor SeiZleba efeqtis Sesaxeb (Goff and Coyle., 2001). arsebuli
ganxorcieldes farmakologiuri zemoqmedebiT gamo sxva Sedegebi, romlebic metyveleben glutamatis
wveuli dofaminis gamoTavisuflebaze in vivo dakvirveba. monawileobaze Sizofreniul procesebSi, moicavs
am dros zomaven D2 receptoris radioligands _ glutamaturi gadacemis pre da post-sinafsuri
[11C]rakloprids. Sizofreniis mqone pacientebSi, sa maCveneblebis darRvevebs, gansakuTrebiT safeTqlis
kontrolo jgufTan SelarebiT amfetaminebis ineq wilis medialur nawilSi, sadac aRiniSneba ara-NMDA
cia iwvevs [11C]raklopridis SeboWvis 2-jer metad receptorebis Semcireba.
Semcirebas. maimunebze Catarebulma kvlevebma aCvena, arsebobs ramdenime Teoria SizofreniaSi gluta
rom SeboWvis aseTi daqveiTeba ganapirobebs dofaminis maturi receptorebis monawileobis Sesaxeb: (1)
gamoTavisuflebis 3-jer metad gazrdas (Laruelle and `NMDA receptorebis hipofunqciis modeli~, romlis
Abi-Dargham., 1999). Semdgomi kvlevebi gviCvenebs mixedviTac, am receptorebis disfunqcia Sizofreniis
mwvave Sizofreniis dros amfetaminis gamoyenebis ganviTarebisTvis mniSvnelovan paTogenur faqtors
gareSe dofaminis gamoyofis gaZlierebas, rac am warmoadgens (Olney and Farber., 1995); (2) kvlevebis
tkicebs imas, rom `hiperdofaminergia~ Sizofreniis umravlesoba aCvenebs, rom Sizofreniis dros dofa
damaxasiaTebeli niSania. remisiis periodSi dofaminis minerguli darRvevebi glutamaturi neironebis abe
gamoTavisufleba normalur niSnuls ubrundeba. rac rantuli regulaciis Sedegia (Laruelle et al., 2003);
miuTiTebs imaze, rom arsebobs pirdapiri kavSiri (3) Sizofreniis ganviTarebaSi glutamatis uSualo
dofaminis Warbi rodenobiT gamoTavisuflebasa monawileobaze miuTiTebs is faqti, rom SizofreniaSi
da fsiqozur simptomatikas Soris (Laruelle and Abi- monawile genebis umravlesoba glutamatur trans
Dargham., 1999). misiaSia CarTuli (Harrisson and. Weinberger., 2005).
Sizofreniis sxva fazebi da niSnebi SeiZleba da
GABA (-aminoerbomJava)
kavSirebuli iyos dofaminis funqciis sxva dar
GABA _ -aminoerbomJava tvinis mTavari mainhi
RvevebTan. kerZod, arsebobs garkveuli monacemebi
birebeli transmiteria. SizofreniaSi mis monawile
Sizofreniis dros prefrontalur korteqsSi do
obas ramdenime mizezi ganpirobebs (Blaum and Mann.,
faminuri regulaciis deficitze (Winterer and
2002): (1) daavadebis dros Tavis tvinis qerqSi misi
Weinberger., 2004), rac daavadebisTvis damaxasiaTebel
enzimis glutamin mJava dekarboqsilazas (GAD) eqs
kognitur daqveiTebas Seesabameba.
presiis daqveiTeba; (2) garkveuli tipis gabaerguli
Sizofreniis ganviTarebaSi dofaminerguli meqa
neironebisa (romlebic Seicaven parvalbumins) da
nizmis monawileoba ar aris bolomde Seswavlili.
maTi sinafsuri terminalebis simkvrivis Semcireba; (3)
SesaZlebelia genetikuri komponentis arseboba.
GABAA receptorebis eqspresiis darRvevebi (Lewis et
Tumca, Tanamedrove Teoriebis Tanaxmad, dofaminis
_ 306 _
etiologia
al., 2005). am cvlilebebis mizezi da maTi kavSiri zemoT romlebic nikotinuri qolinerguli receptoris qve
aRweril sxva neirotransmiterebis darRvevebTan jgufis kodirebas gansazRvraven. Sizofreniis dros
gaurkvevelia. GABA-s SesaZloa hqondes kauzaluri qolinerguli neirotransmisiis darRvevebi SeiZleba
rolic, vinaidan winaswari monacemebiT cnobilia, rom iyos informaciuli procesis damuSavebis anomaliis
erTerTi GAD-is geni asocirebulia SizofreniasTan. mizezi. uaxlesi metaanalizuri kvlevebiT damtkicda
Sizofreniis dros P300-isa da P50-is deficitis
serotonini
arseboba (Bramon et al., 2004)
didi xania msjeloben imis Taobaze, Tu ra roli
eniWeba serotonins (5-HT) Sizofreniis dros . amis Tvalis gayolebis disfunqcia
mizezi serotoninis antagonistis lizerginuli mJa Sizofreniis mqone pacientebis 50%-ze meti ver
vis dieTilamidis (LSD) halucinogenuri moqmedebaa. asrulebs am tests. pirveli rigis naTesavebSi msgavsi
axali monacemebiT dadginda, rom 5-HT2 receptorebis darRvevebi SemTxevaTa 25%-Si gamovlinda. holcmanma
mimarT antagonizmi sxvadasxva antifsiqozuri pre (Holzman., 2000) gamoTqva mosazreba, rom Tvalis
paratebis atipiur moqmedebas gansazRvravs (gv. 532). gayolebis disfunqcia genetikuradaa ganpirobebuli
amasTan 5-HT2A genis aleluri variaciebi SeiZleba iyos da Sizofreniis msubuq variants warmoadgens.
Sizofreniis umniSvnelo risk-faqtoric. damatebiTi
monacemebi serotoninis paTofiziologiuri mniSv socialuri da fsiqosocialuri faqtorebi
nelobis Sesaxeb efuZneba imas, rom gakveTiTa da socialuri klasi
neirovizualuri gamokvlevebiT miRebuli Sede
ramodenime kvleva miuTiTebs imaze, rom Sizofrenia
gebi adasturebs frontalur korteqsSi 5-HT2A re
ufro xSirad emarTeba dabali socialuri klasis
ceptorebis eqspresiis daqveiTebas (Dean., 2003).
warmomadgenlebs. magaliTad, CikagoSi (Hollingshead
aseve, gaZlierebulia 5-HT1A receptorebis Se
and Redlich., 1958) Catarebulma gamokvlevebma aC
boWva. gansakuTrebul interess serotoninis Se
vena, rom daavadebis gavrcelebis sixSirec da
saxeb arsebuli monacemebis mimarT ganapirobebs
SemTxvevaTa raodenobac metia yvelaze dabal socio-
neiroganviTarebaSi misi monawileobis mniSvneloba da
ekonomikur jgufebSi. Tavdapirvelad egonaT, rom
serotonins, dofaminsa da glutamats Soris arsebuli
am faqts etiologiuri mniSvneloba hqonda, magram
urTierTkavSiri (Carlsson et al., 2001).
aRmoCnda, rom es SeiZleba Sizofreniis Sedegic
yofiliyo. magaliTad, goldbergma da morisonma
neirofiziologiuri monacemebi
(Goldberg and Morrison, 1963) naxes, rom Sizofreniis
eleqtroencefalografia mqone pirebs ufro dabali socialuri statusi
eeg gamokvlevebi ZiriTadad gviCvenebs Tetaaqtivobis hqondaT, vidre maT mSoblebs. amasTan, statusis
momatebas, aCqarebul da paroqsizmul aqtivobas. ar gauareseba emTxveoda daavadebis dawyebas. kastelma
aris cnobili am aRmoCenis mniSvneloba. ukanasknel (Castle et al., 1993) daadgina, rom Sizofreniis mqone
periodSi iyeneben ufro daxvewil teqnikas, romelSic pirebi, kontrolebTan SedarebiT, ufro xSirad
SemTxvevasTan dakavSirebuli potencialebisa da eeg socialurad deprivirebul ojaxebSi ibadebian.
analizia gaerTianebuli. am kvlevebiT gamovlinda mecnierebi miiCneven, rom garkveul garemo pirobebs
prefrontalur korteqsSi eleqtruli aqtivobis etiologiuri mniSvneloba aqvs da isini ufro xSirad
sinqronizaciis problemebi, rac Sizofreniis dros dabal socio-ekonomikur klasSi iCenen Tavs.
`xmaurian~ an araefeqtur qerqul procesebze
sacxovrebeli adgili
miuTiTebs (Winterer and Weinberger, 2004).
CikagoSi, fsiqikuri aSlilobis mqone pirebis sac
sensoruli gamowveuli potencialebi: P300 da P50 xovrebeli adgilis Seswavlisas, naxes, rom Si
P300 pasuxi aris auditoruli gamowveuli poten zofreniis mqone pirebi upiratesad Rarib ub
ciali, romelic aRmocendeba 300 miliwamSi, mas nebSi cxovrobdnen (Faris and Dunham., 1939). sxva
Semdeg, rac pirovneba aramiznobrivi stimulebidan qalaqebSic msgavsi monacemebi miiRes da daaskvnes,
samizne stimuls gamoarCevs. es pasuxi auditoruli rom aradamakmayofilebeli sacxovrebeli pirobebi
informaciis damuSavebis maCvenebelia. Sizofreniis SeiZleba Sizofreniis gamomwvevi mizezi iyos. am
mqone pacientebsa da maTi pirveli rigis naTesavebs monacemebis axsna SesaZlebelia zemoT ganxiluli
P300 talRis amplituda Semcirebuli aqvT. socialuri da okupaciuri gauaresebiTac, an Si
Sizofreniis mqone pacientebisa da maTi pirveli zofreniis mqone pirebis izolaciisaken midre
rigis naTesavebis P50 talRis maCveneblebic Secv kilebiT.
lilia. amasTan, molekuluri genetikis kvlevebiT Tanamedrove monacemebi miuTiTebs imaze, rom
dadgenilia P50-is deficitis kavSiri genebTan, dabadebis adgili da garemo, sadac bavSvi izrdeba,
_ 307 _
12 Sizofrenia
mogvianebiT Sizofreniis ganviTarebasTanaa dakav da socialuri faqtorebiT, magaliTad, virusuli
Sirebuli. es faqti ver aixsneba, rogorc daavadebis infeqciebiT, haSiSis moxmarebiT, fsiqosocialuri
Sedegi. sxvadasxva qveyanaSi Catarebuli populaciaze warumateblobiT, stresiTa da rasobrivi diskri
dafuZnebuli kvlevebi gviCvenebs, rom qalaqSi minaciiT (Sharpley et al., 2001).
dabadeba zrdis Sizofreniis ganviTarebis risks.
socialuri izolacia
did qalaqebSi Sansebis Tanafardoba ufro maRalia,
vidre patara qalaqebSi an qalaqgareT (Pedersen Sizofreniis mqone pirebi xSirad marto cxovroben.
andMortensen, 2001). amis mizezi ar aris bolomde isini iSviaTad arian daqorwinebulebi da Zalian
dadgenili da SeiZleba dakavSirebuli iyos socialur cota megobari hyavT. zemoT aRwerili monacemebidan
deprivaciasTan, migraciasTan, infeqciebTan, stresTan gamomdinare, SeiZleba vivaraudoT, rom izolaciis
an genetikur mowyvladobasa da urbanul garemos paternebma SesaZloa daavadebis dawyebamde da,
Soris urTierTkavSirTan (Peen and Dekker, 2004). zogjer, adreuli bavSvobidanve iCinos Tavi. ra Tqma
unda, zogi pacienti imitom miiswrafvis izolaciisken,
migracia rom Tavidan aicilos socialuri stimulacia. aqedan
Sizofreniis maRali maCvenebeli aRiniSneba mig gamomdinare, socialuri izolacia, miuxedavad imisa,
rantebSi. odegaardma (Odegaard., 1932) daadgina, rom rom, zogadad, arasasurveli faqtoria, ar SeiZleba
Sizofreniis SemTxvevaTa raodenoba minesotaSi mig uSualo stresorad CaiTvalos.
rirebul norvegielebSi 2-jer aRemateboda nor
cxovrebiseuli gamocdileba da sirTuleebi
vegiaSi mcxovrebi norvegielebis maCveneblebs. aseTi
maRali sixSiris mizezi gaugebaria. es SeiZleba aixsnas cxovrebiseul sirTuleebs xSirad ganixilaven,
imiT, rom fsiqikuri problemebis mqone pirebi, rogorc Sizofreniis gamSveb meqanizms, Tumca am
romlebic avadmyofobis gamo ver axerxeben cxovrebis mimarTulebiT mxolod ramdenime damakmayofilebeli
mowyobas, ufro xSirad migrireben. axali garemoc kvlevaa Catarebuli. erT-erTma, yvelaze metad
SeiZleba xelSemwyobi faqtori iyos daavadebisadmi sarwmuno kvlevam (Brown and Birley., 1968) gamoiyena
mowyvladi pirebisTvis. amdenad, `socialuri se informaciis Segrovebis standartuli procedura.
leqciac~ da `socialuri mizez-Sedegobrivi~ kavSiric gamoikvlies axlad stacionirebuli pirveladi an
mniSvnelovnad ganapirobebs migrantebs Soris Si gamwvavebuli 50 pacienti. sakontrolo jgufTan Se
zofreniis mqone pirebis maRal maCvenebels. darebiT, `damoukidebeli~ SemTxvevebis sixSire,
uaxlesma metaanalizma daadastura, rom migracia stacionirebamde sami kviris ganmavlobaSi, mniSvne
Sizofreniis ganviTarebis mniSvnelovani risk-faq lovnad iyo gazrdili. am SemTxvevebis (magaliTad,
toria. am faqtis mxolod~socialuri seleqciiT~ sacxovreblis Secvla, samuSaos dawyeba an dakargva,
axsna SeuZlebelia (Cantor-Grae and Selten., 2005). ojaxuri krizisi) Sedarebisas im movlenebTan, romlebic
daavadebis ganviTarebis riski migrantebs Soris 2.7- win uswreben depresias, nevrozul aSlilobebsa da
ia (95% sarwmuno intervali, 2.3-3.2-ia). es ricxvi suicids, maTi specifikuroba ar gamovlinda. pe
gansakuTrebiT maRalia migrantebis Svilebisa (4.5, 95% ikelma (Paykel., 1978) gamoTvala, rom cxovrebiseuli
sarwmuno intervali, 1.5-13.1) da, aseve, ganviTarebadi sirTuleebis SemTxvevaSi Sizofreniis ganviTarebis
qveynebis migrantebSi. riski momdevno 6 Tvis manZilze gaormagebulia. es
urTierTgamomricxavi monacemebia miRebuli brita monacemi sxva kvlevebiTac dadasturda da naxes,
neTSi emigrirebuli afro-karibul populaciaSi rom, rogorc pirveli epizodisTvis, aseve daavadebis
Sizofreniis maCveneblebTan dakavSirebiT. arse gamwvavebisTvisac igive riski arsebobda (Bebbington
bobs monacemebi, rom Sizofreniis SemTxvevebi dau et al., 1993). normanma da mallam (Norman and Malla,
jereblad matulobs (daaxloebiT 6 SemTxveva 1000 1993) ivaraudes, rom qronikuli Sizofreniis mqone
sul mosaxleze; Harrison et al., 1988), gansakuTrebiT pirebisTvis simptomebis simwvave cxovrebiseul faq
meore TaobaSi, maTTan, vinc britaneTSia dabadebuli, tebTan korelirebs. Tumca, unda aRiniSnos, rom
maSin, rodesac karibebze es maCvenebeli ucvlelia. mwiri monacemebi arsebobs imis Taobaze, ganicdian Tu
amis erT-erTi axsna SeiZleba iyos arasworad dasmuli ara pacientebi met cxovrebiseul sirTuleebs, vidre
diagnozi, rasac, SesaZloa, ganapirobebs is, rom janmrTelebi adamianebi.
britaneli fsiqiatrebi kargad ar icnoben karibis
kultura
mcxovrebTa faseulobebs, rwmenasa da tradiciebs.
Tu Sizofreniis etiologiaSi kulturaluri
Tumca, es faqti uaxlesi metaanalizuri kvleviT ar
faqtorebi monawileobs, maSin daavadebis gavrceleba
dadasturda (Cantor-Grae and Selten., 2005). Tu afro-
sxvadasxva qveyanaSi sxvadasxva sixSiris unda iyos.
karibelebs Soris Sizofreniis SemTxvevebi namdvilad
kvlevaTa umravlesoba gviCvenebs, rom avadobis
gazrdilia, es SeiZleba aixsnas imave biologiuri
_ 308 _
etiologia
maCvenebeli sxvadasxva kulturebSi da erTmaneTisgan rTulia premorbiduli pirovnuli cvlilebebisa
sruliad gansxvavebul qveynebSi absoluturad da dunedganviTarebuli procesis prodromuli
erTnairia (Jablensky., 2003). periodis gamijvna. Tumca, kreCmeris idea axlos
dgas Sizofreniis speqtris daavadebebis Tanamedrove
fsiqologiuri faqtorebi koncefciasTan, romlis mixedviTac, daavadebaTa
personologiuri faqtorebi am speqtrSi, Sizofrenia yvelaze mZime formaa.
daskvnis saxiT SeiZleba iTqvas, rom im pirebs,
mravali avtori da maT Soris bleileric (Bleuler.,
romlebsac mogvianebiT Sizofrenia uviTardebaT da,
1911) miiCnevda, rom garkveuli tipis personologiuri
aseve, maTi pirveli rigis naTesavebs, xSirad aqvT
aSlilobebi win uswrebs Sizofreniis ganviTarebas.
personologiuri aSlilobebi. Tumca, unda iTqvas,
kreCmerma (Kretschmer, 1936) SemogvTavaza mosazreba,
rom bevr Sizofreniis mqone pacients daavadebamde
rom Sizofreniac da personologiuri aSlilobebic
aranairi personologiuri aSlilobebi ar aReniSneba,
dakavSirebulia asTeniur agebulebasTan. man erT
xolo Sizoiduri da Sizotipuri aSlilobebis
xazze ganalaga normaluri pirovnebis mdgomareoba,
mqone pirebis did nawils arasdros uviTardebaT
Sizoiduri aSliloba da Sizofrenia da ivarauda,
Sizofrenia.
rom Sizoiduroba aris fsiqologiuri anomaliis
nawilobrivi manifestacia, romelic srulad ga neirofsiqologiuri faqtorebi
movlindeba Sizofreniis dros. am mosazrebas di cnobilia da kargadaa dasabuTebuli, rom Sizo
di sifrTxiliT unda mivudgeT, radgan Zalian freniis mqone pacientebs kognituri deficitis
boqsi 12.4 etiologiis fsiqodinamiuri da ojaxuri uTanasworoba rodesac erTi mSobeli

ojaxis Teoriebi (upiratesad deda) emorCileba ojaxSi dominanturi
pirovnebis eqscentrul moTxovnebs;
fsiqodinamiuri Teoriebi
ojaxuri uTanxmoeba rodesac mSoblebs gansxvavebuli
froidma Tavisi Teoria Sizofreniis asaxsnelad gamoiyena Sexedulebebi aqvT da bavSvi iZulebulia gaixliCos maT
1911 wels gamoqveynebuli Sreberis SemTxvevis analizSi Soris.
da, aseve, Camoayaliba 1914 wels dabeWdil naSromSi
narcisizmze: `Sesavali. froidis mixedviT libido gare ojaxis am Taviseburebebs miiCnevdnen Sizofreniis
obieqtidan gadatanilia egoze. amis Sedegad pirovnebas mizezad da ara Sedegad.
uCndeba sakuTari Tavis gadametebuli mniSvnelobis
sxva kvlevebma ar daadastura es monacemebi. dadasturebis
gancda. radgan meze gadatanili libido mniSvnelobas
SemTxvevaSic, aRwerili problemebi ganpirobebulia ufro
ukargavs gare samyaros, pacienti cdilobs am mniSvnelobis
metad mSoblebis genetikuri TaviseburebebiT an meoradia
anomaliuri rwmenebiT Sevsebas. gadatanili libidos
da pacientis avadmyofobiTaa gamowveuli. am da sxva tipis
gamo transferi ver xorcieldeba da amitom SeuZlebelia
mosazrebebma, romlebic ojaxs Sizofreniis gamomwvev
pacientis fsiqoanaliziT mkurnaloba. Tavisi zogadi
mizezad moiazrebden, arasasurveli Sedegebi gamoiRo da
debulebebi froidma, savaraudod, 1914 wlis Semdeg
mSoblebs, sruliad usafuZvlod, braleulobis gancda
Camoayaliba, magram Sizofreniaze Tavisi originaluri
gauCina.
mosazreba aRar Seucvlia.
melani klaini (Melanie Klein., 1952) miiCnevda, rom uwesrigo urTierTobebis mimdevrebi xelmZRvanelobdnen
Sizofrenia bavSvobidan iRebs saTaves. misi mosazrebiT, ormagi gzavnilis ideiT (Bateson et al., 1956). ormagi
axalSobili paranoiduli Sizoiduri poziciis etapze gzavnilis mdgomareoba viTardeba maSin, roca pirovneba
(dabadebidan oTx an eqvs Tvemde) cdilobs daZlios erTdroulad iRebs gacxadebul instruqcias, romelsac
sakuTari Sinagani destruqciuli impulsebi Tavisi Tan axlavs sawinaaRmdego Sinaarsis SeniRbuli gzavnili.
egosa da dedis xatis or sapirispiro mxared, erTis magaliTad, deda, romelic uxmobs Svils da sityvierad
mTlianad karg da meoris sruliad cud nawilebad gayofis eubneba, rom masTan mivides, amave dros, Tavisi xmis
gziT. bavSvi mxolod mogvianebiT xvdeba, rom erTi da toniTa da sxeulis eniT gamoxatavs, rom surs SvilTan
igive adamiani SeiZleba erTdroulad kargic iyos da urTierTobas Tavi aaridos. betsonis azriT, ormagi
cudic. am stadiis adekvaturad gadalaxvis uunaroba qmnis gzavnilze bavSvs SeuZlia mxolod orazrovani an uazro
Sizofreniis ganviTarebis safuZvels. sapasuxo reaqciis miReba da Tu es procesi mudmivia, maSin
viTardeba Sizofrenia. Teoria TavisTavad originaluria,
ojaxi, rogorc Sizofreniis gamomwvevi mizezi magram mtkicebulebebiT gamyarebuli araa.
Sizofreniis ganviTarebaSi ojaxis rolis Sesaxeb arsebobda
Seiswavles ra Sizofreniis mqone ojaxebis urTierTobebi,
ori saxis Teoria: devianturi urTierTobis roli (From-
miiRes urTierTgamomricxavi monacemebi (Singer & Wynne.,
Reichmann & Lidz) da uwesrigo urTierTobebi (Betson
1965; Hirsch & Leff., 1975). Tumca, savaraudoa, rom mSoblebisa
&Wyenne). ojaxis gavlenas Sizofreniis mimdinareobaze
da Svilebis araswori komunikaciis mizezi gaziarebuli
mogvianebiT ganvixilavT.
genebi iyos. magaliTad, naCvenebia, rom Sizofreniis
Sizofrenogenuri dedis koncefcia 1948 wels Semoitana
mqone pacientis pirveli rigis naTesavebSi Sizotipuri
fromreiCmanma. lidzma (Lidz, 1965), Tavis TanamoazreebTan
aSlilobis SemTxvevebi (romelsac axasiaTebs azrovnebisa
erTad gamoiyena intensiuri fsiqoanalizuri kvleva, raTa
da metyvelebis darRvevebi) mniSvnelovnad gazrdilia.
Seeswavla 17 Sizofreniis mqone pacientis ojaxi. aqedan
14 pacienti maRali socialuri fenis warmomadgeneli iyo.
gamovlinda ojaxis ori tipis anomaluri paterni:
_ 309 _
12 Sizofrenia
farTo gamovlinebebi axasiaTebT, rac gansakuTrebiT dinamiuri da interpersonaluri faqtorebi
TvalsaCinoa daswavlisa da mexsierebis testebis
es Teoriebi mtkicebulebebze dafuZnebuli eti
Sesrulebisas. neirofsiqologiuri kvlevebis mizania,
ologiis TvalsazrisiT mxolod istoriuli rakur
pasuxi gasces or gansxvavebul kiTxvas:
siTaa saintereso (boqsi 12.4). Tumca isini ar
1. romelia SizofreniisTvis damaxasiaTebeli neiro kargaven TavianT mniSvnelobas, radgan yuradRebas
fsiqologiuri defeqtis paternebi da rogor amaxvileben interpersonalur aspeqtebze. Tu
asaxaven isini am procesebSi monawile Tavis tvinis gaviTvaliswinebT, rom Sizofreniis mqone pacientebs
sxvadasxva ubnis darRvevebs? bavSvobidanve socialuri ganviTarebis problemebi
2. rogoraa dakavSirebuli specifikuri kognituri aqvT, interpersonalur faqtorebs gansakuTrebuli
darRvevebi Sizofreniis damaxasiaTebel simpto yuradReba unda mieqces. garda amisa, medicinis bevri
mebTan? muSaki da pacientebis momvleli miiCnevs, rom es
kargad cnobili neirofsiqologiuri modeli Se Teoriebi aqtualuria.
mogvTavaza greim (Grey et al., 1991). misi azriT, Si
zofreniis pozitiuri simptomebi gamowveulia Tanamedrove etiologiuri hipoTezebi
imiT, rom pirovneba ver axerxebs mimdinare Sizofreniis Sesaxeb
stimulebisa da damaxsovrebuli informaciis erT Cven ukve ganvix. dofaminuri (gv. 288), glutamaturi
maneTTan integrirebas. es Teoria im droisTvis (gv. 289) da cerebruli asimetriis (gv. 283) hipoTezebi.
sakmaod originaluri iyo, radgan cdilobda aexsna am TavSi visaubrebT damatebiT sam Tanamedrove
fsiqologiuri Taviseburebebi limburi sistemisa da hipoTezaze, romlebSic zemoT motanili etiologiuri
dofaminuri gzebis CarTulobis TvalsazrisiT. faqtorebia asaxuli.
gamoiyena ra sxvadasxva modeli, friTma (Frith,
neiroganviTarebis hipoTeza
1996) uaryo Sizofreniis dros fsiqikuri moqmedebis
Sinagani dezintegraciis arseboba. mas miaCnda, rom wamyvani hipoTezis arsia is, rom Sizofrenia neiro
gare wyarodan wamosuli azrebi da qmedebebi imitom ganviTarebis daavadebaa. pirvelad es mosazreba
ganapirobeben kontrolis bodvis ganviTarebas, rom gamoTqva kloustonma 1892 wels (Clouston, 1982),
pirovnebas uWirs Tavisi survilebisa da miznebis xolo SemdgomSi, gasuli saukunis mijnaze, gaimeora
identificireba da monitoringi. krepelinma (Kraepelin). TanamedroveTa interesi am
socialuri kogniciis koncefciam (Sizofreniis sakiTxis mimarT ganapiroba miureis da luisisa
dros socialuri funqcionirebis gauaresebaSi (Murrey and Lewis, 1987) da vainbergeris (Weinberger,
kognituri faqtoris mniSvneloba) ukanasknel wlebSi 1987) Sromebma. hipoTeza TavisTavad Zalian mar
farTo aRiareba moipova. mniSvneloba mieniWa saxeebis tivia: Sizofrenia Tavis tvinis ganviTarebis zo
amocnobisa da emociuri procesebis darRvevebs, aseve, gierTi aspeqtis darRvevis Sedegia. es mosazre
gonebis Teorias. xazi gaesva imas, rom am procesebSi ba ewinaaRmdegeba azrs, rom Sizofrenia neiro
monawileobas iRebs frontaluri korteqsi da degeneraciuli daavadebaa (McClure and Liberman., 1987).
amigdala (Pinkham et al., 2003). neiroganviTarebis hipoTeza yuradRebas amaxvilebs
prenatalur da mozardobis periodebze da maT
Soris urTierTkavSirze. mtkicebulebebi, romlebic
cxrili 12.13 monacemebi, romlebic adasturebs am modelis sasargeblod metyveleben, miRebulia
Sizofreniis neiroganviTarebis hipoTezas ramdenime wyarodan (Lewis and Levitt., 2002) da
daavadebis dawyebamde an pirveli epizodis dros tvinis Sejamebulia cxrilSi (cxrili 12.13). masSi motanili
struqturuli cvlilebebi;
faqtorebis umravlesoba ukve iyo ganxiluli,
daavadebis dawyebis Semdeg struqturuli cvlilebebis danarCeni ki mokledaa CamoTvlili. msubuqi fizikuri
umniSvnelo progresi;
anomaliebis arseboba, aberantuli TiTis anabeWdebis
bavSvobaSi kognituri da socialuri deficiti; paternebi (dermatoglifika; Bramon et al., 2005) da
nevropaTologiuri cvlilebebi gliozis gareSe; cavum septum pellucidum (iSviaTi warmonaqmni, romelic
daavadebis etapze rbili nevrologiuri niSnebi; magnitur-rezonansulma gamokvlevebma aCvena) uf
ro xSiria Sizofreniis dros. yvela es cvlileba
msubuqi fizikuri darRvevebi da aberantuli
dermatoglifia; adreuli neiroganviTarebis damadasturebel niSnadaa
miCneuli (McGrath and Murray., 2003). mniSvnelovania
pre da perinataluri riskfaqtorebi;
gliozis ararseboba (astrocitebis proliferacia
cavum septum pellucidum gazrdili sixSire;
da hipertrofia), radgan ewinaaRmdegeba mosazrebas
cxovelebis Tavis tvinis adreuli dazianebebis modeli prenatalur periodSi (mesame trimestrSi) nervuli
gviCvenebs mogvianebiT efeqts.
_ 310 _
paTologiis ganviTarebis Sesaxeb. mimdinareoba da prognozi
Sizofreniis neiroganviTarebis hipoTezis, rogorc
krepelini (Kraepelin) Tavdapirvelad fiqrobda, rom
daavadebis paTogenezuri modelis, seriozuli sapi
dementia praecox-s aucileblad cudi gamosavali unda
rispiro mtkicebulebebi ar arsebobs. es, SesaZloa,
hqonoda, magram mogvianebiT gamoaqveyna monacemebi,
nawilobriv gamowveulia imiT, rom misi sazRvrebi
rom misi pacientebis 17% socialurad adaptirebuli
bundovania, rac saSualebas iZleva, rom masSi
iyo. miuxedavad amisa, dRemde iTvleba, rom Sizofreniis
mravali monacemi gaerTiandes. misi meore naklia is,
gamosavali, yvela sxva fsiqikur aSlilobasTan
rom am hipoTeziT ver xerxdeba verc Sizofreniis
SedarebiT, yvelaze arakeTilsaimedoa. Zalian Znelia
dawyebisa da mimdinareobis (Broome et al., 2005) da verc
am sakiTxTan dakavSirebiT erTmniSvnelovani daskvnis
SemTxvevaTa raodenobis axsna.
gakeTeba (Hafner and der Heiden, 2003).
aberantuli kavSirebi mniSvnelovani kvleva Caatara evgen bleileris
Svilma manfred bleilerma (Manfred Bleuler, 1974). igi
bleilers Sizofreniis fundamentur niSnad `fsiqikuri
piradad akvirdeboda 208 pacientis mdgomareobas,
gaxleCa~ anu mentaluri funqciebis integraciis
romlebic Sveicariis fsiqiatriul saavadmyofoebSi
uunaroba miaCnda. es Sexeduleba Tanxvedri aRmoCnda
1942-43 wlebSi iyvnen moTavsebulni. stacionirebidan
aberantuli kavSirebis Sesaxeb arsebuli mosazrebis,
20 wlis Semdeg 20%-s aReniSneboda sruli remisia
romlis mixedviTac, Sizofreniis dros tvinis
yovelgvari simptomis gareSe, 35% socialurad
sxvadasxva ubnebs Soris kavSirebi anomaliuria
kargad iyo adaptirebuli, xolo 24%-s hqonda
(McGuire and Frith., 1996; Andreasen, 1999). am modelis zogi
gamoxatuli darRvevebi. sruli gamojanmrTeleba,
variaciis Tanaxmad amaSi struqturuli komponenti
rogorc wesi, xdeboda pirveli ori wlis manZilze.
monawileobs, magaliTad, hipoTeza, rom Sizofrenia
rekurentuli mdgomareobebis SemTxvevaSi, yoveli
sinafsebis an TeTri nivTierebis daavadebaa (gv. 286)
momdevno epizodi hgavda pirvel Setevas. bleileri
(Frankle et al., 2003). Tumca, arsebobs mosazreba, rom
iyenebda SezRudul diagnostikur kriteriumebs.
SesaZlebelia struqturuli nevropaTologiuri
mas miaCnda, rom mosazreba Sizofreniaze, rogorc
cvlilebebis gareSec advilad xdebodes kavSirebis
progresirebad daavadebaze, romelic iwvevs ga
funqciuri darRvevebi (magaliTad, impulsis max
moxatul unarSezRudulobas, mcdaria da saWiroebs
asiaTeblebi). am hipoTezebis umravlesoba miiCnevs,
gadasinjvas. Tumca, unda aRiniSnos, rom misi
rom kavSirebis darRvevebi TandaTanobiT viTardeba,
pacientebis 10% daavadebis gamo imdenad mZime
Tumca es yovelTvis aucilebeli ar aris.
mdgomareobaSi imyofeboda, rom saWiroebda xangrZliv
stres-mowyvladobis modeli stacionarul mkurnalobas.
es modeli, romelic, aseve, cnobilia stres-diaTezis bleileris mosazrebas iziarebda kiompi, romelmac
modelis saxelwodebiT, yuradRebas amaxvilebs ufro farTo, magram naklebad detaluri kvleva
pirovnebis ganviTarebaze, da, amasTan, xazs usvams Caatara (Ciompi, 1980). man Seiswavla me-20 saukunis
adreuli garemo faqtorebis mniSvnelobas (magaliTad, dasawyisidan 1962 wlamde lozanis fsiqiatriul
wamalmoxmarebas, cxovrebiseul movlenebs). adreuli saavadmyofoebSi Sizofreniis diagnoziT stacioni
faqtorebi aZlierebs Sizofreniisadmi mowyvladobas, rebuli pacientebis istoriebi. pacientebze dak
es ukanaskneli ki gansazRvravs daavadebis dawyebasa virveba grZeldeboda daaxloebiT 37 weli. man na
da mimdinareobas (Neuchterlein and Dawson, 1984). es xa, rom pacientebis mesameds hqonda kargi an damak
modeli msgavsia depresiis ganviTarebis Teoriisa mayofilebeli gamosavali. amasTan, droTa gan
(Brown and Harris), romelic me-11 TavSia ganxiluli. mavlobaSi simptomebis simwvavec iklebda.
mizanSewonilia pacientis axlo warsulSi momxdari igive Sedegebia miRebuli SedarebiT axali kvlevebiT.
cxovrebiseuli movlenebis mxedvelobaSi miReba, magaliTad 3_13-wliani dakvirvebis Semdeg jonstouni
radgan isini SeiZleba mniSvnelovani aRmoCndes (Johnstone, 1991) darwmunda, rom stacionaridan
mkurnalobis procesSi. amasTan, aucilebelia yu 1975-1985 wlebSi gawerili Sizofreniis mqone pa
radRebis gamaxvileba sxvadasxva etiologiuri cientebis TiTqmis naxevari socialurad kargad iyo
faqtorebis urTierTkavSirze. mravali kvleva adaptirebuli. CineTSi 330 pirvelad stacionirebul
gviCvenebs, rom garemo faqtorebi uSualod axdens pacientze 15-wliani dakvirvebis Sedegad naxes, rom
gavlenas im pirebze, romlebsac genetikuri an sxva maTi erTi mesamedi gamojanmrTelda, xolo 17%-
saxis mowyvladoba aReniSnebaT. imisaTvis, rom aseTi is mdgomareoba imdenad mZime iyo, rom ar SeeZloT
damokidebuleba dasabuTdes, saWiroa samomavlod stacionaris gareT funqcionireba (Tsoi and Wong,
farTomasStabiani kvlevebis Catareba. 1991). ukanasknelma 15 da 25-wlianma kohortulma
kvlevam, romelic 15 qveyanaSi Catarda, aCvena,
_ 311 _
12 Sizofrenia
rom avadmyofebis erT meeqvsedze meti srulad kriteriumebi aRmoCda, SesaZloa imitom, rom am kla-
ganikurna. aRsaniSnavia, rom daavadebis mogvianebiT sifikaciis Tanaxmad, diagnozis dasmisTvis aucilebe-
stadiebze gamojanmrTeleba TiTqmis ar xdeboda, rac lia simptomebis arseboba, sul cota, 6 Tvis manZilze
ganapirobebda Terapiul pesimizms da amyarebda azrs, mainc.
rom Sizofreniis dros gaumjobeseba Zalian iSviaTia Sizofreniis arakeTilsaimedo prognozis maCvene-
(Harrison et al., 2001). blebia: daavadebis dawyebis adreuli asaki, mamrobiTi
ramdenad gaumjobesda gamosavali krepelinis sqesi, cudi premorbiduli funqcionireba da gamoxat-
(Kraepelin) Semdeg, dReisTvis ucnobia. metaanaliziT uli negatiuri simptomebi. arsebobs monacemebi, rom
daadgines, rom `gamojanmrTelebis maCvenebeli~ 1955 fsiqozuri simptomebis xangrZlivoba mkurnalobis
wlamde 35% iyo, xolo 1956-85 wlebSi 49%-mde gaizarda, dawyebamde korelirebs remisiis xangrZlivobasa da
rac, savaraudod, antifsiqozuri preparatebis ga xarisxTan (Marshall et al., 2005). SesaZlebelia pacien-
moyenebis Sedegi unda iyos. es maCvenebeli kvlav tis eqimisaTvis mimarTva dakavSirebuli iyos cudi
Semcirda 1986-92 wlebSi (Hegarty et al., 1994). monacemTa gamosavlis sxva prediqtorebTan, Tumca, savaraudoa,
sxvaoba drois nebismier intervalSi didi sifrTxiliT rom, rogorc medikamenturi, aseve fsiqologiuri
unda Sefasdes, vinaidan saukunis ganmavlobaSi mkurnalobis drouli dawyeba mniSvnelovnad aum-
icvleboda rogorc Sizofreniis diagnostirebis jobesebs gamosavals (gv. 304).
praqtika, aseve daavadebis gamosvalis kriteriumebi. cxrilSi (12.14) CamoTvlilia sxvadasxva prediq-
torebi, romlebic mravali kvleviTaa gamovlenili. am
sikvdilianoba Sizofreniis dros
monacemebiT Tavisuflad SegviZlia vixelmZRvaneloT
yvela grZelvadiani kvleva Sizofreniis dros sikv praqtikaSi, magram didi sifrTxiliT unda movekidoT
dilianobis maRal maCvenebels adasturebs. 36000 yoveli individualuri SemTxvevis prognozirebas.
pacientze Catarebuli metaanaliziT harisma da aqamde ganvixilavdiT faqtorebs, romlebic win
barakloum (Harris and Barraclough, 1998) daadgines,
rom Sizofreniis dros, yvela SesaZlo mizezis
gaTvaliswinebiT, sikvdilis riski 1.6-jeraa gazrdili. cxrili 12.14 faqtorebi, romlebic
TiTqmis 40% modis arabunebriv mizezebze, ZiriTadad gansazRvraven Sizofreniis gamosavals
TviTmkvlelobaze, romlis maCvenebelic 10-jeraa kargi prognozi cudi prognozi
momatebuli. TviTmkvlelobis riski daavadebis
uecari dasawyisi Semparavi dasawyisi
manZilze 10%-ia, Tumca qronikuli mimdinareobisas,
mogvianebiT stadiebze es ricxvi 4%-mde klebulobs xanmokle epizodi xangrZlivi epizodi
(Palmer et al., 2005). es imiTaa gamowveuli, rom suicidis fsiqiatriuli istoriis fsiqiatriuli istoriis
yvelaze maRali riski diagnozis dasmidan Zalian ararseboba arseboba
maleve aRiniSneba da droTa ganmavlobaSi mcirdeba. gamoxatuli afeqturi negatiuri simptomebi
axali kvlevebis monacemebze dayrdnobiT, SeiZleba simptomebi
vivaraudoT, rom ukanasknel wlebSi Sizofreniis
daavadebis paranoiduli gafarToebuli
dros suicidis sixSire Semcirebulia (Nordentoft et al.,
tipi lateraluri parkuWebi
2004). sikvdilis xSiri mizezia gulsisxlZarRvTa da
mamrobiTi sqesi
respiratoruli daavadebebi, rac Tambaqos moxmarebis,
daavadebis dawyebis gviani daavadebis dawyebis
arasakmarisi kvebisa da umoZrao cxovrebis wesis
asaki axalgazrda asaki
Sedegia. Sizofreniis mqone pacientebs gacximovneba
da Saqriani diabetic maRali procentiT aReniSnebaT. daojaxebuli dauqorwinebeli, gayrili
an daqvrivebuli
gamosavlis prediqtorebi
kargi fsiqoseqsualuri cudi fsiqoseqsualuri
Sizofreniis gamosavali araerTgvarovani da ara- adaptacia adaptacia
prognozirebadia (Hafner andan der Heiden, 2003). mag-
kargi premorbiduli anomaliuri premorbiduli
aliTad, Sizofreniis saerTaSoriso piloturi kvle-
personologiuri personologiuri
vis konteqstSi (msoflio janmrTelobis organizacia,
maCveneblebi maCveneblebi
1973) Seiqmna gamosavlis ganmsazRvreli testebis ram-
Sromisunarianoba Sromisuunaroba
denime kompleqti, romlebsac sxvadasxva simptomebze
damyarebuli kriteriumebi edo safuZvlad. 2-5 wlis kargi socialuri socialuri izolacia
Semdgom damdgari gamosavlis gansazRvrisTvis amaT- urTierTobebi
gan arc erTi ar iyo damakmayofilebeli. cudi gamo- mkurnalobis reJimis daniSnulebis
savlis saukeTeso prediqtori Sizofreniis DSM-IV-is dacva Seusrulebloba
_ 312 _
uZRvis Sizofrenias an daavadebis sawyis etapze and Brown, 1970) pacientebi sam sxvadasxva stacionarSi
iCens Tavs. SemdgomSi visaubrebT im garemoebebze, gamoikvlies. erTi iyo tradiciuli institucia,
romelTac aqvT gavlena daavadebis mimdinareobaze. meores hqonda aqtiuri reabilitaciuri programa
da mesame gamoirCeoda progresuli politikiTa da
Sizofreniis mimdinareobis geografiuli
xanmokle dayovnebiT. mkvlevarTa jgufma SeimuSava
variaciebi
`socialuri garemos~ Sefasebis kiTxvari, romelSic
saerTaSoriso kvlevebma aCvena, rom, marTalia, Si gaTvaliswinebuli iyo gare samyarosTan kontaqti,
zofreniis avadobis maCveneblebi sxvadasxva qve pacientis kuTvnili nivTebi, konstruqciuli saq
yanaSi praqtikulad erTnairia, magram gamosavali mianobis saSualeba da samedicino personalis pe
da mimdinareoba gansxvavebulia. SizofreniasTan simisturi molodinis xarisxi. aradamakmayofilebel
dakavSirebuli saerTaSoriso piloturi kvleva socialur garemos ukavSirebdnen Semdeg sam klinikur
(msoflio janmrTelobis organizacia, 1973) gviCvenebs, aspeqts: socialur izolacias, emociur gasadavebasa
rom orwliani vadis gasvlis Semdeg gamosavali da metyvelebis gaRaribebas. mizezSedegobrivi kavSiri
ukeTesi iyo indoeTSi, nigeriasa da kolumbiaSi, am socialur faqtorebsa da klinikur mdgomareobas
risi axsnac mxolod pacientebis gansxvavebuli Soris daadastura 4 wlis Semdgom Catarebulma
inicialuri maCveneblebiT SeuZlebelia, magram es kvlevam. kerZod, gaumjobesebuli stacionaruli
gasaTvaliswinebelia; aRmoCnda, rom am sam qveyanaSi garemo pacientis mdgomareobis am sam klinikur
fsiqiatriul saavadmyofos ufro xSirad mimarTaven aspeqtze dadebiTad aisaxa.
mwvave simptomebis mqone pacientebi da naklebad is saavadmyofoSi arasaTanadod mastimulirebeli
pirebi, romlebsac Semparavi dasawyisiT mimdinare socialuri garemo sazianod moqmedebs pacientis
formebi aReniSnebaT. Semdgomi kvlevebiT, romlebSic mdgomareobaze, Tumca, zedmeti stimulacia xels
gaTvaliswinebuli iyo es gansxvaveba, igive Sedegebi uwyobs pozitiuri simptomebis ganviTarebasa da
miiRes (Jablensky, 2003). ZiriTadi daskvna, rac gamwvavebas. gamomdinare iqidan, rom stacionarSi ar
daavadebis gamosavalTan dakavSirebiT gakeTda, sebuli garemo faqtorebi mniSvnelovnad zemoqmedebs
iyo is, rom ganviTarebad qveynebSi gamosavali daavadebis prognozze, unda vivaraudoT, rom imave
ukeTesia da pacientebi srul remisias ufro xSirad faqtorebis gaTvaliswineba aucilebelia sociumSic.
aRweven. ganviTarebul qveynebSi ki Sizofreniis
mqone pirebisTvis metadaa damaxasiaTebeli gaxan ojaxi da emociebis eqspresia
grZlivebuli rezidualuri simptomebis arseboba. brauni (Brown et al., 1958) darwmunda, rom
ganviTarebad qveynebSi Sizofreniis ukeTesi stacionaridan gamoweris Semdeg Sizofreniis mqone
gamosavlis mizezi axsnili ar aris, rac ar SeiZleba pacientebis prognozi gacilebiT uaresia ojaxSi
mxolod emociuri eqspresiis gansxavebuli xarisxis dabrunebisas, vidre sacxovrebelSi gadasvlisas.
Sedegi iyos. 15 da 25-wliani grZelvadiani kvlevebiT man daadgina, rom gamwvavebaTa sixSire metia
dadasturda daavadebis mimdinareobis geografiuli emociuri eqspresiis (ee) maRali intensivobis mqone
variabeloba da dadginda, rom pirveli epizodis dros ojaxebSi. aseTi ojaxebisTvis damaxasiaTebelia
mdgomareobis simwvave da daavadebis tipi daavadebis kritikuli da arakeTilganwyobili damokidebulebebi
mimdinareobis mniSvnelovani ganmsazRvreli faq an zedmeti emociuri CarTuloba. gamwvavebaTa
torebia. sixSire matulobs, Tu pacienti iZulebulia ojaxis
wevrebTan kviraSi 35 saaTze meti dro gaataros.
cxovrebiseuli movlenebi
es monacemebi dadasturda da gamdidrda axali
mwvave simptomebis manifestaciamde ramdenime kvi faqtebiT, rodesac gamoikvlies kavSiri naTesavebis
riT adre zogi pacientis SemTxvevaSi aRiniSneba emociebis eqspresias, cxovrebiseul movlenebsa da
cxovrebiseuli movlenebis gaxSireba. es xdeba gamwvavebebs Soris (Leff and Vaughn, 1981). daavadebis
ara marto pirveli epizodis, aramed gamwvavebebis dawyeba da axali epizodebis ganviTareba ukavSirdeba
drosac (Bebbington et al., 1993). amasTan, gaxSirebuli sami Tvis ganmavlobaSi emociebis eqspresiisa da
cxovrebiseuli movlenebis dros damaxasiaTebelia damoukidebeli cxovrebiseuli SemTxvevebis maRal
ufro gamoxatuli simptomaturi mimdinareoba. maCveneblebs. mniSvnelovani iyo, aseve, naTesavebis
socialuri stimulacia emociuri eqspresiisa da pacientebis medikamenturi
mkurnalobis efeqturobis kavSiri. im SemTxvevebSi,
1940-50-ian wlebSi Catarebulma kvlevebma aCvena, rom
rodesac pacientebi 35 saaTze met xans atarebdnen
hospitalizebuli pacientebisTvis damaxasiaTebeli
maRali emociuri eqspresiis ojaxebSi da ar iRebdnen
bevri klinikuri Tavisebureba aramastimulirebel
wamlebs, gamwvavebebi 92%-s, xolo mkurnalobis
garemosTan iyo dakavSirebuli. vingma da braunma (Wing
reJimis dacvis pirobebSi pacientTa mxolod 53%-
_ 313 _
12 Sizofrenia
s aReniSneboda. xolo Tu pacientebi iRebdnen pacientebisa da maTi ojaxebis wevrebisTvis ar aris
daniSnulebas da ojaxSi 35 saaTze nakleb dros sakmarisi. britaneTis fsiqikuri jandacvis erovnuli
atarebdnen, mdgomareoba mxolod 15%-s umwvavdeboda. programis prioritetia pacientebis momvlelTa
Semdgom kvlevebSi lefma (Leff, 1976) gamoTqva servisis gaumjobeseba avadmyofTa mimarT Tanadgomis,
mosazreba, rom emociur eqspresias kauzaluri daxmarebis TvalsazrisiT (jandacvis departamenti,
mniSvneloba unda hqondes. man Seiswavla 24 1999). lefs (Leff, 1998) uweria:
ojaxi, romlebSic Sizofreniis mqone pacientebi
`pativi unda vceT pacientis naTesavebs im zrunvis
TavianT maRali eqspresiis mqone naTesavebTan
gamo, rasac isini dRe da Rame mravali wlis
intensiur kontaqtSi imyofebodnen. yovel maTgans
ganmavlobaSi ewevian. maT ar surT, rom ganixilavdnen
utardeboda mkurnaloba. 12 ojaxidan pacientebi
maT, rogorc paTogenur faqtors da miiCnevdnen
mxolod ambulatoriul daxmarebas Rebulobdnen.
mkurnalobis samizned, aramed, SizofreniasTan
danarCeni 12 ojaxis SemTxvevaSi _ medikamentur
brZolaSi maT mxolod partnioroba surT.~
mkurnalobasTan erTad, pacientebi da maTi ojaxis
wevrebi eswrebodnen mecadineobebs, romlebzec pacientis momvlelebTan muSaobis sakiTxebi
SizofreniasTan dakavSirebul informacias iRebdnen. ganxilulia amave TavSi, `daavadebis marTvis~ nawilSi
meore jgufSi gamosavali gacilebiT ukeTesi iyo. (gv. 306).
es Sedegi adasturebs, erTi mxriv, mdgomareobis
daskvna
gamwvavebisTvis emociuri eqspresiis mniSvnelobas da,
meore mxriv, xazs usvams kombinirebuli mkurnalobis, Seswavlili SemTxvevebis safuZvelze SeiZleba iTqvas,
e.i. medikamenturi da fsiqosocialuri intervenciis rom socialuri faqtorebi gavlenas axdens Sizofreniis
erToblivi gamoyenebis efeqturobas. dawyebasa da simptomatikis Taviseburebaze. axloblebis
emociuri eqspresiis mniSvneloba sakmaod farTod emociurma CarTulobam SeiZleba gaamwvavos mdgomareoba.
Seiswavles da daadgines, rom aseT ojaxebSi SesaZlebelia, rom ganviTarebad qveynebSi dabali
cxovrebisas, gamwvavebis sixSire 2-3-jeraa gazrdili. intensivobis emociuri eqspresia dadebiT gavlenas
Sesabamisad, dabali emociuri eqspresiis ojaxebSi axdendes daavadebis gamosavalze. zogadad, garemo
ufro adekvaturi damokidebulebaa Sizofreniisa faqtorebTan dakavSirebiT, unda gaviTvaliswinoT,
da daavadebasTan dakavSirebuli qcevis mimarT, rac rom zedmeti stimulacia xels uwyobs pozitiuri
TavisTavad gavlenas axdens gamosavalze (Barrowclough simptomebis ganviTarebas da mdgomareobis gamwvavebas,
et al., 1994) xolo aramastimulirebeli garemo auaresebs negatiur
simptomatikas.
Sizofreniis gavlena ojaxze
stacionarsgareTa fsiqiatriuli momsaxurebis da mkurnaloba
nergvam ojaxebs garkveuli sirTuleebi Seuqmna. Sizofreniis mkurnaloba iTvaliswinebs rogorc
Sizofreniis mqone pacientebis naTesavebi ZiriTadad mwvave, ise qronikuli mdgomareobebis marTvas. zo
ori saxis problemaze amaxvileben: pirvelia gadad, saukeTeso Sedegis miRweva SesaZlebelia
socialuri izolacia. pacienti gaurbis ojaxis sxva antifsiqozuri mkurnalobisa da garkveuli fsiqo
wevrebTan urTierTobas. isini iSviaTad saubroben, socialuri RonisZiebebis kombinaciiT. am nawilSi
arian Senelebulebi, aqvT SezRuduli interesebi da ganvixilavT calkeuli mkurnalobis efeqturobas.
ar uvlian sakuTar Tavs. meore ZiriTadi problemaa TavSi _ `daavadebis marTva~, visaubrebT imis
aSkarad Semawuxebeli da socialurad miuRebeli Taobaze, Tu rogor gamoiyeneba mkurnalobis es
qcevebi da Zaladobis saSiSroeba. es problema xels saxeebi praqtikaSi. antifsiqozuri preparatebis
uwyobs ojaxis wevrebs Soris maRali emociuri farmakologiuri aspeqtebi ganxilulia 21-e TavSi,
eqspresiis ganviTarebas, rac, Tavis mxriv, auaresebs xolo Temze dafuZnebuli movla da daxmarebis
mdgomareobas. dagegmva _ 23-e TavSi.
pacientis axloblebs SeiZleba aReniSnebodeT mkurnalobis Tanamedrove midgomebi mocemulia
SfoTva, depresia, braleulobis gancda an klinikuri praqtikis erovnul rekomendaciasa (NICE)
dabneuloba. maT ar ician, rogor moiqcnen rTul da lemanis saxelmZRvaneloSi (Lehmann et al., 2004).
viTarebaSi an ra reaqcia hqondeT ucnaur qcevaze.
damatebiTi sirTuleebi SeiZleba gamoiwvios ojaxis antifsiqozuri preparatebi
wevrebs Soris gansxvavebulma damokidebulebam da
axloblebisa da mezoblebis mxridan Tanadgomis
mwvave Sizofrenia
ararsebobam. axloblebis cxovrebaze gavlena xSirad mwvave Sizofreniis dros antifsiqozuri prepa
Zalian seriozulia. samwuxarod, TemSi momsaxureba ratebis efeqturoba kargadaa Seswavlili. maga
_ 314 _
mkurnaloba
liTad, fsiqikuri janmrTelobis erovnuli ins dacva. aqedan gamomdinare, sasurvelia atipiuri
titutis xelmZRvanelobiT Catarda kvleva, rom antifsiqozuri preparatebis depo formebis arseboba;
lis drosac qlorpromazini, flufenazini da amJamad mxolod risperidonis depo variantia
Tioridazini Seadiares placebos (Cole et al., 1964). xelmisawvdomi.
6 Tvis ganmavlobaSi antifsiqozuri mkurnalobis
gansxvavebebi antifsiqozur preparatebs Soris
Sedegad pacientebis erTi meoTxedis mdgomareoba
gaumjobesda, placeboze myofi pacientebis naxevrisa tipiuri preparatebis efeqturoba erTmaneTisagan
ki _ gauaresda. metaanalizur kvlevaSi gaaanalizes mniSvnelovnad ar gansxvavdeba. klozapinis garda,
qlorpromazinze Catarebuli 42 randomizebuli atipiuri preparatebis SemTxvevaSic, atipiuri
kvlevis Sedegi. 8 kviris Semdeg qlorpromazini, antifsiqozuri medikamentebi TiTqmis erTnairad
placebosTan SedarebiT, ufro xSir SemTxvevaSi, moqmedebs.
iwvevda gaumjobesebas (55% vs. 37%, NNT=6). tipiur da atipiur preparatebs Soris gansxvaveba
medikamenturma mkurnalobam ufro kargi Sedegi mravalma kvlevam Seiswavla da xSirad urTierT
gamoiRo pozitiuri (bodva da halucinacia) da naklebi gamomricxavi monacemebi miiRo. metaanalizuri
negatiuri da kognituri simptomebis mkurnalobis kvlevebis monacemebi mwvave fazis mkurnalobasa da
dros. sedatiuri efeqti Tavidanve iyo gamoxatuli, preparatis amtanobaze, aseve, gansxvavebis SemTxvevaSi,
Tumca, antifsiqozuri moqmedeba, romelic iTvleba, efeqtis zomasa da klinikur mizanSewonilobaze
rom dauyovnebliv unda gamovlindes (Agid et al., araerTgvarovania. magaliTad, gedesma (Geddes et
2003) Zalian nela, zogjer ramdenime kviris Semdeg, al., 2000) daaskvna, rom nebismieri upiratesoba
xdeboda SesamCnevi. umniSvneloa, xolo devisma (Davis et al., 2003) atipiuri
preparatebis mniSvnelovani efeqturoba aCvena. axali
mwvave fazis mkurnaloba grZelvadiani kvleviT, romlis drosac mravali
gamwvavebis profilaqtikisTvis xangrZlivi anti atipiuri preparati Seadares tipiur antifsiqozur
fsiqozuri Terapia mravali kontrolirebadi kvle medikaments perfenazins, mcire gansxvavebebi miiRes
viTaa dadasturebuli (Pasmanick et al., 1964., Gilbert et (Liberman et al., 2005). mkurnalobis saxelmZRvaneloSi
al., 1995). sistematurma analizma (Thornley et al., 1995) (gaidlaini), romelsac amJamad britaneTSi iyeneben,
aCvena, rom qlorpromazinis 6-24 Tvis ganmavlobaSi miTiTebulia, rom atipiuri antifsiqozuri
miRebisas, gamwvavebis riski mcirdeba (SedarebiTi preparati pirveli arCevis medikamentia Sizofreniis
riski = 0.65, NNT=3) da zogadi funqcionireba samkurnalod, Tumca, tipiuri antifsiqozuri
umjobesdeba (SedarebiTi riski = 0.76; NNT=7), preparatebis mniSvnelobac aRiarebulia (NICE., 2002).
preparatis wyvetilad, mxolod gamwvavebis niSnebis azrTa sxvadasxvaoba arsebobs gamwvavebebis pro
gamovlenisas, micema nakleb efeqturia, vidre filaqtikis mizniT preparatebis gamoyenebasTan
profilaqtikis mizniT wamlis xangrZlivad miReba dakavSirebiTac, Tumca, unda iTqvas, rom monacemebi
(Jolley et al., 1990). mainc atipiuri preparatebis sasargeblod metyvelebs.
zogi qronikuli Sizofreniis mqone pacienti amasTan dakavSirebiT pirveli fundamenturi kvleva
rezistentulia xangrZlivi mkurnalobis mimarT, Catarda 2002 wels, romlis drosac 365 stabilur
xolo zogi _ TavisTavad gamodis mdgomareobidan. pacientze dakvirvebiT Seiswsvles haloperidolisa
samwuxarod, ar arsebobs validuri maCveneblebi, da risperidonis efeqturoba (Csernansky et al., 2002). 12
romlebic dagvexamreba sworad ganvsazRvroT, Tu Tvis ganmavlobaSi mdgomareoba gaumwvavda pacientebis
romel pacients esaWiroeba preparatis xangrZlivad 25%-s, romlebic risperidoniT mkurnalobdnen,
miReba da ramden xans unda gagrZeldes grZelvadiani xolo haloperidebis mimRebTagan _ 40%-s. gansxvaveba
profilaqtikuri mkurnaloba. zogadad Tanxmdebian, TvalsaCino da sarwmuno iyo rogorc klinikurad,
rom xangrZlivi remisiac ar iZleva imis garantias, ise statistikurad. axali, sistematuri mimoxilvis
rom wamlis Sewyvetis SemTxvevaSi mdgomareoba Sedegebis mixedviT (Leucht et al., 2003), gamwvavebis
ar gamwvavdeba (Cunningham and Johnstone, 2000). profilaqtikisTvis atipiuri preparatebi placeboze
antifsiqozuri preparatis moxsnisas, aucilebelia ufro efeqturi aRmoCnda (NNT=3-5). amasTan,
dozebis TandaTanobiT, nela Semcireba da Tveebis tipiurebTan SedarebiT, gamwvavebebis sixSire bevrad
manZilze xangrZlivi monitoringi. naklebi iyo (NNT =9-13). am kvlevis monacemebi
arsebobs mosazreba, romelic zogad klinikur safuZvlianad gaanalizda da dasabuTda (Csernansky et
STabeWdilebas eyrdnoba da romlis mixedviTac, al.,). aqve unda aRiniSnos, rom sxva kvlevebiT miRebuli
gamwvavebebis profilaqtikisTvis depo preparatebi monacemebi naklebad STambeWdavia.
ufro Sedegiania (Davis et al., 1994) SesaZloa imitom, klinikur praqtikaSi atipiuri preparatebi pirveladi
rom pacientebs uadvildebaT mkurnalobis reJimis SemTxvevebis samkurnalod gamoiyeneba, an iniSneba
_ 315 _
12 Sizofrenia
maSin, Tu Catarebuli mkurnaloba araefeqturia an sisxlis mudmivi monitoringi, vinaidan arsebobs
pacients tipiur preparatebze gverdiTi movlenebi agranulocitozis ganviTarebis saSiSroeba. pre
uviTardeba. wamlebis individualur arCevans mTeli paratis miRebam SesaZlebelia gamoiwvios wonaSi
rigi faqtorebi ganapirobebs, rasac daavadebis mateba, sedacia da hipersalivacia (gv. 536). mosazreba,
marTvasTan dakavSirebul TavSi ganvixilavT (gv. 301). rom klozapinis gamoyeneba Sizofreniis adreul
mkurnalobis mimarT rezistentuli Sizofrenia stadiaze aumjobesebs gamosavals, ar dadasturda.
pacientebis 30% antifsiqozuri mkurnalobis mimarT magaliTad, erTwlianma kvlevam ar aCvena klozapinis
rezistentulia an, upiratesad, eqstrapiramiduli aSkara upiratesoba qlorpromazinTan, pirveli
garTulebebis gamo, preparatebis autanloba aRe epizodisa da aranamkurnalebi pacientebis SemTxvevaSi
niSnebaT. aseTi mdgomareobebis samkurnalod erT (Lieberman et al., 2003).
aderTi rekomendebuli preparatia klozapini, rezistentuli pacientebis mkurnalobasTan da
romelic efeqts iZleva SemTxvevaTa mesameds an kavSirebiT, romlebsac sxvadasxva mizezis gamo
TiTqmis naxevarSi (Kane et al., 1999). es monacemebi klozapinis miReba ar SeuZliaT an visTvisac es
ramodenime kvlevam daadastura (Wahlbeck et al., 1999. preparati araefeqturia, Zalian cota monacemi
ix. suraTi 12.1). arc erTi sxva atipiuri preparati arsebobs. miRebuli strategiaa (romlis garkveuli
ar xasiaTdeba aseTi efeqturobiT (Chakos et al., 2001). mtkicebulebebi arsebobs) augmentacia D2 receptoris
klozapini unikaluria Sizofreniis dros suicidis mimarT gamoxatuli afinurobis mqone preparatebiT,
prevenciisTvisac (gv. 305). magaliTad, sulpiridiT, amisulpiridiT an ris
klozapiniT mkurnalobis rekomendacia unda ga peridoniT. es erTaderTi SemTxvevaa, rodesac anti
ewios yvela im pacients, visTvisac ori sxvadasxva fsiqozuri polifarmacia dReisTvis gamarTlebulia
antifsiqozuri preparatiT mkurnaloba ar aRmoCnda (Freudenreich and Goff., 2002). arsebobs lamotrijiniTa
efeqturi an visac sxva preparatebis mimarT da valproatiT augmentaciis susti mtkicebulebebi
autanloba aReniSneba. xazi unda gaesvas imas, rom (mkurnalobis mimarT rezistentuli Sizofreniis
klozapinis gamoyeneba misi sxva gverdiTi efeqtebis mimoxilva ix. Barnes et al., 2003).
gamo SezRudulia. misi daniSvnisas aucilebelia
suraTi 12.1 klozapiniT (eqsperimentuli kgufi) an tipiuri antifsiqozuri preparatebiT (sakontrolo jgufi) xanmokle da
grZelvadiani mkurnalobis Sedegebi. analizi gakeTebulia 30 kvlevis monacemebis safuZvelze.
Sedegi modeli eqsperimentuli sakontrolo
sikvdili
relafsi
moklevadiani
grZelvadiani
klinikuri gaumjobesebis gareSe
moklevadiani
grZelvadiani
gaweras ar eqvemdebareba
moklevadiani
grZelvadiani
Sromisuunaro
moklevadiani
mkurnalobis miuRebloba
moklevadiani
grZelvadiani
pacientis ukmayofileba
moklevadiani
grZelvadiani
gverdiTi efeqtebi
sisxlis problemebi
hipersalivacia
sicxe
sedacia
gulyra
hipotenzia an Tavbrusxveva
wonaSi mateba
eqstrapiramiduli simptomebi
qserostomia
Odds ratio -Sansebis Tanafardoba, CL-sarwmunoebis intervali, NNT-mkurnalobisTvis saWiro raodenoba, NNH-zianisTvis
saWiro raodenoba. FEM-fiqsirebuli efeqtis modeli, REM-randomuli efeqtis modeli. svetebSi saTauriT Experimental
da `Control~ mocemulia pacientebis raodenoba jgufebSi. terminebisTvis ixileT Tavi 5.
_ 316 _
mkurnaloba
antidepresantebi da guneb-ganwyobis dros ekT-s gamoyenebasTan dakavSirebiT arsebuli
stabilizatorebi (normoTimikebi) mtkicebulebebi Zalian sustia (Thyrian and Adams.,
2000). amitom, sxva qveynebTan SedarebiT, britaneTSi
Sizofreniis xSiri Tanmxlebi simptomia depresia.
ekT-s iSviaTad mimarTaven.
gamomdinare iqidan, rom Znelia depresiuli da ne
gatiuri simptomebis diferencireba, Sizofreniis
fsiqosocialuri midgomebi
dros antidepresantis efeqturad gamoyenebis Seswavla
sakmaod garTulebulia. ris gamoc am sakiTxTan Sizofreniis samkurnalod Temze dafuZnebuli ser
dakavSirebiT mxolod ramdenime damakmayofilebeli visebis ganviTarebam fsiqosocialuri intervenciis
kvlevaa Catarebuli (Whitehead et al., 2003). mimarT interesi mniSvnelovnad gazarda. aq ga
imipraminis placebo-kontrolirebadi kvleviT Se erTianebulia sxvadasxva saxis intervencia, romlebsac
iswavles Sizofreniis mqone pacientebi, romlebsac saerTo miznebi aqvT:
daniSnuli hqondaT flufenazi da romlebsac 1 .socialuri da interpersonaluri funqcionirebis
fsiqozuri simptomebis nivelirebis Semdeg ganuvi gaumjobeseba;
TardaT gamoxatuli depresiuli simptomebi. dep 2. sazogadoebaSi damoukideblad cxovrebis xelSew
resiuli guneb-ganwyobis gaumjobesebisTvis mni yoba;
Svnelovnad efeqturi aRmoCnda imipramini, vidre
3. simptomebis simwvavis Sesusteba da komorbiduli
plaqcebo; amasTan, igi ar iwvevs fsiqozuri sim
mdgomareobebis (magaliTad, wamalmoxmarebis) marTva;
ptomebis gamwvavebas (Plasky, 1991). serotoninis
ukumitacebis seleqciuri inhibitorebi farTod 4. sakuTari daavadebis marTvis unaris gaumjobeseba.
gamoiyeneba Sizofreniis dros depresiuli sim arsebobs mTeli rigi mtkicebulebebisa, romle
ptomebis samkurnalod, miuxedavad imisa, rom jerac bic ukavSirdeba garkveuli fsiqosocialuri inter
ar momxdara maTi saTanadod Sefaseba. venciebis efeqturobas (cxrili 12.15).
ar aris dasabuTebuli liTiumisa da sxva nor
ojaxuri Terapia
moTimikebis gamoyeneba Sizofreniis dros. arc
mtkicebulebebi arsebobs maT antifsiqozur moq Sizofrenia mniSvnelovani tvirTia pacientis oja
medebasTan dakavSirebiT. ramdenime kvleviT miRebuli xisTvis, amitom daavadebis sxvadasxva etapze xSi
sasurveli Sedegi SeiZleba afeqtur simptomebze rad mimarTaven ojaxur Terapias. ojaxuri Terapia,
moqmedebiT aixsnas. magaliTad, norTvikis parkis romelic gamoiyeneba ojaxis wevrebs Soris emociis
funqciuri fsiqozebis (Northwick Park Functional eqspresiis Sesasusteblad, yvelaze kargadaa Ses
Psychosis study) kvlevaSi, diagnozis miuxedavad, wavlili. procedura ZiriTadad moicavs fsiqo
liTiumi efeqturi iyo aweuli guneb-ganwyobis ganaTlebas daavadebis niSnebisa da misi Sedegebis
dros, Tumca, aranairi gavlena ar mouxdenia Sesaxeb, aseve, rCevebs mdgomareobis marTvasTan
pozitiur an negatiur simptomebze (Johnstone et al., dakavSirebiT (cxrili 12.16). axlaxans Catarebulma
2004). axalma sistematurma mimoxilvam aCvena, rom metaanalizma daadastura, rom aseTi intervenciis
Sizofreniis dros liTiumis gamoyeneba mxolod dros mcirdeba hospitalizaciis SemTxvevebi (NNT=7)
afeqturi simptomebis (an Sizoafeqturi aSlilobis) da umjobesdeba mkurnalobis reJimis dacva; Tumca,
SemTxvevaSi iZleva dadebiT Sedegs. am simptomebis calkeuli kvlevebiT gansxvavebuli Sedegebia miRe
gareSe, Sizofreniis dros liTiumis efeqturobis buli. magaliTad, SedarebiT axalma kvlevam (Pharoah
aSkara mtkicebulebebi ar arsebobs (Leuch et al.,
2004). klozapinis augmentaciisTvis guneb-ganwyobis cxrili 12.15 fsiqosocialuri intervenciebi,
stabilizatorebis gamoyenebis Sesaxeb zeviT iyo romlebic efeqturia Sizofreniis samkurnalod
saubari.
ojaxuri Terapia (fsiqoganaTleba)
eleqtrokrunCxviTi Terapia kogniturbihevioruli Terapia
Sizofreniis dros ekT-s gamoyenebis tradiciuli socialuri unarebis daswavla

Cvenebaa katatonuri mdgomareoba da depresiuli dasaqmeba mxardaWeriT
simptomebi. orive mdgomareobisTvis ekT-s moqmedebis
daavadebis marTvis unarebi
efeqti xSirad Zalian swrafi da gasaocaria. arsebobs
garkveuli mtkicebulebebi, rom mwvave epizodebis integrirebuli mkurnaloba komorbiduli
mkurnalobisas ekT iZleva swraf efeqts da, aseve, wamalmoxmarebisTvis
aumjobesebs rezistentuli SemTxvevebis dros asertuli stacionargareSe mkurnaloba

antifsiqozur mkurnalobaze pasuxs. Sizofreniis
Mueser & McGurk (2004)
_ 317 _
12 Sizofrenia
socialuri unarebis treningi

cxrili 12.16 ojaxuri Terapiis elementebi
socialuri unarebis treningi gulisxmobs komp
Sizofreniis mkurnalobis dros
leqsuri interpersonaluri unarebis daswavlas,
Sizofreniis Sesaxeb ganaTleba romlisTvisac bihevioruli Terapia, ukukavSiri,
komunikaciis gaumjobeseba interpersonaluri unarebis treningi da sxva in
emociebis eqspresiis Sesusteba tervenciebi gamoiyeneba. SeiZleba, unarebis treningis
kombinireba fsiqoganaTlebasa da daavadebis marTvis
socialuri kavSirebis gazrda
treningTan, romelic iTvaliswinebs mkurnalobis
molodinis marTva reJimTan adaptaciasa da cxovrebis imdagvarad
dRiuri sakontaqto saaTebis Semcireba organizebas, rom Semawuxebeli simptomebis gavlena
minimaluri iyos. aseTi Terapiis efeqti zogadad
Leff., 1998
Zalian pozitiuria, Tumca bolomde naTeli araa,
ramdenad myaria es efeqti intevenciis dasrulebis
et al., 2003) gamoavlina ojaxuri Terapiis naklebi
Semdegac, an xom ar aris efeqturi mxolod im
efeqturoba. Tanamedrove midgomis Tanaxmad, fsi
pacientebisTvis, romlebsac prognozulad ukeTesi
qoganaTleba da ojaxuri Terapia rekomendebulia
mdomareoba aqvT. dReisTvis arsebuli metaanaliziT
pacientebisTvis, romlebic cxovroben an axlo ur
socialuri unarebis treningis TvalsaCino efeqti
TierTobaSi imyofebian TavianT ojaxebTan (Pilling et
dadasturebuli araa, amitom socialuri unarebis
al., 2002b; NICE., 2002).
treningis rutinulad gamoyeneba rekomendebuli ar
kognitur-bihevioruli Terapia aris (Pilling et al., 2002b).
is, rom Sizofreniis dros kognitur-bihevioruli kognituri daqveiTebis mkurnaloba
Terapiis (kbT) gamoyeneba mizanSewonilia, efuZneba
kognituri daqveiTeba Sizofreniis cudi gamosav
mosazrebas, rom pozitiuri simptomebi struqturul
lis mniSvnelovani determinantia. dReisTvis ori
msjelobasa da qceviT modifikacias eqvemdebareba.
ve midgoma, rogorc farmakologiuri, ise fsi
magaliTad, bodviTi azrebis SemTxvevaSi ganixilaven
qologiuri, miznad isaxavs kognituri funqciebis
misi warmoSobis mizezebs da sTavazoben alternatiul
gaumjobesebasac.
axsnas. Tumca, bodviT azrebTan roca gvaqvs saq
konvenciuri antifsiqozuri preparatebi mini
me, pirdapiri konfrontacias unda moveridoT. amis
malurad moqmedeben kognitur simptomebze (Mishara
msgavsad, SesaZlebelia halucinaciebis yovlis
and Goldberg, 2004), xolo maRali dozebiT miRebuli,
SemZleobaze, identurobasa da miznebze pacientis
gansakuTrebiT antiqolinerguli moqmedebis pre
rwmenis modificireba. amiT SevZlebT am gancdis
paratebi, auareseben mdgomareobas. atipiuri anti
Tanmxlebi distresisa da sixSiris Semcirebs.
fsiqozuri saSualebebi zogierTi funqciis umni
ramdenime kontrolirebadma klevam aCvena, rom
Svnelo gaumjobesebas iwveven (Harvey and Keefe, 2001).
Sizofreniis dros kbT dadebiT Sedegebs iZleva.
dReisTvis gaurkvevelia da arc mtkicebulebebi
erT-erTis Tanaxmad (Tarrier et al., 1998), pozitiuri
arsebobs, Tu ra ganasxvavebs medikamentebs kognitur
simptomebis simwvavis Sesamcireblad kbT, mxardaWeriT
funqciebze moqmedebis TvalsazrisiT. mimdinareobs
TerapiasTan SedarebiT, ufro efeqturia. meore
sxvadasxva wamlis Seswavla da SemuSaveba im mizniT,
kvlevam gamoavlina, rom kbT-c da nakleb specifikuri
rom es wamlebi antifsiqozuri moqmedebisagan damo
`megobruli~ intervenciac rogorc pozitiuri, ise
ukideblad, efeqturi iyos kognituri mdgomareobis
negatiuri simptomebis mniSvnelovan gaumjobesebas
gasaumjobeseblad.
iwvevda. mkurnalobis 9 Tvis manZilze kbT-s jgufSi
kognituri deficitis dasaZlevad mTeli rigi
efeqti ufro TvalsaCino iyo (Sensky et al., 2000).
fsiqologiuri mkurnalobis meTodebic gamoscades.
turkingtonma (Turkington et al., 2004) gamoTqva mosazreba,
ZiriTadi aqcenti gakeTda trenirebaze da praqtikis
rom kbT karg Sedegebs iZleva pozitiuri, negatiuri
saSualebiT Sesrulebis gaumjobesebaze. yvelaze
da, zogadad, Sizofreniis simptomebis mkurnalobisas
intensiurad Seiswavles kognituri aRdgenis Terapia,
da rom is fsiqiatriulma eqTanma unda Caataros. kbT-s
Tumca, Sedegebma aSkara suraTi ar mogvca. erTi
efeqturobis, mniSvnelobis, gansakuTrebiT, klinikaSi
metaanalizisa da Semdgomi grZelvadiani kvlevis
misi rutinulad gamoyenebis mimarT ufro frTxili
meSveobiT pozitiuri Sedegebi miiRes (Krabbendam
midgomac arsebobs (Pilling et al., 2002a; Turkington and
and Aleman, 2003; Hogarty et al., 2004), xolo meore me
McKenna, 2003). miuxedavad amisa, Sizofreniis mqone
taanaliziT daaskvnes, rom es intervencia mniSvnelovan
pacientebisTvis kbT integrirebuli mkurnalobis
gaumjobesebas ar iwvevs (Pilling et al., 2002b)
paketis nawilad unda moiazrebodes.
_ 318 _
daavadebis marTva
dinamiuri fsiqoTerapia daavadebis bunebidan gamomdinare, Zalian Znelia,

Tumca profesiuli unar-Cvevebisa da moTminebis
warsulSi, Sizofreniis dros dinamiuri fsiqoTerapia
wyalobiT SesaZlebelia am rTuli amocanis daZ
Zalian xSirad gamoiyeneboda ufro metad aSS-Si, vidre
leva. mniSvnelovania realuri miznebis dasaxva (gan
britaneTSi. miRebuli Sedegebi Zalian usistemoa,
sakuTrebiT mZime pacientebis SemTxvevaSi), romlebic
arc erTi ar metyvelebs am Terapiis Catarebis
misaRebi iqneba pacientisa da misi axloblebisTvisac.
mizanSewonilobaze. mei (May, 1968) darwmunda, rom
yovelTvis unda avuxsnaT maT, Tu riTia daniSnuli
fsiqoTerapia umniSvnelod aumjobesebda mdgo
wamali sasargeblo da, aseve, unda mivawodoT
mareobas. Tumca, mis mier Seswavlili mkurnaloba iyo
informacia preparatis gverdiTi movlenebis Sesaxebac.
xanmokle da mas SedarebiT gamoucdeli fsiqiatrebi
ukanasknel wlebSi SemuSavebulma mkurnalobis axalma
atarebdnen. garda imisa, rom Sizofreniis dros
meTodebma mniSvnelovnad gaaumjobesa daavadebis
individualuri fsiqoTerapia araefeqturia, arsebobs
marTva, amitom aucilebelia am mimarTulebiT codnis
imis saSiSroebac, rom SeiZleba moxdes pirovnebis
mudmivi ganaxleba.
zedmetad stimulacia da fsiqozuri simptomebis
cxrilSi 12.17 Sejamebulia Sizofreniis marTvis
gamwvaveba (Malberg and Fenton, 2000).
ramdenime ZiriTadi sakiTxi (NICE) (zogadi mimoxilva
wamlebis urTierTqmedeba da fsiqosocialuri ix. Cunningham Owens and Johnstone, 2000).
mkurnaloba
fsiqosocialuri mkurnaloba upiratesad farmakoTe mwvave mdgomareoba
rapiasTan erTad tardeba. orive intervencia amJamad stacionarSi moTavseba da mkurnaloba, Cveulebriv,
Sizofreniis mkurnalobis integrirebuli paketis saWiroa, rodesac saxezea Sizofreniis pirveli
ganuyofel nawils warmoadgens. Zneli saTqmelia, epizodi da gamwvavebis faza. Tumca, adekvaturi
ramdenad efeqturia fsiqosocialuri intervencia resursebis arsebobisas, SesaZlebelia saxlSi
damoukideblad, radgan igi, pirvel rigSi, aumjobesebs mkurnaloba, rasac Tavisi upirateosoba aqvs (maT
mkurnalobis reJimis dacvas. es ar aris mniSvnelovani Soris, pacientis survilis gaTvaliswineba) (Dedman,
argumenti fsiqosocialuri intervenciis sasargeblod, 1993). amis mxedvelobaSi miRebiT, Seiqmna krizisuli
radgan fsiqologiuri intervencia, romelic miznad intervenciis jgufi, romelic miznad isaxavs mwvave
isaxavs komplaenturobis (mkurnalobis reJimis dacvis) mdgomareobaSi myofi pacientis mkurnalobas binaze.
gaumjobesebas, rogorc Tanmxlebi mkurnaloba, Tumca, stacionarul mkurnalobas Tavisi upiratesoba
TavisTavadaa efeqturi (Kemp, 1996). aqvs: klinikaSi uzrunvelyofilia daculi garemo,
SesaZlebelia pacientze ufro safuZvliani dak
daavadebis marTva virveba, da ojaxsac, romelic xangrZlivi drois
manZilze ganicdis distress, amosunTqvis saSualeba
daavadebis marTvis upirvelesi sawindaria paci
eZleva.
entTan kargi urTierTobis damyareba. amis miRweva,
mniSvnelovania pacientze dakvirveba mkurnalobis
Catarebamde, magram es xSirad ver xerxdeba
cxrili 12.17 Sizofreniis marTvis principebi da saWiroa gadaudebeli Terapiis dawyeba. da
da komponentebi kvirveba pacientze, romelic medikamentebs ar
Terapiuli partnioroba pacientsa da mis mzrunvelebTan iRebs, gvexmareba fsiqikuri statusisa da qcevis
srulyofil SeswavlaSi, diagnozis dasmasa da
integrirebuli, multidisciplinuri muSaoba, romelic
sxva daavadebebisagan, magaliTad, fsiqoaqtiuri
pirvelad da meorad jandacvas moicavs
nivTierebebiT gamowveuli mdgomareobisa da
antifsiqozuri preparatebiT mkurnaloba da organuli fsiqozebisagan, diferencirebaSi. SesaZloa,
profilaqtika _ minimaluri efeqturi dozebiT
saWiro iyos mkurnalobisagan Tavisufali pacientebis
kognitur bihevioruli Terapia specialurad Seswavla. praqtikaSi yvelaze rTulia
ojaxuri intervencia eWviani (interviueris mimarT ar aris ndobiT
ganwyobili) an sakuTar TavSi Caketili pacientis
adreuli intervencia
gamokvleva. diagnozis dasasmelad SeiZleba saWiro
mowyvladi pacientebis asertuli momsaxureba gaxdes ramdenime intervius Catareba, axloblebis
saWiroebebis regularulad Sefaseba gamokiTxva da eqTnebis dakvirvebiT miRebuli
monacemebis gaTvaliswineba.
krizisuli intervencia da Sin momsaxurebis gundi,
antifsiqozuri mkurnaloba Sizofreniisa da sxva
rogorc stacionirebis alternativa
fsiqozebis mkurnalobis mTavari saSualebaa, igi
realisturi Terapiuli optimizmis SenarCuneba
xSirad diagnozis dasmisTanave iwyeba da SesaZlebelia
_ 319 _
12 Sizofrenia
mTeli cxovrebis manZilze gagrZeldes. amdenad, nalobis mniSvneloba da miviRoT misgan sruli
fsiqofarmakoTerapiaze gadawyvetilebis miReba Tanxmoba, radgan arsebobs mogvianebiTi seriozuli
da pacientisa da axloblebis adekvaturi CarTvis garTulebis, tardiv (mogvianebiTi) diskineziis
uzrunvelyofa Sizofreniis marTvis umniSvnelovanes ganviTarebis riski (ix. gv. 530_8). im SemTxvevaSi, Tu
aspeqts warmoadgens. mwvave fazaSi unda Sesustdes pacients ar SeuZlia gacnobierebuli gadawyvetilebis
pozitiuri simptomebi da agznebis kontroli. miReba, mkurnaloba unda warimarTos `fsiqiatriuli
amasTan, maqsimalurad unda aviciloT Tavidan daxmarebis Sesaxeb~ kanonis sruli dacviT. pacientis
gverdiTi efeqtebis ganviTareba, gansakuTrebiT, naTesavebi, ramdenadac es SesaZlebelia, unda Ca
mwvave distonia. amis misaRwevad sasurvelia, ben erTon mkurnalobis Sesaxeb gadawyvetilebis miRebis
zodiazepinebTan erTad, antifsiqozuri prepa procesSi ori mizezis gamo: (1) amas SeiZleba kanoni
ratebis saSualo dozebiT daniSvna (magaliTad, moiTxovdes da (2) pacientis mier mkurnalobis
haloperidoli 2-6 mg/dRe an risperidoni 2-6 mg/ reJimis dacva SeiZleba mniSvnelovnad waaxalison
dRe plus lorazepami 2 mg, saWiroebis dros, yovel axloblebma. SesaZloa, saWiro gaxdes pacientis
saaTSi erTxel). haloperidolic da lorazepamic advokatis daxmarebac.
SeiZleba mivceT intramuskulurad, Tu amis saWiroeba simptomebis nivelirebis Semdeg, mkurnalobaSi Car
arsebobs. alternatiuli daniSnulebis saxiT, SeiZ Tulma gundma, daavadebis Semdgomi marTvisTvis,
leba gamoviyenoT ufro sedatiuri antifsiqozuri unda SeimuSaos mkurnalobis grZelvadiani gegma,
preparatebi, rogorebicaa olanzapini (10-20 mg/dRe) an romelic socialur Sefasebas efuZneba. marTalia,
qlorpromazini (200-400mg/dRe). umjobesia oraluri Znelia mdgomareobis samomavlo prognozi, magram
medikamentebis gamoyeneba, Tumca, im SemTxvevaSi, aucilebelia daskvnis gakeTeba axlo periodis gamo
Tu pacienti Zalian agznebulia an ar emorCileba savalze. daskvna keTdeba mkurnalobaze pasuxis
mkurnalobas, saWiroa wamlis ineqciis gziT Seyvana. xarisxisa da xangrZlivobis mixedviT, aseve, wina
Tu eWvi gvepareba, rom pacienti ar ylapavs abebs, maSin epizodebisa da sxva faqtorebis gaTvaliswinebiT,
unda mivceT suspenziis an pirSi xsnadi tabletis saxiT. romlebic cxrilSia (cxrili 12.14) CamoTvlili.
SesaZlebelia xanmokle periodis depo preparatebis
gamoyeneba, magaliTad zuklopentiqsol acetatis an antifsiqozuri preparatebis arCeva
olanzapinis. aucilebelia depo preparatebis didi sxvadasxva antifsiqozuri preparatebis efeqturobisa
sifrTxiliT xmareba. zuklopentiqsol acetati ar da maT Soris arsebuli msgavsebis Sesaxeb ukve
unda davniSnoT, Tu ar viciT antifsiqozur mkur visaubreT, aqedan gamomdinare, medikamentis Ser
nalobaze pacientis amtanoba (fsiqiatrTa samefo Cevisas sxva faqtorebi unda gaviTvaliswinoT, kerZod:
koleji, 1993). antiqolinerguli preparatebi iniSneba warsulSi pacientis pasuxi mkurnalobaze, misi ar
parkinsonuli niSnebis gamovlenis Semdeg. ar SeiZleba Cevani, preparatis forma (abebi, suspenzia, xsnadi
maTi rutinulad an xangrZlivad gamoyeneba. sakiTxebi, tabletebi, depo) da mosalodneli gverdiTi efeqtebi,
romlebic exeba imas, Tu ramdenad itans pirovneba riTac, farmakologiuri moqmedebis Sesabamisad,
individualurad antifsiqozur preparatebs, Semdeg wamlebi mniSvnelovnad gansxvavdeba erTmaneTisagan
nawilSi iqneba ganxiluli. (gv. 530). preparatis arCevisas, gasaTvaliswinebelia
mosalodnelia, rom agzneba, mousvenroba, gaRi Semdegi gverdiTi efeqtebi:
zianebadoba, insomnia, stacionirebidan ramdenime
eqstrapiramiduli sindromi: yvela metaanaliziT
dReSi alagdeba. bodviTi azrebi, halucinaciebi
eqstrapiramiduli gverdiTi movlenebi ufro nak
da sxva fsiqozuri simptomebi ufro nela, xSirad,
lebad viTardeba atipiuri antifsiqozuri pre
ramdenime kviris Semdeg, emorCileba mkurnalobas.
paratebis miRebisas. tardiv (mogvianebiTi) dis
Tu mdgomareoba ar umjobesdeba, savaraudoa, rom
kineziis ganviTarebac ufro iSviaTia atipiuri
pacienti an ar iRebs wamals, an iRebs arasakmarisi
preparatebiT mkurnalobis dros (Correll et al., 2004).
doziT. pacientebis mxolod Zalian mcire nawilia
hiperprolaqtinemias iwvevs D2 receptoris mi
rezistentuli yvelanairi mkurnalobis mimarT.
marT gamoxatuli afinurobis mqone preparatebi.
mas Semdeg, rac TvalsaCino gaumjobeseba eWvs
maT miekuTvneba tipiuri da ramdenime atipiuri
aRar iwvevs, simptomebis mudmivi monitoringis
antifsiqozuri preparati (magaliTad, amisulpi
qveS (raTa mdgomareoba ar gamwvavdes) SegviZlia
ridi, rispiridoni). danarCenebi naklebad moq
dozebis frTxilad Semcireba. dozebis dakleba xdeba
medeben prolaqtinze, xolo aripiprazoli ki
TandaTanobiT, xangrZlivi drois ganmavlobaSi (ix.
amcirebs prolaqtinis dones. prolaqtinis momateba
qveviT).
yuradsaRebia rogorc swrafi efeqtis gamo, rac
Tu pacientis fsiqikuri mdgomareoba amis saSualebas
menstrualuri ciklis darRvevebsa da galaqtoreaSi
iZleva, aucilebelia avuxsnaT medikamenturi mkur
_ 320 _
daavadebis marTva
gamoixateba, ise mogvianebiTi garTulebis Tval kardiogramaze QTc intervalis gazrdas, rac
sazrisiTac, vinaidan zrdis simsivneebisa da kardialuri ariTmiis saSiSroebas qmnis. amis gaT
osteoporozis ganviTarebis risks (Wieck and valiswinebiT, pirovnebas, romelsac aReniSneba
Haddad., 2004). unda gvaxsovdes, rom orive gverdiTi kardialuri an vaskuluri movlenebi, unda mivceT
efeqti dakavSirebulia dozasTan da ufro mwvavdeba iseTi antifsiqozuri preparati, romelsac am
Terapiul dozaze meti doziT miRebisas (Kapur et cvlilebebis gamowvevis yvelaze naklebi potencia
al., 1999). maTi ganviTareba miuTiTebs preparatis aqvs. aseve, saWiroa xandazmuli pirebisTvis anti
zedmet dozaze. Tu Terapiuli pasuxi ar aris fsiqozuri wamlebis didi sifrTxiliT daniSvna (me-
damakmayofilebeli, saWiroa preparatis Secvla 20 Tavi).
naklebi gverdiTi efeqtebis mqone medikamentiT. yvela am faqtoridan gamomdinare, klinicisti Za
sedacia. zog antifsiqozur preparats gamoxatuli lian kargad unda erkveodes tipiur da atipiur
sedaciuri efeqti aqvs. upiratesad im medikamentebs, preparatebsa da gverdiTi efeqtebis mixedviT maT
romlebsac histaminuri da muskarinuli recep Soris gansxvavebaSi. aseve, mniSvnelovania preparatis
torebisadmi gamoxatuli afinuroba axasiaTebT, oraluri da parenteraluri formebisa da sxva
magaliTad, qlorpromazini, olanzapini da klo wamlebTan urTierTqmedebis codna.
zapini. am preparatebis es Tviseba xSirad saWiroc
aris, gansakuTrebiT, fsiqomotoruli agznebis `Semdgomi movla~ kargi prognozis
SemTxvevaSi, Tumca xangrZlivi gamoyenebis dros SemTxvevaSi
SeiZleba zogadi funqcionirebis daqveiTeba gamo Sizofreniis pirveli epizodis Semdeg, efeqturi
iwvios. mkurnalobis SemTxvevaSi, rodesac axlo periodis
wonaSi mateba mravali tipiuri da atipiuri prognozi dadebiTia, mniSvnelovania ori principis
antifsiqozuri preparatis mniSvnelovani gverdiTi dacva: (1) mdgomareobidan gamosvlis Semdeg, ramdenime
efeqtia. gansakuTrebiT damaxasiaTebelia im wam Tvis ganmavlobaSi, umciresi efeqturi doziT
lebisTvis, romlebic histaminisa da 5-HT2C medikamenturi mkurnalobis gagrZeleba da (2) aSkara
receptorebs blokaven da nawilobriv 5-HT2C stresuli situaciisTvis Tavis arideba.
receptorebis genetikur variaciasTan arian pacienti TemSi momuSave multidisciplinuri
dakavSirebulni. magaliTad, olanzapiniT sami gundis wevrma, ZiriTadad fsiqiatriulma eqTanma,
kviris mkurnalobis Semdeg wonaSi saSualo mateba regularulad unda moinaxulos. dakvirveba mkur
5 kg-ia. atipiuri preparatebidan amisulpirids, nalobis Sewyvetidan ramdenime Tve grZeldeba.
aripiprazolsa da risperidons yvelaze naklebad miuxedavad dadebiTi da optimisturi prognozisa,
axasiaTebs wonaSi momateba. ojaxis wevrebs unda ecnobos, rom dauyovnebliv
II tipis Saqriani diabeti xSirad problemuri mimarTon specialists, Tu mdgomareobis gauaresebis
xdeba. bolomde naTeli ar aris, es antifsiqozuri raime eWvi gaCndeba. mkurnalobis am etapze ojaxis
mkurnalobiTaa gamowveuli, Tu dakavSirebulia eqims gansakuTrebuli roli akisria.
daavadebis faqtorebTan (magaliTad, saerTo `cudi prognozis~ mqone pacientebis, romlebsac
genetikuri winaganwyoba, cxovrebis stili). aseve, ar aqvT gamoxatuli daqveiTeba, Semdgomi movla
naklebadaa cnobili, Tu romeli antifsiqozuri umravles SemTxvevaSi savaraudoa momavali
preparatia metad negatiuri sxvasTan SedarebiT. gamwvavebebis ganviTarebis fonze, rasac dasWirdeba
zogi gamokvleva gviCvenebs, rom riski gansakuTrebiT grZelvadiani zrunva.
momatebulia klozapinisa da olanzapinis miRebisas aseT viTarebaSi antifsiqozuri preparatebis
(Lieberman et al., 2005). gamomdinare iqidan, rom xangrZlivad gamoyeneba daavadebis marTvis mniS
arsebobs azrTa sxvadasxvaoba, antifsiqozuri vnelovani komponentia. SesaZloa, ukeTesi iyos depo
mkurnalobisas aucilebelia diabetze rutinuli preparatebis daniSvna, vinaidan pacientebis did
gamokvlevis Catareba. aseve, unda gavakontroloT nawils uWirs xangrZlivi mkurnalobis reJimis dacva.
lipidebis done sisxlSi da pacientis wona (amerikis Tumca, am SemTxvevaSi, risperidonis garda, sxva
diabetis asociacia da sxvebi, 2004). atipiuri preparatebis miReba gamoricxulia. wamlis
dozis (simptomebis SemcirebisTvis minimaluris)
kardiovaskuluri risk-faqtorebi. antifsiqozuri
regulireba pacientis klinikur mdgomareobaze
preparatebis miReba dakavSirebulia kardiovas
dakvirvebiTaa SesaZlebeli. Tu pirvelad arCeuli
kuluri da cerebrovaskuluri garTulebebis maR
antifsiqozuri wamlis maqsimaluri doza saTanado
al riskTan, rac nawilobriv ganpirobebulia maTi
Sedegs ar iZleva, saWiroa preparatis gamocvla.
gavleniT wonis matebaze, insulin-rezistentobasa
sasurvelia sxva receptorebze moqmedi medikamentebis
da dislipidemiaze. zogi preparati iwvevs
_ 321 _
12 Sizofrenia
gamoyeneba. Tumca, aseTi situaciebis marTvis Sesaxeb unda gakeTdes reabilitaciaze, fsiqosocialur
naklebi informacia arsebobs. klozapini erTaderTi intervenciasa da socialur Tanadgomaze, rac
preparatia, romlis efeqturoba pacientTa am konkretuli pirovnebis saWiroebebzea iqneba
jgufisTvis dadasturebulia, magram aucilebelia morgebuli. aseve, mniSvnelovania okupaciuri
am wamlis miRebasTan dakavSirebuli riskis gaT Terapevtisa da klinikuri fsiqologis wvlili.
valiswineba (gv. 238). suicidis riskis arsebobac sakiTxebi, romlebic gansakuTrebul yuradRebas
klozapinis adreuli gamoyenebis Cvenebaa (gv. 503). saWiroeben:
Tuki kognitur-bihevioruli Terapia xelmisawvdomia, sacxovrebeli garemo pirobebi _ SeuZlia pacients
mizanSewonilia rezidualur pozitiur simptomebze damoukideblad cxovreba? SeiZleba pacienti
mimarTuli kbT-s Catareba (gv. 300). dabrundes Tavis mSoblebTan an naTesavebTan? xom ar
mkurnalobis grZelvadiani gegma unda moicavdes aris saWiroa sacxovrebelSi (sacxovrisSi) gadayvana?
pacientis fsiqikuri mdgomareobis, mkurnalobis, w dasaqmeba _ SeuZlia pirovnebas raime anazRaurebadi
socialuri adaptaciisa da saqmianobis regularul an voluntaruli samuSaos Sesruleba?
Semowmebas. SesaZloa, sasargeblo aRmoCndes
w yoveldRiuri unar-Cvevebi _ pacienti xSirad
stresul da ojaxur problemebTan dakavSirebiT
saWiroebs bazisuri unar-Cvevebis aRdgenas,
rCevebis micema; agreTve, ojaxisTvis specifikuri
magaliTad, saWmlis momzadeba, Tanxis gadanawileba,
daxmarebis gaweva, raTa ojaxis wevrebs hqondeT
sayidlebis gakeTeba, binis dasufTaveba da piradi
ufro realuri molodini pacientis mdgomareobis
higienis dacva;
mimarT, ukeT gaerkvnen daavadebaSi da, saWiroebis
w socialuri unar-Cvevebi da is, Tu rogor atarebs
SemTxvevaSi, moxerxdes emociuri damokidebulebis
pacienti Tvisufali dros;
Semcireba. aseTi moculobis samuSaos Sesruleba
SesaZlebelia TemSi momuSve fsiqiatriuli eqTnis, w socialuri da kognituri funqciebis aRdgena
socialuri muSakis, fsiqiatrisa da ojaxis eqimis _ rodesac SesaZlebelia, zeviT ganxiluli,
erToblivi ZalisxmeviT. zogi pacienti, gasagebi Tanamedrove Terapiebis gamoyeneba socialuri da
mizezebis gamo, xSirad anebebs Tavs mkurnalobas kognituri funqciebis gasaumjobeseblad;
da mxolod mdgomareobis gaumjobesebis Semdeg w antifsiqozuri mkurnalobis optimizacia saukeTeso
ubrundeba. iseT SemTxvevebSi, rodesac gamwvavebebi wamlisa da saTanado dozis SerCevis gziT.
xSiria, asertul stacionargareSe mkurnalobas im SemTxvevaSi, Tu pacients aReniSneba gamo
gansakuTrebuli roli eniWeba (ix. 23-e Tavi) (Marshall xatuli qcevis problemebi, misi ojaxis wevrebi
and Lockwood, 2000). gansakuTrebul zrunvas saWiroeben. naTesavebisTvis
garkveul SemTxvevebSi, pozitiuri simptomebis SesaZloa mizanSewonili iyos jgufebSi gaerTianeba
nivelirebis miuxedavad, pacientebi veRar ubrun da Sexvedra maTTan, vinc msgavsi problemebis
debian funqcionirebisa da aqtivobis Zvel dones. daZleva iswavla. maT unda hqondeT imis imedi, rom
amis mizezi SeiZleba iyos negatiuri, depresiuli mdgomareobis garTulebis SemTxvevaSi, miiReben
an kognituri simptomebis arseboba, an sedaciuri profesiul daxmarebas. axloblebs unda vurCioT,
an antiqolinerguli preparatebis miReba. yvela Tu rogor unda upasuxon anomaliur qcevas da
es faqtori unda gaviTvaliswinoT da Sesabamisi avuxsnaT, ras unda elodon pacientis mxridan.
zomebi miviRoT. es problemebi SeiZleba nawilobriv aseT SemTxvevebSi saukeTeso rCevebis micema TemSi
mogvardes medikamentebis optimizaciisa da fsiqo momuSave fsiqiatriul eqTans SeuZlia (Gournay,
socialuri intervenciis meSveobiT. 2000). axloblebis darigebisa da daxmarebis saqmeSi
socialur muSaksac mniSvnelovani roli eniWeba.
gamoxatuli daqveiTebis mqone `cudi
prognozis~ pacientebis Semdgomi movla daavadebis marTvis sxva sakiTxebi
pacientebs romlebsac aqvT gamoxatuli negatiuri
zrunvis gegma
simptomebi, cudi socialuri adaptacia da qcevis
fsiqiatriuli daavadebis marTvisas, Zalian didi
problemebi, rac qronikuli SizofreniisTvisaa
mniSvneloba aqvs zrunvis gegmis SemuSavebas, raTa
damaxasiaTebeli, ufro metad organizebuli da
sworad warimarTos multidisciplinuri gun
SeuzRudavi zrunva sWirdebaT. qronikuli Sizof
dis koordinirebuli muSaoba da riskis marTva.
reniis mqone pirebisTvis gaTvaliswinebuli, Temze
masSi detaluradaa gawerili gundis wevrebis
dafuZnebuli fsiqiatriuli zrunvis komponentebi
movaleobebi da servisis miwodebis saSualebebi
23-e TavSia aRwerili.
(23-e Tavi). aseTi midgoma gansakuTrebiT saWiroa
medikamenturi mkurnaloba daavadebis marTvis
rTuli da grZelvadiani momsaxurebis dros, Tumca
mniSvnelovani Semadgeneli nawilia, Tumca, aqcenti
_ 322 _
daavadebis marTva
mizanSewonilia yvela Sizofreniis mqone pacientis wamalmoxmareba
SemTxvevaSic. zrunvis gegmis mTavari Semadgeneli
Sizofreniis mqone bevri pacienti borotad moixmars
komponentebia Semdegi sakiTxebis identificireba da
rogorc legalur, aseve aralegalur fsiqoaqtiur
dokumentireba:
nivTierebebs. magaliTad, aSS-Si, gansazRvrul raionSi
w samedicino da socialuri saWiroebebis sistematuri Catarebulma epidemiologiurma kvlevam aCvena, rom
Sefaseba; fsiqoaqtiur nivTierebaTa avadmoxmarebis riski
w mkurnalobis gegma, romelic SeTanxmebulia Sesa Sizofreniis mqone pacientebSi 4-5-jer iyo gazrdili.
bamis StatTan, pacientTan da mis axloblebTan; amas mravali mizezi unda hqondes; gamovyofT
w ZiriTadi personalis CamonaTvali, romlebsac ramodenimes:
aqvT pcientTan kontaqti, uweven monitorings meti sensitiuroba socioekonomikuri faqtorebis
da uzrunvelyofen mkurnalobis programis Ses mimarT, rac wamalmoxmarebasTan dakavSirebiT
rulebas; janmrTeli populaciisTvisac mniSvnelovania;
w pacientis mdgomareobis progresisa da misi saWi pirovnuli distresis, romelic fsiqikuri simp
roebebis regularuli mimoxilva. tomebiTa an mkurnalobiTaa gamowveuli, Semsu
buqebis mcdeloba;
adreuli intervencia
saerTo/gaziarebuli genetikuri winaganwyoba.
sul ufro izrdeba interesi im mosazrebis mimarT, rom
wamalmoxmarebis SemTxvevaSi Sizofreniis mim
Sizofreniis mkurnalobis adreul stadiaze dawyeba
dinareoba simptomaturad mZimdeba da aseTi pacientebis
aumjobesebs gamosavals. am mxriv, gansakuTrebiT
mkurnalobaSi CarTva nelia. wamalmoxmareba aso
mniSvnelovania avstraliaSi Catarebuli kvleva
cirebulia usaxlkarobasTan, Zaladobriv qcevasa da
(McGorry and Killackey, 2002). es mosazreba Semdeg
zogadi janmrTelobis gauaresebasTan. Tanamedrove
faqtebs efuZneba:
kvlevebiT dadginda, rom dadebiTi Sedegis miRweva
w xangrZlivad aranamkurnaleb pacientebs mniSvne
SeiZleba kompleqsuri ambulatoriuli da asertuli
lovnad uaresi gamosavali aqvT (Marshall et al., 2005);
Terapiis programebiT, rac orive mdgomareobis
w yoveli momdevno epizodis mkurnalobas meti dro (wamalmoxmarebisa da fsiqozis) integrirebulad
esaWiroeba; mkurnalobas iTvaliswinebs (Drake et al., 1998). aseve, am
w socialuri daqveiTeba yvelaze intensiurad di- jgufisTvis SeiZleba efeqturi iyos kbT.
agnozis dasmidan pirveli ori wlis manZilze vi-
moZalade pacienti
Tardeba;
Sizofreniis dros xSirad gvxvdeba qcevis darRvevebi
am monacemebidan gamomdinare, miiCneven, rom mni
da mousvenroba. marTalia, sxvebis mimarT Zaladobrivi
Svnelovania fsiqozis mqone pacientebis, ramdenadac
qceva SizofreniisTvis damaxasiaTebeli ar aris,
SesaZlebelia, adreuli gamovlena da mkurnalobis
magram arc gamoricxulia. magaliTad, rodesac
dawyeba. amJamad mimdinareobs adreuli intervenciis,
Seiswavles 253 pacienti Sizofreniis pirveli
rogorc dabali dozebiT antifsiqozuri mkurnalobis,
epizodis dros, naxes, rom 52 pacienti Tavisi qceviT
ise fsiqologiuri intervenciis efeqturobis
sxvebis sicocxles safrTxes uqmnida (Humphreys and
Seswavla da, winaswari monacemebiT Tu vimsjeleT,
Johnstone, 1992). amasTan, daaxloebiT SemTxvevaTa
misi upiratesoba aSkaraa (Marshall and Lockwood, 2004).
naxevarSi Zaladobrivi qceva fsiqozuri simptomebiT,
umravlesoba eTanxmeba mosazrebas, rom adre dawye-
upiratesad bodviT iyo ganpirobebuli. Zaladobrivi
buli mkurnaloba prognozis TvalsazrisiT ukeTesia.
qcevis saSiSroebas wamalmoxmarebac zrdis (Citrome
Tumca, zogi Tvlis, rom mkurnalobis dawyeba sa-
andVolodka, 1999).
survelia daavadebis prodromul periodSi, rodesac
moZalade pacientebis daavadebis marTvis zogadi
fsiqozuri simptomebi jer kidev ar aris gamovleni-
principebi igivea, rac Sizofreniis mqone sxva
li an, rodesac pirovneba janmrTelia, magram Sizo-
pacientebisa, Tumca, SesaZloa, ufro xSirad ara
freniis maRali riskis mqonea (magaliTad, Sizofre-
nebayoflobiTi mkurnalobis Catareba iyos saWiro.
niis mqone mSoblebis Svilebi). es mosazreba dReisT-
aseT SemTxvevebSi, mdgomareobis gakontrolebis
vis seriozuli kamaTis sagans warmoadgens, radgan
mizniT, medikamenturi mkurnalobis dauyovnebliv
gaurkvevelia, rogor SeiZleba ùsimptomo pacientis~
dawyebasTan erTad aucilebelia didi Zalisxmeva
sworad amocnoba. amasTan, gasaTvaliswinebelia im
mSvidi da stabiluri garemos Sesaqmnelad, romelSic
pirebis mkurnalobisa da stigmatizaciis riski, rom-
Zaladobis provocireba Tavidan iqneba acilebuli.
lebsac arasdros ganuviTardebaT Sizofrenia (Warner,
Zaladobis saSiSroebas saTanado yuradReba un
2002; Pelosi and Birchwood, 2003).
da mivaqcioT. gansakuTrebiT yuradsaRebia ise
_ 323 _
12 Sizofrenia
Ti SemTxvevebi, rodesac warsulSi pacients (avad (1) daavadebis dawyebis asaki _ krepelinis droidan
myofobis arseboba_ararsebobis miuxedavad) Zala moyolebuli, mravalma kvlevam, qalebSi Sizofreniis
dobrivi qmedeba aqvs Cadenili. mwvave simptomebis dawyebis mogvianebiTi asaki daadastura SedarebiT
gakontrolebasTan erTad, Zaladobis saSiSroeba naklebi maCvenebeli cxovrebis meore da mesame
ixsneba. pacientebis mxolod Zalian mcire nawili aTwleulSi, xolo meore piki, upiratesad, mexuTe
didi xnis manZilze rCeba sazogadoebisTvis saSiS aTwleulSi aRiniSneba;
pirovnebad. Zaladobis marTva ganxilulia 26-e TavSi. (2) Sizofreniis sixSire qalebTan SedarebiT mama
kacebSi metia (SemTxvevaTa riskis Tanafardoba
suicidis riski
1.42; 95% sarwmunoebis intervaliT 1.3-1.56; Aleman
kvlevebidan Cans, rom Sizofreniis dros suicidis
el al., 2003); mamakacebSi daavadeba ufro mZimed
riski mniSvnelovnadaa gazrdili. iseve, rogorc
da mwvaved midis. es ar aris dakavSirebuli arc
sxva fsiqikuri aSlilobebis dros, Sizofreniis Sem
daavadebis asakTan da arc imasTan, mimarTa Tu
TxvevaSic demografiuli risk-faqtorebia: mamrobiTi
ara pacientma eqims. amis mizezad estrogenebis
sqesi, socialuri izolacia, umuSevroba da warsulSi
neiroproteqtoruli bunebaa miCneuli, Tumca,
suiciduri qcevis arseboba.
sakmarisi damatkicebeli monacemebi ar gvaqvs;
sxva risk-faqtorebs miekuTvneba:
sqesTa Soris gansxvavebas, SesaZloa, genetikuri da
depresia da uimedoba; epigenetikuri risk-faqtorebic ganapirobebs;
fsiqozuri mdgomareobis xSiri gamwvavebebi; (3) sikvdilianobis maCvenebeli Sizofreniis mqone
premorbidulad kargi funqcionireba; mamakacebSi, qalebTan SedarebiT, 2-jer metia.
daavadebis adreuli stadia; genderuli faqtorebi gavlenas axdens mkurnalobis
stacionarSi yofnis an stacionirebis Semdgomi proceszec (Seeman, 2004):
periodi. (1) wamlebis farmakokinetika, maT Soris kloza
gamoxatuli negatiuri simptomebis mqone pacients pinisTvisac, mamakacebsa da qalebSi gansxvavebulia;
suicidis mcdeloba naklebad aReniSneba. suicidi (2) hiperprolaqtinemia da estrogenebis Semcireba,
ufro metad asocirebulia pozitiuri simptomebis rac antifsiqozuri mkurnalobis xSiri gverdiTi
simwvavesTan, rogoricaa auditoruli halucinaciebi movlenebia, ufro negatiurad moqmedebs qa
da kontrolis bodva. daavadebis arafsiqozur pe lebze, vidre mamakacebze. es saSiSia ara marto
riodSi TviTmkvlelobis faqtebs ufro xSirad menstrualuri ciklis darRvevebis TvalsazrisiT,
vxvdebiT ganaTlebis maRali donis mqone pacientebSi. aramed zrdis osteoporozisa da zogierTi simsivnis
aseTi pacientebis depresias da daqveiTebul TviT ganviTarebis risksac (Wieck and Haddad, 2003).
Sefasebas ganapirobebs is, rom avadmyofobamde pa
cients hqonda maRali molodinisa da perspeqtiuli rasobrivi gansxvaveba da Sizofrenia
momavlis gancda, rac daavadebis gamo ganadgurda da eTnikuri umciresobebis aranebayoflobiTi
daingra. mkurnalobis gazrdili maCvenebeli azrTa
Sizofreniis dros suicidis riskis Semcireba niSnavs sxvadasxvaobas iwvevs. gansakuTrebiT, afro-
suicidis risk-faqtorebis karg codnasa (De hert and karibuli populaciis SemTxvevaSi, romelic did
Peuskens, 2000) da depresiuli simptomebis aqtiur brtaneTSi cxovrobs (gv. 290; Morgan et al., 2005).
mkurnalobas. randomizebuli kvlevebiT dadgenilia, ramdenime avtoris mier es, rogorc ìnstituciuri
rom Sizofreniis dros klozapini mniSvnelovnad rasizmi, ~ ise Sefasda (Sashidharan, 2001). Tumca, ar
amcirebs suicidis risks (Meltzer et al., 2003), Tumca aris saubari am populaciis mimarT siZulvilze.
efeqtis zomisa da meqanizmis gansazRvrisTvis dama diagnozi yovelTvis unda efuZnebodes ICD-10-sa
tebiTi kvlevebia saWiro (Hennen and Baldessarini, 2005). da DSM-IV-is kriteriumebs, eTnokulturaluri
Taviseburebebis gaTvaliswinebiT, rogorc am
sxva sakiTxebi klasifikaciebSia miTiTebuli (gv. 8). qceviTi
manifestacia (magaliTad, agresia), romelic
qalebi da Sizofrenia
SecdomiT SeiZleba rasobriv gansxvavebas mivaweroT,
Sizofreniis zogierTi aspeqtisa da misi mkurnalobis ar ganixileba sxva simptomebisagan damoukideblad.
TvalsazrisiT, qalebsa da mamakacebs Soris mni medikamentebis gamoyeneba da aranebayoflobiTi
Svnelovani gansxvavebebi arsebobs (ix. Castle et al., mkurnalobis principebi yvela erovnebisa da rasis
2000). warmomadgenlisTvis erTnairi unda iyos. (eTnikuri
epidemiologiuri kvlevebis meSveobiT dadginda variaciebis mimoxilva ix. Bhui et al., 2003).
Semdegi gansxvavebebi:
_ 324 _
sxva sakiTxebi
Sizofreniis Sesaxeb saubari pacientebTan Semdegi gansxvaveba samedicino xedvasa da ojaxis
da maT axloblebTan wevrebis damokidebulebas Soris aris is, rom
pacientic da misi axloblebic ufro met aqcents
Sizofreniis dros, sxva fsiqozur daavadebebTan
akeTeben simptomebis Sinaarsze da ara bunebaze
SedarebiT, metia gaugebroba da ufro Zlieri stigma
(McCabe et al., 2002). fsiqiatrs ufro metad ain
arsebobs. amitom Zalian mniSvnelovania terminebis
teresebs azrebis bodviTi buneba, an aRqmis paTo
sworad da miznobrivad gamoyeneba. yvela pacientsa
logiis arseboba (aris Tu ara halucinaciebi), xolo
da mis axlobels, yovelgvari SezRudvis gareSe, unda
pacientebs bodvisa da halucinaciebis Sinaarsa da
SeeZlos kiTxvebis dasma, Tavisi Sexedulebebisa da
maT mniSvnelobaze surT saubari. fsiqiatrma unda
problemebis ganxilva.
acados pacientsa da mis axloblebs, gamoTqvan
msjelobis saSualeba unda mivceT pacientebsa
TavianTi mosazrebebi fsiqopaTologiuri simptomebis
da mis naTesavebs daavadebis bunebaze, gamwvavebis
SinaarsTan dakavSirebiT da axsnan, ratom aris
niSnebze, realur molodinsa da Sizofreniis
mniSvnelovani fsiqozuri gamocdilebis bunebaze
Tanamedrove monacemebze (ix. Barrowclough et al., 2001).
detaluri kiTxvebis dasma.
unda davsaxoT daavadebis realisturi gamosavali da,
pacentebTan da maT axloblebTan am farTo dia
amasTan, SeZlebisdagvarad, optimisturi molodinis
pazonis Temebis ganxilva verc erTi konkretuli
gancda SevqmnaT. unda gvaxsovdes, rom umravlesoba
proceduriT ver moxerxdeba. amaze daxarjul dros,
Sizofrenias miiCnevs ganukurnebel daavadebad,
sakiTxis Sinaarssa da SexvedrebSi monawileobas
romlis drosac mdgomareobis permanentuli gau
gansazRvravs maTi saWiroebebi, survilebi, pacientis
areseba gardauvalia. unda ganvumartoT maT, Tu
fsiqikuri statusi, warsulis gamocdileba da
ra mniSvneloba aqvs daavadebis mimdinareobisa da
ojaxis moTxovnileba. fsiqiatri mzad unda iyos
gamosavlisTvis medikamentebsa da fsiqosocialur
nebismieri sakiTxis ganxilvisTvis. pacientisa
faqtorebs (ojaxuri garemo, nivTierebaTa avad
da misi axloblebis CarTva Sizofreniis marTvis
moxmareba). aseve, aucilebelia antifsiqozuri
ganuyofeli nawilia. danamdvilebiT SeiZleba iTqvas,
mkurnalobis dadebiTi da gverdiTi efeqtebis
rom WeSmariti Terapiuli aliansis damyareba da misi
ganxilva. kargia, Tu visaubrebT Sizofreniis
SenarCuneba zrdis imis albaTobas, rom pacienti
etiologiazec, raTa Tavidan aviciloT daavadebis
gaagrZelebs kontaqts fsiqiatriul servisebTan,
araswori interpretaciiT gamowveuli braleulobis
daicavs mkurnalobis reJims da, yovelive amis
gancda. magaliTad, zogierTi mSobeli ganicdis, rom
Sedegad, daavadebis prognozi gaumjobesdeba.
daavadeba misi araswori qceviTaa gamowveuli da mas
Semdeg, rac gaigebs, rom aseTi fiqris safuZveli ar
arsebobs, Tavisufldeba danaSaulis gancdis mZime
tvirTisgan. gamomdinare iqidan, rom Sizofrenias damatebiTi literatura
memkvidruli xasiaTi aqvs, SeiZleba amasTan da Bleuler, E (1911) Dementia praecox or the group of schizophre-
kavSirebiT bevri kiTxva gaCndes. kompetenturi nias (English edition 1950). International University Press,
pasuxis gasacemad SegiZliaT gamoiyenoT cxrili 12.9. New York.
miuTiTeT gazrdil riskze da iqve aRniSneT, rom
Kraepelin, E (1919) Dementia praecox and paraphrenia.
janmrTeli naTesavebi kargad iqnebian. miuxedavad
Churchill Livingstone, Edinburgh.
micemuli axsna-ganmartebebisa, unda gvaxsovdes, rom
pacientis ojaxis wevrebi Sizofrenias samedicino Hirsch SR, Weinberger D (2003) Schizophrenia, 2nd edn.
personalisagan gansxvavebulad aRiqvamen da maT am Blackwell Scientific, Oxford. (ganaxlebuli rekomenda-
damokidebulebas pativi unda vceT. ciebi Sizofreniis yvela aspeqtze)
_ 325 _
Tavi 13 paranoiduli
simptomebi da bodviTi aSliloba
Tavis Sinaarsi
dasmas, aramed misi winapirobaa (rogorc es xdeba stu-
paranoiduli simptomebi
poris an depersonalizaciis dadgenis SemTxvevaSi).
paranoiduli simptomebis
paranoiduli sindromebi mniSvnelovan problemebs
gamomwvevi mizezebi
qmnis klasifikaciisa da diagnostikis TvalsazrisiT,
romelTa nawilobrivi daZleva maTi or gansxvavebul
paranoiduli simptomebi fsiqikuri
jgufSi ganTavsebiTaa SesaZlebeli:
aSlilobebis dros
1. paranoiduli simptomebi, romlebic warmoadge-
bodviTi aSlilobebi (paranoiduli fsiqozi)
nen sxva fsiqikuri aSlilobis Semadgenel nawils
bodviTi aSlilobebis klasifikacia
(mag., iseTi daavadebebis, rogorebicaa Sizofrenia,
bodviTi aSlilobebis epidemiologia
guneb-ganwyobis aSliloba an organuli fsiqikuri
bodviTi aSlilobis etiologia
aSliloba).
specifikuri bodviTi aSlilobebi
paTologiuri eWvianoba 2. paranoiduli simptomebi, romlebic Tavs iCenen ma-
erotomania da siyvarulis bodva Sin, rodesac ar aRiniSneba safuZvlad mdebare dar-
somaturi bodviTi aSliloba Rveva. aSlilobaTa es jgufi sxvadasxva saxeliT aris
kverulanturi bodva da cnobili. Cveulebriv mas paranoidul mdgomareobas
reformistuli bodva an paranoidul fsiqozs uwodeben. Tumca, diagnos-
mcdari identifikaciis tikuri da statistikuri saxelmZRvanelos IV gamo-
bodviTi sindromi cemis (DSM-IV) da daavadebebis meaTe saerTaSoriso
inducirebuli bodva klasifikaciis (ICD-10) mixedviT, isini klasificire-
paranoiduli simptomebis gamokvleva bulia, rogorc bodviTi aSliloba. es meore jgufi
paranoiduli simptomebis mkurnaloba terminologiuri TvalsazrisiT gamudmebul siZne-
zogadi principebi leebs warmoqmnis, SizofreniasTan mimarTebaSi da
fsiqologiuri mkurnaloba sasamarTlos mier ganaCenis gamotanisas.
medikamenturi mkurnaloba es Tavi iwyeba gavrcelebuli paranoiduli simp-
tomebis ganmartebiT, ris Semdegac maTi gamomwvevi
termini paranoiduli SeiZleba gamoviyenoT simpto- mizezebia ganxiluli. Semdeg modis paranoiduli pi-
mebis, sindromebisa da pirovnebis tipebis mimarT. rovnebis mokle aRwera, rasac Tan axlavs im ZiriTa-
paranoiduli simptomebi warmoadgens zeRirebulo- di fsiqikuri aSlilobebis ganxilva, romlebTanac
van ideebs an bodvas, romelsac Cveulebriv (magram Cveulebriv asocirdeba paranoiduli simptomebi da
ara yovelTvis) devnis Sinaarsi aqvs (boqsi 1.2, gv. ??). amgvari aSlilobebis gamijvna bodviTi aSlilobebis-
paranoiduli sindromis mniSvnelovani nawili speci- gan. aseve, ganxilulia bodviTi aSlilobebis zogadi
fikuri paranoiduli bodviTaa warmodgenili (mag., maxasiaTeblebi da maTi ZiriTadi qvetipebi. aqve moce-
paTologiuri eWvianoba an erotomania). paranoiduli mulia paranoiasa da parafreniis istoriuli perspeq-
pirovnuli aSlilobis dros, adamiani gadaWarbebu- tiva. mocemuli Tavi mTavrdeba paranoiduli simpto-
lad ukavSirebs sakuTar Tavs nebismier movlenasa Tu mebis mqone pacientebis gamokvlevasa da mkurnalo-
faqts da realuri an warmosaxviTi Seuracxyofis an basTan dakavSirebuli sakiTxebis SejamebiT.
ukmexi uaris miRebis mimarT Seusabamo mgrZnobelobas
iCens. yovelive zemoT Tqmuli xSirad gvxvdeba saku- paranoiduli simptomebi
Tari TavisTvis gadaWarbebuli mniSvnelobis miniWe-
rogorc zemoT iyo aRniSnuli, yvelaze ufro gavr-
basTan da agresiulobasTan erTad. amgvarad, termi-
celebuli paranoiduli bodva devniTi Sinaarsisaa.
ni paranoiduli aRweriTi xasiaTisaa. paranoiduli
termini paranoiduli aseve ixmareba ufro naklebad
sindromis an simptomis dadgena ar niSnavs diagnozis
gavrcelebuli gandidebisa da eWvianobis bodvasTan
_ 326 _
paranoiduli simptomebi
dakavSirebiT. xadaxan am termins agreTve siyvarul-
boqsi 13.1 zogierTi paranoiduli sindromi
Tan, sasamarTlo davas an religiasTan dakavSirebul
bodvasTan dakavSirebiTac iyeneben. Tumca, aseTi gan- damokidebulebis ideebi aqvT adamianebs, romelTac
gazviadebuli `me~-s cnobiereba axasiaTebT. subieqti
sxvavebuli saxis bodvebis erT jgufSi gaerTianeba ver Tavisufldeba im SegrZnebisgan, rom adamianebi
SeiZleba damabnevlad mogveCvenos, amas Tavisi mize- mas yuradRebas aqceven avtobusSi, restoranSi an sxva
zi aqvs. anomalia, romelsac ZiriTadad termini pa- sazogadoebriv adgilebSi da akvirdebian imas, rac mas
ar unda, rom sxvam dainaxos. pirovneba acnobierebs, rom
ranoiduli gulisxmobs, warmoadgens im rwmenisa da es gancda misgan momdinareobs da rom is sxvebze ufro
damokidebulebis avadmyofur deformacias, romelic metad ar imyofeba yuradRebis centrSi. miuxedavad
pirovnebasa da sxva adamianebs Soris urTierTobebs amisa, is mainc ver Tavisufldeba realobasTan Seusabamo
amgvari gancdebisagan.
exeba. Tu adamians SecdomiT an usafuZvlod sjera,
rom is msxverplia, sxvaze aRmatebulia, motyuebulia damokidebulebis bodva damokidebulebis ideebis ufro
kargad damuSavebul variants warmoadgens, rodesac es
an romeliRac gamoCenil adamians uyvars, TiToeul am
ideebi TavianTi intensivobiT iseT xarisxsa da masStabs
SemTxvevaSi is sxva adamianebTan urTierTobebs avad- aRwevs, rom bodvaSi gadadis. subieqts hgonia, rom mTeli
myofuri deformaciis gziT agebs. samezoblo masze Woraobs an, rom mediaSi gakeTebuli
gancxadeba mas exeba. man SeiZleba radioSi gaigonos iseT
paranoiduli simptomis saxeebi pirvel TavSi iyo
Temaze saubari, romelzedac swored axlaxan fiqrobda.
ganxiluli, magram maTi mniSvnelovani tipebi naCvene- mas, aseve, SeiZleba egonos, rom uTvalTvaleben an
bia aseve boqsSi 13.1. ganmartebebi `statusis gamokv- mis saubars iweren. damokidebulebis bodvisa da
levis~ (Present State Examination) terminologiuri leq- damokidebulebis ideebis gansxvaveba mniSvnelovania,
radgan pirveli fsiqozis simptoms warmoadgens.
sikonidanaa aRebuli (Wing et al., 1974).
devnis bodvis arsebobisas pirovnebas sjera, rom adamiani,
organizacia an raime Zala cdilobs, moklas igi, an
paranoiduli simptomebis gamomwvevi raime sxva saxiT avnos mas, an mis reputacias. simptomma
mizezebi SeiZleba mravalgvari forma miiRos: dawyebuli rwmeniT,
rom garkveul adamianTa jgufs misi xelSi Cagdeba surs,
rodesac paranoiduli simptomebi Tavs iCens, rogorc damTavrebuli gaurkveveli, ucnauri an warmoudgeneli
sxva fsiqiatriuli aSlilobis Semadgeneli nawili, SeTqmulebiT, romelsac mis winaaRmdeg awyoben.
mTavari etiologiuri faqtorebi is faqtorebia, rom- gandidebis bodva SeiZleba or jgufad daiyos: unarebTan
lebic pirvelad daavadebas gansazRvraven. miuxedavad dakavSirebuli gandidebis bodva da identurobasTan
amisa, kvlavac dgas sakiTxi imis Sesaxeb, Tu ratom uy- dakavSirebuli gandidebis bodva. pirvel SemTxvevaSi
subieqti fiqrobs, rom is Tavisi araCveulebrivi
alibdeba zog adamians paranoiduli simptomebi, zogs
niWierebis gamo raRac Zalis an bedis mier gansakuTrebuli
ki _ ara. am kiTxvaze pasuxis gasacemad, Cveulebriv, miznisTvis aris arCeuli. man SeiZleba ifiqros, rom
premorbiduli pirovnuli Tvisebebisa da socialuri sxva adamianebis azrebis kiTxva SeuZlia, rom sxvebze
ufro Wkviania an, rom misi gamogoneba an maTematikuri
izolaciis cnebebs iSvelieben.
problemis miseuli gadawyveta imdenad genialuria, rom
adamianebis umetesobas misi gageba ar SeuZlia.
premorbiduli pirovnuli Tvisebebi
subieqti, romelsac identurobasTan dakavSirebuli
mravali avtori, krepelinis CaTvliT, miiCnevs, rom bodva axasiaTebs, darwmunebulia, rom saxelganTqmul,
paranoiduli simptomebi ufro metad Tavs iCens iseT mdidar an gamoCenil adamianTa ricxvs miekuTvneba. mas
SeiZleba sjerodes, rom is bavSvobaSi ipoves, xolo
pacientebTan, romelTac paranoiduli tipis premor- sinamdvileSi ki samefo ojaxis warmomadgenelia.
biduli pirovnuli Tvisebebi aqvT (ix. Semdegi qveTa-
vi). kreCmeric Tvlida (Kretschmer, 1927), rom aseT da axdens maT proeqcias gare samyaroze. froidi,
adamianebs uviTardebaT damokidebulebis sensiti- aseve, miiCnevda, rom paranoiduli simptomebi Sei-
uri bodva (sensitive Beziehungswahn), rogorc gasagebi Zleba aRmocendes maSin, rodesac uaryofa da proeq-
fsiqologiuri reaqcia winmswreb, biZgis mimcem mov- cia gamoiyeneba, rogorc aracnobieri homoseqsual-
lenaze. e.w gvian aRmocenebuli parafreniis Taname- uri tendenciebisgan dacvis meqanizmi. es daskvna man
drove kvlevebi adasturebs aseT Sexedulebas (ix. bo- gamoitana daniel Sreberis, drezdenis saapelacio
qsi 3.2). qeim da roTma (Kay, Roth, 1961) aRmoaCines, rom sasamarTlos mTavari mosamarTlis, SemTxvevis Seswav-
99 cdis piridan, romlebTanac parafreniam cxovrebis lis safuZvelze (Freud, 1911). froidi arasodes Sexve-
gviandel periodSi iCina Tavi, naxevarze meti para- dria Srebers, magram mas wakiTxuli hqonda misi av-
noiduli an hipersensitiuri pirovneba iyo. tobiografiuli mogonebebi, romelSic is Tavis para-
froidi (Freud, 1911) varaudobda, rom Sesabamisi noidul daavadebas aRwers (amJamad mas paranoidul
midrekilebis mqone adamianebSi paranoiduli simp- Sizofrenias uwodeben). garda amisa, froidi gaecno
tomebi SeiZleba aRmocendes uaryofisa da proeqci- misi eqimis, veberis, Canawerebs. froidi fiqrobda,
is dacviTi meqanizmebis meSveobiT. is Tvlida, rom rom Sreberi cnobierad ar uSvebda Tavis homoseqsua-
pirovneba cnobierad ar aRiarebs sakuTar arasru- lobas da amitom azri _ `me is miyvars~ (mamakacs exeba)
lyofilebasa da undoblobas sakuTari Tavis mimarT uaryo da Caanacvla reaqciis formirebiT, romelic
_ 327 _
13 paranoiduli simptomebi da bodviTi aSliloba
Camoyalibda, rogorc `me is mZuls~, rac SemdgomSi w eWvianoba.
proeqciis meSveobiT Seicvala azriT _ `me ki ar mZuls w midrekileba arasworad ganmartos sxvaTa qmedebebi,
is, aramed mas vZulvar me~, xolo es ukanaskneli, Ta- rogorc mis mimarT mtruli da damamcirebeli.
vis mxriv, gardaiqmna azrad _ `me is mdevnis~. froids
w agresiuloba da piradi uflebebis araswori gageba.
sjeroda, rom nebismieri paranoiduli bodva SeiZleba
reprezentirebuli iyos, rogorc winaaRmdegobis Sem- es gansazRvreba sxvadasxva tipis adamians miesadageba:
cveli idea _ `me (mamakacs) miyvars is (mamakaci)~. is dawyebuli metismetad mgrZnobiare axalgazrdaTi, ro-
imdenad Sors wavida, rom amtkicebda, rom eWvianobis melic gaurbis socialur kontaqtebs da fiqrobs, rom
bodva SeiZleba aracnobieri homoseqsualizmiT aix- yvela mas akritikebs, damTavrebuli sakuTar TavSi dar-
snas. eWvian qmars aracnobierad izidavs is mamakaci, wmunebuli da momTxovni qaliT, romelTanac sul mcire
romlis siyvarulSic is Tavis cols adanaSaulebs. provocirebac afeTqebas iwvevs. amerikaSi axlaxan Cat-
aseT SemTxvevaSi gvaqvs Semdegi formulireba: `me ki arebulma gamokvlevebma aCvena, rom 4.4%-s aReniSneba
ar miyvars is (mamakaci), aramed Cems cols~. erT dros paranoiduli pirovnuli aSliloba DCM-IV-is mixedviT.
froidis es ideebi farTod iyo gavrcelebuli, magram es monacemi wina wlebis monacemebTan SedarebiT ufro
dResdReobiT naklebadaa miRebuli, radgan ar das- maRalia. gamokvlevebma aseve aCvena, rom am aSlilobas
turdeba klinikuri monacemebiT. mniSvnelovani zegavlena aqvs socialuri da roluri
funqciebis ganxorcielebaze (Grant et al., 2004).
socialuri izolacia da siyrue mkurnalobis TvalsazrisiT, mniSvnelovania, erTma-
socialuri izolacia aseve xels uwyobs paranoiduli neTisgan ganvasxvaoT paranoiduli pirovnuli aSli-
simptomebis aRmocenebas. patimrebi (gansakuTrebiT isi- loba da paranoiduli sindromebi (bodviTi aSlilo-
ni, romlebic calke sakanSi imyofebian), ltolvilebi da bebi), romlebic mogvianebiT iqneba aRwerili. gan-
migrantebi, paranoiduli simptomebisa da sindromebi- sxvavebis danaxva SeiZleba Zalze rTuli aRmoCndes.
saken midrekil pirebad ganixilebian, romlebTanac mTa- diferenciacia efuZneba im faqts, rom paranoiduli
var faqtors socialuri izolacia warmoadgens. migra- pirovnuli aSlilobis dros ar aris bodva da halu-
ciasTan dakavSirebuli monacemebi da maTi interpreta- cinaciebi (saxezea mxolod zeRirebuli ideebi).
cia meTormete TavSia ganxiluli (gv. ??). paranoiduli ideebis bodvisgan gamocalkeveba sak-
faqtia, rom siyrue zrdis paranoiduli simptomebis maod kargad ganviTarebul profesiul unar-Cvevebs
risks (rogorc es Tavdapirvelad krepelinma aRniSna) moiTxovs. saWiro kriteriumebi, romlebic gansx-
da, Cveulebriv, miewereba socialur izolacias, ro- vavebis dadgenaSi gvexmareba, pirvel TavSia moce-
melic siyruiT aris gamowveuli. houstonma da roisma muli, xolo boqsSi 13.1 magaliTis saxiT naCvenebia,
(Houston and Royse 1954) daadgines kavSiri siyruesa da Tu ra gansxvavebaa damokidebulebis bodvasa da
paranoidul Sizofrenias Soris. xolo qeim da roTma damokidebulebis ideebs Soris. es ori mdgomareoba,
(Kay and Roth, 1961) daafiqsires smenis daqveiTeba im faqtiurad, raodenobrivad gansxvavdeba erTmaneTis-
pacientebis 40%-Tan, romlebic daavaddnen parafre- gan. mag., ojaxebis Seswavlam uCvena, rom paranoidul
niiT cxovrebis gviandel periodSi. pirovnul aSlilobasa da bodviT aSlilobas Soris
ufro gviandeli gamokvlevebi adasturebs, rom genetikuri kavSiri arsebobs, xolo paranoiduli
smenis daqveiTeba warmoadgens risk-faqtors iseTi pirovnuli Tvisebebis mqone adamianebi bodviTi aSli-
aSlilobebisTvis, romelTa drosac paranoiduli lobis Camoyalibebis ufro maRali riskis qveS imy-
simptomebi aRiniSneba da es kavSiri xandazmul ada- ofebian (filosofosis _ Jan Jak rusos da diqtato-
mianebTan ufro TvalsaCinoa (David et al., 1995; Prager ris _ ioseb stalinis magaliTi). (Hachinski, 1999).
and Jeste, 1993). miuxedavad amisa, unda gvaxsovdes, rom
smenadaqveiTebuli adamianebis udidesi nawili ar paranoiduli simptomebi fsiqikuri
aris paranoiiT daavadebuli da bevri maTgani SeiZle- aSlilobebis dros
ba socialur izolaciaSi ar imyofebodes.
paranoiduli simptomebi xSirad meoradi xasiaTisaa
ZiriTadi anu pirveladi fsiqikuri aSlilobis mimarT.
paranoiduli pirovnuli aSliloba amdenad, paranoiduli simptomebis, gansakuTrebiT
pirovnuli aSlilobis cneba ganxilulia meSvide ki devnis bodvis gamovlenis Semdeg, mniSvnelovania
TavSi. am TavSi paranoiduli pirovnuli aSlilobis aSlilobis sxva maxasiaTeblebis gamokvlevac. bod-
mokle aRweraa mocemuli. am daavadebis mqone pirebi- viTi aSlilobis diagnostika, romelic qvemoT iqneba
sTvis damaxasiaTeblia: ganxiluli, ase vTqvaT, `narCeni~ kategoriaa da im pa-
w ukiduresi mgrZnobeloba marcxisa da uxeSi, ugul- cientebis mimarT gamoiyeneba, romelTa bodvis mikuT-
vebelmyofeli damokidebulebis mimarT. vnebac ver xerxdeba romelime kategoriisTvis. ramde-
_ 328 _
paranoiduli simptomebi fsiqikuri aSlilobebis dros
nadac pirveladi aSlilobebi momdevno TavebSi iqneba romlis drosac aseTi devna Zlier aRSfoTebas iwvevs.
aRwerili, aq maT mxolod mokled SevexebiT. paranoiduli simptomebi gvxvdeba aseve maniis dros
da Seesabameba pacientis guneb-ganwyobas. aqedan gamom-
paranoiduli simptomebi deliriumisa da
dinare, maT gandidebis Sinaarsi aqvT da ara devnisa.
demenciis dros
paranoiduli simptomebi Cveulebrivi movlenaa de- paranoiduli simptomebi da paranoiduli
liriumis dros. pacients darRveuli aqvs garemoSi Sizofrenia
garkvevis unari, rac iwvevs daZabulobas, movlenebis paranoiduli Sizofrenia meTormete TavSi iyo aR-
mcdar interpretacias, da, Sesabamisad, undoblobas. werili. misi gansxvaveba bodviTi aSlilobebisgan gan-
aseT SemTxvevaSi SeiZleba aRiniSnebodes bodva, ro- sakuTrebiT problematuria rogorc konceptualuri,
melic, Cveulebriv, xanmokle da araorganizebulia. aseve praqtikuli TvalsazrisiT (ix. boqsi 13.2). magram
aman SesaZloa, migviyvanos iseT qceviT aSlilobam- amaSi gvexmareba im ZiriTad maxasiaTeblebze miTiTe-
de, rogoricaa agresia. analogiurad, devnis bodva ba, romlebic gansxvavebulia am ori daavadebisTvis
Cveulebriv Tavs iCens demenciis zogierT stadiaze (SeadareT erTmaneTs cxrilebi 12.6 da 13.1). qvemoT
da zogjer mis ZiriTad maxasiaTebels warmoadgens. mocemulia sami maxasiaTebeli, romlebic dagvexmareba,
paranoiduli simptomebisa da mdgomareobebis gamom- davadginoT gansxvaveba saorWofo SemTxvevebis dros.
wvevi organuli mizezebi ganxiluli aqvT gormansa da w paranoiduli Sizofreniis diagnozis dasma savarau-
kamings (Gorman and Cummings, 1990). doa maSin (ufro, vidre bodviTi darRvevis), rode-
sac paranoiduli bodva gansakuTrebiT ucnauria
nivTierebebis borotad gamoyenebiT gamowveuli
aSlilobis paranoiduli simptomebi Sinaarsis TvalsazrisiT (fsiqiatrebi mas xSirad uc-
naur bodvas uwodeben. gansakuTrebuli SemTxvevebis
paranoiduli simptomebi vlindeba nivTierebebis
garda, daskvna imisa, Tu ramdenad ucnauria esa Tu
borotad gamoyenebiT gamowveuli mravali aSlilobis
is bodva, TviTneburi iqneba (Flaum et al., 1991). diag-
dros, gansakuTrebiT amfetaminis, kokainis an alko-
nostikuri da statistikuri saxelmZRvanelos IV ga-
holis moxmarebisas. mniSvnelovania kavSiri, romelic
mocemaSi mocemuli ganmartebis mixedviT, ucnauro-
alkoholis borotad gamoyenebasa da avadmyofur eW-
bis elfers moklebuli bodva exeba iseT situaciebs,
vianobas Soris SeiniSneba (aRwerilia qvemoT). zogi-
romlebic SeiZleba namdvilad arsebuliyo realur
erTma Terapiuli daniSnulebis mqone preparatma, mag.
cxovrebaSi. mag., pirovnebas, SesaZloa, realurad
levodopam, SeiZleba agreTve misces biZgi paranoidu-
devnidnen, wamlavdnen an Soridan etrfodnen. daa-
li simptomebs aRmocenebas (Gorman and Cummings 1990).
vadebebis me-10-e saerTaSoriso klasifikacia ugule-
paranoiduli simptomebi guneb-ganwyobis belyofs am kriteriums, iTvliswinebs ra ùcnauro-
aSlilobis dros bis~ gansazRvrebasTan dakavSirebul sirTules.
paranoiduli simptomebi gavrcelebulia pacientebSi, w Sizofreniis dros bodva ufro fragmentuli da
romlebsac mZime depresiuli aSliloba aqvT, xolo, mravalobiTi Sinaarsisaa, xolo bodviTi aSlilobi-
paranoiduli bodva fsiqozuri depresiis maxasiaTeb- sas is sistematizebuli da monoTematuria. agreTve,
els warmoadgens. bodviTi aSlilobis dros bodviTi sistema, Cveu-
xandaxan Zneli dasadgenia, paranoiduli simptomebi lebriv, isea inkafsulirebuli, rom danarCeni
meoradia depresiuli aSlilobis mimarT, Tu, piriqiT, fsiqikuri aqtivoba (Sizofreniisgan gansxvavebiT),
win uswrebs depresiul aSlilobas. orive SemTxveva savsebiT normalurad gamoiyureba.
sakmaod gavrcelebulia, Tumca, maT diferenciacias w paranoiduli Sizofreniis mqone pacientebs xSirad
garkveuli mniSvneloba aqvs, radgan aSlilobis es ori aqvT smeniTi halucinaciebi da maTi Sinaarsi, rogorc
tipi gansxvavdeba mkurnalobisa da prognozis Tval- Cans, ar aris pacientebis bodvasTan dakavSirebuli.
sazrisiT. depresiuli aSliloba mosalodnelia maSin, bodviTi aSlilobis dros halucinaciebis arseboba
rodesac mas win uswrebs guneb-ganwyobis cvlilebebi iSviaTia da, rodesac halucinaciebi iCens Tavs, isini
da am cvlilebebs ufro intensiuri xasiaTi aqvT, vidre droebiTia da aSkarad bodvasTanaa dakavSirebuli.
paranoidul maxasiaTeblebs. fsiqiatriuli daavade-
bebis adreulma istoriam da ojaxurma anamnezma Sei- paranoiduli simptomebi Sizofreniismagvari
Zleba sasargeblo informacia mogvawodos. da bolos, sindromebis dros
depresiuli aSlilobis dros pacienti, rogorc wesi, paranoiduli simptomebi zogierTi Sizofreniis
Tvlis, rom mas samarTlianad devnian Cadenili dana- magvari sindromebis maxasiaTeblebia da isini
Saulis an uzneobis gamo. klinikuri TvalsazrisiT, es meTormete TavSia ganxiluli (maTi CamonaTvali mo-
sasargeblo maxasiaTebelia, radganac amiT depresiu- cemulia 12.5 cxrilSi). isini moicaven DSM-IV-is kat-
li aSliloba gansxvavdeba ara-afeqturi fsiqozisgan, egoriebs _ `xanmokle fsiqozuri aSliloba~ da `Sizo-
_ 329 _
boqsi 13.2 istoriuli konteqsti: paranoia mimdinareobs, Tumca, gauareseba ar aris aucilebeli.
da parafrenia mniSvnelovania, rom paranoiis dros pacients ar
aReniSneba halucinaciebi.
terminebs _ paranoia da parafrenia, mniSvnelovani adgi- w parafrenia Sualeduri daavadebaa im gagebiT, rom am
li ukavia fsiqiatriul azrovnebaSi. maTTan dakavSirebu- dros pacients aReniSneba ganuwyveteli sistemuri bodva,
li konceptualuri siZneleebis ganxilva, udavod, zogadi magram is demenciaSi ar gadaizrdeba. paranoiisagan
sargeblobis momtania. ganmasxvavebeli mTavari niSania is, rom parafreniis
termins _ paranoia, romlisganac Tanamedrove zedsar- dros halucinaciebic aRiniSneba.
Tavi saxeli _ `paranoiduli~, warmoiqmna, xangrZlivi da naadrevi Wkuasustobis paranoiduli formis bleileriseuli
mravalmxrivi istoria aqvs. SeiZleba iTqvas, rom man gaci- gageba (romelsac man mogvianebiT paranoiduli Sizofrenia
lebiT meti kamaTi da azrTa sxvadasxvaoba gamoiwvia, vidre uwoda) ufro farToa krepelinis TvalsazrisTan SedarebiT
sxva terminebma, romlebic fsiqiatriaSi gamoiyeneba. lui- (Bleuler 1906, 1911). bleileri parafrenias ganixilavs ara
si (Lewis, 1970) gvTavazobs saTanado literaturis amomwu- rogorc calke arsebul mdgomareobas, aramed rogorc
rav mimoxilvas. es umeteswilad germanuli literaturaa, naadrevi Wkuasustobis Semadgenel nawils. Tumca, is
romelic ZiriTadad 1970 wlamdea Seqmnili (agreTve, ixi- eTanxmeba krepelinis Sexedulebas, rom paranoia calke
leT boqsi 1.2). sityva `paranoia~ berZnuli warmoSobisaa: daavadebaa, magram misgan gansxvavebiT Tvlis, rom am dros
para (gareSe) da nous (goneba). Zvel berZnul literaturaSi halucinaciebi xSirad aRiniSneba. bleileri gansakuTrebiT
igi `gonebis gadacdenis~, anu arajansaRi gonebis, sulieri dainteresebuli iyo paranoiis fsiqologiuri ganviTarebiT.
avadmyofobis mniSvnelobiT ixmareboda. am sityvis farTo man Riad datova kiTxva _ udevs Tu ara paranoias safuZvlad
mniSvnelobiT gamoyeneba aRadgines meTvramete saukune- somaturi paTologia.
Si; magram, rodesac mecxramete saukunis meore naxevarSi dRevandel dRes paranoiis ori xedvaa gabatonebuli.
germanul fsiqiatriaSi man gansakuTrebuli mniSvneloba pirvelis mixedviT paranoia gansxvavdeba Sizofreniisagan da
SeiZina, es termini uSualod daukavSirda mdgomareobas, Tavisi warmoSobiT fsiqogenur daavadebas warmoadgens. meore
romelic devnis da gandidebis bodvisaTvis aris damaxa- Sexedulebis Tanaxmad paranoia Sizofreniis Semadgeneli
siaTebeli. germanuli termini Verrucktheit xSirad gamoiye- nawilia. calkeuli SemTxvevis zogierTi gamokvleva pirvel
neboda aseTi mdgomareobebis aRsawerad, magram sabolood Sexedulebas adasturebs. magaliTad, gaupma (Gaupp, 1974)
is paranoiam Secvala. am aSlilobis Sesaxeb mravali Se- intensiurad gamoikvlia seriuli mkvlelis, vagneris,
xeduleba arsebobda. ZiriTadi sakiTxebi, romlebic dRe- dRiurebi da misi fsiqikuri mdgomareoba. vagnerma mokla
sac problemad rCeba, Semdegia: coli, oTxi Svili da kidev rva adamiani. es misi kargad
w warmoadgens Tu ara amgvari mdgomareoba pirvelad aSli- gaTvlili gegmis nawili iyo, raTa Suri eZia Tavis `mtrebze.
lobas, Tu is meoradia sxva aSlilobis mimarT? gaupma daaskvna, rom vagneri paranoiiT iyo daavadebuli
(am terminis krepeliniseuli gagebiT). amavdroulad mas
w ucvlelia Tu ara is wlebis manZilze, Tu mxolod avad-
sjeroda, rom vagners pirveli Camouyalibebeli bodva
myofobis ganviTarebis etapia, romlis Semdgom stadiaze
ganuviTarda, rogorc fsiqogenuri reaqcia. fsiqogenezisis
inteleqtisa da pirovnebis daqveiTeba vlindeba?
sasargeblod yvelaze ufro detaluri argumetebi
w aRmocendeba Tu ara halucinaciis gareSe? wamoayena kreCmerma (Kretschmer, 1927) Tavis monografiaSi
w arsebobs Tu ara am aSlilobis iseTi forma, romelsac Der Sensitive Beziehungswahn. kreCmers miaCnda, rom paranoia
kargi prognozi aqvs? unda ganxiluliyo ara rogorc daavadeba, aramed rogorc
kalbaumma es sakiTxebi jer kidev 1863 wels wamoWra, rodesac fsiqogenuri reaqcia, romelic Tavs iCens iseT adamianebSi,
man paranoia gamoyo, rogorc damoukidebeli pirveladi romlebic gansakuTrebuli mgrZnobelobiT gamoirCevian.
mdgomareoba, romelic ucvlelad narCundeba wlebis Tumca, dResdReobiT, kreCmeris mier aRwerili mravali
manZilze. krepelinma Zlieri zegavlena moaxdina paranoiis SemTxveva klasificirebulia, rogorc Sizofrenia. 1931 wels
cnebis Camoyalibebaze, Tumca mas ar akmayofilebda es kolem warmoadgina meore Tvalsazrisis mxardamWeri faqtebi,
termini da misi Sexeduleba amis Taobaze droTa ganmavlobaSi romelTa mixedviTac, paranoia Sizofreniis Semadgenel nawils
mniSvnelovnad icvleboda. 1896 wels is am termins iyenebda warmoadgens. man gaaanaliza 66 pacientisagan Semdgari jgufi,
mxolod ganukurnebeli, qronikuli da sistematuri bodvis romlis wevrebsac egreTwodebuli paranoia aReniSnebodaT
mniSvnelobiT, romelsac ar axlavs mZime pirovnuli (im pacientebis CaTvliT, romlebsac diagnozi krepelinma
aSliloba. Tavisi naSromis meeqvse gamocemaSi is wers: dausva). garkveuli mosazrebis gamo, romelic iTvaliswinebda
`bodva, romelic naadrevi Wkuasustobis [Sizofrenia] simptomatikasa da genetikur faqtorebs, kole mivida im
dros gvxvdeba, ukiduresad fantastikuria. is icvleba daskvnamde, rom paranoia realurad Sizofreniis msubuq
yovelgvari mizezis gareSe, usistemod da pacienti mas ver formas warmoadgens.
ukavSirebs Tavisi warsuli cxovrebis movlenebs; maSin, roca parafreniis Sesaxeb gacilebiT ufro cota ram aris
paranoiis dros bodva ZiriTadad Semoifargleba realuri dawerili. miuxedavad amisa, sainteresoa, rom maierma
movlenebis avadmyofuri interpretaciiT, rac erTmaneTSia (Mayer, 1921) Seiswavla 78 pacienti, romelTac, krepelinis
gadaxlarTuli da organizebul, arawinaaRmdegobriv klasifikaciis mixedviT, parafrenia aReniSnebodaT da
mTlianobas qmnis. bodva TandaTanobiT farTovdeba da axlad aRmoaCina, rom aqedan ormocdaaTs droTa ganmavlobaSi
momxdar movlenebsac moicavs. am movlenebis Seusabamobebsa Sizofrenia Camouyalibda. aseve, aRmoCnda, rom am 78
da mizezebs pirovneba Tavisebur axsnas uZebnis~. pacientis sawyisi klinikuri suraTi erTnairi iyo, Tumca
(Kraepelin 1904, p.199) zogierT maTgans SemdgomSi Sizofrenia Camouyalibda,
zogierTs ki ara. aqedan moyolebuli, parafrenia sul ufro
ufro gvian krepelini (Kraepelin, 1919) iyenebs iaspersis xSirad ganixileba, rogorc mogvianebiTi Sizofrenia an
(Jaspers, 1919) mier dadgenil gansxvavebas pirovnebis Sizofreniismagvari aSliloba, romelsac kargi prognozi
ganviTarebasa da daavadebis process Soris. is Tvlis, rom ukavSirdeba. qei da roTi (Kay and Roth, 1961) iyenebdnen
paranoia, rogorc daavadebis procesis magaliTi, gansxvavdeba termins _ `gviani parafrenia~ xandazmul adamianebSi
naadrevi Wkuasustobis ganviTarebis procesisagan. Tavis iseTi paranoiduli mdgomareobis aRsaniSnad, romelic
bolo naSromSi krepelini (Kraepelin, 1919) erTmaneTisagan ar iyo ganpirobebuli pirveladi organuli an afeqturi
ganasxvavebs naadrev Wkuasustobas, paranoias da mesame daavadebiT. am avtorebma daadgines, rom maTi pacientebis
paranoidul fsiqozs anu parafrenias. is varaudobda, rom: (99 pacienti) did umravlesobas SizofreniisaTvis
w naadrevi Wkuasustoba adreul asakSi iwyeba da savalalo damaxasiaTebeli niSan-Tvisebebi aReniSneboda.
Sedegi aqvs, radgan fsiqikuri mdgomareobis gauaresebiT Tanamedrove klasifikaciebSi termini `paranoia~,
mTavrdeba. is arsebiTad afeqturi da nebelobiTi faqtiuriad, Canacvlebulia, `bodviTi aSlilobiT~.
sferos paTologiiT xasiaTdeba termini `parafrenia~ aseve amoRebulia xmarebidan, magram
w paranoia gvxvdeba im pacientebTan, romlebTanac srulad klinicistebi dRemde iyeneben, raTa aRweron qronikuli,
sistematizirebuli bodva mogvianebiT iCens Tavs. paranoia atipiuri, paranoiduli fsiqozebi saSualo da xandazmuli
xangrZlivad, Cveulebriv, gamojanmrTelebis gareSe asakis pacientebSi.
_ 330 _
bodviTii aSlilobebis epidemiologia
freniformuli aSliloba~, xolo ICD-10-is mixedviT
ki, im kategoriebs, romlebic `mwvave da gardamavali cxrili 13.1 bodviTi aSlilobis kriteriumebi
DSM-IV-is mixedviT
fsiqozuri aSlilobebis~ jgufSia gaerTianebuli.
A. àra-ucnauri~ bodva gulisxmobs situaciebs, rom
lebic SeiZleba arsebobdes realur cxovrebaSi
bodviTi aSlilobebi (paranoiduli (mag., pirovnebis devna, mowamvla, inficireba,
fsiqozi) Soridan trfoba, meuRlis an partnioris Ralati
an avadmyofoba), romlebic, sul cota, erTi Tvis
rogorc am wignis SesavalSi ukve aRvniSneT, fsiqoze- ganmavlobaSi grZeldeba.
bTan dakavSirebuli terminologia da maTi klasifi-
B. Sizofreniis dros A kriteriumi arasodes gvxvdeba.
kacia (laparakia fsiqozebze, romlebic arc afeq-
SeniSvna: taqtilur da ynosviT halucinaciebs SeiZleba
turia da arc organuli) wlebis ganmavlobaSi davis SevxvdeT bodviTi aSlilobisas, Tu maT kavSiri aqvT
sgans waroadgens. boqsSi 13.2 Sejamebulia mTavari bodvis SinaarsTan.
tradiciuli terminebi da Temebi da am aSlilobebis C. garda im zemoqmedebisa, romelic gamowveulia
uaxlesi kategorizacia. am qveTavSi aRwerilia bod- bodviT an bodviT ganpirobebuli simptomatikiT,
funqcionireba ar aris SesamCnevad gauaresebuli da
viTi aSlilobebis ZiriTadi maxasiaTeblebi da moce-
qceva ar aris axirebuli an ucnauri.
mulia terminologia, romelic amJamad maT aRsawerad
D. Tu bodvis paralelurad aRiniSneba guneb-ganwyobis
gamoiyeneba. bodviTi aSlilobis konkretuli tipebi
aSlilobis epizodebi, maSin maTi saerTo xangrZlivoba
ganxilulia Semdeg TavSi. xanmoklea bodviT periodTan SedarebiT.
E. aseTi darRveva ar aris ganpirobebuli nivTierebebis

bodviTi aSlilobebis klasifikacia uSualo fiziologiuri zegavleniT (mag., fsiqoaqtiuri
nivTierebebis borotad gamoyeneba, medikamenturi
DSM-IV-Si termini bodviTi aSliloba gamoyenebulia mkurnaloba) an janmrTelobis zogadi mdgomareobiT.
myari, ara ucnauri bodvebis aRsawerad, romlebic
raime sxva darRveviT ar aris ganpirobebuli. `bod- garda, ar aris savaldebulo, rom bodva ar iyos ucn-
viTi aSliloba~ farTod gavrcelebuli terminis _ auri. ICD-10 agreTve Seicavs qvetipebs (modaveoba da
paranoiduli fsiqozis, sinonimia da, aseve, moicavs damokidebulebis bodva) da, aseve, calke qvekatego-
araspecifikur termins _ paranoiduli mdgomareobe- rias (F22.8), romelsac `sxva myari bodviTi aSlilo-
bi. ICD-10-Si mocemulia msgavsi kategoria, romelsac bebi~ ewodeba (ix. qvemoT).
myari bodviTi aSliloba ewodeba. bodviTi aSlilobis bodviTi aSlilobis Sesaxeb informaciis mosapove-
Tanamedrove koncefciis arsi imaSi mdgomareobs, rom blad ix. (Sedler, 1995) da (Munro, 2000).
stabiluri bodviTi sistema Suaxnisa da xanSiSesul
pirebTan SeumCnevlad yalibdeba, naTlad gamoxatuli bodviTi aSlilobebis
simptomebis gareSe. bodviTi sistema inkafsulirebu- epidemiologia
lia da sxva fsiqikuri funqciebi ar aris dazianeb-
bodviTi aSliloba ganixileba, rogorc iSviaTi aSli-
uli. xSir SemTxvevaSi, pacients SeuZlia, samsaxurSi
loba, Tumca amis Sesaxeb SedarebiT naklebi monace-
siaruli da misi socialuri cxovreba SeiZleba norm-
mebi arsebobs. rodesac koplendma da misma kolegebma
alurad mimdinareobdes.
(Copeland et al., 1998) Caatares gamokiTxva 5000 kacian
DSM-IV-Si mocemuli bodviTi aSlilobis kriteri-
jgufSi, romlis wevrebi 65 wlis an ufro asakovani
umebi Sejamebulia cxrilSi 13.1, romelSic aRwerilia
adamianebi iyvnen, aRmoCnda, rom maT 0.04%-s bodviTi
bodviTi aSlilobis xuTi konkretuli qvetipi da ori
aSliloba aReniSneboda. 10000 ambulatoriuli paci-
damatebiTi kategoria:
entis retrospeqtuli gamokvlevis Sedegad, 86 (0.83%)
w devnis pirovnebas dausves sxvadasxva saxis bodviTi aSlilo-
w eWvianobis bis diagnozi, romelic DSM-IV-Si mocemul krite-
w erotomaniis riumebs Seesabameba (Hsiao et al., 1999) (cxrili 13.2).
bodviTi aSliloba ondav ufro metad gavrcelebulia
w somaturi
qalebSi, vidre mamakacebSi. simptomebis aRmocenebis
w gandidebis
saSualo asaki 42 welia. fsiqiatriuli pacientebis
w Sereuli daaxloebiT 5 procenti, romlebic stacionarulad
w dauzustebeli (unspecified) mkurnalobdnen da funqciuri fsiqoziT iyvnen daa-
ICD-10 myari bodviTi aSlilobebis ZiriTadi kat- vadebulni, akmayofilebdnen bodviTi aSlilobis kri-
egoriis (F22.0) msgavs ganmartebas iZleva. DSM-IV-gan teriumebs (Kendler and Walsh, 1995).
gansxvavebiT, ICD-10-is mixedviT, simptomebi unda mkveTrad gamoxatuli depresiuli sindromebi Cveu-
aRiniSnebodes sul mcire sami Tvis manZilze. amas lebrivi movlenaa bodviTi aSlilobis dros (ix. cxri-
_ 331 _
li 13.1-is D kategoria). aseTi simptomebi Tavs iCens zogadad, rogorc Cans, sustia bodviTi aSlilobis
yovel mesame pacientTan (Hsiao, 1999; Serretti, 2004). genetikuri kavSiri erTis mxriv SizofreniasTan da,
meores mxriv, paranoidul pirovnul aSlilobasTan.
bodviTi aSlilobis etiologia miuxedavad amisa, am daavadebebs Soris arsebuli gene-
is mciredi, rac cnobilia bodviTi aSlilobis eti- tikuri gadafarvis xarisxi ar aris naTeli. avtoritet-
ologiis Sesaxeb, efuZneba mis kavSirs Sizofreniasa uli mkvlevarebis umravlesoba bodviT aSlilobas
da paranoidul pirovnul aSlilobasTan da mis Se- Sizofreniis Semadgenel nawilad miiCnevs (Kendler, 2003).
darebas am daavadebebTan. am sakiTxis Sesaswavlad ojaxuri fonis kvlevisas gamovlinda kavSiri alko-
gamoiyeneba ojaxuri anamnezi da neirobiologiuri holizmsa da bodviT aSlilobas Soris (Kendler and
gamokvleva. Catarebuli kvlevebi SerCevis simcirisa Walsh, 1995), ramac SeiZleba axsnas kavSiri avadmyo-
da gansxvavebuli diagnostikuri definiciebis gamo, fur eWvianobasa da alkoholis borotad gamoyenebas
mwiri daskvnebis gakeTebis saSualebas iZleva. bod- Soris (ix. qvemoT).
viTi aSlilobis fsiqologiuri axsna Tavad bodvazea
neirobiologiuri gamokvlevebi
mimarTuli da sxva adgilas iqneba moxseniebuli.
magnitur-rezonansuli tomografiis gamoyenebiT Cat-
bodviTi aSlilobis kvleva ojaxur konteqstSi arebuli Tavis tvinis struqturuli gamokvlevis
bodviTi aSlilobis mqone pacientis uaxloes naTe- Sedegebi gviCvenebs, rom bodviTi aSlilobis mqone
savebSi (mSoblebi, Svilebi, da-Zma) xSirad gvxvdeba xandazmul pacientebs, Sizofreniis mqone pacientebis
paranoiduli pirovnuli aSliloba (Kendler et al., 1985). msgavsad, gafarToebuli aqvT Tavis tvinis parkuWebi
naklebad naTelia ojaxuri kavSirebis roli bodviTi (Howard et al., ., 1995). am orive jgufis warmomadgenlebs
aSlilobisa da Sizofreniis urTierTmimarTebaSi. SeiZleba aReniSnebodeT msgavi anomalia Tvalis gay-
rogorc Cans, bodviTi aSlilobis riski SizofreniiT olebis amocanis Sesrulebisas. (Campana et al., 1998). zo-
daavadebuli pacientebis uaxloes naTesavebTan gaz- gierTi monacemebis mixeviT (romlebic urTierTgamom-
rdilia, magram, bodviTi aSlilobis mqone pacientebis ricxavia da savsebiT damajerebeli ar aris), bodviTi
naTesavebTan Sizofreniisa da Sizotipuri aSlilobis aSliloba SeiZleba dakavSirebuli iyos dofaminerguli
riski ar aris gazrdili (Kendler et al., 1995; Kendler genebis polimorfulobasTan (Morimoto et al., 2002).
and Walsh, 1995; Tienari et al., 2003). ojaxuri kavSirebis
amgvar paterns asimetriul koagregacias uwodeben da specifikuri bodviTi aSlilobebi
is SeiZleba mravali faqtoriT iyos ganpirobebuli: rogorc zemoT uvke aRvniSneT, bodviTi aSlilobis
w saerTo populaciaSi am ori tipis aSlilobis six- specifikuri qvetipebis dadgena xdeba upiratesi bod-
Siris gansxvavebuli xarisxi. vis Sinaarsis safuZvelze (cxrili 13.3). istoriulad,
w probandebTan da naTesavebTan diagnostikuri amgvari simptomebiT frangi fsiqiatrebi iyvnen dain-
cdomilebis xarisxis gansxvaveba. probandebs, Cveu- teresebulni. am sferoSi arsebuli klasifikacia dam-
lebriv, ufro intensiuri gamokvleva utardebaT. abnevelia ramdenime mizezis gamo:
w mZime daavadebebis ufro didi genetikuri datvirTva w zogierTi aSliloba xSirad moZvelebuli, epon-
im adamianebTan, romlebic klinicistebis yuradRebis imuri terminebiT aRiniSneba.
centrSi eqcevian (Sesabamisad, maTi matarebeli ada- w zogierTi sindromi SeiZleba ganixilebodes, ro-
mianebis Sefaseba probandebis msgavsad xdeba). gorc simptomi (mag., mcdari bodviTi identifika-
cia) an rogorc sxva fsiqikur aSlilobaze meora-
dad aRmocenebuli.
cxrili 13.2 bodviTi aSlilobis qvetipebi 86
Cinel ambulatorul pacientTan w yvela kategoria ar aris Setanili DSM-IV-is da
ICD-10-is klasifikaciebSi. miuxedavad amisa, moce-
devnis 61
mul wignSi isini mainc naxsenebia, radgan am kat-
Sereuli 12 egoriebs mudmivad iyeneben.
am qveTavSi Cven ganvixilavT devnasa da modaveo-
eWvianobis 7
bas, radgan orive qceva SeiZleba bodviTi aSlilobis
somaturi 2 Sedegi iyos.
erotomanuli 1
paTologiuri eWvianoba
gandidebis 1 am wignSi, upirveles yovlisa, yvelaze detalurad
dauzustebeli 1 aRwerilia avadmyofuri eWvianoba (sxva sinonimebi
_ 332 _
mocemulia 13.3 cxrilSi), radgan is arqetipuli bodviTi eWvianoba ar aris iSviaTi fsiqiatriul praqtikaSi da
aSlilobaa da garda `devnis bodviTi aSlilobisa, srul ganakveTze momuSave fsiqiatrebis umravlesoba
romelic sxvagvarad ar aris dazustebuli~, yvelaze albaT weliwadSi erT an or aseT SemTxvevas mainc
gavrcelebul formas warmoadgens. mniSvnelovani xvdeba. aseTi paTologia saguldagulo yuradRebas
isaa, rom igi safrTxis udidesi riskis matarebelia. moiTxovs ara mxolod imitom, rom uaRresad
arsebiTi maxasiaTebeli paTologiuri rwmenaa, rom amZimebs colqmrul da ojaxur urTierTobebs,
pacientis partniori moRalatea. am mdgomareobas aramed imitomac, rom SeiZleba Zalian did safrTxes
paTologiurs uwodeben, radgan aseTi rwmena Seicavdes.
(romelic bodvas an zeRirebul ideas SeiZleba rogorc Cans, paTologiuri eWvianoba ufro
warmoadgendes) araadekvatur safuZvels emyareba gavrcelebulia mamakacebSi, vidre qalebSi. mag.,
da masze racionaluri argumentebi ar moqmedebs. gamokiTxvebi gviCvenebs, rom paTologiuri eWvianobis
aseT rwmenas xSirad Tan sdevs Zlieri emociebi SemTxvevebi mamakacebSi orjer ufro xSirad
da damaxasiaTebeli qceva, magram es TavisTavad gvxvdeba. miuxedavad amisa, zusti Sefardebis dadgena
ar warmoadgens paTologiur eWvianobas. mamakacs, qalebsa da mamakacebs Soris imazea damokidebuli,
romelmac Tavis cols sayvarelTan Seuswro, SeiZleba Tu konkretulad romeli jgufi Seiswavleba da,
ukiduresad Zlieri eWvianobis grZnoba daeuflos da rac mTavaria, imaze, warmoadgens Tu ara eWvianoba
misi qcevac SesaZloa, umarTavi gaxdes, magram amas meorad movlenas sxva aSlilobasTan mimarTebaSi.
paTologiur eWvianobas ver davarqmevT. es termini mag., stacionaruli pacientebis retrospeqtuli
mxolod maSin unda gamoviyenoT, rodesac eWvianoba gamokiTxvisas soikam Tavis kolegebTan erTad (Soyka
dausabuTebel mtkicebulebebs da gansjas emyareba. et al., 1991) aRmoaCina, rom paranoiduli Sizofreniis
paTologiuri eWvianobis Sesaxeb informaciis mqone pacientebis SemTxvevaSi eWvianobis bodva
mTavari wyaroa Seperdis klasikuri naSromi (Shepherd, umetesad qalebs axasiaTebT, xolo alkoholuri
1961), langfeldtis mier Catarebuli gamokiTxva fsiqozis dros eWvianobis bodva umetesad mamakacebs
(Langfeldt, 1968) da sxva naSromebi (Vaukhonen, 1985; uviTardebaT (im faqtis gaTvaliswinebiTac ki, rom
Mullen and Maack, 1985). Seperdma londonSi Seiswavla qalebTan ufro naklebad aRiniSneba alkoholuri
81 pacientis avadmyofobis istoria. igive gaakeTa fsiqozi).
langfeldtma norvegiaSi (66 pacienti). vaukhonenma
paTologiuri eWvianobis klinikuri
fineTSi 55 pacienti gamokiTxa, xolo mulenma da
maxasiaTeblebi
maakma Seiswavles 138 pacientis istoriis Canawerebi.
paTologiuri eWvianobis sixSire saerTo popu rogorc zemoT aRvniSneT, paTologiuri eWvianobis
laciaSi ucnobia, Tumca eWvianobis gancda sayovelTao arsebiTi maxasiaTebelia paTologiuri rwmena, rom
movlenaa (Mullen and Martin, 1994). paTologiuri partniori moRalatea. mas SeiZleba Tan sdevdes
sxva paTologiuri rwmena (mag., pacients sjera,
rom partniori mis winaaRmdeg SeTqmulebas awyobs,
cxrili 13.3 bodviTi aSlilobis tipebi
cdilobs mowamlos, arTmevs seqsualur potencias
tipi sinonimuria Semdeg aSlilobebTan/ an cdilobs misi veneriuli daavadebiT inficirebas).
sindromebTan an moicavs Semdeg
aSlilobebs/sindromebs
paTologiuri eWvianobis mqone pacientis guneb-
ganwyoba SeiZleba icvlebodes ZiriTadi aSlilobis
eWvianobis avadmyofuri eWvianoba; paTologiuri
eWvianoba; erotiuli xasiaTis eWvianoba;
mixedviT, magram xSirad is tanjvis, undoblobis,
eWvianoba seqsualur niadagze; otelos gaRizianebisa da sibrazis nazavs warmoadgens.
sindromi. Cveulebriv, pacienti intensiurad eZebs partnioris
erotiuli erotomania; de klerambos sindromi Ralatis damamtkicebel sabuTs. mag., kiTxulobs
dRiurs, amowmebs TeTreulsa da sacvlebs sqesobrivi
somaturi monosimptomuri ipoqondriuli fsi
qozi; sxeulis dismorfuli bodviTi aqtis damadasturebeli niSnebis dasadgenad.
aSliloba pacientma SeiZleba uTvalTvalos partniors an
kverulanturi inducirebuli bodviTi aSliloba; fole kerZo deteqtivi daiqiraos. xSirad eWviani pirovneba
deux; Tanaziari SeSliloba ganuwyvetliv uwyobs partniors jvaredin dakiTxvas.
devnis mcdari identifikaciis bodviTi
aman SeiZleba pacienti Zalmomreobamde an Zlieri
sindromi; kapgras sindromi; fregolis brazis Setevamde miiyvanos. zogjer partniori
bodva; intermetamorfoza; aRSfoTebuli da qancgamoleulia da SesaZloa
gaziarebuli subieqturi oreulebis sindromi iZulebuli Seiqnas, àRiaros Tavisi danaSauli~. aseT
SemTxvevaSi pacientis eWvianoba Cacxrobis magivrad
sxva kidev ufro Zlierdeba.
_ 333 _
saintereso isaa, rom xSirad pacients warmodgena ar klinikurma gamokvlevebma ar daadastura kavSiri
aqvs imaze, Tu vin an rogori pirovneba SeiZleba iyos pomoseqsualizmsa da paTologiur eWvianobas Soris.
misi partnioris savaraudo sayvareli. ufro metic, aseve, mosazreba, rom paTologiuri eWvianoba zogjer
man SeiZleba Tavi aaridos iseTi nabijebis gadadgmas, SeiZleba mieweros seqsualuri xasiaTis problemebis
romlebic amas gamoaaSkaravebs. aRmocenebas, naklebad dadasturda (Langfeldt, 1961;
pirovnebis qceva SeiZleba TvalSi sacemad Shepherd, 1961).
paTologiuri iyos. mag., warmatebul biznesmens Tan
paTologiur eWvianobasTan dakavSirebuli
daaqvs portfeli, romelSic ara marto finansuri
prognozi
dokumentebi udevs, aramed iaraRic, raTa gauswordes
colis sayvarels, Tu mas sadme aRmoaCens. xelosans paTologiur eWvianobasTan dakavSirebuli prognozis
ise aqvs damontaJebuli Tavis saxlSi sarkeebis rTuli Sesaxeb cota ram aris cnobili. is SeiZleba damokide-
sistema, rom meore oTaxidan colis TvalTvali buli iyos mraval faqtorze, maT Soris ZiriTadi
SeuZlia. mesame pacienti cdilobs, SuqniSanze manqana fsiqikuri aSlilobis bunebaze da pacientis premor-
ar gaaCeros sxva manqanis gverdiT, raTa misma colma bidul pirovnul Tvisebebze. langfeldtma (Langfeldt,
meore manqanis mZRols paemani ar dauniSnos. 1961), romelic 17 wlis manZilze 27 pacientze at-
arebda Semdgom dakvirvebas, daadgina, rom maTgan
paTologiuri eWvianobis etiologia naxevarze mets kvlav aReniSneboda mudmivi (persis-
paTologiuri eWvianoba, iseve rogorc sxva tentuli) an perioduli eWvianoba. es adasturebs
paranoiduli simptomebi da sindromebi, mTel rig klinicistebis zogad mosazrebas imis Taobaze, rom
pirvelad aSlilobebTan aris dakavSirebuli (cxrili paTologiur eWvianobasTan dakavSirebuli prognozi
13.4). zemoT xsenebuli gamokiTxvebis mixedviT dad xSirad optimisturi ar aris.
genilia, rom sxvadasxva tipis aSlilobebi sxvadasxva
Zaladobis riski
sixSiriT gvxvdeba. miRebul Sedegebs, savaraudod,
sakvlevi populacia da gamoyenebuli diagnostikuri miuxedavad imisa, rom ar arsebobs Zaladobis riskis
sqema ganapirobebs. mag., paranoiduli Sizofrenia jerovani Sefaseba, aranair eWvs ar iwvevs is faqti,
dadgenilia pacientebis 17-44%-Tan, depresiuli aS rom paTologiuri eWvianobis mqone adamianebi SeiZle-
liloba _ 3-16%-Tan, pirovnuli aSliloba da nevrozi ba saSiSni iyvnen (Silva et al., ., 1998). Seperdis (Shep-
_ 38-57%-Tan, alkoholizmi _ 5-7%-Tan da organuli herd, 1961) jgufSi 81 pacientidan samma mkvlelobis
aSliloba _ 6-20%-Tan. tendencia gamoavlina. garda mkvlelobis momatebu-
paTologiuri eWvianobis genezSi xazgasasmelia li riskisa, angariSgasawevia aseTi pacientebis mier
pirovnuli maxasiaTeblebis roli. xSirad pacients, fizikuri Zaladobis riski. mulenisa da makis (Mullen
dabal TviTSefasebasTan erTad, axasiaTebs zogadi and Maack, 1985) jgufSi pacientebis meoTxedi imuqre-
arasrulfasovnebis gancda. mis ambiciebsa da mis boda, rom moklavda an fizikur zians miayenebda
miRwevebs Soris Seusabamobaa. aseTi pirovneba partniors. am pacientebidan mamakacebis 56%-ma da
gansakuTrebiT mowyvladia yvelafris mimarT, ramac qalebis 43%-ma an ukve Zaladoba ixmara warmosaxul
SeiZleba misi arasrulfasovnebis gancda gaaZlieros metoqeze an amis survils gamoTqvamda. Sanda (Schanda
(mag., statusis dakargva an sibere). rodesac adamiani et al., 2004), romelmac Seiswavla msjavrdebuli mkv-
aseTi saSiSroebis winaSe aRmoCndeba, man SeiZleba lelebi avstriaSi, amtkicebs, rom bodviTi aSliloba
sxva adamianze danaSaulis proeqcia moaxdinos, ramac (qvetipi ar aris gansazRvruli) dakavSirebulia mkvl-
SesaZloa RalatSi dadanaSaulebis paTologiuri elobasTan (SefardebiT 1:6). aseve, arsebobs suicidis
forma miiRos. rogorc ukve aRvniSneT, froidi Tvlida, riski, gansakuTrebiT maSin, rodesac pacientis mier
rom nebismieri saxis eWvianobis gancda aracnobieri braldebuli partniori sabolood gadawyvets urT-
homoseqsualuri xasiaTis ltolvis Semcvelia, magram ierTobebis gawyvetas.
paTologiuri eWvianobis gamokvleva

cxrili 13.4 paTologiur eWvianobasTan
dakavSirebuli aSlilobebi paTologiuri eWvianobis mqone pacientebis gamokvl-
eva gansakuTrebiT amomwuravi unda iyos da yovelT-
Sizofrenia
vis, rodesac ki es SesaZlebelia, unda CavrToT part-
guneb-ganwyobis aSliloba niori, romelsac interviu calke unda Cautardes.
organuli aSliloba partniorma SeiZleba bevrad ufro detalurad aR-
weros pacientis avadmyofuri azrebi da qmedebebi,
nivTierebebis (gansakuTrebiT alkoholis)
avadmoxmarebis Sedegad gamowveuli aSliloba vidre pacientma. eqimi taqtianad unda ecados imis
dadgenas, Tu ramdenad mtkiced aris darwmunebuli
pirovnebis paranoiduli aSliloba
_ 334 _
pacienti partnioris RalatSi, ramdenad aRSfoTebu- vti saSualebas aZlevs pacients (da mis partniors),
lia da xom ar aqvs ganzraxuli raime saxis SurisZieba. isaubros da imsjelos sakuTari gancdebis Sesaxeb,
man pasuxi unda gasces Semdeg kiTxvebs: ra faqtoreb- rasac gantvirTva moaqvs. bihevioristuli meTodebis
ma moaxdina braldebebisa da dakiTxvebis afeTqeba- gamoyenebiT partniors exmarebian, ganaxorcielos is-
amoxeTqvis provocireba? rogor reagirebs part- eTi qceva, romelic pacientis eWvianobas Seasustebs
niori amaze? rogor reagirebs pacienti, Tavis mxriv, (mag., uari Tqvas kamaTze, Tumca esec individualur
partnioris aseT qcevaze? xom ar ganuxorcielebia SemTxvevazea damokidebuli). erT-erTma gamokvlevam
aqamde pacients raime Zaladobrivi qceva? xom ar hqo- daadastura, rom kognituri Terapiis gamoyenebisas,
nia pacients raime saxis seriozuli zianis miyenebis romlis drosac pacients exmarebian, amoicnos Ta-
mcdeloba? visi mcdari azrebi da aswavlian emociebis marTvis
am kiTxvebis garda, eqimma, orive partniorisgan unda strategiebis gamoyenebas, ukeTesi rezultatebi mi-
moiZios colqmruli da seqsualuri cxovrebis deta- iReba, vidre sakontrolo jgufSi, sadac Terapia ar
luri istoria da gamoavlinos fsiqikuri aSliloba, Catarebula (Dolan and Bishay, 1996).
radganac es mkurnalobis process gansazRvravs. Tu pacientis ambulatoriul mkurnalobas Sedegi
ar moyveba an Tu maRalia Zaladobis gamovlenis ris-
paTologiuri eWvianobis mkurnaloba
ki, maSin SeiZleba aucilebeli gaxdes misi staciona-
paTologiuri eWvianobis, iseve rogorc sxva bodviTi ruli mkurnaloba. arcTu ise iSviaTad, pacientis md-
aSlilobis, mkurnaloba sakmaod calsaxaa (ZiriTadad gomareoba stacionarSi yofnisas umjobesdeba, magram
xdeba antifsiqozuri medikamentebis daniSnva), ma- gaweris Semdeg kvlav mosalodnelia recidivi.
gram praqtikaSi SeiZleba bevr sirTules wavawydeT, Tu eqimi daadgens Zaladobis riskis arsebobas, man
radganac pacienti SeiZleba insaitis naklebobas gan- amis Sesaxeb unda gaafrTxilos partniori maSinac
icdides da mkurnalobis dadgenil gegmas uxalisod ki, Tu es konfidencialurobis darRvevas moiTxovs
asrulebdes. (ix. meoTxe Tavi). zogierT SemTxvevaSi yvelaze ufro
upirveles yovlisa mkurnaloben paTologiur eW- usafrTxo proceduraa, vurCioT partniorebs urT-
vianobasTan dakavSirebul aSlilobas (mag. Sizofre- erTobis gawyveta. urTierTobis gawyvetis Semdeg
nias an guneb-ganwyobis afeqtur aSlilobas). alko- paTologiuri eWvianobis gancda xSirad sustdeba,
holis an sxva nivTierebebis arasworad gamoyenebis Tumca, zogjer problema kvlav iCens Tavs, rodesac
SemTxvevaSi, specialuri mkurnalobis Catareba iqneba pacienti axal urTierTobebs iwyebs.
saWiro. garkveul SemTxvevebSi paTologiuri eWvi-
anoba SeiZleba warmoadgendes bodviTi aSlilobis erotomania da siyvarulis bodva
simptoms an zeRirebulovan ideas iseT pacientTan,
erotikul bodvas SeiZleba SevxvdeT nebismieri fsiq-
romelsac dabali TviTSefaseba da pirovnuli sirTu-
ikuri aSlilobis dros, gansakuTrebiT paranoiduli
leebi axasiaTebs.
Sizofreniisas, magram is dominanturi da persisten-
maSin, rodesac eWvianoba Tavisi bunebiT bodviTi
tuli simptomia iseTi formis bodviTi aSlilobisT-
xasiaTisaa, rekomendebulia antifsiqoturi medika-
vis, romelsac erotomanias uwodeben. frangma fsiqi-
mentebis frTxili gamoyeneba, Tumca Sedegi xSirad
atrma _ de klerambom 1921 wels gamoTqva mosazreba,
damakmayofilebeli ar aris. rodesac eWvianoba zeRi-
rom unda movaxdinoT paranoiduli bodvisa da Cveu-
rebulovan ideas warmoadgens, SeiZleba sasargeblo
lebrivi vnebiT, siyvaruliT gamowveuli bodvis dife-
aRmoCndes serotoninis mitacebis seleqtiuri inhib-
renciacia. es ukanaskneli gansxvavebulia paTogenezis
itorebiT mkurnaloba (Stein et al., 1994). miuxedavad
mixedviT da mas Tan axlavs agzneba. es gansxvaveba mx-
amisa, jer-jerobiT araferia cnobili SemTxveviTi
olod istoriuli TvalsazrisiT aris saintereso, ma-
SerCevis meTodis gamoyenebiT Catarebuli kvlevis
gram mocemuli sindromi dResac klerambos sindro-
Sedegebis Sesaxeb. rogorc zemoT aRvniSneT, rode-
mis saxelwodebiTaa cnobili. igi iSviaTi movlenaa
sac depresiuli aSliloba pirvelad diagnozs ar war-
da ZiriTadad qalebTan gvxvdeba. Tumca, teilorma
moadgens, is xSirad amZimebs paTologiur eWvianobas
(Taylor et al., 1983) daafiqsira oTxi SemTxveva 112 ma-
da SeiZleba gaauaresos pacientis mdgomareoba. aseT
makacisgan Semdgar jgufSi, romlebsac ZaladobaSi
dros SesaZloa sasargeblo iyos antidepresantebiT
edebodaT brali.
mkurnaloba.
erotomaniis dros subieqts, Cveulebriv martoxela
fsiqoTerapiuli mkurnaloba rekomendebulia
qals, sjera, rom is keTilSobil pirovnebas uyvars.
iseT pacientebTan, romlebsac, eWvianoba, SesaZloa
es warmosaxviTi Seyvarebuli, Ceulebriv, miuwvdo-
pirovnul TvisebebTan dakavSirebuli problemebis
melia, radgan ukve coliania, an saxeganTqmuli msax-
Sedegad hqondeT aRmocenebuli. fsoqoTerapiis
iobia, an sazogado moRvawea. klerambos mixedviT
erT-erTi mizani daZabulobis Semcirebaa. Terape-
uzomod Seyvarebul qals sjera, rom warmosaxviT
_ 335 _
Seyvarebuls is pirvelad Tavad Seuyvarda da rom an erotikuli aSliloba, rac sxva fsiqozuri aSli-
mamakacis grZnoba mis mimarT ufro Zlieria, vidre lobis meorad movlenas warmoadgens. paTologiuri
misi am kacis mimarT. es rwmena mas kmayofilebisa da eWvianobis mqone pacientebi, agreTve, SeiZleba uT-
siamayis grZnobas uRvivebs. is darwmunebulia, rom valTvalebdnen TavianT msxverpls (Silva et al., 2000).
warmosaxviTi Seyvarebuli verasodes ver iqneba mis ufro xSirad mdevnelebi mosazRvre, narcisuli da
gareSe bednieri an srulyofili adamiani. sociopaTuri Tvisebebis matarebeli personologi-
pacients xSirad sjera, rom mis warmosaxvaSi ar- uri aSlilobis mqone pirebia. isini xSirad kontaqtSi
sebul Seyvarebuls ar SeuZlia gamoamJRavnos si- imyofebian TavianT msxverplTan. am saxis kontaqti
yvaruli mTeli rigi gaugebari mizezebis gamo, uWirs SeiZleba sakmaod zedapiruli iyos, zog SemTxvevaSi
masTan miaxloeba, arapirdapiri gziT esaubreba mas ki, odesRac seriozuli urTierTobis narCens war-
da iZulebulia, paradoqsulad da araadekvaturad moadgendes. Tu msxverplisa da mdevnelis urTierTo-
moiqces. qalma SeiZleba sakmaod didi uxerxuloba bas ojaxuri Zaladobis adreuli istoria aqvs, msxver-
Seuqmnas warmosaxviT Seyvarebuls, romelic SeiZleba pli Tavdasxmisa da dazianebis gansakuTrebiT maRali
iqamde mivides, rom mas policiaSi an sasamarTloSi riskis qveS imyofeba. miuxedavad imisa, moxdeba Tu
uCivlos. zogjer pacientis bodva uryevi rCeba da igi ara Tavdasxma realurad. msxverpli mudmivad ganic-
sxva adamianis paradoqsul qcevas axsnas uZebnis. is dis Zlier fsiqologiur stress, romelmac SeZleba
SeiZleba realobis mimarT ukiduresad jiuti da Seu- SfoTva, guneb-ganwyobis (afeqturi) aSliloba an po-
vali iyos. zogierTi pacienti siyvarulis bodvidan stravmuli stresuli aSliloba gamoiwvios (Kamphuis
devnis bodvaze gadadis, xdeba uxeSi da sazogadoe- and Emmelkamp, 2000; Mullen et al., 2000). agreTve ix.
baSi xmamaRla gamoTqvams ukamyofilebas `Seyvarebu- ocdameeqvse Tavi.
lis~ mimarT. es dinamika klerambos mier aRwerilia
ori fazis saxiT _ imedi, romelic mtruli damokide- somaturi bodviTi aSliloba
bulebiT icvleba. somaturi bodviTi aSlilobis mqone adamianebs
erotomaniis cneba ganxilulia Semdeg wyaroSi: Berrios sjeraT, rom raRac fizikuri daavadeba an defeqti
and Kennedy, 2002. aqvT. es termini moicavs monosimptomur ipoqon-
driul fsiqozs, romlis drosac am tipis mxolod
devna
erTi bodviTi idea aRiniSneba. somaturi bodviTi
pacientebis garkveul nawils, romelic devnas ax-
aSliloba unda ganvasxvaoT ipoqondriuli bodvis-
orcielebs, aqvT sxvadasxva bodviTi aSliloba, maT
gan, romelsac mZime depresiis da Sizofreniis dros
Soris erotomaniac. swored amitom es Tema aq aris
vxvdebiT; agreTve, sxeulis mZime dismorfuli aSli-
ganxiluli. devnis definiciasTan dakavSirebiT er-
lobisgan (mas aseve dismorfofobias uwodeben), rom-
Tiani, SeTanxmebuli azri ar arsebobs. gansazrRvre-
lis drosac zeRirebulovani ideebi SeiZleba bodvis
baTa umetesoba Semdeg elementebs Seicavs:
intensivobas miuaxlovdes. realurad, rogorc Cans,
w mabezari, intruziuli qcevis paterni. sxeulis dismorfuli aSlilobis bodviTi da ara-
w mabezari, intruziuli qceva dakavSirebulia aSkara bodviT formebis klinikuri suraTi erTmaneTis ms-
an dafarul muqarasTan. gavsia da mkurnalobis sqemac ar aris didad gansx-
w pirovneba, romelic devnis obieqtia, SiSisa da daZ- vavebuli (Phillips, 2004). somaturi bodviTi aSlilobis
abulobis qveS imyofeba. samkurnalod rekomendebulia specifikuri medikamen-
turi mkurnaloba, romelic qvemoT iqneba ganxiluli.
mdevneli, Cveulebriv, uTvalTvalebs Tavis msxver-
pls da misi saxlis an samsaxuris win usaqmod daxeti-
kverulanturi bodva da reformistuli
alobs. msxverplTan kontaqts telefonis, werilebis,
bodva
kedelze warwerebisa da, ukanasknel xans, eleqtro-
nuli fostis saSualebiT amyarebs. pacientis qcevam kverulanturi bodva (Krafft-Ebing, 1888) specialuri
droTa ganmavlobaSi SeiZleba ufro saSiSi forma mi- Seswavlis sgans warmoadgenda. am tipis bodvis mqone
iRos (msxverplis Sesaxeb iseTi gancxadebebis gakeTe- pacientebi mudmiv ukmayofilebas gamoTqvamen Tanam-
ba, romlebic realobas ar Seesabameba, misTvis raimes debobis mqone pirebis mimarT da mudmivad uCivian
davaleba, skandaluri Worebis gavrceleba, msxverp- maT. am tipis pacientebTan axlos dganan paranoid-
lis qonebis dazianeba, muqara da realuri Tavdasxma). uli momCivanebi, romlebsac ganuwyvetliv SeaqvT
mdevnelebi warmoadgenen heterogenul jgufs. maT, sasamarTloSi saCivari da uamravi saqmis mosmenaSi
Cveulebriv, sxvadasxva saxis fsoqopaTologia aR- iReben monawileobas. sasamarTlo procesis msvlelo-
eniSnebaT, rac safuZvlad udevs maT qcevas. zogierT bisas isini SeiZleba ukiduresad gacxardnen da dae-
maTgans, Cveulebriv qalebs, aReniSnebaT erotomania muqron mosamarTleebs. kverulanturi bodvis mqone
_ 336 _
pacientebisTvis damaxasiaTebeli Tvisebebi ganxilu- kapgras sindromi
li aqvT roulends (Rowlands, 1988) da lesters (Lester
miuxedavad imisa, rom qvemoT ganxiluli SemTxveva
et al., 2004).
adrec iyo aRwerili, is amJamad kapgras sindromis
baruks (Baruk, 1959) aRwerili aqvs `reformatoruli
saxeliTaa cnobili, radgan 1923 wels safuZvlianad
bodva~, romelic religiur, filosofiur an poli-
iqna aRwerili rebus da laSozis mier (Reboult _ Lachoz,
tikur Tematikazea koncentrirebuli. aseTi bodvis
1923). isini mas l~illusion des sosies (oreulebis iluzias)
mqone adamianebi mudmivad akritikeben sazogadoebas
uwodebdnen, Tumca es bodvaa da ara iluzia. aqedan
da zogjer dagegmil qmedebebsac axorcieleben. maTi
momdinareobs alternatiuli termini _ kapgras bodva.
qceva SeiZleba Zaladobrivic iyos, gansakuTrebiT
pacients sjera, rom misi axlobeli adamiani
maSin, rodesac bodvas politikuri xasiaTi aqvs. am
oreuliT aris Secvlili. is aRiarebs, rom arasworad
jgufs ganekuTvneba, aseve, zogierTi adamiani, ro-
identificirebuli pirovneba Zalin hgavs mis nacnobs,
melic politikur mkvlelobas sCadis. uaRresad
magram mainc darwmunebulia, rom es ori sxvadasxva
mniSvnelovania, rom am dros diagnozi daisvas fsiqi-
adamiania. es iSviaTi mdgomareobaa da ufro xSirad
atriul da ara politikur konteqstSi, rogorc es
mas qalebTan vxvdebiT. depersonalizacia, dereal-
sabWoTa kavSirSi xdeboda (ix. meore Tavi; Bloch and
izacia da dj vu gancda. yvelaze xSirad am dros
Chodoff, 1981).
Sizofreniis diagnozs svamen (Berson, 1983). arasworad
identificirebuli pirovneba, Cveulebriv, pacien-
mcdari identifikaciis bodviTi sindromi
tis partniori an naTesavia. kapgras sindromis mqone
bodvaTi aSlilobebis Semdegi jgufi moicavs aras- zogierTi pacienti SeiZleba agresiulad moiqces da
wori identifikaciis sxvadasxva aspeqtebs, romle- Tavs daesxas warmosaxviT oreuls. mocemuli sindro-
bic sakuTar Tavs an sxva adamianebs exeba. mas xSirad mi reduplicirebuli paramneziis magaliTs warmoad-
vxvdebiT sxva fsiqozuri aSlilobebis SemTxvevaSi, gens (Lishman, 1998). es sakiTxi agreTve sxva wyaroSi-
gansakuTrebiT _ Sizofreniisa da organuli aSli- caa ganxiluli (Edelstyn and Oyebode, 1999).
lobebis dros. Tumca, SeiZleba izolirebuladac aR-
mocendes da am SemTxvevaSi maT `mcdari identifika- fregolis sindromi
ciis bodviT sindroms~ uwodeben (Ellis and Young, 1990; am sindroms, aseve, fregolis bodvas uwodeben. es
Christodoulou, 1991). mocemuli kategoria ar aris calke saxelwodeba dakavSrebulia msaxiob fregolisTan,
gamoyofili DSM-IV-Si da ICD-10-Si, magram ICD-10-Si romelsac ieris Secvlis araCveulebrivi unari hqon-
Sesulia `sxva mudmivi bodviTi aSlilobis~ katego- da. fregolis sindromi pirvelad 1927 wels kurbonma
riaSi. erT-erTi argumenti, ris safuZvelzec aseTi da failma aRweres. es sindromi ufro iSviaTia, vidre
aSlilobebi erT kategoriaSi unda gaerTiandnen, aris kapgras bodva. pacients sjera, rom erTma an ramden-
is, rom isini, rogorc Cans, warmoadgenen àdamianis ime adamianma Seicvala garegnoba, raTa mis axlobels
saxidan wamosuli informaciis gadamuSavebis dar- (an axloblebs) damsgaveboda, Cveulebriv, im mizniT,
Rvevas~ da dakavSirebulni arian marjvena hemisferos rom mis mimarT devna ganexorcielebina. Tumca paci-
ukana wilis anomaliasTan, romelic, saxis amocnobis enti aRiarebs, rom ar arsebobs fizikuri msgavseba
procesSi monawileobs (Cutting, 1991; Breen et al., 2000). mis axloblebsa da am adamianebs Soris, isini mainc
agreTve aRsaniSnavia am darRvevebis mWidro kavSiri fsiqologiurad identurebi arian. es simptomi, Cveu-
prozopagnoziis nevrologiur kategoriasTan, rac lebriv, SizofreniasTan an tvinis organul daavade-
aris kargad nacnobi adamianebis saxeebis amocnobis basTan aris dakavSirebuli (Portwich and Barocka, 1998).
uunaroba. sainteresoa, rom amgvari bodva mxolod
intermetamorfozis sindromi
ramdenime, Cveulebriv nacnob adamians exeba, xolo
sxva adamianebis saxis (da obieqtebis) amocnoba ar am sindromis dros pacients sjera, rom pirovneba (an
aris darRveuli. miuxedavad imisa, rom pacientis pirovnebebi) rogorc fizikurad, aseve fsiqologiu-
rwmena bodviTi xasiaTisaa, mas gacnobierebuli aqvs, rad transformirda da sxva adamianad gadaiqca an, rom
rom im adamianTan dakavSirebiT, romliTac nacnobi adamianebma erTmaneTSi identuroba gacvales. unda
adamiania Canacvlebuli, `raRac ise ar aris~. pacienti aRiniSnos, rom mcdari identifikaciis bodvis sxva
SeiZleba Zlier distress ganicdides da zogjer im formebis msgavsad, intermetamorfozac ar aris halu-
pirovnebis winaaRmdeg imoqmedos, romelic, misi az- cinacia; es interpretacis da ara aRqmis paTologiaa.
riT, TviTmarqviaa.
subieqturi oreulebis sindromi
mcdari identifikaciis bodvis oTxi ZiriTadi vari-
am dros pacients aReniSneba bodva, rom sxva pirovne-
antia dadgenili da TiToeul SemTxvevaSi sakamaToa
ba fizikurad masSi transformirda, rogorc es Dop-
simptomebia es Tu sindromi.
pelganger-is dros xdeba.
_ 337 _
inducirebuli bodva moavlinos TanagrZnoba da hkiTxos pacients, Tu riT
zogjer adamians, romelic axlo urTierTobaSia meore SeuZlia daexmaros mas. Tumca, is ar unda gaxdes pa-
pirovnebasTan, romelsac ukve Camoyalibebuli aqvs cientis bodviTi ideebis Tanamonawile da ar unda da-
bodviTi sistema, igive ideebi uyalibdeba. yvelaze pirdes imas, rasac ver Seasrulebs. Terapevtma unda
ufro gavrcelebuli terminia folie feux. Tumca, is gamoiCinos sakmarisi taqti da ar unda moiSvelios
ICD-10-Si mocemulia, rogorc kategoria _ gaziare- iseTi argumenetebi, romlebic gaanawyenebs pacients.
buli bodviTi aSliloba, xolo DSM-IV-Si _ rogorc Tumca, miuxedavad yovelive amisa, gamocdilma fsiqi-
inducirebuli bodviTi aSliloba. mas, Tanaziar SeS- atrma SeiZleba xangrZlivi intervius Semdegac ki
lilobas uwodebdnen. zustad ar aris cnobili in- ver daadginos pacientis morbiduli azrebi. rode-
ducirebuli fsiqozis sixSire, magram is arcTu ise sac aSkarad mcdari rwmena ukve aRmoCenilia, saWiroa
xSirad gvxvdeba. zogjer inducirebul fsiqozSi or didi dro da Zalisxmeva, raTa ganisazRvros es rwmena
adaminze metia CarTuli (folie plusieurs), magram es Za- bodvis kriteriumebs Seesabameba, Tu zeRirebulovani
lze iSviaTia. arsebobs mosazreba, rom zogierTi apo- idea an raime sxva saxis rwmenaa. amas gadamwyveti di-
kalifsuri kulti am tipis fenomenebs Seicavs. agnostikuri mniSvneloba aqvs, radgan bodvis arse-
dafiqsirebuli SemTxvevebis 90%-ze meti adas- boba, savaraudod, is simptomia, romlis safuZvelzec
turebs, rom es adamianebi erTi da imave ojaxis wevre- fsiqozuri aSlilobis diagnozi daismis, maSin, rode-
bi arian. Cveulebriv, arsebobs fiqsirebuli bodvis sac arabodviTi azrebi, romlebic Sinaarsobrivad
mqone dominanturi partniori, romelic, rogorc Cans, SeiZleba igive iyos, pirovnul aSlilobaze an nev-
unergavs daqvemdebarebul an sugestiur partniors rotul aSlilobaze (mag., ipoqondriaze) miuTiTebs,
msgavs rwmenas (zogjer Tavdapirveli winaaRmdegobis imisda mixedviT, Tu ras gvaCvenebs avadmyofobis is-
gawevis Semdeg). recipientTan es rwmena SeiZleba iyos toria da fsiqikuri mdgomareobis gamokvleva.
an ar iyos WeSmaritad bodviTi xasiaTis. Cveulebriv, Tu bodva ukve dadgenilia, Semdegi nabijia im fsiqi-
es ori adamiani didi xnis ganmavlobaSi cxovrobs er- kuri aSlilobis diagnostireba, romelic mas udevs
Tad, xSirad gare samyarosgan izolirebulad, da maT safuZvlad, rac gulisxmobs aSlilobebis diagnosti-
axlo, intimuri urTierToba aqvT. daimkvidrdeba ra kuri maxasiaTeblebis Ziebas. es maxasiaTeblebi mox-
erTxel, es mdgomareoba qronikul saxes iZens. seniebulia mocemul TavSi, xolo maTi detaluri aR-
Cveulebriv, zegavlenis qveS myof adamians urCeven, wera sxva TavebSi iqneba mocemuli. mniSvnelovania da-
daSordes Tavis partniors, radgan swored am gziT vadginoT, xom ar aris albaToba imisa, rom pacientma
partniori SeiZleba gamovides kvazi-bodviTi mdgo- Tavis warmosaxviT mdevars raime ziani miayenos, rac
mareobidan. pacients unda Cautardes mkurnaloba, pacientis pirovnuli Tvisebebis, misi bodvisTvis dam-
romelic Cveulebrivi bodviTi aSlilobis dros tar- axasiaTebeli Tvisebebisa da masTan dakavSirebuli
deba xolme (Silveira and Seeman, 1995). halucinaciebis dawvrilebiT Seswavlas moiTxovs. ga-
nakuTrebuli yuradReba unda mivaqcioT homicidze
miniSnebebs an muqaras. es suicidsac exeba. aseT dros
paranoiduli simptomebis saWiroa, moxdes riskis sruli Sefaseba. eqimi mzad
gamokvleva unda iyos, taqtianad dausvas pacients SekiTxvebi mkv-
paranoiduli simptomebis gamokvleva or safexurad lelobis SesaZlo gegmisa da misTvis mzadebis Taobaze,
warmoebs: Tavad simptomebis dadgena da im mdgomare- raTa daadginos, xom ar aqvs pacients dagegmili vinmes
obis diagnostireba, romelic maT udevs safuZvlad. mokvla an xom ar emzadeba amisTvis. gamokiTxvis meTo-
zogjer, is, rom pacients devnis ideebi an bodva di mravali TvalsazrisiT suicidis riskis Sefasebis
aqvs, aSkaraa, zogjer ki paranoiduli simptomebis msgavsia: àmasTan dakavSirebiT xom ar gifiqriaT raime
dadgena SeiZleba uaRresad Zneli aRmoCndes. paci- qmedebaze?~, `raime gegma xom ar gaqvT mofiqrebuli?~,
enti SesaZloa, undoblobas iCendes an gabrazebuli `ram SeiZleba gibiZgoT amis gakeTebisaken?~.
iyos, SeiZleba TavdacviT pociziaSi imyofebodes, Tema _ xifaTis Sefaseba, ufro mogvianebiT, ocda-
cotas laparakobdes an Tavisuflad laparakobdes meeqvse TavSi iqneba ganxiluli.
sxva Temebze, xolo devnasTan dakavSirebul rwmen-
aze saubars ki gaurbodes an saerTod uaryofdes mis paranoiduli simptomebis
arsebobas. imisTvis, rom fsiqiatrma SeZlos mcdari
mkurnaloba
rwmenis dadgena, mas gansakuTrebuli unar-Cvevebi
unda hqondes, kerZod, igi unda iyos tolerantuli zogadi principebi
da momTmeni. is unda iqceodes rogorc miukerZoebe- xSirad sakmaod Znelia paranoiduli simptomebisa da
li, magram dainteresebuli msmeneli, romelsac surs, bodviTi aSlilobis marTva. pacients SeiZleba sje-
gaigos pacientis Tvalsazrisi. interviuerma unda ga- rodes, rom fsiqiatriuli mkurnaloba misTvis zia-
_ 338 _
paranoiduli simptomebis mkurnaloba
nis miayenebazea gamiznuli da amitom mkurnalobis antifsiqoturi saSualebebi, romlebic bodviTi
mimarT eWvsa da undoblobas iCendes an Tavis bod- aSlilobis dros gamoiyeneba
viT ideebs gamarTlebulad miiCnevdes da Tvlides, munro momxrea pimozidis gamoyenebis, gansakuTrebiT
rom mkurnaloba saerTod ar sWirdeba. aqac taqti monosimptomuri ipoqondriuli fsiqozis (DSM-IV-is
da unar-Cvevebia saWiro, raTa davexmaroT mas deta- mixedviT, somaturi tipis bodviTi aSliloba) da pa-
lurad aRweros Tavisi simptomebi. aseve, aucilebe- Tologiuri eWvianobis dros (Munro, 2000). miuxedavad
lia, mkurnalobaze daviTanxmoT igi. zogjer, Sesa- amisa, ar arsebobs kargad randomizirebuli monace-
Zloa, pacientisTvis mkurnaloba misaRebi gaxdes, mebi, romelTa Tanaxmad, pimozidi ufro efeqturia,
Tu mas araspecifikuri simtomebis, mag., SfoTvis vidre sxva antifsiqozuri saSualebebi (Sultana and
an uZilobis daZlevaSi SevTavazebT daxmarebas an, McMonagle, 2000). aseve, gasaTvaliswinebelia, rom
mivuTiTebT imaze, Tu ra saziano Sedegebi SiZle- pimozidi kardiotoqsikuria. uaxlesi antifsiqozuri
ba mohyves mis Sexedulebebs. amgvarad, pacienti, saSualebebis mimarT tolerantoba SeiZleba ufro
romelsac sjera, rom garSemortymulia adamian- maRali aRmoCndes. Cveulebriv, umjobesia, gamoviy-
ebiT, romlebic mas devnian, SeiZleba dagveTanxmos, enoT arasedaciuri medikamentebi. romeli medikamen-
rom is imdenad daZabulia, rom mis am daZabulobas tic ar unda SeirCes, mniSvnelovania, rom misi miReba
mkurnaloba sWirdeba. mcire dozidan daviwyoT da gaviTvaliswinoT pacien-
klinicistma unda gadawyvitos, saWiroa Tu ara pa- tis asaki, misi janmrTelobis statusi, adre Catare-
cientis stacionarul mkurnalobaze daTanxmeba. amis bul mkurnalobaze pacientis reaqcia.
dasadgenad unda gairkves, ramdenad SeiniSneba sxve-
bze Zaladobis an suicidis maRali an pirdapiri riski. antidepresantebi, romlebic gamoiyeneba bodviTi
aseTi faqtorebis Sefasebisas konsultaciisTvis unda aSlilobis dros
mivmarToT im pirebs, romlebic floben informacias zogierTi randomizirebuli sakontrolo kvlevis mo-
pacientis Sesaxeb da movipovoT misi qcevis istoria. nacemebi gviCvenebs, rom sxeulis dismorfuli aSli-
Tu nebayoflobiTi Tanxmoba ver iqna miRebuli, paci- lobis bodviTi formis mkurnaloba unda daiwyos se-
entis an sxva adamianebis dasacavad, gamarTlebulia rotoninis seleqciuri ukumitacebis inhibitorebiT
misi stacionarSi iZulebiT moTavseba. Tumca, imasac da ara antifsiqozuri saSualebebiT. antifsiqozur
unda velodoT, rom es pacients kidev ufro aRaS- saSualebebs damatebiT vuniSnavT im pacientebs, rom-
foTebs. lebic ar reagireben serotoninis seleqciuri uku-
mitacebis inhibitorebze (Phillips, 2004). gaurkveveli
fsiqologiuri mkurnaloba rCeba antidepresantebis roli sxva bodviTi aSli-
paranoiduli simptomebis mqone pacients mxardaWera, lobebis dros, Tumca, isini xSirad gamoiyeneba
waxaliseba da damSvideba sWirdeba. araspecifikuri mkurnalobis zogierT etapze, romlis drosac xSirad
fsiqologiuri mkurnalobis es forma daavadebis mar- gvxvdeba komorbiduli depresiuli simptomebi da
Tvis ganuyrel nawils warmoadgens da mas arsebiTi maTi aRmoceneba mkurnalobis procesSi. suicidis
mniSvneloba eqneba, Tu davarwmunebT pacients, rom riskis monitoringi regularulad unda xdebodes.
miznobrivi Careva sasargebloa. rogorc wesi, medi- gaumjobesebis niSnebi (gansakuTrebiT ki imis
kamentebi mkurnalobis ZiriTadi saSualebaa (ix. qve- dadgena, rom pacienti naklebadaa bodviT moculi
moT), magram specifikurma fsiqologiurma Terapia- da nakleb aJitirebulia) SeiZleba medikamenturi
mac SeiZleba garkveuli roli iTamaSos. kerZod, kog- mkurnalobis dawyebidan ramdenime dReSi dafiq-
niturma Terapiam Sizofreniis dros arsebuli bodvis sirdes. arsebobs Zalian cota monacemi imis Sesaxeb,
mkurnalobisas SeiZleba Sedegi gamoiRos, Tu Terape- Tu rogoria am daavadebis mkurnalobis grZelvadi-
vtsa da pacients Soris sakmarisad kargi Terapiuli ani Sedegebi. klinikuri monacemebi imaze miuTiTebs,
raporti damyarda. axsna-ganmartebiTi da jgufuri rom bodviT aSlilobasTan dakavSirebuli prognozi
fsiqoTerapia ar aris efeqturi. ar aris saxarbielo. Tumca munro (Munro, 2000) amt-
kicebs, rom damyoli pacientebis 50%-Tan aRiniSneba
medikamenturi mkurnaloba sruli gamojanmrTeleba, xolo pacientebis 30%-Tan
bodviTi aSlilobis dros paranoidul simptomebs, aSkara gaumjobeseba SeiniSneba. zogierT pacients
sxva fsiqozebis msgavsad, antifsiqoturi medika- medikamentis doza SeiZleba Seumcirdes an saerTod
mentebiT mkurnaloben. Tu ra mniSvneloba aqvs pa- Seuwydes medikamenturi mkurnaloba uaryofiTi Sede-
cientTan kargi Terapiuli urTierTobis damyarebas gebis gareSe, xolo zogs (savaraudod, pacientebis
imisTvis, rom igi mkurnalobis procesSi CaerTos, ze- umravlesobas) bodva medikamentebis Sewyvetis Semdeg
moT ukve aRvniSneT. swrafadve aRudgeba da mkurnaloba am SemTxvevaSi
didi xnis manZilze unda gagrZeldes. am problemis
_ 339 _
Sesaxeb msjeloba SesaZlebelia mxolod sagulda- Hirsch, SR and Shepherd, M (eds) (1974) Themes and vari-
gulo klinikuri gamokvlevisa da fsiqikuri mdgo- ations in European psychiatry. John Wright, Bristol. (ix. E
mareobis regularuli monitoringis safuZvelze. Strmgren, Psychogenic psychoses; R Gaupp, The scientific
garda amisa, pacientTan erTad unda ganvixiloT, Tu significance of the case of Ernst Wagner and The illness and
ramdenad sasargebloa grZelvadiani medikamenturi death of the paranoid mass murderer schoolmaster Wanger: a
mkuraloba da, aseve, masTan dakavSirebuli riskebi. case history; E Kretschmer, The sensitive delusion of refer-
ence; H Baruk, Delusions of passion; H Ey,)
Lewis, A (1970) Paranoia and paranoid: a historical perspec-
damatebiTi literatura tive. Psychological Medicine 1, 2-12. (ganixileba `ter-
Enoch MD, Ball HN (2001) Uncommon psychiatric syndromes, mini paranoiduli~ _ misi warmoSoba da ganviTareba,
4th edn. London, Edward Arnold. (wignSi mocemulia da masTan masTan dakavSirebuli cnebebi.)
mravali bodviTi aSlilobis, iSviaTi da eponimuri Munro A (1999) Delusional disorder. Cambridge, Cambridge
fsiqiatriuli sindromis saintereso aRwera) University Press.
_ 340 _
individualuri
Tavi 14 demencia, deli-

riumi da sxva fsiqikuri aSlilobebi
Tavis Sinaarsi
klasifikacia prionuli daavadebebi
Tavis tvinis sxvadasxva ubnis hanTingTonis daavadeba
paTologiasTan asocirebuli simptomebi aiv infeqciiT gamowveuli demencia
Sublis wili alkoholis borotad moxmarebiT
Txemis wili gamowveuli demencia
safeTqlis wili demenciis Tanamedrove koncefciebi
kefis wili epilefsia
korZiani sxeuli (Corpus Callosum) gulyris saxeebi
subkortikuli da epilefsiis epidemiologia
kortikul_subkortikuli kavSirebi epilefsiis etiologia
TeTri nivTiereba diagnozis dasma
mexsiereba da misi neiroanatomia epilefsiis fsiqiatriuli aspeqtebi
kognituri darRvevebis mqone epilefsiis socialuri aspeqtebi
pacientis Sefaseba epilefsiis mkurnaloba
anamnezis Sekreba da fsiqikuri qala-tvinis travma
statusis kvleva mwvave fsiqologiuri Sedegebi
gamokvlevebi qronikuli fsiqologiuri Sedegebi
amneziuri sindromi qala-tvinis travmis mkurnaloba
gardamavali globaluri amnezia sxva neirofsiqiatriuli sindromebi
deliriumi distonia
klinikuri niSnebi tikebi
etiologia gafantuli (mravlobiTi) sklerozi
deliriumis marTva hidrocefalia normaluri wneviT
demencia anoqsia, hipoglikemia da naxSirJangiT
demenciis klinikuri niSnebi intoqsikacia
demenciis Sefaseba insulti
alchaimeris daavadeba subduruli hematoma
vaskuluri demencia subaraqnoiduli hemoragia
levis sxeulebis demencia Tavis tvinis simsivne
parkinsonis daavadeba meoradi an simptomuri
frontotemporaluri demencia neirofsiqiatriuli sindromebi
neirofsiqiatria moicavs fsiqikur aSlilobebs, rom- (mag., endokrinuli an metaboluri daavadebebi). es

lebic gamowveulia Tavis tvinis gamoxatuli struq- daavadebebi ganxilulia me-16 TavSi. unda aRiniSnos,
turuli da funqciuri darRvevebiT. am aSlilobebs, rom termini òrganuli~, fundamentur problemas
mag., demenciasa da deliriums, yvelaze metad kogni- warmoSobs, radgan SeiZleba SecdomiT miviCnioT,
turi daqveiTeba axasiaTebs, Tumca xSirad viTarde- TiTqos sxva fsiqikur aSlilobebs aseTi safuZveli
ba qceviTi da emociuri simptomebic da SeiZleba es ar aqvs (ix. me-2 Tavi). am mcdari diqotomiuri Sexed-
mdgomareobis erTaderT gamovlinebas warmoadgendes. ulebis sawinaaRmdegod neiromedicinas uamravi mt-
termini `neirofsiqiatria~, xSirad ixmareba òr- kicebuleba aqvs.
ganuli fsiqiatriis sinonimad~ (Leshman, 1998). Tum- orive terminis gamoyenebisas arsebobs fsiqologi-
ca, terminis Tanamedrove gageba ufro farToa da uri da socialuri faqtorebis ugulebelyofis ris-
moicavs fsiqikur aSlilobebs, romlebic zogadi saki, radgan aseTi aSlilobebi, upiratesad, `fizikur~
medicino problemebiTaa ganpirobebuli da mizezic problemad ganixileba.
SeiZleba Tavis tvinis gareT iyos lokalizebuli am TavSi gamoviyenebT termins `neirofsiqiatria~ da
_ 341 _
14 demencia, deliriumi da sxva fsiqikuri aSlilobebi
ganvixilavT im aSlilobebs, romlebic, Cveulebriv,
daavadebaTa mocemul jgufSi moiazreba:
cxrili 14.1 organuli fsiqikuri aSlilobebis
klasifikacia
w deliriumi: mwvave generalizebuli kognituri
DSM-IV ICD-10
daqveiTeba Secvlili cnobierebis fonze;
w demencia: qronikuli, generalizebuli kognituri deliriumi, demencia, amnezuri organuli warmoSobis
da sxva kognituri darRvevebi aSlilobani, simptom-
daqveiTeba naTeli cnobierebis dros. uri fsiqikuri aSli-
deliriumic da demenciac SeiZleba gamoiwvios lobebis CaTvliT
sxvadasxva damoukidebelma daavadebam. mocemul deliriumi: deliriumi, romelic

TavSi ganxilulia demenciis klinikuri niSnebi w deliriumi _ gamowveuli zo ar aris gamowveuli
gadi samedicino mdgomareo- fsiqoaqtiuri nivTi
da etiologia, xolo demenciis mkurnalobisa bebiT erebebiTa da alkoho
da marTvis Sesaxeb saubari gveqneba me-20 TavSi, w fsiqoaqtiuri nivTierebebiT liT
romelic xandazmulTa fsiqikur problemebs eZRvneba gamowveuli deliriumi
w fsiqoaqtiuri nivTierebebis
(miuxedavad imisa, rom demencia SeiZleba SedarebiT moxsniT gamowveuli deliriumi
axalgazrda asakSic ganviTardes, misi marTva da w mravlobiTi etiologiis de-
mkurnaloba mainc geriatriul servisebSi xdeba). liriumi
w sxvagvarad dauzustebeli
w amnezia: amneziuri sindromi _ mexsierebis daqveiTeba deliriumi
(sxva kognituri funqciebi Senaxulia)
demencia: alchaimeris tipis de
w epilefsia w alchaimeris tipis demencia mencia (adreuli da
adreuli dasawyisiT gviani dasawyisiT)
w qala-tvinis travma w alchaimeris tipis demencia
mogvianebiTi dasawyisiT vaskuluri demencia
w sxva neirofsiqiatriuli mdgomareobebi: fokaluri
w vaskuluri demencia
cerebruli sindromi, infeqciebi, simsivneebi da w pikis daavadebiT gamowveuli demencia im daavade
gafantuli sklerozi demencia bebis dros, romlebic
w parkinsonis daavadebiT gamo sxva TavSia mocemuli
w meoradi an simptomuri neirofsiqiatriuli daava wveuli demencia
debebi. igulisxmeba iseTi fsiqikuri aSlilobebi w Hantingtonis daavadebiT w demencia pikis daava
gamowveuli demencia debis dros
(mag., depresia an SfoTviTi aSlilobebi), rom
w Creutzfeldt-Jakobis daavadeb- w demencia parkinsonis
lebic aSkarad neirofsiqiatriuli mizezebiTaa iT gamowveuli demencia daavadebis dros
ganpirobebuli. mag., cerebruli vaskulitis Sede w aiv infeqciiT gamowveuli w demencia Hantington
demencia is daavadebis dros
gad ganviTarebuli fsiqozebi. (meoradi fsiqi w fsiqoaqtiuri nivTierebebis w demencia Creutzfeldt-
kuri aSlilobebi, gamowveuli sxva somaturi daa moxmarebiT gamowveuli de- Jakobis daavadebis
vadebebiT, ganxilulia me-16 TavSi). mencia dros
w qalatvinis travmiT ga w demencia aiv infeq
owveuli demencia ciis dros
klasifikacia w multietiologiuri demencia
w sxvamxriv dauzustebeli de- dauzustebeli
ICD-10-Si organuli fsiqikuri aSlilobebi mocemulia mencia demencia
saTauriT òrganuli warmoSobis aSlilobani, sim
amnezia: organuli amnezuri
ptomur fsiqikur aSlilobaTa CaTvliT~, xolo DSM- w zogadi samedicino mdgomareo- sindromi, romelic ar
IV-Si _ `deliriumi, demencia, amnezia da sxva kog bebiT gamowveuli amnezia aris gamowveuli alko-
w fsiqoaqtiuri nivTierebebis holisa an sxva fsiqoaq-
nituri darRvevebi~. am ori klasifikaciis Sedareba
moxmarebiT gamowveuli per- tiuri nivTierebebis
mocemulia cxrilSi 14.1. maT Soris arsebobs Semdegi sistentuli amnezia miRebiT
ZiriTadi gansxvavebebi:
Tavis tvinis daziane
w DSM-IV klasifikaciis avtorTa gadawyvetilebam biTa da disfunqciiT,
_ amoeRoT sityva òrganuli~, gamoiwvia im agreTve, somaturi daa
vadebebiT gamowveuli
mdgomareobebis gadajgufeba, romlebic organul fsiqikuri aSlilobebi:
aSlilobebad moiazrebodnen. mag., organuli etio w organuli halucin
logiis didi depresia klasificirdeba `zogadi ozi
w organuli bodviTi
samedicino problemebiT~ an `fsiqoaqtiuri niv (Sizofreniismagv a
TierebebiT~ gamowveuli afeqturi aSlilobebis ri) aSliloba
w organuli afeqturi
qveS. aseTi cvlilebebis Sedegad DSM-IV ascda
aSlilobebi
im problemebs, romlebic ICD-10-Si terminebis w organuli SfoTviTi
_ òrganuli, simptomuri da meoradi~, defini aSlilobebi
ciasTanaa dakavSirebuli (Spitzer et al., 1992).
_ 342 _
Tavis tvinis sxvadasxva ubnis paTologiasTan asocirebuli simptomebi
vidre Zlieri. disfazia, agnozia da dispraqsia, rac
cxrili 14.1 organuli fsiqikuri aSlilobebis tradiciulad nevrologiuri sakiTxia, aq detalurad
klasifikacia (gagrZeleba)
ganxiluli ar aris (damatebiTi informacia ix.
DSM-IV ICD-10 Lishman, 1998; aseve, ix. gv. 50_1, neirofsiqiatriuli
gamokvlevis Sesavali).
sxvamxriv dauzustebeli kogni- Tavis tvinis dazianebi-
turi darRvevebi: Ta da disfunqciiT,
w postkomociuri mdgomareoba agreTve, somaturi daa- Sublis wili
vadebebiT gamowveuli
Sublis wili, masTan ormxrivad dakavSirebuli kor
pirovnuli da qceviTi
aSlilobebi tikuli da subkortikuli regionebiT, mniSvne
w organuli pirovnu- lovnad gansazRvravs pirovnul Tvisebebsa da ga
li aSliloba
w postencefaluri si
dawyvetilebebis miRebis unars (Dolan, 1999). Sublis
ndromi wilis dazianebis dros SeiZleba sxvadasxva klinikuri
w postkomociuri sin- sindromi ganviTardes:
dromi
w pirovneba SeiZleba iyos zedmetad ganmuxruWebuli,
dauzustebeli familaruli, utaqto, Seusveneblad saubrobdes,
organuli da
simptomuri fsiqikuri uniWod xumrobdes an Sairobdes (Witzelsucht),
aSlilobebi iRebdes araswor gadawyvetilebebs, aseve, iyos
seqsualurad TavSeukavebeli da ar uwevdes angariSs
w orive klasifikaciis mixedviT, mdgomareobis ga
irgvlivmyofebs;
momwvevi samedicino problema SegviZlia damatebiT
mivuTiToT. DSM-IV-Si damatebiTi kodisTvis III w SeiZleba iyos uiniciativo, apaTiuri, abuliuri da
aqsisi gamoiyeneba. aReniSnebodes spontanuri metyvelebis, moZraoba-
moqmedebebisa da emociuri gamoxtvis deficiti;
w ICD-10-Si organuli aSlilobebi moicavs qveka
tegoriebs: `Tavis tvinis dazianebiTa da dis w SeiZleba axasiaTebdes obsesiebi, ritualuri qceva
funqciiT, agreTve, sxva somaturi daavadebebiT da azrebisa da Jestikulaciis perseveracia.
gamowveuli fsiqikuri aSlilobebi~ da `Tavis Sublis wilis daavadebebis dros inteleqti, Cve
tvinis dazianebiTa da disfunqciiT, agreTve, sxva ulebriv, Senaxulia. Tumca, SeiZleba gaZnelebuli iyos
somaturi daavadebebiT gamowveuli pirovnuli abstraqtuli azrovneba (riTi gansxvavdeba yinuli
da qceviTi aSlilobebi~. mag., òrganuli SfoT SuSisgan?), aseve, sazomi erTeulebiT Sefaseba araswori,
viTi aSliloba, Tireotoqsikozi~. DSM-IV-Si es magram konkretulia (mag., 364 mili londonidan niu-
kategoriebi Sesulia Sesabamisi fsiqikuri aS iorkamde). koncentracia da yuradReba daqveiTebuli
lilobebis jgufebSi da damatebiTi kodiT mivu da, xSirad, TvalsaCinod darRveulia. sityvaTa maragi
TiTebT, rom aSliloba meoradia da zogadi sa (romelic fasdeba, mag., erT asoze garkveul droSi
medicino mdgomareobiTaa gamowveuli. CamoTvlili sityvebis raodenobiT) Semcirebulia
w DSM-IV-Si am kategoriaSi, aseve, Sesulia fsiqo da kategorizacia _ gaZnelebuli. pacients SesaZloa
aqtiuri nivTierebebiT gamowveuli deliriumi, (umniSvnelo sixSiriT) sxva darRvevebic aReniSnebodes.
demencia da amneziuri sindromi. ICD-10-Si ki es pirovnebas uWirs erTi amocanidan meoreze gadasvla
mdgomareobebi fsiqoaqtiuri nivTierebebis miRebiT (perseveracia), Tanmimdevruli qmedebebisa da
gamowveuli fsiqikuri da qceviTi aSlilobebis moZraobebis ganxorcieleba da wesebis gageba. SeiZleba
jgufSia Setanili. gamoxatuli iyos utilizaciuri qceva (mag., ramdenime
saTvalis erTad gakeTeba).
dominanturi Sublis wilis dazianeba, romelic
Tavis tvinis sxvadasxva ubnis paTo brokas centrs moicavs, ganapirobebs eqspresiul
logiasTan asocirebuli simptomebi disfazias. dazianebis motorul korteqstze an
sindromebis ganxilvamde sasurvelia visaubroT Rrma proeqciiT gavrcelebis SemTxvevaSi, SeiZleba
Tavis tvinis sxvadasxva ubnis dazianebis niSnebze da kontralateraluri hemiparezi ganviTardes. sxva
mexsierebis neiroanatomiur safuZvlebze. niSnebidan aRsaniSnavia ifsilateraluri mxedvelobis
nevrologiuri da fsiqopaTologiuri niSnebis re nervis atrofia da anosmia, tacebisa da sxva
gionaluri kavSirebis codna dagvexmareba neiro primitiuli refleqsebi. Tu dazianeba bilateraluria
fsiqiatriuli mdgomareobebis lokalizaciis gansa an medialuradaa lokalizebuli, SeiZleba iyos Sardis
zRvraSi. Tumca, gasaTvaliswinebelia, rom klinikuri Seukavebloba. (Sublis wilis darRvevebis Tanmxlebi
Taviseburebebi diagnostikurad araspecifikuria da fsiqikuri problemebis Sesaxeb informacia ix. Ron,
klinikopaTologiuri korelaciebi ufro sustia, 1989; Gerrard and Hodges, 2000).
_ 343 _
Txemis wili domiT SeiZleba fsiqologiur paTologiad miviCnioT.
Txemis wilis dazianebis dros ganviTarebuli neirof- aseTi fenomenebi xSirad gvxvdeba Sakikisa da kefis
siqiatriuli problemebi SeiZleba advilad agverios wilis epilefsiis dros. mxedvelobasTan dakavSirebu-
konversiul aSlilobebSi (gv. 206 ??). aradominanturi li ubnebis dazianebisas SeiZleba ganviTardes rTuli
Txemis wilis dazianebisas, Cveulebriv, viTardeba halucinaciebi, poliopia _ pirovneba erT sgans ram-
sivrciT-mxedvelobiTi darRvevebi kontalateraluri denime sagnad aRiqvams, palinofsia _ pirovneba xedavs
sivrcis ugulebelyofiT, konstuqciuli da Cacmis sgans misi mxedvelobis velidan gaqrobis Semdegac da
apraqsia. dominanturi mxaris dazianebas SeiZleba mo- metamorfofsia _ rodesac realuri sagnebis formebi
hyves recepciuli disfazia, kidurebis apraqsia, sxe- da zomebi darRveulia. parietaluri da temporaluri
ulis sqemis darRvevebi, marjvena da marcxena mxaree- ubnebis CarTvisas, SeiZleba ganviTardes vizualuri
bis aRreva, diskalkulia, TiTebis agnozia da agrafia. dezorientacia (sivrceSi sagnis lokalizaciis dad-
sxva niSnebidan SeiZleba iyos kontralateralurad genis uunaroba), simultagnozia _ (pirovnebas ar Seu-
mgrZnobelobis dakargva, astereognozia (sagnebis Zlia sagnis mTlianad danaxva, miuxedavad imisa, rom
Secnobis uunaroba SexebiT, rodesac SenarCunebu- aRiqvams mis calkeul nawilebs) da prozopagnozia _
lia taqtiluri, temperaturuli da Rrma kunTovani (pirovneba ver cnobs nacnob saxeebs). kefis wilis pa-
mgrZnobeloba), agrafestezia (agraphaesthesia). ufro Tologiis SemTxvevaSi, agnoziis dasadgenad, neirof-
didi dazianebis SemTxvevaSi SeiZleba ganviTardes siqologiuri testebis gamoyenebiT unda gamovikv-
kontralateraluri hemiparezi da homonimuri qveda lioT mxedvelobis veli. zogi pacienti, romelic ver
kvadrantanopia (homonymous inferior quadrantanopia). xedavs kefis wilis dazianebis gamo, uaryofs Tavis
ar aris iSviaTi anozognozia (nevrologiuri defi- sibrmaves (antonis (Anton~s) sindromi).
citis ugulebelyofa), gansakuTrebiT, aradominantu-
ri Txemis wilis dazianebis dros. mwvave SemTxvevebSi korZiani sxeuli (Corpus Callosum)
pacienti SeiZleba uaryofdes, rom paralizebuli ki- korZiani sxeulis dazianeba (klasikurad, gliomis
duri mas ekuTvnis. es mdgomareoba unda ganvasxvavoT dros), Cveulebriv, orive naxevarsferos mimarTule-
fsiqologiuri mizezebiT gamowveuli uaryofisgan, biT vrceldeba. am dros swrafad viTardeba inteleq-
rodesac pirovnebas ar surs daijeros Tavisi avad- tualuri daqveiTeba. lokaluri nevrologiuri niSne-
myofoba da misi Sedegebi. bi gansxvavebulia xarisxisa da mdebareobis mixedviT
da dazianebul ubnebs Seesabameba. korZiani sxeulis
safeTqlis wili umniSvnelo dazianeba (romelic, Cveulebriv, iatro-
temporolimbur sindroms axasiaTebs rTuli da mra- genulad, qirurgiulma Carevam SeiZleba gamoiwvios)
valsimptomuri neirofsiqiatriuli klinikuri su- Zalian Zneli gamosavlenia. saWiroa specialuri nei-
raTi (Trimble, 1997). SesaZlebelia iyos Sublis wilis rofsiqologiuri testireba `gaTiSulobis sindro-
dazianebisTvis damaxasiaTebeli pirovnuli cvlile- mis~ dasadgenad, rac hemisferoebs Soris urTierT-
bebi. amasTan, ufro xSiria kognituri deficiti da kavSiris darRvevebs gamoavlens. korZiani sxeulis
nevrologiuri niSnebi. qceviTi darRvevebi SedarebiT dazianebiT gamowveuli `gaxleCili tvinis~ fenomeni
metadaa gamoxatuli frontotemporaluri demen- warmoSobs saintereso sakiTxs tvinis erTian muSao-
ciebis dros, rodesac frontaluri da temporaluri basTan dakavSirebiT: ra meqanizmebiT xdeba ori nax-
niSnebi kombinirebuli da urTierTdakavSirebulia. evarsferos erToblivi, SeTanxmebuli moqmedebiT
safeTqlis wilis unilateraluri medialuri da- mTliani `me~-s gancda (Gazzaniga, 2000). korZiani sxeu-
zianebis SemTxvevaSi, gansakuTrebiT maSin, rodesac lis degeneracia marCiafava_bignamis (Marchiafava_Big-
hipokampia CarTuli, viTardeba lateralizebuli mex- nami) (iSviaTi mdgomareoba, romelic mZime alkohol-
sierebis deficiti. hipokampis marcxenamxrivi daziane- damokidebulebis dros viTardeba) sindromis ZiriTa-
ba iwvevs verbaluri mexsierebis darRvevebs (SesaZloa di maxasiaTebelia.
gamoiwvios semantikuri da recepciuli disfazia),
xolo marjvenamxrivi _ azianebs mexsierebis araver- subkortikuli da kortikul-subkortikuli
balur (sivrciT) aspeqtebs. zogi monacemis Tanaxmad, kavSirebi
safeTqlis wilis marcxena medialuri dazianeba ganapi- `lokaluri~ klasikuri midgoma nevrologiasa da nei-
robebs fsiqozuri simptomebis, xolo marjvenamxrivi rofsiqiatriaSi, romlis mixedviTac kognituri, afeq-
defeqti _ afeqturi simptomebis ganviTarebas. turi da qceviTi Taviseburebebi Tavis tvinis konkre-
tul ubnebTanaa dakavSirebuli, TiTqmis mTlianad
kefis wili
Seicvala `kavSirebis~ TeoriiT, romlis Tanaxmadac,
oqcipitaluri wilis dazianebisas SeiZleba ganvi- qerquli ubnebi subkortikul struqturebTanaa daka-
Tardes mxedvelobis iseTi darRvevebi, romlebic Sec-
_ 344 _
Tavis tvinis sxvadasxva ubnis paTologiasTan asocirebuli simptomebi
vSirebuli da maTTan erTad `gadanawilebul~ nervul mag., leikodistrofiam (TeTri nivTierebis degenera-
sistemebs qmnis. subkortikuli ubnebis mniSvnelobas, cia) SeiZleba gamoiwvios Sizofreniismagvari mdgo-
aseve, gansazRvravs maTi CarTuloba mexsierebis pro- mareoba (Hyde et al., 1992), xolo TeTri nivTierebis
cesebsa da sxva umaRles funqciebSi (Brown and Mars- mravlobiTi fokaluri dazianeba zrdis afeqturi
den, 1998). aSlilobebisa da demenciis ganviTarebis risks. iTv-
leba, rom aseTi klinikur-paTologiuri gamovline-
Talamusi da bazaluri ganglia
bebi aris Tavis tvinis sxvadasxva ubnebs Soris urT-
subkortikuli ruxi nivTierebis dazianebam, SeiZleba, ierTkavSiris darRvevis Sedegi.
mravali kognituri da fsiqikuri darRveva gamoiwvi-
os; maT Soris: mexsierebis, metyvelebisa da guneb-gan- mexsiereba da misi neiroanatomia
wyobis cvlilebebi da inicirebis problemebi.
klinikuri, neirofsiqologiuri da neirovizualuri
retikuluri formacia kvlevebi (orive _ struqturuli da funqciuri) ada-
mianis Tavis tvinSi mexsierebis ramdenime sistemis ar-
tvinis Reros rostraluri dazianebis SemTxvevaSi
sebobaze miuTiTebs. am sistemebis darRvevebi Tavis
xSiria qceviTi darRvevebi. yvelaze metad damaxa-
tvinis sxvadasxva ubnis dazianebis dros garkveuli
siaTebelia amneziuri sindromi, hipersomnia da àki-
seleqciurobiT gamoirCeva. mexsierebis yvelaze ba-
netikuri mutizmi~ (`fxizeli koma~).
zisuri dayofis safuZvelze ganasxvaveben implici-
kortikul-subkortikuli kavSirebi tur (procedurul) da eqsplicitur (deklaraciul)
arsebobs ramdenime kortikul-subkortikuli qseli mexsierebas. es ukanaskneli moicavs iseT fenomenebs,
da sistema, romlebic, arsebuli mosazrebiT, adamia- romlebic, Cveulebriv, cnobier analizs ar eqvemde-
nis tvinis umaRles funqciebSi monawileoben. 5 aseTi bareba, mag., motoruli unarebi, pirobiTi refleqsebi
qseli aRwera mezulamma (Mesulam, 1998): da ganmeorebiTi praimingi. eqsplicitur mexsierebas
aqvs epizoduri (autobiografiuli movlenebi) da se-
1. marjvena naxevarsferos sivrciTi Secnobis qseli,
mantikuri (samyaros Sesaxeb codna) funqciebi.
romelic moicavs ukana parietalur korteqssa da
mexsiereba SeiZleba iyos xanmokle da xangrZlivi.
frontalur mxedvelobiT velebs;
xanmokle mexsiereba exmareba muSa mexsierebas (mag.,
2. marcxena hemisferos metyvelebis qseli, romelic rodesac vimaxsovrebT ucnob telefonis nomers).
moicavs brokasa da vernikes centrebs; iTvleba, rom arsebobs ori anatomiurad gansxvave-
3. mexsiereba _ emociuri qseli, romelic moicavs buli substrati verbaluri da sivrciTi xanmokle
hipokamps, amigdalasa da sartylisebri xveulis mexsierebisTvis, romlebic centraluri meqanizmebiT
qerqs; kontrolirdeba. neirofsiqologiaSi xanmokle mex-
4. muSa mexsiereba _ aRmasrulebeli funqciebis qseli, siereba niSnavs dauyovnebliv gaxsenebas. amis sawi-
romelic moicavs prefrontalur korteqssa da uka- naaRmdegod, klinicistebis mier xSirad naxmari ter-
na parietalur korteqss; mini `xanmokle mexsiereba~, romelic asaxavs ramdenime
5. saxeebisa da sagnebis cnobis qseli temporoparieta- saaTisa da winadRis mogonebebi, ar gulisxmobs amis
lur da temporooqcipitalur qerqSi. Sesabamis anatomiur substrats.
mexsierebis gansakuTrebuli formebi, rogorebicaa
aleqsandernma da kruCerma (Alexander and Crutcher,
saxeebis damaxsovreba, topografiuli informacia,
1990) SeimuSaves sxva mniSvnelovani modeli, romlis
SesaZloa, Sesabamisi qvesistemebiT ganisazRvrebodes.
Tanaxmad, oTxi paraleluri wredi cerebruli korte-
epizoduri mexsiereba SeiZleba moicavdes antero-
qsis sxvadasxva nawilebs bazalur gangliasa da Tal-
gradul (axali masalis daswavla) da retrogradul
amur birTvebTan akavSirebs. yoveli wredi calkeul
(Zveli masalis gaxseneba) komponentebs. savaraudod,
funqciebzea pasuxismgebeli. mag., `limburi~ wredi,
igi regulirdeba qerquli da qerqqveSa struqture-
romelic moicavs emociebsa da motivacias, akavSirebs
biT, romelic moicavs hipokampuss, parahipokampalur
sartylisebri xveulas qerqs da medialur prefron-
da entorinalur qerqs, amigdalas, sartylisebur
talur korteqss ventralur striatumTan, ven-
xveulas, mamilarul sxeulebs, TaRs da frontobaza-
tralur palidumTan da Talamusis mediodorsalur
lur korteqss. semantikuri mexsiereba, nawilobriv,
birTvebTan.
damoukidebeli qseliT regulirdeba, romelic me-
tyvelebis ubnebs gadafaravs. farTo gagebiT, ver-
TeTri nivTiereba
baluri mexsiereba marcxena (dominantur) naxevars-
gaizarda interesi subkortikuli da periventraluri ferosTan, xolo araverbaluri _ marjvena naxevars-
TeTri nivTierebis dazianebiT gamowveuli qceviTi da ferosTanaa dakavSirebuli.
neirofsiqiatriuli paTologiebisadmi (Filley, 1998).
_ 345 _
kognituri darRvevebis mqone warmodgenili (gv.511). orive mdgomareobisTvis mniS-

pacientis Sefaseba vnelovania òrganuli~ da `funqciuri~ gamomwvevi
mizezebis gamijvna, radgan es gansazRvravs mkurnalo-
kognituri funqciebis Sefaseba, rogorc zogadi
bis taqtikas da gvexmareba daavadebis prognozireba-
fsiqikuri statusis kvlevis nawili, pirvel da mesame
Si. deliriumis, amneziuri sindromisa da funqciuri
TavebSia mocemuli. am TavSi damatebiT visaubrebT
mdgomareobebis gamoricxvis Semdeg rCeba demencia,
amneziis, deliriumisa da demenciis gamovlenaze.
romelic daavadebis tipisa da mdgomareobis simwvavis
ganvixilavT inicialuri midgomis sakvanZo sakiTxebs
dasadgenad detalur gamokvlevas saWiroebs.
iseT pacientebTan dakavSirebiT, romlebsac, Sesa-
Zloa, kognituri darRvevebi aReniSnebodeT (mimox-
gamokvlevebi
ilva ix. Kipps and Hodges, 2005; aseve, waikiTxeT me-20
damatebiTi gamokvlevebis SerCeva xdeba avadmyofobis
TavSi xandazmuli pirebis Sefasebis sakiTxebi).
istoriis, fsiqikuri statusisa da fizikuri kvlevis
anamnezis Sekreba da fsiqikuri statusis safuZvelze. Tumca, arsebobs ZiriTadi testebis kom-
pleqti, rogorebicaa kognituri testebis batarea da
kvleva
sisxlis analizebi, romlebic demenciis dros keTdeba
miuxedavad imisa, rom fizikuri gamokvleva da lab-
(ix. qvemoT). rTul da atipiur SemTxvevebSi an, rode-
oratoriuli testireba daavadebaTa am jgufisTvis
sac pacienti axalgazrdaa, gamokvleva SeiZleba ufro
gansakuTrebulad mniSvnelovania, vidre sxva fsiqi-
intensiuri iyos da saWiro gaxdes nevrologis, Tera-
kuri aSlilobebis dros, umTavresi mainc, anamnezis
pevtisa da neiroqirurgis konsultacia.
srulfasovani Seswavlaa. saWiroa axloblebisa da
zogierTi gamokvleva, romelic neirofsiqiatriaSi
sxva pirebis gamokiTxvac, visac informaciis mowo-
gamoiyeneba:
deba SeuZlia, vinaidan kognituri funqciebis gaua-
w struqturuli neirovizualuri gamokvlevebi mag-
reseba gavlenas axdens pacientis unarze _ zustad da
nituri rezonansiTa (MRI) da kompiuteruli tomo-
Tanmimdevrulad aRweros Tavisi mdgomareoba. avad-
grafiiT (CT). am kvlevebiT SeiZleba gamovavlinoT
myofobis istoriis gamokiTxvisas, gansakuTrebuli
fokaluri da difuzuri paTologiebi. longitu-
yuradReba unda movaqcioT daavadebis dawyebas, xan-
dinaluri skanirebiT, SegviZlia SeviswavloT pro-
grZlivobasa da simptomTa gauaresebis progresulo-
gresuli cvlilebebi, romlebic klinikur gauare-
bas. mwvave dawyeba miuTiTebs deliriumze an, Tu vi-
sebas Seesabamebian. zog SemTxvevaSi MRI_s CT_Tan
Tardeba Zirs dacemis Semdeg, SeiZleba saqme gvqondes
SedarebiT garkveuli upiratesoba aqvs. mag., TeTri
subduralur hematomasTan. yvelaferi _ nevrologi-
nivTierebis daavadebaTa kvlevisas, aseve, SesaZle-
uri, samedicino da ojaxis istoria, mniSvnelovania,
belia volumetruli gazomvebis warmoeba.
vinaidan kognituri darRvevebi SeiZleba samedicino
problemis Sedegad, meoradad ganviTardes an, Sesa- w neirofsiqologiuri testireba kognituri defici-
Zloa, mas genetikuri safuZveli hqondes. fizikuri tis xarisxisa da xasiaTis dasadgenad dRes ufro
mdgomareobis Sefaseba did yuradRebas moiTxovs, iSviaTad gamoiyeneba, risi mizezic, SesaZloa, nei-
radgan daavadebis niSnebi yovelTvis ar aris aSkarad rovizualuri kvlevebis xelmisawvdomoba iyos, ma-
gamoxatuli. gansakuTrebiT unda gamovikvlioT ner- gram mas kvlav didi roli eniWeba kognituri dar-
vuli sistema, aseve, sistemuri daavadebebis niSnebi Rvevebis xasiaTis gansazRvraSi (mag., yvelaze metad
da alkoholdamokidebuleba. darRveuli kognituri funqciis gamovlena), da-
Tavidanve unda SevafasoT cnobiereba, raTa gamovav- zianebis lokalizebis dadgenasa da mdgomareobis
linoT deliriumi da daviwyoT misi gamomwvevi mizeze- progresirebis SeswavlaSi.
bis Zieba. im SemTxvevaSi, Tu cnobiereba naTelia, unda w eeg kvlevebi SedarebiT naklebad gamoiyeneba, ma-
vifiqroT demencias an amneziaze an kognituri dar- gram garkveul SemTxvevebSi mainc didi mniSvn-
Rvevebis `funqciur~ mizezebze. amneziuri sindromis eloba eniWeba. eeg maxasiaTeblebi informaciulia
ZiriTadi niSania epizoduri mexsierebis deficiti deliriumis, prionuli daavadebebisa da krunCxvis
(rogorc zemoT iyo aRwerili). mexsierebis sxva, iSvi- gareSe mimdinare epilefsiis dros. aseve, eeg mona-
aTi darRvevebi, aseve saWiroebs guldasmiT gamokvl- cemebi gamoiyeneba stuporis diferencialuri diag-
evas, gansakuTrebiT alkoholdamokidebulebis SemTx- nozisTvis, kerZod, eeg-ze cvlilebebis ararseboba
vevaSi. aucilebelia amneziis `funqciuri~ mizezebis miuTiTebs disociaciur aSlilobaze.
gamoricxvac, radgan mexsierebis darRvevebi SeiZleba w Tavzurgtvinis siTxis (CSF) gamokvleva, lumbaluri
meoradad ganviTardes sxvadasxva fsiqikuri aSlilo- punqciis Semdeg, informaciulia anTebadi da in-
bebis fonze. mag., depresiis dros xandazmul paci- feqciur daavadebaTa diagnozis TvalsazrisiT. CSF
entebs, SeiZleba, `fsevdodemenciis~ saxiT hqondeT gamokvleva ukanasknel dros ufro farTod gamoiy-
_ 346 _
amneziuri sindromi
eneba demenciis diagnozisTvis, radgan aRmoCenilia klinikuri suraTi
sxvadasxva cila, romlebsac prognozuli an diag-
mdgomareobis kardinaluri niSania epizoduri mex-
nostikuri mniSvneloba aqvT.
sierebis deficiti. saerTo klinikuri suraTi sakmaod
w tvinis biofsia, Cveulebriv, marjvena naxevarsfer- gamoxatulia. pirovneba dezorientirebulia droSi,
osi, rekomendebulia, rogorc ukanaskneli meTodi ar axsovs avtobiografiuli faqtebi (xSirad moicavs
gaurkveveli genezis kognituri daqveiTebis diag- sakmaod did epizods), aReniSneba mwvave antero-
nozis dasadgenad. mag., prionuli daavadebebis Sem- graduli amnezia (verbaluri da vizualuri masalis
TxvevaSi; Tumca, yovelTvis unda gaviTvaliswinoT damaxsovrebis mwvave deficiti). pacientma SeiZleba
am meTodis gamoyenebasTan dakavSirebuli riski gaimeoros axlad damaxsovrebuli masala, magram ram-
da kargad avwonoT, Tu ramdenad Seefardeba di- denime wuTSi advilad daiviwyos. amdenad, testis
agnostikuri da prognozuli informaciis miRebis Sedegebi xanmokle mexsierebaze, Cveulebriv, normis
saWiroebas. farglebSia. axali masalis daswavla mniSvnelovnad
gaZnelebulia, Tumca, retrograduli mexsiereba met-
amneziuri sindromi naklebad Senaxulia da axasiaTebs TandaTanobiTi gau-
amnezia aris mexsierebis dakargva, xolo amneziuri areseba axlidan Zveli mogonebebisken (Zveli mogone-
sindromebi an amneziuri daavadebebi iseTi mdgomareobebi ukeTesadaa Senaxuli). sxva kognituri funqciebi
bebia, rodesac aRiniSneba mexsierebis specifikuri da SedarebiT intaqturia, Tumca, xSiria garkveuli emo-
persistentuli darRvevebi (cxrili 14.2). DSM-IV- ciuri gasadavebisa da inertulobis gamovlinebebi.
Si amneziuri sindromi ganmartebulia, rogorc epi- sxva klasikuri niSani, romelic damaxasiaTebelia
zoduri mexsierebis specifikuri darRveva, romlis korsakovis sindromisTvis, esaa konfabulacia, rode-
drosac aRiniSneba axali masalis daswavlis gaZneleba sac mexsierebis Cavardnebi Sevsebulia cocxali da
(anterograduli amnezia) da Zveli movlenebis gax- detaluri, magram mTlianad mcdari mogonebiT, rom-
senebis uunaroba (retrograduli amnezia). amas Tan lis WeSmaritebaSic pacienti darwmunebulia. kon-
axlavs socialuri da okupaciuri funqcionirebis fabulaciebis mqone pirovneba, Cveulebriv, advilad
gauareseba; aseve, saxezea zogadi samedicino prob- eqvemdebareba STagonebas.
lema, romelic kavSirSia mexsierebis daqveiTebasTan. etiologia da paTogenezi
demenciisgan gansxvavebiT, amneziuri sindromis dros
amnezia viTardeba medialuri Talamusis, sxva dience-
mexsierebis darRvevebs ar axlavs inteleqtis zoga-
faluri struqturebis an medialuri safeTqlis wilis
di gauareseba. termini korsakovis sindromi, xSirad
(hipokampi da mimdebare temporaluri korteqsi) da-
SecdomiT ixmareba amneziuri sindromis sinonimad,
zianebis SemTxvevaSi. yvelaze ufro `sufTa~ saxis am-
sinamdvileSi ki mis erT-erT formas warmoadgens (mi-
nezia viTardeba safeTqlis wilis medialuri nawilis
moxilva ix. Kopelman, 2000; Berrios and Hodges, 2000).
dazianebisas. am dros iSviaTia dezorientacia da kon-
fabulaciebi, rac ufro xSirad Talamuri da dience-
cxrili 14.2 amneziis mizezebi faluri struqturebis dazianebis dros iCens Tavs.
neirofsiqologiaSi amneziuri sindromisTvis dam-
gardamavali
axasiaTebeli axali informaciis damuSavebis defeqti
w gardamavali globaluri amnezia (masalis grZelvadian `sacavSi~ moTavseba da Semdgom
w gardamavali epilefsiuri amnezia gaxseneba), sxvadasxva xarisxiT, dazianebis konkretul
w qala-tvinis travma anatomiur mdebareobazea damokidebuli (Hodges, 1994).
w alkoholuri amovardnebi korsakovis sindromi

w posteleqtroSokuri Terapia yvelaze gavrcelebuli amneziuri sindromia koras-
w posttravmuli stresuli aSliloba kovis sindromi, romelic rusma fsiqiatrma korsa-
w fsiqogenuri fuga kovma aRwera 1889 wels. misi alternatiuli saxelwo-
w amnezia kriminalur danaSaulze
deba _ vernike_korsakovis sindromi, Semoitana viq-
torma (Victor et al., 1971), radgan es sindromi xSirad
persistentuli (amneziuri sindromi) aRmocendeba mwvave nevrologiuri paTologiis Sem-
w korsakovis sindromi deg, romelsac vernikes encefalopaTia ewodeba (aR-
w encefaliti wera vernikem 1881 wels). vernikes encefalopaTiis
dros viTardeba deliriumi, sxeulis ataqsia, Tva-
w ukana cerebruli arteriisa da Talamusis insulti
lis moZraobis darRvevebi, nistagmi, oftalmoplegia
w qala-tvinis travma
da periferiuli neiropaTia. korsakovis sindromi,
_ 347 _
Cveulebriv, Tiaminis (B1 vitaminis) naklebobiTaa travmis Sedegad ganviTarebuli amneziuri sindromi
gamowveuli, rac alkoholis borotad moxmarebis prognozis TvalsazrisiT ufro keTilsaimedoa. pro-
Sedegia. Tumca, SeiZleba ganviTardes orsulTa to- gresuli amnezia miuTiTebs nela ganviTarebad struq-
qsikozisa (Hyperemesis gravidarum) da sakvebis mwvave turul dazianebaze, rogoricaa Sua tvinis simsivne.
ukmarisobis drosac. gakveTis Sedegad, rogorc wesi,
aRiniSneba peteqialuri sisxlCaqcevebi, mamilarul gardamavali globaluri amnezia
sxeulebSi astrocitebis degeneracia da dazianebis mniSvnelovania gardamavali globaluri amneziuri
kerebi mesame parkuWis, mediodorsaluri Talamuri sindromis paroqsizmuli nevrologiuri da fsiqi-
birTvebis, ruxi nivTierebisa da varolis xidis midam- atriuli mdgomareobebisgan diferencireba (cxrili
oebSi. amneziuri sindromis sxva mizezebia: simsivneebi 14.3). es mdgomareoba, Cveulebriv, Sua an mogvianebiT
da infarqti medialur TalamusSi (diencefaluri am- asakSi viTardeba. klinikuri suraTisTvis damaxa-
nezia), encefalopaTiebi (gv. 355??). siaTebelia mwvave dasawyisi da naTeli cnobierebis
fonze ganviTarebuli izolirebuli anterograduli
gamokvlevebi da marTva
amnezia, romelic 24 saaTi grZeldeba. gardamavali
mniSvnelovania amneziis arsebobis SesaZleblobis
globaluri amneziis dros funqciuri neirovizua-
mimarT fxizeli damokidebuleba, radgan pacienti
luri kvlevebiT naCvenebia epizoduri mexsierebis
SeiZleba ar tovebdes alkoholis Warbi momxmareblis
maregulirebeli rkalis tranzitoruli hipo da hip-
STabeWdilebas. korsakovis sindromi potenciurad
erperfuziis Sesabamisi disfunqcia. am dros pacien-
Seqcevadi mdgomareobaa. Tiaminis naklebobis damaxa-
tebi dabneulebi arian da saWiroeben mudmivad re-
siaTebeli markeria eriTrocitebis transketolazas
orientacias (saWiroa erTi da imave kiTxvis xanmokle
donis daqveiTeba da MRI signalis intensivobis gaz-
intervalebis Semdeg gameoreba). cnobiereba naTelia
rda Tavis tvinis Suamdebare struqturebSi.
(fsiqologiuri fugisgan gansxvavebiT), Senaxulia sa-
praqtikaSi, Tu ar aris dadgenili sxva etiolo-
kuTari identobis gancda. proceduruli mexsiereba
gia (cxrili 14.2), amneziuri sindromis mizezad,
intaqturia (pacients Setevis periodSi manqanis uSec-
pirvel rigSi, korsakovis sindromi unda miviCnioT
domod tareba SeuZlia). mexsierebis darRvevebis gar-
da dauyovnebliv unda daviwyoT Tiaminis deficitis
da, nevrologiuri gamokvleva sruliad normaluria.
mkurnaloba (gamokvlevis pasuxis miRebamde). Tiamini
rogorc wesi, xdeba sruli gamojanmrTeleba da md-
pacients eZleva parenteralurad. mwvave SemTxveveb-
gomareoba iSviaTad meordeba. Tumca, yovelTvis unda
Si, rehidrataciasTan erTad, xdeba sakvebis miRebis
Catardes gamokvleva, radgan aseTi mdgomareoba Sei-
daregulireba da alkoholuri abstinenciis marTva.
glukozis Semcveli siTxis intravenurad Seyvanamde,
aucilebelia Tiaminis micema. mniSvnelovania nevrolo-
cxrili 14.3 paroqsizmuli neirofsiqiatriuli
simptomebis diferencialuri diagnozi
gebTan da TerapevtebTan mWidro TanamSromloba.
mdgomareobis grZelvadiani marTva saWiroebs in- organuli
tensiur reabilitaciasa da pirovnebis aqtiur mx- w sinkope (kardiogenuri, vazovagaluri, refleqsuri)
ardaWeras, radgan aRiniSneba normaluri funqcioni- w tranzitoruli iSemiuri Seteva
rebisa da Tavis movlis uunaroba. w Sakiki
w epilefsiuri krunCxva
amneziuri sindromis mimdinareoba da prognozi
w hipoglikemia, sxva metaboluri encefalopaTia, feo-
viqtorma (Victor et al., 1971) kolegebTan erTad Seiswav- qromocitoma
la 245 pacienti vernike_korsakovis sindromiT, aqe- w gardamavali globaluri amnezia
dan 96%-s hqonda vernikes encefalopaTia. mwvave w narkolefsia, katapleqsia, somnambulizmi, parasomnia
mdgomareobaSi sikvdilianobis maCvenebeli 17% iyo, w mravlobiTi sklerozi (tonuri spazmebi)
xolo gadarCenili pacientebis 84%-s amneziuri sin- w parkinsonis mkurnalobasTan dakavSirebuli garTulebebi
dromi ganuviTarda. pacientTa naxevris mdgomareoba w wamalmoxmareba (faruli)
ar gaumjobesebula, meoTxedi _ mTlianad gamovida funqciuri
mdgomareobidan, xolo danarCeni _ nawilobriv gamo-
w panikuri Setevebi da hiperventilacia
janmrTelda. kargi gamosavlis winapirobebi iyo diag-
w disociaciuri aSlilobebi
nozamde avadmyofobis xanmokle istoria da TiaminiT
w Sizofrenia
mkurnalobis dauyovnebliv dawyeba.
w bipolaruli afeqturi aSlilobebi
encefalopaTiiT an sxva mizezebiT gamowveuli amne-
w agresiis Setevebi personologiuri aSlilobebis dros
ziuri sindromis prognozi cudia, Tu gvaqvs hipokampu- w risxvis Setevebi (bavSvebSi)
ri an diencefaluri Seuqcevadi dazianeba. qala-tvinis w sunTqvis Sekaveba bavSvebSi
_ 348 _
deliriumi
Zleba ganviTardes safeTqlis wilis simsivnis SemTx- saZlebelia. xSiria damokidebulebis ideebi da
vevaSic. aseve, unda gamoiricxos amneziuri sindromis bodva (upiratesad, devnis), magram gardamavali da
sxva mizezebic (cxrili 14.2). gardamavali global- naklebad Camoyalibebulia. mxedvelobiTi aRqma,
uri amneziis mqone pacientebi, ZiriTadad, gadaude- Cveulebriv, Secvlilia. damaxasiaTebelia iluziebis,
beli Terapiis ganyofilebaSi an ojaxis eqimebTan cru Secnobebis an (zogjer fantastikuri Sinaarsis)
mkurnaloben, sadac maT SeiZleba arasworad dausvan vizualuri halucinaciebis arseboba. SeiZleba aRe
disociaciuri fugis diagnozi. niSnebodes taqtiluri da smeniTi halucinaciebic.
aseve, xSiria depresia, SfoTva da emociuri meryeoba.
deliriumi pacienti SeiZleba SeSinebuli an dabneuli iyos.
zogjer pirovneba aRwers depersonalizaciisa da
deliriumisTvis damaxasiaTebelia cnobierebis glo
derealizaciis gancdas. gansakuTrebiT, darRveulia
baluri gauareseba (gabruebidan komamde), rac iwvevs
yuradReba da mimdinare movlenebis fiqsacia, amitom
gare movlenebis aRqmisa da maT mimarT yuradRebisa
mdgomareobidan gamosvlis Semdeg, rogorc wesi,
da sifxizlis daqveiTebas. am mdgomareobas sxva
deliriumis periodi amnezirebulia.
terminebiTac aRniSnaven, mag., `konfuziuri mdgo
mareoba~ an `mwvave organuli sindromi~, Tumca, orive
etiologia
klasifikaciaSi gamoyenebulia termini `deliriumi~.
deliriumi uviTardeba Terapiul da qirurgiul deliriumis ZiriTadi mizezebi CamoTvlilia cxrilSi
ganyofilebaSi moTavsebuli pacientebis 15_30%- (cxrili 14.4). xandazmuli asaki, zogadi sisuste da
s; ufro mets _ intensiuri Terapiis ganyofilebaSi arsebuli somaturi an nevrologiuri daavadebebi
(Lipowski, 1990). dileriumi ufro xSirad uviTardebaT
xandazmul pirebs, romlebsac `SezRuduli cerebruli
cxrili 14.4 deliriumis gamomwvevi mizezebi
unarebi~ an demencia aqvT. prognozi damokidebulia wamlebi
gamomwvev mizezze. ZiriTadad, pacientebi male
w alkoholuri intoqsikacia
gamodian mdgomareobidan, xolo SemTxvevaTa 25% sami w alkoholuri abstinencia da TeTri cxeleba
Tvis manZilze letalurad mTavrdeba. monacemebi w opiatebi
imis Taobaze, rom deliriumi demenciaSi gadadis, ar w samkurnalod daniSnuli medikamentebi
arsebobs (deliriumisa da misi marTvis sakiTxebi ix. w nebismieri antiqolinerguli moqmedebis preparatebi
Burns et al., 2004). w nebismieri sedaciuri saSualeba
w digoqsini
klinikuri niSnebi w Sardmdenebi
deliriumis ZiriTadi niSania cnobierebis darRveva. w liTiumi
am dros pirovneba gabruebulia, adgilsa da dro w steroidebi
Si dezorientirebulia, srulad ver aRiqvams ga samedicino mdgomareobebi
re movlenebs da axasiaTebs yuradRebis swrafi
w febriluri daavadebebi (magaliTad, saSarde gzebis
gadanacvleba. mwvave SemTxvevebSi pacients SeiZ infeqcia)
leba hqondes stuporozuli mdgomareoba da ar w septicemia
reagirebdes gare gamRizianeblebze, Tumca, umetesad, w ukmarisoba (RviZlis, Tirkmlis, gulis)
Secvlili cnobiereba naklebad SesamCnevia. amdenad, w hipo an hiperglikemia
pirvel niSnebs, romlebic deliriumze miuTiTeben, w postoperaciuli hipoqsia
miekuTvneba: fsiqikuri funqciebis Seneleba, yurad w Tiaminis deficiti
Rebis gadanacvleba, aRqmis paTologia da dReRamuri
nevrologiuri daavadebebi
ciklis darRveva.
simptomebi da niSnebi didi mravalferovnebiT w epilefsiuri krunCxva (postiqtaluri)
gamoirCeva. erTsa da imave pacients dRis sxvadasxva w qalatvinis travma

w moculobiTi simsivneebi
periodSi an sxvadasxva pacients, SeiZleba sruliad
w encefalitebi
gansxvavebuli gamovlinebebi hqondes. mag., zo
w cerebruli hemoragia
gi pacienti gaRizianebuli, mousvenari da hiper
aqtiuria da fsiqozuri simptomebi aqvs, xolo zogi sxva
fsiqomotorulad Senelebulia da perseveraciebi w yabzoba
aReniSeneba. ganmeorebadi, umizno qceva orive w faRaraTi
mdgomareobisTvisaa damaxasiaTebeli. azrovneba Se w tkivili
nelebuli da abneulia, Tumca, azris gageba Se w sensoruli deprivacia
_ 349 _
zrdis deliriumis ganviTarebis risks. benzodiazepinisa da qlordiazepoqsidis dozebis
deliriumis ganviTarebis paTofiziologiuri sa TandaTanobiTi SemcirebiT warmoebs. RviZlis ukma
fuZvlebi ucnobia. mdgomareobis simwvave korelirebs risobis dros yvela wamali minimalur dozebSi unda
eeg-ze cerebruli ritmis Senelebis xarisxTan. aseve, davniSnoT, raTa ar ganviTardes RviZlismieri koma.
naCvenebia neirotransmiterebis _ dofaminisa da
acetilqolinis, monawileobac (Tzepacz, 2000). demencia
demencia gulisxmobs inteleqtis, mexsierebisa da
deliriumis marTva
pirovnebis globalur daqveiTebas cnobierebis dar
zogadi sakiTxebi
deliriumi samedicino gadaudebeli problemaa. cxrili 14.5 demenciis mizezebi
mniSvnelovania misi gamomwvevi mizezis dadgena da
pirveladi neirodegeneraciuli daavadebebi
mkurnaloba. deliriumi xSirad aris Sedegi wamlebis
alchaimeris daavadeba*, levis sxeulebis demencia, pikis
rogorc moxmarebis, ise abstinenciis, amitom es daavadeba da sxva frontotemporaluri demencia*,
mizezi Tavidanve unda gamoiricxos. distresis parkinsonis daavadeba*, prionuli daavadebebi*,
Semsubuqebis, agznebis kontrolisa da gamofitvis hanTingTonis daavadeba*.
prevenciis mizniT saswrafo zomebis miReba iseve vaskuluri
aucilebelia, rogorc gamokvlevebis dauyovnebliv vaskuluri demencia, mravlobiTi insulti, fokaluri
Catareba. amis ganxorcieleba SesaZlebelia, Tu pa Talamuri da bazaluri gangliis insulti, subduruli
hematoma.
cients xSirad mivcemT axsna-ganmartebebs, reori
entacias da gavamxnevebT mas. sasurvelia, pacients anTebiTi da autoimunuri
emsaxurebodes erTi da igive samedicino personali. wiTeli mglura da sxva vaskulitebi, rodesac
centraluri nervuli sistemac CaTreulia. Bechet-is
idealur SemTxvevaSi, pacienti unda movaTavsoT
daavadeba, neirosarkoidozi, Hashimoto-s encefalopaTia,
mSvid garemoSi, calke oTaxSi. axloblebi xSirad mravlobiTi sklerozi.
unda naxulobdnen mas. Ramis ganaTeba sakmarisi unda
travmuli
iyos orientaciisTvis da Tanac iseTi, rom xels ar
mZime qalatvinis dazianeba an ganmeorebiTi qalatvinis
uSlides Zils (mimoxilva ix. amerikis fsiqiatrTa travma (magaliTad, mokriveebSi mokriveebis demencia)
asociacia _ APA, 1999; Burns et al., 2004). da sxva.
medikamenturi mkurnaloba infeqciebi da maTTan dakavSirebuli mdgomareobebi

aiv infeqcia, prionuli daavadebebi, neirosifilisi,
pirvel rigSi, unda gamovavlinoT deliriumis postencefaliti, limis daavadeba
gamomwvevi mizezi, raTa minimalurad gamoviyenoT
metaboluri da endokrinuli
sxva medikamentebi. Tumca, miuxedavad zogadi (zemoT
qronikuli uremia, Tirkmlis dializi, RviZlis
aRwerili) intervenciisa, romelic yovelTvis Ta ukmarisoba, hipoTiroidizmi, hiperTiroidizmi (apaTiuri
vidanve unda ganxorcieldes, SesaZlebelia agzne an maskirebuli), hipoglikemia, kuSingis sindromi,
bis, distresisa da Zilis mosawesrigeblad saWiro hipopituitarizmi, Tirkmelzeda jirkvlis ukmarisoba
gaxdes medikamentebis daniSvna. pirveli arCevis simsivneebi
wamlebi, Cveulebriv, antifsiqozuri preparatebia. ixileT cxrili 14.21
haloperidoli iniSneba dozebis TandaTanobiTi
postradiaciuli
matebiT, sanam ar miiRweva sasurveli efeqti ga
ixileT cxrili 14.21
dametebuli sedaciisa da gverdiTi movlenebis gareSe.
es doza meryeobs 2_10 mg/dRe farglebSi. Tu saWiro postanoqsiuri
gaxda, pirveli doza SeiZleba intramuskulurad mwvave anemia, operaciisSemdgomi (gansakuTrebiT, gulis
Suntireba), naxSirJangiT mowamvla, qronikuli filtvis
gakeTdes. deliriumis gamomwvevi zogierTi mizezis ukmarisoba
arsebobis SemTxvevaSi, antifsiqozuri preparatebi
vitaminebisa da sxva nivTierebebis nakleboba
didi sifrTxiliT unda gamoviyenoT, mag., demenciis,
B12 vitamini, foliumis mJava
kerZod, levis sxeulebis (Lewy bodies) demenciis dros
aseTi pacientebi gansakuTrebiT mgrZnobiareni arian toqsikuri
antifsiqozuri preparatebis mimarT. antifsiqozuri alkoholi, mZime metalebiT mowamvla, organuli
nivTierebebiT, organofosfatebiT intoqsikacia
medikamentebis daniSvnas unda moveridoT alko
holuri abstinenciis (TeTri cxelebis) an epilefsiis sxva
SemTxvevaSi, radgan izrdeba krunCxvebis ganviTarebis hidrocefalia (normaluri wneviT)
riski. TeTri cxelebis standartuli mkurnaloba *genetikurad determinirebuli formebi
_ 350 _
demencia
Rvevis gareSe (Lishman, 1998). igi upiratesad, magram cientis premorbiduli pirovnuli Tvisebebi. kargi
ara yovelTvis, progresirebs. demencias iwvevs socialuri unarebis mqone pirebi, inteleqtis daq
bevri daavadeba (cxrili 14.5), maT Soris yvelaze veiTebis miuxedavad, agrZeleben adekvatur fun
gavrcelebulia alchaimeris daavadeba (SemTxvevaTa qcionirebas. asakovani, socialurad izolirebuli,
50_60%), vaskuluri demencia (20_25%) da levis cudi smenadobis mqone pirebi ki naklebad axerxeben
sxeulebis demencia (15_20%) (mimoxilva ix. Ritchie and daqveiTebuli inteleqtualuri SesaZleblobebis kom
Lovestone, 2002). pensirebas. amasTan, maTi problemebi, SeiZleba ara
demencia globaluri da generalizebuli aSlilobaa, saTanadod iqnes Sefasebuli an ugulebelyofilic ki.
Tumca, xSirad iwyeba fokaluri kognituri an qceviTi Cveulebriv, yvelaze pirveli da TvalsaCino simptomia
darRvevebiT. orive klasifikaciiT _ rogorc gulmaviwyoba, Tumca, misi adreul stadiebze gamovlena
ICD-10-iT, aseve, DSM-IV-iT, demenciis diagnozis yovelTvis advili araa. mexsierebis problemebi
dasmisTvis saWiroa ori an orze meti kognituri ar aris anatomiurad lokalizebuli: SeiZleba ga
funqciis (mexsierebis, metyvelebis, abstraqtuli movlindes registraciis (frontotemporaluri kav
azrovnebisa da msjelobis, vizuoperceptualuri Sirebi), kodirebis (medialuri safeTqlis wili) an
unarebis, pirovnuli Taviseburebebisa da socialuri reminescenciis (Sublis wili) unaris daqveiTebis
funqcionirebis) iseTi gauareseba, romelic gavlenas saxiT. yuradRebisa da koncentraciis deficiti
axdens socialur da okupaciur funqcionirebaze. gvxvdeba xSirad, magram ar aris specifikuri niSani.
Tavdapirvelad gamovlenili deficiti SeiZleba iyos erT-erTi yvelaze gamoxatuli maxasiaTebelia axa
umniSvnelo an situaciuri da ver akmayofilebdes am li masalis daswavlis gaZneleba. mexsiereba daq
kriteriumebs. aseT SemTxvevaSi saqme gvaqvs msubuq veiTebulia ufro metad axali, vidre Zveli
kognitur daqveiTebasTan (ix. gv. 334??). demenciis movlenebis mimarT. epizoduri mexsierebis darRvevebi
dros deliriumisTvis damaxasiaTebeli fxizeli pe vlindeba axlo warsulis movlenebis Tanmimdevruli
riodebis fluqtuacia, Cveulebriv, ar aRiniSneba, daviwyebiT. SedarebiT Senaxulia warsuli codna
garda levis sxeulebis demenciisa, rodesac saxezea da gamocdileba (yovel SemTxvevaSi, Tavidan), mag.,
cnobierebis gardamavali darRvevebi (ix. qvemoT). velosipedis tareba an zogadi codna samyaros
am TavSi ganxilulia demenciisTvis, rogorc kla Sesaxeb. semantikuri mexsierebis darRvevebis dros
nikuri sindromisTvis, damaxasiaTebeli klinikuri (mag., frontotemporaluri demenciis dros), sityvebi
niSnebi da maTi gamokvlevis principebi. Semdeg vi da, Sesabamisad, sagnebi, romlebsac es sityvebi
saubrebT demenciis gamomwvevi ZiriTadi daavadebebis aRniSnaven, kargaven TavianT mniSvnelobas.
klinikur, epidemiologiur, etiologiur da nev daqveiTebulia axal situaciasTan adaptaciis una
ropaTologiur Taviseburebebze. cxrilSi 14.5 moce ri. pirovneba naklebad moqnilia, rigidulad da
mulia sxva neirofsiqiatriuli daavadebebic, rom stereotipulad icavs cxovrebis dadgenil wess
lebic SedarebiT iSviaTad an naklebi xarisxiT iwveven (òrganuli mowesrigebuloba~). moxvedra iseT si
kognitur daqveiTebas (mag., gafantuli sklerozi, tuaciaSi, romelic pacientisgan zedmet Zalis
hidrocefalia normaluri wneviT), rasac winamdebare xmevas moiTxovs, xSirad iwvevs ganrisxebas an glovis
Tavis Semdeg nawilSi mimovixilavT. cxrilSi 14.5. reaqcias (`katastrofuli reaqcia~). demenciis
CamoTvlilia samedicino daavadebebi (mag., wi gauaresebasTan erTad, pirovneba naklebad axerxebs
Teli mglura), romlebic me-16 TavSia mocemuli. Tavis movlas da ugulebelyofs socialur normebs.
fsiqoaqtiuri nivTierebebiT, gansakuTrebiT, alko damaxasiaTebelia droSi, mogvianebiT, adgilsa da
holis moxmarebiT gamowveuli demencia me-18 TavSia sakuTar TavSi dezorientacia, qceva xdeba umizno.
(gv. 354??) ganxiluli. demenciis mkurnaloba da SesaZlebelia, saxeze iyos stereotipia da maneruloba.
marTva, agreTve, demenciis kavSiri asakTan mocemulia azrovneba Senelebuli da TandaTan Sinaarsobrivad
me-20 TavSi. perseveraciuli da Raribi xdeba. advilad aRmo
cendeba mcdari ideebi (ufro devnis Sinaarsis).
demenciis klinikuri niSnebi daavadebis mogvianebiT etapze azrovneba sruliad
yvelaze xSirad uCivian mexsierebis daqveiTebas. sxva fragmentuli da inkoherentulia, rac aisaxeba
simptomebia: qcevis, metyvelebis, personologiuri, metyvelebaSi sintaqsuri da disnomiuri Secdomebis
guneb-ganwyobisa da aRqmis darRvevebi. demenciis saxiT. ukanasknel stadiaze pirovnebam SeiZleba
ganviTarebas xSirad biZgs aZlevs Secvlili so dakargos metyvelebis unari da dadumdes. maRalia
cialuri garemo an interkurentuli daavadebebi. letaloba. sikvdils, ufro xSirad, bronqopnevmonia
demenciis mqone pacientebi ufro metad arian mid an terminaluri koma uZRvis win.
rekilebi deliriumisadmi. demenciis dros qceviTi, afeqturi da fsiqozuri
klinikur niSnebs mniSvnelovnad gansazRvravs pa simptomebi kognituri daqveiTebis xSiri Tanmxlebi
_ 351 _
cxrili 14.6 klinikuri niSnebi, romlebic gvexmareba demenciis mTavari gamomwvevi mizezebis
diferencirebaSi
gamoxatuli niSnebi da simptomebi sxva klinikuri Taviseburebebi
alchaimeris mexsierebis, gansakuTrebiT xanmokle mexsierebis, da swrafad progresirebs,

daavadeba kargva, disfazia da dispraqsia, ynosvis daqveiTeba, grZeldeba 58 weli
qceviTi darRvevebi (magaliTad, xetiali)
vaskuluri demencia pirovnuli cvlilebebi, emociuri labiloba, Senaxulia safexureobrivi progresireba, ce

kritika daavadebis mimarT rebrovaskuluri daavadebis niS
nebi, anamnezSi hipertenziis ar
seboba, ufro xSiria mamakacebsa da
mwevelebSi
levis sxeulebis fxizlad yofnis periodebis fluqtuacia, parkinsonizmi, antifsiqozuri preparatebis mi

demencia mxedvelobiTi halucinaciebi, xSirad Zirs dacema da marT momatebuli mgrZnobeloba
gulis wasvla
frontotemporaluri gamoxatuli qceviTi darRvevebi, eqspresiuli disfazia, Cveulebriv, iwyeba 70 wlamde.

demencia daavadebis mimarT kritikis adreul stadiazeve dakargva, iyofa klinikur qvetipebad
primitiuli refleqsebis arseboba
hanTingTonis Sizofreniismagvari fsiqozi, anomaliuri moZraobebi iwyeba cxovrebis mesamemexuTe de

daavadeba (qoreaformuli), depresia da gaRizianebadoba. demencia kadaSi. ojaxuri anamnezis arseboba
mogvianebiT viTardeba
prionuli mioklonuri krunCxvebi, krunCxviTi Setevebi, cerebruli xSirad adreuli dasawyisi, swrafi
daavadebebi ataqsia, fsiqiatriuli simptomebi dawyebiTa da progresirebiT. ga
damdebia
hidrocefalia mentaluri Seneleba, apaTia, uyuradReboba, Sardis gvxvdeba 5070 wlis pirebSi. aqvs
normaluri wneviT Seukavebloba, siarulis Secvla (siarulis maneris apraqsia) Seqcevadi xasiaTi
niSnebia. maT, savaraudod, daavadebis biologiuri inteleqtualuri amocanebis gadawyvetis problemebi,

procesebi udevs safuZvlad. Tumca, adreul sta emociuri gasadaveba da pirovnuli daqveiTeba;
diaze, rodesac kritika Senaxulia, am simptomebs, xolo metyvelebis, daTvlisa da daswavlis unarebi
SesaZloa, daavadebaze fsiqologiuri pasuxi gana SedarebiT Senaxulia. amis sapirispirod, kortikuli
pirobebdes. yvelaze xSiria afeqturi paTologia, demenciis dros, mag., alchaimeris demenciis
romelsac Tan axlavs SfoTva, gaRizianebadoba da SemTxvevaSi, aRiniSneba mexsierebis, saxeldebisa da
agresiac. mogvianebiT emociuri reaqciebi gasa mxedvelobiT-sivrciTi procesebis disfunqcia.
davebulia. iSviaTad, SesaZlebelia moxdes guneb_
preseniluri da seniluri demencia
ganwyobis ucabedi da moulodneli cvlilebebis
ganviTareba. demenciis SemTxvevaSi xSiria fsiqozuri warsulSi mkveTrad ganasxvavebdnen 65 wlamde
simptomebi da isini gardamavali xasiaTisaa. balansi ganviTarebul demenciasa (preseniluri demencia) da
demenciis ZiriTad niSnebsa da simptomebs Soris, sxva 65 wlis Semdeg ganviTarebul demencias (seniluri
TaviseburebebTan erTad, qmnis demenciis klinikuri demencia), im mosazrebidan gamomdinare, rom maT
diferencirebis safuZvels (cxrili 14.6), rasac am sxvadasxva mizezi ganapirobebda. kerZod, iTvleboda,
TavSi mogvianebiT ganvixilavT. rom preseniluri demencia ZiriTadad alchaimeris
daavadebiT iyo gamowveuli, xolo seniluri ki,
subkortikuli da kortikuli demencia upiratesad, vaskulur demenciad miaCndaT. dReisTvis
savaraudo neiroanatomiuri Taviseburebebidan cnobilia, rom orive asakobriv jgufSi alchaimeris
gamomdinare, ganasxvaveben kortikul da subkortikul daavadeba demenciis mTavar mizezs warmoadgens da,
demencias (Cummings, 1990), Tumca, klinikuri da amdenad, aseTi dayofa dRes aRaraa aqtualuri. Tumca,
paTologiuri niSnebis mixedviT aseTi gamijvna sak arsebobs ramdenime aspeqti, romelTa mixedviTac
maod bundovania da mas mxolod aRwerilobiTi ganasxvaveben senilur da presenilur demenciebs
mniSvneloba aqvs (Turner et al., 2002). ZiriTadi (Greicius et al., 2002). preseniluri demenciis dros,
maxasiaTeblebi Sejamebulia cxrilSi 14.7, xolo am vaskulurTan SedarebiT, ufro xSiria genetikurad
mdgomareobebis magaliTebi CamoTvlilia cxrilSi ganpirobebuli daavadebebiT gamowveuli demencia,
14.8. termini `subkortikuli demencia~, aRniSnavs frontotemporaluri demencia da prionuli daava
iseT mdgomareobas, romlisTvisac damaxasiaTebelia debebiT gamowveuli demencia. es gansazRvravs daa
azrovnebis Seneleba, kompleqsuri, Tanmimdevruli, vadebis marTvis Taviseburebebsac. preseniluri
_ 352 _
demencia
pasuxi unda gaeces, imis dadgenaa, aris Tu ara
cxrili 14.7 kortikuli da subkortikuli demencia. unda gamovricxoT deliriumi, amnezia,
demenciis niSnebi
fsevdodemencia (gv. 326??) da unda vixelmZRvaneloT
subkortikuli kortikuli me-3 TavSi aRwerili Sefasebis principebiT. demenciis
diagnozis dasmis Semdeg, vafasebT simptomebis
mexsierebis zomieri gamoxatuli,
daqveiTeba adreul etapze simwvaves, qceviT darRvevebsa da riskis xarisxs;
bolos, vikvlevT gamomwvev mizezs (mimoxilva ix.
maTematikuri Senaxulia gauaresebulia
unarebi adreuli Fleminger, 2000a; Rossand and Bowen, 2002).
etapidanve
demenciis simwvavisa da profilis gansazRvra
metyveleba normaluri disfazia,
adreul etapze skrining-testebiT efeqturad xdeba demenciisa da misi
simwvavis Sefaseba, aseve, daavadebis progresirebis
pirovnuli apaTiuri, ganurCeveli
Tvisebebi inertuli gansazRvra. sxvadasxva skalebiT fasdeba kognicia,
qceva, globaluri funqcionireba, yoveldRiuri
gunebganwyoba gasadavebuli, normaluri
depresiuli aqtivoba da depresia. mniSvnelovania am ukanasknelis
dadgena, radgan depresia SesaZlebelia Tan axldes
koordinacia darRveuli normaluri
demencias da ufro auaresebdes funqcionirebas.
kognituri da Senelebuli normaluri zogierTi kvlevis testi CamoTvlilia cxrilSi
motoruli
aqtivoba 14.9. kognituri gauaresebis Sefasebis saorientacio
testia mini-mentaluri gamokvlevis skala (mocemulia
anomaliuri damaxasiaTebelia iSviaTia
moZraobebi tremori an me_3 Tavis danarTSi), romlis specifikuroba da
qoreaformuli sensitiuroba demenciis mimarT `23~ zRvruli qulis
moZraobebi SemTxvevaSi 80%_ia.
Svidi wuTis testi da saaTis testebi validuri da
cxrili 14.8 kortikuli, subkortikuli da mokle alternativaa. ADAS-Cog arCeviTad alchaimeris
Sereuli demenciis gamomwvevi mizezebi daavadebisTvisaa SemuSavebuli da mdgomareobis
kortikuli
cxrili 14.9 demenciis skriningis testebi
w alchaimeri
w frontotemporaluri kognituri funqciebi
w Creutzfeldt-Jacob (kreicfeldiakobis) daavadeba
w minimentaluri gamokvlevis skala (MMSE)
subkortikuli w SvidwuTiani skriningi (7MS)
w saaTis testi
w hidrocefalia noramluri wneviT w hopkinsis verbaluri daswavlis testi (HVLT)
w hanTingTonis daavadeba w mentaluri testi (MTS)
w parkinsonis daavadeba w alchaimeris daavadebis Sefasebis skala kognituri
w fokaluri Talamuri da bazaluri gangliis dazianeba seqcia (ADAS-Cog)
w gafantuli sklerozi w kembrijis asakovani pirebis fsiqikuri aSlilobebis
Sefasebis testi kognituri nawili (CAMCOG)
Sereuli
qceviTi da fsiqologiuri maxasiaTeblebi
w vaskuluri demencia
w levis sxeulebis demencia w neirofsiqiatriuli gamokvleva
w kortikobazaluri degeneracia w demenciis fsiqopaTologiis Sefasebis manCesterisa da
w neirosifilisi oqsfordis universitetebis skala (MOUSPAD)
w alchaimeris qcevis Sefasebis kiTxvari (BEHAVE-AD)
demenciis SemTxvevaSi, ufro mosalodnelia, rom w koenmasfildis agresiis Sefasebis kiTxvari
pacientma mimarTos nevrologs da mxolod mogvi dRiuri aqtivobis Sefaseba

anebiT fsiqiatrs. gamokvlevebi ufro intensiuri
w bristolis skala
da kompleqsuria, radgan aucilebelia gamomwvevi w alchaimeris funqcionirebis Sefasebisa da
mizezis zusti diagnostireba da prognozis gan funqcionirebis cvlilebebis skala
w unarebis daqveiTebis Sefaseba demenciis dros
sazRvra. genetikuri daavadebis SemTxvevaSi, gamok
vlevis Sedegebs garkveuli mniSvneloba aqvs naTe depresia
savebisTvisac (Sampson et al., 2004).
w kornelis skala
w geriatriuli depresiis Sefasebis skala
demenciis Sefaseba
globaluri Sefaseba
kognituri problemebis mqone pirovnebis gamokvleva
ramdenime etaps moicavs. pirveli sakiTxi, rasac w klinikuri demenciis Sefaseba (CDR)
_ 353 _
progresirebis gansazRvrisTvis gamoiyeneba. xolo, glukozis metabolizmi), struqturuli da nevro
CAMCOG-s samecniero kvlevebisTvis iyeneben. logiuri darRvevebi didi xniT adre iCens Tavs
qceviTi simptomebis guldasmiT Sefaseba demenciis (Scheltens et al., 2002; Nestor et al., 2004). mag., hipokampis
gamokvlevis mniSvnelovan nawils warmoadgens. yovelwliurad 2%-iT (normaa mxolod 0.5%) atrofia
aucilebelia maTi periodulad gadamowmeba, radgan alchaimeris daavadebis simptomebis gamovlenamde
xSiria da pacientis movlasTan dakavSirebiT uamrav ramdenime wliT adre iwyeba. Tavzurgtvinis siTxeSi
problemas qmnis. es sakiTxi detalurad me-20 TavSia maRali specifikurobiTa da sensitiurobiT SeiZleba
ganxiluli (gv. 507??). specifikuri cilebis gamovlena (mag., -amiloidi da
tau, ix. qvemoT) (Blennow and Hampel, 2003). dReistvis,
demenciis dros riskis gansazRvra
pozitronul-emisiuri tomografiiT SesaZlebelia
demenciis mqone pacientebi maRali riskis jgufs tvinSi _amiloidis adgilmdebareobis gansazRvra (PIB
miekuTvnebian. xSiria Tavis movlis ugulebelyofa, ligandis gamoyenebiT). es mniSvnelovnad aumjobesebs
moxetiale cxovrebis stili da Zaladobis SemTxvevebi. alchaimeris daavadebis droulad diagnostirebis
gamomdinare iqidan, rom daavadebas axasiaTebs qceviTi Sansebs an, daavadebis ganviTarebis SemTxvevaSi, gvex
ganmuxruWeba da agresia, SeiZleba gareSemomyofebs mareba sxva demenciebisgan diferencialuri diagnozis
safrTxe SeeqmnaT. specifikuri sakiTxia manqanis dasmaSi.
marTvis mowmobis gacema. daavadebis sawyis etapze amis premorbiduli diagnostireba klinikurad Zalian
dadgena gansakuTrebiT Znelia (Brown and Ott, 2004). mniSvnelovania, radgan uaxloes momavalSi ukve
britaneTSi arsebuli regulaciiT, demenciis neli SesaZlebeli iqneba misi prevencia an daavadebis
`progresirebis~ dros, im pirebs, romlebsac aqvT retardaciuli mkurnaloba (me-20 Tavi).
`saTanado gamocdileba~, marTvis mowmobis licenziis
gasagrZeleblad yovelwliurad utardebaT gamokvleva. demenciis mizezis gansazRvra
amdenad, riskis gansazRvra demenciis Sefasebis demenciis mizezis zusti gamovlena SesaZlebelia
ganuyofeli nawilia. Zalian mniSvnelovania anamnezis mxolod nevropaTologiuri gamokvlevebiTa da, iSviaT
srulfasovnad Sekreba da axloblebis gamokiTxva. SemTxvevaSi, genetikuri mutaciis identifikaciiT.
okupaciur Terapevts gansakuTrebuli roli eniWeba Tumca, sxvadasxva demenciis ganmasxvavebeli niSnebi
pirovnebis funqcionirebis xarisxis dadgenaSi. gamocdil klinicists `savaraudo~ diagnozis dasmis
saSualebas aZlevs. mag., naCvenebia, rom alchaimeris
demenciis adreuli gamovlena
diagnozi SemTxvevaTa 88%-Si autofsiiT dadasturda
msubuqi kognituri daqveiTeba (Burns et al., 1990). gavrcelebuli mizezebiT gamo
gazrdilia interesi demenciis adreuli diagnos wveuli demenciis SemTxvevaSi, bioqimiuri, radio
tirebis mniSvnelobis mimarT. am mxriv, sayuradReboa logiuri da genetikuri gamokvlevebi zomierad
pirovnebis subieqturi Civili mexsierebis gaua zrdis diagnozis dazustebis Sansebs, amasTan maTi
resebaze (Peterson et al., 2001). ICD-10-Si aseT mdgo monacemebi mniSvnelovania demenciis iSviaTi an
mareobas msubuqi kognituri daqveiTeba ewodeba.
SemTxvevaTa 10_20%-Si erTi wlis manZilze demencia cxrili 14.10 bazisuri gamokvlevebi demenciis
viTardeba. am etapis dadgena ufro didi sizustiT dros
SesaZlebelia neirofsiqologiuri testebiT yvela pacientisTvis
(Blackwell et al., 2004). nevropaTologiurad msubuqi
w sisxlis saerTo analizi
kognituri daqveiTeba asocirebulia alchaimeris w eriTrocitebis sedimentaciis siCqare
daavadebebisTvis damaxasiaTebel cvlilebebTan da w Sardovana da eleqtrolitebi
vaskulur paTologiasTan (Bennett et al., 2005); (msu w RviZlis funqciebi
w kalciumi da fosfati
buqi kognituri daqveiTebis mimoxilva ix. Davis and w Tiroidis funqcia
Rockwood, 2004). w serologiuri analizi sifilisze
w Sardis saerTo analizi
presimptomuri diagnozi w foliati da B12
arsebobs mzardi monacemebi imisa, rom alchaimeris SesaZloa saWiro gaxdes

diagnostireba premorbiduladaa SesaZlebeli, bevrad w aiv gamokvleva
adre, vidre simptomebi gamovlindeba. grZelvadianma w gulmkerdis radiografia
kvlvebma aCvena, rom arsebobs seleqciuri da da w eleqtrokardiograma
w kompiuteruli tomografia, magniturrezonansuli
maxasiaTebeli nevropaTologiuri niSnebi, romelTa gamokvleva
gamovlenac daavadebis ganviTarebamde 20 wliT adrea w eleqtroencefalografia
w neirofsiqologiuri gamokvlevebi
SesaZlebeli. Tavis tvinis funqciuri (regionaluri
_ 354 _
demencia
Seqcevadi mizezebis gamosaricxad an gamosavlenad
(Lovestone, 2000; Sheltens et al., 2002). cxrilSi 14.10
cxrili 14.11 alchaimeris daavadebis ZiriTadi
klinikuri niSnebi (DSM IV-is mixedviT)
Sejamebulia demenciis sabaziso kvlevis meTodebi.
asakis, anamnezis, sawyisi testebis monacemebisa da mexsierebis daqveiTeba;
Semdgomi diferencialuri diagnozisTvis, SesaZloa, TandaTanobiTi dasawyisi da progresuli gauareseba;
metad specifikuri gamokvlevebis Catareba gaxdes erTi an meti qveviT CamoTvlili niSnebis arseboba:
saWiro. axalgazrda pacientebis SemTxvevaSi (rogorc w afazia,
w apraqsia,
zemoT aRvniSneT), gamokvlevebi ufro intensiur
w agnozia,
xasiaTs atarebs.
w aRmasrulebeli funqciebis deficiti (dagegmva,
msjeloba).
alchaimeris daavadeba demenciis gamomwvevi sxva daavadebebi ar aRiniSneba.
1907 wels alchaimerma gamoaqveyna daavadebis aR
wera erTi preseniluri demenciis diagnozis mqo depresia
ne qalbatonisa (Auguste D), romlis tvinSic damaxa
depresiasa da alchaimeris daavadebas Soris rTuli
siaTebeli cvlilebebi naxes. krepelinma aseT mdgo
urTierTkavSiri arsebobs. depresia alchaimeris
mareobas alchaimeris daavadeba uwoda (Maurer et al.,
demenciis ganviTarebis risk-faqtoria. depresia
1997). didi xnis manZilze iTvleboda, rom es iSviaTi
SeiZleba demenciaSi agverios an SeiZleba mis nawils
daavadebaa da, rom mxolod presenilur demencias
warmoadgendes. pacientTa 10%-s didi depresia
udevs safuZvlad. Semdgomi klasikuri kvlevebiT
aReniSneba, xolo nakleb gamoxatuli an calkeuli
rotma (Roth) daadgina, rom es daavadeba seniluri
depresiuli simptomebi 50%-s uviTardeba. depresiis
demenciis yvelaze xSiri mizezia (Blessed et al., 1968).
mqone pacientebs autofsiiT serotoninisa da
es monacemebi daadastura mosaxleobis SedarebiT
noradrenerguli markerebis daqveiTeba metad aqvT
axalma gamokvlevamac, romlis mixedviT, demenciis
gamoxatuli, vidre alchaimeris daavadebis mqone sxva
mqone pacientebis 64%-s autofsiiT alchaimeris
pacientebs.
daavadeba daudasturda (Neuropathology Group of the MRC
Cognitive Functioning and Aging Study, 2001). daavadebis fsiqozuri simptomebi
gavrcelebis sixSire 65 wlis asakisTvis 1_2%-ia, 80
bodviTi ideebi da halucinaciebi, daavadebis
wlisTvis _ 8_10%, xolo 90 wlisTvis 30_40%-mde
garkveul stadiaze, iSviaTad viTardeba. maTi sixSiris
izrdeba (Nassbaum and Ellis, 2003; ix. gamosaxuleba 20.3,
zusti gansazRvra Znelia, kvlevaTa umravlesobaSi
gv. 499??; alchaimeris daavadebis epidemiologiis
ar aris gamijnuli alchaimerisa da levis sxeulebis
mimoxilva ix. Jorm, 2000).
demencia (ix. qvemoT). ukanaskneli kvlevebiT bodviTi
alchaimeris daavadebis klinikuri niSnebi ideebi SemTxvevaTa 10_50%-Si, xolo halucinaciebi
_ 10_25%-Sia naCvenebi. yvelaze damaxasiaTebelia
alchaimeris daavadebis (ufro sworia vixmaroT
qurdobis Sinaarsis Semcveli devnis bodva (Tumca,
termini àlchaimeris tipis demencia~, radgan
Tu bodviTi azrebi gulmaviwyobas ukavSirdeba,
formaluri diagnozisTvis nevrologiuri dasa
maSin gasarkvevia, es azrebi WeSmarit bodvas unda
buTebaa saWiro) ZiriTadi niSnebi CamoTvlilia
mivakuTvnoT, Tu ara). fsiqozis mkurnalobisas
cxrilSi 14.11. ix. agreTve, cxrili 14.6.
unda gaviTvaliswinoT am simptomebis gardamavali
Tavdapirveli niSani, Cveulebriv, gulmaviwyobaa,
xasiaTi da pacientis momatebuli mgrZnobeloba
romlis gansxvavebac normaluri asakobrivi cvli
antifsiqozuri medikamentebis mimarT (gv. 507_9).
lebebisgan, Tavidan Znelia. pirveli 2-4 wlis manZilze
mdgomareoba nela progresirebs. TandaTan uaresdeba qceva
mexsiereba da spontanuroba. daavadebis dasawyisSi
damaxasiaTebelia qceviTi cvlilebebi da es gan
pacients jer axlo warsulis mogonebebi aviwydeba.
sakuTrebiT problematuria momvlelisTvis. pacienti
metyvelebis problemebi adreul etapzeve vlindeba.
mousvenaria da Rame xSirad dgeba, dezorientirebuli
aRiniSneba saxeldebisa da saWiro sityvebis moZebnis
da agznebulia. motoruli aqtivoba momatebulia
sirTuleebi. pirovneba kargavs informaciuli da sxarti
saRamos saaTebSi (`mzis Casvlis~ simtomi), SesaZ
winadadebis Sedgenis unars. mxedvelobiT-sivrciTi
lebelia areuli iyos dReRamuri cikli. xSiria agre
darRvevebi vlindeba figuris kopirebis problemebis an
siuloba _ verbaluric da fizikuric. piradi higienis
ucxo garemoSi gzis gakvlevis sirTuleebis saxiT (mag.,
dacvis dros pacienti SeiZleba aqtiur winaaRmdegobas
sastumroSi an ucxo saxlSi). droSi dezorientacia
uwevdes momvlelebs. seriozuli fizikuri Zaladoba
iwvevs daniSnul dros gamocxadebis uunarobas da
SedarebiT iSviaTia. damaxasiaTebelia, rogorc aq
dReRamuri saqmianobis paternebis Secvlas.
_ 355 _
tivobis momateba, aseve gaRaribeba. sxvadasxva xa lebis demenciis dros mxedvelobiTi halucinaciebi da
risxiTaa gamoxatuli umizno saqmianoba. xetialisken bodviTi ideebi ufro gamoxatuli da persistentuli
midrekileba SeiZleba sarisko aRmoCndes pacien simptomebia, romlebic daavadebis adreul stadi
tisTvis, vinaidan igi SeiZleba potenciurad saSiS azeve iCenen Tavs. aseve, ufro damaxasiaTebelia
garemoSi aRmoCndes. demenciis mqone pacienti sak parkinsonizmi, cnobierebisa da kognituri gauaresebis
vebs zedmeti an arasakmarisi raodenobiT iRebs, rac fluqtuacia da umizezod Zirs dacema.
iwvevs wonisa da saWiro nivTierebebiT organizmis
momaragebis cvlilebebs. seqsualuri qceva upira gamokvlevebi
tesad gamoixateba survilis daqveiTebiT, Tumca, genetikuri testi da neirovizualuri meTodebi
SeiZleba gvqondes seqsualuri ganmuxruWebac. yvela gvexmareba alchaimeris sxva daavadebebisgan dife
am maxasiaTeblis gamokvleva unda Sevides `riskis rencirebaSi, maagram maTi gamoyeneba sxvadasxva
gansazRvris~ nawilSi, rogorc me-20 TavSi iyo qveyanaSi rutinulad ar xdeba. kompiuteruli tomo
miTiTebuli (gv. 333??).Tavis movla da socialuri grafiiTa da magnitur-rezonansuli gamokvleviT
qceva mniSvnelovnad uaresdeba, Tumca, zog pacients aRiniSneba hipokampis atrofia, parkuWebis dilatacia
garegnuli fasadi Senaxuli aqvs, gansakuTrebiT maSin, da am cvlilebebis swrafi progresireba. genetikuri
Tu pacients amaSi momvlelebi exmarebian. testis validurobas ori mizezi ganapirobebs: (1)
alchaimeris daavadebis iSviaTi ojaxuri SemTxvevebis
mimdinareoba dros SeiZleba dadgindes kauzaluri genetikuri
daavadebis sawyis etapze klinikur suraTs gansazRvravs mutacia da (2) apo E4 (ix. boqsi 5.3. es aris daavadebis
pacientis premorbiduli pirovnuli Tvisebebi da ZiriTadi genetikuri risk-faqtori) statusis dadgena
maTi gamkacrebis tendencia. daavadebis mogvianebiT zomierad zrdis daavadebis adreuli diagnostirebis
stadiaze gamoxatulia kognituri daqveiTeba, rasac sizustes. nebismier SemTxvevaSi, gasaTvaliswinebelia
Tan axlavs, zemoT aRwerili, nevrologiuri da qce genetikuri gamokvlevis klinikuri mniSvneloba
viTi cvlilebebi. Tanmxlebma daavadebam SeiZleba da eTikuri mxare (rogorc alchaimeris, aseve
gamoiwvios deliriumi, ramac, Tavis mxriv, SeiZleba sxva demenciebis SemTxvevaSi), romelic dReisTvis
gaauaresos kognituri mdgomareoba. daavadebis sa sakamaToa da ar aris rekomendebuli (van de Cammen
Sualo xangrZlivoba daaxloebiT 5_8 welia da mama et al., 2004). (alchaimeris dros naTesavebisTvis ge
kacebSi SedarebiT xanmokle, vidre qalebSi. ufro netikuri analizis gakeTebasTan dakavSirebuli
swraf mimdinareobas ganapirobebs xandazmuli asaki mimoxilva, ix. Liddell et al., 2001). amJamad, arsebobs
da kognituri daqveiTebis xarisxi. SeTanxmeba imis Taobaze, rom momavali demenciis
ganviTarebis gamosavlenad janmrTeli adamianebis
alchaimeris daavadebis diferencialuri
genetikuri gamokvleva ar unda moxdes.
diagnozi
klinikuri niSnebi alchaimeris daavadebis nevropaTologia
tvinis saerTo Seswavlisas aRiniSneba misi zomebSi
klinikuri niSnebis saTanado Sefaseba, sakmarisad
Semcireba da xveulebisa da parkuWebis gafarToveba.
maRali sizustiT, iZleva alchaimeris daavadebis sxva
tvini wonaSi daklebulia. mikroskopuli gamokvleviT
mdgomareobisgan diferencirebis saSualebas (cxrili
fiqsirdeba kardinaluri niSani _ cerebrul qerqsa
14.6). amasTan, unda gvaxsovdes, rom SesaZlebelia
da qerqqveSa ubnebSi neirofibriluri gorglebisa
Sereuli demenciis arsebobac (gv. 345??). alchaimeris
da amiloduri folaqebis arseboba. es cvlilebebi
demencia, rogorc vTqviT, demenciis yvelaze gav
damaxasiaTebelia normaluri daberebis procesisTvis
rcelebuli mizezia, amitom misi diferencirebisas,
an sxva daavadebebisTvisac, Tumca, alchaiemeris
pirvel rigSi, unda gaviTvaliswinoT sxva demen
dros Tavis tvinis sxvadasxva ubanSi ufro metadaa
ciebisTvis damaxasiaTebeli niSnebis arseboba.
warmodgenili. diagnozi maT raodenobasa da gana
vaskuluri demenciisgan diferencireba unda moxdes
wilebazea damokidebuli (CERAD_alchaimeris da
safexurebrivi progresirebis, fokaluri motoruli
avadebis kriteriumebis registraciis SemuSavebis
niSnebis, fluqtuaciuri mimdinareobisa da vaskuluri
konsorciumi, Mirra et al., 1991).
daavadebis arsebobis safuZvelze. ganviTarebis gar
gorglebsa da folaqebTan erTad gamoxatulia
kveul etapamde, alchaimeris daavadebis dros, ufro
hipokampsa da entorinalur korteqsSi neironebis
metad epizoduri mexsierebis daqveiTebaa gamoxatuli,
arCeviTi kvdoma, astrocitebis proliferacia
xolo vaskuluri demenciis dros semantikuri
(gliozi) da sinafsebis masiuri degeneracia. es
mexsiereba da yuradRebis koncentraciis problemebi
ukanaskneli korelaciaSia kognitur gauaresebasTan.
aRiniSneba (Graham et al., 2004).
sxva cvlilebebi moicavs sisxlZarRvebis kedlebSi
alchaimeris demenciisgan gansxvavebiT, levis sxeu
_ 356 _
demencia
amiloidis Calagebas (vaskuluri amiloidi an dominanturi tipi. gamovlenilia sami genis mu

kongofiluri angiopaTia), hiranos sxeulebisa tacia: (1) amiloduri cilis prekursori (APP,
(intraceluluri aqtinisa da aqtinTan dakavSirebuli 21-e qromosomaSi), (2) presenilini 1 (PS1, me-14
cilebis depoziti) da granulovakuoluri degene qromosomaSi) da (3) presenilini 2 (PS2, pirvel
raciis (neironebSi warmoiqmneba vakuolebi e.w. qromosomaSi). pirveli àlchaimeris genis~ gamoyofa
`xvrelebi~) arsebobas. (alchaimeris nevropaTologiis (APP) didi movlena iyo fsiqiatriaSi (cxrili 14.1).
mimoxilva ix. Morris and Nagy, 2004). ojaxuri SemTxvevebis ZiriTad mizezad es sami genia
miCneuli. TiToeuli genisTvis sxvadasxva mutaciaa
alchaimeris daavadebis progresireba cnobili. daavadebis dawyebis asaki, daavadebis
daavadeba iwyeba entorinalur korteqsSi, xolo mimdinareobis Tavisebureba da progresirebis xarisxi
Semdeg hipokampze, parietalur asociaciur ubnebsa mniSvnelovnadaa damokidebuli kazualur mutaciaze.
da zogierT subkortikul birTvebze vrceldeba.
ganasxvaveben eqvs, braakis stadiebad (Braak and alchaimeris daavadebis sporaduli SemTxvevebis
Braak, 1991) cnobil, nevropaTologiur etaps, rom genetikuri faqtorebi
lebic -amiloidis depozitTanaa dakavSirebuli da alchaimeris daavadebebis SemTxvevaTa umravlesoba,
davadebis simwvavesTan korelirebs. kortiko-kor xolo mogvianebiT asakSi ganviTarebuli ki, praq
tikuli proeqciis gaswvriv paTologiuri procesis tikulad, yvela, memkvidreobiTobis mendelianur
ganviTareba iwvevs dazianebul ubnebs Soris kav kanonzomierebas ar eqvemdebareba. amitom maT xSirad
Sirebis gawyvetas. `sporadul~ SemTxvevebs uwodeben. Tumca, xandazmul
asakSi ganviTarebuli alchaimeris daavadebis mqo
seniluri (amiloiduri) folaqebi ne pacientebis pirveli rigis naTesavebs, zogad
seniluri folaqebi qerqis dazianebuli ubnebia, populaciasTan SedarebiT, demenciis ganviTarebis
romlebic uxsnadi cilebis (milodebis), degeneraciuli samjer ufro maRali riski aReniSnebaT. genetikuri
neiritebisa (aqsonebisa da dentritebis) da astro winaganwyobis mniSvneloba mravali kvleviTaa naCvenebi,
citebisa da mikrogliebis erToblivi Calagebis rac daavadebis polimorfizmsa da ramdenime gens
adgilebs warmoadgenen. isini neironebs Soris mde Soris urTierTkavSiriTaa dasabuTebuli. kerZod,
bareoben. rogorc degeneraciuli neiritebis, aseve dadgenilia asociacia apo E4-isa da alchaimeris
difuzuri folaqebis gamovlena vercxlis saRebaviTaa daavadebis yvela formas Soris. boqsSi 5.3 (gv. 103??)
SesaZlebeli. neiritebis folaqebis birTvebi muqad
iRebeba, xolo difuzuri folaqebi bambis qulebs boqsi 14.1 APP genis mutaciis aRmoCena
mogvagonebs. neiritebis folaqebi paTologiurad alchaimeris ojaxuri SemTxvevebis dros
ufro mniSvnelovania. seniluri folaqebis centrSi 1984 wels naxes, rom cila, romelic grovdeba senilur
gamuqebuli ubani _amilodia (romelsac agreTve A folaqebSi, sisxlZarRvovan qselsa da meningialur
an A4 ewodeba). es cila da misi makodirebeli geni garsSi, amiloidia. aminomJavebis Tanmimdevrobis
codnis safuZvelze, masSi daadgines makodirebeli geni,
daavadebis etiologiaSi wamyvan rols asrulebs.
romelsac amiloiduri cilis prekursori daarqves (APP).
cnobili iyo, rom arsebobs kavSiri daunis sindromsa da
neirofibriluri gorglebi alchaimeris daavadebas Soris (21e qromosomis trisomia;
neirofibriluri gorglebi mdebareobs neironebis Holland & Oliver, 1995); amdenad, APP 21e qromosomaSi unda
yofiliyo lokalizebuli. am hipoTezis Sesamowmeblad,
sxeulSi, gansakuTrebiT, cerebruli korteqsisa da
Seiswavles autosomuri dominanturi alchaimeris
hipokampis piramidul neironebSi. maT Sewyvilebuli daavadebis SemTxvevebi. Seagroves yvela pacientisa da maTi
spiraluri boWkoebis forma aqvT. es boWko, Tavis mxriv, ojaxis wevrebis dnm. kvlevis Sedegad dadginda, rom iyo
APPs mutacia (717e poziciaSi valini Canacvlebuli iyo
tau-cilas warmoadgens. normaSi tau-cila aqsonur
izoleiciniT), rac alchaimeris daavadebis ganviTarebas
transportirebasa da ujredis ConCxis SenarCunebaSi ganapirobebda. es aRmoCena gakeTda londonSi (Goete
monawileobs. varaudoben, rom gorglebi tau-cilebis et al, 1991). mas Semdeg APPs mutacia sxva ojaxebis
hiperfosforilebis Sedegad warmoiqmneba, rac mis kvlevamac aCvena. APPs mutaciasTan dakavSirebuli
yvela eWvi Tagvebze Catarebulma cdebma gaaqarwyla.
uxsnadobas ganapirobebs. gorglebis arseboba iwvevs transgenuri kvlevebiT miiRes, rom APP mutaciuri
neironebis disfunqciasa da kvdomas. genis matarebel yvela Tagvs daavadebis niSnebi da
amiloidis Calagebis ubnebi aReniSneboda (Games et al.,
alchaimeris daavadebis etiologia 1991). APPs mutacia daavadebis paTogenuri niSania,
vinaidan igi pirdapir arRvevs amiloidis sinTezs.
ojaxuri alchaimeris daavadeba APPs mutaciiT alchaimeris daavadebis SemTxvevaTa
mxolod mcire nawilis axsnaa SesaZlebeli, maSin rodesac
ojaxebSi iSviaTad, gansakuTrebiT maSin, rodesac
APPs metabolizmis darRvevebi, romlebic mravali
aris adreuli dasawyisis mqone SemTxvevebi (60 faqtoriTaa gamowveuli, alchaimeris daavadebis yvela
wlamde), aRiniSneba memkvidreobiTobis autosomur- SemTxvevaSi mTavar rols TamaSobs.
_ 357 _
ganxilulia mogvianebiTi alchaimeris daavadebis (NSAID) da hormon-CanacvlebiTi TerapiisTvis gamoy-
ganviTarebaSi apo E4-is monawileobis mniSvneloba enebuli (NRT) preparatebis gamoxatuli dadebiTi
(daaxloebiT 50%-ia). misi ZiriTadi efeqti daavadebis efeqti. mag., NSAID gamoyeneba 50%-iT amcirebs daa-
adreuli ganviTarebis xelSewyobaSi gamoixateba. sxva vadebis ganviTarebis risks. igi specifikur gavlenas
monacemebiT, pozitiuri apo E4-is dros SesaZlebelia axdens APP metabolizmze. Tumca, naadrevia imis mt-
iyos gansxvavebuli paTologia. kavkasiur rasaSi apo kiceba, rom es medikamentebi pirovnebas daavadebis
E2 variantis arsebobas proteqtoruli mniSvneloba gamovlenamde profilaqtikuri mizniT unda daeniS-
aqvs, Tumca msgavsi asociacia afro_amerikelebis nos, vinaidan maTi mizezobrivi kavSiri alchaimeris
SemTxvevaSi ar dadasturda. diagnozis dazustebis daavadebasTan jer-jerobiT gaurkvevelia. SesaZloa,
mizniT apo E4-is gamovlena (rogoc ukve aRvniSneT) sapirispiro asociaciac arsebobdes. mag., NRT-s, ufro
araa mizanSewonili. apo E4 ar warmoadgens daavadebis xSirad ganaTlebuli da janmrTeli pirebi iReben. ho-
paTognomur niSans. pacientTa 1/3-is apo E4 _ mocistinis momateba daavadebis damoukidebel risk-
negatiuria. apo E4-is mqone monozigoturi tyupebis faqtoradaa miCneuli. amiT SeiZleba aixsnas alchaim-
SemTxvevaSic, zogjer, meore tyupiscals arasdros eris daavadebisa da vaskuluri demenciis msgavseba
uviTardeba daavadeba. da urTierTkavSiri (Seshadri et al., 2002). naCvenebia,
cnobilia, rom apo E4 asocirebulia alchaimeris rom maRali fizikuri da inteleqtualuri aqtivoba
daavadebis momatebul riskTan, Tumca, savaraudoa, rom xels uSlis alchaimeris demenciis ganviTarebas da
es misi -amiloidis metabolizmTan, qolesterolTan amyarebs hipoTezas _ `gamoiyene an dakargav~ (aseTi
da tvinis sxva ujredul funqciebTan kavSiriT damokidebuleba àmdidrebs cerebrul rezervebs~)
aixsnas. SesaZlebelia misi modificireba garemo risk- (Wilson et al., 2002). Saqriani diabeti alchaimeris daa-
faqtorebiTac xdeba (Lahiri et al., 2004). vadebis ganviTarebis mniSvnelovani risk-faqtoria,
gamovlenilia alchaimeris daavadebis ganviTarebis Tumca, meqanizmi Seswavlili ar aris (Green et al., 2004).
sxva genetikuri risk- faqtorebic, Tumca, isini sa- arsebobs mosazreba, romelic luminis Warb raodeno-
Tanadod dasabuTebuli ar aris. erT-erTi aseTi kan- bas ukavSirdeba, magram monacemebi sustia da, zoga-
didatia ubiqvilin 1, romelic me_9 qromosomaSia dad, dasabuTebul risk-faqtorad ar ganixileba.
lokalizebuli (Bertram et al., 2005). ubiqvilin 1 pro-
teinebis degradaciaSi monawileobs. amilodis kaskadis hipoTeza
APP-s mutaciis aRmoCenam, romelic aRwerilia
garemo faqtorebi boqsSi 14.1, àmiloiduri kaskadis hipoTezas~ misca
uamravi garemo faqtori dakavSirebulia daavadebis dasabami (Hardy and Higgins, 1992). es daavadebis wamyvani
ganviTarebasTan (ix. cxrili 14.12). umetes SemTx- molekuluri hipoTezaa da mkurnalobis Tanamedrove
vevaSi, ar aris dadgenili, isini kazualuri Tu da- meTodebis kvlevebis safuZvels warmoadgens (ix. me-
moukidebeli faqtorebia, Tu genetikur winaganwyo- 20 Tavi). arsebuli mosazrebis Tanaxmad, daavadebis
baze moqmedebiT xasiaTdebian. mTavar paTogenur mizezs -amilodis, kerZod, misi
dadgenilia arasteroiduli anTebis sawinaaRmdego 42-e aminomJavas variacia warmoadgens (Hardy and Selkoe,
2002). APP transmembranuli proteinia, romelic
sami enzimis (, da -sekretazas) saSualebiT
cxrili 14.12 garemo faqtorebi da alchaimeris
iSleba. Cveulebriv, normaSi -sekretazas aqtivoba
daavadeba
dominirebs. am SemTxvevaSi ar xdeba -amiloidis
riskfaqtorebi warmoqmna. alchaimeris dros APP-s daSlaSi, upi
w ganaTlebis dabali done; ratesad, an -sekretaza monawileobs. es ganapirobebs
w qalatvinis travmis anamnezi; -amiloidis formirebasa da dagrovebas. presinili,
w cerebrovaskuluri daavadeba; romelic ojaxuri SemTxvevebis paTognomur efeqts
w depresiis anamnezi; ganapirobebs, -sekretaza kompleqsis nawilia.
w homocistinis maRali done; -amiloidis didi raodenobiT dagroveba iwvevs
w Saqriani diabeti. daavadebis ganviTarebas. saxezea -amiloidis ag
damcavi faqtorebi regacia, romelic uxsnadi da neirotoqsikuria.
dReisTvis dazustebuli araa, ra kavSirSia tau-
w arasteroiduli anTebis sawinaaRmdego preparatebis
gamoyeneba;
cila da neirofibriluri gorglebi amilodur
w hormonCanacvlebiTi Terapia; paTologiasTan. iTvleba, rom -amiloidis Calageba
w statinis miReba (savaraudod); ufro mniSvnelovania, vidre neirofibriluri gor
w kognituri da fizikuri aqtivoba zrdasrul da glebis arseboba.
xandazmul asakSi. alchaimeris daavadebis paTogenezis damatebiTi
_ 358 _
demencia
hipoTezebi moicavs oqsidaciur stress, anTebas, vaskuluri demenciis klinikuri niSnebi
apoptozs (ujredis daprogramebuli TviTlikvidacia)
daavadeba, Cveulebriv, cxovrebis meSvide an merve
da ujredebis ciklis Seferxebas. am Teoriebis ume
aTwleulSi vlindeba. upiratesad, mwvave dasawyisi
tesoba sxvadasxva xarisxiT -amiloidis metabolizmis
axasiaTebs da xSirad insultis Semdeg viTardeba.
darRvevebs ukavSirdeba.
Tavdapirvelad TvalsaCinoa pirovnuli da
neirotransmiterebis cvlilebebi: qolinerguli emociuri cvlilebebi, rasac Semdgom mexsierebisa
hipoTeza da inteleqtis daqveiTeba mohyveba. gauareseba
safexurebrivad progresirebs. xSiria depresia,
amiloidur hipoTezis gaCenamde dominirebda qoli
damaxasiaTebelia emociuri labilobisa da
nerguli hipoTeza, romelsac safuZvlad edo 1970
cnobierebis darRvevis epizodebi, gansakuTrebiT,
wels aRmoCenili faqti, rom cerebrul korteqsSi
Ramis saaTebSi. SeiZleba ganmeordes tranzitoruli
aris acetilqolinis gamoxatuli deficiti. es
iSemiuri mdgomareobebi an mikroinsulti. kritika,
gamowveulia meinertis bazaluri birTvis ujredebis
Cveulebriv, gviani stadiis dadgomamdea Senaxuli.
atrofiuli da paTologiuri procesebiT. am hipoTezis
qceviTi darRvevebi da SfoTva ufro gamoxatulia,
safuZvelze daavadebis mkurnalobisTvis SemuSavda
vidre alchaimeris dros.
acetilqolinis Canacvlebis Terapia (gv. 509).
diagnostikuri kriteriumebi moicavs ramdenime
marTalia, qolinerguli Teoria iZleva kognituri
damaxasiaTebel simptoms (Gold et al., 2002). vasku
daqveiTebis axsnis karg SesaZleblobas, magram igi
luri demenciis mimdinareobas axasiaTebs safexu
ver ganmartavs daavadebis mizezs (mimoxilva ix.
rebrivi progresi. gauaresebis periodebs mosdevs
Francis et al., 1999). qolinerguli paTologia SeiZleba
gaumjobesebis an nawilobrivi aRdgenis etapi, ro
ufro metad dakavSirebuli iyos levis sxeulebis
melic SeiZleba ramdenime Tve gagrZeldes. pacientebis
demenciasTan, romelsac adre, xSirad, alchaimeris
50% kvdeba gulis iSemiuri daavadebis Sedegad, xolo
daavadebis SemTxvevebTan erTad ganixilavdnen.
danarCeni _ cerebruli infarqtis an Tirkmlis
ukmarisobis gamo. diagnozis dasmis Semdeg daavadebis
vaskuluri demencia
xangrZlivoba farTo diapazons moicavs. kvlevebis
cerebrovaskuluri daavadebebis Sedegad ganviTarebul umravlesoba aCvenebs, rom daavadebis mimdinareoba
demencias, warsulSi àTerosklerozul fsiqozs~ vaskuluri demenciis SemTxvevaSi, alchaimeris daava
uwodebdnen. mogvianebiT asakSi ganviTarebuli sxva debasTan SedarebiT, xanmoklea.
fsiqozebisgan gansxvavebiT, aseT SemTxvevaSi demencia Znelia vaskuluri demenciis diagnozis dazustebiT
asocirebulia Tavis tvinSi mravlobiTi infarqtis dadgena, Tu ar gvaqvs insultis anamnezi an lokaluri
kerebTan, amitom mas multiinfarqtuli demencia nevrologiuri niSnebi. damaxasiaTebeli simptomebia:
ewoda (Roth et al., 1955; Hachinski et al., 1974). es termini (1) mravalferovani fsiqologiuri deficiti, (2)
kvlav ixmareba, Tumca, kvlevebiT gamovlinda, rom mdgomareobis gauaresebis araTanabari progresi da
es mdgomareoba warmoadgens ufro farTo jgufis (3) SedarebiT Senaxuli pirovneba. fizikuri gamo
`vaskuluri demenciis~ qvejgufs. amitom dRes upi kvlevebis Sedegad, rogorc wesi, aRiniSneba hiper
ratesad gamoiyeneba termini `vaskuluri demencia~. tenzia, periferiuli da Tvalis sisxlZarRvebis
paTogenuri meqanizmebi gansxvavebulia da moicavs arteriosklerozi. SesaZlebelia arsebobdes iseTi
wvrili da msxvili sisxlZarRvebis arteriosklerozs, nevrologiuri niSnebi, rogorebicaa fsevdobul
embolias, vaskulits, amiloidur angiopaTias da in baruli dambla, rigiduloba, akinezia, gacxovelebuli
trakranialur sisxlCaqcevebs. gansxvavebuli qve refleqsebi. zogjer gamoiyeneba haCinskis skala
jgufebis dasaxasiaTeblad Semotanilia terminebi: (mimoxilva ix. Erkinjuntti, 2000).
binsvangeris daavadeba, leikoareozi da tat lacunaire
(lakunuri sindromi). vaskuluri demenciis etiologia
demenciis gamomwvev mizezebs Soris vaskuluri fokaluri iSemiiT gamowveuli vaskuluri demencia
demencia meore adgilzea. SedarebiT ufro xSiria neironuli disfunqciisa da neironebis kvdomis
mamakacebSi, vidre qalebSi. daavadebis sixSire asak Sedegad viTardeba. bunebrivia, vaskuluri demenciis
Tan erTad matulobs da yovel 5 weliwadSi 2-jer risk-faqtoria cerebro-vaskuluri daavadebebi.
izrdeba. geografiuli gavrcelebis TvalsazrisiTac ukanaskneli wlebis kvlevebiT naCvenebia misi kavSiri
daavadeba gansxvavebul suraTs gviCvenebs; mag., da msgavseba alchaimeris tipis demenciasTan. mag.,
CineTSi, iaponiasa da ruseTis federaciaSi ufro iTvleba, rom maT saziaro risk-faqtorebi da
xSirad gvxvdeba (vaskuluri demenciis mimoxilva ix. paTofiziologiuri maxasiaTeblebi aqvT (Jagust, 2001;
Roman, 2002; O'Brien et al., 2003). ix. gv. 345).
_ 359 _
levis sxeulebis demencia vizualuri halucinaciebi. am kriteriumebis maRali
1980-ian wlebSi aRweres demenciis axali tipi, sensitiurobiTa da specifikurobiT gamoyeneba iZleva
romelsac SedarebiT gansxvavebuli klinikuri da diagnozis zustad dadgenis saSualebas. daavadebis
paTologiuri niSnebi axasiaTebda. mas sxvagasxva xangrZlivoba daaxloebiT 5 welia.
terminebiT aRniSnavdnen, mag., `levis sxeulakebi~, levis sxeulebis nevropaTologia
`levis sxeulebis demencia~, `kortikuli levis
damaxasiaTebeli histologiuri cvlilebebia ce
sxeulis daavadeba~ da àlchaimeris daavadebis levis
rebrul korteqsSi levis sxeulebis arseboba.
sxeulebis varianti~. `levis sxeulebis demencia~ _
iseve, rogorc parkinsonis daavadebis dros, isini
amJamad SeTanxmebuli terminia. nevropaTologiuri
SesaZlebelia bazalur gangliaSi, Sav substanciaSic
kvlevebiT dadgenilia, rom levis sxeulebis demencia
aRiniSnebodes. aseT SemTxvevaSi vlindeba orive
demenciebis saerTo SemTxvevebis 15_20%-is mizezia.
daavadebis niSnebi. mTavari cila alfa-sinukleinia.
iTvleba, rom igi demenciis ganviTarebis rigiT
Tumca, dRes levis sxeulebis gamovlena, ufro
mesame, Tu ara meore, yvelaze gavrcelebuli mizezia
xSirad, sxva cilis (ubiqvetinis) arsebobas efuZneba.
(alchaimeris daavadebisa da vaskuluri demenciis
bolomde ar aris dasabuTebuli, Tu ramdenadaa
Semdeg). daavadebis saxelwodebidan gamomdinare, mis
levis sxeulebis demencia parkinsonis daavadebisgan
kardinalur nevropaTologiur niSans cerebrul
damoukidebeli mdgomareoba (gv. 341??) an ramdenad
korteqsSi levis sxeulebis arseboba warmoadgens.
gansxvavebuli etiologiuri da nevropaTologiuri
aseve, mas damaxasiaTebeli klinikuri suraTi aqvs.
safuZveli aqvs mas (McKeith et al., 2004; Singleton and
demenciis SedarebiT axali àRmoCena~ ganapiroba iman,
Gwinn-Hardy, 2004). levis sxeulebis demenciis dros
rom kortikuli levis sxeulebis `danaxva~ (autofsiis
amiloduri folaqebi uxvadaa warmodgenili, Tumca,
Sedegadac ki) rutinuli reagentebiT ver xerxdeba
iSviaTia neirofibriluri gorglebi. es mdgomareoba
(ix. McKeith et al., 2004).
asocirebulia neokorteqsSi acetiltransferazas
levis sxeulebis demenciis klinikuri niSnebi gamoxatul deficitTan (ufro metad, vidre
daavadebisTvis damaxasiaTebeli klinikuri niSnebi, alchaimeris daavadebis dros). kudian birTvSi
romlebic komisiis SeTanxmebiTaa miRebuli (McKeith aRiniSneba dofaminerguli markerebis donis Semcireba.
et al., 1996), mocemulia cxrilSi 14.13. yvel es cvlilebebi ganapirobebs fsiqopaTologiuri
aze xSiria deliriumis msgavsi fazebis mona simptomebis maRali sixSiriT ganviTarebas. tvinis
cvleoba, parkinsonizmis niSnebis arseboba da (gansakuTrebiT, hipokampis) atrofia naklebadaa
gamoxatuli, vidre alchaimeris daavadebis dros.
cxrili 14.13 levis sxeulebis demenciis levis sxeulebis demenciis etiologia

klinikuri niSnebis mokle CamonaTvali levis sxeulebis demencia mWidrodaa dakavSirebuli
ZiriTadi niSnebi parkinsonis daavadebasTan. orivesTvis damaxasi
aTebelia `sinukleinopaTia~, romelic levis sxe
w progresirebadi kognituri gauareseba. gansakuTrebiT
gamoxatulia yuradRebisa da mxedvelobiTsivrciTi ulebSi arsebuli protein alfa-sinukleinis ano
unarebis daqveiTeba; maliur agregacias asaxavs. misTvis ar aris dama
w kogniturisa da yuradRebis deficitis gamoxatuli xasiaTebeli TvalsaCino genetikuri komponenti,
fluqtuacia;
Tumca, dakavSirebulia apo E4 statusTan. naklebadaa
w Cveulebriv, kargad formirebuli, detaluri da
ganmeorebadi mxedvelobiTi halucinaciebi; Seswavlili garemo faqtorebis gavlena. savaraudoa,
w parkinsonuli motoruli niSnebi. rom is garemoebebi, romlebic gavlenas axdenen
parkinsonis daavadebis ganviTarebaze, levis sxeulis
damatebiTi niSnebi
demenciisTvisac mniSvnelovani iyos.
w ganmeorebadi Zirs dacema;
w sinkope; parkinsonis daavadeba
w gardamavali cnobierebis darRvevebi;
miuxedavad imisa, rom parkinsonis daavadeba ar
w antifsiqozuri preparatebisadmi momatebuli mgrZnobeloba;
warmoadgens demenciis gamomwvev mTavar mizezs,
w sistemuri bodviTi ideebi;
mas mainc ganvixilavT. es aris neirodegeneraciuli
w sxva (aravizualuri ) halucinaciebi.
daavadeba, romelic mWidrodaa dakavSirebuli levis
diagnozi SesaZloa gamoiricxos am niSnebis arsebobisas sxeulebis demenciasTan.
w cerebrovaskuluri daavadebebis arseboba; demencia da fsiqikuri darRvevebi mravali eqs
w sxva daavadebebi, romelTa arseboba sakmarisia trapiramiduli daavadebis (mag., idiopaTuri parkin
gamovlenili niSnebis asaxsnelad. sonis daavadebis, progresuli supranuklearuli
_ 360 _
demencia
xangrZlivobasTan da, SesaZloa, dakavSirebuli iyos
cxrili 14.14 parkinsonis daavadebis dofaminergul sistemasa da Sublis wilSi arsebul
neirofsiqiatriuli manifestacia
darRvevebTan. antidepresantebi didi sifrTxiliT
deliriumi, stupori (xSirad gamowveulia wamlebiT an unda gamoviyenoT, raTa Tavidan aviciloT kognituri
interkurentuli infeqciiT);
gauareseba an deliriumis ganviTareba. triciklurebis
kognituri daqveiTeba;
magivrad, umjobesia susi-ebis an axali Taobis
depresia, mania;
antidepresantebis gamoyeneba, romlebsac naklebi
halucinaciebi (ZiriTadad mxedvelobiTi);
antiqolinerguli efeqti aqvT.
bodviTi ideebi;
Zilis Setevebi, REM Zilis qceviTi aSliloba; fsiqozuri simptomebi
seqsualuri aSlilobebi.
fsiqozuri simptomebi vlindeba SemTxvevaTa 20%-
damblisa da sxva, maTTan dakavSirebuli sindromebis) Si. vizualuri halucinaciebi, ZiriTadad, do
Tanmxlebi mdgomareobebia. am daavadebebisTvis da faminerguli preparatebis gamoyenebis Sedegad
maxasiaTebelia rigidoba, Seneleba, mizanmimarTuli viTardeba. aseve, SeiZleba dakavSirebuli iyos asakis
moZraobebis ganxorcielebis unaris daqveiTeba, rac matebasTan, daavadebis simwvavesa da xangrZlivobasTan,
akinetikur-rigidul sindromSi erTiandeba. ynosvis depresiisa da kognituri daqveiTebis ganviTarebasa
deficiti ganasxvavebs idiopaTur parkinsonul daa da mxedvelobis gauaresebasTan. bodviTi ideebi
vadebas parkinsonis msgavsi sindromebisgan. mniS iSviaTia da upiratesad paranoiduli Sinaarsisaa.
vnelovania, gavarCioT parkinsonis daavadeba da iTvleba, rom fsiqozuri simptomatikis ganviTarebas
antifsiqozuri medikamentebiT gamowveuli par antiparkinsonuli preparatebi uwyobs xels, amitom,
kinsonuli gverdiTi efeqtebi (gv. 534??). ramdenadac SesaZlebelia, mcire dozebi unda
vixmaroT. antifsiqozuri mkurnalobis saWiroebis
klinikuri niSnebi SemTxvevaSi, umjobesia, atipiuri preparatebi _
parkinsonuli daavadebis kardinaluri niSnebia: (1) klozapini an qvetiapini, gamoviyenoT.
mosvenebis tremori, (2) rigidoba da (3) bradikinezia.
yvelaze xSiri fsiqiatriuli niSnebia: (1) subkortikuli sxva neirofsiqiatriuli simptomebi
tipis kognituri daqveiTeba da (2) depresia (cxrili momatebuli Zilianoba, areuli dReRamuri cikli,
14.14). (mimoxilva ix. Lauterbach, 2004). Zilis Setevebi da REM Zilis mdgomareobaSi yofnis
msgavsi qceva yvelaze damaxasiaTebelia parkinsonis
demencia daavadebisas. amitom, demenciis ar arsebobis Sem
parkinsonis daavadebis dros demenciis ganviTarebis TxvevaSic, unda daisvas parkinsonis daavadebis mqone
sixSire gamoirCeva didi variabelobiT. SesaZloa, pirisTvis avtomobilis marTvis mowmobis gagrZelebis
es gamowveulia imiT, rom kvlevebi sxvadasxva sakiTxi (Schrag, 2005).
populaciazea Catarebuli da gansxvavebuli diag
parkinsonis daavadebis etiologia
nostikuri kriteriumebia gamoyenebuli. amasTan, uka
nasknel wlebSi gaizarda levis sxeulebis demenciis idiopaTuri parkinsonis daavadeba mogvianebiTi
diagnostirebac. SeTanxmebis Tanaxmad, diagnozi asakis mniSvnelovani problemaa, romelic 55 wels
`demencia parkinsonis daavadebis dros~, ismeba maSin, gadacilebuli populaciis 1%-s aReniSneba (Nussbaum
rodesac demenciis niSnebi viTardeba parkinsonis and Ellis, 2003). igi Savi substanciis kompaqtur zonaSi
daavadebis dawyebidan 12 Tvis Semdeg (Emre, 2003). ganlagebuli dofaminuri neironebis dazianebis
parkinsonis daavadebis dros SemTxvevaTa 40%-Si Sedegad viTardeba. pirveladi procesi iwyeba IX da
demencia viTardeba. gansakuTrebiT xSiria maSin, X kranialuri nervebis birTvebSi da Semdgom sxva
rodesac daavadeba mogvianebiT iwyeba an gamoxatuli dofaminur neironebze vrceldeba. dofaminergul da
bradikinezia aRiniSneba. L-DOPA ver aumjobesebs sxva neironebSi levis sxeulebis arseboba parkinsonis
mdgomareobas, xolo acetilqolinesTerazas inhibi daavadebis paTognomur niSnad iTvleba (levis
torebi gacilebiT ufro efeqturia (Press, 2004). sxeulebze zemoT iyo saubari).
iSviaTia parkinsonis daavadebis autosomuri do
depresia minanturi forma, romelic -sinukleinis, UCHL1,
depresiisa da parkinsonis daavadebis kavSiri kar NR4A2 da LRRK2 genebis mutaciiTaa gamowveuli.
gadaa Seswavlili. depresiis gamovlenaTa sixSire arsebobs autosomuri recesiuli formac, romlis
daaxloebiT 40%-ia. igi ufro xSiria daavadebis sawyis da drosac sxva genebis (Dj-1 da Pink 1) mutaciaa. am da
terminalur etapze. meqanizmi gaurkvevelia. depresia sxva genebis polimorfizmi ganapirobebs parkinsonis
ar asocirdeba invalidobis xarisxs an daavadebis daavadebis sporadiul SemTxvevebs (mimoxilva ix.
_ 361 _
cxrili 14.15 frontotemporaluri demenciis cxrili 14.16 frontotemporaluri demenciis

zogierTi klinikuri kriteriumi diagnostikuri qvekategoriebi
qceviTi simptomebi w pikis daavadeba
w lobaruli (wilovani) atrofia
w Semparavi dasawyisi, neli progresireba
w araalchaimeruli tipis Sublis wilis degeneracia
w kritikis dakargva adreul stadiaze
w demencia gamoxatuli histologiis gareSe
w qceviTi ganmuxruWebisa da gansjis unaris daqveiTeba
adreul stadiaze w motoruli neironebis daavadeba demenciiT
w fsiqikuri rigidoba w semantikuri demencia
w stereotipuli da imitaciuri qceva w progresuli afaziuri sindromi
w hiperoraloba (didi raodenobiT tkbili sakvebis w frontotemporaluri demencia parkinsonizmiT
miReba) w kortikobazaluri degeneracia
w impulsuroba da TavSeukavebloba w progresuli supranuklearuli dambla
w guamis kompleqsi
metyveleba
w metyvelebis progresuli gaRaribeba klinikuri niSnebi da qvetipebi

w perseveracia
frontotemporaluri demencia moicavs heterogenul
w eqolalia
mdgomareobebs, romlebsac gansxvavebuli klini
afeqturi niSnebi kuri suraTi aqvT (cxrili 14.16). misTvis, kog
w depresia nitur daqveiTebaze metad, qceviTi darRvevebia
w apaTia damaxasiaTebeli (Perry and Miller, 2001). ganasxvaveben
w emociuri gasadaveba frontalur da temporalur variantebs imis mixedviT,
w hipoqondria Tu romeli wilis paTologiaa metad gamoxatuli (gv.
323_4). frontaluri formis SemTxvevaSi, pirovnuli
fizikuri niSnebi
da qceviTi cvlilebebi metad TvalsaCinoa, xolo
w primitiuli refleqsebi (adreul stadiaze) temporaluri variantis dros gvaqvs metyvelebis
w Sardisa da defekaciis Seukavebloba (adreul stadiaze) darRvevebi. xSirad aRiniSneba cerebruli korteqsis
w mogvianebiTi parkinsonizmi asimetriuli CarTuloba. marjvenamxrivi deficiti
w dabali da labiluri sisxlis wneva ganapirobebs qceviT darRvevebs, xolo marcxenamxrivi
dazianeba _ metyvelebis problemebs. sxvagvari
Hardy et al., 2003). garemo risk-faqtorebia zogierT
klasifikacia SeiZleba efuZnebodes genetikur da
toqsinTan, gamxsnelTan da naxSirJangTan Sexeba, xolo
sporadul SemTxvevebad dayofas da parkinsonizmis an
Wis wyals, kofeinsa da, SesaZloa, nikotinsac damcavi
motoruli neironebis dazianebas.
efeqti aqvs (Di Monte, 2003). paTofiziologiuri
TvalsazrisiT miiCneva, rom aris mitoqondriuli da pikis daavadeba
sinafsuri moqmedebis darRvevebi da oqsidaciuri
arnold pikma (Arnold Pick, 1892) aRwera daavadeba, romlis
stresi (Moor et al., 2005).
ZiriTadi klinikuri gamovlinebaa afazia demenciasTan
erTad. pikis daavadebis dros aRiniSneba TvalsaCino
frontotemporaluri demencia
fokaluri atrofiuli ubnebi Sublisa da safeTqlis
frontotemporaluri demencia preseniluri demen polusebze (ukiduresad ganleuli cerebruli korteqsi
ciis meore, yvelaze gavrcelebuli fromaa. igi, `knife-blade~ atrofia), piramiduli neironebis gajirjveba
aseve, mogvianebiT asakSi ganviTarebuli demenciis da maTSi pikis sxeulebis arseboba. pikis sxulebi
SemTxvevaTa 7%-s Seadgens. Cveulebriv, iwyeba 45_70 hipokampSic gvxvdeba. igi Sedgeba tau, ubiqvinisa da
wlis asakSi. es termini, daavadebis kriteriumebTan sxva proteinebisgan. alchaimeris daavadebisTvis
erTad, 1994 wels SemoiRes (Lund-Manchester kri damaxasiaTebeli cvlilebebi ar vlindeba. pikis
teriumebi SemdgomSi ganaxlda; Nearty et al., 1998). am daavadeba arqetipuli frontotemporaluri daava
jgufisTvis damaxasiaTebelia (Sublisa da safeTqlis debaa da xSirad mis sinonimadac xmaroben, Tumca, igi
wilebis darRvevebis) saziaro klinikuri simptomebi frontotemporaluri demenciis SemTxvevebis mxolod
(cxrili 14.15) da nevropaTologiuri niSnebi (cxrili mcire nawils moicavs.
14.16). ukanasknel periodSi dagrovili monacemebis
Tanaxmad, frontotemporalur demencias iwvevs frontotemporaluri demenciis ojaxuri SemTx-
procesebi, romlebSic tau-cila mTavar rols vevebi
asrulebs (mimoxilva ix. Neary et al., 2005). pacientTa daaxloebiT 1/3-is pirveli rigis naTe
savs igive daavadeba aReniSneba. miuxedavad amisa,
_ 362 _
demencia
frontotemporaluri demenciis genetikuri safu rovizualuri da eeg gamokvlevebi gvexmareba. nei
Zveli da memkvidruli xasiaTi mTlianobaSi (da rovizualuri kvlevebiT frontotemporaluri demen
calke pikis daavadebis SemTxvevaSic) Seswavlili ciis SemTxvevaSi aRiniSneba fokaluri, asimetriuli,
ar aris (Bird et al., 2003). gamoyofilia qvejgufebi, atrofiuli ubnebis arseboba Sublisa da safeTqlis
romlebsac autosomuri dominanturi tipis mem polusebze da ara medialuri temporaluri wilis
kvidreobiToba axasiaTebT. erT-erTi aseTi formaa midamoSi, rogorc es aris alchaimeris dros. eeg-
frontotemporaluri daavadeba parkinsonizmiT, ze cvlilebebi ar gvaqvs, alchaimeris daavadebisgan
romelic me-17 qromosomasTanaa dakavSirebuli gansxvavebiT, rodesac aRiricxeba difuzuri Seneleba.
(FTDP-17 da, SesaZloa, tau genis mutaciiTaa gan
frontotemporaluri demenciis nevrologia
pirobebuli. Tumca, tau mutacia SeiZleba sxva
frontotemporaluri demenciis drosac Segvxvdes, pikis daavadebisTvis damaxasiaTebeli nevrolo
magram am formis dros yovelTvis ar gamovlindes. giuri niSnebi zemoT ukve ganvixileT. sxva fron
sxva ojaxuri SemTxvevebi dakavSirebulia me-3 totemporalur demenciebs ar axasiaTebT aseTi
qromosomasTan, xolo frontotemporaluri demencia gamoxatuli nevropaTologiuri korelatebi. yvela
motoruli niSnebiT ki _ me-10 qromosomasTan. SemTxvevaSi aris progresuli atrofia Sublisa da
safeTqlis wilis midamoSi. aRiniSneba neironebis
semantikuri demencia kvdoma, gliozi, korteqsis zeda Sris Rrublisebri
semantikuri demenciisTvis damaxasiaTebelia seleq cvlilebebi da, xSirad, gajirjvebuli neironebi,
ciurad verbaluri da araverbaluri masalis semantikis romlebSic tau, ubiqvitini da fosforilirebuli
(mniSvnelobis) progresuli gauareseba, rasac Tan neirofilamentebia. arsebul cvlilebebsa da klinikur
axlavs saxeldebis, kategorizaciisa da gagebis niSnebs Soris pirdapiri korelacia ar arsebobs.
gamoxatuli sirTuleebi (Gerrard and Hodges, 2000). daavadebis paternebi sakmaod mravalferovania,
mas yovelTvis miakuTvnebdnen frontotemporalur kavSiri paTologiur cvlilebebsa da daavadebis
demencias, vinaidan igi arCeviTad asocirebulia simptomebs Soris _ gaurkveveli (Munoz et al., 2003).
safeTqlis, upiratesad, marcxena wilis atrofiasTan. neiroqimiuri TvalsazrisiT, alchaimeris demen
avtobiografiuli mexsiereba SedarebiT Senaxulia ciisgan frontotemporaluri demencia imiT ga
(Tumca, SeiZleba gagviWirdes gamokiTxva). rodesac moirCeva, rom qolinerguli deficiti ar aRiniSneba.
pacients vTxovT raime nivTis Cvenebas an raime dofanic normaSia, xolo serotonini tvinis da
moqmedebis demonstrirebas, igi gaognebuli gviyu zianebul ubnebSi mniSvnelovnadaa daqveiTebuli
rebs, imeorebs instruqcias ise, TiTqos misTvis (Perry and Miller, 2001).
ucxo enaze iyos naTqvami. kognituri, fsiqikuri da
frontotemporaluri demenciis etiologia
nevrologiuri niSnebi sawyis etapze umniSvnelodaa
gamoxatuli; mravali wlis manZilze simptomatika frontotemporaluri demenciis etiologia, praq
SeiZleba SemoisazRvros mwvave progresirebadi tikulad, ucnobia, garda ojaxuri SemTxvevebisa,
semantikuri metyvelebis darRvevebiT. razec zemoT visaubreT da romelic, savaraudod,
tau-s mutaciiTaa gamowveuli. genetikuri faqtorebi,
diferencialuri diagnozi da gamokvlevebi SeiZleba, sxva faqtorebzec iyos damokidebuli,
1993 wels Catarebuli kvlevebiT naxes, rom 21-dan 18 Tumca, es ar aris bolomde Seswavlili.
SemTxvevaSi pikis daavadebis mqone pacientebs SecdomiT miuxedavad imisa, rom tau-s mutacia yovel
alchaimeris daavadebis diagnozi hqondaT dasmuli. Tvis ar vlindeba da uciloblad ar monawi
ukanasknel wlebSi, mas Semdeg, rac diagnostikuri leobs nevropaTologiur cvlilebebSi, mas fron
kriteriumebi SemuSavda da frontotemporaluri totemporaluri demenciis paTogenezSi centra
demenciis Sesaxeb eqimebis informirebuloba gaum luri adgili ukavia; savaraudod, imitom, rom
jobesda, situacia SedarebiT gamosworda. Tumca, cilis sinTezia darRveuli. am cilis sxvadasxva
frontotemporaluri demenciis diagnostireba varianti (izoformebi) `gameorebebis~ gansxvavebul
kvlav rTulia, rac misi heterogenulobiTa da mas raodenobas Seicavs. zogi, SesaZloa, asocirebuli
Tan dakavSirebuli kvlevebis naklebobiT aixsneba. iyos frontotemporalur demenciasTan. mag., pikis
alchaimeris daavadebisa da sxva demenciebisgan daavadebis dros gvaqvs `samjer gameorebuli~ tau
diferencirebisTvis ufro mniSvnelovania qceviTi cila, xolo progresirebadi supranuklearuli
cvlilebebis gamovlena, vidre neirofsiqologiuri damblis dros ki _ òTxjer gameorebuli~ tau
gamokvlevebi (Perry and Miller, 2001). zusti diagnozis da kortikobazaluri degeneracia (cxrili 14.16).
dasmis gasaumjobeseblad Zalian cota kvlevaa tau-paTologiis gansxvaveba frontotemporaluri
Catarebuli (Pasquier et al., 2003). difdiagnozSi nei demenciisa da alchaimeris daavadebis SemTxvevebSi
_ 363 _
cnobili ar aris da, savaraudod, tau `gameorebebis~ Creutzfeldt-Jakob_is daavadebis (axali) varianti
ricxvsa da hiperfosforilirebis xarisxzea damo
1996 wels britaneTSi Creutzfeldt_Jakob-is erT-erTi
kidebuli (mimoxilva ix. Lee et al., 2001).
variantis (vCJD) gamovlenisa da aRweris Semdeg,
prionuli daavadebebis mimarT interesi gaizarda. mas
prionuli daavadebebi
Semdeg 150 SemTxveva Seiswavles, romlebic dakavSire-
prionuli daavadebebi daavadebaTa unikaluri jgu buli iyo im dros inglisSi gavrcelebul msxvilfexa
fia. isini SeiZleba ganviTardnen rogorc gen saqonlis Rrublisebri encefalopaTiis (BSE) epi-
etikuri, infeqciuri an iatrogenuli mizezebis ga demiasTan. vCJD-isa da BSE-s SemTxvevebis Sedarebisas
mo, aseve, sporadiulad (Collins et al., 2004). maTi erT gamovlinda msgavseba prionul Stamebs Soris da daas-
jgufSi gaerTianeba saerTo ZiriTadi gamomwvevi kvnes, rom pirovneba dainficirebuli xorciT daavad-
mizezis, cila prionis (PrP), gamo moxda. maT saerTo da (Harrison, 1997). Zneli saTqmelia, arsebuli SemTx-
nevropaTologiuri niSnebic aqvT, kerZod: difuzuri vevebi ramdenad miuTiTebs momavalSi ufro moculo-
spongiozi (Zveli saxelwodebaa transmisiuli Rrub biTi epidemiebis ganviTarebaze, amJamad iTvleba, rom
lisebri encefalopaTia), neironebis kvdoma, gliozi es aRar ganmeordeba. gamovlenilia polimorfizmi
da, xSir SemTxvevaSi, amiloduri folaqebi (Johnson, prionis genis 129-e kodonSi, romelic meTioninisa da
2005). es ukanaskneli Sedgeba ara -amiloduri valinis kodirebas axdens. yvela vCJD SemTxvevaSi iyo
cilisgan (rogorc es aris alchaimeris daavadebis homozigoturi formebi meTioniniT (zogad popula-
dros), aramed prionis cilisgan. ciaSi 40%-Tan SedarebiT), rac miuTiTebs imaze, rom
aseTi genetikuri maxasiaTeblebis mqone qvejgufi
Creutzfeldt-Jakob-is daavadeba
metadaa midrekili vCJD_sadmi.
Creutzfeldt_Jakob-is daavadeba (CJD) ZiriTadia prionuli
CJD-is sxva formebisgan gansxvavebiT, vCJD-s axasi-
daavadebebis jgufSi. yovel weliwads erT milion
aTebs ufro adreuli dasawyisi, neli mimdinareoba da
mosaxleze 1 axali SemTxveva vlindeba. garkveuli
fsiqikuri aSlilobebis (depresia, personologiuri
SemTxvevebi autosomur dominanturi tipiT gadadis,
cvlilebebi) arseboba (Spencer et al., 2002); eeg cvli-
rodesac aris PrP genis konkretuli monakveTisa
lebebi naklebad aRiniSneba. magnitur-rezonansuli
da sigrZis dazianeba (ix. qvemoT). aseve, daavadeba
gamokvleviT gamovlenili `pulvinaruli~ niSani (hi-
SeiZleba iatrogenulad ganviTardes, mag., hipofizisgan
perintensivoba TalamusSi) mniSvnelovani da arain-
warmoebuli zrdis hormoniT, dabinZurebuli
vaziuri diagnostikuri maxasiaTebelia. vCJD-s diag-
neiroqirurgiuli instrumentebiT, an uxarisxo
nostikisTvis SeiZleba nuSisebri jirkvlis biofsiac,
qirurgiuli masaliT, an, SesaZloa, sisxlis gadasxmiT.
Tumca, am gamokvlevis klinikuri mniSvneloba saeWvoa.
inkubaciuri periodi daaxloebiT 20 welia. inficirebis
potenciuri saSiSroebis gamo arc erTi daavadebuli sxva prionuli daavadebebi
piri ar SeiZleba iyos organos an sisxlis donori. kuru aRwerilia fores mosaxleobaSi (papua axali
sporadiuli CJD SemTxvevebi orive sqesTan Tanabrad gvineas xalxi); igi gadadis ritualuri kanibalizmiT.
gvxvdeba. daavadeba, Cveulebriv, 50_60 wlis asakSi es daavadeba oficialurad aRar dafiqsirebula 1950
iwyeba. pirveli niSani mexsierebis daqveiTebaa, rasac wlidan, mas Semdeg, rac es rituali aikrZala. 1970
Tan sdevs qceviTi darRvevebi, pirovnuli cvlilebebi, wels maimunebze kurus transmisia prionuli daavade-
rac fsiqiatrTan vizitis mizezi xdeba. xSiria bebis infeqciuri bunebis pirveli eqsperimentuli
vizualuri simptomebi, naTxemis dazianebis niSnebi, dasabuTeba iyo.
uneblie moZraobebi, mioklonuri krunCxvebi da sxva sxva memkvidruli prionuli daavadebebia gerst-
motoruli niSnebi. krunCxviTi Setevebi daavadebis man_Strausler_Seinkeris (Gerstmann_Strussler_Scheink-
mogvianebiT stadiaze viTardeba. daavadeba uwyvetad er) sindromi da fataluri insomnia. iseve, rogorc
da swrafad progresirebs da 6 TveSi, SesaZloa, ojaxuri CJD-is SemTxvevaSi, es orive mdgomareoba
sikvdiliT dasruldes. eeg-ze samfazuri ganmuxtva gamowveulia prionuli cilis genis autosomuri dom-
(1_2Hz), anamnezsa da swraf mimdinareobasTan erTad, inanturi mutaciiT. pirdapiri korelacia mutaciis
diagnostikurad sarwmunoa. Tavzurgtvinis siTxeSi xasiaTs, klinikuri sindromebis Taviseburebasa da
bioqimiurad vlindeba `14_3_3 proteinebi~, rasac, nevropaTologiur cvlilebebs Soris ar aris gamov-
aseve, didi diagnostikuri mniSvneloba aqvs. Tumca, lenili. es orive daavadeba Zalze iSviaTia.
imisTvis, rom pacients sicocxleSive zusti diagnozi
davusvaT, saWiroa tvinis biofsia. prionuli daavadebis etiologia
britaneTSi yvela prionuli daavadebis mqone paci- saxelwodeba `prioni~ niSnavs cilovan infeqciur
enti an misi monacemebi igzavneba edinburgis erovnu- nawilaks. igi 1982 wels gamoavlina prusinerma,
li meTvalyureobis centrSi. romelmac 1999 wels miiRo nobelis premia medicinaSi
_ 364 _
demencia
(Prusiner, 2001). prionuli cilis (PrP) kodireba xdeba gadametebuli umizno `mousvenrobis~ saxiT (Tumca,
me-20 qromosomaSi moTavsebuli genis mier. normal- pacienti SeiZleba cdilobdes amis SeniRbvas). aseTma
uri prionuli cilis (PrPC) funqcia ucnobia. ner- avadmyofebma SeiZleba mimarTon fsiqiatrs depresiis
vul ujredSi man SeiZleba Seasrulos receptoruli gamo, rac damaxasiaTebelia daavadebis adreul sta-
funqcia da gavlena moaxdinos sinafsur gadacemaze. diaze. mogvianebiT, ufro xSirad, aRiniSneba sakuTar
prionuli daavadebebis dros PrPC iZens anomaliur TavSi Caktva, èqscentruli~ qceva da socialuri
Tvisebebs da warmoiqmneba PrPSc.(`scrapie~ pironuli izolacia. depresiis klinikuri suraTi msgavsia didi
daavadebis saxelia, romelic cxvris am saxeobas depresiis simptomebisa. savaraudod, mis ganviTare-
emarTeba). PrPSc aris daavadebis ZiriTadi molekuluri baSi rogorc biologiuri, aseve reaqtiuli komponen-
markeri da, savaraudod, ZiriTadi gamomwvevi agentic. tebic monawileobs. xSiria, paranoiduli simptomebi,
PrP-sTan SedarebiT, PrPSc uxsnadi, proteazas mimarT Sizofreniismagvari an afeqturi fsiqozebi. subkor-
rezistentuli cilaa. mas axasiaTebs TviTagregacii- tikuli bunebis kognituri daqveiTeba, Cveulebriv,
saken midrekileba da warmoqmnis dagrovebis ubnebs mogvianebiT stadiebze vlindeba. misi simwvave da
tvinSi. iTvleba, rom PrPSc xels uwyobs sinafsebisa progresirebis siswrafe mniSvnelovnad meryeobs (Ho
da neironebis kvdomas, gliozs da ganapirobebs et al., 2003). damaxasiaTebelia yuradRebis advilad
Rrublisebr cvlilebebs Tavis tvinSi. gadanacvleba. pacients aReniSneba koncentraciis
miiCneven, rom ojaxur SemTxvevebSi mutaciuri daqveiTeba da mizanmimarTuli fsiqomotoruli aqti-
PrP metadaa midrekili TviTagregaciisaken. SeZenili vobis ganxorcielebis uunaroba da mogvianebiT _ apa-
formebis dros ki (iatrogenulad an sakvebiT daa- Tia. mzeris apraqsia da enis myari protruzia (`gve-
vadebis SemTxvevaSi) varaudoben, rom normaluri cila lis ena~) tipiuria hanTingTonis daavadebisTvis (meti
PrPC `ziandeba~ SeZenili PrPSc mier da mTlianad gar- informaciis misaRebad ix. Tost et al., 2004).
daiqmneba anomaliur (PrPSc) formad. amis Sedegad PrPSc
hanTingTonis daavadebis nevropaTologia
raodenoba kidev ufro matulobs. am mniSvnelovani
molekuluri procesis detalebi ucnobia. periferi- paTologiuri cvlilebebi, upiratesad, vlindeba
uli dainficirebis SemTxvevaSi, PrPSc cila SeiZleba kudian birTvsa da Sublis wilSi. kudiani birTvi
gavrceldes nervebis, sisxlisa da limfis saSuale- TvalsaCinod atrofiuli da gliozuria. Sublis
biT da miaRwios Tavis tvins. PrP cilis gansxvavebuli wilSi ziandeba piramiduli ujredebi da xdeba ruxi
konfiguraciisa da modifikaciis Stamebi (glikozil- nivTierebis gaTxeleba. zogierTi ujredis birTvSi
irebis paternebidan gamomdinare) sxvadasxva daavade- aRiniSneba poliglutaminuri CanarTebi, rac, qveviT
bas iwvevs. ar aris dadgenili `sporadiuli~ prionu- aRwerili, kauzaluri mutaciis Sedegia (ix. qvemoT).
li daavadebis etiologia, rac SeiZleba gamowveuli neiroqimiurad kudian birTvSi daqveiTebulia mainhi-
iyos normaluri prionuli cilis (PrPC) spontanuri birebeli neirotransmiteris, gama_amino_erbo mJavas
konversiiT an mutaciiT anomaliur prionul cilaSi (GABA), koncentracia.
(PrPSc); an SeiZleba okulturi miznebiT gamoyenebuli
hanTingTonis daavadebis etiologia
nivTebiT gadavides. jer-jerobiT ar aris garkveuli,
hanTingTonis daavadeba fsiqiatriaSi erT-erTi auto-
ratom aqvs PrPSc cilas infeqciuri buneba, maSin roca
somur dominanturi daavadebaa im iSviaTi daavadebe-
sxva amiloidogenur cilebisTvis es ar aris damaxa-
bidan, romlebic erTi geniT gadadis. axasiaTebs sru-
siaTebeli (magaliTd, -ailoidi). winaT egonaT, rom
li penetrantoba (rac niSnavs imas, rom aseTi mutaci-
prionis daavadebas neli virusi iwvevda, rac Semdgom-
uri genis mqone yvela pirs uviTardeba es daavadeba).
Si ar dadasturda.
axali mutacia Zalian iSviaTia. gamokvleuli spora-
diuli SemTxvevebis umetesoba ar iZleoda sakmaris
hanTingTonis daavadeba
informacias ojaxis anamnezs an pacientis biologiur
es daavadeba, romelsac hanTingTonis qoreasac uwo-
mSoblebTan dakavSirebiT. 4p qromosomaSi moTavse-
deben, pirvelad aRwera niu inglendSi moRvawe eq-
bulia geni, romelic axdens hanTingTonis cilis ko-
imma jorj hanTingTonma 1872 (George Huntington, gan-
direbas. mutacia, romelic 1993 wels gamoavlines,
meorebiT gamoica 2003 wels). hanTingTonis qorea
warmoadgens `tripletur gameorebas~ anu xdeba CAG
gavrcelebulia mTels msoflioSi da misi sixSire
kodonis, romelic glutamins akodirebs, `trinukle-
meyeobs 4_7%-is farglebSi 100 000 sul mosaxleze.
otiduri gameoreba~. normaSi aseTi poliglutaminuri
Cveulebriv, iwyeba saSualo asakSi, Tumca, SesaZlebe-
Tanmimdevroba 30-ze nakleb gameorebas Seicavs, xolo
lia, mozardobaSic gamovlindes. ufro xSirad axasi-
daavadeba vlindeba im SemTxvevaSi, rodesac es ricx-
aTebs progresirebadi kognituri da qceviTi gauare-
vi 36-ze metia. memkvidreobaSi aRiniSneba am ricxvis
seba. damaxasiaTebeli qoreaformuli moZraobebi yov-
gazrdis tendencia, rac iwvevs daavadebis ufro ax-
elTvis ar aris gamoxatuli. igi SeiZleba gamovlindes
_ 365 _
algazrda asakSi ganviTarebas (am Tvisebas ewodeba nis daavadebisas (Lovestone and McLoughlin, 2001; Soto,
anticipacia) da damaxasiaTebel `trinukleotiduri 2003). msgavsebaa imaSic, rom ar aris pirdapiri kavSiri
gameorebis~ daavadebas (Everett and Wood, 2004). han- proteinsa da sindroms Soris. mag., tau cila monawil-
TingTonis cilis normaluri funqcionireba da muta- eobs rogorc alchaimeris daavadebis, ise frontotem-
ciis meqanizmi amJamad intensiuri kvlevis sgania (Li poraluri demenciis etiologiaSic. am faqtorebidan
and Li, 2004). diagnostikuri da prognozuli testire- gamomdinare, molekuluri klasifikaciis mixedviT, de-
ba farTodaa danergili. daavadebis memkvidruli xa- menciebi, rogorc amiloidopaTebi, iyofa `taupaTebad~
siaTidan gamomdinare, am genis matarebeli pirebi da da `sinukleinopaTebad~ (Hardy and Gwinn-Hardy, 1998;
maTi naTesavebi genetikur konsultacias saWiroeben Forman et al., 2004). arsebuli klasifikaciiT, prionuli
(Harper et al., 2004). daavadebebi ukve amis mixedviTaa klasificirebuli.
hanTingTonis daavadebis raime specifikuri Te- garda amisa, calkeuli demenciis genetikuri qveti-
rapia ar arsebobs. mwvave qoreas SemTxvevaSi, gansa- pebis gamovlena (mag., alchaimeris daavadeba, romelic
kuTrebiT, gamofitvis saSiSroebis an mobilurobis gamowveulia sxvadasxva genis _ APP, PS1 da PS2 muta-
SezRudvis dros, SeiZleba saWiro gaxdes dofaminuri ciiT) miuTiTebs imaze, rom es gansxvavebuli daavade-
blokada. depresiul mdgomareobas antidepresante- bebia. yvela es sakiTxi amJamad kvlevis sgania; axlo
biT mkurnaloben. momavalSi, mas Semdeg, rac dadasturdeba maTi mniS-
vneloba mkurnalobasa da daavadebis prognozirebis
aiv infeqciiT gamowveuli demencia sakiTxebSi, es gavlenas moaxdens klinikur azrovnebasa
ix. me-16 Tavi da praqtikul saqmianobaze (me-20 Tavi).
alkoholis borotad moxmarebiT gamowveuli epilefsia

demencia epilefsia esaa rekurentuli gulyrebisadmi mid
ix. me-18 Tavi rekileba. gulyra warmoadgens paroqsizmul
eleqtrul ganmuxtvas Tavis tvinSi da mis klinikur
demenciis Tanamedrove koncefciebi Sedegs. gulyris ganmeorebis tendencia ganasxvavebs
demenciis klasifikacia da klinikuri praqtika eyrd- epilefsias izolirebuli gulyrebisgan. gulyras
noba zemoT aRweril demenciis sindromebs. Tumca, iwvevs uamravi mizezi, maT Soris: medikamentebi, hipo-
epidemiologiuri da biologiuri kvlevebi eWvqveS glikemia da interkurentuli daavadebebi. epilefsiis
ayenebs arsebul diagnostikur koncefciebs. mkurnaloba da marTva nevrologebis saqmea, amitom
daavadebis Sesaxeb sruli informaciis misaRebad
Sereuli demencia gamoiyeneT nevrologiis saxelmZRvanelo. Tumca, epi-
ufro TvalsaCino gaxda demenciis Sereuli formebis lefsias garkveuli fsiqiatriuli aspeqtebic axlavs
sixSire da mniSvneloba. es gansakuTrebiT exeba al- Tan (rac fsiqiatriul da nevrologiur problemebs
chaimerisa da vaskuluri demenciis Tanaarsebobas. Soris mWidro kavSirze miuTiTebs):
aseTi Sereuli formebi demenciis saerTo SemTx- w qcevis epizoduri darRvevebi, kerZod, àtipiuri
vevebis 20%-s warmoadgens. am daavadebebis erTdrou- Setevebis~, agresiuli qcevisa da Zilis problemebi,
li ganviTareba auaresebs demencias (Nagy et al., 1997) rac saWiroebs diferencialur diagnozs epilef
da gavlenas axdens mkurnalobaze (Langa et al., 2004). siisgan;
vaskuluri demenciisa da alchaimeris demenciis
w epilefsiis fsiqiatriuli da socialuri garTu
klinikuri gadafarva SeiZleba aixsnas maTi risk_faq-
lebebis mkurnaloba;
torebis gadafarviTa (mag., apoE, homocistini; Mattson
and Shea, 2003) da im mosazrebiT, rom alchaimeris daa- w fsiqotropuli preparatebiT gamowveuli gulyrebi;
vadebas vaskuluri safuZveli aqvs (de la Torre, 2004). w antikonvulsantebis gverdiTi efeqtebi.
neirodegeneraciuli daavadebebis molekuluri gulyris saxeebi

klasifikacia
gulyrebis Tanamedrove klasifikacia SemogvTavaza
diagnostikuri kriteriumebis sazRvrebi molekulur
epilefsiis sawinaaRmdego saerTaSoriso ligam 1969
doneze ufro metadaa waSlili. damaxasiaTebelia erTi
wels, rac mogvianebiT gadaisinja (Dreifuss et al., 1981).
da igive bioqimiuri procesebi _ proteinebis dagrove-
es klasifikacia gamartivebuli saxiT mocemulia
ba, agregacia da akumulacia, rac centraluria yvela
cxrilSi 14.17. masSi ZiriTadad gamijnulia ori saxis
neirodegeneraciuli daavadebisTvis; mag., -amilodi
gulyra: (1) gulyra fokaluri dasawyisiT, romelsac
alchaimeris daavadebis dros, PrP _ prionis daavade-
parcialuri gulyra ewodeba da (2) gulyra, romelic
bebis SemTxvevaSi da hanTingTonis cila _ hanTingTo-
_ 366 _
epilefsia
rTuli parcialuri gulyrebi

cxrili 14.17 gulyrebis klasifikacia
kompleqsuri parcialuri gulyrebis dros alo da
fokalurad dawyebuli gulyrebi
autofsiqikuri cnobiereba Secvlilia. pirovnebas
w martivi motoruli an sensoruli (Secvlili aReniSneba mTeli rigi `fsiqiatriuli~ simptomebi
cnobierebis gareSe); (cxrili 14.8), rasac warsulSi `fsiqomotorul
w rTuli parcialuri (Secvlili cnobierebiT);
epilefsias~ uwodeben. am niSnebis gamo epilefsia
w parcialuri gulyra meoradi generalizaciiT.
fsiqiatrebisTvisac mniSvnelovania; xSirad saWiroa
generalizebuli gulyra fokaluri dasawyisis gareSe maTi sxva fsiqikuri aSlilobebisgan diferencireba.
meoradi generalizaciis ganviTarebamde pacienti
w tonurklonuri;
w mioklonuri; gonebas ar kargavs. miuxedavad amisa, igi kontaqtisTvis
w atonuri; miuwvdomelia da mogvianebiT uWirs gadatanili
w absansi; mdgomareobis gaxseneba da aRwera. gulyrebis um
w araklasificirebuli. ravlesoba, ufro xSirad, safeTqlis wilSi aR
mocendeba, amitom iyeneben termins `safeTqlis wilis
cxrili 14.18 kompleqsuri parcialuri gul epilefsia~, magram es ar aris Sesabamisi termini,
yrebis klinikuri niSnebi vinaidan rTuli parcialuri gulyra SeiZleba
Sublis wils an sxva ubnebSic aRmocendes. aseT
sfero niSnebi
SemTxvevebSi gulyrebi SeiZleba SecdomiT CaiTvalos
cnobiereba Secvlili funqciurad, radgan mas xSirad Tan axlavs ucnauri
avtonomiuri da epigastruli aura, Tavbrusxveva, pozebi, nawilobriv mizanmimarTuli moZraobebi da
visceruli taqikardia, sisxlis mowola, sxva rTuli motoruli qcevebi. safeTqlis wilis rTuli
usiamovno SegrZnebebi sxeulSi
parcialuri gulyrebi, Cveulebriv, iwyeba auriT,
perceptualuri Secvlili aRqma, smeniTi, romelsac ynosviTi, gemovnebiTi, auditoruli,
mxedvelobiTi ynosviTi, gemovnebiTi,
vizualuri an somaturi halucinaciebis saxe aqvs.
somaturi halucinaciebi, dj vu,
jamais vu gansakuTrebiT xSiria èpigastruli (visceruli)
aura~ _ kuWis midamodan kisris aremde aRmavali
kognituri metyvelebis, azrovnebisa
da mexsierebis, darRvevebi, ucnauri, arasasiamovno (buybuyis) SegrZneba.
derealizacia da depersonalizacia pacients SeiZleba hqondes ucnauri azrebi da
afeqturi SiSi, SfoTva, zogjer eiforiuli an emociebi, maT Soris `nacnobis~dj vu (ukve nanaxis)
eqstazuri mdgomareoba an ùcnobis~ jamais vu (arasdros nanaxis) intensiuri
fsiqomotoruli avtomatizmebi, manWva da sxeulis sxva SegrZneba, depersonalizacia, derealizacia an, iS
moZraobebi, ganmeorebadi an ufro viaTad, gadatanilis cocxali halucinaciebi (`ga
rTuli, stereotipuli moZraobebi.
mocdilebis fenomeni~ experiential phenomena). gulyris
ganviTarebis Tanmimdevroba yovel individualur
Tavidanve generalizebulia. amitom diagnostikurad
SemTxvevaSi stereotipulobiT gamoirCeva, risi
gulyris dasawyisis zusti aRwera Zalian mniSv
gaTvaliswinebac diagnostikurad mniSvnelovania. sruli
nelovania. aseve, aucilebelia ganvasxvavoT epilefsiis
iqtaluri (epilefsiur SetevasTan dakavSirebuli)
tipebi da gulyris saxeebi. tradiciuli terminebi
faza, Cveulebriv, 1-2 wuTi grZeldeba. mdgomareobidan
petit mal da grand mal orazrovania da umjobesia
gamosvlis Semdeg, pacientma, SeiZleba, mxolod aura
moveridoT maT gamoyenebas. unda gvaxsovdes, rom
gaixsenos. krunCxvis gareSe mimdinare epilefsiurma
àura~ praqtikulad parcialuri gulyraa. petit mal
statusma, SesaZloa, erTi gaxangrZlivebuli gulyris
da `gaTiSvebi~ sinamdvileSi rTuli parcialuri
an mravali swrafad monacvle gulyris forma miiRos.
gulyrebia, romlebic, WeSmariti absansebisgan gan
droSi gaWianurebuli avtonomiuri qceviTi darRvevebi
sxvavebiT, fokalur da ara generalizebul gulyrebs
SeiZleba SecdomiT disociaciur fugad an sxva fsiqikur
ganekuTvneba. calkeuli gavrcelebuli gulyrebis
daavadebad miviCnioT.
aRwera qveviTaa mocemuli.
martivi parcialuri gulyrebi absansebi

absansis ZiriTadi maxasiaTebelia cnobierebis uc
am tips ganekuTvneba jeqsonis gulyrebi, sxvadasxva
bad dakargva, rac iwyeba moulodnelad, auris
motoruli da sensoruli, naklebad formirebuli
gareSe, grZeldeba ramdenime wami da uecrad mTavr
gulyrebi. cnobiereba ar aris Secvlili. gulyris
deba. martivi avtomatizmebi (mag., quTuToebis
Semdeg fokaluri nevrologiuri da kognituri
TrTola) xSirad Tan axlavs Setevas. postiqtaluri
disfunqcia SeiZleba gagrZeldes gaurkveveli vadiT.
darRvevebi, Cveulebriv, ar aRiniSneba. diagnozisa
_ 367 _
da mkurnalobisTvis mniSvnelovania WeSmariti epilefsiis etiologia
absansi rTuli parcialuri gulyrisgan ganvasxvavoT. daavadebis dawyebis asaki etiologiuri faqtoris
es ukanaskneli ufro xangrZlivia, Setevis dros mniSvnelovani maCvenebelia. mag., axalSobilebSi
ganviTarebuli avtomatizmebi ufro kompleqsuri ganviTarebuli epilefsiis mizezebia samSobiaro
xasiaTisaa; gamojanmrTeleba ufro nela xdeba da travma, Tandayolili tvinis malformaciebi da
mdgomareobidan gamosvlis Semdeg pacientma SeiZleba metaboluri darRvevebi. bavSvebSi febriluri krun
aura gaixsenos. bavSvebSi ganviTarebul absansebs winaT Cxvebi, gansakuTrebiT ~status epilepticus, Cveulebriv,
`petit mal ewodeboda. igi klasikurad asocirdeba eeg- dakavSirebulia mogvianebiT parcialuri gulyrebis
ze wamSi 3 `pik talRis~ arsebobasTan. ganviTarebasTan, rasac hipokampis dazianeba gana
generalizebuli tonur-klonuri gulyrebi pirobebs (hipokampuri sklerozi). arsebobs mzar
di monacemebi genetikuri mutaciis Sedegad gan
generalizebuli tonur-klonuri gulyra aris
viTarebuli epilefsiis Sesaxeb. Tumca, es SemTxvevebi
kargad cnobili krunCxviTi Seteva, romlisTvisac
epilefsiiT daavadebulTa saerTo raodenobis
damaxasiaTebelia moulodneli dasawyisi, tonuri
Zalian mcire nawilia (Gutirriez-Delicado and Sarratosa,
da klonuri fazebi da sxvadasxva (ramdenime saaTis)
2004). mozrdilebSi gamovlenili mizezebia: cereb
xangrZlivobis krunCxvisSemdgomi periodi. Setevis
rovaskuluri daavadebebi, Tavis tvinis simsivneebi,
Semdeg pacienti dezorientirebulia, mTvlemare an
qala-tvinis travma, neirodegeneraciuli daavadebebi.
Rrma Zilis mdgomareobaSi imyofeba. krunCxvis dros
alkoholisa da wamalmoxmarebis faqtebi yovelTvis
SeiZleba iyos uneblie Sardva an defekacia; saSiSia enis
saTanadod unda Sefasdes, gansakuTrebiT axal
mokvneta an sxva saxis TviTdazianeba. postiqtalur
gazrdebSi. krunCxviTi zRurbli SeiZleba daqveiTdes,
periodSi SesaZloa deliriumis ganviTarebac, rac
Tu gamoviyenebT sxvadasxva preparats, mag., an
SeiZleba diagnostikuri Secdomis mizezi gaxdes, Tu
tifsiqozur preparatebsa da antidepresantebs.
krunCxvis epizodis mowme aravinaa. generalizebuli
antikonvulsiuri moqmedebis wamlebis, kerZod,
tonur-klonuri gulyris ganviTarebas SeiZleba win
diazepamisa da alkoholis ucbad moxsnam, SeiZleba
uZRodes parcialuri gulyra (rac SeiZleba mxed
xeli Seuwyos gulyrebis da, zogjer, epilefsiuri
velobidan gamogvrCes), romelic Tavis tvinis lo
statusis ganviTarebas.
kalur dazianebaze miuTiTebs. aucilebelia pirveladi
da meoradi generalizebuli gulyrebis zusti
diagnozis dasma
diagnostika, radgan isini gansxvavdebian TavianTi
mniSvnelobiT da sxvadasxva midgomas saWiroeben. epilefsiis diagnozi efuZneba daavadebis klinikur
suraTs, romelic iTvaliswinebs Setevis detalur
mioklonuri, atonuri da sxva saxis gulyrebi aRweras rogorc TviTmxilvelis, aseve pacientis
arsebobs ramdenime tipis gulyra, upiratesad, mier. anamnezuri, fizikuri mdgomareobisa da
motoruli simptomebiT. maT miekuTvneba mioklonuri damatebiTi specialuri gamokvlevebis monacemebi
krunCxvebi _ Zirs dacemis Setevebi kunTTa tonusis gvexmareba epilefsiis etiologiis dadgenaSi. gamo
gamoxatuli sisustiT. aseTi gulyrebis SemTxvevebSi kvlevebis moculoba damokidebulia pirvelad
pacientebi iSviaTad xvdebian fsiqiatrTan. maCveneblebze, Setevebis Taviseburebasa da paci
entis asakze. am sakiTxebs aq Zalian zogadad
epilefsiis epidemiologia ganvixilavT. ufro sruli informaciis mosaZieblad
britaneTSi daadgines, rom epilefsiis gavrcelebis ix. nevrologiis an epilefsiis saxelmZRvanelo. eeg
sixSire mozrdilebSi daaxloebiT 6 kacia 1000 sul gamokvleviT SegviZlia davadasturoT diagnozi,
mosaxleze. daavadeba upiratesad adreul bavSvobaSi magram ver gamovricxavT mas. misi gamoyeneba ufro
iwyeba. epilefsiis ganviTarebis Semdegi pikebi modis saWiroa epilefsiis tipisa da dazianebuli keris
mozardobis asaksa da 65 wlis zemoT. epilefsias, dasadgenad. standartul eeg gamokvlevas SeiZleba
Cveulebriv, xanmokle mimdinareoba aqvs da qronikuli davamatoT Zilis eeg, ambulatoriuli monitoringi
mdgomareoba pacientTa mxolod mexuTeds aReniSneba. da video eeg anu video telemetria. ukanasknel
es niSnavs, rom pacientebi, romlebic klinikebs dros neirovizualur gamokvlevebs didi klinikuri
regularulad akiTxaven, epilefsiiT daavadebulTa mniSvneloba eniWeba (Koepp and Duncan, 2004), Tumca
saerTo raodenobis mcire nawils warmoadgenen. specifikuri tvinis anomalia epilefsiis mqone
maT Soris arian pirebi, romlebsac gamoxatuli pacientebis umravlesobaSi ar aris dafiqsirebuli.
samedicino da socialuri problemebi aqvT. bavSvobaSi epilefsias xSirad SecdomiT miiCneven sxvadasxva
ganviTarebuli epilefsia ufro xSirad asocirebulia paroqsizmuli, nevrologiuri da fsiqiatriuli simp
kognitur daqveiTebasTan. tomebis mizezad. es aucileblad unda gaviTvaliswinoT
_ 368 _
epilefsia
diferencialuri diagnozis SemTxvevaSi (ix. cxrili postiqtalur periodSi sisxlis plazmaSi prolaqtinis
14.3). Zalian mniSvnelovania Setevis epizodisa da momateba mniSvnelovani maCvenebelia (prolaqtinis
gare faqtorebis zusti aRwera. upirveles yovlisa, momateba, Cveulebriv, generalizebuli gulyris
generalizebuli gulyris diferencialuri diagnozis Semdeg xdeba), Tumca, amaze dayrdnobiT ar unda
dros unda gamovricxoT vazovagaluri sinkope, gakeTdes saboloo daskvna (informacia epilefsiasa
romelic xSirad uneblie moZraobebTanaa asocirebuli da epizoduri qceviTi darRvevebis fsiqiatriul
(es faqti xSirad ugulebelyofilia) da kardialuri mizezebs Soris arsebuli gansxvavebis Sesaxeb ix.
ariTmia. hiperventilacia (romlis arsebobac xSirad Brown and Trimble, 2000).
Tavad pacients ar aqvs gacnobierebuli) da panikuri
Seteva zogjer rTuli parcialuri gulyris msgavs epilefsiis fsiqiatriuli aspeqtebi
gulyras iwvevs da gaxangrZlivebis SemTxvevaSi pa epilefsiis mqone pirebs Soris xSiria fsiqiatriuli
cientma SeiZleba gonebac ki dakargos. Sizofreniis garTulebebi; saerTo maCvenebeli, sul cota,
dros SeiZleba moxdes aqtivobisa da kognituri 2_jeraa gazrdili. es ricxvi ufro maRalia im
funqcionirebis ucabedi Secvla. pacientebis SemTxvevaSi, romlebsac specialistis
epilefsiuri gulyris arsebobaze miuTiTebs Sem mudmivi meTvalyureoba esaWiroebaT. epilefsiasTan
degi niSnebis erToblioba: moulodneli dasawyisi, mravali fsiqikuri aSlilobaa asocirebuli, maT
stereotipuli mimdinareoba, romelic ramdenime Soris, kognituri, afeqturi, emociuri da qceviTi
wamidan ramdenime wuTamde grZeldeba; Setevis dros _ darRvevebi. es darRvevebi SeiZleba gamovlindes
enis mokvneta, cianozi, uneblie Sardva, TviTdazianeba gulyris dawyebamde, mimdinareobis periodSi an
da postiqtalur periodSi Secvlili cnobierebis Semdeg (cxrili 14.19). urTierTkavSiri epilefsiasa
gaxangrZlivebuli mdgomareoba. calke aRebuli da fsiqikur aSlilobebs Soris moicavs Semdeg
romelime niSani ar aris aucilebeli da sakmarisi faqtorebs:
piroba diagnozis dasmisTvis. xSirad frontaluri
w saerTo etiologia an paTofiziologia. mag.,
epilefsiis zogierTi forma SecdomiT fsiqogenur
safeTqlis wilis paTologia qmnis rogorc epi
gulyrad diagnostirdeba. Tu diagnozis dazusteba
lefsiis, aseve fsiqozis ganviTarebis winaganwyobas;
ver xerxdeba, xolo gulyrebi xSirad viTardeba,
w epilefsiasTan asocirebuli stigma da fsiqoso
umjobesia, dakvirvebis mizniT, pacientis stacionarSi
cialuri gauareseba;
moTavseba, video da eeg telemetriis Catareba an
ambulatoriuli monitoringis uzrunvelyofa. w antiepilefsiuri mkurnalobis gverdiTi movlenebi.
Zalian Znelia araepilefsiuri Setevebisa (fsevdo
gulyrebis) da disociaciuri mdgomareobebis dife cxrili 14.19 asociacia epilefsiasa da
rencireba epilefsiisgan. pacientebis TiTqmis 50%-s, fsiqologiur darRvevebs Soris
romelic epilefsiis samsaxurebs mimarTavs, epilefsia
fsiqikuri aSlilobebi, romlebic gamomwvev mizezTanaa
ar aReniSneba an Sereuli gulyrebi aqvs (Brown and asocirebuli
Trimble, 2000). diagnozis dasasmelad umTavresia
qceviTi darRvevebi, romlebic gulyrasTanaa
gulyrebis aRmocenebisa da mimdinareobis detaluri dakavSirebuli
aRwera. niSnebi, romlebic miuTiTeben araepilefsiur w preiqtaluri: prodromuli mdgomareobebi da guneb
gulyraze: aSkara maprovocirebeli fsiqosocialuri ganwyobis darRvevebi;
faqtorebis arseboba, fizikuri an seqsualuri w iqtaluri: kompleqsuri parcialuri gulyra (afeqturi
aSlilobebi, halucinaciebi, gamocdilebis fenomeni,
Zaladobis anamnezi, fsiqikuri aSlilobebis piradi avtomatizmebi), absansebi (Secvlili cnobiereba,
an ojaxuri istoria da uCveulod gansxvavebuli avtomatizmebi);
Setevebi, romlebic Tavs iCens an sazogadoebaSi an w postiqtaluri: cnobierebis darRvevebi, deliriumi,
mxolod marto yofnis dros. aseTi gulyrebis dros fsiqozebi, todis (Todds paresis - Robert Bentley Todd)
parezebi, hemiparezi, disfazia da sxva.
pacients ar aReniSneba avtonomiuri niSnebi, kanis
safarveli ar icvlis fers. igi SeiZleba iyos zedmetad epilefsiuri fsevdodemencia (aragulyriTi mdgomareoba)
STagonebuli da arasworad axsovdes Setevis dros interiqtaluri aSlilobebi:
mimdinare movlenebi. rTuli umizno moZraobebi ufro kognituri;
disociaciuri mdgomareobebisTvisaa damaxasiaTebeli. fsiqozebi;
ambulatoriuli eeg gamokvleva SeiZleba dagvexmaros seqsualuri qceva;
diagnozis dazustebaSi. Tumca, unda gvaxsovdes, rom w depresia da afeqturi aSlilobebi;
zogierTi gulyra SeiZleba ar dafiqsirdes eeg-ze w TviTmkvleloba da TviTdazianeba.
da piriqiT (janmrTeli populaciis TiTqmis 3%-s w kriminaluri da antisocialuri qceva (ix. gv. ??)
aReniSneba cvlilebebi eeg-ze). zog SemTxvevaSi, w pirovnuli cvlilebebi (ix. gv. ??)
_ 369 _
(epilefsiis fsiqiatriuli aspeqtebis mimoxilva ix. postiqtaluri Zaladobis SemTxvevebi SeiZleba
Marsh and Rao, 2002; Gaitatzis et al., 2004). ganmeorebadi da stereotipuli xasiaTis iyos. ufro
xSirad gvxvdeba mamakacebSi gulyrebis klasteruli
preiqtaluri fsiqikuri darRvevebi
Setevebis Semdeg (Gerard et al., 1998). pacients, Cveulebriv,
gulyris ganviTarebamde ramdenime saaTisa da, amnezirebuli aqvs gadatanili mdgomareoba.
SesaZloa, ramdenime dRiT adrec pacienti SeiZleba
grZnobdes daZabulobas, SfoTvas, gaRizianebas, interiqtaluri fsiqikuri darRvevebi
romelTa intensivoba gulyris moaxloebasTan erTad kognituri darRvevebi
izrdeba.
me-19 saukuneSi, institucionirebul pirebze dak
iqtaluri fsiqikuri darRvevebi virvebis Sedegad, farTod iqna aRiarebuli, rom
epilefsias axasiaTebs gamoxatuli inteleqtualuri
iqtaluri fsiqikuri darRvevebi, anu is fsiqo
daqveiTeba. amJamad cnobilia, rom epilefsiis mqone
paTologiuri niSnebi, romlebic uSualod gulyris
pacientTa mxolod mcire nawils aReniSneba kognituri
dros vlindeba, mravalferovnebiT gamoirCeva.
cvlilebebi. am niSnebis gamovlenis SemTxvevaSi,
rogorc ukve aRvniSneT, damaxasiaTebelia cnobierebis
rogorc wesi, unda vifiqroT Tanmxleb tvinis
Secvla, afeqturi aSlilobebi, SfoTva, avtomatizmebi
dazianebaze, aradiagnostirebul, krunCxvisgareSe
da sxva anomaliuri qceva (gansakuTrebiT, parcialuri
mimdinare gulyrebis arsebobas an antiepilefsiuri
gulyris dros). zogjer fsiqikuri darRvevebi
preparatebis gverdiT movlenebze. progresuli
SeiZleba krunCxvis gareSe mimdinare epilefsiuri
kognituri daqveiTeba epilefsiis mqone pacientebis
statusis erTaderTi gamovlineba iyos (rTuli
umniSvnelo nawilisTvisaa damaxasiaTebeli. aseT
parcialuri gulyrebi an absansebi), rac SesaZloa
dros aucilebelia, gamovricxoT sxva nevrologiuri
diagnostikuri Secdomis mizezic gaxdes.
daavadebebis arseboba. amas gansakuTrebuli
fsiqozi SeiZleba iqtaluri fenomenis saxiT ga
mniSvneloba eniWeba pediatriul praqtikaSi.
movlindes. diferencirebaSi dagvexmareba Semdegi
niSnebis gaTvaliswineba: mdgomareobis dawyebisa personologiuri cvlilebebi
da dasrulebis moulodneli, krizisuli xasiaTi,
istoriulad èpilefsiuri pirovnebis~ koncefcia
gemovnebiTi da ynosviTi halucinaciebis arseboba
gulisxmobda iseT adamians, romelsac axasiaTebs
(gansakuTrebiT parcialuri krunCxvebis dros),
egocentruloba, gaRizianebadoba, religiuroba,
pirveladi niSnebis iSviaToba da amnezia gadatanil
kverulantoba da `webovani~ azrovneba. ukanasknel
mdgomareobasTan dakavSirebiT.
periodSi, kvlevebis monacemebis safuZvelze, es
Zaladobis SemTxvevebi iqtalur periodSi uki
midgoma Seicvala. zogadi mosaxleobis kvlevebma
duresad iSviaTia (erT-erTi farTomasStabiani
aCvena, rom epilefsiis mqone pirTa mxolod um
gamokvlevebis mixedviT, 0, 3%-ze naklebia, Delgado_
ciresobas aReniSneboda personologiuri Tavise
Escueta et al., 1981). kidev ufro cotaa epilefsiuri
burebebi, rasac, upiratesad, ganapirobebda tvinis
avtomatizmebis dros Cadenili kriminaluri Sem
dazianebis gavlena ganaTlebaze, dasaqmebasa da
Txvevebi. es monacemebi mniSvnelovania samedicino da
socialur urTierTobebze, da ara, spcifikurad,
iuridiuli TvalsazrisiT (Treiman, 1999).
epilefsia (Trimble, 1997). arsebobs mosazreba, rom
postiqtaluri darRvevebi qceviTi anomaliebi (hipergrafiis CaTvliT _ we
fsiqikuri aSlilobebi SeiZleba gamovlindes gulyris ris stili, romlisTvisac damaxasiaTebelia mra
Semdeg periodSic. postiqtaluri fsiqopaTologiuri valsityvaoba, umniSvnelo detalebze yuradRebis
simptomebis ganviTareba aReniSneba pacientTa 10%-s gamaxvileba, pedanturoba) dakavSirebulia medialur-
da asocirebulia bilateraluri keris arsebobasTan, temporaluri wilis dazianebasTan.
epilefsiis xangrZlivobasa da tvinis struqturul
depresia da afeqturi aSlilobebi
dazianebasTan. es gardamavali fsiqozebi gasnxvavdeba
depresia gansakuTrebiT damaxasiaTebelia epilefsiis
zemoT aRwerili iqtaluri fsiqikuri darRvevebisgan.
mqone pirebisTvis. amas rogorc biologiuri, aseve
am dros damaxasiaTebelia sxvadasxva motoruli,
socialuri mizezebi gaaCnia. amitom depresiis sixSire
sensoruli, kognituri da avtonomiuri disfunqcia.
epilefsiis dros ufro maRalia, vidre sxva qronikuli
fsiqozuri niSnebi SeiZleba gamovlindes deliriumis
nevrologiuri daavadebebis SemTxvevaSi (Kanner,
klinikur suraTSi an aRmocendes naTeli cnobierebis
2003). afeqturi aSlilobebis, kerZod, unipolaruli
fonze. postiqtaluri Zaladoba iSviaTia, Tumca, ufro
depresiis gavrcelebis sixSire ramdenjermea
xSiria, vidre iqtalur periodSi da SesaZloa iyos
gazrdili da SemTxvevaTa 22_27%-Si aRiniSneba. bevri
fsiqosocialuri gamocdilebis Sedegi. eqstremaluri
pacientis mdgomareoba akmayofilebs disTimiis
_ 370 _
epilefsia
naklebad didi depresiis kriteriumebs. depresiis and Barraclough, 1997). epilefsiis SemTxvevaSi suicidis
risk-faqtorebi Sejamebulia cxrilSi 14.20. risk-faqtorebi imave sakiTxebs moicavs, romlebic
zogad mosaxleobaSi gvxvdeba.
interiqtaluri fsiqozebi
interiqtaluri fsiqozebis xasiaTi da sixSire xan epilefsiis socialuri aspeqtebi
ZgrZlivi drois manZilze kamaTis sgans warmoadgenda. cxovrebis xarisxze epilefsiis gavlena korelirebs
gansxvavebul azrs gamoTqvamdnen fundamentur daavadebis simwvavesa da tvinis struqturuli
sakiTxTan dakavSirebiTac _ Tu ramdenad mosa paTologiis arsebobasTan. epilefsiis mimarT ar
lodnelia am Tu im sixSiriT orive mdgomareobis sebuli stigma da masTan dakavSirebuli socialuri
Tanaarseboba (mimoxilva ix. Mace, 1993). Catarebuli izolacia mtkivneuli sakiTxia da mniSvnelovan
farTomasStabiani kvlevis Sedegebis mixedviT (Slater gavlenas axdens pacientis cxovrebaze. miT ufro, rom
et al., 1963) dadginda, rom epilefsia fsiqozebis Znelia gulyris ganviTarebis winaswar prognozireba,
gazrdil riskTanaa asocirebuli. gansakuTrebiT rac zrdis SiSisa da daucvelobis gancdas. kon
damaxasiaTebelia (Tumca, ara eqskluziurad) Sizo sultirebisas, yovelTvis unda gvaxsovdes, rom
freniismagvari simptomebi (Sachdev, 1998). aseve, re pacientisa da misi ojaxistvis es sensitiuri Temebia
ligiuri da paranoiduli bodviTi ideebi, xolo da unda vecadoT gavuqarwyloT maT epilefsiasTan
afeqturi gasadaveba naklebad SeimCneva. fsiqozebis dakavSirebuli mcdari Sexedulebebi. erT-erTi
ganviTarebis risk-faqtorebia: rTuli parcialuri mTavari problema, romelic SeiZleba zRudavdes
gulyrebi, dazianebis upiratesi arseboba medialur pirovnebis socialur CarTulobas, marTvis mowmobis
frontalur da temporalur ubnebSi, ufro marcxena uflebaa. britaneTSi marTvis licenziis misaRebad
naxevarsferoSi, prenataluri dazianeba (Flor- aucilebelia, rom epilefsiis mqone pirovneba,
Henry, 1969) da gulyrebis ganviTareba mozardobis aranakleb erTi wlis manZilze, gulyrebisgan Ta
asakSi. es biologiuri maxasiaTeblebi asocirebulia visufali iyos (miuxedavad imisa, iRebs Tu ara
neiroganviTarebasTan, lateralizaciasTan da antiepilefsiur preparatebs). im pirebs, romlebsac
safeTqlis wilTan dakavSirebul Sizofreniis gulyra mxolod ZilSi uviTardebaT, marTvis mowmoba
TeoriebTan (Roberts et al., 1990a). eZlevaT mas Semdeg, rac dadasturdeba mdgomareobis
stabiluroba sami wlis manZilze.
suicidi
biologiuri da fsiqologiuri mizezebidan gamom
zogad populaciasTan SedarebiT, epilefsiis
dinare, epilefsias xSirad, kriminalur qmedebebs
dros suicidi 4-jer, xolo TviTdazianeba 6-jeraa
ukavSireben (Tone, 2000). Tumca, es, SesaZloa, epi
gazrdili. es ricxvi gacilebiT maRalia safeTqlis
lefsiaze arsebuli kidev erTi miTi iyos, vinaidan
wilis epilefsiis dros (25-jeraa gazrdili) da
patimrebs Soris epilefsiis SemTxvevebis raodenoba,
epilefsiis qirurgiuli mkurnalobis Semdeg (Harris
zogad populaciasTan SedarebiT, ar aris gazrdili
(Fazel el al, 2002).
cxrili 14.20 epilefsiis dros depresiis
ganviTarebis risk-faqtorebi epilefsiis mkurnaloba
biologiuri
epilefsiis medikamentur mkurnalobas nevrologebi
atareben (McCorry et al., 2004). am TavSi SevexebiT
w afeqturi aSlilobebis ojaxuri anamnezi;
ramdenime iseT sakvanZo sakiTxs, romlebic
w dazianeba upiratesad safeTqlisa da Sublis wilebSi;
fsiqiatriul problemebTanaa dakavSirebuli.
w dazianeba upiratesad marcxena mxares.
mkurnalobis dagegmvisas, mniSvnelovania ganva
fsiqosocialuri sxvavoT periiqtaluri da interiqtaluri fsiqikuri
w stigma;
aSlilobebi. periiqtaluri fsiqikuri aSlilobebis
w gulyrebis ganviTarebis SiSi; mkurnaloba miznad isaxavs gulyrebis kontrols.
w daswavlili uZlureba; interiqtaluri fsiqikuri aSlilobebis mkurnaloba
w pesimisturi atribuciis stili; ki araepilefsiuri fsiqikuri problemebis mqone
w arasakmarisi socialuri Tanadgoma; pacientebis mkurnalobis msgavsia. Tumca, unda
w umuSevroba. gvaxsovdes, rom zogierTi fsiqotropuli preparati
zrdis krunCxviT mzaobas da SeiZleba gulyrebis
iatrogenuli
ganviTarebis sixSirec gaizardos. epilefsiis
w epilefsiis qirurgiuli mkurnalobis Sedegi; dros Sesabamisi antidepresantebia susi-ebi da mao
w antiepilefsiuri preparatebis gamoyeneba, gansakuT inhibitorebi, xolo antifsiqozuri preparatebidan
rebiT polifarmacia da plazmaSi maRali Semcveloba.
_ 371 _
umjobesia amisulpiridis, risperidonis an halo dazianebebsa da destruqciul cvlilebebs TeTr
peridolis gamoyeneba. nivTierebaSi. es faqtorebi gansazRvravs komis
antikonvulsantebma SeiZleba sxvadasxva fsiqikuri xangrZlivobas. sxva garTulebebi moicavs eqstra da
da kognituri problemebi ganapirobos (Ovsiew, 2004). subdurul hemoragiebsa da anoqsias. zog SemTxvevaSi
mag., vigabatrinis da topiramatis gamoyenebis Sedegad xdeba -amiloidis Calageba garkveul ubnebSi, riTac
SeiZleba guneb-ganwyobis aSlilobebi an fsiqozuri SesaZloa aixsnas kavSiri qala_tvinis travmas,
simptomebi ganviTardes. topiramati, marTalia alchaimeris daavadebasa (Fleminger et al., 2003) da
iSviaTad, magram iwvevs gamoxatul Seqcevad kognitur `mokriveebis demencias~ (dementia pugilistica) Soris.
gauaresebas, gansakuTrebiT, metyvelebis darRvevebs. garkveuli monacemebis Tanaxmad, apolipoproteinis
garda amisa, yovelTvis unda gaviTvaliswinoT (apoE4) genotipi zrdis sikvdilis an demenciis
antiepilefsiuri da antifsiqozuri preparatebis ganviTarebis risks qala-tvinis travmis Semdeg (qala-
urTierTSeTavsebis sakiTxebic. aucilebelia dozis tvinis travmasTan dakavSirebuli fsiqiatriuli
sworad SerCeva, raTa Tavidan aviciloT toqsikuroba sakiTxebis mimoxilva ix. Fleminger, 2000b).
an, piriqiT, preparatis subTerapiuli doziT gamo
yeneba (Monaco and Cicolin, 1999). mwvave fsiqologiuri Sedegebi
qala-tvinis travmiT gamowveuli komis Semdeg
qala-tvinis travma SesaZloa ganviTardes deliriumi. gaxangrZlivebul
fsiqiatriul praqtikaSi, upiratesad, gvxvdeba qala- deliriums SeiZleba Tan axldes gardamavali
tvinis travmis mqone pacientTa ori jgufi: konfabulatoruli mdgomareoba. zogjer viTardeba
cru Secnobebis bodviTi ideebi an reduplikaciuri
1. SedarebiT mcirericxovani _ persistentuli, gamo
paramnezia (ix. gv.317). mag., stacionaris TanamSromels
xatuli kognituri da qceviTi aSlilobebiT da
pacienti Tavis Zvel megobrad miiCnevs an Tvlis,
2. ufro farTo _ pirovnuli da afeqturi paTolo- rom ganyofileba, romelSic igi imyofeba, Soreul
giebiT. qalaqSi arsebuli sxva dawesebulebis aslia. xSiria
daxuruli qala-tvinis travmis simZimis xarisxis seqsualuri an qceviTi agzneba da ganmuxruWeba, rac
Sefaseba yvelaze kargad SesaZlebelia travmis SeiZleba ramdenime dRe an kvira gagrZeldes.
Semdgomi amneziis xangrZlivobiT (posttravmuli
amnezia _ pta). es aris drois intervali travmidan qronikuli fsiqologiuri Sedegebi
normaluri yoveldRiuri mexsierebis aRdgenamde. am orive saxis _ rogorc pirveladi, aseve meoradi
parametris upiratesobaa is, rom sakmarisi sizustiT (Tavis tvinis SeSupeba da qalaSida wnevis momateba)
misi gansazRvra SesaZlebelia retrospeqtulad _ dazianebebi mTel rig nevrologiur da kognitur
ramdenime xnis Semdegac. mag., ramdenime Tvis Semdeg darRvevebs iwvevs. mdgomareobis grZelvadiani
pacients vekiTxebiT, ra iyo misi pirveli mogoneba prognozi damokidebulia premorbidul pirovnul
travmis Semdeg. Tu pta erT kviraze nakleb xans maxasiaTeblebze, okupaciur unarebze, socialuri
grZeldeba, es ukeTes gamosavalze metyvelebs. aseTi Tanadgomis arsebobasa da kompensatorul meqanizmebze.
pacientebis umravlesoba ubrundeba samsaxurs da travmis Semdeg zogjer posttravmuli epilefsia
agrZelebs Tavis profesiul moRvaweobas. xolo, Tu viTardeba, rac SesaZloa damatebiTi seriozuli
pta erT Tveze metxans gastans, umravlesoba veRar dazianebebis mizezi gaxdes da mniSvnelovnad gaar
axerxebs muSaobis gagrZelebas. retrograduli (anu Tulos mdgomareoba. qala-tvinis travmis Semdeg
qala-travmamde) amneziis ganviTareba prognozulad suicidis riski samjeraa gazrdili.
nakleb mniSvnelovania. magnitur-rezonansuli gamo
kvlevebi Zalian informaciulia Tavis tvinis dazi Tavis tvinis Seryevis Semdgomi mdgomareoba
anebis xarisxis dasadgenad; Tumca, normis farglebSi qala-tvinis travmis Semdeg bevri pacienti aRwers
miRebuli Sedegebi ar gamoricxavs Tavis tvinis simptomTa jgufs, romelic post-kontuziuri sin
garkveuli xarisxis dazianebas. naklebad sensitiuria dromis saxeliTaa cnobili. am mdgomareobis mTa
kompiuteruli tomografia. vari damaxasiaTebeli niSnebia SfoTva, depresia,
daxurul qala-tvinis travmebs iwvevs garegani gaRizianebadoba, rasac Tan axlavs Tavis tkivili,
Zalis amaCqarebeli an damamuxruWebeli moqmedeba. Tavbrusxveva, advilad daRla, koncentraciis daq
ramdenime wamiT gonebis dakargvis mizezad miiCneven veiTeba da insomnia. aseTi mdgomareobis xangrZlivoba
tvinis ReroSi qolinerguli transmisiis Seferxebas. da simwvave sxvadasxva pacientis SemTxvevaSi
ufro mZime dazianebis SemTxvevaSi vxedavT Semdeg sxvadasxvaa. gamomdinare iqidan, rom msgavsi niSnebi
ZiriTad paTologiur procesebs: dartymis Sedegad qala-tvinis msubuqi travmis Semdgomac aRiniSneba,
hemoragiuli ubnebis ganviTarebas, difuzur aqsonur maT nawilobriv an mniSvnelovanwilad fsiqologiuri
_ 372 _
qala-tvinis travma
safuZveli gaaCniaT (Lishman, 1988; Jacobson, 1995). mag., erT-erTma kvlevam qala-tvinis travmis mqone
umetes SemTxvevaSi mdgomareoba specifikuri mkur omis monawileebSi 2-3-jer gazrdili riski gamoavlina
nalobis gareSe umjobesdeba. (Davidson and Bagley, 1969). Tumca, SedarebiT
Tanamedrove kvlevebi fsiqozebis ganviTarebaSi
gaxangrZlivebuli kognituri darRvevebi
qala-tvinis travmis gazrdil rols ar adasturebs
daxuruli qala-tvinis travmis dros, frontaluri (David and Prince, 2005).
da temporaluri wilebis upiratesi dazianebis gamo,
neirofsiqologiuri deficitis damaxasiaTebeli krivi da qala-tvinis travma
paternebi iCens Tavs. yvelaze metad ziandeba mex profesionali mokriveebis 10_12%-s uviTardeba
siereba da aRmasrulebeli funqciebi. pacientebs, qronikuli travmuli encefalopaTia, romelsac
mniSvnelovani inteleqtualuri daqveiTebis gareSe, xSirad `Sekavebulis~ (`cemisgan mTvralis~) sindroms
SeiZleba aReniSnebodeT saqmianobis dagegmvisa da an `mokrivis demencias~ (dementia pugilistica) uwodeben
organizebis gamoxatuli deficiti (e.i. aRmasrulebeli (Roberts., 1969). aseTi mdgomareoba viTardeba Tavis
funqciebis deficiti). aRmasrulebeli funqciebis tvinis mravlobiTi dazianebis SemTxvevaSi.
Sesafaseblad gamoiyeneba axali da ufro sensitiuri es sindromi, Cveulebriv, Tavs iCens da pro-
instrumenti, rogoricaa aRmasrulebeli disfunqciis gresirebs ringidan daTxovnis Semdeg da, savaraudod,
qceviTi Sefaseba (BADS _ Behavioral assessment of asakTanaa dakavSirebuli. gamoxatuli adreuli niSne-
Dysexecutive Syndrome). bidan damaxasiaTebelia aRmasrulebeli funqciebis
deficiti, bradifrenia, msubuqi dizarTria, koordi-
personologiuri cvlilebebi
naciis darRvevebi, rasac Semdeg daerTvis parkinso-
qala-tvinis mZime travmis Semdeg xSirad viTardeba nizmi, spastikuroba da ataqsia. sindromis gaSlili
personologiuri cvlilebebi, gansakuTrebiT, Tu suraTi moicavs naTxemur, piramidul da eqstrapir-
Sublis wilia dazianebuli. am dros pirovneba advilad amidul niSnebs, Sereul kortikul da subkortikul
Riziandeba; damaxasiaTebelia apaTia, spontanurobisa kognitur deficits da qceviTi darRvevebis farTo
da motivaciis nakleboba, qceviTi ganmuxruWeba da, speqtrs.
zogjer, agresiul impulsebze kontrolis dakargva. gakveTis Semdeg qerqSi, Sav substanciasa da naTx-
ICD-10-Si aris kategoria _ òrganuli pirovnuli emSi fiqsirdeba nervuli ujredebis kvdoma, neiro-
aSlilobebi~, romelic am jgufis diagnostirebisTvis fibriluri gorglebi da difuzuri amiloduri fo-
gamoiyeneba. aseTi mdgomareobebis mkurnaloba da laqebi (Roberts et al., 1990b).
marTva Zalian Znelia. xSir SemTxvevaSi saWiroa
mniSvnelovani socialuri mxardaWera da xangrZlivi qala-tvinis travmis mkurnaloba
reabilitacia, risi resursic, Cveulebriv, naklebia
prospeqtuli kvlevebiT dadgenilia, rom adreuli
an, umeteswilad, arc arsebobs.
nevrologiuri niSnebis monacemebi grZelvadiani
afeqturi aSlilobebi fizikuri mdgomareobis paternebis prognozistvis,
informaciis TvalsazrisiT, Zalian mniSvnelovania.
qala-tvinis travmis Semdeg xSirad viTardeba depresia,
aucilebelia saTanadod Sefasdes neirofsiqiatri-
SfoTva da emociuri labiloba. persistentuli dep
uli problemebi, maTi savaraudo Sedegebi da, aseve,
resia da SfoTva pacientebis meoTxeds aReniSneba da
gakeTdes yovelmxrivi socialuri Sefaseba. klinikur
sixSiriT sxva seriozuli somaturi daavadebebisTvis
fsiqologs qceviTi da kognituri teqnikebis gamoy-
damaxasiaTebeli raodenobis tolia. marcxena Sub
enebasa da Terapiis CatarebaSi didi wvlili miuZRvis
lis wilis dazianeba dakavSirebulia depresiis
(Wilson. 1999). rodesac saWiro xdeba fsiqotropuli
ganviTarebis ufro maRal riskTan, Tumca, qala-
preparatebis daniSvna, yovelTvis unda daviwyoT
tvinis Ria travmis dros marjvenamxrivi dazianeba
mcire dozebiT, avarCioT iseTi medikamenti, ro-
ufro metad asocirebulia afeqtur aSlilobebTan.
melic gavlenas ar axdens krunCxviT mzaobaze da na-
SedarebiT iSviaTia travmisSemdgomi maniis SemTxvevebi
klebad iwvevs antiqolinergul da eqstrapiramidul
da isini xSirad, SecdomiT, personologiur
gverdiT movlenebs. ojaxis wevrebsa da momvlelebs
aSlilobebSi erevaT.
sWirdebaT praqtikuli daxmareba. ramdenadac Sesa-
fsiqozebi Zlebelia, droulad unda mogvardes iuridiuli da
qala-tvinis travmis Semdeg, deliriumis dros, finansuri kompensaciis sakiTxebi (mdgomareobis mar-
sakmaod xSirad viTardeba gardamavali fsiqozuri Tvis sakiTxebxe arsebuli damatebiTi informacia ix.
simptomebi. is, Tu ramdenadaa gazrdili am fazis janmrTelobis erovnuli institutis ganviTarebis
dasrulebidan didi xnis Semdeg Sizofreniismagvari jgufis SeTanxmebaSi, 1999).
simptomebis ganviTarebis riski, dRemde sakamaToa.
_ 373 _
sxva neirofsiqiatriuli sindromebi meti gansxvavebuli Setevaa damaxasiaTebeli (mrav-

lobiTi tiki). iseve, rogorc sxva uneblie moZraobe-
distonia bi, tikebic SfoTvisas uaresdeba.maTi gakontroleba
distonia aris arakontrolirebadi, lokaluri kunT- SesaZlebelia mcire drois manZilze, magram es usia-
Ta spazmi, romelic iwvevs warbebis, saxis, kisris, ybis, movno daZabulobis SegrZnebas iwvevs. tikebis umrav-
yelis, mxrebis, xelebisa da, ufro iSviaTad, sxeulis lesoba ramdenime kviraSi qreba. maTi 80_90% gaivlis
sxva nawilebis uneblie moZraobebs. es niSnebi iSvia- 5 wlis ganmavlobaSi. bavSvebSi tikebis arseboba Sei-
Tia; xolo maTi arseboba gamoxatuli unarSezRudu- Zleba ramdenime fsiqikur problemasTan iyos asoci-
lobis ganviTarebas uwyobs xels. etiologia ucno- rebuli. maT Sorisaa obsesiur-kompulsuri aSliloba,
bia. adre mas konversiul fenomenad miiCnevdnen (gv. yuradRebis deficitiTa da hiperaqtivobiT mimdinare
206). amJamad arsebobs myari mtkicebuleba imisa, rom aSliloba da SfoTviTi aSlilobebi (Kurlan et al., 2002).
distonia genetikuri, idiopaTiuri an wamlis miRebiT tikebis samkurnalod gamoiyeneba antifsiqozuri pre-
gamowveuli nevrologiuri darRvevaa da iSviaTadaa paratebis an alfa_2_adrenoreceptorebis agoniste-
ganpirobebuli fsiqogenuri mizezebiT (Trost, 2003). bi.
fsiqiatriulma faqtorebma SeiZleba daamZimos mdgo-
mareoba da gaaRrmavos Sromisunarianobis daqveiTeba. Jil de la turetis sindromi
distoniis klinikuri tipebia: blefarospazmi, tor- es sindromi pirvelad aRwera itardma (Itard) 1825 wels
tikolisi (dagrexili kiseri), xelis distonia (`mw- da Semdgom Jil de la turetma (Gilles de la Tourette)
erlis spazmi~) da laringealuri distonia. yvelaze 1885 wels. Jil de la turetis sindromi yvelaze
efeqturi mkurnalobaa uSualod dazianebul kunTSi gavrcelebul tikur aSlilobad iTvleba. ZiriTadi
botulinis ineqcia; agreTve, Tavis tvinis Rrma stimu- damaxasiaTebeli niSania 16 wlis asakamde mravlobiTi
lacia. fizikuri problemebiT gamowveuli fsiqikuri tikis ganviTareba, rasac vokaluri tikebi axlavs Tan
aSlilobebis samkurnalod SesaZlebelia antidepre- (mag., Rrutuni, Rmuili da a.S.). pacientTa daaxloe-
santebis an qceviTi Terapiis gamoyeneba. biT mesameds (maT Soris, bavSvebs ufro iSviaTad) aR-
eniSneba koprolalia (uxamsi frazebisa da sityvebis
okupaciuri distonia uneblie wamoZaxili). daaxloebiT 10_40%-s aqvs eqo-
kunTebTan dakavSirebuli problemebi xSirad gvx- lalia da eqopraqsia. SesaZloa, iyos stereotipuli
vdeba musikosebs Soris da es maTi karierisTvis did moZraobebi, rogoricaa xtoma an cekva. tikebs xSirad
safrTxes warmoadgens. amas mravali mizezi aqvs, kerwin uZRvis prodromaluri SegrZnebebi. damaxasiaTe-
Zod, zedmeti datvirTviT gamowveuli dazianeba, per- beli damatebiTi simptomebia: hiperaqtivoba, swavlas-
iferiul nervebze zewola da lokaluri distonia. es Tan dakavSirebuli sirTuleebi, emociuri darRvevebi
mdgomareobebi unda Seafasos am sferoSi gamocdilma da socialuri problemebi. zogad populaciasTan
specialistma. mniSvnelovania warmodgenasTan daka- SedarebiT, Jil de la turetis mqone pacientsa da
vSirebuli SfoTvac, romelic gavlenas axdens Ses- misi ojaxis wevrebs obsesiur-kompulsuri aSliloba
rulebis xarisxze. aseT SemTxvevebSi gamoiyeneba ufro xSirad uviTardebaT. aseve, ar aris iSviaTi yu-
beta-blokatorebi; bevri musikosi am preparatebs radRebis deficitiTa da hiperaqtivobiT mimdinare
xSirad eqimis meTvalyureobis gareSec iyenebs. zog aSlilobis SemTxvevebic.
SemTxvevaSi SfoTvis marTvis teqnika sakmaod efeq- sindromis gavrcelebis sixSire meryeobs daavadebis
turia (sxva okupaciur distoniebs gansxvavebuli niS- diagnostikuri kriteriumebisa da maTi Sefasebis
nebi da maxasiaTeblebi aqvs, mag., àqcionerebis yba~ meTodebis gamoyenebis Sesabamisad. zogadad miCneu-
an `golfis moTamaSeebis TeZo~. mimoxilva ix. Frucht lia, rom SemTxvevaTa raodenoba 0, 5-ia 1000 sul mo-
et al., 1999). saxleze. 3-jer da 4-jer ufro xSiria biWebSi, vidre
gogonebSi; xolo mozrdilebTan SedarebiT, bavSvebSi
tikebi
10-jer metia.
tikebi esaa umizno, stereotipuli da ganmeorebadi, etiologia ucnobia. mniSvnelovania genetikuri wi-
Setevismagvari uneblie moZraobebi, romlebic upi- naganwyoba rogorc tikebis, aseve obsesiur-kompul-
ratesad saxisa da kisris areSi warmoiqmneba. ufro suri aSlilobis mimarT. gamovlenilia, aseve, dofam-
xSirad gvxvdeba bavSvobaSi da, iSviaTad, mozrdil inuri gadacemis darRvevebi da aberantuli kortiko-
asakSi. mcire raodenobis SemTxvevebi iwyeba 40 wlis striatuli kavSirebis disfunqcia (Hoekstra et al., 2002).
Semdeg. tikebis aRmocenebis piki 7 wlis asakze mo- msubuq SemTxvevebSi ar aris saWiro specifikuri
dis da xSirad emociur gancdebTanaa dakavSirebuli. mkurnalobis Catareba; xolo saSualo da mZime md-
ufro metad biWebs axasiaTebT. umravlesobas saxis gomareobis dros medikamenturi mkurnalobis mra-
erTi da igive moZraobebi aReniSneba. iSviaTad orze vali meTodi gamoiyeneba. efeqturia haloperidoli,
_ 374 _
sxva neirofsiqiatriuli sindromebi
Tumca, gasaTvaliswinebelia am preparatis Tanmxlebi naklebi simwvaviT xasiaTdeba da nela progresirebs.
gverdiTi movlenebi. randomizebuli kvlevebiT dad- problemis gadaWris, abstraqtuli azrovnebisa da
genilia, rom efeqturia risperidoniT, dezipraminiTa daswavlis unaris, aseve, mexsierebis daqveiTebis
da qlonidiniT mkurnaloba. SeiZleba ufro Sedegiani miuxedavad, sityvaTa maragi, Cveulebriv, Senaxulia.
aRmoCndes komorbiduli fsiqikuri aSlilobebis kognituri daqveiTeba korelirebs dazianebis saerTo
(obsesiur-kompulsuri da hiperaqtivobiTa da yur- moculobasTan da kalozuri atrofiis xarisxTan.
adRebis deficitiT mimdinare aSliloba) mkurnaloba, magnitur-rezonansuli gamokvlevebis CvenebiT de-
vidre Tavad daavadebis ZiriTadi simptomebisa. mielinizaciaze metad gamoxatulia aqsonuri daziane-
rac Seexeba daavadebis gamosavals, aRwerilia mx- ba (gafantuli sklerozis fsiqiatriuli aspeqtebis
olod umniSvnelo warmatebuli SemTxvevebi. klini- mimoxilva, ix. Feinstein, 2004).
kuri gamocdileba gviCvenebs, rom axalgazrda pacien-
tebis mdgomareoba umjobesdeba an gvaqvs xangrZlivi hidrocefalia normaluri wneviT
remisia SemTxvevaTa or mesamedSi; Tumca, daavadebis am mdgomareobis damaxasiaTebeli klinikuri triada
saboloo gamosavali, Cveulebriv, cudia. kopro- aRweres adamsma da hakimma 1965 wels (Adams and Ha-
lalia nivelirebs pacientTa erT mesamedSi, Tumca, kim, 1965). igi moicavs: (1) damaxasiaTebel `siarulis
tikebi da obsesiur-kompulsuri simptomebi SeiZleba apraqsias~ (niSandoblivia moZraobebis diapazonis
mTeli cxovrebis manZilze aRiniSnebodes. (mimoxilva Semcireba, mokle nabijebiT siaruli, siarulis inici-
ix. Robertson, 2000). rebis gaZneleba); (2) bradifrenias (progresul sub-
kortikul frontalur sindroms bradifreniiT) da
gafantuli (mravlobiTi) sklerozi (3) mogvianebiT, Sardis Seukaveblobis ganviTarebas.
ganviTarebuli qveynebis axalgazrdebSi gafantuli gamoxatuli demencia iSviaTia. ar aris dadgenili hi-
sklerozi Sromisunarianobis daqveiTebis gamomwvev drocefaliis gavrcelebis sixSire. zogadad iTvleba,
yvelaze gavrcelebul nevrologiur daavadebas war- rom SemTxvevebis mizezs mogvianebiT asakSi ganviTa-
moadgens. misi Sedegebi, mogvianebiT stadiaze mZime rebuli demenciebis 0-6% warmoadgens. es mdgomareo-
tvirTad awveba ojaxebsa da pacientis momvlelebs. gaba ufro xandazmuli asakisTvisaa damaxasiaTebeli,
fantuli sklerozi dakavSirebulia gamoxatul okupa- Tumca, SesaZloa saSualo asakis pirebSic Segvxvdes
ciur da interpersonalur problemebTan. daavadebis an Tandayolili anomaliebis mqone bavSvebSic iCinos
adreul stadiaze misi diagnostireba rTulia; xSirad Tavi.
somatur Civilebs SecdomiT fsiqikur aSlilobad mi- paTogenezurad iTvleba, rom hidrocefaliis dros
iCneven. iSviaTad daavadeba fsiqopaTologiuri simp- xdeba parkuWebSi Tavzurgtvinis siTxis blokireba,
tomebiT vlindeba, Tumca SemTxvevaTa or mesamedSi, rodesac Seferxebulia liqvoris Tavisufali dineba
daavadebis sxvadasxva stadiaze, aRiniSneba depresia, parkuWovani sistemidan subarqnoidul sivrceSi. hi-
eiforia, emociuri labiloba da advilad daRla. es drocefaliis ganviTarebis yvelaze xSiri mizezi sil-
niSnebi, SesaZloa, uSualod daavadebiT iyos ganpiro- viis wyalsadenis stenozia. Tumca, zogjer, SeiZleba
bebuli an Tanmxlebi Sromisunarianobis daqveiTebis mizezi verc dadgindes. ventrikuluri wneva, zoga-
Sedegs warmoadgendes. gafantuli sklerozis dros dad, normaluri an daqveiTebulia. SesaZlebelia, wn-
suicidis riski Svidjeraa gazrdili. evis momatebac, rac am sindromisTvis saxelis gadar-
sxva nevrologiur daavadebebTan SedarebiT, gafan- qmevis sababs iZleva (Bret er al, 2002). neirovizualuri
tuli sklerozis SemTxvevaSi depresia ufro xSirad gamokvlevebis meSveobiT vlindeba qerquli atrofiis
viTardeba. cxovrebis manZilze depresiis ganviTa- disproporciuli parkuWebis gafarToeba da periven-
rebis riski 50%-s aRwevs. misi ganviTareba, rogorc trikuluri cvlilebebi, rac am sindromis damaxasi-
Cans, ar aris uSualod dakavSirebuli mdgomareobis aTebel niSanTvisebas warmoadgens.
simwvaves an dazianebis mxaresTan. savaraudoa, rom mniSvnelovania am mdgomareobis diferencireba de-
biologiur faqtorebs afeqturi paTologiebis gan- generaciuli demenciisa da depresiuli fsevdodemen-
viTarebaSi mniSvnelovani roli eniWeba (Siegert and ciisgan. SemTxvevebi, romlebsac axasiaTebT SedarebiT
Abernethy, 2005). depresia, SesaZloa, beta interfer- xanmokle mimdinareoba da gamoxatuli siarulis dar-
onis (romelsac zogjer gafantuli sklerozis sam- Rvevebi da, amavdroulad, inteleqtualuri daqveiTeba
kurnalod iyeneben) gverdiTi efeqtic iyos. naklebad TvalsaCinoa, SeiZleba operaciul mkurnalo-
pacientTa 40 %-s aReniSneba kognituri daqveiTe- bas daeqvemdebaron. am dros mizanSewonilia Suntire-
ba. es, SeiZleba, daavadebis adreul manifestacias ba, romelic Tavzurgtvinis siTxis mimoqcevis aRdge-
warmoadgendes. iSviaTad viTardeba swrafad pro- nas Seuwyobs xels. Tumca, gasaTvaliswinebelia isic,
gresirebadi demencia (Zarei et al., 2003). umetes Sem- rom operaciis Sedegis winaswar gansazRvra Znelia da
TxvevaSi, inteleqtualuri daqveiTeba gvian vlindeba, gamosavalic gansxvavebulia. hipokampSi atrofiuli
_ 375 _
kerebis arseboba miuTiTebs alchaimeris daavadebis `katastrofuli reaqciis~ (gv. 331) ganviTareba. qcev-
arsebobaze da prognozulad cudia. iTi darRvevebi xSirad iseTive distresuli da un-
arSemzRudavia, rogoricaa rezidualuri hemiplegiis
anoqsia, hipoglikemia da naxSirJangiT an disfaziis dros. es ufro metad dakavSirebulia
intoqsikacia difuzur aTerosklerozul cvlilebebTan, vidre
anoqsias (stenokardiuli daavadebebis Sedegi), hipo- erTjeradad ganviTarebul insultTan da, Sesabam-
glikemiasa da naxSirJangiT intoqsikacias Tavis tvi- isad, insultis lokaluri niSnebis gaumjobesebis
nis dazianebis erTnairi niSnebi aqvs. SeiZleba ganvi- miuxedavad, SeiZleba, progresirebdes.
Tardes atrofiuli cvlilebebi qerqs an naTxemSi, gan- insultis Semdeg zogi pirovneba zedmetad emociuri
sakuTrebiT mgrZnobiarea hipokampi da mkrTali sfero. xdeba. SeiZleba aReniSnebodes spontanurad ganviTa-
klinikuri gamocdileba aCvenebs, rom gamojanmrTele- rebuli tirilisa da sicilis Sereuli epizodebi. pa-
ba, qala-tvinis travmasTan SedarebiT, ufro swrafad cientis emociuri mdgomareoba xSirad mis guneb-gan-
xdeba da nevrologiuri garTulebebic naklebad iwvevs wyobas ar Seesabameba. aseT SemTxvevebSi efeqturadaa
invalidizacias. latenturi periodis Semdeg ar aris miCneuli antidepresantebiT mkurnaloba.
iSviaTi parkinsonizmis ganviTareba. yvelaze xSiri guneb-ganwyobis aSlilobebi
kognituri darRveva mexsierebis daqveiTebaa. (mimox-
insultis Semdeg xSirad viTardeba depresia, rac gav-
ilva ix. Caine and Watson, 2000; Auer, 2004).
lenas axdens inteleqtualur daqveiTebaze da afer-
naxSirJangiT intoqsikacia ufro xSiria suicidis
xebs reabilitaciis process (Robinson, 2003). depre-
an TviTdazianebis mizniT manqanis gamonabolqviT
siis ganviTarebis sixSire meryeobs 12_64%-s Soris;
an naxSiris wviT miRebuli toqsikuri gaziT mowamv-
xolo, albaToba damokidebulia imave premorbidul
lisas. Tumca, SeiZleba ubeduri SemTxvevis Sedegic
fsiqologiur da socialur faqtorebze, romlebic,
iyos, mag., gazis gamaTboblis an Rumelis cudi ven-
zogadad, afeqturi aSlilobebis ganviTarebisTvisaa
tilacia. mowamlvis Sedegad ganviTarebul garTule-
mniSvnelovani (Sharpe et al., 1994). arsebobs mosazreba,
baTa Taviseburebebi saTanadod Seswavlili ar aris
rom depresiis ganviTareba asocirebulia dazianebis
da moicavs simptomTa farTo speqtrs. aseve, ucnobia,
lokalizaciasTan marcxena wina an marjvena ukana
ramdenad viTardeba tvinis dazianeba maSin, rodesac
hemisferoSi (Starkstein and Robinson, 1993), Tumca, es
mowamlva gonebis dakargvas ar iwvevs. pirebi, rom-
dRemde dazustebuli araa. postinsulturi depresia
lebmac naxSirJangiT intoqsikacia gadaitanes, uCiv-
dakavSirebulia sikvdilianobis maRal maCvenebelTan.
ian mexsierebisa da koncentraciis unaris daqveiTe-
insultisSemdgomi depresiis mkurnaloba aqtiuri re-
bas, advilad daRlasa da Tavis tkivils (mimoxilva ix.
abilitaciis Semadgenel nawils warmoadgens. xSirad
Ernst and Zibrak, 1998).
gamoiyeneba antidepresantebi, Tumca, gverdiTi mov-
lenebidan gamomdinare, maTi daniSvnisas didi si-
insulti
frTxile unda gamoviCinoT. amasTan, gasaTvaliswine-
kognituri deficiti belia isic, rom sistemurma mimoxilvam ar daadas-
insulti, romelic SeiZleba mwvaved ganviTardes (rac tura TvalsaCino kavSiri medikamentur mkurnalobas,
yovelTvis ar aris aucilebeli), xSirad vaskuluri fsiqoTerapiasa da mdgomareobis gaumjobesebul ga-
demenciis ganviTarebas ganapirobebs (aRwerilia ze- mosavals Soris (Hackett et al., 2004). pacientebs, rom-
moT, ix. gv. 339; Leys et al., 2005). garda amisa, insults lebsac insulti aqvT gadatanili, suicidis gazrdili
sxva neirofsiqiatriuli garTulebebic axasiaTebs. riski aReniSnebaT (Strenager et al., 1998).
insultian pacientebs intensiuri Terapiis nevrolo-
giur ganyofilebaSi aTavseben. maT xSirad aReniSne- subduruli hematoma
baT hemiparezi, disfazia an sxva lokaluri dazianebis subduruli hematoma viTardeba, upiratesad, xan-
niSnebi. mdgomareobidan gamosvlis Semdeg, rig SemTx- dazmul asakSi Zirs dacemis Sedegad, gansakuTrebiT
vevebSi, es simptomebi rCeba da sxva neirofsiqiatri- alkoholizmTan dakavSirebul SemTxvevebSi. Tumca,
ul problemebs emateba. gamosavali damokidebulia aRsaniSnavia, rom anamnezSi travmis arseboba xSirad
dazianebuli ubnis lokalizaciasa da moculobaze. gamorCenilia. moculobiTi hematomis ganviTarebas
Tan axlavs koma da cnobierebis fluqtuacia, hemipa-
pirovnuli cvlilebebi
rezi an okulomotoruli niSnebi. ufro savaraudoa,
pirovnuli cvlilebebidan damaxasiaTebelia gaRiz-
rom fsiqiatrs qronikulma pacientebma miakiTxon; maT,
ianebadoba, apaTia, guneb-ganwyobis labiloba,
visac Tavis tkivili, advilad daRla, koncentraciis
zogjer agresiuloba; aseve, problemebis gadawyve-
daqveiTeba, auxsneli somaturi Civilebi da gardama-
tisas rigiduloba, xolo eqstremalur SemTxvevebSi
vali cnobierebis paTologia aReniSnebaT. aseT pacien-
_ 376 _
sxva neirofsiqiatriuli sindromebi
tebs iSviaTad aqvT lokaluri nevrologiuri niSnebi. warmodgenili afeqturi da fsiqozuri simptomebi.
neirodegeneraciuli progresirebadi demenciis Sem- klasikurad aRiniSneba eiforia da gandidebis
TxvevaSi, Zalian mniSvnelovania saTanadod Sefasdes bodviTi ideebi. progresuli damblis gamomwvevi
mdgomareoba, vinaidan hematomis qirurgiuli gziT mizezis aRmoCena didi movlena iyo fsiqiatriis
evakuaciis dros SesaZlebelia simptomTa reversia. istoriaSi, ramac dasabami misca sxva fsiqikuri
aSlilobebis organuli mizezebis Ziebas (Hare, 1959).
subaraqnoiduli hemoragia 3. zurgis tvinis tabesis (Tabes dorsalis) dros zurgis
subaraqnoidul sisxlCaqcevas, Cveulebriv, ganapiro- tvinSi degeneraciuli procesebi viTardeba. aseTi
bebs didi tvinis arteriuli wris midamoSi intrakra- pacientebi iSviaTad xvdebian fsiqiatrTan.
niuli anevrizmis gaskdoma. gadarCenis SemTxvevaSi, daavadebis adreul stadiaze peniciliniT mkur
kognituri darRvevebi da pirovnuli cvlilebebi naloba aumjobesebs mdgomareobas da daavadebis
(rac xSirad viTardeba) rogorc Tavad sisxlCaqceviT progresirebas uSlis xels. pacienti, romelic ar
gamowveuli dazianebebis, aseve anevrizmis emboliza- itarebs mkurnalobas, Cveulebriv, 5 weliwadSi iRu
ciis an klipirebis Sedegia. wina SemaerTebeli arte- peba.
riis anevrizmis dros ufro xSiria amneziuri sindro-
mis ganviTareba konfabulaciiT. es SesaZloa bazal- encefaliti
uri wina tvinis dazianebiT iyos gamowveuli. encefaliti SeiZleba iyos pirveladi _ (upiratesad
virusuli) infeqciiT gamowveuli an meoradi (romelime
intrakranialuri infeqciebi
daavadebis fonze), mag., baqteriuli meningitis,
intrakranialuri infeqciebis didi nawili kognitur septicemiis an cerebruli abscesis garTulebis Se
daqveiTebas iwvevs. maTi umravlesobis efeqturi degi. dReisTvis gamovlenilia encefalitis uam
mkurnaloba SesaZlebelia. aiv infeqcia me-16 TavSia ravi virusuli mizezi, maT Soris, herpes simplex,
ganxiluli. auxsneli kognituri da fsiqiatriuli romlis warmatebiT mkurnaloba (intravenuri aci
simptomebis dros yovelTvis unda gaviTvaliswinoT kloviriT) SesaZlebelia. mkurnalobis ar Catarebis
uCveulo infeqciis arsebobis SesaZlebloba. emTxvevaSi Sedegebi SeiZleba Zalian mZime iyos.
neirosifilisi mwvave mdgomareobas axasiaTebs Tavis tkivili, pir
Rebineba, cnobierebis darRvevebi da gulyrebis
neirosifilisi, romelic mkrTali treponemiTaa
ganviTareba. xSiria deliriozuli mdgomareobac.
gamowveuli, daavadebis meoTxe stadias warmoadgens.
aseT SemTxvevebSi, SeiZleba, fsiqiatris konsultacia
es daavadeba ganviTarebul qveynebSi iSviaTad gvxvde-
gaxdes saWiro, Tumca, ufro xSirad fsiqiatrTan
ba. Tumca, misi sixSire gazrdilia aRmosvleT evro-
xvdebian qronikuli simptomebis mqone pacientebi,
pis qveynebSi da aiv infeqciasTanaa asocirebuli. misi
romlebsac gaxangrZlivebuli SfoTviTi simptomebi,
araerTgvarovani klinikuri suraTidan gamomdinare,
depresia, gamoxatuli mexsierebis daqveiTeba,
am infeqciis arseboba unda Semowmdes yvela `neirof-
personologiuri cvlilebebi an rTuli parcialuri
siqiatriuli~ simptomebis, gansakuTrebiT, delirium-
gulyrebi aReniSnebaT.
isa da demenciis mqone pacientebSi. amisTvis aucile-
mozrdilebSi encefalitis gamomwvev sxva mizezebs
belia sisxlis an Tavzurgtvinis siTxis serologiuri
Sorisaa virusuli encefalitebi, romlebic cxo
gamokvleva. antibiotikebiT mkurnalobam SeiZleba
velebs gadaaqvT (mag., iaponuri B encefaliti,
Secvalos klinikuri suraTi da parcialuri an atipi-
avstraliuri encefaliti) da Cutyvavilas gamomwvevi
uri simptomebis ganviTareba ganapirobos.
virusi (varicella zoster).
daavadebis klinikur manifestacias win uswrebs sx-
vadasxva xangrZlivobis asimptomuri mdgomareoba. leTargiuli encefaliti
cnobilia simptomuri neirosifilisis sami forma:
epidemiuri leTargiuli encefalitis (romelic,
1. meningovaskuluri sifilisi, romelic inficirebidan aseve, postencefaluri parkinsonizmis saxeliTaa
daaxloebiT 5 weliwadSi viTardeba. misTvis dama cnobilia) xanmokle afeTqeba pirvelad, 1917 wels,
xasiaTebelia insulti an personologiuri cvli aRwera ekonomom (Von Economo, 1929), romelic venis
lebebi, emociuri labiloba da Tavis tkivili. fsiqiatriul klinikaSi moRvaweobda. leTargiulma
mogvianebiT viTardeba demencia da Tan fsiqozuri encefalitma epidemiur dones 1920 wels miaRwia,
simptomebi axlavs. xolo 1930 wlisTvis TiTqmis mTlianad gaqra. amJamad
2. progresuli paraliCi (paralizuri demencia) _ mxolod erTeuli sporadiuli SemTxvevebi gvxvdeba
viTardeba inficirebidan daaxloebiT 20 wlis (Howard and Lees, 1987). iTvleba, rom misi gamomwvevi
Semdeg. gamoxatulia demencia, pirovnuli cvli mizezia gripis virusi an masze imunuri reaqcia.
lebebi, dizarTria da motoruli niSnebi. farTodaa yvelaze mZime garTulebaa parkinsonizmi, xolo meore
_ 377 _
adgilzea antisocialuri pirovnuli aSliloba, ro
melsac gamoxatuli qceviTi darRvevebi axasiaTebs.
cxrili 14.21 simsivnis mqone pacientebSi kog
nituri daqveiTebis gamomwvevi ramdenime mizezi
zog SemTxvevaSi viTardeba Sizofreniismagvari
mdgomareoba. zaksma (Sacks, 1973) detalurad aRwera es simsivnis uSualo efeqti
mdgomareoba da, zogi pacientis SemTxvevaSi, L-dofas w moculobiTi efeqti (Tavis tvinis pirveladi simsivne
xanmokle da gasaocari `gamojanmrTelebis~ efeqti an metastazebis arseboba Tavis tvinSi)
aCvena. nevropaTologiurad es daavadeba progresuli w obstruqciuli hidrocefalia
supranukleuri damblis msgavsia. w Tavis tvinSi simsivnis difuzuri infiltracia
w gliomatozi (Gliomatosis cerebri)
Tavis tvinis simsivne w karcinomatozuri meningiti
w meningioma (En plaque meningioma)
Tavis tvinis simsivneebi daavadebis sxvadasxva etap
ze mTel rig fsiqologiur da kognitur simp simsivnis arapirdapiri Sedegi
tomebs ganapirobebs (Ron, 1989; Jarguin-Valdivia,
w paraneoplasturi sindromi (magaliTad, limburi
2004). fsiqiatrebi ufro xSirad naxuloben paci encefaliti)
entebs, romlebsac nelad mzardi `Cumi~ simsivne w hiperkalcemia
aReniSnebaT (upiratesad Sublis wilSi). aseTi w hiponatriemia
mdgomareobisTvis ufro metad fsiqologiuri da, w hipoglikemia
iSviaTad, nevrologiuri niSnebia damaxasiaTebeli. w gulyrebi
amis magaliTia subfrontaluri meningioma an
oportunistuli infeqciebis Sedegi
korZiani sxeulis glioma. fsiqologiuri simptomebis
Tavisebureba, simsivnis lokalizaciasTan erTad, w herpes zosteri
w kriptokoki da sxva sokovani infeqciebi
damokidebulia moculobiTi procesiT (mag., qalaSida
w progresuli multifokaluri leikoencefalopaTia
wnevis momatebiT) gamowveul globalur efeqtze.
mniSvnelovania simsivnis zrdis siswrafec. swrafad mkurnalobis efeqti
mzardi simsivnis SemTxvevaSi, ufro savaraudoa w radioTerapia (radionekrozi, TromboangiopaTia,
deliriumis ganviTareba, xolo Senelebuli pro leikodistrofia)
cesis dros _ qronikuli kognituri daqveiTeba. es w qimioTerapia
ukanaskneli ufro xSirad simsivnis dominantur w neiroqirurgia
naxevarsferoSi ganviTarebis Sedegad vlindeba.
kraniofaringioma da hipoTalamusis midamoSi simptomuri an organuli daavadebebia da ICD-10-sa
ganviTarebuli simsivneebi ufro metad asocirebulia da DSM-IV-is klasifikaciebSi maT dasaxasiaTeblad
personologiur aSlilobebsa da apaTiasTan. sxvadasxva terminologia gamoiyeneba (gv. 322). am
wignSi Tavis tvinis dazianebiT gamowveuli fsiqikuri
kognituri darRvevebi simsivneebis dros aSlilobebi mocemul TavSia ganxiluli, xolo
simsivnis uSualo zemoqmedebis garda, qala-tvinis sistemuri daavadebebiT ganpirobebuli cvlilebebi
SigniT da gareT arsebuli neoplazmuri warmonaqmnebi me-16 TavSia aRwerili. meoradi neirofsiqiatriuli
kognitur unarebze mravali meqanizmis saSualebiT daavadebebis magaliTebi moyvanilia cxrilSi 14.22.
moqmedebs (Taphoorn and Klein, 2004; cxrili 14.21). mag., am daavadebebis klinikuri niSnebi, Cveulebriv,
centraluri nervuli sistemis limfomas SemTxvevaSi pirveladi fsiqikuri aSlilobebisgan ar gansxvavdeba.
kognituri daqveiTeba daavadebis mogvianebiT amdenad, meoradi daavadebis diferencialuri di
stadiaze iCens Tavs da, upiratesad, radioTerapiis agnozis dasma masTan asocirebuli simptomebiTaa
garTulebas warmoadgens. SesaZlebeli. ICD-10-is safuZvelze SemuSavebuli
kriteriumebiTs mixedviT somaturi daavadebis Sede
meoradi an simptomuri gad ganviTarebul meorad fsiqikur aSlilobebad
iTvleba iseTi mdgomareobebi, rodesac:
neirofsiqiatriuli sindromebi
w gvaqvs cerebruli daavadebis, dazianebis an
am TavSi aRweril yvela daavadebas bazisuri paTo
disfunqciis, an romelime CamoTvlil sindromTan
logiuri meqanizmebi (mag., demencia) an aSkara
asocirebuli somaturi daavadebis arsebobis da
biologiuri mizezebi (mag., epilefsia) aqvs. marTalia,
madasturebeli monacemebi;
neirofsiqiatriaSi arsebobs daavadebaTa jgufi,
w saxezea droSi Tanxvedrili kavSiri (kvirebis an
romelic am kategoriaSi ar jdeba (anu aris e.w.
Tveebis manZilze) gamomwvev daavadebasa da gan
`funqciuri~ an idiopaTuri), Tumca maTi axsna
viTarebul fsiqikur aSlilobebs Soris;
msgavsi midgomiT xSirad SesaZlebelia. es meoradi,
w fsiqikuri gamojanmrTeleba gamomwvevi daavadebis
_ 378 _
meoradi an simptomuri neirofsiqiatriuli sindromebi
mkurnalobis Sedegad miiRweva;
cxrili 14.22 simptomuri an meoradi fsiqikuri w ar arsebobs fsiqikuri aSlilobis sxva `fsiqo
aSlilobebis zogierTi gamomwvevi mizezi
logiuri~ mizezi. mag., rodesac depresiis Sem
sindromi gamomwvevi mizezi TxvevaSi ar aRiniSneba afeqturi aSlilobis oja
fsiqozebi safeTqlis wilis daavadebebi, xuri anamnezi, damaxasiaTebeli pirovnuli Tavi
hanTingTonis daavadeba, bazaluri seburebebi an gmomwvevi cxovrebiseuli movlenebi.
gangliis lokaluri dazianeba,
demenciebi, endokrinopaTiebi,
metaboluri darRvevebi, cerebruli damatebiTi literatura
vaskulitebi, neirosifilisi
Lishman, WA. (1998) Organic psychiatry, 3rd edn. Blackwells,
afeqturi alchaimeris davadeba, insulti, qa
la-tvinis travma, gafantuli skle Oxford. (standartuli saxelmZRvanelo neirofsiqi-
aSlilobebi
rozi, hanTingTonis daavadeba, atriaSi)
krutcfeldt-jakobis daavadeba
(CJD), paraneoplasturi limburi Asbury AK, McKhann GM, McDonald WI, et al. (2002) Dis-
encefaliti, endokrinopaTiebi, eases of the nervous system. Clinical neuroscience and thera-
metaboluri darRvevebi peutic principles, 3rd edn. Cambridge University Press, Cam-
(gansakuTrebiT, hiperkalcemia),
neirosifilisi bridge. (ortomeuli, romelic moicavs nevrologiur
da neirofsiqiatriul aSlilobebs da maTi neirobi-
personologiuri frontotemporaluri demencia,
Sublis wilis simsivneebi, ologiuri safuZvlebis ganaxlebul mimoxilvas)
aSlilobebi
hanTingTonis daavadeba, bazaluri
gangliis lokaluri dazianeba,
neirosifilisi, krutcfeldt-
jakobis (CJD) daavadeba,
paraneoplasturi limburi
encefalopaTia,
obsesiur- frontotemporaluri demencia, rTu

kompulsuri li parcialuri gulyrebi, bazaluri
gangliis dazianeba, retis sindromi
aSliloba
TviTdazianeba leS-nihanis sindromi
_ 379 _
Tavi 15 kvebiTi da
Zilis aSlilobebi
Tavis Sinaarsi
jgufis qvejgufi, romelic Sedgeba am ori ZiriTa-
kvebiTi aSlilobebi
di diagnozis klinikurad msgavsi mdgomareobebisgan,
nervuli anoreqsia
magram isini ver akmayofileben am diagnozebis zust
nervuli bulimia
kriteriumebs. es aSlilobebi DSM-IV-is mixedviT kla-
dauzustebeli kvebiTi aSlilobebi (atipiuri
sificirdeba, rogorc kvebiTi aSlilobebi, romlebic
kvebiTi aSlilobebi)
sxvagvarad ar aris dazustebuli (EDNOS). isini ase-
ukontrolo kvebasTan dakavSirebuli aSli-
ve cnobilia, rogorc atipiuri kvebiTi aSlilobebi
loba
da realurad ufro xSirad gvxvdeba, vidre nervuli
gacximovneba
anoreqsia da nervuli bulimia. am tipis aSlilobebis
fsiqogenuri pirRebineba
mqone bevr pacients anamnezSi aReniSneboda nervuli
Zilis aSlilobebi
anoreqsia an nervuli bulimia da maTi nawili sabo-
epidemiologia
lood SesabamisobaSi movida am ori daavadebis krite-
insomnia
riumebTan. is faqti, rom kvebiTi aSlilobis mqone pa-
parasomniebi
cientebi midrekilni arian `meryeobisken~ am or diag-
sxva parasomniebi
nozs Soris (suraTi 15.1), gvafiqrebinebs, rom nervul
anoreqsias, nervul bulimiasa da EDNOS-s saerTo pa-
fsiqiatriaSi kvebiT aSlilobebs ganmartaven, rogorc Tofiziologia aqvs, romelic SeiZleba ase ganisazRv-
kvebis paternebis darRvevas, romelsac ganapirobebs ros: sxeulis wonisa da formisTvis gansakuTrebuli
pirovnebis damokidebuleba sakuTari sxeulis wonisa mniSvnelobis miniWeba. es imas niSnavs, rom kvebiTi aS-
da formis mimarT. am TavSi ganxiluli aSlilobebi lilobis mqone pacientebi sakuTar Rirsebas afaseben
moicavs nervul anoreqsias, nervul bulimias da msgavs mxolod sxeulis wonis, formisa da misi kontrolis
mdgomareobebs. aqve ganxilulia simsuqne, magram is ar unaris TvalsazrisiT (Fairburn, Harrison, 2003).
iTvleba fsiqikur aSlilobad, Tumca, mas SeiZleba ax-
ldes rogorc fsiqologiuri, ise somaturi garTule- nervuli anoreqsia
bebi. amave TavSi saubari iqneba Zilis aSlilobebze.
termini `nervuli anoreqsia~, pirvelad gamoiyena ing-
liselma eqimma uiliam galma 1868 wels, Tumca, nervu-
kvebiTi aSlilobebi li anoreqsiis mravali SemTxveva adrec iyo dafiqsi-
1970 wlamde kvebiTi aSlilobebi iSviaT, gamonaklis
SemTxvevad iTvleboda. nervuli bulimiis aRweris
nervuli
Semdeg imata gamovlenili SemTxvevebis ricxvma, ro- anoreqsia
melTac gamoxatuli simptomatika da qmedunarianobis
daqveiTeba axasiaTebdaT. dRemde sakamaToa, aris Tu
ara kvebiTi aSlilobebis sixSire SemTxvevaTa WeSma-
riti matebis Sedegi, Tu gaumjobesda am aSlilobis
gamovlena da diagnostika (Curren et al., 2005). kvebi-
Ti aSlilobebis klinikurad Sefaseba yovelTvis ver
xerxdeba. naCvenebia, rom pirvelad jandacvaSi nervu- atipiuri kvebiTi
aSliloba nervuli
li anoreqsiis SemTxvevaTa mxolod naxevris amocnoba bulimia
da diagnostireba xdeba, xolo nervuli bulimia, ro-
gorc wesi, bevrad iSviaTia da bulimiiT daavadebul suraTi 15.1. kvebiTi aSlilobebis erTmaneTSi gadasvlis
pirTa umravlesobas mkurnaloba ar utardeba. sqematuri gamosaxuleba. isris zoma mianiSnebs gadasvlis
albaTobasa da mimarTulebaze. wridan gareT mimarTuli
nervuli anoreqsia da nervuli bulimia SeiZleba isrebi gamojanmrTelebis maniSnebelia (gadmotanilia
ganvixiloT rogorc kvebiTi aSlilobis ufro didi Fairburn da Harrisson-is TanxmobiT, 2003).
_ 380 _
kvebiTi aSlilobebi
rebuli. man xazi gausva am mdgomareobis fsiqolo- wonaSi matebis mizniT sxvisagan daxmareba miiRos.
giur safuZvels, wonis aRdgenis saWiroebas da ojaxis sigamxdrisaken swrafva SeiZleba ramdenime formiT
rols. amave periodSi mocemuli mdgomareoba aRwera gamovlindes. zogadad, pacientebi Wamen Zalian co-
Sarl lasegmac (Charles Lasgue), romelic parizSi moR- tas da sakuTar Tavs Zalian dabalkaloriul zRvars
vaweobda (ix. Palmer, 2000). nervuli anoreqsiis wamyva- uweseben (xSirad 600-sa da 1000 kkal-s Soris). zogi-
ni niSnebia sxeulis Zalian dabali wona (standartul erTi cdilobs, wonis daklebas miaRwios pirRebinebis
wonaze 15%-iT naklebi; sxeulis masis indeqsi <17.5), gamowveviT, intensiuri varjiSiT da safaRaraTe sa-
gansakuTrebuli damokidebuleba sxeulis wonisa da Sualebebis borotad gamoyenebiT. xSirad pacientebs
formis mimarT, wonaSi matebisa da simsuqnis Zlieri moicavs sakvebze fiqri da drodadro siamovnebas
SiSi, sigamxdris Zlieri moTxovnileba da amenorea qa- iReben imiT, rom sxvisTvis `kulinarul Sedevrebs~
lebSi (ix. boqsi 15.1 DSM-IV-is kriteriumebi). qmnian. nervuli anoreqsiiT daavadebuli zogierTi
pacientebis umravlesoba axalgazrda qalia (ixile pacienti aRiarebs, rom saWmels malavs, zogi ki maRa-
epidemiologia). es mdgomareoba, rogorc wesi, vi- ziidan iparavs an sxva gziT Soulobs mas.
Tardeba mozardobis periodSi, Tumca, is SesaZlebe- ukontrolo kveba. pacientebis erT jgufs axasiaTebs
lia bavSvobaSi an ufro gviandel asakSic ganviTardes. ukontrolo kvebis ganmeorebiTi epizodebi. aseTi ti-
is Cveulebrivi dietis dacvis msgavsad iwyeba, magram pis qceva intensiuri xdeba asakTan erTad da qronikul
SemdgomSi umarTavi xdeba. centraluri fsiqolo- saxes iRebs. ukontrolo kvebis epizodebis dros paci-
giuri niSania sxeulis formasa da wonasTan dakav- enti, rogorc wesi, iseT sakvebs Rebulobs, romlis-
Sirebuli zeRirebulovani ideebi. pacients SeiZleba ganac, Cveulebriv, Tavs ikavebs. gadaWarbebuli Wamis
hqondes damaxinjebuli warmodgena Tavis sxeulze, Semdeg pacienti Seberilobas grZnobs da, SeiZleba man
sjerodes, rom is Zalian msuqania, xolo sinamdvileSi xelovnurad gamoiwvios pirRebineba. aseT epizodebs
wonis mwvave deficits ganicdides. amiT aixsneba is Tan sdevs sindisis qenjna da wonaSi daklebis inten-
faqti, rom pacientebis umravlesobas ar surs, rom siuri Zalisxmeva. pacientis aRSfoTebas iwvevs nebis-
mieri adamiani, romelic urCevs mas Wamisagan Tavi ar
boqsi 15.1 nervuli anoreqsiis Seikavos. mas SeuZlia, gadamalos sakvebi, an Wamis dam-
kriteriumebi DSM-IV mixedviT TavrebisTanave, sxvebisTvis SeumCnevlad, gamoiwvios
w uaris Tqma simaRlisa da asakis mixedviT dadgenili pirRebineba. DSM-IV-is mixedviT, nervuli anoreqsia,
wonis minimaluri normis SenarCunebaze (mag. wonaSi romelic ukontrolo kvebasTan da gamwmendi saSuale-
klebisas, pacientis wona mosalodneli wonis 85%-s bebis (laqsativebi, diuretikebi da oyna) borotad gam-
an naklebs Seadgens an wonaSi matebisas is ver aRwevs
oyenebasTan aris dakavSirebuli, restriqciulisagan
saWiro standarts, ris gamoc misi wona mosalodnel
wonaze naklebia da standartuli wonis 85%-s, an gansxvavebul tipad iTvleba.
naklebs Seadgens) amenorea erT-erTi fizikuri anomaliaa, romelic
w wonis naklebobis miuxedavad wonaSi matebisa da tradiciulad Setanilia diagnostikur kriteriumeb-
gasuqebis Zlieri SiSi
Si. is vlindeba nervuli anoreqsiis adreul stadiaze
w wuxili sxeulis wonis da formis gamo; sxeulis wonisa
da SemTxvevaTa mexuTedSi win uswrebs wonis mkveTr
da formis araadekvaturi zegavlena TviTSefasebaze;
im faqtis miuRebloba, rom sxeulis dabali wona klebas; Tumca, anamnezis Sekrebis dros irkveva, rom
seriozul problemas warmoadgens pacients dieta adre hqonda dawyebuli. rig SemTx-
w amenorea reproduqciuli asakis qalebSi, anu erT vevebSi, Tavidan yuradRebas iqcevs amenorea, xolo
maneTis miyolebiT sami ukanaskneli menstrualuri mogvianebiT _ kvebiTi aSliloba.
ciklis gamotoveba (qals maSin udasturdeba amenorea,
Tu cikli aRdgeba mxolod hormonis mag. estrogenis sxva simptomebi: depresiuli, SfoTviTi da obsesi-
miRebis Semdeg). uri simptomebi, guneb-ganwyobis labiloba da sociumi-
dan gariyva am mdgomareobis saerTo niSnebia. rogorc
nervuli anoreqsiis tipebi wesi, mas Tan sdevs seqsualuri interesis daqveiTebac.
SezRudviTi/restriqciuli tipi. nervuli anoreqsiis
mimdinare epizodis dros pirovneba regularulad ar fizikuri Sedegebi
aris dakavebuli ukontrolo kvebiTa da gamwmendebis nervuli anoreqsiisTvis damaxasiaTebeli mniSvne
gamoyenebiT (TviTgamowveuli pirRebinebiT an safaRaraTe
saSualebebiT, diuretikebisa da oynis borotad gamo lovani simptomebi da niSnebi meoradia da SimSilis
yenebiT) Sedegs warmoadgens. maT SeiZleba organizmis sx-
gawmendiTi tipi/ukontrolo kveba. nervuli anoreqsiis vadasxva sistema daazianon (cxrili 15.1).
mimdinare epizodis dros pirovneba regularulad aris
dakavebuli ukontrolo kvebiT da gamwmendebis gamo epidemiologia
yenebiT (TviT-gamowveuli pirRebinebiT an safaRaraTe
saSualebebis, diuretikebisa da oynis borotad gamoye nervuli anoreqsiis sixSiris maCvenebeli efuZneba
nebiT). britaneTsa da aSS-Si SemTxvevaTa registraciis mona-
_ 381 _
15 kvebiTi da Zilis aSlilobebi
cxrili 15.1 nervuli anoreqsiis fizikuri cxrili 15.1 nervuli anoreqsiis fizikuri
maxasiaTeblebi maxasiaTeblebi (gagrZeleba)
fizikuri simptomebi
w sicivis mimarT momatebuli mgrZnobeloba; sxva metaboluri anomaliebi
w gastrointestinuri simptomebi _ Sekruloba, Wamis w hiperqolesterolemia;
Semdeg sisavsis SegrZneba, Seberiloba; w plazmis karotinis maRali done;
w Tavbrusxveva da sinkope; w hipofosfatemia (zemoT iwevs kvebis Semdeg);
w amenorea qalebSi, romlebic ar iReben oralur w dehidracia;
kontraceptivebs; seqsualuri moTxovnilebis w eleqtolituri disbalansi (damokidebulia formaze;
daqveiTeba; unayofoba; aReniSnebaT pirebs, romlebic xSirad aRebineben
w cudi Zili, diliT adre gaRviZeba. an didi raodenobiT iyeneben laqsativebsa da
diuretikebs);
fizikuri niSnebi w hipokaliemia.
w ganleva, zrdaSi Seferxeba, mkerdis ganviTarebis
SeCereba (prepubertatis dros);
sxva saxis anomaliebi
w mSrali kani, nazi RinRli (lanugo) zurgze, winamxrebsa
w osteopenia da osteoporozi (motexilobis maRali
da saxeze; kanis, fexisa da xelis gulebis agurisferi
riskiT).
Seferiloba;
w yursukana da ybisqveSa jirkvlebis Sesieba
(gansakuTrebiT, bulimiis mqone pacientebSi); Fairburn, Harrison, 2003.
w wina kbilebis Sida zedapiris erozia (perimilolizisi)
maTTan, visac xSirad aqvs pirRebineba;
w civi xelebi da fexebi; hipoTermia; gavrceleba _ sakmaod rTulia daadgino nervuli an-
w bradikardia; hipotenzia, ariTmia (gansakuTrebiT, oreqsiis gavrcelebis WeSmariti maCvenebeli, radgan
dabali wonis mqone pacientebSi, romlebsac aqvT
am mdgomareobis mqone bevri piri uaryofs misTvis
eleqtrolituri darRvevebi);
w damokidebuli SeSupeba (rac arTulebs sxeulis wonis damaxasiaTebeli simptomebis arsebobas. gamokiTxva
Sefasebas); gviCvenebs, rom gavrcelebis miaxloebiTi xarisxi
w proqsimaluri kunTebis sisuste (mjdomare
skolis moswavle da student gogonebSi 0.7%-ia.
mdgomareobidan wamodgomis gaZneleba).
sqesi, socialuri fena da eTnikuri warmoSoba. ro-
fizikuri gamokvlevebiT gamovlenili anomaliebi gorc zemoT iyo aRniSnuli, axalgazrda qalebis sak-
w endokrinuli darRvevebi;
w maluTeinizirebeli hormonis, maod didi raodenoba zRudavs sakvebis miRebas da
folikulomastimulirebeli hormonisa da zedmet mniSvnelobas aniWebs sxeulis formasa da wo-
estradiolis dabali koncentracia; nas, magram mainc ar akmayofilebs nervuli anoreqsiis
w T4-is normaluri maCveneblis dros dabali T3,
Tiroidmastimulirebeli hormonis normaluri diagnostikur kriteriumebs. klinikur praqtikaSi,
koncentracia (dabali T3 sindromi); nervuli anoreqsiiT daavadebuli mamakacebi pacien-
w plazmaSi kortizolis maRali done deqsametazonis
tebis populaciis mxolod 5-10%-s Seadgenen. SemTx-
supresiis gareSe;
w zrdis hormonis maRali koncentracia; vevaTa raodenoba, dabalTan SedarebiT, ufro metia
w hipoglikemia (iSviaTad). maRal socialur fenaSi; Zalze iSviaTia aRmosavlur
kardiovaskuluri qveynebSi da aRmosavluri qveynebis araTeTrkanian
w darRvevebi ekg-ze (gansakuTrebiT, eleqtrolituri mosaxleobaSi (Hoek, van Hoeken, 2003, Currin 2005) .
disbalansis dros);
w gamtareblobis defeqtebi, gansakuTrebiT, Q-T genetika
intervalis gaxangrZliveba.
nervuli anoreqsiis dadgenili SemTxvevebi biologiur
gastrointestinuri debSi 5-10%-s Seadgens, maSin rodesac amave asakis go-
w kuWis daclis dagvianeba;
w msxvili nawlavis moZraobis Seneleba (meoradia - gonebis mTel populaciaSi is mxolod 0.5-1.0%-ia. bi-
laqsativebis xSiri gamoyenebis gamo); ologiur debSi aseve maRalia kvebiTi aSlilobis sxva
w kuWis mwvave gafarToeba (iSviaTia, meoradia formebis ganviTarebis riski (rogoricaa nervuli buli-
ukontrolo da gadaWarbebuli Wamis gamo).
mia da EDNOS), rac adasturebs ojaxuri predispoziciis
hematologiuri mniSvnelobas. maRali ojaxuri riski SeiZleba iyos ro-
w saSualo simZimis normoqromul-normocituli anemia;
w msubuqi leikopenia SedarebiTi limfocitoziT;
gorc ojaxuri garemos, aseve genetikuri zemoqmedebis
w Trombocitopenia. Sedegi; miT umetes, rom tyupebis Seswavlam gamoavlina
monizigotur tyupebSi nervuli anoreqsiis sixSiris bev-
cemebs da Seadgens 100000 sul mosaxleze weliwadSi
rad ufro maRali Tanxvedra (daaxloebiT 55%), dizigo-
0.37-4.06 SemTxvevas. savaraudod, es monacemebi re-
tur tyupebTan SedarebiT (daaxloebiT 5%), rac nervuli
alurze ufro dabalia. meoce saukunis dasawyisidan
anoreqsiis SemTxvevaSi genetikuri komponentis arsebiT
1970-ian aRricxul SemTxvevaTa sixSire gaizarda da
rolze mianiSnebs (Treasure, Holland, 1989).
mas Semdeg garkveulwilad stabiluri gaxda (Hoek, van
nervuli anoreqsiis ganviTarebaSi genetikuri faq-
Hoeken, 2003, Currin et al., 2005) (suraTi 15.2).
toris roli naTeli ar aris. zogierTi asociaciuri
_ 382 _
kvebiTi aSlilobebi
75
sixSiris maCvenebeli 100 000 SemTxvevaze

nervuli bulimia
50
suraTi 15.2 nervuli anoreqsiisa 25

da bulimiis yovelwliuri sixSiris
grafikuli gamosaxuleba 10-39
wlis asakobrivi jgufis qalebSi. nervuli anoreqsia
1988-2000 wlebis monacemebi.
cdomilebis Zelaki warmoadgens
sarwmunoebis 95%-ian intervals 0
(Currin et al.,2005) 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
wlebi
gamokvlevis mixedviT, am SemTxvevaSi adgili aqvs robebi. misi azriT, nervuli anoreqsiis mqone pacien-
5-HT2A receptoris promotoruli regionis poli- tebi CarTulni arian sakuTar TavTan umowyalo brZo-
morfizms, magram sxva gamokvlevebis Sedegebi amas ar laSi TviTkontrolis, identobis gancdisa da efeq-
adasturebs. amis msgavsad, 200 ojaxis (ojaxis mini- turobis miRwevis mizniT. maTi Zalisxmevis saboloo
mum or wevrs dausves nervuli anoreqsiis diagnozi) mizania gaxdoma. am mosazrebas adasturebs epidemi-
Seswavlam, SeWidulobis farTo-genomuri analizis ologiuri kvlevebis Sedegebi, romelTa mixedviT,
gamoyenebiT, naklebad daadastura SeWidulobis ar- mocemuli aSlilobis ganviTarebis meqanizmSi dabali
seboba qromosoma 1p-is ubanTan (Grice, 2002). nervuli TviTSefaseba da srulyofilebisken swrafva erTma-
anoreqsiisadmi Tandayolili predispozicia SeiZleba neTzea gadajaWvuli (Fairburn, 1999). savaraudoa, rom
gamowveuli iyos iseTi pirovnuli maxasiaTeblebiT, es premorbiduli pirovnuli Taviseburebebi gansa-
rogorebicaa srulyofilebisaken swrafva da obse- kuTrebiT arTulebs axalgazrdis morgebas mozardo-
siuri azrovneba (ix qvemoT). da bolos, ojaxurma bis xanis moTxovnebTan. aSlilobis debiutis periodi
gamokvlevebma daadgina kavSiri kvebiT aSlilobebsa gvafiqrebinebs, rom pirovnebis ganviTarebasTan daka-
da guneb-ganwyobis aSlilobas Soris, magram nakleb vSirebuli problemebi marTlac mniSvnelobis mqonea,
savaraudoa, rom am or mdgomareobas erTi, saerTo rac daadastura epidemiologiur doneze gakeTebul-
etiologiuri faqtori hqondes (Lilenfeld, Kaye, 1998). ma SemTxveva-kontrolis gamokvlevebma (Fairburn, 1999).
socialuri faqtorebi Sida ojaxuri mizezebi

is faqti, rom nervuli anoreqsia garkveuli social- nervuli anoreqsiiT daavadebuli pacientebis ojaxeb-
uri fenis problemas warmoadgens, gvafiqrebinebs, Si sakmaod xSiria garTulebuli urTierTobebi, rac
rom mis ganviTarebaSi mniSvnelovan rols asrulebs avtorebis nawils afiqrebinebs, rom am tipis prob-
kulturaluri faqtorebi. am faqtorebs Soris cen- lemebi garkveul rols TamaSobs daavadebis ganviTa-
traluria farTod gavrcelebuli Tvalsazrisi, rom- rebis meqanizmSi. zogi avtori Tvlis (Minuchin, 1978),
lis Tanaxmad, sigamxdre mimzidveli da sasurvelia. rom daavadebis ganviTarebis safuZvels SesaZloa
SeZlebuli socialuri fenis Seswavlam aCvena, rom am ojaxuri urTierTobebis specifikuri modeli war-
fenis moswavle da studenti gogonebis umravlesoba moadgendes. aseTi modeli gulisxmobs gadaWarbebul
drogamoSvebiT dietas icavs. Tu ar gaviTvaliswinebT mfarvelobas, sixistes da konfliqtebis mogvarebis
erTjerad risk-faqtorebs, pirebi, romlebsac uvi- uunarobas. avtorebi aseve miiCneven, rom nervuli an-
TardebaT nervuli anoreqsia, ar ganicdian sxva risk- oreqsiiT ojaxis wevris daavadeba emsaxureba ojax-
faqtorebis mniSvnelovan zemoqmedebas. es gvafiqre- uri uTanxmoebebis mowesrigebas.
binebs, rom am SemTxvevaSi mTavaria individis reaqcia epidemiologiuri kvlevebiT dadginda, rom pirebi,
dietaze da ara TavisTavad dietis dacva (Fairburn, 1999). romelTac uviTardebaT nervuli anoreqsia, bavS-
vobaSi izrdebodnen konfliqtur ojaxur garemoSi
individualuri fsiqologiuri mizezebi
(cudi urTierToba mSoblebTan; mSoblebis fsiqikuri
bruCi (Bruch 1974) iyo pirveli mkvlevari, romelmac aSlilobebi, kerZod, depresia). Tumca, unda aRin-
Seiswavla nervuli anoreqsiis fsiqologiuri winapi- iSnos, rom es risk-faqtorebi ar aris specifikuri
_ 383 _
nervuli anoreqsiisTvis, radgan am fonze imave six- gamokvleva
SiriT gvxvdeba sxva fsiqikuri aSlilobebic, mag.,
pacientebis umravlesobas ar surs fsiqiatrTan kon-
guneb-ganwyobis aSlilobebi (Fairburn, 1999). rogorc
taqti, amitom Zalian mniSvnelovania maTTan kargi
Cans, nervuli anoreqsiis ganviTarebis winapirobaa am
urTierTobis damyareba, rac gulisxmobs pacientis
zogadi risk-faqtorebis urTierTqmedeba individis
mosmenas da misi Tvalsazrisis gagebas; pacientisTvis
iseT konkretul Sinagan faqtorebTan, rogorebicaa
mkurnalobis alternativebis ganmartebas. garda ami-
srulyofilebisaken swrafva da dabali TviTSefaseba.
sa, dasaSvebi unda iyos kompromisuli gadawyvetilebis
aSlilobis mimdinareoba da gamosavali miReba. aucilebelia, dawvrilebiTi anamnezis Sekreba
aSlilobis ganviTarebis, axlandeli kvebis racionis,
sawyis stadiebze nervuli anoreqsiis mimdinareoba
wonis kontrolisa da sxeulis sasurvel wonaze pa-
cvalebadi xasiaTisaa. erTmaneTs enacvleba gamwvave-
cientis Sexedulebis Sesaxeb (ix. boqsi 15.2 da 15.3).
bebisa da nawilobrivi remisiis periodebi. xanmokle
fsiqikuri statusis Sefasebisas, gansakuTrebuli
anamnezis SemTxvevebSi sruli gamojanmrTeleba ar
yuradReba unda mivaqcioT depresiul simptomebs.
warmoadgens iSviaT movlenas. grZelvadiani prog-
sruli informaciis misaRebad da pacientis ndobis
nozis gakeTeba rTulia, radgan gamoqveynebuli ma-
mosapoveblad SeiZleba saWiro gaxdes erTze meti in-
sala efuZneba arCeviT SemTxvevebs, xolo Semdgomi
tervius Catareba. mSoblebisa da sxva informatorebis
dakvirvebiT miRebuli monacemebi _ arasruli. gamo-
gamokiTxva rac SeiZleba adreul etapze unda moxdes.
savali sakmaod gansxvavebulia, Tumca, dadgenilia
aucilebelia fizikuri mdgomareobis gamokvleva.
Semdegi zogadi kanonzomierebebi:
gansakuTrebuli yuradReba unda mivaqcioT kaxeqsiis
1. miuxedavad imisa, rom, Cveulebriv, wona da men-
xarisxs, gul-sisxlZarRvTa sistemis mdgomareobas,
strualuri cikli normaSi dgeba, kvebiTi Cvevebi da
vitaminebis naklebobis niSnebs. aucilebelia sxva ga-
damokidebuleba sxeulis wonisa da formis mimarT
momfitavi darRvevebis (rogorebicaa malabsorbcia,
anomaliuri rCeba da zogierT pacients uviTardeba
endokrinuli darRvevebi, simsivne) gamoricxva. Tu
bulimia an sxvagvarad dauzustebeli kvebiTi aSli-
gvaqvs eWvi, rom pacienti xelovnurad iwvevs pirRe-
lobebi.
binebas an xmarobs gamwmend saSualebebs, aucileblad
2. nervuli anoreqsia arasodes gardaiqmneba fsiqi- unda ganvsazRvroT sisxlSi eleqtrolitebi.
kuri aSlilobis sxva formad.
mtkicebulebaze damyarebuli mkurnaloba
3. miuxedavad aSlilobis qronikuli mimdinareobisa,
pacienti SeiZleba gamojanmrTeldes mravali wlis fsiqoTerapia
Semdeg. Cven ara gvaqvs sakmarisi raodenobis mtkicebuleba
4. im gamokvlevebis mixedviT, romelTa drosac tar- nervuli anoreqsiis mkurnalobisa da marTvis Sesaxeb.
deboda mZime SemTxvevebze xangrZlivi Semdgomi da- es, nawilobriv, asaxavs nervuli anoreqsiis simZimis
kvirveba, letalobis maCvenebeli daaxloebiT 15% xarisxis farTo diapazons da kompleqsuri interven-
aRmoCnda, rac eqvsjer aRemateba letalobis stan- ciis Sefasebis siZneleebs, rac imas niSnvs, rom bevri
dartul maCvenebels. zogadad, sikvdilis uSualo Tanamedrove mosazreba mkurnalobis Taobaze mxolod
mizezia TviTmkvleloba an samedicino garTulebe- klinikur gamocdilebaze da Sexedulebebzea damyare-
bi. savaraudoa, rom letalobis maCvenebeli ufro buli. nervuli anoreqsiis dros sxvadasxva saxis
dabali iqneba, Tuki kvleva Catardeba ufro did fsiqoTerapias iyeneben. saerTo mosazrebis Tanaxmad,
populaciaze; is SeiZleba kidev ufro metad Sem- am SemTxvevaSi gamousadegaria intensiuri fsiqoanali-
cirdes mkurnalobis gaumjobesebuli meTodebis tikuri meTodebis gamoyeneba. klinikuri gamocdileba
danergvis Semdeg (Nelsen, 1998). imas gveubneba, rom pirovnuli urTierTobebis gaum-
5. pacientebis erTi mexuTedi aRwevs srul gamo- jobesebasa da TviTefeqturobis gancdis amaRlebaze
janmrTelebas, xolo meore mexuTedi mZime avadmyo- mimarTuli saSualebebi garkveulwilad Rirebulia.
fi rCeba. danarCen pacientebs aReniSnebaT sxvadasx- bolo wlebSi rekomendebulia ojaxuri Terapi-
va xarisxis qronikuli da cvalebadi darRvevebi. is Catareba. Sedegebi aCvenebs, rom am tipis Tera-
pia garkveul rezultatebs iZleva SedarebiT ufro
6. keTilsaimedo gamosavlis mTavari prediqtori
axalgazrda pacientebis SemTxvevaSi, magram, zogadad,
aris xanmokle avadmyofobis istoria da aSlilobis
ojaxuri Terapiis efeqturoba saeWvoa (Russel et a.,
gamovlena adreul asakSi. xolo, simsuqne bavSvobis
1987). Tu am tipis Terapia mainc gamoiyeneba, is unda
asakSi, dabali TviTSefaseba da personologiuri
CavataroT seleqciurad, anu iq, sadac dominirebs
aSlilobebi arakeTilsaimedo gamosavlis prediq-
ojaxuri problemebi da ojaxis sxva wevrebi gamoT-
torebia (Sullivan, 1998).
qvamen Terapiis procesSi monawileobis survils. ar
_ 384 _
kvebiTi aSlilobebi
boqsi 15.2 kvebis Sefaseba; boqsi 15.3 fsiqologiuri mdgomareobis

gasaTvaliswinebeli kiTxvebi: Sefaseba; gasaTvaliswinebeli kiTxvebi:
ras Wams Cveulebriv dRis manZilze pacienti? ra xarisxiT ras fiqrobs pacienti sakuTari sxeulis wonasa da for-
izRudavs Tavs? maze?
misdevs Tu ara igi kvebis raime sqemas? icvleba Tu ara es ikavebs Tu ara Tavs Wamisgan? ra motiviT?
sqema? aris Tu ara kveba ritualuri procesi?
Tavs msuqan adamianad aRiqvams? ar moswons Tavisi
aridebs Tu ara Tavs raime konkretul sakvebs? Tu ki, sxeuli? Tu ki, ra niSniT?
ratom?
aqvs Tu ara damaxinjebuli warmodgena sxeulze? Tu ki,
zRudavs Tu ara siTxis miRebas? ra saxiT?
ra xdeba SimSilis an Wamis Zlieri moTxovnilebis dros? ras fiqrobs, ra moxdeba, Tu ar gaakontrolebs wonasa
rogoria am mxriv pacientis gamocdileba? da kvebas?
axasiaTebs Tu ara mas ukontrolo kveba? iRebs Tu ara eSinia Tu ara kontrolis dakargvis? SeuZlia ganmartos,
obieqturad marTla didi raodenobis sakvebs? grZnobs ras gulisxmobs amaSi?
Tu ara, rom ver akontrolebs sakuTar Tavs?
miiCnevs Tu ara Tavs damnaSaved da aqvs Tu ara sakuTari
dagegmilia Tu ara sakvebis ukontrolod miReba? rogor Tavis mimarT zizRi? Tu ki, ra udevs amas safuZvlad?
iwyeba es procesi? rogor mTavrdeba? ramdenad xSiria?
aris Tu ara am aSlilobaSi iseTi ram, ris gamoc is kargad
iwvevs Tu ara pacienti xelovnurad pirRebinebas? Tu ki, grZnobs Tavs?
rogor?
Tu aqvs ukontrolo kvebis epizodebi, rogoria misi ganc-
xom ar aRebinebs sisxls? iyenebs Tu ara Camosarecxad debi am epizodebis dawyebamde, mimdinareobisas da dam-
didi raodenobiT wyals? Tavrebis Semdeg?
iRebs Tu ara gamxsnelebs, Sardmdenebs, pirRebinebis ga- ras eubneba sxvebs sakuTari kvebiTi aSlilobis Sesaxeb?
momwvev da madis damTrgunav saSualebebs? rogoria maTi Tu arafers ambobs amis Sesaxeb?
miRebis efeqti?
ras fiqrobs Tavis mdgomareobaze? ra sargebels xedavs
ise xom ar xdeba, rom pacienti jer ReWavs sakvebs, xolo masSi?
mere gadmoafurTxebs mas? erTi dRe SimSilobs Tu meti?
BB. Palmer, ed. (2000). Helping people with eating disorders. A
SeuZlia Tu ara Wama sxvisi TandaswrebiT? clinical guide to assessment and treatment. JoHn Willey, Chichester
varjiSobs Tu ara? ratom varjiSobs? kaloriebis da-
sawvavad? xovs (Kaye, 2001). arsebobs, agreTve, calkeuli faq-
tebi, romlebic nervuli anoreqsiis dros atipiuri
B .Palmer, ed. (2000). Helping people with eating disorders. A antifsiqozuri agentis _ olanzapinis, efeqturo-
clinical guide to assessment and treatment. John Willey, Chichester
baze miuTiTebs, magram am sakiTxTan dakavSirebiT
aris cnobili, ojaxuri Terapiis sxvadasxva formi- dRemde randomizebuli gamokvleva ar Catarebula
dan, nervuli anoreqsiis SemTxvevaSi, romels eniWeba (Powers, Santana, 2004).
upiratesoba. sxeulis formaze, wonasa da kvebaze ano-
marTva
maliuri warmodgenebis Secvlis mizniT, kognitur-bi-
hevioruli Terapiac gamoiyeneba (Hey et al., 2003). am mkurnalobis dawyeba
sferoSi arsebul siZneleebs asaxavs bolodroindeli mkurnalobis warmateba didad aris damokidebuli pa-
randomizebuli kvlevis Sedegebi, romelTa mixedviT, cientTan kargi urTierTobis damyarebaze. pacients
arc kognitur-bihevioruli da arc interpersonalu- kargad unda gavagebinoT, rom aucilebelia adekva-
ri Terapia ar SeiZleba CaiTvalos nervuli anoreq- turi wonis aRdgena SimSiliT gamowveuli fizikuri
siis araspecifikuri klinikuri marTvis warmmarTvel da fsiqologiuri efeqtebis mosaxsnelad. mniSvnelo-
meTodad (McIntosh et al., 2005). vania, rom Terapevti pacients SeuTanxmdes dietis
sqemaze, magram ar unda CaerTos kamaTSi. aqve unda
medikamenturi mkurnaloba
aRiniSnos, rom wonis kontroli problemis gadaWris
nervuli anoreqsiis mkurnalobis dros medikamentu- mxolod erTi aspeqtia; amitom pacients unda SevTava-
ri Terapia ar aris wamyvani. Tumca, bevr pacients zoT daxmareba, raTa man SeZlos Tanamdevi fsiqolo-
aReniSneba depresiis seriozuli niSnebi da am miz- giuri problemebis mogvareba.
niT, rig SemTxvevebSi, serotoninis ukumitacebis aucilebelia pacientis da mSoblebis gaTviTcnobie-
seleqciuri inhibitori gamoiyeneba. Cveulebriv, reba aSlilobasTan da mis mkurnalobasTan dakavSire-
depresiuli simptomebi wonis aRdgenisTanave qreba. bul sakiTxebSi. SemTxvevaTa umravlesobis mkurnalo-
arsebobs winaswari monacemebi axlad aRdgenili wo- ba mimdinareobs ambulatoriul da dRis stacionaris
nis SenarCunebis mizniT fluoqsetinis gamoyenebis pirobebSi. hospitalizacia unda moxdes maSin, Tu sa-
Taobaze, magram misi efeqturoba damtkicebas moiT- xezea qvemoT CamoTvlili Cvenebebi:
_ 385 _
1. pacientis ukiduresad dabali, safrTxis Semcveli wona;
boqsi 15.4 iZulebiTi mkurnaloba
2. gamoxatuli mZime depresia da TviTmkvlelobis riski;
3. Tu ambulatoriul mkurnalobas ar mohyva Sedegi. kanonmdebloba iZulebiTi mkurnalobis Catarebis
SemTxvevaSi moiTxovs mtkicebulebas imis Taobaze,
pacientis hosiptalizacia aucilebelia, Tu saWiroa rom saxezea fsiqikuri daavadeba da nebayoflobiTi
wonis klebis Sedegad ganviTarebuli, sicoxlisTvis mkurnalobis Catareba SeuZlebelia. iZulebiTi
mkurnalobis gamoyeneba nervuli anoreqsiis mimarT
saSiSi eleqtrolituri darRvevebis, hipoglikemiisa winaaRmdegobis Semcvelia. aris Tu ara nervuli anoreqsia
da mwvave infeqciis mkurnaloba. fsiqikuri daavadeba samarTlebrivi TvalsazrisiT?
SesaZlebelia Tu ara warmatebuli mkurnaloba pacientis
wonis aRdgena Tanxmobis gareSe?
ambulatoriuli mkurnaloba. wonis aRdgena, Cveu- iZulebiTi mkurnaloba praqtikaSi iSviaTad gamoiyeneba.
mas mimarTaven, rogorc ukidures saSualebas maSin,
lebriv, ambulatoriulad xdeba. racionaluri miza- rodesac pacientis sicocxles safrTxe emuqreba. aseT
nia _ kviraSi 0.5 kg-is mateba, rac, rogorc wesi, dros iZulebiTi mkurnalobiT SegviZlia gadavarCinoT
dReSi 500-1000 zedmeti kaloriis akrefas moiTxovs. pacientis sicocxle da gamoviyenoT es periodi Terapiuli
urTierTobis dasamyareblad, rac dagvexmareba imaSi,
saboloo wona, Cveulebriv, unda iyos kompromisuli rom Semdgom CavataroT xangrZlivi nebayoflobiTi
wonis normalur maCvenebelsa (smi.>20) da pacientis mkurnaloba.
sasurvel maCvenebels (ramdens unda rom iwonides) iZulebiT mkurnalobas bevri uaryofiTi mxare aqvs.
Soris. dabalansebuli dieta gulisxmobs dReSi daax- aseT SemTxvevebSi mniSvnelovnad mcirdeba, pacientis
nebismier racionaluri mkurnalobis sqemaSi CarTvis
loebiT 3000 kkal-is miRebas, rac 3-4 kvebad unda
SesaZlebloba.
daiyos. sasurvelia pacientis fizikuri mdgomareobis
regularuli monitoringi da Cvenebis mixedviT vita- xdeba misi iZulebiTi hospitalizacia (boqsi 15.4).
minebis daniSvna. aseve, unda Sefasdes da Seicvalos ix. klinikuri daxelovnebis erovnuli institutis
wonis damklebi sxva strategiebi, romlebsac pacienti (National Institute of Clinical Excellence) mier Sedgenili
adre iyenebda, mag., gadaWarbebuli varjiSi da gamw- nervuli anoreqsiis mkurnalobis saxelmZRvanelo
mendi saSualebebis borotad gamoyeneba. principebi (2004b) (boqsi 15.5).
stacionaruli mkurnaloba. Tu saWiro gaxda paci-
entis hospitalizacia, masTan winaswar unda SevTanx- nervuli bulimia
mdeT, rom igi darCeba saavadmyofoSi samizne wonis
termini `bulimia~, asaxavs ukontrolo, gadaWarbe-
miRwevasa da mis SenarCunebamde. aseve, masTan unda
buli Wamis epizodebs. rogorc zemoT iyo aRniSnuli,
SevaTanxmoT momdevno ambulatoriuli mkurnalobis
bulimiis simptomi Cndeba nervuli anoreqsiis zogi-
detalurad Sedgenili gegma. stacionarSi mkurnalo-
erT SemTxvevaSi. nervuli bulimiis sindromi pirve-
bis warmateba didad aris damokidebuli pacientis
lad aRwera raselma (Russel, 1979) Tavis sakmaod gavle-
movlaze, mkafio miznis SemuSavebasa da mkurnalo-
nian naSromSi, romelic asaxavda 1972-1978 wlebSi 30
bis daxvewil, kargad gaazrebul gegmaze. warsulSi
pacientze Catarebuli dakvirvebis Sedegebs, maTi md-
hospitalSi myofi, pacientis mimarT mkacr reJims
gomareobis sakvanZo klinikur niSnebs da am mdgomare-
iyenebdnen, Tumca, amas mxolod sadamsjelo xasiaTi
obis diagnostirebas. Tumca, bulimiis SemTxvevebSi,
hqonda da araviTari sargebeli ar mohqonda.
romlebsac raseli Seiswavlida, nervuli anoreqsiis
pacientis kveba meddis meTvalyureobis qveS unda
SemTxvevebic iyo Sereuli, ris gamoc maTi aRwera gan-
iyos. meddas sami mniSvnelovani funqcia akisria: man
sxvavdeba im paTologiis aRwerisagan, romelic dRes
unda daarwmunos pacienti, rom mas SeuZlia Wamos
`nervuli bulimiis~ sxelwodebiTaa cnobili. mas Sem-
wonaze kontrolis dakargvis riskis gareSe; naTlad
deg, rac sindromi bulimia~ Setanil iqna DSM-III
ganumartos dasaxuli mizani; daarwmunos pacienti,
klasifikaciaSi, cxadi gaxda, rom nervuli bulimia
rom man ar unda gamoiwvios pirRebineba da ar unda mi-
sakmaod gavrcelebulia im populaciaSi, romelsac
iRos gamwmendi saSualebebi. kviraSi 0.5-1.0 kg-s mateba
nervuli anoreqsia ar aReniSneba (Palmer 2004).
realistur mizans warmoadgens. am SemTxvevaSi wonis
miuxedavad imisa, rom raselma daaxasiaTa bulimiis
srul aRdgenas 8-12 kvira sWirdeba. zogierTi pacien-
sindromi, rogorc nervuli anoreqsiis àvismomas-
ti iTxovs saavadmyofos datovebas mkurnalobis dam-
wavebeli mdgomareoba~, nervuli bulimiiT daavade-
Tavrebamde, magram medpersonalma moTminebiT unda
bul pacientTa mxolod meoTxeds daudginda nervuli
daarwmunos igi, rom misTvis umjobesia mkurnalobis
anoreqsiis diagnozi.
bolomde saavadmyofoSi darCena.
nervuli bulimiis ZiriTadi niSnebia:
wonis dakargva iSviaTadaa imdenad mZime, rom si-
cocxlis SesanarCuneblad saswrafo, gadaudebel 1. gadametebuli Wamis dauZleveli survili;
mkurnalobas moiTxovdes. Tu aseT pacients ver varw- 2. sxeulis wonis kontrolis mizniT ukiduresi saSu-
munebT, rom aucilebelia hospitalizacia, saWiro alebebis gamoyeneba;
_ 386 _
kvebiTi aSlilobebi
boqsi 15.5 nervuli anoreqsiis marTvis boqsi 15.6 nervuli bulimiis DSM IV
saxelmZRvanelo principebi kriteriumebi
w nervuli anoreqsiis SemTxvevaTa umravlesobis mar ukontrolo kvebis ganmeorebiTi epizodebi. aseT
Tva unda moxdes ambulatoriulad, fsiqologiuri epizodebs axasiaTebs qvemoT mocemuli ori niSani:
mkurnalobisa da fizikuri mdgomareobis monitoringis
pirobebSi; w drois calkeul monakveTSi (mag., 2 saaTis ganmavlobaSi)
sakvebis iseTi raodenobiT miReba, romelic
w fsiqologiuri Terapia moicavs kognitur-analiti sagrZnoblad aRemateba adamianTa umravlesobis mier
kur Terapias, kogniturbiheviorul Terapias, in drois imave monakveTSi da pirobebSi miRebuli sakvebis
terpersonalur fsiqoTerapias, fokusur fsiqo raodenobas;
dinamikur Terapias da ojaxur intervencias, romelic
uSualod kvebiT aSlilobazea mimarTuli; w aseTi epizodebis dros Wamaze kontrolis dakargva
(pacients iseTi SegrZneba aqvs, rom mas ar SeuZlia
w ambulatoriuli fsiqologiuri Terapia, Cveulebriv, Wamis Sewyveta an ver akontrolebs imas, Tu ras Wams da
sul mcire, 6 Tvis manZilze unda gagrZeldes. Tu ra raodenobiT).
pacientis mdgomareoba arc umjobesdeba da arc
uaresdeba, saWiroa mkurnalobis ufro intensiur wonis matebis Tavidan asacileblad perioduli, Seusabamo,
formaze gadasvla (mag., gadasvla individualuri kompensatoruli qceva, rogoricaa: xelovnurad gamo
Terapiidan kombinirebul-individualur Terapiaze wveuli pirRebineba, laqsativebis, diuretikebisa da
an ojaxTan muSaobaze, an dRis stacionarul an sxva medikamentebis miReba an oynis borotad gamoyeneba;
hospitalur mkurnalobaze). nervuli anoreqsiis SimSiloba da gaZlierebuli varjiSi. ukontrolo kvebisa
mkurnalobis erTaderTi meTodi ar unda iyos dietis da Seusabamo kompensatoruli qcevis epizodebi kviraSi
mowesrigeba. saSualod orjer aRiniSneba da 3 Tve grZeldeba. zemoT
aRwerili qcevis darRvevebi mxolod nervuli anoreqsiis
w kvebis aRdgenis periodSi hospitalizebul pacientebTan epizodebis dros ar iCens Tavs.
aucilebelia fizikuri mdgomareobis monitoringis
Catareba. fsiqologiuri daxmareba mimarTuli unda nervuli bulimiis tipebi
iyos rogorc kvebasTan dakavSirebul qcevebze, aseve
gawmendiTi tipi - nervuli bulimiis mimdinare
sxeulis wonisa da formis mimarT damokidebulebis
epizodis dros pirovneba regularulad dakavebulia
Secvlaze da ufro farTo fsiqosocialur sakiTxebze.
TviTgamowveuli pirRebinebiT an gamwmendebis -
igulisxmeba, rom aseTi Careva wonaSi matebas Seuwyobs
laqsativebis, diuretikebisa da oynis borotad
xels. nervuli anoreqsiis mqone stacionaruli
gamoyenebiT;
pacientebis mimarT ar unda gamoviyenoT qcevis
modifikaciis xisti programebi. aragawmendiTi tipi - nervuli bulimiis mimdinare epizodis
dros pirovneba mimarTavs sxva, Seusabamo kompensatorul
w stacionarSi wonis aRdgenis Semdeg, pacients
saSualebebs, rogoricaa: SimSili, gaZlierebuli varjiSi,
unda SevTavazoT ambulatoriuli fsiqologiuri
magram xelovnurad ar iwvevs pirRebinebas da ar xmarobs
mkurnaloba, romelic unda iyos fokusirebuli rogorc
laqsativebs, diuretikebs da oynas.
kvebasTan dakavSirebul qcevaze, ise sxeulis wonisa
da formis mimarT damokidebulebis Secvlaze, aseve,
mierve Tavsmoxveuli dietis darRveva. es epizodebi
ufro farTo fsiqosocialur sakiTxebze. garda amisa,
mudmivad unda warmoebdes fizikuri da fsiqologiuri zogjer SeiZleba dagegmilic iyos. bulimiis epizo-
riskebis monitoringi. dis dros pacienti didi raodenobiT iRebs sakvebs,
TiTo kvebaze daaxloebiT 2000 kkal-ze meti ode-
3. sxeulis wonasa da formasTan dakavSirebuli zeRi-
nobis. mag., pacientma erT kvebaze SeiZleba SeWamos
rebulovani ideebi, romlebic nervuli anoreqsiis
erTi puri, torti, erTi qila muraba da a.S. aseTi
drosac SeiniSneba.
gaumaZRroba maSin iCens Tavs, rodesac pirovneba
DSM-IV ganasxvavebs nervuli bulimiis or qvetips marto imyofeba. Wamis dawyebisas Cndeba daZabulobis
(boqsi 15.5): 1) `gawmendiTi tipi~ xasiaTdeba wonis moxsnis gancda, magram gantvirTvis gancdas mohyveba
matebis Tavidan asacileblad TviTgamowveuli pir- sinanuli da zizRi sakuTari Tavis mimarT. pacientma
RebinebiT, laqsativebis (safaRaraTe saSualebebis) SeiZleba xelovnurad gamoiwvios pirRebineba an mi-
da diuretikebis moxmarebiT; 2) àragawmendiTi tipi~ iRos laqsativebi. dRis manZilze bulimiisa da gaw-
_ am dros pirovneba ar iyenebs gamwmendebs~ wona- mendis epizodebis monacvleoba mravaljer SeiZleba
Si matebis Tavidan asacileblad, aramed mimarTavs ganmeordes.
sxva saSualebebs, rogoricaa intensiuri varjiSi da depresiuli simptomebi ufro metadaa gamoxatuli,
SimSili. nervuli bulimiiT daavadebul pacientebs, vidre nervuli anoreqsiis dros da, savaraudod, meo-
rogorc wesi, normaluri wona aqvT. normaze dabali radia kvebiTi aSlilobis mimarT. pacientebis didi
wonis mqone pacientebi nervuli anoreqsiis krite- nawilis mdgomareoba akmayofilebs mZime depresiis
riumebs akmayofileben, rac SemdgomSi maTi wamyvani kriteriumebs. depresiis simptomebi, rogorc wesi, ix-
diagnozi xdeba. pacientebis umravlesobis menstrua- sneba kvebiTi aSlilobis gamosworebasTan erTad. iS-
luri cikli savsebiT normaluria. viaTad gvxvdeba mZime da persistentuli depresiuli
bulimiiT daavadebul pacientebs kvebaze kontro- aSlilobis mqone pacientebi, romlebic antidepresan-
li TiTqmis sruliad dakarguli aqvT. bulemiis epi- tebiT mkurnalobas saWiroeben.
zodebs SeiZleba win uZRvodes stresi an pacientis
_ 387 _
zemoqmedeba fizikur janmrTelobaze gansxvavebiT, nervuli bulimiis mqone pacientebi imy-

ofebian iseTi faqtorebis zemoqmedebis qveS, rom-
xSiri pirRebineba iwvevs mraval garTulebas; ker-
lebic pirovnebas dietis dacvisaken ubiZgeben (sim-
Zod, kaliumis donis daqveiTebas, rac sakmaod serio-
suqne bavSvobaSi, mSoblebis simsuqne da adreuli
zuli darRvevaa da iwvevs sisustes, gulis ariTmias
menarxe). srulyofilebisaken swrafva aseve SeiZleba
da Tirkmlebis dazianebas. iSviaTad Cndeba saSarde
CaiTvalos specifikur risk-faqtorad, Tumca, aq is
sistemis infeqciebi, tetania da epilefsiuri krunCx-
naklebad mniSvnelovania, vidre nervuli anoreqsiis
vebi. kuWis mJave SigTavsis zemoqmedebis gamo kbile-
SemTxvevaSi (Fairburn et al., 1999).
bze Cndeba saxasiaTo Rrmulebi, romlebsac stoma-
genetikuri risk-faqtorebi. radgan arsebobs urT-
tologi advilad scnobs.
ierTgamomricxavi mtkicebulebebi, nervuli bulimiis
epidemiologia ganviTarebaSi genetikuri faqtorebis roli da mniS-
dasavleTis qveynebSi mcxovreb 16-dan 40 wlamde asa- vneloba bundovania. rogorc Cans, mniSvnelovania ge-
kis qalebSi nervuli bulimiis gavrcelebis xarisxi netikuri komponenti, kerZod, nervuli anoreqsiisa
daaxloebiT 1%-s Seadgens. es ricxvi mamakacebis Sem- da bulimiis jvaredini ojaxuri transmisia, magram
TxvevaSi, sul cota, aTjer naklebia. nervuli bulimia individualuri geni jer-jerobiT ar aris identi-
gvxvdeba mxolod ganviTarebul qveynebSi. daavadebis ficirebuli (Fairburn, Harrison; 2003).
gamovlenisa da diagnostikis katastrofuli mateba 5-HT neirotransmisia. sxvadasxva eqsperimentuli
aRiricxeboda britaneTSi 1990-iani wlebis dasawyis- paradigmebi, maT Soris neiroendokrinuli stimuli-
Si, rasac Semdgom zomieri klebis tendencia mohyva rebis testi da tvinis radiologiuri kvlevis Sede-
(ix. suraTi 15.2). amgvari zrda albaT iman gamoiwvia, gebi, gvafiqrebinebs, rom Tavis tvinis 5-HT funqcia
rom gaizarda SedarebiT xangrZlivi SemTxvevebis aR- nervuli bulimiis SemTxvevaSi anomaliuria (Keye et
ricxvis sixSire (Currin et al., 2005). al., 2001). triftofanis nakleboba gamojanmrTelebul,
bulimiis simptomebis armqone pacientebSi, iwvevs mw-
aSlilobis ganviTareba vave recidivs guneb-ganwyobisa da kognitur sferoSi,
nervuli bulimia Tavs iCens gviani mozardobis asakSi romelic sxeulis wonasa da formasTan aris dakav-
(e.i. ramdenime wliT gvian, vidre nervuli anoreqsia). Sirebuli. es faqti gvafiqrebinebs, rom nervuli bu-
is, rogorc wesi, Tan axlavs im periods, rodesac ada- limiis anamnezis mqone pacientebs axasiaTebT neirof-
miani wuxs sakuTari sxeulis wonisa da formis gamo. siqologiuri mowyvladoba Tavis tvinSi serotoninis
pacientTa meoTxeds anamnezSi aReniSneba nervuli an- dabali donis mimarT. interss moklebuli ar aris is
oreqsiis epizodi. Cveulebriv, daavadebis sawyisi pe- faqti, rom dietiT daklebuli wona iwvevs trifto-
riodi xasiaTdeba dieturi SezRudvebiT, rasac mogvi- fanis moxmarebis daqveiTebas, rac adasturebs imas,
anebiT (ufro xSirad 3 wlis ganmavlobaSi), enacvleba rom maRali riskis mqone pirebisTvis, gadametebuli
gadametebuli Wamis bevrad xSiri epizodebi. gadamete- dieta nervuli bulimiis CamrTav meqanizmad iqceva
buli Wamis gaxSirebas mohyveba sxeulis wonis dabrune- (Smith et al., 1999).
ba normalur sazRvrebSi. garkveul stadiaze, gadame-
tebuli Wamis kompensaciis mizniT, iwyeba pirRebinebis
mimdinareoba da gamosavali
TviTgamowveva da laqsativebis borotad gamoyeneba, nervuli bulimiis mimdinareoba da gamosavali sak-
rasac Sedegad Wamaze kontrolis dakargva mohyveba. maod bundovania imdenad, ramdenadac ar arsebobs
grZelvadiani gamokvlevebis sakmarisi raodenoba. im
etiologia pirebis SemTxvevaSi, romelTac mkurnaloba ar Cat-
zogadi risk-faqtorebi. nervuli anoreqsiis ms- arebiaT, daavadebis mimdinareoba da gamosavali uc-
gavsad, nervuli bulimiis ganviTareba sxvadasxva nobia. klinikuri SemTxvevebis saSualo xangrZlivoba
risk-faqtorebis zemoqmedebis Sedegia. es faqtore- daaxloebiT 5 welia, rac am qvejgufSi aSlilobis
bia: ojaxur anamnezSi mSoblebis fsiqikuri aSliloba, qronikuli mimdinareobis maCvenebelia. zogadad, daa-
gansakuTrebiT, depresia da medikamentebze damokide- vadebis gamosavali sakmaod gansxvavebulia. faqtebze
buleba; aseve, bavSvobisdroindeli gamocdilebis damyarebuli mtkicebulebebis mixedviT, aSlilobis
mTeli gama. arsebobs mosazreba, rom nervuli bulimi- mwvave forma qronikulSi gadadis. amgvarad, 5-10
is yvelaze xSiri risk-faqtori seqsualuri Zalado- wlis Semdeg, 1/3-dan -mde pacientebs isev aReniSne-
baa, Tumca, faqtobrivi mtkicebulebebis Tanaxmad, baT klinikurad gamoxatuli kvebiTi aSliloba, Tum-
am fonze bulimiis sixSire ar aRemateba sxva tipis ca, umravles SemTxvevaSi, atipiuri formiT (Fairburn
fsiqikuri aSlilobebis sixSires (Fairburn et al., 1999). et al., 2000). ar arsebobs imis mtkicebuleba, rom ner-
specifikuri risk-faqtorebi. epidemiologiuri kv- vuli bulimia asocirebulia sxva fsiqikuri aSlilo-
levebiT dasturdeba, rom, nervuli anoreqsiisgan bis dawyebasTan.
_ 388 _
kvebiTi aSlilobebi
nervuli bulimiis letalobis maCvenebeli, nervul marTva
anoreqsiasTan SedarebiT, dabalia, magram aris Tu ara
nervul anoreqsiasTan SedarebiT, nervuli bulimiis
is momatebuli saerTo populaciasTan mimarTebaSi,
marTva iolia, radgan aseT pacientebs ufro metad
gaurkvevelia (Keel et al., 2003). asea Tu ise, nervuli
aqvT gamojanmrTelebis survili da advilad modian
bulimia mtkiced aris asocirebuli depresiasa da im
urTierTTanamSromlobaze. amas garda, am SemTxvevaSi
medikamentebis avadmoxmarebasTan, romlebic sakmaod
ar arsebobs wonis aRdgenis saWiroeba. aucilebelia
maRali letalobis maCveneblebiT xasiaTdebian (Harris,
gamovikvlioT pacientis fsiqikuri mdgomareoba da
Barraclough; 1995). pacientis mdgomareoba umjobesdeba
ganvsazRvroT iseTi pacientebis eleqtrolitebis
orsulobis periodSi, xolo orsulobis Semdeg vi-
done, romlebsac xSirad aqvT pirRebineba da romle-
Tardeba recidivi. ar arsebobs daavadebis mimdinare-
bic gamwmend saSualebebs iyeneben.
obisa da prognozis damajerebeli winapiroba, Tumca,
aseTive tipis sxva mravali aSlilobis msgavsad,
simsuqne bavSvobis asakSi da dabali TviTSefaseba,
aqac `safexurebrivi movla~ saukeTeso gzaa pacien-
rogorc wesi, asocirebulia arakeTilsaimedo gamosa-
tebis didi raodenobisTvis, romelTac sxvadasxva
valTan (Fairburn et al., 2000).
simZimis aSliloba axasiaTebT. nervuli bulimiis mar-
mkurnalobasTan dakavSirebuli mtkicebulebebi Tva klinikuri daxelovnebiserovnuli institutis
bolo wlebis ganxilvis sagani gaxda (2004b).
mocemuli aSlilobis SemTxvevaSi, yvelaze ukeT Ses-
wavlili fsiqologiuri mkurnalobaa kognitur-bi- w safexuri pirveli _ pacientebis im mcire raode-
hevioruli Terapia, romelic pacients kvebaze kon- nobis identifikacia (5%-ze naklebi), romlebic
trolis aRdgenaSi exmareba. agreTve, araerTgzisaa saWiroeben specializebul mkurnalobas _ a) mZime
nacadi antidepresantebis (kerZod, serotoninis depresiis gamo; b) iseTi fizikuri garTulebebis
ukumitacebis seleqciuri inhibitoris) gamoyeneba. gamo, romelTa drosac saWiroa saavadmyofos an
mkurnalobis sxvadasxva meTodis efeqturobis Sej- dRis stacionaris pirobebSi mkurnaloba; g) niv-
amebis Sedegad (Bakaltchuk et al., 2000; Wilson and Fairburn, TierebaTa borotad gamoyenebis gamo, rac da-
2002), SesaZlebelia Semdegi daskvnebis gamotana: moukidebel mkurnalobas moiTxovs.
w sadReisod nervuli bulimiis mkurnalobis yvelaze w safexuri meore _ warimarTeba kognitur-bihevioru-

efeqtur saSualebad miCneulia specifikuri kogni- li TviTdaxmarebis saxiT, specialuri wignis gamoy-
tur-bihevioruli Terapia, romelic fokusirebu- enebiTa da araprofesionali fasilitatoris xelmZ-
lia im qcevisa da azrebis Secvlaze, romlebic xels RvanelobiT. pacienti fasilitators 4 Tvis ganmav-
uwyoben kvebiTi aSlilobis SenarCunebas. lobaSi xvdeba. ewyoba daaxloebiT 8-10 Sexvedra. ase-
Ti tipis mkurnaloba pirveladi jandacvis doneze
w am formis kognitur-bihevioruli TerapiiT
unda xorcieldebodes. am tipis Terapia pacientebis
mkurnalobisas pacientebis 1/3-dan 1/2-mde srul da
myar gamojanmrTelebas aRwevs.
w antidepresantebiT mkurnaloba (mag., serotoninis boqsi 15.7 kiTxvebi, romlebic unda dasvan
ukumitacebis seleqciuri inhibitoris gamoyeneba) pacientma da misi ojaxis wevrebma kvebiTi
amcirebs ukontrolo Wamas da, aqedan gamomdinare,
aSlilobisa da misi mkurnalobis Sesaxeb
gamwmendebis gamoyenebis sixSiresac; aumjobesebs
pacientis guneb-ganwyobas, Tumca, kognitur-bihevi- pacienti
orul TerapiasTan SedarebiT, misi efeqti sustia 1. ra tipis kvebiTi problema maqvs?
da Sedegic SeiZleba myari ar iyos. 2. rogor imoqmedebs igi Cems janmrTelobaze, yoveld-
Riur cxovrebaze, muSaobasa da swavlaze?
w kognitur-bihevioruli Terapiisa da antidepre- 3. ratomgadawyviteT, SemomTavazoT aseTi saxis mkur-
santebiT mkurnalobis kombinacia, calke Catare- naloba?
bul fsiqologiur mkurnalobasTan SedarebiT, ar 4. arsebobs Tu ara sxva tipis mkurnaloba, romelic CemT-
vis ufro misaRebi iqneba?
aCvenebs aSkara upiratesobas.
ojaxi
w interpersonaluri fsiqoTerapia, SesaZloa, iseTive
1. riT SegviZlia dagexmaroT?
efeqturi aRmoCndes, rogoric kognitur-bihevior-
2. SeiZleba Tu ara uSualo monawileoba miviRoT
uli Terapiaa, magram mis Catarebas meti dro sWird- pacientis kvebis meTvalyureobaSi?
eba. 3. SeiZleba Tu ara vicodeT mkurnalobis mimdinareobis
w martivi, TviTdaxmarebiTi mkurnaloba SegviZlia Sesaxeb?
4. SegviZlia Tu ara Cven, rogorc ojaxma, mxardaWeriT
sawyis stadiebze gamoviyenoT, magram, rogorc wesi,
visargebloT?
umravles SemTxvevaSi is uSedegoa.
National Institute for Clinical Excellence (2004 b)
_ 389 _
mesamedi nawilisTvis warmatebis momtania. siuli simptomebi da hqondeT ukmayofilebis gancda
w safexuri mesame _ pacientebi, romlebTanac 6 kviris sakuTari sxeulis wonisa da formis gamo, Tumca, es
ganmavlobaSi meore safexurze muSaoba uSedego aR- ukanaskneli, nervul bulimiasTan SedarebiT, nak-
moCnda, saWiroeben srul kognitur-biheviorul Te- lebad mwvavedaa gamoxatuli.
rapias. pacientebis im mcire nawilisTvis, romleb- ukontrolo kvebasTan dakavSirebuli aSliloba,
sac aReniSnebaT Tanmxlebi mZime depresiuli simp- zogadad, asocirebulia rogorc fsiqikuri aSlilo-
tomebi, Sedegiania antidepresantebis (fluoqsetini bebis, aseve, Warbwonianobis ganviTarebis maRal risk-
60 mg/dR) damateba. depresiuli simptomebis didi Tan. pacientebis daaxloebiT 25%-s, romelic Warbwo-
nawili qreba warmatebuli kognitur-bihevioruli nianobis gamo mkurnalobas itarebs, ukontrolo kve-
mkurnalobis fonze. basTan dakavSirebuli aSlilobis simptomebi aReniSne-
ba. nervuli bulimiisgan gansxvavebiT, es mdgomareoba
w safexuri meoTxe _ pacientebi, romelTa mdgomareoba
viTardeba SedarebiT gviandel asakSi. pacientebis meo-
ar umjobesdeba kognitur-bihevioruli mkurnalo-
Txeds mamakacebi Seadgenen. zemoT ganxiluli sxva kve-
biT, ganmeorebiT da srulad unda gamoikvlios spe-
biTi aSlilobebisgan gansxvavebiT, ukontrolo kvebas-
cialistma. rig SemTxvevaSi kognitur-bihevioruli
Tan dakavSirebuli aSliloba xasiaTdeba spontanuri
Terapia an antidepresantebiT mkurnaloba SesaZloa
remisiis maRali sixSiriT. is advilad emorCileba
Sedegiani aRmoCndes. mniSvnelovania mkurnalobis
kognitur-biheviorul Terapias da serotoninis uku-
sqemis ganxilva pacientTan erTad da misTvis mis-
mitacebis seleqciuri inhibitoris antidepresantebiT
aRebi midgomebis gaTvaliswineba (ix. boqsi 15.7).
mkurnalobas (Dingemans et al., 2002).
dauzustebeli kvebiTi aSlilobebi gacximovneba

(atipiuri kvebiTi aSlilobebi) gacximovneba aris mdgomareoba, romelsac axasiaTebs
DSM-IV-isa da ICD-is mixedviT, dauzustebeli kvebiTi sxeulis Warbi cximianoba. gacximovnebis diagnozi
aSlilobebi mwvave klinikuri mimdinareobis daavade- maSin daismis, rodesac sxeulis masis indeqsi (smi =
bebia, romlebic ar akmayofileben nervuli anoreq- sxeulis wona(kg)/simaRle(m2) aRemateba 30-s. britane-
siisa da nervuli bulimiis diagnostikur kriteri- Tis zrdasruli mosaxleobis 20% am kriteriums ak-
umebs. rogorc zemoT iyo aRniSnuli, es daavadebebi mayofilebs da es maCvenebeli yovelwliurad matu-
sakmaod xSiria da misi diagnozi daismis am CiviliT lobs. gacximovneba asocirebulia letalobis maRal
momarTuli pirebis, sul cota, erT mesameds. atipi- maCvenebelTan, xolo mZime SemTxvevebSi (smi >40) 25-35
uri kvebiTi aSlilobebis mimdinareobaze cota ramaa wlis asakobriv populaciaSi es maCvenebeli 12-jer
cnobili, Tumca, SegviZlia vivaraudoT, rom isini izrdeba. iTvleba, rom yovelwliurad aSS-Si 300 000
nervuli anoreqsiisa da nervuli bulimiis SemTxve- letaluri SemTxvevis mizezi gacximovnebaa, ris gamoc
vaTa daaxloebiT naxevarSi gvxvdeba. atipiuri kvebi- is sazogadoebrivi jandacvisTvis, prevenciis Tval-
Ti aSlilobebis mkurnalobas arasakmarisi yuradReba sazrisiT, Tambaqos moxmarebis Semdeg, rigiT meore
eqceva. klinicistebs rekomendebuli aqvT, mihyvnen problemas warmoadgens (Zohrabian, 2005).
nervuli anoreqsiis mkurnalobis sqemas dabali wo-
nis pacientebTan da nervuli bulimiis mkurnalobis etiologia
sqemas, upiratesad, ukontrolo kvebasTan dakavSire- gacximovnebis axsna SeiZleba genetikuri faqtore-
buli problemebis dros (Fairburn, Harrison; 2003). biT, romlebsac aZlierebs socialuri faqtore-
bic, romlebic xels uwyoben, mag., maRalkaloriuli
ukontrolo kvebasTan dakavSirebuli sakvebis gadametebuli raodenobiT miRebas da imas,
aSliloba rom pirovneba arasakmarisad varjiSobs. fsiqologi-
DSM-IV-is dauzustebeli kvebiTi aSlilobebis (ED- uri mizezebi, ZiriTadad, nakleb mniSvnelovania, ma-
NOS) jgufi, romelic `saWiroebs Semdgom Seswavlas~. gram, rig SemTxvevebSi, rodesac gadametebuli Wama,
am jgufSi Sedis ukontrolo kvebasTan dakavSirebu- savaraudod, emociuri faqtorebiT aris ganpirobe-
li aSliloba (binge eating disorder). mocemuli termi- buli, saWiroa fsiqiatris konsultacia. fsiqiatrs
nis definicia da misi validuroba sakmaod bundova- gacnobierebuli unda hqondes, rom fsiqotropuli
nia, radgan mis Sesaxeb mwiri informacia mogvepoveba. preparati xels uwyobs wonis matebas da masTan aso-
mas axasiaTebs ganmeorebiTi bulimiuri epizodebi, cirebul metabolur darRvevebs (boqsi 15.8).
Tumca, nervuli bulimiisagan gansxvavebiT, am dros fsiqologiuri Sedegebi
pacienti ar mimarTavs pirRebinebasa da gamwmend sa-
miuxedavad imisa, rom afeqturi aSlilobebis diag-
Sualebebs. pacientebs SeiZleba aReniSnebodeT depre-
nozi xSirad daesmiT Warbwonian adamianebs, mravalma
_ 390 _
atipiuri kvebiTi aSlilobebi
kvlevam, romelTa drosac Seadares guneb-ganwyobis
boqsi 15.8 wonis matebasTan asocirebuli
aSlilobebis sixSire Warbi wonis mqone pirebsa da
zogad populaciaSi, umniSvnelo gansxvaveba aCvena. zogierTi fsiqotropuli wamali
Warbwonianobis sakiTxi yvelaze metad maRali da sa- antidepresantebi: amitriptilini, imipramini, mianserini,
Sualo socio-ekonomikuri klasis Tineijer da axal- mirtazapini, fenelzini
gazrda qalebs awuxebT. isini iseT socialur gare- antifsiqozuri agentebi: qlorpromazini, qlozapini,
olanzapini, qvetiapini
moSi cxovroben, romelSic diskriminacia da winas-
guneb-ganwyobis stabilizatorebi: liTiumi, valproati
warganwyobebia gavrcelebuli.
msuqani adamianebis fsiqopaTologiis damaxasiaTebeli neba (Padwal et al., 2003). antidepresanebTan da antif-
niSania is, rom maT sakuTar sxeulze damaxinjebuli siqozur wamlebTan erTad ar aris rekomendebuli
warmodgena aqvT, sakuTar Tavs groteskulad aRiqva- sibutraminis daniSvna.
men da swamT, rom garSemo myofi pirebi agdebulad
nebismieri formis mkurnalobis grZelvadiani Sede-
uyureben maT. es darRveva dakavSirebulia garkveuli
gi aradamakmayofilebelia, ganurCevlad imisa, imy-
saxis TviTcnobierebasTan da socialur SezRudvebT-
ofeboda pacienti eqimis meTvalyureobis qveS, Tu
an. is aReniSneba msuqani adamianebis mxolod mcire
_ ara. qcevis modifikaciis principebze dafuZnebul
nawils, romelsac bavSvobidan Warbi wona da dabali
jgufur Terapias da TviTdaxmarebis jgufebs aqvs
TviTSefaseba axasiaTebs (Stunkard, Waddon; 2000).
moklevadiani sargebeli, magram grZelvadian Sedegs
mimdinareoba ver aumjobeseben. igive SeiZleba iTqvas iseT meTo-
debze, rogoricaa madis daTrgunva da bihevioruli
simsuqne qronikuli, mudmivi problemaa. msuqani bavS-
meTodi (Eckel, 2002).
vebi da mozardebi am problemas mkurnalobis gareSe
ver umklavdebian. zrdasruli adamianebis udidesi qirurgiuli mkurnaloba
nawili, romelsac ar gauvlia mkurnaloba, agrZelebs
qirurgiuli Careva dasaSvebia mxolod mZime simsuq-
wonaSi matebas da yovelwliurad daaxloebiT 1 kg-s
nis dros (smi>40), rodesac sxeulis masis indeqsi
imatebs.
aRemateba 35-s, da iseTi seriozuli samedicino gar-
mkurnaloba Tulebebis dros, romlebsac wonaSi kleba amsubuqebs.
dResdReobiT sayovelTaod miRebulia, rom mkur simsuqnis dros ori tipis qirurgiul Carevas mimar-
nalobis mizania wonis 5-10 %-iT Semcireba. ideal- Taven: pirvelia kuWis Seviwroeba, rac gulisxmobs
uri wonis miRwevis mcdelobebi realur Sedegebs ar damWerebis gamoyenebiT kuWis zomis Semcirebas da,
iZleva, radgan Zneli misaRwevi da SesanarCunebelia. aqedan gamomdinare, zrdis kuWis avsebis SegrZnebas.
zomieri miznis dasaxvas ki moaqvs samedicino sarge- meore meTodi gulisxmobs nawlavebis Suntirebas.
beli da, aseve, sxeulis xatisa da guneb-ganwyobis aseT dros mokldeba is nawlavebi, romlebic sakvebis
gaumjobeseba. agreTve, saWiroa, rom pacients See- SewovaSi monawileoben. es ori operacia seriozuli
Zlos xangrZlivi periodis manZilze wonis marTva. riskis Semcvelia da mas mxolod im SemTxvevaSi mimar-
mkurnalobis ZiriTadi variantebia: Taven, rodesac mkurnalobis sxva meTodebi uSedegoa
(National Institute for Clinical Excellence, 2002).
w qcevis modifikacia. am SemTxvevaSi gamoyenebuli in-
tervenciis samiznea kvebis paternebi da moxmarebu- marTva
li sakvebis Tavisebureba. amave dros, aseT inter- mkurnaloba ZiriTadad tardeba pirveladi jandacvis
vencias mosdevs miRebuli kaloriebis raodenobis dawesebulebebsa da samedicino klinikebSi. fsiqia-
zomieri Semcireba. qcevis modifikaciis meTodis trebma kargad unda icodnen, Tu rogori standartu-
gamoyenebisas, TandaTanobiT zrdian fizikur aq- li mkurnaloba tardeba simsuqnis dros da ra roli
tivobas. miuxedavad imisa, rom es midgoma efeqtu- eniWeba TviTdaxmarebisa da komerciul programebs,
ria xanmokle periodSi gamoyenebis dros, mogvi- mag., programa Weight Watcher. miuxedavad imisa, rom am
anebiT wonis TandaTanobiTi aRdgena xdeba. ukanasknelis efeqturoba bundovania, gasaTvaliswine-
w farmakologiuri mkurnaloba. britaneTSi sa- belia, rom esa da sxva msgavsi programebi kvebisa da
dReisod mkurnalobis ori saSualeba gamoiyene- fizikuri aqtivobis mkafio da validur principebzea
ba: orlistati _ lipazas inhibitori, romelic dafuZnebuli, ris gamoc, isini, savaraudod, sasarge-
aqveiTebs cximebis absorbcias da sibutramini, ro- blo unda iyos zomieri xarisxis gacximovnebisa da
melic Sereuli monoaminebis ukumitacebis inhibi- janmrTelobasTan dakavSirebuli riskis SemTxvevaSi.
toria da madas aqveiTebs. orive wamali zomieri msubuqi Warbwonianobis mqone pirebis daxmareba Ses-
sargeblis momtania, iwvevs wonaSi klebas da Ses- aZlebelia martivi rCevis micemiT dietisa da varji-
aZlebelia miRebuli Sedegis erT wlamde SenarCu- Sis Sesaxeb; xolo ufro mZime SemTxvevebi ki saWiroebs
_ 391 _
ufro metad struqturirebul biheviorul progr-
amebs Tanmxlebi farmakologiuri mkurnalobiT, Tu
cxrili 15.2 Zilis pirveladi darRvevebis
klasifikacia DSM-IV mixedviT
wina mkurnaloba uSedego aRmoCnda. pacients unda
vurCioT, SezRudos kvebis racionSi rafinirebuli dissomniebi
Saqari da comeuli da miiRos boWkos Semcveli naxSir- w pirveladi insomnia
wylebi. Cveulebriv, dReSi miRebuli kaloriebis ra- w pirveladi hipersomnia
odenoba unda SeizRudos 500kkal-iT, raTa wonaSi kle- w narkolefsia
ba kviraSi erT girvanqas (daaxloebiT, 0.45 kilograms) w sunTqvasTan dakavSirebuli Zilis aSliloba
Seadgendes. aseve, unda gaizardos fizikuri aqtivoba, w cirkaduli ritmis darRvevasTn dakavSirebuli Zilis
aSliloba
rac xels Seuwyobs wonaSi klebas da gaaumjobesebs
w dissomnia, romelic sxvagvarad ar aris dazustebuli
gul-sisxlZarRvTa sistemis mdgomareobas. miuxeda-
vad imisa, rom gavrcelebuli azris Tanaxmad, dietis parasomnia
dacvas arasasurveli fiziologiuri da fsiqologi- w koSmarebi (Zilis SfoTviTi aSliloba)
uri gverdiTi movlenebi axlavs Tan, es, wesiT, ar unda w Ramis SiSebi
iyos problema im Warbwoniani pirebisTvis, romlebic w somnambulizmi
zomier dietas icaven (Hitchcokc, Pugh, 2002). w parasomnia, romelic sxvagvarad ar aris dazustebuli
mZime Warbwonianobis mqone adamianebs sWirdebaT sxva fsiqikur aSlilobasTan dakavSirebuli Zilis
gamokvleva da mkurnaloba specializirebul klinkeb- aSliloba
Si. simsuqnis problemebi ganxilulia Semdeg wyaroSi: w insomnia
Stinkard, Wadden (2000); Eckel (2002). w parasomnia
sxva Zilis aSlilobebi

fsiqogenuri pirRebineba w meoradi Zilis aSliloba gamowveuli janmrTelobis
saerTo mdgomareobiT
fsiqogenuri pirRebineba qronikuli da epizoduri
w fsiqoaqtiuri nivTierebebiT gamowveuli Zilis
pirRebinebaa, romelsac ar aqvs organuli mizezebi.
aSliloba
Cveulebriv, iwyeba Wamis Semdeg da mas ar axlavs gu-
lisrevis SegrZneba. is unda gaimijnos ufro farTod garda im SemTxvevebisa, rodesac adamianis movaleobebi
gavrcelebuli nervuli bulimiis sindromisgan, rom- da saqmianoba gansakuTrebul sifxizles moiTxovs. simp-
lis drosac TviTgamowveuli pirRebineba Tan sdevs tomebi, romlebic dRis ganmavlobaSi iCens Tavs insom-
ukontrolo kvebis epizodebs. fsiqogenuri pirRe- niis mqone pirebTan, ufro metad uZilobis mizezebTan
bineba ufro xSirad aqvT qalebs, vidre mamakacebs da (depresias an SfoTviT aSlilobasTan) unda iyos dakav-
vlindeba axalgazrda da saSualo asakSi. rekomende- Sirebuli, vidre uSualod uZilobasTan.
buli mkurnalobis saxeebia fsiqoTerapia da bihevi-
oruli Terapia. klasifikacia
cxrilSi 15.2 naCvenebia Zilis aSlilobebis klasifi-
Zilis aSlilobebi kacia DSM-IV-is mixedviT, romelic eTanxmeba Zilis
aSlilobebis bevrad ufro damuSavebul saerTaSor-
fsiqiatrebs xSirad mimarTaven TxovniT, konsul-
iso klasifikacias.
tacia gauwion pacientebs, romelTa mTavari prob-
ICD-10-Si Sesuli kategoriebi sakmaod gansxvavebulia.
lema uZiloba an, SedarebiT iSviaTad, gadametebuli
aq Zilis aSlilobebis klasifikacia sam sxvadasxva
Zilianobaa. am sferoSi arsebuli problemebidan unda
nawilSi gvxvdeba.
gamoiyos:
w Zilis pirveladi aSliloba, razec swored mocemu-
epidemiologia
li qveTavia fokusirebuli;
Zilis aSliloba xSiri movlenaa. monacemebi insomniis
w Zilis aSliloba, rogorc fsiqologiuri simptom-
gavrcelebis xarisxis Sesaxeb Zalian gansxvavebulia,
ebis mizezi
rac ganpirobebulia am cnebis gansazRvrebaTa simrav-
w Zilis aSliloba, rogorc fsiqikuri aSlilobis, liT da Seswavlili populaciiT. zrdasruli pirebis
gansakuTrebiT, depresiuli da SfoTviTi aSlilo- 30%-ze meti uCivis uZilobas, amaTgan erTi mesamedi
bebis simptomi, rac Sesabamis TavebSia ganxiluli. ki _ qronikul uZilobas. zedmeti Zilianoba zrdas-
bevri pacienti, visac cudad sZinavs, uCivis dRis gan- rulebis 5%-s da mozardebis daaxloebiT 15%-s aqvs.
mavlobaSi daRlilobas da ugunebobas. miuxedavad imisa, zrdasruli populaciis 14%-s awuxebs Zil-RviZilis
rom xangrZlivi uZiloba iwvevs inteleqtualuri aqti- sxvadasxva formis qronikuli aSliloba.
vobis xarisxis gauaresebas da guneb-ganwyobis daqveiTe- mocvis epidemiologiuri zonis gamokvlevis monace-
bas, drogamoSvebiTi uZiloba nakleb mniSvnelovania, mebis Tanaxmad (Epidemiologic Catchment Area Study, Ford, Ka-
_ 392 _
Zilis aSlilobebi
problemebi, aseve, iCens Tavs tkivilTan da diskom-
boqsi 15.9 Zilis darRvevebis Sefaseba
fortTan asocirebuli avadmyofobisa da metaboluri
skrininguli kiTxvebi darRvevebis dros. uZiloba, SesaZloa, provocireb-
w sakmaod kargad gZinavT? sakmaod didxans gZinavT? uli iyos eqimis mier daniSnuli wamlebiT. uZilobis
w geZinebaT dRis ganmavlobaSi? 15%-is mizezi ar aris dadgenili (pirveladi insom-
w darRveuli gaqvT Ramis Zili? nia). adamianebi gansxvavdebian Zilis xangrZlivobis
Zilis anamnezi moTxovnilebis mixedviT da garkveul nawils, vinc
w ZilTan dakavSirebuli Civilebis detaluri istoria;
uCivis uZilobas, SeiZleba sakmarisad didxansac sZi-
w uZilobis epizodebis modeli; faqtorebi, romlebic
navs, magram ver acnobierebs am faqts. insomniis mi-
iwveven Zilis gaumjobesebas da gauaresebas;
w gavlena xasiaTze, yoveldRiur cxovrebaze, ojaxze;
moxilva ix. Sateia, Nowell; 2004.
w warsuli da axlandeli mkurnaloba; insomniis gamokvleva
w tipiuri dReRamuri Zil-RviZilis grafiki.
Cveulebriv, insomniis diagnozs svamen pacientis mier
Zilis dRiuri
mowodebuli informaciis safuZvelze. yuradReba
w sistematiuri Canawerebi 2 kviris an ufro xangrZlivi
drois manZilze. eqceva, rogorc Zilis problemebis bunebas, ise maT
im piris mier gadmocemuli anamnezi, romelsac pacientTan zemoqmedebas dRis ganmavlobaSi mimdinare aqtivobaze.
erTad sZinavs garda amisa, tardeba fsiqikuri da zogadi samedicino
gamokvleva darRvevebis skriningi. agreTve, yuradRebis gamaxvile-
w video Canaweri baa saWiro narkotikebisa da alkoholis moxmarebaze.
w manJetiani scintigrafia (sxeulis moZraobebis
Zilis laboratoriuli Seswavla iSviaTad xdeba.
monitoringi)
w polisomnografia (eeg, emg) insomniis mkurnaloba
Stores, 2000
Sedegiani SeiZleba gamodges rogorc farmakologiuri,
merow, 1989), populaciis 10.2% uCioda insomnias, xolo ise ara-farmakologiuri mkurnaloba (Sateia, Nowell;
3.2% _ hipersomnias. uZilobis mqone pirebis 40.%-sa da 2004). miuxedavad imisa, rom ufro farTod gamoiyeneba
Warbi Zilianobis mqone pirebis 46.5%-s aReniSneboda medikamenturi mkurnaloba, is dRes ar aris rekomende-
fsiqikuri aSlilobebi, im dros, rodesac populaciaSi, buli, rogorc pirveli rigis saSualeba.
romelsac ar aReniSneboda ZilTan dakavSirebuli Civi- Zilis higiena moicavs ramdenime safexurs, romelic
lebi, fsiqikuri aSlilobebi 16.4%-s Seadgenda. Zilis efeqturia insomniis mqone yvela pirisTvis da, SeiZle-
persistentuli aSlilobebis risk-jgufSi Sedian bavS-
vebi, mozardebi, somaturi daavadebis mqone pacientebi, boqsi 15.10 ra unda vicodeT Zilis Sesaxeb
daswavlis darRvevisa da demenciis mqone pirebi. (Zilis higiena)
gamokvleva Zilis garemo:
gamokvlevisas xdeba sruli anamnezis Sekreba (fsiqi- w nacnobi da komfortuli;
atriuli da samedicino istoria) da ZilTan dakav- w Cabnelebuli;
Sirebuli Civilebis Sesaxeb detaluri gamokiTxvis w mSvidi;
Catareba (boqsi 15.9). rig SemTxvevebSi aucilebelia ecadeT:

w daZinebis win SeasruloT yvela saWiro procedura da
specialuri gamokvlevebis Catareba (Stores, 2000).
rituali;
w adgeT da dawveT erTsa da imave dros;
insomnia w dasaZineblad mxolod maSin dawveT, rodesac
gardamavali uZiloba Cndeba stresis da `jet-legis~ daiRlebiT;
(cirkaduli ritmis desinqronizacia) dros; xanmokle w ifiqroT sakuTar problemebze dawolamde;
uZiloba dakavSirebulia pirovnul problemebTan, w regularulad ivarjiSoT;
rogorebicaa: avadmyofoba, axloblis dakargva, urT- garda amisa:
ierTobebis garTuleba, stresi da damqancavi samuS- w dawolamde ecadeT, ar CaerToT iseT aqtivobaSi,
romelic Zlier aRgagznebT;
ao. klinikur praqtikaSi uZiloba meoradia da Cndeba
w gvian nu ivarjiSebT;
gansakuTrebiT mtkivneuli fizikuri mdgomareobebis,
w dRis bolos ar miiRoT kofeinis Semcveli sasmelebi;
depresiuli da SfoTviTi aSlilobebis fonze. is w bevrs nu mowevT da ar miiRoT didi raodenobiT
xSirad axlavs alkoholis da kofeinis gadametebul alkoholi;
gamoyenebas da demencias. Zili SeiZleba dairRves xan- w dRis manZilze didxans nu daiZinebT;
grZlivi drois manZilze didi raodenobis alkoholis w dawolis win nu miiRebT didi raodenobiT sakvebs;
Sewyvetidan ramodenime kviris ganmavlobaSi. Zilis w fxizel mdgomareobaSi sawolSi didxans nu gaCerdebiT.
_ 393 _
axeb Semdgom iqneba saubari (gv. ??). insomniis xanmokle
cxrili 15.3 insomniis mkurnaloba mkurnalobis alternatiuli saSualebaa trazodoni _
arafarmakologiuri mkurnaloba sedaciuri antidepresanti. is SeiZleba dainiSnos se-
w Zilis higiena; rotoninis ukumitacebis seleqciuri inhibitorebiT
w kognituri Terapia; mkurnalobis adreul stadiaze.
w stimul-makontrolebeli Terapia;
w Zilis SezRudva; hipersomnia da dRis manZilze gadametebuli
w progresuli kunTTa relaqsacia; Zilianoba
dRis manZilze gadametebuli Zilianoba gavrcelebu-
farmakologiuri mkurnaloba
li mdgomareobaa (gancxadebuli gavrcelebis sixSire
w benzodiazepinebi, mag., temazepami;
_ 3-5%), Tumca, is xSirad ar aris diagnostirebuli.
w z-wamlebi _ zolpidemi, zaleponi, zopikloni;
w sedaciuri antidepresantebis dabali dozebi, mag., SemTxvevaTa umravlesoba meoradia da gamowveulia
trazodoni. Ramis uZilobiT. cxrilSi 15.14 mocemulia hipersom-
niis ZiriTadi mizezebi. mimoxilva ix. Zeman et al., 2004.
dRis manZilze gadametebuli Zilianobis mkurnaloba
cxrili 15.4 dRis manZilze gadametebuli
Zilianobis mizezebi ganxilulia Semdeg wyaroSi: Anonymous, 2004.
arasakmarisi Ramis Zili narkolefsia

aradamakmayofilebeli Zilis reJimi da pirobebi Cveulebriv, narkolefsia iwyeba 10-dan 20 wlamde,
Zilis cirkaduli ritmis darRveva Tumca, is SeiZleba ufro adrec daiwyos. narkolefsia
xSiri parasomniebi
iSviaTad iwyeba saSualo asakis Semdeg. gavrcelebis
qronikuli somaturi daavadeba
sixSirea 5/10000 sul mosaxleze. misi ZiriTadi niSania
fsiqikuri aSlilobebi
katapleqsia (paralizis uecari, xanmokle epizodi,
paTologiuri Zili
kunTTa tonusis dakargviT), rac damaxasiaTebelia
narkolefsia
SemTxvevaTa umravlesobisTvis; aseve, paralizi
obstruqciuli Zilis apnoe
ZilSi da hipnagogiuri halucinaciebi, rac mxolod
centraluri nervuli sistemis sxva daavadebebi
pacientTa meoTxed nawilSi iCens Tavs. narkolefsia,
wamlismieri efeqti
klein-levinis sindromi
rogorc wesi, vlindeba gadametebuli Zilianobis
depresiuli daavadeba an katapleqsiis Sedegebis saxiT (mag., kolafsi) da
seriozul gavlenas axdens cxovrebis Cveul wesze.
ba, pirveladi jandacvis doneze ganxorcieldes (boqsi mimoxilva ix. Zeman et al., (2004.
15.10). ufro seriozuli da persistentuli insomniis
SemTxvevaSi arafarmakologiuri Carevis ufro farTo narkolefsiis etiologia
speqtria rekomendebuli (cxrili 15.3). kognituri Te- arsebobs narkolefsiis mravali etiologiuri Te
rapia (aseve cnobilia, rogorc kognituri restruq- oria. mtkicebulebebi metyvelebs kompleqsuri ge
turizacia) gansazRvravs da cvlis insomniis Sesaxeb netikuri predispoziciis sasargeblod, Tumca, dro
arsebul araswor Sexedulebebs. stimul-makontrole- dadro gvxvdeba iseTi ojaxebic, romlebSic aRiniSneba
beli Terapiis mTavari principia is, rom adamiani unda autosomur-dominanturi tipis transmisia. yvelaze
dawves dasaZineblad mxolod maSin, roca eZineba da mWidro genetikuri asociacia aRiniSneba HLA DR2
Tu 20 wuTis ganmavlobaSi ver daiZina, unda adges da tipis qsovilTan, konkretulad ki HLA DQB1*0602
xelmeored dawolamde CaerTos nebismier aqtivobaSi, tipTan, rac dadginda narkolefsiis SemTxvevaTa
romelic misTvis simSvidis momtania. umetesobaSi (85%-ze meti), im dros, rodesac zogad
ar aris rekomendebuli saZile saSualebebis pro- populaciaSi mxolod 18-35%-s Seadgens. es asociacia
longirebuli moxmareba, miuxedavad imisa, rom autoimunuri meqanizmis arsebobaze miuTiTebs.
zogjer gamarTlebulia maTi gamoyeneba ramdenime Ra- hipokretinebi (anu oreqsinebi) warmoadgens hipo
mis ganmavlobaSi. amis mizezi is aris, rom saZileebis Talamur neiropeptidur transmiterebs, romlebic
moxsnam SesaZloa TavisTavad gamoiwvios insomnia, rac aregulireben Zil-RviZilis cikls. uaxlesi mona
aranakleb stresulia, vidre Zilis pirveladi aSli- cemebiT, isini narkolefsiasTan, gansakuTrebiT
loba. saZileebis xangrZlivi gamoyeneba SeiZleba aso- katapleqsiasTan, arian dakavSirebulebi. aseT pirebs
cirebuli iyos dRis ganmavlobaSi aqtivobis xarisxis hipokretin-1 da hipokretin-2-is koncentracia Tavis
gauaresebasTan. garda amisa, pirovnebas uviTardeba tvinsa da Tavzurgtvinis siTxeSi daqveiTebuli aqvT
tolerantoba sedativebis mimarT da maTze xdeba da hipoTalamusSi aReniSnebaT hipokretin-dadebiTi
damokidebuli. saZile saSualebebis gamoyenebis Ses- ujredebis mcire raodenoba.
_ 394 _
Zilis aSlilobebi
narkolefsiis gamokvleva mkurnaloba gulisxmobs obstruqciis mizezis Semsub-

uqebas da wonis daklebaze muSaobas. xSir SemTxvevaSi
narkolefsia, Cveulebriv, nevrologebis kompetenciis
efeqti aqvs dadebiTi wneviT uwyvet ventilacias saxis
sferos ganekuTvneba. diferencialuri diagnozis
niRbis gamoyenebiT. pacientebi, rogorc wesi, ar as-
dasmisas xdeba narkolefsiis gamijvna gadametebuli
ruleben eqimis rekomendacias. obstruqciuli Zilis
Zilianobis sxva mizezebisagan, rogorebicaa iSviaTi
apnoe insultis maRali riskis Semcveli faqtoria.
SetevebiT mimdinare epilefsia, Sizofrenia an qronikuli
daRlilobis sindromi. Tu aris eWvi am daavadebaze, klein-levinis sindromi
aucilebelia pacientis gagzavna fsiqiatrTan. diagnozis
es Zalian iSviaTi meoradi Zilis aSliloba warmoad-
dazustebis mTavari iaraRia sruli anamnezis Sekreba
gens somnolenciisa da gaZlierebuli madis epizo-
Zilze fokusirebiT. xSirad gamoiyeneba epuorTis
debis erTobliobas. es epizodebi ramdenime dRe an
(Epworth) Zilis skala. sakmaod informaciulia Zilis
ramdenime kvira grZeldeba da monacvleobs normal-
laboratoriuli gamokvleva. HLA statusi da hipokreti-
uri mdgomareobis xangrZliv periodebTan. madisa da
nis donis gansazRvra Tavzurgtvinis siTxeSi ar warmoad-
Zilis aSlilobebis kombinacia hipoTalamuri funqci-
gens rutinul procedurebs.
is darRvevasa da autoimunuri safuZvlis arsebobaze
narkolefsiis fsiqiatriuli mxareebi mianiSnebs, Tumca Cven ar gagvaCnia Sesabamisi sarwmu-
no mtkicebuleba. klinikuri gamocdileba gviCvenebs,
zogjer Zlieri emociebi katapleqsiis precipitatu-
rom liTiumis miReba amcirebs epizodebis simwvaves.
li faqtoria. narkolefsiis mqone pacientebs xSirad
aReniSnebaT meoradi xasiaTis emociuri da social- idiopaTiuri hipersomnia
uri sirTuleebi, romlebic ufro sagrZnobi xdeba
esaa iSviaTi mdgomareoba, romlis drosac pacientebi
imis gamo, rom adamianebi ar ekidebian gagebiT maT
Civian, rom ver axerxeben srulad gamoRviZebas ad-
mdgomareobas.
gomidan ramdenime saaTis ganmavlobaSi. am xnis man-
narkolefsiis mkurnaloba Zilze pacienti dabneuli da dezorientirebulia (`Zi-
lis simTvrale~); damaxasiaTebelia gaxangrZlivebuli
raTa gaumklavdnen qronikul daavadebas, romelic
da Rrma Ramis Zili. pacientebis TiTqmis naxevars aR-
Sromisunarianobis gamoxatul daqveiTebas iwvevs, pa-
eniSneba avtomaturi qceva dRis ganmavlobaSi, rom-
cientebs mniSvnelovani daxmreba sWirdebaT, kerZod,
lis etiologia bundovania. pacientebis umravlesoba
unda movexmaroT, rom Cveuli wesiT icxovron da dRis
kargad reagirebs stimulantebis dabal dozebze.
ganmavlobaSi Zilis xanmokle epizodebi dagegmon (Tv-
lema). Tu savaraudoa, rom stresulma movlenam an cirkaduli ritmis Zilis aSlilobebi
romelime sxva faqtorma (mag., daRlilobam) SeiZleba (Zil-RviZilis ciklis darRveva)
katapleqsiis provocireba gamoiwvios, unda vecadoT, arsebobs cirkaduli Zilis aSlilobebis ramden-
Tavidan aviciloT an, yovel SemTxvevaSi, maTi zemoq- ime forma, romelTagan yvelaze cnobilia jet-legi
medeba minimumamde daviyvanoT. (bioriTmis darRveva saaTobrivi sartylebis gadafre-
pacientebis umravlesobas sWirdeba stimulantebiT nis Sedegad). dilisa da Ramis cvlaSi monacvleobiT
mkurnaloba (mag., deqsamfetamini), romlebic amcire- muSaoba sakmaod xSiri da mzardi problemaa, romlis
ben Zilianobas da zomierad aiSviaTeben Zilis Sete- Sedegebsac ar eqceva saTanado yuradReba. samuSao
vebis sixSires. bolo drois preparatia modafilini, grafikis regularul cvlilebebs Tan axlavs daRli-
araamfetaminis jgufis stimulanti, romelic aseve loba da daZinebis droebiTi gaZneleba. aseve, Ramis
amcirebs Zilianobas dRis ganmavlobaSi da xasiaTdeba cvlisa da Tavisufali dReebis araregularuli mona-
naklebi gverdiTi movlenebiT. katapleqsiis Sesamci- cvleoba iwvevs qronikul cud Zils, daRlilobas, kon-
reblad, aseve, SegviZlia klomipraminisa da sxva anti- centraciis darRvevas, ubeduri SemTxvevebis sixSiris
depresantebis gamoyeneba. matebas da uaryofiTad moqmedebs ojaxur probleme-
bze. aseT SemTxvevebSi rekomendebulia modafilinis
sunTqvasTan dakavSirebuli Zilis aSliloba
daniSvna, magram TavisTavad sakamaToa, Tu ramdenad
am sindroms axasiaTebs dRis ganmavlobaSi Zilianoba,
marTebulia aseT mdgomareobaSi myofi pacientisTvis
periodul da ganmeorebad apnoes epizodebTan erTad;
medikamenturi mkurnalobis Catareba (Anonymous, 2004).
aseve, RamiT Zlieri xvrinva. xSirad asocirdeba zemo
sasunTqi gzebis obstruqciasTan. aqedanaa misi sax-
parasomniebi
elwodeba _ obstruqciuli Zilis apnoes sindromi.
parasomniebs axasiaTebs ZilTan asocirebuli anoma-
gavrcelebis sixSirea daaxloebiT 4% mamakacebis pop-
liuri qceva an specifikuri Zilis stadiebi, an Zil-
ulaciaSi. tipiuri pacienti saSualo asakis, Warbi wo-
RviZilis gardamaval periodebTan dakavSirebuli
nis mqone mamakacia, romelic ZilSi xmamaRla xvrinavs.
_ 395 _
fiziologiuri Zvrebi. mimoxilva ix. Mahowald et al., 2004. izianos, saWiroa misi usafrTxoebis dacva. fanjrebi
da karebi Caketili unda iyos da saxifaTo sagnebi
Ramis koSmarebi (Ramis SfoTviTi aSliloba)
_ mocilebuli. Tu zrdasrul adamians am tipis se-
koSmaruli sizmrebi aris REM-Zilidan gamoRviZe- riozuli problema aqvs, mas unda vurCioT, daicvas
ba, srul gamofxizlebamde, sizmris detaluri gax- usafrTxoebis wesebi, mouaros uZilobas da ar miiRos
senebiT. bavSvebSi koSmaruli sizmrebis sixSire piks Rrma Zilis gamomwvevi saSualebebi (mag., alkoholi
aRwevs 5-6 wlis asakSi. koSmaruli sizmrebi SeiZle- Zilis win).
ba stimulirebuli iyos dRis manZilze gadatanili
SiSiT. koSmaruli sizmrebi xSirad aRiniSneba SfoTvis sxva parasomniebi
periodSi. sxva mizezebia: posttravmuli stresuli
Tvalis swrafi moZraobis Zilis (REM-Zilis) qceviTi
aSliloba, cxeleba, fsiqotropuli wamlebis zemoq-
aSliloba warmoadgens parasomnias. mas axasiaTebs
medeba da alkoholuri detoqsikacia.
qceviTi problemebi, kerZod aJitacia an agresia, rac
Ramis SiSebi. Ramis SiSebi, koSmarul sizmrebTan
RamiT iCens Tavs. savaraudoa, rom is viTardeba REM
SedarebiT, iSviaTad gvxvdeba. isini rig SemTxvevebSi
Zilis normaluri atoniis gaqrobisas, rac iwvevs
ojaxuri genezisaa. es aSliloba, rogorc wesi, iwyeba
sizmrebis `qcevaSi gamotanas~. am tipis aSliloba
bavSvobis asakSi da imave asakSi mTavrdeba, magram,
ufro xSirad aqvT xanSiSesul adamianebs, upiratesad
rig SemTxvevebSi, SeiZleba zrdasrulobis asakSic
mamakacebs da igi nevrologiur darRvevebTan (gan-
gagrZeldes. CaZinebidan ramdenime saaTis Semdeg,
sakuTrebiT, parkinsonis daavadebasTan) aris asoci-
bavSvi, romelic REM Zilis III-IV fazaSi imyofeba,
rebuli. mis samkurnalod, SeiZleba, klonazepami da
SeSinebuli gamometyvelebiT sawolSi wamojdeba. man
donepezili efeqturi aRmoCndes.
SeiZleba wamoiyviros, magram, Cveulebriv, dabneuli
Zilis dambla aris nebelobiTi moZraobis Ses-
gamoiyureba. sunTqvis da guliscemis sixSire mkve-
rulebis uunaroba Zilsa da sifxizles Soris gar-
Trad momatebulia. ramdenime wuTis Semdeg bavSvi mS-
damaval periodSi; aseve, Zilis dasawyisSi (hipnogo-
viddeba da mSvid Zils ubrundeba. sizmris gaxseneba
giuri periodi) an Zilis bolos (hipnopompiuri peri-
uWirs. dadebiTi Sedegi aqvs erTsa da imave dros da-
odi). Zilis damblis epizodebs, rogorc wesi, Zlieri
wolas da Zilis higienis gaumjobesebas. efeqturia
SiSi axlavs Tan.
benzodiazepinebisa da imipraminis daniSvna, Tumca,
unda veridoT maT xangrZliv moxmarebas.
somnambulizmi (ZilSi siaruli) damatebiTi literatura

ZilSi siaruli es aris avtomatizmi, romelic Cndeba
Cooper M (2003) A psychology of bulimia nervosa: a cognitive
Rrma Zilis dros da ara-REM Zilis fazaSi. is dam-
perspective. Oxford University Press, Oxford (naSromSi aR-
axasiaTebelia 5-12 wlis asakisTvis; am asakis bavS-
werilia bulimiasTan dakavSirebuli ZiriTadi kog-
vebis 15%-Tan ZilSi siarulis erTi epizodi mainc
nituri fsiqologiuri sakiTxebi).
fiqsirdeba. zogjer aSliloba grZeldeba zrdasrul
asakSic. ZilSi siaruli SeiZleba ojaxur aSlilobas Fairburn C and Brownell K (2001) Eating disorders and obesi-
warmoadgendes. bavSvebis umravlesosoba ZilSi ar ty. a comprehensive handbook. Guilford Press, London (sax-
dadis am sityvis zusti mniSvnelobiT, aramed jdeba elmZRvaneloSi aRwerilia yvela kvebiTi aSliloba).
sawolSi da asrulebs ganmeorebiT moZraobebs. zogi- Kryger MH, Roth T, Dement WC (2000) Principles and practice
erTi Tvalgaxelili iwyebs meqanikur siaruls, magram of sleep medicine. Saunders, Philadelphia (ganxilulia meT-
gars uvlis nacnob sagnebs. bavSvi ar pasuxobs dasmul odologiuri sakiTxebi da Zilis medicinis ZiriTadi
kiTxvebs da Znelad iRviZebs. Cveulebriv, SesaZlebe- sferoebi, fsiqiatriuli aspeqtebis CaTvliT).
lia bavSvis sawolSi dabruneba. epizodebis umravle- Palmer B (2000) Helping people with eating disorders (gzam-
soba grZeldeba ramdenime wamidan erT wuTamde, Tum- kvlevis tipis naSromi, romelic exeba klinikuri
ca, iSviaTad SeiZleba 1 saaTic gagrZeldes. gamokvlevisa da mkurnalobis sakiTxebs.) John Wiley,
radgan ZilSi mosiarulem SeiZleba zogjer Tavi da- Chichester.
_ 396 _
Tavi 16 fsiqiatria da
zogadi medicina
Tavis Sinaarsi
Sesavali mzrunvelobis qveS myof adamianebSi
fsiqiatria, zogadi medicina da paTomimikriuli aSlilobis gamowveva
fsiqikisa da sxeulis dualizmi simulacia
zogadi samedicino diagnozi fsiqiatriuli samsaxurebi
fsiqiatriuli diagnozi rogor aris agebuli
zogadi medicina, fsiqiatria da dualizmi fsiqiatriuli samsaxuri
dualizmis praqtikuli Sedegebi fsiqiatriuli konsultacia
integrirebuli midgoma samedicino garemoSi
fsiqikuri aSlilobebis zogierTi gadaudebeli SemTxveva
epidemiologia samedicino garemoSi problemebi, romlebic ukavSirdeba
fsiqikuri aSlilobis gamovlinebebi mkurnalobaze Tanxmobis gacemas
samedicino garemoSi zogadi samedicino procedurebisa da
komorbidoba: fsiqikuri da mdgomareobebis fsiqiatriuli aspeqtebi
somaturi daavadebebis Tanxvedra genetikuri konsultacia
epidemiologia daavadebis skriningi
fsiqikuri aSlilobis prevencia qirurgiuli Carevis
somaturi daavadebis mqone pirebTan fsiqiatriuli aspeqtebi
fsiqiatriuli mkurnalobis efeqturoba plastikuri qirurgia
somaturi daavadebis mqone pirebTan kiduris amputacia
fsiqikuri aSlilobis marTva organoTa transplantacia
somaturi daavadebis mqone pirebTan diabeti
somaturi paTologiiT auxsneli sxva endokrinuli aSlilobebi
somaturi simptomebi sxva metaboluri da
terminologia autoimunuri darRvevebi
epidemiologia kardialuri darRvevebi
etiologia sensoruli aSlilobebi
samedicino TvalsazrisiT infeqciebi
auxsneli simptomebis klasifikacia aiv-infeqcia
samedicino TvalsazrisiT avTvisebiani simsivne
auxsneli simptomebis prevencia ubeduri SemTxvevebi
samedicino TvalsazrisiT auxsneli meanobisa da ginekologiis
simptomebis mkurnaloba fsiqiatriuli aspeqtebi
samedicino TvalsazrisiT auxsneli orsuloba
simptomebis marTva arasasurveli orsulobis Sewyveta
qronikuli daRlilobis sindromi spontanuri aborti
gaRizianebuli nawlavis sindromi antenataluri sikvdili
fibromialgia sakeisro kveTa
paTomimikriuli aSliloba mSobiarobis Semdgomi fsiqikuri aSlilobebi
miunhauzenis sindromi ginekologiis fsiqiatriuli aspeqtebi
_ 397 _
16 fsiqiatria da zogadi medicina
Sesavali adi samedicino diagnozis msgavsad, fisiqiatriuli

diagnozic miuTiTebs im mdgomareobaze, romelsac,
am TavSi saubaria fsiqiatriis kavSirze sxva saxis sa-
Cveulebriv, eqimebi _ fsiqiatrebi an sxva praqtikose-
medicino praqtikasTan. kerZod, ganxilulia Semdegi
bi, mkurnaloben. fsiqiatriuli diagnozi Setanilia
Temebi:
daavadebaTa klasifikaciaSi zogad samedicino di-
1. fsiqiatria, zogadi medicina da fsiqikurisa da
agnozTan erTad, magram zog fsiqiatriul diagnozs
fizikuris dualizmis cneba;
Tan axalavs Sesabamisi fizikuri paTologia, zogs ki
2. fsiqikuri aSlilobis epidemiologia samedicino _ ara. swored imitom, rom fsiqiatriul diagnozs,
garemoSi; Cveulebriv, Tan ar axlavs Sesabamisi paTologia,
3. komorbidoba: fsiqikuri da somaturi darRvevebis fsiqikuri daavadebis magivrad mas fsiqikur aSlilo-
erTdrouli mocemuloba; bas uwodeben.
4. samedicino TvalsazrisiT auxsneli simptomebi: so- warsulSi fsiqiatriul diagnozebs, maTi xasiaTidan
maturi simptomebi, romlebic ar aixsneba somaturi gamomdinare, `fsiqikuri~ bunebis mqoned ganixilavd-
darRvevebiT; nen, zogadi samedicino diagnozis `fizikuri~ bunebis
sapirispirod. es gansxvaveba miuTiTebs mniSvnelovani
5. momsaxureba da konsultacia _ kooperaciuli
paTologiis ararsebobaze fsiqiatriul aSlilobaTa
fsiqiatria;
umravlesobis SemTxvevaSi. aseve, im faqtsac asaxavs,
6. calkeuli somaturi darRvevebis fsiqiatriuli as- rom es paTologia, Cveulebriv, vlindeba darRveuli
peqtebi. fsiqikuri mdgomareobis an qcevis saxiT da ara fizi-
am Tavis gacnoba rekomendebulia sxva qveTavebTan kuri simptomebis saxiT (fizikuri simptomebiT gamov-
erTad. es gansakuTrebiT exeba im qveTavebs, romle- lenili mdgomareobebi am TavSi mogvianebiT iqneba
bic eZRvneba stresTan dakavSirebul aSlilobebs, ganxiluli).
adaptaciur aSlilobebsa da neirofsiqiatrias.
zogadi medicina, fsiqiatria da dualizmi
fsiqiatria, zogadi medicina da fizikuri da fsiqikuri avadmyofobis gamijvna emyare-
fsiqikisa da sxeulis dualizmi ba im mosazrebas, rom janmrTel adamianebSi SegviZlia
davuSvaT ori paraleluri mocemulobis _ sxeulisa
pacientebi, Cveulebriv, akiTxaven eqims imis gamo, rom
da fsiqikis, arseboba, rac dualizmis saxeliTaa
awuxebT TavianTi mZime mdgomareobisa da disfunq-
cnobili. iTvleba, rom es Tvalsazrisi filosofos
ciis gamomwvevi simptomebi, anu isini maSin mimarTaven
dekartes ekuTvnis. kartezianuli dualizmi kvlav
eqims, rodesac avad arian. samedicino gamokvleva miz-
mniSvnelovan gavlenas axdens dasavlur samedicino
nad isaxavs maTi avadmyofobis Sesaferisi diagnozis
azrovnebaze (Brown, 1989). fizikurisa da fsiqikuris
dasmas. Semdgom, diagnozi warmarTavs daavadebis mar-
erTmaneTisgan gamocalkeveba garkveulwilad sa-
Tvis gegmas. tradiciulad, pacients usvamen somatu-
sargebloa, Tumca, erTgvar problemebs qmnis.
ri an fsiqikuri daavadebis diagnozs.
dualizmis susti mxareebi
zogadi samedicino diagnozi
dualizmi realobis zedmetad gamartivebuli saxiT
somaturi daavadebis diagnozs upiratesad sva- warmogvidgens, radgan ar arsebobs arc janmrTeli
men simptomebis, fizikuri niSnebisa da biologiuri da arc avadmyofi adamianebis wminda fizikuri an
gamokvlevis Sedegebis safuZvelze. yvela es monacemi fsiqikuri mdgomareoba. mosazreba, romlis Tanax-
erToblivad miuTiTebs sxeulis paTologiis arsebo- mad fsiqologiuri simptomebis arseboba miuTiTebs
baze (sxeulis paTologiuri struqtura da/an funq- fsiqopaTologiaze, xolo fizikuri simptomebisa _
cionireba), rasac daavadebas uwodeben. Tumca, yvela fizikur paTologiaze, Sedegad gvaZlevs kategoriebs,
samedicino diagnozis dasma am saxiT ar xdeba (mag., romlebic warmodgenilia cxrilSi 16.1. masSi mocemu-
Sakiki). saboloo jamSi, zogadi samedicino diagnozi lia ori kategoria _ daavadeba da aSliloba; danar-
warmoadgens im mdgomareobis saxelwodebas, romelsac Ceni ori kategoria _ komorbidoba da somatizacia _
eqimebi mkurnaloben da romelic daavadebaTa kla- qvemoT iqneba ganxiluli.
sifikaciaSia Setanili (mag., ICD-10 klasifikaciaSi). komorbidoba aRniSnavs ori aSlilobis/darRvevis
erTdroul mocemulobas. is Setanilia cxrilSi aS
fsiqiatriuli diagnozi karad gamoxatuli fizikuri paTologiisa da fsiqikuri
fsiqiatriul diagnozze am wignSi ukve iyo saubari. aq simptomebis erTdrouli mocemulobis aRsaniSnad,
mokled SegaxsenebT im ZiriTad punqtebs, romlebic radgan aseT dros pacientebs, Cveulebriv, usvamen
ganvix. fsiqiatriul diagnozTan dakavSirebiT. zog- rogorc somaturi daavadebis, ise fsiqikuri daavadebis
_ 398 _
fsiqiatria, zogadi medicina da fsiqikisa da sxeulis dualizmi
integrirebuli midgoma
cxrili 16.1 somaturi da fsiqikuri daavade-
bis tradiciuli `dualisturi~ kategoriebi fsiqikuri aSlilobis nevrologiuri safuZvlebis
fsiqologiuri fizikuri Sesaxeb mecnierebis uaxlesma miRwevebma aCvena,
simptomebi simptomebi rom dualisturi midgoma aradamajerebelia. amaze
sxeulebrivi komorbiduloba samedicino miuTiTebs miokardiumis infarqtze fsiqikuri aS
paTologia daavadeba lilobis zemoqedebis faqtebi (Frasure _ Smith et al.,
fsiqopaTologia fsiqikuri somatizacia 1993). sul ufro metad mkvidrdeba Tvalsazrisi,
aSliloba
romlis Tanaxmadac fsiqikuri da fizikuri erTi
diagnozs (Kisely and Goldberg, 1996). praqtikaSi, am mocemulobis ori ganuyofeli mxarea (Granville _
diagnozTagan verc erTma SeiZleba ver migviyvanos Grossman, 1993). aseTi cvlileba mecnierul paradigmaSi
efeqtur mkurnalobamde, radgan fsiqiatriul an gulisxmobs imas, rom fsiqikuri aSliloba fizikuri
zogad samedicino diagnozze yuradRebis gamaxvilebam daavadebisgan imaze metad araa daSorebuli, vidre
SesaZloa gamoiwvios meore diagnozis ugulebelyofa. umaRlesi nervuli sistema _ sxeulis danarCeni
amis magaliTia depresiis ugulebelyofa somaturi sistemebisgan (Sharpe and Carson, 2001). aizenbergis
daavadebis mqone pacientebTan, rac gavrcelebul sityvebiT rom vTqvaT (Eisenberg, 1986a), fsiqiatria
movlenas warmoadgens (Sharpe et al., 2004). naklebad unda iyos `daclili tvinisgan~, xolo
somatizacia. zogierT pacients aReniSneba soma zogadi medicina _ `fsiqikisagan~. Sesabamisad, pa
turi simptomebi fizikuri paTologiis gareSe cientis zogadi samedicino da fsiqiatriuli movla
(DeGucht and Fischler, 2002). aseT SemTxvevaSi sadavoa erTmaneTTan ufro metad unda iyos integrirebuli
is, Tu rogor unda moxdes maTi avadmyofobis ka (Mayou et al., 2004).
tegorizacia _ rogorc somaturis (nagulisxmevi, Tumca, dResdReobiT, azrovnebasa da praqtikas
magram araidentificirebuli somaturi paTologiiT), mainc dualizmi warmarTavs. daavadebebs usvamen
Tu rogorc fsiqiatriulis (nagulisxmevi fsiqo zogad samedicino an fsiqiatriul diagnozs, es
paTologiiT). warsulSi, aseTi viTarebis dros diagnozebi ki codnisa da mzrunvelobis gansxvavebul
svamdnen funqcionaluri avadmyofobis diagnozs sistemebs efuZneba. samedicino garemoSi momuSave
(funqcionireba anomaliuria, magram paTologia fsiqiatrebi unda acnobierebdnen am problemebs
ar aRiniSneba). dRes aseT SemTxvevaSi, Cveulebriv, da xels unda uwyobdnen maT gadaWras. magaliTad,
svamen fsiqiatriul diagnozs anu somatoformuli pacientTan muSaobisas isini yuradRebas unda
aSlilobis diagnozs, rac imas gulisxmobs, rom: amaxvilebdnen ara mxolod biologiur, aramed
(1) somaturi simptomebi fsiqopaTologiiTaa gamo fisqologiur da socialur aspeqtebzec. es swored is
wveuli; (2) saxezea hipoTeturi procesi _ soma biofsiqosocialuri midgomaa, romelsac didi xnis win
tizacia, romlis meSveobiTac fsiqopaTologia engeli gvTavazobda (Engel, 1977). biofsiqosocialuri
iwvevs sxeulebriv simptomebs. Sesabamisad, aseT midgomis dros gaTvaliswinebuli faqtorebi mo
pacientebs SeiZleba dausvan rogorc zogadi sa cemulia cxrilSi 16.2. isini SeiZleba daiyos pre
medicino diagnozi (funqcionaluri darRveva), ise dispoziciur, precipitatul da SemanarCunebel faq
fsiqiatriulic (somatoformuli aSliloba). is, Tu torebad. faqtorebis ukanaskneli jgufi mkurnalobis
ra winaaRmdegobasa da gaurkvevlobas iwvevs yovelive samiznes warmoadgens, xolo wina or jgufze prevencia
zemoT Tqmuli, ilustrirebulia literaturaSi qro unda iyos mimarTuli.
nikuli daRlilobis sindromisa da mialgiuri en
cefalomielitis Sesaxeb (Sharpe, 2002). cxrili 16.2 bio-fsiqo-socialuri
formulireba
dualizmis praqtikuli Sedegebi biologiuri faqtorebi
dualizmis erT-erTi praqtikuli Sedegia zogadi daavadeba
medicinisa da fsiqiatriis sferoebis gamijvna pro fiziologia

fesiuli da organizaciuli TvalsazrisiT, rac fsiqologiuri faqtorebi
arTulebs komorbidobisa da somatoformuli aS kognicia
lilobis mqone pacientebze mzrunvelobis gawe guneb-ganwyoba
vas. organizaciul doneze am problemis gadaW qceva
ris mcdelobis magaliTia zogadi profilis saa socialuri faqtorebi
vadmyofoebSi fsiqiatriuli samsaxurebis Seqmna (ix. interpersonaluri
qvemoT). socialuri da okupaciuri
jandacvis sistemasTan dakavSirebuli
_ 399 _
cxrili 16.3 fsiqikur aSlilobaTa sixSire sxvadasva arafsiqiatriul dawesebulebaSi

zogadi samedicino saswrafo Terapiuli da Terapiuli da
profilis daxmarebis qirurguli qirurguli
dawesebuleba ganyofileba poliklinika saavadmyofo
depresia/SfoTva ++ ++ +++ +++

deliriumi _ + _ +++
alkoholis borotad moxmareba ++ +++ ++ +++
fsiqozi + + _ _
somatoformuli aSliloba +++ + +++ ++
fsiqikuri aSlilobebis ganuyofel nawils, radgan, rogorc cnobilia, es

epidemiologia samedicino garemoSi mniSvnelovnad gansazRvravs Sedegebis gaumjobesebas.
depresia janmrTelobis mdgomareobis gauaresebis
miuxedavad imisa, rom fsiqikuri aSlilobebi
gavrcelebuli mizezia.
yvela samedicino garemocvaSi gvxvdeba, isini mainc
specifikuria TiToeuli maTganis SemTxvevaSi. yvelaze Terapiuli da qirurgiuli saavadmyofo
gavrcelebuli diagnozebi mocemulia cxrilSi 16.3. Terapiul da qirurgiul ganyofilebaSi myofi sta
zogadi samedicino profilis dawesebuleba cionaruli pacientebis 20%-s aReniSneba depresiuli
an SfoTviTi aSliloba somatur daavadebasTan
zogadi samedicino profilis dawesebulebaSi yve
erTad. 10%-s _ alkoholis borotad moxmarebasTan
laze gavrcelebuli fsiqikuri aSlilobebia soma
dakavSirebuli seriozuli problemebi, xolo
toformuli aSlilobebi, depresia, SfoTva, stresTan
xandazmuli pacientebis erT meoTxeds _ deliriumis
dakavSirebuli aSlilobebi da wamalmoxmareba. fsi
epizodebi (Mayou et al., 1991). diagnozis dasmamde,
qozis mqone pacientebi aq naklebad gvxvdeba (Ansseau
mwvave somatoformuli aSlilobis mqone zog pacients
et al., 2004).
utardeba ramdenime saxis gamokvleva da zogjer
saswrafo daxmarebis ganyofileba qirurgiuli operaciac ki.
aq umTavresi fsiqiatriuli problema ganzrax TviT
fsiqikuri aSlilobis gamovlinebebi
dazianebaa. miuxedavad imisa, rom pacientebis mci
re raodenobas aReniSneba persistentuli fsi samedicino garemoSi
qikuri aSlilobebi, bevr maTgans aqvs stresTan miuxedavad imisa, rom samedicino garemoSi fsiqikuri
dakavSirebuli aSlilobebi, xolo zogierTs _ aSliloba Cveulebriv vlindeba fsiqologiuri
depresiuli aSliloba. agreTve, gavrcelebulia simptomebisa da qceviTi darRvevebis saxiT, xSirad
alkoholiTa da narkotikebiT gamowveuli into gvxvdeba sxva, naklebad TvalsaCino gamovlinebebic.
qsikacia da deliriumi. es gansakuTrebiT xSiria esaa: (a) somaturi simptomebi; (b) janmrTelobis
qalaqis centralur saavadmyofoebSi; umetesad marTvis problemebi; (g) janmrTelobis mdgomareobis
emarTebaT im adamianebs, romlebic katastrofaSi aSkara gauareseba.
moxvdnen. saswrafo daxmarebis ganyofilebaSi xSi
somaturi simptomebiT gamovlenili fsiqikuri
rad gvxvdeba somatoformuli aSlilobis mqone
aSliloba
pacientebis garkveuli raodenoba da paTomimikriuli
poliklinikebisa da zogadi profilis eqimebis pa
aSlilobis mqone ramdenime pacienti (E.R. Williams et
cientTa mniSvnelovan umciresobas aReniSneba
al., 2001).
somaturi simptomebi, romlebic ver aixsneba somaturi
Terapiuli da qirurgiuli poliklinika daavadebiT. maTgan mravals aReniSneba fsiqikuri
im adamianTa erT mesameds, romelic samedicino aSliloba (Gureje et al., 1997a).
da qirurgiul poliklinikebs akiTxavs, aReniSneba depresiuli da SfoTviTi aSlilobiT gamowveuli
fsiqikuri aSliloba (Carson et al., 2000; Maiden et al., somaturi simptomebi. depresia dakavSirebulia iseT
2003). amaTgan naxevars aReniSneba depresiuli da somatur simptomebTan, rogorebicaa daRliloba,
SfoTviTi aSliloba, xolo danarCeni pacientebis wonaSi kleba da tkivili. am simptomebis gamo SeiZleb,
umetesobas _ somatoformuli aSliloba. am orive a saWiro gaxdes pacientis gadamisamarTeba iseT
jgufSi fsiqikuri aSlilobis saTanado identifikacia specialistTan, romelic fizikuri janmrTelobis
da mkurnaloba unda warmoadgendes daavadebis marTvis problemebze muSaobs. SfoTva dakavSirebulia ve
_ 400 _
komorbidoba: fsiqikuri da somaturi daavadebebis Tanxvedra
getaturi nervuli sistemis agznebasTan (pulsis
gaxSireba, sunTqvis ukmarisoba da sensoruli sim
cxrili 16.4 fsiqikuri aSlilobebi, romlebic
ptomebi). jandacvis saerTaSoriso organizaciis xSirad gvxvdeba somaturi daavadebis mqone pirebSi
kolaboraciul gamokvlevaSi Seiswavles 14 qveynis adaptaciuri aSliloba
pacientebi, romlebic pirveladi jandacvis orga
didi depresia
nizaciebs akiTxavdnen. gamokvlevam dadgina aSkarad
SfoTviTi aSliloba
gamoxatuli kavSiris arseboba, erTis mxriv, somatur
simptomebsa, xolo, meores mxriv, depresiul da generalizebuli SfoTviTi aSliloba
SfoTviT aSlilobas Soris. es kavSiri gamovlinda panikuri aSliloba
yvela samedicino centris pacientebTan, miuxedavad
fobikuri aSliloba
kulturuli gansxvavebisa da samedicino momsaxurebis
xarisxis sxvaobisa. yvela SemTxvevaSi dadasturda mwvave stresuli aSliloba
wrfivi damokidebuleba somatur simptomebsa da posttravmuli stresuli aSliloba
depresiul da SfoTviT aSlilobas Soris (Simon et
somatoformuli aSliloba
al., 1999). SfoTviT aSlilobebSi, samedicino Tval
sazrisiT, panikuri aSliloba auxsneli simptomebis fsiqotropuli niviTierebebis arasworad moxmareba
(tkvili mkerdis areSi, Tavbrusxveva, xmauri yurebSi) kvebiTi aSliloba

yvelaze mniSvnelovani mizezia (Katon, 1996). Zilis darRveva
somatoformuli aSlilobebi. rodesac depresiuli
simulaciuri avadmyofoba
an SfoTviTi aSlilobis ar arsebobis dros, Tavs iCens
pacientis fizikuri janmrTelobis mdgomareobiT seqsualuri aSliloba
auxsneli somaturi simptomebi, yvelaze xSirad svamen
somatoformuli aSlilobis diagnozs (ix. zemoT). muSaveblad garkveuli modifikaciebi iqna Semo
tanili, arc erTi maTgani ar aRmoCnda savsebiT
fsiqikuri aSliloba, romelic vlindeba fiziku damakmayofilebeli. aqedan gamomdinare, umjobesia
ri janmrTelobis mdgomareobis gauaresebis saxiT Tavidan gamoviyenoTY standartuli kriteriumebi,
Civilebis mateba janmrTelobis qronikul mdgo xolo Semdeg gaviTvaliswinoT somatur daavadebaze
mareobasTan dakavSirebuli simptomebis an unar arsebuli informacia da am gziT gadavwyvitoT,
SezRudulobis Taobaze, zogjer gamowveulia komor fsiqikuri aSlilobis romeli simptomebi SeiZleba
biduli depresiuli aSlilobiT. momdinareobdes somaturi mdgomareobidan. Tumca,
mkurnalobaze uaris Tqma zogjer fsiqikuri aSli aseTi midgoma SeiZleba ganaxorcielos gawafulma
lobis pirveli indikatoria. interviuerma da, amdenad, misi farTo masStabiT
gamoyeneba advili ar aris.
komorbidoba: fsiqikuri da somaturi ufro advilia suicidis identificireba. somaturi
daavadebebis Tanxvedra daavadebis mqone pacientebTan, zogad populaciasTan
SedarebiT, gazrdilia suicidis albaToba. dadginda
fsiqikuri aSlilobis komorbidoba somatur daava
suicidis kavSiri iseT daavadebebTan, rogoricaa
debebTan mniSvnelovani problemaa. magaliTad, kve
avTvisebiani simsivne, gafantuli sklerozi da a.S.
biTma aSlilobam SeiZleba Zalian gaarTulos diabetis
(Harris and Barraclough, 1995).
mkurnaloba; xolo, depresia miokardiumis infarqtis
cxrilSi 16.4 warmodgenilia is fsiqikuri da
Semdgomi sikvdilianobisa da avadobis risk-faqtoria.
somaturi daavadebebi, romlebic xSirad erTdroulad
gvxvdeba. fsiqikuri aSlilobis epidemiologia soma
epidemiologia
tur daavadebebTan kavSirSi ganxilulia Semdeg
fsiqikuri aSliloba aReniSneba seriozuli mwvave, wyaroSi: Mayou and Sharpe, 1995.
ganmeorebadi da progresirebadi somaturi daavadebis
mqone pacientTa erT mesameds. am pacientTa zus fsiqikuri aSlilobis komorbidobis mniSvneloba
ti proporciis dadgena Zalin rTulia, radgan somaturi daavadebis mqone adamianebis SemTxvevaSi
fsiqikuri aSlilobis diagnostirebis standartuli fsiqikuri aSlilobis komorbidobas SeuZlia mni
kriteriumebi moicavs zogierT iseT simptoms, romelic Svnelovnad imoqmedos somaturi daavadebis efeqtsa
SeiZleba somaturi daavadebiTac iyos gamowveuli da Sedegebze, magaliTad, gulis iSemiuri daavadebis
(magaliTad, daRliloba an cudi Zili). miuxedavad (Lesperance et al., 1996) da diabetis (Ludman et al., 2004)
imisa, rom somaturi darRvevebisa da fsiqikuri mqone pacientebSi. SfoTva da depresia somaturi
aSlilobebisTvis specifikuri kriteriumebis Sesa daavadebis mkurnalobisadmi pacientis daumorCile-
_ 401 _
blobis risk-faqtors warmoadgens (ix. zemoT; DiMat-
teo et al., 2000).
cxrili 16.6 fsiqologiuri gverdiTi
efeqtebis mqone zogierTi medikamenti
fsiqikuri aSlilobis komorbidobis mizezebi medikamenti gverdiTi efeqti
somaturi daavadebis mqone adamianebis SemTxvevaSi
antiparkinsonuli preparatebi
somaturi daavadebis mqone pacientebTan fsiqikuri
aSliloba ZiriTadad sami mizezis gamo gvxvdeba: antiqolinergiuli dezorientacia,
preparatebi (benzeqsoli, aJitacia, cnobierebis
1. SemTxveviT, ramdenadac orive gavrcelebulia; benztropini, Secvla, mxedvelobiTi
prociklidini) halucinaciebi
2. fsiqikurma aSlilobam SeiZleba gamoiwvios soma-
turi daavadeba. magaliTad, alkoholuri damokide- L-Dopa mwvave organuli sindromi,
depresiuli fsiqozuri
buleba iwvevs RviZlis cirozs.
sindromi
3. somaturma daavadebam SeiZleba gamoiwvios fsiqi-
hipertenziis sawinaaRmdego preparatebi
kuri aSliloba daavadebis an misi mkurnalobis Ta-
vis tvinze zemoqmedebis Sedegad; fsiqikuri aSli- meTildopa daRliloba, sisuste,
depresia
loba SeiZleba iyos reaqcia somaturi mdgomareobis
an misi mkurnalobisa fsiqologiur efeqtze; fsiqi- kalciumis arxis
kuri aSliloba SeiZleba warmoadgendes somaturi blokatorebi
daavadebis an misi mkurnalobis socialuri efeqtis klonidini

Sedegs (magaliTad, samuSaos dakargva). yvela es
simpaTikuri blokatorebi impotencia, msubuqi
faqtori urTierTqmedebs pirovnebis premorbidul depresia
mowyvladobasTan.
digitalisi dezorientacia,
somaturi daavadeba da misi mkurnaloba cnobierebisa da guneb-
ganwyobis darRvevebi
biologiuri meqnizmebi
diuretikebi sisuste, apaTia da
deliriumis da demenciis garda, mravali fsiqikuri depresia (gamowveuli
aSliloba SeiZleba gamowveuli iyos Tavis tvinze eleqtrolitebis
raodenobis SemcirebiT)
somaturi daavadebis zemoqmedebiT. amgvari zemoq-
medeba SeiZleba hqondes mwvave infeqcis, endokrinul analgetikebi
darRvevebsa da avTvisebian simsivnur warmonaqmnebs. salicilamidi cnobierebis paTologia,
DSM-Si aseT fsiqikur mdgomareobebs organul fsiq- aJitacia, amnezia
ikur aSlilobas uwodeben. cxrilSi 16.5 mocemulia
fenacetini demencia qronikuli Warbi
moxmarebisas
cxrili 16.5 samedicino problemebi, romle- antituberkulozuri
bic uSualod iwveven fsiqikur aSlilobebs Terapia
depresia izoniazidi mwvave organuli sindromi

da mania
karcinoma
cikloserini cnobierebis paTologia,
infeqciebi Sizofreniismagvari
sindromi
nevrologiuri darRvevebi (Tavi 14)
steroidebi
diabetis, farisebri jirkvlis funqciis darRvevebi,
adisonis daavadeba ZiriTadi somaturi daavadebebi, romlebic SeiZleba
sistemuri daavadeba wiTeli mglura am saxiT moqmedebdnen.
somaturi daavadebis mkurnalobam, Tavis tvinze zemo-
SfoTva
qmedebis gamo, agreTve, SeiZleba gamoiwvios fsiqikuri
hiperTiroidizmi aSliloba. cxrilSi 16.6 warmodgenilia medikamentebi,
hiperventilacia romlebsac xSirad iyeneben da romelTac SeuZliaT
gamoiwvion fsiqikuri aSliloba, rogorc gverdiTi mov-
feoqromocitoma
lena. mkurnalobis saxeebi, romlebic kavSirSia fsiqi-
hipoglikemia
kur aSlilobasTan, esaa: radioTerapia, qimioTerapia
narkotikebis moxmarebis aRkveTa avTvisebiani simsivnis dros da operaciebi, romelTa
zogierTi nevrologiuri darRveva (Tavi 14) drosac sxeulis dasaxiCreba xdeba (mag., masteqtomia).
_ 402 _
komorbidoba: fsiqikuri da somaturi daavadebebis Tanxvedra
fsiqologiuri da socialuri meqanizmebi monawileoben iseTi pacientebi, romlebsac komor

bidoba aReniSnebaT. arsebobs mxolod ramdenime
yvelaze xSirad somaturi daavadebebi fsiqikur aSli-
gamokvleva, romelic Seiswavlis somaturi daavadebis
lobas iwvevs fsiqologiuri zemoqmedebis gamo. zo-
mqone pacientebis antidepresantebiT mkurnalobas
gierTi somaturi daavadeba ufro advilad axdens se-
(Gill and Hatcher, 1999). klinikuri gamocdileba imasac
riozuli fsiqikuri Sedegebis provocirebas. aseTia
gviCvenebs, rom kognitur-bihevioruli Terapia efeq
sicocxlisTvis saSiSi daavadebebi da ganmeorebiT aR-
turia somaturi daavadebis dros, magram esec ar
mocenebadi, progresirebadi mdgomareobebi. fsiqikuri
aris mtkiced dadasturebuli sakmarisi raodenobis
aSliloba ufro xSiria iseTi qronikuli somaturi daa-
klinikuri gamokvlevebiT. ufro meti mtkicebuleba
vadebis dros, rodesac aRiniSneba mtkivneuli an usia-
metyvelebs `TanamSromlobiTi zrunvis~ sasargeblod,
movno simptomebi (Zlieri tkivili, uwyveti pirRebineba
rac gulisxmobs somaturi daavadebisa da fsiqikuri
an Zlierad gamoxatuli sunTqvis ukmarisoba). kidev
aSlilobis koordinirebul mkurnalobas, gansak
erTi mizezia mZime invalidoba (Mayou and Sharpe, 1995).
uTrebiT qronikuli daavadebebis marTvisas (mag.,
somaturi daavadebis mqone pacientebi, romlebic imy-
Saqriani diabeti). (Katon et al., 2004).
ofebian mwvave da persistentuli fsiqikuri aSlilobis
ganviTarebis riskis qveS, Semdeg kategoriebad iyofa:
fsiqikuri aSlilobis marTva somaturi
w pacientebi, romlebsac warsulSi hqondaT fsiqolo-
daavadebis mqone pirebTan
giuri problemebi stresis gancdis dros;
gamokvleva
w pacientebi, romlebmac axlaxan gadaitanes mZime
cxovrebiseuli movlenebi; am SemTxvevaSic gamokvleva iseTive saxiT tardeba,
rogorc sxva fsiqikuri aSlilobebis dros, im
w pacientebi, romlebic mZime socialur pirobebSi
gansxvavebiT, rom aq damatebiT gasaTvaliswinebelia
imyofebian.
Semdegi:
ojaxis, megobrebis, damsaqmeblebisa da eqimebis
w eqimi kargad unda iyos informirebuli pacientis
reaqciam SeiZleba zegavlena iqonios somaturi daavadebis
somaturi daavadebisa da misi mkurnalobis Sesaxeb;
fsiqologiur efeqtze. maT SeuZliaT somaturi
daavadebis Sedegebis Sesusteba pcientis mxardaWeris, w unda moxdes SfoTvisa da depresiis gamijvna
misi damSvidebis da sxva saxis daxmarebis gziT. amasTan, im normaluri emociuri reaqciisgan, romelsac
zedmeti sifrTxile, urTierTgamomricxavi rCevebis adamiani avadmyofobasa da mkurnalobaze iZleva.
micema da TanagrZnobis nakleboba aZlierebs somaturi amaSi gvexmareba is simptomebi, romlebic iSviaTad
daavadebis uaryofiT Sedegebs. iCens Tavs normaluri distresis dros (uimedoba,
danaSaulis gancda, interesis dakargva da Zlieri
fsiqikuri aSlilobis prevencia somaturi insomnia);
daavadebis mqone pirebTan w kargad unda gavacnobieroT, rom somaturi da
arsebobs prevenciis sami strategia: (1) riskis qveS avadeba da misi mkurnaloba SeiZleba iwvevdes iseT
myofi pirebis identifikacia; (2) daavadebis uaryofiTi simptomebs, rogoricaa daRliloba da umadoba,
efeqtebis minimizacia xarisxiani samedicino daxmarebisa romlebic mniSvnelovania fsiqikuri aSlilobis di
da mzrunvelobis meSveobiT; (3) nebismieri fsiqikuri agnostirebis dros;
aSlilobis adreul stadiaze dadgena da efeqturi w kargad unda gvesmodes, Tu rogor aRiqvams pacienti
mkurnaloba. prevenciuli zomebi, mimarTuli unda iyos sakuTar avadmyofobas da mis mkurnalobas.
im adamianebze, romlebic daavadebulni arian an itareben
zogadi principebi
mkurnalobas da romelTa daavadeba fsiqikuri aSlilobis
ganviTarebis saSiSroebas Seicavs. aseve, fsiqologiurad pacients naTlad unda avuxsnaT, Tu rogoria mi
mowyvlad pacientebze, romelTa gamovlena, magaliTad, si somaturi daavadebis buneba da mkurnalobis
fsiqikuri aSlilobis istoriiT xdeba. procedura. mas saSualeba unda, mivceT gamoxatos
Tavisi wuxili da SiSi. somatur daavadebasTan da
fsiqiatriuli mkurnalobis efeqturoba kavSirebuli fsiqikuri aSlilobis mkurnaloba ise
somaturi daavadebis mqone pirebTan ve unda warimarTos, rogorc es xdeba janmrTeli
pacientebis SemTxvevaSi. gansakuTrebuli yuradReba
klinikuri gamocdileba gviCvenebs, rom fsiqiatriuli
unda mivaqcioT fsiqiatriuli mkurnalobis SesaZlo
mkurnaloba zogadad efeqturia somaturi daava
urTierTqmedebas somatur daavadebasa da mis mkur
debis mqone pirebTan. Tumca, randomizebuli kon
nalobasTan. mkurnalobas, Cveulebriv, atarebs
trolirebadi gamokvlevebi mcire informacias iZ
zogadi profilis eqimi an Terapevti, magram rTul
leva, radgan aseT gamokvlevebSi, Cveulebriv, ar
SemTxvevebSi saWiroa fsiqiatris Carevac.
_ 403 _
medikamentebi erTi ar aris bolomde damakmayofilebeli. es ter-

minebia: isteria, ipoqondria, somatizacia, somato-
hipnozuri da anqsiolizuri saSualebebis gamoyeneba
formuli simptomebi, funqcionaluri somatofor-
iZleva xanmokle, magram mniSvnelovan Svebas mZime
muli simptomebi da arsebul daavadebasTan axali
distresis dros. antidepresantebis daniSvna ise
daavadebis funqcionaluri dakavSireba.
ve xdeba, rogorc somaturi daavadebis armqone
pirebTan. wamlis gamoweramde unda gaviTvaliswinoT w somatizacia. mocemuli termini meoce saukunis da-
fsiqotropuli preparatebis gverdiTi movlenebi da sawyisSi Semoitana germanelma fsiqoanalitikosma
maTi SesaZlo urTierTqmedeba sxva preparatebTan. Stekelma (Stekel) sxeulebrivi simptomebis saxiT
gamoxatuli emociuri distresis aRsawerad. mogvi-
fsiqologiuri mkurnaloba anebiT am termins iyenebdnen rogorc aSlilobis,
yoveli pacientis mkurnalobis ganuyofeli nawilia ise misi gamomwvevi procesis aRsaniSnad. am termi-
axsna-ganmartebisa da rCevis micema. kognitur- nis dRevandeli mniSvneloba ufro farToa. is gu-
bihevioruli Terapia gamoiyeneba distresis, aseve, lisxmobs sxeulebrivi SegrZnebebis somatur simp-
iseTi xarisxis uunarobis Sesamcireblad, romelic tomebad aRqmas da amis gamo samedicino daxmarebis
araproporciulia daavadebis simZimis mimarT da, Ziebas; qcevas. mocemuli terminis mniSvnelobaTa
aseve, cxovrebis stilTan dakavSirebuli risk- umetesobaSi gancxadebuli an nagulisxmevia Steke-
faqtorebis Sesasusteblad. agreTve, gvexmareba imaSi, lis sawyisi idea, romlis Tanaxmad, fizikuri simp-
rom pacienti mkurnalobaze daviyolioT. tomebi warmoadgens fsiqopaTologiis gamoxat-
ulebas, magaliTad, `tendenciisa, ganicado da sx-
somaturi paTologiiT auxsneli vas Seatyobino fsiqologiuri distresi somaturi
simptomebis formiT da eZio maTTan dakavSirebiT
somaturi simptomebi
samedicino daxmareba~ (Lipowski, 1988). zogierTi
iseTi somaturi simptomebi, romlebic mkafiod
definicia uaryofs Stekelis Sexedulebas da Se-
ar ukavSirdeba romelime fizikur paTologias,
moaqvs iseTi kriteriumebi, romlebic moiTxovs,
gavrcelebulia rogorc zogad populaciaSi, ise
rom fizikur simptomebs Tan axldes SfoTviTi an
samedicino dawesebulebebis pacientebSi (Mayou and
guneb-ganwyobis aSliloba, rac standartuli kri-
Farmer, 2002). miuxedavad imisa, rom am simptomebis
teriumebis Sesabamisad iqneba diagnostirebuli
umetesoba droebiTi xasiaTisaa, maTi mcire nawili
Tanamedrove kvlevebiT emociuri distresi da so-
did xans narCundeba da pacientis dauZlurebas
maturi simptomebi pozitiurad da ara sapirispi-
iwvevs, rac xSiri samedicino konsultaciebis mizezi
rod arian erTmaneTTan dakavSirebuli, rogorc im
xdeba. zogierTi aseTi mdgomareoba, romelic aRZravs
SemTxvevaSi iqneboda, isini rom ZiriTadi fsiqopa-
somatur simptomebs, Setanilia cxrilSi 16.7.
Talogiis alternatiul klinikur gamoxatulebas
cxrilSi 16.7. CamoTvlilia sxeulebrivi SegrZnebebis
warmoadgendnen. erTiani dadgenili gansazRvrebis
is wyaroebi, romlebic SeiZleba interpretirebul
ararsebobisa da dausabuTebeli etiologiuri daS-
iqnas, rogorc daavadebis simptomi.
vebebis gamo, termini `somatizacia~ ar aris damak-
rogorc ukve aRiniSna, yvelaze xSirad es simptomebi
mayofilebeli.
gvxvdeba SfoTviTi da depresiuli aSlilobis dros,
w somatoformuli aSliloba. es termini Tavidan
xolo zog viTarebaSi pacientis mdgomareoba ufro
gamoiyenes DSM-III klasifikaciaSi aSlilobaTa ise-
somatoformuli aSlilobis kriteriumebs Seesabameba
Ti jgufis aRsawerad, romelSic Sedioda tradici-
(gv. ??). am tipis pacientebidan ramdenimes aReniSneba
uli fsiqiatriuli kategoriebi (isteria da ipoqon-
paTomimikriuli aSliloba da Zalian mcire nawils _
dria) da axali kategoriebi, somatizaciis aSlilo-
simulacia. Tumca, mravali adamiani, romelic akiTx-
bis CaTvliT. somatizaciis aSliloba ganxilulia
avs eqims auxsneli somaturi simptomebis gamo, arc
?? gverdze.
erTi am aSlilobis diagnostikur kriteriumebs ar
akmayofilebs. aradiagnostirebul SemTxvevebSic ki, w funqcionaluri somaturi simptomebi esaa termini,
fsiqologiuri da socialuri faqtorebi xSirad simp- romelsac mxolod zogadi profilis eqimebi iyene-
tomebis mniSvnelovan mizezs warmoadgens, iseve, ro- ben. is miuTiTebs sxeulis funqciis darRvevaze
gorc daxmarebis Ziebis motivs. amis gamo sasargebloa struqturuli paTologiis gareSe. es termini Se-
fsiqologiuri meTodebis gamoyeneba. darebiT misaRebia pacientebisTvis, magram sityva
`funqcionaluris~ gamoyeneba (organulis sapirisp-
terminologia irod) ar miiCneva misaRebad.
samedicino TvalsazrisiT auxsneli simptomebis aR- w samedicino TvalsazrisiT auxsneli simptomebi. am
sawerad mraval termins iyeneben, magram maTgan arc terminis upiratesoba SemdegSi mdgomareobs: igi
_ 404 _
somaturi paTologiiT auxsneli somaturi simptomebi
mxolod da mxolod aRwers klinikur problemebs pirovnebis reaqcias sakuTar SegrZnebebsa da
da aranair miniSnebas ar akeTebs maT safuZvlad- simptomebze. aseT Sexedulebebs SeiZleba gana
mdebare mizezebze. mocemuli termini gaakritikes, pirobebdes cxovrebis adreul etapze gadatanili
radgan is gulisxmobs, rom pacientis mdgomareo- daavadebis gamocdileba, avadmyofobaSi ojaxisa da
bis gageba SeuZlebelia. miuxedavad misTvis damaxa- megobrebis CarTuloba, an daavadebis is suraTi,
siaTebeli xarvezebisa, es termini mainc iqneba am romelsac media warmogvidgens (ix. cxrili 16.8);
TavSi gamoyenebuli. w bavSvobisdroindeli uaryofiTi gamocdileba.
samedicino TvalsazrisiT auxsneli simptomebis
epidemiologia mqone zrdasrul adamianebs, Cveulebriv, aqvT
samedicino TvalsazrisiT auxsneli simptomebi uaryofiTi bavSvobisdroindeli gamocdileba (ara
gavrcelebulia zogad populaciasa da pirveladi sakmarisi mzrunveloba mSoblebis mxridan an ama Tu
jandacvis samedicino dawesebulebebis pacientebSi. im saxis sastiki mopyroba);
mamakacebTan SedarebiT, ufro xSirad qalebTan gvx- w socialuri mdgomareoba. samedicino TvalsazrisiT
vdeba (Gureje et al., 1997b). miuxedavad imisa, rom aseTi auxsneli simptomebi dakavSirebulia cud socialur
simptomebis umetesoba ar miiCneva seriozulad, da mdgomareobasTan da mwvave an qronikul uaryofiT
isini, Cveulebriv, did xans ar gastans, maTi sagrZno- movlenebTan;
bi umciresoba iwvevs distress da imas, rom pacienti w personologiuri maxasiaTeblebi. samedicino
acdens samsaxurs, konsultaciisTvis mimarTavs eqims, TvalsazrisiT auxsneli simptomebis mqone zog ada
iwyebs medikamentebis miRebas (Kroenke et al., 1994). mians fizikur janmrTelobasTan dakavSirebuli
sakiTxebi mozardobidan an ufro adreuli asakidan
etiologia aRelvebs, rac maT personologiur maxasiaTeblad
unda CaiTvalos.
miuxedavad imisa, rom xsenebuli simptomebi ar aixs-
neba fizikuri xasiaTis paTologiiT, am simptomebis
mizezebis Sesaxeb mainc arsebobs garkveuli infor- SemanarCunebeli faqtorebi:
macia. maTi umetesoba aRmocendeba normaluri sxeu- w qceviTi faqtorebi, rogoricaa daavadebis Sesaxeb
lebrivi SegrZnebebis mniSvnelobis mcdari interpre- informaciis ganmeorebiTi Zieba da inaqtiuroba;
taciis gamo da daavadebis niSnebad aRiqmeba. es iwvevs w emociuri faqtorebi, gansakuTrebiT SfoTva da
yuradRebis koncentracias am SegrZnebebze, rac kidev depresia;
ufro aZlierebs maTTan dakavSirebul wuxils, iwvevs w sxva adamianebis reaqcia, eqimebis, ojaxis wevrebisa
cud winaTgrZnobas da SfoTvas, rac xels uwyobs da megobrebis CaTvliT. eqimebma SeiZleba uneblieT
simptomebis SenarCunebas. magaliTad, SfoTvisas an gaaxangrZlivon pacientis problema, Tu isini mas ar
aRelvebisas gulis cemis aCqarebis gacnobierebam Sei- miawodeben Sesabamis, naTel informacias avadmyo-
Zleba gamoiwvios wuxili gulis daavadebis Taobaze, fobasTan dakavSirebuli SiSisa da wuxilis Sesaxeb.
yoveldRiuri aqtivobis SezRudva da mravaljeradi auxsneli simptomebis mizezebi ganxilulia Semdeg
gamokvlevebis Catareba eqimebisgan damaimedebeli in- wyaroSi: Mayou and Farmer, 2002.
formaciis misaRebad. klinicistebis mier efeqturi
komunikaciis uzrunvelyofa exmareba pacients, gaum- samedicino TvalsazrisiT auxsneli
klavdes aseTi mcdari interpretaciis Sedegebs. simptomebis klasifikacia
predispoziciuri faqtorebi: samedicino TvalsazrisiT auxsneli simptomebis kla-
w Sexedulebebi avadmyofobis Sesaxeb ayalibebs sifikacia ori sxvadasxva kuTxiTaa ganxiluli.
1. zogadi samedicino midgoma gulisxmobs fizikuri
cxrili 16. 7 sxeulebrivi SegrZnebebis simptomebis identificirebas, rogoricaa gaRiz-
zogierTi mizezi ianebuli nawlavis sindromi da fibromialgia. es
sinusuri taqikardia da keTilTvisebiani ariTmia
sindromebi sxvadasxva qveyanSi sxvadasxvaa. magali-
Tad, dabali arteriuli wnevis sindromi miRebulia
daRlilobis efeqti
germaniaSi, mal de foie _ safrangeTSi, magram arc
abstinencia erTi maTgani ar aris miRebuli inglisSi. isini aR-
zedmeti sakvebis miRebis efeqti weriTi sindromebia, ar warmoadgens etiologiur
erTeulebs da nawilobriv emTxveva sxva darRvevebs
xangrZlivi umoqmedobis efeqti
(Wessely et al., 1999). zogierT sindromTan dakavSire-
SfoTvis vegetaturi efeqti biT SemuSavda diagnostikuri kriteriumebi, romle-
uZilobis efeqti bic kvlevis Catarebisa da momsaxurebis dagegmvisT-
_ 405 _
bisa da kognitur-bihevioruli Terapiis gamoyenebisa.
cxrili 16. 8 gamocdileba, romelic zemoqmedebs zogi maTgani moxseniebulia mocemul TavSi.
sxeulebrivi SegrZnebebis interpretaciaze
naCvenebia, rom antidepresantebi Svelis samedicino
bavSvobisdroindeli avadmyofoba, samedicino TvalsazrisiT auxsnel zogierT simptoms, maT Soris
dawesebulebebTan urTierTobisa da skolis gacdenis gaRizianebuli nawlavis sindromsa da fibromialgias.
CaTvliT facialur tkivilze kargad moqmedebs tricikluri
bavSvobisdroindeli gamocdileba - axlo ojaxis wevris antidepresantebi. samedicino TvalsazrisiT, isini
avadmyofoba gansakuTrebiT rekomendebulia auxsneli simptomebis
somaturi daavadeba zrdasrul asakSi mqone iseTi pacientebisTvis, romelTa simptomebs Tan
axlavs aSkarad gamoxatuli depresia (O~Malley et al.,
zrdasruli asakis gamocdileba ojaxis wevris an
1999). Tumca, mocemuli preparatebis efeqturoba am
megobris avadmyofoba
tipis pacientebiT ar Semoifargleba.
masmediis siuJetebi daavadebis Sesaxeb kognitur-bihevioruli Terapia iZleva saSualo
sxva informaciis wyaroebi daavadebis Sesaxeb xarisxis efeqts gulmkerdis arakardialuri tkivi-
lis, gaRizianebuli nawlavis sindromisa da qroniku-
vis metad sasargeblo aRmoCnda. li daRlilobis sindromis dros (Kroenke and Swindle,
2. fsiqiatriuli midgoma. es alternatiuli midgoma 2000).
cdilobs im fsiqiatriuli sindromebis identifika-
cias, romlebic simptomebis safuZvels warmoadgens samedicino TvalsazrisiT auxsneli
da moicavs SfoTvasa da depresiul aSlilobas, so-
simptomebis marTva
matoformul aSlilobasa da paTomimikriul aSli-
lobas. gamokvleva
erTi da imave pacientisTvis SesaZlebelia fsiqi- arsebiTi mniSvneloba aqvs saTanado gamokvlevis Cat-
atriuli da zogadi samedicino diagnozis dasma. arebas. gamokvlevis dasrulebisas eqimma unda SeZlos
magaliTad, pacients, romelsac aReniSneba tkivili Semdegi ganmartebis micema:
gulmkerdis areSi da ar aqvs gulis daavadeba, SeiZle- w axsnas yvela Catarebuli gamokvlevis mizani da
ba dausvan samedicino diagnozi _ àra-kardialuri Sedegi; aseve, unda ganmartos, Tu ras efuZneba is
tkivili gulmkerdis areSi~ an `panikuri aSlilobis~ daskvna, rom simptomebs ar aqvs somaturi safuZve-
fsiqiatriuli diagnozi, erTi da imave simptomebis li;
aRsawerad. w rom, miuxedavad amisa, simptomebi realuradaa miC-
neuli da rom azri aqvs sxva mizezebis Ziebas.
samedicino TvalsazrisiT auxsneli
Tu eqimma pacienti fsiqiatrTan gadaamisamarTa, am
simptomebis prevencia ukanasknels unda ecnobos gamokvlevis Sedegebi da
iqmade, sanam dadgindeba samedicino TvalsazrisiT is, Tu ra saxiT ganumartes pacients isini.
auxsneli simptomebis mizezebi, ar arsebobs prevenci- fsiqiatri arkvevs, Tu ra xasiaTisaa auxsneli simp-
is Catarebis seriozuli safuZveli. miuxedavad imisa, tomebi da ra mniSvnelobis mqonea isini pacientisT-
rom populaciaSi zogierTi predispoziciuri faqto- vis. is wers fsiqiatriuli daavadebis istorias da
ris Sesusteba (sastiki mopyroba bavSvobis asakSi an fsiqikuri statusis gamokvlevis Sedegebs. am dros
arasakmarisi mzrunveloba mSoblis mxridan) garkveul igi gansakuTrebul yuradRebas uTmobs Semdegs:
Sedegs mogvcemda, ufro realuria iseT faqtorebze w wuxda Tu ara warsulSi pacienti daavadebis gamo;
muSaoba, rogoricaa eqimebis mier komunikaciis ara-
w avadmyofobaze pacientis axlandel Sexedulebebs;
damakmayofileblad ganxorcieleba (Ring et al., 2004)
da depresiisa da SfoTvis arasakmarisi mkurnaloba w mis pirovnul maxasiaTeblebs;
somaturi Civilebis mqone pacientebTan. prevenciis w mis socialur da fsiqologiur problemebs;
zomebi ufro srulad ganxilulia Semdeg wyaroSi: Ho- w SfoTviTi an depresiuli aSlilobis dadgenas.
topf, 2004.
informaciis mopoveba unda warmoebdes ara mxolod
pacientisgan, aramed sxva informatorebisganac.
samedicino TvalsazrisiT auxsneli
simptomebis mkurnaloba marTva
arsebobs Zalian mwiri moncemebi samedicino Tval- marTvis ZiriTadi gegma erTi da igivea samedicino
sazrisiT auxsneli simptomebis mkurnalobis Sesaxeb. TvalsazrisiT auxsneli nebismieri simptomis Sem-
ramdenjerme iyo mcdeloba medikamenturi mkurnalo- TxvevaSi, magram individualuri samkurnalo gegma
_ 406 _
unda iTvaliswinebdes pacientis individualur prob- warmoeba, vidre damatebiTi axsna-ganmartebis micema.
lemebs, auxsneli simptomebis tips da maTTan dakav- Semdgomi mkurnaloba unda daefuZnos pacientis in-
Sirebul nebismier fsiqikur aSlilobas. dividualuri problemebis formulirebas. mkurnalo-
qronikuli daRlilobis sindromisa da zogierTi bis gegma SeiZleba moicavdes antidepresantebiT
sxva funqcionaluri samedicino sindromis marTva mkurnalobas, SfoTvis marTvas da kognitur Tera-
ganxilulia qvemoT; somatoformuli aSlilobis mar- pias, raTa pacients SevucvaloT mcdari Sexedulebebi
Tva aRwerilia me-10 TavSi. simptomebis warmoSobisa da mniSvnelobis Sesaxeb.
boqsSi 16.1 mocemuli procedurebis Sesrulebis pirveladi jandacvis jgufi SeiZleba Zalian efeq-
Semdeg, bevri pacienti mSviddeba, xolo vinc kvlav turi aRmoCndes, iseve, rogorc zogadi profilis
daeWvebulia, agrZelebs gamokvlevebis Catarebas, eqimi, romelic ZiriTad procedurebs atarebs. Tum-
raTa moispos eWvis mizezi. rodesac yvela zogadi ca, qronikuli da ganmeorebiTi xasiaTis problemebis
samedicino gamokvleva Catarebulia, klinicistma gamo SeiZleba saWiro gaxdes pacientis gadamisamarTe-
safuZvlianad unda auxsnas pacients, Tu ratom aRar ba fsiqiatrTan an klinikuri fsiqologiis special-
aris saWiro damatebiTi gamokvlevebis Catareba. aseTi istTan, raTa pacients Cautardes simptomebTan da-
sawyisi diskusiis Semdeg, mizezebTan dakavSirebuli kavSirebuli fsiqikuri aSlilobis mkurnaloba an
damatebiTi argumentebis motana iSviaTad gvaZlevs kognituri da dinamikuri fsiqoTerapia. fsiqiatrma,
Sedegs. pacientebis umetesoba misaRebad miiCnevs im SeiZleba, moaxdinos nebismieri saxis uwyveti samedi-
mosazrebas, rom maT simptomebs ganapirobebs rogorc cino momsaxurebis koordinacia. es gansakuTrebiT
biologiuri, ise fsiqologiuri faqtorebi. pacien- maSin xdeba, rodesac pacientze zrunvis gegmaSi sx-
tebis mier am faqtis mimRebloba SegviZlia fsiqolo- vadasxva profilis specialistia CarTuli.
giuri marTvis safuZvlad gamoviyenoT.
Tu problema axlad gaCenilia, xSirad sakmarisia ax- prognozi
sa-ganmartebis micema da pacientis darwmuneba. rode- prognozi dadebiTia axlad gamovlenili SedarebiT
sac simptomebi ufro didi xnis manZilzea gamovleni- martivi SemTxvevebis dros, magram is bevrad uaresia,
li, darwmuneba da damSvideba iSviaTad aris sakmarisi; rodesac saqme gvaqvs qronikul, mravlobiT da ganmeo-
Tu Cven gavagrZelebT pacientis damSvidebas, aman rebad SemTxvevebTan. am ukanasknelis dros yvelaze
SeiZleba kidev ufro gazardos misi survili _ mois- realuri mizania unarSezRudulobisa da arasaWiro
minos ufro meti damamSvidebeli argumenti. fsiqo- samedicino gamokvlevaTa moTxovnilebis minimizacia.
socialur mizezebTan simptomebis dasakavSireblad ufro sruli informacia samedicino TvalsazrisiT
ufro damajerebeli da efeqturi iqneba dRiuris auxsneli simptomebis marTvis Sesaxeb mocemulia Sem-
deg wyaroebSi: Richardson and Engel, 2004; Mayou et al.,
1995.
boqsi 16.1 samedicino TvalsazrisiT
auxsnel simptomebTan dakavSirebuli
ZiriTadi procedurebi qronikuli daRlilobis sindromi
am sindromis aRwerisTvis, romlis wamyvani niSani
xazi gausviT imas, rom simptomebi realuria da nacnobia
klinicistisaTvis qronikuli, damauZlurebeli daRlilobaa, mraval
termins iyeneben, rogoricaa: virusis Semdgomi daR-
axseniT fsiqologiuri faqtorebis roli yvela somatur
SemTxvevaSi
lilobis sindromi, nevrasTenia da mialgiuri ence-
falomieliti. amJamad upiratesoba eniWeba termins
warmoadgineT da ganixileT simptomebis fsiqologiuri
_ `qronikuli daRlilobis sindromi.~ am diagnozis
axsna
mixedviT, avadmyofoba unda grZeldebodes minimum
sakmarisi dro mieciT pacientsa da partniors/ojaxs
eqvsi Tve da unda gamoiricxos daRlilobis sxva mize-
kiTxvebis dasasmelad.
zebi (Fukuda et al., 1994).
SeTanxmdiT mkuranlobis gegmaze, romelic moicavs:
qronikuli daRlilobis sindroms xangrZlivi isto-
w im nebismieri umniSvnelo samedicino problemis mov ria aqvs. mecxramete saukuneSi is diagnostirebuli
las, romelsac Tavisi wvlili Seaqvs simptomatikaSi
iyo, rogorc nevrasTenia (Wessely, 1994). ICD-10-Si es
w nebismieri dakavSirebuli fsiqikuri aSlilobis mkur sindromi kvlav aseTi saxelwodebiTaa Sesuli. CineTsa
nalobas (Cveulebriv esaa depresia da SfoTva) da zogierT sxva qveyanaSic amave saxeliTaa cnobili.
w Tu es mizanSewonilia, fsiqikuri janmrTelobis gaum qronikuli daRlilobis sindromis diagnostikuri
jobesebas safexurebivi aqtivobiT; kriteriumebi nawilobriv emTxveva sxva fsiqikuri
w Tu es mizanSewonilia, dRiuris warmoebas simptomebsa aSlilobebis diagnostikur kriteriumebs, depresiis,
da SesaZlo fsiqosocialur mizezebs Soris kavSiris SfoTvis da somatoformuli aSlilobis CaTvliT.
gasarkvevad.
_ 407 _
klinikuri niSnebi
cxrili 16.9 qronikuli daRlilobis sind
sindromis ZiriTadi niSania daRlilobis SegrZneba
romis SemTxvevis gansazRvra (Fukuda et al., 1994)
dasvenebisas da qancgamoleulobis gaxangrZlivebuli
gancda umniSvnelo fizikuri da fsiqikuri Zalisxme- kriteriumebi, romlebic sindromis arsebobaze miuTiTebs
vis Semdeg. amas Tan axlavs kunTebis tkivili, cudi klinikurad Sefasebuli, samedicino TvalasazrisiT
koncentracia da sxva simptomebi, romlebic moce- auxsneli daRliloba, romelic minimum 6 Tve grZeldeba:
mulia cxrilSi 16.9. am mdgomareobaSi myof adamian-
w axali dawyebuli (ar aRiniSneba mTeli cxovrebis
ebs, upirveles yovlisa, awuxebT aqtivobisTvis Ta- manZilze)
vis aridebis sakiTxi. frustracia, depresia da cud
w ar warmoadgens amJamad gaweuli fizikuri an sxva
fizikur formaSi yofna yvelaze gavrcelebuli maxa-
saxis Zalisxmevis (daZabulobis) Sedegs
siaTeblebia.
w mniSvnelovnad ar mcirdeba dasvenebis Sedegad
epidemiologia
w aqtivobis Cveuli done mniSvnelovnad daweulia
zogadi populaciis gamokvleva gviCvenebs, rom
persistentul daRlilobas uCivis yovel gamokiTxvaSi qvemoT CamoTvlili simptomebidan 4 an meti simptomis
arseboba:
monawile populaciis erTi meoTxedi. am tipis
Civilebi aqvT im adamianebs, romlebic pirveladi w individi Tvlis, rom mexsiereba gauuaresda
jandacvis dawesebulebebsa da poliklinikebs
w yelis tkivili
akiTxaven. Tumca, im adamianebidan, romlebic uCivian
gansakuTrebulad intensiur daRlilobas, mxolod w mgrZnobiare limfuri jirkvlebi
mcire nawili akmayofilebs qronikuli daRlilobis w kunTebis tkivili

sindromis kriteriumebs. gavrcelebis sixSire zogad
w saxsrebis tkivili
populaciaSi 0.3-1%-s Seadgens (Jason et al., 1999).
w Tavis tkivili
etiologia
w Zili, romelsac ar mosdevs Zalebis ganaxleba
qronikuli daRlilobis sindromis etiologia wi
w Zalisxmevis gawevis Semdegomi diskomforti, romelic
naaRmdegobrivi xasiaTisaa. sindromis gamomwvevad
24 saaTze met xans grZeldeba
iTvleba Semdegi faqtorebi:
w biologiuri mizezebi. qronikuli daRlilobis kriteriumebi, romlebic gamoricxavs sindromis arsebobas
sindromis mizezad asaxeleben qronikul infeq w amJamindeli daavadeba; daavadeba, romelic ar

cias, imunur disfunqcias, kunTuri sistemis ganikurna; eWvi daavadebis arsebobaze
darRvevebs, neiroendokrinul disfunqciasa da w fsiqozuri, melanqoliuri an bipolaruli depresia
cudad gansazRvrul nevrologiur darRvevas. (magram ara didi depresia garTulebebis gareSe)
arc erTi am mizezTagani ar dasturdeba sakmarisi
w fsiqozuri aSliloba
mtkicebulebiT, garda infeqciisa, romelic SeiZleba
precipitatuli faqtoris rols asrulebdes. w demencia
w fsiqologiuri da qceviTi faqtorebi. eseni, w nervuli anoreqsia an bulimia

rogorc Cans, mniSvnelovani faqtorebia, gansa
w alkoholisa da sxva fsiqoaqtiuri nivTierebis
kuTrebiT, wuxili simptomis mniSvnelovnebis gamo,
borotad moxmareba
ris Sedegadac xdeba simptomebze yuradRebis kon
centracia da fizikuri da fsiqikuri aqtivobisTvis w mZime simsuqne
Tavis arideba, rac auaresebs misi Sesrulebis

xarisxs. mravali pacienti depresiulia da/an Sfo gulisxmobs predispoziciuri, precipitatuli da
Tvas ganicdis. SemanarCunebeli faqtorebis rolis dadgenas:
w socialuri faqtorebi. samuSao adgilze miRebuli w predispoziciur faqtorebSi Sedis didi depr
stresi zogjer Zalian mniSvnelovan faqtors esiuli aSlilobis warsuli istoria da, albaT,
warmoadgens. rwmena, romlis Tanaxmad, mizezi iseTi personologiuri maxasiaTeblebi, rogoricaa
wesiT fizikuri xasiaTisa unda iyos, SeiZleba perfeqcionizmi;
ganpirobebuli iyos fsiqiatriul diagnozebTan w precipitatul faqtorebSi Sedis virusuli infeqcia
dakavSirebuli stigmiT da, agreTve, pacientebisgan da cxovrebiseuli stresuli movlena;
da praqtikosebisgan miRebuli informaciiT. w SemanarCunebel faqtorebSi SeiZleba Sediodes
etiologiis mimarT alternatiuli midgoma neiroendokrinuli disfunqcia, emociuri aSli
_ 408 _
loba, arsebuli darRvevis mTlianad fizikur 3. etiologiuri formulirebis wardgena samuSao
daavadebasTan dakavSireba, ganridebis daZlevis hipoTezis saxiT, romelic kamaTis sagnad ki ar
strategiis gamoyeneba, qronikuli pirovnuli da unda iqces, aramed safuZvlianad unda gadamowmdes;
socialuri siZneleebi, mediisa da sxva wyaroebis 4. dadgenili depresiisa da SfoTvis mkurnaloba;
mier mowodebuli mcdari informacia.
5. xelis Sewyoba pacientisTvis, raTa igi TandaTano-
damatebiTi informacia mocemulia Semdeg wyaroSi: biT daubrundes funqcionirebis normalur dones,
Wessely et al. (1998). qronikuli daRlilobis sindromi ganridebis daZlevisa da fizikuri aqtivobis unaris
bavSvebTan ?? gverdzea ganxiluli aRdgenis gziT;
mimdinareoba da prognozi 6. daxmarebis gaweva, raTa pacientma SeZlos samuS-
aosTan dakavSirebuli an nebismieri sxva saxis praq-
grZelvadiani prognozi, Cveulebriv, dadebiTi ar
tikuli problemebis mogvareba.
aris. Tumca, unda gvaxsovdes, rom prognozis Semswav-
lel gamokvlevaTa umetesobaSi monawile pacientebs, medikamentebi
samedicino centrebSi moxvedramde, albaT, bevrad
rodesac depresiuli aSlilobis niSnebi mkafiodaa
ufro adre aReniSnebodaT daRlilobis sindromi.
gamoxatuli, pacients antidepresantebi Cveulebrivi
garda amisa, gamokvlevaTa umravlesoba prognozis
doziT unda gamovuweroT. klinikuri gamocdileba
problemas Seiswavlida iqamde, sanam farTod damkvi-
gviCvenebs, rom pacientebi yvelaze maRal toleran-
drdeboda mkurnalobis axali meTodebi (ix. qvemoT).
tobas serotoninis ukumitacebis seleqciuri inhibi-
mkurnaloba torebis mimarT amJRavneben. antidepresantebi gamo-
qronikuli daRlilobis sindroms mravali meTodiT sadegia, aseve, SfoTvisa da tkivilis Sesamcireblad
mkurnaloben, magram mxolod ramdenime maTgania efeq- da Zilis gasaumjobeseblad.
turi. Catarda ramdenime randomizebuli kontroli-
rebadi gamokvleva kognitur-bihevioruli Terapiisa
minimaluri intervenciis dros pacients unda mi-
da graduirebuli varjiSis reJimis gamoyenebiT. aR-
vawodoT informacia misi mdgomareobis Sesaxeb;
moCnda, rom es procedurebi ufro efeqturia samedi-
aseve unda SevZloT am mdgomareobis mizezebisa da
cino procedurebTan da relaqsaciis TerapiasTan
mkurnalobis Sesaxeb arsebuli mcdari warmodgenebis
SedarebiT, im SemTxvevaSi, Tu maT damoukideblad iy-
koreqcia. kognitur-bihevioruli meTodebi mimarTu-
eneben (Whiting et al., 2001).
lia pacientis mcdar warmodgenebze sakuTari mdgo-
marTva mareobis Sesaxeb da mis gadametebul wuxilze aqti-
vobis donis daqveiTebis gamo. amave dros, pacients
gamokvleva
xeli unda SevuwyoT, raTa man SeZlos aqtivobis donis
iseve, rogorc nebismieri sxva tipis samedicino
TandaTanobiT amaRleba. pacientis pirovnuli da so-
TvalsazrisiT auxsneli viTarebis SemTxvevaSi, aqac
cialuri xasiaTis sirTuleebis dasaZlevad SeiZleba
gamokvlevis Sedegad unda gamoiricxos qronikuli
problemis gadaWraze mimarTuli teqnikis gamoyenebac.
daRlilobis gankurnebadi somaturi da fsiqikuri
daRlilobis qronikuli sindromi ganxilulia Sem-
mizezebi. mniSvnelovania, pacients saguldagulod
deg wyaroSi: Afari and Buchwald (2003); Wessely et al.,
gamovkiTxoT depresiuli simptomebis Sesaxeb, radgan
(1998).
man SeiZleba sakuTari surviliT ar moindomos maTi
gamJRavneba. miuxedavad imisa, rom azri ar aqvs mra- gaRizianebuli nawlavis sindromi
valmxrivi somaturi gamokvlevis Catarebas, aseTi pa-
gaRizianebuli nawlavis sindroms axasiaTebs abdomi-
cientebis gamokvlevisas fsiqiatrs SeuZlia zogadi
naluri tkivili da diskomforti, rasac Tan axlavs an
profilis eqimTan iTanamSromlos. SemTxvevis nebism-
ar axlavs nawlavis Cveuli funqcionirebis Secvla da
ieri saxiT formulireba Sesabamis etiologiur faq-
es yovelive grZeldeba sam Tveze met xans yovelgvari
torze unda miuTiTebdes (ix. zemoT).
gamovlenli daavadebis gareSe. gamoiyeneba e.w. romis
mkurnalobis dawyeba kriteriumebi, romlebic sadiagnostiko operaciuli
kriteriumebia (Thompson et al., 1999).
gasavlelia eqvsi ZiriTadi safexuri:
epidemiologia. gaRizianebuli nawlavis sindromi
1. pacientis somptomebis realurobisa da maTTan da-
gvxvdeba zogadi populaciis aT procentTan (Wilson
kavSirebuli uunarobis gaTvaliswineba;
et al., 2004). amaTgan umravlesoba rCevisTvis eqims ar
2. pacientisa da misi ojaxisTvis Sesabamisi informa- mimarTavs.
ciis miwodeba sindromis bunebis Sesaxeb; etiologia. sindromis mizezi ar aris cnobili,
_ 409 _
Tumca, am dros, rogorc Cans, darRveulia nawla-
cxrili 16.10 samedicino TvalsazrisiT
vis funqcia da masTan dakavSirebuli SegrZnebebi.
am sindromis mqone mraval adamians, romlebic gas-
auxsnelia zogierTi sxva simptomi da sindromi
facialuri tkivili
troenterologiur klinikas akiTxaven, ZiriTadad
depresiuli da SfoTviTi aSliloba axasiaTebs. isini zurgis tkivili
Seadgenen pacientTa im jgufs, romelic, Cveulebriv, ara-kardialuri warmoSobis tkivili gul-mkerdis areSi
mkurnalobas ar eqvemdebareba. gaxSirebuli majiscema

mkurnaloba. msubuqi simptomebis mqone pacientebi, Tavbrusxveva
Cveulebriv, reagireben sganmanaTleblo xasiaTis in- arawylulovani dispepsia
formaciasa da damamSvidebel saubarze seriozuli alergia garemo gamRizianeblebze
paTologiis ararsebobis Sesaxeb, iseve rogorc di- wina mxris tkivili (ganmeorebiTi daWimuloba)
etaSi cvlilebebis Setanasa da medikamentebze, rom- sparseTis yuris sindromi
lebic iwveven kuW-nawlavis traqtis peristaltikis
dros xdeba simptomebis gamogoneba, rac pirovnebas
inhibicias. ufro mZime da qronikul simptomebs dam-
saSualebas aZlevs, Sevides avadmyofis rolSi da
atebiTi mkurnaloba esaWiroeba. efeqturia rogorc
miiRos samedicino daxmareba. (simptomebis simulaciis
kognitur-bihevioruli, ise dinamikuri fsiqoTera-
mizania sxva saxis sargeblis mopoveba. ix. qvemoT).
piis gamoyeneba, iseve, rogorc antidepresantebiT
termini `miunhauzenis sindromi~, am aSlilobis
mkurnaloba (Raine et al., 2002).
ukidures formas asaxavs.
gaRizianebuli nawlavis sindromi ganxilulia Sem-
epidemiologia. paTomimikriuli aSlilobis gavrce
deg wyaroSi: Ringel et al., 2001.
lebis sixSire zustad ar aris cnobili; kooperaciul
samsaxurebSi gadamisamarTebuli pacientebis daax
fibromialgia
loebiT erT procents Seadgens. mocemuli aSliloba,
termini `fibromialgia~, miuTiTebs sindromze, ro Cveulebriv, iwyeba 30 wlamde asakSi.
melsac axasiaTebs kunTebis aralokalizebuli tkivi- etiologia. aSlilobis mizezebi ar aris cnobili,
li, mgrZnobiaroba, daWimuloba da daRliloba. am sin- nawilobriv imis gamo, rom pacientebis mier monaTxrobi
droms Tan axlavs cudi Zili. operaciuli definicia istoriebi arazustia. xSirad gvxvdeba mSoblebis
SemuSavebulia amerikis revmatologiis kolejis mier mxridan sastiki mopyrobis an Svilis ugulebelyofis
(Wolfe et al., 1990). erT-erT fizikur maxasiaTeblad SemTxvevebi; qronikuli daavadeba, adreul asakSi
iTvleba mravlobiTi mgrZnobiare ubnebis arseboba, samedicino samsaxurebTan xSiri kontaqtis CaTvliT;
magram, rogorc Cans, es ar warmoadgens specifikur zogjer, saavadmyofoSi gatarebuli xangrZlivi
niSans. ufro xSirad es sindromi aReniSnebaT qalebs, periodi, zogjer ki imis mtkiceba, rom eqimebis mier
vidre mamakacebs; umetesad saSualoi asakis adamian- daavadebis marTva arasworad warimarTeboda. xSirad
ebTan gvxvdeba. etiologia daudgenelia, magram Sein- aRiniSneba warsulSi fsiqoaqtiuri nivTierebebis
iSneba misi aSkara kavSiri depresiasa da SfoTvasTan. borotad moxmareba, guneb-ganwyobis aSliloba da
kontrolirebadma gamokvlevebma aCvena, rom anti- personologiuri aSliloba. mravalia pacienti, ro
depresantebs aqvT efeqturi moqmedeba (O~Malley et al., melic medicinasTan dakavSirebul sferoebSi muS
2000). garda amisa, dadebiTi Sedegi aCvena qceviTma aobda.
intervenciamac, gansakuTrebiT _ fizikuri varjiSis prognozi sxvadasxvagvaria, magram Tavad pacientis
intensivobis gazrdam (Sim and Adams, 2002). mdgomareoba did xans gastans. Zalian cota pacien-
fibromialgia ganxilulia Semdeg wyaroSi: Thompson tisTvisaa misaRebi fsiqologiuri mkurnaloba, magram
et al., 2003. zogierTis mdgomareoba umjobesdeba mxardamWeri sa-
medicino momsaxurebis gawevis SemTxvevaSi. zogjer
paTomimikriuli aSliloba aRiniSneba sxva saxis qceviTi darRvevebi, rogoricaa,
DSM-IV-Si paTomimikriuli aSliloba gansazRvrulia, magaliTad, bavSvebTan sastiki mopyroba (maTi mxri-
rogorc `fizikuri an fsiqologiuri simptomebis dan, vinc jandacvis sferoSi muSaobs) da pacientisT-
ganzrax gamowveva an gamogoneba, rac SeiZleba vis zianis miyeneba.
ganpirobebuli iyos pirovnebis moTxovnilebiT _ iyos
daavadebis marTva
avadmyofis rolSi~. es kategoria iyofa: SemTxvevebad,
romelSic Sedis mxolod fsiqologiuri simptomebi; gamokvleva. rodesac arsebobs eWvi paTomimikriul
SemTxvevebad, romelSic mxolod fizikuri simp aSlilobaze, yuradRebiT unda ganvixiloT CvenT-
tomebia da, aseve, SemTxvevebad, romlebic orive vis xelmisawvdomi informacia, informatorebisa da
saxis simptomebs moicavs. paTomimikriuli aSlilobis Tavad pacientis mier moTxrobili istoriis CaTv-
liT. fsiqiatrs SeuZlia daxmarebis gaweva gamokvle-
_ 410 _
las. is, agreTve, unda SeTanxmdes imis Taobaze, Tu
boqsi 16.2 paTomimikriuli aSlilobis
mqone jandacvis muSakebi ra saxis daxmareba sWirdeba pacientsa da mis ojaxs
aSlilobasTan dakavSirebuli poroblemebis gamo. Tu
sazogadoebisaTvis cnobili gaxda, rom paTomimikriuli
pacienti jandacvis sferoSi muSaobs, es damatebiT
aSlilobis mqone jandacvis muSakebis raRac raodenoba
seriozul fizikur zians ayenebda pacientebs. aseve aRmoCnda, risks Seicavs da aRZravs rTul eTikur problemebs
rom paTomimikriis SemTxvevebi aRiniSneboda im adamianebSi, (ix. boqsi 16.2).
romlebic maTi mzrunvelobis qveS imyofebodnen. aqedan mocemuli sakiTxi ganxilulia Semdeg wyaroSi: Bass
gamomdinare, rodesac pacienti janmrTelobis dacvis
sferoSi muSaobs, arsebiTi mniSvnelobis mqonea sxvebisaTvis and Gill, 2000.
zianis miyenebis riskis gaTvaliswineba.
amgvari iSviaTi SemTxvevebi warmoSoben rTul same miunhauzenis sindromi
dicino da samarTlebriv problemebs. Tu diagnozi
riCard aSerma (Ascher, 1951) Semoitana termini `mi-
saeWvoa, SeiZleba saWiro gaxdes damatebiTi mtki
cebulebis mopoveba pacientis kuTvnilebaSi myofi iseTi unhauzenis sindromi~, paTomimikriuli aSlilobis
nivTebis gaCxrekiT (nemsebi an medikamentebi), romlebsac ukiduresi formis aRsaniSnad. am aSlilobis mqone
igi SeiZleba simptomebis stimulaciisaTvis iyenebdes.
pacientebi akiTxaven saavadmyofos yalbi, magram dam-
zogadad araeTikuria pacientebis nivTebis Cxreka axsna-
ganmartebisa da nebarTvis mopovebis gareSe. Tu pacienti ajerebeli da xSirad dramatuli istoriebiT, romle-
Cxrekaze uars acxadebs, xolo diagnozis daudgenlobis bic seriozul daavadebaze miuTiTebs. xSirad aseTi
SemTxvevaSi sxva adamianebi seriozuli riskis qveS adamianebi bevr saavadmyofos akiTxaven da eqimebi
imyofebian, swori iqneba, Tu rCevisaTvis erT-or gamocdil
profesionals mivakiTxavT, romelic samedicino da SecdomaSi SehyavT. pacienti, Cveulebriv, saavadmyo-
iuridiul konsultacias Cagvitarebs. rCevis miReba foebs sxvadasxva gamogonili saxeliT akiTxavs xolme.
SeiZleba aseve saWiro gaxdes riskis Sefasebisas, maTgan mravals aqvs iara, romelic uaryofiTi war-
seriozuli riskis pirobebSi, da konfidencialobis
suli gamocdilebis Sedegia.
darRvevasTan dakavSirebiT gadawyvetilebis miRebisas
iseT SemTxvevaSi, rodesac pacienti ar iZleva Tanxmobas aseTi aSlilobis mqone adamianebma SeiZleba xeli
damsaqmeblebTan misi problemis garCevis Taobaze. SeuSalon maTze informaciis mopovebas, xolo zogi-
erTma _ diagnozis dadgenas. Semdgomi informaciis
vis Catarebisas. eWvis gaCenis SemTxvevaSi, SeiZleba mopovebisas (gansakuTrebiT, saavadmyofoebSi vizitis
saWiro gaxdes damatebiTi samedicino gamokvlevis istoriis Sesaxeb), pacienti, Cveulebriv, gauCinardeba
Catareba. damatebiTi informaciis miReba SesaZle- xolme. am ucnauri aSlilobis etiologia da gamosava-
belia pacientze faruli dakvirvebis gziT, magram li ucnobia.
aseTi SesaZleblobis ganxilvisas seriozulad unda
movekidoT mocemuli proceduris samarTlebriv da mzrunvelobis qveS myof adamianebSi
eTikur aspeqtebs. paTomimikriuli aSlilobis gamowveva
mkurnalobis dawyeba. diagnozis dasmis Semdeg,
1997 wels medoum aRwera bavSvebis mimarT sastiki
eqimma unda auxsnas pacients miRebuli Sedegebi da
mopyrobis erT-erTi forma, romlis drosac mSoble-
ganixilos maTi mniSvneloba. am dros eqimi gagebiT
bi (an sxva momvlelebi) mcdarad warmoadgenen bavS-
unda moekidos pacientis distress da Seqmnas Sesa-
vebis simptomebs, ayalbeben daavadebis niSnebs, usas-
Zlo fsiqosocialuri mizezebis ganxilvis pirobebi.
rulod utareben bavSvebs samedicino gamokvlevas da
am etapze zogi pacienti aRiarebs, rom simptomebi
arasaWiro mkurnalobas (Meadow, 1958). (saxelwodebis
mis mieraa gamogonili, xolo zogierTi gamudmebiT
miuxedavad, DSM-IV-is mixedviT, es ar aris paTomimi-
uaryofs amas. meore SemTxvevaSi, eqimma mainc unda
kriuli aSliloba).
warmarTos pacienti imisaken, rom man SeZlos Sesabam-
gamowveuli simptomebidan yvelaze xSirad asaxele-
isi fsiqologiuri da socialuri siZneleebis iden-
ben nevrologiur niSnebs, sisxldenasa da gamonayars.
tifikacia da daZleva im imediT, rom problemebis
zogi bavSvi Tavadac monawileobs simptomebisa da
gadaWra sabolood Seasustebs aSlilobas. personali,
niSnebis gamowvevaSi. Cveulebriv, am danaSaulebrivi
romelic zrunavs pacientze gamokvlevis Catarebis
qcevis Camdens axasiaTebs mZime personologiuri aSli-
procesSi, SeiZleba ukmayofilo iyos imis gamo, rom
loba da Tavad aReniSneba paTomimikriuli aSliloba.
pacienti mas atyuebda. personalis aseTi gancdebi ar-
bavSvebisTvis ufrosebis amgvar qcevas moaqvs iseTi
Tulebs daavadebis marTvas. fsiqiatrma unda Searbi-
uaryofiTi Sedegebi, rogoricaa ganaTlebis procesis
los amgvari viTareba da ganumartos samedicino per-
CaSla da socialuri ganviTarebis Seferxeba. prognozi
sonals, Tu ra saxisaa da ramdenad mZimea pacientis
uaryofiTia, rogorc bavSvisTvis, ise damnaSavisTvis.
fsiqosocialuri problemebi. pacientTan momuSave
aRiniSneba sikvdilianobis maRali koeficienti. aRwer-
mTeli samedicino personali unda iRebdes monaw-
ilia bavSvTa mkvlelobis SemTxvevebic profesionali
ileobas samkurnalo gegmis SemuSavebaSi, romelic
mzrunvelebis mier, rac aSlilobis ukidures formad
gansazRvravs pacientis samomavlo samedicino mov-
_ 411 _
iTvleba. am adamianTagan zogierTs Tavad aReniSneba gairCes kritikis gareSe. mas xeli unda SevuwyoT
paTomimikriuli aSliloba (ix. boqsi 16.2). imaSi, rom is ufro Sesaferisi saxiT gaumklavdes
zemoT aRwerili mdgomareoba iSviaTia da diagnozis iseT problemebs, romlebic simulaciur qcevas
dasma didi sifrTxiliT unda moxdes (safuZvliani iwvevs. Sesaferis SemTxvevaSi, pacients vutarebT
gamokvlevis Semdeg). britaneTSi sagangebod gamoqveyn- xanmokle intervencias, romelic mas unda daexmaros
da sasamarTlo SeTxvevebi imis saCveneblad, Tu ramde- TviTSefasebis SenarCunebasa da simptomebis ukug
nad saxifaToa, roca diagnozis dasma xdeba arasakma- debaSi. simulaciis Tema ganxulilia Semdeg naSromSi:
risi dadebiTi mtkicebulebis safuZvelze da bavSvis Sharpe, 2003.E
simptomebis sxva mizezebis gamoricxvis gareSe.
fsiqiatriuli samsaxurebi
simulacia
zogadi profilis saavadmyofoebis fsiqiatriuli
simulacia ar aris samedicino diagnozi. es termini samsaxurebi ramdenime saxiTaa organizebuli.
aRwers qcevas. is gulisxmobs simptomebis ganzrax sakonsultacio da kooperaciuli fsiqiatria tra
gazviadebas an simulirebas raime sargeblis miRebis diciuli terminia. sakonsultacio samsaxurSi fsi
mizniT (mag., finansuri kompensaciis misaRebad). Zne- qiatri gamoTqvams Tavis Sexedulebas im pacientebze,
lia misi diferencireba paTomimikriuli da somato- romlebsac masTan Terapevti an qirurgi agzavnis.
formuli aSlilobisgan, radgan amisTvis kargad unda kooperaciul samsaxurSi fsiqiatri eqimTa gundis
gvesmodes, Tu ra motivacia aqvs pirovnebas. wevria. is iZleva rCevas nebismier pacientTan da
simulaciuri aSlilobis gavrcelebis sixSire daba- kavSirebiT, romlis mkurnalobaSic SeuZlia Tavi
lia da umetesad gvxvdeba patimrebSi, samxedroebSi si wvlili Seitanos. kooperaciuli samsaxuris
da im adamianebSi, romelTac surT, miiRon kompensa- fsiqiatri, agreTve, exmareba danarCen personals im
cia ubeduri SemTxvevis gamo. simulaciis ramdenime fsiqologiuri problemebis gadaWraSi, romlebsac
klinikuri suraTia aRwerili: isini yoveldRiuri profesiuli saqmianobisas awy
w somaturi mdgomareobisa da unarSezRudulobis debian (im pacientis problemebis CaTvliT, romlebic
simulacia; ukve ganixila samedicino personalma, magram
w simulirebuli fsiqozi, romelic aReniSneba mas, fsiqiatris azri jer ar mousmenia).
visac surs saavadmyofoSi dawola, TavSesafris fsiqologiuri medicina zogadi terminia, romelic
mopovebis an saavadmyofoSi ufro did xans darCe- gulisxmobs eqimebisa da eqTnebis mier sakonsultacio
nis mizniT; agreTve, samarTaldarRvevaSi dadana- da kooperaciuli meTodebis gamoyenebas ZiriTadi
Saulebul pirebs, romlebsac ar undaT sasamarTlo fsiqologiuri da fsiqiatriuli daxmarebis gawevis
procesze gasvla an surT zegavlena moaxdinon sa- mizniT (Mayou et al., 2004).
samarTlos gadawyvetilebaze; termini `qceviTi medicina~, aRniSnavs msgavsi ti
pis daxmarebas, romelSic fsiqiatrebis nacvlad
w simulirebuli an gazviadebuli post-travmuli
klinikuri fsiqologiis specialistebi monawileoben.
stresuli aSliloba;
fsiqosomaturi medicina esaa termini, romelic
w kognituri funqciis daqveiTebis simulireba.
warsulSi farTod gamoiyeneboda aSS-Si da sxva
simulaciis Sefaseba qveynebSi. am terminiT isev sargebloben germaniaSi.
aSS-Si igi aRadgines sakonsultacio-kooperaciuli
simulaciis Sesafaseblad dakvirvebiT ikribeba anam
fsiqiatriis aRsaniSnad, romelic fsiqiatriis dargad
nezi da tardeba klinikuri gamokvleva. am dros
ganixileba (Gitlin et al., 2004).
yuradRebas aqceven imas, Tu ramdenad Tanmimdevrulia
adamianis qceva. advokatebi da dazRvevis war
rogor aris agebuli fsiqiatriuli
momadgenlebi zogjer videos an sxva saSualebebis
gamoyenebiT akvirdebian adamians, raTa daafiqsiron samsaxuri
simulaciuri qceva, magram, eTikuri mizezebis gamo, sakonsultacio da kooperaciuli erTeulebi gan
klinicistebi aseT zomebs iSviaTad mimarTaven. si sxvavdeba TavianTi zomiTa da struqturiT. zo
mulaciuri qcevis dasafiqsireblad iyeneben fsi gierTi mxolod fsiqiatrebisgan Sedgeba, zogSi
qologiur testirebas, magram gamoyenebuli teste ki muSaoben multidisciplinaruli jgufebi, rom
bidan arc erTis validuroba ar aris dadgenili. lebSic Sedian fsiqiatrebi, eqTnebi, socialuri
muSakebi da klinikuri fsiqologiis specialistebi.
marTva ramdenime kooperaciul samsaxurs aqvs stacionari,
rodesac simulacia aSkaraa, pacients taqtianad rogorc somaturi, ise fsiqikuri daavadebebis mqone
unda ecnobos amis Sesaxeb da misi mdgomareoba unda pacientebisTvis. Crdilo amerikis saavadmyofoebis
_ 412 _
fsiqiatriuli samsaxurebi
did sakonsultacio samsaxurebSi Semosuli pa pacients awuxebs fsiqiatriul vizitTan dakavSirebiT
cientebis 5 procentis referali fsiqiatrebTan (magaliTad, fsiqiatrTan viziti ar gulisxmobs imas,
xdeba. britaneTsa da mraval sxva qveyanaSi SedarebiT rom adamiani aranormaluria) da imis ganmarteba,
naklebi raodenobis hospitalizebuli pacientebis Tu ra mniSvneloba aqvs intervius mkurnalobis
referali xdeba. maTgan umravlesobas ganzrax TviT- gegmisTvis (interviu iZleva damatebiT informacias).
dazianebis SemTxvevebi warmoadgens (ix. me-17 Tavi). amis Semdeg xdeba detaluri anamnezis Segroveba da
sakonsultacio-kooperaciul fsiqiatrias miZRvnili warmoebs fsiqikuri statusis gamokvleva. Cveulebriv,
literaturis udidesi nawili fokusirebulia sta zogadi janmrTelobis statusi ukve mocemulia
cionarul avadmyofebze, Tumca, pacientebis um CanawerebSi. zogjer aucilebelia fizikuri jan
ravlesoba aq poliklinikebidan da gadaudebeli mrTelobis Sesamowmeblad zogierTi gamokvlevis
samedicino momsaxurebis dawesebulebidan xvdeba. Catareba (magaliTad, nervuli sistemis gamokvleva).
sakonsultacio-kooperaciuli fsiqiatria sul intervius Semdeg, SeiZleba saWiro gaxdes palataSi
ufro metadaa fokusirdeba fsiqiatriuli da fsi momuSave personalisTvis an socialuri muSakebisTvis
qologiuri gamokvlevis Catarebaze da iseTi damatebiTi kiTxvebis dasma, naTesavebis gamokiTxva, an
pacientebis kolaboraciul marTvaze, romlebsac ojaxis eqimTan telefoniT dakavSireba, raTa miviRoT
samedicino TvalsazrisiT auxsneli simptomebi an informacia pacientis socialuri mdgomareobisa da
qronikul somatur daavadebasTan komorbiduli warsulSi fsiqikuri aSlilobis arsebobis Sesaxeb.
fsiqikuri aSliloba axasiaTebT. mTavari amocanaa
klinikuri Canawerebi
is, rom am saxis momsaxureba gavrceldes pirveladi
jandacvis sistemaSi myof amave kategoriis pa gamokvlevis sruli Canawerebi da informatorebisgan
cientebze. miRebuli informacia fsiqiatrma calke unda Seinaxos.
konsultaciis, kooperaciuli fsiqiatriisa da samedicino Canawerebis punqtebi unda gansxvavdebodes
fsiqosomaturi medicinis sakiTxebi ganxilulia Sem fsiqiatriuli Canawerebis punqtebisgan. isini unda
deg wyaroSi: Kornfeld, 2002. iyos mokle da maTSi ar unda iyos gamoyenebuli
fsiqiatriuli terminebi. unda Seicavdes mxolod
fsiqiatriuli konsultacia samedicino iseT informacias, romelic arsebiTi mniSvnelobisaa
garemoSi pacietze mzrunvelobis gamwevi pirebisTvis. same
dicino Canawerebi, ramdenadac es SesaZlebelia,
konsultacia ori komponentisgan Sedgeba: pacientis
ar unda Seicavdes konfidencialur informacias.
gamokvleva da pacientTan da mis eqimTan (romelmac
yuradReba unda iyos gamaxvilebuli praqtikul
igi fsiqiatrTan gadaamisamarTa) komunikacia. am
sakiTxebze da gacemuli unda iyos pasuxi im
SemTxvevaSi iseTive gamokvleva tardeba, rogoric
eqimis kiTxvebze, romelmac pacienti fsiqiatrTan
nebismier sxva SemTxvevaSi, rodesac saWiroa fsiqiatris
gamoagzavna.
konsultaciis miReba, Tumca, am dros aucilebelia
damatebiT gaviTvaliswinoT janmrTelobis zogadi referalze werilobiTi pasuxis gacema
mdgomareoba da Catarebuli mkurnaloba; aseve is,
zogjer, saboloo fsiqiatriuli daskvnis daweramde,
unda Tu ara pacients fsiqiatrTan Sexveda.
swori iqneba, Tu ganvixilavT marTvis gegmas
pirveli nabiji konsultantTan, palatis eqimTan an eqTanTan erTad.
es saSualebas aZlevs fsiqiatrs darwmundes imaSi, rom
mas Semdeg, rac fsiqiatrs mimarTaven konsultaciis
misi rekomendaciebi ganxorcielebadi da misaRebia da
gawevis TxovniT, igi unda darwmundes imaSi, rom
rom is pasuxs scems pacientTan dakavSirebiT dasmul
eqimma, romelmac masTan pacienti gamogzavna, ganixila
kiTxvebs.
pacientTan referalis sakiTxi da rom pacienti
samedicino Canawerebis punqtebi unda Seesaba
Tanaxmaa Sexvdes fsiqiatrs. pacientTan intervius
mebodes zogadi profilis eqimisadmi miwerili we
Catarebamde, fsiqiatri unda gaecnos samedicino
rilis Sesabamis punqtebs (gv. ??). mniSvnelovania
Canawerebs da gaesaubros eqTnebs pacientis fsiqikuri
Tavidanve dadgindes, Tu amJamad ra tipis mkur
mdgomareobisa da qcevis Sesaxeb. fsiqiatrma unda
nalobis Catarebaa rekomendebuli; aseve, saWiroa
gaarkvios, Tu ra mkurnaloba utardeba pacients da,
mivuTiToT, Tu vis mier Catardeba mkurnaloba. Tu
Tu es saWiroa, gaecnos wamlebis gverdiT movlenebs.
gamokvlevis Sedegebi saboloo ar aris iqamde, sanam
gamokvlevisas Catarebuli interviu interviu informatorebTan Catardeba, fsiqiatrma
intervius dasawyisSi fsiqiatrma unda ganumartos unda miuTiTos, Tu rodis gakeTdeba saboloo
pacients, Tu ra mizani aqvs konsultacias. SeiZleba fsiqiatriuli daskvna. man garkveviT unda moaweros
saWiro gaxdes im sakiTxebis garCeva, romlebic xeli Canawers da palatis personals dautovos
_ 413 _
sakuTari an Tavisi asistentis koordinatebi, raTa, SfoTviani pacienti
saWiroebis SemTxvevaSi, mas advilad daukavSirdnen.
panikis Seteva. panikis Setevis somaturi simptomebi
marTva xSirad ganapirobebs pacientis mdgomareobis
imgvar gamovlenas, romelic saWiroebs gadaudebel
iniSneba iseTive mkurnaloba, rogoric fsiqikuri
daxmarebas. gavrcelebuli simptomebia arakardialuri
aSlilobis mqone pacientis SemTxvevaSi, romelic
tkvili gulmkerdis areSi, Cxvletis SegrZneba
fizikurad janmrTelia. fsiqikuri mdgomareobis
kidurebSi da hiperventilaciis efeqti (gv. ??).
samkurnalo medikamentebis daniSvnisas, gansakuTreb
pacientebis umravlesobasTan SesaZlebelia panikis
uli yuradReba unda mivaqcioT pacientis somaturi
epizodis safuZvliani ganxilva. hiperventilaciis
daavadebis zegavlenas medikamentebis metabolizmze,
dros sasargebloa qaRaldis paketSi CasunTqvis
organizmidan gamodevnaze da medikamentebis urTi
teqnikis gamoyeneba. zogjer SfoTvis samarTavad
erTqmedebas sxva preparatebTan, romlebsac im
saWiroa benzodiazepinis mcire dozis gamoyeneba.
periodSi iRebs pacienti. samkurnalo gegma unda
panikuri aSlilobis mkurnalobis dasrulebis Semdeg,
iTvaliswinebdes imas, Tu realurad ra xarisxiTaa
SeiZleba saWiro gaxdes pacientze Semdgomi dakvirveba
SesaZlebeli meTvalyureobis gaweva qiururgiul
(gv. ??).
an Terapiul palataSi myof pacientebze (mag., meT
generalizebuli SfoTvis mZime forma SeiZleba
valyureobis gaweva suiciduri azrebis mqone
arTulebdes nebismier somatur gamovlinebas. ga
pacientze). SeiZleba zogadi profilis saavadmyofoSi
daudebeli samedicino daxmarebis ganyofilebaSi
gamovlenili xanmokle fsiqikuri aSlilobebis marTva
moxvedrisas pacients SeiZleba gauCndes SiSi, rom
fsiqiatris daxmarebiT SeuZliaT eqTnebs, Tumca maT
liT gamowveuli SfoTva SesaZloa gaaZlieros saa
SeiZleba dasWirdeT fsiqiatriaSi specializaciis
vadmyofos personalis reaqciam, romelic kargad ver
mqone eqTnis daxmarebac (es ukanaskneli SeiZleba iyos
acnobierebs pacientis mdgomareobas. Cveulebriv,
sakonsultacio-kooperaciuli gundis wevri).
SfoTva sustdeba, rodesac pacients TanagrZnobiT
uwyveti mzrunveloba ganumartaven arsebul mdgomareobas. zogjer SfoT
fsiqiatrs SeiZleba dasWirdes hospitalizebuli pa vis samarTavad saWiroa benzodiazepinis mcire dozis
cientis mdgomareobis dinamikaze dakvirveba. saavad gamoyeneba.
myofodan gamoweris Semdeg, mniSvnelovania, ar Sewydes
braziani pacienti
pacientze mzrunveloba. swored amitom fsiqiatri
klinicistebisTvis da pacientze mzrunveli sxva
kontaqtSi imyofeba zogadi profilis eqimTan. mo
pirebisTvis usiamovnoa, rodesac pacienti, romlis
cemuli SemTxvevis saWiroebebidan gamomdinare,
daxmarebasac isini cdiloben, maT agresiiT pasuxobs.
mzrunvelobis Semdgom procesze pasuxismgebelia
aseT SemTxvevaSi mTavaria simSvidis SenarCuneba
zogadi profilis eqimi, samedicino gundis wevri
da iseTi saqcielis an sityvebisgan Tavis Sekaveba,
fsiqiatri an TemSi momuSave fsiqiatrTa jgufi.
romlebic kidev ufro metad gaabrazebs pacients. amave
dros, gasaTvaliswinebelia fizikuri usafrTxoebac
zogierTi gadaudebeli SemTxveva
(ix. qvemoT). klinicistma unda gaarkvios, Tu ratom
zogadi midgoma aris pacienti gabrazebuli. zogjer sasargebloa
nebismieri gadaudebeli fsiqiatriuli SemTxvevis komentaris gakeTeba pacientis brazze da misTvis
marTva mniSvnelovnadaa damokidebuli sawyis klinikur pirdapiri kiTxvis dasma imis Taobaze, Tu ra aris
interviuze. pacientis gamosakvlevi nebismeri misi amgvari mdgomareobis mizezi. arasodes ar aris
intervius amocanaa masTan kargi urTierTobis swori brazze braziTve reagireba an pacientis mimarT
damyareba, pacientisa da sxva informatorebisgan morCilebis gamoxatva. Tu, magaliTad, pacients
informaciis miReba da pacientis qcevasa da fsiqikur did xans valodineT, albaT, aucilebelia bodiSi
mdgomareobaze dakvirveba. Sinaganad mtkice, mSvidi da movuxadoT am problemisTvis, ramac misi sibraze
TanamgrZnobi Terapevti xels uwyobs daZabulobisgan gamoiwvia.
Tavisufali atmosferos Seqmnas. es saSualebas aZlevs
mas, gaigos pacientis wuxilis mizezi da SesTavazos mas
agresiuli pacienti
iseTi gegma, pacientisTvis misaRebi iqneba. gadaudebel Tu pacienti realurad an potenciurad agresiulia,
SemTxvevaSi yovelTvis ar aris SesaZlebeli Catardes mniSvnelovania, uzrunvelvyoT sakmarisi xarisxis
pacientis gamosakvlevi sruli interviu, magram is daxmareba, romelic pacientis mier Tavs moxveulad
gegmazomieri da, SeZlebisdagvarad, sruli unda iyos ar unda ganicdebodes. fizikuri kontaqti (fizikuri
(gv. ??). mdgomareobis gamokvleva) ar aris rekomendebuli, Tu
pacients ar esmis gamokvlevis mizani da Tu masTan
_ 414 _
zogadi samedicino procedurebisa da mdgomareobebis fsiqiatriuli aspeqtebi
ver SevTanxmdebiT amis Taobaze. Tu aucilebelia pa-
boqsi 16.3 samedicino-iuridiuli da eTi
cientis fizikuri SezRudva, es swrafad unda gakeT- kuri sakiTxebi: pacientebi, romlebic
des Sesabamisi raodenobis adamianebis mier da Zalis uars amboben rCevis miRebaze gadaudebeli
minimaluri gamoyenebiT. personalma ar unda gamoi- mkurnalobis CatarebasTan dakavSirebiT
yenos erTi xelis moZraobis SezRudvis teqnika. ra w rodesac sococxlisaTvis saSiS viTarebebSi SuZlebe-
Tqma unda, gansakuTrebiT frTxilad unda viyoT im lia pacientisagan Tanxmobis miReba (cnobiereba daq-
SemTxvevaSi, Tu pacients saSiSi iaraRi aqvs. agresi- veiTebulia, SeimCneva fsiqikuri aSlilobis niSnebi,
romelTa gamokvleva im momentSi ver xerxdeba) unda
ul pacientTan dakavSirebuli sakiTxebi ?? gverdzea gavesaubroT eqimebsa da eqTnebs da, Tuki es SesaZle-
ganxiluli. belia, pacientis naTesavebs. miRebuli gadawyvetilebis
mizezebi detalurad unda iyos aRnusxuli. aucilebe-
agznebuli an agresiuli pacientis gadaudebeli lia, rom yvela eqimma icodes, Tu rogori kanonebi mo-
medikamenturi mkurnaloba qmedebs aseT SemTxvevaSi im qveyanaSi, sadac isini mu-
Saoben.
SeSinebul pacientebTan sasargebloa 5-idan 10 mili-
w Tu pacents aReniSneba fsiqikuri aSliloba, romelic
gramamde diazepamis gamoyeneba. ufro agznebuli pa- aqveiTebs mis unars ganacxados informirebuli Tan-
cientebis swrafad dasamSvideblad rekomendebulia xmoba, SeiZleba mizanSewonili iyos gamoviyenoT pa-
2-5 mg haloperidolis kunTebSi inieqcia. saWiroe- cientis mdgomareobis gamokvlevisa da fsiqikuri aS-
lilobis mkurnalobis iZulebiT Catarebis iuridiuli
bis SemTxvevaSi, keTdeba ganmeorebiTi inieqcia. aseT ufleba. britaneTSi, fsiqikuri aSlilobis iZulebiT
dros wamlis dozas, Cveulebriv, maqsimumamde zrd- mkurnalobis ufleba ar aZlevs eqims uflebas umkur-
ian (34 mg-s 24 saaTSi), pacientis sxeulis zomisa da nalos Tanmdev fizikur daavadebas pacientis nebar-
Tvis gareSe. Tumca, fsiqikuri aSlilobis warmatebuli
fizikuri mdgomareobis mixedviT. rodesac pacienti mkurnalobis Semdeg, pacientma, SeiZleba, ganacxados
zedmetad agznebulia an mZime distresSi imyofeba, informirebuli Tanxmoba somaturi daavadebis mkuran-
SeiZleba efeqturi iyos haloperidolis da benzo- lobaze.
diazepinis kombinacia. pacientis damSvidebis Semdeg, micema, maSin did britaneTSi da bevr sxva qveyanaSic,
SeiZleba gavagrZeloT haloperiodolis ufro mci- pacientze pasuxismgebel eqims ufleba aqvs Caataros
re dozebiT mkurnaloba (Cveulebriv, orjer-samjer gadaudebeli mkurnaloba sicocxlisTvis saxifaTo
dReSi), dasalevi siropis saxiT, Tu pacients uWirs momentebSi. am sakiTxis samedicino da iuridiuli
abebis gadaylapva. dozireba damokidebulia pacien- aspeqtebi ganxilulia boqsSi 16.3.
tis wonaze da imaze, Tu rogoria misi sawyisi reaqcia. intensiur palataSi fsiqiatriuli sindromebis
mkurnalobis ganmavlobaSi eqTnebi yuradRebiT unda marTva ganxilulia bolandisa da misi kolegebis
akvirdebodnen pacientis fsiqikur mdgomareobas da mier (Boland et al., 2000), xolo somaturi daavadebis
qcevas. SeiZleba saWiro gaxdes parkinsonis sawinaaR- mqone pacientebis movlasTan dakavSirebuli eTikuri
mdego preparatebis gamoyeneba, eqstrapiramiduli sakiTxebi streinisa da misi kolegebis naSromSia mo-
gverdiTi efeqtebis samkurnalod (gv. ??). cemuli (Strain et al., 2000).
problemebi, romlebic ukavSirdeba

zogadi samedicino procedurebisa
mkurnalobaze Tanxmobis gacemas
da mdgomareobebis fsiqiatriuli
ZiriTadi principebi, romlebic dakavSirebulia
aspeqtebi
mkurnalobaze Tanxmobis gacemasTan, me-4 TavSia ganx-
iluli. zogjer fsiqiatrebs rCevas ekiTxebian iseT genetikuri konsultacia
pacientebTan dakavSirebiT, romlebic uars amboben genetikuri konsultacia reproduqciul risksa da
Terapiuli an qirurgiul mkurnalobaze. arsebobs memkvidreobiT daavadebebTan dakavSirebiT ZiriTa-
ramdenime mizezi, ris gamoc pacientma SeiZleba uari dad unda gavuwioT im wyvilebs, romlebic fiqroben
Tqvas daniSnul mkurnalobaze. pacients SeiZleba ar daqorwinebas an elodebian bavSvs. am konsultaciis
esmodes misTvis miwodebuli informacia, an is Sei- gaweva ufro iolia, Tu Catarebulia im saxis winas-
Zleba SeSinebuli an gabrazebuli iyos. zogjer mas wari testireba, romelic minimumamde daiyvans dis-
aqvs iseTi fsiqikuri daavadeba, romelic xels uSlis tress (boqsi 16.4). konsultaciis dros pacients
mas, miuxedavad informirebulobisa, miiRos gadaw- w awvdian informacias riskis Sesaxeb;
yvetileba.
w exmarebian imaSi, rom man moaxerxos diagnozTan
saR gonebaze myof, fsiqikurad janmrTel zrdas-
dakavSirebuli wuxilis daZleva;
rul pirs ufleba aqvs uari Tqvas mkurnalobaze,
mkurnalobis Catarebis mizezebis srulad da racio- w saSualebas aZleven, miiRos informirebuli gadaw
nalurad ganxilvis Semdegac ki. rodesac pacients yvetileba ojaxis dagegmvis Taobaze.
Tavisi mdgomareobis gamo ar SeuZlia Tanxmobis konsultacia aradireqtiuli unda iyos. wyvilebs
_ 415 _
eZlevaT saSualeba, mocemuli momentisTvis arsebuli
boqsi 16.4 genetikuri testirebis
sruli informaciis mopovebis Semdeg, Tavad mi warmatebuli praqtika
iRon gadawyvetileba. konsultaciis Catareba gan
w testirebis programis dawerili protokoli, romel
pirobebulia Semdegi mizezebT: SfoTvis gancda
Sic asaxulia rogor unda Catardes laboratoriuli
prenataluri testebis Sedegebis molodinSi; gancdebi, testireba da rogor warimarTeba pacientTan
romlebic Tan axlavs samedicino mizezebiT Sewyvetil urTierToba.
orsulobas, Sewyvetamde da mis Semdeg; pirovnebas w advilad gasagebi informacia. sanam pirovnebas vTxovT
aRelvebs, Tu ramdenad aris is memkvidreobiTi miiRos gadawyvetileba testirebis Catarebaze, mas
kargad unda avuxsnaT, Tu raSi mdgomareobs gamokvlevis
daavadebis matarebeli da imyofeba Tu ara misi Svili upiratesoba, gamokvlevis uaryofiTi mxareebi da,
aseTi daavadebis ganviTarebis riskis qveS. agreTve, yvela SesaZlo Sedegis mniSvneloba.
Cveulebriv, konsultacia pacientis SfoTvis Sem w sakmarisi dro gadawyvetilebis misaRebad. testirebis
cirebisa da misi damSvidebis SesaZleblobas iZleva. Catarebis SeTavazeba unda moxdes erTi, an ramdenime
dRiT adre biologiuri nimuSebis aRebamde.
aseve, aucilebelia davexmaroT wyvilebs Tvali
w aucilebelia Sedegebis axsna-ganmarteba da mxarda
gausworon distresul faqtebs da miiRon rTuli Weris aRmoCena testirebagavlili pirebisa da maTi
gadawyvetilebebi. am SemTxvevaSi aucilebelia vi naTesavebisaTvis
codeT, Tu rogoria mocemuli wyvilis zogadi w programis Sefaseba. unda Sefasdes testirebis pro-
viTareba, ra rwmenebi da Sexedulebebi aqvT maT da, gramis efeqturoba im TvalsazrisiT, Tu ramdenad
aadvilebs is im qcevis gagebasa da xelSewyobas,
agreTve, gaviTvaliswinoT is, Tu ra Sedegebi SeiZleba
romelic mimarTulia riskis Semcirebaze Zlieri
mohyves maTTvis am saxis informaciis miwodebas. distresis gamowvevisa da pacientis usafuZvlod
riskis Sesaxeb informaciis miwodebis Semdeg, damSvidebis gareSe.
konsultanti unda moeTaTbiros wyvilebs moqmedebis
alternatiuli gzebis Sesaxeb. aq igulisxmeba efeqturi boqsi 16.5 genetikuri konsultacia: zogi
kontracefcia da drouli prenataluri diagnozi, erTi eTikuri da samarTlebrivi sakiTxi
orsulobis Sewyvetis SesaZleblobis CaTvliT. or w Tanxmoba testirebis Catarebaze
sulobis Sewyvetis Sesaxeb gadawyvetilebis miReba Zalian w testis Sedegebis konfidencialoba
mZimea, gansakuTrebiT im wyvilebisTvis, romlebsac w Svilebi. zogadad miRebulia, rom bavSvebze testireba
ukve hqondaT paTologiuri orsulobis SemTxveva. Catardes im asakSi, rodesac isini sakmarisad mzad
bevri aseTi wyvili mainc iRebs gadawyvetilebas, arian gadawyvetilebis misaRebad.
SeinarCunos orsuloba, miuxedavad imisa, rom icis w genetikuri informaciis Senaxvisa da gamoyenebis dacu-
lobis garantiebi
Svilis mosalodneli daavadebis maRali riskis Sesaxeb.
w Sedegebis ufro zogadi mniSvneloba, maT Soris sico-
Zalian mZimea imis gageba, rom Svils axasiaTebs cxlis dazRvevis CaTvliT
genetikuri mowyvladoba garkveuli daavadebebis
mimarT, magram am gancdiT gamowveuli distresi, ara pirovneba skrinings; arian Tu ara skriningisTvis
Cveulebriv, ar utoldeba Tavisi simZimiT fsiqikur mosul pacientebs Soris iseTebi, romlebSic aseTi
aSlilobas. da mainc, aseTi pacientebis nawils gamocdileba iwvevs distress. adamianebis umetesoba
sWirdeba konsultacia; aseve, maTi ojaxis wevrebsac, kargad umklavdeba skriningis dadebiT Sedegebs.
romelTac Seityves testirebis Sedegebi. uaryofiTi Sedegi yovelTvis ar amcirebs SfoTvas
gadawyvetilebebi genetikuri konsultaciis moc da skriningma SeiZleba gazardos janmrTelobasTan
emuli da sxva aspeqtebis Sesaxeb unda iTvaliswinebdes dakavSirebuli SiSi, gansakuTrebiT im adamianebSi,
eTikis principebs. zogierTi zogadi xasiaTis eTikuri romlebic Semdgom gamokvlevas saWiroeben. fsiqiatrebi
problema CamoTvlilia boqsSi 16. 5. monawileoben skriningis programebSi. isini CarTulebi
genetikuri darRvevebis testirebis fsiqologiuri arian personalis treningis programebSi, exmarebian
aspeqtebi ganxilulia Semdeg naSromSi: Svenson and eqimebs pacientebisTvis misawodebeli informaciis
Folstein, 2000. formulirebaSi; agreTve, utareben gamokvlevasa da
mkurnalobas mZime distresis mqone pacientebs (Rimes
daavadebis skriningi and Salkovski, 2000).
presimptomuri (adreuli) skriningi gulisxmobs pre
qirurgiuli Carevis fsiqiatriuli aspeqtebi
natalur (nayofis) skrinings nayofis arasrul
fasovnebis gamosavlenad; agreTve, sarZeve jirkvlisa operaciamdeli problemebi
da saSvilosnos yelis avTvisebiani simsivnisa da qirurgiuli Carevis molodinSi myof pacientebs
hipertenziis skrinings. skriningis nebismieri programis xSirad aReniSnebaT SfoTva. im pacientebis ume
warmateba, nawilobriv, damokidebulia fsiqologiur tesobas, romlebic gansakuTrebiT SfoTaven ope
faqtorebze, romlebic gansazRvraven: mimarTavs Tu raciamde, operaciis Semdegac aReniSnebaT Zlieri
_ 416 _
SfoTva. gamokvlevaTa umetesoba, romelic exe eTi qirurgiuli operaciebis Semdeg, romlebsac ar
ba qirurgiuli operaciisTvis fsiqologiur mom mohyveba mosalodneli gaumjobeseba. fsiqiatrebis
zadebas, gviCvenebs, rom mosamzadebeli periodi Careva, aseve, saWiroa maSin, rodesac qirurgiuli
amcirebs postoperaciuli distresis ganviTarebas, operacia tardeba recidivis mkurnalobis mizniT,
gansakuTrebiT maSin, rodesac mosamzadebel periodSi agreTve, qronikuli an progresirebadi daavadebebis
mimdinareobs muSaoba gamklavebis saSualebaTa dros. fsiqiatrebs SeuZliaT daxmarebis gaweva im
gaumjobesebaze. fsiqosocialuri faqtorebis aRmoCenaSi, romle-
operaciis win, SesaZloa, saWiro gaxdes, rom pa bic aferxeben adaptacias, xels uwyoben pacients _
cienti fsiqiatrma gamoikvlios. am saWiroebas Semdegi gadaWras an Seeguos problemas. zogierT pacients
mizezebi ganapirobebs: sWirdeba antidepresantebiT mkurnaloba (Rodin and
w pacientis fizikur CivilebSi emociuri faqtoris Abbey, 2000; Stoddard et al., 2000).
gacnobiereba;
plastikuri qirurgia
w ar aris naTeli, rogoria pacientis kognituri md-
gomareoba da aqvs Tu ara mas unari, ganacxados in- fizikuri naklis mqone adamianebi xSirad grZno-
formirebuli Tanxmoba; ben uxerxulobas da ganicdian distress, rac mniS-
vnelovnad zRudavs maT cxovrebas, rogorc bavS-
w daxmareba mimdinare fsiqiatriuli problemebis
vobisas, aseve zrdasrul asakSi. Tu aseTi pacienti
marTvaSi;
fsiqikurad janmrTelia, plastikur operacias dadeb-
w daxmareba operaciaze avadmyofis reaqciis prog- iTi Sedegi mohyveba. maSinac ki, rodesac garegnuli
nozirebaSi. agreTve, fsiqiatri uzrunvelyofs obieqturi defeqti SeSfoTebis safuZvels ar iZleva,
imas, rom pacientma iTanamSromlos samedicino per- cxviris, saxisa da mkerdis plastikuri operaciebi,
sonalTan postoperaciuli mkurnalobisa da re- Cveulebriv, warmatebulia. da mainc, fsiqologiurma
abilitaciis procesSi. gamokvlevam SeiZleba Tavisi wvlili Seitanos plas-
fsiqiatriuli problemebi postoperaciul tikur operaciamde Catarebul gamokvlevaSi. aRsaniS-
periodSi navia, rom dadebiTi Sedegi ar aris mosalodneli is-
eTi pacientebis SemTxvevaSi, romlebsac aReniSnebaT
deliriumi garegnobasTan dakavSirebuli bodva, dismorfofobia,
didi qirurgiuli operaciebis Semdeg, gansakuTrebiT Zlieri ararealisturi molodini an ukmayofileba
xandazmuli pacientebis SemTxvevaSi, ZiriTad gar- wina operaciis gamo (Sarwer et al., 1998).
Tulebas deliriumi warmoadgens (Brown and Boyle,
2002). ganviTardeba Tu ara deliriumi, es damokide- kiduris amputacia
bulia qirurgiuli Carevis tipze, anesTeziis tipze, axalgazrda da xandazmul pacientebSi kidurebis
postoperaciuli fizikuri garTulebebis arsebobasa amputacias gansxvavebuli fsiqologiuri Sedegebi
da medikamenturi mkurnalobis tipze. axlavs. axalgazrdebi, romlebsac kiduri aqvT ampu-
deliriumi asocirdeba sikvdilianobis maRal risk- tirebuli (sagzao SemTxvevis an samxedro moqmedebis
Tan da avadmyofis hospitalizaciis gaxangrZlivebas- gamo), Cveulebriv, Tavidan iZlevian uaryofiT reaq-
Tan. cias, rasac SeiZleba mohyves depresia da fantomuri
tkivilebi. bavSvebsa da mozardebSi igive Sedegebia
tkivili
mosalodneli. xandazmul adamianebs, Cveulebriv,
fsiqiatrebs xSirad mimarTaven konsultaciisTvis
amputacia utardebaT sisxlZarRvebis daavadebiT
maSin, rodesac avadmyofs aReniSneba operaciis Sem-
gamowveuli, xangrZlivi problemebis Semdeg. aseTi pa-
dgomi uCveulod mZime tkivilebi. pacientebi, rom-
cientebi, zogadad, ar ganicdian distress uSualod
lebsac ufro meti saSualeba eZlevaT, dagegmon anal-
operaciis Semdeg, magram xSirad awuxebT fantomuri
getikebis miRebis perioduloba, Cveulebriv, nakleb
tkivilebi. zogierTs aReniSneba proTezTan dakav-
tkivils ganicdian da naklebad iReben analgetikebs.
Sirebuli problemebi da fizikuri mdgomareobis Seu-
zogierTTan iyeneben SfoTvis marTvas, zogs ki aswav-
sabamo funqcionaluri uunaroba.
lian sibrazis marTvas, romelic SeiZleba saavadmyo-
fos personalTan uTanxmoebiT iyos gamowveuli.
organoTa transplantacia
qirurgiuli operaciis Semdgomi, xangrZlivi am saxis operaciebTan asocirebulia mniSvnelovani
fsiqologiuri problemebi fsiqiatriuli Sedegebi, romlebic damokidebulia
adaptaciuri problemebis regulireba gansakuTrebiT qirurgiuli operaciis xasiaTze, agreTve, imaze, es-
mniSvnelovania masteqtomiis, laringeqtomiisa da is- aWiroebaT Tu ara SemdgomSi avadmyofebs uwyveti da
_ 417 _
intensiuri samedicino movla. diabetiT daavadebuli adamianis problemebi
organoTa SerCeva transplantaciisTvis. SerCevis
diabetiT daavadebuli adamianis fsiqologiur da so-
procesi SeiZleba stresuli aRmoCndes. pacientisT-
cialur problemebs SeiZleba ganapirobebdes dieta da
vis, aseve, stresulia imis molodini, Tu rodis gax-
aqtivobis SezRudva, sakuTari Tavis movlis aucile-
deba misTvis xelmisawvdomi Sesaferisi organo. viTa-
bloba da iseTi seriozuli fizikuri garTulebebi,
reba ufro martivia Tirkmlis transplantaciis Sem-
rogoricaa sisxlZarRvovani daavadebebi da mxedv-
TxvevaSi, radgan alternativa
elobis daqveiTeba. miuxedavad imisa, rom diabetiT
dializis gagrZelebaa. aseT operaciebTan dakav-
daavadebuli adamianebis umravlesoba umklavdeba
Sirebuli fsiqologiuri ukuCvenebebi bevri ar aris.
am saxis problemebs, anu adaptacias axdens maTTan,
maTi umravlesoba xangrZlivi postoperaciuli peri-
mniSvnelovan umciresobas aReniSneba siZneleebi. te-
odis moTxovnebTan gamklavebis uunarobasTanaa daka-
stirebis Catarebis, dietisa da insulinis miRebis re-
vSirebuli.
Jimis dacva xSirad ar aris damakmayofilebeli. aseT
transplantaciis operaciis Semdgom periodSi
SemTxvevebSi glikemiis kontroli ar aris optimal-
gvxvdeba igive fsiqiatriuli da emociuri xasiaTis
uri. am tipis problemebi, savaraudod, ufro mozard-
problemebi, rogorebic sxva didi operaciebis Sem-
ebTanaa mosalodneli.
degaa. gansakuTrebiT xSiria SfoTva, deliriumi da
depresia. arsebobs, agreTve, problemebi, romlebic sxva problemebi
specifikurad ukavSirdeba garkveuli tipis trans- diabetTan dakavSirebuli kvebiTi aSliloba. diabetis
plants. magaliTad, RviZlis transplantacias Tan kontroli ufro rTulia, rodesac diabetiT daa-
axlavs maqsimaluri neirofsiqiatriuli garTulebebi vadebul pirovnebas kvebiTi aSliloba aqvs. arsebobs
operaciamde da mis Semdeg. SemTxvevebi, rodesac diabetiT daavadebuli qalebi,
es problemebi sakmarisad xSiri da seriozulia, rac romelTac, amave dros, kvebiTi aSlilobac aqvT,
imaze migvaniSnebs, rom aucilebelia fsiqiatrebis borotad moixmaren insulins wonaSi daklebis mizniT.
TanamSromloba transplantaciis centrebTan, sadac diabetTan dakavSirebuli samedicino garTulebebi.
isini SeZleben samedicino personalis daxmarebas da fsiqosocialuri problemebi ufro metad axasiaTebT
maT momzadebas, raTa SeZlon pacientebis amgvari im avadmyofebs, romelTac aReniSnebaT diabetiT
problemebis gamovlena da maTze saTanado reagireba. gamowveuli mZime garTulebebi: mxedvelobis dakarg-
transplantaciis fsiqiatriuli aspeqtebi ganxilu- va, Tirkmlis ukmarisoba da sisxlZarRvovani daavade-
lia Semdeg wyaroSi: Trzepacz and Di Martini (2000); House bebi.
(2000). seqsualuri problemebi. seqsualuri problemebi
tipiuria diabetiT daavadebuli avadmyofebisTvis.
diabeti diabetiT daavadebul mamakacebSi ori tipis impoten-
Saqriani diabeti cia gvxvdeba. pirveli aris fsiqogenuri impotencia,
romelic sxva qronikuli daavadebebiT dauZlurebul
diabeti qronikuli mdgomareobaa, romelic moiTxovs
avadmyofebsac aReniSnebaT. meore tipi metad dam-
xangrZliv samedicino dakvirvebas da sakuTari Ta-
axasiaTebelia diabetisTvis da SesaZloa win uswreb-
vis movlis codnas. bevri eqimi gansakuTrebul yur-
des daavadebis sxva gamovlinebebs. iTvleba, rom igi
adRebas aqcevs diabetis mkurnalobis fsiqologiur
dakavSirebulia menjis avtonomiur neiropaTiasa da
aspeqtebs.
vaskulitTan, raSic, SeiZleba endokrinuli faqtore-
fsiqologiuri faqtorebi da diabetis kontroli bi garkveul rols TamaSobdes.
Camoyalibebuli diabetisTvis mniSvnelovania orsuloba. orsuloba rTuli periodia diabetiT
fsiqologiuri faqtorebi, radgan isini zemoqmedeben daavadebuli qalebisTvis, romelTac uWirT diabetis
mis kontrolze. dReisTvis dadgenilia, rom sisxlSi kontroli da orsulobis Sewyvetisa da nayofis aras-
glukozis donis kontroli yvelaze mniSvnelovani wori ganviTarebis riskis qveS imyofebian.
damoukidebeli faqtoria Semdgomi garTulebebis
organuli fsiqiatriuli sindromebi diabetis
prevenciisTvis. fsiqologiur faqtorebs SeuZlia mqone pacientebSi
kontrolis ori gziT Sesusteba: pirveli, stress
deliriumi. zog SemTxvevaSi, diabeturi koma SeiZle-
SeuZlia gamoiwvios endokrinuli cvlilebebi. meo-
ba, upirveles yovlisa, darRveuli qcevis epizodSi
rec, diabetis mqone bevri avadmyofi kargad ver icavs
gamoixatos, romelic myisierad an farulad iwyeba.
mkurnalobis reJims, gansakuTrebiT, stresuli mdgo-
aseTi qcevis mizezi naTeli xdeba mas Semdeg, rac
mareobebis dros da swored es xdeba e.w. `labiluri~
gamovlindeba diabetisTvis damaxasiaTebeli sxva pro-
Saqriani diabetis ganviTarebis mizezi.
dromuli simptomebi, rogorebicaa wyurvili, Tavis
_ 418 _
daavadebis marTvis fsiqiatriuli aspeqtebi

boqsi 16.6 sxva endokrinul darRvevaTa
fsiqiatriuli aspeqtebi da steroidebiT depresiuli aSlilobis dros Semdeg saSualebebs
mkurnaloba. mimarTaven: depresiuli aSlilobis mkurnalobas;
hiperTireoidizmi (Tireotoqsikozi). fsiqiatriul simp- sisxlSi glukozis donis gazomvis mniSvnelobis gac-
tomebTan erTad xSirad vxvdebiT Semdeg simptomebs: nobierebas, raTa gaumjobesdes da dastabilurdes
SfoTva, gaRizianebadoba, emociuri labiluroba da yura-
sisxlSi glukozis Semcveloba; sxeulis wonis mar-
dRebis koncentraciis problemebi. Tu zemoTCamoTvlil
simptomebs Tan erTvis hiperaqtiuloba, daRlilobis Tvas; kognitur-biheviorul midgomas sakuTari Ta-
SegrZneba da tremori, sakmaod rTuli xdeba diferen- vis movlis xarisxis gasaumjobeseblad; daxmarebas
cialuri diagnozis gatareba SfoTviT aSlilobebTan. fsiqosocialuri problemebis gadaWraSi da seqsual-
Cveulebriv, Tiroiduli disfunqciis mkurnaloba xels
uwyobs fsiqikuri simptomebis gaumjobesebas. uri disfunqciis mkurnalobas.
hipoTireoidizmi (miqsedema). am dros, Cveulebriv, gvxvde- tricikluri antidepresantebi SeiZleba gamoviye-
ba kognituri funqciis gauareseba da sxva fsiqikuri aS- noT neiropaTiiT gamowveuli tkivilis gasayuCeblad.
lilobebi. guneb-ganwyobis aSlilobas, SesaZloa, hqondes insulin-damokidebuli diabetiT daavadebuli pacien-
swrafad cvalebadi cikluri forma. (ix.gv.???? )Canacvle-
biTma Terapiam SeiZleba Seasustos guneb-ganwyobis simp-
tebis fsiqologiuri momsaxureba ganxilulia Semdeg
tomebi, magram neiro-fsiqiatriuli problemebi SesaZle- wyaroSi: Jacobson, 1996.
belia kvlavac grZeldebodes (Dugbartey, 1998).
hiperadrenalinizmi (kuSingis sindromi). am dros ZiriTa- sxva endokrinuli aSlilobebi
dia depresiuli simptomebi. maTi simZime ar aris mWidro
kavSirSi sisxlis plazmaSi kortizolis SemcvelobasTan. fsiqikur aSlilobebs Tan sdevs mravali saxis en-
pirovnuli faqtorebi da stresis Semcveli movlenebi dokrinuli darRveva. maT Soris, yvelaze xSiria
SeiZleba garkveul rols TamaSobdnen. samedicino as- farisebri jirkvlis disfunqcia.
peqtebis gakontrolebasTan erTad Cveulebriv swrafad
umjebesdeba fsiqologiuri simptomebi. gansakuTrebiT boqsSi 16.6 Sejamebulia xSiri Tanmxlebi daavadebe-
mZime daavadebebis dros SesaZloa Tavi iCinos paranoi- bi da, agreTve, mocemulia steroiduli preparatebiT
dulma simptomebma. (W.F. Kelly, 1996; Sonino and Fava, 1998). mkurnalobis aspeqtebi.
steroiduli preparatebiT mkurnaloba. steroiduli endokrinul darRvevaTa fsiqiatriuli aspeqtebi
preparatebiT mkurnalobisas xSiria afeqturi simptomebi;
gansakuTrebiT, eiforia an sustad gamoxatuli mania.
ganxilulia Semdeg wyaroSi: Kornstein et al., 2000.
paranoiduli simptomebi naklebadaa damaxasiaTebeli.
fsiqikuri aSlilobis simZime ar aris mWidro kavSirSi sxva metaboluri da autoimunuri
steroidebis dozebTan. simptomebi, Cveulebriv, darRvevebi
umjobesdeba dozebis Semcirebisas, magram mZime
mdgomareobis dros avadmyofs SeiZleba SevTavazoT porfiriebis, sarkoidozis, sistemuri wiTeli mglu-
liTiumiT profilaqtika. es xdeba im SemTxvevaSi, rodesac rasa da mZime miasTeniis fsiqiatriuli aspeqtebi ganx-
guneb-ganwyobis gakontrolebis Semdeg avadmyofi ilulia Semdeg wyaroSi: New Textbook of Psychiatry; Sec-
saWiroebs steroidebiT mkurnalobis gagrZelebas.
kortikosteroidebiT mkurnalobis uecarma Sewyvetam tion 5.3.4. (Gelder et al., 2000).
SeiZleba gamoiwvios leTargia, sisuste da saxsrebis tki-
vili. kardialuri darRvevebi
anaboluri steroidebi. anabolur-androgenuli steroi-
mravali wlis ganmavlobaSi emociuri xasiaTis dar-
debi farTod gamoiyeneba sportsmenebis mier. am prepara-
tebis moxmarebisas aRwerilia guneb-ganwyobis aSliloba Rvevebi ganixileboda, rogorc gulis iSemiuri daa-
da agresiulobis mateba (Wroblewska, 1997; W.F. Keely, 1996; vadebis winaswari dispozicia. dunbarma (Dunbar, 1954)
Sonino and Fava, 1998).
aRwera `pirovnebis koronaruli tipi~. uaxlesi kv-
levebi Seiswavlis gulis iSemiuri daavadebis ganvi-
tkivili, tkivili muclis areSi, gulis revis SegrZne-
Tarebis ramdenime SesaZlo risk-faqtors. maT Sori-
ba, pirRebineba. pulsi aCqarebulia, xolo arteriuli
saa qronikuli emociuri aSliloba, socialuri da
wneva _ dabali. avadmyofs aReniSneba dehidrataci-
ekonomiuri warumatebloba, Zlieri datvirTva da
is niSnebi. SesaZlebelia pacientis mier amonasunTq
sxva saxis qronikuli stresi; agreTve, e.w. A tipis
haerSi acetonis suni SevigrZnoT.
qceviTi paterni. es ukanaskneli moicavs agresiulo-
kognituri fuqnciis qronikuli daqveiTeba. qroniku-
bas, konkurenciis Zlier draivs, ambiciurobas, drois
li diabetis mqone avadmyofebisTvis aseve damaxasiaTe-
qronikuli ukmarisobis SegrZnebas da Zlier wuxils
belia msubuqi demencia. misi gamomwvevi mizezia hipog-
imis gamo, rom dadgenil vadebSi SeiZleba ver moxerx-
likemiis ganmeorebadi SemTxvevebi, an Tavis tvinis sisx-
des amocanis Sesruleba (Friedman and Rosenman, 1959).
lZarRvebis sklerozi (Tavis tvinis arteriosklerozi).
miuxedavad imisa, rom qcevis A tipi iTvleba gulis
ufro mZime demencia SeiZleba ganuviTardeT im pacien-
iSemiuri daavadebis damoukidebel risk-faqtorad,
tebs, romlebsac, aseve, aReniSnebaT demenciasTan daka-
uaxlesi monacemebi saeWvos xdis amas.
vSirebuli cerebrovaskuluri daavadeba.
_ 419 _
gulis stenokardiuli Seteva sikvdilianobis SemTxvevaTa zrda, mohyva specialuri

gamokvlevebi, romlebsac unda SeefasebinaT depresiis
gulis stenokardiul Setevas xSirad win uZRvis is-
mkurnalobisa da socialuri izolaciis Semcirebis Sede-
eTi emociuri mdgomareobebi, rogorebicaa SfoTva,
gebi. kognitur-bihevioruli Terapia (Berkman et al., 2003)
sibraze da agzneba. es aris SiSis-momgvreli simptomi.
da antidepresantuli medikamentebi (Glassman et al., 2002)
zogierTi pacienti zedmet sifrTxiles iCens, miuxe-
efeqturia miokardiumis infarqtis Semdgomi depresiis
davad imisa, rom mas amSvideben da mouwodeben, Sein-
samkurnalod, magram es ver amcirebs sikvdilianobis Sem-
arCunos cxovrebis normaluri riTmi.
TxvevaTa raodenobas (Frasure-Smith et al., 1997).
gulis stenokardiul Setevas zogjer Tan axlavs
atipiuri tkivili mkerdis areSi da sunTqvis ukmari- arakardialuri tkivili gulmkerdis areSi
soba, rac gamowveulia SfoTviT an hiperventilaciiT.
aSS-Si, samoqalaqo omis periodSi da kostam (Da Costa,
stenokardiuli Setevis sawinaaRmdego medikamentur
1871) aRwera mdgomareoba, romelsac `gaRizianebuli
mkurnalobaze fokusirebis nacvlad, Zalian mniS-
guli~ uwoda. am sindromis dros avadmyofi darwmune-
vnelovania yuradReba gavamaxviloT misi mizezebis
bulia imaSi, rom misi guli daavadebulia. mas aReniS-
dadgenaze.
neba gaZlierebuli guliscema, sunTqvis ukmarisoba,
miokardiumis infarqti daRliloba da tkivili gulmkerdis areSi. simptomTa
am kombinacias, aseve, ewodeba: `gulis muSaobis aSli-
pacientebi ZiriTadad, uaryofen miokardiumis in-
loba~, `neirocirkularuli asTenia~ da `daZabvis sin-
farqtis adreul simptomebs, ris gamoc gviandeba
dromi~. es simptomebi Tavidan miiCnies gulis funqci-
mkurnalobis daniSvna. hospitalizaciis pirvel dRee-
uri darRvevebis maCveneblebad.
bSi wamyvani simptomebia mwvave organuli fsiqikuri
gulis daavadebis gareSe arsebuli arakardialuri
aSliloba da SfoTva.
tkivili gulmkerdis areSi, romelsac Tan axlavs
uaxlesi gamokvlevebi fokusirebulia im ukve dad-
sunTqvis ukmarisoba da gaxSirebuli guliscema, Za-
genil monacemebze, rom depresia, SfoTva da social-
lian gavrcelebulia pirveladi samedicino dax-
uri izolacia miokardiumis infarqtiT gamowveu-
marebisa da kardiologiuri poliklinikebis pacien-
li sicocxlis dabali xarisxis (Ruo et al., 2003) da
tebSi. pacientTa umravlesoba mSviddeba safuZvliani
sikvdilianobis (Frasure-Smith, 1993, 2000) mniSvnelovani
gamokvlevebis Catarebis Semdeg, magram mniSvnelovan
risk-faqtorebia.
umciresobasTan kvlav gvxvdeba fizikuri da fsiqi-
miokardiumis infarqtis gadatanis Semdeg zogierT
kuri xasiaTis Civilebi da yoveldRiur aqtivobaTa
pacients aReniSneba kognituri disfunqcia. rodesac
SezRudva. Semdgomma dakvirvebebma im pacientebze,
disfunqcia msubuqia, SemdgomSi is SeiZleba gamov-
romlebsac aReniSnebaT tkivili gulmkerdis areSi
lindes pirovnuli cvlilebebis an qceviTi simptom-
da normaluri koronaruli angiograma, aCvena, rom
ebis saxiT, romlebic SeiZleba mcdarad miviCnioT
maTTan mosalodnelze odnav ufro xSiria gulis
emociur reaqciad gadatanil daavadebaze.
daavadebebi da amiT gamowveuli gardacvalebis Sem-
saavadmyofodan dabrunebis Semdeg, pacientebi
Txvevebi, magram persistentuli unarSezRuduloba
xSirad uCivian iseT araspecifikur simptomebs, ro-
gavrcelebul movlenas warmoadgens.
gorebicaa daRliloba, uZiloba, koncentraciis
atipiuri kardialuri simptomebi, SeiZleba
unaris daqveiTeba. aseve, aRiniSneba somatur simp-
gamowveuli iyos mravali mizeziT, maT Soris tki-
tomebze zedmeti koncentracia da gansakuTrebuli
viliT, romelic aRmocendeba mkerdis ZvalSi, say-
sifrTxilis gamoCena fizikuri datvirTvis mimarT.
lapavi milis refluqsiTa da spazmiT, mikrovasku-
Tumca, pacientebis umravlesoba umklavdeba am prob-
laruli warmoSobis gulis tkiviliT, mitraluri
lemebs da ubrundeba srulyofil, aqtiur cxovre-
sarqvelis prolapsiTa da fsiqikuri aSlilobiT.
bas. maTi mxolod mcire nawili agrZelebs cxovrebas
pacientebis umravlesobaSi tkivils gulmkerdis
fizikur statusTan Seusabamo emociuri distresiTa
areSi SeiZleba iwvevdes umniSvnelo arakardialuri
da socialuri unarSezRudulobiT, rasac xSirad Tan
fizikuri mizezebi an hiperventilacia, rac mcdarad
sdevs atipiuri somaturi simptomebi. msgavsi prob-
miiCneva gulis daavadebad da SfoTvasTan aris aso-
lemebi ufro damaxasiaTebelia xangrZlivi fsiqi-
cirebuli. etiologia igivea, rac medicinaSi arse-
kuri an socialuri problemebis mqone pacientebisT-
buli sxva auxsneli simptomebis SemTxvevaSi (gv. ??).
vis; aseve, iseT ojaxebSi mcxovrebi adamianebisTvis,
Cveulebriv am simptomebis fsiqiatriuli Tanmdevia
romelTa ojaxis wevrebi zedmet mzrunvelobas iCenen
panikuri aSliloba. naklebad gvxvdeba depresiuli
avadmyofis mimarT da imaTTvisac, vinc garTulebebiT
aSliloba da ipoqondria.
mimdinare miokardiumis infarqti gadaitana.
daavadebis marTva unda ganxorcieldes ?? gverdze
im dakvirvebas, rom depresiasa da socialur izola-
aRwerili zogadi principebis gaTvaliswinebiT. gan-
cias Tan sdevs miokardiumis infarqtiT gamowveuli
_ 420 _
sakuTrebuli yuradReba unda mivaqcioT hiperven- lebsac sibrmave mogvianebiT ganuviTardaT, xSirad
tilaciis mkurnalobas, aqtivobis safexurebriv zr- aqvT misiT gamowveuli seriozuli distresi. sawyis
das da tkivilis warmoSobis Sesaxeb pacientis azris etapze xSiria uaryofa da Semdgomi depresia, agreTve,
ganxilvas. SesaZloa, kognitur-bihevioruli Terapia gaxangrZlivebuli adaptaciuri xasiaTis sirTuleebi
efeqturi iyos hiperventilaciiT mimdinare SfoT- (Fitzgerald and Parkes, 1998).
vis mkurnalobisas. antidepresiuli medikamenturi
mkurnaloba naCvenebia depresiuli aSlilobebis dros infeqciebi
(Chambers et al., 1999). mwvave infeqciebi. mravalma fsiqologiurma faqtorma
SeiZleba imoqmedos mwvave infeqciuri daavadebis Sem-
sensoruli aSlilobebi dgom gamojanmrTelebis procesze (Hotopf et al., 1996).
adreul klasikur gamokvlevebSi fsiqologiuri tes-
siyrue
tebi Cautarda 600 adamians, romlebsac momavalSi
siyrue SeiZleba ganviTardes metyvelebis daswav- ganuviTardaT aziuri gripi. gripis Semdgomi gviani
lamde (prelingvuri siyrue) an mis Semdeg. adreuli gamojanmrTelebis SemTxvevebi ar iyo ufro xSiri im
sruli siyrue xels uSlis metyvelebas, enis Tvise- pirebSi, romlebsac daavadeba mZimed daewyoT, magram
bas da emociur ganviTarebas. prelingvuri siyruis aRmoCnda SedarebiT xSiri im adamianebSi, romlebsac
mqone zrdasruli adamianebi xSirad erTiandebian so- hqondaT ufro anomaliuri monacemebi avadmyofobis
cialur jgufSi da erTmaneTTan niSnebis enis saSu- dawyebamde Catarebul fsiqologiur testebze (Imboden
alebiT urTierToben. maT ufro xSirad axasiaTebT et al., 1961). uaxlesma kvlevebma, romlebic Catarda
qceviTi da socialuri dezaptaciis problemebi, vi- zogadi profilis klinikaSi virusul daavadebebsa da
dre emociuri aSliloba. am problemebs ukeT marTavs infeqciur mononukleozze, igive Sedegebi aCvena (White
is pirovneba, romelmac icis siyruis efeqtebi. et al., 1998). infeqcia, rogorc qronikuli daRlilobis
mogvianebiT siyruis efeqtebi SedarebiT msubuqi xde- sindromis mizezi, ?? gverdzea ganxiluli.
ba. Tumca, mwvaved ganviTarebulma srulma siyruem Sei- virusul encefalits xSirad Tan axlavs fsiqiatri-
Zleba Zlieri stresi gamoiwvios; smenis SedarebiT zom- uli simptomebi. amasTan, zogierT infeqciur daavade-
ieri dakargva ki SesaZloa, depresiisa da mniSvnelovani bas, mag., hepatit A-s, grips da brucelozs, xSirad
socialuri unarSezRudulobis mizezi gaxdes. mosdevs depresiisa da daRlilobis periodebi.
krepelinma pirvelma gamoTqva mosazreba, rom siyrue
SeiZleba gaxdes mniSvnelovani faqtori devniTi xasi- aiv-infeqcia
aTis bodviTi ideebis ganviTarebisa. Semdgomma mona-
aiv-infeqcia ganviTarebis sawyis stadiaSive azianebs
cemebma daadastura, rom xandazmul asakSi arsebobs
Tavis tvins. mas axasiaTebs qronikuli, progresuli
kavSiri siyruesa da paranoidul aSlilobas Soris (gv.
ganviTareba, rasac Tan axlavs fsiqiatriul simptom-
??). am sakiTxis mimoxilva ix. Hindley and Kitson, 1999.
Ta farTo speqtri. miuxedavad amisa, SidsiT daavade-
xmauri yurebSi buli bevri pacienti axerxebs cxovrebis normaluri
wesis SenarCunebas sakmaod didi xnis manZilze. Tu
xmauri yurebSi Zalian xSiri movlenaa, Tumca arc
gaviTvaliswinebT fizikuri simptomebis bunebas, maT
Tu ise bevri pacienti mimarTavs mkurnalobas. maTi
ganviTarebas da sxva adamianebis reaqcias, gasagebi
umetesoba Cveul cxovrebas ganagrZobs. mudmivi xmau-
iqneba, Tu ratom aris emociuri distresi wamyvani aiv-
ri yurebSi SesaZloa ukavSirdebodes daqveiTebul
inficirebul avadmyofebSi. amgvari distresis kidev
guneb-ganwyobas. zogierTi pacienti xmarobs yuris
erTi mizezia is, rom zogierT adamians, romelic aiv-
aparats, romelic yurebSi xmaurs gadafaravs ufro
inficirebis maRali riskis qveS imyofeba (magaliTad,
advilad asatani xmebiT. antidepresiulma mkurnalo-
moixmars narkotikul nivTierebebs), SeiZleba sxva
bam SeiZleba gaaumjobesos guneb-ganwyoba da Seam-
fsiqologiuri problemebic axasiaTebdes. Tu ojaxSi
ciros yurebSi xmauris intensivoba (Sullivan et a., 1993).
erT-erTi partniori an erTi an meti bavSvia inficire-
kognituri da qceviTi meTodebi exmareba adamianebs,
buli, amas mniSvnelovani gavlena aqvs ojaxis cxovre-
Seurigdnen xmaurs da minimumamde daiyvanon social-
baze. qalebs SeiZleba adardebdeT is, rom infeqciis
uri unarSezRuduloba.
gamo ziani miadgeba nayofs mucladyofnis periodSi.
sibrmave fsiqiatrebs SeuZliaT daxmarebis gaweva SidsiT daa-
miuxedavad imisa, rom sibrmave aseve warmoSobs uamrav vadebuli pacientebisTvis neirofsiqiatriuli da
siZneles, adreul asakSi sibrmave yovelTvis ar iwvevs sxva saxis fsiqiatriuli garTulebebis mkurnalobisa
bavSvis anomaliur fsiqologiur ganviTarebas an Sem- da saTanado konsultaciebis gziT.
dgomi ganviTarebis Seferxebas. im adamianebs, rom- reaqciebi testirebaze. miuxedavad imisa, rom aiv
_ 421 _
antisxeulebze testireba mZime gancdebs iwvevs im lemebi arTulebs aiv-infeqciis mkurnalobas.
pirebis umravlesobaSi, vinc testirebas itarebs, dis- eTikuri problemebi dakavSirebulia konfidenci
tresi xanmoklea imisda miuxedavad, Tu rogoria te- alobasTan. esaa: konfidencialobis SenarCunebis mniS-
stirebis Sedegebi. im pirebs, romlebsac aReniSnebaT vneloba; informaciis gandoba mesame pirisTvis, vinc
mdgradi da usafuZvlo gancdebi SidsiT daavadebas- inficirebis riskis qveS imyofeba; sadazRvevo samsax-
Tan dakavSirebiT, esaWiroebaT iseTive fsiqiatriuli uris muSakTa da damsaqmeblebis saqmis kursSi Cay-
daxmareba, rogoric gamoiyeneba sxva daavadebebTan eneba; sazogadoebis dacva aiv-infeqciis gavrcelebis
dakavSirebuli SiSis dros (gv. ??). riskisgan, rodesac inficirebis saSiSroeba janmrT-
fsiqiatriuli problemebi. sxvadasxva saxis fsiqia- elobis dacvis muSakisgan momdinareobs.
triuli problemebi, (rogorebicaa adaptaciuri aSli- aiv-infeqciis fsiqiatriuli aspeqtebi ganxilulia
loba, depresiuli aSliloba da SfoTviTi aSliloba) Semdeg wyaroebSi: Bialer et al. (2000) da Grant and Atkinson
xSirad vlindeba diagnozis dasmis periodSi. Tumca, (2000)
SesaZlebelia ganviTardes daavadebis nebismier sta-
diazec. adamianebi, romlebsac adre aReniSnebodaT
avTvisebiani simsivne
fsiqologiuri problemebi, xangrZlivi socialuri
avTvisebiani simsivniT gamowveuli fsiqologiuri
sirTuleebi an hqondaT arasakmarisi socialuri mx-
Sedegebi yvela sxva seriozuli fizikuri daavadebis
ardaWera, gansakuTrebiT mowyvladebi arian.
Sedegebis msgavsia:
suicidi da ganzrax TviTdazianeba SeiZleba damaxas-
iaTebeli iyos im adamianebisTvis, romlebsac awuxebT w samedicino daxmarebisTvis dagvianebuli mimarTva,
aiv-infeqciiT daavadebis SesaZlebloba, iseve, ro- SiSis an daavadebis arsebobis faqtis uaryofis
gorc im pirebisTvis, romlebsac, es daavadeba daudg- gamo.
indaT. am ukanasknelTa Soris riski gazrdilia ufro w reaqcia diagnozze, rac SeiZleba gamoixatebodes
Sorswasuli daavadebis simptomebis arsebobisas. Tum- SfoTviT, SokiT, sibraziT, depresiiT. pacients
ca, ar aris dadgenili, ramdenad maRalia suicidisa SeiZleba uWirdes daavadebis faqtis aRiareba.
da ganzrax TviTdazianebis riski SidsiT daavadebul zogjer diagnozze reaqcia imdenad mZimea, rom
pacientebSi zogad populaciasTan SedarebiT. igi fsiqikuri aSlilobis, Cveulebriv, adaptaciis
neirofsiqikuri aSlilobebi xSiria, rogorc imu- aSlilobis, zogjer ki depresiuli aSlilobis kri-
nodeficitis garTulebebiT gamowveuli meoradi teriumebs akmayofilebs. izrdeba suicidis riski
reaqcia da, aseve, rogorc aiv-infeqciis Tavis tvinze (Harris and Barraclough, 1995).
uSualo zemoqmedebis Sedegi. xSiria umniSvnelo kog- w Semdgomi Sedegebi. daavadebis mimdinareobisas Rrma
nituri darRvevebi. aiv-infeqciasTan dakavSirebuli depresia aReniSneba pacientTa 10-20%-s da ufro
demencia (Sidsi-demenciis komleqsi), aiv-iT gamowveu- xSirad gvxvdeba im pacientebSi, romlebic tkiviliT
li encefalopaTia da qvemwvave encefaliti gvxvde- itanjebian. zogadad, misi sixSire iseTivea, rogoric
ba pacientTa daaxloebiT erT mesamedSi, daavadebis sxva fizikuri daavadebebis SemTxvevaSi (Holland, 1998).
mogvianebiT stadiaze. Cveulebriv, demenciis dawyeba
w avTvisebiani simsivnuri daavadebis progresireba
SeumCnevelia. Semdgom is progresirebs da Rrma de-
da recidivebi xSirad asocirebulia fsiqikuri
menciad yalibdeba. aiv-infeqciam SesaZloa gamoiwvios
aSlilobebis sixSiris matebasTan, rac SeiZleba
nevrologiuri simptomebi da demencia im pirebSic,
gamowveuli iyos iseTi fizikuri simptomebiT, rog-
visac Sidsi ar aReniSneba. deliriumi SesaZloa ganvi-
orebicaa tkivili da gulisrevis SegrZneba, sikvdi-
Tardes, agreTve, oportunistuli infeqciis an Tavis
lis SiSi da organuli fsiqiatriuli sindromebi.
tvinis simsivnis dros. aiv-infeqciasTan dakavSire-
buli demencia ganxilulia Semdeg wyaroSi: Maj, 2000. w deliriumi da demencia SeiZleba gaCndes Tavis
socialuri Sedegebi mniSvnelovania stigmisa da im tvinSi arsebuli metastazebisgan, romlebic ufro
SiSis gamo, romelic arsebobs sazogadoebaSi am daa- xSirad Cndeba filtvis karcinomisgan, agreTve,
vadebasTan dakavSirebiT. kulturaluri gansxvavebe- sarZeve jirkvlis, saWmlis momnelebeli traqtis
bi, romlebic SeiniSneba damokidebulebaSi mocemuli simsivneebisgan da melanomisgan. zogjer, metasta-
daavadebis mimarT (mimRebloba/ miuRebloba), iseve zebi Tavis tvinSi ganapirobebs fsiqiatriuli simp-
rogorc ojaxuri da sxva saxis mxardaWeris arseboba/ tomebis gaCenas dazianebis pirveladi keris aRmoCe-
ararseboba, avadmyofis cxovrebis xarisxis ZiriTadi namde (ix. agreTve, me-14 Tavi).
ganmsazRvreli faqtorebia. w neirofsiqiatriuli problemebi (para-neoplasti-
wamalmoxmarebasTan dakavSirebuli problemebi ganx- kuri sindromebi). aRniSnuli problemebi zogjer
ilulia ?? gverdze. wamalmomxmarebelTa araorganize- gamowveulia avTvisebiani simsivniT, romelic
buli cxovrebis wesi, maTi piradi da socialuri prob- metastazebis gareSe mimdinareobs, ufro xSirad
_ 422 _
filtvis, sakvercxeebis, sarZeve jirkvlisa da kuWis uaryofa. zogjer Tveebia saWiro imisTvis, rom maT
karcinomebiTa da hojkinis limfomiT. iTvleba, rom srulad aRiqvan mocemuli diagnozi. zogierT dedas
am problemebs warmoSobs simsivneze autoimunuri uviTardeba SfoTva an depresiuli aSliloba. diag-
reaqcia (ix. agreTve, me-14 Tavi). nozis codna aseve zemoqmedebs ojaxis sxva wevrebzec.
avTvisebiani simsivnis mkurnalobam SeiZleba daavadebis sawyis stadiaze mSoblebisTvis daxmare-
gamoiwvios fsiqikuri aSliloba. emociuri distresi ba, Cveulebriv, praqtikuli rCevebis micemaa, xolo
gansakuTrebiT xSiria masteqtomiis da adamianis sxe- mogvianebiT rekomendebulia maTi gancdebis ganxilva,
ulis sxva damasaxiCrebeli operaciebis Semdeg. ra- romelTa Soris xSirad danaSaulis gancdaa wamyvani.
dioTerapia iwvevs gulisrevisa da daRlilobis Seg- zrdasruli adamianebi, romlebic bavSvobaSi da mo-
rZnebas da emociur distress. qimioTerapia xSirad zardobaSi avTvisebiani simsivniT iyvnen daavadebul-
iwvevs sisustes, pirRebinebas da SfoTvas imis gamo, ni, xSirad imyofebian socialuri xasiaTis siZnelee-
rom qimioTerapiam SesaZloa gamoiwvios anticipator- bis riskis qveS.
uli gulisrevis SegrZneba mkurnalobis dawyebamde. avTvisebiani simsivnis fsiqiatriuli aspeqtebi ganx-
am ukanasknelis sawinaaRmdegod SesaZlebelia Cat- ilulia Semdeg wyaroebSi: Rouhani and Holland, 2000;
ardes bihevioruli mkurnaloba da masTan erTad pir- Roth et al., 2000; Holland, 1998.
Rebinebis sawinaaRmdego medikamenturi mkurnaloba.
ojaxi da sxva axlo naTesavebi. avTvisebiani sim- ubeduri SemTxvevebi
sivniT daavadebuli adamianis ojaxis wevrebsa da
fsiqiatriuli asociaciebi
axlo naTesavebs SesaZloa gauCndeT fsiqologiuri
problemebi, romlebic SeiZleba pacientis gankur- fsiqikuri aSlilobebi, romlebic ganapirobeben pre-
nebis Semdegac gagrZeldes. miuxedavad amisa, bevri dispozicias ubeduri SemTxvevebis mimarT. es, Cveu-
pacienti da misi naTesavebi adekvaturad eguebian lebriv, xdeba kognituri darRvevebis gamo, romleb-
avTvisebian simsivnes. maTi adaptaciis done nawilo- sac sxvadasxva gamomwvevi mizezebi aqvT (mag., alko-
briv damokidebulia maT informirebulobaze. holiT an wamlebiT intoqsikacia, deliriumi an de-
mencia).
fsiqologiuri Sedegebis mkurnaloba ubeduri SemTxvevebiT gamowveuli fsiqikuri aSli-
warsulSi eqimebi eridebodnen avadmyofebisTvis imis lobebi moicavs: adaptaciis aSlilobas, SfoTviT da
Tqmas, rom maTi daavadebis diagnozi avTvisebiani depresiul aSlilobebs da posttravmul stresul
simsivnea. Tumca pacientebis umravlesobas urCev- aSlilobas. xSirad aRiniSneba ubedur SemTxvevebTan
nia icodes Tavisi diagnozi da informirebuli iyos dakavSirebuli situaciebis Tavidan acileba, ramac
imis Sesaxeb, Tu ra gavlenas iqoniebs es daavadeba SeiZleba imdenad mZime formebi miiRos, rom fobikuri
mis cxovrebaze. aucilebelia, rom amgvari informa- SfoTviTi aSlilobis suraTi mogvces. Tavis daziane-
cia sworad iyos miwodebuli. winaaRmdeg SemTxveva- bam SeiZleba specifikuri kognituri aSlilobebi
Si, SesaZlebelia gaCndes fsiqologiuri adaptaciis gamoiwvios (gv. ??).
problemebi. aseTi pacientebisTvis ar aris damaxasi-
kavSiri gansakuTrebuli saxis ubedur
aTebeli SfoTviTi da depresiuli aSliloba. am pa-
SemTxvevebTan
cientebTan rekomendebulia regularuli skriningis
Catareba (Sharpe et al., 2004). kriminalur Zaladobas msxverplisTvis gansakuTrebiT
kognitur-bihevioruli midgomebi gvexmareba gavaum- mZime da mdgradi Sedegebi moaqvs (Acierno et al., 1997).
jobesoT aseTi pacientebis adaptaciis unari (Sheard msxverplis problemebi ganxilulia ?? gverdze.
and Maguire, 1999). es yvelaze metad esaWiroebaT iseT sagzao SemTxvevebi 40 wlamde asakis adamianTa gar-
pacientebs, romelTac anamnezSi aqvT fsiqikuri aSli- dacvalebis yvelaze gavrcelebuli mizezia. agreTve,
loba, axasiaTebT arasakmarisi adaptacia sxva prob- somaturi daavadebebis ZiriTad mizezs warmoadgens.
lemebis mimarT an ar hyavT mxardamWeri ojaxi. fsiqiatriuli faqtorebi, romelTac TavianTi wvli-
li SeaqvT sagzao SemTxvevebSi, moicavs: narkotikuli
avTvisebiani simsivne bavSvobis asakSi nivTierebebisa da alkoholis borotad gamoyenebas,
bavSvobis asakSi avTvisebian simsivnes axasiaTebs fsiqikur daavadebebs, suicidur da sxva riskis Semcv-
specifikuri problemebi. gansakuTrebiT Znelia di- el qcevebs, zogierTi fsiqotropuli wamlis gverdiT
agnozis Setyobineba, magram, sazogadod, umjobesia movlenebs. fsiqiatriuli Sedegebi moicavs: mwvave
diagnozis axsna-ganmarteba bavSvis ganviTarebis do- stresul aSlilobas, SfoTviT da depresiul aSlilo-
nis gaTvaliswinebiT. bavSvi xSirad daavadebasa da bas, posttravmul stresul aSlilobas, mogzaurobis
mis mkurnalobaze qceviTi problemebiT reagirebs. fobias da Tavis tvinis dazianebiT gamowveul dar-
aseT dros mravali mSoblis pirveli reaqciaa Soki da Rvevebs. zogierTi aseTi mdgomareoba gardamavalia,
_ 423 _
magram zog SemTxvevaSi gvaqvs mdgradi darRvevebi, daewvaT. aseTi pacientebi amjobineben socialuri
rasac SeiZleba mohyves seriozuli unarSezRudulo- cxovrebisgan gandgomas. maT sWirdebaT garkveuli
ba. umetes SemTxvevaSi, aseT adamianebs ubedur SemTx- mxardaWera damwvrobis centris TanamSromelTa mxri-
vevamde fsiqologiuri mowyvladoba ar aReniSnebaT dan; mxolod calkeuli pacientebi saWiroeben fsiqi-
(Hickling and Blanchard, 1999). atriul daxmarebas (mimoxilva ix. Bernstein, 2000).
profesiuli travmebiT gamowveuli fsiqiatriuli
`kompensaciuri nevrozi~
Sedegebi sxva ubeduri SemTxvevebis Sedegebis msgav-
sia. zogierTi mosazrebis Tanaxmad, simptomebisa da termini `kompensaciuri nevrozi~ (an ubeduri SemTx-
unarSezRudulobis SenarCunebas xels uwyobs kompen- vevebiT gamowveuli nevrozi), aRniSnavs fsiqologi-
saciisa da daxmarebebis miRebis molodini (ix. qvemoT uri faqtorebiT ganpirobebul fizikur an fsiqikur
_ `kompensaciuri nevrozi~). simptomebs, romlebic maSin Cndeba, rodesac mougva-
zurgis tvinis dazianeba. im pacientTa daaxloe- rebelia kompensaciis miRebis sakiTxi. sakuTar gamoc-
biT meoTxeds, romelTac dazianebuli aqvT zurgis dilebaze dayrdnobiT, nevrologma milerma (Miller,
tvini, aReniSnebaT fsiqiatriuli problemebi, romle- 1961) daaskvna, rom aseTi fsiqologiuri faqtorebi
bic mkurnalobas saWiroebs. zurgis tvinis dazianebas mniSvnelovania kompensaciis miRebis moTxovnisas,
uSualod mohyveba depresia, romelic wamyvani simp- profesiuli travmebiTa da sagzao SemTxvevebiT
toms warmoadgens, magram droTa ganmavlobaSi paci- gamowveuli mdgradi fizikuri unarSezRudulobis
enti gamodis depresiuli mdgomareobidan. Tumca, gamo. igi gansakuTrebul mniSvnelobas aniWebda kom-
zogad populaciasTan SedarebiT, swored am pacien- pensaciis moTxovnis rols simptomTa gaxangrZlive-
tebSi gvxvdeba yvelaze xSirad suicidis SemTxvevebi. baSi da Tvlida, rom gamojanmrTeleba xdeba am prob-
damwvroba. bavSvebSi damwvroba asocirdeba hiper- lemis daregulirebis Semdeg. uaxlesi monacemebi ar
aqtiurobasTan da daswavlis darRvevasTan. agreTve, adasturebs am mosazrebas.
damwvrobis faqtebi xSiria iseT bavSvebSi, romlebsac realurad, ubeduri SemTxvevis Sedegad dazarale-
sastikad epyrobian da romelnic mzrunvelobas arian buli mravali adamiani ar iTxovs kompensacias, xolo
moklebulni. zrdasruli adamianebis SemTxvevaSi dam- zogierTi ki kompensaciis mosapoveblad ebmeba xan-
wvroba asocirdeba alkoholisa da narkotikuli niv- grZliv sasamrTlo davaSi. Tumca, rogorc aRmoCnda,
Tierebebis borotad gamoyenebasTan, ganzrax TviTda- samuSaos gareSe gatarebuli dro da unarSezRudu-
zianebasa da demenciasTan. mZime damwvroba da misi loba damokidebulia ubeduri SemTxvevis tipze, so-
gaxangrZlivebuli mkurnaloba SeiZleba gaxdes mZime cialur faqtorebsa da kompensaciis miRebis perspeq-
fsiqologiuri problemebis gamomwvevi mizezi. ham- tivaze,
burgma da misma kolegebma (Hamburg et al., 1953) aR- socialur dacvasa da sxva sargebelze. Cveulebriv,
weres damwvrobis sami stadia: SegviZlia davaskvnaT, rom kompensaciis problemis
mogvarebas mohyveba pacientis mdgomareobis gaum-
w I stadia grZeldeba dReebi, an kvirebi; am dros
jobeseba. Tumca es mosazreba ar aris gaziarebuli
ZiriTadi reaqciaa uaryofa. yvelaze xSiri fsiqi-
gamokvlevebSi, romlebic pacientebze Semdgom dak-
kuri aSlilobaa organuli sindromebi. am stadiaze
virvebas awarmoeben (Mendelson, 1995).
xSirad seriozuli daxmareba esaWiroebaT naTe-
ubedur SemTxvevebTan, damwvrobasa da sxva saxis
savebs.
travmebTan dakavSirebuli fsiqiatriuli problemebi
w II stadia xangrZlivi da mtkivneulia; aq uaryofis
ganxilulia Semdeg wyaroSi: Malt, 2000.
nacvlad wina planze gamodis emociuri aSliloba.
pacientebs sWirdebaT daxmareba, raTa gaumklavdnen
tkivilebs, gamoxaton emociebi da TandaTanobiT
meanobisa da ginekologiis
Seeguon sxeulis damaxinjebas. fsiqiatriuli aspeqtebi
w III stadiaze pacienti tovebs klinikas da saWiroebs orsuloba
Semdgom adaptacias sxeulis deformaciasa da fizi- orsulobis mimdinareobis dros fsiqikuri aSlilo-
kur invalidobasTan. garda amisa, pacienti unda bebi, meoresTan SedarebiT, ufro damaxasiaTebelia
Seeguos im reaqciebs, romlebsac adamianebi gamoav- pirveli da mesame trimestrisTvis. pirvel trimes-
lenen masTan Sexvedrisas. trSi arasasurvel orsulobas Tan sdevs SfoTva
posttravmuli stresuli aSliloba ZiriTadad aR- da depresia. mesame trimestrSi SesaZloa gaCndes
eniSnebaT im adamianebs, romlebmac gadaitanes mZime SiSi mosalodneli mSobiarobis an nayofis arasru-
damwvroba. maTgan daaxloebiT erT mesamedze mets lyofilebis gamo. orsulobis periodSi fsiqiatriu-
aReniSneba mdgradi SfoTva da depresia. gamosavali simptomebi ufro xSirad aReniSnebaT im qalebs,
li ufro mZime aqvT im pacientebs, romlebsac saxe romlebsac warsulSi hqondaT fsiqikuri aSliloba an
_ 424 _
meanobisa da ginekologiis fsiqiatriuli aspeqtebi
iseTi seriozuli samedicino problemebi (mag., dia- arasasurveli orsulobis Sewyveta
beti), romlebmac SeiZleba imoqmedon orsulobaze. warsulSi, did britaneTSi fsiqiatrebs xSirad mimar-
Tumca, orsulobis dros ufro xSiria susti afeq- Tavdnen imisTvis, rom maT SeemowmebinaT orsuli qa-
turi simptomebi, xolo seriozuli fsiqikuri aSli- lebi, romlebic cdilobdnen, fsiqikuri daavadebis
lobebi ufro iSviaTad gvxvdeba, vidre imave asakis gamo, Terapiuli abortis gamowvevas. did brita-
araorsul qalebSi. neTSi da sxva qveynebSi amJamad arsebuli kanonmde-
zogierT qals, romelsac orsulobamde aReniSnebo- bloba ufro metad iTvaliswinebs ojaxis eqimisa da
da qronikuli fsiqologiuri problemebi, orsulobis ginekologis gadawyvetilebas fsiqiatris Carevis
periodSi mdgomareoba uumjobesdeba, maSin rodesac gareSe. Tumca, zogjer mainc xdeba fsiqiatris rCe-
sxva pacientebi saWiroeben damatebiT fsiqiatriul vis gaTvaliswineba ara mxolod orsulobis Sewyvetis
daxmarebas. pacientebis meore kategoria xSirad dagvi- safuZvlis Taobaze, aramed, calkeuli pacientis Sem-
anebiT moiTxovs antenatalur daxmarebas da cudad mi- TxvevaSi, orsulobis Sewyvetis fsiqologiur Sede-
hyveba mkurnalobis gegmas, rac zrdis sameano da fsiq- gebTan dakavSirebiT. SemTxvevaTa umetesoba mowmobs,
iatriuli problemebis risks. alkoholis, opiatebisa rom orsulobis Sewyvetis fsiqologiuri Sedegebi,
da sxva fsiqoaqtiur nivTierebaTa borotad gamoyeneba Cveulebriv, msubuqi da cvalebadia. Tumca, es Sede-
mkacrad unda aikrZalos, gansakuTrebiT pirvel tri- gebi ufro mZimea im SemTxvevaSi, roca orsulobis
mestrSi, rodesac nayofze zemoqmedebis riski udide- Sewyveta kulturalur da religiur rwmenebTan aris
sia (gv. ??). orsuloba ar iwvevs kvebiTi aSlilobis dakavSirebuli (Major et al., 2000). orsulobis Sew-
provocirebas da bulimiuri simptomebi SeiZleba Ses- yveta genetikuri testirebis Semdeg ganxilulia ??
ustdes kidec. didi sifrTxiliT unda movekidoT or- gverdze.
sulobisa da ZuZuTi kvebis periodSi fsiqotropuli
nivTierebebis gamoyenebas (21-e Tavi, gv. ??). spontanuri aborti
orsulTa hiperemezisi dadasturebuli orsulobis SemTxvevaTa daaxloebiT
orsul qalTa daaxloebiT naxevars pirvel trimes- mexuTedi wydeba 20 kviramde periodSi, ZiriTadad,
trSi aReniSneba gulisrevis SegrZneba da pirRebineba. nayofis arasrulfasovani ganviTarebis gamo. frid-
zogierT avtors miaCnia, rom es simptomebi, iseve ro- manma da gaTma (Friedman and Gath, 1989) Caatares qa-
gorc orsulTa hiperemezisis mZime forma, upirveles lTa interviuireba spontanuri abortidan 4 kviris
yovlisa, fsiqologiuri etiologiisaa, Tumca, es ar Semdeg da aRmoaCines, rom maT naxevars aReniSneboda
aris damtkicebuli. savaraudoa, rom fsiqologiuri depresiis fsiqiatriuli forma (rac 4-jer aRemateba
faqtorebi zemoqmedebs am simptomTa mimdinareobasa SemTxvevaTa ricxvs qalebis zogad populaciasTan Se-
da simZimeze. darebiT).
bevr qals aReniSneboda dardis niSnebi. depre-
cru orsuloba siuli simptomebi, umetesad, aRmoaCndaT im qalebs,
cru orsuloba aris iSviaTi mdgomareoba, rodesac romelTa anamnezi moicavda spontanuri abortis Sem-
qals mcdarad sjera, rom is orsuladaa da uviTarde- Txvevas. miuxedavad imisa, rom umravlesobas droTa
ba amenorea, ezrdeba muceli da aReniSneba adreuli ganmavlobaSi gauumjobesda mdgomareoba (Janssen et al.,
orsulobisTvis damaxasiaTebeli sxva cvlilebebi. es 1996), avadobis sixSire gviCvenebs, Tu ramdenad mniS-
mdgomareoba ufro xSiria axalgazrda qalebSi. cru vnelovania, gaviTvaliswinoT im qalebis saWiroebebi
orsuloba, Cveulebriv, swrafad gadis pirvelive di- romlebsac SeuwydaT orsuloba.
agnostirebasTan erTad, magram zogierT pacients
amis Semdegac mtkiced sjera, rom igi orsuladaa. antenataluri sikvdili
xSiria am mdgomareobis ganmeoreba. igi iSviaTadaa da- antenataluri (dabadebamde) sikvdili iwvevs danakar-
kavSirebuli fsiqikur aSlilobasTan. gis gancdis mwvave reaqcias da, zogierTi qalis Sem-
TxvevaSi, xangrZliv fsiqiatriul problemebs, rasac
kuvadis sindromi
ganapirobebs momaval orsulobasTan dakavSirebuli
am sindromis dros, orsuli qalis qmari grZnobs gancdebi. glovis dros unda davexmaroT mSoblebs
orsulobisTvis damaxasiaTebel zogierT simptoms. raTa maT naxon gardacvlili bavSvi da xeliT Seexon
es mdgomareoba SeiZleba gaCndes qalis orsulo- mas, daarqvan mas saxeli da dakrZalon igi. isini aseve
bis adreul TveebSi. am dros mamakaci, Cveulebriv, saWiroeben Tanadgomas dakrZalvis Semdeg da Semdgo-
uCivis gulisrevas, dilis sisustes da xSirad _ kbi- mi orsulobis dros, romelic, SesaZloa, emociurad
lis tkivils. Civilebi, Cveulebriv, qreba ramdenime gansakuTrebiT mZime periods warmoadgendes.
kviris Semdeg.
_ 425 _
sakeisro kveTa logias, gansxvavebuls sxva fsiqikuri daavadebebisgan
iTvleba, rom sakeisro kveTas aqvs arasasurveli (Esquirol, 1945). mogvianebiT, fsiqiatrebma miiCnies, rom
fsiqologiuri Sedegebi rogorc mSoblebis, ise Cvi- samSobiaro fsiqozi ar gansxvavdeba sxva fsiqozebisgan.
li bavSvebisTvis. gamokvlevaTa umravlesobam ver es ukanaskneli azri dResac farTodaa damkvidrebuli.
moaxerxa am kavSiris dadgena, radgan ar gancalkevda epidemiologia. mSobiarobis Semdgomi fsiqozebis
qirurgiuli operaciebis Sedegebi sxva uaryofiTi faq- ricxvi gamoangariSebulia fsiqiatriul saavadmyo-
torebisgan. Tumca, gonivruli iqneba, Tu mivaqcevT foSi mimarTvianobis safuZvelze (Kendell et al., 1987).
saTanado yuradRebas mSoblebis mxardaWerasa da deda- aRricxul SemTxvevaTa raodenoba cvalebadia, magram
Svils Soris sawyisi kavSiris damyarebis sakiTxs. erTi SemTxveva 500 mSobiarobaze reprezentatuli
orsulobis fsiqiatriuli aspeqtebi ganxilulia maCvenebelia. sixSiris es maCvenebeli seriozulad
Semdeg wyaroSi: Brockington (1998, 2000). aRemateba mosalodnel fsiqozTa raodenobas imave
asakis aramSobiare qalebTan. samSobiaro fsiqozi
mSobiarobis Semdgomi fsiqikuri ufro xSirad aqvT pirvelad mSobiare qalebs,
aSlilobebi romelTac adre gadatanili aqvT fsiqiatriuli daa-
vadeba, aqvT fsiqikuri aSlilobis ojaxuri istoria
es aSlilobebi iyofa: guneb-ganwyobis msubuqi aSli-
da ar arian daqorwinebulebi. ar arsebobs mkafiod
loba, samSobiaro fsiqozi da saSualo simZimis qroni-
gamoxatuli urTierTdamokidebuleba fsiqozsa da
kuli depresiuli aSliloba.
sameano faqtorebs Soris. mSobiarobasTan dakavSire-
mSobiarobis Semdgomi guneb-ganwyobis msubuqi buli daavadebebi, ganviTarebulTan SedarebiT, ufro
aSliloba (maternity blues) xSiria ganviTarebad qveynebSi. amas SesaZloa ganapi-
im qalebs, romelTac janmrTeli Svili uCndebaT, robebs organuli etiologiis mqone SemTxvevebi.
xSirad (SemTxvevaTa naxevridan or mesamedamde) aR- etiologia. mSobiarobis Semdgomi fsiqozis adreuli
eniSnebaT gaRizianebadobis, labiluri guneb-ganwyo- gamovlinebis faqtebma mecnierebi im mosazrebamde mi-
bisa da tirilis xanmokle epizodebi. gansakuTrebiT iyvana, rom am tipis fsiqozi SeiZleba hormonuli faq-
damaxasiaTebelia guneb-ganwyobis labiloba, romelic torebiT iyos gamowveuli (rogorc mSobiarobis Semd-
gvxvdeba swrafad cvalebadi formiT. is meryeobs gomi guneb-ganwyobis msubuqi aSlilobis SemTxvevaSi).
eiforiasa da ubedurebis gancdas Soris. Tumca, ar arsebobs imis damadasturebeli faqtebi, rom
simptomebi piks aRwevs mSobiarobidan mesame an meo- mSobiarobis Semdgomi fsiqozis mqone qalebSi mimdin-
Txe dRes. are hormonuli cvlilebebi gansxvavdeba im hormonuli
pacientebi xSirad uCivian dabneulobas, magram Zvrebisgan, romlebic aReniSnebaT sxva qalebs mSobiar-
kognituri funqcionirebis testebze maTi maCvene- obis Semdgom periodSi. Sesabamisad, Tu endokrinuli
blebi normaluria. miuxedavad imisa, rom pacientebs faqtori raime rols TamaSobs, is moqmedebs rogorc
cremlianoba axasiaTebT, isini tirilis momentSi ar precipitatuli faqtori predispoziciis mqone qalebSi.
grZnoben Tavs depresiulad, magram daZabulni da bipolaruli aSlilobis genetikuri faqtorebi ganxi-
gaRizianebulni arian. lulia Semdeg wyaroSi: Chaudron and Pies, 2003.
guneb-ganwyobis msubuqi aSliloba ufro xSirad
gvxvdeba pirvel mSobiareebs Soris. es mdgomareoba
samSobiaro fsiqozis gamovlineba, Cveulebriv, xdeba
ar aris damokidebuli mSobiarobasTan dakavSirebul
mSobiarobidan 1-2 kviris manZilze, magram iSviaTad
garTulebebze an anesTeziaze. pacientebi orsulo-
_ pirveli ori dRis ganmavlobaSi. aq gvxvdeba sami
bis bolo trimestrSi xSirad ganicdian SfoTvas da
tipis klinikuri suraTi: deliriumi, guneb-ganwyobis
depresiuli simptomebi axasiaTebT. maTi istoria
aSliloba da Sizofreniformuli aSliloba. deliri-
miuTiTebs premenstrualur daZabulobaze, mSobiaro-
umi xSirad gvxvdeboda, magram axla is ufro iSviaTia,
bis SiSsa da cud socialur adaptaciaze.
radgan antibiotikebma Seamcira samSobiaro sefsisis
emociuri mdgomareobis cvalebadobis dro da sixSire
SemTxvevebi. dResdReobiT dominirebs guneb-ganwyo-
gvafiqrebinebs, rom is, SesaZloa, dakavSirebuli iyos
bis aSliloba, bipolaruli aSliloba an Sizoafeqtu-
mSobiarobis Semdgom hormonul cvlilebebTan, Tum-
ri aSliloba. Sizofreniformuli aSlilobis pirve-
ca, es ar aris damtkicebuli. am dros ar aris saWiro
ladi gamovlinebis SemTxvevebi iSviaTia. am sindromTa
mkurnalobis Catareba, radgan mdgomareoba spontanu-
klinikuri maxasiaTeblebi, Cveulebriv, iseTivea, ro-
rad regulirdeba ramdenime dRis ganmavlobaSi.
goric arasamSobiaro sindromebis dros.
mSobiarobis Semdgomi fsiqozi uZiloba da hiperaqtiuroba gavrcelebuli adreu-
mecxramete saukuneSi samSobiaro da laqtaciur li gamovlinebebia. avadmyofebs xSirad aReniSnebaT
fsiqozs ganixilavdnen, rogorc specifikur nozo- gaogneba da abneva.
_ 426 _
marTva siuli aSlilobis recidivi mSobiarobis peroidSi

daaxloebiT 20-30 procentTan gvxvdeba. zogi avto-
gamokvleva. iseve, rogorc nebismieri standartuli
ris monacemebiT (Protheroe, 1969), im qalebis minimum
fsiqiatriuli gamokvlevis dros, aqac mniSvnelovania
50%-s, romlebsac gadatanili hqondaT samSobiaro
dadgindes dedis warmodgenebi Svilis Sesaxeb. gansa-
depresia, SemdgomSi arasamSobiaro depresia aReniS-
kuTrebiT, mZime depresiis mqone pacientebs SesaZlebe-
neboda. yvela qalma, romelmac gadaitana samSobiaro
lia, hqondeT bodviTi ideebi bavSvis arasrulyofili
fsiqozi, yoveli Semdgomi orsulobis dros fsiqia-
ganviTarebis an raime sxva saxis arasrulfasovnebis
triuli gamokvleva unda Caitaros, raTa droulad da
Sesaxeb. aseTma uaryofiTma azrebma SeiZleba pacienti
efeqturad moxdes mSobiarobis Semdgomi problemebis
bavSvis mokvlis mcdelobamde miiyvanos, raTa, saku-
identificireba da gadaWra.
Tari warmodgeniT, daicvas igi Semdgomi tanjvisgan.
Sizofreniis mqone pacientebsac SeiZleba hqondeT
bavSvTan dakavSirebuli bodviTi ideebi. magaliTad,
msubuqi an zomierad gamoxatuli mSobiarobis
Semdgomi depresia
maT SeiZleba sjerodeT, rom bavSvi anomaliuria an
borotebis gansaxierebas warmoadgens. aseTi ideebi mSobiarobis Semdeg, ramdenime kviris manZilze qalTa
mSoblebis mier bavSvis mokvlis riskze miuTiTebs. daaxloebiT 10 procents aReniSneba naklebad mZime
depresiisa da Sizofreniis mqone pacientebs aseve depresiuli aSliloba, romelic, Tavis mxriv, gacile-
SeiZleba gauCndeT suicidis mcdelobebi. biT ufro xSiria, vidre samSobiaro fsiqozi. ufro
mkurnaloba iniSneba klinikur sindromTa Sesabam- metad fiqsirdeba daRlilobis SegrZneba, gaRiz-
isad, rogorc es sxva TavebSia aRwerili. Cveulebriv, ianebadoba da SfoTva, vidre guneb-ganwyobis depre-
saWiroa pacientis hospitalizacia. gamoTqmulia mo- siuli cvlilebebi. aseve, gvxvdeba fobikuri simptom-
sazreba, rom pacienti unda moTavsdes deda-SvilisT- ebic. pacientebis umravlesobis gamojanmrTelebas
vis gankuTvnil specialur blokSi, raTa SesaZle- daaxloebiT 2-6 Tve sWirdeba.
beli iyos bavSvis dedasTan darCena, rac Seasustebs etiologia. klinikurma gamokvlevebma cxadyo, rom
uaryofiTi faqtorebis zemoqmedebas dedasTan mis amgvari aSlilobebi mowyvlad dedebSi provocirebu-
kavSirze. Tumca, am dros Zalze rTuldeba bavSvis lia fsiqologiuri adaptaciiT mSobiarobis Semdgomi
usafrTxoebis dacva da masze zrunva. amas garda, periodis mimarT, uZilobiTa da mZime datvirTviT,
amgvari midgomis dadebiTi Sedegebi jer-jerobiT rasac bavSvze zrunva moiTxovs. empiriuli monace-
ar aris dadgenili. Tu gadawydeba deda-Svilis hos- mebi naklebad adasturebs am aSlilobaTa biologi-
pitalizacia, urTierToba bavSvsa da dedas Soris uri safuZvlis arsebobas. ZiriTad risk-faqtors war-
mudmivi zedamxedvelobis qveS unda mimdinareobdes, moadgens adre gadatanili depresia (gansakuTrebiT
razec eqTani unda iyos pasuxismgebeli. SemdgomSi, maSin, rodesac mas Tan erTvis sameano garTulebebi)
ganixileba individualuri SemTxvevebi klinikuri da socialuri xasiaTis problemebi.
progresis TvalsazrisiT. marTva. miuxedavad imisa, rom mSobiarobis Semdeg
eleqtrokonvulsiuri Terapia (ECT) xSirad mkur qalebi samedicino da sxva saxis mzrunvelobis qveS
nalobis saukeTeso meTodia depresiuli da saSualo imyofebian, mSobiarobis Semdgomi depresiis mravali
simZimis mqone maniakaluri aSlilobis mqone paci- faqti ar aris aRricxuli, xolo maTi dadgenis SemTx-
entebisTvis, radgan igi swrafad iZleva efeqts da vevaSi, ar aris namkurnalevi. aqedan gamomdinare, maT,
saSualebas aZlevs dedas maleve ganaaxlos zrunva visac dedisa da Cvilis janmrTelobaze zrunva akis-
Tavis Svilze. naklebad urgentuli depresiuli riaT, gansakuTrebuli sifxizle marTebT, raTa ar
aSlilobebis dros, sasurvelia Tavidan movsinjoT gamorCeT depresiis ganviTareba. antidepresantebiT
antidepresantuli medikamentebiT mkurnaloba. Tu mkurnalobasTan erTad, aranaklebi mniSvneloba eni-
pacientis simptomebSi Warbobs Sizofreniis magvari Weba fsiqologiur da socialur daxmarebas. qalebis
simptomebi, SeiZleba saWiro gaxdes antifsiqozuri umravlesobisTvis efeqturia mkurnaloba pirveladi
wamlebis daniSvna. Tu drois xanmokle periodSi ar jandacvis dawesebulebebSi, sadac maT aRmouCenen mx-
fiqsirdeba aSkara gaumjobeseba, albaT mizanSewo- ardaWeras da daexmarebian praqtikuli problemebis
nilia eleqtrokonvulsiuri Terapiis gamoyeneba, gan- gadaWraSi. qalebis mcire nawils sWirdeba antidepre-
sakuTrebiT, daavadebis mwvave debiutis SemTxvevaSi. santebiT mkurnaloba da mxolod erTeulebi (mZime da
rTuli problemebis mqone pirebi) saWiroeben fsiqi-
prognozi atris daxmarebas.
pacientebis umravlesoba swrafad gamodis samSo- bavSvebze zegavlena. postnataluri depresia mZimed
biaro fsiqozis mdgomareobidan, magram isini, visac aisaxeba bavSvis urTierTobaze dedasTan da mis ad-
aReniSneboda Sizofreniuli aSliloba, qronikul reul kognitur da emociur ganviTarebaze (Stein et al.,
avadmyofebad rCebian. Semdgomi mSobiarobisas depre- 1991). negatiuri Sedegebi bavSvobis gviandel peri-
_ 427 _
odze naklebadaa cnobili (Murray and Cooper, 1997). vagvari fsiqologiuri TeoriebiT, romlebic ar aris
postnataluri depresiis sakiTxi ganxilulia ku- empiriulad dadasturebuli. es Teoriebi mocemul
perisa da mareis naSromSi (Cooper and Murray, 1998), sindroms ukavSirebs nevrotulobas an damokideb-
xolo broqingtonis naSromebSi mSobiarobis Semd- ulebas menstruaciis mimarT.
gomi fsiqologiuri garTulebebis yvela aspeqtia mkurnaloba. premenstrualuri sindromis sam-
mimoxiluli (Brockington, 1998, 2000). orsulobisa da kurnalod farTod gamoiyeneba progesteroni da mas-
orsulobis Semdgomi periodis fsiqofarmakologiis Tan erTad oraluri kontraceptivebi _ bromkripti-
sakiTxebis mimoxilva ix. Viguera, Cohen, 2000. ni, diuretikebi da fsiqotropuli preparatebi.
ar arsebobs am wamalTa efeqturobis damadasture-
ginekologiis fsiqiatriuli aspeqtebi beli mtkicebulebebi. maTi gamoyenebiT Catarebuli
premenstrualuri sindromi mkurnalobis gamokvleva placebo efeqtis maRal
maCvenebelze miuTiTebs (65%-mde). am dros aRmoCe-
es termini aRniSnavs fizikur da fsiqologiur simp-
nilma fsiqologiurma daxmarebam da mxardaWeram
tomTa jgufs, romelic Tavs iCens menstrualuri pe-
SesaZloa iseTive dadebiTi Sedegi mogvces, rogorc
riodis dawyebamde ramdenime dRiT adre da swrafad
medikamenturma mkurnalobam. zogierTi gamokvleva
qreba menstruaciis damTavrebis Semdeg. fsiqologi-
miuTiTebs mowyvladobis periodSi serotoninis uku-
uri simptomebia: SfoTva, gaRizianebadoba, Wamis Zl-
mitacebis seleqciuri inhibitoris, antidepresan-
ieri survili da depresia.
tebis maRalefeqturobaze da kognitur-bihevioruli
fizikuri simptomebia: mkerdis momatebuli mgrZno-
Terapiis upiratesobaze.
beloba, diskomforti muclis areSi da Seberilo-
menstrualuri sindromi da misi fsiqologiuri
bis SegrZneba. premenstrualuri sindromi ar Sedis
mkurnaloba ganxilulia Semdeg wyaroSi: Blake et al.,
fsiqikur aSlilobaTa Tanamedrove klasifikaciaSi,
1995.
Tumca, premenstrualuri disforiuli aSliloba
moxseniebulia DSM-IV-Si, rogorc mdgomareoba, ro- menopauza
melic Semdgom Seswavlas saWiroebs. es sindromi unda menopauzis dros, iseT fizikur simptomebTan erTad,
ganvasxvavoT ufro xSirad fiqsirebuli msgavsi simp- rogorebicaa wamowiTleba, oflianoba da saSos simS-
tomebisgan, romlebic ar warmoadgenen viwro gagebiT rale, qalebi uCivian Tavis tkivils, Tavbrusxvevasa
premenstrualur simptomebs, maTi gamovlenis peri- da depresias. Tumca, ar aris garkveuli, ramdenad
odidan gamomdinare. ufro metadaa gavrcelebuli es simptomebi menopauz-
epidemiologia. premenstrualuri sindromis Sem- is mqone qalebSi im qalebTan SedarebiT, romlebsac
Txvevebis sixSire farTod varirebs (30-80%-is far- menopauza ar dawyebiaT. da mainc, im pacientebs So-
glebSi) zogad populaciaSi reproduqciuli asakis ris, romlebic emociuri xasiaTis simptomebis gamo
qalebs Soris. aseT farTo varirebas sami mTavari mimarTaven zogadi profilis eqims, disproporci-
mizezi aqvs: upirveles yovlisa, es aris simptom- ulad maRalia saSualo asakis qalTa ricxvi, romle-
ebis dadgenis problema. msubuqi da xanmokle simp- bic menopauzis periodSi imyofebian.
tomebi xSiria premenstrualur periodSi da rTulia menopauzis periodSi depresiasTan da SfoTvas-
imis gadawyveta, unda klasificirdnen Tu ara isini Tan dakavSirebul simptomebs SeiZleba gansxvave-
premenstrualur sindromad. meorec, informacia am buli mizezebi hqondes. erT-erT mizezad xSirad
simptomebis Sesaxeb ufro xSirad grovdeba gasuli, asaxeleben hormonul cvlilebebs, gansakuTrebiT ki
adrindeli ricxviT, anu qalebis mier menstrual- estrogenebis naklebobas. zogierT qveyanaSi, gansa-
uri periodis gaxsenebiT, rac arcTu ise sarwmunoa kuTrebiT ki aSS-Si, estrogenebs iyeneben menopauzis
am simptomebis drosTan dasakavSireblad. da bolos, asakis mqone qalebTan, emociuri xasiaTis simptomebis
premenstrualur simptomTa aRwera subieqturia. pa- samkurnalod; magram, rodesac amgvari mkurnalo-
cientze SeiZleba gavlena iqonios imis codnam, rom ba Seiswavles, Sedegebi ar aRmoCnda damaimedebeli
mas gamokiTxva utardeba swored premenstrualur (Pearce et al., 1995). cxovrebis am periodis fsiqiatri-
sindromTan dakavSirebiT. uli simptomebi SeiZleba zustad aseve gamoiwvios
etiologia. etiologia dadgenili ar aris. am sin- qalis rolis Secvlam, ojaxidan Svilebis wasvlis
droms biologiuri TvalsazrisiT xsnidnen sakvercx- Semdeg; cvlilebam qmarTan urTierTobaSi da saku-
eebisa da hipofizis funqcionirebiT (estrogenebis Tari mSoblebis avadmyofobam an sikvdilma. aqedan ga-
siWarbe da progesteronis nakleboba; hipofizis hor- momdinare, menopauzis mqone qalebis depresias unda
monis gamoyofa) da, agreTve, siTxisa da eleqtro- vumkurnaloT yvela im meTodiT, romelic efeqturad
litebis balansis darRveviT. arc erTi es mosazreba gamoiyeneba cxovrebis nebismier etapze ganviTarebu-
ar dadasturda. am sindroms, aseve, xsnian sxvadasx- li depresiis dros.
_ 428 _
histereqtomia (saSvilosnos amokveTa) seba. Civilebi gauaresebis Taobaze gvxvdeba mxolod

20-idan 1 SemTxvevaSi.
ramdenime retrospeqtuli kvlevis Semdeg dadginda,
ginekologiis fsiqologiuri aspeqtebi ganxilulia
rom histereqtomiis Semdeg depresiuli aSlilo-
Semdeg wyaroebSi: Robinson(2000); Brockington (2000).
bebis sixSire izrdeba. mniSvnelovanma prospeqtulma
gamokvlevam, romelic Catarda standartuli meTo-
debis gamoyenebiT (Gath et al., 1982a, 1982b), gviCvena, damatebiTi literatura
rom im pacientebs, romelTac ar aReniSnebaT fsiqia- Gelder, MG, Lpez-Ibor, JJ Jr and Andreasen, NC (eds) (2000)
triuli simptomebi operaciamde, iSviaTad uviTarde- The new Oxford textbook of psychiatry. Oxford University
baT isini operaciis Semdeg. aRwerilia SemTxvevebi, Press, Oxford. (ix. Tavi 5, romelSic ganxilulia sx-
rodesac pacients operaciis Semdeg moexsna manamde vadasxva avtorebis mosazrebebi fsiqiatriisa da
arsebuli fsiqiatriuli simptomebi, xolo zog SemTx- zogadi medicinis Sesaxeb.)
vevaSi, es simptomebi mdgradi aRmoCnda.
Rundell, JR and Wise, MG (eds) (1999) Essentials of consulta-
savaraudoa, rom isini, visac aReniSneba simptomebi
tion liaison psychiatry. Americal Psychiatric Press, Washing-
operaciamde da operaciis Semdgom, dafiqsirebulni
ton, DC. (am naSromSi mokledaa ganxiluli ZiriTadi
arian retrospeqtul kvlevebSi, rasac mivyavarT mc-
klinikuri sakiTxebi.)
dar daskvnamde, rom histereqtomia iwvevs depresiul
aSlilobas. Stoudemire, A, Fogel, BS and Greenbury, D (eds) (2000) Psy-
chiatric care of the medical patient, 2nd edn. Oxford Uni-
sterilizacia versity Press, Mew York. (am wignSi detaluradaa ganxi-
Sexedulebebi am proceduraze Zalian hgavs histereq- luli fsiqiatriuli daxmarebis sakiTxebi.)
tomiis Sesaxeb arsebuls. miuxedavad imisa, rom ret- Levenson, JL (ed.) (2004) Textbook of psychosomatic medicine.
rospeqtuli kvlevebis mixedviT, sterilizacia iwvevs American Psychiatric Publishing, Washington DC. (detal-
fsiqikur aSlilobasa da sqesobriv disfunqcias, uri saxelmZRvanelo.)
prospeqtuli kvlevebi sawinaaRmdegos amtkicebs.
Mayou, R, Sharpe, M and Carson, A (2003) ABC of psychologi-
marTlac, albaT, am dros ufro mosalodnelia sqe-
cal medicine. BMJ Books, London. (praqtikuli xasiaTis
sobrivi urTierTobebis gaumjobeseba, vidre gauare-
mimoxilvebis mokle krebuli.)
_ 429 _
Tavi 17 suicidi da
ganzrax TviTdazianeba
Tavis Sinaarsi
umetes qveynebSi, sadac Sesabamisi informacia xelmi-
suicidi
sawvdomia, TviTmkvleloba sikvdilis mizezTa pirvel
suicidis aqti
aTeulSi Sedis. britaneTSi daavadebiT ganpirobebu-
suicidis epidemiologia
li dakarguli wlebis mixedviT, gulis daavadebebisa
demografiuli maxasiaTeblebi
da avTvisebiani simsivnis Semdeg, suicidi mesame adg-
suicidis mizezebi
ilzea. ukanaskneli ori aTwleulis manZilze ramden-
gansakuTrebuli jgufebi
ime qveyanaSi axalgazrda mamakacebs Soris TviTmkv-
suicidis riskis Sefaseba
lelobis SemTxvevebi gaizarda, Tumca, bolo dros
suiciduri ideebis mqone
am tendenciis kleba aRiniSneba. suicidis Tema mniS-
pacientebis marTva
vnelovania yvela eqimisTvis, visac saqme aqvs sui-
suicidis prevencia
cidis riskis mqone adamianebTan da vinc daxmarebas
uwevs gardacvlili piris ojaxsa da axloblebs. am
ganzrax TviTdazianebis aqti
sakiTxis mniSvneloba suicidis prevenciis erovnul
ganzrax TviTdazianebis epidemiologia
da saerTaSoriso iniciativebSia asaxuli (World Health
ganzrax TviTdazianebis mizezebi
Organization. 1998; Department of Health, 2002).
motivacia da ganzrax TviTdazianeba
arsebuli monacemebiT, erTi TviTmkvlelobis Ses-
ganzrax TviTdazianebis aqtis Sedegebi
abamisad 30 da met arafatalur mcdelobas aqvs ad-
mkurnalobis Sedegebi ganzrax
gili. ganzrax TviTdazianebas, ufro xSirad, mimar-
TviTdazianebis Semdeg
Taven is pirebi, romlebsac depresia, wamalmoxmarebis
specialuri jgufebi
problemebi an sxva fsiqikuri aSlilobebi aReniSne-
ganzrax TviTdazianebis marTva
baT. TviTdazianebis epizodis momdevno wlis ganma-
servisebis saorganizacio mowyoba
vlobaSi TviTmkvlelobis SemTxvevebi, zogad popu-
pacientebis gamokvleva ganzrax
laciasTan SedarebiT. 60-100-jer aris gazrdili.
TviTdazianebis aqtis Semdeg
(Hawton et al., 2003a). suicidis sixSire momatebulia,
pacientis marTva gamokvlevis Semdeg
agreTve, fsiqiatriuli saavadmyofodan gaweris Semd-
marTvis zogierTi
gom periodSic. amitom, fsiqiatri kargad unda erkve-
gansakuTrebuli problema
odes TviTdazianebisa da suiciduri qcevis bunebasa
da mizezebSi da unda icodes prevenciis meTodebi.
ganzrax TviTdazianebisa da suicidis yvela aspeqti
ganxilulia Semdeg wyaroSi: Hawton, van Heeringen, 2000.
sixSire
suraTi 17.1. suicidis sixSiris

zogadi maCveneblebi (100 000-
ze) sqesis mixedviT. 1990-1995
World Health Organization Figures sul
and Facts about Suicide. World Health kacebi
Organization. Geneva. 1999. qalebi
wlebi
_ 430 _
suicidi
suicidi Zaladobrivi an ucabedi sikvdilis SemTxvevebs) sa-

samarTlos~ mier miRebul gadawyvetilebas. sasamarT-
suicidis aqti los mxolod maSin gamoaqvs gadawyvetileba suicidis
suicids gansazRvraven, rogorc letaluri dasasru- Sesaxeb, rodesac arsebobs naTeli mtkicebuleba,
lis mqone aqts, romelic ganzrax aris inicirebuli rom saqme gvaqvs TviTdazianebasTan da gardacv-
da ganxorcielebulia im adamianis mier, romelmac lil pirs TviTmkvleloba hqonda ganzraxuli. Tu am
icis am aqtis letaluri dasasrulis Sesaxeb an elis oridan erT-erTi piroba mainc eWvs iwvevs, miiReba
aseT dasasruls. suicidi SeiZleba sxvadasxva meTo- gadawyvetileba SemTxveviTi gardacvalebis anu `Ria
diT ganxorcieldes. 2001 wels, inglissa da uelsSi verdiqtis~ Sesaxeb. `Ria verdiqtis~ gamotana ufro
Tavis CamoxrCoba yvelaze gavrcelebuli meTodi iyo xSirad maSin xdeba, rodesac TviTdazianebis aqti Se-
mamakacebs Soris da suicidis SemTxvevebis saerTo darebiT pasiuria (mag., wyalSi Tavis daxrCoba Tavis
raodenobis 40%-s Seadgenda. mas, sixSiris Tval- CamoxrCobasTan SedarebiT) da rodesac gardacvlili
sazrisiT, mohyveboda wamlis gadaWarbebuli doziT piri SedarebiT axalgazrdaa (Neeleman, Wessely, 1997).
miReba (20%), Tavis mowamvla manqanis gamonabolqviT yovelive amis gamo, miiCneva, rom TvTmkvlelobis Sem-
(TiTqmis 10%), Tavis daxrCoba wyalSi da simaRlidan Txvevebi ufro xSiria, vidre es oficialur statisti-
gadmoxtoma. qalebSi yvelaze gavrcelebuli meTodi kaSia asaxuli. erT-erTi naSromis Tanaxmad (Barraclough
iyo wamlis didi doziT miReba (46%-ze meti), Tavis et al., 1974), im adamianebidan, romelTa gardacvaleba
CamoxrCoba (TiTqmis 27%) da wyalSi Tavis daxrCoba SemTxveviTobad iyo kvalificirebuli, ukanasknel
(7%) (Brock, Griffiths, 2003). aSS-Si cecxlsasroli iara- xanebSi mravals aReniSneboda depresia da alkoholis
Risa da sxva Zalismieri meTodebis gamoyeneba ufro an narkotikebis moxmareba, anu isini iseT cxovrebas
xSiri movlenaa, vidre britaneTSi. eweodnen, romelic ar gamoricxavda TviTmkvlelobis
letaluri dasasrulis mqone suicidis SemTxvevaTa aqtis ganxorcielebas. mag., im periodSi, fsiqiatrebma
umetesoba dagegmilia. pirovneba, romelsac suicidi dublinSi aRricxes oTxjer meti suicidis SemTxve-
aqvs dagegmili, xSirad sgangebo zomebs mimarTavs (ar- va, vidre koroneris sasamarTlom. aseTi didi gansx-
Cevs ganmartoebul adgils da iseT dros, rodesac mo- vaveba monacemebs Soris sxvaganac iyo SeniSnuli. am
salodnelia, rom aravin gamoCndeba). Tumca, umravles problemis gadaWra nacadi iyo `SesaZlo suicidebis~
SemTxvevaSi, is mainc, raRac saxiT migvaniSnebs Tavisi SemTxvevebis aRricxviT, romlebSic gaerTianebuli
ganzraxvis Sesaxeb. aSS-Si Catarebuli gamokvlevebis iyo TviTmkvlelobis da `Ria verdiqtis~ SemTxvevebi
mixedviT, im adamianebis or mesamedze meti, vinc sui- (Schapira et al., 2001).
cidi ganaxorciela, manamde gamoxatavda suicidur gansxvaveba suicidis maCveneblebSi. zemoT ganxilu-
ideebs, xolo TviTmkvlelobis ganzraxvaze erT mesa- li mizezebis gamo, gansakuTrebuli sifrTxile unda
medze meti saubrobda. xSirad, pirovneba erTze met gamoviCinoT, rodesac erTmaneTs vadarebT suicidis
adamians afrTxilebs suicidis SesaZlo aqtis Sesaxeb. maCveneblebs qveynebisa da periodebis mixedviT. miuxe-
erT-erTi mniSvnelovani britanuli gamokvlevis Tanax- davad amisa, aSkaraa, rom sxvadasxva qveynis maCvene-
mad (Barraclough et al., 1974), im adamianebis orma mesamedma, blebs Soris stabiluri gansxvaveba SeiniSneba. kv-
romelmac SemdgomSi suicidi ganaxorciela, sxvadasxva levebis saSualebiT, romelic aSS-Si mcxovrebi 11 sx-
mizeziT gaiara konsultacia zogadi profilis eqimTan vadasxva qveynis emigrantebze Catarda (Sainsbury, Barra-
suicidis aqtis wina Tves, xolo 40%-ma _ wina kviras. clough; 1968), miiRes arapirdapiri mtkicebuleba imisa,
suicidis aqtamde erTi meoTxedi Sexvda Tavis fsiqi- rom sxvadasxva eris warmomadgenlebisTvis suicidis
atrs. aqedan, naxevari Sexvda fsiqiatrs erTi kviriT sixSire realurad gansxvavebulia, rac dadasturda
adre suicidis aqtis ganxorcielebamde. SedarebiT imiT, rom emigrantebSi TviTmkvlelobis raodenoba
axali monacemebi adasturebs suicidis aqtamde fsiqi- Seesabameboda maTi qveynebis suicidis maCveneblebs.
kuri janmrTelobis dacvis samsaxurebTan kontaqtis suicidis oficialuri maCvenebeli britaneTSi dasav-
gaxSirebas. aRsaniSnavia, rom aseTi kontaqti ufro iS- leTis qveynebis maCveneblebTan SedarebiT dabalia.
viaTia axalgazrda mamakacebSi. zogadad, ufro maRali maCveneblebia Crdilo aR-
mosavleT evropis qveynebSi, xolo xmelTaSua zR-
suicidis epidemiologia vis qveynebSi isini SedarebiT dabalia. oficialuri
statistikuri monacemebis sizuste. zusti statisti- maCvenebeli Zalian dabalia mahmadianur qveynebSi.
kuri monacemebi suicidis Sesaxeb advili mosapove- genderuli gansxvaveba sixSiris TvalsazrisiT ufro
beli ar aris, radgan informacia ucabedi sikvdilis gamokveTilia dasavleTis qveynebSi aziur qveynebTan
zust mizezze yovelTvis ar aris xelmisawvdomi. SedarebiT. suicidis zogierTi meTodi damaxasiaTebe-
mag., inglissa da uelsSi, oficialuri monacemebi lia adgilobrivi kulturisTvis (mag., sakuTari Tavis
eyrdnoba `koroneris (gamomZiebeli, romelic iZiebs dawva an ritualuri gamofatvra) (Cantor, 2000; Cheng,
_ 431 _
17 suicidi da ganzrax TviTdazianeba
Lee, 2000). ukanasknel xans, Tavis mowamvla qvanaxSiris sezonuri cvlilebebi
wvisas gamoyofili gaziT honkongSi TviTmkvlelobis
1921-1930-iani wlebidan moyolebuli, yvela aTwliani
gavrcelebul meTodad gadaiqca (Leung et al., 2002).
periodis maCveneblebiT, inglissa da uelsSi suicidis
cvlilebebi suicidis maCveneblebSi sixSire gazafxulisa da zafxulis TveebSi yvelaze
maRalia. igive monacemebia miRebuli CrdiloeTis
gasuli saukunis dasawyidan suicidis maCveneblebi
naxevarsferos sxva qveynebSic. miuxedavad imisa, rom
ramdenjerme Seicvala. yvelaze maRali maCvenebeli,
zafxulisa da zamTris sezoni samxreT naxevarsfero-
rogorc qalebSi ise mamakacebSi, orive msoflio omis
Si sxva Tveebs emTxveva, aqac TviTmkvlelobis SemTx-
dros aRiricxa. garda amisa, es maCvenebeli kidev
vevebi metia am periodSi. amgvari fluqtuaciis mizezi
ori periodis ganmavlobaSi gaizarda. pirvelad es
cnobili ar aris, Tumca arsebobs mosazreba, rom es
moxda 1932-1933 wlebSi, ekonomikuri depresiisa da
afeqturi aSlilobebis sezonur meryeobasTanaa da-
umuSevrobis dros. meore periodi moqceulia 1950-
kavSirebuli. yovel SemTxvevaSi, arsebobs garkveu-
iani wlebis dasasrulsa da 1960-iani wlebis dasawyiss
li mtkicebuleba, rom inglissa da uelsSi da zo-
Soris, rodesac arc ekonomikuri depresia iyo da arc
gierT sxva qveyanaSi, sezonuri variaciebi Semcirda
umuSevroba. 1963-1974 wlebSi suicidis maCvenebeli
ukanaskneli aTwleulis ganmavlobaSi (Yip et al., 2000).
Semcirda inglissa da uelsSi (magram ara evropis
sxva qveynebSi, saberZneTis gamoklebiT) da Crdilo
demografiuli maxasiaTeblebi
amerikaSi. inglissa da uelsSi suicidis maCveneblis
Semcireba albaT imiT iyo gamowveuli, rom Seicvala suicidi daaxloebiT samjer ufro xSirad gvxvde-
sacxovrebeli saxlebisTvis miwodebuli gazis Semad- ba mamakacebSi, vidre qalebSi. rogorc mamakacebSi,
genloba. Tu adre iyenebdnen gazis toqsikur formas, ise qalebSi, suicidis yvelaze maRali maCvenebeli
romelic qvnaxSiris wviT iyo miRebuli, SemdgomSi asakovan adamianebTan aris dadgenili. garda amisa,
daiwyes CrdiloeTis zRvidan miRebuli sawvavis ara- suicidis sixSire ufro dabalia daqorwinebul ada-
toqsikuri formis gamoyeneba. am cvlilebamde, gaziT mianebTan imaTTan SedarebiT, vinc arasodes yofila
mowamvla TviTmkvlelobis xSir meTods warmoadgenda. daqorwinebuli da aCvenebs zrdis tendencias Semdeg
suraTi 17.2 gviCvenebs cvlilebas suicidis sixSiris jgufebSi aseTi TanmimdevrobiT: qvrivi mamakacebi,
maCveneblebSi inglissa da uelsSi 1979-2001 wlebSi. qvrivi qalebi, ganqorwinebulebi. suicidis sixSire
monacemebi genderis da suicidis meTodis mixedvi- dasaqmebulebTan SedarebiT umuSevar pirebTan ufro
Taa gaanalizebuli. rogorc vxedavT, ufro maRali maRalia. socialuri klasis mixedviT, umaRlesi
maCveneblebi aRiricxeba mamakacebTan. diagrama, maCvenebeli gvxvdeba V klasSi (profesiuli unar-
agreTve, miuTiTebs maCveneblebis zrdas kategori- Cvevebis armqone fizikuri SromiT dakavebuli ada-
aSi `CamoxrCoba, moxrCoba da mogudva~ (ZiriTadad mianebi). am jgufs mosdevs I socialuri klasi (pro-
CamoxrCoba) da klebis tendencias kategoriaSi `sxva fesionalebi), romlis maCveneblebi aRemateba II, III
saxis mowamvla~ (ZiriTadad manqanis gamonabolqvi). da IV klasebis monacemebs. suicidis sixSire maRalia
inglisi da uelsi
10
100 000-ze (evropis standartul populaciasTan)
100 000-ze (evropis standartul populaciasTan)
10 mamakacebi qalebi
asakis mimarT standartizebuli maCvenebeli
asakis mimarT standartizebuli maCvenebeli
9 9
CamoxrCoba, moxrCoba da mogudva
8 8
7 7
6 6
5 sxva saxis 5
mowamvla
4 wamliT mowamvla
4
3 wamliT mowamvla 3 sxva saxis wyalSi
mowamvla daxrCoba
2 2 CamoxrCoba, moxrCoba
da mogudva
wyalSi daxrCoba 1
1
0 0
1979 1982 1985 1990 1991 1994 1997 2000 2001 1979 1982 1985 1990 1991 1994 1997 2000 2001
wlebi wlebi
suraTi 17. 2 asakis mimarT suicidis xarisxis standartizebuli maCvenebeli TviTdazianebis meTodisa da
sqesis mixedviT. 15 weli da zemoT. 1979-2001 (3-wliani moZravi saSualo maCvenebeli).
_ 432 _
suicidi
patimrebTan, gansakuTrebiT ki droebiT dapatimre- lobis mqone adamianebis daaxloebiT 6 procenti
bul pirebTan. sicocxles TviTmkvlelobiT amTavrebs. depresiuli
suicidis done gansakuTrebiT maRalia zogierTi pacientebis avadmyofobis istoriaSi, romlebmac
profesiis adamianebTan. veterinar qirurgebs mosa- TviTmkvleloba Caidines, sxva depresiul pacien
lodnelze samjer ufro maRali maCvenebeli aqvT, tebTan SedarebiT ufro xSirad fiqsirdeba TviT
xolo farmacevtebisa da fermerebis monacemebi mo- dazianebis epizodebi da uimedobis gancda (Fawcett
salodnelze orjer ufro maRalia (Charlton et al., et al., 1980). garda amisa, am jgufSi ufro xSirad
1993). aseve, suicidis maCvenebeli SedarebiT maRalia gvxvdeba martoxela, ganqorwinebuli, daqvrivebuli
eqimebSi (mamakac eqimebTan SedarebiT, qal eqimebTan da ufrosi asakis adamianebi, ufro xSirad _
suicidis ufro maRali maCvenebelia dadgenili) (Haw- mamakacebi.
ton et al., 2001a; Schernhammer, Colditz, 2004). suicidi eq- w alkoholmoxmareba. alkoholdamokidebulebis mqone
imebSi ?? gverdzea ganxiluli. pacientebze Catarebulma Semdgomma dakvirvebam
aCvena suicidis mudmivi riskis arseboba. 7%-is
suicidis mizezebi SemTxvevaSi aseTi riski sicocxlisTvis saSiSi
kvlevis meTodebi iyo (Inskip et al., 1998). alkoholdamokidebul
suicidis mizezebis gamokvlevas ramdenime sirTule adamianebSi suicidis SemTxvevebi ufro xSirad
ukavSirdeba. SeuZlebelia piradapiri informaciis mop- dafiqsirebulia ufrosi asakis mamakacebTan,
oveba pirovnebis janmrTelobisa da misi mdgomareobis romelTac aqvT alkoholizmis xangrZlivi istoria,
Sesaxeb suicidis ganxorcielebis momentSi. suicidis depresiis istoria da warsulSi hqondaT suicidis
prospeqtuli gamokvlevebis Catareba rTulia, radgan mcdeloba. suicidis riski agreTve, gazrdilia im
suicidi iSviaT movlenas warmoadgens da, Sesabamisad, adamianebSi, visTanac alkoholmoxmarebam gamoiwvia
misi Seswavla didi jgufebis gamokvlevas moiTxovs. am somaturi problemebi, problemebi col-qmrul da
sirTuleebis dasaZlevad or strategias iyeneben: samsaxureobriv urTierTobaSi da, agreTve, imaTTan,
vinc dapatimrebuli yofila nasvam mdgomareobaSi
1. retrospeqtul gamokvlevebSi grovdeba informa-
Cadenili kanondarRvevis gamo.
cia im viTarebis Sesaxeb, romelSic ganxorcielda
suicidi. es xdeba Canawerebis SeswavliT da im eq- w wamalmoxmareba SedarebiT gavrcelebulia im ada
imebis, naTesavebisa da megobrebis interviuirebiT, mianebSi, visTanac suicidis mcdeloba fatalu
romlebic gardacvlils kargad icnobdnen. rad mTavrdeba. es pirebi, Cveulebriv, axalgazrda
asakis arian (Oyefeso et al., 1999).
2. epidemiologiur gamokvlevebSi Seiswavlian kavSirs
erTi mxriv socialur da demografiul faqtorebs, w Sizofrenia. suicidis maCvenebeli izrdeba am aS
xolo, meore mxriv, sxvadasxva periodSi da popula- lilobis mqone axalgazrda mamakacebSi daavade
ciaSi suicidis maCveneblebs Soris. bis sawyis etapze. suicidis maCveneblebis zrda
gansakuTrebiT dafiqsirebulia (a) recidivis
TiToeul midgomas specifikuri meTodologi-
dros; (b) depresiuli simptomebis dros; (g) maRali
uri problemebi ukavSirdeba, Tumca, pirveli tipis
akademiuri moswrebis mkveTrad gauaresebisas avad
gamokvleva, romelsac `fsiqologiur autopsias~
uwodeben, gvexmareba suicidis winmswrebi faqtorebis
identifikaciaSi. meore midgoma gvexmareba gaverkveT
cxrili 17.1 fsiqikuri aSlilobis procentu-
li maCvenebeli letaluri dasasrulis mqone
im socialur viTarebaSi, romelmac ganapiroba suici-
suicidis xuT fsiqologiur autopsiur gamo-
dis maCveneblebis zrda.
kvlevaSi. DSMIII an DSMIII R kriteriumebis
calkeuli fsiqologiuri da somaturi faqtorebi gamoyenebiT
calkeuli faqtorebis Seswavlisas (cxrili 17.1) Sem- depresiuli aSliloba 36-90
degi ZiriTadi Sedegi iqna miRebuli: im adamianebis um- alkoholmoxmareba an alkoholdamokidebuleba 43-54
ravlesobas, vinc sicocxles suicidiT amTavrebs, gar-
wamalmoxmareba an wamaldamokidebuleba 4-45
dacvalebis momentSi ama Tu im saxis fisqikuri aSli-
loba aReniSneba (Barraclough et al., 1974). msgavsi Sede- Sizofreniuli aSliloba 3-10
gebi sxva qveynebSic miiRes (Cheng, Lee, 2000), esenia: organuli fsiqikuri aSliloba 2-7
w personologiuri aSliloba. aRiniSneba erT mesa personologiuri aSliloba 5-44
medidan naxevramde raodenobis im adamianebSi, visac
Lonnqvist, JK (2000). Epidemiology and causes of suicide. In MG
hqonda suicidis mcdeloba (Foster et al., 1997). Gelder, JJ Lopez-Ibor JR, and NC Andreasen (eds). The new Oxford
textbook of psychiatry. Chapter 4.15.1. Oxford University Press,
w guneb-ganwyobis aSliloba. guneb-ganwyobis aSli
Oxford
_ 433 _
myofobis gamo. am jgufSi suicidis riski cxovrebis Ceulia suicidis gaxmaurebuli faqtebis zegavleniT,
manZilze 7%-s Seadgens (Inskip et al., 1998). romlebmac miipyres sazogadoebis, presis da televi-
suicidTan asocirebuli sxva faqtorebia ganzrax ziis yuradReba (Eisenberg, 1986b; Gould et al., 1990).
TviTdazianebis istoria (gv. ??) da mZime fizikuri
biologiuri faqtorebi
daavadeba (gansakuTrebiT epilefsia). (ix. Harris,
ikveTeba kavSiri suicidsa da suicidis ojaxur isto-
Barraclough, 1995; Stenager and Stenager, 2000).
rias Soris. naSvilebi pirebis gamokvlevebi (Wender et
suicidTan dakavSirebuli socialuri faqtorebi al., 1986) imaze miuTiTebs, rom suicidis meqanizmi ge-
ukve didi xania tardeba iseTi gamokvlevebi, romelTa netikuri xasiaTisaa. es genetikuri meqanizmi SeiZleba
meSveobiT SeiZleba xdeba suicidis maCveneblis Sedar- damoukidebeli iyos im meqanizmebisgan, romlebic ga-
eba erTi qveynis SigniT da ramdenime qveyanas Soris. napirobebs nebismier fsiqikur aSlilobas (Roy et al.,
amaTSi arc erTi maTgani ar aris iseTi gavleniani, 2000) da, SesaZloa, iseT pirovnul TvisebebTan iyos
rogorc emil durkhaimis mier mecxramete saukunis dakavSirebuli, rogoric impulsuroba da agresiaa.
dasasruls Catarebuli gamokvleva (Durkheim, 1951). suiciduri qceva, agreTve, dakavSirebulia Tavis
durkhaimma Seiswavla suicidis maCveneblebi safr- tvinis 5-HT-is gzebis aqtivobis daqveiTebasTan. mag.,
angeTSi da Seadara isini evropis sxva qveynebis mo- suicidantebSi daqveiTebulia 5-HT funqciis presinaf-
nacemebs. man aCvena, rom suicidis sixSires mravali suri markerebisa (CSF da 5-HIAA) da 5-HT transpor-
socialuri faqtori ganapirobebs. suicidis xarisxi teris ubnis simkvrive. amis sapirispirod, prefronta-
ufro dabali aRmoCnda omianobisa da revoluciis lur korteqsSi gazrdilia 5-HT1A da 5-HT2A postsinaf-
periodSi da izrdeboda ekonomikuri aRmavlobis da suri receptorebis simkvrive, rac SeiZleba asaxavdes
ekonomikuri depresiis dros. amis safuZvelze man 5-HT-is daqveiTebuli gamoTavisuflebis sapasuxo kom-
daaskvna, rom suicidis dones, ZiriTadad, ganapiro- pensatorul regulacias (Mann, 2003). rogorc Cans,
bebs socialuri integracia da socialuri regulacia. asociacia 5-HT-is gzebis aqtivobis daqveiTebasa da
durkhaimma aRwera suicidis oTxi tipi, saidanac erT- suicidur qcevas Soris ufro farToa da ukavSird-
erTi _ anomiuri suicidia. mocemul konteqstSi sui- eba Tavis tvinis daqveiTebuli 5-HT funqciis mqone
cidis swored am tipis ganxilvaa yvelaze saintereso. adamianebis impulsurobisa da agresiulobis maRal
termini ànomiuri suicidi~ aRwers iseTi adamianis xarisxs (Mann, 2003). 5-HT-is fuqnciasa da suicids So-
TviTmkvlelobas, romelsac gawyvtili aqvs kavSiri ris gamovlenilma kavSirma ganapiroba interesi iseTi
sxva adamianebTan da aRar miiCnevs Tavs sazogadoebis kvlevebis mimarT, romliTac swavloben 5-HT recep-
wevrad (durkhaimis mier identificirebuli danarCeni torebis makodirebeli genebis polimorfizms sui-
tipebia egoisti, altruisti da fatalisti). cidisadmi midrekil pirebSi. jer-jerobiT sarwmuno
ufro gviandelma gamokvlevebma aCvena, rom suici- asociaciebis dadgena ver moxerxda (Arango et al., 2003).
dis SedarebiT maRali maCvenebeli dakavSirebulia
fsiqologiuri faqtorebi
umuSevrobisa da siRaribis maRal donesTan (Gunnel
suicidis fsiqologiuri faqtorebis Sesaxeb, ZiriTa-
et al., 1995), ganqorwinebasTan da socialur fragmen-
dad, msjeloben ganzrax TviTdazianebis qcevis Seswav-
taciasTan (Whitley et al., 1999). miuxedavad imisa, rom
liT, romelsac ar aqvs letaluri dasasruli, Tumca,
am gamokvlevebis Sedegebi ar gvaZlevs saSualebas Se-
suicidis faqtorebi SeiZleba amisgan gansxvavebuli
viswavloT im adamianebis maxasiaTeblebi, romlebmac
iyos. gamonakliss warmoadgens bekisa da misi ko-
TviTmkvleloba Caidines, isini gvawvdis mniSvnelo-
legebis gamokvleva. maT Caatares dakvirveba 200 pa-
van informacias sazogadoebaSi arsebul faqtorze,
cientze, romlebic manamde hospitalizebulni iyvnen
romlebic zemoqmdeben suicidis doneze. kros-kul-
suiciduri azrebis gamo (Beck et al., 1985). aRmoCnda,
turuli monacemebi imas miuTiTebs, rom suicidis
rom uimedobis maRali maCveneblis mqone pirebs aR-
mniSvneloba da misdami damokidebuleba Zalian gan-
eniSnebodaT suicidis momatebuli sixSire momdevno
sxvavebulia sxvadasxva kulturaSi, rac, Tavis mxriv,
5-10 wlis manZilze. Semdgomi kvlevebiT dadgenilia,
kavSirSia suicidis xarisxTan.
rom suiciduri qceva SeiZleba dakavSirebuli iyos: im-
kidev erTi faqtori, romelic, rogorc Cans zemoq-
pulsurobasTan, diqotomiur azrovnebasTan (ukidure-
medebs suicidis xarisxze, mediis mier suicidis Temis
si azrovneba, rodesac pirovnebisTvis yvelaferi, mx-
gaSuqebaa. aRmoCnda, rom suicidis da suicidis mcd-
olod, an TeTri an Savia)kognitur SezRudulobasTan,
elobis SemTxvevebis raodenoba izrdeba iseTi mxat-
problemis gadaWris daqveiTebul unarTan da auto-
vruli satelevizio filmebisa da programebis Semdeg,
biografiuli mexsierebis zedmetad ganzogadebasTan.
romlebic Seicavs kadrebs suicidis Sesaxeb (Hawton
yvela am faqtors SeuZlia, impulsuri qcevisaken ga-
et al., 1999b). zogjer, suicidis mizniT gamoyenebuli
nawyos adamiani (Williams, Pollock, 2000).
saSualebebi da suicidis ganxorcielebis dro Ser-
_ 434 _
suicidi
daskvna w aucilebelia pacientebisTvis intensiuri mxar

CamoTvlil faqtorebs ar aqvT uSualo mizez-Sede- daWeris gaweva saavadmyofodan gaweris Semdeg
gobrivi kavSiri suicidTan, Tumca isini miuTiTeben ramdenime kviris ganmavlobaSi. pacientebze Sem
samive jgufis faqtorebis mniSvnelobaze: (1) soma- dgomi pirveli dakvirveba unda ganxorcieldes
turi faqtorebi, romlebic moicavs depresiul aSli- saavadmyofodan saboloo an droebiTi gaweridan
lobas, alkoholis borotad moxmarebasa da person- ramdenime dRis Semdeg.
ologiur aSlilobebs; (2) fsiqologiuri faqtorebi, w winaswar dagegmeT is RonisZiebebi, romlebic
romelTa Sorisac yvelaze Zlieria uimedobis gancda; unda ganaxorcieloT pacientis mier mkurnalobis
(3) socialuri faqtorebi, gansakuTrebiT, izola- reJimis daucvelobis SemTxvevaSi.
cia da siRaribe. SesaZloa, mniSvnelovani iyos iseTi w CataareT medikamentebis gverdiTi efeqtis moni
pirovnuli maxasiaTeblebi, rogoricaa impulsuroba toringi. Tu aRmoCnda, rom pacienti uars ambobs
da agresiuloba, romelTa biologiur safuZvels damatebiTi medikamenetebis miRebaze misTvis da
5-HT sistemis dazianeba unda warmoadgendes. niSnuli preparatebis gverdiTi efeqtebis gamo,
CaanacvleT es medikamanetebi naklebi gverdiTi
gansakuTrebuli jgufebi efeqtis mqone erTi preparatiT.
suicidi fsiqiatriuli servisebis momxmareblebSi. w palataSi myofi sagnebi: radgan suicidis gavrce
Tu gaviTvaliswinebT mWidro kavSiris arsebobas lebuli meTodi Tavis CamoxrCobaa, palataSi ar
fsiqikur aSlilobasa da suicids Soris, ar unda iyos unda iyos iseTi sagnebi, romelTa gamoyenebasac
gasakviri, rom bevri piri, romelic TviTmkvlelobiT SeZlebs pacienti Tavis CamoxrCobis mizniT.
asrulebs cxovrebas, fsiqiatriuli servisis momx- am zogadi punqtebis garda, depresiuli aSlilobisa
marebelia. da Sizofreniis dros, damatebiTi punqtebia gasaT
inglissa da uelsSi daarsebuli konfidencialuri valiswinebeli.
erovnuli gamokiTxvis centris meSveobiT Segrovda depresiuli aSliloba. depresiuli aSlilobis
informacia yvela suicidant pacientze, romelic mqone pacientebSi suicidis riski SeiZleba gai
ukanaskneli 12 Tvis manZilze fsiqiatriuli momsax- zardos mkurnalobis dasawyisSi, fsiqomotoruli
urebiT sargeblobda (Appleby et al., 2001). suicidis retardaciis SemcirebasTan erTad. Tumca, savaraudoa,
maCveneblebi SedarebiT maRali iyo stacionirebul rom suicidis ganxorcielebis etapze pacientTa
pacientebs Soris. TviTmkvlelobis SemTxvevebis umetesoba antidepresiul mkurnalobas ar itarebs
TiTqmis erTi meoTxedi stacionirebis pirvel kvi- (Isacsson et al., 1994). zogierTi antidepresantis mier
raze modioda. suicidis SemTxvevebis daaxloebiT suiciduri qcevis riskis gazrdis sakiTxi?? gverdzea
erTi mesamedi emTxveoda stacionaridan droebiT ganxiluli.
gaweris periods, xolo pacientebis erTi meoTxedi Sizofrenia. Sizofreniis diagnozis mqone pi
_ gaweridan sami Tvis, upiratesad ki pirveli ori rebTan suicidTan asocirebuli faqtorebia afeq
kviris ganmavlobaSi (eqimTan sakontrolo vizita- turi aSliloba, suiciduri azrebi, wuxili imis
mde) iklavda Tavs. suicidis faqtebi ufro xSiri iyo Taobaze, rom daavadeba uaryofiTad imoqmedebs
xanomkle hospitalizaciis Semdeg da maSin, rodesac maT fsiqikur funqcionirebaze, marcxis gancda,
pacienti samedicino Cvenebis sawinaaRmdegod ewere- medikamenturi mkurnalobisadmi daumorCilebloba
boda stacionaridan. da wamalmoxmareba. Sizofreniis, rogorc daavadebis
gamokiTxvaSi monawile suicidis mcdelobis mqone maxasiaTeblebi naklebad warmoadgens pirdapir risk-
pacientebis TiTqmis naxevari CarTuli iyo specialur faqtors, magram isini arapiradipiri gziT moqmedeben
programaSi (Care Programm Approach) (gv. ??), romlis zemoT xsenebul faqtorebze (Hawton et al., 2005).
farglebSic xdeboda maTi mdgomareobis dinamikis
multidisciplinuri Sefaseba. pacientebis erTi meo-
racionaluri suicidi
Txedi ar icavda programis moTxovnebs da erTi mex- zemoT Tqmulis miuxedavad, suicidi, zogjer, fsi
uTedi ar iRebda daniSnul medikamentebs. pacientebis qikurad janmrTeli adamianis racionalur qmedebas
TiTqmis ori mesamedis SemTxvevaSi, fsiqikur prob- warmoadgens. garda amisa, aRwerilia masobrivi TviT
lemebze momuSave gunds dasWirda gansakuTrebuli mkvlelobis faqtebi, mag., garkveuli tipis religiur
Zalisxmeva pacientebTan TanamSromlobis aRsadgenad. jgufebSi. am faqtebis aRwera namdvilad saeWvos
im pacientebis did nawils, romelic uars ambobda xdis imas, rom religiuri ritualis yvela monawiles
TanmSromlobaze, Sizofreniis diagnozi dausves. fsiqikuri daavadeba aReniSneboda. miuxedavad ase
zemoTxsenebuli monacemebi Semdeg saWiroebebze Ti gamonaklisi SemTxvevebis arsebobisa, mainc
miuTiTebs: unda davuSvaT, rom adamians, romelic saubrobs
_ 435 _
suicidis Sesaxeb, fsiqikuri problemebi aReniSneba, siuli da sakuTar TavSi Caketilebi iyvnen da
Tu faqtebis Semdgomi analizi sapirispiros zogierTma Sewyvita skolaSi siaruli. meore jgufSi
ar daamtkicebs. Tu es daSveba sworia (zogjer Sedioda impulsuri bavSvebi, romlebic Zaladobisaken
rTulia depresiuli aSlilobis identifikacia iyvnen midrekilni da zedmetad mgrZnobiareni iyvnen
pacientis pirvelad naxvisas), sikvdilis impulsi kritikis mimarT (Pfeffer, 2000; Shaffer et al., 2000).
unda Sesustdes normaluri sulieri mdgomareobis mozardebi. ukanasknel wlebSi gaizarda suicidis
aRdgenis Semdeg. ufro metic, Tu gadawyvetileba done mozardebis populaciaSi. inglissa da uelsSi
TviTmkvlelobis Sesaxeb racionaluradaa miRebuli, suicidis xarisxis zrda, ZiriTadad, aRiniSneba 15-
mainc mizanSewonilia TviTdazianebis prevencia, 19 wlis asakis vaJebis populaciaSi (McClure, 2000).
radgan racionaluri gadawyvetileba suicidis TviTmkvlelobis ZiriTadi meTodebia Tavis CamoxrCoba
Sesaxeb SeiZleba mcdar Sexedulebebs emyarebodes da manqanis gamonabolqviT Tavis mowamvla (Hawton et
da damatebiTi informaciis miRebis Semdeg SeiZleba al., 1999a). fsiqologiurma autofsiam (Houston et al.,
Seicvalos (mag., rodesac mas ecodineba, rom 2001) aCvena, rom im mozardebis daaxloebiT 70%-s,
avTvisebiani simsivniT gardacvaleba iseTi mtkivneuli romlebmac suicidiT daasrules cxovreba, fsiqikuri
ar aris, rogorc mas hgonia). aSliloba aReniSnebodaT (ZiriTadad, depresiuli da
personologiuri aSlilobis komorbidoba). mravali
xandazmuli adamianebi
axalgazrda narkotikebisa da alkoholis momxmarebeli
qveynebis umravlesobaSi, suicidis SemTxvevebi yvelaze iyo. TviTmkvleloba xSirad warmoadgenda xangrZlivi
xSiria 75 wels gadacilebul pirebSi. mamakacebSi problemebis kulminacias interpersonalur da
yvelaze gavrcelebuli meTodi Tavis CamoxrCobaa, fsiqosocialur sferoSi. mozardebis or mesamedTan
xolo qalebSi _ wamlis gadaWarbebuli doziT miReba warsulSi dafiqsirda suicidis mcdeloba. damatebiTi
(Harwood et al., 2000a). aqtiuri TviTdazianebis garda, informaciisTvis ix. Wilde, 2000.
zogierTi adamiani kvdeba sakuTari Tavis ganzrax
ugulebelyofisgan (mag., uars ambobs sakvebze an eTnikuri jgufebi
mkurnalobis Catarebaze). axalgazrdebis msgavsad, emigrantebs Soris suicidis sixSire maTi mSobliuri
depresia xandazmul adamianebTanac suicidis Zlier qveynebis suicidis maCveneblebs Seesabameba. brita
prediqtors warmoadgens. danarCeni faqtorebia neTSi azieli qalebis populaciaSi suicidis sgangaSo
izolacia da susti fizikuri janmrTeloba, Tum monacemebi aRiniSneba.
ca es ukanaskneli faqtori SeiZleba depresiis ga
maRali riskis profesiuli jgufebi
mowvevis gziT moqmedebdes (Conwell et al., 2002).
aseve, mniSvnelovania pirovnuli maxasiaTeblebi, eqimebi. suicidis maCveneblebi ufro maRalia eqimebSi
gansakuTrebiT, SfoTva da obsesia (Harwood et al., zogad populaciasTan SedarebiT, da ufro maRalia
2000b). suicidi xandazmul pirebTan Semdeg wyaroSia qal eqimebSi, mamakac eqimebTan SedarebiT (Hawton
ganxiluli: Harwood, Jacoby, 2000. et al., 2000; Schernhammer, Colditz, 2004). eqimebTan
suicidis maRali maCveneblis axsna mrvali mizeziT
bavSvebi da mozardebi iyo nacadi (medikamentebis xelmisawvdomoba, wamal
bavSvebi. suicidi iSviaTia bavSvebSi. 1989 wels, damokidebulebisa da alkoholdamokidebulebis ma
suicidis sixSire 5-14 wlis asakis bavSvebSi Seadgenda Rali xarisxi, samuSaosTan dakavSirebuli stresi,
0.7/100, 000 aSS-Si da 0.8/100, 000 _ britaneTSi. depresiuli aSlilobis mkurnalobis dabali motivacia,
Zalian cotaa cnobili im garemoebebis Sesaxeb, eqimis profesiis arCeva garkveuli predispoziciis
romlebic iwvevs suicids bavSvobis asakSi, garda im mqone pirebis mier). suicidiT gardacvlili 38
faqtorebisa, romlebic mZime pirovnul da socialur eqimis fsiqologiurma autofsiam (Hawton et al., 2004a)
problemebTan aris dakavSirebuli. suicidis Sedegad aCvena, rom maT or mesameds aReniSneboda fsiqikuri
gardacvlil bavSvebs, Cveulebriv, aReniSnebaT an aSliloba (ZiriTadad depresiuli aSliloba) da
tisocialuri qceva, xolo suiciduri qceva da alkohol an wamalmoxmareba. amdenive SemTxvevaSi
depresiuli aSliloba bavSvis mSoblebTan da da- dafiqsirda samsaxureobrivi problemebi. daaxloebiT
ZmasTan fiqsirdeba (Shaffer, 1974). Saferi (Shaffer) erT mesameds hqonda urTierTobebTan dakavSirebuli
asxvavebda bavSvebis or jgufs: pirvel jgufSi problemebi, xolo erT meoTxeds _ finansuri
Sedioda gansakuTrebiT maRali inteleqtis mqone poblemebi. suicidis meTodebSi yvelaze xSiri
bavSvebi, romlebic, rogorc Cans, izolirebulni gamodga wamliT Tavis mowamvla (rac aRemateboda
iyvnen TavianTi, naklebad ganaTlebuli, mSoblebisgan. zogadi populaciis Sesabamis maCvenebels). garda
aseTi bavSvebis dedebs xSirad aReniSnebodaT fsi amisa, anesTeziologebis naxevarma gamoiyena
qikuri daavadeba. gardacvalebamde, bavSvebi depre saanesTezio saSualebebi. orive rigis faqtorebi
_ 436 _
suicidi
gaTvaliswinebulia prevenciis programebis mier. suicidis riskis Sefaseba
zogadi medicinis dargSi momuSave eqimebis popu
zogadi sakiTxebi
laciasTan SedarebiT, suicidis ufro maRali
nebismier eqims unda SeeZlos suicidis riskis
maCvenebeli dafiqsirda anesTeziologebTan, Temis
Sefaseba. suicidis riskis Sefaseba or moTxovnas
doneze momuSave eqimebTan, zogadi profilis eqimebTan
unda akmayofilebdes: pirvelia eqimis mcdeloba,
da fsiqiatrebTan (Hawton et al., 2000). ar aris cnobili,
dasvas pirdapiri, magram taqtiani kiTxvebi
es maCveneblebi individualuri maxasiTeblebiTaa
pacientis ganzraxvis Sesaxeb. arsebobs damajerebeli
gamowveuli (romlebic ganapirobeben specialobis
mtkicebuleba imis Taobaze, rom pacientisTvis
arCevas da suicidis xarisxs) Tu samuSaos xasiaTiT.
suicidTan dakavSirebiT kiTxvebis dasma zrdis
fermerebTanac SeiniSneba suicidis maRali xarisxi.
suicidiuri qcevis albaTobas. amis sapirispirod,
SesaZlo mizezebs Soris asaxeleben TviTdazianebis
rodesac eqimi Seexeba suicidis Temas adamianTan,
saSualebebis (momwamvleli nivTiereba da iaraRi)
romelsac ufiqria TviTmkvlelobaze, pacients
xelmisawvdomobas, samuSaosTan dakavSirebul stress
uCndeba gancda, rom misi ukeTesad esmiT, ramac
da finansur sirTuleebs (Malmberg et al., 1999).
SeiZleba Seamciros suicidis riski.
studentebSi suicidis maCveneblebi, Cveulebriv,
meore moTxovna gulisxmobs sifxizlis gamoCenas
zogadi populaciis Sesabamisi asakobrivi jgufis
iseTi faqtorebis mimarT, romlebic suicidis pred
maxasiaTeblebis msgavsia, rac ar Seesabameba im mo
iqtorebs warmoadgenen. Tumca, am faqtorebze dam
sazrebas, rom studentebi maRali riskis jgufs
yarebuli prognozi ar aris sakmarisad sensitiuri
warmoadgenen.
da specifikuri. amis gamo, maSinac ki, rodesac ris
SeTanxmeba suicidis Sesaxeb ki, sruliad marTebulad, maRali xarisxis riskad
suicidis Sesaxeb SeTanxmebis dadebisas ori an meti aris kvalificirebuli, Zneli gansasazRvria, Tu
adamiani Tanxmdeba, rom sicocxles daasruleben rodis ganxorcieledeba suicidis aqti. gold
TviTmkvlelobiT erTsa da imave dros. aseTi Stainis gamokvlevaSi (Goldstein et al., 1991) mcdeloba
SeTanxmebebi xSirad ar sruldeba. Soreuli aR iyo, suiciduri qcevis prognozis mizniT, statis
mosavleTis qveynebSi xelSekrulebas, Cveulebriv, tikuri modelis Seqmna. avtorebma scades am
deben 30 wlamde asakis Seyvarebulebi, xolo da modelis gamoyenebiT suicidis 46 SemTxvevis prog
savleTis qveynebSi _ 50 wels gadacilebuli wyvi nozi stacionaruli pacientebis maRali riskis
lebi, romlebic erTmaneTze arin damokidebuli. jgufSi, magram ver moaxerxes verc erTi pacientis
SeTanxmeba suicidis Sesaxeb unda gavarCioT iseTi identifikacia, romelmac momavalSi suicidi gana
SemTxvevebisgan, rodesac mkvlelobas suicidi xorciela.
mohyveba (gansakuTrebiT maSin, rodesac erTi adamiani
riskis Sefaseba
kvdeba, meore ki gadarCeba) an rodesac erTi adamiani
yvelaze aSkara gamafrTxilebeli niSani aris suicidis
exmareba meores suicidis aqtis ganxorcielebaSi,
Sesaxeb ganzraxvis pirdipiri gancxadeba. rogorc
xolo Tavad TviTmkvleloba ar aqvs ganzraxuli.
ukve aRvniSneT, moaruli azri, romlis Tanaxmad, is,
amgvari SeTanxmebebis mizezebi zustad ar aris
vinc xSirad laparakobs TviTmkvelobaze, arasodes
dadgenili. Cveulebriv, or adamians gansakuTrebiT
axorcielebs mas, arasworia. piriqiT. im adamianebis
axlo urTierToba akavSirebs, magram isini sxvebisgan
ori mesamedi, vinc sicocxles TviTmkvlelobiT
socialurad izolirebulni arian. xSirad suicidis
asrulebs, yovelTvis atyobinebs sxvebs sakuTar
iniciatori dominanturi partnioria.
ganzraxvas. zogi adamiani gamudmebiT laparakobs
masobrivi suicidi iSviaTobas warmoadgens. masob
TviTmkvlelobaze, ris gamoc mis naTqvams seriozulad
rivi suicidis magaliTia 1978 wels xalxebis taZris
aravin uyurebs da is aRiqmeba, rogorc muqara,
kultis 913 mimdevris TviTkmvleloba jeimstaunSi
romelic sxvebze zegavlenis moxdenas emsaxureba.
(gaiana) da 1997 wels samoTxis karibWis kultis 39
Tumca, adamianebi, romlebic xSirad imuqrebian,
mimdevris TviTmkvleloba kaliforniaSi. amgvari
rom Caidenen TviTmkvlelobas, sabolood marTlac
tragikuli movlenebi, Cveulebriv, inicirebulia
iklaven Tavs. uSualod suicidis aqtamde, maT,
qarizmatuli lideris mier, romelsac mtkice rwmena
SeiZleba, gansxvavebulad daiwyon saubari sikvdilis
aqvs da, zogjer, iluzoruli ideebiT aris Sepyrobili.
Sesaxeb da Ria gancxadebebis gakeTebis nacvlad masze
aseT jgufebSi suicids, xandaxan, mkvleloba mohyveba.
miniSnebebiT isaubron.
bolo xans SeSfoTebas gamoTqvamen imis gamo, rom
riskis Sefaseba, agreTve, xdeba im faqtorebis
suicidis Sesaxeb SeTanxmebis miRweva internetis
gaTvaliswinebiT, romlebic suicidTanaa asocirebuli
meSveobiT xdeba (Rajagopal, 2004). SeTanxmeba suicidis
(gv. ??).
Taobaze Semdeg wyaroSia ganxiluli: Nock, Marzuk, 2000.
_ 437 _
maRal riskze Semdegi faqtorebi mianSinebs: fsiqikuri statusis gamokvleva
w aSkarad gamoxatuli uimedoba; gansakuTrebiT safuZvlianad unda moxdes guneb-
w warsulSi suicidis mcdeloba: im pirebis 40-60%-s, ganwyobis gamokvleva. garda amisa, Sesafasebelia
romlebic cxovrebas TviTmkvlelobiT asruleben, pacientis kognituri funqciebi. amis Semdeg, in
adrec hqoniaT suicidis mcdeloba; terviuerma unda Seafasos suicidis ganzraxva.
w socialuri izolacia; Tavidan pacients ekiTxebian, xom ar Tvlis is, rom
cxovreba gausaZlisi gaxda an surs Tu ara cxovrebis
w SedarebiT xandazmuli asaki;
gagrZeleba. pirvel kiTxvas mivyavarT ufro pirdapir
w depresiuli aSliloba, gansakuTrebiT guneb-gan gamokiTxvamde suiciduri azrebis, konkretuli
wyobis cvlilebebi, romlebsac Tan axlavs insomnia, gegmebis da TviTmkvlelobisTvis mzadebis Sesaxeb
anoreqsia da wonaSi dakleba; (mag., abebis momarageba). mniSvnelovania gvaxsovdes,
w alkoholdamokidebuleba, romelsac Tan axlavs so rom mZime depresiis mqone pacientebs drodadro
maturi garTulebebi da mZime uaryofiTi socialuri aReniSnebaT homiciduri ideebi. maT SeiZleba
Sedegebi; sjerodeT, rom meore adamianis (xSirad meuRlis an
w wamaldamokidebuleba; Svilis) mokvla mowyalebis aqtia, radgan amiT xdeba
maTi autaneli tanjvisgan gaTavisufleba. aseT
w Sizofrenia, gansakuTrebiT axalgazrda mamakacebSi,
homicidur ideebs yovelTvis seriozulad unda
romelTac aReniSnebaT ganmeorebadi mZime daavadeba,
movekideoT.
depresia, inteleqtualuri funqciis daqveiTeba da
warsulSi suicidis mcdeloba (ix. gverdebi ?? da ??); suicidis riskis Sefaseba stacionarul
w qronikuli daavadeba Tanmxlebi tkiviliT; pacientebSi
w epilefsia; stacionaruli pacientis TviTmkvleloba gansa
w paTologiuri pirovneba. kuTrebiT SemaSfoTebeli faqtia, ris gamoc
Zalze sasurvelia, rom moxdes riskis mqone
anamnezis Sekreba pacientebis identifikacia. samwuxarod, es rTuli
zogadi risk-faqtorebis dadgenis Semdeg, saWiroa gansaxorcielebelia, radgan zemoT mocemuli
informaciis mopoveba detalebis Sesaxeb. interviu zogadi risk-faqtorebi stacionaruli pacientebis
unda Catardes auCqareblad. intervius ganmavlobaSi umravlesobas aReniSneba, amitom maTze dayrdnobiT
eqimi TanagrZnobas unda gamoxatavdes pacientis Znelia riskis xarisxis dadgena. mocemuli problemis
mimarT, rac pacients gauadvilebs aRiaros Tavisi ilustracia SesaZlebelia im stacionarul pacie
sasowarkveTili mdgomareoba da TviTganadgurebasTan ntebze Catarebuli SemTxveva-kontrolis gamo
dakavSirebuli azrebi. Umjobesia, interviu daviwyoT kvlevis Sedegebis retrospeqtuli analiziT, rome
kiTxvebis dasmiT amJamindeli problemebis da maTze lTac suiciduri aqti ganaxorcieles (Powell et
pacientis reaqciis Sesaxeb. kiTxvebi unda exebodes al., 2000). avtorebma moaxdines xuTi prediqtoris
pacientis mier gancdil danakargs (axloblis dakargva identifikacia. esenia: (1) suiciduri azrebi; (2) axlo
an ganqorwineba), finansur zarals da statusis warsulSi mZime danakargi; (3) bodviTi ideebi; (4)
dakargvas. pacientisgan unda movipovoT informacia qronikuli fsiqikuri daavadeba; (5) suicidis ojaxuri
sxva adamianebTan konfliqtisa da socialuri istoria. xuTive risk-faqtoris mqone pacientTan
izolaciis Sesaxeb. yovelTvis unda davsvaT kiTxvebi riskis xarisxi 30 procents Seadgenda, magram 100
somatur daavadebasTan dakavSirebiT. xandazmul pacientSi mxolod 1-Tan dadginda xuTive risk-
pacientebTan gansakuTrebiT unda gavamaxviloT faqtoris arseboba. danarCenebTan prediktorebis
yuradReba mtkivneul simptomebze. depresiul sensitiuroba da specifikuroba dabali iyo. kerZod,
pacientebTan suicidi zogjer ukavSirdeba fizikuri oci erTTan Tanafardobis riskis mqone pirebidan
daavadebis usafuZvlo SiSs, romelic, pacientis moxerxda mxolod 2 procentis zusti identifikacia,
azriT, Tan axlavs fsiqikur aSlilobas. xolo gardacvlili pirebis umravlesobasTan riskis
pirovnuli Tvisebebis gamokvlevisas, unda xarisxi 1 procents an naklebs Seadgenda. amgvarad,
gvaxsovdes, rom pacientis mier sakuTari Tavis riskis mqone pacientebis gamovlena SesaZlebelia
aRwera SeiZleba mis depresiul mdgomareobas mxolod bevri damatebiTi mcdari dadebiTi
asaxavdes. roca ki es SesaZlebelia, interviu unda faqtorebis gaTvaliswinebiT. rasac Tan axlavs im
CamovarTvaT kidev erT informators. anamnezis pirebze, romlebic arasdros Caidenen suicids,
Sekrebisas yuradReba unda mivaqcioT guneb-ganwyobis intensiuri supervizia (pirovnebisTvis am superviziis
cvalebadobas, impulsur da agresiul tendenciebs da Sedegebis gaTvaliswinebiT) da momsaxure personalis
damokidebulebas religiisa da sikvdilis mimarT. Statis gazrda.
_ 438 _
suicidi
suiciduri ideebis mqone pacientebis marTva suicidis riskis regularul Sefasebas da Sesatyvisi
mkurnalobisa da daxmarebis SeTanxmebuli gegmis
zogadi sakiTxebi
SemuSavebas (ix. cxrili 17.2). Tu es SesaZlebelia,
suicidis riskis Sefasebis Semdeg, klinicistma unda
pacientis Tanxmobis SemTxvevaSi, pacientis marTvis
Seadginos mkurnalobis gegma da daarwmunos pacienti,
procesSi naTesavebi da mzrunvelobis gamwevi sxva
rom Seasrulos am gegmis moTxovnebi. pirvel
pirebic unda monawileobdnen. wamyvani personali
etapze unda gadawydes, pacienti saavadmyofoSi
intensiurad unda TanamSromlobdes Temis doneze
unda moTavsdes, Tu mas ambulatorulad an dRis
momuSave gundis wevrebTan, raTa uzrunvelyos
centrSi unda Cautardes mkurnaloba. gadawyvetileba
drouli da Sesatyvisi reagireba pacientis an misi
damokidebuli iqneba suicidis ganzraxvis siZliereze,
momvlelis moTxovnebis sapasuxod. Tu saWiroa
asocirebuli fsiqikuri daavadebis simZimeze da
pacientis medikamentebiT mkurnaloba (mag., depr
saavadmyofos gareT socialuri mxardaWeris xel
esiuli aSlilobis gamo), iseTi preparatebi unda
misawvdomobaze. Tu gadawydeba ambulatoruli
SevarCioT, romelTa gadametebuli doziT gamoyeneba
mkurnalobis Catareba, pacients unda mivceT sa
naklebad saSiSia. medikamentis SerCeva zogadi pro
kontaqto telefoni, romelsac is gamoiyenebs ne
filis eqimTan erTad unda xdebodes. TiTo jerze
bismier momentSi, rodesac uaresad igrZnobs Tavs
pacients mcire doza unda gamovuweroT. pacientis
da specialistis rCeva dasWirdeba. eqimis povnis
momvlelma wamali usafrTxo adgilas unda Seinaxos.
uSedego mcdeloba SeiZleba aRmoCndes is ukanaskneli
pacientmac da misma momvlelebmac unda icodnen,
wveTi, romelic suiciduri ganzraxvis mqone pacients
Tu rogor miiRon daxmareba sgangebo viTarebis
TviTmkvlelbas Caadeninebs.
SemTxvevaSi.
Tu suicidis momentaluri riski maRalia, albaT
pacients stacionaruli mkurnaloba dasWirdeba, pacientebis marTva saavadmyofos pirobebSi
garda im SermTxvevebisa, rodesac (1) TemSi moqmedebs upirveles yovlisa, yvelaferi unda gakeTdes imisT-
krizisis marTvis efeqturi gundi, an (2) rodesac vis, rom pacients xeli SevuSaloT Tavis CamoxrCo-
pacienti mzrunvel naTesavebTan erTad cxovrobs, baSi. es moiTxovs sakmarisi raodenobis personals da
romelTac kargad esmiT TavianTi pasuxismgebloba palatis usafrTxod mowyobas. pacientis hospital-
da mzad arian am pasuxismgeblobis Sesasruleblad. izaciisas unda SemuSavdes Sesabamisi politika mTeli
amgvari gadawyvetileba saWiroebs pacientis, misi personalis monawileobiT (cxrili 17.3).
problemisa da naTesavebis zedmiwevniT kargad codnas. palatis mowyoba. palatis dizaini iseTi unda iyos,
Tu aucilebelia pacientis hospitalizacia, razedac rom minimumze daiyvanos TviTdazianebis riski. es
is uars ambobs, saWiro xdeba specialuri orderiT Semdegi pirobebis dacvas gulisxmobs: (1) SeuZlebeli
gacemuli brZanebiT misi iZulebiTi hospitalizacia. unda iyos Ria fanjarasTan an nebismier iseT adgilT-
personali unda icnobdes Tavisi samuSao adgilis an miaxloveba, saidanac gadmoxtoma seriozul fizi-
iuridiul moTxovnebs da unda icavdes maT. kur travmas gamoiwvevs; (2) oTaxSi ar unda imyofe-
bodes iseTi sagnebi, romelTa gamoyenebiT SesaZlebe-
pacientis marTva pirveladi jandacvis sistemis
lia Tavis CamosaxrCobi mowyobilobis konstruireba
doneze
(mag., yuTebis erTmaneTze dawyoba). (3) pacientisTvis
suicidis riskis mqone im pacientebis marTva,
blokirebuli unda iyos palatis iseTi adgilebi, sa-
romlebic ar saWiroeben hospitalizacias, moiTxovs
dac ufro advilia sakuTari Tavis dazianeba; (4) pi-
radi moxmarebis iseTi saxifaTo nivTebis amoReba,
cxrili 17.2 suiciduri ideebis mqone paciene- rogoric samarTebeli da qamaria. maRali riskis Sem-
tebis movla pirvaladi jandacvis (Temis) doneze TxvevaSi palataSi mudmivad unda imyofebodes erT-
pacientisa da misi momvlelebisaTvis sruli gamokvlevis erTi eqTani, raTa pacienti marto ar darCes.
Catareba suicidis marTvis politika (cxrili 17.3)
Sesabamisi socialuri mxardaWeris organizeba w marTvis politika yuradRebiT unda ganvixiloT
suicidis riskisa da masTan gamklavebis saSualebebis garkveuli periodulobiT, manam, sanam Caivlis
regularuli ganxilva
saxifaTo periodi;
usafrTxo fsiqiatriuli mkurnaloba medikamentis
sakmarisi dozebiT da SedarebiT nakleb toqsikuri w yoveli axali cvlis personals unda avuxsnaT da
preparatebis gamoyenebiT SevaTanxmoT masTan suicidis marTvis politika.
wamlis mcire doziT gamowera es gansakuTrebiT mniSvnelovania maSin, rodesac
naTesavebis monawileoba wamlis usafrTxod SenaxvaSi mimoxilvis Sedegad gegmaSi Setanilia cvlilebebi;
pacientisa da misi momvlelebisaTvis damatebiTi w suicidis marTvis politika unda avuxsnaT pacients
gadaudebeli daxamarebis gawevis organizeba
_ 439 _
asocirebuli fsiqikuri daavadebis drouli mkur
cxrili 17.3 suicidis ganzraxvis mqone hospi- naloba da mxardaWera aRmouCinos pacients iqamde,
talizebuli pacientebis movla
sanam mkurnaloba Sedegs gamoiRebs. ramdenad mtkicec
1. usafrTxo palata ar unda iyos TviTmkvlelobasTan dakavSirebuli
2. kargad momzadebuli personalis sakmarisi raodenoba gadawyvetileba, yovelTvis arsebobs cxovrebis
gagrZelebis Tundac sustad gamoxatuli survili.
3. kargi TanamSromloba personals Soris da personalsa
da pacients Soris
Tu saavadmyofos personali mzrunvelobiT moeqceva
pacients da imedianad iqneba ganwyobili, pacientis
4. dakvirvebis, gamokvlevisa da ganxilvis SeTanxmebuli Tundac minimaluri pozitiuri survili SeiZleba
politika
gaZlierdes da mas, SeiZleba, gauCndes ufro
hospitalizaciis dros dadebiTi damokidebuleba momavlis mimarT. amave
riskis Sefaseba dros, pacients unda vaCvenoT, rom Cven SegviZlia
movuaroT problemebs, romliTac is aris moculi, Tu
SeTanxmeba dakvirvebis intensivobis Taobaze
maT gadaWraze saTiTaod vimuSavebT.
iseTi sagnebis mocileba, romlebic SeiZleba pacientma suicidis riski maSin izrdeba, rodesac paci
TviTmkvlelobis mizniT gamoiyenos
ents, saavadmyofodan droebiT saxlSi uSveben (sa
mkurnalobis gegmis pacientTan SeTanxmeba da ganxilva avadmyofodan paientis droebiTi gawera). es xdeba
mnaxvelebTan dakavSirebuli politikis SeTanxmeba (mnax- imis Sesamowmeblad, Tu ramdenad mzad aris pacienti
velebis raodenoba, vizitis xangrZlivoba, ra unda icod- saavadmyofodan gasawerad. suicidis riski aseve,
nen mnaxvelebma)
SedarebiT maRalia, uSualod saavadmyofodan ga
hospitalizaciis ganmavlobaSi weramde da ramdenime kviris ganmavlobaSi saavad
riskebisa da gegmebis regularuli ganxilva myofodan gaweris Semdeg (gv. ??). aqdan gamomdinare,
stacionaridan gaweris gegmaSi unda Sediodes pa
SeTanxmebuli gegmebi superviziis xarisxis Taobaze
cientis xelaxali gamokvleva, efeqturi fsiqo
aqtiuri komunikacia sxvadasxva cvlaSi momuSave saavad- logiuri da socialuri daxmarebis gaweva da
myofos personals Soris Sefasebebisa da gegmebis Tao-
baze swrafi reagireba damatebiTi daxmarebis miRebis
saWiroebaze. pacientTan erTad unda ganvixiloT
SeTanxmeba qmedebaze, romelic unda ganxorcieldes
pacientis mier palatis gaufrTxileblad an nebarTvis stacionaridan gawerisa da saavadmyofodan drobiTi
gareSe datovebis SemTxvevaSi gaweris sakiTxebi, raTa gavarkvioT, Tu ra awuxebs
mas. saWiroebis SemTxvevaSi gegmaSi cvlilebebi unda
saavadmyofodan gawerisas
iqnes Setanili.
saavadmyofodan gaweramde SeTanxmdiT pacientis Semdgomi ra didi mzrunvelobiTac ar unda vekidebodeT
movlis gegmaze
pacientebs, personalis maqsimaluri Zalisxmevis
ganixileT pacientTan da mis momvlelebTan erTad miuxedavad, drodadro, mainc aqvs adgili TviT
pacientis movlis gegma da SeTanxmdiT mis Taobaze
mkvlelobis SemTxvevebs. eqimi mniSvnelovan rols
gamowereT wamali sakmarisi, magaram ara potenciurad asrulebs personalis mxardaWeris saqmeSi. es
saziano doziT
upiratesad im eqTnebs exeba, romlebic gansakuTrebiT
awarmoeT pacientze Semdgomi dakvirveba da SeTanxmdiT kargad icnobdnen pacients. miuxedavad imisa, rom
im qmedebebze, romlebsac mimarTavT pacientis mier
eqimis miTiTebebis Seusruleblobis SemTxvevaSi namdvilad sasargbloa suicidis TiToeuli SemTxvevis
gaanalizeba saWiro daskvnebis gamotanis mizniT, es ar
da, SesaZleblobis SemTxvevaSi, SevaTanxmoT masTan. unda iqces procedurad, romelic TviTmkvlelobaSi
Tu pacienti ar eTanxmeba gegmis mniSvnelovan damnaSave piris gamovlenaze iqneba mimarTuli.
punqtebs, mas guldasmiT unda avuxsnaT, Tu ratom
pacientis naTesavebi
aris gegmaSi es punqtebi Setanili. Tu pacienti
kvlav uars ambobs TanamSromlobaze, xolo su adamianis gardacvalebis SemTxvevaSi misi naTesavebi
icidis riski maRalia, mkurnalobis Casatareblad saWiroeben mxardaWeras, magram, rodesac pacienti
unda gamoviyenoT qveyanaSi moqmedi samarTlebrivi amTavrebs sicocxles TviTmkvlelobiT, garda Cveu-
berketebi. lebrivi nugeSisa, mis axloblebs sWirdebaT daxmare-
ba brazisa da danaSaulis grZnobis daZlevaSi. garda
rodesac intensiuri zedamxedveloba ramdenime
amisa, axloblebs xSirad uCndebaT iseTi gancda, rom
dReze did xans grZeldeba, pacienti SeiZleba
maT yvelaferi ar gaakeTes TviTmkvlelobis Tavi-
gaaRizianos mudmivma zedamxedvelobam da ecados
dan asacileblad. naTesavebs am gancdis daZlevaSic
misgan Tavis daRwevas. saavadmyofos personalma
unda davexmaroT. erT-erT mniSvnelovan gamokvlevaSi
winaswar unda ganWvritos es problema, uzrunvelyos
_ 440 _
suicidi
(Barraclough, Shepherd, 1976), naTesavebi aRniSnavdnen, aSlilobis diagnostirebasa da mkurnalobaze. mo
rom policia, Cveulebriv, gulisxmier damokidebule- cemuli sganmanaTleblo programis danergvis Semdeg,
bas iCenda dakiTxvis dros, magram sasamarTloSi sa- suicidis maCveneblebi mniSvnelovnad Semcirda im
jaro dakiTxva TiTqmis yvelasTvis distresis gamom- maCveneblebTan SedarebiT, romlebic xangrZlivi drois
wvevi iyo. amasTan, suicidis faqtis presaSi gaSuqeba manZilze aRiricxeboda ara marto kunZul goTlandze,
xelaxla acocxlebda suicidTan dakavSirebul deta- aramed mTel SvedeTSi. momdevno gamokvlevam aCvena,
lebs da kidev ufro amZafrebda mZime mdgomareobas rom 1988 wlisTvis (anu proeqtis dasrulebidan 3
da stigmatizaciis gancdas. TanagrZnobiT mosmena, wlis Semdeg), suicidis maCveneblebi TiTqmis sawyis
axsna-ganmarteba da konsultacia daxmarebas uwevs doneze avida (Rutz et al., 1992). mkvlevarebma daaskvnes,
am rTul viTarebaSi gardacvlili piris naTesavebs. rom sganmanaTleblo programa efeqturia, magram
mniSvnelovania gvesmodes, rom brazi xSirad dardis grZelvadiani Sedegebis misaRwevad is or weliwadSi
nawilia da rom mas unda davupirispiroT moTmineba erTxel unda ganmeordes. garda amisa, gairkva, rom
da TanagrZnobiT mosmenis unari, raTa respondentis- programa mxolod qalebisTvisaa sasargeblo. msgavsi
gan sruli informacia miviRoT. is, Tu ra Sedegebi kvleva mas Semdeg aRar Catarebula.
mohyveba pacientis naTesavebisTvis suicidis faqts, fsiqiatriuli momsaxurebis gaumjobeseba. mo
Semdeg wyaroSia ganxiluli: Wertheimer, 2001. salodnelia, rom fsiqikuri aSlilobis adreuli
diagnostika da mkurnalobis gaumjobeseba Seamcirebs
suicidis prevencia suicidis maCveneblebs. gamoqveynebuli gamokvlevebi
zogad populaciaSi suicidi iSviaTi movlenaa. dasav- calsaxad ar miuTiTebs amgvar kanonzmierebaze,
lur kulturaSi weliwadSi sikvdilis 10 000 SemTx- magram, servisis xarisxis gaumjobesebas, ra Tqma
vevaze modis suicidis erTi an ori SemTxveva. xolo, unda, sxva mizezebic gaaCnia.
kontrolirebadi kvlevebi, romliTac SesaZlebe- maRali riskis jgufebze mimarTuli daxmareba.
li gaxdeboda intervenciis efeqturobis Seswavla maRali riskis mqone jgufebisTvis damatebiTi
im pirebisTvis, vinc TviTmkvlelobiT daasrula daxmarebis gaweva gavrcelebul klinikur praqtikas
cxovreba, bevri cdis piris gamokvlevas moiTxovs. warmoadgens. aseT jgufebSi Sedian stacionaruli
amitom, aseTi kvlevebi Catarebuli araa. Tumca arse- pacientebi, romelTac axalaxan CautardaT fsi
bobs dakvirvebis Sedegad miRebuli monacemebi, rom- qiatriuli mkurnaloba da pacientebi, romlebsac
lebic gviCvenebs, Tu ra faqtorebi axdenen gavlenas hqondaT ganzrax TviTdazianebis SemTxvevebi (krizisis
suicidis riskis Semcirebaze zogad populaciaSi (ix. centrebi qvemoTaa ganxiluli).
cxrili 17.4). es sakiTxebi SemdgomSia ganxiluli. dam- grZelvadiani medikamenturi mkurnaloba. miuxe
atebiTi informaciisTvis ix. Hawton, 2000b. davad imisa, rom depresiis epizodis Semdeg anti
depresantebis uwyvetad miReba amcirebs depresiis
cvlilebebi servisebis muSaobaSi Semdgomi epizodebis risks, amas ar mosdevs suiciduri
pirveladi jandacvis sistemis eqimebis ganaTleba. qcevis sixSiris Semcireba. Tumca, sakmarisi mtki
sakiTxavia, Tu ramdenad efeqturia pirveladi cebuleba dagrovda im mosazrebis sasageblod,
jandacis doneze ganxorcielebuli intervencia. rom liTiumiT Catarebuli profilaqtika amcirebs
erT-erT cnobil gamokvlevaSi, rucma da misma suicidis xarisxs (Cipriani et al., 2005c) da rom klozapinma
kolegebma, 1983-1984 wlebSi, Caatares intervenciuli SeiZleba Seamciros suicidis mcdelobis maCveneblebi
gamokvleva, romelSic monawileobda SvedeTis kunZul Sizofreniis da Sizoafeqturi aSlilobis dros
goTlandze (Gotland) momuSave yvela zogadi profilis (ufro detalurad ?? gverdzea ganxiluli).
eqimi. mocemul gamokvlevas unda daedgina, Tu ra nakleb toqsikuri antidepresantebis daniSvna.
gavlenas axdens eqimebis informirebuloba afeqturi serotoninis ukumitacebis seleqciuri inhibitorebis
Warbi doziT miReba nakleb toqsikuria, vidre tri
cxrili 17.4 suicidis prevencia cikluri antidepresantebis. meores mxriv, se
rotoninis ukumitacebis seleqciuri inhibitorebi
ukeTesi da xelmisawvdomi fsiqiatriuli servisi
apirobebs suiciduri azrebis aRmocenebas an gaZ
suicidis saSualebebis gamoyenebis SezRudva lierebas, albaT imis gamo, rom es preparatebi
sando angariSgebis xelSewyoba pirvelad miRebisas SfoTvis momatebasa da insomnias
iwvevs. miuxedavad imisa, rom Znelia arsebuli mtki
saganmanaTleblo programebi
cebulebis safuZvelze saboloo daskvnis gakeTeba,
ufro intensiuri mzrunvelobis uzrunvelyofa maRali rogorc Cans, suicidis zogadi riski serotoninis
riskis jgufebisTvis
ukumitacebis seleqciuri inhibitorebis gamoyenebisas
krizisis centrebi da cxeli xazi iseTivea, rogorc tricikluri antidepresantebis
_ 441 _
SemTxvevaSi (Cipriani et al., 2005 b). da mainc, met adamians SeunarCundeba sicocxle. Tumca, unda
epidemiologiuri gamokvlevebi gviCvenebs, rom nakleb gvaxsovdes, rom adamianebi, romlebsac TviTmkvleloba
toqsikuri antidepresantebis daniSvna suicidis riskis aqvT ganzraxuli, yovelTvis axerxeben suicidis aqtis
SemcirebasTanaa asocirebuli (Grunebaum et al., 2004). ganxorcielebas Cvens mier gamoyenebuli zomebis
aseTi kavSiris dadasturebis SemTxvevaSi, dasadgeni miuxedavad. qvemoT mocemulia suicidis prevenciis
iqneba am kavSiris xasiaTi. iqamde, sanam movipovebdeT zomebi, romlebic britaneTSi gamoiyenes:
mtkicebulebas, romelic saboloo daskvnis gakeTebis w gazis detoqsikacia: britaneTSi, 1948-1950 wleb
saSualebas iZleva, calkeul pacientTan dakavSirebiT Si, suicidis mizniT naxSiris wviT miRebul
unda gadawydes, Tu romeli preparatis daniSvnaa am gazs iyenebdnen (registrirebuli SemTxvevebis
SemTxvevaSi yvelaze mizanSewonili. amasTan, preparatis 40% mamakacebSi da 60% _ qalebSi). CrdiloeTis
miRebidan ramdenime kviris manZilze unda davakvirdeT zRvidan miRebuli nakleb toqsikuri gazis ga
pacientis mdgomareobis dinamikas da davexmaroT mas. moyenebis Semdeg, mniSvnelovnad Semcirda gaziT
serotoninis ukumitacebis seleqciuri inhibitorebis TviTmkvlelobis SemTxvevebis raodenoba; garda
gamoyenebasTan dakavSirebuli riski ?? gverdzea amisa, Semcirda suicidis erovnuli maCvenebelic.
ganxiluli. arsebobs mosazreba, rom es gansxvaveba nakleb
sakonsultacio samsaxurebi. britaneTSi arsebobs toqsikuri gazis gamoyenebiT iyo gamowveuli.
organizacia `samaritelebi~, romelic daaarsa reverend
w manqanebis gamonabolqvis detoqsikacia. varau
Cad varahma (Chad Varah) 1953 wels. es organizacia
doben, rom manqanebis gamonabolqvis detoqsikacia
exmareba adamianebs, romlebic sasowarkveTil
Seamcirebs am meTodis gamoyenebiT ganxorcielebuli
mdgomareobaSi imyofebian da TviTmkvlelobaze
TviTmkvlelobis sixSires.
fiqroben. am organizaciis sakontaqto nomrebi
w analgetikebis raodenobis SezRudva. didi bri
farTod aris reklamirebuli. aq momuSave adamianebi
taneTis kanoniT paracetamolis, salicilatebis da
araprofesionali moxaliseebi arian, romlebsac
maTi komponentebis erTjeradi gacema garkveuli
gavlili aqvT Sesaferisi treningi da SeuZliaT
odenobiT aris daSvebuli. arsebobs mtkicebuleba,
TanagrZnobiT mousminon adamianebs, romlebic maT
rom am kanonis amoqmedebam Seamcira aRniSnuli
SvelisTvis mimarTaven. amave dros, samaritelebi
preparatebis gadaWarbebuli dozis miRebiT ga
Tavis Tavze ar iReben im pasuxismgeblobas, romelic
mowvuli suicidis sixSire.
profesionalebis kompetenciis sferos ganekuTvneba.
xSirad, citirebuli gamokvlevis monacemebiT, im w saxifaTo sagnebis xelmisawvdomobis SezRudva.
pirebs Soris, romlebic samaritelebs telefoniT saavadmyofos palatebSi policiisa da cixis saknebSi
mimarTaven, Semdgom weliwads TviTmkvlelobis ar unda iyos iseTi sagnebi, romelTa gamoyeneba
maCvenebeli ufro maRalia, vidre zogad populaciaSi SesaZlebelia CamoxrCobis mizniT(gv. ??). xidebze,
(Barraclough and Shea, 1970). es monacemebi imaze sadguris platformebze da sxva potenciurad
miuTiTebs, rom samaritelebis organizacia izidavs saxifaTo adgilebze fizikuri barierebis aRmarTvam
suicidis riskis qveS myof adamianebs, magram, amave SeiZleba Seamciros aseT adgilebSi suicidis riski.
dros, eWvs badebs misi efeqturobis Taobaze. am
sxva zomebi
organizaciis efeqturobis dasadgenad SearCies
ori qalaqi, saidanac erT-erTSi samaritelebis medias mier pasuximgeblobiT SerCeuli informaciis
organizacia moqmedebda, meoreSi ki ara. aRniSnul mowodeba. zogjer suicidisTvis meTodebis SerCeva
qalaqebSi suicidis maCveneblebis urTierTSedarebam iseTi SemTxvevebis zegavleniT xdeba, romlebic
ar aCvena mnivnelovani gansxvaveba (Jennings et al., 1978). mediis yuradRebis centrSi moeqca. am da sxva
Tumca, amis gaTvaliswinebiTac Znelia daaknino iseTi mizezebis gamo, Jurnalistebisa da masmediis sxva
organizaciis mniSvneloba, romelic daxmarebas uwevs warmomadgenlebs unda movuwodoT, pasuximgeblobiT
sasowarkveTil da martoxela adamianebs. moekidon reportaJebs suicidis Sesaxeb.
socialuri politika. vinaidan mudmivad aRiniSneba
suiciduri ganzraxvis mqone populaciasTan umuSevrobasa da suicids Soris kavSiris arseboba,
dakavSirebuli strategiebi gamoiTqva mosazreba, rom umuSevrobis donis
suicidis saSualebebis xelmisawvdomobis Semcirebam SeiZleba Seamciros suicidis ricxvi (Lewis
SezRudva et al., 1997). zogi avtoris azriT, sxva faqtorebic (mag.,
mzardi socialuri izolacia) aseTive yuradRebas
suicidis saSualebebis xelmisawvdomoba zemoqmedebs
imsaxurebs. miuxedavad imisa, rom ar aris naTeli, Tu
gamoyenebuli saSualebebiT gaxorcielebuli suicidis
rogor SeiZleba ganxorcieldes aseTi strategiebi da
sixSireze da, zogadad, suicidis maCveneblebze. Tu
rogor unda Sefasdes maTi efeqturoba am faqtorebze
xelmisawvdomi meTodebi naklebad saziano iqneba, ufro
_ 442 _
miTiTeba mainc mniSvnelovania, radgan isini xvdeba da gadaWarbebuli doziT wamlis miRebas
Segvaxsenebs socialur politikasa da janmrTelobas ukavSirdeba. am SemTxvevebis umravlesoba ar aris
Soris kavSiris mniSvnelobas. sicocxlisTvis saSiSi. gamoyenebuli preparatebis
sazogadoebis informireba. sazogadoebis infor saxeoba damokidebulia asakze, wamlis gamoweris
mireba fsiqikuri daavadebebisa da maTi mkurnalobis adgilobriv praqtikaze da wamlis xelmisawvdomobaze.
Sesaxeb xorcieldeba saskolo sganmanaTleblo preparatebidan yvelaze xSirad araopiaturi
programebis meSveobiT. am programebis farglebSi analgetikebi gamoiyeneba (paracetamoli da aspirini).
moswavleebTan muSaoben problemis gadaWraze da paracetamoli gansakuTrebiT saxifaToa, radgan is
daxmarebis Ziebaze distresis pirobebSi. azianebs RviZls da SeiZleba, mogvianebiT, gamoiwvios
im pirebis sikvdili, romlebsac ara aqvT sikvdili
ganzrax TviTdazianeba ganzraxuli. gansakuTrebiT SemaSfoTebelia is
faqti, rom axalgazrda pacientebi, romlebic ver
1950-ian wlebamde TviTmkvlelobis letalur Sem
acnobiereben riskis seriozulobas, am preparats
Txvevebs naklebad ganasxvavebdnen iseTi Sem
xSirad iyeneben. epizodebis erTi meoTxedis
Txvevebisgan, rodesac suicidis aqtis Semdeg adamiani
SemTxvevaSi gamoiyeneba rogorc tricikluri, ise
cocxali rCeboda. britaneTSi, stengelma (Stengel,
seratononis ukumitacebis seleqciuri inhibitorebis
1952), pirvelma daadgina epidemiologiuri gansxvaveba
jgufis antidepresantebi. mamakacebis, daaxloebiT,
am or jgufs Soris. man Semoitana termini `suicidis
erTi mesamedi da, qalebis, daaxloebiT erTi meoTxedi
mcdeloba~ iseTi TviTdazianebis aRsaniSnad, romlis
moixmars alkohols TviTmowamvlis aqtamde 6 saaTiT
Semdegac adamians ar aqvs gadarCenis garantia.
adre (Hawton et al., 2003b).
Semdgomma gamokvlevebma Seiswavla amgvari epizodebis
motivacia da aRmoaCines, rom Zalian xSirad, sikvdili ganzrax TviTdaSavebis meTodebi
ar warmoadgenda pirovnebis mizans. amas mohyva
ganzrax TviTdaSaveba Seadgens britaneTis zogadi
iseTi terminebis damkvidreba, rogoricaa `sakuTari
profilis saavadmyofoebSi registrirebuli ganzrax
Tavis ganzrax mowamvla~, `parasuicidi~ da `ganzrax
TviTdazianebis SemTxvevebis 10%-s. TviTdaSavebis
TviTdazianeba~. yoveli maTgani aRwerda ganzrax
yvelaze gavrcelebuli meTodi sakuTari TavisTvis
TviTdazianebis SemTxvevebs letaluri gamosavlis
Wrilobebis miyenebaa (ZiriaTadad mklavze, an ma
gareSe, romlebic iyo an ar iyo sikvdilis surviliT
jebze). WrilobebiT TviTdaSaveba zogadi profilis
motivirebuli. kraitmanma (Kreitman, 1977) aRwera es
saavadmyofoSi registrirebuli TviTdaSavebis Sem
qceva, rogorc àrafataluri aqti, romlis drosac
Txvevebis daaxloebiT oTx mexuTeds Seadgens. (sa
adamiani ganzrax iwvevs TviTdazianebas an Warbi
kuTari TavisTvis Wrilobebis miyeneba SemdgomSia
doziT iRebs wamals~. aseTi definicia sasargebloa,
ganxiluli). TviTdaSavebis sxva formebia simaRlidan
radgan is ar azustebs suiciduri ganzraxvis xarisxs.
gadmoxtoma, matareblis an avtomanqanis win Caxtoma,
am TavSi, termini `ganzrax TviTdazianeba~ aseTi
cecxlsasroli iaraRis gamoyeneba da Tavis daxrCoba.
incidentebis aRsawerad gamoiyeneba.
aseTi Zaladobrivi aqtebi ZiriTadad, SedarebiT,
suicidiT dasrulebuli aqtebi da ganzrax TviT
xandazmul adamianebTan gvxvdeba, romelTac TviT
dazianebis aqtebi urTierTgadamkveTia. zogi adamiani,
mkvleloba aqvT ganzraxuli (Harwood and Jacoby, 2000).
visac ar aqvs sikvdili ganzraxuli, wamlis Warbi dozis
msxverpli xdeba, zogi ki, visac sikvdili aqvs ganzraxuli, sakuTari TavisTvis Wrilobebis ganzrax miyeneba
cocxali rCeba. mniSvnelovania, rom TviTdazianebis arsebobs sakuTari TavisTvis Wrilobebis ganzrax
momentSi Zalin bevr adamians ar aqvs mkafiod gamoxatuli miyenebis sami forma: (1) Rrma da saSiSi Wrilobebi,
sicocxlis an sikvdilis survili. unda gvaxsovdes, romlebic, ZiriTadad, miyenebulia suicidis se
rom adamianebTan, romlebmac ganaxorcieles ganzrax riozuli mcdelobis mqone mamakacebis mier; (2)
TviTdazianebis aqti, momdevno 12 Tvis manZilze suicidis sakuTari Tavis dasaxiCreba Sizofreniis mqone
aqtis albaToba asjer maRalia, vidre zogad populaciaSi pacientebis mier (xSirad smeniTi halucinaciebis
da is mravali wlis manZilze maRali rCeba. Sesabamisad, sapasuxod) an daswavlis seriozuli sirTuleebis
ganzrax TviTdazianebis SemTxvevebs saTanado yuradReba mqone pirebis mier; (3) zedapiruli, sicocxlisTvis
unda mivaqcioT. usafrTxo Wrilobebis miyeneba, ZiriTadad, qalebis
mier. aq mxolod es ukanaskneli jgufi iqneba aRwerili.
ganzrax TviTdazianebis aqti sakuTari TavisTvis Wrilobis miyenebis aqts xSirad
ganzrax TviTmowamvlis meTodebi win uZRvis mzardi daZabuloba da gaRizianeba, romlebic
britaneTSi, ganzrax TviTmowamvlis SemTxvevebis SemdgomSi sustdeba. aqtis Semdeg, pacients xSirad
daaxloebiT 90%, zogadi profilis saavadmyofoSi sircxvilisa da zizRis grZnoba eufleba. zogierTi
_ 443 _
250
mamakacebi
200
qalebi
orive sqesi
150
raodenoba
100
50
0
<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
asakobrivi jgufi
suraTi 17.3 ganzrax TviTdazianebis epizodebis mqone pacientebi asakobrivi jgufebis mixedviT.
(reproduqcia nebadarTulia prof. KE Hawton, oqsfordis universiteti)
maTgani ambobs, rom TviTdazianebis dros cnobiereba maCvenebelia dafiqsirebuli (Kerkhof, 2000).
ramdenadme Secvlili hqonda da tkivils saerTod
variaciebi pirovnuli maxasiaTebelebis mixedviT
an odnav ganicdida. Cveulebriv aRiniSneba miniTa
an samarTebliT miyenebuli mravlobiTi Wrilobebi, ganzrax TviTdazianebis epizodebi ufro xSiria
ZiriaTadad, mklavebze, an majebze. zogi adamiani axalgazrdebSi da maTi raodenoba klebulobs
gansxvavebuli saxiT izianebs Tavs (mag., sigaretis saSualo asakis adamianebSi (suraTi 17.3). ukanasknel
sxeulze CaqrobiT an sisxlCaqcevebis gamowveviT). wlebSi, epizodebis sixSire gaizarda mamakacebis
sakuTari TavisTvis Wrilobebis miyenebis gamo, populaciaSi. 1960-ian da 1970-ian wlebSi, epizodebis
saavadmyofoSi ufro xSirad mamakacebi xvdebian (Hawton sixSiris Tanafardoba qalebsa da mamakacebs Soris
et al., 2004c). adamianebi, romlebic zereled iWrian 2:1-s Seadgenda. uaxlesi gamokvlevebi ufro mcire
Tavs, ar mimarTaven samedicino dawesebulebebs. maTi gansxvavebaze miuTiTebs. qalebTan SedarebiT, epi
umravlesoba axalgazrda qalia, romelTac xSirad zodebis piki mamakacebSi ufro maRal asaks emTxveva.
personologiuri xasaiTis problemebi aReniSnebaT orive sqesis SemTxvevaSi, maCveneblebi Zalian dabalia
(dabali TviT-Sefaseba, impulsuri an agresiuli 12 wlamde asakis bavSvebSi. ganzrax TviTdazianebis
qceva, arastabiluri guneb-ganwyoba). maT, SeiZleba, epizodebi ufro gavrcelebulia dabal socialur
agreTve, axasiaTebdeT sirTuleebi interpersonalur fenaSi. gansxvaveba SeiniSneba agreTve ojaxuri
urTierTobaSi da alkohol da wamalmoxmarebasTan statusis TvalsazrisiT. mamakacebSic da qalebSic
dakavSirebuli problemebi. yvelaze maRali maCvenebeli ganqorwinebul pirebTan
gvxvdeba, iseve, rogorc mozardi asakis (Tineijer)
ganzrax TviTdazianebis epidemiologia colebTan da SedarebiT axalgazrda martoxela
mamakacebTan da qalebTan (Hawton et al., 2003b).
1960-iani wlebis dasawyisSi, ganzrax TviTdazianebis
ukanasknel wlebSi, xandazmul adamianebTan Sei
epizodebis sixSire gaizarda dasavleTis qveynebis
cvala TviTdazianebis maCveneblebi. isini im pi
umetesobaSi. didi britanetis zogadi profilis
rebis maxasiaTeblebis msgavsi gaxda, romlebsac
saavadmyofoebSi, 1973 wlamde mimarTvis sixSire
TviTmkvleloba aqvT ganzraxuli da ara ganzrax
oTxjer gaizarda 10 wlis ganmavlobaSi. mimarTvianobis
TviTdazianeba. es ukanaskneli ufro axalgazrda
maCvenebeli ufro neli tempiT izrdeboda 1970-
populaciisTvis aris tipiuri (Harwood and Jacoby, 2000).
iani wlebis Sua periodSi, magram 1970-iani wlebis
miwuruls is mniSvnelovnad Semcirda. amis Semdeg variaciebi sacxovrebeli adgilis mixedviT
isev SeiniSneboda zrdis tendencia. dRevandeli
maRali maCveneblebi gvxvdeba im teritoriebze,
monacemebiT, britaneTSi ganzrax TviTdazianebis
romlebic xasiaTdeba umuSevrobis maRali doniT,
epizodebis sixSire weliwadSi 1000 SemTxvevaze
mosaxleobis maRali simWidroviT da mniSvnelovani
3-is tolia. evropis sxva qveynebSi ufro dabali
_ 444 _
socialuri mobilurobiT. garda amisa, isini iseT fsiqikuri aSliloba
teritoriebzec registrirdeba, sadac mzrunvelobis
winaT iTvleboda, rom adaptaciuri aSlilobis gamo
qveS mravali bavSvi imyofeba (Gunnel et al., 1995).
klebiT, fsiqikuri aSliloba ar iyo gavrcelebuli
im adamianebSi, romlebsac aReniSnebodaT ganzrax
ganzrax TviTdazianebis mizezebi
TviTdazianebis epizodebi. Tumca, standartizebuli
precipitatuli faqtorebi Sefasebis danergvis Semdeg, fsiqikuri aSliloba
generalur populaciasTan SedarebiT, adamianebs, dadginda TviTdazianebis epizodebis mqone hospi
romlebic ganzrax izianeben Tavs, 6 TviT adre talizebuli populaciis daaxloebiT 90%-Si (Haw et
TviTdazianebis aqtamde, oTxjer meti stresuli al., 2001; Suominen et al., 1996). yvelaze gavrcelebuli
movlena aqvT gadatanili (Paykel et al., 1975). es diagnozi depresiuli aSlilobaa. mas mosdevs al
movlenebi sxvadasxvagvari SeiZleba iyos. maT Soris kohol da wamaldamokidebuleba. qalebSi, meore
yvelaze gavrcelebulia uTanxmoeba meuRlesTan, adgilze imyofeba SfoTviTi aSliloba. xSiria ko
partniorTan, daSoreba seqsualur partniorTan an mis morbidoba, gansakuTrebiT fsiqikur aSlilobasa da
mier uaryofa; agreTve, ojaxis wevris avadmyofoba, pirovnul aSlilobas Soris.
axlo warsulSi somaturi daavadebis gadatana da
sasamarTlos winaSe wardgoma. motivacia da ganzrax TviTdazianeba
predispoziciuri faqtorebi ganzrax TviTdazianebis motivebi, xSirad, ara
erTgvarovania, ris gamoc, rTulia maTi identifikacia.
ojaxurma da ganviTarebasTan dakavSirebulma faq
maSinac ki, rodesac pacientebi acnobiereben TavianT
torebma SeiZleba winaswar ganawyon pirovneba gan
motivebs, maT SeiZleba ar gaamJRavnon isini. mag.,
zrax TviTdazianebis mimarT (Statham et al., 1998).
adamianebi, romlebmac didi doziT miiRes wamali
gavrcelebuli faqtorebia adreul asakSi mSoblis
frustraciisa da sibrazis gamo, SeiZleba sircxvils
gardacvaleba, mSoblis mier bavSvis ugulebelyofa
ganicdidnen da amis gamo Tqvan, rom maT sikvdilis
da masze Zaladoba.
survili amoZravebda. da piriqiT; adamianebma,
pirovnuli aSliloba. britaneTsa (Haw et al., 2001)
romlebsac ganzraxuli hqondaT TviTmkvleloba,
da sxva qveynebSi (Suominen et al., 1996) pirovnuli
SeiZleba uaryon es faqti. amis gamo, pacientis
aSliloba ganzrax TviTdazianebis epizodebis mqone
gamokvlevis dros, misi qmedebis motivis Sefasebisas,
pacientebis TiTqmis naxevarTan aRiniSneba. mosazRvre
umjobesia daveyrdnoT saR azrs, vidre pacientis mier
pirovnuli aSliloba gavrcelebul faqtorad iTv
mowodebul informacias sakuTari motivebis Sesaxeb.
leba, Tumca im gamokvlevebSi, romlebSic stan
zemoT Tqmulis miuxedavad, pacientebis gamokiTxvam
dartuli meTodebi gamoiyeneba, ufro xSirad dasa
maTi motivebis Sesaxeb mkvlevarebs sasargeblo
xelebulia SfoTviTi, anankastiuri (obsesiuri) da
informacia miawoda. evropis 13 qveyanaSi Catarebulma
paranoiduli pirovnuli aSliloba (Haw et al., 2001).
gamokvlevam daafiqsira erTi da igive motivebis
sxva faqtorebia interpersonaluri problemebis
arseboba yvela adgilas, sadac es gamokiTxva Catarda
gadaWrisTvis arasakmarisad ganviTarebuli unar-
(Hjelmeland et al., 2002). dasaxelebuli motivebi
Cvevebi da impulsuroba.
xangrZlivi problemebi partniorTan urTierTobaSi.
erT-erT mniSvnelovan adreul gamokvlevaSi (Bancroft cxrili 17.5 ganzrax TviTdazianebis dasaxele-
et al., 1977), ganzrax TviTdazianebis epizodebis mqone buli mizezebi
pacientebis daaxloebiT or-mesamedTan dadasturda
sikvdili
problemebi partniorTan urTierTobaSi.
gausaZlisi tanjvis acileba
ekonomikuri da socialuri garemo. ganzrax TviT
dazianebis maCveneblebi ufro maRalia dausaqmebel Svebis mopoveba
populaciaSi. Tumca, umuSevroba dakavSirebulia sxvaTa qcevis Secvla
ganzrax TviTdazianebasTan asocirebul sxva faqto
situaciidan Tavis daRweva
rebTan (mag., finansuri sirTuleebi), ris gamoc Zneli
saTqmelia, ramdenad warmoadgens umuSevroba pirvelad sxvisTvis sasowarkveTili mdgomareobis Cveneba
mizezs. ganzrax TviTdazianebis maCveneblebi agreTve sxvebis dasja; maTTvis danaSaulis grZnobis gaCena
SedarebiT maRalia socio-ekonomikuri TvalsazrisiT
sxvebisgan daxmarebis miReba
dabalganviTarebul regionebSi (Gunnell et al., 1955;
Hawton et al., 2001b). Hawton K. (2000). Treatment of suicide attempters and prevention
of suicide and attemted suicide. In MG Gelder, JJ Lopez-Ibor Jr, and
cudi fizikuri janmrTeloba gavrcelebul mizezs NC Andreasen (eds) The new Oxford textbook of psychiatry, Chapter
warmoadgens. 4.15.4. Oxford University press, Oxford.
_ 445 _
CamoTvlilia cxrilSi 17.5. mxolod ramdenime motivi izianebs Tavs, rasac, zogjer, letaluri dasasruli
miuTiTebs imaze, rom TviTdazianebis aqti ganzrax mohyveba. ouenma Caatara 90 gamokvlevis sistemuri
iyo ganxorcielebuli. gamokiTxul pirTa daaxloebiT mimoxilva (Owens et al., 2003), da daaskvna, rom im
erTi meoTxedi acxadebs, rom maT sikvdilis survili adaminebSi, vinc ganaxorciela TviTdazianebis aqti:
amoZravebdaT. zogi ambobs, rom zustad ar icoda, w daaxloebiT 6-dan 1 imeorebs am aqts erTi wlis gan-
undodaT Tu ara sikvdili, zogi `beds~ miendo, sxvebi mavlobaSi;
ki ambobdnen, rom undoda daekargaT cnobiereba, raTa
w daaxloebiT 4-dan 1 imeorebs am aqts oTxi wlis gan-
droebiT mainc gaqceodnen TavianT problemebs. erT-
mavlobaSi.
erTma jgufma ganacxada, rom am aqtiT undoda sxva
ganzrax TviTdazianebis gameorebasTan asocirebu-
adamianebze zemoqmedeba moexdina (mag., danaSaulis
li faqtorebi (Kreitman, 1977; Appleby, 1993), cxril
grZnoba gaeRviZebina erT-erT naTesavSi, radgan
17.6-Sia CamoTvlili.
man imedi gaucrua). sxvaze zemoqmedebis motivis
arsebobaze pirvelad stengelma da kukma miuTiTes ganzrax TviTdazianebis Semdgomi suicidi
(Stengel, Cook, 1958). es avtorebi werdnen, rom am
adamianebi, romlebmac ganzrax daizianes Tavi,
saqcieliT adamianebi cdiloben sxvebis reaqciis
mogvianebiT suicidis ufro maRali riskis qveS
gamowvevas. mas Semdeg, aseT qcevas `Svelis Zaxili~
imyofebian. ouensis mimoxilvaSi (Owens et al., 2003) am
uwodes. zogierT TviTdazianebis aqts mosdevs
populaciaSi
pacientze ufro aqtiuri zrunva. Tumca, arsebobs
SemTxvevebi, rodesac aseTi aqti sxvebSi uaryofiT w 1 wlis manZilze suicidis aqts axorcielebs 100-Si
reqcias iwvevs, gansakuTrebiT maSin, rodesac is 1 adamianidan 40-Si 1 adamianamde;
ramdenjerme meordeba. w 9 wlis da ufro xangrZlivi periodis manZilze
suicidis aqts 15-Si 1 adamiani axorcielebs.
ganzrax TviTdazianebis aqtis Sedegebi es moancemebi riskis Sesaxeb sxvadasxva qveynebis
TviTdazianebis aqtis gameoreba monacemebis kompilaciiTaa miRebuli, ris gamoc
SeuZlebelia maTi Sedareba didi britaneTis maC
ganzrax TviTdazianebis epizodis Semdeg, mravali
venebelTan, romelic weliwadSi 10 000 SemTxvaSi 1-s
pacienti aRniSnavs cvlilebebs ukeTesobisaken. fsi
Seadgens. miuxedavad amisa, suicidis riski aSkarad
qikuri aSlilobis simptomebis mqone pacientebi
bevradaa gazrdili.
aRniSnaven, rom maTi simptomebi sustdeba. aseTi
im populaciaSi, vinc axorcielebs ganzrax
gaumjobeseba SeiZleba ganpirobebuli iyos pro
TviTdazianebis aqts, suicidis riski ufro maRalia
fesionalebis mier gaweuli daxmarebiT an pirovnebis
xandazmul adamianebSi, alkoholikebSi da depresiis
urTierTobebSi, damokidebulebebSi da qcevaSi
mqone pirebSi. TviTdazianebisas saxifaTo da Zala
momxdari cvlilebebiT. zogi adamiani xelaxla
dobrivi meTodebis gamoyeneba, agreTve, maRal
riskze miuTiTebs. Tumca, nakleb saxifaTo meTodebis
cxrili 17.6 suicidis mcdelobis gameorebis gamoyeneba suicidis riskis Semcirebaze calsaxad ar
riskTan dakavSirebuli faqtorebi metyvelebs da, SeiZleba, nawilobriv, imis amsaxveli
iyos, rom pacienti ar flobs srul informacias
warsulSi ganxorcielebuli mcdeloba
xelmisawvdomi meTodebis saSiSroebis xarisxis Se
pirovnuli aSliloba saxeb.
alkoholis an narkotikebis borotad moxmareba Znelia imis winaswarmetyveleba, Tu romeli pa
fsiqiatriuli mkurnalobis istoria
cientebi gardaicvlebian suicidis Sedegad winmswrebi
TviTdazianebis aqtis Semdeg. amis mizezi SemdegSi
umuSevroba
mdgomareobs: miuxedavad imisa, rom am populaciaSi
dabali socialuri klasi suicidis maCvenebeli maRalia zogad populaciasTan
kriminaluri warsuli SedarebiT, is, mainc sakmaod dabalia; garda amisa,
prediqtorebi ar aris sakmaod specifikuri. bekis
Zaladobrivi qcevis istoria
suicidis ganzraxvis skala suicidis imwuTieri riskis
asaki 24-54 weli Sesafaseblad gamoiyeneba (Beck Suicide Intent Scale; Beck
martoxela, ganqorwinebuli an gacilebuli et al., 1974), magram is mainc sasargebloa suicidis
riskis Sesafaseblad pirveli wlis manZilze, romelic
Hawton K. (2000). Treatment of suicide attempters and prevention
of suicide and attemted suicide. In MG Gelder, JJ Lopez-Ibor Jr, and mosdevs ganzrax TviTdazianebis pirvelad aqts (Harris
NC Andreasen (eds) The new Oxford textbook of psychiatry, Chapter et al., 2005).
4.15.4. Oxford University Press, Oxford.
_ 446 _
mkurnalobis Sedegebi ganzrax TviTdazianebis Semdeg
mkurnalobis Sedegebi ganzrax zogadi profilis eqimisgan, romelsac SeuZlia sTxo-

TviTdazianebis Semdeg vos eqTans ojaxis Sesaxeb saWiro informaciis mopoveba.
randomizebuli kontrolirebadi gamokvlevis mixed bavSvebi da mozardebi

viT, sxvadasxva saxis mkurnalobis Semdeg aRiniSneba 1990-ian wlebSi mraval ganviTarebad qveyanaSi gaiz-
fsiqopaTologiis Sesusteba da socialuri prob arda bavSvebsa da mozardebSi ganzrax TviTdazianebis
lemebis mogvareba. miuxedavad amisa, ar arsebobs SemTxvevebi. amis Taobaze rTulia zusti monacemebis
imis sakmarisi mtkicebuleba, rom mkurnaloba am mopoveba, radgan mravali aseTi aqti mdgomareobda
cirebs ganzrax TviTdazianebis aqtis gameorebis wamlis odnav gadaWarbebuli doziT miRebaSi an um-
albaTobas. mtkicebulebis nakleboba, nawilobriv, niSvnelo TviTdaSavebaSi, ris gamoc isini ar regis-
imiTaa gamowveuli, rom Seiswavleboda sxvadasxva trirdeboda samedicino dawesebulebebis mier (Hawton
saxis mkurnaloba da gamokvlevebis umravlesobaSi et al., 2002). zogadad iTvleba, rom ganzrax TviTda-
Zalian cota SemTxveva iyo gaanalizebuli. Catarda zianeba iSviaTi movlenaa skolamdeli asakis bavSveb-
20 ranmdomizebuli kontrolirebadi gamokvlevis Si da misi zrdis tendencia 12 wlis Semdeg SeiniS-
meta-analizi, romlis Sesaswavl cvlads ganzrax neba. aRsaniSnavia, rom ufro dabal asakSi is ufro
TviTdazianebis aqtis ganmeorebiToba warmoadgenda. gogonebSia gavrcelebeuli. garda amisa, ganzrax
am 20 gamokvleviT Seiswavleboda 10 tipis intervencia, TviTdazianeba TeTrkanian qalebSi ufro gavrcele-
ris gamoc miRebuli Sedegebi winaswar xasiaTs bulia, vidre aziel qalebSi (Hawton et al., 2003c).
atarebda (Hawton et al., 1998). meta-analizis Sedegad gamoyenebuli meTodebi. wamlis gadaWarbebuli doz-
gakeTda Semdegi daskvnebi: iT miReba saavadmyofoSi moxvedris yvelaze gavrcele-
w im pirebTan, romlebTanac aRiniSneboda ganzrax buli mizezia. sakuTari TavisTvis Wrilobebis miyeneba
TviTdazianebis mravlobiTi epizodebi, TviT gansakuTrebiT axalgazrda gogonebSia gavrcelebu-
dazianebis aqtis prevenciis TvalasazrisiT depo li, magram aseTi pacientebi saavadmyofoSi iSviaTad
flupentiqsoli ufro efeqturi gamodga placebosTan xvdebian. TviTdazianebis SedarebiT saxifaTo meTo-
SedarebiT (es daskvna erT gamokvlevas efuZneba); debs ufro metad biWebi iyeneben (Hawton et al., 2003c).
w mosazRvre pirovnuli aSlilobis mqone adamianebTan motivacia. Znelia bavSvebSi TviTdazianebis moti-
ganmeorebis xarisxi ufro dabali iyo dialeqtikuri vis dadgena, gansakuTrebiT imis gaTvaliswinebiT, rom
bihevioruli Terapiis Catarebisas, vidre pacientze sikvdilis cneba 12 wlamde Cveulebriv ar yalibdeba.
Semdgomi standartuli movlis ganxorcielebis savaraudoa, rom suicidis seriozuli ganzraxva, daba-
SemTxvevaSi (erTi kvlevis monacemebi); li asakis bavSvebidan sul ramdenimes aReniSneba. ufro
xSirad, aseTi qcevis motivia sxvebisTvis sakuTari
w TviTdazianebis SemTxvevebis klebis tendencia
mZime mdgomareobis demonstrireba, stresisgan ganTa-
aRiniSneboda (1) problemis gadaWraze mimarTuli
visufleba da sxva adamianebze zemoqmedebis moxdena.
Terapiis dros; (2) pacientisTvis sakontaqto
fsiqiatriulSi da sxva dawesebulebebSi myof axalgaz-
baraTebis miwodebisas, romlebic uzrunvelyofdnen
rdebSi, ganzrax TviTdazianebis epidemia iSviaTad war-
daxmarebisTvis myisier mimarTvas; (3) TemTan
moadgens imitaciuri qcevis Sedegs (Wilde, 2000).
muSaobisas, rac ufro efeqturi gamodga Semdgom
mizezebi. mozardebSi, ganzrax TviTdazianebasTan
standartul movlasTan SedarebiT. Tumca, pacientis
asocirebuli faqtorebia ganqorwinebuli mSoblebi,
uzrunvelyofis efeqturoba sakontaqto baraTebiT
fsiqikuri aSlilobis mqone ojaxis wevris arseboba
ar dadasturda evansis mier (M.O.Evans et al., 1999).
da bavSvze Zaladoba. precipitatuli faqtoris rolSi
erT-erTi randomizebuli gamokvlevis mixedviT (gv.
xSirad gamodis socialuri problemebi. SedarebiT da-
??) xanmokle fsiqodinamikuri Terapia amcirebs TviTda-
bali asakis mozardebSi _ ufro metad ojaxuri prob-
zianebis mcdelobis SemTxvevebs (Guthrie et al., 2001).
lemebi; maRali asakis axalgazrdebSi _ megobar gogo-
nasTan an biWTan urTierTobaSi arsebuli sirTuleebi;
specialuri jgufebi
orive asakobriv jgufSi _ skolaSi swavlasTan daka-
dabali asakis bavSvebis dedebi vSirebuli sirTuleebi. mozardebSi, gansakuTrebiT
dabali asakis bavSvebis dedebs gansakuTrebuli yu- vaJebSi, ganzrax TviTdazianebasTan asocirebuli sxva
radReba unda mivaqcioT, radgan, rogorc cnobilia, faqtorebia alkoholmoxmareba da wamalmoxmareba,
SeiniSneba kavSiri ganzrax TviTdazianebas da bavSvze Za- Zaladoba da Zaladobis msxverplad yofna, afeqturi
ladobas Soris. mniSvnelovania gavarkvioT, Tu ras gan- aSliloba da pirovnuli aSliloba (Hawton et al., 2003c).
icdian dedebi TavianT SvilebTan dakavSirebiT da da- ganzrax TviTdazianebis aqtis gamosavali. bavSvebTan
vusvaT kiTxvebi maTi keTildReobis Sesaxeb. britaneTSi da mozardebTan ganzrax TviTdazianebis epizodebis
bavSvebis Sesaxeb informaciis mopoveba SesaZlebelia gamosavali, Cveulebriv, dadebiTia, magram mniSvnelo-
_ 447 _
van umcirebas SemdgomSic aReniSneba socialuri da SesaZlebelia, bavSvebsa da mozardebs gamokvleva
fsiqiatriuli problemebi da ganzrax TviTdazianebis unda Cautaros personalma, romelsac gavlili aqvs
ganmeorebiTi epizodebi. uaryofiTi prognozi aso- treningi axalgazrdebis gamokvlevasa da mkurnalo-
cirebulia cud SeguebasTan, ganzrax TviTdazianebis baSi da icnobs konfidencialobasTan da Tanxmobas-
warsul epizodebTan da mZime ojaxur problemebTan. Tan dakavSirebul problemebs, romlebic SeiZleba
am kategoriis mozardebi (gansakuTrebiT biWebi) sui- aseT SemTxvevaSi aRmocendes. aseve, 65 wels gadac-
cidis mniSvnelovani riskis qveS imyofebian. ilebul pacientebs gamokvleva unda Cautaros iseTma
marTva. bavSvebis TviTdazianebis SemTxvevaSi, um- personalma, romelic icnobs xanSi Sesuli adamianebis
jobesia, maT gamokvleva Cautaros bavSvTa fsiqiatrma problemebs da acnobierebs, rom am asakobriv jgufSi
da ara ganzrax TviTdazianebaze momuSave servisma, gazrdilia fataluri Sedegebis mqone suicidis riki.
romelic mozrdilebisTvisaa gankuTvnili. mkurnalo-
baSi, Cveulebriv, CarTuli arian ojaxis wevrebi.
pacientebis gamokvleva ganzrax
mkurnaloba, rogorc wesi, mimarTulia kauzaluri
TvTdazianebis aqtis Semdeg
xasiaTis problemebze da mozardis kopingis unar-
Cvevebze (Shaffer et al., 2000). zogadi amocanebi
gamokvleva unda iyos mimarTuli Semdeg ZiriTad sa
ganzrax TviTdazianebis marTva kiTxebze:
1. suicidis uSualo riskze;
servisebis saorganizacio mowyoba
2. momavalSi ganzrax TviTdazianebis riskze;
ganzrax TviTdazianebis epizodebis mqone pacientebze
mzrunvelobas axorcielebs ramdenime samsaxuri, maT 3. fizikur janmrTelobasTan dakavSirebul da amJa-
Soris, pirveladi samedicino servisi, saswrafo dax- mindel socialur problemebze.
mareba, gadaudebeli momsaxurebis ganyofileba da so- gamokvleva ise unda tardebodes, rom pacients
cialuri servisebi. am servisebSi momuSave personals xeli SevuwyoT sakuTari problemebisa da maTTan
sWirdeba treningi, raTa man gauwios pacients Sesabam- damoukideblad gamklavebis meTodebis konstruqci-
isi daxmareba da miiRos saswrafo gadawyvetileba imis ulad ganxilvaSi. mniSvnelovania waxaliseba TviTdax-
Sesaxeb, Tu rogor Seafasos riski da rogor miiRos pa- marebis qcevis, radgan pacientebis umravlesobas ar
cientisgan informirebuli Tanxmoba. garda amisa, unda surs fsiqiatrTan ganmeorebiT Sexvedra.
gairkves, aqvs Tu ara pacients Tanxmobis micemis unari Cveulebriv, gamokvleva tardeba gadaudebeli dax-
da ra viTarebaSi SeiZleba ganxorcieldes pacientze marebis ganyofilebaSi an palataSi, sadac ar aris
mzrunveloba misgan Tanxmobis miRebis gareSe. zogadi intimuri saubrisTvis Sesaferisi garemo. Tu es Se-
samedicino da qirurgiuli momsaxurebis saorganiza- saZlebelia, interviu SedarebiT izolirebul oTaxSi
cio sakiTxebi scildeba mocemuli wignis formats. unda Catardes, raTa daculi iyos pacientTan saubris
dainteresebul mkiTxvels SeuZlia gaecnos klinikuri privatuli xasiaTi. Tu pacientma wamali gadaWarbebu-
daxelovnebis erovnuli institutis monacemebs (Nation- li doziT miiRo, upirveles yovlisa, unda davrwmun-
al Institute for Clinical Excellence, 2004 c). deT imaSi, rom is sakmarisad kargad grZnobs Tavs da,
fsiqosocialuri gamokvleva SeiZleba sxvadasxva- Sesabamisad, SeuZlia mogvawodos saWiro informacia.
nairad iyos organizebuli. zog centrSi gamokvlevas Tu pacients cnobierebis darRveva aReniSneba, inter-
fsiqiatri atarebs, zogan _ saTanadod momzadebuli viu unda gadaidos. pacientis garda, informacia unda
personali _ Terapevtebi, eqTnebi an socialuri mu- movipovoT misi megobrebisa da naTesavebisgan, oja-
Sakebi. nebismier SemTxvevaSi, yvela pacientTan unda xis eqimisgan da nebismieri pirisgan (mag., socialuri
Catardes TviTdazianebis Sedegebis Sefaseba, rogorc muSakisgan), romelic ukve muSaobs pacientTan. Zalian
fsiqologiuri TvalsazrisiT, ise fizikuri janmrT- mniSvnelovania, rom gamokiTxvaSi rac SeiZleba meti
elobis TvalsazrisiT (ix. qvemoT). yvela saavadmyofoSi respondenti monawileobdes, radgan maT mier mowo-
unda arsebobdes praqtikis kodeqsi, romelSic deta- debuli informacia, SeiZleba Zalian gansxvavdebodes
lurad unda iyos gawerili fsiqosocialuri gamokvle- pacientisgan miRebuli informaciisgan. pacientis ga-
vis CatarebasTan dakavSirebuli moTxovnebi. am wesebis mokvleva zogadi profilis saavadmyofoSo Semdeg wy-
Taobaze unda arsebobdes SeTanxmeba zogad samedicino aroSia ganxiluli: (Hawton, 2000 b).
da fisqiatriul servisebSi da isini kargad unda iyos
interviu
cnobili dawesebulebis TanamSromlebisTvis.
eTnikuri umciresobebisTvis xelmisawvdomi unda intreviu Semdeg xuT ZiriTad kiTxvas unda pasuxobdes:
iyos is momsaxureba da saSualebebi, romlebic maT 1. ra hqonda pacients ganzraxuli TviTdazianebis
gansakuTrebul saWiroebebs daakmayofilebs. Tu es aqtis dros?
_ 448 _
2. aqvs Tu ara amJamad pacients sikvdili ganzraxuli? (mag., datova anderZi an werili TviTmkvlelobis
3. rogoria pacientis axlandeli problemebi? Sesaxeb?) Tu es asea, fataluri dasasrulis mqone
recidivis riski ufro maRalia.
4. aRiniSneba Tu ara fsiqikuri aSliloba?
am kiTxvebze pasuxebis mixedviT, interviuers SeuZ-
5. ra resursebi gaaCnia pacients?
lia gamoitanos daskvna pacientis ganzraxvis Sesaxeb
aq TiToeuli kiTxva cal-calke iqneba ganxiluli. suicidis aqtis dros (cxrili 17.7).
ra hqonda pacients ganzraxuli TviTdazianebis amave midgomas efuZneba bekis suicidis ganzraxvis
aqtis dros? skala (Beck Suicide Intension Scale) (boqsi 17.1).
rogorc ukve aRiniSna, zogjer pacienti zust in- aqvs Tu ara amJamad pacients sikvdili ganzraxuli?
formacias ar gvawvdis Tavisi ganzraxvis Sesaxeb. interviuerma pirdapir unda hkiTxos pacients, sia-
amis gamo, interviuerma maqsimaluri sizustiT unda movnebs Tu ara is faqti, rom sikvdils gadaurCa an
aRadginos is movlenebi, romlebmac pacienti TviTda- xom ar surs, rom momkvdariyo. Tu pacientis mier gan-
zianebamde miiyvana, raTa SeZlos pasuxis gacema Sem- xorcielebuli aqti seriozul suicidur ganzraxva-
deg kiTxvebze: ze miuTiTebs, xolo pacienti uaryofs amJamad aseTi
1. TviTdazianebis aqti dagegmili iyo Tu impulsuri? ganzraxvis arsebobas, interviuerma, taqtiand dasmu-
rac ufro didi xnis manZilze da guldasmiT igegme- li kiTxvebis meSveobiT, unda gaarkvios ramdenad re-
boda TviTdazianebis aqti, miT ufri maRalia imis aluria es cvlileba.
albaToba, rom igi ganmeordeba da mas fataluri
gamosavali eqneba. rogoria pacientis axlandeli problemebi?
2. ramdenad izruna pacientma imaze, rom TviTdazia- mravali pacienti suicidur aqtamde ramdenime kvi-
nebis aqtis ganxorcielebisTvis arafers SeeSala ris an Tvis manZilze ganicdis sirTuleebsa da pro-
xeli? rac ufro metad izruna pacientma amaze, miT lemebs, romelTa raodenoba stabilurad matulobs.
ufro maRalia imis riski, rom TviTdazianebis aqti zogierTi problema SeiZleba gadaiWras intervius Ca-
ganmeordeba da mas fataluri gamosavali eqneba. ra tarebis periodisTvis, zogjer, TviTdazianebis aqtis
Tqma unda, winaswar gaTvlili scenari realur si- Sedegad (mag., pacientis partniori, romelic imuqre-
tuaciaSi yovelTvis gegmis mixedviT ar xorciel- boda, rom datovebda pacients, suicidis aqtis Semdeg
deba (mag. pacientis meuRle, SeiZleba, Sin Cveu- masTan rCeba). rac ufro seriozulia darCenili pro-
lebrivze adre dabrunebuliyo da amiT, pacientis blemebi, miT ufro didia fataluri gamosavlis mqone
ganzraxvis ganxorcielebisTvis SeeSala xeli). aseT suiciduri aqtis riski. riski gansakuTrebiT maRalia,
viTarebaSi, riskis prognozi pacientis gonivrul
cxrili 17.7 faqtorebi, romlebic suicidis
molodinebs unda iTvaliswinebdes.
Zlier ganzraxvaze miuTiTebs
3. mimarTa TuU ara pacientma vinmes daxmarebisTvis?
izolirebulad ganxorcielebuli aqti
Cven SegviZlia davaskvnaT, rom pacients seriozuli
ganzraxva amoZravebda, Tu man daxmarebisTvis ara- aqtis ganxorcieleba iseT dros aris dagegmili,
rodesac dabalia Carevis albaToba
vis mimarTa.
zrunva imaze, rom ar gairkves TviTmkvlelobis
4. ramdenad saxifaTod aRiqmeboda pacientis mier ga- ganzraxva
moyenebuli TviTdazianebis meTodi? Tu pacientma
sikvdilisTvis winaswari mzadeba (anderZis dawera,
wamali gamoiyena, ra raodenobiT miiRo igi? miiRo
dazRveva)
Tu ara pacientma wamali im odenobiT, romelic
TviTmkvlelobis aqtis Semzadeba (TviTmkvlelobis
misTvis iyo xelmisawvdomi? ra saxiT ganmxorciel-
saSualebebis SeZena, wamlis momarageba)
da TviTdazianebis aqti? (rogorc aRiniSna, rac
ufro Zlieria suicidis ganzraxva, miT ufro ma- sxvebisTvis TviTmkvlelobis ganzraxvis Setyobineba
Ralia misi ganmeorebis riski). unda Sefasdes ara winasawari gaTvlebis warmoeba
mxolod is, Tu ramdenad saxifaToa gamoyenebuli werilobiTi Setyobinebis datoveba
meTodi, aramed isic, Tu ramdenad saxifaTod miaC-
aqtis Semdeg pacienti erideba momxdaris Sesaxeb im pirebis
nia es meTodi pacients. ar aris gamoricxuli, rom informirebas, romlebmac mas SeiZleba daxmareba gauwion
pacients mcdari warmodgena hqondes gamoyenebuli
suicidis ganzraxvis aRiareba
meTodis Sesaxeb. mag., bevrs hgonia, rom gadametebu-
li doziT paracetamolis miReba usafrTxoa, an rom Hawton K. (2000). Treatment of suicide attempters and prevention of
suicide and attemted suicide. In MG Gelder, JJ Lopez-Ibor Jr, and
benzodiazepinebis miReba saSiSia.
NC Andreasen (eds) The new Oxford textbook of psychiatry, Chapter
5. xom ar ganaxorciela pacientma `saboloo qmedeba~ 4.15.4. Oxford University Press, Oxford.
_ 449 _
boqsi 17.2 bekis suicidis ganzraxvis skala

suicidis ganzraxvasTan dakavSirebuli garemoebebi angariSi sakuTari Tavis Sesaxeb
izolaciis xarisxi molodinebi suicidis aqtis fatalurobasTan dakavSirebiT

0. pacienti marto ar imyofeba 0. pacienti ar Tvlida, rom aqti SeiZleba sasikvdilo yo-
1. arsebobs iseTi piri, romelic pacientis siaxloves an filiyo
masTan kontaqtSi (mag., satelefono kontaqti) imyofeba 1. pacienti fiqrobda, rom aqti SeiZleba sasikvdilo yo-
2. aravin imyofeba pacientis siaxloves (aravin imyofeba filiyo, Tumca dabali albaTobiT
masTan kontaqtSi) 2. pacienti fiqrobda, rom aqts sikvdili mohyveboda an
darwmunebuli iyo amaSi
droSi dagegmva
0. suicidis aqti isea droSi dagemili, rom intervencia warmodgena imis Sesaxeb, Tu ramdenad SeuZlia gamoyenebul
mosalodnelia meTods sikvdilis gamowveva
2. isea droSi dagegmili, rom intervencia ar aris mosa- 0. pacientma sakuTar Tavs ufro mcire ziani miayena,
lodneli vidre, misi azriT, sasikvdilo
3. isea droSi dagegmili, rom intervenciis albaToba Za- 1. pacientma zustad ar icoda, Tu ramdenad saSiSia ga-
lian mcirea moyenebuli meTodi, an moimoqmeda iseTi ram, rac sa-
sikvdilod miaCnda
zrunva imaze, rom ar gairkves TviTmkvlelobis ganzraxva/ar 2. suicidis aqtis saSiSroebis xarisxi utoldeba pacientis
moxdes Careva warmodgenas misi fatalurobis Sesaxeb, an aRemateba mas
0. ar iRebs winasawar zomebs
mcdelobis seriozuloba
1. pasiuri zomebi; mag., Tavs aridebs adamianebs, magram
arafers akeTebs imisaTvis, rom xeli SeuSalos maTi 0. pacienti ar Tvlida, rom mocemuli aqti warmoadgens
mxridan Carevas; sicocxlis dasrulebis seriozul mcdelobas
2. aqtiuri zomebi (mag., karis Caketva). 1. pacientma ar icoda, Tu ramdenad warmoadgens
TviTmkvlelobis mocemuli aqti sicocxlis dasrulebis
TviTmkvlelobis mcdelobis dros/ Semdeg daxmarebis Zieba seriozul mcdelobas
0. damxmare pirebisTvis TviTmkvlelobis mcdelobis 2. pacienti Tvlida, rom mocemuli aqti warmoadgens
Setyobineba sicocxlis dasrulebis seriozul mcdelobas.
1. damxmare pirebTan kontaqtis damyareba konkretuli ambivalenturi damokidebuleba sicocxlis mimarT
Setyobinebis gareSe
0. pacients ar undoda sikvdili
2. ar mimarTavs kontaqtis damyarebas an Setyobinebas
1. pacients ar adardeba, gadarCeboda Tu ara
saboloo qmedebebi sikvdilis win 2. pacients sikvdili undoda.
0. ara
warmodgena Sedegis Seqcevadobis Sesaxeb
1. nawilobrivi mzadeba an ideacia
0. pacienti Tvlida, rom gadarCeba samedicino daxmarebis
2. konkretuli gegmebi (anderZSi cvlilebebis Setana, miRebis SemTxvevaSi
saCuqrebis gacema, dazRveva)
1. pacientma ar icoda, gadarCeba Tu ara samedicino
suicidis mcdelobis dagegmvis xarisxi daxmarebis miRebis SemTxvevaSi
0. winaswari momzadebis gareSe 2. pacienti darwmunebuli iyo, rom ar gadarCeba maSinac
ki, Tu miiRebs samedicino daxmarebas.
1. minimaluri momzadeba
2. safuZvliani momzadeba aqtis winaswari gaazreba
0. gaazrebis gareSe; impulsuri
werili TviTmkvlelobis Sesaxeb
1. pacienti suicidze fiqrobda sami saaTiT an naklebi
0. werili ar dauweria droiT adre suicidis mcdelobamde
1. dawera da Semdeg daxia 2. pacienti suicidze fiqrobda sami saaTis ganmavlobaSi
2. dawera an sam saaTze met xans suicidis mcdelobamde
suicidis aqtamde TviTmkvlelobis ganzraxvasTan dakavSire-

biT komunikaciis mcdeloba
1. ar momxdara
2. araerTgvarovani komunikacia
3. erTgvarovani komunikacia
suicidis mcdelobis mizani

0. ZiriTadad garemos Secvla
1. 0-sa da 2-is komponentebi Beck et al., (1974). The prediction of suicide. Charless press,
2. ZiriTadad garemosgan Tavis daRweva Philadelphia
Tu pacienti martoxelaa da susti janmrTeloba aqvs. w intimuri kavSiri meuRlesaTan an sxva pirTan;
pacientis problemebis Sefaseba regularulad unda
w urTierToba SvilebTan da sxva naTesavebTan;
xdebodes. Sefasebisas Semdegi momentebi unda iyos
gaTvaliswinebuli: w dasaqmeba, finansebi, sacxovrebeli;
w samarTlebrivi problemebi;
_ 450 _
orive sqesis 935 warmomadgeneli
9.0
8.0
7.0
6.0
procentuli raodenoba
5.0
4.0
3.0
2.0
1.0
0.0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
ganzraxvis maCvenebeli
dabali (0-6)
(7-12)
saSualo (13-20)
maRali Zalian maRali (21+)
29.0% 41.0% 25.9% 4.1%
suraTi 17.4. 2002 wels bekis suicidis ganzraxvis skalis monacemebi im pirebisTvis, vinc TviTdazianebis gamo
stacionarSi moTavsda
w socialuri izolacia, Zvirfasi adamianis gar adamianebis Sesaxeb, agreTve, nebismieri daxmarebis
dacvaleba da sxva saxis danakargi; Sesaxeb, romelsac pacienti iRebs, an SeuZlia miiRos
w fizikuri janmrTeloba. zogadi profilis eqimisgan, socialuri muSakisgan an
organizaciisgan, sadac moxaliseebi muSaoben.
narkotikebTan da alkoholTan dakavSirebuli
problemebi unda gaviTvaliswinoT fsiqiatriuli arsebobs Tu ara suicidis mudmivi riski?
gamokvlevis am etapze, an mogvianebiT, fsiqikuri zemoT aRwerili gamokvlevis Catarebis Semdeg,
mdgomareobis Sefasebisas. interviuers xelTa aqvs informacia am mniSvnelovan
kiTxvaze pasuxis gasacemad. aRniSnuli informaciis
aRiniSneba Tu ara fsiqikuri aSliloba?
gaTvaliswinebiT, fsiqiatri pasuxs scems pirvel oTx
am kiTxvaze pasuxis gacemisas unda daveyrdnoT anamnezs
kiTxvas:
da pacientis fsiqikuri mdgomareobis xanmokle, magram
w ganzraxuli hqonda Tu ara pacients sikvdili?
regularul Sefasebas. gansakuTrebuli yuradReba unda
mivaqcioT iseTi daavadebebis arsebobas, rogoricaa w aqvs Tu ara amJamad aseTi ganzraxva?
depresiuli aSliloba, alkoholizmi, SfoTviTi w ZalaSia Tu ara is problemebi, romlebmac moaxdines
aSliloba da personologiuri aSliloba. agreTve, suicidis aqtis provocireba?
gasaTvaliswinebelia, xom ar aqvs pacients Sizofrenia w aReniSneba Tu ara pacients fsiqikuri aSliloba?
an demencia, Tumca isini SedarebiT iSviaTad gvxvdeba.
w SesaZlebelia Tu ara damatebiTi daxmarebis miReba
ra resursebi gaaCnia pacients? da ramdenad mosalodnelia, rom pacienti miiRebs am
daxmarebas?
resursebSi igulisxmeba problemis gadaWris unari,
materialuri resursebi da daxmareba, romelic am kiTxvebze pasuxis gacemis Semdeg, Terapevti
pacients SeiZleba sxva adamianebma SesTavazon. is, adarebs pacientis maxasiaTeblebs im adamianebis maxas-
Tu rogor umklavdeboda pacienti warsulSi Tavis iaTeblebs, romelTac sicocxle suicidiT daasrules.
problemebs (mag., samuSaos dakargva an urTierTobis es maxasiaTeblebi mocemulia cxrilSi 17.7.
gawyveta), momaval sirTuleebTan gamklavebis yve
arsebobs Tu ara Semdgomi TviTdazianebis riski
laze kargi prediqtoria. imis dasadgenad, Tu
letaluri dasasrulis gareSe?
ramdenad xelmisawvdomia pacientisTvis daxmareba,
unda davusvaT mas kiTxvebi megobrebisa da sando cxrilSi 17.6 Sesabamisi prediqtorebia warmodge-
_ 451 _
boqsi 17.2 pacientebi, romlebic izianeben aseTi qmedeba SeiZleba gulisxmobdes pacientis arane
sakuTar Tavs da uars amboben mkurnalobaze bayoflobiT stacionirebas da gadaudebel mkurnalobas
pacientis sicocxlis gadarCenis mizniT (ix, gv. ???).
gaiTvaliswineT, rom msoflios sxvadasxva qveyanaSi gan
w personals unda axsovdes, rom pacientis gadawyvetilebis
sxvavebuli kanonmdeloba da praqtika arsebobs.
miRebis unari SeiZleba droTa ganmavlobaSi Seicvalos.
w pacienti unda moinaxulos gamocdilma eqimma, da gani amis gamo, yoveli axali poceduris an mkurnalobis Ca-
xilos masTan erTad SeTavazebuli mkuranloba, mkur tarebamde, Tanxmobis misaRebad pacients unda avuxsnaT
nalobis alternativebi da is sakiTxebi, romlebic TiToeuli maTganis xasiaTi.
pacients awuxebs. zogjer sasurvelia pacientis naTe
w rodesac, sakiTxis sruli ganxilvis Semdeg pacienti, ro-
savebisa da axlo megobrebis monawileoba. xSirad,
melsac ar aqvs cnobieri gadawyvetilebis miRebis unari,
pacientis problemebis TanagrZnobiT ganxilvis Semdeg
uars ambobs Tanxmobaze da, amave dros, ar arsebobs misi
pacienti Tanxmdeba mkurnalobaze.
iZulebiTi mkurnalobis safuZveli, unda vecadoT Sevimu-
w pacienti, romelmac ganaxorciela TviTdazianebis aqti, SaoT alternatiuli gegma, romelic orive mxarisTvis iq-
magram saR gonebaze imyofeba da naTeli cnobiereba neba misaRebi. Tu es mcdelobac uSedego gamodga, pacients
aqvs, unda CaiTvalos sakmarisad unarianad imisaTvis, naTlad unda avuxsnaT miRebuli gadawyvetilebis Sedegebi
rom uari Tqvas samedicino rCevaze, TuU sawinaaRmdego da SevadginoT diskusiis sruli oqmi. Tu pacienti daJine-
ar iqna damtkicebuli. pacientis es unari rac biT moiTxovs saavadmyofodan gaweras, mas unda davrToT
SeiZleba swrafad unda Sefasdes (gv. ???). personalis neba datovos saavadmyofo, magram, amave dros, vecadoT
nebismier warmomadgenels unda SeeZlos am tipis gavuCinoT saavadmyofoSi dabrunebis survili. amave dros,
Sefaseba, magram, roca ki es SesaZlebelia, pacientis pacients unda mivawodoT sakontaqto nomeri, romelsac is
gadawyvetilebis miRebis uunaroba unda dadasturdes gamoiyenebs sagangebo situaciaSi aRmoCenisas. aseve unda Se-
fsiqiatris mier. Tu saWiroa, unda Catardes pacientis vatyobinoT Semdgomi mkurnalobis alternativebi. es viTa-
gamokvleva aranebayoflobiTi mkurnalobis Catarebis reba rac SeiZleba swrafad unda ganvixiloT ojaxis eqimTan.
mizanSewonilobis dasadgenad.
w zogadad, mizanSewonilia pacients davukavSirdeT momde-
w rodesac iTvleba, rom pacients ar aqvs gacnobierebuli vno dRes da xelaxla SevTavazoT daxmareba. ojaxis eqim-
gadawyvetilebis miRebis unari (mag., medikamentis Tan erTad ganvixiloT, Tu vin unda daukavSirdes pacients.
gadaWarbebuli dozis miRebiT gamowveuli intoqsikaciis
gamo), kanonis mixedviT, samedicino personali valdebulia damatebiTi informaciisaTvis ixileT
imoqmedos pacientis interesebidan gamomdinare. National Institute for Clinical Excellence, 2004c.
nili. interviuerma unda ganixilos yvela punqti sab- mniSvnelovania, rom intervium xeli Seuwyos pa
oloo gadawyvetilebis miRebamde. cientTan Terapiuli urTierTobis damyarebas. sa
momavlo gegmebi pacientTan unda SevaTanxmoT da
ra tipis mkurnaloba unda Cautardes pacients da Tu maTTan dakavSirebiT ver moxerxda SeTanxmebis
daTanxmdeba Tu ara pacienti mis Catarebaze? miRweva, unda ganvixiloT alternatiuli, ormxriv
Tu CaiTvleba, rom suicidis riski maRalia, unda Cat- misaRebi gegma. pacientebis saWiroebebi SeiZleba sam
ardes is procedurebi, romlebic am Tavis pirvel nawil- kategoriad dajgufdes:
Sia aRwerili (gv. ??). im pacientebis 5-10%, romelTac 1. umniSvnelo umciresobas (albaT 5-10%) sWirdeba
ganzrax TviTdazianebis aqti ganaxorcieles, hospital- hospitalizacia mkurnalobis Casatareblad;
izacias saWiroebs. umravlesobasTan naCvnebia depre-
2. daaxloebiT erT mesameds aReniSneba fsiqikuri
siis an alkoholizmis mkurnaloba, ramdenime pacient-
aSliloba, romelic saWiroebs mkurnalobas pir
Tan ki _ Sizofreniis mkurnaloba. zogierTs sWirdeba
veladi daxmarebis doneze; mag., Temis doneze
droebiT moSoreba stresuli situaciidan.
momuSave fsiqiatriuli jgufis mier.
rodesac hospitalizacia ar aris naCvenebi, pacient-
Tan da mis momvlelebTan erTad unda SemuSavdes mo- 3. danarCen pacientebs sWirdebaT daxmarebis gaweva
cemuli SemTxvevis marTvis gegma. Tu pacienti uars sxvadasxva saxis fsiqosocialur problemebTan
ambobs daxmarebaze, misi movlis gegma unda ganvixi- dakavSirebiT, raTa maT moaxerxon stresorebTan
loT zogadi profilis eqimTan erTad, sanam pacients gamklaveba. amgvari daxmareba maSinacaa saWiro,
Sin dabrunebis nebas darTaven (boqsi 17.2). zogjer rodesac dabalia suicidis uSualo riski an misi
mizanSewonilia pacientisTvis telefonis nomris ganmeorebis riski fataluri gamosavlis gareSe,
micema, rac mas saSualebas miscems dauyovnebliv mi- radgan mudmivi problemebis arseboba zrdis
iRos specialistis rCeva an Sexvdes specialists Sem- suicidis aqtis ganmeorebis risks. praqtikuli
dgomi krizisis aridebis mizniT. daxmarebis gawevis garda, Cveulebriv, yvelaze
efeqturia problemis gadaWraze mimarTuli mid
pacientis marTva gamokvlevis Semdeg gomis gamoyeneba. problemebis identifikacia ga
mokvlevis mizniT Catarebuli intervius dros unda
pacientebi, romlebmac ganaxorcieles TviTdazianebis
daiwyos. samwuxarod, pacienti xSirad uars ambobs
aqti, xSirad uars ambobens Semdgom mkurnalobaze.
am tipis daxmarebaze.
_ 452 _
rodesac TviTdazianebis epizodi asocirebulia movlis gegmis Taobaze, romelic unda iTvaliswinebdes
konkretul problemebTan interpersonalur urTi konstruqciuli qcevis dajildovebas. amave dros,
erTobaSi, xSirad mizanSewonilia im piris gamokvleva, erTi adamiani mudmivad unda uwevdes pacients
romelTanac pacienti urTierTobs. am piris mxardaWeras. Tumca, ra saxiTac ar unda iyos pacientze
gamokvleva jer individualurad unda Catardes, xolo zrunva organizebuli, suicidiT gardacvalebis riski
mogvianebiT pacientTan erTad, Tu es ukanaskneli mainc maRalia.
amaze Tanxmobas ganacxadebs. erToblivma intervium
sakuTari TavisTvis ganmeorebiT Wrilobebis
SeiZleba gaaumjobesos dialogi partniorebs Soris,
miyeneba
rac Seamcirebs suicidis xelaxali mcdelobis risks.
am SemTxvevaSi gamoyenebuli mkurnalobis meTodebi am qcevis marTva mraval problemas ukavSirdeba.
ganxilulia Semdeg wyaroSi: Hawton, 2000a. xSirad pacients uWirs sakuTari grZnobebis sityvebiT
gamoxatva, ris gamoc fsiqoTerapia efeqturi ar aris.
marTvis zogierTi gansakuTrebuli problema martivi mcdeloba, romelic mimarTulia pacientis
ndobis mopovebasa da misi TviTSefasebis amaRlebaze,
pacientebi, romlebic uars amboben gamokvlevaze
wesiT ufro efeqturi unda iyos. gamokvleva moicavs
ganzrax TviTdazianebis Semdeg, zogierTi pacienti im movlenaTa jaWvis biheviorul analizs, romelmac
uars ambobs interviuze, zogi ki saavadmyofodan pacienti sakuTari TavisTvis Wrilobebis miyenebamde
ewereba gamokvlevis dasrulebamde. am kategoriis miiyvana. es dagvexmareba movlenaTa jaWvis garRvevaSi
pacientebTan maRalia xelaxali TviTdazianebis an sakuTari Tavis daservis qcevis CanacvlebaSi
riski (Crawford and Wessely, 1998). aseT SemTxvevaSi alternatiuli meTodebiT, romlebic Svebis momtania.
aucilebelia sxva wyaroebidan didi raodenobiT rogorc Cans, medikamenturi mkurnaloba nakleb
informaciis mopoveba, raTa pacientis saavadmyo efeqturia, Tumca, antifsiqozuri agentebis (rsipe
fodan gaweramde gamoiricxos seriozuli fsi ridoni an alanazapini) mcire doziT gamoyeneba
qikuri aSlilobiT gamowveuli suicidis riski. xanmokle drois manZilze SeiZleba sasargeblo
mniSvnelovania am problemis zogadi profilis eqim gamodges daZabulobis Sesamcireblad. mraval ada
Tan da Temis doneze momuSave fsiqiatrTa gundTan mians, vinc sakuTar Tavs Wrilobebs ayenebs, seriozuli
erTad (Tu, ra Tqma unda, orive maTgani ukve muSaobs pirovnuli problemebi gaaCnia. mkurnaloba swored
mocemul SemTxvevaze). rodesac suicidis riski am problemebze unda iyos mimarTuli, Tumca is
maRalia, SeiZleba saWiro gaxdes gamokvlevis mizniT, SeiZleba rTuli da xangrZlivi gamodges. drodadro
pacientis dakaveba iZulebiTi mkurnalobis orderis aucilebeli xdeba pacientis hospitalizacia. Za
gamoyenebiT. lian mniSvnelovania, rom yvela monawile mxarem
erToblivad SeimuSavos mkafio da detaluri stra
TviTdazianebis aqtis xSiri ganmeoreba
tegia, radgan TviTdaservis qceva stacionarSi Zneli
zogi pacienti ganmeorebiT iRebs wamlis ga
samarTavia da, SesaZloa, sxva pacientebis mier moxdes
daWarbebul dozas stresis dros. xSirad iseTi
misi imitacia.
STabeWdileba iqmneba, rom es qceva xorcieldeba
stresis Sesasusteblad an yuradRebis mipyrobis
mizniT. Tumca, misi xSirad ganxorcielebisas, damatebiTi literatura
naTesavebi kargaven pirovnebis mimarT TanagrZnobas
da misdami mtrul damokidebulebasac ki amJRavneben. Gelder, MG, Lopez-Ibor JJ JR, and Andreasen NC (eds) (2000).
saavadmyofos gadaudebeli SemTxvevebis ganyofilebis The new Oxford textbook of psychiatry. Section 4.1.5. Sui-
TanamSromlebic SeiZleba ukmayofilebas ganicdidnen cide. Oxford University Press, Oxford (am nawilis oTx
aseTi faqtebis gamo. pacientebs, romlebTanac xSiria TavSi mocemulia ganzrax TviTdazianebis da suici-
suicidis mcdeloba, Cveulebriv pirovnuli aSliloba dis mravalmxrivi mimoxilva).
aReniSnebaT da mravali gadauWreli socialuri Hawton, KE and van Heeringen, K (2000). The interational
problema aqvT, magram maTTan arc konsultaciaa handbook of suicide and attemted suicide. John Wiley, Chich-
efeqturi da arc intensiuri fsiqoTerapia. yvela ester (wamyvani avtorebis avtoritetuli mimoxil-
mxare, romelic monawileobas iRebs mocemuli vebi, romlebic suicidisa da suicidis mcdelobis
SemTxvevis marTvaSi, unda SeTanxmdes pacientis yvela aspeqts moicavs).
_ 453 _
Tavi 18 alkoholizmi
da wamalmoxmareba
Tavis Sinaarsi
ebTan an bavSvebTan, romlebic aqrolad nivTierebebs
fsiqoaqtiuri nivTierebebis moxmarebiT
SeisunTqaven.
gamowveuli aSlilobebis klasifikacia
fraza _ fsiqoaqtiuri nivTierebebis moxmarebiT
DSM-IV-sa da ICD-10-Si mocemuli
gamowveuli aSlilobebi (DSM-IV) an fsiqoaqtiur niv-
ganmartebebi
TierebaTa moxmarebiT gamowveuli fsiqikuri da qcevi-
alkoholis moxmarebiT
Ti aSlilobani (ICD-10), im mdgomareobebs aRwers, rom-
gamowveuli aSlilobebi
lebic alkoholis, fsiqoaqtiuri narkotikuli niv-
terminologia
Tierebebis da sxva qimiuri nivTierebebis (rogoricaa,
moraluri da samedicino modelebi
magaliTd, aqroladi nivTierebebi) moxmarebis Sedegad
alkoholis Warbi gamoyeneba
aRmocendeba. am TavSi jer ganxilulia alkoholTan
alkoholdamokidebulebis sindromebi da
dakavSirebuli problemebi, romlebic gaerTianebulia
alkoholuri aRkveTis mdgomareoba
qveTavSi àlkoholmoxmarebiT gamowveuli aSlilobe-
alkoholis moxmarebasTan
bi~. Semdeg modis narkotikul da sxva qimiur nivTiere-
dakavSrebuli sxva saxis aSlilobebi
bebTan dakavSirebuli problemebis ganxilva, rac gaer-
socialuri ziani
Tianebulia qveTavSi `sxva fsiqoaqtiuri nivTierebebis
alkoholis Warbi raodenobiT moxmarebisa
moxmarebiT gamowveuli aSlilobebi~.
da alkoholmoxmarebis mizezebi
alkoholmoxmarebis dadgena
mkurnaloba alkoholmoxmarebis dros fsiqoaqtiuri nivTierebebis
alkoholmoxmarebisa da alkohol moxmarebiT gamowveuli aSlilobebis
damokidebulebis prevencia klasifikacia
sxva fsiqoaqtiuri nivTierebebis DSM-IV da ICD-10 klsifikaciebSi fsiqoaqtiuri niv-
moxmarebiT gamowveuli aSlilobebi Tierebebis moxmarebis Sedegad gamowveuli aSli-
epidemiologia lobebis erTi da igive kategoriebia gamoyenebuli,
wamalmoxmarebis mizezebi Tumca maTi dajgufeba gansxvavebulad xdeba. orive
wamalmoxmarebis mavne Sedegebi sistemaSi identificirebulia Semdegi aSlilobebi:
wamalmoxmarebis diagnozi intoqsikacia, borotad gamoyeneba (an mavne SedegiT
prevencia, mkurnaloba da moxmareba), damokidebuleba, aRkveTis mdgomareobe-
reabilitacia _ zogadi principebi bi, fsiqozuri aSlilobebi da amneziuri sindromebi.
specifikuri tipis narkotikuli es da kidev ramodenime sxva kategoria mocemulia
nivTierebebis avadmoxmareba cxrilSi 18.1.
orive diagnostikuri sistemis mixedviT, klasifi-
alkoholisa da fsiqoaqtiuri nivTierebebis borotad kaciis pirveli etapia pirovnebis mier gamoyenebuli
gamoyenebis Tema ar ganekuTvneba fsiqiatriuli an fsiqoaqtiuri nivTierebis an nivTierebaTa klasis
miT umetes samedicino dargis romelime viwro sfer- dadgena (cxrili 18.2), rac pirveladi diagnostikuri
os. alkoholisa da narkotikuli nivTierebebis mox- kategoriis gansazRvras uzrunvelyofs. miuxedavad
mareba SeiZleba mniSvnelovan rols TamaSobdes nebi- imisa, rom narkotikuli nivTierebebis momxmareblebi
smieri aspeqtis mqone fsiqiatriul praqtikaSi. igi xSirad erTze meti saxis narkotiks iyeneben, aSlilo-
relevanturia, mag., Terapiul ganyofilebaSi mwvave bis diagnostireba yvelaze mniSvnelovani fsiqoaq-
abnevis mqone pacientis gamokvlevisas; gadaudebeli tiuri nivTierebis moxmarebis safuZvelze xdeba.
daxmarebis ganyofilebaSi suicidis mcdelobiT Semo- rodesac Zneldeba aseTi nivTierebis dadgena, an mox-
sul pacientTan; xandazmul pacientebTan, romlebsac marebas qaoturi da ganurCeveli xasiaTi aqvs, maSin
sakuTari Tavis movla uWirT; problemur mozard- SesaZlebelia gamoviyenoT mravlobiTi fsiqoaqtiuri
_ 454 _
fsiqoaqtiuri nivTierebebis moxmarebiT gamowveuli aSlilobebis klasifikacia
nivTierebebiT gamowveuli aSlilobis (DSM-IV) an sx-

cxrili 18.1 fsiqoaqtiuri nivTierebebiT
vadasxva saxis nivTierebis erTdrouli moxmarebiT
gamowveuli aSlilobebi
gamowveuli aSlilobebis (ICD-10) kategoria. amis Sem-
DSM-IV ICD-10 deg fsiqoaqtiuri nivTierebebis araswori moxmarebis
intoqsikacia intoqsikacia maCvenebel cxrilSi 18.1 CamoTvlili aSlilobebidan
borotad gamoyeneba moxmarebiT gamowveuli
Sesatyviss unda mivakuTvnoT. am sistemis mixedviT,
mavne SedegebiT nebismieri saxis aSliloba SeiZleba garkveuli tipis
narkotikul nivTierebas davukavSroT. Tumca, parq-
damokidebuleba damokidebulebis sindromi
tikaSi zogierTi aSliloba ar viTardeba erTi rome-
aRkveTa aRkveTis mdgomareoba
lime konkretuli narkotikuli nivTierebis gamoy-
aRkveTis deliriumi aRkveTis mdgomareoba enebis Sedegad. ICD-10-Si agreTve mocemulia special-
deliriumiT uri kategoria _ rezidualuri da mogvianebiT asakSi
fsiqozuri aSlilobebi fsiqozuri aSliloba ganviTarebuli fsiqozuri aSliloba. am kategoriaSi
demencia aRwerilia iseTi fiziologiuri da fsiqologiuri
cvlilebebi, romlebic uSualod narkotikuli niv-
amneziuri aSliloba amneziuri sindromi Tierebebis miRebis dros aRmocendeba da SemdgomSic
guneb-ganwyobis rezidualuri da mogviane-
aSlilobebi biT asakSi ganviTarebuli
fsiqozuri aSiloba cxrili 18.3 fsiqoaqtiuri nivTierebebis avad-
SfoTviTi aSlilobebi sxva fsiqikuri da qceviTi moxmarebis (DSM-IV) da fsiqoaqtiuri nivTie-
aSlilobebi rebebis moxmarebiT gamowveuli mavne Sedegebis
(IDC-10) kriteriumebi
seqsualuri disfunqcia
DSM-IV ICD-10
Zilis darRvevebi
A nivTierebebis moxmarebis araada A fsiqoaqtiuri ni
ptaciuri paterni, romelic vTierebebis mox
iwvevs klinikuri TvalsazrisiT marebis paterni,
mniSvnelovan gauaresebas an romelic zians
distress; an iseT fsiqikur ayenebs janmrTe
mdgomareobas, romelic 12 Tvis lobas. ziani Se
cxrili 18.2 fsiqoaqtiur nivTierebaTa klasebi
ganmavlobaSi vlindeba erT-erTi iZleba fizikuri
DSM-IV ICD-10* (an ramdenime) qvemoT CamoTvlili an fsiqologiuri
formiT: xasiaTisa iyos.
alkoholi alkoholi
(1) fsiqoaqtiuri nivTierebis si
amfetaminebi sxva stimulatorebi, stematuri moxmareba, romlis
kofeinis CaTvliT Sedegadac pirovneba ver axe
rxebs Tavisi ZiriTadi mova
kofeini leobebis Sesrulebas (samsa
xurSi, skolaSi an ojaxSi).
kanabisi kanabinoidebi
(2) fsiqoaqtiuri nivTierebis si
kokaini kokaini stematuri moxmareba fizikuri
safrTxis Semcvel situaciebSi
halucinogenebi halucinogenebi
(3) fsiqoaqtiuri nivTierebebis
inhalantebi aqroladi gamxsnelebi
sistematurad moxmareba, rome
nikotini Tambaqo lic kanonmdeblobasTan dakav
Sirebul problemebs warmo
opioidebi opioidebi Sobs.
enciklidini (4) fsiqoaqtiuri nivTierebis si

stematuri moxmareba miuxe
sedaciuri da saZile saSuale sedaciuri an saZile davad im mudmivi an peri
bebi an anqsiolitikebi saSualebebi oduli socialuri Tu inter
personaluri xasiaTis pro
mravlobiTi fsiqoaqtiuri sxvadasxva saxis blemebisa, romlebic gamo
nivTiereba fsiqoaqtiuri nivTierebis wveulia an gamwvavebulia am
erTdroulad moxmareba nivTierebis zemoqmedebiT.
sxva B am klasis fsiqoaqtiur nivTi
erebebTan dakavSirebiT arasodes
* cxrilSi moyvanili nivTierebebis Tanmimdevroba Secv- akmayofilebs fsiqoaqtiur niv
lilia, raTa naTlad gamoCndes DSM-IV-Tan arsebuli Tierebebze damokidebulebis
paralelebi. kriteriumebs
_ 455 _
18 alkoholizmi da wamalmoxmareba
(fsiqoaqtiuri nivTierebis zemoqmedebis periodis borotad gamoyeneba. terminebi _ borotad gamoy-
Semdegac) ganagrZobs arsebobas. aseT kategoriebs eneba (DSM-IV) da mavne SedegebiT gamoyeneba (ICD-10),
SeiZleba ganekuTvnebodes halucinogenebiT gamowveu- miuTiTebs fsiqoaqtiuri nivTierebis moxmarebis ara-
li `fleSbeki~ da alkoholiT gamowveuli demencia. adaptaciur paternebze, romlebic iwveven janmrT-
elobis gauaresebas am sityvis farTo gagebiT (cxrili
DSM-IV-sa da ICD-10-Si mocemuli 18.3). gavrcelebul termins _ avadmoxmareba, msgavsi
ganmartebebi mniSvneloba gaaCnia. DSM-IV-isa da ICD-10-is kriteri-
intoqsikacia. intoqsikaciis ganmarteba mocemulia umebi nawilobriv gansxvavdeba erTmaneTisgan. DSM-IV
rogorc DSM-IV-Si, ise ICD-10-Si. orive sistemaSi yuradRebas amaxvilebs fsiqoaqtiuri nivTierebebis
intoqsikacia ganxilulia, rogorc fsiqoaqtiuri moxmarebis negatiur socialur Sedegebze, xolo ICD-
nivTierebis miRebiT ganpirobebuli droebiTi sin- 10 _ maTi moxmarebiT gamowveul arasasurvel soma-
dromi, romelic klinikuri TvalsazrisiT seriozul tur da fsiqologiur Sedegebze. zogierT pirovne-
fiziologiuri da fsiqologiuri xasiaTis gauaresebas, romelic aSkarad borotad iyenebs fsiqoaqtiur
bas iwvevs. amgvari cvlilebebi qreba, rogorc ki niv- nivTierebas, ar aqvs damokidebulebis simptomebi
Tiereba sxeulidan gamoidevneba. fsiqologiuri cv- (cxrili 18.4). sapirispiro SemTxvevaSi, unda daisvas
lilebebis xasiaTi damokidebulia rogorc pirovne- damokidebulebis da ara borotad gamoyenebis an mavne
baze, aseve gamoyenebul fsiqoaqtiur nivTierebaze. SedegebiT gamoyenebis diagnozi.
mag., zogierTi adamiani alkoholuri intoqsikaciis damokidebuleba. termini damokidebuleba aRniS-
dros agresiuli xdeba, zogi ki _ sentimentaluri. navs garkveuli tipis fiziologiur da fsiqolo-
cxrili 18.4 damokidebulebis kriteriumebi DSM-IV da ICD-10 mixedviT

DSM-IV ICD-10
A damokidebulebis diagnozis dasma SeiZleba maSin, A damokidebulebis diagnozis dasma SeiZleba maSin,
rodesac Tormeti Tvis manZilze, nebismier dros, rodesac bolo erTi wlis ganmavlobaSi garkveul
saxezea qvemoT CamoTvlili movlenebidan minimum sami: periodSi saxezea qvemoT CamoTvlili movlenebidan
(1) pirovnebas aReniSneba tolerantoba, rac vlindeba: minimum sami:
a. intoqsikaciis an sasurveli efeqtis misaRwevad (1) pirovnebas aqvs fsiqoaqtiuri nivTierebis miRebis
fsiqoaqtiuri nivTierebis raodenobis TvalsaCinod Zlieri survili an kompulsuri midrekileba.
gazrdis aucileblobaSi; b. am nivTierebis igive (2) pirovnebas axasiaTebs fsiqoaqtiuri nivTierebebis
raodenobiT miRebisas efeqtis SesamCnevad daq miRebis qcevis kontrolTan dakavSirebuli siZ
veiTebaSi. neleebi. es siZneleebi exeba am fsiqoaqtiuri
(2) pirovnebas axasiaTebs aRkveTis mdgomareoba, razec nivTierebis moxmarebis dawyebas, Sewyvetas an
miuTiTebs: odenobas.
a. fsiqoaqtiuri nivTierebisaTvis damaxasiaTebeli (3) fsiqoaqtiuri nivTierebebis moxmarebis Sem
aRkveTis sindromis arseboba; cirebis an Sewyvetis gamo pirovnebas aReniSneba
b. aRkveTis simptomebis Sesamsubuqeblad an Tavidan fiziologiuri aRkveTis mdgomareoba, razec
asacileblad igive (an msgavi) fsiqoaqtiuri miuTiTebs an fsiqoaqtiuri nivTierebisaTvis da
nivTierebis moxmareba. maxasiaTebeli sindromis arseboba an is faqti,
rom pirovneba iRebs igive (an msgavs) nivTierebas
(3) pirovneba ufro xangrZlivi drois manZilze iRebs aRkveTis simptomebis Semsubuqebis an Tavidan
ufro didi raodenobiT fsiqoaqtiur nivTierebas, acilebis mizniT.
vidre mas hqonda ganzraxuli.
(4) pirovnebas aReniSneba tolerantobis niSnebi, ris
(4) pirovnebas aqvs fisiqoaqtiuri nivTierebebis gamoc saWiro xdeba fisiqoaqtiuri nivTierebebis
moxmarebis Semcirebis an masze kontrolis gawevis dozis gazrda, raTa miRweul iqnas is efeqti,
gamudmebuli survili an is uSedegod cdilobs romelsac, winaT, Cveulebriv ufro dabali doza
fisiqoaqtiuri nivTierebebis moxmarebis Semcirebas iwvevda.
an masze kontrolis gawevas
(5) fsiqoaqtiuri nivTierebis moxmarebis gamo pirovneba
(5) pirovneba didi dros uTmobs iseT aqtivobebs, TandaTanobiT uars ambobs siamovnebis miRebis
romlebic saWiroa fsiqoaqtiuri nivTierebis alternatiul saSualebebze an interesebze da sul
mosapoveblad, gamosayeneblad an misi zemoqmedebidan ufro met dros uTmobs fsiqoaqtiuri nivTierebis
gamosasvlelad. mopovebas, gamoyenebas an misi zemoqmedebidan
(6) fsiqoaqtiuri nivTierebebis gamoyenebis Sedegad gamosvlas.
pirovneba wyvets an amcirebs mniSvnelovan socialur, (6) pirovneba daJinebiT agrZelebs fsiqoaqtiuri niv
profesiul an rekreaciul aqtivobebs. Tierebis moxmarebas miuxedavad imisa, rom misi
(7) pirovneba agrZelebs fisqoaqtiuri nivTierebebis mavne Sedegebi (fizikuri da fsiqikuri) aSkarad
moxmarebas imis miuxedavad, rom icis im mudmivi an saxezea.
perioduli xasiaTis fizikuri Tu fsiqologiuri
problemebis Sesaxeb, romlebic fsiqoaqtiuri
nivTierebebis moxmarebiT aris gamowveuli an
gamwvavebuli.
_ 456 _
alkoholis moxmarebiT gamowveuli aSlilobebi
giur fenomenebs, romlebic nivTierebis mravaljera- 2. alkoholmoxmareba _ alkoholis miReba im odeno-
di miRebiT aris gamowveuli. orive klasifikaciaSi biT, romelic pirovnebas fsiqikuri, fizikuri an
damokidebulebis diagnostireba msgavsi kriteriume- socialuri xasiaTis zians ayenebs. Tumca, es ter-
biT xdeba. es kriteriumebia: mini ar miesadageba im adamianebs, romlebsac alko-
w fsiqoaqtiuri nivTierebis miRebis Zlieri survili; holdamokidebuleba aqvT Camoyalibebuli.
w siamovnebis miRebis alternatiuli wyaroebis Tan- 3. alkoholdamokidebuleba _ es termini gamoiyeneba
daTan ugulebelyofa; maSin, rodesac pirovnebis mdgomareoba akmayofi-
lebs cxrilSi 18.4 CamoTvlili damokidebulebis
w tolerantobis ganviTareba;
sindromis kriteriumebs.
w fizikuri aRkveTis mdgomareoba (ix. cxrili 18.4).
alkoholis problemuri gamoyeneba. am termins iy-
tolerantoba aris mdgomareoba, rodesac ganmeore-
eneben im adamianebis mimarT, romlebsac alkoholiT
biTi miRebis Semdeg fsiqoaqtiuri nivTiereba iwvevs
gamowveuli aSliloba an invalidizacia aReniSnebaT.
zemoqmedebis efeqtis Sesustebas an, rodesac imave
misi mniSvneloba, ZiriTadad, alkoholmoxmarebis
efeqtis misaRwevad am nivTierebis dozis gazrdaa sa-
msgavsia, Tumca, is SeiZleba alkoholdamokidebul
Wiro.
pirebsac moicavdes.
aRkveTis mdgomareoba aris simptomebisa da niSnebis
termini àlkoholizmi~ (Tu misi gamoyeneba saer-
jgufi, romelic Tavs iCens fsiqoaqtiuri nivTierebe-
Tod mizanSewonilia) pirobiTad am oTxi mdgomareobis
bis naklebi odenobiT miRebisas an maTi miRebis Sew-
romelime kombinaciaze miuTiTebs. radgan es specifi-
yvetis dros. aseTi mdgomareoba mxolod garkveuli
kuri terminebi arc ise didi xnis win SemoiRes, mo-
periodis manZilze grZeldeba da misi xasiaTi moxma-
cemul TavSi termini àlkoholizmi~ ufro adreuli
rebuli fsiqoaqtiuri nivTierebis klaszea damokide-
literaturis ganxilvisas iqneba gamoyenebuli.
buli.
mocemul etapze mizanSewonilia ganvixiloT alko-
holmoxmarebis moraluri da samedicino modelebi.
alkoholis moxmarebiT gamowveuli
aSlilobebi moraluri da samedicino modelebi
terminologia moraluri modelis mixedviT, Tu pirovneba sakuTari
nebiT moixmars alkohols Zalian didi raodenobiT
alkoholizmi. warsulSi termini alkoholizmi, Cveu-
da amis gamo mas an misi ojaxis wevrebs ziani adge-
lebriv, samedicino literaturaSi gamoiyenebo-
baT, pirovnebis qceva amoraluria. aseTi pozici-
da. miuxedavad imisa, rom dResdReobiT es termini
idan gamomdinare, sazogadoebaSi daTroba dasjadi
yoveldRiur metyvelebaSi farTod gamoiyeneba, te-
unda iyos. bevr qveyanaSi es oficialuri praqtikaa.
qnikuri TvalsazrisiT is aradamakmayofileblad aris
sazogadoebaSi mTvral mdgomareobaSi gamoCenis gamo
miCneuli, radgan erTze meti mniSvneloba aqvs. termi-
adamianebs akaveben da, Tu maT jarimis gadaxda ar
ni àlkoholizmi~, SeiZleba gamoviyenoT rogorc aRm-
SeuZliaT, apatimreben. bevri fiqrobs, rom aseTi mid-
niSvneli alkoholis miRebis iseTi Cvevisa, romelic
goma zedmetad mkacri da aragulisxmieria. rac Se-
gadaWarbebulad iTvleba garkveuli pirobiTad aRe-
exeba dasjis efeqturobas, is, praqtikulad, arafris
buli kriteriumebis mixedviT. aseve, iseTi fsiqikuri,
momtania, radganac Zalian cota faqti adasturebs
fizikuri an socialuri xasiaTis zianis aRsaniSnad,
imas, rom dasja zemoqmedebs alkoholis momxmareb-
romelsac alkoholis amgvari gadaWarbebuli mox-
lis qcevaze.
mareba iwvevs. ufro viwro mniSvnelobiT alkohol-
samedicino modelis mixedviT, alkoholis momx-
izmi SeiZleba konkretul daavadebas gulisxmobdes,
marebeli pirovneba avadmyofia da ara uzneo. amgvari
romelic samedicino mkurnalobas moiTxovs. garda
mosazreba manamdec arsebobda, magram mas cota
amisa, sityva àlkoholiki~ xSirad uaryofiTi mniS-
momxre hyavda manam, sanam 1960 wels ar gamoqveynda
vnelobiT ixmareba, radgan iTvleba, rom amoralur
mniSvnelovani naSromi _ àlkoholizmis, rogorc daa-
qcevasTan aris dakavSirebuli. mravali mizezis gamo
vadebis, koncefcia~ (The disease concept of alcoholism,
umjobesia im oTxi terminis gamoyeneba, romlebic ze-
Jellinek, 1960), romelSic sami ZiriTadi mosazreba iyo
moT aRweril klasifikaciebs miekuTvneba. esenia:
gaerTianebuli:
1. alkoholis Warbi moxmareba _ alkoholis yovel-
1. zogierT adamians alkoholis Warbi moxmarebis
dRiuri an yovelkvireuli miReba im odenobiT, ro-
mimarT specifikuri mowyvladoba aqvs.
melic aWarbebs dadgenil normas (ix. qvemoT). alko-
holis gadaWarbebuli moxmareba aseve cnobilia, 2. alkoholis Warbad gamoyeneba garkveul etapebs
rogorc _ alkoholis gamoyeneba mavne SedegebiT. gaivlis da erT-erT etapze pirovnebas ukve aRar
SeuZlia akontrolos alkoholis moxmareba.
_ 457 _
3. alkoholis Warbad gamoyenebam SeiZleba sxvadasxva
cxrili 18.5 alkoholis moxmareba da masTan
fsiqikuri da fizikuri daavadeba gamoiwvios.
dakavSirebuli sociluri da janmrTelobis
samedicino modelis erT-erTi mTavari miRweva alko- problemebis aRmocenebis riski
holis Warbad momxmareblebis mimarT ufro humanur alkoholis miReba problemebis aRmocenebis
damokidebulebaSi mdgomareobs. dadanaSaulebisa da (erTeulebi/kvira) riski
dasjis magivrad maT mkurnalobas sTavazoben. daa- mamakaci 0 _ 21 dabali
vadebis models, agreTve, garkveuli naklovanebebic qali 0 _ 14
gaaCnia. gulisxmobs ra, rom riskis qveS mxolod garkveu- mamakaci 22 _ 50 gazrdili, gansakuTrebiT
li tipis adamianebi imyofebian, is ar iTvaliswinebs or qali 15 _ 35 mwevelebTan
mniSvnelovan faqtors: jer erTi, nebismieri adamiani, mamakaci > 50 maRali, gansakuTrebiT
romelic didi xnis manZilze alkohols gadaWarbebuli qali > 35 mwevelebTan
raodenobiT moixmars SeiZleba alkoholdamokidebuli

es sazomi zusti ar aris, radgan ludi da Rvino sx-
gaxdes. meorec, alkoholis araswori moxmarebis Sem-
vadasxva simagris SeiZleba iyos (ix. cxrili 18.6).
cirebis saukeTeso saSualebaa alkoholis moxmarebis
garda amisa, moxmareba izomeba alkoholis gramebSi
SezRudva mTel populaciaSi da ara mxolod mis mimarT
gamoxatuli raodenobiT. aseTi sazomi zusti da sa-
midrekilebis mqone mcire jgufebSi.
sargebloa mecnieruli muSaobis dros, magram bevri
albaT, ajobebs, rom moraluri modeli mTel popu-
adamianisTvis Znelia misi dakavSireba alkoholis
laciaSi alkoholis gadaWarbebuli moxmarebis mimarT
yoveldRiur moxmarebasTan.
gamoviyenoT, radgan es, savaraudod, Seamcirebs im
swored amitom jansaRi cxovrebis wesis sagan-
adamianebis ricxvs, romlebic sakuTar Tavs alkohol-
manaTleblo programis farglebSi SemoRebul iqna
iT gamowveuli invalidizaciis riskis qveS ayeneben.
alkoholis erTeulis cneba. alkoholis erTeuli
Tumca, alkoholdamokidebulebisa da alkoholis mox-
daaxloebiT 8 gram alkohols Seadgens. igi SegviZlia
marebaze kontrolis dakargvis stadiaze ufro mizan-
alkoholis yoveldRiur moxmarebas SevufardoT,
Sewonili iqneba, Tu samedicino midgomas mivmarTavT.
radgan is Seesabameba naxevar pinta luds, erT Wiqa
alkoholis Warbi gamoyeneba sufris Rvinos, erT Cveulebriv Wiqa xeress an port-
veins da erT ulufa magar spirtian sasmels barSi. is
mraval sazogadoebaSi alkoholis moxmareba ara mx-
aseve SeiZleba SevufardoT alkoholis saSualo ra-
olod daSvebulia, aramed zogjer waxalisebuli-
odenobas (ix. cxrili 18.6). amgvarad, am sazomis mixed-
caa daxvewili marketinguli teqnologiebis meSveo-
viT, erTi qila ludi (450 ml) Seicavs daaxloebiT 1.5
biT. swored amitom, alkoholis moxmarebis is done,
alkoholis erTeuls, erTi boTli sufris Rvino _
romelic alkoholis Warb moxmarebas Seesabameba,
daaxloebiT 7 erTeuls, erTi boTli magari spirtiani
garkveulwilad pirobiTi cnebaa. Cveulebriv, is gan-
sasmeli ki _ daaxloebiT 30 erTeuls.
isazRvreba moxmarebis doniT, romlis drosac maRa-
lia alkoholiT gamowveuli socialuri da janmrT- alkoholis Warbi gamoyenebisa da
elobasTan dakavSirebuli problemebis aRmocenebis alkoholmoxmarebis epidemiologiuri aspeqtebi
riski da gamoixateba erTeulebSi, romlebic indivi- epidemiologiuri meTodebi SeiZleba gamoyenebul
dis mier erTi kviris manZilze moxmarebul alkohols iqnes im kiTxvebze pasuxis gasacemad, romlebic alko-
Seesabameba (Austoker 1994) (cxrili 18.5). holis Warb gamoyenebasa da alkoholis moxmarebas
Tumca, savaraudoa, rom xangrZlivi drois manZilze exeba. es kiTxvebia:
sakmaod didi raodenobiT alkoholis miiRebisas, nebi-
w rogoria alkoholis yovelwliuri moxmareba erT
smieri adamiani SeiZleba gaxdes alkoholdamokide-
sul mosaxleze mTlianad qveyanaSi? rogor cva-
buli. aSkarad gamoxatuli individualuri gansxvave-
lebadobs es maCvenebeli mocemul qveyanaSi wlebis
bebis gamo, SeuZlebelia alkoholis usafrTxo mox-
manZilze da rogoria misi Tanafardoba sxvadasxva
marebis zusti zRurblis dadgena. miuxedavad amisa,
qveynebSi?
qalebi mamakacebze ufro sensitiurebi arian alko-
holis mavne zemoqmedebis mimarT. w rogoria alkoholis moxmarebis paterni mocemuli
imisTvis, rom termini àlkoholis Warbi moxmare- populaciis sxvadasxva jgufebSi?
ba~, gasagebi da misaRebi gaxdes, aucilebelia ganvmar- w ra raodenobis adamiania alkoholis momxmarebeli
toT is erTeulebi, romelTa meSveobiTac xdeba misi mocemul populaciaSi?
Sefaseba. yoveldRiur cxovrebaSi aseT sayovelTaod w rogor cvalebadobs alkoholis moxmareba iseTi max-
miRebul sazoms warmoadgens pinta (0, 57l) ludi an asiaTeblebis mixedviT, rogoricaa sqesi, asaki, pro-
erTi Wiqa Rvino. amgvari sazomis upiratesoba imaSi fesia, socialuri klasi da ojaxuri mdgomareoba?
mdgomareobs, rom is yvelasTvis gasagebia. Tumca,
_ 458 _
cxrili 18.6 alkoholis Semcveloba zogierTi sasmelSi

sasmelebi alkoholis alkoholis raodenoba alkoholis erTeulebis
miaxloebiTi standartul sazomSi raodenoba standartul sazomSi
Semcveloba (%) (grami) (miaxloebiTi)
ludi da sidri (vaSlis Rvino)
Cveulebrivi ludi 3% 16 gr. pintaSi* 2 erT. pintaSi

12 gr. qilaSi 1.5 erT. qilaSi
magari ludi 5.5% 32 gr. pintaSi 4 erT. pintaSi

24 gr qilaSi 3 erT. qilaSi
Zalian magari ludi 7% 40 gr. pintaSi 5 erT. pintaSi

32 gr. qilaSi 4 erT. qilaSi
sidri 4% 24 gr. pintaSi 3 erT. pintaSi
magari sidri 6 32 gr. pintaSi 4 erT pintSi
Rvino
sufris Rvino 8-10% 8 gr. WiqaSi 1 erT. WiqaSi

56 gr. boTlSi 7 erT. boTlSi
Semagrebuli Rvinoebi 13-16% 8 gr. ulufaSi 1 erT. ulufaSi

(xeresi, portveini, vermuti) 120 gr. boTlSi 15 erT. boTlSi
magari spirtiani sasmelebi 32% 8-12 gr. ulufaSi 1-1.5 erT. ulufaSi
(viski, jini, brendi, arayi) 240 gr. boTlSi 30 erT. boTlSi
*1 pinta = 473 ml
samwuxarod, am kiTxvebze Zalian cota sarwmuno Si 4 litramde Semcirda. Semdgom wlebSi moxmarebam
pasuxi gvaqvs, nawilobriv imitom, rom alkoholis nel-nela imata da 1950-iani wlebis Semdeg sul ufro
moxmarebisa da àlkoholizmis~ gansasazRvrad an ga- swrafi tempebiT iwyo zrda.
mosavlenad sxvadasxva mkvlevarebi sxvadasxva meTo- alkoholis raodenobasTan erTad, icvleboda sx-
debs iyeneben; nawilobriv ki imitom, rom alkoholis vadasxva tipis alkoholuri sasmelis moxmarebac.
Warbad momxmareblebs tendencia aqvT, Tavi aaridon 1900 wels britaneTSi yvelaze ufro gavrcelebuli
pasuxis gacemas iseT kiTxvebze, romlebic maT mier sasmeli iyo ludi da spirtiani sasmelebi. 1980 wels
moxmarebuli alkoholis raodenobasa da maTTvis Rvinis moxmareba daaxloebiT oTxjer gaizarda da
Semawuxebel simptomebs exeba. TiTqmis gautolda spirtiani sasmelebisas. Tumca,
ludi kvlavac yvelaze gavrcelebuli alkoholuri
alkoholis moxmareba sxvadasxva qveyanaSi sasmelia did britaneTSi (diagrama 18.1).
britaneTSi alkoholis yovelwliuri moxmareba erT alkoholis moxmarebasTan dakavSirebuli Cvevebi
zrdasrul adamianze (gamoangariSebulia rogorc sxvadasxva jgufebSi. alkoholis moxmarebasTan da-
wminda eTanolis gamoyeneba) 1950 wlidan 2000 wlamde kavSirebuli qcevebis Seswavla, Cveulebriv, efuZneba
gaormagda da oTxi litridan rva litramde gaizarda.
dasavleT evropaSi alkoholis moxmareba, Cveulebriv, 11 mzad aris
ufro maRalia, gansakuTrebiT ki safrangeTSi. mox- 10 sasmelis
9 misaRebad
alkoholi litrebSi
marebis maRali donea, agreTve, yofil sabWoTa kav-

8 Rvino
Siris qveyenSi, xmelTaSua zRvis aRmosavleT regionsa 7 spirtiani
da mahmadianur qveynebSi alkoholis moxmarebis done 6 sasmeli
bevrad ufro dabalia (Rehm et al., 2003). 5 sidri
4 ludi
sakmaod informaciulia britaneTSi gakeTebuli 3
bolodroindeli cvlilebebis analizi istoriul 2
konteqstSi. 1860 wlidan 1900 wlamde did britaneT- 1
0
Si moxmarebuli alkoholis wliuri raodenoba erT
1900
1904
1908
1912
1916
1920
1924
1928
1932
1936
1940
1944
1948
1952
1956
1960
1964
1968
1972
1976
1980
1984
1988
1992
1996
2000
sul mosaxleze (igulisxmeba 15 wels gadacilebuli wlebi

adamianebi) daaxloebiT 10 litr wminda alkohols
suraTi 18.1 britaneTSi yovelwliurad moxmarebuli
Seadgenda _ 1930-iani wlebis pirveli naxevrisTvis
alkoholis raodenobis saSualo maCveneblebi. 1900-2000.
alkoholis moxmareba erT sul mosaxleze weliwad- BBPA Statistical Handbook (2001).
_ 459 _
Tavad momxmareblebis mier gakeTebul gancxadebebs. gamowveuli sikvdilianoba SeiZleba alkoholis bo-
aseTi meTodis gamoyenebisas Secdomebi gardauvalia. rotad gamoyenebis sixSiris Sesafaseblad gamoviye-
am tipis gamokiTxvebi Catarda ramdenime qveyanaSi, noT. bevr ganviTarebul qveyanaSi RviZlis ciroziT
didi britaneTisa da aSS-s CaTvliT. gamowveuli sikvdilianobis procentuli maCvenebeli
gamokvlevebma aCvena, rom alkoholis moxmarebis Semcirebulia. mag., samxreT evropaSi ciroziT ga-
done yvelaze ufro maRalia ucolo, martoxela an mowveuli sikvdilianoba stabilurad iklebs, rac,
gaSorebul axalgazrda mamakacebSi. bolo 15 wlis savaraudod, fiskalur, samarTaldamcav da janmrTe-
manZilze, gaizarda alkoholis moxmareba qalebSic. lobis sferoSi gatarebuli politikis Sedegia. meo-
2001 wels mosaxleobaSi Catarebuli gamoTvlebis res mxriv, inglisSi, alkoholuri RviZlis cirozis
Sedegad dadginda, rom inglisSi mamakacebi kviraSi, SemTxvevebis raodenoba gazrdilia hospitalizire-
saSualod, 16.9 erTeul alkohols iRebdnen, xolo qa- bul pacientebs Soris. 1995-1996 wlebSi dafiqsire-
lebi _ saSulod 7.5 erTeuls. alkoholis moxmareba buli iyo 14100 SemTxveva, xolo 2000-2001 wlebSi _
mamakacebis 27%-Tan da qalebis 15%-Tan aWarbebda 24300 (Academy of Medical Sciences, 2004).
rekomendebul limits. aqedan gamomdinare, isini Seg- zogad populaciaSi Catarebuli gamokiTxvebi. mo-
viZlia alkoholiT gamowveuli aSlilobisa da alko- saxleobaSi alkoholmoxmarebis sixSiris gamovlenis
holdamokidebulebis ganviTarebis riskis qveS myof erT-erTi meTodia informaciis Segroveba alkoholis
individebad miviCnioT. mamakacebis 30% da qalebis 6% momxmarebel pirebTan uSualo kontaqtSi myofi spe-
kviraSi 35 erTeulze met al., kohols moixmarda (Offi- cialistebisgan (zogadi profilis eqimebi, social-
ce for National Statistics, 2003). uri muSakebi, probaciis samsaxuris TanamSromlebi,
pirveladi jandacvis sistemis TanamSromlebi). meore
alkoholis moxmarebis gavrceleba midgomaa _ mosaxleobis gamokiTxva, romlis drosac
alkoholmoxmarebis gavrceleba SegviZlia gamoviT- respondentebs usvamen kiTxvebs moxmarebuli alko-
valoT sami meTodiT: (1) stacionirebis sixSiriT; (2) holuri sasmelebis raodenobisa da Sesabamisi simp-
alkoholuri RviZlis ciroziT gamowveuli sikvdi- tomebis Sesaxeb. aSS-Si Catarebulma orma epidemi-
lianobis maCvenebeliTa da (3) zogadi populaciis ga- ologiurma gamokvlevam (Epidemiological Catchment Area
mokiTxvis Sedegad miRebuli monacemebiT. Programme and the National Comorbidity Survey) aCvena, rom
hospitalizaciis SemTxvevebis raodenoba ar gvaZ- erTi wlis manZilze alkoholmoxmarebisa da alko-
levs sakmarisad adekvatur warmodgenas alkohol- holdamokidebulebis gavrcelebis saerTo maCvenebe-
moxmarebis gavrcelebis Sesaxeb, radgan im adamianebis li 7-10%-s Seadgenda. Sesabamisi riskebi, romlebmac
umravlesoba, romlebic alkohols Warbad moixmaren, cxovrebis manZilze SeiZleba iCinon Tavi, 14-20% iyo.
ar xvdebian saavadmyofoSi. (Kassler at al., 1994; Regier et al., 1994).
w inglisSi, 2000-2001 wlebSi, jandacvis erovnuli 2002 wels britaneTSi Catarebuli kvlevis Sede-
samsaxuris (NHS) fsiqiatriul saavadmyofoSi sta- gad (British Psychiatric Morbidity Survey) dadginda, rom
cionirebuli adamianebis raodenoba, romelTac al- mozrdilTa 26% alkoholis borotad momxmarebelia,
koholiT gamowveuli pirveladi fsiqikuri an qce- xolo 7% ki _ alkoholdamokidebuli (Coulthard et al.,
viTi aSliloba aReniSnebodaT, daaxloebiT ocdaaT 2002). Tumca, imave populaciaze TvarmetTviani dak-
aTass Seadgenda (Office for National Statistics, 2003). virvebis Sedegad aRmoCnda, rom droTa ganmavlobaSi
w alkoholmoxmareba xSiria zogadi profilis saa- xdeba mniSvnelovani cvlilebebi: adamianebis garkveu-
vadmyofoebSi stacionirebul pacientebs Soris. li nawili alkoholis Warbi moxmarebidan usafrTxo
skrininguli gamokiTxvebis Sedegad, aseT saavad- moxmarebaze gadadis, nawili ki _ piriqiT, Warb mox-
myofoebSi hospitalizebuli mamakacebis 20-30%-sa marebaze (Farrel 2003).
da qalebis 5-10%-s alkoholmoxmarebis diagnozi Tuki mxolod ojaxebs gamovikvlevT, arsebobs
daudgindaT. didi albaToba imisa, rom ar moxdeba maRali riskis
jgufebis an alkoholdamokidebuli pirebis gamokvl-
w saswrafo da gadaudebel samedicino daxmarebis
eva. wina fsiqikuri avadobis britanul gamokvlevaSi
centrebSi moxvedris xSiri mizezi (SemTxvevaTa
(British Psychiatric Morbidity Survey) ar iyvnen gaTval-
erTi mesamedi) alkoholmoxmarebaa (Academy of Medi-
iswinebulni usaxlkaro da Tavisuflebis aRkveTis
cal Sciences, 2004).
adgilebSi myofi adamianebi. aRmoCnda, rom 40% im ada-
alkoholuri ciroziT gamowveuli sikvdili. War- mianebisa, romlebic Ramis TavSesafarSi cxovrobdnen
bi raodenobiT alkoholis momxmarebelTa 10-20%- an quCaSi eZinaT, kviraSi 50 erTeulze met alkohols
s RviZlis cirozi uviTardeba. arsebobs korelacia moixmarda; xolo, im adamianebis daaxloebiT 35%-s,
populaciaSi RviZlis cirozis sixSiresa da alkoho- romlebsac quCaSi eZinaT, mZime alkoholdamokide-
lis saSualo moxmarebas Soris, ris gamoc ciroziT buleba axasiaTebda (Dill et al., 1996). alkoholmox-
_ 460 _
marebis maRali maCvenebeli dafiqsirda patimrebSi, genlebSi, romelic krZalavs alkoholis gamoyene-
gansakuTrebiT TeTrkanian mamakacebs Soris (Singleton bas, naklebadaa gavrcelebuli alkoholmoxmareba.
et al., 1997). aseve, unda aRiniSnos, rom britaneTsa da aSS-is ara-
sxvadasxva kulturis mqone aT regionSi Catareb- TeTrkanian mosaxleobaSi ufro iSviaTad vxvdebiT
ulma kros-nacionalurma gamokvlevebma aCvena, rom alkoholis Warbad moxmarebas, vidre TeTrkanian
cxovrebis manZilze alkoholmoxmarebisa da alko- mosaxleobaSi. aqedan gamomdinare, aq ufro dabalia
holdamokidebulebis gavrcelebis sixSire gansxvaveb- alkoholiT gamowveuli aSlilobebis sixSire (Kessler
ulia sxvadasxva kulturaSi (mag., SanxaiSi 0.5%, xolo et al., 1994; Coulthard et al., 2002).
koreaSi _ 22%. Helzer and Canino, 1992). alkoholmox- zogjer garkveul eTnikur jgufebSi alkoholis
marebisa da alkoholdamokidebulebis gavrcelebis mcire raodenobiT moxmareba SeiZleba dakavSirebuli
mxriv, qveynebs Soris udavod didi gansxvaveba Sein- iyos alkoholis mimarT biologiurad ganpirobebul
iSneba. Tumca, zogierT mkveTrad gamoxatul gansx- dabal tolerantobasTan. mag., azielebs, romlebsac
vavebas SeiZleba isic ganapirobebdes, rom alkohol- aqvT aldehid dehidrogenazas specifikuri izofer-
moxmarebis Sesaxeb sxvadasxva kulturaSi gansxvave- menti, alkoholis miRebis dros aReniSnebaT Sewi-
buli Sexedulebebi arsebobs. mniSvnelovania isic, Tu Tleba, pirRebineba da taqikardia, rasac organizmSi
ramdenad gulaxdilad saubroben adamianebi sakuTari acetaldehidis dagroveba iwvevs. aseT SemTxvevaSi
Cvevebis Sesaxeb, romlebic alkoholis moxmarebasTa- naklebia alkoholis Warbad gamoyenebisa da alko-
naa dakavSirebuli. holiT gamowveuli problemebis ganviTarebis riski.
miuxedavad imisa, rom aldehid dehidrogenazas vari-
alkoholmoxmareba da populaciis maxasiaTeblebi anti, romelic iwvevs gawiTlebis reaqcias, iaponiis
sqesi. alkoholmoxmarebisa da alkoholdamokide- generaluri populaciis 35%-s daudginda, is alko-
bulebis procentuli maCvenebeli, zogadad, ufro holiT gamowveuli RviZlis daavadebis mqone iapone-
maRalia mamakacebSi, vidre qalebSi, magram sxvadasxxva li pacientebis mxolod 7%-s daufiqsirda (Shibuya and
kulturaSi alkoholmoxmarebis Sedegad dazaralebu- Yoshida, 1988).
li mamakacebisa da qalebis Sefardeba gansxvavebulia. profesia. alkoholis borotad gamoyenebis riski
dasavleTis qveynebSi alkoholmoxmareba da alkohol- mniSvnelovnad gazrdilia garkveuli tipis profesiis
damokidebuleba, qalebTan SedarebiT, mamakacebSi sam- adamianebTan: mzareulebTan, barmenebTan, samzareulo-
jer metia, xolo aziur da espanurenovan qveynebSi _ Si an ludsaxarS qarxnebSi momuSave personalTan da im
aTjer meti (Helzer and Canino, 1992). aSS-Si Catarebuli pirebTan, visTvisac alkoholuri sasmelebi advilad
komorbidobis erovnuli gamokvlevis Sedegad dadg- xelmisawvdomia; aseve, administratorebTan da vaWro-
inda, rom erTi wlis manZilze alkoholmoxmarebisa bis sferoSi momuSave adamianebTan, romlebic miRebeb-
da alkoholdamokidebulebis gavrcelebis sixSire, sa da prezentaciebs dawesebulebis biujetis xarjze
qalebTan SedarebiT (5.3%), TiTqmis samjer ufro atareben; msaxiobebsa da artistebTan, mezRvaurebTan,
maRalia mamakacebSi (14.1%) (Kessler et al., 1994). bri- Jurnalistebsa da gamomcemlebTan. eqimebi warmoad-
taneTSi Catarebulma fsiqiatriuli avadobis gamokv- genen kidev erT mniSvnelovan jgufs, sadac alkoholis
levam aseve aCvena, rom alkoholdamokidebulebis problemuri gamoyenebis riski maRalia. maTTvis dax-
gavrcelebis sixSire samjer ufro maRalia mamakaceb- marebis gaweva xSrad gansakuTrebul siZneleebTan aris
Si, vidre qalebSi (Coulthard et al., 2002). Tumca, sazoga- dakavSirebuli (Murray 1976; Rawnsley 1984).
doebis damokidebulebaSi momxdari cvlilebebis
gamo, mraval evropul qveyanaSi sxvaoba mamakacebsa alkoholdamokidebulebis sindromebi da
da qalebs Soris alkoholis moxmarebis raodenobis alkoholuri aRkveTis mdgomareoba
TvalsazrisiT TandaTan mcirdeba. es SemaSfoTebeli
rodesac pacients aReniSneba fsiqoaqtiur nivTie-
faqtia, radgan gamokvlevebis Sedegad cnobilia, rom
rebebze damokidebulebis simptomebi (cxril 18.4),
qalebi ufro mgrZnobiareni arian alkoholis mavne
iTvleba, rom is alkoholzea damokidebuli. alko-
zegavlenis mimarT, vidre mamakacebi (ix. qvemoT).
holdamokidebulebis diagnozis dasasmelad ar aris
asaki. rogorc ukve aRvniSneT, alkohols yvelaze
aucilebeli aRkveTis simptomebis arseboba. im adami-
ufro didi raodenobiT 17-dan 25 wlamde mamakacebi
anebis mniSvnelovan umciresobas, romelic damokide-
moixmaren. kulturebis umetesobaSi alkoholmox-
bulebis kriteriumebs akmayofilebs, alkoholis mox-
marebisa da alkoholdamokidebulebis gavrcelebis
marebis Semcirebis an Sewyvetis Semdeg ar aReniSneba
sixSire ufro dabalia 45 wels gadacilebul pirebs
aRkveTis simptomebi. Tumca, alkoholdamokidebuli
Soris (Helzer and Canino, 1992; Coulthard et al., 2002).
pirebis daaxloebiT 5%-s aReniSneba mwvave aRkveTis
eTnikuri warmoSoba da kultura. im religiis (mag.,
simptomatika TeTri cxelebisa da didi epilefsiuri
islami, induizmi, baptisturi eklesia) warmomad-
gulyris CaTvliT.
_ 461 _
alkoholmoxmarebisa da cxrili 18.7 mwvave alkoholuri aRkveTis simp-

alkoholdamokidebulebis mimdinareoba tomebi da niSnebi
erT-erT gamokvlevaSi (Schuckit et al., 1993) Seiswavles SfoTva, aJitacia, uZiloba
alkoholdamokidebulebis mimdinareoba 600-ze met ma- taqikardia da oflianoba
makacTan, romlebmac 1985-1991 wlebSi stacionaruli kidurebis, enis da quTuToebis tremori
mkurnaloba aSS-is erT samedicino dawesebulebaSi gai- gulisrevis SegrZneba da pirRebineba
ares. maT oci wlis asakSi gamouvlindaT mZime loTo- gulyrebi
bis eskalaciis zogadi paterni, rasac 30-35 wlis asakSi
cnobierebis Scvla da halucinaciebi
daemata seriozuli sirTuleebi rogorc profesiul,
(Ritson 2005)
ise socialur cxovrebaSi. 35-40 wlis asakSi isini ve-
Rar akontrolebdnen alkoholis miRebis process da rogorc alkoholdamokidebuleba. Tu aRkveTis simp-
samsaxursa Tu socialur aqtivobasTan dakavSirebuli tomebis Tavidan acilebis moTxovnileba dRis ganmav-
problemebis matebasTan erTad fizikuri janmrTelo- lobaSi TandaTan Zlierdeba, pirovneba, Cveulebriv,
bis mniSvnelovani gauaresebac aReniSnebodaT. cdilobs damalos miRebuli alkoholis raodenoba,
2003 wels vailantma (Vaillant, 2003) gamoaqveyna Ta- gadamalos an jibiT ataros sasmeli. zogierTi maTga-
visi dakvirvebis Sedegebi, romlebic miiRo cxovre- ni regularulad svams gadaumuSavebel sidrs (vaSlis
bis garkveul etapze alkoholis Warbad momxmarebeli Rvino) an iaffasian magar luds, raTa naklebi dana-
194 mamakacis 60-wliani periodis Seswavlis safuZvel- xarjiT didi raodenobiT alkoholi moipovos.
ze. 70 wlis asakisTvis am adamianebis naxevarze meti alkoholuri aRkveTis pirveli da yvelaze ufro
gardaicvala, 20% Tavs ikavebda alkoholis miRebis- tipiuri niSania xelebis, fexebisa da sxeulis Zlieri
gan, 10% akontrolebda alkoholis miRebis process, tremori (`kankali~). am dros adamians ar SeuZlia
xolo danarCeni 10% agrZelebda alkoholis moxma- wynarad jdoma, Wiqis xelSi myarad daWera an Rilebis
rebas. am pirebis garkveuli nawili, warsulSi, aTw- Sekvra. is aJitirebulia da SeiZleba iolad Secbes.
leulebis manZilze alkoholis Warbad momxmarebeli mag., xSirad ganicdis Zlier SiSs sxva adamianebTan
iyo ise, rom ar hqoniaT remisia, letaluri gamosava- Sexvedrisas an quCaze gadasvlis dros. xSiria gu-
li da alkoholdamokidebulebis Camoyalibeba. kvle- lisrevis SegrZneba, pirRebineba da oflianoba. aseve,
vaSi monawile alkoholdamokidebuli pirebi ki, kont- Cveulebriv movlenas warmoadgens uZiloba. alkoho-
rolirebadi moxmarebis periodebis Semdeg yovelTvis lis miRebisas es simptomebi swrafad qreba, Tumca,
ubrundebodnen alkoholdamokidebulebis paternebs. zog SemTxvevaSi, SeiZleba ramodenime dRe gagrZel-
dadebiTi Sedegebis saukeTeso prediqtors warmoad- des (cxrili 18.7).
genda alkoholizmis problemebis mqone pirebis ano- aRkveTis mdgomareobis gagrZelebis SemTxvevaSi
nimur Sexvedrebze daswreba. am gamokvlevam aCvena, SeiZleba Tavi iCinos (Cveulebriv, mxolod mcire
rom alkoholmoxmarebis prognozi gansxvavebulia. droiT) aRqmiTi xasiaTis darRvevebma da halucina-
Tumca, Tu adamians erTxel mainc Camouyalibdeba al- ciebma. aseT dros pirovneba sagnebs deformirebulad
koholdamokidebuleba, prognozi sakmaod uaryofi- aRiqvams an eCveneba, rom Crdilebi moZraoben; esmis
Tia, garda im SemTxvevebisa, rodesac xdeba abstinen- areuli xmebi, yvirili an musikis nawyvetebi. mogvi-
ciuri mdgomareobis SenarCuneba. anebiT SesaZlebelia daewyos epilefsiuri gulyrebi
da bolos, 48 saaTis Semdeg, SeiZleba TeTri cxeleba
alkoholuri aRkveTis sindromi ganuviTardes (Victor and Adams 1953) (ix. qvemoT).
aRkveTis simptomebi SeiZleba sxvadasxva simZimis
iyos: dawyebuli msubuqi fromis SfoTviT da Zilis alkoholis moxmarebasTan dakavSrebuli
aSlilobiT, damTavrebuli sicocxlisTvis saSiSi md- sxva saxis aSlilobebi
gomareobiT, romelic TeTri cxelebis saxeliT aris am qveTavSi aRwerilia alkoholis borotad gamoy-
cnobili. aRkveTis simptomebi, Cveulebriv, iseT ada- enebis mavne Sedegebi: fizikuri, fsiqologiuri da
mianebs aReniSnebaT, romlebic wlebis ganmavlobaSi, socialuri. pirovnebas, romelsac aseTi darRvevebi
yovelkvireulad didi raodenobiT alkohols moixma- aReniSneba, araa aucilebeli alkoholdamokidebuli
ren. amgvari simptomebi Tavs iCens sisxlSi alkoholis iyos.
koncentraciis daqveiTebisas. aRsaniSnavia, rom isini
vlindeba gaRviZebisas, rodesac alkoholis koncet- fizikuri darRvevebi
racia dabalia. alkoholdamokidebuli adamianebi, alkoholis Warbad moxmarebam, SeiZleba, sxvadasxva
aRkveTis simptomebis Tavidan acilebis mizniT, alko- saxis fizikuri darRveva gamoiwvios: (1) alkohols
hols xSirad gamoRviZebisTanave Rebuloben. mraval garkveuli tipis qsovilebze, gansakuTrebiT, RviZlsa
qveyanaSi alkoholis dilidan miReba diagnostirdeba, da Tavis tvinze, uSualo toqsikuri moqmedeba axasi-
_ 462 _
aTebs; (2) alkoholis Warbad gamoyenebas xSirad Tan alkoholis Warb moxmarebasTan dakavSirebuli sxva
sdevs cudi kveba, rac iwvevs cilebisa da B jgufis saxis fizikuri darRvevebi imdenad mravalricxova-
vitaminebis naklebobas; (3) izrdeba ubeduri SemTx- nia, rom maTze aq detalurad ar SevCerdebiT. esenia:
vevebis, gansakuTrebiT, qala-tvinis travmis miRebis anemia, miopaTia, epizoduri hipoglikemia, hemoqroma-
riski; (4) alkoholis Warbad moxmarebas Tan sdevs tozi, kardiomiopaTia, vitaminebis nakleboba da tu-
daudevroba da, aqedan gamomdinare, gazrdilia mow- berkulozi. am tipis darRvevebi aRwerilia samedici-
yvladoba infeqciebis mimarT. no saxelmZRvaneloebSi, mag., oqsfordis samedicino
saxelmZRvaneloSi (Oxford Textbook of Medicine) (Warrell
gastrointestinuri darRvevebi et al., 2003).
alkoholis Warbad moxmarebis dros xSiria kuW-naw-
lavTan dakavSirebuli darRvevebi, gansakuTrebiT alkoholmoxmareba qalebTan
RviZlis dazianeba, gastriti, peptikuri wyluli, gamokvlevebma aCvena, rom mamakacebTan SedarebiT, qa-
saylapavis varikozi da mwvave an qronikuli pankre- lebSi ufro swrafad viTardeba alkoholis problem-
atiti. gansakuTrebiT mniSvnelovania RviZlis da- uri gamoyeneba. maTTan ufro xanmokle periodSi da
zianeba, rogoricaa cximovani infiltracia, hepatiti, ufro naklebi raodenobis alkoholis zemoqmedebis
cirozi da hepatoma. alkoholdamokidebulebis mqone Sedegad iCens Tavs alkoholiT gamowveuli janmrT-
adamianebTan RviZlis ciroziT gamowveuli sikvdilis elobis problemebi. garda zemoT Tqmulisa, msmel
riski saSualoze aTjer ufro maRalia. meores mxriv, qalebs ufro xSirad aReniSnebaT sarZeve jirkvlis
alkoholdamokidebulebis mqone adamianebis mxolod avTvisebiani simsivneebi da reproduqciuli tipis pa-
10-20%-s uviTardeba cirozi. Tologiebi (amenorea, anovulacia da adreuli meno-
pauza).
nervuli sistema
alkoholi aseve azianebs nervul sistemas. neirof- nayofis paTologiebi
siqikuri xasiaTis garTulebebi mogvianebiT iqneba damtkicebulia, rom nayofis alkoholuri sindromi
aRwerili. alkoholiT gamowveuli nevrologiuri Tavs iCens im bavSvebSi, romelTa dedebic alkohols
daavadebebia periferiuli neiropaTia, epilefsia da Warbad moixmaren. es sindromi pirvelad aRweres saf-
cerebruli degeneracia. ukanasknels dgomisa da sia- rangeTSi 1968 wels (Lemoine et al., 1968). misTvis dam-
rulis darRvevebi axasiaTebs. am dros xelebis moZ- axasiaTebelia: qala-saxis dismorfia, susti aRnagoba,
raoba da metyveleba naklebad aris darRveuli. iS- dabadebisas wonaSi CamorCena, inteleqtis daqveiTeba
viaT garTulebebs ganekuTvneba mxedvelobiTi nervis da zeaqtiuroba. nayofis alkoholuri sindromis
atrofia, varolis xidis centraluri mielinolizi mqone bavSvebze aTwliani dakvirvebis Sedegad mkv-
da markiafava_ biniamis sindromi, romelic korZiani levarebma (Spohr et al., 1993) daadgines, rom kranio-
sxeulis, optikuri traqtisa da naTxemis fexebis facialuri darRvevebi droTa ganmavlobaSi iklebs,
demielinizaciis Sedegs warmoadgens. am sindromis Tumca, bevr bavSvs daswavlis persistentuli dar-
ZiriTadi maxasiaTeblebia: dizarTria, ataqsia, epi- Rveva aReniSneba.
lefsia da cnobierebis aSkarad gamoxatuli dar- nayofis alkoholuri sindromi dakavSirebulia
Rveva. ufro prolongirebuli formebis dros aRin- orsulobis periodSi alkoholis Warb moxmarebas-
iSneba demencia da kidurebis dambla. alkoholuri Tan. Tumca, ufro gviandeli gamokvlevebis Tanaxmad
damokidebulebis mqone adamianebs, agreTve, xSirad orsulobis periodSi alkoholis zomieri an mcire
aqvT qala-tvinis travma. raodenobiT moxmarebamac ki SeiZleba bavSvis ganvi-
Tarebaze mavne zegavlena moaxdinos. mag., axalSobil
kardiovaskuluri sistema bavSvebs qceviTi darRvevebi maSinac aReniSnebodaT,
alkoholmoxmareba arteriuli hipertenziisa da in- rodesac deda mxolod kviraSi erTxel moixmarda
sultis gazrdil riskTan aris dakavSirebuli. sain- alkohols (Mukherjee et al., 2005). radgan dResdReobiT
tereso faqtia is, rom adamianebi, romlebic alko- ar aris cnobili orsulobis periodSi alkoholis
hols zomierad moixmaren (kviraSi daaxloebiT 10 moxmarebis ùsafrTxo raodenoba~, mizanSewonilia,
erTeuls) ufro iSviaTad kvdebian koronaruli ar- rom fexmZime qalebma saerTod Seikavon Tavi alko-
teriebis daavadebiT, vidre isini, romlebic saerTod holis miRebisgan.
ar Rebuloben alkohols (Goldberg et al., 1999). alko-
holmoxmareba, agreTve, dakavSirebulia garkveuli sikvdilianoba
tipis avTvisebiani simsivnis ganviTarebasTan (gansa- im pirebTan, romlebic alkohols mcire raodeno-
kuTrebiT, piris Rrus, xaxis, kuW-nawlavis, RviZlisa biT moixmaren (dReSi daaxloebiT erT erTeuls)
da sarZeve jirkvlis). sikvdilianobis procentuli maCvenebeli ufro da-
_ 463 _
balia, vidre maTTan, vinc saerTod ar moixmars cvlilebebs, rac, Tavis mxriv, iwvevs alkoholisT-
alkohols (Doll et al., 2005). sikvdilianobis dabal vis damaxasiaTebel farmakologiur moqmedebas. mag.,
procents, ZiriTadad, ganapirobebs gulsisxlZarRv- alkoholis zemoqmedebis sasiamovno efeqts ganapiro-
Ta daavadebiT gamowveuli sikvdilianobis dabali bebs mezolimbur sistemaSi dofaminisa da opioidebis
maCvenebli (ix. zemoT). miuxedavad amisa, ar aris ga- gamoyofa, xolo SfoTvis Semcirebis efeqts _ Tavis
sakviri, rom sikvdilianobis sixSire gazrdilia im tvinSi gama-aminoerbomJavas (GABA) Semakavebeli moq-
SemTxvevaSi, rodesac pacientebi alkoholmomxmare- medebis gaZliereba (Lingford _ Huges et al., 2003).
blebi arian. Catarebulma gamokvlevebma, romlebic, termini _ idiosinkraziuli alkoholuri intoqsi-
ZiriTadad, alkoholis Warbad momxmarebel saSualo kacia, qcevaSi aSkara araadaptaciuri cvililebebis
asakis mamakacebs Seiswavlidnen, aCvena, rom maTTan aRsaniSnad gamoiyeneba. aseTi qcevaa, mag., agresia,
sikvdilianobis saerTo maCvenebeli, sul cota, or- romelic ramodenime wuTis Semdeg mosdevs alko-
jer mainc aris gazrdili. alkoholis Warbad momx- holis iseTi doziT miRebas, romelic adamianebis
marebel qalebTan sikvdilianoba mniSvnelovnad ufro umravlesobisTvis ar aris sakmarisi intoqsikaciis
maRalia (Harris and Barraclough, 1998). gamosawvevad (Tanac, amgvari qceva, Cveulebriv, ar
im faqtis gaTvaliswinebiTac ki, rom alkoholis aris damaxasiaTebeli mocemuli pirovnebisTvis). wi-
Warbad momxmareblebi, xSirad Tambaqos aqtiuri mw- naT, qcevaSi aseT uecar cvlilebebs paTologiur
evlebic arian, mzardi sikvdilianobis mizezi TiTqmis simTvrales an manie poti-s uwodebdnen da am mdgo-
yovelTvis mainc alkoholia. dadgenilia, rom bri- mareobis aRwerisas xazs usvamdnen agresiuli qcevis
taneTSi weliwadSi 33 000 adamianis naadrevi sikvdi- feTqebad xasiaTs. Tumca, saeWvoa, Tu ramdenad Seu-
lis mizezi alkoholis Warbi moxmarebaa (umTavresad, Zlia alkoholis mcire dozas aseTi qcevis gamowveva.
gulsisxlZarRvTa daavadebebis, cirozis, ubeduri termini _ idiosinkraziuli alkoholuri intoqsika-
SemTxvevebisa da avTvisebiani simsivnis Sedegad) (Ash- cia, ar figurirebs DSM-IV-sa da ICD-10-Si.
worth and Gerada, 1997). mexsierebis amovardnas anu xanmokle amnezias xSir-
ad vxvdebiT mZime simTvralisas. upirveles yovlisa,
fsiqikuri aSlilobebi
pirovnebas ar axsovs wina RamiT momxdari movlenebi,
alkoholis moxmarebasTan dakavSirebuli fsiqikuri maSinac ki, rodesac mas cnobiereba ar daukargavs.
aSlilobebi oTx jgufad iyofa: mexsierebis amovardna Zlieri daTrobis erTi epozo-
1. intoqsikaciis fenomenebi dis Semdeg SeiZleba daemarToT im adamianebsac ki,
2. aRkveTis fenomenebi romelTac ar axasiaTebT alkoholdamokidebule-
ba. Tu aseTi ram regularulad meordeba, es imaze
3. toqsikuri an kvebiTi aSlilobebi
miuTiTebs, rom adamiani alkohols, Cveulebriv,
4. Tanmdevi fsiqikuri aSlilobebi Warbad moixmars. im SemTxvevaSi, Tu pirovneba alko-
intoqsikaciis fenomenebi hols Warbi doziT regularulad moixmars, mex-
sierebis amovardnam SeiZleba mZime forma miiRos da
alkoholuri intoqsikaciis simptomebis simZime da
dRis garkveuli monakveTi an mTeli dRe moicvas.
axloebiT Seesabameba sisxlSi alkoholis koncentra
cias. rogorc zemoT aRvniSneT, alkoholis fsiqolo- aRkveTis fenomenebi
giuri zemoqmedebis TvalsazrisiT bevri individu- aRkveTis zogadi sindromi ukve iyo aRwerili am wig-
aluri gansxvaveba arsebobs, magram zogierTi reaq- nis qveTavSi alkoholdamokidebulebis Sesaxeb. aq
cia, rogoricaa, mag., guneb-ganwyobis labiloba da SevexebiT TeTri cxelebis ufro seriozul fsiqi-
agresiuloba, ufro xSirad iwvevs socialuri xasi- atriul sindroms. bodviTi mdgomareobebi zogadad
aTis garTulebebs. alkoholis didi dozis miRebiT meToTxmete TavSia aRwerili, magram TeTr cxelebas,
gamowveulma intoqsikaciam SeiZleba iseT seriozul misi gavrcelebisa da sikvdilianobis sixSiris gamo,
uaryofiT Sedegebamde migviyvanos, rogorebicaa calke ganvixilavT. garda amisa, is gansxvavebul
dacema, sunTqvis daTrgunva, pirnaRebi masis sasunTq mkurnalobas saWiroebs.
gzebSi gadacdena da hipoTermia. TeTri cxeleba aReniSnebaT adamianebs, romle-
molekuluri meqanizmebi, romlebic safuZvlad bic ramdenime welis manZilze an ufro met xansac,
udevs mwvave alkoholur reaqciebs, ar aris naTlad alkoholmomxmareblebi arian. aRkveTis Semdeg Zalian
dadgenili. erT-erTi gavrcelebuli azris Tanaxmad, swrafad da mniSvnelovnad icvleba adamianis fsiqi-
alkoholi urTierTqmedebs neironebis membranasTan kuri aqtivoba, rasac Tan axlavs cnobierebis dar-
da zrdis maT Txevadobas. amgvari moqmedeba zogierT Rveva, dezorientacia drosa da sivrceSi da, agreTve,
anesTeziur saSualebasac axasiaTebs. es biZgs aZlevs axlo warsulis mogonebebze mexsierebis daqveiTeba.
neirotransmiterebis gamoyofis ufro specifikur aRqmis darRvevebi moicavs sensoruli stimulebis
_ 464 _
araswor interpretacias da aSkarad gamoxatul an, romlebsac aSkara nevrologiuri darRvevebi ar
halucinaciebs. halucinaciebi, Cveulebriv, mxedv- aReniSebaT. Tumca, rogorc ukve aRvniSneT, fsiqolo-
elobiTi xasiaTisaa, Tumca, xandaxan SeiZleba sxva giuri testireba, Cveulebriv, kognituri funqciebis
modalobisac iyos. am dros SeiniSneba Zlieri aJi- deficits adasturebs. Tavis tvinis struqturuli
tacia, romelsac Tan axlavs mousvenroba, yvirili cvlilebebi da kognituri funqciebis daqveiTe-
da aSkarad gamoxatuli SiSi. agreTve, damaxasiaTe- ba, rasac alkoholis Warbi moxmarebisas vxvdebiT,
belia xangrZlivi uZiloba, xelebis Zlieri tremori garkveulwilad sustdeba alkoholis moxmarebis Sew-
(pirovnebas TiTqos warmosaxuli sagnisTvis xelis yvetasTan erTad; Tumca, bevri anomalia xangrZlivi
Cavleba surs) da zogjer statikuri ataqsia. veg- abstinenciis Semdegac SeiniSneba (alkoholis zegav-
etatur darRvevebs ganekuTvneba oflianoba, cieb- lenis gamokvleva Tavis tvinis funqciuri neirovi-
cxeleba, taqikardia, maRali arteriuli wneva da zualuri meTodebiT ganxilulia Semdeg wyaroSi: Ling-
Tvalis gugebis gafarToeba. aseve, damaxasiaTebelia ford-Hughes et al., 2003).
dehidratacia da eleqtrolituri balansis darRveva.
sisxlis analizi aCvenebs leikocitozs da RviZlis Tanmdevi fsiqikuri aSlilobebi
funqciis darRvevas. pirovnuli cvlilebebi. radgan pacienti sul ufro da
amgvari mdgomareoba sami-oTxi dRe grZeldeba ufro wuxs imaze, Tu rogor moipovos alkoholi, misi
(Cveulebriv, simptomatika RamiT ufro mwvavea) da interpersonaluri unar-Cvevebi da pasuxismgeblobis
xSirad xangrZlivi Rrma ZiliT mTavrdeba. gamoRvi- grZnoba daqveiTebulia, xolo interesebis sfero _
Zebisas pacients aRar aReniSneba simptomebi da cota SezRuduli. amgvari cvlilebebi interpersonalur
ram (an saerTod araferi) axsovs deliriumis peri- da socialur funqcionirebaSi ar unda agverios per-
odis Sesaxeb. TeTri cxeleba sikvdilianobis maRal sonologiur aSlilobaSi, romlis diagnostirebac
risks Seicavs da gadaudebel samedicino daxmarebas mxolod maSin xdeba, rodesac misi Sesabamisi niSnebi
saWiroebs. mkveTrad aris gamoxatuli alkoholdamokidebulebis
Camoyalibebamde.
toqsikuri an kvebasTan dakavSirebuli mdgomare guneb-ganwyobis aSliloba. alkoholis moxmarebasa
obebi da guneb-ganwobas Soris rTuli urTierTkavSiri ar-
aseT mdgomareobebs ganekuTvneba korsakovis fsiqozi, sebobs. erTis mxriv zogierTi depresiuli pacienti
vernikes encefalopaTia (ix. me-14 Tavi) da alkohol- Warbi raodenobiT iRebs alkohols, raTa guneb-gan-
uri demencia. wyoba gaiumjobesos; meors mxriv, alkoholis Warb-
ma moxmarebam SeiZleba persistentuli depresia da
alkoholuri demencia. warsulSi arsebobda gansxvave- SfoTva gamoiwvios. stacionarul pacientebs, alko-
buli mosazrebebi imis Taobaze, Tu ramdenad SeuZlia holmoxmarebasa da alkoholdamokidebulebasTan er
alkoholmoxmarebas demenciis gamowveva. aseTi eWvi Tad, xSirad aReniSnebaT komorbiduli rekurentu
aRmocenda imitom, rom zogadi inteleqtis defeqtis li guneb-ganwyobis aSliloba. TemSi Catarebuli
mqone pacientebs SecdomiT korsakovis fsiqozis di- gamokvlevebi gviCvenebs, rom depresia ufro xSirad
agnozs usvamdnen xolme. Tumca, dResdReobiT sayov- dakavSirebulia interpersonalur da socialur
elTaodaa aRiarebuli, rom qronikul alkoholmox- problemebTan, romlebic alkoholgamoyenebiT aris
marebas SeuZlia kognituri darRvevebis gamowveva, gamowveuli. urTierTkavSiri depresiasa da alkohol-
rac gansakuTrebiT vlindeba mexsierebisa da kogni- moxmarebas Soris ufro metad gamoxatuli aqvT qa-
turi funqciebis testirebisas (Zinn et al., 2004). lebs. Semdgomi dakvirvebebis Sedegad dadginda, rom
yuradReba aseve gamaxvilebuli iyo imazec, Tu ram- alkoholis Warbi raodenobiT moxmarebis riski gaor-
denad SeeZlo qronikul alkoholmoxmarebas Tavis magebulia depresiuli aSlilobis anamnezis mqone qa-
tvinis atrofiis gamowveva. magnitur-rezonansulma lebSi (Dixit and Crum, 2000).
tomografiam da CT skanirebam aCvena, rom alkoholis suiciduri qceva. alkoholmoxmarebiT gamowveuli
Warbi moxmareba dakavSirebulia Tavis tvinis later- aSlilobis mqone pirebSi TviTmkvlelobis sixSire
aluri parkuWebis gafarToebasTan. garda amisa, magni- bevrad maRalia, amave asakis adamianebTan SedarebiT,
tur-rezonansulma tomografiam aCvena adgilobrivi romlebic alkohols borotad ar moixmaren. fosterma
deficiti ruxi nivTierebis ganleviT, rogorc kor- ganixila, Tu ra mniSvneloba aqvs alkoholmoxmarebis
tikul, ise subkortikul zonebSi. subkortikuli cv- Seswavlas suicidis globaluri prevenciisTvis (Foster
lilebebi umetesad aReniSnebaT korsakovis sindro- 2001). suicidis maRal procentul maCvenebels bevri
mis mqone pacientebs. alkoholdamokidebulebis dros mizezi aqvs. mag., kvlevam, romliTac ormocdaaTi sui-
aseve fiqsirdeba korZiani sxeulis gaTxeleba. cidis mcdelobis mqone alkoholis Warbi momxmare-
zemoT aRniSnuli cvlilebebi gvxvdeba pacientebT- beli Seiswavles (Murphy et al., 1992), suiciduri qcevis
_ 465 _
mravali risk-faqtori gamoavlina. maT Soris, sasme- `nacemi colebis~ qmrebi, xSir SemTxvevaSi, alkohol-
lis sistematurad miReba, komorbiduli didi depre- is Warbi raodenobiT momxmareblebi arian. zogierTi
sia, seriozuli somaturi daavadebebi, umuSevroba qali, romelic saavadmyofoSi Tavis mowamvlis gamo
da arasakmarisi socialuri mxardaWera. aseve, unda xvdeba, mizezad qmris loTobas asaxelebs. ojaxuri
aRiniSnos, rom axalgazrda mamakacebis SemTxvevaSi atmosfero, Cxubisa da Zaladobis gamo, bavSvebisT-
suicidi dakavSirebulia fsiqoaqtiuri nivTierebebis visac sazianoa, xolo mTvrali mSobeli SvilebisT-
(maT Soris, alkoholis) arasworad moxmarebasTan. vis cud rolur models warmoadgens. im adamianebis
fsiqoseqsualuri funqciis moSla. Cveulebriv mov- Svilebi, romlebic didi raodenobiT alkohols moix-
lenas warmoadgens ereqciuli disfunqcia da dagvi- maren, emociuri da qceviTi aSlilobebis ganviTa-
anebuli eakulacia. es disfunqciebi SeiZleba gau- rebis maRali riskis qveS imyofebian da skolaSic cu-
aresdes, rodesac loTobis Sedegad col-qmars Soris dad swavloben.
gaucxoveba xdeba an rodesac cols loT partniorTan
Tanacxovrebis mimarT zizRi uCndeba. samuSaosTan dakavSirebuli problemebi da sag
paTologiuri eWvianoba. adamianebs, romlebic al zao SemTxvevebi
kohols Warbi raodenobiT moixmaren, SeiZleba ganu- adamians, romelic alkohols didi raodenobiT moix-
viTardeT zeRirebulovani idea an bodva, rom part- mars, samsaxurSi xSirad eqmneba problemebi, romlebic
niori maT Ralatobs. paTologiuri eWvianobis Sesaxeb TandaTanobiT mZimdeba. mas jer Sromis nayofiereba
zemoT ukve iyo saubari (gv. ??). uqveiTdeba, rasac Semdgom Tanamdebobrivi daqveiTe-
alkoholuri halucinozi. damaxasiaTebelia smen- ba, samsaxuridan araerTgzis daTxovna da, bolos, xan-
iTi halucinaciebi (pacients, Cveulebriv, esmis xmebi, grZlivi umuSevroba mosdevs. aseve, mWidro kavSiria
romlebic mas Seuracxyofas ayeneben an emuqrebian). sagzao SemTxvevebsa da alkoholmoxmarebas Soris.
alkoholuri halucinozi naTeli cnobierebis fonze aSS-Si 1990 wels avtokatastrofaSi 44 529 adamiani
viTardeba. amgvari movlenebis gamo pacienti xSirad daiRupa. am ubeduri SemTxvevebis 41% alkoholiT
distress ganicdis, SfoTavs da mousvenrad gamoiyure- iyo gamowveuli (Zobeck et al., 1994). avtokatastrofa-
ba. halucinaciebi ar aris ganpirobebuli mwvave alko- Si daRupuli mZRolebis TiTqmis igive procentuli
holuri aRkveTiT da SeiZleba abstinenciis Semdeg maCvenebeli (44%) dafiqsirda espaneTSi, 1991-2000
ramdenime Tve gagrZeldes. am mdgomareobis etiolo- wlebSi (Carmen del Rio et al., 2002).
giis Sesaxeb mniSvnelovnad gansxvavebuli mosazrebebi
danaSauli
arsebobs. zogierTi mkvlevari iziarebs krepelinisa da
bonhoferis azrs da Tvlis, rom halucinozi alkohol- alkoholis Warbi moxmareba, aseve, dakavSirebulia
izmis iSviaT organul garTulebas warmoadgens. zo- samarTaldarRvevebTan, ZiriTadad wvrilman da-
gierTebi ki, bleileris msgavsad, varaudoben, rom is
Sizofreniis niSania. Tanamedrove mkvlevarebis umete- boqsi 18.1 did britaneTSi alkoholis
sobas miaCnia, rom alkoholuri halucinozi alko- Warbi moxmarebis samedicino da socialuri
holiT gamowveuli organuli fsiqozia, romelsac ar Sedegebi
aqvs kavSiri SizofreniasTan da, alkoholisgan Tavis 1. yovelwliurad alkoholiT gamowveul danaSaulTan da
Sekavebis SemTxvevaSi, mas SeiZleba dadebiTi prognozi sazogadoebrivi wesrigis darRvevasTan dakavSirebuli
xarjebi Seadgens 7.3 miliard girvanqas, samuSao
hqondes (Greenberg and Lee, 2001). adgilebTan dakavSirebuli xarjebi _ 6.4 miliards, xolo
DSM-IV-sa da ICD-10-Si alkoholuri halucinozi janmrTelobasTan dakavSirebuli xarjebi _ 1.7 miliards.
Setanilia kategoriaSi _ `fsiqoaqtiuri nivTiere- 2. alkoholis Warbi raodenobiT momxmareblebi Seadgenen
bebis Sedegad gamowveuli fsiqozuri aSliloba~. daaxloebiT erT mesameds im adamianebisa, romlebic
sagzao SemTxvevebis msxverpls warmoadgenen an
saswrafo samedicino daxmareba esaWiroebaT.
socialuri ziani (ix. boqsi 18.1) 3. zrdasruli mosaxleobis 2.9 milioni (7%) alkoholda-
mokidebulia.
ojaxuri problemebi
4. Zaladobis msxverplTa 47% Tvlis, rom adamiani, ro-
alkoholis Warbi raodenobiT miRebam SeiZleba so- melmac maTze Zaladoba ganaxorciela, alkoholis ze-
cialuri urTierTobebis seriozuli gauareseba ga gavlenis qveS imyofeboda.
moiwvios, gansakuTrebiT, ojaxSi. daZabuli urTier- 5. 1993 wlidan 2000 wlamde, alkoholiT gamowveuli
sagzao SemTxvevebis Sedegad gardacvlili adamianebis
Tobebi colqmrul da ojaxur urTierTobebSi faqti- raodenoba 20%-iT gaizarda.
urad gardauvali xdeba. ganqorwineba Zalian xSiria 6. bavSvTa dacvis statistikis mixedviT, bavSvebis 30-
im adamianebis ojaxebSi, romlebic didi raodenobiT 60 procenti alkoholizmis msxverplia. ojaxSi
alkoholis moxmarebis gamo daaxloebiT 1.3 milioni
alkohols moixmaren; aseTi mamakacebis meuRleebs aR-
bavSvia dazaralebuli.
eniSnebaT SfoTva, depresia da socialuri izolacia.
wyaro: Prime Ministers Strategy Unit (2003)
_ 466 _
naSaulTan, rogoricaa, mag., qurdoba. Tumca, aris ebiT. zogadad, monozigoturi da dizigoturi tyu-
SemTxvevebic TaRliTobis, seqsualuri da Zalado- pebis Sedarebam aCvena, rom mamrobiTi da mdedrobiTi
brivi danaSaulis, mkvlelobis CaTvliT. inglissa da sqesis monozigotur tyupebSi ufro maRalia konkor-
uelsSi recidivisti patimrebis gamokvlevis Sedegad dantoba alkoholdamokidebulebis mimarT. am tipis
dadginda, rom bevr maTgans cixeSi moxvedramde alko- gamokvlevebis mixedviT, alkoholdamokidebuleba
holTan dakavSirebuli problemebi aReniSnebodaT. Tandayolili aqvs mamakacebis 50%-s da qalebis 25%-s
Zneli gansasazRvria, Tu rogoria alkoholis roli (Ball, 2004).
im adamianebis danaSaulebriv qmedebebSi, romlebic genetikuri axsnis sasargeblod metyvelebs,
alkohols Warbad moixmaren an ramdenad aris loTo- agreTve, naSvilebi bavSvebis Seswavlac. mravali
ba damnaSavis cxovrebis wesis erT-erTi Semadgeneli gamokvlevis Sedegad dadginda, rom alkoholmox-
nawili. garda amisa, arsebobs kavSiri alkoholmoxmarebisa da alkoholdamokidebulebis riski ufro
marebis garkveul formasa da antisocialur person- maRalia im mamrobiTi sqesis gaSvilebul bavSvebTan,
ologiur aSlilobas Soris (ix. qvemoT. gv. ??). romelTa biologiur mSoblebsac alkoholdamokide-
buleba aReniSnebaT, vidre im mamarobiTi sqesis gaS-
alkoholis Warbi raodenobiT moxmarebisa vilebul bavSvebTan, romelTa biologiur mSobleb-
sac ar aReniSnebaT alkoholdamokidebuleba. aseTi
da alkoholdamokidebulebis mizezebi
tipis gamokvlevebi miuTiTebs genetikur meqanizme-
miuxedavad mravalicxovani gamokvlevebisa, alkohol-
bze, magram ar xsnis maT bunebas.
is Warbi moxmarebisa da alkoholdamokidebulebis ga-
naSvileb bavSvebze SvedeTSi Catarebulma gamokv-
momwvevi mizezebis Sesaxeb cota ram aris cnobili.
levebma aCvena, rom arsebobs ori, erTmaneTisgan gan-
odesRac iTvleboda, rom zogierT adamians, pirovnu-
sxvavebuli saxis alkoholdamokidebuleba, romleb-
li Taviseburebebis an Tandayolili bioqimiuri
sac tipi 1 da tipi 2 ewodeba (Cloninger et al., 1988).
anomaliis gamo, alkoholis mimarT gansakuTrebuli
alkoholizms, romelic meore tips ganekuTvneba, mka-
predispozicia axasiaTebs. dResdReobiT aseT martiv
crad gansazRvruli genetikuri xasiaTi aqvs. is ad-
axsnas naklebad iziareben da miaCniaT, rom alkohol-
reul asakSi vlindeba da biologiuri mamisa da naS-
moxmareba mravalricxovani faqtorebis urTierTze-
vilebi piris samarTaldarRvevebsa da sociopaTur
moqmedebis Sedegs warmoadgens. es faqtorebi SeiZle-
aSlilobasTanaa asocirebuli. amisgan gansxvavebiT,
ba individualur da socialur faqtorebad daiyos.
pirveli tipis alkoholizmi ufro gviandel asakSi
individualuri faqtorebi vlindeba da naklebadaa damokidebuli genetikur faq-
torebze (Gurling and Cook, 1999).
genetikuri faqtorebi im SemTxvevaSic ki, rodesac etiologiaSi gene-
alkoholis gamoyeneba. tyupebis Seswavla saSuale- tikuri faqtoris roli dasturdeba, mainc saWiroa
bas gvaZlevs, vikvlioT genetikuri da ojaxuri faq- misi meqanizmis dadgena. es meqanizmi SeiZleba iyos an
torebis roli alkoholis moxmarebis paternebSi. im bioqimiuri (alkoholis metabolizmi) an centraluri
gamokvlevis Tanaxmad, romelic amgvar midgomas iy- anu fsiqologiuri (pirovnuli maxasiaTeblebi). garda
enebs, cxovrebis manZilze alkoholis moxmarebisaken amisa, mniSvnelovania imis aRniSvna, rom alkoholmox-
midrekilebas ganapirobebs garemo. Tumca, arasrulw- marebis mimarT predispozicia da alkoholdamokideb-
lovnebSi alkoholis aralegalurad moxmarebis risks ulebis ganviTareba Tavs iCens mxolod maSin, rodesac
Zlieri genetikuri determinantebi gaaCnia (Maes et al., pirovneba Warbi raodenobis alkohols moixmars. aseT
1999). SemTxvevebSi mTavar rols, savaraudod, arageneti-
alkoholmoxmareba da alkoholdamokidebuleba. kuri ojaxuri faqtorebi asruleben (Ball, 2004).
alkoholizmis genetikuri kvlevebis umravleso- SeWidulobis da asociaciuri gamokvlevebi ori
ba alkoholdamokidebulebis niSnebis mqone pirebs mTavari molekulur-genetikuri midgomaa, romlebic
Seiswavlis. naklebad mkacri diagnostikuri krite- alkoholmoxmarebasa da alkoholdamokidebulebis
riumebis gamoyenebis SemTxveevaSi, mag., alkoholmox- ganviTarebaSi genetikuri faqtoris rolis Sesaswav-
marebis sakmaod farTo gansazRvrebisas, genetikuri lad gamoiyeneba. alelur asociaciaTa Seswavla do-
faqtorebis wvlili SedarebiT mcirea. famin D2 receptoris alelebzea mimarTuli. amgvari
dadgenilia, rom alkoholdamokidebuleba agre- gamokvlevebis Sedegebi urTierTgamomricxavia. amas
girebulia ojaxebSi. Tu es, nawilobriv, genetikuri SeiZleba ganapirobebdes D2 receptorTa polimor-
faqtorebiT aris gamowveuli da ara ojaxis social- fizmebis sixSireSi arsebuli eTnikuri gansxvavebebi
uri zegavleniT, maSin alkoholdamokidebulebis da kidev is, rom SemTxveva _ kontrolis am tipis
procentuli maCvenebeli ufro maRali unda iyos gamokvlevebi, Cveulebriv, mcdarad dadebiT pasuxebs
monozigotur tyupebSi, dizigotur tyupebTan Sedar- iZleva (gv. ??) Tumca, es debatebi grZeldeba; rogorc
_ 467 _
Cans, D2 receptoris genis monawileoba SecdomiTaa moxmarebis xarisxis gansazRvrisas. Tumca, arcTu
daSvebuli (Ball, 2004). ise iSviaTia iseTi SemTxvevebic, rodesac loTi mSo-
adamianebis mTeli genomis skriningis kolaboraci- blebis Svilebi saerTod ar moixmaren alkohols.
ulma gamokvlevam gviCvena ramdenime qromosomaze alkoholdamokidebuleba. arsebobs mosazreba, rom
(konkretulad ki _ me-4 qromosomaze) iseTi ubnebis daswavlis procesi ufro specifikuri gziT uwyobs
arseboba, romlebic, savaraudod, ganapirobeben al xels alkoholdamokidebulebis Camoyalibebas. mag.,
koholdamokidebulebisadmi predispozicias. am in- amJamad gavrcelebuli mosazrebis Tanaxmad, romelic
teress iwvevs GABA receptorebis makodirebeli bioqimiur da kognitur midgomebs aerTianebs, daswav-
genebis siaxlove. genetikuri midgoma alkohold- lis `waxalisebisTvis~ mezolimbur sistemaSi dofami-
amokidebulebis mimarT ganxilulia Semdeg wyaroSi: nis gamoyofis mniSvnelobas esmeba xazi. am midgomis
Ball, 2004. Tanaxmad, iseTi nivTierebebi, romlebic alkoholis
msgavsad Tavis tvinis am ubanSi zrdian dofaminis
sxva biologiuri faqtorebi dones, aZlierebs iseTi qcevis motivacias, romelic
alkoholmoxmarebisa da alkoholdamokidebulebi- mimarTulia imisaken, rom uzrunvelyos mocemuli
sadmi midrekilebis asaxsnelad SemoTavazebul iqna nivTierebis saTanado raodenobiT tvinis momarageba.
ramodenime SesaZlo bioqimiuri faqtori, romlebic aseTi qcevebi SeiZleba aracnobierad mimdinareobdes
moicaven alkoholdehidrogenazas anomaliebs an nei- da maTi Caqroba iolad ar xdeba (Robbins and Everitt,
rotransmiterul meqanizmebs. rogorc zemoT aRin- 199).
iSna, azielebis mniSvnelovan nawils, romelTac aqvT
aldehiddehidrogenazas izofermentis gansakuTreb- pirovnuli faqtorebi
uli aleli, alkoholze usiamovno reaqcia uviTarde- mcire progresia miRweuli im pirovnuli faqtorebis
ba da amitom maTTan naklebia alkoholmoxmarebis al- dadgenaSi, romlebic xels uwyoben alkohold-
baToba. amokidebulebis ganviTarebas. klinikur praqtikaSi,
alkoholdamokidebulebis mqone mamakacebis vaJiS- Cveulebriv, iTvleba, rom alkoholis Warbi raodeno-
vilebi imyofebian alkoholdamokidebulebis Camoya- biT moxmareba dakavSirebulia qronikul SfoTvasTan,
libebis maRali riskis qveS. mravali mkvlevari cdi- mkveTrad gamoxatul arasrulfasovnebis gancdas-
lobda aRmoeCina biologiuri anomaliebi, romlebic Tan an sakuTari survilebis ayolis tendenciasTan.
aseT bavSvebSi SeiZleba win uZRvodes alkohold- miuxedavad amisa, am tipis pirovnuli problemebis
amokidebulebis Camoyalibebas da misi prognozis mqone bevr adamians ar aReniSneba alkoholis Warbad
saSualebas iZleodes. aRwerilia sxvadasxvagvari moxmareba an alkoholdamokidebuleba. ufro Taname-
disfunqcia, maT Soris, kognituri amocanebis Ses- drove gamokvlevebi xazs usvams iseTi pirovnuli
rulebis deficiti da P300 vizualuri gamowveuli Tvisebebis rols, romlebic riskis Semcvel qcevasa
potencialebis (riTac xdeba vizualuri informaciis da siaxlis Ziebas ganapirobeben (Kampov-Polevoy et
damuSavebis procesis Seswavla) anomaliuri monace- al., 2004). savsebiT SesaZlebelia, rom im adamianebs,
mebi (Carlson et al., 1999). arsebobs, agreTve, sakmaod romlebsac antisocialuri personologiuri aSli-
damajerebeli mtkicebulebebi imisa, rom alkohol- loba axasiaTebT da alkoholmoxmarebisa da alko-
damokidebulebis mqone mamakacebis vaJiSvilebi nak- holdamokidebulebis Camoyalibebis maRali riskis
lebad sensitiurebi arian alkoholis mwvave intoqsi- qveS imyofebian, es maxasiaTeblebi hqondeT. Tumca,
kaciuri efeqtis mimarT (Heath et al., 2002). savaraudod, alkoholdamokidebuli pirebis umravlesobas ar aR-
Tu pirovnebas alkoholis mimarT naklebi subieqturi eniSneba antisocialuri personologiuri aSliloba.
mgrZnobeloba aqvs, is ufro midrekilia didi raode-
nobis alkoholis moxmarebisaken da, aqedan gamomdi- fsiqikuri aSlilobebi
nare, sakuTar Tavs alkoholdamokidebulebis gan- alkoholmoxmareba, Cveulebriv, sxva fsiqikur aSli-
viTarebis riskis qveS ayenebs. miuxedavad imisa, rom lobebTan erTad gvxvdeba da zogjer meoradia maT
es hipoTeza damajereblad JRers, is ar dasturdeba mimarT. mag., depresiuli aSlilobebis mqone zogier-
empiriuli monacemebiT. Ti pacienti alkohols guneb-ganwyobis gasaumjobese-
blad moixmars (rac Secdomas warmoadgens). SfoTviTi
daswavlis faqtorebi aSlilobebis, gansakuTrebiT panikuri aSlilobisa da
alkoholis gamoyeneba. bavSvebi alkoholis gamoy- socialuri fobiis mqone adamianebi, agreTve, maRali
enebis mSoblebis paternebs imeoreben. adreuli riskis qveS imyofebian. alkoholmoxmarebas vxvdebiT
asakidan biWebs ufro metad aqezeben alkoholis mox- im pacietebTanac, romlebic bipolaruli aSlilobiTa
marebisaken, vidre gogonebs. rogorc Cans, arageneti- da SizofreniiT arian daavadebulni. mZime fsiqikuri
kuri ojaxuri faqtorebi mniSvnelovania alkoholis daavadebebis mqone pacientebis mkurnaloba, romle-
_ 468 _
bic, amave dros, fsiqoaqtiuri nivTierebebis araswo- ebraelTa TemSi alkoholTan dakavSirebuli prob-
rad momxmareblebic arian, ?? gverdzea ganxiluli. lemebi iSviaTia iseT qveynebSic ki, sadac sazogadoe-
baSi alkoholis moxmarebis done maRalia. alkoholis
alkoholis moxmareba sazogadoebaSi
moxmarebis ekonomikuri da socialuri aspeqtebis
dResdReobiT yvela eTanxmeba im mosazrebas, rom gansaxilvelad ix. samedicino mecnierebebis akademiis
alkoholdamokidebulebis SemTxvevebisa da alko- monacemebi (Academy of Medical Sciences, 2004).
holiT gamowveuli aSlilobebis sixSire sazogadoe-
baSi alkoholis moxmarebis saerTo doniTaa ganpiro- alkoholmoxmarebis dadgena
bebuli. winaT miaCndaT rom, alkoholis raodenoba,
gamovlena
romelsac Warbi gamoyenebis SemTxvevaSi iReben,
ar aris damokidebuli im raodenobaze, romelsac sazogadoebaSi myofi alkoholmomxmareblebis mx-
sazogadoebaSi zomierad moixmaren. frangma demo- olod mcire nawili aris cnobili specializebuli
grafma ledermanma (Ledermann, 1956) uaryo es idea. dawesebulebebisTvis. rodesac klinikis Terapiul
man gamoTqva mosazreba, rom homogenur populacia- da qirurgiul ganyofilebebSi pacientebis Sesamowme-
Si alkoholis moxmarebis gadanawileba normaluri blad specialur zomebs mimarTaven, irkveva, rom maTi
logariTmuli mrudis mixedviT xdeba. Tu es asea, ma- 10-30% alkohols borotad moixmars. aseTi pirebis
Sin alkoholis saSualo moxmarebis zrdasTan erTad, ricxvi gansakuTrebiT maRalia travmatologiur da
aucileblad unda gaizardos im adamianebis ricxvi, saswrafo daxmarebis ganyofilebebSi.
romelTa mier moxmarebuli alkoholis raodenoba alkoholmoxmarebis faqtebi xSirad daudgeneli rCeba,
zianis momtania. radgan adamianebi ar amJRavneben maT mier moxmarebuli
miuxedavad imisa, rom ledermanis naSromis maTema- alkoholis raodenobas. garda amisa, eqimebi da sxva spe-
tikuri mxare gaakritikes, ar uaryves is, rom sazoga- cialistebi xSirad ar usvamen pacientebs saWiro SekiTx-
doebaSi alkoholis yovelwliur saSualo moxmare- vebs. samedicino muSakebis standartul praqtikas unda
basa da sazogadoebis wevrebisTvis alkoholiT miy- warmoadgendes Terapiuli, qirurgiuli da fsiqiatriu-
enebuli zianis mTel rig maCveneblebs Soris aSkara li pacientebis SemTxvevaSi, saTanado kiTxvebis dasmis
korelacia arsebobs. amitom, dRes aRiarebulia, rom meSveobiT, imis garkveva, Tu ra raodenobis alkohols
populaciaSi alkoholis Warbi raodenobiT momxmare- moixmaren isini. SesaZloa sasargeblo iyos, skriningis
belTa ricxvi mniSvnelovnad aris damokidebuli amave mizniT, CAGE-is saxeliT cnobili mokle kiTxvaris gam-
populaciaSi alkoholis moxmarebis saSualo doneze. oyeneba, romelic Semdeg oTx kiTxvas Seicavs:
mainc ra gansazRvravs qveyanaSi alkoholis mox- w odesme xom ar gigrZvniaT, rom unda SeamciroT
marebis saSualo dones? aq aucilebelia gaviTval- alkoholis moxmareba?
iswinoT ekonomikuri, formaluri da araformaluri w Tqvens garemocvaSi myofi adamianebi xom ar gabez-
kontroli. ekonomikuri kontroli alkoholis Rire- reben Tavs imiT, rom gakritikeben smis gamo?
bulebaa. dReisTvis arsebuli monacemebiT, did bri-
w xom ar gqoniaT odesme danaSaulis gancda alko-
taneTsa da sxva qveynebSi arsebobs utyuari mtkiceb-
holis moxmarebis gamo?
ulebebi imisa, rom alkoholis realuri Rirebuleba
w dagileviaT Tu ara odesme diliT (`Tvalis gaxel-
(anu saSualo SemosavalTan Sefardebuli fasi) mniS-
isTanave~) nervebis dasawynareblad an nabaxusevs,
vnelovan gavlenas axdens qveyanaSi mis moxmarebaze.
ukeT rom gegrZnoT Tavi?
alkoholze gadasaxadis gazrda amcirebs alkoholis
Warbi da zomieri raodenobiT momxmarebelTa mier am kiTxvebze ori an orze meti dadebiTi pasuxis
gamoyenebuli alkoholis raodenobas. SemTxvevaSi, SeiZleba davaskvnaT, rom pirovnebas
formaluri kontrolis ZiriTad saSualebas war- alkoholmoxmareba aReniSneba. zogierTi pacienti
moadgens licenzirebasTan dakavSirebuli kanonebi; araswor pasuxebs iZleva, magram arseboben iseTi pa-
Tumca, isini calsaxad ar axdenen gavlenas alko- cientebic, romlebic Tvlian, rom amgvari SekiTxvebi
holis moxmarebis qcevaze, rac sxvadasxva qveynebis maT problemebis gansazRvraSi daexmarebaT. zogadad,
monacemebis urTierTSedarebiT dasturdeba. ara- CAGE sensitiuri instrumentia, magram is naklebad
formaluri kontroli aris sazogadoebaSi arsebuli specifikur informacias iZleva (Warner, 2004. gv. ??).
wes-Cveulebebi da moraluri principebi, romlebic arsebobs alternatiuli kiTxvari, romelic AUDIT-
gansazRvraven, Tu vis aqvs alkoholis miRebis ufle- is saxeliTaa cnobili da aTi punqtisgan Sedgeba. is
ba, rogor viTarebaSi, dRis romel monakveTSi da ra Seiqmna jandacvis msoflio organizaciis moTxovniT,
raodenobiT. miuxedavad imisa, rom alkoholi yvelas- raTa dadgeniliyo alkoholis mavne SedegebiT gamoy-
Tvis xelmisawvdomia, zogierTi sazogadoeba icavs Ta- enebis arsebuli da potenciuri riski. kiTxvari sen-
vis wevrebs alkoholis arasworad moxmarebisgan. mag., sitiuria da konkretul informacias iZleva. mas Seu-
_ 469 _
boqsi 18.2 AUDIT kiTxvari: alkoholmoxma w TveSi erTxel

rebis skriningi w kviraSi erTxel
w yoveldRiurad an TiTqmis yoveldRiurad
1. ramdenad xSirad moixmarT alkoholur sasmelebs?
w arasodes
7. gasuli wlis ganmavlobaSi radenjer gqoniaT danaSaulis
w TveSi erTxel an ufro iSviaTad
an sinanulis gancda alkoholis miRebis Semdeg?
w TveSi 2-4-jer
w arasodes
w kviraSi 2-3-jer
w ufro iSviaTad, vidre TveSi erTxel
w kviraSi 4-jer an ufro xSirad
w TveSi erTxel
2. alkoholis moxmarebis dRes, Cveulebriv alkoholis w kviraSi erTxel
ramden standartul dozas iRebT? w yoveldRiurad an TiTqmis yoveldRiurad
w 1 an 2
8. gasuli wlis ganamvlobaSi yofila Tu ara iseTi SemTxve-
w 3 an 4
va, rodesac simTvralis gamo ver gagixsenebiaT, Tu ra
w 5 an 6 moxda wina saRamos?
w 7 an 9 w arasodes
w 10 an meti w ufro iSviaTad, vidre TveSi erTxel
3. ramdenad xSirad migiRiaT 6 an ufro meti alkoholis w TveSi erTxel
standartuli doza erT jerze? w kviraSi erTxel
w arasodes w yoveldRiurad an TiTqmis yoveldRiurad
w ufro iSviaTad, vidre TveSi erTxel
9. xom ar yofila iseTi SemTxveva, rodesac Tqveni
w TveSi erTxel simTvralis Sedegad vinme daSavebula fizikurad an
w kviraSi erTxel Tavad daSavebulxarT?
w yoveldRiurad an TiTqmis yoveldRiurad w ara
w diax, magram ara gasul wels
4. gasuli wlis ganmavlobaSi ramdenjer yofila iseTi
SemTxveva, rodesac alkoholuri sasmelis miRebis w diax, gasul wels
Semdeg veRar SegiwyvetiaT sma?
10. xom ar gamouTqvamT SeSfoTeba naTesavebs, megobrebs,
w arasodes eqimebs an jandacvis muSakebs Tqvens mier alkoholis
w ufro iSviaTad, vidre TveSi erTxel moxmarebis gamo an xom ar urCeviaT alkoholis moxmarebis
w TveSi erTxel Semcireba?
w kviraSi erTxel w ara
w yoveldRiurad an TiTqmis yoveldRiurad w diax, magram ara gasul wels
w diax, gasul wels
5. gasuli wlis gamavlobaSi ramdejer yofila iseTi
SemTxveva, rodesac alkoholis miRebis gamo ver
gagikeTebiaT is, rasac Tqvengan Cveulebriv moelian? yoveli kiTxvis pirveli pasuxi 0 quliT fasdeba, xolo
w arasodes bolo _ 4 quliT. mecxre da meaTe kiTxvebs mxolod sami
w ufro iSviaTad, vidre TveSi erTxel pasuxi gaaCniaT. aqedan pirveli 0 quliT fasdeba, meore _ 2
quliT, xolo mesame _ 4 quliT.
w TveSi erTxel
isini, vinc 8-15 qulas agroveben alkoholiT gamowveuli
w kviraSi erTxel
zianis riskis qveS imyofebian da, amitom, xanmokle Carevas
w yoveldRiurad an TiTqmis yoveldRiurad saWiroeben. isini, vinc 16-19 qulas agrovebs, xanmokle
Carevasa da regularul monitorings saWiroebs. Tu isini
6. gasuli wlis ganmavlobaSi ramdejer yofila iseTi agrZeleben alkoholis didi raodenobiT moxmarebas, ufro
SemTxveva, rodesac alkoholis didi raodenobiT formaluri diagnostikuri gamokvlevis mizniT SeiZleba
miRebis Semdeg, meore diliT `gonze mosasvlelad~ saWiro gaxdes maTi gadamisamarTeba sxva specialistTan.
alkoholis miReba dagWirvebiaT? im adamianebs, romlebic 20-40 qulas agroveben, unda
w arasodes CautardeT diagnostikuri gamokvleva, detoqsikacia da
w ufro iSviaTad, vidre TveSi erTxel sxva saxis mkurnaloba fizikuri damokidebulebis siZlieris
mixedviT (Room et al., 2005).
Zlia susti xarisxis alkoholdamokidebulebis gamov- is borotad moxmareba SeiZleba dadgindes im prob-
lena da, albaT, pirveladi jandacvis organizaciebis lemebis mixedviT, romlebic pirovnebas alkoholis
klinicistebisa da mkvlevarebisTvis skriningis moxmarebis Sedegad eqmneba rogorc colqmrul da
yvelaze sasargeblo instrumentia (boqsi 18.2). ojaxur cxovrebaSi, ise samsaxurSi an finansebTan da
`riskis~ zogadi maCveneblebi. eqims moeTxoveba, rom kanonTan dakavSirebiT. alkoholis borotad momx-
man saTanado yuradReba miaqcios alkoholizmis maRa- marebeli pirovneba ufro xSirad acdens samsaxurs,
li riskis maCveneblebs. zogad praqtikaSi alkohol- vidre is, romelic alkohols zomierad moixmars. or-
_ 470 _
SabaTobiT samsaxurSi ar gamocxadeba, aseve, eWvisa
boqsi 18.3 alkoholmoxmarebis anamnezis
da dafiqrebis safuZvels iZleva. yuradReba unda
Segroveba
mieqces im profesiebsac, romlebic alkoholis mox-
marebis maRal riskTanaa dakavSirebuli. w alkoholis miRebis `tipuri dRis~ aRwera. rodis xdeba
dRis ganmavlobaSi alkoholis pirveli dozis miReba
`riskis~ samedicino maCveneblebi. saavadmyofos
praqtikaSi alkoholdamokidebuleba SeiZleba dadg- w rodis daiwyo alkoholis yovedRiuri moxmareba
indes maSin, rodesac pacients aRkveTis sindromi w aRiniSneba Tu ara aRkveTis simptomebi diliT an absti
nenciis Semdeg
hospitalizaciis Semdeg ewyeba. mkveTrad gamoxatuli
TeTri cxeleba ioli dasadgenia, magram SedarebiT w SeiniSneboda Tu ara warsulSi mkurnalobis mcdeloba
zomieri gamovlineba SeiZleba agverios mwvave or- w aRiniSneba Tu ara zogadi samedicino garTulebebi
ganul sindromSi, romelic aRiniSneba, mag., filt- w pacientis damokidebuleba alkoholis miRebis mimarT
vebis anTebis an postoperaciuli periodis dros. ro-
gorc zogad, aseve saavadmyofos praqtikaSi arsebuli mizezi. amis Semdeg SegviZlia TandaTanobiT gadavi-
risk-faqtorebi moicavs fizikur darRvevebs, romle- deT iseT kiTxvebze, romlebic warsulSi mkurnalo-
bic SeiZleba alkoholis moxmarebiT iyos gamowveuli. bis Catarebis mcdelobas exeba.
xSir SemTxvevaSi esaa gastriti, peptikuri wyluli da radganac mkurnalobas SeiZleba ramdenime mizani
RviZlis daavadeba. aseve, unda gvaxsovdes iseTi daa- hqondes, aucilebelia naTeli warmodgena SeviqmnaT
vadebebi, rogorebicaa neiropaTia da gulyrebi. dae- imaze, Tu ras fiqrobs Tavad pacienti qcevis model-
Wvebis safuZvels iZleva, agreTve, xSiri travmebi. ze, romelic alkoholis moxmarebasTan dakavSirebiT
`riskis~ fsiqiatriuli maCveneblebia SfoTva, Camouyalibda. pacientis damokidebuleba sakuTari
depresia, meryevi (cvalebadi) guneb-ganwyoba, kon- problemebis mimarT mTavar rols TamaSobs mkurnalo-
centraciis darRveva, mexsierebasTan dakavSirebuli bis yvelaze efeqturi meTodis SerCevaSi (ix. qveTavi
problemebi da seqsualuri disfunqcia. sakuTari Ta- _ motivaciuri interviu).
visTvis ganzrax zianis miyenebis nebismieri faqtis
gamovlenisas, unda vivaraudoT, rom es SeiZleba
laboratoriuli testebi
alkoholmoxmarebasTan iyos dakavSirebuli. alkoholmoxmarebis dasadgenad SesaZlebelia ramden-
ime laboratoriuli testis gamoyeneba, Tumca arc
alkoholmoxmarebis istoria erTi maTgani ar aris absoluturad zusti. amis mize-
Tu zemoT CamoTvlili romelime faqtori alkohol- zia is, rom SedarebiT mgrZnobiare testebma SeiZle-
moxmarebis eWvs badebs, Semdeg safexurs alkoholis ba mcdari `dadebiTi~ pasuxi mogvces im SemTxvevaSi,
gamoyenebis amomwuravi anamnezis Segroveba unda war- rodesac pacients aqvs RviZlis, Tirkmlis, gulis an
moadgendes (boqsi 18.3). anamnezis Sekrebisas unda sisxlis daavdeba an rodesac igi fermentebis main-
gamoviCinoT taqti, radgan pacients SeiZleba gau- ducirebel samkurnalo saSualebebs Rebulobs (ro-
Wirdes kiTxvebze zusti pasuxis gacema. klinicistma goricaa, mag., antikonvulsantebi, steroidebi an bar-
unda daadginos, romel alkoholur sasmels moix- bituratebi). miuxedavad amisa, testis anomaliuri
mars, Cveulebriv, pacienti dRis ganmavlobaSi da ra maCveneblebi imaze miuTiTebs, rom pacients SeiZleba
raodenobiT. mag., dRis romel monakveTSi da ra situ- alkoholmoxmareba axasiaTebdes. boqsSi 18.4 mocemu-
aciaSi iRebs is alkoholis pirvel dozas. pacients lia yvelaze ufro sasargeblo testebi. alkoholmox-
unda SevekiTxoT, Tu rogor grZnobs Tavs gamoRvi- marebis biologiuri markerebis Sesaxeb informaciis
Zebisas an maSin, rodesac erTi an ori dRis manZilze mosapoveblad ix. Sharpe, 2002.
ar Rebulobs alkohols. amas TandaTanobiT mivyavarT
alkoholdamokidebulebis tipiuri niSanTvisebebisa mkurnaloba alkoholmoxmarebis dros (boqsi
da masTan dakavSirebuli fizikuri, fsiqologiuri da 18.5)
socialuri problemebis dadgenasTan.
imisTvis, rom warmodgena Segveqmnas alkoholTan adreuli gamovlena da mkurnaloba
dakavSirebuli problemebis xangrZlivobaze, aucile- gansakuTrebiT mniSvnelovania alkoholis Warbad mox-
belia gavarkvioT, Tu rodis daiwyo pacientma pirve- marebis adreul etapze gamovlena, radgan ukve Camo-
lad alkoholis yoveldRiurad miReba da diliT da- yalibebuli alkoholizmis mkurnaloba Znelia, gansa-
leva, pirvelad rodis igrZno (Tu aseTi ram odesme kuTrebiT maSin, rodesac adamians mkveTrad gamoxat-
momxdara) aRkveTis simptomebi. unda davadginoT uli alkoholdamokidebuleba axasiaTebs. zogadi pro-
alkoholisgan Tavis Sekavebis periodebi, Tu ra faq- filis eqimebs, Terapevtebsa da qirurgebs SeuZliaT
torebi uwyobs xels am mdgomareobis SenarCunebas da mravali SemTxvevis adreul etapze gamovlena maSin,
ra aris alkoholis moxmarebasTan xelaxla mibrunebis rodesac pacienti maT sxva problemiT mimarTavs.
_ 471 _
xanmokle Careva aqvs, gansakuTrebiT, alkoholdamokidebulebis Sem-

TxvevaSi (Room et al., 2005).
zogadi profilis eqimebs yvela piroba aqvT imisa,
rom alkoholTan dakavSirebuli problemebis mqone motivaciuri interviu (boqsi 18.6)
pirs adreuli mkurnaloba Cautaron, radgan isini
pacientebs, romlebsac aqvT alkoholmoxmarebasTan
kargad icnoben pacients da misi ojaxis wevrebs.
dakavSirebuli problemebi, gansakuTrebiT ki imaT,
xSirad efeqturia ubralo rCevac ki, romelsac zog-
visac es problemebi skriningis Sedegad daudginda,
adi profilis eqimi gulaxdilad da saqmianad, magram
SeiZleba ar hqondeT gadawyvetili, rom miiRon monaw-
taqtiT aZlevs pacients.
ileoba samkurnalo programebSi. interviuirebis sa-
xanmokle Careva, Cveulebriv, gulisxmobs pacien-
Tanado stilis gamoyeneba, gansakuTrebiT pacientis
tisTvis zogadi inforamciis miwodebas alkoholis
pirveladi gamokvlevisas, gvexmareba davarwmunoT
Warbad moxmarebis mavneblobis Sesaxeb da rCevis
pacienti, rom alkoholis moxmarebis misi amJamind-
micemas alkoholis moxmarebis usafrTxo odeno-
eli paternis ganxilva SeiZleba Zalian sasargeblo
basTan dakavSirebiT. am SemTxvevaSi mizani alko-
aRmoCndes.
holis usafrTxod moxmarebis propagandaa da ara
motivaciuri intervius Catarebisas xdeba konfron-
misi miRebisgan sruli Tavis Sekaveba. Cveulebriv,
taciis Tavidan acileba. es midgoma naklebad direq-
xanmokle Careva iwvevs alkoholis moxmarebis mniS-
tiulia. intervius mimdinareobisas pacients saSu-
vnelovan Semcirebas momdevno wlis manZilze, magram
aleba eZleva Seafasos, Tu rogoria mis cxovrebaze
daudgenelia, Tu ramden xans SeiZleba SenarCundes es
alkoholis pozitiuri da negatiuri zegavlenis Tana-
dadebiTi efeqti. sazogadod cnobilia, rom xanmokle
fardoba. klinicisti xels uwyobs am process imiT,
Careva ar aris efeqturi maTTvis, visac alkoholis
rom pacients ukukavSirs awodebs im riskis Sesaxeb,
moxmarebasTan dakavSirebuli seriozuli problemebi
romelsac Seicavs alkoholis moxmareba piradad misT-
boqsi 18.4 alkoholdamokidebulebis vis da misi ojaxisTvis da pacients misi mdgomareobis
dasadgeni laboratoriuli testebi Secvlis sxvadasxva variants sTavazobs. motivaci-
uri intervius mizania is, rom pacientma daasabuTos
gama-glutamil-transpeptidaza (GGT). sisxlSi GGT-is
Semcvelobis gansazRvra sasargeblo skrining tests war- fsiqoaqtiuri nivTierebis moxmarebis sakuTari pa-
moadgens (Rosalki et al., 1970). misi done alkoholis araswo- ternis Secvlis sargeblianoba (boqsi 18.6). informa-
rad momxmareblebis 80%-Tan (rogorc mamakacebSi, aseve cia motivaciuri intervius Sesaxeb da fsiqoaqtiuri
qalebSi) aweulia imis miuxedavad aReniSnebaT Tu ara maT
RviZlis aSkara dazianeba. rac ufro met alkohols moix-
nivTierebebis moxmarebis mkurnalobaSi misi rolis
mars adamiani, miT ufro maRalia masTan GGT-is done. Taobaze mocemulia Semdeg wyaroSi: Treasure, 2004.
eriTrocitebis saSualo korpuskuluri moculoba (MCV). mkurnalobis gegma alkoholmoxmarebisa da
MCV-is done alkoholis arasworad momxmareblebis 60%-
Si (ufro xSirad qalebSi) normaze ufro maRalia. Tu sxva
alkoholdamokidebulebis ufro rTuli
mizezebs gamovricxavT, gazrdili MCV alkoholis Warbi SemTxvevebis dros
moxmarebis sando maCvenebelia. ufro metic, ramdenime rodesac pacients aReniSneba alkoholiT gamowveuli
kviraa saWiro imisaTvis, rom es maCvenebeli abstinenciis
Semdeg normaSi Cadges. mkveTrad gamoxatuli aSliloba, gansakuTrebiT
alkoholdamokidebuleba, mkurnaloba ufro inten
karbohidrat-deficituri transferini Sratis pro
teinis variantia, romelic rkinis transportirebas siuri unda iyos (suraTi 18.2). nebismier Carevas
uzrunvelyofs. misi Semcveloba gazrdilia alko win unda uZRvodes pacientis sruli gamokvleva,
holimoxmarebis dros. is albaT ufro konkretul rac gulisxmobs alkoholis moxmarebis anamnezis
informacias iZleva, vidre GGT (Salaspuro, 1999).
Segrovebasa da amJamad arsebuli samedicino, fsi
sisxlSi alkoholis koncentracia. sisxlSi alkoholis qologiuri da socialuri xasiaTis problemebis
maRali koncentraciis dros ara aqvs mniSvneloba
mZime daTrobis calkeuli epizodTan gvaqvs saqme, Tu boqsi 18.5. alkoholmoxmarebis
qronikul alkoholmoxmarebasTan. da mainc, Tu saWesTan
mjdom adamians ar aReniSneba alkoholuri intoqsikacia
mkurnalobisas gamoyenebuli midgomebi
miuxedavad imisa, rom sisxlSi dasaSveb normaze bevrad w problemis ukeTesi gacnobiereba
ufro maRali alkoholis koncentracia aRmoaCnda, es
w cvlilebebis ganxorcielebis motivaciis gazrda
albaT alkoholis mimarT mis gasaocar tolerantobaze
miuTiTebs. amgvari tolerantoba imis maCvenebelia, w mxardaWera da rCeva
rom pirovneba mudmivad imyofeba Zlieri alkoholuri w alkoholis aRkveTa (an kontrolirebadi moxmareba)
zemoqmedebis qveS. alkoholi sakmaod nela gamoidevneba w kognitur-qceviTi Terapia (socialuri unar-Cvevebi,
sisxlidan da misi dadgena SesaZlebelia mZime daTrobis recidivis prevencia)
Semdeg 24 saaTis ganmavlobaSi. klinikur praqtikaSi
w Terapia wyvilebTan
sisxlSi alkoholis Semcvelobis gasazomad xSirad
gamoiyeneba amosunTqviT alkoholis odenobis dadgenis w ànonimuri alkoholikebi~
testi. w medikamenturi mkurnaloba (disulfirami, akamprosati)
_ 472 _
waaxalisos da man mkurnaloba gaagrZelos.
boqsi 18.6 motivaciuri interviu
grZelvadiani miznebis dasaxva SesaZlebelia gar
w gamoxateT empaTia pacientis mimarT. kveuli warmatebebis miRwevis Semdeg. aseT mizans
w Tavi aarideT pacientTan kamaTs; nu iqnebiT kritikuli. SeiZleba warmoadgendes im precipitatuli da Sema
w gaiTvaliswineT da Tavidan aicileT pacientis rezis- narCunebeli faqtorebis Secvla, romlebic xels
tentoba
uwyoben alkoholis Warbad moxmarebas (mag., daZabuli
w yuradReba miaqcieT avadmyofobis istoriaSi arsebul
Seusabamobebs. mdgomareoba ojaxSi). amgvari mkurnalobis gegmis Sed
w gaacnobierebineT pacients fsiqoaqtiuri nivTierebebis genisas, unda miviRoT gadawyvetileba imis Taobaze,
arasworad momxmarebeli adamianebis miznebsa da Tu ra aris saboloo mizani: alkoholisgan sruli
qcevebs Soris arsebuli gansxvaveba.
TavSekaveba, Tu misi moxmarebis SezRudva (alkoholis
kontrolirebuli miReba).
Sefasebas. intensiuri da detaluri gamokvleva
xSirad exmareba pacients amoicnos da gaigos alkoholis moxmarebisgan sruli TavSekaveba da
sakuTari problemebi, rac mkurnalobis safuZvels alkoholis kontrolirebuli moxmareba
warmoadgens. Tumca, rogorc zemoT aRiniSna, unda
alkoholizmis daavadebis modeli gviCvenebs, rom al-
veridoT pacientTan konfrontacias, radgan es
koholdamokidebulma pirovnebam saerTod unda Sei-
mxolod da mxolod gaucxovebas iwvevs iseT adamianSi,
kavos Tavi misi moxmarebisgan, radgan erTma ylupma
romelsac momavalSi alkoholis gareSe cxovrebis
spirtianma sasmelmac ki SeiZleba recidivi gamoiwvios.
mimarT araerTgvarovani gancdebi aqvs. Cveulebriv,
sruli TavSekaveba ànonimuri alkoholikebis~ sam-
sasurvelia, pacientis gamokvlevaSi misi meuRle
kurnalo midgomis mTavar princips warmoadgens.
iRebdes monawileobas. is, erTis mxriv, informaciis
es sakiTxi (sruli TavSekaveba Tu kontrolire-
damatebiT wyaros warmoadgens, meores mxriv ki,
buli moxmareba) dRemde gadauwyveteli rCeba. far-
gamokvlevaSi monawileobiT mas sakuTari gancdebis
Tod gavrcelebuli mosazrebis Tanaxmad, alkoholis
gamoxatvis saSualeba eZleva.
kontrolirebuli moxmareba SeiZleba miRwevadi miza-
mkurnalobis dawvrilebiTi gegma pacientTan da
ni iyos im adamianebisTvis, romelTa alkoholTan da-
Tu es SesaZlebelia, mis partniorTan erTad unda
kavSirebuli problemebi droulad iqna aRmoCenili,
SemuSavdes. unda daisaxos konkretuli miznebi
romlebsac ar axasiaTebT alkoholdamokidebuleba an
da pacientma pasuxismgebloba unda aiRos maT
fizikurad ar dazaralebulan alkoholis moxmarebis
ganxorcielebaze. es miznebi orientirebuli unda iyos
gamo. alkoholisgan sruli TavSekaveba sjobs miznad
ara marto alkoholTan dakavSirebuli problemebis
davusaxoT im adamianebs, romlebTanac alkoholis
gadawyvetaze, aramed Tanmxleb problemebzec, rom
kontrolirebuli moxmarebis mcdeloba marcxiT dam-
lebic janmrTelobas, qorwinebas (ojaxs), samuSaos
Tavrda. miuxedavad imisa, rom am sakiTxTan dakavSi-
da socialur adaptacias ukavSirdeba. mkurnalobis
rebiT arcTu ise bevri kontrolirebuli gamokvle-
adreul stadiaze moklevadiani da SedarebiT advilad
va arsebobs, bolo dros Catarebuli gamokvlevebis
miRwevadi miznebi unda davsaxoT (mag., alkoholisgan
safuZvelze gamoiTqva mosazreba, rom alkoholis
sruli TavSekaveba ori kviris manZilze). adreul
kontrolirebuli moxmareba realisturi mizani SeiZ-
stadiaze miRweulma Sedegebma SeiZleba pacienti
leba iyos im pacientebisTvis, romelTac ar aReni-
mavne Sedegebis riskiT SnebaT alkoholdamokidebuleba da naklebad mZime
gamoyeneba alkoholuri aSliloba axasiaTebT. Tu gadawyda, rom
sazianod gamoyeneba
pacientma alkoholis kontrolirebuli moxmareba
damokidebuleba unda daisaxos miznad, maSin eqimma garkveviT unda
ganumartos mas, Tu ra aris alkoholis usafrTxo
moxmarebis zRurbli (anu ra raodenobiT alkoholis
miRebas gulisxmobs usafrTxo moxmareba).
alkoholis moxmarebis zrda
alkoholis miRebisgan Tavis Sekaveba
xanmokle Careva damokidebulebis sindromis mqone pacientebisTvis al-
specialistis Careva koholis miRebisgan Tavis Sekaveba mkurnalobis mniSv-
aRkveTa daxmarebis pirobebSi nelovan safexurs warmoadgens, romelic didi sifr-
Careva rezidenciul dawesebulebebSi TxiliT unda Catardes. naklebad mZime SemTxvevebis
dros is SeiZleba saxlis pirobebSi ganxorcieldes, Tu
suraTi 18.2 urTierTdamokidebuleba alkoholmoxmarebis arsebobs Sesatyvisi mxardaWerisa da klinikuri moni-
xarisxsa da gamoyenebul intervencias Soris (Lingford-Hughes
et al., 2004). toringis saSualeba (cxrili 18.8). aucilebelia, rom
_ 473 _
zogadi profilis eqimma, pirveladi jandacvis dawese- gansakuTrebiT stacionarul avadmyofebTan, Cveu
bulebaSi momuSave eqTanma an alkoholizmis proble- lebriv, ufro did dozas iyeneben. Tu pacients
mebze momuSave specialistma yoveldRiurad Seamowmon aReniSneba konvulsiebi, benzodiazepinis doza un
pacientis fizikuri mdgomareoba da Tvalyuri adevnon da gadaisinjos da, saWiroebis SemTxvevaSi, gai
medikamentur mkurnalobas (boqsi 18.17). naklebad mZi- zardos. iseTi benzodiazepinis gamoyeneba, romelic
me SemTxvevebSi, aRkveTis simptomebi, Cveulebriv, 4-6 parenteralurad kargad absorbirdeba (mag., lora
dReSi gadis. aucilebelia im pacientebis stacionire- zepami), SeiZleba sasargeblo iyos mZime aRkveTis
ba, romlebsac SeiZleba mZime aRkveTis simptomebi ga- SemTxvevebis Sesamsubuqeblad, Tumca, peroraluri
nuviTardeT (es gansakuTrebiT exeba TeTri cxelebisa medikamentis miReba SeiZleba swrafadve ganaxldes.
da gulyris anamnezis mqone pacientebs)(Ritson, 2005). karbamazepini, aseve, erT-erTi efeqturi saSualebaa
alkoholuri aRkveTis farmakologiuri mkurna alkoholuri aRkveTis samkurnalod. miuxedavad imisa,
lobis kvlevis sistemuri mimoxilva mocemulia Sem rom karbamazepini britaneTSi xSirad ar gamoiyeneba, is
deg wyaroSi: Lingford _ Hughes et al., 2004. upirveles benzodiazepinis kargi Semcvlelia. karbamazepinisa da
sazrunavs aRkveTis mTavari garTulebebis _ gul benzodiazepinis erTad miReba ar zrdis mkurnalobis
yrebisa da TeTri cxelebis, prevencia warmoadgens. efeqturobas (Lingford-Hughes et al., 2004).
maTi mkurnalobis yvelaze efeqturi saSualeba qlomeTiazols winaT xSirad iyenebdnen alkoholuri
benzodiazepinebia. aRkveTis samkurnalod, magram, radgan alkoholTan
benzodiazepinebi gansxvavdeba erTmaneTisgan ze kombinaciaSi is toqsikuria, misi miReba amJamad ar
moqmedebis xangrZlivobis mixedviT. xangrZlivi ze aris rekomendebuli. qlomeTiazols xandaxan iyeneben
moqmedebis mqone benzodiazepinebma xandazmul da gansakuTrebiT mZime aRkveTis mdgomareobebis dros,
RviZlis seriozuli daavadebis mqone adamianebSi rodesac SesaZlebelia stacionaruli pacientis
SeiZleba zedmetad Zlieri sedaciuri efeqti ga intensiuri samedicino monitoringi; magram misi
moiwvios. Tumca, benzodiazepinebis upiratesoba upiratesoba, benzodiazepinis adekvaturi dozis
imaSi mdgomareobs, rom maTi gamoyenebisas aRkveTis gamoyenebasTan SedarebiT, ar aris dadgenili.
procesi naklebad mtkivneulad mimdinareobs da isini, antifsiqozuri saSualebebi adablebs gulyris
Cveulebriv, ukeT amsubuqeben aRkveTis simptomebs. zRurbls da, benzodiazepinTan SedarebiT, deliriumis
xSirad iyeneben preparats _ qlordiazepoqsidi. am prevenciisas naklebad efeqturia. isini xandaxan
bulatoriuli pacientebisTvis Cveulebrivi do gamoiyeneba alkoholuri aRkveTis dros aJitaciis
zaa 20-30mg oTxjer dReSi. mkurnaloba 5-7 dRis Sesamcireblad, magram ufro usafrTxo strategiaa
manZilze mimdinareobs, romlis drosac xdeba dozis benzodiazepinis adekvaturi dozis daniSvna.
TandaTanobiT Semcireba. ufro mZime SemTxvevebSi, vitaminuri danamatebi, gansakuTrebiT Tiamini,
unda gamoviyenoT vernike-korsakovis sindromis
cxrili 18.8 detoqsikaciis dawyebamde prevenciisTvis (gv. ??). maRali riskis mqone pacientebs
gansaxilveli sakiTxebi, (alkoholdamokidebulebis mqone pacientebs, rom
1. rogoria zogadi samedicino riski? lebic cudad ikvebebian) Tiamini parenteralurad
2. romel garemoSia detoqsikaciis Catareba unda miewodos. TeTri cxelebisa da vernikes ence-
mizanSewonili? falopatis dros TiaminiT mkurnalobas yovelTvis
3. ra Sedegs elodeba pacienti detoqsikaciisagan? win unda uswrebdes glukozis miReba (Royal College of
4. ra saxis reabilitacia da movla sWirdeba pacients
Physicians, 2001).
abstinenciis SesanarCuneblad?
boqsi 18.7 detoqsikaciis procesis rogorc zemoT aRiniSna, mkurnalobis mniSvenlovani
zogadi marTva pirveli safexuria pacientisTvis informaciis miwo-
1. pacientisa da misi ojaxis wevrebis unda ganemartos deba da rCevis micema imis Taobaze, Tu ra Sedegebi
detoqsikaciis procesi SeiZleba hqondes alkoholis gadaWarbebulad mox-
2. pacienti unda rCebodes saxlSi da iyos mosvenebul
marebas. miwodebuli informacia unda exebodes paci-
mdgomareobaSi; ar unda dadiodes samsaxurSi an
marTavdes manqanas. entis pirad problemebs, romlebic ukve aRiniSneba an
3. pacientma bevri siTxe unda miiRos, magram Tavi unda SeiZleba aRmocendes, Tu pacienti ganagrZobs alko-
aaridos kofeinis Semcvel sasmelebs. holis miRebas. aseT SemTxvevebSi SeiZleba sasarge-
4. jandacvis sferos muSakma yoveldRiurad unda moi- blo iyos motivaciuri intervius teqnikis gamoyeneba
naxulos pacienti.
(boqsi 18.6).
5. pacientma ar unda miiRos sasmeli; 6. 5-7 dRis
ganmavlobaSi TandaTanobiT unda Semcirdes jgufuri Terapia. jgufuri Terapia saSualebas
benzodiazepiniT mkurnaloba (ix. teqsti) aZlevs pacients, ukeT gaacnobieros alkoholTan da-
_ 474 _
kavSirebuli sakuTari problemebi sxva adamianebze farmakologiuri mkurnaloba, romelic xels
dakvirvebis gziT da SeimuSaos saukeTeso gzebi am uwyobs alkoholuri abstinenciis SenarCunebas
problemebis dasaZlevad. jgufis wevrebi erTad cdi-
disulfirami (antabusi). disulfirami aferxebs alko-
loben gardaqmnan TavianTi cxovreba, rac pacients
holis daJangvis process, ris Sedegadac xdeba acet-
TviTdajerebulobas sZens. arcTu ise didi xnis win,
aldehidis akumulacia. zogierTi pacienti disulfi-
alkoholis samkurnalo specializebul ganyofile-
rams sasargeblod miiCnevs, radganac is imdenad usia-
bebSi mkurnalobas yvelaze ufro gavrcelebul saxes
movno reaqciebs iwvevs (saxis siwiTle, Tavis tkivili
warmoadgenda jgufuri Terapiis stacionaruli pro-
pulsaciis SegrZnebiT, hipoTenzia, pulsis aCqareba,
gramebi, romlebic daaxloebiT rva kvira grZelde-
taqikardia, gulisrevis SegrZneba da pirRebineba),
boda. aseT mkurnalobas, saWiroebis SemTxvevaSi, win
rom xels uSlis alkoholis impulsur miRebas. paci-
uZRvoda detoqsikacia. radgan ar arsebobs imis dama-
entebs SeiZleba aReniSnebodeT kardialuri ariTmia
mtkicebeli faqtebi, rom am tipis intensiur Terapias
da kolafsi.
raime gansakuTrebuli sargebloba moaqvs, klinikebis
disulfiramis gamoyenebis mTavari ukuCvenebebia
umravlesoba dResdReobiT movlis ufro farTo
gulis ukmarisoba, koronaruli arteriuli daavadeba,
speqtrs gvTavazobs, romelic moicavs programebs
hipertenzia, fsiqozi da orsuloba. pacients unda mi-
ambulatoriuli da dRis centrebis pacientebisT-
vceT rogorc sityvieri, aseve werilobiTi instruq-
vis. amgvari programebi gulisxmobs sxvadasxva tipis
cia da, agreTve, CamonaTvali alkoholis Semcveli
fsiqoTerapiul midgomebs, rogoricaa col-qmrisa
im nivTierebebisa, romelTa miRebisgan man Tavi unda
da ojaxuri Terapia, aseve, mkurnalobis kognitur-
Seikavos. Cveulebriv, disulfiramis gverdiTi mov-
bihevioruli meTodebi (ix. qvemoT).
lenebia hipersomnia (anu Zilianoba), pirSi usiamovno
kognitur-bihevioruli Terapia. mkurnalobis kog
suni, gulisrevis SegrZneba da yabzoba. mkurnalobis
nitur-bihevioruli meTodebi Tavad alkoholis
pirvel dRes pacents erTjeradad eZleva disulfi-
miRebis qcevazea mimarTuli da ara im fsiqologiur
ramis 800mg-iani doza. Semdgomi xuTi dRis manZilze
problemebze, romlebic safuZvlad udevs alko-
doza TandaTanobiT iklebs (100-200 mg-mde dReSi).
holizms. amgvari midgomebi xazs usvams alkoholis
disulfiramis efeqturoba damokidebulia ima-
moxmarebis sakiTxebSi pacientis informirebisa da
ze, Tu ramdenad asrulebs pacienti daniSnulebas.
socialuri da interpersonaluri unar-Cvevebis Se-
mkurnaloba ufro warmatebuli iqneba, Tu partniors
muSavebis rols. mag., SeiZleba sasargeblo gamodges
an samedicino personals SesaZlebloba eqneba Tvaly-
iseTi situaciuri an interpersonaluri faqtorebis
uri adevnos mkurnalobis process. Cveulebriv, di-
dadgena, romlebic pirovnebas ubiZgeben gadaWarbebu-
sulfirami amcirebs alkoholis moxmarebis sixSires,
lad moixmaros alkoholi, Semdeg ki am situaciebTan
magram yovelTvis ar uwyobs xels abstinenciis mdgo-
gamklavebis axali meTodebis dagegmva da pacientis
mareobis gaumjobesebas (Garbutt et al., 1999).
gavarjiSeba imaSi, Tu rogor gamoiyenos isini. amas
akamprosati (kalciumis acetilhomotaurinati).
recidivis prevencia ewodeba. pacientze alkoholis
akamprosati axSobs alkoholTan asocirebuli das-
miRebasTan dakavSirebuli stimulebiT zemoqmedeba
wavlili signalebis sapasuxod alkoholis miRebis
alkoholis Semdgomi moxmarebis gareSe, aseve amci-
survilis aRmocenebas da alkoholdamokidebulebis
rebs recidivis risks iseT sazogadoebriv adgileb-
mqone subieqtebSi iwvevs alkoholis miRebasTan da-
Si, sadac alkoholi advilad xelmisawvdomia. mniS-
kavSirebuli qcevebis umniSvnelo, magram pozitiur
vnelovania pacientma gaigos, rom alkoholis miRebis
klebas. iTvleba, rom akamprosati moqmedebs GABA
epizodebi _ `Cavardnebi~, yovelTvis ar gadaizrdeba
inhibitoruli neirotransmisiis gziT da amcirebs
srul recidivSi. mravali pacienti, romelic alko-
glutamatis amgzneb efeqts. Catarda didi raodeno-
hols arasworad moixmars, problemis gadawyvetisT-
biT meta-analizi da randomizebuli kontrolirebadi
vis saWiro unar-Cvevebis deficits ganicdis; maTTvis
kvlevebis sistemuri mimoxilva. rogorc Cans, alko-
Sesabamisi treningis Catarebam SeiZleba recidivis
holis moxmarebisgan Tavis Sekavebis sixSire TiTqmis
riski Seamciros. rodesac pacientebs SedarebiT sta-
ormagdeba. arsebobs imis mtkicebuleba, rom miRweu-
biluri urTierToba aqvT TavianT partniorebTan,
li Sedegi medikamentis miRebis Sewyvetis Semdegac
wyvilebTan Terapiis Catarebam SeiZleba alkoholis
narCundeba. miuxedavad amisa, ar aris dadgenili, Tu
moxmarebasTan dakavSirebuli qcevebis gaumjobese-
ra tipis pacientebisTvisaa sasargeblo akomprosatiT
ba gamoiwvios da, aseve, daareguliros colqmruli
mkurnaloba.
urTierTobebi (sxvadasxva fsiqologiuri mkurnalo-
akamprosatis Cveulebrivi dozaa ori abi (TiTo abi
bis Sesaxeb informaciis mosapoveblad ix. Miller and
_ 333mg) samjer dReSi, saWmlis miRebasTan erTad.
Wilbourne, 2002).
ufro mcire wonis individebiTvis (>60kg) dReSi oTxi
_ 475 _
abis miRebaa rekomendebuli. akamprosati ar metabo- mdgomareoba `tip 2~ alkoholdamokidebulebis dros
lizdeba RviZlSi da Tirkmlebis meSveobiT gamoid- (alkoholdamokidebuleba gvian yalibdeba, dadeb-
evneba. aqedan gamomdinare, naklebad savaraudoa, rom iTi ojaxuri anamnezi, impulsuri/antisocialuri
is sxva medikamentebTan Sevides urTierTqmedebaSi. pirovnuli niSnebi) (Lingford-Hughes et al., 2004).
akomprosatis Tanmxlebi arasasurveli movlenebia
faRaraTi, ufro iSviaTad _ gulis revis SegrZneba, sxva organizaciebi, romlebic alkoholTan daka
pirRebineba da abdominaluri tkivili. aseve, SeiZleba vSirebul problemebze muSaoben
pacients kanze gamonayari da libidos fluqtuacia ànonimuri alkoholikebi~ (AA) aris organizacia,
aReniSnebodes. romelic pirvelad Camoayaliba orma alkoholikma
naltreqsoni. iTvleba, rom naltreqsoni (opiodis mamakacma (qirurgma da brokerma) aSS-Si da romlis
antagonisti) alkoholis zogierTi gamaZlierebeli mizansac sakuTari TavisTvis daxmarebis gaweva war-
efeqtis blokirebas axdens da am gziT amcirebs deto- moadgens. SemdgomSi amgvari organizaciebi msoflios
qsikaciis Semdeg recidivis albaTobas. zogierTma mraval qveyanaSi daarsda. misi wevrebi didi xnis man-
gamokvlevam aCvena, rom mas ar aqvs mniSvnelovani upi- Zilze kviraSi orjer eswrebian jgufur Sexvedrebs.
ratesoba placebosTan SedarebiT. kokreinis mimox- krizisul situaciebSi maT telefonis meSveobiT Seu-
ilvis Tanaxmad (Srisurapont and Jarusuraisin, 2003), nal- ZliaT jgufis sxva wevrebisgan dauyovnebeli dax-
treqsoni efeqturia alkoholuri damokidebulebis marebis miReba. organizaciaSi myarad icaven Semdeg
moklevadiani mkurnalobis dros, magram misi upirate- princips: misma wevrebma alkoholis miRebaze saerTod
soba disulfiramTan an akamprosatTan SedarebiT ar unda Tqvan uari. dResdReobiT britaneTSi anonimuri
aris dadgenili. SesaZloa, naltreqsonis mTavari efeq- alkoholikebis daaxloebiT 1200 jgufi arsebobs.
ti imaSi mdgomareobs, rom is xels uSlis alkohol- alkoholTan dakavSirebuli problemebis mqone
ozmis mkurnalobisas umniSvnelo `Cavardnebis~ srul pirebi xSirad Tavs arideben aseT jgufebSi gaer-
recidivSi gadazrdas. aqedan gamomdinare, naltreqso- Tianebas, radgan jgufuri Sexvedrebi sakuTari
nis miReba ar unda Sewydes im SemTxvevaSic ki, Tu paci- problemebis Sesaxeb emociurad datvirTul sajaro
enti agrZelebs alkoholis miRebas. misi efeqturoba saubars gulisxmobs. organizacias didi sargebloba
SeiZleba gaizardos, Tu pacients paralelurad kog- moaqvs alkoholdamokidebuli pirebisTvis, amitom
nitur-biheviorul Terapias CavutarebT (Garbutt et al., isini unda wavaxalisoT, gaerTiandnen am jgufebSi.
1999). naltreqsoniT mkurnalobis gverdiTi movle- mkurnalobis mimarT ànonimuri alkoholikebis~ ms-
nebia Tavis tkivili, Tavbrusxveva da wonaSi dakleba. gavsi midgomaa gamoyenebuli erT-erT fsiqologiur
antidepresantebi. antidepresantebiT mkurnaloba TerapiaSi, romelic MATCH-is proeqtSi xorcield-
sasargebloa im pacientebisTvis, romlebsac deto- eba (ix. qvemoT). aRmoCnda, rom mkurnalobis gamoy-
qsikaciis Semdeg Rrma depresiis persistentuli simp- enebul meTodebs Soris efeqturobis TvalsazrisiT
tomebi aReniSnebaT. miuxedavad amisa, tricikluri didi gansxvaveba ar SeiniSneba. miuxedavad amisa, paci-
antidepresantebi ar aris rekomendebuli potenciu- entebi, romlebsac naklebi fsiqiatriuli problemebi
rad seriozuli urTierTzemoqmedebaTa gamo, ramac aqvT, MATCH-is proeqtSi monawileobisas ukeTes
SeiZleba kardiotoqsikuroba an hiperdozirebiT Sedegebs aRweven, vidre ànonimuri alkoholikebis~
sikvdili gamoiwvios (Lingford-Hughes et al., 2004). zo- programiT mkurnalobis dros.
gierTma gamokvlevam aCvena, rom serotoninis ukumi- àl-anoni~ aris analogiuri organizacia, romelic
tacebis seleqciur inhibitorebs, rogoricaa, mag., daxmarebas uwevs alkoholis Warbad momxmareblebis
citaloprami, SeuZlia alkoholdamokidebulebis meuRleebs. organizacia àl-atini~ exmareba alko-
mqone aradepresiuli avadmyofis SemTxvevaSi alkoholmomxmareblebis Svilebs, romlebic gardamaval
holis moxmarebis Semcireba gamoiwvios. Tumca, yve- asakSi imyofebian.
la gamokvleva ar adasturebs am faqts (Chick, 2000). nebayoflobiTi organizaciebi alkoholTan da-
zogierTi gamokvlevis ganmeorebiTi analizi saSu- kavSirebuli problemebis mqone adamianebsa da maT
alebas gvaZlevs vivaraudoT, rom serotoninis mi- ojaxis wevrebs sxvadasxva tipis daxmarebas sTavazo-
tacebis seleqciuri inhibitorebis efeqtebi vari- ben. aq maT rCevebisa da konsultaciebis miReba Seu-
rebs klonin~enisa da misi kolegebis (Cloningen, et al., ZliaT. ukve gamojanmrTelebul adamianebs exmarebian
1998) mier aRwerili `tipi 1~ da `tipi 2~ kategoriebis dasaqmebasa da socialur aqtivobaSi.
mixedviT. serotoninis ukumitacebis seleqciuri in- saerTo sacxovreblebi umTavresad usaxlkaro
hibitorebis gamoyenebam SeiZleba dadebiTi Sedegebi alkoholikebisTvis aris gankuTvnili. aq maT reabil-
mogvces alkoholdamokidebulebis dros, romelic itacia da konsultaciebi utardebaT. aq cxovrebis
`tip 1~-s (alkoholdamokidebuleba adre yalibdeba, aucilebeli pirobaa is, rom pirovnebam uari unda Tq-
SfoTvis niSnebi) miekuTvneba da, piriqiT, gaauaresos vas alkoholis miRebaze.
_ 476 _
mkurnalobis Sedegebi ani~ filosofia. kvlevis mTavari mizani iyo pacientis

iseTi maxasiaTeblebis dadgena, romelTa meSveobiTac
edvardsma da misma kolegebma (Edwards et al., 1977) 100
SesaZlebeli iqneboda mkurnalobis TiToeul tipze
alkoholik mamakacze Caatares kontrolirebadi kv-
reagirebis prognozi. mkurnalobis tipebs Soris,
leva, romelSic erTmaneTs adarebdnen pacientebis
maTi efeqturobis TvalsazrisiT, mniSvnelovani gan-
or jgufs. erT jgufs aZlevdnen rCevebs, xolo
sxvaveba ar aRiniSna. garda amisa, mxolod ramdenime
meore jgufs utardeboda intensiuri mkurnaloba,
SemTxvevaSi dadginda maRali korelacia mkurnalo-
romelSic Sedioda ànonimur alkoholikebTan~ Sex-
bis tipis efeqturobasa da pacientis maxasiaTeblebs
vedrebi, medikamenturi mkurnaloba, mravaljera-
Soris. miuxedavad amisa, zogadad, Sedegebi dadebiTi
di interviuireba, konsultacieb meuRleebTan da,
aRmoCnda da avtorebma is daskvna gamoitanes, rom
saWiroebis SemTxvevaSi, stacionaruli mkurnaloba.
sxvadasxva saxis struqturirebuli fsiqologiuri
pirvel jgufs Cautarda samsaaTiani gamokvleva da
mkurnaloba sasargebloa alkoholis arasworad mox-
konsultaciis erTi seansi, romelsac meuRleebic
marebis marTvisTvis.
eswrebodnen. sxva parametrebis mixedviT jgufebi ar
savaraudod, arsebobs pacientTan dakavSirebuli
gansxvavdebodnen erTmaneTisgan. Tormeti Tvis Sem-
faqtorebi, romlebic sxvadasxva tipis mkurnalo-
deg jgufebs Soris ar SeiniSneboda mniSvnelovani
bis Catarebisas dadebiTi prognozis saSualebas
gansxvaveba alkoholis moxmarebasTan dakavSirebuli
iZleva. arsebobs azrTa sxvadasxvaoba imis Taobaze,
qcevis, subieqturi Sefasebebisa da socialuri adap-
Tu romelia es faqtorebi. nebismieri mkurnalobis
taciis TvalsazrisiT.
Catarebisas, saukeTeso prognozi, zogadad, Semdeg
alkoholis moxmarebis qcevasTan dakavSirebuli ms-
faqtorebzea damyarebuli: pacientis mier sakuTari
gavsi Sedegebi miiRes Cikma da misma kolegebma (Chick
problemebis naTlad gacnobiereba; socialuri sta-
et al., 1998). orwliani Semdgomi dakvirvebis Sedegad
biluroba, rac gulisxmobs mudmivi sacxovrebeli ad-
aRmoCnda, rom stabiluri alkoholuri abstinenciis
gilis qonas, mxardaWeras ojaxis mxridan da samuSaos
sixSiris mixedviT, ar SeiniSneba gansxvaveba im paci-
SenarCunebas; sakuTari impulsurobis kontrolis un-
entebs Soris, romlebTanac minimaluri Careva ganx-
ari; sakuTari survilebis myisieri dakmayofilebis-
orcielda (ZiriTadad, rCevis micema) da romlebsac
gan Tavis Sekaveba da adamianebTan damakmayofilebeli
sxvadasxva saxis Terapia CautardaT (stacionaruli
emociuri urTierTobebis Camoyalibeba.
mkurnalobisa da jgufuri Terapiis CaTvliT). Tum-
alkoholis moxmarebiT gamowveuli aSlilobebis sx-
ca, meore jgufSi naklebi iyo alkoholis moxmare-
vadasxva meTodebiT mkurnalobis efeqturoba ganxi-
biT gamowveuli zianis SemTxvevebi (gansakuTrebiT,
lulia Semdeg wyaroSi: Miller and Wilbourne, 2002.
ojaxur cxovrebaSi).
zogierTs miaCnia, rom alkoholis miRebisgan Tavis
alkoholmoxmarebisa da
Sekavebis sixSiris maCvenebeli mkurnalobis rezul-
tatis zust sazoms ar warmoadgens. mag., pirovnebam, alkoholdamokidebulebis prevencia
romelic ganagrZobs smas, SeiZleba naklebi odenobis arsebobs alkoholis Warbad moxmarebisa da alko-
alkoholi miiRos, rac, rogorc ukve aRiniSna, amci- holTan dakavSirebuli aSlilobebis prevenciis ori
rebs alkoholis moxmarebiT gamowveul zians (Chick et SesaZlo gza. pirveli midgoma gulisxmobs calkeuli
al., 1998). am TvalsazrisiT, zianis Semcireba (maSinac individebisTvis daxmarebis gawevisa da maTi warmarT-
ki, rodesac pirovneba agrZelebs alkoholis miRebas) vis xarisxis gaumjobesebas. meore ki _ iseTi social-
mniSvnelovani miRwevaa. zianis Semcirebaze mimarTu- uri cvlilebebis ganxorcielebas, romlebic zemoq-
li midgomis principebi sxva fsiqoaqtiuri nivTiere- medebas moaxdenen alkoholis moxmarebis paternze
bebis arasworad moxmarebis drosac gamoiyeneba (ix. mTel populaciaSi. arsebobs mosaxleobaSi alkohol-
qvemoT). is moxmarebis Semcirebis oTxi meTodi:
interesi struqturirebuli fsiqologiuri mkur 1. alkoholuri sasmelebis Rirebuleba. alkoholur
nalobis efeqturobis mimarT kidev ufro gaizarda sasmelebze fasis awevam, SesaZlebelia, maTi mox-
MATCH-is programis Sedegebidan gamomdinare. es marebis Semcireba gamoiwvios (ix. zemoT).
programa alkoholTan dakavSirebuli problemebis 2. reklamis kontroli. alkoholuri sasmelebis rek
sami saxis fsiqologiuri mkurnalobis farTo ran- lamirebaze kontrolis daweseba an misi akrZalva
domizebul kontrolirebad gamokvlevas warmoadgens kidev erT SesaZlo prevenciul zomas warmoadgens.
(Project MATCH Research Group 1997). Seiswavleba kogni- ar aris naTeli, reklama garkveuli alkoholuri
tur-bihevioruli intervencia, motivaciuri Terapia brendis moxmarebas ufro uwyobs xels, Tu zoga-
da mkurnaloba, romlis mizania daexmaros adamianebs, dad alkoholis. miuxedavad amisa, 1980-2000 wlebSi,
gamoiyenon anonimuri alkoholikebis `12-safexuri- britaneTSi alkoholis reklamirebaze daxarjuli
_ 477 _
yovelwliuri Tanxa 150 milioni girvanqa sterlin- turobas Zalian cota damajerebeli faqti adas-
gidan 250 milion girvanqa sterlingamde gaizarda. turebs (Room et al., 2005).
am periodSi Zalian maRali iyo korelacia reklam-
aze daxarjul Tanxasa da 11-15 wlis bavSvebis mier sxva fsiqoaqtiuri nivTierebebis
kviraSi moxmarebuli alkoholis saSualo raodeno-
moxmarebiT gamowveuli aSlilobebi
bas Soris (Academy of Medical Sciences, 2004).
am qveTavSi SevexebiT alkoholisgan gansxvavebuli
3. kontroli gayidvaze. erT-erTi prevenciuli zomaa
fsiqoaqtiuri nivTierebebis gamoyenebas da maT avad
alkoholiT vaWrobaze kontrolis daweseba. es Sei-
moxmarebas. miuxedavad imisa, rom amgvar fsiqoaqti-
Zleba ganxorcieldes supermarketebSi alkohol-
ur nivTierebebSi aqroladi nivTierebebic (inhalan-
uri sasmelebis gayidvis akrZalviT an maTi gayidvis
tebi) igulisxmeba, Cven gamoviyenebT zogadi xasiaTis
saaTebis SezRudviT. miuxedavad imisa, rom zogierT
termins _ `narkotikuli nivTierebebi~, radgan maTi
qveyanaSi SezRudvebis Sesustebam alkoholuri sa-
moxmareba yvelaze ufro gavrcelebulia. termins _
smelebis gayidvis zrda gamoiwvia, es imas ar niSnavs,
àvadmoxmareba~, imave mniSvnelobiT vixmarT, rac ma-
rom SezRudvebis gamkacreba Seamcirebs alkoholis
vne SedegebiT gamoyenebas (ICD-10) da borotad gamoy-
moxmarebis dones. Tumca faqtia, rom alkoholis
enebas (DSM-IV) aqvs (cxrili 18.3).
legalur moxmarebaze maRali asakobrivi zRurblis
daweseba dakavSirebulia skoladamTavrebul axal-
epidemiologia
gazrdebTan alkoholis moxmarebis, avtokatastro-
febisa da suicidis SemTxvevebis SemcirebasTan akrZaluli narkotikuli nivTierebebi
(Links, 2000). britaneTis mraval qalaqSi matulobs 2003 wels aSS-Si Catarebulma erovnulma gamokvlevam
SeSfoTeba imis gamo, rom Ramis cxovrebis kul- narkotikuli nivTierebebis gamoyenebisa da janmr-
turam mZime loTobis gavrceleba gamoiwvia. Telobis Sesaxeb aCvena, rom 2002 wels mosaxleobis
4. mosaxleobis informireba jansaRi cxovrebis we- 14.7%, romelic asakiT 11 wels aRemateboda, akrZa-
sis Sesaxeb. ar aris cnobili, Tu ramdenad efeqtu- luli narkotikuli nivTierebebis momxmarebeli iyo
ria alkoholis arasworad gamoyenebis mavneblobis (Substance Abuse and Mental Health Services Administration
Sesaxeb informaciis miwodeba. aseve, naklebad aris [SAMHSA], 2004). garda amisa, 46, 4% Tavisi cxovrebis
cnobili, Tu rogor yalibdeba an cvalebadobs manZilze ama Tu im akrZalul narkotikul nivTiere-
alkoholis mimarT damokidebuleba. marTalia, ak- bebs moixmarda. moxmarebis yvelaze ufro maRali done
loholis mavneblobis Sesaxeb informaciis miwode- 16-dan 25 wlamde umuSevar adamianebTan dafiqsirda,
ba namdvilad sasurvelia, magram es ar niSnavs imas, xolo yvelaze ufro gavrcelebuli narkotikuli
rom leqciebisa da masmediis saSualebiT gatarebul nivTiereba kanabisi aRmoCnda (akrZalul narkotikul
propagandas alkoholis mimarT damokidebulebis nivTierebaTa momxmareblebis 55% mxolod kanabiss
Secvla SeuZlia. zogadad, aseTi midgomis efeq- moixmarda). britaneTSi Catarebulma danaSaulebrivi
qcevis gamokvlevam (British Crime Survey) igive Sedegebi
aCvena: britaneTSi 2001 wels zrdasruli adamianebis
12% akrZalul narkotikul nivTierebebs moixmarda,
boqsi 18.8 samedicino mecnierebaTa
yvelaze ufro xSirad ki kanabiss. britaneTis mo-
akademiis zogierTi rekomendacia (2004)
britaneTSi alkoholis moxmarebiT ga saxleobis daaxloebiT 3% A klasis narkotikul niv-
mowveuli zianis Semcirebis Sesaxeb Tierebebs (opiati, kokaini, lizergiuli mJavis dieTi-
lamidi [LSD], ineqciuri stimulantebi) iyenebda (Aust
w gaizardos gadasaxadebi alkoholze, raTa maTi xel
misawvdomobisa da Semosavlis Tanafardoba gautoldes
et al., 2002).
70-iani wlebis dasawyisSi arsebul Tanafardobas britaneTSi 15-16 wlis asakis 7722 skolis moswav-
w Semcirdes alkoholur sasmelebis fasze dawesebuli lis gamokiTxvis Sedegad (mocemuli gamokiTxva ev-
sabaJo SeRavaTi mgzavrebisTvis ropaSi Catarebuli vrceli gamokiTxvis nawils war-
w gadaixedos alkoholuri sasmelebis reklamireba da moadgenda), milerma da plantma (Miller and Plant, 1996)
promocia (gansakuTrebiT axalgazrdebisTvis)
daadgines, rom mozardebis 42% zogjer iyenebs
w gaumjobesdes samedicino gamokvlevebi alkoholis
mavne zegavlenis Sesaxeb akrZalul narkotikul nivTierebebs, ufro xSirad ki
w sazogadoebas miewodos saWiro informacia da xeli kanabiss. es jvaredin-seqciuri kvleva ar gvawvdis in-
Seewyos debatebs alkoholis moxmarebis Sedegad formacias regularuli momxmareblebis Sesaxeb. Tum-
gamowveuli zianis Sesaxeb (ix. boqsi 18.1).
ca, igi imaze miuTiTebs, rom akrZaluli narkotikuli
w mZRolebisaTvis sisxlSi alkoholis kanoniT dasaSvebi
koncentraciis done Semcirdes 80%-dan 50%-de, xolo nivTierebebiT eqsperimentireba am asakis mozardTa
axalgazrda mZRolebisTvis (21 wlamde) dadgindes jgufSi Cveulebriv movlenas warmoadgens. maRalia
sisxlSi alkoholis Semcvelobis nulovani done. korelacia sigaretis mowevasa da kanabisis moxmare-
_ 478 _
sxva fsiqoaqtiuri nivTierebebis moxmarebiT gamowveuli aSlilobebi
bas Soris. aseve, akrZalul narkotikul nivTiere- bulebis yvelaze maRali sixSire dafiqsirda zrdas-
bebs ufro xSirad moixmaren biWebi, vidre gogonebi, rul adamianebSi, gansakuTrebiT 16-24 wlis mamakaceb-
Tumca, maT Soris gansxvaveba umniSvneloa (biWebis Si. gamokiTxvis adreul fazaze SerCeuli usaxlkaro
43%-ma da gogonebis 38%-ma daafiqsira, rom kanabiss adamianebis 24% (Gill et al., 1996), romelsac quCaSi
moixmarda). mogvianebiT evropaSi Catarebuli gamok- eZina, wamaldamokidebulebis kriteriumebs akmayo-
iTxvis Semdgomma etapma (2003 wels) aCvena, rom bri- filebda. britaneTSi narkotikuli nivTierebis mox-
taneTSi, narkotikuli nivTierebebis moxmarebis mo- marebis yvelaze ufro maRali maCvenebeli patimrebs
nacemebSi ar aRiniSneboda mniSvnelovani cvlilebebi. Soris dafiqsirda. maTi umravlesoba adasturebda,
gamokiTxvebis es faza 35 evropul qveyanas moicavda. rom warsulSi akrZalul narkotikul nivTierebebs
SerCeuli populaciis monacemebis mixedviT, am qvey- iyenebda (Singleton et al., 1997). winaswar patimrobaSi
nebSi britaneTs saSualoze mniSvnelovnad maRali myofi mamakacebis 51% da qalebis 54% acxadebda, rom
maCvenebeli aRmoaCnda im axalgazrdebis wilis mixed- isini cixeSi moxvedramde ukve iyvnen narkotikul niv-
viT, romlebic kanabiss an sxva akrZalul narkotikul Tierebebze damokidebulni. msjavrdebulTa Soris
nivTierebebs moixmardnen. britaneTs axalgazrdebis wamaldamokidebuleba mamakacebis 43%-s da qalebis
mniSvnelovani nawili Ramis klubebSi dadis, sadac 41%-s daudasturda.
narkotikuli saSualebebis kombinirebuli araswori wamalmoxmarebisa da wamaldamokidebulebis sixSire
moxmareba Cveulebriv movlenas warmoadgens. 18 wlis maRalia didi qalaqebis SedarebiT Rarib raionebSi.
axalgazrdebis erTi meoTxedi or an met akrZalul mozardebi (gansakuTrebiT damamTavrebeli klasis)
narkotikul nivTierebas moixmars (Robson, 2000). maRali riskis jgufs miekuTvnebian. didi qalaqebis
klinikebis (romlebic wamaldamokidebulebaze muS-
wamalmoxmareba da wamaldamokidebuleba
aoben) pacientebis umetesoba umuSevaria. maT, sxva
sxvadasxva tipis narkotikuli nivTierebebis araswori adamianebisgan gansxvavebiT, naklebad axasiaTebT sta-
moxmarebisa da maTze damokidebulebis gavrcelebis biluri urTierTobebi da isini, Cveulebriv, araor-
Sesaxeb danamdvilebiT cota ram aris cnobili. bri- ganizebul cxovrebas ewevian. Tumca, narkotikuli
taneTSi amis Taobaze informacias ramdenime wyaro- nivTierebis momxmarebeli bevri axalgazrda dasaqme-
dan iReben. esenia: kriminaluri statistika, romelic, bulia. am axalgazrdebis wrisTvis, rogorc Cans, nar-
ZiriTadad, wamalmoxmarebasTan dakavSirebul kanond- kotikuli nivTierebebis moxmareba tipiur rekreaci-
arRvevebs efuZneba; specialuri gamokiTxvebi da hos- ul aqtivobas wrmoadgens.
pitalizaciis SemTxvevebi. britaneTis saTavo ofisi
mravali wlis manZilze awarmoebda im adamianebis reg- wamalmoxmarebis mizezebi
istracias, romlebsac eqimebma wamaldamokidebuleba
wamalmoxmarebas yovelTvis ramdenime mizezi aqvs; iT-
daudgines, magram 1997 wels registracia Sewyda. arc
vleba, rom mas oTxi ZiriTadi faqtori ganapirobebs:
erTi zemoT naxsenebi wyaro ar iZleva sakmaris in-
1. narkotikuli nivTierebebis xelmisawvdomoba;
formacias, radganac wamalmoxmarebis mravali SemTx-
veva aRuricxavi rCeba. qveyanaSi wamalmoxmarebisa da 2. pirovnuli maxasiaTeblebi, romlebic mowyvlado-
wamaldamokidebulebis gavrcelebis sixSiris Sesaxeb bas ganapirobeben;
arsebuli monacemebi sakmaod gansxvavebulia (nawilo- 3. araxelsayreli socialuri garemo;
briv imitomac, rom mkvlevarebi Sefasebis gansxvave- 4. farmakologiuri faqtorebi.
bul meTodebs iyeneben). aSS-Si Catarebuli `komor-
akrZaluli narkotikuli nivTierebebis ioli xelmi-
bidobis erovnuli gamokiTxvis~ mixedviT (Kessler at
sawvdomoba imis maniSnebelia, rom axalgazrdis mier
al., 1994), wamalmoxmarebisa da wamaldamokidebulebis
maTi drogamoSvebiT moxmareba aRar miiCneva paTolo-
gavrcelebis sixSire erTi wlis manZilze 3, 6%-s
giur qcevad. Tumca, adamianebis daaxloebiT 10%-s,
Seadgenda, xolo mTeli cxovrebis manZilze _ 11, 9%-
romelic akrZaluli narkotikuli nivTierebebiT
s. wamalmoxmareba da wamaldamokidebuleba erTi wlis
eqsperimentirebas eweva, momavalSi maT moxmare-
manZilze mamakacebSi orjer ufro meti aRmoCnda (5,
basTan dakavSirebuli problemebi uCndeba (Robson,
1%), vidre qalebSi (2, 2%).
2000). rogorc ki pirovneba narkotikuli nivTiere-
fsiqiatriuli morbidobis britanuli gamokvlevis
bebis miRebas iwyebs, maTi araswori moxmarebisa da
mixedviT (Coulthard et al., 2002), im pirebs Soris, rom-
maTze damokidebulebis CamoyalibebaSi garkveuli
lebsac sakuTari sacxovrebeli aqvT, zrdasruli ada-
wvlili Seaqvs pirovnul, socialur da farmakolo-
mianebis 4% wamaldamokidebulebis kriteriumebs ak-
giur faqtorebs. gamokvlevebi, romlebic Seiswavlian
mayofilebda, umravlesoba ki kanabisis momxmarebeli
alkoholisgan gansxvavebuli fsiqoaqtiuri nivTiere-
iyo. wamaldamokidebuleba mamakacebSi, qalebTan Se-
bebis arasworad moxmarebas, jer kidev ar aris sak-
darebiT, orjer ufro meti aRmoCnda. wamaldamokide-
marisad srulyofili. mag., ar aris naTeli, sxvadasxva
_ 479 _
fsiqoaqtiuri nivTierebis (alkoholis CaTvliT) avad kavSiri wamalmoxmarebasa da socialur deprivacias
moxmarebas msgavsi risk-faqtorebi gansazRvravs, Tu Soris, rogoricaa, mag., umuSevroba da usaxlkaroba
arsebobs konkretuli meqanizmebi, romlebic ganapi- (Gill et al., 1996).
robeben garkveuli tipis adamianebis mier garkveuli
narkotikuli nivTierebebis gamoyenebis,
fsiqoaqtiuri nivTierebis avad moxmarebas.
wamalmoxmarebisa da wamaldamokidebulebis
narkotikuli nivTierebebis xelmisawvdomoba neirobiologia
arsebobs avad moxmarebuli narkotikuli nivTiere- narkotikuli nivTierebebis gamoyeneba, wamalmoxma-
bebis mopovebis sami ZiriTadi saSualeba: reba da wamaldamokidebuleba. bevr adamians, romle-
1. narkotikuli nivTierebebis legalurad SeZena re- bic narkotikul nivTierebebs moixmaren ar aReniSneba
ceptis gareSe. dRevandel dRes amis TvalsaCino wamalmoxmareba (anu narkotikuli nivTierebebis avad
magaliTia nikotinisa da alkoholis SeZena. mecx- moxmareba), da arc wamaldamokidebuleba uyalibde-
ramete saukuneSi opioidebze damokidebulebas xSi ba. amitom sasargebloa cal-calke SeviswavloT is
rad iwvevda morfinis Semcveli samkurnalo saSu- biologiuri meqanizmebi, romlebic safuZvlad udevs
alebebis gamoyeneba, romelTa SeZena Tavisuflad narkotikuli nivTierebebis gamoyenebas, wamalmoxma-
SeiZleboda. rebasa da wamaldamokidebulebas. narkotikuli niv-
2. narkotikuli nivTierebebis SeZena eqimis mier ga Tierebebis gamoyenebisa da maTi araswori moxmarebis
mowerili receptiT. meoce saukunis pirvel nax- mizezi aris is, rom maT aqvT qcevis dadebiTi ganmt-
evarSi dasavleTis qveynebSi opioidebsa da barbi- kicebis unari, rac, Tavis mxriv, zrdis iseTi qceve-
turatebze damokidebulebis cnobili SemTxvevebis bis sixSires, romlebsac maT gamoyenebamde mivyavarT
umetesi nawili, ufro mogvianebiT ki, benzodiaze- (Robbins and Everitt, 1999). narkotikuli nivTierebebi
pinze damokidebuleba, xSirad am gziT yalibdeboda. imitom moqmedeben, rogorc dadebiTi ganmamtkiceb-
3. narkotikuli nivTierebebis SeZena arakanonieri lebi, rom maT SeuZliaT pozitiuri subieqturi ganc-
gziT (`quCis narkotikebi~). debis gamowveva (rogoricaa, mag., eiforia an SfoTvis
Semcireba).
pirovnuli faqtorebi neirobiologiuri meqanizmebi. amgvari efeqte-
imaT, vinc narkotikuli nivTierebebiT eqsperimenti- bis gamaSualebeli mniSvnelovani neirobiologiuri
rebas eweva da visac SemdgomSi amasTan dakavSirebiT substrati Sua tvinis dofaminis sistemaa, romlis
problemebi uCndeba, rogorc Cans, am nivTierebebis soma warmoqmnilia ventralur segmentur ubanSi da
mimarT garkveuli xarisxis pirovnuli mowyvladoba uzrunvelyofs winatvinis, gansakuTrebiT ki nucleus
axasiaTebT. isini SeiZleba arasrulfasovan ojaxeb- accumbens (mimdebare birTvebis) inervacias. gamoTq-
Si cxovrobdnen da SedarebiT adreul asakSi daiwyes mulia mosazreba, rom es dofaminuri gzebi warmoad-
narkotikebis miReba. aseTi bavSvebisTvis damaxasiaTe- gens fiziologiuri dajildovebis sistemis nawils.
beli qcevebia dabali akademiuri moswreba, skolis am sistemas SeuZlia gazardos iseT qcevaTa sixSire,
xSirad gacdena da kanonis daRveva; aseve, sxvadasxvag- romlebic mis gaaqtiurebas iwveven. sxvadasxva saxis
vari SegrZnebebis gamocdis survili da impulsuro- narkotikuli nivTierebebis, alkoholis, nikotinisa
ba. wamalmomxmareblebs xSirad aReniSnebaT SfoTva da da opioidebis cxovelebSi Seyvana zrdis dofaminis
depresia; Tumca, Zneli dasadgenia es mdgomareobebi gamoyofas mimdebare birTvSi. es imas niSnavs, rom Sua
wamalmoxmarebisa da wamaldamokidebulebis mizezia tvinis dofaminuri gzebis gaaqtiureba, SeiZleba, nar-
Tu Sedegi. zogierT SemTxvevaSi ojaxSi fiqsirdeba kotikul nivTierebaTa moxmarebis (aseve, maTi avad
fsiqikuri daavadebis an personologiuri aSlilobis moxmarebis) saerTo maxasiaTebeli iyos. miuxedavad
SemTxvevebi. imisa, rom mocemuli hopoTeza nawilobriv gvixsnis
garkveuli narkotikuli nivTierebebis socialur ga-
socialuri garemo
moyenebas, is ver ixsnis zogierT viTarebaSi maT bo-
wamalmoxmarebis riski ufro maRalia im sazogadoeba- rotad moxmarebas. rogorc Cans, narkotikebis moxma-
Si, romlisTvisac misaRebia narkotikuli nivTiere- reba ramdenime faqtoris urTierTqmedebis Sedegia.
bebis sxvadasxva saxiT moxmareba. jgufi, romelsac es faqtorebia: narkotikuli nivTierebis farmakolo-
axalgazrda miekuTvneba, SeiZleba axorcielebdes so- giuri Tvisebebi, biologiuri dispozicia, momxmareb-
cialur zewolas, raTa axalgazrdam statusis mosa- lis personologiuri maxasiaTeblebi da socialuri
poveblad narkotikuli nivTiereba gamoiyenos. amg- garemo. wamaldamokidebulebis Tanamedrove neiro-
varad, individis mier narkotikuli nivTierebis mox- biologiuri interpretacia yuradRebas amaxvilebs
marebaze gavlenas axdens Tanatolebis mier fsiqoaq- genebis eqspresiasa da prefrontaluri qerquli ubnis
tiuri nivTierebebis moxmareba. agreTve, arsebobs sinafsur kavSirebSi, iseve rogorc dajildovebasa da
_ 480 _
motivaciaSi monawile limbur ubnebSi, mimdinare cv- livi mkurnalobisas, Tavs iCens GABA-s da benzodia-
lilebebze. dofaminuri sistemis gaaqtiurebis meqa- zepinis receptorTa mgrZnobelobis adaptaciuri cv-
nizmi gvixsnis imas Tu ratom xdeba, rom narkotiku- lilebebi. es cvlilebebi akompensirebs am nivTiere-
li nivTierebebis mravaljeradi moxmareba pirovnebis baTa efeqts, raTa gaaiolos GABA-s neirotransmisia.
qcevas mTlianad narkotikuli nivTierebis moxmarebis aseTi efeqti SeiZleba tolerantobas ganapirobebdes,
Cvevis samsaxurSi ayenebs da wamaldamokidebul ada- rac imaSi vlindeba, rom erTi da imave farmakologiu-
mianebSi iwvevs gansjisa da gadawyvetilebis miRebis ri efeqtis misaRebad pirovnebas sWirdeba sul ufro
unaris daqveiTebas (Volkow and Li, 2004). meti narkotikuli nivTierebis miReba.
fiziologiuri da arafiziologiuri wamaldamoki- Tu narkotikis miRebis Sewyveta ucbad xdeba, recep-
debuleba. tradiciulad, ganasxvaveben narkotikul toris funqciaSi mimdinare persistentulma adapta-
saSualebebze fsiqologiur da fiziologiur damo- ciurma cvlilebebma SeiZleba gamoiwvios GABA aqti-
kidebulebas. DSM-IV-Si narkotikul nivTierebebze vobis mkveTri Semcireba. anqsiolizuri narkotikuli
damokidebuleba kategorizebulia fiziologiur da nivTierebebis moxmarebis aRkveTis mravali klinikuri
arafiziologiur damokidebulebad. fiziologiu- niSani (SfoTva, insomnia, gulyra) SeiZleba aixsnas Ta-
ri damokidebulebis diagnozs svamen maSin, rodesac vis tvinSi GABA funqciis SesustebiT. aseTi efeqti
fsiqoaqtiuri nivTierebis momxmarebeli toleran- gvisxnis gadamkveTi tolerantobis cnobil fenomens
tobas avlens narkotikuli nivTierebebis farmako- anqsiolizur da hipnozur nivTierebebsa da alkohols
logiuri zemoqmedebis mimarT an, rodesac mas maTi Soris, rac benzodiazepinebiT alkoholis aRkveTis
moxmarebis Semcirebisas aRkveTis sindromi uviTar- mdgomareobis mkurnalobis saSualebas iZleva.
deba. rogorc fiziologiuri, aseve arafiziologiu- iTvleba, rom msgavsi adaptaciuri cvlilebebi ga-
ri damokidebulebis mTavar maxasiaTebelia narko- napirobebs tolerantobisa da aRkveTis fenomenebs,
tikuli nivTierebis miRebis Zlieri survili da mis romlebsac sxva narkotikuli nivTierebebis borotad
mopovebaze mimarTuli qceva. rogorc zemoT iTqva, moxmarebisas vxvdebiT. mag., opioidebis swrafi Sey-
amas ganapirobebs narkotikuli nivTierebis, rogorc vana tvinis ReroSi iwvevs noradrenalinis aqtivobis
dadebiTi ganmamtkiceblis, mopovebis ganuwyveteli daqveiTebas da agznebis Sesustebas. preparatis gan-
saWiroeba. aq, albaT, mniSvnelovan rols asrulebs meorebiTi gamoyenebisas, am efeqtis mimarT toleran-
daswavlisa da ganpirobebis faqtorebi (Robbins and toba izrdeba, rac, albaT, opioidebis receptorebis
Everitt, 1999). mgrZnobelobaSi momxdari adaptaciuri xasiaTis cv-
unda aRiniSnos, rom arafiziologiuri damokidebu- lilebebis Sedegia. Tu xdeba opoiodebis moxmarebis
lebis SemTxvevaSic ki, iseTi fenomenebi, rogorebi- myisieri aRkveTa, ucbad izrdeba noradrenalinis ga-
caa narkotikis miRebis Zlieri survili da disforia, moTavisufleba terminalur ubnebSi. noradrenalinis
Tavis tvinis funqciis SecvlasTanaa dakavSirebuli. aqtivobis gaZliereba ganapirobebs opioidebis mwvave
eqsperimentuli gamokvlevebi gviCvenebs, rom kokainis aRkveTis ramdenime klinikur gamovlinebas, maT Soris
Sewyveta garkveuli drois manZilze misi moxmarebis oflianobas, taqikardias, hipertenziasa da SfoTvas.
Semdeg, iwvevs dofaminis gamoyofis mkveTr daqveiTebas am kvlevebis safuZvelze opioidebis aRkveTis marT-
mimdebare birTvSi (nucleus accumbens). amgvari efeqtis visTvis gamoiyeneba noradrenalinis autoreceptore-
klinikuri korelatebi SeiZleba iyos iseTi simptomebis agonistebi _ klonidini da lofeqsidini (gv. ??).
bi, rogorebicaa anhedonia da maqsimaluri raodenobis miuxedavad imisa, rom gavrcelebuli Sexedulebis
narkotikuli nivTierebis mopovebis Zlieri survili. Tanaxmad, narkotikuli nivTierebebis uwyveti moxma-
reba ZiriTadad ganpirobebulia maTi dadebiTi ganmt-
tolerantobisa da damokidebulebis neirobio
kicebis efeqtiT, savaraudod, amaSi garkveul rols
logia
asrulebs aRkveTis efeqtic, radgan is yovelTvis
iTvleba, rom tolerantobisa da aRkveTis fenome- usiamovnoa da adamiani cdilobs mis Tavidan acile-
nebi Tavis tvinSi mimdinare neiroadapturi cvlilebas sul ufro didi raodenobis narkotikuli nivTie-
bebis rezultats warmoadgens. isini homeostazuri rebis miRebiT. aRsaniSnavia, rom aRkveTis sindromis
procesis nawilia, romelic narkotikuli nivTiere- Sewyvetidan mravali Tvis Semdeg, pirovnebas SeiZleba
bis Semcirebisas aRmocenebul mwvave farmakologiur narkotikuli nivTierebis moxmarebis uecari, Zlieri
efeqts aneitralebs. mag., bevr narkotikul nivTie- survili gauCdes. fsiqologiurma da socialurma
rebas, romelTa araswori moxmarebac maTi anqsioli- stimulebma, romlebic winaT narkotikuli nivTiere-
zuri da hipnozuri Tvisebebis gamo xdeba (mag., bar- bis moxmarebas ukavSirdebodnen, SeiZleba aRkveTis
bituratebi, benzodiazepini da alkoholi), Zlieri mdgomareobis simptomebis msgavsi Zlieri survili
farmakologiuri efeqti aqvs da SeuZlia Tavis tvinSi aRZras. iTvleba, rom aRkveTis periodSi narkotiku-
GABA funqciis gaZliereba. am nivTierebebiT xangrZ- li nivTierebis erTjeradma zemoqmedebam SeiZleba
_ 481 _
dauyovnebliv gamoiwvios maTze damokidebulebis re-
cidivi, rasac aRdgenis efeqti ewodeba. analogiuri
cxrili 18.9 narkotikuli nivTierebebis
intravenuri moxmarebis zogierTi Sedegi
efeqti aReniSneba narkotikul nivTierebebze damo-
kidebul cxovelebs, romlebTanac erTjeradi dozis lokaluri
miReba srulad aRadgens narkotikis Ziebis qcevas, w venis Trombozi
romelic manamde Camqrali iyo. robinsi da everiti w ineqciis adgilis inficireba
(Robbins and Everitt; 1999) ganixilaven wamalmoxmarebaSi w arteriebis dazianeba
monawile Tavis tvinis meqanizmebs da am meqanizmebis
sistemuri
codnis mniSvnelobas mkurnalobis sworad warmarT-
vaSi. Tavis tvinis funqciuri neirovizualuri meTo- w baqteriuli endokarditi
debiT Catarebuli gamokvlevebis Sesaxeb informaciis w B da C hepatiti

w aiv infeqcia
mosapoveblad ix. Daglish and Nutt (2003).
w SemTxveviTi hiperdozireba
wamalmoxmarebis mavne Sedegebi lia, rodesac intravenuli moxmarebis dros heroinis

wamalmoxmareba mravali arasasurveli Sedegis momta- dozis gadaWarbeba xedeba.
nia rogorc pirovnebisTvis, ise sazogadoebisTvis.
wamaldamokidebuleba qalebSi
fizikuri janmrTeloba im samsaxurebSi, sadac mkurnaloben fsiqoaqtiuri niv-
wamalmoxmareba sakuTari janmrTelobis mimarT dau- Tierebebis araswormoxmarebas (alkoholiT gamowveu-
devar damokidebulebas iwvevs (garda im uaryofiTi li aSlilobebis CaTvliT), ar iTvaliswineben qalebis
Sedegebisa, rac adamianis organizmze fsiqoaqtiuri specifikur saWiroebebs, radgan mkurnalobis arse-
nivTierebis uSualo zemoqmedebas mohyveba). es sakiT- buli modelebi mamakacebisTvis aris SemuSavebuli
xi ufro dawvrilebiT iqneba ganxiluli qveTavSi, ro- (Marsh et al., 2000). sviftisa da misi kolegebis (Swift
melic farmakologiur saSualebebs exeba. et al., 1996) azriT, qali pacientebis mkurnalobisas
narkotikuli nivTierebis intravenuri gamoyeneba klinicistma unda gaiTvaliswinos Semdegi faqtorebi:
janmrTelobisTvis gansakuTrebuli riskis Semcve- w bavSvebis aRzrdasTan dakavSirebuli valdebule-
lia. amgvari praqtika Zalian gavrcelebulia opioi- bebi da socialuri pasuxismgeblobebi;
dis moxmarebisas, Tumca, intravenulad SesaZlebelia
w viqtimizaciisa da seqsualuri Zaladobis gamoc-
barbituratebis, benzodiazepinebis, amfetaminebis da
dileba;
sxva narkotikuli nivTierebebis miRebac. narkoti-
kuli nivTierebebis am gziT moxmarebas mohyveba ro- w socialuri barierebi, romlebic xels uSlian sa-
gorc lokaluri, aseve zogadi xasiaTis seriozuli medicino momsaxurebiT sargeblobas;
Sedegebi (cxrili 18.9). w qalebTan momuSave Terapevtebis xelmisawvdomoba.
intravenuri moxmarebis yvelaze ufro seriozu-
wamalmoxmareba fexmZimobis an mSobiarobis Semd
li garTulebebia adamianis imunodeficitis virusiT
gom periodSi
(aiv) dainficireba da hepatiti. britaneTSi narkoti-
kuli nivTierebebis momxmareblebSi aiv-iT inficire- xSirad janmrTelobis dacvis samsaxurebi ar
buli adamianebis raodenoba ufro naklebia, vidre mkurnaloben narkotikuli nivTierebebis momxmareb-
zogierT sxva evropul qveyanaSi. zogi mecnieri am el qalebs fexmZimobis gviandel stadiamde. es zrdis
faqts britaneTis gatarebul aqtiur politikas mi- rogorc dedis, ise bavSvis janmrTelobasTan dakav-
awers, romelic narkotikebis moxmarebiT gamowveuli Sirebuli problemebis risks. fexmZimobis periodSi
zianis Semcirebazea mimarTuli (metadonis daniSvna, narkotikuli nivTierebis moxmarebam SeiZleba ziani
Spricebis gacvlis programa da narkotikebis momxma- miayenos nayofs. narkotikuli nivTierebebis mox-
reblebis informireba). miuxedavad amisa, hepatiti C mareba fexmZimobis adreul stadiaze zrdis nayofis
britaneTSi ZiriTadi problemaa. rogorc winaswarma paTologiuri ganviTarebis risks. opioidebma SeiZle-
gamokvlevebma aCvena, am qveyanaSi narkotikuli niv- ba uSualod Seaferxos nayofis zrda. rodesac nar-
Tierebebis inieqciis gziT momxmarebelTa 50-80 pro- kotikebis moxmareba fexmZimobis gviandel stadiaze
centi C hepatitiT aris daavadebuli. B hepatitis xdeba, nayofs SeiZleba wamaldamokidebuleba ganu-
gavrcelebis sixSire ufro dabalia, magram mas mainc viTardes. wamaldamokidebulebis ganviTarebis riski
mniSvnelovani maCvenebeli aqvs (30-50 procenti). nar- maRalia heroinis jgufis narkotikuli nivTierebebis
kotikuli nivTierebis SemTxveviT hiperdozireba moxmarebis SemTxvevaSi. mSobiarobis Semdeg axalSo-
SeiZleba moxdes narkotikis nebismieri gziT moxma- bils SeiZleba ganuviTardes seriozuli aRkveTis
rebisas, magram sikvdilis riski bevrad ufro maRa- sindromi, romelic kvalificirebul mkurnalobas
_ 482 _
moiTxovs. dedam, romelic mSobiarobis Semdegac ga- (Svilebis mimarT daudevari damokidebulebis CaT-
nagrZobs narkotikuli nivTierebebis miRebas, SeiZle- vliT) mizezi gaxdes.
ba naklebi yuradReba dauTmos axalSobils da amis 2. radgan akrZaluli narkotikebi, Cveulebriv, Zviri
gamo Cvili mzrunvelobis gareSe darCes. narkoti- Rirs, narkotikuli nivTierebis momxmarebelma fu-
kuli nivTierebis intravenuri moxmarebis Sedegad lis mosapoveblad SeiZleba iqurdos an sakuTari
deda SeiZleba aiv-iT dainficirdes an sxva daavadeba sxeuliT ivaWros.
ganuviTardes, ramac SesaZloa nayofic daazianos.
3. narkotikuli nivTierebis momxmareblebi xSirad
mkurnalobis Catareba da kargi prenataluri movla
erT jgufad erTiandebian da am jgufSi moxvedril-
amcirebs dedasTanac da SvilTanac amgvari saSiSroe-
ma adamianebma, romelTac adre stabiluri social-
bebis risks.
uri statusi hqondaT, jgufis zegavleniT SeiZleba
fsiqiatriuli komorbidoba antisocialuri an kriminaluri qmedebebi ganaxor-
cielon.
fsiqoaqtiuri nivTierebebis araswor moxmarebasa da
fsiqikur komorbidobas Soris mWidro kavSiri ar- britaneTSi narkotikuli nivTierebebis problem-
sebobs (xSirad mas ormag diagnozs uwodeben). mag., uri moxmarebiT gamowveuli ekonomikuri danaxarji
fsiqoaqtiuri nivTierebebis momxmareblebs xSirad yovelwliurad 10.1 _ 17.4 miliard girvanqa ster-
aReniSnebaT personologiuri aSliloba, depresia da lings Seadgenda (Godfrey et al., 2002) (boqsi 18.9).
SfoTva. zogjer guneb-ganwyobis aSlilobis simptom-
ebi uSualod narkotikuli nivTierebebis moxmarebiT wamalmoxmarebis diagnozi
aris gamowveuli. mag., adamianebs, romlebic stimula- Zalze mniSvnelovania, rom wamalmoxmarebis di-
torebs iyeneben, mogvianebiT depresia unviTardebaT. agnostireba adreul stadiaze moxdes, anu sanam
premorbiduli fsiqikuri aSlilobisa da fsiqoaqti- pirovnebas Camouyalibdeba wamaldamokidebuleba da
uri nivTierebebis araswori gamoyenebis urTierTze- moxmarebis qcevis myari paterni, aseve, sanam gaCndeba
moqmedeba ufro rTuli xasiaTisaa. ase mag., paciente- intravenuri gamoyenebiT gamowveuli garTulebebi.
bi, romlebsac iseTi pirveladi fsiqikuri aSlilobe- sxvadasxva tipis narkotikuli nivTierebisTvis dam-
bi aReniSnebaT, rogorebicaa Sizofrenia, bipolaru- axasiaTebeli klinikuri gamovlinebis aRweramde, ram-
li aSliloba da pirovnebis sociopaTuri aSliloba, denime zogad principze gveqneba saubari. klinicists,
xSirad arasworad moixmaren alkoholsa da akrZalul romelsac ar aqvs narkotikuli nivTierebis momx-
narkotikul nivTierebebs. amgvari praqtika zrdis ba- mareblis mkurnalobis gamocdileba, unda axsovdes,
zisuri aSlilobis morbidulobas da Zaladobisa da rom misTvis daxmarebis gawevis mcdelobisas SeiZle-
TviTdazianebis risks. ar arsebobs erTiani azri imis ba uCveulo situaciaSi aRmoCndes, radgan pacientma
Sesaxeb, Tu romeli mkurnalobaa aseTi pacientebisT- SeiZleba misi SecdomaSi Seyvana scados. heroinis
vis saukeTeso. jer-jerobiT mkurnalobis arc erT momxmarebelma pacientma SesaZloa specialurad gaaz-
meTods ar eniWeba upiratesoba, radgan ar arsebobs viados mis mier yoveldRiurad gamoyenebuli nar-
sakmarisi mtkicebulebebi (Cochrane review by Jeffrey kotikis doza, raTa moipovos damatebiTi maragi saku-
et al., 2000). zogadi SeTanxmebis mixedviT, saukeTeso Tari moxmarebisTvis an sxvebisTvis misayidad. aseve,
midgomas, savaraudod, warmoadgens integrirebuli bevri pacienti erTze met narkotikul nivTierebas
momsaxureba, romlis drosac klinicistebis erTi
gundi muSaobs rogorc fsiqikur, aseve fsiqoaqtiuri
boqsi 18.9 wamalmoxmarebiT gamowveuli
socialuri xarjebi britaneTSi
nivTierebebis araswori moxmarebiT gamowveul dar-
Rvevebze. Tumca, momsaxurebis amgvari modelis real- w momxmareblebi: naadrevi sikvdili, fizikuri da fsi
qikuri daavadebebi, dabali akademiuri moswreba,
izacia garkveul sirTuleebTan aris dakavSirebuli
umuSevroba.
(Abou-Saleh, 2004). ormagi diagnozis mqone pacientebT-
w ojaxi: negatiuri zegavlena bavSvebze, siRatake da de
an gamoyenebuli marTvis modelebi mogvianebiT iqneba privacia.
ganxiluli. w sxva: avtomobilis saxifaTo marTvis, danaSaulis an
Zaladobis msxverpli.
wamalmoxmarebis socialuri Sedegebi w Temi: narkotikiT vaWrobasTan dakavSirebuli dana
arsebobs sami mizezi, romelTa gamoc wamalmoxmarebam Saulebrivi qmedeba, garemos gaRaribeba, sazogadoebaSi
janmrTelobis problemebisa da kriminalis zrda
SeiZleba arasasurvel socialur Sedegebamde migvi-
w warmoeba: samuSaos gacdena avadmyofobis gamo, samuSao
yvanos: adgilze qurdobis SemTxvevebi, Sromis nayofierebis
daqveiTeba, usafrTxoebaze gaweuli xarjebi.
1. qronikulma intoqsikaciam SeiZleba uaryofiTad
w saxelmwifo seqtori: jandacvasa da kriminalur marTl
imoqmedos adamianis qcevaze da samsaxuris dakarg- msajulebaze gaweuli xarjebi, socialuri momsaxureba
vis, avtokatastrofis da ojaxuri problemebis da daxmarebebi.
_ 483 _
moixmars, magram SeiZleba malavdes am faqts. mniS- anamnezis Segroveba

vnelovania gadavamowmoT pacientis mier mowodebuli anamnezis Segrovebisas (boqsi 18.10) klinicistma unda
informacia mis mier moxmarebuli narkotikuli niv- daadginos, Tu rodis miiRo pacientma ukanasknelad
Tierebebis odenobis Sesaxeb. amisaTvis saWiroa deta- narkotikuli nivTiereba. pacientma unda aRweros es
lurad gamovkiTxoT pacients, Tu ramdeni xania, rac SemTxveva da, agreTve, narkotikis miRebis tipiuri
moixmars narkotikul nivTierebebs, ra Rirebulebisaa dRe (romel narkotikul nivTierebas iRebs, ramden-
isini da vin aris momwodebeli; aseve SevamowmoT, xom jer da ra gziT). tipiuri kviris aRwera saWiroa maSin,
ar Seicavs pacientis mier mowodebuli informacia rodesac ar xdeba narkotikuli nivTierebis yovel-
Sinagan winaaRmdegobebs da, SeZlebisdagvarad, sxva dRiuri moxmareba. klinicistma unda gaarkvios, xom
wyaroebidan movipovoT misi naTqvamis damadasture- ar aqvs pacients paTologiuri ltolva, aRkveTis
beli mtkicebulebebi. simptomebi an damokidebulebis sindromis sxva dam-
fizikuri niSnebi axasiaTebeli niSnebi (gazrdili tolerantoba nar-
kotikuli nivTierebis mimarT an movaleobebsa da
arsebobs garkveuli fizikuri niSnebi, romlebic
garTobaze ufro metad narkotikuli nivTierebebis
badebs eWvs, rom narkotikuli saSualebebi ineqciis
mopovebisTvis upiratesobis miniWeba). gansakuTreb-
gziTaa miRebuli. aseTi niSnebia: Spricis moxmarebis
uli yuradReba unda mieqces iseTi riskis Semcveli
Sedegad datovebuli kvali da venebis Trombozi (gan-
qcevebis dadgenas, rogoricaa inieqcia saxifaTo
sakuTrebiT mklavis Sida mxares, idayvis moxris adgi-
areebSi (sazardulSi, kiserSi an inieqciiT inficire-
las); aseve, cxel amindSi grZelsaxeloebiani tansac-
bul adgilebSi) da saineqcio saSualebebis sxva momx-
mlis tareba da naiarevi. narkotikuli nivTierebebis
mareblebTan saziarod gamoyeneba.
intravenuri moxmarebis SesaZlebloba unda ganvixi-
yovelive amis Semdeg SesaZlebelia qronologiu
loT nebismier pacientTan, romelsac kanqveSa abscesi
ri anamnezis Segroveba calkeuli narkotikuli niv-
an hepatiti daudginda.
Tierebis moxmarebis Sesaxeb. am dros yuradReba unda
qceviTi niSnebi mivaqcioT mniSvnelovan etapebs: rodis gasinja pa-
wamalmoxmarebaze SeiZleba mianiSnebdes pirovnebis cientma pirvelad narkotikuli nivTiereba, rodis
qcevis cvlilebebi (mag., skolis an samsaxuris xSiri daiwyo misi yoveldRiuri moxmareba, rodis gamou-
gacdena da muSaobis xarisxis gauareseba). wamal- vlinda pirvelad aRkveTis simptomebi da pirvelad
damokidebulebis mqone adamianebi SeiZleba ar aqcev- rodis moixmara narkotikuli nivTiereba inieqciis
dnen yuradRebas TavianT garegnobas. isini SeiZleba meSveobiT. mniSvnelovania sainieqcio saSualebebis
CamoSordnen Zvel megobrebs da dauaxlovdnen iseT sxva momxmareblebTan saziarod gamoyenebis istoria,
adamianebs, romlebic narkotikebs moixmaren. danaSau- raTa Sefasdes pacientis aiv-iT an hepatitiT dain-
lis Cadena, rogoricaa wvrilmani qurdoba da pros- ficirebis riski.
titucia, aseve SeiZleba narkomaniis maCvenebeli iyos. im pacientebis SemTxvevaSi, romlebsac hqondaT ab-
stinenciis periodebi, unda davadginoT, Tu ra dae-
klinikuri gamovlineba xmara maT abstinenciis miRwevaSi da ra faqtorebma
wamaldamokidebulebis mqone adamianebma SeiZleba sx- gamoiwvia recidivi. garTulebebis istoria unda
vadasxva mizeziT miipyron eqimebis yuradReba. zogi- moicavdes rogorc Tavad narkotikuli nivTierebebis
erTi maTgani Tavad acxadebs, rom narkotikul niv- mavne efeqtebs, aseve im garTulebebs, romlebsac maTi
Tierebebzea damokidebuli, zogi ki malavs am faqts
da maT daniSvnas Tirkmlis kolikiT an dismenoreiT boqsi 18.10 narkotikuli nivTerebis
gamowveuli tkivilebis mosaxsnelad iTxovs. gansa- moxmarebis istoria
kuTrebuli sifrTxilis gamoCenaa saWiro im SemTx-
w narkotikis miRebis tipiuri dRe an kvira
vevaSi, rodesac aseTi TxovniT droebiTi pacientebi
w moxmarebuli narkotikebis tipebi da raodenoba (alko-
mogvmarTaven. zogierTi adamiani eqims narkotikuli holisa da nikotinis CaTvliT)
nivTierebebis miRebiT gamowveuli garTulebebis w simptomebi, romlebic Tavs iCens maSin, rodesac
(celuliti, filtvebis anTeba, hepatiti, travma) an narkotikebis miReba ar aris SesaZlebeli
maTi mwvave zemoqmedebis (hiperdozireba, aRkveTis w tolerantoba; ramdenad mkafiodaa Camoyalibebuli
narkotikis miRebis Cveva
simptomebi, halucinogenebze adversiuli reaqcia)
w riskis Semcveli qceva
samkurnalod mimarTavs. narkomaniis SemTxvevebis
w wamalmoxmarebis ganviTarebis istoria
dafiqsireba iSviaTad xdeba maSin, rodesac pirovneba
w abstinencia da recidivisaTvis biZgis mimcemi faqtorebi
saavadmyofoSi Semodis iseTi daavadebiT, romelic ar
w samedicino da socialuri tipis garTulebebi
aris narkotikebis miRebasTan asocirebuli. w fsiqiatriuli da sasamarTlo istoria
_ 484 _
miRebis xerxi iwvevs. pacients unda davusvaT kiTx- mkurnaloba
vebi, hqondaT Tu ara maT ojaxTan, profesiasTan da
motivacia da cvlileba
kanonTan dakavSirebuli problemebis. agreTve, unda
davadginoT SemTxveviTi hiperdozirebis nebismieri mkurnaloba ufro efeqturia maSin, rodesac nar-
faqti da movipovoT informacia warsulSi Catarebuli kotikuli nivTierebebis momxmarebels jer kidev ar
mkurnalobis Sesaxeb. wamalmoxmarebis mkurnalobas aqvs Camoyalibebuli wamaldamokidebuleba. am da mom-
SeiZleba hqondes ramdenime mizani; erT-erTia absti- devno etapebze aucilebelia pacients SevuqmnaT mo-
nenciis miRweva, Tumca, narkotikebis usafrTxo mox- tivacia _ gaakontrolos narkotikebis miReba. amisaT-
mareba (zianis Semcireba) SeiZleba bevri pacientisTvis vis saWiroa mivawodoT informacia im Sedegebis Ses-
ufro realisturi mizani iyos. swored amitom mniS- axeb, romlebic mohyveba maTi moxmarebis gagrZele-
vnelovania imis garkveva, Tu ras fiqrobs Tavad paci- bas; amasTanave, davexmaroT mas, gadaWras nebismieri
enti mis mier narkotikuli nivTierebebis moxmarebaze fsiqologiuri an socialuri problemebi. aseT dros
da ra cvlilebebis ganxorcieleba surs mas. SeiZleba sasargeblo iyos motivaciuri intervius
meTodebis gamoyeneba (Miller and Rollnick, 1991) (boqsi
laboratoriuli diagnozi 18.6). proCaskas da diklementes mier aRwerili cvli-
rodesac arsebobs amis saSualeba, wamalmoxmarebis lebis modelis etapebi (Prochaska and Diclemente, 1986)
diagnozi laboratoriuli testebiT unda gadamowm- daexmareba klinicists, efeqturad SeZlos pacientis
des. yvelaze ufro xSirad mimarTaven Sardis analizs, motivireba (boqsi 18.11).
radgan misi gakeTeba advilia da is naklebad invazi-
uria, vidre sisxlis analizis ramdenjerme gakeTeba. mkurnalobis miznebi
Tumca, garkveul viTarebebSi, SeiZleba sasargeblo wamaldamokidebulebis mqone pirovnebis mkurnalo-
iyos nerwyvis, sisxlisa da Tmis analizi. labora- bis saboloo mizania damokidebulebis gamomwvevi
torias unda hqondes im narkotikuli nivTierebebis narkotikuli nivTierebis aRkveTa. miuxedavad amisa,
maqsimalurad sruli sia (eqimis mier gamowerili nar- narkotikuli nivTierebis aRkveTa (detoqsikacia) Ta-
kotikuli nivTierebebis CaTvliT), romelTa gamoy- visTavad ar axdens gavlenas grZelvadian rezulta-
enebis albaTobac maRalia (laboratoriuli gamokv- tze (Vaillant, 1988) da amitom es procesi ufro far-
levebis Sesaxeb informaca ix. Wolff et al., 1999). To samkurnalo programis nawils unda warmoadgen-
des. Tu aRkveTa ver iqna miRweuli, eqimma SeiZleba
prevencia, mkurnaloba da reabilitacia- gaagrZelos pacientisTvis garkveuli narkotikuli
zogadi principebi nivTierebebis, mag., opioidebis, daniSvna, rac zianis
Semcirebis programis Semadgeneli nawilia (ix. qve-
prevencia
moT). garda amisa, saWiroa pacientisTvis fsiqologi-
mkurnalobasTan dakavSirebuli sirTuleebis gamo, uri mkurnalobis Catareba da socialuri mxardaWer-
mniSvnelovani Zalisxmeva prevenciaze unda iyos mi is gaweva. am TavSi jer-jerobiT mkurnalobis zogad
marTuli. mravali narkotikuli nivTierebis SemTx- principebzea saubari. sxvadasxva tipis narkotikuli
vevaSi mniSvnelovan prevenciul zomas maTi xelmi- nivTierebisTvis Sesatyvisi mkurnalobis formebi
sawvdomobis SezRudva da socialuri deprivaciis mogvianebiT iqneba ganxiluli.
Semcireba warmoadgens, rac damokidebulia xelisu-
flebis (da ara samedicino) politikaze. Tumca, aseve samkurnalo dawesebulebebi
mniSvnelovania Semcirdes eqimebis mier pacientebi- did britaneTSi narkotikuli nivTierebis arasworad
sTvis narkotikuli nivTierebebis gamowera, gansa- momxmareblebs mkurnaloba sxvadasxva tipis garemoSi
kuTrebiT benzodiazepinebis da sxva anqsiolizuri utardebaT. klinikebis umravlesoba dakavSirebulia
saSualebebis. fsiqiatriul servisebTan, romlebic fsiqiatriuli
prevenciis mizniT sganmanaTleblo programebis saavadmyofoebis an saTemo dawesebulebebis bazazea
ganxorcieleba TavisTavad ar aris efeqturi. amitom Seqmnili. stacionaruli mkurnaloba, Cveulebriv,
mniSvnelovania, rom informacia wamalmoxmarebis mavne- tardeba fsiqiatriul klinikebSi, zogadi profilis
blobis Sesaxeb mivawodoT axalgazrdebs masmediisa da saavadmyofoebis fsiqiatriul ganyofilebebSi an
saskolo saswavlo programebis meSveobiT. prevenciis mcirericxovan specializebul stacionarul dawe-
kidev erTi aspeqtia iseTi ojaxuri problemebis dad- sebulebebSi. individualur konsultacias, jgufur
gena da mogvareba, romlebic SeiZleba narkotikuli Terapias da Terapiul TemebSi muSaobas atareben sx-
nivTierebebis moxmarebas uwyobdnen xels. nebismieri vadasxva arakomerciuli organizaciiebi. zogadi pro-
prevenciuli zomis ganxorcielebisas gansakuTrebuli filis eqimebs SeuZliaT warmarTon wamaldamokide-
roli eniWeba zogadi praqtikis eqims. bulebis mqone pacientebis mkurnaloba specialize-
_ 485 _
moixmars da, amasTanave, ar iRebs barbituratebs.
boqsi 18.11 cvlilebis modelis etapebi
miuxedavad amisa, unda gvaxsovdes, rom yovelTvis
problemis gaazrebis wina etapi arsebobs depresiis ganviTarebisa da suicidis riski.
momxmarebel ar ijerebs, rom arsebobos problema, Tumca
sxvebi naTlad xedaven mas. mxardamWeri anu CanacvlebiTi Terapia
problemis gaazreba zogierTi klinicisti Tavis Tavze iRebs garkveuli
pirovneba afasebs situaciis dadebiT da uaryofiT narkotikuli nivTierebebis daniSvnas im pacientebi-
mxareebs da miiCnevs, rom cvlileba, SeiZleba, aucilebeli
iyos.
sTvis, romlebsac narkotikuli damokidebuleba aqvT,
magram uars amboben maTi moxmarebis Sewyvetaze. Cveu-
gadawyvetileba lebrivi proceduraa iseTi narkotikuli nivTierebis
gadawyvetilebas iReben imis Taobaze, saWiroa Tu ara raime
daniSvna, romelsac ufro neli moqmedeba aqvs (da ami-
qmedebis ganxorcieleba fsiqoaqtiuri nivTierebebis
araswor moxmarebasTan dakavSirebiT. tom naklebad iwvevs damokidebulebas) vidre `quCis
narkotiks~ (mag., heroinis magivrad metadonis dan-
qmedeba
iSvna). Tu aseT procedurasTan erTad pacients ex-
momxmarebeli irCevs strategias cvlilebis gansaxor
cieleblad da Tanmimdevrulad anxorcielebs mas marebian socialuri problemebis gadaWraSi da, amas-
Tanave, cdiloben daiTanxmon uari Tqvas narkotikul
SenarCuneba
saSualebebze, aseT samkurnalo taqtikas mxardamWeri
miRweeuli rezultati SenarCunebuli da gamyarebulia.
warumateblobam SeiZleba recidivi gamoiwvios.
(CanacvlebiTi) Terapia ewodeba.
amgvar midgomas orgvari dasabuTeba aqvs:
recidivi
1. klinicistis mier narkotikis xangrZlivi vadiT dan-
qcevis adrindel paternTan mibruneba. Tumca, recidivi
SeiZleba pozitiur gamocdilebas warmoadgendes, Tu iSvna Tavidan aacilebs pacients `quCis narkotikis~
pirovneba mas samomavlod gaiTvaliswinebs. mopovebis saWiroebas da amiT Seamcirebs masTan da-
kavSirebul fizikur da socialur zians.
buli samsaxurebis daxmarebiT. Seiqmna gaziarebuli
2. socialuri da fsiqologiuri daxmareba pirovnebas
mzrunvelobis modelebi pirveladi da meoradi jan-
TviTdajerebulobas matebs da uviTarebs im unar-
dacvis samsaxurebis monawileobiT (Department of
Cvevebs, romlebic exmareba mas, sabolood Tqvas
Health, 1999). britaneTis nebismierma eqimma, romelic
uari narkotikul nivTierebebze.
mkurnalobs narkotikuli nivTierebebis momxmareb-
lebs, standartuli formis saxiT unda waradginos mkurnalobis aseT formas gansakuTrebiT xSirad
informacia wamalmomxmareblebis Sesaxeb adgilobriv mimarTaven opioidze damokidebulebis mqone adami-
regionalur monacemTa bazaSi. sakontaqto nomrebi anebTan. narkotikuli saSualebebis daniSvnisas unda
britaneTis nacionalur cnobarSia mocemuli. gvaxsovdes, rom zogierTi pacienti abebsa da kafsu-
lebs iyenebs, rogorc sainieqcio masalas, rac gan-
somaturi garTulebebi sakuTrebiT saSiSia. garda amisa, zogierTi maTgani
garTulebebs, romlebsac Tavad momxmareblis mier zogadi profilis eqimebs akiTxavs narkotikuli niv-
gakeTebuli ineqcia iwvevs, SeiZleba zogadi pro- Tierebebis maragis mosapoveblad.. maT SieZleba da-
filis saavadmyofoSi dasWirdes mkurnaloba. amgvari malon is faqti, rom sxva klinikebSic iyvnen an Tavi
garTulebebia: SemTxveviTi hiperdozireba, kanis in- droebiT macxovreblad warmoadginon.
feqciebi, abscesebi, septicemia, hepatiti da aiv in-
pacientebis nawili, romelic eqimis mier daniSnul
feqcia. wamalmomxmareblebs SeiZleba dasWirdeT dax-
narkotikul saSualebebs moixmars, garkveuli xarisx-
marebis gaweva zogad samedicino problemebTan daka-
is socialur stabilurobas aRwevs, magram zogierTi
vSirebiT, rogoricaa, mag., kveba da stomatologiuri
maTgani agrZelebs wamalmoxmarebas da degradirdeba
momsaxureba. aseve, mizanSewonilia B hepatitis sawi-
rogorc fizikuri, ise socialuri TvalsazrisiT.
naaRmdego imunizaciis Catareba.
individebi, romelTa mxardaWerac metadonis saSu-
alebiT xdeba, ufro didxans itareben mkurnalo-
aRkveTis principebi
bis kurss, vidre araCanacvlebiTi programebis
wamalmoxmarebis aRkveTas zogjer detoqsikacias monawileebi. es SeiZleba mniSvnelovani iyos, radgan
uwodeben. mravali narkotikuli nivTierebis, gansa- mkurnalobis xangrZlivoba (mkurnalobis tipis miuxe-
kuTrebiT opioidebis, aRkveTa ufro efeqturadaa davad), dadebiTi Sedegis saukeTeso momaswavebelia
SesaZlebeli saavadmyofos pirobebSi (ix. qvemoT). (opioidze damokidebulebis marTvis dros metadonis
stimulantebisa da benzodiazepinebis aRkveTis pro- Terapiis gamoyeneba ufro detalurad mogvianebiT
cedura SeiZleba xSirad ambulatoriuladac Cat- iqneba ganxiluli).
ardes im pirobiT, Tu pacienti maT didi doziT ar
_ 486 _
zianis Semcireba kuli nivTierebis gamoyenebisaken ubiZgeben. amgvarad,
damokidebulebis mqone adamianebTan gamklavebis sx-
aiv-iTa da C hepatitiT dainficirebis SemTxvevebis
vadasxva meTodebis dagegmva SesaZlebelia. rogorc
zrda imis maCvenebelia, Tu ra mniSvneloba aqvs zianis
ukve aRvniSneT, iseT situaciaSi aRmoCenisas, ro-
Semcirebis programebs, romelTa erT-erT Semadge-
melic narkotikuli nivTierebebis moxmarebis aRmZ-
nel komponents SeiZleba narkotikuli nivTierebebis
vrel stimulebs Seicavs, pacientma SeiZleba mZafri
daniSvna warmoadgendes. aseTi programebi mimar-
diskomforti igZnos, rasac maTi miRebis Zlieri sur-
Tulia imisken, rom fsiqoaqtiuri saSualebebis rac
vili iwvevs. narkotikul nivTierebasTan dakavSire-
SeiZleba metma momxmarebelma miiRos monawileoba
buli signalebiT pacientze zemoqmedebis teqnika,
mkurnalobis procesSi da misdios mas. agreTve, xdeba
romelic am signalebis ganmeorebiT eqspozicias gu-
mkurnalobis Sualeduri miznebis dasaxva, romle-
lisxmobs, iwvevs desensitizaciis efeqts da es aum-
bic, miuxedavad imisa, rom ar iTvaliswineben srul
jobesebs abstinenciis SenarCunebis unars.
abstinencias, mainc amcireben wamalmoxmarebis risks
rogorc calkeul individTan, ise sazogadoebaSi. ma- reabilitacia
Sinac ki, rodesac pirovneba agrZelebs narkotiku-
bevr narkomans Zalian uWirs normalur sazogadoe-
li nivTierebebis moxmarebas, aiv-Ta da C hepatitiT
baSi Tavis damkvidreba. reabilitaciis mizania iseTi
dainficirebis riski SeiZleba Semcirdes misTvis Se-
pirobebis Seqmna, romlebic saSualebas miscems aseT
satyvisi informaciis miwodebiT da praqtikuli dax-
adamianebs ganeridon narkotikul nivTierebebTan
marebis gaweviT. aseTi Carevis Sedegad narkotikuli
dakavSirebul subkulturas da axali socialuri
nivTierebebis momxmarebelma SeiZleba maTi miRebis
kavSirebi daamyaron. Tu es ar moxerxda, nebismieri
ufro usafrTxo gza airCios an steriluri sainieq-
mkurnaloba uSedego aRmoCndeba.
cio saSualebebi gamoiyenos. mizanSewonilia aiv-ze da
reabilitacia SeiZleba ganxorcieldes Terapiul
C hepatitze gamokvlevebisa da konsultaciebis Cat-
TemSi mkurnalobis Semdeg (gv. ??). Tavdapirvelad
areba. agreTve, aucilebelia, rom pacientebs, rom-
pacientebi dacul garemoSi imyofebian, sadac isini
lebsac dabali imuniteti aqvT, B hepatitis sawinaaR-
Sromoben da sazogadoebriv saqmianobas ewevian. amis
mdego vaqcinacia SevTavazoT.
Semdeg, iseT pirobebSi moxvedrisas, romlebic sul
fsiqologiuri mkurnaloba ufro metad emsgavseba maT yoveldRiur cxovrebas,
isini ufro met pasuxismgeblobas iReben sakuTar
wamaldamokidebulebis mqone zogierT pacients Svelis
Tavze. saerTo sacxovrebelSi cxovreba mniSvnelovani
iseTi martivi zomis gamoyeneba, rogoricaa, mag., kon-
stadiaa reabilitaciis Tanmimdevrul procesSi. gar-
sultacia. mraval dawesebulebaSi tardeba jgufuri
damaval periodSi, rodesac pirovneba normalur muS-
fsiqoTerapia, raTa pacientebma TavianTi personal-
aobasa da cxovrebas iwyebs, mas, Cveulebriv, mudmivi
uri da interpersonaluri problemebi gaacnobieron.
socialuri mxardaWera sWirdeba.
zogierTi pacientisTvis sasargebloa mkurnaloba
Terapiul TemSi, sadac urTierTdaxmarebis atmos- ormagi diagnozis mqone pacientebi
feroSi mimdinareobs gulaxdili saubari imis Sesaxeb,
rogorc zemoT iTqva, iseTi pacientebis marTva, rom-
Tu ra gavlenas axdens narkotikuli nivTierebebis
lebic wamalmomxmareblebi arian da, amasTan erTad, aR-
moxmareba adamianis pirovnul Tvisebebze da sxva ada-
eniSnebaT seriozuli fsiqikuri aSliloba (mag., Sizo-
mianebTan urTierTobaze (Terapiul TemSi mkurnalo-
frenia an bipolaruli aSliloba), mTel rig damatebiT
bis sqema ix. gv. ??).
problemebTan aris dakavSirebuli. amgvari komorbi-
aseve, sasargebloa mkurnalobis kognitur-bihevi-
doba zrdis Zaladobisa da suicidis risks da auare-
oruli meTodebis gamoyeneba, romlebic alkoholis
sebs klinikur da socialur rezultatebs (Department
araswori moxmarebis marTvis aRweris dros ganvix. (gv.
of Health, 2002). ormagi diagnozis mqone pacientebis
??). Tumca, es, savaraudod, imave efeqts iZleva, ra-
SemTxvevaSi gansakuTrebiT Znelia mkurnalobis kursis
sac sxva fsiqologiuri midgomebi (Luty, 2003). amgvari
bolomde Catareba. isini xSirad imyofebian krizisul
mkurnalobis mizania rekreaciuli da pirovnuli un-
mdgomareobaSi da mravali daukmayofilebeli social-
ar-Cvevebis SemuSaveba, rac, pacients narkotikebze
uri moTxovnileba aqvT. qvemoT mocemulia ormagi di-
da narkokulturaze, rogorc siamovnebis miRebis wy-
agnozis mqone pacientebis integrirebuli mkurnalo-
aroze, naklebad damokidebuls xdis. kargi iqneba, Tu
bis saerTo komponentebi (Drake and Mueser, 2000). esenia:
mkurnalobis processSi pacientebis ojaxis wevrebi
w multidisciplinuri qeis-menejmenti da aqtiuri Za-
da partniorebi Caebmebian. iseve rogorc alkohol-
lisxmeva, raTa davarwmunoT pacientebi mkurnalo-
damokidebulebis dros, aqac SegviZlia gamoviyenoT
bis kursis Catarebisa da misi bolomde miyvanis
kognitur-bihevioruli teqnikebi iseTi situaciebis
aucileblobaSi;
identificirebisTvis, romlebic pacients narkoti-
_ 487 _
w krizisul situaciebSi intervenciisTvis mzaoba; erT-erTi yvelaze ufro maRalia evropaSi (Kraus et
w yuradRebis gamaxvileba motivaciur interviusa da al., 2003). savaraudod, aseTi problemebi ufro xSirad
zianis Semcirebaze; fiqsirdeba usaxlkaro adamianebsa da patimrebTan.
w zog situaciaSi, sadac es marTebulia, iZulebiTi moxmareba da avad moxmareba

zomebis gamoyeneba (mag., narkotikuli nivTierebis
epidemiologiuri monacemebis mixedviT, bevr adamians
moxmarebis mkurnalobisa da testirebis orderi);
ar uCndeba damokidebuleba heroinis mimarT. Tumca,
w aqtiuri monitoringi, medikamentur mkurnalobaze eWvgareSea, rom heroinis mravaljeradma gamoyene-
kontrolis gawevisa da Sardis skriningis CaTvliT; bam SeiZleba damokidebulebis swrafi ganviTareba da
w sazogadoebis mxridan grZelvadiani mxardaWera mkveTrad gamoxatuli fiziologiuri tolerantoba
dRis centrebSi, rezidenciul dawesebulebaSi mz- gamoiwvios. intravenulis garda, opioidebis momxma-
runvelobis gawevis CaTvliT; reblebi maTi miRebis sxva meTodebsac iyeneben (mag.,
w SizofreniiT daavadebuli wamalmomxmarebeli paci- kanqveS SeSxapuneba an cxviriT SesunTqva). heroini, ase-
entebisTvis klozapinis gamoyenebiT farmakologi- ve, SeiZleba SeisunTqo metalis folgaSi gacxelebis
uri Terapiis Catareba. Semdeg. heroinis momxmareblebma SeiZleba drodadro
Secvalon narkotikis miRebis xerxi. zianis Semcirebis
specifikuri tipis narkotikuli TvalsazrisiT, umjobesia narkotikuli nivTierebebis
nivTierebebis avad moxmareba miRebis araintravenuri meTodebis gamoyeneba.
opioidebi klinikuri efeqtebi

am jgufis narkotikul nivTierebebs ganekuTvneba eiforiasa da analgeziasTan erTad, opioidebi iwvevs
morfini, heroini, kodeini da sinTetikuri analgeti- sunTqvis daTrgunvas, Sekrulobas, madis dakargvasa
kebi, rogorebicaa petidini, metadoni da dipipanoni. da libidos daqveiTebas. tolerantoba swrafad vi-
opioidebis farmakologiuri efeqti ZiriTadad ga- Tardeba, rac dozis gazrdis aucileblobas iwvevs.
Sualebulia specialur opioidur receptorebTan opioidebis sxvadasxva efeqtis mimarT tolerantoba
urTierTzemoqmedebiT, sadac morfini da opioidebi erTnairad ar viTardeba. mag., Sekruloba xSirad ma-
gansakuTrebiT seleqtiuria -opioiduri tipis recep- Sinac aRiniSneba, rodesac sxva efeqtebi ukve Sesus-
torebis mimarT. medicinaSi opioidebs pirvel rigSi tebulia. opioidis miRebis SewyvetasTan erTad, to-
maTi Zlieri analgetikuri zemoqmedebis gamo iyeneben, lerantoba maleve qveiTdeba da abstinenciis perio-
xolo am preparatebis narkotikis saxiT moxmareba maTi dis Semdeg miRebul dozas ufro Zlieri zemoqmedeba
eiforiuli da anqsiolizuri efeqtebis gamo xdeba. aqvs, vidre Sewyvetamde. garkveuli periodiT narko-
warsulSi morfinis moxmareba farTod iyo gavrce- tikis Sewyvetis Semdeg (mag., saavadmyofoSi an cixeSi
lebuli dasavleTis qveynebSi, magram Semdgom, mori- yofnis Semdeg), misi iseTi doziT miRebam, romlis mi-
fini heroinma Caanacvla, romelsac, gansakuTrebiT marTac pirovneba winaT tolerantuli iyo, SeiZleba
intravenurad miRebisas, Zalian Zlieri eiforiuli saxifaTo (zogjer letaluri Sedegis mqone) sunTqvis
efeqti aqvs. daTrgunva gamoiwvios.
epidemiologia opioidebis aRkveTa

2003 wels aSS-Si Catarebulma NHSDUS gamokvle- opioidebis aRkveTis simptomebia:
vam aCvena, rom amerikelebis 0.1%-s wina TveSi, sul w narkotikuli nivTierebis mimarT paTologiuri
cota, erTxel mainc hqonda heroini miRebuli. mTe- ltolvis gaZliereba;
li cxovrebis manZilze heroinis moxmarebis sixSiris
w mousvenroba da uZiloba;
procentuli maCvenebeli 1.6%-s Seadgenda (SAMHSA,
w kunTebisa da saxsrebis tkivili;
2004). sanam britaneTSi moqmedebda wamaldamokidebu-
li pirebis saregistracio indeqsi, misi monacemebiT w surdo da cremlianoba;
1997 wels daregistrirebuli pirebis raodenoba daa- w abdominaluri spazmebi, gulisreva da faRaraTi;
xloebiT 40 000 iyo. ra Tqma unda, momxmareblebis w piloereqcia, oflianoba, Tvalis gugis gafarToe-
ufro didi nawili ar iyo daregistrirebuli. bri- ba, gaxSirebuli pulsacia;
taneTis erovnulma gamokvlevam aCvena, rom gasul
w Termoregulaciis darRveva.
wels opiatis moxmarebis saSualo done zrdasrul
mosaxleobaSi daaxloebiT 1%-s Seadgenda (Coulthard et es simptomebi, Cveulebriv, bolo dozis miRebidan
al., 2002). britaneTSi opiatis problemuri moxmarebis daaxloebiT eqvsi saaTis Semdeg iCens Tavs, 36-48 saa-
gavrcelebis done (yoveli aTasi adamianidan eqvsi) TSi maqsimalur intensivobas aRwevs da Semdeg qreba.
_ 488 _
aRkveTis simptomebi iSviaTadaa saSiSi janmrTeli sac narkotikuli nivTierebis maragi ileva. am dros
adamianis sicocxlisTvis; Tumca, Zlier distress maT SeiZleba pirdapir sTxovon eqims narkotikuli
iwvevs da, swored es aiZulebs pirovnebas izrunos nivTierebis gamowera an tkivilis simulireba moax-
narkotikuli nivTierebebis mopovebaze. dinon. miuxedavad imisa, rom aRkveTis simptomebi
imdenad arasasiamovnoa, rom pirovneba narkotikis
metadoni mosapoveblad SeiZleba bevr rameze wavides, Cveu-
metadoni daaxloebiT imave siZlieris preparatia, ro- lebriv, heroinze damokidebuleba ar aris Zalian
goric morfini. is iwvevs xvelebis daTrgunvas, Sekru- saSiSi sxva mxriv janmrTeli adamianisTvis. amitom
lobasa da centraluri nervuli sistemisa da sunTq- maTTvis narkotikuli nivTierebis daniSvna mizanSe-
vis daTrgunvas. Tvalis gugebis Seviwroveba naklebaa wonilia mxolod da mxolod dagegmili mxardaWeris
gamoxatuli. aRkveTis sindromi iseTivea, rogoric an aRkveTis programis farglebSi, mis pirvel etapze.
heroinisa da morfinis dros da mas aranakleb mwvave aseTi programa Semdeg qveTavebSi iqneba aRwerili. (2)
xasiaTi aqvs. radgan metadons xangrZlivi naxevrad- SemTxveviTi hiperdozirebis dros. aseT SemTxvevaSi
daSlis periodi axasiaTebs (1-2 dRe), aRkveTis simptom- saWiroa samedicino mkurnaloba, romelic, privel
ebi SeiZleba mxolod 36 saaTis Semdeg gamovlindes da rigSi, mimarTuli iqneba narkotikuli nivTierebiT
maqsimalur intensivobas 3-5 dReSi miaRwios. swored gamowveuli sunTqvis daTrgunvis moxsnaze. (3) mwvave
amitom heroinze damokidebulebis mqone pacientebTan garTulebebis dros, rasac iwvevs narkotikis intra-
metadons xSirad heroinis Camnacvleblad iyeneben. venuri gziT miReba; mag., lokaluri infeqcia, nekrozi
im areSi, sadac inieqcia gakeTda an raime sxva organos
opioidebze damokidebulebis bunebrivi mimdin
(xSirad gulis an RviZlis) inficireba.
areoba
opioidebis momxmareblebis grZelvadiani da sistem- dagegmili aRkveTa (detoqsikacia) (boqsi 18.12)
uri Seswavlis Sedegad aRmoCnda, rom maT umravle- aRkveTis simptomebis simZime damokidebulia rogorc
sobasTan aSliloba, rogorc Cans, qronikuli recidi- farmakologiur, ise fsiqologiur faqtorebze. ami-
vebisa da remisiebis fonze mimdinareobda da aTi wlis tom aRkveTis dros pacientis fsiqologiuri marTva
manZilze xSirad aRiniSneboda letaluri SemTxvevebi iseTive mniSvnelovania, rogorc narkotikuli niv-
(10-20%). miuxedavad amisa, aRmoCnda, rom opioidebis Tierebebis miRebis reJimi. aRkveTis mimdinareobis
momxmareblebis daaxloebiT 50%-ma aTi wlis Semdeg tempi pacientTan unda iqnes SeTanxmebuli. SemuSave-
Tavi Seikava maTi moxmarebisgan, rac imaze miuTiTebs, buli grafiki arc imdenad dinamikuri unda iyos, rom
rom cocxlad darCenil pirebs aqvT remisiis bune- pacientma uari Tqvas TanamSromlobaze da arc imde-
brivi tendenca. (Robson, 2000). nad neli, rom damokidebulebis mdgomareobis Senar-
sikvdils xSirad iwvevs SemTxveviTi hiperdozireba, Cuneba gamoiwvios. aRkveTis periodSi pacientis mxar-
rac, Cveulebriv, iZulebiTi abstinenciis Semdeg tol- dasaWerad eqimma masTan xSiri kontaqti unda iqonios.
erantobis dakargvasTan aris dakavSrebuli. aseve, aseTi urTierToba SeiZleba mniSvnelovani aRmoCndes
xSiria suicidis SemTxvevebi. bolo wlebSi imata aiv Semdgomi mkurnalobisTvis.
infeqciiTa da hepatitiT gamowveulma sikvdiliano- rodesac opioidis doza mcirea, misi aRkveTa
bam. xangrZlivi periodiT dasaqmeba da ojaxis Seqm- swrafad xdeba, Tumca, am dros paralelurad unda
na dadebiTi rezultatis indikatoria. abstinencia tardebodes aRkveTis efeqtebis simptomaturi mkur
xSirad cxovrebis pirobebis SecvlasTanaa dakavSire- naloba. iseTi preparatebi, rogorebicaa loperamidi
buli. mag., amerikeli jariskacebis 95%-ma, romlebsac an metoklopramidi, SeiZleba sasargeblo iyos kuW-
opioidebze damokidebuleba vietnamis omSi monawile- nawlavis simptomebis mosaxsnelad, xolo arasteroid-
obis dros ganuviTardaT, aSS-Si dabrunebis Semdeg uli analgetikebi _ rekomendebulia sxvadasxva saxis
Sewyvites maTi moxmareba (Robins, 1993). tkivilebis dros. aseve SeiZleba sasargeblo gamodges
2 adrenoceptoris agonistis _ lofeqsidinis, gamoy-
prevencia
eneba. mas klonidinis msgavsi zemoqmedeba aqvs, magram
radgan pirovnebas opioidebze damokidebuleba swra naklebad iwvevs hipotenzias. zogierTi gamokvlevis
fad uviTardeba da misi mkurnaloba, rogorc wesi, mixedviT, es preparati iseTive efeqturia aRkveTis
aradamakmayofilebelia, am dros gansakuTrebiT mniS- sindromis Sesamsubuqeblad, rogorc metadoni (ix.
vnelovania prevenciuli zomebis gatareba (gv. ??). Gowing et al., 2004).
rodesac heroinis yoveldRiuri doza maRalia,
mkurnaloba krizisuli periodis dros
SeiZleba aucilebeli gaxdes pacientisTvis rome-
heroinze damokidebulebis mqone adamianebi krizisul
lime opioidis daniSvna, romlis dozac TandaTano-
periodSi eqims sam SemTxvevaSi mimarTaven: (1) rode-
biT Semcirdeba. erT-erTi gza metadonis gamoyene-
_ 489 _
baa, romelsac ufro Senelebuli moqmedeba aqvs. aq opioidebs vuniSnavT arsebobs imis saSiSroeba, rom es
siZneles metadonis dozis swori SerCeva warmoad- preparatebi Sav bazarze gaedineba. amis Tavidan asac-
gens, radganac pacientebi xan azviadeben maT mier gam- ileblad saWiroa pacientis mier yoveldRiuri dozis
oyenebuli heroinis raodenobas aRkveTis sindromis miRebaze meTvalyureobis daweseba, risi gakeTebac
SiSiT, xan ki, gakicxvis Tavidan asacileblad, ufro SeuZlia eqTans an afTiaqis personals. amgvari praq-
mcire dozas asaxeleben. garda amisa, rogorc mogvi- tika hiperdozirebis risksac amcirebs. garda amisa,
anebiT iqneba aRniSnuli, yvela `quCis narkotiki~ pacientTan yoveldRiuri kontaqtis damyarebas sxva
erTi da igive siZlieris ar aris. Terapiuli upiratesobac aqvs. yoveldRiuri kontaq-
metadoni unda dainiSnos Txevadi formiT da misi ti gansakuTrebiT mniSvnelovania mkurnalobis sawyis
miReba perorarulad unda xdebodes. metadonis sawy- etapze, Tumca, es SeiZleba garkveul sirTuleebTan
isi doza dReSi 10 an 40 miligrams Seadgens imisda iyos dakavSirebuli im pacientebisTvis, romlebic
mixedviT, Tu ra raodenobis nakotikul nivTierebas srul samuSao ganakveTze muSaoben.
moixmars, Cveulebriv, pacienti. opioidebis mimarT
fexmZimoba da opioidebze damokidebuleba
tolerantobis mqone momxmareblebisTvis SeiZleba
saWiro gaxdes sawyisi dozis maqsimaluri odenobis opioidebis arasworad momxmarebeli qalebis SemTx-
daniSvna. Tu sawyisi dozis miRebidan 4 saaTis Semdeg vevaSi ufro didia naadrevi mSobiarobis albaToba,
pacients isev aReniSneba aRkveTis simptomebi, SeiZle- xolo maTi Svilebi dabadebisas xSirad sxva bavSve-
ba mas damatebiTi doza daneniSnos. Tumca, aseT Sem- bze naklebs iwonian. axalSobilebs SeiZleba gamou-
TxvevaSi, sifrTxile unda gamoviCinoT, radgan meta- vlindeT aRkveTis simptomebi, rogorebicaa, mag.
doni xangrZlivi moqmedebis preparatia da, amdenad, gaRizianebadoba, mousvenroba, tremori da xmamaRali
SeiZleba akumulireba da toqsikuroba gamoiwvios. sx- tirili. Tu deda heroins moixmars, bavSvTan es simp-
vadasxva adgilas da sxvadasxva dros SeZenili `quCis tomebi dabadebidan ramodenime iCens Tavs, xolo Tu
heroinis~ zemoqmedebis Zala Zalian gansxvavebulia. deda metadons Rebulobs, maSin SeiZleba mogvianebiT
amitom misi Sesabamisi metadonis dozis daniSvnisas gamovlindes, radgan am nivTierebas organizmSi ufro
unda gaviaroT konsultacia eqimTan, romelsac wa- xangrZlivi naxevrad-daSlis periodi axasiaTebs.
maldamokidebulebis mkurnalobis gamocdileba aqvs. ar aris aucilebeli, rom axalSobilis mcire wonas
metadonis Semcirebis tempi damokidebulia klini- da naadrev mSobiarobas uSualod narkotikuli niv-
kur viTarebebze da avadmyofis klinikur reaqciebze. Tierebebis moxmareba iwvevdes, radgan heroinis momx-
yvelaze ufro swrafi tempis reJimi SeiZleba 10 dRi- mareblebi xSirad cudad ikvebebian da bevrs ewevian.
dan sam kviramde gagrZeldes. Tumca, zogjer, upri- metadoniT mxardamWeri Terapiis programaSi monawile
ania metadonis dozis ufro neli tempiT kleba, mag., qalebisTvis fexmZimobis periodi da mSobiaroba nak-
ramdenime Tvis ganmavlobaSi. leb riskTan aris dakavSirebuli (Ward et al., 1999).
opioidebis aRkveTis marTvisas buprenorfinsac arsebobs monacemebi am narkotikuli nivTierebis
(opioiduri receptorebis nawilobrivi agonisti) ufro gviandeli efeqtebis Sesaxeb. opioidebze da
iyeneben (Gowing et al., 2004). am SemTxvevaSic dozis mokidebulebis mqone dedis Svilebs ufro xSirad
TandaTanobiT Semcirebis tempi pacientTan unda Se- axasiaTebT hiperaqtiuroba fexis adgmis periodSi da
vaTanxmoT. buprenorfinis mimarT, umetes SemTxveva- naklebad mizanmimarTuli arian. Tumca, ar aris gamor-
Si, kargi amtanianoba aRiniSneba, magram mkurnalobis icxuli, rom amgvari gviandeli efeqtebi ufro arax-
dasawyisSi didi sifrTxile unda gamoviCinoT, radgan elsayreli ojaxuri viTarebiT iyos gamowveuli, vidre
am preparatis, rogorc nawilobrivi agonistis moq- nayofze narkotikuli nivTierebebis zemoqmedebiT.
medebam, SeiZleba mwvave aRkveTis sindromi gamoi-
wvios im pacientebTan, romlebic masze metadonis boqsi 18.12 opioidebis aRkveTis
maRali dozidan (30mg-ze meti) an heroinis maRali farmakologiuri marTva
dozidan gadadian. amis Tavidan asacileblad, Cveu-
w Tu sasurvelia, moklevadiani, araopioiduri mkurnalbis
lebriv, mkurnalobas maSin iwyeben, rodesac pacienti Catareba unda gamoviyenoT 2 - adrenoceptoris agonisti
ukve aRkveTis msubuq mdgomareobaSi imyofeba. w buprenorfini SegviZlia gamoviyenoT opioidebis mokle-
naltreqsonis (opioidebis antagonisti) gamoyeneba, vadiani aRkveTis dros. mas ukeTesi efeqti aqvs, vidre
qlonidins
Zlier sedaciasTan da zogjer zogad anesTeziasTan
w aRkveTis dros SeiZleba warmatebuli gamodges metado-
erTad, warmoadgens proceduras, romelic swrafi niT mkurnaloba, magram amgvari mkunaloba nela, dozis
opioiduri detoqsikaciis saxeliT aris cnobili. TanaTanobiT SemcirebiT unda mimdinareobdes.
amgvari proceduris usfrTxoeba da efeqturoba ar w metadoniT mkurnaloba umjobesia fexmZimobis period-
aris dadgenili (Spanagel, 1999). Si, radgan amis didi gamocdileba arsebobs.
rodesac wamaldamokidebulebis mqone pacientebs (Lingford-Hughes et.al., 2004)
_ 490 _
mxardamWeri Terapia opioidebze damokidebu metadoniT mxardamWeri mkurnaloba ufro efeqtu-
lebis mqone pacientebTan ria iseT programebTan SedarebiT, romelTa Tera-
piis umTavres mizans abstinencia warmoadgens. gar-
rogorc zemoT aRiniSna, opioidebis aRkveTa mkur
da amisa, aRmoCnda, rom ufro efeqturi klinikebi
nalobis yvelaze ufro miRebuli formaa. Tu amgvari
maRali xarisxis konsultaciebiTa da samedicino
mkurnaloba ar aris xelmisawvdomi, SegviZlia gamov-
momsaxurebis farTo speqtriT gamoirCevian (Ward
iyenoT mxardamWeri Terapia (am dros, Cveulebriv,
et al., 1999). amasTan, sul ufro meti monacemi me-
gamoiyeneba metadoni), romelic mimarTulia akrZa-
tyvelebs imis sasargeblod, rom opioidebis momx-
luli narkotikuli nivTierebebis intravenuri mox-
mareblebTan mxardamWeri mkunalobis Catarebisas
marebis Sedegad gamowveuli fizikuri da socialuri
SesaZlebelia buprenorfinis, rogorc metadonis
zianis Semcirebaze. am mkurnalobis principebi aRwer-
alternatiuli saSualebis, gamoyeneba (Mattick et
ilia ?? gverdze. mxardamWeri Terapiis dros paci-
al., 2003b). am dros mkurnalobis imave principebiT
entebs heroinis nacvlad eniSnebaT Txevadi formis
xelmZRvaneloben.
metadoni, romelic isea damzadebuli, rom pacientma
eqimis mier gamowerili opioidebis Sav bazarze
ver SeZlos misi inieqciis gziT miReba.
gadinebasTan da hiperdozirebasTan dakavSirebuli
metadonis gamoyenebiT Catarebuli mxardamWeri Te-
problemebi ganxiluli iyo qveTavSi opioidebis aRkve-
rapia safuZvlianadaa gaanalizebuli (Cochrane review
Tis marTvis Sesaxeb (ix, zemoT). SesaZloa, amgvarma
by Mattick et al., 2003a). arsebobs randomizebuli gamokv-
problemebma mxardamWeri mkurnalobis drosac iCi-
levebis monacemebi, romelTa mixedviTac, metadoniT
nos Tavi da amitom mkurnalobis porcesSi CarTuli
mxardaWera amcirebs akrZaluli opioidebis moxmare-
pacientebis mier preparatebis yeveldRiuri miRebis
basa da kriminalur qmedebebs. garda amisa, aseT Tera-
gakontroleba mudmivad unda xdebodes.
piul programebSi monawile pirebi naklebad iReben
naltreqsoni xangrZlivi moqmedebis mqone opioi-
inieqciis gziT narkotikul nivTierebebs da, Sesabam-
debis antagonistia. igi gamoiyeneba recidivis pre-
isad, ufro mcirea aiv-iT dainficirebis SemTxvevebi.
venciisTvis opioidebze damokidebulebis mqone pa-
im pacientebis SemTxvevaSi, romlebsac utardebaT
cientebis mkurnalobisas, romlebmac ukve gaiares
metadoniT mxardamWeri Terapia, daaxloebiT samjer
detoqsikaciis kursi. zog SemTxvevaSi naltreqsoniT
maRalia mkurnalobis kursis bolomde miyvanis alba-
mkurnalobam SeiZleba dadebiTi roli iTamaSos, Tuki
Toba; garda amisa, Terapiuli kursis monawileTa or-
damokidebulebis mqone pirs maRali motivacia aqvs
mesamedTan dabalia imis albaToba, rom isini akrZa-
(mag., eqimebi, romlebic opioidebze damokidebulebis
lul heroins moixmaren (Mattick et al., 2003a).
mdgomareobidan gamodian an pacientebTan, romlebic
mxardamWeri TerapiisTvis Sesabamis yoveldRiur
sisxlis samarTlis sistemasTan dakavSirebul struq-
dozad rekomendebulia 20-40 miligrami metadoni.
turirebul programebSi iReben monawileobas. magram
Tumca, aris iseTi SemTxvevebic, rodesac ufro didi
opioidebis momxmareblebis ufro farTo wreSi nal-
dozis (60-100mg) gamoyeneba amcirebs akrZaluli opi-
treqsoniT mkurnalobis sargeblianoba naklebad aris
oidebis mixmarebis sixSires da zrdis programaSi pa-
dadgenili (Kirchmayer et al., 2003).
cientis monawileobis xangrZlivobas (Faggiano et al.,
2003). es ukanaskneli pirdapir kavSirSia Terapiuli Temze dafuZnebuli mkurnalobis meTodebi
Sedegebis gaumjobesebasTan. albaT, dozirebis mo-
am tipis mkurnalobis mizania abstinenciis miRweva
qnili politikis gatareba yvelaze swori arCevania.
pacientis damokidebulebebsa da qcevaSi arsebiTi
aseTi politika unda iTvaliswinebdes metadonis po-
cvlilebebis Setanis meSveobiT. narkotikebis miReba
tenciur toqsikurobas im pirebTan, romelTa toler-
ganixileba, rogorc adre arsebuli problemebisT-
antobac ar aris cnobili an Znelad dasadgenia. zoga-
vis Tavis aridebis saSualeba da axali problemebis
dad, umjobesia mkurnalobis dabali doziT dawyeba
aRmocenebis wyaro. midgoma, romelic gulisxmobs
(dReSi maqsimum 40mg) da ramdenime kviris manZilze
jgufuri Terapiisa da TemSi cxovrebis kombinacias,
misi TandaTanobiT gazrda. amave dros, unda xdebodes
mimarTulia pacientebis TviTcnobierebis amaRlebaze
aRkveTis simptomebis titrireba. unda gvaxsovdes,
da socialuri unar-Cvevebis gaumjobesebaze. garda
rom metadonis done izrdeba daaxloebiT xuTi dRis
amisa, pacientebs sxva adamianebze zrunvas aswavlian.
ganmavlobaSi, dozirebis ukanaskneli koreqtirebis
Terapiuli Temebis umravlesobaSi personalis zogi-
Semdeg. praqtikuli rCevebi metadoniT mkurnalobis
erTi warmomadgeneli warsulSi Tavad iyo narkoti-
Sesaxeb mocemulia janmrTelobis departamentis do-
kul nivTierebebze damokidebuli, swored amitom, mas
kumentSi (Department of Health, 1999).
sxvebze metad uadvildeba mkurnalobis adreul sta-
im klinikebis Sefasebam, romlebic metadoniT
diaze pacientebis ndobis mopoveba.
Canacvlebis programebs axorcieleben, aCvena, rom
_ 491 _
anqsiolizuri da saZile saSualebebi mesameds, romlebic benzodiazepinis Terapiul dozas

eqvs Tveze met xans iReben, SeiZleba masze damokide-
am jgufis preparatebidan yvelaze ufro gavrcele-
buleba ganuviTardeT (ix. Lingford-Hughes et al., 2004).
bulia benzodiazepinebis araswori moxmareba. dRes
mkurnaloba. damokidebulebis mkurnaloba, Cveu-
barbituratebs ufro iSviaTad niSnaven, ris gamoc
lebriv, benzodiazepinis TandaTanobiTi aRkveTiT
iklo maTma arasworma gamoyenebam. aseve, gavrcele-
xdeba, rac, minimum, rva kvira grZeldeba. am periodSi
bulia qlormeTiazolisa da glutetimidis araswo-
pacients utardeba mxardamWeri konsultaciebi. im
ri moxmareba. iTvleba, rom am jgufis preparatebis
tipis benzodiazepinebis aRkveTis procesi, romleb-
klinikur efeqtebs iwvevs maTi unari xeli Seuwyon
sac xanmokle naxevr-daSlis periodi da benzodiaz-
Tavis tvinis GABA funqcionirebas. benzodiazepin-
epinuri receptorebis mimarT maRali potenciuroba
iebi amgvar efeqtebs specifikur benzodiazepinur
aqvT, ufro rTulad mimdinareobs. amitom miiCneven,
receptorebTan dakavSirebiT warmoqmnis.
rom aseT SemTxvevaSi, pacienti aRkveTis mcdelo-
benzodiazepinebi bamde jer xangrZlivi moqmedebis mqone preparatebze
am preparatebs mravali wlis manZilze iyenebdnen ro- unda gadaviyvanoT (mag., diazepamze). pacientebTan,
gorc samkurnalo saSualebebs, sanam ar dadginda, rom romlebsac aRkveTis zemoT naxseneb zomebTan daka-
maTma xangrZlivma moxmarebam SeiZleba tolerantoba vSirebiT garkveuli sirTuleebi aqvT, SeiZleba sa-
da damokidebuleba gamoiwvios. benzodiazepinebze sargeblo iyos SfoTvis marTvis gamoyeneba (gv. ??).
damokidebulebas aqvs damaxasiaTebeli aRkveTis sin- iTvleba, rom benzodiazepinis doza yoveli ori
dromi, romelic moicavs: kviris Semdeg erTi-mervediT unda Semcirdes. mZime
aRkveTis sindromis SemTxvevaSi, SeiZleba doza igive
w SfoTvis simptomebs _ SfoTva, gaRizianebadoba,
darCes an droebiT gaizardos kidec, sanam simptom-
oflianoba, tremori, Zilis aSliloba;
ebi ar moixsneba. rodesac pacienti benzodiazepinebs
w cvlilebebs aRqmaSi _ depersonalizacia, dere- arasworad da didi doziT moixmars, SeiZleba gar-
alizacia, hipersensitiuloba stimulebis mimarT, Tuldes Sesabamisi sawyisi dozis dadgena. Cveulebriv,
anomaliuri sxeulebrivi SegrZnebebi, moZraobis pacients ar unda mivceT dReSi 40-60 miligramze meti
anomaliuri SegrZnebebi; diazepami. es doza TandaTanobiT unda Semcirdes da
w sxva maxasiaTeblebs (ufro iSviaTia) _ depresia, sui- eqvsi Tvis manZilze, TiTqmis ganaxevrdes (Department
ciduri qceva, fsiqozi, gulyra da TeTri cxeleba. of Health, 1999).
epidemiologia. benzodiazepinis moxmareba Zalze bevr pacients aRkveTis simptomebi maSinve umwvavde-
gavrcelebulia. dadgenilia, rom evropisa da aSS-is ba, rogorc ki benzodiazepinis dozis miRebas sruli-
mosaxleobis daaxloebiT 10% iyenebs mas, rogorc anad wyvets. Cveulebriv, simptomebi ramdenime kviraSi
qsiolizur an saZile saSualebas. sustdeba, Tumca, es procesi erTnairi xangrZlivobis
bolo wlebSi benzodiazepini ufro iSviaTad iniS- ar aris da zogierTi simptomi, mag., kunTebis spazmi,
neba SfoTvis sawinaaRmdegod. mis xangrZlivad momx- SeiZleba ar gamovlindes manam, sanam aRkveTis sxva
mareblebs, umetasad, xanSi Sesuli qalebi warmoad- simptomebi TiTqmis sruliad ar gaqreba. zogierTi
genen, Tumca, aseve aRiniSneba am preparatis araswori pacienti benzodiazepinis miRebis Sewyvetis Semdeg,
moxmareba axalgazrdebSi, rac xSirad ukavSirdeba in- aRkveTismagvar simptomebs Tveebis an wlebis manZilze
travenuri gziT miRebasa da ramdenime fsiqoaqtiuri SeigrZnobs (`gaxangrZlivebuli aRkveTis sindromi~).
nivTierebebis erTdroulad moxmarebas. alkohold- prevencia. benzodiazepinze damokidebulebis pre-
amokidebulebis mqone pirebis mniSvnelovani nawili vencia misi daniSvnis SezRudviTaa SesaZlebeli.
benzodiazepinebzec aris damokidebuli. SfoTviTi aSlilobis umetes SemTxvevaSi efeqtu-
damokidebuleba. xSirad benzodiazepinebze damoki ria fsiqoTerapiuli mkurnaloba (gv. ??). arafarma-
debuleba mkurnalobis mizniT misi xangrZlivi gamoy- kologiuri midgoma, aseve, sasargebloa uZilobis
enebis Sedegad viTardeba; aseve, SeiZleba mizezi iyos mkurnalobis drosac (gv. ??). benzodiazepinebi unda
benzodiazepinis, rogorc iolad mosapovebeli `quCis dainiSnos xanmokle droiT, iseTi simptomebis Sesa-
narkotikis~ moxmareba, romelsac eiforiuli da rbi- msubuqeblad, romlebic aqveiTeben pacientis funq-
li zemoqmedeba aqvs. aRkveTis sindromi Zalian hgavs cionirebis xarisxs an iwveven distress. zogierTi pa-
SfoTvis simptomebs, romelTa mosaxsneladac, Cveu- cientisTvis, romelic benzodiazepins ukve didi xnis
lebriv, am preparats niSnaven. amitom, Tu simptomebma manZilze moixmars, am preparatis uwyvetad miRebisas,
benzodiazepinis dozis daklebis Semdeg kvlav iCina saukeTesoa riskisa da sargeblis Tanafardoba, ma-
Tavi, eqimma SeiZleba es Zlieri SfoTviTi aSlilo- gram aseTi pacientebis gakontroleba regularulad
bis gamovlenad miiCnios da SecdomiT isev gauzar- unda xdebodes da diazepamis yoveldRiurma dozam
dos pacients doza. dadgenilia, rom pacientebis erT 30mg-s ar unda gadaaWarbos (Department of Health, 1999).
_ 492 _
benzodiazepinebis xangrlivad momxmarebeli pirebis aqvs kanabisi gasinjuli, xolo 8% -kanabisis momxmare-
20-40%-isTvis zogadi profilis eqimis rCeva SeiZleba belia. britaneTSi Sesabamisi maCveneblebia _ 27% da
sakmarisi iyos imisTvis, rom Seamciros yoveldRiuri 6% (Ramsay et al., 2001). rogorc Cans, kanabisis momx-
doza an saerTod Sewyvitos mkurnaloba. benzodiaz- marebelTa umravlesoba ar iRebs sxva akrZalul nar-
epinze damokidebulebisa da misi mkurnalobis Sesaxeb kotikul nivTierebebs, Tumca, zogierT maTgans aR-
informacia ix. Lingford-Hughes et al., 2004. eniSneba alkoholis Warbi moxmareba.
klinikuri efeqtebi. kanabisis zemoqmedeba vari-
barbituratebi rebs dozis, pirovnebis molodinebis, misi guneb-gan-
bolo aTi wlis manZilze mniSvnelovnad Semcirda wyobisa da socialuri garemocvis mixedviT. kanabi-
pacientebisTvis barbituratebis daniSnvis faqtebi, sis momxmareblebi kanabisis miRebis Semdeg TavianT
radgan eqimebi ufro axal anqsiolizur da anti- mdgomareobas axasiaTeben rogorc àweuls~, magram
depresantul saSualebebs aniWeben upiratesobas. sinamdvileSi, kanabisi, alkoholis msgavsad, mxolod
Sesabamisad, Semcirda maTi arakanonieri moxmarebac. aZlierebs mis miRebamde arsebul guneb-ganwobas _
winaT barbituratebis, rogorc saZile saSualebis, rogorc àweuls~, ise depresiuls. momxmareblebi,
daniSvnis gamo, mraval adamians uviTardeboda ma- aseve, saubroben kanabisis miRebis Sedegad esTetkuri
Tze damokidebuleba. axalgazrda narkomanebi zogi- siamovnebis gamZafrebis, droisa da sivrcis araadekva-
erT barbiturats intravenurad (kafsulebis gaxsnis turi aRqmis Sesaxeb. amas garda, maT SeiZleba aReniS-
gziT) moixmardnen. aseve, gavrcelebuli iyo barbi- nebodeT Tvalebis siwiTle, piris simSrale, taqikar-
turatebis sxva fsiqoaqtiur nivTierebebTan erTad dia, sasunTqi gzebis gaRizianeba da xvela. kanabisiT
moxmareba. gamowveuli intoqsikacia saSiSia mZRolebisTvis.
aRkveTa. barbituratebis swrafi aRkveTa damokide- arasasurveli efeqtebi. im pirebs, romlebic kanabiss
bulebis mqone pirebisTvis sakmaod saSiSia, radgan drogamoSvebiT, mcire dozebiT iyeneben, ar aReniSne-
mas SeiZleba mohyves deliriumi (rogorc es xdeba baT seriozuli arasasurveli efeqtebi. miuxedavad
alkoholis aRkveTis SemTxvevaSi), gulyra an zogjer imisa, rom ar arsebobs zusti monacemebi kanabisis
kardiovaskuluri kolafsiT gamowveuli sikvdili. teratogenulobis Sesaxeb, misi moxmareba saxifaToa
amitom rekomendebulia, rom pirovnebam, romelic fexmZimobis pirveli sami Tvis ganmavlobaSi. kanabi-
barbituratebs Terapiul dozaze gacilebiT ufro sis SesunTqva aRizianebs sasunTq gzebs da potenciu-
maRali doziT moixmars, detoqsikacia stacionaris rad kancerogenulia. misi gadaWarbebulad moxmarebis
pirobebSi gaiaros. Tumca, im pacentebs, romlebic yvelaze ufro gavrcelebuli arasasurveli fsiqolo-
barbituratebis Terapiul dozas iReben, aRkveTis giuri efeqtia SfoTva. aseve, xSiria msubuqi formis
procedura SesaZlebelia ufro neli tempiT, ambula- paranoiduli ideebi. iSviaTad, kanabisis didi doziT
toriul pirobebSi CautardeT. moxmarebis dros, SeiZleba SeimCneodes toqsikoziT
gamowveuli abnevis mdgomareoba an fsiqozi naTeli
kanabisi
cnobierebis fonze.
kanabisi mindvris kanafisgan (Cannabis sattiva) miiReba. kanabisi da fsiqikuri daavadebebi. dadgenilia, rom
misi moxmareba xdeba an mcenaris gamxmari foTlebis kanabisma SeiZleba Secvalos Sizofreniis mimdinareo-
saxiT, romelic cnobilia rogorc marixuana (`bal- ba. Catarebuli gamokvlevebis mixedviT, mis momxmare-
axi~), an fisis saxiT, romelsac mdedrobiTi sqesis blebs ufro xSirad aReniSnebaT fsiqozuri epizode-
mcenaris yvavili gamoyofs. kanabisi ramdenime far- bi da recidivebi (Hall and Solowij, 1998). axdens Tu ara
makologiurad aqtiur nivTierebas Seicavs, romelTa- kanabisis moxmareba, mogvianebiT, Sizofreniis ganvi-
gan yvelaze ufro Zlieri fsiqoaqtiuri komponentia Tarebis provocirebas, sakamaTo sakiTxia. andreason-
delta-9-tetrahidrokanabinoli. rogorc Cans, kanabi- ma da misma kolegebma (Andreasson et al., 1987), romlebic
nolis farmakologiuri efeqtebi gaSualebulia misi 15 wlis manZilze 45 570 Sved axalwveuls akvirdebod-
urTierTzemoqmedebiT centralur nervul sistemaSi nen, aRmoaCines, rom Sizofreniis ganviTarebis riski
arsebul sfecifikur kanabinoidur receptorebTan. 2.5-jer maRali hqondaT kanabisis momxmareblebs da
am receptorebis endogenur ligands, savaraudod, 6-jer maRali _ kanabisis didi raodenobiT momxmare-
anandamidi warmoadgens (Howlett et al., 2004). blebs. miuxedavad imisa, rom am monacemebis mixedviT,
epidemiologia. Crdilo afrikisa da aziis zogierT kanabisis moxmareba SeiZleba iyos Sizofreniis ganvi-
qveyanaSi kanabisis produqti iseve gamoiyeneba, ro- Tarebis risk-faqtori, aseve SesaZlebelia isic, rom
gorc dasavleTSi _ alkoholi. Crdilo amerikasa da vinc Sizofreniis ganviTarebisken aris midrekili,
britaneTSi kanabisis perioduli moxmareba farTod midrekili iyos kanabisis arasworad moxmarebisakenac.
aris gavrcelebuli. rogorc zemoT aRiniSna, aSS-is Tumca, bolodroindeli prospeqtuli kohortuli
mosaxleobis 40%-s cxovrebis manZilze erTxel mainc gamokvlevis Sedegad aRmoCnda, rom axalgazrdebSi
_ 493 _
fsiqozisaken midrekileba ar aris imis momaswavebeli, da metilfenidati. kokainic erT-erTi stimulato-
rom es axalgazrdebi momavalSi kanabiss moixmaren ria, magram is calke, momdevno qveTavSi, iqneba ganxi-
(Henquet et al., 2005). am gamokvlevis mixedviT, kanabi- luli.
sis moxmareba axalgazrdebis mier, garkveulwilad
zrdis fsiqozuri simptomebis aRmocenebis risks, ma- amfetamini
gram kanabisis miRebas gacilebiT ufro Zlieri zemo- dResdReobiT amfetaminebi TiTqmis amoRebulia sa-
qmedeba aqvs im axalgazrdebze, romlebsac, damatebiT medicino praqtikidan. maT iyeneben mxolod bavSvebT-
fsiqozis ganviTarebis sxva risk-faqtorebic aReniS- an, hiperkinetikuri sindromis (gv. ??) da narkolefsi-
nebaT. Sesabamisi literaturis Tanaxmad (Arseneaul et is (gv. ??) samkurnalod. iTvleba, rom amfetaminebis,
al., 2004), mozardebis SemTxvevaSi kanabisis moxmareba rogorc fsiqomotoruli stimulatorebis, efeqtebs
daaxloebiT orjer zrdis Sizofreniis gaviTarebis ganapirobebs maTi unari _ moaxdinon dofaminisa da
risks. garda amisa, es avtorebi Tvlian, rom sazoga- noradrelanis ukumitacebis gamonTavisufleba da
doebaSi kanabisis moxmarebis aRmofxvra 8%-iT Seamci- blokireba.
rebs Sizofreniis SemTxvevebis raodenobas. epidemiologia. britaneTSi stimulatorebidan yve
SeSfoTebas iwvevs is faqti, rom mozardebis (gan- laze ufro xSirad amfetaminebi gamoiyeneba, xolo
sakuTrebiT gogonebis) mier kanabisis moxmarebam Sei- aSS-Si _ kokaini. NSDUH-is gamokiTxvis Sedegad aR-
Zleba mogvianebiT gazardos depresiis ganviTarebis moCnda, rom 2003 wels SeerTebuli Statebis mosaxle-
riski (Patton et al., 2005). Tumca, sistematurma dak- obis 9%-s cxovrebis manZilze, sul cota, erTxel
virvebam aCvena, rom axalgazrdebTan kanabisis mox- mainc aqvs miRebuli romelime stimulatori, xolo
marebiT gamowveuli fsiqosocialuri zianis faqtebi 0.5% SeiZleba maT momxmareblad CaiTvalos (SAMHSA,
winaaRmdegobrivia da zians SeiZleba sxva faqtorebic 2004).
ganapirobebdnen (mag., bavSvobisdroindeli uaryofi- britaneTis 16-dan 29 wlamde asakis mosaxleobis
Ti gamocdileba) (MaCleod et al., 2004). aseve, gamoiTqva daaxloebiT 22%-s, sul cota, erTxel mainc hqonda
mosazreba imis Taobaze, rom kanabisis qronikulad amfetaminebi gasinjuli, xolo 2%-s _ isini erTi
moxmarebam SeiZleba pirovneba apaTiamde da aqtivobis wliT adre hqonda miRebuli (Ramsay et al., 2001). wa-
donis daqveiTebamde (aramotivirebul mdgomareobam- malmoxmarebis specializebuli samsaxurebis pacient-
de) miiyvanos. Tumca, amgvari mosazreba ar daadas- Ta daaxloebiT 10% iyenebda amfetaminebs, rogorc
tura epidemiologiurma gamokvlevebma. aramotivi- ZiriTad narkotikul nivTierebas, xolo danarCeni
rebuli mdgomareobis simptomebi da niSnebi SeiZleba 10% _ rogorc meorad narkotiks, romlis gamoyene-
qronikuli intoqsikaciis maCvenebeli iyos (ix. Hall and bac, Cveulebriv, opiatebTan erTad xdeboda. maTgan
Solowij, 1998). TiTqmis naxevari amfetaminebs inieqciis gziT iRebda
tolerantoba da damokidebuleba. cxadia, rom da, aqedan gamomdinare, sakuTar janmrTelobas in-
kanabisis mimarT tolerantobas vxvdebiT im pirebTan, travenuri moxmarebiT gamowveuli riskis qveS ayeneb-
romlebic mas xangrZlivi drois manZilze didi do- da (Seivewright and McMahon, 1996).
zebiT moixmaren. maT, vinc kanabiss drogamoSvebiT warsulSi stimulatorebze damokidebulebas um-
an mcire dozebiT moixmars, tolerantobis faqtebi Tavresad eqimebis windauxedaoba iwvevda, radgan isini
naklebad udasturdebaT. Tumca, zogierTi acxadebs, xSirad uniSnavdnen pacientebs am preparatebs. dRes-
rom mas ar SeuZlia akontrolos kanabisis moxmare- dReobiT amfetaminebis uravlesoba arakanonierad
ba, miuxedavad im pirovnuli Tu socialuri zianisa, aris sinTezirebuli da gamoiyeneba rogorc `quCis~
romelic kanabisis gamoyenebas axlavs Tan. kanabisis narkotiki, romlis Jargonuli saxelwodebaa spidi da
didi doziT momxmareblebSi aRkveTis mdgomareoba uizi. amfetamins iReben rogorc peroralurad da in-
gaRizianebadobis, gulis revis SegrZnebis, uZilobis travenurad, aseve cxviriT Seynosvis gziT. agreTve,
da anoreqsiis sindroms iwvevs. es simptomebi, rogorc SesaZlebelia sufTa saxis amfetaminis (yinuli) moweva
wesi, sustia. epidemiologiuri monacemebis mixedviT, an inieqciis gziT miReba, rasac gansakuTrebulad Zl-
kanabisis momxmarebelTa umravlesoba ar mimarTavs ieri zemoqmedeba aqvs.
sxva narkotikuli nivTierebebis araswor moxmarebas klinikuri efeqtebi. guneb-ganwyobaze swrafi zemo-
an ar aris maTze damokidebuli. kanabisis moxmarebis qmedebis garda, stimulatorebi iwvevs uZilobas, an-
arasasurveli efeqtebis Sesaxeb informacia ix. Hall, oreqsias, tuCebis, pirisa da cxviris simSrales, Tva-
2000. lis gugebis gafarTovebas, aCqrebul pulsacias da
arteriuli wnevis awevas. pirovneba hiperaqtiuria da
stimulatorebi zedmetad bevrs laparakobs. amfetaminebis didi doz-
stimulatorebs ganekuTvneba amfetaminebi da maTi iT moxmarebisas SeiZleba aRiniSnebodes kardialuri
monaTesave preparatebi, rogorebicaa fenmetrazini ariTmia, Zlieri hipertenzia, insulti da, zogjer,
_ 494 _
msubuqi SemTxvevebis dros is ZiriTadad cud guneb-
cxrili 18.10 zogierTi garTuleba
ganwyobasa da energiis daqveiTebaSi gamoixateba.
amfetaminisa da kokainis araswori moxmarebisas
zog SemTxvevaSi, gansakuTrebiT am preparatis didi
samedicino
raodenobiT moxmarebisas, SeiZleba ganviTardes mZime
kardiovaskuluri _ hipertenzia, insulti, ariTmia,
miokardiumis infarqti. depresia, romelsac Tan axlavs SfoTva, tremori,
infeqciuri _ abscesebi, sefsisi, hepatitebi, aiv. moduneba, daRliloba da koSmaruli sizmrebi. ase
sameano _ embrionis zrdis Seferxeba, spontanuri ve, aRiniSneba narkotikuli nivTierebebis mimarT
aborti, naadrevi mSobiaroba. paTologiuri ltolva da suiciduri azrebi. amfe
sxva _ wonis dakargva, dentaluri problemebi, epilefsia, taminebze damokidebuleba SeiZleba swrafad gan
Tavis movlis ugulebelyofa.
viTardes. stimulatorebze damokidebulebis amoc
fsiqiatriuli noba SesaZlebelia individze dakvirvebiT. mas mo
SfoTva, depresia, antisocialuri qceva, paranoiduli
nacvleobiT aReniSneba xan hiperaqtiuroba da amaR
fsiqozi.
lebuli guneb-ganwyoba, xan ki _ umoqmedoba da
cirkulatoruli kolafsi; xolo, gansakuTrebulad depresia. rodesac arsebobs eWvi, rom pirovneba amfe
gadaWarbebuli dozis SemTxvevaSi _ nevrologiuri taminebs moixmars, saswrafod unda gakeTdes Sardis
simptomebi, mag., gulyra an koma. amfetaminebis mwvave analizi, radgan es preparati swrafad gamoidevneba
fsiqologiuri gverdiTi efeqtebia disforia, gaRiz- organizmidan.
ianebadoba, uZiloba da abneva. aseve, SeiZleba aRin- prevencia da mkurnaloba. amfetaminebis araswori
iSnebodes panika da SfoTva. sameano garTulebebia: moxmarebis prevencia damokidebulia am preparatebis
spontanuri aborti, naadrevi mSobiaroba da placen- xelmisawvdomobis SezRudvaze da pacientisTvis ma
tis CamoSla (cxrili 18.10). Ti daniSnvisas sifrTxilis gamoCenaze. eqimma win
amfetaminis moxmarebiT gamowveuli fsiqozi. xan daxeduloba unda gamoiCinos iseT pacientebTan,
grZlivi drois manZilze amfetaminis didi dozebiT romlebic pirvelive vizitze amtkiceben, rom nar
miRebam SeiZleba ganmeorebadi stereotipuli qce kolefsia awuxebT.
va gamoiwvios (mag., gamudmebuli lageba). aseve, mZime hiperdozirebis mkurnalobisas saWiroa se
SeiZleba ganviTardes paranoiduli fsiqozi, rome daciuri saSualebebis gamoyeneba da, agreTve, hi
lic paranoiduli Sizofreniis msgavsia. misi dama perpireqsiisa da kardialuri ariTmiis moxsna.
xasiaTebeli niSan-Tvisebebia devnis bodva, smeniTi toqsikuri simptomebis umravlesoba, paranoiduli
da mxedvelobiTi halucinaciebi da zogjer mtruli fsiqozis CaTvliT, amfetaminebis miRebis Sewyvetis
da safrTxis Semcveli agresiuli qceva (Connell, Semdeg maleve qreba. mkveTrad gamoxatuli simpto
1958). amgvari mdgomareoba, Cveulebriv, erT kviraSi mebis kontrolis mizniT, SeiZleba saWiro gaxdes
gadis, magram zogjer SeiZleba Tveebis manZilze neiroleptikebis gamoyeneba, magram, Tu SesaZlebelia
gagrZeldes. aseTi gaxangrZlivebuli SemTxvevebis am saSualebebiT mkurnalobis Tavidan acileba, es
dros daudgenelia, Tu rasTan gvaqvs saqme: fsiqozTan, gaaadvilebs mocemuli mdgomareobis diferenciacias
romelic am preparatebis moxmarebiT aris gamowveuli; Sizofreniisgan.
SizofreniasTan, romlis provocirebac amfetaminis amfetaminze damokidebulebis mkurnaloba rTulia,
miRebam moaxdina, Tu ubralo damTxvevasTan. ro radgan am dros narkotikuli nivTierebisadmi ltol
goric ar unda iyos am kavSirebis buneba, pacientebi, va SeiZleba Zalze Zlieri iyos. mkurnalobis mizani,
romlebic amfetamins xSirad arasworad moixmaren, Cveulebriv, abstinenciaa, romlis misaRwevadac SeiZ
akiTxaven fsiqiatriul samsaxurebs. erT-erTi dak leba farTo speqtris socialuri da fsiqologiuri
virvebis mixedviT, amfetaminebs fsiqozis gamowvevis intervenciis Catareba gaxdes saWiro (ix. zemoT).
unari aqvT, rac adasturebs Sizofreniis ganviTarebis mwvave aRkveTis sindromiT gamowveuli mZime dep
dofaminur hipoTezas (ix. me-12 Tavi). resiis marTvis dros SeiZleba sasargeblo iyos
tolerantoba da damokidebuleba. amfetaminis benzodiazepinebis gamoyeneba. miuxedavad imisa,
moxmarebis epidemiologiidan gamomdinare, mraval rom antidepresantebi xels ar uwyobs abstinenciis
adamians, romlebic am preparats rekreaciuli miz miRwevas, maTi gamoyeneba SeiZleba mizanSewonili
nebisTvis moixmaren, ar uyalibdeba masze damo aRmoCndes persistentuli depresiuli aSlilobis
kidebuleba da ar xdeba amfetaminis borotad momx mkurnalobisas. abstinenciaze dafuZnebuli prog
marebeli. is pirebi, romlebic amfetamins ufro ramebi ar iZleva efeqts amfetaminebis zogierTi
xSirad iyeneben, tolerantobis gamo iZulebulni momxmareblis SemTxvevaSi. intravenuri miRebiT gamo
arian es narkotikuli nivTiereba ufro didi doziT wveuli seriozuli zianis gamo tardeba mxardamWeri
miiRon. amfetaminis moxmarebis Sewyvetas sxvadasxva mkurnaloba, rac amfetaminis peroraluri gziT
simZimis aRkveTis sindromi (`lomka~) mohyveba. miRebas gulisxmobs. es praqtika ar aris gamyarebuli
_ 495 _
sakmarisad mkafio mtkicebulebiT, amitom saWiroa drois manZilze kokainis didi doziT moxmarebisas
randomizebuli kontrolirebadi kvlevebis Cata pirovnebas SeiZleba paranoiduli fsiqozi ganuvi
reba. Tumca, guldasmiT SerCeul situaciebSi, Tardes, rasac Zaladobrivi qceva axlavs Tan. ase
misi gamoyenebiT SesaZlebelia zianis Semcireba Ti mdgomareoba, Cveulebriv, xanmoklea, magram
(Bruce, 2000). farmakologiuri mkurnalobis Sesaxeb fsiqozuri aSlilobis mimarT mowyvladobis mqone
infromacia ix. Strisurapont et al., 2004. adamianebs is SesaZlebelia ufro xangrZlivi drois
manZilze gaugrZeldeT. zogjer kokainis arasworad
kokaini
momxmareblebs axasiaTebT formikacia _ SegrZneba,
kokaini centraluri nervuli sistemis stimulatoria, TiTqos kanqveS mwerebi dacocaven.
romelsac amfetaminis msgavsi efeqtebi axasiaTebs kokainis somaturi efeqtebia gaxSirebuli pulsacia
(aRwerilia zemoT). cxovelebSi mas SeuZlia gamoiwvios da maRali arteriuli wneva. aseve, xSiria Tvalis gugebis
gansakuTrebiT Zlieri dadebiTi ganmtkiceba, xolo gafarToveba. kokainis moxmarebis arasasurveli
adamianebSi is Zlier damokidebulebas iwvevs. es efeqtebia: kardialuri ariTmia, miokardiumis infa
ukanaskneli efeqti, savaraudod, dakavSirebulia ko rqti, miokarditi da kardiomiopaTia. kokainis mox
kainis unarTan _ moaxdinos dofaminis ukumitacebis mareba, aseve, dakavSirebulia cerebrovaskulur
blokireba dofaminis presinafsur terminalebSi, rac daavadebebTan, rogorebicaa, mag., cerebruli infa
iwvevs mimdebare birTvSi (nucleus accumbans) dofaminis rqti, subaraqnoiduli hemoragia da tranzituli
eqstraujreduli koncentraciis mniSvnelovan zrdas iSemiuri Setevebi. xandaxan aRiniSneba gulyra da
da fiziologiuri dajildovebis sistemis Semdgom sunTqvis gaCereba. sameano garTulebebia: spontanuri
aqtivacias (Robbins and Everitt, 1999). aborti, placentis CamoSla da naadrevi mSobiaroba.
kokainis miReba xdeba ineqciis meSveobiT, moweviT tolerantoba da damokidebuleba. mudmiv momxma
an cxviris nestoebidan SesunTqviT. es ukanaskneli reblebs kokainis efeqtebis mimarT uviTardebaT
zogjer cxviris Zgidis perforacias iwvevs. `Tavisu tolerantoba da amfetaminebis msgavsi aRkveTis
fal bazarze~ qimiurad sufTa saxis kokains `quCis~ sindromi. kokainis gansakuTrebiT didi raodenobiT
narkotikisgan amzadeben da mas Zalian swrafi moq moxmarebis Semdeg pirovnebas uviTardeba `lomka~,
medeba aqvs (gansakuTrebiT misi inhalaciuri gziT romelsac axasiaTebs disforia, anhedonia, gaRi
miRebisas). zianebadoba, daRliloba da moWarbebuli Zilianoba.
epidemiologia. 2003 wlis monacemebiT, amerikelebis Tu kokainis moxmareba SedarebiT zomieria, am
daaxloebiT 15% mTeli cxovrebis manZilze kokains gvari simptomebi 24 saaTSi gadis, magram misi
moixmarda, xolo 3% _ kokainisgan damzadebul ufro xangrZlivad gamoyenebis Semdeg simptomebi
`kreks~. am narkotikuli saSualebis momxmareblebis ufro mwvave da persistentulia (mag., Zlieri
raodenoba gasul Tves ltolva, depresia da zogjer mZime suiciduri
6%-s Seadgenda da aqedan 1% mas respiratoruli gziT azrebi). kokainisadmi Zlierma ltolvam SeiZleba
iRebda (SAMHANA, 2004). aSS-Si kokainis moxmareba abstinenciidan erTi Tvis Semdeg kvlav iCinos Tavi,
dakavSirebulia Zaladobrivi danaSaulis maRal do gansakuTrebiT im SemTxvevaSi, Tu subieqti iseTi
nesTan. bolo aTi wlis manZilze gaerTianebul fsiqologiuri an socialuri stimulebis zegavlenas
samofosa da evropaSi imata kokainis moxmarebis ganicdis, romlebic warsulSi mis moxmarebasTan iyo
SemTxvevebma, Tumca, mainc ufro naklebia, vidre dakavSirebuli.
aSS-Si. britaneTSi im pirTa raodenoba, romlebic mkurnaloba. mwvave intoqsikaciis SemTxvevaSi
mTeli cxovrebis manZilze moixmaren kokains, 6%-ia SeiZleba saWiro gaxdes pacientis benzodiazepinebiT
da yvelaze ufro gavrcelebulia axalgazrdebSi, damSvideba an, mZime SemTxvevebis dros, neiro
romelTa saqmianoba dakavSirebulia cekvasa da qo leptikebis gamoyeneba. Tanmdevi movlenebis (mag.,
reografiasTan; aseve, marginalebSi da opiatebze gulyra an hipertenzia) marTva Cveuli meTodebiT
damokidebulebis mqone pirebSi (Ramsay et al., 2001). unda ganxorcieldes.
kokainis momxmarebelTa umetesoba, rogorc Cans, ar amfetaminebis msgavsad, kokainze damokidebulebis
sargeblobs samedicino momsaxurebiT. mkurnaloba rTulia, radgan am dros aRiniSneba
klinikuri efeqtebi. kokainis fsiqologiuri efeq abstinenciiT gamowveuli Zlieri ltolva. koka
tebia emociuri agzneba, mozRvavebuli energia da inis zomierad momxmarebeli adamianebisTvis SeiZ
eiforia, aseve, gandidebis ideebi, gansjis una leba sakmarisi iyos ambulatoriul pirobebSi
ris daqveiTeba da seqsualuri Seukavebloba. koka fsiqologiuri da socialuri daxmarebis gaweva,
inis didi doziT moxmarebam SeiZleba smeniTi da magram kokainis gadaWarbebulad an qronikulad
mxedvelobiTi halucinaciebi gamoiwvios, xolo para momxmarebleblebs, romlebsac Zlieri damokidebuleba
noidulma ideebma _ agresiuli qceva. xangrZlivi axasiaTebT, ufro intensiuri mkurnaloba esaWi
_ 496 _
roebaT, romelic, savaraudod, stacionarul pi (kbilebis kraWuni) da oflianoba. eqstazis Semdgomi
robebSi unda Catardes. miuxedavad imisa, rom dozebis mimarT tolerantoba swrafad viTardeba.
gakeTda farmakologiuri mkurnalobis zogierTi im pirebs, romlebic eqstazs gamosasvlel dReebSi
midgomis Sefaseba, dResdReobiT ar arsebobs maTi (SabaT-kviras) moixmaren, maTive TqmiT, Sua kviraSi
mxardamWeri sakmarisi mtkicebuleba. arsebuli aReniSnebaT guneb-ganwyobis `Cavardna~, rac SeiZleba
faqtobrivi monacemebidan gamomdinare, ar aris aRkveTis efeqts warmoadgendes (Curran and Travill,
rekomendebuli antidepresantebis, karbamazepinis 1997).
da dopaminis agonistebis (mag., bromokriptinis an arasasurveli reaqciebi. iSviaT SemTxvevebSi eqs
amantadinis) gamoyeneba (Lima et al., 2003a, b). arsebobs tazis moxmarebam SeiZleba seriozuli arasasurveli
monacemebi, romlebic mianiSnebs disulfiramis reaqciebi gamoiwvios. axalgazrda zrdasrul ada
sargeblianobaze, magram ara alkoholis Tanmdev mianebs misi moxmarebis Sedegad SeiZleba hqondeT
moxmarebaze zemoqmedebis gamo (Carroll et al., 2004). hiperTermiiT gamowveuli garTulebebi, fiqsirdeba
kokainze damokidebulebis mqone pirebisTvis SeiZleba letaluri SemTxvevebic. hiperTermiis mizezi
sasargeblo aRmoCndes sxvadasxva fsiqoTerapiuli SeiZleba iyos eqstazis zemoqmedebis Sedegad Tavis
programebis gamoyeneba (kognitur-bihevioruli mid tvinSi 5-HT-is gamoyofis gaZliereba da socialuri
gomebi, situaciuri marTva da Tormetsafexuriani garemocva, sadac, Cveulebriv, miRebulia am nar
midgomis Semcveli programebi (Higgins et al., 2003). kotikuli nivTierebis gamoyeneba (xalxmravali wve
rac Seexeba individualuri mkurnalobis programebs, ulebebi xangrZlivi da energiuli cekvebiT). aseve,
samwuxarod, unda aRiniSnos, rom kokainis borotad dafiqsirebulia kardialuri ariTmiiT gardacvalebis
momxmareblebTan xSirad gvxvdeba sxva fsiqoaqtiuri SemTxvevebi, Tumca, aq SeiZleba ukve arsebuli kar
nivTierebebis, mag., opioidebis da alkoholis, dialuri daavadeba TamaSobdes garkveul rols.
borotad moxmarebac. eqstazis momxmareblebSi dafiqsirebulia in
tracerebruli hemoragiis SemTxvevebi, romlebic,
eqstazi (MDMA)
savaraudod, hipertonuli kriziT aris gamowveuli.
bolo aTi welia, rac swrafad gaizarda 3, 4 me toqsikur hepatits SeiZleba ganapirobebdes eqstazis
Tilendioqsiamfetaminis anu èqstazis~ rekreaciuli usufTaod damzadeba an metaboluri idiosinkrazia
mizniT gamoyeneba. misi moxmarebis maCvenebeli axlac (Winstock, 2000).
izrdeba, Tumca, SedarebiT ufro neli tempebiT. 1998 eqstazis moxmareba mwvave da qronikul paranoidul
wels 16-24 wlis axalgazrdebis daaxloebiT 5% bolo fsiqozTan aris dakavSirebuli, magram, iseve rogorc
erTi wlis manZilze eqstazis momxmarebeli iyo. 2002 sxva narkotikuli nivTierebebiT gamowveuli fsi
wels am nivTierebis momxmareblebis raodenoba 7%-mde qozuri mdgomareobebis dros, am SemTxvevaSic ar
gaizarda (Aust et al., 2002). aSS-Si, 2003 wels, cxovrebis aris naTeli, Tu ramdenad warmoadgens es aSlilobebi
manZilze eqstazis gamoyenebis riski daaxloebiT 5%-s mowyvladi individis idiosinkraziul reaqciebs. aseve,
Seadgenda, xolo bolo wels _ daaxloebiT 0.9%-s, dafiqsirebulia `fleSbekis~ SemTxvevebi _ paTologiuri
rac gacilebiT dabalia britaneTis maCveneblebTan gamocdilebis mravaljeradi gameoreba narkotikuli
SedarebiT (SAMHSA, 2003). eqstazi sinTeziT miRe nivTierebis miRebis Semdeg ramdenime kviris an Tvis
buli narkotikuli nivTierebaa, romelic DCM- manZilze. aseT efeqts sxva halucinogenebis moxmarebis
IV-Si klasificirebulia, rogorc halucinogeni, drosac vxvdebiT (ix. qvemoT).
Tumca, mas msubuqi halucinogenuri efeqtis garda sacdeli cxovelebis (primatebis CaTvliT) mkur
mastimulirebeli Tvisebebic aqvs. eqtazis miReba, naloba eqstazis mravaljeradi gamoyenebiT iwvevs
Cveulebriv, abebis an kafsulebis saxiT xdeba. misi Tavis tvinis qerqsa da wina tvinSi 5-HT nervuli
doza daaxloebiT 50-150 miligrams Seadgens. aseTi daboloebebis degeneracias. aqedan gamomdinare,
gziT miRebuli eqstazis zemoqmedeba daaxloebiT 4-6 amgvarma efeqtebma SeiZleba adamianebSic iCinos Ta
saaTi grZeldeba. eqstazi, amfetaminebis msgavsad, vi. Tavis tvinis tomografiam aCvena cvlilebebi
aZlierebs dofaminis gamoyofas. garda amisa, is serotoninis transporteris SeboWvaSi, rac Seesa
gamoyofs 5-hidroqsitriptamins (5-HT), rac SesaZloa bameba 5-HT-is neironul dazianebas (McCann et al.,
misi halucinogenuri Tvisebis mizezi iyos. 1998). daudgenelia, Tu ramdenadaa SesaZlebeli, rom
klinikuri efeqtebi. eqstazi iwvevs dadebiT gu aseTi cvlilebebi xangrZliv neirofsiqologiur an
neb-ganwyobas, romelsac Tan axlavs eiforiis, fsiqiatriul garTulebebs ukavSirdebodes.
urTierTobisadmi Riaobisa da intimurobis gancda. prevencia da zianis Semcireba. miuxedavad imisa,
aseve, iwvevs movlenebis axleburad wvdomis rom eqstazis arasworad gamoyenebisas dabalia
SegrZnebas da aRqmis gamZafrebas. eqstazis somaturi seriozuli zianis riski, mniSvnelovania, rom mis
efeqtebia: madis dakargva, taqikardia, bruqsizmi potenciur momxmarebels mivawodoT informacia
_ 497 _
neirotoqsikurobis maRali riskisa da potenciurad predispoziciis mqone adamianebSi halucinogenebis
xangrZlivi saSiSroebis Sesaxeb. fsiqikuri aSlilobis hipertenziulma zemoqmedebam SeiZleba arasasurveli
mqone adamianebis SemTxvevaSi eqstazis didi dozebiT miokardiuli da cerebrovaskuluri efeqtebi gamo
moxmareba, savaraudod, zrdis arasasurveli re iwvios. fsiqologiuri efeqtebi LSD-s miRebis Semdeg
aqciebis aRmocenebis risks. informirebuloba, aseve, ori saaTis ganmavlobaSi viTardeba da, Cveulebriv,
SeiZleba daexmaros eqstazis momxmareblebs, aicilos rvidan ToTxmet saaTamde grZeldeba. yvelaze ufro
Tavidan siTburi dartyma. am mizniT rekomendebulia mkveTrad gamoxatuli gancdaa grZnobadi aRqmis
cekvis dros Sesveneba da intensiuri varjiSis dros gaZliereba an gamrudeba. SeiZleba aRiniSnebodes
sakmarisi raodenobiT izotonuri CanacvlebiTi sensoruli SegrZnebebis aRreva (sinesTezia), romlis
xsnaris miReba. drosac pirovneba xmebs vizualurad aRiqvams an
moZraobas _ smeniT. mas SeiZleba moeCvenos, rom sagnebi
halucinogenebi
ritmulad moZraoben an erwymian erTmaneTs, an TiTqos
halucinogenebs zogjer fsiqodelikebsac uwodeben, dro Senelebulia da gancdebi Rrma Sinaarss iZens.
magram mocemul saxelmZRvaneloSi am terminis sxeulis deformaciis SegrZneba, romlis drosac
gamoyeneba ar aris rekomendebuli, radgan mas ar adamians eCveneba, rom is sakuTari sxeulis gareT
aqvs erTi zusti mniSvneloba. aseve, gamoiyeneba imyofeba, SeiZleba distresul gamocdilebas war
termini `fsiqomimetikebi~, radgan es narkotikuli moadgendes. aman SesaZloa panika da fsiqikuri aS
nivTierebebi iwvevs iseT cvlilebebs, romlebic lilobis SiSi gamoiwvios. xandaxan aRiniSneba
garkveulwilad funqcionaluri fsiqozis dros aweuli guneb-ganwyoba, distresi an Zlieri SfoTva.
mimdinare cvlilebebis msgavsia. vinaidan es msgavseba adrindeli monacemebis mixedviT, am narkotikuli
ar aris sakmarisad mkveTrad gamoxatuli, Cven arc am nivTierebebis zemoqmedebis gamo adamianis qceva
termins gamoviyenebT. SeiZleba araprognozirebadi da ukiduresad saSiSi
sinTetikur halucinogenebs ganekuTvneba lizer gaxdes. ase mag., yofila SemTxvevebi, rodesac LSD-s
ginis mJavis dieTilamidi (LSD), dimeTiltriftamini momxmarebels, romelic darwmunebuli iyo, rom mas
da meTildimetoqsiamfetamini. am narkotikuli niv araferi SeiZleba dauSavdes, sakuTari TavisTvis
Tierebebidan britaneTSi yvelaze xSirad LSD-s seriozuli Wrilobebi miuyenebia an TviTmkvlelobiT
moixmaren. halucinogenebi, aseve, gvxvdeba garkveuli daumTavrebia sicocxle. dResdReobiT aseTi reaqciebi
saxis sokoebSi, romlebic fsilocebins Seicaven. SedarebiT naklebia. es SeiZleba imiT aixsnas, rom
maT swored halucinogenuri efeqtis misaRebad momxmareblebi ufro kargad acnobiereben arsebul
moixmaren. halucinogenebis moqmedebis meqanizmi ar saSiSroebebs da `mogzaurobaSi~ gamgzavrebamde sa
aris dadgenili, Tumca maTi umravlesoba zemoqmedebs gangebo zomebs iReben (mag., cdiloben, gverdze hyav
Tavis tvinis 5-HT2A receptorebze, rogorc nawi deT iseTi adamiani, romelic saWiroebis SemTxvevaSi
lobrivi agonisti. daxmarebas aRmouCens maT).
epidemiologia. aSS-sa da britaneTSi arsebuli saWiroa pacients davexmaroT, rom gadalaxos es
tendencia imaze metyvelebs, rom bolo TxuTmeti arasasurveli reaqciebi. amisaTvis LSD-s zemoqmedebis
wlis ganmavlobaSi gaizarda halucinogenebis avad qveS myof adamians unda gavesaubroT da avuxsnaT, rom
moxmareba. mag., aSS-Si, 1988 wlidan 1997 wlamde, amgvari SfoTvis momgvreli gancdebi narkotikuli
saSualo skolis moswavleebis mier halucinogenebis nivTierebiT aris gamowveuli. Tu amisaTvis sakmarisi
cxovrebis manZilze moxmareba 7.7%-dan 13.6%- dro ara gvaqvs, pacients unda mivceT trankvilizatori
mde gaizarda. 2003 wels cxovrebis manZilze (mag., diazepami), rac, Cveulebriv, dadebiT efeqts
halucinogenebis arasworad moxmarebis riski 14.5%-s iZleva. pacientma SeiZleba gamoavlinos tole
utoldeboda (SAMHSA, 2004). britaneTSi 16-29 wlis rantoba LSD-s fsiqologiuri efeqtebis mimarT,
asakis axalgazrdebis 29%-s cxovrebis manZilze, sul Tumca, aRkveTis sindromis SemTxvevebi ar aris
cota, erTxel mainc hqonda halucinogenebi miRebuli. dafiqsirebuli. agreTve daudgenelia, viTardeba Tu
aqedan, 5% adasturebda, rom maT es narkotikuli ara LSD-ze damokidebuleba, magram, rogorc Cans,
nivTiereba bolo erTi Tvis manZilze miiRes (Ramsay aseTi SemTxvevebi iSviaTias (Nichols, 2004).
et al., 2001). arsebobs mosazreba, rom LSD-s moxmarebam Se
klinikuri efeqtebi. LSD-s efeqtebi yvelaze uf iZleba azrovnebis an qcevis xangrZlivi darRveva
ro kargadaa Seswavlili. misi fizikuri zemoqmedeba an Sizofreniac ki gamoiwvios, magram ar arsebobs
cvalebadia. sawyisi simptomaturi efeqtebia: gulis am faqtis damamtkicebeli sakmarisi raodenobis
cemis gaxSireba, arteriuli wnevis momateba da gugebis monacemebi. Tumca, `fleSbeqi~, anu LSD-s miRebis
gafarToeba. Tumca, rogorc Cans, hiperdozireba ar Semdeg ramodenime kviris an Tvis ganmavlobaSi
iwvevs mZime fsiqologiur reaqciebs. fsiqodeliuri SegrZnebis ganmeorebiT aRmoceneba,
_ 498 _
sayovelTaod cnobili movlenaa. iTvleba, rom ise gvaqvs letaluri SemTxvevebic, romlebic ZiriTadad
Ti medikamentebi, rogoricaa benzodiazepinebi da hipertoniuli kriziT da sunTqvis ukmarisobiT aris
antikonvulsantebi, `fleSbeqis~ samarTav efeqtur gamowveuli. aseve, dafiqsirebulia, TviTmkvlelobis
saSualebas warmoadgens, magram es jer-jerobiT faqtebic. qronikulma moxmarebam SeiZleba gamoiwvios
ar aris damtkicebuli kontrolirebadi kvlevebiT agresiuli qceva, romelsac mexsierebis dakargva
(Halpern and Pope, 2003). axlavs Tan. fenciklidinis efeqtebis mimarT yalibdeba
tolerantoba, Tumca, aRkveTis simptomebi iSviaTad
fenciklidini
aRiniSneba. cxovelebze Catarebulma gamokvlevebma
zemoqmedebis mixedviT, fenciklidini mniSvnelovnad aCvena, rom fenciklidinis borotad momxmareblebs
gansxvavdeba halucinogenebisgan da amitom calke SeiZleba masze damokidebuleba ganuviTardeT
aRweras saWiroebs. misi sinTezireba iolia, xolo (Abraham, 2000).
miReba peroralurad, moweviT an inieqciis meSveobiT fenciklidiniT gamowveuli intoqsikaciis mkurna
xdeba. fenciklidini Seiqmna rogorc disociaciuri loba. mwvave intoqsikaciis mkurnalobas simptomaturi
anesTetiki, magram Semdgom, iseTi uaryofiTi xasiaTi aqvs da damokidebulia gamovlenil niSnebze,
efeqtebis gamo, rogorebicaa bodviTi ideebi da romlebic zemoT iyo CamoTvlili. am dros pacients
halucinaciebi, uari Tqves mis gamoyenebaze. fen SeiZleba daeniSnos diazepami, haloperidoli an
ciklidini dResdReobiT gamoyenebuli anesTeTikis _ orive erTad. sifrTxile unda gamoviCinoT mxolod
ketaminis magvari preparatia. benzodiazepinebis daniSvnisas (sxva medikamentebis
fenciklidini da ketamini N-meTil-D-aspartat gareSe), radganac es kidev ufro zrdis qcevis
(NMDA) receptorebiT warmoebuli neirotransmisiis ganmuxruWebis risks. agreTve, unda veridoT
antagonistebia, rac maT halucinogenur efeqts ga qlorpromazinis gamoyenebas, radgan es preparati
napirobebs. janmrTeli pirebisTvis damaxasiaTebeli aZlierebs fenciklidinis antiqolinergiul efeqtebs
ketaminis fsiqologiuri efeqtebi gamoiyenes Si da auaresebs fsiqikur mdgomareobas. hipertoniuli
zofreniiT daavadebul pacientebTan, gamovlenili krizis dros pacients unda vumkurnaloT anti
zogierTi klinikuri simptomisa da kognituri cvlil hipertoniuli saSualebebiT, rogoricaa, mag., fen
ebebis modelirebisTvis (Krystal et al., 1999). es sakiTxi tolamini. gansakuTrebuli gakontroleba sWirdeba
ganxilulia ?? gverdze. sunTqviT funqciebs, radgan gadaWarbebulma sekreciam
fenciklidini farTodaa gavrcelebuli aSS-Si, SeiZleba gaauaresos sasunTqi gzebis funqcionireba
magram naklebad _ britaneTSi. misi momxmareblebis cnobierebadakargul pacientTan.
umetesoba sxva fsiqoaqtiur nivTierebebsac iyenebs,
gansakuTrebiT alkoholsa da kanabiss. fenciklidinis aqroladi nivTierebebi (gamxsnelebi da inhalantebi)
peroraluri gziT miReba iSviaTad xdeba, radgan aqroladi nivTierebebis (aseve, cnobilia, rogorc
mas, efeqtis gasaZliereblad, xSirad `quCis~ gamxsnelebi) arasworad moxmareba siaxles ar war
narkotikebTan erTad moixmaren. moadgens, magram maTma farTod gavrcelebam
klinikuri efeqtebi. fenciklidinis mcire doziT sazogadoebis SeSfoTeba pirvelad 1950-iani wlebis
miReba iwvevs Trobas, romelsac Tan sdevs xelisa amerikaSi gamoiwvia. analogiuri problemebi bri
da fexis TiTebis analgezia da zogjer anesTeziac taneTSi 1970-iani wlebis dasawyisSi aRmocenda. Tum
ki. am narkotikuli nivTierebiT gamowveuli intoq ca, mogvianebiT sazogadoebis yuradReba am problemis
sikacia xangrZlivia da misi damaxasiaTebeli niSnebia: mimarT TandaTan ganelda. dResdReobiT aqroladi
aJitacia, cnobierebis daqveiTeba, agresiuloba, nivTierebebis arasworad moxmarebis done kvlavac
fsiqozis magvari simptomebi, nistagmi da maRali maRalia, gansakuTrebiT mozardebSi.
sisxlis wneva. fenciklidinis didi doziT moxma centralur nervul sistemaze aqroladi nivTie
rebisas SeiZleba aRiniSnebodes ataqsia, kunTebis rebebis farmakologiuri zemoqmedeba ar aris zus
rigiduloba da konvulsiebi. garda amisa, pirovneba tad dadgenili, magram maT, alkoholis msgavsad,
SeiZleba ar reagirebdes garemos gaRizianeblebze SeuZliaT gazardon neironuli ujredebis membranebis
maSinac ki, rodesac Tvalebi farTod aqvs gaxelili. Txevadoba da, aseve, gaaZlieron Tavis tvinis GABA
fenciklidinis SardSi Semcveloba SeiZleba dafiq funqcia (Beckstead et al., 2000).
sirdes ukanaskneli miRebidan 72saaTis ganmavlobaSi. epidemiologia. aqroladi nivTierebis araswori
Zlieri hiperdozirebis SemTxvevaSi SeiZleba gan moxmareba sayovelTao problemas warmoadgens. 2003
viTardes adrenergiuli krizi hipertoniul gu wels Catarebuli narkotikuli nivTierebebisa da
lis ukmarisobasTan, insultTan an avTvisebian hi janmrTelobis erovnuli kvlevis Tanaxmad (NSDUH),
perTermiasTan erTad. zogjer fiqsirdeba epilefsiuri amerikis mosaxleobis daaxloebiT 10%-s cxovrebis
statusis SemTxvevebi. Zlieri hiperdozirebisas manZilze, sul cota, erTxel mainc aqvs gamoyenebuli
_ 499 _
aqroladi nivTiereba; Tumca, mxolod 0.2% afiqsirebs amgvarma kombinaciam SeiZleba pirovneba ubedur
mis moxmarebas bolo erTi Tvis manZilze (National SemTxvevamde miiyvanos.
Institute on Grug Abuse, 1991). britaneTSi axalgazrdebis arasasurveli efeqtebi. aqroladi nivTierebebis
daaxloebiT erT mexuTedTan fiqsirdeba aqroladi arasworad moxmarebas mravali mZime arasasurveli
nivTierebis SesunTqvis gamocdileba (Miller and Plant, efeqti aqvs, romelTaganac yvelaze ufro seriozuli
1996). aqroladi nivTierebebis araswori moxmareba uecari sikvdilia. letalur SemTxvevebs vxvdebiT
Zalian gavrcelebulia usaxlkaro axalgazrdebis mwvave intoqsikaciis dros. 1990-ian wlebSi, bri
wreSi samxreT amerikis qveynebSi. taneTSi, aqroladi nivTierebebiT intoqsikaciis
aqrolad nivTierebebs umetesad axalgazrda mamakacebi Sedegad yovelwliurad daaxloebiT 100 adamiani
iyeneben. maTi moxmareba gansakuTrebiT gavrcelebulia kvdeboda (Ives, 2000). letaluri SemTxvevebis da
dabali socialur-ekonomiuri fenis warmomadgenlebSi. axlobiT naxevari uSualod aqroladi nivTierebebis
axalgazrdebis umravlesoba aqrolad nivTierebebs toqsikuri efeqtebiT, gansakuTrebiT kardialuri
jgufurad moixmars da mxolod 5%-ia individualuri ariTmiiTa da sunTqvis daTrgunviT, iyo gamowveuli;
momxmarebeli. arsebobs faqtebi, romelTa Tanaxmad, danarCenis mizezi iyo travma, asfiqsia (celofanis
aseTi jgufebis wevrebs antisocialuri pirovnuli parkis Tavze Camocmis SemTxvevaSi) an pirnaRebi masis
Tvisebebi axasiaTebT da, savaraudod, sxvadasxva sasunTq gzebSi gadacdena.
fsiqoaqtiur nivTierebebsac borotad moixmaren. qronikul momxmareblebs SeiZleba aReniSnebodeT
Tumca, epidemiologiuri monacemebis mixedviT, aqroladi nivTierebebis neirotoqsikuri efeqtebi;
aqroladi nivTierebebis momxmareblebis umravlesoba xolo mozardebs, am nivTierebebis araswori mox
amgvar praqtikas mxolod ramdenjerme mimarTavs da marebisas, SeiZleba mZime invalidizaciis gamo
Semdeg uars ambobs masze (Ives, 2000). mwvevi, periferiuli nevropaTia ganuviTardeT, gan
aqroladi nivTierebebi da maTi moxmarebis meTodebi. sakuTrebiT toluolis gamoyenebis dros. sxva ara
aqroladi nivTierebebis moxmarebisas yvelaze uf sasurveli nevrologiuri efeqtebia cerebruli fun
ro xSirad gamxsnelebsa da webos iyeneben (aqedan qciis moSla, encefaliti da demencia. aqroladi niv
momdinareobs termini `webos ynosva~), Tumca, maT aseve Tierebebis arasworma moxmarebam SeiZleba, agreTve,
ganekuTvneba benzini, sawmendi siTxeebi, nebismieri sxva organoebic daazianos, mag., RviZli, Tirkmelebi,
saxis aerozoli, cecxlsaqrobi nivTierebebi da guli da filtvebi. gastrointestinuri simptomebia:
butani. xSirad iyeneben toluolsa da acetons. gulisrevis SegrZneba, pirRebineba da hematemezisi
am TavSi termini àqroladi nivTiereba~, yvela (sisxliani pirRebineba).
zemoT CamoTvlil nivTierebas aRniSnavs. moxmarebis tolerantoba da damokidebuleba. aqroladi niv
meTodebi Tavad nivTierebazea damokidebuli. maTi Tierebebis regularulad moxmarebisas SeiZleba
SesunTqva xdeba boTlis yelidan, ludis qilidan an ganviTardes maTze damokidebuleba, magram absti
celofanis parkidan; aseve, SesaZlebelia nivTierebiT nenciis fizikuri simptomebi iSviaTad iCens Tavs.
gaJRenTili Cvris pirTan mitana da SesunTqva an amgvari simptomebis aRmocenebis SemTxvevaSi, pirov
pulverizatoris gamoyeneba. aqroladi nivTierebebis nebas, Cveulebriv, aReniSneba Zilis darRveva, gaRi
moxmarebis paralelurad, xSirad sxva aralegalur zianebadoba, gulisrevis SegrZneba, taqikardia da,
narkotikul saSualebebs an Tambaqosa da alkohols ufro iSviaTad, halucinaciebi da bodviTi ideebi.
iyeneben (zogjer sakmaod didi raodenobiT). aqroladi nivTierebebis 6-12 Tvis manZilze uwyveti
klinikuri efeqtebi. aqrolad nivTierebebs alko moxmarebisas SeiZleba ganviTardes tolerantoba.
holis msgavsi klinikuri efeqtebi aqvT. pirvel diagnozi. arsebobs ramdenime niSani, romlebic
etapze xdeba centraluri nervuli sistemis sti aqroladi nivTierebebiT gamowveuli mwvave intoq
mulacia, xolo Semdeg _ daTrgunva. intoqsikaciis sikaciis diagnozze miuTiTeben. esaa xelebze, saxeze
stadiebic alkoholuri intoqsikaciis msgavsia: ei an tansacmelze webos kvali; sunTqvis dros qimiuri
foriuli mdgomareoba, mxedvelobis dabindva, ga nivTierebebis suni; intoqsikaciis swrafi debiuti
urkveveli metyveleba, koordinaciis darRveva, da Caqroba; dezorientacia drosa da sivrceSi.
barbaciT siaruli, gulisrevis SegrZneba, pirRebineba qronikulad moxmarebis diagnostireba umTavresad
da koma. aqroladi nivTierebebiT intoqsikacia, xdeba moxmarebis istoriis, tolerantobis zrdisa da
alkoholurisgan gansxvavebiT, swrafad viTardeba damokidebulebis safuZvelze. damaxasiaTebeli niSania
da swrafadve qreba (ramdenime wuTis an ori saaTis gamonayari saxeze (`webos mynosavebis gamonayari~),
ganmavlobaSi). am dros aRiniSneba dezorientacia romelic celofanis parkidan aqroladi nivTierebebis
da, zog SemTxvevaSi (individebis or mexuTedTan), mravaljeradi SesunTqvis Sedegad Cndeba.
halucinaciebi, romlebic ZiriTadad vizualuri mkurnaloba. rogorc zemoT ukve aRiniSna, bev
xasiaTisaa da xSirad SiSismomgvrelia. simptomebis ri adamianisTvis aqroladi nivTierebebiT eqs
_ 500 _
perimentireba droebiTi movlenaa da, savaraudod, pirvelad miRebas ukavSirdeba. rekomendebulia ufro
ar iwvevs am nivTierebebis araswor moxmarebas an masStaburi socialuri zomebis miReba, rogoricaa,
maTze damokidebulebas. aseTi pirebisTvis SeiZ mag., gaumjobesebuli rekreaciuli saSualebebiT
leba sakmarisi aRmoCndes rCevis micema da mxar pacientebis uzrunvelyofa. aqroladi nivTierebebis
daWeris gamoxatva. Tumca, toqsikomanebis mniSv araswori moxmarebis Sesaxeb informacia ix. Ives, 2000.
nelovani nawili aqroladi nivTierebebis garda
sxva fsiqoaqtiuri nivTierebebis, mag., alkoholisa
da opioidebis momxmarebelicaa. maT ufro xSirad damatebiTi literatura
axasiaTebT antisocialuri personologiuri aSli Department of Health (1999) Drug misuse and dependence _
loba da aqvT qaoturi an Zaladobrivi ojaxuri Guidenes of clinical management. HMSO, London. (moce-
cxovrebis gamocdileba. maTi mkurnaloba sakmaod mulia wamalmoxmarebis Sefasebisa da mkurnalobis
rTulia da farTo speqtris fsiqologiur da so saxelmZRvanelo proncipebi.)
cialur midgomas saWiroebs (ix. zemoT). aqroladi
Lingford-Hughes, AR, Welch, S and Nutt, D (2004) Evidence-
nivTierebebis moxmarebis SemTxvevaSi ar mimarTaven
based guidelines for the treatment of substance misuse, ad-
raime specifikur farmakologiur mkurnalobas,
diction and comorbidity: recommendations from the British
magram SeiZleba saWiro gaxdes masTan dakavSirebuli
Association for Psychopharmacology. Journal of Psychophar-
fsiqikuri aSlilobis (mag., depresiis) Sesabamisi
macology 18(3) 293-335. (brwyinvaledaa Sejamebuli
mkurnalobis Catareba.
alkoholmoxmarebisa da wamalmoxmarebis farmak-
prevencia. prevenciuli zomebi, pirvel rigSi, mi
ologiuri mkurnalobis sakiTxebi.)
marTuli unda iyos im mravalricxovani axalgaz
rdebis mimarT, romlebic cnobismoyvareobis an Miller, WR and Rollnik, S (1991) Motivational interviewing:
Tanatolebis zewolis gamo aqroladi nivTierebebiT preparing people to change addictive behaviour.Guilford
eqsperimentirebas ewevian. unda gatardes iseTi Press, London. (naSromi exeba imas, Tu rogor Sevu-
politika, romelic SezRudavs bavSvebisTvis da mo muSavoT wamalmomxmareblebs TavianTi mavne Cvevebis
zardebisTvis aqroladi nivTierebebis miyidvas. Secvlis motivacia.)
aseve, mizanSewonilia informaciis miwodeba SesaZlo Robson, P (1999) Forbidded drugs. Oxford University Press,
Sedegebis, gansakuTrebiT mZime travmebisa da sikvdilis Oxford. (aRwerilia narkotikuli nivTierebebis mox-
riskis Sesaxeb, rac aqroladi nivTierebebis iSviaT an marebis mizezebi da wamalmoxmarebis mkurnaloba.)
_ 501 _
Tavi 19 seqsualobasTan da genderul
identobasTan dakavSirebuli
problemebi
Tavis Sinaarsi
TviTaRqma, rodesac is Tavs miakuTvnebs romelime
variaciebi seqsualur qcevaSi
genders. pirovneba SeiZleba axdendes TviTidenti-
seqsualuri qcevis kvleva
fikacias mamakacad an qalad. zog SemTxvevaSi ki,
seqsualuri orientacia
misi TviTaRqma scildeba mamakacurobis an qaluro-
seqsualuri orientaciis
bis socialur konstruqts an maT Sorisaa. gender-
ganmsazRvreli faqtorebi
uli identoba SeiZleba iyos an ar iyos TanxmobaSi
seqsualur orientaciasTan dakavSirebuli
adamianis dabadebis sqesTan.
fsiqologiuri problemebi
imis dasadgenad, Tu romeli seqsualuri aqtivoba
seqsTan da genderul identobasTan
aris anomaliuri, saWiroa gavecnoT normaluri seq
dakavSirebuli problemebi
sualuri funqcionirebis sxvadasxva SemTxvevebs. es
seqsTan da da genderul identobasTan
Tavi maTi ganxilviT iwyeba. aq ar aris ganxiluli
dakavSirebuli problemebis
sqesis fiziologia. am sakiTxze informaciis mosa
klasifikaciebi
povevblad ix. Levin, 2000.
seqsualuri disfunqciebi
seqsualuri upiratesobis
aSlilobebi (parafiliebi) variaciebi seqsualur qcevaSi
genderuli identobis anomaliebi adamianis seqsualuri qceva mravalferovania. ucnobia,
transseqsualizmi Tu ra gansazRvravs am mravalferovnebas, magram,
eTikuri problemebi seqsualuri da savaraudoa, rom mas biologiuri da socialuri
genderuli aSlilobebis determinantebi aqvs. sxva primatebTan SedarebiT
diagnostirebisa da mkurnalobis dros adamianis seqsualoba naklebadaa dakavSirebuli
biologiur faqtorTan. magaliTad, is ar aris Se
mofargluli estrusis (sqesobrivi aqtivobis peri
es Tavi exeba oTx Temas, romlebic dakavSirebulia
odi) periodiT. bevr kulturaSi biologiurad
seqsualobasTan da genderTan. esenia: seqsualuri
gansazRvruli seqsualuri signalebi, romlebic da
orientacia, seqsualuri disfunqcia, seqsualuri
kavSirebulia mkerdTan, genitaliebis Tmovan sa
preferenciebis anomaliebi da genderuli identobis
farTan, dundulebTan da tuCebTan, kosmetikiT,
darRvevebi.
parfiumeriiTa da samosiTaa gamokveTili. zog kul
1. seqsualuri orientacia individis mdgradi emoci-
turaSi ki tansacmels imisTvis iyeneben, rom xelebisa
uri, romantiuli da/an seqsualuri ltolva qalis,
da fexebis da, zog sazogadoebaSi, qalis saxis
mamakacis an orive sqesis mimarT.
dafarviT, damalon bunebrivi seqsualuri signalebi.
2. seqsualuri disfunqcia aRniSnavs iseT viTarebas, adamiani iyenebs Tavis SemoqmedebiT SesaZleblobebs
rodesac adamiani ver iRebs adekvatur siamovnebas erotiuli mxatvrobisa da literaturis Sesaqmnelad,
seqsualuri aqtisagan an, rodesac seqsualuri aqti romelic zrdis seqsualur agznebas.
srulyofili ar aris. aseTi viTarebebi xSirad gvx- socialuri wesebi akontrolebs manifestirebul
vdeba; seqsualur qcevebs. seqsualuri urTierTobebi oja
3. seqsualuri upiratesobebis anomaliebi ar aris xis wevrebs Soris akrZalulia dadgenili socialuri
gavrcelebuli, magram isini mravali formiT gvx- wesebiT da kanoniT. aseve, akrZalulia seqsualuri
vdeba da, Sesabamisad, met adgils ikavebs seqsua- urTierToba mcirewlovan pirebTan, maSinac ki,
lobasTan dakavSirebul problemebs Soris, vidre rodesac isini sisxliT naTesavebs ar warmoadgenen
ufro metad gavrcelebuli seqsualuri disfun- (Tumca seqsualuri urTierToba sxvadasxva sazoga
qciebi; doebaSi sxvadasxva asakSi xdeba dasaSvebi). zogierTi
4. genderuli identoba aris adamianis genderuli seqsualuri qceva, romelic miuRebeli iyo warsulSi,
_ 502 _
variaciebi seqsualur qcevaSi
dRes sruliad misaRebia. magaliTad, me-19 saukunis seqsualuri aqti wina wels; 16% _ ramdenjerme
bolos, masturbacia akrZaluli iyo bevr qveyanaSi, gasul wels; 40% _ TveSi ramdenjerme; 26% _ kviraSi
radgan iTvleboda codvad da janmrTelobisTvis 2-jer an 3-jer; 8% _ ufro xSirad;
sazianod. dRes is normad aris miCneuli. antikur w 18-60 wlis qalebis mesamedi ar iyo dainteresebuli
saberZneTSi homoseqsualuri urTierToba misaRebi seqsiT;
iyo, axlo warsulSi is daigmo, Tumca, dRes, aseTi
w yvelaze mimzidvel seqsualur aqtivobad dasaxel-
urTierToba misaRebia (gamonakliss garkveuli re
da vaginaluri seqsi (80%), romelic mosdevs part-
ligiuri jgufebi warmoadgens). klinicistebma un
nioris gaxdis procesis yurebas (mamakacebi _ 50%;
da gaacnobieron seqsualuri qcevisa da misdami
qalebi _ 30%);
damokidebulebis mrvalaferovneba da ar unda moa
w oraluri seqsi gavrcelebulia. oraluri seqsis
xvion Tavs pacients sakuTari faseulobebi da
dros qalebis 68% aqtiuria, xolo 73% _ pasiuri;
damokidebulebebi.
w analuri seqsi ar iTvleba mimzidvelad mamakacTa
seqsualuri qcevis kvleva 73%-Tvis da qalebis 87%-Tvis;
gavrcelebuli seqsualuri qcevebis gamosakvlevad w seqsualuri aqtis sixSire ukuproporciuli aRmo
gamokiTxvas iyeneben. pirveli mniSvnelovani kvle Cnda asakTan da Tanacxovrebis xangrZlivobasTan. is
va Catarda amerikeli biologis alfred qinsis ar aRmoCnda dakavSirebuli rasasTan, ganaTlebasa
xelmZRvanelobiT (Kinsey et al., 1948, 1953). kvlevaSi da religiasTan.
monawileobda 12 000 mamakaci da 8000 qali, magram isini britanul gamokvlevaSi (Wellings et al., 1994) mona-
ar iyvnen zogadi populaciis warmomadgenlebi. amitom, wileobda 18 876 mozrdili adamiani. Sedegebi ameri-
marTalia, kvleva mniSvnelovani iyo seqsualuri kuli kvlevis msgavsi aRmoCnda. miuxedavad amisa, sa-
qcevis mravalferovnebis gamovlenis TvalsazrisiT, Wiroa maTi frTxili interpretacia, radgan 30%-ma
magram miRebuli monacemebis ganzogadeba ver mox uari Tqva interviuze. aqtis saSualo sixSire 20-dan
deboda. es axlac problemas warmoadgens, rac imi 30 wlamde adamianebSi TveSi 5-s Seadgenda. es monacemi
Taa ganpirobebuli, rom gamokvleva Catarda me-20 asakTan erTad mcirdeboda da 55-59 wlis asakSi 2-s
saukunis 50-ian wlebSi, xolo seqsualuri qceva da udrida. oraluri seqsi yvelaze ufro gavrcelebu-
damokidebuleba seqsis mimarT mas Semdeg mravalmxriv li seqsualuri aqtivoba aRmoCnda vaginaluri seqsis
Seicvala. Semdeg. analuri aqtis sixSire dabali aRmoCnda. mxo-
SedarebiT axal gamokvlevebSi mopovebulia mona lod mamakacebis 14% da qalebis 13% misdevda analur
cemebi zogadi populaciis ufro reprezentatuli seqss. sxva britanul gamokvlevaSi mamakacebis 30%-ma
(tipiuri) SerCevebidan, romlebic SeerTebuli Sta da qalebis 26%-ma ganacxada, rom maT pirveli seqsu-
tebisa da britaneTis mosaxleobiTaa warmodgenili. aluri kontaqti 16 wlis asakamde hqondaT (Wellings et
miuxedavad imisa, rom msgavsi kulturis (anu Se al., 2001).
darebadi kulturebis) qveynebidan msgavsi monacemebis homoseqsualuri urTierToba heteroseqsualur
miRebaa SesaZlebeli, maTi zedmetad ganzogadeba ma urTierTobasTan SedarebiT naklebadaa Seswavlili,
inc ar aris mizanSewonili. magram is aranakleb mravalferovania. vaginaluri aq-
amerikul gamokvlevaSi (Michael et al., 1994) gamokiTxva tis gamoklebiT, is moicavs heteroseqsualebis mier
Cautarda 3194 inglisurenovan monawiles. daaxloebiT aRweril yvela seqsualur aqtivobas, oralur-genita-
20%-ma uari Tqva gamokiTxvaze. miuxedavad imisa, luri kontaqtisa da urTierTmasturbaciis CaTvliT.
rom gamoikiTxes sakmarisi raodenobis piri, ar aris mamakacebTan es SeiZleba iyos analuri seqsi, qaleb-
gamoricxuli, rom maT, vinc uari Tqva gamokiTxvaze, Tan ki xelovnuri falosi. aseTi aqtis dros partni-
gansxvavebuli damokidebuleba hqondaT seqsis mimarT orebi rolebs icvlian an mudmivad aqtiur da pasiur
da gansxvavebuli seqsualuri qceva axasiaTebdaT. funqciebs inarCuneben.
ZiriTadi Sedegebi aseTia: gavrcelebuli Tvalsazrisis mixedviT, bevri seqsu-
w mamakacebi ufro xSirad fiqrobdnen seqsze, vidre aluri aqtivoba, romelic paTologiuradaa miCneuli,
qalebi. mamakacTa naxevari aRniSnavda, rom isini im SemTxvevaSi, rodesac is seqsualuri qcevis upira-
fiqrobdnen seqsze dReSi ramdenjerme; gamokiTxuli tes formas warmoadgens, mas drodadro mimarTaven,
qalebis umravlesoba am Temaze fiqrobda kviraSi rogorc heteroseqsualuri, aseve homoseqsualuri
ramdenjerme, an ufro iSviaTad; wyvilebi da is seqsualuri aqtivobis umniSvnelo
w im mamakacebisa da qalebis procentuli raodenoba, komponents warmoadgens. magaliTad, mtkivneuli sti-
romelic pasuxobda kiTxvas seqsualuri aqtis mulacia an garkveuli tansacmlis tareba agznebis
sixSiris Sesaxeb ase ganawilda: 14% _ ar hqoniaT misaRwevad.
_ 503 _
19 seqsualobasTan da genderul identobasTan dakavSirebuli problemebi
seqsualuri orientacia orientaciis adamianebis umetesoba, ZiriTadad, gr-

Zelvadian urTierTobebs aniWeben upiratesobas, ma-
qinsi da misi kolegebi (Kinsey et al., 1948) Tvlidnen,
gram orive jgufSi arsebobs umciresoba, romelic
rom adamianebis mkacrad dayofa orientaciis mixed-
xanmokle seqsualur kavSirebs amjobinebs.
viT homoseqsualebad da heteroseqsualebad SeuZle-
TviTidentifikacia mniSvnelovnad gansxvavebulia
belia. gamokveTil heteroseqsualebsa da homoseq-
erTi da imave seqsualuri orientaciis adamianebSi.
sualebs Soris Tavsdeba adamianTa jgufi, romelic
zogierT gamokveTil homoseqsuals aqvs Zlieri iden-
homoseqsualur da heteroseqsualur miziduloba-
tifikacia sxva homoseqsualebTan da maTTan urTier-
sa da fantaziebs sxvadasxva xarisxiT ganicdis. isi-
Toba bevrad urCevnia heteroseqsualebTan kontaqts.
ni CarTulni arian iseT qcevebsa da urTierTobeb-
Si, romlebic homoseqsualuri da heteroseqsualu-
seqsualuri orientaciis ganmsazRvreli
ri komponentebis nazavs warmoadgens da iTaviseben
cxovrebis iseT stils, romelSic homoseqsualuri
faqtorebi
da heteroseqsualuri elementebi sxvadasxva xarisxi- ucnobia, Tu ra faqtorebi ganapirobeben seqsualur
Taa warmodgenili. am da sxva mizezebis gamo, klainis orientacias. arsebobs ramdenime Teoria, romlebic
(Klein et al., 1985) mixedviT seqsualuri orientacia yuradRebas sxvadasxva faqtorebze amaxvilebs. esenia
unda Sefasdes eqvsi kriteriumis mixedviT. esaa seq- genetikuri faqtorebi, dabadebis rigiToba, hormo-
sualuri ltolva, seqsualuri fantaziebi, seqsualu- nuli zemoqmedeba, neiroanatomiuri gansxvavebebi da
ri qceva, emociuri upiratesoba, cxovrebis stili da fsiqologiuri faqtorebi (Mutasnski et al., 2002).
TviTidentifikacia. homoseqsualuri da heteroseq-
genetikuri determinantebi
sualuri qcevis gamoxatva icvleba pirovnebis asaksa
da situaciasTan erTad. biseqsualuri mizidulobisa tyupebisa da naSvilebi pirebis Seswavla
da qcevis potencia ufro didia mozardebSi, vidre ramdenime mkvlevaris Tanaxmad, monozigoturi tyu-
zrdasrul adamianebSi. homoseqsualuri qceva ufro pebi homoseqsualobis TvalsazrisiT ufro xSirad
maSinaa gamoxatuli, rodesac heteroseqsualuri qce- gvanan erTmaneTs, vidre dizigoturi tyupebi (Kall-
vis ganxorcieleba SeuZlebelia (magaliTad, cixeSi); mann, 1952; Eckhert et al., 1986; Bailey, Pillard, 1991; King,
garda amisa, aseTi qceva ufro maSin aris daTrgunu- McDonald, 1992). es monacemebi eTanxmeba genetikuri
li, rodesac is miuRebelia religiuri mizezebis an etiologiis monacemebs, magram, agreTve, asaxavs im
sazogadoebis uaryofiTi damokidebulebis gamo. faqts, rom adreuli bavSvobisdroindeli garemo bev-
zemoT aRniSnul kvlevaSi, qinsim daadgina (Kinsey et rad ufro msgavsia monozigoturi tyupebis, vidre
al., 1948), rom mamakacTa 10%-s aqvs homoseqsualuri dizigoturi tyupebis SemTxvevaSi. Svilad ayvanis ga-
qcevis met-naklebi gamocdileba minimum 3 wlis manZil- mokvlevebi SeiZleba adasturebdes am SesaZleblobas,
ze, xolo mamakacTa 4%-s _ mTeli cxovrebis ganmavlo- magram, jer-jerobiT, ar aris xelmisawvdomi iseTi
baSi. qinsi (Kinsey et al., 1953) aRniSnavda, rom 20-dan gamokvleva, romelic saboloo daskvnis gakeTebis
35 wlamde martoxela qalebis 4%-ia mxolod homoseq- saSualebas mogvcemda.
sualuri orientaciis. arc erT gamokvlevaSi ar ga- molekuluri genetika da qromosomuli kvleva ar
moiyeneboda populaciis warmomadgenlobiTi (tipiuri) gvawvdis damajerebel mtkicebulebebs homoseqsual
nimuSi. ufro gviandeli SefasebiT, zusti cifrebi da heteroseqsual adamianebs Soris arsebul gansxva-
Seadgens daaxloebiT 3%-s mamakacebSi da 1%-s qalebSi vebaze (es exeba rogorc qalebs, ise mamakacebs).
(Gagnon and Simon, 1973; Laumann et al., 1994).
cxovrebis stili aris seqsualuri orientaciis dabadebis rigiToba
aspeqti, romelic icvleba kulturaluri faqto- ufrosi Zmis arseboba zrdis homoseqsualobis alba-
rebis Sesabamisad. miuxedavad amisa, sazogadoebaTa Tobas. mizezi ucnobia, magram arsebobs mosazreba,
umetesobaSi homoseqsualTa umravlesobis cxovre- rom dedis imunuri sistema mgrZnobiare xdeba mamro-
bis stili arafriT gansxvavdeba heteroseqsualebis biTi sqesis nayofis (embrionis) zogierTi aspeqtis mi-
cxovrebis stilisagan. danarCeni homoseqsualebi marT (Quinsey, 2003).
irCeven samuSaos da garTobas, romelic metwilad
hormonuli Teoriebi
arCeulia sapirispiro sqesis mier. homoseqsualebis
mcire nawili manerebiT da CacmulobiT sapirispiro cxovelebze Catarebuli kvleva gvaCvenebs, rom ZuZu-
sqess baZavs; zogjer, sakmaod utrirebulad (trans- mwovrebis Tavis tvinis Tandayolili paterni mded-
seqsualebisgan gansxvavebiT, isini amas maSinac akeTe- risTvisaa specifikuri, xolo mamris Tavis tvinis
ben, rodesac xvdebian, rom maTi genderuli identoba maxasiaTeblebis ganviTareba damokidebulia nayofSi
maT anatomiur sqess Seesabameba). orive seqsualuri androgenebis gamomuSavebaze. cxovelebSi, mamrisa da
mdedris Tavis tvinis maxasiaTeblebi ganapirobeben
_ 504 _
seqsualuri orientacia
gansxvavebul reproduqciul qcevas, rogoricaa, ma- seqsualur orientaciasTan dakavSirebuli
galiTad, sqesobrivi aqtis dros mamris mier mdedris fsiqologiuri problemebi
zemodan moqceva da lordozi seqsualurad aqtiur
nebismieri seqsualuri orientaciis mqone adamiani,
mdedrebSi. naTeli araa, informacia cxovelebSi ase-
metwilad, dakmayofilebulia da stabiluri ur-
Ti Sejvarebis nervuli kontrolis Sesaxeb Seesabameba
TierToba aqvs Tavis partniorTan. Tumca, adamianebi
Tu ara adamianTa seqsualur qcevas. isic unda aRi-
eqims seqsualur orientaciasTan dakavSirebiT rCe-
niSnos, rom Tumca mamri cxovelebi, drodadro, seq-
visTvis mainc mimarTaven. maTi problemebi SeiZleba
sualur urTierTobas sxva mamrebTan amyareben, eqs-
ramdenime kategoriad daiyos. am problemaTa didi
kluziurad homoseqsualuri qceva, albaT, mxolod
nawili exeba sazogadoebis damokidebulebas, reli-
adamianebs axasiaTebT.
giur Sexedulebebs, adamianis pirad Sexedulebebs,
Tu prenataluri androgenuli aqtivoba seqsualuri
romlebic winaaRmdegobaSi modis mis seqsualur
orientaciis ganmsazRvrelia, unda arsebobdes didi
orientaciasTan.
raodenobis homoseqsualuri orientaciis mqone ada-
miani im mamakacebs Soris, romlebsac prenataluri an- seqsualur orientaciasTan dakavSirebuli
drogenuli ukmarisoba an daqveiTebuli mgrZnobelo- gaurkvevloba
ba axasiaTebs da im qalebs Soris, romelTac andro- morcxvi da gamoucdeli axalgazrdebi, SesaZloa,
genebis siWarbiT gamowveuli sindromebi aReniSneba eqims konsultaciisTvis imis gamo mimarTaven, rom ara
(Byrne and Parsons, 1993). homoseqsualuri orientaciis aqvT mkafio warmodgena TavianTi seqsualuri orien-
maRali procenti gvxvdeba im qalebSi, romlebsac vi- taciis Sesaxeb. maTi daxmareba SeiZleba gulisxmieri
rilizebuli Tirkmelzeda jirkvlis Tandayolili saubriT. saubris dros maT saSualeba eZlevaT da-
hiperplazia axasiaTebT (Money et al., 1984; Byrne and fiqrdnen TavianT gancdebze da situaciaze, romel-
Parsons, 1993). am monacemebis interpretacia sadavoa, Sic amJamad imyofebian.
radgan es qalebi mamakacis gare genitaliebiT daibad-
nen, da, SesaZloa, maTi seqsualuri orientacia zr- mozardobis problemebi
dasrul cxovrebaSi amiT iyos gapirobebuli da ara axalgazrdebs, romlebic acnobiereben, rom nawilob-
hormonebis uSualo zegavleniT Tavis tvinze. riv an upiratesad homoseqsualebi arian, SesaZloa ar
hqondeT gaazrebuli, ras niSnavs homoseqsualad yo-
neiroanatomiuri gansxvaveba fna aratolerantul garemoSi. zogierTi aseTi axal-
naSromebi, romlebSic nacadia homoseqsual da hete- gazrda skolaSi bulingis mxverplia. amerikeli sko-
roseqsual mamakacebs Soris arsebuli gansxvavebebis lis moswavleebis gamokvlevis Sedegad dadginda, rom
axsna hipoTalamusis zogierTi birTvis struqturis suiciduri ganzraxvebi da mcdelobebi ufro xSiria
safuZvelze (LeVay, 1991), gakritikebulia teqnikuri homoseqsual vaJebTan, heteroseqsual vaJebTan Se-
mizezebis gamo (Byrne and Parsons, 1993). darebiT. es kanonzomiereba ar dadasturda moswavle
gogonebis gamokvleviT (Ramafedi et al., 1998).
fsiqologiuri mizezebi
zogierT homoseqsual axalgazrdas ainteresebs,
Teoriebi seqsualuri orientaciis fsiqologiuri Seicvleba Tu ara misi seqsualuri orientacia asak-
mizezebis Sesaxeb eyrdnoba calkeuli SemTxvevebis Tan erTad. am sakiTxze ar arsebobs zusti informa-
fsiqoanalitikur gamokvlevebs an homoseqsualTa cia, magram, rogorc Cans, is, vinc zrdasrul asaks
`gansakuTrebulad SerCeul~ jgufebs. isini efuZneba miaRwevs heteroseqsualuri survilebisa da fanta-
mozardebis bavSvobisdroindel mogonebebs, romle- ziebis gareSe, SemdgomSi isini ar ganuviTardeba.
bic ar aris dasabuTebuli. es Teoriebi, Cveulebriv,
varaudobs, rom homoseqsualuri orientacia mamaka- problemebi mozrdili asakis adreul etapze
cebSi determinirebulia adreul bavSvobaSi mSobleb- nebismieri seqsualuri orientaciis adamianebma SeiZ-
Tan cudi urTierTobiT (distanciuri urTierToba leba specialistebs daxmarebisTvis mimarTon emoci-
mamasTan an masTan xangrZlivi daSoreba; zedmetad mz- uri aSlilobebis gamo, romlebic seqsualur an soci-
runveli deda). iTvleba, rom TiToeulma am faqtor- alur urTierTobebTan aris dakavSirebuli, an maSin,
Tagan SeiZleba SeuSalos heteroseqsualuri orienta- rodesac maTi seqsualuri ltolva konfliqtSi mo-
ciis ganviTarebas. aseve iTvleba, rom homoseqsualu- dis maT religiur rwmenasTan an sxva SexedulebebTan.
ri orientacia qalebSi momdinareobs adreul asakSi zogi homoseqsuali iTxovs daxmarebas mis mimarT ua-
problemuri urTierTobidan dedasTan, romelic an ryofiTi damokidebulebis gamo. zogi homoseqsuali
indiferentulia qaliSvilis mimarT an uaryofs mas qali Txovdeba da amis Semdeg mimarTavs specialis-
(Wolff, 1971). es Teoriebi mecnieruli faqtebiT ar tebs konsultaciisTvis (xSirad meuRlis TxovniT)
aris gamyarebuli. heteroseqsualuri aqtis disfunqciis gamo.
_ 505 _
saSualo asakis problemebi Setanilia kategoria iseTi iSviaTi aSlilobisTvis,

romelic froterizmis saxeliTaa cnobili. ICD-10-Si
nebismieri seqsualuri orientaciis mqone adamianebi,
es mdgomareoba Setanilia kategoriaSi~ seqsualuri
romlebmac ver daamyares stabiluri seqsualuri ur-
upiratesobis sxva aSlilobebi~.
TierToba, marto rCebian da depresiiT xdebian Sepy-
robilni, Tu maT ar hyavT ojaxi da axlo megobrebi.
cxrili 19.1 seqsualuri da genderuli
mamakacebs, romlebic winaT SemTxveviTi xasiaTis seq-
identobis aSlilobebis klasifikacia
sualur kontaqtebs amyarebdnen, asakTan erTad SeiZ-
leba, gauWirdeT am tipis urTierTobebis damyareba. DSM - IV ICD _ 10
seqsualuri disfunqcia seqsualuri disfunqcia,
sxva problemebi romelic ar aris
gamowveuli organuli
sxva problemebi, xSirad, dakavSirebulia seqsualu- darRvevebiT*
ri gziT gadamdebi daavadebebis SiSTan. dResdReobiT seqsualuri ltolvis seqsualuri ltolvis
es aris Sidsis da aiv testze dadebiTi Sedegis SiSi. aSlilobebi daqveiTeba an ararseboba
seqsualuri ltolvis
am problemebis mqone adamianebi saWiroeben Sesabamis
daqveiTeba
samedicino mkurnalobas da konsultacias. seqsualuri zizRi seqsualuri zizRi
da seqsualuri
dakmayofilebis ararseboba
seqsTan da genderul identobasTan seqsualuri agznebis
dakavSirebuli problemebi aSliloba
seqsualuri agznebis genitaluri reaqciebis
seqsTan da genderul identobasTan aSliloba qalebSi ukmarisoba
dakavSirebuli problemebis klasifikaciebi ereqciuli disfunqcia
mamakacebSi
DSM-IV-sa da ICD-10-Si seqsisa da genderuli idento- orgazmuli aSlilobebi orgazmuli disfunqcia
bis problemebi sam jgufadaa dayofili: orgazmuli aSliloba
qalebSi
1. seqsualuri disfunqcia; orgazmuli aSliloba
2. aSlilobebi, romlebic klasificirebulia, rogorc mamakacebSi
naadrevi eakulacia naadrevi eakulacia
`parafilia~ DSM-IV-Si da `seqsualuri upirateso-
seqsualuri tkivilis
bebis aSliloba~ ICD-10-Si; aSlilobebi
3. genderuli identobis aSlilobebi. dispareunia araorganuli dispareunia
vaginizmi araorganuli vaginizmi
DSM-IV- Si es mdgomareobebi erTadaa dajgufe-
zogadi somaturi momatebuli seqsualuri
buli seqsualuri da genderuli identobis katego- mdgomareobiT gamowveuli ltolva
riaSi, xolo ICD-Si isini klasifikaciis or nawilSi seqsualuri disfunqcia
gvxvdebian: seqsualuri disfunqciebi Seatanilia F52. parafiliebi seqsualuri upiratesobis
aSlilobebi**
(`fsiqikur an qceviT faqtorebTan dakavSirebuli eqshibicionizmi eqshibicionizmi
fiziologiuri disfunqciebi~); seqsualuri upirate- fetiSizmi fetiSizmi
sobebis da genetikuri identurobis aSliloba moce- froterizmi -
mulia F60_69-Si (`mozrdilTa pirovnuli da qceviTi pedofilia pedofilia
aSlilobebi). es orive klasifikacia gverdi-gverd seqsualuri mazoxizmi sadomazoxizmi
seqsualuri sadizmi
mocemulia cxrilSi 19.1. am or sistemaSi warmodge-
nili sami ZiriTadi kategoriidan TiToeuli qvekat- vuaierizmi vuaierizmi
fetiSuri transvestizmi fetiSuri transvestizmi
egoriebadaa dayofili. seqsualuri disfunqciebi
genderuli identobis sqesis identifikaciis
iyofa imis mixedviT, Tu seqsualuri reaqciis romel aSlilobebi aSlilobebi***
etapzea disfunqcia yvelaze metad gamoxatuli. aqe- bavSvebSi
dan gamomdinare, gamoiyofa seqsualuri survilis mozardebSi da
aSlilobebi, seqsualuri agznebis aSlilobebi da or- mozrdilebSi
gazmis aSlilobebi. arsebobs, agreTve, kategoriebi * ICD _ 10-Si seqsualuri disfunqcia F5-is nawils
mtkivneuli mdgomareobebis klasifikaciisTvis, rog- warmoadgens (fiziologiur darRvevebTan da fizikur
faqtorebTan asocirebuli qceviTi sindromebi);
orebicaa vaginizmi da dispareunia. mcireodeni gansx- ** ICD _ 10-Si seqsualuri upiratesobis aSlilobebi F6-
vaveba DSM-IV-sa da ICD-10-is terminologiaSi ilus- is nawils warmoadgens (mozrdili adamianis pirovneba da
qceva). DSM _ IV-Tan Sedarebis gasaadvileblad, ICD _ 10-Si
trirebulia cxrilSi 19.1.
Setanili aSlilobebi aq gansxvavebuli TanmimdevrobiTaa
parafilias (seqsualuri upiratesobis aSlilobani) dalagebuli;
aqvs qvekategoriebi orive klasifikaciaSi. erTader- *** ICD _ 10-Si , genederuli identobis aSlilobebi F6-is
nawils warmoadgens.
Ti mniSvnelovani gansxvaveba is aris, rom DSM-IV-Si
_ 506 _
seqsTan da genderul identobasTan dakavSirebuli problemebi
genderuli identobis aSlilobebi dayofilia aSli-

cxrili 19.2 seqsualuri partnioris mqone
lobebad, romlebic bavSvobis, mozardobis da zr-
16-44 wlis asakis adamianebis seqsualur
dasruli asakisTvisaa damaxasiaTebeli. aseTi dayofa
funqcionirebasTan dakavSirebuli proble
gvxvdeba mxolod DSM-IV-Si da ara ICD-10-Si. mebis sixSire*
seqsualuri disfunqciebi grZeldeba grZeldeba

1 Tve (%) 6 Tve (%)
mamakacebSi seqsualuri disfunqcia gamoixateba
normaluri seqsualuri interesis daqveiTebaSi an mamakacebi
seqsualuri aqtis arasrulyofil ganxorcielebaSi, seqsualuri interesis 17 2
rac ganmeorebiT xasiaTs atarebs. qalebSi is um nakleboba
Tavresad ukavSirdeba aradamakmayofilebel seqsua 6 1
ereqciuli disfunqcia
lur gamocdilebas; seqsualuri aqti SeiZleba das
naadrevi orgazmi 12 3
rulebuli iyos, magram ar axldes siamovnebis Se
grZneba. amgvarad, Tu ra CaiTvleba normalur seq seqsualuri aqtis 9 2
sualur aqtad, an naklovan, aradamakmyofilebel SesrulebasTan
dakavSirebuli SfoTva
aqtad, seqsualuri partniorebis molodinzea da
mokidebuli. magaliTad, erTi wyvili SeiZleba nor qalebi
malurad miiCnevdes, rom qals iSviaTad aqvs orgazmi,
seqsualuri interesis 40 10
xolo meore wyvilma ki, SesaZloa, analogiur vi nakleboba
TarebaSi eqims mimarTos.
orgazmis miRwevis uunaroba 14 4
rogorc iTqva, seqsualuri disfunqciis problemebi
dayofilia iseT problemebad, romlebic ukavSirdeba: tkivili koitusis dros 12 3
w seqsualur survilsa da seqsualur siamovnebas; seqsualuri aqtis 7 2

SesrulebasTan
w genitalur reaqcias (ereqciuli impotencia kacebSi dakavSirebuli SfoTva
da agznebis ararseboba qalebSi);
*monacemebis wyaro: Mercer et al., 2003. respondentebs
w orgazms (naadrevi an dagvianebuli eakulacia kaceb SeeZloT erTze meti aSlilobis dasaxeleba
Si da orgazmuli disfunqcia qalebSi);
w tkivils (vaginizmi da dispareunia qalebSi; mtkiv uTedma miuTiTa amJamindeli seqsualuri problemis
neuli eakulacia kacebSi). arsebobaze. mamakacebSi yvelaze ufro gavrcelebuli
unda gvaxsovdes, rom seqsualuri disfunqcia SesaZ problema iyo ereqciuli disfunqcia da naadrevi eak-
loa pirdapir ar gamomJRavndes, magram Tavi iCinos sxva ulacia, xolo qalebSi ki, ZiriTadad, vaginaluri sim-
saxis CivilebiT (depresia, uZiloba, ginekologiuri Srale da iSviaTi orgazmi. problemebis mqone adami-
problemebi) pacientis interviuirebis dros. anTa naxevarma gamoxata daxmarebis miRebis survili,
magram mxolod aTidan erTma miiRo daxmareba. meore
seqsualuri disfunqciis gavrcelebis sixSire gamokvlevaSi (Nazareth et al., 2003), gamokiTxva Cau-
britaneTSi, stratificirebuli SerCeviT Seiswav tarda londonis 13 samedicino samsaxuris pacients.
les 16-dan 44 wlamde 11161 respondenti. sTxoves kiTxvarebze pasuxi gasca gamokiTxulTa 70%-ma. mamak-
daesaxelebinaT seqsualuri problemeba, romlis xan acebis, daaxloebiT, 22% da qalebis 40% akmayofileb-
grZlivoba 1 Tveze da 6 Tveze meti xani grZeldeboda da seqsualuri xasiaTis problemis ICD-10-Si war-
(Mercer et al., 2003). monawileTa 65%-ma gasca pasuxi modgenil diagnostikur kriteriumebs. yvelaze xSir
dasmul kiTxvebs. ar aris cnobili, respondentebis problemebs warmoadgenda orgazmis inhibicia qalebSi
mier aRwerili problemebi ramdenad Seesabameboda (19%), seqsualuri ltolvis ararseboba an daqveiTeba
seqsualuri disfunqciis diagnostikur kriteriumebs. (qalebis 17 da mamakacebis 7%), ereqciuli disfunqcia
maTi pasuxebi mocemulia cxrilSi 19.2. mamakacebTan mamakacebSi (9%) da seqsualuri agznebis disfunqcia
SedarebiT, bevrad metma qalma ganacxada problemebis qalebSi (3, 6%).
arsebobis Sesaxeb. orive jgufSi problemebi metwilad samkurnalod mosuli wyvilebis, daaxloebiT, erTi
6 Tveze naklebi xangrZlivobis iyo. mesamedidan orive partniors hqonda problemebi.
or britanul kvlevaSi Seiswavles zogadi samedici- Cveulebriv, es iyo daqveiTebuli libido qalebSi
no praqtikis pacientebi. erT-erTSi (Dunn et al., 1998) da naadrevi eakulacia kacebSi. seqsualuri xasiaTis
Catarda safosto gamokiTxva, romelSic responden- problemebis gavrcelebis sixSire da seqsualuri
tebi avsebdnen fostiT miRebul formebs. responden- disfunqciis mizezebi da mkurnaloba Semdeg wyaroSia
ti mamakacebis erTma mesamedma da qalebis orma mex- ganxiluli: Heiman (2002a).
_ 507 _
seqsualuri disfunqciis zogadi mizezebi daavadebiT gamowveul uZlurebasTan (cxrili 19.3).

im daavadebebs Soris, romlebic uSualod moqmedeben
seqsualuri disfunqcia Cndeba faqtorebis sxvadasxva
seqsualuri aqtis ganxorcielebaze, gansakuTrebiT
kombinaciebis Sedegad. esaa:
mniSvnelovania Saqriani diabeti. erT-erTi gamokvle-
zogadad, cudi urTierToba partniorTan, daqveiTe-
vis mixedviT, pirveli tipis diabetis mqone mamakacTa
buli seqsualuri ltolva, seqsualuri teqnikis ar-
22%-sa da qalebis 27%-s aReniSneboda xangrZlivi se-
codna da seqsualur aqtTan dakavSirebuli SfoTva.
qsualuri disfunqcia. iTvleba, rom es disfunqcia
sxva mniSvnelovani faqtorebia: fizikuri daavadeba,
dakavSirebulia avtonomiur neiropaTiasTan an vasku-
depresiuli da SfoTviTi aSliloba, medikamentebis
lur darRvevasTan. qalebis sakontrolo jgufSi se-
miReba, alkoholisa da wamalmoxmareba. zogierTi
qsualuri disfunqcia asocirebuli iyo depresiasTan
es faqtori aq aris ganxiluli. rodesac vikvlevT
(Enzlin et al., 2002, 2003). diabetis seqsualuri disfun-
konkretul pirovnebaSi seqsualuri disfunqciis eti-
qciis paTofiziologia ganxilulia Semdeg wyaroSi:
ologias, aucilebelia gaviTvaliswinoT, rom xSirad
Morano, 2003.
saqme gvaqvs rogorc fsiqologiur, ise fizikur faq-
miokardiumis infarqtis Semdgomi seqsualuri dis-
torebTan.
funqcia, SesaZloa, ufro SfoTviTa da medikamentebis
seqsualuri ltolvis daqveiTeba gverdiTi movlenebiT iyos gamowveuli, vidre fizi-
seqsualuri ltolva gansxvavebulia sxvadasxva adami- kuri mizezebiT (H.A. Taylor, 1999). ZiriTadad, kavSiri
anSi, magram amis mizezi ar aris cnobili. mamakacebSi,
gazrdili seqsualuri moTxovnileba pubertatis pe- cxrili 19.3 seqsualur disfunqciasTan
riodSi dakavSirebulia androgenebis gamoyofis ga- xSirad asocirebuli zogadi samedicino da
ZlierebasTan. amis sapirispirod, androgenebis Sem- qirurgiuli problemebi
cireba kastraciis, estrogenebiT mkurnalobisa da
samedicino
antiandrogenuli wamlebis miRebis dros, asustebs
mamakacis seqsualur ltolvas. Tumca, androgenebis endokrinuli
dabal donesa da sust seqsualur ltolvas Soris w diabeti, hiperTiroidizmi, miqsedema

mkafio kavSiri ar dadginda im mamakacebSi, romlebic
w adisonis daavadeba, hiperprolaqtinemia
am problemis gamo daxmarebas mimarTavdnen. agreTve,
androgenebiT mkurnaloba, Cveulebriv, ar aZlierebs ginekologia
seqsualur ltolvas im mamakacebSi, romelTac norm- w vaginiti, endometriozi, menjis infeqciebi

aluri endokrinuli funqciebi aqvT. Tumca, andro-
kardiovaskuluri
genebis dabali dozebi garkveulad zrdis seqsualur
ltolvas qalebSi (Hawton, 1985). w angina peqtoris, gadatanili miokardiumis infarqti
respiratoruli
SfoTva
w asTma, sasunTqi gzebis obstruqciuli daavadeba
SfoTva seqsualuri disfunqciis mniSvnelovani mize-
zia. zogjer SfoTva SiSis gamomwvevi adreuli ga- arTriti
mocdilebis Sedegia. aseTia mamakacis mier marcxis w nebismieri mizeziT gamowveuli arTriti
gancda pirveli seqsualuri aqtis ganxorcielebisas
Tirkmlis
an seqsualuri Zaladoba qalebSi. zogjer, SfoTva
gamowveulia mSoblebis an sxvaTa monaTxrobiT seq- w Tirkmlis ukmarisoba dializiT an dializis gareSe
sualuri urTierTobebis SiSis momgvreli aspeqtebis nevrologiuri
Sesaxeb. fsiqoanalitikosebi Tvlian, rom seqsua-
w menjis avtonomiuri neiropaTia, xerxemlis dazianeba,
lur urTierTobebTan dakavSirebuli SfoTva mom- insulti
dinareobs kidev ufro adrindeli gamocdilebidan,
qirurgiuli
kerZod, biWis uunarobidan gadalaxos oidiposis kom-
pleqsi da gogonas uunarobidan daZlios msgavsi mi- w masteqtomia
jaWvuloba mamis mimarT (gv. ??). am Tvlasazriss mec- w kolostomia, ileostomia
nieruli dasabuTeba ar gaaCnia.
w ooforeqtomia
fizikuri daavadeba da qirurgiuli mkurnaloba w epiziotomia, saSvilosnos daweva
seqsualuri disfunqcia zogjer seqsualuri kon-
w amputacia
taqtisgan Tavis Sekavebis Sedegia, rac dakavSire-
bulia orsulobasa da mSobiarobasTan an fizikuri Hawton and Oppenheimer (1983). adaptirebuli versia
_ 508 _
seqsualur disfunqcias da fizikur daavadebas an mis w problemis formulireba. problema formulirebuli
mkurnalobas Soris, naTelia. da mainc, eqimebi xSirad unda iyos TiTouli pacientis TvalsazrisiT.
ver acnobiereben im Sedegebs, romlebic mohyveba daa- interviuerma ar unda gamotovos detalebi, mxolod
vadebas seqsualuri aqtivobis TvalsazrisiT da mis- imitom, rom maTze saubrisas uxerxulad grZnobs
gan gamomdinare (xSirad araTvalsaCino) problemebs. Tavs.
w problemis warmoSoba da ganviTareba. mocemuli
medikamenturi mkurnalobis efeqti
problema mudam arsebobda, Tu normaluri fun
zog wamals gaaCnia gverdiTi movlenebi, romlebic
qcionirebis periodis Semdeg gamovlinda.
seqsualur funqciaze zemoqmedebs (ix. cxrili 19.4).
w Tavs iCens Tu ara es problema erTze met par
es, upirveles yovlisa, exeba antihipertenziul
tniorTan? es kiTxva TiToeul partniors cal-
preparatebs (gansakuTrebiT, adrenoceptorebis
calke unda davusvaT.
antagonistebs), antifsiqozur preparatebs (gansa
kuTrebiT, Tioridazins), monoaminooqsidazas in w seqsualuri ltolvis intensivoba dgindeba Ti
hibitorebs da serotoninis ukumitacebis SerCeviT Teuli partnioris cal-calke gamokiTxviT. kiTxvebi
inhibitorebs. anqsiolizuri da sedaciuri prepa exeba seqsualuri aqtisa da masturbaciis sixSires,
ratebi da hormonebi ufro metad zemoqmedebs azrebs seqsis Sesaxeb da seqsualur agznebasTan
mamakacebis seqsualur aqtivobaze, vidre qalebisaze. dakavSirebul SegrZnebebs.
zemoTCamoTvlili wamlebis garda, alkoholi da e.w. w seqsualuri teqnikis codna da seqsTan dakavSirebuli
quCis narkotikebis moxmareba uaryofiTad moqmedebs SfoTva. dasadgenia mcdari informaciisa da SfoTvis
seqsualuri aqtis xarisxze. wyaro. kiTxvebi exeba ojaxis damokidebulebas seqsis
mimarT, seqsis Sesaxeb gaTviTcnobierebulobis
zogadi midgoma seqsualuri disfunqciis mqone
xarisxs da seqsualur gamocdilebas. TiToeul
pacientebis gamokvlevis mimarT
respondents ekiTxebian, Tu romel seqsualur
anamnezis Sekreba teqnikas iyenebs misi partniori.
interviu unda CavutaroT, rogorc pacients, ise w socialuri urTierToba sapirispiro sqesTan. aris
mis seqsualur partniors. maT jer cal-calke unda Tu ara romelime partniorTagani morcxvi da
SevxvdeT, Semdeg ki _ erTad. mniSvnelovania, rom axasiaTebs Tu ara socialuri inhibicia.
gamokvleva Semdegi sqemiT mimdinareobdes:
w wyvilis socialuri urTierToba. zogierTi wyvili
daxmarebas iTxovs iseTi seqsualuri problemis
cxrili 19.4 zogierTi preparati, romelic gamo, romelic warmoadgens col-qmris konfliqtis
uaryofiTad moqmedebs seqsualur funqciaze
Sedegs da ara mis mizezs (rogorc es wyvils mcdarad
hipertenziis sawinaaRmdego preparatebi hgonia).
w diuretikebi, spironolaqtoni, simpaTolitikebi
cxrili 19.5 seqsualuri disfunqciis Sefaseba
w - blokatorebi, -blokatorebi
gansazRvre problema (gamohkiTxe orive partniori)
antidepresantebi
warmoSoba da mimdinareoba
w triciklurebi, maoi, serotoninis ukumitacebis
ra xdeba sxva partniorebTan urTierTobaSi
specifikuri inhibitorebi
seqsualuri ltolva
guneb-ganwyobis regulatorebi
codna da SiSi
w liTiumi
socialuri urTierTobebi (zogadad)
anqsiolitikebi da hipnotikebi
socialuri urTierTobebi partniorebs Soris
w benzodiazepinebi
fsiqikuri aSliloba
fsiqoaqtiuri nivTierebebis avadmoxmareba
w gansakuTrebiT Tioridazini
somaturi daavadeba; Terapiuli an qirurgiuli mkurnaloba
hormonaluri agentebi
ratom iTxovs pacienti swored axla daxmarebas?
w anaboluri steroidebi, kortikosteroidebi,
estrogenebi fizikuri mdgomareobis gamokvleva
arasworad moxmarebuli fsiqoaqtiuri nivTierebebi laboratoriuli gamokvlevebi (ix. teqsti)
w Tambaqo, alkoholi, kokaini, marixuana specialuri gamokvlevebi ereqciuli fuqnciisaTvis
_ 509 _
w fsiqikuri aSliloba. xom ar aReniSneba erT-erT

cxrili 19.6 seqsualuri disfunqciis
partniors fsiqikuri aSliloba (gansakuTrebiT
mqone mamakacebis fizikuri gamokvlevis
depresiuli aSliloba), romelmac, SeiZleba, ga
mniSvnelovani aspeqtebi
moiwvios seqsualuri xasiaTis problemebi, an
uSualod im wamlebis zemoqmedebis Sedegad, rom zogadi gamokvleva (gansakuTrebiT mimarTulia
Saqriani diabetis, farisebri jirkvlis darRvevisa da
liTac pacienti mkurnalobs (ix. cxrili 19.4). Tirkmelzeda jirkvlis paTologiis gamovlenaze)
w alkohol da wamalmoxmareba (ix. zemoT).
Tmis safaris ganawileba
w fizikuri daavadeba da samedicino an qirurgiuli
ginekomastia
mkurnaloba. gansakuTrebuli yuradReba unda mivaq
cioT faqtorebs, romlebic mocemulia cxrilSi sisxlis wneva
19.3 da 19.4. periferiuli pulsi
w ratom mogvmarTa wyvilma daxmarebisTvis swored Tvalis fskeri
am dros? SeiZleba seqsualuri problemebi ufro
refleqsebi
seriozuli gaxda an erT-erTi partniori meores
daemuqra, rom gawyvetda masTan seqsualur ur periferiuli SegrZnebebi
TierTobas am problemebis gamo. zogadi gamokvleva
fizikuri mdgomareobis Semowmeba da specialuri penisi: kongenitaluri anomaliebi, rbili qsovili,

pulsacia, mtkivneuloba, fibrozuli qsovili, infeqcia,
gamokvleva
ureTraluri gamoyofa
fizikuri mdgomareobis Semowmeba. aucilebelia Se
saTesle jirkvlebi: zoma, simetriuloba, simkvrive, Segr
vamowmoT pacientis fizikuri mdgomareoba, Tu Zneba
zogadi profilis eqims an sxva specialists jer ar
prostata - daaxloebiT 50 wels gadacilebul mamakacebSi
Cautarebia misi Semowmeba (ix. cxrili 19.6)
garkveul SemTxvevebSi unda CavataroT labo Hawton 1985. adaptirebuli versia
ratoriuli analizebi (mag., uzmoze izomeba Sa
qari da ganisazRvreba testosteronis, sasqeso tomiisa da fiziologiis Sesaxeb;
hormonebis SemakavSirebeli globulinis, luTeinis 4. isini monawileoben safexurebrivi amocanebis Ses
mastimulirebeli hormonisa da prolaqtinis done rulebaSi.
ereqciuli disfunqciis mqone mamakacebSi). mastersi da jonsoni Tvlidnen, rom kidev arse
damatebiTi informacia seqsualuri disfunqciis bobs ori mniSvnelovani faqtori. pirveli isaa,
mqone pirebis gamokvlevis Sesaxeb mocemulia Semdeg rom mkurnaloba intensiuri unda iyos. magaliTad,
wyaroSi: Tomlinson, 2005. orive partniors yoveldRiurad unda vxvdebodeT
daaxloebiT sami kviris ganmavlobaSi. meorec, mkur
zogadi midgoma seqsualuri disfunqciis
mkurnalobis mimarT naloba unda Caataros mamakacma da qalma Terapevtma,
romlebic wyvilSi imuSaveben. rogorc gairkva, arc
iqamde, sanam daviwyebT seqsualuri xasiaTis prob
erTi am damatebiTi faqtorebidan ar aris ZiriTadi.
lemaze muSaobas, mniSvnelovania gadavwyvitoT, xom
kargi Sedegebi miiReba maSinac, rodesac mkurnaloba
ar aris ufro mizanSewonili wyvilebis Terapiis
kviraSi erTxel tardeba da rodesac wyvilTan erTi
Catareba, radgan seqsualuri xasiaTis problema
Terapevti muSaobs.
meoradia, urTierTobis problemas mosdevs. Tu
wyvilis mkurnaloba. miuxedavad imisa, rom Sedegebi
aucilebelia mkurnalobis fokusireba seqsualur
ukeTesia, rodesac wyvils erTad mkurnaloben, gar
problemaze, SeiZleba sakmarisi aRmoCndes mxolod
kveuli daxmareba SeiZleba gaewios pacients, romelsac
rCevis micema da pacientis informireba.
mudmivi partniori ara hyavs. aseT pacientebs Se
Tu rekomendebulia seqs Terapiis Catareba, is
saZlebloba eZlevaT imsjelon TavianT siZneleebze
mimarTuli unda iyos orive partniorze. Cveulebrivi
da maTi daZlevis gzebze, rac, zogjer, xels uwyobs
midgoma, romelic didwilad eyrdnoba mastersisa
socialuri inhibiciis moxsnas.
da jonsonis naSroms (Masters and Johnson, 1970), oTx
komunikacia ar aris mxolod konkretul seqsualur
specifikur punqts Seicavs:
problemebze Tavisuflad saubris unari. is, ag
1. partniorebs erTad mkurnaloben; reTve, gulisxmobs meore adamianis survilebisa da
2. maT exmarebian, rom ukeTesi komunikacia daamyaron grZnobebis ukeTes gagebas. TiTeul partniors hgonia,
seqsualur urTierTobaze saubrisas; rom meorem instinqturad icis, Tu rogor mianiWos
3. isini iReben informacias seqsualuri aqtis ana mas siamovneba seqsualuri aqtis dros. amitom, igi
_ 510 _
partnioris uunarobas, mianiWos mas siamovneba, ise sxva saxis problemebis SemTxvevaSi (Hawton et al.,
miawers ara partnioris arainformirebulobas, ara 1986).
med sxva mizezebs (mag., partniori nakleb interess
seqsualuri disfunqciis tipebi
iCens mis mimarT, an ar uyvars igi). am problemis
movla SesaZlebeli gaxdeba, Tu partniorebi TavianT seqsualuri survilis nakleboba an dakargva
survils ufro gulwrfelad gamoxataven. (hipoaqtiuri seqsualuri ltolva)
informaciis miwodeba. miwodebuli informacia, aRwera da mizezebi. Civili seqsualuri survilis
ZiriTadad, seqsualuri reaqciis fiziologiur daqveiTebis Taobaze ufro metad qalebTanaa gavr
aspeqts exeba. magaliTad, Tu problemas warmoadgens celebuli. termini `seqsualuri survilis nakleboba~
anorgazmia qalebSi, eqimma unda auxsnas pacients, rom imaze miuTiTebs, rom es mdgomareoba seqsualuri
qals ufro didi dro sWirdeba seqsualuri agznebis cxovrebis dasawyisidanve aRiniSneba. termini `seqsua
misaRwevad da xazi gausvas erotikuli stimulaciis luri survilis dakargva~ imaze miuTiTebs, rom es
mniSvnelobas (magaliTad, klitoris stimulacia), mdgomareoba gamovlinda normaluri intensivobis
rac iwvevs vaginalur lubrikacias. swored SerCeuli seqsualuri survilis qonis Semdeg. survilis da
literatura seqsualuri ganaTlebis Sesaxeb, ganam kargva SeiZleba iyos globaluri an situaciuri.
tkicebs Terapevtis rCeviT miRebul efeqts. xSirad, seqsualuri survilis globaluri nakleboba mi
aseTi konsultacia seqsualuri disfunqciebis mkur uTiTebs seqsualuri ltolvis sisusteze, rac bio
nalobis umniSvnelovanesi nawilia. logiuradaa ganpirobebuli, an homoseqsualur ori
safexurebrivi davalebebis Sesruleba iwyeba nazi entaciaze, Tu Civili exeba heteroseqsualur kon
fizikuri kontaqtiT. wyvilebs aqezeben, rom mieferon taqts.
partnioris sxeulis nebismier nawils, genitaliebis survilis globaluri dakargva zogad samedicino
garda, raTa siamovneba mianiWon mas. mastersi da an fsiqiatriul mizezze miuTiTebs. zogadi sa
jonsoni amas àgznebis keras~ uwodeben. amis Semdeg medicino mizezebia testosteronis dabali done,
wyvils SeuZlia erTmaneTis genitaliebis stimulireba, prolaqtinis maRali done, sistemuri daavadeba, gi
magram ar aqvs ufleba gadavides penetraciaze. orive nekologiuri daavadeba an zogierTi medikamentis
safexurze, TiToeul partniors aqezeben aRmoaCinos (mag., antifsiqozuri wamlebi an susi-ebi) gverdiTi
is gamocdileba, romelic yvelaze didi siamovnebis movlenebi. fsiqiatriuli mizezebia depresiuli aS
momgvrelia misi partniorisTvis da mianiWos mas liloba, seqsualuri travmis Sedegebi da mZime
am tipis siamovneba. garda amisa, partniorebs ar intrafsiqikuri konfliqti, romelic seqsualuri
rTaven imis nebas, rom amowmon sakuTari seqsualuri survilis damuxruWebas iwvevs. depresiuli aSli
agznebis xarisxi, radgan am tipis Semowmeba, zogadad, lobis Semdeg seqsualuri survili sustdeba, magram
inhibiciuri efeqtis mqonea. am saxis Semowmeba tipiuri misi intensivoba, Cveulebriv, pirvandel dones
qcevaa seqsualuri aSlilobis mqone adamianebisTvis. ubrundeba depresiuli mdgomareobidan gamosvlis
mas `mayureblis rolSi~ yofna ewodeba. safexurebrivi Semdeg. Tumca, is, zogjer, SemdgomSic susti rCeba.
davalebebi ara mxolod uSualo sargeblis momtania, qalebSi seqsualuri survili SeiZleba Semcirdes
aramed, agreTve, exmareba partniorebs faruli Si premenstrualur periodSi, fexmZimobis dros da
Sebis gamovlenaSi an iseTi sferoebis aRmoCenaSi, uSualod mis Semdeg (zog qalTan _ ufro xangrZlivi
romlebic ganxilvas saWiroebs. drois manZilze), agreTve histereqtomiis an mkerdis
damatebiTi informacia wyvilebTan seqsualuri Te mokveTis Semdeg. qalebs, romlebsac aReniSnebaT
rapiis Sesaxeb Semdeg wyaroebSia mocemuli: Hawton, seqsualuri survilis dakargva am mizezebis gamo,
1995; Crowe, 1998. unda avuxsnaT, rom es gavrcelebul da xanmokle
movlenas warmoadgens.
seqs-Terapiis Sedegebi
survilis situaciuri dakargva asaxavs zogad
arsebobs seqs-Terapiis ramdenime kontrolirebadi
problemebs partniorebis urTierTobaSi.
kvleva. wina kvlevebiT dadginda, rom zemoT aRwerili
gamokvleva. fsiqikuri aSlilobis mqone qalebTan
zogadi meTodebi warmatebulia SemTxvevaTa, daax
xSirad xdeba seqsualur survilTan da agznebasTan
loebiT, erT mesamedSi, xolo kidev erT mesamedSi
dakavSirebuli problemebis ignorireba. maT unda
mniSvnelovan gaumjobesebas iwvevs (Heinman and
mieceT saSualeba isaubron TavianT seqsualur cxov
LaPiccolo, 1983; Hawton et al., 1986). mkurnalobiT miR
rebaze qal specialistebTan.
weuli gaumjobeseba Tveebis ganmavlobaSi narCundeba
seqsualuri survilis Sefaseba xdeba SekiTxvebis
(Heinman and LaPiccolo, 1983), magram SeiZleba ar
dasmiT Semdegi Temebis garSemo:
SenarCundes Terapiidan sami wlis Semdeg (De Amicis et
w fantaziebi. seqsualuri Sinaarsis fantaziebisa da
al., 1985). Sedegebi dadebiTia, rogorc grZelvadiani,
_ 511 _
sizmrebis sixSire da buneba. spermis danaxva, spermis suni; zogjer kocnac ki).
w seqsualuri qcevis survili da sixSire (partniorTan specifikuri SiSis miuxedavad, maT SeiZleba mainc
erTad an marto); miiRon siamovneba seqsualuri aqtisagan sxva mizezebis
gamo. seqsualuri SiSis Sefaseba da mkurnaloba zemoT
potenciuri mizezebis Sefaseba xdeba SekiTxvebis
aRweril zogad midgomas efuZneba (gv. ??).
dasmiT Semdegi Temebis garSemo:
w urTierTobis problemebi: siyvarulis dakargva; seqsualuri agznebis aSliloba qalebSi
brazi da a.S; qalebSi seqsualuri agznebis nakleboba gamoixateba
w seqsualuri orientacia. seqsualuri preferenciebi; vaginaluri simSraliTa an lubrikaciis ukmarisobiT,
w daRliloba, SfoTva, depresia; rac, SeiZleba, garkveuli mizezebiT iyos gamowveuli.
esaa:
w warsuli seqsualuri gamocdileba, romelic SiSsa
da zizRs iwvevs; w arasakmarisi erotikuli stimulacia partnioris
mxridan;
w zogadi samedicino mizezebi: unda gaviTvaliswinoT
yvela zemoT CamoTvlili mizezi. calkeul Sem w seqsualuri interesis nakleboba;
TxvevebSi saWiro xdeba testosteronisa da pro w seqsualur aqtTan dakavSirebuli SfoTva.
laqtinis donis gazomva. menopauzis Semdgom hormonul cvlilebebs mohyveba
seqsualuri survilis aSlilobebis gamokvleva mo vaginaluri sekreciis Semcireba. misi gamokvleva da
cemulia Semdeg wyaroSi: Rosen and Leiblum, 1987. mkurnaloba zemoT aRweril zogad midgomas efuZneba
mkurnaloba. radgan kvleviT miRebuli mtki (gv. ??). arsebobs monacemebi sildenafil citratis
cebuleba mwiria, mkurnaloba, ZiriTadad, klini dadebiTi efeqtis Sesaxeb, magram kontrolirebadi
kur gamocdilebazea dafuZnebuli. unda moxdes klinikuri kvleviT (Basson et al., 2002) ar dadasturda
nebismieri fsiqikuri an somaturi mizezis mkur placebosagan mniSvnelovani gansxvaveba. Sesabamisad,
naloba. konkretuli SemTxvevis mizezebidan an am preparatis efeqturobis dadgena damatebiT kvle
pacientis survilidan gamomdinare SegviZlia gamo vas moiTxovs. yovel SemTxvevaSi, medikamenturi
viyenoT wyvilebis Terapia, kognituri Terapia an mkurnaloba unda dainiSnos fsiqologiuri da sxva
konsultacia. testosteronma SeiZleba gaaZlieros potenciuri mizezebis sruli gaTvaliswinebis Semdeg
seqsualuri survili testosteronis dabali donis (Bancroft, 2002).
mqone pacientebSi, magram kontrolirebadi kvlevebi
ar aCvenebs seqsualuri survilis stabilur zrdas ereqciuli aSliloba mamakacebSi
im pacientebSi, romlebsac axasiaTebT susti ereqciuli aSlilobis dros SeuZlebelia ereqciis
seqsualuri survili da testosteronis normaluri miRweva an misi sakmarisi droiT SenarCuneba sqesobrivi
done. apomorfinis yoveldRiuri gamoyeneba hipoaq aqtis dasrulebamde. es SeiZleba moxdes pirvelive
tiuri seqsualuri survilis aSlilobis mqone pre aqtis dros (pirveladi ereqciuli disfunqcia) an
menopauzul qalebSi kargi Sedegis momtania (Caruso et ganviTardes normaluri funqcionirebis periodis
al., 2004), Tumca es sakiTxi Semdgom kvlevas saWiroebs. mere (meoradi disfunqcia). naadrevi eakulaciisagan
gansxvavebiT ereqciuli aSliloba ufro xSirad
seqsualuri aversiuli aSliloba gvxdeba asakovan mamakacebSi.
seqsualuri siamovneba zogjer icvleba zizRiT ge mizezebi: pirveladi disfunqcia SeiZleba aRmocendes
nitaluri kontaqtis mimarT. rodesac es aversia susti seqsualuri ltolvisa da seqsualur aqtTan
persistentuli an Zlieria da mas Tan erTvis seq dakavSirebuli SfoTvis kombinaciis Sedegad. meoradi
sualur partniorTan yvela saxis genitaliuri seq disfunqciis mizezi SeiZleba iyos seqsualuri draivis
sualuri kontaqtisTvis Tavis arideba, es mdgomareoba Sesusteba saSualo asakis an xandazmul mamakacebSi,
klasificirebulia, rogorc seqsualuri aversiuli interesis dakargva seqsualuri partnioris mi
aSliloba. misi mizezebi ar aris naTeli. isini, marT, SfoTva, depresiuli aSliloba, organuli da
rogorc Cans, hipoaqtiuri seqsualuri survilis avadeba da misi mkurnaloba. iTvleba, rom penisis
aSlilobis fsiqologiuri mizezebis msgavsia da maTi qsovilebisTvis sisxlis miwodebis moSla ereqciuli
Sefaseba da mkurnaloba hipoaqtiuri seqsualuri disfunqciis mniSvnelovani mizezia da zogierT fi
survilis aSlilobis msgavsad unda xdebodes. zikur daavadebasTan (diabeti, periferiuli vasku
luri daavadeba) aris asocirebuli.
specifikuri seqsualuri SiSi gamokvleva. gansakuTrebiT mniSvnelovania gamokv
zogi qali Zlier SfoTvas ganicdis seqsualuri aqtis levis Semdegi aspeqtebi:
zogierTi aspeqtis gamo (mag., genitaliebze Sexeba, w aRiniSneboda Tu ara normaluri funqcionireba wi
_ 512 _
na periodSi? ereqciuli aSliloba SeiZleba dro Sesaxeb. yvelaze xSiri gverdiTi movlenebia: Tavis
ebiT movlenas warmoadgendes, romelic Tavs iCens tkivili, gawiTleba, dispepsia da cxviris gaWedva.
stresis dros an partnioris mimarT interesis xangrZlivi mkurnalobis Sedegad es gverdiTi
dakargvis SemTxvevaSi. movlenebi Cveulebriv mcirdeba. am sami preparatidan
w aRiniSneba Tu ara ereqciuli disfunqcia erTze met tadalafils aqvs yvelaze xangrZlivi naxevardaSlis
partniorTan urTierTobisas? periodi da masze reaqcia yvelaze didxans gastans.
damatebiTi informaciisTvis sildenafilis Sesaxeb
w aRiniSneba Tu ara ereqcia erotikuli stimulaciis
ix. Kuthe, 2003.
(sasiyvarulo TamaSebis) dros?
vaskuluri da neirogenuli mizezebis mkurnaloba.
w aRiniSneba Tu ara ereqcia gaRviZebisas an mastur arsebobs vaskuluri an neirogenuli paTologiebiT
baciis Sedegad? dadebiTi pasuxi imaze miuTiTebs, (maT Soris diabetis mimarT meoradi paTologiebiT)
rom ereqciis disfunqcia ufro fsiqologiuri gamowveuli impotenciis mkurnalobis ramdenime
mizeziTaa gamowveuli. saxe. es meTodebia: medikamentebi, vakuumis aparati,
w aRiniSneba Tu ara alkohol an wamalmoxmareba? vaskuluri paTologiebis qirurgiuli koreqcia da
(hkiTxeT pacients da mis partniors). penisis proTezi.
w xom ar aris disfunqcia gamowveuli medikamentebis w intrakavernozuli inieqciebi. gluvi kunTis re
miRebiT? laqsanti papaverini an -receptorebis blokatori
specialuri testireba ereqciuli disfunqciis fenoqsinbenzamini iwveven ereqcias, ris gamoc maT
dros. rodesac disfunqciis etiologia daudgenelia impotenciis samkurnalod xmaroben (Virag, 1982; Padma-
anamnezis Sekrebis Semdeg, unda gakeTdes sisxlis Nathan et al., 1987). alprostadili SedarebiT axali
analizi da Catardes pacientis fizikuri janmrTe wamalia, romelsac intrakavernozuli inieqciebisTvis
lobis da ramdenime specialuri gamokvleva. spe iyeneben (Linet and Ogrinc, 1996). Tavidan pacients
cialuri xelsawyos, rijiskanis gamoyenebiT, xdeba SerCeuli wamlis patara dozebs aZleven da mere am
penisis sisxliT avsebisa da simkvrivis gansazRvra. dozebs nel-nela zrdian. rodesac saWiro doza ukve
izomeba reaqcia vizualur seqsualur stimulze da dadgenilia, pacientebs inieqciis gakeTebas aswavlian
vibratoris zemoqmedebaze. gazomvebi warmoebs Zilis (aq dozebi ar aris naCvenebi, radgan mkurnalobis
drosac. es testebi fsiqogenuri da nevrologiuri kursi iseTma eqimma unda warmarTos, visac am wamlis
xasiaTis disfunqciis gamijvnaSi gvexmareba. Tu eWvia gamoyenebis gamocdileba aqvs). dozis gadametebas
vaskuluri warmoSobis disfunqciaze, ultrabgeriTi prolongirebuli ereqcia SeiZleba mohyves da saWiro
dopleri da dupleqsuri ultrasonografia arteri gaxdes sisxlis aspiracia da 1-agonistis (magaliTad,
uli an venozuri disfunqciis identificirebaSi fenilefrinis) ineqcia (Kirby, 1994).
gvexmareba. intrakavernozulad prostaglandinis w intraureTruli mkurnaloba. alprostadili
gamoyeneba iwvevs penilur reaqcias pacientis sis SeiZleba SeviyvanoT intraureTrulad (Padma-Nathan
xlZarRvebis Sesaferisi mdgomareobis dros. sis et al., 1997) da, aseve, intrakavernozulad, rogorc
xlZarRvovani qirurgiis saWiroebis SemTxvevaSi, es zemoTaa aRwerili.
ufro specializebuli gamokvlevaa Casatarebeli (ix. w vakuumis aparatis gamoyeneba iseT pacientebTan,
Althof and Seftel, 1995). romlebzec intrakavernozuli wamliT inieqcia
mkurnaloba. mkurnaloba unda Catardes nebismier ar moqmedebs (Wylie et al., 2003), penisi Tavsdeba
SemTxvevaSi, romelic, potenciurad, mkurnalobas cilindrSi, romelSic wneva daklebulia. am
eqvemdebareba. fsiqologiuri mizezebis arsebobisas proceduras mohyveba ereqcia. mis SenarCunebas
naCvenebia kognituri an fsiqodinamiuri Terapiis exmarebian SemzRudveli rgolis CamocmiT penisis
Catareba, Tumca, drodadro recidivebi SeiZleba bazisur nawilze iqamde, sanam cilindrs ar moxsnian.
ganmeordes. miuxedavad imisa, rom es efeqturi proceduraa
oraluri medikamentebi. me-5 tipis fosfodi ereqciis misaRwevad, bevr pacients uaryofiTi
esTerazas inhibitorebi sidenafili, vardenafili damokidebuleba aqvs mis mimarT.
da tadalafili amuxruWebs cikluri guanozin
w qirurgiuli meTodebi gamoiyeneba im ereqciuli
monofosfatis daSlas fosfodiesTerazas mier,
aSlilobis dros, romelic vaskuluri anomaliebiTaa
romelic penisis vaskulur gluv kunTSi imyofeba.
ganpirobebuli. mikroqirurgias mimarTaven korpora
isini ar iwveven agznebas, magram aZliereben seq
kavernozas revaskularizaciisas, im SemTxvevaSi,
sualuri stimulaciis efeqts. yuradsaRebia wamlis
Tu aRiniSneba arteriebis stenozi an okluzia
mwarmoebelTa rCevebi ukuCvenebis, gverdiTi mov
(venebis trombozi). aseT SemTxvevaSi, moklevadiani
lenebisa da sxva wamlebTan urTierTmoqmedebis
gaumjobeseba daaxloebiT 50%-Si gvxvdeba (Goldstein,
_ 513 _
1986). alternatiuli varianti penisis proTezis naadrevi eakulacia
Cadgmaa, romelic SeiZleba naxevrad xisti iyos an
es termini gulisxmobs, rom eakulacia, Cveulebriv,
aqtis win iberebodes.
seqsualur penetraciamde an myisierad penetraciis
ereqciuli disfunqciis da misi mkurnalobis Semdeg xdeba, ris gamoc qali ver aswrebs siamovnebis
mimoxilva ix. Semdeg wyaroSi: Ralph and McNicolas (2000). miRebas. es problema ufro axalgazrda mamakacebisTvis
aris damaxasiaTebeli da gansakuTrebiT xSiria maTi
orgazmuli aSliloba qalebSi
pirveli seqsualuri urTierTobis dros.
bevri qali orgazms vaginaluri aqtis dros mizezebi. es aSliloba imdenad gavrcelebulia
regularulad ver aRwevs, magram amas klitoris seqsualuri gamocdilebis armqone axalgazrda
stimulaciiT axerxebs. sakiTxavia, unda CaiTvalos mamakacebSi, rom is SeiZleba normad CaiTvalos.
Tu ara aSlilobad qalis uunaroba regularulad rodesac is mudmiv saxes iZens, mis gamomwvev mizezs,
miaRwios orgazms (Heiman, 2002b). zogierTi qali amas metwilad, seqsualuri aqtis dros marcxis gancdis
problemad miiCnevs da rCevasa da daxmarebas iTxovs. SiSi warmoadens.
mizezebi: es aSliloba seqsualuri ltolvis nor mkurnaloba. fsiqologiuri mizezebis mkurnalobi
maluri cvalebadobis Sedegad aRmocendeba. danarCeni sas iyeneben zogad midgomas, romelic ?? gverdzea
mizezebia partnioris mier araefeqturi seqsualuri aRwerili. Tu partniori Tanaxmaa, misi mkurnaloba e.w.
teqnikis gamoyeneba, partnioris mimarT dadebiTi `moWeris teqnikiT~ aris SesaZlebeli. rodesac mamakaci
emociis nakleboba, daRliloba, depresiuli aSliloba qals atyobinebs, rom mas male orgazmi daewyeba,
da fizikuri avadmyofoba (ginekologiuri aSlilobis qali xelSi iWers peniss ramdenime wamis ganmavlobaSi
CaTvliT). garda amisa, orgazmuli aSliloba SeiZleba da Semdeg, uceb, xels uSvebs mas. amis Semdeg aqti
gamowveuli iyos seqsualuri Zaladobis grZelvadiani grZeldeba. aRwerilia alternatiuli `dawyeba-
SedegebiT da mkurnalobiT. damTavrebis~ meTodi. am dros qali cdilobs aqtis
gamokvleva. zogad gamokvlevasTan erTad, mniSv dros sxvadasxva intensivobis seqsualuri stimulaciis
nelovania Semdegi kiTxvebis dasma: regulirebas. msgavsi teqnika SeiZleba gamoyenebul
w rodesme hqonia Tu ara qals orgazmi? iqnas masturbaciis drosac. `mSvidi vaginas~ teqnikis
w Tu es asea, hqonia Tu ara orgazmi partniorTan gamoyenebisas, penisi uZravad Tavsdeba vaginaSi sul
seqsualuri aqtis dros, masturbaciis dros, Tu ufro da ufro xangrZlivi drois manZilze iqamde,
raime saxis fantaziis Sedegad? sanam ar moxdeba eakulacia. mniSvnelovania kargad
am problemis mizezi SeiZleba iyos iseTi wamlebis gavarkvioT qalis pozicia iqamde, sanam mas vTxovdeT
gamoyeneba, rogoricaa susi_ebi (serotoninis uku daxmareba gagviwios amgvar mkurnalobaSi.
mitacebis seleqciuri inhibitorebi), sxva anti serotoninis ukumitacebis seleqciuri inhibitori
depresantebi da antihipertenziuli saSualebebi. da zogierTi sxva antidepresanti, magaliTad, klo
mkurnaloba. partniors sTavazoben àgznebis keris~ mipramini, ayovneben eakulacias, rogorc normalurs,
teqnikis gamoyenebas (ix. zemoT). qalebma SeiZleba aseve naadrevs. Tumca, Cveulebriv, efeqti qreba
mimarTon TviTstimulacias, xeliT an vibratoriT medikamenturi mkurnalobis dasrulebasTan erTad.
an klitoris hiperemiis gazrdas vakuumis aparatis saerTod, medikamenturi mkurnaloba ar unda iyos
gamoyenebiT (Billups, 2002). nebismieri midgomis ga wamyvani da fsiqologiur teqnikasTan kombinaciaSi
moyenebisas, pacients unda gavuwioT daxmareba ga unda gamoiyenebodes.
nurCevlad imisa, Tu rogoria misi urTierTobebi da
seqsualuri tkivilis aSliloba
problemebi.
dispareunia. es termini aRniSnavs tkivilis SegrZnebas
mamakacTa orgazmuli disfunqcia seqsualuri aqtis dros. aseT tkivils bevri
es termini aRniSnavs dagvianebul eakulacias an mizezi aqvs. tkivili, romelic penisis nawilobriv
mis ararsebobas. Cveulebriv, es problema Tavs penetracias mohyveba, SeiZleba vaginas arasakmarisi
iCens mxolod koitusis dros, magram is SeiZleba lubrikaciis Sedegi iyos. sxva mizezebia qsovilis
masturbaciis drosac iCendes Tavs. is, Cveulebriv, dazianeba an vaginizmiT gamowveuli kunTovani spazmi.
asocirebulia saerTo fsiqologiur inhibiciasTan tkivili Rrma pentraciis Semdeg gamowveulia menjis
seqsualur urTierTobebSi, magram, aseve, SeiZleba paTologiiT (mag., endometrioziT) sakvercxis kistiTa
iyos gamowveuli iseTi medikamentebiT, rogorebicaa da simsivniT an menjis infeqciiT. is, aseve, SeiZleba
antifsiqozuri preparatebi, monoaminis oqsidazas iyos gamowveuli arasakmarisi lubrikaciiT, romelic
inhibitorebi da serotoninis ukumitacebis SerCeviTi dabal seqsualur agznebasTanaa dakavSirebuli.
inhibitorebi. vaginizmi. vaginizmi vaginas kunTis spazmia, ro
melic iwvevs tkivils seqsualuri aqtis dros iseT
_ 514 _
SemTxvevaSi, rodesac tkivilis gamomwvevi fi w SiSi, romelic exeba seqsualuri aqtis SesaZlo
zikuri dazianeba ar aRiniSneba. Cveulebriv, spazmi uaryofiT zemoqmdebas zogad, avadmyofur mdgo
penetraciis sapasuxo fobikuri reaqciis nawilia, mareobaze;
romelic SeiZleba gauaresdes gamoucdeli partnioris w informaciis nakleboba aseTive unarSezRudulobis
qmedebis Sedegad. spazmi xSirad mamakacis mier vaginaSi mqone adamianebis seqsualuri qcevis Sesaxeb.
SeRwevis mcdelobisTanave iwyeba. vaginizmis rTuli
bevri ram SeiZleba gakeTdes unarSezRuduli
formis dros spazmi maSinac iCens Tavs, rodesac
adamianebis dasaxmareblad SiSis moxsnis gziT da
qali Tavisi TiTis penetracias cdilobs. vaginizmis
maTTvis xelmisawvdomi seqsualuri aqtivobis for
mZime formam SesaZloa xeli SeuSalos meuRlesTan
mebis SeTavazebiT. Sesaferis SemTxvevebSi, SesaZ
pirveli seqsualuri kontaqtis damyarebas. e.w.
lebelia zemoT aRwerili meTodebis elementebis
`qalwul colebs~ SeiZleba hqondeT zogadi SiSi da
gamoyeneba seqsualuri disfunqciis samkurnalod.
braleulobis gancda penetraciis Taobaze, vaginizmis
mqone zogierTi qali ki, daqorwinebulia pasiur
seqsualuri upiratesobis aSlilobebi
mamakacze, romelsac dabali libido aqvs. aseTi
(parafiliebi)
mamakacisTvis savsebiT misaRebia, rom misi coli uars
acxadebs srulfasovan seqsualur urTierTobaze
seqsualuri upiratesobis aSlilobebis
(Dawkins, 1961). mas mere, rac mkurnalobis Sedegad Seswavlis istoria
qalis problema Semcirdeba, aSkara xdeba, rom mis
warsulSi, saukuneebis ganmavlobaSi, seqsualuri pre
meuRles dabali libido aqvs.
ferenciebis anomaliebi ganixileboda ufro reli
pacientis seqsualuri cxovrebis istoriaSi Semdeg
giis kanonebis Seuracxyofad, vidre im adamianis
momentebze unda gavamaxviloT yuradReba:
mdgomareobad, romelic eqimebs unda gamoekvliaT
w garemoebebi, romlebic axdenen spazmis provocirebas da emkurnalaT. am aSlilobis sistemuri kvleva
(seqsualuri aqti, tamponi, partnioris TiTi, paci 1870-ian wlebSi daiwyo. kraft-ebingma (Ktafft-Ebing,
entis TiTi); 1840-1902) venaSi moRvawe fsiqiatriis profesorma,
w partnioris seqsualuri teqnika; mogvca parafiliebis sistemuri aRwera Tavis wignSi
w nebismieri travmuli seqsualuri gamocdileba. Psychopathia sexualis (seqsualuri fsiqopaTiebi), ro
melic, pirvelad, 1886 wels gamoqveynda. amis Semdeg,
mkurnaloba. dispareuniis mkurnalobis Zalze co
Srenk-notcingma (Schrenck-Notzing, 1895) SeimuSava am
ta SemTxvevaa aRwerili (ix. McGuire, Hawton, 2003,
anomaliebis mkurnalobis warmatebuli Terapiuli
kokreinis mimoxilvisTvis). ase rom, Terapia klinikur
meTodi sugestiis gamoyenebiT. inglisSi havelok
gamocdilebas unda daefuZnos. mkurnalobaSi iyeneben
elisi (Havelock Ellis, 1859-1939) sakmaod vrclad Seexo
seqs-Terapiis zogad teqnikas, romelic zemoT
am Temas da sxva seqsualur aSlilobebs.
iyo aRwerili da romelSic vaginaluri kontaqtia
akrZaluli. SiSebs kognituri an fsiqodinamiuri anomaliuri seqsualuri upiratesobebis
midgomiT mkurnaloben. qalebs TviT-desensitizaciaSi koncefcia
exmarebian, jer sakuTari TiTis penetraciiT, Sem mocemul koncefcias sami aspeqti gaaCnia:
deg vaginis kunTebis sul ufro didi zomis gam
1. socialuri qceva ar eqvemdebareba gavrcelebul
farToeblebis gamoyenebiT.
Sexedulebebs imis Sesaxeb, Tu ra iTvleba nor
tkivili eakulacis dros. es iSviaTi problemaa.
malurad. miRebuli Tvalsazrisi normis Sesaxeb ar
Cveulebrivad misi mizezia ureTriti an prostatiti.
aris igive yvela sazogadoebaSi da yvela istoriul
zogjer ver xerxdeba mtkivneuli eakulaciis mizezis
periodSi. magaliTad, regularuli masturbacia
dadgena.
ganixileboda normidan gadaxrad bevri medikosis
seqsualuri disfunqcia fizikurad mier viqtorianul inglisSi.
unarSezRudul adamianebSi 2. ziani, romelic SeiZleba miadges seqsualur
fizikurad unarSezRudul adamianebSi seqsualuri urTierTobaSi myof meore adamians. amis magaliTebia
xasiaTis problemebs ramdenime gamomwvevi mizezi aqvs: seqsualuri urTierToba bavSvebTan an seqsualuri
w fizikuri unarSezRudulobis konkretuli zemoq sadizmis ukiduresi formebi.
medeba seqsualur funqciaze (magaliTad, nervuli 3. Tavad adamianis mier gancdili tanjva, gamowveuli
sistemis daavadeba, romelic moqmedebs avtonomiur sazogadoebis damokidebulebiT misi cxovrebis wesis
nervul regulaciaze); mimarT (magaliTad, damokidebuleba transvestizmis
w saerTo zemoqmedeba, rogoricaa daRliloba da mimarT), konfliqtiT pirovnebis seqsualur sur
tkivili; vilebsa da mis moralur standartebs Soris,
_ 515 _
da sxvebisadmi miyenebuli zianis an distresis Seqmnilia aratipiuri seqsualuri preferenciebis
gacnobierebiT. mqone adamianebisTvis, upriania misi am TavSi ganxilva.
2002 wels norvegiaSi Catarebul gamokvlevaSi, ro
zogadi sakiTxebi
melSic qalebi da mamakacebi Seiswavlebodnen (Traeen et
anomaliis gamovlenis saxe al., 2004), respodentebis 90%-ma pornografia minimum
seqsualuri upiratesobis aSlilobam SeiZleba mi erTxel naxa, metwilad JurnalSi (76%) an filmSi
ipyros eqimis yuradReba sxvadasxva mizezis gamo. (67%), an internetSi (24%). bevrad naklebi adamiani
eqimma unda icodes, Tu rogori formiT SeiZleba uyurebda mas regularulad. ucnobia, Tu ramdenad
gamovlindes am tipis anomaliebi. uvnebelia seqsualuri impulsebis am gziT gantvirTva
(im impulsebis CaTvliT, romlebic, sxva SemTxvevaSi,
daxmarebis pirdapiri moTxovna meore adamianze iqneboda mimarTuli) da aZlierebs
SeiZleba eqims daxmarebisTvis anomaliebis mqone Tu ara pornografiis yureba seqsualur impulsebs
pirovnebam mimarTos. mas, agreTve, SeiZleba dax da ubiZgebs Tu ara adamianebs seqsualuri qcevisaken.
marebisTvis mimarTos avadmyofis meuRlem an seq am kiTxvaze pasuxis gacema ramdenime gziT iyo nacadi.
sualurma partniorma, zogjer imitom, rom pacientis epidemiologiuri kvleva cdilobs seqsualuri
qceva swored mocemul dros gamomJRavnda, zogjer ki xasiaTis danaSaulis sixSiresa da pornografiaze
imitom, rom misi qceva gaxSirda da gausaZlisi gaxda. arsebul kanonSi cvlilebaTa Soris kavSiris dadgenas,
magram gamokvlevis Sedegebi sabolo daskvnis ga
arapirdapiri gamovlineba motanis saSualebas ar iZleva.
zogjer problema warmodgenilia, rogorc seqsualuri parafiliebTan dakavSirebuli klinikuri gamoc
disfunqcia da seqsualuri upiratesobis aSlilobis dileba gviCvenebs, rom pornografiuli masalis
anamnezis Segrovebis dros iCens Tavs. gamoyenebiT SesaZlebelia fantaziis asocirebuli
Sinaarsebis gaZliereba seqsualuri agznebis
rogorc sasamarTlo problema dros. Tumca, ar aris cnobili, Tu ramdenadaa da
eqims SeiZleba dausvan SekiTxva iseT pacientze, kavSirebuli fantaziebis gaZliereba Sesabamisi qcevis
romelic Cadis kanondarRvevas anomaliur_seqsu intensiurobis zrdasTan.
aluri upiratesobis aSlilobis gamo. am saxis am mniSvnelovan sakiTxebTan dakavSirebuli sajaro
kanondarRvevebia tansacmlis moparva fetiSistebis politika unda daefuZnos SezRudul samecniero
mier, uxamsi gaSiSvleba, `moTvalTvale tomis~ (`peeping informacias. ufro sando mtkicebulebis mopovebamde
Tom~) qceva, sazogadoebaSi sawinaaRmdego sqesis mizanSewoniladaa miCneuli, rom pornografiuli an
tansacmelSi gamoCena, bavSvebze seqsualuri Zaladoba ZaladobasTan dakavSirebuli seqsualuri aqtivobis
da gaupatiureba. gaupatiurebis garda, romelic Sesaxeb masala bavSvebisTvis ar iyos xelmisawvdomi,
ganxilulia sxva seqsualur danaSaulebTan erTad gansakuTrebiT axalgazrdebisTvis, romelTa seqsu
??-e gverdze, yvela sxva seqsualuri upiratesobis aluri ganviTareba jer ar dasrulebula. aseTi
aSliloba mocemulia am TavSi. masala, farTodaa gavrcelebuli internetSi, ris
gamoc misi xelmisawvdomobis regulacia advili
fsiqiatris roli
ar aris. pornografiis SezRudvis sasargeblo ar
arsebobs sxvadasxva Sexeduleba imis Taobaze, Tu gumentebi is aris, rom igi amcirebs qalis Rirsebas,
ra xarisxiT SeiZleba CaerTon eqimebi anomaliur- axdens bavSvebis eqspluatacias da zians ayenebs maT.
seqsualuri upiratesobis aSlilobebis mkurnalobaSi. kidev erTi argumenti isaa, rom pornografiuli
erTis mxriv, gaugebaria, Tu ratom ar unda daexmaron masalis uvnebloba damtkicebuli araa.
eqimebi adamianebs, romlebsac surT Secvalon Ta
vianTi seqsualuri qcevis paterni. magram eqimebi ar rekomendaciis gaweva
unda ecadon umkurnalon adamianebs, romlebsac amis eqimebs SeiZleba hkiTxon, Tu ra zegavlenas axdens
survili ar gaaCniaT. imis gadawyveta, Tu vis sWirdeba colis an mSoblis mier aRmoCenili pornografiuli
fsiqiatris daxmareba da vis ara, rTuli sakiTxia, masala qmarze an arasrulwlovan vaJebze. eqimma
romelsac mogvianebiT am TavSi ganvixilavT. unda ganmartos, rom amasTan dakavSirebiT arsebobs
sxvadasxva Sexeduleba da rom arsebuli mecnieruli
pornografia mtkicebuleba bundovania. unda aRiniSnos, rom por
pornografiis kiTxva ar aris seqsualuri aSliloba, nografiuli masalis efeqti icvleba sxvadasxva
magram am TavSi es sakiTxi imitom aris ganxiluli, rom konkretul SemTxvevaSi, masalis specifikisa da misi
eqimebs SeiZleba dausvan kiTxvebi amgvari literaturis gamoyenebis sixSiris mixedviT. man unda SesTavazos
zegavlenis Taobaze. radgan zogi aseTi literatura pirovnebas intervius Catareba. Tu pirovnebis seqsu
_ 516 _
aluri cxovreba guldasmiTaa ganxiluli, misTvis lizmis, depresiuli aSlilobisa da maniis Semdeg.
zogierTi saWiro rCevis micema xdeba SesaZlebeli. albaT isini gamoaTavisuflebs pirovnebis iseT
aseTi rCeva SedarebiT farTo xasiaTis unda iyos qcevas, romelsac adrec hqonda msgavsi seqsualuri
da unda exebodes pirovnul urTierTobebs da ara fantaziebi, magram akontrolebda maT.
mxolod pornografiuli masalis zemoqmedebas. w seqsualuri qcevis detalizacia. moipoveT infor
macia amJamindeli da adrindeli anomaliur-
anomaliur-seqsualuri upiratesobis
aSlilobebis saxeebi seqsualuri qcevis detalebis Sesaxeb. gaxsovdeT,
rom rogorc zemoT iyo aRniSnuli, calkeul
anomaliur-seqsualuri upiratesobis aSlilobebis
adamianebs anomaliuri seqsualuri preferenciebis
saxeebi SeiZleba or jgufad daiyos. esaa: pirovnebis
erTze meti forma axasiaTebT.
seqsualuri interesis obieqtTan dakavSirebul
anomaliebi da seqsualuri aqtis upiratesobebis w aRwereT am qcevis ufro farTo mniSvneloba. ga
anomaliebi (anu ra tipis aqts aniWebs pirovneba arkvieT, Tu ra rols TamaSobs anomaliuri
upiratesobas). seqsualuri interesis obieqtTan seqsualuri preferencia pacientis cxovrebaSi,
dakavSirebuli anomaliebi moicavs: fetiSizms, pe garda imisa, rom is seqsualuri agznebis wyaros
dofilias, fetiSistur transvestizms, zoofilias warmoadgens. es SeiZleba iyos komfortis mom
da nekrofilias, seqsualuri aqtis preferenciis gvreli aqtivoba, romelic adamians martoobis,
anomaliebi ki eqshibicionizms, vuaerizms, sadizms, SfoTvis an depresiis daZlevaSi exmareba. Tu es
mazoxizms da autoerotikul asfiqsias. asea, mkurnalobam, romelic asustebs aseT pre
ferenciebs, SeiZleba pacientis emociuri mdgo
seqsualuri upiratesobis aSlilobebis gamokv- mareoba gaauaresos, im SemTxvevaSi, Tu gancdebTan
levis ZiriTadi aspeqtebi gamklavebis sxva saSualebebi ar iqneba gamoyenebuli.
gamokvleva xSirad tardeba SesaZlo an mimdinare w motivaciis gamokvleva. mkurnalobis motivacia
sasamarTlo procesis konteqstSi, amitomac, mniSv xSirad araerTgvarovania. adamianebi, romelTac
nelovania interviusa da sasamarTlo process So sakuTari seqsualuri qcevis Secvlis didi
ris arsebuli kavSiris axsna-ganmarteba, aseve, kon survili ar gaaCniaT, eqims, metwilad, seqsualuri
fidencialobisa da misi sazRvrebis ganmarteba partnioris, naTesavis an policiis daJinebiTi
da Tanxmobis mopoveba intervius Casatareblad. Txovnis gamo mimarTaven. isini imedovneben, rom eqimi
SeiZleba saWiro gaxdes warmmarTveli kiTxvebis dasma, maT uars etyvis mkurnalobaze misi usargeblobis
raTa pacients davexmaroT garkveuli problemebis gamo, rac gaamarTlebs SemdgomSi anomaliuri
gamJRavnebaSi, magram am saxiT mopovebuli nebismieri qcevis SenarCunebas. pacientebis nawili maSin
informacia unda gadamowmdes respondentis mier iTxovs eqimis daxmarebas, rodesac depresiaSia an
anomaliuri qcevis sademonstracio magaliTebis danaSaulis grZnoba awuxebs, romelic maTi qceviTaa
motaniT. im pirebs, romlebsac utardebaT gamokvleva ganpirobebuli. cvlilebis gamokveTili survili,
anomaliuri seqsualuri preferenciis gamo, xSirad romelic depresiis dros iCens Tavs, normaluri
erTze meti anomalia aReniSnebaT (Abel and Osborn, guneb-ganwyobis dabrunebisTanave qreba. Zlieri
2000); amitom, pirveli intervius dros, maT SesaZloa motivacia Zalze mniSvnelovania nebismieri saxis
ar gaamJRavnon es informacia. SeiZleba ramdenime mkurnalobis SemTxvevaSi, ris gamoc motivaciis
interviu gaxdes saWiro imisaTvis, rom pacientma Sefasebas didi mniSvneloba eniWeba.
mogvawodos sruli informacia Tavisi seqsualuri w fsiqofiziologiuri gamokvleva. zogierTi speci
qcevis Sesaxeb. rodesac ki es SesaZlebelia, interviu alisti seqsualuri interesebis SefasebisTvis
unda CamovarTvaT nebismier regularul seqsualur penisis pletizmografs an poligrafs iyenebs (Abel
partniors da yvela sxva informators, romelsac and Osborn, 2000). pirvel rigSi izomeba cvlilebebi
SeuZlia dagvexmaros, magaliTad, pacientis pirovnuli penisis garSemowerilobaSi, roca pacienti vizu
Tvisebebis SefasebaSi. alur masalas aTvalierebs an audioCanawers us
gamokvlevis dros xdeba fsiqikuri daavadebis mens. pozitiuri reaqciebi SegviZlia pacientTan
anamnezis Segroveba, romelic Semdegi safexurebisgan erTad ganvixiloT. es meTodi srulyofilebiT
Sedgeba: ar gamoirCeva, radgan reaqcia SeiZleba mcdarad
w fsiqikuri aSlilobis gamoricxva xdeba gansakuT negatiuri iyos imis gamo, rom pacienti yuradRebas
rebiT maSin, roca anomaliuri seqsualuri pre ar aqcevs stimulebs. poligrafiam, romelic zomavs
ferenciebi pirvelad saSualo asakSi an mogvianebiT zogierT fiziologiur cvlilebebs, aseve, SeiZleba
iCens Tavs. anomaliur-seqsualuri upiratesobis asaxos stimulis sapasuxo seqsualuri agzneba. am
aSlilobebi xSirad meoradia demenciis, alkoho meTodis SesaZleblobebi iseTive SezRudulia,
_ 517 _
rogorc pletizmografis. mocemuli meTodebi parafiliis aRmofxvra
rutinuli Sefasebis nawils ar warmoadgens.
mxolod zemoT aRwerili zomebis miRebis Semdeg
seqsualuri preferenciebis anomaliebis marTvis SeiZleba yuradRebis koncentracia arasasurveli
zogadi aspeqtebi seqsualuri qcevis daTrgunvaze. zogjer, aseTi
zomebi sakmarisia imisaTvis, rom pirovnebam moaxerxos
anomaliuri seqsualuri preferenciebis marTvis zo
sakuTari Tavis marTva, magram xSirad, damatebiTi
gierTi aspeqti yvela saxis anomalias miesadageba. es
zomebis miReba xdeba saWiro.
aspeqtebi aq aris aRwerili. konkretuli aSlilobis
masturbaciis dros parafiliasTan asocirebuli
dros gamoyenebuli marTvis specifikuri meTodebi
fantaziebis gamoyeneba xSirad xels uwyobs ano
qvemoTaa aRwerili aSlilobis sxva aspeqtebTan er
maliuri seqsualuri qcevis SenarCunebas. amitom,
Tad.
pirovneba unda wavaqezoT, rom masturbaciisas am
SeTanxmeba miznis Taobaze tipis fantaziisagan ganTavisufldes da, maT nacvlad,
normaluri heteroseqsualuri aqti warmoidginos.
mkurnalobis mizani pacientTan erTad unda iyos
Tu mas ar SuZlia anomaliuri fanataziebisagan gan
ganxiluli. es SeiZleba iyos qcevis kontroli, misi
Tavisufleba, man unda scados maTi TandaTanobiTi
Sewyveta, an qcevasTan adaptacia, raTa pacients
modifikacia, raTa seqsualuri Temebi naklebad
naklebad hqondes danaSaulis da distresis gancda.
anomaliuri gaxdes da mas interesi gauCndes Cve
am miznebis Sefasebisas, eqimma unda gaiTvaliswinos,
ulebrivi heteroseqsualuri aqtis mimarT.
pacienti sxva adamians xom ar ayenebs fsiqologiur
an fizikur zians. sawyis etapze mniSvnelovania hormonuli mkurnaloba
naTlad gavagebinoT pacients, rom rac ar unda iyos
parafiliiT daavadebul pacientTa umetesoba ma
mkurnalobis mizani, misi miRweva pacientis mxridan
makacia, ris gamoc androgenebis Semcirebaze mi
mniSvnelovan Zalisxmevas moiTxovs.
marTuli mkurnaloba fsiqologiuri mkurnalobis
SeguebisTvis xelSewyoba Semavsebel komponents warmoadgens. evropaSi am
mizniT, Cveulebriv, testosteronis antagonists-
im SemTxvevaSi, Tu mkurnalobis mizani adaptaciis
ciproteronis acetats iyeneben, xolo aSS-Si _
gaumjobesebaa, pacientis grZnobebSi gasarkvevad
medroqsiprogesteronis acetats. orive medikamenti
iyeneben konsultacias, imisTvis, rom daexmaron
zogierT SemTxvevaSi efeqturia eqshibicionizmis
mas sakuTari seqsualuri praqtikidan gamomdinare
da pedofiliis samkurnalod (Murray, 1998). maluT
problemebis gaazrebasa da gadawyvetaSi.
nizirebeli hormonis (rilizing-hormoni) xangrZlivi
Tu SeTanxmebuli mizani anomaliuri preferenciis
moqmedebis agonistebi Sedegiania ramdenime saxis
Secvlaa, pirvel safexurze cdiloben pacientis
parafiliis mkurnalobisas, magram ar arsebobs sak
ordinaruli heteroseqsualuri urTierTobebis gaum
marisi mtkicebuleba imis gadasawyvetad, Tu ra
jobesebas. mkurnaloba mimarTulia im saxis SfoTvis
adgili unda daikavon am agentebma TerapiaSi (ix.
aRmofxvraze, romelic xels uSlis sawinaaRmdego
Briken et al., 2003).
sqesTan pacientis socialur urTierTobas. amis
Semdeg, iwyeba muSaoba seqsualur disfunqciebze bihevioruli mkurnaloba
zemoT aRwerili meTodebis gamoyenebiT. es ori
biheviorul mkurnalobas iyeneben, uSualod, para
safexuri, Cveulebriv, mkurnalobis yvelaze mni
filiis samkurnalod da, aseve, arapirdapiri gziT
Svnelovani nawilia.
nebismieri seqsualuri disfunqciis mosavlelad.
abstinenciis problemebis winaswar ganWvreta pirdapiri meTodebia rCevis micema masturbaciis
dros fantaziebis Secvlis Taobaze (ix. zemoT).
zogi adamiani Tavisi drois did nawils seqsualuri
faruli sensitizaciiT warmosaxvaSi xdeba uSualo
aqtivobisTvis mzadebas uTmobs. magaliTad, fe
kavSiris damyareba, erTis mxriv, parafiliasTan
tiSistma SeiZleba didi dro moandomos qalis
asocirebul azrebsa da survilebs, xolo, meores
gansakuTrebuli saxis sacvlebis Zebnas. rogorc
mxriv, damamcirebel, uaryofiT Sedegebs Soris (mag.,
ukve aRiniSna, aseTi qceva SeiZleba martoobis
ojaxis mier am midrekilebis aRmoCena an dapatimreba).
an sasowarkveTis gancdisTvis Tavis daRwevis
aversiuli Terapiis erT-erT versiaSi, usiamovno
gamoxatulebas warmoadgendes. am tipis gancdebisagan
suni da gemo parafiliur fantaziebTan asocirdeba.
adamianis dasacavad, unda davexmaroT mas iseTi
am teqnikis grZelvadiani efeqturoba ar yofila
aqtivobis dagegmvaSi, romliTac is Tavisufal dros
dadasturebuli.
Seavsebs, aseve, axali megobrebis SeZenasa da usiamovno
recidivis prevencia fokusirebulia iseT situ
emociebTan gamklavebaSi.
aciebze, romlebSic xdeba parafiliuri survilebis
_ 518 _
gancda. pacientebma unda moaxdinon aseTi situaciebis wyaros mixedviT, homoseqsualebi fetiSistebis 20%-
identifikacia da Tavi aaridon maT. gansakuTrebuli s Seadgenen (Chalkley and Powell, 1953). seqsualuri
yuradReba eTmoba qcevaTa jaWvis im adreul sa agznebis gamomwvevi SeiZleba iyos mravali obieqti,
fexurebs, romlebsac parafiliis Camoyalibebamde magram calkeuli pirovneba, Cveulebriv, obieqtebis
mivyavarT (magaliTad, qmari regularulad abrazebs mcire jgufs aniWebs upiratesobas. aseTia samosis
cols da amiT amarTlebs iseT adgilas wasvlas, detali, romelic rezinisganaa damzadebuli, qa
sadac parafiliis stimulacia xdeba). fsiqologiuri lis sacvlebi, maRalqusliani fexsacmeli, xolo ho
mkurnalobis mimoxilva Semdeg wyaroSia mocemuli: moseqsuali fetiSistebisTvis _ mamakacis fexsacmeli
Wylie, 1994. (Weinberg et al., 1994). zogjer es obieqti meore
pirovnebis atributia (parcializmi; magaliTad,
samarTlebrivi aspeqti sikoWle an deformacia), adamianis sxeulis nawili (Tma
anomaliuri seqsualuri preferenciis mqone mrava an terfi), an amputaciis Sedegad mokveTili nawili
li adamiani sasamarTlos winaSe warsdgeba. maT (apotemnofilia). sagnis faqtura da suni xSirad
mieyenebaT pirobiTi an probaciiT gaTvaliswinebuli iseTive mniSvnelovania, rogorc misi garegnuli mxare
sasjeli, rac, zogjer, exmareba pacients sakuTari (mag., bewvi, xaverdi, rezinis samosi da gaprialebuli
qcevis kontrolSi. Tumca, eqimebma ar unda um tyavi). nivTebTan kontaqti seqsualur agznebas
kurnalon pacients, romelTa referali maTi iwvevs. mas mosdevs masturbacia an seqsualuri aqti
nebis sawinaaRmdegod xdeba. seqsualuri xasiaTis partniorTan seqsualuri ltolvis sagnis gamoyenebiT,
danaSaulebi ganxilulia ?? gerdebze. Tu partniori amaze Tanxmobas ganacxadebs.
fetiSistebi sasurveli nivTebis mopovebas bevr
dros uTmoben. zogi maT yidulobs, zogic iparavs
seqsualuri ltolvis obieqtze mimarTuli anoma-
(magaliTad, sacvlebis Camoxsna sarecxi Tokidan). Tu
liuri upiratesobebi
òbieqti~ pirovnebis atributia, fetiSistma bevri
am tipis anomaliebis dros, seqsualuri agznebis dro SeiZleba dauTmos am atributis mqone piris
misaRwevad, meore mozrdili adamianis nacvlad, Ziebas (magaliTad, koWli qalis adevneba). fetiSistebi
upiratesobas òbieqtebs~ aniWeben. aseTi òbieqti~ xSirad agroveben fetiSizmis sagnebs, rogoricaa
SeiZleba iyos usulo sagani, rogorc es xdeba qalis fexsacmeli an sacvlebi, an am sagnebis fotoebs.
fetiSizmis da fetiSuri transvestizmis SemTxvevaSi, etiologia. mizezi ucnobia, magram arsebobs ramdenime
bavSvi (pedofilia) an cxoveli (zoofilia). Teoria fetiSizmis etiologiis Sesaxeb.
fetiSizmi w ganpirobeba. fetiSizmi pirveli seqsualuri aSli

lobaa, romlis axsnis mcdelobac iyo asociaciuri
seqsualuri fetiSizmis dros, seqsualuri agznebis
daswavlis Teoriis TvalsazrisiT. bines mixedviT
miRwevis saukeTeso an erTaderTi saSualeba nivTebis
(Binet, 1877), fetiSizmi viTardeba seqsualuri
an adamianis sxeulis iseTi nawilebia, romelTac ara
agznebis asociaciiT raime obieqtTan, romelic,
aqvT uSualo seqsualuri datvirTva. es elementebi
SemdgomSi, fetiSizmis obieqtad gadaiqceva.
SeiZleba normaluri seqsualuri qcevis komponentebs
warmoadgendes. mamakacebSi agznebas xSirad iwvevs w fsiqoanalitikuri Teoriebi. am Teoriebis mixedviT,
samosis romelime elementi (magaliTad, windebi), an seqsualuri fetiSizmi maSin viTardeba, roca
qalis sxeulis iseTi nawilebi, romelTanac uSualo bavSvobaSi ar aris daZleuli kastraciis SiSi. am tipis
seqsualuri asociacia ar aris dakavSirebuli SiSis dasaZlevad, mamakacis aracnobierSi narCundeba
(magaliTad, Tma), Tumca aseTi ram anomaliad iTvleba, idea imis Sesaxeb, rom qals penisi aqvs (Freud, 1927).
rodesac is wamyvani xdeba seqsualuri aqtis Cveul am Tvalsazrisis mixedviT, yvela fetiSi falosis
paternebTan SedarebiT. simbolur reprezentacias warmoadgens. zogierTi
gavrceleba. seqsualuri fetiSizmi, rogorc seq fetiSi amgvarad SeiZleba iyos interpretirebuli,
sualuri agznebis miRwevis upiratesi gza, ar zogis aseTi interpretacia ki bevrad ufro rTuli
aris gavrcelebuli, Tumca ar arsebobs zusti logikis gamoyenebas gulisxmobs (ix. Stekel, 1953).
raodenobrivi monacemebi zogad populaciaSi misi ar arsebobs araviTari obieqturi mtkicebuleba
gavrcelebis sixSiris Sesaxeb. mocemuli Teoriis gasaziareblad.
aRwera. fetiSizmi, Cveulebriv, mozardobis asakSi w Tavis tvinis disfunqcia. zogierTi SemTxvevis
iwyeba. is mxolod mamakacebSia gavrcelebuli. qalebSi analizis mixedviT, eleqtroencefalografiis mo
fetiSizmis sul ramdenime SemTxvevaa aRwerili. nacemebis safuZvelze, fetiSizmi ukavSirdeba
fetiSistebis umravlesoba heteroseqsualebi ari safeTqlis wilis disfunqcias (Epstein, 1961) an
an, magram maTi nawili homoseqsualia. zogierTi klinikurad gamoxatul epilefsias (Mitchell et al.,
_ 519 _
1954). Tumca, ZiriTadad, aseTi asociaciebi ar ramdenime aqsesuaris tarebiT, Semdeg ki xdeba sxva
aRiniSneba da zemoT motanili magaliTebi, albaT, detalebis damateba iqamde, sanam pirovneba bolomde
SemTxveviT kavSirebs gamoxatavs. sapirispiro sqesis tansacmliT ar Seimoseba. feti-
w SemanarCunebeli faqtorebi. ra warmoSobisac ar Sisti transvestebi seqsualur agznebas ganicdian
unda iyos fetiSizmi, klinikuri gamocdilebis sapirispiro sqesis tansacmlis Cacmisas da es qceva
mixedviT mis SenarCunebas, nawilobriv, xels xSirad masturbaciiT mTavrdeba. seqsualuri agzneba
uwyobs normaluri seqsualuri qcevis gamoxatvis ufro xSiria axalgazrdebSi da, SesaZloa, Sesustdes
daTrgunva morcxvobis an SiSis gamo. inhibiciis asakTan erTad. am dros pirovneba sapirispiro sqesis
kidev erTi mizezia fetiSizmis obieqtTan realuri tansacmels imis gamo icvams, rom qalad igrZnos Tavi.
an warmosaxuli kontaqtis dros gancdili zogjer aseTi tansacmeli sazogadoebaSi acviaT, xan
seqsualuri gantvirTvis ganmamtkicebeli efeqti. mamakacis tansacmlis qveS, xan ki garedan.
gansxvavebiT transseqsualebisgan, romlebzec Sem-
prognozi. ar arsebobs mkurnalobis Semdgomi dak
dgomSi gveqneba saubari, fetiSist transvestebs eWvi
virvebiT miRebuli sarwmuno monacemebi. klinikuri
ar eparebaT imaSi, rom maTi sqesi Seesabameba maT
gamocdilebis mixedviT, mozardebsa da mozrdilebSi
garegnul seqsualur maxasiaTeblebs. maTi umravle-
fetiSizmi xSirad sustdeba an saerTod qreba
soba heteroseqsualia da bevrs seqsualuri partnio-
damakmayofilebeli heteroseqsualuri urTierTobis
ri hyavs. Tumca, maTi umravlesoba, vinc fsiqiatrTan
damyarebis Semdeg. martoxela mamakacebis SemTxvevaSi,
dadis, Tavis qcevas partniors umalavs. aseTi qcevis
romlebic morcxvoben qalebTan urTierTobisas da ara
gamoaSkaravebisas, partniorebis umetesoba distressa
hyavT seqsualuri partniori, prognozi uaresia, vidre
da zizRs gamoxatavs. iSviaTia iseTi SemTxvevebi,
ukeTesad adaptirebul axalgazrda mamakacebTan.
rodesac partniorebi fetiSistebs tansacmlis mop-
prognozi uaresia maSinac, rodesac qceva xSiria da
ovebaSi exmarebian.
mudmivad arRvevs socialur da iuridiul normebs.
etiologia. mizezi ucnobia. arsebobs ramdenime
pirvelad SemoRebulma samarTlebrivma sanqciebma
Teoria, romlebic faqtebiT ar aris gamyarebuli.
SeiZleba gazardos qcevis kontrolis motivacia.
mkurnaloba. arsebobs monacemebi fsiqoanaliziT w genetikuri faqtorebi. ar arsebobs sarwmuno mtki
an bihevioruli TerapiiT fetiSizmis warmatebuli cebuleba, romelic miuTiTebs fetiSistebis qro
mkurnalobis Sesaxeb, magram es monacemebi ar mosomuli sqesis an hormonuli Taviseburebebis
aris miRebuli kontrolirebadi kvlevis Sedegad. anomaliurobaze. fetiSuri transvestizmi ar aris
klinikuri gamocdileba gviCvenebs, rom am TavSi genetikuri warmoSobis da ar arsebobs mtkicebuleba
aRwerili zogadi saSualebebi iseTive efeqturia, misi memkvidreobiTi gadacemis Sesaxeb.
rogorc mkurnalobis nebismieri konkretuli teqnika. w tvinis disfunqcia. miuxedavad imisa, rom TiTqos
medikamenturi mkurnaloba ganxilulia zemoT dadgenilia asociaciebi safeTqlis wilis disfun
mocemul zogad nawilSi. qciasTan (Davies and Morgenstern, 1960; Epstein, 1960),
aseTi asociaciebis povna SeuZlebeli aRmoCnda
fetiSuri transvestizmi SemTxvevaTa umravlesobaSi.
ICD-10-Si es mdgomareoba fetiSuri transvestizmis w ganpirobeba erT-erT mizezad aris dasaxelebuli
saxelwodebiTaa cnobili. termini `fetiSuri trans (ix. zemoT qveTavi fetiSizmis Sesaxeb).
vestizmi~ aq imis gamo gamoiyeneba, rom is aRniSnavs
w fsiqoanalitikuri Teoriebi im Teoriebis msgavia,
msgavsebas seqsualuri fetiSizmis SemTxvevebTan,
romlebic fetiSizmis axsnas iZleva, magram isini ar
sadac òbieqts~ tansacmlis detali warmoadgens.
aris obieqturi mtkicebulebebiT gamyarebuli.
fetiSuri transvestizmis dros zogjer sapirispiro
prognozi. ar arsebobs iseTi gamokvleva, romelsac
sqesis ramdenime aqsesuars atareben, zogjer ki
SeiZleba daveyrdnoT. klinikuri gamocdileba gviC
mTeli Cacmuloba sapirispiro sqesisaa. fetiSuri
venebs, rom SemTxvevaTa umravlesobaSi es anomalia
transvestizmi iSviaTad gvxvdeba qalebSi (yvela qali,
wlebis ganmavlobaSi gastans. is TandaTan mcirdeba
romelic sawinaaRmdego sqesis samoss specifikurad
sqesobrivi ltolvis SesustebasTan erTad, saSualo
icvams, an transseqsualia, an lesboseli). qvemoT
asakSi an mogvianebiT. Tumca, fetiSur transvestizms
moyvanili aRweriloba mxolod mamakacebs miesadageba.
sxvadasxvagvari gamosavali SeiZleba hqondes da
gavrceleba. im populaciis procentuli maCvenebeli,
fetiSizmis mimarT gamoTqmuli prognozi masac
romelsac odesme sapirispiro sqesis tansacmeli
miesadageba. transvesti fetiSistebis umciresobas
utarebia, 1, 5 da 10 procents Soris meryeobs.
TandaTanobiT uyalibdebaT rwmena, rom isini qalebi
aRwera. pirovneba qalis tansacmlis Cacmas, Cveu-
arian. transvesti fetiSistebi sapirispiro sqesis
lebriv, sqesobrivi momwifebis asakSi iwyebs. es iwyeba
samoss icvamen, magram amas Tan ar axlavs seqsualuri
_ 520 _
agzneba, ris gamoc isini transseqsualebs emsgavsebian dofiliis iSviaTi da tragikuli SemTxvevebi, romlebic
(gv. ??). seqsualur sadizmTanaa asocirebuli (seqsualuri
mkurnaloba. ar arsebobs fetiSuri transvestizmis Zaladoba bavSvebze ?? gverdzea aRwerili).
specifikuri mkurnaloba. misi marTva xdeba im zogadi diferencialuri diagnostika. pedofilia unda
procedurebiT, romlebic ?? gverdzea aRwerili. gavmijnoT eqshibicionizmisagan gogonebis winaSe,
romlis drosac ar SeiniSneba uSualo seqsualuri
pedofilia kontaqtis damyarebis mcdeloba. zogjer, bavSvebTan
pedofilia aris bavSvebTan dakavSirebuli siste seqsualuri kontaqtis damyarebis mcdeloba demen
maturi xasiaTis seqsualuri aqtivoba (an am aqtivobis ciisa da normaze dabali inteleqtis mqone adamianebs
warmosaxva), rac seqsualuri agznebis miRwevis upi da alkoholikebs axasiaTebT.
rates an erTaderT gzas warmoadgens. bavSvebi, bavSvi. pedofilebTan kontaqtSi myofi gogonaTa
romlebTanac pedofili cdilobs seqsualuri kon umravlesoba 6-dan 12-wlis asakisaa, xolo biWebis
taqtis damyarebas, ar arian pubertatis asaks umravlesoba ki ufrosia. pedofilebTan seqsualur
miRweuli. es paTologia, faqtiurad, mxolod ma urTierTobaSi myofi bavSvebidan, romelTa saqme
makacebSi gvxvdeba. pedofilia unda gavmijnoT seq sasamarTlos mier iqna garCeuli, mravals ramdenjerme
sualuri urTierTobisgan im axalgazrdebTan, hqonda damyarebuli seqsualuri urTierToba erTsa
romlebmac sqesobriv simwifes miaRwies, magram jer da imave an ramdenime mozrdil adamianTan. maT
ara aqvT legaluri ufleba Tanxmoba ganacxadon umravlsobas ufro metad SiSi amoZravebda, vidre
seqsualur urTierTobaze (es asaki gansxvavebulia interesi. maTi umciresoba delinquenti iyo an adre
sxvadasxva kanonmdeblobaSi). pedofilia ar aris hqonia mravali xanomkle seqsualuri urTierToba.
dakavSirebuli Tanxmobis gacemis iuridiuli uf seqsualuri Zaladobis zegavlena bavSvebze ??
lebis dasaSveb zRvarTan, aramed, dakavSirebulia gverdzea ganxiluli.
seqsualur urTierTobebTan zrdasrul adamiansa da etiologia ucnobia. pedofilebs xSirad axasiaTebT
sqesobrivad moumwifebel bavSvs Soris. zrdasrul adamianebTan urTierTobis damyarebis
gavrceleba. ar arsebobs sarwmuno informacia pe uunaroba da qalebTan urTierTobis SiSi.
dofiliis gavrcelebis sixSiris Taobaze. Tumca prognozi. imis gamo, rom ar arsebobs Semdgomi
garkveuli monacemebis mixedviT (zogierTi qveyanis dakvirvebiT miRebuli sando informacia, TiTo
monacemebi bavSvTa prostituciis Sesaxeb; gasayidi eul SemTxvevaSi prognozi keTdeba istoriis xan
pornografiuli masala seqsis Sesaxeb mcirewlovan grZlivobidan, pedofiluri qcevis sixSiridan da
bavSvebTn; internetsaitebze ganTavsebuli masala), pirovnuli sisustidan da siZlieridan gamomdinare.
is iSviaTobas ar unda warmoadgendes. cxadia, rom kidev erTi indikatoria socialuri da seqsualuri
interesi bavSvebTan seqsualuri kontaqtis mimarT kontaqtebis ararseboba. qceva, romelic xSirad
sakmaod gavrcelebuli movlenaa, Tumca, pedofilia, meordeba, savaraudod, SenarCundeba mkurnalobis
rogorc seqsualuri qcevis erTaderTi forma, albaT miuxedavad.
iSviaTobas warmoadgens. mkurnaloba. ar arsebobs monacemebi romelime sa
aRwera. pedofilebi, Cveulebriv, irCeven bavSvs, xis mkurnalobis efeqturobis Sesaxeb. pedofilebs,
romelTa asaki meryeobs 6 wlidan sqesobrivi mom romlebic namdvilad motivirebulni arian, gaakon
wifebis asakamde, Tumca, zogierTi intress iCens trolon TavianTi impulsebi, SegviZlia davexmaroT
Zalian dabali asakis bavSvebis mimarT. bavSvi SeiZleba mxardaWeriT da konsultaciebiT problemis gadaWris
igive sqesisa iyos (homoseqsualuri pedofilia) an Sesaxeb. seqsualuri xasiaTis danaSaulis gamo msjavr
sapirispiro sqesis (heteroseqsualuri pedofilia). debuli adamianebis mkurnaloba ganxilulia ?? gverdze.
zogi pedofili bavSvs Tavis sanaTesaoSi an samsaxurSi pedofiliis Tema ganxilulia Semdeg wyaroSi:
poulobs, zogi ki ucnob bavSvebs imegobrebs. McConaghy (1998).
miuxedavad imisa, rom pedofilebis didi nawili,
romelic daxmarebisTvis eqims mimarTavs, saSualo seqsualuri obieqtis upiratesobebis sxva anoma-
asakis mamakacebisagan Sedgeba, pedofilia adreul liebi
asakSi viTardeba. ar arsebobs imis mtkicebuleba, rom zoofilia, romelsac sxvagvarad bestializmi an
myari interesi mozrdili seqsualuri partniorebis zooseqsualoba ewodeba, gulisxmobs cxovelebis
mimarT icvleba interesiT bavSvi-partniorebis mi regularul gamoyenebas seqsualuri agznebis mi
marT. patara bavSvebTan seqsualuri kontaqti ufro saRwevad. am SemTxvevaSi, es agznebis miRwevis
moferebas an masturbaciaSi vlindeba, vidre srul upiratesi an eqskluziuri meTodia. zoofilia ar
koitusSi. Tumca, zogjer, patara bavSvebs zians aris gavrcelebuli da iSviaTad gvxvdeba samedicino
ayeneben iZulebiTi penetraciis dros. arsebobs pe praqtikaSi.
_ 521 _
nekrofilia aris seqsualuri agznebis miRwevis interpretacias Tan axlavs intensiuri agzneba.
Zalze iSviaTi saSualeba, romelic gvamTan seq zogadad aRwerilia eqshibicionistebis ori
sualuri kavSiris damyarebas gulisxmobs. arsebobs jgufi. pirvelSi Sedian inhibirebuli temperamentis
iseTi mamakacebis winaaRmdeg aRZruli sasamarTlo mqone mamakacebi, romlebic ebrZvian TavianT im
saqmeebi, romlebic jer klaven msxverpls da Semdeg pulsebs da danaSaulis Zlier grZnobas ganicdian
cdiloben masTan seqsualuri kavSiris damyarebas. ar eqshibicionisturi aqtis Semdeg. isini, zogjer,
moiZebneba sando informacia anomaliuri seqsualuri axdenen modunebuli penisis demonstracias. meo
upiratesobis am eqstremaluri formis mizezebis an re jgufSi Sedian agresiuli Tvisebebis mqone
prognozis Sesaxeb. mamakacebi, romlebsac, zogjer, antisocialuri
pirovnuli aSlilobis niSnebi axasiaTebT. isini,
seqsualuri aqtis upiratesobis aSlilobebi Cveulebriv, axdenen ereqciis mdgomareobaSi myofi
seqsualuri upiratesobis aSlilobebis es jgufi penisis demonstrirebas masturbaciis procesSi.
moicavs iseTi qcevis variaciebs, romlebic xorci maT siamovnebas aniWebT distresi, romelsac meore
eldeba seqsualuri agznebis misaRwevad. Cveulebriv adamianSi iwveven da, Cveulebriv, naklebad euflebaT
seqsualuri aqti mimarTulia mozrdil adamianebze, danaSaulis gancda.
magram zogjer, seqsualuri aqtis obieqtis rol britaneTSi, eqshibicionizmis gamo sasamarTlos
Si bavSvebic gamodian (magaliTad, zogierTi eqshi winaSe wardgenisas, mamakacs msjavri edeba uxams
bicionistis SemTxvevaSi). gaSiSvlebaSi (ix. Tavi 26, gv. ??). aseTi braldebis
mqone mamakacebis oTxi mexuTedi _ eqshibicionistia.
eqshibicionizmi eqshibicionizmi da uxamsi satelefono zarebi. ar
eqshibicionizmi gulisxmobs genitaliebis Cvenebas aris naTeli, Tu ra kavSiria eqshibicionizmsa da
ucxo pirisaTvis, romlisTvisac es moulodnelobas uxams satelefono zarebs Soris, romlis drosac
warmoadgens. am qcevis mizani seqsualuri agznebis mamakaci, masturbaciis procesSi, qalebs seqsualur
miRwevaa, magram am dros ar SeiniSneba meore adamianTan kontaqtze esaubreba. erT-erTi mosazrebis Tanaxmad
seqsualuri kontaqtis damyarebis mcdeloba. sityva (Tollison and Adams, 1979), am tipis mamakacebi, amave
eqshibicionizmi SemoRebulia lasegis mier (Lasgue dros, eqshibicionistebic arian, magram advili araa
E.Ch., 1877). am terminis teqnikuri mniSvneloba sruliad maTi identifikacia maTi fsiqopaTologiis Seswavlis
gansxvavdeba misi yoveldRiuri mniSvnelobisagan, mizniT.
romelic sakuTari Tavis warmoCenas gulisxmobs. etiologia. eqshibicionizmis mizezi ucnobia. fsiqo
gavrceleba. gavrcelebis sixSire ar aris cnobili. analitikuri Teoriebis mixedviT, is dakavSirebulia
TiTqmis yvela eqshibicionisti mamakacia. Zalian cota oidipaluri konfliqtis gadaWris uunarobasTan an
qali iSiSvlebs mudmivad sxvis winaSe mkerds da kidev zogad SeboWilobasTan qalTan urTierTobaSi. Tavis
ufro naklebi _ genitaliebs. gavlenian naSromSi, riklesi (Rickles, 1950) aRniSnavs,
aRwera. im eqshibicionistebs Soris, romlebic rom zogi eqshibicionisti aRwers zedmetad axlo
klinikur praqtikaSi gvxvdeba, ZiriTadi nawili 20- urTierTobas dedasTan da cud urTierTobas uunaro
40 wlisaa da 2/3 daqorwinebulia (Gayford, 1981). mamasTan, Tumca es informacia retrospeqtuli xa
zogierTTan eqshibicionizmis survili permanentulia, siaTisaa da SesaZloa ar Seesabamebodes im realur
sxvebTan ki epizoduri. sxeulis Cvenebis aqts, viTarebas, romelSic gaizarda pacienti. garda
Cveulebriv, win uZRvis daZabulobis zrdis SegrZneba. amisa, mravali mamakaci, romelic ar Camoyalibda
eqshibicionistebis didi nawili irCevs iseT adgilebs, eqshibicionistad, aRwers msgavs bavSobisdroindel
saidanac gaqceva advilia. eqshibicionisti SeiZleba gamocdilebas.
gamovides mofarebuli adgilidan da meore adamianis eqshibicionizmi, romelic Tavs iCens saSualo an
winaSe penisi gaiSiSvlos an moulodnelad gamoaCinos xandazmul asakSi, zogjer dakavSirebulia Tavis tvi
penisi, romelic, magaliTad, gazeTis ukanaa damaluli. nis organul daavadebasTan an alkoholizmTan. advili
zogjer eqshibicionisti sxvis winaSe SiSveli Cndeba. SesaZlebelia, rom eqshibicionisturi impulsebis
zogierTi masturbirebs meore adamianis winaSe efeqturi kontroli SemdgomSi sustdeba Tavis tvinis
gaSiSvlebisas, zogi ki amis Semdeg. eqshibicionisti daavadebis an alkoholizmis gamo.
cdilobs meore adamianSi Zlieri emociuri reaqcia prognozi. ar moiZebneba mkurnalobis Semdgomi dak
gamoiwvios. rogoric ar unda iyos meore adamianis virvebiT miRebuli informacia. mamakacebi, romlebic
reaqcia, is eqshibicionistis mier seqsualuri in mxolod erTxel axorcieleben eqshibicionistur aqts,
teresis gamoxatulebad aRiqmeba, miuxedavad imisa, ar kvalificirdebian, rogorc eqshibicionistebi.
rom, meore adamianSi, is Cveulebriv, Sokis, SiSis rac Seexeba eqshibicionistebad kvalificirebul
an sicilis reaqcias iwvevs. aseT damaxinjebul mamakacebs, klinikuri gamocdileba sxvadasxva saxis
_ 522 _
gamosavalze miuTiTebs. Tu mamakaci ganmeorebiT gavrceleba. tkivilis miyeneba fantaziaSi an
axorcielebs eqshibicionistur aqts mxolod stresis realobaSi iSviaTobas ar warmoadgens, rodesac es
mdgomareobaSi yofnis dros, prognozi damokidebuli Tan axlavs seqsualuri qcevis sxva formebs. seqs
iqneba stresoris xelaxali aRmocenebis albaTobaze. maRaziebSi iyideba jaWvebi, maTraxebi da borkilebi,
Tu mamakaci xSirad axorcielebs eqshibicionistur xolo pornografiul Jurnalebsa da internet
aqts ara mxolod stresis mdgomareobaSi yofnisas, saitebze ganTavsebulia sadisturi seqsualuri
albaT is mravali wlis manZilze ganaxorcielebs am praqtikis aRwera da suraTebi. seqsualuri sadizmi,
qcevas fsiqiatriuli mkurnalobisa da sasamarTlo rogorc upiratesi seqsualuri praqtika, savaraudod,
sanqciebis miuxedavad. sasamarTlodan miRebuli iSviaTia, magram misi sixSire ar aris cnobili.
monacemebiT, xelaxali msjavrdebis sixSire uxamsi aRwera. cema, gamaTraxeba da dabma sadisturi qcevis
gaSiSvlebis gamo dabalia pirveli msjavrdebis Sem gavrcelebuli formebia. ganmeorebiTi sadisturi
deg, magram maRalia meore msjavrdebis Semdeg. miu aqtebi xorcieldeba mazoxist partniorebTan da
xedavad imisa, rom zogierTi mamakaci, romelic meZavebTan erTad. sadizmi SeiZleba warmoadgendes
axorcielebs gaupatiurebas, eqshibicionisticaa, rogorc homoseqsualuri, ise heteroseqsualuri
rogorc Cans, eqshibicionistebis umetesoba ar aqtis komponents. sadisturi aqtebi SeiZleba iyos
axorcielebs Zaladobriv seqsualur aqts da ar iCens simboluri da naklebad gulisxmobdes partniorisTvis
interess bavSvebis mimarT (Rooth, 1973). fizikuri zianis miyenebas, zogierTi ki ufro metad
mkurnaloba. fsiqiatrma unda gamoavlinos da um partnioris damcirebas gulisxmobs. Tumca, zogjer
kurnalos nebimismier asocirebul fsiqikur aS seriozuli fizikuri zianis miyenebac xdeba. amis
lilobas (depresiuli aSliloba, alkoholizmi an eqstremaluri magaliTi, e.w. `vnebis mkvlelobebi~,
demencia). konkretulad eqshibicionizmis samkur rodesac mkvleli seriozul fizikur zians ayenebs
nalod mravali saxis mkurnaloba yofila gamo msxverpls genitaliebSi danis Casobis an dasaxiCrebis
yenebuli, fsiqoanalizis, individualuri da jgu gziT. am iSviaT SemTxvevebSi, SesaZlebelia, adgili
furi fsiqoTerapiis da faruli sensitizaciis hqondes eakulacias an sadisturi aqtis dros an
CaTvliT. ar arsebobs sarwmuno mtkicebuleba am mogvianebiT, cxedarTan seqsualuri aqtis damya
meTodebis efeqturobis Sesaxeb. praqtikaSi iyeneben rebisas (nekrofilia). am anomaliis istoriuli mniSv
konsultaciisa da bihevioruli teqnikis kombinacias. nelobis mqone aRwera mocemulia Semdeg wyaroSi:
konsultacia mimarTulia eqshibicionisturi qcevisa Hirschfeld (1944).
da piradi urTierTobebis problemebze. bihevioruli etiologia cnobili ar aris. fsiqoanalitikuri
teqnikis gamoyenebisas mimarTaven TviTmonitorings ganmarteba yuradRebas amaxvilebs asociaciaze
im viTarebebis identifikaciisTvis, romlebic biZgs siyvarulsa da agresiul grZnobebs Soris, romlebic
aZlevs eqshibicionistur qcevas da exmareba pirovnebas mSoblebTan bavSvis adreul urTierTobebs axasiaTebs.
aseTi qcevis Tavidan acilebaSi. seqsualuri draivis bihevioruli midgoma yuradRebas amaxvilebs aso
Sesasusteblad nacadi iyo ciproteronis acetatis da ciaciur daswavlaze. arc erTi Tvalsazrisi ar aris
masTan dakavSirebuli wamlebis gamoyeneba, magram es obieqturi mtkicebulebiT dasabuTebuli.
medikamentebi ar aris rekomendebuli, radgan kargad prognozi. ar moiZebneba intervenciis Semdgomi
ar aris cnobili maTi efeqti; garda amisa, maTi dakvirvebiT miRebuli informacia. klinikuri gamoc
xangrZlivi gamoyenebisas aRiniSneba ginekomastia da dileba gviCvenebs, rom Tuki am tipis qceva Camoyalibda,
depresia. SesaZlebelia gv. ??-ze aRwerili zomebis is mravali wlis manZilze SenarCundemkurnaloba.
gamoyeneba, magram warmatebis molodinis gareSe. klinikuri kvlevis mixedviT, arc erTi tipis
damatebiTi informaciisTvis eqshibicionizmis Sesaxeb mkurnaloba ar aris efeqturi. mamakacebs, romlebmac
ix. Abel, Osborn; 2000. msxverpls seriozuli fizikuri ziani miayenes,
samarTlebrivi zomebi miesadageba. saTanado yurad
seqsualuri sadizmi
Reba unda davuTmoT sadistur seqsualur qcevasTan
termini `sadizmi~ markiz de sadis (1740-1814) saxelidan dakavSirebuli riskis seriozulobas, rodesac xdeba
momdinareobs, romelic seqsualuri dakmayofilebis potenciurad saSiSi qcevis dagegmva da ganxorcieleba.
miRwevis mizniT qalebis mimarT ukidures sisas
tikes iCenda. seqsualuri sadizmi gulisxmobs seq seqsualuri mazoxizmi
sualuri agznebis miRwevas meore adamianisadmi mazoxizmis dros seqsualuri agznebis miRweva xde
tkivilis miyenebis, SeboWvis an damcirebis gziT. ba tanjvis an damcirebis gancdis gziT, rac pi
seqsualur sadizmTan maSin gvaqvs saqme, rodesac rovnebisTvis upiratesi an erTaderTi seqsualuri
amgvari qceva regularulia da upiratesoba eniWeba praqtikaa. rogorc upiratesi aqtivoba, is gansxvavdeba
heteroseqsualur kontaqtTan SedarebiT. seqsualuri aqtis Tanmxlebi tkivilis umniSvnelo
_ 523 _
gancdisagan, rac gavrcelebul movlenas warmoadgens. qalis mier tansacmlis gaxdis process (Simon, 1997).
termini mazoxizmi, avstrieli romanistis _ leopold vuaierizmi, rogorc seqsualuri paTologia,
fon zaxer mazoxis (1836-1905) saxels ukavSirdeba, Cveulebriv axasiaTebs heteroseqsual mamakacebs,
romelmac aRwera tkivilis gancdiT gamowveuli seq romelTa seqsualuri aqtivoba aradamakmayofilebelia.
sualuri siamovneba. miuxedavad imisa, rom vuaieristebi cdiloben,
gavrceleba. fantaziebi sxvebis mier cemisa da rom SeumCnevelni darCnen qalisTvis, romelsac
damcirebis Sesaxeb sakmarisadaa gavrcelebuli akvirdebian, isini mainc mniSvnelovani riskis qveS
mamakacebSi, rac ganapirobebs moTxovnas am Temaze imyofebian, radgan sxvebma SeiZleba SeamCnion isini.
Seqmnil pornografiul publikaciebze. amgvari fan amis gamo, vuaierizmis SemTxvevebi, Cveulebriv,
taziebi, agreTve, gavrcelebulia meZavebSi, romlebic dafiqsirebulia SemTxveviTi gamvlelebis mier da ara
saSualebas aZleven partniors qcevaSi gamoavlinos vuaierizmis msxverplis mier.
Tavisi seqsualuri fantaziebi. seqsualuri mazoxizmis etiologia. vuaierizmi gavrcelebulia mozardebSi,
dadgenili SemTxvevebis raodenoba, albaT, arc Tu sadac is seqsis mimarT cnobismoyvareobis gamom
imdenad didia, magram amis Taobaze ar moipoveba xatvelia, magram es qceva, Cveulebriv, momavalSi,
zusti informacia. pirdapiri seqsualuri gamocdilebiT icvleba.
aRwera. tanjva SeiZleba sxvadasxva formisa iyos vuaieristi ki sxvis seqsualur aqtze dakvirvebas
(jaWviT dabma, fexiT gadavla, cema, damcirebis momavalSic agrZelebs, radgan is morcxvia, uWirs
simboluri formebis gamoyeneba, rogoricaa bavSviviT gogonebTan socialuri kontaqti an mas normalur
Cacma, romelsac ufrosebi sjian). mazoxizmi, seqsualur aqtivobaSi sxva mizezebi uSlis xels.
sxva seqsualuri gadaxrebis msgavsad, Tavs iCens fsiqoanalizi mocemul paTologias iseTive meqa
mamakacebSic da qalebSic, rogorc homoseqsualur, nizmiT xsnis, rogorc zemoT aRweril seqsualur
ise heteroseqsualur urTierTobebSi. zog mazoxists paTologiebs. bihevioruli Teoriis mixedviT, es
aqvs saxifaTo qcevis ganxorcielebis survili, qceva aixsneba SemTxveviTi xasiaTis asociaciebis
rogoricaa yelze moWeris praqtika, romelic aZ damyarebiT TvalTvalis pirvandel gamocdilebasa da
lierebs seqsualur agznebas nawilobrivi anoqsiis seqsualur agznebas Soris. arc erTi Teoria ar aris
gamowvevis gziT (ix. qvemoT autoerotiuli asfiqsia). saTanado mtkicebulebiT gamagrebuli.
etiologia cnobili ar aris. ganpirobebis Teoriis prognozi. sando informacia ar aris xelmisawvdomi.
mixedviT, mazoxizmi viTardeba asociaciis damyarebiT mkurnaloba. klinikuri kvlevis mixedviT arc erTi
seqsualur agznebasa da dasjis mizniT mozardis cemas tipis mkurnaloba ar aris efeqturi. mizanSewonilad
Soris, upiratesad, pubertatul asakSi. fsiqoanalizis migvaCnia zogadi xasiaTis zomebis gamoyeneba, rom
mixedviT, mazoxizmi Sebrunebuli sadizmia, ris gamoc lebic am TavSi zemoTaa aRwerili.
misi axsna sadizmis msgavsad xdeba (ix. zemoT). arc
erTi Tvalsazrisi ar aris Sesabamisi mtkicebulebiT seqsualur aqtTan dakavSirebuli sxva anomali-
dasabuTebuli. uri upiratesobebi
prognozi. ar moiZebneba intervenciis Semdgomi autoerotiuli asfiqsia gulisxmobs cerebruli
dakvirvebiT miRebuli sando informacia. klinikuri anoqsiis gamowvevas seqsualuri agznebis gasaZ
gamocdileba gviCvenebs, rom Tuki am tipis qceva liereblad masturbaciis procesSi. asfiqsia na
Camoyalibda, is mravali wlis manZilze SenarCundeba. wilobriv gamowveulia yelze Tokis moWeriT an
mkurnaloba. rekomendebulia fsiqoanalitikuri da Tavze polieTilenis parkis CamocmiT. es praqtika,
bihevioruli Terapiis gamoyeneba, Tumca arc erTi faqtiurad, mxolod mamakacebSi gvxvdeba. is saxifaToa
maTgani ar aris efeqturi. SegviZlia vcadoT zogadi da SeiZleba sikvdiliT dasruldes. am tipis aqts
saSualebebis gamoyeneba (gv. ??), magram am SemTxveva- SeiZleba Tan axldes analuri stimulaciis gamomwvevi
Sic warmateba ar aris garantirebuli. sagnebis gamoyeneba, fetiSizmis obieqtebis gamoyeneba
an sapirispiro sqesis tansacmlis Cacma. pirovneba
vuaierizmi SeiZleba sakuTar Tavs sarkeSi akvirdebodes an
mraval mamakacs aRagznebs sxva adamianebis seqsualuri fotosuraTebi gadauRos, an man SeiZleba Tavi
aqtis yureba. vuaierizmi gulisxmobs sxvaTa seqsualur daibas. imaTgan, vinc upiratesobas aniWebs am tipis
aqtivobaze sistematiur dakvirvebas, rac seqsualuri seqsualur praqtikas, Zalian cota adamiani mimarTavs
agznebis miRwevis upirates meTods warmoadgens. am eqims daxmarebisTvis. mocemuli paTologiis Sesa
paTologiis mqone adamiani uTvalTvalebs qalebs, xeb ZiriTadi informaciis wyaros warmoadgens
rodesac isini SiSvlebi arian an tansacmels ixdian, sasamarTlo fsiqiatria, romelic Seiswavlis moce
ris gamoc misi saqcieli SeiZleba sxvebma SeamCnion. muli tipis seqsualur praqtikas aqtis dros
zogierTi maTgani kameriT iRebs seqsualur aqts an gardacvlili adamianebis magaliTze; Tumca, zogjer
_ 524 _
genderuli identobis anomaliebi
am populaciis Seswavla mis sicocxleSive xdeba (mag., mamakacs uwodeben dabadebiT qals, romelic
Quinn and Twomey, 1998). damatebiTi informaciisaTvis Tavs mamakacad ganicdis. warsulSi, samedicino
ix. Blanchard, Hacker, 1991; Hucker, 1990. literaturaSi transseqsual mamakacs ufro xSirad
froterizmi. rodesac froterizmi warmoadgens uwodebdnen im pirebs, romlebic dabadebisas iyo
seqsualuri agznebis miRwevis upirates gzas, seq identificirebuli, rogorc mamakaci, magram Tavs
sualuri agzneba sxva adamianTan xaxunisas (magaliTad, qalad ganicdida. aq Cven gamoviyenebT termins
mamakacis genitaliebis xaxunisas) an, Cveulebriv, `mamakaci~ qali transseqsualis mimarT da termins
ucnobi qalis mkerdis moferebisas miiRweva. amgvari `qali~ mamakaci transseqsualis mimarT, ramdenadac
qmedeba xSiria xalxiT gadaWedil adgilebSi, es terminebi miuTiTebs movlenaTa Tanmimdevrobaze
magaliTad metroSi. pirovnebis cxovrebaSi. amgvarad, qalad gardaqmnili
koprofilia, koprofagia, seqsualuri ureTizmi da mamakaci transseqsuali aris pirovneba, romelic
urofilia. koprofiliis dros, seqsualur agznebas dabadebisas mamakacad iyo identificirebuli, magram,
iwvevs fiqri defekaciis aqtis Sesaxeb an misi yureba, SemdgomSi, sakuTari Tavi qalad ganicada. zogierTi
rac upirates seqsualur aqtivobas warmoadgens. transseqsualisTvis miuRebelia am terminis arse
koprofagiis dros seqsualuri agzneba mosdevs biTi saxelis formiT gamoyeneba. rodesac mocemul
fekaliebis Wamas. seqsualuri ureTizmis dros, ro teqstSi es termini am saxiT gamoiyeneba, is
melic, ZiriTadad, qalebSi gvxvdeba, erotiuli gulisxmobs transseqsual pirovnebas, iseve, rogorc
agzneba ureTris stimulaciiT miiRweva. urofiliis `heteroseqsuali~ gamoiyeneba, rogorc arsebiTi
dros seqsualuri agzneba miiRweva Sardvis procesis saxeli heteroseqsualuri orientaciis mqone
yurebiT, partniorze (an piriqiT) moSardviT an pirovnebis aRsaniSnad.
Sardis daleviT. mravali transseqsuali miiCnevs, rom maTi mdgo
am paTologiebis gavrcelebis sixSire ar aris mareoba fsiqikur aSlilobad ar unda iTvlebodes.
cnobili, magram, rogorc Cans, isini sakmaod gavr miuxedav amisa, is Setanilia orive (ICD, DSM)
celebulia, razec metyvelebs seqs_muSakebisagan klasifikaciaSi. es exmareba transseqsualebs survilis
am tipis aqtivobebis ganxorcielebis moTxovna. SemTxvevaSi Caitaron mkurnaloba, radgan mraval
damatebiTi informaciisTvis ix. Tollison and Adams, qveyanaSi, rogorc saxelmwifo, ise kerZo sadazRvevo
1979. programebi, faravs mxolod iseT aSlilobebs, rom
lebic daavadebaTa erT-erT klasifikaciaSi mainc
genderuli identobis anomaliebi aris Setanili.
transseqsualizmi gavrceleba
transseqsualebi darwmunebulni arian, rom maT epidemiologiuri monacemebi rTuli mosapovebelia.
TavianTi qromosomuli sqesis sapirispiro genderi niderlandebSi Catarebuli gamokvlevis mixedviT,
aqvT. maT aqvT Zlieri survili icxovron ise, rogorc genderuli identobis aSlilobis SemTxvevebSi,
cxovroben maTi anatomiuri sqesis sapirispiro zrdasruli adamianebis mamakacad dabadebul 10 000
genderis mqone adamianebi da cdiloben TavianTi pirze modis genderuli identobis aSlilobis mqone
sxeulisa da genitaliebis Secvlas. erTi piri, xolo 30 000 qalad dabadebul adamianze
warsulSi, am anomalias ewodeboda eonizmi, radgan _ 1 piri (Kesteren et al., 1996). im adamianebs Soris,
is axasiaTebda d'eon de bomons. is fsiqiatriul romlebic klinikur centrebSi mkurnaloben, ufro
literaturaSi aRwera eskirolma 1838 wels. misi ufro metia qalad gardaqmnili mamakaci transseqsuali,
detaluri aRwera mogvca kraft-ebingma 1886 wels vidre mamakacad gardaqmnili qalad dabadebuli
(Krafft-Ebing, 1924). 1960-ian wlebSi, benjaminis wignSi transseqsuali. SemTxvevaTa Tanafardobaa 4/1 (Green,
(Benjamin, 1966) aRwerili gansacvifrebeli faqtebis 2000a).
gamo es mdgomareoba eqimebisa da sazogadoebis
aRwera
yuradRebis centrSi moeqca.
transseqsualebi darwmunebulni arian, rom isini
terminologia miekuTvnebian imis sapirispiro sqess, romelic maT
terminebs `transseqsuali mamakaci~ da `transseqsuali dabadebidan daudgindaT. aseTi rwmena, Cveulebriv,
qali~ sxvadasxva mniSvnelobiT xmaroben. trans pubertatis asakis dadgomamde yalibdeba. mSob
seqsual adamianebs Cveulebriv urCevniaT, rodesac lebis gadmocemiT, momavali transseqsualebi,
maT garkveuli saxiT moixsenieben. kerZod, trans bavSvobaSi, sapirispiro anatomiuri sqesis bavSvebis
seqsual qals uwodeben dabadebiT mamakacs, ro wreSi yofnas amjobineben, Tumca es tipiuri ar
melic Tavs qalad ganicdis, xolo transseqsual aris. qaluri bunebis mqone biWebze warmoebuli
_ 525 _
Semdgomi gamokvlevis monacemebiT, aseTi biWebi aSlilobis mqone biWebis umravlesoba zrdasrul asakSi
ufro xSirad homoseqsualebad yalibdebian, vidre yalibdeba homoseqsualad da ara transseqsualad.
transseqsualebad (ix. Green, 1974). endokrinuli mizezebi. mozrdil transseqsualebSi
im droisTvis, rodesac transseqsualebi iTxoven ar dadginda raime endokrinuli paTologiis arseboba.
samedicino daxmarebas, maT ukve dawyebuli aqvT erT-erTi mosazrebis Tanaxmad, transseqsualizms
sapirispiro sqesis tansacmlis tareba. transvestiti ganapirobebs hormonuli anomaliebi nayofis ganv
fetiSistebisagan gansxvavebiT, qalad gardaqmnili iTarebis dros. rodesac fexmZime rezus-maimunebs
mamakaci transseqsualebi qalis tansacmels ufro ukeTebdnen didi raodenobiT androgenebs, maTi
metad imitom icvamen, rom qalad igrZnon Tavi da ara mdedrobiTi sqesis Svilebi TamaSisas mamakacis
imitom, rom seqsualuri agzneba ganicadon. (maTgan, msgavsad iqceodnen (Young et al., 1964). garda amisa,
agreTve, gansxvavdebian homoseqsuali mamakacebi, adrenogenitaluri sindromis mqone mdedrobiTi
romlebic qalis tansacmels imitom icvamen, rom sqesis bavSvebi, romlebic imyofebodnen didi raod
aqtiuri homoseqsualebi miizidon). transseqsualebi enobiT androgenebis zemoqmedebis qveS dabadebamde
iwyeben makiaJisa da qalis varcxnilobis tarebas, da dabadebis Semdeg, avlendnen biWebisTvis damaxa
icileben Tmovan safars saxesa da sxeulze siaTebel qcevas bavSvobaSi (Erhardt et al., 1968),
eleqtrolizis saSualebiT. am fizikur cvlilebebTan magram transseqsualebad ar Camoyalibdnen. im
erTad isini inviTareben qalisTvis damaxasiaTebel qal transseqsualebSi, romelTac miiRes mamakacis
Jestebs da xmis simaRles; cdiloben TavianTi roli, maRal procents aReniSneboda sakvercxis
socialuri rolis Secvlas. polikistozi (Boinski et al., 1997), xolo sakvercxis
qalad gardaqmnili mamakaci transseqsualebi polikistozis mqone qalebis mxolod umniSvnelo
xSirad iTxoven daxmarebas mkerdisa da garegani raodenobas hqonda genderuli identobis aSliloba
genitaliebis garegnuli mxaris Secvlis mizniT. (Green, 2000a).
isini, Tavidan, Cveulebriv, iTxoven estrogenebis gansxvaveba tvinis struqturaSi. terminaluri
Seyvanas mkerdis gazrdis mizniT. amis Semdeg, maT zolis sayrdeni birTvebis (bed nucleus of the stria
SeiZleba moiTxovon mkerdis plastikuri qirurgia, terminalis) centraluri nawilis moculoba ufro didia
kastracia da penisis mokveTa da operaciis Catareba mamakacebSi, vidre qalebSi. erT-erT gamokvlevaSi,
xelovnuri saSos Sesaqmnelad. mraval transseqsualSi romelSic Seiswavleboda qalad gardaqmnili mamakaci
Zlier distress iwvevs TavianTi mZime mdgomareoba. transseqsualebis Tavis tvini maTi gardacvalebis
maTSi gavrcelebulia depresia, zogs aqvs suicidis Semdeg, aRmoCnda, rom am birTvis zoma qalebSi
mcdeloba, zogi ki imuqreba, rom Tavad gaikeTebs dadgenili zomis msgavsi iyo (Zhou et al., 1995), magram
kastracias, Tu SeuZlebelia qirurgiuli operaciis am gamokvlevis Sedegebi gaakritikes teqnikuri
Catareba. aseTi muqara seriozulad unda miviRoT, mizezebis gamo (Green, 2000a).
radgan is ukidures distresze miuTiTebs da, transvestizmidan gadasvla transseqsualizmze. im
SeiZleba, marTlac ganxorcieldes pirovnebis mier. mamakacTa mcire nawilSi, romelic Tavs qalad aRiqvams,
mamakacad gardaqmnili qali transseqsualebi icva transseqsualad Camoyalibeba xdeba transvestizmis
men mamakacis tansacmels da gamoimuSaveben mamakacis xangrZlivi periodis Semdeg. es adamianebi iwyeben
xmas, Jestebs da socialur qcevas. maT surT sapirispiro sqesis tansacmlis tarebas agznebis
ganaxorcielon iseTi seqsualuri aqti, romelSic miRwevis mizniT, magram maT mier gancdili agzneba
isini heteroseqsuali qalis (da ra homoseqsuali TandaTanobiT sustdeba. isini, paralelurad, ufro
qalis) mamakaci partnioris rolSi iqnebian. zogi da ufro rwmundebian, rom qalebi arian.
moiTxovs masteqtomiis an histereqtomiis Catarebas, mimdinareoba. ar arsebobs sando informacia imis
zogierTi maTgani ki moiTxovs plastikuri qirurgiis Sesaxeb, Tu rogor viTardeba transseqsualizmi im
Catarebas xelovnuri penisis Seqmnis mizniT. adamianebSi visac eqimisTvis ar miumarTavs. erT-
etiologia ucnobia. Seswavlil iqna Semdegi faq erTi gavleniani naSromis mixedviT (Harry Benjamin
torebi: International Gender Dysphoria Association, 2001) zogierTi
genetikuri mizezebi. transseqsualebs aqvT nor zustad identificirebuli transseqsuali cvlis
maluri sqesis qromosomebi. ar arsebobs sarwmuno Tavis `survilebs~. zogi egueba sasurvel genderul
mtkicebuleba, romelic metyvelebs genetikuri mi identobas samedicino daxmarebis gareSe, zogi ki Tmobs
zezebis sasargeblod. cvlilebebTan dakavSirebul survilebs mkurnalobis
aRzrda. ar dasturdeba mosazreba, rom trans adreul etapze. ar aris cnobili transseqsualebis
seqsualebs aRzrdis procesSi uyalibdebaT maTi ra nawili miekuTvneba TiToeul am kategorias.
anatomiuri sqesis sapirispiro genderuli roli. mkurnaloba. pirveli etapi. mkurnaloba Cveulebriv
rogorc zemoT aRiniSna, genderuli identobis mihyveba hari benjaminis saxelobis genderuli dis
_ 526 _
genderuli identobis anomaliebi
foriis saerTaSoriso asociaciis standartebs (ix. qvemoT). pirovnebas mxolod maSin aqvs ufleba
(Harry Benjamin International Gender Dysphoria Association, Caitaros hormonuli mkurnaloba, Tu is (a) 18 welze
2001). qvemoT mocemulia mkurnalobis safexurebi. ufrosia; (b) garkveulia hormonebis moqmedebaSi,
damatebiTi informaciisTvis ix. originaluri pub maTi uaryofiTi efeqtebis CaTliT; (g) warmatebiT
likacia an Green, 2000a. gaiara `realuri cxovrebiseuli gamocdilebis~ 3
w gegmaze SeTanxmeba. transseqsualebi xSirad Tavad Tve an konsultaciis SeTanxmebuli periodi. wlis
wyveten, Tu ra tipis mkurnaloba sWirdebaT da dasasruls, is pirebi, romlebic SeZleben daumtkicon
mouTmenlad moiTxoven mis Catarebas. maT SeiZleba Semfasebel komisias, rom isini ukeTesad arian
fsiqiatriuli gamokvleva zedmet dabrkolebad adaptirebulni axal genderul rolSi yofnisas
miiCnion hormonuli da qirurgiuli mkurnalobisaken Zvel rolTan SedarebiT, qirurgiuli operaciis
mimaval gzaze. zogi imuqreba TviTmkvlelobiT an kandidatebi xdebian.
sakuTari Tavis dasaxiCrebiT, Tu misi moTxovnebi hormonuli mkurnaloba: estrogenebiT mkurnaloba
droze ar iqneba dakmayofilebuli. aseT muqaras iwvevs mkerdis gazrdas. estrogenis es efeqti SeiZleba
yovelTvis seriozulad unda movekidoT, radgan is gansxvavebuli iyos, rogorc genetikurad mamrobiTi
miuTiTebs pacientis mZime distresze da saswrafo sqesis pirebSi, ise genetikurad mdedrobiTi sqesis
daxmarebis miRebis gadaudebel saWiroebaze. pirebSi, magram SemTxvevaTa umravlesobaSi cximi
miuxedavad amisa, pacients unda avuxsnaT, rom mas grovdeba TeZoebisa da dundulebis garSemo, rac
garkveuli safexurebis gavla mouwevs. upirveles sxeuls ufro qalur iers aniWebs. estrogenebiT
yovelisa, man unda icodes, rom fsiqologiuri gaxangrZlivebuli mkurnaloba Rrma venebis trom
stabiluroba udidesi mniSvnelobis mqonea imisTvis, bozis saSiSroebas Seicavs (van Kestern et al., 1997).
rom gardamavali periodi warmatebuli aRmoCndes. dadasturebulia mkerdis avTvisebiani simsivnis
aseTi stabilurobis misaRwevad, pirovnebam unda ganviTarebis SemTxvevebi (Symmers, 1968), magram
gaiaros `realuri cxovrebiseuli gamocdileba~ (ix. msgavsi SemTxvevebi ar dafiqsirebula estrogenebiT
qvemoT). mkurnalobis gviandel praqtikaSi, romelic 816
genetikurad mamakac transseqsuals Cautarda (van
w konsultacis dros unda iqnas gaTvaliswinebuli
Kestern et al., 1997).
sxvadasxva SesaZleblobebi, maT Soris iseTic,
androgenebiT mkurnaloba utardeba genetikurad
romlebzec pacients adre ar ufiqria. konsul
mdedrobiTi sqesis transseqsualebs. mkurnalobis
taciisas aqcenti gadatanilia realisturi miz
Sedegad xma boxdeba, Tmovani safari ufro xSiri
nebis dasaxvis aucileblobaze da yvela im Sedegis
xdeba saxeze da sxeulze, menstruacia wydeba, kli
gaTvaliswinebaze, romelic SeiZleba mohyves ne
tori izrdeba da seqsualuri ltolva Zlierdeba.
bismieri saxis cvlilebas rogorc Tavad pirov
es cvlilebebi, Cveulebriv, ufro gamokveTilia
nebisTvis, ise misi SvilebisTvis da, zogadad,
im cvlilebebTan SedarebiT, romlebic Tavs iCens
ojaxisTvis. konsultantma, agreTve, Semdegi sakiTxi
estrogeniT mkurnalobisas genetikur mamakacebTan,
unda ganixilos: savaraudod, verc erTi Terapia
romlebsac qalis genderuli rolis miReba surT.
mudmivad ver aRmofxvris pirovnebis Tavdapirveli
androgenebis xangrZlivi gamoyenebisas Cndeba RviZlis
sqesis yvela kvals (Harry Benjamin International Gender
dazianebis riski.
Dysphoria Association, 2001).
qirurgiuli Careva. im pirebs, romlebmac warma
`realuri cxovrebiseuli gamocdileba~. mamakaci tebiT gaiares mkurnalobis wina safexuri, amzadeben
transseqsuali, romelic qalis genderul rols qirurguli operaciisTvis. radganac qirurgiis
iRebs, unda SeeCvios imas, rom is qaliviT unda grZelvadiani Sedegebi kargad ar aris cnobili (ix.
gamoiyurebodes, iqceodes da saubrobdes. saxeze qvemoT), am tipi Carevis garSemo azrTa sxvadasxvaoba
Tmovan safars xSirad acileben eleqtrolizis SeiniSneba. gadawyvetileba erToblivad unda mii
meSveobiT an lazeriT. SeiZleba saWiro gaxdes xmis Ron fsiqiatrma da qirurgma, zogadi profilis
gavarjiSebac. `realuri cxovrebiseuli gamocdilebis~ eqimTan konsultaciis pirobebSi. TiToeuli maT
moTxovniT pirovneba axal genderul rolSi uwyvetad gani gamocdili unda iyos am tipis pacientebis
unda imyofebodes minimum 1 wlis manZilze, an ori mkurnalobaSi. operacias intensiuri, grZelvadiani
wlis manZilze, rac kidev ufro sasurvelia. am drois mxardaWera unda mohyvebodes.
ganmavlobaSi, is unda muSaobdes srul ganakveTze an genetikurad mamakac transseqsualebTan qirur
studentis statusi unda hqondes. (srul ganakveTze giuli procedura gulisxmobs mamoplastikas, pene
muSaobis moTxovna SeiZleba Zneli Sesasrulebeli qtomias, orqideqtomias da saSos msgavsi organos
iyos maRali donis umuSevrobis periodSi). am wlis Seqmnas penisis kanisagan, sxva saxis kanis an msxvili
manZilze tardeba Sesabamisi hormonuli mkurnaloba nawlavis damatebiT.
_ 527 _
genetikurad qal transseqsualebTan qirurgiuli aseT pirebs ubralod siamovnebT sapirispiro sqesis
proceduris dros tardeba masteqtomia, ovareqtomia tansascmlis tareba imis gamo, rom droebiT maT wres
da faloplastia. klitorisagan, romelic ukve gadi miekuTvnebodnen.
debulia androgenebis moqmedebis Sedegad, an sxeulis
genderuli identobis aSliloba mozardebsa
sxva nawilis kanisagan, iqmneba mikrofalosi (ix. Green,
da mozrdil adamianebSi (ara-transseqsualuri
2000a).
tipi)
daxmarebis gaweva ojaxisTvis. mravali transseqsuali
DSM-IV-Si es termini gamoiyeneba im adamianebis
daqorwinebulia da bevr maTgans Svilebi hyavs. maTi
aRsaniSnad, romlebic gascdnen pubertatis asaks
meuRleebi, da gansakuTrebiT Svilebi, Seguebas
da ganicdian mudmiv an xSir diskomforts TavianTi
saWiroeben TavianT cxovrebaSi momxdar siaxleebTan,
biologiuri sqesis gamo an euflebaT Seusatyvisobis
romlebic transseqsual pirovnebaSi momxdari cvli
gancda masTan mimarTebaSi. isini xSirad an
lebebiTaa gamowveuli. gasaTvaliswinebelia genderul
mudmivad icvamen sapirispiro sqesis tansacmels an
rolTan dakavSirebuli problemebis aRmocenebis
warmoidgenen am qmedebas, magram maTSi amgvari qmedeba
SesaZlebleoba transseqsualebis mcirewlovan Svi
da fantaziebi ar iwvevs seqsualur agznebas. maT arc
lebTan. Tumca gamokvlevaSi, romelSic 34 aseTi
TavianTi pirveladi da meoradi sqesobrivi niSnebis
bavSvi Seiswavleboda, ar dafiqsirebula genderuli
Secvla surT.
identobis aSlilobis SemTxvevebi (Green, 1998).
genderuli identobis aSliloba bavSvebSi
gamosavali. mravali gamokvlevidan arc erTSi ar
mSoblebi ufro xSirad iTxoven rCevas vaJebis
moxerxda im pacientebis Sedareba, romlebic Sem
qaluri qcevis gamo, vidre gogonebis biWuri qcevis
TxveviTi wesiT gaanawiles qirurgiul da araqi
gamo (ar aris garkveuli aseTi qceva gogonebTan
rurgiul jgufebSi. 10 wlis ganmavlobaSi gamo
ufro iSviaTia, Tu is ufro misaRebia socialuri
qveynebuli inglisurenovani literaturis mimoxilva
TvalsazrisiT). qalur biWebs urCevniaT gogonebis
gviCvenebs, rom mamakacis genderuli sqesis mqone
TamaSebi da qalis tansacmlis tareba. amgvar qcevas
transseqsualebis 90%-Tan plastikuri qirurgia
biWebSi SeiZleba sxvadasxva gamosavali hqondes. zog
warmatebuli gamodga (Green, Fleming, 1991). Tumca, am
maTgans normaluri mamakacuri interesebi da qceva
maCvenebels sifrTxiliT unda SevxedoT, SerCevisas
uyalibdeba. bavSvobaSi genderuli aSlilobis mqone
daSvebuli SesaZlo Secdomebisa da Semdgomi
biWebis umravlesoba homoseqsualad yalibdeba.
dakvirvebidan pacientebis SemTxveviTi gaTiSvis gamo
damatebiTi informaciisTvis ix. Green, 2000b.
(Green, 2000a). erT-erT gamokvlevaSi (Mate-Kole et al.,
1990), operaciisTvis 40 pacienti SearCies. amis Semdeg
maTi erTi nawilisTvis operaciis Catareba 3 Tvis seqsualuri qcevis sxva aspeqtebi
ganmavlobaSi daigegma, meore nawilisTvis ki _ 2 wlis gaupatiureba da incesti ganxilulia 26-e TavSi
Semdeg. operaciidan ori wlis Semdeg, pirvel jgufTan sasamarTlo fsiqiatriis Sesaxeb.
dadginda nevrotizmis ufro dabali maCvenebeli da
ukeTesi Segueba, im jgufTan SedarebiT, romelic
eTikuri problemebi seqsualuri
kvlav elodeboda operacias. erT-erT naSromSi
da genderuli aSlilobebis
(Meyer, Reter, 1979) naoperaciebi pacientebi Seadares
im pacientebs, romlebsac operacia ar CatarebiaT. diagnostirebisa da mkurnalobis
orive jgufSi gaumjobesebis erTi da igive xarisxi dros
dafiqsirda. Tumca, am Sedegis ganzogadeba ar aris fsiqiatriul praqtikaSi seqsualuri aSlilobebis
marTebuli, radgan es jgufebi ar iyvnen SemTxveviTi mkurnalobisas SeiZleba aRmocendes nebismieri xa
wesiT ganawilebulni, mxolod pacientebis naxevari siaTis eTikuri problemebi, magram qvemoT CamoTvlili
gamoikvlies Semdgomi dakvirvebis dros da Semdgomi problemebi SedarebiT seriozuli sirTuleebis
dakvirvebis periodi ufro xangrZlivi iyo im gamomwvevia.
pacientebisTvis, romlebsac operacia CautardaT.
profesiuli urTierToba
ormagi rolis transvestizmi rodesac intervius ZiriTadi Tema seqsualuri
es termini gamoiyeneba ICD-10-Si im adamianebis problemebia, arsebobs imis riski, rom urTierToba
aRsawerad, romlebic atareben sapirispiro sqesis pacientsa da Terapevts Soris seqsualuri xasiaTis
tansacmels, magram arc transvestuli fetiSistebi gaxdeba. samedicino praqtikis kodeqsi kategoriulad
arian, romlebic amiT seqsualuri agznebis miRwevas krZalavs seqsualuri urTierTobis damyarebas
cdiloben da arc transseqsualebi, romlebsac pacientTan, radgan es eqspluatacias uwevs pacients
genderuli da seqsualuri rolis Secvla surT. da xels uwyobs ndobis dakargvas eqimebis mimarT.
_ 528 _
eTikuri problemebi seqsualuri da genderuli aSlilobebis diagnostirebisa da mkurnalobis dros
konfidencialoba maSinac ki, rodesac isini emTxveva erTmaneTs. ma

galiTad, mecxramete saukunis dasasruls, masturbacia
rodesac erT-erTi seqsualuri partniori umJRavnebs
moralurad araswor saqcielad iTvleboda da,
Terapevts informacias Tavisi seqsualuri par
amave dros, mavne seqsualur praqtikad samedicino
tnioris Sesaxeb da amave dros krZalavs misTvis
TvalsazrisiT. mas gmobda eklesia da mkurnalobda
am informaciis gadacemas maSin, rodesac es mi
medicina.
zanSewonilia, aseTma viTarebam SeiZleba problemebi
zogi adamiani amtkicebs, rom garkveuli saxis
warmoSvas. am problemas Cveulebriv aviridebT, Tu
seqsualuri qcevis aSlilobad diagnostireba aci
orive poartniorisagan aviRebT srul anamnezs iqamde,
lebs pirovnebas pasuxismgeblobas sakuTari qcevis
sanam gadavwyvetT, Tu ramdenad mizanSewonilia seqs-
Sedegebze. diagnozi, rogorc aseTi, marTlac aZlevs
Terapiis Catareba da Tu cal-calke ar SevxvdebiT
adamians saSualebas Sevides avadmyofis rolSi
partniorebs Terapiis dawyebis Semdeg.
(gv. ??), magram am rolSi yofna mas rodi acilebs
diagnozi, stigmatizacia da pasuxismgebloba yovelgvar pasuxismgeblobas. es piriqiT, matebs mas
arsebobs mosazreba, rom seqsualuri qcevis romelime daxmarebis Ziebis pasuxismgeblobas, magram namdvilad
paternisTvis fsiqiatriuli diagnozis dasmas ori ar aTavisuflebs im pasuxismgeblobisagan, rom sxva
uaryofiTi Sedegi mohyveba. erTi isaa, rom diagnozis adamianebs ziani ar moutanos.
dasma xels uwyobs pacientis stigmatizacias; meorec,
man SeiZleba gaamarTlos moralurad araswori qceva.
orive problema imas Segvaxsenebs, rom diagnozi, damatebiTi literatura
ZiriTadad, Seiqmna mkurnalobasTan dakavSirebuli
sakiTxebis gadaWris mizniT, ris gamoc ar SeiZleba
Gelder, MG, Lpez-Ibor, JJ Jr and Andreasen, NC (eds) (200)
misi ukritikod gamoyeneba sxva problemebis mimarT,
The new Oxford textbook of psychiatry, Section 4.11: Sexual-
maT Soris pasuxismgeblobis problemis mimarT.
ity, gender identity, and their disorders. Oxford University
mravali adamiani, romelTa qceva diagnostirebulia,
Press, Oxford. (am nawilis oTx TavSi normaluri seq-
rogorc genderuli aSliloba, amtkicebs, rom es
sualuri qcevaa aRwerili.)
diagnozi axdens maT stigmatizacias, radgan is
gulisxmobs, rom maTi qceva, normaluris nacvlad, Golombek, S and Fivush, R (1998) Gender development, In H
paTologiuria. msgavsi mosazreba iyo gamoTqmuli Freeman, I Pullen, G Stein and G Wilkinson (eds), Psycho-
warsulSi homoseqsualuri qcevis mimarT, rodesac, sexual disorders, Chapter 2. Gaskell, London.
dRevandelobisagan gansxvavebiT, is aSlilobad Tomlinson, J (ed.) (2005) ABC of sexual health. BMJ Books,
ganixileboda. transseqsualebis sakiTxi kvlav de London. (mokle, praqtikuli, mimoxilviTi xasiaTis
batebis sagans warmoadgens. ama Tu im Temaze debatebis seriebi seqsualuri disfunqciis gamokvlevisa da
gamarTvisas, erTmaneTisagan naTlad unda gavmijnoT mkurnalobis da seqsualuri janmrTelobis sxva
samedicino mtkicebuleba da religiuri akrZalva, aspeqtebis Sesaxeb.)
_ 529 _
Tavi 20 xandazmulTa
fsiqiatria
Tavis Sinaarsi
daberebis normaluri procesi Zaladoba xandazmul adamianebze da maTi
demografia ugulebelyofa
daberebis Sedegebi demencia
Tavis tvinSi mimdinare demenciis bihevioruli da
fizikuri cvlilebebi fsiqologiuri simptomebis mkurnaloba
fsiqikuri aSlilobis epidemiologia alchaimeris daavadebis
asakovan adamianebSi medikamenturi mkurnaloba
demencia sxva saxis demenciebis
guneb-ganwyobis aSliloba medikamenturi mkurnaloba
SfoTva da stresTan dakavSirebuli guneb-ganwyobis aSliloba
aSlilobebi xandazmul pirebSi
Sizofreniis msgavsi aSlilobebi depresiuli aSliloba
da paranoiduli mdgomareobebi bipolaruli aSliloba
xandazmulTa fsiqiatriis SfoTviTi aSlilobebi xandazmul pirebSi
principebi da praqtika Sizofreniis msgavsi aSlilobebi
servisebis organizeba xandazmul pirebSi
xandazmulebis klinikuri Tvisebebi
fsiqiatriuli gamokvleva personologiuri aSliloba
xandazmulebis xandazmul pirebSi
fsiqiatriuli mkurnaloba xandazmulTa sxva fsiqiatriuli sindromebi
iuridiuli, finansuri da sibinZuris seniluri sindromi
eTikuri sakiTxebi Sarl bones sindromi
fsiqikuri janmrTelobis problemebis mqone asakovani socialur da fsiqologiur saWiroebebs. am geg

adamianebi specifikur sirTuleebs warmoSoben, mis ganxorcieleba, xSirad, ramdenime sferos spe
rogorc xandazmulTa fsiqiatriis praqtikisTvis, cialistis TanamSromlobas moiTxovs. swored aseTi
ise, am sferoSi servisebis organizebis TvalsazrisiT. tipis sirTuleebSi mdgomareobs xandazmuli asakis
isini xSirad fizikurad da fsiqikurad sustebi fsiqiatriis xibli da gamowveva.
arian, rac zemoqmedebs daavadebis gamovlenasa am TavSi ganxilulia xandazmuli asakis fsiqiatriis
da mimdinareobaze. meore mxriv, am adamianebis sakiTxebi, deliriumisa da demenciis gamoklebiT,
upiratesoba imaSi mdgomareobs, rom maT bevri ram romlebic me-14 TavSia ganxiluli (deliriumi _ gv.
aqvT saTqmeli da aqvT bednierebasa da ubedurebaze ??; demencia _ gv. ??).
reagirebis cxovrebiseuli gamocdileba. klinikuri
praqtikis mniSvnelovan nawils demencia warmoadgens. daberebis normaluri procesi
asakovan adamianebSi fsiqikuri aSlilobis Ses
wavlisas klinicistma unda SeZlos sxvadasxva demografia
wyarodan informaciis mopoveba, misi integrireba, 1993 wels msoflio populaciis 6%-s 65 wels
da marTvis iseTi gegmis SemuSaveba, romelic gadacilebuli adamianebi warmoadgenen. ganviTarebul
gaiTvaliswinebs xandazmulTa populaciis fizikur, qveynebSi, es maCvenebeli daaxloebiT 14%-s Seadgenda,
_ 530 _
daberebis Sedegebi
25 ganviTarebul qveynebSi. miuxedavad imisa, rom zogi-
metad erTi saxis fsiqikuri aSlilobis sixSire klebulobs
65 wels gadacilebuli populaciis
ganviTarebuli
naklebad (suraTi 20.2), asakTan erTad demenciis gavrcelebis
20
procentuli maCvenebeli
ganviTarebuli sixSire swrafad matulobs (ix. qvemoT).

yvela qveyana dgas mzardi mniSvnelobis proble-
15 mis winaSe: rogor marTos xandazmuli adamianebis
didi raodenoba, romlebsac kognituri funqciebis
10 daqveiTeba aReniSnebaT.
5
daberebis Sedegebi
Tavis tvinSi mimdinare fizikuri cvlilebebi
0 30 dan 70 wlamde adamianis Tavis tvinis wona
1950 1975 2000 2025 2050 mcirdeba daaxleobiT 5%-iT, 80 wlisTvis _ damatebiT
wlebi
5-iT, xolo 90 wlisTvis _ damatebiT 10-12%-iT. am
suraTi 20.1 65 wels gadacilebuli populaciis procentuli
cvlilebebTan erTad parkuWebi izrdeba da tvinis
maCvenebeli naklebad da metad ganviTarebul qveynebSi.
garsi sqeldeba. magnitorezonansuli kvlevebi
gaeros 1996 wlis monacemebi populaciis raodenobis
aCvenebs droiT-sivrciTi maxasiaTeblebis kompleqsur
Sefasebisa da prognozis Sesaxeb (AF Jorm, 2000).
cvlilebebs, romlebic dakavSirebulia Tavis tvinis
rux da TeTr nivTierebaSi mimdinare cvlilebebTan,
10
aseve, hipokampis, Tavis tvinis qerqis asociaciuri
zonebisa da cerebelumis moculobaSi SemcirebasTan
8 (Raz et al., 2005).
gavrceleba bolo erTi
Tvis ganmavlobaSi (%)
xandazmulobis dros aRiniSneba neironebis kvdoma. es

6 seleqciuri procesia da ufro sustadaa gamoxatuli,
vidre adre egonaT. ufro metadaa gamoxatuli
sinafsebisa da dendritebis raodenobis Semcireba.
4
zogierTi neironis citoplazma Seicavs pigment
lipofuscins. Tavis tvinSi, agreTve, akumulirdeba
2 seniluri folaqebi da neirofibriluri kvanZebi,
magram isini ufro mcire areebzea ganawilebuli da
naklebi raodenobiT gvxvdeba, vidre alchaimeris
0
1824 2544 4564 65+ daavadebis dros. neirofibriluri kvanZebi, Ziri
asakobrivi jgufi Tadad, gvxvdeba hipokampsa da enTorinaluri
korteqsis neironebSi, xolo seniluri folaqebi
SfoTviTi aSlilobebi afeqturi aSlilobebi SeiZleba Segvxvdes neokorteqsSic da amigdalaSic.
fsiqoaqtiuri nivTierebebis mwvave kognituri
garda amisa, janmrTeli asakovani adamianebis
araswori moxmareba disfunqcia
suraTi 20.2 fsiqikuri aSlilobebis gavrceleba asakobriv
jgufebSi. erTi Tvis maCveneblebi gavrcelebis Sesaxeb.
cxrili 20.1 msoflio populaciis procentuli
(Epidemiologic Catchment Area Study using DSM-III criteria). (AF Jorm, cvlileba 1975-2000
2000).
asaki sul % cvlileba 1975-2000
xolo naklebad ganviTarebul qveynebSi _ 4%-s. ganviTarebuli nakleb ganviTarebuli
naklebad ganviTrebul qveynebs aqvT Sobadobis
maRali maCveneblebi, magram sicocxlis xangrZlivoba < 15 57.7 20.2 72.6
15-24 41.8 8.6 50.0
sagrZnoblad dabalia ganviTarebul qveynebTan
25-34 56.5 4.2 75.0
SedarebiT (60-73 weli). britaneTSi sicocxlis
35-44 72.2 16.9 95.0
xangrZlivoba 1840 -1900 wlebSi 41 wlidan 46 wlade
45-54 74.5 33.2 104.2
gaizarda. man 1950 wlisTvis 69 wels miaRwia, xolo
55-64 64.5 30.5 86.7
2004 wlisTvis _ 76 wels. 65-74 68.9 33.2 104.2
cxrili 20.1 da suraTi 20.2 aCvenebs, rom gansxvaveba 75-79 84.3 53.4 121.2
populaciis asakobriv struqturaSi cvlilebas gan- >80 91.7 64.7 138.0
icdis. naklebad ganviTarebul qveynebSi asakovani
wyaro : United Nations, 1988.
adamianebis proporcia ufro swrafad izrdeba, vidre
_ 531 _
20 xandazmulTa fsiqiatria
Tavis tvinis mcire nawili Seicavs levis sxeulebs. saavadmyofos sawolebis naxevari uWiravT. aseTi vi-
daberebis normaluri procesis nevropaTologiis Tareba, gansakuTrebiT, 75 wels gadacilebul adami-
mimoxilvisTvis ix. Hof, Morrison, 2004. anebTan gvxvdeba. samedicino marTva rTuldeba erTze
bioqimiur doneze, dabereba aisaxeba cvlilebebSi meti aSlilobis erTdrouli arsebobis, mkurnalobis
kalciumis regulaciasa da mitoqondriul funqci gverdiTi movlenebis gazrdili riskisa da fsiqiatri-
onirebaSi (Toescu et al., 2004). es, nawilobriv, gan uli da socialuri problemebis gamo (Kane, 1985).
pirobebulia Tavisufali radikalebiT gamowveuli xandazmul adamianebSi xSiria sensoruli da motor-
oqsidaciuri dazianebiT (Barja, 2004) da zrdis faq uli SezRudvebi. ierusalimSi Catarebul kvlevaSi,
torisa da neirotransmiterul sasignalo arxebSi romelSic 80 wels gadacilebuli adamianebi monawil-
momxdari cvlilebebiT (Hof and Morrison, 2004; Mattson eobdnen, 50-60% asaxelebda mxedvelobasTan, smenas-
et al., 2004). Tan an siarulTan dakavSirebul problemebs, 22% ki _
saubarTan dakavSirebul sirTuleebs (Davies and Fleis-
daberebis neirofsiqologia
chman, 1981). es cifrebi reprezentatiulia da asaxavs
asakovani adamianebis kognituri funqciebis Sefaseba sxva qveynebSi dafiqsirebul maCveneblebs.
rTulia, radgan xandazmulebi xSirad fizikurad
sustad arian da axasiaTebT sensoruli deficiti, socialuri viTareba
rac saWiroebs normis frTxil da zust garCevas bevri adamianisTvis dabereba iwvevs seriozul cvli-
demenciis yvelaze adreuli fazisgan. lebebs socialur mdgomareobaSi. pensiaze gasvla ze-
longituduri kvlevebis mixedviT, standartuli moqmedebs ara mxolod Semosavalze, aramed, agreTve,
inteleqtis testebiT gazomili inteleqtualuri socialur statusze, dasvenebisTvis gankuTvnil
funqcia aCvenebs mniSvnelovan daqveiTebas mxo droze da socialur kontaqtebze. xelfasis dakarg-
lod Zalian xandazmul asakSi. cvlilebisTvis va seriozuli problemaa, romlis winaSec bevri xan-
damaxasiaTebeli paterni vlindeba fsiqomotorul dazmuli adamiani dgeba. erT _ erTi farTomasStabi-
SenelebaSi da axali informaciiT manipulirebis ani evropuli gamokiTxvis mixedviT, romelic 65 wels
gauaresebaSi. amis sapirispirod, kargad daswavlili gadacilebul adamianebze Catarda, yvelaze didi sa-
unarebis testebi (mag., verbaluri aRqmis testebi) nerviulo swored finansuri problemebia.
aCvenebs umniSvnelo daqveiTebas, romelic asakTan ar socialuri izolacia bevri xandazmuli adamianisT-
aris dakavSirebuli. vis saerTo problemas warmoadgens, gansakuTrebiT
magaliTad, cifrebis diapazonis testiT gazomili ganviTarebul qveynebSi. 1993 wels, amerikasa da bri-
xanmokle mexsiereba ar icvleba normalur xandaz taneTSi 65 wels gadacilebuli adamianebis erTi mesa-
mulebSi. operaciuli mexsierebis testebi aCvenebs medi marto cxovrobda, im dros, rodesac Cilesa da
SesaZleblobebis TandaTanobiT daqveiTebas. am CineTSi marto mcxovrebi adamianebis raodenoba 7%
gvarad, xandazmulebi sagrZnoblad uaresad as da 3%-s Seadgenda. britaneTSi es cifri Zalian gaiz-
ruleben davalebas axalgazrdebTan SedarebiT, Tu arda gasuli saukunis meore naxevarSi: 1851 wels is
yuradRebis ganawileba or saqmezea saWiro an Tu Seadgenda 7%-s, xolo 1921 wels _ 11%. Tumca bevri
masala, damatebiT, sxva saxiTac unda gadamuSavdes. xandazmuli adamianisTvis marto cxovreba problemas
xandazmuli adamianebi, Cveulebriv, cxadad ixseneben ar warmoadgens. amas xels uwyobs mzardi pensiebi da
pirovnuli mniSvnelobis mqone Soreul movlenebs. ufro meti Sesaferisi sacxovrisis arseboba. bevri
sxva saxis Soreuli movlenebis grZlevadiani mex maTgani regularulad naxulobs ojaxis wevrebs,
siereba daqveiTebulia (mimoxilvisTvis ix. Morris, mezoblebsa da megobrebs da sxvebs uwevs imdenive
1997). mTlianobaSi SeiniSneba balansi problemis mo- mxardaWeras, ramdensac Tavad iRebs. evrokomisiis
qnilad gadaWris uunarobas da gamocdilebis proces- mier 1993 wels Catarebuli gamokiTxvis mixedviT, xan-
Si dagrovil sibrZnes Soris. dazmuli evropelebis 44% yoveldRe naxulobda Ta-
kognituri da motoruli cvlilebebis msgavsad, vis naTesavebs. es cifri yvelaze maRali iyo samxreT
mniSvnelovani cvlilebebi SeimCneva pirovnul maxa- evropaSi da yvelaze dabali _ Crdilo evropaSi,
siaTeblebSi da damokidebulebebSi (mag., matulobs Tumca, unda aRiniSnos, rom gamokiTxvaSi dafiqsire-
sifrTxile da sixiste). buli martooba orive SemTxvevaSi erTnair paterns
aCvenebda da martoobis maCvenebeli yvelaze maRali
fizikuri janmrTeloba
iseT qveynebSi aRmoCnda, sadac ojaxuri kontaqtebis
funqciuri unarebis da adaptaciis zogad daqveiTe- intensivoba yvelaze maRali iyo.
basTan erTad, xSirad aRiniSneba qronikuli degener- cxrilSi 2.3-Si Sejamebulia britaneTSi 2001 wels
aciuli mdgomareobebi. amis gamo, xandazmuli adami- Catarebuli mosaxleobis aRweris monacemebi (www.sta-
anebi xSirad dadian ojaxis eqimebTan da, Cveulebriv, tistics.gov.uk/cci/). es monacemebi exeba marto mcxovrebi
_ 532 _
fsiqikuri aSlilobis epidemiologia asakovan adamianebSi
cxrili 20.2 marto an rezidenciul dawesebu cxrili 20.3 fsiqikuri aSlilobebis gavrcelebis
lebaSi mcxovrebi adamianebis procentuli maCveneblebi 65 wels gadacilebul adamianebSi
maCveneblebi inglissa da uelsSi, 2001
aSliloba gavrceleba (%)
sacxovrebeli adgili 65 weli da zemoT 85 weli da zemoT
demencia (mZime) 5.6
mamakaci qali mamakaci qali demencia (msubuqi) 5.7
saxlSi, marto 21 43 42 70 nevrozi da personologiuri aSliloba 12.5
rezidenciul maniakaluri depresia 1.4
dawesebulebaSi 2 5 11 21
Sizofrenia 1.1
xandazmuli adamianebis Tanafardobas `saTemo in- nebismieri aSliloba 26.3
stituciebSi~ (rezidenciuli dawesebulebebi da xan-
Kay et al., (1964)
grZlivi stacionarizacia) myof adamianebTan. orive
SemTxvevaSi qalebi Warboben mamakacebs da qvrivi qa-
lebis ricxvi aRemateba qvrivi mamakacebis raodeno- cxrili 20.4 fsiqikuri aSlilobebis gavrce
bas. nebimier asakobriv jgufSi unarSezRudulobis lebis sixSireSi momxdari cvlilebebi,
maCvenebeli ufro maRali aRmoCnda qalebSi. aseve
romlebic ukavSirdeba xandazmuli
adamianebis asaks
aRsaniSnavia, rom qveda mwkrivis mixedviT, im xandaz-
mulTa 93%, romelSic Sedis 85 wels gadacilebuli asaki demencia* depresia SfoTviTi
adamianebis, 67%, cxovrobs saxlSi da ara reziden- fsiqozuri
ciul dawesebulebaSi. aSlilobebi
Slilobebi
sxva faqtorebi
70 (n=392) 2 6 6 1
garda imisa, rom droTa ganmavlobaSi icvleba xan
75 (n=303) 5 6 4 2
dazmul adamianTa raodenoba, momdevno kohortebis
79 (n=206) 11 11 3 3
gamocdilebasa da molodinebSic SesamCnevi cvli
85 (n=494) 31 13 10 5
lebebi aRiniSneba. Taobas, romelic meoce saukunis
pirvel naxevarSi evropaSi daibada, ZiriTadad, * zomieri an mZime
hqonda sabaziso ganaTleba, hyavda didi ojaxi da cifrebi procentul maCvenebels warmoadgens (Skoog,
mravali saaTis ganmavlobaSi cud pirobebSi muSaobda. 2004).
man, agreTve, meore msoflio omi gaiara. is, vinc
daavadebebis SemTxvevebis gamovlenis problemebi.
daibada 50 wlis Semdeg, gaizarda ukeTes pirobebSi
mag., ukanasknel xanebSi did populaciaze Catarebulma
da miiRo ukeTesi ganaTleba. garda amisa, am Taobas
erT-erTma frangulma kvlevam, 65 wels gadacilebul
Camouyalibda ufro maRali molodinebi. britaneTsa
adamianebSi daadgina SfoTviTi aSlilobis gavrcelebis
da evropis umetes nawilSi ukanasknel xanebSi moxda
14%, fobiis 11%, Rrma depresiis 3%, da fsiqozis
swrafi cvlilebebi eTnikur SemadgenlobaSi da ojaxis
1.7%. DSM- IV-Si Setanili diagnozebis dasadgenad
struqturaSi. yvela es faqtori momavalSi imoqmedebs
mkvlevarebma intervius meTodi gamoiyenes (Ritchie et
im moTxovnebze, romlebsac adamianebi janmrTelobis
al., 2004). aRsaniSnavia, rom mocemuli cifrebi niRbavs
dacvisa da socialur servisebs wauyeneben (Royal
mniSvnelovan cvlilebebs aSlilobebis gavrcelebasa
Commission on Long Term Care, 1999).
da proporciebSi xandazmulobis sxvadasxva etap
ze, rac SvedeTSi Catarebul farTomasStabur ga
fsiqikuri aSlilobis mokvlevaSia naCvenebi (Skoog, 2004). am ukanaskneli
epidemiologia asakovan adamianebSi gamokvlevis Sedegebi cxril 20.4-Sia Sejamebuli.
keim da misma kolegebma Kay et al., (1964) Caatares sxva kvlevebi aCvenebs TavSesafris tipis sacxovre-
pirveli sistemuri kvleva zogad populaciaSi xan blebSi da saavadmyofoebSi myof asakovan adamianebSi
dazmul pirebs Soris fsiqikuri aSlilobebis six fsiqikuri aSlilobebis gavrcelebis maRal sixSires.
Siris gamosavlenad. maT niukaslis regionSi (Crdi moxucTa saxlebSi mcxovrebi adamianebis erT mesa-
loeT inglisi) Seiswavles rogorc saxlebSi, aseve meds aReniSneba kognituri funqciebis mniSvnelovani
instituciebSi myofi asakovani adamianebi. daqveiTeba. zogadi profilis saavadmyofoebis gan-
Sedegebi (cxrili 20.3) didwilad momdevno kvle yofilebebSi, 65 wels gadacilebuli pacientebis 30-
vebSic ganmeorda, romlebSic gaTvaliswinebuli iyo 50%-s fsiqikuri daavadebis esa Tu is forma aReniSneba.
cvlilebebis Setana diagnostikur kriteriumebSi Cveulebriv, zogadi profilis eqimebma ar ician, Tu
(mag., depresiis CarTva nevrozis kategoriaSi) da ra fsiqiatriuli problemebi aqvT TemSi mcxovreb
_ 533 _
xandazmul adamianebs. zogadi profilis eqimebsa da sixSireze Catarda mravali gamokvleva da, aseve, ram-
fsiqiatrebs maT arsebobaze xSirad mianiSnebT so- denime meta-analizi (nax. 20.3). gavrcelebis sixSire
cialuri faqtebi. mag., pacientis garemoSi SeiZleba asakTan erTad mkveTrad izrdeba 90 wlamde; amis Sem-
moxdes raime ucabedi cvlileba (mag., naTesavis avad- deg zrda neldeba da asi wlis da am asaks gadacile-
myofoba an mZime danakargi); an kidev, ukiduresad buli adamianebis erT meoTxeds SenarCunebuli aqvs
gadaRlilma an imedgacruebulma ojaxma SeiZleba kognituri funqciebi (Perls, 2004). rogorc me-14 TavSi
gadawyvitos, rom aRar SeuZlia xandazmul adamianze aRvniSneT, demenciis yvelaze xSiri mizezebia alchai-
zrunva. xandaxan SeimCneva manipulireba naTesavebis meris daavadeba, vaskuluri demencia da demencia le-
mxridan, romlebic cdiloben Tavidan aicilon arasa- vis sxeulebiT, romelic, xSirad, erTze meti aSlilo-
surveli pasuxismgebloba. bis maxasiaTeblebTan erTad gvxvdeba.
iseve rogorc axalgazrda populaciaSi, xandazmu-
lebSic arsebobs genderuli gansxvavebebi fsiqikuri guneb-ganwyobis aSliloba
aSlilobis gavrcelebis TvalsazrisiT, aseve gansx- miuxedavad imisa, rom asakovan adamianebSi demencia-
vavebebi aSlilobis gamovlenasa da mimdinareobaSi da zea gamaxvilebuli yuradReba, maTTan depresiuli
mkurnalobasTan dakavSirebul saWiroebebSi (Lehmann, aSlilobebi mniSvnelovnad metadaa gavrcelebuli.
2003). Temze dafuZnebuli kvlevebis sistemurma mimoxilvam
aCvena depresiis klinikuri SemTxvevebis gavrcele-
demencia bis sixSiris Semdegi saSualo maCveneblebi: 13.5% 55
miuxedavad imisa, rom klasikur literaturaSi ar- wels gadacilebul pirebSi, romelTaganac 9.8% kla-
sebobs miniSnebebi demenciis Sesaxeb, Tanamedrove sificirda, rogorc mcire, xolo 1.8%, rogorc didi
medicinis mier xandazmul adamianebSi demenciis ar- depresia. gavrcelebis maCveneblebi ufro maRali iyo
seboba mas Semdegaa aRiarebuli, rac frangma fsiqi- qalebSi da im xandazmul pirebSi, romlebic cud pi-
atrma eskirolma (Esquirol) 1838 wels aRwera dmence robebSi cxovrobdnen (Beekman et al., 1999). es cifrebi
senile. eskirolma demencia aRwera zogadi terminebis aCvenebs, rom depresiuli xandazmulebis didi nawili
gamoyenebiT, magram misi aRwera mainc hgavs dReisT- ar akmayofilebs didi depresiis kriteriumebs. maT-
vis arsebul koncefcias (Alexander, 1972). krepelinma Tan ufro metad svamen msubuqi depresiis, disTimiis
(Kraeplin) ganasxvava demencia fsiqozebisgan organuli an qvezRurblovani depresiis diagnozs. Tumca, amiT
mizezebis safuZvelze (mag., neirosifilisi) da masSi maTi depresiuli mdgomareoba ar xdeba klinikurad
ramdenime forma gamoyo: preseniluri, seniluri da nakleb mniSvnelovani, radgan mocemul SemTxvevebSi
arteriosklerozuli. erT-erT mniSvnelovan kvleva- morbidoba da daavadebis mimdinareoba iseTivea, ro-
Si roTma (Roth, 1955) aCvena, rom xandazmulebSi de- gorc Rrma depresiis mqone pacientebTan (Beekman et
mencia imiT gansxvavdeba afeqturi da paranoiduli al., 1997, 2002).
aSlilobebisgan, rom mas cudi prognozi ukavSirdeba. depresiis maCveneblebi garemozea damkidebuli. ko-
roTis (Roth, 1955) Semdeg, demenciis gavrcelebis enigma da bleizerma (Koenig and Blazer, 1992) daasaxe-
les Semdegi maCveneblebi: 0.4-1.4% _ TemSi,
5-10% _ ambulatoriul pacientebSi, 10-15% _ sta-
40 cionarul pacientebSi da 15-20% _ moxucTa saxlebSi.
Jorm et al, 1987 es gansxvavebebi asaxavs xandazmulebSi depresiis xSir
Hofman et al. 1991 komorbidobas sxva fsiqikur (Devanand, 2002) da fizi-
30 Ritchie et al. 1995
kur (Krishnan et al., 2002) darRvevebTan, gansakuTre-
biT ki vaskulur darRvevebTan (gv ??). mag., depresiis
gavrceleba (%)
maCveneblebi maRalia im pirebSi, visac gulis proble-

20 mebi da neirodegeneraciuli aSlilobebi aReniSnebaT.
garda amisa, pacientebis erT mesameds aReniSneba al-
koholis borotad moxmarebiT gamowveuli aSliloba.
10 komorbidobis es SemTxvevebi xels uwyobs depresiis
mqone xandazmulebSi unarSezRudulobisa da sikvdi-
lianobis SemTxvevebis zrdas, romlebic, gansakuT-
0 rebiT kardialuri movlenebiTaa gamowveuli (Penninx
65 70 75 80 85 90 95
asaki et al., 1999). xandazmul patimrebTan dafiqsirebulia
suraTi 20.3 demenciis gavrcelebis maCveneblebi asakobrivi depresiis gansakuTrebiT maRali maCveneblebi (Fazel
jgufebis mixedviT: monacemebi sami meta-analizidan. AF Jorm et al., 2001).
(2000)
depresiuli aSlilobis gavrcelebis sixSire niRbavs
_ 534 _
xandazmulTa fsiqiatriis principebi da praqtika
im faqts, rom depresiis pirveladi epizodebi klebu- -s. ar arsebobs zusti monacemebi TemSi gavrcelebis
lobs 60 wlis Semdeg da iSviaTad gvxvdeba 80 wlis sixSiris Sesaxeb, radgan rTulia daavadebis yvela
Semdeg. amjerad mimdinareobs debatebi imis Taobaze, SemTxvevis identificireba. mravali adamiani am tipis
aqvs Tu ara gviandel periodSi dawyebul depresias gamocdilebas sxvas ar umJRavnebs da ar iRebs monawi-
adreul wlebSi dawyebuli depresiisgan gansxvavebu- leobas `karis zRurblTan~ Catarebul interviuebSi.
li biologiuri safuZveli (gv. ??). agreTve, Temis doneze SeiZleba garTuldes am tipis
suicidis sixSire stabilurad izrdeba asakTan SemTxvevebis gamorCeva iseTi SemTxvevebisgan, rom-
erTad (Tavi 17). suicidi xandazmulebSi, ZiriTadad, lebsac axasiaTebs demenciis an mZime depresiisTvis
depresiul aSlilobasTan aris dakavSirebuli (Waern tipiuri fsiqozuri simptomebi.
et al., 2002). depresiuli aSlilobisgan gansxvavebiT,
bipolaruli aSliloba da mania, rogorc Cans, nakle- xandazmulTa fsiqiatriis
badaa gavrcelebuli xandazmul asakSi (Depp and Jeste,
principebi da praqtika
2004).
epidemiologiuri sakiTxebis mimoxilvis Semdeg, am na-
SfoTva da stresTan dakavSirebuli wilSi mokled CamovayalibebT xandazmulTa fsiqiat-
riis principebsa da praqtikas gamokvlevis, marTvisa
aSlilobebi
da servisebis organizebis TvalsazrisiT, da, agreT-
zogad samedicino praqtikaze dayrdnobiT Seferdma
ve, imas, Tu rogor asaxavs yovelive es am tipis pa-
(Shepherd et al., 1966) aRmoaCina, rom nevrozis axali
cientebis maxasaiTebelebs, saWiroebebs da maTTvis
SemTxvevebis (mag., SfoTviTi aSlilobis) sixSire kle-
specifikur aSlilobebs. am TavSi, agreTve, aRwerilia
bulobs 55 wels gadacilebul pacientebSi. Tumca,
xandazmuli asakisTvis damaxasiaTebeli calkeuli
zogadi profilis eqimTan nevrozTan dakavSirebuli
fsiqikuri aSlilobis niSnebi da mkurnaloba.
konsultaciebis sixSire ar mcirdeba _ savaraudod
qronikuli an rekurentuli SemTxvevebis gamo. zo- servisebis organizeba
gadi populaciis gamokiTxva miuTiTebs, rom 65 wlis
saerTaSoriso konsensusis debulebaSi gansazRvru-
Semdeg Cndeba emociuri aSlilobis axali SemTxveve-
lia xandazmuli adamianebis fsiqikuri janmrTelobis
bi, sadac saSualo simZimis SemTxvevebis gavrcelebis
servisis umTavresi elementebi (Wertheimer, 1997):
sixSire daaxloebiT 12% -s Seadgens (Kay and Begmann,
1980). posttravmuli stresuli aSlilobis gavrcele- pirveladi jandacvis gundi
bis sixSire xandazmulebSi daaxleobiT 1%-s udris xandazmulTa fsiqiatriis specialistTa gundi
(van Zeist et al., 2003). stacionaruli ganyofileba
xandazmulebSi SfoTviTi aSlilobebis mimoxil-
reabilitacia
visTvis ix. Alwahhabi, 2003.
dRis ganmavlobaSi zrunvis servisebi
Sizofreniiis msgavsi aSlilobebi da zrunva momvlelebze maTi pasuxismgeblobebis
paranoiduli mdgomareobebi droebiT gadabarebis gziT (respite care _ droebiTi
zrunva)
xandazmul populacaSi Sizofreniis msgavsi da para-
noiduli aSlilobebi didi xania iwvevs aqtiur deba- rezidenciuli samzrunvelo dawesebulebebi
tebsa da terminologiur gaurkvevlobas (ix. boqsi ojaxuri da socialuri mxardaWera
13.2). terminebs parafrenia da gviani parafrenia sak- TanamSromloba geriatriul medicinasTan
maod xSirad iyeneben, Tumca arc Tu ise zusti mniSv-
jandacvis sferos warmomadgenlebis informire-
nelobiT. ICD-isa da DSM-is momaval versiebSi termi-
ba fsiqiatriuli problemebis mqone pacientebis
ni `Zalian gviani debiutis mqone Sizofreniis msgavsi
saWiroebebze
fsiqozi~ moicavs iseTi tipis fsiqozebs, romlebic
60 wlis Semdeg viTardeba. am jgufis Semofargvla kvleva (gansakuTrebiT epidemiologiuri sakiTxebi)
da misi diferenciacia `gviani debiutis mqone Sizo- da servisebis Sefaseba.
frniisgan~, romlis debiuti, Cveulebiv, 40-59 wlis zogadad, `gundi~ efeqturi mzrunvelobis uzrun-
adamianebTan gvxvdeba, efuZneba gansxvavebebs simp- velyofis mTavar komponentad iTvleba (Collighan et
tomebis profilSi da asocirebul risk-faqtorebSi al., 1993) da multidisciplinuri intervencia nor-
(Howard et al., 2000). madaa miCneuli. praqtikaSi, es principebi mravalgvari
pacientebi, romlebsac aReniSnebaT `Zalian-gviani erovnuli politikis meSveobiT xorcieldeba, romle-
debiutis mqone Sizofreniis msgavsi fsiqozi~, Sead- bic gansxvavdeba servisebis ganviTarebisa da uzrunve-
genen geriatriuli ganyofilebebis pacientTa 10% lyofis TvalsazrisiT (Johnston and Reifler, 2000). ameri-
_ 535 _
kaSi, aqcenti gadatanilia zrunvasa da mkurnalobaze xandazmulTa fsiqiatriuli servisebi
saavadmyofoebSi da moxucTa saxlebSi. evropaSi, kana-
fsiqiatriuli servisebis organizeba gansxvavdeba
dasa da avstraliaSi socialuri politika yuradRebas
adgilis mixedviT, radgan asaxavs servisis mimwode-
amaxvilebs TemSi TavSesafris tipis sacxovreblisa da
blebis lokalur stils, adgilobriv saWiroebebs,
mzrunvelobis uzrunvelyofaze. aq, sailustraciod,
imas, Tu ramdenad iTvaliswinebs zogadi fsiqiatri-
britaneTSi arsebuli servisebi iqneba moyvanili.
uli servisebi daxmarebis gawevas am asakobrivi jgu-
janmrTelobis, socialuri da moxaliseTa servisebi
fisTvis da, aseve, erovnul politikas. servisis miza-
cal-calke iqneba aRwerili, Tumca, xarisxiani mzrun-
nia xandamzuli adamianis, SeZlebisdagvarad, didxans
veloba damokidebulia yvela donis servisebis mWidro
sakuTar saxlSi gaCereba, wamoWril samedicino da
TanamSromlobaze, romelic yvela sferoSi unda xor-
socialur problemebze swrafi reagireba, xangrZlivi
cieldebodes: dawyebuli strategiuli dagegmvidan,
daxmarebis gamwevTa koordinaciis uzrunvelyofa da
damTavrebuli yoveli individualuri pacientisTvis
im naTesavebisa da axloblebis mxardaWera, romlebic
koordinirebuli mzrunvelobis uzrunvelyofiT. am
Sinaur pirobebSi zrunaven asakovan adamianze. unda
saWiroebidan gamomdinare, britaneTSi mocemul etapze
damyardes mWidro kavSiri pirvelad momsaxurebas, saa-
mimdinareobs janmrTelobis dacvisa da socialuri
vadmyofos sxva specialistebs, socialur servisebs da
servisebis da maTi biujetebis integracia.
moxaliseTa saagentoebs Soris. klinicistebis gundma
janmrTelobis servisebi unda SeimuSavos multidisciplinuri midgoma. gundSi
SeiZleba Sediodnen fsiqiatrebi, fsiqologebi, TemSi
pirveladi jandacva momuSave fsiqiatri eqTnebi, okupaciuri Terapevte-
zogadi profilis eqims mTavari roli eniWeba fsiqi- bi da socialuri muSakebi. gundis zogierTma wevrma
kuri aSlilobis mqone xandazmuli adamianebis prob- ufro meti dro unda moandomos pacientebis saxlSi
lemebis Sefasebasa da marTvaSi. britaneTSi yvela 75 yofnasa da zogadi praqtikis samedicino personalis
wels gadacilebul pacients SeuZlia gaiaros janmr- fuqnciebis Sesrulebas, vidre saavadmyofoSi muSao-
Telobis yovelwliuri Semowmeba, rac fsiqikuri bas. mniSvnelovania, rom sxvadasxva saagentoebis mier
aSlilobebis regularuli skriningis Catarebis sa- gaweuli daxmareba koordinirebul saxes atarebdes.
Sualebas iZleva. bevr instanciaSi, zogadi profilis britaneTSi moqmedi zrunvis programa (Care Programme
eqimi, pirveladi jandacvis doneze momuSave sxva Approach) mimarTulia koordinaciis gaumjobesebaze,
profesionalebTan erTad, gamokvlevas utarebs da rac erTi konkretuli adamianisTvis, ZiriTadi mu-
marTavs pacientebs specialistTan gadamisamarTebis SakisTvis, gansakuTrebuli pasuxismgeblobis miniWe-
gareSe. aSlilobebis SemTxvevaSic ki (mag., demenci- biT xdeba. am muSakma unda uzrunvelyos Sesabamisi
isas, romlis drosac gadamisamarTeba Cveulebriv gamokvlevis Catareba, daxmarebis dagegmva da ganxil-
praqtikas warmoadgens), zogadi profilis eqimi mainc va (gv.??). qvemoT saubaria imaze, Tu ra wvlili Seaqvs
pasuxismgebelia pirvelad gamokvlevasa da diag- sxvadasxva fsiqiatriul serviss xandazmul adamian-
nostirebaze (Turner et al., 2004). Tumca, rogorc ukve ebze zrunvaSi.
aRiniSna, zogadi profilis eqimebi xandazmul adami- binaze gaweuli fsiqiatriuli momsaxureba. sul
anebSi ver amCneven adreul stadiaze yvela fsiqikur ufro xSirad xdeba pacientis binaze gamokvleva da
problemas da yovelTvis ar uzrunvelyofen yvela mkurnaloba. es mosaxerxebelia pacientebisTvis da
aucilebel xangrZliv samedicino zedamxedvelobas. saSualebas gvaZlevs ufro realisturad da adek-
es, nawilobriv, gamowveulia xandazmulebSi fsiqi- vaturad SevafasoT is siZneleebi, romelTa winaSec
kuri daavadebis mniSvnelovnebis naklebi gacnobiere- dgebian pacientebi da maTi momvlelebi. TemSi mo-
biT, nawilobriv ki iseTi tipis servisiT, romelic muSave fsiqiatri eqTnebi pirveladi jandacvisa da
ufro metad gulisxmobs eqimis mxridan pacientebis specialuri servisebis makavSireblis rolSi gamo-
moTxovnebze reagirebas, vidre problemis Ziebas. dian. eqTnebma SeiZleba Seafason zogadi profilis
xandazmulTa fsiqiatriis zogierTi servisi iRebs eqimebisgan momdinare gadamisamarTebebi, Tval-yuri
mxolod zogadi profilis eqimis mier gadamisamarTe- adevnon mkurnalobas zogadi profilis eqimebTan da
bul pacientebs. Tumca, bolo xanebSi, xdeba nebism- fsiqiatriul servisebTan erTad da monawileoba mi-
ieri wyarodan gadamisamarTebuli pacientebis miRe- iRon demenciis mqone asakovani adamianebisTvis binaze
ba. es ar niSnavs imas, rom zogadi profilis eqimTan daxmarebis aRmoCenaSi.
TanamSromloba kargavs mniSvnelobas. ambulatoriuli klinikebi SedarebiT meorex-
zog regionSi Temis fsiqiatriuli eqTnebi pirve- arisxovan rols asrulebs xandazmulebisTvis dax-
lad jandacvaSi muSaoben, Tumca, ufro xSirad, isini marebis aRmoCenis saqmeSi, radgan binaze gamokvlevis
meoradi jandacvis, kerZod, xandazmulTa fsiqiatri- Catareba gansakuTrebiT mniSvnelovania asakovani pa-
uli gundis wevrebi arian.
_ 536 _
cientebisTvis. Tumca, aseTi klinikebi mosaxerxebelia geriatriuli medicina. geriatriuli ganyofile-
mobiluri pacientebis gamokvlevisa da maTze Semd- bebisa da fsiqiatriuli ganyofilebebis pacientebs
gomi dakvirvebis warmoebisTvis. klinikebi, romlebic yovelTvis saerTo maxasiaTeblebi gaaCniaT. orive
aRWurvilia, rogorc geriatriis specialistebiT, ganyofileba mkurnalobs demenciis mqone pacien-
ise xandazmuli asakis pacientebTan momuSave fsiqi- tebs, Tumca funqciuri aSlilobis mqone pacientebs
atrebiT, garkveuli upiratesobis mqonea. bolo wleb- ufro xSirad mkurnaloben xandamzuli asakisTvis
Si bevrgan gaixsna mexsierebis klinikebi mexsierebis gankuTvnil fsiqitriul ganyofilebebSi. warsulSi,
adreuli problemebis mqone pacientebis specialuri mravaljer gamoiTqva SeSfoTeba imis Taobaze, rom
gamokvlevisTvis (Phipps and O~Brien, 2002). britaneTSi, bevri pacienti àrasworad xvdeboda~ fsiqiatriul
am tipis klinikebSi, aseve, xdeba alchaimeris daa- ganyofilebaSi, iRebda uxarisxo Terapiul momsax-
vadebis samkurnalo wamlebis gamowera, radgan maTi urebas da stacionarSi zedmetad didxans rCeboda. am
xelmisawvdomoba SezRudulia (gv. ??). kategoriis pacientebTan avadmyofobis mkurnalobis
dRis saavadmyofoebi da dRis centrebi. miuxedavad Sedegi aradamakmayofilebeli iyo. zogadad, SeiZleba
imisa, rom zogierTi saxis mkurnalobis Catareba bin- iTqvas, rom arsebuli SeSfoTeba gamokvlevebiT ar
azea SesaZlebeli, zogjer mkurnalobisTvis SeiZleba dadasturebula. mag., koplandma (Copeland et al., 1975)
aucilebeli gaxdes pacientis dRis saavadmyofoSi ga- aRmoaCina, rom Tumca geriatriul saavadmyofoebSi
dayvana, sadac arsebobs intensiuri stimulaciisa da moTavsebuli adamianebis 64%-s fsiqikuri aSliloba
socialuri interaqciis pirobebi. dRis mkurnaloba aReniSneboda, maTgan mxolod 12% iyo am tipis saa-
geriatriul saavadmyofoebSi 1950-ian wlebSi daiwyo. vadmyofoSi usafuZvlod moTavsebuli. ufro metic,
ramdenime wlis Semdeg xandazmulebisTvis gaixsna am 12%-ze geriatriul saavadmyofoSi yofnam aranairi
dRis pirveli fsiqiatriuli saavadmyofoebi. aseTma uaryofiTi zegavlena ar iqonia. rogorc Cans, xseneb-
saavadmyofoebma unda uzrunvelyon diagnostikuri uli ori tipis saavadmyofodan oriveSia SesaZlebeli
servisebis sruli speqtri; SeZlon funqciuri da or- mravali pacientis Tanabrad efeqturad mkurnaloba.
ganuli aSlilobebis mqone pacientebis moklevadiani danarCeni pacientebis saavadmyofoSi optimalurad
da xangrZlivi mkurnaloba, da, aseve, maTi naTesavebis moTavseba imaze iqneba damokidebuli, Tu ramdenad
mxardaWera. amJamad, dRis ganmavlobaSi mzrunvelo- wamyvania maTTan qceviTi da somaturi problemebi.
bas ufro xSirad dRis centrebi gasweven, vidre dRis zogadi samedicino profilisa da fsiqiatriuli pro-
saavadmyofoebi. aseTi centrebi aerTianeben jan- filis mqone gundebma mWidrod unda iTanamSromlon
dacvisa da socialuri mzrunvelobis elementebs. erTmaneTTan, raTa yvela pacients Cautardes xarisx-
centrebis saqmianobaSi xSirad monawileobs moxali- iani mkurnaloba.
seTa organizaciebi (mag., alchaimeris sazogadoeba), xangrZlivi mkurnaloba saavadmyofos garemoSi.
romlebic exmarebian centrs finansuri da praqti- zog qveyanaSi xandazmuli fsiqiatriuli paciente
kuli sakiTxebis gadawyvetaSi. dRis centrebi uzrun- bis umetesoba kvlav mkurnalobs fsiqiatriul saa-
velyofen imgvar servisebs, romlebic mniSvnelovani vadmyofoebSi. Tumca, mkurnalobis xasiaTi ufro
da xelmisawvdomia fsiqiatriuli problemebis mqone mniSvnelovania, vidre dawesebuleba, sadac tardeba
xandazmuli pacientebisTvis. dRis centrebi, ZiriTa- mkurnaloba. mTavari moTxovnebia okupaciuri da so-
dad, msubuqi da saSualo simZimis demenciis mqone pa- cialuri Terapiis Catareba, privatulobis uzrunve-
cientebzea fokusirebuli. dRis ganmavlobaSi gansax- lyofa da piradi nivTebis moxmarebis SesaZlebloba.
orcielebuli yvela RonisZieba damokidebulia, um- Tu es kriteriumebi dakmayofilebulia, xangrZlivi
Tavresad, adekvatur satransporto saSualebebze. hospitaluri mkurnaloba SeiZleba saukeTeso ga-
stacionaruli ganyofilebebi. stacionarSi momuSave mosavals warmoadgendes mZime unarSezRudulobis
gundebs unda SeeZloT multidisciplinuri gamokv- mqone pacientebisTvis. britaneTSi xangrZlivi sta-
levisa da mkurnalobis uzrunvelyofa mZime prob- cionaruli mkurnalobis wili Zalian Semcirebulia
lemebis mqone fsiqiatriuli pacientebisTvis. fsiqi- (garkveulwilad, gaizarda Temze dafuZnebuli mz-
atri eqimebisa da eqTnebis garda am gundSi SeiZleba runvelobis xarisxi). amJamad, xangrZlivi mzrun-
Sediodnen okupaciuri Terapevtebi, fsiqologebi, veloba da mkurnaloba, ZiriTadad, xorcieldeba
metyvelebis Terapevtebi, fizioTerapevtebi, social- hospitals gareT, rezidenciul dawesebulebebSi da
uri muSakebi, jandacvis asistentebi da sxvebi. gunde- moxucTa saxlebSi. aqtiuri debatebia gamarTuli imis
bis Semadgenloba gansxvavebulia sxvadasxva regionisa Taobaze, Tu rogor unda finansdebodes grZelvadi-
da momsaxurebis moculobis mixedviT (gundi SeiZleba ani mzrunveloba, radgan jandacvis erovnuli servi-
axorcielebdes mxolod funqciuri problemebis mqone sis (NHS-National Health Servise) mier uzrunvelyofili
pacientebze zrunvas, an organuli daavadebebis mqone mkurnaloba ufasoa, xolo socialuri servisebis
xandazmul pirebsac uwevdes momsaxurebas). mier ganxorcielebuli mzrunveloba iTvaliswinebs
_ 537 _
finansuri mdgomareobis Semowmebas (Royal Commission miscems, isargeblon damoukideblobis sxvadasxva
on Long Term Care, 1999). xarisxiT. am tipis uzrunvelyofa ufro xarisxiania
evropis qveynebSi, amerikasa da avstraliaSi (Grundy,
socialuri servisebi
1987).
binaze momsaxureba ùwyveti mzrunveloba~ gulisxmobs xandazmulebis
samedicino servisebTan erTad, binaze momsaxurebaSi iseTi sacxovrisiT uzrunvelyofas, sadac personali
Sedis daxmarebis gaweva saSinao saqmeebis keTebaSi mudmivad adgilze imyofeba. rezidenciul dawese-
da sxva saxis msgavsi momsaxureba (saWmlis binaze mi- bulebebSi macxovreblebis pirad higienasTan dakav-
wodeba, sarecxi, telefoniT sargebloba, saswrafo Sirebuli saWiroebebi SeiZleba dakmayofildes spe-
daxmarebis satelefono zaris sistemebis gamoyeneba). cialuri asistentebis mier. maTi samuSao ar iTxovs
britaneTSi adgilobrivi mmarTveloba Tavad uzrun- gansakuTrebuli treningis gavlas. rac Seexeba mox-
velyofs da marTavs am tipis servisebs. is, aseve, ex- ucTa saxlebis macxovreblebs, maT esaWiroebaT mud-
mareba moxaliseTa organizaciebs da xels uwyobs ad- mivi zrunva, ris gamoc momvleli personali, ZiriaTa-
gilobriv iniciativebs (mag., samezoblo programebisa dad, treninggavlili eqTnebisgan Sedgeba. zogierTi
da TviTdaxmarebis jgufebis Seqmnas). 65 wels gadac- moxucTa saxli fsiqikuri janmrTelobis problemebis
ilebuli saxlSi mcxovrebi 500 adamianisgan Semdgari mqone xandazmulebis mzrunvelobazea fokusirebuli.
SemTxveviTi SerCevis SeswavliT fosterma (Foster et al., britaneTSi, rezidenciuli sacxovreblis da Tav
1976) daadgina, rom 12% sargeblobda binaze momsax- Sesafris tipis sacxovreblebis uzrunvelyofaze
urebiT, magram damatebiT 20%-sac esaWiroeboda am pasuxismgebelia adgilobrivi socialuri servise-
saxis servisi. miuxedavad imisa, rom izrdeba am tipis bi, Tumca bevri damoukidebeli da saqvelmoqmedo
servisebis moculoba, aseve izrdeba im adamianebis organizacia, aseve, uzrunvelyofs xandazmulebs
ricxvi, visac am tipis momsaxureba sWirdeba. berg- rezidenciuli dawesebulebebiT. ùwyveti mzrun-
manis (Bergmann et al., 1978) sityvebs Tu gavixsenebT, velobis~ gawevam kerZo seqtoris mier xeli Seuwyo
rodesac resursebi SezRudulia, ufro meti resur- am tipis mravalferovani instituciebis Seqmnas, ma-
si unda iqnas mimarTuli im pacientebze, romlebic gram, zogjer, mzrunvelobis standartebis nacvlad
ojaxebTan erTad cxovroben, vidre marto mcxovreb yuradRebis zedmetad gamaxvilebam fasze da arasak-
pacientebze. es imiTaa gamarTlebuli, rom pirveli marisad koordinirebulma dagegmvam, gaarTula xan-
kategoriis adamianebs SeuZliaT sakuTar saxlSi dazmulTaTvis integrirebuli lokaluri servisebis
darCena aseTi daxmarebis miRebis SemTxvevaSi, xolo Seqmna. ukanaskneli oci wlis manZilze stabilurad
meore kategoriis adamianebidan mravali ukve didi gaizarda instituciebSi mcxovrebi xandazmulebis un-
xania saWiroebs saavadmyofoSi moTavsebas, maSinac arSezRudulobis xarisxi.
ki, rodesac maTTvis damatebiTi daxmarebis gawevaa
moxaliseTa servisebi
SesaZlebeli.
moxaliseTa organizaciebi mnSvnelovan rols as-
rezidenciul dawesebulebaSi da moxucTa saxlSi ruleben pacientebis, maTi ojaxebisa da momvlelebis
gaweuli mzrunveloba mxardaWeraSi da maT uzrunvelyofaSi sacxovrisiT.
xandazmul adamianebs, socialuri servisebiT sarge- mniSvnelovania, rom ojaxebisa da momvlelebis saqmi-
blobis mizniT, SeiZleba dasWirdeT sxvadasxva tipis anoba integrirebuli iyos janmrTelobisa da so-
sacxovrisSi moTavseba. es SeiZleba iyos sruliad cialuri servisebis mier gaweul momsaxurebaSi. garda
damoukidebeli sacxovrisi, TavSesafris tipis, sa- amisa, fsiqikuri daavadebis mqone xandazmulebisTvis
dac adamianebi saerTo momsaxurebiT sargebloben servisis gawevisas yovelTvis unda gaviTvaliswinoT,
(aseT saxlebs xSirad hyavs zedamxedveli) da rezi- rom araoficialuri momvlelebi mniSvnelovan rols
denciuli da samzrunvelo saxlebi, sadac personali asruleben maT momsaxurebaSi.
mudmivad adgilze imyofeba. xandazmulebs sWirde- araoficialuri momvlelebi
baT mosaxerxebel adgilas ganTavsebuli da advilad
araoficialur momvlelebs miekuTvneba naTesavebi
samarTavi specialuri saxlebi. idealur SemTxvevaSi,
(romlebic ar iReben anazRaurebas gaweuli samuS-
maT unda SeeZloT TavSesafris tipis sacxovreb-
aosTvis), mezoblebi da megobrebi, romlebic unar-
elSi gadasvla fizikuri da fsiqikuri mdgomareo-
SezRudul xandazmulebs (ZiriTadad, demenciis mqone
bis gauaresebis SemTxvevaSi. mniSvnelovania, rom am
pirebs) binaze uvlian. termini àraoficialuri~ ga-
dros maT mTlianad ar dakargon damoukidebloba
nasxvavebs maT iseTi momvlelebisgan, romlebic dax-
da ar mouwioT nacnobi adgilebidan Sors gadasvla.
marebas uweven moxucebs saSinao saqmeebSi da, aseve,
britaneTSi jer kidev ar aris sakmarisi raodeno-
ubnis an Temis fsiqiatriuli eqTnebisgan. araofi-
bis sacxovrebeli, romelic pacientebs saSualebas
_ 538 _
cialuri momvlelebi bevrad ufro met mzrunvelo- lelebs xandazmuli naTesavebis movliT gamowveuli
bas gasweven, vidre oficialuri servisebi da maTi frustraciisa da SfoTvis Tavidan nawilobriv ac-
roli xandazmulebze mzrunvelobaSi saTanadod unda ilebaSi. rekomendebulia internetSi gamoqveynebuli
iqnas Sefasebuli. xandazmulTa araoficialuri mom- saxelmZRvaneloebis gamoyeneba. momvlelebisTvis sx-
vlelebis umetesobas Seadgenen maTi meuRleebi, qa- vadasxva saxis daxmarebis gawevaa SesaZlebeli. esaa:
liSvilebi an vaJiSvilebi (dalagebulia klebadi six- moxucebze zrunva dRis ganmavlobaSi, dasvenebis
Siris mixedviT). mdedrobiTi sqesis araoficialuri dReebSi pacientis saavadmyofoSi moTavseba, binaze
momvlelebi mamakacebze orjer metni arian. arao- saWmlis miwodeba da daxmarebis gaweva saSinao saqmee-
ficialuri momvlelebis daaxloebiT naxevari Tavad bSi (mag., sarecxi da sxva). aseTi daxmarebis pirobebSi
xandazmulia. bevr pacients SeuZlia Sin darCes da ar daawves mZime
ramdenime kvlevam aCvena, rom momvlelebSi yvelaze tvirTad ojaxs. saWiroebebis Sefaseba da momvlelis
did stress demenciis mqone pacientebi iwveven mxardaWera, xSirad, multidisciplinurad xorciel-
(Baumgarten et al., 1994). zogadad, rac ufro mZimea de- deba. Temis fsiqiatri eqTnebi da socialuri muSakebi
mencia, miT ufro meti daZabulobis Semcvelia mom- mTavar rols asruleben amgvari servisebis koordina-
vlelis Sroma. momvlelebs yvelaze Zlier stress ciaSi, naTesavebis mxardaWerasa da pirdapiri saeqTno
ayenebs TavSeukavebloba, RamiT gamovlenili qceviTi mzrunvelobis uzrunvelyofaSi.
darRvevebi da agresia. janmrTelobis zogadi mdgo- miuxedavad imisa, rom sul ufro meti yuradReba
mareobis kiTxvaris (General Health Questionnaire) gamoy- eTmoba momvlelebis saWiroebebs, Zalian cota mt-
enebiT Catarebulma kvlevam aCvena, rom bevr momv- kicebuleba adasturebs imas, rom maTi fsiqosocial-
lels aReniSneba iseTive mZime simptomebi, rogorc uri keTildReoba nebismieri intervenciiT miiRweva
fsiqikuri aSlilobis mqone adamianebs. simptomebi (Thompson and Birggs, 2000). Tumca, garkveulwilad
qreba, rodesac pacienti mudmivi mzrunvelobis rezi- dadasturebulia problemis gadaWrisa da bihevioru-
denciul dawesebulebaSi gadadis sacxovreblad (Mor- li menejmentis strategiebis efeqturoba (Pursey and
ris et al., 1988; Henderson, 1990). Richards, 2001).
mniSvnelovania momvlelTa saWiroebebis zustad
Sefaseba. amJamad, britaneTSi, socialur servisebs xandazmulebis fsiqiatriuli gamokvleva
kanoniT evalebaT, moTxovnis mixedviT, momvlel- xandazmuli adamianebis gamokvlevis principebi da
Ta saWiroebebis Sefaseba. cxrilSi 20.5. Sejamebu- mizani, ZiriTadad, igivea, rac sxva saxis pacientebis
lia levinis (Levin, 1997) ZiriTadi rekomendaciebi. SemTxvevaSi. gamokvlevis mizania diagnostireba,
garkveuli dro unda davuTmoT ojaxis momvlelebi- mzrunvelobis saukeTeso gegmis SemuSaveba da gamo
sTvis rCevis micemas pacientebis movlis Taobaze savlis prognozireba. Tumca, xandazmulebis gamo
da maTi problemebis ganxilvas. es daexmareba momv- kvlevis procesi, nawilobriv, gansxvavebulia, radgan
yuradReba Semdeg sakiTxebsa da procesebzea gamaxvi-
cxrili 20.5 demenciis mqone xandazmuli lebuli:
pacientebis momvlelTa mxardaWera w savaraudod, gamokvleva ufro didxans grZeldeba.
1. demenciis adreuli identifikacia tardeba erTze meti interviu da informaciis
2. identificirebuli SemTxvevebis sruli samedicino da mopoveba, ZiriTadad, informatorebze dayrdnobiT
socialuri gamokvleva xdeba. mag., demenciaze eWvis gaCenisas, informators
3. servisebs Soris drouli referireba, magaliTad, mTavari roli ekisreba avadmyofobis istoriis
zogadi profilis eqimisagan, xandazmulebTan
sruli suraTis aRdgenaSi da imis dadgenaSi, Tu
momuSave fsiqiatramde
ra xarisxiT zemoqmedebs pacientis funqcionirebis
4. TviToeuli pacientis saWiroebebis mudmivi ganxilva
da momvlelebis mxardaWera daqveiTeba mis unarebsa da usafrTxoebaze. kog
5. Tanmdevi daavadebis aqtiuri samedicino mkurnaloba
nituri funqciis daqveiTebis Sefasebisas garvkeuli
dro eTmoba Sefasebis skalebis administrirebas.
6. momvlelebis informireba da maTTvis rCevis micema;
konsultireba w gamokvleva, Cveulebriv, gascdeba pacientis mdgo
7. regularuli daxmareba saSinao da piradi higienis mareobis da misi mkurnalobis viwro samedicino
saqmeebSi CarCoebs da moicavs farTo fsiqosocialuri
8. momvlelebisaTvis regularuli Sesvenebebis mowyoba situaciis Sefasebas, romelSic gaTvalswinebuli
(magaliTad, dRis ganmavlobaSi mzrunvelobis gaweva
da maTi movaleobebis droebiT Sesruleba) iqneba ara marto pacientis, aramed momvlelebis
da sxva adamianebis saWiroebebi. es, gansakuTrebiT,
9. Sesabamisi finansuri mxardaWera
exeba zomieri da mZime xarisxis demenciis mqone
10. aucileblobis SemTxvevaSi, uwyveti mzrunvelobis
gaweva rezidenciul dawesebulebaSi. pacientebs.
_ 539 _
w fizikuri da laboratoriuli gamokvlevebi did xandazmuli asakis adamianebTan momuSave fsiqi
rols TamaSobs am asakobriv jgufSi, radgan xan atrebs SeiZleba, aseve, sTxovon pacientebis
dazmulebSi ufro xSirad gvxvdeba fsiqiatriuli gamokvleva zogadi profilis saavadmyofos gan
simptomebis gamomwvevi organuli aSlilobebi. yofilebebSi. miuxedavad imisa, rom am dros bevrad
fsiqiatriulma Sefasebam, SeiZleba, TandarTuli nakleb informacias movipovebT pacientis garemos
samedicino problemebic gamoavlinos. Sesaxeb, Cven gveZleva saavadmyofos gundTan axlo
xandazmulebSi fsiqiatriuli aSlilobis Sefase kavSiris damyarebis saSualeba. saavadmyofos piro
bisTvis ix. Jacoby, 2000b. bebi xSirad Seuferebelia mSvidi, privatuli inter
viusTvis, magram Tavidan Cven SegviZlia sakmarisi
referali/gadamisamarTeba dro davuTmoT Canawerebis gacnobas, eqTnebTan da
Cven Tavidanve kargad unda gvqondes gacnobierebuli, saavadmyofos sxva personalTan saubars. amis Semdeg,
Tu ra aris referalis mizezi da risi momtania igi. SegviZlia moviTxovoT myudro oTaxi pacientTan
es SeiZleba moiTxovdes informaciis moZiebas iqamde, Sesaxvedrad. Tu ojaxs an sxva momvlelebs ar
sanam pacients SevxvdebodeT. informaciis mopovebis SeuZliaT interviuze daswreba, Cven SegviZlia
erT-erTi mizezia gamokvlevis mimarT optimaluri maT telefoniT davukavSirdeT. igive principebi
midgomis SemuSaveba. nebismieri pacientis SemTxvevaSi, gamoiyeneba pacientis gamokvlevisas rezidenciul
mis mzrunvelobaSi CarTul adamianebs SeiZleba gan dawesebulebaSi da moxucTa saxlSi.
sxvavebuli da konfliqturi saWiroebebi gaaCndes. kognituri funqciis adreuli daqveiTebis mqone
sul ufro met pacients utardeba gamokvleva mex
informatorebi sierebis klinikebSi (gv. ??), ZiriTadad, saavadmyofos
fsiqiatrebis mier monaxulebul bevr asakovan ada ambulatoriul ganyofilebaSi. zogi pacientisTvis
mians ar SeuZlia sakuTar Tavze sruli da sando aseTi mowyoba Zalian xelsayrelia, radgan regula
informaciis mowodeba. xSirad pacientis Sesaxeb ruli da detaluri gamokvlevis saSualebas iZleva.
informacias masTan mcxovrebi partniorisgan an axlo garda amisa, amgvari sistema efeqturi Semdgomi
naTesavisgan vRebulobT. zogjer, SeiZleba saWiro gamokvlevisa da dakvirvebis Catarebis saSulebas
gaxdes mezoblebTan an megobrebTan gasaubreba. iZleva.
SeiZleba sasargeblo gamodges garkveuli drois
daxarjva satelefono zarebze pacientis naTesavebTan gamokvleva
an masTan kavSirSi myof sxva pirebTan, romlebsac xandazmul pirebTan muSaobisas movipovebT igive
SeuZliaT mogvawodon informacia ojaxis istoriaze informacias maTi samedicino da fsiqiatriuli is
an aRgviweron pacientis pirovneba, rogorsac mas toriis Sesaxeb, rasac axalgazrda pacientebis
warsulSi icnobdnen. pacients, romelsac Tqven pir SemTxvevaSi. Tumca, SeiZleba saWiro gaxdes pacientisa
velad xvdebiT, rogorc wesi, ukve kargad icnobs zo- da sxva informatorebis mier mowodebuli informaci-
gadi profilis eqimi an janmrTelobis sxva speciali- is Tavmoyra da integracia. Zalian mniSvnelovania mka-
sti, ris gamoc yovelTvis Rirs maTTan konsultaciis fio monacemebis Semcveli samedicino istoriis mop-
gavla. oveba. garda amisa, zustad unda vicodeT, Tu romel
medikamentebs iRebda warsulSi pacienti da ra saxis
sad unda gamovikvlioT pacienti medikamenturi mkurnaloba utardeba mas amJamad.
britaneTSi xandazmuli asakis adamianebTan momuSave fsiqikuri mdgomareobis gamokvlevisas, gansakuT
fsiqiatrebs umetesad urCevniaT pacientebis binaze rebiT mniSvnelovania kognituri funqciebis Sefaseba,
gamokvleva saerTaSoriso rekomendaciebis dacviT miT ufro iseT pacientebTan, romlebsac TvalsaCino
(Wertheimer, 1997). es gvawvdis informacias pacientis an saeWvo mexsierebis daqveiTeba aReniSnebaT. am ti-
`realuri cxovrebis~da misi Sin fuqncionirebis pis gamokvleva moiTxovs klinikur gamokiTxvas, dak-
zogadi donis Sesaxeb (mag., Cais momzadeba, saojaxo virvebis Catarebas da am miznisTvis gankuTvnili erTi
fotoebSi naTesavebis amocnoba). garda amisa, saxls an meti kiTxvaris administrirebas (cxrili 14.9, gv.
gareT gamokvlevis Catarebisas pacienti xSirad ??). erT-erTi aseTi kiTxvaria fsiqikuri mdgomareo-
dezorientirebulad gamoiyureba, radgan mas saa bis Sesafasebeli mini testi (Mini-Mental State Examina-
vadmyofoSi gamokvlevaze mosaxvedrad ucnob ga tion) (gv. ??).
remoSi uwevs mgzavroba. binaze gamokvlevis gasa gamomdinare iqidan, rom xandazmul pirebSi somatu-
advileblad SegviZlia ojaxis sxva wevrebis da ri problemebi xSiria, saWiroa safuZvliani gamokvle-
pacientis mezoblebis interviuireba, rac mogvawvdis vis Catareba (gansakuTrebiT maSin, Tu aseTi gamokv-
informacias pacientis socialuri mxardaWeris xa leva bolo xanebSi ar Catarebula zogadi profilis
risxze. eqimis mier). misi erT-erTi komponenti nevrologiuri
_ 540 _
gamokvlevaa. laboratoriuli gamokvlevebi mniSvne- riumi an sxva fsiqikuri aSlilobebi. yvelaze maRa-
lovania iseTi pacientebisTvis, romlebsac saavadmyo- li riskis Semcvelia kardiovaskuluri preparatebi
foSi aTavseben, da, aseve, mZime fsiqikuri aSlilobis (wnevis damwevi wamlebi, Sardmdenebi da digoqsini)
mqone nebismieri pacientisTvis (demenciis gamokvleva da is preparatebi, romlebic centralur nervul
?? gverdzea ganxiluli). sistemaze moqmedebs (antidepresantebi, saZile
da bolos, gamokvlevis procesi moicavs riskebis da saSualebebi, anqsiolitikebi da antiparkinsonuli
momvlelebis saWiroebebis Sefasebas (ix. zemoT), rad- wamlebi). problemebi imis gamo warmoiSveba, rom
gan fsiqikuri aSlilobis mqone xandazmuli adamiane- siberesTan erTad icvleba organizmis farmakoki-
bis umetesoba Sin cxovrobs da maTze ojaxis wevrebi, netika. garda amisa, xandazmul adamianebs didi rao-
mezoblebi an megobrebi zrunaven. denobiT aqvT gamowerili sxvadasxva wamlebi, rac
zrdis maTi uaryofiTi urTierTmoqmedebis risks.
xandazmulebis fsiqiatriuli mkurnaloba garkveuli SeSfoTeba arsebobs demenciis dros an-
gamokvlevis msgavsad, xandazmuli pirebis fsiqiat- tifsiqoturi wamlebis gamoyenebasTan dakavSirebiT
riuli mkurnalobis principebi hgavs zrdasruli ada- (gv. ??).
mianebis mkurnalobis principebs, magram xandazmuli
daniSnulebis Sesrulebas SeiZleba xeli SeuSalos
asaki iTxovs im sami faqtoris gaTvalswinebas, romle- adamianis marto cxovrebam, cudma mxedvelobam,
bic zemoqmedebs mkurnalobis procesze (Oppenheimer, gulmaviwyobam an dabneulobam.
2000): am faqtorebidan gamomdinare, fsiqikuri aSlilobis

pacientebs, rogorc wesi, erTsa da imave dros awu- mqone xandazmuli adamianisTvis wamlis gamowerisas
xebT mravali problema. fsiqikuri, fizikuri da so- unda gaviTvaliswinoT:
cialuri xasiaTis sirTuleebi, rogorc wesi, erTd-
mkurnaloba yovelTvis iwyeba wamlis mcire do-
roulad aris warmodgenili. `mkurnaloba~ SeiZleba ziT; doza unda gavzardoT TandaTanobiT; sabo-
moicavdes intervenciebis farTo speqtrs, romelic loo doza axalgazrda pacientebis dozaze dabali
scildeba Cveul fsiqiatriul intervenciebs (mag., unda iyos. gamonakliss warmoadgens serotoninis
saWiro xdeba antibiotikebis daniSvna saSarde gze- ukumitacebis seleqciuri inhibitorebi, romelTa
bis infeqciebis dros, an ubnis eqTanTan an dieto- SemTxvevaSi gamoiyeneba SedarebiTi dozebi.
logTan TanamSromloba). amgvari viTareba moiTxovs

yvela medikamenturi daniSnulebis gadaxedva regu-
multidisciplinur servisebs (ix. zemoT) da, Sesaba-
larulad unda xdebodes da wamlis doza minimumam-
misad, amgvari servisebis safuZvlian dagegmvas da
de iyos dayvanili. medikamentis miRebis dawyebamde,
integrirebas.
kargi iqneba, Tu werilobiT mivuTiTebT wamlis mi-

norma da daavadeba erTmaneTisgan rTuli gasamij- Rebis mizezs (mag., depresiis skalis maCvenebels) da
nia. es warmoSobs sirTuleebs mkurnalobis dawye- mkurnalobis efeqturobis Sefasebis kriteriumebs.
bisas da servisis miwodebis dros. Tu efeqturobis sasurveli done ar aris miRweuli,

xSirad pacienti ar aris sakmarisad qmedunariani wamali TandaTanobiT unda moixsnas.
kognituri fuqnciebis daqveiTebis gamo. sul ufro
wamlis miRebis reJimi maqsimalurad martivi unda
meti yuradReba eTmoba imas, Tu rogor unda moxdes iyos. wamlebis yuTebs unda hqondes mkafio warwere-
qmedunarianobis Sefaseba da ra unda movimoqmedoT bi; unda gamoviyenoT samaxsovro saSualebebi (mag.,
amasTan dakavSirebiT. qmedunarianobis sakiTxi war- erT dReSi misaRebi wamlebis Sekvra, romelic
moSobs mTel rig eTikur da iuridiul problemebs, dRiur dozas warmoadgens). Tu es SesaZlebelia,
romelTa gadaWraSic monawileoben xandazmul po- wamlis miReba zedamxedvelobis qveS unda xdebodes.
pulaciasTan momuSave fsiqiatrebi (ix. qvemoT).
eleqtrokrunCxviTi Terapia
somaturi daavadebebis mkurnaloba
eleqtrokrunCxviTi Terapia kvlav iTvleba erT-
fsiqotropuli wamlebis efeqturoba, zogadad, ar erT yvelaze efeqtur da Rirebul samkurnalo me
aris damokidebuli pacientis asakze. amitom, xan- Todad xandazmulebSi seriozuli depresiuli aS
dazmul adamians ar unda eTqvas uari medikamentu- lilobis samkurnalod (gv. ??). xandazmuli asaki
ri mkurnalobaze, metadre depresiuli aSlilobebis eleqtrokonvulsiuri Terapiis ukuCvenebas ar wa
dros. Tumca, rogorc 21_e TavSia aRniSnuli (gv. ??), rmoadgens. Tumca, yuradReba unda mivaqcioT im
asakovani pirebisTvis wamlebis daniSvnisas, ori mize- xandazmuli pacientebis janmrTelobas, vinc ga
zis gamo, gansakuTrebuli sifrTxilea saWiro: dis am tipis mkurnalobas. Terapiis dawyebamde,

maRalia iseTi usaimovno da saSiSi gverdiTi movle- susti pacientebi gamocdilma anesTeziologma unda
nebis riski, romlebmac SeiZleba gamoiwvios deli- gamoikvlios.
_ 541 _
fsiqologiuri mkurnaloba mniSvnelovania xandazmulebisTvis ramdenime mizezis

gamo (cxrili 20.6):
yvela pacientTan efeqturad muSaobs mkafio miz
nebis mqone mxardamWeri Terapia, romelSic Sedis
im daavadebebis buneba, romelic, Cveulebriv,
erToblivi seansebi pacientis meuRlesTan an sxva xandazmulebs aReniSnebaT (gansakuTrebiT demencia),
momvlelebTan. xels uSlis maT qmedunarianobas, romelic sa
kognituri disfunqciis armqone pacientebTan, iseve Wiroa gadawyvetilebebis misaRebad da Tanxmobis
warmatebulad iyeneben specifikur fsiqologiur gansacxadeblad.
Terapiebs, rogorc imave xarisxis aSlilobis mqone
asakis matebasTan da mowyvladobis zrdasTan da
ufro axalgazrda pacientebTan. guneb-ganwyobis da kavSirebuli problemebi (mag., sirTuleebi manqanis
SfoTviTi aSlilobebis dros gansakuTrebiT efeqturia marTvaSi).
kognituri da bihevioruli intervenciebis Catareba.
sikvdilis moaxloveba, rac mniSvnelovans xdis
pacientebi, xSirad, aseT teqnikas aniWeben upiratesobas. anderZTan dakavSirebul sakiTxebs (ix. Posener and Ja-
miuxedavad imisa, rom ojaxuri da sistemuri Terapia coby, 2002 mimoxilvisa da Semdgomi miTiTebebisTvis).
ar aris farTod xelmisawvdomi, mainc rekomendebulia
britaneTSi am sakiTxebis gadaWra damokidebuli
misi gamoyeneba, radgan igi pacients socialur
iqneba samarTlebriv aqtze fsiqikuri qmedunarianobis
konteqstSi ganixilavs (Jacoby, 2000b). fsiqodinamiuri
Sesaxeb, romelic amJamad parlamentSi gansaxilveladaa
fsiqoTerapia xandazmulebisTvis naklebad Sesaferisia
wardgenili.
da iSviaTad gamoiyeneba.
zogadi fsiqologiuri Terapiebis umetesobis gan finansuri sakiTxebi
xorcielebas msubuqi kognituri daqveiTebac ki xandazmul adamianebs, gansakuTrebiT ki, fsiqikuri
uSlis xels, radgan pacients ar esmis raSi mdgo janmrTelobis problemebis mqone pirebs, SeiZleba
mareobs mkurnalobis arsi (Oppenheimer, 2000). Tum gauWirdeT finansuri saqmeebis marTva. britaneTis
ca specialuri fsiqologiuri da bihevioruli kanonmdeblobiT, Tu saqme SedarebiT martiv Sem
intervenciebi (mag. gaxsenebis/mogonebis Terapia) sul Txvevebs exeba (mag., saxelmwifo pensias da daxmarebebs),
ufro farTod gamoiyeneba am populaciasTan. am tipis pirovnebam SeiZleba moiTxovos, rom mis magivrad,
Terapias sargebeli moaqvs, rogorc pacientisTvis, vinme sxvam (daniSnulma pirma) gamoitanos misi pensia
ise momvlelisTvis (ix. qvemoT, gv. ??). an daxmareba. Tu adamians jer kidev aqvs unari
ix. Woods and Charlesworth 2002 xandazmulebis fsi gaerkves arsebul viTarebaSi, man SeiZleba gaakeTos
qologiuri Sefasebisa da mkurnalobis mimoxilvisTvis. grZelvadiani mindobiloba erTi an meti adamianis
fsiqosocialuri mkurnaloba saxelze. amis Semdeg, ndobiT aRWurvil pirs eZleva
ufleba mis magivrad Caataros nebismieri finansuri
zogierTma pacientma SeiZleba miaRwios damou
operacia. Tu mindobilobis damweri piri TandaTanobiT
kideblobas iseTi saSualebebiT, romlebic xels
kargavs sakuTari saqmeebis marTvis unars, ndobiT
uwyobs sakuTar Tavze zrunvas, saSinao saqmeebisTvis
aRWurvil pirs SeuZlia gadaibaros saqmeebis marTva
saWiro unar-Cvevebis SemuSavebas da socialuri
(britaneTis kanonmdeblobiT es maSinaa SesaZlebeli,
kontaqtebis damyarebas. Sin mcxovreb xandazmul
Tu mocemuli procedura daregistrirebulia dacvis
pirebs SeuZlia, daexmaros okupaciuri Terapevti,
sasamarTloSi _ Court of Protection). xandaxan pirovneba
romelic iZleva rCevas pacientis garemos SecvlasTan
fsiqikurad imdenad uunaroa, rom veRar axerxebs
dakavSirebiT. aseTi cvlilebebi xels uwyobs
sakuTari saqmeebis marTvas sxvisTvis maTi oficialuri
pacientis damoukideblobas. instituciebSi myof
gadabarebis gareSe (raTa meore pirma misi saxeliT
ufro mZime disfunqciis mqone pacientebisTvis
imoqmedos). aseT SemTxvevaSi, dacvis sasamarTloSi
xelsayrelia iseT garemoSi cxovreba, sadac pativs
keTdeba ganacxadi qmeduunarobis damadasturebel
scemen individualur saWiroebebs da Rirsebas da
samedicino mtkicebulebasTan erTad, raTa dainiSnos
sadac yoveli adamiani pirad nivTebs inarCunebs. am
piri, romelic warmarTavs qmeduunaro pirovnebis
tipis fsiqosocialuri intervenciebi ganxilulia
saqmeebs. unda aRiniSnos, rom yvela es procedura
qveTavSi demenciis Sesaxeb.
exeba mxolod finansur sakiTxebs da ar gulisxmobs
pacientis magivrad mkurnalobasTan dakavSirebuli
iuridiuli, finansuri da eTikuri sakiTxebi
raime gadawyvetilebebis miRebis uflebas.
kanonic da eTikuri principebic Tanabrad exeba
xandazmul da axalgazrda populacias. es sakiTxebi manqanis marTva
am wignis sxva nawilSia ganxiluli. Tumca, zogierTi gavrcelebuli problemaa xandazmuli adamianebis
iuridiuli da eTikuri sakiTxi gansakuTrebiT uunaroba, usafrTxod marTon avtomanqana, gan
_ 542 _
demencia

momvlels aqvs fsiqikuri aSliloba an alkoholis
cxrili 20.6 xandazmul pirebTan
momxmarebelia;
dakavSirebuli eTikuri da iuridiuli sakiTxebi

momvleli Zalian aris damokidebuli msxverplze
momvlelebisgan miRebuli informaciis
konfidencialoba
(mag., finansurad).
finansuri mdgomareobis Sesaxeb informaciis xandamzulebze Zaladobisas sikvdilianobis maCvene-
konfidencialoba beli samjer ufro maRalia im xandazmulebTan Sedar-
Tanxmoba mkuranlobis Catarebaze ebiT, romlebic Zaladobis msxverpls ar warmoadgenen
w fizikur da fsiqologiur mkurnalobaze Tanxmobis (Lachs et al., 1998) da, aseve, im asakovan populaciasTan
gacemis unari
SedarebiT, romelic arasaxarbielo mdgomareobaSi
w winaswari miTiTebebi
imyofeba (aqvs depresia, cxovrobs moxucTa TavSesa-
w gadawyvetileba ar Catardes mkurnaloba
farSi da sxva).
zianis momtani qceva
miuxedavad imisa, rom amJamad gacnobierebulia mox-
finansuri sakiTxebis marTva
ucebze Zaladobis problemis arseboba da masze re-
w pasuxismgeblobis mqone piris dasaxeleba
(mindobiloba)
agirebis saWiroeba, ar moiZebneba mtkicebuleba in-
w procedurebi, romlebic saSualebas aZlevs sxva
tervenciis meTodebis efeqturobis Sesaxeb. am etapze
pirebs, ikisron pasuxismgebloba gamoiyeneba sxvadasxva zomebi, rogoricaa socialuri
manqanis marTvis ufleba mxardaWera, momvlelebisTvis droebiTi Sesvenebis
Tanxmoba kvlevaSi monawileobaze uzrunvelyofa, ojaxuri konsultireba da momv-
lelTa saganmanaTleblo programebi. SeiZleba, aseve,
sakuTrebiT, msubuqi demenciis (gv. ??) da parkinsonis saWiro gaxdes iuridiuli zomebis miReba (mag., meur-
daavadebis dros (gv. ??). iseve, rogorc sxva veoba, samarTaldamcavi organoebis Careva da sxva).
aSlilobebis SemTxvevaSi, eqimebi valdebulni arian xandazmulebze Zaladoba ganxilulia Semdeg naSrom-
daarRvion konfidencialoba da Seatyobinon amis Si: Lachs and Pillemer, 2004.
Sesaxeb marTvis mowmobis gacemaze pasuxismgebel
organoebs. Tumca, xandazmuli adamianebi, xSirad,
demencia
Tavad amboben uars manqanis marTvaze an maT naTesavebi
arwmuneben amis aucileblobaSi. demenciis klinikuri, epidemiologiuri da etiologi-
uri Tvisebebi aRwerili iyo me-14 TavSi. aq demenciis
Zaladoba xandazmul adamianebze da maTi marTva or nawiladaa ganxiluli. pirvelia, demenciis
ugulebelyofa fsiqikuri da qceviTi darRvevebi, romelTa mimarTac
gamoiyeneba arafarmakologiuri da farmakologiuri
xandazmulebze Zaladoba da misi ugulebelyofa ojaxis
midgoma. meorea, alchaimeris daavadebis mkurnaloba
wevrebisa da sxva momvlelebis mier, warmoadgens SeS-
da ramdenime sxva specifikuri demencia, romelTa
foTebis sagans janmrTelobis dacvis sferoSi momuSave
samkurnalod ukve arsebobs xelmisawvdomi farmak-
yvela profesionalisTvis, visac ki xandazmulebTan
ologiuri saSualebebi.
aqvs saqme. es sakiTxi mniSvnelovania fsiqiatriisT-
vis imis gamo, rom Zaladoba gansakuTrebiT demenciis
demenciis bihevioruli da fsiqologiuri
mqone pacientebis mimarT xorcieldeba.
simptomebis mkurnaloba
Zaladoba xandazmulebze gulisxmobs momvlelis
an sxva ndobiT aRWurvili piris mier iseTi qmede- rogorc es zemoT iyo naCvenebi (me-14 TavSi, cxrili
bebis ganxorcielebas, romlebic vnebs xandazmulebs 20.7), demenciis dros Tavs iCens mTeli rigi qceviTi
an qmnis zianis seriozul risks; kidev, gulisxmobs cvlilebebi da fsiqologiuri simptomebi. isini aR-
momvlelis uunarobas, daakmayofilos asakovani ada- eniSneba pacientTa 60%-s daavadebis ganviTarebis
mianis bazisuri saWiroebebi an daicvas igi zianis- romelime safexurze, Tumca, maTi gavrcelebis six-
gan. ganasxvaveben `xandazmulebze Zaladobis~ xuT Sire gasnxvavdeba demenciis tipis mixedviT (Lyketsos et
formas: fizikurs, fsiqologiurs, seqsualurs, fi- al., 2000). qceviTi da fsiqologiuri simptomebi prob-
nansurs da ugulebelyofas. gavrcelebis sixSiris lemebs uCens momvlelebs da maTi marTva SeiZleba
maCvenebelia 2-10%. SedarebiT maRali riski ramdenime rTuli aRmoCndes. mzardi SeSfoTeba aRiniSneba wam-
garemoebasTanaa dakavSirebuli: lebis araswori gamoyenebis gamo. amasTan, ar arsebobs
sakmarisi alternatiuli arafarmakologiuri saSu-

msxverpls (xandazmul adamians) aqvs demencia;
alebebi, romelTa efeqturoba obieqturi mtkiceb-

momvleli da msxverpli erTad cxovroben; ulebiT aris gamyarebuli.

msxverpli socialurad izolirebulia (mag., axlo nebismieri mkurnalobis dawyebamde unda Catardes
megobrebis nakleboba); saguldagulo gamokvleva, romlis drosac ramdenime
_ 543 _
momentzea yuradReba gasamaxvilebeli: iyos nebismier mkurnalobaSi, gansakuTrebiT medi-

problemuri qceva naTlad unda iyos identificireb- kamenturSi. regularuli, ganmeorebiTi gamokvleva
uli. saWiroa dafiqsirdes misi xangrZlivoba, simZime, da medikamentebis moxnis mcdeloba marTvis gegmis
misi gamomwvevi mizezebi da, agreTve, is faqtorebi, mTavar nawils unda warmoadgendes.
romlebsac SeuZliaT am qcevis Secvla. SeiZleba sa-
demenciisas qceviTi cvlilebebi, ZiriTadad, momv-
sargeblo aRmoCndes Sefasebis skalebis gamoyeneba lelebs uqmnis problemebs da ara pacients. es unda
(cxrili 14.9, gv. ??). gankurnebadi gamomwvevi faq- gvaxsovdes mkurnalobasTan dakavSirebuli gadaw-
torebis magaliTebia saSarde traqtis infeqciebi, yvetilebebis miRebisas, gansakuTrebiT maSin, rode-
Sekruloba da tkivili. xSirad xdeba am ukanasknelis sac pacientisgan ver viRebT informirebul Tanxmo-
gauTvaliswinebloba, ris gamoc pacients droulad bas misi kognituri funqciebis daqveiTebis gamo.
ar awvdian tkivilgamayuCebel saSualebebs (Scherder
qceviTi da fsiqologiuri simptomebis
et al., 2005). demenciis dros tkivili, SeiZleba, Tan-
arafarmakologiuri mkurnaloba
mxlebi fizikuri problemebiT iyos gamowveuli (mag.,
fexis wylulebi, arTriti) an is, SeiZleba, daavadebis Tu gamokvlevis Semdeg CaiTvleba, rom simptomi
atributs warmoadgendes. moiTxovs mkurnalobas, mizanSewonilia ierarqiuli
midgomis gamoyeneba. pirvel rigSi, unda movuaroT

fsiqikuri mdgomareobis kvleva mniSvnelovania imis
nebismier ZiriTad gankurnebad mizezs, rogorc es
dasadgenad, Tu ramdenad aris SesaZlebeli qce-
zemoT iyo aRniSnuli. Tu problema ar moixsneba,
vis axsna arsebuli fsiqopaTologiiT; mag., arse-
unda vecadoT pacientis garemos Secvlas, qceviTi an
bobs Tu ara fsiqozuri simptomebis, daqveiTebuli
fsiqologiur intervenciis gamoyenebas. intervenciis
guneb-ganwyobis an SfoTvis niSnebi. Tu gamokvleva,
arCevas gansazRvravs problemis buneba, demenciis
avadmyofobis istoriasa da sxva dakvirvebebTan er-
simZime, garemo, arsebuli resursebi (cxrili 20.8).
Tad, adasturebs arsebul diagnozs (mag., fsiqozs,
medikamenturi mkurnaloba unda gamoviyenoT im
depresias an deliriums), es, savaraudod, gavlenas
iqoniebs mkurnalobis gegmaze. Tu aseTi diagnosti-
kuri mtkicebuleba ar moiZebneba, maSin intervencia cxrili 20.8 arafarmakologiuri intervenci
Tavad am qcevaze iqneba mimarTuli. ebi, romlebic gamoiyeneba demenciis dros qce

Cveulebriv, demenciis qceviTi da fsiqologiuri viTi da fsiqologiuri simptomebis arsebobisas
simptomebi cvalebadia da xSirad sam Tveze nakleb sensoruli stimulacia
xans gastans (Hope et al., 1999). es faqti asaxuli unda
w musikoTerapia
w aromaTerapia (mag., lavandis zeTi)
cxrili 20.7 demenciis qceviTi da
w mkveTri Suqis Terapia
fsiqologiuri simptomebi
w masaJi/Sexeba
qcevebi
w TeTri xmauri
w aJitacia
qcevis marTva
w yvirili
w diferencialuri ganmtkiceba
w xetiali
w stimulis marTva
w apaTia
w Seusabamo seqsualuri qceva socialuri kontaqti
w darRveuli Zili w erTi-erTze interaqcia
simptomebi w Terapia Sinauri cxovelebiT

w simulaciuri kontaqti, mag., video
w bodva
w halucinaciebi varjiSi
w depresia struqturirebuli aqtivobebis programebi

w SfoTva garemos Secvla
xelSemwyobi faqtorebi w Sesustebuli stimulacia
w Sekruloba w `saxetialo~ teritoriebi
w tkivili
momvlelis informireba da mxardaWera
w demencias TandarTuli deliriumi
w sensoruli deficiti kombinirebuli Terapiebi
_ 544 _
demencia
adamianebTan, rolebTanac aseTi midgoma warumatebeli
ar moixsneba damamZimebeli fizikuri da garemo
aRmoCndeba. faqtorebi
cxril 20.8-Si CamoTvlili intervenciebis ume
ar iqneba mosinjuli arafarmakologiuri stra
tesoba gamyarebulia garkveuli mtkicebulebiT mi tegiebi.
si efeqturobis Sesaxeb (kvlevaTa umravlesoba
mimoxilvisTvis ix. Sink et al., 2005. am naSromSi,
exeba sensorul stimulacias da qcevis marTvas;
agreTve, medikamenturi mkurnalobis algoriTmia
Cohen-Mansfield, 2001), magram arc erT SemTxvevaSi ar
ganxiluli.
Catarebula randomizebuli kontrolirebadi ga
mokvleva. gamonakliss warmoadgens kvleva, romelSic antifsiqozuri wamlebi
gamoyenebulma intervenciam (varjiSi momvlelebis
orma metaanalizma aCvena, rom 3-16 kviris ganmavlobaSi
treningTan erTad) Seamsubuqa depresia da gaaumjobesa
tipiuri antifsiqozuri preparatebis gamowera
fizikuri janmrTeloba alchaimeris daavadebis mqone
placeboze odnav ukeTes Sedegs iZleva demenciis dros
153 pacientTan. garda amisa, gamovlinda Semdegi
problemuri qcevebis marTvis TvalsazrisiT, magram
tendencia: ori wlis Semdeg iklo qceviTi problemebiT
ufro farTo metaanalizma, romelic haloperidolze
gamowveuli institucionalizaciis SemTxvevaTa ra
iyo fokusirebuli, aCvena, rom mxolod agresis Sem
odenobam (Teri et al., 2003). arafarmakologiuri in
cirebaa SesaZlebeli (Anonymous, 2003a). es Sedegebi unda
tervencia demenciis SemTxvevaSi Semdeg wyaroSia
ganvixiloT iseT riskebTan mimarTebaSi, rogoricaa
ganxiluli: Cohen-Mansfield, 2001 and Livingston et al., 2005.
eqstrapiramiduli gverdiTi movlenebi, posturaluri
qceviTi da fsiqologiuri simptomebis arteriuli hipotenzia, gviani diskinezia da tipiuri
medikamenturi mkurnaloba antifsiqozuri preparatebisTvis damaxasiTebeli mrav
ali gverdiTi movlena, romliskenac midrekilia mra
moxucTa saxlebSi da am tipis sxva dawesebulebebSi,
vali xandazmuli adamiani.
demenciis dros, xdeba fsiqotropuli wamlebis didi
amJamad, am populaciaSi aratipiur antifsiqozur
raodenobiT gamowera, metwilad, qceviTi probleme-
preparatebs ufro farTod iyeneben, vidre tipiur
bis gakontrolebis mizniT. mag., 1996 wlis gamokvle-
antifsiqozur wamlebs (Liperoti et al., 2003), ukeTesi
vis mixedviT, glazgos moxucTa saxlebis macxovreb-
amtanobisa da, savaraudod, ufro maRali efeqturobis
lebis daaxloebiT 30% iRebda antifsiqozur wamlebs
gamo. Sesabamisi metaanalizi ar Catarebula, magram
(McGrath and Jackson, 1996), xolo farTomasStabiani
randomizebuli kvleva aCvenebs, rom risperidoni da
amerikuli gamokvlevis mixedviT, demenciis mqone
olanzapini efeqturia agresiis da fsiqozis dros.
adamianebis 18% iRebda antifsiqozur medikamentebs
SesaZlebelia miRebuli Sedegebis Sedareba tipiuri
(Liperoti et al., 2003). xandazmulebTan sxvadasxva jgufis
antifsiqozuri preparatebis SedegebTan (Sink et al., 2005).
wamlebs iyeneben (cxrili 20.9). Tumca, mtkicebuleba
demenciis dros antifsiqozuri preparatebis ga
aCvenebs, rom wamals, saukeTeso SemTxvevaSi, saSualo
moyenebis gamo SeSfoTebas aZlierebs kidev sami
Sedegi moyveba, xolo antifsiqozuri wamlebis gamo-
seriozuli potenciuri riski:
yeneba asocirebulia avadobis maRal xarisxTan da si-
kvdilianobasTanac ki. rogorc qvemoTaa aRniSnuli, 1. am prepartebma SeiZleba gazardon insultis ri
am demenciis dros qceviTi da fsiqologiuri proble- ski. es mosazreba gamoiTqva olanzapinTan da ris
mebis mosavlelad ar unda davniSnoT medikamenturi peridonTan dakavSirebiT, magram, rogorc Cans,
mkurnaloba manam, sanam: aseTi riski yvela antifsiqozur preparatis ga
moyenebas ukavSirdeba (Gill et al., 2005).

ar Catardeba pacientis sruli gamokvleva
2. antifsiqozurma preparatebma SeiZleba biZgi misces
cxrili 20.9 demenciis dros qceviTi da parkinsonis Seuqcevadi da zogjer fataluri
fsiqologiuri simptomebis samkurnalod sindromis ganviTarebas, cnobierebis daqveiTebas
gamoyenebuli wamlebi da avtonomiuri nervuli sistemis disfunqcias,
tipiuri antifsiqozuri wamlebi gansakuTrebiT im pacientebSi, romlebsac axa
atipiuri antifsiqozuri wamlebi siaTebT levis sxeulebiT mimdinare demencia
qolinesTerazas inhibitorebi (McKeith et al., 2004).
antidepresantebi (mag: trazodoni) 3. antifsiqozurma preparatebma SeiZleba daaCqaros

karbamazepini
kognituri funqciebis daqveiTeba (McShane et al.,
1997). es dadasturda kvetiapinze Catarebuli ram
valprotis mJava
domizebuli gamokvleviT (Ballard et al., 2005). meqanizmi
anqsiolitikebi
ucnobia, magram is SesaZloa antimuskarinul
memantini efeqts ukavSirdebodes. ukanaskneli kvleviT
_ 545 _
dadginda, aseve, rom mocemuli preparati aJitaciis Tumca, bolo wlebSi gaCnda pirveli preparatebi,
mkurnalobisas ar aris efeqturi. romlebic Tavad demenciis mkurnalobazea mimar
amJamindeli britanuli saxelmZRvanelo principebis Tuli. esaa qolinesTerazas inhbitorebi. amJamad
rekomendaciiT antifsiqozuri preparatebi ar unda mimdinareobs muSaoba am daavadebis da sxva saxis
gamoviyenoT demenciis dros, Tu pacientis problemebi demenciebis mkurnalobaze. mimoxilvisTvis ix.
ar aris Zalian mZime da ar aris dakavSirebuli fsiqozur Cummings, 2004.
simptomebTan an seriozul distresTan, an kidev, Tu
qolinesTerazas inhibitorebi
qceva fizikuri zianis safrTxes qmnis. es SezRudvebi
alchaimeris daavadebis mniSvnelovani neiroqimiuri
aseve ZalaSia aSS-Si, sadac izRudeba antifsiqozuri
maxasiaTebeli (gv. ??), romelic pirvelad iqna
wamlebis gamoyeneba moxucTa saxlebSi. antifsiqozuri
dadgenili, acetilqolinis raodenobis Semcirebaa.
preparatebi Zalian iSviaTad unda gamoviyenoT levis
aman gamoiwvia qolinesterazis inhibitorebis Seqmna,
sxeulebiT mimdinare demenciis dros (zogadad, am
romlebic warmoadgendnen am daavadebis samkurnalo
dros saerTod ar aris rekomendebuli maTi gamoyeneba).
pirvel efeqtur saSualebas. miuxedavad imisa, rom
rekomendebulia vaskuluri risk-faqtorebis Sefaseba
maTi efeqturoba SezRudulia da isini ar cvlian
insultis riskis gamo. mkurnaloba unda daiwyos
daavadebis mimdinareobis process, maT mniSvnelovani
dabali doziT, romelic nel-nela gaizrdeba.
roli eniWebaT klinikur praqtikaSi. am preparatebis
Sedegebze unda dawesdes regularuli monitoringi.
Seqmnam warmoSva optimizmi Terapiis sferoSi.
radganac ar moiZebneba mtkicebuleba diferencialuri
qolinesTerazas inhibitorebi zrdian gadarCenis
efeqturobis Sesaxeb, antifsiqozuri preparatebis
albaTobas da, Sesabamisad, uzrunvelyofen sinafsSi
SerCeva unda xdebodes gverdiTi movlenebis riskis
acetilqolinis arsebobas. zogierTma SeiZleba
safuZvelze. gansakuTrebiT misaqcevia yuradReba
gazardos aqtivobis done nikotinis mimaT mgrZnobiare
eqstrapiramidul da antiqolinergiul zegavlenasa da
qolinergul receptorebSi.
sedaciur efeqtze.
qolinesTerazas pirveli inhibitoria takrini.
qolinesTerazas inhibitorebi misi gamoyeneba SezRuduli iyo hepatotoqsikurobis
qolinesTerazas inhibitorebi Seiqmna alchaimeris gamo. amJamad, iyeneben donepezils, rivastigmins
daavadebis kognituri simptomebis samkurnalod. isini da galantamins. yvela damtkicda maregulirebeli
farTod gamoiyeneba qceviTi problemebis gadasWrelad, organos mier, rogorc alchaimeris msubuqi da
da, aseve, fsiqologiuri simptomebis mosaxsnelad. saSualo simZimis formis dros naCvenebi saSualeba.
amis nawilobrivi mizezi is SeSfoTebaa, romelic es daskvna daefuZna kvlevis monacemebs, romlebmac
antifsiqozur preparatebs ukavSirdeba. Tumca, ucnobia, aCvena placebosTan SedarebiT dadebiTi zegavlena
Tu ramdenad efeqturad xdeba demenciis fsiqologiuri pacientis kognitur funqcionirebaze (ZiriTadad,
da qceviTi problemebis gadaWra am preparatebis izomeba alchaimeris daavadebis Sefasebis skalis
gamoynebiT. metaanalizma aCvena statistikurad sando, kognituri komponentiT (ADAS-Cog)) da zogad fun
magram umniSvnelod dadebiTi Sedegebi (Trin et al., 2003). qcionirebaze (izomeba cvlilebis Sesaxeb klinikur
Semdgomi kvlevebi da mimoxilvebi (Anonymous, 2003a) maT interviuze dafuZnebuli STabeWdilebis skaliT,
araefeqturobaze miuTiTebs. momvlelis monacemebTan erTad; CIBIC-Plus). am sami
wamlis efeqturoba erTmaneTis msgavsia, magram maTi
sxva wamlebi erTmaneTTan Sedareba ar momxdara. wamlebis efeqti
erTma randomizebulma kvlevam aCvena karbamazepinis SedarebiT sustia. mag., dadebiTi Sedegi gamoixateba
efeqturoba aJitaciis da agresiis dros (Tariot et al., 3 quliT ADAS-Cog-ze (qulebis rigia 0-70), da 0.4
1998). demenciis dros efeqturia antidepresantebis CIBIC-Plus-ze (qulebis rigia 1-7). rodesac daavadebis
gamoyeneba. xSirad gamoiyeneba susi da trazodoni. progresireba weliwadSi, saSualod, udris 7 qulas
anqsiolitikebi demenciis dros ar unda gamoviyenoT ADAS-Cog skalis mixedviT. SeiZleba CaiTvalos,
sedaciuri efeqtis, dacemis riskis da preparatis rom qolinesTerazas inhibitorebi 6 TviT anelebs
dabali amtanobis gamo. ar arsebobs sakmarisi mtki daavadebis progress. sxvagvarad rom vTqvaT,
cebuleba valprotis mJavas da memantinis gamo wamlebi, zogadad, oTxi quliT aormagebs pacientis
yenebasTan dakavSirebiT. gaumjobesebis Sansebs ADAS-Cog-ze. ar aris cnobili,
Tu ramdenad vlindeba gazomviT miRebuli dadebiTi
alchaimeris daavadebis medikamenturi Sedegebi realur cxovrebaSi, anu umjobesdeba, Tu
mkurnaloba ara, realurad, pacientis funqcionirebis xarisxi.
gverdiTi movlenebi SedarebiT xSiria da SeiZleba
demenciis Terapiis yvelaze mniSvnelovan elementad
sakmaod problemur saxes atarebdes. esaa gulisrevis
rCeba qceviTi da kognituri simptomebis mkurnaloba.
_ 546 _
demencia
SegrZneba, pirRebineba, faRaraTi, kunTebis fasci memantini
kulacia (kunTebis uneblie SekrTomebi), uZiloba,
qolinesTerazas inhibitorebis garda, memantini aris
bradikardia, sinkope da daRliloba. maTi gamovlena
erTaderTi preparati, romelic amJamad licenzirebulia
Sesustdeba, Tu pacienti wamlis miRebas mcire
alchaimeris daavadebis samkurnalod. memantini NMDA
doziT daiwyebs, wamals saWmelTan erTad miiRebs da
glutamatis receptoris antagonistia. mTavari principi
TandaTanobiT gazrdis dozas.
imaSi mdgomareobs, rom neirotoqsikuroba, romelic
mkurnaloba unda daniSnos specialistma (rogorc
gamowveulia Warbi raodenobis glutamatis gadacemiT
wesi, xandazmuli asakis pacientebTan momuSave fsi
NMDA receptoris meSveobiT, SeiZleba xels uwyobdes
qiatrma, nevrologma an geriatriis specialistma),
daavadebis ganviTarebas.
pacientis gamokvlevis safuZvelze ismeba alchaimeris
28 kvirian randomizebul kontrolirebad kvlevaSi,
daavadebis diagnozi, dgindeba misi simZime da
romelic 252 pacientze Catarda, raisbergma (Reisberg
minimaluri MMSE qula _ 12. mkurnalobisadmi
et al., 2003) aCvena, rom klinicistebisa da momvlelebis
daqvemdebareba unda Sefasdes 2-4 Tvis Semdeg. wamlis
monacemebiT, memantins aqvs, placebosTan SedarebiT,
miReba unda gagrZeldes mxolod im SemTxvevaSi, Tu
odnav ukeTesi kognituri efeqti alchaimeris da
MMSE qula ar mcirdeba da ar SeiniSneba zogadi an
avadebis saSualo da mZime SemTxvevebSi (sawyisi MMSE
qceviTi gaumjobeseba. im pacientebTan, romlebic
qula: 3-14). Sesabamisad, qolinesTerazas inhibitorebTan
Tavidanve eqvemdebarebian mkurnalobas, wamlis
SedarebiT memantins, SesaZloa, hqondes ufro Zlieri
micema unda gagrZeldes iqamde, sanam MMSE qula
zemoqmedeba daavadebis ufro gviandel safexurze.
12-s aRemateba. garda amisa, unda gaviTvaliswinoT
Tumca, jer kidev dasadgenia memantinis efeqturoba da
pacientis zogadi mdgomareba da funqcionirebis
xarjis efeqtianoba klinikur praqtikaSi (Anonymous,
saerTo done. gadawyvetilebas medikamentis Sewyvetis
2003b). am preparatis gamowera ar xdeba britaneTis
Taobaze arTulebs imis albaToba, rom SeiZleba
janmrTelobis dacvis erovnuli samsaxuris mier.
daCqardes kognituri funqciebis daqveiTeba da
ramdenime TveSi pacienti funqcionirebis im doneze ginko biloba
aRmoCndes, romelzedac, savaraudod, mkurnalobis ginko xis foTlebis eqstraqti ginko biloba didi
Catarebis gareSe iqneboda. xania gamoiyeneba CineTSi sxvadasxva daavadebebis
alchaimeris daavadebis mkurnalobaSi qolines samkurnalod. es mcenare, aseve, rekomendebulia
Terazas inhibitorebis statusi gaurkvevelia. am alchaimeris daavadebis da sxva saxis demenciebis
preparatis gamoyenebis momxreebi xazs usvamen misi samkurnalod. misi moqmedeba kvleviTaa dadgenili.
efeqturobis TvalsaCino mtkicebulebas, da, zogierT amJamindeli monacemebiT, misi efeqti minimaluria.
pacientSi, mniSvnelovani pozitiuri Sedegebis miR mopovebuli mtkicebuleba ufro winaaRmdegobrivia,
wevis faqts, rac obieqturi mtkicebulebiT ar vidre qolinesTerazas inhibitorebis SemTxvevaSi.
aris gamyarebuli. momvlelebi da saqvelmoqmedo Tumca, mcenaris mimarT tolerantoba maRalia (Kurz
organizaciebi mxars uWeren maT gamoyenebas. am and Van Baelen, 2004).
pozitiuri Sexedulebebis gaTvaliswinebiT, qoli
nesTerazas inhibitorebis gamoyeneba amerikuli axali midgoma mkurnalobis mimarT
praqtikis saxelmZRvanelo principebSi mkurnalobis ganviTarebis stadiaSi myofi mkurnalobis strategiebi
standartadaa miCneuli (Doody et al., 2001) da miRebulia gamiznulia daavadebis procesis Secvlaze, da,
britaneTSi (National Institute of Clinical Excellence, 2001). Sesabamisad, arsebul wamlebTan SedarebiT ukeTesi
kvlevebi, romlebic miuTiTebs maT efeqturobas da ufro stabiluri Sedegebis miRebaze.
daavadebis adreul safexurebze, kidev ufro amyarebs
amiloidi
am mosazrebas (Seltzer et al., 2004). Tumca, zogierTebi
sifrTxiliT ekidebian am tipis preparatebs da sul ufro meti mtkicebuleba adasturebs imas, rom
aRniSnaven, rom qolinesTerazas inhibitorebis efeqtis amiloidi mTavar rols asrulebs alchaimeris
xarisxi meryeobs mciredan saSualomde (Rockwood, daavadebis ganviTarebaSi (gv. ??). amis gamo, es
2004). garda amisa, sakamaToa maTi praqtikuli da molekula da misi bioqimiuri gzebi mkurnalobis
xarjis efeqtianoba (AD2000 Collaborative Group, 2004). ZiriTad samizneebad iqca (Hardy and Selkoe, 2002).
mocemuli wignis weris procesSi, preparatis xarjis am SemTxvevSi gamoiyeneba Semdegi sami strategia:
efeqtianobiT gamowveul SeSfoTebas britaneTSi
iseTi fermentebis Semakavebeli wamlebi, romelTa
mohyva ganaxlebuli debatebi. debatebi exeboda saSualebiTac amiloidi warmoiqmneba Tavisi
imas, Tu ramdenad gagrZeldeba qolenesTerazas prekursori molekulisgan;
inhibitorebis dafinanseba janmrTelobis dacvis wamlebi, romlebic xels uSlis amiloidis dag

erovnuli samsaxuris mier. rovebas;
_ 547 _
imunizaciis strategiebi: amiloidi an misi
efeqturoba am daavadebis mkurnalobasa da prevenciaSi
sawinaaRmdego antisxeulebi gamoiyeneba pacientebis ar aris sakmarisad dasabuTebuli (Pantoni, 2004).
an alchaimeris daavadebis riskis qveS myofi
demencia levis sxeulebiT
adamianebis vaqcinaciisTvis (Dodel et al., 2003).
am midgomis Camoyalibebas biZgi misca im cdebis qolinerguli deficiti iseve mkafiodaa gamoxatuli
moulodnelma Sedegebma, romlebic tardeboda am saxis demenciis dros, rogorc alchaimeris
Tagvebze daavadebis modelirebis mizniT (ganxilulia daavadebisas, Tumca ar arsebobs imis obieqturi
boqs 14.1-Si, gv. ??) (Schenk et al., 1999). arsebobs mtkicebuleba, rom qolinesTerazas inhibitorebi am
winaswari mtkicebuleba efeqturobis Sesaxeb, SemTxvevaSic efeqturia (Simard an van Reekum, 2004).
romelic klinikuri cdebiTa da nevropaTologiuri maTi efeqturoba SeiZleba gavrceldes zogierT
SemTxvevebis analiziTaa miRebuli, magram saWiro qceviT da fsiqologiur simptomze (Wild et al., 2003) da
gaxda kvlevis SeCereba, radgan kvlevis zog parkinsonis daavadebis demenciaze (Emre et al., 2004).
monawiles encefaliti ganuviTarda (Bennett and
fronto_temporaluri demencia
Holtzmann, 2005). mimdinareobs kvlevebi, romlebic
sxvadasxva vaqcinebs Seiswavlis. Tu maTi Sedegebi ar arsebobs srulyofili gamoqveynebuli masala
warmatebuli gamodga, es Zalian mniSvnelovani iqneba fronto-temporaluri demenciis samkurnalo prepa
ara mxolod xandazmuli asakis fsiqiatriisTvis, ratebis gamocdis Sesaxeb. winaswari monacemebis
aramed mTlianad sazogadoebisTvis. mixedviT, antidepresant trazodons, romelic
blokavs 5-HT2 receptorebs, SeiZleba hqondes mcire
sxva strategiebi dadebiTi Sedegi qceviTi darRvevebis mkurnalobisas
rogorc es me-14 TavSi iyo aRniSnuli, hormonuli (Pasquier et al., 2003). qolinesTerazas inhibitorebi,
CanacvlebiTi Terapia, anTebis sawinaaRmdego ara savaraudod, ar unda iyos efeqturi, radgan qo
steroiduli preparatebi da statinebi asocirebulia linergiuli deficiti ar warmoadgens am daavadebis
alchaimeris daavadebis dabal maCveneblebTan (gv. ??). wamyvan Tvisebas.
aqedan gamomdinare, TviToeuls am preparatebidan
prionuli daavadeba
iyeneben mocemuli daavadebis samkurnalod, magram
aSkara dadebiTi Sedegis gareSe (Launer, 2003; Citron, sxvadasxva wamlebis da imunizaciis strategiebi
2004). iqidan gamomdinare, rom homocisteini alc kvlevis procesSi imyofeba (Mallucci and Collinge, 2005).
haimeris daavadebis risk-faqtors warmoadgens, amis mizezia Creutzfeldt-Jakob-is daavadebis (CJD-is)
mimdinareobs gamokvlevebi foliatis danamatebis nairsaxeobis warmoSoba (gv. ??). amJamad mimdinareobs
efeqturobaze. garda amisa, Seiswavlian taus da mis antimalariuli preparati qvinakrinis gamocda. zo
fosforilebas (gv. ??). gierT pacients daniSnuli aqvs antikoagulant pen
tozan polifosfatis intraventrikuluri inieqciebi.
sxva saxis demenciebis medikamenturi mocemul etapze ar moiZebneba mtkicemuleba misi
mkurnaloba efeqturobis Sesaxeb.
amJamad ar arsebobs licenzirebuli preparatebi sxva hanTingTonis daavadeba

saxis demenciebis samkurnalod. Tumca, alchaimeris amJamad ikvleven iseT samkurnalo saSualebebs,
daavadebisas gamoyenebuli strategia aseve gamoiyeneba rogoricaa minociklini (tetraciklini neiro
am tipis aSlilobebis mimarT. proteqtoruli TvisebebiT), antisxeulebi, ujredebis
vaskuluri demencia gadanergva da genuri Terapia (Hersch, 2003)
arsebobs Zalian cota randomizebuli kvleva vas

kuluri demenciis mkurnalobisa da prevenciis Sesa guneb-ganwyobis aSliloba
xeb. arsebuli monacemebis mixedviT, zogierTi xandazmul pirebSi
qolinesTerazas inhibitori garkveulwilad efeqturia.
depresiuli aSliloba
amis mizezi, savaraudod, qolinerguli neironebis
iSemiuri dazianebaa da ara alchaimeris daavadebis an klinikuri Tvisebebi
Sereuli demenciis mqone pacientebis SemTxveviTi CarTva depresiuli aSlilobebis klinikuri suraTi ar
gamosakvlev SemTxvevaTa erTobliobaSi (Erkinjuntti et aris mkveTrad gansxvavebuli axalgazrdebsa da
al., 2004). vaskuluri demenciis dros araqolinerguli xandazmulebSi, magram zogi simptomi ufro Tval
wamlebis, gansakuTrebiT ki vazodilatatorebisa Sisacemia asakovan pacientebSi. erT-erTi wyaros
da antihipertenziuli preparatebis gamoyenebas Tanaxmad (Post, 1972), depresiis mqone xandazmuli
seriozuli Teoriuli safuZveli gaaCnia, magram maTi adamianebis erT mesameds aReniSneba mZime xarisxis
_ 548 _
guneb-ganwyobis aSliloba xandazmul pirebSi
CamorCeniloba da aJitacia. xSiria siRaribesTan da aSlilobis sixSiris maCvenebelTan pacientis ojaxis
fizikur daavadebasTan dakavSirebuli depresiuli wevrebSi (Maier et al., 1991).
bodviTi ideebi. zogjer aRiniSneba nihilisturi mosalodnelia, rom martooba da xandazmulobasTan
xasiaTis bodviTi ideebi (mag., pacients sjera, dakavSirebuli sirTuleebi depresiuli aSlilobis
rom misi sxeuli carielia, ar arsebobs an ar mniSvnelovan predispoziciur faqtors warmoadgens.
funcqionirebs) (ix. kotaris sindromi, gv. ??). SeiZleba am molodinis sawinaaRmdegod, aseTi asociaciis
aRiniSnebodes damadanaSaulebeli an uxamsi Sinaarsis damajerebeli mtkicebuleba ar moipoveba (Murphy, 1982).
mqone halucinaciebi. Tavad depresia, SeiZleba, ar ufro metic, parksma (Parks et al., 1969) daadgina, rom
iyos TvalsaCinod gamoxatuli da SeniRbuli iyos xandazmul pirebSi aRar dasturdeba kavSiri axlobeli
sxva simptomebiT, gansakuTrebiT ipoqondriuli xa adamianis dakargvasa da fsiqikur daavadebas Soris.
siaTis CivilebiT. xandazmul pirebSi yovelTvis
unda davuSvaT depresiuli aSlilobis arseboba vaskuluri depresia
iseT SemTxvevaSi, roca pacientTan gamoxatulia postma daafiqsira vaskuluri faqtorebis roli
SfoTva, ipoqondriuli sindromi an dabneuloba. depresiis mqone xandazmul pirebSi (Post, 1972). kavSiri
mimoxilvisTvis ix. Alexopoulos (2005). vaskulur faqtorebsa da depresias Soris kidev
ufro dafiqsirda mas Semdeg, rac aleqsopulosma
depresiuli fsevdodemencia (Alexopoulos et al., 1997) Semoitana termini `vaskuluri
zog retardirebul depresiul pacients aReniSneba depresia~. amJamad arsebobs mtkice da mravalferovani
fsevdodemencia, anu koncentraciisa da damaxsovrebis mtkicebuleba, romelic miuTiTebs ormxriv kavSirze
aSkarad gamoxatuli sirTuleebi, magram safuZvliani gviandel periodSi dawyebul depresias, vaskulur
klinikuri testireba aCvenebs, rom maT ar axasiaTebT daavadebas da mis risk-faqtorebs Soris (Thomas et
mexsierebis seriozuli defeqti. mniSvnelovania am al., 2004). am asociaciaciis arsebobas adasturebs
pacientebis gamijvna imaTgan, visac adreuli demencia epidemiologiuri da biologiuri monacemebi. am
aReniSneba (igulisxmeba depresiis mqone pacientebi), ukanasknels miekuTvneba monacemebi, rolebic
rac, SeiZleba, rTul amocanas warmoadgendes. gviCvenebs, rom gviani depresiis dros magnitur
depresiuli fsevdodemenciis savaraudo niSnebia: rezonansuli tomografiiT dafiqsirebuli TeTri

pacienti uCivis mexsierebasTan dakavSirebul uf nivTierebis dazianebis nevropaTologiuri safuZveli,
ro seriozul problemebs, vidre es dasturdeba romelic xSirad fiqsirdeba gviani periodis depresiis
informatoris mier pacientis yoveldRiur qcevaze magnito rezonansuli skanirebiT, asaxavs tvinis iSemiur
dakvirvebiT; dazianebas da iseTi ubnebis arsebobas, sadac infarqtia
ganviTarebuar aris naTeli `vaskuluri depresia~

depresiuli simptomebi win uswrebis mexsierebis
calke qvejgufs warmoadgens, Tu vaskulur faqtorebs
sirTuleebs;
(rogorc biologiur faqtorebs) TavianTi wvlili SeaqvT

neirofsiqologiuri testebis dros xSiria pasuxi xandazmulebTan depresiis CamoyalibebaSi (Baldwin,
àr vici~ da dabali xarisxis CarTuloba; 2005). zogierTi mosazrebis Tanaxmad, vaskuluri risk-

guneb-ganwyobis aSlilobis piradi an ojaxuri faqtorebis arseboba ufro metad dakavSirebulia
istoria. arasakmaris daqvemdebarebasTan mkurnalobis mimarT,
maRali xarisxis kognitur disfunqciasa da SedarebiT
etiologia
uaryofiT gamosavalTan (Baldwin et al., 2004).
biologiuri (Krishnan, 2002), fsiqologiuri da so
cialuri faqtorebis (Blazer and Hybels, 2005) mo diferencialuri diagnozi
nawileobis TvalsazrisiT, xandazmul asakSi daw rogorc zemoT iyo aRniSnuli, zogjer rTulia
yebuli depresiuli aSlilobis etiologia iseTivea, depresiuli fsevdodemenciisa da demenciis erT
rogorc depresiuli aSlilobis etiologia axal maneTisgan garCeva. es problema kidev ufro rTuldeba
gazrda asakSi. im faqtiT, rom depresia SeiZleba gamovlindes
tyupebis gamokvleva aCvenebs, rom mamakacebSic demenciis mimdinareobis dros.
da qalebSic memkvidreobiTi faqtoris zegavlena mniSvnelovania sxva informatorebisgan detaluri
zomieria da Tavisi intensivobiT axloa adreul istoriis mopoveba da fsiqikur mdgomareobasa da
periodSi dawyebuli depresiis dros dafiqsirebuli qcevaze safuZvliani dakvirvebebis Catareba im
memkvidreobiTi faqtoris zegavlenasTan (Tumca, ganmasxvavebeli niSnebis gaTvaliswinebiT, romlebic
odnav ufro sustia masTan SedarebiT). es genetikuri ?? gverdzea CamoTvlili. SeiZleba sasargeblo
faqtoris SedarebiT sisusteze miuTiTebs (Johnson et gamodges damatebiTi fsiqologiuri testirebis Cata
al., 2002). Sesabamisad, SedarebiT dabalia asociacia am reba, magram am SemTxvevaSi mniSvnelovania monacemebis
_ 549 _
gamocdili interpretatoris arseboba. zogadad, depresiis mqone xandazmulebSi suicidis riski maRali
testirebis Sedegebi bevrs arafers matebs xarisxian rCeba, gansakuTrebiT, mamakacebSi (Jacoby, 2000a).
klinikur Sefasebas. xandaxan demencia da depresiuli miuxedavad im mtkicebulebisa, rom depresiis
daavadeba erTdroulad gvxvdeba. Tu depresiaze istoria demenciis risk-faqtors warmoadgens, ara
eWvi realuria, SegviZlia daviwyoT pacientis feri adasturebs imas, rom gviandel periodSi
antidepresantebiT mkurnaloba. dawyebuli depresia demenciis momaswavebelia
klinicistma yovelTvis unda gaiTvaliswinos, rom (Schweitzer et al., 2002). garda amisa, maT ar gaaCniaT
guneb-ganwyobis aSliloba xandazmul pirebSi SeiZleba saerTo genetikuri predispozicia (Heun et al., 2001).
meoradi iyos somaturi daavadebis an medikamenturi
mkurnaloba
mkurnalobis mimarT, radgan aseTi daavadebebi
xSirad Tanaarsebobs, xolo am populaciaSi farTod rogorc es me-11 TavSi iyo aRwerili, xandazmulebTan
gamoiyeneba medikamenturi mkurnaloba. depresiuli aSlilobis mkurnalobis principebi
ufro iSviaTad, depresiuli aSliloba unda igivea, rac depresiuli aSlilobis mqone axalgazrda
ganvasxvavoT ara-afeqturi fsiqozuri aSlilobisgan, zrdasrul populaciasTan. arsebobs efeqturi mkur
iseTisgan rogoricaa bodviTi aSliloba. rodesac nalobis saSualebebi, magram, xSirad, aseTi mkur
depresiuli aSlilobis dros Tavs iCens devnis ideebi, naloba ar xorcieldeba, radgan ar xdeba konkretuli
pacients, Cveulebriv, sjera, rom warmosaxviTi devna SemTxvevebis diagnostireba da saWiro intervenciebis
misi borotebiTaa gamarTlebuli. gamoyeneba (Chew-Graham et al., 2004). Seqmnilia
saxelmZRvanelo principebi pirveladi jandacvis
mimdinareoba da prognozi servisebisTvis gviani periodis depresiis samarTavad
Tavis klasikur kvlevaSi postma (Post, 1972) aRniSna, (Baldwin et al., 2003). yovelTvis unda gvaxsovdes, rom
rom depresia xandazmulebSi samobis kanons mihyveba: xandazmul pacientebTan arsebobs suicidis riski.
pacientebis erTi mesamedi gamojanmrTeldeba, erTi safuZvlianad unda vumkurnaloT nebismier somatur
mesamedi igive mdgomareobaSi rCeba, xolo danarCeni darRvevebs, romlebic depresiis dros iCens Tavs.
erTi mesamedis mdgomareoba uaresdeba da am jgufSi antidepresantebi am populaciaSi iseve efeqturia,
Semavali pirebi `qronikul invalidebad~ yalibdebian. rogorc axalgazrdebSi (Katona and Livingston, 2002),
bolo periodis bevrma kvlevam, zogadad, igive Tumca, arsebuli mtkicebuleba sakmaod mwiria (Taylor and
Sedegebi aCvena (Cole et al., 1999). mag., depresiis Doraiswamy, 2004). wamlebi sifrTxiliT unda davniSnoT.
mqone 277 xandazmul adamianze Catarebuli 6wliani SegviZlia daviwyoT normaluris naxevari doziT da
grZelvadiani kvleviT bikmanma (Beekman et al., 2002) TandaTanobiT gavzardoT doza gverdiTi movlenebis
daadgina, rom 32%-s hqonda mwvave qronikuli da wamalze pacientis reaqciis gaTvaliswinebiT.
mimdinareoba, 44%-s _ cvalebadi mimdinareoba da susi-ebs, zogadad, upiratesoba eniWebaT triciklur
mxolod 23%-ma miaRwia mniSvnelovan remisias. `qve antidepresantebTan SedarebiT, radgan maT naklebi
zRurblovan~ jgufTanac ki, rogorc es zemoT iyo gverdiTi movlenebi axasiaTebT da naklebad
aRniSnuli, met-naklebad cudi Sedegebi dadasturda. kardiotoqsikurebi arian. aseve, unda gaviTvaliswinoT
xandazmul asakSi ganviTarebuli depresia marTvis urTierTqmedeba pacientis mier miRebul sxva wamlebTan,
gansxvavebul strategias saWiroebs (ix. qvemoT). ramac, SeiZleba, gavlena iqonios antidepresantis
faqtorebi, romlebic xandazmul asakSi ganviTarebuli SerCevaze (Spina and Scordo, 2002). im pacientebTan,
depresiis karg prognozs moaswavlebs: romlebic ar reagireben antidepresantis maqsimalur
debiuti 70 wlamde
dozaze, SeiZleba aucilebeli gaxdes wamlebis iseTive
kombinaciis gamoyeneba, rogorc axalgazrdebTan, an

daavadebis mokle xangrZlivoba
medikamenturi mkurnalobis kombinireba fsiqologiur

depresiis ganviTarebamde kargi adaptacia mkurnalobasTan.

SemzRudveli fizikuri daavadebis ararseboba medikamentebis msgavsad, fsiqologiuri inter

depresiis wina epizodebis warmatebiT daZleva venciebi xandazmulebTan iseTive efeqturia, rogorc

religiuroba (pacientis monacemebiT an religiuri axalgazrdebSi. xSirad pacientebi fsiqologiur
jgufisadmi mikuTvnebuloba). intervenciebs aniWeben upiratesobas, magram isini ar
aris sakmarisad xelmisawvdomi pirvelad jandacvaSi,
cudi Sedegi dakavSirebulia sawyisi daavadebis
sadac xorcieldeba SemTxvevaTa 90%-is marTva
simZimesTan, organuli cerebruli paTologiis
(Thompson et al., 1987). sul ufro meti mtkicebuleba
arsebobasTan, mkurnalobis mimarT cud daqvem
Cndeba imis sasargeblod, rom pirvelad jandacvaSi
debarebasTan da mZime cxovrebiseul movlenebTan
Sedegebi umjobesdeba erToblivi mzrunvelobis
Semdgom periodSi. rogorc me-17 TavSi iyo aRniSnuli,
modelebis gamoyenebiT. am modelebSi, specialistebis
_ 550 _
Sizofreniis msgavsi aSlilobebi xandazmul pirebSi
mier gaweul serviss emateba pacientebis informireba rom pacientebi ar Civian Sesabamisi simptomebis
depresiisa da medikamentebis Sesaxeb (Untzer et al., 2002). Sesaxeb, xolo zogadi profilis eqimebi naklebad
eleqtrokonvulsiuri Terapiis gamoyeneba mizan afiqsireben am simptomebs da iSviaTad mimarTaven
Sewonilia iseT SemTxvevaSi, rodesac depresiul gadamisamarTebas. realurad, am aSlilobebis sixSire
aSlilobas Tan axlavs mZime da distresis Semcveli mocemul populaciaSi bevrad maRalia, rogorc es
aJitacia, suiciduri azrebi da qceva da, agreTve, naCvenebi iyo riCis mier Catarebul gamokvlevaSi
sicocxlisTvis saSiSi stupori; an kidev, roca pacienti (Ritchie et al., 2004). amJamad aRiarebulia, rom
ar eqvemdebareba medikamentur mkurnalobas. mcdaria SfoTviTi aSlilobebi xandazmulebSi klinikurad
SeSfoTeba imis Taobaze, rom xandazmul adamianebTan ufro mniSvnelovania, vidre es adre iTvleboda.
eleqtrokonvulsiuri Terapiis gamoyeneba saSiSia meores mxriv, saboloo diagnozis dasmamde yovelTvis
an araefeqturi. misi zRurbli iseTive unda iyos, unda gvaxsovdes, rom SfoTviTi simptomebi SeiZleba
rogorc axalgazrda adamianebSi (gv. ??), Tumca, meoradi iyos depresiuli epizodis dros.
sasurvelia ufro dabali sixSiris gamoyeneba. Tu SfoTviTi aSlilobis simptomebi xandazmulebSi
pacientisTvis eleqtrokonvulsiuri Terapia an xSirad araspecifikuria da xasiaTdeba, rogorc
antidepresantebiT mkurnaloba efeqturi iyo, xolo SfoTvis, ise depresiis niSnebiT. ipoqondriuli
amJamad mkurnalobis mimarT rezistentulia, unda simptomebi SeiZleba mkafiod iyos gamoxatuli
gamovavlinoT is savaraudo somaturi daavadeba, (Lindesay, 2000).
romelic amis mizezs warmoadgens. personologiuri aSliloba predispoziciuri faq
axalgazrda pacientebis msgavsad, gamojanmrTelebis toria, xolo fizikuri daavadeba da cxovrebiseuli
Semdeg, sul mcire, ramdenime Tvis ganmavlobaSi movlenebi (mag., pensiaze gasvla an garemos Secvla)
unda gagrZeldes antidepresantebis sruli doziT SeiZleba precipitatuli faqtoris rolSi gamovides.
miReba. Tumca, faqtebi imas gveubneba, rom xandazmul xandazmul adamianebSi panikuri Setevebis debiutma
adamianebSi mkurnaloba unda gagrZeldes ufro met yovelTvis unda gvafiqrebinos, rom mis ukan SeiZleba
xans da, SesaZloa, mudmivadac ki (Old Age Derpression somaturi darRveva an depresiuli aSliloba
Interest Group, 1993). imalebodes (Flint and Gagnon, 2003).
mkurnalobis mimarT iseTive midgoma gamoiyeneba,
bipolaruli aSliloba rogorc SfoTviTi aSilobebis mqone axalgazrdebSi
Broadhead and Jacoby (1990), romlebmac Caatares (Alwahhabi, 2003; Flint and Gagnon, 2003). Tumca,
pirveli prospeqtuli kvleva xandazmul asakSi xandazmuli pirebis SemTxvevaSi prioritetulia fsi
gamovlenil maniaze, aRmoaCines, rom klinikuri qologiuri da qceviTi intervenciebi, xolo medi
suraTi am populaciaSi igivea, rac axalgazrda kamentebis gamoyenebas sifrTxiliT unda movekidoT.
pacientebSi, magram depresiuli epizodi maniakalur
epizods, uSualod, ufro xSirad mosdevs. Sereuli Sizofreniis msgavsi aSlilobebi
afeqturi epizodebi cotaTi ufro gaxSirebulia, xandazmul pirebSi
vidre axalgazrdebSi da organuli faqtorebi ufo
Sizofrenia, ZiriTadad, iwyeba adreul zrdasru
mniSvnelovan rols TamaSobs (Depp and Jeste, 2004).
lobaSi an Sua xnis asakSi (Tavi 12), magram misi
etiologiuri faqtorebi mimoxilulia kriShanis
debiuti, iSviaTad, 60 wels zeviTac gvxvdeba.
(Krishhan, 2002) mier.
mocemuli qveTavi exeba im Tvisebebs, romlebic
xandazmulebSi bipolaruli aSlilobis mar
axasiaTebs gvian gamovlenil Sizofrenias axalgazrda
Tva mihyveba me-11 TavSi aRweril principebs. mniS
asakSi gamovlenil aSlilobasTan SedarebiT. es
vnelovania liTiumis donis profilaqtika. Za
nawili aseve gamokveTs zogierT sakiTxs, romelic
lian zustad unda xdebodes sisxlSi liTiumis
exeba Sizofreniis mqone yvela xanSiSesuli pacientis
Semcvelobis monitoringi da misi koncentracia
marTvas.
Terapiulad efeqturi raodenobis qveda zRvars unda
am sferoSi arsebuli rTuli terminologia ze
Seesabamebodes (0.4-0.6 mmol/l). (mimoxilvisTvis ix.
moT iyo mimoxiluli. misi arseboba asaxavs didi
Shulman, 2002).
xnis manZilze damkvidrebul Sexedulebas, romlis
Tanaxmad gviandeli debiutis SemTxvevebi garkveuli
SfoTviTi aSlilobebi xandazmul xarisxiT klinikurad gansxvavebulia adreuli
pirebSi debiutis SemTxvevebisgan (boqsi 13.2; gv. ??). Tumca
SfoTviTi da emociuri aSlilobebi fsiqiatrTan ar arsebobs imis mtkicebuleba, rom debiutis asaki
vizitis iSviaTi mizezia cxovrebis gviandel periodSi. Sizofrenias am kategoriis gansxvavebul qvetips mi
es, SeiZleba, didwilad, imiT iyos gamowveuli, akuTvnebs.
_ 551 _
gviani periodis Sizofreniis mimoxilvisTvis ix. gamokveTili gauareseba da uyalibdebaT zomieri an
Howard et al., 2000, and Tune and Salzman, 2003. mZime xarisxis demencia (Harvey, 2001, gv. 272).
klinikuri Tvisebebi mimdinareoba da prognozi

ar arsebobs Tanamedrove monacemebi xandazmul
miuxedavad imisa, rom ZiriTadi simptomebi da zogadi
asakSi gamovlenili Sizofreniis mimdinareobaze da
klinikuri profili axalgazrda asakSi gamovlenili
Sedegebze. aseve ar aris cnobili, ramdenad war
SemTxvevebis msgavsia, zogi Tviseba xandazmulobisas
moadgens is demenciis momaswavebels da gadaizrdeba
ufro mkafiodaa gamoxatuli (cxrili 20.10). amaTSi
Tu ara demenciaSi.
yvelaze TvalSisacemia azrovnebis darRvevebisa da
negatiuri simptomebis iSviaToba. diferencialuri diagnozi
rac Seexeba neirofsiqologiur aspeqts, asakisgan
adreul asakSi dawyebuli Sizofreniisgan gan
ganurCevlad aRiniSneba kognituri funqciebis zogadi
sxvavebiT, rodesac xandazmul adamianTan vlindeba
daqveiTeba. Tumca, gviani debiutis SemTxvevebs axa
fsiqozuri simptomebi, mas, Cveulebriv, raime ti
siaTebs ufro msubuqi deficiti. es, gansakuTrebiT,
pis organuli fsiqozi aReniSneba. amgavarad, yve
exeba operaciul da verbalur mexsierebas. aRniSnuli
la xandazmuli pacienti, romelsac pirvelad
profili aSkarad kontrastulia im suraTis mi
gamouvlinda Sizofreniis msgavsi maxasiaTeblebi,
marT, romelic gvxvdeba adreuli debiutis mqone
unda safuZvlianad iqnes gamokvleuli deliriumis,
xandazmuli pacientebis mniSvnelovan umciresobaSi.
demenciis an organuli fsiqozis gamoricxvis
maT aReniSnebaT inteleqtualuri funqciebis aSkarad
mizniT, romelic, SeiZleba, gamowveuli iyos iseTi
nevrologiuri an somaturi darRveviT, rogoricaa
cxrili 20.10 gviani debiutis neirosifilisi, aiv, an neoplazma. iseve rogorc
SizofreniisaTvis damaxasiaTebeli Tvisebebis axalgazrda pacientebis SemTxvevaSi, Sizofrenia
Sedareba adreuli debiutis SemTxvevebTan unda gamovarCioT sxva fsiqikuri aSlilobebisgan,
gavrcelebuli simptomebi romlebsac axasiaTebs fsiqozuri simptomebi, gan
sakuTrebiT bodviTi aSliloba an afeqturi fsi
w vizualuri, taqtiluri da ynosviTi halucinaciebi
qozi. maTi gamijvna SeiZleba rTuli aRmoCndes
w mesame piris, makomentirebeli da Seuracxmyofeli gansakuTrebiT im SemTxvevaSi, Tu pacients aRe
Sinaarsis smeniTi halucinaciebi
niSneba devniTi xasiaTis ideebi, magram sxva sim
w devnis bodviTi ideebi ptomebi masTan ar aris mkafiod gamoxatuli da Tu
w SeRwevadobis bodva (pacients sjera, rom xalxs an avadmyofobis istoria paranoiduli personologiuri
sagnebs an gamosxivebas SeuZleba iq SeRweva da iseTi maxasiaTeblebis arsebobaze miuTiTebs. Tu pacients
winaRobis gadalaxva, rac Cveulebriv maT akavebs aReniSneba vizualuri halucinaciebi izolirebuli
kedelSi, iatakSi da sxv.) simptomis saxiT, es SeiZleba Sarl bones sindromze
SedarebiT iSviaTi simptomebi miuTiTebdes.
w formaluri azrovnebis aSliloba etiologia

w emociuri gasadaveba pacientis ojaxis wevrebSi gavrcelebis sixSire ufro
w emociuri siClunge dabalia, vidre adreuli debiutis mqone Sizofreniis
w negatiuri simptomebi dros, rac ufro sust genetikur predispoziciaze
miuTiTebs. ar SeiniSneba memkvidreobiTi asociacia
sxva Tvisebebi
neirodegeneraciul da cerebrovaskulur aSli
w gvxvdeba upiratesad qalebSi lobebTan. Tavis tvinis vizualizaciiT dafiqsirebuli
w ar SeiniSneba aSkara genetikuri datvirTva cvlilebebi iseTive bunebisa da xarisxisaa, rogorc
w kavSiri sensorul deficitTan da socialur adreul periodSi gamovlenili Sizofreniis dros.
izolaciasTan gviani debiutis mqone depresiisgan gansxvavebiT,
w SedarebiT susti premorbiduli disfunqcia TeTri nivTierebis hiperintensivoba momatebuli
ganaTlebis da fsiqosocialur sferoSi araa. arsebobs mosazreba (Seeman, 1997), rom gviani
w operaciuli mexsierebis da verbaluri daswavlis debiutis mqone Sizofreniis etiologiaSi garkveul
SedarebiT susti pr disfunqcia rols TamaSobs sasqeso hormonebi, rac dafuZnebulia
w antifsiqozuri preparatebi bevrad ufro mcire im faqtze, rom gviani debiuti qalebSi ufro xSirad
doziT gamoiyeneba gvxvdeba, Tumca am mosazrebis damadasturebeli
uSualo mtkicebuleba bevri ar aris. Sizoiduri
adaptirebulia Semdegi wyarodan: Howard et al., 2000
_ 552 _
xandazmulTa sxva fsiqiatriuli sindromebi
da paranoiduli personologiuri maxasiaTeblebi ufro TvalsaCino gaxdes (Enels et al., 2003). Sizoiduri
xSiria xandazmulebSi, romlebsac uviTardebaT gviani an paranoiduli maxasaiTeblebi SeiZleba gaamwvavos
debiutis mqone fsiqozuri aSlilobebi (Kay et al., xandazmul asakTan dakavSirebulma socialurma izo
1976). laciam, imdenad, rom, isini profesionalebma, SeiZ
leba SecdomiT bodviT aSlilobad an Sizofreniad
mkurnaloba
miiCnion. am asakobriv jgufSi kriminaluri qceva
Sizofreniis gviani debiutis dros, iseve, rogorc Zalian iSviaTia. inglissa da uelsSi danaSaulis gamo
SedarebiT adreuli debiutis SemTxvevaSi, ZiriTadad, msjavrdebul pirebs Soris 60 wels gadacilebuli
gamoiyeneba antifsiqozuri wamlebi, Tumca, am dros, mamakacebis raodenoba, mxolod 1.7%-ia (Fazel et al.,
sakmarisia xolme bevrad ufro dabali dozebis 2001).
daniSvna. (`normaluri~ dozis 10-20%). es ar aris xandazmulebSi personologiuri aSliloba xSirad
ganpirobebuli mxolod pacientis asakiT, vinaidan, komorbidulia depresiasTan da sxva fsiqikur aSli
rogorc wesi, adreuli debiutis mqone pacientebisTvis lobebTan (Devenand, 2002). iseve, rogorc axalgazrda
ufro maRali dozebi iniSneba, rodesac isini xandaz pacientebSi, is cud prognozTanaa dakavSirebuli.
mulobis asaks aRweven. antifsiqozuri wamlebis personologiuri aSliloba, SeiZleba, gviani periodis
sifrTxiliT gamoyenebis meore mizezi isaa, rom depresiis risk-faqtorsac warmoadgendes (Abrams et
axalgazrdebTan SedarebiT, am asakobriv jgufSi al., 1987).
maRalia, gviani diskineziis ganviTarebis riski (Jeste xandamzulebSi personologiuri aSlilobis mimo
et al., 1995), Tumca, daavadebis dawyebisas, is SeiZleba xilvisTvis ix. Holroyd, 2000.
asakisgan damoukideblad ganviTardes. atipiur
antifsiqozur preparatebTan gviani diskineziis
xandazmulTa sxva fsiqiatriuli
ganviTarebis ufro dabali riskia asocirebuli, vidre
tipiur antifsiqozur preparatebTan, magram bolo
sindromebi
periodSi SeSfoTeba gamoiwvia im garemoebam, rom maT sibinZuris seniluri sindromi
SeuZliaT gazardon cerebrovaskuluri movlenebi, sibinZuris seniluri sindromi aseve cnobilia,
rac aucileblad unda iyos gaTvaliswinebuli (gv. ??). rogorc diogenes sindromi (Clark et al., 1975). am
adreuli debiutis SemTxvevebis msgavsad, kogniturma sindroms axasiaTebs sakuTari Tavisa da garemos
da sxva saxis fsiqologiurma intervenciebma SeiZleba ugulebelyofa, Sin sibinZureSi yofna, socialuri
Seamciron pacientis unarSezRuduloba, Tumca am gariyuloba da izolacia. xandazmul pirebSi silo
debulebas arasakmarisi uSualo mtkicebuleba gaaCnia gamaniac (Syllogamania _ arasaWiro sagnebis daxvaveba)
(Schimming and Harvey, 2004). iCens Tavs. am sindromis provocireba SeiZleba
xandazmulebSi Sizofreniis marTvisas unda gavi moaxdinos stresulma cxovrebiseulma movlenebma.
TvaliswinoT mravali pacientis kompleqsuri same saavadmyofoSi moTavsebis Semdgom maRalia sikvdi
dicino da socialuri saWiroebebi. arsebuli ser lianoba. diogenes sindromis arsebobisas unda
visebi xSirad fragmentuli da araadekvaturia, nawi gamoiricxos sakuTari Tavis ugulebelyofis sxva
lobriv, axalgazrda pacientebze fokusirebis gamo mizezebi, gansakuTrebiT demencia, fsiqozi an mZime
(Cohen et al., 2000). depresia. rogorc wesi, adamiani jiutad ambobs uars
nebismier daxmarebaze. rTulia imis gansazRvra, Tu
personologiuri aSliloba rodis unda moxdes iZulebiTi Careva.
xandazmul pirebSi mimoxilvisTvis ix. (Reyes-Ortiz, 2001).
rogorc me-7 TavSi aRvniSneT, asakTan erTad zogierTi
personologiuri maxasiaTebeli da aSliloba sust Sarl bones sindromi
deba, zogi iseTive intensiobis rCeba, zogi ki Sarl bones sindromi gulisxmobs vizualuri
ufro mwvavdeba. metaanalizma aCvena, rom 50 wels halucinaciebis arsebobas fsiqozis, demenciis an
gadacilebul pirebSi, personologiuri aSlilobis deliriumis maxasiaTeblebis gareSe. es yuradsaRebi
gavrcelebis sixSire Seadgenda 7-10%-s (Abram and sindromia, radgan yofila mcdari diagnozis (gan
Horowitz, 1996), xolo axalgazrdebTan, garkveul wi sakuTrebiT fsiqozis) dasmis SemTxvevebi, rasac
lad, ufro dabalia es maCvenebeli. maCveneblis mosdevda araswori mkurnalobis daniSvna. sindromi
aseTi daqveiTeba xSirad miewereba imas, rom atarebs Sveicarieli filosofosis saxels, romelmac,
personologiuri aSlilobebis `b~ klasteri naklebad 1760 wels aRwera Tavisi papis SemTxveva.
gamokveTili xdeba (Cohen et al., 1994), xolo obsesiur- aRiSnuli sindromi gansakuTrebiT xSiria cu
kompulsuri da Sizoiduri maxasiaTeblebi SeiZleba di mxedvelobis mqone xandazmul adamianebSi. gav
_ 553 _
rcelebis sixSire daaxloebiT 10-15%-ia. amboben, sindromis specifikuri mkurnaloba. gamoTqmulia
rom es sindromi xandazmuli asakis fsiqiatrebTan mosazreba, rom sindromi, SeiZleba, demenciis ad
gagzavnili pacientebis 3.5%-Si vlindeba. reul niSans warmoadgendes, magram es mosazreba
vizualuri halucinaciebi kargad Camoyalibebuli dadasturebuli ar aris.
da cxadia, da gare sivrceSi myofad aRiqmeba. isini mimoxilvisTvis ix. Jacob et al., 2004.
SeiZleba perioduli an mudmivi iyos. maTi Sinaarsi xan
cvalebadia, xan stereotipuli. isini pacientisTvis damatebiTi literatura:
aranairi pirovnuli mniSvnelobis matareblebi ar
arian. miuxedavad imisa, rom isini akmayofileben 1. Gelder M.G. Lopez-Ibor JJ, Andreasen NC (eds) (2000) The
namdvili halucinaciebis ZiriTad kriteriumebs (gv. new Oxford textbook of psychiatry, Section 8: The psychiatry
??), pacients iseTi gancda aqvs, rom isini ararealuria of old age. Oxford, Oxford University Press.
da, xSirad, maTi gaqroba Tvalebis daxuWviT SeuZlia. 2. Jacoby R, Oppenheimer C (2002) Psychiatry in the elderly.
mdgomareoba umjobesdeba, Tu mxedveloba aRdgeba 3rd edn. Oxford, Oxford University Press. (Definitive text-
an pacienti sruliad dabrmavdeba. ar arsebobs am book)
_ 554 _
Tavi 21 medikamenturi
da sxva fizikuri mkurnaloba
Tavis Sinaarsi
Cven ganvixilavT klinikuri Terapiis sakiTxebs
fizikuri mkurnalobis istoria
da ara bazisur fsiqofarmakologias. imisTvis,
zogadi ganxilva rom medikamentebi racionalurad gamoviyenoT, au
fsiqotropuli medikamentebis cilebelia maTi moqmedebis meqanizmebis saTanado
farmakokinetika codna, aseve, gasaTvaliswinebelia sityva `sifr
zogadi rCevebi medikamentis gamowerisas Txile~. klinicists ar unda egonos, rom fsi
wamlis gamowera specifikuri qotropuli medikamentebis Terapiuli efeqti
mxolod misi im farmakologiuri moqmedebiT aixsneba,
jgufebisTvis
rac karga xnis dadgenilia. mag., antidepresantebisa
ra vqnaT, roca Terapiuli
da antifsiqozuri medikamentebis gviani efeqti
efeqti ar aris savaraudos xdis, rom maTi moqmedeba transmiterebze,
fsiqiatriaSi gamoyenebuli rac preparatis miRebisTanave xdeba, mimdinare
medikamentebis klasifikacia bioqimiur cvlilebaTa jaWvis mxolod pirveli
anqsiolizuri medikamentebi safexuria.
saZile medikamentebi sifrTxilis gamoCena ar niSnavs imas, rom far
makologiuri meqanizmebis codna ar zemoqmedebs
fsiqiatriul Terapiaze. piriqiT, pirveli fsiqo
antiparkinsonuli medikamentebi tropuli medikamentebis gamoyenebidan (1950-iani
antidepresantebi wlebidan), farmakologiuri codna mniSvnelovnad
guneb-ganwyobis stabilizatorebi wavida win da klinicistisTvisac, medikamentebis Ser
fsiqostimulatorebi Cevisas, gansakuTrebiT aucilebeli gaxda am codnis
sxva fizikuri mkurnaloba gamoyeneba.
eleqtrokonvulsiuri Terapia (ekT)

fotoTerapia fizikuri mkurnalobis istoria
fsiqiatriuli aSlilobebis fsiqikuri aSlilobebis dros fizikur mkurnalobas
jer kidev antikur xanaSi mimarTavdnen. retro
neiroqirurgiuli mkurnaloba
speqtuli Sefasebisas, yvelaze kargi, rac SeiZleba am
(fsiqoqirurgia)
mkurnalobaze iTqvas, aris is, rom aseTi mkurnaloba
Tavis tvinis stimulaciis teqnika SedarebiT uvnebeli iyo. ra Tqma unda, amave tipis
mkurnalobas warmoadgens sxvadasxva samedicino
mocemuli Tavi exeba medikamenturi da sxva iseTi mdgomareobebis marTva sisxlis gamoSvebis an sa
fizikuri mkurnalobis saSualebebis gamoyenebas, faRaraTo saSualebebis gamoyenebiT, rac xSirad
rogorebicaa eleqtrokonvulsiuri Terapia da ne diagnozisgan damoukideblad keTdeboda. keTil
iroqirurgiuli procedurebi. fsiqologiuri mkur gonivruli iqneba, Tu Zalian kritikuladac ar
nalobis sakiTxebi ganxilulia 22-e TavSi. aseTi ganvsjiT aseT mkurnalobas, radgan etiologia
dayofa mosaxerxebelia mxolod mkurnalobis ti jer kidev ucnobi iyo, magram unda gvaxsovdes,
pebis gasarCevad da ar unda miiCnioT erTmaneTis rom àswleulobiT gamoyenebuli fsiqoTerapia da
alternativad. piriqiT, bevr pacients orive esa Terapiis fizikuri saSualebebi isev ise saeWvo da
Wiroeba. kombinirebuli mkurnaloba ganxilulia im mouqnelia~ (Kiloh, 1988).
TavebSi, romlebSic saubaria konkretuli sindromis istoriulad fizikuri mkurnaloba iyofa or jgu-
mkurnalobaze. roca am Tavs da Semdeg Tavs gaecnobiT, fad:
mniSvnelovania, rom ar dagaviwydeT aseTi dayofis w mkurnaloba, romelic mimarTulia uSualod paTo-
mizezi.
_ 555 _
21 medikamenturi da sxva fizikuri mkurnaloba
fiziologiur procesze, rac, xSirad, Tavis tvinis ham, 1962) kontrolirebadma kvlevam, romelmac aCve-
funqciaze axdens gavlenas; na, rom Sizofreniis mqone pacientebTan insulinuri
w mkurnaloba, romelic iwvevs simptomur gaumjobe- koma ar iyo ufro metad efeqturi, vidre barbitu-
sebas mkveTri fsiqologiuri zemoqmedebiT. ratebiT gamowveuli koma. es kvleva maSin gamoqveyn-
da, roca gaCnda qlorpromazini da orive am faqtorma
am oridan ukanaskneli intervencia xSirad efuZne-
Seamcira insulinuri komis gamoyeneba. unda aRiniS-
boda SeSlilobis moraluri safuZvlis filosofiur
nos, rom kontrolirebadi kvlevebi ar gamoricxavs
Teorias. mag., bevri eqimi iziarebda hainroTis (Hein-
insuliniT mkurnalobis efeqturobas garkveuli md-
roth, 1773-1843) Teorias, romlis mixedviTac fsiqi-
gomareobebis dros da zogi avtori kvlavac efeq-
kuri aSlilobis mizezad iTvleboda boroteba da
turad miiCnevs mis gamoyenebas. sainteresoa, rom
codva. Sesabamisad, jaWviT dabma da sxeulis gvema
ukanasknelma eqsperimentulma kvlevebma aCvena, rom
saTanado mkurnalobad miiCneoda. iTvleboda, rom
insulini mniSvnelovan gavlenas axdens Tavis tvinSi
zogierTi fizikuri mkurnaloba (mag., mbrunavi skami,
monoaminis neirotransmiterebis gamoTavisuflebaze.
romelic gamoiyena erazmus darvinma; Erasmus Darwin,
albaT, insulinuri komiT mkurnalobidan is ZiriTadi
1731-1802), iwvevda mTeli `sistemis Soks~ da albaT
daskvna unda gamovitanoT, rom axali medikamenturi
am gziT moqmedebda pacientis daavadebaze. Sedar-
mkurnalobis danergvamde unda Catardes misi Tera-
ebiT ufro msubuqi reJimis iyo konolis (Connolly,
piuli efeqturobisa da usafrTxoebis dasadgeni ad-
1794-1866) da krepelinis (Kraepelin, 1856-1926) mier
ekvaturi kontrolirebadi kvlevebi (ix. Tavi 6). es
gamoyenebuli meTodi _ xangrZlivi cxeli abazanis
gansakuTrebiT mniSvnelovania fsiqiatriaSi, radgan
kombinireba civad SefuTvasTan, rac 1950-ian wlebSic
zogierTi darRvevis etiologia bundovania da, amas-
gamoiyeneboda beTlemis hospitalSi.
Tan, Tundac erTi da imave sindromis gamosavali sx-
iseTi medikamentebi, romlebic iwvevs centraluri
vadasxva SemTxvevaSi SeiZleba sxvadasxva iyos.
nervuli sistemis funqciis cvlilebebs (mag., opiate-
eleqtrokonvulsiuri Terapia (ekT) daaxloebiT
bi da antiqolinerguli saSualebebi), ramdenime aseu-
imave periodSi gamoiyenes, ra drosac insulinuri
li welia, rac fsiqikuri aSlilobebis samkurnalod
koma. ukanasknelisgan gansxvavebiT ekT Tanamedrove
gamoiyeneba. miuxedavad imisa, rom zogi maTgani
klinikur praqtikaSic gamoiyeneba. konvulsiuri Ter-
zogjer namdvilad amSvidebs pacients, fsiqikuri
apiis efeqturobis postulati efuZneba gulyrebis da
aSlilobebis samkurnalod raime specifikuri Rireb-
Sizofreniis antagonizms _ erTi TiTqos gamoricxavs
uleba ar gaaCnia. xSirad fizikur mkurnalobas mimar-
meores. am Sexedulebis mcdarobas adasturebs is faq-
Tavdnen ara imitom, rom gamocdili hqondaT misi
ti, rom Sizofreniis msgavsi daavadeba ufro xSirad
efeqturoba, aramed mxolod imitom, rom mas niSnavda
gvxvdeba safeTqlis epilefsiis mqone pacientebTan,
cnobili eqimi. yvela SemTxvevaSi efeqturoba TiTq-
vidre saerTo populaciaSi (gv. ??). klinikuri dak-
mis srulad efuZneboda arakontrolirebad klinikur
virvebisa da kontrolirebadi kvlevebis kombinirebiT
dakvirvebas.
dadasturda, rom ekT efeqturia mZime guneb-ganwyobis
1933 wels, banTingis da bestis mier insulinis
aSlilobis intensiuri, magram xanmokle mkurnalobis
gamoyofidan daaxloebiT 10 wlis Semdeg, sakelma
dros. ase rom, miuxedavad ekT-s pirveli gamoyenebis
fsiqozis samkurnalod gamoiyena insulinuri komiT
araswori ganmartebisa da misi moqmedebis meqanizmis
mkurnaloba (Sakel, 1938). komis efeqtis misaRebad
gaurkvevlobisa, kontrolirebadma kvlevebma daa-
iRebdnen insulinis Sesabamis dozas, xolo procesi
dastura, rom konkretul klinikur situaciebSi ekT
sruldeboda zondiT kvebiT an glukozis intrave-
usafrTxo da efeqturia.
nuri infuziiT. mkurnalobis kursi iTvaliswinebda
liTiumis moqmedebis gamoyeneba maniis Sesamcire-
60-mde komas. gasakviri araa, rom aseT mkurnalobas
blad aRmoaCina kadem (Cade, 1949), romelic swavlobda
xSirad axlda seriozuli garTulebebi da rom let-
cxovelebSi uratebis moqmedebas da gadawyvita li-
alobac, pacientis fizikuri mdgomareobisa da klini-
Tiumis marilis gamoyeneba misi xsnadobis gamo. li-
kis standartis mixedviT, minimum 1% iyo. insulinuri
Tiumi toqsikuria da amitom kades mniSvnelovanma
komiT mkurnaloba swrafad gavrcelda mTel evropaSi
dakvirvebam klinikur praqtikas veraferi Semata. mx-
da Seiqmna bevri specializebuli samkurnalo gan-
olod momdevno aTwleulSi kontrolirebadi kvleve-
yofileba. pacientebi da personali imediT aRivsnen,
biT dadasturda liTiumis efeqturoba maniis inten-
radgan SesaZlebeli gaxda zogierTi yvelaze mZime
siuri, magram xanmokle mkurnalobisas, aseve, guneb-
fsiqikuri aSlilobis simptomebis gankurneba
ganwyobis ganmeorebadi aSlilobebis profilaqtiki-
magram yovelTvis iyvnen iseTi eqimebic, romlebsac
sTvis.
eWvi eparebodaT insulinuri komis efeqturobaSi.
sxva revoluciuri fsiqofarmakologiuri saSu-
maTi eWvi gaaZliera akneris da oldhamis (Ackner, Old-
alebebi mocemulia boqsSi 21.1. maTi efeqturoba da
_ 556 _
zogadi ganxilva
Cvenebebi pirvelad gamovlinda klinikuri dakvirvebis receptorebis nawilis klonireba da xelmisawvdomi
dros da Semdeg dadasturda kontrolirebadi klini- gaxda arCeviTi ligandebi. gaizarda codna imis Sesaxeb,
kuri kvlevebiT. arc erTi es saSualeba ar yofila Tu es qimiuri mesinjerebi rogor axdenen qcevis
SemoRebuli etiologiuri hipoTezis mixedviT. piriq- modificirebas Tavis tvinis specifikur midamoze
iT, iseve, rogorc biologiur fsiqiatriaSi, zogier- moqmedebisa da neironul wreebSi gavrcelebis gziT.
Ti etiologiuri hipoTeza Seiqmna efeqturi medika- mimdinareobs muSaoba axal-axal nivTierebebze,
mentis moqmedebis meqanizmis mixedviT. Sizofreniis romelTa aRmoCenac efuZneba mecnierul miRwevebs.
dofaminur hipoTezas dofaminis receptoris antago- maTi zegavlena qcevaze arsebuli medikamentebisgan
nisti antifsiqozuri medikamentebis Tvisebebi daedo gansxvavebulia da fsiqofarmakologiis axali
safuZvlad. aseve, tricikluri antidepresantebis da warmatebebis imeds iZleva. fsiqikuri aSlilobebis
monoaminis oqsidazis inhibitorebis (maoi) gamoyenebi- sirTulidan gamomdinare, maTi etiologiisa da
sas noradrenalinis da 5-hidroqsitriptaminis (5-HT) paTofiziologiis detaluri Seswavla CamorCeba
moqmedebis gaZliereba _ guneb-ganwyobis monoaminur mkurnalobis meTodebis ganviTarebas. ra Tqma unda,
hipoTezas. msgavsi Seusabamoba medicinis sxva dargebisTvisac
ukanaskneli 30 weli fsiqofarmakologiis intensiuri ucxo ar aris. Sesabamisad, izrdeba axali fsi
ganviTarebis periodia. farTod gamoiyeneba klini qofarmakologiuri mkurnalobis SefasebisTvis ran
kuri kvlevebi konkretuli medikamentiT mkurnalobis domizebuli klinikuri kvlevebis Catarebis mni
Cvenebebis da riskis sargebelTan Tanafardobis Svneloba.
gansazRvrisTvis. xelmisawvdomi xdeba axali pre
paratebi, magram, radgan isini momdinareobs manamde zogadi ganxilva
arsebuli medikamentebisgan, gansxvaveba maTsa da
winamorbedTa moqmedebis speqtrs Soris umniSvneloa. fsiqotropuli medikamentebis
zogadad, axali Taobis medikamentebi xasiaTdeba farmakokinetika
ukeTesi amtanobiT da zogjer Zvel medikamentebze imisTvis, rom ganviTardes farmakologiuri efeqti,
ufro usafrTxoc aris, rac klinikuri praqtikisTvis fsiqotropulma medikamentma Tavis tvinamde saTanado
maRali Rirebulebisaa. raodenobiT unda miaRwios. es damokidebulia misi
amJamad fsiqofarmakologiuri optimizmisTvis absorbciis, metabolizmis, eqskreciisa da hemato-
ufro meti safuZvelia. mag., swrafad farTovdeba encefalur barierSi SeRwevadobis Taviseburebebze.
codna Tavis tvinis qimiuri signalebis Sesaxeb. aq mocemulia am procesis mokle ganxilva. mkiTxvels,
mravali neirotransmiteri da neiromodulatori romelic pirvelad ecnoba am sakiTxs, vurCevT,
urTierTqmedebs receptorebis specifikur jgufze, waikiTxos graham-smiTisa da aronsonis wignSi
romelTa dayofac SesaZlebelia qvetipebad. moxda am (Grahame-Smith, Aronson, 2002) Tavi farmakokinetikis
Sesaxeb. mniSvnelovania Semdegi procesebi:
boqsi 21.1 fsiqiatriaSi zogierTi w absorbcia (Sewova)
fizikuri mkurnalobis SemoReba
w ganawileba
1934 _ insulinuri komiT mkurnaloba (sakeli)
w metabolizmi
1936 _ frontaluri leikotomia (moniSi)
1936 _ metrazoliT konvulsiuri Terapia (meduna) w eqskrecia (gamoyofa)
1938 _ eleqtrokonvulsiuri Terapia (Cerleti, bini)
absorbcia
1949 _ liTiumi (kade)
1952 _ qlorpromazini (delai, denikeri) saerTod fsiqotropuli medikamentebi nawlavebidan
1954 _ benzodiazepinebi (Sternbaxi) advilad absorbirdeba, radgan maTi umetesoba li
1957 _ iproniazidi (qreini, qlaini) pofiluria da fiziologiuri pH-is pirobebSi nak
1957 _ imipramini (kuni) lebad ionizirdeba. sxva medikamentebis msgavsad, maTi
1966 _ valpromidi (valproati) bipolaruli Sewova ufro swrafad xdeba uzmoze da isini ufro
aSlilobebis dros (lamberti) advilad Seiwoveba naklebi raodenobiT, Tu pacients
1967 _ klomipramini obsesiur-kompulsiuri aSlilobebis aqvs gaZlierebuli peristaltika an malabsorbciis
dros (fernandesi, lopez-ibori) sindromi.
1971 _ karbamazepini bipolaruli aSlilobebis dros
(takezaki, hanoaka) ganawileba
1988 _ klozapini mkurnaloba-rezistentuli
fsiqotropuli medikamentebi nawildeba plazmaSi
Sizofreniis dros (qeini)
1999 _ lamotrijini bipolaruli depresiis dros
da maTi umetesi nawili ukavSirdeba cilas (mag.,
(kalabreze) diazepamisa da amitriptilinis daaxloebiT 95%).
_ 557 _
isini plazmidan advilad xvdeba Tavis tvinSi ma amitomac, TiTqos mosalodnelia, rom medikamentis
Rali lipofilobis gamo. amave mizeziT grovdeba plazmuri koncentraciis gansazRvra sasargeblo
cximovan qsovilSi, saidanac gamoTavisufldeba nela, unda iyos klinikuri TvalsazrisiT, magram (liTiumis
medikamentis miRebis Sewyvetis Semdegac. es niSnavs, garda) is praqtikulad usargebloa, radgan plazmuri
rom fsiqotropul medikamentebs aqvT ganawilebis koncentracia, romelic gansazRvravs Terapiul pa-
farTo moculoba. suxs an toqsikurobas, yvela konkretul SemTxvevaSi
gansxvavebulia. imisTvis, rom medikamentma imuSaos,
metabolizmi plazmaSi unda arsebobdes dadgenil minimumze maRali
fsiqotropuli preparatebis umetesoba metabo koncentracia. xolo zogierTi medikamentisTvis mo-
lizdeba RviZlSi. es procesi iwyeba medikamentis wodebulia `samizne~ done. miuxedavad amisa, arc Tu
RviZlis gavliT nawlavidan portul cirkulaciaSi ise iSviaTad, Terapiuli pasuxis miReba SesaZlebelia
gadasvlisas. aseTi `pirveli-gasvlis~ metabolizmi rekomendebulze naklebi maCveneblisganac.
amcirebs preparatis koncentracias sisxlSi. es
erT-erTi mizezia imisa, rom medikamentis (mag., farmakodinamikuri Sefaseba
qlorpromazinis) peroralurad miRebisas ufro rogorc alternativa, SesaZlebelia ganisazRvros
maRali dozebia saWiro, vidre intramuskuluri ineq konkretuli medikamentis Terapiuli efeqtis far-
ciis dros. RviZlSi metabolizmi sxvadasxva adamianSi makologiuri Tviseba. mag., pozitron-emisiuri tomo-
garkveuli TaviseburebebiT xasiaTdeba. metabolizmis grafiiT SesaZlebelia inaxos antifsiqozuri mkurna-
procesze gavlenas axdens iseTi medikamentebis miReba, lobiT gamowveuli Tavis tvinis dofaminis recepto-
romlebic iwvevs RviZlis enzimebis inducirebas (mag., rebis blokadis xarisxi. es informacia Rirebulia Se-
karbamazepini) an, piriqiT, inhibicias (mag., seroto- sabamisi dozirebis reJimis SerCevisTvis (ix. cxrili
ninis ukumitacebis seleqciuri inhibitorebi [susi]). 21.6). miuxedavad amisa, es farmakodinamikuri kvleva
zog medikaments, rogoricaa, vTqvaT, karbamazepini, ver gansazRvravs, Tu ratom aris zog SemTxvevaSi me-
aqvs sakuTari metabolizmi, gansakuTrebiT xangrZli- dikamenti araefeqturi. mag., dofaminis receptore-
vi miRebis dros; zogs _ aqtiuri metabolitebi aqvs, bis blokadis xarisxi fsiqotropuli mkurnalobis
mag., fluoqsetini metabolizdeba hidroqsi-warmo- SemTxvevaSi Tanabrad efeqturic da araefeqturic
ebulad, norfluoqsetinad, romelic serotoninis aRmoCnda (Geaney et al., 1992). dReisTvis did interess
(5-HT) ukumitacebis seleqciuri inhibitoria. im Se- iwvevs mkurnalobis efeqturobis winaswar dasadgenad
mTxvevaSi, roca medikamenti iZleva aqtiur metabo- farmakogenetikuri midgoma (boqsi 21.2). mimoxilvis-
lits, preparatis Terapiuli aqtivobis Sesafaseblad Tvis ix. Straddon et al., 2002
mxolod medikamentis plazmuri koncentraciis gansa-
plazmuri naxevardaSlis periodi
zRvra ar aris sakmarisi.
medikamentis plazmuri koncentracia dRis ganmavlo-
eqskrecia baSi meryeobs _ izrdeba miRebisas da mcirdeba medika-
fsiqotropuli medikamentebi da maTi metabolitebi mentisa da pacientis individualuri Taviseburebebis
ZiriTadad TirkmelebiT gamoiyofa. Tirkmlis funq- Sesabamisad. erTjeradi dozis Semdeg medikamentis
ciis daqveiTebis dros eqskrecia mcirdeba da saWiro donis daqveiTebis tempi icvleba saaTebidan (rogorc
xdeba dozis Semcireba. liTiumi pasiur filtracias es aris liTiumis SemTxvevaSi) kvirebamde (rogorc es
ganicdis, Semdeg nawilobriv reabsorbirdeba imave xdeba gaxangrZlivebuli moqmedebis saineqcio antif-
meqanizmiT, riTac natriumi. es ori ioni avsebs am me- siqozuri medikamentebis SemTxvevaSi). am gansxvavebis
qanizms: liTiumis reabsorbcia matulobs, roca mcir- codna dozebs Soris adekvaturi intervalis dacvis
deba natriumis Sewova. lipofiluri medikamentebis, saSualebas iZleva.
mag., qlorpromazinis garkveuli fraqcia nawilobriv plazmuri naxevardaSlis periodi aris is dro,
eqskretirdeba naRvelSi, ganmeorebiT aRwevs nawlavSi romelic esaWiroeba, erTjeradi dozis SemTxvevaSi,
da Semdeg nawilobriv reabsorbirdeba anu medikamen- nivTierebis plazmuri koncentraciis ganaxevrebas.
tis nawili moZraobs nawlavsa da RviZls Soris. umetesi fsiqotropuli medikamentisTvis plazmidan
sruli gamoyofa ikavebs daaxloebiT 5-jer naxevar-
medikamentis koncentraciis gansazRvra daSlis periods. aseve, imisTvis, rom plazmuri kon-
zemoT aRwerili meqanizmis variabilobis gamo fsiqo- centracia gaxdes myari, saWiroa xuTi naxevardaSlis
tropuli medikamentis standartuli dozis plazmu- dro. es gansakuTrebiT mniSvnelovania mkurnalobis
ri koncentracia SesaZlebelia sxvadasxva pacientTan dasagegmad. mag., monoaminoqsidazas inhibitorebi
sxvadasxva iyos. aRwerilia antidepresant nortrip- (maoi-ebi) ar unda dainiSnos susi-ebTan erTad. Tu
tilinis aTjeradi sxvaoba sxvadasxva SemTxvevaSi. pacienti iRebs sertralins, romlis naxevardaSlis
_ 558 _
zogadi ganxilva
mniSvnelovnad gaumjobesda mikrosomul cito

boqsi 21.2 farmakogenetika fsiqiatriaSi
qrom-P-450 enzimebis sistemis codna. es enzimebi
w dnm-is polimorfulma (alelurma) variaciam SeiZ ZiriTadad moTavsebulia RviZlSi, Tumca, aris
leba gamoiwvios im cilebis warmoqmna, romlebic
sxvadasxvagvar gavlenas axdens fsiqotropul medi
sxva qsovilebSic, nawlavebsa da Tavis tvinSi. maTi
kamentebze funqciaa egzogenuri nivTierebebis, maT Soris me
w am polimorfulma variaciebma SeiZleba Secvalos sava
dikamentebis, detoqsikacia. sxvadasxva medikamentis
raudo Terapiuli pasuxi an gamoiwvios gverdiTi movlenebi erTdrouli moqmedebiT maTi aqtivoba SeiZleba
w CYP-enzimis genetikurma variaciebma SeiZleba gavlena gaizardos an daqveiTdes. amas efuZneba medikamentebis
moaxdinos sisxlSi medikamentis doneze da, Sesabamisad, klinikurad mniSvnelovani urTierTqmedeba (Grahame-
Tavis tvinze mis zemoqmedebazec. CYP2D6-is genis mutacia Smith, Aronson, 2002). ramdenime axali antidepresanti,
SeiZleba asocirdebodes antifsiqozuri medikamentebiT
kerZod, zogierTi susi ainhibirebs P-450 enzimebs (ix.
gamowveul mogvianebiT (tardiul) diskineziasTan
cxrili 21.11).
w serotoninis transporteris daqveiTebul eqspresiasTan
asocirebuli alelebi dakavSirebulia serotoninis
farmakodinamikuri urTierTqmedeba
ukumitacebis inhibitorebis araefeqturobasTan
farmakodinamikuri urTierTqmedebis magaliTia sero
w klozapinze Terapiuli pasuxi SesaZloa ukavSirdebodes
5-TH-2A receptoris specifikur alelebs toninis sindromi, romlis drosac medikamentebi,
romlebic sxvadasxva meqanizmebiT iwveven Tavis tvin
w antifsiqozuri medikamentebiT gamowveuli wonis
mateba dakavSirebulia 5-HT-2C receptoris alelTan Si 5-HT funqciis gaaqtiurebas (mag., susi da maoi),
kombinirebisas avlenen saSiS serotoninul toq
periodi 26 saaTia, aucilebelia, rom maoi-is daniSvna sikurobas.
gadavaddes minimum xuTi naxevardaSlis vadiT (anu da- rogorc wesi, erTi medikamentiTac SesaZlebelia
axloebiT 1 kviriT). roca iwyeba sertraliniT mkur- imave efeqtis miReba, rogoric miiReba kombinirebisas;
naloba, plazmuri koncentracia izrdeba daaxloebiT mag., bevr antidepresants aqvs kargi anqsiolizuri
erTi kviris ganmavlobaSi da Semdeg aRwevs SedarebiT moqmedeba. sasurvelia fsiqotropuli medikamentebis
myar niSnuls. kombinirebis SeZlebisdagvarad Tavidan arideba. Tu
kombinireba gardauvalia, unda gaviTvaliswinoT
medikamentebis urTierTqmedeba
SesaZlo urTierTqmedeba. britanuli erovnuli
ori fsiqotropuli medikamentis erTdrouli micemisas farmacevtuli cnobari am mxriv saukeTeso saxel
erTma SeiZleba gaaZlieros an Seamciros meores mZRvaneloa.
moqmedeba. es zemoqmedeba SeiZleba gamowveuli iyos
absorbciis, SekavSirebis, metabolizmis an eqskreciis medikamentis moxsna
cvlilebiT (farmakokinetikuri urTierTqmedeba) an bevri fsiqotropuli medikamentis Terapiuli efeqtis
moqmedebis farmakologiuri meqanizmebis gavleniT misaRebad saWiroa ramdenime dRe an kvirac. wamlis
(farmakodinamikuri urTierTqmedeba). Sewyvetis Semdegac garkveuli droa saWiro misi
moqmedebis mosaxsnelad. ganmeorebiTi gamoyenebisas
farmakokinetikuri urTierTqmedeba
aramarto fsiqotropuli, aramed sxva wamlebic iwvevs
urTierTqmedeba, romelic gavlenas axdens medi neiroadaptaciur cvlilebebs. qsovilebs sWirdebaT
kamentis absorbciaze, iSviaTad aris mniSvnelovani wamlis SewyvetasTan Segueba, rac klinikurad SeiZleba
fsiqotropuli medikamentebisTvis, Tumca, mag., gamovlindes moxsnis anu abstinenciis sindromiT.
qlorpromazinis absorbcia mcirdeba antacidebiT. aRwerilia antidepresantebisTvis, antifsiqozurebis,
cilasTan SekavSirebiT gamowveuli zemoqmedebac da anqsiolitikebisTvis damaxasiaTebeli abstinenciis
ar aris xSiri, Tumca qloralis metabolit tri sindromi. liTiumis uecari Sewyveta ki iwvevs `ri
qloracetilis mJavam SeiZleba gadaanacvlos val koSetul~ manias. saWiroa moxsnis sindromis gan
farini albuminidan. SedarebiT mniSvnelovania ur sxvaveba mkurnalobis Semdgomi recidivisgan. aseve,
TierTqmedeba, romelic cvlis medikamentis me abstinenciis riskis gamo, mniSvnelovania, rom
tabolizms, risi magaliTebicaa antifsiqozuri fsiqotropuli medikamentebi SeZlebisdagvarad nela
medikamentebis moqmedebis inhibicia susi-ebiT da moixsnas.
tricikluri antidepresantebis metabolizmis sti
mulacia karbamazepiniT, romelic astimulirebs zogadi rCevebi medikamentis gamowerisas
citoqrom-P-450 enzims. urTierTqmedeba, romelic
gamocdili medikamentebis gamoyeneba
moqmedebs Tirkmlis gamoyofis unarze, ZiriTadad
mniSvnelovania liTiumisTvis, romlis gamoyofac kargi Sedegis momcemia Terapiuli efeqtis mqone ga-
Tiaziduri diuretikebiT qveiTdeba. mocdili medikamentebis gamoyeneba, romelTa gver-
_ 559 _
diTi moqmedebac ukve kargadaa cnobili. klinicis- miiReben. hospitalSi ufro xSiri jeradobis gamoy-
ti kargad unda erkveodes medikamentebis ZiriTadi eneba efuZneba meddebis mier mkurnalobis fsiqolo-
jgufebis ramdenime warmomadgenelSi, icodes dozis giuri sakiTxebis mogvarebis SesaZleblobas. zogi wa-
SerCeva da SeeZlos gverdiTi moqmedebebis amocnoba. mali, rogoricaa anqsiolizurebi, gamoiyeneba ufro
gamocdili medikamentebi, Cveulebriv, axal prepa- metad dauyovnebeli, vidre mogvianebiTi efeqtisTvis.
ratebze ufro iafia. is ar unda dainiSnos regularuli intervalebiT, ar-
amed im konkretuli droisTvis, roca mosalodnelia
adekvaturi dozis SerCeva simptomebis gauareseba. mkurnalobis xangrZlivoba
Sesaferisi medikamentis SerCevis Semdeg, eqimma is damokidebulia im darRvevaze, rasac vmkurnalobT; es
unda gamoweros adekvaturi doziT. wamali ar unda Tema mocemulia Sesabamis TavSi.
gamoicvalos an mniSvnelovani mizezis gareSe ar unda
daematos sxva wamali. saerTod iTvleba, rom, Tu erTi risi codna surs pacients
wamliT Terapiuli efeqti ar vlindeba, imis albaTo- fsiqotropul medikamentebs SeuZlia Secvalos ada-
ba, rom msgavsi farmakologiuri moqmedebis sxva me- mianis azrovneba da SegrZnebebi. ar aris gasakviri,
dikaments ukeTesi efeqti eqneba, ar arsebobs (ra Tqma rom bevr pacients eSinia wamlis miRebis. amitom mniS-
unda, mxolod im SemTxvevaSi, Tu pirveli medikamenti vnelovania, rom gasagebad avuxsnaT mas, Tu ratom
gamoyenebul iqna adekvaturi doziT). radgan adekva- gamoiyeneba wamali, rodis da ra Terapiul efeqts
turi dozis gamoyenebis mTavari dabrkoleba gverdi- unda elodos. sxva sakiTxebi, razec saWiroa saubari:
Ti moqmedebaa, erTi medikamenti SeiZleba Seicvalos w ra SegrZneba SeiZleba gaCndes wamlis pirveli
sxva tipis gverdiTi moqmedebis mqone meore wamliT _ miRebisas;
mag., tricikluri antidepresanti susi-iT an piriqiT.
w ra gverdiTi moqmedeba SeiZleba axldes wamlis
medikamentebis kombinirebis frTxilad gamoyeneba miRebas;
zogjer fsiqotropuli wamlebis kombinireba xdeba w romeli iTvleba iseT seriozul gverdiT moq-
im ganzraxviT, rom urTierTqmedeba ufro efeqturi medebad, romelic dauyovnebliv unda acnobos eq-
iyos, vidre TiToeuli wamlis sruli doziT xmarebi- ims;
sas (mag., tricikluri antidepresanti maoi-sTan er- w ramdeni xniT iniSneba wamali;
Tad). Tu medikamentebis kombinireba aucilebelia, w axasiaTebs Tu ara wamals damokidebulebis gaCena;
es unda ganaxorcielos gamocdilma fsiqiatrma (an
w ra SeiZleba gamovlindes wamlis Sewyvetis SemTx-
ganxorcieldes misi zedamxedvelobiT), radgan kom-
vevaSi.
binirebuli mkurnalobis gverdiTi moqmedebis amoc-
noba ufro rTulia. daniSnulebis Sesruleba, Tanxmoba da
TanamSromloba
dozireba da mkurnalobis xangrZlivoba
bevri pacienti ar iRebs gamoweril wamals. es prob-
wamlis gamoweris Semdeg unda ganisazRvros doza, lema gansakuTrebiT aqtualuria ambulatoriuli
dozebs Soris intervali da mkurnalobis savaraudo pacientebis SemTxvevaSi, Tumca, SeiZleba am prob-
xangrZlivoba. im wamlebis dozirebis diapazoni, rom- lemas wavawydeT hospitalSic, sadac pacientebi aTas-
lebsac xSirad viyenebT, mocemulia qvemoT. sxvebis gvari gziT axerxeben, Tavi aaridon wamlis miRebas.
ki SesaZlebelia moiZebnos britanul erovnul farma- Tu aucilebelia, rom pacientma miiRos medikamenti,
cevtul cnobarSi. konkretuli pacientisTvis swori saWiroa igi davarwmunoT, rom mas sWirdeba es wamali,
doza unda SeirCes Terapiul diapazonSi simptomebis rom igi usafrTxoa. aseve, aucilebelia miRebis wesis
simZimis, pacientis asakis, wonisa da sxva iseTi faq- dawvrilebiT ganmarteba. yvela es moTxovna warmo-
torebis gaTvaliswinebiT, romlebic gavlenas axdens Sobs gansakuTrebul problemas, roca pacients aqvs
wamlis metabolizmze (mag., sxva wamlebi an Tirkmlis fsiqikuri aSliloba. Znelia Sizofreniis an seriozu-
daavadeba). li depresiis mqone pacientis darwmuneba, rom is namd-
Semdeg unda ganisazRvros dozebs Soris intervali. vilad avad aris; SeiZleba mas gamojanmrTelebis sur-
fsiqotropuli wamlebi xSirad dReSi samjer iniSneba, vili arc ki hqondes. motyuebuli pacienti SesaZloa
Tumca, zogis moqmedebis xangrZlivoba iZleva misi or- ar endos personals, xolo ipoqondriul pacients
jeradi an erTjeradi gamoyenebis saSualebas, radgan SeiZleba SeeSindes sarisko gverdiTi efeqtebis.
plazmuri koncentracia dozebs Soris mniSvnelovnad SfoTvis mqone pacientebs xSirad aviwydebaT gamow-
ar ecema. SedarebiT ufro naklebi sixSiriT daniSvna erili wamlis doza da jeradoba. amitomac, gasakviri
gansakuTrebiT rekomendebulia ambulatoriuli pa- ar aris, rom fsiqiatriuli pacientebi ar iReben wam-
cientebisTvis, radgan ufro sarwmunoa, rom isini mas lebs daniSnulebis mixedviT. klinicistisTvis gansa-
_ 560 _
zogadi ganxilva
kuTrebiT mniSvnelovania am problemaze yuradRebis niT mkurnalobis efeqturoba ver gadawonis Tanmxleb
gamaxvileba. mkurnalobis Sesaxeb pacientis Sexed- arasasurvel movlenebs: SfoTvasa da suicidur qce-
ulebebis ganxilvaze daxarjuli dro ar aris fuWi, vas (Whittington et al., 2004). praqtikosma eqimma unda
radgan am SemTxvevaSi ufro metia imis Sansi, rom igi icodes adgilobrivi gaidlaini fsiqotropuli wam-
daniSnulebas sworad Seasrulebs. aseve, am mxriv, dilebis gamoyenebis Sesaxeb, xolo daeWvebis SemTxveva-
dad gvexmareba werilobiTi instruqciac. Si, unda mimarTos specialists rCevisTvis.
imisTvis, rom medikamentebis gamoyeneba warmate- fsiqotropul wamlebze Catarebul klinikur kv-
buli da usafrTxo iyos, aucilebelia pacient-eqimis levebSi asakovani adamianebi naklebad monawileoben,
TanamSromloba. zogierTi termin `Tanxmobis~ (concor- miuxedavad imisa, rom moxucebSi depresia sakmaod
dance) nacvlad, iyenebs termins _ `damyoloba~ (compli- xSiria. xandazmuli pacientebi gansakuTrebiT mgrZ-
ance), radgan gulisxmobs pacientis mier daniSnulebis nobiareni arian medikamentebis gverdiTi movlenebis
Sesrulebas (Mullen, 1997). romeli terminic ar unda mimarT da xSirad uCivian Tirkmlis an RviZlis funq-
vixmaroT, naTelia, rom medikamenturi mkurnalobis ciis ukmarisobas. amitom mniSvnelovania, rom mkurna-
gamoyenebisas, gansakuTrebiT fsiqiatriaSi, saWiroa loba daiwyos dabali dozebiT.
daavadebisa da mkurnalobis Sesaxeb pacientis Sexed-
orsuli qalebi
ulebis codna.
fsiqotropuli wamlebis orsulisTvis gamowerisas,
wamlis gamoweris eTikuri mxare dgeba specifikuri probleba teratogenobis riskis
eTikuri sakiTxebi ganxiluli aqvT braunsa da pante- gamo. aseTi riskis Sesaxeb informaciis mopoveba Se-
liss (Brown, Pantelis, 1999): saZlebelia mwarmoeblisgan da britanuli erovnuli
1. praqtikosis mier wamlis gamowera unda efuZne- farmacevtuli cnobaridan, magram xelmisawvdomi fa-
bodes medikamenturi Terapiis riskisa da sargeblis qtebi cotaa da rTulia maTi interpretireba. eqimma
codnas, xolo es informacia unda eyrdnobodes mt- da pacientma erTad unda gadawyviton, rogoria me-
kicebulebebze damyarebuli medicinis monacemebs; dikamenturi mkurnalobis gareSe daavadebasTan ga-
mklavebis riski. amasTan, radgan xSirad orsuloba
2. eqim-pacientis kavSiri urTierTobis iseTi formaa,
daugegmavia, mizanSewonilia, rom yovelTvis, roca
rodesac pacients gadaecema codna;
ki es SesaZlebelia, ganemartos Svilosnobis asakis
3. pacientisa da eqimis Terapiuli partniorobis yvela qals, romelic saWiroebs fsiqotropul wamle-
mizani unda iyos WeSmaritad gacnobierebuli Se- bs, Tavidan aicilos orsuloba, sanam ar daasrulebs
Tanxmeba, romelic, aseve, unda iTvaliswinebdes in- mkurnalobas (orsulobisas fsiqotropuli wamlebis
saiTis mqone pacientis uflebas, uari ganacxados gamoyenebis Sesaxeb ix. Wieck, 2004).
mkurnalobaze.
problemebi gansakuTrebiT maSin wamoiWreba, roca anqsiolitikebi da antidepresantebi
ar arsebobs mtkicebulebebze damyarebuli medici- anqsiolizuri wamlebi iSviaTadaa aucilebeli adreu-
nis monacemebi da dazustebuli ar aris romelime li orsulobis periodSi da SesaZlebelia Semovi-
midgomis upiratesoba. aseT SemTxvevaSi klinicistma fargloT mxolod fsiqologiuri mkurnalobiT. Tu
unda airCios is mkurnaloba, romelsac iziareben sxva medikamenturi mkurnaloba aucilebelia, benzodiaze-
kolegebi an gamoiyenos klinikuri saxelmZRvanelo pinebi ar iTvleba teratogenulad, Tumca, erT-erTi
principebi (gaidlaini). man unda daicvas pacientis meta-analizuri kvleviT gamovlinda, rom orsulobis
uflebebi da SesTavazos mas efeqturi mkurnaloba pirvel trimestrSi benzodiazepinebis gamoyeneba zr-
yovelTvis, garda im SemTxvevebisa, roca wamlis fasi dis sasis napralis ganviTarebis risks. Tu saWiroa
an raime sxva ekonomiuri faqtori ar iZleva amis sa- antidepresanti, albaT sjobs kargad nacnobi imi-
Sualebas. praminis an amitriptilinis daniSvna, romelTa tera-
togenobis Sesaxebac, miuxedavad maTi mravalwliani
wamlis gamowera specifikuri jgufebisTvis gamoyenebisa, jer-jerobiT araferia cnobili. aseve,
bavSvebi da moxucebi gamocdilia fluoqsetinis moqmedeba, romlis xmare-
basac ar axlavs malformaciebis maRali riski.
fsiqotropul wamlebs, Cveulebriv, ar gaaCniaT li-
cenzia maTi bavSvTa asakSi gamoyenebis Taobaze, xolo antifsiqozuri preparatebi da guneb-ganwyobis
am mimarTulebiT Catarebuli sarwmuno kontroli- stabilizatorebi
rebadi kvlevebic Zalian cotaa. amis miuxedavad,
orsulobis dasawyisSi iSviaTad aris saWiro antif-
britaneTis medikamentebis usafrTxoebis komisiam
siqozuri wamlebis daniSvna. Zalian mcirea informa-
gamoaqveyna daskvna, romlis mixedviTac, depresiis
cia iseTi Zliermoqmedi wamlis teratogenulobaze,
mqone mozardebSi zogierTi susi-Ta da venlafaqsi-
_ 561 _
rogoricaa haloperidoli. amasTan, ufro maRalia gavlena SeiZleba gamovlindes mogvianebiTac, Tavis
Tandayolili malformaciebis sixSire im bavSvebSi, tvinis ganviTarebisa da qcevis darRvevebis saxiT. ar-
romelTa dedebic iRebdnen SedarebiT naklebi poten- sebuli mcire raodenobis prospeqtuli kvlevebiT,
ciurobis preparatebs, rogoricaa qlorpromazini. romelTa drosac xdeboda bavSvebze dakvirveba pir-
axali antifsiqozuri wamlebis teratogenuli riskis veli ramdenime wlis ganmavlobaSi, msgavsi monacemebi
Sesaxeb informacia Zalian cotaa. dadasturebuli ar aris.
orsulobis adreul etapze liTiumiT mkurnalo-
ZuZuTi kveba
bas axlavs kardialuri anomaliebis, kerZod, ebStei-
nis anomaliis ganviTarebis riski. amitom yvela qals fsiqotropuli wamlebi sifrTxiliT iniSneba ZuZu-
unda mieces rekomendacia, rom Casaxvamde Sewyvitos Ti kvebis dros. diazepami da sxva benzodiazepinebi
liTiumis miReba. aseve, Tu qali iRebs liTiums da iolad gadadis rZeSi da iwvevs bavSvis sedaciasa da
daorsulda, aucileblad unda Sewyvitos misi miReba. hipotonias. antifsiqozurebi da antidepresantebic
ukanaskneli epidemiologiuri kvlevis Tanaxmad, roca gadadis rZeSi, magram SedarebiT ufro naklebad.
nayofi ganicdis liTiumis gavlenas pirvel trimes- mniSvnelovani raodenobiT xvdeba rZeSi sulpiridi
trSi, ebSteinis anomaliis SedarebiTi riski 10-jer da amitom ar aris rekomendebuli. fluoqsetini da
maRalia; Tumca, am dros dabalia absoluturi riski, misi metabolitebi SeiZleba dagrovdes, magram sxva
romelic 0, 05-0, 1%-s Seadgens. liTiumis Sewyveta susi-ebi rZeSi mcire raodenobiT gadadis da amitom,
ukavSirdeba bipolaruli aSlilobis maRal risks da sedaciisa da kvebis problemebis gamo bavSvze dakvir-
dedisa da Cvilis riskis wonasworoba, zog SemTxve- vebis warmoebis periodSi, maTi miReba SeiZleba ZuZu-
vaSi, ixreba mkurnalobis gagrZelebis sasargeblod. Ti kvebis drosac gagrZeldes (Weissman et al., 2004).
iseTi antikonvulsantebi, rogorebicaa karbamaze- Cveulebriv, rekomendebulia, rom dedam wamlis maq-
pini da valproati sul ufro xSirad gamoiyeneba gu- simaluri plazmuri koncentraciis periodSi rZe ga-
neba-ganwyobis stabilizatorebad. orive antikonvul- moiwvelos da gadaRvaros.
sants axlavs nayofis nervuli lulis defeqtis da liTiumis marilebi advilad xvdeba rZeSi da dedi-
sxva anomaliebis ganviTarebis maRali riski. nervuli sa da bavSvis plazmuri koncentracia SeiZleba Tana-
lulis defeqtis ganviTareba, savaraudod, unda ukav- baric iyos, amitom didi sifrTxilea saWiro ZuZuTi
Sirdebodes antikonvulsantis zegavleniT foliumis kvebis dros. karbamazepinis da valproatis koncen-
mJavis metabolizmis cvlilebas, Tumca foliumiT tracia imdenad dabalia rZeSi, rom ar SeiZleba iyos
mkurnalobis roli am defeqtis ganviTarebis preven- mavne. zogadad iTvleba, rom im SemTxvevaSic ki, roca
ciaSi dadgenili ar aris. fsiqotropuli medikamentebis zegavleniT bavSvs
raime klinikuri niSani ar uCndeba, SeuZlebelia imis
neonataluri intoqsikacia gansazRvra, Tu ra gavlenas moaxdens es wamali Ta-
orsulobis bolo periodSi fsiqotropuli wamlebis vis tvinis ganviTarebasa da qcevaze; amitom zogierTi
zemoqmedeba iwvevs neonatalur intoqsikacias an wa- avtori im qalebs, romlebic iReben fsiqotropul wa-
mlis moqmedebis an moxsnis sindromis Sedegad. mag., mlebs, saerTod ar urCevs ZuZuTi kvebas. ufro prag-
im axalSobilebs, romelTa dedebic iRebdnen trici- maturi Tvalsazrisi mocemulia britaneTis erovnul
klur antidepresants, aReniSnebaT moxsnis sindromi formularSi.
kankaliT, RebinebiT, kvebis problemebiT da gulyre-
biT. aRwerilia, aseve, pirdapiri antiqolinerguli ra vqnaT, roca Terapiuli efeqti ar aris
efeqti kuW-nawlavis traqtis hipoperistaltikiT da 1. iRebs wamals pacienti rekomendaciis mixedviT?
Sardis buStis hipotoniiT. es reaqciebi, miuxedavad pirvelad unda gadamowmdes, iRebs Tu ara igi daniS-
imisa, rom Zalian problemuria, ukvalod gaivlis. nul dozas. SeiZleba pacientma ver gaigos instru-
arsebobs monacemebi orsulobis bolo periodSi qcia an SiSobdes, rom srulma dozam ar gamoiwvios
susi-ebis gamoyenebis Sedegad axalSobilis Wirveu- arasasurveli Sedegi. zog pacients hgonia, rom is
lobis, hipoglikemiis, kunTTa hipotoniisa da sun- damokidebuli gaxdeba wamalze, Tu mas regularu-
Tqvis problemebis momatebuli riskis Sesaxeb (Sanz lad miiRebs. SeiZleba iyos raime sxva mizezebic.
et al., 2005). liTiumTan dakavSirebuli perinataluri 2. iRebs pacienti raime sxva wamals, romelsac SeuZlia
intoqsikacia vlindeba dune Cvilis sindromis saxiT, zegavlena moaxdinos fsiqotropuli medikamentis
rasac axlavs cianozi da hipotonia, xolo benzo- metabolizmze an farmakologiur moqmedebaze?
diazepinebiT mkurnalobas axlavs Termoregulaciis sxvadasxva nivTierebebis arasworma miRebam SeiZ-
darRvevebi, sunTqvisa da kvebis problemebi. leba zegavlena moaxdinos fsiqotropuli wamlebis
cxovelebze Catarebuli kvlevebis Sedegad aR- Terapiul moqmedebaze.
moCnda, rom nayofze fsiqotropuli medikamentebis
_ 562 _
fsiqiatriaSi gamoyenebuli medikamentebis klasifikacia
3. sworia diagnozi? wamlis dozis momatebamde unda marTalia, fsiqotropuli wamlebis farmakologiu-
gadamowmdes diagnozi da mkurnalobis Sesabamisoba. ri moqmedeba cnobilia, magram am farmakologiuri mo-
fsiqotropuli medikamenturi mkurnalobis araefe- qmedebis neirofsiqologiuri Sedegebi da sxvadasxva
qturoba aris fsiqiatriuli referalis yvelaze xSi- sindromis dros am neirofsiqologiuri cvlilebis
ri mizezi. konkretuli darRvevis specifikuri far- klinikur gaumjobesebad gardaqmna kargad ar aris
makologiuri midgoma mocemulia Sesabamis TavebSi. garkveuli. dReisTvis klasifikaciis saukeTeso gza
_ esaa maTi Terapiuli gamoyenebis mixedviT dayofa,
magram imis gaTvaliswinebiT, rom sxvadasxva klasis
fsiqiatriaSi gamoyenebuli wamlebis Terapiuli efeqti SeiZleba mniSvnelovnad
medikamentebis klasifikacia daemTxvas erTmaneTs.
wamlebs, romlebic ZiriTadad fsiqopaTologiur wamlebis jgufebi aq ar aris ganxiluli rigis mi-
simptomebze moqmedeben, fsiqotropuli preparatebi xedviT. TiToeuli jgufisTvis mocemulia Terapiu-
ewodebaT. fsiqiatrebi, aseve, iyeneben antiparkinso- li efeqti, farmakologia, xelmisawvdomi prepara-
nul preparatebs fsiqotropuli wamlebis gverdiTi ti, farmakokinetika, arasasurveli efeqti (rogorc
moqmedebis kontrolisTvis. antikonvulsantebs sul Cveulebrivi dozis gamoyenebisas, aseve maRali dozis
ufro mzardi roli eniWeba guneb-ganwyobis aSlilo- toqsikuroba) da ukuCveneba. zogadi rCevebi exeba Ti-
bebis samkurnalod. Toeuli jgufis yoveldRiur praqtikaSi gamoyenebas,
fsiqotropuli wamlebi iyofa sxvadasxva jgufebad, xolo specifikuri, konkretuli darRvevis mkurna-
rac mocemulia cxrilSi 21.1, magram maTi Terapiuli lobis Sesaxeb informacia mocemulia Sesabamis TavSi.
moqmedeba ar Tavsdeba erT diagnostikur kategoria- wamlebi, romlebic gamoiyeneba mxolod erTi darR-
Si. mag., susi-ebi klasificirebulia antidepresante- vevis dros, mag., disulfirami _ alkoholizmis dros
bad da iniSneba didi depresiis samkurnalod, magram an qolinesTerazas inhibitorebi _ demenciis dros,
misi Terapiuli efeqti aseve gamoiyeneba SfoTviTi ganxilulia im TavebSi, romlebic am klinikur sin-
mdgomareobebis, obsesiur-kompulsuri aSlilobebisa dromebs exeba.
da kvebiTi aSlilobebis dros. aseTi farTo speqtris
moqmedeba ar niSnavs, rom CamoTvlili sindromebi anqsiolizuri medikamentebi
depresiis formebia, aramed niSnavs, rom Tavis tvin- iseTi anqsiolizuri medikamentebi, rogorebicaa benzo-
Si 5-HT funqciis gaaqtiurebis neirofsiqologiuri diazepinebi, farTod gamoiyeneba da xSirad Seusabamo-
efeqti karg Sedegs iZleva sxvadasxva fsiqikuri aS- dac. anqsiolizuri wamlis gamoweramde yovelTvis mniS-
lilobis dros. vnelovania SfoTvis mizezis gamoZieba da misi modifi-
cxrili 21.1 klinikuri fsiqotropuli wamlebis klasifikacia

wamlebis klasi magaliTi Cveneba
antifsiqozuri fenoTiazinebi Sizofreniisa da maniis mwvave mkurnaloba, Sizofreniis

profilaqtika
butirofenonebi
benzamidis warmoebulebi
antidepresantebi tricikluri antidepresantebi didi depresia (mwvave da profilaqtikuri mkurnaloba)
maoi-ebi SfoTviTi aSliloba, obsesiur-kompulsiuri aSliloba
ssui-ebi (susi-ebi)
guneb-ganwyobis liTiumi maniis mwvave mkurnaloba

stabilizatorebi
karbamazepini guneb-ganwyobis ganmeorebadi aSlilobis profilaqtika
anqsiolitikebi benzodiazepinebi generalizebuli SfoTviTi aSliloba
azapironebi (buspironi)
saZile saSualebebi benzodiazepinebi insomnia
ciklopirolonebi (Z-wamlebi)
fsiqostimulantebi amfetamini bavSvTa asakis hiperkinetikuli sindromi
modafinili narkolefsia
_ 563 _
cireba. gasaTvaliswinebelia isic, rom garkveul pro-
boqsi 21.3 zogierTi im wamlis
blemaze SfoTva pacientisTvis am problemis mogvarebis
naxevardaSlis periodi, romlebic
motivaciaa. amitom nebismieri SfoTvis droebiT moxsna,
moqmedebs gaem-benzodiazepinuri
Soreuli perspeqtivis TvalsazrisiT gamarTlebuli ar receptorebis kompleqsze
aris. benzodiazepinis jgufis anqsiolitikebis miReba
diazepami 20-100 saaTi*
gansakuTrebiT sasargebloa xanmokle periodSi, krizi-
sis an specifikuri problemis dasaZlevad. qlordiazepoqsidi 5-30 sT*
tolerantoba da wamaldamokidebuleba gansakuTre- lorazepami 8-24 sT
buli problemaa barbituratebisa da benzodiazepine-
temazepami 5-11 sT
bis jgufis anqsiolizuri preparatebis SemTxvevaSi.
vinaidan benzodiazepinebi ufro farTod gamoiyeneba, zaleploni 1-1,5 sT
ganxilva am jgufiT iwyeba. specifikuri SfoTviTi aS- zopikloni 4-6 sT
lilobebis samkurnalod sul ufro xSirad mimarTa-
zolpidemi 1,5-2 sT
ven antidepresantebs, magram maTi Terapiuli aqtivoba
qlormeTiazoli 4-6 sT (moxucebSi 4-12 sT)
benzodiazepinebisgan gansxvavebulia. SfoTviTi aSli-
lobebis dros maTi gamoyenebis Cveneba ganxilulia am qlorali 6-8 sT
nawilSi, xolo detaluri farmakologia _ antidepre- * - aqtiuri metaboliti
santebis Sesaxeb monakveTSi. mocemuli nawilis gac-
nobisas unda gvaxsovdes, rom fsiqologiuri mkurna- qlordiazepoqsidi, alprazolami da klonazepami.
loba aris SfoTviTi aSlilobebis efeqturi marTva, diazepami swrafad absorbirdeba da misi miReba SeiZ-
iZleva ufro myar efeqts mkurnalobis Sewyvetis Sem- leba rogorc xangrZlivad, aseve `saWiroebis dros~.
degac da gverdiTi moqmedebac naklebi aqvs. alprazolami Zlieri benzodiazepinia da efeqturia
benzodiazepinebi panikuri aSlilobis SemTxvevaSi. aseTi Terapiuli
efeqti mxolod alprazolams ar aqvs; aseve efeqtu-
farmakologia ria klonazepamis eqvivalenturi dozac.
benzodiazepinebs aqvs ramdenime moqmedeba: flumazenili benzodiazepinis receptoris antago-
w anqsiolizuri nistia, romlis farmakologiuri moqmedebac sustia,
w sedaciuri da saZile magram sxva benzodiazepinebis moqmedebas blokavs.
w kunTTa relaqsaciuri amitom misi gamoyeneba efeqturia benzodiazepinuri
w antikonvulsiuri mwvave, Seqcevadi intoqsikaciis dros, Tumca axlavs
maTi farmakologiuri moqmedeba xdeba specifiku- benzodiazepinis moxsnis sindromis gamowvevis riski.
ri receptorebis adgilas, romlebic moTavsebulia flumazenili ixmareba mxolod intravenurad.
supramolekulur kompleqsSi gama-amino-erbos mJavas
(gaem) receptorebTan erTad. benzodiazepinebi aZlie- farmakokinetika
rebs gaem-is gadacemas da am gziT arapirdapirad benzodiazepinebi swrafad Seiwoveba, mZlavrad uka-
cvlis sxva, mag., noradrenaluri da serotoninuli vSirdeba plazmis cilebs, magram lipofilobis gamo
neirotransmiteruli sistemebis aqtivobas. swrafadve aRwevs Tavis tvinSi. metabolizdeba mraval
nivTierebad, romelTa umetesobasac TviTon aqvs Te-
xelmisawvdomi preparatebi rapiuli efeqti. temazepami da oqsazepami diazepamis
xelmisawvdomia bevri benzodiazepini, romlebic erT- metabolitebia. eqskrecia ZiriTadad SardiT xdeba.
maneTisgan gansxvavdeba benzodiazepinis recepto- xanmokle naxevardaSlis periodis mqone benzodia-
rebze moqmedebis ZaliT da plazmaSi naxevardaSlis zepinebs, rogorebicaa temazepami da lorazepami,
droiT (boqsi 21.2). zogadad, Zlieria is benzodia- aqvT 3-hidroqsilis jgufi, rac iZleva araaqtiur
zepinebi, romlebsac mokle naxevardaSlis periodi glukuronidebad erTsafexuriani gardaqmnis saSua-
aqvs da iwvevs wamaldamokidebulebasa da moxsnis sin- lebas. sxva benzodiazepinebi, rogorebicaa diazepami
droms. xanmokle naxevardaSlis periodis (<12 sT-ze) da klorazepati, metabolizdeba gaxangZlivebuli mo-
benzodiazepinebs miekuTvneba lorazepami, tazepami qmedebis iseT warmoebulebad, rogoricaa, mag., desme-
da lormetazepami. Tildiazepami, romelic Terapiulad aqtiuria.
SfoTvis marTvisTvis, wamaldamokidebulebis pro- am bolo xanebSi fsiqozebis dros, dasamSvideblad,
blemis gamo, umjobesia SedarebiT xangrZlivmoqmedi xSirad gamoiyeneba benzodiazepinebi (umetesad daba-
benzodiazepinebis gamoyeneba, maSinac ki, roca iniS- li doziT da antifsiqozurebTan erTad). aseT situa-
neba xangamoSvebiT an `saWiroebis dros~. xangrZlivi ciaSi benzodiazepinebi SeiZleba dainiSnos parentera-
moqmedebis benzodiazepinebs miekuTvneba diazepami, lurad, magram kunTSiga ineqciisas cudi absorbciis
_ 564 _
gamo diazepami SeiZleba Seicvalos lorazepamiT. bas (Ashton, 2004).
benzodiazepinebis moxsnis sindroms axasiaTebs
arasasurveli efeqti sxvadasxva simptomebi:
pacientebi benzodiazepinebs kargad itanen. Tu is
w cudi winaTgrZnoba, SfoTva, insomia
iniSneba anqsiolizuri efeqtis gamo, ZiriTadi gver-
w tremori
diTi moqmedeba ukavSirdeba maRali dozebis sedaciur
Tvisebas, rasac SeiZleba axldes ataqsia da Zilianoba w gulisreva
(gansakuTrebiT moxucebSi), iSviaTad _ konfuziuri w aRqmul stimulze gaZlierebuli mgrZnobeloba da
azrovneba da amnezia. msubuqad gamoxatulma Ziliano- perceptuli darRvevebi
bam da koordinaciis darRvevam SeiZleba problemebi w depresia da suiciduri azrebi
Seqmnas avtomobilis marTvis dros an aparaturasTan
w epilefsiuri gulyrebi (iSviaTad)
muSaobisas. amasTan, aseTi pacientebi TviTon ver xv-
debian, rom aqvT problemebi; amitom benzodiazepine- vinaidan am simptomTa didi nawili axasiaTebs Sfo-
bis (gansakuTrebiT xangrZlivi moqmedebis) daniSvnis TviT aSlilobas, Zneli gasarkvevia, arsebuli simpto-
dros pacienti unda gavafrTxiloT, rom arsebobs mebi moxsnis sindromis nawilia Tu im SfoTviTi aSli-
garkveuli safrTxeebi da alkoholis gamaZlierebeli lobis recidivi, risTvisac Tavdapirvelad dainiSna
efeqti. sifrTxilis dacva gansakuTrebiT mniSvnelo- benzodiazepini. perceptuli darRvevebi upiratesad
vania moxucebis, Tirkmlisa da RviZlis problemebis benzodiazepinis moxsnis sindroms axasiaTebs.
mqone pacientebis SemTxvevaSi. moxsnis sindromi iwyeba xanmokle moqmedebis ben-
miuxedavad imisa, rom benzodiazepinebi amcire- zodiazepinis Sewyvetidan 2-3 dReSi, xolo gaxangr-
bs daZabulobas da agresias, im pirebs, romlebsac Zlivebuli moqmedebis benzodiazepinis Sewyvetidan _
aqvT agresiuli qcevisadmi midrekileba, inhibiciis 7 dReSi. simptomebi gaivlis 3-10 dReSi. moxsnis sin-
gamo SeiZleba agresia gauZlierdeT. am mxriv is wa- dromis ganviTareba ufro xSiria xanmokle naxevar-
agavs alkoholis moqmedebas. es SesaZlo efeqti ga- daSlis periodis benzodiazepinebze. Tu benzodia-
Tvaliswinebuli unda iyos anamnezSi bavSvze Zala- zepinebi dainiSna xangrZlivi periodis ganmavlobaSi
dobis an impulsuri agresiuli qcevis mqone pirebis misaRebad, moxsna unda moxdes TandaTanobiT, ramde-
SemTxvevaSi. nime kviris manZilze (Schweizer, Rickels, 1998). aseT Se-
mTxvevaSi moxsnis simptomebi minimaluria an saerTod
toqsikuri efeqti ar vlindeba.
benzodiazepinebs naklebad aqvs toqsikuri efeqti.
azapironebi (buspironi)
zedmeti dozirebis SemTxvevaSi seriozuli proble-
mebi arcTu ise xSiria, radgan es medikamenti ise ar Cveneba da farmakologia
aqveiTebs sunTqvas da arteriul wnevas, rogorc bar- azapironis klasis medikamentebidan erTaderTi xel-
bituratebi. amis miuxedavad, aRwerilia benzodiaze- misawvdomi aris buspironi. is efeqturia generali-
pinebis fataluri intoqsikaciis iSviaTi SemTxvevebi. zebuli SfoTviTi aSlilobis samkurnalod, magram
araefeqturia panikuri aSlilobis dros. benzodia-
sxva wamlebTan urTierTqmedeba zepinebisgan gansxvavebiT, buspironis anqsiolizuri
benzodiazepinebi, sxva sedaciuri anqsiolitikebis efeqti vlindeba miRebis dawyebidan ramdenime dRis
msgavsad, aZlierebs alkoholis da sxva iseTi wamle- Semdeg. yuradsaRebia, rom buspironi ar gamoiyeneba
bis efeqts, romlebic centralur nervul sistemaze benzodiazepinis moxsnis sindromis samkurnalod.
damTrgunvelad moqmedebs. aRwerilia sunTqvis mniS- farmakologiurad buspirons ar aqvs kavSiri ben-
vnelovani depresia benzodiazepinebis da klozapinis zodiazepinebis receptorebTan, magram astimulire-
kombinirebuli gamoyenebis dros. bs 5-HT receptorebis qvetips _ 5-HT1A receptors.
es receptorebi dafiqsirebulia Tavis tvinis Reros
wamaldamokidebuleba da moxsnis sindromi
raphe nuclei-Si, sadac is aregulirebs serotoninuli
miCneulia, rom wamaldamokidebuleba Cndeba benzo- ujredebis sxeulebis agznebas. buspironi amcirebs
diazepinebis xangrZlivi miRebis Sedegad. sixSire da- serotoninuli neironebis agznebis xarisxs da amiT
mokidebulia wamalze da dozaze da saSualod Sead- aqveiTebs serotoninis neirotransmisias Tavis tvinis
gens 50%-s. benzodiazepinebs axasiaTebs toleranto- garkveul ubnebSi. es moqmedeba warmoadgens misi anq-
ba da moxsnis sindromi. miuxedavad imisa, rom wamlis siolizuri moqmedebis safuZvels.
moZiebis qceva SedarebiT iSviaTia, is mainc SeiZleba
aRiniSnebodes. xSirad es qceva ukavSirdeba ramdenime farmakokinetika da arasasurveli efeqti
wamlis borotad gamoyenebas da wamaldamokidebule- buspironis sistemuri moqmedeba sustia, radgan misi
_ 565 _
pirveladi metabolizmi intensiuria. gverdiTi moqme- Zlivia, mogvianebiTi (tardiuli) diskineziis riski
debis profili benzodiazepinebisgan gansxvavebulia. mainc arsebobs.
mag., buspironiT mkurnaloba ar iwvevs sedacias, ma-
gram mkurnalobis dasawyisSi iwvevs saerTo sisutes, beta-adrenoreceptorebis antagonistebi,
romlebic gamoiyeneba SfoTvis dros
nevrozulobas da Tavis tkivils. buspironis tole-
rantobisa da wamaldamokidebulebis Sesaxeb Zalian am jgufis wamlebi amcireben SfoTvis Tanmxleb iseT
cota monacemebi arsebobs, magram mainc saWiroa win- vegetatiur simptomatikas, rogoricaa taqikardia. es
daxedulebis gamoCena. medikamentebi gansakuTrebiT efeqturia, roca Sfo-
Tvis mqone pacientis ZiriTadi Civilia guliscemis
sxva wamlebTan urTierTqmedeba aCqareba an tremori, gansakuTrebiT socialur si-
buspironi ar axdens gansakuTrebul zegavlenas sxva tuaciaSi. Sesabamisi medikamentia propranololi _
medikamentebze, mxolod maoi-ebTan kombinirebisas doziT 20-40 mg 3-jer dReSi. ukuCvenebaa: gulis ga-
fiqsirdeba arteriuli wnevis momatebis riski. mtareblobiTi blokada, sistoluri wnevis daqveiTeba
(<90 mm vercxliswylis sv.) an bradikardia (<60/wT)
antidepresantebi, romlebic gamoiyeneba SfoTvis da bronqospazmis anamnezi. beta-adrenoreceptorebis
dros
antagonistebis gamoyenebas iSviaTad SeiZleba axl-
antidepresantebi, Cveulebriv, xsnis SfoTvas, rome- des gulis ukmarisoba da ar unda dainiSnos atrio-
lic axlavs depresiul aSlilobas. iTvleba, rom tri- ventrikuluri kvanZis blokadis dros, radgan is am-
cikluri antidepresantebi, benzodiazepinebis msgav- cirebs atrio-ventrikulur kvanZsa da hisis konaSi
sad, efeqturia generalizebuli SfoTviTi aSlilo- impulsebis gadacemas. SeiZleba gamoiwvios reinos
bisa da panikuri aSlilobis dros, miuxedavad imisa, sindromis gauareseba, xolo diabetis SemTxvevaSi _
axlavs Tu ara mniSvnelovani depresiuli simptomebi. hipoglikemia.
aseve, orive _ susi-ebi da maoi-ebi, efeqturia paniku-
ri aSlilobis samkurnalod, magram ara maprotilini, rCevebi, pacientis marTvis Sesaxeb
romelic noradrenalinis ukumitacebis seleqciuri anqsiolizuri wamlis daniSvnamde unda gairkves Sfo-
inhibitoria. ukanaskneli kvlevebiT dadasturda, rom Tvis mizezi. sasurvelia, klasificirdes SfoTviTi
susi-ebi efeqturia socialuri fobiisa da obsesiur- aSliloba, raTa sworad SeirCes medikamenti. unda
kompulsuri aSlilobis samkurnalod (Bandelow et al., gvaxsovdes, rom SfoTviTi sindromis SemTxvevebSi,
2002). miuxedavad medikamenturi mkurnalobis efeqturobi-
SfoTviTi aSlilobis dros gamoyenebuli antide- sa, fsiqologiuri mkurnalobac Sedegis momcemia da
presantebis Terapiuli profili gansxvavebulia ben- pacientisTvis ufro sasurveli. wamlebi praqtiku-
zodiazepinebisgan. antidepresantis efeqtis dadgo- lad mxolod maSin unda dainiSnos, Tu fsiqologiuri
mas didi dro sWirdeba, gansakuTrebiT panikuri aS- mkurnaloba ver Catarda an ar aRmoCnda efeqturi.
lilobis dros; SesaZlebelia, dasawyisSi simptomebis generalizebuli SfoTviTi aSlilobis mqone pacien-
gauaresebac ki moxdes. amis miuxedavad, maTi moqme- tebis umetesobisTvis yuradRebis gadatana sakuTar
debis efeqti saboloo jamSi ar Camouvardeba ben- cxovrebiseul problemebze, saubris SesaZlebloba
zodiazepinebisas, Tanac naklebad axlavs kognituri sakuTar gancdebze da rwmena eqimis mimarT sakmarisia
problemebi (Nutt, Bell, 1997), aseve, tolerantoba da imisTvis, rom SfoTva asatan donemde Seumcirdes. Tu
damokidebuleba, Tumca uecarma Sewyvetam SeiZleba saWiroa anqsiolitiki, unda dainiSnos benzodiazepi-
gamoiwvios abstinenciis sindromi. ni xanmokle vadiT (araumetes 3 kvirisa) da moixsnas
TandaTanobiT. wamaldamokidebuleba ufro xSiria
antifsiqozurebi, romlebic gamoiyeneba SfoTvis
alkoholis problemis arsebobis SemTxvevaSi. Tu pa-
dros
cienti wamals iRebs ramdenime kvira, igi unda gavafr-
am jgufis wamlebs iSviaTad xmaroben anqsiolizuri TxiloT, rom moxsnis Semdeg ramdenime dRe SeiZleba
efeqtisTvis. iseTi dabali dozebiT gamoyenebisas, hqondes daZabuloba.
romlebic ar iwvevs gverdiT moqmedebas (mag. 1, 0 preparati diazepami SeiZleba dainiSnos xangamoSve-
mg flupenTiqsoli), isini benzodiazepinebze metad biT da xangrZlivi mkurnalobisTvis. `saWiroebis Se-
efeqturi ar aris. miuxedavad amisa, antifsiqozu- mTxvevaSi~ diazepamis gamoyeneba niSnavs _ mis dabali
rebi gamoiyeneba im or iSviaT SemTxvevaSi, roca doziT miRebas, tolerantobisa da damokidebulebis
SfoTva persistentulia da pacienti wamaldamoki- dabal risks. mZime generalizebuli SfoTviTi aSli-
debulia an, roca gamoxatuli aqvs agresiuloba da lobis xangrZlivi mkurnalobisTvis umjobesia anti-
anqsiolitikebis disinhibiciuri efeqti sustia. da- depresantebis gamoyeneba.
bali dozis SemTxvevaSic ki, Tu mkurnaloba xangr- antidepresantebi efeqturia panikuri aSlilobis
_ 566 _
dros, magram maTi miRebis sawyis etapze arsebobs
simptomuri gauaresebis riski, rac eqimsac unda ax-
cxrili 21.2 antifsiqozuri wamlebi
sovdes da pacientsac unda ganemartos. amitom sjobs fenoTiazinebi
w qlorpromazini
dabali doziT dawyeba (mag., 10 mg imipramini an 5 mg
w Tioridazini
citaloprami). Zlieri benzodiazepinebi alprazola- w pipoTiazini
mi da klonazepami _ efeqturia panikuri aSlilobis w trifluoperazini
w flufenazini
dros, magram SeiZleba gamoiwvios kognituri gauare-
seba da moxsnis sindromi. maTi gamoyeneba SeiZleba im TioqsanTinebi
w flupenTiqsoli
SemTxvevebSi, roca sxva mkurnaloba uSedegoa. rezis- w klopenTiqsoli
tentul SemTxvevebSi SeiZleba maoi-ebis gamoyenebac
butirofenonebi
(Bandelow et al., 2002). w haloperidoli
sxva anqsiolizuri wamlebi unda SemovinaxoT im spe-
dibenzodiazepinebi
cifikuri saWiroebebisTvis, razec zemoT iyo saubari:
w klozapini
beta-adrenoreceptorebis antagonistebi _ SfoTvis w olanzapini
Tanmxlebi guliscemis gaZlierebisa da tremoris kon-
dibenzoTiazepini
trolisTvis; antifsiqozuri wamlebis dabali dozebi w qvetiapini
_ sedaciuri anqsiolitikebis susti disinhibiciuri
benzamidis warmoebulebi
efeqtis (mag., anomaliurad agresiul pacientebTan) an w sulpiridi
wamaldamokidebulebis SemTxvevebisTvis. w amisulpridi
benzisoqsazoli
saZile medikamentebi w risperidoni
saZile anu hipnozuri medikamentebi is wamlebia, rom-

an masTan axlos. am ukanasknels miekuTvneba zopiklo-
lebic gamoiyeneba Zilis gasaumjobeseblad. bevri an-
ni, zolpidemi da zaleploni (e.w. Z-wamlebi). benzo-
qsiolizuri medikamenti moqmedebs rogorc saZile da
diazepinis receptorebis antagonisti flumazenili
maT Sesaxeb zemoT iyo saubari. saZile wamlebi far-
warmoadgens am wamlebis antidots. sxva xelmisawvdo-
Tod da xangrZlivad gamoiyeneba, rac maCvenebelia in-
mi saZileebia: qloralhidrati (an misi warmoebulebi),
somniis, rogorc simptomis, sixSiris (Ohayon, Lemoine,
qlormeTiazoli da sedaciuri antihistaminebi (gan-
2004). insomnia umetesad gvxvdeba qalebsa da moxuce-
sakuTrebiT es ukanaskneli mravalgvari dasaxelebis
bSi. insomniis fsiqologiuri mkurnaloba efeqturia
gamodis).
da ufro xangrZliv Sedegs iZleva, vidre medikamen-
benzodiazepinebidan, saZile saSualebad gamoiyeneba
turi (Morin et al., 1999).
xanmokle moqmedebis iseTi preparatebi, rogorebicaa
farmakologia temazepami da lormetazepami, radgan abstinenciis Se-
idealurma saZile medikamentma unda gaaumjobesos darebiT susti efeqti axasiaTebT (ix. boqsi 21.3.). sxva
Zilis xangrZlivoba da xarisxi ise, rom ar hqondes benzodiazepinebi, romlebic aseve saZileebad iTvle-
rezidualuri efeqti diliT. es ise unda moxdes, rom ba, flurazepami da nitrazepami, xangrZlivi moqmede-
ar Seicvalos Zilis paterni da ar ganviTardes moxs- bisaa, magram miRebis meore dRes axasiaTebT kognitu-
nis sindromi. samwuxarod, arc erTi wamali bolom- ri funqciis daqveiTeba.
de ar akmayofilebs am kriteriumebs. iseTi wamlis zopikloni ciklopirolonia; igi, saZile benzodia-
warmoeba, romelic imoqmedebs mTeli Ramis Zilze, zepinebTan SedarebiT, naklebad cvlis Zilis arqite-
gamoiyofa srulad da ar datovebs sedaciur efeqts qturas. yvelaze damaxasiaTebeli gverdiTi moqmedebaa
diliT, arcTu ise iolia. mware gemo pirSi, aseve, SeiZleba axldes cnobierebis
saZile saSualebebis umetesoba aZlierebs gaem-is paTologia, amnezia da depresiuli guneb-ganwyobac.
moqmedebas benzodiazepinis receptorebze an moqme- zolpidemi da zaleploni msgavsi medikamentebia, ma-
debs gaem-is mezobel makromolekulur kompleqsze. gram ufro xanmokle naxevardaSlis periodiT. zale-
Zilis gasaumjobeseblad iyeneben aseve antihistami- plons dReisTvis arsebul saZileebs Soris yvelaze
nebsa da sedaciuri antidepresantebis dabal dozebs, xanmokle moqmedebis dro aqvs (1 saaTi). misi gamoyene-
amitriptilinsa da trazodons. ba rekomendebulia `saWiroebis SemTxvevaSi~, kerZod,
roca pacienti SuaRamisas iRviZebs da veRar axerxebs
xelmisawvdomi preparatebi CaZinebas.
saZile wamlebi, romlebsac yvelaze xSirad xmaroben, gaem-ze moqmedi saZile saSualebebidan bavSvebisa
benzodiazepinebia an arabenzodiazepinuri ligandebi, da moxucebisTvis rekomendebulia qloralhidrati.
romlebic moqmedeben benzodiazepinis receptorebze radgan igi iwvevs kuWis gaRizianebas, saWiroa misi
_ 567 _
cxrili 21.3 atipuri antifsiqozurebi

wamali eps* prolaqtini wonis mateba mavne efeqti
amisulpridi + +++ + insomnia, SfoTva, gulisrevis SegrZneba, yabzoba, Q-T

intervalis gaxangrZliveba (iSviaTad)
sulpiridi + +++ + insomnia, SfoTva, RviZlis funqciis darRvevebi
klozapini 0 0 +++ agranulocitozi _ aucilebelia leikocitebis monitoringi,

miokarditi da miopaTia (iSviaTad), daRliloba, gabrueba,
piris simSrale, oflianoba, taqikardia, posturuli
hipotenzia, gulisrevis SegrZneba, yabzoba, gauvaloba, Sardis
Sekaveba, gulyrebi, diabeti
olanzapini +/0 + +++ somnolencia, Tavbrusxveva, SeSupeba, hipotenzia, piris

simSrale, yabzoba, diabeti
qvetiapini 0 0 ++ somnolencia, Tavbrusxveva, posturuli hipotenzia, piris

simSrale, RviZlis funqciis darRvevebi, Q-T intervalis
gaxangrZliveba (tranzitoruli)
risperidoni + +++ ++ insomnia, SfoTva, foriaqi, Tavis tkivili, koncentraciis

daqveiTeba, gulisrevis SegrZneba, muclis tkivili
zotepini = +++ +++ yabzoba, piris simSrale, insomnia, Zilianoba, advilad daRla
aripirazoli 0 0 0 SfoTva, insomnia, gulisrevis SegrZneba, pirRebineba
eps* - eqstrapiramiduli simptomebi: 0 ar aris, + zogjer, ++ xSirad, +++ SeiZleba iyos Zalian xSiri
kargi ganzaveba. qlorali xelmisawvdomia abebis sa- yvelaze mniSvnelovani urTierTqmedeba saZile saSua-
xiTac. klomeTiazol-edizilatic saZilea, romelsac lebebs aqvs alkoholTan, radgan aZlierebs mis zemo-
aqvs antikonvulsiuri Tvisebebi. mas xSirad uniSnaven qmedebas. klomeTiazolis da alkoholis erTdrouli
alkoholdamokidebul pacientebs abstinenciis pre- moqmedeba SeiZleba letaluri gamosavliT damTavr-
venciis mizniT. swored amitom, xSirad, mas SecdomiT des, sunTqvis mZime ukmarisobis ganviTarebis gamo.
miiCneven alkoholizmiT daavadebuli pacietebisTvis amitom gansakuTrebuli yuradRebaa saWiro, roca wa-
gamosadeg saZiled, rac ar aris swori, radgan, sxva mali iniSneba alkoholuri abstinenciis dros. misi
saZileebis msgavsad, masac axasiaTebs wamaldamokide- gamowera ar SeiZleba im pacientebisTvis, romlebic
bulebis ganviTareba, xolo alkoholTan kombinire- agrZeleben alkoholuri sasmelebis miRebas. saZilee-
bisas _ sunTqvis depresia. misi xanmokle moqmedebis bs SeuZliaT sxva wamlebis sedaciuri efeqtis gaZlie-
gamo, mas ufro moxucebs uniSnaven insomniis samkur- rebac (mag., zogi antidepresantis da antifsiqozuri
nalod. arasasurveli efeqtidan, am medikamentis xma- preparatebis).
rebas SeiZleba Tan axldes cemineba, koniunqtivis ga-
rCevebi pacientis marTvis Sesaxeb
Rizianeba da gulisreva.
saZiles daniSvnamde mniSvnelovania gairkves, namdvi-
gverdiTi efeqti lad aqvs Tu ara pacients Zilis problema, da Tu es
zemoT CamoTvlili specifikuri gverdiTi moqmedebe- asea, ra aris amis mizezi. bevr adamians Zilis xangr-
bis garda, yvela saZiles aqvs saerTo arasasurveli Zlivobis Sesaxeb aqvs araadekvaturi warmodgena. maT
efeqtic. amaTgan yvelaze mniSvnelovania rezidua- SeiZleba arc icodnen, rom Zilis xangrZlivoba Suax-
luri efeqti, romelsac pacienti meore dRes Seigr- nis da moxucebulobis asakSi klebulobs. zogi dRi-
Znobs Senelebisa da gabruebis saxiT. msgavsi efeqti siT CaTvlems da Tvlis, rom RamiT Cveuli xangrZli-
naklebad vlindeba xanmokle moqmedebis preparatebis vobis Zili unda hqondes. zogi iTxovs saZile abebs
gamoyenebisas. sxva Tanmxleb problemebs miekuTvneba mgzavrobisas uZilobis mosaxsnelad. aseT SemTxveveb-
tolerantobis ganviTareba, roca sawyisi doza pro- Si ki Zilis anazRaureba xdeba momdevno Rames, saZile
gresulad araefeqturia da moxsnis SemTxvevaSi Tavs wamlis gamoyenebis gareSe.
iCens `rikoSetuli~ insomnia, ris gamoc Sewyveta Seu- Zilis darRvevis xSir mizezs warmoadgens alkoho-
Zlebeli xdeba. tolerantobis problema sedaciur an- lis an kofeinis Warbi miReba, xvela, qavili, dispnoe,
tidepresantebs naklebad axasiaTebs, magram maT aqvT SfoTva da depresia. roca arsebobs nebismieri pir-
xangrZlivi moqmedeba da meore dRes vlindeba rezi- veladi mizezi, mkurnaloba sWirdeba mizezs da ara
dualuri fsiqomotoruli efeqti. insomnias. xSirad mxolod Zilis higienuri wesebis da-
cva sakmarisia mis mosawesrigeblad (gv. ??) Tu mainc
urTierTqmedeba saWiro xdeba saZiles daniSvna, aucilebelia saZile
_ 568 _
saSualebebi dainiSnos mxolod ramdenime dRiT. kli- dros. aseve, gamoiyeneba Sizofreniis recidivis pro-
nicistma es unda ganumartos pacients da gaafrTxi- filaqtikisTvis. 1952 wels, qlorpromazinis SemoRe-
los, rom SesaZloa wamlis Sewyvetas mohyves mousve- bis Semdeg, Sizofreniis mkurnaloba mniSvnelovnad
nari Zilis ramdenime Rame, magram wamlis miReba ar gaumjobesda da gaCnda axali fsiqotropuli wamlebis
unda gavagrZeloT. aRmoCenis SesaZlebloba, romlebic dReisTvis xelmi-
bavSvebisTvis saZileebis daniSvna ar aris gamar- sawvdomia.
Tlebuli, garda Ramis SiSebis an somnambulizmis er-
Teuli gamonaklisebisa. sifrTxiliT unda daeniSnoT farmakologia
saZileebi moxucebs, vinaidan RamiT sawolidan adgo- antifsiqozuri wamlebi (cxrili 21.2) axdens dofami-
misas maT SeiZleba gamoiwvion cnobierebis abneva, nis receptorebis blokirebas. es miiCneva maTs Tera-
rasac SesaZloa, mohyves sxeulis dazianeba. stacio- piul moqmedebad, rac dadasturda in vitro dofaminuri
narSi rutinuli gamoyenebis gamo bevri pacienti da- receptorebis blokirebiT.
mokidebuli xdeba saZileebze. sasurvelia, rom aseTi dofaminuri receptorebi sxvadasxva bioqimiur da
rutinuli gamoyeneba Sewydes manam, sanam pacients bi- morfologiur qvetipebad iyofa. antifsiqozuri wa-
naze gaweren. mlebis umetesoba mWidro kavSirs qmnis dofamin-D2
britanuli saxelmZRvanelo principebis mixedviT receptorTan, rac ganapirobebs antifsiqozur moq-
(UK National Institute for Clinical Excellence, 2004e) saZi- medebas da moZraobiTi darRvevis warmoSobas. pozi-
le wamlebis miReba SeiZleba mxolod xanmokled, tronul-emisiuri tomografiuli (pet) kvlevis mona-
gamomfitavi insomniis dros. amasTan, zopiklonis, cemebis safuZvelze ivaraudeba, rom antifsiqozuri
zolpidemis da zaleplonis gamoyeneba ar aris reko- efeqti miiRweva maSin, roca D2 receptorebis 60-70%
mendebuli, radgan ar arsebobs benzodiazepinebTan dakavebulia. ufro maRali donis SemTxvevaSi vlin-
maTi upiratesobis maCvenebeli faqtebi; aseve, maTi deba eqstrapiramiduli moZraobiTi aSlilobebi da
maRali fasis gamo. hiperprolaqtinemia (Kapur et al., 1999).
gansxvaveba tipiur da atipiur antifsiqozur wam-

lebs Soris
ase ewodeba wamlebs, romlebic amcirebs fsiqomoto-
termini atipiuri antifsiqozuri preparatebi SemoRe-
rul agznebas da akontrolebs fsiqozur simptomebs.
buli iqna imisTvis, rom ganesxvavebinaT erTmaneTis-
am preparatebis alternatiuli saxelebia neirolep-
gan axali antifsiqozurebi iseTi Zveli preparatebis-
tikebi da didi trankvilizatorebi. arc erTi es ter-
gan, rogorebicaa qlorpromazini da haloperidoli.
mini ar aris srulyofili. dasaxeleba _ neirolepti-
miuxedavad imisa, rom terminis _ àtipiuri~, gansazR-
ki, asaxavs ufro wamlis gverdiT movlenebs da ara mis
vreba literaturaSi sxvadasxvaa, atipiuri antifsi-
Terapiul efeqts, xolo termini `didi trankviliza-
qozurebis ZiriTadi maxasiaTebeli aris antifsiqozu-
tori~, ar asaxavs maT yvelaze mniSvnelovan klinikur
ri efeqti eqstrapiramiduli gverdiTi moqmedebis ga-
moqmedebas. mocemul wignSi gamoyenebulia termini
reSe. es ganmarteba namdvilad ar aris srulyofili,
àntifsiqozuri~, romelic britanuli farmacevtuli
radgan aseTi moqmedeba aqvs, mag., haloperidolsac
cnobaridanaa aRebuli.
sakmaod dabali doziT gamoyenebisas. erTi ram namd-
antifsiqozuri wamlebi ZiriTadad iniSneba haluci-
vilad sworia: atipiur antifsiqozurebs SedarebiT
naciis, bodvis, aJitaciis da fsiqomotoruli agzne-
naklebad aqvT eqstrapiramiduli gverdiTi moqmedeba
bis Sesamcireblad Sizofreniis, maniis an fsiqozis
cxrili 21.4 antifsiqozuri depo-preparatebis zogierTi farmakokinetikuri maxasiaTebeli

depo plazmaSi pikuri stabiluri mdgoma- daniSvnis ekvivalenturi
koncentraciis dro (dRe) reobis dro (kvira) sixSire (kvira) doza (mg)
flupenTiqsol-dekanoati 7-10 8 2 40
flufenazin-dekanoati 1-2 8 2 25
haloperidol-dekanoati 3-9 1 2 100
pipoTiazin-palmitati 9-10 8-12 4 5
zuklopenTiqsol-dekanoati 4-7 8 2 200
risperidonis gaxangrZlivebuli 28 6 2 25
moqmedebis inieqcia
adaptirebulia Taylor, 1999.
_ 569 _
Terapiuli dozebiT gamoyenebis dros. tenzias. antiqolinerguli moqmedeba vlindeba pi-
aseve, iTvleba, rom atipiuri antifsiqozuri wamle- ris simSraliT, Sardvis problemebiT da Sekrulo-
bi tipiur preparatebTan SedarebiT, ufro metad au- biT, xolo, meores mxriv, amcirebs eqstrapiramidu-
mjobesebs fsiqozis pozitiur da negatiur simptomebs. li gverdiTi efeqtis ganviTarebis albaTobas.
maSin, roca atipiuri antifsiqozuri klozapinis Se- 2. piperidinis naerTebi, rogorebicaa Tioridazini da
mTxvevaSi es namdvilad asea, bolo dros warmoebuli pipoTiazini, qlorpromazinis msgavsia, magram aqvT
preparatebi am kriteriums ver akmayofilebs. am mxriv Zlieri antimuskarinuli moqmedeba, ris gamoc nak-
gansakuTrebiT gamoirCeva amisulpiridi, risperidoni lebad axlavT moZraobiTi darRvevebi.
da olanzapini (Davis et al., 2003). aumjobeseben Tu ara
3. piperazinis naerTebi, rogorebicaa trifluopera-
kognitur unarebs Sizofreniis SemTxvevaSi atipiuri
zini an flufenazini, yvelaze metad aris arCeviTad
antifsiqozurebi Zvel preparatebze ufro metad, jer
dofaminuri receptorebis antagonisti, amitom nak-
kidev aqtiuri kvlevis procesSia (Mortimer, 2004).
lebad aqvT sedaciuri da metad _ eqstrapiramidu-
tipiuri (konvenciuri) antifsiqozuri prepa- li efeqti.
ratebis farmakologia
TioqsanTenebi da butirofenonebi
yvela es wamali dofaminis receptorebis efeqturi
TioqsanTenebs, rogorebicaa flupenTiqsoli da
antagonistia, magram bevr maTgans aqvs damatebiTi
klopenTiqsoli, aqvs fenoTiazinis msgavsi struqtu-
farmakologiuri Tvisebebi, rac ganapirobebs gver-
ra. Terapiuli efeqti waagavs piperazinis jgufi-
diT efeqtebs.
sas. butirofenonebs, maT Soris haloperidols, aqvs
fenoTiazinebi: gamoyofen fenoTiazinebis sam jgufs:
gansxvavebuli struqtura, magram klinikurad Tioq-
1. aminoalkilis naerTebi, rogoricaa qlorpromazini, sanTenebis msgavsia. isini dofaminis receptorebis an-
romelic alfa-1-adrenoreceptorebis, histamin-H1- tagonistebia da naklebad moqmedebs sxva neirotras-
receptorebis da muskarinuli qolinerguli recep- miterebis receptorebze. ar iwvevs sedacias, magram
torebis antagonistia. alfa-1-adrenoreceptore- xSiria eqstrapiramiduli gverdiTi moqmedeba.
bis da histamin-H1-receptorebis blokadis xarjze
qlorpromazins aqvs sedaciuri moqmedeba, amasTan, atipiuri antifsiqozuri wamlebis farmakologia
alfa-1-adrenoreceptorebis blokada iwvevs hipo- (ix. cxrili 21.3)
seleqciurad D2 receptorebis antagonistebi. ati-
cxrili 21.5 antifsiqozuri wamlebis piur antifsiqozur preparatebs aqvT gansxvavebuli
zogierTi arasasurveli moqmedeba farmakologia. ukanasknel xans gamoyofen 2 jgufs.
erTi esaa benzamidis warmoebulebi, rogorebicaa
antidofaminerguli efeqti
moZraobis darRvevebi: sulpiridi da amisulpridi. es wamlebi gansakuTrebu-
w mwvave distonia li arCeviTobiT moqmedebs rogorc D2 receptorebis
w akaTizia antagonistebi da, dauzustebeli mizezis gamo, nakle-
w parkinsonizmi bad iwvevs eqstrapiramidul moZraobiT darRvevebs;
w tardiuli diskinezia am medikamentebs arc sedaciuri da antiqolinerguli
antiadrenerguli efeqti moqmedeba axasiaTebs; amasTan, iwvevs plazmaSi prola-
w sedacia qtinis mniSvnelovan zrdas.
w posturuli hipotenzia 5-HT2-D2 receptorebis antagonistebi. atipiuri an-
w eakulaciis inhibicia tifsiqozurebis meore did jgufs aqvs 5-HT2 recep-
antiqolinerguli efeqti torebis antagonisturi moqmedeba. sxva mxriv, am jgu-
w piris simSrale fSi Semavali preparatebi mniSvnelovnad gansxvavde-
w ofldenis Semcireba bian erTmaneTisgan, mag., D2 receptorebis blokirebis
w Sardvis Sekaveba unariT (Meltzer, 2004). risperidoni aris rogorc 5-HT2
w yabzoba receptorebis, aseve dofaminis D2 receptorebis an-
w bundovani mxedveloba tagonisti. mas aseve aqvs alfa-1-adrenoreceptore-
w glaukomis ganviTareba bis blokirebis unari, rac iwvevs msubuq sedacias da
sxva efeqtebi hipotenzias. zotepins risperidonis msgavsi farmako-
w kardiuli ariTmia logiuri Tvisebebi aqvs, magram SedarebiT naklebia
w wonis mateba da diabeti 5-HT2, vidre D2 receptorebze gavlena. mas aseve Zlie-
w amenorea ri antihistaminuri moqmedeba axasiaTebs, ris gamoc
w galaqtorea iwvevs wonaSi matebas.
w hipoTermia
olanzapini D2 receptorebis SedarebiT susti anta-
_ 570 _
gonistia, vidre risperidoni, magram aqvs antiqoli- antifsiqozuri wamlebis gaxangrZlivebuli moq-
nerguli da histamin-H1-receptorebis mablokirebeli medebis formebi
moqmedeba. amitom is Zlieri sedaciuri efeqtiT ga-
antifsiqozuri wamlebis gaxangrZlivebuli moq-
moirCeva. qvetiapini Tanamedrove 5-HT2 receptorebis
medebis formebi rekomendebulia im pacientebisT-
antagonistia SedarebiT sustad gamoxatuli D2 re-
vis, romlebsac recidivis prevenciisTvis mudmivad
ceptorebis blokirebis unariT. moZraobiTi darRve-
sWirdebaT antifsiqozuri mkurnaloba, magram maTi
vebic SedarebiT iSviaTad viTardeba.
regularuli miReba garantirebuli ar aris. aseTi
sertindoli 5-HT2 receptorebis antagonistia
`depo~ preparatebia flufenazin-dekanoati, flupen
sustad gamoxatuli D2 receptorebis antagonis-
Tiqsol-dekanoati, zuklopenTiqsol-dekanoati, ha
turi moqmedebiT. sertindoli iwvevs klinikurad
loperidol-dekanoati da pipoTiazin-palmitati. yo
mniSvnelovani Q-T intervalis gaxangrZlivebas
veli maTgani keTdeba kunTSi da zeTovani xsnaria.
eleqtrokardiogramaze da misi gamoyeneba amJamad
zuklopenTiqsolis acetatis plazmuri koncentraci
SeCerebulia. ziprazidoni aris 5-HT2 da D2 recep-
is piki miiRweva 1-2 dReSi da mas aqvs ufro xanmokle
torebis kidev erTi antagonisti, romlis klinikuri
moqmedeba sxva depo-preparatebTan SedarebiT. is
gamocdac amJamad mimdinareobs. is gansxvavdeba sxva,
gamoiyeneba mwvave fsiqozis myisieri kontrolisT-
zemoT aRwerili 5-HT2/D2 receptorebis antago-
vis, Tumca, is, Tu ra upiratesoba aqvs mas sxva depo-
nistebisgan, radgan is, aseve, ukavSirdeba 5-HT1A
preparatebTan SedarebiT, dadgenili ar aris. amJamad
receptorebs da aris noradrenalinis ukumitacebis
xelmisawvdomia risperidonis gaxangrZlivebuli moq-
inhibitori. ziprazidonis maxasiaTebeli gverdiTi
medebis inieqciac.
moqmedebaa somnolencia da Tavbrusxveva, magram igi
SedarebiT naklebad iwvevs wonis matebas. mas aqvs farmakokinetika
Q-T intervalis gaxangrZlivebis tendencia da ami- antifsiqozuri preparatebi kargad absorbirdeba.
tom britaneTSi klinikur praqtikaSi misi gamoyeneba peroraluri miRebisas RviZlismieri metabolizmi
akrZalulia. aripiprazoli aris dofaminis nawilo- nawilobriv sruldeba, roca portuli sistemis gav-
brivi agonisti, romelsac aqvs 5-HT2 receptorebis liT preparati sisxlSi gadadis (pirveladi metabo-
mablokirebeli unari. mas aqvs gamaaqtivebeli gav- lizmi). antifsiqozuri wamlebi advilad ukavSirdeba
lena da iseTi dofaminerguli gverdiTi moqmedeba, cilebs.
rogoricaa insomnia, gulisreva da pirRebineba. is amisulpridis garda, romelic ucvlelad gamoiyo-
naklebad iwvevs wonis matebas an eqstrapiramidul fa TirkmelebiT, antifsiqozuri medikamentebi aqtiu-
simptomebs. rad metabolizdeba RviZlSi da warmoqmnis sxvadasxva
garkveuli TvalsazrisiT, es atipiuri preparatebi aqtiur da pasiur metabolitebs. mag., qlorpromazi-
Seqmnes klozapinis farmakologiuri efeqtis mis- nis micemis Semdeg, sisxlsa da SardSi aRmoCenilia 75
aRebad. es aris pirveli antifsiqozuri preparati, sxvadasxva metaboliti. metabolizmis aseTi sirTule
romelic iZleva aSkara Sedegebs iseT SemTxvevebSi, medikamentis plazmuri koncentraciis gansazRvris
rodesac Cveulebrivi antifsiqozuri preparatebi klinikur mniSvnelobas akninebs da amitomac iSviaTad
araefeqturia. amasTan, mas ar axasiaTebs gverdiTi gamoiyeneba. antifsiqozuri preparatebis umetesobis
eqstrapiramiduli darRvevebi da amitomac miiCneva naxevar-daSlis dro (daaxloebiT 20 sT) iZleva maTi
atipiur antifsiqozur medikamentad (Kane et al., 1988). dReSi erTjeradad miRebis saSualebas. qvetiapins
klozapini aris dofaminis D2 receptorebis susti an- aqvs 7-saaTiani naxevar-daSlis dro da rekomendebu-
tagonisti, magram aqvs Zlieri swrafva 5-HT2 recep- lia misi dReSi orjeradi miReba.
torebisadmi. is aseve ukavSirdeba sxva neirotrans- depo-preparatebis farmakokinetikuri profili mni
miterebis receptorebsac, maT Soris H1-histaminis, Svnelovnad gansxvavdeba standartuli preparatebis-
5-HT2, alfa-1-adrenergul da muskarinul qoliner- gan. yvela nivTierebisTvis, garda zuklopenTiqsolis
gul receptorebs (Meltzer, 2004). sxvadasxva kvlevebSi acetatisa, saWiroa ramdenime kvira plazmaSi stabi-
miuTiTeben Terapiuli plazmuri koncentraciis sx- luri donis misaRwevad (cxrili 21.4). es niSnavs, rom
vadasxva cifrebze; misaRebi kompromisia 350-500 g/l. mkurnalobis Sewyvetis Semdegac recidivi SedarebiT
is, Tu ra aris klozapinis Zlieri efeqtis farma- gvian viTardeba.
kologiuri safuZveli, bundovania. cnobilia, rom
klozapinis gamoyenebisas maRalia leikopeniis riski, wamlebis urTierTqmedeba
ris gamoc misi gamoyeneba SezRudulia. klozapiniT antifsiqozuri wamlebi aZlierebs sxva centralur
mkurnalobis dros hematologiuri monitoringi ganx- sedatiur preparatebs. maT SeiZleba Seanelon tri-
ilulia qvemoT. cikluri antidepresantebis da antikonvulsante-
bis RviZlismieri metabolizmi da gamoiwvion maTi
_ 571 _
plazmuri koncentraciis momateba. qlorpromazinis bodes aJitacia suiciduri ideaciiT. akaTizia Sei-
hipotenziurma efeqtma SeiZleba gaaZlieros antihi- Zleba arasworad miviCnioT fsiqozis gauaresebad
pertenziuli medikamentebis, maT Soris ACE-inhibi- da SecdomiT gavzardoT antifsiqozuri preparatis
torebis, efeqti. doza. Cveulebriv, aseTi efeqti viTardeba mkur-
antifsiqozurma wamlebma, kerZod, pimozidma da nalobis dawyebidan pirveli ori kviris manZilze,
Tioridazonma, SeiZleba gamoiwvios Q-T intervalis Tumca, SeiZleba, ganviTardes ramdenime Tvis Sem-
gaxangrZliveba, amitomac es medikamentebi ar unda degac. akaTizia srulad ver kontroldeba antipa-
dainiSnos amave efeqtis mqone sxva wamlebTan, anti- rkinsonuli wamlebiT. beta-adrenoreceptorebis
ariTmiul preparatebTan, astemizolTan da terfena- antagonistebi da benzodiazepinis xanmokle kursi
dinTan, cisapridsa da triciklur antidepresanteb- SeiZleba efeqturi aRmoCndes. saukeTeso strate-
Tan erTad. aRwerilia gulis ariTmiis riskis moma- giaa antifsiqozuri wamlebis dozis SeZlebisdagva-
teba pimozidis klaritromicinsa da eriTromicinTan rad Semcireba.
kombinirebisas. klozapini ar unda dainiSnos iseT 3. parkinsonuli sindromi _ antifsiqozuri medika-
preparatTan erTad, romelic amcirebs leikocitebis mentebiT gamowveul parkinsonul sindroms axasia-
raodenobas, mag., karbamazepinTan, kotrimoqsazolsa Tebs akinezia, saxis amimia, siarulisas asocirebuli
da penicilaminTan erTad. susi-ebi anelebs RviZl- moZraobebis simcire, rigidoba, tlanqi tremori,
Si metabolizms da zrdis antifsiqozuri wamlebis moxrili poza da, mZime SemTxvevebSi, specifikuri
plazmur koncentracias, maT Soris haloperidolis, aCqarebuli, mokle da patara nabijebiT siaruli. es
risperidonisa da klozapinis. sindromi umetesad Tavs iCens mkurnalobis dawye-
bidan ramdenime Tvis Semdeg da zogjer SeiZleba
arasasurveli efeqti
spontanurad, antifsiqozuri wamlebis dozis Sem-
sxvadasxva antifsiqozuri wamlebis umetesobas aqvs
cirebis gareSec alagdes. simptomebis kontroli
saerTo arasasurveli gverdiTi moqmedeba, rac ukav-
SesaZlebelia antiparkinsonuli wamlebiT. miuxeda-
Sirdeba maTs antidofaminergul, antiadrenergul da
vad amisa, ar aris rekomendebuli antiparkinsonuli
antiqolinergul moqmedebas (cxrili 21.5). TiToeuli
wamlebis damateba rutinulad, profilaqtikisTvis,
wamlis moqmedebis gacnoba SesaZlebelia britanul
radgan yvela pacientTan ar aris saWiro maTi ga-
farmacevtul cnobarSi. aq mocemulia mxolod xSirad
moyeneba. amasTan, am tipis wamlebs zogjer arasa-
gamoyenebuli wamlebis gverdiTi moqmedebis zogadi
surveli moqmedebac aqvs _ SeiZleba gamoiwvios,
paternebi.
mag., mwvave organuli sindromi, gaauaresos an ga-
eqstrapiramiduli efeqtebi moaaSkaravos Tanmxlebi mogvianebiTi (tardiuli)
diskinezia.
aseTi efeqtebi dakavSirebulia bazalur gangliebze
(qerqqveSa kvanZebze) antidofaminergul moqmedebas- 4. tardiuli diskinezia _ sakmaod seriozuli garTu-
Tan. ukve aRvniSneT, rom am preparatebis antidofa- lebaa, radgan, sxva eqstrapiramiduli efeqtisgan
minerguli moqmedeba mezolimbur da mezokortikul gansxvavebiT, antifsiqozuri wamlebis moxsnis Sem-
ubnebze gansazRvravs maTs Terapiul efeqts. atipiu- degac SeiZleba narCundeba. mas axasiaTebs ReWviTi
ri preparatebi ufro metad moqmedeben am ukanasknel da woviTi moZraobebi, grimasebi, qoreoaTetozuri
velebze, vidre qerqqveSa kvanZebze da moZraobiTi moZraobebi da, iSviaTad, akaTizia. moZraobebi Ziri-
darRvevebic ufro iSviaTia. eqstrapiramiduli sis- Tadad saxisaa, magram SesaZloa gavrceldes kidu-
temis gamovlinebebi iyofa 4 jgufad (Barnes and Spen- rebsa da sasunTq kunTebze. es sindromi SeiZleba
ce, 2000): ganviTardes antifsiqozuri medikamentebis miRebis
gareSec, magram ufro xSiria mkurnalobis dawye-
1. mwvave distonia _ viTardeba mkurnalobis dawyebi-
bidan ramdenime wlis Semdeg. igi zogjer SeiZle-
dan mokle droSi, upiratesad axalgazrda mamaka-
ba ganviTardes dofaminis receptorebis mabloki-
cebSi. SedarebiT xSiria butirofenonebis da fe-
rebeli wamlebis sxva mizniT gamoyenebis drosac,
noTiazinebidan piperazinis jfufis gamoyenebisas.
mag., kuW-nawlavis qronikuli problemebis dros
ZiriTadi niSnebia tortikolizi, enis protruzia,
metoklopramidis miRebis SemTxvevaSi.
grimasebi, opistotonusi da sxvadasxva tipis iseTi
qceva, romelic SeiZleba SecdomiT miCneul iqnes epidemiologia. tardiuli diskinezia ufro xSirad
isteriulad. kontroli miiRweva antiqolinerguli emarTebaT qalebs, asakovan pirebs da im pacientebs,
medikamentebis frTxili kunTSiga ineqciiT. romlebsac aqvT Tavis tvinis difuzuri paTologia.
guneb-ganwyobis aSlilobis diagnozi risk-faqtoria.
2. akaTizia _ aris fizikuri mousvenrobisa da moZra-
tardiuli diskinezia 2-dan 1 SemTxvevaSi antifsiqo-
obis survilis usiamovno SegrZneba, rac pacients
zuri wamlebis Sewyvetis Semdeg qreba. misi sixSire
ar aZlevs gaCerebis saSualebas. SeiZleba aRiniSne-
_ 572 _
sxvadasxva kvleviT gansxvavebulia, magram Sizofre- receptorebis blokators da ojaxuri anamnezi dis-
niis im SemTxvevebSi, romelTa mkurnalobisTvisac toniaze uaryofiTia. mkurnaloba, xSir SemTxvevaSi,
xangrZlivad gamoiyeneba antifsiqozuri preparate- araefeqturia. distonia grZeldeba antifsiqozuri
bi, saSualod 20%-s Seadgens. arsebuli monacemebiT, wamlebis moxsnisa da antiqolinerguli wamlebis da-
tardiuli diskineziis sixSire iseTi atipiuri antif- niSvnis Semdegac. arsebobs monacemebi, rom mdgomare-
siqozurebis xmarebis dros, rogorebicaa klozapini, oba SeiZleba gaumjobesdes klozapiniT mkurnalobi-
olanzapini da risperidoni, haloperidolTan Seda- sa da, aseve, Sesabamis kunTebSi botulinis toqsinis
rebiT ufro dabalia (Kane, 2004; Jeste, 2004). miuxeda- lokaluri inieqciebiT.
vad amisa, mainc arsebobs iSviaTi SemTxvevebi.
paTofiziologia. tardiuli diskineziis mizezi antiadrenerguli moqmedeba
dauzustebelia, Tumca, SesaZloa, es iyos xangrZlivi aseT moqmedebas miekuTvneba sedacia, posturuli hi-
dofaminerguli blokirebiT gamowveuli momatebuli potenzia refleqsuri taqikardiiT, cxviris gaWedi-
mgrZnobeloba dofaminis mimarT. am mosazrebas adas- loba, eakulaciis inhibicia. arteriul wnevaze gavle-
turebs is faqtic, rom tardiuli diskinezia mwvav- na ZiriTadad kunTSi inieqciis dros vlindeba, Tumca
deba antifsiqozuri preparatebis moxsnisa an anti- moxucebSi SeiZleba gamovlindes wamlis nebismieri
qolinerguli antiparkinsonuli wamlebis daniSvnis formiT miRebis dros.
SemTxvevaSi (rac, savaraudod, bazalur gangliaSi
antiqolinerguli moqmedeba
qolinerguli da dofaminerguli sistemebis Semdgomi
disbalansiT aixsneba). amgvar moqmedebas miekuTvneba piris simSrale, Sardis
mkurnaloba. tardiuli diskineziis samkurnalo be- Sekaveba, yabzoba, oflis gamoyofis Semcireba, bundo-
vri sxvadasxva meTodi arsebobs, magram arc erTi ar vani mxedveloba, iSviaTad _ glaukoma.
aris universaluri. amitom mniSvnelovania, rom, ram-
sxva moqmedeba
denadac es SesaZlebelia, im pacientebs, romlebic mi-
aRwerilia kardialuri gamtareblobiTi defeqtis
drekilni arian amgvari garTulebisken, maqsimalurad
_ ariTmiis iSviaTi SemTxvevebi. ekg-cvlilebebidan
SeezRudoT xangrZlivi antifsiqozuri mkurnaloba.
yvelaze xSiria Q-T intervalis gaxangrZliveba da
amasTan, aseTi mkurnalobisas saWiroa monitorin-
T-talRis cvlilebebi. pimozidis gamoyenebas axlavs
gis Catareba, raTa droulad gamovlindes moZraobis
seriozuli kardiuli ariTmia. rekomendebulia dozis
darRvevebi. diskineziis aRmoCenisTanave unda Sewydes
SerCeva ekg-monitoringiT. kvlevebma gamoavlina Tio-
antifsiqozuri mkurnaloba, Tu fsiqikuri mdgomare-
ridazinis gavlena Q-T intervalis gaxangrZlivebaze,
oba iZleva amis saSualebas.
ris gamoc britaneTSi misi gamoyeneba SeizRuda.
miuxedavad imisa, rom wamlis moxsnis Semdeg tar-
SeiZleba ganviTardes guneb-ganwyobis daqveiTeba
diuli diskinezia SeiZleba gauaresdes, xSirad isec
da depresia, magram es rTuli Sesafasebelia, radgan
xdeba, rom ramdenime Tvis Semdeg mdgomareoba umjo-
aranamkurnalevi Sizofreniis SemTxvevaSic SesaZloa
besdeba. Tu diskinezia mainc grZeldeba an antifsi-
SevxvdeT depresiul periodebs. mezolimburi nawilis
qozuri mkurnalobis Sewyveta SeuZlebelia, sasurve-
dofaminuri receptorebis Warbi blokadis Sedegad
lia atipiuri preparatebis gamoyeneba, rogorebicaa
namdvilad SesaZlebelia ganviTardes anhedonia da
olanzapini an qvetiapini, romlebsac SedarebiT sus-
motivaciis daqveiTeba, rac iZleva depresiisa an Si-
tad gamoxatuli dofamin-receptorebis antagonis-
zofreniis negatiuri simptomebis imitacias.
turi moqmedeba axasiaTebT. wamlis Secvlam zog Se-
endokrinuli da metaboluri cvlilebebidan SeiZ-
mTxvevaSi SeiZleba gamoiwvios remisia. sxva gamocdil
leba ganviTardes wonis mateba, gansakuTrebiT qlor-
saSualebebs miekuTvneba E-vitamini, romlis efeqtu-
promazinis da atipiuri antifsiqozurebis, olanza-
robis Sesaxebac urTierTgamomricxavi informacia
pinis, zotepinisa da klozapinis, gamoyenebis dros
arsebobs.
(cxrili 21.3). Sizofrenia TavisTavad ukavSirdeba
tardiuli distonia diabetis momatebul risks, romelic gansakuTrebiT
miuxedavad imisa, rom es ori darRveva SeiZleba Ta- izrdeba antifsiqozuri preparatebis gamoyenebis
naarsebobdes, tardiuli diskinezia unda diferen- dros, rac nawilobriv ganpirobebulia Tanmxlebi
cirdes tardiuli distoniisgan, romlis drosac mo- wonis matebiT. atipiuri antifsiqozuri preparatebi
ZraobiTi darRvevebi xangrZlivadaa SenarCunebuli. ufro metad iwvevs glukozis mimarT tolerantobis
tardiuli distonia sxva idiopaTuri distoniebisgan daqveiTebas, vidre konvenciuri antifsiqozuri wam-
_ blefarospazmisa an tortikolizisgan, klinikurad lebi. aris Tu ara gansxvaveba atipiur preparatebs
ar gansxvavdeba. wamlismieri tardiuli distoniis Soris _ es davis sgania, Tumca, yvelaze metad gamoyo-
diagnozi ismeba maSin, roca pacienti iRebs dofaminis fen olanzapinsa da klozapins (Taylor, 2004).
_ 573 _
zogierT qals prolaqtinis donis momatebis gamo aRwerilia fataluri miokarditisa da miokardiopa-
SeiZleba ganuviTardes galaqtorea da amenorea li- Tiis SemTxvevebi. wonis mateba SeiZleba nawilobriv
bidos daqveiTebiTa da seqsualuri disfunqciiT. ganapirobebdes diabetis riskis matebas (amerikis dia-
SesaZloa gaizardos osteoporozis riski. zogierTi betis asociacia, 2004).
atipiuri preparati mniSvnelovnad ar zrdis prola-
qtinis dones (cxrili 21.3). hiperprolaqtinemiis ara- avTvisebiani neirolefsiuri sindromi
sasurveli efeqtis Sesaxeb ix. Wieck, Haddad, 2004. es iSviaTi, magram seriozuli garTuleba aReniSneba
moxucebisTvis mniSvnelovani arasasurveli efeqtia pacientebis mcire nawils, gansakuTrebiT Zlieri an-
hipoTermia. zogi antifsiqozuri wamali, kerZod, ise- tifsiqozuri wamlebis miRebis dros. aRweril mdgo-
Ti susti moqmedebis, rogorebicaa qlorpromazini da mareobaTa umetesoba aris garTuleba, romelic ga-
klozapini, amcirebs gulyrebis zRurbls da epilef- mowveulia Sizofreniis, SedarebiT iSviaTad, maniis,
siis mqone pacientebis SemTxvevaSi zrdis gulyrebis depresiuli aSlilobisa da samedicino problemebis
ganviTarebis sixSires. qlorpromaziniT xangrZlivma Sedegad gaCenili fsiqozuri simptomebis samkurna-
mkurnalobam SeiZleba gamoiwvios fotosensitivo- lod daniSnuli antifsiqozuri preparatebiT. am sin-
ba, pigmentis dagroveba kanSi, rqovanasa da brolSi, dromisken midrekilebas iwvevs liTiumis kombinacia
xolo maRali dozebiT miRebulma Tioridazinma (>800 antifsiqozur preparatebTan. antifsiqozuri prepa-
mg/dR) _ baduris degeneracia. ratebis gamoyenebis SemTxvevaTa saerTo sixSire 0,
fenoTiazinebma, kerZod, qlorpromazinma, SeiZleba 2%-s Seadgens.
gamoiwvios qolestazi siyviTliT, magram misi sixSire sindromi, magram ara yovelTvis, pirvel 10 dReSi
dabalia (daaxloebiT 0, 1%). iSviaTia sisxlis ujre- vlindeba. klinikuri suraTi aCvenebs motoruli, fsi-
duli diskrazia, da umetesad gvxvdeba klozapinis Se- qikuri da avtonomiuri darRvevebis swraf ganviTa-
mTxvevaSi. SesaZlebelia ganviTardes kanze gamonaya- rebas (Cveulebriv 24-72 saaTSi), rasac axlavs hiper-
ri. pireqsia:
w gamoxatuli motoruli simptomi aris kunTTa ge-
klozapinis arasasurveli efeqti
neralizebuli hipertonia. yelisa da gulmkerdis
klozapinis gamoyeneba ukavSirdeba leikopeniis mniSv- kunTebis daWimulobam SeiZleba gamoiwvios disfa-
nelovan risks (daaxloebiT 2-3%), rac SeiZleba gadai- gia da dispnoe;
zardos agranulocitozSi. pirveli 18 kviris ganma-
w fsiqikuri simptomebi moicavs akinezur mutizms,
vlobaSi yovelkvireuli, xolo momdevno kvirebSi _ 2
stupors an cnobierebis daqveiTebas;
kviraSi erTxel sisxlis saerTo analizis gadamowmeba
w hiperpireqsia viTardeba avtonomiuri darRvevebiT
aucilebelia. erTi wlis Semdeg Semowmebis sixSire
_ arteriuli wnevis arastabilurobiT, taqikar-
SeiZleba Semcirdes da TveSi erTxel gakeTdes. ase-
diiT, Warbi oflianobiT, nerwyvdeniTa da Sardvis
Ti intensiuri monitoringiT aRmoCenili leikopeniis
SeukaveblobiT;
SemTxvevaSi, unda moixsnas klozapini, rasac mohyve-
ba leikocitebis raodenobis aRdgena. aseTi midgoma w sisxlSi kreatinin-fosfokinazas (kfk) done mkve-
mniSvnelovnad amcirebs, magram ar xsnis, agranulo- Trad izrdeba da matulobs leikocitebis raode-
citozis progresirebis risks. Cveulebriv, rekomen- noba;
debulia, rom klozapini gamoyenebul iqnes antifsi- w meoradi garTulebebia pnevmonia, Tromboembolia,
qozuri monoTerapiis saxiT. cxadia, ar unda moxdes kardiovaskuluri kolafsi da Tirkmlis ukmarisoba.
iseT preparatTan kombinireba, rogoricaa karbamaze- neirolepsiuri sindromis letalobis sixSire uka-
pini, romelic aseve iwvevs leikocitebis raodenobis nasknel wlebSi Semcirda, magram mainc 10%-s aRwe-
Semcirebas. vs. mdgomareoba swordeba oraluri neiroleptikis
Klozapini, sustad gamoxatuli dopaminis D2 recep- Sewyvetidan 1-2 kviraSi, magram gaxangrZlivebuli mo-
torebis blokirebis gamo, naklebad iwvevs eqstrapi- qmedebis preparatis xmarebis SemTxvevaSi mdgomare-
ramidul moZraobiT darRvevebs, maT Soris tardiul obidan gamosvlis dro SeiZleba 2-3-jer gaizardos.
diskinezias. is ar zrdis plazmaSi prolaqtinis dones, mdgomareobidan gamosvla upiratesad, magram ara yo-
Sesabamisad, galaqtoreac ar axlavs, magram SeiZleba velTvis, xdeba narCeni movlenebis gareSe.
gamoiwvios hipersalivacia, Zilianoba, posturuli diferenciuli diagnozia encefaliti da zogierT
hipotenzia, wonis mateba da hiperTermia. gulyrebi qveyanaSi _ siTburi dakvra. antifsiqozuri wamlebis
SesaZloa mohyves maRali dozebis gamoyenebas. kloza- SemoRebamde fiqsirdeboda msgavsi darRveva katato-
pini sedaciuri nivTierebaa da klozapinsa da benzo- niiT, romelsac zogjer uwodebdnen mwvave letalur
diazepinebTan kombinirebisas, man SeiZleba gamoiwvios katatonias. amgvari mdgomareoba, savaraudod, SeiZ-
sunTqviTi da cirkulaciuri problemebi. iSviaTad leba ganviTardes nebismieri antifsiqozuri wamlis
_ 574 _
gamoyenebisas, magram aRwerili SemTxvevebis umete- ridonis an olanzapinis gamoyenebisas insultis riski
soba ukavSirdeboda haloperidols da flufenazins; sammagdeba da faqtiurad igivea, rac Zveli Taobis
aRwerilia atipiuri antifsiqozurebis, maT Soris antifsiqozuri wamlebis gamoyenebis dros (Herrman et
klozapinis, gamoyenebisasac. mizezi unda ukavSirde- al., 2004).
bodes Warb dofaminergul blokadas, magram is, Tu
dozireba
ratom viTardeba mxolod pacientTa mcire nawilSi,
daudgenelia. doza unda moergos individualur pacients da cvli-
mkurnaloba simptomuria. unda moixsnas wamali, mo- leba unda ganxorcieldes TandaTanobiT. moxucebs,
xdes pacientis gagrileba, SenarCundes siTxis balan- Tavis tvinis dazianebis an epilefsiis mqone da fi-
si da CaerTos interkurentuli infeqciiis mkurnalo- zikurad dauZlurebul pacientebs unda daeniSnoT
ba. efeqturi medikamenturi mkurnaloba ar arsebobs. dabali doza. konkretuli wamlis dozis moZieba Sesa-
kunTTa daWimulobis mosaxsnelad SeiZleba diazepamis Zlebelia britanul erovnul farmacevtul cnobarSi
gamoyeneba. avTvisebiani hiperTermiis SemTxvevaSi Sei- an mwarmoeblis literaturaSi.
Zleba moisinjos dantroleni. aseve, rekomendebulia
pet (pozitronul-emisiuri tomografia) kvleva
dofaminis agonisti bromokriptini. mZime SemTxveve-
rekomendebulia antifsiqozuri wamlebis dabali do-
bSi saWiroa intensiuri Terapia: intubacia, damxmare
zebis gamoyeneba, rac nawilobriv efuZneba pet-kvle-
sunTqva da Tirkmlis ukmarisobis koreqcia.
vebs, romelTa mixedviTac dofamin D2 receptorebis
zog SemTxvevaSi, sindromis CaTavebis Semdeg, Sesa-
adekvaturi blokireba (sul mcire, bazalur ganglie-
Zlebelia imave wamlis usafrTxo gamoyeneba, magram
bSi mainc) miiRweva Cveulebrivi antifsiqozuri wam-
mainc miiCneva, rom, Tu saWiroa antifsiqozurebis ga-
lebis dabali dozebiT _ mag., haloperidolis 5 mg-iT
grZeleba, umjobesia mkurnaloba ganaxldes atipiuri
(cxrili 21.6) (Farde et al., 1989; Kapur et al., 1999). axali
antifsiqozurebiT da daiwyos dabali doziT. sul
preparatebisTvis Sesabamisi pet-is monacemebi xelmi-
mcire, 2 kvira mainc unda gavides, sanam mkurnaloba
sawvdomia da iZleva dozebis mkafio rekomendaciebs.
ganaxldeba.
umetes SemTxvevaSi, rekomendebuli dabali dozebi iZ-
antifsiqozuri wamlebis ukuCveneba leva adekvatur antifsiqozur efeqts. ufro maRali
arsebobs mxolod mcire odenobis absoluturi uku- doza ufro metad amSvidebs pacients, magram axlavs
Cveneba antifsiqozuri mkurnalobisTvis da yoveli mniSvnelovani arasasurveli movlenebi, romelTa na-
konkretuli wamlis SemTxvevaSi ukuCveneba sxvadasxva wilic sakmaod seriozulia (mag., kardiuli ariTmia).
SeiZleba iyos. nebismieri aseTi wamlis gamoyenebamde miRebulia Sexeduleba, rom antifsiqozuri wamle-
sasurvelia, informacia moviZioT britanul farma- bis zomieri dozebis benzodiazepinebTan kombinireba
cevtul cnobarSi. ukuCvenebebia: miasTenia, adisonis ufro usafrTxo da efeqturia, vidre antifsiqozu-
daavadeba, glaukoma (Tu preparats aqvs mniSvnelovani rebis ufro maRali dozebi.
antiqolinerguli moqmedeba) da, klozapinis SemTxve-
antifsiqozuri medikamentebi da uecari
vaSi, Zvlis tvinis funqciis darRvevis nebismieri sikvdilis riski
gamovlineba. Tu pacients daavadebuli aqvs RviZli,
uecari, auxsneli sikvdilis antifsiqozur wamleb-
mas ar unda daeniSnos qlorpromazini; aseve, sxva wam-
Tan kavSiri xangrZlivi debatebis Temaa. pacientebs,
lebic sifrTxiliT unda SevurCioT. sifrTxilis da-
romlebsac aqvT Sizofrenia da mkurnaloben antif-
cvaa saWiro Tirkmlis daavadebis, kardio-vaskuluri
siqozuri wamlebiT, ufro xSirad aReniSnebaT gulis
darRvevis, epilefsiis an seriozuli infeqciis dro-
gaCereba da parkuWovani ariTmia, vidre sakontrolo
sac. parkinsonis daavadebis mqone pacientebs zogjer,
jgufis wevrebs. isini, aseve, ufro xSirad kvdebian
dofaminerguli preparatebiT gamowveuli fsiqozuri
moxrCobis gamo (Hennesy et al., 2002; Ruschena et al.,
mdgomareobis koreqciisTvis esaWiroebaT antifsiqo-
2003). yovelive es SeiZleba ukavSirdebodes avadmyo-
zuri wamlebi. amgvar situaciaSi umjobesia atipiuri
fobas an mkurnalobas. cnobilia, rom antifsiqozu-
preparatebis gamoyeneba. antifsiqozurma wamlebma
rebi iwvevs gulis gamtareblobis cvlilebas, xolo
SeiZleba gamoiwvios moZraobis mZime darRvevebi da
iseTi wamlebi, rogoricaa, mag., qlorpromazini _ hi-
cnobierebis moSla demenciis, kerZod, levis sxeule-
potenzias. miuxedavad imisa, rom antifsiqozurebis
bis demenciis dros.
maRali doziT gamoyenebasa da uecar sikvdils Soris
antifsiqozur wamlebs axlavs insultis ganviTare-
kavSiri dazustebuli ar aris, mainc rekomendebulia,
bis riski, amitomac cerebro-vaskuluri daavadebis
klinikuri mdgomareobis mixedviT, maqsimalurad da-
mqone pacientebs isini ar eniSnebaT, Tu fsiqiatriu-
bali dozebis SerCeva. mocemuli sferoSi Semavali
li darRvevis gamo es aucilebeli ar aris. ukanaskne-
problemebi da didi doziT antifsiqozuri wamlebis
li monacemebiT, demenciis mqone pacientebTan rispe-
_ 575 _
gamoyenebis sakiTxi ganxilulia Semdeg wyaroSi: Royal ri gza dasaSvebia haloperidolisa da lorazepamis
College of Psychiatrists, 1993. gamoyenebisas, magram mxolod gamonaklis SemTxveve-
zogierTi, xSirad xmarebuli peroraluri wamlebis bSi. Tu iniSneba haloperidoli, mwvave moZraobiTi
dozebi mocemulia cxrilSi 21.6. praqtikuli sakiTxebi darRvevis riskis Semcireba SesaZlebelia antiqoli-
am wamlebis dozebis Sesaxeb ganxilulia Semdeg nawilSi. nerguli preparatebiT. mniSvnelovania, rom Sefasdes
sunTqvis daTrgunvis albaToba, gansakuTrebiT moxu-
rCevebi, pacientis marTvis Sesaxeb
cebsa da dauZlurebul pacientebSi. xelmisawvdomi
gadaudebeli daxmareba unda iyos benzodiazepinebis antagonisti flumazeni-
antifsiqozuri wamlebi da benzodiazepinebi gamoiye- li (Taylor et al., 2003).
neba SizofreniiT, maniiT an organuli fsiqoziT ga- qvemoT mocemulia mwvave epizodis mqone pacien-
mowveuli fsiqomotoruli agznebis an sxva anomaliu- tis marTvasTan dakavSirebuli ramdenime praqtikuli
ri qcevis sakontrolod. Tu pacienti Zalian agzne- sakiTxi. qcevis darRvevebis gamovlenis adreul eta-
bulia da aqvs anomaliurad agresiuli qceva, Careva pze ar aris ioli maniis Sizofreniisgan diferenci-
qcevis SeZlebisdagvarad swraf kontrolze unda iyos reba; Tumca, unda SevZloT maTi gansxvaveba sxva same-
mimarTuli. Tanamedrove rekomendaciiT, upirateso- dicino mdgomareobiT gamowveuli meoradi fsiqozi-
ba eniWeba haloperidolis dabal dozas (2-5 mg), an sa da pirovnuli aSlilobebiT gamowveuli agresiis
lorazepams (1-4 mg) erTjeradad, an, saWiroebis Se- Setevebisgan. samedicino mdgomareobebs Soris gasa-
mTxvevaSi, maT kombinirebas. mwvave SemTxvevebis dros Tvaliswinebelia epilefsiuri statusi, qala-tvinis
mimarTaven olanzapinis (2, 5-10 mg) kunTSiga inieqciis travma, tranzitoruli globaluri amnezia da hipo-
formas, rogorc alternativas. olanzapinis kunTSi- glikemia. Tu pacienti Warbad moixmars alkohols, ar
ga gamoyenebisas, unda gaviTvaliswinoT ukuCvenebebi, unda daviviwyoT antifsiqozuri wamlebis da benzo-
gansakuTrebiT kardiovaskuluri daavadebebis mqone diazepinebis potenciuri sedaciuri efeqtis safr-
pacientebTan. kunTSiga olanzepini ar unda dainiSnos Txe. aseve, epilefsiuri statusis Semdeg gulyrebis
parenteralur benzodiazepinebTan erTad. maprovocirebeli antifsiqozuri wamlebi sifrTxi-
haloperidoli, olanzapini da lorazepami SeiZleba liT unda vixmaroT.
dainiSnos oralurad an parenteralurad (diazepami damatebiTi informaciis mosapoveblad ix. gv ??.
cudad absorbirdeba intramuskulurad). intravenu-
mwvave epizodis medikamenturi mkurnaloba
gadaudebeli daxmarebis aRmoCenis Semdeg an Tavi-
cxrili 21.6 zogierTi antifsiqozuri medika-
danve naklebad mwvave SemTxvevebSi mkurnaloba unda
mentis doza da D2 receptorebis blokireba
daiwyos oraluri antifsiqozurebis zomieri doze-
wamali doza maqsimalu- D2 receptore- biT. adekvaturad iTvleba haloperidoli 4-12 mg/dR
(oraluri) ri doza (mg) bis dakaveba in
vivo (%) [dRiu- gayofili ramdenime miRebaze, qlorpromazini 150-300
ri doza (mg)]* mg/dR, risperidoni 2-4 mg/dR an olanzapini 10 mg/dR.
qlorproma- 100 1000 80 [200] mkurnalobis adreul etapze raodenoba da dozebs
zini Soris intervali unda SeirCes yoveldRiuri saWiroebis
trifluo- 5 ? 80 [10] Sesabamisad, manam, sanam ar moxdeba yvelaze mwvave simp-
perazini tomebis kontroli. amdenad, regularuli erTjeradi
haloperi- 2 30 80 [4] an orjeradi doza iTvleba adekvatur reJimad. frTxi-
doli lad unda gakeTdes mwvave distoniuri reaqciebis moni-
flupentiq- 1 18 74 [10] toringi mkurnalobis adreul stadiaze. mkurnalobis
soli progresirebasTan erTad, yuradReba unda gamaxvildes
sulpiridi 200 2400 74 [800] parkinsonul gverdiT moqmedebaze da droulad daiwyos
antiparkinsonuli mkurnaloba. moxucebisa da dauZlu-
klozapini 60 900 65 [600]
rebuli pacientebis SemTxvevaSi aucilebelia tempera-
risperi- 2 16 75 [4] turisa da arteriuli wnevis kontroli, raTa droulad
doni
aRmovaCinoT hipoTermia an hipotenzia.
olanzapini 8 20 75 [15] miuxedavad imisa, rom pacientebi antifsiqozuri
aripipra- 5 30 80 [15] wamlebis dawyebidan ramdenime dReSi mSviddebian,
zoli fsiqozuri simptomebis gaumjobeseba TandaTanobiT,
maqsimaluri dozebi mocemulia britanuli erovnuli ramdenime kviraSi xdeba. dReisTvis saukeTeso midgo-
farmacevtuli cnobaris mixedviT
mad iTvleba antifsiqozuri wamlis zomier, stabilur
*Farde, 1989; Nyberg, Farde, 2000; Yokoi, 2002. doneze SenarCuneba da gaumjobesebis dasaCqareblad
_ 576 _
dozis SenarCuneba. im pacientebs, romlebsac mkurna- mebis samkurnalod mxolod antiqolinerguli prepa-
lobis miuxedavad mainc aReniSnebaT SfoTva da dis- ratebi gamoiyeneba. es wamlebi, rogorc centraluri,
tresi, antifsiqozuri wamlis dozis gazrdas, ajobe- aseve periferiuli muskarinuli qolinerguli recep-
bs xanmokled davumatoT benzodiazepinebi. torebis antagonistebia. zogierTs aqvs antihistami-
Tanamedrove rekomendaciiT, atipiur antifsiqo- nuri moqmedebac.
zur wamlebs upiratesoba eniWeba, Tu aris:
xelmisawvdomi preparatebi
w daavadebis pirveli epizodi;
xelmisawvdomia mravali antiqolinerguli wamali da
w Terapiuli efeqti araadekvaturia;
maT Soris mniSvnelovani gansxvaveba ar aris. zogier-
w pacients aReniSneba arasasurveli gverdiTi moqme- Ti avtori mainc upiratesobas aniWebs im preparate-
deba moZraobis darRvevis an hiperprolaqtinemiis bs, romlebic seleqciurad, upiratesad muskarinuli
saxiT; receptorebis M1 qvetipze moqmedebs. aseTia, mag.,
w klozapini naCvenebia sxva atipiuri fsiqozurebis biperideni, romelsac naklebi periferiuli antiqo-
araefeqturobis an autanlobis dros. linerguli moqmedeba axlavs. aseve, gamoiyeneba sxva
preparatebi, rogorebicaa prociklidini da benzheq-
medikamenturi mkurnaloba mwvave epizodis Semdeg soli. orfenadrins da benztropins aqvs kombinirebu-
samedicino mdgomareobebiT gamowveuli meoradi mali histaminuri da antiqolinerguli moqmedeba.
niisa da mwvave fsiqozis epizodebi, Cveulebriv, ra-
mdenime kviraSi amoiwureba, xolo Sizofreniis dros
farmakokinetika
pacientebs esaWiroebaT xangrZlivi, ramdenimeTviani am sferoSi mwiri monacemebi gvaqvs. iTvleba, rom
an wliani mkurnaloba. aseTi SemanarCunebeli mkur- antiqolinerguli preparatebi kargad absorbirdeba
naloba upiratesad gulisxmobs oraluri medikamen- da aqtiurad metabolizdeba RviZlSi. aqtiurad ukav-
tebis dabali dozebiT mkurnalobis gagrZelebas. Tu Sirdeba cilebs. naxevar-daSlis dro ZiriTadad 15-20
pacienti regularulad ar iRebs wamals, umjobesia saaTia.
dainiSnos inieqciuri depo-preparatebi. mkurnalobis
arasasurveli efeqti
dasawyisSi testuri dabali dozis mosinjviT dginde-
ba seriozuli gverdiTi moqmedebis riski (Taylor, 1999), didi doziT miRebam SeiZleba gamoiwvios mwvave or-
dakvirvebis safuZvelze ki _ Semdegi SemanarCunebe- ganuli sindromi, gansakuTrebiT moxucebSi. misi an-
li doza. rogorc zemoT iyo aRniSnuli, depo-prepa- tiqolinerguli aqtivoba SeiZleba daematos antifsi-
ratebs aqvs xangrZlivi naxevar-daSlis dro, amitom qozuri wamlebis moqmedebas da gamoiwvios glaukoma,
esaWiroba ramdenime kvira plazmaSi maqsimaluri kon- xolo prostatis hiperplaziis mqone mamakacebSi _
centraciis misaRwevad. am Tvisebis gaTvaliswinebiT Sardvis problemebi. aseve, SesaZlebelia gamovlindes
unda SeirCes dozis momateba/daklebis tempi da Tan- Zilianoba, piris simSrale da yabzoba. droTa ganma-
daTanobiT moixsnas oraluri antifsiqozurebi, roca vlobaSi, Tu wamlis miReba grZeldeba, es simptomebi
iniSneba depo-preparati. mcirdeba.
mniSvnelovania umciresi dozis dadgena, romliTac Warbi dozis gamoyenebisas orfenadrini SeiZleba
SesaZlebelia simptomebis kontroli. aucilebelia ufro toqsiuri aRmoCndes, vidre sxva antiqoli-
narCeni simptomebisa da wamlis gverdiTi efeqtebis nerguli wamlebi, xolo benztropinma SeiZleba ga-
mudmivi Sefaseba. ar aris sasurveli antiparkinso- moiwvios siTburi dakvra. yvela antiqolinergulma
nuli wamlebis rutinuli gamoyeneba. saWiroebis Se- wamalma SeiZleba gaamwvavos tardiuli diskinezia,
mTxvevaSi unda dainiSnos depo-preparatis inieqcia magram, savaraudod, ar unda iyos predispoziciuri
pirveli dReebis ganmavlobaSi (rodesac plazmuri faqtori (Barnes, Spence; 2000).
koncentracia yvelaze maRalia). wamlebis urTierTqmedeba
antiparkinsonuli medikamentebi iwvevs wamlebis me-
antiparkinsonuli medikamentebi tabolizmSi monawile RviZlis enzimebis inducirebas
fsiqiatriaSi ar xdeba am wamlebis pirdapiri Tera- da, Sesabamisad, antifsiqozuri wamlebis plazmuri
piuli gamoyeneba, aramed ZiriTadad ixmareba tipiuri koncentraciis garkveulad daqveiTebas. rogorc ukve
antifsiqozuri wamlebis eqstrapiramiduli gverdiTi aRvniSneT, antiqolinerguli preparatebi aZlierebs
moqmedebis kontrolisTvis. sxva iseTi wamlebis antiqolinergul moqmedebas, ro-
gorebicaa qlorpromazini da amitriptilini.
farmakologia
idiopaTiuri parkinsonizmis samkurnalo wamlebidan rCevebi pacientis marTvis Sesaxeb
medikamentiT gamowveuli eqstrapiramiduli simpto- rogorc aRvniSneT, antiqolinerguli wamlebi ar unda
_ 577 _
iqnes gamoyenebuli rutinulad, radgan SeiZleba gaa- Sesafaseblad mkurnalobis dawyebidan, sul mcire, 6
Zlieros tardiuli diskinezia. pacientebi, romlebic kviraa saWiro.
iReben inieqciur antifsiqozur depo- preparatebs, an es Seferxeba garkveulad ukavSirdeba farmakokine-
saerTod ar saWiroeben antiqolinergul wamlebs, an tikur faqtorebs. mag., umetesi tricikluri antide-
maTi miReba unda xdebodes inieqciidan mxolod ra- presantebis naxevar-daSlis periodi daaxloebiT 24
mdenime dRis ganmavlobaSi. aRwerilia antiqoliner- saaTia anu plazmaSi stabiluri koncentraciis donis
guli wamlebis borotad gamoyenebis an wamaldamoki- miRweva SesaZlebelia mkurnalobis dawyebidan mxolod
debulebis SemTxvevebi, rac, savaraudod, ukavSirdeba 5-7 dRis Semdeg. miuxedavad amisa, antidepresantebis
guneb-ganwyobis amamaRlebel efeqts. efeqtis Seyovnebis mizezi mxolod es ar unda iyos.
Tu mainc saWiroa antiqolinerguli wamlebis daniS- noradrenalinisa da serotoninis gzebis mniSvnelova-
vna, biperideni (2-12 mg/dR) an prociklidini (5-30 mg/ ni Tviseba is aris, rom Sua tvinSi moTavsebuli ujre-
dR) iTvleba saukeTeso variantad rutinuli gamoye- dis sxeulebi Seicaven inhibitorul autoreceptorebs,
nebisTvis. es wamlebi ZiriTadad iniSneba 3-jer dReSi, romelTa stimulaciac aqveiTebs ujredebis agznebas.
magram maTi naxevar-daSlis dro iZleva ufro nakle- wamlebi, romlebic xels uwyoben sinafsur napralebSi
bi sixSiriT micemis saSualebas. agznebisa da Zilis noradrenalinisa da serotoninis donis swraf matebas
darRvevebis Tavidan asacileblad, kargi iqneba, Tu (triciklurebi da maoi-ebi), dendritebSi noradrenali-
antiqolinerguli wamali ar dainiSneba saRamos saa- nisa da serotoninis gamoTavisuflebis gamo iribad aa-
TebSi misaRebad. qtiureben am avtoreceptorebs. amiT mcirdeba ujredis
sxeulis agzneba da sustdeba antidepresantebiT gamo-
antidepresantebi wveuli neirogadacemis gaaqtiureba.
bioqimiuri da qceviTi kvlevebiT aRmoCnda, rom, Tu
amJamad gamoyenebuli antidepresantebi, mwvave far-
antidepresantebiT mkurnaloba grZeldeba ramdenime
makologiuri moqmedebis mixedviT, SeiZleba daiyos 3
dRe, noradrenalinisa da serotoninis ujredis sxeu-
ZiriTad jgufad:
lebis avtoreceptorebis mgrZnobeloba qveiTdeba,
w monoaminebis ukumitacebis inhibitorebi.prepara-
anu xdeba subsensitiuri. amis Sedegad adrenerguli
tebi, romlebic axdens noradrenalinis da/an 5-HT
da serotoninerguli neironebi Tavisufldeba inhi-
ukumitacebis inhibicias (tricikluri antidepre-
bitoruli ukukavSirisgan da, miuxedavad noradrena-
santebi, susi-ebi, noradrenalinis da serotoninis
linisa da serotoninis maRali sinafsuri koncentra-
ukumitacebis seleqciuri inhibitorebi (snui) da
ciisa, ujredebis sxeulis agzneba normalur dones
noradrenalinis ukumitacebis seleqciuri inhibi-
ubrundeba, rac, savaraudod, damatebiT aZlierebs
torebi (naui).
antidepresantebis noradrenergul da serotoniner-
w monoaminis oqsidazis inhibitorebi (maoi-ebi). pre- gul moqmedebas.
paratebi, romlebic axdenen monoaminis oqsidazis am monacemebis mixedviT, antidepresantebiT mkur-
Seuqcevad (fenelzini da tranilcipromini) an Se- nalobis klinikuri efeqti unda ukavSirdebodes no-
qcevad (moklobemidi) deaqtivacias. radrenalinisa da serotoninis neirogadacemis Tan-
w 5-HT2 receptorebis antagonistebi. am preparatebs daTanobiT gaZlierebas. ukanasknel eqsperimentul
(mianserini, mirtazepini, trazodoni) aqvs rTuli kvlevebze dayrdnobiT gamoiTqva mosazreba, rom mo-
moqmedeba monoaminur meqanizmebze, magram aseve noaminebis gaaqtiureba iwvevs ujredSiga meore mesen-
ablokirebs 5-HT2 receptorebs. jeris, mag., cikluri adenozin-monofosfatis (amf-is)
mZime depresiis farTo speqtrisTvis es wamlebi aqtivacias, rac Tavis mxriv zrdis neironis funqcio-
Tanabrad efeqturia. isini ZiriTadad gansxvavdebian nirebisa da sicocxlisunarianobisTvis aucilebeli
arasasurveli gverdiTi moqmedebebis, toqsikurobisa neirotropuli faqtoris gamomuSavebas. aseTi mode-
da fasis TvalsazrisiT (cxrili 21.7). antidepresan- lis mixedviT, antidepresantebis efeqti gamovlinde-
tebis samive klasis savaraudo moqmedebis meqanizmi ba uSualod sinafsebis plastikurobisa da remodeli-
ganxiluli iqneba rigrigobiT. rebis doneze (Manji et al., 2003).
moqmedebis meqanizmi tricikluri antidepresantebi

ukumitacebis inhibitorebis da maoi-ebis efeqti aris farmakologia
noradrenalinis da/an serotoninis funqciuri aqti- triciklur antidepresantebs aqvT samrgoliani
vobis gaZliereba. es moqmedeba SeiZleba gamoCndes struqtura gverdze mimagrebuli jaWviT. mniSvnelo-
mkurnalobis dawyebidan ramdenime saaTSi, xolo sru- van gansxvavebas warmoadgens gverdiT jaWvSi termina-
li antidepresiuli efeqti vlindeba ramdenime kvi- luri meTilis jgufis arseboba (mesameuli amini) an
ris Semdeg, e.i. antidepresiuli moqmedebis Sedegis ararseboba (meoreuli amini). zogadad, mesameul ami-
_ 578 _
cxrili 21.7 antidepresantebis jgufebi

preparati upiratesoba uaryofiTi mxareebi
tricikluri kargadaa Seswavlili kardiotoqsikuroba*, zedmeti doza saSiSia

antidepresantebi
Terapiul dozaze xangrZlivi antiqolinerguli gverdiTi moqmedeba
seriozuli toqsikurobis ararseboba
zogierTi SemTxvevisTvis saWiro kognituri funqciobis daqveiTeba

sedaciuri efeqti
siiafe xangrZlivi gamoyenebisas wonis mateba
susi-ebi kardiotoqsikurobis ararseboba: mogvianebiTi toqsikuroba srulad Seswavlili ar aris

SedarebiTi usafrTxoeba Warbi
dozirebisas
Snui ar aris antiqolinerguli gastro-intestinuli darRvevebi, seqsualuri disfunqcia
ar axlavs kognituri funqciis sawyis etapze SeiZleba Zilis da SfoTviTi simptomebis

daqveiTeba gauareseba
SedarebiT advilia efeqturi dozis wamlebis urTierTqmedebis maRali riski

micema
siZvire**
trazodoni kardiotoqsikurobis ararseboba***, Zilianoba dRis ganmavlobaSi

Warbi dozirebis SedarebiTi
usafrTxoeba
mianserini ar aris antiqolinerguli kognituri funqciis daqveiTeba
mirtazepini zogierTi SemTxvevisTvis saWiro mZime depresiis dros efeqturoba naklebadaa dadgenili
sedaciuri efeqti
siZvire
* lofepramini mniSvnelovnad gansxvavdeba Cveulebrivi tricikluri antidepresantebisgan.

** trazodonis gamoyenebisas kardiuli ariTmia Zalian iSviaTia.
*** zogierTi generikuli susi-ebi xelmisawvdomia.
nebs (mag., amitriptilins, klomipramins da imipramins) farmakokinetika

meoreul aminebTan SedarebiT, aqvT ufro meti swra-
tricikluri antidepresantebi kargad absorbirdeba
fva serotoninis mitacebis adgilebisken da ufro me-
kuW-nawlavis traqtidan da plazmaSi pikuri koncen-
tad gamoxatuli antagonizmi alfa-1-adrenorecepto-
tracia miiRweva 2-4 saaTSi. triciklurebi mniSvne-
rebisa da muskarinuli qolinerguli receptorebis
lovnad metabolizdeba pirveli gasvlis dros Rvi-
mimarT. amdenad, mesameul aminebs klinikurad ufro
ZlSi da aqtiurad ukavSirdeba cilebs. Tavisufali
metad aqvT gamoxatuli sedacia da antiqolinerguli
fraqcia farTod vrceldeba sxeulis qsovilebSi. zo-
efeqti, vidre meoreul aminebs (mag., desipramins, lo-
gadad, triciklurebis naxevar-daSlis periodis ga-
fepraminsa da nortriptilins).
TvaliswinebiT, ar aris aucilebeli maTi erTjeradze
tricikluri antidepresantebi iwvevs orives _ se-
ufro meti sixSiriT micema.
rotoninisa da noradrenalinis, ukumitacebis inhibi-
triciklurebi metabolizdeba RviZlSi hidroqsi-
cias. maT aseve aqvT antagonisturi moqmedeba sxva-
laciisa da demeTilaciis gziT. sayuradReboa, rom
dasxva neirotransmiteruli receptorebis mimarTac.
mesameuli amino-struqturis mqone triciklurebis
zogadad, es receptor-mablokirebeli moqmedeba
demeTilacia plazmaSi zrdis meoreuli aminebis kon-
iwvevs arasasurvel gverdiT moqmedebas (cxrili 21.8).
centracias. mniSvnelovani (10-40-jer) gansxvaveba aR-
Tumca, zogi avtori amtkicebs, rom ramdenime tri-
moaCndaT plazmaSi tricikluri antidepresantebis
cikluri antidepresantis antagonizmi 5-HT2 recep-
doneebs Soris im pirebs, romelTac hqondaT fiqsire-
torebis mimarT, maT garkveul Terapiul efeqtsac
buli dozis reJimi.
ganapirobebs.
miuxedavad mravali kvlevisa, triciklurebis plaz-
triciklurebs aqvT qvinidinis msgavsi membranis
muri koncentraciis monitorirebis mniSvneloba dad-
mastabilizirebeli efeqti; amiT SeiZleba aixsnas
genili ar aris. zogadad, myari kavSiri plazmur kon-
maTi kardiotoqsikuroba da is, rom, Warbi dozebiT
centraciasa da Terapiul efeqts Soris ar arsebobs.
miRebis SemTxvevaSi gulis gamtareblobis darRvevebi
miuxedavad amisa, nortriptilinis plazmur koncen-
aRiniSneba.
tracias aqvs mrudxazovani kavSiri klinikur gamosa-
_ 579 _
cxrili 21.8 tricikluri antidepresantebis cxrili 21.9 Cvenebebi tricikluri antidepre-

zogierTi arasasurveli moqmedeba santebis plazmuri monitoringisTvis
farmakologiuri arasasurveli efeqti pacientis mier daniSnulebis Sesrulebis Semowmeba
moqmedeba
toqsikuri gverdiTi efeqti dabal dozaze
muskarinuli piris simSrale, taqikardia, bun-
receptorebis blokada dovani mxedveloba, glaukoma Terapiuli dozis SemTxvevaSi (>200 mg) Terapiuli
(antiqolinerguli) efeqtis ararseboba
yabzoba, Sardvis Sekaveba, seq-
sualuri disfunqcia Tanmxlebi samedicino darRvevebi (magaliTad, epilefsia)
kognituri daqveiTeba wamlebis urTierTqmedebis albaToba
alfa-1- Zilianoba, posturuli hipo- zRurbls. antikonvulsantebTan erTad daniSvnisas,

adrenoreceptorebis tenzia, seqsualuri disfunqcia maTi farmakokinetikuri Taviseburebebidan gamomdi-
blokada
kognituri daqveiTeba nare, triciklurebis plazmuri done SeiZleba gai-
zardos an Semcirdes.
histaminis H1- Zilianoba, wonis mateba
receptorebis blokada
membranis gulis gamtareblobis
mastabilizirebeli darRvevebi, gulis ariTmia, xelmisawvdomi tricikluri antidepresantebia ami-
moqmedeba epilefsiuri gulyrebi triptilini, amoqsapini, klomipramini, dezipramini,
sxva gamonayari, SeSupeba, leikopenia, dosulepini (doTiepini), doqsepini, imipramini, lofe-
RviZlis enzimebis inducireba pramini, nortriptilini da trimipramini. zogierTi
sakmaod gansxvavdeba amitriptilinisgan, amitom maT
valTan. saukeTeso pasuxi aris 50-150 ng/ml plazmuri
calke ganvixilavT.
koncentraciisas da am cifrebze zemoT pasuxi fa-
amoqsapini aris noradrenalinis ukumitacebis se-
qtiurad klebulobs.
leqciuri inhibitori, magram tricikluri antidepre-
amitriptiliniT mkurnalobis dros Terapiul efe-
santebisTvis uCveulod iwvevs dofaminis D2 recep-
qtsa da plazmur koncentracias Soris kavSiri bun-
torebis mniSvnelovan blokadas. amoqsapinis kombini-
dovania, sxvadasxva kvlevaSi miTiTebulia xazovani,
rebuli moqmedeba _ noradrenalinis neirogadacemis
zogan _ mrudxazovani kavSiri da zogan ki _ kavSiris
gaZliereba da D2 receptorebis antagonizmi _ sava-
ararseboba.
raudos xdis mis gamoyenebas depresiuli fsiqozis
arsebobs monacemebi, rom tricikluri antidepre-
dros, radgan xSirad aseT SemTxvevebSi saWiro xde-
santebis maRali done sisxlSi maRali albaTobiT uka-
ba antidepresantisa da antifsiqozuris kombinireba.
vSirdeba toqsikur gverdiT moqmedebas: deliriums,
erTi preparatis daniSvna kombinirebuli farmakolo-
gulyrebs, gulis ariTmias. am tipis gverdiTi moqme-
giuri efeqtis misaRebad zRudavs misi gamoweris mo-
debis riski minimaluria, Tu tricikluri antidepre-
qnilobas. amasTan, mosalodnelia rom, amoqsapinis D2
santis plazmuri koncentracia 300 ng/ml-ze dabalia
receptorebis mablokirebelma moqmedebam gamoiwvios
(Burke, Preskorn; 1999). pacientTa mcire nawils, romel-
eqstrapiramiduli darRvevebi da hiperprolaqtine-
Ta organizmSic wamlis metabolizmi Senelebulia,
mia.
SeiZleba aReniSnos triciklurebis plazmuri koncen-
klomipramini triciklurebidan serotoninis uku-
traciis momateba rutinul klinikur dozazec.
mitacebis yvelaze Zlieri inhibitoria, magram misi
zogadad, tricikluri antidepresantebiT mkurna-
meoradi aminis metaboliti, desmeTilklomipramini,
lobisas, plazmuri koncentraciis monitoringi mkur-
aris noradrenalinis ukumitacebis efeqturi inhibi-
nalobis marTvisTvis saWiroa, magram SezRuduli mniS-
tori. depresiuli pacientebis kvleva aCvenebs, rom
vnelobisaa (cxrili 21.9). plazmuri monitoringi SeiZ-
klomipraminis antidepresiuli efeqti aWarbebs susi-
leba gamogvadges Sesabamisobis Sesafaseblad, gansaku-
ebis, citalopramisa da paroqsetinis antidepresiul
TrebiT im pacientebis mkurnalobisas, romlebTanac
moqmedebas (daniis universitetis antidepresantebis
efeqtis miRweva ver xerxdeba triciklurebis adekva-
Semswavleli jgufi, 1990). sxva tricikluri antide-
turi doziT miRebisas, kerZod, 200 mg/dR-ze zemoT.
presantebisgan gansxvavebiT, klomipramini gamoiyene-
plazmuri koncentraciis gansazRvra saWiroa Tanmx-
ba obsesiur-kompulsuri aSlilobebis drosac (miu-
lebi samedicino mdgomareobebis dros, gansakuTre-
xedavad mZime depresiuli aSlilobis arseboba-arase-
biT wamlebis urTierTqmedebis albaTobis SemTxveva-
bobisa).
Si. mag., gulyrebis mqone pacientis triciklurebis
lofepramini aris mesameuli amini, romelic meta-
plazmuri done unda imyofebodes Terapiul sazR-
bolizdeba dezipraminad, magram lofepraminiT mkur-
vrebSi, radgan triciklurebi aqveiTebs gulyrebis
_ 580 _
nalobisas dezipraminis done imdenad dabalia, rom modaciis problemebi.
Terapiul efeqtze gavlenas, savaraudod, ver axdens. nortriptilins da lofpamins aqvs SedarebiT nak-
lofepramini noradrenalinis ukumitacebis seleq- lebi antiqolinerguli gverdiTi moqmedeba.
ciuri inhibitoria da, amitriptilinTan SedarebiT, w fsiqikuri. daRliloba da Zilianoba _ amitripti-
naklebad aqvs antiqolinerguli da antihistaminuri linis da sxva sedaciuri preparatebis gamoyenebis
Tvisebebi. lofepramins sxva triciklur antidepre- dros; insomnia _ dezipraminiTa da lofepraminiT
santebTan Sedarebisas aRmoaCnda Tanabari antidepre- mkurnalobis dros; mwvave organuli sindromi; bi-
siuli efeqti (Anderson, 1999). polaruli aSlilobis mqone pacientebSi _ maniis
lofepraminis yvelaze mniSvnelovani Tviseba is gamowveva.
aris, rom sxva Cveulebrivi tricikluri antidepre-
w kardiovaskuluri. xSiria taqikardia da hipotenzia.
santebisgan gansxvavebiT, is ar aris kardiotoqsikuri
eleqtrokardiogramaze xSiria PR da QT interva-
Warbi doziT miRebisas. es niSnavs, rom lofepraminis
lebis gaxangrZliveba, ST segmentis depresia da
daniSvna kardiovaskuluri daavadebis mqone paciente-
T-talRis gabrtyeleba. zogjer _ ventrikuluri
bisTvis SedarebiT ufro usafrTxoa sxva triciklu-
ariTmia da gulis blokada, ufro metad manamde ar-
rebTan SedarebiT, Tumca, sifrTxilis dacva mainc
sebuli gulis daavadebis SemTxvevebSi.
rekomendebulia. aRwerilia hepatitis SemTxvevebi,
w nevrologiuri. mcire amplitudis tremori (xSirad),
rac lofepraminis gamoyenebas axlavs, Tumca, dau-
diskoordinacia, Tavis tkivili, kunTebis krampebi
zustebelia, sxva triciklurebTan SedarebiT, ramde-
(mtkivneuli uneblie kunTovani spazmebi), midrekil
nad maRalia amis sixSire.
pacientebSi epilefsiuri gulyrebi, iSviaTad _ pe-
maprotilini miiCneva kvadriciklur antidepresan-
riferiuli neiropaTia.
tad, radgan tricikluri birTvi Canacvlebulia eTi-
lenis xidiT Sua rgolSi. is, dReisTvis arsebul tri- w sxva. kanze alergiuli gamonayari, qolestazuri
ciklurebs Soris, noradrenalinis ukumitacebis yve- siyviTle da, iSviaTad, agranulocitozi; aseve, xSi-
laze Zlieri seleqciuri inhibitoria. aqvs zomieri ria wonis mateba da seqsualuri disfunqcia.
antihistaminuri Tviseba, magram imipraminze naklebi w moxsnis efeqti. tricikluri antidepresantebi unda
antiqolinerguli efeqti. ar aris dadgenili, Tu de- moixsnas SeZlebisdagvarad nela. uecar moxsnas Sei-
presiis romel SemTxvevebSia maprotilini placeboze Zleba mohyves gulisreva, SfoTva, ofldena, gas-
metad efeqturi, magram triciklurebis SedarebiT tro-intestinuri simptomebi da insomnia.
kvlevebSi misi Terapiuli moqmedeba maTi ekvivalen-
turi aRmoCnda. toqsikuri efeqti
maprotilinis gamoyeneba 200 mg-ze maRali doziT Warbi dozis SemTxvevaSi tricikluri antidepresan-
ukavSirdeba gulyrebis ufro maRal sixSires, vidre tebi iwvevs sakmaod seriozul garTulebebs, rac ga-
es Cveulebrivi triciklurebis SemTxvevaSia. amitom daudebel hospitalur mkurnalobas moiTxovs. mniSv-
rekomendebuli dozaa 75-150 mg/dR da daniSvna sxva nelovania, rom fsiqiatrma icodes dozis gadaWarbe-
iseT wamlebTan erTad, romlebic amcireben gulyrebis ZiriTadi niSnebi.
bis zRurbls, mag., fenoTiazinebTan, da isic didi si- kardio-vaskulur efeqts miekuTvneba parkuWova-
frTxiliT. maprotilini gulze moqmedebs iseve, roni fibrilacia, gulis gamtareblobis darRvevebi da
gorc sxva Cveulebrivi triciklurebi da misi dozis dabali arteriuli wneva. guliscemis sixSire SeiZle-
gadaWarbeba, sul cota, sxva triciklurebis msgavsad, ba iyos momatebuli an daqveiTebuli da, ZiriTadad,
toqsikuria. damokidebulia gamtareblobis darRvevis xarisxze.
respiraciuli efeqti vlindeba sunTqvis daTrgunviT,
tricikluri antidepresantebis arasasurveli rac, Tavis mxriv, zrdis kardialuri garTulebebis
moqmedeba albaTobas; SeiZleba ganviTardes aspiraciuli pnev-
aseTi moqmedeba bevria da mniSvnelovani (ix. cxrili monia.
21.8): centraluri nervuli sistemis garTulebebi moi-
w avtonomiuri. piris simSrale, akomodaciis moSla, cavs SfoTvas, krampebs, konvulsiebs, halucinaciebs,
Sardvis garTuleba SekavebiT, yabzoba, iSviaTad deliriums da komas. parasimpaTikuri efeqtebidan
garTulebuli gauvalobiT, posturuli hipotenzia, mosalodnelia piris simSrale, gugebis gafarToveba,
taqikardia da Warbi oflianoba. Sardis Sekaveba, bundovani mxedveloba, Sardis Sekaveba da pireqsia.
gansakuTrebiT xandazmul mamakacebSi, romlebsac pacientebis umetesobas mxolod mxardamWeri zrunva
aReniSnebaT prostatis hiperplazia da glaukomis esaWiroeba, Tumca, mniSvnelovania kardiuli niSnebis
gauareseba, iTvleba yvelaze seriozul gverdiT monitoringi, xolo ariTmia saWiroebs intensiuri
moqmedebad. yvelaze xSiria piris simSrale da ako- Terapiis ganyofilebaSi gadaudebel mkurnalobas.
_ 581 _
tricikluri antidepresantebi didxans rCeba kuW- klonidinis hipotenziuri efeqtis mimarT, Tumca,
Si, amitom ar aris azrs moklebuli kuWis amorecxva SesaZloa maTi usafrTxo kombinireba TiazidebTan
Warbi doziT miRebidan ramdenime saaTis Semdegac. es da angiotenzin-gardamqmneli fermentis (ACE) inhi-
procedura ise unda Catardes, rom ar moxdes kuWis bitorebTan.
SigTavsis aspiracia. saWiroebis SemTxvevaSi, kuWis w triciklurebis noradrenalinis ukumitacebis blo
amorecxvis dawyebamde unda Caidgas manJetiani endo- kirebis unari iwvevs hipertenzias noradrenalinisa
traqealuri mili. da adrenalinis sistematurad miRebis SemTxvevaSi.
antidepresantebi da gulis daavadeba w triciklurebi ar unda dainiSnos anti-ariTmiul

wamlebTan erTad, kerZod, amiodaronTan.
tricikluri wamlebis kardiovaskuluri gverdiTi
moqmedebis safuZvelze, razec zemoT iyo saubari da w triciklurebis plazmuri done SeiZleba gaizar-
rac ukavSirdeba am wamlebis Warbi doziT gamowveul dos sxvadasxva wamliT, maT Soris cimetidiniT,
toqsikur efeqts, gaCnda varaudi, rom tricikluri natriumis valproatiT, kalci-blokatorebiT da
antidepresantebi gulis daavadebis mqone paciente- susi-ebiT. triciklurebma SeiZleba gaaZlieros
bisTvis saxifaToa. marTlac, gulis daavadebebis Se- valfarinis moqmedeba. triciklurebis maoi-ebTan
mTxvevaSi tricikluri antidepresantebiT mkurnalo- urTierTqmedeba ganxilulia qvemoT.
bisas maRalia orTostatikuli hipotenziisa da gu-
ukuCvenebebi
lis blokadis ganviTarebis riski.
gulis daavadebis mqone pacientebisTvis ufro usa- ukuCvenebebia: agranulocitozi, RviZlis mZime dazia-
frTxodaa miCneuli zogierTi axali antidepresanti, neba, glaukoma, prostatis hipertrofia da seriozu-
kerZod, susi-ebi. amitom ar aris mizanSewonili kar- li kardio-vaskuluri daavadeba. sifrTxilis gamoCe-
diuli klinikuri da eleqtrografiuli niSnebis ar- naa saWiro epilefsiis mqone pacientebisa da moxuce-
sebobisas tricikluri antidepresantebis gamoyeneba. bis SemTxvevaSi.
ukanasknelma epidemiologiurma kvlevam aCvena, rom tricikluri antidepresantebis klinikuri gamo-
miokardiumis infarqtis riski ufro maRalia trici- yeneba
klurebis gamoyenebis dros, vidre susi-ebiT mkurna-
triciklurebis gamoyenebisas unda gavixsenoT
lobisas da SedarebiTma riskma 2, 2 Seadgina (95% CI
Zveli gamoTqma: saukeTeso variantia, kargad ico-
1, 2-3, 8) (Cohen et al., 2000). arsebobs mosazreba, rom
de mxolod ramdenime wamali da isini gamoiyeno.
susi-ebis kardioproteqtuli efeqti SesaZloa gan-
albaT, marTlac, sakmarisia, kargad icnobde erT
pirobebuli iyos maT mier Trombocitebis aqtivobis
sedaciur preparats (mag., amitriptilins) da erT
daqveiTebiT (Sauer et al., 2003).
naklebsedaciurs (mag., nortriptilins). sxva tri-
antidepresantebi da epilefsia ciklurebi ki unda SemoinaxoT gansakuTrebuli
SemTxvevebisTvis; mag., lofepraminis daniSvna Sei-
antidepresantebis didi nawili amcirebs gulyrebis
Zleba im pacientebisTvis, romlebTanac arsebobs
ganviTarebis zRurbls, rac epilefsiisa da gulyre-
dozis gadaWarbebis riski, xolo klomipraminis _
bisadmi midrekil pacientebSi zrdis epilefsiuri
roca depresiuli aSliloba dakavSirebulia obse-
Setevebis ganviTarebis risks. zogadad iTvleba, rom
siur daavadebasTan.
susi-ebi da trazodoni, aseve, mao-s inhibitorebic,
mag. gamodgeba amitriptilinis daniSvna. dasawyisSi
triciklurebTan SedarebiT, naklebad zrdis krun-
pacients unda ganemartos, rom miuxedavad gverdiTi
CxviT mzaobas.
moqmedebebis adreul etapzeve gamovlenisa, guneb-
sxva garTuleba, romelic SeiZleba gamoiwvios anti-
ganwyobis gaumjobesebis Terapiuli efeqti Cndeba
depresantebma, aris antikonvulsantebze farmakoki-
mogvianebiT, erTi an ramdenime kviris Semdeg da ami-
netikuri urTierTqmedeba; mag., susi-ebs SeuZlia ga-
tomac wamlis miReba unda gagrZeldes. ukeTesobis
zardos karbamazepinis done, xolo valproats Seu-
adreuli niSani SeiZleba iyos Zilis gaumjobeseba da
Zlia gazardos triciklurebis koncentracia. anti-
daZabulobis Semcireba. pacients aucileblad unda
konvulsantTan erTad antidepresantis daniSvnamde
ganemartos, Tu ra SeiZleba iyos yvelaze xSiri gver-
sasurvelia, gadamowmdes savaraudo urTierTqmedeba
diTi movlena, radgan informirebuli pacienti ume-
britanul erovnul farmacevtul cnobarSi (ix. cxri-
tes SemTxvevaSi wamlis miRebas ar wyvets.
li 21.11).
Cveulebriv, mkurnaloba iwyeba amitriptilinis daba-
sxva wamlebTan urTierTqmedeba li doziT da mateba xdeba TandaTanobiT, radgan aseTi
midgomiT gverdiTi moqmedeba ufro msubuqia da pacien-
w tricikluri antidepresantebi avlens antagonizms
tic kargad egueba. sawyisi doza damokidebulia pacien-
alfa-2 adrenoreceptorebis agonistebis, mag.,
_ 582 _
tis asakze, wonaze, fizikur mdgomareobaze da trici- SemanrCunebeli doza da profilaqtika
klurebis miRebis warsul gamocdilebaze. marTebulad
Tu amitriptilinis efeqti TvalsaCinoa, misi miRe-
iTvleba 25-50 mg/dR _ ambulatoriuli pacientisTvis
ba unda gagrZeldes sul mcire 6 Tvis ganmavlobaSi,
da 50-75 mg/dR _ stacionarulisTvis. sruli doza Sei-
radgan aseT SemTxvevaSi mniSvnelovnadaa Semcirebuli
Zleba daeniSnos Ramis Zilamde 1-2 saaTiT adre, radgan
recidivis riski. sasurvelia imave dozis SenarCuneba,
wamlis sedaciuri efeqti aumjobesebs Zils.
magram, Tu Tavs iCens gverdiTi movlenebi, doza unda
mkurnalobis dawyebidan pirveli kvirebis ganma-
Semcirdes damakmayofilebel tolerantul donemde.
vlobaSi, rodesac mkurnalobis reJimis dacvisTvis
Zneli dasadgenia, rodis unda moixsnas antidepre-
mniSvnelovania pacientis mxardaWera da waxaliseba,
santi, radgan zog pacients aReniSneba rekurentu-
aucilebelia misi mdgomareobis xSirad gadamowmeba.
li depresiuli aSliloba. aseT SemTxvevaSi saWiroa
klinicists, ukve mkurnalobis adreul etapze, Seu-
xangrZlivi profilaqtikuri mkurnaloba. rac ufro
Zlia gamoavlinos mdgomareobis gaumjobesebis niS-
metia epizodebis raodenoba, miT maRalia recidivis
nebi, risi ganxilvac pacientTan erTad dadebiTad
riski. mdgomareobis gamwvavebis klinikuri an bioqi-
imoqmedebs mkurnalobis gagrZelebis motivaciaze.
miuri prediqtorebi jer-jerobiT ar aris sakmarisad
amitriptilinis samizne dozaa daaxloebiT 125 mg/dR
Seswavlili.
an meti. monitoringisa da gamxnevebis fonze am dozis
miRweva SesaZlebelia 2-4 kviraSi. mZime depresiebis serotoninis ukumitacebis seleqciuri
ambulatoriulad mkurnalobis SemTxvevaSi, Tu am inhibitorebi (susi-ebi)
preparats ufro dabali doziT viyenebT, misi efe- farmakologiuri Tvisebebi
qturoba sakamaToa (Furukawa et al., 2002).
klinikuri mniSvnelobis 6 susi _ citaloprami, esci-
zog SemTxvevaSi gverdiTi moqmedeba zRudavs dozis
taloprami, fluoqsetini, fluvoqsamini, paroqsetini
momatebis SesaZleblobas, magram, Tu aris klinikuri
da sertralini _xelmisawvdomia britaneTSi. susi-ebi
gaumjobeseba, SeiZleba morgeba dabal dozazec. sa-
struqturulad gansxvavebuli jgufia, magram yoveli
erTod, gverdiTi moqmedeba Zlieri ar aris da mas pa-
maTgani axdens serotoninis amorCeviT da Zlier uku-
cienti advilad egueba. Tuki gaumjobeseba ar aris an
mitacebis inhibicias. arc erTi ar moqmedebs nora-
umniSvneloa, rekomendebulia amitriptilinis gagr-
drenalinis receptorebze. Tanamedrove monacemebis
Zeleba maqsimaluri tolerantuli doziT _ 4 kvira,
mixedviT varaudoben, rom maT aqvT sxva monoaminuri
da araefeqturobis sakiTxis amis Semdeg gadawyveta.
neirotrasmiterebis receptorebze msubuqi zemoqme-
zogjer Terapiuli moqmedeba mxolod maRali do-
debis unari.
zebiT mkurnalobisas aRiniSneba (300 mg/dR-mde). aseT
SemTxvevaSi frTxilad unda davakvirdeT, Tu ramde- farmakokinetika
nad asatania gverdiTi efeqtebi. Tu vumatebT 225 mg/
zogadad, susi-ebi nela absorbirdeba da plazmuri
dR dozaze mets, yoveli momatebis win aucilebelia
koncentraciis piki miiRweva 4-8 saaTSi, Tumca cita-
plazmaSi triciklurebis donisa da eleqtrokardio-
loprami da escitaloprami ufro swrafad absorbir-
grafiuli monitoringi.
deba. citalopramis, escitalopramis, fluvoqsaminis,
plazmuri koncentraciis interpretacia unda gake-
paroqsetinis da sertralinis naxevardaSlis periodi
Tdes pacientis klinikuri mdgomareobis gaTvaliswi-
aris 20-30 sT, xolo fluoqsetinis _ 48-72 saaTi. susi-
nebiT, magram, saerTod, 450 ng/ml-ze maRali done
ebis pirveladi metabolizeba xdeba RviZlSi. fluo-
ufro xSirad ukavSirdeba mZime intoqsikaciur rea-
qsetini metabolizdeba norfluoqsetinad, romelic
qcias. Tanmxlebi samedicino mdgomareobebis dros
aseve serotoninis mitacebis blokatoria da misi na-
zeda zRvrad miiCneva 300 ng/ml (Burke, Preskorn; 1999).
xevardaSlis dro 7-9 dRea. sertralini gardaiqmneba
ekg-ze mniSvnelovania gamtareblobis nebismieri
desmeTilsertralinad, romlis naxevardaSlis dro
problema, mag., QT-intervalis gaxangrZliveba, ro-
2-3 dRea da 5-10-jer naklebi siZlieris serotoninis
melime fexis blokada an ariTmia. amitriptilinis
ukumitacebis inhibitoria, vidre sawyisi sertralini.
naxevar-daSlis drois gamo, yoveli dozis momatebis
mkurnalobis efeqturobaze desmeTilsertralinis
Semdeg, plazmaSi stabiluri donis miRwevas sWirdeba
gavlena gaurkvevelia.
1 kvira. Tu pacientis mdgomareoba ar umjobesdeba,
an dozasTan Segueba ver xdeba, an maRal dozazec Te- susi-ebis efeqturoba depresiis dros
rapiuli efeqti ver miiReba, unda ganvixiloT sxva mravali kvlevaa Catarebuli susi-ebis placebosTan
mkurnalobis sakiTxi. zogierTi SesaZlo strategia da triciklurebTan Sesadareblad. susi-ebs aSkarad
mocemulia me-11 TavSi, romelic guneba-ganwyobis aS- placeboze upiratesi da triciklurebis Tanabari
lilobas eZRvneba (gv ??). efeqti aqvT didi depresiis mkurnalobisas (Anderson,
1999). SedarebiTi kvlevebis umetesobaSi dakvirveba
_ 583 _
zomieri depresiis mqone ambulatoriul pacientebze
boqsi 21.4 suicidis sixSire antidepre
warmoebda. ufro mZime, stacionarul depresiul pa-
santebis gamoyenebisas sakvlev jgufSi
cientebTan susi-ebi Cveulebriv triciklur antide-
presantebTan SedarebiT, naklebad efeqturi aRmoCn- mkurnaloba placebo susi-ebi sxva*
da, (Anderson, 1999). pacientebis 4, 895 26, 109 17, 272

raodenoba
susi-ebis gverdiTi efeqti
suicidi 5 38 34
susi-ebis gverdiTi efeqti mniSvnelovnad gansxvavde-
suicidis % 0, 10 0, 15 0, 20
ba tricikluri antidepresantebis moqmedebebisgan.
susi-ebi triciklur antidepresantebTan SedarebiT 95% CI intervali 0, 01-0, 19 0, 10-0, 20 0, 09-0, 27
nakleb kardiotoqsikurebi arian da maRali dozebiT * tricikluri antidepresantebi sxva antidepresantebTan

miRebisas meti usafrTxoeba axasiaTebT (Tumca, cita- erTad, maT Soris: bupropioni, mianserini, mirtazapini,
nefazodoni, trazodoni da venlafaqsini.
lopramis usafrTxoebis profili damatebiT kvleve- (Khan, 2003)
bs saWiroebs). susi-ebs ara aqvT antiqolinerguli da
sedaciuri moqmedeba. gverdiTi moqmedebebi SeiZleba placebosTan an triciklur antidepresantebTan Se-
daiyos Semdegnairad (cxrili 21.10): darebiT ar daadastura (Khan et al., 2003; aseve, ix.
Semdegi saiti: http://www.mhra.gov.uk/news/2004/SSRIfi-
w gastro-intestinuli. gulisreva aReniSneba pacien-
nal.pdf). sxva antidepresantebis msgavsad, susi-ebmac
tebis daaxloebiT 20%-s da igi TandaTanobiT gai-
mkurnalobis adreul etapze SeiZleba gamoiwvion
vlis; dispepsia, Seberiloba da diarea; paroqsetinis
SfoTva da mousvenroba, xolo suicidisadmi mi-
garda susi-ebi, Cveulebriv, ar iwvevs wonis matebas.
drekili pacientebis SemTxvevaSi moaxdinon saxi-
w neirofsiqiatriuli. insomia, somnolencia _ dRis faTo qcevis provocireba. ambulatoriul pacien-
saaTebSi; SfoTva, tremori, mousvenroba, gaRiziane- tebze Catarebuli ukanaskneli epidemiologiuri
badoba da Tavis tkivili. susi-ebs aseve ukavSirdeba kvlevis Tanaxmad, suiciduri qcevisa Tu ganxorcie-
gulyrebi da mania, magram TiTqos triciklurebze lebuli suicidis sixSire susi-ebisa da triciklu-
ufro iSviaTad. amis sapirispirod, iseTi eqstra- rebis miRebis dros erTnairi iyo (Jick et al., 2004).
piramiduli gverdiTi moqmedebebi, rogorebicaa sayuradReboa, rom suicidis mcdeloba 4-jer metia
parkinsonizmi da akaTizia ufro xSiria susi-ebiT, nebismieri antidepresantis dawyebidan pirveli 9
vidre triciklurebiT mkurnalobisas. kerZod, pa- dRis ganmavlobaSi, vidre mogvianebiT (>90 dRe). am
roqsetiniT mkurnalobis dasawyisSi SeiZleba gamo- momatebuli riskis periodSi ganxorcielebuli sui-
vlindes mwvave distonia. cidis raodenoba (miuxedavad maTi mcire ricxvisa)
w sxva. susi-ebiT mkurnalobisas xSiria seqsualuri 40-jer aRemateba SemdgomSi Cadenil TviTmkvlelo-
disfunqcia, eakulaciis Seferxeba da anorgazmia. baTa ricxvs (Jick, 2004).
aRwerilia oflianoba da piris simSralec. kar- amas SeiZleba ramdenime axsna hqondes. mag., depre-
dio-vaskuluri gverdiTi moqmedeba iSviaTia, ma- siuli pacientebi yvelaze mZime periodSi akiTxaven
gram SeiZleba iyos pulsis garkveuli Seneleba da eqims da iwyeben mkurnalobas. aseve, es SesaZloa asaxa-
aRwerilia posturuli hipotenziis SemTxvevebic. vdes tradiciul mosazrebas, rom antidepresantebiT
fluoqsetins SeiZleba axldes kanze gamonayari da, mkurnalobis sawyis etapze motoruli gaaqtiureba
ufro iSviaTad, generalizebuli alergiuli reaq- win uswrebs guneb-ganwyobis gaumjobesebas. nebismier
cia arTritiT. susi-ebi, antidiurezuli hormonis SemTxvevaSi, rogorc ar unda avxsnaT es fenomeni, an-
sekreciis darRvevis gamo, zogjer (gansakuTrebiT
moxucebSi), hiponatriemias iwveven. tricikluri an-
cxrili 21.10 susi-ebis gverdiTi moqmedeba
tidepresantebis msgavsad, SeiZleba moxdes RviZlis
fermentebis momateba, magram es Seqcevadia da wa- gastro- xSiria: gulisreva, madis daqveiTeba,
intenstinuri piris simSrale, diarea, yabzoba,
mlis SewyvetasTan erTad gaivlis. susi-ebma SeiZ- traqti dispefsia
leba gazardon kuW-nawlavis traqtis zeda nawilis iSviaTia: Rebineba, wonis daqveiTeba
sisxldenis riski, gansakuTrebiT arasteroiduli centraluri xSiria: Tavis tkivili, insomnia,
anTebis sawinaaRmdego wamlebTan kombinirebisas. nervuli Tavbrusxveva, SfoTva, daRliloba,
sistema tremori, somnolencia
w suiciduri qceva. susi-ebiT gamowveuli suicidu- iSviaTia: eqstrapiramiduli reaqcia,
ri qcevisa da agresiis Sesaxeb monacemebi Semdgom gulyrebi, mania
dazustebas saWiroeben. susi-ebis kontrolireba- sxva xSiria: oflianoba, anorgazmia,

di kvlevebis meta-analizma suiciduri azrebisa da iSviaTia: gamonayari, faringiti,
dispnoe, Sratismieri daavadeba,
suiciduri moqmedebebis riskis mniSvnelovani zrda hiponatriemia, alopecia
_ 584 _
cxrili 21.11 susi-ebiT citoqrom-450-is inhibicia

CYP1A2 CYP2D6 CYP2C9 CYP2C19 CYP3A4
fluvoqsamini (+++) fluoqsetini (+++) fluoqsetini (+++) fluvoqsamini (+++) fluvoqsamini (++)
inhibitorebi
duloqsetini (+) paroqsetini (+++) fluvoqsamini (+++) fluoqsetini (++) fluoqsetini (+)
duloqsetini (++) venlafaqsini (+)
sertralini (+)
olanzapini tricikluri varfarini Tricikluri karbamazepini

antidepresantebi antidepresantebi
zogi nivTiereba (izrdeba
plazmuri koncentracia)
klozapini tolbutamidi benzodiazepinebi
haloperidoli venlafaqsini Fenitoini diazepami qvetiapini
tricikluri anti- haloperidoli propranololi klozapini

depresantebi
Tioridazoni omeprazoli
Teofilini Risperidoni
Klozapini
olanzapini
inhibicia: +++ Zlieri, ++ zomieri, + msubuqi
tidepresiuli mkurnalobis dawyebis Semdeg pacienti 450-is, inhibicia da Seamciron sxva wamlebis meta-
saWiroebs mudmiv meTvalyureobas. bolizmi anu gazardon maTi plazmuri koncentracia
mozardebTan dakavSirebiT, arsebobs mtkicebule- (cxrili 21.11). SemTxvevebi, rodesac klinikurad
ba, rom am asakobriv jgufSi, zogi susi-s gamoyeneba, mniSvnelovani reaqciebia aRwerili, moicavs trici-
placebosTan SedarebiT, zrdis suicidis saSiSroebas klur antidepresantebs, antifsiqozur preparatebs,
(Ryan, 2005). mag., klozapinsa da risperidons, antikonvulsantebsa
da valfarins; aseTi moqmedeba naklebadaa damaxasia-
sxva wamlebTan urTierTqmedeba Tebeli citalopramisTvis, escitalopramisa da ser-
farmakodinamikuri urTierTqmedeba. yvelaze saxifa- tralinisTvis.
To urTierTgavlena aRiniSneba susi-ebisa da maoi-
ebis erTdrouli gamoyenebisas, roca vlindeba se- susi-ebis klinikuri gamoyeneba depresiis dros
rotoniniT intoqsikaciis sindromi (`serotoninuli ambulatoriul praqtikaSi susi-ebma Caanacvla tri-
sindromi~), romelsac axasiaTebs SfoTva, hiperpireq- cikluri antidepresantebi, radgan maT ukeTesi am-
sia, rigidoba, mioklonia, koma da, mZime SemTxvevebSi, tanoba da gaadvilebuli dozireba axasiaTebT. kli-
letaloba (ufro dawvrilebiTi informacia mocemu- nikuri kvlevebis mixedviT, susi-ebis gverdiTi moqme-
lia maoi-ebis nawilSi). debis gamo wamlis Sewyvetis SemTxvevebi mniSvnelov-
sxva wamlebi, romlebic iwveven Tavis tvinSi sero- nad dabalia triciklurebTan SedarebiT. rutinul
toninis momatebas, susi-ebTan erTad sifrTxiliT klinikur praqtikaSi es gansxvaveba, SesaZloa, kidev
unda davniSnoT (mag., liTiumi da triftofani), vi- ufro didi iyos (Anderson, 1999).
naidan aman SeiZleba gamoiwvios fsiqikuri statusis xarjTefeqturobis ekonomikuri analizis monace-
cvlileba, mioklonusi da gulyrebi. serotoninis mebiT, susi-ebis triciklurebTan Sedarebis Sedegebi
toqsikuroba SeiZleba gamovlindes susi-ebis kombi- urTierTgamomricxavi iyo, magram susi-ebis jeneriu-
nirebiT 5-HT receptorebis iseT agonistebTan, roli formebis gamoyenebisas medikamentis fasi nakle-
goricaa sumatriptani. bad mniSvnelovania. miuxedavad amisa, triciklurebi
antifsiqozur preparatebTan erTad gamoyenebi-
sas susi-ebma SeiZleba gamoiwvion eqstrapiramidu- boqsi 21.5 depresiis dros susi-ebiT
li darRvevebis provocireba, rac nawilobriv far-
mkurnalobis Cvenebebi
makokinetikuri urTierTqmedebiTaa ganpirobebuli, w Tanmxlebi gulis daavadeba
vinaidan susi-ebi zrdis zogierTi antifsiqozuris w antiqolinerguli efeqtis autanloba
plazmur koncentracias (ix. qvemoT). w dozis gadaWarbebis riski
farmakokinetikuri urTierTqmedeba. susi-ebma Sei- w wonaSi mateba
w arasasurveli sedacia
Zleba moaxdinon RviZlis fermentis _ citoqrom-P-
w depresia da obsesiur-kompulsuri aSliloba
_ 585 _
cxrili 21.12 susi-ebs Soris gansxvaveba

wamali farmakokinetikuri moxsnis sindromi sxva
urTierTqmedebis riski*
citaloprami dabali xSiri ar aris naklebad usafrTxoa Warbi

doza
escitaloprami dabali mcire monacemebia citalopramis izomeri
fluoqsetini maRali iSviaTia SfoTvis maRali riski,

moqmedebis neli dawyeba
fluvoqsamini maRali xSiria Segueba SedarebiT naklebad

xdeba
paroqsetini maRali xSiria mkurnalobis adreul

etapze mwvave distonia
sertralini Zomieri xSiria SeiZleba iyos

dofaminerguli efeqti
* efuZneba ferment citoqrom-P-450-is inhibicias (ix. cxrili 21.11).
ZiriTad samkurnalo saSualebad rCeba, maSin, roca zemoT izrdeba Terapiuli efeqti.
axal preparatebze Terapiuli pasuxi ar miiReba. me- iseve, rogorc tricikluri antidepresantebis Se-
taanaliziT dadginda, rom dRemde yvelaze efeqturi mTxvevaSi, pacienti, romelsac eniSneba susi-ebiT
xelmisawvdomi antidepresanti aris Sesabamisi doze- mkurnaloba, unda gavafrTxiloT SesaZlo gverdiTi
biT gamoyenebuli amitriptilini (Barbui, Hotopf, 2001). efeqtebis, maT Soris gulisrevisa da mousvenari Zi-
arsebobs iseTi klinikuri situaciebi, roca susi- lis Sesaxeb. zogjer susi-ebiT mkurnalobis periodSi
ebiT mkurnaloba pirdapir Cvenebas warmoadgens. maTi vlindeba SfoTva. amdenad, mniSvnelovania imis gan-
CamonaTvali mocemulia boqsSi 21.5-Si. marteba, rom msgavsi efeqti SeiZleba gaCndes da rom
miuxedavad imisa, rom susi-ebi mniSvnelovnad ar es ar niSnavs depresiis gauaresebas. mkurnalobis ga-
gansxvavdeba erTmaneTisgan efeqturobis Tvalsa- grZelebis SemTxvevaSi SfoTva da agzneba mcirdeba,
zrisiT, garkveuli klinikuri sxvaoba maT Soris magram benzodiazepinebis xanmokle gamoyeneba SeiZle-
mainc SeiniSneba, rac specialur ganxilvas saWiroebs ba efeqturi iyos, gansakuTrebiT Zilis darRvevebis
(Edwards, Anderson, 1999) (cxrili 21.12). fluvoqsamins dros. trazodonis mcire doza (50-150mg) aumjobesebs
ufro xSirad anebeben Tavs, risi savaraudo mizezic Zils, magram aseTi kombinaciis iSviaT SemTxvevebSi
naklebi amtanoba unda iyos. fluoqsetins axasiaTebs SeiZleba ganviTardes serotoninuli sindromi (Mir,
yvelaze metad gamoxatuli gamaaqtiurebeli moqmede- Taylor, 1999).
ba da aqvs gansxvavebuli farmakokinetikuri profili tricikluri antidepresantebiT mkurnalobis msga-
xangrZlivmoqmedi metabolitis mxriv, romlis naxe- vsad, Tu pacientis mdgomareoba kargad emorCileba
vardaSlis periodi daaxloebiT 1 kviraa. amitom sxva susi-ebs, ramdenime TviT mkurnalobis gagrZeleba
wamalze arasasurveli gavlena SeiZleba gamovlindes recidivis risks amcirebs. amasTan, placebo-kontro-
fluoqsetinis Sewyvetidan ramdenime kviris Semdegac. lirebadi kvleviT dadginda, rom susi-ebi efeqturia
mag., fluoqsetinis Sewyvetidan maoi-ebis daniSvnam- ganmeorebadi depresiuli epizodebis profilaqti-
de, sul mcire, 5 kvira unda gavides. meores mxriv, kisTvis. susi-ebi ar unda moixsnas swrafad, radgan
fluoqsetinis plazmuri koncentraciis daqveiTebis SeiZleba ganviTardes reaqcia moxsnaze insomniis, gu-
aseTi neli tempi ganapirobebs susi-ebSi yvelaze nak- lisrevis, SfoTvisa da Tavbrusxvevis saxiT, gansaku-
lebad gamoxatul moxsnis sindroms. escitaloprami TrebiT paroqsetinis SemTxvevaSi (informacia anti-
citalopramis aqtiuri izomeria da iTvleba ufro depresantebis moxsnis Sesaxeb ix.: Haddad et al., 2004).
aqtiurad, vidre sawyisi nivTiereba. dReisTvis am mo- susi-ebis Txevadi preparatebi aiolebs nel moxsnas.
sazrebas sakmarisi mtkicebuleba ar gaaCnia. monoaminis oqsidazis inhibitorebi (maoi-ebi)
depresiuli aSlilobis mkurnalobis dros susi- maoi-ebi aRmoaCines triciklur antidepresantebam-
ebisTvis ufro advilia dozis SerCeva, vidre trici- de, magram maT naklebad iyenebdnen sakvebsa da sxva
kluri antidepresantebisTvis, radgan susi-ebis ume- medikamentebTan SeuTavseblobisa da dauzustebeli
tesoba SeiZleba daviwyoT standartuli doziT da Terapiuli efeqtis gamo. miuxedavad amisa, adekvatu-
Semdeg SevinarCunoT mkurnalobis ganmavlobaSi. mag., ri doziT gamoyenebisas, maoi-ebs gamoxatuli anti-
fluoqsetini SeiZleba dainiSnos 80 mg-mde dReSi, ma- depresiuli moqmedeba axasiaTebT; klinikur efeqti,
gram ar arsebobs monacemebi, rom 20 mg/dR dozaze gansakuTrebiT, im depresiuli pacientebis mkurna-
_ 586 _
lobisas aRiniSneba, romlebsac sxva wamlebze an ele- aqvT xanmokle naxevardaSlis periodi (daaxloebiT
qtrokonvulsiur Terapiaze Sedegi ar aqvT. amasTan, 2-4 saaTi), radgan swrafad metabolizdeba RviZlSi
maoi-ebi SeiZleba gamoviyenoT SfoTviTi mdgomareo- acetilaciiT, oqsidaciiTa da deaminaciiT. adamianebi
bebis dros (Thase et al., 1995). erTmaneTisgan gansxvavdebian wamlebis acetilirebis
saWiroa Sefasdes, Tu misi efeqturoba ramdenad unariT. mag., britaneTis mosaxleobis 60%-s swrafi
gadawonis dietisa da sxva wamlebis gamoyenebis Se- acetilirebis unari aqvs, amitom maT hidrazin maoi-
zRudvas Tiraminsa da sxva simpatomimetikebze reaq- ebis metabolizeba ufro swrafad SeuZliaT, vidre
ciis Tavidan asacileblad. praqtikaSi es niSnavs, rom, neli acetilirebis unaris mqone pirebs. zog kvlevaSi
Cveulebriv, maoi-ebi pirveli arCevis preparatad Za- miTiTebulia fenalzinis ukeTesi klinikuri Sedegi
lian iSviaTad gamoiyeneba. neli acetilirebis SemTxvevaSi, Tumca es yvela kv-
leviT ar dasturdeba. aRmoCnda, rom maoi-ebis moqme-
farmakologiuri Tvisebebi debis saukeTeso Sedegi miiReba maRali dozis gamoye-
maoi-ebi iwveven im fermentebis inaqtivacias, romle- nebisas, risi mizezic, savaraudod, maoi-ebis swrafi
bic axdenen noradrenalinis, serotoninis, dofaminis, metabolizmis SemTxvevaSic preparatis adekvaturi
Tiraminisa da sxva aminebis daJangvas. es nivTierebe- doziT miRebaa.
bi gvxvdeba mTels organizmSi an miiReba sakvebisa an fenelzini, izokarboqsazidi da tranilcipromini
wamlebis saxiT. monoaminoqsidaza mravali formiTaa Seuqcevadad ukavSirdeba orives _ mao-A-s da mao-B-s
warmodgenili, romlebic erTmaneTisgan gansxvavdebian kovalenturi kavSiriT. ase rom, fermenti mudmivad
TavianTi substratiTa da inhibitoruli TvisebebiT. deaqtivirdeba da mao-s moqmedeba SeiZleba aRdges
fsiqotropuli Tvisebebis TvalsazrisiT, mniSvne- mxolod axali fermentis sinTezirebis Semdeg anu,
lovania monoaminoqsidazis ori forma _ A da B tipi, miuxedavad xanmokle naxevardaSlis periodisa, Seu-
romlebsac sxvadasxva geni akodirebs. mao A monawi- qcevadi maoi-ebi iwvevs mao-s xangrZliv inhibicias.
leobs noradrenalinisa da serotoninis, xolo mao am preparatebis sapirispirod, maklobemidi Seqceva-
A da mao B _ dofaminisa da Tiraminis metabolizmis dad ukavSirdeba mao-A -s, aqvs xanmokle naxevardaS-
procesSi. lis dro (daaxloebiT 2 saaTi), amitom mao-A-s inhi-
bicia xanmoklea da zogjer dReSi samjeradi dozac
ar aris sakmarisad efeqturi. mao-s moqmedebis sruli
fenelzini aris yvelaze kargad Seswavlili da yve- aRdgena xdeba maklobemidis Sewyvetidan 24 saaTSi.
laze farTod gamoyenebuli preparati. miuTiTeben, Seuqcevadi maoi-ebis SemTxvevaSi, 2 kvira an metia sa-
rom izokarboqsazids aqvs naklebi gverdiTi efeqte- Wiro mao-s xelaxali sinTezisTvis.
bi, vidre fenalzins da misi gamoyeneba SeiZleba im
SemTxvevebSi, roca fenalzini efeqturia, magram aqvs maoi-ebis efeqturoba depresiis dros
gverdiTi moqmedeba hipotenziisa da Zilis darRvevis mravali wlis ganmavlobaSi maoi-ebi aRar gamoiyenebo-
saxiT. tranilcipromini sxva preparatebisgan gansxva- da bevri kvlevis, maT Soris erT-erTi didi kontro-
vdeba mao-inhibitoruli da amfetaminis msgavsi sti- lirebadi kvlevis, monacemebis safuZvelze, romlis
mulaciuri moqmedebis kombinirebuli efeqtiT, rac mixedviTac depresiuli aSlilobebis SemTxvevebSi
SeiZleba gamodges anergiisa da retardaciis dros. fenelzini ar iyo ufro efeqturi, vidre placebo
zog SemTxvevaSi pacienti SeiZleba damokidebuli ga- (klinikuri fsiqiatriis komiteti, 1965). savaraudod,
xdes tranilciprominis stimulaciur efeqtze. amas- es adreuli monacemebi efuZneboda maoi-ebis dabali
Tan, fenelzinTan SedarebiT, tranilcipromini ufro doziT gamoyenebis Sedegebs: fenelzinis maqsimalur
xSirad iwvevs hipertenziul krizs, Tumca naklebad dozad iTvleboda 45 mg/dR, rac dRevandeli monace-
azianebs RviZls. amitom tranilcipromini gansaku- mebiT 90 mg/dRea (Tu gverdiTi moqmedeba amis saSua-
Trebuli sifrTxiliT unda dainiSnos. lebas iZleva). Semdgomma kvlevebma daadastura, rom
maklobemidi SedarebiT axali preparatia. igi sxva dozis aseTi farTo diapazonis gamo maoi-ebis Tera-
maoi-ebisgan gansxvavebiT, seleqciurad ukavSirdeba piuli moqmedeba sjobs placebos da utoldeba tri-
mao A -s da axdens mis inhibirebas, rasac Seqcevadi cikluri antidepresantebisas (Thase et al., 1995).
xasiaTi aqvs. es ganapirobebs sakveb produqtebTan aSS-Si Catarebulma kvlevebmac daadastura adreu-
mis nakleb urTierTqmedebasa da swraf efeqturobas li klinikuri STabeWdileba maoi-ebis gansakuTrebu-
(Bonnet, 2003) (ix. qvemoT). li mniSvnelobis Sesaxeb atipiuri depresiebis dros.
amasTan, maoi-ebi triciklurebze ufro efeqturi
farmakokinetika
aRmoCnda bipolaruli depresiis iseT SemTxvevebSi,
fenelzini, izokarboqsazidi da tranilcipromini romlebsac axlda hipersomnia da anergia. arsebobs,
swrafad absorbirdeba da farTod vrceldeba. maT aseve, monacemebi maoi-ebis efeqturobis Sesaxeb de-
_ 587 _
boqsi 21.6 maoi-ebis arasasurveli efeqti boqsi 21.7 sakvebi, romlis miRebac ara-
mizanSewonilia maoi-ebiT mkurnalobis
centraluri nervuli sistema
insomnia, Zilianoba, SfoTva, Tavis tkivili, daRliloba, procesSi
saerTo sisuste, tremori, mania, dabneuloba
avtonomiuri w yvelis yvela saxeoba, garda xaWosi da naRebisa. wiTe-
mxedvelobis gabundovaneba, Sardvis gaZneleba, ofli li Rvino, xeresi, ludi da liqiori
anoba, piris simSrale, posturuli hipotenzia, yabzoba w damarilebuli da Sebolili Tevzi
sxva w ludis safuaris produqtebi (konservirebuli sousebi
seqsualuri disfunqcia, wonis mateba, periferiuli da supebi)
neiroopaTia (piridoqsinis deficiti), SeSupeba,
gamonayari, hepatoceluluri toqsikuroba (iSviaTad), w marcvlovani produqtebi (mag., mwvane lobio)
leikopenia (iSviaTad) w Zroxis da qaTmis RviZli
w fermentirebuli Zexvi (mag., peperoni, saliami, bolo-
presiis (endogenuri niSnebiT an mis gareSe) iseT Se- nia)
mTxvevebSi, romlebic ar emorCileba triciklurebs w gadamwifebuli an daZvelebuli sakvebi (mag., xoxbis an
irmis xorci, Zveli rZis produqtebi)
da ukumitacebis sxva inhibitorebs (Thase, 1995).
hipertenziul reaqcias unda vumkurnaloT parente-
arasasurveli efeqti
ruli alfa-1-adrenoreceptorebis antagonistebiT,
esaa: piris simSrale, Sardvis gaZneleba, posturuli rogoricaa fentolamini. am preparatis ararsebobis
hipotenzia, cnobierebis aSla, mania, Tavis tkivili, SemTxvevaSi, SeiZleba qlorpromazinis gamoyeneba.
Tavbrusxveva, tremori, mtevnebisa da terfebis pa- ukanasknel periodSi amjobineben oralur nifedipins.
resTezia, yabzoba da koWis SeSupeba. hidrazinis pre- mkurnalobis daniSvnis yvela varianti saWiroebs ar-
paratebis gamoyenebas SeiZleba axldes hepatocelu- teriuli wnevis monitorings.
luri siyviTle (boqsi 21.6).
maklobemidi da Tiraminis reaqcia
kvebis produqtebis gavlena
Tiramini metabolizdeba orive fermentiT _ mao-A-
zogierTi sakvebi Seicavs Tiramins, nivTierebas, ro- Ti da mao-B-Ti. eqsperimentuli kvlevebiT aRmoCn-
melic normis farglebSi RviZlsa da nawlavis kedel- da, rom oraluri Tiraminis hipertenziuli efeqti
Si inaqtivirdeba mao-iT. roca mao inhibirebulia, ar naklebad potencirdeba maklobemidiT, vidre arase-
xdeba Tiraminis daSla da izrdeba misi hipertenziuli leqciuri maoi-ebiT (Bonnet, 2003). maklobemidis 900
efeqti, rac gamowveulia simpaTikuri nervuli termi- mg-mde dRiuri doziT miRebis SemTxvevaSi maRali ar-
nalebidan noradrenalinis sisxlSi gadmotyorcniTa teriuli wneva viTardeba maSin, rodesac Tiraminis
da, Sedegad, arteriuli wnevis momatebiT. arteriu- done 100 mg/dR-ze metia. Tumca, xuTjeradi kvebisa
li wneva SeiZleba gaizardos saxifaTo donemde da da Rvinis damatebis drosac ki Tiraminis raodenoba
gamoiwvios subaraqnoiduli sisxlCaqcevac. am tipis iSviaTad aRemateba 40 mg-s.
krizisis mniSvnelovani adreuli simptomia Zlieri, maklobemidiT mkurnalobis dros Tiraminis naklebi
mopulsire Tavis tkivili. efeqturoba aixsneba mao-B-s (arsebobas nawlavis ke-
maoi-ebis gamoyenebis SemTxvevebSi hipertenziuli delsa da RviZlSi) aqtivobiT, romelic axdens miRe-
reaqciis sixSire dieturi SezRudvis drosac ki 10%- buli Tiraminis metabolizms. meore faqtori SeiZle-
ia. amitom saWiroa dietis SezRudvis regularuli ba iyos maklobemidis mao-A-ze Seqcevadi moqmedeba,
Sexseneba, gansakuTrebiT xangrZlivi mkurnalobis rac, Warbi Tiraminis SemTxvevaSi, iZleva mao-s gamo-
dros (boqsi 21.6). miuTiTeben bevr produqtze, rom- Tavisuflebis saSualebas.
lebic iTvleba hipertenziuli reaqciis gamomwvevad
maoi-ebis gamoyenebis dros, Tumca, zogierT maT- wamlebTan urTierTqmedeba
ganTan dakavSirebiT mxolod erTeuli SemTxvevebia pacients, romelic iRebs maoi-ebs, ar unda daeniSnos
aRwerili da amitom arasarwmunoa. sirTules qmnis iseTi wamali, romlis metabolizmi damokidebulia im
sxvadasxva produqtSi Tiraminis sxvadasxva Semcve- fermentebze, romlebzec maoi-ebi axdenen gavlenas.
loba da sxvadasxva pacientis hipertenziul reaq- aseT wamlebs miekuTvneba iseTi simpaTomimetikuri
ciaze individualuri mgrZnobeloba. Tu akrZaluli aminebi, rogorebicaa adrenalini, noradrenalini da
produqtis miRebisas ar gamovlinda arasasurveli amfetamini, aseve, fenilpropanolamini da efedrini
efeqti, es ar niSnavs imas, rom momavalSi igi ar iCens (rac SeiZleba Sediodes gripis sawinaaRmdego prepa-
Tavs. ratebSi). L-dofas da dofaminsac SeuZlia hiperten-
mniSvnelovania, rom kvebis produqtebisa da maoi- ziuli reaqciis gamowveva. adgilobrivi gautkiva-
ebis aRwerili reaqciebis 4/5 da sikvdilis TiTqmis rebis saSualebebi xSirad Seicavs simpaTomimetikur
yvela SemTxveva ganviTarda yvelis miRebis Semdeg. aminebs, amitomac saWiroa Tavis arideba. opiatebi,
_ 588 _
tilini an trimipramini.
boqsi 21.8 serotoninis sindromis
klinikuri niSnebi w maoi-sa da tricikluris miReba unda daiwyos er-
Tdroulad da dabali doziT an maoi daematos tri-
nevrologiuri
miokloniebi, nistagmi, Tavis tkivili, tremori,
ciklurs (tricikluris maoi-ze damateba iwvevs Ta-
rigidoba, gulyrebi vbrusxvevas da posturul hipotenzias).
fsiqikuri statusis
gaRizianebadoba, cnobierebis aSla, SfoTva, hipomania, koma maoi-ebisa da triciklurebis kombinirebis sasar-
sxva geblo da mavne Sedegebi dadgenili ar aris. erTis
hiperpireqsia, oflianoba, diarea, gulis ariTmia,
sikvdili mxriv, pacients, romelic iRebs triciklurs maoi-
sTan erTad, naklebad aReniSneba maoi-iT gamowveuli
kokaini da insulini SeiZleba monawileobdes saxifa- insomnia; meores mxriv, xSiria posturuli hipotenzia
To urTierTqmedebis procesSi. matulobs oraluri da autaneli wonis mateba. iTvleba, rom kombinire-
antidiabeturi wamlebis sensitivoba da amis Sedegad bis gamoyeneba sasargebloa rezistentuli depresiis
hipoglikemiis riski. maoi-ebis posturuli hipoten- dros. pacientTa aseT jgufze kvlevebi ar Catarebu-
ziis gamomwvevi moqmedeba zrdis sxva preparatebis la, Tumca, aRwerilia erTeuli SemTxvevebi, rodesac
hipotenziur efeqts. karbamazepinis, fenitoinis da maoi-triciklurebis kombinacia efeqturi aRmoCnda,
sxva iseTi wamlebis metabolizmi, romlebic iSleba maSin, roca calke gamoyenebulma arc erTma prepa-
RviZlSi, SeiZleba Seneldes. ratma ar gamoiRo Sedegi. trazodonis dabali doza
serotoninuli sindromi. ramdenime wamals, romle- (50-150mg) gamoiyeneba maoi-iT gamowveuli insomniis
bic iwveven Tavis tvinSi serotoninis potencirebas, koreqciisTvis. arsebuli gamocdilebis Tanaxmad,
maoi-ebTan kombinirebisas SeuZliaT gamoiwvion mZi- aseT kombinirebas pacientebi kargad eguebian, magram
me neirotoqsikuri sindromi. am sindromis ZiriTadi iSviaTad SeiZleba Tavi iCinos arasasurvelma gver-
niSnebi mocemulia boqsSi 21.8. zogierTi es simptomi diTma moqmedebam, risi mizezic, savaraudod, unda
hgavs avTvisebian neirolefsiur sindroms, romelic iyos serotoninis toqsikuroba (Mir, Taylor, 1999).
zogjer serotoninul intoqsikaciaSi erevaT. dofa-
minisa da serotoninis traqtebs Soris urTierTmoq-
ukuCvenebebi
medebis gaTvaliswinebiT, simptomebis msgavseba Sesa- ukuCvenebebia: RviZlis daavadeba, feoqromocitoma,
Zloa erTi da imave meqanizmebis monawileobiT iyos gulis ukmarisoba SegubebebiT, mdgomareobebi, ro-
ganpirobebuli. Tanamedrove klinikuri monacemebiT, melTa drosac saWiroa iseTi wamlis daniSvna, romel-
maoi-ebisa da susi-ebis kombinireba, venlafaqsini da sac axasiaTebs maoi-sTan urTierTqmedeba.
klomipramini, ukunaCvenebia. maoi-ebis L-triftofan-
depresiis dros maoi-ebis klinikuri gamoyeneba
Tan kombinireba iwvevs serotoninul toqsikurobas.
aRwerilia arasasurveli reaqcia 5-HTJA recepto- wamlebis arasasurveli urTierTqmedebis riskisa da
ris agonist buspironis da maoi-ebis kombinirebisas. Tiraminis Semcveli produqtebis kvebidan amoRebis
5-HTJA receptoris agonist sumatriptanis gamoyeneba gamo, Seuqcevadi maoi, rogorc pirveli rigis anti-
Tavidan unda iqnes acilebuli. liTiumisa da maoi- depresiuli saSualeba iSviaTad gamoiyeneba. gamo-
ebis frTxili kombinacia naklebad iwvevs problemebs nakliss mxolod is SemTxvevebi warmoadgenen, roca
da SeiZleba efeqturi iyos rezistentuli depresiis pacients am wamlebze sxva antidepresantebTan Seda-
SemTxvevaSi. rebiT, saukeTeso Sedegebi aReniSneba. atipiuri de-
serotoninuli sindromis ganviTarebisas, yvela wa- presiis SemTxvevaSic ki, romlis samkurnalodac maoi-
mali unda moixsnas da daiwyos simptomaturi mkurna- ebi yvelaze efeqturad miiCneva, pirvel rigSi, ufro
loba. 5-HT receptorebis antagonistebi, rogorebi- mizanSewonili susi-ebis daniSvnaa. aseTi midgoma Zi-
caa cipropeptadini an propranololi, SesaZloa iyos riTadad Sedegiania.
efeqturi, magram kontrolirebadi kvlevebi Catare- fenelzinis klinikuri gamoyenebisas mkurnaloba
buli ar aris (serotoninis sindromis Sesaxeb infor- unda daiwyos 15 mg-dan dReSi da pirveli kviris gan-
macia ix. Gillman, Whyte, 2004). mavlobaSi unda gaizardos 30 mg-mde dReSi (gayofi-
maoi-ebis kombinacia triciklur antidepresanteb- li unda iyos ramdenime miRebaze ise, rom ar miiRos
Tan amoRebuli iyo xmarebidan, radgan serotoninuli 15.00. saaTze gvian). pacients unda mieces naTeli we-
sindromis mZime reaqciis ganviTarebis riskis Semcve- rilobiTi instruqcia sakvebis SezRudvis Sesaxeb (ix.
li iyo. amJamad iTvleba, rom kombinirebuli Terapia qvemoT) da gafrTxilebuli unda iyos, ar miiRos sxva
usafrTxoa, Tu daculi iqneba Semdegi wesebi: preparati im eqimTan konsultaciis gareSe, romelmac
icis, rom iRebs maoi-ebs. pacienti iseve, rogorc sxva
w ar gamoiyeneba klomipramini da imipramini; maoi-eb-
antidepresantebis SemTxvevaSi, unda gavafrTxiloT,
Tan erTad triciklurebidan saukeTesoa amitrip-
dayovnebuli Terapiuli efeqtisa (6 kviramde) da yve-
_ 589 _
la gverdiTi moqmedebis (Zilis darRveva, Tavbrusxve- maklobemidi
va) Sesaxeb.
Seqcevadi maoi-A-is inhibitoria. kerZod, maklobe-
meore kviras fenelzinis doza izrdeba 45mg-mde. am
midi Tiraminis reaqciisgan Tavisufalia da swrafad
etapze 60mg-mde momateba iZleva ufro swraf Sedegs,
iwyebs moqmedebas, ris gamoc aSkara upiratesoba aqvs
magram, amasTanave, izrdeba arasasurveli gverdiTi
sxva maoi-ebTan SedarebiT. iseve, rogorc sxva axali
moqmedebac. Sesabamisad, Tu SesaZlebelia, jobia, mo-
antidepresantebis, maklobemidis Terapiuli efeqtu-
matebis dawyebamde (90mg-mde dReSi) moisinjos dabali
robac, gansakuTrebiT mZime depresiis SemTxvevebSi,
dozis efeqturoba (daaxloebiT 45mg). Tu efeqti ar
dazustebuli ar aris (Anderson, 1999). jer-jerobiT
aris 45mg-ze, doza SeiZleba gaizardos 15mg-iT kvi-
ucnobia, aris Tu ara maklobemidi efeqturi atipiuri
raSi manam, sanam gverdiTi movlenebi amis saSualebas
depresiisa da triciklur-rezistentuli depresiis
iZleva.
SemTxvevebSi, maSin roca Cveulebrivi maoi-ebi gamo-
maoi-ebze organizmis pasuxi yovelTvis moulodne-
sadegia. ukanaskneli kvleviT aRmoCnda, rom maklo-
lia; mkurnalobis dros, erT dResac, pacienti Tavs
bemidis gamoyeneba SeiZleba rezistentuli depre-
ukeT grZnobs. Tu viTardeba hiperaqtiuroba an pa-
siis dros sxva wamlebTan kombinirebiT, rogorebicaa
cienti zedmetad energuli xdeba, doza unda Sem-
liTiumi da tricikluri antidepresantebi (Kennedy,
cirdes. hipomaniis niSnebis gamosavlenad saWiroa
Paykel, 2004).
mdgomareobis monitoringi. gansakuTrebiT Semawu-
maklobemidis sawyisi dozaa 150-300mg/dR, romlis
xebel gverdiT moqmedebas miekuTvneba insomnia da
momatebac SesaZlebelia 600-mde ramdenime kviris gan-
posturuli hipotenzia. insomniis marTvis saukeTeso
mavlobaSi. rezistentul SemTxvevebSi saWiro xdeba
saSualebaa maoi-is dozis SeZlebisdagvarad Semcire-
ufro maRali dozebis daniSvna, magram dReSi 900mg-ze
ba. arsebobs sxva SesaZleblobac _ benzodiazepinis
zemoT aucilebelia Cveulebrivi dieturi SezRudva,
an trazodonis (50-150mg RamiT) damateba; Tumca, es
rac maoi-ebis gamoyenebisasaa saWiro. maklobemidisa-
ukanaskneli iwvevs Tavbrusxvevasa da posturul hi-
dmi tolerantoba ukeTesia, vidre tricikluri an-
potenzias.
tidepresantebis an Seuqcevadi maoi-ebisadmi, Tumca,
maoi-ebis gamoyenebisas ganviTarebuli posturu-
gverdiTi moqmedebebi, gulisrevisa da insomiis saxiT,
li hipotenzia iwvevs Sromisunarianobis daqveiTebas.
aRiniSneba SemTxvevaTa 20-30%-Si.
aqac saukeTeso gzaa dozis Semcireba. SeiZleba sxva-
dasxva saSualebebis mosinjva, maT Soris elastiuri maklobemidis da wamlebis urTierTqmedeba
windebis xmareba, marilis damateba sakvebSi, minera- serotoninis sindromis maRali riskis gamo maklo-
lokortikoidebis daniSvnac ki. Tumca es ori ukanask- bemidis kombinireba susi-ebTan, venlafaqsinTan an
neli Tavad iwvevs arasasurvel moqmedebas. klomipraminTan ar SeiZleba. sifrTxilea saWiro su-
matriptanTanac. Seuqcevadi maoi-ebis msgavsad, opia-
maoi-ebis moxsna
tebTan kombinirebisas SeiZleba gamovlindes arasa-
pacientebs, romlebic iReben maoi-ebs, xSirad aqvT
surveli moqmedeba. aseve, maklobemidma SeiZleba ga-
mravalTviani an mravalwliani depresiis anamnezi. ase-
aZlieros simpatomimetikuri aminebis efeqti, amito-
Ti pacientebisTvis saukeTeso mkurnalobad miiCneva
mac kombinireba Tavidan unda aviciloT. ar SeiZleba
weliwadSi, sul mcire, 6 Tvis ganmavlobaSi maoi-ebis
maklobemidis kombinireba L-dofasTan hipertenziuli
daniSvna. mizanSewonilia, aseve, dozis Semcireba, Tu
krizis riskis gamo. cimetidini aferxebs maklobemi-
pacienti amas recidivis gareSe egueba. maoi-is uecari
dis metabolizms.
Sewyveta iwvevs SfoTvas da disforias. neli moxsnac
ki iwvevs SfoTvisa da depresiis momatebas.
sxva antidepresantebi
klinikuri gamocdileba aCvenebs, rom maoi-ebis mo-
arsebobs sxva antidepresantebi, romelTa moqmedebis
xsna ufro rTulia, vidre tricikluri antidepresan-
meqanizmis gamo maTi mikuTvneba triciklur antide-
tebisa. am gansxvavebis axsna SesaZlebelia imiT, rom
presantebTan, susi-ebsa an maoi-ebTan ver xerxdeba.
maoi-ebisTvis damaxasiaTebelia ufro mZime Sewyvetis
maT gverdiT efeqtebs damoukideblad ganvixilavT.
sindromis ganviTareba, vidre sxva antidepresantebis-
Tvis. meore SeiZleba iyos is, rom maoi-ebi iniSneba mianserini
qronikuli, unarSezRudulobis gamomwvevi aSlilo- mianserini kvadricikluri preparatia rTuli far-
bis dros, romelsac axlavs xSiri recidivi. unda aRi- makologiuri moqmedebiT. mas aqvs susti noradre-
niSnos, rom axal maoi-s sinTezamde da dieturi sakve- nalinis ukumitacebis inhibitoruli efeqti da se-
bisa da wamlebis SezRudvis moxsnamde, saWiroa, sul rotoninuli receptorebis ramdenime qvetipis, gan-
mcire, 2 kvira mas Semdeg, rac Sewydeba Seuqcevadi sakuTrebiT 5-HT2 receptorebis, sakmaod aqtiuri
maoi-iT mkurnaloba. antagonistia. mianserini, aseve, histamin H1 Hrecep-
_ 590 _
torebis, 1 _ da 2 _ adrenoreceptorebis antagonis- farmakokinetikis mxriv, mirtazapini kargad absor-
tia. ukanaskneli efeqtiT is iwvevs noradrenalinuri birdeba da plazmuri koncentraciis piki miiRweva 1-2
ujredebis agznebasa da gamoTavisuflebas. is ar aris saaTSi. naxevardaSlis dro daaxloebiT 16 saaTia da
muskarinuli qolinerguli antagonisti da ar aris dRiuri dozis micema SesaZlebelia mxolod RamiT.
kardiotoqsikuri. aseTi mravalmxrivi moqmedebis mirtazapini intensiurad metabolizdeba RviZlSi da
gamo mianserins aqvs sedaciuri moqmedeba, magram ar aqvs msubuqi inhibitoruli moqmedeba citoqrom P-450
aris antiqolinerguli da misi miRebisas SedarebiT izoenzimebze.
usafrTxoa dozis gadaWarbeba. zomieri da mZime depresiis mqone pacientebis Se-
farmakokinetikis mxriv mas axasiaTebs swrafi ab- mTxvevaSi mirtazapini avlens klinikur efeqturobas
sorbireba da plazmuri koncentraciis piki miiRweva orive _ placebo-kontrolirebad da SedarebiT kv-
2-3 saaTSi. naxevardaSlis periodi 10-20 saaTia, dRiu- levebSi, susi-ebsa da triciklur antidepresantebze.
ri dozis micema SeiZleba RamiT, erTjeradad. efeqturi doza, Cveulebriv, aris 30-45mg/dR. zo-
efeqturobis Seswavlis mizniT Catarebulma kvle- gierTi avtori miiCnevs, rom mirtazapiniT mkurnalo-
vebma aCvena, rom depresiis mkurnalobisas mianserins ba unda daiwyos pirdapir 30 mg-iT Zilis win, radgan
placebosTan SedarebiT aSkara upiratesoba gaaCnia da Warbi sedacia arc ise xSiria da ufro naklebi doziT
imipraminisa da klomipraminis msgavsi efeqtiT xasia- dawyeba saWiro araa. amis Teoriul mizezad asaxele-
Tdeba. am Sedegebis ganzogadebas arTulebs is faqti, ben maRal dozaze noradrenalinuri gzis aqtivaciiT
rom kvlevebSi preparatis dozebis farTo diapazoni antihistaminuri moqmedebis Sesustebas.
iyo gamoyenebuli. adreul kvlevebSi mianserini iniS- mirtazapinis xSir gverdiT moqmedebas miekuTvne-
neboda 30-60mg/dRiuri doziT, Tumca stacionarul ba misi antihistaminuri efeqti, Zilianoba da piris
pacientebs xSirad ufro maRali dozebiT mkurnalo- simSrale. xSiria madisa da wonis mateba. miuxedavad
bdnen ( 200mg/dRe). imisa, rom sxva antidepresantebTan SedarebiT leiko-
arasasurveli efeqtebidan yvelaze xSiria Zilianoba peniis riskis zrda damtkicebuli araa, mkurnalobis
da Tavbrusxveva, magram maTi Semsubuqeba SesaZlebe- procesSi leikocitebis monitoringi mainc rekomen-
lia zomieri doziT dawyebisa da dozis neli matebiT. debulia.
xSiri problemaa wonis mateba. aRwerilia dispefsia rac Seexeba sxva wamlebTan mis urTierTqmedebas,
da gulisreva. triciklurebis msgavsad, mianserinic aRsaniSnavia sxva centraluri moqmedebis sedaciu-
amcirebs gulyris zRurbls, magram naklebad. zogjer ri preparatebis moqmedebis gaZliereba. mianserinis
SeiZleba iyos posturuli hipotenzia. msgavsad, arsebobs Teoriuli riski, rom gamoiwvios
mianserinis yvelaze seriozuli arasasurveli moq- alfa-2-adrenoreceptoris agonistebis moqmedebis
medeba aris leikopenia da aRwerilia fataluri agra- daTrgunva.
nulocitozi. aseTi reaqcia ufro xSirad aqvT moxu-
cebs. mianseriniT mkurnalobis dawyebamde rekomende- trazodoni
bulia sisxlis saerTo analizis Semowmeba da pirveli trazodoni triazolopiridinis warmoebulia, rome-
3 Tvis ganmavlobaSi leikocitebis yovelTviuri mo- lic moqmedebs serotoninul gzebze. In vitro kvlevebis
nitoringi. mianserinis iSviaTi gverdiTi moqmedebaa Tanaxmad, trazodons aqvs 5-HT-is ukumitacebis susti
arTriti da hepatiti. inhibitoruli moqmedeba, romelic, savaraudod, kli-
wamlebTan urTierTqmedebis mxriv, aRsaniSnavia, nikuri gamoyenebisas ar gamovlindeba. mag., trazodo-
rom mianserini aZlierebs centraluri sedaciuri nis ganmeorebiTi daniSvniT TrombocitebSi seroto-
preparatebis moqmedebas. arsebobs Teoriuli riski, nini ar mcirdeba.
rom mianserinma gamoiwvios alfa-2-adrenorecepto- trazodons aqvs 5-HT2 receptorebis mimarT antago-
ris agonistis klonidinis moqmedebis daTrgunva. nisturi moqmedeba, magram misi aqtiuri metaboliti
m-qloro-fenilpiperazini (m-CPP) aris 5-HT recep-
mirtazapini toris agonisti. amdenad, trazodoniT mkurnalobi-
mirtazapini mianserinis analogia, msgavsi farmako- sas, 5- HT receptorebze efeqtis zusti balansi rTu-
logiuri profiliT, magram aqvs naklebi swrafva li dasadgenia da damokidebuli unda iyos sisxlSi
1-adrenoreceptorebisadmi. iTvleba, rom es mirta- pirveladi nivTierebis da Svileuli metabolitis
zapins aZlevs serotoninuli da noradrenalinuri Semcvelobaze. trazodoni aseve ablokirebs postsi-
neironebis gaaqtiurebis unars; Tumca, ra xdeba kli- nafsur alfa-1-adrenoreceptorebs. mas aSkara seda-
nikuri gamoyenebisas, daudgeneli araa. mianserinis ciuri profili aqvs.
msgavsad, mirtazapinsac aqvs sedaciuri moqmedeba. farmakokinetikis mxriv, trazodons aqvs xanmokle
mirtazapini cnobilia, rogorc noradrenalinisa da naxevardaSlis dro (daaxloebiT, 4-14sT). is metabo-
serotoninis specifikuri antidepresanti (NASSA). lizdeba oqsidaciiTa da hidroqsilaciiT da qmnis
_ 591 _
ramdenime metabolits, maT Soris m-CPP-s. mkurnalo- reboqsetini
bis procesSi sisxlSi m-CPP-s donem SeiZleba gadaa-
reboqsetini aris morfolini da struqturulad da
Warbos TviT trazodonis dones.
kavSirebulia fluoqsetinTan. is noradrenalinis
sxvadasxva kontrolirebadi kvleviT dadasturda,
ukumitacemis seleqciuri inhibitoria (nusi) da sxva
rom trazodoni efeqturia, Tu mas viyenebT 150-600
neirotransmiterebis receptorebze mniSvnelovan ga-
mg-is odenobiT, xolo depresiul pacientebTan aR-
vlenas ar axdens.
moCnda placeboze metad efeqturi. trazodons aR-
farmakokinetikis mxriv, aRsaniSnavia, rom oralu-
moaCnda imipraminis tolfasi antidepresiuli efeqti.
ri miRebidan plazmuri koncentraciis piki miiRweva 2
kvlevebis umetesoba dakvirvebas awarmoebda zomieri
saaTSi. misi naxevardaSlis dro 13 saaTia da rekomen-
simZimis depresiis mqone ambulatoriul pacientebze,
debulia dReSi 2-jer daniSvna. reboqsetini metabo-
amitom, sxva antidepresantebTan SedarebiTi, efeqtu-
lizdeba RviZlSi, sadac is citoqrom P450 CYP3A-is
roba kargad dadgenili ar aris (Anderson, 1999).
substrati xdeba.
zogi avtori kvlavac saukeTesod miiCnevs mkurna-
placebo-kontrolirebadi kvlevebis Tanaxmad, re-
lobis dabali doziT (50mg) dawyebas da nela moma-
boqsetini efeqturia triciklur antidepresantebsa
tebas 300mg-mde 2-3 kviris ganmavlobaSi. miuxedavad
da susi-ebTan SedarebiT (Burrows et al., 1998). damtki-
xanmokle naxevardaSlis droisa, umetes SemTxvevaSi
cda, rom depresiuli pacientebis socialuri funq-
dReSi erTjeradi doza sakmarisia. Cveulebriv, iniS-
ciis gaumjobeseba ukeT mimdinareobs reboqsetiniT,
neba saRamos, misi sedaciuri efeqtis gaTvaliswine-
vidre fluoqsetiniT mkurnalobisas, magram es daskv-
biT. dReSi 300mg-ze maRali doza ukeTesia daiyos. da-
na saWiroebs damatebiT mtkicebulebebs. reboqseti-
bali dozebi (50-150mg) zogjer iniSneba susi-ebTan da
nis Cveulebrivi dozaa 4mg 2-jer dReSi da maqsimalu-
maoi-ebTan kombinaciaSi am ukanasknelTa mier Zilis
ri dozaa12 mg/dR.
darRvevis efeqtis Sesamsubuqeblad.
arasasurveli efeqtebidan aRsaniSnavia, rom miu-
trazodonis yvelaze mniSvnelovani arasasurve-
xedavad muskarinuli receptorebis mimarT naklebi
li moqmedeba zedmeti sedaciaa, ramac SeiZleba ga-
aqtiurobisa, reboqsetini iwvevs qolinerguli recep-
moiwvios kognituri gauareseba. SeiZleba Tavi iCinos
torebis blokadisTvis damaxasiaTebel niSnebs, rac
gulisrevam da Tavbrusxvevam, gansakuTrebiT wamlis
gamowveuli unda iyos noradrenerguli da qoliner-
uzmoze miRebis SemTxvevaSi. trazodonis alfa-1-
guli gzebis urTierTqmedebiT. yvelaze xSiri gver-
adrenoreceptorebis mimarT antagonisturi moqme-
diTi moqmedebebia: piris simSrale, yabzoba, ofliano-
deba iwvevs arteriuli wnevis daqveiTebas. aRwerilia
ba da insomnia; iSviaTad fiqsirdeba Sardis Sekaveba,
posturuli hipotenziac. trazodoni naklebad kar-
impotencia, taqikardia da Tavbrusxveva.
diotoqsikuria, vidre sxva Cveulebrivi triciklure-
sxva wamlebTan urTierTqmedebis Sesaxeb informa-
bi, magram gulis daavadebis mqone pacientebSi aRwe-
cia mwiria. rekomendebulia, ar dainiSnos reboqseti-
rilia ariTmiis SemTxvevebi. miuxedavad amisa, tra-
ni im preparatebTan erTad, romlebic aZliereben no-
zodonis zedmeti doza naklebad toqsikuria, vidre
radrenalinis funqcias, rogorc maoi-ebi, da zrdian
tricikluri antidepresantebisa.
arteriul wnevas, rogorc ergotebi. reboqsetinis
yvelaze seriozuli gverdiTi moqmedebaa priapizmi.
plazmuri koncentracia matulobs im wamlebTan kom-
aseTi reaqcia iSviaTia (6000 mamakaci pacientidan daa-
binirebisas, romlebic ainhibireben citoqrom P450
xloebiT erTi), magram iwvevs mniSvnelovan problemas
3A4-s, rogoricaa sokos sawinaaaRmdego zogi wamali,
da saWiro xdeba noradrenalinis agonistis, adrena-
fluvoqsamini da makroliduri antibiotikebi.
linis, lokaluri ineqcia an qirurgiuli dekompresia.
zogjer SeiZleba ganviTardes xangrZlivi seqsualuri venlafaqsini
disfunqciac. rekomendebulia mamakaci pacientebis venlafaqsini aris fenileTilaminis warmoebuli, ro-
gafrTxileba, rom am potenciuri gverdiTi moqmede- melic iwvevs serotoninis ukuSewovis blokirebas da
bisa da problemis gaCenisTanave mimarTon eqims. SedarebiT naklebad moqmedebs noradrenalinze. am ku-
sxva wamlebTan urTierTqmedebis mxriv, aRsaniSnavia, TxiT misi farmakologiuri moqmedeba waagavs klomi-
rom iseve, rogorc sxva sedaciuri antidepresantebi, praminisas, magram, klomipraminis da sxva tricikluri
trazodonic iwvevs alkoholisa da sxva centraluri antidepresantebisgan gansxvavebiT, venlafaqsini ar
trankvilizatorebis sedaciuri efeqtis gaZlierebas. moqmedebs sxva neirotransmiterebis receptorebze
cxovelebze Catarebuli kvlevebiT aRmoCnda, rom da, amdenad, arc sedaciuri da antiqolinerguli efe-
trazodoni amcirebs klonidinis hipotenziur efeqti aqvs. farmakologiuri meqanizmidan gamomdinare,
qts, magram dazustebuli ar aris, ramdenad meordeba venlafaqsini klasificirdeba rogorc serotoninisa
aseTi efeqti adamianebSic. da noradrenalinis ukumitacebis seleqciuri inhibi-
tori (snusi).
_ 592 _
farmakokinetikas rac Seexeba, aRsaniSnavia, rom w venlafaqsiniT mkurnalobis dawyebamde unda gakeT-
venlafaqsini kargad absorbirdeba, plazmuri koncen- des ekg.
traciis piks aRwevs oraluri miRebidan 1, 5-2 saaTSi, susi-ebis msgavsad, venlafaqsinis uecarma Sewyvetam
naxevardaSlis periodia 3-7 saaTi, magram metaboli- SeiZleba gamoiwvios gulisrevis, daRlilobis, mu-
zdeba desmeTilvenlafaqsinad, romelsac igive far- clis tkivilisa da Tavbrusxvevis simptomebi. im Se-
makodinamikuri Tvisebebi aqvs, magram misi naxevar- mTxvevaSi, roca pacienti venlafaqsins iRebs 6 kviris
daSlis periodi 8-13 saaTia. gaxangrZlivebuli moqme- ganmavlobaSi da met xansac, rekomendebulia dozis
debis formis venlafaqsinis (Venlafaxine XL) plazmuri TandaTan Semcireba sul cota 1 kvira mainc. mimdina-
koncentraciis piki 6 saaTSia. es iZleva xangrZliv re kvlevebis mixedviT, savaraudoa, rom venlafaqsi-
naxevardaSlas (daaxloebiT 15 saaTi), magram wamali nis Warbi doza triciklurebze naklebad toqsikuria.
mainc swrafad gamoiyofa. aseTi preparatis micema Se- sxva wamlebTan urTierTqmedebis TvalsazrisiT,
saZlebelia dReSi erTxel. venlafaqsini, susi-ebisgan gansxvavebiT, naklebad
venlafaqsinis efeqturoba Seswavlilia mZime de- moqmedebs wamlebis metabolizmze moqmed RviZlis
presiis mqone rogorc ambulatoriul, ise staciona- fermentebze da amitom naklebad cvlis sxva wamlebis
rul pacientebSi da Sedarebulia rogorc placebos, metabolizms. im wamlebis msgavsad, romlebic ainhibi-
aseve aqtiur preparatebs. axali kvlevebis Tanaxmad, reben serotoninis mitacebas, venlafaqsinic, toqsi-
is placeboze ufro efeqturia da, minimum, sxva antikuri serotoninis sindromis safrTxis gamo maoi-eb-
depresantebis, maT Soris triciklurebis, tolfasi Tan erTad ar unda dainiSnos. rekomendebulia venla-
efeqturobiT xasiaTdeba (Anderson, 1999). ramdenime, faqsinis daniSvna maoi-ebiT mkurnalobis Sewyvetidan
maT Soris metaanalizuri kvleviT aRmoCnda, rom ven- mxolod 14 dRis Semdeg, xolo maoi-ebis daniSvna _
lafaqsini ufro efeqturia, vidre susi-ebi, gansaku- venlafaqsinis Sewyvetidan, sul mcire, 7 dRis Semdeg.
TrebiT mZime depresiis SemTxvevebSi (Smith et al., 2002).
venlafaqsins aqvs dozis ufro farTo diapazoni, duloqsetini
vidre susi-ebs da meryeobs dReSi 75-dan 375mg-s So- venlafaqsinis msgavsad, duloqsetinic snus-ad iTv-
ris, rac unda ganawildes 2 miRebaze da, gaxangrZli- leba. is noradrenalinze daaxloebiT 5-jer ufro
vebuli formis SemTxvevaSi, aRwevs 225mg-s dReSi, er- Zlierad ainhibirebs serotoninis ukumitacebas da
Tjeradad. Cveulebrivi sawyisi dozaa 75mg/dR, rac naklebad moqmedebs sxva neirotransmiterebis recep-
umeteswilad SeiZleba sakmarisi iyos. arasakmarisi torebze (Cowen et al., 2005).
efeqtis SemTxvevaSi doza SeiZleba gaizardos. farmakokinetikis mxriv, aRsaniSnavia, rom is kar-
venlafaqsinis arasasurveli efeqti susi-ebis msga- gad absorbirdeba, sisxlSi maqsimaluri koncentracia
vsia. yvelaze xSiria gulisreva, Tavis tkivili, som- miiRweva miRebidan daaxloebiT 6 saaTis Semdeg. misi
nolencia, piris simSrale, Tavbrusxveva da insomnia. naxevardaSlis dro aris 12 saaTi da intensiurad me-
SeiZleba iyos SfoTva da seqsualuri disfunqcia. iS- tabolizdeba Terapiulad araaqtiur nivTierebebad.
viaTad iwvevs posturul hipotenzias, magram SeiZle- efeqturobis gasarkvevad Catarebulma kvlevebma
ba dafiqsirdes dozasTan dakavSirebuli arteriuli aCvena, rom duloqsetinis erT 60mg-ian dozas aqvs
wnevis momatebac. im pacientebTan, romlebic iReben placeboze gacilebiT meti antidepresiuli da susi-
>150mg/dR, rekomendebulia arteriuli wnevis moni- ebis ekvivalenturi efeqti. susi-ebTan SedarebiT
toringi. susi-ebis msgavsad, venlafaqsinma SeiZleba venlafaqsinis msgavsi upiratesi moqmedeba da rezis-
gamoiwvios hiponatriemia. saerTod, gaxangrZlivebul tentuli mdgomareobebis dros misi gamoyenebis efe-
preparatis amtanoba Cveulebriv venlafaqsinTan Se- qturoba damatebiT Seswavlas saWiroebs.
darebiT ukeTesia, Tumca susi-ebTan SedarebiT, mainc duloqsetinis arasasurveli efeqti sxva serotoni-
uaresia (National Institute for Clinical Excellence, 2004). nul receptorebze moqmedi antidepresantebis msga-
dozis mwvave gadaWarbebis SemTxvevaSi venlafaqsini vsia: gulisreva, piris simSrale, Tavbrusxveva, kuW-
ufro toqsikuria, vidre susi-ebi (Cheeta et al., 2004). nawlavis problemebi, insomnia da somnolencia. mona-
britaneTis samkurnalwamlo preparatebis usafrTxo- cemebi seqsualuri disfunqciis Sesaxeb dazustebuli
ebis komitetis rCevebi Semdegia: ar aris. Terapiuli doziT duloqsetini ar iwvevs
w venlafaqsini unda gamoviyenoT mxolod im SemTxve- wnevis momatebas. mwiria monacemebi dozis gadaWarbe-
vebSi, roca sxva antidepresantebis adekvaturi dobis toqsikurobis Sesaxebac. rogorc mosalodnelia,
ziT gamoyenebis ori cda araefeqturia; duloqsetinis uecar Sewyvetas axlavs Tavbrusxveva,
insomnia, SfoTva da Tavis tkivili (Cowen et al., 2005).
w venlafaqsini ar aris rekomendebuli kardiovasku-
sxva wamlebTan urTierTqmedebis mxriv, aRsaniS-
luri daavadebis, hipertenziisa an eleqtrolituri
navia, rom duloqsetini iwvevs zomierad CYP2D6-is
disbalansis SemTxvevebSi;
da naklebad CYP1A2-is inhibicias. amitom plazmaSi
_ 593 _
im wamlebis koncentraciam, romlebzec es fermente- ara uSualod L-triftofaniT, aramed mwarmoeblis
bi moqmedebs, SeiZleba moimatos (cxrili 21.11). misi mier damatebuli minarevebiT (Kilbourne et al., 1996).
farmakologiuri moqmedebidan gamomdinare, dulo- L-triftofani rCeba mZime rezistentuli depresiis
qsetini ar unda dainiSnos maoi-ebTan erTad, sero- samkurnalo saSualebad, romelic gamoiyeneba sxva
toninis sindromis ganviTarebis safrTxis gamo. amave antidepresiul wamlebTan kombinaciaSi (mag., Barker et
mizeziT maoi-ebiT mkurnalobis dasrulebidan unda al., 1987). pacienti, romelic iRebs L-triftofans, sa-
gavides 14 dRe, raTa SesaZlebeli gaxdes duloqse- Wiroebs regularul monitorings, raTa droulad iq-
tinis miReba; aseve, duloqsetinis Sewyvetidan unda nes aRmoCenili ems-is simptomebi. Tu arsebobs ems-is
gavides 7 dRe, rom daviwyoT maoi-ebiT mkurnaloba. ganviTarebis saSiSroeba, yvela SemTxvevaSi L-trif-
tofani unda moixsnas da saswrafod ganisazRvros eo-
L-triftofani zinofilebis raodenoba.
L-triftofani aris bunebrivi aminomJava, romelic L-triftofanis sxva wamlebTan erTaderTi mniSv-
arsebobs yoveldRiur sakvebSi. kvebis tipiuri da- nelovani urTierTqmedeba SeiZleba iyos mxolod im
savluri reJimiT adamiani dReSi iRebs 500mg trif- medikamentebTan, romlebic aZliereben Tavis tvinSi
tofans. misi umetesi nawiliT xdeba cilebis sinTezi serotoninis moqmedebas. miuxedavad imisa, rom maoi-
da nikotinamidis nukleotidebis formireba. mxolod ebTan erTad daniSvna efeqturia, miuTiTeben seroto-
mcire nawili (daaxloebiT 1%) 5-hidroqsitriftofa- ninuli neirotoqsikurobis SesaZleblobazec. aseve,
nidan (5-htf) serotoninad sinTezirdeba. triftofan L-triftofanis kombinirebas susi-ebTan SeiZleba da-
hidroqsilaza, romelic L-triftofanidan 5-htf-is erTos mioklonusi, kankali da fsiqikuri mdgomareo-
sinTezis qimiuri reaqciis katalizatoria, Cveule- bis cvlileba (Gillman, Whyte, 2004).
briv triftofans ukavSirdeba. amdenad, Tavis tvinSi
triftofanis xelmisawvdomobis gazrdiT matulobs krazanas eqstraqti
serotoninis sinTezi. krazanas eqstraqtis (e.w. St. Johns Word) ZiriTadi ni-
farmakokinetikis TvalsazrisiT aRsaniSnavia, rom vTierebaa mcenare Hypericum perforatum. mas saukuneebia
L-triftofani swrafad absorbirdeba, plazmaSi pi- iyeneben sxvadasxva daniSnulebiT _ damwvrobis, ar-
kur koncentracias aRwevs miRebidan 1-2 saaTSi. is Tritis, gvelis nakbenisa da depresiis dros. aqtiuri
aqtiurad ukavSirdeba albumins. L-triftofanis ra- nivTiereba warmodgeba 6 ZiriTadi produqtis jgu-
odenoba, romelic saWiroa Tavis tvinSi serotonini fidan da hipericinebs da hiperforinebs moicavs.
sinTezisTvis damokidebulia mraval faqtorze, maT krazanas eqstraqtis farmakologia rTulia, magram
Soris plazmaSi Tavisufali L-triftofanis rao- cxovelebze Catarebulma eqsperimentebma da kvleve-
denobaze, triftofanis pirolazis aqtiurobasa da bma monoaminur neirogadacemaSi misi monawileoba ga-
plazmaSi sxva aminomJavebis koncentraciaze, romle- moavlina (Nathan, 1999).
bic saWiroa L-triftofanis Tavis tvinSi SesaRwevad. krazanas eqstraqtze Catarebulia ramdenime kvleva,
arsebobs susti mtkicebuleba imisa, rom damouki- magram Sedegebis interpretireba rTulia dozisa da
deblad L-triftofans antidepresiuli efeqti ga- momzadebis wesis arastandartulobis gamo. kvlevebic
aCnia da ambulatoriul SemTxvevebSi, zomieri de- ZiriTadad ganxorcielda msubuqidan saSualo simZi-
presiis dros placeboze metad efeqturia. ukeTesi mis depresiis mqone pacientebze. metaanalizis mixed-
efeqti miiReba L-triftofanis maoi-ebTan kombinire- viT, pacientTa aseT jgufSi mcenaris 0, 4-2, 7mg ufro
bisas, rac iwvevs maoi-ebis antidepresiuli efeqtis efeqturi iyo, vidre placebo (Linde et al., 1996). Seda-
gaZlierebas. msgavsi sinergiuli efeqti aRwerilia L- rebiT ufro axali kvlevebiT mZime depresiis mqone
triftofanis triciklurebTan kombinirebisas, Tumca pacientebSi mniSvnelovani antidepresiuli efeqti ar
aseTi kombinaciis Terapiuli sargebeli aramyaria. gamovlinda (Werneke et al., 2004).
gverdiTi efeqtebi L-triftofani saerTod kargi rac Seexeba gverdiT moqmedebebs, aRsaniSnavia, rom
amtanobiT xasiaTdeba, magram ar aris iSviaTi gulis- mas pacientebi kargad itanen. yvelaze xSiri arasasur-
reva da Zilianoba. ukanasknel wlebSi gamovlinda, veli moqmedeba SeiZleba iyos gastro-intestinuri
rom L-triftofanis miReba iwvevda sklerodermiis darRvevebi, Tavbrusxveva, daRliloba. mkurnalobis
msgavs mZime daavadebas, eozinofilur-mialgiur sin- periodSi aRwerilia maniis SemTxvevebi. iSviaTad fiq-
droms (ems), romelsac axlda eozinofilebis momateba sirdeba fotosensitivoba. krazanas eqstraqti gavle-
(periferiuli leikocitebis daaxloebiT 20%), kunTe- nas axdens RviZlis fermentebze da aRiniSneba mkur-
bis Zlieri tkivili, SeSupeba, kanis sklerozi da pe- nalobis periodSi eufilinis, ciklosporinis, di-
riferiuli neiropaTia. aRwerili iyo aseTi SemTxve- goqsinisa da eTinilestradiolis donis daqveiTeba.
vebis fataluri dasasrulic. amasTan, krazanas eqstraqtis susi-ebTan an sxva 5-HT
magram dReisTvis dadginda, rom ems gamowveuli iyo wamlebTan kombinirebisas, SeiZleba ganviTardes se-
_ 594 _
rotoninis neirotoqsikurobis sindromi (Ernst, 1999). vaSi efeqturi ar aris.
bupropioni liTiumi
bupropioni ar aris daSvebuli britaneTsa da evropa- placebo-kontrolirebadi kvlevebiT dadginda, rom
Si, magram rogorc antidepresanti farTod gamoiye- liTiumi efeqturia sxvadasxva mdgomareobis dros:
neba aSS-Si. britaneTSi is licenzirebulia rogorc w maniis mwvave mkurnaloba;
sigaretis mowevis Tavis dasanebebeli damxmare sa-
w unipolaruli da bipolaruli guneb-ganwyobis aS
Sualeba. gansxvavebulia sxva antidepresantebisgan
lilobebi;
struqturulad da farmakologiurad da warmoadgens
w rezistentuli depresiis damatebiTi Terapia;
uniciklur aminoketonur warmoebuls. bupropioni
aZlierebs orive _ dofaminur da noradrenalinur, w daswavlis unarSezRudulobis mqone pacientebSi
funqcias Tavis tvinSi, savaraudod, ukumitacebis agresiuli qcevis prevencia.
blokirebis xarjze. moqmedebis meqanizmi: cxovelebze Catarebulma
efeqturoba da gverdiTi efeqtebi: kontrolirebadi cdebma aCvena, rom liTiums aqvs mniSvnelovani gav-
kvlevebiT dadginda, rom bupropions aqvs placebo- lena ujredSiga sasignalo molekulebze anu `meorad
ze upiratesi da susi-ebis tolfasi antidepresiuli macneebze~, romlebic aqtiurdeba neirotransmiteris
efeqti. zogi maxasiaTebliT bupropionis gverdiTi an agonistis mimagrebiT specifikur receptorebze.
moqmedeba susi-ebis msgavsia. yvelaze xSirad aRweri- Sesabamisi klinikuri doziT liTiumi ainhibirebs
lia insomia, SfoTva, tremori da gulisreva. susi- cikluri adenozin-monofosfatis (c-amf) warmoqmnas
ebis sapirispirod, is ar iwvevs seqsualur disfunq- da amcirebs inozitolis lipidebidan warmoebul sx-
cias da amitomac zog SemTxvevaSi mniSvnelovani upi- vadasxva mediatorebs. aseTi moqmedebiT liTiumi gav-
ratesobiT sargeblobs. lenas axdens neirotransmiterebis mraval traqtze,
bupropionis gamoyenebisas ZiriTadi problemaa romelTagan bevri iyenebs zemoTxsenebul macneTa
gulyrebis riskis momateba. maRal dozaze gulyrebis sistemas. ukanasknel xans interesi gamoiwvia liTiu-
riski (0, 4%) 4-jer metia, vidre susi-ebiT mkurna- mis unarma, xeli Seuwyos ujredebis gadarCenas da
lobis dros (daaxloebiT 1%). riski SedarebiT daba- gazardos sinafsebis plastikuroba, rasac, savarau-
lia gaxangrZlivebuli preparatebis miRebisas, rom- dod, axorcielebs ferment glikogen-sinTaz-kinaza-
lebsac iyeneben mowevisTvis Tavis danebebis mizniT. 3-is moqmedebis inhibirebiT (Pilcher, 2003).
roca misi dozaa 300 mg da ufro naklebi, gulyrebis farmakokinetika: liTiumi nawlavebidan swrafad ab-
riski daaxloebiT 0, 1%-ia. esaa sigaretis dasanebebe- sorbirdeba da swrafadve vrceldeba mTeli sxeulis
li maqsimaluri rekomendebuli doza da, aseve, stan- ujredebsa da siTxeSi. liTiumi ujredidan natriumze
dartuli doza depresiis samkurnalod. bupropioni nela gamodis. plazmidan gamoiyofa Tirkmlis eqskre-
ar unda daeniSnoT gulyrebis an kvebis darRvevebis ciis da ujredebsa da sxeulis sxva nawilebSi SeRw-
mqone pacientebs. evis gziT. ase rom, liTiumi swrafad eqskretirdeba
wamlebTan urTierTqmedebis mxriv, aRsaniSnavia, plazmidan, xolo neli faziT _ mTeli sxeulidan.
rom bupropioni ar unda dainiSnos im wamlebTan er- natriumis msgavsad, liTiumic ifiltreba da nawi
Tad, romlebic amcireben gulyrebis zRurbls. ase- lobriv reabsorbirdeba TirkmelebSi. roca proqsim-
Tebia: triciklurebi, antifsiqozurebi da malariis aluri milakebi meti wylis absorbcias axdens, matu-
sawinaaRmdego preparatebi. aseve, ukunaCvenebia maoi- lobs liTiumis absorbciac. amdenad, dehidratacia
ebi. susi-ebis araefeqturobis SemTxvevaSi, aSS-Si bu- zrdis plazmaSi liTiumis koncentraciis momate-
propions usafrTxod iyeneben liTiumTan erTad. bas. radgan liTiumi transportirdeba natriumTan
konkurenciis pirobebSi, natriumis koncentraciis
guneb-ganwyobis stabilizatorebi Semcirebisas meti liTiumi reabsorbirdeba. am meqa-
am saTauris qveS gaerTianebulia sxvadasxva prepa- nizmiT Tiazidis diuretikebi iwvevs sisxlSi liTiu-
ratebi, rogorebicaa liTiumi da ramdenime antikon- mis toqsikur koncentracias.
vulsanti, maT Soris karbamazepini da natriumis val- dozireba da plazmuri koncentracia: vinaid-
proati. es sami wamali efeqturia ganmeorebadi afe- an Terapiuli da toqsikuri dozebi Zalian axlo-
qturi aSlilobis prevenciisa da maniis mwvave mkur- saa, mkurnalobis periodSi aucilebelia liTiumis
nalobisTvis. liTiums axasiaTebs antidepresiuli plazmuri koncentraciis gansazRvra. Sefaseba unda
efeqti, magram valproatisa da karbamazepinis msgavsi moxdes dawyebidan 4-7 dRis Semdeg, momdevno 3 kvira _
moqmedeba dadgenili ar aris. antikonvulsanti lamo- kviraSi erTxel; damakmayofilebeli stabiluri mdgo-
trijini ukanasknel periodSi warmatebiT gamoiyeneba mareobis miRwevisas _ yovel 6 kviraSi erTxel. Semdeg
bipolaruli aSlilobis dros, magram maniis SemTxve- liTiumis done stabiluria da plazmis monitoringi
_ 595 _
unda ganxorcieldes 2-3-Tviani intervalebiT, Tu ar koncentracia araefeqturia da SeiZleba saWiro gax-
aris ufro xSiri gadamowmebis klinikuri Cveneba. des 0, 8-1, 0 mmol/l. seriozuli toqsikuri efeqti
oraluri dozis Semdeg plazmaSi liTiumis done vlindeba 2, 0 mmol/l-ze ufro maRali koncentraciis
matulobs daaxloebiT 4 saaTSi. koncentracia, Cveu- dros, Tumca adreuli simptomebi SeiZleba gaCndes
lebriv, unda gaizomos bolojer miRebuli dozidan >1, 2 mmol/l-ze (Macritchie, Young, 2004).
12 saaTis Semdeg, rac xSirad emTxveva Ramis dozas. amJamad arsebobs liTiumis gaxangrZlivebuli
mniSvnelovania am rutinis Sesruleba, radgan, gamo- moqmedebis preparatebi, magram maTi in vivo far
qveynebuli informaciiT, liTiumis doned iTvleba 12 makokinetika mniSvnelovnad ar gansxvavdeba stan
saaTis Semdeg arsebuli koncentracia da ara pikuri dartuli liTiumis karbonatis preparatebisgan.
_ 4 saaTis Semdeg arsebuli maRali done. Tu Semow- im pacientebisTvis, romlebsac uWirT abebis saxiT
mebis Sedegad dadgindeba Seusabamod maRali koncen- preparatis miReba, arsebobs liTiumis citratis
tracia, mniSvnelovania imis dazusteba, Tu pacientma xsnari. liTiumi SeiZleba dainiSnos erTxel an orjer
sisxlis analizis aRebamde ramdeni xniT adre miiRo dReSi. miRebis sixSire ar cvlis Sardis raodenobas.
dilis doza. saerTod, ufro mosaxerxeblad iTvleba liTiumis
adekvatur plazmur koncentraciad iTvleboda 0, micema erTxel, RamiT, magram, Tu pacients aseTi
7-1, 2 mmol/l dozidan 12 saaTis Semdeg. Tanamedrove reJimis gamo aqvs kuWis problemebi, SesaZlebelia
midgomiT, upiratesoba eniWeba liTiumis ufro da- dozis dayofa.
bal plazmur dones (0, 5-0, 8mmol/l), radgan nakle- arasasurveli moqmedeba (cxrili 21.13): susti
bia gverdiTi moqmedebebis riski. zogierTi kvlevis diurezi natriumis eqskreciis gamo vlindeba wamlis
Tanaxmad, liTiumis dabali koncentraciis SemTx- dawyebidan mokle periodSi. sxva gverdiT moqmedebebs
vevebSi (0, 4-0, 7mmol/l) SemanarCunebeli mkurnalo- miekuTvneba xelebis tremori, piris simSrale,
bis dros ufro xSiria afeqturi aSlilobebi, vidre metalis gemo pirSi, kunTebis sisustis SegrZneba da
ufro maRali koncentraciisas (0, 8-1, 0 mmol/l). daRliloba.
Tumca, es myari monacemebi araa (Ferrier et al., 1999). msubuqi xarisxis wyurvili da poliuria xSiria li
praqtikaSi pacientebis didi nawilis marTva efeq- TiumiT mkurnalobis dros, radgan liTiumi Tirkmlis
turad xorcieldeba, roca liTiumis plazmuri kon- milakebze antidiurezuli hormonis (adh) moqmedebas
centraciaa 0, 4-0, 7 mmol/l. pacientis arastabiluri blokavs. es movlena klinikurad mniSvnelovan
mdgomareobis dros dozis momateba SesaZlebelia ma- simwvaves iSviaTad aRwevs, Tumca pacientebis TiT
Sin, roca gverdiTi moqmedeba amis saSualebas iZl- qmis mesameds uSaqro diabetis msgavsi sindromi
eva. mwvave maniis samkurnalod 0, 8 mmol/l-ze naklebi uviTardeba, romelsac gamoxatuli poliuria da
cxrili 21.13 liTiumis, karbamazepinis da valproatis zogierTi gverdiTi moqmedeba

liTiumi karbamazepini valproati
nevrologiuri tremori, sisuste, dizarTria, Tavbrusxveva, sisuste, tremori, sedacia

ataqsia, mexsierebis daqveiTeba, Zilianoba, ataqsia, Tavis
gulyrebi (iSviaTi) tkivili, mxedvelobis darRveva
Tirkmlis/wylis Sardis gamoyofis gaZliereba Sardis koncentraciis unaris plazmaSi amiakis momateba
cvla koncentraciis daqveiTebiT. momateba. hiponatriemia,
wyurvili, uSaqro diabeti SeSupeba
(iSviaTi), SeSupeba
gastro- gemovnebis Secvla, anoreqsia, anoreqsia, gulisreva, yabzoba, anoreqsia, gulisreva,

intestinuri/ gulisreva, Rebineba, diarea, hepatitis Rebineba, diarea, wonis
RviZlis wonis momateba mateba, hepatiti (iSviaTi),
pankreatiti (iSviaTi)
endokrinuli Tiroqsinis daqveiTeba Tiroqsinis daqveiTeba menstrualuri darRvevebi

Tiroid-mastimulirebeli Tiroid-mastimulirebeli
hormonis momatebiT, Ciyvi, hormonis normaluri doniT
hiperparaTiroidizmi (iSviaTi)
hematologiuri leikocitozi leikopenia, agranulocitozi Trombocitebis raodenobis

(iSviaTi) daqveiTeba, Trombocitebis
anomaliuri agregacia
dermatologiuri akne, fsoriazis gamwvaveba, Tmis eriTemuli gamonayari Tmis cvena

cvena
kardio- ekg cvlilebebi (Cveulebriv, gulis gamtareblobiTi -

vaskuluri klinikurad keTilTvisebiani) darRvevebi
_ 596 _
polidifsia axasiaTebs. aseT SemTxvevaSi SeiZleba sac. aRwerilia liTiumiT mravalwliani mkurnalobis
aucilebeli gaxdes liTiumis Sewyveta, magram dabali Sedegad milakebis funqciis Seuqcevadi daqveiTeba. es
plazmuri koncentraciis gamoyenebisas, SesaZloa ufro xSiria liTiumis maRali plazmuri koncentra-
ganviTardes sindromis recidivi. ciis SemTxvevebSi, rodesac gamoyenebulia fsiqotro-
zogierT pacients, gansakuTrebiT qalebs, wona puli mkurnalobac (Bendz et al., 1994).
Si mateba aReniSneba. xSiria mudmivi, dabalampli ramdenime kvleviT Seiswavles liTiumiT Semanar-
tudiani tremori, ZiriTadad xelebis, magram maRal Cunebeli xangrZlivi mkurnalobis gavlena glomer-
amplitudiani tremoris ganviTareba ukve liTiumis ulebis funqciaze. saerTod, glomerulebis funq-
plazmuri koncentraciis toqsikur doneze mianiSnebs. ciis nebismieri daqveiTeba msubuqia da ukavSirdeba
pacientebis umetesoba egueba dabalamplitudian liTiumiT intoqsikacias. miuxedavad amisa, aRwerilia
tremors. xolo maTTvis, vinc ver egueba, 40 mg-mde liTiumiT mkurnalobis fonze Tirkmlis ukmariso-
propranololi dReSi samjer Seamcirebs simptoms. bis ganviTarebac ki, roca nefrotoqsikurobis sxva
SeiZleba ganviTardes Tmis cvena da Tmis struqturis mizezi dafiqsirebuli ar iyo. gavrcelebuli mid-
gauxeSeba. gomis Tanaxmad, guneb-ganwyobis profilaqtikuri
pacientebis 5%-s, romlebic liTiumiT mkurnaloben, mkurnaloba xangrZlivia; Sesabamisad, aucilebelia
aReniSnebaT Tiroiduli jirkvlis gadideba, romelic plazmis kreatininis regularuli monitoringi. sa-
pataravdeba, Tu liTiumiT mkurnalobis periodSi varaudod, nefrotoqsikurobis riski minimaluria,
pacients eZleva Tiroqsini da, saerTod, liTiumis Tu plazmaSi liTiumis done Terapiul qveda zRvarze
Sewyvetidan 1-2 TveSi normalur zomas ubrundeba. SenarCundeba, rac individualuri pacientisTvis Sei-
liTiumi moqmedebs Tiroidis gamomuSavebaze _ Zleba efeqturi iyos (Macritchie, Young, 2004).
hipoTiroidizmi aReniSneba pacienti qalebis daax toqsikuri efeqti dakavSirebulia preparatis
loebiT 20%-s da xdeba Tiroid-mastimulirebeli dozasTan da vlindeba ataqsiiT, kidurebSi koordi-
hormonis kompensatoruli momateba. naciis moSliT, kunTebis SekrTomiT, dizarTriiTa
am cvlilebebis aRmosaCenad yovel 6 TveSi unda da cnobierebis SecvliT. es mdgomareoba saWiroebs
Catardes Tiroiduli funqciis testireba, Tumca, gadaudebel mkurnalobas, vinaidan SesaZloa pro-
es ver Caanacvlebs klinikur monitorings iseTi gresirdes koma da sikvdili.
klinikuri niSnebis gamosavlenad, rogorebicaa le aseT dros unda Sewydes liTiumis micema da dain-
Targia da wonis mniSvnelovani mateba. Tu viTardeba iSnos didi raodenobiT siTxeebi. mZime SemTxvevebSi
hipoTiroidizmi, magram liTiumiT mkurnalobis SeiZleba saWiro gaxdes Tirkmlis dializi. Tirkm-
gagrZelebis Cveneba isev arsebobs, unda daematos lis normaluri funqcionirebisas liTiumi srulad
TiroqsiniT mkurnaloba. hiperparaTiroidizmis ga gamoiyofa anu SemTxvevaTa umetesoba sruldeba
mo liTiumis miRebas, aseve, SeiZleba axldes hi sruli gamojanmrTelebiT, magram iSviaTad SesaZloa
perkalciemia. zogjer mas axlavs mZime depresiac, sikvdiliTac dasruldes. aRwerilia iseTi situa-
rac arsebuli guneb-ganwyobis aSlilobisgan di ciebic, rodesac, hemodializis miuxedavad, viTarde-
ferencirebas arTulebs. ba myari nevrologiuri disfunqcia.
aseve, SesaZloa gaCndes ekg-s Seqcevadi cvlilebebi, rogorc wina nawilSi iyo aRniSnuli (gv. ??), liTiu-
risi mizezic SeiZleba iyos miokardiumSi kaliumis mi zrdis nayofis anomaliebis, kerZod, gulis mankebis
Canacvleba liTiumiT da hipokaliemiis msgavsi niS ganviTarebis risks, magram individualuri riskis
nebis gaCena, T-talRis gabrtyeleba, QRS inversia mniSvneloba dabalia. orsulobis yovel konkretul
da gafarToveba. am niSnebs iSviaTad aqvs klinikuri SemTxvevaSi, gadawyvetileba, gagrZeldes Tu ara li-
mniSvneloba. sxva cvlilebebs miekuTvneba Seqce TiumiT mkurnaloba, zedmiwevniT dakvirvebiT unda
vadi leikocitozi da, iSviaTad, papuluri an maku aiwonos. mniSvnelovan faqtorebs miekuTvneba li-
lopapuluri gamonayari. Tiumis Sewyvetisas afeqturi recidivis albaToba da
zogjer pacientebi uCivian gavlenas mexsierebaze, afeqturi epizodis marTvis siZneleebi.
rac vlindeba imaSi, rom aviwydebaT kargad nacnobi Tu orsuli agrZelebs liTiumis miRebas, aucile-
saxelebi. SesaZlebelia, es ar iyos wamlis moqmedebis belia plazmuri koncentraciis monitoringi. orsu-
Sedegi, aramed iyos mxolod guneb-ganwyobis aS lobis gagrZelebis SemTxvevaSi unda Catardes ul-
lilobis gamovlena. Tumca, arsebobs monacemebi, rom trabgeriTi gamokvleva da nayofis eqokardiografia.
liTiumiT mkurnalobisas kognituri testebis Ses- bipolaruli aSlilobis anamnezis mqone pacients
rulebis problemebi Cndeba. mSobiarobis Semdeg periodSi fsiqozuri recidivis
Tirkmelebze xangrZlivi efeqtis Sesaxeb cnobilia, mniSvnelovnad maRali riski aqvs. am dros, profilaq-
rom liTiumiT mkurnaloba amcirebs milakebis kon- tikis mizniT, SeiZleba liTiumis xanmokle droiT
centraciis unars da zogjer iwvevs uSaqro diabet- daniSvna. vinaidan Cvilis plazmaSi SesaZloa liTium-
_ 597 _
TandaTanobiT xdeba, maSin swrafi recidivis ganviTarebis
boqsi 21.9 liTiumis sxva preparatebTan
riski mcirdeba. im pacientebSic ki, romlebic mravali
urTierTqmedeba
wlis ganmavlobaSi kargad arian, liTiumis Sewyvetam
farmakokinetikuri SeiZleba afeqturi aSlilobis epizodi gamoiwvios.
zrdis liTiumis dones
aseTi pacientebis umetesoba kargad pasuxobs liTiumis
w diuretikebi (yvelaze usafrTxoa _ frusemidi)
w anTebis sawinaaRmdego arasteroiduli saSualebebi xelaxla daniSvnas (Tondo et al., 1997).
w yvelaze usafrTxoa _ aspirin/sulindaki ukuCvenebebs miekuTvneba: Tirkmlis ukmarisoba
w ACE-inhibitorebi an Tirkmlis axali daavadeba, gulis ukmarisoba
w angiotenzin-II receptoris antagonistebi an axali gulis infarqti da eleqtrolitebis
w antibiotikebi (streptomocini/metronidazoli) disbalansis gamomwvevi qronikuli diarea. liTiumi
aqveiTebs liTiumis dones ar unda dainiSnos iseT SemTxvevaSi, roca pacientis
w eufilini eqimTan TanamSromloba ar iZleva usafrTxoebis
w natriumis bikarbonati
dacvis saSualebas; igulisxmeba, rom gafrTxilebis
farmakodinamikuri miuxedavad, pacientma SeiZleba TviTneburad Sew
viTardeba serotoninuli neirotoqsikuroba yvitos preparatis miReba.
w susi-ebi (SeiZleba gamoviyenoT didi sifrTxiliT)
w 5-HT1 agonistebi liTiumze myofi pacientis marTva
viTardeba eqstrapiramiduli gverdiTi movlenebi momzadeba: liTiumis Terapiuli dozis Tiroidul
w antifsiqozuri wamlebi, metokloprammidi,
jirkvalsa da Tirkmelebze gavlenisa da Warbi dozis
domperidoni
Zlierdeba neirotoqsikuroba toqsikuri efeqtis gamo, aucilebelia marTvis
w karbamazepini, fenitoini, kalciumis arxis rutinuli wesebis dacva. qvemoT mocemuli wesebis
blokatorebi, meTildofa sistema erT-erTia SemoTavazebulebs Soris da
SesaZlebelia misi usafrTxo adaptacia. warmatebuli
is mniSvnelovani koncentracia aRmoCndes, umjobesia mkurnalobisTvis saWiroa yuradRebis gamaxvileba de
bavSvis xelovnur kvebaze gadayvana. talebze da qvemoT mocemuli safexurebis garkveuli
wamlebTan urTierTqmedeba (boqsi 21.9): liTiumis dacva.
viwro Terapiuli Cvenebis gamo, mis wamlebze farma- liTiumiT mkurnalobis dawyebamde aucilebelia
kokinetikur gavlenas gansakuTrebuli mniSvneloba pacientis fizikuri gasinjva arteriuli wnevis ga
eniWeba. farmakodinamikuri urTierTqmedeba SeiZleba zomvis CaTvliT. aseve, aucilebelia misi wonis gan
moicavdes serotoninerguli preparatebis gaZliere- sazRvrac.
bas, rac serotoninis sindroms iwvevs. centralur saWiroa sisxlis aReba eleqtrolitebis, SratSi
nervul sistemaze moqmed zog preparatTan erTad kreatininisa da saerTo analizis gansazRvrisTvis.
miRebisas, liTiumis Terapiulma koncentracia Sei- gansakuTrebul SemTxvevebSi unda ganisazRvros kre
Zleba neirotoqsikuri aRmoCndes. atininis klirensi, risTvisac sakmarisia 18 saaTiani
eleqtrokonvulsiuri Terapia (ekT) da qirurgia: Segroveba. aseve, saWiroa Tiroiduli funqciis tes
ekT-sTan erTad liTiumis miRebis gagrZeleba zrdis tireba. Cvenebis mixedviT, unda Catardes ekg da
neirotoqsikurobis ganviTarebis risks. aseT SemTx- orsulobis testi.
vevebSi, liTiumis dozebi unda Semcirdes an moixs- Tu kvlevebiT liTiumis daniSvnis ukuCveneba ar
nas. gasaTvaliswinebelia dehidrataciis saSiSroebac. gamovlinda, sxva preparatebTan SeuTavseblobis
qirurgiuli manipulaciis Catarebamde, sasurvelia, Tavidan acilebis mizniT, unda dadgindes, Tu ra
preparatis miRebis Sewyveta, raTa Tavidan aviciloT preparatebs iRebs pacienti. amis Semdeg pacients unda
miorelaqsantebis moqmedebis gaZliereba. Tumca, mieces dawvrilebiTi axsna-ganmarteba _ pacientma
unda gaviTvaliswinoT moxsnis mdgomareobisa da ma- unda icodes SesaZlo toqsikuri efeqtis adreuli
niis ganviTarebis riski. niSnebi da misi ganviTarebis xelSemwyobi pirobebi,
liTiumis moxsna: kvlevebiT dadasturebulia, rom rogoricaa, mag., gastroenteriti, Tirkmlis infeqcia
liTiumis uecar Sewyvetas maniakaluri mdgomareobis an cxelebiT gamowveuli dehidratacia. pacienti unda
ganviTareba mohyveba. arsebobs imis mtkicebuleba, gavafrTxiloT, rom msgavsi movlenebis ganviTarebis
rom vinaidan liTiums gamoxatuli normoTimiuli SemTxvevaSi, Sewyvitos wamali da mimarTos eqims.
efeqti gaaCnia, misi moxsna zrdis afeqturi aSlilo- Cveulebriv, kargia, Tu diskusiaSi monawileobas
bebis recidivebis risks. Tumca, maniisa da moxsnis miiRebs ojaxis wevri. gansakuTrebiT sasargebloa
sindromis ganviTareba ufro bipolaruli pacien- werilobiTi saxelmZRvanelos micema (eqimis dawerili
tebisTvisaa damaxasiaTebeli. an mwarmoeblis mier gamoSvebuli). diskusiaSi gonieri
Tu liTiumis Sewyveta ramdenime kviris ganmavlobaSi wonasworobis dacva, anu informaciis miwodeba, ise
_ 598 _
unda gakeTdes, rom pacientma icodes SesaZlo riskis tom mokle periodSi guneb-ganwyobis aSlilobis ram-
Sesaxeb da, amave dros, esmodes, rom mkurnalobis denime epizodis arsebobisa an warsulSi gadatanili
procesSi aucilebelia TanamSromloba. mZime epizodebis SemTxvevaSi aucilebelia mkurnalo-
mkurnalobis dawyeba: liTiumi unda gamoiweros bis gagrZeleba.
karbonatis saxiT da mkurnaloba daiwyos da zogi pacienti liTiums 15 an meti wlis manZilze
gagrZeldes erTjeradi dRiuri doziT, Tu pacients uwyvetad iRebs. Tumca, 5 welze met xans mkurnalobis
kuWis problemebi ar aReniSneba. winaaRmdeg gagrZeleba seriozul ganxilvas saWiroebs. liTiu-
SemTxvevaSi, doza or micemaze unda gaiyos. Tu wamali mis moxsna, rogorc aRvniSneT, dozebis TandaTanebiT
profilaqtikisTvis iniSneba, maSin sawyisi dRiuri Semcirebas iTvaliswinebs. pacienti unda gavafrTxi-
doza _ 200-400 mg-ia. Tu pacienti iRebs susi-s an sxva loT, rom ar SeiZleba liTiumis uecari, sakuTari
preparats, romelic liTiumis koncentraciaze axdens iniciativiT Sewyveta.
gavlenas, maSin liTiumis ufro dabali doza iniSneba.
karbamazepini
sisxlis analizi unda gakeTdes liTiumis koncen-
traciis gansazRvrisTvis kviraSi erTxel, sanam Se- karbamazepini Tavidan, rogorc antikonvulsanti ise
sabamisi koncentracia ar miiRweva. 0, 4-0, 7mmol/l gamoiyeneboda. mogvianebiT gairkva, rom igi efeq-
(bolo miRebidan 12 saaTis Semdeg aRebul sisxlSi), turia bipolaruli aSlilobebis iseTi SemTxvevebis
rogorc zemoT iyo ganmartebuli, adekvatur pro- drosac, romlebic liTium-rezistentulia. arsebobs
filaqtikur doned iTvleba. Tu aseTi doza ar aris argumentirebuli mtkicebuleba, rom karbamazepini
efeqturi da Tu gverdiTi moqmedeba saSualebas iZl- efeqturia mwvave maniis marTvisa da, aseve, bipolaru-
eva, SeiZleba ufro maRali dozis _ 0, 8-1, 0 mmol/l, li aSlilobebis profilaqtikisTvis. misi saerTo
gamoyeneba. unda gvaxsovdes, rom sruli efeqtis mis- efeqturoba liTiumze odnav naklebia. karbamazepini
aRwevad SeiZleba ramdenime Tve iyos saWiro. SeiZleba kargi Sedegis momcemi iyos wamlebze rez-
mkurnalobis gagrZeleba: mkurnalobis gagrZelebis istentuli bipolaruli depresiis mkurnalobisas,
SemTxvevaSi, plazmuri koncentracia unda ganisazRv- Tumca rekurentuli unipolaruli aSlilobebis pro-
ros yovel 6-12 kviraSi. mniSvnelovania, rom Sefasebis filaqtikis TvalsazrisiT, misi roli dadgenili ar
Sexseneba uzrunvelyofili iyos eqimisTvisac da paci- aris (Goodwin, 2003).
entisTvisac. am mxriv efeqturia kompiuteruli pro- moqmedebis meqanizmi: sxva antikonvulsantebis ms-
gramis gamoyeneba. yovel 6 TveSi unda gadamowmdes gavsad, karbamazepini ablokirebs neironebis natriu-
sisxlis analizi eleqtrolitebze, Sardovanasa da mis arxebs. gaurkvevelia, es moqmedeba rogor iwvevs
kreatininze, gakeTdes sisxlis saerTo da Tiroiduli guneb-ganwyobis stabilizebis efeqts. rogorc adami-
funqciis analizi ise, rogorc es zemoT iyo miTiTe- anebSi, aseve cxovelebSi karbamazepini aiolebs sero-
buli. Tu Tiroiduli funqciis Sefasebis ori mom- toninis neirogadacemas, riTac liTiumis moqmedebas
devno testi miuTiTebs hipoTiroidizmze, liTiumi imeorebs.
unda Sewydes an dainiSnos _ Tiroqsini. Semawuxebeli farmakokinetika: karbamazepini nela, magram sru-
poliuriis dros doza unda Semcirdes, xolo myari lad absorbirdeba. intensiurad metabolizdeba da
poliuria pirdapiri Cvenebaa Tirkmlis funqciuri warmoSobs minimum erT Terapiulad aqtiur metabo-
sinjebis CatarebisTvis da, maT Soris, koncentraciis lits karbamazepinis epoqsids. xangrZlivi mkurnalo-
unaris gansazRvrisTvis. myari leikocitozi xSiri, bis dros naxevardaSlis periodi daaxloebiT 20 saa-
Tumca naklebad saSiSi movlenaa. igi Seqcevadia da Tia. karbamazepini RviZlis mikrosomuli fermentebis
wamlis moxsnisTanave ubrundeba normas. Zlieri stimulatoria da SeuZlia sxva wamlebis
liTiumis daniSvnisas, eqims unda axsovdes liTium- plazmuri koncentraciis Semcireba.
is fsiqotropulebsa da sxva jgufis medikamentebTan dozireba da plazmuri koncentracia: karbamazepi-
urTierTqmedeba. damatebiTi sifrTxilea saWiro ekT- nis doza guneb-ganwyobis stabiluri moqmedebisTvis
sTan erTad gamoyenebisas. Tu pacients raime mizeziT iseTivea, rogoric antikonvulsantisa da Seadgens
esaWiroeba anesTezia, anesTeziologi gafrTxilebu- 400-1600 mg/dR. mkurnaloba, Cveulebriv, iniSneba
li unda iyos, rom pacienti iRebs liTiums, radgan, dRiuri dozis Tanabari gadanawilebiT 2-jerad miRe-
rogorc zemoT iyo aRniSnuli, arsebobs miorelaqsan- baze, radgan aseTi miReba aumjobesebs amtanobas. kar-
tebis moqmedebis gaZlierebis riski. bamazepinis plazmur koncentraciasa da mis Terapiul
liTiumiT mkurnaloba, Cveulebriv, grZeldeba 1 efeqturobas Soris aSkara kavSiri ar aris, magram
weli da meti. wamlis saWiroeba unda weliwadSi erTx- mizanSewonilad iTvleba plazmuri donis monitor-
el gadaisinjos da guneb-ganwyobis nebismieri msubuqi ingi (ukanaskneli dozidan 12 saaTis Semdeg) da, to-
cvalebadobas saTanado yuradReba mieqces. liTiumis qsikurobis Tavidan asacileblad, misi donis antikon-
moxsna recidivis maRal riskTanaa dakavSirebuli, ami- vulsiur sazRvrebSi SenarCuneba.
_ 599 _
arasasurveli moqmedeba (cxrili 21.13): gverdiT ufro efeqturia;

moqmedebaTa gamovlena xSiria mkurnalobis dasawy- w emateba liTiumiT mkurnalobas, roca liTiu-
isSi; esaa: Zilianoba, Tavbrusxveva, ataqsia, diplopia mis efeqturoba nawilobrivia; aseT SemTxvevebSi
da gulisreva. am moqmedebaTa mimarT tolerantoba aucilebelia imis gaTvaliswineba, rom am kombina-
male viTardeba. potenciuri seriozuli gverdiTi ciam SesaZloa neirotoqsikuroba gamoiwvios;
moqmedebaa agranulocitozi, Tumca, Zalian iSviaTia
w maniis mwvave mkurnaloba, rogorc liTiumis al-
(sxvadasxva monacemebiT: 1/10000_1/125000).
ternatiuli, aseve litiumTan kombinirebuli mkur
xSiria SedarebiTi leikopenia, romelic pirvel kvi-
naloba.
rebSi iCens Tavs, Tumca, Cveulebriv, normis farg-
Tu klinikuri mdgomareoba saSualebas iZleva, um-
lebSi narCundeba. gamonayari aReniSneba pacientebis
jobesia karbamazepiniT mkurnalobis dawyeba nela
5%-s. SeiZleba ganviTardes RviZlis fermentebis
mzardi dozebiT 100-200mg/dR, SemdgomSi dozis mate-
momateba da Zalian iSviaTad aRwerilia hepatitic.
biT 100-200mg-iT 2-jer kviraSi. pacientebi aRniS-
karbamazepinma SesaZloa gamoiwvios gulis gamtare-
naven arasasurvel moqmedebas sisxlSi karbamazepinis
blobis darRvevebi da is ukunaCvenebia am problemis
farTo diapazonis farglebSi. Sesabamisad, saukeTeso
mqone pacientebisTvis.
variantia dozis momateba gverdiTi moqmedebisa da
karbamazepini amcirebs plazmaSi Tiroqsinis kon-
klinikuri efeqturobis gaTvaliswinebiT.
centracias, magram Tiroid-mastimulirebeli hormo-
leikocitebis raodenobis Semcirebis gamo, mizan-
nis done ar izrdeba da klinikuri hipoTiroidizmi
Sewonilia leikocitebis raodenobis monitoringi
xSiri araa. karbamazepins SeiZleba axldes hiponatri-
mkurnalobis pirveli 3 Tvis ganmavlobaSi. pacienti
emia. karbamazepinis, liTiumisa da valproatis gver-
unda gavafrTxiloT, rom cxelebis an infeqciis sxva
diTi efeqtebi Sedarebulia cxrilSi 21.21.
niSnebis gamovlenis SemTxvevaSi, dauyovnebliv mim-
wamlebTan urTierTqmedeba: karbamazepini aZlierebs
arTos eqims. Tu liTiumze karbamazepinis damateba
sxva wamlebis metabolizms, maT Soris tricikluri an-
efeqturia, SesaZlebelia liTiumis frTxilad moxsna.
tidepresantebis, benzodiazepinebis, haloperidolis,
Tumca, Tanamedrove midgomis Tanaxmad, guneb-ganwy-
oraluri kontraceptivebis, Tiroqsinis, valfarinis,
obis stabilizaciisTvis saWiroa mkurnalobis orive
sxva antikonvulsantebisa da zogierTi antibiotiki-
preparatiT gagrZeleba.
sas. imave meqanizmiT SeiZleba moxdes karbamazepinis
plazmuri koncentraciis daqveiTeba mkurnalobis natriumis valproati
dawyebidan pirveli ramdenime kviris Semdeg.
karbamazepinis msgavsad, natriumis valproatic Ta-
susi-ebi da eriTromicini zrdian karbamazepinis
vidan, rogorc antikonvulsanti ise gamoiyeneboda.
koncentracias. kalciumis arxebis blokatorebis
ukanasknel wlebSi, didi interesi gamoiwvia am wamlis
miReba, rogorebicaa diltiazemi da verapamili kar-
gamoyenebam guneb-ganwyobis marTvaSi.
bamazepinis farmakodinamikur efeqtsa da plazmur
ramdenime kontrolirebadi kvleva adasturebs val-
dones aZliereben. Sesabamisad, karbamazepinma kal-
proatis efeqturobas maniis mwvave epizodis marT-
ciumis arxebis zogi antagonistis (mag., felodipinisa
visas. SedarebiT naklebi mtkicebulebebi arsebobs
da nikardipinis) moqmedeba SeiZleba, Seasustos. kar-
valptroatis efeqturobis Taobaze bipolaruli
bamazepinisa da liTiumis kombinirebuli gamoyenebi-
aSlilobebis xangrZlivi profilaqtikisTvis. miuxe-
sas, maSinac ki, roca liTiumis done normaluria, Ses-
davad amisa, Bowden-is da misi kolegebis (2000) ran-
aZloa neirotoqsikuroba ganviTardes. karbamazepinis
domizirebulma kvlevam, erTwliani dakvirvebis Sem-
mwarmoeblebi ar gvirCeven mis maoi-ebTan erTad gam-
deg, gamoavlina valproatis liTiumsa da placeboze
oyenebas, Tumca, aRwerilia am kombinaciis usafrTxo
upiratesi minimaluri sargebeli bipolaruli aSli-
moxmarebis SemTxvevebic. SesaZlebelia maoi-ebiT kar-
lobebis mqone pacientebSi. mravali SemTxveva da Ria
bamazepinis plazmuri donis momateba.
kvlevaa aRwerili, romlebSic miTiTebulia valpro-
karbamazepinis klinikuri gamoyeneba atis profilaqtikuri efeqti liTiumisa da karbam-
azepinis araefeqturobis SemTxvevaSi, maT Soris gun-
karbamazepinis gamoyenebis Cvenebebia:
eb-ganwyobis cikluri aSlilobis dros (Ferrier, 2001).
w bipolaruli aSlilobis profilaqtikuri marT- moqmedebis meqanizmi: valproati martivi datot-
va liTiumis araefeqturobisa an cudi amtanobis viljaWviani cximovani mJavaa, romlis moqmedebis meqa-
dros; nizmi ucnobia. miuxedavad amisa, arsebobs garkveuli
w im pacientebis mkurnaloba, romlebsac guneb-ganw- mtkicebulebebi, rom valproati anelebs inhibitor-
yobis xSiri monacvleoba da Sereuli afeqturi md- uli neirotransmiter gaem-is daSlas. es moqmedeba
gomareobebi aReniSnebaT da karbamazepini liTiumze SeiZleba iyos valproatis antikonvulsiuri efeqtis
_ 600 _
safuZveli, magram ramdenad iwvevs igi fsiqotropul ime kontrolirebadi kvleviT (Goodwin, 2003). brita-
efeqtsac, gaurkvevelia. neTSi licenzirebulia naxevar-natriumiani prepara-
farmakokinetika: valproati swrafad absorbird- tis am mizniT gamoyeneba. mwvave maniis mkurnalobi-
eba da plazmaSi koncentraciis piks aRwevs miRebidan sas efeqti ufro swrafad miiRweva, vidre liTiumisa
2 saaTis Semdeg. farTod da swrafad vrceldeba da da karbamazepinis gamoyenebisas, radgan Tavidanve
misi naxevardaSlis dro 8-18 saaTia. valproati me- SeiZleba maRali dozis gamoyeneba. mag., Terapiuli
tabolizdeba RviZlSi da iZleva mraval metabolits, efeqtis miRweva SesaZlebelia valproatis 20mg/kg
romelTa nawils aqvs antikonvulsiuri moqmedeba. gajerebis dozis miRwevidan 1-2 dReSi. valproati,
karbamazepinisgan gansxvavebiT, ar astimulirebs Rvi- liTiumTan SedarebiT, SeiZleba ufro efeqturi iyos
Zlis mikrosomul fermentebs da naklebad aferxebs Sereuli afeqturi mdgomareobebis dros.
sxva wamlebis metabolizms. profilaqtikis mizniT gamoyenebisas, valproati
dozireba da plazmuri koncentracia: valpro- ufro efeqturia maniis, vidre depresiis SemTx-
atis dawyeba SeiZleba doziT 200-400mg/dR, romelic vevebSi. bipolaruli aSlilobebis dros warmatebiT
dasaSvebia, rom gaizardos kviraSi erTxel an orjer gamoiyeneba liTiumTan erTad, roca liTiumis efeq-
diapazoniT 1-2mg/dR. plazmuri koncentracia ar ti mxolod nawilobrivia. amasTan, aseTi kombinacia
asaxavs valproatis antikonvulsiur an guneb-ganw- usafrTxoa. SeiZleba valproatis kombinireba karbam-
yobis stabilizaciur efeqts, magram mwvave maniis azepinTan. im SemTxvevebSi, roca grZeldeba guneb-gan-
mkurnalobisas efeqturoba vlindeba mxolod maSin, wyobis aSlilobis epizodebi, valproatis kombinireba
roca plazmuri koncentracia aWarbebs 50mkg/ml. SesaZlebelia antidepresantebTan an antifsiqozur
gverdiTi efeqti (cxrili 21.13): valproatis yvelaze wamlebTan (Ferrier, 2001).
xSiri gverdiTi moqmedebebia _ gastro-intestinuri
lamotrijini
darRvevebi, tremori, sedacia da daRliloba. sxva
mniSvnelovan gverdiT moqmedebebs miekuTvneba wonis lamotrijini aris triazinis warmoebuli, romelic
mateba da Tmis droebiTi cvena struqturis cvlile- blokavs voltaJ-damokidebul natriumis arxebs da am-
biT. cirebs amgznebi neirotransmiterebis, kerZod _ glu-
pacientebs, romlebic iReben valproats, SeiZleba tamatis gamoTavisuflebas. lamotrijini britaneTSi
RviZlis transaminazebis momateba aReniSnebodeT. licenzirebulia monoTerapiisa da damatebiTi Tera-
imis gaTvaliswinebiT, rom es RviZlis funqciur dar- piis saxiT epilefsiis dros. magram ar aris licen-
RvevasTan dakavSirebuli araa, fermentebis donisa da zirebuli guneb-ganwyobis aSlilobebis samkurnalod,
RviZlis funqciis monitorirebis fonze, SesaZlebe- Tumca arsebobs Ria kvlevebi, romelTa mixedviTac
lia wamlis gagrZeleba. Tumca, aRsaniSnavia fatal- dasturdeba misi Terapiuli efeqturoba standar-
uri hepatotoqsikurobis iSviaTi SemTxvevebic. isini tuli mkurnalobisadmi rezistentuli bipolaruli
upiratesad im bavSvebSi dafiqsirda, romlebic erT- daavadebis dros. amasTan, placebo-kontrolireba-
droulad ramdenime antikonvulsants iRebdnen. Re- di kvlevebis meSveobiT gamovlinda lamotrijiniT
binebis, anoreqsiis, siyviTlisa an uecari Zilianobis monoTerapiis efeqturoba gamovlinda lamotrijiniT
ganviTarebis dros aucilebelia valproatis dauy- monoTerapiis efeqturoba bipolaruli depresiis mw-
ovnebliv Sewyveta. vave mkurnalobisas (Calabrese et al., 1999) da, aseve, xan-
valproatma, aseve, SeiZleba gamoiwvios Tromboci- grZlivi prevenciisTvis (Bowden et al., 2003). monoTer-
topenia da daTrgunos Trombocitebis agregacia. apiis saxiT lamotrijins ar gaaCnia mniSvnelovani mw-
mwvave pankreatiti iSviaTi, magram seriozuli gar- vave an profilaqtikuri antimaniakaluri moqmedeba.
Tulebaa. SesaZlebelia, adgili hqondes plazmaSi farmakokinetika: oraluri miRebis Semdeg, la-
amiakis momatebas. sxva SesaZlo gverdiT moqmedebebs motrijini swrafad absorbirdeba da plazmuri kon-
miekuTvneba: SeSupeba, amenorea da gamonayari. centraciis piki miiRweva 1, 5 saaTSi. wamali aqtiurad
wamlebTan urTierTqmedeba: valproati aZlierebs metabolizdeba RviZlSi, magram ar astimulirebs ci-
centraluri sedaciuri preparatebis moqmedebas. toqrom P450 enzimebs. misi naxevardaSlis periodi 30
miuTiTeben valproatis gavleniT sxva antikonvul- saaTia. Terapiuli moqmedebis plazmuri koncentra-
santebis gverdiTi moqmedebis gaZlierebaze (zogjer ciis diapazoni dadgenili ar aris.
antikonvulsiuri kontrolis gaumjobesebis gar- arasasurveli gverdiTi moqmedeba: kanis gamonayari,
eSe). valproatis miRebisas izrdeba fenitoinis da upiratesad makulo-papuluri, uviTardeba pacientTa
tricikluri antidepresantebis plazmuri done. 3%-s da SeiZleba Tan axldes cxeleba. es ufro xSi-
klinikuri gamoyeneba ria mkurnalobis pirvel kvirebSi da misi Semcireba
is, rom valproati efeqturia maniis mwvave da gaxan- SesaZlebelia dozis frTxili SerCeviT. sxva gverdiT
grZlivebuli mkurnalobis dros, dadgenilia ramden- moqmedebebs miekuTvneba gulisreva, Tavis tkivili,
_ 601 _
diplopia, mxedvelobis gabundovneba, Tavbrusxveva, plazmuri koncentracia piks 2-3 saaTSi aRwevs. gaba-
ataqsia da tremori. iseTi seriozuli gverdiTi moq- pentini ar metabolizdeba RviZlSi da srulad gamoi-
medebani, rogorebicaa angioSeSupeba, stivens-jonsis yofa TirkmelebiT. misi naxevardaSlis periodi daax-
sindromi da toqsikuri epidermuli nekrolizi, Za- loebiT 5-7 saaTia da rekomendebulia dReSi 3-jer
lian iSviaTia. daniSvna.
wamlebTan urTierTqmedeba: lamotrijinis plazmuri gverditi movlenebi: gabapentinis yvelaze xSiri
done SeiZleba daqveiTdes im wamlebiT, romlebic as- gverdiTi moqmedebebia: somnolencia, YTavbrusxveva,
timulireben hepato-metabolizaciis fermentebs, daRliloba da nistagmi. seriozuli gverdiTi moq-
aseT wamlebs miekuTvneba karbamazepini, romlis la- medeba aRwerili ar aris.
motrijinTan kombinaciam aseve SeiZleba gamoiwvios wamlebTan urTierTqmedeba: vinaidan igi naklebad
neirotoqsikuroba. lamotrijinis done matulobs metabolizdeba RviZlSi, amdenad, mniSvnelovani far-
valproatTan erTad miRebisas. makokinetikuri urTierTgavlena sxva wamlebze dafiq-
sirebuli araa. mas SeuZlia sxva centraluri sedaci-
klinikuri gamoyeneba uri moqmedebis preparatebis potencireba.
sakmarisi sarwmuno monacemebis dagrovebamde la-
motrijinis daniSvna bipolaruli aSlilobebis dros, klinikuri gamoyeneba
SeiZleba mxolod mas Semdeg, roca sxva gamocdili iseve rogorc lamotrijini, gabapentinic SeiZleba
wamlebi araefeqturi aRmoCndeba. amis Semdeg ukve gamoyenebul iqnes bipolaruli aSlilobebis dros,
SesaZlebelia lamotrijinis damatebiT Terapiad gam- magram mxolod standartuli mkurnalobis araefeq-
oyeneba da yuradRebis gamaxvileba wamlebTan urT- turobis SemTxvevaSi. gabapentins aqvs dozis farTo
ierTqmedebis zemoT miTiTebul Taviseburebebze. diapazoni, oRond bipolaruli daavadebis dros Cveu-
bipolaruli depresiis samkurnalod lamotrijinis lebrivi doza meryeobs 600-dan 2400 mg-mde dReSi.
miReba SeiZleba standartuli preparatebis arae- sedaciuri da anqsiolizuri efeqti xSirad vlindeba
feqturobis an amtanobasTan dakavSirebuli proble- dabal dozaze. miuxedavad imisa, rom am tipis moq-
mis SemTxvevaSi. ivaraudeba, rom lamotrijini Cveu- medeba rezistentuli bipolaruli aSlilobebis Sem-
lebriv antidepresantebze naklebad iwvevs manias an TxvevebSi saWiroa, am mimarTulebiT kontrolirebadi
bipolarul pacientebTan swraf ciklurobas, magram kvlevebis mtkicebulebebi ar gvaqvs.
amas damatebiTi mtkicebulebebi sWirdeba.
lamotrijiniT mkurnalobis dawyebisas, gamonayaris fsiqostimulatorebi
riskis Sesamcireblad, mniSvnelovania, davicvaT bri- wamlebis am jgufSi gaerTianebulia msubuqi stimu-
taneTis nacionaluri farmacevtuli cnobaris reko- latorebi, romelTa Soris yvelaze kargadaa cnobili
mendaciebi preparatis dozirebasTan dakavSirebiT kofeini da ufro Zlieri stimulantebi _ amfetamini
(25mg/dR _ pirveli 2 kvira, 50mg/dR _ Semdegi 2 kvi- da meTilfenidati. pemolins aqvs Sualeduri efeqti.
ra). bipolaruli aSlilobis dros Cveulebrivi Tera- kokaini Zlieri stimulantia, romelic iwvevs Zlier
piuli doza aris 50-300 mg/dRe. wamaldamokidebulebas. is gamoiyeneba adgilobrivi
anesTeziisTvis da sxva klinikuri Cveneba ar aqvs.
gabapentini
yvela es fsiqostimulanti zrdis dofaminisa da nor-
gabapentini Seiqmna, rogorc gaem-is funqciuri adrenalinis gamoTavisuflebas da ablokirebs maT
analogi. miuxedavad misi gaem-Tan struqturuli ms- ukumitacebas. axali nivTiereba _ modafinili, zrdis
gavsebisa, misi antikonvulsiuri meqanizmi daudgene- sifxizles da amcirebs Zilianobas kateqolaminuri
lia, igi ar zrdis gaem-is cvlas Tavis tvinSi. meqanizmebis gareSe (Saper, Scammel, 2004). modafinili
gabapentini licenzirebulia rogorc damatebiTi licenzirebulia narkolefsiis samkurnalod.
samkurnalo saSualeba gulyrebis dros, magram ar
aris licenzirebuli guneb-ganwyobis aSlilobebis Cvenebebi
samkurnalod. gamoqveynebulia Sromebi, romlebSic amfetaminebs iyenebdnen mravali mizniT, magram
naCvenebia, Tu ramdenad efeqturia gabapentini stan- ukanasknel xans, damokidebulebis ganviTarebis maRa-
dartuli mkurnalobisadmi rezistentuli bipolaruli riskis gamo, ufro iSviaTad niSnaven. araadekva-
li aSlilobebis dros misi damatebis SemTxvevaSi turia maTi miReba simsuqnis gamo. mozrdilebs amfe-
(Young et al., 1999). Tumca, maniisa da rezistentuli taminebs uniSnaven narkolefsiis dros. meTilfeni-
bipolaruli depresiis kontrolirebadi kvlevebis datiT miRebulia yuradRebis deficitis sindromis
Sedegebi arasaimedoa (Yatham, 2004). gabapentins aqvs mkurnaloba bavSvebSi. is, aseve, efeqturia mozrdi-
sedaciuri moqmedeba da, aseve, anqsiolizuri Tviseba. lebSi, romlebsac yuradRebis deficitis simptomebi
farmakokinetika: oraluri absorbciis Semdeg, ugrZeldebaT, Tumca mozrdilebSi yuradRebis defi-
_ 602 _
sxva fizikuri mkurnaloba
citis sindromis diagnozi da misi mkurnaloba jer-
boqsi 21.10 ekT-s Cvenebebi (britaneTis
jerobiT sakamaToa (ix. Zwi, York, 2004).
janmrTelobisa da klinikuri
warsulSi amfetaminebs farTod iyenebdnen depre-
daxelovnebis instituti, 2003)
siis mkurnalobisas, magram is Caanacvla antidepre-
rekomendebulia, rom ekT gamoyenebul iqnes mxolod
santebma. zogi specialisti, ZiriTadad aSS-Si, dRe-
mZime simptomebis swrafi da xanmokle gaumjobesebis
sac miiCnevs, rom fsiqostimulantebi calke an sxva misaRwevad iseT SemTxvevebSi, roca sxva mkurnalobis
antidepresantebTan kombinaciaSi garkveulwilad adekvaturi cdebi araefeqturi aRmoCnda da/an, roca
mdgomareoba Sefasda, rogorc sicocxlisTvis saSiSi da
efeqturia rezistentuli depresiuli aSlilobebis pacients hqonda:
dros. fsiqostimulantebis gamoyenebis garkveuli 1. mZime depresiuli daavadeba
interesi arsebobs moxucebulobis asakis depresiis 2. katatonia
mqone pacientebSi, romlebsac aqvT sxva samedicino 3. gaxangrZlivebuli an mZime maniakaluri epizodi
daavadebac. ase rom, depresiis dros fsiqostimulan-
tebiT mkurnalobis xelaRebiT uaryofa gaumarTle- boqsi 21.11 ekT-s Cvenebebi (fsiqiatriis
belia. fsiqostimulatorebi unda gamoiyenon im klin- samefo koleji, 2005)
icistebma, romlebsac aqvT rezistentuli depresiis mZime depresiis dros ekT SeiZleba iyos arCeviTi mkur
fsiqofarmakologiuri marTvis specifikuri gamoc- naloba, roca daavadebas axlavs:
dileba. modafilins warmatebiT iyenebdnen Ziliano- w sicocxlisTvis saxifaTo daavadeba, romelic
gamowveulia imiT, rom uars amboben sakvebisa da siTx-
bisa da daRlilobis samkurnalod depresiis mqone eebis miRebaze;
pacientebSi, romlebic susi-ebs iRebdnen (Menza et al., w suicidis maRali riski;
2000). ekT SeiZleba ganvixiloT mZime depresiuli daavadebis
ZiriTadi preparatia deqsamfetaminis sulfati, samkurnalo saSualebad, roca saxezea:
romlis sawyisi doza narkolefsiis dros aris 10mg/ w stupori;
w mniSvnelovani fsiqomotoruli Sekaveba;
dR, dayofili ramdenime miRebaze. dozis mateba xdeba
w depresiuli bodva da halucinaciebi;
maqsimum 50mg-mde dReSi, yovelkvireuli 10mg-is mo-
ekT SeiZleba ganxilul iqnes im mZime depresiuli daa-
matebiT. ZiriTad preparatebs miekuTvneba meTilfen- vadebis meore an mesame rigis mkurnalobad, romelic
idati, romelsac deqsamfetaminis sulfatis msgavsi ar pasuxobs antidepresantebs;
efeqti aqvs. narkolefsiis dros modafinili iniSneba ekT SeiZleba gamoviyenoT maniis samkurnalod, romelsac
axlavs:
doziT _ 200-400mg. w sicocxlisTvis saSiSi fizikuri dauZlureba;
arasasurveli efeqtebi: esaa _ mousvenroba, insom- w mania, romelic ar pasuxobs Sesabamis medikamentur
nia, madis daqveiTeba, Tavbrusxveva, tremori, pulsa- mkurnalobas;
ciis SegrZneba da kardiuli ariTmia. didi dozebis ekT SeiZleba ganxilul iqnes mZime rezistentuli Sizo-
freniis meoTxe rigis mkurnalobad, Tuki ori antifsiqo-
toqsikuri efeqtia dezorientacia, agresiuli qceva, zuri wamliT da Semdeg klozapiniT mkurnaloba araefe-
halucinaciebi, gulyrebi da koma. mudmivi borotad qturi gamodga.
ekT SeiZleba daeniSnoT katatoniis mqone pacientebs,
gamoyeneba iwvevs paranoiduli Sizofreniis msgavs romlebTanac benzodiazepinebiT (Cveulebriv, lorazepa-
paranoidul mdgomareobas. amfetaminebma maoi-ebTan miT) mkurnaloba araefeqturi aRmoCnda.
kombinaciaSi SeiZleba gamoiwvios hipertenzia, rac
tarda, Tavi iCina gansakuTrebiT gasaocarma cvli-
triciklurebTan kombinirebisas naklebia. maTi uku-
lebebma, rac exeboda ara Sizofrenias, aramed mZime
Cvenebaa kardio-vaskuluri daavadeba da Tiroto-
depresiuli aSlilobebis dros qronikulobisa da
qsikozi. modafilinis miRebas SeiZleba axldes piris
letalobis Semcirebas (Slater, 1951).
simSrale, gulisreva, muclis tkivili, Tavis tkivili,
avdapirvelad gulyrebs iwvevdnen kardiazoliT
taqikardia, SfoTva da insomnia.
(Meduna, 1938) an eleqtruli nakadis gatarebiT Tavis
tvinSi (Cerletti, Bini, 1938). droTa ganmavlobaSi eleqt-
sxva fizikuri mkurnaloba ruli stimulacia wesad iqca. SemdgomSi xanmokle
eleqtrokonvulsiuri Terapia (ekT) anesTeziisa da kunTTa relaqsantebis gamoyenebis wy-
alobiT mkurnaloba usafrTxo da misaRebi gaxda.
istoria
konvulsiuri Terapia SemoiRes 1930-iani wlebis bo- Cvenebebi
lodan da mas safuZvlad daedo mcdari Sexeduleba mocemul nawilSi mocemulia eleqtrokrunCxviTi Te-
imis Taobaze, rom epilefsia da Sizofrenia SeuZ- rapiis zogadi Cvenebebi. calkeuli daavadebis mkur-
lebelia erTdroulad arsebobdes. iTvleboda, rom nalobis efeqturoba, sxvadasxva TavSi, Sesabamis aS-
xelovnurad gamowveuli krunCxvebi ukan daxevda Si- lilobebTan erTadaa ganxiluli.
zofrenias. magram, rodesac amgvari mkurnaloba Ca- ekT mZime depresiuli aSlilobis swrafi da efeq-
_ 603 _
turi mkurnalobaa. samedicino kvlevebis sabWos zustebelia, Tu ramdenad Sedegiania ekT-iT im paci-
cdebis Tanaxmad (1965), is moqmedebs ufro swrafad, entebis mkurnaloba, romlebic antifsiqozuri pre-
vidre imipramini an fenelzini da ufro efeqturia, paratebis mimarT rezistentulebi arian. am sakiTx-
vidre imipramini _ qalebTan da vidre fenelzini _ Tan dakavSirebiT, atipiuri antifsiqozuri wamlebis
orive sqesis pirebisTvis. britaneTis janmrTelo- gamoyenebaze meti mtkicebulebebi moipoveba. brita-
bisa da klinikuri daxelovnebis institutis mier neTis janmrTelobisa da klinikuri daxelovnebis in-
mowodebuli ekT-s Cvenebebi mocemulia boqsSi 21.10, stitutis (2003) mier rezistentul pacientebSi ekT-s
xolo, fsiqiatriis samefo kolejis mier rekomende- gamoyeneba saerTod araa rekomendebuli, Tumca fsiq-
buli Cvenebebi (2005) _ boqsSi 21.11. iatriis samefo koleji ekT-s meoTxe arCevis saSu-
orive rekomendacia iTvaliswinebs bevri klinicis- alebad ganixilavs.
tis mosazrebebs da maT Soris am wignSi gamoTqmul
Sexedulebebs, rom ekT unda gamoviyenoT maSin, roca moqmedebis meqanizmi
aucilebelia swrafi gaumjobeseba. amdenad, yvelaze gulyrebis roli: ekT-s specifikuri Terapiuli efe-
Zlieri Cveneba aris suicidi, depresiuli stupori an qtis ganviTarebas ganapirobebs fiziologiuri da
fizikuri janmrTelobis safrTxis (radgan pacienti bioqimiuri cvlilebebi Tavis tvinSi. moqmedebis meqa-
ar iRebs imden siTxes, rom SenarCundes Tirkmlis ad- nizmSi gasarkvevad, pirvel rigSi saWiroa imis gageba,
ekvaturi funqcia) maRali riski. Tu Terapiuli efeqti ramdenad aris damokidebuli
ekT iwvevs maniis swraf gaumjobesebas (Mukherjee et krunCxvaze an mkurnalobis sxva maxasiaTeblebze, ro-
al., 1994), magram ZiriTadad Seqcevadia maSin, roca me- gorebicaa, mag., eleqtruli nakadi an anesTeziisa Tu
dikamenturi mkurnaloba araefeqturia an maniakal- kunTTa relaqsantebis gamoyeneba.
uri daavadeba imdenad mZimea, rom saWiroebs antif- klinicistebs sjeraT, rom pacientis mdgomareo-
siqozuri wamlebis maRal dozebs. ba ver gaumjobesdeba, Tu ekT-is proceduris dros
klinikuri SemTxvevebis kvlevebis safuZvelze, didi krunCxva ar ganviTarda. es mosazreba ramdenime or-
xania cnobilia, rom ekT saWiroa mwvave katatonuri magi brma kvleviT safuZvelze gamoiTqva, romlis
mdgomareobebis samkurnalod. kontrolirebadi kv- drosac ekT placebo (rodesac mxolod anesTezia da
levebiT aRmoCnda, rom ekT efeqturia upiratesad kunTebis relaqsacia Catarda) da sruli procedura
pozitiuri simptomebiT mimdinare mwvave Sizofreniis Seadares (ix. UK ECT Review Group, 2003) (suraTi 21.1)
dros. am kvlevebis Tanaxmad, ekT efeqturia aramar- arsebuli monacemebiT imis dadastureba, rom
to afeqturi simptomebis, aramed iseTi pozitiuri krunCxva ekT-is aucilebeli Terapiuli komponentia
simptomebis drosac, rogorebicaa bodviTi ideebi ver xerxdeba. ekT-s Tanamedrove danadgari war
da akviatebuli azrebi (Brandon et al., 1985). iTvleba, moqmnis eleqtruli denis xanmokle nakads, rac
rom ekT odnav aumjobesebs antifsiqozuri wamlebis eleqtruli energiis dabali doziT krunCxvis ga
adekvaturi dozebis efeqts da, savaraudod, swraf mowvevis saSualebas iZleva. aseT reJimSi muSaobisas,
da xanmokle simptomur gaumjobesebas iwvevs. dasa- eleqtrodis ganlagebisa da eleqtroobis do
kvleva monawileTa raodenoba standartuli efeqtis zoma
Wilson 196310 12 -1.078 (-2.289-dan 0.133-mde)
West 198111 25 -1.255 (-2.170-dan -0.341-mde)
Lambourn 197815 40 -0.170 (-0.940-dan 0.600-mde)
Freeman 197812 40 -0.629 (-1.2647-dan 0.006-mde)
Gregory 198513 69 -1.418 (-2.012-dan -0.824-mde)
Johnstone 198014 70 70 -0.739 (-1.253-dan -0.224-mde)

gaerTianebuli
fiqsirebuli efeqti -0.911 (-1.180-dan -0.645-mde)
gaerTianebuli
randomuli efeqti -0.908 (-1.270-dan -0.537-mde)
3 2 1 0 1
ECT-s aniWebs aniWebs
upiratesobas upiratesobas
simulacias
suraTi 21.1 depresiis dros ekT-s gamoyenebis randomizebuli, placebo-kontrolirebadi kvlevebis metaanalizi (2003)
_ 604 _
zirebis mixedviT ekT-s Terapiuli efeqti mniS efeqturia, vidre zomieri (2, 5-jer meti) zRurbl-
vnelovnad icvleba. gansakuTrebiT aRsaniSnavia is, zeda marjvenamxrivi unilateraluri ekT;
rom SesaZlebelia yoveli konkretuli pacientis w kognituri daqveiTeba marjvenamxrivi unilatera-
SemTxvevaSi gamoviyenoT is eleqtruli doza, luri ekT-s dros matulobs, roca doza aWarbebs
romelic aWarbebs krunCxvis ganviTarebis zRurbls gulyris zRurbls, magram ufro naklebia, vidre
da gansazRvravs rogorc ekT-is efeqturobas, nebismieri bilateraluri ekT-s dros.
aseve kognitur sferoze arasasurvel moqmedebas. am monacemebis mixedviT, SeiZleba iTqvas, rom ekT-
amasTan, krunCxvis zRurbli sxvadasxva pacientisTvis s gamoyenebisas eleqtrodebis moTavsebisTvis sauke-
sxvadasxvaa da SeiZleba 15-jer gansxvavebulic iyos. Tesoa _ marjvena unilateraluri, xolo dozisTvis
am mdgomareobas, ekT-s praqtikaSi, mniSvnelovani _ gulyris gamowvevis sawyisi zRurblidan 5-jer
klinikuri gamoyeneba aqvs _ unda moiZebnos saukeTeso mateba. aseTi reJimi iZleva saukeTeso kombinacias
wonasworoba Terapiul efeqtsa da kognitur ara rogorc efeqturobis, aseve minimaluri kognituri
sasurvel moqmedebas Soris. Teoriulad SeiZleba daqveiTebis TvalsazrisiT (Sackheim et al., 2000). miu-
iTqvas, rom ekT-s efeqturobas mniSvnelovnad xedavad amisa, Tu gaumjobesebis saWiroeba gansakuT-
gansazRvravs eleqtruli energiis is doza, romliTac rebiT maRalia, ganxilul unda iyos bilateraluri
individualur SemTxvevaSi krunCxvis zRurblis ga ekT-is sakiTxi (boqsi 21.12).
daWarbeba xdeba.
ekT-is neiroqimiuri efeqti: eleqtruli krunCxvebi ekT-s Tanmxlebi arasasurveli moqmedeba
cxovelTa organizmSi mraval bioqimiur da eleq konvulsiur Soks SeiZleba mohyves SfoTva da Tavis
trofiziologiur Zvrebs iwvevs da amitom rTuli tkivili. ekT-m SeiZleba gamoiwvios xanmokle retro-
dasadgenia, ekT-is antidepresiuli moqmedebisTvis graduli amnezia da maxsovrobis amovardna Setevidan
konkretulad romeli procesia mniSvnelovani. sain daaxloebiT 30 wT-is ganmavlobaSi. SeiZleba gamov-
teresoa, rom mRrRnelebSi ekT-s Semdeg monoaminur lindes xanmokle dezorientacia, gansakuTrebiT bi-
gzebSi iseTive cvlilebebi dafiqsirda, rogorc lateraluri ekT-s Semdeg. aseve, SesaZlebelia Tavis
antidepresiuli wamlebis gamoyenebisas (mag., no tkivilic. zog SemTxvevaSi mkurnalobidan ramdenime
radrenalinis beta-receptorebis raodenobis daq saaTis ganmavlobaSi SeiZleba adgili hqondes cnobie-
veiTeba). amasTan, orive _ ekT da antidepresantebi, rebis Secvlas, ganviTardes gulisreva da Tavbrusxve-
zrdis dofamin-D2-receptorebis arsebobas nucleus va; magram, Tu gamoviyenebT zomier meTods, es ara-
accumbens-Si, rac motivaciuri qcevis gaumjobesebas sasurveli moqmedeba msubuqi da xanmokle iqneba.
unda ukavSirdebodes. ekT-s dros CarTuli unda iyos iSviaTad, SeiZleba kunTebis, gansakuTrebiT ybis
glutamaterguli gzebic. tkivili ganviTardes, rac miorelaqsantiT unda iyos
gamowveuli. aRwerilia sporaduli didi gulyrebis
ekT-s dros mimdinare fiziologiuri Zvrebi
ramdenime SemTxveva ekT-dan erTi Tvis Semdeg, rasac
Tu ekT atropiniT premedikaciis gareSe iwyeba, pul- sxva mizezi unda hqondes. SeiZleba moxdes kbilebis,
si jer neldeba, Semdeg swrafad Cqardeba 130-190/wm- enis an tuCebis SemTxveviTi dazianeba. eleqtrodebis
mde, xolo krunCxvis dasrulebisas ecema da sawyis arasworma mimagrebam SeiZleba gamoiwvios mcire zomis
niSnuls uaxlovdeba. Semdeg, isev, odnav matulobs adgilobrivi damwvroba. iSviaTad gvxvdeba motexi-
da zomieri taqikardia ramdenime wuTis ganmavloba- lobac, maT Soris xerxemlisac, gansakuTrebiT maSin,
Si grZeldeba. xSiria arteriuli wnevis momateba da roca miorelaqsantebis gamoyenebis gareSe tardeba.
sistoluri wneva SeiZleba 200mm Hg gaizardos. aseve,
matulobs cerebruli sisxlis nakadi (200%-mde).
boqsi 21.12 depresiis dros ekT-s efeq
unilateraluri an bilateraluri ekT turoba antidepresantebiT mkurnalobas-
Tan SedarebiT da sxvadasxva stimulis
bilateraluri ekT unilateralurze ufro efeqtu-
parametrebi
ria, magram meti kognituri problemac axlavs. uka-
naskneli kvleviT gamovlinda, rom: mkurnalobis Sedareba *hxs-d sxvaoba efeqtis
(95% CI) zoma
w maRali dozis marjvenamxrivi unilateraluri ekT
ekT ukeTesia antidepresiul 5, 2 (1, 4-8, 9) 0, 46
(dozis matebiT krunCxvis zRurblze 5-jer metad) wamlebze
iseTive efeqturia, rogoric dabali dozis bila-
bilateraluri ekT ukeTesia 3, 6 (2, 2-5, 2) 0, 32
teraluri ekT da kognitur daqveiTebas naklebad unilateralurze
iwvevs;
maRali ekT doza ukeTesia 4, 1 (2, 4-5, 9) 0, 57
w maRali, fiqsirebuli dozis marjvenamxrivi unila-
*hxs-d _ hamiltonis xarisxobrivi skala depresiisTvis
teraluri ekT (daaxloebiT 400 mili-kuloni) ufro
_ 605 _
yvela es fizikuri gavlena iSviaTia Tu anesTeziis lebdnen (Freeman et al., 1980). Tumca, maT rezidualuri
teqnika daxvewilia da Setevac adekvaturad imarTe- depresiis simptomebic aReniSnebodaT da, SesaZlebe-
ba. ekT-s sxva garTulebebi iSviaTad viTardeba da Zi- lia, rom maxsovrobis problemebi swored arsebuli
riTadad im pacientebs aqvT, romlebsac iseTi fiziku- depresiuli aSlilobiT yofiliyo ganpirobebuli.
ri daavadeba aReniSnebaT, rogorebicaa: gulis ariT- zogadad miiCneven, rom ekT-s Cveulebrivi wesiT ga-
mia, pulmonuri embolizmi, aspiraciuli pnevmonia da moyenebisas mexsierebis myari anterograduli darR-
cerebrovaskuluri daavadeba. gaxangrZlivebuli ap- vevebi ar viTardeba, xolo ganviTarebis SemTxvevaSi,
noe relaqsantebis gamoyenebisas iSviaTi garTulebaa. msubuqia da depresiul simptomebs axlavs Tan (Cohen
arcTu ise xSirad, pacients SeiZleba epilefsiuri et al., 2000). zog SemTxvevaSi, gansakuTrebiT bilater-
statusi ganuviTardes, gansakuTrebiT maSin, Tu iseT aluri ekT-s Semdeg, pirad da zogad ambebze SeiZleba
medikamentebs iReben, romlebic gulyris xangrZlivo- SedarebiT myari retrograduli amnezia ganviTardes.
basa an statusis ganviTarebas uwyoben xels. pacientTa umravlesobisTvis es mniSvnelovani prob-
ekT-s danergvis Semdeg, sul iyo kamaTi imis Taobaze, lema araa, Tumca, zogisTvis es, SesaZloa, Zalian Se-
iwvevs Tu ara is Tavis tvinis dazianebas. cxovelebSi mawuxebelic aRmoCndes.
ekT-is Cveulebrivi klinikuri reJimiT gamoyenebisas,
Tavis tvinis dazianebis raime faqti ar dafiqsire- ekT-iT gamowveuli letaloba
bula. amasve adasturebs pacientebis struqturuli beikeris (Baker, 1959) kvlevis mixedviT, ekT-iT ga-
neirovizualuri kvlevebi (UK ECT Review Group, 2003). mowveuli sikvdilianobis sixSire Seadgens 3-4 SemTxve-
vas 100000 mkurnalobaze. es daaxloebiT igivea, rac
ekT-s Semdgomi mexsierebis darRveva sxvadasxva samedicino procedurebisTvis Catarebuli
ekT-s Catarebis Semdeg, rogorc aRvniSneT, pacient- zogadi anesTeziis letalobaa. riski ukavSirdeba saa-
Ta nawils mkurnalobamde (retrograduli amnezia) nesTezio procedurebs da yvelaze maRalia kardio-
da mkurnalobis Semdeg (anterograduli amnezia) mov- vaskuluri daavadebis mqone pacientebSi. sikvdilis
lenebze mexsierebis xanmokle amovardna aReniSneba. yvelaze xSiri mizezi parkuWovani fibrilacia an mio-
es efeqti damokidebulia eleqtrodebis ganlagebaze kardiumis infarqtia.
(unilateraluri Tu bilateraluri) da eleqtrul ukuCvenebebi: ekT-s ukuCvenebaa nebismieri samedici-
dozaze. eleqtrodebis ganlageba SedarebiT ufro no daavadeba, romelic zrdis saanesTezio procedu-
mniSvnelovan faqtorad iTvleba. ris risks, rogorebicaa, mag., respiraciuli infeqcia,
kontrolirebadi kvlevebis Tanaxmad, ekT-iT ga- gulis seriozuli daavadeba da seriozuli pireqsiu-
mowveuli anterograduli amnezia droebiTia. erT-erT- li daavadeba. sxva ukuCvenebebs miekuTvneba iseTi
ma gamokvlevam (Sackheim, et al., 1993) aCvena, rom mexsiere- daavadebebi, romlebic uaresdeba arteriuli wnevisa
bis testirebis monacemebi ekT-s Catarebidan ramdenime da kardiuli riTmis cvlilebis gamo, rac SeiZleba
kviris Semdeg igive an gaumjobesebuli iyo. depresiuli ganviTardes krunCxviTi Setevis dros. aseTi daava-
guneb-ganwyoba mniSvnelovnad moqmedebs kognitur una- debebia: gulis seriozuli problemebi, axali miokar-
rebze da bevri pacienti ekT-is Semdeg maT subieqtur diumis infarqti, cerebruli an aortis anevrizma da
gaumjobesebas aRniSnavs (Sackheim et al., 1993). intrakraniuli hipertenzia.
ekT-is Semdeg ganviTarebuli mexsierebis gaxangrZ- xmelTaSuazRvispireTisa da afro-karibuli regio-
livebuli darRvevebi ZiriTadad ori saxisaa. (1) pa- nebis pacientebi, romlebsac SeiZleba hqondeT namg-
cients piradi da arapiradi Soreuli ambebi aviwydeba lisebrujredovani anemia, Jangbadis wnevis SenarCune-
(retrograduli amnezia). mag., erT-erTi naSromis Ta- bis TvalsazrisiT damatebiT sifrTxiles saWiroeben.
naxmad (Squire, et al., 1981), bilateraluri ekT-s Semdeg aseve, gansakuTrebul marTvas saWiroeben Saqriani
fiqsirdeba mexsierebis araerTgvarovani dakargva, diabetis mqone pacientebi, romlebic imyofebian in-
rac zogierT pirad ambavs, satelevizio programasa sulinze. riski matulobs xandazmul asakSi, aseve,
da axal ambebs exeba. SedarebiT mogvianebiT daadgines aranamkurnalevi depresiisa da medikamenturi mkur-
(Lisanby, et al., 2000), rom ekT-dan 2 Tvis Semdeg zogadi nalobis SemTxvevebSi.
Sinaarsis Zveli ambebi pirad mogonebebze metad iyo arasasurveli efeqtebi, maT Soris kognituri da-
daviwyebuli. am mxriv bilateraluri ekT ufro met qveiTebis gazrda, dafiqsirebulia ekT-s liTiumTan
deficits iwvevs, vidre unilateraluri. (2) pacients erTad gamoyenebisas. Tu avadmyofi iRebs susi-ebs,
uWirs axali informaciis daswavla (xangrZlivi ante- ekT-s dros matulobs krunCxvebis gaxangrZlivebis
rograduli amnezia). riski. zogi anesTeziologi erideba maoi-ebiT mkur-
is pacientebi, romlebic maxsovrobis mudmiv prob- nalobaze myofi pacientebisTvis anesTeziis micemas,
lemebs uCiodnen, ekT-s Semdeg, sakontrolo jgufTan Tumca, ekT-s gamoyeneba im pacientebTan, romlebic
SedarebiT, maxsovrobis tests ufro cudad asru- iReben maoi-ebs, usafrTxoa.
_ 606 _
daniSvnis teqnika
3cm
mocemul nawilSi ganvixilavT mkurnalobis procesSi ga- 2.
moyenebul teqnikur procedurebs. am informaciis cod-
na aucilebelia; ekT praqtikuli proceduraa da moiT- 2.
1. 1.
xovs rogorc Teoriul, aseve praqtikul momzadebas. 3cm 3cm
ekT-s klinika: ekT unda Catardes usafrTxo da sa-
1.2 1.2 1.2 1.2
siamovno garemoSi. pacienti ar unda icdides iseT
adgilas, sadac is SeZlebs imis danaxvas an gagone-
bas, Tu rogor tardeba procedura. calke unda ar-
sebobdes mosacdeli da proceduris Semdgomi perio-
disTvis gankuTvnili oTaxi, adekvaturi sareanimacio
bitemporaluri (BT) calmxrivad marjvena (RL)
aparatura, aRWurvili aspiratoriT, endotraqealu-
ri milebiT, Jangbadis adekvaturi miwodebiT. ekT-s suraTi 21.2 eleqtrodebis adgilmdebareoba ECT-sTvis
ganmaxorcielebeli personali unda iyos Sesabamisad
cemebi gvaqvs, romlebic atropinis gamoyenebis sasar-
momzadebuli da unda hqondes akreditacia.
geblod metyvelebs. Tu sekreciis Sesamcireblad sa-
pacientis miReba: pirveli etapia pacientisTvis iseTi
Wiro xdeba antiqolinerguli preparatis gamoyeneba,
pirobebis Seqmna, rom igi Tavs Tavisuflad grZnobdes;
upiratesoba unda glikopirolats mieniWos, radgan
unda dadgindes misi pirovneba. Semdeg unda gadamowm-
is hemato-encefalur bariers ver gadalaxavs.
des, arsebobs da aris Tu ara ZalaSi informirebuli
ekT-is saukeTeso anesTetikia meToheqsitoni _
Tanxmoba. unda Semowmdes, ra wamlebs iRebs pacienti,
xanmokle moqmedebis barbiturati, magram misi Sov-
raTa dadgindes, xom ar iRebs igi iseT medikaments, ro-
na rTulia. alternativebia: propofoli, etomidati
melic gaarTulebs anesTeziis proceduras. aseve, au-
an Tiopentoni, magram yovel maTgans aqvs garkveuli
cilebelia gadamowmdes, aqvs Tu ara pacients alergia
xarvezi (Freeman, 1999). dRis stacionarebSi yvelaze
romelime wamalze an hqonda Tu ara garTuleba wina
aqtiurad propofoli gamoiyeneba, magram gasaTva-
zogadi anesTeziis dros. mkurnalma eqimma srulad
liswinebelia isic, rom ekT-s dros man SesaZlebelia
unda gasinjos pacienti. Tu arsebobs ekT-s samedicino
krunCxvis xangrZlivobis Semcireba gamoiwvios an
ukuCveneba, saWiroa specialistis konsultacia.
krunCxvidan da mdgomareobidan gamosvlis dayovneba,
eleqtrodebis moTavsebis sakiTxi mkurnalma eqimma
anafilaqsia ganapirobos.
uSualod proceduris win unda gadawyvitos. unila-
sainduqcio preparatis Semdeg, kunTebis relaqsan-
teraluri mkurnalobis gamoyenebisas, mniSvnelova-
ti (ZiriTadad, suqsameToniumis qloridi) meore Sp-
nia, rom eleqtrodi moTavsdes aradominantur hemis-
riciT maSinve keTdeba, Tumca, SesaZlebelia, imave
feroze. memarjveneebSi TiTqmis yovelTvis marcxena
nemsis gamoyenebac. anesTeziologi pasuxs agebs pre-
hemisferoa dominanturi, xolo memarcxeneebSi _ erT-
paratis SerCevasa da filtvebis adekvaturi oqsigena-
erTi. amitom Tu pacienti ar aris memarjvene, umjo-
ciis uzrunvelyofaze.
besia, gamoviyenoT bilateraluri mkurnalobis.
ekT-s aplikacia: anesTeziis Semdeg fsiqiatri, Tavisive
anesTeziis procedura: anesTeziamde aucilebelia
daniSnul, eleqtroobis dozasa da eleqtrodis moTav-
davrwmundeT, rom pacients 5 saaTis ganmavlobaSi
sebas amowmebs. Sesabamis adgilas kani iwmindeba da masze
araferi miuRia; Semdeg man unda moixsnas kbilis pro-
namiani eleqtrodi Tavsdeba (kargi eleqtruli kontaq-
Tezi an moiSoros motexili kbili. bolos unda gada-
tisTvis, proceduris dawyebamde kani unda gasufTavdes
mowmdes ekT-is wina proceduris oqmi, raTa gairkves,
cximisa da Tmebisgan). mSrali eleqtrodis gamoyeneba
xom ar hqonda pacients relaqsantebis moqmedebis
iwvevs kanis damwvrobas, xolo zedmeti sisvele _ da-
gaxangrZliveba (fsevdoqolinesTerazas deficitis
moklebas da krunCxviTi pasuxis Tavidan acilebas.
gamo) an sxva garTulebebi.
miuxedavad imisa, rom miorelaqsantebis dozam unda
anesTezia unda gakeTdes gamocdili specialistis
uzrunvelyos minimaluri konvulsiuri moZraobebi,
mier (rac xSirad ver xerxdeba ganviTarebad qveynebSi).
medda an asistenti mzad unda iyvnen pacientis das-
xelmisawvdomi unda iyos aspiratori, Jangbadis dadebi-
aWerad. unilateraluri ekT-sTvis pirveli eleqt-
Ti wneviT miwodebis aparati da reanimaciuli wamlebi,
rodi Tavsdeba aradominantur mxares _ yuris gareTa
aseve, funqciuri sawoli. proceduras unda eswrebodes
xvrelsa da Tvalis lateralur kuTxes Soris gavle-
anesTeziologi, sul cota, erTi medda da fsiqiatri.
buli xazidan 3 sm-iT zemoT. meore eleqtrodi Tavs-
sakamaToa is, Tu ramdenad saWiroa atropiniT pre-
deba pirvelidan minimum 10 sm-is daSorebiT _ yuris
medikacia vagusuri ariTmiisa da bronqialuri sekre-
gareTa xvrelis vertikalurad zemoT (ix. suraTi
tis gaZlierebis prevenciisTvis. mxolod mwiri mona-
21.2). eleqtrodebis daSorebis sigrZe unilateralu-
_ 607 _
ri ekT-s efeqturobis proporciulia (Lock, 1999). amis wneva unda SenarCundes im xnis manZilze, sanam gulyra
Semdeg stimuli irTveba. ganviTardeba da Semdeg moixsnas. gulyraze dakvirve-
fiqsirebuli dozis marjvena unilateraluri ekT-s ba SesaZlebelia xelis izolirebuli nawilis kunTeb-
sawyisi dozaa 400 milikuloni; dozis morgeba xdeba ze. manJetis wnevis SerCevisas unda gaviTvaliswinoT
TandaTanobiT, klinikuri efeqturobis da kognituri gulyris dros wnevis momateba. Tu manJetis wneva ar
gverdiTi moqmedebis gaTvaliswinebiT. dozis mateba aris sakmarisi, miorelaqsanti winamxarSic SeaRwevs.
dozis individualizaciis saSualebas iZleva. pirvel pirdapiri korelacia mkurnalobis gamosavalsa da
proceduraze, dozis matebis dros, yoveli pacien- krunCxvis xangrZlivobas Soris ar aris, magram re-
tisTvis dgindeba individualuri gulyris zRurbli komendebulia eleqtroobis dozis ise SerCeva, rom
_ minimaluridan dozis matebiT krunCxvis ganviTare- krunCxvis xangrZlivoba 20-dan 50 wamamde iyos, rad-
bamde (Lock, 1999). gan xanmokle gulyrebi Terapiulad efeqturia, xolo
bilateraluri ekT-s dros eleqtrodebi Tavsdeba xangrZlivi gulyrebi ufro metad iwveven kognitur
yuris gareTa xvrelsa da Tvalis lateralur kuTxes darRveebs.
Soris gavlebuli xazidan 3 sm-iT zemoT, Tmebis daw- fsiqotropul wamlebs SeuZlia gulyrebis zRur-
yebis xazTan (ix. suraTi 21.2). bilateraluri eleqt- blisa da xangrZlivobis Secvla. mag., antidepresan-
rodebis gamoyenebisas, iReben dozas, romelic zomie- tebis umetesoba da antifsiqozuri wamlebi amcirebs
rad (daaxloebiT 50%-iT) aWarbebs gulyris zRurbls. gulyris zRurbls, xolo benzodiazepinebs, valpro-
gulyris zRurblis dadgena xdeba zemoTaRwerili we- atsa da lamotrijins, sawinaaRmdego efeqti aqvT.
siT. sxva SemTxvevaSi Sesabamisi doza SeiZleba im mo- aRdgenis faza: gulyris Semdeg filtvebis oqsigena-
nacemiT gamoiTvalos, romlis mixedviTac mosaxleobis cia srulad aRdgeba. pacienti sunTqvisa da cnobiere-
2/3-is krunCxvis zRurbli 100-dan 200 milikulonamdea. bis srul aRdgenamde anesTeziologis meTvalyureo-
amasTan, krunCxvis zRurbli ufro maRali aqvT kacebs, bis qveS unda darCes. aRdgenis dros pacienti gverdze
vidre qalebs da matulobs asakTan erTad. mag., 40 wlam- unda davawvinoT da aucilebelia yvela im wesis dacva,
de mamakacisTvis bilateraluri ekT-s sawyisi doza rac anesTeziiT Catarebuli nebismieri xanmokle qi-
unda iyos 150 milikuloni. es doza unda Seicvalos rurgiuli operaciis Semdeg sruldeba. kvalificiuri
krunCxvis xangrZlivobis, kognituri gverdiTi efeqtisa medda srulad axerxebs pacientis zedamxedvelobas. am
da klinikuri pasuxis mixedviT. doza unda gaizardos, dros, fsiqiatri akeTebs Canawers TariRis, eleqtro-
Tu krunCxva xanmokle iyo, an saerTod ar ganviTarda, debis moTavsebis tipis, gamoyenebuli wamlebis, eleq-
an ramdenime seansis Semdeg pacientis mdgomareoba ar troobis dozis, krunCxvis mokle aRwerisa da wamoW-
gaumjobesda. aseve, post-ekT kognituri darRvevebis rili problemebis Sesaxeb. mas Semdeg, rac pacienti
SemTxvevaSi doza unda Semcirdes an unda gamoviyenoT gamofxizldeba da orientaciis unari aRudgeba, igi
eleqtrodebis bilateraluri moTavseba. mniSvnelova- mosvenebul mdgomareobaSi (sawolSi an savarZelSi),
nia imis gaTvaliswineba, rom ekT-is kursebis ganmavlo- daaxloebiT, erTi saaTiT unda davtovoT.
baSi krunCxvis xangrZlivoba SeiZleba Semcirdes, rad- Tu ekT tardeba dRis stacionarSi, mniSvnelovania
gan mkurnalobis gameorebas SeuZlia gazardos krun- imis garkveva, rom stacionarSi mosvlamde pacients
Cxvis zRurbli. eleqtroobis doza, romelic iwvevda siTxe da sakvebi ar miuRia. proceduris Semdeg pa-
damakmayofilebeli xangrZlivobis krunCxvas, momdevno cientma unda moisvenos ramdenime saaTi da ar da-
seansebis dros SeiZleba mosamatebeli gaxdes. tovos stacionari srul aRdgenamde. saxlSi wasvlis
krunCxvebi: saWiroa guldasmiT davakvirdeT krun- ufleba unda mieces pasuxismgebel mozrdil adamian-
Cxvas. damakmayofilebeli relaqsaciis pirobebSi Tan erTad; misTvis ar SeiZleba motociklis an manqa-
krunCxva Semdegnairad mimdinareobs: jer iwyeba saxis nis marTva.
kunTebis SekumSvebi da iReba piri, Semdeg, naxevari warumatebeli stimulacia: anesTeziis garda yvelaze
wuTis ganmavlobaSi grZeldeba zeda quTuTos da cera mniSvnelovani problemaa is, Tu ver ganviTarda klo-
TiTebis riTmuli SekrTomebi. mniSvnelovania, rom es nuri krunCxvebi, (denis nakadiT gamowveuli tonuri
krunCxviTi moZraobebi ar agverios suqsameToniumiT krTomebi ar unda CaiTvalos krunCxvad). Tu darwmu-
gamowveul depolarizaciul kunTTa SekrTomebSi. nebiT SegviZlia vTqvaT, rom krunCxva ar yofila, unda
gulyris arsebobis dasadastureblad eeg gamoiyene- gadamowmdes aparati, eleqtrodebi da kanTan kontaq-
ba, magram Canaweris interpretirebas Sublis kunTebis ti. unda gaviTvaliswinoT mokle CarTvis albaTobac,
pirdapiri stimulaciiT gamowveuli artefaqtebi ar- rac skalpis zedmeti dasvelebis gamo SeiZleba moxdes.
Tulebs. amis Tavidan acileba miorelaqsantis moqme- Tu yvela es mizezi gamoiricxeba, rCeba eqstrakrani-
debisgan erTi winamxris izolirebiT xdeba. amisTvis, uli qsovilebisa da qalas gansakuTrebiT maRali wi-
relaqsantis ineqciamde, arteriuli wnevis gasazom naRoba an gulyris maRali zRurbli. datvirTva unda
manJets sistolur wnevaze metad beraven. manJetis es gaizardos 50%-iT da mieces axali stimuli.
_ 608 _
mkurnalobis sixSire da raodenoba bul Setevebs. mas Semdeg, rac eqimi darwmundeba, rom
pacientma gaigo, rac iyo saWiro, Tanxmobas xeli unda
ekT, Cveulebriv, iniSneba kviraSi orjer. saerTod,
moeweros. pacientma unda icodes, rom Tanxmoba exeba
kviraSi samjerad ekT-s orjeradTan SedarebiT mci-
ara erT mkurnalobas, aramed mTel kurss; amasTan, mas
re Terapiuli upiratesoba aqvs, magram SeiZleba meti
nebismier dros SeuZlia uaris Tqma.
kognituri darRvevebi gamoiwvios.
Tu pacienti ewinaaRmdegeba `Tanxmobas~ an ar SeuZ-
gadawyvetileba, Tu ramdenad xangrZlivi unda iyos
lia xelmowera cnobierebis Secvlisa an sxva raime mi-
ekT-s kursi, damokidebulia klinikur gamocdileba-
zezis gamo, xolo proceduris Catareba aucilebelia,
ze, radgan klinikuri kvlevebiT miRebuli Sesabami-
britaneTSi sxva gzas mimarTaven. pirveli, unda dad-
si informacia ar arsebobs. Cveulebriv, ekT-s kursi
gindes, ramdenad aucilebelia fsiqikuri janmrTelo-
moicavs 6-dan maqsimum 12 mkurnalobas. yoveli mkur-
bis aqtis Sesabamisi nawilis CarTva (naxeT damateba).
nalobis Semdeg, unda Sefasdes progresi. gaumjo-
fsiqikuri aqtis arc erTi nawili ar iZleva pacientis
beseba, Cveulebriv, ori-sami kviris Semdeg dgeba da
saxeliT Tanxmobis micemis uflebas, magram SesaZle-
TandaTanobiT matulobs. Tu pasuxi ufro swrafia,
belia oficialurad damtkiceba imisa, rom pacienti
SesaZlebelia mkurnalobis intensivobis Semcireba. im
fsiqikurad daavadebulia da saWiroebs mkurnalobas.
SemTxvevaSi, Tu Sedegi ar vlindeba 6-8 mkurnalobis
1983 wlis fsiqikuri janmrTelobis aqtis mixedviT,
Semdeg, kursi unda Sewydes, radgan ekT-s ganmeore-
inglissa da uelsSi daadgines, rom saWiroa meore da-
bisas gaumjobesebis miRwevis Sansi naklebia. yove-
moukidebeli konsultantis azri. mkiTxvelma, sadac
li mkurnalobis Semdeg unda Sefasdes mexsierebac.
ar unda muSaobdes, unda moiZios adgilobrivad moq-
mniSvnelovani kognituri daqveiTeba imis maniSnebe-
medi Sesabamisi sakanonmdeblo moTxovnebi.
lia, rom aucilebelia eleqtruli dozisa da eleqt-
Tu gadawyvetileba miRebuli iqneba frTxilad da
rodebis ganlagebis gadamowmeba.
srulad iqneba ganmartebuli, Zalian iSviaTad xdeba,
recidivis prevencia rom pacientma morCenis Semdeg ikiTxos, ramdenad sa-
depresiul pacientebSi ekT iwvevs gaumjobesebas, ma- Wiro iyo mkurnaloba. piriqiT, umetesoba madlieria
gram recidivis sixSire maRali iqneba, Tu antidepre- imisa, rom mkurnaloba daexmara da imasac xvdeba, Tu
santebiT mkurnaloba ar gagrZeldeba. zogjer anti- ratom Cautarda Tanxmobis gareSe. saerTod, mimdina-
depresiuli preparatis SerCeva rTulia, radgan Tu re kontroliT irkveva, rom pacientebis umetesoba
ekT-mde antidepresantis adekvaturi doza araefeq- kmayofilia ekT-iT. arasasiamovno gancdebis Tval-
turi iyo, imave preparatis gagrZelebas ekT-s kur- sazrisiT, ekT stomatologTan vizitis tolfasia.
sis Semdeg SeiZleba saWiro profilaqtikuri efeqti yvelaze xSirad pacientebi uCivian iseT gverdiT moq-
ar mohyves (Sackeim et al., 1990). Tu pacients ekT esa- medebebs, rogorebicaa mexsierebis problema, Tavis
Wiroeba antidepresiuli wamlebis araefeqturobis tkivili, Tavbrusxveva da cnobierebis Secvla (Ben-
gamo, miRebulia ekT-s Semdeg sxva jgufis antidep- bow, Crentsil, 2004).
resantis gamoyeneba, an liTiumis karbonatis gagrZe-
ekT-sTan dakavSirebuli eTikuri problemebi
leba da profilaqtikuri medikamenturi mkurnaloba.
iseve, rogorc medikamenturi mkurnalobis dros,
ekT pacientebis cota raodenobisTvisaa efeqturi da,
Seracxadi pacientis SemTxvevaSi sakvanZo sakiTxia
miuxedavad medikamenturi mkurnalobis SenarCunebi-
misi sruli informirebuli Tanxmoba. zogadad, ekT
sa, viTardeba recidivi. amitom zogi klinicisti upi-
usafrTxo da efeqtur mkurnalobad iTvleba, rasac
ratesobas aniWebs SemanarCunebel ekT-s Semcirebuli
randomizebuli kontrolirebadi kvlevebi adastu-
sixSiriT _ TveSi an or kviraSi erTxel, magram aseTi
reben. miuxedavad amisa, mniSvnelovania, pacienti ga-
Terapia britaneTis janmrTelobisa da klinikuri da-
vafrTxiloT, rom arsebobs zemoTaRwerili mexsiere-
xelovnebis institutis mier rekomendebuli araa.
bis problemebis ganviTarebis riski; wamalrezisten-
Tanxmoba ekT-s Catarebaze tul pacientebs ki mivawodoT informacia recidivis
sanam pacients vkiTxavT, Tanaxmaa Tu ara Caitaros Sesaxeb.
ekT, aucilebelia, mas gasagebad da srulad ganemar- araqmedunarian pacientebs damatebiTi sirTuleebi
tos procedura, misi mosalodneli sargebeli da Se- eqmnebaT. Cveulebriv, aseT situaciaSi ekT utarde-
saZlo riski, gansakuTrebiT ekT-s mexsierebaze gav- baT im pacientebs, romelTa sicocxlec daavadebis
lena. saTanadod Sedgenili sainformacio furceli gamo safrTxeSia. procedurasTan dakavSirebuli
unda iyos Tanxmobis proceduris standartuli nawi- iuridiuli sakiTxebi zemoT iyo ganxiluli, Tumca
li (ix. National Committee for Clinical Excellence, 2003). klinicistis movaleobaa pacientisa da misi ojaxis
bevri pacienti elodeba maxsovrobis mZime da myar wevrebisTvis yvela proceduris gacnoba da saWiro
daqveiTebas mkurnalobis Semdeg an aramodificire- axsna-ganmartebebis micema. merski (Merskey, 1999) xazs
_ 609 _
usvams `gulwrfeli, urTierTndobaze dafuZnebuli Terapiuli efeqti da Cvenebebi
midgomis~ mniSvnelobas.
sinaTliT mkurnalobis ZiriTadi Cvenebaa sezonuri
afeqturi aSliloba, romlis drosac pacients zamTris
fotoTerapia
depresia aqvs. kontrolirebadi kvlevebis Tanaxmad,
fotoTerapia anu xelovnuri, kaSkaSa sinaTlis gamoy- aRmoCnda, rom zamTris depresiis mqone pacientebSi
eneba, rogorc fsiqiatriuli mkurnalobis meTodi, kaSkaSa sinaTle placeboze metad efeqturia, gansa-
pirvelad rozenTalma da misma kolegebma Seiswavles kuTrebiT iseT SemTxvevebSi, rodesac adgili aqvs:
(Rosenthal et al., 1984). am mkvlevarebma kaSkaSa sinaTle
w Zilis gaxangrZlivebas
axlad identificirebuli sindromis _ sezonuri
w naxSirwylebis moTxovnilebas
afeqturi aSlilobis, mqone pacientebis samkurnalod
gamoiyenes. mas Semdeg, fotoTerapia zamTris depre- w SuadRisas energiis mkveTr klebas
siis, gansakuTrebiT, atipiuri depresiuli niSnebis _ sezonuri depresiis mqone pacientebisTvis, rom
hiperfagiisa da hipersomniis, mqone pacientebisTvis lebsac, ufro metad, melanqoliuri simptomebi, mag.,
mkurnalobis ZiriTad meTodad iqca (Eagles, 2004). wonis kleba da insomnia aReniSnebaT, fotoTerapia
naklebad efeqturia. fotoTerapias SeiZleba kargi
moqmedebis meqanizmi
Sedegi hqondes sxva aSlilobebis drosac, romlebsac
sinaTle-sibnelis cikli miiCneva cirkaduli da sezon- depresia, madis cvlilebebi, premenstrualuri sin
uri ritmulobis erT-erT mniSvnelovan regulaciur dromi da nevrozuli bulimia axasiaTebT. mrava
faqtorad ZuZumwovrebSi. Tavidan iTvleboda, rom li kontrolirebadi kvlevaa Catarebuli, rom
fotoTerapia amcirebda zamTris depresiis simptom- lebic fotoTerapiiT depresiuli mdgomareobis ga
ebs fotoperiodis gaxangrZlivebiT, rac efuZneboda umjobesebas adastureben. Tumca, kaSkaSa sinaTlis
Sexedulebas, rom zamTris depresiis mqone pacientebi efeqtis placebosgan gamijvnis sirTulis gamo,
gansakuTrebiT mgrZnobiareni arian zamTris mokle arsebuli monacemebis interpretireba Znelia.
dRis mimarT, xolo kaSkaSa sinaTliT mkurnaloba
iZleva zafxulis dRis ekvivalentur xangrZlivobas. arasasurveli moqmedeba
SedarebiT bolo monacemebis Tanaxmad, kaSkaSa saerTod, fotoTerapia kargi tolerantobiT gamo
sinaTlis antidepresiuli efeqti cirkadul ritmSi irCeva, magram mkurnalobis dasawyisSi pacientTa
fazis gadaweva unda iyos. amas adasturebs kontro- 45%-s SeiZleba msubuqi gverdiTi moqmedeba hqondes.
lirebadi kvleva, romlis monacemebis mixedviT, dRis aseTi moqmedebebia: Tavis tkivili, Tvalebis daZabva,
fotoTerapia saRamos fotoTerapiaze ufro efeqtu- mxedvelobis gabundovneba, Tvalebis gaRizianeba
ri aRmoCnda. amasTan, sxva kvlevebi adasturebs, rom da daZabulobis momateba. SeiZleba iyos insomnia,
SuadRis kaSkaSa sinaTlec efeqturia. rTulia namd- gansakuTrebiT maSin, roca mkurnaloba gvian saRamos
vilad sarwmuno placebo mdgomareobis miRweva kaS- tardeba. iSviaT arasasurvel moqmedebas miekuTvneba
kaSa sinaTliT mkurnalobisTvis. zogi mkvlevaris az- maniakaluri epizodis ganviTareba da suiciduri
riT, kaSkaSa sinaTlis antidepresiuli moqmedeba mniS- mcdelobis faqtebi. es ukanaskneli, savaraudod,
vnelovanwilad ganpirobebulia placebo-efeqtiT, ukavSirdeba sinaTliT gamowveul gamofxizlebisa da
gansakuTrebiT, pacientis molodiniT (Golden, 2005). amgzneb efeqts, romelic win uswrebs guneb-ganwyobis
gaumjobesebas. aris Tu ara, es iSviaTi movlena,
aparatura
sinaTleze arasasurveli reaqcia, saeWvoa. ar arse
ganaTebis mowyobiloba Seicavs fluorescenciul mi- bobs monacemebi imis Taobaze, rom rekomendebuli
lebs, romlebic CamontaJebulia gamWvirvale plas- sqemiT Catarebuli fotoTerapia Tvalis an baduris
tikuri ekranis ukan. milebi iZleva 2500-10000 luqs dazianebas iwvevs.
sinaTles. 10000 luqsis gamomcemi naTurebi ufro
Zviria, magram Terapiuli efeqtis misaRwevad ufro fotoTerapiis klinikuri gamoyeneba
xanmokle gamoyenebis saSualebas iZleva (30 wuTi Se- fotoTerapiis yvelaze kargad dadgenili Cvenebaa
darebiT 120 wuTTan). sezonuri afeqturi aSliloba. qvemoT mocemulia misi
fotoTerapiisTvis ixmareba Tavze dasamagrebeli kom- gamoyeneba zamTris depresiis dros. fotoTerapiis
pleqtic, romelic sinaTles TvalebSi asxivebs, riTac praqtikuli sirTule misi Catarebis xangrZlivobaa.
adamians mkurnalobis procesSi gadaadgilebis SesaZle- am TvalsazrisiT saukeTeso unda iyos 10000 luqsiani
bloba eZleva. miuxedavad imisa, rom sinaTlis `Cafxuti~ naTura, radgan Terapiis dRiuri xangrZlivoba
ufro mosaxerxebelia, vidre ganaTebis mowyobiloba, SeiZleba 30-45 wuTamde Semcirdes. civ, TeTr naTebas
placebo-kontrolirebadi kvlevebis Tanaxmad, `Cafxu- da sruli speqtris sinaTles erTnairi efeqti aqvs,
ti~ ar aRmoCnda efeqturi da is rekomendebuli araa. magram civi, TeTri naTeba ar Seicavs ultraiisfer
_ 610 _
sinaTles da Teoriulad ufro usafrTxoa. koronaruli naWdevi gaakeTes. miuxedavad imisa, rom
arsebobs mtkicebulebebi, rom zamTris depresiis maT mier Sesrulebuli e.w. `standartuli leikotomia~
mkurnalobisas ufro efeqturia adre diliT Cata Sors iyo standartulisgan da arasasurveli gverdiTi
rebuli seansebi. miuxedavad amisa, dRis sxva dros, moqmedebebic axlda, am proceduram britaneTsa da sxva
Tundac saRamos, Catarebuli mkurnaloba SeiZleba qveynebSi mainc farTo gamoyeneba hpova. enTuziazms
efeqturi da pacientisTvis mosaxerxebeli iyos. sawyis asazrdovebda pacientebis sawyis etapze gaumjobeseba,
etapze rekomendebulia diliT mkurnaloba. amasTan, magram matulobda monacemebic arasasurveli efeqtis
pacients unda ganemartos, rom Terapiuli efeqtis _ inteleqtis daqveiTebis, emociuri labilobis,
SenarCunebisTvis, SesaZlebelia, fotoTerapiisTvis apaTiis, ganmuxruWebis, Seukaveblobis, simsuqnisa
praqtikulad mosaxerxebeli drois SerCeva, Tumca da epilefsiis Sesaxeb. swored amitom daiwyo
mkurnaloba gvian saRamos ar unda Catardes, radgan kvlevebi, rom danergiliyo SedarebiT ufro naklebi
SeiZleba Zilis darRveva gamoiwvios. gverdiTi moqmedebisa da aseTive efeqtis mqone mcire
dilis fotoTerapia unda daiwyos gaRviZebidan operaciebi. garkveul progress stereotaqsiuli
ramdenime wuTSi. sawyis etapze mkurnalobis xan teqnikis danergva warmoadgenda (Christmas, 2004).
grZlivobad unda ganisazRvros 30 wuTi, 10000 luqsi Tumca, farmakologiis winsvlam SesaZlebeli gaxada
naTuriT an 2 saaTi, 2500 luqsiT. pacienti unda iseTi mdgomareobebis mkurnaloba, romlis drosac
ijdes sanaTi mowyobilobidan 30-40 sm-is moSorebiT. qirurgiuli Careva aucilebeli iyo.
pirdapir ar unda uyurebdes, aramed saxe 45-gradusiani
kuTxiT unda imyofebodes mowyobilobis mimarT da Tanamedrove midgoma
pacientma yovel wuTSi 1-2-jer unda gaixedos misken. termini `fsiqoqirurgia~ Seicvala fraziT `nei
fotoTerapiis antidepresiuli efeqti vlindeba roqirurgia fsiqikuri aSlilobebisTvis~. termi
ramdenime dReSi, magram kontrolirebadi kvlevebiT nologiis aseTi cvlileba xazs usvams imas, rom:
dadginda ufro xangrZlivi periodi: daaxloebiT w gamoyenebuli teqnikiT lokalurad specifikur ce
sami kvira, raTa Terapiul efeqts placeboze metad rebrul ubanze moqmedeben;
emoqmeda. rogorc zemoT iyo miTiTebuli, adreul w xdeba mxolod specifikuri fsiqikuri aSlilobebis
etapze xSiria arasasiamovno msubuqi moqmedeba, (rezistentuli depresia da obsesiur-kompulsuri
romelic specifikuri Carevis gareSe regulirdeba. aSliloba) da ara pirveladi qceviTi darRvevebis
Tu aseTi movlenebi myaria da Semawuxebeli, SeiZleba mkurnaloba
pacienti dajdes sinaTlis wyarosgan cota ufro
moSorebiT an Semcirdes seansis xangrZlivoba. xan Cvenebebi
grZlivoba unda Semcirdes maSinac, roca gamovlindeba britaneTSi fsiqikuri aSlilobebis neiroqirurgiis
guneb-ganwyobis aweva. Cvenebebi Semoifargleba mxolod qronikuli, mkur-
Terapiuli efeqtis miRebis Semdeg, aucilebelia nalobisadmi rezistentuli, unarSemzRudavi mZime
fotoTerapiis gagrZeleba bunebriv remisiamde, wi depresiiTa da obsesiur-kompulsuri aSlilobiT.
naaRmdeg SemTxvevaSi, SesaZloa ganviTardes recidivi. neiroqirurgia ar aris naCvenebi Tavis tvinis organu-
SeiZleba moxerxdes mkurnalobis yoveldRiuri xan li dazianebiTa an zogadi ganviTarebis darRvevebiT
grZlivobis Semcireba. SesaZlebelia, rom foto gamowveuli mdgomareobebis dros.
Terapia daiwyos depresiis savaraudo epizodis win,
raTa mas profilaqtikuri efeqtic hqondes. operaciis tipebi
dReisTvis Zveli `brma~ operaciebi Seicvala stere
fsiqikuri aSlilobebis neiroqirurgiuli otaqsiuli procedurebiT, romlebic ufro mcire
mkurnaloba (fsiqoqirurgia) da zusti dazianebis saSualebas iZleva (boqsi
procedurebis istoria 21.13). britaneTSi amJamad wina kafsulotomia da
fsiqoqirurgia ewodeba neiroqirurgiul procedu

boqsi 21.13 fsiqoqirurgiaSi gamoyenebuli
rebs anu operaciebs Tavis tvinis birTvebsa an TeTr stereotaqsiuri procedurebi
nivTierebaze, fsiqikuri aSlilobis simptomebis
subkauduri traqtotomia _ dazianeba xdeba TiToeuli
modificirebis mizniT. fsiqoqirurgias safuZveli
kudiani birTvis Tavis ukan, orbituli qerqis
Caeyara 1936 wels, roca moniSma (Moniz) Sublis wilis rostralur nawilSi
TeTr nivTierebaSi intensiuri ganakveTi gaakeTa wina cingulotomia _ dazianeba xdeba bilateralurad,
sartylis konebSi
(frontaluri leikotomia). am operaciis modificireba limburi leikotomia _ subkauduri tratotomia kombi-
1942 wels moxda (Freeman, Watts; 1942), rodesac Sublis nirdeba cingulotomiasTan
wina kafsulotomia _ dazianeba xdeba bilateralurad,
wilSi, lateraluri xvrelidan burRiT patara zomis SigniTa kafsulis wina fexSi
_ 611 _
da mZime qronikuli depresiuli aSlilobebis Sem
boqsi 21.14 fsiqoqirurgiis gamosavali
TxvevebSi. ar arsebobs mtkicebulebebi SfoTvi
britaneTSi 1961-97 ww.
Ti aSlilobebis an Sizofreniis efeqturi neiro
depresia (N=727) oka (=478) qirurgiuli mkurnalobis Sesaxeb (ufro dawvrilebiT
aSkara gaumjobeseba 63% 58% gaecaniT: Christmas at al, 2004).
naklebi gaumjobeseba 22% 27% eTikuri sakiTxebi

araefeqturoba 14% 14% fsiqoqirurgiasTan dakavSirebuli eTikuri sakiTxebi
gauareseba 1% 1% ganxilulia merskis SromaSi (Merskey, 1999). Tavis
tvini gansjisa da gadawyvetilebis miRebis organoa,
fsiqiatriis samefo koleji, 2000.
Tumca masze operaciis ganxorcieleba mag., simsivnis
wina cingulotomia gamoiyeneba. dazianeba xdeba SemTxvevaSi, eTikurad dasaSvebia (cxadia, Tu pacienti
TermokoagulaciiTa an gama radiaciiT (`gama dana~) Tanaxmaa). fsiqoqirurgiis dros, saqme sxvagvaradaa,
da bilateralurad keTdeba. radgan am SemTxvevaSi aradaavadebuli qsovili zi
andeba. fsiqoqirurgiis praqtikuli problemebi (ri
efeqturoba
Tac is ganirCeva ekT-sgan) Semdegia:
kontrolirebadi kvlevebis ararsebobis pirobebSi
w randomizebuli kvlevebis simcire, romlebic daa
Sefaseba xdeba xangrZlivi dakvirvebis safuZvelze.
mtkicebda operaciis efeqturobas;
fsiqiatriis samefo kolejis monacemebis mixedviT,
w proceduris Seuqcevadoba;
mZime depresiis SemTxvevebSi aSkara gaumjobesebis
sixSire 63%, xolo obsesiur-kompulsuri aSlilobebis w zogierTi gverdiTi moqmedebis potenciurad seri-
dros _ 58% iyo (boqsi 21.14). ozuli buneba.
aqedan gamomdinare, eTikis TvalsazrisiT, dasaSvebia
gverdiTi efeqtebi
fsiqoqirurgiis Catareba im qmedunariani pacientisT-
Tanamedrove procedurebs mZime gverdiTi moq vis, romelsac SeuZlia sruli informirebuli Tanxmo-
medebebi iSviaTad axlavs. operaciis Semdeg xSiria bis mocema. qmedunarianobis dadgenac, ra Tqma unda,
Tavis tkivili da gulisreva, konfuzia uviTardeba qronikuli mZime guneb-ganwyobis aSlilobis arsebobisas,
pacientTa 10%-s. aseTi gverdiTi moqmedebebi SeiZ rTulia. britaneTSi, 1983 wlis fsiqikuri janmrTelobis
leba alagdes ramdenime dReSi, magram SesaZloa erT aqtis 57-e nawilis Sesabamisad, aucilebelia, rom:
Tvemdec gagrZeldes. mogvianebiT ganviTarebuli
w pacientisgan miviRoT sruli informirebuli Tanxmoba;
kognituri daqveiTeba ar gvxvdeba (cxrili 21.14).
w fsiqikuri janmrTelobis aqtis komisiis mier daniS-
klinikuri gamoyeneba nulma multidisciplinurma komisiam daadasturos,
fsiqikuri aSlilobebis dros neiroqirurgiuli rom pacientis Tanxmoba ZalaSia;
procedurebi ar gamoiyeneba, Tu ramdenimewliani w eqimma multidisciplinuri komisiis winaSe daadas-
energiuli multimodaluri mkurnalobebi mosinjuli turos, rom mkurnaloba saWiroa. eqimma winaswar
araa. mxolod am wesis dacvis Semdegaa SesaZlebeli unda gaiaros konsultacia 2 adamianTan, romelTa-
operaciuli Careva. britaneTSi yovelwliurad 20- gan erTi SeiZleba iyos medda, meore _ medda an eqi-
mde fsiqoqirurgiuli operacia tardeba, rac 1980- mi, romlebic monawileoben pacientis mkurnalobaSi
ian wlebSi Catarebuli operaciebis 1/4-s Seadgens.
qirurgiuli mkurnalobis sakiTxi unda dadges mxolod Tavis tvinis stimulaciis teqnika
qronikuli, rezistentuli obsesiuri aSlilobebisa transkraniuli magnituri stimulacia
transkraniuli magnituri stimulaciis (tms) teqnika
cxrili 21.14 stereotaqsiuri
fsiqoqirurgiis arasasurveli moqmedeba efuZneba princips, romlis mixedviTac, gamtari ma-
teria, rogoric aris Tavis tvini, magnituri velis
mwvave
zemoqmedebiT eleqtrobas warmoqmnis. tms-is dros
operaciis letaloba (<0, 1%)
eleqtromagnituri koWa Tavsdeba Tavis qalaze. koWa-
hemoragia, hemiplegia (<0, 3%)
gardamavali konfuzia, leTargia Si maRali intensivobis eleqtruli impulsis gatare-
mogvianebiT ganviTarebuli ba mZlavr magnitur vels warmoSobs _ tipiurad
epilefsia (1-2%) daaxloebiT 2 t (teslas), romelic nervul qsovilSi
wonis momateba (10%) denis gavlasa da neironebis depolarizacias ganapi-
Sublis wilis sindromi (Zalian iSviaTia) robebs. tms-is neirofsiqologiuri efeqti miiRweva
pirovnuli cvlilebebi (Cveulebriv, msubuqia) maSin, roca eleqtruli denis impulsi swrafad miewo-
_ 612 _
deba, e.w. ganmeorebadi tms anu g-tms. Tu stimulacia vagusis nervis stimulacia
xdeba ufro swrafad, vidre 1/wm (1 hc), mas swrafi vagusis nervis stimulacia (vns) _ es meTodi rezisten-
g-tms ewodeba. Sesabamisi formis koWa iZleva qerqis tuli epilefsiis SemTxvevaSi gamoiyeneba. aRmoCnda,
specifikuri midamos lokalizebul stimulacias. rom vns, aseve, guneb-ganwyobasac aumjobesebs. amJa-
tms-is gamoyeneba: tms-s klinikur neirofiziolo- mad, mimdinareobs kvlevebi, romliTac swavloben am
giaSi kvlevebis mizniT, mag., insultis Semdeg mo- proceduris efeqturobas depresiis dros.
toruli qerqis mTlianobis gamosakvlevad, didi xa- Tavis tvinidan wamosuli parasimpaTikuri eferentu-
nia iyeneben. kvleviT laboratoriebSi tms gamoiyeneba li impulsebis garda cTomili nervi atarebs aferen-
specifikuri neirofsiqologiuri funqciis qerquli tul sensorul impulsebs, romlebic miemarTebian
substratis dasadgenad. mag., safeTqlis marcxena nucleus tractus solitaries-Si da iqidan wina tvinSi. vagu-
qerqul nawilze g-tms-is moqmedebiT, SeiZleba, Sew- sis nervis stimulacia aris operaciuli procedura,
ydes xanmokle verbaluri pasuxi. romlis drosac xdeba impulsebis generatoris Caner-
klinikurad g-tms gamoiyeneba depresiuli mdgomareo- gva kanqveS, gulmkerdis wina marcxena naxevarSi. bipo-
bis Sesamsubuqeblad. kvlevebSi sawyis etapze iyenebdnen laruli eleqtrodebi, romlebic mierTebulia gen-
swraf g-tms-s marcxena prefrontalur qerqze. zog, ma- eratorTan, Tavsdeba kisris midamoSi, marcxena cTo-
gram ara yvela kvlevaSi, g-tms-is 1-2 kviris manZilze mili nervis garSemo. es eleqtrodebi drogamoSvebiT
yoveldRe gamoyeneba ufro efeqturi iyo, vidre fiqti- stimulirdeba generatoriT, romlis stimulaciuri
uri sakontrolo mkurnaloba. sxva kvlevebSi gamoiyene- parametrebi regulirdeba telemetruli pultiT, ro-
boda sxvadasxva saxis eleqtromagnituri koWebi, stimu- melic mierTebulia personalur kompiuterTan. stimu-
laciuri parametrebi da moqmedebis veli. metaanalizis lis parametrebis modifikacia xdeba arasasurveli mo-
Tanaxmad, g-tms-s depresiis donis SemcirebaSi mxolod qmedebisa da Terapiuli efeqtis gasawonasworeblad.
susti da gardamavali efeqti aRmoaCnda, Tumca, kv- gamoyeneba depresiis dros: vns-is ZiriTadi Cveneba
levebis xarisxi dabali iyo (Martin et al., 2002). aris rezistentuli depresiis mkurnaloba. Ria kvle-
tms-s mimarTavdnen sxva darRvevebis drosac, maT vam gamoavlina, rom 12 Tvis ganmavlobaSi Catarebuli
Soris maniasa da obsesiur-kompulsuri aSlilobebis mkurnalobis Sedegad pacientTa 50%-s hqonda kargi
dros. jer mxolod winaswari monacemebia cnobili klinikuri gamosavali. dReisTvis iTvleba, rom vns-is
(Lisanby, Sackheim, 2002). saukeTeso antidepresiuli efeqti zomieri rezisten-
tms-is gverdiTi moqmedeba: neirofiziologiuri tobis dros (rodesac antidepresantebisa da maTi aug-
kvlevebis dros tms-is erTi impulsis gamoyenebas mentaciis mravaljeradi gamoyenebis mimarT myari rez-
usafrTxoebis problemebi ar Seuqmnia. yvelaze mniS- istentoba ar aRiniSneba) vlindeba, (Marangell et al., 2002).
vnelovani, rac SeiZleba g-tms-m gamoiwvios, aris gu- vns-is gverdiTi moqmedeba: vns-iT mkurnalobis pe-
lyra. es riski gansakuTrebiT maRalia swrafi, vidre riodSi xSiria xmis CaxleCa, yelis tkivili, xvela da
neli g-tms-is dros. Tanamedrove usafrTxoebis prot- dispnoe. es yovelive droTa ganmavlobaSi mcirdeba
okoli gulisxmobs magnituri stimulaciis raodenobis da am mizezTa gamo mkurnalobis mitovebis SemTxveve-
individualuri motoruli zRurblisTvis morgebas, bi ar aris xSiri. iSviaTad aRwerilia hipomania, ma-
rac gulyrebis ganviTarebis albaTobas mniSvnelovnad gram misi kavSiri vns-sTan ar aris Seswavlili (Christ-
amcirebs. aseve, janmrTeli moxaliseebis jgufSi, maRa- mas et al., 2004).
li riskis mqone pirebis (mag., epilefsiis ojaxuri anam-
neziT) monawileoba unda gamoiricxos.
SedarebiT ufro xSiria msubuqi gverdiTi moqmedeba, damatebiTi literatura
maT Soris daZabvis Tavis tkivili, aseve, aparatis mier
Haddad P, Dursan S, Deakin JFW (2004) Adverse syndromes and
warmoqmnili xmauri iwvevs smenis zRurblis xanmokle
psychiatric drugs: a clinical guide. Oxford University Press,
cvlilebas. am garTulebis prevencia SesaZlebelia
Oxford. (ganixileba fsiqotropuli wamlebis gamoyene-
yuris tamponis gamoyenebiT (rogorc kvlevis obi-
basTan asocirebuli xSiri arasasurveli efeqtebi)
eqtisTvis, aseve mkvlevarisTvis). sworad lokalize-
buli g-tms-s SemTxvevaSic SesaZlebelia ganviTardes Stahl, SM (2000) Essential psychopharacology. Cambridge Uni-
kognituri funqcionirebis Seferxeba, Tumca, es cvli- versity press, Cambridge. (magaliTebiT gamdidrebuli
leba droebiTia da ar grZeldeba stimulaciis Sewyve- naSromi fsiqotropuli wamlebis ZiriTadi farmak-
tis Semdeg. ar aris sakmarisi monacemebi tms-iT war- ologiuri da klinikuri gamoyenebis Sesaxeb.)
moqmnili maRali intensivobis magnituri velis mier Taylor, D, Paton C, Kerwin D (2003) The Maudsley Prescrib-
Tavis tvinze an sxva organoze xangrZlivi Sedegebis ing Guidelines. Martin Dunitz, London (SesaniSnavi sax-
Sesaxeb; arc raime specifikuri safrTxea gamovlenili. elmZRvanelo, romelSic ganixileba medikamentebis
gamoweris praqtikuli sakiTxebi).
_ 613 _
Tavi 22 fsiqologiuri
mkurnaloba
Tavis Sinaarsi
rogor warmoiSva individualuri dinamiuri fsiqoTerapia
fisqologiuri mkurnaloba insaiTze orientirebuli
kognitur-bihevioruli xanmokle Terapia
Terapiis ganviTareba kognitur-analitikuri Terapia
fsiqologiuri mkurnalobis klasifikacia fsiqodinamiuri
saerTo faqtorebi interpersonaluri Terapia
fsiqologiur mkurnalobaSi jgufuri Terapia
gadatana da ukugadatana fsiqoTerapia mcire jgufebSi
(transferi da kontrtransferi) fsiqoTerapia mcire jgufebSi.
konsultireba da krizisuli intervencia Terapiis tipebi
konsultacia Terapiuli jgufebi
krizisuli intervencia Terapia did jgufebSi
mxardamWeri fsiqoTerapia wyvilebis Terapia da ojaxuri Terapia
interpersonaluri fsiqoTerapia wyvilebis Terapia
kognitur-bihevioruli Terapia ojaxuri Terapia
kognitur-bihevioruli bavSvTa fisqoTerapia
Terapiis zogadi maxasiaTeblebi xandazmuli pirebis fsiqoTerpia
gamokvleva kognitur-bihevioruli sxva saxis fsiqologiuri mkurnaloba
Terapiis Catarebisas istoriuli interesis Semcveli
bihevioruli teqnika fsiqologiuri mkurnaloba
kognituri teqnika meditacia da tradiciuli mkurnaloba
kognitur-bihevioruli Terapia fsiqologiuri mkurnalobis
xangrZlivi individualuri eTikuri sakiTxebi
dinamiuri Terapia
am TavSi saubaria sxvadasxva saxis fsiqologiur kon- xis kombinacia unda gamoviyenoT yovel konkretul
sultirebaze, rogoric aris fsiqoTerapia, qceviTi SemTxvevaSi, ganxilulia Sesabamisi aSlilobisadmi
da kognituri Terapiebi da maT mier gamoyenebuli miZRvnil TavSi;
teqnika. es Tavi ufro martivi wasakiTxi iqneba, Tu w vinaidan yovel aseT TavSi mravali saxis teqnika
mkiTxvelis yuradRebas Tavidanve mivapyrobT misi ganixileba, arc erTi maTgani ar aris detalurad
strquturis zogierT aspeqts. aRwerili. swored amitom, ramdenime adgilas aris
w fsiqologiuri mkurnaloba ar aris izolirebuli miTiTebuli Sesabamisi damatebiTi literatura;
procesi, amitom mocemul Tavs unda gavecnoT im Ta- w miuxdavad imisa, rom ramdenime adgilas vxvdebiT
vebTan erTad, romlebSic saubaria somaturi daava- ama Tu im teqnikis zogad daxasiaTebas, pacientTan
debebis mkurnalobasa da samedicino momsaxurebaze; maTi praqtikuli gamoyeneba meTvalyureobis qveS
w mocemuli Tavi gviCvenebs sxvadasxva saxis fsiqo- unda mimdinareobdes.
logiuri mkurnalobis Rirebulebas. rCevebi ama Tu w seqsualuri aSlilobis dros gamoyenebuli fsiqo-
im fsiqikuri aSlilobis dros rekomendebuli mkur- logiuri mkurnaloba me-19 TavSia aRwerili.
nalobis Sesaxeb warmodgenilia im TavSi, romelic
terminologia. termini `fsiqoTerapia~ ori mniSvne-
Sesabamisi aSlilobisadmi aris miZRvnili;
lobiT ixmareba. pirvelis Tanaxmad, fsiqoTerapia aR-
w fsiqologiuri mkurnaloba xSirad gamoiyeneba me- niSnavs nebismieri saxis fsiqologiur mkurnalobas,
dikamentur mkurnalobasTan erTad. is, Tu ra sa- konsultirebisa da kognitur-bihevioruli Terapiis
_ 614 _
rogor warmoiSva fsiqologiuri mkurnaloba
cxrili 22.1 mocemul TavSi ganxiluli fsiqologiuri mkurnaloba

konsultacia gv ???? Terapia mcire jgufebSi gv ????
mxardamWeri jgufebi gv ????
krizisuli intervencia gv ???? TviTdaxmarebis jgufebi gv ????
interpersonaluri jgufuri Terapia gv ????
mxardamWeri fsiqoTerapia gv ???? jgufuri analizi gv ????
kongruentuli jgufebi da fsiqodrama gv ????
interpersonaluri fsiqoTerapia gv ????
fsiqoTerapia did jgufebSi gv ????
kognitur _ bihevioruli Terapia gv ???? palatis jgufebi gv ????
bihevioruli teqnika gv ???? Terapiuli sazogadoebebi gv ????
treningi relaqsaciaSi gv ????
eqspozicia gv ???? wyvilebis fsiqoTerapia gv ????
eqspozicia reaqciis prevenciiT gv ???? fsiqodinamiuri midgoma gv ????
socialuri unar-Cvevebis treningi gv ???? sistemuri midgoma gv ????
treningi asertuli qcevis ganxorcielebaSi gv ???? kognitur _ bihevioruli midgoma gv ????
sibrazis marTva gv ???? biheviorul-sistemuri Terapia wyvilebTan gv ????
TviT-kontrolis teqnika gv ????
qcevis koreqcia mis Sedegebze zemoqmedebis gziT gv ?? ojaxuri Terapia gv ????
sxva meTodebi gv ???? fsiqodinamiuri gv ????
struqturuli gv ????
kognituri teqnika gv ???? sistemuri gv ????
SfoTviTi aSlilobis dros gv ???? ekleqturi gv ????
depresiuli aSlilobis dros gv ????
nervuli bulimiis dros gv ???? fsiqoTerapia bavSvebTan gv ????
ipoqondriis dros gv ????
Sizofreniis dros gv ???? fsiqoTerapia xandazmulebTan gv ????
personologiuri aSlilobis dros gv ????
ZiriTadad, istoriuli TvalsazrisiT saintereso
mkurnaloba gv ????
individualuri dinamiuri fsiqoTerapia gv ????
xanmokle insaiTze orientirebuli fsiqoTerapia gv ??? hipnozi gv ????
kognitur-analitikuri Terapia gv ???? autogenuri treningi gv ????
fsiqodinamiuri interpersonaluri Terapia gv ???? abreaqcia gv ????
xangrZlivi individualuri dinamiuri fsiqoTerapia gv ?? meditacia da tradiciuli mkurnaloba gv ????
CaTvliT. meore mniSvnelobiT, fisqoTerapiaSi ar Se- avtoris azriT arsebobs garkveuli msgavseba Ta
dis konsultireba da kognitur-biheivioruli Tera- namedrove Terapiul teqnikasa da im samkurnalo
pia. aq termini `fsiqologiuri mkurnaloba~ farTo ritualebs Soris, romelsac Zveli saberZneTis
mniSvnelobiT gamoiyeneba, xolo termini `fsiqoTera- taZrebSi atarebdnen. Tumca, fsiqiatriis istoriis
pia~ _ ufro konkretuli mniSvnelobiT (magaliTad, Tanaxmad, fsiqologiuri mkurnaloba warmoiSva me
dinamiuri fsiqoTerapia). cxramete saukuneSi, hipnozis ganviTarebasTan erTad.
mocemul TavSi ganxiluli mkurnalobis saxeebi da am mimarTulebas safuZveli Cauyara venelma eqimma
am Tavis struqtura qvemoT motanil cxrilSia war- anton mesmerma (1734-1815), romelic Tvlida, rom
modgenili (cxrili 22.1.). sxeulis funqcionirebis Sesacvlelad SesaZlebelia
magnituri Zalebis gamoyeneba. misi azriT, aseT Zalebs
rogor warmoiSva fsiqologiuri warmoSobda ara mxolod namdvili magniti, aramed
Terapevtis sxeulSi myofi `cxoveluri magnitizmi~.
mkurnaloba
garda amisa, is Tvlida, rom Terapiuli efeqtis
fsiqologiuri mkurnaloba iseTive Zveli droidan
gasaZliereblad, am oris kombinaciaa SesaZlebeli
modis, rogorc samedicino praqtika. zogierTi
_ 615 _
22 fsiqologiuri mkurnaloba
(Block, 1980). miuxedavad imisa, rom mesmeris Teoriebi represirebuli ideebi mocemuli simptomebis mizezs
ar miiRes samedicino wreebSi, manCesterelma eqimma warmoadgenda). 1889 wels, man aRwera axali teqnikis
jeims breidma irwmuna mesmeris mier aRwerili gamoyenebis pirveli mcdeloba. pirvelad froidma es
fenomenis realuroba. Tumca, breidi Tvlida, rom teqnika Tavis pacientTan _ emi fon n-Tan gamoiyena.
misi gamowveva magnitizmis gareSecaa SesaZlebeli. SemdgomSi froidma SeniSna, rom bernhaimis paci
man warmoadgina fiziologiurad ufro damajerebeli entebs SeeZloT daviwyebuli faqtebis gaxseneba hip
interpretacia, romlis mixedviT mesmeris mier ga nozis gareSe. sakuTar pacientebTan igive efeqtis
mowvuli `mdgomareoba~ sizmris msgavsia, ris gamoc misaRwevad, froidi sToxvda maT, Tvalebi daexuWaT,
mas hipnozi unda ewodos (Braid, 1843). xolo TviTon, am dros, maT Sublze xels adebda (Bruer
miuxedavad imisa, rom am fenomenis bunebis and Freud, 1893-5, gv. 109, 279). Semdeg froidma aRmoaCina,
garSemo azrTa sxvadasxvaoba SeiniSneboda, hipnoziT rom gaxseneba aseve efeqturad mimdinareobda, ro
mkurnaloba popularuli gaxda safrangeTSi. li desac pacienti, ubralod, taxtze iwva, xolo fsi
ebo (1823-1904) da ipolite bernhaimi (1837-1919) qoTerapevti mis mzeras iyo mifarebuli. ase Seiqmna
miiCnevdnen, rom hipnozi Zilis msgavsi normaluri Tavisufali asociaciebis meTodi. SemdgomSi, paci
mdgomareobaa, romlis gamowveva adamianTa umete entebTan muSaobisas, froidi xels uwyobda Tavi
sobaSia SesaZlebeli da romlis efeqtebi suges sufali asociaciebis producirebas da xsnida, Tu
tiiT miiReba. bernhaimis wigni `sugestiuri Te ramdenad mniSvnelovania esa Tu is asociacia. man,
rapiebi~ (Bernheim, Suggestive therapeutics, 1980) aR dainaxa, agreTve, rom aucilebelia pacientTan ur
wers sugestiis gamoyenebas isteriisa da sxva nev TierTobis intensivobis gakontroleba. amgvari dak
rotuli mdgomareobebis, mtkivneuli fizikuri virvebebis safuZvelze Seiqmna fsiqoanalizis Ziri
mdgomareobebisa da kuW-nawlavis problemebis mkur Tadi teqnika, mogvianebiT ki _ teqnika, romelsac
nalobis mizniT. sapiripiro mosazrebaze idga Jan dinamiuri fsiqoTerapiebis ufro farTo jgufi iye
martin Sarko (1825-1893) _ parizis salpetrieris nebda. dainteresebul mkiTxvels SeuZlia gaecnos
saavadmyofos nevrologi. Sarko Tvlida, rom hipnozi froidis erT-erT naSroms, romelic am saxis teqnikis
paTologiuri mdgomareobaa, romelic mxolod iste SemuSavebas exeba (Freud, 1895a, 1923).
riis mqone pacientebTan SeiZleba aRmocendes. mogvianebiT, ufro popularuli gaxda fsiqoanali
im periodSi, hipnozis mTavar alternativas war tikuri da msgavsi sxvadasxva teqnika, vidre hipnozi
moadgenda `darwmuneba~ _ meTodi, romelic guli da darwmunebis teqnika. froidma gamoaqveyna STam
sxmobs simptomebisa da sxva problemebis axsnasa da beWdavi monacemebi am teqnikiT mkurnalobis Taobaze
ganxilvas sugestiurobis gazrdis gareSe. am midgomis da ganaviTara Tavisi Teoria, romelic, safuZvliani
mniSvnelovani warmomadgeneli iyo Sveicareli pro damuSavebis Semdeg, sakmaod rTuli gaxda. man
fesori da nevropaTologi pol diubua, romlis wigni Semoikriba mimdevarTa jgufi, romlTaganac, zogierTi,
nervuli aSlilobebis fsiqiatriuli mkurnaloba ar eTanxmoboda froidis gviandel mosazrebebs.
(The psychiatric treatment of nervous disorders, 1904) Zalze froidis mimdevrebma SemdgomSi, Seqmnes dinamikuri
gavleniani aRmoCnda (am wignis inglisuri Tar fsiqoTerapiis sakuTari `skolebi~, romlebic qvemoT
gmanistvis ixileT Dubois, 1909). diubua Tvlida, rom mokled iqneba ganxiluli. ufro detaluri informaciis
miuxeadavad imisa, rom hipnozs garkveuli Rirebuleba mosapoveblad ixileT qveTavi holmsis avtorobiT
gaaCnia isteriis mkurnalobisas, sxva saxis nevrozebis (Holmes, 2000) da monros naSromi (Munroe, 1955).
SemTxvevaSi ufro marTebulia darwmunebis gamoyeneba. pier Jane (1859-1947) moRvaweobda im periodSi,
mecxramete saukunis dasasruls, nevrozebis um rodesac froidi fsiqoanalitikuri ideebis ganvi
ravleobas nevrologebi mkurnalobdnen. rodesac Tarebaze muSaobda. Janec dainteresda nevrozis
froidma daiwyo nevrologad muSaoba, misi pacientebis mizezebiT da, froidis msgavsad, pirveli gamokvleva,
umravlesobas nevrozi aReniSneboda. froidi saf hipnozis gamoyenebiT, isteriis mqone pacientebze
rangeTSi ewvia bernhaimsa da Sarkos, hipnozis Caatara. Tumca, igi, froidisagan gansxvavebul
Seswavlis mizniT (Freud, 1892). venaSi dabrunebisas, daskvnebamde mivida. Janes azriT, nevrozi gamowveuli
man scada nevrozis mqone ramdenime pacientis mimarT iyo fsiqikur aqtivobaTa normaluri integraciis
hipnozis gamoyeneba. Tavidan, is kmayofili iyo darRveviT. am process man disociacia uwoda. is
SedegebiT, magram SemdgomSi ver moaxerxa miRweuli disociacias ukavSirebda nervuli funqcionirebis
Sedegis SenarCuneba da gadawyvita, hipnozi sxva miz saerTo sisustes _ nevrasTenias. Janes, froidisagan
niT gamoeyenebina. hipnozis meSveobiT simptomebis gansxvavebiT, ar aRuweria teqnikuri inovaciebi.
Secvlis nacvlad, man gadawyvita es teqnika rep is, rom misi vrceli naSromebi bevrad naklebad
resirebul ideebTan dakavSirebuli emociebis gamo gavleniani iyo froidis naSromebTan SedarebiT,
sanTavisufleblad gamoeyenebina (is miiCnevda, rom albaT, nawilobriv, amiTaa gamowveuli. meore mizezi
_ 616 _
rogor warmoiSva fsiqologiuri mkurnaloba
is unda iyos, rom froidisagan gansxvavebiT, Janes ar
boqsi 22.1 neofroidianelebi
Seuqmnia mimdevarTa skola, romelic, momavalSi, mis
ideebs ganaviTarebda. karen horni (Karen Horney) ar eTanxmeboda froidis
Tvalsazriss qalis fsiqologiuri ganviTarebis Sesaxeb,
pirveli fsiqoanalitikosebi, romlebic gansakuTrebiT ki, froidis cnebas- `penisis Suri~.
daSordnen froidis tradiciul moZRvrebas hornisaTvis, bavSvobisdroindeli SfoTvis mizezia
sakuTari Tavis gancda umniSvnelo da uZlur arsebad,
alfred adleri daSorda froids 1910 wels. man uaryo romelsac xifaTi emuqreba. amgvari SfoTvis daZleva,
libidos Teoria (gv. ??) da yuradReba gaamaxvila Cveulebriv, xdeba, bavSvis aRzrdiT moyvaruli mSoblebis
mier. sapirispiro SemTxvevaSi SfoTvis mdgomareoba
ganviTarebis procesSi socialuri faqtorebis rolze. narCundeba da bavSvs uviTardeba dacviTi meqanizmebi
individualuri analizis Terapiuli teqnikis gamoyenebiT, SfoTvis winaaRmdeg. es meqanizmebi moicavs siyvarulis
adleri cdilobda, gaego, Tu rogor yalibdeba adamianis mopovebis Zlier survils, ltolvas Zalauflebisaken
da, agreTve, ukidures morCilebas. horni ase aRwerda
cxovrebis stili da arsebul problemebze amaxvilebda
gansxvavebas miseul da froidiseul midgomebs Soris:
yuradRebas. adleris ideebi naklebad saintereso `me imiT ganvsxvavdebi froidisgan, rom nevrotuli
da originaluri iyo, vidre froidis ideebi. misma tendenciebis aRmoCenis Semdeg, froidi, upirveles
mkurnalobis teqnikam ver hpova farTo gavrceleba. yovlisa, ikvlevs maT warmoSobas, me ki vikvlev maT
realur funqciasa da Sedegebs. (Horney, 1939, p.282).
Tumca, iTvleba, rom adleris ideebma safuZveli Cauyara
amerikeli analitikosebis dinamiur-kulturul skolas, erix fromma (Erich Fromm) agreTve uaryo froidis
instinqturi ganviTarebis Teoria, rogorc nevrozis
romelic sakmaod gavleniani gamodga (ix. qvemoT). mizezi. is Tvlida, rom xasiaTis CamoyalibebaSi
adleris wvlili ganxilulia Semdeg naSromSi: Ansbacher mniSvnelovania ojaxuri zegavlena da, agreTve,
and Ansbacher (1964). yuradRebas amaxvilebda kulturis ufro farTo
zegavlenaze. zogadad, froms ufro metad ainteresebda
Tu adleris interesis sagans pacientis cxovrebis socialuri sakiTxebi, vidre klinikuri. mis ideebs mainc
realuri problemebi Seadgenda, iungis yuradReba, da mainc didi zegavlena ar mouxdenia Terapiaze.
ufro metad, fantaziis Sinagan samyaroze iyo mi fromisgan gansxvavebiT, hari sTek salivani (Harry
marTuli (Tumca igi ar ugulebelhyofda Tanamed Stack Sullivan) TerapiiT ufro iyo dainteresebuli,
rove problemebs). Tavis fsiqoTerapiul midgomaSi, vidre TeoriiT. misi mkurnaloba fokusirebuli
iyo analitikosisa da pacientis urTierTobaze da
iungi yuradRebas amaxvilebda aracnobieri masalis
yoveldRiuri socialuri kontaqtebis ganxilvaze.
interpretaciaze, romelic sizmrebis, naxatebis da froidiseuli fsiqoanalizisagan gansxvavebiT, salivanis
xelovnebis sxva nimuSebis analiziT iyo miRebuli. TerapiaSi pacienti da Terapevti SedarebiT Tanasworni
arian. salivani pirdapir kiTxvebsa da provokaciul
iungi miiCnevda, rom aracnobieris garkveuli Si
gamonaTqvamebs aniWebda upiratesobas da naklebad
naarsebi saerToa yvela adamianistvis (`koleqtiuri ainteresebda Teoriaze damyarebuli interpretacia
aracnobieri~) da rom isini vlindeba universalur (Sullivan, 1953).
xatebSi. am universalur xatebs iungma arqetipebi
Sejamebulia boqsSi 22.1.
uwoda. miuxedavad imisa, rom iungi gansakuTrebul
melani klainma (Melanie Klein) ganaviTara froidis
yuradRebas uTmobda fantaziasa da aracnobiers,
Teoria bavSvis adreuli ganviTarebis Sesaxeb. is
iungianur analizSi kavSiri Terapevtsa da pacients
miiCnevda, rom dabali asakis bavSvebTan gamoyenebis
Soris naklebad calmxrivia, vidre fsiqoanalizSi,
mizniT, SesaZlebelia fsiqoanalitikuri teqnikis
radgan Terapevti ufro aqtiuria da ufro metad
adaptireba. am SemTxvevaSi, bavSvis TamaSis inter
gamoxatavs sakuTar Tavs. iungis ideebi ganxilulia
pretacia zrdasruli adamianebis gamonaTqvamebis
Semdeg wyaroSi: Storr, 2000.
interpretaciis eqvivalents warmoadgens. òbieqti~
neofroidianelebi aris klainis Teoriis erT-erTi centraluri cneba,
romelmac zegavlena moaxdina dabali asakis bavSvebTan
fsiqoanalizis neofroidianuli skola 1930-ian wlebSi
gamoyenebis mizniT fsiqologiur azrovnebaze. es
aSS-Si Camoyalibda. misi warmomadgenlebi Tvlidnen,
termini miuTiTebs rogorc emociuri TvalaszrisiT
rom nevrozi bavSvobidan momdinareobs, magram isini
mniSvnelovan pirovnebaze (magaliTad, dedaze), ise am
miuReblad miiCnevdnen froidis Sexedulebas, romlis
pirovnebis nawilze (magaliTad, dedis mkerdze) da mis
Tanaxmad, bavSvobis periodSi libidos ganviTarebas
(am nawilis) Sinagan fsiqologiur reprezentaciaze.
arsebiTi mniSvneloba aqvs Semdgomi fsiqikuri jan
klaini Tvlida, rom bavSvis mier òbieqtebis~ gancda
mrTelobistvis. neofroidianelebis azriT, ojaxi da
siyvarulisa da siZulvilis Zlier instinqtur
socialuri faqtorebi ufro didi zegavlenis mqonea.
grZnobasTan aris dakavSirebuli. radgan bavSvs,
am skolis sami cnobili warmomadgenelia karen
Tavidan ar SeuZlia Sereuli grZnobebis gancda, mas
horni, erix fromi (orive iyo ltolvili nacisturi
obieqtebi an uyvars an sZuls. aqedan gamomdinare,
germaniidan da StatebSi 1930-an wlebSi dasaxlda) da
Tu romelime òbieqti~ (magaliTad, deda) aRZravs
amerikeli hari sTek salivani. am avtorebis wvlili
orive tipis gancdas, es obieqti `gaixliCeba~ karg
_ 617 _
da cud nawilebad. mogvianebiT, bavSvs uviTardeba xanmokle fsiqodinamiuri fsiqoTerapia. froidis
Sereuli grZnobebis gancdis unari da, Sesabamisad, Teoriis es versia saTaves ferencidan (Ferenczi) iRebs,
SeuZlia warsulSi gaxleCili obieqtebis gamTeleba romelmac dainaxa ufro xanmokle fsiqoanalizuri
(anu, SeuZlia erTsa da imave adamianTan dakavSirebiT, Terapiis Seqmnis aucilebloba. man es ganaxorciela
dadebiTi da uaryofiTi grZnobebis gancda). aseT droiTi SezRudvebis dawesebiT, Terapevtis rolis
dros, mas uCndeba sinanuli imis gamo, rom obieqti gaaqtiurebiT da mkurnalobis ZiriTadi etapebis
warsulSi mxolod uaryofiT grZnobebs aRZravda. dagegmviT. am inovaciebis safuZvelze Seiqmna xan
amgvar dinamikas klaini uwodebda gadasvlas para mokle dinamiuri fsiqoTerapia, romelic dRes
noidul-Sizofreniuli `poziciidan~ (igi am terminiT gamoiyeneba (gv. ??).
ganviTarebis safexurebs aRniSnavda) depresiul ufro gviandeli midgomebi upiratesobas aniWeben
`poziciaze~. klainis Teoriis detalebis Sejameba xanmokle mkurnalobas da yuradRebas amaxvileben
advili ar aris. aseve Znelia maTi ukritikod miReba, metad pacientis mimdinare da, naklebad, warsul
magram misma zogadma midgomam bavSvis Terapiis mimarT problemebze. ufro gviandeli midgomebidan mniS
da obieqtis cnebam mniSvnelovani zegavlena moaxdines vnelovania:
fsiqologiur azrovnebaze. klainis Teoriis zogadi 1. interpersonaluri Terapia (ix. gv. ??), romlis
monaxazi sigalTan aris mocemuli (Segal, 1963), xolo avtorebi arian klermani da vaismani (Klerman and
teqnika, romelsac is bavSvebis analizisas iyenebda, Weissman). igi amJamindeli interpersonaluri prob
missave naSromSia warmodgenili (Klein, 1963). lemebisken aris mimarTuli;
obieqtTan urTierTobis skola, romelic muSaobda
2. kognitur _ analitikuri Terapia (gv. ??), romlis
melani klainis ideebis ganviTarebze, Camoyalibda
avtoricaa raili (Ryle). aq kognitur Terapiul
britaneTSi 1930-40-an wlebSi. fairburnma (W.R.D.
teqnikas fsiqodinamiur konteqstSi iyeneben (ix.
Fairburn) gaiziara klainis Teoria dedasTan adreuli
Llewellyn, 2003);
gamocdilebis mniSvnelobis Sesaxeb, iseve rogorc
ideebi obieqtisa da misi gaxleCis Sesaxeb. is Tvlida, 3. fsiqodinamiuri interpersonaluri Terapia (gv.
rom obieqtic da `me~-c SeiZleba sam nawilad daiyos: ??), avtori _ hobsoni. es aris mkurnalobis gamar
1. idealurad, romelic arasodes iwvevs frustracias; tivebuli forma, romelic `saubris~ saxiT mimdi
2. libidonalurad, romelsac SeuZlia draivebis nareobs (Hobson, 1985).
dakmayofileba da 3. antilibidonalurad, romelic
iwvevs frustracias. konfliqti or ukanasknel nawils kognitur-bihevioruli Terapiis
Soris, Cveulebriv, iwvevs represias, magram zogjer, ganviTareba
ucabed meryeobas sapirispiro grZnobebs Soris. hari bihevioruli Terapia. interesi mecnierul fsi
gantripma (Harry Guntrip) da, mogvianebiT, jozef qologiaze dafuZnebuli mkurnalobis mimarT saTaves
sandlerma (Joseph Sandler) SemdgomSi ganaviTares iRebs Janes meTodidan, romelic pacientis `xelaxal
fairbernis ideebi da isini Terapiul praqtikaSi gam ganaTlebas~ gulisxmobda (Janet, 1925), uotsonisa da
oiyenes. obieqtTan urTierTobis Teoriis mimoxilva raineris mier gamoyenebuli midgomidan (Watson, Rayner,
mocemulia Semdeg naSromSi: Gomez, 1997. 1920), romelic gulisxmobda daswavlis principebis
mijaWvulobis Teoriis avtoria britaneli anali gamoyenebas bavSvebTan SiSis mkurnalobisas, da
tikosi jon boulbi (John Bowlby). mis TeoriaSi 1930-ian wlebSi, aversiuli Terapiis gamoyenebidan
ar monawileobs iseTi cnebebi, rogoricaa draivi, alkoholizmis mkurnalobis mizniT. Tumca, am mi
instinqti an obieqtTan urTierToba. amosavali idea marTulebiT mniSvnelovan progress mxolod 1950-
imaSi mdgomareobs, rom Cvil bavSvebs sWirdebaT ian wlebSi miaRwies, rodesac londonis moudslis
usafrTxo urTierTobebi TavianT mSoblebTan. ro saavadmyofoSi momuSave fsiqologebma gamoT
desac mijaWvuloba ar aris usafrTxo, mas miv qves ukmayofileba fsiqoanalizTan dakavSirebu
yavarT sirTuleebamde urTierTobis damyarebaSi li eqstravagantuli ganacxadebisa da misi aramec
da emociuri xasiaTis problemebTan. Tavis droze nieruli midgomis gamo. maT fobikuri aSlilobis
boulbis ideebma mniSvnelovani zegavlena moaxdines mqone pacientebis mkurnalobisas daiwyes daswavlis
bavSvis aRzrdaze (magaliTad, yuradReba miaqcies principebis gamoyeneba im imediT, rom amgvari
imas, rom bavSvi, stacionirebis dros, kontaqtSi gamocdileba mocemuli principebis ufro farTo gamo
unda imyofebodes mSoblebTan). holmsis naSromSi yenebaSi daexmareboda. daaxloebiT imave periodSi,
ganxilulia mijaWvulobis Teoriis istoriuli gan samxreT afrikaSi momuSave fsiqiatrma jozef volpma
viTareba (Holmes, 2000), xolo am Teoriis ufro gvi ganaviTara msgavsi ideebi, romlebic Camoayaliba Tavis
andeli ganviTareba fonagisa da misi kolegebis mieraa erT-erT gavlenian wignSi `fsiqoTerapiis Catareba
aRwerili (Fonagy et al., 1996). reciprokuli inhibiciis gamoyenebiT (Psychotherapy
_ 618 _
fsiqologiuri mkurnalobis klasifikacia
by Reciprocal Inhibition, Wolpe, 1959). wignSi man aRwera monacemebisa da mkurnalobis SedarebiT xanmokle da
nevrotuli aSlilobebis mkurnaloba farTod mkafio procedurebis gamo, kognitur-bihevioruli
gamoyenebuli midgomiT, romelic daswavlis Teorias Terapia gadaiqca mravali fsiqikuri aSlilobis sam
efuZneboda da relaqsaciis Zalze saintereso meTods kurnalo upirates meTodad.
iyenebda. amave periodSi, SeerTebul StatebSi skinerma
(Skinner, 1953) gamoTqvma mosazreba operantuli gan fsiqologiuri mkurnalobis
pirobebis principebis gamoyenebiT fsiqikuri aSli
klasifikacia
lobebis mkurnalobis Taobaze. garkveul periodSi es
fsiqologiuri mkurnalobisadmi arsebuli midgo
ideebi sakmaod gavleniani iyo.
mebis mravalferovnebis gamo, sasargebloa maTi
volpis ideebi gaiziares did brintaneTSi, radganac
dajgufeba martivi klasifikaciebis saxiT. arsebobs
isini Zalian kargad moergo moudslis saavadmoyofos
am tipis mravali klasifikacia, maTgan sami qvemoT
iniciativas, magram SeerTebul StatebSi, ufro
iqneba ganxiluli. Semdeg modis martivi sqema, ro
didi interesi skineris ideebma daimsaxura, yovel
melic mkiTxvels daexmareba mkurnalobis tipebis
SemTxvevaSi, fsiqologTa Soris. mogvianebiT, es ori
dakavSirebaSi maT gamoyenebasTan jandacvis sistemaTa
midgoma erTmaneTs Seerwya da am qveynebSi, amJamad,
umravlesobaSi.
erTmaneTis msgavsi meTodebi gamoiyeneba.
mkurnalobis am axali meTodebis Sefasebis mimarT I. klasifikacia gamoyenebuli teqnikis mixedviT
seriozulma interesma dasawyisSive iCina Tavi. pirvel w eklekturi
klinikur kvlevaSi (1978) desensitizacia Seadares w fsiqodinamiuri
individualur da jgufur dinamiur fsiqoTerapias
w kognitur-bihevioruli
(Gelder et al., 1978). Tanamedrove standartebiT kvlevas
mravali sisuste axasiaTebda, magram, SemdgomSi, w sxva, magaliTad, sistemebis Teoria.
TandaTan daixvewa da, amJamad, gamoyenebuli bihe II. klasifikacia monawile pacientebis raodenobis
vioruli meTodebis umravlesobisTvis arsebobs mixedviT:
mtkicebulebebze dafuZnebuli myari monacemebi. individualur Terapias (erTi pacienti) SegviZlia
xolo is meTodebi, romlebsac aseTi mtkicebuleba ar maSin mivaniWoT upiratesoba, rodesac mkurnaloba
gaaCnia, xmarebidan aris amoRebuli. unda movargoT pacientis konkretul problemebs an
kognituri Terapia iwyeba amerikeli fsiqiatris, rodesac jgufuri diskusia distress iwvevs. garda
bekis (A.T. Beck) naSromiT, romelic ukmayofilo iyo amisa, individualuri Terapiis gamoyenebas SeiZleba
depresiuli aSlilobis fsiqoTerapiuli mkurnalobiT ganapirobebdes problemis xasiaTi (magaliTad,
da am midgomis alternativas eZebda. bekma yuradReba seqsualuri gadaxra) an pacientistvis damaxasiTebeli
miaqcia, rom depresiuli pacientebis azrovnebaSi socialuri SfoTva.
erTi da igive Temebi iCenda Tavs (magaliTad, wyvilTa Terapia gamoiyeneba iseT SemTxvevaSi,
marcxis Tema). man CaTvala, rom amgvari Temebi rodesac fsiqikur aSlilobaSi mniSvnelovani wvlili
depresiuli aSlilobis arsebiT nawils warmoadgens Seaqvs urTierTobis problemebs.
da aucilebelia maTi Secvla Sesabamisi meTodis ojaxuri Terapia maSin gamoiyeneba, rodesac
gamoyenebiT. bekma Seqmna aseTi warmodgenebis Secvlis bavSvis an mozardis sirTuleebi ufro didi ojaxuri
originaluri meTodi (gv. ??). problemis nawils warmoadgens;
kognituri Terapiis Camoyalibeba amerikel fsi Terapia mcire da did jgufebSi. am tipis Terapias
qologTa erT-erTi jgufis moRvaweobamac ganapiroba. maSin eniWeba upiratesoba, rodesac ramdenime pacients
isini ukmayofilebas gamoTqvamdnen operantuli gan erTnari mkurnaloba esaWiroeba (eqspoziciuri Tera
pirobebis meTodis gamo, romelic fsiqikas `Sav pia agorafobiis dros), an rodesac jgufis sxva
yuTad~ ganixilavda da ugulebelyofda grZnobebsa da wevrebs SeuZliaT mniSvnelovani wvlili Seitanon
azrebs. magaliTad, maixenbaumi Tvlida (Meichenbaum, Terapiul procesSi (magaliTad, daexmaron alkoholis
1977), rom emociuri aSlilobis mqone adamianebis momxmareblebs ufro obieqturad Sexedon TavianT
ganmeorebiTi azrebi distresis SenarCunebas uwyobs problemebs).
xels da maTi marTvis meTodi SeimuSava. SesaZlebelia pirveli ori saxis Terapiis erT
kognitur-bihevioruli Terapia. sxva fsiqologebma maneTTan kombinacia, ris Sedegadac miiReba indi
da fsiqiatrebma moaxdines kognituri meTodebis vidualuri kognitur-bihevioruli Terapia an jgu
integracia qceviT TerapiasTan. am kombinaciis Se furi fsiqodinamiuri Terapia.
degad warmoiSva kognitur-bihevioruli Terapiis fsiqoTerapiis gamoyeneba zogad samedicino praq
Tanamedrove meTodebi, romlebic qvemoTaa aRwerili. tikaSi. zogierTi fsiqikuri aSlilobis dros, Zi
arsebul mtkicebulebebze damyarebuli medicinis riTadad, fsiqologiuri mkurnaloba gamoiyeneba.
_ 619 _
mas iyeneben an damoukideblad, an medikamentur
boqsi 22.2 sxvadasxva saxis
mkurnalobasTan erTad. konsultacia, krizisuli
fsiqoTerapiis saerTo faqtorebi
intrevencia da kognitur-bihevioruli Terapia am
saxiT maSin gamoiyeneba, rodesac klinikuri kvleva Terapiuli urTierToba fsiqoTerapiis yvelaze mni
Svnelovani da gavrcelebuli faqtoria, magram zedmetad
maT efeqturobaze miuTiTebs. amJamad, dinamiuri fsi
intensiurma Terapiulma urTierTobam SeiZleba
qoTerapia, ZiriTadad, gamoiyeneba iseTi faqtorebis problemebi gamoiwvios (ix. teqsti).
modifikaciistvis, romlebic zrdian aSlilobis mosmena. rodesac Terapevti yuradRebiT usmens pacients,
recidivis risks (mag., muSaoba mimdinareobs TviT pacienti xedavs, rom Terapevts ainteresebs misi
Sefasebis amaRlebaze). warsulSi, dinamiur fsi problemebi. es xels uwyobs maT Soris iseTi urTierTobis
Camoyalibebas, romelic exmareba pacients. mas eufleba
qoTerapias iyenebdnen iseTi mdgomareobebis sam
gancda rom misi esmiT.
kurnalod, romelsac, dRes, qvezRurblovans uwo
emociebisgan gantvirTva SeiZleba sasargeblo gamodges
deben, anu iseTi emociuri xasiaTis problemebis
mkurnalobis dawyebis win, magram xSiri gantvirTva
mosagvareblad, romlebic distresis gamomwvevia, mag iSviaTadaa sasargeblo. emociebisagan intensiur da
ram ar aris imdenad mwvave an xangrZlivi, rom fsiqikur swraf gantvirTvas abreaqcia ewodeba.
aSlilobad CaiTvalos. axla amgvari problemebis optimisturi suliskveTeba. bevr pacients mravaljer aqvs
mosagvareblad konsultacias iyeneben, xolo imave gancdili marcxi da aRar aqvs sakuTari Tavis imedi.
optimisturi suliskveTebis gamowveviT, Terapevti xels
mizniT fsiqodinamiuri meTodebis gamoyeneba mxolod
uwyobs pacients sakuTari Tavis daxmarebaSi.
kerZo praqtikaSi xdeba.
informaciis miwodeba. daqveiTebuli koncentraciis gamo,
jandacvis sistemaSi zemoT aRwerili meTodebisa
distresSi myof pacientebs SeiZleba cudad axsovdeT is
da midgomebis gamoyeneba safuZvlad udevs mesame informacia, romelic maT sakuTari mdgomareobis Sesaxeb
klasifikacias: miawodes.
informacia, SeZlebisdagvarad, martivi unda iyos da
w yvelaze martivi meTodebi, romlebic jandacvis mkafiod miewodebodes. SeiZleba saWiro gaxdes mniSvne-
nebismieri servisis mier gamoiyeneba. aq Semodis lovan momentebTan dakavSirebiT axsna-ganmartebis ram-
konsultaciis is meTodebi, romlebsac viyenebT denjerme micema, an misi werilobiTi saxiT Camoyalibeba.
naklebad mwvave emociuri problemebis dros da pacientisTvis misi mdgomareobis axsna-ganmarteba. nebismie-
romlebic exmareba stresuli situaciebisadmi adap ri fsiqologiuri mkurnalobis dros pacients ganumarta-
ven Tavisi mdgomareobis mizezs, rac TviTdajerebulobas
tacias da rTuli gadawyvetilebebis miRebas (mag., matebs mas. pacients, Tavisi mdgomareobis mizezi an pirda-
Sewydes Tu ara orsuloba). samedicino praqtikaSi, pir unda movaxsenoT (rogorc es xdeba moklevadiani fsi-
es meTodebi eqimisa da pacientis yoveldRiuri qoTerapiis dros), an unda mivawodoT arapirdapiri gziT
kiTxvebisa da interpretaciebis gamoyenebiT (rogorc es
urTierTobis nawilia.
xdeba grZelvadiani Terapiis SemTxvevaSi).
w saSulo sirTulis meTodebi, romlebsac fsiqiatrTa
rCeva da warmarTva yvela saxis fsiqoTerapiis nawilia. xan-
umravlesoba iyenebs. mocemul jgufs miekuTvneba mokle TerapiaSi, rCeva da gaZRola pirdapiri saxiT xdeba,
kognitur-bihevioruli Terapiis ufro martivi xolo xangrZlivi mkurnalobisas pacients ubiZgeben, rom
formebi da xanmokle dinamiuri fsiqoTerapia. am man Tavad ipovos pasuxi misTvis saintereso kiTxvebze. am
ukanasknel SemTxvevaSic xdeba pacientis warmarTva, swori
tipis mkurnaloba gamoiyeneba SfoTviTi, kvebiTi pasuxis arCevisas, Tumca, arc ise aSkarad.
da guneb-ganwyobis naklebad mZime aSlilobebis
sugestia. miuxedavad imisa, rom hipnozis gamoklebiT,
dros. is xSirad gamoiyeneba socialur meTodebTan sugestias specialurad ar iyeneben fsiqologiuri mkur-
da medikamentebTan kombinaciaSi, rogorc zogadi nalobis dros, yvela saxis fsiqologiuri mkurnaloba
samkurnalo gegmis nawili. mainc sugestiis elementis Semcvelia. es elementi aum-
jobesebs mkurnalobis Sedegebs adreul etapze, magram
w rTuli meTodebi, romlebsac profesiuli ganaT miRweuli efeqti xangrZlivi ar aris.
lebis mqone fsiqiatrebi iyeneben. am kategorias
miRebuli Sedegebis msgavsia an maTze ukeTesi. es
ganekuTvneba ufro rTuli fsiqodinamiuri da
imaze metyvelebs, rom fsiqoTerapiuli meTodebis
kognitur-bihevioruli Terapiebi. maT iyneben Seda
saerTo Tvisebebi ufro mniSvnelovania, vidre maT
rebiT mZime da rTuli aSlilobebis samkurnalod
Soris arsebuli gansxvaveba. am daskvnamde didi
an damoukideblad, an rogorc daavadebis marTvis
xnis win mivida jerom frenki (Jerome Frank, 1967),
zogadi gegmis komponents.
romelic Tvlida, rom mniSvnelovani saerTo niSnebia
Terapiuli urTierToba; pacientis TanagrZnobiT
saerTo faqtorebi fsiqologiur mosmena; pacientistvis iseTi pirobebis Seqmna, rom
mkurnalobaSi man sakuTari grZnobebisagan gantvirTva moaxerxos;
fsiqologiuri mkurnalobis kvlevam aCvena, rom pacientistvis informaciis miwodeba da sakuTari
mravali aSlilobis dros sxvadasxva meTodis gamo mdgomareobis axsna-ganmarteba; optimisturi sulis
yenebiT miRebuli Sedegebi mkurnalobis gareSe kveTebis Canergva; sugestiuroba, romlis mizezi
_ 620 _
konsultireba da krizisuli intervencia
Terapevtis prestiJulobaa; urTierTobis damyareba. ararealistur grZnobebsa da damokidebulebebs gu-
yvela es maxasiaTebeli warmodgenilia boqsSi 22.2. lisxmobs).
gadatanis problemebi. gadatanis gamo, pacienti
gadatana da ukugadatana (transferi da SeiZleba Terapevtze ukiduresad damokidebuli gax-
kontrtransferi) des. es SeiZleba gamoixatebodes intrevius gaxangrZ-
rodesac Terapiuli urTierToba intensiuri xdeba, livebis mcdelobaSi, damatebiTi Sexvedrebis daniS-
is garkveuli saxiT viTardeba, rasac gadatanas da nvnis moTxovnaSi, da iseTi qcevebis ganxorcieleba-
ukugadatanas uwodeben. miuxedavad imisa, rom gada- Si, romlebic damatebiTi mzrunvelobis mopovebas
tana da ukugadatana yvelaze mkafio saxiT dinamiur isaxavs miznad (magaliTad, TviTmkvlelobis muqara).
midgomaSi iCens Tavs, isini, garkveuli xarisxiT, ne- Terpavetze aseTi damokidebuleba arTulebs mkur-
bismieri fsiqologiuri mkurnalobis dros yalibde- nalobis dasrulebas simptomebis xelaxali gamovle-
ba. Terapevtis mier am fenomenis gauTvaliswinebloba nisa da mkurnalobis gagrZelebis moTxovnis gamo. Tu
xifaTis Semcvelia. Terapevti adreve SeamCnevs, rom pacients masze damo-
gadatana Terapiuli urTierTobis elementia. is kidebuleba gauCnda da Tu is Sesaferisi formiT gani-
sul ufro intensiuri xdeba mkurnalobis mimdina- xilavs pacientTan am sakiTxs, man SeiZleba moaxerxos
reobasTan erTad. gadatana gansakuTrebiT Zlieria, aseTi sirTuleebistvis Tavis arideba. amave dros, pa-
rodesac pacienti Terapevts gaandobs pirad pro- cients saSualeba eZleva ukeT gaicnos sakuTari Tavi,
blemebs, romlebsac, Cveulebriv, mxolod intimur Tuki is gaacnobierebs, saidan momdinareobs misi grZ-
urTierTobaSi myof adamianebs gaumxelda. piradi nobebi da damokidebulebebi ara mxolod Terapevtis,
problemebis gandoba TerapevtTan urTierTobas ki- aramed sxva adamianebis mimarT.
dev ufro intimurs xdis. radgan Terapevti pacients ukugadatanis problemebi maSin aRmocendeba, ro-
igiveTi ar pasuxobs da ar andobs mas piradi cxovre- desac Terapevti zedmetad aris CarTuli pacientis
bis detalebs, pacienti intimurobis gancdaze gark- problemebSi an Seusabamod avlens sibrazes mis mi-
veuli saxiT reagirebs: is aracnobierad qmnis Tera- marT. am problemebis gacnobiereba droulad moxde-
pevtis portrets mexsierebis im Sinaarsebze dayrd- ba, Tu Terapevti gaaanalizebs sakuTar grZnobebs da
nobiT, romlebic konkretul adamians (Cveulebriv, ipovis maT mizezs pirad gamocdilebaSi. nawilobriv
mSobels) ukavSirdeboda, radgan, mis mimarT, intimur amis gamoa, rom fsiqoterapiaSi intensiuri treningis
grZnobebs ganicdida. rodesac aseTi ram xdeba, ambo- gavlisas fsiqoterapevtebs xSirad exmarebian kavSi-
ben, rom pacientma Terapevtze is grZnobebi da damo- ris danaxvaSi TavianT warsul gamocdilebasa da amJa-
kidebulebebi gadaitana, romlebsac mSobelTan akav- mindel emociur reaqcias Soris.
Sirebda. am process gadatana ewodeba. rodesac gada-
tanili grZnobebi dadebiTia, amboben, rom gadatana konsultireba da krizisuli
pozitiuria, xolo rodesac isini uaryofiTia, iTv- intervencia
leba rom gadatana uaryofiTia. rodesac mSobelTan
dakavSirebuli grZnobebi ambivalenturia, gadatanac, konsultacia
erTdroulad, dadebiTi da uaryofiTi komponentebis yoveldRiur metyvelebaSi, sityva `konsultireba~
Semcveli iqneba. is SeiZleba warmoadgendes siyvaru- rCevis micemas gulisxmobs. rogorc teqnikuri ter-
lis, siZulvilis, eWvisa da Suris nazavs. mini, is aRniSnavs ufro farTo procedurebs, romle-
ukugadatana. fsiqoTerapevtis mier interesis gamo- bic codnasa da emociebs exeba. konsultirebis mra-
xatva Tavisi pacientis yvelaze intimuri problemebis vali teqnika arsebobs. TiToeuli maTgani sxvadasxva
mimarT savsebiT bunebrivi movlenaa, magram, fsiqoTe- problemis dros da sxvadasxva garemoSi gamoiyeneba
rapevti, am dros, miukerZoebeli unda iyos da profe- (magaliTad, zogad samedicino praqtikaSi, rogorc
siuli urTierTobis farglebs ar unda scildebodes. fsiqiatriuli momsaxurebis nawili; studentebistvis
Tumca, maSinac ki, rodesac Terapevtebs specialuri samedicino momsaxurebis gawevisas).
treningi aqvT gavlili, isini yovelTvis ver axerxe- konsultireba moicavs araspecifikur faqtorebs,
ben interesisa da miukerZoeblobis aseTi idealuri romlebic saerToa yvela saxis fsiqoTerapiuli mid-
balansis miRwevas. Tu es ver moxerxda, Terapevtis gomistvis (ix. boqsi 22.2). nebismieri teqnikis gamoy-
reaqcia pacientis pirovnul Tvisebebs ki ar asaxavs, enebisas mniSvnelovania urTierToba konsultantsa
aramed gulisxmobs pacientze im grZnobebisa da war- da im pirs Soris, visac utardeba konsultacia. kon-
modgenebis gadatanas, romlebic fsiqoTerapevts pi- sultaciis miznidan gamomdinare, informaciis miwo-
rad cxovrebaSi monawile adamianebTan akavSirebda. deba, emociebisagan gantvirTva da situaciis axle-
am process ukugadatana ewodeba. (zogi avtori uku- burad danaxva sxvadasxvagvarad aris aqcentirebuli.
gadatanaSi pacientTan dakavSirebul realistur da warsulSi, konsultaciis dros, ZiriTadad, klientze
_ 621 _
centrirebul midgomas iyenebdnen. aseTi midgomis ga- danakargi, interpersonaluri konfliqti, socialuri
moyenebisas konsultanti pasiur rolSi imyofeba. is rolis Secvla, interpersonaluri deficiti. Tera-
mcire informacias awvdis pacients da misi interven- pevti, romelic iyenebs problemis gadaWraze mimar-
cia ifargleba komentarebiT klientis gamonaTqvame- Tul midgomas (es midgoma zemoT aRwerilis msgavsia)
bis emociuri Sinaarsis Taobaze. magaliTad, nacvlad aqezebs pacients, rom man ganixilos axleburi gzebi
imisa, rom konsultantma klients moTxovos faqtebSi sirTuleebTan gasamklaveblad da scados maTi gamoy-
sicxadis Setana, man SeiZleba klients aseTi ram uTx- eneba Terapiul seansebs Soris. es meTodi efeqturi
ras: `rogorc Cans, es TqvenSi sibrazes iwvevs~ (grZ- aRmoCnda pacientebTan samuSaod pirveladi jandac-
nobis refleqsia). janmrTelobis dacvis sistemebSi vis doneze. es is pacientebia, romlebsac msubuqi
es teqnika Seicvala ufro fokusirebuli da stru- afeqturi aSliloba axasiaTebT (Klerman et al., 1987).
qturirebuli procedurebiT, romlebic qvemoT iqne- fsiqodinamiuri konsultacia ufro metad imaze
ba ganxiluli. iTvleba, rom mocemuli procedurebi amaxvilebs yuradRebas, Tu rogor moqmedebs warsuli
efeqts ufro swrafad iZleva. Tumca, damoukidebeli gamocdileba amJamindeli qcevis Camoyalibebaze. iTv-
praqtikis mqone zogi konsultanti kvlav iyenebs ara- leba, rom es zegavlena aracnobieri procesebiT aris
direqtiul midgomas. gaSualebuli. mocemuli meTodi Seiqmna obieqtTan
urTierTobis Teoriis zegavleniT, romlis mixedviT,
konsultirebis midgomebi
warsuli urTierTobebi adamianSi Rrma kvals tovebs,
problemis gadaWraze mimarTuli konsultacia kon- rac zemoqmedebs mis TviTSefasebasa da amJamindel
sultaciis Zalze struqturirebuli formaa. is sa- urTierTobebze. garda amisa, iTvleba, rom konsul-
sargebloa pacientebistvis, romelTa problemebi tantze pacientis emociuri reaqciis mixedviT, Cven
aSkarad ukavSirdeba stresul viTarebas. mas pirvel SegviZlia gamovitanoT daskvna im problemebis Ses-
rigSi Semdegi mizezis gamo ganvixilavT: am tipis axeb, romlebic pacients gaaCnia sxva tipis urTier-
konsultacia miesadageba iseT SemTxvevebs, rodesac TobebSi. am saxis konsultacia gamoiyeneba studen-
cxovrebiseuli problemebi xels uwyobs aSlilobis tebistvis gankuTvnil janmrTelobis centrebSi,
gamwvavebas an SenarCunebas. es sakonsultacio teqnika radganac is iTvaliswinebs pirovnebis ganviTarebis
gamoiyeneba kombinaciaSi sistemur midgomasTan pro- Taviseburebebs da kargad ergeba studentebistvis
blemis gadaWris dros. pacients daxmarebas uweven: damaxasiaTebel problemebs. aseTi problemebi uni-
w distresis gamomwvevi problemebis identifikaciasa versitetSi swavlisas iCens Tavs, magram, xSirad, mom-
da CamoTvlaSi; dinareobs im gamocdilebidan, romelic win uswrebs
w iseTi moqmedebis kursis ganxilvaSi, romelmac Sei- studentobis periods. fsiqodinamiuri konsultacia
Zleba gadaWras an Seamciros TiToeuli problema; jekobss aqvs aRwerili (Jacobs, 1988). misi Sefaseba na-
klebad safuZvlianad Catarda wina or midgomasTan
w iseTi problemis an moqmedebis kursis arCevaSi, ro-
SedarebiT.
melic realisturad gamoiyureba, da, savaraudod,
warmatebuli aRmoCndeba; konsultaciis Catareba konkretuli mizniT
w problemis gadaWris mcdelobaTa Sedegebis mimox-
debrifingi
ilvaSi. amis Semdeg xdeba axali problemis SerCeva,
debrifingi gamoiyeneba adamianebTan, romlebmac
Tu wina qmedeba warmatebuli gamodga an moqmedebis
katastrofa gadaitanes. maT konsultanti exmareba
axali kursis SerCeva, Tu wina qmedeba warumatebeli
uaryofiTi gancdebis gamomwvevi movlenebis gaxsene-
aRmoCnda.
baSi. aqcenti gadatanilia emociebisagan gantvirT-
zemoT aRwerili midgoma efeqturi gamodga guneb-
vaze da amJamindel problemebTan gamklavebis strat-
ganwyobis aSlilobis SedarebiT msubuqi formebis
egiebze. klinikuri kvleviT miRebuli monacemebi
samkurnalod. problemis gadaWraze mimarTuli kon-
cxadyofs, rom debrifingi ar aumjobesebs Sedegebs
sultaciis mimoxilvistvis ixileT Mynors-Wallace,
im adamianebTan, romlebic katastrofa gadaitanes. am
2001.
kategoriis populaciasTan ufro sasargebloa kogni-
interpersonaluri konsultaciis avtoria kler-
turi teqnikis gamoyeneba (gv. ??).
mani (Klerman et al., 1987). interpersonaluri konsul-
tacia Seiqmna interpersonalur Terapiaze dayrdno- konsultacia urTierTobaSi problemebis mqone
biT (aRwerilia ?? gv-ze). is bevri niSniT hgavs prob- pirebTan
lemis gadaWraze mimarTul konsultacias. yuradReba am tipis konsultacia exmareba wyvilebs konstruq
gamaxvilebulia amJamindel problemebze urTierTo- ciulad isaubron TavianT urTierTobaSi arsebuli
bis sxvadasxva sferoSi _ ojaxSi, samsaxurSi da sxva. problemebis Sesaxeb. konultaciis procesi iTvali
es problemebi oTx mTavar TemaSi Sedis. es Temebia swinebs imas, rom TiToeul mxares sWirdeba partnioris
_ 622 _
konsultireba da krizisuli intervencia
Tvalsazrisis, moTxovnilebebis da grZnobebis gageba, konsultaciis dagegmva ise unda xdebodes, rom is
da, agreTve, urTierTobis rogorc dadebiTi, ise moergos saswavlo semestrebs da iTvaliswinebdes
konfliqtis gamomwvevi aspeqtebis gaazreba. im faqts, rom studenti universitetSi ar imyofeba
ardadegebis dros. konsultaciis dagegmva gansa
konsultireba glovis dros kuTrebul codnas saWiroebs.
am SemTxvevaSi konsultaciis procesi `mihyveba~
glovis stadiebs (gv. ??) da moicavs garkveuli kom konsultireba pirveladi jandacvis sistemaSi
ponentebis kombinacias. esaa emociebisagan gan pirveladi jandacvis sistemaSi msubuqi fsiqikuri
tvirTvis SesaZlebloba (Sesabamis viTarebaSi brazis aSlilobis mqone pacientebs mkurnalobas utarebs
gamoxtvis CaTvliT); informaciis miwodeba glovis praqtikosi konsultanti, romelsac miRebuli aqvs
normaluri dinamikis Sesaxeb; mgloviare pirovnebis profesiuli ganaTleba, magaram ar aris eqimi, eqTani
waqezeba, raTa man ganaxorcielos saboloo aqti an socialuri muSaki. am tipis konsultantebi iyeneben
(ixilos gardacvlilis sxeuli; Tavidan moiSoros xanmokle mkurnalobis sxvadasxva meTodebs. seansebis
gardacvlili piris tansacmeli); rCevis micema im saSualo raodenoba, Cveulebriv, Svidia, xolo TiTo
praqtikul problemebTan dakavSirebiT, romlebsac seansi, saSualod, 50 wuTi grZeldeba (Sibbad et al.,
adamiani awydeba gardacvlili adamianis gareSe 1996a). miuxedavad imisa, rom pacientebs moswonT
cxovrebisas (konsultaciis gaweva glovis dros am tipis daxmareba, monacemebi misi efeqturobis
ganxilulia ?? gverdze). Sesaxeb calsaxa ar ris (Bower et al., 2003; Chilvers
et al., 2001). agreTve, ar ris garkveuli, ramdenad
konsultaciis gaweva travmis gviandel efeqtTan efeqturia xarjis TvalsazrisiT es midgoma (Friedli et
dakavSirebiT al., 2000). konsultaciaTa umravlesoba, romlebic am
klinikuri gamocdileba imaze miuTiTebs, rom, gamokvlevebSi Seiswavleboda, aradireqtiul meTods
aseT dros, ar aris sasurveli aradireqtiuli da iyenebda. ar aris gamoricxuli, rom problemis ga
arastruqturirebuli midgomis gamoyeneba Semdegi daWraze mimarTuli teqnikis gamoyeneba ufro Se
mizezis gamo: am meTodebiT muSaobam SeiZleba degiani aRmoCndeba (ix. zemoT).
gamoiwvios usiamovno gamocdilebis gaxseneba iseT
pirobebSi, rodesac adamians ar aqvs saSualeba krizisuli intervencia
gaumklavdes am gamocdilebasTan dakavSirebul krizisuli intervencia exmareba pacientebs cxovre
uaryofiT emociebs an ar SeuZlia maTi kognituri biseul krizisTan gamklavebaSi da im xerxebis
gadamuSaveba, rac aucilebel process warmoadgens. daswavlaSi, romlebic maT gauadvilebs momavali sir
am SemTxvevaSi ufro Sesaferisia kognituri da Tuleebis daZlevas. mocemuli midgoma gamoiyeneba
fsiqodinamiuri meTodebis gamoyeneba, magram isini iseTi SemTxvevevbis dros, rogoric urTierTobis
saguldagulod unda daigegmos da specialisti gawyvetaa. mas, agreTve, iyeneben im pirebTan samuSaod,
gawafuli unda iyos maT gamoyenebaSi. romlebmac bunebrivi katastrofa (miwisZvra, wyal
didoba) gadaitanes. Tumca, amJamad, am viTarebaSi,
riskTan dakavSirebuli konsultacia upiratesoba kognitur meTodebs eniWeba (ix. qve
konsultacia riskis Taobaze moicavs konsultacias moT). krizisuli intervenciis meTodi, romelic
genetikuri riskisa da sqesobrivi gziT gadamdebi lindemanisa da kaplanis naSromebidan momdinareobs
daavadebebis Sesaxeb. am SemTxvevaSi konsultanti (Lindemann, 1944; Caplan, 1961), efuZneba kaplanis mier
klients, ZiriTadad, awvdis informacias riskis aRweril krizisTan gamklavebis oTx safexurs:
Sesaxeb, exmareba SesaZlo Sedegebis gaazrebaSi da 1. emociuri agzneba da problemis gadaWris mcdeloba;
imis gadawyvetaSi, Tu romeli reaqcia aris yvelze
2. Tu is uSedego gamodga, agznebis donis mateba, rac
efeqturi.
iwvevs qcevis dezorganizacias;
konsultaciis gaweva studentebistvis 3. gamklavebis gansxvavebuli gzebis gamoyenebis mcd-
universitetebTan arsebobs im studentebistvis eloba;
gankuTvnili sakonsultacio samsaxurebi, romel 4. Tu esec uSedego gamodga, qancgamoleva da dekom-
Tac, Cveulebriv, axasiaTebT SeguebasTan an stres pensacia.
Tan dakavSirebuli aSlilobebi. amis mizezia sa krizisuli intervenciis dros cdiloben, rom pi
universiteto cxovrebidan momdinare zewola (is rovnebis reaqcia pirveli safexuriT Semoifargle-
xSirad ewinaaRmdegeba studentis ojaxur tradi bodes, xolo, Tu pirovnebam specialists daxmarebi-
ciebs), an kidev, sauniversiteto garemos gareT stvis pirveli safexuris gavlis Semdeg mimarTa, maSin
mimdinare urTierTobebiT gamowveuli problemebi. mizans meoTxe stadiistvis Tavis arideba warmoadgens.
_ 623 _
dikamentebi. miuxedavad imisa, rom zogadi principis
cxrili 22.2 krizisuli intervencia Tanaxmad, pacienti Tavad unda daexmaros sakuTar
mkurnaloba myisieria, xanmokle da TanamSromlobaze Tavs, pirvel etapze pacients uweven daxmarebas, mag-
damyarebuli
aliTad, bavSvebis movlis saqmeSi.
I safexuri meore etapze, krizisuli intervencia proble-
mis gadaWraze mimarTul konsultacias mogvagonebs,
w agznebis donis Semcireba
w fokusireba amJamindel problemebze romelic zemoT iyo aRwerili. am etapze guldasmiT
w TviTdaxmarebis stimulacia xdeba pacientis problemebisa da resursebis Sefase-
II safexuri ba. pacients aqezeben, rom man wamoayenos problemis
gadaWris alternatiuli gzebi da amaTSi yvelaze
w problemebis Sefaseba
w problemis gadaWris sxvadasxva variantis ganxilva
perspeqtiuli SearCios. Terapevtis roli pacien-
w problemis gadaWris sxvadasxva variantis gamocda tis waqezebaSi, misi iniciativis stimulaciaSi da
kiTxvebis dasmis gziT mis gaZRolaSi mdgomareobs.
III safexuri
Terapevti Tavad ar ayalibebs problemas da pirda-
w problemis daZlevis im meTodebis ganxilva, pir ar sTavazobs pacients problemis gadaWris gzas.
romlebsac pacienti momavalSi gamoiyenebs
amis nacvlad, is cdilobs, rom pacientma es TviTon
problemebi, romlebsac krizisamde mivyavarT moaxerxos. pacientma unda aRmoaCinos gamklavebis is
meTodebi, romlebic momavali problemebis gadaWri-
es problemebi SeiZleba Semdeg tipebad daiyos:
sas iqneba efeqturi.
w danakargTan dakavSirebuli problemebi, romlebic
moicavs adamianis dakargvas gardacvalebis an mas- rodis aris naCvenebi krizisuli intervencia
Tan daSorebis gamo, sxeulis nawilis dakargvas, an klinikuri gamocdileba gviCvenebs, rom sjobs kri
organos funqciis dakargvas; zisuli intervencia motivirebul adamianebTan gamov-
w roluri cvlileba, rogoricaa gaTxoveba, Svilis iyenoT, romlebsac Sinagani stabiloba axasiaTebT da
yola an axali samuSaos dawyeba, romelic ufro met droebiTi sirTuleebis winaSe dganan. anu, am midgomis
pasuxismgeblobas moiTxovs; gamoyeneba iseT adamianebTanaa naCvenebi, romlebic,
w urTierTobasTan dakavSirebuli problemebi, rom- savaraudod, damoukideblad moaxerxeben TavianTi
lebic SeiZleba aRmocendes seqsualur partnio- problemebis movlas. krizisul intervencias, xSir-
rebs Soris an mSobelsa da Svils Soris; ad, iyeneben ganzrax TviTdazianebis Semdeg, rodesac
TviTdazianeba socialur krizisze gacemul reaqcias
w konfliqtTan dakavSirebuli problemebi, romle-
warmoadgens.
bic, Cveulebriv, gulisxmobs arCevanis gakeTebas
krizisis Teoriis gamoyeneba krizisTan dakavSire-
or arasasurvel alternativas Soris.
buli Terapiuli momsaxurebis gawevisas ganxilulia
krizisuli intervenciis meTodebi Semdeg wyaroSi: Bridget and Polak, 2003.
es meTodebi interpersonaluri konsultaciis (gv.
??) da problemis gadaWraze mimarTuli konsultaci- mxardamWeri fsiqoTerapia
is meTodebis gv. ??) msgavsia, magram, am SemTxvevaSi, mxardamWeri fsiqoTerapia gamoiyeneba distresis Ses-
aqcenti agznebis donis daqveiTebazea gadatanili. amcireblad an sirTuleebis daZlevaSi dasaxmareblad
mkurnaloba krzisis Semdeg rac SeiZleba swrafad (es im SemTxvevaSi, rodesac problemis gadaWraze
iwyeba. mkurnaloba xanmoklea. tardeba ramdenime se- mimarTuli midgoma warumatebelia). mxardamWeri Te-
ansi ramdenime dRis an kviris manZilze. mocemuli rapia gamoiyeneba qronikuli fsiqikuri an somaturi
midgoma TanamSromlobis princips efuZneba. Terapev- daavadebis mqone pacientebTan da momakvdav pacien-
ti cdilobs, maqsimalurad CarTos pacienti (da, Tuki tebTan (gv. ??). mxardamWer Terapias mxolod maSin
es SesaZlebelia, misi megobrebi da ojaxis wevrebi) mimarTaven, rodesac Carevis aqtiuri formebis gamoy-
mkurnalobis procesSi. yuradReba mimarTulia amJa- eneba uSedegoa an rodesac dabalia maTi warmatebuli
mindel problemebze, Tumca, mniSvnelovania warsuli gamoyenebis albaToba.
movlenebis gaTvaliswinebac. krizisSi myof pacients mxardamWeri Terapia efuZneba fsiqologiuri mkur
emociuri agznebis maRali done axasiaTebs, rac xels nalobistvis saerTo elementebs (boqsi 22.2). misi mTa-
uSlis problemis gadaWraSi. amitom, upirvelesi amo- vari elementebia Terapiuli urTierToba, mosmena,
canaa agznebis xarisxis Semcireba. Cveulebriv, es mi- emociebisagan gantvirTvistvis xelsayreli pirobebis
iRweva pacientis damSvidebiT da emociuri gantvirT- Seqmna, axsna-ganmarteba, imedis micema da darwmuneba.
vistvis Sesaferisi pirobebis SeqmniT. Tumca, zogjer, es komponenetebi qvemoT mokled iqneba ganxiluli.
ramdenime dRis manZilze iniSnaeba anqsiolizuri me-
_ 624 _
interpersonaluri fsiqoTerapia
w Terapiuli urTierToba gamoiyeneba pacientis mxar ganxilva da pacientis waqezeba, raTa man gamoiyenos
daWeris mizniT. mniSvnelovania, aviciloT pacentis resursebi da SesaZleblobebi, romlebic jer kidev
mijaWvuloba Terapevtze, radgan mkurnaloba, aqvs darCenili.
xSirad, xangrZlivia. Tu pacienti Zalze mowyvladia w darwmuneba. mxardamWeri mkurnalobisas Tavad pa
an naklebad damoukidebel pirovnebas warmoadgens, cientma unda gadawyvitos, Tu romel qmedebas ga
es, SesaZloa, Zneli gansaxorcielebeli iyos. naxorcielebs, situaciis sakuTari aRqmidan gamom
Tu Terapevtze pacientis mijaWvulobas ver avi dinare. miuxedavad amisa, zogjer marTebulia,
cilebT, umjobesia, Tu mas damokidebuls gavxdiT rom eqimma gamoiyenos darwmunebis teqnika, raTa
specialistTa jgufze, romelsac pacientze mzrun daexmaros pacients swori nabijis gadadgmaSi
veloba daekisreba, da ara romelime erT pirovnebaze. (magaliTad, gaagrZelos sirTuleebTan gamklaveba
sxvaze damokidebulebis riski mcirdeba, rodesac viTarebis droebiTi gauaresebis miuxedavad).
pacientTan Tavidanve vTanxmdebiT, Tu ramden dros
ar aris aucilebeli, rom mxardamWeri Terapia
davuTmobT mxardamWer Terapias.
yovelTvis samedicino sferos warmomadgenlis mier
w mosmena. fsiqologiuri mkurnalobis nebismieri tardebodes. TviTdaxmarebis jgufebi mniSvnelovan
formis dros, pacienti unda grZnobdes, rom Te daxmrebas uweven zogierT pacients da mis naTesavebs.
rapevti mas maqsimalurad uTmobs yuradRebas, rom zogjer aseTi daxmareba ufro efeqturia, vidre eqi-
igi TanagrZnobas iCens mis mimarT da seriozulad mis mier gaweuli daxmareba, radganac is iseTi adamian-
ekideba imas, rac pacients awuxebs. ebisagan momdinareobs, romlebic, pacientis msgavsad,
w rCeva da informaciis miwodeba Zalian mniSvnelo cdilobdnen sirTuleebTan gamklavebas. mxardamWeri
vania, Tumca is, Tu ramdeni dro unda davuTmoT am mkurnaloba ganxilulia Semdeg wyaroSi: Bloch , 1986.
procedurebs, guldasmiT unda iyos gansazRvruli.
pacients yovelTvis unda mivawodoT zusti interpersonaluri fsiqoTerapia
informacia, magram ar aris aucilebeli, rom mas
interpersonaluri fsiqoTerapia Seiqmna, rogorc
yvelaferi pirvelive seansze ganvumartoT. paci
struqturuli fsiqologiuri mkurnaloba, romelic
entebTan, romelTac aqvT seriozuli da ukurnebeli
depresiuli pacientebis interpersonaluri prob
daavadeba, SeiZleba umjobesi iyos informaciis
lemebis mogvarebazea mimarTuli (Klerman et al.,
TandaTanobiT miwodeba. ase isini SeZleben infor
1984). Tumca, am meTods ufro farTo gamoyenebac
maciasTan nawil-nawil gamklavebas iqamde, sanam
gaaCnia. is SegviZlia gamoviyenoT iseTi aSlilobebis
mTlianobaSi gaiazreben TavianT problemas. pa
samkurnalod, romelTa drosac msgavsi problemebi
cientebis umravlesoba pirdapiri an arapirdapiri
qcevis SenarCunebas uwyobs xels (magaliTad, kvebiTi
gziT migvaniSnebs imaze, Tu informaciis ra odenoba
aSliloba). interpersonaluri Terapiis aRwerisas,
unda mivawodoT maT TiToeul jerze.
ufro metad amaxvileben yuradRebas mis mier gamo
w emociebisagan gantvirTva sasargebloa mxardamWeri yenebul midgomaze da ara teqnikaze, romelsac sxva
mkurnalobis adreul etapze. Tumca, emociebisagan tipis fsiqoTerapiis drosac moixmaren.
xSiri gantvirTva, savaraudod, ar aris sasargeblo, mkurnaloba mkacrad struqturirebulia. seansebis
garda iseTi SemTxvevisa, rodesac aRmocendeba raodenoba da xangrZlivoba winaswar igegmeba. inter
axali problema (magaliTad, fizikuri daavadeba, personaluri problemebi Semdegi oTxi kategoriis
romelic TandaTanobiT progresirebs). farglebSi ganixileba:
w imedis micema mniSvnelovania, magram pacientis w mZime da sxva saxis danakargi
naadrevma an usafuZvlo damSvidebam SeiZleba Se
w roluri konfliqti
aryios misi ndoba specialistis mimarT. pacienti
w axali rolis miReba
mxolod maSin unda davamSvidoT, rodesac misi
sawuxari bolomdea gagebuli. ra Tqma unda, pa
cientis damSvideba safuZvels ar unda iyos
cxrili 22.3 mxardamWeri Terapiis
ZiriTadi procedurebi
moklebuli da is pacientebi, romlebic aRmoaCenen,
rom maT atyueben, kargaven ndobas Terapevtis w Terapiuli urTierTobis damyareba
mimarT, xolo mxardamWeri Terapia swored ndobazea w pacientis problemebis mosmena
dafuZnebuli. rodesac pacienti svams kiTxvebs w informireba, axsna da rCevis micema
prognozis Sesaxeb, Terapevts SeuZlia mas yvela w emociis gamoxatvisaTvis pirobebis Seqmna
SesaZlo Sedegi dausaxelos, yvelaze optimisturi w imedis micema
Sedegis CaTvliT. urTulesi problemebis drosac w resursebis gadaxedva da ganviTareba
ki aris SesaZlebeli situaciis pozitiuri kuTxiT w TviTdaxmarebis waxaliseba
_ 625 _
w ìnterpersonaluri deficiti~, rogoricaa, magali kognitur-biheviorul Terapias, ainteresebs is
Tad, martooba. faqtorebic, romlebic axdens simptomebis an ano
problemebi ganixileba konkretuli situaciebis maliuri qcevis provocirebas. aseTi faqtorebi
magaliTze. Terapiis dros fasdeba maTi daZlevis yvelaze aSkarad Tavs fobikuri aSlilobis dros
alternatiuli gzebi, isaxeba mkafio miznebi da iCens, Tumca isini aseve mniSvnelovani, magram
tardeba maTi (miznebis) miRwevis monitoringi. saSinao naklebad TvalsaCinoa sxva saxis aSlilobebis
davalebis Sesrulebisas pacientma unda mosinjos drosac. magaliTad, nervuli bulimiis dros Warbi
gamklavebis axali strategiebi. mkurnalobis Sua kvebis epizodebi SeiZleba provocirebuli iyos iseTi
etapze, zemoTCamoTvlil problemaTa oTxi kate situaciebiT, romlebSic pacienti arasrulfasovnad
goriistvis, specifikur meTodebs iyeneben. glovisa ganicdis Tavs. aSlilobis yvelaze gavrcelebuli
da sxva tipis danakargis SemTxvevaSi gamoiyeneba SemanarCunebeli faqtori ganridebaa. is gansakuT
meTodebi, romelTa msgavsic glovis dros gaweuli rebiT mniSvnelovania fobikuri da SfoTviTi aSli
konsultaciis dros aris aRwerili (gv. ??). inter lobebis dros, radganac xels uSlis SfoTviTi re
personaluri konfliqtis dros, pacientebs aqciis Caqrobas. mravali qcevis SenarCunebas qce
exmarebian, rom maT zustad gansazRvron konfliqtis vis Sedegebi ganapirobebs. magaliTad, SfoTvis
Tema, iseve, rogorc gansxvavebebi sakuTar da meore maprovocirebeli situaciidan gaqcevas mohyveba
adamianis Rirebulebebs Soris. maT exmarebian meore SfoTvis Sesusteba, rac ganamtkicebs fobikur gan
pirTan molaparakebebis warmoebaSi da, agreTve, imis ridebas. intensiuri yuradReba qcevis kidev erTi
danaxvaSi, Tu Tavad ra wvlili Seitana pacientma im Zlieri ganmamtkicebelia. magaliTad, bavSvis xmau
problemebis warmoqmnaSi, romelsac meore adamians riani da umarTavi qceva ganmtkicdeba, Tu mSoblebi
miawers. msgavsi saxiT xdeba axali rolis miRebasTan bavSvs ufro met yuradRebas maSin aqceven, rodesac
dakavSirebuli problemebis movla. interpersonaluri is amgvarad iqceva, vidre rodesac is kargad iqceva
deficitis ganxilva, amJamad, arsebuli urTierTobis da mSvidad aris.
problemebis gaanalizebiT xdeba. agreTve, analizs zogadad, kognituri Terapia yuradRebas amaxvi
eqvemdebareba pacientis winare mcdeloba, romelic lebs azrovnebis or tipze: intruziul azrebze
problemuri urTierTobis gadaWraze iyo mimarTuli. (àvtomatur azrebze) da disfunqciur rwmenebsa
mimdinareobs alternativebis ganxilva. ori an sami da damokidebulebebze (`disfuqnciuri daSvebebi~).
saboloo seansis dros, pacientebs exmarebian winaswar intruziuli azrebi axdens myisieri emociuri reaqciis
ganWvriton momavali problemebi da ifiqron imis (Cveulebriv, SfoTvis an depresiis) provocirebas.
Sesaxeb, Tu rogor aris maTi daZleva SesaZlebeli. disfunqciuri rwmenebi da damokidebulebebi gansaz
ramdenime klinikurma gamokvlevam aCvena, rom Rvravs imas, Tu rogor aRiqmeba situacia da rogor
interpersonaluri Terapia efeqturia depresiuli moxdeba misi interpretacia.
aSlilobis mqone mozard da zrdasrul pacientebTan iTvleba, rom arsebobs sami faqtori, romelic
(Mufson, 2004), agreTve, disTimiis (Markowitz, 2003) da xels uwyobs disfunqciuri rwmenebisa da damo
nervuli bulimiis dros. intrepersonaluri Terapiis kidebulebebis SenarCunebas:
mimoxilvistvis ixileT Blanco, Weissman, 2005. 1. seleqciuri yuradReba. yuradRebis miqceva im
informaciistvis, romelic adasturebs adamianis
kognitur-bihevioruli Terapia rwmenebsa da damokidebulebebs da iseTi informaciis
ignorireba da gauTvaliswinebloba, romelic
yvela fsiqikur aSlilobas gaaCnia kognituri da
ewinaaRmdegeba maT. magaliTad, socialuri fobiis
qceviTi komponenti. pacientis gamojanmrTeleba
mqone pacienti ufro met yuradRebas aqcevs sxvebis
am komponentebis Secvlas saWiroebs. sxva saxis
kritikul qcevas, vidre im miniSnebebs, romlebic
mkurnalobisas cvlileba arapirdipiri gziT xor
mowonebasa da mimReblobas gamoxatavs.
cieldeba. magaliTad, guneb-ganwyoba umjobesdeba
antidepresantebiT mkurnalobis Sedegad, an mocemuli 2. alogikuri azrovneba, romelic ramdenime saxiT
aSlilobis warmoSobis ukeT gagebis Sedegad, rac mJRavndeba. informacia sami tipis alogikuri
fsiqoTerapiiT miiRweva. amis sapirispirod, kog azrovnebis Sesaxeb mocemulia boqsSi 22.3.
nitur-bihevioruli Terapia uSualod cvlis qcevas da 3. usafrTxoebis Ziebaze mimarTuli qceva. es qceva
kognicias. dinamiuri fsiqoTerapiisagan gansxvavebiT, imis gamo xorcieldeba, rom pirovnebis rwmeniT,
mas ar ainteresebs is, Tu ra saxiT ganviTarda is amcirebs uSualo safrTxes, magram aseTi qceva
aSliloba warsuli movlenebidan. amis nacvlad, xels uwyobs problemebis SenarCunebas. magaliTad,
aqcenti gadatanilia im faqtorebze, romlebic xels pacientma, romelsac eSinia, rom guli wauva panikis
uwyobs mkurnalobis dros aSlilobis SenarCunebas. Setevis dros, SeiZleba SfoTvis gancdisas yovelTvis
_ 626 _
boqsi 22.3 alogikuri azrovnebis boqsi 22.4 agorafobiis mqone pacientis

magaliTebi Canaweri qceviTi eqsperimentis Sesaxeb
zegeneralizacia. pacientebs gamoqvT zogadi daskvnebi situacia: sayidlebze wasvla xalxmraval supermarketSi.
calkeuli SemTxvevebidan (magaliTad, mas me ar vuyvarvar,
ese igi aravis arasodes Sevuyvardebi); Cemi prognozi: panikaSi Cavvardebi da Tavbru damexveva.
guli wamiva, Tu ar davZabav muclis kunTebs da Rrmad ar
seleqciuri abstraqcia. pacientebi yuradRebas amax visunTqeb.
vileben situaciis erT uaryofiT aspeqtze da ugu
lebelyofen mis dadebiT aspeqtebs. eqsperimenti: SfoTvis dros ar daZabo muclis kunTebi da
Rrmad ar isunTqo.
personalizacia. pacientebi adanaSauleben sakuTar Tavs
sxva adamianebis qcevis Sedegebis gamo. Sedegi: saSinel panikaSi Cavvardi. Tavbru damexva, magram
Cveulebrivze naklebad. guli ar wamsvlia.
`yvelaferi an araferi ~. pacienti xedavs situacias Sav-
TeTr ferebSi. (magaliTad, adamiani an mTlianad kargia an ra viswavle: guli ar wamsvlia, miuxedavad imisa, rom
mTlianad cudi, nacvlad imisa, rom masSi kargi da cudi saSinel panikaSi Cavvardi da araferi gamikeTebia
Tvisebebis nazavi dainaxos). imisaTvis, rom amecilebina gulis wasvla. rogorc Cans
vcdebi, rodesac vfiqrob, rom guli wamiva yovelTvis,
roca ki panikaSi Cavvardebi. garda amisa, daZabuloba da
daZabos kunTebi im imediT, rom amiT gulis wasvlas Rrma sunTqva SeiZleba ar iwvevs im efeqts, romelic me
airidebs. miuxedavad imisa, rom pacients guli ar mgonia. SesaZloa Cemi Terapevti swored miiCnevs, rom
Rrma sunTqvis gamo kidev ufro mexveva Tavbru.
wasvlia panikis mravali Setevis dros, is mainc
ra unda gavakeTo Semdeg jerze: gavimeoro eqsperimenti
darwmunebulia, rom amis mizezi mxolod da mxolod Semdeg jerze sayidlebze wasvlisas.
kunTebis daZabvaa. Sesabamisad, mas kvlav eSinia, rom
SeiZleba, momavalSi, guli wauvides. 22.4 mocemulia qceviTi eqsperimentis magaliTi.
rCevebi qceviTi eqsperimentis dizainis Taobaze mo-
kognitur-bihevioruli Terapiis zogadi cemulia Semdeg wyaroSi: Bennet-Levy et al., 2004.
maxasiaTeblebi w mkacrad struqturirebuli seansebi. TiToeul se-
kognitur-bihevioruli Terapia Semdegi niSnebiT xa- ansze xdeba ganrigis SeTanxmeba da imis ganxilva,
siaTdeba: Tu ra progresi iqna miRweuli bolo seansis Semdeg.
w pacienti aqtiuri partnioria. pacienti mkurnlo- garda amisa, ganixileba nebismieri saSinao davale-
bisas aqtiur rolSi imyofeba, Terapevti ki mrCev- ba. ganixileba axali Temebi, igegmeba Semdegi kviris
elis da eqspertis rolSi, romelic svams kiTxvebs, davaleba da jamdeba seansis mTavari punqtebi.
sTavazobs pacients informacias da uZRveba mas. w progresis monitoringi. progresi ar fasdeba mx-
w yuradRebis gamaxvileba maprovocirebel da Seman- olod pacientis verbalur angariSze dayrdnobiT.
arCunebel faqtorebze. pacienti yovel dRe awarmo- is, agreTve, gulisxmobs pacientis yoveldRiri
ebs dRiurs, raTa daadginos is faqtorebi, romle- Canawerebis Semowmebas da, zogjer, Sefasebis form-
bic win uZRvis an mosdevs aSlilobas, an romlebic aluri skalis gamoyenebas.
axdens mis provocirebas an xels uwyobs mis Senar- w xSirad gamoiyeneba mkurnalobis saxelmZRvanelo,
Cunebas. zogjer, aseT midgomas ABC midgomas uwo- sadac aRwerilia Sesabamisi procedurebi da maTi
deben, sadac A aRniSnavs `winmswrebs~ (antencedent) B gamoyenebis wesi. saxelmZRvanelos arseboba uzrun-
_ `qcevas~ (behaviour), xolo C _ `Sedegs~ (consequence). velyofs imas, rom sxvadasxva klinicistebis mier
w yuradRebis gamaxvileba azrovnebis stilze. iseTi gamoyenebuli procedurebi axloa im procedurebT-
azrebis dafiqsireba, romlebic dakavSirebulia an, romlebic klinikuri gamokvlevebis mixedviT
qceviT an emociur darRvevebTan, situaciebTan, sa- efeqturadaa Sefasebuli.
dac es azrebi iCens Tavs da Tanmxleb guneb-ganwyo-
basTan. gamokvleva kognitur-bihevioruli
Terapiis Catarebisas
w mkurnaloba, rogorc gamokvleva. Cveulebriv, Ter-
apiuli procedurebi warmodgenilia eqsperimentis Temebi, romlebsac unda Seexos Terapiis procesi
saxiT. maSinac ki, rodesac es procedurebi ver aum- fsiqikuri daavadebis sruli anamnezis Sekrebis gar-
jobesebs pacientis mdgomareobas, isini exmareba pa- da, Terapevti moipovebs informacias garkveuli
cients ufro meti Seityos sakuTari mdgomareobis Temebis irgvliv (cxrili 22.4). pacientis TiToeul
Sesaxeb. problemasTan dakavSirebiT is moipovebs informa-
w saSinao davaleba da qceviTi eqsperimenti. pacienti cias winmswrebi movlenebis, pacientis qcevisa da
varjiSobs axali qcevis SesrulebaSi TerapevtTan misi Sedegebis Sesaxeb (ABC midgoma, romelic zemo-
erTad an atarebs eqsperiments Terapevtis mier Taa aRwerili). aRsaniSnavia, rom termini `qceva~ aq
SemoTavazebuli ganmartebis Sesamowmeblad. boqsSi farTo mniSvnelobiT gamoiyeneba da qmedebis garda,
_ 627 _
gansakuTrebuli saxis interviuireba. miuxedavad

cxrili 22.4 Temebi, romlebic unda
imisa, rom zogi pacienti acnobierebs sakuTar
gaviTvaliswinoT kognitur-bihevioruli
araadaptur qcevebs da SeuZlia maTi aRwera, maT
Terapiis Catarebisas
amaSi daxmareba mainc unda gavuwioT. safexurebrivi
1. TiToeuli problemis aRwera emociebis, azrebisa da
gamokiTxva (Laddering) aris teqnika, romelic am mizans
qcevis TvalsazrisiT
w sad iCens Tavs is yvelaze xSirad emsaxureba. am dros pacients TanmimdevrobiT usvamen
w movlenebi, romlebic, Cveulebriv, win uswrebs qcevas kiTxvebs. TiToeuli kiTxva exeba wina kiTxvaze
w pacientis reaqcia am movlenebze gacemul pasuxs. magaliTad, kvebiTi aSlilobis
w ra mosdevs problemas mqone pacients SegviZlia davusvaT aseTi kiTxva:
2. faqtorebi, rolebic amsubuqebs an amZimebs problemas
`ra moxdeba, Tu wonaSi isev moimatebT?~ pacientma
SeiZleba upasuxos, rom is megobrebs dakargavs.
3. SemanarCunebeli faqtorebi
kiTxvaze `ratom~, man SeiZleba gvipasuxos: ìmitom,
w ganrideba
rom maT aRar movewonebi~. Semdeg `ratom~ kiTxvaze
w usafrTxoebis qceva (ix. teqsti)
w seleqciuri yuradReba
sapasuxod, man SeiZleba Tqvas, rom mxolod gamxdari
w azrovnebis stili adamianebi arian mimzidveli da popularuli.
w sxva adamianebis reaqcia
formulireba
azrovnebasa da emociebs moicavs. ramdenime prob- zemoT aRwerili saSualebebis gamoyenebiT miRe
lemasTan dakavSirebiT ABC Tanmimdevrobis gaTval- buli informacia gamoiyeneba fsiqiatriuli aSli
iswinebis Sedegad, SesaZlebeli xdeba azrovnebisa da lobis istoriasTan erTad garkveuli punqtebis for
reaqciis ganmeorebiTi, regularuli paternebis iden- mulirebis mizniT. es punqtebia:
tificireba. mkvlevars, upirveles yovlisa, aintere- w simptomebis maprovocirebeli movlenebis tipi (mag-
sebs is mizezebi, romelTa gamoc pacients swored aliTad, saubris dawyeba);
aseTi rwmenebi axasiaTebs, radganac am tipis codna
w am movlenebis gansakuTrebuli niSnebi (magaliTad,
arsebiTi mniSvnelobisaa imis dasagegmad, Tu rogor
imave asakis mamakacTan saubari);
unda moxdes pacientis gamocdilebis organizeba misi
axlandeli rwmenebis uaryofisa da Secvlis mizniT. w warsuli gamocdilebis faqtorebi (magaliTad, zed-
metad mkacri mSoblebi);
informaciis wyaroebi, romlebsac gamokvlevisas w SemanarCunebeli faqtorebi _ ganrideba, usafrT-
iyeneben xoebaze mimarTuli qceva da azrovnebis stili.
TviT-monitoringi. pacientebi afiqsireben TavianT is, Tu rogor moxdeba punqtebis formulireba,
azrebs, qcevasa da maTTan dakavSirebul faqtorebs mocemuli aSlilobis kognituri modeliTaa gansaz-
dReebisa da kvirebis manZilze. Canawerebis gakeTeba Rvruli (magaliTad, panikuri aSlilobis kognituri
xdeba uSualod movlenis Semdeg, raTa pirovnebas modeliT. ix. gv. ??). Terapevti ganixilavs formu-
ar daaviwydes mniSvnelovani detalebi. Canawerebi, lirebebs pacientTan erTad da, SesaZlebelia, maTze
Cveulebriv, organizebulia cxrilis saxiT, romelic dayrdnobiT agebs sqemas. aseTma sqemam SeiZleba qa-
svetebad aris dayofili. emociebTan, azrebTan da Raldze an dafaze daxazuli diagramis saxe miiRos.
qcevasTan dakavSirebuli Canawerebi keTdeba Sesabamis formulirebebi, saWiroebisamebr, icvleba pacient-
svetSi. amasTanave, aRiniSneba yoveli dRe da saaTi Tan diskusiidan gamomdinare.
TiToeul movlenasTan mimarTebaSi. aRiricxeba is
movlenebi, romlebic uSualod win uZRvis problemas, bihevioruli teqnika
romlebic fiqsirdeba problemis dros da, agreTve,
arsebobs mravali bihevioruli teqnika. amaTgan, zo-
mis Semdeg.
gierTi, romelime konkretuli aSlilobistvis gaoi-
dakvirvebis warmoeba Terapiuli seansebis dros.
yeneba (mag., Ramis enurezisTvis. ix. gv. ??), zogi ki
pacientebs sTxoven im situaciebis warmodgenas,
sxvadasxva saxis aSlilobistvis (magaliTad, eqspo-
romlebSic warmoiSveba problema. maT unda moaxsenon
ziciis teqnika. ixileT qvemoT). aq Cven aRvwerT Se-
Terapevts Tanmxlebi azrebisa da emociebis Sesaxeb.
darebiT gavrcelebul meTodebs. TiToeuli meTodis
garda amisa, aRiricxeba is simptomebi, romlebic hgavs
efeqturoba konkretuli aSlilobis dros ganixileba
pacientistvis damaxasiaTebeli aSlilobis simptomebs
qveTavSi Sesabamisi aSlilobis Sesaxeb.
(magaliTad, panikisTvis damaxasiaTebeli simptomebi,
romlebic hiperventilaciiTaa gamowveuli) da ma treningi relaqsaciaSi
Ti Tanamdevi azrebi da emociebi. aseTi teqnika ga es aris umartivesi bihevioruli teqnika. is, ZiriTa-
moiyeneba panikuri aSlilobis mkurnalobisas (gv. ??). dad, efeqturia qvezRurblovani SfoTvis, strestTan
_ 628 _
dakavSirebuli aSlilobis (magaliTad, pirveladi in- qtia. isini isea SerCeuli, rom SfoTva Tanabari
somniis) (Vienes et al., 2003) da msubuqi hipertenziis intensivobiT izrdeba yovel momdevno situacias-
dros (Young and Keltner, 2000). am meTodis sawyis ver- Tan erTad. Tu es amocana rTuli gansaxorciele-
siaSi, romelsac progresuli relaqsacia ewodeba, pa- belia, maSin xdeba SfoTvis garkveuli stimulebis
cients avarjiSeben kunTebis calkeuli jgufebis re- (punqtebis) mier gamowveuli SfoTvis intensivobis
laqsaciaSi da sunTqvis regulaciaSi (Jacobson, 1938). xarisxis adaptacia garkveuli faqtorebis Semota-
imis gamo, rom progresuli relaqsacia did dros niT, romlebic SfoTvis intensivobis modifikacias
moiTxovs, gamoiyeneba relaqsaciis ufro martivi me- ganapirobeben. magaliTad, situaciaze SfoTviTi
Todebi (Bernstein and Borkovec, 1973; st, 1987b). ukana- reaqcia SeiZleba Semcirdes, rodesac pirovneba iq
saknel wyaroSi relaqsacia aRwerilia, rogorc xan- vinmes TanxlebiT imyofeba. zogjer SfoTvis mapro-
mokle, magram intensiuri teqnika, romelic SemuSavda vocirebeli situaciebi imdenad mravalferovania,
SfoTviTi aSlilobis samkurnalod da romlis gamoy- rom maTgan SeuZlebelia saerTo ierarqiis Seqmna.
enebamac kargi Sedegebi aCvena (Ost and Breitholz, 2000). magaliTad, agorafobiis mqone pacients SeiZleba
relaqsaciis nebismieri meTodis swavla SesaZlebelia silamazis salonSi misvlis, kinoSi wasvlis da mSo-
firze Cawerili instruqciebis gamoyenebiT an jgu- belTa krebaze daswrebis eSinodes. aseT SemTx-
furad. orive meTodi amcirebs Terapevtis dros, ro- vevaSi, unda veZioT am samis gamaerTianebeli SiSi;
melsac is relaqsaciaSi pacientis trenings andomebs. magaliTad, SiSi, romelic ukavSirdeba situaciidan
relaqsaciaSi varjiSi regularulad unda xdebodes gamosvlis (an situaciaSi Sesvlis) uunarobas ux-
treningis seansebs Soris. Zalian cota pacienti axer- erxulobis gancdis gareSe. rodesac SeuZlebelia
xebs xangrZlivi drois ganmavlobaSi saWiro varjiSe- saerTo Temis gamonaxva, xdeba ori ierarqiis ageba.
bis sistematurad Sesrulebas. 2. ierarqiaSi waromodgenil realur an warmosaxul
situaciaSi SesvlaSi, sanam pacienti amas SfoTvis
eqspoziciis teqnika
gareSe moaxerxebdes.
eqspozicia gamoiyeneba ganridebis qcevis Sesamci-
3. relaqsaciis gamoyenebaSi realur situacaSi Sesv-
reblad, gansakuTrebiT, fobikuri aSlilobis dros.
lisas an misi warmodgenisas, raTa Semcirdes SfoT-
martivi fobiebis SemTxvevaSi, xSirad, sakmarisia
viTi reaqcia da warmosaxuli situacia ufro cocx-
mxolod eqspoziciis teqnikis gamoyeneba, xolo sxva
ali gaxdes.
saxis fobikuri aSlilobebisas, mas, Cveulebriv, ko-
gnitur procedurebTan kombinaciaSi iyeneben (ix. gv. 4. ierarqiis TiTo punqtTn dakavSirebuli procedu
??). eqspoziciis gamoyeneba SesaZlebelia SfoTvis rebis ganmeorebaSi.
aRmZvrel realur situaciebSi da warmosaxul situa- rodesac praqtikulad rTulia realur situacias-
ciebSi. meore SemTxvevaSi pacientma sakmarisi sicxa- Tan pacientis dapirispireba (magaliTad, frenis fo-
diT unda warmoidginos fobiis aRmZvreli situacie- biis dros), gamoiyeneba desensitizacia warmosaxul
bi, raTa maT pacientSi SfoTva gamoiwvion. eqspozicia situaciaSi. ise ki, eqspozicia realuri situaciisad-
SeiZleba iyos TandaTanobiTi da intensiuri. pirvel mi, zogadad, ufro efeqturia.
SemTxvevaSi is iwyeba susti SfoTvis aRmZvreli situa-
ciebiT. TandaTanobiT xdeba sul ufro Zlieri SfoT- situaciaSi daZirva
vis aRmZvreli situaciebis Semotana. eqspoziciis situaciaSi daZirvis dros pacienti Sedis ierar-
teqnikis am variants desensitizacia ewodeba. meore qiis umaRles wertilTan axlomdebare situaciaSi
versias, sadac eqspozicia Tavidanve Zlieri stimule- mkurnalobis procesis dasawyisSive da rCeba am si-
biT iwyeba, daZirva an implozia ewodeba. praqtikaSi, tuiaciaSi iqamde, sanam SfoTva Semcirdeba. procesi
Cveulebriv, ar iyeneben ukiduresad sust an intensi- meordeba maqsimalur stimulTan axlo myofi yvela
ur situaciebs. pacients, rogorc wesi, apirispireben stimulis SemTxvevaSi. radgan es procedura mraval
saSualo intensivobis situaciebs da am situaciebis pacientSi iwvevs distress da Sedegebi ar aCvenebs mis
`miwodebac~ saSualo tempiT xdeba. es exeba rogorc upiratesobas desensitizaciis procedurasTan Se-
realur, ise warmosaxul situaciebs. darebiT, daZirvis teqnika iSviaTad gamoiyeneba.
desensitizacia eqspoziciis gamoyeneba yoveldRiur praqtikaSi

desensitizaciis gamoyenebisas pacients exmarebian: mkurnaloba eqspoziciis teqnikis gamoyenebiT, Cveu-
1. ierarqiis agebaSi, anu pacientma unda Seadginos lebriv, xorcieldeba iseTi intensivobis stimulebis
situaciebis CamonaTvali, romlebic dalagebu- da maTi miwodebis iseTi tempis pirobebSi, romelic
lia zrdadi TanmimdevrobiT SfoTvis gamowvevis desensitizaciasa da daZirvas Soris imyofeba. se-
TvalsazrisiT. CamonaTvalSi, Cveulebriv, 10 pun- ansebi, daaxloebiT, 45 wuTi gastans. pacienti Sedis
_ 629 _
saSiS situaciaSi yovel dRe an marto, an naTesavTan obsesiuri azrebis dros gamoiyeneba (Sewyvite fiqri),
da megobarTan erTad. Cveulebriv, SfoTva sustdeba qvemoTaa aRwerili yuradRebis gadatanis teqnikisad-
yoveli eqspoziciis Semdeg. Tu ase ar xdeba, mizezi mi miZRvnil paragrafSi (gv. ??).
SeiZleba iyos mkurnalobis dawyeba ierarqiis zedme-
varjiSi socialuri unar-Cvevebis SemuSavebaSi
tad maRal safexurze. amis gamo mkurnaloba xelaxla
unda daviwyoT ierarqiis ufro dabali safexuridan. socialuri qcevis zogierTi aspeqti ganixileba unar-
zog pacientTan progresi ar SeiniSneba, radgan isini Cvevad, romlis daswavlac SesaZlebelia (mag., mxedv-
varjiSisas SfoTvis aRmZvreli situaciebis nacvlad elobiTi kontaqtis damyareba an saubris dawyeba). am
sxva rameze fiqroben. Tu pacienti moaxerxebs aseTi tipis unar-Cvevebis gaumjobeseba SesaZlebelia mod-
TavdacviTi qcevistvis Tavis aridebas, Cveulebriv, elirebis, varjiSis, rolebis gaTamaSebisa da videos
progresi, SesamCnevi xdeba. meSveobiT ukukavSiris miRebiT. treningi, ZiriTadad,
sasargebloa im pirebistvis, romlebsac uWirT adamian-
eqspozicia reaqciis prevenciasTan erTad ebTan urierToba. is, agreTve, warmoadgens qronikuli
mocemuli saxis mkurnaloba obsesiuri ritualebis fsiqikuri aSlilobis mqone adamianebistvis gankuT-
dros gamoiyeneba. procedura emyareba im dakvirve- vnili ufro farTo sareabilitacio programis nawils.
bas, rom ritualis Sesrulebis impulsi mcirdeba,
Tu adamiani Tavs Seikavebs misi Sesrulebisagan ufro treningi asertuli qcevis ganxorcielebaSi
xangrZlivi drois manZilze (daaxloebiT, erTi saaTis am tipis treningi socialuri unar-Cvevebis Se-
ganmavlobaSi). es procedura Semdegi safexurebisagan muSavebis treningis nawilia da gamoiyeneba im adami-
Sedgeba: anebTan, romelTac uWirT asertuli qcevis ganxor-
1. Terapevti uxsnis pacients mkurnalobis arss da cieleba. pacientebis mier xdeba iseTi socialur kon-
uTanxmebs misaRwev miznebs. mizans SeiZleba war- taqtebis gaTamaSeba, sadac Sesaferisia zomieri aser-
moadgendes `dabinZurebuli~ sagnis, (magaliTad, tulobis gamovlena (magaliTad, situacia, rodesac
saxeluris) Sexeba da xelis dabanvisagan Tavis Se- gamyidveli myidvels ar aqcevs yuradRebas, radgan
kaveba Semdegi erTi saaTis manZilze. ufro rTul WoraobiTaa garTuli). sxvadasxva teqnikis kombinaci-
amocanas SeiZleba warmoadgendes xelebis dabana mx- is meSvebiT (daswavla, modelireba, rolebis gacvla)
olod mas Semdeg, rac pacienti daasufTavebs mTel pacients exmareba gaivarjiSos Sesabamisi verbaluri
saxls. pacienti darwmunebuli unda iyos imaSi, rom da araverbaluri qcevebis ganxorcielebaSi da aser-
is TerapevtTan SeaTaxmebs TiToeul amocanas da tulobis im xarisxis SefasebaSi, romelic sxvadasxva
rom isini ar gadaawydebian moulodnel situacias. situaciistvis aris Sesaferisi. mocemuli teqnika aR-
werilia patersonis mier (Paterson, 2000).
2. Terapevts, SesaZloa, dasWirdes eqsozciis demon-
strireba skuTari Tavis magaliTze. am proceduras brazis marTva
modelireba ewodeba. socialuri unar-Cvevebis SemuSavebis treningis am
3. Tavidan Terapevti Tan axlavs pacients da amxnevebs formis gamoyenebisas, pacients exmarebian:
mas, rodesac pacienti cdilobs ritualis Ses- w brazis gamomwvevi situaciebis identifikaciaSi;
rulebistvis Tavis aridebas. mogvianebiT, pacienti
w iseTi damokidebulebebis identifikaciaSi, romle
amas damoukideblad akeTebs.
bic pacientSi iwvevs arsebuli viTarebis Seusabamod
4. rodesac pacienti iswavlis sakuTari qcevis Sez- Zlier brazs;
Rudvas, Terapevti aZlierebs ritualis Sesrulebis
w iseTi faqtorebis identifikaciaSi, romlebic asus
survils pacientis darwmunebiT, rom is am survi-
teben brazis Semakavebel faqtorebs (gansakuTrebiT
lis maprovocirebel situaciaSi Sevides. radgan wi-
alkoholis gamoyeneba);
naT pacienti am situaciebs Tavs aridebda, mocemul
proceduras eqspozicia ewodeba. w sibrazis maprovocirebel situaciebTan gamklavebis
alternatiuli saSualebebis aRmoCenaSi; agreTve,
mas Semdeg, rac ritualebi marTvadi xdeba, maTi
varjiSSi, romlis drosac pacienti daiswavlis am
Tanmxlebi obsesiuri azrebic, Cveulebriv, mcirdeba.
saSualebebis gamoyenebas (magaliTad, sibrazis ga
obsesiuri azrebi, romlebic Tavs iCens ritualis
davadeba iqamde, sanam misi marTva gaxdebodes
gareSe, ufro rTuli mosavlelia. treningi SeCveva-
SesaZlebeli).
Si warmoadgens fsiqikuri eqspoziciiT mkurnalobis
formas. pacienti fiqrobs obsesiuri azrebis Sesaxeb TviTkontrolis teqnika
didi xnis manZilze an ganmeorebiT usmens xamamRala nebismieri bihevioruli teqnika mimarTulia paci
warmoTqmuli fiqrebis Canawers, romelic erT saaTs entis SesaZleblobaze, ukeT marTos sakuTari qce
an ufro did xans grZeldeba (meore teqnika, romelic va. kognituri Terapiisagan gansxvavebiT, TviTkon
_ 630 _
trolis teqnika uSualod am amocanazea orien adamianisagan momdinareobs. jildod, Cveulebriv, so-
tirebuli da ar gulisxmobs Sualeduri safexurebis cialuri ganmtkiceba gamoiyeneba (signalebi, romle-
gavlas (rogoric, magaliTad, emociebisa da bic mowonebaze an gakicxvaze mianiSnebs; sasiamovno
azrebis Secvlaa). TviTkontrolis teqnika efuZneba aqtivoba, romelic qulebis dagrovebis Sedegad xor-
operantuli ganpirobebis principebs da banduras cieldeba). koreqcia qcevis Sedegebze zemoqmedebis
gamokvlevebs, romlebic Seiswavlis socialuri gziT, ZiriTadad, gamoiyeneba bavSvebisa da daswavlis
qcevis rols TviTdajildovebis marTvaSi (Bandura, darRvevis mqone adamianebis mkurnalobisas.
1969). es teqnika maSinaa sasargeblo, rodesac qceva mocemuli teqnika oTxi etapisagan Sedgeba:
potenciurad marTvadia, xolo pacients uWirs 1. qcevis gansazRvra da aRricxva. ganisazRvreba Se-
misi ganxorcieleba. Warbi kveba da moweva aseTi sacvleli qceva da meore adamiani (Cveulebriv, mSo-
qcevebis magaliTebia. radgan kognituri da emociuri beli an eqTani) gaivlis trenings mis dafiqsirebaSi.
faqtorebi qcevis mniSvnelovani determinantebia, magaliTad, dedam SeiZleba daiTvalos iseTi SemTx-
TviTkontrolis meTodebi, Cveulebriv, ufro farTo vevebis raodenoba, rodesac misi Svili, romelsac
kognitur-bihevioruli programis nawils warmoadgens daswavlasTan dakavSirebuli sirTuleebi aReniSne-
(magaliTad, kvebiTi aSlilobis mkurnaloba) (ix. gv. ??). ba, xmamaRla yviris.
TviTkontroliT mkurnalobis procesi sami safex-
2. stimulisa da ganmtkicebis identificireba. qcevis
urisagan Sedgeba:
stimulebis identificireba xdeba im movlenebis
1. TviTmonitoringi. adamiani yoveldRiurad aRricx- aRricxviT, romlebic regularulad win uZRvis am
avs problemur qcevas da im viTarebebs, romleb- qcevas. zogjer, paTologiuri qcevis provocirebas
Sic is iCens Tavs. magaliTad, pacientebi, romlebic axdens meore adamianis qceva. agresiuli qceva xSi-
zedmetad bevrs Wamen, aRnusxaven, Tu romel sakvebs rad am saxiT iwyeba. ganmamtkiceblebis identifi-
iReben da rodis ikvebebian. isini, agreTve, afiq- cireba xdeba im movlenebis aRricxviT, romlebic
sireben nebismier kavSirs Wamas, stresul movlenasa uSualod mosdevs qcevas. zogjer, am movlenebis
da guneb-ganwyobas Soris. aseTi Canawerebis warmoe- ganmamtkicebeli buneba ar aris aSkara maTSi mona-
ba TavisTavad warmoadgens Zlier stimuls TviT- wile adamianebistvis. magaliTad, mSoblebi SeiZle-
kontrolis ganxorcielebistvis iseT pacientebSi, ba ver acnobierebdnen Semdeg faqts: imis gamo, rom
romlebic winaT eridebodnen sakuTar problemas- isini met yuradRebas aqceven TavianT Svils yviri-
Tan pirispir dadgomas an ar icodnen im faqtorebis lis dros (da ara maSin, rodesac is wynarad imyofe-
Sesaxeb, romlebic masze zemoqmedebs. mogvianebiT, ba), isini ganamtkiceben yvirilis qcevas.
regularuli Canawerebi qcevis Sesaxeb progresis
3. ganmtkicebis Secvla gulisxmobs ganmtkicebis ga-
Sesafaseblad gamoiyeneba.
danacvlebas problemuri qcevidan sasurvel qce-
2. TviTSefaseba. Terapevti pacients uTanxmdeba misi vaze. magaliTad, mSoblebs exmarebian imaSi, rom
im miRwevebis Sesaxeb, romlebic unda dajildovdes. maT naklebi yuradReba miaqcion Svils, rodesac is
pacienti miRweul progress uwevs monitorings. yviris da maSin miaqcion mas ufro meti yuradReba,
3. TviTdajildoeba. zogjer sasargebloa dajildoe- rodesac is mSvidadaa.
bis sistemis SemuSaveba, romelic jildod qulebis 4. progresis monitoringi. mkurnalobis kvalobaze
miweras gulisxmobs. es qulebi SeiZleba boloSi da- aRiricxeba problemuri qcevis sixSire da, aseve,
jamdes da amis safuZvelze pacientma materialuri sasurveli qcevis sixSire.
jildo miiRos. magaliTad, qalma SeiZleba sakuTar
koreqcia qcevis Sedegebze zemoqmedebis gziT ga-
Tavs dauweros erTi qula TiToeuli dRistvis,
moiyeneba izolirebulad, da, aseve, rogorc ufro
romlis ganmavlobaSic man dieta daicva da garkveu-
farTo programis nawili (magaliTad, wamaldamoki-
li raodenobis qulebis dagrovebisas TavisTvis
debulebis mkurnalobisas) (Petry and Simcic, 2002). mo-
jildod fexsacmelebi iyidos.
cemuli teqnikis principebi gamoiyenes pacientebTan,
qcevis koreqcia mis Sedegebze zemoqmedebis gziT romlebic erTad cxovrobdnen palataSi da saerTo
sacxovrebelSi. am sistemas `talonebis ekonomika~
TviTkontrolis teqnikis msgavsad, es teqnikac gu-
daarqves. talonebis ekonomikas dRes iSviaTad iyene-
lisxmobs dajildovebas sasurveli qcevis ganxorcie-
ben, radgan am teqnikiT gamowveuli pozitiuri cvli-
lebis gamo da ganmtkicebis gamouyeneblobas arasa-
lebebi SezRuduli raodenobisaa da maTi ganzogadeba
surveli qcevis ganxorcielebis dros. magram, am Sem-
sxva situaciebze ar xdeba. koreqcia qcevis Sedegeb-
TxvevaSi, pacienti ki ar axorcielebs sakuTari Tavis
ze zemoqmedebis gziT ganixileba rimis da mastersis
marTvasa da TviTmonitorings, aramed, mis qcevas,
naSromSi, romelic dResac informatul wyaros war-
sxva adamiani uwevs monitorings da ganmtkicebac sxva
moadgens (Rimm and Masters, 1979).
_ 631 _
safenisa da zaris meTodi (Ramis enurezi) dagrovili sando mtkicebuleba ar aris sakmarisi
aRniSnuli meTodis Rirebulebis Sesaxeb daskvnis
mocemuli teqnika SemuSavda konkretulad Ramis en-
gamosatanad (Hertlin and Ricci, 2004). mesame komponentis
urezis samkurnalod (ix. gv. ??). `safenisa da zaris
mniSvneloba jer-jerobiT ar aris damtkicebuli
meTodis~ sawyis versiaSi ori liTonis firfita, ro-
(Shapiro, 1995). mocemuli proceduris Sedarebam
melic batareasa da zarTan erTad wredSia CarTuli,
eqspoziciur TerapiasTan ar aCvena am meTodis
gamocalkevdeba safeniT da Tavsdeba zewris qveS. Tu
upiratesoba (Devilly and Spence, 1999; Taylor et al., 2003).
bavSvi RamiT Caisvelebs, safeni sveldeba da misi gaum-
taroba mcirdeba, ris gamoc deni gaivlis firfitebs bihevioruli teqnika, romelic, zogadad,
Soris da CarTavs zars. dRes, firfitebi da safeni Ca- xmarebidan aris amoRebuli
nacvlebulia piJamoze damagrebuli mcire zomis sen-
bioukukavSiri
soriT. maRviZaras xma aRviZebs bavSvs, romelsac uwevs
mosaSardavad adgoma da, saWiroebis SemTxvevaSi, ze- es teqnika pacientebs exmareba gaacnobieron sxeulis
wris gamocvla. ramdenime Ramis ganmavlobaSi am pro- romelime funqciaSi momxdari cvlilebebi (magaliTad,
ceduris gameorebis Semdeg, bavSvi iwyebs gamoRviZe- arteriuli wneva), romelTa marTvac pacients mcire
bas iqamde, sanam misi Sardis buSti uneblied daicle- xarisxiT SeuZlia an saerTod ar SeuZlia. pacients
bodes. saboloo Sedegi imaSi mdgomareobs, rom bavSvs awvdian informacias am funqciis Sesaxeb martivi da
sZinavs mTeli Ramis ganmavlobaSi Casvelebis gareSe. gasagebi formiT (magaliTad, cvalebadi simaRlis
gamoRviZeba Sardis buStis daclamde interpretire- mqone tonis an vizualuri gamosaxulebis saxiT). amis
bulia, rogorc klasikuri ganpirobebis Sedegi. ufro Semdeg, pacienti cdilobs am fuqnciis Secvlas. es,
Zneli gasagebia, ris gamo uzrunvelyofs mocemuli Cveulebriv, xdeba arapirdapiri gziT (magaliTad,
mkurnaloba uwyvet Zils Casvelebis gareSe. es proce- relaqsaciis meSveobiT). bioukukavSiri, zogadad, aRar
dura ?? gverdzea ganxiluli. gamoiyeneba, radganac ar yofila damtkicebuli, rom is
ufro efeqturia, vidre relaqsaciis damoukideblad
rTuli bihevioruli teqnika gamoyeneba. mocemuli teqnika SeiZleba garkveuli
Cvevis Sebruneba Rirebulebis mqone aRmoCndes sensoruli informaciis
dakargvis SemTxvevaSi, magaliTad, xerxemlis travmis
es aris rTuli procedura, romelic gamoiyeneba ti-
Semdeg (Brudny etal., 1974). damatebiTi informacia
kebis, turetis sindromisa da enis borZikis samkurna-
ixileT Semdeg avtorebTan: Basmajian, 1983; Stroebel, 1985.
lod. mkurnaloba xuTi komponentisagan Sedgeba:
(1) treningi qcevis dawyebis gacnobierebaSi; (2) aversiuli Terapia
qcevis monitoringi; (3) treningi konkurentuli rea-
aversiuli Terapia erT-erTi yvelaze adreuli
qciebis iniciaciaSi, romlebic mocemul qcevasTanaa
bihevioruli teqnikaa, romelic Seiqmna 1930-an wleb
SeuTavsebeli; (4) relaqsacia; (5) socialuri daxma-
Si alkoholuri damokidebulebis samkurnalod.
reba. zogi avtori miuTiTebs am teqnikis gamoyenebis
arasasurveli qcevis dasaTrgunad uaryofiT gan
sargeblianobas (Verdellen, Keijers et al., 2004), magram mo-
mtkicebas iyenebdnen, magram es meTodi amoiRes
cemul saxelmZRvaneloze muSaobis periodistvis ar
xmarebidan ori mizezis gamo: jer erTi, uaryofiTi
dagrovda sakmarisi mtkicebuleba mkurnalobis efe-
ganmtkiceba qcevaze mxolod droebiT moqmedebs;
qturobis Sesafaseblad.
meorec, uaryofiTi ganmtkicebis gamoyeneba eTi
Tvalis moZraobis desensitizacia da kur problemebs warmoSobs. miuxedavad imisa,
informaciis xelaxali gadamuSaveba rom uaryofiTi stimulebis gamoyeneba pacientis
mocemuli meTodi SemuSavda posttravmuli stresuli nebarTviT xdeba, Terapevti, mainc, iseT saSualebebs
aSlilobis samkurnalod. is sam komponents moicavs: mimarTavs, romlebic, sxva viTarebaSi, sasjelad
w eqspozicias, rac gulisxmobs travmuli movlenebis gamoiyeneba. mkurnalobisa da dasjis erTmaneTisagan
warmosaxuli scenebis gamoyenebas; gamocalkeveba gansakuTrebiT rTulia iseTi aSli
w kognitur komponents _ pacientis mcdelobas lobis dros, romelTan dakavSirebiTac, SeiZleba,
Caanacvlos warmosaxul xatebTan dakavSirebuli sasamarTlo saqme aRiZras.
uaryofiTi azrebi dadebiTi azrebiT;
w Tvalis sakadur moZraobas. am tipis moZraobis kognituri teqnika
gamosawvevad pacients sTxoven swrafad gadaitanos kognituri gadastruqturebis misaRwevad, anu kogni
mzera sivrcis erTi wertilidan meore wertilze ciebSi cvlilebebis Sesatanad, Cveulebriv, oTx
Terapevtis TiTistvis Tvalis midevnebiT. teqnikas iyeneben:
am saxelmZRvaneloze muSaobis periodiostvis 1. yuradRebis gadatana distresis gamomwvevi azre
_ 632 _
bidan. es xorcieldeba yuradRebis warmarTviT iseT kognitur-bihevioruli Terapia
obieqtebze, romlebic adamianis uSualo garemoSi
SfoTviTi aSlilobis mkurnaloba
imyofeba (magaliTad, vitrinaSi myof sagnebze),
SfoTviTi aSlilobis mkurnalobisas mimarTaven
misi CarTviT iseT fsiqikur aqtivobaSi, romelic
eqspoziciasTan kognituri teqnikis kombinacias (ix.
yuradRebis koncentracias moiTxovs (mag., gonebaSi
zemoT. gv. ??). eqspoziciis mniSvneloba ganridebis
ariTmetikuli operaciebis Sesruleba), an ucabedi
qcevis odenobis proporciulia. es ukanaskneli ufro
sensoruli stimulebis gamoyenebiT (mag., majaze
metadaa gamoxatuli fobikuri aSlilobis dros da
gakeTebuli rezinis samajuris moWera). ukanasknel
naklebadaa gamoxatuli generalizebuli SfoTviTi
teqnikas `fiqris Sewyveta~ ewodeba.
aSlilobis dros.
2. neitralizacia. SfoTvis gamomwvevi azrebis emo
mkurnalobisas sami tipis kognicia aris gaTval-
ciuri zemoqmedeba SeiZleba Sesustdes damam
iswinebuli:
Svidebel reaqciaSi gavarjiSebiT. magaliTad, `guli
1. SiSis SiSi: zogadi wuxili im Sedegebis gamo, ro-
swrafad imitom micems, rom SfoTvas ganvicdi da ara
melic SeiZleba SfoTvam gamoiwvios (mag., TviTkon-
imitom, rom avadmyofi guli maqvs~. imistvis, rom
trolis dakargva);
gaiadvilos damamSvidebel azrebze koncentracia,
2. simptomebis SiSi: wuxili konkretuli simptomebis
pacients SeuZlia Tan iqonios baraTi, romelzec
gamo, mag, SiSi imisa, rom aCqarebuli maja gulis
damamSvidebeli azrebia dawerili.
daavadebis niSania.
3. rwmenaSi eWvis Setana. Terapevti pacients awvdis 3. uaryofiTi Sefasebis SiSi: pacientis wuxili imis
iseT mtkicebulebas, romelic mis rwmenebs ewi gamo, rom masze sxva adamianebis reaqcia uaryofiTi
naaRmdegeba. zogadad (rogorc es zemoT iyo aR iqneba.
niSnuli), logikuri gziT azrebSi eWvis Setana balansi am kogniciebs Soris cvalebadobs sxvadasx-
arasakmarisia, radgan adamianebi aralogikurad va aSlilobis dros. generalizebuli SfoTviTi aSli-
azrovneben. isini zedmetad anzogadeben konkretul lobisas, wamyvania SiSis SiSi da zogadi wuxili (gv.
SemTxvevebs da ufro met yuradRebas im faqtebs ??). socialuri fobiis dros gansakuTrebiT mniS-
aqceven, romlebic adasturebs maT rwmenebs, vidre vnelovania uaryofiTi Sefasebis SiSi, iseve, rogorc
sapirispiro faqtebs (ixileT Beck, 1976). amitom, wuxili uneblie gawiTlebis an kankalis gamo. agora-
informaciis miwodebasTan erTad, Terapevti, aseve, fobiisTvis tipuria SiSis SiSi (gansakuTrebiT, azre-
cdilobs aralogikuri azrovnebis gamoaSkaravebas bi imis Sesaxeb, rom SeiZleba guli wagivides, mokvde
da Secvlas. is amas orgvarad akeTebs: svams kiTxvebs an dakargo TviTkontroli) da SiSi panikis Semote-
(ix. boqsi 22.5) da awyobs qceviT eqsperimenetebs. vis simptomebis gamo. aseTi kogniciebis modifikacia
aseTi eqsperimentebis magaliTi 22.4-e boqsSia xdeba zemoT aRwerili teqnikis gamoyenebiT, anu in-
mocemuli (gv. ??). praqtikuli xasiaTis damatebiTi formaciis miwodebiT, SiSis logikur safuZvelTan
informaciistvis qceviTi eqsperimentis Sesaxeb dakavSirebiT kiTxvebis dasmis gziT da qceviTi eqs-
ixileT Bennett _ Levy et al., 2004. perimentebis gamoyenebiT.
4. pacientis pasuxismgeblobis xelaxali Sefaseba. informacia SfoTvis fiziologiis Sesaxeb exmareba
zogierTi rwmena myaria imis gamo, rom pacienti pacients miaweros garkveuli simptomebi (magaliTad,
azviadebs sakuTar pasuxismgeblobas iseT movle Tavbrus xveva da aCqarebuli majiscema) swor mize-
nebTan dakavSirebiT, romlebsac mravali mizezi zebs da ara fizikur daavadebas (magaliTad, gulis
gaaCnia. pacients SegviZlia davexmaroT imaSi, rom daavadebas). SiSis aralogikuri safuZvlis aRmoCena
man axleburad Seafasos sakuTari pasuxismgebloba. warmoebs kiTxvebis dasmiT im mtkicebulebis Sesaxeb,
am mizniT iyeneben seqtorul diagramas, romelic romelsac pacientis rwmena eyrdnoba. igegmeba qcevi-
yvela determinants aCvenebs. magaliTad, dedas, Ti eqsperimentebi, romlebic morgebulia pacientis
romelic Tvlis, rom misi pasuxismgeblobaa uzrun Sexedulebebs. am Sexedulebebs, Terapevti, alterna-
velyos ojaxis yvela wevris bedniereba da warmateba, tiul axsnas uZebnis.
seqtoruli diagramis gamoyenebiT aCveneben yvela SfoTvis marTva warmoadgens mkurnalobis zogad
im faqtoris monawileobas, romelic ganapirobebs meTods, romelic SfoTviTi aSlilobisas gamoiyeneba.
ojaxis wevrebis viTarebas (movlenebi skolasa da is ramdenime etapisagan Sedgeba:
samsaxurSi, urTierToba megobrebTan da amindic ki). 1. Sefaseba. pacienti dRiurSi aRricxavs:
TiToeuli am faqtoris wilis gamoxatviT diagramis
w simptomebis sixSiresa da simZimes
seqtorebis meSveobiT diagramaSi sakuTari wilis
w situacias, romelSic es simptomebi aRmocendeba
Sesabamisi segmentis gansazRvramde, pacienti aRmo
aCens, rom misi wili ufro pataraa, vidre mas egona. w ganridebis qcevas.
_ 633 _
2. Canawerebis warmoeba. pacienti aRricxavs SfoTvis

boqsi 22.5 sasargeblo kiTxvebi,
Semcvel kogniciebs, romlebic win uswrebs da Tan
romlebsac rwmenebSi eWvis Sesatanad
axlavs panikis Setevas.
iyeneben
3. demonstracia. Terapevti aCvenebs pacients, rom:
ra faqtebs eyrdnoba mocemuli rwmena?
a. fizikur simptomebs SeuZlia SfoTvis Semcveli
arsebobs Tu ara am situaciis alternatiuli xedva?
kogniciebis provicireba. magaliTad, is sTxovs
rogori azrebi gauCndebodaT sxva adamianebs igive pacients gamoiwvios aseTi simptomebi intensiuri
situaciaSi aRmoCenisas?
sunTqviT an daZabulobis gamomwvevi savarjiSoe-
Tqven imaze xarT koncentrirebuli rac igrZeniT, Tu rac
moxda?
biT da miaqcios yuradReba Tanmxleb azrebsa da
SiSebs;
gaviwydebaT Sesabamisi faqtebi? amaxvilebT yuradRebas
irelevantur faqtebze? b. amgvar kogniciebs SeuZliaT SfoTvis gamowveva.
xom ar aWarbebT am movlenis moxdenis albaTobas? is, magaliTad, sTxovs pacients moaxdinos yur-
adRebis koncentracia am kogniciebze da daak-
sakuTar Tavs ufro maRal moTxovnebs xom ar uyenebT,
vidre sxva adamianebs? virdes, Tu ra mohyveba amas.
Sav-TeTr ferebSi xom ar azrovnebT, nacvlad imisa, rom imis demonstracia, rom fizikur simptomebs mi-
nacrisferi tonebic dainaxoT? vyavarT SfoTvis Semcvel azrebamde, romlebic,
xom ar azviadebT sakuTar pasuxismgeblobas SedegebTan Tavis mxriv, iwvevs SfoTvas, exmareba Terape-
mimarTebaSi? vts daarwmunos pacienti Caketili wris versiis
ra aris yvelaze saSineli ram, rac SeiZleba moxdes da sisworeSi, romelic panikis Setevis etiologiis
ramdenad cudi iqneba es?
asaxsnelad gamoiyeneba.
ra iqneba, Tu yvelaze uaresi ram moxdeba? ramdenad saSi-
neli iqneba es? SeZlebdiT amasTan gamklavebas? 4. usafrTxoebis Ziebis qceva. yuradReba gamaxvilebu-
xom ar akninebT Tqven SesaZleblobebs, anu imas, risi ga- lia usafrTxoebis qcevaze da nebismier disfuqn-
keTebac SegiZliaT am situaciasTan gasamklaveblad? ciur qcevaze, romlebic stresuls xdis ordina-
rul situacias (gv. ??)
adaptirebulia Semdegi wyarodan: Clark, 2000.
5. qceviTi eqsperimentebi gamoiyeneba pacientis az-
rebis sisworis Sesamowmeblad Terapevetis mier
2. iseTi informacia SfoTvis fiziologiis Sesaxeb SemoTavazebul azrebTan maTi Sedarebis gziT. am
an nebismieri sxva sakiTxis Sesaxeb, romelmac, Se eqsperimentis detalebTan gasacnobad ixileT Hack-
iZleba, mcdari Sexedulebebi gamoasworos. mann, 2004.
3. axsna-ganmarteba SfoTvasTan dakavSirebuli Caketi 6. kognituri restruqturizaciis dros pacienti ak-
li wreebis Sesaxeb (ixileT zemoT da Tavi 9). virdeba kogniciaSi momxdari clilebebis gavle-
4. treningi relaqsaciaSi, romelic gamoiyeneba, ro- nas panikis Setevis xarisxze. am proceduris mra-
gorc SfoTvis marTvis saSualeba. valjeradi gameorebiT, is TandaTanobiT axerxebs
panikis Setevis marTvas.
5. eqspozicia. SfoTvis gamomwvev situaciasTan dapir-
ispireba. post-travmuli stresuli aSlilobis mkurnaloba
gulisxmobs yuradRebis warmarTvas im intruziul
6. yuradRebis gadatana SfoTvis gamomwvevi azrebis
vizualur xatebze, romlebic Tan axlavs am mdgo-
zemoqmedebis Sesamcireblad.
mareobas. pacientebi mravaljer warmoidgenen situa-
panikuri aSlilobis mkurnaloba fokusirebulia ciebs, romlebic am xatebSia asaxuli. msgavsi proce-
saxasiaTo Sexedulebebze, magaliTad, imaze, rom Sfo dura gamoiyeneba sistematuri desensitizaciis dros
Tvis fizikuri simptomebi seriozuli fizikuri md- (ixileT zemoT). pacienti cdilobs mocemuli xatebis
gomareobis niSania (Cveulebriv, gulis daavadebis) (ix Sinaarsis imgvarad gardaqmnas, rom maT naklebi dis-
gv. ??). aseTi rwmenebi da Sexedulebebi qmnian Caketil tresi gamoiwvion. pacientebs, agreTve, exmarebian
wres, romelSic SfoTvis simptpomebi (magaliTad, taq- travmul movlenebTan dakavSirebuli fragmentuli
ikardia) iwvevs damatebiT SfoTvas, rac, TavisTavad, da distresis gamomwvevi mogonebebis integraciasa da
aZlierebs fizikur simptomebs. mkurnaloba Semdegi gadamuSavebaSi. post-travmuli stresuli aSlilobis
safexurebisagan Sedgeba: mkurnaloba ?? gverdzea ganxiluli. informacia Se-
1. axsna-ganmarteba. Terapevti ganumartavs pacients, sabamisi teqnikis Sesaxeb mocemulia Semdeg wyaroSi:
rom fizikuri simptomebi stresze gacemuli norm- Muller et al., 2004.
aluri reaqciis nawils warmoadgens. is mas ganumar- damatebiTi informaciistvis SfoTviTi aSlilobis
tavs, Tu rogor CarTavs SfoTvis Caketil wres am kognituri Terapiis Sesaxeb ixileT Clark, 2000.
simptomebis SiSi.
_ 634 _
kognitur-bihevioruli Terapia depresiuli 22.5 boqsSi mocemuli teqnikisa da qceviTi eqsperi-

aSlilobis dros mentis kombinaciiT. damatebiTi informacia am tipis
depresiuli aSlilobis kognituri Terapiis avtoria eqsperimentebis Sesaxeb mocemulia Semdeg wyaroSi:
a.t. beki (Beck, 1976). misi midgoma kognituri Terapiis Fennell et al., 2004.
pirvel efeqtur versias warmoadgens. bekis Terapia depresiis dros kognituri Terapiis gamoyenebisas,
moicavs rTul procedurebs, romelTa mizania depre- mniSvnelovania, gaviTvaliswinoT Semdegi:
siuli pacientebis azrovnebis sami aspeqtis Secvla. w faqtebis (mtkicebulebis) gadaxedva. depresiuli
esenia: negatiuri intruziuli azrebi; rwmenebi da pacientebi yuradRebas amaxvileben iseT faqtebze,
daSvebebi, romlebic ordinarul situaciebs stre- romlebic adasturebs maT uaryofiT Sexedulebebs.
sul situaciebad gardaqmnis; logikuri Secdomebi, isini naklebad amCneven im faqtebs, romlebic maTi
romlebic xels uwyobs am rwmenebisa da daSvebebis Sexedulebebis sawinaaRmdegoa.
SenarCunebas sapiripiro faqtebis arsebobis miuxeda- w alternativebis ganxilva. depresiuli pacientebi
vad. xSirad uaryofen TavianTi azrebisa da rwmenebis sa-
am dros gamoiyeneba sami saxis monitoringi: pirispiro dadebiT Sexedulebebs. Terapevti exmare-
1. pacientebi axdenen intruziuli azrebis identi- ba pacients sxvadasxva dadebiTi alternativebis
fikacias (magaliTad, `me warumatebeli var~). maT gaTvaliswinebaSi Semdegi kiTxvebis dasmiT: rogor
moeTxovebaT TavinTi azrebis Cawera, rodesac cud ggoniaT, ras ifiqrebda sxva adamiani am situaciis
gunebaze imyofebian; Sesaxeb? ras ifiqrebdiT, sxvas rom eqna igive, rac
2. Terapevti gamoaaSkaravebs disfuqnciur rwmenebsa Tqven gaakeTeT? (ixileT boqsi 22.5, sadac analo-
da daSvebebs im tipis kiTxvebis dasmiT, romlebic giuri kiTxvebia mocemuli). pacientis rwmenebsa da
22.5 boqsSia mocemuli. depresiuli pacientistvis daSvebebSi eWvis Sesatanad qceviTi eqsperimentebic
tipuri rwmenaa `Tu ar vecade vasiamovno sxva ada- gamoiyeneba.
mianebs, me maT ar movewonebi.~ w Sedegebis gaTvaliswineba. pacienti unda xedavdes,
3. pacientebi aRricxaven TavianT qmedebebs da moniS- Tu ra mohyveba mis negatiur azrovnebas. magali-
naven TiToeul maTgans asoTi P, Tu is sasiamovnoa Tad, rwmena, rom yovelgvari imedi amowurulia,
da asoTi M, Tu am aqtivobas Tan axlavs miRwevis xels uSlis pacients Tundac umniSvnelo cvlile-
gancda, da, agreTve, gancda imisa, rom pacients xe- bebis gamowvevaSi, romlebsac, saboloo jamSi, Sei-
lewifeba mocemuli aqtivoba. Zleba dadebiTi Sedegi mohyves.
Tu pacienti mZime depresiaSi imyofeba, droebiT w logikuri Secdomebis ganxilva (boqsi 22.6). pa-
unda SevwyvitoT misi azrebis monitoringi da yur- cients unda davexmaroT imaSi, rom man sakuTar Tavs
adReba mis qmedebebze gadavitanoT. am dros iyene- aseTi saxis kiTxvebi dausvas: `Sav-TeTr ferebSi xom
ben e.w. àqtivobis grafiks~, raTa waaxalison paci- ar vxedav movlenebs?~ `zedmetad xom ar vanzogadeb
enti iseTi aqtivobis SesrulebaSi, romelic, misi calkeuli SemTxvevebidan gamomdinare daskvnebs?~
azriT, siamovnebis momgvrelia da romelsac igi `xom ar vidanaSualeb Tavs iseTi ramistvis, razec
kargad flobs. es grafiki pacients imiTac exmareba, ara var pasuximgebeli?~ `xom ar vazviadeb mov-
rom pacientis cxovrebaSi Semoaqvs wesrigi da is- lenebis mniSvnelobas?~. am kiTxvebis dasma xdeba
eTi miznebi, romelsac man unda miaRwios. am etapze konkretul azrebTan, rwmenebTan da situaciebTan
Terapevti exmareba pacients gadawyvetilebis miRebis mimarTebaSi.
moTxovnilebis SesustebaSi, rac mZime depresiis mqone w rwmenebis gadaxedva. depresiis SesustebasTan er
adamianistvis Zneli gasakeTebelia. Tad ufro meti yuradReba eniWeba pacientis
TuU pacientis depresia imdenad mZime ar aris, rwmenebs, radgan anomaliurma rwmenebma SeiZleba
mkurnaloba iwyeba depresiis kognituri modelis recidivi gamoiwvion. Cven SegviZlia gamoviyenoT
ganmartebiT da intruziuli azrebis Semcirebis mcd- safexurebrivi teqnika (gv. ??) aseTi rwmenebis
elobiT. es xorcieldeba yuradRebis gadataniT (ix. gamosaaSkaraveblad:
gv. ??) da simSvidis momgvrel alternativebSi ga- `ratom aris es azri sasargeblo?~
varjiSebiT (mag., `miuxedavad imisa, rom, Cemis azriT, `ratom aris is arafris momcemi ?~
samuSao cudad Sevasrule, Cemma bosma guSin Semaqo.~). `kidev ra alternativebi arsebobs?~
imistvis, rom pacients davexmaroT dadebiT gamonaTq- w gacnobiereba mindfulness. Tisdeilis Tanaxmad, dep
vamebze koncentraciaSi, SegviZlia alternatiuli resiisaken midrekili adamianebs aqvT iseTi tipis
gamonaTqvamebi baraTebze CamovweroT. mkurnalobis kogniciebi, romelTa gamo azrebi da grZnobebi
gagrZelebasTan erTad, sul ufro meti dro eTmoba ganicdeba, rogorc movlenebi da ara rogorc
pacientis daeWvebas depresiul kogniciebSi. es xdeba
_ 635 _
da safaRaraTo saSualebebis gamoyenebis uaryofiT
boqsi 22.6 logikuri Secdomebi
Sedegebs. pacientebi regularulad aRricxaven imas,
depresiuli aSlilobis dros
Tu ra sakvebs iReben, rodis iReben sakvebs, rodis
gazviadeba. umniSvnelo Secdomebis gazviadeba da maTi aR- iwveven pirRebinebas da rodis iReben diuretikebsa
qma mniSvnelovan marcxad;
da safaRaraTo saSualebebs. agreTve, aRiricxeba is
katastrofizacia. umniSvnelo problemebidan gamomdi-
nare seriozuli Sedegebis molodini (mag., pacienti fi-
situaciebi, romlebic iwveves didi raodenobiT sak-
qrobs, rom naTesavi, romelsac saxlSi mosvla daagvianda, vebis arakontrolirebul miRebas. am informaciaze
sagzao katastrofaSi moxvda); dayrdnobiT, pacients ukeT SeuZlia gaakontrolos
zegeneralizacia. pacienti fiqrobs, rom ama Tu im mov- Warbi kvebis impulsi, da, Sesabamisad, pirRebinebis pe-
lenis uaryofiTi Sedegi yovelTvis mohyveba momavalSi
msgavsi movlenis aRmocenebas (mag., partnioris dakargvis riodebi. pacientebi gamafrTxilebel zomebs iReben,
Semdeg, verasodes eqneba myari urTierToba) rac maT kvebis kontrolSi exmareba. es gamafrTxile-
pozitiuris ugulebelyofa. pirovneba koncentrirebulia beli zomebi SemdegSi mdgomareobs:
sakuTar sisusteebze an situaciis uaryofiT aspeqtebze
da yuradRebas ar aqcevs dadebiT aspeqtebs. w sakvebis miReba ar xdeba im adgilas, sadac mas amz-
adeben da inaxaven;
`me~-s aspeqtebi. Sesabamisad, am kogniciebis Secvla w TiToeul jerze miiReba SezRuduli raodenobis
amcirebs recidivis risks. am naSromis weris sakvebi. magaliTad, magidaze ideba ori naWeri puri
periodistvis, xsenebuli mosazreba arasakmarisi da ara mTeli puri;
mtkicebulebiT iyo gamyarebuli (Teesdale et al., 2002).
w TefSze rCeba mcire raodenobis sakvebi, romelic
kognituri Terapiis gamoyeneba depresiul pacien pacientma unda gadaagdos, raTa amiT aRniSnos kve-
tebTan ufro detalurad fenelTanaa ganxiluli bis procesis dasruleba;
(Fennell, 2000).
w sakvebis yidvisas, winaswar unda Sedges sia da paci-
kognitur-bihevioruli Terapia nervuli entma mxolod is da im raodenobis sakvebi SeiZinos,
bulimiis dros romelic siaSia dasaxelebuli.
nervuli bulimiis dros kognitur-bihevioruli Te Terapevti mkacrad ukrZalavs pacients wonisa da
rapiis gamoyeneba emyareba im mosazrebas, rom mocemul garegnobis xSir Semowmebas, radgan orive Cveva xels
SemTxvevaSi centralur problemas warmoadgens uwyobs mocemuli aSlilobis SenarCunebas.
sxeulis wonisa da formistvis gadametebuli mniS radgan pacientebi zedmetad didi raodenobis sak-
vnelobis miniWeba da dabali TviTSefaseba. es iwvevs vebs iReben maSin, rodesac cud gunebaze arian an
umkacresi dietis dacvas, rac arTulebs kvebiTi martod ganicdian Tavs, maT exmarebian axali saSu-
procesis marTvas da, Sesabamisad, iwvevs didi ra alebebis povnaSi usiamovno emociebTan gasamklaveb-
odenobiT sakvebis arakontrolirebul miRebas. xe lad. magaliTad, maT SeuZliaT ipovon megobrebi an
lovnurad gamowveuli pirRebineba, romelic, zogjer, mousminon musikas. pirRebineba, Cveulebriv, wydeba
diuretikebTan da safaRaraTo saSualebebTan erTad kvebis gakontrolebasTan erTad. kidev erTxel xde-
gamoiyeneba, xels uSlis wonis akrefas da, agreTve, ba yuradRebis gamaxvileba safaRaraTo saSulebebis
naklebad zRudavs sakvebis gadametebuli raodenobiT da diuretikebis arasworad moxmarebis saSiSroebaze.
miRebas, rac, Tavis mxriv, iwvevs kidev ufro didi pacientebTan intensiurad muSaoben imaze, rom maT ga-
raodenobiT sakvebis arakontrolirebul miRebas da dayaron am tipis medikamentebi.
dietis dacvis gamkacrebas. ase iqmneba Caketili wre, kvebis procesis gaumjobesebasTan erTad, Terapevts
romelic SeuZlia gaarRvios: yuradReba kogniciebze gadaaqvs. pacientebi kogniciebs
w kvebis normaluri reJimis aRdgenam (samjeradi kveba); aRricxaven kvebis qcevasTan erTad. Sesabamisi kogni-
ciebi exeba ara mxolod sxeulis formasa da wonas,
w didi raodenobiT sakvebis arakontrolirebul mi
aramed, agreTve, TviTSefasebas. aseTi kogniciebia:
Rebaze ufro mkacri SezRudvebis dawesebam;
w simsuqne _ marcxia;
w sxeulis formasa da wonasTan da TviTSefasebasTan
dakavSirebuli Sexedulebebis gaanalizebam. w dietis dacva Zlieri nebisyofisa da TviTkontrolis
niSania;
iqamde, sanam daiwyebdes kogniciebis Secvlaze mu-
Saobas, Terapevti, upirveles yovlisa, yuradRebas w bednierebisa da warmatebistvis sigamxdrea aucile-
warmarTavs arakontrilirebad kvebaze. is ganumar- beli.
tavs pacients kognitur models da ukavSirebs mas aseTi rwmenebis SenarCuneba xdeba azrovnebis ara-
pacientis gamocdilebas. Terapevti xazs usvams regu- logikurobis gamo (boqsi 22.3. gv. ??), rac gamoixateba
laruli kvebis mniSvnelobas, xangrZlivi SimSilis Se- faqtebis mimarT seleqciur damokidebulebaSi, konkre-
degebs, ganmeorebiTi pirRebinebisa da diuretikebisa tuli SemTxvevebis zegeneralizaciaSi, `yvelaferi an
_ 636 _
araferi~ azrovnebis stilSi da sakuTari wvlilis gada-
boqsi 22.7 TviTdaxmareba nervuli
metebaSi im movlenebis gansazRvrisas, romlebsac mrav-
bulimiis dros
lobiTi mizezi gaaCniaT (boqsSi 22.5.) gamoiyeneba qcevi-
Ti eqsperimenetebi, iseve, rogorc sxva saxis kognituri monitoringi
Wamis procesis, didi raodenobiT sakvebis arakontro-
Terapiis SemTxvevaSi (ix. Cooper et al., 2004). nervuli bu-
lirebuli miRebis da pirRebinebis monitoringi;
limiis mqone zogierT pacients SeiZleba axasiaTebdes awonva ara umetes kviraSi erTxel;
sxeulis xatis darRveva, romlis gamosworebac, Cveu- regularuli dagegmili kveba;
lebriv, ar xdeba uSualod kognituri procedurebis samjeradi kveba. TiToeuli kvebisas normaluri rao-
gamoyenebiT. Tumca, sxeulis xatis darRveva mcirdeba denobis sakvebis miReba;
sxva simptomebis gakontrolebasTan erTad. ZiriTad kvebaTa Soris samjer msubuqad waxemseba;
didi raodenobiT sakvebis arakontrolirebuli miRe-
garda amisa, mkurnaloba SeiZleba tardebodes bis Sewyveta;
TviTdaxmarebis formatis gamoyenebiT. is SeiZleba mxolod dagegmili raodenobis sakvebis miReba;
efeqturi aRmoCndes motivirebul pacientebTan (ix. sxva sakvebis moSoreba mxedvelobis aridan;
boqsi 22.7). mcire zomis maragis qona;
damatebiTi informacia kognitur-bihevioruli Te sakvebis yidvisas, mxolod sakmarisi odenobis fulis
qona;
rapiis gamoyenebaze nervuli bulimiis SemTxvevaSi
mocemulia Semdeg wyaroebSi: Fairburn et al., 1993; Wil pirRebinebis kontroli
son, Fairburn, Agrass (1996). nervuli bulimiis dros kog didi raodenobiT sakvebis arakontrolirebulad mi-
Rebis SewyvetasTan erTad gulis revis moTxovnileba
nitur-bihevioruli Terapiis gamoyenebis sakiTxi gani- sustdeba.
xileba uilsonisa da fairburnis mier (Wilson, Fairburn;
organizmis gawmendis kontroli
2002).
safaRaraTe saSualebebisa da diuretikebis dozis Sem-
kognitur-bihevioruli Terapia araefeqturi ga- cireba, Tu saWiroa, TandaTanobiT.
modga nervuli anoreqsiis dros, Tumca, SesaZlebe-
didi raodenobiT sakvebis arakontrolirebuli miRebis
lia, misi safuZvlad mdebare zogierTi principi mis alternativebis moZebna
samarTavadac gamoviyenoT (gv. ??) im qmedebebis CamoTvla, romlebic fantavs yuradRebas;
am qmedebebis mosinjva.
kognitur-bihevioruli Terapia ipoqondriis
dros cxovrebiseuli problemebis Semcireba
ix. konsultireba problemis gadawyvetaSi (cxrili 18.2).
es midgoma or amocanazea mimarTuli. es amocanebia im
qcevis identifikacia, romelic xels uwyobs aSlilo- damatebiTi informaciisTvis ixileT Fairburn, 1995.
bis SenarCunebas da ipoqondriuli ideebis uSualod
Secvla. ipoqndriistvis tipiuri qcevebia: la SemTxvevaSi xdeba stresuli situaciebis identi-
w damamSvidebeli informaciis mudmivi Zieba, rac ficireba da maTi mosavleli gzebis moZieba. pacients
droebiT asustebs SfoTvas, magram grZelvadian exmarebian halucinaciebTan gamklavebaSi maTgan saku-
perspeqtivaSi aZlierebs pacientis wuxils; Tari Tavis distancirebiT da im frazebis warmoTqmiT,
w sxeulis funqciebis Semowmeba (magaliTad, pulsis romlebic aneitralebs maT efeqts.
sixSiris daTvla); meore midgomis mizania bodvaSi eWvis Setana. es
w sxeulis struqturis Semowmeba (magaliTad, pal- midgoma mimarTulia meorad bodviT ideebze, gansa-
pacia simsivnis aRmoCenis mizniT). kuTrebiT ki iseTze, romlebic, rogorc Cans, haluci-
naciebs ganmartavs. Terapevti xels uwyobs imas, rom
ipoqondriul ideebs iseTive saxiT udgebian, ro-
pacientma Sexedos halucinaciebs, rogorc rwmenebs
gorc SfoTviTi da depresiuli aSlilobisas kogni-
da ara rogorc faqtebs da SesaZlo alternativebi
tur-bihevioruli Terapiis gamoyenebis dros. am Sem-
ganixilos. imistvis, rom aseTi midgoma efeqturad
TxvevaSic kiTxvebis dasmas da qceviT eqsperimentebs
gamoviyenoT, unda moxdes TiToeuli pacientis bod-
iyeneben. damatebiTi informaciistvis ixileT Salkovs-
viTi ideebisa da rwmenebis zusti formulireba. bod-
kis, Bass (1997).
vis safuZvlis `mosaryevad~ kiTxvebis dasmisas, Tera-
kognitur-bihevioruli Terapia Sizofreniis pevtma sifrTxile unda gamoiCinos, raTa pacientist-
dros vis misi kiTxvebi bodviT ideebze uSualod mimarTul
am SemTxvevaSi ori midgoma gamoiyeneba. pirveli miznad kiTxvebad ar aRiqmebodes. Terapevtma unda aiZulos
isaxavs im stresorebis Semcirebas da ufro srulyofil pacienti, rom man dainaxos, Tu ra Sedegebi mohyveba
daZlevas, romlebic SeiZleba amwvavebdnen aSlilobas aseTi bodvebis qonas da ra moxdeba, Tu mas gansx-
da halucinaciebTan ukeT gamklavebas. stresorebTan vavebuli rwmenebi eqneba. amis Semdeg, Terapevti unda
gasamklavebeli teqnika zemoT aRwerilis msgavsia. yve- ecados bodviTi ideebis axlebur formulirebas,
_ 637 _
raTa zogierTi movlenebi pacientis gamocdilebidan ne iseTi pacientebistvis, romlebic sakuTar Tavs
azris Semcveli gaxados. es movlenebi SeiZleba iyos ganmeorebiT ayenebdnen zians. am Terapiuli midgo-
gagebuli im codnis konteqstSi, romelic pacients mis saxelwodebis miuxedavad, masSi kognituri da
adre hqonda, magram axla, isini, axleburad unda iyos bihevioruli teqnikaa gamoyenebuli. mkurnaloba,
danaxuli. SerCeuli pacientebi, romlebic gamoTqva- romelic mkacrad struqturirebul saxes atarebs,
men survils gadaxedon TavianT bodviT ideebs, sxva saxelmZRvaneloebSia aRwerili. Terapiis procesi in-
niSnebiTac gansxvadebian Sizofreniis mqone adamian- tensiuria. am dros tardeba individualuri seansebi
ebis umravlesobisagan, ris gamoc ar aris cnobili, da unar-CvevebSi jgufuri gavarjiSeba. agreTve, pa-
mkurnalobis Semdgomi Sedegebi Tavad mkurnalobis cients SeuZlia seansebs Soris telefoniT Terapevts
efeqtia, Tu SerCevis meTodiTaa gamowveuli. miuxe- daukavSirdes. Terapias atarebs Terapevtebis patara
davad imisa, rom arsebuli angariSebis Tanaxmad, jgufi. seansebi erT wlamde grZeldeba.
mkurnaloba dadebiTi Sedegebis momtania, misi efeq- individualuri seansebi oTxi elementisagan Sedge-
turobis xarisxi bolomde ar aris dadgenili (ix. Cor- ba. esaa:
mac et al., 2004 da mocemuli saxelmZRvanelos gv. ??). 1. kognitur-bihevioruli teqnika (gv. ??), romelSic
damatebiTi informacia Sizofreniis dros kogni- Sedis TviTmonitoringi da pacientTan muSaobis Ta-
tur-bihevioruli Terapiis gamoyenebis Sesaxeb moce- namSromlobiTi stili.
mulia Semdeg wyaroSi: Turkington et al., 2005. 2. problemebze fiqris dialeqtikuri stili; maga-
liTad, kauzalobis danaxva ~orive/da~ kategorie-
kognituri Terapiis gamoyeneba personologiuri
bis gamoyenebiT (àn-an~ sqemis sawinaaRmdegod) da
aSlilobis dros
sapirispiroTa urTierTmorgebis SesaZleblobis
beki Tvlida, rom teqnika, romelic man depresiuli daSveba. aseTi midgoma gvexmareba pacientTan kon-
aSlilobistvis SeimuSava, SeiZleba personlogiuri frontaciis aridebaSi.
aSlilobis mimarTac iyos adaptirebuli. man aRwera 3. gacnobiereba (maindfulness), rac gulisxmobs pacien-
rwmenebi da azrovnebis stili, romelic TiToeuli tis gavarjiSebas imaSi, rom man moaxerxos sakuTari
saxis personologiur aSlilobas axasiaTebs. TiToeu- gancdebisgan distancireba.
li saxis aSliloba SegviZlia ganvixiloT ramdenime 4. aforizmebi. es aris frazebi, romlebSic pacientis
TvalsazrisiT. esaa pirovnebis TviTaRqma, sxva ada- mier gamoyenebuli midgomis arsia Camoyalibebuli
mianebis Sexedulebebi, zogadi rwmenebi, aRqmuli (magaliTad, miuxedavad imisa, rom Tavad adamiani
safrTxe, daZlevis ZiriTadi strategiebi da pirve- yovelTvis ar iwvevs sakuTar problemebs, es prob-
ladi afeqturi reaqcia. bekma, agreTve, warmoadgina lemebi mainc misi gadasaWrelia).
TiToeuli personologiuri aSlilobistvis damaxa-
seansebis dros xdeba mkurnalobis gegmebis priori-
siaTebeli `sqema~, romelic garkveuli gamonaTqv-
tetebad dalageba. Tavidan muSaoba unda warimarTos
amebisagan Sedgeba. mkurnalobis procesSi Terapevti
sicocxlistvis saxifaTo situaciebze; Semdeg iseT
cdilobs pacients eWvi Seataninos am gamonaTqvamebis
Temebze, romlebic xels uSlis pacientis mxridan
sisworeSi. magaliTad, isteriuli personologiuri
TanamSromlobas; da bolos, pacientis iseT qcevebze,
aSlilobis sqemebi Semdeg gamonaTqvamebs moicavs:
romlebic auaresebs cxovrebis xarisxs.
w me araraoba viqnebi Tu ver movxiblav adamianebs unar-CvevebSi gavarjiSebis seansebi Cveulebriv
w imistvis rom bednieri viyo, sxva adamianebi unda tardeba jgufurad, kviraSi erTxel da or an met
meTayvanebodnen saaTs gastans. pacientebi swavloben (1) brazisa da
w unda vaCveno sxvebs, rom maT guli matkines. sxva Zlieri emociebis marTvas; (2) distresis atanas;
sqemebis `Seryeva~ xdeba kognituri Terapiis zogadi (3) interpersonalur unar-Cvevebs; (4) problemisagan
teqnikis gamoyenebiT (ix. gv. ?? da boqsi 22.5). am tipis gandgomas. saxelmZRvaneloSi aRwerilia am unar-Cve-
mkurnaloba jer-jerobiT ar yofila ise srulyofi- vebSi gasavarjiSebeli procedurebi.
lad Sefasebuli, rogorc mocemul TavSi aRwerili satelefono kontaqti exmareba pacientebs daZlion
kognituri Terapiis sxva meTodebi. informacia per- krizisi seansebze SeZenili unar-Cvevebis meSveobiT.
sonologiuri aSlilobis kognituri Terapiis gamoye- pacienti da Terapevti winaswar Tanxmdebian sakonta-
nebis Sesaxeb mocemulia Semdeg wyaroebSi: Beck, Free- qto saaTebze.
man, 1990; Beck, 1998. iTvleba, rom dialeqtikuri qceviTi Terapia dade-
biT Sedegebs iZlveva mosazRvre personologiuri aS-
dialeqtikuri bihevioruli Terapia mosazRvre lilobis mqone pacientebTan, magram amJamad arsebu-
personologiuri aSlilobis dros li mtkicebulebis safuZvelze Znelia amis Taobaze
linehanma (Linehan et al., 1994) SeimuSava Terapiuli saboloo daskvnis gamotana. damatebiTi informaci-
midgoma mosazRvre personologiuri aSlilobis mqo- istvis ixileT: Palmer, 2002.
_ 638 _
individualuri dinamiuri fsiqoTerapia
individualuri dinamiuri w ifiqros imis Sesaxeb, Tu rogor gamovlinda pir

fsiqoTerapia velad qcevis amJamindeli paternebi, ra funqcias
asrulebdnen isini warsulSi da ratom ganagrZoben
insaiTze orientirebuli xanmokle Terapia arsebobas;
am tipis fsiqoTerpia cdilobs daadginos fsiqikuri w ganixilos azrovnebisa da qcevis alternatiuli
aSlilobis wyaro adreul bavSvobisdroindel gamoc- saxeebi rTul situaciebSi aRmoCenisas;
dilebaSi da, agreTve, is aracnobieri faqtorebi,
w mosinjos qcevisa da emociebze reagirebis axali da
romlebic ganapirobebs anomaliur qcevas, emociebsa
ufro adapturi formebi.
da azrovnebas. is cdilobs gamoiwvios SezRuduli,
Terapevtis funqciaa pacientis gamonaTqvamis in
magram Rirebuli cvlilebebi yovelkvireuli sean-
teleqtualur da emociur Sinaarsze reagireba (mag.,
sebis meSveobiT, romlebic 6-9 Tve grZeldeba (aseTi
`rogorc Cans gabrazdiT, rodesac es moxda~). Te
Terapia SedarebiT xanmoklea fsiqoTerapiuli mkur-
rapevti exmareba pacients gaanalizos is gancdebi,
nalobis srul kursTan SedarebiT. gv. ??). mkurnaloba
romelTa arsebobasac is adre uaryofda da ifiqros
konkretul problemebzea fokusirebuli, ris gamoc
im warsuli situaciebis Sesaxeb, romlebSic aseTi
mas, fokusur fsiqoTerapiasac uwodeben. Sesabamisi
gancdebi iCenda Tavs. Terapevti Tanabar yuradRebas
procedurebi qvemoT aris aRwerili.
uTmobs pacientis sityvebsa da araverbalur qcevas,
mkurnalobis dawyeba radgan maT Soris arsebuli winaaRmdegoba xSirad
sawyisi gamokvleva Zalian mniSvnelovania. is naCqa- miuTiTebs iseTi problemis arsebobaze, romelsac
revad ar unda CavataroT. Terapevti gadawyvets, pacienti uSualod ar gamoxatavs. Terapevti cdilobs
Tu ramdenad Sesaferisia pacientistvis xanmokle ZiriTad Temebze fokusirebas anu cdilobs Tavi
mkurnalobis Catareba (ix. qvemoT). igi SearCevs pro- aaridos iseT problemur sferoebs, romlebzec mu
blemebs, romlebzec mkurnaloba iqneba fokusirebu- Saoba daTqmul droSi ver moxerxdeba maTi sirTulis
li, uTanxmebs pacients am problemebs da Terapiis gamo.
xangrZlivobas. Cveulebriv, mkuranlobis dasasruls Terapevtis mier gakeTebuli interpretacia SeiZ
zogierTi problema gadauWreli rCeba, ris Sesaxebac leba warmoadgendes (1) hipoTezas, romelic erT
pacients Tavidanve afrTxileben. Terapevti ganumar- maneTs ukavSirebs warsulsa da awmyo qcevebsa da
tavs pacients, Tu ra mizans emsaxureba warsuli da movlenebs, an (2) komentars dacviTi meqanizmebis
awmyo qceviTi paternebis urTierTdakavSireba. garda Sesaxeb (magaliTad, seansebis dros aRdgenili mex
amisa, Terapevti ganmartavs, rom misi mizania paci- sierebis Sinaarsebis blokireba; is saSualebebi, ro
entis daxmareba sakuTar problemebSi garkvevasa da melTa meSveobiT pacienti aracnobierad icavs Tavs
pasuxebis povnaSi, rom mis funqciaSi ar Sedis pa- usiamovno gancdebisagan).
cientis magivrad misi problemebis gadaWra. atmos- transferi da kontr-transferi (gadatana da uku-
fero, romelic iqmneba Terapiis pirvelive seansze, gadatana). Terapevti sifxizles iCens gadatanisa da
agrZnobinebs pacients, rom is am procesis monawilea. ukugadatanis Camoyalibebis mimarT (ix. gv. ??). gada-
is grZnobs, rom mas usmenen da Tavisuflad SeuZlia tanam SeiZleba gamoaaSkaravos is, Tu rogor reagi-
saubari iseT azrebsa da fantaziebze, romlebic adre rebs amJamad pacienti sxva adamianebze da rogor rea-
aravisTvis gaumxelia. girebda is, bavSvobaSi, Tavis mSoblebze. xanmokle Te-
rapiisas, ukugadatanad iTvleba Terapevtis rogorc
Semdgomi seansebi Sesabamisi, ise Seusabamo reaqciebi pacientis emo-
Semdgom seansebze pacients exmarebian: ciur mdgomareobaze. Terapevti, romelsac SeuZlia
w daasaxelos SerCeuli problemis konkretuli maga gaacnobieros sakuTari reaqciebi, ufro obieqturi
liTebi da ganixilos is, Tu ras fiqrobda, grZnobda, iqneba da ukeT gaigebs pacientis mdgomareobas. rad-
da akeTebda aseT SemTxvevebSi; gan amgvari insaiTi Zneli misaRwevia, Terpevti xSirad
muSaobs supervaizorTan erTad, romelic exmareba mas
w Tavisuflad isaubros emociurad mtkivneul sakiT
ukugadatanis identifikaciaSi. zogi Terapevti Tavad
xebze TerapevtTan SeTanxmebuli Temis farglebSi;
gaivlis Terapiul kurss, raTa ukeT gaigos, Tu ro-
w gamoxatos azrebi da grZnobebi maSinac ki, rodesac
gor gansazRvraven pacientze mis reaqcias warsuli
isini mas aralogikurad da samarcxvinod eCveneba;
movlenebi.
w dainaxos sakuTari roli im sirTuleebSi, romlebsac
sxva adamianebs miawers; mkurnalobis dasruleba
w eZebos saerTo Temebi sakuTar problemebSi da imistvis, rom uzrunvelvyoT mkurnalobis drouli
situaciebze gacemul reaqciebSi; dasruleba, unda davsaxoT realisturi miznebi da mo-
_ 639 _
vaxerxoT am miznebze fokusis SenarCuneba. garda amisa, ganmeorebad intepersonalur problemebze da am pro-
adreul etapzeve unda ganvixiloT Terapiis dasrule- blemebis warmoSobaSi pacientis wvlilze fokusire-
basTan dakavSirebuli potenciuri problemebi. Tera- biT. pacienti aqtiurad monawileobs am problemebis
piuli seansebis dasrulebisas pacienti unda grZnob- daZlevaSi. mas SegviZlia SevTavazoT Semdgomi seanse-
des, rom mas ukeT esmis mis mier SerCeuli problemebi bi, romlebzec pacientis mcdelobebi ganixileba. xan-
da ufro metadaa darwmunebuli, rom SeuZlia maTTan mokle Terapiiis mimoxilvistvis ixileT Aveline, 2001.
gamklaveba. Terapiis dasrulebis procesi gaadvilde-
ba, Tu pacients movelaparakebiT Semdgomi Sexvedrebis kognitur-analitikuri Terapia
Sesaxeb, romlebic momdevno 2-3 Tvezea gawerili. kognitur-analitikuri Terapia, rogorc Terapiis
xanmokle forma, Seiqmna railis mier (Ryle, 1990).
rodis aris naCvenebi individualuri dinamiuri
fsiqoTerapia mkurnaloba efuZneba models, romelic procedure-
bis garkveul mimdevrobas gulisxmobs. miznobrivi
imis gamo, rom randomizebuli klinikuri kvlevebi ar
qceviTi aqtivobebi Semdeg sqemas miyveba: miznis da-
iZleva damakmayofilebel da sakmaris mtkicebulebas,
saxva, garemos Sefaseba, dagegmva, qmedeba, Sedegebis
xanmokle dinamiuri Terapiis Catarebis Cveneba kli
Sefaseba, da, Tu aucilebelia, maTi gadasinjva. pro-
nikur gamocdilebas efuZneba. klinikuri gamocdileba
ceduraTa Tanmimdevroba SeiZleba sami tipis Secdo-
gveubneba, rom am tipis Terapiis Catareba maSin aris
mas Seicavdes. esenia:
ufro sasargeblo,
w xafangi. qcevis ganmeorebiTi cikli, romelSic qce-
1. rodesac problema
vis Sedegi win uswrebs mas. magaliTad, depresiuli
I. SegviZlia moviazroT fsiqodinamiur kategorieb- adamianebis azrovnebis stilis gamo izrdeba mar-
Si; cxis gancdisa da, momavalSi, depresiis Camoyalibe-
II. emociuri da interpersonaluri xasiaTisaa (da ar bis albaToba (gv. ??);
warmoadgens konkretul fsiqikur aSlilobas); w dilemebi, anu mcdari an zedmetad Seviwrovebuli
III. CairTavs dabal TviTSefasebas da intimuri ur- arCevani. magaliTad, adamianebi, romlebsac brazis
TierTobis damyarebisas xSirad erTi da igive gancdis eSiniaT, SeiZleba fiqrobdnen, rom sxvebis
problemebi aRmocendeba; mimarT an mSvidi toni unda gamoiyenon an agre-
2. rodesac pirovneba siuli. pirvel SemTxvevaSi sxva adamianebi iyeneben
maT Tavis sasargeblod, rac kidev ufro aZlierebs
I. mkurnalobis procesSi iRebs sakmaris socialur
maT brazs.
mxardaWeras;
w winaRobebi, anu qmedebis Zalian uaryofiTi Sedege-
II. mosurnea, gamoiwvios cvlilebebi sakuTari Za-
bis anticipacia, ris gamoc es qmedeba aRar xor-
lisxmeviT;
cieldeba, da, Sesabamisad, arasodes xdeba misi
III. SemZlea, Tvali gausworos sakuTar motivebs;
gamocda realur situaciaSi.
IV. SemZlea, Sewyvitos TviTanalizi seansebis dasru-
reciprokuli rolebis Teoria maSin Seiqmna, rodesac
lebis Semdeg.
mosazRvre personologiuri aSlilobis samkurnalod
ukuCvenebebi daiwyes kognitur-analitikuri Teoriis gamoyeneba.
raili Tvlida, rom adamianebs bavSvobidan uyalibdebaT
klinikuri gamocdilebis Tanaxmad, am tipis Terpia ar
socialuri rolebis Sinagani `nimuSebi~, romlebic
aris naCvenebi obsesiuri da ipoqondriuli aSlilo-
moicavs sakuTar rols, meore adamianis rols da
bis dros, mZime afeqturi aSlilobisas da Sizofre-
urTierTobis paradigmas. aseTi rolebia maswavlebeli
niis dros, radgan aseT SemTxvevebSi warsulSi aRmo-
da moswavle, mdevari da devnili, moZalade da
cenebuli emociuri problemebis analizma SeiZleba
Zaladobis msxverpli. rodesac erTi adamiani iRebs
gaaZlieros amJamindeli distresi. garda amisa, misi
erT-erT reciprokul rols, meore adamiani imyofeba
gamoyeneba ar aris rekomndebuli personologiuri
meore rolis aRebis zewolis qveS. railis mixedviT, es
aSlilobis dros, gansakuTrebiT maSin, rodesac es
rolebi anomaliuria, rac SemdegSi gamoixateba:
problemebis qcevaSi gamotanas iwvevs.
xanmokle individualuri dinamiuri fsiqoTerapiis 1. adamianis rolebis repertuari izRudeba an de-
meTodebi mokled aris warmodgenili Semdeg naS- formirdeba;
romebSi: Ursano and Ursano, 2000; Hobbs, 2005. 2. advilad ver xerxdeba erTi rolidan meoreze ga-
dasvla;
Zalze xanmokle Terapia
3. rolebi xisti xdeba da rTuldeba maTi morgeba ax-
axlaxan scades SeemcirebinaT dinamiuri Terapiis xan-
ali situaciebis mimarT.
grZlivoba (da Sesabamisad xarjebi) mcire raodenobis
_ 640 _
individualuri dinamiuri fsiqoTerapia
am dros mniSvnelovania sayrdenebis gamoyeneba. es Tan urTierTobisa (ixileT zemoT) da socialuri
imas niSnavs, rom adamians mxardaWera sWirdeba. mas mx- urTierTqmedebis cnebebi. dacviT meqanizmebs naklebi
olod im xarisxiT uweven mxardaWeras, ra xarisxiTac mniSvneloba eniWeba.
es daexmareba problemis gadaWris gzebis damoukide- randomizebuli klinikuri kvleviT miRebuli sar-
blad mignebaSi. gamoyenebuli procedura moqnili wmuno mtkicebulebis ar arsebobis gamo, kognitur-
unda iyos da Seesabamebodes TiToeuli pacientis analitikuri Terapia, ZiriTadad, klinikur gamoc-
moTxovnilebebs. dilebas efuZneba. mas ar gaaCnia kognituri Terapiis
mgavsi sarwmuno empiriuli safuZveli.
procedurebis monaxazi ufro detaluri informacia kognitur-analiti-
mas Semdeg, rac Terapevti auxsnis pacients gamokv- kuri Terapiis Sesaxeb mocemulia Semdeg wyaroebSi:
levisa da mkurnalobis arss, pacients exmarebian Ryle, Kerr, 2002; Denman, 2001.
problemebis, sxvdasxva guneb-ganwyobisa da qcevebis
nusxis SedgenaSi da sTxoven aRniSnos, Tu ra sixSiriT fsiqodinamiuri interpersonaluri Terapia
iCens Tavs TiToeuli maTgani mis cxovrebaSi. anamne- xanmokle Terapiis es forma hobsonma SeimuSava (Hob-
zsa da dRiurSi Setanil informaciaze dayrdnobiT son, 1985). is interpersonaluri Terapiis msgavsia,
xdeba ganmeorebiTi araadapturi qcevebis, rolebTan magram aq ufro didi yuradReba eTmoba pacientisa
dakavSirebuli problemebisa da mcdari proceduru- da Terapevtis urTierTobas, romelic interperson-
li Tanmimdevrobis identificireba da formulireba. aluri problemebis gagebisa da gadaWris saSualebas
xSirad gamoiyeneba diagramebi procedurebis Tan- warmoadgens. meores mxriv, sxva saxis fsiqodinami-
mimdevrobis axsna-ganmartebis mizniT. magaliTad, uri Terapiisagan gansxvavebiT, gadatanis fenomenis
mcdari Tanmimdevroba SeiZleba daiwyos im azriT, interpretacias naklebi yuradReba eTmoba. fsiqo-
rom pacienti unda ecados yvelas asiamovnos, rasac dinamiur interpersonalur Terapias Semdegi mniS-
mohyveba sxvebistvis gzis daTmoba, Semdeg ki frus- vnelovani maxasiaTeblebi gaaCnia:
tracia da marcxisa da brazis gancda. zogadi pro-
w iTvleba, rom arsebuli problemebi aRmocendeba an
cedurebis konkretul magaliTebs eZeben dRiuris
mZimdeba darRveuli interpersonaluri urTierTo-
CanawerebSi; xdeba saSinao davalebebis dagegmva, para-
bis gamo;
lelurad ki _ alternatiuli procedurebis mosinjva
(magaliTad, Sesabamisi asertuli qcevis ganxorciele- w Terapevti aqezebs da mxars uWers klients;
ba). araadapturi procedurebis warmoSobas fsiqo- w Terapevti cdilobs pacientis gagebas mis grZno-
dinamiuri TvalsazrisiTac ganixilaven. magaliTad, bebSi garkveviT da pacientsa da Terapevts Soris
amJamindeli araadapturi qcevis safuZvels eZeben arsebuli urTierTobis meSveobiT;
iseT qcevaSi, romelic mocemul pirovnebasTan axal- w Terapevti pacientTan metaforebis gamoyenebiT ur-
gazrdobaSi adaptur funqcias asrulebda. TierTobs;
Camoyalibebuli formulireba garkveuli saxiT Se-
w pacientis distresi dakavSirebulia sxvebTan ur-
jamdeba, da pacientisadmi miwerili werilis saxes
TierTobaSi arsebul konkretul problemebTan;
iZens. Terapevtis daxmarebiT pacienti acnobierebs
w pacienti realur situaciebSi mosinjavs problemis
Tavis qcevebs, procedurebis Tanmimdevrobasa da
gadaWris im variants, romelic Terapiul situaciSi
rolur problemebs, cdilobs, TandaTanobiT, maT
SeimuSava.
Secvlas. Tavidanve xdeba gadataniTa da ukugadata-
niT gamowveuli SesaZlo problemebis gaTvaliswineba, zemoT aRwerili Terapiuli midgoma Semowmda
identificireba da ganxilva. mkurnaloba, Cveulebriv, klinikuri kvlevis gziT sxvadasxva tipis klientebTan:
16-24 seansi grZeldeba. Terapiis dasasruls, Terape- fsiqiatriuli momsaxurebis xSir momxmareblebTan
vti kidev erT werils swers pacients. am werilSi Sej- (Guthrie et al., 1999); qronikuli funqciuri dispepsiis
amebulia miRweuli Sedegebi, prognozi da samomavlo mqone pirebTan (Hamilton et al., 2000) da ganzrax
qmedebebi. mosazRvre pirovnuli aSlilobis mqone TviTdazianebis SemTxvevebSi (Guthrie et al., 2001).
piri (borderline personality), Cveulebriv, manamde, sanam
sakuTari problemebis gacnobierebas SeZlebs (`dam- xangrZlivi individualuri dinamiuri
kvirvebeli me-s Camoyalibeba~) damatebiT daxmarebas Terapia
saWiroebs. am tipis daxmareba, Cveulebriv, gulisx- xangrZlivi individualuri dinamiuri Terapia war
mobs iseTi saxis modelirebis gamoyenebas, romlis modgens zogad termins, romelic mravali saxis
drosac xdeba araadapturi elementebis Sefaseba da individualur fsiqoTerapias moicavs. maTi xan
gaanalizeba (xSirad, diagramebis gamoyenebiT). prob- grZlivoba aRemateba 9 Tves. gavrcelebuli mosazrebis
lemebis genezisis gagebis mizniT gamoiyeneba obieqt- Tanaxmad, xanmokle dinamiuri fsiqoTerapiia 9 Tveze
_ 641 _
didxans ar unda gagrZeldes. dinamiuri fsiqoTerapiis jobeseba.
yvelaze xangrZlivi, intensiuri da cnobili forma interpretacia am tipis mkurnalobis erT-erT Zi-
fsiqoanalizia. dinamiuri fsiqoTerapiis meTodebis riTad teqnikad iTvleba. Tumca, interpretaciis
umravlesoba swored fsiqoanalizidana aris nasesxebi. gamoyeneba Zalze gansxvavebulad xdeba sxvadasxva
xangrZlivi dinamiuri fsiqoTerapia did xarjebs tipis xangrZlivi dinamiuri fsiqoTerapiis dros. in-
moiTxovs. radganac is ar gamodga Terapiis xanmokle terpretacia SeiZleba exebodes dacviT meqanizmebs,
formebze ufro efeqturi, is, Cveulebriv, ar aris aracnobier procesebs, gadatanas, an kavSirs warsul
Setanili umetesi qveynebis jandacvis servisebSi. mas, gamocdilebasa da amJamindel paternebs Soris. xSi-
Cveulebriv, iyeneben im pacientebTan, romelTtvisac rad xdeba gadatanis interpretacia. gadatanas ufro
xanmokle Terapia ar aris naCvenebi, Tumca swored didi mniSvneloba eniWeba xangrZlivi fsiqoTerapiis
aseT SemTxvevaSia misi efeqturoba yvelaze saeWvo. dros, vidre moklevadiani Terapiisas.
xangrZlivi individualuri dinamiuri fsiqoTerapiis xangrZlivi fsiqodinamiuri fsiqoTerapia xanmokle
mizania insaiTis ganviTareba, romelic ganisazRvreba, dinamiuri fsiqoTerapiisagan kidev Semdegi niSnebiT
rogorc àmJamindel gancdebsa da qcevaze ara gansxvavdeba:
cnobieri faqtorebis zemoqmedebis gacnobiereba~ w is naklebad struqturirebulia. pacients ubiZge-
(Fonagy, 2000). Tumca, insaiTi ufro metia, vidre am ben isaubros da Tavisuflad (asociaciurad) dau-
faqtorebis codna. is gulixmobs am tipis codnis kavSiros erTmaneTs ideebi konkretul Sinaarsebze
integracias azrovnebis, gancdisa da qcevis stilSi. fokusirebis gareSe;
es procesi cnobilia, rogorc 'working through'.
w Terapevti nakleb aqtiuria da naklebad warmar-
insaiTi miiRweva cnobierebis gareT myofi fsiqikuri
Tavs pacients. is cdilobs, ufro naTeli gaxados
Sinaarsebis cnobierebaSi SemotaniT. es xorcieledeba
masala kiTxvebis dasmiT, winaaRmdegobebis xazgas-
am Sinaarsebis mniSvnelovnebis interpretaciiT da
miT, Tavis aridebisa da rezistentobis reaqciebis
warsuli movlenebis dakavSirebiT funqcionirebis
gamoaaSkaravebisa da interpretaciis gziT.
amJamindel modusTan.
w pacientTan Sexvedrebi ufro xSirad iniSneba (xuT
aracnobieri masalis cnobierebaSi Semotana xor
Sexvedramde kviraSi). es aris erT-erT faqtori,
cieldeba Tavisufali asociaciebiT da fantaziebisa
romelic ganapirobebs ufro intensiur gadatanis
da sizmrebis Sinaarsis analiziT. Terapevtze paci
process. fsiqoanalizSi, gadatana SegviZlia ufro
entis ararealisturi reaqciebis gaanalizebiT
intensiuri gavxadoT, Tu Terapevti, mwoliare pa-
(gadatana) xdeba damatebiTi informaciis mopoveba
cientis mxedvelobis aris miRma darCeba.
aracnoberi procesebis Sesaxeb. Terapevtebi gan
sxvavebul dros andomeben transferze muSaobas. damatebiTi informaciistvis xangrZlivi dinamiuri
ukugadatanis analizi gvawvdis damatebiT relevantur fsiqoTerapiisa da fsiqoanalizis Sesaxeb ixileT Gab-
informacias, radgan is asaxavs ara mxolod Terapevtis bard, 2005.
fsiqologiur konstitucias, aramed pacientis im
xangrZlivi dinamiuri fsiqoTerapiis Cveneba da
aspeqtebsac, romlebzec reagirebs Terapevti. erT-
Sedegebi
erTi mizezi, ris gamoc Terapevtebs Tavad utardebaT
fsiqoTerapia xangrZliv dinamiur fsiqoTerapiaSi zogadad, pacientebis umravlesobasaTan SegviZlia
gavarjiSebis mizniT, swored ukugadatanis arsis Tanabrad efeqturad gamoviyenoT rogorc xangrZli-
gagebaa. vi, ise xanmokle Terapia. Tumca, klinikuri gamocdi-
aracnobier masalaSi SeRwevisa da insaiTis gan leba gveubneba, rom grZelvadiani Terapia naCvenebia
viTarebis mcdeloba aRZravs rezistentobas, romelic iseTi pacientebistvis, romlebsac aReniSnebaT xan-
SeiZleba sami saxis iyos: grZlivi da rTuli emociuri xasiaTis problemebi an
pirovnul ganviTarebasTan (pirovnul momwifebasTan)
1. represiiT gamowveuli rezistentoba, romelic
dakavSirebuli mniSvnelovani problemebi. specifiku-
xels uSlis aracnobier masalSi SeRwevas;
ri fsiqikuri aSliloba naklebad emorCileba am tipis
2. gadataniT gamowveuli rezistentoba, romelic Terapias, vidre personologiuri da urTierTobis
xels uSlis TerapevtTan intensiuri urTierTobis problemebi. xangrZlivi fsiqoTerapia ar unda gamovi-
damyarebas; yenoT Sizofreniis, maniakalur-depresiuli aSlilo-
3. negatiuri Terapiuli reaqcia, romelic gamoixateba bis an aSkarad gamoxatuli paranoiduli pirovnuli
axali simptomebis aRmocenebaSi. es simptomebi Tvisebebis mqone pacientebTan. miuxedavad imisa, rom
anelebs progress. am tipis Terapia ar warmoadgens ukuCvenebas iste-
miuxedavad imisa, rom rezistentoba aferxebs prog riuli da Sizoiduri pirovnebebistvis, isini mainc
ress, rezistentobis analizs SeuZlia insaiTis gaum Znelad emorCilebian mis zemoqmedebas.
_ 642 _
jgufuri Terapia
jgufuri Terapia gramebi alkohol da wamaldamokidebuli pirebist-

vis da, agreTve, jgufuri kognitur-bihevioruli
fsiqoTerapia mcire jgufebSi Terapia;
am TavSi saubaria fsiqoTerapiaze, romelic, Cveu- 2. konkretuli miznebi _ lideris aqtivobis dabali
lebriv, mcire jgufebSi (daaxloebiT 8 kacian jgu- done: problemis gadawyvetis jgufebi;
febSi) tardeba. Terapia didi zomis jgufebSi mog-
3. arakonkretuli miznebi _ lideris aqtivobis maRa-
vianebiT iqneba ganxiluli. fsiqoTerapia mcire jgu-
li done: sxvadasxva tipis xanmokle jgufuri Tera-
febSi ufro xSirad gamoiyeneba interpersonaluri
pia da fsiqodrama;
problemebis modifikaciistvis, rogorc mxardamWeri
Terapia. mas, agreTve, iyeneben fizikuri an fsiqikuri 4. arakonkretuli miznebi _ lideris aqtivobis daba-
daavadebis SedegebTan Seguebis gasaumjobeseblad. li done: sxvadasxva tipis fsiqodinamiuri jgufebi
(tavistokis, eklekturi da interpersonaluri mid-
rogor Seiqmna jgufuri fsiqoTerapia goma) da jgufuri analitikuri Terapia.
xSirad amboben, rom jgufuri Terapia momdinareobs am meTodTagan ramdenime qvemoT iqneba ganxiluli.
amerikeli eqimis jozef pratis naSromebidan, rome-
lic filtvis tuberkulozis mqone pacientebs uwevda terminologia
daxmarebas (Pratt, 1908). pratis jgufebSi iyenebdnen jgufebs xSirad aRweren struqturis, procesisa da
mxardamWer Terapias da pacientebs awvdidnen infor- Sinaarsis TvalsazrisiT:
macias. Tumca, jgufur Terapias hyavs ufro pirdapi- w struqtura miuTiTebs myar da droSi xangrZliv re-
ri winamorbedebi. esenia j.l. moreno, rumineli emi- ciprokul urTierTobebze jgufis TiToeul wevrsa
granti SeerTebul StatebSi da amerikeli t. barou da Terapevts Soris, da, aseve, jgufis wevrebs So-
(Burrow, 1927). jgufuri Terapia, ZiriTadad, aRmo- ris.
cenda 1940-ian wlebSi, omis nevrozebis mkurnalobis
w procesi miuTiTebs xanmokle cvlilebebze jgufis
procesSi dagrovili gamocdilebis safuZvelze.
emociebSi, qcevasa da urTierTobebSi da jgufSi
inglisSi, norTfildis samxedro hospitalSi, s.
mimdinare movlenebze.
foulkesma jgufuri analizi SeimuSava (Foulkes, Lewis,
w Sinaarsi miuTiTebs dakvirvebad movlenebze, rom-
1944). man sakuTari midgoma fsiqoanalizs daafuZ-
lebic jgufur Sexvedrebze iCens Tavs (Temebi, rea-
na, ris gamoc jgufis xelmZRvaneli sakmaod pasiur
qciebi, diskusia, siCume).
rolSi imyofeboda da analitikur interpretacias
iyenebda (Foulkes, 1948, gv. 136). melani klainis sko- Terapiuli faqtorebi jgufur TerapiaSi
lis warmomadgenelma analitikosma bionma, romelic
jgufuri Terapiistvis damaxasiaTebeli faqtorebi
norTfildis samxedro hospitalSi muSaobda, sru-
saerToa yvela saxis fsiqologiuri mkurnalobistvis
liad gansxvavebuli midgoma SeimuSava (Bion, 1961).
(imedis Casaxva, emociebisagan gantvirTva, informa-
man fokusireba moaxdina jgufis, rogorc mTelis,
ciis miwodeba, Terapevtis qmedebebis mizezebis axsna
aracnobier dacviT reaqciebze da ara jgufis cal-
da citatebis miwera prestiJuli wyarostvis) (ix. boq-
keuli wevris problemebze.
si 22.2). jgufuri Terapiis dros moqmedebs damatebi-
1960-ian wlebSi da 1970-iani wlebis dasawyisSi, aSS-
Ti faqtorebi, romlebic ar axasiaTebs individualur
Si moqmedebda e.w. `qmedebis jgufebi~, romelTa mizans
Terapias, magram saerToa nebismieri saxis jgufuri
jgufuri gamocdilebis ufro intensiuri formebis
Terapiistvis. es faqtorebia gaziarebuli gamocdi-
damkvidreba Seadgenda. SemuSavda jgufuri teqnikis
leba, jgufis wevrebisagan mxardaWeris miReba da maT
mravali, gansxvavebuli versia, Tumca dRes iTvleba,
mimarT mxardaWeris gamoxatva, socializacia, imita-
rom am versiebis saerTo niSnebi ufro mniSvnelova-
cia da interpersonaluri daswavla (Yalom, 1985). es
nia, vidre maT Soris arsebuli gansxvaveba.
faqtorebi dajamebulia boqsSi 22.8.
Terapia mcire jgufebSi. klasifikacia
zogadad, rodis aris naCvenebi jgufuri Terapia
painsma da Slapoberskim (Pines and Schlapobersky, 2000)
SeimuSaves sasargeblo klasifikacia, romelic efuZ- jgufuri Tu individualuri Terapia?
neba jgufis miznebs (konkretuli _ ara konkretuli ar moiZebneba imis mtkicebuleba, rom erTi da igive
miznebi) da lideris aqtivobis dones (aqtivobis maRa- xangrZlivobisa da erTsa da imave problemaze mimar-
li _ dabali done). am principebis kombinaciis safuZ- Tuli jgufuri da individualuri Terapia, zogadad,
velze gamoiyo Semdegi oTxi kategoria: gansxvavebul Sedegebs iZleva. arc is aris damtkice-
1. konkretuli miznebi _ lideris aqtivobis maRali buli, rom jgufuri Terapiis romelime erTi forma
done: am kategoriaSi Sedis struqturirebuli pro- sxvebisagan gansxvavebul Sedegebs iZleva. saxeldobr,
_ 643 _
jgufSi yofnisas gaivarjiSon socialuri qcevis gan-
boqsi 22.8 Terapiuli faqtorebi jgufur
xorcielebaSi. aRsaniSnavia, rom Zlieri socialuri
TerapiaSi
SfoTvisas ar aris rekomendebuli jgufuri Terapiis
universaloba (gaziarebuli gamocdileba) pacients gamoyeneba.
exmareba imis gacnobierebaSi, rom is ar aris gariyuli da
rom sxva adamianebsac msgavsi gamocdileba da problemebi
aqvT. sxvisi gamocdilebis mosmena, xSirad, ufro zogadad, rodis ar aris naCvenebi jgufuri Terapia
efeqturia, vidre Terapevtis damamSvidebeli saubari. am SemTxvevaSi SeiniSneba igive ukuCvnebebi, rac in-
altruizmi. sxvebisTvis mxardaWeris gaweva, garda imisa, dividualuri fsiqoTerapiis dros (ixileT zemoT).
rom exmareba mxardaWeris mimReb pirebs, amaRlebs
mxrdamWeri adamianis TviTSefasebas. urTierTmxardaWera garda amisa, jgufuri Terapiis gamoyeneba ar aris
aris erT-erTi faqtori, romlis safuZvelzec viTardeba naCvenebi Zlieri socialuri SfoTvis SemTxvevaSi. aR-
jgufisadmi mikuTvnebulobis gancda.
saniSnavia, rom jgufis arc erT wevrs ar unda hqon-
jgufis SeWiduloba. jgufisadmi mikuTvnebulobis gancda des sxva wevrebisagan Zalze gansxvavebuli probleme-
gansakuTrebulad Rirebulia im pacientisaTvis, romelic
adre gariyulad ganicdida Tavs. jgufis SeWiduloba bi, radgan, jgufma aseTi wevri SeiZleba gariyos an is,
xels uwyobs jgufis SenarCunebas, rodesac sxvadasxva SesaZloa, jgufistvis `gantevebis vaci~ aRmoCndes.
problemebi mas daSliT emuqreba.
socializacia aris jgufSi yofnisas socialuri unar-
Cvevebis SeZena im komentarebisa da reaqciebis Sedegad, fsiqoTerapia mcire jgufebSi. Terapiis
romelsac jgufis wevrebi erTmaneTis qcevaze iZlevian.
jgufis wevrebs SeuZliaT axali socialuri qcevebis tipebi
mosinjva usafrTxo jgufur garemoSi.
mxardamWeri jgufebi
imitacia gulisxmobs daswavlas jgufis wevrebis qcevaze
dakvirvebiT da maTi qcevis gadmoRebiT. Tu jgufis mxardamWeri Terapiis dros `muSaobs~ jgufSi moqmedi
gaZRola kargad xdeba, pacientebi axdenen adapturi
mravali faqtori (ix. boqsi 22.9). aseT jgufSi
qcevis imitacias. sapirispiro SemTxvevaSi, maT SeiZleba
moaxdinon araadapturi qcevis imitacia (mag., emociebis Terapevtma xeli unda Seuwyos TviTdaxmarebas da
eqstravagantuli gamoxatva an imgvari saubari, romelsac jgufis wevrebis gamocdilebis pozitiur gamoyenebas.
yuradReba gadaaqvs pacientis emociuri xasiaTis
problemebidan). Terapevtma unda uzrunvelyos is, rom jgufis wevrebis
interpersonaluri daswavla gulisxmobs daswavlas urTierToba ar gaxdes zedmetad intensiuri, rom maT
jgufSi mimdinare urTierTobis safuZvelze da axali tipis mxardaWera aRmouCinon erTmaneTs da erTmaneTisagan
urTierTqmedebaSi gavarjiSebis gziT. interpersonaluri
daswavla jgufuri Terapiis mniSvnelovani komponentia.
miiRon daxmareba. garda amisa, Terapevtis funqciaa,
saWiroebis SemTxvevaSi, daicvas mowyvladi pacientebi.
ojaxuri urTierTobis modelis ganmeoreba. jgufuri pro
cesebis ganviTarebasTan erTad, urTierTqmedeba jgufis problemebi, romlebic SeiZleba aRmocendes Terapiul
wevrebs Soris sul ufro da ufro ararealuri xdeba jgufSi (ix. qvemoT), aseve SeiZleba aRmocendes
da efuZneba pacientis iseT urTierTobebs, romlebic mas
warsulSi mSoblebTan da da-ZmasTan akavSirebda. aseTi mxardamWer jgufebSic. mxardamWeri jgufebis lideri
jgufuri gadatana sabolood yvela jgufSi iCens Tavs. sifxizles unda iCendes potenciuri problemebis
zogierTi saxis Terapia (ZiriTadad fsiqoanalituri
Terapia) xels uwyobs da iyenebs mas.
mimarT da unda SeZlos maTTan gamklaveba qvemoT
aRwerili meTodebiT (gv. ??)
araferi adasturebs imas, rom urTierTobis jgufebi
TviTdaxmarebis jgufebi
(enqaunTer-jgufebi) an moqmedebis meTodebi (maga-
liTad, fsiqodrama) sxva meTodebTan SedarebiT upi- TviTdaxmarebis jgufebs uZRveba amJamindeli an
ratesobis mqonea. Tumca arsebobs imis damamtkicebe- yofili pacienti, romelmac iswavla, Tu rogor
li faqtebi, rom zogierT SemTxvevaSi maT simptomebis unda daZlios jgufSi aRmocenebuli problemebi
gauareseba SeuZliaT (Yalom et al., 1973). da rogor Seeguos mis siZneleebs. jgufis sxva
wevrebi sargebels iReben am gamocdilebidan.
ra tipis problemebisTvis aris naCvenebi jgu- agreTve, Zalze mniSvnelovania, rom maT SeuZliaT
furi Terapia sakuTar problemebze saubari, sakuTari grZnobebis
rogorc Cans, jgufuri Terapia efeqturia iseTi pa- gamoxatva da erTmaneTisagan mxardaWeris miReba.
cientebisTvis, romlTa problemebi, ZiriTadad, sxva jgufuri procesebi am jgufebSi iseTive xarisxiT
adamianebTan urTierTobas exeba. iseve, rogorc in- viTardeba, rogorc sxva jgufebSi. amis gamo, Zalian
dividualuri Terapiis SemTxvevaSi, ukeTes Sedegebs mniSvnelovania, rom jgufis liderebs hqondeT gav
aCvenebs axalgazrda, motivirebuli pacientebi, rom- lili Sesabamisi treningi da sargeblobdnen sa
lebsac Tavisuflad SeuZliaT sakuTar Tavze sauba- Wiro mxardaWeriT. zogierT jgufs (mag. anonimur
ri da ar axasiTebT mZime personologiuri aSlilo- alkoholikebs) TavianTi mkacri wesebi da procedurebi
ba. jgufuri Terapia, agreTve, naCvenebia zomieri gaaCniaT, sxva jgufebs ki profesionali mrCevelebi
socialuri SfoTvis dros. amis mizezi is unda iyos, hyavT.
rom SfoTvis mqone pacientebs saSualeba eZlevaT arsebobs TviTdaxmarebis jgufebi sxvadasxva pro
_ 644 _
jgufuri Terapia
blemis mqone adamianebistvis. esaa anonimuri al jgufuri muSaobistvis mzadeba
koholikebi (gv. ??), jgufebi wonaSi daklebis msu
sasurvelia pacientebis Semzadeba jgufSi muSa
rvelTtvis (Weight Watchers), qronikuli fiziku
obistvis. am mizniT Terapevti yuradRebas amaxvilebs
ri mdgomareobis (mag., kolostomia) mqone paci
Semdeg sakiTxebze:
entebistvis, gansakuTrebuli problemebis mqone
w konfidencialoba: is, rac jgufSi moxdeba, konfi-
mSoblebistvis (mag. invalidi bavSvebis mSoblebi).
dencialur informacias warmoadgens.
agreTve, arsebobs iseTi adamianebisagan Semdgari
jgufebi, romlebmac axlobeli adamiani dakarges w sandooba: jgufis wevrebi regularulad unda es-
(CRUSE Club). jer-jerobiT Catarda sul ramdenime wrebodnen seansebs da ar unda igvianebdnen seanse-
TviTdaxmarebis jgufis Sefaseba. erT-erTi gamo bze; isini droze adre ar unda tovebdnen jgufur
kvlevis Tanaxmad, iseTi axalgazrda qalebistvis Se Sexvedrebs.
qmnili TviTdaxmarebis jgufi, romelTac danakargi w problemebis gamJRavneba: jgufis wevrebs moeTxove-
ganicades, iseve efeqturia, rogorc xanmokle baT saubari TavianT problemebze.
dinamiuri fsiqoTerapia (Marmar et al., 1988). w jgufis wevrebma unda gamoamJRavnon interesi sx-
TviTdaxmarebis jgufebis mimoxilvistvis ixileT visi problemebis mimarT.
Lieberman, 1990.
w imedis gacrueba: Tavidan jgufis wevrebi imedga-
cruebulni arian, radgan cvlilebebi sakmarisad
Terapiuli jgufebi
swrafad ar mimdinareobs. aseve, isini SeiZleba ganic-
interpersonaluri jgufuri Terapia didnen frustracias imis gamo, rom ver axerxeben sa-
interpersonaluri jgufuri Terapia ialomis naS kuTar problemebze saubars mTeli drois manZilze.
romebs efuZneba (Yalom, 1985). Terapia axlandeli w jgufis wevrebi ar unda xvdebodnen erTmaneTs Ter-
urTierTobebis problemebzea fokusirebuli. aqcenti apiul jgufs gareT. am wesis darRvevis SemTxvevebi
gadatanilia imaze, Tu rogor aisaxeba jgufze es unda ecnobos jgufs Semdeg Sexvedraze.
problemebi. warsuli movlenebi mxolod im xarisxiT
w xangrZlivoba: jgufis wevrebs atyobineben, Tu ram-
ganixileba, ra xarisxiTac maT SeuZliaT sicxadis
deni xani gagrZeldeba jgufSi muSaoba da uxsnian
Setana amJamindel problemebSi.
jgufSi darCenis saWiroebas Terapiis kursis das-
Terapiis safexurebi
rulebamde.
pirvel etapze jgufis wvrebi cdiloben Terapevtze
iyvnen damokidebulni. maT surT miiRon profesiuli jgufis Camoyalibeba
rCeva TavianT problemebTan dakavSirebiT da, aseve, zogadi principebi. jgufSi monawileobistvis arCev-
imis Taobaze, Tu rogor unda iqceodnen jgufSi en daaxloebiT 8 adamians. maT unda hqondeT saerTo
yofnisas. sul male, jgufis wevrebs uqrebaT iluzia problemebi. arc erT maTgans ar unda hqondes iseTi
imis Taobaze, rom Terapevti gadaWris maT pirad problema, romelic mas jgufisagan gamoacalkevebs.
problemebs, ris gamoc jgufis zogierTi wevri iwyebs jgufis wevrebs unda SeeZloT empaTiis gamovlena
Terapiuli Sexvedrebis gacdenas an maTze dagvianebas. erTmaneTis problemebis mimarT da unda amJRavnebdnen
zogierTi wevri saerTod Tavs anebebs Terapias, radgan urTierTdaxmarebis survils. Sexvedrebi unda tarde-
uxerxulobas ganicdis jgufSi sajaro saubris gamo. bodes Sesaferisi zomis oTaxSi. skamebi wreSi unda
meore etapze jgufSi darCenili wevrebi ukeT ec idges, raTa jgufis TiToeul wevrs SeeZlos danar-
nobian erTmaneTs, eCvevian erTmaneTTan problemebis Ceni monawileebis danaxva.
ganxilvas da iwyeben maTze pasuxis Ziebas. es is TiToeuli Sexvedra daaxloebiT 60-90 wuTs gastans.
etapia, rodesac yvelaze didi cvlilebebi iCens amis gamo, jgufis TiToeul wevrs sakmarisi dro eZl-
Tavs. Terapevti xels uwyobs mimdinare problemebisa eva jgufur procesebSi monawileobis misaRebad. es
da urTierTobebis garkvevas da akeTebs komentars Sexvedrebi, Cveulebriv, tardeba kviraSi erTxel da
jgufuri dinamikis Sesaxeb. 12-18 Tve grZeldeba. jgufebis umravlesoba daxuru-
ukanasknel etapze jgufSi dominirebs im wevrebis lia, anu pirveli kviris Semdeg jgufSi gawevrianeba ar
narCeni problemebi, romelTac yvelaze naklebi aris SesaZlebeli (im jgufebs, romlebic axal wevrebs
progresi ganicades da kvlav sagrZnoblad avlenen iReben Ria jgufebi ewodeba. isini, Cveulebriv, mxar-
sxvaze damokidebulebis qcevas. procesis aseTi damWeri da informaciuli xasiaTisaa).
mimdinareoba winaswar unda ganvWvritoT da Terapiuli erTi Tu ori Terapevti? zog jgufs erTi Terapevti
procesis dasrulebasTan dakavSirebuli am da sxva uZRveba, zogs ki _ ori. ori Terapevtis kombinacia
problemebis ganxilva unda daiwyos ramdenime TviT im upiratesobis mqonea, rom erTs SeuZlia daexma-
adre Terapiuli seansebis damTavrebamde. ros meores ukugadatanasTan dakavSirebuli prob-
_ 645 _
lemebis identifikaciasa da movlaSi (es problemebi degi problemebi:
iseTive mniSvnelovania jgufuri muSaobisas, rogorc qvejgufebis formireba. jgufis zogierTma wevrma
individualuri Terapiis dros). uaryofiTi mxare is SeiZleba Seqmnas koalicia, romelSic saerTo maxasi-
aris, rom or Terapevts SeiZleba hqondes gansxvave- aTeblebis mqone adamianebi erTiandebian. es maxasi-
buli Sexeduleba jgufis gaZRolis Taobaze an erT- aTeblebia asaki, socialuri klasi, Rirebulebebi da
maneTTan urTierTobisas Tavdacvaze iyos gadasuli. a.S. radgan aseTi jgufebis arseboba aferxebs Tera-
Tumca, rodesac Terapevtebi endobian erTmaneTis piul process, Terapevtma adreul etapzeve unda
Sefasebebs, nebismieri zemoT aRniSnuli problemis gamoiCinos sifxizle da xeli SeuSalos amgvari alian-
gaCenisas, isini SeZleben ukeT Cawvdnen jgufur pro- sebis warmoqmnas jgufis wevrebistvis kiTxvebis das-
cesebs. Tavidan, Terapevtebis Sexedulebebs Soris miT maTi Camoyalibebis mizezebis Taobaze.
arsebuli gansxvaveba SeiZleba ganixilebodes jgufs jgufis wevrebi, romlebic zedmetad bevrs lapara-
gareT, magram rodesac jgufi integrirebuli xdeba, koben. adreul etapze jgufebis wevrebi miesalme-
aseT gansxvavebebs jgufSive ganixilaven, rac miznad bian aseTi adamianebis jgufSi yofnas, radgan isini
isaxavs jgufis wevrebis mier interpersonaluri pro- anTavisufleben maT sakuTar Tavze saubris valdeb-
cesebis gagebis gaumjobesebas. ulebisagan. magram, droTa ganmavlobaSi, jgufi uk-
mayofilebas iCens im wevris mimarT, romelic axdens
jgufis marTva sxva monawileebistvis gankuTvnili drois monopoli-
Terapevtma unda icodes, rom arsebobs xuTi ZiriTa- zacias. Terapevtma adreve unda miaqcios yuradReba
di sakiTxi, romelsac man yuradReba unda miaqcios. am problemas. es iqamde unda moxdes, sanam jgufi
esenia: gariyavs ybed monawiles. am mizniT, Terapevts Seu-
1. konfliqti daxmarebis miRebis survilsa da sxvisT- Zlia SeekiTxos jgufs, Tu ratom rTavs igi nebas erT
vis daxamarebis gawevis saWiroebas Soris, romelsac adamians xeli SeuSalos mas saubarSi sakuTari Tavis
jgufis TiToeuli wevri ganicdis; Sesaxeb.
2. konfliqti Semdeg or survils Soris: iyo mowoneb- jgufis wevrebi, romlebic zedmetad cotas lapara-
uli Terapevtis mier da iyo mowonebuli jgufis koben. Terapevti unda ecados aalaparakos aseTi
sxva wevrebis mier; monawileebi. es saWiroebs maTi siCumis mizezis gage-
3. procesi, romlis meSveobiTac jgufis wevrebi aya- bas. zogi pacienti sxvebis TandaswrebiT Tavs uxerx-
libeben dominantobis ierarqias da amiT gamowveu- ulad grZnobs, zogs eSinia, saubrisas jgufs Tavisi
li konkurencia/qiSpoba; problema ar gaumJRavnos, zogi ki Cumad imitom aris,
4. riski imisa, rom jgufis ukmayofilebis SemTxveva- rom gabrazebulia da ukmayofiloa jgufuri proce-
Si misi erT-erTi wevri SeiZleba gantevebis vacis sis msvlelobiT.
rolSi aRmoCndes; konfliqti jgufis wevrebs Soris. Terapevtma kon-
5. riski imisa, rom jgufis wevrebi SeiZleba zedmetad fliqtSi myofi pirebidan arc erTis mxare ar unda
pasiurni da Terapevtze damokidebulni aRmoCnd- daiWiros, magram xeli unda Seuwyos jgufis mier
nen, nacvlad imisa, rom Tavad imuSavon problemis konfliqtis imgvar ganxilvas, romelic mas kon-
gadaWraze. fliqtis aRmocnebis mizezebSi gaarkvevs (mag. mtruli
jgufis Terapevtis rols diriJoris rols adare- damokidebulebis gadatanis gamo).
ben. is exmareba monawileebs harmoniulad muSaobaSi; centraluri Temistvis Tavis arideba. Cveulebriv,
xels uSlis imas, rom romelime wevri jgufze domini- jgufi fokusirebulia jgufis wevrebis mimdin-
rebdes da aregulirebs komunikaciis tempsa da mis are problemebze da imaze, Tu rogor aisaxeba es
emociur intensivobas. igi, agreTve, exmareba jgufis problemebi jgufis wevrebis urTierTqmedebaze.
wevrebs, raTa maT ukeTesad gaugon erTmaneTs, miiRon monawileTa warsul gamocdilebas mxolod imdenad
sxvisi winadadebebi da dainaxon sakuTari pirovnebis ganixilaven, ramdenadac es exmareba axlandeli prob-
mxareebi sxva adamianebSi. Tu Terapiuli jgufi kar- lemebis gagebas. zogjer jgufis wevrebi zedmetad
gad muSaobs, misi wevrebi aqtiurebi arian, iReben da bevrs saubroben warsulze, radganac amiT gverds uv-
gascemen daxmarebas da mxars uWeren erTmaneTs. isini lian axlandel sirTuleebs. aseT SemTxvevaSi, Tera-
konstruqciulad ganixilaven problemebs, ar adana- pevts SeuZlia dasvas kiTxvebi da gamoiyenos inter-
Sauleben sxva wevrebs da ar cdiloben maT Cayenebas pretacia, raTa arapirdapiri gziT daabrunos disku-
gantevebis vacis rolSi. sia amJamindeli problemebis kalapotSi. magaliTad,
qals, romelic didxans da Seusabamod saubrobs im
jgufuri Terapiis zogierTi problema
sirTuleebze, romlebic axasiaTebda mis urTierTo-
rogori gawafulic ar unda iyos Terapevti jgufuri bas dominantur mamasTan, Terapevti ekiTxeba: amis
Terapiis CatarebaSi, am dros mainc aRmocendeba Sem- mizezi is xom ar aris, rom jgufis erT-erTi wevri
_ 646 _
jgufuri Terapia
mamakaci mamamisis msgavsad iqceva. taqtsac CairTavdes (mag., moxveva, Caxuteba da sxva).
potenciurad uxerxuli Temebi. jgufis erT-erTma zogjer, jgufuri gamocdilebis intensifikaciis miz-
wevrma SeiZleba Tqvas, rom is usamarTlod gaakri- niT, mimarTaven jgufuri Sexvedrebis gaxangrZlive-
tika jgufis romeliRac wevrma. aseT SemTxvevaSi, bas mTeli dRiT an kidev ufro didi xnis manZilze
Terapevti unda daexmaros jgufs am naTqvamis kon- (e.w. maraTonuli jgufebi). miuxedavad imisa, rom ur-
struqciulad ganxilvaSi, raTa gaarkvios _ jgufis TierTobis jgufebi efeqturia zogierTi pacientis
monawilis es gancda mis jgufgareSe warsul da aw- SemTxvevaSi, bevr pacientTan isini ar gamodga efe-
myo gamocdilebas ukavSirdeba, Tu jgufsSida gamoc- qturi. ufro metic, ramdenime SemTxvevaSi pacientis
dilebas. aseTi diskusia ufro sasargebloa, rode- mdgomareobis gauaresebac ki yofila dafiqsirebuli
sac is konkretul saxes atarebs. magaliTad, ufro (Lieberman et al., 1973). arasasurveli efeqti ufro xSi-
sasargebloa ganvixiloT, Tu ratom brazobs qali, rad gvxvdeba seriozuli emociuri aSlilobis mqone
rodesac jgufis erT-erTi wevri mamakaci mas rCevas pacientebTan da, agreTve, iseT jgufebSi, sadac yve-
sTavazobs, vidre gavaanalizoT misi zogadi prob- laze metad gamoiyeneba konfrontaciuli meTodebi.
lema _ agresiuli reaqcia mamakacebis mimarT. aseTi fsiqodrama intensiuri jgufuri gamocdilebis ki-
konkretuli SemTxvevebis gaTvaliswineba gvexmareba dev erT formas warmoadgens. am meTodis gamoyenebi-
ufro farTo problemis gagebaSi. sas jgufi ganasaxierebs movlenebs erT-erTi monawi-
damatebiTi informaciis mosapoveblad interper- lis cxovrebidan. dadgmuli scenebi asaxavs mis amJa-
sonaluri jgufuri Terapiis Sesaxeb mkiTxvels Seu- mindel urTierTobebs an im ojaxur urTierTobebs,
Zlia gaecnos Semdeg naSroms: Bloch, Aveline, 1996. romelSic pirovneba gaizarda. molenebis gaTamaSe-
ba, Cveulebriv, Zlier emociebs aRZravs im adamian-
jgufuri analizi
Si, romelic maTi realuri monawilea, da, SeiZleba,
es teqnika, romlis avtoricaa foulki (ix. zemoT), agreTve, jgufis sxva wevrebis problemebs asaxavdes.
yvelaze farTod gamoiyeneba britaneTis jandac- monawileebi erTmaneTSi xSirad cvlian rolebs, raTa
vis samsaxurebSi. jgufuri analizi Semdegi niSnebiT ukeT gaigon erTmaneTis pozicia. aseT dadgmebs mos-
gansxvavdeba interpersonaluri meTodisagan: (1) is devs jgufuri diskusiebi. erTi adamianis gamocdi-
ufro xSirad mimarTavs gadatanisa da aracnobieri lebaze dramatuli siuJetis dafuZnebis nacvlad,
meqanizmebis interpretacias; (2) fokusirebis nacv- SesaZlebelia gaTamaSdes iseTi problemebi, romle-
lad ufro metad iyenebs `Tavisuflad mimdinare dis- bic gaziarebulia monawileTa mier (mag. ra movimo-
kusias~. Terapevti (`diriJori~) yuradRebas amaxvi- qmedoT xelisuflebasTan dakavSirebiT). am meTods
lebs kofliqtur situaciebze, akviatebul Temebze, sociodrama ewodeba. fsiqodramas eZRvneba Semdegi
Tavidan aridebis SemTxvevebze da interpretacias naSromi: Holmes, Karp, 1991.
mimarTavs. gansakuTrebuli yuradReba eqceva gadata- amJamad, qmedebis teqnikas, ZiriTadad, sxva jgufuri
nas (transfers) Terapevtze da jgufis erTi wevri- meTodebis Semavsebel saSualebad iyeneben. fsiqodra-
dan meoreze. Terapevtis interpretaciiT es asaxavs mis seansma SeiZleba warmoSvas sadiskusio sakiTxebi
cxovrebis adreul etapze mSoblebTan da da-ZmasTan maSin, rodesac sxva meTodebis gamoyenebiT mocemul
arsebul urTierTobas. hipoTezebi adrindeli urT- jgufTan progresi ar miiRweva. rolebis gacvla exma-
ierTobebis Sesaxeb axlandeli problemebis gasagebad reba zogierT pacients sakuTari problemebis ufro
gamoiyeneba. am procesis Sedegad jgufis wevrebs obieqtur aRqmaSi. maT, SeiZleba, pirvelad moaxerxon
eWvi SeaqvT TavianT didi xnis SexedulebebSi da ukeT am problemebis danaxva meore adamianis Tvalsazri-
axerxeben sakuTari Tavis gagebas. jgufuri proces- siT.
ebis ganviTarebis kvalobaze lideri nakleb aqtiuri
xdeba. is Tavis zemoqmedebas, ZiriTadad, magaliTebis Terapia did jgufebSi
moSveliebiT axocielebs da naklebad gamodis eqsper-
fsiqiatriuli ganyofilebis jgufebi
tis rolSi. amiT is aqezebs jgufis wevrebs, rom
ufro meti pasuxismgebloba aiRon jgufSi mimdinare am saxis jgufuri Terapia mravali fsiqiatriuli
procesebze. ganyofilebis yoveldRiuri programis nawilia. is,
agreTve, Terapiuli Temis programis tipiuri kom-
urTierTobis jgufebi (enqaunTer-jgufebi) da ponentia. didi zomis jgufebi, Cveulebriv, moicavs
fsiqodrama (moqmedebis teqnika) Terapiuli ganyofilebis yvela pacients personalis
urTierTobis jgufebSi xeli ewyoba monawileTa in- zogierTi warmomadgenlis CaTvliT. didi jgufebi,
tensiur urTierTqmedebas ufro Zlieri cvlilebebis pacientebs minimum imis saSualebas aZlevs, rom maT
gamowvevis mizniT. jgufuri Sexvedra SeiZleba mim- gamoxaton problemebi, romlebic Tanacxovrebas ax-
dinareobdes verbalur doneze, an araverbalur kon- lavs Tan. Tumca, aseT jgufebs bevrad metis gakeTeba
_ 647 _
SeuZliaT. maT SeuZliaT cvlilebebi gamoiwvion Tavi- bierebis ganviTarebas da, amave dros, igi realur
anT wevrebSi maTi araorganizebuli qcevis an arara- cxovrebiseul situaciebSi dabrunebistvis Seamzado.
cionaluri reaqciis magaliTebze miTiTebiT. amave meorec, konfliqti warmoiSveba individebistvis dax-
dros, jgufis wevri iRebs mxardaWeras sxva wevrebis- marebis gawevis saWiroebasa da jgufuri procesebis
gan, romlebsac msgavsi socialuri problemebi da so- marTvis saWiroebas Soris. personalma unda uzrun-
cialuri daswavlis msgavsi SesaZleblobebi gaaCniaT. velyos balansi jgufs SigniT, daicvas jgufis mowy-
zogjer jgufs iyeneben, rogorc erTgvar mmarTvel vladi wevrebi da uzrunvelyos usafrTxoeba. garda
organos, romelic ayalibebs wesebs da cdilobs maT amisa, personalma unda uzrunvelyos is, rom jguf-
praqtikul ganxorcielebas. radgan didi zomis jgu- ma sakmarisi raodenobis aqtivobebi ganaxorcielos,
febs SeuZliaT intensiuri SfoTvis gamowveva rogorc raTa miagnos iseT aqtivobas, romelic TanamSrolo-
pacientebSi, ise saavadmyofos personalSi, maTTan mu- biTi urTierTobisa da pasuxismgeblobis aRebis Se-
Saoba did sifrTxiles moiTxovs. muSaobis ZiriTadi saZleblobas iZleva.
proncipebi hgavs mcire jgufebSi muSaobis principebs personologiuri aSlilobis samkurnalo zogierT
(ixileT zemoT). gansakuTrebuli yuradRebiT unda centrSi Seiqmna Terapiuli Temis dRis jgufebi (Ba-
movekidoT jgufis axali wevrebis Semzadebas maTT- teman, Fonagy. 1999, 2001). isini uzrunvelyofs damate-
vis axali jgufuri gamocdilebistvis, Sexvedrebze biT mxardaWeras dRis saaTebSi, maSin rodesac Temi
emociuri donis regulacias, mowyvladi adamianebis ar fuqncionirebs (daxurulia). es xdeba sxvadasxva
dacvas da daTmobaze wasvlas im adamianebTan, rom- saSualebis gamoyenebiT (mag., satelefono kontaqte-
lebic sakmarisad kargad ver grZnoben Tavs imistvis, bis gziT).
rom jgufur muSaobaSi miiRon monawileoba.
Cveneba da ukuCveneba
Terapiuli Temi Znelia Terapiul TemSi gamoyenebuli meTodebis mniSv-
Terapiul TemSi yoveli saerTo aqtivoba ganixile- nelobis Sefaseba. garda amisa, ar arsebobs klinikuri
ba, rogorc potenciuri cvlilebis wyaro. jgufis kvleviT miRebuli sakmarisi mtkicebuleba maTi efe-
wevrebi erTad cxovroben, muSaoben da TamaSoben da qturobis Sesaxeb. zustad ar aris cnobili, Tu visT-
Seicnoben sakuTar Tavs jgufis sxva wevrebis reaq- vis aris naCvenebi es midgoma, magram mainc iTvleba,
ciebis safuZvelze, romlebsac isini saerTo aqti- rom misi gamoyeneba rekomendebulia antisocialuri
vobebis dros amJRavneben. Temis usafrTxo garemoSi da mosazRvre anu labiluri pirovnuli aSlilobebis
myof jgufis wevrebs ubiZgeben, rom maT axali qceve- mqone pirebisTvis, romlebsac warsulSi wamaldamoki-
bis SesrulebaSi gaivarjiSon da sakuTari Tvalsazri- debuleba aReniSnebodaT (yvela Terapiul jgufSi mo-
sis garda, sxvisi Tvalsazrisic gaiTvaliswinon. xSi- qmedebs abstinenciis wesi, anu TerapiaSi monawileoba
rad ewyoba jgufuri Sexvedrebi. maqsuel jonsi, Te- daSvebulia mxolod im pirebisTvis, vinc ar moixmars
rapiis am formis erT-erTi avtori, Terapiul TemSi alkohols an fsiqoaqtiur nivTierebebs). es Tera-
damkvidrebul atmosferos cxovreba-swavlis situa- piuli midgoma ar gamoiyeneba mZime depresiis, hipo-
cias uwodebda (Jones, 1968). jgufSi, Cveulebriv, 20-30
kacia gaerTianebuli. jgufis wevroba 9-dan 18 Tvemde boqsi 22.9 Terapiuli Temis ZiriTadi
gastans. jgufSi momqmedi ZiriTadi principebia de- maxasiaTeblebi
mokratia, sinamdvilesTan dapirispireba, Semwynareb- araformaluri atmosfero. jgufSi muSaobas aregulirebs
loba da komunis wevroba (Rapaport, 1960). es principe- sul ramdenime wesi; personali araformaluradaa Cacmu-
li da araformalurad iqceva.
bi ganapirobebs jgufis specifikur maxasiaTeblebs,
romlebic boqs 22.9-Sia Camoyalibebuli. urTierTdaxmareba. jgufis wevrebi erTmaneTs exmarebian
ukeTesi cvlilebebisTvis.
personalis roli imaSi mdgomareobs, rom man uz-
Semwynarebloba. jgufis wevrebi tolerantobas iCenen
runvelyos ZiriTadi struqtura, romlis SigniTac iseTi qcevis mimarT, romelic, sxva viTarebaSi, maTTvis
jgufis wevrebs mouwevT urTierTqmedeba. personali miuRebeli iqneboda.
ufro aqtiuria, rodesac jgufSi konfliqti an pro- pirdapiroba da patiosneba. jgufis wevrebi uSualod rea-
blemebi warmoiSveba da naklebad aqtiuri, rodesac gireben nebismieri realuri faqtis damaxinjebasa da Ta-
vis motyuebaze.
jgufs efeqturi funqcionireba SeuZlia. personali
saerTo gadawyvetilebebi. jgufis wevrebi da personali
exmareba jgufis wevrebs gaigon sxva wevrebTan ur- iReben erTobliv yoveldRiur gadawyvetilebebs jgufis
TierTobis arsi. is, agreTve, uzrunvelyofs pro- gaZRolis, misi wevrebis qcevis da axali kandidatebis mi-
blemebis ganxilvas konstruqciul WrilSi. konfli- Rebis Sesaxeb.
qti, Ceulebriv, or saWiroebas Soris aRmocendeba. saerTo aqtivoba. Temis wevrebi gasweven `sastumros~ ti-
pis momsaxurebas, raTa Temis TiToeul wevrs hqondes sa-
jer erTi, pacients unda darTo neba ganaxorcielos muSao, romelic sxva wevrebis mimarT garkveul pasuxism-
iseTi qcevebi, romlebic xels uwyobs misi TviTcno- geblobas gulisxmobs.
_ 648 _
wyvilebis Terapia da ojaxuri Terapia
maniis, Sizofreniisa da persistentuli Zaladobis an sakuTari Rirebulebebi, Terapevti irCevs amocanaze
paranoiduli Tvisebebis mqone pirebis SemTxvevaSi. anu `samizne problemaze~ orientirebul midgomas.
TerapiaSi monawile potenciur wevrebs unda hqondeT wyvils evaleba im sirTuleebis identificireba, ro-
cvlilebis Zlieri motivacia da mzad unda iyvnen didi melTa gamosworebac mas surs.
xnis manZilze mkurnalobis CatarebisTvis. es ori moT- arsebobs ramdenime Terapiuli teqnika. isini gark-
xovna arTulebs im Terapiebis Sedegebis Sedarebas, veuli saxis Teoriul midgomebs efuZneba. es mid-
romelSic aseTi motivirebuli pacientebi agrZeleben gomebia fsiqodinamiuri, bihevioruli da sistemuri
mkurnalobas, im TerapiebTan SedarebiT, romelic pa- midgoma. garda amisa, arsebobs teqnikaTa kombinacia,
cientebs nakleb moTxovnebs uyenebs. romelic bolo or midgomazea dafuZnebuli.
pacientebis Semzadeba wyvilebis fsiqodinamiuri Terapia

nakleb savaraudoa, rom pacientebi droze adre gaam tipis fsiqoTerapiis mTavari idea imaSi mdgoma-
moeTiSebian Terapiul process, Tuki kargad ecodi- reobs, rom col-qmris qceva, urTierTobis dawyebis
nebaT, ras unda elodnen am procesisagan. Terapiuli pirveli dRidan, aracnobieri ZalebiT aris ganpiro-
Temis wevroba monawileebs gansakuTrebiT maRal moT- bebuli. TiToeuli adamiani irCevs iseT partniors,
xovnebs uyenebs. amis gamo, Temis potenciur wevrebs romelic, misi azriT, sakuTari Tavis ganuxorcie-
xSirad utareben axsna-ganmartebas winaswari gamokv- lebeli mxareebis Semavsebelia. rodesac partnioris
levis dros da awvdian Sesabamis werilobiT infor- SerCevis procesi warmatebulia, partniorebi avseben
maciasa da audio da video Canawerebs. zogierT paci- erTmaneTs, magram, zogjer, erT-erTi maTgani ver
ents sacdel vadas aZleven iqamde, sanam is srulad ar amarTlebs meores aracnobier molodins. magaliTad,
CaerTveba programaSi. colma SeiZleba gaakritikos qmari imis gamo, rom is
damatebiTi informaciistvis Terapiuli Temis Sesa- ar aris sakmarisad damoukidebeli da sakuTar TavSi
xeb ixileT Kennard (1998) da Campling (2001). darwmunebuli, radgan mas Tavad aklia es Tvisebebi.
garda amisa, partniorebma, SeiZleba, erTmaneTze sa-
wyvilebis Terapia da ojaxuri kuTari `me~-s arasasurveli aspeqtebi gadaitanon anu
is aspeqtebi, romlebic `moglejilia~ maT `me`-s da
Terapia
uaryofilia maT mier. magaliTad, qmarma, SeiZleba
wyvilebis Terapia Tavis colze gadaitanos sakuTari mowyvladoba, ro-
fsiqoTerapia wyvilebTan imis gamo tardeba, rom melsac is grZnobs, magram ar iRebs mas, rogorc saku-
konfliqturi urTierToba SeiZleba erT-erT part- Tari Tavis nawils.
niorTan emociuri aSlilobis mizezi gaxdes, an kidev am dros gamoyenebuli Terapiis mizania daexmaros
imis gamo, rom urTierTobis xarisxi aradamakmayofi- TiToeul partniors sakuTari emociuri moTxovni-
lebelia, ris gamoc urTierToba SeiZleba gawydes, lebebis gagebaSi da imis garkvevaSi, Tu rogor `mo-
xolo partniorebs uRirT misi SenarCuneba. TiTqos eqces~ sxvebis emociur moTxovnilebebs. es SeiZleba
da martivi gadasvla individualuri Terapiidan Te- ramdenime gziT ganxorcieldes. partniorebTan, SeiZ-
rapiis iseT formaze, romelic wyvilebTan tardeba, leba, erTdroulad muSaobdes erTi an ori Terapevti
mnSivnelovan konceptualur gansxvavebas gulisx- (meore SemTxvevaSi, TiToeuli Terapevtis interesis
mobs, radgan Tu pirvel SemTxvevaSi problema erTi sagans erT-erTi partniori Seadgens) an kidev part-
adamianiT Semoifargleba, meore SemTxvevaSi is ori niorebTan, SeiZleba, cal-calke muSaobdes ori Te-
adamianis mier aris gaziarebuli. aseT dros arsebu- rapevti. ukanasknel SemTxvevaSi, es ori Terapevti
li problema ori adamianis urTierTqmedebis wesis regularulad xvdeba erTmaneTs mkurnalobis pro-
rezultadad ganixileba da mkurnaloba swored am cedurebis SesaTanxmeblad. Terapevtis roli ufro
urTierTqmedebazea mimarTuli. urTierTobis Sefase- aqtiuria wyvilebTan muSaobisas, vidre individualur
bisas, sasargebloa iseTi Temebis gaanalizeba, rom- pacientebTan fsiqodinamiuri midgomis gamoyenebis
lebic yvela saxis urTierTobisTvisaa mniSvnelovani. dros. garda amisa, interpretacia ufro metad exe-
aseTi Temebia Rirebulebebis gaziareba, keTildReo- ba partniorebis urTierTobas, vidre gadatanis pro-
bis mniSvneloba, partnioris pirovnuli ganviTareba, cess, romelSic Terapevtia CarTuli.
tolerantoba gansxvavebebis mimarT, gadawyvetilebis wyvilebis fsiqodinamiuri Terapiis mimoxilva Sem-
miReba. unda gvaxsovdes, rom qorwinebaTa da xangrZ- deg wyaroSia mocemuli: Scharff, Scharff, 2001.
livi urTierTobebis umravlesoba sam stadias gaiv-
wyvilebis sistemuri Terapia
lis. esaa Tanacxovreba, Svilebis gazrda da xelaxa-
sistemuri Terapia mimarTulia im farul wesebze,
li adaptaciis gavla, mas Semdeg rac Svilebi ojaxs
romlebic aregulirebs mewyvileebis qcevas erTmane-
datoveben. imistvis, rom pacientma Tavs ar moixvios
_ 649 _
Tis mimarT, uTanxmoebaze imis Sesaxeb, Tu vin adgens adReba~ _ aRweris Seuferebeli formaa). partniorebi
am wesebs da winaaRmdegobaze urTierTqmedebis am or Tanxmdebian, Tu ra saxiT daajildoveben erTmaneTs sa-
`dones~ Soris. am konteqstSi mniSvnelovani cnebebia surveli qcevis Sesrulebisas. jildo unda gamoxatav-
sxva adamianTan gaTqvefa anu zedmeti CarTuloba mis des siyvarulsa da mowonebas, an iseT qmedebaSi unda
problemebSi da mizez-Sedegobrivi ciklis cneba, ro- gamoixatebodes, romelic mewyvilesTvisaa sasurveli.
melic imas gulisxmobs, rom arasodes ar unda xdebo- urTierTgacvlis aseT process `reciprokuli molapa-
des mxolod erTi partnioris dadanaSauleba. moce- rakeba/garigeba~ ewodeba. garda amisa, mewyvileebs ex-
mul cnebebs ganixilaven im konfliqtebTan mimarTe- marebian imaSi, rom maT uSualo komunikacia daamyaron
baSi, romlebic wyvilis urTierTobaSi aRmocendeba erTmaneTTan, mousminon erTmaneTs da ufro mkafiod
(mag. vin iRebs gadawyvetilebas imis Taobze, Tu sad gamoxaton TavianTi survilebi. Terapiis mocemuli
unda gaataros wyvilma Sevebulebada rogor gadawy- formis aseTi saxiT warmodgenili reziume ufro gari-
vets wyvili imas, Tu vin iqneba gadawyvetilebis mim- gebasa da vaWrobas hgavs, vidre moyvaruli adamianebis
Rebi piri). am gziT wyvils exmarebian TanamSromlo- urTierTobas, magram praqtikuli ganxorcielebisas, is
biTi da gawonasworebuli urTierTobis damyarebaSi. exmareba wyvils TanamSromlobaSi da iseTi usargeblo
zogi Terapevti iyenebs e.w. `paradoqsul davalebebs~ Cvevebis daZlevaSi, rogoric erTmaneTis kritika da wu-
anu provokaciul winadadebebs. maTi funqciaa sasar- wunia. amis Sedegad partniorebs ufro dadebiTi gan-
geblo ukureaqciis gamowveva, romelsac, wyvili adre cdebi uCndebaT erTmaneTis mimarT. mocemuli meTodi
gaurboda. am procesSi SeiZleba erTma an orma Tera- aRwerilia stiuartis mier (Stuart, 1980). zogierTi Te-
pevtma miiRos monawileoba, magram muSaoba yovelTvis rapevi, damatebiT, iyenebs bekis Teoriaze damyarebul
or partniorTan erTdroulad xdeba. mocemuli me- kognitur midgomas (Beck, 1988). wyvilebTan kognitur-
Todi Semdeg naSromSia ganxiluli: Haley, 1963. bihevioruli Terapiis gamoyeneba Semdeg wyaroSia ganxi-
luli: Darttilio, 2005.
wyvilebis kognitur-bihevioruli Terapia
am saxis Terapia xanmokle da Zalze struqturirebulia. wyvilebis biheviorul-sistemuri Terapia
is operantuli ganpirobebis principebzea damyarebuli. aq aRwerili midgoma qrous (Crowe) ekuTvnis. is gan-
Terapevti cdilobs imis dadgenas, Tu ranairad xdeba kuTvnilia wyvilebis im problemebze samuSaod, rom-
erTmaneTis mimarT ganxorcielebuli qcevis aracno- lebic fsiqiatriul praqtikaSi gvxvdeba. mocemuli
bierad ganmtkiceba misi Sedegebis mier. TiToeulma midgoma detalurad aris Semdeg wyaroSi aRwerili:
mewyvilem unda daasaxelos is alternatiuli qcevebi, Crowe, Ridley, 1990. rogorc am midgomis saxelwodebi-
romelic surs rom ganaxorcielos misma partniorma. dan Cans, is ori rigis komponentebs moicavs. qcevTi
es qcevebi, rac SeiZleba zustad unda iqnas aRwerili. komponentebia `reciprokuli molaparakeba~ (ix. ze-
magaliTad, sasurveli qcevis aRwera aseTi saxiT unda moT) da treningi komunikaciaSi. sistemuri komponen-
xdebodes: `damelaparakos naxevari saaTis ganmavloba- tebia `struqturuli nabijebi~ (ix. qvemoT), ganrigi,
Si samsaxuridan dabrunebis Semdeg~ (`momaqcios yur- amocanebi da paradoqsebis gamoyeneba. es komponente-
wyvilis maxasiaTeblebi:
meti simptomebi
individualuri fokusi
sistemis sixiste
7. Terapiis Sewyveta an Terapiis

sxva formis gamoyeneba
6. simptomTan Segueba
5. paradoqsi
4. sistemuri amocanebi
3. struqturuli nabijebi
2. treningi komunikaciaSi
suraTi 22.1 intervernciis ierarqiis 1. reciprokuli molaparakeba

mzardi doneebi. Crowe, 2000. mo
dificirebuli versia.
Terapiuli intervencia: ufro metad saWiroebs fsiqoTerapevtis kreatiulobas
naklebad eyrdnoba wyvilis mier gancxadebul miznebs
_ 650 _
bi gaerTianebulia mzardi sirTulis mixedviT. Tavi- sistemuri amocanebi exeba zedmetad xSir an iSviaT
dan gamoiyeneba umartivesi procedurebi, romlebic, urTierTobas. partniorebi adgenen drois grafiks,
saWiroebis SemTxvevaSi, TandaTanobiT rTuldeba. ga- romelSic, garkveul urTierTqmedebas garkveuli six-
mosaxuleba 22.1-Si naCvenebia am procedurebis kombi- Sire miewereba. magaliTad, Tu wyvili erTad ar atarebs
naciaTa Tanmimdevroba. bihevioruli meTodebi ufro im dros, romelic ar aris individualuri saqmianobist-
martiv SemTxvevebSi gamoiyeneba, xolo SedarebiT vis gankuTvnili, partniorebi Tanxmdebian im droze,
kompleqsuri sistemuri procedurebi damatebiT Se- romelsac erTad gaatareben (Tanac ise, rom maTi yur-
moaqvT iseTi wyvilebistvis, romlebsac ufro meti adReba sxva arafriT iqneba dakavebuli). Tu erT-erTi
simptomi aReniSnebaT, naklebad surT, rom Terapia partniori mudmivad Civis raimes Sesaxeb, partniorebi
maT urTierTobaze iyos fokusirebuli da urTierTq- Tanxmdebian, rom Civilis gamoxatva mxolod garkveul
medebis ufro xisti paterni axasiaTebT. mrvali aseTi dros moxdeba da rom meore partniori, mzad aris mous-
procedura ukve zemoT iyo aRwerili. minos Civils winaswar gansazRvrul dros.
Terapia, Cveulebriv, 5-10 seanss moicavs da 3-6 Tve paradoqsi. paradoqsebis gamoyeneba zemoT iyo ganx-
grZeldeba. Terapevtma unda daamyaros urTierToba iluli. paradoqsuli davalebebi mxolod maSin unda
orive partniorTan, arc erTs ar unda mianiWos upi- mivceT pacients, rodesac Cvens mier ganzaraxuli
ratesoba da arc erTis mxare ar unda daikavos. Tera- Sedegis garda, yvela sxva SesaZlo Sedegsac gaviT-
pevtis yuradReba wyvilis urTierTqmedebazea mimarTu- valiswinebT. garda amisa, am saxis davalebis micema
li, raTa daexmaros mas Secvalos urTierTobis stili. zrunvis gamoxtvis pirobebSi unda xdebodes. zogjer
Terapevti damdgmeli reJisoris rolSi ufro gamodis, paradoqsi `simptomis gamoweraSi~ mdgomareobs. Tera-
vidre molaparakebis monawilis. is ubiZgebs mewyvileebs pevti eubneba wyvils gaagrZelos problemuri qcevis
Terapevtis nacvlad erTmaneTs esaubron da akeTebs ko- ganxorcieleba da daasaxelos am qcevis iseTi mizezi,
mentars seansis ganmavlobaSi maT moqmedebasa da saubar- romelic wyvilistvis aris miuRebeli. erT-erT wy-
ze. sirTule Cndeba iseT wyvilebTan muSaobisas, rom- aroSi mocemul magaliTSi Terapevti eubneboda qron-
lebsac kargad SeuZliaT komunikacia inteleqtualuri ikul depresiaSi myof pacients da mis pasiur cols,
sakiTxebis irgvliv, magram ara sakuTar grZnobebTan rom coli swored ise unda moqceuliyo, rogorc is
dakavSirebiT. aseT SemTxvevaSi, erT-erTi maTganistvis iqceoda, radgan, sapirispiro SemTxvevaSi, is da misi
kiTxvebis dasmis nacvlad, sjobs vTxovoT mewyviles, meuRle mudmivad uTanxmoebaSi iqnebodnen (Crowe,
rom mas kiTxvebi dausvas. magaliTad: `xom ver hkiTxav 2000). interevencia (romelic, am SemTxvevaSi warmate-
jons, ras fiqrobs Sens naTqvamze?~ seansi, Cveulebriv, buli gamodga), miznad isaxavda colis waqezebas, raTa
mTavrdeba mocemuli wyvilistvis gankuTvnili Semaja- is ufro aqtiuri da asertuli gamxdariyo.
mebeli SetyobinebiT. es Setyobineba mewyvileebma Sin unda gvaxsovdes, Tu ramdenad mniSvnelovania Ti
dabrunebisas erTad unda ganixilon. Toeuli partnioris pirovnebis gageba sarisko para-
doqsuli davalebis micemamde, romelsac yovelTvis
specialuri teqnika
SeiZleba ganzraxulis sapirispiro efeqti mohyves.
struqturuli nabijebi moicavs iseT davalebebs, ro- damatebiTi informacia wyvilebis bihevioruli-siste-
goricaa uTanxmoebis gamoxatva, gacvlili rolebis muri Terapiis Sesaxeb mocemulia Semdeg wyaroSi:
gaTamaSeba da gamoqandakeba. wyvilebs SeiZleba sTxo- Crowe and Ridley, 1990.
von, ar daeTanxmon erTmaneTs raime sakiTxTan daka-
vSirebiT iseT SemTxvevaSi, rodesac erTi partniori araformaluri midgoma
dominirebs meoreze, xolo es ukanasakneli, Cveu- praqtikulad, mraval wyvils ufro araformaluri saxiT
lebriv, midis daTmobaze uTanxmoebis Tavidan ac- exmarebian. Cveulebriv, gamoiyeneba zogadi principebi,
ilebis mizniT. am SemTxvevaSi uTanxmoebis mizezi mniS- romlebic zemoTaa aRwerili, da intervencia ifargleba
vnelovani ar aris. mTavaria, rom pasiur partniors im procedurebiT, romlebic gamosaxuleba 22.1-Si war-
davexmaroT azris mtkiced gamoxatvaSi, xolo meore modgenili ierarqiis dabal dones Seesabameba.
partniors _ am azris dafasebaSi. rolebis gacvla ex-
wyvilebis Terapiis Sefaseba
mareba erT partniors meores Tvalsazrisisa da ga-
mocdilebis gagebaSi. gamoqandakebisas partniorebi wyvilebis Terapiis gamoyeneba, ZiriTadad, klinikuri
usityvod iReben raime pozas, raTa TavianTi urTier- praqtikiT miRebul STabeWdilebas efuZneba, radgan mis
Tobis zogierTi mxare moZraobiT gamoxaton. magali- Sesafaseblad Zalian cota klinikuri gamokvlevaa Cat-
Tad, erT-erTma partniorma, SeiZleba gamoxatos urT- arebuli. erT-erT mimoxilvaSi (Baucom, 1998) naTqvamia,
ierTobis Sedegad gancdili ukmayofileba erTmaneTis rom col-qmarTan Terapiis Catareba ufro efeqturia,
gverdi-gverd mjdomi ori figuriT, romlebic erTma- vidre Terapiuli intervenciisagan Tavis Sekaveba. ker-
neTisagan sapirispiro mimarTulebiT iyurebian. Zod, bihevioruli da insaiTze orientirebul wyvilebis
_ 651 _
Terapia met-naklebad Tanabrad efeqturia. qceviT Tera- blebTan mcxovreb axalgazrdebs. es problemebi
pias mohyva gaumjobeseba aRwerili SemTxvevebidan ori- xSirad ukavSirdeba ojaxis wevrebs Soris komunika-
mesamedis SemTxvevaSi. lefma da misma kolegebma (Leff et ciis sirTules, zogjer ki isini roluri xasiaTisaa.
al., 2000) daadgines, rom wyvilebis Terapiis eklekturi zrdasruli pirebis fsiqiatriul praqtikaSi xSirad
forma iseve efeqturia, rogorc antidepresantebiT mimarTaven ojaxuri Terapiis kombinacias mkurnalo-
mkurnaloba depresiis mqone pacientebTan, romlebic maT bis sxva meTodebTan (mag, depresiis dros antidepre-
mimarT kritikul partniorTan erTad cxovroben. santebis gamoyenebasTan). ojaxuri Terapia gamoiyene-
wyvilebis Terapiis istoriuli mimoxilva mocemu- ba zogierT axalgazrdasTan, romelsac nervuli an-
lia Semdeg wyaroSi: Gurman, Fraenkel, 2002. oreqsia aReniSneba (mas Semdeg, rac misi wona aRdgeba
sxva saSualebebis gamoyenebiT) (gv. ??). Sizofreniis
ojaxuri Terapia dros recidivebis Sesamcireblad SemuSavda ojaxuri
am tipis mkurnalobaSi monawileobas iRebs ojaxis Terapiis specialuri meTodi (gv. ??).
ramdenime an yvela wevri. Cveulebriv, masSi monawil-
eobs orive mSobeli, xSirad im SvilTan erTad, romlis
fsiqodinamiuri ojaxuri Terapia
problemebma ojaxi TerapevtTan miiyvana. garada amisa, am meTodis safuZvlad ganixileba mosazreba, romelic
ojaxur TerapiaSi SeiZleba CarTuli iyos gafarToe- SemdegSi mdgomareobs: ojaxis axlandeli problemebi
buli ojaxis wevrebi: Svilebi, bebia-babua da sxvebi. momdinareobs ojaxis calkeuli wevris, gansakuTrebiT
mkurnalobis mizezi ojaxis funqcionirebis gaumjobe- ki mSoblebis, individualuri warsuli gamocdilebi-
seba da identificirebuli pacientistvis daxmarebis dan. amJamindeli problemebi nawilobriv aRmocendeba
gawevaa. radaganac Terapiis warmateba ramdenime ada- ojaxis calkeuli wevrebis aracnobieri intraperson-
mianis TanamSromlobazea damokidebuli, Terapiis ga- aluri konfliqtebidan. ojaxis wevrebma unda gaigon am
moTiSvis maCvenebeli _ maRalia. ojaxis Terapevtebi, konfliqtebis buneba, Tu surT TavianTi qcevis Secv-
romlebic sxvadasxva meTodebs iyeneben, ojaxTan daka- la. Terapevtis amocanaa daexmaros ojaxis TiToeul
vSirebiT ramdenime mizans isaxaven. esenia: wevrs amgvari insaiTis miRwevaSi da imis gaazrebaSi, Tu
rogor zemoqmedebs erTmaneTze misi individualuri
w komunikaciis gaumjobeseba;
da ojaxuri problemebi. Terapevti amas axorcielebs
w TiToeuli wevris avtonomiurobis gazrda;
TiToeul ojaxis wevrTan sakuTari urTierTobis gaan-
w rolebTan dakavSirebiT ufro maRali xarisxis
alizebiT. am dros Terapevti iyenebs aradireqtiul
Tanxmobis miRweva;
meTods, romelic ganxilulia qveTavSi individualuri
w konfliqtis Semcireba;
ojaxuri Terapiis Sesaxeb (gv. ??).
w distresis Semcireba ojaxis im wevrSi, romelic pa-
msgavsi midgoma SeimuSava skinerma (Skynner, 1991)
cientis rolSi imyofeba.
obieqtTan urTierTobis Teoriaze dayrdnobiT (gv.
ojaxuri Terapiis istoria 1950-an wlebSi iwyeba.
??). skineri yuradRebas amaxvilebda imaze, Tu rogor
iTvleba, rom is ori wyarodan iRebs saTaves. es gax-
zemoqmedebs mSoblis bavSvobisdroindeli gamoc-
lavT akermanis (Ackerman, 1958) gavleniani wigni The
dileba SvilebTan urTierTobaze. magaliTad, dedas,
psychodynamics of family life (ojaxuri cxovrebis fsiqo-
romelsac bavSvobaSi dedobrivi zrunva moaklda, Sei-
dinamika) da beitsonisa da misi kolegebis naSromi ko-
Zleba SeumuSavdes `proeqciuli sistema~, anu iseTi
munikaciaze, romelic zemoT iyo naxsenebi. akermanis
molodinebi, romlebic bavSvobisdroindeli gamoc-
naSromma safuZveli daudo mkurnalobis fsiqodina-
dilebiTaa ganpirobebuli da ara axlandeli realo-
miur meTods, xolo beitsonis Terapiam _ sistemuri
biT. proeqciuli sistemebi ganapirobeben mSoblebis
midgomis Camoyalibebas. es ukanaskneli midgoma aSS-
urTierTobas erTmaneTTan da TavianT SvilebTan.
Si ganaviTara salvador minuxinma, romelmac Seqmna
zogjer konfliqti mSoblebis proeqciul sistemebs
struqturuli ojaxuri Terapia, rogorc praqtikuli
Soris gadawydeba proeqciis sakuTar Svilze warmarT-
midgoma problemis gadaWris mimarT. italiaSi, mila-
viT. am sistemebis identifikaciiT, Terapevti exmare-
nis skolaSi, SeimuSaves ojaxis sistemis hipoTeza,
ba ojaxs konfliqtis gadaWraSi.
rogorc cvlilebis gamowvevis saSualeba. es midgome-
bi eklektur midgomasTan erTad qvemoT aris mokled struqturuli ojaxuri Terapia
ganxiluli. (damatebiTi informaciisTvis ixileT Tavi termini òjaxis struqtura~ aRniSnavs nagulisxmevi
Bloch da Harrari-is avtorobiT, 2005; da, agreTve, Gur- wesebis eTobliobas, romlebic aregulireben ojaxis
man-is mier redaqtirebuli wigni, 2003). wevrebis urTieTobas. zogierTi wesi gansazRvravs
ojaxis ierarqias (mag., mSoblebs Svilebze meti pasux-
ojaxuri Terapiis Cvenebebi da ukuCvenebebi
ismgemloba akisriaT da ufro meti uflebamosileba
ojaxuri Terapia, ZiriTadad, gamoiyeneba im pr-
aqvT). zogi wesi gansazRvravs TanamSromlobas ojaxis
blemebis mosavlelad, romlebic aReniSnebaT mSo-
_ 652 _
wevrebs Soris (magaliTad, dedisa da mamis zogierTi erTmaneTs unda daaaxlovos.
amocana da pasuxismgebloba gaziarebulia, zogi ki _ sistemur midgomas akritikeben imis gamo, rom, is,
individualuri). zog ojaxSi orive mSobeli gansaz- erTi mxriv, ar iTvaliswinebs warsul gamocdilebas
Rvravs qcevis wesebs da kicxavs bavSvebs, rodesac da aracnobier motivebs, xolo, meores mxriv, ugule-
isini am wesebs arRveven, zog ojaxSi ki mama ufro belyofs iseTi qmediTi faqtorebis zegavlenas, ro-
mkacri mSobelia. wesebiT, agreTve, sazRvrebis dad- goric umuSevroba da siRaribea.
genac xdeba. zogjer xdeba wesebis darRveva (magali- milanis skolis midgomiT Catarebuli sistemuri
Tad, qmarTan urTierTobaSi problemebis mqone coli ojaxuri Terapiis Sedegebis Sefasebam (aTi gamokv-
sakuTar Svils am problemebSi CaiTrevs). struqtu- levidan xuTSi sakontrolo jgufi iyo gamoyenebu-
rul ojaxur TerapiaSi hopoTezebs aseTi wesebis Ses- li) aCvena, rom Terapiis mocemuli meTodi iseTive
axeb, xSirad, ojaxs, paradoqsuli saxiT awvdian (mag. efeqturia, rogorc ojaxuri Terapiis sxva meTodebi.
`rogorc Cans Zalian xarT Tqvens colze damokide- pacientebis daaxloebiT or mesamedSi SeiniSneboda
buli. ras akeTebs is iseTs, ris gamoc Tqven nakleb simptomebis gaumjobeseba, xolo ojaxebis daaxloe-
unarianad ganicdiT sakuTar Tavs?~). am tipis Careva, biT naxevarSi gaumjobesda funqcionirebis xarisxi.
romelic xanmokle drois manZilze Zabavs ojaxur zogadad, am Sedegebis miRebas aTze naklebi seansi
urTierTobas, cvlilebis gamowvevis mizniT tardeba. dasWirda (Carr, 1991).
sistemuri ojaxuri Terapia eklekturi ojaxuri Terapia

sistemuri ojaxuri Terapia exeba ojaxis amJamindel yoveldRiur klinikur praqtikaSi da, gansakuTrebiT,
funqcionirebas da ara misi wevrebis warsul gamoc- mozardebTan muSaobisas, praqtikulia mokle meTo-
dilebas. Terapevtis amocanaa daadginos ojaxis dau- debis gamoyeneba mcire drois manZilze. es meTodebi
wereli kanonebi, ojaxis wevrebis uTanxmoeba imasTan miznad isaxavs SezRuduli raodenobis cvlilebebis
dakavSirebiT, Tu vin unda adgendes am kanonebs da gamowvevas ojaxis cxovrebaSi. aseT dros koncentra-
maTi komunikaciis darRveuli paterni. Terapevti ex- cia unda movaxdinoT ojaxis amJamindel viTarebaze
mareba ojaxs gaacnobieros da Secvalos aseTi wesebi da gavaanalizoT, Tu ra saxiT urTierToben ojaxis
da gaaumjobesos komunikacia. wevrebi erTmaneTTan. is Tu, ojaxis ramdeni wevri unda
milanis skolis midgomaSi am sakiTxis mimarT aseTi CavrToT Terapiul procesSi damokidebulia praqti-
praqtika arsebobs (Palazzoli et al., 1978): Cveulebriv kul mosazrebebze. magaliTad, zogierTi bavSvi zed-
ewyoba 5-10 Terapiuli seansi erTi Tvis intervaliT metad pataraa, xolo zogi _ saxlidan Sors imyofeba.
(`gaxangrZlivebuli xanmokle Terapia~). xSirad, ojax- intervali seansebs Soris Seicvleba iqidan gamomdin-
is gamokvlevisas, wriul gamokiTxvas iyeneben. am te- are, Tu ramdeni dro sWirdeba ojaxs im problemebze
qnikis gamoyenebisas erT pirovnebas sTxoven komen- samuSaod, romlebic Terapiul seansebze aRmocenda.
taris gakeTebas ojaxis sxva wevrebis urTierTobebze.
magaliTad, dedas SeiZleba hkiTxon, Tu rogori urT- gamokvleva
ierToba aqvs mis qmars maT vaJiSvilTan, xolo ojaxis gamokvleva iwyeba ojaxis struqturis dadgeniT, ro-
danarCen wevrebs sTxoven gaakeTon komentari dedis melic, sqematurad, genogramiT gamoixateba. geno-
reaqciaze. mizani konfliqturi da winaaRmdegobri- gramaSi konvenciuri simboloebia gamoyenebuli (ix.
vi Sexedulebebis gamoaSkaravebaa. amis safuZvelze gamosaxuleba 22.2). Semdgomi kiTxvebi exeba ojaxis
aigeba hipoTeza ojaxis funqcionirebis Sesaxeb. mag- awmyo da warsul cxovrebas da ojaxis wevrebis ro-
aliTad, SeiZleba aRmoCndes, rom sazRvari mSoblisa lebs. gamoiyeneba gamokiTxvis ramdenime saxe: wri-
da Svilis qvesistemebs Soris darRveulia, ramdena- uli gamokiTxva (ix. zemoT); kiTxvebis dasma ojaxis
dac, erT-erTi mSobeli, erT-erT SvilTan zedmetad wevrebis rolebis Sesaxeb (vin zrunavs sxvebze, vin
mWidro aliansSi imyofeba. aseT hipoTezebs ojaxs ac- nerviulobs yvelaze metad, vin iRebs gadawyvetilebas
noben da sTxoven, rom isini seansebze da seansebs So- da sxva); kiTxvebis dasma triaduli urTierTobebis
ris ganixilos. ojaxs, SeiZleba, moTxovon axleburad Sesaxeb (mag. ras akeTebs A, rodesac B akritikebs
daiwyos moqceva. zogjer Terapevti axdens cvlile- C-s). agreTve, kiTxvebi SeiZleba exebodes reaqcias
bebis provocirebas paradoqsuli davalebis meSveo- warsulSi momxdar cvlilebebze (magaliTad, babuis
biT. amiT is ubiZgebs ojaxs gamoiwvios cvlilebebi, gardacvaleba).
rasac sxvagvarad ver moaxerxebda. magaliTad, Tu Terapevti cdilobs pasuxi gasces or kiTxvas: (1)
pacienti SiSobs, rom misi mSoblebi erTmaneTs gaS- rogor funqcionirebs ojaxi da (2) monawileobs Tu
ordebian, paradoqsuli davaleba SeiZleba imaSi md- ara ojaxuri faqtorebi pacientis problemebSi. blo-
gomareobdes, rom pacientma Terapevts daumtkicos qi da harari (Bloch, Harrari, 2005) gvTavazoben sasarge-
sakuTari azris simcdare, risTvisac, man mSoblebi blo sqemas am kiTxvebis gansaxilvelad:
_ 653 _
mamakaci qali Sinameurneobis Semadgenloba
daq. 1965
pacienti ganq 1980
daq. 1987
gaS 1988 ganq 1990
daq. 1948 wels
daqorwinebuli gaSorebuli/ ganqorwinebuli
d. 1979
ganq 1980
1987
urTierTobebi
ganqorwinebuli da xelaxla daqorwinebuli
Zalian axlo/Sekruli
1979
erTad mcxovrebi, dauqorwineblebi konfliqturi
1950
gardacvlili
gaucxoebuli axlo
1948
naSvilebi mkvdradSobili
bavSvebi
suraTi 22.2 genogramis agebisas gamoyenebuli simboloebi
1. rogor funqcionirebs ojaxi? intervencia

w struqtura aRiricxeba genogramaSi (mag. mart
Terapevti uTanxmdeba ojaxis wevrebs cvlilebis
oxela mSobeli; dedinacvali/maminacvali, da-Zme
miznebze, anu imaze, Tu ra unda Seicvalos. maT sTxoven
bis raodenoba da maTi asakis amplituda).
gaiTvaliswinon is, Tu ranairad imoqmedebs nebismieri
w cvlilebebi da movlenebi: dabadeba, gardacvaleba,
cvlileba maTze da sxva adamianebze da ram SeuSala
ojaxis datoveba (sacxovrebeli adgilis Secvla)
ojaxs xeli aseTi cvlilebebis ganxorcielebaSi.
da finansuri problemebi;
Terapevts, agreTve, SeuZlia paradoqsuli davalebebis
w urTierTobebi: axlo, Soreuli, moyvaruli, kon
teqnikis gamoyeneba, magram es mxolod mas Semdeg unda
fliqturi.
moxdes, rac is guldasmiT ganixilavs am teqnikaze
w urTierTqmedebis paterni: moicavs or an met ada
yvela SesaZlo reaqcias. Terapevts unda axsovdes,
mians; magaliTad, baSvs, romelic iWers erT-erTi
rom saxlSi dabrunebis Semdeg ojaxi, savaraudod,
mSoblis mxares meores winaaRmdeg.
gaagrZelebs igive saxis urTierTqmedebas, rac Terapiis
2. monawileobs Tu ara pacientis problemebSi ojaxuri dros xorcieledeboda, amitom man unda uzrumvelyos,
faqtorebi: rom aseTma urTierTobebma ar warmoSvas damatebiTi
w reaqcia pacientis problemebze _ magram aq SeiZleba problemebi.
kavSirSi ar myofi problemebic monawileobdes;
w pacientis mxardaWera; ojaxuri Terapiis Sedegebi
w wvlilis Setana pacientis problemebSi. mag., ojaxuri Terapiis 19 gamokvlevis Sedegebis meta-
qaliSvilis problemebi, romelsac ar SeuZlia analizma aCvena, rom miRebuli efeqti SesaZlebelia
martoxela dedis datoveba. Sedardes sxva meTodiT Catarebuli fsiqoTerapiis
pasuxs am kiTxvebze mivyavarT hipoTezasTan imis Sedegebs. im pacientebis 75%-Tan, romelsac ojaxuri
Sesaxeb, Tu ra unda Seicvalos da risi Secvlaa Terapia Cautarda, ukeTesi Sedgebi iqna miRweuli,
SesaZlebeli. vidre msgavs pacientebTan, romlebTanac gamoiyenes
_ 654 _
sxva saxis fsiqologiuri mkurnaloba
minimaluri intervencia an intervencia saerTod ar bavSvobisdroindeli nevrotuli aSlilobisas da
yofila gamoyenebuli (Markus et al., 1990). rogorc Cans, sxva mravali Sereuli aSlilobis dros umjobesia
bavSvebsa da mozardebTan ojaxuri fsiqoTerapiis analitikuri teqnikis gamoyeneba, raTa moxdes aS
gamoyeneba efeqturia kvebiTi aSlilobebis, fsiqo lilobis aracnobieri Sinaarsis identifikacia da
aqtiuri nivTierebebis borotad moxmrebisa da qce misi imgvari interpretacia, romelic xels Seuwyobs
viTi aSlilobis dros. (damatebiTi informacia ixi egos funqciis gaZlierebas. ana froidis Tvalsazrisi
leT, Cottrel, Boston, 2002). monacemebi, fsiqiatriaSi bavSvis analizis Sesaxeb mokle saxiTaa warmodgenili
ojaxuri Terapiis gamoyenebis Sesaxeb, mocemulia Semdeg wyaroSi: Freud, 1966 (Tavi 2 da 6).
Semdeg wyaroSi: Bloch, Harari; (2000). britaneTSi bavSvebTan muSaobisas, ZiriTadad, ek
lektur Terapias iyeneben. Terapevti cdilobs bav
bavSvTa fsiqoTerapia SvTan kargi urTierTobis damyarebas da misi azrebisa
zemoTaRwerili fsiqoTerapiuli meTodebi ar mie da gancdebis gagebas, nawilobriv, masTan saubrisa da
sadageba iseT bavSvebs, romlebsac sakmarisi xarisxiT misi mosmenis gziT, nawilobriv ki, TamaSis meSveobiT.
ara aqvT ganviTarebuli verbaluri unar-Cvevebi. ufrosi asakis bavSvebs SeuZliaT mozrdilebTan
Tumca, realurad, am populaciasTan mocemuli tipis verbaluri komunikaciis damyareba, magram umcrosi
fsiqoTerapiis gamoyenebas bevrad naklebi sirTule asakis bavSvebs ukeT SeuZliaT komunikacia qmedebis
ukavSirdeba, vidre es mosalodnelia, radgan Seda meSveobiT (TamaSis CaTvliT). Terapevts SeuZlia,
rebiT dabali asakis bavSvebis emociuri xasiaTis daexmaros bavSvs ipovos azrebisa da grZnobebis
problemebi meoradia maTi mSoblebis problemebis gamomxatveli sityvebi, rac mas am azrebisa da
mimarT, ris gamoc, ufro mizanSewonilia Terapia grZnobebis kontrolsa da Secvlas gauadvilebs. am
mSoblebze warimarTos. dros mniSvnelovania, rom Terapevtis intrepretacia
zog fsiqoTerapevts miaCnia, rom Tu zrdasrulTa asaxavdes bavSvis azrebs da interpretaciisas ar
TerapiaSi Terapevti sityvebs iyenebs, bavSvTa xdebodes bavSvistvis ucxo azrebis Tavs moxveva.
TerapiaSi man TamaSi unda gamoiyenos. melani klainma bavSvis fsiqoTerapia SemdgomSi 24-e TavSia ganxi
safuZvlianad daamuSava es midgoma. is xSirad luli, romelic bavSvis fsiqiatrias eZRvneba (gv. ??).
mimarTavda TamaSis dros bavSvis qmedebis simboluri damatebiTi informaciistvis ixileT Target et al., 2005.
mniSvnelobebis fsiqoanalitikur interpretacias da
cdilobda am qmedebebis dakavSirebas im grZnobebTan, xandazmuli pirebis fsiqoTerpia
romlebsac bavSvi Tavis mSobelebis mimarT ganic fsiqologiuri mkurnaloba sul ufro xSiradaa Car
dida. miuxedavad Tavisi originalobisa, es midgoma Tuli xandazmuli pirebisaTvsi gankuTvnili mzrun
Zalzed spekulaciuria, radgan ar arsebobs empi velobis gegmaSi. Tu xandazmuli piris kognituri
riuli masala, romlis safuZvelzec SesaZlebeli funqciebi ar aris dazianebuli, mas SegviZlia
gaxdeboda interpretaciis sisworis Sefaseba. ana CavutaroT nebismiri mkurnaloba, romelic ufro
froidis mier SemuSavebuli fsiqoTerapiuli midgoma dabali asakis mozrdili adamianebisTvis aris gan
warmoadgens Tavisi mamis mier Seqmnili teqnikis kuTvnili. kognituri Terapiis gamoyenebisas gaiTva
naklebad radikalur adaptacias bavSvis saWiroebebis liswineT Semdegi: kognituri fuqnciis arsebuli
mimarT. ana froidi kargad acnobierebda bavSvebTan daqveiTeba SeiZleba sakmaod umniSvnelo iyos imistvis,
fisqoanalizis Catarebis specifikur sirTules. is rom man adamianis fuqncionirebis saerTo doneze
imaSi mdgomareobs, rom bavSvs ar aqvs verbaluri iqonios zegavlena, magram sakmarisi iyos imistvis,
Tavisufali asociaciebis producirebis survili da rom pacientma ver aRiqvas da ver daimaxsovros
unari. Tumca, ana froidi Tvlida, rom Tavisufali fsiqoTerapiuli procesis detalebi. xandazmul
asociaciebis eqvivalentad arc saTamaSoebiT Ta pirebTan fsiqoTerapiis gamoyenebis mimoxilva Sem
maSi gamodgeba, arc xatva da arc iseTi TamaSebi, deg wyaroSia mocemulia: Garner, 2003. ufro sruli
romlebSic warmosaxva monawileobs. garda amisa, mimoxilvistvis ixileT Cook et al., 2005.
is ambobda, rom ukontrolo TamaSebs sifrTxiliT
unda movekidoT, radgan maT, SeiZleba, agresiuli
impulsebis destruqciul gamovlenasTan migviyvanon. sxva saxis fsiqologiuri mkurnaloba
ana froidi aRiarebda, rom ganviTarebis procesSi istoriuli interesis Semcveli
gamovlenil mraval aSlilobas SesaZlebelia movua fsiqologiuri mkurnaloba
roT arafsiqoanalitikuri teqnikis gamoyenebiT.
aseT teqnikas miekuTvneba damSvideba, STagoneba,
hipnozi
rCevis micema da roluri modelis (anu `damxmare hipnozi aris mdgomareoba, romlis drosac pirovneba
egos~) gamoyeneba. Tumca, is mainc miiCnevda, rom relaqsirebul da Zilis magvar mdgomareobaSi
_ 655 _
imyofeba da ufro STagonebadia, sxva mdgomareobasTan (Schultz, 1932). am dros pacientebi asruleben var
SedarebiT. gazrdili sugestiuroba iwvevs daqvei jiSebs, romelTa meSveobiT isini swavloben
Tebul mgrZnobelobas tkivilis gamomwvevi stimu simZimis, siTbos an sigrilis SegrZnebis gamowvevas
lebis mimarT, cocxal warmosaxul xatebs, halu sxeulis sxvadasxva nawilSi da sunTqvis Senelebas.
cinaciebs, mexsierebis daqveiTebas da àsakobriv am varjiSebis regularuli Sesruleba cvlilebebs
regresias~, romlis drosac pirovneba ise iqceva, iwvevs avtonomiuri nervuli sistemis muSaobaSi da,
TiTqos ufro patara asakis yofiliyos. miuxedavad amiT, exmareba iseT pacientebs, romelTac stresTan
imisa, rom sugestiurobis gazrda hipnozisTivs aris dakavSirebuli aSlilobisa da SfoTviTi aSlilobis
damaxiasiTebeli, is mxolod hipnoturi mdgomareobis dros somaturi simptomebi aReniSnebaT. ar aris
dros ar gvxvdeba. zogi adamiani aseTive saxiT reagirebs cnobili, ramdenad mniSvnelovnad gansxvavdeba av
STagonebaze sruli sifxizlis dros (Barber, 1962). tonomiuri nervuli sistemis funqcionirebaSi au
rogorc Cans ar arsebobs fenomeni, romelic mxolod totreningiT gamowvuli cvlilebebi martivi re
hipnoturi mdgomareobisTvis iyos specifikuri. laqsaciiT gamowveuli cvlilebebisagan. arc is
hipnozis gamowveva mrvali saxiTaa SesaZlebeli. aris cnobili, Tu ramdenad gaaCnia autotrenings
ZiriTadi moTxovna imaSi mdgomareobs, rom pirov konkretuli Terapiuli efeqti. am sakiTxiT dain
nebas undodes hipnotur seansSi monawileoba da teresebul mkiTxvels SeuZlia gaecnos Semdeg wyaros:
darwmunebuli iyos, rom is, am dros, hipnotur Schultz, Luthe, 1959.
mdgomareobaSi aRmoCndeba. hipnoturi procedurebis
abreaqcia
umravlesoba moicavs yuradRebis fokusirebis amo
canebs (magaliTad, moZrav saganze dakvirveba), abreaqcia anu emociis SeuzRudavi gamoxatva didi
riTmuli monotonuri instruqciebisa da STagonebebis xania gamoiyeneba fsiqikuri distresisa da zogierTi
graduirebuli seriis (mag. STagoneba, rom pirovnebis fsiqikuri simptomis mosaxsnelad. miuxedavad imisa,
xeli nel-nela maRla aiwevs) kombinacias. Terapevti rom, abreaqcias amJamad iSviaTad iyeneben, mas aq
iyenebs pacientis sugestiurobas an pirdapiri STa imis gamo movixseniebT, rom is saintereso meTodia
gonebebistvis, romlebic raimes gaumjobesebas isaxavs istoriuli TvalsazrisiT. abreaqcia mravali re
miznad an warsulSi represirebuli mexsierebis ligiuri mkurnalobis komponentia (ix. qvemoT). mas
Sinaarsebis aRsadgenad. iyenebdnen fsiqiatriaSi meore msoflio omis dros
mZime nevrozis mdgomareobidan da mwvave stresuli
rodis aris hipnozi naCvenebi aSlilobisa da post-travmuli stresuli aSlilobis
hipnozi fsiqiatriSi xSirad ar gamoiyeneba. msubuqi mdgomareobidan pacientis swrafad gamoyvanis miz
transi dro da dro gamoiyeneba, rogorc relaqsaciis niT (Sargant, Slater, 1940). Cveulebriv praqtikaSi ab
erT-erTi forma. am TvalsazrisiT hipnozi ar aris reaqcia nakleb efeqturia, albaT imis gamo, rom,
upiratesobis mqone relaqsaciasTan SedarebiT. ufro yoveldRiurobaSi, Zlieri stresiT naklebi aSlilobaa
Rrma transi zogjer ganmoiyeneba sugestiurobis gamowveuli (Zlieri stresiT gamowveuli aSlilobebi
gasaZliereblad simptomebis Semsubuqebis mizniT, _ post-travmuli stresuli aSliloba gv. ??-zea
gansakuTrebiT, konversiuli aSlilobis simptomebis ganxiluli). abreaqcia SegviZlia imiT gamoviwvioT,
dros. miuxedavad imisa, rom hipnozis meTodi efeq rom pacients travmuli movlenebis xelaxali gancda
turia xanmokle periodis manZilze, misi upiratesoba movTxovoT. omis periodSi am proceduras zogjer
sugestiis gamoyenebasTan hipnozis gareSe ar aris amartivebdnen sedativebis mcire dozis intravenulad
dadasturebuli. garda amisa, hipnozis mdgomareobSi gamoyenebis gziT. es procedura ufro safuZvlianad
sugestiis gamoyenebiT simptomebis myisier moxsnas Semdeg wyaroSia gaxiluli: Sergant, Slater, 1963.
SeiZleba mosdevdes SfoTva an depresia. fsiqoTerapiis
dros hipnozs iyenebden gaxsenebis procesis xel meditacia da tradiciuli mkurnaloba
Sesawyobad, magram ar aris damtkicebuli, rom es meditacia
procedura aumjobesebs Sedegebs. am mizezebis gamo,
miuxedavad imisa, rom meditacias fsiqiatriaSi
avtorebi ar gvirCeven hipnozis gamoyenebas klinikur
regularulad ar iyeneben, is sul ufro xSirad
fsiqiatriaSi. damatebiTi informaciistvis ixileT
gamoiyeneba umniSvnelo fsiqiatriuli problemebis
Burrows et al., 2002.
mqone pacientebTan, rogorc fsiqiatriuli mkur
autotreningi nalobis alternativa. arsebobs meditaciis mravali
es teqnika aRwera Sulcma 1905 wels. mas, kontinentur meTodi. TiToeuli maTgani sxvadasxva midgomasTan
evropaSi, ZiriTadad, emociuri aSlilobiT gamow aris dakaSirebuli, magram maT saerTo maxasiaTeblebic
veuli fizikuri simptomebis samkurnalod iyenebdnen gaaCniaT. pirveli saerTo komponentia relaqsaciisa
_ 656 _
fsiqologiuri mkurnalobis eTikuri sakiTxebi
da sunTqvis regulaciis instruqciebi. meorea yu romlebic axdenen araspecifikuri procesebis aq
radRebis gadatana gare samyaros sagnebidan, mov tivacias. es procesebi saerToa dasavluri fsiqo
lenebidan da azrebis nakadidan, romelic yuradRebis logiuri mkurnalobis sxvadasxva midgomistvis (ix.
gadatanis gareSe cnobierebaSi iqneboda gabatonebuli. boqsi 22.1). garda amisa, mkurnalebma ician, Tu ramdenad
xSirad, aseTi mdgomareobis misaRwevad pacients eva mniSvnelovania pacientis mdgomareobsitvis saxelis
leba sityvebis an frazebis gameoreba (mantra). mesame darqmeva da pasuxis gacema iseT kiTxvebze, rogoricaa:
komponentia yoveldRiuri saqmianobidan mowyveta, rac `ratom davavaddi?~, an `ratom daavadda Cemi ojaxis
adamians saSualebas aZlevs aRidginos simSvide. dabolos, swored es wevri?~. am kiTxvebze pasuxis gacema bolos
pirovneba erTiandeba iseTi adamianebisagan Semdgar uRebs gaurkvevlobas, dadanaSaulebasa da danaSaulis
jgufSi, romelsac eWvi ar epareba meditaciis meTodebis gancdas. tradiciuli meTodebiT momuSave zogi
efeqturobaSi. aseTi jgufis wevrebi erTmaneTs xels mkurnali iyenebs Terapiul STagonebas, bevri ki CarTavs
uwyoben specialuri varjiSebis SesrulebSi, raTa moxdes ojaxis wevrebs daavadebis diagnostirebis procesSi
saWiro meTodebis tviseba. jgufis zewola, romelic, da samkurnalo ritualebSi. zogi iyenebs ganwmendis
Cveulebriv, ar monawileobs, rogorc calke faqtori, ritualebs damabiZurebeli agentebis mosaspobad.
saavadmyofoebSi ganxorcielebul relaqsaciis prog zogi mkurnali iyenebs msxverplSewirvis rituals,
ramebSi, albaT, nawilobriv ganapirobebs meditaciis raTa `guli moulbos~ zebunebriv Zalas. am ritualebs
meTodebis warmatebulobas. zogjer Tan axlavs aRsareba. zogjer, pacienti pirobas
Cvgen ar gagvaCnia sakmarisi mtkicebuleba imistvis, debs, rom Secvlis sakuTar qcevas. ritualebi SeiZleba
rom vimsjeloT meditaciis meTodis Rirebulebaze. Catardes jgufurad _ mravali adamianis monawileobiT,
klinikuri gamocdileba gviCvenebs, rom mraval an mxolod pacientisa da misi ojaxis wevrebis
pacients, romelsac meditaciis teqnika sasargeblod monawileobiT. rogorc Cans, amgvari praqtika axdens
miaCnia, cxovrebis garkveuli stili (zedmeti stre jgufuri Terapiistvis saerTo faqtorebis aqtivacias,
si da aCqarebuli tempi) garkveul problemebs uq romlebic boqs 22.7-Sia aRwerili.
mnis. meditaciis ramdenime forma da maTi efeqti tradiciuli medicinis mravali warmomadgeneli
ganxilulia Semdeg wyaroSi: West, 1990. `dasavlur~ daavadebebs, romlebic konkretuli wam
liT ikurneba, ganasxvavebs sxva daavadebebisagan,
tradiciuli mkurnaloba
romelTa drosac garkveuli procedurebi gamoiyeneba.
arsebobs mkurnalebis ramdenime kategoria, romlebic es procedurebi Svelis pacientsac da mis ojaxsac.
tradiciuli meTodebiT muSaoben. isini SeiZleba oTx arsebobs mecnieruli mtkicebuleba, romlis Tanaxmad
kategoriad daxarisxdes (Jilek, 2000): tradiciuli mkurnaloba efeqturia wamalmoxmarebis
w fitoTerapevtebi, romlebic mcenreul saSualebebs SemTxvevaSi (Jilek, 2000), xolo zogierTi mosazrebis
iyeneben. am saSualebebidan zogierTi aqtiur ingre Tasnaxmad, is msubuqi fsiqikuri aSlilobis drosac
dientebs Seicavs, zogi, ki rogorc Cans, placebos aris efeqturi.
warmoadgens. tradiciuli meTodebiT mkurnaloba da misi gamoyneba
w mkurnalebi/eqimbaSebi romlebic ritualebs da fsiqiatriaSi ganxilulia Semdeg wyaroSi: Jilek, 2000.
sityvier meTodebs iyeneben. zogjer es meTodebi
mcenareul saSualebebTan kombinaciaSi gamoiyeneba. fsiqologiuri mkurnalobis eTikuri
iTvleba, rom am kategoriis mkurnalebi gansakuTrebul sakiTxebi
(maT Soris zebunebriv) Zalebs floben.
avtonomiuroba
w Samanebi eqimbaSebis msgavs meTodebs iyeneben. gar
da amisa, isini sakuTar TavSi iwveven cnobierebis informirebuli Tanxmobis miReba iseve mniSvnelovania
Secvlil mdgomareobas. iTvleba, rom aseT mdgo fsiqologiuri mkurnalobisas, rogorc sxva sa
mareobaSi yofnisas isini sulebTan da winaprebTan xis mkurnalobis SemTxvevaSi. amgvari Tanxmobis
amyareben kontaqts da ubruneben warTmeul suls im mosacemad pacients unda esmodes mkurnalobis
adamianebs, romlebic avad gaxdnen am danakargis gamo. xasiaTi da misi Sedegebi. am moTxovnas advilad ak
mayofilebs kognitur-bihevioruli Terapia, rome
w Semlocveli aRmoaCens daavadebis mizezs da adgens,
lic naTlad aris gansazRvruli da romelic kl
Tu riTia adamiani daavadebuli. is amas adgens
nikuri gamokvlevebiTaa Seswavlili. dinamiuri da
winaswarmetyvelis sityvebis interpretaciiT (cno
jgufuri Terapiis mimdinareoba Tavidan ufro Zneli
bierebis normalur an Secvlil mdgomareobaSi
gansasazRvria, magram is pacients unda aRvuweroT
yofnisas), sizmrebis interpretaciiT an sulebTan
ufro farTo kategoriebis gamoyenebiT. pacientis
da winaprebTan kontaqtis gziT.
amgvari Semzadeba sasurvelia ara marto eTikuri
yvela tradiciuli mkurnali iyenebs meTodebs, TvalsazrisiT. is, agreTve, aumjobesebs Terapiul
_ 657 _
urTierTobas. kidev erTi problema maSin aRmocendeba, saxiT da SeuniRbavad xdebodes (magaliTad, Terapevti
rodesac dinamiuri Terapia moiTxovs pacientis gan pacients eubneba, rom fexmZimobis Sewyveta moralurad
Tavisuflebas fsiqologiuri SezRudvebisagan da, arasworia) an kidev SeniRbulad da arapirdapiri
amis meSveobiT, misi avtonomiurobis gazrdas. amgvari gziT (magaliTad, Terapevti ar gamoxatavs saku
mkurnalobisas, aucilebelia, situacia pacientTan Tar azrs, magram ufro met yuradRebas aqcevs fex
erTad ganvixiloT, raTa davrwmundeT, rom mas bo mZimobis Sewyvetis sawinaaRmdego argumenetebs,
lomde esmis igi da rom misTvis misaRebia Terapiis vidre sapirispiro argunebtebs). aseTive problema
axali miznebi da misi SesaZlo Sedegebi. aRmocendeba wyvilebTan Terapiis Catarebisas, Tu
Terapevtis Rirebulebebi gavlenas moaxdens mis
konfidencialoba midgomaze ganqorwinebis sakiTxis mimarT (anu, moce
jgufur fsiqoTerapiaSi axleburad dgeba konfi muli wyvili unda ganqorwindes, Tu ara).
dencialobis sakiTxi. pacientistvis bolomde un jgufuri Terapiisas SeiZleba pacientebma erT
da iyos gasagebi, Tu ratom aris aucilebeli jguf maneTs gauwion eqspluatacia. Terapiul seansebze erTi
Si pirad sakiTxebze saubari. mas, aseve, kargad pacienti SeiZleba meores aSinebdes, xolo es ukanaskneli
unda esmodes, rom sxva pacientebis naTqvami kon gantevebis vacis rolSi imyofebodes; an kidev erTi
fidencialur informacias warmadgens. igive prob pacienti SeiZleba cdilobdes meore pacientTan
lemebi aRmocendeba ojaxuri Terapiis dros, gan seqsualuri urTierTobis damyarebas. Terapevtma
sakuTrebiT maSin, rodesac Terapevti calke xvdeba una daicvas mowyvladi pacientebi maSin, rodesac
ojaxis erT-erT wevrs da is Terapevts ojaxis sa isini seansze ar imyofebian da akrZalos pacientebis
idumlos gaandobs (magaliTad, col-qmruli Ralatis Sexvedrebi seansebs gareT. Tu maTi Sexvedra mainc Sedga,
faqts). Tuki es SesaZlebelia, Terapevtma uari unda man es unda Seatyobinos jgufs Semdeg Sexvedraze da es
uTxras mas individualur Sexvedraze, magram Tu am sakiTxi jgufurad unda iqnes ganxiluli.
tipis Sexvedra mizanSewonilad iTvleba (magaliTad,
rodesac ojaxis erT-erT wevrs seriozuli depresia
aqvs), man Sexvedraze Tavisi kolega unda gauSvas. aseTi
problemebi wyvilebis TerapiisTvisac aris tipuri. Bloch, S (2005) An introduction to the psychotherapies, 4th
sakiTxi imis Sesaxeb, Tu rodis unda gaumJRavnos edn. Oxford University Press, Oxford. (Sesavali fsiqoTe-
Terapevtma konfidencialuri informacia mesame mxa rapiaSi. ganixileba fsiqologiuri mkurnalobis
res iseve wydeba, rogorc sxva Terapiul situaciebSi: gavrcelebuli meTodebi. erT-erTi Tavi eZRvneba
amis gakeTeba gamarTlebulia, Tu mesame mxare eTikis sakiTxebs.)
seriozuli riskis qveS imyofeba. Bateman, A, Brown, D and Pedder, J (2000) Introduction to
psychotherapy: an outline of psycho-dynamic principles and
eqspluatacia practice. 3rd edn. Tavistock/Routledge, London. (dinamiuri
pacientebi, romlebsac utardebaT fsiqologiuri Teoria; wyvilebis, ojaxuri da jgufuri Terapiis
mkurnaloba mowyvladebi arian eqspluataciis mi praqtikuli sakiTxebi.)
marT. amis mizezi, zogjer is gamocdilebaa, romlis Frank, JD and Frank JB (1993) Persuasion and healing, 3rd
gamoc maT fsiqoTerapevts mimarTes, Tumca maT edn. Johns Hopkins Press, Baltimore, MD. (am mniSvnelo-
aseT mowyvladobas TerapevtTan urTierTobac gana van naSromSi ganxilulia araspecifikuri faqtore-
pirobebs. medicinis sxva dargebSi, eqspluatacia bi fsiqoTerapiaSi. gadasinjuli versia.)
SeiZleba finansuric iyos da seqsualuric. finansuri
Gabbard, G, Beck, JS and Holmes, J (2005) Oxford text-
eqspluatacia potenciuri problemaa kerZo praq
book of psychotherapy. Oxford University Press, Oxford.
tikaSi, rac imaSi gamoixateba, rom Terapevti uf
(fsiqoTerapiis ZiriTadi saxeebi da maTi gamoyeneba
ro xangrZlivad mkurnalobs pacients, vidre amas
klinikur praqtikaSi. mimoxilva.)
aucilebloba moiTxovs. arsebobs seqsualuri
eqspluataciis SemTxvevebic. samedicino profesiaSi, Gurman, AS (ed.) (2003) Family therapy: theory, practice and
iseve, rogorc sxva profesiebSi, romlebic adamianze research. Brunner-Routledge. (detaluri da amomwuravi
zrunvas moiTxovs, eqspluatacia akrZalulia profe naSromi ojaxuri Terapiis Sesaxeb.)
siuli kodeqsiT. es ar aris is sakiTxi, romelzec Hawton, K, Salkovskis, PM, Kirk, JW and Clark, DM (2000)
utilitaruli TvalsazrisiT msjeloben. Cognitive behavioural approaches for adult psychiatric dis-
arsebobs eqspluataciis kidev erTi forma, rome orders: a practical guide, 2nd edn. Oxford University Press,
lic pacientistvis sakuTari Rirebulebebis Tavze Oxford. (am praqtikul saxelmZRvaneloSi mravali sa-
moxvevas gulisxmobs. aseTi ram SeiZleba pirdapiri sargeblo magaliTia mocemuli.)
_ 658 _
23 fsiqiatriuli servisebi
pacientebs mkurnalobda. da ar saWiroebda fizikur SezRudvas da sastik
britaneTSi meTvramete saukunis Sua wlebamde somatur mkurnalobas.
fsiqikuri daavadebis mqone adamianebis umetesoba,
xSir SemTxvevaSi siRaribis kanonis daxmarebiT, TemSi TavSesafrebis dafuZneba
cxovrobda an sapyrobileSi iyo moTavsebuli. 1744 miuxedavad aseTi Zalisxmevisa, mecxramete saukunis
wels inglisSi miRebuli mawanwalobis aqtiT moxda adreul wlebSi fsiqikurad daavadebuli bevri adamiani
Raribebis da `SeSlilebis~ erTmaneTisgan gamijvna ar iRebda aranair daxmarebas da cxovrobda rogorc
Seiqmna maTi mkurnalobis pirobebi. amis Sedegad gaCnda mawanwala, an sapatimroebsa da gamosasworebel banakebSi
kerZo tipis dawesebulebebi fsiqikurad daavadebul imyofeboda. inglisis sazogadoebis yuradReba mi
pirTaTvis (`sagiJeTebi~), romlebsac mogvianebiT iqcia servisebSi myofi pacientebis mdgomareobam,
uwodes kerZo fsiqiatriuli saavadmyofoebi. isini rac mohyva kerZo `sagiJeTebSi~ dabali standartebis
imaTTvis Seiqmna, visac SeeZlo servisis safasuris Sesaxeb skandaluri masalebis gamoqveynebas. amis
gadaxda, Tumca xelmisawvdomi iyo im RaribebisTvisac, Semdeg gamovida 1808 wlis dadgenileba sagrafoebis
romelTa servisis xarjebsac samrevloebi faravdnen fsiqiatriuli saavadmyofoebis Sesaxeb, romelic
(Parry-Jones, 1972). daaxloebiT amave periodSi gaCnda iTvaliswinebda fsiqiatriuli saavadmyofoebis aSe
ramdenime hospitali da palata, romelic arsebobda nebas inglisis yvela sagrafoSi. samwuxarod Za
saqvelmoqmedo Semowirulobebisa da sazogadoebrivi lian cota gakeTda sagrafoebis xelisufalTa
sawevroebis xarjze. 1713 wels noruiCSi Seiqmna be mier da 1845 wels aucilebeli gaxda dadgenilebis
Tlemis hospitali. 1728 wels londonSi, gais hos gamocema suliT daavadebulebis Sesaxeb. es aqti
pitalSi specialuri palata gaixsna. 1751 wels Se moiTxovda fsiqiatriuli saavadmyofoebis aSenebas
iqmna wminda lukas hospitali, rogorc beTlemis yvela sagrafoSi. sawyis etapze axal fsiqiatriul
gadatvirTuli hospitlis alternativa. im dros, zo saavadmyofoebSi mkurnaloba kargad xorcieldeboda.
gadi profilis saavadmyofoebSi fsiqiatriuli gan moralur principze dafuZnebuli mkurnaloba wa
yofilebebis arseboba, iseve rogorc dRes, sakamaTo moiwyes im mimarTulebis mimdevrebma, romlebic pa
sakiTxs warmoadgenda. (Allderidge, 1979). cientebis fizikuri SezRudvis winaaRmdeg gamo
diodnen. is 1837 wels wamoiwyo gardiner hilim,
moraluri marTva romelic linkolnis fsiqiatriul saavadmyofoSi
meTvramete saukunis miwuruls, cudi pirobebi ker muSaobda da SemdgomSi ganaviTara jon konolim
Zo da saxelmwifo instituciebSi mravali qveynis midlseqsis sagrafos fsiqiatriul saavadmyofoSi
sazogadoebis yuradRebis centrSi moeqca. aman biZ (hanueli). 1856 wels konolim gamoaqveyna mniSvnelovani
gi misca fsiqikurad daavadebulTa servisebis ga wigni `SeSlilTa mkurnaloba meqanikuri SezRudvis
umjobesebas. 1913 wels, parizSi pinelis lide gareSe~.
robiT xmarebidan amoiRes jaWvebi, romlebsac pa samwuxarod, am liberalur nabijs mohyva moZ
cientebis fiqsaciisTvis iyenebdnen. mogvianebiT, raoba, romelic sapirispiro principebs izia
pinelma Semoitana iseTi cvlilebebi, romlebic uz rebda. sazogadoebis mzardi Seuwynareblobis ga
runvelyofda pacientebis ufro humanur movlas. mo, sul ufro meti adamiani, sazogadoebis Cve
inglisSi msgavsi humanuri reformebi wamoiwyo ulebrivi wevrebi da patimrebi, Tavsdebodnen
uiliam tukma, kvakerma filantropma, romelmac 1792 axal fsiqiatriul saavadmyofoebSi. fsiqikuri aS
wels, iorkSi, daarsa fsiqiatriuli TavSesafari. lilobebis gankurnebadobis sawyisi optimizmi mas
TavSesafarSi sufevda sasiamovno atmosfero da Semdeg ganelda, rac gamovlinda moraluri mkur
sakmarisi pirobebi iyo Seqmnili dasaqmebisa da nalobis arasrulyofileba. gabatonda SedarebiT
garTobisTvis. mkurnaloba efuZneboda `moralur~ ufro pirquSi Sexeduleba organuli da memkvidruli
(e.i. fsiqologiur) marTvas da pacientebis survilebis mizezebis Sesaxeb. 1850-iani wlebisTvis gamoaSkaravda
pativiscemas, rac ewinaaRmdegeboda am periodSi bevri fsiqiatriuli saavadmyofoebis gadavsebis problema.
eqimis mier aRiarebul fizikur mkurnalobas (is xSirad qronikuli pacientebi SedarebiT naklebad SezRudul,
gaigivebuli iyo sisxlis gamoSvebasa da gamwmendebis Sinaurul garemoSi, fsiqiatriul saavadmyofos
gamoyenebasTan) da avtoritarul midgomas. axali bazaze calke gamoyofil sacxovreblebsa da sax
midgoma servisisadmi ramdenime wliT gvian aRwera lebSi ganaTavses. saavadmyofoebma pacientebi
uiliam turkis SviliSvilma, samuelma 1813 wels TemSi daabrunes: nawili ganaTavses ojaxTan er
gamoqveynebul naSromSi fsiqiatriuli TavSesafris Tad pansionatebSi (servisis forma, romelic
aRwera. es humanuri meTodebi damkvidrda sxva gansakuTrebuli warmatebiT dainerga belgiis qalaq
hospitlebSic, radgan gairkva, rom bevr fsiqikurad giilSi), xolo nawili samuSao banakebSi daabrunes.
daavadebul pacients SeeZlo sakuTari Tavis marTva `suliT daavadebulTa sakiTxebze momuSave ko
_ 660 _
fsiqiatriuli servisebi
mitetma~, romlis misias fsiqikurad daavadebul danergvam, gazarda optimizmi. amave dros, yvelaferi
pirTa servisis zedamxedveloba Seadgenda, yuradReba keTdeboda saavadmyofoebSi arsebuli mdgomareobis
miaqcia aseTi servisis dros Zaladobis risks da gaumjobesebis mizniT: gaixsna manamde Caketili
winaaRmdegoba gauwia mas. miuxedavad amisa, mecxramete palatebi da xeli Seewyo okupaciur saqmianobas.
saukunis fsiqiatriuli TavSesafrebi, gadatvirTvis msgavsi cvlilebebi sxva qveynebSic SeiniSneboda.
pirobebSic ki standartis dacviT axorcielebda qveynebis umetesobaSi es reformebi SeaCera meore
fsiqikurad daavadebul pacientTa serviss, rac msoflio omma. eqimebisa da meddebis omSi gawvevis
sxvagan ar xdeboda. amdenad, fsiqikurad daavadebuli gamo fsiqiatriul hospitlebs daaklda personali.
daculi iyo eqspluataciisgan da uzrunvelyofili amasTan, isini isev gadaitvirTa, radgan zogierT
iyo TavSesafriT, sakvebiT da zogadi jandacviT. aseTi maTganSi moaTavses omSi daWrilebi da fsiqiatriuli
sargeblis sapirwone aRmoCnda pirovnuli arCevanis da pacientebi Tavisufal adgilebze gadaanawiles.
avtonomiis dakargva da monotonuri hipermeurveuli inglisis sagrafoebis fsiqiatriul TavSesafrebze
reJimi, romelic institucionalizaciis winapirobas omis gavlena aRwera kramerma (Crammer, 1990).
warmoadgenda. germaniaSi fsiqikuri aSlilobis mqone bevri pacienti
sawolebisa da personalis simciris gamo sul evgenikis programebis gamo daiRupa. es samarcxvino
ufro cota dro rCeboda moraluri marTvisTvis. periodia iseTi qveynis istoriaSi, romelic mec
isev moikida fexi meurveulma reJimma. meurveul xramete saukuneSi da meoce saukunis dasawyisSi
midgomaze gadasvla dadginda 1890 wlis aqtiT fsiqiatriis ganviTarebis avangardSi idga. nacisturi
sulieri daavadebis Sesaxeb, romelic saavadmyofodan evgenikis programebis gasacnobad ix. Burleigh, 2000.
gaweraze SezRudvebs awesebda. aseTi meurveuli
sistema meoce saukuneSic arsebobda, rac aisaxeba didi socialuri fsiqiatria da Temze
viqtorianuli hospitlebis zomasa da struqturaSi, dafuZnebuli momsaxurebis dasawyisi
sadac, ukanasknel dromde, ZiriTadad, praqtikuli meore msoflio omis fsiqiatriul saavadmyofoebSi
fsiqiatriuli saqmianoba mimdinareobda. (mecxramete sxvadasxva faqtoris zegavleniT ganxorcielda
saukuneSi gaerTianebul samefosa da aSS-Si arsebuli Semdgomi cvlilebebi. sazogadoeba ufro Tana
fsiqiatriuli hospitlebis Sesaxeb informacia ix. mgrZnobi gaxda arasasurvel pirobebSi myofi ada
Jones, 1972 da Rothman, 1971). mianebis mimarT. omis periodSi òmis nevrozis~
mkurnalobis gamocdileba fsiqiatrebs daexmara
adreuli mkurnalobis organizeba dainteresebuliyvnen fsiqikuri aSlilobebis adreuli
britaneTSi SedarebiT ufro liberalur politikasTan mkurnalobiT, jgufuri mkurnalobis gamoyenebiTa da
mibrunebis dasawyisi aRiniSna pirveli msoflio omis socialuri reabilitaciiT. britaneTSi erovnuli
dawyebamde cota xniT adre, rodesac henri moudslim, janmrTelobis servisis (National Health Servise - NHS)
mdidarma fsiqiatrma, soliduri Tanxa saCuqrad Seqmnam gamoiwvia samedicino servisebis, maT Soris
gadasca hospitals, romelsac unda ganexorcielebina fsiqiatriis, sruli reorganizacia. 1952 wels
adreuli mkurnaloba. samwuxarod, omma CaSala qlorpromazinis danergvam gaaiola fsiqozis mqone
proeqtis miznebi da moudslis hospitlis gaxsna pacientebis qceviTi darRvevebis marTva, SesaZlebeli
1923 wlamde gadaido. hospitalSi ambulatoriuli gaxada Caketili ganyofilebebis gaxsna da zogierTi
servisi da pacientebis nebayoflobiTi stacionaruli pacientis TemSi gawera.
mkurnaloba im garemoSi warmoebda, sadac swavleba da am cvlilebebis miuxedavad, servisebi mainc
kvleva mimdinareobda. erT adgilas koncentrirebuli rCeboda, xSirad
omebs Soris periodSi moTxovna cvlilebebze kvlav dasaxlebuli centrisgan moSorebiT. aSS-Si gofmani
gaZlierda. 1930 wlis àqtma fsiqikuri mkurnalobis amtkicebda, rom saxelmwifo saavadmyofoebi `WeSmarit
Sesaxeb~ moxsna pacientebis stacionaridan gaweraze instituciebs~ warmoadgenda, vinaidan iq adamianTa
dadebuli bevri SezRudva, romelic gansazRvruli jgufi yoveldRiur cxovrebas sruliad mowyvetili
iyo 1890 wlis aqtiT sulieri daavadebis Sesaxeb da iyo (Goffman, 1961). igi maT usaxur, mouqnel da
neba darTo sagrafoebis fsiqiatriul saavadmyofoebs avtoritarul dawesebulebebad miiCnevda. britaneTSi
mieRoT pacientebi nebayoflobiTi mkurnalobis uingma da braunma gamoavlines, rom zogierTi didi
Casatareblad. 1930 wlis aqti xels uwyobda fsiqiatriuli saavadmyofo klinikurad ususuri~
adgilobriv xelisuflebas moewyo ambulatoriuli da `socialurad gaRatakebuli~ iyo (Wing and Brown,
klinikebi da servisebi, romelic stacionaridan 1970). saavadmyofoSi mdgomareobis gasaumjobeseblad
gaweril pacientebs moemsaxureboda. mkurnalobis da xangrZlivi institucionalizmis Sedegebis
axali meTodebis, insulinuri komisa (mogvianebiT Sesamcireblad aqtiuri socialuri reabilitaciis
iqna amoRebuli) da eleqtrokonvulsiuri Terapiis meTodebi gamoiyenes. okupaciuri da ergoTerapiis
_ 661 _
saSualebiT qronikul pacientebs saavadmyofoebidan TvisebebiTa da unarebiT SesZlo TemSi pacientTa
TavSesafrebSi an Cveulebriv sacxovreblebSi gada momsaxurebisTvis axali saSualebebis gamoZebna.
sayvanad amzadebdnen (Bennett, 1983). bevri, stacionarSi sxva specialistebs gauWirdaT misi warmatebuli
xangrZlivad myofi pacientisTvis, aseTi intensiuri praqtikis ganmeoreba. Tavdapirvelad am uecari
reabilitacia efeqturi aRmoCnda. gaCnda optimizmi cvlilebis Sedegebi gansxvavebuli iyo. italiis im
imasTan dakavSirebiT, rom axlad stacionirebuli nawilSi, sadac reformebi sakmarisi xarisxiT fi
pacientisTvisac aseTi meTodebi Sedegiani iqneboda. nansdeboda da implementacia moxda enTuziasti
TemSi myofi pacientebis uwyveti mkurnalobisa personalis mier, axali servisi warmatebulad
da reabilitaciisTvis gaixsna dRis stacionarebi, muSaobda, im adgilebSi ki, sadac axali saSualebebiT
sacxovrebliT uzrunvelyofisTvis _ hostelebi. uzrunvelyofa arasakmarisad xdeboda, problemebi
am cvlilebebis Sedegad fsiqiatriul klinikebSi iCenda Tavs (Bollini and Mollica, 1989). mogvianebiT am
pacientTa raodenoba mniSvnelovnad Semcirda, ro siZneleebis umetesi nawili warmatebiT daZlies da
gorc britaneTSi, ise sxva qveynebSi. cvlilebebi 1989 wels fisiqtriuli saavdmyofoebis saxelmwifo
gansakuTrebiT swrafi tempiT aSS-Si mimdinareobda. struqturam Sewyvita arseboba (Burti, 2001).
am cvlilebebis miuxedavad servisebi isev dafuZ gaerTianebul samefosa da sxva qveynebSi, cvli
nebuli iyo did fsiqiatriul saavadmyofoebze, lebebis SedarebiT neli tempis miuxedavad, prob
romelic pacientis saxlisgan sakmaod moSorebiT lemebi mainc igive rCeboda. zogierTi pacienti in
imyofeboda. samwuxarod, klinikidan axalgawerili tensiuri mxardaWeris gareSe ver axerxebda TemSi
mravali pacientisTvis TemSi sakmarisi resursebi ar cxovrebas da zogjer saWiro xdeboda hospitalSi maTi
arsebobda. ganmeorebiTi moTavseba, ris gamoc mowyobis am sistemas
`mbrunavi karis politika~ ewoda. reabilitaciuri
saavadmyofoebis daxurva servisebi imedovnebdnen pacientebis gaumjobesebul
sawyis etapze instituciebidan pacientebis war mdgomareobaSi gaweras, magram aRmoCnda, rom amis
matebuli gaweris Semdeg, gadawyda didi fsiqiatriuli Tvis imdenad xangrZlivi servisia saWiro, rom
saavadmyofoebis daxurva da maTi patara fsi SeuZlebelia axali pacientebis miReba. zogierTi
qiatriuli ganyofilebebiT Canacvleba, romlebic gawerili pacienti wlebis ganmavlobaSi akiTxavda
zogadi profilis saavadmyofoebSi Seiqmneboda da dRis hospitals Semdgomi gaumjobesebis gareSe (Gath
saTemo servisebis mxardaWeriT isargeblebda. qvey et al., 1973). gairkva, rom adreul etapze arsebuli
nebis umetesobaSi hospitlebis daxurvis procesi Sexeduleba `deinstitucionalizaciis~ warmatebis
TandaTanobiT ganxorcielda. gamonakliss italia Sesaxeb gadaWarbebulad optimisturi iyo da arsebuli
warmoadgenda, romelic sxva qveynebs mniSvnelovnad stacionaris gareTa servisebi ver uzrunvelyofdnen
CamorCeboda, magram Semdeg swrafi cvlilebebi saavadmyofoebidan gawerili pacientebisa da maTi
ganaxorciela. 1978 wels italiis parlamentma miiRo ojaxebis saWiroebebis dakmayofilebas. mTeli Za
inovaciuri kanoni #180, romlis mizani fsiqiatriuli lisxmeviT daiwyo adekvaturi saTemo samsaxurebis
saavadmyofoebis gauqmeba da maTi saTemo samsaxurebis ganviTareba. es mimarTuleba Temze dafuZnebuli
srulyofili sistemiT Canacvleba iyo. fsiqiatriul zrunvis saxeliTaa cnobili.
saavadmyoebSi aikrZala pacientebis miReba. gadawyda
zogadi profilis saavadmyofoebSi fsiqiatriuli Temze dafuZnebuli zrunvis aRmavloba
ganyofilebebis gaxsna da garkveul teritoriebze saavadmyofoebis daxurvis Semdeg, fsiqiatriul
Temze dafuZnebuli fsiqiatriuli moqmedmomsaxurebis servisebs unda Seesrulebina sami funqcia: pirveli,
ganviTareba. es sqema efuZneboda franko bazalias mZime fisiqikuri daavadebis mqone im adamianebis TemSi
saqmianobas, romelsac is Crdilo-aRmosavleT it mkurnaloba, romlebic manamde wlobiT stacionarSi
aliis saavadmyofoebSi axorcielebda da mis mier mkurnalobdnen; meore, pirveladi jandacvis doneze
daarsebuli profesionalTa da politikosTa SedarebiT naklebad mZime fsiqikuri aSlilobebis mqone
moZraobis gegmas. es moZraoba _ demokratiuli pacientebis gamovlena, avadmyofobis prevencia da
fsiqiatria (Psichiatria Democratica) _ politikuri adreuli mkurnaloba; mesame, mZime da mwvave fsiqikuri
xedvis ukiduresad memarcxene frTas warmoadgenda aSlilobebis mkurnaloba stacionarSi minimaluri
da gulisxmobda, rom fsiqiatriul saavadmyofoebSi dayovnebiT da sacxovrebeli adgilidan maqsimalurad
ganTavsebuli pacientebi kapitalisturi sistemis axlos myof dawesebulebaSi. es momsaxureba
Cagvris msxverpls warmoadgendnen. maT sjerodaT, mosaxleobis garkveul nawils moicavda. miwodebuli
rom mZime fsiqikuri aSlilobebi gamowveuli iyo servisi kompleqsuri da uwyveti unda yofiliyo,
socialuri mdgomareobiT da ara biologiuri romelsac multidisciplinuri gundi axorcielebda.
mizezebiT. bazaliam (Basaglia) Zlieri pirovnuli es zogadi principebi sakmaod gansxvavebulad dainerga
_ 662 _
fsiqikuru aSlilobis sixSire TemSi
gaerTianebul samefosa da aSS-Si. kuTrebuli aqcenti keTdeboda adamianis uflebebze.
britaneTSi, sawyis etapze aqcenti gakeTda im reformis dawyebis Semdeg gamocdilebis dagro
pirebze, romlebic xangrZlivi stacionaruli mkur vebasTan erTad gamoikveTa axali damatebiTi ma
nalobis Semdeg binaze gaewernen. aSS-Si yuradReba xasiaTeblebi:
gamaxvilebuli iyo prevenciasa da fsiqikuri w momsaxurebis paketi dafuZnebuli calkeuli pirov
aSlilobebis adreul mkurnalobaze; garda amisa, nebis saWiroebebis Sefasebaze;
aSS-Si Tavs aridebdnen hospitalSi pacientis
w SemTxvevis marTva servisis muSakis mier, romelic
moTavsebas. aSS-Si fsiqikur daavadebaTa da
uzrunvelyofs servisSi monawileTa muSaobis koor-
janmrTelobis gaerTianebulma komisiam 1961 wels
dinirebas;
gamoaqveyna moxseneba. is rekomendacias uwevda TemSi
w momxmareblis CarTva _ servisis momxmareblebi sul
mkurnalobas, romelic unda ganxorcielebuliyo
ufro aqtiurad monawileobdnen rogorc sakuTari
sxvadasxva specialistebiT dakompleqtebuli fsiqi
mkurnalobis, aseve mosaxleobis servisebis dagegm-
kuri janmrTelobis adgilobriv centrebSi. cen
vaSi;
trebi momxmareblebs sTavazobdnen fsiqologiur
da socialur daxmarebas. yuradReba ufro metad w sainformacio-saganmanaTleblo programebi momsax-
gamaxvilebuli iyo krizisul intervenciasa da urebis uzrunvelsayofad im mowyvladi adamianebi-
mwvave fsiqikuri aSlilobebis mkurnalobaze, vidre sTvis, romlebsac sxva SemTxvevaSi gauZneldebaT
qronikuli da mZime fsiqikuri daavadebebis mqone SeTavazebul servisSi CarTva da misi bolomde mi-
pacientebis mkurnalobaze. aseTma midgomam gamoiwvia yola;
ukmayofileba centrebis mimarT, radgan hospitalSi w riskis Sefaseba unda moxdes regularulad da,
xangrZlivi mokurnalobis Semdeg gawerili adamianebi saWiroebis SemTxvevaSi, unda Seicvalos mkurnalo-
iwyebdnen kerZo saavadmyofoebiT sargeblobas an bis gegma.
kidev sapyrobileebSi aRmoCndebodnen. zogi uerT zemoT xsenebulma procesebma safuZveli daudo
deboda didi qalaqebis miusafar mosaxleobas (Goldman servisis Tanamedrove models, romelic qvemoT aris
and Morrisey, 1985). aRwerili.
aseT adreul gamocdilebaze dayrdnobiT bri
taneTsa da sxva qveynebSi fsiqikuri janmrTelobis
adgilobriv samsaxurebTan dakavSirebiT Camoyalibda
fsiqikuri aSlilobebis sixSire
ramdenime urTierTSeTanxmebuli principi: TemSi
w minimaluri stacionaruli momsaxureba _ sta adgilobrivi fsiqiatriuli servisebis saWiroebebis
cionireba unda yofiliyo xanmokle. pacien gansasazRvrad saWiroa mosaxleobaSi fsiqikuri aSli-
ti, SeZlebisdagvarad, zogadi profilis saavad lobebis sixSiris da identificirebul adamianTa
myofosTan arsebul fsiqiatriul ganyofilebaSi mkurnalobasTan dakavSirebuli saWiroebebis cod-
unda moTavsebuliyo da ara fsiqiatriul saavad na. amis Semdeg unda SemuSavdes politikuri gadaw-
myofoSi. SesaZleblobis SemTxvevaSi, mkurnaloba yvetileba imis Taobaze, Tu rogor unda ganawildes
unda Catarebuliyo ambulatoriulad an dRis sta momsaxureba pirvelad da specializebul samedicino
cionarSi. servisebs Soris, samedicino da socialur servisebs
Soris da sxvadasxva saxis fsiqikuri aSlilobebis
w sawyis etapze reabilitacia tardeboda im ime
mqone adamianebs Soris. ukanasknel wlebSi erovnuli
diT, rom adamianebis umetesoba miaRwevda prog
janmrTelobis servisis (NHS - National Health Service)
ress damoukidebel cxovrebaSi. mogvianebiT, rea
resursebi mimarTulia im adamianebze, romlebsac
bilitaciis mizani nakleb ambiciuri gaxda da
aqvT mZime fsiqikuri problemebi. garda amisa, unda
fokusirda pacientis mdgomarebis gauaresebis
moxdes SedarebiT msubuqi daavadebis mqone rac Sei-
prevenciaze.
Zleba meti piris mkurnaloba pirveladi jandacvis
w multidisciplinuri gundi _ servisi unda ganxor doneze.
cielebauliyo gundis mier, romelSic, Cveulebriv, rTulia zustad ganisazRvros mosaxleobaSi fsi
Sevidoda fsiqiatri, adgilobrivi medda, klinikuri qikuri aSlilobebis gavrcelebis zusti sixSire
fsiqologi da socialuri muSaki. maT unda (epidemiologiuri kvlevis meTodebi ?? gverdzea
eTanamSromlaT moxaliseTa jgufebis wevrebTan. mocemuli), magram servisebis dagegmvisTvis, Cve
w sakanonmdeblo reforma _ gamoica axali kano ulebriv, sakmarisia miaxloebiTi monacemis gan
ni, romlis mixedviT unda SezRuduliyo iZu sazRvra. cxrilSi 23.1 mocemulia monacemTa ori
lebiT mkurnaloba da waxalisebuli yofiliyo wyeba, romelTagan erTi warmoadgens aSS-Si didi zomis
stacionaruli momsaxurebis alternativebi. gansa populaciaze Catarebuli kvlevis Sedegebs, xolo
_ 663 _
cxrili 23.1 TemSi fsiqikuri aSlilobebis cxrili 23.2 fsiqikuri aSlilobebis sixSire
gavrcelebis sixSire (daaxloebiT erTi wlis mozrdilebSi, romlebic sxvadasxva donis ser
manZilze) visiT sargebloben*
aSS-s britanuli SemTxvevaTa rao
kvleva* (%) kvleva ** (%) denoba 1000-dan
weliwadSi
yvela aSliloba 20.0 _
TemSi 260-315
araspecifikuri nevrotuli _ 7.7-12.4
aSliloba mimarTva pirvelad jandacvaSi 230
SfoTviTi aSliloba 13.5 4.7 gamovlenili pirvelad jandacvaSi ** 102
fsiqoaqtiur nivTierebaTa 8.8 6.9 mimarTva fsiqiatriul servisSi 24

moxmareba
stacionaruli 6
afeqturi aSlilobebi 4.3 2.1
* modificirebuli Goldberg and Huxley, 1992.
obsesiur-kompulsuri 1.7 1.2 ** aSkara fsiqiatriuli morbidoba
aSlilobebi
Sizofrenia 1.0 0.4*** nawili TviTon umklavdeba problemas, nawils _ ojaxi,

megobrebi, saeklesio piri an konsultanti, romelic
somatizacia 0.1 _
ar miekuTvneba medicinis sferos. fisoqoaqtiuri
* monacemebi eyrdnoba kvlevas Robins and Regier, 1991. nivTierebebis momxmareblebi yvelaze iSviaTad iT
yvela maCvenebeli miuTiTebs gavrcelebis sixSireze xoven samedicino daxmarebas.
erTi wlis manZilze
cxrili 23.2 aseve aCvenebs, rom britaneTSi, sadac
** monacemebi kvlevidan Jenkins et al., 1997. yvela maCvenebeli
miuTiTebs gavrcelebis sixSires erTi kviris manZilze, pirveladi jandacva kargad aris ganviTarebuli, fsi
garda funqciuri fsiqozisa, romelic erTwliani qikuri aSlilobis mqone 10-dan 9 adamiani mimarTavs
prevalentobis monacemia. ojaxis eqims.
*** funqciuri fsiqozi
faqtorebs, romlebic gansazRvraven adamianis mier
_ ar Sefasebula
fsiqikuri aSlilobis gamo samedicino servisisTvis
meore _ britaneTSi Catarebuli Sinameurneobebis mimarTvas, miekuTvneba:
gamokvlevebis Sedegebs. aSS-Si SfoTviTi aSlilobebis w aSlilobis simZime da xangrZlivoba;
maRali sixSire dabalansebulia britaneTSi ara
w pirovnebis damokidebuleba fsiqikuri aSlilo
specifikuri nevrotuli aSlilobebis sixSiriT. da
bisadmi; zog adamians rcxvenia mimarTos servisebs
narCeni gansxvavebebi SeiZleba ufro metad ukav
daxmarebisTvis;
Sirdebodes gansxvavebas kvlevis meTodebSi da
w informirebuloba SesaZlo daxmarebis Sesaxeb _
ara sxvaobas populaciebSi dadgenil gavrcelebis
Tu adamianma ar icis, Tu ra daxmarebaa misTvis
sixSiris WeSmarit maCveneblebs Soris.
xelmisawvdomi, is arasodes gamoiyenebs mas;
es da sxva kvlevebi aCvenebs, rom fsiqikuri
aSlilobebi xSiria da wlis ganmavlobaSi xuTidan erT w pirovnebis mier fsiqikuri aSlilobisadmi eqimis
adamians SeiZleba erT-erTi aSliloba aReniSnebodes. damokidebulebis aRqma _ Tu eqimis mxridan pirovneba
bevri maTgani mxolod xanmokle SfoTviTi an dep ver xedavs TanagrZnobas, naklebad savaraudoa, rom
resiuli aSllilobaa, romelic warmoadgens re mimarTos dasaxmareblad;
aqcias stresul situaciaze. yvelaze xSiria Sfo w ojaxisa da megobrebis damokidebuleba da informi
TviTi aSlilobebi; maT mosdevs wamalmoxmareba da rebuloba _ Tu es adamianebi ar iCenen TanagrZnobas,
alkoholmoxmareba; rigiT mesamea guneb-ganwyobis naklebad mosalodnelia, rom pirovnebam maT dax
aSlilobebi. SedarebiT naklebad xSiria obsesiuri marebisTvis mimarTos.
aSlilobebi da Sizofrenia.
ramdeni daavadebuli adamiani mimarTavs
dasaxmareblad pirvelad jandacvas?
fsiqikuri aSlilobebis sixSire pirveladi
cxrili 23.2 aCvenebs, rom 1000 mozrdilidan 230
jandacvis momxmareblebSi
adamiani fsiqikuri aSlilobis gamo yovelwliurad
ramdeni daavadebuli adamiani iTxovs daxmarebas? mimarTavs pirvelad jandacvas. sxva sityvebiT rom
cxrilSi 23.2 gviCvenebs, rom TemSi Catarebuli kvlevis vTqvaT, Seferdis gamoTvliT erTi wlis ganmavlobaSi
mixedviT, britaneTis mozrdilTa populaciaSi 1000- mozrdil adamianTa 10% registrirdeba ojaxis
dan 260-315 adamians aReniSneba fsiqikuri aSliloba. eqimTan konsultaciis misaRebad sufTa fsiqiatriuli
yvela maTgani ar mimarTavs samedicino samsaxurebs. mdgomareobis gamo, xolo 5% konsultacias gadis
_ 664 _
saWiroebebis Sefaseba
iseTi darRvevis gamo, romelic moicavs rogorc gram goldbergis gamoTvlebiT ojaxis eqimTan dafiq-
fsiqikur, ise fizikur komponentebs (Shepherd et sirebuli fsiqikuri aSlilobebis 20%-s gaxangrZlive-
al., 1966). SedarebiT mogvianebiT dadginda, rom im buli mimdinareoba axasiaTebs (Goldberg et al., 2000).
pirebidan, romlebic pirvelad jandacvas mimarTavda,
faruli da aSkarad gamovlenili avadoba
erT meoTxeds hqonda ICD-10-is kriteriumebis
Sesabamisi minimum erTi fsiqikuri aSlilobis cxrilSi 23.2 naCvenebia, rom pirvelad jandacvaSi
diagnozi. maT Soris yvelaze xSiri iyo SfoTviTi da aSlilobis SemTxvevebis TiTqmis naxevarze naklebia
depresiuli aSlilobebi (Ustun and Sartorius, 1995). dafiqsirebuli. amis mizezi is aris, rom pacientebi ar
erT-erT gamokvlevaSi dawvrilebiT Seiswavles pir warmoadgenen fsiqikur simptomebs sircxvilis gamo, an
veladi jandacvis doneze registrirebul sxvadasxva kidev imitom, rom ar ician, Tu ramdenad TanagrZnobiT
aSlilobaTa sixSire da gamoTvales, rom ojaxis eqims moekideba eqimi maT. isini, zogjer, fsiqikuri aSlilo-
2000 mozrdili adamianidan eyoleba (Strathdee and bis mxolod fizikur simptomebs amJRavneben. is, Tu
Jenkins, 1996): ramdenad warmatebiT moaxerxebs eqimi faruli aSli-
lobis gamovlenas damokidebulia faqtorebze, romle-
w 60-100 depresiis mqone piri;
bic qvemoT aris ganxiluli (gv. ??).
w 70-80 _ SfoTviTi aSlilobis mqone piri;
w 50-60 _ situaciuri reaqciis mqone pacienti;
saWiroebebis Sefaseba
w 2-4 _ SizofreniiT daavadebuli pacienti;
saWiroeba, moTxovna, miwodeba da gamoyeneba
w 6-7 _ afeqturi fsiqoziT daavadebuli pacienti;
martivi ganmartebiT: saWiroeba aris is, saidanac
w 4-5 _ alkoholze an wamalze damokidebuli piri. xalxi iRebs sargebels; moTxovna aris is, rasac xalxi
aseTive Sedegebi miiRes bavSvebSic. 7-12 wlis asakis iTxovs; miwodeba aris is, risi uzrunvelyofac xor-
bavSvebidan, romlebmac mimarTes pirvelad jandacvas, cieldeba; gamoyeneba aris is, rac moixmareba (Thorni-
daaxloebiT meoTxeds aReniSneboda fsiqikuri aSli- croft and Tansella, 2000). zogierTi es martivi definicia
loba, romelic Tanabrad nawildeboda emociur, qce- saWiroebs ufro vrcel ganmartebas.
viT, da Sereul qceviT da emociur Sereul aSlilo- saWiroeba _ breikim SemogvTavaza saWiroebis ori
bas Soris (Garralda and Bailey, 1986). im mozardebidan, definicia (Breakey, 2000):
rolebmac ojaxis eqims mimarTes, daaxloebiT erT 1. calkeuli pirovnebisTvis _ servisebi, romlebTan
mesameds aReniSneboda fsiqikuri aSliloba (Garralda, dakavSirebiT specialistebi, servisis momxmare-
1994). iseve rogorc mozrdilebSi, fsiqikuri aSli- blebi da naTesavebi Tvlian, rom drois Sesabamis
lobis mqone bavSvebisa da mozardebis didi nawili monakveTSi unda moxdes maTi uzrunvelyofa, raTa
uCioda fizikur simptomebs. zogierT aseT SemTxveva- pacienti imdenad janmrTeli iyos, ramdenadac es
Si ver moxerxda fsiqikuri aSlilobis identifikacia. SesaZlebelia Tanamedrove codnis pirobebSi;
ramden xans gastans aSliloba? 2. populaciisTvis _ servisebi, romlebic special-
pirvelad jandacvaSi aRmoCenili bevri aSliloba istTa, momxmarebelTa da informirebuli sazoga-
droebiT stresorze xanmokle pasuxs warmoadgens, ma- doebis Sejerebuli azriT, drois mocemul mon-
akveTSi saWiroa mosaxleobisTvis, rom misi wevrebi
arsebuli samedicino codnisa da obieqturi epide-
cxrili 23.3 fsiqikuri aSlilobiT gamowveuli
miologiuri monacemebis pirobebSi maqsimalurad
SezRuduli SesaZleblobebis mqone pacientebis
janmrTlebi iyvnen.
saWiroebis sferoebi (samaxsovro abreviatura
_ SHARES) fsiqiatrebs, jandacvis sxva specialistebs, ser-
visis momxmareblebsa da naTesavebs sxvadasxva meTo-
S (Symptoms) simptomebi
debis efeqturobasa da upiratesobis Sesaxeb SeiZleba
H (Housing) sacxovrebeli _ uzrunvelyofa da gansxvavebuli azri hqondeT (magaliTisTvis ix. Slade
zedamxedveloba
et al., 1998). servisis momxmareblebisTvis, Cveulebriv,
A (Activities of daily living) _ yofiTi aqtivobebi, maT Soris yvelaze mniSvnelovani finansuri usafrTxoeba, mego-
kveba, sakuTari Tavis movla da garToba
broba, damakmayofilebel samuSao, seqsualuri part-
R (Recreation, training, and occupation) dasveneba, swavla nioris yola da wamlis gverdiTi efeqtebisgan gaTa-
da specializacia
visuflebaa. xolo, fsiqiatrebisTvis prioritetuli
E (Employment) dasaqmeba simptomebis mkurnaloba da riskis Semcirebaa.
S (Significant others) sxva mniSvnelovani daukmayofilebeli saWiroebebi _ individis doneze,
fsiqiatri am termins iyenebs im problemis aRsawerad,
adaptirebuli Primm, 1966.
rodesac servisis momxmarebels potenciurad efeq-
_ 665 _
turi intervenciis adekvaturi momsaxureba ar miuRia ar saWiroebs specialistebs; meore done imaTTvisaa
(ix. Marshall, 1944). gankuTvnili, romelTa mkurnalobac pirvelad
moTxovna damokidebulia imaze, Tu ramdenad in- jandacvaSia SesaZlebeli (Marshall et al., 2005);
formirebulia mosaxleoba ama Tu im servisis Sesaxeb danarCeni doneebi gankuTvnilia im pirebisTvis,
da rogor afasebs mis Sesabamisobasa da efeqturobas. visac esaWiroebaT specialuri servisi _ dawyebuli
servisis zogierT momxmarebels SeiZleba undodes ambulatoriuli momsaxureobiT (mesame done),
alternatiuli samedicino saSualebebis gamoyeneba, damTavrebuli xangrZlivi momsaxurebiT TemSi an
maSin roca specialistebi upiratesobas mtkicebule- saavadmyofoSi (meeqvse done).
baze damyarebul meTodebs aniWeben. iSviaTi, uki-
duresad sastiki Zaladobis Sesaxeb gakeTebuli media- populaciis saWiroebebis Sefaseba
reportaJis Semdeg sazogadoebam SeiZleba usafrTxo upirveles yovlisa ganisazRvreba sxvadasxva fsi
servisebisTvis prioritetis miniWeba moiTxovos. qikuri aSlilobis mqone adamianebis raodenoba
utilizacia (servisis moxmareba) _ saWiroeba xar- msgavs populaciaze Catarebuli epidemiologiuri
jebTan dakavSirebuli araa, Tumca servisis moxmare- kvlevis Sedegebis mixedviT. es monacemi koregirdeba
ba Tanxebzea damokidebuli. pacientis mkurnaloba am populaciis specifikuri maxasiaTeblis mixedviT
(erovnuli janmrTelobis servisebSi) ufasoa, Tumca (magaliTad, xandazmulTa an eTnikuri umciresobebis
am servisiT sargeblobisTvis pirovnebam arapirda- warmomadgenelTa didi wili). amis Semdeg, calkeuli
piri xarjebi unda gawios, magaliTad, servisiT sarge- diagnostikuri jgufis adamianebisTvis saWiro ser
blobis periodSi samsaxuris gacdena an bavSvis mov- visebis Sefaseba miesadageba am populaciis Se
laze daxarjuli Tanxa. utilizacia, aseve, xelmisawv- fasebas. praqtikulad iSviaTad aris SesaZlebeli
domobasa da mimReblobazea damokidebuli. yvela am saWiroebis uzrunvelyofa da saWiro xdeba
prioritetebis gamoyofa. britaneTSi prioriteti
pirovnebis saWiroebebis Sefaseba eniWeba seriozuli fsiqikuri daavadebis mqone
klinikuri Sefaseba adamianebs.
yoveli fsiqiatriuli Sefaseba mkurnalobis saWiroe-
bebis Sefasebas moicavs, rac, xSirad zrunvis gegmis fsiqiatriuli servisis dagegmva
Sedgenas gulisxmobs. primma saWiroebebis gansazRvr-
dagegmva adgilmdebareobis mixedviT
isTvis saintereso mnemoniki SemogvTavaza (ix. cxrili
qveynebis umetesobaSi fsiqiatriuli servisebis
23.3, Primm, 1966).
dagegmva xdeba geografiuli raionis mixedviT,
standartuli Sefaseba rasac xSirad seqtori an momsaxurebis zona ewodeba.
qvemoT miTiTebulia saWiroebis Sefasebis meTodebis evropaSi seqtorebi mniSvnelovnad varirebs zomis
magaliTebi. isini umTavresad kvlevebSi gamoiyeneba: mixedviT: 15000-50000-dan SvedeTSi da 250000-mde
Cveulebrivi klinikuri daniSnulebisTvis standar germaniaSi (ix. Thornicroft and Tansella, 2000).
tuli meTodebis gamoyeneba ar xdis servisis dagegmvas dagegmvas adgilmdebareobis mixedviT garkveuli
ufro efeqturs (Marshall et al., 2005a; Ashaye et al., 2003). upiratesobebi aqvs, radgan:
w kambervelis (Camberwell) saWiroebebis Sefaseba _ga w populaciis Semadgenlobis lokaluri varirebis

miznulia seriozuli fsiqikuri daavadebis mqone saSualebas iZleva (magaliTad, xandazmulTa ara
pacientTa saWiroebebis SefasebisTvis (Phelan et Cveulebrivad didi wili)
al., 1995). fasdeba saWiroebebis 22 sfero, maT w sxva SemTxvevaSi fsiqiatriuli servisebis urTi
Soris sacxovrebliT uzrunvelyofa, sakuTari Ta erTgancalkevebuli nawilebis integrireba (magali
vis movla, fsiqozuri siptomebi, fizikuri jan Tad, mozardebisa da mozrdilebis servisebis)
mrTeloba, usafrTxoeba, nivTierebaTa moxmareba, w fsiqiatriuli da zogadi samedicino servisebis in-
bavSvis movla da finansebi. tegrireba (magaliTad, bavSvTa fsiqiatriis da pe-
w ZiriTadi saWiroebebis Sefaseba _ (Marshall et al., 1995) diatriis servisebis)
afasebs daukmayofilebel saWiroebebs (ix. zemoT). w samedicino, socialuri da moxaliseTa servisebis
w servisis Sefasebis saWiroebebi, romlebic mxolod integrireba.
kvlevisTvis Seiqmna (Brewin et al., 1987). adgilmdebareobis mixedviT dagegmvas garkveuli na-
w servisis done _ altrnatiuli midgomaa, rac pa klic gaaCnia:
cientisTvis servisis konkretuli donis gansazRvras w SeiZleba ar gamodges xarjTefeqturi iseTi md-
niSnavs. uingma SemogvTavaza eqvsi done (Wing, 1994): gomareobebis servisis ganxorcieleba, romleb-
yvelaze dabali done imaTTvisaa gankuTvnili, vinc
_ 666 _
fsiqiatriuli servisis dagegmva
sac sWirdeba specialistis daxmareba da dabali dacvis trastebs (PCT) aniWebs da, amasTan, miuTiTebs,
prevalentobiT xasiaTdeba (magaliTad, pacientebi, Tu ra servisebi unda Seisyidon. es miTiTebebi
romlebsac saSualo an maRali usafrTxoeba sWird- efuZneba fsiqiatriuli jandacvis servisebis erovnu-
ebaT) servisis xarisxi SeiZleba gansxvavdebodes li sitemisa da jandacvis erovnuli servisebis
seqtorebs Soris, Tumca am gansxvavebis Semcireba trastis (NHS) gegmas da ufro detalurad politi-
SesaZlebelia minimaluri erovnuli standartis kis danergvis gzamkvlevSia gawerili. masSi miTiTe-
dadgeniT bulia mizani da yvela pirveladi jandacvis trasti
w janmrTelobis servisis da socialuri servisis se- valdebulia daTqmul vadaSi am mizans miaRwios. aseTi
qtorebi SeiZleba erTmaneTs ar emTxveodes Tavi- miznis magaliTebia: asertuli Sinmomsaxurebis sam-
si saqmianobis TvalsazrisiT. am problemis movla saxuri, krizisuli intervencia, adreuli interven-
servisis mimwodebelTa TanamSromlobiTaa SesaZle- ciis servisebi. agilobrivi da provaideri trastebis
beli. progresi strategiuli saxelmwifo organoebis mier
fasdeba. Sedegi stacionarebisTvis `varskvlavebis
dagegmvis procesi miniWebis~ erovnul sistemaSi aisaxeba da sazogadoe-
bisTvis xdeba cnobili.
ar arsebobs fsiqiatriuli samsaxuris dagegmvis uni-
samizne servisebis garda, klinikuri daxelovnebis
versaluri meTodi. sxvadasxva qveyanaSi gansxvavebuli
erovnuli instituti (NICE National Institute of Clini-
midgomebi gamoiyeneba da qveynis SigniTac xSirad xde-
cal Excellence) aqveynebs mtkicebulebebze damyare-
ba maTi gadasinjva politikosTa da profesionalTa
bul saxelmZRvanelo principebs konkretuli saxis
SecvlasTan erTad. miuxedavad amisa, mainc SesaZle-
mkurnalobisTvis. am saxelmZRvanelo principebSi
belia dagegmvaze moqmedi ramdenime parametris gamo-
dazustebulia konkretuli mkurnaloba, romelsac
yofa. am nawilSi Cven ganvixilavT aseT parametrebs
sxvadasxva saxis aSlilobis mqone adamianebi moelian
da maT zegavlenas inglisis erovnuli janmrTelo-
NHS-dan (magaliTad, Sizofreniis mkurnalobis sax-
bis servisis (NHS National health Service) dagegmvaze.
elmZRvanelo principebi). am saxelmZRvanelo prin-
dagegmvis strategiis am magaliTs viyenebT imis sai-
cipebis implementacia akisria provaider trastebs,
lustraciod, Tu rogor gadadis principebi praqti-
romlebic, amave dros, atareben miRweuli Sedegebis
kaSi. amave dros, Cven ar vgulisxmobT, rom mocemuli
audits. provaideri trastebis mier miRweuli pro-
praqtika sxvebze ukeTesia.
gresi jandacvis erovnuli komisiis Sefasebis sgania.
finansuri wyaroebi _ fsiqiatriuli servisis dafi-
servisebis morgeba adgilobriv pirobebze _ fsiqi-
nanseba SesaZlebelia pirdapiri gadaxdiT, samedicino
atriuli servisis dagegmvis dros yovelTvis unda
dazRveviT, dabegvriT, saqvelmoqmedo Semowirulo-
iyos gaTvaliswinebuli adgilobrivi faqtorebi. gan-
bebiT an am wyaroebis kombinirebiT. dazRvevaze da-
sakuTrebuli mniSvnelobisaa:
fuZnebuli da pacientis mier anazRaurebuli ser-
visebi ufro moqnili da efeqturia maTTvis, vinc mas w urbanizaciis xarisxi (rac sxva faqtorebTan erTad
iyenebs, magram aq arsebobs im adamianebis uyuradRe- gansazRvravs fsiqozebis sixSires)
bod datovebis riski, romlebic gadaxdisunariani w populaciis eTnikuri Semadgenloba
ar arian. zogadad, saxelmwifos mier dafinansebuli w misi lokalizacia (magaliTad did sasoflo far-
servisebi ufro miukerZoebelia, magram maT axlavs Tze)
arasakmarisi dafinansebis, biurokratiis da momxmare-
w asakobrivi struqtura
blis saWiroebebis daukmayofileblobis riski. ing-
lisis NHS, romelic dabegvriT finansdeba, cdilobs w deprivaciis done
ukeT pasuxobdes arsebul moTxovnebs da gazardos sa- w saSualebebisa da personalis xelmisawvdomoba.
kuTari efeqturoba fsevdo-bazris SeqmniT. kerZod, fsiqiatriuli, socialuri da moxaliseTa ser
saxelmwifo finansebi eZleva pirveladi jandacvis visebis integracia _ fsiqikurad daavadebul pirebs
adgilobriv trastebs, romlebic yiduloben serviss esaWiroebaT farTo speqtris servisebi, xolo maTi
meoreuli donis momsaxurebis gamwevi trastebisgan. ganxorcieleba moiTxovs erTze meti saagentos mo
centraluri kontroli da lokaluri avtonomia nawileobas. magaliTad, Sizofreniis mqone pi
_fsiqiatriuli servisebi mTeli qveynis masStabiT rovneba SeiZleba iRebdes medikaments fsiqiatris
Tanabari xarisxiT unda iyos ganviTarebuli da ad- daniSnulebiT, dRis serviss socialuri servisisgan
ekvaturad pasuxobdes adgilobriv saWiroebebs. inda sacxovrebels _ moxaliseTa organizaciidan.
glisSi jandacvis erovnuli servisebis trasti (NHS) momsaxurebis efeqturi dagegmva moiTxovs am da
am sakiTxebis dabalansebas cdilobs imiT, rom ser- sxva organizaciebs Soris urTierTmxardamWer
visebis Sesyidvis uflebas, lokaluri pirveladi jan- TanamSromlobas. inglisis NHS cdilobs amis miRwevas
_ 667 _
lokaluri implementaciis gundis daxmarebiT, daavadebis mqone mowyvladi adamianebisTvis an ad
romelic Sedgeba pirveladi jandacvis trastebis, reuli intervenciis gundi fsiqozis pirveli
fsiqiatriuli servisis provaiderebis, socialuri epizodis mqone adamianebisTvis. inglisis NHS-
servisebis, moxaliseTa organizaciebis, servisis Si damkvidrebulia tendencia, rom mimarTva mox
momxmareblebis da mzrunvelebis warmomadgenlebisgan. des specializirebul gundSi da servisis yve
lokaluri implementaciis gundi zrunavs pirveladi la momxmareblisTvis saWiroebis SemTxvevaSi
jandacvis trastebis daxmarebaze, raTa man ga xelmisawvdomi gaxdes asertiuli programis gundis,
naxorcielos erovnuli servisis CarCos mier gan krizisis/binaze mkurnalobis gundisa da adreuli
sazRvruli miznebi. intervenciis gundis mier gaweuli daxmareba. ag
NHS-Si sul ufro metad izrdeba fsiqikuri reTve iqmneba specialuri servisebi qalebisTvis da
daavadebis mqone adamianebis samedicino da socialuri pirovnuli aSlilobebis mqone pirebisTvis.
servisebis saqmianobis integracia. magaliTad, Temis fsiqiatriuli qvespecialobebis urTierTgamijvna
fsiqikuri janmrTelobis gunds, romelic aerTianebs _ rTulia sxvadasxva fsiqiatriul qvespecialobebis
socialur muSakebsac, moeTxoveba, rom integrirebuli zusti gamijvna. gansakuTrebiT Znelia mkacri
marTvis struqtura hqondes. socialuri servisis sazRvrebis dadgena erTis mxriv bavSvTa da mozardTa
ganyofilebebi fsiqikuri janmrTelobis sferoSi fsiqiatriul servisebsa da, meores mxriv, mozrdilTa
momuSave socialuri muSakebis marTvas akisreben zogad servissa da xandazmulTa serviss Soris. asakis
NHS-s, da, amave dros, axdenen TavianTi funqciebis mixedviT zRvaris daweseba iolia, magram servisis
integracias pirveladi jandacvis trastebTan. zogan, momxmareblisTvis es yovelTvis kargi ar aris.
garkveuli servisebis gadabareba xdeba erToblivad magaliTad, Sizofreniis mqone xandazmuli piris
NHS-isa da moxalise provaiderebis mier. es sistema momsaxureba Sedegiani ver iqneba, Tu misTvis nacnobi
gansakuTrebiT kargad pasuxobs marginaluri jgufebis fsiqiatri, ZiriTadi personali da dRis centri
(ltolvilebisa da usaxlkaroTa) saWiroebebs. aRar iqneba xelmisawvdomi 65 wlis Semdeg. meores
pirveladi da meoreuli servisebis funqciebis mxriv, SedarebiT ufro moqnili sistema naklebad
gamijvna _ mas Semdeg rac aRmoCnda, rom ojaxis mkafioa, xolo garkveuloba aucilebelia sazRvrebis
eqimTan konsultaciaze misuli oTxi pacientidan Sesaxeb kamaTis Tavidan asacileblad. inglisis
erTs fsiqiatriuli daavadeba aReniSneboda (ix. NHS-Si gaerTianebulia erovnuli miznebisTvis sa
zemoT), gaizarda moTxovna specialur fsiqiatriul Wiro SeTanxmebuli gardamavali protokolebi pir
momsaxurebaze. amitom aucilebelia gaimijnos pir veladi jandacvis trastebisa da fsiqiatriuli
veladi da specialuri servisis mimwodeblebis trastebisTvis.
pasuxismgeblobebi. sxva SemTxvevaSi meoreul ser servisis momxmareblebis da mzrunvelebis mona
visSi referalebis raodenoba imdenad maRali iq wileoba _ roca dagegmvis procesSi monawileoben
neba, rom gadaaWarbebs servisis SesaZleblobebs. servisis momxmareblebi da mzrunvelebi, servisis
pasuxismgeblobebis aseTi gamijvna moqnili un xarisxi umjobesdeba da adamianebic ufro metad
da iyos. winaaRmdeg SemTxvevaSi is adamianebi, rom endobian mas. servisis momxmareblebs da mzrunvelebs
lebsac esaWiroebaT specialistis momsaxureba, SeuZliaT mniSvnelovani wvlilis Setan adgilobrivi,
mas ver miiReben, xolo isini, visac esaWiroebaT regionuli da erovnuli gegmis SedgenaSi. maTi
saavadmyofodan gawera, ver miiReben reabilitaciur amgvari CarTuloba saWiroebs specialistebis mxridan
momsaxurebas. inglisis NHS am problemas agvarebs garkveul da uwyvet Zalisxmevas. ukanasknel wlebSi
ramdenime gziT. jer erTi, izrdeba investicia inglisis NHS-Si miRweuli iqna momxmareblebisa da
pirvelad doneze momuSave fsiqikuri janmrTelobis mzrunvelebis maRali xarisxis CarTuloba, magaliTad,
muSakebSi, raTa gaumjobesdes msubuqi fsiqikuri servisis momxmareblebi da mzrunvelebi monawileoben
aSlilobebis mkurnalobis xarisxi. meorec, xeli klinikuri daxelovnebis erovnuli institutis mi
ewyoba specialuri momsaxurebis mxolod erTi gziT er momzadebuli saxelmZRvanelo principebis
miRebas, rac xdeba referalis im SeTanxmebuli pro momzadebaSi. NHS-is yvela fsiqiatriul mmarTvelobas
tokolis dacviT, romelic monitorings eqvemdebareba hyavs momxmareblebisa da mzrunvelebisgan Semdgari
da praqtikaSi xorcieldeba. mesamec, pirveladi komiteti, xolo zogan ki maTi warmomadgenlebi
jandacvis trastebSi fsiqiatriuli servisebis sru sabWos wevrebi arian.
lad integrireba. qalebis saWiroebebis gaTvaliswineba _ fsiqiat
specialuri da zogadi servisi _ arCevani unda riulma servisma mxedvelobaSi unda miiRos qalebis
gakeTdes TemSi moqmed fsiqikuri janmrTelobis iseTi saWiroebebi, rogoric aris: bavSvis movla;
zogad gundsa da iseT specialur gunds Soris, survilis SemTxvevaSi, qal medicinis muSakTan
rogoric aris asertiuli gundi mZime fsiqikuri mkurnaloba; mxolod qalebisTvis gankuTvnili
_ 668 _
fsiqikuri janmrTelobis sarvisis komponentebi
ganyofilebis arseboba stacionarSi (maT Soris Sesabamisobis Semowmeba). NHS-s aqvs ramdenime gare
dacul ganyofilebebSi), dRis stacionarSi da kontrolis meqanizmic, romelSic Sedis jandacvis
sacxovrebelSi. unda arsebobdes perinataluri komisiis inspeqcia, erovnuli miznis miRwevis moni
fsiqikuri aSlilobebis momsaxureba da yuradReba toringi, gare auditi da arasasurveli movlenis gare
unda mieqces qalebis iseT saWiroebebs, rogoric mokvleva. aucilebelia daculi iyos wonasworoba
aris kvebiTi aSliloba, fsiqotropuli nivTierebebis servisis xarisxianad ganxorcielebis moTxovnasa da
borotad moxmareba, pirovnuli aSliloba da Warbi regulaciiT gamowveul saSiSroebas Soris.
TviTdazianeba. feradkanian da eTnikuri umciresobis Tornikroftma da tanselam (Thornicroft and Tansella,
warmomadgenel qalebs aqvT specifikuri saWiroebebi, 2000) aRweres servisi dagegmvis odnav gansxvavebuli
iseve rogorc Zaladobis msxverpl qalebs. qalebi principebi da Seqmneses saWiro samaxsovro (ix. boqsi
xSirad gamoTqvamen ukmayofilebas xelmisawvdomi 23.1).
servisebis gamo da bevri maTgani ver iRebs maTgan
saWiro sargebels (J. Williams et al., 2001). amdenad, fsiqikuri janmrTelobis servisis
qalebi CarTulni unda iyvnen servisis dagegmvaSi.
komponentebi
NHS-is gegma da fsiqikuri janmrTelobis erovnuli
fsiqikuri aSlilobis mqone pirebis saWiroebebis
servisis CarCo yuradRebas amaxvilebs qalebis
dasakmayofileblad fsiqikuri janmrTelobis servisi
saWiroebebze.
moiTxovs bevri komponentebis arsebobas:
xarisxis kontroli da servisis xarisxis ga
umjobeseba _ servisis dagegmvam unda uzrunvelyos 1. fsiqikuri jandacvis gundi pirvelad doneze ex
servisis ganxorcielebis uwyveti monitoringi mareba pirvelad jandacvas da axorcielebs sawyis
da gaumjobeseba. am miznis miRweva SesaZlebelia Sefasebas
sxvadasxva saxis gare da Sida kontrolis saSualebiT. 2. ambulatoriuli momsaxureoba
inglisis NHS-is Sida kontrolis ZiriTadi meqanizmia 3. specialist-fsiqologis mkurnaloba xSirad integ-
klinikuri marTva, romelic xarisxis gaumjobesebis rirebulia specialistis an pirveladi donis fsiqi-
da riskis kontrolis uwyvet process warmoadgens. kuri jandacvis gundSi
klinikuri marTvis sakvanZo elementebia: mtkicebu
4. krizisis/binaze mkurnalobis gundi mkurnalobs mw-
lebebze damyarebuli praqtika, codnisa da in
vave fsiqikur aSlilobebs binaze
formaciis xelmisawvdomoba, kvleva da ganviTareba,
klinikuri xarisxis da efeqturobis Sefaseba (maT 5. (A&E Accident & Emergency) ubedur SemTxvevas-
Soris auditi da saxelmZRvanelo principebTan Tan dakavSirebuli gadaudebeli servisi xSirad
krizisuli servisis nawilia da axorcielebs A&E
ganyofilebaSi moxvedrili pacientebis Sefasebas
boqsi 23.1 servisis dagegmvis cxra
da mkurnalobas
principi: sami ACE*
6. zogadi profilis saavadmyofosTan dakavSirebu-
1. (Autonomy) avtonomia _ pacients unda hqondes
li servisi fsiqikuri janmrTelobis problemebis
arCevanis ufleba
mqone pirebisTvis
2. (Continuity) uwyvetoba _ drosa da servisebis
sxvadasxva nawilebs Soris 7. TemSi moqmedi asertiuli mkurnalobis gundi mZime
3. (Effectiveness) efeqturoba _ mtkicebuleba, rom fsiqikuri aSlilobebis mqone adamianebisTvis, rom-
gamiznuli sargebeli miRweulia lebic rTuli `CasarTavia~ servisSi an servisis
4. (Accessibility) xelmisawvdomoba _ momsaxureba unda xSiri momxmarebelia
ganxorcieldes iq da maSin, sadac da roca saWiroa
8. adreuli intervenciis servisi emsaxureba adamian-
5. (Comprehensiveness) srulyofileba _ sxvadasxva ebs pirveli fsiqozuri epizodidan sami wlis ganma-
saWiroebebis da momxmareblebis gaTvaliswinebiT
vlobaSi
6. (Equity) miukerZoebloba _ resursebis ganawileba da
amis Sesaxeb gadawyvetilebis miReba samarTliani da 9. dasaqmebis servisi, maT Soris daxmarebis gaweva da-
swori unda iyos saqmebaSi. adamianebs exmarebian ipovon anazRaureba-
7. (Accountability) angariSvaldebuleba _ servisis di samuSao da maT treningsa da swavlebas utareben
momxmareblebisa da damfinanseblebisadmi 10. profesiuli reabilitacia, rac CairTavs semin-
8. (Coordination) koordinacia _ fsiqikuri janmrTelobis arebs, droebiT dasaqmebas da klubur models
serviss SigniT, mas da sxva servisebs Soris
11. dRis stacionaris dRis momsaxurebis servisi
9. (Efficiency) qmediToba _ saWiroebebis maqsimaluri
Semcireba xelmisawvdomi resursebis gamoyenebiT
moicavs Ria tipis centrebs
12. TviT-daxmarebisa da servisis momxmarebelTa jgu-
adaptirebuli Thornicroft and Tansella, 2000.
febi da saadvokato servisi
_ 669 _
13. stacionaruli servisi faruli morbidoba, rogorc wesi, naklebad mZimea,

14. fsiqiatriuli eqspertizis servisi uzrunvelyofs vidre aSkara morbidoba.
maRali, saSualo da dabali donis usafrTxoebis rogorc zemoT iTqva, ojaxis eqimis mier ucnobi
sacxovrebliT da exmareba sasjelis SemsubuqebaSi. fsiqikuri aSlilobis identificireba damokidebulia:
15. sxva rezidenciuli servisi moicavs mwvave formis w mis unarze, moipovos pacientis ndoba, raTa man
daavadebis an sxva saxis krizisis dros saavadmyofos gaumJRavnos Tavisi fsiqiatriuli problema;
gareT sacxovrebliT xanmokle uzrunvelyofas w mis unarze, gaarkvios da Seafasos, Tu riTia
16. servisi specifikuri jgufebisTvis _ kvebiTi gamowveuli fizikuri simptomi, fizikuri, Tu
aSlilobebis mqone adamianebi; dedaTa da bavSvTa fsiqikuri daavadebiT. es moiTxovs rogorc zogadi
ganyofilebebi medicinis, ise fsiqiatriis codnas.
17. socialuri uzrunvelyofis servisi exmareba aSlilobebi, romelTac mkurnaloben pirvelad

pacientebs pensiis miRebaSi, sakuTari uflebebis jandacvaSi
dacvaSi, TemSi moqmed mxardamWer muSakebTan
pirvelad jandacvaSi SesaZlebelia fsiqikuri aS
dakavSirebaSi; binaze daxmarebiTa da sakvebiT
lilobebis umetesobis warmatebuli mkurnaloba
uzrunvelyofs maT.
ojaxis eqimis an gundis sxva wevris mier. amis
18. specifikuri jgufebis servisi _ àuTriC~ servisi magaliTebia adaptaciis aSliloba, naklebad mZime
marginaluri socialuri jgufebisTvis, rogoricaa SfoTviTi da depresiuli aSlilobebi, somatizacia
usaxlkaroebi da ltolvilebi. (ix. qvemoT) da alkoholis moxmarebis zogierTi
SemTxveva. qvemoT mocemulia damatebiTi sakiTxebi,
romlebic ganxilvas saWiroebs. ufro sruli
pirveladi jandacvis doneze arsebuli informaciisTvis ix. Goldberg et al., 2000.
fsiqiatriuli servisebi .fizikuri simptomebis mqone pacientebi _ fsiqikuri
pirvelad jandacvaSi fsiqikuri aSlilobebis aSlilobis mqone bevri pacienti mimarTavs pirveladi
klasifikacia jandacvis eqims fizikuri simptomebis Sesaxeb
ICD-10 da DSM-IV Seiqmna fsiqiatriaSi gamoyenebis CiviliT. aseT mdgomareobas, xSirad, somatizebuls
mizniT. isini zedmetad detaluria pirvelad do uwodeben. am pacientebis did nawils fsiqikuri
neze gamosayeneblad da maT Soris arsebuli na simptomebi aReniSneba da swori interviuirebis Semdeg
tifi gansxvavebebi iSviaTad gamodgeba am doneze fsiqiatriuli diagnozi iCens Tavs. aseT SemTxvevebs
mkurnalobis SesarCevad. amis gamo, msoflio jan fakultaturi somatizacia ewodeba. zog SemTxvevaSi
dacvis organizaciam Camoayaliba ufro martivi pacientebi uaryofen fsiqikuri problemebis arse
klasifikacia jandacvis pirveladi donisTvis. yovel bobas da miuxedavad kvalificiuri gamokvlevisa,
diagnozs aqvs Sesabamisi marTvis gegma. fsiqikuri aSlilobis diagnozs ar eTanxmebian. am
SemTxvevebs WeSmariti somatizacia ewodeba.
fsiqikuri aSlilobis identifikacia pirvelad distresSi myofi pirebi, romlebic servisis xSirri
jandacvaSi momxmareblebi arian, eqims sxvadasxva CiviliT
fsiqiatriuli servisis ganxorcielebis sawyis etapze, mimarTaven. maTi umatesoba Sua xnis qalia. 80%-s aqvs
pirvelad doneze, dgindeba fsiqikuri aSliloba. es an hqonda fsiqikuri aSliloba, umetesad, depresia,
ar aris martivi, radgan rogorc zemoT aRiniSna, somatizacia an generalizebuli SfoTviTi aSliloba
adamianebis didi nawili fsiqikuri simptomebis da 60%-s aReniSneba Tanmxlebi fizikuri daavadeba
nacvlad fizikur simptomebs uCivis. es ukanaskneli (Katon et al., 1990). vinaidan bevri maTgani uars
SeiZleba warmoadgendes Tanmxlebi msubuqi fizikuri acxadebs fsiqiatrTa gundTan gadamisamarTebaze,
daavadebis simptomebs, an fsiqikuri aSlilobis maT momsaxurebas ojaxis eqimi uwevs. erT-erTi
simptomebis nawils (magaliTad, aCqarebuli guliscema midgomiT, pacients exmarebian fizikuri simptomebis
SfoTviTi aSlilobisas an daRliloba depresiuli cxovrebiseul stresul movlenasTan dakavSirebiT,
aSlilobis dros). zogierTma pacientma icis, rom aqvs amasTan, ar exebian Sualedur fsiqologiur
emociuri problema, magram ufro fizikur simptomebs meqanizmebs da ganixilaven stresis daZlevisa an
aRwers, vidre fsiqiatriul simptomebs, radgan SiSobs, Semsubuqebis gzebs.
rom eqimi TanagrZnobiT ar moekideba fsiqiatriul
daavadebas. zogi ver xvdeba, rom fizikur simptomebs aSlilobebi, romelTa referirebac xdeba
pirveladi daxmarebidan fsiqiatriul servisebSi
fsiqologiuri mizezebi aqvs. termini aSkara mor
bidoba aRniSnavs identificirebul SemTxvevebs, cxrilSi 23.2 naCvenebia, rom fsiqikuri aSlilobis
xolo yvela danarCens ewodeba faruli morbidoba. mqone yoveli 4 SemTxvevidan, ojaxis eqimis mier
_ 670 _
xdeba erTi pacientis identificireba, romelsac SeaTanxmos. am gegmaSi fsiqiatriuli da pirveladi
fsiqiatriul servisSi mkurnaloben. referirebul jandacvis gundebis kompetenciebi cal-calkea gan
jgufSi Sedis pacientebi mZime depresiuli aSli sazRvruli (rogorc zemoT moyvanil magaliTSi iyo
lobiT, bipolaruli aSlilobiT, SizofreniiT da naCvenebi).
demenciiT. ojaxis eqimi fsiqiatrTan referals iseT
fsiqiatriuli gundis muSaoba pirvelad
SemTxvevaSic mimarTavs, roca:
jandacvaSi
w diagnozi gaurkvevelia
arsebobs fsiqiatriuli gundis da pirveladi jan
w mdgomareoba mZimea dacvis gundis TanamSromlobis oTxi modeli.
w SeiniSneba suicidis mniSvnelovani riski
zogadi praqtikis eqimisa da misi personalisTvis
w mdgomareoba qronikulia
rCevis micema da maTi swavleba
w saWiro mkurnalobas ver Caatarebs pirveladi
aseTi stiliT muSaobisas fsiqiatri da gundis
jandacvis gundis wevri
sxva wevrebi ar naxuloben pacients, magram rCevas
w pirvelad jandacvaSi Catarebuli wina mkurnaloba iZlevian ojaxis eqimis mier pacientis gamokvlevaze
uSedego iyo dayrdnobiT. fsiqiatri atarebs seminarebs an ga
w fsiqiatriuli servisi xelmisawvdomi da sandoa nixilavs SemTxvevebs pirveladi momsaxurebis per
w pacients surs fsiqiatrTan mkurnalobis gagrZe sonalTan. aseTi sistema zrdis pirveladi jandacvis
leba. gundis unar-Cvevebs da aumjobesebs msgavsi pacientis
mkurnalobas momavalSi. aseve, fsiqiatriuli gundis
pirveladi jandacvis gundis mier Catarebuli wevr meddasac SeuZlia imuSaos pirveladi jandacvis
mkurnaloba meddasTan, romelic iTamaSebs mniSvnelovan rols
mwvave aSlilobebis mkurnaloba fsiqiatriuli aSlilobis mkurnalobaSi.
mwvave problemebis mkurnaloba xdeba mxolod gamokvleva da referali
konsultaciiT an medikamentur mkurnalobasTan
fsiqiatri gamokvlevas utarebs pacients iseT
kombinaciiT. zogi praqtikosi mimarTavs martiv
SemTxvevaSi, roca diagnozi an mkurnaloba zogadi
biheviorul mkurnalobas. radgan zogadi praqtikis
praqtikis eqimisTvis gaurkvevelia. es man SeiZleba
eqims iSviaTad rCeba dro yvelas konsultirebisTvis,
gaakeTos damoukideblad an ojaxis eqimTan erTad.
pirveladi jandacvis gundSi xSirad Sedis konsul
pacienti, romelsac specialistis mkurnaloba esa
tanti. damatebiTi treningis gavlis Semdeg praq
Wiroeba, dadgenili wesiT, ambulatoriul klinikaSi
tikos meddas SeuZlia warmatebiT Seasrulos es
igzavneba.
roli (Wilkinson et al., 1993). konsultantis arseboba
ar amcirebs fsiqotropuli wamlebis gamoweris gamokvleva da mkurnaloba
saWiroebas (Mynors-Wallis et al., 1995; Sibbald et al., 1996b).
fsiqiatri, ZiriTadad, pirvelad jandacvaSi muSaobs
xSirad, medikamentur mkurnalobas da konsultirebas
da pacientebis umravlesobas, ufro xSirad, pirveladi
erTdroulad iyeneben, radgan isini avseben erTmaneTs.
jandacvis centrebsa an saxlebSi naxulobs, vidre
qronikuli aSlilobebis mkurnaloba saavadmyofos ambulatoriul klinikebSi. klinikuri
fsiqologi da fsiqiatriuli eqTanic pirvelad
nebismieri qronikuli fsiqikuri aSlilobis mqone
jandacvaSi muSaoben da Sefasebas, konsultirebasa an
pacientTan dakavSirebiT naTlad unda ganisazRvros
biheviorul mkurnalobas axorcieleben. pacientisTvis
(da regularulad gadaisinjos ojaxis eqimisa
aucilebeli araa fsiqiatriul klinikaSi misvla.
da TemSi moqmedi gundis roli. magaliTad, qro
Tumca, fsiqiatriul gundsa da pirveladi jandacvis
nikuli Sizofreniis mqone zogierTi pacientis
gunds Soris kontaqti, SeiZleba, Zalian iSviaTi iyos.
momsaxurebisas ojaxis eqimi zrunavs pacientis
fizikur janmrTelobaze, afasebs zogad progress, gaziarebuli momsaxureba
niSnavs wamals, xels uwyobs mkurnalobis reJimis
aseTi midgoma xelsayrelia mZime fsiqikuri daavadebis
dacvas da exmareba ojaxs. kendrikma, (Kendrick et
mqone pacientebis momsaxurebis dagegmvisas, magram
al., 1995) Tavis kolegebTan erTad, daadgina, rom
mxolod am tipis pacientebiT ar Semoifargleba.
ojaxis eqimi damatebiTi treningis Semdegac ver
ojaxis eqimi da fsiqiatriuli gundis xelmZRvaneli
axerxebs xangrZlivi fsiqiatriuli daavadebis mqone
Tanxmdebian, Tu rogoria TiToeuli maTganis mo
pacientis struqturirebul gamokvlevas. umjobesia,
nawileoba marTvis erTian gegmaSi. amis Semdeg iniSneba
rom fsiqiatriulma gundma Seafasos aseTi pacientis
wamyvani muSaki.
mdgomareoba da mkurnalobis gegma ojaxis eqimTan
am sistemis Sesabamisoba damokidebulia ojaxis eqimis
_ 671 _
resursebze, saavadmyofos ambulatoriuli klinikis guneb-ganwyobis mZime aSliloba, Sizofrenia an de-
xelmisawvdomobaze (zogadad, xelmisawvdomoba ufro mencia aqvs. specialistebi ufro metad mkurnalo-
maRalia did qalaqebSi, vidre soflad) da pirveladi ben suiciduri an sxvebisTvis potenciurad saxifaTo
jandacvis centrebis raodenobaze, sadac fsiqiatri qcevisa an ormagi diagnozis mqone pirebs, romlebsac
muSaobs (rac meti centria, miT naklebia TiToeulSi fsiqikur aSlilobasTan erTad, wamalmoxmareba an
samuSao saaTebi). pirovnuli aSliloba aReniSnebaT.
prioritetebis dadgena pirvelad jandacvaSi specializebuli servisis mimwodeblebi

aq kamaTis sagans Semdegi sakiTxi warmoadgens: TemSi britaneTsa da zogierT sxva qveyanaSi rTulia spe-
arsebuli fsiqiatriuli gundis wevrebma pirdapir cialuri servisis organizeba, radgan gamijnulia
unda miiRon ojaxis eqimisgan referirebuli paci pasuxismgeblobebi sxvadasxva servisis mimwodebels
entebi, Tu unda moxdes referalebis skriningi da Soris da arsebobs sxvadasxva dafinansebis wyaroebi
maTi dayofa prioritetebad fsiqiatriuli gundis da prioritetebi. britaneTSi, magaliTad, central-
xelmZRvanelis mier, raTa gundis fokusireba moxdes uri mTavroba afinansebs saavadmyofoze dafuZnebul
seriozuli fsiqikuri aSlilobebis mqone pacientebze. saTemo serviss, xolo adgilobrivi xelisufleba
Temis fsiqiatriis meddas SeuZlia miiRos skriningis _ asaqmebs socialur muSakebs, uzrunvelyofs dRis
gareSe msubuqi aSlilobis mqone mravali pacienti centrebis saqmianobas da dacul sacxovreblebs. mox-
(Warner et al., 1993). romlebTan muSaoba SeiZleba aliseTa organizaciebic garkveul rols TamaSoben
xarjefeqturi ar iyos (Gournay and Brooking, 1994). servisis ganxorcielebaSi. magaliTad, socialuri
konfliqtis Tavidan asacileblad, prioritetebi servisebisTvis SeiZleba gansakuTrebiT prioritetu-
da referalis procedurebi pirveladi jandacvis li iyos bavSvebTan muSaoba, fsiqiatriuli servisebi-
provaiderebsa da Temis fsiqiatriul gunds Soris sTvis _ seriozuli fsiqikuri aSlilobis mqone pa-
TanamSromlobis dasawyisSive unda SeTanxmdes. cientebTan, xolo moxaliseTa servisebisTvis _ xan-
dazmulebTan. sxvadasxva provaiders Soris mWidro
specializebuli servisi mwvave fsiqikuri kavSiris gareSe, servisebi arakoordinirebuli da
aSlilobis mqone pacientebisTvis arasrulyofili iqneba. ufro gawonasworebuli da
mravalmxrivi servisis misaRebad dagegmvis dros gaT-
pacientebis referali specialistTan
valiswinebuli unda iyos provaiderebis gansxvavebu-
fsiqiatriuli servisi uzrunvelyofs mkurnalobas li prioritetebi. britaneTSi fsiqiatriuli da Se-
fsiqikuri aSlilobebis mqone pacientebis mxolod sabamisi socialuri servisebi erTian dafinansebaze
erTi nawilisTvis. zogierT qveyanaSi pacients gadadis.
SeuZlia pirdapir mimarTos specialists da amitom
pacientebi, romlebic mkurnaloben fsiqiatriul specializebuli servisis uzrunvelyofa mwvave
servisSi da pirvelad doneze, erTmaneTisgan di mdgomareobebis dros
dad ar gansxvavdebian. iseT qveynebSi, rogoric, mwvave fsiqiatriuli aSlilobis dros specialis-
magaliTad, britaneTia, sadac ojaxis eqimi faqtiurad tis momsaxurebisTvis saWiroa TemSi momuSave gundi,
moqmedebs, rogorc specialuri servisis `kariskaci~, romelsac exmareba ambulatoriuli, dRis staciona-
fsiqiatriul servisamde miRweuli pacientebis ris da stacionaruli servisebi.
raodenoba da tipi damokidebulia:
zogadi Tu specializebuli servisi
w ojaxis eqimis survilze, umkurnalos fsiqikuri
aSlilobebis mqone pirebs TemSi moqmedi gundi SeiZleba zogadi profilis iyos
da muSaobdes mozrdilTa yvela saxis fsiqiatriul
w pirveladi jandacvis gundis resursebsa da
problemaze, an kidev, hqondes specializebuli pro-
mkurnalobis unar-Cvevebze
fili (magaliTad, krizisis marTva da uwyveti momsax-
w pacientebis survilze, mimarTos specialists fsiq- ureba). aseTi sistemebidan TiToeulis upiratesobebi
iatriuli rCevisTvis Sejamebulia cxrilSi 23.4.
w kriteriumebze, romlebsac iyenebs ojaxis eqimi
fsiqiatriul servisebSi pacientebis referalisT- TemSi moqmedi asertiuli mkurnaloba
vis steinma da testma, romlebic muSaobdnen aSS-Si, aR-
w fsiqiatriul servisebSi referirebuli pacientebis weres swrafi reagirebis specialuri sistema (Stein and
miRebis kriteriumebze. Test, 1980). mas TemSi moqmedi asertiuli mkurnaloba
uwodes (ACT - Assertive Community Treatment), mwvave
britaneTSi fsiqiatriuli servisis momxmareblebis
fsiqikuri aSlilobis mqone pacientebs, romleb-
umetesobas mZime da qronikuli SfoTviTi aSliloba,
sac, savaraudod, saavadmyofosTvis unda miemar-
_ 672 _
jgufSi. aseve, Semcirda gamoyenebuli sawolebis
cxrili 23.4 zogadi da specializebuli raodenoba. avstraliaSi, houltmac miiRo msgavsi
servisebis Sedareba
Sedegebi TemSi intensiuri mkurnalobis Catarebis
zogadi servisis specializebuli modelis Sedegad da ganacxada, rom aseTi mkurnaloba ufro
upiratesobebi susti mxareebi
iafia stacionarulTan SedarebiT (Hoult et al., 1983).
martivi modelia; rTuli modelia; Znelia ACT-is an misi msgavsi midgomis xuTi randomizebuli
advilia ganxorcieleba ganxorcieleba kvlevis metaanaliziT joim da misma kolegebma
tradiciuli, axali, klinikur praqtikaSi daadgines, rom standartul momsaxurebasTan Seda
gamocdili da SedarebiT gamoucdeli rebiT ACT 40%-iT amcirebs erTi wlis ganmavlobaSi
testirebuli
saavadmyofoSi mimarTvas klinikuri da socialuri
mravalmxrivi erTi gundis momsaxurebidan gamosavlis gauaresebis gareSe (Joy et al., 2004). termini
meore gundis momsaxurebaze
gadasvlis problema an gunde- asertuli àuTriC~ momsaxureba zogjer gamoiyeneba
bis kriteriumebis daukmayo- im midgomis aRsaniSnad, romelic iyenebs ACT-s
filebloba principebs, magram SeiZleba zustad ar imeorebdes
naklebad Zviri ufro Zviri yvela mis detals. am midgomis gamoyeneba xangrZlivi
uwyvetobis miRweva uwyvetobis miRweva ufro
avadmyofobis gamo pacientebis xelaxali mimarTvis
iolia Znelia prevenciisTvis qvemoTaa aRwerili.
zogadi modelis susti specializebuli modelis binaze momsaxureba

mxareebi upiratesobebi
binaze momsaxurebis mizanic pacientebis gamokvleva
arasakmarisi meti mtkicebuleba
mtkicebulebebi metyvelebs zogierTi
da mkurnalobaa. aseTi sistema moiTxovs pacientze
specializebuli gundis pasuxismgebeli pirveladi jandacvis gundisa
sasargeblod da fsiqikuri janmrTelobis gundis mWidro
naklebad efeqturia ufro efeqturia SedarebiT TanamSromlobas. es midgoma ufro gamosadegia
bevri sxvadasxva mcire diapazonis amocanebis naklebad mZime aSlilobis mqone pacientebTan,
amocana gamo
vidre imaTTan, visac ACT an dRis saavadmyofoebSi
personali nakleb personali metadaa kmayofili momsaxureba esaWiroeba (ix. qvemoT). binaze
kmayofilia
momsaxurebis gansaxorcieleblad unda arsebobdes
Znelia kompleqsuri ufro advilia kompleqsuri pirveladi jandacvis kargad Camoyalibebuli gundi,
mkurnalobis Catareba mkurnalobis Catareba
ris gamoc misi Sefaseba mxolod britaneTSi moxda.
SedarebiT ufro hete momxmareblebis jgufi ufro ori randomizebuli kontrolirebadi kvleviT
rogenulia momxmareb homogenuria; gamosavalis
dadginda, rom Semcirda saavadmyofoSi mimarTvianoba
lebis jgufi; Sefaseba SedarebiT advilia
gamosavali rTuli klinikuri da socialuri gamosavlis gauaresebis
Sesafasebelia gareSe da ar moiZebna mtkicebuleba usafrTxoebis
Semcirebis Sesaxeb (Merson et al., 1992; Burns et al.,
TaT, mkurnaloba utardebaT personaliT kargad 1993). gaweuli xarjebic ufro dabali iyo, vidre
dakompleqtebul TemSi moqmedi gundis mier. ACT-s Sesadarebel jgufSi. yvela kvlevam daadastura da
specifikuri maxasiaTeblebia: avadebis mwvave periodis mkurnalobisTvis ramdenime
w calkeuli SemTxvevebis aRnusxvis nacvlad person- sawolis arsebobis aucilebloba.
ali muSaobs pacientTan ise, rogorc mas esaWiroeba sifrTxile unda gamoviCinoT am da sxva kvlevebis
w sakmarisi pesonaliT dakompleqteba _ daaxloebiT klinikuri monacemebis rutinul praqtikaSi gamo
erTi personali 10 pacientze yenebisas, radgan aseT kvlevebSi monawileobs mxolod
Zalian motivirebuli personali SezRuduli drois
w fsiqiatri muSaobs gundTan erTad
ganmavlobaSi (Audini et al., 1994).
w 24 saaTiani xelmisawvdomoba
ACT detalurad aris aRwerili da xelmisawvdomia ambulatoriuli klinikebi
modelis gameorebis sizustis gasazomi Skalebi (Teague miuxedavad imisa, rom fsiqiatrisTvis yovelTvis
et al., 1998). umjobesia mwvave fsiqikuri aSlilobis pirvelad
steinma da testma Seadares ACT standartul jandacvaSi mkurnaloba (ix. zemoT), centralur
mkurnalobasTan, romelic utardebodaT saavad klinikaSi muSaobas ori upiratesoba gaaCnia: jer
myofoSi mwvave mdgomareobis mqone pacientebs (Stein erTi, specialistTa gundi nakleb dros kargavs
and Test, 1980). 14 Tvis Semdeg simptomebi, socialuri mgzavrobaze da met dros uTmobs mkurnalobas;
funqcia da kmayofilebis xarisxi ukeTesi iyo saTemo meorec, naklebad gamocdil personals ufro ad
_ 673 _
vilad SeuZlia gamocdil kolegas rCevisTvis efeqturi.
mimarTos. ambulatoriuli klinikebis nakli is aris, dRis servisi qalebisTvis _ qalebis saWiroebebs
rom pacientebs da maT naTesavebs uwevT xangrZlivi yuradReba miaqcies ukanasknel xans dagegmil dRis
mgzavroba, ris gamoc isini nakleb regularulad servisebSi. es servisebi mxolod qalebs emsaxureba.
iyeneben aseT serviss. Tu ar SemuSavda mkacri personals gavlili aqvs treningi specialuri
referaluri politika, specializebuli momsaxureba saWiroebebis mqone qalebTan muSaobaSi (eTnikuri
gaewevaT iseT adamianebs, romelTa daxmarebac umciresobebis warmomadgenlebi; qalebi, romlebsac
araspecializebuli servisiTacaa SesaZlebeli. sxvaze mzrunveloba akisriaT; unarSezRuduli da
sxva specifikuri saWiroebebis mqone qalebi). qalebi,
dRis stacionarebi romlebic iReben am serviss, monawileoben mis
dRis stacionarebi ZiriTadad oTxi saxiT gamoiyeneba: dagegmvasa da warmarTvaSi.
1. dRis stacionari mwvave SemTxvevebisTvis _ servisi
stacionaruli momsaxureba
im adamianebisTvis, romlebsac aqvT mwvave daavade-
ba da sxva SemTxvevaSi stacionarSi moxvdebodnen. ramdeni adgili? Tavidan imedovnebdnen, rom
aseTi daxmareba Sesaferisia imaTTvis, visac Seu- kargad dakompleqtebuli personalis mqone Temze
Zlia saRamos saaTebSi da dasvenebis dReebSi ojax- dafuZnebuli momsaxureba mniSvnelovnad Seamcirebda
Tan erTad yofna. dRis stacionarSi samkurnalod stacionaruli momsaxurebis saWiroebas, magram
Sesaferisi mdgomareobebia: zomieri intensivobis im dros ar iyo gaTvaliswinebuli, rom yovel
depresiuli aSlilobebi, romlebsac ar axlavs fsiqiatriul serviss esaWiroeba stacionaruli
suicidis mniSvnelovani riski, SfoTviTi aSli- ganyofileba, romelic mwvave mdgomareobis mqone
loba, obsesiuri aSlilobebi da zogierTi kvebiTi pacientebis swor mkurnalobas uzrunvelyofs.
aSliloba. cxra kvlevis monacemiT (1568 monawile) ivaraudeba, rom Sesabamisi wonasworoba stacionarul
dRis stacionarSi mwvave SemTxvevebis mkurnaloba da TemSi moqmed momsaxurebas Soris maSin miiRweva,
Sesaferisia im pacientTa meoTxedisTvis, romleb- roca mwvave pacientebis momsaxurebisTvis saavad
mac saavadmyofoSi gaiares mkurnaloba Semdgomi myofoSi gaTvaliswinebulia 100 adgili 65 wlamde
gaumjobesebiT da romlebmac ganmeorebiT Caitares asakis 250000 pirze (xandazmulTa momsaxureba ??
saavadmyofoSi mkurnaloba. xuTidan oTx kvlevaSi gverdzea ganxiluli). specialuri uzrunvelyofaa
aRmoCnda, rom dRis stacionaris momsaxureba ufro saWiro im pacientebisTvis, romlebsac esaWiroebaT
iafi iyo, vidre saavadmyofos stacionaruli mom- intensiuri movla qceviTi darRvevis epizodis
saxureba (ix. Marshall 2003 da Marshall et al., 2003). ganmavlobaSi da, agreTve, imaTTvis, vinc sxvebisTvis
xifaTis Semcvelia (am ukanasknelTaTvis gamoiyofa
2. dRis droebiTi momsaxureba _ emsaxureba saavad
specialuri usafrTxo ganyofileba, romelic did
myofodan adre gaweras. amJamad jer kidev ar aris
ubans emsaxureba). mwvave fsiqiatriisTvis saWiro
dadgenili, aris Tu ara pacientis adreuli gawera
sawolebis zusti raodenobis gansazRvra rTulia,
iseTive efeqturi, rogorc mogvianebiT gawera.
radgan es damokidebulia:
3. dRis samkurnalo programebi _ axorcielebs
w populaciaSi, romelsac ganyofileba emsaxureba,
ufro intensiur mkurnalobas im adamianebisTvis,
avadobis, maT Soris, fsiqoaqtiur nivTierebaTa
romlebisTvisac ambulatoriuli daxmareba ar
moxmarebis, doneze
aRmoCnda efeqturi. ar arsebobs sakmarisi mtki
cebuleba imis dasadgenad, Tu rodis da ra saxis w ojaxebis mzaobasa da SesaZleblobaze izrunon
problemisTvis aris dRis mkurnaloba efeqturi. mwvave mdgomareobis mqone avadmyofze, rac, Tavis
mxriv, damokidebulia sacxovrebel pirobebsa da
4. dRis centrebi daxmarebas uwevs servisis xangrZliv
ojaxis wevrebis CarTulobaze
momxmareblebs. aseTi momsaxureba yuradRebiT
unda daigegmos aqtiuri mkurnalobis programasTan w krizisis servisis da binaze 24 saaTiani intensiuri
erTad, romelic specifikuria TiToeuli pacientis momsaxurebis ganmaxorcielebeli fsiqiatriuli
saWiroebebis mimarT. winaaRmdeg SemTxvevaSi meddis da TemSi moqmedi sxva personalis xel
momxmarebels SeiZleba gauCndes damokidebuleba. misawvdomobaze
arsebuli mtkicebulebiT, dRis stacionarebi saa w saavadmyofos garda, mwvave fsiqikuri aSlilobebis
vadmyofoSi stacionaruli momsaxurebis alter samkurnalo sxva dawesebulebebis arsebobaze,
nativas unda warmoadgendes. miuxedavad amisa, dRis rogoricaa, magaliTad, personaliT kargad da
stacionarma mwvave SemTxvevebisTvis naklebad moikida kompleqtebuli sacxovrisi
fexi, savaraudod imitom, rom krizisis gundi nakleb w dawesebulebebze, romlebic emsaxureba aSlilobis
xarjiania (ar moiTxovs Senobis xarjebs) da iseTive mwvave fazis Semdeg saavadmyofodan adre gaweril
_ 674 _
pacientebs; es dawesebulebebi waagavs imaT, stacionaruli ganyofilebebi mwvave SemTxvevebisTvis
romlebic zemoT, pirvel or punqtSia miTiTebuli, _ mwvave fsiqikuri aSlilobebis stacionaruli
Tumca, zogadad, ufro advilia adre gawera, vidre momsaxureba zogadi profilis saavadmyofos na
mimarTvis Tavidan acileba. wils warmoadgens. aseTi sistema amcirebs stigmas
ar aris miRebuli fsiqiatriuli palatebis sruli da aiolebs zogadi samedicino momsaxurebiT sar
datvirTviT muSaoba, radgan es iwvevs gadaudebeli geblobas. misi nakli imaSi mdgomareobs, rom iq ar
SemTxvevebis miRebis SeuZleblobas. aseT SemTxvevaSi aris sakmarisi sivrce okupaciuri saqmianobisTvis
arasasurveli wnexis qveS eqcevian pacientebic da da araformaluri aqtivobebisTvis, rac sWirdebaT
personalic, Tu ar arsebobs sakmarisi raodenobis fsiqiatriul pacientebs, romlebic sxvadasxva tipis
personali da ganyofileba ar aris sakmarisad tevadi. somaturi daavadebis mqone pacientebisTvis Seqmnil
cvlilebebi saWiroebebSi _ mas Semdeg, rac SemoiRes saavadmyofoSi imyofebian. am problemaTa nawils
Temze dafuZnebuli momsaxureba, imedovnebdnen, moevleba, Tu fsiqiatriuli ganyofileba ganTavsdeba
rom stacionaruli dawesebulebebis saWiroeba zogadi profilis saavdmyofos kompleqsis calke
mniSvnelovnad Semcirdeboda. inglisisa da uelsis SenobaSi.
gamocdilebam es molodini ar gaamarTla: magaliTad, TanamSromloba TemSi moqmed gundTan _ pacientebi
iZulebiTi mimarTvianoba 1990-dan 1995 wlebSi 50%- didi riskis qveS eqcevian, roca stacionaridan
ze metad gaizarda (Department of Health, 1996), xolo TemSi moqmed momsaxurebaze gadadian. aseT dros,
palatis datvirTva gaizarda TiTqmis 100%-iT (Ford gansakuTrebiT maRalia suicidis riski. inglissa da
et al., 1998). amas ramdenime mizezi hqonda, maT Soris: uelsSi fsiqiatriul pacientebSi suicidis riskis
meoTxedi modis fsiqiatriuli stacionaridan gaweris
1. stacionaris alternatiuli momsaxurebis nakleboba
Semdeg pirvel 3 Tveze, pikiT pirvel-meore kviraze.
im pirebisTvis, romlebisTvisac sruli datvirTviT
amdenad, riskis mqone adamianebi meTvalyureobas
stacionaruli mkurnaloba aucilebeli araa,
saWiroeben TemSi gawerisTanave.
an stacionaridan droze adre gawera, rodesac
pacients jer kidev esaWiroeba sruli stacionaruli
xangrZlivi momsaxurebis ganmxorcielebeli
servisi (magaliTisTvis ix. Beck et al., 1997).
fsiqiatriuli servisebi
2. riskisadmi sazogadoebis tolerantobis Semcireba
xangrZlivi momsaxurebis saWiroebis mqone
3. momsaxurebis programuli midgomis SemoRebam (1991
adamianebis daxasiaTeba
wels) fsiqiatriuli servisebi ufro efeqturi
gaxada, radgan fsiqiatriuli servisebi inarCunebda diagnozi
kontaqts servisis momxmareblebTan. aqedan xandazmulebis garda (ganxilulia me-20 TavSi)
gamomdinare, gaizarda ganmeorebiTi mimarTvebis fsiqiatriuli pacientebis umetesobas, romlebic
raodenobac. saWiroeben xangrZliv momsaxurobas, aqvT Sizofrenia,
ix. Szmuckler and Holloway, 2001, sadac ganxilulia qronikuli afeqturi aSliloba, preseniluri de
zogad fsiqiatriaSi sawolebisa da sxva resursebis mencia an pirovnuli aSliloba agresiul qce
saWiroebis sakiTxebi. vasTan an nivTierebebis moxmarebasTan erTad. pa
stacionaruli ganyofilebis dizaini _ mwvave cienti, romelsac esaWiroeba erT welze meti
daavadebis mqone pacientebis SemTxvevaSi daculi xniT hospitalizacia, ganixileba, rogorc àxali
unda iyos wonasworoba pacientis privatulobasa da xangrZlivad dayovnebuli~ (`Zveli xangrZlivad da
personalis saWiroebas Soris, awarmoos dakvirveba yovnebulis~ sapirispirod, romelic mravali wlis
palataSi myof pacientebze. palatis dizaini mi ganmavlobaSi, hospitlebis daxurvis programis daw
nimumamde unda amcirebdes CamoxrCobiT suicidis yebamde, saavadmyofoSi imyofeboda).
SesaZleblobas. unda arsebobdes usafrTxo sivrce
agznebuli pacientebisTvis, aseve sivrce, sadac
problemebi
pacients SeuZlia ganmartovdes da sivrce, sadac im pacientebis saWiroebebis klasifikacia, romle
is SeZlebs sxvebTan urTierTobas. stacionarul bisTvisac xangrZlivi fsiqiatriuli momsaxurebis
ganyofilebaSi unda iyos SesaZlebeli okupaciuri gawevaa mizanSewonili, ramdenime saxiT SeiZleba
Terapiis Catareba, saojaxo saqmeebis keTeba da ganxorcieldes. erT-erTi midgomis mixedviT, prob
dasveneba. sasurvelia, stacionars ezoc hqondes. lemebi iyofa Svid jgufad, romelTagan sami Sedis
mamakacebsa da qalebs unda hqondeT erTmaneTisgan msoflio jandacvis organizaciis unarSezRudulobis
izolirebuli saZineblebi da unda arsebobdes klasifikaciaSi (gv. ??).
izolirebuli sivrce maTTvis, visac dRis ganmavlobaSi w simptomebi, rogoricaa persistentuli halucina-
am sivrciT sargebloba surs. ciebi, an suiciduri azrebi
_ 675 _
w miuRebeli qceva, rogoric aris uxamsi sityvebis 4. saSualebebi, romlebic uzrunvelyofs pacientis
wamoZaxeba, Zaladobrivi muqara an moqmedeba CarTulobas mkurnalobis procesSi
w darRvevebi, romlebic fizikur da fsiqikur aqtivo- 5. regularuli ganmeorebiTi Sefaseba, maT Soris, fi-
bas aferxebs, magaliTad, cudi mexsiereba an moti- zikuri janmrTelobis
vaciis daqveiTeba. unarSezRuduloba, rac gavlenas 6. efeqturi TanamSromloba mzrunvelebs Soris
axdens mTlianad pirovnebis aqtivobaze (magaliTad,
7. momsaxurebis uwyvetoba da swrafi reagireba
Cacmis uunaroba)
krizisul viTarebze.
w invalidoba _ unarSezRudulobiT gamowveuli so-
imisTvis, rom es Svidi moTxovna saTemo momsaxurebis
cialuri barieri (magaliTad, muSaobis, an bavSvebis
doneze iseTive xarisxiT iyos daculi, rogorc
movlis SeuZlebloba)
stacionarSi mkurnalobisas, unda Seiqmnas garkveuli
w sxva socialuri barierebi, romlebic uSualod ar sistema, romelic rTulicaa da Zvirad Rirebulic.
ukavSirdeba unarSezRudulobas (rogoric aris aseTi sistemis ararsebobisas, pacientma SeiZleba
umuSevroba, siRaribe da usaxlkaroba) magram iwvevs dakargos sacxovrebeli da samsaxuri, aRmoCndes
sxva adamianebis stigmatizebul damokidebulebas mzrunvelebisa da saWiro mkurnalobis gareSe. TemSi
w uaryofiTi pirovnuli reaqciebi daavadebisadmi da moqmedi momsaxurebis arasrulfasovnebam SeiZleba
socialuri barierebi, rogoricaa dabali TviTSe- gamoiwvios mzrunvelis uyuradRebod datoveba da
faseba, uimedoba, avadmyofobis uaryofa an wamal- ojaxuri urTierTobebis gauareseba. rodesac gaCnda
moxmareba. TemSi moqmedi momsaxureba, misi klientebi is pacientebi
uingma da furlongma warmoadgines pacientTa maxa- iyvnen, romlebic mravali wlis manZilze imyofebodnen
siaTeblebis is CamonaTvali, romelic arTulebs maT stacionarSi da saavdmyofodan gaweris Semdegac
TemSi mkurnalobas (Wing and Furlong, 1986). es nusxa aReniSnebodaT Civilebi. aseTi pacientebis TemSi
dResac ZalaSia (ix. cxrili 23.5). pacientebi, rom- marTva sirTuleebis gareSe mimdinareobda. rogorc es
lebsac aqvT am tipis mZime da persistentuli prob- SemdgomSi gairkva, TemSi SedarebiT garTulda iseTi
lemebi, saWiroeben momsaxurebas personaliT kargad pacientebis marTva, romlebmac naklebi xani dahyves
dakompleqtebul hostelSi an saavadmyofoSi, sadac stacionarSi. es, nawilobriv, iman ganapiroba, rom
xorcieldeba Sesabamisi reabilitacia da usafrTxoe- saavadmyofodan gaweris Semdeg pacientebi naklebad
bis zomebia daculi. emorCilebodnen eqimis daniSnulebas.
moTxovnebi TemSi moqmedi xangrZlivi mzrunvelebi

momsaxurebis servisisadmi roca mZime fisiqkuri daavadebis mqone adamiani
Tu fsiqikuri aSlilobebis mqone pacients unda ojaxSi cxovrobs, misi ZiriTadi mzrunvelebi ojaxi da
umkurnalon TemSi, aucilebelia ganxorcieldes megobrebi arian. isini pacients uweven im daxmarebas,
momsaxurebis yvela is elementi, romelsac igi romelsac saavadmyofoSi meddebi gasweven. magaliTad,
stacionarSi miiRebda. xangrZlivi stacionaruli isini xels uwyoben pacients, rom diliT adges,
momsaxurebis Casanacveblad Temis doneze daculi daicvas piradi higiena, regularulad miiRos sakvebi
unda iyos Semdegi Svidi piroba: da saqmiT dakavdes. mzrunvelebi, aseve, exmarebian
1. saTanado mzrunveli, romelic iRebs saWiro dax- pacients daicvas eqimis daniSnuleba. Tu pacients
marebas xSirad aReniSneba problemuri qceva, xangrZlivi
movla sakmaod stresuli xdeba. aseT SemTxvevaSi,
2. Sesabamisi sacxovrebeli
mzrunvelebs SeiZleba dasWirdeT daxmareba, rCevis
3. Sesabamisi dasaqmeba micema da zogjer _ Sesveneba.
moxalise mzrunvelebi TemSi mniSvnelovan rols
cxrili 23.5 maxasiaTeblebi, romlebic TamaSoben mravalgvar momsaxurebaSi. trening
arTulebs TemSi momsaxurebas gavlil moxaliseebs SeuZliaT daexmaron pacients da
sakuTari Tavis an sxvisi dazianebis riski ojaxs. zogierTi saqvelmoqmedo organizacia iyenebs
araprognozirebadi qceva da recidivisken midrekileba profesional mzrunvelebs (rogoric, magaliTad,
hostelebis personalia).
fsiqoaqtiuri nivTierebebis avadmoxmareba
Temis fsiqiatriuli medda mniSvnelovan rols
dabali motivacia da sakuTari Tavis marTvis an TamaSobs Temze dafuZnebul momsaxurebaSi. is
socialuri rolis Sesrulebis arasakmarisi unari
exmareba pacients da mis mzrunvels, awarmoebs
mkurnalobis saWiroebis danaxvis uunaroba mis Sefasebas, zedamxedvelobas uwevs wamlebiT
dabali mimRebloba sazogadoebis mxridan mkurnalobas da xels uwyobs pacientis socialur
_ 676 _
urTierTobebs. Sefasebis warmoeba gansakuTrebiT dasaqmeba
mniSvnelovania arastabiluri fsiqikuri mdgomareobis
mZime da xangrZlivi fsiqikuri aSlilobis mqone
mqone pacientebisTvis, romlebic Zlieri agznebis
adamianebis umetesobas SeiZleba muSaobis survili
dros SeiZleba imuqrebodnen an safrTxes uqmnidnen
hqondes da zogierT maTgans SeeZlos kidec nor
garSemo myofT. TemSi moqmedi momsaxurebis erT-
malurad muSaoba. zogs sWirdeba daxmareba, romelic
erTi problema imaSi mdgomareobs, rom medda iseTi
sxvadasxva saxis SeiZleba iyos:
sixSiriT ver awarmoebs pacientebis Sefasebas,
w SromiTi reabilitacia yvelaze popularuli saxea.
rogorc es moxdeboda maTi stacionarSi yofnisas.
sakonkurso samuSaoze dasaqmebisTvis aucilebeli
sacxovrebliT uzrunvelyofa unar-Cvevebis gansaviTareblad da sakuTar SesaZ
stacionaridan gaweril pacients sWirdeba sakvebiTa leblobebSi rwmenis gansamtkiceblad unda ganxor
da sacxovrebliT uzrunvelyofa. bevri maTgani cieldes intensiuri treningi. treningi SeiZleba
cxovrobs ojaxTan erTad. zogierTi TviTon qiraobs tardebodes sxvadasxva saxiT. esaa: praqtikuli
binas, zogs sWirdeba daxmareba, rac sami gziT xasiaTis treningi, gunduri muSaoba an droebiTi
SeiZleba ganxorcieldes: samsaxuri (am dros fisiqkurad daavadebuli
daqiraveba _ zog adamians surs mdgmurad aiyvanos adamiani muSaobs anazRaurebad adgilze, romelic
fsiqikurad daavadebuli pacienti da aRmouCinos sareabilitacio programaSia CarTuli).
damatebiTi daxmareba. aseTi praqtika kargad muSaobs w kluburi modeli aris profesiuli reabilitaciis
zogierT qveyanaSi, magram britaneTSi farTod ar specialuri forma. is xorcieldeba SenobaSi,
aris damkvidrebuli. romelsac erToblivad xelmZRvaneloben fisiqikuri
sacxovrisi jgufuri cxovrebisTvis _ zogierT daavadebis mqone adamianebi (Beard et al., 1987).
pacients SeuZlia jgufurad cxovreba, anu iseT w mxardaWeriT mimdinare dasaqmeba Tavdapirvelad
saxlSi cxovreba, sadac oTxi-xuTi pacienti erTad Camoyalibda daswavlis darRvevis mqone pirebisTvis.
cxovrobs. saxli SeiZleba ekuTvnodes socialur an adamianebs awyebineben sakonkurso adgilze muSaobas
janmrTelobis dacvis serviss, an kidev saqvelmoqmedo momzadebis gareSe, magram exmarebian samuSaos
organizacias. aseT saxlSi mcxovrebni xSirad SesrulebaSi (Bond et al., 1997). 18 randomizebuli
Sizofreniis mqone adamianebi arian, romlebsac kontrolirebadi kvlevis sistemur mimoxilvaSi
socialuri unarSezRuduloba axasiaTebT da Zalian Seadares profesiuli reabilitacia da dasaqmeba
cota pozitiuri simptomi aReniSnebaT. maTi SerCevisas mxardaWeris pirobebSi (Crowther et al., 2001). 18
gaTvaliswinebulia TiToeuli pirovnebis is unarebi, Tvis Semdeg, sakonkurso samuSaoze myof adamianTa
romlebic gamodgeba sxvebTan erTad damoukideblad raodenoba mniSvnelovnad ufro meti aRmoCnda
cxovrebisTvis da saojaxo saqmianobisTvis. jgufurad daxmarebis pirobebSi mimdinare dasaqmebisas
mcxovreb adamianebs, Cveulebriv, regularulad (34%), vidre profesiuli treningis pirobebSi
exmareba da zedamxedvelobas uwevs TemSi moqmedi (12%). Tumca, arc erTi modeli ar gamodga
medda, romelic akontrolebs sistemis gamarTul sakmarisad warmatebuli. gairkva, rom profesiuli
muSaobas da xels uwyobs macxovreblebis mier iseTi reabilitacia ar aris ufro metad efeqturi, vidre
pasuxismgeblobebis aRebas, romelTa TavianT Tavze Temze dafuZnebuli mzrunvelobis standartuli
aReba maT SeuZliaT. sqema.
hosteli _ hosteli SedarebiT ufro xangrZlivi
w specialuri daculi samuSao. am dros adamiani
mzrunvelobisTvis gankuTvnili rezidenciuli dawe
muSaobs produqtiulad, magram ufro nela, vidre
sebulebaa. zogierTi adamianisTvis hosteli aris
es sxva samuSao adgilasaa misaRebi. aseTi samuSao
droebiTi sacxovrebeli, saidanac is SedarebiT
SeiZleba iyos mebaReoba an xelosnoba.
damoukidebel cxovrebaze gadadis, zogi pacienti
w moxalisobrivi saqmianoba _ zogi pacienti, romelsac
ki hostelSi wlobiT rCeba. hostelSi mcxovrebTa
ar SeuZlia raime konkretuli samuSaos Sesruleba,
umetesoba sakmaod damoukideblad cxovrobs. maTgan
SeiZleba dakavdes moxalisobrivi saqmianobiT.
mcire raodenobas, gansakuTrebiT maRali xarisxis
unarSezRudulobis mqone pirebs, damatebiTi momsa w okupaciuri Terapia _ gansakuTrebiT SezRuduli
xureba esaWiroeba. zedamxedvelobis done SeiZleba SesaZleblobebis mqone pirebi saWiroeben okupaciur
varirebdes mcxovrebTa saWiroebis mixedviT; ma Terapias, raTa Tavidan aicilon mowyeniloba,
galiTad, personals SeiZleba Rame eZinos an Se arasakmarisi stimulacia da socialuri kontaqtebis
iZleba iseve fxizlobdes, rogorc saavadmyofoSi nakleboba. aseTi okupaciuri Terapia unda Catardes
morigeobisas. aseT mowyobas zogjer saavadmyofo dRis stacionarSi an dRis centrSi.
hosteli ewodeba.
_ 677 _
daniSnulebis dacva problema isaa, rom TemSi gamokvleva ufro iS

viaTad tardeba, vidre saavadmyofoSi. amitom,
saavadmyofos medda, romelic mudmivad pacientis
saavadmyofoSi myof pacientTan SedarebiT, Temis
gverdiT imyofeba, exmareba pacients, raTa man daicvas
doneze daxmarebis mimRebi pacientis saziano an
daniSnuleba, xolo roca mkurnaloba TemSi tardeba,
muqaris gamomxatveli qcevis winaswari ganWvreta
SedarebiT ufro rTuli xdeba amis uzrunvelyofa.
ufro rTulia. ganmeorebiTi Sefasebis mniSvnelovani
ZiriTad muSaks am miznis miRwevaSi gansakuTrebuli roli
nawilia sakuTar TavTan an sxvebTan dakavSirebuli
akisria. mniSvnelovania, rom pacients, mis naTesavebs an
riskis xarisxis regularuli Sefaseba. aseTi Sefaseba
sxva mzrunvelebs naTlad esmodeT mkurnalobis gegmis
moicavs statikur faqtorebs, rogoricaa servisis
daniSnuleba da Sinaarsi (magaliTad, wamlis doza da
momxmareblis warsuli qceva da dinamikur risk-
miRebis dro). mzrunvelma, aseve, unda icodes, Tu vis
faqtorebs, rogoricaa fsiqoaqtiur nivTierebaTa
acnobos gegmaSi momxdari cvlilebebi. im pacientebs,
moxmarebis an fsiqosocialuri stresoris axlandeli
romlebic ar icaven mkurnalobis sqemas, unda mieceT
xarisxi (gv. ??). riskis Sefasebis mixedviT dgeba
azris gamoxatvis saSualeba. zogjer, SeiZleba saWiro
riskis marTvis gegma, rac momsaxurebis saerTo
gaxdes advokatis CarTva.
gegmis mniSvnelovani komponentia. riskis Sefasebis
qronikuli fsiqikuri aSlilobis mqone zogi
mecnieruli Rirebuleba sakamaToa (ix. Szmuckler,
pirovneba ver acnobierebs xangrZlivi mkurnalobis
2003). miuxedavad yvelafrisa, aseTi Sefaseba mainc
saWiroebas da antifsiqozuri wamlis miRebis
mniSvnelovania, radgan adasturebs, rom klinikuri
Sewyvetis gamo recidivi uviTardeba. britaneTSi,
gadawyvetileba miRebuli iyo arasasurveli gar
fsiqikuri janmrTelobis aqtis 25-e paragrafis
Tulebis SesaZleblobis gaTvaliswinebiT.
mixedviT, TemSi myofi fsiqikurad daavadebuli piri,
romelic ar icavs mkurnalobis gegmas, SeiZleba
momsaxurebis uwyvetoba
gadayvanil iqnas saavadmyofoSi gamokvlevis Casa
tareblad. am wignis weris periodSi jer kidev TemSi momuSave personalma unda daimsaxuros
ar arsebobs iZulebis samarTlebrivi meqanizmi, pacientis ndoba, raTa uzrunvelyos misi mkurnaloba
garda stacionaruli mkurnalobisa. grZeldeba da problemebis matebis SemTxvevaSi, droze moi
debatebi im meqanizmebis Sesaxeb, romlebic daicavda Txovos daxmareba. personali imdenad kargad unda
pacientis uflebebs da, amave dros, gaiTvaliswinebda icnobdes pacients, rom SeeZlos stresze reaqciis
sazogadoebis usafrTxoebas. mkiTxveli unda gaecnos winaswarmetyveleba da mis qcevaSi recidivis maniS
sakanonmdeblo da administraciuli mowyobis wesebs, nebeli mcire cvlilebebis danaxva. es mizani ver
romlebic moqmedebs im qveyanaSi, sadac is muSaobs. ganxorcieldeba, Tu personali xSirad icvleba.
amitom, mniSvnelovania momsaxurebis uwyvetobis
xelaxali gamokvleva uzrunvelyofa. personali gansakuTrebiT yuradRebiT
pacientebi, romlebic saavadmyofos gareT cxovroben, unda iyos iseT SemTxvevaSi, roca momsaxureba icvleba
saWiroeben iseTive regularul gamokvlevas, ro da pacienti sxva specialistis xelSi gadadis.
gorsac saavadmyofoSi xangrZlivi mkurnalobis Sem
TxvevaSi. fsiqikuri statusis regularul Sefasebas krizisze reagireba
da pacientis mier daniSnulebis dacvas, Cveulebriv, Temis personali swrafad unda reagirebdes kri
uzrunvelyofs ZiriTadi muSaki, romelic, umetes zisze. ojaxi da moxaliseTa organizaciebis personali
SemTxvevaSi, aris TemSi momuSave medda, xolo dagegmil, ufro advilad iRebs pacients, rodesac icis, rom
magram SedarebiT iSviaT, ganmeorebiT Sefasebas saWiroebis SemTxvevaSi, mis daxmarebas ganaxorcielebs
axorcielebs fsiqiatri. qronikuli aSlilobis gadaudebeli ganyofileba. swori moqmedebiT
mqone zog adamians aviwydeba vizitze misvla. amitom SesaZlebelia hospitalizaciis Tavidan acileba.
aucilebelia, rom arsebobdes Sexsenebis sistema da mniSvnelovania krizisis gegmis winaswar SeTanxmeba
kontaqtis ganaxlebis SesaZleblobebi. mniSvnelovania, pacientTan da mis mzrunvelTan. swrafi reagirebisTvis
rom fsiqikur aSlilobasTan erTad, inaxos pacientis unda arseobdes personalis sakmarisi raodenoba. es,
fizikuri janmrTelobac, radgan xangrZlivi fsiqikuri gansakuTrebiT, exeba iseT personals, romelic icnobs
aSlilobis mqone pacientebma SeiZleba ar moiTxovon pacients an gadaudebeli daxmarebis gundis wevria.
daxmareba somaturi daavadebis gamo, an ar isargeblon
SeTavazebuli daxmarebiT. amdenad, ojaxis eqimis TemSi moqmedi asertuli mkurnaloba da asertiu-
mier pacientis fizikuri mdgomareobis gamokvleva li àuTriC~ programa
pacientze mzrunvelobis mniSvnelovani nawilia. miuxedavad imisa, rom TemSi moqmedi asertuli
riskis Sefaseba _ rogorc zemoT iyo aRniSnuli, mkurnaloba Seiqmna mwvave daavadebis mqone
TemSi ganxorcielebuli daxmarebis erT-erTi pacientebisTvis (gv. ??), is SedarebiT ufro farTod
_ 678 _
gamoiyeneba qronikuli Sizofreniis mqone pacientebis individualuri saWiroebebis dakmayofileba:
TemSi mkurnalobisTvis. ACT-s gamoyeneba xangrZlivi SemTxvevis marTva (mzrunvelobis programa)
fsiqikuri aSlilobebis mqone adamianebisTvis Seis TemSi moqmedi momsaxurebis efeqturoba moiTxovs
wavles 14 kvlevaSi (2647 pacientis monawileobiT), rTul sistemas, romelSic CarTuli unda iyos ram-
romelTa mimoxilvac Caatares marSalma da lokvudma denime specialisti, naTesavebi da moxaliseTa or-
(Marshall and Lockwood, 1998). aRmoCnda, rom ACT-m ganizaciebi. sistemas, romelic pacients aucilebel
Seamcira stacionarSi xelaxali mimarTvebis raodenoba, serviss sTavazobs, SemTxvevis marTva, momsaxurebis
xolo hospitaluri momsaxurebis raodenoba 40%- marTva an mzrunvelobis programa (es ukanaskneli
iT Semcirda. miuxedavad imisa, rom klinikuri da termini britaneTSi gamoiyeneba) ewodeba.
socialuri gamosavali standartuli momsaxurebis termini `SemTxvevis marTva~ (an programa) ufro me-
msgavsi iyo, ACT pacientebSi naklebad gvxvdeboda tad gamoiyeneba ramdenime da ara gansxvavebuli pro-
usaxlkaro adamianebi. ACT-iT mkurnaloba SeiZleba cedurebis aRsawerad. misTvis damaxasiaTebelia xuTi
ar iyos iseTive efeqturi sxva qveynebSi, rogorc elementi:
es aSS-s kvlevebSi dadasturda. amis nawilobrivi
1. pacientis keTildReobaze pasuxismgebelia erTi
mizezi SeiZleba imaSi mdgomareobs, rom sxva qveynebSi
piri
ar iyo uzrunvelyofili personalis sakmarisi ra
odenoba. britaneTis kvlevebSi (magaliTad, kvleva 2. fasdeba pacientis saWiroebebi
UK700, Burns et al., 1999), ar gamovlinda iseTive 3. dgeba gegma im servisis uzrunvelsayofad, romelic
mniSvnelovani gansxvaveba SedegebSi, rogoric daakmayofilebs pacientis saWiroebebs
aSS-s adreul kvlevebSi. am gansxvavebis mizezebi 4. xorcieldeba servisi
daudgenelia, magram, savaraudod, is SemdegSi unda
5. pacienti da servisis miwodeba monitorings eqvemde-
mdgomareobdes: (I) Sesadarebel jgufebTan ukeTesi
bareba.
gamosavali dadasturda britaneTis kvlevebSi, vidre
mocemuli midgomis sxvadasxva variantis gansxvave-
amerikul kvlevebSi; (II) gunduri marTva ufro susti
buli elementebis daxasiaTeba SesaZlebelia maTi Sem-
iyo britaneTSi, rac, nawilobriv, ganpirobebuli
degnairi dayofiT:
iyo organizaciuli faqtorebiT. zogierTi avtoris
mosazrebiT (Weaver et al., 2003), sistema ufro moqnili w brokerobad, romlis drosac menejerebi organize-
unda iyos, radgan zogierT pacients ar esaWiroeba bas ukeTeben sxvis mier ganxorcielebul serviss da
asertuli programa. aseTi pacientebi iReben wamlebs uSualod ar gasweven klinikur momsaxurebas
da akiTxaven eqims. aseve, pacientTa umetes nawils w klinikuri momsaxurebis marTva, romlis drosac
asertuli programa mxolod garkveul SemTxvevebSi menejerebi ara marto àwesrigeben~ sxva saagentoe-
esaWiroeba. zogierT SemTxvevaSi aseTi programa bis serviss, aramed uSualod axorcieleben pacien-
SeiZleba ar aRmoCndes saWiro an sulac uaryofiTi tis mkurnalobas, ris gamoc maT pirdapiri kavSiri
Sedegebi gamoiRos. Terapevtebi unda cnobdnen aqvT pacientTan.
recidivis adreul niSnebs da droulad mimarTavdnen britaneTSi damkvidrebuli meTodi zemoT aRwerili
prevenciul zomebs, rac, zogjer, asertuli àuTriC~ meTodebis nazavs warmoadgens da sxvadasxva adgilas
programis gamoyenebas gulisxmobs. gansxvavebulad gamoiyeneba. mzrunvelobis programa
xels uwyobs servisis gaumjobesebas da farTodaa
ojaxTan da moxaliseebTan muSaoba
miRebuli. inglissa da uelsSi is gaTvaliswinebulia
TemSi moqmedi momsaxureba Zviria, xolo bevr
Temze dafuZnebuli mzrunvelobis aqtis (1990) mier.
qveyanaSi saxelmwifo dafinanseba SezRuduli, ris
am midgomis efeqturoba Sefasda 11 kvlevis analiziT,
gamoc sistemis moqmedeba ojaxebis da moxaliseebis
sadac monawileobda 1751 pacienti (Marshall et al., 1998).
wvlilze aris damokidebuli. mniSvnelovania, rom
SemTxvevis marTva efeqturi iyo pacientTan kon-
ojaxebi da moxaliseTa jgufebi CarTulni iyvnen
taqtis SesanarCuneblad, magram ar amcirebda mimarT-
servisis dagegmvaSi da rom maTi da profesionali
vianobas; piriqiT, mimarTvianobam moimata standartu-
personalis pasuxismgeblobebi erTmaneTTan iyos
li momsaxurebis SemTxvevebTan SedarebiT. amis miuxe-
SeTanxmebuli. aseTi SeTanxmebis gareSe, ojaxis
davad, SemTxvevis marTvis da `standartuli~ momsax-
wevrebma SeiZleba CaTvalon, rom maT saWiroze meti
urebis klinikuri da socialuri gamosavali Tanabari
saqmis keTeba moeTxovebaT, xolo profesionalebma
iyo, Tumca `standartuli~ momsaxureba, zogadad,
miiCnion, rom moxaliseebis moqmedeba scildeba maT
naklebad Zviria. damatebiTi Sefasebaa saWiro imis
pasuxismgeblobas. servisis SefasebaSi ojaxebisa
dasadgenad, Tu romeli jgufisTvis SeiZleba iyos es
da moxaliseTa jgufebis monawileoba dadebiTi Se
midgoma efeqturi (ix. aseve Rossler et al., 1992).
degebis momtania.
_ 679 _
Temze dafuZnebuli servisis sxva komponentebi va axasiaTebT, saWiroeben dacul sivrces, romelsac
eqneba gare teritoria. okupaciuri da socialuri
reabilitacia da gamojanmrTeleba
saqmianobisTvis unda iyos gamoyofili sivrce imave
fsiqiatriaSi termini reabilitacia aRniSnavs im pro- an axlomdebare SenobaSi.
cedurebs, romlebic exmareba pacients misi funqcio-
bis optimaluri donis miRwevasa da SenarCunebaSi. dRis stacionaruli momsaxureba
aseTi daxmareba SeiZleba ganxorcieldes staciona- miuxedavad TemSi moqmedi momsaxureobis efeqturo-
rSi, dRis stacionarSi an sareabilitacio centrSi. bisa, dRis stacionari SeiZleba daexmaros xangrZlivi
reabilitaciis dros gamoyenebuli procedurebi sx- darRvevis mqone pacientebs (ix. zemoT). pacientma
vadasxva xasiaTisaa: samedicino, fsiqologiuri, oku- mas SeiZleba mimarTos gamokvlevisTvis, zedamxed-
paciuri, socialuri da sayofacxovrebo. velobis gasawevad medikamentur mkurnalobaze da
samedicino _ reabilitaciis programaSi CarTul okupaciuri da socialuri saqmianobisTvis. radganac
bevr pacients sWirdeba wamlebi Sizofreniis an qron- rTulia mwvave da xangrZlivi darRvevis mqone pacien-
ikuli afeqturi aSlilobis kontrolisTvis. tebis saWiroebebis erTdrouli momsaxureba, sjobs
fsiqologiuri _ fsiqologiuri meTodebi moicavs SenobaSi sxvadasxva aqtivobebisTvis gamoiyos calke
mxardamWer Terapias, biheviorul programebs da teritoria an es aqtivobebi ganxorcieldes sxvadasx-
trenings socialur unar-CvevebSi (ix. Tavi 22). va dros.
okupaciuri muSaoba exmareba pacients dRis dageg-
mvaSi da aZlevs sxva adamianebTan urTierTobis Ses- ambulatoriuli momsaxureba
aZleblobas. kargi Sedegi amaRlebs TviT-Sefasebas, ambulatoriuli klinikebi SedarebiT umniSvnelo
xolo anazRaureba stimuls aZlevs pacients. adami- rols asruleben xangrZlivi fsiqikuri aSlilobis
anebis umetesobis mizania Cveulebriv samsaxurSi da- mqone pacientebTan, mwvave aSlilobis mqone pacien-
bruneba. imaT, romlebsac es ar SeuZliaT, aswavlian tebTan SedarebiT. amis savaraudo mizezi unda iyos
iseT saqmianobas, rogoricaa mebaReoba, xeloba an xangrZlivi aSlilobis mqone pacientebis mier daniS-
kulinaria. yvela maTgani aZlierebs miRwevis motivs nuli vizitis gamotoveba, ris gamoc, xSirad, saWiro
da iZleva drois konstruqtiulad gamoyenebis saSu- xdeba pacientis ojaxisa da misi mzrunvelis monax-
alebas. sadac ki es SesaZlebelia, swavleba unda mim- uleba. amis gamo, TemSi momuSave meddis zedamxedv-
dinareobdes Cveulebriv, TemSi arsebul pirobebSi, eloba, SedarebiT ufro efeqturia, vidre ambulato-
specifikur saqmianobasTan dakavSirebuli izolaciis riuli momsaxureba.
da potenciuri stigmatizaciis Tavidan asacileblad.
socialuri _ SezRuduli SesaZleblobebis mqone Temze dafuZnebuli servisis
adamianebs xeli unda SevuwyoT gawevriandnen iseT
Sefaseba
jgufebSi, romlebSic gaerTianebulni arian janmrTe-
li adamianebi. unda arsebobdes klubebi da social- midgomebi Sefasebebis mimarT
uri centrebi, sadac gaTvaliswinebuli iqneba maTi arsebobs ori midgoma TemSi moqmedi servisis Sesafa-
unarSezRuduloba. seblad:
1. mTlianad servisis Seswavla
stacionaruli momsaxureba
2. servisis konkretuli elementebis kvleva, magali-
xangrZlivi fsiqikuri aSlilobis mqone adamianebs Tad, dRis stacionaris momsaxurebis Seswavla.
SeiZleba dasWirdeT stacionaruli momsaxureba re-
es ori midgoma erTmaneTs avsebs. TiToeuli sax-
cidivis dros mkurnalobis Casatareblad, intensiuri
is Sefasebisas saWiroa miznis naTlad Camoyalibeba.
reabilitaciisTvis da Zalian iSviaTad, xangrZlivi
analizisas gamoyofen ramdenime komponents: sawyis
dayovnebis SemTxvevaSi. ZiriTadi moTxovnebi, rom-
investicias, process da gamosavals. sawyisi inves-
lebsac uyeneben xangrZlivi daavadebis mqone paci-
ticia gulisxmobs xelmisawvdom resursebs, rogori-
entebis stacionarul ganyofilebas, ZiriTadad, im
caa sawolebis raodenoba an TemSi moqmedi meddebis
moTxovnebis msgavsia, romlebic mwvave SemTxvevebis
raodenoba. procesi aris gza, romliTac resursebi
ganyofilebas waeyeneba (gv. ??). Tumca, pirvel SemTx-
gamoiyeneba (magaliTad, stacionaruli mimarTvebis
vevaSi, garemo ufro metad saojaxo tipisa unda iyos.
raodenoba da dayovnebis xangrZlivoba). gamosavali
miuxedavad amisa, zogadad, umjobesia, rom am ori
aris servisebis sargebeli, rac gulisxmobs simptom-
jgufis momsaxureba erTmaneTisgan izolirebulad
ebis, mzrunvelis datvirTvis da suicidis sixSiris
mimdinareobdes, radgan xangrZlivi daavadebis mqone
Semcirebas (ix. cxrili 23.6).
pacientebis mkurnalobis tempi da intensivoba ufro
mosaxleobis fsiqiatriuli servisebi unda
dabalia. pacientebi, romlebsac qcevis mZime darRve-
pasuxobdes Semdeg eqvs kiTxvas, romlebic Tavis
_ 680 _
Temze dafuZnebuli servisis Sefaseba
Sesafaseblad, rogoric aris saavadmyofos daxurva.
cxrili 23.6 fsiqiatriuli servisis SekiTxvebi xarjebis Sesaxeb SeiZleba daematos zeda
gamosavlis sazomi
CamonaTvals. aseT kiTxvebze pasuxis gacema xdeba
simptomebis simZime ekonomikuri analizis gziT (ix. qvemoT ekonomikuri
funqcionirebis xarisxi Sefaseba).
unarSezRudulobis sazomi
Sesafasebel monacemTa wyaroebi
cxovrebis xarisxi
zemoT CamoTvlil kiTxvebze pasuxis gacema SesaZ
fizikuri avadoba da letaloba lebelia sxvadasxva meTodis gamoyenebiT: SemTxvevaTa
TviTdazianebis da suicidis sixSire reestris warmoebiT, praqtikis yoveldRiuri kom
ponentebis Sesaxeb Canawerebis warmoebiT, momxma
Zaladobrivi qcevis sixSire
reblebisa da mzrunvelebis Canawerebis warmoebiT,
usaxlkaro pacientebis raodenoba gamokiTxviT. amas SeiZleba daematos specifikuri
mzrunvelis datvirTvis Sefaseba kvlevebi sxva procesebis an gamosavlis variabelobis
servisiT kmayofileba
Sesafaseblad.
SemTxvevaTa reestri
droze SemogvTavazes uingma da heilim (Wing and
Hailey, 1972): SemTxvevaTa reestri uwyvet monitorings uwevs
servisis sxvadasxva segmentSi kontaqtebis raod
1. ramdeni pacientia CarTuli servisSi?
enobas. aseTi midgomis magaliTi naCvenebia im kvle
2. ra saWiroebebi aqvT maT da maT naTesavebs? vebSi, romlebic ganxorcielda stacionaruli mom
3. akmayofilebs Tu ara amJamad servisi am saWiroe- saxurebidan TemSi moqmed momsaxurebaze gadasvlis
bebs? dros gaerTianebul samefosa (Leff, 1993b) da ita
4. kidev ramden adamians (romelic ar aris CarTuli liaSi (Tansella, 1991). amJamad, xelmisawvdomia sxva
servisSi) aqvs daukmayofilebeli saWiroebebi? saxis reestri (magaliTad, britaneTis daremis uni
versitetis fsiqikuri janmrTelobis saxelmwifo
5. ra axali servisebia saWiro an rogor unda moxdes
centrSi). es reestri internetiT agrovebs monacemebs
arsebuli servisis modifikacia daukmayofilebeli
fsiqiatriuli morbidobis Sesaxeb inglisis yvela
saWiroebebis momsaxurebisTvis?
municipaluri danayofis doneze. am wesiT mopovebuli
6. kmayofildeba Tu ara saWiroebebi SemoRebuli, ax-
informaciis kombinacia xdeba Sesabamis danayofSi
lad SemoRebuli an modificirebuli servisebiT?
servisebis tipisa da aRWurvis donis Sesaxeb arsebul
es kiTxvebi dResac aqtualuria, magram Taname- informaciasTan. yvela es informacia sajaroa.
drove praqtikis gaTvaliswinebiT, maT kidev sami mas iyenebs jandacvis departamenti im servisebis
kiTxva unda daematos: muSaobis Sesafaseblad, romlebic uSualod gasweven
w ramdenad eyrdnoba servisi mtkicebulebebze momsaxurebas an mas sxva organizaciebs gadaabareben.
damyarebul medicinas da ramdenad icavs igi
Canawerebi praqtikis yoveldRiuri
mkurnalobis erovnul saxelmZRvanelo principebs
komponentebis Sesaxeb
(aseTis arsebobis SemTxvevaSi)?
am meTodiT fasdeba investicia, procesi da gamosavali.
w rogor aRiqmeba servisi momxmareblebis da mz-
gamosavlis Sesaxeb imformaciis mopoveba yvelaze
runvelebis mier? magaliTad, aris is momxmareblis
rTulia. is SeiZleba moicavdes im pacientebis sixSires,
mimarT keTilganwyobili (megobruli), stigmatiza-
romelTa meTvalyureobac veRar gagrZelda, suicidis
ciisgan Tavisufali da xelmisawvdomi? miiRweva is
sixSires ukanasknel periodSi gaweril pacientebSi,
gamosavali, romelic klientisa da misi mzrunvel-
an usaxlkaro pacientebSi fsiqikurad daavadebuli
isTvisaa mniSvnelovani? xdeba maTTvis konsulta-
pirebis raodenobas. ukanaskneli ori sidide servisis
ciis gaweva? cdilobs servisi maT Cabmas servisis
gamosavalisTvis naklebad mniSvnelovania, radgan orive
dagegmvasa da ganviTarebaSi; afasebs igi regularu-
maTganze gavlenas axdens sxva, fsiqiatriuli servisis
lad momxmareblis kmayofilebas? aanalizebs maT
xarisxisgan damoukidebeli faqtorebi. gamosavlis
Civilebs? moqmedebs Sedegebis gaTvaliswinebiT?
kargi indikatorebis ararsebobisas, TemSi moqmedi
w pasuxobs Tu ara servisi eTnikur umciresobaTa servisebis yoveldRiuri Canawerebi fasdeba iseTi
saWiroebebs? komponentiT, rogoricaa monacemebi investiciebis
es SekiTxvebi unda daisvas arsebuli servisebis Sesaxeb. esaa dasaqmebuli meddebis raodenoba an
Sesamowmeblad an iseTi cvlilebebis efeqturobis hostelebSi adgilebis raodenoba. procesis cvladi
_ 681 _
monacemebis monitoringic sakmaod rTulia. aseT mTel jandacvis sistemas da mikroanalizad, romelic
maCveneblebs SeiZleba miekuTvnebodes dro, romelsac afasebs sistemis mxolod iseT nawils, rogoric aris
TemSi momuSave medda andomebs qronikuli Sizofreniis gansazRvruli populaciis fsiqiatriuli servisi an
mqone pacientebTan muSaobas. Tumca, momsaxurebis am servisis romelime komponenti (magaliTad, sta-
xarisxi damokidebulia ara mxolod im droze, romelic cionaruli da dRis momsaxurebis urTierTSedareba).
TiToeul pacientze ixarjeba, aramed imazec, Tu risi mikroanalizi ikvlevs xarjebis Tanafardobas dan-
uzrunvelyofa xdeba Sexvedris dros. azogTan, xarjebis minimizacias, xarjT-efeqturobas,
ukanasknel xans, inglissa da uelsSi, Camoyalibda xarjT-sargebels da xarjT-sargeblianobas.
fsiqikuri janmrTelobis minimalur monacemTa xarjebis Tanafardoba danazogTan. erT-erTi meTo-
baza. masSi Tavs iyris rutinuli informacia spe di gulisxmobs Tanafardobis dadgenas mkurnalobis
cialistebis mier fsiqikuri janmrTelobis prob an servisis xarjebs da danazogs Soris. am dros ar
lemebis mqone adamianebis momsaxurebis Sesaxeb (ix. xdeba gamosavlis Sefaseba.
Glover, 2000). erovnuli jandacvis servisis mmar xarjebis minimizaciis analizis dros erTmaneTs
Tvelobis mier sxvadasxva wyaroebidan miRebuli adareben or mkurnalobas an serviss, romelic Tana-
monacemebi nawildeba eleqtronulad, raTa gamov bari gamosavlis mqonea, raTa daadginon, Tu romeli
lindes servisis momxmareblis TvaliT danaxuli prob maTgania nakleb Rirebuli.
lemebi, momsaxureba da gamosavali. es monacemebi unda xarjT-efeqturobis analizi. erTmaneTs udare-
Segrovdes qveynis masStabiT, raTa SesaZlebeli iyos ben Tanabarxarjian ori saxis mkurnalobas an ser-
maTi gamoyeneba: (1) sxvadasxva provaideri trastis viss, imis dasadgenad, Tu romelia ufro efeqturi.
Sedegebis auditisTvis; (2) iseTi organizaciebis izomeba mxolod erTi gamosavali. am tipis analizis
Sesadareblad, romlebic momsaxurebas sxva da xarjebis minimizaciis analizis dros maSin Cndeba
organizaciebs gadaabareben, da (3) klinikur aqtivobas problemebi, roca sxvadasxva gamosavlis sazomi erT-
da mis gamosavals Soris kavSiris dasadgenad. maneTs ar Seesabameba.
xarjT-sargeblis analizi akavSirebs xarjs sarge-
klinikuri auditi
belTan da afasebs erTze met gamosavals, magram erTi
rutinul monacemTa Segrovebis msgavsad, klinikuri sazomiT (fuladi RirebulebiT), raTa SesaZlebeli
auditic uwyveti unda iyos, magram rutinulisgan gaxdes sxvadasxva sargeblis dajameba. es midgoma mim-
gansxvavebiT, misi aqcentebi SeiZleba dro da zidvelia, magram Znelad gansaxorcielebeli, radgan
dro icvlebodes. magaliTad, erT SemTxvevaSi au rTulia fulad RirebulebasTan iseTi gamosavlis
ditma SeiZleba Seafasos pacientis kmayofileba morgeba, rogoricaa, magaliTad, ojaxis datvirTvis
ambulatoriuli momsaxurebiT, sxva SemTxvevaSi ki Semcireba. sargeblis gasazomi erT-erTi midgomis
is, Tu ramdenad xdeboda klinikuri saxelmZRvanelo gamoyenebisas, adamianebs ekiTxebian, Tu (Teoriulad)
principebis dacva liTiumis monitoringis dros. ramdens gadaixdidnen isini mocemuli sargeblis mis-
miuxedavad amisa, zogierTi indikatorebis moni aRebad.
torireba SeiZleba uwyvetad mimdinareobdes. xarjT- sargeblianobis analizi waagavs xarjT-
momxmareblebis da provaiderebis gamokiTxva efeqturobis analizs, magram iyenebs gamosavlis
sxva sazoms. fuladi Rirebulebis nacvlad fasdeba
momxmareblebi da mzrunvelebi, ojaxis eqimebi, so
cxovrebis xarisxis gaumjobeseba, rac, Cveulebriv,
cialuri servisebi da moxaliseTa saagentoebi
xarisxze morgebul sicocxlis wlebSi gamoixateba.
mniSvnelovnad gansazRvraven servisis efeqturobas
is iZleva sicocxlis xangrZlivobisa da cxovrebis
da imas, Tu ramdenad saWiroebs esa Tu is servisi
xarisxis kombinacias. miuxedavad imisa, rom es midgo-
modifikacias.
ma, principSi, mimzidvelia, aseTi gazomvis praqtikaSi
specifikuri kvlevebi gamoyeneba rTulia.
servisis Sedegebis SefasebisTvis specifikuri kv- idealuri ekonomikuri analizi unda iyos prospeq-
levebia saWiro. (magaliTad, kvleva asertuli pro- tuli, adarebdes sakmarisi sididis SemTxveviTi wesiT
gramis londonSi implementaciis Sesaxeb) (Wright et ganawilebul jgufebs, zomavdes yvela mniSvnelovan
al., 2003). am tipis ararandomizebuli kvlevebi Rire- xarjs da gamosavals, xolo gamosavals afasebdes ise,
bulia mkurnalobis implementaciis realuri efeqtis rom SesaZlebeli iyos gamosavlis saerTo qulis ga-
SefasebisTvis. moTvla. fsiqiatriuli servisis Seswavlis dros ase-
Ti idealuri analizi ver miiRweva. xarjT-efeqturo-
ekonomikuri Sefaseba bis analizis magaliTi (pirvelad doneze depresiis
fsiqiatriuli momsaxurebis ekonomikuri Sefaseba gaZlierebuli da Cveulebrivi mkurnalobis Sedareba)
SeiZleba daiyos makroanalizad, romelic afasebs mocemulia Semdeg wyaroSi: Pyne et al., 2003. xarjT-
_ 682 _
gansakuTrebuli saWiroebis mqone adamianebis servisebi
sargeblis analizi (qolinesTerazas inhibitorebi kuri aSlilobis SemTxvevaSi upiratesobas aniWebs
msubuqidan zomieri simZimis demenciis dros) mocemu- tradiciul mkurnalobas (Bhopal, 1986). sxvebi iReben
lia Semdeg wyaroSi: Wu et al., 2003. fsiqiatriaSi eko- konsultacias ojaxis eqimisgan, magram, ufro metad
nomikuri analizis zogadi mimoxilvisTvis ix. Knapp amJRavneben fizikur, vidre fsiqiatriul simptomebs.
and Chisholm, 2000 an Singh et al., 2001. zogierT eTnikur umciresobaSi, Tavis Sekaveba fsiqi-
atrTan referalisgan imiTaa gamowveuli, rom aman,
gansakuTrebuli saWiroebis mqone SeiZleba, pirovnebis qorwinebas SeuSalos xeli.
adamianebis servisebi fsiqikuri aSlilobis identifikaciis dabali

klinikurma praqtikam da kvlevam gamoavlina pacien- xarisxi
tebis iseTi jgufebi, romelTa saWiroebebs ver ak- arsebobs ori mizezi, ris gamoc ojaxis eqims da fsiq-
mayofilebs Cveulebrivi fsiqiatriuli servisebi. iatriul personals SeiZleba gauWirdes fsiqikuri
eTnikur umciresobaTa warmomadgenlebi darRvevis amocnoba eTnikur umciresobis warmomad-
genelSi. pirveli, SeiZleba iyos komunikaciis prob-
eTnikur umciresobaTa warmomadgenlebs aqvT spe-
lema, romlis nawilobrivi daZlevac SesaZlebelia
cialuri saWiroebebi, romlebic maT kulturasTanaa
eTnikuri umciresobis warmomadgeneli eqimis CarTviT
dakavSirebuli. bevris saWiroebebi dakavSirebulia
an Tarjimnis moSveliebiT. meore, fsiqikuri aSlilo-
siRaribesTan da sxva socialurad araxelsayrel pi-
bis gamovlineba zogad populaciasa da eTnikur umci-
robebTan; zogierTi _ axali migranti an ltolvilia.
resobaSi SeiZleba gansxvavebuli iyos. rogorc ukve
eTnikur umciresobaTa warmomadgenlebi ufro xSirad
aRvniSneT, indoeTis qvekontinentis xalxebi, brita-
warmoadgenen diskriminaciis obieqts. or eTnikur um-
neTis zogad populaciasTan SedarebiT, ufro xSirad
ciresobas Soris arsebuli gansxvaveba SeiZleba ufro
uCivian fizikur simptomebs SfoTvisa da depresiis
didi iyos, vidre gansxvaveba romelime erT eTnikur
dros.
umciresobas da zogad populacias Soris. amitomac,
ar arsebobs servisis erTi saukeTeso modeli, ro- diagnostikis problema
melic gamosadegia yvela eTnikuri umciresobisTvis. afro-karibielebs, romlebic britaneTSi cxovroben,
amis miuxedavad, arsebobs zogadi sakiTxebi, romle- zogadi populaciis warmomadgenlebze ufro xSirad
bic yvela jgufis mimarTaa relevanturi. isini qvemo- usvamen Sizofreniis diagnozs, roca maT Zlieri qcev-
Taa ganxiluli. iTi darRveva axasiaTebT (Flaskerud and Hu, 1992). ar
servisebis gamoyeneba aris cnobili, es gansxvaveba realurad asaxavs Sizo-
freniis gavrcelebis maRal sixSires mocemul popu-
eTnikuri umciresobis warmomadgenlebi populaciis
laciaSi, Tu qceviTi darRveva arasworad fasdeba da
umetesobasTan SedarebiT ufro iSviaTad iyeneben
aseTi qceva, SeiZleba, magaliTad, stresul reaqcias
moqmed servisebs. isini naklebad iReben konsulta-
warmoadgendes. miuxedavad amisa, niderlandebis same-
cias ojaxis eqimisgan, rodesac aReniSnebaT fsiqi-
foSi surinameli emigrantebis SeswavliT aRmoCnda,
kuri aSliloba; maTTvis nakleb misaRebia referali
rom fsiqozuri aSlilobebi, marTlac, warmoadgenda
fsiqiatriul servisebSi; da, isini, naklebad asrule-
maTTan xSirad mimarTvis mizezs (Selten et al., 2001; Bo-
ben eqimis daniSnulebas. roca eTnikuri umciresobis
gers et al., 2000). aseve, maRalia iZulebiT mimarTvis
warmomadgeneli iTxovs daxmarebas, personals ufro
sixSirec. amis savaraudo mizezi imaSi mdgomareobs,
metad uWirs fsiqikuri aSlilobis identifikacia;
rom eTnikuri umciresobis warmomadgenelebi Sedare-
garda amisa, misTvis SedarebiT rTulia daavadebisa
biT gvian iwyeben fsiqiatris momsaxurebiT sargeblo-
da mkurnalobis Sesaxeb iseTi terminebiT saubari,
bas (ix. Burnett et al., 1999).
romelic iTvaliswinebs pacientis Sexedulebebsa da
servisis uzrunvelyofa
kulturas. es da qvemoT ganxiluli sxva problemebi
am SemTxvevaSi gamoiyeneba ori midgoma: a) SeiZleba
gamowveulia ara marto inglisuri enis arasakmarisi
ganxorcieldes specifikuri servisebi, an, b) yvela
codniT, aramed, kulturebs Soris arsebuli gansx-
servisSi kulturuli faqtori iyos gaTvalsiwineb-
vavebiT, rac kidev ufro mniSvnelovan faqtors war-
uli. servisebis sargebeli TvalsaCinoa. maTi arasa-
moadgens.
surveli Sedegebi ki Semdegia:
britaneTSi es problemebi Seiswavleboda aziur da
afro-karibul populaciaSi. zogad populaciasTan w SeiZleba gaizardos izolacia Cveulebrivi
SedarebiT, azielebi ufro xSirad mimarTaven ojaxis populaciisgan
eqims sxvadasxva mdgomareobis gamo, magram naklebad w servisi mxolod maSinaa praqtikuli da xarjT-
_ fsiqiatriuli simptomebis gamo (Murray and Wil- efeqturi, roca eTnikuri umciresobis populacia
liams, 1986; Gillam et al., 1989). zogierTi azieli, fsiqi- didi da SedarebiT homogenuria.
_ 683 _
calkeuli servisebis upiratesobani da susti alkoholmoxmareba da wamalmoxmareba. maTgan mxolod
mxareebi ganxilulia Semdeg wyaroSi: Bhui and mcire nawils aReniSneba Tavis tvinis dazianeba.
Sashidharan, 2003. warsulSi pacientebis es patara jgufi wlebis
ganmavlobaSi rCeboda stacionarSi, radgan agresiuli
fsiqikurad daavadebuli usaxlkaro pirebi
qcevis periodebi adreul etapzeve dgindeboda da
saavadmyofoebis daxurvis Semdeg SiSobdnen, rom bevri swrafadve xdeboda darRvevis mkurnaloba. aseTi
gawerili pacienti miusafari (usaxlkaro) gaxdeboda, adamianebis didi nawili amJamad TemSi mkurnalobs,
magram rodesac daxurva gegmiurad ganxorcielda, sadac maT esaWiroebaT intensiuri zedamxedveloba,
mxolod mcire nawili aRmoCnda aseT mdgomareobaSi rac did xarjebs moiTxovs. garda amisa, maTi
(Leff, 1993a; Harrison et al., 1994). amis miuxedavad, mxridan mkurnalobaze Tanxmoba arc Tu ise advili
mimoxilviTi kvleviT gamovlinda, rom maRali iyo (30- mosapovebelia. intensiuri zedamxedvelobis fonzec ki,
50%) qronikuli fsiqikuri aSliloba usaxlkaroTa xSirad, rTulia problemuri qcevis wimaswarmetyveleba.
hostelebSi, rogorc britaneTSi (magaliTad, Marshall problemas isic arTulebs, rom Zaladobrivi an sxva
and Reed, 1992), ise aSS-Si (magaliTad, Susser et al., mxriv rTuli qceva yovelTvis qronikuli fsiqikuri
1989) da avstraliaSi (Herrman et al., 1989). fsiqikuri aSlilobis gamovlinebas ar warmoadgens. zog
aSlilobis msgavsi maRali maCvenebeli (60%-mde) SemTxvevaSi, es ukavSirdeba asocirebul pirovnul
dafiqsirda usaxlkaro adamianebSi. am jgufSi, aseve, aSlilobas an fsiqoaqtiuri nivTierebebis moxmarebas.
xSiri iyo wamalmoxmareba. gansakuTrebiT rTulia am mizeziT gamowveuli
roca fsiqikuri aSlilobis mqone adamiani mawan Zaladobis epizodis prevencia an prognozi.
walaa, rTulia daarwmuno igi mkurnalois saWiroebSi radgan agresiuli qceva SemaSfoTebelia da SeiZleba
an sacxovrebliT daexmaro, Tumca, asertuli àuTriC~ sxvebisTvis saziano gamodges, sazogadoeba xSirad
programa SeiZleba sasargeblo gamodges am SemTxvevaSi kicxavs fsiqiatriuli servisebis efeqturobas am
(Lehman et al., 1997). damatebiTi informaciisTvis ix. mcire jgufis momsaxurebis TvalsazrisiT. sakmaod
Craig, 2000. rTulia aseTi adamianebis marTva zogad fsiqiatriul
ganyofilebaSi, radgan maTma agresiulma an mou
persistentuli fsiqikuri aSlilobis mqone
axalgazrdebi lodnelma qcevam SeiZleba SeaSfoTos sxva pacientebi
da saWiro gaxdes maTi specialur ganyofilebaSi
fsiqiatriuli pacientebis umetesi nawilis mkur
gadayvana. aseTi pacientebis nawils esaWiroeba
naloba SesaZlebelia fsiqiatriul ganyofilebaSi
xangrZlivi momsaxureoba dacul da personaliT
xanmokle dayovnebiT, rasac unda mohyves intensiuri
kargad dakompleqtebul hostelSi.
momsaxureba TemSi. miuxedavad amisa, arsebobs
pacientebis sakmarisad didi jgufi. is, ZiriTadad, fsiqikuri aSlilobis mqone eqimebi
Sedgeba axalgazrda mamakacebisgan, romlebsac miuxedavad imisa, rom eqimebi cdiloben Seamciron
aReniSnebaT persistentuli fsiqozuri daavadeba da fsiqikur aSlilobasTan asocirebuli stigma, bevri
esaWiroebaT xangrZlivi momsaxureba. aseTi adamianebi maTgani ar iTxovs daxmarebas, roca es aSliloba
ver eguebian mwvave SemTxvevebisTvis gankuTvnili TviTon emarTeba. kargia, roca arsebobs iseTi sistema,
palatis pirobebs, amitom sjobs maTi mkurnaloba romelic fsiqikurad daavadebul eqims saSualebas
SedarebiT naklebad stresul garemoSi Catardes. aZlevs Caitaros mkurnaloba Tavisi samsaxuridan
bevri maTganis mkurnaloba SesaZlebelia personaliT moSorebiT. roca eqimi iTxovs mkurnalobas, same
kargad aRWurvil hostelSi (`saavadmyofo hosteli~) dicino profesiebis warmomadgenelebma unda ga
da maTi gadayvana mwvave SemTxvevebis fsiqiatriul moiCinon ufro didi mimRebloba fsiqikuri aS
ganyofilebaSi unda moxdes aSlilobis recidivis lilobis mimarT; unda arsebobdes Sesabamisad
SemTxvevaSi (Creighton et al., 1991). TemSi moqmedi servisis mowyobili sareabilitacio samsaxuri da specilisti
dagegmvisas gaTvaliswinebuli unda iyos is faqti, rom TandaTanobiT unda daubrundes (zog SemTxvevaSi
am jgufis bevr warmomadgenels SeiZleba dasWirdes zedamxedvelobis fonze) samuSao adgils. es sakiTxi
intensiuri daxmareba mTeli cxovrebis ganmavlobaSi. Riad unda ganixilebodes samedicino swavlebis da
adreuli intervenciis servisi SemoRebul iqna treningis dros. qronikuli an recidiuli fsiqikuri
fsiqozis pirveli epizodis mqone pacientebisTvis. is aSlilobis SemTxvevaSi aRmocendeba praqtikuli
?? gverdzea aRwerili. saqmianobisTvis vargisianobis rTuli problema.
pacientebi gamomwvevi qceviT ltolvilebi

aseTi pacientebis umetesobas aqvs Sizofrenia, ltolvilebs aqvT eTnikur umciresobasTan (zemoTaa
romelsac, xSirad, Tan axlavs pirovnuli aSliloba an aRwerili) saerTo problemebi im specifikur prob
_ 684 _
servisis uzrunvelyofis kulturaTSorisi aspeqtebi
lemebTan erTad, romlebmac aiZula isini eZiaT xelSewyoba, wamlebis miRebaze zedamxedvelobis da
TavSesafari sxva qveyanaSi. es SeiZleba iyos devna, weseba, recidivis niSnebis specialistisTvis Set
fizikuri travma, wameba an gaupatiureba; sxvisi yobineba), isini kargad unda iyvnen informirebulni,
daSavebis, wamebis an gaupatiurebis TviTmxilvelad unda iRebdnen sakmaris mxardaWeras da unda SeeZloT
yofna; da mZime danaklisi. aseT gamocdilebas SeiZleba daxmarebis miReba gadaudebel SemTxvevaSi. aseTi
Sedegad mohyves zogadi samedicino da fsiqiatriuli mxardaWera drois danaxarjebTan aris dakavSirebuli,
darRvevebi. ukanasknels miekuTvneba posttravmuli Zviria da ar aris xelmisawvdomi, Tu TemSi arsebul
stresuli aSliloba da depresiuli aSliloba momsaxurebas ara aqvs sakmarisi resursebi da ojaxis
(aRwerilia ?? da ?? gverdebze) iseTi kulturisTvis saWiroebebi prioritetulad ar aris miCneuli. bevri
specifikuri variaciebiT, rogoricaa depresiuli mzrunveli uCivis arasakmaris kontaqts fsiqiatriul
aSlilobis dros fizikuri simptomebis dominireba. servisebTan (magaliTad, gaweris gegmasTan dakav
ltolvilebs esaWiroebaT samedicino da fsiqi SirebiT). mzrunvelebi, aseve, miuTiTeben sirTuleebs
atriuli integrirebuli momsaxureba im gundis mi negatiur simptomebTan da asocialur an agresiul
er, romelic garkveulia maTTvis specifikur kul qcevasTan dakavSirebiT. momsaxurebis gegma yovel
turalur faqtorebSi. mniSvnelovania integrirebuli Tvis unda iTvaliswinebdes pacientis daavadebis
momsaxurebis gaweva, radgan fizikuri da fsiqikuri zegavlenas ojaxSi myof nebismier bavSvze.
darRvevebi erTdroulad iCens Tavs; radgan ltolvilebi
resursebis ganawilebis problemebi
xSirad iseTi kulturis warmomadgenlebi arian, sadac
distresi da fsiqikuri aSliloba, zogadad, fizikuri SezRuduli resursebis pirobebSi, iqmneba konfliqti
simtomebiT gamoixateba; da, radgan daxmarebis gamwevi mwvave da qronikuli fsiqikuri aSlilobis mqone
specialistebi zogjer ewinaaRmdegebian ltolvilebis pacientebis saWiroebebs Soris. es konfliqti gan
mxolod fsiqiatriul servisSi gadagzavnas, radgan sakuTrebiT aSkaraa jandacvis pirvelad doneze,
Tvlian, rom amgvari reagireba mZime cxovrebiseul sadac mwvave fsiqikuri aSlilobis pacientebi,
gamocdilebaze savsebiT normaluria. zogadad, ufro metad moiTxoven momsaxurebas da
ltolvilebTan momuSave personals unda hqondes ufro metad reagireben masze.
posttravmuli mdgomareobebis mkurnalobis gamoc
servisebis koordinirebis problema
dileba. mas daxmarebas unda uwevdes Tarjimani.
umetes qveynebSi qronikuli fsiqikuri aSlilobebis
qali personali unda muSaobdes qal ltolvilebTan,
mqone pacientebisTvis xangrZliv hospitalur mom
gansakuTrebiT gaupatiurebis msxverpli qalebis
saxurebas axorcielebs erTi saagento (hospitlis
SemTxvevaSi. zogierT specialists unda hqondes
administracia). TemSi moqmed momsaxurebas esa
bavSvebis da mozardebis mkurnalobis gamocdileba.
Wiroeba sxvadasxva saagentos koordinirebuli
ltolvilTa fsiqikuri problemebis mimoxilvisTvis
moqmedeba, sadac TiToeuls aqvs gansxvavebuli
ix. Mollica, 2000; ltolvili bavSvebisa da mozar
pasuxismgebloba (magaliTad, socialuri servisis
debisTvis specifikuri problemebis mimoxilva
ganyofilebebi pasuxs ageben, rogorc fsiqikurad
ixileT Semdeg wyaroSi: Lustig et al., 2004.
janmrTel bavSvebsa da moxucebze, ise fsiqiatriul
pacientebze). pasuxismgeblobis aseTi ganawileba qmnis
Temze dafuZnebuli momsaxurebis zogierTi
ori saxis problemas. erTi exeba resursebis mTeli
sirTuleebi
servisisTvis (rogorc erTeulisTvis) gamoyofas,
gamomwvevi qcevis mqone pacientebi
xolo meore _ servisis im specifikuri komponentebis
rogorc zemoT iyo aRniSnuli, TemSi moqmed sam xelmisawvdomobas, romelsac gaswevs janmrTelobis
saxurebs yvelaze did problemas uqmnian agresiuli dacvis seqtors gareT myofi saagentoebi (magaliTad,
an damazianebeli qcevis epizodebis mqone pacientebi. daculi sacxovrebliT uzrunvelyofa). am problemebis
aseT pacientebs esaWiroebaT personaliT kargad gadaWra SesaZlebelia sakoordinacio komitetis
dakompleqtebuli xangrZlivi momsaxureba, romelic SeqmniT, romelSic gaerTianebuli iqneba yvela im
hostelis an saavadmayofos ganyofilebaSi unda saagentos warmomadgeneli, romelic CarTulia TemSi
Catardes, sadac daculi iqneba usafrTxoebis pi moqmedi momsaxurebis dafinansebaSi.
robebi (ix. zemoT). sanam aseTi ganyofilebebi farTod
ar iqneba xelmisawvdomi, am tipis pacietebis marTva
servisis uzrunvelyofis
sirTuleebs warmoqmnis.
kulturaTaSorisi aspeqtebi
naTesavebis pasuxismgeblobebi ganviTarebad qveynebSi fsiqiatriuli daavadebebis
Tu pacientze ojaxis wevrebi arian pasuxismgebelni gavrcelebis sixSire da xasiaTi ganviTarebuli
(sacxovrebliT uzrunvelyofa, adaptaciuri qcevis qveynebis msgavsia. miuxedavad amisa, ganviTarebad
_ 685 _
qveynebSi ufro maRalia fsiqiatriuli morbidoba, im qveynebSi, sadac fsiqiatriul servisSi cota
romelic Tan axlavs umkurnalebel da arasakmarisad specialistia gaerTianebuli, aucilebelia priori
namkurnaleb somatur daavadebas. agreTve, arsebobs tetebis dadgena. msoflio jandacvis organizaciam
garkveuli sxvaoba daavadebis gamovlinebas Soris (1984) daadgina 4 aseTi prioriteti, romelic am
(magaliTad, ganviTarebad qveynebSi ufro xSiria Jamadac moqmedebs. esaa
fsiqikuri daavadebis gamovlena fizikur simptomebSi). 1. swrafi reagireba gadaudebel fsiqiatriul SemT
suraT 23.1-Si warmodgenili momsaxurebis sqema xvevaze
modificirebulia im qveynebSi, sadac pirveladi
2. mZime qronikuli fsiqikuri aSlilobis SemTxvevebis
jandacvis servisi nakleb ganviTarebulia, vidre
gaTvaliswineba
britaneTSi. qveynebSi, sadac kerZo jandacva ar aris
3. somatur daavadebasTan asocirebuli fsiqikuri
imdenad kargad ganviTarebuli, rogorc, magaliTad,
aSlilobis mqone SemTxvevebis momsaxureba
aSS-Si, pacients SeuZlia pirdapir, pirveladi donis
avliT miiRos specialistis momsaxureba (suraTi 4. qveyanaSi arsebuli nebismieri maRali riskis jgu
23.1). aseT qveynebSi fsiqologi, socialuri muSaki fis momsaxureba (magaliTad, narkotikebis momxma
da fsiqiatri naxulobs Zalian bevr iseT pacients, reblebi).
romlebsac, britaneTSi, mkurnaloba pirvelad doneze msoflio jandacvis organizacia xels uwyobs
Cautardeboda. im damxmare muSakebis swavlebas, romlebic pro
SedarebiT naklebad ganviTarebul mraval qveyanaSi, fesionalebs uweven daxmarebas. im qveynebSi, sadac
rogorc pirveladi, ise specializebuli momsaxureba cotaa trening gavlili fsiqiatri, resursebi uf
arasakmarisia da bevri saWiroeba _ daukmayofilebeli ro efeqturad unda iyos gamoyenebuli; unda ga
(Kohn et al., 2004). aseT qveynebSi, mravali pacien umjobesdes im eqTnebis unar-Cvevebi, romlebic
ti, romelsac momsaxurebis sxva sistemis arsebobis warmarTaven ojaxis eqimis daxmarebiT mimdinare
pirobebSi profesionali umkurnalebda, konsul fsiqikuri aSlilobis marTvas pirvel doneze. mso
tacias tradiciul mkurnalTan gadis. am tipis flio jandacvis organizaciis rekomendaciiT, fsi
mkurnalebi zogadad dafasebulni arian, radgan qiatriuli problemebis marTva pirvelad jandacvaSi
maTi midgoma Seesabameba fsiqikuri daavadebisadmi momuSave yvela gundis saqmianobis mniSvnelovan
mocemul kulturaSi arsebul damokidebulebas nawils unda warmoadgendes (World Health Organization,
(gv. ??). zogierT qveyanaSi samedicino servisebi 1978).
mWidrod TanamSromloben tradiciul mkurnalebTan.
magaliTad, zimbabveSi mimdinare `daamarcxe depresia~ fsiqiatriuli servisebis eTikuri
kampaniaSi, adgilobrivi kulturisTvis Sesabamisi
problemebi
konsultacia fsiqikuri aSlilobebis Sesaxeb mecni
erul codnasTanaa integrirebuli. es kampania gan resursebis ganawileba
sakuTrebul mniSvnelobas aniWebs adgilobriv faq resursebis ganawilebis problemebi dakavSirebulia
torebs, rogoricaa qalebis dabali statusi da ganawilebis samarTlianobis eTikur principebTan.
ojaxuri mxardaWeris tradiciuli sistemis rRveva arsebobs ori tipis sirTule. pirveli aris sxvadasx-
(Abas et al., 1994). va aSlilobis mqone adamianebis saTanado saWiroebis
dadgena da wonasworobis damyareba arsebul saWiroe-
daxmarebis maZiebeli piri
bebs (mkurnaloba) da samomavlo saWiroebebs (e.i. pre-
vencia) Soris. meore problema aris mkurnalobis Ser-
Ceva xarjisa da sargeblis Sedarebis safuZvelze.
resursebis ganawilebis Sesaxeb codnis arsebul done-
ze gadawyvetilebis miReba xdeba arasrulyofili in-
pirveladi sxva momsaxureba
formaciis safuZvelze. amitom, danielsma da sabinma
momsaxureba
SemogvTavazes resursebis ganawilebis oTxi principi,
alternatiuli medicina
romlebic mosaxleobis umetesobisTvis maqsimalurad
saxalxo mkurnalebi da sxv.
misaRebs gaxdis am process (Daniels and Sabin, 1997):
1. resursebis ganawilebis politika unda adgendes
Sesabamis procedurebs da gadawyvetilebis miRebis
specializebuli kriteriumebs
momsaxureba
2. politika sajaro dokumentis saxiT unda iyos war-
suraTi 23.1 britaneTSi arsebuli momsaxurebis sqema modgenili
_ 686 _
fsiqiatriuli servisebis eTikuri problemebi
3. unda arsebobdes procedura politikisa da gadawy- interesTa konfliqti
vetilebis oponirebisTvis
konfliqti, gansakuTrebiT, Cndeba iseT pacientTan
4. procedurebi unda regulirdebodes sazogadoe- dakavSirebiT, romlis movlac damatebiT tvirTad
briv an moxaliseTa gare organizaciebis mier awveba naTesavebs da sxva mzrunvelebs; agreTve,
erT-erT naSromSi aRwerilia, Tu rogor SeiZleba iseT SemTxvevaSic, roca arsebobs sxvebisTvis zi
es principebi praqtikaSi dainergos britaneTis anis miyenebis riski. mzrunvelTan dakavSirebuli
jandacvis administraciis mier (Hope et al., 1998). interesTa konfliqti SeiZleba gadawydes pacientis
momsaxurebaSi CarTuli fsiqiatris diskusiiT ojaxis
momsaxureba Temis doneze eqimTan an sxva specialistTan, romelic uSualodaa
TemSi moqmedi momsaxurebisas vlindeba iseTive eTi pasuxismgebeli pacientis movlaze. safrTxis prob
kuri problemebi, rogoric yvela saxis mkurnalobis lema Zneli gadasaWrelia, radgan is moiTxovs: (1)
dros. riskis dasaSvebi xarisxis gansazRvras, da (2) riskis
xarisxis Sefasebas (rac SeuZlebelia didi sizustiT
konfidencialoba gakeTdes _ ix. gv. ??). zedamxedvelobis qveS myofi
pacientis mezoblebma SeiZleba gaigon masTan per pacientebi gansakuTrebul problemas warmoSoben imis
sonalis vizitis Sesaxeb. asertuli programebi Se gadawyvetisas, Tu rogoria riskis is xarisxi, romlis
iZleba moiTxovdes gamokiTxvis Catarebas im pacientis drosac dasaSvebia pacientis saavadmyofodan gawera, da,
Sesaxeb, romelic ar gamocxadda daniSnul vizitze da romelic, amave dros, amarTlebs moqalaqis zogierTi
recidivis maRali riski axasiaTebs. TemSi warmoebul uflebis darRvevas. eTikuri problema kidev ufro
momsaxurebaSi SeiZleba CarTuli iyos sacxovrebliT rTulia, radgan riskis saukeTeso Sefasebis drosac
uzrunvelyofis da sxva saxis saagentoebi, romlebic SeiZleba moxdes iseTi adamianis uflebebis SezRudva,
ar aris jandacvisa da socialuri uzrunvelyofis romelic, realurad, safrTxes ar warmoadgens.
uSualo nawili. es problemebi winaswar unda iyos
gaTvaliswinebuli da, SesaZleblobis SemTxvevaSi,
ganxiluli unda iyos pacientTan misgan Tanxmobis
miRebis mizniT. gadaudebel situaciaSi piradi 1. Breakey WR (ed.) (1996) Integrated mental health servic-
saidumlos dacvis moTxovna pacientis an sxvaTa es. Oxford University Press, New York. (dawvrilebiTi
dazianebis riskTan unda dabalansdes. angariSi, romelic aSS-is poziciidan daiwera)
avtonomia 2. Gelder MG, Lopez-Ibor JJ Jr and Andreasen NC (eds) (2000)

The new Oxford textbook of psychiatry, Part 7: Social psychi-
zogierT pacients, romelic TemSi iRebs momsaxurebas,
atry and service provision. Oxford University Press, Oxford.
dabali motivacia gaaCnia, zogs ki iseTi aSliloba
(saxelmZRvanelos an nawilis me-12 Tavi srulad mi-
aReniSneba, romelic aqveiTebs mkurnalobis Sesaxeb
moixilavs Temis fsiqiatrias, maT Soris fsiqiatri-
gadawyvetilebis miRebis unars. gundis wevrebma unda
ul momsaxurebas pirvelad doneze)
waaxalison pacienti, raTa saavadmyofodan gaweris
Semdeg man daicvas mkurnalobasTan dakavSirebuli 3. Goldberg D and Huxley P (1992) Common mental disorders:
moTxovnebi. zogadad, damatebiTi daxmarebis SeTa a biosocial model. Routledge, London. (es naSromi kvlav
vazeba daniSnulebis dacvis stimulirebis gamar Rirebulia `gafiltvris~ modelis Camoyalibebisa
Tlebuli saSualebaa, magram muqaris gamoyeneba ar da gamoyenebisTvis, romelic epidemiologias ser-
aris gamarTlebuli. miuxedavad imisa, rom sazRvrebis viss ukavSirebs)
daweseba xSirad rTulia, problema, SesaZlebelia, 4. Thornicroft G and Szmukler G (2001) Textbook of community
gadawydes diskusiiT TemSi moqmedi gundis wevrebs psychiatry. Oxford University Press, Oxford. (amomwuravi
Soris. xasiaTis citirebadi naSromi)
_ 687 _
Tavi 24 bavSvTa
fsiqiatria
Tavis Sinaarsi
normaluri ganviTareba medikamenturi mkurnaloba
cxovrebis pirveli weli fsiqologiuri mkurnaloba
meore weli socialuri samsaxuri
skolamdeli asaki (25 weli ) okupaciuri Terapevti
umcrosi saskolo asakisTvis specialuri ganaTleba
damaxasiaTebeli problemebi biologiuri ojaxis Canacvleba
mozardoba sindromebis mimoxilva
ganviTarebis fsiqopaTologia skolamdeli asakis bavSvebisa
bavSvTa da mozardTa fsiqikur da maTi ojaxebis problemebi
aSlilobaTa klasifikacia ganviTarebis specifikuri aSlilobebi
epidemiologia ganviTarebis zogadi aSlilobebi
grZelvadiani kvlevebi hiperkinetikuri aSliloba
etiologia qcevis aSlilobebi
genetikuri faqtorebi iuveniluri deliqventoba
temperamenti da individualuri SfoTviTi aSlilobebi
gasxvavebebi somatoformuli aSlilobebi
tvinis daavadeba da sxva auxsneli somaturi simptomebi
garemo faqtorebi gunebganwyobis (afeqturi) aSlilobebi
socialuri da kulturaluri faqtorebi suicidi bavSvTa asakSi
bavSvebisa da maTi ojaxebis skolis gacdena
fsiqiatriuli Sefaseba bavSvTa asakSi ganviTarebuli
mSoblebis interviuireba sxva fsiqikuri aSlilobebi
ganviTarebis Sefaseba sqesis identobis problemebi
ojaxis interviuireba suicidi da TviTdazianeba
fsiqologiuri Sefaseba bavSvobaSi fizikuri daavadebebis
sxva informacia fsiqikuri aspeqtebi
fizikuri gamokvleva mozardebis fsiqikuri problemebi
Sefasebis dasruleba bavSvebze Zaladoba
formulireba bavSvTa da mozardTa fsiqiatriis
sasamarTlo angariSi eTikuri da samarTlebrivi sakiTxebi
bavSvebi, rogorc mowmeebi interesTa konfliqti
fsiqiatriuli daxmareba bavSvebisa konfidencialoba
da ojaxebisaTvis Tanxmoba
pirveladi jandacvis roli danarTi: anamnezis Sekreba da
fsiqiatriuli gundi gmokvlevebi bavSvTa fsiqiatriaSi
bavSvTa fsiqiatriasa da mozrdilTa fsiqiatrias So- ramdenad mizanSewonilia es referali, damokide-

ris xuTi mniSvnelovani gansxvavebaa. bulia am zrdasruli adamianis Sexedulebebsa da mis
w konsultaciis inicireba iSviaTad xdeba bavSvis mier. mier bavSvis qcevis aRqmaze. zedmetad SfoTianma da
amis sapirispirod, bavSvi specialistTan mihyavs mSo- mzrunvelma mSobelma an pedagogma SeiZleba eqimTan
bels an sxva ufros adamians, romelic Tvlis, rom janmrTeli bavSvi miiyvanos maSin, rodesac sxva gare-
bavSvis qceva an ganviTareba ar aris normaluri. moebebSi myofi mwvave aSlilobis mqone bavSvi Sesa-
_ 688 _
normaluri ganviTareba
Zloa sruliad uyuradRebod darCes. naxos, rom problemebi, romlebic dakavSirebulia
w bavSvis problemebi SeiZleba asaxavdes sxvebis prob- gonebrivi CamorCenilobis mqone bavSvebis movlasa
lemebs, mag., dedis avadmyofobas. bavSvi, romlis da mkurnalobasTan msgavsia am TavSi aRwerili
problemebi daregulirebuli iyo ojaxSi an skola- sirTuleebisa.
Si, eqimTan mihyavT mas Semdeg, rodesac Tavs iCens
axali problema, romelic arTulebs bavSvis saTana- normaluri ganviTareba
dod movlas. bavSvTa fsiqiatriuli praqtika gviCvenebs, rom au
w rodesac vsaubrobT normidan gadaxraze, unda cilebelia dabadebidan mozrdilobamde norma
gaviTvaliswinoT ganviTarebis ra stadiaze imyofe- luri ganviTarebis procesebis codna. imisTvis,
ba bavSvi. qceva, romelic normaluria umcrosi asak- rom mivxvdeT, Tu ramdenadaa emociuri, socialuri
isTvis, anomaliuria ufrosi bavSvisTvis, mag., Ramis Tu inteleqtualuri funqciebi darRveuli, unda
enurezi dasaSvebia 3 wlis, magram ara 7 wlis asakSi. moxdes maTi ganxilva Sesabamis asakobriv jgufTan
asakTan erTad icvleba bavSvis reaqciebi garemo kavSirSi. am nawilSi mokled da gamartivebulad
movlenebzec. mag., mSoblebTan ganSoreba metad im- ganxilulia normaluri ganviTarebis etapebi, rac
oqmedebs mcirewlovan bavSvze, vidre mozrdilze. fsiqiatrisTvisaa saWiro. ufro detaluri in
w bavSvebs naklebad SeuZliaT sityvebiT gamoTqvan Ta- formacia ganviTarebis fazebis Sesaxeb mocemulia
vianTi grZnobebi. amis gamo, darRvevebis Sesaxeb in- pediatriis an ganviTarebis fsiqologiis hopkinsisa
formaciis ZiriTad wyaros mSoblebis, pedagogebisa da sxv. (Hopkins et al., 2004) saxelmZRvaneloebSi.
da sxvaTa mier bavSvis qcevaze gakeTebuli dakvir-
vebebi warmoadgens. sxvadasxva adamianis mier mow- cxovrebis pirveli weli
odebuli cnobebi SeiZleba gansxvavdebodes erTman- es aris motoruli da socialuri funqciebis swrafi
eTisgan, vinaidan bavSvis qceva sxvadasxva garemoSi ganviTarebis periodi. dabadebidan sami kviris Tavze
gansxvavebulia da amasTan, informaciis momwode- bavSvi ukve iRimis, arCeviTad iRimeba eqvsi Tvis asakSi,
blebs aqvT gansxvavebuli Sexedulebebi imaze, Tu ucxos mimarT SiSi uCndeba rva Tvisas da maleve amis
ra aris anomaliuri qceva. amitom mniSvnelovania in- Semdeg uviTardeba dedasTan ganSorebis SfoTva.
formators vTxovoT mogvces specifikuri magaliTi boulbi (Bowlby, 1980) yuradRebas amaxvilebda ad
im problemisa, romelzec saubrobs da aRweros is reuli ganviTarebis etapze mSoblebsa da bavSvs
garemoebebi, romelSic es problemebi aRmocenda. Soris siaxlovisa da Zlieri emociuri kavSiris
w mkurnalobis aqcentebi gansxvavebulia bavSvebSi, mniSvnelobaze. dedasTan siaxlove umTavresia,
mozrdilebTan SedarebiT, farmakoTerapia nakle- Tumca aranakleb aucilebelia mamasTan da sxva
bad gamoiyeneba. mkurnaloba, Cveulebriv, iwyeba axlo adamianebTan Tbili urTierTobis arsebobac.
specialistisa da ara ojaxis eqimis mier. ZiriTa- am procesis mniSvneloba dadasturebulia sxva
di aqcenti keTdeba mSoblebTan da mTel ojaxTan kvlevebiTac. ruterma (Rutter, 1995) aCvena, rom arsebobs
muSaobaze, bavSvebis trenirebaze da im pirebis Za- kavSiri ganviTarebis adreul etapze deda-Svilis
lisxmevis koordinirebaze, romlebsac SeuZliaT siaxlovesa da momavalSi urTierTobis inicirebis
bavSvis daxmareba, gansakuTrebiT skolaSi. unars Soris. mijaWvulobisa da urTierTobis mni
Svneloba ganxilulia 654 gverdze.
Tavis struqtura da Sedgeniloba. am Tavis pirvel
erTi wlisTvis bavSvs unda hqondes axlo da
nawilSi mocemulia zogadi debulebebi, romlebic
usafrTxo urTierToba dedasTan an sxva aRmzrdelTan.
exeba bavSvTa asakSi fsiqikur aSlilobebs sixSiris,
mas aqvs Camoyalibebuli kvebisa da Zilis paternebi
mizezebis, Sefasebis kriteriumebisa da marTvis
da, rogorc wesi, dasrulebuli aqvs ZuZus wova. am
CaTvliT. meore nawili exeba ZiriTad sindromebs,
droisTvis bavSvebi iwyeben maT irgvliv arsebuli
romlebsac vxvdebiT bavSvTa fsiqiatriul praqtikaSi.
sagnebis Secnobas, amyareben martiv mizez-Sedegobriv
meore nawilis sakiTxebi mocemulia 24.4 cxrilSi
da sivrciT kavSirebs. am asakSi bavSvebs moswonT
(gv. 665) es Tavi ar Seicavs amomwurav informacias
sxvadasxva bgerebis gamocema da SeuZliaT warmoTqvan
bavSvTa fsiqiatriasTan dakavSirebiT, aramed exeba
`deda~, `mama~, an sxva martivi sityvebi.
ZiriTad sakiTxebs, romelic zogadi profilis fsi
qiatrebisTvisaa gankuTvnili. am teqstis wakiT
meore weli
xvis Semdeg mkiTxveli unda gaecnos damatebiT li
teraturas, romlis CamonaTvali mocemulia 703- es asakic swrafi ganviTarebis periodia. bavSvs uCndeba
e gverdze. gonebrivi CamorCena ganxilulia 25-e survili daimsaxuros mSoblebis Seqeba da ganicdis,
TavSi. sakiTxebis aseTi ganawileba gamarTlebulia, rodesac kicxaven. isini iwyeben qcevis gakontrolebas.
radgan mkiTxvels saSualeba eZleva Seadaros da am droisTvis urTierTobis unari saTanadodaa
_ 689 _
24 bavSvTa fsiqiatria
ganviTarebuli. TavSeukavebeli qceva da risxvis rovneba bavSvis cxovrebaSi. am periodSi bavSvi
Setevebi (temper tantrum) upiratesad imedgacruebis TandaTan iwyebs Tavisi SesaZleblobebisa da SezRu
Sedegia. mas Semdeg, rac bavSvi iswavlis SezRudvebis dvebis Sefasebas. grZeldeba eTikuri da zneobrivi
daSvebas, aseTi reaqcia TandaTan Sesustdeba. ori normebis daswavla. fsiqoanalizuri Teoriis Tana
wlis asakisTvis bavSvi axerxebs ori an sami sityvis xmad, fsiqoseqsualuri ganviTarebis am mSvid, e.w.
martiv winadadebebSi gaerTianebas. latentur periodSi, viTardeba damatebiTi dacviTi
meqanizmebi. Tumca, dRes am asakSi seqsualuri simSvide
skolamdeli asaki (2- 5 weli) sakamaTo sakiTxia. dadgenilia, rom 5-10 wlis bavSvebSi
am dros viTardeba inteleqtualuri unarebi, gan arsebobs seqsualuri interesic da aqtivobebic, rac,
sakuTrebiT metyveleba. socialuri funqciebi ya savaraudod, damalulia ufrosebisgan.
libdeba imiT, rom bavSvi swavlobs ojaxSi cxovrebas.
umcrosi saskolo asakisTvis damaxasiaTebeli
xdeba maTi mSoblebTan identificireba, moraluri da problemebi
qcevis standartebis daswavla. mas Semdeg, rac bavSvebi
am asakisTvis damaxasiaTebelia SiSi, Ramis koSma
iwyeben urTierTobas da-ZmasTan, TanatolebTan da
rebi, TanatolebTan urTierTobis sirTuleebi, da
ufrosebTan, maTi socialuri cxovreba aqtiurdeba.
umorCilebloba da moCxubaroba.
risxvis Setevebi (temper tantrum) jer kidev aris, mag
ram Sesustebulia da skolis asakamde mTlianad
mozardoba
unda gaqres. yuradReba da koncentraciis unari
TandaTan ixveweba. am asakisTvis damaxasiaTebelia mozardoba aris bavSvobidan mowifulobamde zrdis
cnobismoyvareoba da bavSvi uamrav kiTxvas svams. periodi. pubertuli asakis yvelaze TvalsaCino ma
2-5 wlis asakis bavSvebisTvis ojaxuri cxovreba xasiaTebeli fizikuri cvlilebebia. asaki, romelSic
mdidari da STambeWdavia. man SeiZleba Caanacvlos es cvlilebebi iCens Tavs, meryeobs gogonebSi 11-dan
realuri samyaro, rac survilebis asrulebis sa 13 wlamde da biWebSi 13-dan 17 wlamde. am process
Sualebas iZleva. bavSvisTvis romelime nivTi, mag., 8-10 wlisTvis dawyebuli sqesobrivi hormonebis
saTamaSo daTunia an sabnis piri, gansakuTrebul gamomuSaveba ganapirobebs. mozardoba aris pirovnuli
mniSvnelobas iZens. isini qmnian simyudrovisa da identobisa da individualuri Tvisebebis ganviTarebis
simSvidis gancdas, rac bavSvs daZinebaSi exmareba. maT asaki. am dros yalibdeba TviTSefaseba, xdeba sakuTar
`gardamaval (tranzitorul) nivTebs~ uwodeben. raobaSi garkveva da pirovneba saxavs samomavlo
bavSvebi iwyeben sakuTari identobis gacnobierebas. gegmebs. igi fiqrobs momavalze, arCevs alternativebs,
xvdebian gansxvavebas mamrobiT da mdedrobiT sqess aqvs imediani ganwyoba an sasowarkveTis gancda. zogi
Soris maTi garegnobis, Cacmulobis, qcevisa da ana SeiZleba ganicdides emociur qaoss da ojaxisgan
tomiis mixedviT. seqsualuri TamaSebi da interesi gaucxoebas, Tumca es mdgomareoba universaluri ar
Cveulebrivia am asakisTvis. aris.
fsiqodinamiuri Teoriis Tanaxmad, ganviTarebis metad mniSvnelovania TanatolebTan urTierToba.
am etapze yalibdeba dacviTi meqanizmi, romelic safuZveli eyreba axlo megobrobas, gansakuTrebiT
exmareba bavSvs misTvis miuRebeli emociiT gamowveuli gogonebSi. jgufis wevroba saSualebas aZlevs pi
SfoTvis daZlevaSi. dacviTi meqanizmebi ganxiluli rovnebas gaikvalos gza avtonomiisken. pubertul
iyo 154-e gverdze. asakSi aqtiurdeba seqsualuri interesebi. Tavidan,
SeiniSneba sapirispiro sqesis mimarT gaubedavi
adreuli bavSvobisTvis damaxasiaTebeli mcdelobebi. SemdgomSi es damokidebuleba ufro
problemebi miznobrivi da Tavdajerebuli xdeba. gviani mozar
dabadebidan xuTi wlis asakamde Tavs iCens iseTi dobis asakSi SesaZlebelia Seyvarebac da seqsualuri
problemebi, rogorebicaa Zilisa da kvebis darRvevebi. ltolvac sapirispiro sqesis warmomadgenlebisadmi.
aseve, mSoblebTan mijaWvuloba (ganSorebiT gamow Tu ramdenad Sors Setopavs mozardi seqsualur
veuli SfoTviTi aSlilobebi bavSvebSi), TavSeuka urTierTobebSi, damokidebulia sazogadoebriv
vebloba (temper tantrum), opoziciuri qceva da zomieri standartebze, Tanatolebis qcevasa da ojaxis da
agresia. mokidebulebaze.
umcrosi saskolo asaki mozardobisTvis damaxasiaTebeli problemebi

12-16 wlis asakisTvis damaxasiaTebelia guneb-
xuTi wlisTvis bavSvs gacnobierebuli aqvs Tavisi
ganwyobis meryeoba, SfoTva, skolaSi siarulze uaris
sqesi da pozicia ojaxSi. is mzad aris daZlios skolis
Tqma, TanatolebTan urTierTobebis sirTuleebi,
moTxovnebi, iswavlos wera-kiTxva da ariTmetikuli
daumorCilebloba da winaaRmdegoba, rac vlindeba
moqmedebebi. maswavlebeli xdeba mniSvnelovani pi
_ 690 _
normaluri ganviTareba
pasiuri agresiiT, fsiqoaqtiuri wamlebis moxmarebiT, garemos gavlena. garemo faqtorebma SeiZleba
konfliqturobiT, CxubiTa da qurdobiT (Sizofrenia Seasrulos winaganwyobis, xelSemwyobi an Sema
da bipolaruli aSliloba, romelic am asakobriv narCunebeli, agreTve, proteqtoruli faqtorebis
jgufSi iwyeba, ar aris damaxasiaTebeli). roli. mag., depresiis ganviTarebis riski, romelic
ganpirobebulia mSoblebis arasaTanado zrunviT
ganviTarebis fsiqopaTologia adreul asakSi, mcirdeba sxva pirovnebasTan urTi
bavSvTa fsiqiatriaSi ganviTarebis etapebis gaTva erTmzrunveli urTierTobis damyarebis Semdeg.
liswineba mniSvnelovania sami mizezis gamo: Tumca, es gamocdileba ver icavs yvela mizezobrivi
1. ganviTarebis etapi gansazRvravs qceva paTolo faqtorisgan, mag., ver asustebs depresiis ganv
giuria, Tu normaluri: mag., rogorc zemoT aR iTarebis risks im pirovnebisTvis, vinc bavSvobaSi
vniSneT, Ramis enurezi normaa 3 wlis asakSi, xolo Zaladobis msxverpli gaxda (Hill et al., 2001). zogjer,
paTologiaa 7 wlis asakSi. rodesac mizezobriv garemo faqtorad ojaxuri
uTanxmoeba gvevlineba, WeSmariti mizezi aris erTi
2. bavSvis ganviTarebasTan erTad icvleba cxovre
an orive mSoblis pirovnuli Tvisebebi, romlebic
biseuli movlenebis gavlena: mag., 6 Tvemde
iwvevs rogorc ojaxur usiamovnebebs, aseve, bavSvis
bavSvi gansakuTrebuli gancdis gareSe egueba
fsiqikuri aSlilobis uSualo mizezad iqceva.
momvlelis Secvlas, maSin roca 6 Tvidan 3 wlamde,
hormonuli cvlilebebi. axalSobilebSi hipoTa
Camoyalibebuli mijaWvulobis gamo, momvlelTan
lamo-hipofizarul-adrenaluri sistema ukiduresad
ganSoreba Zlier stresulia. 3 wlis Semdeg
mgrZnobiarea. es mgrZnobeloba TandaTan klebulobs
mijaWvuloba kvlav Zlieria, magram, saTuTi da
Semdgomi 2 wlis manZilze. arsebobs monacemebi,
mokidebulebis SemTxvevaSi, ukve ganviTarebuli
rom es cvlilebebi ufro efeqturad mimdinareobs
metyvelebis unari uadvilebs bavSvs axal mzrun
usafrTxo garemoSi myof bavSvebSi, vidre zrun
velTan Seguebas.
vamoklebul patarebSi (Gunnar, 1998). am da sxva
3. bavSvis zrdasTan erTad icvleba fsiqopaTologiuri aRmoCenebis safuZvelze warmoiSva azri, rom mo
simptomebi: SfoTviTi simptomebi asakTan erTad gvianebiT asakSi endokrinuli pasuxi stresze,
mcirdeba. depresiuli aSlilobebi mimdinareobs nawilobriv, determinebulia Zalian adreuli ga
recidivebiT da gZeldeba mozrdilobaSic. qceviTi mocdilebiT (naCvenebia eqsperimentul cxovelebSi);
aSlilobebi mozardobaSi vlindeba agresiuli amdenad, gansxvavebuli sapasuxo reaqcia SeiZleba
da deliqventuri qcevebiT an wamalmoxmarebiT _ dakavSirebuli iyos ganviTarebis fsiqopaTologiasTan
problemiT, romelic iSviaTia adreul bavSvobaSi. es (naxeT, Goodyer et al., 2001). am etapze, am mosazrebis
cvlilebebi, zogjer, ufro garemos cvlilebebiTaa aranairi pirdapiri mtkicebuleba ar arsebobs,
ganpirobebuli, vidre bavSvis ganviTarebiT. gan magram es kidev erTxel Segvaxsenebs imas, rom
viTarebis fsiqopaTologia Seswavlilia ruTeris fsiqopaTologiis gagebisTvis fiziologiuri da
(Rutter, 2002) mier. fsiqologiuri ganviTarebis etapebis codna Zalian
calkeuli daavadebis fsiqopaTologia am TavSi mniSvnelovania.
mogvianebiT iqneba ganxiluli. aq mocemulia bavSvTa gamyofi zRvari normasa da paTologias Soris.
fsiqopaTologiis ramdenime zogadi maxasiaTebeli: bavSvTa bevri fsiqikuri aSliloba normis uki
genebis mniSvneloba. garkveuli genebis monawileoba duress zRvarzea. amis miuxedavad, mkurnalobisas
dadgenilia sxvadasxva daavadebis, mag., autizmis, swori gadawyvetilebis misaRebad gamoiyeneba mdgo
yuradRebis deficitisa da kiTxvis specifikuri mareobis Sefasebis kategoriuli sistemebi `ki~ an
darRvevebis dros. Tumca, gamovlenili genebiT àra~ pasuxebiT. aseTi kategoriebis Sesaqmnelad
dispersiis axsna bolomde ver xerxdeba, rac xmaroben zRvrul maxasiaTeblebs, romelTac uf
mravali genis mcire efeqtiTa da gensa da garemos ro pirobiTi xasiaTi aqvs. bavSvebi, romelTa
Soris urTierTgavleniTaa gamowveuli. genma SeiZ maCveneblebi naklebia diagnozis dasmisTvis saWiro
leba gavlena moaxdinos garemo faqtorebze sapa niSnulze, SeiZleba ganicdidnen mZime distress da
suxo reaqciis xasiaTze. amdenad, cxovrebiseuli saWiroebdnen daxmarebas. mag., mozards, romelsac
movlenebis Sedegad mozardebSi depresiis ganviTareba depresiis diagnozisTvis arasakmarisi niSnebi aqvs,
mniSvnelovnadaa damokidebuli imaze, hqondaT, Tu ara SesaZlebelia hqondes seriozuli fsiqo-socialuri
maT mSoblebs emociuri aSliloba (Silberg et al., 1999). problemebi. amasTan, msubuqi da zomieri depresiac
amasTan, geni SeiZleba iribad gaxdes stresis mizezic, SeiZleba gaxdes akademiuri moswrebis mniSvnelovani
mag., genetikurad ganpirobebuli pirovnuli Tvisebebi, gauaresebis mizezi (Pickles et al., 2001).
rogorebicaa gaRizianebadoba da impulsuroba, iwvevs wyveta da uwyvetoba. bavSvobaSi arsebuli zogi
urTierTobis problemebsa da gayras. simptomi an qceviTi darRveva asocirebulia prob
_ 691 _
lemebTan zrdasrul asakSi. mag., hiperaqtivoba specifikuri CamorCeniloba gaerTianebulia RerZ
3 wlis bavSvebSi kavSirSia kriminalur qcevasTan Si 1 (I aqsisSi), danarCenebi igivea, rac meaTe
mozrdilebSi (Stevenson and Goodman, 2001). amis gadasinjvaSi, anu xuTi RerZia gamoyenebuli. sqema
sawinaaRmdegod, bavSvobaSi aRmocenebuli SfoTviTi advili gamosayenebelia da klinicistebs mimdinare
simptomebi iSviaTad grZeldeba zrdasrul asakSic gansxvavebuli problemebis sistematuri aRricxvis
(gv. 683) saSualebas aZlevs.
urTierToba bavSvsa da mSobels Soris. mSoblebis bavSvTa fsiqikuri aSlilobebis CamonaTvali orive
damokidebuleba gavlenas axdens bavSvze, amasTan, ICD-10 da DSM-IV klasifikaciis mixedviT mocemulia
bavSvi magaliTs iRebs mSoblebisgan. mag., deda naklebad cxrilSi 24.1. (am wignSi daswavlis darRvevebi, e.i.
efereba Svils, romelic ar reagirebs Caxutebasa da gonebrivi CamorCeniloba, mocemulia 25-e TavSi). orive
TamaSze da met dros uTmobs mosiyvarule Svils. sqema rTulia da mocemuli cxrili asaxavs ZiriTad
dedis amgvari uyuradReboba uaryofiTad moqmedebs kategoriebs. ZiriTadad, orive klasifikaciaSi
bavSvze da kidev ufro arTulebs siaxlovisa da warmodgenili sqemebi msgavsia. oriveSi warmodgenilia
mijaWvulobis Camoyalibebas. Semdegi kategoriebi:
w ganviTarebis zogadi da specifikuri aSlilobebi,
bavSvTa da mozardTa fsiqikur romlebic Tavis mxriv iyofa motoruli funqciis,
aSlilobaTa klasifikacia metyvelebisa da komunikaciis, aseve saskolo Cve
vebis ganviTarebis aSlilobebad.
orive klasifikaciaSi ICD-10-sa da DSM-IV-Si mo
cemulia bavSvTa fsiqikuri aSlilobis sqemebi. mo w qcevis aSlilobebi, romlebic iyofa qcevis (we
zardebis fsiqikuri aSlilobebi nawilobriv Sedis srigis darRvevis) da yuradRebis deficitiT
am TavSi da nawilobriv _ mozrdilTa fsiqiatriis (hiperkinetikur) mimdinare aSlilobebad.
nawilSi. w SfoTviTi (emociuri) aSlilobebi (DSM IV-Si bavSvTa
multivariaciuli analizis gamoyenebiT, kvlevebSi SfoTviTi aSlilobebi calke gamoyofili araa da
dadasturebulia da zogadad klinicistebis mier gamoiyeneba mozrdilebis kategoria).
aRiarebulia bavSvTa fsiqikuri aSlilobebis Svidi w tikebi
ZiriTadi jgufi (Quay and Werry, 1986), romelTa
erTi gansxvaveba, DSM IV-Si aris kvebisa da
aRsaniSni terminebi CamoTvlilia qvemoT, maTi al
gamoyofis aSlilobebis damoukidebeli kategoria,
ternatiuli dasaxelebebi mocemulia frCxilebSi:
maSin, roca meaTe gadasinjvaSi es aSlilobebi Zilis
1. adaptaciis reaqcia darRvevebTan erTadaa gaerTianebuli sxva `qcevisa
2. ganviTarebis zogadi darRvevebi da emociur aSlilobebSi~. bavSvTa fsiqikuri aS
3. ganviTarebis specifikuri aSlilobebi lilobebis klasifikaciasTan dakavSirebiT ufro
dawvrilebiTi informacia SegiZliaT moiZioT tei
4. qcevis aSlilobebi (antisocialuri an eqsternali
lorisa da ruteris naSromSi (Taylor and Rutter (2002).
zebuli)
5. yuradRebis deficitiTa da hiperaqtivobiT mimd
inare aSlilobebi
epidemiologia
qcevisa da emociuri aSlilobebi sakmaod gavrce
6. emociuri (nevrozuli an internalizebuli) aSli
lebulia bavSvTa asakSi. gamoyenebuli meTodisa da
loba
diagnostikuri kriteriumebidan gamomdinare gav
7. simptomuri aSlilobebi
rcelebis sixSire gansxvavebulia sxvadasxva kvlevaSi,
bavSvTa fsiqikuri aSlilobebis didi nawilis erT
Tumca, ZiriTadad, erTnairia ganviTarebul qveynebSi.
kategoriaSi klasificireba ver xerxdeba, amitom gamo
ufro metic, ganviTarebad qveynebSic TiTqmis ise
iyeneba mravalRerZuli (multiaqsialuri) sistema.
Tive monacemebia, rac ganviTarebulSi. inglisSi
meaTe gadasinjvaSi eqvsi RerZia gamoyenebuli:
Catarebuli kvlevebiT dadginda, rom eTnikur umci
1. klinikuri fsiqiatriuli sindromebi resobaSi bavSvTa fsiqikuri aSlilobebis gavrceleba
2. ganviTarebis specifikuri CamorCeniloba iseTivea, rogoric danarCen populaciaSi. ramdenime
3. inteleqtis done gamonaklisi ganxiluli iqneba amave wignSi.
bazisuri kvleva Catarda 30 wlis win uaitis kun
4. somaturi mdgomareoba
Zulze britaneTSi. kvleva miznad isaxavda 10-11
5. anomaliuri socialuri viTareba wlis skolis moswavleebis janmrTelobis, inte
6. adaptaciuri unarebis ganviTarebis done leqtis, ganaTlebisa da fsiqologiuri problemebis
DSM IV-Si fsiqiatriuli sindromebi da ganviTarebis Seswavlas kunZulze. sul gamoikvlies 2193 bav
_ 692 _
epidemiologia
aSlilobebsa da socialur klass Soris, Tumca aS
cxrili 24.1 bavSvTa fsiqikuri aSlilobebis lilobaTa gavrcelebis sixSire matulobda inte
klasifikacia
leqtis koeficientis daqveiTebasTan erTad. fsi
diagnostikur- daavadebaTa saerTaSoriso qikuri problemebi asocirebuli iyo fizikur unar
statistikuri klasifikacia, meaTe gadasinjva
saxelmZRvanelo ICD 10 SezRudulobasTan, gansakuTrebiT, tvinis organul
DSM IV dazianebasTan. gamovlinda mWidro kavSiri qcevis
aSlilobebi, romle F8 fsiqologiuri ganviTarebis
darRvevebsa da kiTxvaSi CamorCenas Soris. mogvianebiT
bic pirvelad diag darRvevebi aseTive kvleva, imave meTodis gamoyenebiT Catarda
nostirdeba Cviloba londonSic (Rutter et al., 1975a, b) da am SemTxvevaSi
Si, bavSvobasa da mo
zardobaSi; yvela maCvenebeli iyo gaormagebuli uaitis kunZulis
monacemebTan SedarebiT.
daswavlis darRvevebi; saskolo Cvevebis ganviTare
basTan dakavSirebuli speci fsiqikuri aSlilobebis zogadi sixSire. SemdgomSi,
fikuri aSlilobani standartuli diagnostikuri kriteriumebis gamoye
motoruli unar- motoruli funqciis nebiT Catarebuli mravali kvleviT did britaneTSi
Cvevebis darRvevebi; ganviTarebis specikfiuri (Meltzer et al., 2000), kanadaSi, ontarioSi (Offord et al., 1987),
aSliloba
axal zelandiaSi, kraistCerCsa (Fergusson et al., 1993) da
komunikaciis metyvelebis specifikuri dunedinSi (Anderson et al., 1987) aSS-Si, did kvamlian
darRvevebi; aSliloba
mTebSi (Costello et al., 1996) da puerto rikoSi (Bird et al.,
ganviTarebis zogadi ganviTarebis zogadi 1988) dadasturda manamde arsebuli monacemebi. did
aSlilobebi; aSlilobebi;
britaneTSi meaTe gadasinjvis aSlilobebi 5-15 wlis 10
- F9 bavSvTa da mozardTa asakSi 000 bavSvidan gamovlinda 9, 5% -Si.
dawyebuli qceviTi da emociuri
aSlilobani gavrcelebis sixSire mozardebSi. Tavdapirvelad
mozardebis monacemebi Seiswavles uaitis kunZulebze
yuradRebis deficiti hiperkinetikuri aSliloba;
da socialuri qcevis qcevis aSlilobebi; pirveli kvlevidan 4 wlis Semdeg (Rutter et al., 1976b).
darRvevebi; 14 wlis asakSi erTwliani gavrceleba seriozuli
- qcevisa da emociebis Sereuli fsiqikuri aSlilobebisa iyo daaxloebiT 20%. mo
aSliloba; maval kvlevebSi (Roberts et al., 1998) es ricxvi ram
emociuri aSlilobebi denadme gansxvavdeboda, magram kvlevebis um
bavSvebSi; ravlesoba amyarebs manamde miRebul Sedegebs da es
tikebi tikebi; ricxvi meryeobs 15-20%-is farglebSi. Tumca, droTa
ganmavlobaSi mainc SeiniSneba garkveuli cvlilebebi.
CvilTa da bavSvTa -
kvebis aSlilobebi; mag., ukanaskneli 25 wlis manZilze did britaneTSi
mniSvnelovnad gaizarda qcevisa da emociuri aSli
socialuri funqcionirebis
- aSliloba bavSvTa da mozardTa lobebi mozardebSi (Collishaw et al., 2004).
asakSi specifiKuri dasawyisiT gansxvaveba sqesisa da asakis mixedviT. mozardobamde
gamoyofis - fsiqikuri aSlilobebi ufro xSiria biWebSi, vidre
(eliminaciis) gogonebSi, pubertatis Semdeg ki gogonebSi. zogi
darRvevebi
fsiqikuri aSlilobis gavrcelebis sixSire, romelic
CvilTa, bavSvTa da mo sxva qceviTi da emociuri aS icvleba asakisa da sqesis mixedviT mocemulia
zardTa sxva aSlilo lilobani ganviTarebuli bav
bebi Svebsa da mozardebSi. cxrilSi 24.2.
variaciis sxva mizezebi. skolis asakis bavSvebSi
Svi (Rutter et al., 1970a). kvlevis pirvel etapze fsiqikuri problemebi gansxvavebulia sacxovrebeli
skriningisTvis gamoiyenes kiTxvarebi mSoblebisa da adgilis mixedviT: orjer metia qalaqSi (daaxloebiT
pedagogebisTvis. am meTodiT gamovlenili bavSvebi 25%), vidre sofelSi (daaxloebiT 12%) (Rutter et al.,
gadiodnen fsiqologiur da saswavlo testirebas, 1975a). Semdgomi kvlevebiT dadasturda manamde
xolo maT mSoblebTan tardeboda gasaubreba. fsi arsebuli monacemebi, rom fsiqikur aSlilobaTa
qikur aSlilobaTa erTwliani gavrceleba TiTqmis gavrcelebis sixSires zrdis Semdegi faqtorebi:
7% iyo, amasTan, biWebSi 2-jer meti, vidre gogonebSi. w mSoblebis gayra, mSoblis avadmyofoba, mSoblebis
emociuri aSlilobebis 2, 5%, xolo qcevis da qcevisa samarTaldarRvevebi;
da emociuri aSlilobebis erTiani maCvenebeli _
w socialurad daucvel urbanul raionSi cxovreba;
4%. qcevis aSlilobebi 4-jer meti iyo biWebSi,
w iseT skolaSi swavla, sadac pedagogebi xSirad
xolo emociuri darRvevebi _ gogonebSi, Sesabamisi
icvlebian.
sixSiriT 1.5:1. ar gamovlinda korelacia fsiqikur
_ 693 _
cxrili 24.2 fsiqikuri aSlilobebis gavrcelebis SedarebiTi sixSire gogonebsa da biWebSi

ufro xSirad biWebSi erTnairad ufro xSirad gogonebSi
ganviTarebis zogadi aSlilobebi; depresia pubertatul asakamde; depresia pubertatuli asakis Semdeg
ganviTarebis specifikuri aSlilobebi; skolis gacdena; specifikuri fobia
hiperaqtivoba; seleqtiuri mutizmi; kvebis aSlilobebi;
opoziciur-gamomwvevi qceviTi dRis enurezi;

aSliloba;
mozardTa deliqventoba*; TviTdazianeba pubertatis Semdeg;
Ramis enurezi- mozrdil bavSvebSi;
tikebi;
TviTmkvleloba;
aSlilobebi, romlebic viTardeba

pubertuli asakis Semdeg;
depresia, mania, fsiqozebi, agorafobia

da panikuri aSliloba, kvebis aSliloba,
wamalmoxmareba, TviTdazianeba da
suicidi, mozardTa deliqventoba
*mozardTa deliqventoba da skolis gacdena aRwerilobiTi terminebia da ara diagnozi.
komorbidoba. DSM IV-iT kriteriumebiT Cata cudi gamosavali. mozrdilobaSi, rogoc wesi, isini
rebuli kvlevebiT gamovlinda bavSvTa fsiqikuri antisocialur an alkoholdamokidebul pirebad
aSlilobebis komorbidobis maRali sixSire. es, yalibdebodnen; hqondaT dasaqmebisa da daojaxebis
SesaZloa, ganapiroba iman, rom erTi daavadeba qmnis problemebi an samarTaldarRvevebi. momdevno kvle
winaganwyobas sxva aSlilobebisTvis, an maT saerTo vebma aCvena, rom mwvave hiperkinetikuri aSlilobis
gamomwvevi faqtorebi aqvT, an klasifikacia zedmetad SemTxvevaSi riski imave problemebis ganviTarebisa
cdilobs gamoyos damoukidebel aSlilobebad qcevis izrdeba im SemTxvevaSi, rodesac agresia an mZime
paternebi, romlebic ramdenime aSlilobisTvisaa ojaxuri mdgomareoba figurirebs. aRniSnuli uar
damaxasiaTebeli. yofiTi faqtorebis gareSe hiperkinezuri darRvevebi
bavSvTa da mozardTa fsiqikur aSlilobaTa epi mcirdeboda asakTan erTad da bavSvebi Tavs aRwevdnen
demiologiis mimoxilva ix. ofordTan (Offord, 2002). invalidobas. zogi bavSvobaSi dawyebuli emociuri
aSliloba cudi prognoziT xasiaTdeba. fombonem
grZelvadiani kvlevebi (Fombonne et al., 2001a, b) Seiswavla 149 piri, romlebic
zomierad gamoxatuli qceviTi da ganviTarebis 20 wlis win bavSvTa da mozardTa fsiqiatriul
problemebi, Cveulebriv, maleve amoiwureba. xolo, klinikaSi depresiis diagnoziT mkurnalobdnen.
mwvave mdgomareobebi, rodesac ismeba fsiqikuri maT nawils hqonda qcevis aSlilobebic. depresiis
aSlilobis diagnozi, sakmarisad didxans grZeldeba. diagnozi bavSvobaSi maRali albaTobiT moaswavebda
mag., uaitis kunZulze Catarebulma kvlevebma aCvenes, depresiis ganviTarebas mozrdilobaSic, xolo dep
rom bavSvebis sam meoTxeds, romelTac hqondaT resias darTuli qcevis aSliloba zrdida alkohol
qceviTi aSlilobebi da bavSvebis naxevars, romlebsac da wamaldamokidebulebisa da antisocialuri per
emociuri aSlilobebi aReniSnebodaT, 10 wlis asakSi, sonologiuri aSlilobis ganviTarebis risks. prog
oTxi wlis Semdegac isev rCebodaT igive diagnozi nozuli kvlevebis mimoxilva ix. haringtonTan
(Rutter et al., 1976b). (Harrington., 2001).
bavSvobaSi fsiqikuri aSlilobis diagnozis prog
nozuli mniSvneloba Seswavlilia xangrZlivi kvle etiologia
vebiT. robinsi (Robins., 1996) xangrZlivi drois bavSvTa fsiqikuri aSlilobebis gamomwvev mizezebze
ganmavlobaSi akvirdeboda pirebs, romlebic 30 wlis saubrisas imave ZiriTad principebs veyrdnobiT, rasac
win imyofebodnen aRricxvaze bavSvTa klinikaSi da mozrdilTa fsiqikuri aSlilobebis SemTxvevaSi,
adarebda sakontrolo jgufs, romlebic swavlobdnen rac mexuTe TavSia ganxiluli. bavSvTa aSlilobebis
imave skolaSi, magram arasdros miumarTavT kli umetesobas mravali mizezi ganapirobebs, romlebic
nikisTvis. qcevis aSlilobebis mqone bavSvebs hqondaT moicavs rogorc genetikur, aseve garemo faqtorebs (ix.
_ 694 _
etiologia
Rutter, 1999). mniSvnelovania ganviTarebis aspeqtebic. 2 wlamde xasiaTis garkveuli Taviseburebebi gansaz-
bavSvebis fsiqologiuri da socialuri momwifeba Rvravda fsiqikuri aSlilobebis ganviTarebas mogvi-
aisaxeba maT darRvevebSi. momdevno paragrafSi mokled anebiT asakSi. maT Seadares bavSvebis ori jgufi. I
ganxilulia urTierTdakavSirebuli faqtorebis oTxi jgufis (Zneli bavSvebi) maxasiaTeblebi cxovrebis
jgufi. pirveli ori wlis manZilze iyo: momvlelis mier
bavSvis ugulebelyofa, neli adaptacia, intensiuri
genetikuri faqtorebi qceviTi reaqcia; II jgufis (ioli bavSvebi) ki _ pozi-
fsiqikuri aSlilobis mqone bavSvebis mSoblebi xSirad tiuri damokidebuleba, swrafi adaptacia da zomieri
fsiqikurad daavadebulebi arian. am SemTxvevaSic qceviTi reaqcia. pirvel jgufTan SedarebiT, meore
garemo faqtorebi udides rols TamaSoben. tyupebis jgufis bavSvebSi fsiqikuri aSlilobebi ufros asak-
kvlevam aCvena, rom genetikur winaganwyobas gan Si iSviaTad viTardeboda. mkvlevarebi varaudoben,
sakuTrebuli mniSvneloba aqvs konkretuli aSli rom temperamentis es adreuli gansxvaveba ganpiro-
lobebis, mag., hiperaqtivobisa da autizmis dros. bebulia rogorc genetikuri, aseve garemo faqtore-
genetikur daavadebebze SemdgomSi iqneba saubari, biT. marTalia, amis damamtkicebeli monacemebi jer
rodesac calkeul aSlilobebs ganvixilavT. am TavSi ar arsebobs (Belskey et al., 1998), magram miiCneven, rom
mocemulia genetikuri kvlevebiT miRebuli zogadi temperamentisa da mSoblebis zrunvis Taviseburebas
monacemebi. genetikuri kvlevebis meTodologia Soris urTierTkavSiris roli metad mniSvnelovania.
ganxilulia gv. 98-103. bavSvTa fsiqiatriis genetikuri sxva, xangrZlivma kvlevebma, aCvena susti kavSiri bavS-
monacemebis magaliTebi moyvanilia daavadebebis vis 3 wlamde daumorCilebel (mousvenari, xifaTiani
Sesabamisad, mag., TavSi autizmis Sesaxeb. am daavadebaze bavSvi) xasiaTsa da momavalSi antisocialuri perso-
gansakuTrebiT mdidari masalaa dagrovili (gv. 672). nologiuri aSlilobis ganviTarebasa da morcxv xa-
genetikuri monacemebis interpretaciis ramdenime siaTsa (mSiSara, mgrZnobiare bavSvi) da mozardobaSi
zogadi debuleba mocemulia boqsSi 24.1. depresiis ganviTarebas Soris (Caspi et al., 1996).
ufro detaluri informaciisTvis ix. gudmani da
skoti (Goodman and Scott., 2005), 29-e Tavi. tvinis daavadeba
mZime somaturi daavadebebi warmoadgens fsiqikuri
temperamenti da individualuri aSlilobisTvis mniSvnelovan winaganwyobas. am mxriv
gasxvavebebi gansakuTrebiT mniSvnelovania tvinis daavadebe-
mravali wlis win tomasma (Tomas et al., 1968) Caatara bi. uaitis kunZulis kvlevaSi (ix. zeviT) fsiqikuri
xangrZlivi kvleva niu iorkSi. maT aRmoaCines, rom problemebis mqone bavSvebidan mxolod 7% iyo fizi-
boqsi 24.1. 1 bavSvTa fsiqikuri poligenuri efeqti da garemos gavlena bavSvTa fsiqiatriaSi:
aSlilobebis genetikuri kvlevebis memkvidruli faqtorebi upiratesad poligenuria. iseve,
rogorc mozrdilebSi, mravali geni urTierTqmedebs so-
Sedegebis interpretacia
cialur faqtorebTan, amitom genetikuri kvlevebi moicavs
fenotipi da genotipi: radgan, kvlevisas fsiqikuri garemos gavlenis Sefasebasac.
aSlilobis yvela diagnostikuri kriteriumis Seswavla iribi efeqti: genebma SesaZloa moaxdinon gavlena iseT faq-
xdeba, Sedegebma aCvena, rom daavadebis etiologiaSi torebze zemoqmedebiT, rogorebicaa inteleqti da xasiaTi,
diagnostikuri maxasiaTeblebis nawili naklebadaa rac Tavis mxriv gansazRvravs, Tu romeli situaciaa piro-
dakavSirebuli genetikur faqtorebTan. magaliTad, vnebisTvis stresuli.
autizmis fenotipi moicavs metyvelebis aSlilobebsac,
xolo turetis (Gilles de la Tourette) sindromi _ akviatebebs. gansxvavebuli garemo faqtorebi: mosaxleobis genetikuri
kvlevebis monacemTa analizSi gamoyofilia genetikuri,
komorbidoba: bevr bavSvs aReniSneba iseTi simptomebi, saerTo da gansxvavebuli garemo faqtorebi (ixile gv. 99).
romlebic damaxasiaTebelia sxvadasxva fsiqikuri fsiqologiuri Taviseburebebis 50%-s memkvidruli xasiaTi
aSlilobisTvis, magaliTad, depresiisa da qcevis aqvs (memkvidruli faqtorebis axsna mocemulia gv. 98), maT
aSlilobebisTvis an depresiisa da kvebis aSlilobebisTvis. umravlesobaze saerTo garemo faqtorebis gavlena um-
rogorc zeviT aRvniSneT (epidemiologiis TavSi), bolomde niSvneloa. aqedan gamomdinare, SeiZleba vivaraudoT, rom
cnobili araa, ra ganapirobebs aseT gadafarvas. SesaZloa, gansxvavebuli garemo faqtorebi danarCeni 50%-is ganmsa-
erTi daavadeba warmoadgens winaganwyobas meoresTvis an zRvrelia. Tumca, es darCenili nawili, SesaZloa, Seicavs
orive aSliloba erTi da imave genetikuri mowyvladobis CvenTvis ucnob mraval sxva komponentsac.
gamovlenaa. amasTan, saerTo garemo faqtorebi gansxvavebulad mo-
SeniRbuli erTi-genis efeqti: erTi genis efeqti Tavs qmedebs sxvadasxva bavSvze, da es efeqti analizSi gvevli-
iCens maSin, rodesac ar aris memkvidreobis gamoxatuli neba, rogorc gansxvavebuli garemo faqtorebi. amitom
mendelianuri (Mendel) paternebi. es xdeba im SemTxvevaSi, kvlevebi, romlebiTac gamovlinda gansxvavebuli garemos
rodesac bevr daavadebul pirovnebas ar hyavs Svili an mniSvnelovani efeqti, unda am faqtorebs uSualod ikvle-
rodesac fenotipi didi variabelurobiT xasiaTdeba da vdes. klinicistebma ar unda CaTvalon, rom saerTo ojaxu-
genis efeqti advili SesamCnevi araa. ri garemo faqtorebis gavlena umniSvneloa.
_ 695 _
kurad janmrTeli, 12% iyo somaturad avad, xolo w
kompensaciis meti unari: moumwifebeli tvini me-
34%-s hqonda tvinis daavadebebi (Rutter et al., 1976b). tad avlens kompensatorul unars lokaluri da-
am jgufSi fsiqikur aSlilobaTa maRali sixSire ar zianebis SemTxvevaSi. mag., marcxena naxevarsferos
iyo axsnili uaryofiTi socialuri faqtorebiT, rac destruqcia adreul asakSi SeiZleba srulad iyos
TavisTavad asocirdeba tvinis daavadebebis ganviTa- kompensirebuli metyvelebis normaluri ganviTare-
rebis riskTan, an fizikuri unarSezRudulobiT. cno- biT (Goodman, 1987).
bilia, rom fsiqikuri aSlilobebi iSviaTia kunTovani w
dayovnebis efeqti: adreuli dazianebis manifesta-
daavadebebis dros. tvinis daavadebebis SemTxvevaSi cia SeiZleba moxdes ganviTarebis mogvianebiT
fsiqikur aSlilobaTa simwvave damokidebulia tvinis etapze, rodesac dazianebuli ubani erTveba sakvan-
dazianebis xarisxze, Tumca es damokidebuleba yov- Zo funqciebSi. cnobilia, rom samSobiaro travmam
elTvis pirdapirproporciuli araa. fsiqikuri aSli- ramdenime wlis Semdeg SeiZleba gamoiwvios krunCx-
lobebi Tanabrad xSiria rogorc tvinis dazianebis vis ganviTareba. arsebobs mosazreba, rom qcevis
mqone gogonebSi, aseve biWebSi, rac gansxvavebuladaa paTologiis ganviTarebis dayovnebac amis mgavsad
zogad populaciaSi, sadac fsiqikuri aSlilobebi xdeba.
ufro xSiria mamrobiTi sqesis warmomadgenlebSi.
arasasurvel fsiqosocialur garemoSi, ufro mosa- lateralizebuli dazianeba da fsiqopaTologia
lodnelia, rom fsiqikuri problemebi ganuviTardeT tvinis lateralizebuli dazianebis qceviTi efeqti
tvinis dazianebis mqone bavSvebs, vidre janmrTelebs nakleb specifikuria bavSvebSi, vidre mozardebSi.
(ix. tvinis dazianebis mqone bavSvebze Catarebuli kv- amitom mcdeloba imisa rom, marjvena da marcxena
leva Rutter et al., 1983). mxrivi dazianebiT aixsnas swavlis problemebi, sakma-
od saeWvoa da Sesabamisad marjvena da marcxena tvi-
tvinis minimaluri disfunqciis Teoria
nis trenirebiT Sedegic naklebad miiRweva.
tvinis minimaluri disfunqciis Teoria aRaraa aRi-
arebuli, magram mainc mniSvnelovnad migvaCnia misi bavSvobaSi miRebuli Tavis tvinis dazianebis
ganxilva, radgan Tavis droze es iyo Tanamedrove Sedegebi
etiologiuri Teoriebisken win gadadgmuli nabiji. Tavis tvinis dazianeba bavSvobaSi ganviTarebuli
dakvirveba, rom tvinis garkveuli saxis dazianebebi nevrologiuri problemebis ZiriTadi mizezia. Tavis
asocirebulia fsiqikur aSlilobebTan, gvafiqre- tvinis dazianebiT gamowveuli darRvevebi specifi-
binebs, rom naklebi siRrmis dazianeba, romelic kuri araa, nawilobriv imitom, rom dazianeba iSvi-
saWiroa nevrologiur simptomatikis ganviTarebisT- aTadaa lokalizebuli erT ubanSi. Cveulebriv, Rrma
vis, iwvevs sxva saxis auxsnel daavadebebs. Tavidan dazianeba iwvevs inteleqtisa da qcevis darRvevebs.
iyenebdnen termins `tvinis minimaluri dazianeba~, es ukanaskneli kavSirSia dazianebis simZimesTan, ma-
romelic, mravali warumatebeli mcdelobis Semdeg gram fsiqikuri, kerZod, qcevis aSlilobebis ganviTa-
aRmoeCinaT struqturuli cvlilebebi, Seicvala reba naklebadaa pirdapir dakavSirebuli dazianebis
terminiT _ `tvinis minimaluri disfunqcia~. arse- xarisxTan.
bobda mosazreba, rom tvinis disfunqcia gamowveuli
epilefsia, rogorc bavSvTa fsiqikuri
iyo samSobiaro travmiT da am aRmoCenis aRsaniSna-
aSlilobebis ganviTarebis mizezi
vad gamoiyenes fraza `samSobiaro katastrofis Sede-
gi~ (à continuum of reproductive casualty~, Pasamanick and mozrdilebSi epilefsiasa da fsiqikur aSlilobebs
Knobloch, 1966). am ideas amyarebda cnobili asocia- Soris kavSiri ganxilulia 349 gverdze. bavSvebSi ar-
ciebi garTulebul mSobiarobas, umwifarobas, axal- sebobs mWidro kavSiri ganmeorebad krunCxviT Sete-
SobilTa asfiqsiasa da fsiqikur aSlilobebs Soris. vebsa da fsiqikur aSlilobebs Soris. rogorc mozr-
Tumca, gasaTvaliswinebelia socialuri problemebic, dilebSi, ise am SemTxvevaSic oTxi saxis mizez-Sedego-
romlebic, SesaZloa, warmoadgenen fsiqikuri aSli- brivi kavSiri arsebobs:
lobis ganviTarebis realur mizezs. marTalia, tvinis 1. tvinis dazianeba, romelic iwvevs epilefsias, Sei-
minimaluri dazianebis (disfunqciis) koncefcia aRa- Zleba iyos fsiqikuri aSlilobis ganviTarebis
raa aqtualuri, magram gamoxatuli tvinis dazianebis mizezic;
mniSvneloba safuZvlianadaa damtkicebuli. 2. krunCxviTi daavadebiT gamowveuli fsiqologiuri
da socialuri Sedegi SeiZleba gaxdes fsiqikuri
mowifulobis cvlilebebi da dayovnebis efeqti
aSlilobis ganviTarebis mizezi;
radgan tvini agrZelebs ganviTarebas, Tavis tvinis
3. epilefsiis gavlenam akademiur moswrebaze SeiZleba
dazianebis efeqti ufro kompleqsuria bavSvebSi, vi-
ganapirobos fsiqikuri aSlilobis ganviTareba;
dre mozrdilebSi. amas orgvari Sedegi aqvs:
_ 696 _
etiologia
4. epilefsiis samkurnalod gamoyenebulma medika- Sic damokidebulia temperamentze, kognitur Tavise-
mentebma SeiZleba gamoiwvios fsiqikuri aSliloba burebebsa da cxovrebiseul gamocdilebaze.
maTi gverdiTi efeqtis gamo;
ojaxis gavlena
epilefsiis tipi da dazianebis lokalizeba, zoga-
vinaidan bavSvis ganviTareba warmoebs sruli damokide-
dad, naklebad mniSvnelovania. gamonaklisia safeTq-
bulebidan srul damoukideblobamde, mas esaWiroeba
lis wilis epilefsia, romelic ufro metadaa daka-
stabiluri, usafrTxo ojaxuri garemo, emociurad
vSirebuli fsiqologiur problemebTan. daavadebis
Tbili da mzrunveli urTierTobebiT. Cvilobasa da
dawyebis asakic gansazRvravs bavSvis sapasuxo reaq-
adreul bavSvobaSi dedasTan xangrZlivma ganSorebam
cias epilefsiaze.
an mSoblis gardacvalebam SeiZleba udidesi gavlena
moaxdinos bavSvis fsiqologiur ganviTarebaze. cud
garemo faqtorebi
urTierTobebsac SeuZlia aseTive uaryofiTi gavle-
tyviiT mowamvla, rogorc fsiqologiuri nis moxdena. mSoblebs Soris zedmet konfliqturobas
problemebis mizezi gansakuTrebuli mniSvneloba aqvs (Jenkins and Smith,
mravali wlis manZilze arsebobs mosazreba, rom ty- 1990).
viiT dabinZurebul garemosTan xangrZlivi Sexeba
iwvevs gonebrivi ganviTarebis CamorCenas da, amdenad, dedis deprivacia da mijaWvuloba
xdeba inteleqtis daqveiTebisa da qcevis darRvevebis boulbis (Bowlby, 1951) yvelaze xSirad citirebul kv-
mizezi. zogadad, miRebulia, rom arsebobs kavSiri in- levaSi, romelic exeba `dedis deprivacias~, naTqvamia,
teleqtis koeficientsa da sisxlSi an kbilis dentinSi rom mozardTa deliqventoba dedasTan xangrZlivi
tyviis Semcvelobas Soris. nawilobriv es kavSiri Sei- ganSorebis Sedegia. marTalia, es mosazreba damtkice-
Zleba ganpirobebuli iyos socialuri faqtorebiT: buli araa, magram mniSvnelovnad win gadadgmuli nabi-
dabali inteleqti kavSirSia socialur statusTan, jia im mosazrebisken, rom mijaWvulobis Camoyalibeba
xolo tyviiT dabinZureba socialurad arakeTilsaim- bavSvis fsiqologiuri ganviTarebis umniSvnelovanesi
edo garemoSi gvxvdeba. rodesac socialuri garemos safexuria. mijaWvuloba yalibdeba cxovrebis meore
faqtori gamoricxulia, mainc rCeba mcire, magram my- eqvsi Tvis manZilze da adaptaciuri mijaWvuloba xa-
ari uaryofiTi korelacia tyviis maRal Semcvelobasa siaTdeba Sesabamisi balansiT usafrTxoebasa da Sem-
da inteleqtis koeficients Soris (Schwartz, 1994). ty- ecnebas Soris. boulbi (Bowlby) aRniSnavda, rom bavSvi
viis kavSiri qceviT darRvevebTan ufro rTuli dasa- swavlobs mSobelTan mijaWvulobis, sakuTari `me~-s
dgenia, vinaidan qcevas ver vsazRvravT iseTi zusti Sinagani modelisa da sxva adamianebTan urTierTobis
sididiT, rogoricaa inteleqtis koeficienti. aSS-s sakuTari gamocdilebiT. igi Tvlida, rom `me~-s Sina-
ramdenime qalaqSi Catarebulma kohortulma kvleveb- gani modelis gancda grZeldeba mTeli cxovrebis man-
ma raime konkretuli Sedegebi ar aCvena (mimoxilvisT- Zilze da gansazRvravs TviTSefasebasa da urTierTo-
vis ix. Taylor, 1991). im qalaqebSi, sadac daSvebulia bebis damyarebis unars. amdenad, bavSvebi, romlebic
tyviisgan Tavisufali sawvavi, mniSvnelovnad Sem- izrdebian mosiyvarule, maTi moTxovnebisadmi sensi-
cirda haeris tyviiT dabinZurebis maCvenebeli. aSS- tiur da Tanmimdevrul garemoSi, metad xasiaTdebian
Si 1976-1994 wlebSi bavSvebis sisxlSi tyviis saSualo dadebiTi TviTSefasebiTa da erTguli da gulwrfeli
koncentraciam iklo TiTqmis 80%-iT (Needleman, 1998). urTierTobis damyarebis unariT.
boulbis (Bowlby) ideebi, ZiriTadad, gamyarebulia
cxovrebiseuli SemTxvevebis efeqti
kvlevebiT, romlebSic izomeboda mijaWvuloba Cvi-
cxovrebiseuli SemTxvevebis koncefcia (gv. 94) mniS- lobasa da mogvianebiT asakSi. mijaWvulobas, Cveu-
vnelovania rogorc bavSvTa, aseve mozrdilTa fsiqi- lebriv, 6-18 Tvis asakSi ùcxo situaciebis proce-
atriaSi. cxovrebiseulma gamocdilebam SeiZleba duriT~ (Strange Situation Procedure, Ainsworth et al., 1978)
ganapirobos, xeli Seuwyos an SeaCeros fsiqikuri ikvlevdnen. am SemTxvevaSi adgendnen Cvilis reaqcias
aSlilobebis ganviTareba. cxovrebiseuli SemTxvevebi dedasTan ganSorebaze da Semdgom dedasTan an sxva
SeiZleba daxarisxdes maTi simwvavis; maTi socialuri momvlelTan kvlav SeerTebaze. testis mixedviT,
maxasiaTeblebis (mag., ojaxuri problemebi, an mSob- gayraze sapasuxo reaqcia ufro xasiaTis Tavisebure-
lis gardacvaleba): an maTi mniSvnelobis mixedviT, biTaa ganpirobebuli, vidre mijaWvulobis xarisxiT.
mag., gayra, ganSoreba an axali ojaxis wevris Semateba swored, SeerTebis reaqcia ganszRvravs mijaWvulobis
(dis an Zmis dabadeba). rogor moqmedebs stresuli xarisxs. mijaWvulobis sxva sazomebi SemuSavda ufro-
situaciebi bavSvTa fsiqikuri aSlilobebis ganviTa- si bavSvebisTvis. am testebis safuZvelze gamoiyo mi-
rebaze, bolomde garkveuli ar aris, magram, rogorc jaWvulobis oTxi tipi:
mozrdilebSi, fsiqologiuri Sedegi aseT SemTxveveb-
1. usafrTxo: aReniSneba bavSvebis 60%-s, romlebsac
_ 697 _
maTi moTxovnebisadmi sensitiuri da mgrZnobiare oTxi risk-faqtoris arsebobis dros yoveli xuTi
momvleli hyavT. bavSvidan erTs fsiqikuri aSlilobis diagnozi aqvs
2. acilebadi: aqvs bavSvebis 15%-s, romlebic momv- (Garmezy and Mastern, 1994).
lelisgan ganicdian uaryofas an intruzias.
damcavi (proteqtoruli) faqtorebi
3. dezorganizebuli: vlindeba bavSvebis 15%-Si, rom-
damcavi faqtorebi amcireben fsiqikuri aSlilobebis
lebic izrdebian momvlelTan, romlis qceva ara-
ganviTarebis albaTobas arsebuli risk-faqtorebis
prognozirebadi an safrTxis Semcvelia.
SemTxvevaSi. damcav faqtorebs ganekuTvneba kargi de-
4. rezistentul-ambivalenturi: yalibdeba bavSvebis doba, myari emociuri kavSirebi ojaxis SigniT, bavS-
10%-Si, im SemTxvevaSi, Tu movlis tipi araTanmim- vis socializacia da problemebis mogvarebis unari
devruli an arasakmarisia. da ojaxsgareTa kavSirebi, mag., skolaSi, eklesiaSi da
ufros bavSvebze Catarebuli kvlevebi cxadyofs, a.S. (Rutter, 1985)
rom mijaWvulobis tipis Camoyalibeba xdeba adreul
bavSvis aRzrdis praqtika
asakSi da mTeli cxovrebis manZilze stabiluri rCeba,
Tumca SeiZleba cxovrebiseuli gamocdilebis Sede- bavSvis aRzrdis zogadi paternebi pirdapir kavSir-
gad umniSvnelod Seicvalos. usafrTxo mijaWvulo- Si ar aris fsiqikuri aSlilobebis ganviTarebasTan,
bis mqone bavSvebi, zogadad, ukeTesad arTmeven Tavs garda im SemTxvevebisa, rodesac saqme gvaqvs araTan-
sirTuleebs, vidre daucveli mijaWvulobis mqoneni. mimdevrul an gadametebulad mkacr disciplinasTan,
daucveli mijaWvuloba, aseve, kavSirSia dedis depre- gantevebis vacad yofnas an ZaladobasTan (Rutter and
siulobasTan, mSoblebis alkohol da wamalmoxmare- Madge, 1976). rogorc fizikuri, aseve seqsualuri
basTan da bavSvze ZaladobasTan. dezorganizaciuli Zaladoba fsiqikuri aSlilobebis ganviTarebis mniS-
tipis mijaWvuloba samomavlo problemebis TvalsaCi- vnelovani risk-faqtorebia (gv. 697 da 699).
no indikatoria, gansakuTrebiT xSiria qceviTi aSli-
bavSvis alternatiuli movlis efeqti
lobebis ganviTareba.
ganSorebis efeqti: boulbis (Bowlby) Tavdapirveli momuSave dedas sxvebTan aqvs ganawilebuli Svilze
kvleviT miRebuli Sedegebi SemdgomSi mravaljer zrunva. zogadad, zrunvis ganawileba ar warmoadgens
iyo damtkicebuli, magram damatebiT gamoikveTa, fsiqikuri aSlilobis ganviTarebis risk-faqtors.
rom ganSorebis efeqti bevr sxvadasxva faqtorzea kargi movlis pirobebSi umjobesdeba mojaWvuloba da
damokidebuli, kerZod esaa: metyveleba im bavSvebSi, romelTa dedebic nakleb sen-
sitiurebi arian Svilis moTxovnebisadmi.
w bavSvis asaki, rodesac moxda ganSoreba
w ganSorebamde momvlelTan Camoyalibebuli urTier- mSoblebis fsiqikuri aSlilobis efeqti
Tobis tipi Tavis mniSvnelovan kvlevaSi ruterma (Rutter, 1966)
w ganSorebis mizezi aCvena, rom fsiqologiuri problemebi ufro xSiria
w ganSorebis periodSi bavSvis movlis xarisxi maSin, rodesac bavSvs fsiqikurad daavadebuli mSo-
blebi hyavs, vidre janmrTeli mSoblebis SemTxvevaSi.
mijaWvulobasTan dakavSirebuli ufro detaluri
ZiriTadad, adgili aqvs cud adaptacias saxlSi da
informaciis misaRebad gaecaniT o~konors O~Connor
skolaSi da wesrigis darRvevebs (Radke-Yarrow et al.,
(2002); an 28-e Tavs gudmanis da skotis saxelmZR-
1993). amas mravali mizezi aqvs, magram cnobilia, rom
vaneloSi (Goodman and Scott, 2005), romelic am TavSi
depresiuli deda naklebad urTierTobs bavSvebTan da
mocemuli informaciisTvisaa gamoyenebuli.
ver uzrunvelyofs maTi ganviTarebisTvis xelSemwyob
ojaxis risk-faqtorebi garemos (Stein et al., 1991). depresiuli dedis ufros
Svilebs SeiZleba Tavad ganuviTardeT depresia, rac
fsiqikuri aSlilobebis ganviTarebisTvis ojaxis faq-
rogorc genetikur, aseve garemo faqtorebiTaa gan-
tors mravlobiTi da kumulaciuri efeqti aqvs. riski
pirobebuli. kvebiTi aSlilobebis mqone dedas axa-
gazrdilia fsiqikuri aSlilobebisa da dabali so-
siaTebs gansakuTrebuli Camciebluri qceva sakvebis
cialuri statusis mqone, mravalwevrian da krimino-
miRebisa da TamaSis dros (Stein et al., 1995). Sizofre-
genul ojaxebSi. riski gazrdilia im bavSvebisTvisac,
niisas fsiqozuri, negatiuri an afeqturi simptomebi
romlebic saxlidan Sors izrdebian. erTi risk-faq-
uaryofiTad moqmedebs dedobis unarze.
toris arsebobis dros fsiqikuri aSlilobis ganviTa-
alkohol an wamalmomxmarebeli deda. aseTi dedis
rebis albaToba didad ar aRemateba riskis ararsebo-
Svilebs mTeli rigi problemebi aReniSnebaT, rac daka-
bis SemTxvevaSi gamovlenil statistikur monacemebs.
vSirebulia fexmZimobis dros dedis mier alkoholisa
ori risk-faqtoris arsebobisas fsiqikuri aSlilo-
da wamal moxmarebasTan da, aqedan gamomdinare, nayo-
bebis ganviTarebis albaToba 4-jer izrdeba, xolo
_ 698 _
bavSvebisa da maTi ojaxebis fsiqiatriuli Sefaseba
fis ganviTarebis Seferxebasa da dedis movlis tipTan socialuri faqtorebi uSualod moqmedebs masze. am
(I), dedis pirovnebasTan (II), romelic gansazRvravs mis faqtorebis mniSvnelobis Sefaseba xdeba kvlevebiT,
midrekilebas alkoholisa da narkotikuli nivTiere- romlebic Seiswavlis kavSirs fsiqikur aSlilobebsa
bebisadmi da wamalmoxmarebiT gamowveul socialur da samezoblosa da skolis gavlenas Soris.
problemebTan (III) (Hogan, 1998).
samezoblos efeqti
gayris efeqti bavSvebis fsiqikur aSlilobaTa sixSire metia social-
gayrili mSoblebis Svilebs meti fsiqologiuri prob- urad arakeTilsaimedo samezobloSi. mag., rogorc
lemebi aReniSnebaT, vidre srul ojaxebSi aRzrdil aRvniSneT (gv. 650), qceviTi da emociuri aSlilobebi
bavSvebs. bolomde Seswavlili ar aris, ramdenad mniS- ufro xSiria londonis Rarib ubnebSi, vidre uaitis
vnelovania es faqtori, romelic TavisTavad kavSirSia kunZulze. londonis mniSvnelovani maxasiaTeblebia
mSoblebs Soris disharmoniulobasTan (I), erT-erTi bavSvebisTvis saTamaSo adgilis nakleboba, mozard-
an orive mSoblis qcevasTan, ramac gayramde miiyvana ebisTvis arasakmarisi infrastruqtura, mosaxleobis
saqme (II), ojaxuri urTierTobis cvlilebebTan, rasac siWarbe da sazogadoebis naklebi CarTuloba.
SeiZleba mohyves axali qorwineba an sxva adamianTan
skolis efeqti
Tanacxovreba (III). distresi gansakuTrebiT Zlieria
gayridan pirveli wlis manZilze. ori wlis Semdeg didi xania cnobilia, rom bavSvTa referali da deli-
problemebi kvlav aRiniSneba, magram nakleb mwvavea, qventuri qceva gansxvavebulia skolebis mixedviT. es
vidre im bavSvebSi, romlebic konfliqtur ojaxebSi gansxvaveba ar aris damokidebuli samezoblos faq-
agrZeleben cxovrebas. (gayris xangrZlivi efeqtis mi- torze da, rogorc Cans, fsiqikuri problemebi na-
moxilva ix. naSromSi Hetherington and Stanley Hagan, 1999). klebad uviTardebaT bavSvebs, romlebic swavloben
skolebSi, sadac pedagogi waaxalisebs, afasebs da pa-
mSoblis gardacvaleba suxismgeblobis grZnobas uRvivebs Tavis moswavleebs,
mSoblis gardacvalebaze Svilis reaqcia icvleba nergavs maRal standartebs da kargad aqvs organize-
asakTan erTad. 4-5 wlamde asakis bavSvebSi sikvdilis, buli swavleba (Rutter et al., 1979). faqtorebi, romle-
rogorc samudamo ganSorebis mizezis gacnobiereba bic gavlenas ar axdenen fsiqikuri aSlilobebis six-
ar xdeba. am asakSi bavSvebi reagireben sasowarkveTiT, Sireze, skolis sidide da Senobis siZvelea.
SfoTviTa da ganSorebis uaryofiT. bulingi (Sarianoba) bavSvisTvis erT-erTi stresu-
5-11 wlis bavSvebs ukve esmiT ra aris sikvdili. isi- li movlenaa skolaSi. gudmeni da skoti (Goodman and
ni, rogorc wesi, reagireben depresiiTa da hiperaqti- Scott, 2005, gv 243) bulings ganmartaven, rogorc gan-
vobiT, an SesaZloa ganviTardes qceviTi aSlilobebi. meorebad da mizanmimarTul fizikur da fsiqologiur
zog SemTxvevaSi Cndeba azrebi TviTmkvlelobaze im zewolas bavSvsa an mozardze, upiratesad skolaSi,
fiqris safuZvelze, rom sikvdili Seaxvedrebs say- misTvis tkivilis miyenebis mizniT, adekvaturi pro-
varel mSobelTan. suiciduri qmedebebi iSviaTia. 11 vocirebis gareSe da im SemTxvevaSi, Tu cnobilia, rom
wlis zemoT bavSvebi TiTqmis mozrdilebiviT ganic- sapasuxod efeqturi mogerieba ar aris mosalodne-
dian (gv. 168). li. kvlevebiT naCvenebia, rom bavSvebis 2-8% kviraSi
danaklisma SeiZleba gaxangrZlivebuli efeqti iqo- erTxel an orjer ganicdis bulings skolaSi (Good-
nios ganviTarebaze, gansakuTrebiT mcirewlovan bavS- man and Scott., 2005). maT Soris gamoyofen or jgufs:
vebze, rodesac sikvdili moulodneli an Zaladobri- (1) pasiur jgufs, romelic Setevisas Tavs grZnobs
vi iyo. gamosavali didadaa damokidebuli cocxali daucvelad, ganicdis SfoTvas da cdilobs gaecalos
mSoblis mdgomareobaze. danaklisze Catarebul kv- im adgils da (2) provokaciul jgufs, romelic Tavad
levebSi upiratesad gamokvleulia mSoblis gardacva- agresiulia. bulingi ufro xSiria biWebSi, vidre go-
lebis gavlena bavSvze da naklebad dis an Zmis dakarg- gonebSi. biWebi ZiriTadad fizikur agresias avlenen,
va. damatebiTi informaca ix. blekTan (Black, 2000). xolo gogonebi gariyaven msxverpls. bulings dauy-
ovnebeli fsiqologiuri Sedegebi aqvs. misi mogvi-
socialuri da kulturaluri faqtorebi anebiTi efeqti araa Seswavlili. skolas SeuZlia Seam-
ojaxi, uTuod, udides rols asrulebs bavSvis gan- ciros bulingis SemTxvevebi. damatebiTi informacia
viTarebaSi, magram aranakleb mniSvnelovania ufro ix., Salmon and West (2000).
farTo socialuri garemos gavlenac, gansakuTrebiT
qceviTi aSlilobebis ganviTarebaSi. adreul asakSi, bavSvebisa da maTi ojaxebis
ojaxis paternebze zemoqmedebiT, socialuri faq- fsiqiatriuli Sefaseba
torebi iribad moqmedebs. bavSvi zrdasTan erTad Sefasebis mizania gamovavlinoT arsebuli problema,
met dros atarebs ojaxis gareT da am SemTxvevaSi gamovikvlioT, rogoraa es problema dakavSirebuli
_ 699 _
bavSvis ganviTarebis procesTan, amJamindel cxovre- CamonaTvalSi, mag., Rutter and Taylor (2002).
basTan fsiqologiur da socialur konteqstSi, da Se- intervius dawyeba. dasawyisisTvis aucilebelia me-
vimuSavoT mkurnalobis gegma bavSvisa da ojaxisTvis. gobruli atmosferos Seqmna da bavSvis ndobis mop-
bavSvebisa da mozrdilebis fsiqikuri Sefaseba ram- oveba. Cveulebriv, sasurvelia vkiTxoT, rogor surs,
denime niSniT gansxvavdeba erTmaneTisgan: rom mivmarToT da daviwyoT neitraluri TemebiT,
w metad moqnili damokidebuleba: bavSvebTan xSirad mag., sayvarel cxovelebze, TamaSebsa an dabadebis
Znelia rutinulad mihyve Sefasebis process, ami- dReze saubriT.
tom gamokiTxvis dros saWiroa moqniloba, Tumca intervius teqnika. megobruli garemos Seqmnis Sem-
mniSvnelovania gvaxsovdes, rom informaciis Seg- deg viwyebT kiTxvebis dasmas problemasTan dakav-
roveba da mdgomareobaze dakvirveba sistematur SirebiT, ra moswonT an ar moswonT da maT momaval
xasiaTs unda atarebdes. imedebze. xSirad, sakmaod informatiulia, Tu vkiTx-
avT, ras inatrebdnen sami survilis SemTxvevaSi. um-
w ojaxis wevrebis interviuireba: orive mSobeli da
cros bavSvebs unda mivceT SesaZlebloba gamoxaton
sxva momvlelebic unda monawileobdnen Sefasebis
TavianTi wuxili da emociebi naxatebiT an TamaSiT.
interviuSi, aseve sasurvelia dis an Zmis mowveva.
zogadad, bavSvebs SeuZliaT sworad gadmogvcen mov-
w informacia skolidan: did dros davzogavT, Tu lenebi, magram ara yovelTvis qronologiurad. bavS-
klinikaSi bavSvis moTavsebamde, aviRebT skolis vebi ufro STagonebadebi arian, vidre mozrdilebi da
pedagogTan moswavlis akademiur moswrebasa da cdiloben kiTxvaze ise upasuxon, rogorc ufrosebs
skolaSi qcevis problemebze gasaubrebis nebarTvas. surT, gansakuTrebiT skolaSi. amitom unda moveri-
gansxvavebulia bavSvTa fsiqiatrebis Sefasebis doT mimaTiTebeli kiTxvebis dasmas; Tavs ar unda
meTodic. yvela Tanxmdeba imaze, rom mniSvnelovania movaxvioT qcevebi da interpretaciebi im bavSvebs,
ojaxis erTad naxva, raTa Sefasdes maTi urTierT- romlebzec dakvirveba warmoebs TamaSis an kiTxvis
damokidebulebebi. zogi fsiqiatri ojaxs xvdeba bavS- dros.
vTan gasaubrebis Semdeg, xolo zogi manamde. zogadad fsiqikuri statusis kvleva. sakiTxebis CamonaTvali
iTvleba, rom mozardTan gasaubreba ojaxTan Sexve- mocemulia am Tavis damatebaSi (gv. 702). fsiqiatrTan
dramde jobs. misuli bavSvi, pirveli Sexvedrisas, SeiZleba Caike-
umcrosi bavSvebis SemTxvevaSi informaciis Ziri- tos Tavis TavSi da ar isaubros. aseTi qceva ar unda
Tad wyaros maTi mSoblebi da sxva momvlelebi war- miviCnioT depresiul mdgomareobad.
moadgenen. 6 wlis da ufrosi asakis bavSvebs SeiZleba ganviTarebis Sefaseba. bavSvis gamokiTxvis bolos
mSoblebisgan damoukideblad gavesaubroT. bavSvze unda Sefasdes misi ganviTarebis done da Seudardes
Zaladobis dros, gansakuTrebiT mniSvnelovania, misi imave asakis normalur maCveneblebs.
damoukideblad gamokiTxva. problemis bunebis miuxe- intervius teqnikisa da bavSvebTan, gansakuTrebiT
davad, intervius dros mSoblebma Tanadgoma unda mowyvlad populaciasTan, urTierTobis unar-Cveve-
igrZnon da ar unda moxdes maTi kompetenciis ugule- bze damatebiTi informacia ix. jonsis (Jones, 2003)
belyofa. naSromSi.
mSoblebis interviuireba ojaxis interviuireba

mSoblebs xSirad aqvT SfoTva da SiSi, rom ar daadan- ojaxTan gasaubreba kargi saSualebaa davakvirdeT
aSaulon Svilebis problemebSi. ar unda dagvenanos urTierTobas ojaxis wevrebs Soris, Tumca naklebad
dro imaze, rom mSoblebs avuxsnaT intervius mniSvn- gamosadegia faqtiuri informaciis Sesagroveblad. am
eloba. es waaxalisebs da ganawyobT maT spontanuri mxriv umjobesia mSoblebisa da ojaxis wevrebis cal-
saubrisTvis. gamokiTxvis meTodi msgavsia mozrdil- calke gamokiTxva. ojaxuri urTierTgavlenis mrava-
ebTan gamoyenebuli teqnikisa (Tavi 2) da mocemulia li aspeqtidan fsiqiatrisTvis yvelaze mniSvnelova-
am Tavis damatebaSi. rogorc mozrdilTa fsiqiatri, nia dezorganizebulobisa da ojaxis wevrebs Soris
gamocdili bavSvTa fsiqiatric awarmoebs srul uTanxmoebis gamovlena, rac metadaa dakavSirebuli
gamokiTxvas, Tumca met yuradRebas amaxvilebs im fsiqikuri aSlilobebis ganviTarebasTan. aranakleb
sakiTxebze, romlebic uSualodaa dakavSirebuli am- mniSvnelovania ojaxis wevrebs Soris urTierTobis
Jamindel problemasTan. Zalian mniSvnelovania zog- paternebi.
adi problemis specifikuri mizezebis moZieba, raTa Cveulebriv, sasurvelia ojaxTan Sexvedra pirve-
moxdes faqtiuri informaciisa da grZnobebisa da ladi Sefasebisas an, maleve, sanam eqimsa da bavSvs
damokidebulebebis srulfasovnad gamovlena. arse- Soris, an eqimsa da erT-erT mSobels Soris Camoy-
bobs mSoblebis interviuirebis ramdenime standar- alibdeba axlo urTierToba, rac gaarTulebs sxva
tizebuli sqema, romelic mocemulia literaturis wevrebTan gasaubrebas.
_ 700 _
bavSvebisa da maTi ojaxebis fsiqiatriuli Sefaseba
saubari unda daiwyos kiTxviT: `vis jobs vesaubro dins, es SeiZleba miuTiTebdes zogadi, an specifi-
arsebul problemaze?~. Tu erTi wevri moaxdens sau- kuri ganviTarebis darRvevebze, an sxva daavadebebiT
bris monopolizebas, unda mivmarToT ojaxis sxva gamowveul stresze. yvelaze xSirad gamoyenebuli
wevrs da vTxovoT komentari. msjelobis waxalisebi- procedurebi CamoTvlilia cxrilSi 24.3. proeqciuli
sTvis gamodgeba kiTxva: `ras fiqrobT, rogor afasebs testebis gamoyeneba ar aris mizanSewonili, vinaidan
Tqveni meuRle (Svili) problemas?~ damswre ojaxis Znelia monacemebis obieqturad Sefaseba da maTi
wevrs SeiZleba sxva ojaxis wevrebis azric vkiTxoT. validurobac saeWvoa.
am da sxva kiTxvebze pasuxisas interviueri akvird-
eba Semdeg Taviseburebebs: sxva informacia
w vin aris ojaxis warmomadgeneli? Zalian mniSvnelovani wyaro damatebiTi informaci-
w yvelaze metad vin ganicdis arsebul problemas? isTvis aris bavSvis maswavlebeli. man icis rogor
iqceva bavSvi klasSi, rogoria misi damokidebuleba
w rogoria ojaxis ierarqia, vin aris ojaxis ufrosi?
sxva bavSvebTan da misi akademiuri unarebi. mas Seu-
w rogoria ojaxis wevrebis erTmaneTTan urTierTo- Zlia saintereso cnobebis mowodeba ojaxur garemoe-
ba? bebsa da urTierTobebze. sasargeblo iqneba fsiqi-
w rogor axerxeben ojaxis wevrebi konfliqtTan gam- kuri janmrTelobis samsaxuris warmomadgenlis viz-
klavebas? iti bavSvis ojaxSi. am vizitiT gairkveva ojaxSi ar-
sebuli atmosfero, urTierTobebi wevrebs Soris da
fsiqologiuri Sefaseba maTi Tanacxovrebis paternebi.
inteleqtisa da ganaTlebis donis gansazRvra yov-
elTvis mniSvnelovania. Tu gonebrivi ganviTareba fizikuri gamokvleva
da akademiuri maCveneblebi ar Seesabameba asakobriv Tu bavSvi ar aris gamokvleuli ojaxis eqimis mier, ma-
maCveneblebs an mSoblebisa da pedagogebis molo- Sin, Sefasebis procesis dasrulebisTvis, aucileblia
cxrili 24.3 bavSvebSi gamosayenebeli fsiqologiuri kiTxvarebi

inteleqtis kvlevis testebi sxva ganviTarebis Sefasebis testebi
stenford-bineTis testi me-4 gamocema (Stanford-Binet test) denveris ganviTarebis skrining testi, me-2 gamocema.
gamoiyeneba 2 wlidan mozardobamde zogadi ganviTarebis skrining testi dabadebidan 6,5 wlamde.
gansazRvravs socialuri da pirovnuli ganviTarebis
inteleqtis zeda zRvaris Sefaseba - gamoiyeneba CamorCenas, natifi da uxeSi motorikisa da metyvelebis
gansakuTrebuli niWis mqone bavSvebis SemTxvevaSi ganviTarebis dones. gamoiyeneba rogorc skrining testi
veqsleris inteleqtis kvlevis Skala (Weschler intelligence im darRvevebis gamosavlenad, romlebic SemdgomSi ufro
scale for children - WISC III). am testiT fasdeba 6-14 wlis detalur gamokvlevas saWiroeben
bavSvebis specifikuri verbaluri da azrovnebis unari.
yvelaze farTod gamoyenebadi testia. naTargmnia mraval
enaze. ver gamoviyenebT im bavSvebTan, romelTa inteleqtis
koeficienti 40-ze dabalia.
veqsleris skolamdeli da inteleqtis pirveladi Sefasebis akademiuri moswrebis Sefaseba

Skala (Weschler pre-school and primary scale of intelligence WPPSI) nilis (Neale) kiTxvis unaris analizi;
aris veqsleris inteleqtis kvlevis Skalis varianti
SemuSavebuli 3-7 wlis bavSvebisTvis. sworad kiTxvisa da gagebis unaris safexurovani Sefasebis
Skala 6 da meti asakis bavSvebisTvis.
unarebis britanuli Skala -
erTi varianti gamoiyeneba 2-6 wlis, xolo meore - 6-18 Sonelis (Shonell) cxrili safexurovani sityvebis
wlis asakisTvis da moicavs 6 sferos: informaciuli pro- damarcvlis testi.
cesis siswrafes, azrovnebas, sivrciT warmodgenas, aRqmas, bavSvs dasamarcvlad eZleva mzardi sirTulis sityvebi.
xanmokle mexsierebas, gaxsenebas, codnis gamoyenebas. ana- maTematikuri unarebis testi;
lizi SeiZleba iyos zogadi an specifikuri.
damoukidebeli srulfasovani testi ar arsebobs. gamoiyeneba
socialuri ganviTrebis Sefaseba WISC, WPPSI da unarebis britanuli Skalis qvetestebi.
vainlendis (Vineland) adaptaciuri qcevis Skala, Sesworebuli.
nawilobriv struqturirebuli interviu mSoblebisTvis
da momvlelebisTvis bavSvebis komunikaciis, yoveldRiuri
unar-Cveebis, socializaciisa da motoruli unarebis
Sesafaseblad. pedagogebisTvis damatebulia skolis
nawili.
Cvilis ganviTarebis beilis Skala, me-2 gamocema;
Cvilis gonebrivi, motoruli da qcevis ganviTarebis
maCveneblebi Sedarebulia normas;
gamoiyeneba 1 Tvidan 1,5 wlamde bavSvebTan.
_ 701 _
misi somaturi mdgomareobis Seswavla. mdgomareobi- atris CaTvliT. Tavis angariSSi fsiqiatrma unda
dan gamomdinare unda SeirCes miznobrivi gamokvleve- gaamaxvilos yuradReba mis kompetenciaSi Semaval
bi, Tumca, yvelaze xSirad, saWiroa im mdgomareobaTa Semdeg sakiTxebze;
diagnostireba, romlebic tvinis disfunqcias iwveven. w bavSvis asaki, ganviTarebis done, temperamenti da
fizikuri Sefaseba iwyeba garegani daTvalierebiT, maTi mniSvneloba arsebul problemasTan dakavSire-
vakvirdebiT bavSvis gamometyvelebas, koordinaciasa biT;
da siarulis maneras TamaSisa da mosvenebis mdgo-
w fsiqikuri aSlilobis diagnozi;
mareobaSi. bazisur fizikur gamokvlevebs SeiZleba
w bavSvis asakisa da ganviTarebis donis gaTval-
daematos nevrologiuri gamokvleva. Tu gamovlinde-
iswinebiT momavalTan dakavSirebuli survilebi;
ba normidan gadaxra, saWiro iqneba pediatris gamoZa-
xeba. gamokvlevebs, romlebic saWiroa seqsualur Za- w bavSvis momvlelebis aRmzrdelobiTi unar-Cveve-
ladobaze eWvis SemTxvevaSi, ganvixilavT mogvianebiT bi; ramdenad SeuZliaT maT izrunon bavSvze misi
(gv. 697-8). saWiroebebis Sesabamisad. agreTve, ojaxis sxva Ta-
viseburebebi.
Sefasebis dasruleba amasTan, fsiqiatri mzad unda iyos sasamarTlos mia-
Sefasebis dasrulebisas fsiqiatrma bavSvsa da mis wodos informacia Semdeg sakiTxebze:
mSobels maTTvis gasageb enaze unda ganumartos kv- w bavSvis fizikuri, emociuri da akademiuri saWiroe-
levis Sedegebi da mdgomareobis marTvis gegma. eqimma bebi;
unda auxsnas, Tu rogor apirebs ojaxis eqimis in-
w bavSvis savaraudo reaqcia SesaZlo cvlilebebze,
formirebas da masTan TanamSromlobas da aiRos sxva
pirebTan, romlebic kavSirSi arian bavSvTan (maswav- boqsi 24.1 sasamarTlosTvis saWiro
lebeli, socialuri muSaki), urTierTobis nebarTva. informaciis mopoveba
zogadad, fsiqiatrma unda waaxalisos kiTxvis dasma angariSi bavSvis Sesaxeb
da diskusia. (a) informaciis mopoveba
tompsonisa da pirsis (Thompson & Pearce, 2000) naSromSi
formulireba mocemulia principebi, romlebic unda davicvaT bavSvi
sgan informaciis mopovebisas:
yvela SemTxveva unda iyos formulirebuli. amas igive
w bavSvs unda mieces azris Tavisuflad gamoxatvis saS
formati aqvs, rogorc mozrdilTa fsiqiatriaSi ualeba, unda davusvaT minimaluri raodenobis kiTxva;
(gv.59). formulireba iwyeba amJamindeli problemebis w informaciis mopoveba unda moxdes SemTxvevidan
mokle aRweriT, rasac mosdevs diagnozi da dife- uaxloes droSi, nebismieri saxis konsultaciis
rencialuri diagnozi. Semdeg modis etiologiuri Catarebamde;
faqtorebis ganxilva, romlis drosac yuradRebas w sasurvelia dafiqsirdes pirveli Cveneba, radgan
momdevno Cvenebebi, Cveulebriv, nakleb zustia;
vamaxvilebT maprovocirebel, gamomwvev da SemanarCu-
w unda gvaxsovdes, rac met zewolas movaxdenT bavSvze
nebel faqtorebze. aucileblad unda aRvniSnoT bavS- da movTxovT ambis gaxsenebas, miT naklebi sizustiT
vis ganviTarebis done, misi Zlieri da susti mxareebi. moaxerxebs igi amas.
Semdeg vafasebT problemas, ojaxis Tanadgomas, da ufro detaluri informaciisTvis, Tu rogor unda
bolos, vadgenT mkurnalobis sqemas da mivuTiTebT davkiTxoT mowme bavSvebi, ixileT tompsoni da pirsis
(Thompson & Pearce, 2000) naSromSi. distresul movlenebTan
SesaZlo gamosavals. dakavSirebiT bavSvis gamokiTxvis Sesaxeb, ixileT jonsis
(Jones, 2003) naSromSi.
sasamarTlo angariSi
(b) angariSi
fsiqiatri SeiZleba valdebuli gaxdes bavSvTan da- angariSis warmdgenis kvalifikacia
kavSirebiT moamzados sasamarTlo angariSi. amis ga- w visi moTxovnis safuZvelze daiwera raporti da ra
keTeba, rogorc wesi, moeTxoveba bavSvTa fsiqiatrs. kiTxvaa dasmuli;
aq ganvixilavT ramdenime zogad debulebas. Tu am w ra saxis werilobiTi informaciaa xelmisawvdomi da
angariSis momzadeba daevala zogad fsiqiatrs, igi visgan aiRes interviu;
unda gaecnos Sesabamis kanonmdeblobas, daekiTxos w interviudan miRebuli monacemebis daskvniT nawilSi
saWiro ar aris gavimeoroT socialuri gamoZiebis
kolegebs da waikiTxos sasamarTlo angariSis momza- Sedegebi;
debis ufro detaluri aRwera (mag., ix. naSromi Black angariSis warmdgenis mier intervius Sedegebisa da
et al., (1998). werilobiTi informaciis interpretacia;
bavSvis Sesaxeb informaciis misaRebad sasamarTlo w yovelTvis gvaxsovdes, rom mopovebuli informacia da
sxvadasxva wyaros iyenebs _ socialuri muSakis, pro- momzadebuli komentarebi aris sasamarTlosTvis da
ara fsiqiatrisTvis, romelic Seafasebs, Tu rogori
baciis oficris, Temis eqTnis, fsiqologisa da fsiqi- arCevania gakeTebuli.
_ 702 _
fsiqiatriuli daxmareba bavSvebisa da ojaxebisTvis
rogorebicaa ojaxidan moSoreba an ded-mamis gay- pirveladi jandacvis roli
ris Semdeg erT-erT mSobelTan sacxovreblad ga- ojaxis eqimi da pirveladi jandacvis sxva wevrebi
dasvla; TavianTi samuSao drois umetes nawils uTmoben mSo-
w nebismieri saSiSroeba, romelic emuqreboda an dae- blebisTvis rCevebis micemas. maTTan misuli bavSvebis
muqreba bavSvs. mxolod mcire nawili igzavneba pediatrTan an fsiqi-
bavSvis survilebi unda ganvixiloT asakisa da am- atrTan. ufro xSirad, pediatrTan gadamisamarTeba
Jamindeli an samomavlo situaciis gacnobierebis xdeba Semdegi mdgomareobebis dros:
unaris Sesabamisad. agreTve, unda gaviTvaliswinoT w ganviTarebis Seferxebebi;
arsebuli faqtorebis Sefasebis unaric, mag., bavSvi, w savaraudod, fsiqologiuri mizeziT gamowveuli
romelic Zaladobis msxverplia, SeiZleba mijaWvuli somaturi problemebi;
iyos moZaladeze.
w somaturi daavadebis fsiqologiuri garTulebebi.
mSoblebis aRmzrdelobiTi unarebi nawilobriv
fasdeba anamnezisa da sxva pirebis angariSebis safuZ- bavSvTa fsiqiatrTan igzavnebian qcevisa da emo-
velze da, agreTve uSualo dakvirvebiT bavSvisa da ciuri sferos aSlilobis mqone bavSvebi. es mdgo-
mSoblebis urTierTobebze, TiToeuli mSoblis mi- mareobebi, xSirad, imaze mwvave araa, rasac ojaxis
jaWvulobaze, bavSvisadmi sensitiurobasa da misi eqimebi Tavad mkurnaloben, magram gadawyvetileba
saWiroebebis dakmayofilebis unarze. sxva specialistebTan gagzavnis Sesaxeb, ufro xSirad,
am angariSis struqtura msgavsia mozrdilTa fsiqi- damokidebulia mSoblis survilsa an ojaxis SesaZle-
atriaSi gamoyenebuli dokumentisa da mocemulia bo- blobaze.
qsSi 24.1.
fsiqiatriuli gundi
bavSvebi, rogorc mowmeebi muSaobis Tavisebureba. miuxedavad imisa, rom bavSvebT-
an momuSave fsiqiatriuli gundis fsiqiatrs, fsiqo-
bavSvis Cveneba gansakuTrebiT mniSvnelovania, rode-
logs, socialur muSaks, specialuri unarebi aqvT,
sac ganixileba masze, an dedaze Zaladobis SemTxveve-
isini ar emijnebian TavianT tradiciul profesiul
bi. interviuerma unda Seafasos bavSvis mexsiereba da
rols. piriqiT, konkretul SemTxvevaze muSaobisas,
is faqtorebi, romlebmac SeiZleba, gavlena moaxdi-
isini maqsimalurad iyeneben im codnasa da gamocdile-
non movlenebis swor gaxsenebaze.
bas, rac TemSi mozrdilebTan muSaobisas daagroves.
unda gvaxsovdes, rom mexsiereba da ambis gadmoce-
gundi upiratesad iyenebs ojaxze centrirebul
mis unari icvleba asakTan erTad. 3 wlamde bavSvebs
midgomas da mWidrod TanamSromlobs sxva speciali-
naklebad aqvT ganviTarebuli kognituri da sxva un-
stebTan, imaTTan, vinc bavSvs an ojaxs uwevs daxmare-
arebi iseTi Cvenebis misacemad, romelic sasamarTlos
bas. es SeiZleba iyos pediatri, bavSvTa samedicino an
gamoadgeba. sami wlis zeviT bavSvebs SeuZliaT mov-
socialuri servisebis muSaki, pedagogi, ganaTlebis
lenebis didi sizustiT aRdgena, Tumca daxmarebis
fsiqologi. vinaidan, bavSvis problemebi xSirad
gareSe ver axerxeben ambis gadmocemas. 6 wlis asakSi
vlindeba skolaSi an iwvevs swavlis sirTuleebs, ami-
bavSvebi ukve iyeneben gramatikulad gamarTul wina-
tom maswavleblis CarTuloba mniSvnelovania. mas
dadebebs, Tumca mwiri sityvaTa maragis gamo uWirT
SeiZleba mieces rCeva, Tu rogor gaumklavdes qcevis
rTuli SekiTxvebis gageba. garda amisa, am asakSi bavSvi
darRvevebs saklaso oTaxSi; bavSvis mdgomareobis gaT-
Tvlis, rom ufrosma yovelTvis icis dasmul kiTxvaze
valiswinebiT sxvanairad dagegmos gakveTilebis cxri-
pasuxi da cdilobs, upasuxos ufrosis molodinis Ses-
li an, saWiroebis SemTxvevaSi, Caataros damatebiTi
abamisad. unda gvaxsovdes, rom umcros asakSi bavSvebs
gakveTili. zogjer mizanSewonilia skolis Secvlac.
ar aqvT movlenebis Tanmimdevrobisa da xangrZlivo-
momdevno TavSi mokled gavnixilavT mkurnalobis
bis swori aRqmis unari. amasTan, unda gaviTvaliswin-
ZiriTad aspeqtebs. am nawilis meore naxevarSi saubari
oT, rom mowmis statusSi bavSvisTvis dasmuli kiTxva,
iqneba calkeuli daavadebebis marTvis sakiTxebze.
Cveulebriv, usiamovno da SiSis momgvrel mogone-
bavSvTa fsiqiatriaSi gamoyenebuli mkurnalobis Ses-
bebTanaa dakavSirebuli da uaryofiT emociebs iwvevs.
axeb ufro detaluri informaciis miReba SesaZlebelia
am Tavis bolos CamoTvlili saxelmZRvaneloebidan.
fsiqiatriuli daxmareba bavSvebisa
da ojaxebisTvis medikamenturi mkurnaloba
am TavSi ganxilulia bavSvTa fsiqiatriuli dax- bavSvTa fsiqiatriaSi wamlebi iSviaTad gamoiyeneba.
marebis zogadi sakiTxebi. sxvadasxva fsiqikuri aSli- medikamenturi mkurnalobisTvis ZiriTadi Cvenebaa
lobis mkurnalobasTan dakavSirebuli specifikuri epilefsia, fsiqozebi, depresia, akviatebebi, hiperaq-
sakiTxebi mocemulia Sesabamis daavadebebTan erTad. tivobisa da Jil de la turetis (Gilles de la Tourette)
_ 703 _
sindromebi da, zogjer, Ramis enurezi (es sakiTxebi meTodi mozrdilebSi gamoyenebuli teqnikis msgavsia
SemdgomSi iqneba ganxiluli). yvela SemTxvevaSi, dan- (ix. 22-e Tavi). bavSvebsa da mozardebSi gamoyenebuli
iSnuli dozebi guldasmiT unda gadamowmdes mwarmoe- bihevioruli meTodebis mimoxila ix. herbertTan (Her-
blis literaturasa an standartul cnobarebSi da bert., 2002).
dainiSnos bavSvis asakisa da sxeulis wonis Sesabamisad. kognituri Terapia gamoiyeneba mozrdil bavSvebT-
an, romlebsac SeuZliaT im azrovnebis procesis aR-
fsiqologiuri mkurnaloba wera da masze kontrolis daswavla, rasac avadmyo-
marTvis fsiqologiuri aspeqtebi furi simptomebis aRmocenebamde da problemur qcev-
amde mivyavarT. depresiis, SfoTviTi da kvebiTi aSli-
rogoric ar unda iyos marTvis gegma, bavSvisTvis yov-
lobebis dros bavSvebisa da mozardebis mkurnaloba
elTvis sasargebloa Tbili, usafrTxo da keTilgan-
imave meTodebiT xorcieldeba, rasac viyenebT mozr-
wyobili urTierToba TerapevtTan. daculi garemo
dilebis SemTxvevaSi. specialuri midgomebi SemuSave-
iZleva alternatiuli qcevisa da grZnobebis Tavisu-
bulia agresiuli qcevis mqone bavSvebisTvis (gv. 679).
flad gamoxatvis saSualebas. patarebTan urTierTo-
depresiisa da SfoTviTi aSlilobebis dros bavSvebsa
bis damyarebaSi TojinebiT TamaSi gvexmareba. Toji-
da mozardebSi kognitur-bihevioruli meTodebis gam-
nis, rogorc Suamavlis saSualebiT, isini ufro ad-
oyenebis efeqturobis Sesaxeb informacia ix. brent-
vilad gadmogvcemen TavianT problemebsa da grZno-
Tan (Brent et al., 2002).
bebs, vidre sityvebiT.
Tavidan bavSvebi Terapevts ise uyureben, rogorc fsiqodinamiuri Terapia
mSoblebis agents da moelian, rom mas igive Sexed- bavSvebSi fsiqodinamiuri midgomebis umravlesoba
ulebebi aqvs. mniSvnelovania, bavSvi grZnobdes, rom efuZneba ana froidisa (Anna Freud) da melani klai-
misi uflebebi daculia. unda moveridoT kritikas, nis (Melanie Klein) meTodologias (gv. 614). zogadad,
Tumca, ar unda mivceT sababi, ifiqros, rom yvelaf- kvlevebis mimoxilvebSi aRniSnulia, rom miuxedavad
ris ufleba aqvs da yvelaferi epatieba. xSirad, um- mkurnalobis efeqturobis SefasebisTvis gamoyenebu-
jobesia gadavdoT problemebze msjeloba manamde, li meTodebis xarvezebisa, Sedegebi adasturebs dina-
sanam bavSvi mzad ar iqneba amisaTvis da gadavitanoT miuri fsiqoTerapiis upiratesobas imasTan SedarebiT,
saubari misTvis saintereso neitralur Temebze. roca aranairi mkurnaloba ar Catarebula. Tumca, ar
ZiriTadad, fsiqologiuri mkurnalobis ori, kar- arsebobs mtkicebuleba, romelic gviCvenebs dinami-
gad damuSavebuli teqnika gamoiyeneba: kognitur-bi- uri fsiqoTerapiis upiratesobas kognitur-bihevior-
hevioruli Terapia da fsiqodinamiuri fsiqoTerapia. ul Terapias an konsultirebasTan SedarebiT. aqedan
kognitur-bihevioruli Terapia: gamomdinare, xangrZlivi analitikuri fsiqodinamiuri
Terapia did britaneTSi amJamad iSviaTad gamoiyeneba.
biheviorul meTodebs xSirad iyeneben bavSTa fsiqi-
Tumca, jgufuri da SemoqmedebiTi Terapia (TamaSis an
atriaSi. maTi saSualebiT pozitiuri ganmtkicebiTa
xelovnebiTi Terapia) kvlav tardeba gansakuTrebuli
da modelirebiT SeiZleba wavaxalisoT axali qceva.
saWiroebebis mqone bavSvebTan, romlebsac mwvave da
jer wavaxalisebT qcevas, romelic gvexmareba sasurve-
xangrZlivi darRvevebi aReniSnebaT.
li qcevis daswavlaSi da Semdeg xdeba ukve am daswavli-
fsiqodinamiuri Terapiis ufro pozitiuri Sefase-
lis gamyareba, mag., autizmis dros es teqnika gamoiy-
ba ix. fonagisa da targeTis naSromebSi (Fonagy and
eneba risxvis Setevebisa (temper tantrum) da daZineba-
Target, 2002). informacia mozardebSi fsiqoTerapiis
ze uaris Tqmis SemTxvevebSi. qcevis modelirebisTvis
gamoyenebis Sesaxeb SegiZliaT moiZioT rainekesa da
dasja mizanSewonili ar aris, radgan xanmokle efeqti
SirkTan (Reineke and Shirk, 2005). bavSvebsa da mozard-
aqvs da eTikuradac miuRebelia. amis sanacvlod unda
ebSi fsiqoTerapiis zogadi efeqturobis Sefaseba ix.
gamovavlinoT da gavaneitraloT yvela faqtori, ro-
jakobsTan (Jacobs, 2002).
melic arasasurveli qcevis gamyarebas uwyobs xels.
zogjer arasasurveli qcevis gamyareba SeiZleba gamoi- mSoblebis treningi
wvios am qcevis mimarT gadametebulma yuradRebamac. mSoblebis treningi mizanSewonilia bavSvis movlis
aseT dros dadebiT Sedegs gvaZlevs bavSvis ugulebe- unarebis gasaumjobeseblad maTTvis, vinc mimarTavs
lyofa da qcevaze yuradRebis mxolod im SemTxvevaSi bavSvze Zaladobas, an iCens uyuradRebobas bavSvis
miqceva, roca igi normalizdeba. specifikuri bihevi- mimarT, an visac dabali inteleqti aqvs. aseve, gamoiy-
oruli Terapia gamoiyeneba enurezisa (gv. 593) da fo- eneba im mSoblebis dasaxmareblad, romlebsac qceviTi
biebis (gv. 591) dros. socialuri unarebis daswavla darRvevebis mqone an hiperaqtiuri Svilebi hyavT. kv-
jgufur an individualur doneze xdeba im bavSvebTan, levaTa umetesoba exeba mSoblebs, romelTa Svilebs
romlebsac komunikaciis problemebi aReniSnebaT. es opoziciuri da gamomwvevi qceviTi aSliloba aReniSne-
_ 704 _
fsiqiatriuli daxmareba bavSvebisa da ojaxebisTvis
baT (ix. Patterson, 1982 adreuli kvlevebi da Webster-Strat- vebis SemTxvevaSi. mag., emociuri da qceviTi aSlilo-
ton., 1991). mSoblebis treningisTvis SeiZleba gamovi- bis mqone bavSvebze Catarebul kvlevaSi (Simpson, 1990)
yenoT saganmanaTleblo midgoma, romelic movlis milanis (Milan) ojaxuri Terapiis efeqturoba ar gan-
unaris zogad gaumjobesebas iTvaliswinebs, an bihevi- sxvavdeboda eklekturi Terapiis Sedegebisgan. mTa-
oruli midgoma, rac mimarTulia specifikuri prob- vari gamonaklisi iyo nervuli anoreqsiis mkurnaloba
lemis aRmofxvraze. bihevioruli midgomis SemTxvevaSi mozardebSi, rodesac dinamiuri ojaxuri Terapia sa-
iwereba bavSvis qcevaze mSoblebis sapasuxo sasurveli kontrolo mkurnalobasTan SedarebiT bevrad efeq-
an arasasurveli qceva da SemdgomSi individualurad turi aRmoCnda (Russel et al., 1987; Robin et al., 1999).
an jgufurad ganixileba mSobelTan. romel meTodsac ojaxur Terapiasa da mis SefasebasTan dakaSirebu-
ar unda mivmarTavdeT, aucilebelia bavSvis asakisa da li informacia ix. jakobsTan da pirsTan (Jakobs and
ganviTarebis etapis gaTvaliswineba da sxvadasxva asa- Pearse., 2002).
kis Sesabamisi saWiroebebis gansazRvra.
jgufuri Terapia
kvlevebiT damtkicda, rom bihevioruli midgoma
efeqturia bavSvis movlis, misi da mSoblebis urT- jgufuri Terapia SeiZleba Cautardes mSoblebs,
ierTobis gaumjobesebisa da Svilebis antisocialuri ufros bavSvebsa da mozardebs. mSoblebisTvis mniS-
qcevis Semcirebis procesSi. kvlevis sagans warmoad- vnelovani daxmareba iqneba is, Tu isini SeZleben
gens ojaxebis tipi, romlisTvisac momgebiania bihevi- bavSvis problemebsa da sirTuleebze viRacasTan
oruli treningi da misi grZelvadiani efeqti (mag., saubars. bavSvebisTvis ki dadebiTi Sedegi moaqvs
Scott et al., 2001). mSoblebisTvis treningis progr- Tanadgomas, diskusiebisa da qcevis modelirebis
amebis mimoxilva ix. skotTan (Scott, 2002). SesaZleblobas, rac jgufuri Terapiis nawilia.
jgufuri Terapia aRwerilia 603-606 gverdebze. jgu-
ojaxuri Terapia furi Terapiis zogadi efeqturoba ganxilulia ja-
es aris mkurnalobis specifikuri forma, rome kobsis mier (Jacobs, 2002).
lic gansxvavdeba ojaxis zogadi CarTulobisgan
mkurnalobis procesSi, razec zemoT iyo saubari. socialuri samsaxuri
ojaxur TerapiaSi bavSvis an mozardis simptomebi
socialuri muSaki fsiqikuri aSlilobis mqone bavS-
ganixileba, rogorc ojaxuri disfunqciis Sedegi da
vebisa da maTi ojaxebis movlaSi mniSvnelovan rols
warmoadgens Terapiis pirdapir samiznes. gamoiyeneba
asrulebs. did britaneTSi igi warmoadgens im bavS-
sxvadasxva midgoma, romlebic efuZneba biheviorul,
vebis interesebis damcvels, romlebic ojaxSi riskis
fsiqoanalitikur, interpersonalur an struqturul
qveS arian an saWiroeben specialur movlasa da super-
Teoriebs. es Terapiebi aRwerilia 611-614 gverdebze.
vizias. socialuri muSaki exmareba mSoblebs Svilebis
praqtikaSi TerapevtTa umravlesoba mimarTavs eklek-
aRzrdis unar-Cvevebis gaumjobesebaSi, finansuri da
tur midgomas (gv. 612).
sacxovreblis problemebis mogvarebaSi. socialuri
Cveneba ojaxuri TerapiisTvis jer kidev ganxilvis
muSaki akeTebs ojaxis Sefasebas da atarebs ojaxur
sagania; Tumca, arsebobs garkveuli SeTanxmeba, rom
Terapias, aseve, mas SeuZlia individualuri Terapia
misi gamoyeneba xdeba, rodesac:
Cautaros bavSvs an misi ojaxis wevrebs.
w bavSvis simptomebi ganixileba mTeli ojaxis prob-
lemis nawilad: okupaciuri Terapevti
w individualuri Terapia efeqturi ar aris: okupaciurma Terapevtma SeiZleba iTamaSos umniS-
w ojaxuri sirTuleebi iCens Tavs sxva Terapiis Cat- vnelovanesi roli bavSvis ganviTarebis Sefasebasa da
arebisas. fsiqologiur daxmarebaSi, aseve, bavSvisa da mSob-
ojaxuri TerapiisTvis ukuCvenebas warmoadgens is lis urTierTobis gaumjobesebisTvis RonisZiebebis
SemTxvevebi, rodesac mSoblebi eyrebian an, rodesac gansazRvraSi. is muSaobs rogorc dRis centrebSi,
bavSvis problema ojaxTan kavSirSi araa. mniSvnelova- aseve stacionarebsa da saTemo servisebSi. is mWidrod
nia, rom Terapevtis interesma ar ganapirobos ojax- TanamSromlobs pedagogebTan bavSvebis Sefasebisa da
uri Terapiis Catareba iq, sadac sxva Terapiebis gam- maTTan Terapiuli RonisZiebebis Catarebis sakiTxe-
oyenebaa saWiro da unda moxdes SemTxvevis srulfa- bze muSaobisas.
sovnad Sefaseba.
arakontrolirebadi kvlevebiT dadgenilia, rom
specialuri ganaTleba
ojaxur Terapias TvalsaCino efeqti aqvs. kontro- bavSvebisTvis, romlebic akiTxaven ambulatorias da
lirebadi kvlevebiT gamovlinda SedarebiT zomieri stacionaruli pacientebis garkveuli nawilisTvis
Sedegebi emociuri da qceviTi aSlilobis mqone bavS- damatebiTi saganmanaTleblo programebi Zalian efeq-
_ 705 _
turia. specialuri swavleba gamoiyeneba weris, kiTx- grZelvadiani daxmarebis dros bavSvebs ufro meti
visa da ariTmetikuli unarebis gasaumjobeseblad, problema aqvT, vidre Svilad ayvanis SemTxvevaSi.
risi problemebic xSirad aRiniSneba qcevisa da gan- Tumca, Znelia imis dadgena, ramdenadaa es dakavSire-
viTarebis specifikuri aSlilobebis mqone bavSvebSi. buli mimReb ojaxSi cxovrebis dawyebamde arsebul
specialuri ganaTlebis Sesaxeb damatebiTi informa- problemebTan, Tu mimReb ojaxSi cxovreba nakleb
ciis misaRebad ix. hovlini (Howlin, 2002). usafrTxoa, vidre Svilad ayvana. ufro meti problema
Cndeba im SemTxvevaSi, rodesac Svilobilad ayvanili
biologiuri ojaxis Canacvleba bavSvi tolia an ufrosia mimReb ojaxSi mcxovreb
sacxovrebeli bavSvebze. bavSvebi xSirad inarCuneben urTierTobas
TavianT biologiur mSoblebTan, Tumca sasurveli
sacxovrebelSi SeiZleba moTavsdes bavSvi, romlis
araa maTTan sporadiuli da stresuli kavSirebi. mim-
simptomebic ganpirobebuli an gauaresebulia arasta-
Rebi ojaxis Sesaxeb mimoxilva ix. ruStonsa da menisis
biluri ojaxuri garemoTi an mSoblebis mxridan Svi-
(Rushton and Mennis, 2002) naSromSi.
lis sruli ugulebelyofiT. ZiriTadad, sacxovreb-
elSi moTavsebul bavSvebs aqvT qcevis an swavlis dRis da dRe-Ramuri stacionaruli daxmareba
gamoxatuli darRvevebi. ojaxidan bavSvis mocileba bavSvTa fsiqiatriul stacionarSi xelmisawvdomi
unda gadawydes mxolod mas Semdeg, roca yvela zoma unda iyos pediatris konsultacia, advili misasvle-
iqneba miRebuli ojaxuri garemos gaumjobesebisTvis. li unda iyos skolasTan, hqondes sakmarisi saTamaSo
sacxovrebeli SeiZleba iyos mimRebi ojaxi, bavSvTa sivrce da araformaluri dizaini, romelic bavSvze
saojaxo tipis saxli (sadac daaxloebiT 10 bavSvi dakvirvebas uzrunvelyofs. aseve, saWiroebis SemTx-
cxovrobs iseTive garemoSi, rogoric aris mraval- vevaSi, dedas unda hqondes bavSvTan darCenis saSu-
ricxovan ojaxebSi), an internati. aleba.
sacxovrebeli, garda mimRebi ojaxisa, iSviaTadaa stacionireba xdeba Semdegi sami mizeziT:
gaTvaliswinebuli 5 welze mcire asakis bavSvebisT-
1. simwvave: mdgomareoba aris imdenad mwvave, rom sxva
vis, vinaidan maT aqvT mSobelTan mijaWvulobis gan-
gvarad misi mkurnaloba SeuZlebelia. mag., gamoxat-
sakuTrebuli saWiroeba. zogadad, bavSvebs, romlebic
uli hiperaqtivoba ganviTarebis darRvevebis dros,
izrdebian sacxovreblebSi, ufro xSirad uviTarde-
sicocxlisTvis saSiSi nervuli anoreqsia an skolis
baT fsiqologiuri problemebi gvian bavSvobasa da
gacdenebi, rac stacionargareSe mkurnalobas ar
mozrdilobaSi. mamakacebSi, upiratesad, aRiniSne-
eqvemdebareba;
ba samarTaldarRvevebi, xolo qalebSi _ uqorwino
fexmZimoba da dedobasTan dakavSirebuli sirTu- 2. dakvirveba: Tavsdeba maSin, rodesac diagnozi dasa-
leebi. bolomde naTeli ar aris, rogoraa es prob- zustebelia;
lemebi dakavSirebuli sacxovreblebSi cxovrebasTan 3. separacia: stacionaruli mkurnaloba SeiZleba au
an im uaryofiT gamocdilebasTan, romelic bavSvis cilebeli iyos im SemTxvevaSi, rodesac bavSvi sa
sacxovrebelSi gadayvanis mizezi iyo. bavSvTa mimarT Wiroebs mZime ojaxuri situaciidan moSorebas. mag.,
Zaladobis arsebuli faqtebi imaze miuTiTebs, rom Zaladobis an hiperproteqciis SemTxvevaSi.
Zalian mniSvnelovania bavSvTa saxlebsa da sacxovre- zogjer bavSvTan erTad stacionarSi dedac Tavs-
blebSi momuSave personalis kargad datreningeba da deba, rac uzrunvelyofs maT Soris kavSiris Senar-
supervizia. Cunebas. aseTi midgoma saSualebas iZleva davakvir-
sacxovreblebSi bavSvTa movlis mimoxilva ix. ruS- deT bavSvis qcevaze dedis sapasuxo reaqcias; mag.,
tonTan da menisTan (Rushton and Mennis., 2002). Zaladobis SemTxvevebSi. amasTan, stacionarSi bavS-
vis movlaSi intensiuri CarTuloba exmareba dedas
mindobiT aRzrda
daiswavlos axali dedobrivi unarebi.
mindobiT aRzrda SeiZleba sami saxis iyos:
1. xanmokle gadaudebeli daxmareba _ mag., rodesac dRis stacionari
momvleli avadaa an autizmis mqone bavSvis mSoblebs dRis stacionaruli mkurnalobis mniSvnelovani up-
sWirdebaT xanmokle amosunTqva. iratesobaa is, rom bavSvi ar mihyavT saxlidan. Tu
2. saSualo xangrZlivobis _ rodesac bavSvi garkveuli ojaxSi ar aris Zaladobis saSiSroeba, umjobesia bavS-
periodis Semdeg brundeba saxlSi; mag., mas Semdeg, vi darCes ojaxis pirobebSi. dRis stacionars SeuZlia
rac momvlels Cautardeba Terapia Zaladobisa da hiperaqtiuli an autisturi bavSvis ojaxis wevrebs
bavSvis ugulebelyofis aRmofxvris mizniT. Seumsubuqos maT movlasTan dakavSirebuli tvirTi.
stacionaruli da dRis stacionaruli movlis mimox-
3. grZelvadiani _ rodesac bavSvi rCeba ojaxSi ma-
ilva ix. grinis (Green, 2002) naSromSi.
namde, sanam SeZlebs damoukideblad cxovrebas.
_ 706 _
sindromebis mimoxilva
sindromebis mimoxilva skolamdeli asakis bavSvebisa da maTi

sindromebis aRwera iwyeba skolamdel asakSi gan- ojaxebis problemebi
viTarebuli problemebiT. amas mosdevs zogadi da ukve aRvniSneT, rom skolamdel asakSi xdeba so-
specifikuri ganviTarebis aSlilobebi, xolo Semdeg, cialuri qcevis daswavla. am periodSi bavSvi swav-
klasifikaciaSi mocemuli TanmimdevrobiT, ganxi- lobs sfinqteris kontrols, Wamis dros moqcevas,
luli iqneba bavSvTa asakSi ganviTarebuli ZiriTadi dasaZineblad droulad wasvlas da agresiis marTvas;
fsiqikuri aSlilobebi. bavSvTa danarCeni fsiqikuri xdeba metad damoukidebeli. yvela am qcevas bavSvi
aSlilobebi mokledaa mocemuli mozardobis asakSi ojaxSi swavlobs.
ganviTarebul fsiqikur aSlilobebamde (romlebic skolamdeli asakis problemebi am qcevebTan kavSir-
ZiriTadad bavSvTa an mozrdil asakSi ganviTarebu- Si iCens Tavs da, upiratesad, gamowveulia rogorc
li fsiqikuri aSlilobebis msgavsia). am Tavs daas- bavSvis, aseve ojaxuri faqtorebiT. am asakSi bevri
rulebs bavSvis mimarT Zaladobis sakiTxebi. cxrili fsiqologiuri problema xanmoklea da SeiZleba gan-
24.4 gviCvenebs darCenili sakiTxebis ganawilebas am vixiloT, rogorc normaluri ganviTarebis CamorCena.
da sxva TavebSi; aseve imas, Tu sad unda vipovoT in- am mdgomareobaTa umravlesobas mkurnaloben ojaxis
formacia sam damatebiT mdgomareobaze, romlebic vi- eqimebi da pediatrebi. ufro seriozuli problema
Tardeba bavSvobasa da mozrdilobaSi. SeiZleba gadamisamarTdes bavSvTa fsiqiatrTan.
cxrili 24.4 bavSvTa fsiqikuri aSlilobebis ganawileba am da sxva TavebSi

skolamdeli asakis bavSvebisa da maTi mSoblebis problemebi; skolaze uaris Tqma;
ganviTarebis specifikuri aSlilobebi; sxva bavSvTa fsiqikuri aSlilobebi;
kiTxvis specifikuri aSlilobebi; funqciuri enurezi;
maTematikuri unarebis darRvevebi (ariTmetikuli araorganuli enkoprezi;

operaciebis warmoebis specifikuri aSlilobebi);
komunikaciuri aSlilobebi; eleqtiuri mutizmi;
motoruli unarebis aSlilobebi; enabluoba;
ganviTarebis zogadi aSlilobebi; demencia;
bavSvTa autizmi; Sizofrenia;
retis sindromi; sqesis identifikaciis aSliloba;
hiperqtiuri aSliloba Tanmxlebi gonebrivi qaluroba biWebSi;

CamorCenilobiTa da stereotipuli moZraobebiT;
bavSvTa dezintegraciuli aSlilobebi; qalabiWoba gogonebSi;
aspergeris sindromi; suicidi da TviTdazianeba;
atipiuri autizmi; fizikuri daavadebebis fsiqiatriuli aspeqtebi bavSvebSi;
hiperkinetikuri aSliloba; mozardTa fsiqikuri problemebi;
qcevis aSlilobebi; Zaladoba bavSvebze;
skolis gacdena; fizikuri Zaladoba (ara SemTxveviTi dazianebebi);
arasrulwlovanTa deliqventoba; emociuri Zaladoba;
SfoTviTi aSlilobebi; bavSvis ugulebelyofa;
ganSorebis SfoTviTi aSliloba; zrdaSi CamorCenis araorganuli mizezi da deprivacia;
fobikur-SfoTviTi aSlilobebi; nanizmi (jujoba)
socialur-SfoTviTi aSliloba; seqsualuri Zaladoba
posttravmuli stresuli aSliloba; sxva TavebSi mocemuli aSlilobebi
obsesiur-kompulsuri aSliloba; tikebi (gv. 352)
somatoformuli aSlilobebi da sxva auxsneli fizikuri suicidi da TviTdazianeba (gv.412 da 422)

simptomebiT mimdinare konversiuli aSlilobebi;
guneb-ganwyobis aSlilobebi; simulacia (gv.390)
_ 707 _
gavrceleba iTvleba. amis uSualo mizezi, xSir SemTxvevaSi, mSob-

lis mxridan gadametebuli yuradRebiTa da araTan-
erT-erTi yvelaze citirebadi kvlevis monacemebiT
mimdevruli discipliniT uneburad gamowveuli aR-
(Richman et al., 1982), sadac gamokvleulia londonis ga-
gznebaa. iq, sadac es xSirad meordeba, savaraudod,
reubanSi mcxovrebi 705 ojaxi, romelsac 3 wlis bavSvi
mSoblebs Tavad aqvT emociuri problemebi an arada-
hyavda, yvelaze xSiri Ramis enurezi iyo, sul cota
makmayofilebeli urTierTobebi.
3-jer kviraSi (aReniSneboda 37%-s), dRis enurezi, sul
risxvis Setevebis aRmofxvra xdeba, rogorc wesi,
mcire erTxel kviraSi (aReniSneboda 7%-s), hiperaqtivo-
keTilganwyobilad, magram SezRudvebis mtkice da
ba (14%-s), enkoprezi (13%-s), Zilis problemebi (13%-
Tanmimdevruli dawesebiT. mkurnalobisTvis, pirvel
s), SiSi (13%-s), daumorCilebloba (11%-s), yuradRebis
rigSi, unda dadgindes, ratom ver axerxeben mSoblebi
miqcevis survili (10%-s) da risxvis Setevebi (5%-s).
limitis dawesebas. maT unda gaewioT daxmareba sa-
ramdenadaa es qceva aRqmuli, rogorc problema,
kuTar problemebTan dakavSirebiT da mieceT rCevebi
damokidebulia rogorc mSobelze, aseve qcevis simw-
imis Taobaze, Tu rogor moiqcnen risxvis Setevebis
vaveze, sixSiresa da bunebaze. am gansxavebis dasaZlevad
SemTxvevaSi.
riCmanma (Richman et al., 1982) SemoiRo problemis Se-
fasebis sistema, romelic iTvaliswinebda `problemuri Zilis problemebi
qcevis~ gavlenas bavSvis keTildReobasa da sxva ojaxis
3-4 wlis bavSvebSi Zilis problemebidan yvelaze xSi-
wevrebis mdgomareobaze. problemis simwvavis xarisxis
ria Rame gamoRviZeba. am asakSi bavSvebis daaxloebiT
dasadgenad gamoiyeneboda saRi azris kriteriumebi. 3
erT mexuTeds sWirdeba erT saaTze meti daZinebisT-
wlis asakis bavSvebis 7%-s hqonda mwvave, xolo 15 %-s
vis, an xangrZlivi droiT RviZavs Ramis ganmavlobaSi.
_ zomierad gamoxatuli problemebi. problemur qcevad
Tu Zilis problemebi gardamavalia da ar iwvevs dis-
umetesad Sefasebuli iyo risxvis Setevebi, yuradRebis
tress, maSin sakmarisia davarwmunoT mSoblebi, rom
miqcevis survili da daumorCilebloba.
mdgomareoba gamoswordeba. Tu Zilis problemebi
prognozi mwvave da mudmivia, unda ganvixiloT ori ZiriTadi
ukve aRvniSneT, rom skolamdeli asakis fsiqologiuri mizezi: pirvel rigSi, Zilis darRvevebi SeiZleba
problemebis umravlesoba xanmokle da gardamavalia, gamoiwvios somaturma avadmyofobam an emociurma
Tumca riCmanma (Richman et al., 1982) naxa, rom sami wlis aSlilobebma da, meores mxriv, mSoblebis gadamete-
asakSi gamovlenili iseTi problemebi, rogoricaa hip- bulma wuxilma da bavSvis damSvidebis uunarobam. Tu
eraqtivoba, bavSvis damorCilebis sirTuleebi da me- arc fizikuri da arc fsiqikuri aSliloba ar dada-
tyvelebis darRvevebi, grZeldeboda 8 wlis asakSic. sturda, maSin dauyovnebliv unda gamovavlinoT mSo-
blebis wuxilis mizezi da aRmovfxvraT igi. zogi mSo-
etiologia beli iwvevs bavSvis hiperstimulacias saRamos saaTeb-
etiologiuri faqtorebi dakavSirebulia ganviTa- Si an Tavis sawolSi iwvens bavSvs da amiT uneburad
rebis etapTan, bavSvis temperamentTan da ojaxis gav- amyarebs Ramis tirils. zogadad, aseT SemTxvevebSi
lenasTan. arsebobs bavSvis normaluri ganviTarebis bihevioruli midgoma Zalian efeqturia. saZile medi-
udidesi diapazoni. gansakuTrebiT, es exeba sfin- kamentebis gamoyeneba unda moxdes didi sifrTxiliT
qteris kontrolsa da metyvelebas. bavSvis tempera- da araviTar SemTxvevaSi xangrZlivad.
menti, rogorc ukve vTqviT, (gv. 652) pirveli kvirebi- Zilis sxva problemebi, rogorebicaa Ramis koSmare-
dan iCens Tavs. bavSvis xasiaTi gavlenas axdens dedis bi da SfoTiani Zili, damaxasiaTebelia patarebisT-
sapasuxo reaqciebze, mag., ra dros gatareba SeuZlia vis, Tumca iSviaTad grZeldeba didi xnis manZilze. es
dedas SvilTan, ramdenad xSirad iyvans xelSi, da a.S. darRvevebi ganxilulia 374-e gverdze.
dedis qceva ki, Tavis mxriv, gavlenas axdens bavSvis Zilis darRvevebis mimoxilva ix. sTorsis (Stores.,
ganviTarebaze. am asakSi ganviTarebuli qcevis prob- 2001) naSromSi.
lemebi mWidro kavSirSia cud ojaxur urTierTo-
kvebis problemebi
bebTan, dedis depresiasTan, da-Zmis metoqeobasTan
da mSoblebis arasakmaris zrunvasTan. damatebiTi in- kvebis msubuqi problemebi da sakvebze uaris Tqma
formaciisTvis ix. kembeli (Campbell, 1995). Cveulebrivi ambavia skolamdel asakSi da iSviaTad
grZeldeba didi xnis manZilze. bavSvebis mcire nawil-
skolamdeli asakis zogierTi gavrcelebuli Si aRiniSneba kvebis ufro mwvave darRvevebi, kvebis
problema naklebobis TvalsaCino niSnebis gareSe. es xdeba maSin,
risxvis Setevebi (temper tantrum) rodesac perfeqcionisti an zedmetad yuradRebiani
mSoblebi uneburad amyareben bavSvis aseT qcevas.
patarebSi risxvis Setevebi Cveulebrivi ambavia, anom-
mkurnaloba iTvaliswinebs mSoblebisTvis proble-
aliurad misi mxolod Zlieri da xSiri gamovlinebebi
_ 708 _
mis marTvis swavlebas. maT unda vurCioT, rom ar mi- kombinacia. bavSvi zedmetad miyuradebulia, aReniSne-
aqcion yuradReba kvebis problemebs, Tavi Seikavon ba SiSi, am mdgomareobas xSirad `gayinuli sifxizle~
bavSvisTvis gansakuTrebuli kerZis SeTavazebisgan an ewodeba. maTi qcevebi ambivalenturia, aqvT siaxlo-
sxva mcdelobebisgan _ nebismieri saSualebiT miaRe- visa da acilebis Sereuli survili; arian ubedurebi,
binon sakvebi. amis sapirispirod, bavSvs unda SevTav- maTi damSvideba TiTqmis SeuZlebelia; zogjer iCenen
azoT Cveulebrivi kerZi da mivceT saSualeba, Tavad agresias; CamorCebian zrdaSi. es aSliloba Zaladobis
gadawyvitos, SeWamos is, Tu _ ara. msxverpl bavSvebs uviTardebaT (gv. 697).
etiologia: rogorc Cans, es sindromi ufro movlis
pika tipTanaa (Zaladobrivi an instituciuri) dakavSire-
pika aris sakvebad gamousadegari nivTierebebis miRe- buli, vidre _ bavSvTan.
ba, rogorebicaa miwa, saRebavi, qaRaldi da sxva. igi prognozi: daucveli mijaWvuloba CvilobaSi xSir-
xSiradaa dakavSirebuli sxva qceviT aSlilobebTan. ad iwvevs momvlelebTan konfliqts an qceviT dar-
aseTi SemTxvevebi yovelTvis guldasmiT unda Se- Rvevebs gvian bavSvobaSi. naCvenebia, rom mdgomareo-
viswavloT, vinaidan amis mizezi SeiZleba tvinis daba SeiZleba gaumjobesdes, Tu uzrunvelyofilia
zianeba, autizmi an gonebrivi CamorCeniloba iyos. usafrTxo mijaWvuloba, mag. gaSvilebiT an mimRebi
zogjer ki es emociur distresTanaa dakavSirebuli, ojaxiT. Tumca es monacemebi miRebulia kvlevebiT,
romelic, SeZlebisdagvarad, unda Sesustdes. sxva romelTa umravlesobaSi araa gamoyenebuli ICD-10 da
SemTxvevebSi unda vixelmZRvaneloT saRi azris prin- DSM-IV klasifikaciebis kriteriumebi.
cipebiT da bavSvs movaSoroT kvebisTvis gamousade- bavSvTa asakis mijaWvulobaTa reaqtiuli aSlilo-
gari nivTierebebi. Cveulebriv, asakis matebasTan er- bis mimoxilva ix. o~konorTan (O~Connor, 2002).
Tad, pika ukuganviTarebas ganicdis. pikas Sesaxeb dam-
atebiTi informacia ix. peri-jonsisa da peri-jonsis skolamdeli asakis problemebis Sefaseba da
naSromSi (Parry-Jones B and Parry-Jones WL, 1992).
mkurnaloba
Sefaseba: informaciis Sekreba ZiriTadad mSoblebis-
bavSvTa asakis mijaWvulobaTa reaqtiuli aSli- gan xdeba. Semfasebeli cdilobs gaarkvios, arsebuli
loba problema uSualod bavSvSia, Tu dakavSirebulia de-
rogorc ukve aRvniSneT, bavSvebis mijaWvuloba Ta- dis an mTeli ojaxis sirTuleebTan. qcevis problemis
vianT mSoblebTan da momvlelebTan gansxvavebulia Sefaseba xdeba bavSvis asakTan da ojaxis funqcioni-
usafrTxoebis mixedviT; mag., SeiZleba usafrTxoa rebasTan kavSirSi.
erTi mSoblis mimarT, magram safrTxis Semcvelia mkurnaloba: daavadebasTan dakavSirebul specifi-
meore mSoblis SemTxvevaSi. mijaWvulobaTa aSliloba kur miTiTebebTan erTad, mkurnaloba agreTve
aris amis ukiduresi gamovlineba da pirdapir ar See- moicavs dedisTvis (Tu saWiroa ojaxis sxva wevrebi-
sabameba manamde aRweril (gv. 655) arasaimedo mijaWvu- sTvisac) bavSvis aRzrdasTan dakavSirebiT Sesabamisi
lobis tipebs. es aris yovlismomcveli mdgomareoba, rCevebis micemas. Zalian cota monacemia mkurnalobis
romelic gavlenas axdens yvelanair urTierTobaze efeqturobasTan dakavSirebiT. bihevioruli meTo-
da iwvevs distress, Tavs iCens 5 wlamde asakSi da dadebi, savaraudod, dadebiT Sedegs gvaZlevs, xolo
kavSirebulia movlis uxeS darRvevebTan. metyvelebis problemebi SeiZleba gaumjobesdes spe-
ganasxvaveben aSlilobis or tips, inhibiciursa da cialuri swavlebiT. gamoxatuli hiperaqtivobis
dizinhibiciurs: dros, SesaZlebelia, medikamentebis gamoyenebac (gv.
dizinhibiciuri: aseTi bavSvebi ganurCevlad eZeben 677). xSirad bavSvisTvis sasargebloa dRis garkveu-
simSvides rogorc ucxo pirebTan, aseve Tavis momv- li periodis sabavSvo baRSi an saTamaSo jgufebSi
lelebTan. CvilobaSi es vlindeba momvlelze miwebe- gatareba. skolamdeli asakis bavSvebis Sefasebis Ses-
biT, xolo adreul bavSvobaSi _ yuradRebis miqcevis axeb damatebiTi informaciis misaRebad ix. amerikuli
surviliT. aseTi qceva ufro xSiradaa aRwerili bavS- akademiis bavSvTa da mozardTa fsiqiatria (1998a).
vTa saxlis aRsazrdelebSi an im bavSvebSi, romlebic
xSirad icvlian mimReb ojaxs. DSM-IV klasifikaciis ganviTarebis specifikuri aSlilobebi
mixedviT, am diagnozis dasmisTvis urTierTobebis orive klasifikaciaSi (ICD-10 da DSM-IV) Sesulia
darRvevebi araswori movlis uSualo Sedegs unda ganviTarebis specifikuri aSlilobebi. esaa ganvi-
warmoadgendes, xolo ICD-10 klasifikaciiT es krite- Tarebis Seferxebebi, romlebic gamowveuli ar aris
riumi mniSvnelovani araa, magram aucilebelia aseTi sxva aSlilobebiT an swavlis saSualebis ararsebobiT
qceva vlindebodes sxvadasxva situaciebSi. (cxrili 24.5). dRemde sakamaToa, ramdenad SeiZleba es
inhibiciuri: es tipi naklebi sizustiTaa gansaz- mdgomareobebi miCneuli iqnes fsiqikur aSlilobebad,
Rvruli. bavSvebs aReniSnebaT inhibiciuri qcevebis vinaidan am diagnozis mqone bavSvebs sxva fsiqopa-
_ 709 _
Tologiuri simptomatika ar aReniSnebaT. meaTe ga-
dasinjvaSi ganviTarebis specifikuri aSlilobebi
cxrili 24.5 fsiqologiuri ganviTarebis
specifikuri aSlilobebi
gayofilia saskolo Cvevebisa da motoruli funqciis
ganviTarebasTan dakavSirebul specifikur aSlilo- DSM -IV ICD-10
bebad. DSM-IV amave mdgomareobebs ewodeba swavlis, swavlis aSlilobebi saskolo Cvevebis ganvi
komunikaciisa da motoruli unarebis aSlilobebi. TarebasTan dakavSirebuli
saskolo Cvevebis ganviTarebasTan dakavSirebul
specifikur aSlilobebSi gamoyofilia kiTxvis, mar- kiTxvis aSlilobebi kiTxvis specifikuri aSli
loba
Tlwerisa da ariTmetikuli operaciebis warmoebis
specifikuri aSlilobebi, xolo DSM-IV maT, Sesabam- weriTi metyvelebis aSli marTlweris specifikuri
lobebi aSliloba
isad, ewodebaT kiTxvis, werisa da maTematikuri un-
arebis aSliloba. maTematikuri unarebis aS ariTmetikuli operaciebis
lilobebi warmoebis specifikuri aS
lilobebi
kiTxvis specifikuri aSliloba
DSM IV-Si amas kiTxvis aSliloba ewodeba. misi dadge- saskolo Cvevebis Sereuli
aSlilobebi
na xdeba asakisa da inteleqtis Sesabamisi kiTxvis una-
komunikaciuri aSlilo enisa da metyvelebis speci-
ris dabali maCveneblis (Cveulebriv, 2 standartuli
bebi fikuri aSlilobebi
deviaciiT dabali maCveneblis) gamovlenisas. yvelaze
citirebadi kvlevis mixedviT, uaitis kunZulze es fonologiuri aSlilobebi metyvelebis artikulaciis
darRveva 10-11 wlis asakis bavSvebis 4%-s aReniSne-
boda, xolo londonSi TiTqmis orjer meti iyo (Yule eqspresiuli metyvelebis eqspresiuli metyvelebis
aSliloba aSliloba
and Rutter, 1985). Semdgomi kvlevebiT es monacemebi kv-
lav dadasturda. Sereuli recefciul-eqs recefciul metyvelebis
presiuli metyvelebis aS aSliloba
kiTxvis specifikuri aSliloba unda ganvasxvav- liloba
oT swavlaSi zogadi CamorCenisgan, rac SeiZleba
+enabluoba epilefsiiT SeZenili afa
gamowveuli iyos dabali inteleqtiT, saxlSi an zia* (enabluoba)
skolaSi swavlis saSualebis arqoniT an cudi mxedv-
koordinaciis ganviTarebis motoruli funqciebis gan
elobiT. am dros bavSvs kiTxvis seriozuli problema aSlilobebi viTarebis specifikuri aS
aqvs, rac skolis pirvelive wlebSi vlindeba da Sesa- lilobebi
Zloa ganapirobos werisa da metyvelebis Seferxebe- *DSM-IV-Si epilefsiiT SeZenili afazia klasificirebulia,
bic. SeiZleba gamoxatuli iyos weriTi, metyvelebisa rogorc SeZenili recefciul-eqspresiuli metyvelebis
aSliloba
da marTlweris problemebi, rac ufro TvalsaCinoa
+enabluoba imdenad zogadia, rom ixmareba aSlilobis
mogvianebiT asakSi, vidre kiTxvis Seferxeba. kiTxvisa gareSe
da marTlweris dros daSvebuli Secdomebia asoebis
gamotoveba, Canacvleba, sityvis damaxinjeba, neli etiologia
kiTxva, didxans yoymani, asoebisa da sityvebis Secvla.
kiTxva rTuli unar-Cvevaa, romelic damokidebu-
SeiZleba Tavi iCinos gagebis problemebmac. SesaZle-
lia ramdenime fsiqologiur procesze da sxvadasxva
belia, es dakavSirebuli iyos emociur mdgomareobas-
safexurs moicavs. amitom gasakviri araa, rom kiTx-
Tan, magram sxvamxriv ganviTareba normalurad mim-
vis specifikur aSlilobebs erTi gamomwvevi mizezi
dinareobs. skolaSi zogad CamorCenasTan SedarebiT,
ar aqvs. kiTxvis daswavlis gavrcelebuli Teoriis
kiTxvis specifikuri aSliloba ufro xSiria biWebSi;
Tanaxmad, bavSvi Tavdapirvelad iyenebs vizualur
maT, aseve, aReniSnebaT zomieri nevrologiuri prob-
meTods: is swavlobs erTiani sityvis xats da ar Seu-
lemebi da isini upiratesad socialurad daucvel
Zlia axali sityvis danaxva. ganviTarebis Semdgom,
ojaxebSi cxovroben.
anbanur safexurze, bavSvebi swavloben axali sityvis
kiTxvis specifikuri CamorCeniloba qcevis aSlilo-
dekodirebas asosTan dakavSirebuli bgerebis JRera-
bebTan mosalodnelze metadaa asocirebuli (Rutter et
dobiT, xolo bolos, daskvniT safexurze, mxedvelo-
al., 1970a, b). es kavSiri nawilobriv SeiZleba gamowveu-
biTi da anbanuri meTodebis kombinaciiT kiTxva xdeba
lia am ori daavadebis neiroganviTarebisa da tem-
avtomaturi da sxarti (es modeli ar aris aRiarebuli
peramentis saerTo warmoSobiT, nawilobriv imiT, rom
yvelas mier, magram gamosadegia klinikur praqtikaSi).
kiTxvaSi CamorCena iwvevs qcevis darRvevebs skolaSi,
disleqsia: iTvleba, rom kiTxvis specifikuri aSli-
vinaidan warumateblobis gamo bavSvi flustrirebu-
lobis mqone bavSvebi qmnian qvejgufs maTTvis dam-
lia da nawilobriv ki imiT, rom qcevis darRvevebi
axasiaTebeli neirofsiqologiuri sindromebiT, ro-
xels uwyobs kiTxvis problemebis ganviTarebas.
gorebicaa cudi koordinacia, konstruirebis uun-
_ 710 _
aroba da marjvena/marcxena mxareebis areva. disleq- fargleba. mkurnaloba unda daiwyos rac SeiZleba
siis dros bavSvebis umravlesobaSi erTi an ori es droulad, sanam bavSvi igrZnobs warumateblobas.
simptomi vlindeba, magram myari mtkicebuleba aseTi mkurnalobisTvis swavlebis sxvadasxva teqnika gamoi-
qvejgufis arsebobis sasargeblod jer-jerobiT ar yeneba, magram yvelaze mniSvnelovania, xangrZlivi
arsebobs. miuxedvad amisa, disleqsiis koncefcia warumateblobis Semdeg bavSvs daubrundes swav-
xSirad gamoiyeneba da garkveuli mniSvnelobac aqvs. lis interesi. mSoblebis CarTuloba da damatebiTi
am terminiT araprofesionalebs vatyobinebT, rom mecadineoba dadebiT Sedegs iZleva, Tumca ar arse-
kiTxvis problemebi gamowveulia ara sizarmaciTa an bobs myari mtkicebuleba imisa, rom swavlebis erTi
CamorCeniT, aramed specifikuri problemiT da bavSvi meTodi ukeTesia meoreze. Tu ki gvaqvs frustraciiT
daxmarebas saWiroebs. gamowveuli qceviTi aSlilobebi, kiTxvis gaumjobese-
genetikuri mizezebi: ojaxis wevrebSi kiTxvis dar- basTan erTad qcevac gamoswordeba. qcevis sxva dar-
Rvevebis sixSire gvafiqrebinebs, rom mas safuZvlad Rvevebis SemTxvevaSi saWiroa specifikuri Careva.
genetikuri mizezebi unda edos. ojaxis paternebi ara
prognozi
erT memkvidrul niSanze miuTiTebs (Rutter et al., 1990).
kvlevebma aCvena, rom ramdenime raodenobrivi maxasi- prognozi damokidebulia mdgomareobis simwvaveze.
aTebeli, rogorebicaa lokusebi me-2, 3, 6, 7, 15 da 18 bavSvebis daaxloebiT meoTxedi, romelTac 7-12 wlis
qromosomebze, kiTxvis darRvevebTanaa dakavSirebuli asakSi zomierad gamoxatuli kiTxvis aSliloba aR-
(Kaminen et al., 2003). yvelaze xSirad dasturdeba me-6 eniSnebaT, aRwevs ganviTarebis normalur dones mo-
qromosomis p ubnis mniSvneloba (Francks et al., 2004). zardobaSi. gamoxatuli aSlilobis mqone Zalian
nevrologiuri mizezebi: cerebruli damblis an epi- mcire nawili axerxebs am problemis gamosworebas
lefsiis dros bavSvebs kiTxvis specifikuri aSlilo- mozardobamde. samwuxarod, ar arsebobs sakmarisi mo-
bis ganviTarebis momatebuli riski aqvT. arsebobs monacemebi imisTvis, rom vimsjeloT, ra emarTebaT am
sazreba, rom bavSvebs, romlebsac aReniSnebaT kiTxvis bavSvebs mozrdilobaSi. Tumca, naCvenebia, rom kiTx-
specifikuri aSliloba, magram ar aqvT gamoxatuli vis gamoxatuli darRvevebis mqone mozardebi mozr-
nevrologiuri darRvevebi, SeiZleba hqondeT zom- dilobaSic avlenen am problemebs (Maughan et al., 1985).
ieri da naklebad TvalsaCino nevrologiuri prob- damatebiTi informaciis misaRebad kiTxvis aSlilo-
lemebi. Tumca, arsebuli monacemebiT, es mosazreba bebTan dakavSirebiT ix. snovlingi (Snowling, 2002).
dadasturebuli araa. arsebobs sxva varaudic, rom
maTematikuri unarebis aSliloba (ariTmetikuli
saqme gvaqvs tvinis ganviTarebis SeferxebasTan, rac operaciebis warmoebis specifikuri aSliloba)
iwvevs kiTxvasTan dakavSirebuli erTi an meti unaris
pirvelad es termini gamoyenebul iqna DSM-IV-Si,
darRvevas. es axsna TanxvedraSia iseT monacemebTan,
xolo ICD-10-Si Sesulia frCxilebSi mocemuli ter-
rogorebicaa am bavSvebSi vizualuri skanirebis sir-
mini. ariTmetikuli operaciebis warmoebis sirTu-
Tuleebi, marjvena/marcxena mxareebis areva. amasTan,
leebi Semdegi, yvelaze gavrcelebuli ganviTarebis
asakTan erTad es darRvevebi umjobesdeba.
specifikuri aSlilobaa. problemebi gulisxmobs mar-
socialuri faqtorebi: rogorc Cans, kiTxvaSi iseTi
tivi maTematikuri koncefciebis gagebis siZnelee-
CamorCenis ganviTarebisTvis, romelic specifikuri
bs, cifrebisa da maTematikuri simboloebis cnobis
kiTxvis aSlilobis kriteriumebs daakmayofilebs, so
uunarobas, ariTmetikuli moqmedebebis Sesrulebis
cialuri sirTuleebis arseboba sakmarisi araa. Tumca,
sirTuleebsa da maTematikuri cxrilebis daswavlis
kiTxvis problemebi xSiria im bavSvebSi, vinc gauna-
SeuZleblobas. es problemebi ar aris gamowveuli
Tlebel an socialurad daucvel ojaxSi izrdeba, an
swavlis saSualebis arqoniT da Tavs iCens maTematikis
roca mas skolaSi saTanado yuradRebas ar aqceven an
swavlis dawyebisTanave. miuxedavad imisa, rom maTema-
xSirad icvlis skolas.
tikuri unarebis aSliloba naklebad iwvevs unarSez-
(etiologiis mimoxilvisTvis ix. Vellutino et al., 2004)
Rudulobas yoveldRiur cxovrebaSi, vidre kiTxvis
Sefaseba da mkurnaloba aSliloba, igi dakavSirebulia emociur distresTan
mniSvnelovania aSlilobis drouli amocnoba. gamokv- skolaSi.
levas atarebs ganaTlebis an klinikuri fsiqologi epidemiologia: sxvadasxva kvlevis mixedviT, gavr
standartizebuli kiTxvarebis saSualebiT, romlebic celebis sixSire meryeobs 1, 3-6%-is farglebSi da
gamoiyeneba kiTxvisa da wakiTxulis gagebis unarebis xSirad vlindeba kiTxvis specifikur aSlilobebTan
Sesafaseblad. im SemTxvevebis garda, rodesac saqme erTad (ix. Snowling, 2002).
gvaqvs damatebiT somatur an qceviT problemebT- etiologia bolomde cnobili araa, magram naCvenebia
an, rac moiTxovs specifikur samedicino Carevas, kognituri deficiti, kerZod, muSa mexsierebis daq
mkurnaloba saganmanaTleblo RonisZiebebiT Semoi- veiTeba. zogjer mozrdilebSi Txemis wilis dazianebis
_ 711 _
dros viTardeba diskalkulacia, Tumca maTematikuri aSliloba moiazreba:
unarebis aSlilobis mqone bavSvebSi tvinis aranairi w fonologiuri aSliloba (DSM-IV) an metyvelebis
dazianeba ar dasturdeba. artikulaciis specifikuri aSliloba (ICD-10);
diagnozis dasma xdeba veqsleris inteleqtis tes- w eqspresiuli metyvelebis ganviTarebis specifi-
tis bavSvTa (Wechsler Intelligence Scale for Children _ kuri aSliloba (orive klasifikaciaSi erTi da
WISC da mozrdilTa (Wechsler Adult Intelligance Scale igive termini gamoiyeneba);
_ WAIS) versiebis ariTmetikuli qveskalis safuZ- w Sereuli recepciul-eqspresiuli aSliloba
velze da sxva specifikuri testebiT. mkurnaloba (DSM-IV); ICD-10-Si ufro viwro mniSvnelobis
iTvaliswinebs damatebiT gakveTilebs, magram maTi termini gamoiyeneba _ recepciuli metyvelebis
efeqturoba da daavadebis prognozi, jer-jerobiT, ganviTarebis aSliloba (am gansxvavebis mizezi
Seswavlili araa. am Temis mimoxilva ix. snovlingTan qvemoTaa ganmartebuli).
(Snowling, 2002). ICD-10-Si, magram ara DSM-IV-Si, aris meoTxe kat-
egoria _ epilefsiiT gamowveuli afazia. DSM-IV-Si
komunikaciis darRvevebi (enisa da metyvelebis
ganviTarebis aSlilobebi) ufro farTo saTauris gamoyeneba iZleva ènabluo-
bis~ CarTvis saSualebas. ICD-10-is ufro viwro mniS-
bavSvebi mniSvnelovnad gansxvavdebian TavianTi eno-
vnelobis saTauri ar faravs ènabluobas~ da es dar-
brivi SesaZleblobebiT. bavSvebis naxevari sityvebis
Rveva Sesulia bavSvobis asakSi dawyebul qceviT aSli-
azrianad gamoyenebas iwyebs 12, 5 Tvis, xolo 97% _ 21
lobebSi (ix. cxrili 24.4).
Tvis asakisTvis. naxevari axerxebs sityvebis winadade-
baSi gaerTianebas 23 TvisTvis (Neligan and Pudham., fonologiuri aSliloba (metyvelebis artikula-
1969). sityvaTa maragisa da gramatikuli wyobis das- ciis specifikuri aSliloba)
wavla swrafad xdeba skolamdel asakSi. miuxedavad
am mdgomareobis dros, saubrisas, bgerebis gamoyenebis
amisa, swavlis dawyebisTvis 1%-s aReniSneba gamoxat-
sizuste bavSvis mentalur asakTan SedarebiT normaze
uli metyvelebis darRvevebi, xolo 5%-s uWirs ucxo
dabalia, magram, sxvamxriv, metyveleba normaluria.
adamianis naTqvamis Sinaarsis gageba. enisa da me-
4 wlamde bgerebis gamoTqmis Secdomebi Cveulebrivi
tyvelebis aTvisebis procesi Zalian rTulia da bo-
movlenaa, magram 7 wlisTvis bgeraTa umravlesobis
lomde Seswavlili araa. metyvelebis darRvevebi aso-
warmoTqma sworad unda xdebodes. 12 wlisTvis ki yve-
cirebulia fsiqikur aSlilobebTan radgan: (I) orive
la bgera uSecdomod unda gamoiTqvas. artikulaciis
SeiZleba gamowveuli iyos tvinis anomaliurobiT da
problemebis mqone bavSvebi uSveben iseT Secdomebs,
(II) metyvelebis aSlilobebi uaryofiT gavlenas ax-
rom maTi metyvelebis gageba SeuZlebelia. isini ver
dens socialur urTierTobebsa da ganaTlebaze.
warmosTqvamen, cvlian an toveben garkveul bgerebs.
enisa da metyvelebis aSlilobebis mizezebi metyvelebis darRvevebis Sefasebisas, saTanadod unda
gaviTvaliswinoT regionisTvis damaxasiaTebeli di-
enisa da metyvelebis aSlilobebis mqone bavSvebis
aleqti. ZiriTadad rTuldeba im bgerebis gamoTqma,
umravlesobaSi aranairi mizezi ar aris nanaxi. aseT
romlebic normaluri ganviTarebis dros mogvianebiT
SemTxvevebSi amboben, rom gvaqvs enisa da metyvelebis
iswavleba (l, r, s, z, ch da th inglisur enaSi).
specifikuri aSlilobebi. sxva SemTxvevebSi Zalian
gavrceleba: gavrcelebis sixSire damokidebu-
mniSvnelovania pirveladi mizezis dadgena. yvelaze
lia imaze, Tu rodis xdeba metyvelebis darRvevebis
xSirad sxva mizezTagan gvxvdeba daswavlis darRveve-
gamovlena. amerikis fsiqiatriuli asociaciis mona-
bi (gonebrivi CamorCeniloba), aseve siyrue, cere-
cemebiT (American Pychiatric Association., 1994a) 6-7 wlis
bruli dambla, autizmi da autizmis speqtris aSli-
asakis bavSvebSi es aSliloba 2-3%-s aReniSneba.
loba. socialurma deprivaciam SeiZleba gamoiwvios
metyvelebis msubuqi CamorCena an gaxdes damatebiTi eqspresiuli metyvelebis ganviTarebis specifi-
faqtori sxva mizezebTan erTad. kuri aSliloba
klasifikacia am aSlilobis dros eqspresiuli metyvelebis unari
mniSvnelovnad CamorCeba bavSvis mentalur asaks. me-
DSM-IV-sa da ICD-10 klasifikaciebs Soris arsebobs
tyvelebis gageba Senaxulia, Tumca, SeiZleba iyos
garkveuli gansxvaveba: meaTe gadasinjvaSi mocemulia
artikulaciis problemebi. metyvelebis ganviTarebis
saTauri ènisa da metyvelebis ganviTarebis specifi-
sazRvrebi mniSvnelovnad gansxvavebulia normaSic,
kuri aSliloba~, maSin, roca DSM-IV-Si ufro farTo
magram, Tu bavSvi 2 wlisTvis ver warmosTqvams verc
terminia gamoyenebuli _ `komunikaciis darRvevebi~.
erT sityvas da 3 wlisTvis ver adgens orsityvian wi-
orive klasifikaciis mixedviT, daavadebaTa am jguf-
nadadebebs, es mniSvnelovan darRvevaze miuTiTebs.
Si, garkveuli nomenklaturuli gansxvavebiT, sami
Semdgom wlebSi aRiniSneba sityvaTa maragis SezRud-
_ 712 _
va, swori sityvis SerCevis sirTuleebi da gaumarTavi asocirebuli socialuri da qcevis problemebi.
gramatikuli formebis xmareba. araverbaluri komuni- gavrcelebis sixSire damokidebulia diagnostikur
kacia praqtikulad Senaxulia an verbalurTan Sedar- kriteriumebze. amerikis fsiqiatriuli asociaciis
ebiT naklebadaa darRveuli, amitom bavSvi cdilobs (American Psychiatric Association, 1994a) monacemebiT, re-
urTierTobas. xSiria qcevis darRvevebic. cepciul-eqspresiuli aSliloba skolamdeli asakis
sulmouTqmeli metyveleba: zogi bavSvi metyvelebs 3%-mde bavSvs aReniSneba.
swrafad, cvalebadi JReradobiT ise, rom sityvebis prognozi arakeTilsaimedoa. 75%-s es problemebi
dajgufeba ar asaxavs metyvelebis gramatikul wyobas. mogvianebiT asakSic rCeba. gacilebiT mZime prognozi
es darRveva, rasac sulmouTqmeli metyveleba ewode- gvaqvs metyvelebis mwvave darRvevebis an Tanmxlebi
ba, DSM-IV-Si klasificirebulia, rogorc eqspresi- qcevis aSlilobebis SemTxvevaSi.
uli metyvelebis aSlilobis Tanmxlebi niSani, xolo mkurnaloba iTvaliswinebs specialur swavlebas.
ICD-10-Si (enabluobasTan erTad) Sesulia bavSvTa fsiqiatri iseTive rols TamaSobs, rogorsac eqspre-
asakSi ganviTarebul sxva qceviT aSlilobebSi. siuli metyvelebis darRvevebisas (ix. zemoT).
gavrceleba: eqspresiuli metyvelebis ganviTarebis recepciuli metyvelebis aSlilobis mimoxilva ix.
aSlilobebis gamovlena damokidebulia Sefasebis bavSvTa da mozardTa fsiqiatriis amerikis akademiis
meTodze. amerikis fsiqiatriuli asociaciis monace- monacemebSi (American Academy of Child and Adolescent
mebiT (American Psychiatric Association, 1994a), es aSli- Psychiatry, 1998b)
loba bavSvebis 3-5%-s aReniSneba.
prognozi: amerikis fsiqiatriuli asociaciis mona- SeZenili epilefsiuri afazia (Landau-Krleffner
cemebiT, daaxloebiT naxevari im bavSvebisa, romlebic sindromi)
akmayofileben DSM-IV-is kriteriumebs, normalurad am iSviaTi aSlilobis dros normalurad ganviTare-
metyveleben zrdasrul asakSi, danarCens ki mTeli buli bavSvi kargavs eqspresiuli da recepciuli me-
cxovreba aReniSneba sulmouTqmeli metyveleba (Amer- tyvelebis unars, magram inarCunebs zogad inteleqts.
ican Psychiatric Association., 1994a). prognozi uaresdeba, amasTan erTad, TiTqmis yovelTvis aReniSneba bilat-
Tu mdgomareoba mwvavea an gvaqvs Tanmxlebi qceviTi eraluri da temporaluri eeg cvlilebebi da xSirad
aSlilobebi. sxva darRvevebic. eqspresiuli metyvelebis aSlilo-
mkurnaloba, ZiriTadad, specialur swavlebas gu- basTan erTad bavSvebis umravlesobas uviTardeba
lisxmobs. fsiqiatris CarTva xdeba Tanmxlebi aSli- krunCxva. daavadeba iwyeba 3-9 wlis asakSi da viTarde-
lobebis SemTxvevaSi an, rodesac saWiroa specialuri ba ramdenime TveSi, zogjer ufro swrafad.
ganaTlebis Sesaxeb mSoblebisTvis rCevebis micema. etiologia ucnobia. prognozi varirebs: daaxloe-
eqspresiuli metyvelebis aSlilobis mimoxilva ix. biT, bavSvebis or mesameds ugrZeldeba recepciuli
bavSvTa da mozardTa fsiqiatriis amerikuli akademi- metyvelebis darRvevebi, xolo mesamedi ki sruliad
is monacemebSi (American Academy of Child and Adolescent ikurneba. mkurnaloba yovelTvis ar aris metyvelebis
Psychiatry 1998b). gaumjobesebis garanti.
recepciul-eqspresiuli (an recepciuli) me- enisa da metyvelebis aSlilobebis Sefaseba

tyvelebis ganviTarebis aSliloba adreuli gamokvleva mniSvnelovania rogorc enisa
am aSlilobis dros metyvelebis gagebis unari, bavS- da metyvelebis aSlilobebis xasiaTisa da simwvavis
vis ganviTarebis asakTan SedarebiT, normaze dabalia. gamosavlenad, aseve imisTvis, rom gamoiricxos si-
TiTqmis yvela SemTxvevaSi gaZnelebulia eqspresiuli yrue, gonebrivi CamorCeniloba, cerebruli dambla
metyvelebac (es faqti aRiarebulia DSM-IV klasifi- da zogadi ganviTarebis aSlilobebi. aucilebelia me-
kaciiT, romelSic mocemulia ara calke recepciuli tyvelebis aparatis gamokvlevac. Zalian mniSvnelova-
aSliloba, rogorc ICD-10-Si, aramed recepciul- nia siyruis droulad gamovlena.
eqspresiuli aSliloba). mSoblebs SeiZleba mieces garkveuli miTiTebebi
recepciuli metyvelebis ganviTarebis normac vari- an standartuli saSualebebi bavSvis enisa da me-
abeluria, Tumca ori wlis asakisTvis araverbaluri tyvelebis Sesafaseblad. patarebisTvis am monacemebs
miniSnebebis gareSe nacnobi dasaxelebebis an martivi SeiZleba gadamwyveti mniSvneloba hqondes, xolo 3
instruqciebis gagebis problemebi mniSvnelovan dar- wlis asakisTvis standartuli testebis saSualebiT,
Rvevaze miuTiTebs. am diagnozSi ar Sedis recepciuli asakTan Sesabamisad unda Sefasdes metyvelebis unari.
metyvelebis iseTi darRvevebi, romlebic gamowveulia ramdenadac SesaZlebelia, es gamokvleva unda Caata-
siyruiT, daswavlis darRvevebiT (gonebrivi CamorCe- ros metyvelebis Terapevtma an Sesabamisi specializa-
nilobiT) an zogadi ganviTarebis aSlilobebiT. re- ciis mqone fsiqologma.
cepciuli metyvelebis aSlilobis dros xSiria masTan
_ 713 _
mkurnaloba
cxrili 24.6 perverziuli ganviTarebis
mkurnaloba nawilobriv damokidebulia gamom- aSlilobebi
wvev mizezze, magram upiratesad iTvaliswinebs me-
DSM IV ICD 10
tyvelebis trenirebas TamaSiTa da socialuri urT-
ierTobebiT. SedarebiT msubuq SemTxvevebSi, Tu autisturi aSlilobebi bavSvTa autizmi
mSoblebs mivcemT Sesabamis instruqcias, mkurnalo- retis sindromi retis sindromi
bis uzrunvelyofa SesaZlebelia ojaxis pirobebSi.
bavSvTa dezintegraciuli bavSvTa sxva dezintegraci
ufro mwvave mdgomareobebisas saWiroa profesiuli aSlilobebi uli aSlilobebi
daxmareba samkurnalo an specializirebul klasebSi. hiperaqtiuri aSliloba Tan
mxlebi gonebrivi CamorCe
mkurnaloba rac SeiZleba adre unda daiwyos. nilobiTa da stereotipuli
enisa da metyvelebis ganviTarebis mimoxilva ix. bi- moZraobebiT
Sofis (Bishop, 2002) naSromSi. ufro detaluri infor- aspergeris Sliloba aspergeris sindromi
macia am mdgomareobebis gamokvlevasa da marTvaze ix.
sxvagvarad dauzustebeli atipiuri autizmi
busarisa da vegelaris naSromebSi (Busari and Weggelar, perverziuli ganviTa
2005) rebis aSlilobebi (moi ganviTrebis zogadi aSli
cavs atipiur autizms) loba dauzustebeli
motoruli unarebis aSlilobebi
vlindeba 5 wlamde asakSi.
zog bavSvs aReniSneba motoruli unarebis ganvi-
ICD-10-Si am aSlilobebis qveS moiazreba eqvsi aSli-
Tarebis Seferxeba, ris gamoc igi xdeba mouqneli
loba (ix. cxrili 24.6) aqedan ori ar aris Sesuli DSM
TamaSis an skolaSi saqmianobis dros. ICD-10-Si am
IV klasifikaciaSi. kerZod, atipiuri autizmi da hip-
aSlilobas ewodeba motoruli funqciis ganviTa-
eraqtiuri aSliloba Tanmxlebi gonebrivi CamorCeni-
rebis specifikuri aSliloba. igi cnobilia, rogorc
lobiT da stereotipuli moZraobebiT. iTvleboda,
mouqneli bavSvis sindromi an specifikuri motoruli
rom am aSlilobaTa gavrcelebis sixSire 3/1000-zea,
dispraqsia. bavSvebs SeuZliaT normaluri moZraoba-
Tumca bolo monacemebiT es ricxvi gaormagebulia
moqmedebebis Sesruleba, magram gamoirCevian cudi
(Fombonne, 2003), risi mizezic SeiZleba iyos mdgo-
koordinaciiT. maT ara aqvT kargad ganviTarebuli
mareobis definiciis Secvla da diagnostikis gaum-
iseTi unarebi, rogoricaa damoukideblad Cacma, sia-
jobeseba.
ruli da Wama. isini xSirad amtvreven nivTebs, uWirT
autisturi speqtris aSlilobebi (asa): es termini
xelsaqme da TamaSebis organizeba. maT aqvT weris,
xSirad gamoiyeneba ganviTarebis zogadi aSlilobebis
xatvis da kopirebis sirTuleebi. Cveulebriv, in-
mTeli speqtris aRsaniSnavad, im mdgomareobebis
teleqtis kvleva gviCvenebs karg verbalur unars, ma-
CaTvliT, romlebic ver akmayofileben ZiriTad di-
gram Sesrulebis maCvenebeli dabalia.
agnostikur kriteriumebs. aRiarebulia, rom zusti
aseTi bavSvebi xvdebian fsiqiatrTan meoradi emoci-
sazRvris gavleba sxvadasxva sindroms Soris Znelia,
uri aSlilobebis gamo. am SemTxvevaSi saWiroa bavSvs,
amitom mSoblebs umjobesia ganemartos, rom bavSvis
mis mSoblebsa da pedagogebs avuxsnaT, Tu ra aris
mdgomareoba erTiani aSlilobis sxvadasxva gamov-
emociuri aSlilobis pirveladi mizezi. mdgomareobis
linebas warmoadgens.
gaumjobeseba SesaZlebelia specialuri swavlebiT.
SeiZleba saWiro gaxdes bavSvis gaTavisufleba orga- bavSvTa autizmi (autisturi aSlilobebi)
nizebuli TamaSebis an sxva iseTi saskolo saqmiano- es mdgomareoba aRwera kanerma (Kanner, 1943), romelmac
bebisgan, romlebic saWiroeben koordinacias. droTa SemoiRo termini ìnfantiluri autizmi~ (bavSvTa ad-
ganmavlobaSi mdgomareoba TandaTan umjobesdeba. reuli autizmi). es aSliloba ICD-10-Si Sesulia bavS-
damatebiTi informacia ix. grahamis (Graham et al., 1999) vTa autizmis, xolo DSM-IV-Si _ autisturi aSlilo-
naSromSi. bebis saxelwodebiT.
ganviTarebis zogadi aSlilobebi klinikuri niSnebi:

termini `ganviTarebis zogadi aSlilobebi~ gamoiy- Tavis am problemasTan dakavSirebul pirvel naSrom-
eneba im aSlilobaTa aRsaniSnad, romlebsac axasi- Si kanerma (1943) gamoyo ZiriTadi niSnebi, romlebic
aTebT komunikaciisa da socialuri urTierTobebis orive klasifikaciaSi dRemde diagnostikur kriteri-
problemebi, aseve, SezRuduli interesebi da ganmeo- umebad gamoiyeneba. autizmis diagnozis dasadgenad
rebadi, stereotipuli qcevebi. es darRvevebi Tavs saWiroa arsebobdes Semdegi sami jgufis simptomebi:
iCens sruliad gansxvavebul situaciebSi. Cveulebriv, 1. socialuri ganviTarebis darRvevebi;
ganviTareba anomaliuria Cvilobidan da upiratesad
2. komunikaciis darRvevebi;
_ 714 _
3. interesTa sferos SezRudva da qcevebis gaRaribeba. ucabedad, TvalsaCino mizezis gareSe, gamoavli-
am darRvevaTagan autizmisTvis yvelaze specifi- non brazi an SiSi. SeiZleba iyvnen hiperaqtiurebi an
kuri socialuri ganviTarebis anomaliaa. klinikuri destruqciulebi, eZinoT cudad, ver akontrolebdnen
suraTi gansxvavebulia rogorc sxvadasxva pacientSi, Sardvasa da kuWis moqmedebas. ar aris gamoricxuli
aseve sxvadasxva asakSi. TviTdazianebac. pacientebis daaxloebiT 25%-s mo-
ganviTarebis darRvevebi, rogorc wesi, TvalsaCino zardobaSi uviTardeba krunCxva.
xdeba 3 wlamde. autizmis adreuli niSnebi Cviloba- inteleqtis done: kaners (Kanner) sjeroda, rom
Sic SeiZleba gamovlindes, mag., 12 Tvis asakSi aseTi autisti bavSvebis inteleqti normis farglebSia.
patarebi ar RuRuneben an ar mianiSneben sagnebze, ar Semdgomma kvlevebma aCvena, rom bavSvebis 3/4-is in-
imeoreben bgerebs, iCenen zemgrZnobelobas xmauris teleqtualuri koeficienti gonebrivi CamorCenilo-
mimarT da ar uyvarT cvlilebebi (dawvrilebiTi in- bis farglebSia, rac inteleqtualur daqveiTebaze
formacia ix. LeCouteure and Baird, 2003). miuTiTebs (RutterandLockyer, 1967). dabali inteleqtis
socialuri ganviTarebis darRvevebi. autistur bavS- miuxedavad, zogi bavSvi avlens gansakuTrebul, magram
vebs uWirT adamianebTan Tbili emociuri kavSirebis arCeviT unars, mag., maTematikis an damaxsovrebis (Her-
damyareba (autisturi martooba), ar reagireben mSo- melin andO~Connor, 1983).
blebis Rimilze an saubarze, maT ar moswonT, rode-
epidemiologia
sac deda ixutebs an kocnis. isini praqtikulad ar
iCenen interess ucnobi adamianebis mimarT. erTnairad autizmis gavrcelebis sixSire 1/1000 bavSvzea da 4-jer
eqcevian adamianebsa da sagnebs. gansakuTrebiT dam- metia biWebSi, vidre _ gogonebSi (Fombonne, 2003),
axasiaTebelia mzeris acileba, anu isini ar amyareben xolo autisturi speqtris daavadebebis gavrcelebis
mzeriT kontaqts. sixSire 5-6 bavSvia 1000-ze (LeCouteur and Bird, 2003).
komunikaciis darRvevebi: bavSvi gvian iwyebs bolo wlebSi autisturi bavSvebis ricxvma imata, rac,
laparaks an saerTod ar iwyebs. zogjer metyveleba SesaZloa, gamoiwvia definiciis cvlilebam da diag-
normalurad viTardeba 2 wlamde da Semdeg ganic- nostikis gaumjobesebam.
dis srul ukuganviTarebas. metyvelebis gaRaribeba etiologia
miuTiTebs mwvave kognitur deficitze. asakis mate-
bavSvTa autizmis ganviTarebis mizezebi dRemde ucno-
basTan erTad, autisturi bavSvebis TiTqmis naxevari
bia, magram misTvis damaxasiaTebeli socialuri, ko-
axerxebs ramdenime aucilebeli sityvis daswavlas.
munikaciuri da qceviTi darRvevebi ara erT, aramed
autizmis dros gamoxatulia nacvalsaxelebis gamoy-
mraval neironul sistemas moicavs.
enebis problemebi da sxva adamianebis mier naTqvami
genetikuri faqtorebi: Zalian mniSvnelovania ge-
sityvebis arasworad gameoreba (eqolalia). autisti
netikuri faqtorebis gaTvaliswineba. savaraudod,
bavSvi SeiZleba zedmetad bevrsac laparakobdes, Tum-
aSlilobis ganviTarebaSi ramdenime geni monawileobs.
ca am dros misi metyveleba ganmeorebadi frazebisgan
zogad populaciasTan SedarebiT, autizmi ufro
Sedgeba da ufro monologia, vidre vinmesTan saubari.
xSirad (50-jer metad) daavadebulTa da-Zmebs emarTe-
kognituri deficiti gavlenas axdens araverbalur
baT (Rutter et al., 1990). ramdenime kvleviT gamovlinda
komunikaciasa da TamaSis xasiaTzec. autisti bavSvebi
ufro meti sixSire monozigitur, vidre dizigotur
ar monawileoben imitaciur TamaSebSi da ver TamaSo-
tyupebSi (mag., Rutter et al., 1993, Bailey et al., 1995),
ben TojinebiT. maT warmosaxvisa da SemoqmedebiTi un-
TiTqmis 90%-iani albaTobiT. kognituri aSlilobebi
arebi daqveiTebuli, cudad ganviTarebuli aqvT.
ufro xSirad emarTebaT autisti bavSvebis da-Zmebs,
interesebis daqveiTeba da qcevebis gaRaribeba: au-
vidre zogadi populaciis warmomadgenlebs, rac me-
tisturi bavSvis stereotipuli moqmedebebi SeiZleba
tyvelebs imaze, rom fenotipi ufro farToa, vidre
ganimartos, rogorc ucvlelobisa da erTgvarovnebis
is sindromebi, romlebic amJamad autizmis kriteri-
akviatebuli survili. garemoSi umniSvnelo cvlile-
umebadaa miCneuli (Beileyet al., 1998). autizmi gansa-
bebi iwvevs distress, rac gamoixateba, mag., imaSi, rom
kuTrebiT dakavSirebulia me-2, me-7, da me-15 qromo-
mas aqvs survili miiRos erTi da igive sakvebi, ataros
somebTan (Veenstra-VandesrWeele and Cook, 2004).
erTi da igive tansacmeli, gaimeoros TamaSebi. zogi
tvinis organuli daavadeba: tvinis struqturulma
bavSvi ejaWveba naWris naqsov Tojinas.
kvlevebma gviCvena, rom autisti bavSvebis tvini ufro
autisti bavSvebisTvis damaxasiaTebelia ucnauri
didi moculobisaa, vidre janmrTelebis. funqciuri
qceva da manerizmi, triali erT adgilze, TiTebis
magnitur-rezonansuli kvlevebiT dagrovda mniS-
(didi TiTebiT) wriuli moZraobebi, taSis Semokvra an
vnelovani informacia autizmis dros Tavis tvinSi
xelebis qneva. Tumca, zogi Tavis qcevebiT SeiZleba
arsebuli cvlilebebis Sesaxeb. dafiqsirebulia
ar gansxvavdebodes janmrTeli bavSvebisgan.
hipoaqtivoba amigdalas, frontalur da temporalur
sxva maxasiaTeblebi: autistma bavSvebma SeiZleba
_ 715 _
ubnebsa (romlebic mniSvnelovan rols asruleben so- sxva SesaZlo `mTavar~ fsiqologiur darRvevebs
cialur funqcionirebaSi) da kefa-safeTqlis (TiTis- autizmis dros miekuTvneba Sublis wilis aRma
tarisebri) xveulis midamoSi (romelic monawileobs srulebeli funqciebis (dagegmvisa da organizebis
saxeebis amocnobaSi). unaris) deficiti. amis Sedegia perseveracia, cudi
sxva biologiuri mizezebi: bavSvebis erT mesameds TviTregulireba da sxvadasxva wyarodan miRebuli
aqvs momatebuli periferiuli serotoninis done. informaciidan ZiriTadi azris gamoyofis uunaroba.
iSviaT SemTxvevaSi, autizmi asocirdeba myife X sin- yvela es darRveva autizmis klinikur suraTSi misi
dromTan (gv. ??), retis sindromTan da tuberozul fsiqologiis mxolod nawils warmoadgens.
sklerozTan. autisturi bavSvebis 10%-s aqvs sx-
vadasxva somaturi problemebi (Rutter et al., 1994). diferencialuri diagnozi:
autizmis dros ufro xSirad gamoxatulia parcialuri
dausabuTebeli Teoriebi: simptomatika, vidre sruli klinikuri suraTi. amitom
mosazreba, rom wiTela/wiTura/ybayuris vaqcina (MMR) diferencireba xdeba parcialur sindromsa da Semdeg
asocirebulia autizmis ganviTarebasTan, skrupulo- mdgomareobebs Soris:
zuri epidemiologiuri kvlevebiT ar dadasturda. w siyrue _ gamoiricxeba smenis Sesabamisi testirebiT;
mSoblebis araswori zrunva. kaneris (Kanner, 1943)
w enisa da metyvelebis spcifikuri aSlilobebi (komu-
yvelaze xSirad citirebad kvlevaSi autizmi ganxilu-
nikaciis darRvevebi, gv. 669) _ rac autizmisgan imiT
lia, rogorc bavSvis sapasuxo reaqcia civi, sakuTar
gansxvavdeba, rom am dros praqtikulad Senaxulia
TavSi Caketili da obsesiuri mSoblebis qcevaze. ka-
araverbaluri komunikacia da bavSvi Cveulebrivad
neris es mosazreba ar iyo saTanadod dasabuTebuli
reagirebs sxvebis momarTvaze;
(ix. Koegel et al., 1983). amJamad iTvleba, rom mSoblebis
nebismier fsiqologiur anomaliebs ganapirobebs, er- w daswavlis darRvevebi (gonebrivi CamorCeniloba) _
Tis mxriv, autisturi bavSvis aRzrdis problemebi, am dros sxvebTan urTierTobis unari bevrad ukeTe-
xolo, meores mxriv, im genebis manifestacia romle- sia, vidre autizmis SemTxvevaSi. autist bavSvs, sxva
bic iwveven autizms bavSvebSi. miuxedavad imisa, rom unarebTan SedarebiT, ufro metad metyveleba aqvs
mSoblebis rolis mniSvneloba damtkicebuli ar aris, darRveuli, vidre amave asakis gonebrivad CamorCe-
gavrcelebuli azri araswori zrunvis Sesaxeb mSob- nil bavSvebs;
lebSi iwvevs mniSvnelovan distress. w aspergeris (Asperger's) sindromi (gv. 675);
kavSiri SizofreniasTan: dRes kavSiri autizmsa da w bavSvTa asakis dezintegraciuli aSlilobebi (gv. 674).
Sizofrenias Soris dadgenili ar aris.
etiologiis mimoxilva ix. volkmaris naSromSi (Volk- prognozi
mar et al., 2004). autisturi bavSvebis daaxloebiT 10-20%-is mdgo
mareoba umjobesdeba 4-6 wlis asakisTvis. maT,
fsiqopaTologia Cveulebriv, skolaSi swavla da muSaobac SeuZliaT.
autizmis gonebis Teoria. es Teoria cdilobs sxva 10-20% SeiZleba darCes saxlSi; maT specialuri
gamoavlinos bazisuri fsiqologiuri darRvevebi swavleba an trenireba esaWiroebaT. isini bolomde
autizmis dros. mag., iTvleba, rom 4 wlis asakSi damokidebulni arian ojaxebs an specialur servisebze.
janmrTel bavSvs aqvs unari mixvdes, Tu ras fiqroben darCenili 60%-is mdgomareoba umniSvnelod icvleba.
sxvebi. amasTan dakavSirebiT Caatares cda: janmrTeli maT ar SeuZliaT damoukidebeli cxovreba. umravlesoba
bavSvi rCeba oTaxSi meore bavSvTan erTad, romelsac saWiroebs xangrZliv stacionirebas. gaumjobesebis
jer uCveneben saTamaSos Senaxvis adgils da Semdeg SemTxvevaSic ki SeiZleba isev gamoxatuli iyos
sTxoven datovos oTaxi. sanam meore bavSvi oTaxidan metyvelebis problemebi, emociuri sicive da ucnauri
gasulia, saTamaSos ucvlian adgils. oTaxSi darCenili qceva. rogorc ukve aRvniSneT, did nawils mogvianebiT
janmrTeli bavSvi moelis, rom ukan dabrunebuli epilefsiuri krunCxva uviTardeba. prognozulad
bavSvi saTamaSos iq moZebnis, sadac is mis Tvalwin dadebiTad iTvleba SedarebiT maRali inteleqti da 6
Seinaxes, xolo autisti bavSvi amas ver xvdeba da wlis asakisTvis komunikaciuri metyvelebis arseboba.
ambobs, rom ukan mobrunebuli bavSvi saTamaSos im Tumca, normaluri inteleqtis farglebSic gamosavali
adgilze moZebnis, sadac gadaitanes. jer-jerobiT, gansxvavebulia (Howlin et al., 2004).
gaurkvevelia, Tu ratom ar SeuZlia autist bavSvs
gansazRvros, Tu ra ician an ras moelian sxvebi, aseve Sefaseba
ar aris cnobili, ramdenad mniSvnelovania es deficiti Sefaseba iTvaliswinebs ufro mets, vidre autizmis
autizmis fsiqopaTologiisTvis (autizmis gonebis diagnostirebas. aucilebelia Semdegi damatebiTi
Teoriis mimoxilva ixileT Baron-Cohen et al., 2000). sakiTxebis gaTvaliswinebac (Lord and Rutter, 1994):
_ 716 _
w kogniciis done; ganmanaTleblo da socialuri servisebidan droulad
w metyvelebis unari; miiRon daxmareba. zogi mSobeli iTxovs genetikur
konsultacias, radgan cnobilia, rom meore bavSvis
w komunikaciuri, socialuri da TamaSis unarebi;
gaCenis SemTxvevaSi, autizmis riski daaxloebiT 3%-ia
w ganmeorebadi an sxvamxriv anomaliuri qceva; (Lord and Rutter, 1994). bevri mSoblisTvis nebayoflo-
w asakis, metyvelebisa da gonebrivi monacemebis Ses- biT organizaciebSi gaerTianeba Zalian Sedegiania.
abamisi socialuri ganviTarebis done; maT aqvT saSualeba, Sexvdnen sxva autisti bavSvebis
w somaturi daavadebebi an sxva samedicino probleme- mSoblebs da ganixilon saerTo problemebi.
bi; mkurnalobis sxva saxeebi. iyo mosazreba, rom in-
dividualur fsiqoTerapias SeeZlo fundamenturi
w fsiqosocialuri faqtorebi da ojaxis saWiroebebi.
cvlilebebis mocema, Tumca, misi warmatebiT gamoy-
(diagnozisa da Sefasebis mimoxilva ix. Baird et al.,
enebis mtkicebulebebi, jer-jerobiT, ar arsebobs.
2003).
aseve, araa damtkicebuli romelime medikamentis
marTva upiratesoba, garda ramodenime SemTxvevisa: qcevis
darRvevebisTvis xanmokle periodiT antifsiqozuri
radgan ar arsebobs specifikuri mkurnaloba, daa-
preparatebis gamoyeneba (I), SfoTvis, depresiisa da
vadebis marTvam unda moicvas Semdegi ZiriTadi
TviTdazianebebis dros _ serotonis ukumitacebis
aspeqtebi: qcevis mowesrigeba, ganaTlebisa da so-
seleqciuri inhibitorebis miReba (II) da hiperaqti-
cialuri servisebis xelmisawvdomoba, agreTve, mSo-
urobis _ stimulatorebiT daregulireba (III); Tum-
blebisa da ojaxis daxmareba.
ca, am ukanasknelis SemTxvevaSi, gasaTvaliswinebelia
qcevis darRvevebis marTva: krizisuli marTvis gam-
stereotipuli moZraobebis gaxSireba (mkurnalobis
oyenebiT (gv. 592) SeiZleba gakontroldes autisti
zogadi mimoxilva ix. Volkmar et al., 2004).
bavSvebis zogierTi qceva. am SemTxvevaSi mkurnalo-
ba ZiriTadad xorcieldeba saxlis pirobebSi ojaxis retis sindromi (Rett~s disorder)
wevrebis mier, xolo klinikuri fsiqologi akontro- retis daavadeba, anu retis sindromi, aris iSviaTi
lebs mkurnalobis process. jer-jerobiT ucnobia am X qromosomasTan SeWiduli aSliloba, romelic mx-
meTodis grZelvadiani Sedegi, magram autizmis dros olod gogonebSi vlindeba. gavrcelebis sixSirea 0.8
mSoblebisTvis xanmokle efeqtic mniSvnelovania. _ 10.000 gogonaze (Kerr and Stivenson, 1985). ramdenime
ganaTleba da socialuri servisebi: autisti bavS- Tvis manZilze normaluri ganviTarebis periodis Sem-
vebis umravlesoba saWiroebs specialur ganaTlebas. deg, xdeba Tavis qalis zrdis tempis Seneleba. Sem-
zogadad, miCneulia, rom umjobesia autisti bavSvebi dgomi ori wlis ganmavlobaSi viTardeba kognituri
cxovrobdnen saxlSi da dadiodnen specializebul CamorCeniloba da zeda kidurebiT mizanmimarTuli
dRis centrebSi. Tu bavSvis mdgomareoba iseTi mZimea, da natifi moZraobebis Sesrulebis uunaroba. dam-
rom misi saxlSi gaCereba SeuZlebelia, maSin saWiroa axasiaTebelia stereotipuli taSis dakvris an weris
misi specializebul dawesebulebaSi gadayvana da swav- msgavsi moqmedebebi. SeiZleba ganviTardes qveda ki-
lebis uzrunvelyofa. aucilebelia damatebiTi Zal- durebisa da sxeulis ataqsia. pirvel xanebSi social-
isxmeva, raTa Tavidan aviciloT institucionalizmis uri garemos mimarT interesi iklebs, Tumca, Semdgom
Sedegebi, radgan xangrZlivma stacionirebam SeiZleba SeiZleba kvlav gaizardos. gamoxatulia recepciuli
gaaRrmavos socialuri izolacia. zog SemTxvevaSi, da eqspresiuli metyvelebis ganviTarebis darRvevebi
autisti bavSvebis ganaTleba da stacionireba SeiZle- da fsiqomotoruli Sekaveba. retis sindromi asoci-
ba ganxorcieldes im servisebSi, romlebic daswavlis rebulia X qromosomaSi lokalizebuli MECP2 genis
darRvevebis mqone bavSvebisTvisaa gankuTvnili. mo- sporadiul mutaciasTan. SeiZleba adgili hqondes
zardebisTvis mniSvnelovania profesiuli ganaTleba. genis aberaciul imprintigs (gv. ??). MECP2 geni are-
ojaxis daxmareba: ojaxi, romelSic autisti bavSvi gulirebs im genebis eqspresias, romlebic tvinis gan-
cxovrobs, saWiroebs mniSvnelovan daxmarebas, raTa viTarebaSi monawileoben (mimoxilva ix. Jellinger, 2003).
man moaxerxos bavSvis ucnaur da distresul qcev-
ebTan gamklaveba. ojaxis wevrebs unda SeeZloT bavS- bavSvTa dezintegraciuli aSliloba
vis saWiroebebis swrafad Sefaseba da maTTvis sagan- bavSvTa dezintegraciuli aSliloba cnobilia heler-
manaTleblo da sxva Sesabamisi servisebi xelmisawv- is (Heller~s) daavadebis saxeliT. iwyeba 2 an meti wlis
domi unda iyos. maSinac ki, rodesac eqimebs SeuZliaT manZilze normaluri ganviTarebis Semdeg. bolomde
garkveuli specifikuri mkurnalobis Catareba, bavSvi ar aris naTeli, Tu ramdenad gansxvavdeba es aSli-
ar unda movaciloT ojaxs. ojaxs sWirdeba mudmivi loba bavSvTa autizmisgan. misTvis, iseve rogorc au-
Tanadgoma, raTa bavSvisa da sakuTari TavisTvis sa- tizmisTvis, damaxasiaTebelia gamoxatuli kognituri
_ 717 _
daqveiTeba, socialuri qcevisa da komunikaciis dar- beli simptomebi mozrdilobaSic rCeba. pacientTa
Rvevebi da arakeTilsaimedo gamosavali. autizmisgan umravlesoba axerxebs muSaobas, Tumca, Zalian mcire
gansxvavdeba motoruli funqciebis daqveiTebiTa da nawili qmnis ojaxs da amyarebs warmatebul urTier-
Sardvisa da defekaciis procesebze kontrolis da- Tobebs.
kargviT. daavadebis progresi SeiZleba SeCerdes an,
SesaZloa, ganviTardes sxva mwvave nevrologiuri md- atipiuri autizmi da perverziuli ganviTarebis
aSlilobebi, dauzustebeli
gomareobebi (mimoxilva ix. Harris, 1996).
terminebi _ àtipiuri autizmi (ICD-10) da perverzi-
aspergeris (Asperger~s) sindromi uli ganviTarebis aSlilobebi, dauzustebeli~ (DSM-
es mdgomareoba pirvelad aRwera aspergerma 1944 IV) gamoiyeneba ganviTarebis aSlilobis rezidualuri
wels. misi originaluri naSromi germanul enaze kategoriebisTvis, romlebic autizmis msgavsia, magram
iyo da Semdeg inglisurad Targna fritma (Frith) 1991 ver akmayofileben am jgufSi Semavali aSlilobebis
wels. am mdgomareobaSi moiazreboda autisturi diagnostikur kriteriumebs. kvlevaSi gamoyenebuli
fsiqopaTiac. es aSliloba ufro xSirad gvxvdeba kriteriumebidan gamomdinare, maTi gavrcelebis six-
biWebSi, vidre gogonebSi. pirveli sami wlis ganmav- Sire gansxvavebulia; Tumca, kvlevaTa umravlesoba
lobaSi bavSvebi normalurad viTardebian, xolo Sem- miuTiTebs imaze, rom igi iseve gavrcelebulia, ro-
deg urTierTobebi TandaTanobiT civdeba. viTardeba gorc autizmi (Fombonne, 1999). dadgenili araa, Tu ra
socialuri qcevis iseTive darRvevebi, rogoric au- kavSiria am SemTxvevebsa da sxva perverziuli ganvi-
tizmis dros. SeiZleba adgili hqondes stereotipul Tarebis aSlilobebis jgufSi Semaval mdgomareobebs
da ganmeorebad moZraoba-moqmedebebs, romlebsac Soris.
motorul manerizmze metad, raRaciT intensiurad
dainteresebis forma aqvT. autizmisgan gansxvavebiT, hiperkinetikuri aSliloba
aspergeris sindromis dros ar viTardeba kognituri bavSvebis daaxloebiT erT mesameds maTi mSoblebi,
funqciebisa da metyvelebis gamoxatuli darRvevebi, xolo skolis moswavleebis 5-20%-s pedagogebi axa-
Tumca, avadmyofebs SeiZleba axasiaTebdes maRalfar- siaTeben, rogorc zedmetad aqtiurebs. es daxasi-
dovani metyveleba uCveulo intonaciiT. aTeba varirebs normaluri aweuli guneb-ganwyobidan
aseTi pacientebis saubari ufro ganmeorebad mono- ufro mwvave persistentul aSlilobamde. zedmeti
logs hgavs, vidre socialur urTierTobas. isini eqs- aqtiuroba sxvadasxva situaciaSi sxvadasxvaa. hip-
centruli, martosuli adamianebi arian da SeuZliaT erkinetikuri aSliloba zedmeti aqtivobis mwvave
didi dro sakuTar viwro interesebs dauTmon. bavS- gamovlinebaa, romelsac Tan axlavs gamoxatuli yu-
vebis umetesoba tlanqi da mouqnelia. autisti bavS- radRebis daqveiTeba, rac asaxulia am mdgomareobis
vebisgan gansxvavebiT, metad iCenen sxvebTan urTier- ganmsazRvrel terminSi _ `yuradRebis deficitiTa da
Tobis survils, magram maTi urTierTobebi siamovne- hiperatiurobiT mimdinare aSliloba~ DSM-IV kla-
basa da interess moklebulia. ar hyavT megobrebi. sifikaciis mixedviT. ICD-10-Si gamoyenebulia termini
epidemiologia. gavrcelebis sixSire dauzustebe- `hiperkinetikuri aSliloba~ da diagnostikur kri-
lia da monacemebi kvlevebSi gamoyenebul aSlilo- teriumebs Soris mcire gansxvavebidan gamomdinare
bis definiciazea damokidebuli. ICD-10 gadasinjvis (ix. qvemoT), SemTxvevebi, romlebic diagnostirdeba
kriteriumebiT Catarebuli kvlevis Tanaxmad (Ehlers hiperkinetikur aSlilobad, ufro mwvavea, vidre hip-
and Gilberg, 1993) gavrcelebis sixSire 10.000 sul mo- eraqtiurobiTa da yuradRebis deficitiT mimdinare
saxleze 39 pacientia, Tumca, mocemul kvlevaSi mx- mdgomareobebi.
olod oTxi SemTxvevaa aRwerili. am kvlevis sarw-
munoebis maCveneli 10.000 sul mosaxleze 0.6-dan 59 klinikuri niSnebi:
pacientamde meryeobs (Fombonne, 1999). rogoric ar aSlilobis kardinaluri niSnebia:
unda iyos gavrcelebis sixSire, aspergeris sindromi w gamoxatuli da persistentuli mousvenroba;
ganviTarebis TvalsazrisiT mniSvnelovan problemas
w Seusvenebeli da xangrZlivi motoruli aqtivoba;
warmoadgens da, amdenad, am aSlilobis mqone bavSvebi
saWiroeben Sesabamis daxmarebasa da specialur gana- w yuradRebis koncentraciis SeuZlebloba;
Tlebas. w impulsuroba da kiTxvaze pasuxis myisierad
etiologia: aspergeris sindromis ganviTarebis gacemisgan Tavis Sekavebis uunaroba.
mizezi ucnobia. bolomde araa garkveuli, igi bavSvTa es aris perverziuli niSnebi, romlebic Tavs iCenen
autizmis ufro msubuq formas warmoadgens, Tu sru- yvela situaciaSi, Tumca, SesaZlebelia, sxvadasxva
liad damoukidebeli mdgomareobaa. situaciaSi xarisxobrivad gansxvavdebodnen. amitom
prognozi: Cveulebriv, aSlilobisTvis damaxasiaTe- mSobelma da pedagogma bavSvis saqcieli SeiZleba
_ 718 _
sxvadasxvagvarad aRweros. ukanaskneli termini gamoiyeneba maSin, rodesac
am aSlilobis mqone bavSvebi xifaTianebi arian orive aSlilobis _ hiperkinetikuri da qcevis
da xSiria ubeduri SemTxvevebi. maT aReniSnebaT _ kriteriumebi dakmayofilebulia (amis calke
swavlis problemebi, rac nawilobriv ganpirobebulia gaTvaliswinebas ganapirobebs is, rom agresiuloba,
yuradRebis daqveiTebiT da, aseve, guldasmiT saqmis deliqventoba da antisocialuri qceva cud gamo
keTebis uunarobiT. mdgomareobis gaxangrZlivebasTan savalTanaa dakavSirebuli (ix. qvemoT).
erTad, zog bavSvs SeiZleba Camouyalibdes msubuqad komorbidoba. bavSvebis naxevarze mets sxva aS
gamoxatuli antisocialuri qceva, kerZod, urCoba, lilobebis niSnebic aReniSneba. yvelaze xSiria qcevis
risxvis Setevebi da agresia. aseTi bavSvebi socialurad darRvevebi, depresiuli da SfoTviTi aSlilobebi.
ganmuxruWebulebi arian da Tanatolebs Soris SesaZlebelia daswavlisa da metyvelebis darRvevebis
naklebi popularobiT sargebloben. damaxasiaTebelia arsebobac. autisti bavSvebic xSirad uyuradReboni
guneba-ganwyobis meryeoba. aseve, sakmaod xSiria daq da hiperaqtiurebi arian, Tumca es Tavad bavSvTa
veiTebuli guneba-ganwyoba da depresia. autizmis sindromis damaxasiaTebeli niSnebia; amitom
mousvenroba, zedmeti aqtiuroba da sxva, amasTan hiperkinetikuri aSlilobis diagnozi, damatebiT
dakavSirebuli niSnebi xSirad skolis asakamde autizmis diagnozTan erTad, ar daismeba.
vlindeba. zogjer hiperaqtiuroba aRiniSneba Cvil
bavSvebSic, rac ufro SesamCnevi xdeba siarulis epidemiologia
dawyebis Semdeg. aseTi bavSvebi mudmiv moZraobaSi hiperkinetikuri aSlilobis gavrcelebis sixSire
arian, yvelaferSi erevian da saSinlad Rlian damokidebulia gamoyenebul diagnostikur krite
mSoblebs. riumebze. DSM-IV-is mixedviT Catarebuli epide
miologiuri kvlevebi 3-5%-s gviCvenebs (American
diagnostikuri kriteriumebi Psychiatric Association, 1994a), xolo ICD-10-is mixedviT
orive klasifikaciis _ rogorc ICD-10-is, aseve Catarebul kvlevebSi ki, skolis moswavleebs Soris, misi
DSM-IV-is mixedviT, aSlilobis ZiriTadi niSnebia: gavrcelebis sixSirea 1.7%. es maCveneblebi izrdeba,
yuradRebis darRvevebi, hiperaqtiuroba da impulsu rac, savaraudod, aSlilobis ukeTes amocnobasa
roba. es niSnebi bavSvobaSive vlindeba da, sul cota, da droul diagnostirebasTanaa dakavSirebuli.
eqvsi Tvis manZilze grZeldeba. es gamovlinebebi hiperkinetikuri aSliloba 3-jer ufro xSiria biWebSi,
dezadaptaciuria da ar Seesabameba bavSvis ganviTa vidre gogonebSi. maTi gavrcelebis sixSire mcirdeba
rebis asaks. Tumca, zogierTi diagnostikuri kri asakTan erTad; ufro gavrcelebulia socialurad
teriumis mixedviT, klasifikaciebs Soris garkveuli deprivirebul mosaxleobasa da bavSvTa saxlebis
gansxvavebebic arsebobs: aRsazrdelebs Soris.
w ICD-10-is mixedviT, aSlilobisTvis damaxasiaTebeli
nevrologiuri niSnebi
niSnebi 6 wlis asakamde unda gamovlindes, xolo
DSM-IV klasifikaciaSi ki _ 7 wlamde asakia mi hiperkinetikuri aSlilobis mqone bavSvebSi da
TiTebuli; fiqsirebulia niSnebi, romlebic neiroganviTarebis
Seferxebas an darRvevebze miuTiTeben. mag., met
w ICD-10-is mixedviT, diagnozis dasmisTvis orive
yvelebis ganviTarebis CamorCena, motoruli sitlanqe
niSnis, yuradRebis deficitisa da hiperaqtiurobis,
da zepiri metyvelebis darRvevebi (Schachar, 1991).
arseboba aucilebelia, DSM-IV-is mixedviT ki,
zogadad, es niSnebi mSobiarobis garTulebebTan aris
unda iyos yuradRebis deficiti an hiperaqtiuroba
dakavSirebuli, Tumca, SesaZlebelia gamowveuli
impulsurobasTan erTad;
iyos im faqtorebiT, romlebic Tavis tvinis adreul
w ICD-10-is mixedviT, aSlilobis niSnebi unda vlin ganviTarebaze axdenen gavlenas. es aSliloba
debodes rogorc saxlSi, ise skolaSic, xolo DSM- aReniSneba bavSvebis erT meoTxeds, romlebsac qala-
IV-is mixedviT, zogi niSani SeiZleba gamovlindes tvinis travma aqvT miRebuli (Max et al., 2004).
erT situaciaSi da zogi ki _ sxva garemoSi. neirovizualuri kvlevebiT dafiqsirebulia fu
am gansxvavebebidan gamomdinare, bavSvs, romelsac nqciuri darvevebi prefrontalur da sxva aR
ICD-10-is mixedviT aqvs dasmuli diagnozi, ufro mZime masrulebel funqciebTan asocirebul ubnebsa da
aSliloba aReniSneba, vidre imas, visi mdgomareobac naTxemSi (Roth and Saykin, 2004).
DSM-IV-is kriteriumebs akmayofilebs. genetikuri kvlevebi. ojaxebis, naSvilebi bavSvebis,
ICD-10klasifikaciaSi gamoyofilia: monozigoturi da dizigoturi tyupebis gamokvlevam
1. aqtiurobisa da yuradRebis darRvevebi; aCvena genetikuri faqtoris mniSvneloba 70% (da
meti) memkvidreobiTobis maCvenebliT. yuradRebis
2. qcevis hiperkinetikuri aSliloba.
deficitisa da hiperaqtiurobis aSlilobis mqone
_ 719 _
probandebs, mniSvnelovnad meti imave aSlilobis da SfoTviTi aSlilobebis ganviTareba. (prognozTan
mqone pirveli rigis naTesavi hyavT, vidre janmrTel dakavSirebuli informacia ix. Willoghby, 2004; yu
kontrolebs (Biederman et al., 1992). gacilebiT metia radRebis deficitiTa da hiperaqtiurobiT mimdinare
konkordantoba monozigotur tyupebs Soris, dizi aSlilobis mimoxilva ix. Wilens et al., 2002).
gotur tyupebTan SedarebiT (Eaves at al, 1997). ayvanili
bavSvebis kvlevebma aCvena, rom bavSvis biologiur mkurnaloba
mSoblebs ufro xSirad aReniSnebaT igive an sxva mxardaWera da fsiqologiuri mkurnaloba. hiper
fsiqikuri aSlilobebi, vidre mimReb mSoblebs (Van aqtiuri bavSvi mSoblebisgan did energias moiTxovs.
der Oord et al., 1994). raTa Tavidan aicilon gadaRliloba da CaerTon
gamovlenilia kavSiri yuradRebis deficitiTa mkurnalobis procesSi, maT Tanadgoma sWirdebaT,
da hiperaqtiurobiT mimdinare aSlilobasa da gansakuTrebiT im SemTxvevaSi, Tu bavSvis qcevis
dofaminergul transmiterul sistemaSi monawile mowesrigeba gaZnelebulia. specialuri ganaTleba
genebs Soris, dofanis D4 receptoris genisa (Smalley et da mxardaWera pedagogebisTvisac mniSvnelovania.
al., 2004) da dofaminis transporteris genis (Heiser et al., fsiqosocialuri intervencia, Cveulebriv, medika
2004) CaTvliT. es aRmoCena SesabamisobaSia im faqtTan, mentur mkurnalobasTanaa kombinirebuli. msubuqi
rom dofaminur sistemaze moqmedi medikamentebiT SemTxvevebis garda, pacients eniSneba stimulantebi.
mkurnaloba aumjobesebs mdgomareobas (ix. qvemoT). mkurnalobis procesSi gamoiyeneba sxvadasxva Te
savaraudod, daavadebis ganviTarebaSi mravali, rapia (ojaxuri, jgufuri an bihevioruli); Tumca,
magram mcire efeqtis mqone geni monawileobs. maTi es medikamentur mkurnalobasTan SedarebiT, nak
mniSvnelobis Sesafaseblad damatebiTi kvlevebis lebad efeqturia. bihevioruli teqnika miznad
Catarebaa saWiro. (genetikuri faqtorebis mimoxilva isaxavs qceviTi darRvevebis koreqcias da xSirad
ix. Heiser et al., 2004). es pedagogebisa da mSoblebis sapasuxo reaqciis
socialuri faqtorebi. socialuri faqtorebi zrdis modificirebas gulisxmobs.
bavSvis Tandayolil tendencias hiperaqtiurobisadmi. medikamenturi mkurnaloba. stimulantebi gamoiyeneba
amitomac, rogorc aRvniSneT, hiperaqtiuroba ufro im SemTxvevaSi, Tu gamoxatul mousvenrobasa da
xSiria socialurad warumatebel da instituciur yuradRebis mwvave deficitTan gvaqvs saqme. es wamlebi
garemoSi. tyupebis kvlevam aCvena, rom, rogorc zrdis dofaminisa da noradrenalinis aqtivobas, riTac
gaziarebul, aseve aragaziarebul garemo movlenebs miiRweva maTi Terapiuli efeqti. yvelaze xSirad
TavianTi wvlili SeaqvT daavadebis etiologiaSi iniSneba meTilfenidati. aseve, farTod gamoiyeneba
(Eaves et al., 1997). deqsamfetamini, romlis miRebis gaxangrZlivebuli
sxva mizezebi. adreuli kvlevebis Tanaxmad hiper formebic arsebobs. dozebi unda SevarCioT pacientis
kinezuri sindromis mizezad tyviiT mowamvla sxeulis masis mixedviT. preparatis daniSvnisas
iTvleboda (Needlemen et al., 1979). ufro mogvianebiT, unda gaviTvaliswinoT mwarmoeblis instruqciebi
cinkis naklebobaze gaamaxviles yuradReba. Tumca, da ukuCvenebebTan dakavSirebuli rCevebi. wamlis
ar arsebobs arc erTi da arc meore mosazrebis xanmokle potenciuri efeqtia is, rom igi asustebs
damamtkicebeli sakmarisi monacemebi. zogi mSobeli mousvenrobasa da agresiulobas da zogjer aum
fiqrobs, rom sxvadasxva sakvebi produqti aZlierebs jobesebs yuradRebis deficits. es efeqti, Cve
hiperaqtiurobas, magram es ar SeiZleba daavadebis ulebriv, droTa ganmavlobaSi ar sustdeba, Tum
zogad mizezad miviCnioT (Schachar and Ickowicz, 2000). ca, ar arsebobs imis mtkicebuleba, rom ukeTes
gamosavalTanaa dakavSirebuli. preparatis gverdiTi
prognozi efeqtebia: gaRizianebadoba, depresia, insomnia
hiperaqtiuroba asakTan erTad iklebs, gansakuTrebiT, da madis daqveiTeba. maRalma dozebma SeiZleba
Tu is zomieradaa gamoxatuli da yvela situaciaSi ar gaaZlieros stereotipuli qceva, romelic dozebis
vlindeba. Cveulebriv, TandaTan sustdeba pubertul SemcirebasTan erTad sustdeba. wamlis maRali
periodSi. Tanmxlebi daswavlis problemebisa da, dozebiT miRebisas bavSvi SedarebiT nela izrdeba,
gansakuTrebiT, antisocialuri qcevis SemTxvevaSi, Tumca, mozrdilis simaRlesa da wonaze es gavlenas
gamosavali ufro cudia. Tu hiperaqtiuroba mwvavea ar axdens (Taylor, 1994; Spencer et al., 1996). miuxedavad
da mas Tan axlavs ganviTarebis CamorCena an dabali imisa, rom xSirad tikebi uaresdeba, zog SemTxvevaSi,
inteleqti, maSin prognozi arakeTilsaimedoa; Se saWiroa preparatis miReba Tveebisa da ramdenime wlis
saZloa, mozrdil asakSic gagrZeldes da hipera manZilzec gagrZeldes. mniSvnelovania monitoringis
qtiurobis nacvlad, antisocialuri qceviTa da guldasmiT Catareba. zogi mSobeli ewinaaRmdegeba
wamalmoxmarebiT gamovlindes. dReisTvis ucnobia, preparatebis xangrZlivi droiT miRebas. aseT
ramdenad xSiria mozrdil asakSi guneb-ganwyobisa SemTxvevaSi, umjobesia wamlis gamosacdeli periodiT
_ 720 _
daniSvna. mSobeli TviTon Seafasebs mkurnalobis Tanatolebis an mozrdilebis mimarT, midrekilia
dadebiT mxareebs konkretuli bavSvis SemTxvevaSi. destruqciuli qcevisken. mogvianebiT asakSi qcevis
SesaZlebelia mkurnalobis SeCereba garkveuli aSlilobebi Tavs iCens ojaxidan nivTebis moparvis,
periodiT. amiT SevamcirebT gverdiT movlenebsac da urCobisa da cruobis saxiT, rasac Tan axlavs
davadgenT mkurnalobis gagrZelebis aucileblobasac. sityvieri da fizikuri agresia. SemdgomSi qcevis
aseve, hiperkinetikuri sindromis samkurnalod darRvevebi SesamCnevi xdeba rogorc saxlSi, aseve
licenzirebulia noradrenalinis ukumitacebis inhi gareT, gansakuTrebiT, skolaSi. xSiria skolis gac
bitori, atomoqsetini, romlis gverdiTi efeqtebia: dena, deliqventoba, vandalizmi, sarisko qcevebi,
gulisrevis SegrZneba, tkivili muclis areSi, madis alkoholisa da sxvadasxva fsiqoaqtiuri nivTierebis
daqveiTeba da Zilis darRvevebi. iSviaT SemTxvevebSi moxmareba. antisocialuri qcevis mqone mozardi
(daaxloebiT, 1 pacients 50.000 pacientidan, visac gogonebisTvis damaxasiaTebelia gaborotebuli, boR
mkurnaloba utardeba), SeiZleba ganviTardes RviZlis miani damokidebuleba Tanatolebis mimarT, emociuri
mZime dazianeba. marTalia, atomoqsetins gaaCnia bulingi, ganurCeveli seqsualuri kavSirebi, saxlidan
Teoriuli upiratesoba fsiqomastimulirebeli ef gaqceva.
eqtis gareSe, magram codna da gamocdileba misi anomaliurad iTvleba nivTebis moparvis per
moxmarebis Sesaxeb, metilfenidatTan SedarebiT manentuli SemTxvevebi 7 wlis asakis Semdeg. 7 wlamde
mniSvnelovnad SezRudulia. bavSvs ar aqvs sxvisi sakuTrebis gacnobierebis unari.
klinikuri kvlevebis Tanaxmad, stimulantebis aseve, bevri bavSvi zogjer ukiTxavad isakuTrebs
xanmokle gamoyeneba bavSvebis or mesameds dadebiT sxvis nivTebs. aseTi SemTxvevebi ar unda miviCnioT
Sedegebs aZlevs (Ottenbacher and Cooper, 1983), Tumca, qcevis darRvevad. bavSvebis garkveuli nawilisTvis
gaurkvevelia maTi xangrZlivad gamoyenebis Sedegebi. damaxasiaTebelia iseTi seqsualuri qceva, romelic
arsebuli monacemebiT, umjobesia, medikamenturi miuRebelia ufrosebisTvis, mag., masturbacia an
mkurnaloba Catardes ufro mZime SemTxvevebSi, seqsualuri cnobismoyvareoba. qceviTi darRvevebis
rodesac mkurnalobis sxva meTodebi uSedegoa. dros aman, SeiZleba, obsesiuri da permanentuli
sainteresoa, rom fsiqostimulantebiT mkurnaloba xasiaTi miiRos. seqsualuri TavSeukavebloba gan
bavSvebSi damokidebulebis ganviTarebas ar iwvevs. sakuTrebiT problemuria mozardi gogonebis Sem
preparatebis daniSvnisas ixelmZRvaneleT bavSvTa TxvevaSi. SedarebiT naklebia ganzrax xanZris gaCenis
da mozardTa fsiqiatriis amerikis akademiisa (2002) SemTxvevebi, Tumca, yovelTvis Zalian saSiSia.
da klinikuri praqtikis erovnuli saxelmZRvanelos qceviTi aSlilobebis dros metadaa gamoxatuli
(2000) gzamkvlevebiT (gaidlainebiT). qcevis darRvevebi vidre cxovrebiseul cvlilebebze
informacia am aSlilobis stimulantebiT mkur (mag., ojaxSi axali wevris _ dedinacvlis an
nalobis Sesaxeb ix. fsiqiatrTa samefo kolejis maminacvlis Semosvlaze) reagirebis SemTxvevaSi. ar
kvlevis jgufis masalebSi (1999). arsebobs mkafio sazRvari qceviT aSlilobebsa da cud
am aSlilobis zogadi menejmentis sakiTxebi mo qcevas Soris. es ufro mdgomareobis kontinuumia,
cemulia klinikuri praqtikis erovnuli institutis romelzedac diagnostikuri kriteriumebi gamyof
gzamkvlevSi (gaidlainSi, 2005). zRvars qmnis. es gamyofi zRvari gadis iseT
SemTxvevebze, romlebsac ufro mwvave mimdinareoba da
qcevis aSlilobebi uaresi gamosavali axasiaTebT. aseTi bavSvebi aqtiur
qcevis aSlilobebi xasiaTdeba mwvave da persis daxmarebas saWiroeben, rac upiratesad socialur
tentuli antisociluri qcevebiT da bavSvTa da da saganmanaTleblo daxmarebas iTvaliswinebs. Tum
mozardTa fsiqikuri aSlilobebis yvelaze farTo ca, komorbiduli daavadebis gamovlenisa da mul
jgufs warmoadgens. tidisciplinuri mkurnalobis dagegmvisas fsiqiatris
roli Zalian mniSvnelovania.
qcevis aSlilobis ZiriTadi maxasiaTebelia mya
klasifikacia
ri anomaliuri qceva, romelic mniSvnelovnad orive klasifikaciaSi (ICD-10 da DSM-IV) CamoTvlili
gansxvavdeba Cveulebrivi bavSvuri usaqcielobisgan. 15 simptomidan aucilebelia, sul cota, sami
anomaliuri qcevisTvis damaxasiaTebelia urCoba, simptomis arseboba aranakleb 6 Tvis manZilze. am
gamomwvevi, agresiuli da antisocialuri qmede klasifikaciebis mixedviT, aSlilobaTa kriteriumebi
bebi. skolamdel asakSi aSliloba vlindeba da msgavsia. gamomdinare iqidan, rom qceviTi aSlilobebi
umorCileblobisa da agresiuli qcevis saxiT, xSiria didi mravalferovnebiT gamoirCeva da Zalian
hiperaqtivobac. bavSvi ar ujerebs mSoblebs, xSirad did jgufs qmnis, orive sistemaSi isini ramdenime
emarTeba risxvis Setevebi, avlens agresias da-Zmis, tipadaa dayofili. DSM-IV-Si gamijnulia bavSvTa
_ 721 _
asakSi (10 wlamde) dawyebuli qceviTi aSlilobebi vidre mozardobaSi ganviTarebuli aSlilobebi
da mozardobis asakSi (10 da meti wlis) gamovlenili (Silberg et al., 1996). mamebis alkoholizmi da pirovnuli
qceviTi aSlilobebi. amave klasifikaciaSi aris aSlilobebi mWidrodaa dakavSirebuli bavSvebSi
damatebiTi kategoria _ òpoziciuri gamomwvevi qceviTi aSlilobebis ganviTarebasTan (Earls et al.,
qceviTi aSliloba~, romelsac axasiaTebs gada 1988). am kavSirs ganapirobebs rogorc genetikuri,
metebuli mtruli, provokaciuli da zianis momtani aseve garemo faqtorebi. arsebobs monacemebi, rom
qmedebebi, agresiuli da socialuri qcevis gareSe. geni monoamin A-oqsidaza ganapirobebs winaganwyobas
aseTi darRvevebi ufro 10 wlamde asakis bavSvebSi qceviTi aSlilobebis mimarT mxolod im SemTxvevaSi,
gvxvdeba. ICD-10-Si qceviTi aSlilobebis oTxi Tu amas adreuli bavSvobis periodSi warumatebeli
qvekategoria arsebobs: socializebuli qcevis aS garemo faqtorebis arseboba emateba (ix. Foley et
liloba, arasocializebuli qcevis aSliloba, qcevis al., 2004). genebis monawileobis SemTxvevaSi, ar aris
aSliloba Semofargluli ojaxis konteqstiT da bolomde naTeli, xasiaTis Taviseburebebze axdenen
opoziciur-gamomwvevi qceviTi aSliloba. isini gavlenas, Tu sxva gziTac moqmedeben.
organuli faqtorebi. bavSvebi, romlebsac epi
gavrcelebis sixSire lefsia an Tavis tvinis dazianeba aReniSnebaT ufro
qceviTi aSlilobebis gavrcelebis sixSiris dadgena midrekilebi arian qceviTi aSlilobebisadmi.
rTulia, radgan Znelia mkveTri sazRvris gavleba sxva kavSirebi. uaitis kunZulze Catarebuli kvle
normalur meamboxeobasa da paTologiur qcevas vebis dros erT-erTi Zalian mniSvnelovani aRmoCena
Soris. SedarebiTi maCvenebeli ramdenime wlis iyo pirovnebis antisocialur aSlilobasa da kiTxvis
win dadginda da mas Semdeg aRarc gadasinjula. am specifikur darRvevebs Soris kavSiris dadgena (gv.
monacemebis mixedviT 10-11 wlis asakis bavSvebSi ??). dReisTvis ucnobia, antisocialuri aSliloba
(Rutter et al., 1975a, 1976b) àntisocialuri aSliloba~ da kiTxvis specifikuri darRvevebi winaganwyobis
uaitis kunZulebze mcxovrebTa 4%-s aReniSneba, xolo erTi da imave faqtorebiTaa ganpirobebuli, Tu erTi
londonis macxovreblebSi es ricxvi TiTqmis 2-jer gansazRvravs meores da, Tu es asea, romelia wamyvani
metia. mogvianebiT, kanadaSi Catarebuli kvlevebis (qceviTi aSlilobis etiologiis sakiTxebi ix. Earls and
Tanaxmad es maCvenebeli 5, 5%-ia (Offord et al., 1987). Mezzacappa, 2002).
ufros asakobriv jgufSi ufro maRali monacemebi
dafiqsirda (Scott, 2000). rogorc mosaxleobaSi, prognozi
aseve arasrulwlovanTa sasjelaRsrulebis dawese qceviTi aSlilobis grZelvadiani gamosavali, misi
bulebebsa da fsiqiatriul servisebSi Catarebuli bunebisa da simwvavis xasiaTidan gamomdinare,
kvlevebiT gamovlinda, qceviTi aSlilobebi biWebSi mniSvnelovnad meryeobs. erT-erTi farTomasStabiani
samjer ufro xSiria, vidre gogonebSi (Rutter et al., 1970a; kvleviT dadginda, rom im bavSvebis TiTqmis naxevarma,
Gath et al., 1977). maRali maCveneblebi asocirebulia romlebic qceviTi aSlilobebis diagnoziT gadiodnen
dabal socio-ekonomikur statussa da mravalwevrian mkurnalobas, mozardobis asakSi antisocialuri qceva
ojaxebTan. gamoavlina (Robins, 1966). mozrdilebSi sociopaTiis
arc erTi SemTxveva ar aris dafiqsirebuli, rom
etiologia pacients mozardobaSi qceviTi aSliloba ar hqonoda.
mniSvnelovania garemo faqtorebi. qceviTi aSli kontrolebsa da bavSvTa saxlebis qceviTi aSlilobebis
lobebi ufro xSirad aReniSnebaT zrunvamoklebul mqone aRsazrdelebze xangrZlivma dakvirvebam igive
bavSvebs, romlebic arastabilur da daucvel Sedegebi aCvena; qceviTi aSlilobebis mqone bavSvebis
ojaxebSi izrdebian. antisocialuri qceva ufro 40%-s 20 wlis asakSi pirovnebis antisocialuri
xSirad vlindeba arasruli an arasrulfasovani aSliloba aReniSneba. danarCenebs _ mudmivi da
urTierTobebis mqone ojaxis, an bavSvTa saxlebis farTo speqtris socialuri sirTuleebi axasiaTebT,
aRsazrdelebSi. qceviTi aSlilobebis ganviTareba, romlebic pirovnuli aSlilobis diagnostikur
aseve, ufro farTo socialuri konteqstis uaryofiT kriteriumebs bolomde ver akmayofileben. mozrdil
faqtorebTanaa dakavSirebuli, rogoricaa skola da asakSi seriozuli socialuri problemebi, aseve,
samezoblo (Rutter et al., 1975b). bavSvTa saxlSi aRzrdasTanaa dakavSirebuli, xolo
genetikuri faqtorebi. qceviTi aSlilobebi ojaxis qceviTi aSlilobis arseboba, Tu am monacemis efeqts
wevrebs Soris ufro xSiria, Tumca, tyupebis kvlevebiT gaviTvaliswinebT, amaze damatebiT, mniSvnelovan gav
dadginda, rom gaziarebuli garemo faqtorebi lenas axdens (Zoccolillo et al., 1992).
genebze ufro mniSvnelovania. aseve, naCvenebia, rom mamrobiTi sqesis mozrdil pirebs qceva da simp
adreuli asakidan gamovlenili persistentuli tomebi, Cveulebriv, bavSvobaSi gamovlenili niSnebis
SemTxvevebi ufro Zlieri genetikuri etiologiisaa, msgavsi aqvT, kerZod, damaxasiaTebelia antisocialuri
_ 722 _
pirovnuli Tvisebebi, agresia, alkoholizmi, wamal gamyareba da anomaliur qcevebze limitis daweseba,
moxmareba da kriminaluri qmedebebi. mag., saTamaSo drois erTi saaTiT SezRudva. damxmare
mdedrobiTi sqesis warmomadgenlebs asakTan erTad saSualebebad gamoiyeneba werilobiTi informacia da
qcevis paternebi da simptomebi ecvlebaT da ufro sxva mSoblebis mier aprobirebuli qceviTi teqnikebis
metad emociur da pirovnul problemebs ukavSirdeba. videoCanawerebi (mSoblebis treningis mimoxilva ix.
cudi gamosavlis ganmsazRvreli faqtorebi (ix. Scott, 2002).
Goodman and Scott, 2005, gv. 68-69): brazis menejmenti. naCvenebia, rom axalgazrda
axalgazrda pirebisTvis: pirebi, romlebsac agresiuli qcevebi axasiaTebT,
w dasawyisi adreul asakSi; arasworad aRiqvamen sxvebis mtrul ganwyobas maT
mimarT maSin, rodesac es ase ar aris. maT, aseve, ar
w mravali da cvalebadi xasiaTis simptomebi da qce
SeswevT unari saTanadod gaacnobieron TavianTi
vebi;
agresiuli qcevebis simwvave da Sesabamisi sityvieri
w mwvave simptomebi da qcevebi; reagirebis nacvlad, Seusabamo qcevas mimarTaven.
w simptomebisa da qcevis gamovlena nebismier garemoSi brazis marTvis programa miznad isaxavs aseTi
(saxlSi, skolaSi, da sxvagan); damokidebulebis koreqcias da aswavlis ucabedad
w asocirebuli hiperaqtiuroba. aRmocenebuli agresiuli grZnobebis inhibicias.
ojaxisTvis: mag., bavSvi eubneba Tavis Tavs _ `SeCerdi, ra unda
gavakeTo?~. isini, aseve, swavloben, rogor gadaafason
w mSoblebis fsiqikuri aSlilobebi;
sxvebis ganzraxvebi da, Tavis dasamkvidreblad, rogor
w mSoblebis kriminaluri istoria; gamoiyenon socialurad ufro misaRebi formebi.
w daZabuli, arakeTilganwyobili urTierTobebi/bav sxva meTodebi. kiTxvis darRvevebis dros auci
SvTan dakavSirebuli uTanxmoebebi. lebelia sakoreqcio Terapiis gamoyeneba. jgufuri
Terapia iSviaT SemTxvevebSia efeqturi. komorbiduli
mkurnaloba aSlilobebis ararsebobis dros medikamenturi
msubuqi xasiaTis qceviTi aSlilobebi mkurnalobis mkurnaloba nakleb Sedegiania. Tanmxlebi daavadebebis
gareSec SeiZleba gamoswordes da mSoblebisTvis SemTxvevaSi saWiroa Sesabamisi mkurnalobis Catareba.
rCevis micema, SeiZleba sruliad sakmarisi aRmoCndes. instituciuri zrunva. zogjer aucilebelia bavSvis
ufro mZime SemTxvevebSi, bavSvis mkurnalobasTan saojaxo tipis saxlSi moTavseba, an specialur skolaSi
erTad, tardeba Terapia da socialuri mxardaWera gagzavna, an mindobiT aRzrdis uzrunvelyofa. es
ojaxisTvisac. nebismieri TandarTuli aSlilobis mxolod gansakuTrebul SemTxvevaSi unda moxdes.
SemTxvevaSi (hiperaqtivobiTa da yuradRebis deficitiT ar arsebobs aranairi mtkicebuleba imisa, rom
mimdinare aSliloba, depresia) unda Catardes Sesabamisi instituciuri zrunva qceviTi aSlilobebis prognozs
mkurnaloba. ar arsebobs aranairi mtkicebuleba imisa, aumjobesebs.
rom romelime mkurnalobam SeiZleba gavlena moaxdinos
mdgomareobis grZelvadian prognozze. Tumca, xanmokle skolis gacdena
gaumjobeseba, umetes SemTxvevaSi, miRwevadia. amasTan, skolis gacdenis SemTxvevaSi mkurnaloba calke unda
SesaZlebelia ojaxis uaryofiTi gavlenis imgvarad daigegmos. saWiroa miznobrivi da energiuli Carevis
modificirebac, rom prognozulad ukeTesi Sedegi ganxorcieleba. mTeli Zalisxmeva mimarTuli unda
miviRoT. zogi ojaxisTvis daxmarebis gaweva praqtikulad iyos bavSvis skolaSi dabrunebaze da, ramdenadac
SeuZlebelia, gansakuTrebiT iseT SemTxvevebSi, SesaZlebelia, am sakiTxSi mSoblebisTvis daxmarebis
rodesac vawydebiT materialur problemebs, qaotur gawevaze. amave dros, unda daiZlios rogorc swav
urTierTobebsa da mSoblebis arasakmaris ganaTlebas lasTan dakavSirebuli, ise sxva saskolo problemebic.
(ix. bavSvTa da mozardTa fsiqiatriis amerikuli yovelive amis ganxorcielebisas, umniSvnelovanesia
akademiis praqtikuli saxelmZRvanelo (1997b), da Earls klinicistebs, ojaxsa da pedagogebs Soris kargi
and Mezzacappa (2002). urTierTobebis arseboba da SenarCuneba. Tu sxva
mSoblebis treningis programa. es programa iyenebs gamosavali ar aris, SeiZleba, sasamarTlo pro
biheviorul principebs (gv. ??) mSoblebs ganumartaven cedurebis gamoyenebac.
Tu, rogor SeiZleba bavSvebis antisocialuri qceva,
Tu masze yuradRebas ar gavamaxvilebT, uneburad iuveniluri deliqventoba
gavamyaroT an ojaxis wevrebs Soris arajansaRi iuveniluri deliqventi aris axalgazrda piri, ro-
urTierTobebiT movaxdinoT misi provocireba. melic scnes damnaSaved iseT qmedebaSi, rac mozrdil
mSoblebs aswavlian, Tu rogor unda SesZlon maT asakSi kriminalur qmedebad fasdeba. bevr qveyanaSi
SeqebiTa da dajildovebiT normaluri qcevis es termini gamoiyeneba mxolod im axalgazrda piris
_ 723 _
mimarT, romelmac miaRwia sisxlissamarTlebrivi pa- qventobis maCvenebeli aseve gansxvavebulia sxvadasxva
suxismgeblobis asaks (did britaneTSi _ 10 welia, skolebSi. kriminaluri bunebis gasagebad bevri so-
xolo sxva qveynebSi _ mniSvnelovnad meryeobs). deli- cialuri Teoriaa gamoyenebuli, Tumca verc erTiT
qventoba ar aris fsiqiatriuli diagnozi, aramed iu- ver xerxdeba misi srulfasovani, adekvaturi axsna
ridiuli kategoriaa. Tumca, iuveniluri deliqven- (socialuri faqtorebis mimoxilva ix. Farrington, 2000).
toba, SeiZleba fsiqikur, gansakuTrebiT ki, qceviT ojaxis faqtori. bevri kvleva adasturebs, rom
aSlilobebTan iyos dakavSirebuli. aqedan gamomdin- samarTaldarRvevebi ojaxur xasiaTs atarebs (Far-
are, mizanSewonilia am aSlilobebis ganxilvisas iuve- rington et al., 1996). mag., kriminaluri istoriis mqone
niluri deliqventobac mimovixiloT. mamebis vaJebis naxevari, arakriminali mamebis vaJebis
mozardi biWebis umravlesoba, rodesac maT sTxoven mxolod mexuTedTan SedarebiT, Tavadac nasamarTle-
TavianTi saqcielis aRweras, aRiarebs kanonis sawi- via (West and Farrington, 1977). amis mizezi ar aris bo-
naaRmdegod Cadenil qmedebebs, xolo, yoveli mexuTe lomde axsnili, Tumca, es SeiZleba mSoblebis arasak-
erTxel mainc dakavebulia amis gamo (West and Farrig- marisi zrunviTa da kanonis mimarT ojaxis damokideb-
ton, 1973). ZiriTadi samarTaldarRvevebi sakuTrebis ulebiT iyos ganpirobebuli.
winaaRmdegaa mimarTuli. gogonebi biWebze bevrad yvelaze xSirad citirebul kvlevaSi (Bowlby, 1944),
naklebad Cadian kriminalur qmedebebs, Tumca, aR- romlis maSveobiTac swavlobdnen deliqventi qur-
saniSnavia, rom ukanaskneli 40 wlis manZilze es Se- debis maxasiaTeblebs, miTiTebulia, rom maTi prob-
fardeba 11:1-dan 4:1-mde Semcirda. msgavsi Sedegebi lemebis ZiriTadi mizezi bavSvobis asakSi dedasTan
sxva qveynebSic miiRes (D.J.Smith, 1995). msjavrdebuli xangrZlivi ganSoreba iyo. ufro Tanamedrove kv-
biWebis naxevari ganmeorebiT Cadis danaSauls, iuveni- levebma es mosazreba ar daadastura (gv. ??). deli-
luri deliqventebis mxolod mcire nawili agrZelebs qventi bavSvebis umravlesoba arasruli ojaxebidanaa,
kriminalur qcevas mozrdil asakSi. erT-erTi kvlevis rac, rogorc Cans, asaxavs ojaxuri uTanxmoebebis
Tanaxmad, im iuveniluri deliqventebis sami meoTxe- arsebobas bavSvobisa da mogvianebiT asakSi (Rutter and
di, romlebmac iuvenilur asakSi sami an meti dana- Madge, 1976). sxva ojaxuri faqtorebi, romlebic del-
Saulebrivi qmedeba Caidines, mozrdil asakSic moxvda iqventobasTanaa dakavSirebuli, esaa mravalricxovani
cixeSi (Farrington, 2002). am monacemebs Tu mivyvebiT, ojaxi da aRzrdis Taviseburebebi, mag., araTanmim-
unda gaviTvaliswinoT, rom kriminalurma statisti- devruli, qaoturi, an zedmetad mkacri, an gulgrili
kam SeiZleba SecdomaSi Segviyvanos. Tumca, rogorc damokidebuleba.
vxedavT, gamokiTxuli da msjavrdebuli damnaSaveebis bavSvis faqtorebi: genetikuri faqtorebi, rogorc
monacemebs Soris garkveuli msgavseba arsebobs (West Cans, naklebad mniSvnelovania deliqventobis gamom-
and Farrington, 1973). wvev mizezebs Soris, vidre es aris mozrdil asakSi
deliqventoba xSirad qceviTi aSlilobebis ekviva- Cadenili seriozuli kriminaluri qmedebebis dros
lentad ganixileba. miuxedavad imisa, rom es ori (gv. ??) (qceviTi aSlilobebis genetikuri faqtore-
kategoria garkveuli TvalsazrisiT faravs erTma- bi ganxilulia zemoT). arsebobs TvalsaCino kavSiri
neTs, maTi gaTanabreba arasworia. bevr deliqvents deliqventobasa da saSualoze dabal IQ maCvenebels,
ar aReniSneba qcevis an sxva fsiqikuri aSliloba. daswavlisa da kiTxvis problemebs Soris (Rutter et al.,
aseve, qceviTi aSlilobebis mqone pirebi, yovelTvis 1976a). amas, sul cota, ori axsna aqvs. xasiaTobri-
ar arRveven kanons. Tumca, gasaTvaliswinebelia, rom vi Taviseburebebi da socialuri faqtorebi ganapi-
xSir SemTxvevaSi, persistentul kanonsawinaaRmdego robebs winaganwyobas rogorc deliqventobis, aseve
qmedebebs Tan axlavs qcevis anomalia, skolis gacde- kiTxvis darRvevebis mimarT. aseve, kiTxvis darRveve-
na, agresiuloba, yuradRebis mipyrobis survili da bi SeiZleba gaxdes imedgacruebisa da TviTSefasebis
koncentraciis daqveiTeba. daqveiTebis mizezi, rac antisocialuri qcevisken
ubiZgebs bavSvs. fizikuri arasrulfasovneba, sa-
mizezebi varaudod, umniSvnelo rols asrulebs deliqvento-
iuveniluri deliqventobis mizezebi kompleqsuria da bis ganviTarebaSi, miuxedavad imisa, rom tvinis da-
moicavs qceviTi aSlilobebis gamomwvev mizezebsac zianeba da epilefsia SeiZleba qceviTi aSlilobebi-
(mizezebi aq mokledaa ganxiluli. ufro detaluri sadmi winaganwyobis mizezi iyos.
informacia ix. Rutter et al., 1998).
socialuri faqtorebi. deliqventoba dakavSire- Sefaseba
bulia dabal socialur fenasTan, cud sacxovrebel bavSvis fsiqiatriul dawesebulebaSi gasinjvis dros,
pirobebTan da ganaTlebis dabal donesTan. deliqven- Tu deliqventobas Tan axlavs fsiqikuri aSliloba,
tobis sixSire, CamoTvlili monacemebis mixedviT, sx- es ukanaskneli Cveulebrivad unda Sefasdes. zogjer
vadasxva raionebSi TvalsaCinod gansxvavdeba. deli- bavSvTa fsiqiatrs, sasamarTlosTvis moxsenebis mo
_ 724 _
gatardes. bevr bavSvsa da mozards, romlebic iuve-
cxrili 24.7 axalgazrda msjavrdebulebis niluri sasamarTlos winaSe warsdgebian, fsiqikuri
Sefaseba*
aSliloba aReniSneba. maT Soris xSiria qceviTi da
danaSauli afeqturi aSlilobebi, yuradRebis deficitiTa da
danaSaulis simZime da xasiaTi hiperaqtivobiT mimdinare aSliloba, wamalmoxmareba
msxverplis maxasiaTeblebi
da wamaldamokidebuleba, daswavlis darRvevebi da
epilefsia. am aSlilobebis mkurnaloba sxvadasxva
motivi
TavSia ganxiluli.
jgufSi msjavrdebulis roli sxvebis monawileobis fsiqiatri, romelic mkurnalobs deliqvent bavS-
SemTxvevaSi
vebsa da mozardebs, kargad unda icnobdes im qveynis
damokidebuleba danaSulisa da msxverplis mimarT samarTlebriv sistemas, romelSic muSaobs. iuridi-
qcevis sxva problemebi
uli Careva moicavs: gafrTxilebas _ar iqnes Cadenili
danaSauli; xelmeored dakisrebul jarimebs; ojaxis
Cadenili sxva danaSauli _ raodenoba, xasiaTi, nasamarTleoba,
wevrebis an meurvis mimarT saTanado kontrolisTvis
Zaladoba wayenebul moTxovnebs; socialuri muSakis superviz-
TviTdazianeba ias; specialur centrebSi dayovnebas an, saWiroebis
SemTxvevaSi, adgilobrivi xelisuflebis CarTvas.
bavSvebis an cxovelebis mimarT sisastike
procedurebis zusti CamonaTvali gansxvavebulia sx-
cecxlis wakideba vadasxva qveyanaSi. deliqventuri qcevebi sakmaod xSi-
*gamoyenebulia Goodman & Scott, 2005 cxrili 7.1 ria; upiratesad, naklebad seriozuli da, ZiriTadad,
gardamavali xasiaTisaa, amitom zogadad miRebulia,
samzadeblad, deliqventi bavSvis naxvas sTxoven. aseT rom pirveli SemTxvevis dros minimaluri Carevaa
SemTxvevaSi aucilebelia informaciis Sekreba ro- saWiro, Tumca, mkacri gakicxva aucilebelia. igive
gorc mSoblebisa da maswavleblebisgan, ise social- midgomaa ganmeorebadi umniSvnelo kanonsawinaaRm-
uri muSakis an probaciis oficrisgan, romelsac bavS- dego qmedebebis SemTxvevaSic. ufro energiuli Ca-
vze zrunva evaleba. reva saWiroa SedarebiT seriozuli da mravaljeradi
aseve, mniSvnelovania ganaTlebis donisa da in- danaSaulis Cadenisas. aseT dros gamoiyeneba Temze
teleqtis fsiqologiuri kvleva. sxva kvlevebi, dafuZnebuli programebi. maTi mTavari mizania ojax-
romlebic unda iyos gaTvaliswinebuli, mocemu- uri garemos gajansaReba, Tanatolebis uaryofiTi
lia cxrilSi 24.7. moxsenebiTi baraTis forma ukve gavlenis prevencia, xolo, Tavad mozardisTvis _
aRwerili formis msgavsia (gv. ??). mas unda axldes problemebis daZlevis ukeTesi unarebisa da profe-
mokle anamnezi, amJamindeli fsiqikuri statusi da siuli unar-Cvevebis swavleba da ganaTlebis donis
mkurnalobasTan dakavSirebuli rekomendaciebi. gaumjobeseba. did britaneTSi aseTi programebi Se-
muSavebulia axalgazrda msjavrdebulTa gundis mier.
Zaladoba mozardebSi
Tu am programebs Sedegi ar aqvs, maSin Tavisuflebis
mozardebSi aRiniSneba Zaladobrivi kriminaluri aRkveTas mimarTaven.
qmedebebis zrdis riski. axalgazrdebSi Zaladobis bavSvebisa da axalgazrda pirebis mimarT arsebuli
mizezebi bolomde ar aris Seswavlili. moZalade kanonmdeblobis ZiriTadi arsi aris mkurnaloba da
damnaSaveebi umeteswilad imeoreben danaSauls. did ara dasja. danergili meTodebis efeqturobis Sesas-
britaneTSi 50 SemTxvevis Seswavlam (Bailey and Aulich, wavlad Catarebulia mravali kriminologiuri kvleva.
1997), romelTa drosac umZimesi danaSauli _ mkvl- zogadi Sedegebi maincdamainc imedis momcemi araa.
eloba iyo Cadenili, aCvena, rom danaSaulis Cadenamde Tumca, es gasakviric ar unda iyos, vinaidan, rogorc
umravlesobas emociuri darRvevebi, aseve, ojax- ukve aRvniSneT, deliqventoba bavSvisgan damoukideb-
uri da ekonomiuri sirTuleebi aReniSneboda. mcire el bevr faqtorTanaa dakavSirebuli, rogoricaa
nawils daswavlis problemebi hqonda. Tumca, Seswav- dezorganizebuli ojaxi, mSoblebis antisocialuri
lili 76 maxasiaTeblidan arc erTi ar ganasxvavebda am qceva da mZime sacxovrebeli pirobebi. ganmeorebiTi
axalgazrdebs sxva damnaSaveebisgan. igive monacemebi gasamarTlebis riski ufro maRalia im SemTxvevaSi,
miiRes aSS-Si Catarebuli kvlevebiT (Meyers and Kemph, Tu piri erTxel ukve warsdga sasamarTlos winaSe
1990. damatebiTi informacia ix. Bailey and Dolan, 2004). an sasjeli moixada, vidre maSin, roca imave danaSau-
marTva lisTvis aranairi oficialuri RonisZieba ar yofila
ganxorcielebuli (West and Farrington, 1977).
am nawilSi visaubrebT im prevenciul zomebze, rom-
deliqventobis mkurnalobis mravali sxvadasxva
lebic danaSaulis Tavidan acilebis mizniT unda
meTodidan SedarebiT warmatebulad miCneulia Sem-
_ 725 _
degi sami:
cxrili 24.8 bavSvobis asakSi ganviTarebuli
1. ojaxis funqciuri Terapia (Alexander and Parsons, SfoTviTi aSlilobebi
1982). Terapevti muSaobs ojaxTan sami Tvis ganmav-
DSM-IV ICD 10
lobaSi. Terapiis mizania: (1) ojaxis motivacia, (2)
specifikuri problemis gamovlena da muSaoba imaze, emociuri aSlilobebi bav
Tu rogor aRmoifxvras igi, (3) problemis daZle- SvebSi F93
vis unar-Cvevebis aTviseba da maTi sxvadasxva situ- ganSorebis SfoTviTi aSli bavSvebSi ganSorebis SfoT
aciebSi gamoyenebis swavleba. loba viTi aSliloba
2. multisistemuri Terapia (Henggeler et al., 1999) moi- fobikuri SfoTviTi aSli bavSvTa fobikur SfoTviTi
loba* aSliloba
cavs eqvs elements: (1) ojaxis Terapias, (2) axal-
gazrda pirebis daxmarebas, raTa maT moZebnon ara- socialuri fobia socialur_SfoTviTi aSli
loba bavSvTa asakSi
deliqventi megobrebi, (3) pirovnul ganviTarebas,
asertuli treningis CaTvliT, (4) ojaxuri proble- siblingebis urTierTobis siblingTa konkurencia
mis daZlevis unarebis gaumjobesebas, (5) maswavleb- problemebi**
lebTan kavSirs, (6) sxva saagentoebTan kontaqts. posttravmuli stresuli posttravmuli stresuli
aSliloba* aSliloba
3. mindobiT aRzrdis mravalganzomilebiani mkurna
loba (Chamberlain, 1990). daaxloebiT eqvsi Tvis obsesiur_kompulsuri obsesiur_kompulsuri
aSliloba* aSliloba
manZilze axalgazrda piri Tavisi deliqventi me-
gobrebisgan moSorebiT cxovrobs da ukeTes cxov- *bavSvTa asakSi ganviTarebuli am aSlilobebisTvis ar
arsebobs damoukidebeli kategoriebi da gamoiyeneba
rebiseul unarebs iTvisebs. amave dros, misi ojaxis
mozrdilTa kategoriebi (ixileT teqsti)
wevrebs aswavlian im unar-Cvevebs, romlebic gamo-
sadegia bavSvis saWiroebebze efeqturad reagire- **Sesulia kategoriaSi _ sxva mdgomareobebi, romlebic
klinikur yuradRebas saWiroeben
bisTvis.
am da sxva midgomebis Seswavlam gamoavlina, rom da DSM-IV-Si CamoTvlili ramdenime diagnozi Seesa-
aucilebelia konkretuli Terapiis individualurad bamebodes, mag., fobikuri aSliloba da ganSorebis
morgeba. zogi samarTaldamrRvevisTvis ufro mkac- SfoTviTi aSliloba.
ri zomebis gatarebaa efeqturi, xolo zogisTvis _
naklebad SemzRudavi Terapiaa Sedegiani. samwuxarod, gavrcelebis sixSire
dReisTvis SeuZlebelia srulfasovani saxelmZRvane- bavSvTa asakis SfoTviTi aSlilobebis gavrcelebis
los Seqmna, romelSic damnaSavis tipTan Sesabamisi sixSire ar aris saTanadod Seswavlili, vinaidan kv-
mkurnalobis meTodi iqneba mocemuli (bavSvTa da mo- levebSi ZiriTadad, ufro farTo kriteriumebi ga-
zardTa sasamarTlo eqspertizis sakiTxebi ix. Bailey moiyeneba, romlebic emociur aSlilobebsac moicaven
and Dolan, 2004). an kiTxvebi SfoTviTi simptomebisa da ara SfoTviTi
sindromis gamosavlenadaa dasmuli. uaitis kunZulze
SfoTviTi aSlilobebi Catarebul kvlevaSi emociuri aSlilobebis sixSire
ar arsebobs mkveTri zRvari normalur SfoTvasa gogonebsa da biWebSi 2, 5% iyo (Rutter et al., 1970a).
da bavSvebSi SfoTvis aSlilobebs Soris. ICD-10-Si londonSi es monacemebi 2-jeraa gazrili (Rutter et al.,
SfoTviTi aSliloba bavSvebSi emociur aSlilobadaa 1975a). londonSic da uaitis kunZulzec qceviTi aS-
klasificirebuli, romelic specifikurad bavSvTa lilobebis sixSire emociur aSlilobebze 2-jer meti
asakSi iwyeba (cxrili 24.8). DSM-IVklasifikaciaSi es iyo. zogadi populaciis SedarebiT Tanamedrove kv-
kategoria Sesuli araa da, ori gamonaklisis garda, levam 7-11 wlis asakis bavSvebSi SfoTviTi aSlilo-
bavSvTa SfoTviTi aSlilobebi mozrdilTa SfoTvi- bebis 6-8% gamoavlina, romlis naxevars ganSorebis
Ti aSlilobebis msgavsadaa mocemuli. gamonaklisia SfoTviTi aSlilobebi warmoadgens (Andrerson et al.,
ganSorebis SfoTviTi aSliloba da reaqtiuli mi- 1987; Bird, 1996).
jaWvulobis aSliloba, rac Sesulia TavSi _ `Cvilo-
SfoTva sxvadasxva asakSi
bis, bavSvTa da mozardTa asakis sxva aSlilobebi~.
ICD-10-Si, aseve, aris diagnozi _ siblingTa konku- bavSvebisTvis SfoTva damaxasiaTebelia. asakTan
rencia. DSM-IV-Si es diagnozi mocemuli araa, Tumca, erTad, SfoTvis xasiaTi icvleba. CvilobaSi bavS-
da-Zmas Soris urTierTobis problemebi ganxilulia vi ucxos mimarT SiSis stadias gadis; skolis asakSi
problemaTa CamonaTvalSi: `sxva mdgomareobebi, rom- xSiria ganSorebis SfoTva da cxovelebis, jadosnuri
lebic klinikur yuradRebas saWiroeben~. konkretul qmnilebebisa da sibnelis SiSi. mozardobaSi SiSi icv-
SemTxvevaSi, bavSvis mdgomareobas SeiZleba ICD-10-sa leba socialur situaciebTan da pirovnul adekvatu-
_ 726 _
robasTan dakavSirebuli SfoTviT. bavSvTa asakSi gan- temperamenti axasiaTebT. zogjer, rogorc Cans, es
viTarebuli SfoTviTi aSlilobebi imeorebs ganviTa- mdgomareoba SfoTviani da hipermzrunveli mSoblebis
rebis am Tanmimdevrobas, magram gamovlenili niSnebi sapasuxod viTardeba.
ufro mwvave da gaxangrZlivebulia. fobikuri da gan-
Sorebis SfoTviTi aSlilobebi, Cveulebriv, adreuli mimdinareoba
bavSvobis asakSi iwyeba, xolo socialuri SfoTviTi ganSorebis SfoTviTi aSlilobis simptomatika asak-
aSliloba mozardobis asakSi viTardeba. Tan erTad TandaTanobiT umjobesdeba, Tumca, SeiZ-
leba gauaresdes, Tu bavSvis rutinuli cxovreba
ganSorebis SfoTviTi aSliloba icvleba (mag., bavSvi skolaSi siaruls iwyebs). zog
ganSorebis SfoTviTi aSliloba _ esaa im pirebTan SemTxvevaSi ganSorebis SfoTviTi aSliloba mozrdil
ganSorebis SiSi, romelTa mimarTac bavSvi mijaWvu- asakSi generalizebul an sxva saxis SfoTviT aSlilo-
lobas ganicdis. ganSorebasTan dakavSirebuli emocia baSi progresirebs.
aSkarad gadaWarbebulia da mniSvnelovnad aRemateba
Cvilobisa da skolamdeli asakis bavSvebSi gamovle- mkurnaloba
nil SfoTvis xarisxs, an grZeldeba mogvianebiT asak- saTanado yuradReba unda mieqces yvela SesaZlo eti-
Sic da iwvevs socialuri funqcionirebis gauarese- ologiur faqtors. maT Soris, mniSvnelovania wina
bas. aSliloba iwyeba 6 wlamde asakSi. diagnozi ar ganSorebebis, SfoTvisadmi midrekili xasiaTisa da
ismeba maSin, rodesac gvaqvs pirovnuli ganviTarebis mSoblebis qcevis gaTvaliswineba. aucilebelia, SeZ-
zogadi darRvevebi. lebisdagvarad, stresorebis Sesusteba da bavSve-
bisTvis sakuTari gancdebis gamJRavnebaSi xelis Sew-
klinikuri suraTi yoba. Zalian mniSvnelovania ojaxis wevrebis CarTva
am aSlilobis mqone bavSvebi mSoblebs an sxva pireb- da maTTvis daxmarebis gaweva, raTa gaacnobieron, Tu
Tan daSorebisas, romelTa mimarT mijaWvuloba axa- rogor moqmedebs gadametebuli SfoTva da hiperpro-
siaTebT, gadametebul SfoTvas avlenen. maT usafuZ- teqcia bavSvis mdgomareobaze. aseve, saWiroa gzebis
vlod eSiniaT, rom maTTvis mniSvnelovan adamians sa- Zieba, romelic uzrunvelyofs bavSvis simSvidesa da
SiSroeba emuqreba an maTi mitoveba aqvs ganzraxuli. daculobis SegrZnebas. saWiroebis SemTxvevaSi, Zali-
isini uars acxadeben am adamianis gareSe daZinebaze an, an mwvave SfoTvis dros, SeiZleba anqsiolizuri pre-
calke daZinebis SemTxvevaSi, Ramis koSmarebi aReniS- paratebis daniSvna, Tumca, maTi miReba mxolod xan-
nebaT. dRis ganmavlobaSi bavSvebi TavianTi mijaWvu- mokle periodiTaa mizanSewonili. ganSorebis SfoT-
lobis obieqts ar scildebian da mudmiv yuradRebas viTi aSlilobis gamwvavebisas, zog SemTxvevaSi, SiSis
moiTxoven. SfoTva upiratesad somaturi niSnebiT dasaZlevad iyeneben biheviorul teqnikas, romelic
vlindeba, rogorebicaa muclis tkivili, Tavis tki- SeiZleba efeqturi aRmoCndes. es sakiTxi momdevno
vili, gulisrevis SegrZneba da pirRebineba. amas xSi- nawilSi iqneba ganxiluli.
rad Tan axlavs xSiri tirili, socialuri izolacia
an risxvis Setevebi. ganSorebis SfoTviTi aSliloba fobikuri SfoTviTi aSliloba
erT-erTi mizezia imisa, rom bavSvi uars ambobs sko- fobikuri SfoTviTi aSlilobis diagnozi bavSvebSi
laSi siarulze. Seesabameba specifikur fobikur aSlilobas
mozrdilebSi (gv. ??). bavSvTa asakSi xSiria mcired
epidemiologia famoxatuli fobiebi da ZiriTadad ukavSirdeba
mosaxleobis gamokvlevam aCvena, rom ganSorebis cxovelebs, mwerebs, sibneles, skolasa da sikvdils.
SfoTviTi aSliloba 7-11 wlis gogonebisa da biWebis fobiebis simwvave asakTan erTad icvleba. cxovelebis
3-4%_s aReniSneba (Anderson et al., 1987; Benjamin et al., Zlieri da persistentuli SiSi 5 wlamde asakSi iwyeba
1990). da, TiTqmis yvela SemTxvevaSi, mozardobis asakSi
sustdeba, xolo 11 wlisTvis mxolod 2%-s aReniSneba
etiologia (Anderson et al., 1987; Milne et al., 1995).
ganSorebis SfoTviTi aSliloba xSirad raime safrT-
xis Semcveli SemTxveviTaa provocirebuli. es SeiZle- mimdinareoba
ba iyos xanmokle problema, rogoricaa saavadmyofoSi umetes SemTxvevaSi mdgomareoba umjobesdeba da
moTavseba, an droSi gaxangrZlivebuli movlena, mag., mxolod 10-15%-s ugrZeldeba mozrdil asakSic (Last
konfliqti mSoblebs Soris. ganSorebis SfoTviTi et al., 1997).
aSliloba zogjer iseT bavSvebs uviTardebaT, rom-
lebic zedmeti emociurobiT reagireben yoveldRiur mkurnaloba
stresorebze, an romlebsac SfoTvisadmi midrekili bavSvTa asakSi gamovlenili fobiebis umravlesoba
mkurnalobis gareSe gadis. mdgomareobis gaumjo
_ 727 _
besebisTvis sruliad sakmarisia mSoblebis mxar radReba. saWiroa ufros bavSvebs limiti dauweson da
daWeriTi da gamamxnevebeli midgoma. fobiebisTvis, Zvirfas adamianad agrZnobinon Tavi.
romlebic SedarebiT persistentulia, gamoiyeneba
martivi bihevioruli Terapia, romlebsac Tan unda posttravmuli stresuli aSliloba
axldes waxaliseba da mxardaWera. bavSvs, iseve, ro ICD-10-Si, bavSvTa SfoTviTi aSlilobebis qveTavSi,
gorc fobikuri aSlilobebis mqone mozrdil pirebs, aseTi kategoria Setanili araa, miuxedavad imisa, rom
aswavlian problemis safexureobrivad gadaWris posttravmuli SfoTviTi aSliloba SeiZleba bavSvTa
teqnikas. aseve, gamoiyeneba dinamiuri fsiqoTerapia, asakSi ganviTardes. klinikuri niSnebi mozrdil
Tumca, misi upiratesoba, martiv biheviorul meTo asakSi ganviTarebuli aSlilobis msgavsia (gv. ??).
debTan SedarebiT, naklebad TvalsaCinoa (mimoxilva gamoxatulia Zilis darRvevebi, Ramis koSmarebi,
ix. Copton et al., 2004). fleSbekebi da im situaciebisTvis Tavis arideba,
romelic travmasTanaa asocirebuli. aseT bavSvebs
socialur- SfoTviTi aSliloba bavSvebSi xSirad uviTardebaT iracionaluri ganSorebis SfoT
socialur-SfoTviTi aSliloba bavSvTa asakSi ICD- va da regresuli qceva.
10-is mixedviT, gulisxmobs 6 wlamde ganviTarebul
mdgomareobas, rodesac bavSvebs ucxos mimarT Si etiologia
Sis grZnoba, rac cxovrebis pirveli wlis meore iseve, rogorc mozrdil asakSi, posttravmuli aS
naxevrisTvisaa damaxasiaTebeli, Cveulebrivze uf liloba viTardeba umZimesi, mwvave stresis Sedegad,
ro intensiurad an xangrZlivad aReniSnebaT. am rogoricaa, bavSvis tyved Cavardna, samoqalaqo
aSlilobis mqone bavSvebi CvilobaSi intravertul konfliqtebi da bunebrivi katastrofebi. post
Tvisebebs avlenen (Schwartz et al., 1999). aseTi bavSvebi travmuli aSlilobis ganviTarebis mizezi, SeiZleba
ucxos danaxvaze aSkarad SfoTaven da cdiloben Tavi fizikuri an seqsualuri Zaladobac iyos (Goodwin,
aaridon mas. SiSi, romelic ufro xSirad mozrdili 1988). es aSliloba, iseve rogorc mozrdilebSi, iSviaT
adamianebis mimarT vlindeba (Tumca, SesaZlebelia Zlier katastrofebTan SedarebiT, ufro xSirad
Tanatolebisa da sxva bavSvebis mimarTac arsebobdes), avtosagzao an sxva saxis avariebis Semdeg viTardeba.
bavSvis socialur funqcionirebaze axdens gavlenas. erTma kvlevam aCvena, rom sagzao SemTxvevebis Semdeg,
am aSlilobis dros mSoblebTan ganSorebis SfoTva bavSvebis 14%-s posttravmuli stresuli aSliloba
gamoxatuli araa. ganuviTarda (Keppel-Benson et al., 2002).
socialuri SfoTviTi aSlilobis etiologia da
prognozi
mkurnaloba igivea, rac bavSvTa asakis sxva SfoTviTi
aSlilobebis dros. bavSvTa asakis posttravmuli stresuli aSlilobis
prognozi sistemurad Seswavlili ar yofila; Tumca,
siblingTa konkurencia dadgenilia, rom mwvave mdgomareobebi grZeldeba 6
es kategoria mocemulia ICD-10-Si da gamoiyeneba im Tvidan erT wlamde da zogjer metxansac (Yule, 1994).
bavSvebis SemTxvevaSi, romlebic amJRavneben eWvian da
mtrul ganwyobas axlad dabadebuli dis an Zmis mimarT. mkurnaloba
aSlilobis niSnebi, romlebic siblingis gaCenidan mkurnaloba iseTivea, rogoric zrdasruli pirebis
ramdenime Tvis ganmavlobaSi unda ganviTardes, Tavisi SemTxvevaSi (gv. ??). Cveulebriv, gadatanili katas
intensivobiT am garemoebebis Tanmxlebi emociuri trofis Semdeg, xdeba dauyovneblivi konsultaciis
gancdis Cveul sazRvrebs scildeba. Zlieri emocia (debrifingis) uzrunvelyofa. mozrdilebisTvis aseTi
persistentulia da socialuri funqcionirebis Carevis efeqturoba, gansakuTrebiT im SemTxvevaSi,
gauaresebas iwvevs. mwvave SemTxvevebSi SeiZleba rodesac konsultaciis dros ar aris gamoyenebuli
siblingisTvis zianis miyenebis mcdelobebic iyos. kognituri Terapiis procedurebi, romelic exmareba
SesaZlebelia, bavSvis qcevam regresi ganicados, msxverpls `gadaamuSavos~ stresTan dakavSirebuli
mag., dakargos Sardvisa da defekaciis kontrolis mogonebebi, sakamaToa (gv. ??). savaraudod, bavSvebisa
ukve daswavlili unari, an Cvili bavSviviT moiqces. da mozrdilebisTvis erTi da igive midgomaa saWiro?
bavSvi, Cveulebriv, mSoblebis mimarT opoziciuradaa
ganwyobili da Tavisi qceviT yuradRebis mipyrobas
cdilobs. xSiria risxvis Setevebi. damaxasiaTebelia bavSvobis asakSi obsesiur-kompulsuri aSliloba
Zilis darRvevebi an daZinebasTan dakavSirebuli iSviaTia. Tumca, ganmeorebadi qcevebi 4-11 wlis asakSi,
problemebi. sakmaod xSiria. aseTi ganmeorebadi qcevebia: cifrebis
mkurnalobisas, mniSvnelovania davexmaroT mSob dajameba, sagnebis Tvla, konkretuli nivTebis amoCemeba
lebs, raTa maT Tanabrad gaanawilon TavianTi yu da Segroveba. normaluri bavSvebi advilad iTviseben
iseT ritualebs, rogoricaa qvafenilis ornamentebze
_ 728 _
dabijeba an raime saxis boZisTvis xelis Sexeba. aseT miuTiTebs. am etapze ar arsebobs aseTi asociaciis
qmedebebs ar SeiZleba vuwodoT obsesiebi, vinaidan damadasturebeli aranairi mtkicebuleba.
pirovneba ar ebrZvis maT (obsesiuri da kompulsuri neirotransmiteruli aSliloba. mozrdilebze
qcevis ganmarteba gv. ??). obsesiur-kompulsuri Catarebuli kvlevebis meSveobiT dadginda tvinSi
aSlilobisTvis damaxasiaTebeli ritualebi da qcevebi serotoninerguli sistemebis CarTuloba (gv. ??).
ufro mwvave xasiaTisaa, vidre janmrTeli bavSvebis bavSvebis susi-ebiT mkurnalobis efeqturoba (ix.
amgvari qmedebebi da bavSvis ZiriTad dros ikavebs. qvemoT) aseT SemTxvevebSic serotoninis monawileobis
amis magaliTia, saSinao davalebebis ramdenjerme mniSvnelobaze miuTiTebs.
gadamowmeba an xelebis xSirad dabana. nevrologiuri faqtorebi. bavSvTa asakSi ganvi
Tarebuli obsesiur-kompulsuri aSliloba asoci
klinikuri suraTi rebulia garkveul mdgomareobasTan, romlis mizezad
obsesiuri aSliloba gviani bavSvobis asakamde iS miCneulia bazaluri gangliis disfunqcia. zog bavSvs
viaTad iZens dasrulebul saxes, Tumca, pirveladi tikebi an qoreaformuli moZraobebi aReniSneba.
niSnebi, SeiZleba adreul asakSic gamovlindes. daw turetis sindromis mqone bavSvebi ki midrekilni arian
yeba swrafi an Semparavia. obsesiebisa da kompulsiebisadmi. aseTive simptomebi
bavSvobaSi ganviTarebuli obsesiur-SfoTviTi axasiaTebs sidenhamis (Sidenham~s) qoreas (ix. qvemoT).
aSliloba zrdasrul pirebSi gamovlenili aSlilobis autoimunuri faqtorebi. sidenhamis (Sidenham~s)
msgavsia (gv. ??). arsebuli simptomebi ufro ritu qorea autoimunuri daavadebaa, romelic A beta-
alebia, vidre obsesiuri azrebi. yvelaze xSirad hemolizuri streptokokiT inficirebis Semdeg vi
xelebis banvis rituali gvxvdeba, meore adgilzea Tardeba. sidenhamis (Sidenham~s) qoreasa da obsesiur-
ganmeorebadi qmedebebi da gadamowmeba. akviatebuli kompulsur aSlilobas Soris kavSiris gamo gaCnda azri,
azrebi ufro xSirad dabinZurebas, mSoblebis an sxva rom obsesiur-kompulsuri mdgomareobebis garkveuli
pirebis avad gaxdomas, an ubedur SemTxvevas exeba. SemTxvevebi imave etiologiisaa. aseTi SemTxvevebi
aseTi bavSvebi Relaven wesrigsa da simetriulobaze. Semdegi saxelwodebiTaa cnobili _ pediatriuli
simptomebis Sinaarsi bavSvis asakis matebasTan er autoimunuri neirofsiqiatriuli daavadebebi, aso
Tad icvleba. obsesiuri simptomebi SeiZleba ga cirebuli streptokokul infeqciasTan _ pandas
remo faqtorebiTac iyos provocirebuli (mag., (PANDAS) (mimoxilva ix. Snider and Swedo, 2004).
dabinZurebuli sagnebi). bavSvebi cdiloben damalon
TavianTi akviatebuli azrebi, gansakuTrebiT, ojaxis epidemiologia
gareT. obsesiebis dros bavSvebi xSirad TavianT obsesiur-kompulsuri aSlilobebis gavrcelebis six-
mSoblebsac sTxoven, gaimeoron ritualebi an sxva Sire 18 wlamde axalgazrdebSi 1-4%-ia (Flament and
gvarad hyavT CarTuli akviatebul qmedebebSi. Chabane, 2000). Tanabrad gvxvdeba orive sqesSi. um-
isini mudmivad saWiroeben damatebiT mxardaWeras cros asakSi ufro iSviaTia da TvalsaCinod matulobs
akviatebul azrebTan dakavSirebiT. asakTan erTad (Heyman et al., 2001).
etiologia asocirebuli aSlilobebi

genetikuri faqtorebi. naCvenebia, rom obsesiur- mwvave da persistentul obsesiur azrebsa da kompul-
kompulsuri aSliloba ufro xSiria am aSlilobis sur ritualebs bavSvobis asakSi xSirad Tan axlavs
mqone bavSvebisa da mozrdilebis pirveli rigis SfoTviTi da depresiuli simptomebi. zog SemTxvevaSi
naTesavebSi, vidre zogad populaciaSi (Lenane et al., SesaZlebelia arsebobdes komorbiduli SfoTviTi
1990). Tumca, gasaTvaliswinebelia, rom es statistika an depresiuli aSliloba. rogorc zemoT aRvniSneT,
moicavs im pirebs, romlebmac mimarTes samedicino tikebi obsesiur-kompulsuri aSlilobebis mqone bavS-
dawesebulebebs, rac, SesaZloa, gamowveulia imiT, vebis 17-40%-s aqvs (Geller et al., 1996). turetis sin-
rom obsesiur-kompulsuri aSlilobis mqone mSoblebi, dromis mqone bevr bavSvs obsesiebi aReniSneba, amitom
savaraudod, maSin mimarTaven eqimebs, rodesac maT mniSvnelovania am ori mdgomareobis diferencireba.
Svilebs msgavsi problemebi uCndebaT. ojaxuri
SemTxvevebi, SesaZloa, ufro socialuri daswavliT prognozi
da ara genetikuri faqtorebiT iyos ganpirobebuli. obsesiur-kompulsuri aSlilobebis gamosavalze da-
amasTan, obsesiur-SfoTviTi aSlilobis mqone sakvirveblad ar Catarebula grZelvadiani kvleva;
bavSvebis mSoblebs emociuri aSlilobebis ufro Tumca, arsebuli monacemebi aSlilobis naklebad
farTo speqtri aReniSnebaT (Black et al., 2003). saimedo prognozze miuTiTebs. mdgomareoba xSirad
obsesiur-kompulsuri aSlilobis kavSiri turetis mozrdil asakSic grZeldeba da perioduli gamwvave-
sindromTan maT saerTo genetikur winaganwyobaze bebiT xasiaTdeba (Rappaport and Swedo, 2002).
_ 729 _
mkurnaloba lobis mqone mozrdili asakis pirebis mkurnalobis

msgavsia (gv. 388). kognitur-bihevioruli Terapia, ro-
pirvel rigSi, aucilebelia bavSvebis, mSoblebisa da
melic mozrdilebSi gamoiyeneba, mozardebisTvisac
pedagogebis informireba aSlilobasTan dakavSire-
efeqturia (Stulemeijer et al., 2005). raTa mkurnaloba
biT da yvela kiTxvaze, SeZlebisdagvarad, amomwuravi
warmatebuli iyos, umjobesia pediatris, fsiqiatrisa
pasuxis gacema. Tu obsesiuri simptomebi SfoTviTi
da klinikuri fsiqologis erToblivi Careva. qroni-
an depresiuli aSlilobebis farglebSi gvxvdeba, ma-
kuli daRlilobis sindromis grZelvadiani prognozi
Sin saWiroa pirveladi daavadebis mkurnaloba. gviani
sakmaod keTilsaimedoa, xolo xanmokle efeqts aka-
bavSvTa asakis obsesiuri aSliloba iseTive midgomas
demiur moswrebaze seriozuli gavlenis moxdena Seu-
saWiroebs, rogorsac viyenebT mozrdilebis SemTxveva-
Zlia (Patel et al., 2003).
Si (gv. ??). am dros mimarTaven kognitur-biheviorul
Terapiasa da medikamenturi mkurnalobis meTodebs, an rekurentuli muclis tkivili
maT kombinacias. mcirewlovani bavSvebis SemTxvevaSi
rekurentuli muclis tkivili bavSvebis 5-17%-s aR-
saWiroa kognitur-bihevioruli Terapiis modificire-
eniSneba da pediatrTan misvlis erT_erT gavrcele-
ba maTi ganviTarebis donis gaTvaliswinebiT (Piacentini
bul mizezs warmoadgens. muclis tkivilis SemTxvevebi
and Langley, 2004). nebismieri mkurnalobis SerCevisas
xSirad asocirebulia Tavisa da kidurebis tkivilTan
aucilebelia mSoblebis CarTvac.
da zogad sisustesTan. aseT SemTxvevebSi fizikuri
medikamentebi. placebosTan SedarebiT, susi-ebic
mizezebis dadgena, ZiriTadad, ver xerxdeba da aSli-
da qlomipraminic ufro efeqturia. did britaneTSi
lobis fsiqologiur safuZvlebze saubroben. zogi
18 wlamde pirebisTvis obsesiur-kompulsuri aSli-
simptomi SfoTvasTanaa dakavSirebuli, zogi `maskire-
lobis samkurnalod sertralini da fluvoqsaminia
buli~ depresiis niSans warmoadgens (gv. 687), xolo
registrirebuli. mozrdilebis SemTxvevaSi aseTi
zogi stresiTaa ganpirobebuli. mkurnaloba sxva emo-
mkurnalobiT SesaZlebelia mxolod simptomebis sim-
ciuri aSlilobebis mkurnalobis msgavsia. grZelvadi-
wvavis Semcireba, magram ara sruli aRmofxvra. erT-
ani kvlevebiT naCvenebia, rom mwvave SemTxvevebis erTi
erT kvlevis dros, rodesac Seiswavles sertralin-
meoTxedi, romelTa drosac pediatris Carevaa saWiro,
iT mkurnalobis efeqturoba obsesiur-kompulsuri
rogorc fsiqikuri problemebis an auxsneli somaturi
aSlilobis mqone bavSvebsa da mozardebSi, remisia
Civilebis saxiT, mozrdil asakSic grZeldeba.
SemTxvevaTa 20%-Si miiRes. ra Tqma unda, Sedegi zo-
mierze uaresia, magram placebos 4%-Tan SedarebiT, konversiuli aSlilobebi
mainc yuradsaRebia. amave kvlevis Tanaxmad, remisiis
konversiuli aSlilobebi (konversiuli da disoci-
sixSire kognitur-bihevioruli Terapiis SemTxvevaSi
aciuri aSlilobebi ICD-10-is mixedviT 206-e gverdzea
_ 40%, xolo kombinirebuli Terapiis SemTxvevaSi _
aRwerili. rogorc individualuri SemTxvevebi, aseve
54% iyo (pediatriuli obsesiur-kompulsuri aSli-
iSviaTi epidemiuri formebi (gv. 208) ufro xSirad
lobebis mkurnalobis kvlevis jgufi, 2004).
mozardebSi da, iSviaTad, bavSvobis asakSi gvxvdeba.
pandas sindromis dros imunologiur mkurnalobas
bavSvebSi simptomebi, Cveulebriv, msubuqi xasiaTisaa
mimarTaven, Tumca, Sedegebi bolomde Seswavlili araa
da didi xnis manZilze iSviaTad grZeldeba. yvelaze
da aseTi mkurnalobis efeqturobis mtkicebuleba
xSiri niSnebia paralizi, siarulis Secvla, smenis an
jer-jerobiT ar arsebobs (ix. Snider and Swedo, 2003).
mxedvelobis gauareseba. mozrdil asakSi konversiuli
aSlilobebi SeiZleba sxvadasxva organuli daavadebis
somatoformuli aSlilobebi da sxva
farglebSi gamovlindes an, damoukideblad, pirveladi
auxsneli somaturi simptomebi konversiuli aSlilobis saxiT ganviTardes. iseve, ro-
fsiqikuri aSlilobis mqone bavSvebi xSirad uCivian gorc mozrdilebSi, adreul asakSic organulad de-
sxvadasxva somatur problemebs, romlebsac fizikuri terminebuli fizikuri simptomebi, zogjer konver-
mizezebi ar aqvT. aseTi Civilebia muclisa da Tavis siul aSlilobadaa diagnostirebuli. gansakuTrebiT
an kidurebis tkivili da xvela. am bavSvebis umrav- iseT SemTxvevebSi, rodesac organuli paTologiis
lesobas ojaxis eqimi mkurnalobs. mcire nawili, ro- gamovlena Znelia da simptomebis ganviTarebas stre-
melic mimarTavs specialists, ufro xSirad midis pe- suli movlena uZRvis win (Rivenus et al., 1975). aqedan ga-
diatrTan, vidre fsiqiatrTan. momdinare, konversiuli aSlilobis diagnozi mxolod
Zalian detaluri gamokvlevebis Semdeg unda daisvas.
qronikuli daRlilobis sindromi
es mdgomareoba, romelic aRwerilia 386-e gverdze, 11 epidemiologia
welze meti asakis bavSvebsa da mozardebSi gvxvdeba mosaxleobis gamokiTxvis dros konversiuli aSli-
(Farmer et al., 2004). mkurnalobis principebi am aSli- lobebis gavrcelebas iSviaTad swavloben. ase moxda
_ 730 _
uaitis kunZulze Catarebuli kvlevis SemTxveva- arebis gadmocema. SesaZlebelia, Zilis darRvevebic
Sic (Rutter et al., 1970a). pediatrTan misuli bavSvebis gansxvavdebodes mozrdilebisTvis damaxasiaTebeli
3-13%-s konversiuli aSlilobebi aReniSneba. erT- Zilis problemebisgan (gv. 694). depresiis mqone bavS-
erTma kvlevam aCvena, rom fsiqiatriul saavadmyo- vebis daaxloebiT meoTxeds saRamos saaTebSi korti-
foebSi moTavsebuli prepubertatuli asakis bavS- zolis hipersekrecia aReniSneba, rac, gansakuTrebiT,
vebis 2%-s konversiuli aSlilobis diagnozi hqonda qronikulad mimdinare depresiis SemTxvevebSi gvxvde-
(Caplan, 1970). am bavSvebis TiTqmis naxevars Semdgomi ba (ix. Goodyer et al., 2001).
dakvirvebis 4-11 wlis manZilze, sabolood, organuli `maskirebuli~ depresia. zogi fsiqiatri miiCnevs,
mizezebi daudginda. ambliopia, romelic organu- rom bavSvebSi depresia iSviaTad vlindeba daqveiTe-
li daavadebis simptomia, yvelaze xSirad, iyo diag- buli guneb-ganwyobiT. am dros ufro damaxasiaTebe-
nostirebuli fsiqogenur mdgomareobad. lia auxsneli muclis an Tavis tkivili, anoreqsia da
enurezi (Kovacs, 1996). es simptomebi SeiZleba pirve-
mkurnaloba ladi niSnebi iyos, romlebic samedicino Carevas
konversiuli aSlilobebisa da sxva somatoformuli saWiroeben; Tumca, maTi gamokvlevisas aucileblad
aSlilobebis mkurnaloba rac SeiZleba adre unda unda vivaraudoT depresiuli aSlilobis arsebobis
daiwyos, rom ar moxdes `meoradi gamorCenis~ (gv. SesaZleblobac. Tu gamokiTxvas sworad CavatarebT,
206) akumulireba. mniSvnelovania fsiqiatrisa da pe- anamnezuri monacemebi da fsiqikuri statusis kvleva
diatris mWidro TanamSromloba. fsiqiatriuli diag- sevdian guneb-ganwyobas, anhedonias, gaRizianebado-
nozis dasmamde, saWiroa detaluri fizikuri gamokv- basa da sxva, depresiisTvis damaxasiaTebel, simptom-
leva, Tumca, zedmeti gamokvlevebis Catareba ar aris ebs gamoavlens, romlebic, SesaZloa, Tavdapirvelad
mizanSewonili. mkurnaloba iTvaliswinebs stresuli verc SevamCnioT (Luby et al., 2003).
garemoebebis Semcirebas da bavSvis waxalisebas, rom
isaubros problemebze. aseTi midgomiT SesaZlebe- epidemiologia
lia simptomebis Sesusteba. SeiZleba, saWiro gaxdes depresiuli aSliloba pubertatiul asakamde iSvia-
imave midgomis gamoyeneba, rogorsac viyenebT moz- Tad vlindeba (depresia ufro mogvianebiTi asakisT-
rdilTa konversiuli aSlilobebis mkurnalobisas. visaa damaxasiaTebeli, gv. 694). bavSvebSi didi depre-
fsiqoTerapias da biheviorul meTodebs motoruli siuli aSlilobis gavrcelebis sixSire 1%-ia. puber-
simptomebisTvis mimarTaven (somaturi simptomebiT tul asakamde depresiuli aSlilobebi ufro xSirad
gamovlenili bavSvTa fsiqikuri aSlilobebis marTvis mamrobiT sqesSi gvxvdeba. nakleb savaraudoa, rom
sakiTxebi ix. Gerralda, 2000). mozardobaSi ganviTarebuli depresia ar gagrZel-
des mozrdil asakSic. es ufro xSirad disfunqciur
guneb-ganwyobis (afeqturi) aSlilobebi ojaxTanaa dakavSirebuli (Harrington, 2002). bavSvebis
iTvleba, rom pubertatiul asakamde mania Zalian iS- umravlesobas, romlebsac depresiuli aSlilobis
viaTad viTardeba, Tumca, amis sawinaaRmdego mosazre- diagnozi aqvT, sxva aSlilobebic aReniSnebaT. gansa-
bebic arsebobs (ix. Biederman, 1998). amitom, roca saqme kuTrebiT xSiria SfoTviTi aSlilobebi (ix. Goodyer,
exeba bavSvebs, ufro xSirad depresiaze saubroben. 2002; damatebiTi informacia ix. Harrington, 2002).
savsebiT normaluria is, rom. rodesac bavSvebi
etiologia
distresul movlenebs depresiiT pasuxoben, mag.,
rodesac bebia-babua gardaicvleba an, roca mSobeli bavSvobaSi ganviTarebuli depresiuli aSlilobis
seriozulad avadaa. zog SemTxvevaSi, glovis dros mizezebi, mozrdil asakSi gamovlenili depresiuli
bavSvs SeiZleba dauqveiTdes interesi da koncentra- epizodis gamomwvevi faqtorebis msgavsia.
ciis unari, daerRves Zili da dakargos mada. am TavSi genetikuri faqtorebi. rogorc ukve aRvniSneT, bi-
ar aris ganxiluli normaluri dardis sakiTxebi da polaruli aSlilobebi bavSvobaSi iSviaTad viTarde-
arc depresiuli mdgomareoba, romelic sxva fsiqi- ba. amitom monacemebi, ZiriTadad, depresiul aSli-
kuri aSlilobis niSans warmoadgens, rogoricaa, mag., lobebs exeba. depresiis mqone bavSvebis pirveli rigis
SfoTviTi an qceviTi aSlilobebi (mozardobis asakis naTesavebSi depresiuli aSliloba ufro xSiria, vidre
afeqturi aSlilobebi ganxilulia 694-e gverdze). zogad populaciaSi, rac genetikur faqtorebs unda
ukavSirdebodes. kvlevebSi gamoyenebuli meTodolo-
klinikuri suraTi giis gansxvaveba eWvqveS ayenebs miRebuli monacemebis
didi depresiis klinikuri niSnebi mozrdil asakSi sizustes; savaraudoa, rom bavSvebSi ganviTarebuli
ganviTarebuli depresiuli epizodis msgavsia. gansx- depresiis dros genetikur faqtorebs naklebi mniS-
vaveba mxolod isaa, rom bavSvebi danaSaulis gancdas vneloba aqvs, vidre mozardobaSi gamovlenili depre-
gansxvavebulad gamoxataven. maT uWirT TavianTi mwux- siuli epizodis SemTxvevaSi (Rice et al., 2002).
_ 731 _
genetikuri faqtorebi ramdenime mimarTulebiT mo- da Sesabamisi eniT mivawodoT informacia bavSvsac. es
qmedebs. maT SeiZleba gavlena moaxdinon: (1) uSualod ganmartebebi da stresoris Zieba unda iTvaliswineb-
depresiis biologiur meqanizmebze, (2) gazardon mow- des eTnikur da kulturalur faqtorebsac.
yvladoba warumatebeli cxovrebiseuli movlenebis fsiqologiuri mkurnaloba. Tu gatarebuli Ronis
mimarT, (3) gaaZlieron stresuli situaciis gavle- Ziebebis Sedegad depresia ar umjobesdeba, saWiroa
nis zemoqmedeba. mag., genebi gansazRvravs garkveul fsiqologiuri mkurnaloba. SesaZlebelia kognituri
pirovnul Tvisebebs, rac SeiZleba urTierTobebis Terapiis, interpersonaluri Terapiisa da xanmokle
xSiri gawyvetis mizezi gaxdes (Silberg et al., 1999). ojaxuri Terapiis Catareba. am meTodebis efeqturo-
kortizoli. rogorc aRvniSneT, depresiis mqone ba Seswavlilia mxolod mozrdili bavSvebisa da mo-
zog bavSvs saRamos saaTebSi kortizolis sekrecia zardebis magaliTze.
ezrdeba. mogvianebiT asakSi, Tu kortizolis hip- medikamenturi mkurnaloba. fsiqologiuri mkur
ersekrecia aqvT aradepresiul pirebs, es moaswavebs nalobis warumateblobis an mwvave depresiis SemTx-
depresiis ganviTarebas fsiqosocialuri faqtorebis- vevaSi mizanSewonilia medikamenturi mkurnaloba.
gan damoukideblad (Goodyer et al., 2003). aseTi kavSiri depresiuli bavSvebis samkurnalod tricikluri an-
ar fiqsirdeba bavSvebis SemTxvevaSi; Tumca, miRebu- tidepresantebis gamoyeneba ar iZleva mniSvnelovan
li Sedegebi miuTiTebs imaze, rom kortizolis hip- Sedegs. susi-ebi, maT Soris fluoqsetini, bevrad
ersekrecia depresiis ganviTarebaze pirdapir an ara- ufro efeqturia, vidre placebo. Tumca, jer-jero-
pirdapir gavlenas unda axdendes. biT ar aris damtkicebuli, rom susi-ebis dadebiTi
sxva mizezebi. uaryofiTi cxovrebiseuli movlene- efeqti bevrad aRemateba wamliT gamowveul uaryofiT
bi, rogorc mozrdilebSi, ise bavSvebSic depresiuli efeqts, amitom bavSvTa asakSi susi-ebis gamoyeneba,
aSlilobis ganviTarebis provocirebas axdens (Goody- zogadad, rekomendebuli ar aris (Jureidini et al., 2004).
er et al., 1985). rogorc Cans, temperamentsac garkveuli es piroba kidev ufro yuradsaRebia, rodesac ukve
mniSvneloba eniWeba. gansakuTrebiT mniSvnelovania gamoqveynebul Sedegebs gamouqveynebel monacemebs
garemo stimulebze gadametebulad reagirebis ten- davumatebT (Whittington et al., 2004).
dencia (Goodyer et al., 1993). mozardebSi depresiis gan- klinikur praqtikaSi wamlis daniSvnis gadaw-
viTarebaze did gavlenas axdens ojaxuri garemo, miT yvetileba bavSvTa fsiqiatrma unda miiRos. poten-
ufro, Tu mSobels depresia aReniSneba (Hammen et al., ciuri sargebeli da gverdiTi movlenebi yovel
2004). igive SeiZleba iTqvas bavSvebzec. konkretul SemTxvevaSi individualurad unda Se-
fasdes. mniSvnelovania am sakiTxebis ganxilva bavS-
prognozi vTan (misTvis gasageb enaze), misi ojaxis wevrebTan da
arsebobs kontinuumi bavSvTa da mozrdilTa depre- bavSvis movlaSi CarTul sxva pirebTan. informacia
sias Soris. kvlevam, romlis drosac ramdenime wlis unda moicavdes mkurnalobis dawyebidan simptomebis
manZilze akvirdebodnen depresiuli aSlilobis mqone gaumjobesebamde droSi arsebul gansxvavebas da wam-
bavSvebis jgufs (depresiis diagnozi Tanamedrove lebis gverdiT efeqtebs. antidepresantis daniSvnis
kriteriumebis Sesabamisad iyo dasmuli), aCvena, rom dros aucilebelia misi kombinireba romelime saxis
mozrdili asakis jgufSi depresiul aSlilobaTa six- fsiqologiur mkurnalobasTan. yvelaze meti monace-
Sire 58%-s, xolo sakontrolo jgufSi _ mxolod, mi gvaqvs fluoqsetinze. dReisTvis sxva susi-ebi da
31%-s aReniSneboda. Tumca, mozrdilTa gamoyofil venlafaqsini depresiis mqone 18 wlamde pacientebSi
jgufSi sxva fsiqikuri aSlilobebi imaze meti ar samkurnalod ar aris rekomendebuli (ix. http://www.
gamovlinda, vidre sakontrolo jgufSi. mhra.gov.uk/news/2003.htm).
gamwvavebis Tavidan acilebis mizniT, mkurnalobis
mkurnaloba
efeqturoba unda SenarCundes gaumjobesebidan mom-
zogadi RonisZiebebi. nebismieri distresuli garemoe- devno erTi wlis manZilze. Zalian iSviaTad staciona-
ba unda saswrafod Semcirdes da bavSvs unda davexma- ris gareT mkurnaloba araefeqturia bavSvebis SemTx-
roT, rom man SeZlos sakuTari grZnobebis gamoxatva. vevaSi da saWiro xdeba maTi saavadmyofoSi moTavseba.
unda droulad gamovavlinoT da vumkurnaloT mSo- (bavSvebSi depresiis aSlilobis mkurnalobasTan da-
blebis depresias. skolis asakis bavSvebis SemTxvevaSi kavSirebuli sruli rekomendaciebi (gaidlaini) ix.
daavadebis marTva gulisxmobs skolis pedagogebTan NICE, 2005).
TanamSromlobas. maT unda ganemartoT, rom depre-
sia gavlenas axdens akademiur moswrebaze. aseve, mniS- suicidi bavSvTa asakSi
vnelovania skolaSi arsebuli SesaZlo stresoris
suicidi bavSvTa asakSi ganxilulia 412_413 gverde-
(mag., bulingis) gamovlena da misi Semcireba. mSob-
bze.
lebs unda avuxsnaT, Tu rogoria depresiis niSnebi
_ 732 _
skolis gacdena mdgomareobas, rogoricaa bebia-babuis avadmyofoba,
skolis gacdena ar aris fsiqikuri aSliloba, aramed romlebTanac bavSvi mijaWvulia. nebismieri mizezis
qcevis paternia, romelic mravali mizeziTaa gan- SemTxvevaSi, bavSvi Zalian rezistentulia da uWirs
pirobebuli. mizanSewonilia am problemis mocemul skolaSi dabruneba. is mwvave distresi, romelic Tan
TavSi ganxilva, radganac arsebobs asociacia skolis axlavs skolaSi wasvlis mcdelobas, urTulebs mSo-
gacdenasa da depresiul, SfoTviT aSlilobebs Soris. bels bavSvisTvis skolaSi siarulis daZalebas.
skolaSi argamocxadebis ZiriTadi mizezia skolaSi
etiologia
siarulze uaris Tqma. yvelaze xSirad es fizikuri
gasaTvaliswinebelia ramdenime mizezi. ganSorebis
avadmyofobiTaa gamowveuli. aseve, bavSvebis mcire
SfoTviT aSlilobas gansakuTrebuli mniSvnelo-
nawili Tavisi surviliT Tanxmdeba mSoblebs darC-
ba aqvs umcrosklaselTa SemTxvevaSi. mozardebSi
es saxlSi, raTa daexmaros maT, an raime sxva miznis
yvelaze mwvaved mimdinare mdgomareobebi, ZiriTadad,
gamo. zogi skolas ganzrax acdens; miuxedavad imisa,
zeda klasebSi iwyeba. Zalian mwire monacemebi gvaqvs
rom SeuZlia skolaSi siaruli, gacdenas arCevs, rac,
skolis gacdenis grZelvadian kvlevebTan dakavSire-
SesaZloa, protests gamoxatavdes. skolaSi siarulze
biT. arsebuli monacemebiT, skolis gamcdeni pirebis
uaris Tqmis mizezi SeiZleba iyos skolasTan dakav-
TiTqmis naxevars momdevno 10 wlis manZilze emoci-
Sirebuli SfoTva an arasrulfasovnebis gancda. erT-
uri problemebi aReniSneba (Berg and Jackson, 1985; Flaki-
erTi kvlevis dros Seadares 50 skolis gamcdeni da 50
erska et al., 1988). naklebad mwvave SemTxvevebis prog-
truanti, anu skolis ganzrax gamcdeni bavSvi. yvela
nozi ufro keTilsaimedoa.
cdis piri SeirCa bavSvTa fsiqiatriul servisebSi
(Herson, 1960). truantebisgan gansxvavebiT, skolis mkurnaloba
gamcdenebi, umetesad nevrotuli ojaxebidan iyvnen.
garda Zalian mwvave SemTxvevebisa, yvela zoma unda iq-
maTi umetesobisTvis damaxasiaTebeli iyo depresiuli
nas miRebuli, rom bavSvi droulad dabrundes skola-
mdgomareoba, pasiuroba, mSoblebis mxridan hiper-
Si. aucilebelia pedagogTan urTierTobis damyareba,
proteqcia. maT hqondaT ukeTesi qceva da akademiuri
skolaSi arsebuli problemebis masTan ganxilva da
moswreba.
imis garkveva, Tu rogor SeiZleba mogvardes gacdeni-
gavrcelebis sixSire li saswavlo masalis aRdgena. aseve, unda daigegmos,
Tu ra zomebia gasatarebeli, rom Tavidan aviciloT
Zalian xSiria skolis perioduli gacdenebi, Tumca,
skolaSi dabrunebasTan dakavSirebuli sirTuleebi.
skolaSi siarulze uaris Tqmis SemTxvevebis sixSire
umjobesia, pirvelad, skolaSi misvlisas, bavSvs ax-
ar aris dazustebuli.
ldes ara mSobeli, aramed sxva piri. zogjer Tavad
uaitis kunZulze skolis gacdenis sixSire fsiqi-
mSobelsac sWirdeba daxmareba. mwvave SemTxvevebSi
kuri aSlilobis mqone 10-11 wlis bavSvebSi 3%-ze
safexureobrivi qceviTi programa unda SemuSavdes.
naklebi iyo. skolis gacdenebi ufro xSiria Semdeg
SesaZlebelia, SfoTvisa da depresiis samkurnalod
periodebSi: 5-dan 7 wlamde, 11 wlis asakSi, skolis
saWiro gaxdes piris stacionireba. zogjer, skolis
Secvlis SemTxvevaSi da 14 wlis Semdeg.
gamocvla dadebiT Sedegs iZleva.
klinikuri suraTi aucilebelia Tanmxlebi depresiis mkurnaloba,
pirveli niSani, romelic mSobels problemis arsebo- rac, ZiriTadad, fsiqo-socialur intervencias gu-
baze mianiSnebs, bavSvis mier skolaSi siarulze kat- lisxmobs. yvela SemTxvevaSi, Terapiis dros bavSvs
egoriuli uaris Tqmaa. skolaSi wasvlis win matulobs unda mieces saSualeba, rom Tavis problemebze isau-
skolis gacdenis survili da bavSvs SfoTvisa da ube- bros. aseve, Tanadgoma unda gaewios mSoblebs (skolis
durebis gancdis niSnebi aReniSneba. SfoTva xSirad gacdenasTan dakavSirebuli sakiTxebis mimoxilva ix.
Tavisa da muclis tkiviliT, faRaraTiT, zogadi King and Bernstein, 2001).
sisustiT an cudad yofnis CivilebiT vlindeba. es
simptomebi mxolod skolaSi wasvlis win iCens Tavs. bavSvTa asakSi ganviTarebuli sxva
zogi bavSvi sityvierad gamoTqvams skolaSi wasvlis fsiqikuri aSlilobebi
survils, magram drois moaxloebasTan erTad, disfunqciuri enurezi
tresi umwvavdeba. skolaSi siarulis sruli uaryofa funqciuri enurezi Sardis ganmeorebadi Seukave-
SeiZleba sxvadasxvagvarad daiwyos. amas SesaZloa win blobaa iseT asakSi, rodesac fizikurad janmrTel
uZRodes zemoT aRwerili sirTuleebi an sxva mizezi, bavSvs kontrolis unari gamomuSavebuli unda hqon
mag., sasunTqi gzebis respiratoruli daavadebebi. des. enurezi SeiZleba aRiniSnebodes Rame, Zilis dros
es yvelaferi SeiZleba mohyves skolaSi momxdar cv- (`sawolis sisvele~) an dRis saaTebSi (`dRis sisvele~)
lilebebs, mag., skolis an klasis gamocvla; ojaxur
_ 733 _
an dRec da Ramec. bavSvebis umetesoba Sardvis gakon- dadginda, unda gamovikvlioT, aris Tu ara distre-
trolebas 3 an 4 wlis asakisTvis swavlobs. si. saWiroa davadginoT mSoblebis damokidebuleba
Ramis enurezi Zalian distresulia, gansakuTrebiT enurezis mimarT _ ra zomebs mimarTaven problemis
maSin, Tu amas mSoblis gabrazeba da bavSvis das- dasaZlevad da rogoria maTi motivacia.
ja mohyveba. distress aZlierebs mSoblebis mier
akrZalvebis daweseba da uneblie Sardvis gamo bavSvis mkurnaloba
ar gaSveba megobrebTan drois gasatareblad an dasas- somaturi daavadebis gamovlenis SemTxvevaSi, unda
veneblad. Catardes Sesabamisi mkurnaloba. funqciuri enurezis
dros mniSvnelovania mSoblebs ganemartos, rom es
epidemiologia sakmaod gavrcelebuli problemaa da rom ar SeiZle-
Ramis enurezis gavrcelebis sixSire sxvadasxva kv- ba bavSvis dasja da dadanaSauleba. ar aris mizanSe-
levis monacemebiT gansxvavebulia, rac gamoyenebuli wonili amkrZalavi zomebis gatareba, radgan es nak-
Sefasebis meTodzea damokidebuli. did britaneTSi lebad efeqturia. mSoblebma unda waaxalison bavSvis
kviraSi erTxel Ramis enurezi 5 wlis asakis bavSvebis warmateba da ar unda gaamaxvilon yuradReba waru-
10%-s, 8 wlis asakis 4%-s, xolo 14 wlis asakis 1%-s mateblobaze. ar unda moxdes problemis dafiqsireba.
aReniSneba. igive Sedegebi miiRes aSS-Si Catarebuli aseTi rCevebis gaTvaliswineba xSir SemTxvevaSi swraf
kvlevebiT. Ramis enurezi ufro xSirad biWebSi gvx- da spontanur gaumjobesebas iwvevs. 6 wlis da meti
vdeba. dRis enurezi SedarebiT iSviaTia da ufro me- asakis bavSvebTan ufro aqtiuri Carevaa saWiro.
tad gogonebs axasiaTebT. dRis enurezis SemTxvevaSi, aseve, gasaTvaliswinebeli rCevebia: saRamos saaTeb-
bavSvebis naxevarze mets Ramis enurezic aReniSneba. Si siTxis SezRudva, moSardvisTvis Rame gaRviZeba da
warmatebis SemTxvevaSi _ dajildoeba.
etiologia enurezis maRviZara. bavSvebTan, romlebsac aseTi
noqturia SeiZleba somaturma problemam gamoiwvios, martivi rCevebi ar SveliT, SeiZleba enurezis maR-
Tumca, ufro xSirad nervuli sistemis ganviTarebis viZara gamoviyenoT. enurezis maRviZaras samagri-de-
dayovnebasTan an garemo faqtorebTanaa dakavSire- teqtori sacvalze magrdeba, xolo sayviri keTdeba
buli. garkveuli monacemebi genetikur faqtorebzec majaze an ideba jibeSi. rogorc ki bavSvi iwyebs Sard-
miuTiTebs. enurezis mqone bavSvebis 70% hyavs imave vas, deteqtori aqtiurdeba da irTveba sayviri. bavS-
problemis mqone pirveli rigis naTesavi (Bakwin, 1961). vma unda gamorTos sayviri, adges da Sardva qoTanze
aseve, konkordantulobis maCvenebeli monozigotur daasrulos. saWiroebis SemTxvevaSi (Tu saWiroa, mSo-
tyupebSi orjer aRemateba dizigoturi tyupebis blebis daxmarebiT), unda gamoicvalos TeTreuli da
maCvenebels (Hallgren, 1960). gamoyofilia ramdenime sacvlebi. am meTodis xangrZlivoba 6-8 kviraa da zog
lokusi (ix. Super and Postlewaite, 1997), Tumca, miRe- ojaxs uWirs misi bolomde Sesruleba.
buli monacemebis mniSvnelobis Sesafaseblad damate- maRviZara iSviaTad iZleva Sedegs, roca 6 wlamde
biTi kvlevebis Catarebaa saWiro (mimoxilva ix. Von asakis an arakomunikabelur bavSvebTan gvaqvs saqme.
Gontard et al., 1998). sxva mxriv, es meTodi erTi Tvis manZilze SemTxve-
enurezis mqone bavSvebis umravlesobas fsiqikuri vaTa 70-80%-Si efeqturia. Semdgomi erTi wlis man-
problemebi ar aqvs, Tumca, janmrTelebTan SedarebiT Zilze mxolod mesameds umeordeba enurezi (Butler et
fsiqikuri aSlilobebi ufro xSirad aReniSnebaT. en- al., 1990). fsiqikuri aSlilobis mqone bavSvebi ufro
urezi ufro metad axasiaTebT mravalwevrian ojax- Znelad emorCilebian mkurnalobas.
Si aRzrdil bavSvebs. stresulma movlenam SeiZleba medikamentebi. sinTezuri antidiurezuli hormoni
provocireba gaukeTos meorad enurezs. Sardis kon- _ dezamino-D-arginini vazopresini (deszmopresini),
trolisTvis rigiduli an sxva saxis trenirebis efeq- ufro xangrZlivi moqmedebisaa, vidre Cveulebrivi
turoba ar aris dasabuTebuli. vazopresini. igi gamoiyeneba 5 wlis da meti asakis
bavSvebSi Ramis enurezis samkurnalod. igi gamodis
gamokvleva
tabletirebuli formiTa da cxviris wveTebis saxiT.
saWiroa anamnezis guldasmiT Sekreba da Sesabamisi erT-erTma kvlevam aCvena, rom intranazaluri wveTe-
fizikuri gamokvleva, raTa gamovricxoT somaturi biT mkurnalobisas, bavSvebis 50%-ma Sewyvita uneblie
problema. gansakuTrebiT yuradsaRebia Sard_sasqeso Sardva (Miller and Klauber, 1990); kargi Sedegebi miiRes
gzebis infeqcia, diabeti da epilefsia. unda Sefasdes tabletirebuli formiT miRebis SemTxvevaSic (Skoog
precipitatuli faqtorebi da bavSvis motivacia. unda et al., 1997). Tumca, wamlis moxsnis Semdeg, mdgomareo-
daisvas kiTxva defekaciis Sekavebis unarze. ba kvlav gauaresda. intranazaluri wveTebis gver-
SesaZlebelia saxeze iyos fsiqikuri aSlilobac. diTi movlenebia riniti da nazaluri tkivili. sxva
Tu arc somaturi da arc fsiqikuri aSliloba ar arasasurveli efeqtebia gulis revis SegrZneba da
_ 734 _
muclis tkivili. amis gaTvaliswinebiT, es preparati sac hqondaT daswavlili defekaciis kontroli, Zl-
situaciisda mixedviT gamoiyeneba, mag., stumrad dar- ieri stresis Sedegad SeiZleba dakargon amis unari,
Cenis dros. mag., seqsualuri Zaladobis Semdeg.
enurezis samkurnalod SeiZleba imipraminis gamoy- protesti. zogi bavSvi ganzrax acxadebs uars Ses-
eneba. dozebi unda SeirCes bavSvis asakisa da mwarmoe- abamis adgilebSi defekaciaze. zogi ki fekalur masebs
blis miTiTebis gaTvaliswinebiT. umetes SemTxvevaSi, kedlebze an sxvagan usvams. aseTi bavSvis ojaxSi, ro-
wamlis miRebis fonze mdgomareoba umjobesdeba, gorc wesi, uamravi socialuri problemaa da Tavad
Tumca, wamlis moxsnisTanave bavSvebi Casvelebas iwye- bavSvs sxva emociuri da qceviTi darRvevebi aReniS-
ben. preparatis gverdiTi efeqtebis gamo da SemTxve- neba. aseTi qceva, upiratesad, mSoblebis mimarT agre-
viT dozis gadaWarbebis saSiSroebidan gamomdinare, siis gamoxatulebaa, Tumca, xSir SemTxvevaSi, bavSvebi
tricikluri preparatebi enurezis samkurnalod iS- amas uaryofen.
viaTad gamoiyeneba (enurezis mimoxilva ix. Clayden et
al., 2002). mkurnaloba
mkurnaloba damokidebulia gamomwvev mizezze.
fekaluri masebiT dasvra pirvel rigSi, unda davadginoT, aris Tu ara yabzoba,
sami wlis asakisTvis bavSvebis 6%, sul cota, kviraSi gamovavlinoT misi mizezi da, dadgenis SemTxvevaSi,
erTxel mainc isvreba fekaluri masebiT. 7 wlisTvis vumkurnaloT mas. amisaTvis saWiroa bavSvis pedi-
es ricxvi 1, 5%-mde mcirdeba, xolo 11 wlis asakSi atrTan erTad gamokvleva. maSinac ki, rodesac yabzo-
mxolod 1%-s (TveSi erTxel an orjer) aReniSneba. ba ZiriTadi mizezi araa, aucilebelia misi, rogorc
ukontrolo defekaciis SemTxvevebi gogonebTan meoradi problemis, mkurnaloba. bavSvs, romelsac
3-jer ufro xSirad gvxvdeba, vidre biWebTan. aqvs SiSi, sWirdeba empaTia da Tanadgoma. tualetis
termini ènkoprezi~ ori mniSvnelobiT ixmareba. araadekvaturi treningis gamosworeba bihevioruli
ufro farTo gagebiT, fekaluri masebiT dasvras, meTodebiTaa SesaZlebeli. kerZod, saWiroa miRwevadi
xolo ufro viwro gagebiT _ Seuferebel adgileb- miznebis dasaxva, dajildovebisa da waxalisebis gam-
Si, maT Soris sacvlebSic, formirebuli fekaluri oyeneba da mSoblebisTvis daxmarebis gaweva. stresiT
masebis ganmeorebad gamoyofas niSnavs. aseTi oraz- inducirebuli regresi, Cveulebriv, aRmoifxvreba,
rovnebis Tavidan asacileblad am TavSi termins _ Tuki bavSvs travmis daZlevaSi davexmarebiT. pro-
`fekaluri masebiT dasvra~, gamoviyenebT. testiT ganpirobebuli ukontrolo defekaciis
mkurnaloba SedarebiT rTulia, radgan aq farTo
etiologia
speqtris socialuri da fsiqologiuri problemebia
bavSvebs, romlebsac nebismieri mizeziT fekaluri CarTuli, rasac xangrZlivi da intensiuri daxmare-
masebiT esvrebaT tansacmeli, SeiZleba rcxvenodeT, ba sWirdeba. rodesac stacionargareSe mkurnaloba
uaryofdnen momxdars da malavdnen WuWyian sacvlebs. araefeqturia, an saWiroa intensiuri trenirebisa da
ukontrolo defekacias ramdenime mizezi aqvs: bihevioruli Terapiebis gamoyeneba, bavSvi stacio-
yabzoba gadavsebuli fekaluri masebiT ukontro- narSi Tavsdeba. aseT SemTxvevaSi mSoblebi aqtiurad
lo defekaciis xSiri mizezia. ujredisiT Raribi unda iyvnen CarTulni mkurnalobis procesSi, raTa
sakvebi an protestis niSnad defekaciaze uaris Tqma saxlSi dabrunebis Semdeg, Tavidan aviciloT mdgo-
iwvevs xangrZliv da myar yabzobas. hirSsprungis mareobis gauareseba.
(Hirschsprung~s) daavadeba iSviaTi, magram mniSvnelovani
mizezia. ukontrolo defekacia xdeba maSin, rodesac prognozi
reqtumSi Txevadi fekaluri masebi myar fekalur nebismieri mizezis SemTxvevaSi, mozardobis asakSi
sacobs SemosazRvravs. enkoprezi Zalian iSviaTia, Tumca, masTan dakavSire-
tualetis gamoyenebis SiSi. zogjer bavSvebs defeka- buli problemebi SeiZleba gagrZeldes. mkurnalobis
ciisas yovelgvari diskomfortisa da tkivilis gar- Catarebisas, umetes SemTxvevaSi, efeqti erTi wlis
eSec eSiniaT mosaqmeba. SesaZloa, isini fiqroben, rom ganmavlobaSi miiRweva. (fekaluri masebiT dasvris
tualetSi raRac saSiSi mxeci binadrobs an skolaSi Sesaxeb mimoxilva ix. Clayden et al., 2002; klinikuri
bavSvebis dacinvis rcxveniaT. rekomendaciebi qronikuli yabzobisa da fekaluri
kontrolis daswavlis uunaroba. aseTi problemebi masebiT dasvris mkurnalobisa da marTvis Sesaxeb ix.
SeiZleba aReniSnebodeT bavSvebs, romlebsac daswav- Felt et al., 1999).
lis problemebi aqvT, an normaluri inteleqtis bavS-
vebs, romelTa trenireba arasistemuri da araadekva- eleqtiuri mutizmi
turi iyo. eleqtiuri mutizmis dros bavSvebi garkveul situa-
stresiT inducirebuli regresi. bavSvebma, romleb- ciaSi uars acxadeben saubarze, maSin, rodesac sxva
_ 735 _
garemoSi isini uproblemod urTierToben. rogorc yvelaze xSirad mimarTaven metyvelebis Terapias.
wesi, bavSvi ojaxSi normalurad metyvelebs, Tum-
tikebi
ca, skolaSi sirTuleebi aReniSneba. bavSvebis mcire
nawils, SeiZleba, metyvelebis garkveuli defeqti aR- Jil de la turetis sindromi ganxilulia 352-e
eniSnebodes. xSirad aseT SemTxvevebSi bavSvebs sxva gverdze.
saxis negatiuri qcevac axasiaTebT, mag., SeTavazebisas
demencia
skamze dajdomas an TamaSze uaris Tqma. aseT bavS-
bavSvebSi demencia iSviaTia. misi gamomwvevi mizezi
vebs SeiZleba Tanmxlebi SfoTviTi aSliloba hqon-
iseTi organuli paTologiebia, rogorebicaa lipi-
deT. eleqtiuri mutizmi, Cveulebriv, 3-dan 5 wlamde
dozi, leikodistrofia an qvemwvave masklerozebeli
iCens Tavs, mas Semdeg, rac bavSvi normalur laparaks
panencefalitia. zogi mizezi genetikuradaa determi-
iwyebs. marTalia, bavSvebis umravlesoba ucxo gare-
nebuli da SeiZleba ojaxSi sxva bavSvebsac hqondeT.
moSi saubars gaurbis, magram eleqtiuri mutizmi
prognozi gansxvavebulia. xSiria fataluri gamosa-
mainc Zalian iSviaTi mdgomareobaa. igi 1000-dan 1
vali an mZime gonebrivi CamorCeniloba.
bavSvSi vlindeba. diagnozis dasma xSirad garTule-
bulia, vinaidan bavSvi uars acxadebs fsiqiatrTan Sizofrenia
saubarze. aseT SemTxvevaSi mSoblis mier mowodebul
Sizofrenia 7 wlamde asakis bavSvebSi praqtikulad
informacias didi mniSvneloba eniWeba. Sefasebisas
ar gvxvdeba da iSviaTad iwyeba adreuli mozardobis
aucilebelia mSobels vkiTxoT, ramdenad normaluria
asakamde. bavSvobaSi dawyebuli Sizofrenia mwvaved
bavSvis metyveleba saxlSi. rogoria naTqvamis gagebi-
an Semparavad viTardeba. SesaZlebelia gamovlindes
sa da azris gadmocemis unari. samkurnalod SeiZleba
simptomebis mTeli speqtri, rac mozrdili paciente-
metyvelebis Terapia, fsiqoTerapia an bihevioru-
bisTvisaa damaxasiaTebeli (ix. me-12 Tavi). orive,
li Terapia gamoviyenoT, Tumca, arc erTi meTodis
DSM-IV da ICD-10 klasifikaciaSi, bavSvebisa da mo-
efeqturoba damtkicebuli ar aris. zog SemTxvevaSi
zrdilebisTvis Sizofreniis erTi da igive diagnos-
eleqtiuri mutizmi ramdenime Tve an weli grZeldeba.
tikuri kriteriumebi gamoiyeneba. ar arsebobs bavSv-
5-10 wlis ganmavlobaSi mcire jgufze Catarebuli
Ta SizofreniisTvis calke gamoyofili kategoria.
Semdgomi dakvirvebis kvleva aCvenebs, rom mxolod
Sizofreniis niSnebis gamovlenamde bavSvTa umravle-
eleqtiuri mutizmis mqone bavSvebis mxolod naxevris
sobas metyvelebis ganviTarebis dayovneba aReniSneba
mdgomareoba umjobesdeba (Kolvin and Fundudis, 1981);
da isini ucnauri, morcxvi da sensitiuri pirovnebis
(mimoxilva ix. Kolvin, 2000).
STabeWdilebas toveben. adreuli diagnostika Znelia,
enabluoba gansakuTrebiT, Tu damaxasiaTebel simptomebs araspe-
cifikuri niSnebi uZRvis win.
enabluoba (enaborZikoba) metyvelebis ritmisa da
mkurnaloba xorcieldeba antifsiqozuri prepara-
JReradobis Seferxebaa. man SeiZleba sityvis an mar-
tebiT. gamoiyeneba igive strategia, rogorc mozrdi-
cvlis gameorebis saxe miiRos, an gamovlindes me-
lebis SemTxvevaSi, Tumca, asakTan Sesabamisi dozebiT.
tyvelebis SewyvetiT. enabluoba 4-jer ufro xSirad
aucilebelia ganaTlebasTan dakavSirebuli proble-
gvxvdeba biWebSi, vidre gogonebSi. es problema, ufro
mebis gaTvaliswineba da ojaxis mxardaWera. (bavSvTa
xSirad, metyvelebis ganviTarebis sawyisi etapisTvis
SizofreniasTan dakavSirebuli informacia ix. Hollis,
xanmokle drois manZilzea damaxasiaTebeli. enaborZi-
2002).
ki bavSvebis mxolod 1%-s saskolo asakSic aReniSneba
es problema.
sqesis identobis problemebi
enabluobis mizezi ar aris cnobili, miuxedavad
imisa, rom mravali Teoria arsebobs. savaraudod, feminuroba (qaluroba) biWebSi
sxvadasxva SemTxvevas gansxvavebuli mizezi aqvs. ge- zogi biWi amjobinebs gogosaviT gamowyobasa da go-
netikuri faqtorebi, tvinis dazianeba da SfoTva gonebTan TamaSs. zogs gamoxatuli qaluri manerebi
mniSvnelovani faqtorebia, magram yvela SemTxvevaze aqvs da ambobs, rom qalad yofna surs. amis mizezi
ganzogadeba ar iqneboda swori. enabluoba araa daka- ucnobia da endokrinuli darRvevebis niSnebic ar
vSirebuli fsiqikur aSlilobebTan, miuxedavad imisa, aRiniSneba. SesaZlebelia, es ukavSirdebodes bavSvis
rom SeiZleba uxerxuloba da distresi gamoiwvios. mimarT ojaxis damokidebulebas. zogjer mSoblebi
bavSvebis umravlesoba mkurnalobis gareSec Cveu- biWebs gogosaviT acmeven, TamaSebSi, partnioris ar
lebrivad iwyebs metyvelebas. rezistentul SemTx- yolis gamo, gogos rols miuCenen. SesaZloa, ojaxSi
vevebSi fsiqiatriuli mkurnalobis mravali meTodi ar iyos mamakaci, romelTanac bavSvi identificirebas
gamoiyeneba, maT Soris, fsiqoTerapia da bihevioruli moaxdenda. Tumca, umravlesoba aseTi gavlenis gare-
Terapia, Tumca efeqturad arc erTi araa miCneuli. Sec xdeba feminuri.
_ 736 _
mkurnalobisas Znelia imis gansazRvra, Tu ramdenad mozrdilebTan (xandazmulebis garda) SedarebiT,
Zlieria es survili. Tanmxlebi emociuri aSlilobe- ufro metad arian midrekilni deliriumisadmi. amis
bi Carevas saWiroebs. aseve, mniSvnelovania mSoble- magaliTia maRal sicxeze ganviTarebuli deliriumi,
bis gamokiTxva da yvela im qcevis ganxilva, romelic rac sakmaod xSirad gvxvdeba.
xels uwyobs aseTi qcevisa da survilis arsebobas an sxva fsiqikuri aSlilobebi. uaitis kunZulze
gamyarebas. prognozi gaurkvevelia. transvestiste- Catarebuli kvlevis mixedviT, fsiqikuri aSlilobebis
bisa da transseqsualebis umravlesoba aRniSnavs, garcelebis sixSire somaturi daavadebis mqone bavS
rom bavSvobaSi gogonebis TamaSi ufro siamovnebdaT. vebSi, romlebsac Tavis tvinTan dakavSirebuli
kvlevebiT dadgenilia, rom feminuroba ufro metad problemebi ar aReniSnebodaT, odnav iyo momatebuli.
biseqsualizmTan an homoseqsualizmTanaa dakavSire- Tumca, mniSvnelovnad meti iyo tvinis organuli
buli, vidre transvestizmsa da transeqsualobasTan daavadebebisa da epilefsiis dros.
(Zuger, 1984; Green, 1985). qronikuli daavadebebis sxva Sedegebi. qronikulma
daavadebebma SeiZleba gamoiwvios kiTxvis unarebisa
maskulinoba qalebSi
da zogadi inteleqtis ganviTarebis CamorCena. aseve,
gogonebSi gamoxatuli maskulinobis kavSiri mozar- gavlena moaxdinos TviTSefasebasa da urTierTobebis
dobis asakis seqsualur orientaciasTan ar aris cno- damyarebaze, rac xSirad zrdasrul asakSic grZeldeba.
bili. umetes SemTxvevaSi SesaZlebelia mSoblebis
damSvideba, xolo zogjer saWiroa mSoblebTan bavSvis gavlena mSoblebze
mimarT damokidebulebaze saubari da qaliSvilis qce- mSoblebze bavSvis qronikuli da invalidobis
vaze maTi reaqciis ganxilva (sqesis identobis saki- gamomwvevi daavadebebi mniSvnelovan gavlenas axdens.
Txebis mimoxilva ix. Zucker, 2002). maTi sapasuxo reaqcia damokidebulia somaturi
daavadebis bunebaze, bavSvis temperamentze, mSob
suicidi da TviTdazianeba lebis emociur resurssa da ojaxur garemoze.
suicidic da TviTdazianebac iSviaTia 12 wlamde asa- mSoblebs SeiZleba mTeli rigi emociuri gancdebi
kis bavSvebSi (Tumca, xSiria mozardobis asakSi). es aReniSnebodeT, maT Soris, glovis reaqciac da maTi
problemebi ganxilulia TavSi, romelic suicidisa da ojaxuri da socialuri cxovreba safrTxis winaSe
TviTdazianebis sakiTxebs exeba (gv. 412 da 422); (ufro dadges. mSoblebis umravlesoba, sabolood, axerxebs
srulad informacia ix. King and Apter, 2003). avadmyof SvilTan Tbili da mzrunveli urTierTobis
damyarebas da sirTuleebTan warmatebulad gam
bavSvobaSi fizikuri daavadebebis klavebas. mxolod mcire nawili ver arTmevs Tavs am
fsiqikuri aspeqtebi problemebs, gansakuTrebiT maSin, Tu maT ararealuri
kavSiri fizikur da fsiqikur problemebs Soris molodini aqvT, an uaryofen problemis arsebobas, an
bavSvTa asakSi iseTivea, rogoricaa mozrdilTa (ix. gadametebul mzrunvelobas iCenen.
me-14 da me-16 Tavebi). arsebobs sami ZiriTadi jgufi, gavlena da-Zmaze
romlebic garkveuli sixSiriT pediatriul da bavSv-
avadmyofi bavSvis da-Zmebma SeiZleba mitovebulad
Ta fsiqiatriul praqtikaSi gvxvdeba:
igrZnon Tavi, an gaRiziandnen imiT, rom SezRudulebi
1. somaturi daavadebis fsiqologiuri da socialuri arian socialur aqtivobebSi; aRSfoTdnen im faqtiT,
Sedegebi; rom avadmyofis movlaSi daxmarebisTvis ojaxis
2. fsiqikuri aSlilobebi, romlebic somaturi sim wevrebi maT did dros akargvineben. avadmyofis da-
ptomebiT iCens Tavs, mag., muclis tkivili; ZmebSi kvlevebiT ufro meti emociuri da qceviTi
3. fsiqikuri aSlilobebis somaturi garTulebebi, darRvevebia gamovlenili, vidre es erTi SexedviT
mag., kvebiTi aSlilobebi da enkoprezi. Cans (Breslau and Prabucki, 1987). umetes SemTxvevaSi
samedicino problemebis umravlesoba, romlebic da-Zmebi mSvenivrad umklavdebian Seqmnil viTarebas;
bavSvTa asakSi gvxvdeba, ganxilulia TavSi _ `fsi zogze gazrdili pasuxismgebloba dadebiT gavlenasac
qiatria da medicina~ (me-16 Tavi). am TavSi mxolod axdens. isini ukeTesad swavloben stresTan gam
Zalian specifikur mdgomareobebs SevexebiT. klavebasa da TanagrZnobas.
bavSvTa somaturi daavadebebis Sedegebi marTva

yvelam, vinc CarTulia fizikuri daavadebebis
somaturi daavadebebiT ganpirobebuli fsiqikuri
mqone bavSvebis movlaSi, unda icodes bavSvisa da
aSlilobebi
misi ojaxis wevrebis fsiqologiuri problemebi.
deliriumi. fizikuri daavadebebis dros bavSvebi, mSoblebisTvis distresuli informaciis miwodebisas
_ 737 _
Zalian mniSvnelovania maTi emociebis gaTvaliswineba. erTad, xdeba gamocdilebis intensiurad dagroveba.
SesaZloa, saWiro gaxdes ojaxTan ramdenjerme Sexvedra mozardi cdilobs ipovos Tavisi identoba, romelic
da xangrZlivi drois manZilze konsultaciebisa asaxavs mis pirovnebasa da mis ojaxs da Seesabameba
da Tanadgomis uzrunvelyofa. pediatri da fsi mis unarebsa da arsebul garemoebebs. am procesSi
qiatri mWidrod unda TanamSromlobdnen. aseve, Tanatolebis, mSoblebisa da maswavleblebis gavlena
mniSvnelovania TiToeuli maTganis, an orives erTad, Zalian didia.
muSaoba socialur muSakebTan, pedagogebTan da sxva, naklebad ganviTarebul qveynebSi mozardebi mu
bavSvis movlaSi CarTul pirebTan. SesaZlebelia, Saobas iwyeben da TandaTanobiT pasuxismgeblobis
saWiro gaxdes ojaxisTvis xanmokle Sesvenebis grZnoba uviTardebaT. ganviTarebul qveynebSi ga
uzrunvelyofa, rom maT avadmyofi bavSvis movlis naTlebis miReba gvian mozardobamde grZeldeba da
gagrZeleba SeZlon (rCevebi mSoblebisTvis, romlebsac pasuxismgeblobis grZnoba SedarebiT gvian yalibdeba.
letaluri daavadebis mqone Svilebi hyavT, mocemulia am asakSi pirovneba, erTis mxriv, valdebulia Se
Wooley et al., 1989; bavSvTa simsivneebi gv. 400). eguos sazogadoebaSi dadgenil wesebs, xolo, meores
mxriv, cdilobs iyos damoukidebeli da Tavad
stacionirebuli bavSvebi
daawesos Tavis qcevaze SezRudvebi. mozardobis
boulbim (Bowlby, 1951) gamoyo protestis, sasowar asakis bevri problema swored am winaaRmdegobrivi
kveTisa da sakuTar TavSi Caketvis Tanmimdevruli moTxovnilebebiTaa ganpirobebuli. SesaZlebelia,
stadiebi, romlebic uviTardebaT im bavSvebs, rom pirovnebam protesti gamoucxados sazogadoebaSi
lebic stacionarSi moTavsebis gamo mSoblebs da arsebul normebs. zogjer es procesebi Zalian
aciles. raTa es Tavidan aviciloT, bavSvi winaswar emociurad da mtkivneulad viTardeba, xolo, zogjer
unda movamzadoT da misTvis gasageb enaze avuxsnaT, sruliad SeumCnevelia. gamokvlevebis Tanaxmad
Tu ra elis saavadmyofoSi. sasurvelia gavacnoT meamboxeoba da mSoblebis mimarT gaucxoveba ar
saavadmyofos Statis TanamSromlebi, romlebTanac aris damaxasiaTebeli maincdamainc saSualo asa
bavSvs urTierToba mouwevs. mSoblebs da ojaxis sxva kis mozardebisTvis, Tumca, Sinagani vnebaTa Re
wevrebs unda SeeZloT bavSvis xSiri monaxuleba da, lva, dardi, daqveiTebuli TviTSefaseba da
saWiroebis SemTxvevaSi, bavSvis movlaSi monawileobis damokidebulebis ideebi axalgazrdebis TiTqmis
miReba. mcirewlovani bavSvis SemTxvevaSi, erT-erT naxevars aReniSneba (Rutter et al., 1976a). es gancdebi
mSobels unda SeeZlos masTan Rame darCena, Tu iSviaTad grZeldeba didi xnis manZilze da
ojaxuri mdgomareoba amis saSualebas iZleva. aseTi ufrosebisTvis xSirad SeumCnevelia. SesaZloa, Tavi
organizeba gansakuTrebiT mniSvnelovania xangrZlivi iCinos urTierTobisa da seqsualur cxovrebasTan
da ganmeorebadi stacionirebis dros. dakavSirebulma problemebma. mogvianebiT, ufro
zrdasrulebs saprotesto ganwyobebi uZlierdebaT
mozardebis fsiqikuri problemebi da saswavlebelSi savaldebulo siarulis bolo
mozardTa specifikuri fsiqikuri aSlilobebi ar aris wlebSi emijnebian skolis cxovrebas. SesaZloa, es
gamoyofili. miuxedavad amisa, saWiroa specialuri problemebi gamovlindes alkoholis an fsiqoaqtiuri
gamocdileba da unar-Cvevebi, raTa bavSvobidan nivTierebebis moxmarebis (ganxilulia me-18 TavSi),
mozrdilobaSi gadasvlis am umniSvnelovanes etapze manqanis an sxva satransporto saSualebebis (mag.,
myof pacients, fsiqiatriuli diagnostirebisa motocikletis) upasuxismgeblo tarebis an sxva
da mkurnalobis ZiriTadi principebi movargoT. destruqciuli qcevis saxiT.
gansakuTrebiT Znelia fsiqikuri aSlilobisa da
mozardobis asakis normaluri emociuri reaqciebis
fsiqikuri aSlilobebis epidemiologia
mozardTa asakSi
erTmaneTisgan gamijvna. amitom am TavSi, pirvel
rigSi, ganvixilavT, Tu ramdenad organulia emociuri miuxedavad imisa, rom fsiqikuri aSlilobebi arc
aSlilobebi mozardebisTvis (mozardobis asakis prob ise metia mozardobis asakSi, vidre bavSvobis
lemebis zogadi mimoxilva da mkurnalobis sakiTxebi saSualo asakSi, maTTvis damaxasiaTebeli paternebi
ix. Goodman and Scott, 2005, 22-e Tavi). mniSvnelovnad gansxvavebulia da ufro mozrdili
asakisTvis damaxasiaTebeli simptomebis msgavsia.
fsiqologiuri cvlilebebi mozardobis asakSi mozardebSi, bavSvebTan SedarebiT, SfoTva naklebadaa
mozardobis asakSi mniSvnelovani fizikuri, fsiqos gamoxatuli, xolo depresia da skolis gacdena ufro
eqsualuri, emociuri da socialuri cvlilebebi xSiria. aSS-Si Catarebulma epidemiologiurma kvlevam
xdeba. am periodSi axalgazrda adamiani fizikurad aCvena, rom mozardobaSi yvelaze gavrcelebuli
da seqsualurad mwifdeba. misi kognituri unarebi fsiqikuri aSlilobebia disTimia, depresia da
ukve mozrdili pirovnebis donis Sesabamisia. amasTan generalizebuli SfoTviTi aSliloba, rasac bulimia,
_ 738 _
nervuli anoreqsia, obsesiur-kompulsuri aSliloba viyenebT. am dros mkurnaloba iwyeba im zogadi
da panikuri aSliloba mohyveba (Whitaker et al., 1990). RonisZiebebiT, rasac bavSvTa depresiuli aSlilobis
dros mimarTaven (gv. 687).
mozrdilTa fsiqikuri aSlilobebis klinikuri
fsiqologiuri mkurnaloba gatarebuli zogadi
suraTi
RonisZiebebis Semdgomi etapia. arsebobs uamravi
SfoTviTi aSliloba mtkicebuleba imisa, rom igi ufro efeqturia
bevri fsiqikuri aSliloba mozardobis asakSi iwyeba. 14 mozardebis mkurnalobisas, vidre bavSvebis. am asakSi
wlidan skolis damTavrebamde sakmaod xSiria skolaSi zomieri depresiuli aSlilobis mkurnalobisTvis
wasvlaze uaris Tqma. generalizebuli SfoTviTi dadasturebulia kognitur-bihevioruli Terapiis
aSliloba bavSvebisTvis ufroa damaxasiaTebeli, dadebiTi Sedegi (Harrington et al., 1998a, b). arsebobs
vidre mozardebisTvis. socialuri fobia adreul, ramdenime mtkicebuleba imisa, rom interpersonaluri
xolo, agorafobia ufro mogvianebiT, mozardobis Terapiac garkveul Sedegs iZleva.
asakSi iCens Tavs. medikamentebi. bipolaruli aSlilobebis dros
iseve, rogorc mozardebSi, liTiumi, Cveulebriv,
qceviTi aSlilobebi Setevebis ricxvs amcirebs. aseve, gamoiyeneba sxva
qceviTi aSlilobebis naxevarze meti, romlebic normoTimikebi, mag., valproati (gv. 562). aucilebelia
mozardebSi gvxvdeba, bavSvobis asakidan iwyeba. dozebis saTanadod SerCeva.
is SemTxvevebi, romlebic mogvianebiT viTardeba, depresiuli epizodisTvis upiratesad iyeneben
gansxvavebulia imiT, rom naklebadaa asocirebuli susi-ebs; Tumca, didi sifrTxile gvmarTebs imasTan
kiTxvis darRvevebTan da paTologiis ojaxur bu dakavSirebiT, rom susi-ebiT mkurnalobis dawyebisas
nebasTan. adreul asakSi dawyebuli qceviTi aSli arsebobs suiciduri azrebisa da qmedebebis gaaq
lobebis mqone bavSvebi agresiul qcevas ufro tiurebis saSiSroeba (gv. 547). did britaneTSi
saxlSi avlenen, vidre gareT. xolo, mozardebi aRiarebulia mxolod fluoqsetini iseT medikamentad,
ufro xSirad saxlis gareT Cadian danaSauls, romelsac aqvs dadebiTi riskisa da efeqturobis
romelic, upiratesad, sxvisi sakuTrebis xelyofazea Sefardeba. sxva susi-ebi, venlafaqsini da mirtazapini,
mimarTuli. skolis ganzrax gacdena (truantoba) am ar aris rekomendebuli. placebosTan SedarebiT
asakisTvis damaxasiaTebeli qceviTi aSlilobis erT- tricikluri antidepresantebis upiratesoba mo
erTi gamovlinebaa. zardebis mkurnalobis dros ar aris naCvenebi
(klinikuri ganviTarebis erovnuli instituti,
guneb-ganwyobis (afeqturi) aSlilobebi 2005). medikamenturi mkurnaloba fsiqoTerapiasTan
depresiuli aSlilobis dros mozardebSi depresiuli kombinaciaSi unda Catardes; aucilebelia suici
guneb-ganwyoba naklebad SesamCnevia, vidre gabrazeba ur azrebsa da aJitaciaze pacientis mudmivi
an mSoblebisgan gaucxoveba, Tanatolebisgan so monitoringi. randomizebuli kvlvevebiT dadginda,
cialuri gariyuloba, moswrebis gauareseba, wamal rom fluoqsetinisa da kognitur-bihevioruli Te
moxmareba da suiciduri qceva. bipolaruli aSli rapiis kombinacia ufro efeqturia, vidre calke
lobac, upiratesad, am asakSi iwyeba da umetesad fluoqsetini an kognitur-bihevioruli Terapia
qceviTi darRvevebiT xasaiTdeba. (March et al., 2004).
epidemiologia. depresiuli simptomebi ufro da eleqtrokrunCxviTi Terapia gamoiyeneba Zalian
maxasiaTebelia mozardebisTvis, vidre bavSvebisTvis. iSviaTad, mxolod mwvave da medikamentebisadmi re
uaitis kunZulze Catarebul kvlevam aCvena, rom zistentul SemTxvevebSi. ekT SedarebiT mogvianebiT,
depresia 10-jer ufro metad aReniSnebodaT14 wlis mozardobis asakSi iniSneba (klinikuri ganviTarebis
mozardebs, vidre 10 wlis bavSvebs. erovnuli instituti, 2005).
etiologia. memkvidruli faqtori mozardebTan prognozi. mozardobis asakSi ganviTarebuli dep
ufro TvalsaCinoa, vidre bavSvebTan, romlebSic resia ufro xSirad rekurentuli xasiaTisaa da
genebi ufro arapirdapir moqmedeben, mag., iseTi mozrdilobaSic grZeldeba. daavadebis xangrZlivoba
qceviT, romelic zrdis negatiur cxovrebiseul zrdis suicidis albaTobas (ix. Goodman and Scott, 2005;
gamocdilebas (gv. 678). stresuli movlenebi ojaxSi gv. 95). amJamad, ganmeorebiTi Setevebis prevenciis
an sxvagan gavlenas axdens genetikur winaganwyobaze TvalsazrisiT arc erTi mkurnalobis efeqturoba
(Hammen et al., 2004). dadasturebuli ar aris (Marry et al., 2004). bipolaruli
aSlilobebis dros, iseve rogorc mozrdilebSi,
mkurnaloba
liTiumiT profilaqtika dadebiT gavlenas axdens
mozardebSi mkurnalobis safexureobrivi strategia daavadebis mimdinareobaze (gv. 557).
imave princips emyareba, rasac bavSvebis SemTxvevaSi
_ 739 _
Sizofrenia qoaqtiur nivTierebebs da iSviaTad xdeba regularuli

momxmarebeli. is pirebi, romlebic eCvevian nar
Sizofrenia mozardebSi ufro xSirad gvxvdeba biWebSi,
kotikuli nivTierebebis miRebas, ufro xSirad
vidre gogonebSi. Cveulebriv, diagnozis dasma did
diskordantuli ojaxebidan arian an ganqorwinebuli
sirTuleebTanaa dakavSirebuli. gansakuTrebiT Znelia
mSoblebi hyavT. isini, Cveulebriv, cudi moswrebiT
specifikuri niSnebis amocnoba iseT SemTxvevebSi,
gamoirCevian da, upiratesad, wamalmomxmarebeli
rodesac daavadeba iwyeba pirovnebis TandaTanobiTi
megobrebi hyavT. aseve, mniSvnelovania gaucxovebis
cvlilebiT, socialuri izolaciiTa da socialuri
grZnobisa da dabali TviTSefasebis arseboba.
funqcionirebis gauaresebiT. prognozi ukeTesia
gamomdinare iqidan, rom wamalmoxmareba ufro xSirad
erTjeradi, mwvave da polisimptomuri dasawyisis
mozardobis periodSi iwyeba da, SedarebiT iSviaTad
SemTxvevaSi, xolo arakeTilsaimedoa simptomTa
mozrdil asakSi, gansakuTrebiT mniSvnelovania swored
TandaTanobiTi, Semparavi ganviTarebis dros.
am asakSi prevenciuli RonisZiebebis gatareba, Tumca,
kvebiTi aSlilobebi maTi efeqturoba dReisTvis dadgenili ar aris. aSS-Si
mozardobis asakSi xSiria kvebisa da wonis problemebi, Seqmnilia wamalmoxmarebis klinikebi mozardebisTvis,
rac ganxilulia me-15 TavSi. mozardobaSi gamovlenili magram damajerebeli Sedegebis demonstrireba jer-
es problemebi mozrdilebSi mimdinare aSlilobebis jerobiT ver xerxdeba. (ix. bavSvTa da mozardTa
msgavsia. Zalian mniSvnelovania mozardi pacientis fsiqiatriis amerikis akademiis gamocema mozardTa
mkurnalobis procesSi mSoblebisa da ojaxis sxva wamalmoxmarebis Sefasebisa da mkurnalobis Sesaxeb,
wevrebis CarTva. formaluri ojaxuri Terapia 1998c). (mozardebSi wamalmoxmarebasTan dakavSirebuli
nervuli anoreqsiis samkurnalod efeqtur meTodadaa sakiTxebis ganxilva ix. Bonomo and Proimus, 2005).
miCneuli (mimoxilva ix. Steiner and Lock, 1998).
seqsualuri problemebi
suicidi da TviTdazianeba seqsualobasTan dakavSirebuli wuxili mozardobis
ukanasknel wlebSi mniSvnelovnad imata mozardTa asakSi Cveulebrivi gancdaa. ukanasknel wlebSi imata
Soris suicidisa da TviTdazianebis SemTxvevebma. es fsiqiatriul dawesebulebebSi seqsualuri Zaladobis
sakiTxebi ganxilulia me-17 TavSi (gv. 412, 422). faqtebis Semdeg momarTvianobam (gv. 699).
mniSvnelovani problemaa mozardTa orsuloba.
alkoholizmi da wamalmoxmareba am asakSi ufro xSiria fexmZimobis Sewyveta, xolo
mozardobis asakSi wamalmoxmarebisa da alkoholizmis danarCen SemTxvevebSi ki, fexmZimoba arasasurvelia.
problemebi iseve vlindeba, rogorc mozrdilebSi prenataluri garTulebebis sixSire mozardebSi bevrad
(ix. me-18 Tavi). alkoholis Warbi raodenobiT miReba momatebulia. mozardi dedebisTvis damaxasiaTebelia
damaxasiaTebelia mozardebisTvis, gansakuTrebiT igive mSobiarobis Semdgomi fsiqikuri aSlilobebi,
qceviTi darRvevebis mqone axalgazrdebisTvis. ume rac zogadad aris cnobili (gv. 402). arasrulwlovani
tesoba, vinc mozardobis asakSi didi odenobiT asakis dedebi iSviaTad arTmeven Tavs TavianT
alkohols moixmars, asakis matebasTan erTad uklebs movaleobebs da mozardTa qorwinebebic umetesad
smas. mcire nawils ki, SemdgomSi alkoholmoxmarebis gayriT mTavrdeba. Zalian mniSvnelovania fexmZime
seriozuli problemebi aReniSneba. ukve danergilia mozardebis grZelvadiani samedicino da socialuri
ramdenime prevenciuli programa, Tumca, maTi efeq servisebiT uzrunvelyofa.
turoba ar aris dadasturebuli (Foxcoft et al., 1997).
mozardebis Sefaseba
mozardobis asakSi xSirad xdeba fsiqoaqtiuri
wamlebis periodulad moxmareba, upiratesad, jgu mozardTa interviuirebisTvis saWiroa specialuri
furad. gansakuTrebiT xSiria haSiSisa da eqstazis unar-Cvevebi. zogadad, adreuli mozardobis asak
miRebis SemTxvevebi. saineqcio formebis gamoyeneba Si myofi pirebisadmi midgoma bavSvebis mimarT
gacilebiT iSviaTi da, Cveulebriv, xanmoklea. am asakSi gamoyenebuli teqnikis msgavsia, xolo, mogvianebiT
barbituratebis, amfetaminebis, opiatebisa da kokainis asakSi myofTTvis _ zrdasruli adamianebisa. yo
miReba SedarebiT naklebadaa damaxasiaTebeli, magram velTvis unda gvaxsovdes, rom axalgazrdebis umrav
ufro mZime SedegebiT gamoirCeva. wamaldamokidebuli lesoba fsiqiatrTan Tavisi survilis sawinaaRmdegod
mozrdili pirebis umravlesobas axalgazrdobaSi es midis, uWirs Tavisi mdgomareobis ise Camoyalibeba da
preparatebi gamocdili aqvs. arsebobs myari kavSiri gadmocema, rogorc amas zrdasruli piri gaakeTebda.
bavSvobaSi ganviTarebul qceviT aSlilobebsa da amitom fsiqiatrma ar unda daiSuros dro da
mozardobaSi fsiqoaqtiuri nivTierebis moxmarebas Zalisxmeva, raTa daamyaros urTierToba mozard
Soris (Robins, 1966). pacientTan. eqimma unda gamoxatos interesi da
mozardebis didi nawili drodadro moixmars fsi pativiscema pacientis mimarT da saubrisas gamoiyenos
_ 740 _
sityvebi da frazebi, romlebic mozardisTvis gasagebi mkurnalobas sTavazobs momxmarebels. am servisebSi
iqneba. mozrdilebTan muSaobisas fsiqiatrisTvis iReben pacientebs, romlebsac agzavnian ara marto
mniSvnelovania informaciis Tanmimdevruli da samedicino dawesebulebebi, aramed pedagogebi, so-
detaluri Segroveba, xolo mozardebTan ufro cialuri muSakebi an sasamarTlo. arasamedicino
mizanSewonilia moqnili intervius teqnikis gamoyeneba. momarTvisas, SemTxvevis ganxilva xdeba ojaxis eqim-
umjobesia mozardTan gasaubreba mSobelTan Sexved Tan erTad. mozardTa yvela dawesebuleba skolebT-
ramde. aseT SemTxvevaSi pacienti darwmundeba, rom an da socialur samsaxurebTan mWidrod TanamSrom-
mas damoukidebel pirovnebad aRiqvamen. Semdgom lobs. stacionireba Zalian SezRudulia. socialur
sasurvelia mSoblebTan an ojaxis sxva wevrebTan cal- servisebTan unda moxdes SeTanxmeba imis Taobaze, Tu
calke an erToblivad gasaubreba. Zalian mniSvnelova- ra saxis problemebi saWiroebs hospitalizacias da
nia informaciis moZieba imis Taobaze, Tu rogor fun- romel mdgomareobebze unda izrunon saTemo ser-
qcionirebs mozardi saxlSi, skolaSi, samsaxurSi an visebma, romlebsac socialuri samsaxurebi uzrunve-
rogor urTierTobs TanatolebTan. saWiroa Sesabami- lyofen. stacionarSi moTavseba xdeba im SemTxvevaSi,
si fizikuri gamokvlevebis Catarebac. roca saxezea Semdegi mizezebi:
aseTi gamokvlevis Semdeg unda gakeTdes proble- w mwvave an uCveulo fsiqikuri simptomebi, romlebic
mis klasificireba, Semdegi sami klasis Sesabamisad: (1) pacientze dakvirvebas, mdgomareobis guldasmiT
mozards fsiqiatriuli diagnozi ar aqvs da gamxneveba Seswavlas an mkurnalobas saWiroeben;
sruliad sakmarisia; (2) fsiqiatriuli diagnozi ar
w sakuTari TavisTvis an sxvebisTvis saxifaTo qcevis
aRiniSneba, magram mozardi, aRelvebuli mSoblebi an
dros, rac fsiqikuri aSlilobiTaa ganpirobebuli.
ojaxuri mdgomareoba saWiroebs daxmarebas; (3) pirs
Tu saSiSi qceva dakavSirebulia pirovnebasTan an
aqvs fsiqikuri aSliloba da saWiroa mkurnalobis
garemoebebTan da ara fsiqikur aSlilobasTan,
Catareba.
maSin fsiqiatriuli stacionari ver iqneba imaze
mkurnaloba efeqturi, vidre saTemo sacxovrisi. amasTan,
aseTi pirovnebis qceva stresuli iqneba fsiqikuri
mozardTa mkurnalobis meTodebi bavSvTa da moz-
aSlilobebis mqone pacientebisTvis.
rdilTa fsiqiatriaSi gamoyenebul midgomebs Soris
Sualeduria. iseve rogorc bavSvebis SemTxvevaSi,
bavSvebze Zaladoba
mniSvnelovania mSoblebTan da pedagogebTan muSaoba.
aucilebelia mSoblebis an, saWiroebis SemTxvevaSi, ukanasknel wlebSi bavSvebze Zaladobis koncefcia
ojaxis sxva wevrebis gamxneveba, daxmareba da Tanad- gafarTovda da amJamad moicavs urTierTgadamfarav
goma, gansakuTrebiT maSin, rodesac referalis dros kategoriebs, rogorebicaa: fizikuri, emociuri,
mSoblebi SfoTaven da Relaven umniSvnelo qceviTi seqsualuri Zaladoba da ugulebelyofa. kvlevebis
problemebis, da ara gamoxatuli fsiqikuri aSli- umravlesoba Catarebulia ganviTarebul qveynebSi
lobis gamo. gasaTvaliswinebelia isic, rom mozards da naklebad ganviTarebad qveynebSi, sadac bavSvebi
moveqceT, rogorc individs, romelic TandaTan ojax- sakvebis naklebobas ganicdian da ufro mZime
isgan damoukidebeli xdeba. amitom ojaxuri Terapiis pirobebSi imyofebian. am qveynebSi sastiki fizikuri
Catareba iseve, rogorc bavSvebis SemTxvevaSi, Seu- dasjis, ugulebelyofis, bavSvTa prostituciisa da
sabamo da zianis momtania. maTxovrobis SemTxvevebi ufro xSiria.
termini `nayofze Zaladoba~, gamoiyeneba iseTi
servisebi mozardebisTvis qcevis aRsaniSnad, romelic nayofisTvis damRupvel
mozardobis asakis pacientTa ricxvi sxva asakobriv Sedegebs iwvevs. es SeiZleba iyos fizikuri dazianeba
jgufTan SedarebiT naklebia, amitom adreuli asa- an dedis mier sxvadasxva preparatis miReba, rac
kis mozardebis mkurnaloba rekomendebulia bavSvTa nayofisTvis fataluri SedegiT mTavrdeba. termini
fsiqiatriul servisebSi, xolo mogvianebiT asakSi `gamowveuli~ aSliloba (miunhauzenis sindromi),
myofi mozardebisa ki _ mozrdilTa dawesebulebebSi. ixmareba iseTi viTarebis aRsaniSnad, rodesac saxezea
Tumca, momsaxurebis didi nawili SesaZlebelia ganx- bavSvebis aSkara avadmyofoba, romelic mSoblebis
orcieldes ufro miznobrivad specializebul mo- mier ganzrax, mag., bavSvis nawilobrivi moxrCobiTaa
zardTa servisebSi. amasTan, uzrunvelyofili unda gamowveuli (gv. 390). (bavSvebze Zaladobisa da maTi
iyos mWidro TanamSromloba bavSvTa da mozrdilTa ugulebelyofis zogadi mimoxilva ix. Jones, 2000).
fsiqiatriul da pediatriul samsaxurebTan. arsebobs
aseTi organizaciebis sxvadasxva variaciebi. maTi um- araSemTxveviTi xasiaTis fizikuri dazianebebi
ravlesoba individualur da ojaxur Terapiebs da, fizikuri Zaladobis SemTxvevebis sixSire gansxva
mwvave SemTxvevebSi, medikamentur an kombinirebul vebulia SefasebisTvis gamoyenebuli kriteriumebis
_ 741 _
Sesabamisad. did britaneTSi 0-dan 18 wlis 1000 etiologia
mosaxlidan 3 _ bavSvTa zrunvis reestrSia gatarebuli
arsebobs uamravi urTierTmoqmedi mizezi (ix. cxrili
(Goodman and Scott, 2005; gv. 170). ufro maRali ricxvia
24.9).
dafiqsirebuli aSS-Si (ix. Jones, 2000). ufro xSiria
garemo. bavSvebze Zaladobis faqtebi ufro xSiria im
naklebad mZime SemTxvevebi, Tumca, isini ar eqcevian
regionebSi, sadac ojaxuri Zaladobaa gavrcelebuli,
profesionalTa mxedvelobis areSi.
aradamakmayofilebelia sacxovrebeli da samuSao
klinikuri suraTi pirobebi, ganaTlebis cudi xarisxi da dabali samo
qalaqo TviTSegneba.
mSoblebma SeiZleba Svili eqimTan miiyvanon da
mSoblebis faqtorebi, romlebic bavSvebze Zalado
ganacxadon, rom dazianebebi SemTxveviTaa miRebuli.
basTanaa dakavSirebuli, Semdegia: axalgazrda asa
SesaZlebelia naTesavebma, mezoblebma, an sxva pi
ki, pirovnebis xasiaTobrivi anomalia, fsiqikuri
rebma mimarTon policias, socialur samsaxurebs an
aSlilobebi, dabali socialuri klasi, socialuri
nebayoflobiT saagentoebs. yvelaze xSiri dazianebebia:
izolacia, ojaxuri Tanacxovrebis disharmonia, mSob
sxeulze mravlobiTi sisxlnaJRenTi, damwvroba, nakbeni,
lebis gayra da kriminaluri warsuli. fsiqikuri
naWdevebi, dazianebuli zeda tuCi, Zvlebis motexiloba,
aSlilobebidan ufro xSiria pirovnebis aSlilobebi,
subduruli da retinuli sisxlCaqcevebi. zogi bavSvi
iSviaTad, Sizofrenia an afeqturi aSlilobebi. bev
baliSiTaa gaguduli, xolo mSoblebi mizezad apnoes
ria iseTi mSobeli, romelic bavSvobaSi Tavad iyo
Setevas asaxeleben. fizikur Zaladobaze miuTiTebs
Zaladobis an deprivaciis msxverpli. moZalade
dazianebis damaxasiaTebeli paternebi, warsulSi
ojaxebSi mSoblebs Soris damokidebuleba, sakon
saeWvo dazianeba, momxdaris aradamakmayofileblad
trolo jgufTan SedarebiT, ufro uxeSi da civia (Jones
da gaugebrad axsna, eqimTan mimarTvis dagvianeba da
and Alexander, 1978). Zaladoba metadaa damaxasiaTebeli
mSoblebis Seusabamo reaqcia. Zaladobis msxverpli
socialurad problematuri ojaxebisTvis, Tumca,
bavSvebis fsiqologiuri Taviseburebani gansxvavebulia,
mxolod aseTi ojaxebiT ar Semoifargleba.
Tumca, damaxasiaTebelia mSoblebis mimarT SiSi,
bavSvebisTvis damaxasiaTebeli risk-faqtorebia:
SfoTvisa da ubedurebis gancda da socialuri
moumwifebeli nayofi, dedasTan adreul asakSi
izolacia. aseT bavSvebs daqveiTebuli TviTSefaseba
ganSoreba, neonatalur periodSi specialuri zrunvis
aqvT, gaurbian ufrosebTan urTierTobas da SeiZleba
saWiroeba, Tandayolili simaxinjeebi, qronikuli
agresiulebic iyvnen.
daavadebebi da mZime xasiaTi.
cxrili 24.9 bavSvebze Zaladobis risk_faqtorebi
Sefaseba da marTva
mSoblebi eqimebi da sxva pirebi, romlebic CarTulni arian
w axalgazrda asaki; zrunvaSi, gansakuTrebul yuradRebas unda iCendnen
w dabali inteleqti; Zaladobrivi qcevis mimarT; miT umetes iseT
w socialuri izolacia/daxmarebis ararseboba; bavSvebTan, romlebsac zemoT CamoTvlili risk-
w mewyvilesTan gayra; faqtorebi axasiaTebT.
w bavSvis movlis unar_Cvevebis nakleboba, bavSvis saWi Zaladobis saeWvo niSnebia:
roebebis arcodna/sastiki dasja/arasakmarisi waxaliseba;
w bavSvobaSi gadatanili Zaladoba an ugulebelyofa; w daxmarebisTvis dagvianebuli mimarTva;
w kriminaluri warsuli; w dazianebis bundovani da gaugebari mizezi;
w fsiqikuri problemebi: depresia, wamalmoxmareba,
pirovnebis aSlilobebi. w dazianebis bunebis an sirTulesTan Seusabamo axsna;
bavSvi
w bavSvis mdgomareobis mimarT aSkara uyuradReboba;
kiTxvebze TavdacviTi an saeWvo reaqcia.
w faqtorebi, romlebic dedasTan mijaWvulobis ganvi
Tarebas uSlian xels; Zaladobaze eWvis mitanis SemTxvevaSi, eqimma bavSvi
w ganviTarebaSi CamorCena/fizikuri nakli; unda gaagzavnos stacionarSi, mimarTos pediatrs
w adreul asakSi dedasTan ganSoreba (magaliTad, an sagangebo SemTxvevebis oficers. pediatrma unda
neonatalur ganyofilebaSi gadayvana);
Caataros sruli fizikuri gamokvleva da yvela
w mZime xasiaTi/xSiri tirili.
saeWvo niSani aRweros (fizikuri daTvalierebis
garemo sakiTxebTan dakavSirebuli damatebiTi informacia
w samezoblosTan dakavSirebuli problemebi: ojaxuri ix. pediatriul saxelmZRvaneloSi). yvela gadau
Zaladobis xSiri SemTxvevebi/skolis problemebi/maRali debeli daxmarebis departamentSi unda arsebobdes
umuSevroba;
stacionaruli dayovnebis ganyofileba im bavSve
w samoqalaqo TviTSegnebis nakleboba;
bisTvis, romlebsac fizikuri Zaladobis niSnebi
w problemis drouli gamovlena da marTva.
_ 742 _
aReniSnebaT. Tu SesaZlebelia, eqimma mSoblebTan unda dakavSirebuli regulaciebi, gansxvavebulia. am sa
ganixilos Tavisi mosazrebebi da yvela SemTxvevaSi kiTxze momuSave personali unda icnobdes Tavis
unda acnobos maT, rom stacionireba aucilebelia qveyanaSi moqmed kanonmdeblobas. (bavSvebze Zaladobis
Semdgomi gamokvlevebis Casatareblad. mSoblebis SemTxvevebis SefasebasTan dakavSirebuli damatebiTi
winaaRmdegobis SemTxvevaSi, inglissa da uelsSi informacia ix. bavSvTa da mozardTa fsiqiatriis
moqmedebs bavSvis usafrTxod ganTavsebis gankarguleba; akademiis gamocemaSi, 1997a an Jones, 2000).
aseTive aqtebi SeiZleba sxva saxelmwifoebSic iyos
gaTvaliswinebuli. stacionirebisas unda Catardes prognozi
detaluri fizikuri da radiologiuri gamokvleva da Zaladobis msxverpl bavSvebs aReniSnebaT sxva prob
yvela niSani unda aRibeWdos firze. radiologiuri lemebis momatebuli riskic. mag., ganmeorebiTi
gamokvlevis Sedegad SeiZleba gamoCndes warsulSi Zaladobis SemTxvevebaTa sixSire 10-30%-ia da maTi
miRebuli dazianebebis niSnebic an sxva anomaliebi, garkveuli nawili fataluradac ki mTavrdeba. am
rogoricaa, mag., arasrulfasovani osteogenezi. bavSvebSi ufro xSirad vxvdebiT fizikur daava
subdurul hematomaze eWvis mitanis SemTxvevaSi unda debebs, ganviTarebis CamorCenilobasa da swavlasTan
gakeTdes kompiuteruli tomografia. aucilebelia dakavSirebul sirTuleebs. Terapiuli Carevis
yvela arsebuli niSnis dokumentireba. drosac, am bavSvebisTvis mozardobisa da mozrdil
Zaladobis dadasturebis SemTxvevaSi, eqimi dau asakSi qceviTi da emociuri aSlilobebis maRali
yovnebliv atyobinebs mSoblebs. unda Semowmdes ojaxis sixSirea damaxasiaTebeli (Lynch and Roberts1982, Cohn
sxva bavSvebic. mSoblebis Sefasebisas yuradReba unda and Daro 1987). zrdasrul asakSi am pirebs uWirT
mivaqcioT Semdeg sakiTxebs (Skuse and Bentovim, 1994): Tavis SvilebTan urTierToba. prognozi keTil
w aqvT Tu ara gacnobierebuli sakuTari braleuloba saimedoa im SemTxvevaSi, Tu bavSvi daamyarebs karg
Zaladobis faqtSi? urTierTobas ufros adamianTan, rac xels Seuwyobs
misi TviTSefasebis gaumjobesebas; aseve, maSin,
w Tvlian Tu ara, rom saWiroa maTi qcevis Secvla?
rodesac tvinis dazianebis niSnebi ar aRiniSneba
w arian Tu ara mowadinebuli Secvalon damokidebuleba (Lynch and Roberts1982, Rutter, 1985). prognozi gar
da qceva? kveulwilad imave faqtorebzea damokidebuli, rom
w arian Tu ara Tanaxmani daxmarebis miRebaze imisTvis, lebic Zaladobas ganapirobeben, rogoricaa, mag.,
rom moagvaron TavianTi piradi problemebi an aradamakmayofilebeli garemo (ix. zemoT) da Tavad
urTierTobebi? Zaladobis faqtebi.
Zaladobaze reagirebis meqanizmi sxvadasxva qve
emociuri Zaladoba
yanaSi sxvadasxvaa. did britaneTSi aucilebelia
termini èmociuri Zaladoba~, upiratesad, ixmareba
socialuri servisebis departamentis saqmis kursSi
persistentuli uyuradRebobis an uaryofis, ase
Cayeneba, raTa man saavadmyofosa da saTemo samsaxurebs
ve gadametebuli hiperproteqciis, sityvieri Seu
Soris informaciis gacvlis mizniT, SemTxvevasTan
racxyofis, umizezod dadanaSaulebis SemTxvevebSi,
dakavSirebuli konferencia uzrunvelyos. SesaZloa,
rac bavSvis ganviTarebis Seferxebas iwvevs. emociur
gadawydes bavSvis Zaladobis reestrSi gatareba, rac
Zaladobas, rogorc wesi, sxva saxis Zaladobac axlavs.
socialuri servisis departaments daavaldebulebs
emociuri Zaladoba mravalmxriv moqmedebs bavSvze:
bavSvis binaze monaxulebas da problemis regu
neldeba bavSvis fizikuri da fsiqologiuri mom
larulad gadamowmebas.
wifeba; SesaZloa ganviTardes qceviTi da afeqturi
zog SemTxvevaSi, bavSvis saxlSi dabruneba Zalian
aSlilobebic (Rutter, 1985). diagnozis dasmisas un
sariskoa da saWiroa misi ojaxidan wamoyvana: Tu
da davakvirdeT bavSvis mimarT mSoblebis damo
mSoblebi daSorebaze uars acxadeben, mzrunvelobaze
kidebulebas. mag., interviuirebisas mSobeli xom ar
pasuxismgeblobas Tavis Tavze iRebs socialuri
akeTebs sarkastul an damamcirebel SeniSvnebs. erT
servisebis departamenti. gaxangrZlivebuli, mZime da
an orive mSobels SeiZleba pirovnebis aSliloba
mudmivi Zaladobis SemTxvevaSi, bavSvis CamorTmeva
aReniSnebodes. fsiqikuri aSlilobebi ufro iSviaTia.
kanonis Sesabamisad xdeba da dgeba mSoblebis
Zaladobis SemTxvevebis gamosavlenad unda moxdes
pasuxismgeblobis sakiTxi. samwuxarod, cnobilia
mSoblebis rogorc cal-calke, ise erToblivad
SemTxvevebi, rodesac mSoblebTan dabrunebuli bav
gamokiTxva. SesaZlebelia, bavSvi ver akmayofilebdes
Svebi mSoblebs mouklavT an dausaxiCrebiaT. amitom
mSoblebis molodins, an agresiis mizezi mSoblisTvis
manam, sanam bavSvis ojaxSi dabrunebas gadavwyvetdeT,
Svilis moZalade pirovnebasTan msgavseba iyos. au
mdgomareoba Zalian detalurad da didi gulisyuriT
cilebelia mSoblebis fsiqikuri statusis Sefaseba
unda SeviswavloT. qveynebSi moqmedi, fizikuri
(mimoxilva ix. Hart et al., 1998).
Zaladobis SemTxvevebis aRwerasa da procedurebTan
_ 743 _
mkurnaloba bavSvi gaRizianebuli da ubeduria an, ufro mZime

SemTxvevebSi, leTargiuli da ukontaqtoa. klinikuri
mkurnalobis dros emociuri problemebis dasaZ
gamovlinebebis sakmaod farTo diapazoni arsebobs,
levad da bavSvTan yoveldRiuri urTierTobis
rac msubuq kvebiT problemebsa da zemoT moyvanil
dasamyareblad, mSoblebs daxmareba unda SevTavazoT.
ufro mZime SemTxvevebTanaa dakavSirebuli. saTanado
xSirad Zalian rTulia mSoblebis darwmuneba imaSi,
kvebisa da movlis pirobebSi bavSvi swrafad izrdeba
rom mkurnaloba aucilebelia. Tu mSoblebi uars
da viTardeba (Kempe and Goldbloom, 1987).
acxadeben daxmarebaze, xolo emociuri Zaladobis
fsiqosocialuri jujovneba anu deprivaciuli
Sedegebi TvalsaCinoa, maSin igive regulaciebi Sedis
nanizmi. aseTi bavSvebi arabunebrivad dablebi arian.
ZalaSi, romlebic moqmedeben fizikuri Zaladobis
maT kvebis ucnauri paternebi, kiTxvis ganviTarebis
SemTxvevaSi. saqmeSi socialuri servisebi erTvebian
CamorCena da risxvis Setevebi axasiaTebT. miuxedavad
da bavSvebs individualur daxmarebas uweven.
sidablisa, bavSvebs SeiZleba normaluri wona
bavSvebis ugulebelyofa hqondeT. zrdis hormonis sekrecia darRveulia
bavSvebis ugulebelyofa gulisxmobs, rom mSobels (Stanhope et al., 1988). viTardeba emociuri da qceviTi
ar aqvs unari izrunos bavSvze. igi sxvadasxva aSlilobebi, saxezea kognituri funqciebisa da
formiT vlindeba da moicavs: emociur deprivacias, ganviTarebis CamorCeniloba, aseve, metyvelebis
fizikuri mdgomareobisa da usafrTxoebis mimarT darRvevebi. bavSvebs aqvT daqveiTebuli TviTSefaseba
uyuradRebobas, ganaTlebisa da aucilebeli sa da depresiuli guneb-ganwyoba. anamnezSi, Cveulebriv,
medicino daxmarebis uaryofas. aseTi saxis ugu deprivacia da fsiqologiuri zewola aReniSnebaT.
lebelyofam SeiZleba gamoiwvios fizikuri an aseTi bavSvebi xarbad etanebian sakvebs.
fsiqologiuri ziani, dabali akademiuri moswreba da
mkurnaloba
qcevis darRvevebi (Hildyard and Wolfe, 2002).
bavSvebis ugulebelyofis faqtebi ufro xSiria, orive mdgomareobis mkurnalobisas, mniSvnelovania
vidre fizikuri Zaladobisa da amas ufro meti bavSvis usafrTxoebis uzrunvelyofa. es, xSirad,
adamiani amCnevs, mag., naTesavebi, mezoblebi, peda stacionirebas gulisxmobs. zogi bavSvis movla
gogebi, eqimebi da socialuri muSakebi. bavSvebis saxlis pirobebSicaa SesaZlebeli, xolo zogi _
ugulebelyofa dakavSirebulia mZime socialur mindobiT zrunvas saWiroebs. mSoblebs sWirdebaT
pirobebTan da mindobiT aRzrdis saWiroebis yvelaze daxmareba, raTa maT SeZlon Svilebis problemebisa
xSiri mizezia. da saWiroebebis gacnobiereba da movlis gegmis
SemuSaveba. zogi mSobeli srul miuReblobasa da
araorganuli CamorCena zrdaSi da deprivaciuli mtrul damokidebulebas amJRavnebs daxmarebis
jujovneba (nanizmi) mimarT. Tu daxmareba SesaZlebelia, aucilebelia
pediatrebi aRiareben, rom zogi bavSvi yovelgvari intensiuri muSaoba da movlis paternebis Secvlisaken
organuli mizezis gareSe ver izrdeba simaRleSi. 3 mTeli Zalisxmevis mimarTva. amis miRweva fsiqozebis
wlamde bavSvebSi am mdgomareobas simaRleSi zrdis mqone mSoblebTan Znelia, Tumca, ufro SesaZlebelia
araorganuli Seferxeba, mogvianebiT asakSi ki de mSobiarobis Semdgomi depresiisa da sxva fsiqikuri
privaciuli nanizmi ewodeba. aSlilobebis SemTxvevaSi.
klinikuri suraTi prognozi

araorganul Seferxebas zrdaSi iwvevs arasakmarisi mwvave SemTxvevebSi, orive sindromis dros, fizi
kveba da emociuri siaxlovis nakleboba. fsiqi kuri da fsiqologiuri ganviTarebis prognozi ara
atriul dawesebulebebSi myof bavSvebs adreuli keTilsaimedoa. maRalia sikvdilianobis maCvenebeli
asakidan mSoblebTan urTierTobis aSkara prob (Skuse, 1989).
lemebi aReniSnebaT. es, upiratesad, bavSvis ugu
ganzrax gamowveuli daavadebebi
lebelyofas an, mwvave SemTxvevebSi, bavSvis mi
marT mtrul ganwyobaSi gamoixateba. SesaZloa, mdgomareoba, rodesac mSobels bavSvi samkurnalod
adgili hqondes fizikur an seqsualur Zaladobas. ganzrax gamowveuli simptomebiT mihyavs, ganxilulia
Tumca, yvela SemTxveva ar aris gamowveuli aseTi 390-e gverdze.
mizezebiT. zogi bavSvis simaRleSi zrdas ReWvisa da
seqsualuri Zaladoba
ylapvis problemebi aferxebs (Wilensky et al., 1996).
termini `seqsualuri Zaladoba~, gamoiyeneba iseT
axalSobilebSi zrdaSi CamorCena wonaSi klebiTa an
SemTxvevebSi, rodesac bavSvi monawileobs seqsualur
sigrZeSi arasakmarisi matebiT vlindeba. SesaZlebelia
qmedebaSi gacnobierebuli Tanxmobis gareSe, rac
kognituri funqciebisa da ganviTarebis Seferxebac.
_ 744 _
kanonisa da kulturaluri normebis sawinaaRmdegoa. seqsualuri qceva; xolo, dafexmZimebisas, arasa
es termini mxolod fizikuri kontaqtis SemTxvevaSi survel orsulobaze reaqcia. xSiria danaSaulisa da
ar gamoiyeneba. pornografiuli fotoebisa da momxdarze sakuTari pasuxismgeblobis gancda. zog
filmebisTvis pozirebasac gulisxmobs. moZalade, bavSvs posttravmuli aSlilobis niSnebi aReniSneba.
Cveulebriv, bavSvis nacnobi an ojaxis wevria (incesti). ar aris Seswavlili is, Tu ramdenad xSiria aseTi
iSviaTad, bavSvi SeiZleba pedofilTa jgufuri reaqcia da ramdenadaa es damokidebuli Zaladobis
gaupatiurebis msxverpli gaxdes. xasiaTsa da garemoebebze.
grZelvadiani Sedegebia: depresia, daqveiTebuli
epidemiologia TviTSefaseba, TviTdazianebebi da sirTuleebi urTi
wliuri SemTxvevebis sixSire 1000 sul mosaxleze erTobaSi. aseve, xSiria seqsualuri problemebi
daaxloebiT 2 bavSvia (Jones, 2000). es monacemebi rogorc hipersensitiurobis, aseve inhibiciis saxiT.
nasesxebia kriminaluri statistikidan da sxvadasxva seqsualuri Zaladobis Sedegebi, Cveulebriv, ufro
mimoxilvidan. Tumca, Zaladobis gansxvavebuli gan mZimea, Tu mas fizikuri zemoqmedeba da seqsualuri
martebebi da arazusti aRricxva arTulebs gamo aqti axlavs Tan. mniSvnelovania ZaladobasTan da
qveynebuli maCveneblebis interpretacias. zo kavSirebuli garemoebebi, mag., Zaladobis gamJRavneba,
gadad miRebulia, rom gaupatiurebis msxverplni, Tanmxlebi samarTlebrivi procedurebi, ojaxuri
upiratesad, gogonebi arian da Sefardeba daaxloebiT problemebi _ bavSvis ugulebelyofa, seqsualuri
aseTia: 2-3:1 (Finkelhor, 1986). moZaladeebi ZiriTadad deviaciebi an wamalmoxmareba (Seghorn et al., 1987).
mamakacebi arian. Zaladoba umTavresad ojaxSi maSinac ki, rodesac SesaZlebelia am faqtorebis
xdeba. gansakuTrebiT xSiria maminacvalis mier geris gakontroleba, mainc seqsualuri Zaladoba mozar
gaupatiurebis faqtebi (Russel, 1984). qalebis mxridan dobis asakSi dakavSirebulia mTeli rigi fsiqikuri
seqsualuri Zaladoba Seswavlili araa. arsebobs aSlilobebis, kerZod, depresiis, SfoTviTi da pi
monacemebi, rom seqsualuri Zaladobis SemTxvevaTa rovnebis aSlilobebis ganviTarebasTan (Spataro et al.,
oTx mexuTedSi bavSvis deda monawileobda (Faller, 2004).
1987); amasTan moZalade qalebis umravlesoba Tavad
iyo seqsualuri Zaladobis msxverpli (Mccarty, 1986). etiologia
zogadi populaciis retrospeqtuli kvlevebi seqsualuri Zaladoba gamovlenilia yvela so
gviCvenebs, rom qalebis 20-50% bavSvobaSi sxvadasxva cio-ekonomikur jgufSi, Tumca, ufro xSiria
saxis seqsualur Zaladobas ganicdida (Peters et socialurad deprivirebul ojaxebSi. iseTi mWidro
al., 1986). am kvlevebSi Seiswavles ubralo Sexebac kavSiri socialur problemebsa da seqsualur
da ganmeorebiTi seqsualuri aqtic. seqsualuri Zaladobas Soris, rogoric aris fizikuri Zaladobis
Zaladobis Sedegebi qvemoT iqneba ganxiluli. SemTxvevaSi, ar Cans. arsebobs ramdenime winapiroba,
romelic seqsualuri Zaladobis albaTobas zrdis:
klinikuri suraTi moZaladisTvis _ deviaciuri seqsualuri motivacia,
ZaladobiT gamowveuli klinikuri niSnebi damo impulsuroba, gacnobierebis daqveiTebuli unari da
kidebulia seqsualuri zemoqmedebis Taviseburebasa garemo SezRudvebis nakleboba (mag., kulturaluri
da moZaladis mimarT bavSvis damokidebulebaze. tolerantoba); bavSvebisTvis _ (daucvelobis, ugu
bavSvebi maSin ufro asaxeleben moZalades, Tu is lebelyofis an sxva mizezebis gamo) winaaRmdegobis
ucnobi piria. seqsualuri Zaladobis faqti SeiZleba gawevis uunaroba.
aRiaros Tavad bavSvma an naTesavma; SeiZleba, agreTve,
arapirdapiri niSnebiT gamovlindes, rogorebicaa: Sefaseba
urogenitaluri an analuri problemebi, fexmZimoba, mniSvnelovania, rom SevZloT seqsualuri Zaladobis
qceviTi an emociuri aSlilobebi, asakisTvis Seu droulad amocnoba da bavSvis Sesabamisi CivilebisTvis
ferebeli, gamomwvevi an sxvagvarad miuRebeli seq seriozuli yuradRebis miqceva. Zaladobis gamov
sualuri qceva. mozardi gogonebis SemTxvevaSi lenis SemTxvevaSi, aucilebelia SevafasoT, ramde
saxlidan gaqceva an auxsneli suicidis mcdeloba nadaa SesaZlebeli Zaladobis ganmeoreba da ramdenad
SeiZleba seqsualur Zaladobaze miuTiTebdes. ojaxSi saSiSia bavSvis saxlSi darCena. Sefaseba unda gakeTdes
Zaladobis SemTxvevebs, xSirad, ojaxuri konfliqtebi ojaxisa da SemTxvevis gulisyuriT Seswavlis
mosdevs xolme. safuZvelze. aseve, unda Catardes bavSvis fizikuri
gamokvleva.
seqsualuri Zaladobis Sedegebi bavSvis gamokiTxva unda mimdinareobdes empaTiur
seqsualur Zaladobaze emociuri Sedegi SeiZleba garemoSi; xeli unda SevuwyoT, rom Zaladobis faqtis
iyos SfoTva, SiSi, depresia, gabrazeba, miuRebeli Sesaxeb man gulwrfelad isaubros. Tojinebis xatva
_ 745 _
SeiZleba daexmaros mcire asakis bavSvebs, raTa maT naloba, raTa daZlion emociuri mdgomareoba da
SeZlon gancdilis gadmocema. interpretaciisas aimaRlon TviTSefaseba. daxmareba unda moicavdes
unda gamoviCinoT sifrTxile, raTa ar davamaxinjoT reabilitaciuri RonisZiebebis safexureobriv
faqtebi da bavSvs Tavs ar movaxvioT araswori programas mTeli ojaxisTvis da ara xanmokle
mosazrebebi. patara bavSvebs SeuZliaT faqtebis intervencias. bavSvebisTvis, romlebsac fsiqikuri
zustad gaxseneba, magram ufro metad STagonebadni aSlilobebi aReniSnebaT, yvelaze efeqturia kog
arian, vidre mozrdilebi. bavSvebis interviuireba nitur-bihevioruli fsiqoTerapiis Catareba (Ramcha
Znelia, amitom Tu ki SesaZlebelia, gamocdil ndani and Jones, 2003).(seqsualuri Zaladobis mkur
bavSvTa fsiqologs, fsiqiatrs an socialur muSaks nalobasTan dakavSirebuli sakiTxebi ix. Jones, 2000).
unda mivmarToT daxmarebisTvis (interviuirebis
sakiTxebTan dakavSirebiT, ix. Jones, 2003). bavSvTa da mozardTa fsiqiatriis
aucilebelia drouli fizikuri gamokvlevebis
eTikuri da samarTlebrivi sakiTxebi
Catareba. saWiroa genitaliebisa da analuri xvrelis
msgavsad mozrdilebisa, eTikuri da samarTlebrivi
daTvaliereba. Tu seqsualuri aqtidan 72 saaTze meti
sakiTxebi (romlebic me-3 TavSia ganxiluli) SeiZleba
ar aris gasuli, mniSvnelovania sasqeso organoebidan
fsiqikuri aSlilobebis mqone bavSvTa da mozardTa
da sxva savaraudo ubnebidan analizisTvis masalis
zrunvasTan dakavSirebiTac aRiZras.
aReba. Cveulebriv, aseT gamokvlevas pediatri an am
sakiTxebSi sagangebod ganswavluli policiis oficeri
interesTa konfliqti
atarebs (fizikur gamokvlevebTan dakavSirebuli
informacia ix. Terapevtebis samefo kolejis zogadad, mSoblebis interesTan SedarebiT, upi
gamocemaSi, 1991). ratesoba bavSvis interess eniWeba. am principis dacva
Zaladobis faqtis Sesaxeb saboloo daskvna keT yvelaze logikuri da advilia bavSvze Zaladobis
deba Segrovebuli informaciis, kerZod, bavSvis mo SemTxvevaSi. sxva dros gadawyvetilebis miReba sakmaod
naTxrobis, fizikuri gamokvlevebiT miRebuli mo rTulia. mag., depresiuli deda ver uvlis Svils
nacemebisa da ojaxis socialuri istoriis safuZvelze. da, amdenad, saxezea bavSvis ugulebelyofa, Tumca
faqtis dadasturebis Semdeg, unda daigegmos bavSvis dedisgan moSoreba kidev ufro aRrmavebs
bavSvis dacvis RonisZiebebi. sxvadasxva qveyanaSi am dedis depresias. aseTi problemebis mogvareba bavSvis
SemTxvevebSi moqmedi kanonmdebloba gansxvavebulia. zrunvaSi CarTuli profesionalebisa da mSoblebis
am sakiTxze momuSave pirebi unda icnobdnen TavianT erToblivi gadawyvetilebiT xdeba.
qveyanebSi arsebul regulaciebs (Sefasebis Sesaxeb
damatebiTi informacia ix. bavSvTa da mozardTa konfidencialoba
fsiqiatriis amerikis akademiis gamocema, 1997a). bavSvze zrunva, xSir SemTxvevaSi, moicavs samedicino
da socialuri servisebis, zogjer, pedagogebis Car
marTva Tulobasac. sxvadasxva saagentos SeiZleba kon
Tavdapirvelad aucilebelia bavSvis usafrTxoebaze fidencialobis sxvadasxva politika hqondes Semu
zrunva. am dros gatarebuli RonisZiebebi fizikuri Savebuli. eqimma unda gaiTvaliswinos es gansxvavebebi,
Zaladobis SemTxvevebis marTvis msgavsia (gv. 697). raTa gadawyvitos, Tu ra informaciis gamxela
iseve wydeba bavSvis ojaxidan daSorebis sakiTxi. SeuZlia.
gansakuTrebiT rTulia im ojaxis interviuireba,
romelSic Zaladobis faqti moxda. isini, Cveulebriv, Tanxmoba
uaryofen momxdari seqsualuri Zaladobis seri yvela qveyanaSi dadgenilia asaki, romlis miRwevamde
ozulobas, ojaxSi seqsualuri deviaciis arsebobas an bavSvis nacvlad Tanxmobaze mSoblebi aweren xels.
ojaxis sxva wevrebis gaukuRmarTebul qcevasa da sxva Tumca, Tu SesaZlebelia, bavSvis Tanxmobac unda
bavSvebze Zaladobis SemTxvevebs. moZalades utareben miviRoT, rac mkurnalobaSi dagvexmareba. magram, Tu
individualur an jgufur Terapias im mizniT, rom bavSvi mkurnalobaze uars acxadebs, gadawyvetilebas
pirovnebam gaacnobieros problema da Zaladobis misi mSoblebi iReben. amgvari problemebi xSiria, mag.,
Sedegebi da Semcirdes problemis uaryofis xarisxi. rodesac srulwlovanebis asakis miRwevamde, mozardi
Tu deda Tavadaa Zaladobis msxverpli, unda avuxsnaT, nervuli anoreqsiis mkurnalobaze uars acxadebs. aseve,
rom misi piradi gamocdileba gavlenas axdens Svilis SeiZleba mSoblebma uari ganacxadon mkurnalobaze.
Zaladobis sapasuxo reaqciaze. Tumca, aseTi ufleba maT movaleobebTanaa kavSirSi,
seqsualuri Zaladobis msxverpli bavSvebi seqsu rac bavSvze zrunvas gulisxmobs. Tu mSoblebis
alurad arasworad viTardebian da saWiroeben gadawyvetileba ewinaaRmdegeba bavSvis interesebs
daxmarebas. maT unda CautardeT Sesabamisi mkur sasamarTlos gadawyvetileba Sedis ZalaSi.
_ 746 _
bavSvTa da mozardTa fsiqiatriis eTikuri da samarTlebrivi sakiTxebi
qvemoT ganvixilavT britaneTSi arsebul sakanon axlavs mozards, inglisis kanonmdeblobiT, SeiZleba,
mdeblo sirTuleebs da warmovaCenT im problemebs, mSoblad ar aRiaron. mag., bavSvis mama, romelic
romlebic yvela sasamarTlo sistemaSi unda gadaiWras daqorwinebuli araa bavSvis dedaze, samarTlebrivad
(am sakiTxTan dakavSirebuli sruli informacia ix. mSobeli ar aris.
Hope et al., 2003). bavSvebsa da mozardebTan muSaobisas gamokvlevaze Tanxmobis micema imave arasrul
aucilebelia specialisti gaecnos am sakiTxebTan wlovanebis problemasTanaa dakavSirebuli. qvey
dakavSirebiT mis qveyanaSi moqmed kanonmdeblobas. nebis umravlesobaSi msgavs gadawyvetilebas mSob
britaneTSi srulwlovan pirovnebad miCneulia lebi iReben. xSirad, maTTvis Znelia kvlevasTan
18 wlis adamiani, romelsac damoukidebeli gadaw dakavSirebuli riskebisa da sargeblis obieqturad
yvetilebis miReba SeuZlia. Tumca, inglisis kanoni Sefaseba. miT ufro, rom sargebeli ara maT Svils,
aRiarebs, rom 16-dan 18 wlamde mozardebs SeswevT aramed sxva, msgavsi problemebis mqone bavSvebs exeba,
unari, rom Tanxmoba ganacxadon mkurnalobaze romlebsac momavalSi am meTodiT umkurnaleben.
da aZlevs maT uflebas, mSoblebis gareSe miiRon mniSvnelovania, rom mSoblebs hqondeT sakiTxis
gadawyvetileba. ufro rTuladaa saqme, Tu 16-17 bolomde garkvevis saSualeba; aseve, maT unda mieceT
wlis mozardi uars acxadebs mkurnalobaze, xolo SesaZlebloba, gaesaubron ara mxolod mas, vinc
mSoblebs misi nebis sawinaaRmdego gadawyvetilebis informirebul Tanxmobas avsebs, aramed damatebiT sxva
miReba SeuZliaT. TiToeuli SemTxvevis dros unda pirebsac (mag., eqTans) (ix. britaneTis pediatriuli
ganvixiloT mkurnalobaze uaris Tqmis Sedegebi. asociaciis gamocema, 1992; mokle mimoxilva ix. Larcher,
mwvave SemTxvevebSi sasamarTlos gadawyvetileba 2005).
ufro mSoblebis sasargeblod ixreba. damatebiTi
sirTuleebi iqmneba, rodesac bavSvi 16 wlamde damatebiTi literatura
asakisaa, magram konkretul mkurnalobaze Tanxmobis
micema SeuZlia. aseT situaciebTan dakavSirebuli Black, D, Hendriks, JH and Wolkind, S (eds) (1998) Child
zogadi debulebebi ar arsebobs. amis garkveva psychiatry and the law, 3rd edn. Gaskell, London. (exmi-
individualuri SemTxvevis farglebSi unda moxdes. aneba yvela aspeqts, rac bavSvTa fsiqiatrias da
zogadi regulaciebis SemoRebis SemTxvevaSi ki, kanonmdeblobas Seexeba, inglisis kanonmdeblobis
arasrulwlovani damoukideblad SeZlebs Tanxmobis farglebSi. relevanturia ZiriTadad britaneTSi
micemas. aseTi problemebi ufro TvalsaCinoa maSin, momuSave profesionalebisTvis, Tumca ufro far-
rodesac saWiroa mcirewlovanis kontracefciiT Tod gamoyenebac SesaZlebelia.)
uzrunvelyofa, mSoblebis damatebiTi Tanxmobis Gelder, MG, Lpez-Ibor, JJ Jr and Andreasen, NC (eds) (2000)
gareSe. giliks (Gillick) aRniSnuli aqvs, rom inglisis New Oxford textbook of psychiatry, Part 9: Child and adoles-
kanonmdeblobiT, arasrulwlovans SeuZlia mkur cent psychiatry. Oxford University Press, Oxford.
nalobaze Tanxmobis miceba mSoblebis nebarTvis Goodman, R and Scott, S (2005) Child psychiatry, 2nd edn.
gareSe, Tumca, TavisTavad cxadia, rom ufro Blackwell Science, Oxford.
invaziuri meTodebis gamoyenebisas, samarTlebrivad Hopkins, B, Ronalg, RG, Michel, GF and Rochat, P (2004) The
mSoblebis Tanxmoba aucilebelia da, amasTan, Cambridge enclyclopaedia of child development. Cambridge
klinikurad sasurveli. Tu arasrulwlovani uars University Press, Cambridge. (kompleqsuri sainforma-
acxadebs mkurnalobaze, rac misTvis, SesaZloa, cio wyaro bavSvis ganviTarebis Sesaxeb)
saziano iyos, maSin mSoblebis Tanxmobas eniWeba
Rutter, M and Taylor, E (eds) (2002) Child and adolescent
upiratesoba. SesaZloa, sirTuleebi Seiqmnas mSoblis
psychiatry, 4th edn. Blackwell, Oxford.
definiciasTan dakavSirebiT. piri, romelic Tan
_ 747 _
danarTi anamnezis Sekreba da gmokvlevebi bavSvTa fsiqiatriaSi

gamokvlevis formati da moculoba damokidebulia 6. pirovnebis anamnezi
arsebuli problemis bunebaze. mocemuli sqema a. fexmZimobis periodSi arsebuli garTulebebi, miRebuli
aRebulia grehemis (Graheham., 1991) wignidan, romelic medikamentebi, gadatanili infeqciuri daavadebebi;
damatebiTi informaciisTvisaa rekomendebuli. grehemi
Tvlida, rom drois deficitis pirobebSi klinicistma b. mSobiaroba da dabadebisas somaturi mdgomareoba. wona,
koncentrireba unda moaxdinos msxvili SriftiT sigrZe da saWmlis moneleba, specialuri daxmarebis
gamoyofil sakiTxebze. saWiroeba;
1. arsebuli problemis buneba da simwvave, sixSire, g. Cvilisa da dedis urTierToba, dedis mSobiarobis
situacia, romelSic is aRmocendeba, maprovocirebeli Semdgomi depresia, bavSvis kvebis paternebi;
da xelSemwyobi fqtorebi. problemiT gmowveuli stresi, d. adreul asakSi gamovlenili temperamenti, advili an
romelic mSoblebisTvis mniSvnelovnadaa miCneuli. rTuli bavSvi, mousvenari axalSobili;
2. sxva problemebis an Civilebis arseboba e. ganviTarebis darRvevebi. gamokiTxeT detalurad,
a. fizikuri. Tavis tkivili, muclis tkivili, mxedvelobis, mxolod, normidan gadaxris SemTxvevaSi;
smenis daqveiTeba, krunCxvebi, gulis wasvla an sxva saxis v. gadatanili daavadebebi, stacionireba;
Setevebi; z. erT kviraze meti xangrZlivobiT ojaxTan gnSorebis
b. kveba, Zili da gamoyofis problemebi; SemTxvevebi, gaweuli zrunvis xarisxi;
g. urTierToba mSoblebTan da da_ZmasTan. siaxlove da T. ganaTleba. saskolo miRwevebis xarisxi;
emociuri damokidebuleba; 7. bavSvis qcevebsa da emociur mdgomareobaze dakvirveba
d. sxva bavSvebTan urTierToba, axlo megobrebi; a. garegnoba. dismorfizmis niSnebi, nakveboba, uaryofis,
e. aqtivobis done, yuradReba, koncentracia; Zaladobis SemTxvevebi;
v. guneb-ganwyoba, energiuloba, wuxili, daqveiTebuli b. aqtivobis xarisxi, uneblie moZraobebi, koncentraciis
TviTSefaseba, depresiuloba, suiciduri azrebi, unari;
SfoTvis xarisxi, specifikuri SiSi; g. sevdiani guneb_ganwyobis, imedgacruebis, daqveiTebuli
z. reaqcia imedgacruebaze. risxvis Setevebi; TviTSefasebis, SfoTvis, mRelvarebis niSnebi;
T. antisocialuri qceva, agresia, qurdoba, skolis gacdena; d. klinicistTan urTierTobis xarisxi. mzeriTi kontaqti,
i. swavlis Sedegebi, skolaSi siarulis mimarT spontanuri metyveleba, inhibicia da dizinhibicia;
damokidebuleba; e. mSoblebis mimarT damokidebuleba, siyvarulis gamovlena,
k. seqsualuri interesebi da qceva; ukmayofileba, ganSorebisadmi mSvidi damokidebuleba;
l. sxva simptomebi, tikebi, da sxva; v. Cvevebi da maneruloba;
3. ganviTarebis done z. halucinaciebi, bodviTi ideebi, asociaciuri procesis
aSlilobebi;
a. metyvelebis unari, sityvaTa maragi;
T. cnobierebis xarisxi. epilefsiis niSnebi;
b. sivrciTi aRqma;
8. ojaxur urTierTobebze dakvirveba
g. motoruli koordinacia, mouqneloba;
a. urTierTobis paternebi _ erTianoba, gadabraleba;
4. ojaxuri mdgomareoba
b. Taobebs Soris urTierTobebis dadgenili sazRvrebi,
a. mSoblebis asaki, profesia, maTi emociuri da fizikuri urTierTpativiscema;
mdgomareoba. fsiqikuri aSlilobisa an somaturi
daavadebis anamnezi, sadac SesaZlebelia bebia_babuas g. ojaxis wevrebs Soris Tavisufali urTierTobebi;
monacemebic; d. emociuri atmosfero ojaxSi: Tbili, daZabuli,
b. da-Zmis asaki, problemis arseboba; kritikuli damokidebulebebi;
g. ojaxuri viTareba, Zilis organizeba; 9. bavSvis fizikuri gamokvleva
5. ojaxis funqcionireba 10. nevrologiuri gamokvlevebi
a. mSoblebis erTmaneTTan urTierTobis xarisxi. a. saxis asimetriuloba;
urTierTTanadgoma da urTierTdamokidebuleba. b. Tvalebis moZraoba. sTxoveT bavSvs Tvali gaayolos
problemebTan dakavSirebiT komunikaciisa da maT TiTs an sagans da daakvirdiT nistagmis arsebobas;
gadawyvetilebaze msjelobis SesaZlebloba. bavSvTan g. TiTebis da ceris opozicioba _ sTxoveT bavSvs TiTis
dakavSirebuli problemebis ganxilva; wverebi swrafi TanmimdevrobiT Seaxos ceris wvers da
b. mSoblebisa da bavSvs Soris urTierTobis xarisxi. daakvirdiT moZraobis koordinirebulobasa da sisxartes;
pozitiuri urTierTdamokidebuleba, erTmaneTTan d. daxatuli sagnebis kopireba;
yofnis siamovneba. mSoblebis kritikulobis, mtruli
damokidebulebisa da uaryofis xarisxi; e. xatvisas daakvirdiT memarjvene_memarcxeneobasa da
fanqris xmarebis unars;
g. da-Zmis urTierToba;
v. zeviT da qveviT gadancvlebas;
d. ojaxis wevrebs Soris urTierTobis zogadi paternebi,
erTianoba, komunikacia. ojaxis sxvadasxva Taobis z. xtunvas;
wevrebs Soris problemebis arseboba, ojaxis wevris T. smenis unari _ sTxoveT bavSvs gaimeoros ricxvebi,
gariyva an yvelafris masze gadabraleba; romlebsac zurgsukan 2 metris daSorebiT xmadabla
(CurCuliT) eubnebiT.
_ 748 _
Tavi 25 daswavlis
darRveva (gonebrivi CamorCeniloba)
Tavis Sinaarsi
terminologia anamnezis Sekreba
daswavlis darRvevis cnebis Camoyalibeba fizikuri mdgomareobis gamokvleva
epidemiologia fsiqikuri statusis Sefaseba
daswavlis unaris darRvevis epidemiologia ganviTarebis Sefaseba
fsiqikuri aSlilobebis epidemiologia qcevis funqciuri Sefaseba
daswavlis darRvevis mqone pirebSi socialuri urTierTobis
daswavlis darRvevis klinikuri niSnebi Sefaseba da koreqcia
zogadi aRwera daswavlis darRvevis mqone pirebis servisi
fizikuri darRvevebi daswavlis istoriuli perspeqtiva
darRvevis mqone pirebSi zogadi midgoma
fsiqikuri aSlilobebi daswavlis calkeuli servisebi
darRvevis mqone pirebSi fsiqikuri aSlilobisa da
sqesobrivi kavSirebi da mSoblis qceviTi problemis mkurnaloba
rolis Sesruleba medikamenturi mkurnaloba
daswavlis darRvevis gavlena ojaxze fsiqologiuri mkurnaloba
daswavlis darRvevis etiologia specifikuri problemebi
Sesavali daswavlis darRvevis mqone pirebis movlis
daswavlis darRvevis eTikuri da sakanonmdeblo problemebi
zogierTi specifikuri mizezi normalizacia, avtonomia da
fsiqikuri aSlilobebis da qcevis problemebi interesTa konfliqti
daswavlis darRvevis mqone pirebSi Tanxoba mkurnalobis Catarebaze
daswavlis darRvevis mqone Tanxmoba kvlevaSi monawileobaze
pirebis gamokvleva da klasifikacia
am TavSi yuradReba gamaxvilebulia daswavlis darR- inteleqtis mniSvnelovan daqveiTebas, xolo ìmbeci-
vevis (gonebrivi CamorCenilobis) niSnebze, epidemio- li~ _ zomieri xarisxis daqveiTebas. iTvleboda, rom
logiasa da etiologiaze, da, agreTve, servisis orga- specialuri gamokvlevebi, romlebic aseT adamianebs
nizebaze, ufro konkretulad ki, daswavlis darRvevis Seiswavlis, gonebrivi ukmarisobis (mental deficiency)
mqone pirebisTvis damaxasiaTebel fsiqikur aSlilo- problemas ikvlevs da rom am kategoriis adamianebis
bebze. daswavlis darRvevis mqone bavSvebis fsiqikuri mimarT gaweuli momsaxurebis sferosac Wkuasustobis
problemebi normaluri inteleqtis mqone bavSvebis problemebTan aqvs saqme. mas Semdeg, rac moxda mo-
msgavsia. am problemebis CamonaTvali mocemulia 24-e cemuli terminis stigmatizacia, is Caanacvles ter-
TavSi, romelic bavSvTa fsiqiatrias eZRvneba. minebiT gonebrivi qvenorma (mental subnormality) da
gonebrivi CamorCeniloba (mental retardation). termini
terminologia gonebrivi invalidobac (mental handicap) farTod ga-
moiyeneboda, magram amJamad britaneTSi upiratesobas
im pirebis mimarT, romelTac adreuli asakidan in-
aniWeben termins daswavlis darRveva (learning disabili-
teleqtis daqveiTeba axasiaTebT, wlebis ganmavlobaSi
ty). miuxedavad amisa, bevr qveyanaSi da, maT Soris ICD-
sxvadasxva termins iyenebdnen. me-19 saukunesa da me-
10-sa da DSM-IV klasifikaciebSi, gamoiyeneba termini
20 saukunis dasawyisSi termini ìdioti~ aRniSnavda
_ 749 _
25 daswavlis darRveva (gonebrivi CamorCeniloba)
gonebrivi CamorCeniloba. ufro metic, aSS-Si termini nawils ki _ ara. am aqtis mixedviT, gogonaTa ukanono
`daswavlis darRveva~ ZiriTadad gamoiyeneba disleq- orsuloba interpretirebuli iyo rogorc `krimina-
siisa da msgavsi tipis darRvevebis aRsaniSnad da ar luri qcevisaken~ midrekilebis niSani.
miuTiTebs gonebriv CamorCenilobaze. amis gamo ter- miuxedavad imisa, rom warsulSi socialuri kri-
mini inteleqtualuri darRveva (intellectual disability) teriumebis Semotanam maTi borotad gamoyeneba ga-
sul ufro misaRebi xdeba. radgan es termini farTod moiwvia, mainc arasakmarisia gonebrivi CamorCeni-
aris damkvidrebuli, is mocemul TavSi ar figuri- lobis mxolod inteleqtis mixedviT gansazRvra.
rebs. amgvarad, am TavSi yvelgan iqneba gamoyenebuli aucilebelia, rom socialuri kriteriumebic iqnas
termini daswavlis darRveva, garda im SemTxvevebisa, Semotanili, raTa erTmaneTisgan gaimijnon adamia-
rodesac istoriuli an raime sxva konteqsti gansxva- nebi, romlebsac SeuZliaT normaluri an normasTan
vebuli terminis gamoyenebas moiTxovs. miaxloebuli cxovreba, iseTi pirebisgan, romlebsac
es ar ZaluZT. DSM-IV_is mixedviT gonebrivi CamorCe-
daswavlis darRvevis cnebis Camoyalibeba niloba ganmartebulia, rogorc:
arsebobs fundamenturi gansxvaveba inteleqtis fun- saSualoze mniSvnelovnad dabali zogadi inte-
qciis daqveiTebas (intellectual impairment), adreuli ga- leqtualuri funqcionireba, romelsac Tan axlavs
movlenis SemTxvevebs (gonebrivi CamorCeniloba anu adaptaciuri funqciis mniSvnelovani SezRudva, qve-
daswavlis darRveva adreul bavSvobaSi vlindeba) da moT CamoTvlilTagan sul mcire or sferoSi. es sfe-
mogvianebiT gamovlenil inteleqtis daqveiTebas (de- roebia: komunikacia; sakuTari Tavis movla; sakuTar
mencia anu Wkuasustoba) Soris. 1845 wels eskiroli sacxovrebelSi cxovreba; socialuri/interpersona-
(Esquirol, 1845) am gansxvavebis Sesaxeb werda: luri unar-Cvevebi, romlebic gamoiyeneba saTemo re-
ìdiotia ar aris daavadeba. es aris mdgomareoba, sursebisTvis; sakuTari Tavis warmarTva; funqciuri
romlis drosac normaluri inteleqti arasodes ga- akademiuri unar-Cvevebi; muSaoba; dasveneba; janmrTe-
movlindeba, anu idioti arasodes ganviTardeba ise, loba da usafrTxoeba.
rom SeZlos im codnis SeZena, romlis miRebac Seu- gonebrivi CamorCeniloba 18 wlamde vlindeba.
Zlia imave asakisa da imave pirobebSi myof pirs~ (Es- darRvevis aseTi ganmartebis safuZvelze misi dayofa
quirol, 1845, 446-7). xdeba inteleqtis donis mixedviT. orive, ICD-10 da
me-20 saukunis dasawyisSi bines inteleqtis gasazomi DSM-IV klasifikaciebSi gamoiyofa Semdegi qvetipebi:
testebiT (Binet~s Tests) dadginda gonebrivi CamorCeni- msubuqi (mild) (IQ _ 50-70), zomieri (moderate) (IQ _ 35-
lobis raodenobrivi kriteriumebi. am testebiT Se- 49), mZime (severe) (IQ _20-34) da umZimesi (profound) (IQ
saZlebeli gaxda gonebrivi CamorCenilobis naklebad <20).
mZime SemTxvevebis identifikacia, romlebic sxvagva- msoflio jandacvis organizaciis klasifikacia
rad ver gamoaSkaravdeboda (Binet, Simon, 1905). samwu- funqcionirebis daqveiTebis (impairment) unarSezRu-
xarod, am droisTvis farTod gavrcelda mosazreba, dulobisa (disability) da invalidobis (handicap) Sesaxeb
rom adamianebi, romlebsac axasiaTebT naklebad mZi- aqtualuria daswavlis darRvevis SemTxvevaSic. (mso-
med gamoxatuli inteleqtis daqveiTeba, socialurad flio jandacvis organizacia amJamad iyenebs ufro
arakompetenturebi arian da instituciur movlas sa- pozitiur terminologias, sadac unarSezRuduloba
Wiroeben. (disability) Canacvlebulia àqtivobiT~, xolo invali-
aseTi Sexedulebebi kanonmdeblobazec aisaxa. mag., doba _ `monawileobiT~.) funqcionirebis daqveiTeba
uelssa da inglisSi 1886 wlis aqtiT idiotiis Sesaxeb centralur nervul sistemasTan aris dakavSirebuli,
(Idiots Act, 1886) moxda idiotiis (inteleqtis mniSvne- unarSezRuduloba (anu aqtivobis SezRudva) axali
lovani daqveiTeba) da imbecilobis (inteleqtis ufro unar-Cvevebis daswavlisa da SeZenis unaris SezRu-
zomieri daqveiTeba) martivi gamijnva. 1913 wels go- dulobas gulisxmobs. ramdenad gamoiwvevs funqcio-
nebrivi ukmarisobis aqtiT (Mental Deficiency Act, 1913) nirebis daqveiTeba unarSezRudulobas (aqtivobis
Semoitanes mesame kategoria im adamianebisTvis, rom- SezRudvas) nawilobriv damokidebulia ojaxisa da
lebsac àdreuli asakidan axasiaTebT mudmivi gone- skolis gamocdilebaze da iseTi Tanmxlebi probleme-
brivi deficiti borotmoqmedebis an kriminalisadmi bis koreqciaze, rogoric siyruea. bolo etapi, inva-
Zlier midrekilebasTan erTad. dasja maTze mcire an lidoba (anu SezRuduli monawileoba) damokidebulia
aranair zegavlenas ar axdens~. am kanonis ZaliT, ada- unarSezRudulobis xarisxze da sxva iseT faqtore-
mianebi, romlebsac hqondaT normaluri an normasTan bze, rogoricaa pirovnebis mimarT gaweuli mxarda-
miaxloebuli inteleqti xangrZlivi droiT Tavsde- Wera.
bodnen hospitalSi mxolod imis gamo, rom maTi qceva ganaTlebis sferos muSakebi iyeneben sxva termine-
Seuracxyofda sazogadoebis Rirebulebebs. am ada- bs da es terminebi sxvadasxva qveyanaSi erTmaneTis-
mianTa nawils marTlac hqonda danaSauli Cadenili, gan gansxvavebulia. britaneTSi gamoiyeneba termini
_ 750 _
epidemiologia
specialuri saWiroebebi, xolo aSS-Si gamoyofen sam fsiqikuri aSlilobebis epidemiologia

jgufs: swavlebadi gonebrivi CamorCenilobis mqone, daswavlis darRvevis mqone pirebSi
trenirebadi gonebrivi CamorCenilobis mqone da mZime daswavlis darRvevis mqone pirebSi fsiqikuri aSli-
gonebrivi CamorCenilobis mqone jgufebi. lobebis gamoqveynebuli sixSire sxvadasxva kvlevaSi
mniSvnelovnad gansxvavebulia SemTxvevaTa dadgenis,
epidemiologia gamovlenis da gansazRvris sirTulis gamo. Zvel kv-
levebSi, pirvel rigSi, SerCevis cdomilebebi aRiniS-
daswavlis unaris darRvevis epidemiologia
neboda, radgan kvleva ZiriTadad warmoebda institu-
1929 wels britaneTis eqvs regionSi saskolo asakis ciebSi myof pirebze. miuxedavad imisa, rom SedarebiT
bavSvebze Catarebuli kvleviT (Lewis E.O., 1929) dad- axal kvlevebSi Temze dafuZnebuli servisis momxmare-
ginda, rom gonebrivi CamorCenilobis gavrcelebis si- blebicaa gaTvaliswinebuli, SeuZlebelia daswavlis
xSire Seadgenda 27/1000, xolo daswavlis unaris zo- darRvevis mqone yvela mozrdilis identifikacia. es,
mieri da mZime xarisxis darRveva _ (IQ<50) _ 3, 7/1000. gansakuTrebiT, msubuq SemTxvevebs exeba. sxvadasxva
mogvianebiT, sxva qveynebSi Catarebulma kvlevebma da- kvlevaSi SemTxvevaTa identifikaciis sxvadasxva me-
adastura es Sedegebi. 15-19 wlis asakis populaciaSi Todi gamoiyeneboda: dawyebuli pirdapiri interviu-
daswavlis unaris zomieri da mZime xarisxis darRve- Ti, damTvrebuli samedicino CanawerebiT. gansxvave-
vis gavrcelebis sixSirea 3, 0-4, 0/1000. 1930-iani wle- buli iyo diagnostikuri kriteriumebic: zogi iyeneb-
bis Semdeg daswavlis unaris zomieri da mZime xaris- da skriningul kvlevebs, zogi ki _ struqturirebul
xis darRvevis gavrcelebis sixSire odnav Seicvala. diagnostikur instrumentebs. aseve, gansxvavdeboda
miuxedavad amisa, daswavlis unaris mZime darRvevis qceviTi darRvevebis fsiqikuri aSlilobebisTvis mi-
sixSiris maCveneblebi mniSvnelovnad Semcirda, rad- kuTvnebis principi.
gan gaumjobesda antenataluri, nataluri da neona- erT-erT adreul mniSvnelovan gamokvlevaSi, ro-
taluri movla. gavrcelebis sixSiris stabilurobis melSic warmoebda dakvirveba IQ<70-is mqone 9-11 wlis
mizezia daswavlis unaris darRvevis mqone pirebis bavSvebze, ruterma (Rutter et al., 1970a) aRmoaCina, rom
sicocxlis xangrZlivobis zrda. es gansakuTrebiT am bavSvebis TiTqmis erTi mesamedi Sefasebuli iyo,
daunis sindromis mqone pirebs exeba. aseTma cvlile- rogorc `darRvevis mqone~ TavianTi mSoblebis mier.
bam gavlena moaxdina daswavlis mZime darRvevis mqone maswavleblebma `darRvevis mqoned~ Seafases bavSvebis
adamianebis asakobriv ganawilebaze. maT Soris imata daaxloebiT 40%. Sefasebis es monacemebi 3-4-jer aRe-
mozrdilTa raodenobam. mateba normaluri inteleqtis mqone bavSvebis Sefase-
Tizardma (Tizard, 1964) yuradReba gaamaxvila gansxva- bis monacemebs. im kvlevebis mixedviT, romelTa ume-
vebaze àdministraciul~ da `WeSmarit~ prevalento- tesobaSic gamoyenebuli iyo standartuli instru-
bas (gavrcelebis sixSires) Soris. misi ganmartebiT, mentebi, daswavlis mZime darRvevis mqone bavSvebis
administraciuli prevalentoba aris ìm adamianebis daaxloebiT naxevars aRmoaCnda fsiqikuri aSliloba.
raodenoba, romlebisTvisac ucilobelia servisis es maCvenebeli gansakuTrebiT maRali iyo daswavlis
miwodeba sazogadoebaSi, romelSic am tipis momsaxu- umZimesi darRvevis SemTxvevaSi (ix. Scott, 1994).
reba uzrunvelyofilia yvelasTvis, vinc amas saWiro- Sizofreniis, guneb-ganwyobis aSlilobisa da Sfo-
ebs~. praqtikulad, es termini aRniSnavs saWiroebis TviTi aSlilobis gavrcelebis sixSire yovel moce-
mqone pirebis im raodenobas, romelTa Sesaxebac cno- mul periodSi msubuqi da zomieri daswavlis darR-
bilia servisis provaiderebisTvis. Tu daswavlis yve- vevis mqone populaciisa da zogadi populaciis zr-
la xarisxis darRvevis (IQ<70) WeSmariti prevalento- dasrul mosaxleobaSi ar aCvenebs statistikurad
ba udris 20-30/1000-s yvela asakis populaciaSi (Bro- mniSvnelovan gansxvavebas (Deb et al., 2001a). xolo, Tu
man et al., 1987), administraciuli prevalentoba iqneba am CamonaTvals davumatebT iseT diagnozebs, rogori-
daaxloebiT 10/1000 yvela asakis populaciaSi. sxva caa qceviTi darRveva da pirovnuli aSliloba, gavr-
sityvebiT rom vTqvaT, aseTi adamianebis daaxloebiT celebis sixSire daswavlis darRvevis mqone pirebSi
naxevarze naklebi iqneba servisiT gaTvaliswinebu- mniSvnelovnad moimatebs (Deb et al., 2001b). bavSvobis
li. administraciuli prevalentoba maRalia dabali asakis zogierTi iseTi darRveva, rogoricaa autizmi
socio-ekonomikuri donis mqone jgufSi da bavSvebSi, da yuradRebis deficitisa da hiperaqtiurobis sin-
sadac servisi ufro met adamians esaWiroeba. es ci- dromi, SeiZleba SedarebiT xSirad iyos warmodgeni-
fri mcirdeba 16 wlis asakis Semdeg (Richardson, 1992), li daswavlis darRvevis mqone mozrdilebSi, vidre
radgan am dros aRiniSneba inteleqtis uwyveti neli zogad populaciaSi. Tumca, es varaudi safuZvlian
ganviTareba da TandaTanobiTi socialuri adaptacia. dasabuTebas moiTxovs, radgan mocemuli darRvevebi,
daswavlis darRvevis epidemiologiis mimoxilvisTvis Cveulebriv, ar aris gaTvaliswinebuli zrdasruli
ix. Fryers, 2000.
_ 751 _
populaciis kvlevebSi. daswavlis darRvevis mqone bisgan da maTi nebismieri sensoruli Tu motoruli
adamianebSi gansakuTrebiT xSiria iseTi qceviTi aSli- deficiti msubuqi xarisxisaa. am jgufis adamianebis
lobebi, rogoricaa hiperaqtiuroba, stereotipebi da umetesobas skolamdel asakSi met-naklebad ganviTa-
TviT-dazianeba (Deb et al., 2001c). rebuli aqvs metyveleba da socialuri qceva da am
adamianebTan, SeiZleba, verasdros moxdes daswavlis
daswavlis darRvevis klinikuri darRvevis identifikacia. maT umetesobas mozrdilo-
bis asakSi SeuZlia Cveulebriv garemoSi damoukide-
niSnebi
blad cxovreba, Tumca, SeiZleba daxmareba dasWirdes
zogadi aRwera ojaxuri pasuxismgeblobebis SesrulebaSi, sacxovre-
daswavlis darRvevis yvelaze xSiri gamovlinebaa belisa da dasaqmebis problemebis gadaWraSi an uCveu-
inteleqtis Sesafasebeli testis yvela davalebis lo stresul situaciaSi aRmoCenisas.
(daswavla, xanmokle mexsiereba, cnebebis gamoyeneba
da problemis gadaWra) calsaxad aradamakmayofile- daswavlis zomieri darRveva (IQ 35-49)
beli Sesruleba. konkretulma anomaliebma SeiZleba am jgufis adamianebi Seadgens daswavlis unaris darR-
gansakuTrebuli siZneleebi gamoiwvios. mag., mxedve- vevis SemTxvevebis daaxloebiT 10%-s. bevr maTgans
lobiT-sivrciTi unar-Cvevebis problemam SeiZleba ukeT aqvs ganviTarebuli recepciuli metyveleba, eqs-
gamoiwvios iseTi praqtikuli siZneleebi, rogoricaa presiulTan SedarebiT, rac frustraciisa da qcevi-
tansacmlis Cacmis uunaroba. SeiZleba aRiniSnebodes Ti problemebis potenciuri mizezi xdeba. sametyvelo
metyvelebis siZneleebi an socialuri urTierTobis leqsika, Cveulebriv, martivia da xSirad imaTTvisaa
problema, romlebic mWidro kavSirSia qceviT darR- ufro gasagebi, vinc ukeT icnobs pacients. bevri iyene-
vevebTan. daswavlis darRvevis mqone bavSvebSi gavr- bs gamartivebuli simboloebis sistemebs, rogoricaa,
celebuli qceviTi problemebi zogad populaciasTan mag., makatonis simboloebis ena (Makaton sign language).
SedarebiT ufro xSirad asakis matebasTan da fizikur droTa ganmavlobaSi pirovneba SeimuSavebs yofiTi
ganviTarebasTan erTad vlindeba; garda amisa, aseTi aqtivobebis (Cacma, Wama da higienis dacva) ganxorcie-
problemebi ufro didxans narCundeba. Cveulebriv, lebisTvis saWiro unar-Cvevebs, magram zogierTi qce-
bavSvis qceviTi problemebi asakis matebasTan erTad vis Sesruleba (fulis moxmareba, quCaSi fexiT gadaad-
TandaTanobiT klebulobs, magram zrdasrul asakSi gileba an transportiT mgzavroba) daxmarebas saWiro-
isini, SeiZleba, axali problemebiT Canacvldes. ebs. am kategoriis pirebs, aseve, daxmareba esaWiroebaT
dasaqmebisa da sacxovrisTan dakavSirebul sakiTxebSi.
daswavlis msubuqi darRveva (IQ 50-70)
daswavlis darRvevis msubuqi forma Seadgens saerTo daswavlis mZime darRveva (IQ 20-34)
raodenobis daaxloebiT 85%-s. aseTi darRvevis mqone Tu IQ 34-ze dabalia, rTulia qulis zustad gansazR-
pirebi garegnulad ar gansxvavdebian sxva adamiane- vra, radgan am jgufis adamianebTan Zneldeba testi-
cxrili 25.1 daswavlis msubuqi, saSualo, mZime da umZimesi darRvevis niSnebi

msubuqi saSualo mZime/umZimesi
IQ-s diapazoni 69-50 49-35 <35
SemTxvevaTa 85% 10% 5%

procentuli maCvenebeli
sakuTari Tavis movlis damoukidebeli sWirdeba garkveuli SezRuduli

unari daxmareba
metyveleba damakmayofilebeli SezRuduli bazisuri an saerTod

ar metyvelebs
wera-kiTxva damakmayofilebeli bazisuri minimaluri an saerTod

ar aqvs es unar-Cveva
muSaobis unari nawilobiriv ar aqvs Sesabamisi unar- SeuZlia bazisuri

ganviTarebuli Cvevebi; esaWiroeba amocanebis Sesruleba
unar-Cvevebi zedamxedveloba zedamxedvelobis qveS
socialuri unar-Cvevebi normaluri saSualo mwiri
fizikuri problemebi iSviaTi zogjer xSiri
dadgenili etiologia zogjer xSirad Cveulebriv
_ 752 _
daswavlis darRvevis klinikuri niSnebi
rebis Sesabamisi wesiT Catareba. iTvleba, rom daswa- biT dabrkolebas warmoadgens. motorul unarSez
vlis darRvevis mZime SemTxvevebi Seadgens daswavlis Rudulobas miekuTvneba spastika, ataqsia da aTetozi.
darRvevis saerTo raodenobis daaxloebiT 3-4%-s. am populaciaSi xSiria yuris infeqcia da kbilis
skolamdel asakSi am adamianebis ganviTareba Zalian kariesi. bavSvis zrdasTan erTad fizikuri problemebis
Seferxebulia. sabolood, bevri maTgani axerxebs albaToba matulobs daswavlis darRvevis rogorc
sxvisi daxmarebiT da zedamxedvelobis qveS sakuTa- msubuq, ise mZime SemTxvevebSi (Cooper, 1999).
ri Tavis movlas da martivi komunikaciis damyarebas, epilefsia _ daswavlis darRvevis mqone pirTa daax
mag., sagnebze miTiTebiT. zrdasrulobisas am adamia- loebiT 14-24%-s aqvs epilefsiis anamnezi, gansxva
nebs SeuZliaT martivi davalebebis Sesruleba da Se- vebiT zogad populaciaSi dafiqsirebuli 5%-isgan.
zRuduli raodenobis socialur aqtivobebSi CarTva, gavrcelebis sixSire kidev ufro maRalia Tanmxlebi
magram isini mainc zedamxedvelobas saWiroeben. garda nevrologiuri darRvevis SemTxvevebSi. sixSire
amisa, aucilebelia, rom maTi cxovreba mkafiod iyos daswavlis unaris darRvevis simZimesTan erTad ma
struqturirebuli. tulobs. mTeli sicocxlis manZilze epilefsiis
anamnezis sixSire daswavlis darRvevis msubuqi da
daswavlis umZimesi darRveva (IQ<20)
saSualo simZimis SemTxvevebSi 7-15%-ia, mZime Sem
am jgufis adamianebi Seadgenen daswavlis darRvevis TxvevebSi _ 45-67%, xolo umZimesi darRvevis dros
mqone pirebis daaxloebiT 1-2%-s. maTi ganviTareba, _ 50-82%.
daaxloebiT, 12 Tvis Cvilis dones Seesabameba. umZi- epilefsia SedarebiT ufro xSirad axlavs Tan
mesi daswavlis darRvevis mqone adamianebi mowyvlad- daswavlis darRvevis gamomwvev iseT mizezebs, ro
ni arian da martivi yofiTi moqmedebebis Sesrulebis goricaa myife X sindromi, tuberozuli sklerozi,
dosac ki esaWiroebaT mniSvnelovani daxmareba da ze- angelmanis sindromi, retis sindromi da neironebis
damxedveloba. migraciuli darRveva. garkveuli epilefsiuri sin
dromebi, rogoricaa vestis sindromi da lenoqs-
fizikuri darRvevebi daswavlis darRvevis gastos sindromi, SedarebiT ufro xSiria daswavlis
mqone pirebSi darRvevis SemTxvevebSi. rezistentuli epilefsiac
daswavlis darRvevis mqone pirebSi xSiria fizikuri daswavlis darRvevis dros ufro xSirad gvxvdeba
darRvevebi, magram maTi dadgena yovelTvis ar zogad populaciasTan SedarebiT. xSirad epilefsia
xdeba. daswavlis darRvevis mqone piri SeiZleba ver gamovlindeba polimorfuli gulyrebiT, romlebic
ayalibebdes Civilebs avadmyofobis Sesaxeb da misi iwyeba adreul asakSi da didi xnis manZilze aRiniSneba
mdgomareoba SeiZleba mxolod qceviT cvlilebebSi (mimoxilvisTvis ix. Deb, 2000).
gamomJRavndes. axloblebma unda icodnen aseTi
cvlilebebis mniSvneloba, raTa droulad mimarTon fsiqikuri aSlilobebi daswavlis darRvevis
specialistebs daxamrebisTvis. klinicisti unda mqone pirebSi
xedavdes kavSirs daswavlis darRvevis garkveul warsulSi daswavlis darRvevis mqone pirebisTvis
sindromebsa fizikur daavadebebs (ix. mag., daunis damaxasiaTebeli fsiqikuri aSlilobebi iTvleboda
sindromi, gv. ??) Soris. gansxvavebulad normaluri inteleqtis mqone pi
sensoruli da motoruli unarSezRuduloba da rebisTvis damaxasiaTebeli aSlilobebisgan. erT-
Seukavebloba (inkontinencia) aris yvelaze xSiri erTi mosazrebis mixedviT, adamianebs, romlebsac
fizikuri darRveva daswavlis darRvevis mqone aReniSnebaT daswavlis darRveva, ar uviTardebaT
pirebSi. daswavlis darRvevis mZime formis SemTxvevaSi emociuri aSlilobebi. sxva mosazrebis mixedviT aseTi
(gansakuTrebiT bavSvebSi) Cveulebriv aRiniSneba erTi aSlilobebi viTardeba, magram maTi mizezi ufro metad
an ramdenime aseTi problema. mxolod erT mesameds biologiuria, vidre fsiqologiuri. dResdReobiT
ar aReniSneba inkontinencia, SeuZlia damoukideblad miiCneven, rom adamianebs, romlebsac aqvT daswavlis
gadaadgileba da ar axasiaTebs seriozuli qceviTi unaris darRveva, aReniSnebaT zogadi populaciis
xasiaTis problemebi. erTi meoTxedi mniSvnelovnadaa msgavsi fsiqikuri aSlilobebi. miuxedavad amisa,
sxvebze damokidebuli. daswavlis msubuqi darRvevis simptomebi zogjer SeiZleba Secvlili iyos dabali
drosac igive problemebi gvxvdeba, magram ufro inteleqtis gamo (Deb et al., 2001a). bodviTi ideebi,
iSviaTad. miuxedavad amisa, Zalian mniSvnelovania halucinaciebi da obsesiebi rTuli amosacnobia
yovelive zemoT Tqmulis gaTvaliswineba, radgan im pirebSi, romelTa metyvelebis ganviTarebac
es gansazRvravs imas, Tu ramdenad aucilebelia ama SezRudulia da maTi mxridan aRwerac _ gaZnelebuli.
Tu im pirovnebasTan specialuri sganmanaTleblo amdenad, daswavlis unaris darRvevis mqone pirebSi
programebis gamoyeneba. sensoruli darRvevebi fsiqikuri aSlilobebis diagnostikisTvis meti
normaluri kognituri ganviTarebisTvis damate yuradReba unda gavamaxvloT qcevaze da naklebi
_ 753 _
_ im fsiqikur fenomenebze, romlebic normaluri Civili guneba-ganwyobis cvalebadobis Sesaxeb, vidre
inteleqtis mqone pirebisTvis aris damaxasiaTebeli. normaluri inteleqtis mqone individebTan. diagnozi,
gamoqveynebuli monacemebis mixedviT, daswavlis ZiriTadad, efuZneba pacientis mier mwuxarebis gamox-
darRvevis mqone pirebSi fsiqikuri aSlilobebis atvas, cvlilebebs madaSi, Zilis paternSi da qceviT
gavrcelebis sixSire zogad populaciaze maRalia, cvlilebebs, romlebic Senelebas an aJitaciaSi iCens
magram meTodologiuri problemebis gamo gavrcelebis Tavs. mZime depresiis mqone pacientebs, romlebsac
maCveneblebis diapazoni sakmaod didia (Scott, 1994). sakmarisad aqvT ganviTarebuli verbaluri unari,
problemuria rogorc daswavlis darRvevis, ise SeuZliaT aRweron halucinaciebi da bodviTi ideebi.
fsiqikuri aSlilobebis gansazRvra da amocnoba. maniis diagnostika unda moxdes gadaWarbebuli aqti-
problemuria, agreTve, SerCevis procesi. rac ufro vobis da qcevaSi gamovlenili mRelvarebis, gaRiz-
dabalia IQ, miT ufro rTulia fsiqikuri aSlilobis ianebisa da nerviulobis safuZvelze.
sindromis diagnostika. bavSvTa asakis am problemebis daswavlis darRvevis mqone pirebSi guneb-ganwyobis
Sesaxeb ix. Einfield and Tonge, 1996, xolo mozrdilebis aSlilobis difernciuli diagnostika unda moicavdes
Sesaxeb _ Deb et al., 2001a, b. Tiroidul disfunqcias, romelic gansakuTrebiT xSi-
ria daunis sindromis SemTxvevebSi.
Sizofrenia
suicidis sixSire ufro dabalia daswavlis zomieri
Sizofreniis gavrcelebis sixSire drois garkveul peda mZime darRvevis mqone pirebSi, vidre zogad popu-
riodSi daswavlis darRvevis mqone pirebSi daaxloe- laciaSi. ganzrax TviT-dazianebis sixSire naklebad
biT 3% -s udris, xolo zogadad populaciaSi _ 1%-s dazustebulia, radgan rTulia imis dadgena, Tu ram-
(Deb et al., 2001b). denad aqvs pacients ganzraxuli amgvari qcevis ganx-
klinikurad gamoxatuli bodviTi ideebi ufro na- orcieleba da ramdenad acnobierebs igi Tavisi qcevis
klebia, vidre normaluri inteleqtis SemTxvevebSi Sedegebs.
da halucinaciebis Sinaarsic SedarebiT ufro mar- gonebrivi CamorCenilobis mqone pirebsa da norm-
tivia. rodesac IQ<45, Sizofreniis darwmunebiT dialuri inteleqtis mqone individebSi guneb-ganwyobis
agnostireba rTulia. amasTan, Tavis tvinis dazianebis aSlilobis mkurnalobis erTi da igive principebi
zogierTi simptomi, rogoricaa stereotipuli moZ- gamoiyeneba (ix. Tavi 11).
raobebi da sociumisgan Tavis arideba, SeiZleba mcda-
rad iyos Sizofreniad miCneuli. amitom yovelTvis SfoTviTi aSliloba da masTan dakavSirebuli
saWiroa savaraudo fsiqikuri aSlilobis dawyebamde mdgomareobebi
arsebuli qceva Sedardes qcevas, romelic aSlilobis adaptaciis darRvevebi xSirad iCens Tavs daswavlis
gamovlenis Semdeg iCens Tavs. darRvevis mqone pirebSi cxovrebis Cveuli wesis Secv-
iseT SemTxvevaSi, roca inteleqtis an socialuri lasTan erTad. aseve, xSiria SfoTviTi aSliloba, gan-
funqciis gauareseba organuli mizezis gareSe vi- sakuTrebiT, stresis dros. SeiZleba aRiniSnebodes
Tardeba, Sizofrenia unda ganvixiloT, rogorc erT- fobikuri aSlilobac, romelic Zneli amosacnobia.
erTi SesaZlo diagnozi, gansakuTrebiT maSin, roca post-travmuli stresuli aSliloba aRwerilia das-
Cndeba nebismieri uCveulo qceva, romelic manamde wavlis darRvevis mqone im pirebSi, romlebzec ganx-
arsebulisgan gansxvavebulia. (sxva SesaZlo diagnoze- orcielda seqsualuri an fizikuri Zaladoba (Ryan,
bia depresiuli da SfoTviTi aSlilobebi da stresze 1994). agreTve, gvxvdeba obsesiur-kompulsuri aSli-
anomaliuri reaqcia.) rodesac didi xnis manZilze ver loba, romelic ufro metadaa gavrcelebuli daswav-
xerxdeba diagnozis dasma, SegviZlia daviwyoT antif- lis darRvevis mqone pirebSi, zogad populaciasTan
siqozuri medikamentebis gamoyeneba, Tumca, medika- SedarebiT. zogjer konversiuli da disociaciuri
menturi mkurnalobis fonze mdgomareobis gaumjobe- simptomebi aSkaradaa gamoxatuli da iseTi saxiT
seba, ra Tqma unda, yovelTvis ar gulisxmobs Sizo- vlindeba, rogori warmodgenac aqvs pacients avadmyo-
freniis diagnozis dadasturebas. fobis Sesaxeb. somatoformuli aSlilobebi da fun-
daswavlis darRvevis mqone pirebSi Sizofreniis qciuri somaturi simptomebi SeiZleba iyos gamowveu-
mkurnalobis principebi igivea, rac normaluri in- li eqimebis yuradRebis mizidvis mudmivi surviliT.
teleqtis mqone pacientebSi (ix. Tavi 12). mkurnaloba, ZiriTadad, mimarTulia pacientis gare-
mos adaptaciaze. zogjer konsultirebac SeiZleba
guneb-ganwyobis aSliloba efeqturi aRmoCndes, Tu mas Sesabamisi sirTulis Sem-
depresiuli aSlilobebis sixSire iseTivea, rogoric TxvevebSi gamoviyenebT.
zogad populaciaSi (Deb et al., 2001a). miuxedavad ami- kvebiTi aSliloba
sa, daswavlis unaris darRvevis mqone pirebTan ufro daswavlis darRvevis mqone pirebSi xSiria zedmeti
iSviaTad gvxvdeba depresiuli ideebis gamoxatva da Wama da uCveulo dieta. paTologiuri kvebis qceva,
_ 754 _
daswavlis darRvevis klinikuri niSnebi
rogoricaa `pika~ (ix. gv. ??) SedarebiT ufro xSiria, kvlevebis miuxedavad, ver dadginda demenciis mizezi.
vidre es adre egonaT (Gravestock, 2003), magram ner- daswavlis darRvevis mqone pirebSi demenciis pirve-
vuli anoreqsia da bulimia, zogad populaciasTan li niSani SeiZleba iyos inteleqtisa da socialuri
SedarebiT, ufro iSviaTia. zedmeti Wama da simsuqne funqcionirebis daqveiTeba. demencia unda ganvasxvav-
prader-uilis sindromis _ daswavlis darRvevis gene- oT iseTi mdgomareobebisgan, rogoric depresia da
tikuri mizezis niSnebia. deliriumia. isinic funqcionirebis msgavs daqveiTe-
bas iwvevs, magram mkurnalobiT miiRweva pacientis
pirovnuli aSliloba
mdgomareobis gaumjobeseba.
daswavlis darRvevis mqone pirebSi xSiria pirovnu-
li aSlilobebi, magram maTi diagnostika advili ar darRvevebi, romelTa pirveladi diagnostikac,
aris. mocemul populaciaSi qceviTi darRvevebi da Cveulebriv, bavSvobisa da mozardobis asakSi
pirovnuli aSlilobebi mniSvnelovnad emTxveva erT-
xdeba
maneTs (Corbett, 1979). zogjer pirovnuli aSliloba am kategoriis bevri darRveva ufro xSiria daswavlis
marTvis ufro seriozul problemebs warmoSobs, vi- darRvevis mqone bavSvebSi, vidre zogad populaciaSi
dre TavisTavad daswavlis darRveva. am dros gamoy- da, Cveulebriv, zrdasrul asakSic narCundeba. mniS-
enebuli ZiriTadi midgoma ?? gverdzea aRwerili, sa- vnelovania vicodeT, rom ganviTarebis iseTi specifi-
dac miTiTebulia, rom ufro mniSvnelovania pacien- kuri darRvevebi, rogoricaa saskolo unar-Cvevebis,
tis temperamentis Sesaferisi garemos migneba, vidre, enis, metyvelebis da motoruli funqciis darRvevebi,
pacientis mier sakuTari Tavis ukeT gagebis gziT, SeiZleba daswavlis darRvevasTan Tanaarsebobdes.
cvlilebebi gamoviwvioT masSi.
autizmi da yuradRebis deficitisa da
deliriumi da demencia hiperaqtiurobis darRveva
deliriumi SeiZleba ganviTardes infeqciis, medika- daswavlis darRvevis mqone pirebSi hiperaqtiuri qce-
mentebis da sxva faqtorebis gavlenis Sedegad. iseve, va SeiZleba daswavlis darRvevis sindromis nawils
rogorc normaluri inteleqtis mqone pirebSi, das- warmoadgendes. miuxedavad amisa, rogorc Cans, au-
wavlis darRvevis mqone pirebSic, deliriumi ufro tizmic, yuradRebis deficitisa da hiperaqtiurobis
xSirad bavSvobisa da xandazmulobis periodSi gvx- darRvevac ufro xSiria daswavlis darRvevis mqone
vdeba. deliriumiT gamowveuli qceviTi darRvevebi, pirebSi, vidre zogad populaciaSi. es darRvevebi gan-
zogjer, SeiZleba iyos fizikuri daavadebis pirveli xilulia ?? gverdebze, ris gamoc aq aRar ganvixilavT
gamoxatuleba. deliriumi, aseve, zogierTi medikamen- maT.
tis (gansakuTrebiT antikonvulsantis, antidepresan-
anomaliuri moZraobebi
tis da sxva fsiqotropuli wamlebis) gverdiT movle-
stereotipia, manerizmi, riTmuli da sxva saxis moZrao-
nas warmoadgens.
bis darRvevebi (magaliTad, Tavis qneva da Tavis rtyma)
demencia _ daswavlis darRvevis mqone pirebis si-
axasiaTebs daswavlis mZime formis darRvevis mqone
cocxlis xangrZlivobis gazrdasTan erTad, gaxSirda
bavSvTa 40% da mozrdilebis 20%-s. ganmeorebadi Tvi-
gviandel asakSi demenciis ganviTarebis SemTxvevebic.
Tdamazianebeli qceva SedarebiT ufro iSviaTia, ma-
alcheimeris daavadeba SedarebiT ufro xSiria dau-
gram mniSvnelovani. aRiniSneba specifikuri kavSiri
nis sindromis mqone pirebSi (ix. gv. ??) da daswavlis
leS-nihenis (Lisch-Nyhan) sindromTan, romlis drosac
darRvevis mqone 65 wels gadacilebul pirebSi, rom-
xSiria tuCis kuTxis moWma. prader-uilis (Prader-Willi)
lebsac ara aqvT daunis sindromi (Barcikowska et al.,
sindromis dros ki xSiria sakuTari kanis CiCqna, ris
1989). aseT SemTxvevaTa umravlesobaSi, intensiuri
drosac, zogjer, SeRweva kanqveSa qsovilamdec ki
xdeba. klinikuri dakvirvebis Sedegad gaCnda cneba
boqsi 25.1 gamomwvevi qcevis mizezebi `qcevis fenotipi~, romelic gulisxmobs qcevis daka-
tkivili da diskomforti vSirebas specifikur genotipTan. Tumca, kvlevebiT
arasakmarisi stimulacia miRebuli monacemebi sul ufro saeWvos xdis am mosa-
zrebas, rom arsebobs qcevis damaxasiaTebeli pater-
Warbi stimulacia
ni, romelic konkretuli genetikuri darRvevisTvisaa
arasasiamovno situaciidan Tavis daRwevis survili
specifikuri (ix. Skuse, 2001).
yuradRebis an jildos miRebis dauZleveli survili
komunikaciis siZneliT gamowveuli frustracia
gamomwvevi qceva
wamlis gverdiTi moqmedeba termini `gamomwvevi~ qceva xSirad gamoiyeneba iseTi
qcevis aRsaniSnad, romelic Tavisi intensivobisa da
fsiqikuri aSliloba
sixSiris gamo, fizikur safrTxes uqmnis daswavlis
_ 755 _
darRvevis mqone pirs, zians ayenebs sxva adamians, kognituri funqciebis gauareseba. am populaciaSi
an arTulebs mis sazogadoebriv CarTulobas. daswa- Zilis aSlilobebis maRali sixSire SeiZleba gan
vlis darRvevis mqone bavSvebisa da mozardebis 20% pirobebuli iyos xuTi faqtoriT. esenia:
da mozrdilebis 15%-s axasiaTebs garkveuli formis 1. Zil-RviZilis ciklisTvis mniSvnelovani centra
gamomwvevi qceva. aseTi qcevis mizezebi mocemulia boluri nervuli sistemis struqturebis Tanmxlebi
qsSi 25.1. zog SemTxvevaSi, Tu es SesaZlebelia, unda dazianeba;
Catardes pirveladi mizezis mkurnaloba. SeiZleba
2. ZilSi dawyebuli epilefsiuri gulyrebi;
efeqturi iyos qcevis modifikacia (ix. gv. ??) im ad-
3. epilefsiasTan dakavSirebuli Zilis arastabilu
gilebSi, sadac is ufro xSirad iCens Tavs, an, mZime
roba, rac arRvevs Zilis arqiteqturas aSkara gul
SemTxvevebSi _ sacxovrebel adgilas. damatebiTi in-
yrebis gareSe;
formaciis moZiebisTvis ix. Emerson, 1995 da Deb, 2001c.
4. zeda sasunTqi gzebis struqturuli anomaliebi,
eqspertizis problemebi romlebic iwvevs Zilis apnoes (gansakuTrebiT xSi
daswavlis msubuqi darRvevis mqone pirebSi ufro ria daunis sindromis mqone pirebSi);
xSiria kriminaluri qceva, vidre zogad populaciaSi 5. yvelaze xSiri mizezia sifxizlis ganmtkiceba da
(ix. cxrili 26.2. gv. ??). amas mravali mizezi aqvs, udevrobiT (mag., sasmelis micema, televizoris
magram gansakuTrebiT mniSvnelovania ojaxisa da ga xangrZlivad yurebis uflebis micema da a.S.).
remos gavlena. impulsuroba, sugestiuroba, eqs
mkurnaloba gamomwvev mizezebzea mimarTuli (ix. gv.
ploataciisgan daucveloba da Tavis mowonebis
??)
dauZleveli survili kriminalur qmedebebze io
lad dayoliebis mizezebs warmoadgenen. zogad po
sqesobrivi kavSirebi da mSoblis rolis
pulaciasTan SedarebiT, danaSaulis Camdeni daswavlis
Sesruleba
darRvevis mqone pirebis gamovlena ufro martivia
da dakavebisas maTgan ufro advilia aRiarebis daswavlis darRvevis mqone pirebis umetesobas iseve
miReba. gansakuTrebiT xSiria seqsualuri xasiaTis uviTardeba seqsualuri interesi, rogorc sxva ada-
(ZiriTadad, eqshibicionizmi) da xanZris ganzrax mianebs. miuxedavad imisa, rom mSoblebi da momvlele-
gaCenis SemTxvevebi. bi cdiloben xeli Seuwyon daswavlis darRvevis mqo-
radgan daswavlis darRvevis mqone pirebi STa ne pirebis maqsimalurad normalur cxovrebas, isini,
gonebadni arian da SeiZleba miscen cru aRiareba, Cveulebriv, xels uSlian maT seqsualur gamovlinebe-
gansakuTrebuli yuradReba unda mivaqcioT kiTxvebs bs da, zogadad, ar surT am Temis ganxilva.
saeWvo danaSaulis Sesaxeb. britaneTSi dakiTxva warsulSi xels uSlidnen daswavlis darRvevis mqo-
xdeba policiisa da kriminalis mtkicebulebebis ne pirebis seqsualur aqtivobas, radgan eSinodaT,
aqtis (Police and Criminal Evidence Act) Sesabamisad. rom aseT wyvils unarSezRuduli Svili eyoleboda.
dakiTxvas aucilebelad unda daeswros zrdasruli amJamad cnobilia, rom daswavlis mZime formis darR-
piri, romelic uzrunvelyofs daswavlis darRvevis veva ar aris memkvidruli da rom im SemTxvevebs, rom-
mqone piris garkvevas situaciaSi da misTvis dasmuli lebic memkvidrulia, xSirad unayofoba axlavs Tan.
kiTxvebis sworad gagebas. miuxedavad imisa, rom meore mizezad Tvlidnen im mosazrebas, rom daswa-
arsebobs oficialuri Sefasebis skala, STagonebadobis vlis darRvevis mqone piri ver iqneba kargi mSobeli.
Sefaseba SesaZlebelia klinikurad (Gudjonsson, 1992). norvegiaSi Catarebuli gamokvlevis mixedviT, daswa-
damnaSaved cnobis Semdeg SeiZleba saWiro gaxdes vlis darRvevis mqone pirebis mier gaCenili 126 ba-
fsiqiatris meTvalyureoba da pacientis specialuri vSvidan 40% ganicdida `zrunvis naklebobas~ (Morch
informireba. daswavlis darRvevasTan dakavSirebuli et al., 1997), xolo britanuli gamokvleviT dadginda,
sasamarTlo sakiTxebi ganxilulia Semdeg wyaroSi: rom daswavlis darRvevis mqone pirebis nawili warma-
Holland, 1997. tebiT axerxebda bavSvis movlas aqtiuri mxardaWeris
pirobebSi (Booth and Booth, 1993).
Zilis aSlilobebi ToToeul SemTxvevaSi es sakiTxebi guldasmiT unda
Zilis iseTi seriozuli problemebi, rogoric aris iyos ganxiluli. Sesabamis SemTxvevaSi SesaZlebeli
Zilis obstruqciuli apnoe, dRis saaTebSi Warbi unda iyos kontracepciis gamoyeneba.
Zilianoba da parasomniebi daswavlis darRvevis
seqsualuri problemebi
mqone pirebSi, rac SeiZleba maTTvis da maTi mom
vlelebisTvis distresis mniSvnelovan mizezs war daswavlis darRvevis mqone zog pirs axasiaTebs ba-
moadgendes (Brylewski and Wiggs, 2004). amasTan, Zilis vSvuri cnobismoyvareoba sxva adamianis sxeulis mi-
aSlilobebs SeiZleba Tan axldes gamomwvevi qceva da marT, rac SeiZleba, mcdarad, seqsualobis gamoxatu-
_ 756 _
daswavlis darRvevis etiologia
lebad iyos miCneuli. zogierTi ise warmoaCens Tavis ebs, romelic Sexvda saskolo ardadegebis periodSi,
sxeuls, rom verc acnobierebs Tavisi moqmedebis dasvenebis dReebsa da saRamos saaTebSi bavSvis mo-
mniSvnelobas. vlaSi damxmares Ziebisas.
asakis matebasTan erTad mSoblebs uCndebaT SiSi
daswavlis darRvevis gavlena ojaxze ukve mozrdili unarSezRuduli qaliSvilis an vaJis
mas Semdeg, rac irkveva, rom Cvili unarSezRudulia, gamo. maT unda vurCioT, Tu rogor miiRon damatebi-
mSoblebi distress ganicdian. maT uCndebaT bavSvis Ti daxmareba maSin, roca veRar SeZleben SvilisTvis
uaryofis gancda, romelic iSviaTad grZeldeba da mxardaWeris aRmoCenas. maT, agreTve, rCeva sWirdebaT
sasurveli normaluri bavSvis dakargvis gancdiT Ca- imis Taobaze, Tu rogor daexmaron TavianT Svils,
nacvldeba. xSirad daswavlis darRvevis diagnozs ver darCes ojaxSi maTi gardacvalebis Semdeg (magaliTis-
svamen Cvilobis asakSi, ris gamoc, mogvianebiT mSo- Tvis ix. Foundation for Learning Disabilities, 2000).
blebi ganicdian bavSvTan dakavSirebuli molodine- ojaxze daswavlis unaris darRvevis zegavlenis mi-
bisa da imedebis gacruebas. maT xSirad aqvT gaxan- moxilvisTvis ix. Gath, 2000.
grZlivebuli depresia, ipyrobT danaSaulis grZnoba,
cudi mopyroba da Zaladoba
ganicdian sircxvils an risxvas da uWirT praqtikul
daswavlis darRvevis mqone bevri bavSvi iseT ojaxSi
da finansur problemebTan gamklaveba. isini Zalian
izrdeba, sadac moqmedebs faqtorebi, romlebic zo-
wuxan im gegmebisa da imedebis gamo, romlebsac nor-
gad populaciaSi bavSvis mimarT cudad mopyrobas-
maluri bavSvis gaCenas ukavSirebdnen. maTi mcire na-
Tan aris asocirebuli (ix. gv. ??). Tumca, ar arsebo-
wili uaryofs bavSvs, zogi piriqiT _ zedmetad daka-
bs sarwmuno informacia imis Sesaxeb, rom daswavlis
vebulia misi movliT, rasac ojaxuri cxovrebis sxva
darRvevis mqone bavSvis ojaxebSi, sxva ojaxebTan Se-
mniSvnelovan mxareebs msxverplad swiravs (Floyd and
darebiT, bavSvze Zaladoba ufro xSiria. seqsualuri
Phillippe, 1993), zogic ki mudmivad eZebs daswavlis
Zaladobis SemTxvevebi, cxovrebis gviandel etapze,
darRvevis ganviTarebis amxsnel mizezebs. ojaxebis
SeiZleba gamovlindes fsiqologiuri problemebi (Se-
umetesoba damakmayofileblad egueba Tavis mdgoma-
quiera et al., 2003).
reobas, Tumca bavSvis zedmeti gaTamamebis sacduri
namdvilad arsebobs. fsiqologiuri adaptaciis miu-
xedavad, mSoblebTan mainc arsebobs xangrZlivi mZime daswavlis darRvevis etiologia
Sromis, imedgacruebisa da socialuri problemebis
Sesavali
perspeqtiva. fizikuri unarSezRuduloba kidev ufro
zogierTi avtori (Lewis, 1929) gamoyofs gonebrivi Ca-
amZimebs am problemebs.
morCenilobis or tips (1) subkulturuli, romelic
arsebobs ramdenime kvleva daswavlis unaris darR-
inteleqtis normaluri ganawilebis mrudis qveda
vevis ojaxze zegavlenis Sesaxeb. erT-erT gamokvle-
zRvarzea da (2) paTologiuri. am SemTxvevaSi Camor-
vaSi erTmaneTs Seadares ojaxebis ori jgufi, erTi
Cena gamowveulia specifikuri daavadebiT. q. kol-
_ saxlSi daunis sindromis mqone bavSviT da meore,
Cesteris fsiqiatriuli saavadmyofos 1280 pacien-
sakontrolo jgufi _ normaluri ineleqtis mqone
tis SeswavliT, romlebsac gonebrivi CamorCeniloba
bavSviT (Ann Gath, 1978). kvlevis avtorebma Semdegi
aReniSnebodaT, penrouzma (Penrose, 1938)aRmoaCina,
daskvna gamoitanes: `bavSvis anomaliurobiT gamowveu-
rom SemTxvevaTa umetesoba gamowveuli iyo ara erTi
li emociuri reaqciis miuxedavad, ojaxebis umeteso-
mizeziT, aramed memkvidruli da garemo faqtorebis
ba kargad Seegua Tavis mdgomareobas da 2 wlis Semdeg
urTierTqmedebiT (Penrose, 1938). mocemuli mosazre-
saxlis garemo gaxda stabiluri da ufro srulyofi-
ba Semdgomi kvlevebiT dadasturda. es daskvna gan-
li, rogorc normaluri, ise unarSezRuduli bavSve-
sakuTrebiT miesadageba msubuqi CamorCenilobis iseT
bisTvis~ (Gath, 1978, gv. 116).
SemTxvevebs, romelTa xSiri mizezic genetikuri da
miuxedavad amisa, daswavlis darRvevis mqone bavS-
garemos mavne zemoqmedebis kombinaciaa da romlebic
vis da-Zma garkveulad araxelsayrel mdgomareobaSi
SedarebiT xSirad gvxvdeba dabali socialuri fenis
imyofeboda, radgan mTeli Zalisxmeva unarSezRudul
warmomadgenlebSi. daswavlis darRvevis mizezi Se-
bavSvze iyo mimarTuli. es monacemebi momdevno kvle-
mTxvevaTa 50%-Si ucnobi rCeba (Xu and Chen, 2003).
vebiTac dadasturda (ix. Gath, 2000).
daswavlis mZime darRvevis SemTxvevebs Soris fizi-
SedarebiT axali kvlevebiT gairkva, rom dedas,
kuri mizezebi dadasturebulia 55-75%-Si (Broman, et
romelsac hyavs daswavlis darRvevis mqone bavSvi,
al., 1987). dominirebs prenataluri mizezebi, iseve, ro-
meuRle xSirad exmareba, magram mas naklebad exmare-
gorc, mag., kavSiri idiopaTur cerebrul damblasa da
bian sxva adamianebi. garda amisa, bevri specialisti,
epilefsiasTan. SesaZlo sxva mizezebs miekuTvneba dau-
mSoblebis mier fasdeboda rogorc gamousadegari da
nis sindromi, myife X sindromi da nayofis (fetalu-
arakompetenturi. bevri mSobeli aRniSnavda siZnele-
_ 757 _
boqsi 25.2 zogierTi specifikuri genetikuri faqtorebi

genetikuri sindromi ojaxebis, tyupebis da naSvilebi bavSvebis kvlevebis
safuZvelze dadasturda, rom normaluri intele-
gamoyofen specifikuri genetikuri sindromebis 6 jgufs:
qtisTvis mniSvnelovania poligenuri memkvidreoba da
1. dominanturi mdgomareobebi _ es mdgomareobebi iS-
rom gonebrivi CamorCenilobis msubuqi SemTxvevebis
viaTia (mag., fakomatozebi neirofibromatozis Ca-
TvliT). umetesoba Seesabameba inteleqtis ganawilebis mrudis
2. recesiuli mdgomareobebi _ es aris specifikuri gene-
qveda zRvars (Thapar et al., 1994). myife X sindromi aris
tikuri sindromebis yvelaze didi jgufi da umetesad daswavlis darRvevis yvelaze cnobili memkvidruli
moicavs iseT memkvidrul metabolur mdgomareobebs, mizezi. is iwvevs msubuq da saSualo simZimis darR-
rogoricaa fenilketonuria (metabolizmis yvelaze
vevas. daswavlis darRvevis mZime SemTxvevebSi bevria
xSiri darRveva), homocistinuria da galaqtozemia.
genetikuri anomalia. calkeuli genis daaxloebiT 180
3. sqesTan SeWiduli qromosomuli anomaliebi _ daswa-
defeqti iwvevs metabolur darRvevas da sxva anoma-
vlis darRvevis prevalentoba mamakacebSi 25%-iT
maRalia qalebTan SedarebiT. lerkem pirvelma iva- liebs, romlebic daswavlis darRvevis mizezi xdeba
rauda, rom maRali maCveneblebi mamakacebSi SeiZle- (ix. cxrili 25.2 da 25.3).
ba gamowveuli iyos X-qromosomasTan dakavSirebuli
cxrilSi 25.2 Sejamebulia yvelaze xSiri mizezebi,
mizezebiT (Lehrke, 1972). uaxlesi kvlevebis mixedviT,
daswavlis darRvevis mqone mamrobiTi sqesis pacien- Tumca es cxrili ar aris srulyofili. bevri maT-
tebis daaxloebiT 1/5-is mizezi X-SeWiduli mdgoma- gani iSviaTi mizezia da am TavSi ar aris ganxiluli.
reobebia. identificirda mravali iSviaTi X-SeWiduli informacia SedarebiT gavrcelebuli mdgomareobebis
sindromi, magaliTad, glukozis dehidrogenazis de-
ficiti da leS-nihenis (Lesch-Nyhan) sindromi. miuxe- Sesaxeb mocemulia cxrilSi 25.3. am sindromebis mqo-
davad amisa, umetes SemTxvevaSi ar aRiniSneba meta- ne bavSvebze mzrunveloba ufro metad pediatris da
boluri anomalia, magaliTad, `myife X sindromi~ (ix. genetikosis saqmea, vidre fsiqiatris. Tu fsiqiatri
gv. ??). daswavlis darRveva SeiZleba gamoiwvios sas-
Tavis Tavze iRebs aseTi iSviaTi sindromis mqone ba-
qeso qromosomebis anomaliebma, rogoric aris klain-
felteris (Klinefelters) sindromi (XXY) da terneris vSvis movlas, man unda imuSaos pediatrTan an ojaxis
(Turners) sindromi (X0). eqimTan erTad da gaecnos yvela Tanamedrove infor-
4. autosomuri qromosomuli anomaliebi _ yvelaze xSi- macias am sindromis Sesaxeb.
ria daunis sindromis dros (gv. ??) daswavlis darRvevebis citogenetikis mimoxilvis-
5. mdgomareobebi nawilobrivi da rTuli memkvidreobiT _ Tvis ix. Xu and Chen, 2003, xolo daswavlis darRve-
aseT mdgomareobebs miekuTvneba anencefalia. es jgu- vebis metaboluli mizezebis mimoxilvisTvis _ Kahler
fi cudad aris Seswavlili.
and Fahey, 2003.
6. neironTa migraciis darRvevebi (nmd) _ iwvevs `cere-
brul disgeneziebs~, romlebsac Tan axlavs daswavlis socialuri faqtorebi
darRveva da epilefsia. aRmoCenilia nmd-sTan asoci-
rebuli 25-ze meti genetikuri sindromi. zogad populaciaze Catarebuli kvlevebi gviCvenebs,
rom socialuri garemo faqtorebis cvlileba IQ-s
ri) alkoholuri sindromi. prenataluri genetikuri TiTqmis 20 quliT cvlis. amis mtkicebuleba 2 tipis
mizezebi moicavs erTi genis defeqts da raodenobrivi kvlevebiTaa miRebuli.
xasiaTis lokusebs, romelic iZleva mravlobiTi anoma- epidemiologiuri kvlevebi _ dabali IQ ukavSirdeba
liuri genuri lokusis akumulaciur qvezRurblovan dabal socialur klass, siRaribes, cud sacxovrebel
efeqts da zrdis mowyvladobas daswavlis darRvevis pirobebs da arastabilur ojaxur garemos. aseTi so-
ganviTarebis mimarT (Daniels et al., 1998). cialuri faqtorebi zemoqmedebs dabal inteleqtze,
post-natalur mizezebs miekuTvneba hipoTiroidiz- magram mis gamomwvev mizezs ar warmoadgens. miuxe-
mi, infeqcia, travma da intoqsikacia. ganviTarebul davad amisa, dabadebidan mozardobamde Catarebuli
qveynebSi es mizezebi SedarebiT iSviaTia genetikur prospeqtuli kvlevebiT dadginda, rom fsiqosocia-
da perinatalur mizezebTan SedarebiT, magram gan- luri faqtorebi IQ-is prediqtoria (Sameroff et al.,
viTarebad qveynebSi post-nataluri mizezebi ufro 1987).
mniSvnelovania. etiologiis mimoxilvisTvis ix. Deb garemos gaumjobeseba _ erT-erTi adreuli eqspe-
and Ahmed, 2000 da Kaski, 2000. rimentis mixedviT, bavSvebi didi zomisa da cudi pi-
unda aRiniSnos, rom daswavlis darRvevis mZime robebis mqone instituciebidan gadaiyvanes patara da
formebis specifikuri mizezebis identifikaciis miu- kadrebiT kargad uzrunvelyofil bavSvTa saxlSi da
xedavad, mainc unda gaviTvaliswinoT yvela damatebi- misces stimulaciuri ganaTleba. 20 wlis Semdeg maTi
Ti socialuri da sxva faqtorebi. IQ ufro maRali iyo im bavSvebTan SedarebiT, romle-
autizmi, romelsac Tan axlavs daswavlis darRveva bmac pirveli tipis instituciebSi ganagrZes cxovreba
ganxilulia 24-e TavSi. (Skeels, 1996). SedarebiT axali kvlevebiT dadasturda,
rom xarisxiani da xangrZlivi intervencia dadebiTad
_ 758 _
rebis gamo ufro didi safrTxis winaSe dgebian, Tumca
cxrili 25.2 daswavlis darRvevis etiologia dabinZurebul garemoSi mcxovrebi bavSvebi umetesad
genetikuri Tavis tvinis uxeSi dazianebiT dabali socio-ekonomikuri fenidan arian, amdenad,
tuberozuli sklerozi gaurkvevelia maTi dabali inteleqti (sxva adgilebSi
qromosomuli anomaliebi neirofibromatozi
cerebruli disgenezia mcxovreb bavSvebTan SedarebiT) sisxlSi tyviis mcire-
myife X sindromi
21-e trisomia: Tavis tvinis malformaciebiT odeni momatebiTaa gamowveuli, Tu socialuri mizeze-
daunis sindromi nevraluri lulis defeqtebi biT (ix. Pocock et al., 1994 mimoxilvisTvis).
me-13 trisomia: hidrocefalia
pataus sindromi mikrocefalia
dabadebis travma
me-18 trisomia:
eduardsis (Edwards) sin- antenataluri dazianeba dabadebis travma daswavlis darRvevis mniSvnelovani
dromi infeqciebi (wiTura, citome
galovirusi, sifilisi, mizezia. adreuli kvlevebis monacemebiT, klinikurad
terminuli delecia 5:
Cri-du-chat (`katis kivili~) toqsoplazmozi) diagnostirebuli dabadebis travma Seadgenda daswa-
intoqsikaciebi (tyvia, zogier- vlis darRvevis SemTxvevebis daaxloebiT 10%-s. pas-
mikrodeleciebi: Ti medikamenti, alkoholi)
uiliamsis sindromi (qromo- fizikuri dazianeba (travma, manikma da knobloxma CaTvales, rom `reproduqciuli
soma 7) radiacia, hipoqsia) mizezobriobis kontiniumi~ iwvevs msubuqi CamorCenis
preder-uilis (Prader-Willi) placentis disfunqcia (to-
sindromi (qromosoma 15;
im damatebiT SemTxvevebs, romelTa mizezic in utero anu
qsemia, sakvebis defici-
xSirad mamisgan) tiT gamowveuli zrdis perinatalurad ganviTarebuli Tavis tvinis naklebad
angelmanis sindromi Seferxeba) gamovlenili dazianebaa (Pasamanick and Knobloch, 1966).
(Angelmans) (qromosoma 15; endokrinuli darRvevebi
xSirad dedisgan) miuxedavad imisa, rom dRenakluloba da dabadebis
(hipoTiroidizmi, hipopa-
raTiroidizmi) mcire wona daswavlis darRvevasTanaa dakavSirebuli
metaboluri darRvevebi,
romlebic moqmedebs: (Hack et al., 1994), reproduqciuli mizezobriobis kon-
aminomJavebze (mag.: fenilketo- perinataluri dazianeba tiniumis Teoria sxva mxriv ar yofila dasabuTebuli.
nuria, homocistinuria, har- dabadebis asfiqsia
tnupis (Hartnup) daavadeba) dRenaklulobis garTuleba
Sardovanas ciklze (mag.: ci- kerniqterusi daswavlis darRvevis zogierTi specifikuri
trulinuria, aminosuqci- intraventrikuluri hemoragia
mizezi
nuri aciduria)
lipidebze (tea-saqsis, goSes postnataluri dazianeba daunis sindromi
da niman-pikis daavadebebi) travma (ubeduri SemTxveva,
naxSirwylebze (galaqtozemia) Zaladoba) 1866 wels lengdon dauni Seecada daekavSirebina pa-
purinebze (leS-nihenis sin- intoqsikacia (tyvia, vercx cientTa erTi jgufis garegnoba eTnikuri jgufebis
dromi) liswyali)
fizikur niSnebTan (Langdon Down, 1866). am jgufebidan
mukopolisaqaridebze (harle- infeqciebi (encefaliti, me-
ris, hanteris, sanfilipos ningiti) erT-erTisTvis tipiur mdgomareobas, Tavdapirvelad,
da morkios sindromebi) Raribi garemo daerqva mongolizmi, rasac amJamad daunis sindromi
ewodeba. es mdgomareoba daswavlis darRvevis xSiri
moqmedebs socialuri deprivaciis mqone bavSvebze
mizezia da 650 axalSobilidan 1 SemTxvevaSi gvxvde-
(Garber, 1988).
ba. is SedarebiT xSiria asakovan dedebSi: 20-25 wlis
sxva garemo faqtorebi dedebSi sixSiris maCvenebelia 1/2000, xolo 45 wlis
garemo faqtorebi CamoTvlilia cxrilSi 25.4. zemo- asakSi _ 1/30. daunis sindromis sixSire mas Semdeg Se-
qmedebis periodi mniSvnelovania, radgan Tavis tvi- mcirda, rac amniocentezis daxmarebiT daiwyes misi
nis ganviTarebas aqvs mowyvladi periodebi, romelTa amocnoba da orsulobis Sewyveta.
drosac advilad xdeba Tavis tvinis dazianeba (Holland, klinikuri suraTi Sedgeba iseTi niSnebisgan, rom-
1994). arasrulfasovani kveba pirveli ori wlis gan- lebic, SeiZleba, normalur adamiansac aReniSnebodes.
mavlobaSi, savaraudod, mTel msoflioSi daswavlis zogadad iTvleba, rom oTxi niSnis arseboba warmoad-
darRvevis yvelaze xSiri mizezia. magram es faqtori gens sindromis myar mtkicebulebas. yvelaze damaxa-
naklebad gvxvdeba ganviTarebul qveynebSi. bevr gan- siaTebeli niSnebi cxril 25.5-Sia mocemuli.
viTarebad qveyanaSi iodis nakleboba mniSvnelovan mi- daswavlis darRvevis xarisxi _ IQ zogadad 20-50-
zezs warmoadgens. ia, magram 15%-Si >50. fsiqikuri unarebi Cveulebriv
eWvi aRaravis epareba imaSi, rom mZime tyviis into- sakmaod kargad viTardeba pirveli 6 Tvis manZilze,
qsikacia iwvevs encefalopaTias inteleqtis Semdgomi Semdeg ki ganviTarebis tempi iklebs.
daqveiTebiT. naklebad cnobilia, Tu ramdenad iwvevs temperamenti da qceva _ daunis sindromis mqone ba-
atmosferoSi tyviis Semcvelobis zomieri mateba (rac vSvebi sayvarel da udardel bavSvebad iTvlebian, ma-
benzinisTvis tyviis damatebiTaa gamowveuli) intele- gram arsebobs am sindromis sakmaod farTo variacie-
qtis CamorCenas. vinaidan bavSvebi ufro metad iTvise- bi. emociuri da qceviTi problemebi SedarebiT nak-
ben tyvias, vidre mozrdilebi, isini garemos dabinZu- lebia, vidre klinikurad gamovlenili Tavis tvinis
_ 759 _
cxrili 25.3 daswavlis darRvevis zogierTi mizezi

sindromi etiologia klinikuri niSnebi SeniSvnebi
qromosomuli anomaliebi (daunis sindromisa da X-SeWiduli daswavlis darRvevebis Sesaxeb ix. teqstSi)
sammagi X X-trisomia ar aqvs damaxiaTebeli niSani daswavlis msubuqi darRveva
trisomia-18 trisomia-18 zrdis deficiti, anomaliuri

Tavis qalis forma da saxis
nakvTebi, muStad Sekruli
xelebi, sarwevelas tipis
terfebi, gulisa da Tirkmlis
anomaliebi
trisomia-13 (pataus trisomia-13 Tavis tvinis, tuCebis da sasis umetesoba kvdeba dabadebidan
sindromi) struqturuli anomaliebi, ramdenime kviraSi
polidaqtilia
Cri-du-chat me-5 qromosomis delecia mikrocefalia, umetesoba kvdeba adreuli

(katis kivili) hipertelorizmi, tipiuri bavSvobis asakSi
katis msgavsi kivili, zrdis
nakleboba
metabolizmis Tandayolili darRveva
fenilketonuria avtosomur-recesiuli, pigmentis nakleboba (Ria aRmoCena SesaZlebelia

RviZlis fenilalanin- feris Tma, cisferi Tvalebi); sisxlisa da Sardis skriningiT;
hidroqsilazis nakleboba zrdis CamorCena; Tanmxlebi mkurnaloba: fenilalaninis
epilefsia, mikrocefalia, Semcveli produqtebis amoReba
egzema da hiperaqtivoba sicocxlis adreul wlebSi
homocistinuria avtosomur-recesiuli, brolis eqtopia, Txeli da sxvadasxva simZimis daswavlis

cistaTion-sinTetazis Ria feris Tma, saxsrebis darRveva; zogjer mkurnaloba
nakleboba gafarToeba, marfanis meTioninis SezRudviT
sindromis msgavsi ConCxovani
anomaliebi; asocirebuli
Tromboemboliuri epizodebi
galaqtozemia avtosomur-recesiuli, iwyeba rZis miRebis aRmoCena SesaZlebelia enzimis

galaqtoz-1-fosfat-uridil- Semdeg; zrdis Seferxeba. defeqtis postnataluri
transferazis nakleboba hepatosplenomegalia, skriningiT; mkurnaloba
kataraqta galaqtozisgan Tavisufali
dietiT; Sardis toluidinis
lurjis testi
tea-saqsis daavadeba avtosomur-recesiuli, mxedvelobisa da smenis sikvdili 2-4 wlis asakSi

lipidebis dagrovebis progresuli kargva;
momateba (cerebro-makuluri spastikuri dambla; alublis
degeneraciis adreuli kurkis laqa baduraze;
forma) epilefsia
harleris sindromi autosomur-recesiuli, groteskuli nakvTebi; sikvdili mozardobis asakamde

mukopolisaqaridebis gamozneqili muceli;
dagrovebis darRveva hepatosplenomegalia;
asocirebuli gulis
anomaliebi
leS-nihenis X-SeWiduli, recesiuli, dabadebisas TiTqmis yvela prenataluri diagnostika

sindromi purinis metabolizmis normaluria. SemdgomSi amnionur siTxeSi enzimis
enzimuri defeqti. viTardeba qoreoaTetozuri gansazRvriT. postnataluri
SardmJavas Warbi produqcia moZraobebi da fexebis diagnostika Tmis fesvSi enzimis
da eqskrecia. geni qromosoma gadajvaredinebuli poza. gansazRvriT. sikvdili adreuli
q26-27-is mokle mxare damaxasiaTebelia tuCebisa da mozrdilobis asakSi. TviT-
TiTebis TviT-dazianeba dazianeba SeiZleba Semcirdes
hidroqsitriftofaniT
mkurnalobiT
sxva memkvidruli darRvevebi

neirofibromatozi autosomur-dominanturi, 2 neirofibromebi, rZiani daswavlis darRveva SemTxvevaTa
(fon reklinhauzenis geni, NF1 da NF2 yavisferi laqebi, vitiligo; minimum 50%-Si NF1 mutaciis gamo
sindromi) neirofibromebis mdebareobaze
damokidebuli asocirebuli
simptomebi; astrocitomebi,
meningioma
_ 760 _
cxrili 25.3 daswavlis darRvevis zogierTi mizezi (gagrZeleba)

sindromi etiologia klinikuri niSnebi SeniSvnebi
tuberozuli avtosomur-dominanturi epilefsia, saxeze adenoma daswavlis darRveva daaxloebiT

sklerozi (variabeluri penetrantoba). sebaceum, kanze TeTri laqebi, 70%-Si (ufro xSiria TSC2 genis
gamowveulia 2 geniT: TSC1 Sagrenis kani, baduris fakoma, dros)
(hamartini) qromosoma 9-ze da frCxilqveSa fibromebi;
TSC2 (tuberini) qromosoma TirkmelebSi, elenTasa da
16-ze filtvebSi mravlobiTi simsivne
lourens-mun- autosomur-recesiuli pigmenturi retiniti, daswavlis darRveva Cveulebriv

bidlis sindromi polidaqtilia, zogjer mZime ar aris
simsuqne da sqesobrivi
funqciis nakleboba
infeqciebi
wiTelas dedis infeqcia orsulobis kataraqta, mikrofTalmia, pirvel trimestrSi dedis

embriopaTia pirvel trimestrSi siyrue, mikrocefalia, gulis inficirebiis 10-15%-Si Cvili
Tandayolili daavadeba dasnebovnebulia (infeqcia
SeiZleba iyos subklinikuri)
Toqsoplazmozi dedis protozouli infeqcia hidrocefalia, mikrocefalia, simZimis farTo variabeloba

intracerebruli
kalcifikaciebi,
baduris dazianeba,
hepatosplenomegalia,
siyviTle, epilefsia
citomegalo intrauterinuli Tavis tvinis dazianeba; mxolod gadarCenilTa 60%-s aqvs

virusi (saSvilosnosSida) infeqcia mZime SemTxvevebi gamovlindeba daswavlis darRveva
dabadebisas
Tandayolili aTaSangiT inficirebuli bevri kvdeba dabadebisas; orsulTa rutinuli testirebis

aTaSangi deda sxvadasxva nevrologiuri Semdeg xSirad aRar gvxvdeba;
niSnebi, stigmebi (hatCinsonis Cvilis pirveli testi SeiZleba
kbilebi da kanis naxeTqebi dadebiTi iyos, magram Semdeg
xSirad ar aRiniSneba) gaxdes uaryofiTi
kraniuli malformaciebi
hidrocefalia sqesTan SeWiduli, recesiu- Tavis swrafi zrda. adreul msubuqi SemTxvevebi SeiZleba
li, memkvidruli ganviTarebi- CvilobaSi intrakraniuli spontanurad SeCerdes; SeiZleba
Ti anomalia, mag., wyalsadenis hipertenziis simptomebi; simptomuri mkurnaloba
atrezia, arnold-kiaris sxva niSnebi damokidebulia SuntirebiT; inteleqti SeiZleba
malformacia, meningiti, Spina etiologiaze normaluri iyos
bifida
mikrocefalia recesiuli damemkvidreba, niSnebi damokidebulia gamovlindeba daswavlis

orsulobis dros dasxiveba, etiologiaze darRvevis mqone
dedis infeqcia institucionalizebul pacientTa
TiTqmis mexuTedSi
Sereuli
Spina bifida etiologia mravlobiTi da xerxemlis arxis daxurvis nakle- mielomeningoceles 4/5-s aqvs
(xerxemlis orad rTulia boba; Spina bifida cystica-s axlavs hidrocefalia; CamorCena am
gaxleCa) meningocele an 15-20%-Si _ mie- jgufSi
lomeningocele; iwvevs zurgis
tvinis dazianebas fexebis pare-
ziT, SeukaveblobiT da a.S.
cerebruli dambla Tavis tvinis perinataluri spastikuri (xSiria), umetesoba saSualoze dabali
dazianeba; myari kavSiri aTetoiduri da ataqsiuri inteleqtiT; aTetoiduri ufro
dRenaklulobasTan tipebi; simZime _ variabeluri metad aris normaluri IQ-iT
hipoTiroidizmi iodis deficiti an (iSviaTad) dabadebisas normaluri gareg- britaneTSi amJamad iSviaTia;
(kretinizmi) Tiroidis atrofia noba; anomaliebi gamovlindeba efeqturia adreuli CanacvlebiTi
6 TvisTvis; zrdaSi CamorCena, mkurnaloba
SeSupebuli kani, leTargia
hiperbilirubinemia hemolizi, rezus-konfliqti kerniqterusi (qoreoaTetozi), prevencia anti-rezus-globuli-

da dRenakluloba opistotonusi, kunTTa tonusis niT; neonaturi mkurnaloba Sena-
momateba, krunCxvebi cvlebiTi gadasxmiT
_ 761 _
kaskadis erT-erT gzas warmoadgens (meore gzaa
cxrili 25.4 daswavlis darRvevis garemo anomaliuri `tau~-s metabolizmi).
mizezebi
intrauterinuli infeqcia _ mag., wiTura myife X sindromi
garemos damabinZureblebi _ mag., tyvia

myife X sindromi, daunis sindromis Semdeg, daswavlis
unaris darRvevis sixSiriT meore da memkvidruli
alkoholizmi orsulobis dros _ ix. gv. ??
mizezebidan yvelaze xSiri paTologiaa. is viTardeba
sakvebi nivTierebebis mwvave nakleboba orsulobis dros vaJebSi daaxloebiT 1/4000 sixSiriT da SedarebiT
iodis deficiti ufro msubuqi formiT gogonebSi 1/6000. saerTo
jamSi is Seadgens daswavlis darRvevis SemTxvevebis
saSvilosnos Warbi dasxiveba
daaxloebiT 10%-s.
dazianebis dros dafiqsirebuli daswavlis darRvevis fizikuri niSnebi _ arsebobs ramdenime damaxasi
SemTxvevebSi. aTebeli, magram variabeluri klinikuri niSani, ro
melTagan arcerTi ar aris diagnostikuri mniSvnelobis
gamosavali mqone. am niSnebs miekuTvneba didi saTesle jirkvlebi,
warsulSi daunis sindromis mqone Cvilebis letalo- didi yurebi, mogrZo saxe da brtyeli terfi.
ba maRali iyo, magram samedicino servisis gaumjo- fsiqologiur niSnebs miekuTvneba enisa da metyve
besebiT aseTi adamianebi mozrdilobis asaks aRweven. lebis darRvevebi, autisturi qceva da sxva socialuri
daunis sindromis mqone adamianebis daaxloebiT me- problemebi; yuradRebis da koncentrirebis darRveva;
oTxedi aRwevs 50 welze maRal asaks. Sua xnis asakSi hiperaqtivoba.
maT Tavis tvinSi ewyebaT alcheimeris msgavsi cvli- memkvidreobiToba uCveulo, rTuli da Znelad
lebebi (Holland et al., 1998), magram nevropaTologiuri amosacnobia. ukanasknel wlebSi identificirda geni
cvllilebebis Sesabamisi klinikuri gamovlinebebi FMR-1. es geni moicavs momatebul trinukleotidur
mosalodnelze gvian iCens Tavs (Wisniewski et al., 1994). (CGG _ citozini-guanini-guanini) gameorebas, rac
daunis sindromis mqone pirebs, romlebic mSoble- warmoadgens myife X sindromis anomalias.
bis saxlSi cxovroben, SeiZleba mouwioT saxlis da- genetikuri anomaliis identificirebiT SesaZle-
toveba, mSoblebis daberebasTan erTad an maTi gar- beli gaxda im heterozigoturi qalebis amocnoba,
dacvalebis Semdeg. aseT SemTxvevaSi maT adaptaciis romlebic ara marto klinikurad, citologiuradac
sirTuleebi uCndebaT. normalurebi arian. aucilebelia STamomavlebis ga-
frTxileba maRali riskis Sesaxeb da prenataluri
etiologia testirebis saWiroebis ganmarteba. Sesabamisad, is
1959 wels aRmoCnda, rom daunis sindromi dakav
Sirebulia trisomiul qromosomul darRvevasTan cxrili 25.5 daunis sindromis niSnebi
(aseT adamianebs Cveulebrivi ori qromosomis na saSualo an mZime xarisxis daswavlis darRveva
cvlad sami qromosoma aqvT). SemTxvevaTa 95%
mSvidi temperamenti
gamowveulia 21-e trisomiiT. am SemTxvevebs iwvevs
fizikuri niSnebi:
meiozis dros gayofis ukmarisoba da dakavSirebulia
dedis asakovnebasTan. momdevno bavSvSi ganmeorebis w Tvalebis iribi Wrili da epikantis nakeci
riski udris 1/100-s. darCenili 5%-is mizezi aris w patara piri da daRaruli ena
21-e qromosomis translokacia an mozaicizmi. trans w brtyeli cxviri
lokacia xSirad memkvidrulia da ganmeorebis riski
w gabrtyelebuli kefa
daaxloebiT 1/10-a. mozaicizmi maSin viTardeba,
w mokle mtevani da TiTebi, xelisgulis erTi ganivi nakeci
roca ganayofierebis Semdeg ujredebis gamravlebis
procesSi ar xdeba gayofa da erTidaigive adamians w hipotonia da saxsrebis hipermobiluroba
aqvs rogorc trisomuli, ise normaluri ujredebi. asocirebuli samedicino problemebi

aseT SemTxvevaSi kognituri ganviTareba variabeluria w gulis anomaliebi, gansakuTrebiT Zgidis defeqti
(Thapar et al., 1994). iTvleba, rom daunis paTologia
w kuW-nawlavis anomaliebi
gamowveulia 21-e qromosomaze genebis Warbi `doziT~.
w atlanto-aqsialuri arastabiluroba
amave mizeziT unda xdebodes alchaimeris adreuli
dawyebac, radgan amiloidis prekursori cilis (apc) w infeqciisken midrekileba
geni moTavsebulia 21-e qromosomaze (gv. ??). apc w smenis daqveiTeba

iwvevs Tavis tvinSi amiloidis anomaliur dagrovebas, leikemiis, hipoTiroidizmis, autoimunuri darRvevebis
rac alchaimeris nevropaTologiuri cvlilebebis maRali riski
_ 762 _
daswavlis darRvevis mqone pirebis gamokvleva da klasifikacia
SfoTviT aSlilobasTan; leS-nihenis sindromis kavSi-
cxrili 25.6 myife X sindromis niSnebi ri TviT-damazianebel qcevasTan; da daunis sindromis
daswavlis darRvevis SemTxvevebis daaxloebiT 10% kavSiri alchaimeris daavadebasTan.
ufro xSiria vaJebSi (>2:1) Tavis tvinis paTologia da epilefsia _ rogorc
ukve aRvniSneT, im pirebs, romlebTanac vxvdebiT
daswavlis darRveva
daswavlis mZime darRvevas, axasiaTebT Tavis tvinis
w cvalebadobs msubuqidan umZimes darRvevamde
garkveuli organuli paTologia; aseTive paTologia
w mZimdeba bavSvobis gviandel periodSi axasiaTebs zomieri da msubuqi xarisxis daswavlis
w amocanis Sesrulebis IQ ufro metad qveiTdeba, vidre darRvevis mqone adamianebis ufro mcire raodeno-
verbaluri IQ bas. 24-e TavSi aRniSnulia, rom fsiqikur aSlilobe-
w koncentracia da yuradReba sustia bs normaluri inteleqtis mqone bavSvebSi Tan axlavs
w metyveleba gameorebebiT, moklebulia Temas da Tavis tvinis dazianeba; amitom mosalodnelia, rom
Sinaarss (`litaniuri metyveleba~) daswavlis darRvevis mqone pirebSi arsebuli zogier-
qcevis niSnebi Ti fsiqikuri aSlilobac dakavSirebuli iyos Tavis
w xSiria autisturi niSnebi tvinis paTologiasTan. epilefsia da qceviTi darR-
vevebi urTierTdakavSirebulia daswavlis darRvevis
fizikuri niSnebi
mqone pirebSi (ix. Deb, 2000) an pirdapiri gziT, an ro-
w didi, gamoweuli yurebi
gorc antikonvulsantis arasasurveli moqmedeba.
w mogrZo saxe maRalTaRiani sasiT ganviTarebis faqtorebi moicavs temperamentis ano-
w brtyeli terfi malias, sametyvelo da socialuri unar-Cvevebis Se-
w dune saxsrebi Zenis siZneleebs, dabal TviTSefasebas da dabal aka-
w nazi kani demiur moswrebas. amgvarma siZneleebma SeiZleba Sea-
sustos ojaxisa da momvlelebis Zalisxmeva da Seqmnas
w didi saTesle jirkvlebi (pubertuli periodis Semdeg)
damatebiTi araxelsayreli pirobebi.
w mitraluri sarqvlis prolafsi
iseve, rogorc normaluri inteleqtis mqone pire-
SeniSvna: yvela niSani didi variabelurobiT xasiaTdeba bis SemTxvevaSi, fsiqosocialuri faqtorebi, rogori-
caa axloblis dakargva an ojaxis dangreva, SeiZleba
qali, romlic SeiZleba riskis qveS imyofebodes, unda gaxdes daswavlis darRvevis mqone pirebis fsiqikuri
darwmundes imaSi, rom es anomalia ar aReniSneba. ase- aSlilobisa da qceviTi problemebis mizezi. daswa-
ve, SesaZlebelia imis gansazRvrac, aris Tu ara ma- vlis darRvevis mqone pirebs SeiZleba ganuviTardeT
makaci am anomaliis matarebeli. adaptaciuri aSliloba an fsiqikuri aSliloba maSin,
am sindromis fsiqologiuri da fsiqiatriuli gar- rodesac maTze mzrunveloba nakleb organizebulad
Tulebebi mianiSnebs pacientebis regularuli Semow- xorcieldeba, rodesac maT cudad epyrobian an xdeba
mebis aucileblobaze. myife X sindromis gasacnobad maTi eqsploatacia. operantuli ganpirobebis modeli
ix. Frints et al., 2002. miuTiTebs garemos mier adaptaciuri qcevis arasakma-
ris ganmtkicebaze da, amis sapirispirod, aradapturi
fsiqikuri aSlilobebis da qcevis qcevis ganmtkicebaze.
problemebi daswavlis darRvevis iatrogenuli faqtorebi SeiZleba gaxdes fsiqiku-
ri aSlilobebis mizezi daswavlis darRvevis mqone
mqone pirebSi
pirebSi. rogorc zemoT aRvniSneT, maT miekuTvneba
fsiqikuri aSlilobebis mravalferovneba daswavlis
wamlebis arasasurveli efeqti (es, gansakuTrebiT,
darRvevis mqone pirebSi saeWvos xdis erTi etiolo-
exeba epilefsiis dros gamoyenebul medikamentebs) da
giis arsebobas. iseve, rogorc fsiqikuri aSlilobe-
Warbi an arasakmarisi stimulaciis Semcveli garemo
bis mqone normaluri inteleqtis pirebSi, aqac ganxi-
TemSi an instituciebSi.
luli unda iyos ramdenime mizezi: biologiuri, fsi-
qosocialuri da ganviTarebiTi (ix. Deb et al., 2001a).
ar aris mosalodneli, rom daswavlis darRvevasTan daswavlis darRvevis mqone pirebis
asocirebul fsiqikur aSlilobas hqondes normalur gamokvleva da klasifikacia
inteleqtTan asocirebuli fsiqikuri aSlilobisgan daswavlis darRvevis mqone pirebis gamokvleva xdeba
gansxvavebuli etiologia. 4 ZiriTadi mimarTulebiT. esaa:
biologiuri faqtorebi moicavs specifikur kavSi- 1. daswavlis darRvevis mizezebi;
rebs, rogoricaa myife X sindromis kavSiri yuradRe- 2. asocirebuli biosamedicino mdgomareobebi;
bis deficitisa da hiperaqtivobis darRvevasTan da 3. inteleqtisa da socialuri unar-Cvevebis ganviTareba;
_ 763 _
4. asocirebuli fsiqikuri aSlilobebi, maTi mizezebi dabadebis paTologiebs. unda dadgindes ganviTare-
da Sedegebi. bis sakvanZo safexurebis daZlevis asaki (gv. ??). unda
zogierTi am informaciis aRsanusxad arsebobs mra- moxdes qcevis nebismieri qceviTi darRvevis sruli
valRerZovani (multiaqsisuri) klasifikacia (fsi- aRwera. unda movipovoT informacia nebismieri Tanmx-
qikuri aSlilobebis diagnostikuri kriteriumebi lebi samedicino mdgomareobis detalebis Sesaxeb,
daswavlis darRvevis mqone mozrdilebSi gamosayene- rogoricaa Tandayolili gulis daavadeba, epilefsia
blad _ Diagnostic Criteria for psychiatric disoders for use an cerebruli dambla.
with adults with LD [DC-LD]; Royal College of Psychiatrists,
2001), kerZod: fizikuri mdgomareobis gamokvleva
RerZi I: daswavlis darRvevis simZime sistemur fizikur gasinjvaSi unda Sediodes Tavis
RerZi II: daswavlis darRvevis mizezi garSemowerilobis gazomva. yuradReba unda gavamaxvi-
RerZi III: fsiqikuri aSlilobebi loT specifikuri sindromis amocnobaze, risTvisac
mniSvnelovania am mxriv informatuli fizikuri niS-
done a: ganviTarebis darRvevebi
nebi (ix. cxrili 25.2). nevrologiuri gasinjva mniSv-
done b: fsiqikuri daavadebebi nelovania da unda moicavdes smenisa da mxedvelobis
done g: pirovnuli aSlilobebi daqveiTebis gamokvlevas. fizikuri gasinjvis garda
done d: problemuri qceva SeiZleba saWiro gaxdes neirovizualizaciuri kvle-
vis Catareba.
done e: sxva darRvevebi.
daswavlis mZime darRvevis diagnozi SeiZleba dais-
fsiqikuri statusis Sefaseba
vas Cvilobisas, gansakuTrebiT ki iseT SemTxvevaSi,
gamoyenebuli midgoma moqnili unda iyos. daswavlis
roca masTan asocirebulia amocnobadi fizikuri ano-
darRvevis mqone bevr pirs axasiaTebs yuradRebisa da
malia an motoruli ganviTarebis Seferxeba. daswa-
koncentraciis problema. amitom, interviu unda Ca-
vlis darRvevis mqone zog adamians aqvs ganviTare-
tardes araformalur garemoSi, radgan pacientis Car-
bis specifikuri darRveva, mag., specifikuri funqcia
Tuloba, SeiZleba, wyvetili iyos. kiTxvebis simartive
ufro metadaa daqveiTebuli, vidre es mosalodnelia
unda Seesabamebodes bavSvis recepciuli metyvelebis
inteleqtis saerTo donidan gamomdinare. bavSvobis
da ganviTarebis dones. ojaxis, megobrebis da momvle-
periodSi diagnostikuri Sefaseba moicavs anamnezis
lis mier qcevaze dakvirveba ufro zust informacias
Segrovebas, fizikur gasinjvas, citogenetikur da
iZleva, vidre Semfasebelis dakvirveba. klinikur ga-
molekuluri genetikis gamokvlevebs (gasacnobad ix.
mokvlevas unda daematos fsiqopaTologiis Sefaseba
Battaglia and Carey, 2003).
iseTi standartuli skalebis gamoyenebiT, romlebic
klinicistma sifrTxiliT unda dasvas daswavlis
adaptirebulia daswavlis darRvevis mqone pirebis mi-
SedarebiT msubuqi darRvevis diagnozi ganviTarebis
marT (ix. Deb et al., 2001a kvlevis damateba).
Seferxebis safuZvelze. miuxedavad imisa, rom bavS-
iseve, rogorc normaluri inteleqtis mqone pire-
vis rutinuli gasinjviT SeiZleba gamovlindes gan-
bis SemTxvevaSi, daswavlis unaris darRvevis mqone
viTarebis Seferxebis niSnebi da gamoiTqvas varaudi
piris SemTxvevaSic, sanam dadgindeba, rom arsebuli
daswavlis darRvevis arsebobis Sesaxeb, sarwmuno
qceva aris fsiqikuri aSlilobis mtkicebuleba, mniS-
diagnozi, xSirad, moiTxovs specialistis Sefasebas.
vnelovania dadgindes winmswrebi bazisuri mdgomare-
sruli gamokvleva moicavs ramdenime etaps: anamne-
oba. zogierTi qceva, rogoricaa stereotipuli mo-
zis Segrovebas, fizikur gasinjvas, fsiqikuri sta-
Zraobebi an socialuri ganrideba, waagavs fsiqikuri
tusis gamokvlevas, ganviTarebis testirebas, qcevis
aSlilobebis simptomebs da SeiZleba mcdarad dauka-
funqcionalur Sefasebas, unarSezRuli pirisa da
vSirdes daswavlis unaris darRvevas maSin, roca misi
ojaxis da socialuri mxardaWeris sistemis urTierT-
mizezi aSlilobaa _ `diagnostikuri daCrdilva~ (Reiss
zegavlenis analizs, aseve, adaptaciis sxva sakiTxebs.
and Szyszko, 1983). miuxedavad amisa, gaxangrZlivebuli
es etapebi TanmimdevrobiT iqneba ganxiluli. miuxe-
qcevis momateba SeiZleba iyos fsiqikuri aSlilobis
davad imisa, rom mocemuli nawili ZiriTadad bavS-
pirveli da zogjer erTaderTi mtkicebuleba _ `bazi-
vebis gamokvlevas exeba, igive principebi gamoiyeneba
suri gaZliereba~ (Sovner and Hurley, 1989).
mozardebsa da mozrdilebis mimarT.
ganviTarebis Sefaseba
anamnezis Sekreba
aseTi Sefaseba dafuZnebulia klinikuri gamocdile-
anamnezis Sekrebis procesSi gansakuTrebuli yu-
bisa da inteleqtis, metyvelebis, motorikisa da so-
radReba unda mivaqcioT savaraudo memkvidruli
cialuri unarebis standartuli meTodebiT Sefasebis
darRvevis ojaxur anamnezs, orsulobisa da bavSvis
_ 764 _
daswavlis darRvevis mqone pirebis gamokvleva da klasifikacia
kombinaciaze. miuxedavad imisa, rom inteleqtis ganvi-
boqsi 25.3 ganviTarebis Sefasebisas
Tarebis saukeTeso maCvenebeli IQ-s qulaa, is sarwmu-
xSirad gamoyenebuli instrumentebi
no ar aris Zalian mcire asakis da daswavlis mZime da
umZimesi darRvevis SemTxvevebSi. vainlandis socialuri momwifebis Skala (Vineland Social
Maturity Scale) _ vainlandis Skala gamoiyeneba im bavSvebis
ganviTarebis Sesafasebeli testebi Sesafaseblad, romlebic ver erTvebian testirebis
procesSi. skalis punqtebze pasuxis gacema xdeba sarwmuno
standartizebuli instrumentebi farTod gamoiyeneba informatorze dayrdnobiT. skalaze Sefasebis Sedegad
fsiqologiuri ganviTarebis darRvevis simZimis skri- miiReba saerTo socialuri asaki, romelsac udareben
fsiqikur da qronologiur asaks.
ningis, diagnostikisa da SefasebisTvis. zogierTis
unarebisa da diferenciuli unarebis britanuli skalebi
gamoyeneba saWiroebs Semfaseblis specialur momza-
(The British Ability Scales and Differential Ability Scales) _ am
debas, zogis ki-ara. testis SerCeva mniSvnelovania, skalebiT afaseben funqciebisa da ganaTlebaSi miRwevebis
radgan bevri neirofsiqologiuri testi SeiZleba diapazons. mati gamoyeneba SesaZlebelia saerTo IQ-s
gamosaTvlelad.
rTuli gamodges daswavlis darRvevis mqone zogierTi
pirisTvis. aseve, mniSvnelovania testis tipi. arsebobs adapturi qcevis skalebi (The Adaptive Behaviour Scales)
_ es skalebi, savaraudod, yvelaze xSirad gamoiyeneba
normaze orientirebuli testebi, rogorica veqsleris daswavlis darRvevis mqone mozrdilebis socialuri
inteleqtis skala zrdasruli pirebisTvis (Wechsler funqciobis Sesafaseblad (Nihira et al., 1975).
Adult Intelligence Scale - WAIS) da IQ-s gasazomi sxva tes- adreuli ganaTlebis saxelmZRvanelo (The Portage Guide to
tebi; kriteriumze orientirebuli testebi, romlebic Early Education) _ es instrumenti saerTaSoriso masStabiT
gamoiyeneba. is iZleva ganviTarebis farTo Sefasebas
gamoiyeneba konkretuli unar-Cvevebis gasazomad da
socializaciis, TviT-daxmarebis da metyvelebis
ar iTvaliswinebs populaciur normasTan Sedarebas; sferoebis CaTvliT. Semfasebels treningi unda
socialur garemoSi adaptaciuri qcevis testebi; da Cautardes. testirebaSi aqtiurad unda CaerTos mSobeli
an sxva momvleli.
qceviTi funqcionirebis Sesafasebeli testebi. amJa-
mad gamoiyeneba veqsleris mozrdilTaTvis gankuTv- autizmis qcevis kiTxvari (Autism Bahaviour Check list)
_ es kiTxvari ivseba mSoblis an momvlelis mier. is
nili inteleqtis skalis Semoklebuli versia, romel- autizmis sferoSi arsebuli problemebisa da socialuri
sac ewodeba veqsleris inteleqtis skalis mokle ver- ganviTarebis Seferxebis sarwmuno indikatoria.
sia (Wechsler Abbreviated Scales of Intelligence - WASI)(The unarSezRudulobis Sefasebis skala (The Disability
Psychological Corporation, 2004). sxva meTodebs, romelTa Assessment Scale) _ es skala fokusirebulia autistur
da masTan dakavSirebul socialur ganviTarebaze,
administrireba mcire dros moiTxovs, miekuTvneba su-
metyvelebis darRvevebsa da qcevis problemebze.
raTebiani leqsikonis testi da araverbaluri teste-
britanuli suraTebiani leqsikonis testi (British Peabody
bi, rogoricaa ravenis progresuli matricebis testi Picture Vocabulary Test) _ es aris metyvelebis gagebis testi.
(Raven~s Progressive Matrices). sxva xSirad gamoyenebuli gamoiyeneba im bavSvebTan, romlebsac ar aqvT metyvelebis
instrumentebis CamonaTvali mocemulia boqsSi 25.3. unari. testis bukleti uxvadaa dasuraTebuli da
asakobrivi diapazoni moicavs 3-19 wels. miuxedavad imisa,
pirveli oTxi iZleva ganviTarebis sferoebis saerTo rom testis gamoyeneba ar moiTxovs profesiul trenings,
Sefasebas. sxvebi mTlianad an umTavresad fokusire- tests, ZiriTadad, iyeneben fsiqologebi da metyvelebis
bulia ganviTarebis raime konkretul mxareze. yvelas Terapevtebi.
axasiaTebs maRali sandooba da validuroba. enis ganviTarebis reinelis skalebi (Reynell Scales of
Language Development) _ am skalebiT afaseben metyvelebis
gagebas da eqspresiul metyvelebas 1 Tvidan 6 wlis asakis
qcevis funqciuri Sefaseba bavSvebSi. testi gansakuTrebiT gamoiyeneba im bavSvebTan,
romlebsac metyveleba ar aqvT ganviTarebuli.
qcevis funqciuri Sefaseba moicavs movlenaTa Sefa-
sebas qcevis dawyebamde, mimdinareobisas da uSualod bebs. Tu daswavlis darRvevis mqone pirs sakmarisi
damTavrebis Semdeg. is efuZneba ojaxis, momvlelis xarixiTa aqvs ganviTarebuli metyveleba, misgan Sesa-
da klinikuri gundis dakvirvebis monacemebs. Sefase- Zlebeli xdeba informaciis udidesi nawilis miReba,
ba exeba sakuTari Tavis movlis unarebs; socialur xolo Tu misi metyveleba naklebad aris ganviTarebu-
unarebs komunikaciis CaTvliT, senso-motorul unar- li _ informaciia ZiriTadad sxva informatorisgan
Cvevebs da socialur urTierTobebs. sakvanZo qceva, miiReba. gansakuTrebiT mniSvnelovania Cveuli qcevis
zogjer, furcelze an kompiuterze aRinusxeba. nimuSis nebismieri cvlilebis sruli aRweris mopove-
ba. Cveulebriv, sasaurvelia vTxovoT mSoblebs, peda-
socialuri urTierTobis Sefaseba da gogebs an momvlel personals, rom maT awarmoon Ca-
koreqcia nawerebi iseTi qcevebis Sesaxeb, rogoricaa Wama, Zili
Sefaseba exeba daswavlis darRvevis mqone piris da mis da zogadi aqtivoba, raTa moxdes problemis amocnoba
movlaSi monawile sxva pirebis urTierTobas. is, ase- da gansazRvra. Semfasebels unda axsovdes zemoT Ca-
ve, exeba axali unar-Cvevebis daswavlas, urTierTobis moTvlili fsiqikuri aSlilobebis SesaZlo mizezebi,
damyarebisa da meti arCevanis miRwevis SesaZleblo- amoucnobi epilefsiis CaTvliT.
_ 765 _
daswavlis darRvevis mqone pirebis pirebi da daakisra mas pasuxismgebloba aseTi pirebis
swavlebasa da dasaqmebaze. momdevno wlebSi, insti-
servisi
tuciebSi moTavsebuli am tipis adamianebis raode-
istoriuli perspeqtiva noba 6000-dan (1916) 50000-mde (1939) gaizarda. insti-
servisis Tanamedrove sistemis da jer kidev gadau- tuciebSi myofi adamianebis maCvenebeli omisSemdgom
Wreli problemebis gagebis saukeTeso gzaa daswavlis periodSic maRali rCeboda.
darRvevis mqone adamianebis servisis ganviTarebis is- 1960-ian wlebSi ramdenime ganviTarebulma qveya-
toriis gacnobaa (damatebiTi informaciisTvis ix. M. nam aRiara reformebis Catarebis aucilebloba. amas,
Thomson, 1998). nawilobriv, biZgi misca fsiqiatriul saavadmyo-
servisis mimoxilva SegviZlia daviwyoT me-19 sauku- foebSi ganxorcielebulma cvlilebebma (gv. ??) da
nis adreuli wlebidan. am dros ukve arsebobda mrava- fsiqologiuri kvlevebis gaumjobesebam. aseT cvli-
li angariSi mzrunvelobis gaumjobesebuli formebis lebebs, ZiriTadad, xeli Seuwyo daswavlis darRve-
Sesaxeb. maT Soris aRsaniSnavia parizis yru-munjTa vis mqone pirebis mSobelTa mier warmoebulma kampan-
saavadmyofos ufrosi eqimis itardis (Itard) angariSi, iam da sazogadoebis SeSfoTebam, rac instituciebSi
romelic Seecada gaewrTvna 1801 wels averonSi na- cxovrebis cudi pirobebiT iyo gamowveuli. `CamorCe-
povni `veluri bavSvi~. bavSvi izrdeboda adamianebi- nil pirTa~ hospitaluri kvleviT dadginda, rom paci-
sgan izolirebul, velur garemoSi. itardma didi entebis IQ-is saSualo maCvenebeli 70-s aRemateboda.
Sroma gaswia bavSvis ganaTlebisTvis, magram 6 wlis hospitalizebuli pirebis umetesobas aReniSneboda
Semdeg daaskvna, rom wvrTna uSedego iyo. miuxeda- daswavlis msubuqi darRveva da bevri maTgani arc ki
vad amisa, misma Sromam mniSvnelovani da xangrZlivi saWiroebda hospitalur movlas. amave dros aRmoCnda,
Sedegebi gamoiRo da biZgi misca swavlebis axali rom swavlebiT SesaZlebelia daswavlis msubuqi da
meTodebis gamocdas. es meTodebi daixvewa segvinis mZime darRvevis mqone pacientebisTvis daxmarebis
(Seguin) - parizis bisetris (Bicetre) idiotebisTvis gaweva (O~Connor, 1968). Semdgomma kvlevebma aCvena mci-
gankuTvnili skolis direqtoris mier, romelmac gare saojaxo tipis sacxovrisSi rezidenciuli zrunvis
moaqveyna naSromi idiotebis swavlebis Teoria da upiratesobebi (Tizard, 1964). miuxedavad amisa, sazoga-
arsi (Seguin, 1842). segvins sjeroda, rom daswavlis doebrivi interesis gamoRviZeba britaneTsa da sxva
darRvevis mqone adamianebs aqvT faruli unari, rom- qveynebSi naklebad iyo gamowveuli kvlevebis Sedege-
lis gamovlena SesaZlebelia specialuri treningiT. biT. is, upiratesad, ganpirobebuli iyo zogierT saa-
aseTi treningi unda moicavdes fizikur varjiSs, vadmyofoSi daswavlis darRvevis mqone pirebis uki-
moralur instruqtaJs da safexurebriv davalebebs duresad cudi pirobebiT.
(Seguin, 1864, 1866). dReisTvis yvela ganviTarebuli qveyana miiCnevs,
msgavs ideebs sxva qveynebSic ganixilavdnen, gansa- rom daswavlis darRvevis mqone pirebi maqsimalurad
kuTrebiT ki Sveicariasa da germaniaSi. Sveicarielma integrirebulni unda iyvnen sazogadoebaSi. miuxeda-
eqimma gugenbulma (Guggenbuhl) 1841 wels abendbergSi vad amisa, arsebobs azrTa sxvadasxvaoba maqsimaluri
daarsa pirveli specializebuli sacxovrebeli insti- socialuri integraciis saukeTeso gzis Sesaxeb. bri-
tucia daswavlis darRvevis mqone adamianebisTvis. ms- taneTSi resursebic arasakmarisia da progresic nela
gavsi instituciebi evropis sxva qveynebSic gaixsna. mimdinareobs. aSS-Si deinstitucionalizacia ufro
aq danergili iyo swavlebis iseTi sistema, romelic swrafad moxda da mas warmatebebic axlda da marcxic.
axalgazrdebs damoukidebeli cxovrebis saSualebas servisis Tanamedrove sakvanZo principia `nor
aZlevda. am instituciebSi isic iyo gaTvaliswinebu- malizacia~. es cneba gaCnda skandinaviaSi 1960-
li, rom bevr maTgans SeiZleba xangrZlivi movla das- ian wlebSi. mocemuli termini aRniSnavs zo
Wirveboda. gad midgomas, romelic gulisxmobs, SeZleb
me-19 saukunis dasasruls Camoayalibda meurveuli isdagvarad, normaluri stiliT cxovrebas.
midgoma daswavlis darRvevis mqone pirebis mimarT, (Nirje, 1970). normalizacia imas niSnavs, rom daswavlis
rac ramdenime faqtorma ganapiroba. erT-erTi iyo ge- darRvevis mqone TiTqmis yvela piri unda cxovrob
netikuri mecnierebisa da inteleqtis Sefasebis meTo- des TemSi, monawileobdes normalur aqtivobebSi
debis ganviTareba, evgenikuri Sexedulebis Camoyali- da urTierTobebSi, hqondes arCevanis saSualeba da
beba da anomaliuri qcevisadmi sazogadoebis toler- eZleodes sruli socialuri SesaZleblobebi. bavS-
antobis daqveiTeba. inglissa da uelsSi es damokide- vebi unda aRizardon TavianT ojaxebSi da mozrdil-
buleba aisaxa 1913 wlis fsiqikuri deficitis aqtSi ebs unda mieceT damoukideblad cxovrebis saSuale-
(Mental Deficiency Act 1913), romelic uflebamosils ba. im mcire raodenobisTvis, romelsac esaWiroeba
xdida adgilobriv xelisuflebas izolaciaSi moeq- specialuri socialuri da janmrTelobis dacva, ise
cia ìnteleqtualurad da moralurad defeqturi~ unda SeirCes sacxovrebeli da aqtivobebi, rom maTi
_ 766 _
daswavlis darRvevis mqone pirebis servisi
situacia maqsimalurad iyos ojaxurs miaxloebuli. vinc saWiroebs ambulatoriul daxmarebas, dRis
normalizaciis koncepcia ufro metad ganviTarda stacionarSi an saavadmyofoSi mkurnalobas;
aSS-sa da sxva qveynebSi da gulisxmobs specialiste- w fsiqiatriuli da fsiqologiuri servisebi.
bis daxmarebas adamianis potencialis sruli ganxor-
prevenciuli servisebi
cielebis mizniT. sul ufro metia unarSezRuduli
pirebisgan Semdgari saadvokato jgufebi. is pirebi, pirveladi prevencia mniSvnelovanwilad damokide-
romlebsac ara aqvT metyvelebis unari, sargebloben bulia genetikur konsultaciaze, orsulobis dros
advokatis momsaxurebiT. nayofis anomaliis adreul aRmoCenaze da usafrTxo
mSobiarobaze. meoradi prevencia mimarTulia unarSe-
zogadi midgoma zRudulobis progresirebis prevenciisken, rogorc
samedicino, ise fsiqologiuri kuTxiT. es ukanaskne-
daswavlis darRvevis mqone pirebisTvis arsebuli
li moicavs `stimulirebul~ ganaTlebas da qceviTi
saTemo servisebis modelze ufro mniSvnelovani, maTi
problemebis Semcirebis adreul mcdelobebs. gan-
dagegmvis detalebi da momsaxurebis ganxorcielebis
viTarebul qveynebSi kvlav aqtualuria daswavlis
enTuziazmia. warmatebuli dagegmvisTvis aucilebe-
darRvevis mZime SemTxvevebis genetikuri mizezebis
lia servisis momxmarebelTa saWiroebebis Seswavla da
Semcireba, magram es, albaT, mniSvnelovnad ver imoq-
individualuri Sefasebis jamuri maCveneblebis gaT-
medebs msubuqi SemTxvevebis sixSireze. ganviTarebad
valiswineba, vinaidan konkretul pirovnebas specifi-
qveynebSi daswavlis darRvevis SemTxvevaTa sixSire
kuri saWiroebebi gaaCnia. amisTvis unda xdebodes Sem-
mniSvnelovnad unda Semcirdes orsulobis periodSi
TxvevaTa lokaluri registracia da mimdinare doku-
qalis janmrTelobaze ukeTesi zrunviT da perinata-
mentaciis warmoeba.
luri servisis gaumjobesebis gziT.
zogadad, daswavlis darRvevis mqone pirebTan mim-
dinareobs sganmanaTleblo saqmianoba da maTTvis genetikuri skriningi da konsultacia
gaweuli daxmareba fsiqosocialur xasiaTs atarebs.
Tavidan xdeba anomaliuri bavSvis dabadebis riskis
daswavlis darRvevis aRmoCena adreul etapze da Se-
Sefaseba. aseTi Sefaseba eyrdnoba ojaxuri anamnezis
faseba, ZiriTadad, ojaxis eqimisa da pediatris pa-
Seswavlas, daswavlis darRvevis gamomwvevi genetiku-
suxismgeblobas Seadgens. gundi, romelSic Sedis
ri mizezebis codnas da genetikuri skriningis Cata-
fsiqologi, metyvelebis Terapevti, momvleli, oku-
rebis Sesaxeb informirebulobas. mSoblebs uxsnian
paciuri Terapevti da fizioTerapevti, uwyvet mz-
skriningTan dakavSirebul risks da xels uwyoben
runvelobas uzrunvelyofs. moxaliseebs SeuZliaT
maTTan am sakiTxis ganxilvas. mSoblebis umetesoba
mniSvnelovani roli Seasrulon. garda amisa, unda
rCevas iTxovs mxolod pirveli anomaliuri bavSvis
wavaxalisoT mSoblebis TviTdaxmarebis jgufebis Se-
dabadebis Semdeg. Svilebis gaCenamde konsultacias
qmna. britaneTSi, rezidenciul sacxovreblebSi myo-
iTxoven iseTi mSoblebi, romlebsac naTesaobaSi hya-
fi daswavlis darRvevis pirebisTvis daxmarebis gaw-
vT daswavlis darRvevis mqone piri. dadebiTi diagno-
eva xdeba sganmanaTleblo, jandacvisa da socialuri
zi, romelsac orsulobis Sewyveta mohyveba da skri-
servisebis mier da, aseve, moxaliseTa organizaciebis
ningis cru dadebiTi pasuxi seriozul wuxils iwvevs.
mier.
amitom Zalian mniSvnelovania, rom skriningis Camta-
rebel pirs esmodes fsiqologiuri sakiTxebi da hqon-
calkeuli servisebi
des konsultaciis Catarebis Sesabamisi kvalifikacia.
daswavlis darRvevis mqone pirebis, maTi ojaxebisa
da momvlelebisTvis gaweuli momsaxurebis ZiriTadi prenataluri zrunva
elementebia: prenataluri servisi Casaxvamde iwyeba. dabali imu-
w daswavlis darRvevis prevencia da adreuli aRmoCe- nitetis mqone gogonebs utardebaT wiTelas sawina-
na; aRmdego vaqcinacia; garda amisa, maT aZleven rCevas
w daswavlis darRvevis mqone pirebis miRwevebisa da dietasTan, alkoholis moxmarebasTan da mowevasTan
unarSezRudulobis regularuli Sefaseba; dakavSirebiT.
w ojaxisTvis rCevis micema, misi mxardaWera da pra- prenataluri diagnozi emTxveva genetikur skrinin-
qtikuli RonisZiebebis ganxorcieleba; gs, romelic sul ufro met SemTxvevaSia xelmisawvdo-
w TiToeuli pirisTvis Sesabamisi ganaTlebis, swavle- mi. SesaZlebeli xdeba anomaliuri bavSvis dabadebis
bisa da dasaqmebis uzrunvelyofa; riskis mqone adamianebis informireba, Cvilis adreu-
w TviTmovlis maqsimizaciisTvis TavSesafriT uzrun- li diagnostika da mkurnaloba. amniocenteziT, fe-
velyofa da socialuri mxardaWera; toskopiiT da meore trimestrSi nayofis ultrabge-
w eqimis, eqTnisa da sxva servisis miwodeba imaTTvis, riTi kvleviT SesaZlebelia qromosomuli anomaliis,
_ 767 _
nevraluri lulis umetesi defeqtebis da metaboliz- CatarebiaT msgavsi treningi. 4, 5 wlis asakSi tre-
mis Tandayolili darRvevebis 60%-is gamovlena. am- nirebuli bavSvebis saSualo IQ 27 quliT maRali aR-
niocentezs axlavs patara, magram garkveuli riski da moCnda sakontrolo jgufTan SedarebiT. mocemuli
amitom misi SeTavazeba xdeba mxolod im qalebisTvis, kvleva xarvezebiT xasiaTdeba, radgan bavSvebis Ser-
romlebsac adre hqondaT anomaliuri nayofi, aqvT me- Ceva ar momxdara mkacrad randomizebuli meTodiT,
mkvidruli daavadebis ojaxuri anamnezi da 35 welze xolo testis qulaSi momxdari zogierTi cvlileba
ufrosi asakisani arian. varjiSiT iyo gamowveuli. miuxedavad amisa, mTavari
amJamad SesaZlebelia rezus konfliqtis prevencia. Sedegi imaSi mdgomareobs, rom kvalificiuri kadre-
rezus-uaryofiTi dedis sensitizaciis Tavidan aci- bis Zalisxmevas SeuZlia mniSvnelovani gaumjobeseba
leba, Cveulebriv, xdeba antirezusuli antisxeulebis gamoiwvios dabali inteleqtis mqone bavSvebSi, ro-
ineqciiT. SesaZlebelia dazianebuli nayofis amocno- melTa dedebi socialurad araxelsayrel pirobebSi
ba amniocenteziT da, saWiroebis SemTxvevaSi, mkur- imyofebian. am monacemebma aCvena, rogorc mSoblebis,
nalobis Catareba SenacvlebiTi gadasxmiT. diabetis ise bavSvebis swavlebis saWiroeba. zogadad aRmoCnda,
mqone qalebis specialuri movla aumjobesebs nayofis rom adreuli intervencia SeiZleba efeqturi gamod-
perspeqtivas. am sakiTxebis Sesaxeb ufro detaluri ges, gansakuTrebiT maSin, rodesac is ojaxzea foku-
informaciis mopoveba SesaZlebelia meanobisa da pe- sirebuli. amis miuxedavad, jer kidev bevri ramaa da-
diatriis saxelmZRvaneloebSi. sazustebeli am tipis daxmarebis komponentebTan da
misi miwodebis wesTan dakavSirebiT (ix. Murphy, 1994).
postnataluri prevencia
britaneTSi yvela axalSobili rutinulad mowmdeba gamokvleva
fenilketonuriaze, hipoTiroidizmze da galaqtoze- daswavlis mZime darRveva adreuli etapze vlindeba. Se-
miaze. tardeba tyviis momatebuli donis universalu- darebiT msubuqi darRveva SeiZleba gamomJRavndes mxo-
ri skriningi, magram ukanaskneli mtkicebulebiT ufro lod bavSvis skolaSi wasvlis Semdeg. ojaxis eqims da
adekvaturad iTvleba skriningis im adgilebSi Catare- pedagogs unda SeeZlos daswavlis darRvevis gamovlena,
ba, sadac dadgenilia, rom tyviis done maRalia (Dier- magram misi sruli SefasebisTvis SeiZleba saWiro gax-
mayer et al., 1994). intensiuri Terapiis ganyofilebebi des specialur centrSi gamokvlevis Catareba, sadac ba-
da dRenaklulebisa da dabadebisas mcire wonis mqo- vSvs daakvirdebian xvadasxva moqmedebis Sesrulebisas.
ne bavSvebis mkurnalobis gaumjobesebuli meTodebi Sesabamisi meTodebi ukve zemoT iyo aRwerili.
daswavlis darRvevis prevenciis saSualebas iZleva im daswavlis darRvevis diagnostikis Semdeg saWiroa
SemTxvevaSi, rodesac manamde aRiniSneboda Tavis tvi- regularuli dakvirvebis warmoeba. bavSvze dakvirve-
nis dazianeba. amasTan, es meTodebi zogierTi unarSe- ba, Cveulebriv, xorcieldeba bavSvis janmrTelobis
zRuduli bavSvis gadarCenis saSualebas iZleva. interdisciplinuri gundis mier, romelic pedago-
gebTan da socialur muSakebTan TanamSromlobs. am
kompensatoruli ganaTleba
gundTan kavSirSi imyofeba bavSvTa fsiqiatri. masTan
kompensatoruli ganaTleba gulisxmobs unarSezRu- xdeba im bavSvebis gadamisamarTeba, romlebsac aRe-
duli bavSvis gonebrivi ganviTarebisTvis optimalu- niSnebaT emociuri, qceviTi da fsiqikuri xasiaTis
ri pirobebis uzrunvelyofas. es iyo aSS-s mTavari problemebi.
sastarto programis (Head Start Program) mizani, rome- mniSvnelovania, rom skolis damTavrebamde bavSvis
lic uzrunvelyofda damatebiT ganaTlebas upovari mdgomareoba detalurad iyos ganxiluli. am dros
bavSvebisTvis. am programis farglebSi xorcielede- unda Sefasdes Semdgomi ganaTlebis aucilebloba,
boda sxvadasxva tipis saqmianoba, baga-baRSi aRzrdi- dasaqmebis perspeqtiva, araanazRaurebadi saqmianoba,
sa da konkretuli unar-Cvevebis swavlebis CaTvliT. damoukidebeli cxovreba da specialuri fizikuri da
mravali mcdeloba uSedego gamodga (Rutter and Mad- fsiqologiuri servisis saWiroeba. daswavlis darR-
ge, 1976). igive miznis mqone ufro intensiuri pro- vevis mqone mozardi saWiroebs regularul Sefasebas,
grama ganxorcielda miluokSi (Garber, 1988). kvali- raTa is mudmivad anviTarebdes Tavis SesaZleblobebs
ficirebuli pedagogebi aswavlidnen jurRmulebSi da ganagrZobdes saWiro momsaxurebiT sargeblobas.
mcxovreb bavSvebs, romelTa dedebs hqondaT dabali Cveulebriv, servisis mimwodebelia TemSi moqmedi
IQ (<75). damatebiTi swavleba iwyeboda 3 Tvis asakSi multidisciplinuri gundi, romelSic Sedis daswa-
da grZeldeboda saskolo asakamde. amave dros, de- vlis darRvevis mqone pirebTan momuSave fsiqiatri.
das utarebdnen trenings saojaxo unar-CvevebSi. Se-
mdeg es bavSvebi Seadares sakontrolo jgufis bavS- ojaxis daxmareba
vebs, romlebic cxovrobdnen msgavs ojaxebSi, magram ojaxi daxmarebas saWiroebs im momentidan, rodesac
ar miuRiaT damatebiTi swavleba da arc maT dedebs pirvelad dadgindeba daswavlis darRvevis diagnozi.
_ 768 _
daswavlis darRvevis mqone pirebis servisi
mSoblebisTvis erTjeradi ganmartebis micema ar aris bisTvis saWiro aRWurviloba. garda amisa, swavlebis
sakmarisi. maT SeiZleba dasWirdeT ganmartebis ram- Cveulebrivi meTodi, romelic TviT-gamoxatvas aniWe-
denjerme mosmena, sanam srulad aRiqvamen mis mniSv- bs gansakuTrebul mniSvnelobas, SeiZleba Seusabamo
nelobas. maT unda mivceT sakmarisi dro prognozis iyos daswavlis darRvevis mqone zogi baSvisTvis, ro-
gasagebad, avuxsnaT, Tu ra tipis daxmarebis gawevaa melsac sWirdeba specialuri swavleba sametyvelo da
maTTvis SesaZlebeli da ganvumartoT maTi roli Ta- sakomunikacio unar-Cvevebis aTvisebSi (Howlin, 1994).
vianTi Svilebis potencialis srulad ganxorciele- Cveulebriv skolaSi unarSezRuduli bavSvis swavla
baSi. am procesSi, Cveulebriv, CarTuli unda iyos maTi TanaklaselebisTvisac sasargebloa: isini eCve-
pediatri da patronaJis medda. vian, rom unarSezRuduli bavSvebis socialuri inte-
amis Semdeg mSoblebs mudmivi mxardaWera esaWiro- gracia normas warmoadgens.
ebaT. roca bavSvi iwyebs skolaSi siaruls, mSoble- skolis damTavrebamde, unda moxdes daswavlis
bi unda informirebulni iyvnen mis mier miRweuli darRvevis mqone bavSvis xelaxali gamokvleva da mis-
progresis Sesaxeb da unda grZnobdnen, rom monawi- Tvis daxmarebis gaweva profesiis SerCevaSi. daswa-
leoben bavSvze mzrunvelobis gegmis Sedgenasa da vlis msubuqi darRvevis mqone axalgazrdebs Seu-
ganxorcielebaSi. maT unda aRmovuCinoT daxmareba ZliaT normalur samsaxurSi an dacul saxelosnoSi
praqtikul sakiTxebSi, rogoricaa bavSvis movla dRis muSaoba. mZime unarSezRudulobis mqone pirebi Segvi-
ganmavlobaSi saskolo ardadegebis dros, bavSvis mo- Zlia gadaviyvanoT dRis centrebSi mozrdilTaTvis,
vla saRamos saaTebSi an saojaxo Svebulebis mowyoba. sadac xorcieldeba sxvadasxva tipis saqmianoba maTi
praqtikul daxmarebasTan erTad mSoblebs sWirdebaT SesaZleblobebis ganviTarebis mizniT.
uwyveti fsiqologiuri mxardaWera, romelic, SeiZle-
sacxovrebliT uzrunvelyofa
ba, mTeli ojaxisTvis gankuTvnili programis saxiT
ganxorcieldes (Murphy, 1994; Petronko et al., 1994). dRes farTodaa gavrcelebulia mosazreba, rom mSo-
rogorc wesi, ojaxs sWirdeba damatebiTi daxmare- blebs maqsimalurad unda SeewyoT xeli, rom binis
ba, rodesac bavSvi aRwevs pubertul asaks an skolas pirobebSi mouaron daswavlis darRvevis mqone bavSve-
amTavrebs. bavSvTa servisidan mozrdilebis servisze bs. Tu bavSvis movlis procesi mSoblebisTvis Zalian
gadasvla yovelTvis mtkivneuli procesia. xSirad sa- mZimea sxva ojaxuri movaleobebis gamo, daswavlis
Wiroa rogorc dRis, ise Ramis servisis gaweva, raTa darRvevis mqone bavSvi, Tu es SesaZlebelia, sxva oja-
momvlelebma SeZlon Zalebis aRdgena, xolo daswa- xSi unda gadaviyvanoT. mozrdilebs unda davexmaroT,
vlis darRvevis mqone pirebi ufro met damoukide- rom dasaxldnen Cveulebriv binaSi, sxva ojaxSi, an
blobas SeeCvion. mcire zomis jgufur sacxovrebelSi. zogierTi kvle-
viT (Landesman-Dyer, 1981) dadasturda, rom daswavlis
ganaTleba, trenireba da dasaqmeba darRvevis mqone piris gadayvana mcire zomis sacxo-
normalizaciis politikis erT-erTi principi imaSi vrebelSi ar aris sasargeblo. personalma unda waaxa-
mdgomareobs, rom daswavlis darRvevis mqone bavSvi, lisos saxlis macxovreblebi, raTa maT ganiviTaron
SesaZleblobis mixedviT, Cveulebriv skolaSi unda socialuri unar-Cvevebi da, SeZlebisdagvarad, nor-
iRebdes ganaTlebas. es principi sxvadasxva xarisxiT maluri wesiT icxovron. aRsaniSnavia, rom pirovnebis
xorcieldeba sxvadasxva qveyanaSi da erTi da igive gadayvaniT mcire zomis sacxovrisSi yovelTvis ar
qveynis sxvadasxva regionSi. xdeba gamomwvevi qcevis reduqcia.
kvlevam aCvena, rom daswavlis darRvevis mqone ba-
samedicino servisebi
vSvebTan mniSvnelovania ganaTlebis adre dawyeba. sa-
survelia, rom isini baga-baRebSi dadiodnen. saskolo daswavlis darRvevis mqone pirebisTvis iseve xelmisa-
asakis miRwevisas naklebad unarSezRuduli bavSvebi wvdomi unda iyos zogadi da specializebuli samedi-
SeiZleba SeviyvanoT Cveulebrivi skolis koreqciul cino servisi, rogorc Cveulebrivi moqalaqeebisTvis,
jgufSi. sxvebs SeiZleba dasWirdeT specialuri sgan- magram sargeblis srulad misaRebad isini saWiroeben
manaTleblo programa daswavlis darRvevis mqone damatebiT mxardaWeras.
bavSvebisTvis. jer-jerobiT dazustebuli ar aris daswavlis darRvevis mqone bavSvebsa da mozrdile-
daswavlis darRvevis mqone romeli bavSvebisTvis aris bs xSirad aReniSnebaT fizikuri unarSezRuduloba
sasargeblo Cveulebriv skolaSi swavla. Cveulebrivi an epilefsia, risTvisac saWiroa uwyveti samedicino
skola bavSvs sTavazobs SedarebiT normalur socia- servisi, romelic, ZiriTadad, jandacvis Cveulebri-
lur garemos, socialuri integraciis SesaZleblobas vi servisiT xorcieldeba. aseTi mowyoba kargad mu-
da bavSvis mimarT ayalibebs molodinebs mis winsvlas- Saobs, Tu eqimi da medda saTanadod informirebuli
Tan dakavSirebiT. Tumca, mas SeiZleba ar hqondes arian daswavlis darRvevis mqone pirebis specifikis
specialuri swavlebis gamocdileba da aseTi bavSve- Sesaxeb da aqvT dro da resursi aseTi servisis gan-
_ 769 _
saxorcieleblad. ojaxebisa da momvlelis daxmareba medikamenturi mkurnaloba
umjobesdeba, roca servisis koordinireba erTi ada- fsiqotropuli wamlebis Cvenebebi igivea, rac norma-
mianis mier xdeba, radgan isini, aseT SemTxvevaSi, ar luri inteleqtisa da igive problemebis mqone pacien-
iReben urTierTgamomricxav rCevebs. specialist-med- tebSi. medikamentebis sruli arsenali xelmisawvdomi
debs gansakuTrebuli roli ekisrebaT koordinaciis unda iyos daswavlis darRvevis mqone pirebisTvis.
procesSi. nevrologisa da fsiqiatris monawileobiT fsiqiatrs aqvs gansakuTrebuli pasuxismgebloba mi-
mimdinare serviss SeuZlia gaaumjobesos zogierTi mdinare efeqturi monitoringis organizebaze, maT
pacientis gamosavali, mag., epizoduri Setevebis diag- Soris, fizikur gasinjvaze. es ukanaskneli gansaku-
nostika da mkurnaloba. TrebiT mniSvnelovania im pacientebisTvis, romlebsac
fsiqiatriuli servisi aqvT komunikaciis mZime problemebi da ar SeuZliaT
arasasurveli efeqtebis aRwera. aseve, nevrologiuri
daswavlis darRvevis mqone pirebisTvis fsiqiatriuli
problemebis mqone pacients SeiZleba ganuviTardes
servisis gaweva Temze dafuZnebuli momsaxurebis au-
arasasurveli efeqti wamlis dabal dozaze da gamou-
cilebeli nawilia. zog qveyanaSi es servisi fsiqikuri
vlindes Warbi sedacia, deliriumi da eqstrapirami-
janmrTelobis zogadi servisis farglebSi xorciel-
duli simptomebi. antifsiqozuri medikamentebi da
deba, magram britaneTSi mas, ZiriTadad, daswavlis
benzodiazepinebi efeqturad gamoiyeneba qcevis pro-
darRvevis mqone pirTa momsaxurebaSi specializire-
blemebis xanmokle kontrolis mizniT. arsebobs mcire
buli personali axorcielebs.
raodenobis kontrolirebadi kvlevebi antifsiqozuri
wamlebis efeqturobisa da amtanobis Sesaxeb anomaliu-
fsiqikuri aSlilobisa da qceviTi ri qcevis xangrZlivi mkurnalobisas (ix. Brylewski and
problemebis mkurnaloba Duggan, 2004). amis miuxedavad, klinikuri gamocdileba
daswavlis darRvevis mqone pirebSi fsiqikuri aSli- gviCvenebs, rom qcevis mZime darRvevis mqone pacien-
lobis mkurnaloba am wignSi aRwerili principebis tebTan, romlebTanac araefeqturia fsiqosocialuri
Tanaxmad xorcieldeba, Tumca, mocemul SemTxvevaSi, intervencia, zogjer SeiZleba sasargeblo gamodges
daswavlis darRvevis mqone pirebis specifikuri pro- xangrZlivi medikamenturi mkurnaloba efeqtis xSiri
blemebia gaTvaliswinebuli. monitoringisa da dozis morgebis pirobebSi.
daswavlis darRvevis mqone pirebSi fsiqikuri aSli- daswavlis darRvevis mqone pacientebis daaxloe-
lobebi, Cveulebriv, qceviT cvlilebebSi vlindeba. biT erT mesameds aqvs epilefsia da antiepilefsiu-
miuxedavad amisa, unda gaviTvaliswinoT, rom qceviTi ri wamlebiT mkurnaloba im SemTxvevaSi xdeba saWi-
cvlileba SeiZleba gamoiwvios fizikurma avadmyofo- ro, roca gulyrebi janmrTelobis, usafrTxoebisa da
bam an stresulma movlenam, ris gamoc aucilebelia cxovrebis xarisxisTvis mniSvnelovan risks warmoad-
orive maTganis gamoricxva. unarSezRudulTa umete- gens. gansakuTrebuli sifrTxile unda gamoviCinoT
sobas da gansakuTrebiT sensoruli deficitis mqone im wamlisa da dozis SerCevisas, romliTac SesaZle-
adamianebs qceviTi darRveva SeiZleba ganuviTardeT belia gulyrebis kontroli arasasurveli efeqtebis
arasakmarisi stimulaciisa da sakuTari survilebisa gareSe. Zveli antikonvulsantebi zogjer iwvevs Warb
da saWiroebebis gamoxatvis uunarobiT gamowveuli sedacias da kognitur daClungebas. `pirveli rigis~
frustraciis gamo. mas Semdeg, rac gairkveva qcevi- Tanamedrove antikonvulsantebad miCneulia karba-
Ti cvlilebebis mizezi, iwyeba pacientis mkurnaloba. mazepini da natriumis valproati (gv. ??). rTulad
saswrafod unda daiwyos fizikuri avadmyofobis mkur- kontrolirebadi epilfsiis SemTxvevebSi saWiro xde-
naloba; garda amisa, SeZlebisdagvarad, unda Sesustdes ba erT-erTi `damatebiTi~ antikonvulsantis CarTva,
stresuli movlena da, saWiroebis SemTxvevaSi, unda rac gansakuTrebul sifrTxiles moiTxovs arasasur-
Seiqmnas stimulaciuri garemo. Tu qcevis darRvevis veli moqmedebis riskis gamo. wamlis SerCevaSi auci-
mizezi fsiqikuri aSlilobaa, mkurnaloba iseTive sa- leblad unda monawileobdes epileftologi.
xiT tardeba, rogorc normaluri inteleqtis da imave
darRvevis mqone pirebSi. momvlelebi xSirad CarTulni fsiqologiuri mkurnaloba
arian qcevis Sefasebasa da mkurnalobaSi. mniSvnelova- miuxedavad imisa, rom metyvelebis problema aSkarad
nia maTTvis sakmarisi mxardaWeris gaweva. zRudavs fsiqoTerapiis gamoyenebas, xSirad, martivi
yvelaze seriozuli da persistentuli aSlilobis diskusiac dadebiT Sedegs iZleva. SegviZlia movsin-
dros SeiZleba saWiro gaxdes pacientis hospitali- joT kognituri Terapiis gamoyeneba kargi verbalu-
zacia qcevis ufro intensiuri marTvis mizniT. qce- ri unaris mqone zogierT pacientTan. mkurnalobis
vis marTva SeiZleba farmakoTerapiasTan erTad xor- mniSvnelovani nawili mSoblebisTvis konsultaciis
cieldebodes. gawevaa. SedarebiT formaluri ojaxuri Terapiis
_ 770 _
daswavlis darRvevis mqone pirebis movlis eTikuri da sakanonmdeblo problemebi
gamoyenebisas, ojaxebi upiratesobas aniWeben iseT iCens Tavs. rodesac momvleli mSobelia, pacientis
struqturul midgomas, romelic iTvaliswinebs maT asakis mateba sul ufro met sirTules uqmnis mas.
problemebsa da gadawyvetilebebs. daswavlis umZimesi mSoblebs xSirad ainteresebT Svilis momavali Ta-
darRvevis mqone pirebis ganviTarebis xelSesawyobad vianTi gardacvalebis Semdeg. miuxedavad amisa, mSo-
SegviZlia gamoviyenoT TamaSi da sensoruli stimula- blebi naklebad Tanxmdebian alternatiul movlaze
ciis meTodebi (Hewett and Nind, 1998). sicocxlis ganmavlobaSi.
daswavlis darRvevis mqone asakovani adamiani awy-
qcevis modifikacia
deba specifikur problemebs. mSoblis gardacva-
qceviTi meTodebi potenciurad efeqturi unda iyos lebis SemTxvevaSi Cndeba Zvirfasi adamianis dakar-
daswavlis mZime darRvevis mqone pirebSi, radgan zo- gvasTan dakavSirebuli problemebi. aseT SemTxvevaSi
gierTi meTodi ar saWiroebs verbaluri unar-Cvevebis maTi izolacia Rrmavdeba, radgan sxva adamianebma ar
gamoyenebas. aseT meTodebs iyeneben bazisuri unar- ician rogor Seuqmnan maT sulieri komforti. daswa-
Cvevebis ganviTarebis mizniT (dabana, tualeti, Cacma). vlis darRvevis mqone piri SeiZleba arc ki dauSvan
xSirad mSobels an pedagogs aswavlian treningis Cata- samgloviaro ritualze. aseTi adamianebi saWiroeben
rebas pacientis yoveldRiur garemoSi (Petronko et al., daxmarebas axloblis dakargvis gamo. mwuxarebis gan-
1994). Tu problema arasasurveli qcevaa, ikvleven im cdisas maT iseve sWirdebaT rCevis micema, rogorc
garemo faqtorebs, romlebic regularulad iwvevs an sxva adamianebs (gv. ??), magram, am SemTxvevaSi, unda
ganamtkicebs am qcevas (funqciuri analizi). Tu es Se- SevarCioT komunikaciis ufro martivi formebi (ix.
saZlebelia, unda Seicvalos Sesabamisi garemo faqto- Hollins and Esterhuyzen, 1997).
rebi. momvlelma unda icodes, rom aseTi qceva ar da- daswavlis darRvevis mqone asakovani adamianebis ki-
ajildovos. amave dros, xdeba alternatiuli adapta- dev erTi problema demenciaa. es problema ?? gver-
ciuri reaqciis ganmtkiceba. agresiuli qcevis dros dzea ganxiluli.
zogjer iyeneben e.w. `taim-auts~. am dros mSobeli qce-
vis dasrulebamde ar aqcevs pacients yuradRebas an eqspluatacia da Zaladoba
izolaciaSi aTavsebs mas. teqnikebi, romlebic iyenebs daswavlis darRvevis mqone adamianebi mowyvladni
negatiur ganmtkicebas, eTikur problemebs aRZravs, arian eqsploataciisa da fizikuri da seqsualuri
ris gamoc Tavi unda SevikavoT maTi gamoyenebisgan Zaladobis mimarT. warsulSi es problemebi cudad
(ix. Matson and Taras, 1989). Tu problema socialurad organizebul did instituciebSi gvxvdeboda, magram
sasurveli qcevebis naklebobaa, SegviZlia qceva mate- isini, SeiZleba, TemSi arsebul patara dawesebule-
rialuri da socialuri dajildovebiT ganvamtkicoT. baSic Segvxvdes. aseTi dawesebulebebi regularul
saWiroebis SemTxvevaSi unda vecadoT saboloo qcevis zedamxedvelobas saWiroebs. klinicists yovelTvis
`Camoyalibebas~ martivi komponentebis gamoyenebiT. unda axsovdes, rom daswavlis darRvevis mqone pire-
dajildoveba unda moxdes dauyovnebliv, sasurveli bSi Zaladoba qcevis Secvlis mniSvnelovani (Tumca
qcevis dasrulebisTanave (mag., uSualod tualetis iSviaTi) mizezia.
gamoyenebis Semdeg). iseTi unar-Cvevebis SesamuSave-
blad, rogoric, mag., Cacmaa, xSir SemTxvevaSi saWiroa daswavlis darRvevis mqone pirebis
qcevis adreuli asakidan modelireba da stimulireba,
movlis eTikuri da sakanonmdeblo
rac, mogvianebiT, nakleb intensiurad xdeba (Petrenko
et al., 1994; Spreat and Behar, 1994).
problemebi
normalizacia, avtonomia da interesTa
pacientebis informireba
konfliqti
sxva pacientebis msgavsad, daswavlis darRvevis mqone
normalizaciis politika gulisxmobs daswavlis
adamianebs ainteresebT, Tu ra bunebisaa maTi daava-
darRvevis mqone pirebisTvis iseTi pirobebis Seqmnas,
deba, rogor imoqmedebs igi maT cxovrebaze da rogo-
rom maTi cxovrebis wesi normalurTan maqsimalurad
ri mkurnaloba unda Cautardes maT. es interesi rac
iyos miaxlovebuli. am politikam SeiZleba warmoS-
SeiZleba martivi saxiT unda dakmayofildes. pasuxi
vas interesTa konfliqti daswavlis darRvevis mqone
unda movargoT pacientis inteleqtis dones da mar-
pirsa da sxva adamianebs Soris. am konfliqtis mize-
tivi, gasagebi eniT CamovayaliboT igi.
zi imaSi mdgomareobs, rom daswavlis darRvevis mqo-
ne mravali adamiani garkveul sferoebSi momvlelis
specifikuri problemebi
mxardaWeras saWiroebs, zog sferoSi ki is sruliad
asakis mateba avtonomiuira. mag., mas SeiZleba dasWirdeTs CacmaSi
daswavlis darRvevis mqone pirebSi, asakis matebasTan daxmarebis gaweva saavadmyofos gareT cxovrobisas.
erTad, zogierTi problema SedarebiT ufro xSirad momvlelTa didi nawili SezRuduli SesaZleblobe-
_ 771 _
bis mqone piris ojaxis wevria da SeTanxmeba, romelic socialur muSakTan erTad. seriozulad daavadebuli
maTi mxridan nebayoflobiT daido, SeiZleba, droTa pacientisTvis, romelic uars acxadebs sicocxlis-
ganmavlobaSi, momvlelebisTvis, mZime tvirTad gadai- Tvis saWiro mkurnalobaze, gaZneldeba samedicino
qces (amis mizezia unarSezRuduli piris saWiroebebis dawesebulebaSi Sesabamisi servisis ganxorcieleba.
gazrda, sxva Svilebis saWiroebebis gazrda, momvle- Tu pacientis inteleqti imdenad daqveiTebulia, rom
lis asakSi Sesvla). amitom rTuli xdeba SezRuduli mas ar esmis arCevanis mniSvneloba, xolo misi mdgo-
SesaZleblobebis mqone piris, momvlelisa da momvle- mareoba gadaudebelia samedicino TvalsazrisiT, Se-
lis ojaxis sxva wevrebis interesebis gawonasworeba. saferisad unda CaiTvalos `Cveulebrivi wesiT~ moq-
es siZneleebi SeiZleba miukerZoeblad gadaiWras, Tu medeba. Tu dro iTmens, SeiZleba saWiro gaxdes saq-
maT ganixilaven SezRuduli SesaZleblobebis mqone mis sasamarTloSi gadagzavna mis gansaxilvelad (mag.,
pirTan, momvlelTan da ojaxis sxva wevrebTan erTad, iseT SemTxvevaSi, roca unda gadawydes orsulobis
TiToeul am adamianze pasuxismgebeli specialistebis Sewyvetis sakiTxi).
SeTanxmebis safuZvelze. mkiTxveli unda gaerkves im samarTlebriv moTxo-
normalizaciam SeiZleba uneblie efeqtic ga- vnebSi, romlebic moqmedebs mis samuSao adgilas da
moiwvios. mag., normalizacia (SesaZleblobis SemTxve- ganixilos aprobirebuli praqtika gamocdil klini-
vaSi) daswavlis darRvevis mqone bavSvis Cveulebriv cistTan erTad.
skolaSi swavlebas gulisxmobs. miuxedavad amisa, ase-
Ti bavSvi Cveulebriv skolaSi 3-jer ufro xSirad Tanxmoba kvlevaSi monawileobaze
xdeba dacinvis obieqti, vidre sxva bavSvebi (Whitney kvlevaSi monawileobaze Tanxmobas sWirdeba informa-
et al., 1994). es imaze miuTiTebs, rom calkeuli baciis gagebisa da racionaluri gamoyenebis, situaciis
vSvis uSualo interess Seadgens specialur skolaSi Sedegebis Sefasebisa da alternativebis SerCevis una-
siaruli, sadac is naklebad iqneba dacinvis obieqti. ri (ix. Tavi 3). zogadad, es unarebi unda izrdebo-
miuxedavad amisa, daswavlis darRvevis mqone bavSve- des SemoTavazebuli kvlevisa riskisa da sargeblis
bis, rogorc jgufis, grZelvadian interesebs ufro Tanafardobis zrdasTan erTad. am unarebis Sefaseba
metad Seesabameba Cveulebriv skolaSi ganaTlebis mi- daswavlis darRvevis mqone pirebSi aRwerilia ameri-
Rebis politika da, amave dros, Zalisxmevis mimarTva kis fsiqiatrTa asociaciis mier (American Psychiatric
maT mimarT damcinavi damokidebulebis aRmofxvraze. Association, 1998). nebismierma adamianma, romelic Tan-
saboloo jamSi, aseTi politika xels Seuwyobs daswa- xmobas acxadebs kvlevaSi monawileobaze, unda ico-
vlis darRvevis mqone pirebis ukeT gagebas da maT mi- des, rom survilisamebr SeuZlia ukan waiRos micemu-
marT pativiscemis damkvidrebas. li Tanxmoba. es punqti gansakuTrebuli guldasmiT
normalizacia, aseve, warmoSobs eTikur problemebs unda ganvumartoT daswavlis darRvevis mqone pirs.
garkveul sakiTxebTan dakavSirebiT. esaa seqsualuri erT-erT kvlevaSi, daswavlis darRvevis mqone pirebis
aqtivoba, kontracepcia da interesTa SesaZlo kon- naxevari, romelmac gaigo kvlevis mizani, ver mixvda,
fliqti daswavlis darRvevis mqone piris dedasa da rom SeeZloT gamoTiSoda kvlevas (Arscott et al., 1998).
mis Svils Soris. zogadad, arc erT kvlevaSi ar unda monawileobdnen
is adamianebi, romlebsac ar SeuZliaT informirebu-
Tanxmoba mkurnalobis Catarebaze li Tanxmobis micema, Tu kvlevaSi am adamianebis mo-
mniSvnelovani zogadi sakiTxebi, romlebic dakavSi- nawileoba ar warmoadgens kvlevis ganxorcielebis
rebulia informirebul TanxmobasTan fizikuri da aucilebel pirobas. unda gvaxsovdes, rom daswavlis
fsiqiatriuli mkurnalobis Catarebaze, ?? gverdzea darRvevis mqone adamianebi gansxvavdebian informire-
ganxiluli. daswavlis mZime darRvevis mqone mraval buli Tanxmobis micemis unaris mixedviT. mag., daswa-
adamians ar SeuZlia informirebuli Tanxmobis mice- vlis msubuqi darRvevis mqone mozrdilTa umeteso-
ma. informirebuli Tanxmobis sakiTxi moiTxovs Cveni bas SeuZlia informirebuli Tanxmobis micema, magram
mxridan adgilobrivi kanonmdeblobis codnas da pra- mZime da umZimesi darRvevis mqone pirebs _ ara. zogs
qtikaSi misi gamoyenebis wesebs. britaneTSi ar aris SeuZlia verbaluri Tanxmobis micema, magram ara we-
nebadarTuli Tanxmobis micema qmeduunaro zrdasru- rilobiTi Tanxmobis. zogisTvis informaciis miwode-
li piris magivrad. am SemTxvevaSi mniSvnelovania kli- bisas SeiZleba dagvWirdes Jestebis enis, suraTebis an
nicistebis gundis moqmedeba, romelic icavs pacien- martivad da didi asoebiT dawerili teqstis gamoye-
tis interesebs (aRsaniSnavia, rom am wignze muSaobis neba, raTa es adamianebi mixvdnen, Tu ras warmodgens
dros, es sakiTxi ganxilvis fazaSi imyofeboda). Tu kvlevis mizai. zogisTvis, informirebuli Tanxmobis
konkretuli SemTxveva eWvs aRZravs da saqme exeba pa- micemamde, saWiroa proeqtis ganmeorebiTi ganxilva
cientis hospitalizacias, praqtikaSi danergili wesis momvlelTan erTad. Tu SeuZlebelia informirebuli
mixedviT, mocemuli sakiTxi unda ganixilos Sesabamis Tanxmobis mopoveba da mocemuli piris kvlevidan ga-
_ 772 _
daswavlis darRvevis mqone pirebis movlis eTikuri da sakanonmdeblo problemebi
TiSva, Tanxmobis miReba xdeba momvlelisgan an mul- ZiriTad sakiTxebs fsiqiatriis SemswavlelTaTvis).
tidisciplinuri gundis wevrebisgan. yvela SemTxve- 3. Gelder MG, Lpez-Ibor JJ Jr and Andreasen NC (eds) (2000)
vaSi kvleva unda icavdes kvlevis warmarTvis krite- The New Oxford Textbook of Psychiatry, Part 10: Mental Re-
riumebs, romelsac adgens Sesabamisi organizaciebi tardation. Oxford University Press, Oxford. (am saxelmZR-
(mag., britaneTSi jandacvis departamenti da eqimebis vanelos me-13 TavSi mocemulia sakiTxis sistemuri
samefo koleji [Department of Health, Royal College of aRwera zogadi profilis fsiqiatrebisaTvis.)
Physicians]).
4. Hamilton-Kirkwood L, Ahmed Z, Allen D, Deb S, Fraser
WI, Lindsay W, McKenzie K, Penny E and Scotland J (Ees)
damatebiTi literatura: (2001) Health Evidence Bulletins Wales: Learning Disabili-
1. Deb S, Matthews T, Holt G and Bouras N (eds) (2001) prac- ties (Intelectual Disability). NHS Wales, http://www.hebw.
tice Guidelines for the Assessment and Diagnosis of Mental uwcm.ac.uk (rekomendaciebi mocemulia xelmisawv-
Health Problems in Adults with Intellectual Disability. Eu- domi mtkicebulebebis ierarqiis mixedviT.)
ropean Association for Mental Health in Mental Retardation 5. NHS Health Scotland (2004) Health Needs Assessment Re-
(EAMHMR), www.estiacntre.org. (naSromSi yuradReba port: People with Learning Disabilities in Scotland. NHS
gamaxvilebulia daswavlis darRvevis mqone mozrdi- Health Scotland, Glasgow, www.healthscotland.com. (reko-
lebSi gamovlenil fsiqiatriul simptomebze) mendebuli dokumenti, romelSic detaluradaa aR-
2. Fraser WI and Kerr M (eds) (2003) Seminars in the Psy- werili daswavlis unaris darRvevis mqone adamian-
chiatry of Learning Disabilities. Gaskell, London (moicavs ebis janmrTelobasTan dakavSirebuli saWiroebebi.)
_ 773 _
Tavi 26 sasamarTlo
fsiqiatria
Tavis Sinaarsi
zogadi kriminologia fsiqiatris roli sisxlis samarTlis
gavrceleba sasamarTloSi
gansxvavebebi qveynebis mixedviT fsiqikuri mdgomareoba, ganzraxva
danaSaulis mizezebi da pasuxismgebloba
genetikuri da fiziologiuri faqtorebi sasamarTlo garCevaSi
fsiqosocialuri faqtorebi monawileobis miRebis unari
fsiqiatriuli mizezebi kriminaluri sasamarTlosTvis mniSvne
kavSiri fsiqikur aSlilobasa lovani sxva fsiqiatriuli sakiTxebi
da danaSauls Soris fsiqikuri aSlilobis
sixSire mqone damnaSaveebis mkurnaloba
konkretuli fsiqikuri aSlilobebi zogadi sakiTxebi
kanondamrRvevi jgufebi fsiqikurad arajansaRi adamianebi cixeSi
qalebi damnaSaveebi saavadmyofoSi
axalgazrdebi TemSi mkurnaloba
eTnikuri umciresobebi Zaladobis marTva samedicino
specifikuri danaSaulis dawesebulebebSi
fsiqiatriuli aspeqtebi riskebis Sefaseba
Zaladobrivi danaSauli fsiqiatris daskvna
seqsualuri xasiaTis mqone danaSauli fsiqiatris roli
bavSvebis gataceba sasamarTlosTan mimarTebaSi
sakuTrebasTan dakavSirebuli danaSauli gamokvleva
danaSaulis msxverplad yofnis fsiqiatriuli daskvnis/angariSis momzadeba
aspeqtebi rCeva samedicino mkurnalobis Taobaze
fsiqologiuri zemoqmedeba fsiqiatri, romelic warsdgeba
marTva sasamarTlos winaSe
meoTxe TavSi ganxiluli iyo samedicino da fsi kanonis mixedviT danaSauli ar CaudeniaT. sasamarT-
qiatriuli praqtikis zogadi iuridiuli da eTikuri lo fsiqiatrebis monawileoba msxverplis gamokvle-
sakiTxebi. es Tavi exeba samarTlisa da fsiqiatriis vasa da mkurnalobaSi sul ufro mniSvnelovani xdeba.
sxva aspeqtebs, romlebic erTiandeba terminSi sasa damnaSaveTa Soris fsiqikuri aSlilobis mqone pire-
marTlo fsiqiatria. termini sasamarTlo fsiqiatria bi umciresobaSi arian, magram isini fsiqiatriasa da
ori mniSvnelobiT gamoiyeneba: samarTalSi bevr rTul problemas warmoSoben. am pro-
1. ufro viwro gagebiT, es aris fsiqiatriis mimarTu- blemebs ganekuTvneba iseTi iuridiuli sakiTxebi, ro-
leba, romelsac exeba fsiqikurad arajanmrTeli goricaa kavSiri fsiqikur aSlilobasa da danaSauls
damnaSaveebis gamokvleva da mkurnaloba. Soris, ramac, SeiZleba, gavlena iqonios sasamarTlos
gadawyvetilebaze pirovnebis pasuxismgeblobis Sesa-
2. ufro farTo mniSvnelobiT, is moicavs fsiqiatriis
xeb da praqtikuli klinikuri sakiTxebi (mag., esaWi-
yvela iuridiul aspeqts, romelSic Sedis samoqala-
roeba Tu ara damnaSaves fsiqiatriuli mkurnaloba
qo samarTali da fsiqiatriuli praqtikis maregu-
da samkurnalod Sesabamisi garemos SerCeva).
lirebeli kanonebi.
aqedan gamomdinare, fsiqiatrma unda icodes ara
sasamarTlo fsiqiatrebi orive rigis problemebze mxolod iuridiuli sakiTxebi, aramed isic, Tu ro-
muSaoben. isini, agreTve, afaseben riskebs da mkurnal- goria urTierTkavSiri danaSaulis garkveul tipebsa
oben Zaladobrivi qcevis mqone adamianebs, romlebsac
_ 774 _
zogadi kriminologia
vilebulia ojaxSi, TanatolTa jgufebsa da sub
boqsi 26.1 eTikuri sakiTxebi sasamarTlo
kulturaSi arsebuli danaSaulis socialur da
fsiqiatriaSi
ekonomikur mizezebze (siRaribe, cudi ganaTleba
principuli eTikuri sakiTxebi sazRvris problemebs da umuSevroba). vinaidan bevri predispoziciuri
ukavSirdeba. fsiqiatrs da am procesSi CarTul sxva
adamianebs unda axsovdeT, rom isini angariSvaldebulni socialuri da individualuri faqtori erTmaneTTanaa
arian iuridiuli avtoritetebis winaSe da ara gamosakvlevi dakavSirebulia, am sferoSi SeuZlebelia martivi
an samkurnalo individis winaSe. aseTi angariSvaldebuleba
sxvadasxva saxis aqtivobas moicavs. esaa daskvnebis gamotana. Tumca, gavrcelebuli azris
1. samedicino-iuridiuli angariSebis momzadeba. did mixedviT, danaSaulis zemoT xsenebuli mizezebi
britaneTSi fsiqiatrs ekisreba pasuxismgebloba ufro mniSvnelovnad iTvleba, vidre individualuri
sasamarTlos winaSe da ara pacientis an misi iuridiuli
warmomadgenlis winaSe fsiqologiuri faqtorebi, rogorebicaa genetika da
2. riskebis Sefaseba. SeiZleba umTavresi aRmoCndes im fsiqologiuri Taviseburebebi. danaSaulis Cadenis
riskis Sefaseba, romlis qveS sxva adamianebi imyofebian fsiqologiur risk-faqtorebze mravali programaa
3. nebayoflobiTi da iZulebiTi mkurnaloba. mkurnalobis fokusirebuli (qcevis koreqciisa da sasamarTlo
ZiriTadi mizani SeiZleba iyos sxvebisTvis zianis
miyenebis riskis Semcireba. gankurnebadobis sakiTxi fsiqiaqtriis programebi). es programebi xels uwyobs
SeiZleba wamoiWras personologiuri aSlilobis mqone garkveuli unarebis ganviTarebas (mag., daZlevis/
pacientebis SemTxvevaSi. (ix. gv. )
kopingis unarebi) (Dowden et al., 2003).
da fsiqikuri aSlilobis specifikur tipebs Soris.
gavrceleba
mniSvnelovania imis gacnobiereba, rom kriminalur
qmedebaze sapasuxo socialur da iuridiul reagi- sifrTxile unda gamoviCinoT danaSaulis gavrce
rebaSi fsiqikuri janmrTelobis samsaxurebs mxolod lebis maCveneblebTan dakavSirebiT, radgan rao
mcire adgili ukaviaT. amitom, fsiqiatrs, romelic denobrivi maCveneblebi SemTxvevaTa dafiqsireba
damnaSaveebTan muSaobs, unda SeeZlos urTierToba zea damokidebuli, xolo kriminaluri qceva xSi
kriminaluri marTlmsajulebis sistemis sxvadasxva rad ar aris registrirebuli policiis mier. es
warmomadgenlebTan, mag: iuristebTan, cixis perso- exeba gansakuTrebiT ojaxuri Zaladobis iseT Sem
nalTan da probaciis oficrebTan. iuridiuli, poli- Txvevebs, rogoricaa gaupatiureba, bavSvebze Za
tikuri da socialuri faqtorebi da klinikuri sa- ladoba an partnioris cema. ufro zusti cifrebi
kiTxebi gavlenas axdens iseT cnebebze, rogorebicaa eyrdnoba gamokiTxvebs danaSaulis Sesaxeb da da
deviacia, danaSauli da kanoniereba. naSaulis britanuli gamokvlevis (British Crime Survey)
am Tavis kiTxvisas mniSvnelovania gvesmodes, rom monacemebs (suraTi 26.1.). suraTi 26.2 aCvenebs
sxvadasxva qveynis iurisdiqciis sistemebi Zalzed inglissa da uelsSi policiis mier 2002-2003 wlebSi
gansxvavdebian erTmaneTisgan. amis gamo qveynebs Soris regsitrirebul danaSauls (klasificirebulia da
mniSvnelovani gansxvaveba SeiniSneba epidemiologiuri naSaulis tipis mixedviT) danaSaulis britanuli
monacemebisa da iuridiuli praqtikis TvalsazrisiT. gamokvlevis monacemebTan erTad (Simmons and Dodd,
garda amisa, sxvadasxva qveyanaSi sxvadasxvagvarad 2003). britaneTSi, iseve rogoc bevr sxva qveyanaSi,
aris ganszRvruli `danaSaulis~ cneba da gansxvave- sakuTrebasTan dakavSirebuli danaSauli yvelaze
buli warmodgena arsebobs fsiqiatris rolis Sesaxeb.
danaSaulebrivi
mkiTxveli unda icnobdes iuridiul problemebsa da
qmedebebis raodenoba
procedurebs, romlebic misTvis Sesabamisi iurisdi-
25000000
qciis farglebSia dadgenili. zogadi Temebis sailu-
straciod aq britaneTisTvis (gansakuTrebiT ingli-
20000000
sisa da uelsisTvis) tipiuri situaciebisa da pro-
cedurebis magaliTebia motanili. eTikuri sakiTxebi
15000000
Sejamebulia boqsSi 26.1.
10000000
zogadi kriminologia
arsebobs Zalian didi raodenobis kriminologiuri 5000000
literatura da mravali Teoria danaSaulis mizezebis
Sesaxeb. dainteresebul mkiTxvels SeuZlia gaecnos 0
kriminologiis Semdeg saxelmZRvanelos: Maguire and
81
83
87
91
93
95
97
2099
20 00
2001-2
-3
02
19
19
19
19
19
19
19
19
Morgan, 2002. bevri Teoria xazs usvams danaSaulis, wlebi

deviaciisa da sxva kanondarRvevis socialur as
suraTi 26.1 sazogadoebis mier danaSaulis Setyobineba
peqtebs. sociologiur kvlevebSi yuradReba gamax danaSaulis britanuli kvlevisTvis 1981-2003
_ 775 _
26 sasamarTlo fsiqiatria
metadaa gavrcelebuli. sasamarTlo- fsiqiatriuli eTnikuri mikuTvnebuloba
daxmarebis samsaxurebs ufro metad saqme aqvT iseT
eTnikur umciresobaTa jgufebi bevr qveyanaSi Warbad
individebTan, romlebsac Cadenili aqvT Zaladoba
arian warmodgenili patimarTa populaciaSi. es
meore adamianze. garda amisa, isini ganixilaven im
ZiriTadad imitom xdeba, rom umciresobaTa jgufebi
SemTxvevebsac, rodesac sakuTrebasTan dakavSirebuli
ufro xSirad Raribi, umuSevari da cud pirobebSi
ganmeorebiTi danaSauli SeiZleba fsiqikur aSli
mcxovrebi adamianebisgan Sedgeba. TiToeuli Camo
lobaze miuTiTebdes.
Tvlili faqtori danaSaulis risk-faqtors war
moadgens. aqedan gamomdinare, sasamarTlo fsiqiatriis
gansxvavebebi
25000000 qveynebis mixedviT
pacientTa populaciis umravlesobas warmoadgenen
didi gansxvaveba SeiniSneba qveynebs Soris danaSau- erovnuli umciresobebi (Kaye and Lingiah, 2000).
20000000
lis maCveneblebsa da paternebSi. mag., avstraliaSi bevr qveyanaSi gamoTqvamen SeSfoTebas imis gamo,
dafiqsirebuli danaSaulis saerTo done ufro maRa- rom umciresobebis warmomadgenelTa dapatimrebis da
15000000
lia vidre _evropis umetes nawilSi. evropis qveynebi- msjavrdebis maRali maCveneblebi ganpirobebulia aseve maT
dan, danaSaulis saerTo done britaneTSi ufro da- mimarT diskriminaciiT kriminaluri marTlmsajulebis
10000000
balia, vidre _ niderlandebSi, magram ufro maRalia, yvela safexurze (eWvis mitana; quCaSi gaCereba da
vidre 5000000
_ skandinaviaSi. Tavdasxmis danaSauli ufro dapatimreba; gafrTxileba da damnaSaved cnoba; braldeba;
gavrcelebulia amerikasa da avstraliaSi, vidre _ sasamarTlo procesis Sedegi; ganaCenis gamotana).
0
dasavleT evropaSi (Farrington et al., 2004). erovnuli
msxverpli
81
83
87
91
93
95
97
2099
20 00
2001-2
-3
statistikis maCveneblebze zemoqmedebs adgilobrivi

02
19
19
19
19
19
19
19
19
kanonmdebloba, danaSaulis registracia da iuridi- sakuTrebasTan dakavSirebuli danaSaulis umetesoba

uli procedurebi. Cadenilia ucnobi adamianebis mimarT, xolo yvelaze
seriozuli Zaladoba meore adamianze (gaupatiureba,
sqesi
mkvleloba, bavSvze Zaladoba) Cadenilia nacnobi
yvela kulturaSi danaSauls ZiriTadad axalgazrda adamianebis mimarT. qalebi mamakacebis mxridan seq
mamakacebi Cadian. inglissa da uelsSi yvela sisxlis sualuri Zaladobis msxverpls warmoadgenen ro
samarTlis danaSaulis SemTxvevaTa naxevari Cadenilia gorc ganviTarebul, aseve ganviTarebad qveynebSi.
21 wlamde mamakacebis mier, xolo meoTxedi _ 17 ganviTarebad qveynebSi qalebi da bavSvebi Seiara
wlamde mamakacebis mier. yvela kulturaSi Catarebuli Rebuli konfliqtebis dros gansakuTrebuli riskis
gamokiTxvis mixedviT, mamakacebi damnaSaveTa minimum 80 qveS imyofebian, Tumca gardacvlilTa 70% ar iRebs
% -s Seadgenen (Monahan 1997). bevr dasavlur qveyanaSi monawileobas saomar moqmedebaSi (Renzetti, 2005).
mamakaci patimrebis Sefardeba qal patimrebTan 30:1 danaSaulis msxverpli xSirad araprivilegirebuli
Seadgens. am genderul gansxvavebas asaxavs pacientTa jgufidanaa, romelic dasaxlebuli punqtebis Rarib
Tanafardoba sasamarTlo _ fsiqiatriuli daxmarebis nawilSi cxovrobs. aqedan gamomdinare, mosalodnelia,
samsaxurebSi, sadac mamakaci pacientebi did umrav rom fsiqikuri aSlilobis mqone adamianebi an dana
lesobas Seadgenen. Saulis msxverpli aRmoCndnen, an moZaladeebi.
policiis mier dafiqsirebuli danaSauli danaSaulis britanuli kvlevis mier
dafiqsirebuli danaSauli
Zaladobrivi Zarcva 8%
danaSauli bergleri 15%
17% satransporto
sxva saxis
qurdoba 30% saSualebebTan
yvela sxva saxis dakavSirebuli
danaSauli 7% satransporto yvela saxis
saSualebis qurdoba 19%
moparva da/an
misi Zarcva 17%
Zarcva satransporto
sakuTrebasTan narkotikebTan quCaSi 3%
dakavSirebuli saSualebebTan
dakavSirebuli dakavSirebuli
sxva danaSauli daWra 6%
danaSauli 2% vandalizmi 12%
19%
sxva saxis Cveulebrivi sxva saxis
qurdoba 23% Tavdasxmebi vandalizmi
14% 8%
suraTi 26.2 policiis mier dafiqsirebuli danaSauli da danaSaulis britanul kvlevaSi 2002-2003 wlebSi danaSaulis
msxverplTa mier dafiqsirebuli danaSauli. am or SemTxvevaSi zogierTi kategoria gansxvavebulia da narkotikTan
dakavSirebuli danaSauli ar Sedis danaSaulis gamokvlevis maCveneblebSi.
_ 776 _
danaSaulis mizezebi
danaSaulis mizezebi naTeli ar aris, Tumca, SeiZleba igulisxmebodes

iseTi Taviseburebebi, rogorebicaa hiperaqtivoba
mniSvnelovania erTmaneTisgan ganvasxvavoT ramdenime
da dabali inteleqti bavSvobaSi, rac mozardTa
termini, romelic am konteqstSi xSirad gamoiyeneba
samarTaldarRvevebisTvis mniSvnelovan risk-
da sxvadasxva mniSvneloba gaaCnia.
faqtorebs warmoadgens. (Rutter, 2005).
kriminaluri (danaSaulebrivi) qceva unda ganvas
sqesobrivma gansxvavebebma kanondarRvevaSi war
xvavoT miRebuli qcevis normebis darRvevebisgan,
moSva sakiTxi imis Taobaze, Tu rogor zemoqmedebs
anu socialurad miuRebeli qceva yovelTvis ar
damnaSaveobaze Y qromosoma da testosteronis done.
aris kriminaluri. amgvarad, cecxlis gaCena aris
cota mtkicebuleba arsebobs imis sasargeblod,
qceva, xolo cecxlis wakideba _ danaSaulia. yvela
rom qromosomuli da hormonuli anomaliebi mizez-
kriminaluri qceva ar aris Zaladobrivi; faqtobrivad
Sedegobrivadaa dakavSirebuli kriminalur qcevasTan,
maTi umravlesoba araZaladobrivia. ase rom, Teoriebi,
an agresiasTan. rogorc adre iyo aRniSnuli (Tavi 7),
romlebic gvisxnis danaSaulis mizezebs, yovelTvis
Tavis tvinSi 5-HT-is dabali aqtivoba dakavSirebulia
ar ganixilavs Zaladobis mizezebsac.
impulsur agresiasTan, romelic SeiZleba iyos
agresiasa da Zaladobas Soris mniSvnelovani gan
mimarTuli sakuTar Tavze an sxva adamianze (Lee and
sxvavebaa. agresiuli qceva yovelTvis ar aris
Coccaro, 2001). amasTanave, sul ufro meti mtkicebuleba
Zaladobrivi, zogjer mas socialuri wesebi gana
moiZebneba imis sasargeblod, rom sociopaTur per
pirobebs.
sonologiur tips axasiaTebs neirofsiqologiuri,
Zaladoba aris agresiuli qceva, romelic scildeba
kerZod, aRmasrulebeli funqciebis didi xnis
socialur normebs. amis magaliTia quCis Cxubi,
deficiti (Raine et al., 2005).
romelic arRvevs sisxlis samarTals, gansxvavebiT
krivisgan, romelic emorCileba socialur wesebs.
fsiqosocialuri faqtorebi
konkretul situaciaSi bevri faqtori gansazRvravs
konkretuli individis agresiulobas: personologiuri danaSaulis Cadenas ganapirobebs individualuri fsi
maxasiaTeblebi; socialuri jgufi, romelsac igi qologiuri ganviTarebis, socialuri faqtorebisa
miekuTvneba; msxverplis qceva; alkoholis an nar da kulturuli Rirebulebebis urTierTzegavlena
kotikis miReba (an sxva saSualebebis), romlebic (cxrili 26.1). kanondarRveva da antisocialuri qceva
socialuri qcevis ganmuxruWebas iwveven, aseTebia: xSirad pirvelad iCens Tavs bavSvobaSi an zrdasruli
zogadi garemo faqtorebi_ xmauri da socialuri asakis adreul periodSi:
zewola; fiziologiuri faqtorebi _ daRla, SimSili, deliqvent axalgazrdebze Catarebuli Semdgomi
Zilis nakleboba da fsiqikuri arastabiluroba. dakvirveba aCvenebs, rom antisocialuri qcevis
agresia ar aris danaSauli, magram Zaladobrivi qceva adreuli paternebi SeiZleba zrdasrul asakSic
danaSaulebrivia, radgan is iwvevs zians, romelic gamovlindes
kanoniTaa gaTvaliswinebuli. delinqventoba dakavSirebulia mkacr aRzrdasTan
da siRaribesTan
genetikuri da fiziologiuri faqtorebi bavSvobaSi fizikuri Zaladobis gadatana an ufrosebis
tyupebze Catarebuli adreuli gamokvlevebis Tanaxmad, mier bavSvis ugulebelyofa mniSvnelovnad zrdis
kriminalurobis konkordantobis maCveneblebi ufro Zaladobrivi danaSaulis risks zrdasrul asakSi,
maRalia monozigotur tyupebSi, vidre dizigotur rogorc mamakacebis, ise qalebis SemTxvevaSi (Rutter,
tyupebSi (Lange, 1931). mogvianebiT, SvedeTsa da 2005).
daniaSi Catarebulma naSvilebi pirebis kvlevam da specifikuri kavSiri mZime bavSvobasa da Zaladobas
adastura genetikuri faqtorebis zegavlena, mag Soris SeiZleba bevri faqtoriT iyos ganpirobebuli.
ram gairkva, rom isini ar arian imdenad Zlieri, pirvel rigSi, Zaladobas daqvemdebarebuli da ugu
rogorc es langes (Lange., 1931) miaCnda. genetikuri lebelyofili bavSvebi SeiZleba gazviadebulad aRi
faqtorebis zemoqmedeba, ZiriTadad, mniSvnelovania qvamdnen sxvis muqaras. meorec, maT, SesaZloa, ar
mZime da persistentuli danaSaulis dros. bavSvebSi hqondeT srulyofili interpersonaluri urTi
qcevis aSlilobis genetikuri faqtorebi kargad aris erTobebis damyarebis unari, sxvebis mimarT sus
Seswavlili da agresiuli, antisocialuri qcevis ti empaTiis an TviTanalizis arasakmarisad gan
gadazrda bavSvobis periodidan mozardobis periodSi viTarebuli unaris gamo. individebi, romlebic
didwilad genetikuri gavleniTaa ganpirobebuli (Eley moZaladeebi xdebian, SesaZloa, ver axerxeben agz
et al., 2003). nebis marTvas, an iseTi afeqturi mdgomareobebis
Tu ra gziT axdenen gavlenas genetikuri faqtorebi regulirebas, rogoric brazi an SfoTvaa. yovelive
kriminaluri qmedebebis riskis gazrdaze, bolomde es, SesaZlebelia, warmoadgendes warsulSi gancdili
_ 777 _
SiSis Sedegs. ra Tqma unda, ar aris gamoricxuli, hospitalizebuli iyvnen Sizofreniis diagnoziT;
rom saerTo genetikuri faqtorebi gavlenas axdenen 2. Zaladobrivi danaSaulis gamo dapatimrebis ris
mSoblebisa da Svilebis afeqtis regulaciisa da ki, aseve, maRali iyo im mamakacebSi, romlebic
sxvebis mimarT empaTiis gancdis unarze. da bolos, warsulSi organuli fsiqozis mizeziT iyvnen
mniSvnelovania medegobis an mowyvladobis faqtorTa hospitalirebulni (Sansebis Tanafardoba 8.8, 95%;
(mag. temperamentis) rolis gaTvaliswineba(Rutter, 2005). sandoobis intervali 7.4-10.0);
3. am jgufebSi Zaladobrivi danaSaulis gazrdili
fsiqiatriuli mizezebi
riski ar aixsneboda demografiuli faqtorebiT an
arsebobs kanondamrRvevTa mcire, magram mniSvnelovani Tanmxlebi wamalmoxmarebiT;
jgufi, romlis kriminaluri qceva, nawilobriv,
4. afeqturi fsiqozis diagnozis mqone qalebmac da
aixsneba specifikuri fsiqologiuri an fsiqiatriuli
mamakacebmac aCvenes Zaladobrivi danaSaulis ma
anomaliebiT. es jgufi fsiqiatris gansakuTebul
Rali riski, Tumca, am jgufSi gazrdili riski
sazrunavs warmoadgens da Semdeg qveTavSia ganxiluli.
SeiZleba aixsnas alkoholisa da wamalmoxmarebiT.
amave jgufis ufro adrindelma gamokvlevam aCvena,
kavSiri fsiqikur aSlilobasa da rom Tavad narkotikebisa da alkoholis moxmareba,
danaSauls Soris iseve, rogorc, antisocialuri personologiuri aS
sixSire liloba, asocirebulia Zaladobrivi danaSaulis
gazrdil riskTan (cxrili 26.2) (Chiswick, 2000).
im mcirericxovani kvlevebidan erTerTSi, romelic
mocemuli gamokvleva, aseve, fokusirebuli iyo
swavlobda kavSirs fsiqikur aSlilobasa da Zaladobas
patimrebSi fsiqikuri aSlilobis gavrcelebaze da
Soris didi zomis SerCevaSi (epidemiologiuri
fsiqikur aSlilobasa da patimrobas Soris kavSirze.
CarTvis arealis kvleva aSS-Si; Epidemiologic Catchment
Tumca, am midgomas garkveuli susti mxareebi gaaCnia:
Area Study in the USA) gamovlinda mniSvnelovani
kavSirebi adamianis Zaladobriv qcevasa da fsiqikur
yvela kriminali ar xvdeba sasamarTloSi da ar aris
aSlilobas Soris (Swanson et al., 1990). Semdgom ga damnaSaved miCneuli;
mokvlevaSi Seiswavles individebi 1944 da 1947 wlebSi
yvela kriminali ar xvdeba cixeSi, ase rom patimarTa
daniaSi dabadebuli kohortidan (Brennan et al., 2000). Seswavlam SeiZleba mcdar SerCevamde migviyvanos;
kvlevis Sedegad miRebuli ZiriTadi Sedegebia:
fsiqikuri aSlilobis mqone damnaSaveebi SeiZleba
1. Zaladobrivi danaSaulis gamo dapatimrebis riski ar warsdgnen sasamarTloSi, an cixidan gadaiyvanon,
sagrZnoblad ufro maRali iyo im mamakacebSi an brali ar wauyenon.
(Sansebis Tanafardoba 4.6, 95% sandoobis intervali bolo periodSi Catarebulma kvlevam aCvena, rom
3.8-5.6) da qalebSi (Sansebis Tanafardoba 23.2, 95%; patimrebis mniSvnelovan nawils axasiaTebs fsi
sandoobis intervali 14.4-37.4) romlebic warsulSi qikuri aSliloba da es proporcia aRemateba Sesa
bamis proporcias zogad populaciaSi. patimrebze
cxrili 26.1 danaSaulis fsiqosocialuri Catarebuli 62 fsiqiatriuli gamokvlevis Sedegad,
risk-faqtorebi romlis monacemebi meta-analiziT damuSavda, fa
zelma da daneSma (Fazel and Danesh, 2000) daadgines,
individualuri faqtorebi
rom yovel Svid patimarSi erT patimars aReniSneba
hiperaqtiuroba da impulsuroba gankurnebadi fsiqiatriuli daavadeba (cxrili 26.3).
dabali inteleqti
bavSvis aRzrda _ cudi meTvalyureoba, mkacri cxrili 26.2 1944-47 wlebSi daniaSi dabadebul
disciplina, uaryofa, mozardi dedebi
admianTa jgufis kvleva: Zaladobrivi danaSa
mSoblebis konfliqti _ gayra ulis fardobiTi riskis Sefaseba 1978-1990
kriminali mSoblebi wlebSi
mravalwevriani ojaxi
aSliloba mamakaci qali
socialuri faqtorebi
seriozuli fsiqikuri aSlilobebi 4.5 8.7
socioekonomikuri deprivacia
daswavlis sirTuleebi 7.7 11.5
TanatolTa zegavlena
antisocialuri pirovneba 7.2 12.2
skolis zegavlena
Temis zegavlena narkotikebis avadmoxmareba 8.7 15.1
Farrington, 2000 alkoholis avadmoxmareba 6.7 14.9
_ 778 _
kavSiri fsiqikur aSlilobasa da danaSauls Soris
re Cveulebrivi populacia. ar arsebobs imis mtki
cxrili 26.3 patimarTa 62 fsiqiatriuli cebuleba, rom mkvlelobis SemTxvevebi ufro xSirad
gamokvlevis meta-analizi
gvxvdeba fsiqikuri aSlilobebis mqone pirebTan
aSliloba mamakaci (%) qali (%) (Taylor and Gunn, 1999).
fsiqozi 4 4 fsiqikur aSlilobasa da danaSauls Soris kavSiris
mimoxilvisTvis ix. Chiswick, 2000. (boqsi 26.2)
didi depresia 10 12
antisocialuri pirovneba 65 42 konkretuli fsiqikuri aSlilobebi
Zalian did raodenobas axasiaTebs antisocialuri fsiqoaqtiur nivTierebaze damokidebuleba da

personologiuri aSliloba. danaSauli
fsiqoaqtiuri nivTierebis moxmarebasa da danaSauls
fsiqikur aSlilobasa da danaSauls Soris Soris sakmaod mWidro kavSiria, ramac mniSvnelovnad
arsebuli kavSiris buneba
imoqmeda kanonmdeblobaze, kanonis aRsrulebasa da
fsiqikur aSlilobasa da danaSauls Soris mizez- erovnul politikaze (Grann and Fazel, 2004).
Sedegobrivi urTierTobis empiriulad Cveneba rTu alkoholi da danaSauli ZiriTadad sami saxiT aris
lia, gansakuTrebiT maSin, Tu danaSualis tipi ar aris erTmaneTTan dakavSirebuli:
gansazRvruli. is faqti, rom fsiqikuri aSlilobis
1. braldebis wayeneba sazogadoebriv adgilebSi
mqone individebi Zalian didi raodenobiT arian
mTvral mdgomareobaSi yofnis gamo da avtomanqanis
warmodgenilni Tavisuflebis aRkveTis adgilebSi,
marTvasTan dakavSirebuli samarTaldarRveva;
srulebiT ar niSnavs imas, rom maT mier kanonis darRveva
2. alkoholuri intoqsikacia aqveiTebs TviTkontrolis
swored maTma fsiqikurma aSlilobam gamoiwvia. da
unars da mWidrod aris dakavSirebuli Zaladobriv
piriqiT, unda gvaxsovdes, rom kriminaluri qceva
danaSaulTan, mkvlelobis CaTvliT;
TavisTavad ar aris fsiqikuri aSlilobis maCvenebeli,
raoden ucnauric da saSinelic ar unda iyos igi. 3. alkoholizmis neirofsiqiatriuli garTulebebi
mag., seqsualuri Zaladobebis umravlesoba ar aris SeiZleba aseve iyos dakavSirebuli danaSaulTan.
dakavSirebuli moZaladis fsiqikur aSlilobasTan. am ukanasknelis magaliTia danaSauli, romelic
dampyrobeli armiebis mier ganxorcielebuli seq SeiZleba iqnes Cadenili alkoholuri amneziis an
sualuri Zaladobis aRwera aCvenebs, rom garkveuli `gamoTiSvis~ dros, ramdenime saaTian an ramdenime
tipis Zaladobas ufro socialuri datvirTva aqvs, dRian periodSi, risi gaxsenebac pirovnebas ar SeuZ-
vidre diagnostikuri mniSvneloba. lia, Tumca, danaSaulis momentSi, sxvebis azriT, igi
mniSvnelovania aRiniSnos, rom Zaladobrivi qce fxizeli da saR gonebazea da, Cveulebriv, SeuZlia
vis ganmxorcielebeli pirebidan, seriozuli fsiqi gaazrebuli moqmedeba. Tumca es kavSiri rTulia da
kuri daavadeba mxolod umciresobas axasiaTebs alkoholis miRebasTan dakavSirebuli socialuri fa-
(mag., fsiqozi). fsiqikuri aSlilobebis mqone paci qtorebi SeiZleba iseTive mniSvnelovani aRmoCndes,
entebis umravlesoba ar aris imaze ufro saSiSi, vid rogorc Tavad alkoholis miReba (Johns, 2000).
narkotikulma intoqsikaciam SeiZleba gamoiwvios
boqsi 26.2. fsiqikuri aSliloba da kriminaluri qceva, Zaladobrivi danaSaulis CaTv-
danaSauli liT. narkotikis momxmareblebi, gansakuTrebiT isini,
w fsiqikuri aSlilobis mqone pirebis dadanaSauleba romlebic heroinze da kokainze arian damokidebulni,
kriminalur da Zaladobriv qmedebebSi, zogad ganmeorebiT sCadian danaSauls, rogorc sakuTrebis,
populaciasTan SedarebiT, ufro xSirad xdeba
(faqtorebis SefardebiT 8 :30, Sesabamisad) aseve adamianebis winaaRmdeg, imisaTvis, rom gadaixa-
w es gazrdili albaToba icvleba lokaluri faqtorebis don narkotikis safasuri. zogierTi am danaSaulidan
zegavleniT, rogoricaa danaSualis done da Zaladobas Seicavs. patimrebSi narkotikebis moxmare-
sociodemografiuli maxasiaTeblebi
bis xarisxi SedarebiT maRalia da Zalian bevri adami-
w antisocialuri personologiuri aSliloba da
fsiqoaqtiuri nivTierebebis moxmarebiT gamowveuli ani axerxebs cixeSi narkotikis mopovebas. kriminalur
fsiqikuri aSliloba ufro mWidro kavSirSia danaSaulis aqtivobaSi monawileobam da sxva kriminalebTan ur-
CadenasTan, vidre seriozuli fsiqikuri aSlilobebi
TierTobam SeiZleba gamoiwvios narkotikebis gamoy-
w fsiqikuri aSlilobebis komorbidoba (gansakuTrebiT
wamal an alkohol_moxmarebis komorbidoba), SesaZloa eneba. kavSiri wamaldamokidebulebasa da danaSauls
ufro relevanturia, vidre calkeuli fsiqikuri Soris ganxilulia Semdeg wyaroSi: Johns, 2000.
aSliloba. fsiqikuri aSlilobis mqone adamianebis
mier Cadenili danaSaulis umetesoba Tavisi bunebiT
umniSvneloa. Zaladobis Cadenisas, Zaladobrivi qceva daswavlis darRveva
ufro xSirad ojaxis wevrzea mimarTuli. ar arsebobs imis mtkicebuleba, rom kriminalebis um-
Chiswick, 2000.
etesoba gamokveTilad dabali inteleqtisani arian,
_ 779 _
Tumca saSualo inteleqtualur SesaZleblobebze gvaqvs paranoidul simptomatologiasTan an pacienti
sagrZnoblad dabali maCvenebeli danaSaulis Cadenis moixmars fsiqoaqtiur nivTierebebs. Zaladobas SeiZ-
damoukidebeli prediqtoria (Holland et al., 2002). leba ganxorcieldes maSin, rodesac damnaSave SeSine-
daswavlis darRvevis mqone adamianebma SeiZleba bulia da fsiqozuri mdgomareobis gamo TviTkontro-
daarRvion kanoni, imitom, rom isini ver acnobiereben li aqvs daqveiTebuli. nebismieri fsiqikuri statusi
sakuTari qcevis Sedegebs an kidev imitom, rom Zalian an aSliloba, romelsac axasiaTebs paranoiduli md-
advilad eqvemdebarebian eqspluatacias sxvebis mx- gomareoba, dakavSirebulia Zaladobrivi qcevis gazr-
ridan. miuxedavad imisa, rom am SemTxvevaSi yvelaze dil riskTan.
ufro metadaa gavrcelebuli sakuTrebasTan dakavSi-
rebuli danaSauli, xSiria, agreTve, seqsualuri xa- epidemiologia
siaTis danaSauli, gansakuTrebiT _ uxamsi gaSiSvleba epidemiologiuri kvlevebi aSkarad imas miuTiTebs,
mamakacebis mier (Perry et al., 2002). adamiani, romelic rom Sizofrenia dakavSirebulia rogorc Zaladobri-
SiSvldeba, xSirad msxverplis nacnobia da, aqedan gavi, aseve araZaladobrivi danaSaulis maRal riskTan
momdinare, misi gamovlenis albaToba maRalia. das- (Brennan et al., Arsenault et al., 2000) (ix.zemoT). am risks
wavlis darRvevas da cecxlis wakidebas (xanZris mi- sagrZnoblad zrdis fsiqoaqtiuri nivTierebis moxma-
zanmimarTulad gaCena) Sorisac SeiniSneba garkveuli reba. Sizofreniis dros mniSvnelovania Zaladobri-
kavSiri (Chiswick, 2000). vi danaSaulis ganxilva riskis konteqstSi, radgan
mosaxleobaSi Cadenili Zaladobis wili, romelic
guneb-ganwyobis aSliloba Sizofreniaze modis, dabalia da yvela kvleviT 10%-
depresiuli aSliloba xandaxan dakavSirebulia maRa- ze naklebia (Walsh et al., 2002). Sizofreniis SemTxveva-
ziidan wvril-wvrili nivTebis moparvasTan. agreTve, Si Zaladobis ramdenime klinikuri risk-faqtoria ga-
mZime depresiulma aSlilobam SeiZleba adamiani mkv- moyofili:
lelobamde miiyvanos. aseT SemTxvevaSi, rogorc wesi,
arasistematizebul bodvasTan asocirebuli SiSi da
depresiul adamians aReniSneba bodva (mag., es samyaro TviTkontrolis unaris dakargva;
Zalian cudi adgilia imisaTvis, rom man an misma ojax-

sistematizebuli paranoiduli bodva mtrebisgan
ma aq icxovron). Semdeg man SeiZleba moklas Tavisi
Tavis dacvis ideebiT;
meuRle an Svilebi, raTa aaridos isini am samyaros
saSinelebebs. amis Semdeg mkvleli xSirad iklavs Tavs.
dauZleveli impulsi;
dedam, romelsac aReniSneba mSobiarobis Semdgomi aS-
halucinaciuri xmebisgan miRebuli instruqciebi
liloba, SeiZleba moklas Tavisi axaldabadebuli Svi- (imperatiuli halucinaciebi);
li an ufrosi Svilebi. mZime depresiuli aSlilobis
ormagi diagnozi, gansakuTrebiT fsiqoaqtiuri niv-
mqone adamianma SeiZleba Caidinos mkvleloba devnis Tierebebis borotad moxmareba;
bodvis gamo (mag., sjerodes, rom msxverpli SeTqmu-

Zlieri negatiuri afeqti (depresia, brazi, agzneba).
lebas amzadebs pacientis winaaRmdeg), Tumca, aseTi
riskebis Sefaseba ganxilulia ?? gverze. Tumca,
SemTxvevebi iSviaTia. xandaxan depresiuli paciente-
aqac mniSvnelovania imis gameoreba, rom:
bi, romelTac awuxebT danaSaulis grZnoba da azre-
bi sakuTari usargeblobis Sesaxeb, iseT danaSauls (1) fsiqozis mqone pacientebis muqaras seriozuli
aRiareben, romelic realurad ar CuadeniaT. yuradReba unda mieqces (es gansakuTrebiT im pa-
maniakalurma pacientebma SeiZleba Zalian bevri cientebs exeba, visac Zaladobrivi qcevis istoria
fuli daxarjon Zvirfas nivTebze (mag., samkauleb- aqvT);
ze an manqanebze), romelTa SeZenac maT ar SeuZliaT; (2) yvelaze mZime Zaladobriv qmedebas Cadian is pi-
iqiravon manqanebi, romlebsac mere veRar abruneben rebi, romlebic fsiqiatrs nanaxi hyavs. amis gaTva-
an moiparon isini. maniis mqone pacientebs SeiZleba liswinebas gansakuTrebuli mniSvneloba aqvs iseTi
brali edebodes TaRliTobaSi, qurdobaSi, an qonebis SemTxvevebisTvis, sadac SeiZleba msxverplis drou-
dasakuTrebaSi faqtebis yalbi interpretaciis gziT. lad amocnoba da dacva.
maniakaluri pacientebi, agreTve, midrekilni arian
gaRizianebisa da agresiisaken, ramac isini SeiZleba
Zaladobriv danaSaulamde miiyvanos, Tumca, Tavad es posttravmuli stresuli aSliloba (PTSD) SeiZleba
Zaladoba iSviaTad aris mZime. sami saxiT iyos danaSaulTan dakavSirebuli:
PTSD-is mqone pacientebi SeiZleba moixmardnen fsi-

Sizofrenia da sxva fsiqozebi
qoaqtiur nivTierebebs, rac zrdis kriminaluri
fsiqikuri daavadebebi SeiZleba ZaladobasTan iyos qcevis risks;
dakavSirebuli, gansakuTrebiT maSin, rodesac saqme
PTSD kavSirSia gaRizianebis momatebasTan da afe-

_ 780 _
kavSiri fsiqikur aSlilobasa da danaSauls Soris
qtis daqveiTebul regulaciasTan, ramac, SeiZleba, vis meta-analizma aCvena, rom es ase ar aris (Fazel et
gazardos agresiuli qcevis albaToba; al., 2002). klinikuri epilefsiis ararsebobisas, Zala-

iSviaT SemTxvevebSi, aseT pacientebs aReniSnebaT dobrivi qceva xandaxan dakavSirebulia eleqtroen-
disociaciuri epizodebi, romelTa ganmavlobaSic cefalogramis anomaliebTan, magram saeWvoa, rom es
maT SeiZleba Zaladobrivi aqti ganaxorcielon. es mizez-Sedegobriv kavSirze mianiSnebdes.
gansakuTrebiT iseT situaciaSi xdeba, romelic maT epilepfsiuri avtomatizmebis dros Zalian iSvia-
Tavdapirvel travmas axsenebs. aseTi SemTxvevis re- Tad gvxvdeba Zaladobrivi qceva. Zaladoba ufro xSi-
trospeqtulad dadgena rTulia. ria Setevis Semdgom periodSi, vidre _ Setevis dros.
PTSD-is dros adamianis fsiqikuri mdgomareoba mis impulsis kontrolis aSlilobebi

mier Cadenili mkvlelobis aqtis gamarTlebis safuZv- DSM-IV Seicavs kategorias _ ìmpulsis kontro-
lad yofila gamoyenebuli, gansakuTrebiT iseT Sem- lis aSlilobebi, romlebic sxvagvarad ar aris da-
TxvevebSi, rodesac nacem qalebs mouklavT moZalade zustebuli~. es saTauri aerTianebs 4 hipoTetur
partniori. xangrZlivi travmis dros xSiria Suris- mdgomareobas, romlebic mniSvnelovania sasamarTlo
Ziebis perioduli Zaladobrivi aqtebi. fsiqiatriisTvis. esenia perioduli feTqebadi aSli-
avadmyofuri eWvianoba loba, paTologiuri azartuli TamaSi, piromania da
kleptomania. (aqve Semodis kidev erTi kategoria _
avadmyofuri (paTologiuri) eWvianobis sindromi
triqotilomania _ sakuTari Tmebis wiwkvna). ICD-10
(gv. ??) SeiZleba dakavSirebuli iyos zemoTaRniSnul
Si es daavadebebi Sedis mozrdilTa pirovnul da qce-
ramdenime diagnozTan. es sindromi identificire-
viT aSlilobebSi, rogorc xasiaTobrivi da impul-
bulia `Seuracxadi~ mamakaci mkvlelebis 12%-Si da
suri aSlilobebi. ra klinikuri Rirebulebac ar unda
`Seuracxadi~ qali mkvlelebis 3%-Si. es sindromi
gaaCndes am kategoriebs, arc erTi maTgani ar aris
imis gamoa gansakuTrebiT saSiSi, rom arsebobs sxva
Camoyalibebuli calke diagnostikur erTeulad.
partniorTan Zaladobrivi qcevis ganmeorebis riski.
xandaxan rTulia aseTi avadmyofuri eWvianobis gar- perioduli eqsploziuri aSliloba
Ceva kulturaSi qalis Sesaxeb damkvidrebuli Sexedu-
es termini gulisxmobs adamianebisa da sakuTrebis
lebebisgan, romlebic mamakacebis zogierT jgufs
mimarT ganmeorebul agresiul qcevas, romelic Ta-
axasiaTebs. zogierT kulturaSi miRebulia qalebis
visi intensivobiT Seusabamoa maprovocirebel gare-
mimarT mesakuTruli damokidebuleba an maTi qcevis
moebebTan da ar aixsneba sxva fsiqikuri aSlilobiT
sruli kontroli. amas, SeiZleba, Tan axldes Zala-
(mag. antisocialuri personologiuri aSlilobiT,
dobrivi qmedeba, romlis mizezs fsiqikuri aSliloba
wamalmoxmarebiT an SizofreniiT). agresias SeiZleba
ar warmoadgens.
win uZRodes daZabuloba da moyvebodes daZabulobis
organuli fsiqikuri aSlilobebi moxsna. SemdgomSi adamiani nanobs Tavis saqciels. sxva
mizezebis gamoricxvis SemTxvevaSi, aseTi mdgomareo-
deliriumi xandaxan dakavSirebulia kriminalur qce-
ba iSviaTad aRmocendeba. bevr fsiqiatrs eWvi epare-
vasTan, ZiriTadad imis gamo, rom am mdgomareobisT-
ba imaSi, rom amgvari qceva damoukidebel fsiqikur
vis damaxasiaTebelia cnobierebis aSla da ganmuxru-
aSlilobaze miuTiTebs.
Weba (disinhibicia). Tu pacientis mdgomareoba manam
gaumjobesdeba, sanam eqimi damnaSaves gamoikvlevs, gemblingi/paTologiuri gataceba azartuli
SeiZleba warmoiSvas diagnostirebis problemebi. TamaSebiT
demencia xandaxan dakavSirebulia danaSaulebriv
azartuli TamaSiT gataceba miCneulia paTologiu-
qmedebasTan, Tumca, is sakmaod iSviaTia asakovan
rad, rodesac is xSirad meordeba da dominirebs ada-
adamianebSi da iSviaTad aris Zaladobrivi xasiaTis.
mianis cxovrebaSi. adamiani agrZelebes TamaSs maSinac
Zaladobrivi da ukontrolo qceva SeiZleba Segvxv-
ki, roca mas aRar SeuZlia valebis gadaxda. adamiani
des qala-tvinis travmuli dazianebis Semdeg. am Sem-
ityueba, iparavs, TaRliTobs imisaTvis, rom iSovos
TxvevaSi, SeiZleba rTuli gaxdes travmis Semdgomi
fuli, an Tavi aaridos mis gadaxdas. misi cxovreba
nevrologiuri garTulebebis garCeva posttravmuli
am damRupveli CveviTaa warmarTuli. adamians SeiZle-
fsiqikuri aSlilobisgan.
ba aerios ojaxuri cxovreba, gaufuWdes socialuri
epilefsia urTierTobebi da misi samsaxuri riskis qveS dadges.
kavSiri epilefsiasa da danaSauls Soris rTuli da paTologiur azartul moTamaSeebs aqvT TamaSis
bundovania, Tumca, farTod gavrcelebuli mosazre- intensiuri moTxovnileba. am moTxovnilebis gakon-
bis Tanaxmad, epilefsiis riski ufro maRalia patim- troleba Zalian rTulia. isini mudmivad TamaSze
rebSi zogad populaciasTan SedarebiT. Svidi kvle- fiqriT arian Sepyrobilni, iseve, rogorc alkoholze
_ 781 _
damokidebuli adamiani Sepyrobilia sasmelze fiqriT. kleptomania
xSirad adamiani TamaSobs Zalian did Tanxaze imisaT-
kleptomaniis dros pacients ar SeuZlia daZlios is-
vis, rom gazardos azarti, mRelvareba an cdilobs
eTi nivTebis moparvis impulsi, romlebic gamoyenebi-
aanazRauros wina wageba. Tu moxda azartuli TamaSis
sa da fuladi Rirebulebis TvalsazrisiT sruliad
prevencia, adamiani Riziandeba da kidev ufro Sepy-
usargebloa. aseTi impulsebi ar aris dakavSirebuli
robili xdeba am qceviT.
bodvebTan, halucinaciebTan an brazisa da SurisZiebis
mocemuli qcevis paternebsa da alkoholze
motivebTan. Tavad moparvis aqtamde daZabuloba matu-
damokidebuli adamianebis qcevis paternebs Soris
lobs, xolo aqtis Semdeg daZabauloba ixsneba. klepto-
msgavsebam gaaCina mosazreba, rom paTologiuri az-
maniis diagnozs ar svamen maSin, rodesac aSkaraa aso-
artuli TamaSi Tavad aris adiqciuri qcevis forma.
cirebuli antisocialuri personologiuri aSliloba,
paTologiuri azartuli moTamaSeebis Tavis tvinis
maniakaluri epizodi an qceviTi aSliloba bavSvebSi da
neirovizualizaciam aCvena funqciuri anomaliebi da-
mozardebSi. misi diagnostireba arc maSin xdeba, rode-
jildovebis mezolimbur gzebSi, romlebic, rogorc
sac qurdobis mizezi seqsualuri fetiSizmia. moparul
cnobilia, icvleba wamaldamokidebulebaSi CarTuli
nivTebs SeiZleba mcire Rirebuleba hqondes da maTi
procesebis zegavleniT (Goudrian et al., 2004).
SeZena advili iyos. adamianma SeiZleba es nivTebi mo-
paTologiuri azartuli TamaSis gavrcelebis
agrovos, gadaagdos an mogvianebiT mflobels daubru-
xarisxi ar aris cnobili. savaraudod, is ufro xSiria
nos. pacientma icis, rom qurdoba arakanonieria da
mamakacebSi. moTamaSeebis umetesoba, romlebTanac
SeiZleba Tavi damnaSaved an daTrgunulad igrZnos, mas
fsiqiatrebi muSaoben, zrdasruli adamianebi arian,
Semdeg, rac gaivlis qurdobis aqtis Semdgomi sasiamov-
Tumca, SemaSfoTebelia is faqti, rom axalgazrdebi
no SegrZnebebi. es aSliloba ufro xSiria qalebSi. aR-
sul ufro didi raodenobiT erTvebian am procesSi
werilia, aseve, kleptomaniis kavSiri SfoTviT da kve-
(ZiriaTadad, TamaSoben gasarTob centrebSi saTa-
biT aSlilobebTan. es qcva SeiZleba iyos perioduli,
maSo manqanebze). paTologiurma azartulma TamaSma
remisiis didi intervalebiT, an samarTlebrivi devnis
SeiZleba gamoiwvios iseTi qceva, romelsac moTamaSe
miuxedavad, stabiluri wlebis manZilze. ganmeorebadi
sasamarTlomde mihyavs (mag., TaRliToba, an fulis
qurdobis sxva mizezebis gamoricxvisas, es mdgomareo-
moparva, rac, xSirad, Tan axalavs azartul TamaSs).
ba iSviaTad gvxvdeba. zogierTi mkvlevari eWvqveS ay-
(paTologiuri azartuli TamaSebis mimoxilva moce-
enebs kleptomaniis, rogorc damoukidebeli sindro-
mulia Semdeg wyaroSi: Dickerson and Barron, 2000).
mis arsebobas da Tvlis, rom diagnozi damokidebulia
piromania damnaSve adamianis mier sakuTari motivebis aRweraze
(mimoxilvisTvis ix. Marazzi et al., 2003).
piromania xanZris gaCenis erT-erTi mizezia (gv.
??). es termini aRwers cecxlis gaCenis winaswar ga-
miznul, ganmeorebiT epizodebs, romlebic ar aris kanondamrRvevi jgufebi
gamowveuli fuladi sargebelis miRebis, danaSaulis qalebi
damalvis an samagieros gadaxdis surviliT, an kidev
qalebi ufro kanonmorCilni arian, vidre mamakacebi.
socialuri an politikuri motivebiT. is arc halu-
qalebSi yvelaze ufro gavrcelebuli danaSaulia qur-
cinaciebis, bodviT an intoqsikaciiT, demenciiTa an
doba. maRaziidan wvrili nivTebis moparva qalebis
fsiqikuri mdgomareobis gauaresebiT gamowveuli az-
mier Cadenili yvela sisxlis samarTlis danaSaulis
rovnebis darRvevebis Sedegia. piromaniis diagnozis
naxevars Seadgens, xolo Zaladobrivi da seqsualuri
dasma ar xdeba asocirebuli antisocialuri perso-
danaSauli _ iSviaTia (Heidensohn 1991). qalebs, agreTve,
nologiuri aSlilobis, maniakaluri epizodebis an
axasiaTebT antisocialuri qcevis garkveuli formebi,
(bavSvebsa da mozardebSi) qceviTi aSlilobis dros.
romlebic kanonis mier naklebad seriozuladaa miC-
am iSviaTi mdgomareobis dros cecxlis gaCenis aqts
neuli, vidre is formebi, romlebic mamakacebisTvisaa
win uZRvis daZabuloba, romelsac mosdevs daZabulo-
tipuri (mag., gamoZalva da socialur dacvasTan dakav-
bisgan gaTavisufleba. piromaniis mqone adamianebi Se-
Sirebuli TaRliTobis sxvadasxva formebi).
pyrobilni arian cecxlis gaCeniTa da cecxlis Caqro-
kriminaluri marTlmsajulebis sistema mamakacebs
bis surviliT. maT Zalian siamovnebT cecxlis yureba.
da qalebs gansxvavebulad eqceva. qali ufro msub-
maT SeiZleba winaswar dagegmon cecxlis gaCena da ar
uqad isjeba mkacri danaSaulis Cadenisas da ufro
gaiTvalsiwinon safrTxe, romelic eqmneba sxva adami-
xSirad aRiqmeba àvadmyofad~. fsiqikuri aSliloba
anebs maTi qcevis gamo. zemoT CamoTvlili mizezebis
xSiria patimar qalebSi. aq gansakuTrebiT xSirad gvx-
gamoricxvis SemTxvevaSi piromania iSviaTad gvxvdeba.
vdeba personologiuri aSliloba da narkotikebis
ufro metic, zogierT avtors saerTod eeWveba misi
moxmareba (Fazel and Danesh, 2002). TviTdazianebis
arseboba.
_ 782 _
specifikuri danaSaulis fsiqiatriuli aspeqtebi
maCveneblebi aseve maRalia dapatimrebamde da patim- li warmoSobis adamianebi dapatimrebis ufro maRali
robis periodSi. riskis qveS imyofebian, magram patimrobaSi yofnisas
advokatebi xSirad asaxeleben `premenstrualur fsiqikuri daavadebis ufro dabali maCveneblebi ax-
sindroms~ kanonsawinaaRmdego qcevis gamomwvev faq- asiaTebT, vidre TeTrkanianebs (Coid et al., 2002). es
torad. bolo periodis sasamarTlo gadawyvetile- monacemebi winaaRmdegobaSi modis im faqtTan, rom
bebSi is zogjer kanonsawinaaRmdego qcevis gamomwvev afro-karibielebi didi raodenobiT imyofebian iseT
faqtorad aris aRiarebuli. premenstrualurma simp- saavadmyofoebSi, sadac usafrTxoebis normebia dacu-
tomebma SeiZleba gaarTulos an gaamwvavos arsebuli li. es SeiZleba imas niSnavdes, rom afro-karibielebi,
socialuri da fsiqologiuri siZneleebi, magram ar romlebsac Cadenili aqvT danaSauli fsiqikuri avad-
arsebobs imis mtkicebuleba, rom es simptomebi dana- myofobis dros, ufro xSirad xvdebian saavadmyofoSi.
Saulis pirveladi mizezia.
specifikuri danaSaulis
axalgazrdebi
fsiqiatriuli aspeqtebi
erovnuli danaSaulis statistika aCvenebs, rom 18
qvemoT saubaria iseTi tipis danaSaulze, romelic
wlamde asakis axalgazrdebSi izrdeba kriminalur
yvelaze xSiradaa dakavSirebuli fsiqologiur faq-
qmedebaTa ricxvi. mag., SotlandiaSi, 2000 wels, 12 dan
torebTan. esenia Zaladobrivi danaSauli, seqsual-
15 wlamde axalgazrdebis 34%-ma aRiara, rom gasul
uri tipis danaSauli da sakuTrebasTan dakavSirebu-
wels kriminaluri danaSauli Caidina. 1992 wels es
li danaSauli.
maCvenebeli 22%-s Seadgenda (Scottish Executive Central
Research Unit, 2002). danaSaulis SemTxvevaTa umetesoba
Zaladobrivi danaSauli
umniSvnelo iyo, magram 19%-Tan dafiqsirda Cxubi. mx-
fsiqikurad arajansaR damnaSaveebSi Zaladoba ufro
olod 2%- ma daafiqsira narkotikebis moxmareba (es
xSirad personologiur aSlilobasTanaa asocirebuli,
SeiZleba warmoadgendes Semcirebul maCveneblebs,
vidre mZime fsiqikur daavadebasTan. is gansakuTrebiT
radgan informacia kvlevis monawileebiis mier aris
gavrcelebulia adamianebSi, romlebsac aReniSnebaT
mowodebuli). rodesac axalgazrda axorcielebs se-
antisocialuri personologiuri maxasiaTeblebi,
riozul Zaladobriv aqts meore adamianis mimarT,
moixmaren alkoholsa da narkotikebs an axasiaTebT
xSirad msxverpli misi kargi nacnobia da SeiZleba misi
paranoiduli an sadisturi Tvisebebi. Zaladobrivi da-
ojaxis wevric ki iyos. seriozuli Zaladoba axalgaz-
naSauli xSirad impulsuri da agresiuli qcevis stabi-
rda adamianebisa da bavSvebis mxridan iSviaTia. Za-
luri paternis nawilia, magram, SeiZleba warmoadgen-
ladobaSi CarTuli adamianebi xSirad Tavad yofilan
des sporadul reaqcias stresis gamomwvev movlenebze
Zaladobis obieqti, rogorc ojaxis SigniT, aseve
zedmetad mkacri kontrolis mqone pirebSi.
ojaxs gareT (Hamilton et al., 2002).
saSiSroebis Sefaseba da Zaladobis marTva ganxilu-
eTnikuri umciresobebi lia gv. ??.
cnobilia, rom garkveuli eTnikuri jgufebi, ro- mkvleloba

gorc damnaSaveebi, meti raodenobiT arian warmod- sakanonmdeblo iurisdiqciebis umetesoba aRiarebs
genili kriminaluri marTlmsajulebis sistemaSi. mkvlelobis sxvadasxva kategorias ganzraxvis xarisx-
igive tendencia SeiniSneba fsiqiatriul sasamarTlo idan da moZaladis mier aRebuli pasuxismgeblobi-
samsaxurebSic. pacientebs arakavkasiuri jgufebidan, dan gamomdinare. mag., amerikaSi damnaSaves SeiZleba
SesaZloa, ufro xSirad usvamen fsiqikuri daavadebis brali dasdon sxvadasxva simZimis mkvlelobis ganxor-
diagnozs da arasakmarisad iTvaliswineben individu- cielebaSi, rac sasjelSi iqneba asaxuli. inglissa da
alur personologiur siZneleebs. garda amisa, isi- uelsSi arsebobs mkvlelobis sami iuridiuli katego-
caa gasaTvaliswinebeli, rom eTnikurad gansxvavebul ria: ganzrax mkvleloba (murder), sicocxlis mospoba
ojaxebSi SeiZleba gansxvavebuli rwmena iyos dam- gaufrTxileblobiT (manslaughter) da bavSvis mkvlelo-
kvidrebuli da sxvadasxva eTnikur jgufebSi fsiqi- ba (infanticide).
kuri daavadebis simptomebi sxvadasxvanairad iyos inglissa da uelsSi ganzrax mkvleloba da sicocx-
gamoxatuli. rogorc zemoT iyo aRniSnuli, eTni- lis mospoba gaufrTxileblobiT gansazRvrulia is-
kuri umciresobebis warmomadgenlebi SeiZleba imy- toriuli precedentiT da ara kanoniT. Zalian far-
ofebodnen diskriminaciis riskis qveS kriminaluri Tod citirebuli gansazRvrebis mixedviT, romelic
marTmsajulebis sistemis mxridan da, aseve, iyvnen SemoTavazebulia 1979 wels lord kokis mier, ganzrax
socialurad stigmatizebulni fsiqikuri aSlilobis mkvlelobas maSin aqvs adgili, rodesac
gamo (Kaye and Lingiah, 2000). britaneTSi afro-karibu- `saRi mexsierebisa da Tavisufali arCevanis mqone
_ 783 _
adamiani mefis mfarvelobis qveS myofi qveynis rome- elobis SemTxvevebis 1/3 _ 1/2-s Seadgens. am tipis mkv-
lime nawilSi ukanonod klavs sazogadoebrivi wesri- leloba ZiriTadad Cadenilia ufro asakovani adamian-
gisa da usafTxoebis pirobebSi mcxovreb nebismier ebis mier. anomaliuri mkvlelobis msxverpli xSirad
moazrovne arsebas winaswar Cafiqrebuli boroti gan- ojaxis wevrebi arian. im adamianebSi, romlebic Cadian
zraxviT, rac aRiarebulia erT-erTi mxaris mier an ànomaliur~ homicidur aqts, yvelaze gavrcelebuli
gamomdinareobs kanonidan, da amis Sedegad daWrili fsiqiatriuli diagnozebia fsiqozi, fsiqoaqtiuri
an dasaxiCrebuli mxare gardaicvleba am Wrilobisgan nivTierebebis moxmarebiT gamowveuli aSliloba da
an dazianebisgan erTi wlis ganmavlobaSi~. personologiuri aSliloba (Fazel and Grann, 2004).
gansxvavebuli danaSaulia sicocxlis mospoba SeiZleba, aseve, gvxvdebodes depresiuli aSliloba,
gaufrTxileblobiT, aq Sedis yvela is homiciduri gansakuTrebiT im adamianebSi, romlebic, SemdgomSi,
aqti, romelic ganzrax mkvlelobas ar warmoadgens. Tavs iklaven. homicidi qalebSi ufro iSviaTia, vidre
am kategorias ganekuTvneba mkvlelobis sxvadasxva mamakacebSi. rodesac mkvleloba qalebis mieraa Cad-
tipi, magram, rogorc wesi, es kategoria iyofa or enili, is TiTqmis yovelTvis ànomaliur~ SemTxvevas
jgufad, `nebismieri~ da ùneblie~ sicocxlis mospo- warmoadgens (Shaw et al., 1999).
ba. `nebismieris~ dros braldebuls SeiZleba winaswar sazogadoebaSi sagrZnobi mRelvareba SeiniSneba
hqondes Cafiqrebuli mkvleloba, magram garkveuli fsiqikuri daavadebis mqone adamianebisgan momdinare
Semamsubuqebeli garemoebebis gamo, misi danaSauli saSiSebroebisa da maTSi homicidis gavrcelebis gamo.
kriminaluri homicidis ufro dabal safexurad Se- Cven ara gvaqvs safuZveli vifiqroT, rom am problemam
fasdes. ùneblies~ dros mkvleloba winaswar ar aris ufro seriozuli saxe miiRo da eWvqveS davayenoT
Cafiqrebuli. amis magaliTia sicocxlis mospoba uxe- fsiqikur daavadebasTan dakavSirebuli usafrTxoebis
Si daudevrobiT. garantiebi (Taylor and Gunn, 1999). da mainc, ufro meti
zrunva gvmarTebs im umciresobis mimarT, romelic
normaluri da anomaluri mkvleloba
saSiSroebis Semcvelia.
rodesac adamians brali edeba ganzrax mkvlelobaSi, mkvlelebis didi nawili danaSaulis Cadenis dros
fsiqikuri aSliloba SeiZleba erT-erT Semamsubuqeb- alkoholis zemoqmedebis qveS imyofeboda. narko
el mizezad CaiTvalos. amgvarad, braldeba SeiZleba tikebis moxmareba aseve mniSvnelovani faqtoria.
Sesustdes da klasificirdes, rogorc sicocxlis
mospoba daudevrobiT. iuridiuli Sedegis mixed- mravlobiTi mkvleloba
viT mkvlelobaSi xSirad gamoiyofa `normaluri~ da mravlobiTi mkvlelobebi iSviaTia, Tumca isini didad
ànomaliuri~ formebi. mkvleloba `normaluria~, Tu ipyrobs sazogadoebis yuradRebas. es mkvlelobebi
dgindeba ganzrax mkvlelobis faqti an, zogadi kan- Semdeg SemTxvevebs aerTianebs:
onis mixedviT, ganzraxvis gareSe mkvlelobis faqti. w mkvlelobebi Cadenili im adamianebis mier, romleb-
mkvleloba ànomaliuria~, Tu vlindeba Seuracxadi sac ara aqvT fsiqikuri daavadeba da klaven ram-
mkvlelobis, suiciduri mkvlelobis, daqveiTebuli denime adamians erTdroulad (zogjer ojaxuri
pasuxismgeblobis an Cvil bavSvTa mkvlelobis niSnebi. mkvleloba), rasac xSirad mosdevs suicidi. aseT
`normaluri~ mkvlelobis wili britaneTSi mkvl- adamianebSi xSiria paranoiduli da sakuTari Tavis
elobis yvela SemTxvevis ori mesamedidan _ naxevars, gandidebis Tvisebebi (Mullen, 2004).
anu mkvlelobis SemTxvevebis umravlesobas Sead-
w mkvlelobebi romlebic miewereba fsiqozur daa-
gens. igive mdgomareobaa dasavleTis qveynebSic, mag.,
vadebas, romlis drosac mkvleli miznad isaxavs sa-
amerikaSi, sadac homicidis saerTo maCvenebeli ufro
kuTari Tavis an ojaxis gadarCenas mis mier aRqmuli
maRalia, vidre britaneTSi. `normaluri~ mkvleloba
safrTxisgan.
yvelaze xSirad Cadenilia axalgazrda mamakacebis
mier dabali socialuri fenidan. britaneTSi msxverp- w seriuli mkvlelobebi. isini drois garkveuli pe-
li, ZiriTadad, ojaxis wevri an axlobelia. homicidis riodis ganmavlobaSi xorcieldeba. aseTi mkvlelo-
maRali maCveneblebis mqone qveynebSi, mkvlelobebis bebi SeiZleba iyos `normaluri~ (mag., teroristu-
ufro didi nawili dakavSirebulia ZarcvasTan an seq- li mkvlelobebi) an ànomaliuri~ (mag., gamowveuli
sualur danaSaulTan. seqsualuri xasiaTis homicidi fsiqoziT, an motivirebuli seqsualuri sadizmiT
SeiZleba iyos seqsualuri danaSaulis Cadenis dros an nekrofiliiT).
gancdili panikis Sedegi an sadisturi mkvlelobis
mkvleloba, romelsac mohyveba suicidi
niSani. aseT SemTxvevaSi mkvleloba zogjer Cadenilia
britaneTSi homicidis Semdgomi suicidi weliwadSi,
morcxvi mamakacebis mier, romlebsac axasiaTebT sa-
daaxloebiT, 50 SemTxvevas Seadgens, xolo amerikaSi
disturi an sxva Zaladobrivi fantaziebi.
_ 1000-1500-s (Chiswick, 2000). 327 aseTi SemTxvevis epi-
ànomaliuri~ homicidi britaneTSi Cadenili mkvl-
_ 784 _
demiologiurma gamokvlevam (180 msxverpli da 147 mo- taneTSi aseTi SemTxevevebi weliwadSi 5-ze naklebia
Zalade), romelic britaneTSi Catarda (Barraclough and (Chiswick, 2000). marksma da kumarma (Marks and Kumar,
Harris, 2002), aCvena, rom 1993) Seiswavles yvela im erT wlamde bavSvis saqme,
w incidentebis 80%-Si monawileobda erTi msxverpli romelic, 1982-88 wlebSi, mkvlelobis msxverpli gax-
da erTi moZalade da. yvelaze ufro didi riskis qveS es bavSvebi si-
cocxlis pirvel dRes imyofebodnen. amis Semdeg ris-
w incidentebis 88%-Si mxolod erTi da imave ojaxis
kis xarisxma stabilurad daiwyo kleba da pirveli
wevrebi monawileobdnen
wlis bolo meoTxedSi zogadi populaciis maCveneb-
w msxverplis 75% qali iyo, xolo moZaladeebis 85% _ els gautolda. rogorc gairkva, mkvlelebi yvelaze
mamakaci xSirad bavSvis mSoblebi iyvnenen: bavSvis sococxlis
w moZalade mamakacebis msxverpli TiTqmis yovelTvis pirvel dRes _ ZiriTadad dedebi, xolo mogvianebiT
amJamindeli an yofili partniorebi an maTi Svilebi _ mamebi, romelTa mier Cadenili mkvleloba ricxo-
arian, xolo moZalade qalebis msxverpls, umetesad, brivad odnav aRemateboda dedebTan dafiqsirebul
TavianTi Svilebi warmoadgendnen. monacemebs. qalebisTvis gamotanili ganaCeni ufro
w Zalian iSviaTia iseTi SemTxvevebi, rodesac adamiani msubuqi iyo mamakacebisTvis gamotanil ganaCenTan Se-
klavs ucnob pirs da Semdeg iklavs Tavs. aseT in- darebiT. gavrcelebuli azris sawinaaRmdegod, mSo-
dividebs SeiZleba fsiqozi hqondeT. ufro xSirad, biarobis Semdgomi fsiqozuri daavadeba SedarebiT iS-
isini paranoiduli an narcisuli pirovnebebi arian viaTad iyo dedis mier bavSvis mokvlis mizezi, Tumca
da umniSvnelo an warmosaxviTi ugulebelyofis an depresia, garkveul SemTxvevebSi, mkvlelobis erTerT
damcirebis gamo Surs iZieben. faqtors warmoadgenda. Cvil bavSvTa mkvleloba Sem-
dgom periodSi ufro metad bavSvze Zaladobis Sede-
mSoblebi, romlebic sakuTar Svilebs klaven gia. Cvil bavSvTa mkvleloba Zalian mWidrodaa da-
britaneTSi yvela mkvlelobis msxverplis meoTxedi kavSirebuli dedis axalgazrda asakTan. miuxedavad
16 wlamde adamianebi arian, xolo asakobriv jgufebs imisa, rom mSobiarobis Semdgomi fsiqozi, rogorc
Soris erT wlamde asakis bavSvebi yvelaze ufro maRa- Cvil bavSvTa mkvlelobis mizezi, iSviaTad gvxvdeba,
li riskis qveS imyofebian (Breslin and Evans, 2004). bavS- am SemTxvevaSi mkvlelobis prevencia SesaZlebelia.
vebis umetesobas klavs fsiqikuri daavadebis mqone es imas niSnavs, rom mSobiarobis Semdgomi fsiqikuri
mSobeli, ZiriTadad deda. bavSvebis mkvlelobis kla- daavadebis aRmoCena da mkurnaloba prioritets unda
sifikacia rTulia, Tumca gamoyofilia sami katego- warmoadgendes (Spinelli, 2004).
ria _ evTanazia, fsiqozuri mkvleloba da cemiTa
an ugulebelyofiT gamowveuli mkvleloba (D~Orban, ojaxuri mkvleloba
1979). es ukanaskneli kategoria yvelaze ufro metadaa mkvlelobis SemTxvevebis erTmaneTisgan diferencia-
gavrcelebuli. ciis mizniT sasargebloa maTi analizi moZaladesa da
msxverpls Soris arsebuli urTierTobis konteqstSi.
Cvil bavSvTa mkvleloba yvelaze ufro seriozuli Zaladoba ojaxSi xdeba.
qali, romelic klavs Tavis Svils, SeiZleba bralde- rogorc zemoT iyo aRniSnuli, mkvlelobis saerTo
buli iyos ganzrax mkvlelobaSi an sicicxlis mospo- SemTxvevebis erT meoTxedSi msxverpls 16 wlamde
baSi gaufrTxileblobiT. zogierTi iurisdiqcia (mag., adamianebi warmoadgenen. maTi 80% mSoblebma mokles.
inglisis kanonmdebloba) aRiarebs bavSvis mkvlelo- mkvlelobis dros moZaladeebis umravlesoba kargad
bis specialur kategorias, romelsac ewodeba Cvil icnobs Tavis msxverpls. msxverpli qalebis naxevars
bavSvTa (12 Tvemde asakis bavSvTa) mkvleloba. Cvil moZaladeebis colebi an partniorebi Seadgenen, meore
bavSvTa mkvleloba ganixileba, rogorc sicocxlis naxevars ki, ufro xSirad, megobrebi an naTesavebi.
mospoba winaswari ganzraxvis gareSe da, aqedan gamom-
dinare, naklebad mZimed isjeba. mosamarTles Tavi- ojaxuri Zaladoba
suflad SeuZlia gamoitanos gaufrTxileblobiT si- ojaxuri Zaladoba Zaladobis yvela SemTxvevis daax-
cocxlis mospobis ganaCeni Cvili bavSvis mkvlelobis loebiT erT meoTxeds Seadgens. es faqti danaSaulis
nacvlad. Cvil bavSvTa mkvlelobis inglisuri iurid- britanul gamokvlevaSia asaxuli (British Crime Survey)
uli koncefcia uCveuloa, radgan damnaSaves mxolod (Mirrlees-Black, 1999).
imis Cveneba moeTxoveba, rom igi ar iyo saR gonebaze inglissa da uelsSi, weliwadSi Cadenili ojaxuri
mSobiarobis an laqtaciis gamo da ar sWirdeba imis Zaladobis SemTxvevaTa raodenoba, daaxloebiT,
damtkiceba, rom mkvleloba seriozuli fsiqikuri milions Seadgens. aqedan 2/3-s Seadgens Zaladoba
darRvevis Sedegia. qalebis winaaaRmdeg. moZaladeebs, ZiriTadad, ar
Cvil bavSvTa mkvleloba sakmaod iSviaTia da bri- aReniSnebaT diagnostirebadi fsiqikuri aSliloba da
_ 785 _
moZaladis interviuirebiT. Zaladobis `sayovelTao~
cxrili 26.4 ojaxuri Zaladoba _ eTikuri da problemad aRqma xels uSlis Zaladobrivi qcevis
iuridiuli sakiTxebi
Sewyvetas. mniSvnelovania gvaxsovdes, rom partnioris
ojaxuri Zaladobisas gansakuTrebiT mniSvnelovania regularuli cema, gansakuTrebiT eWvianobis niadagze,
konfidencialobis dacva, radgan arsebobs moZaladis mier
SurisZiebis riski. mkvlelobis risk- faqtors warmoadgens.
mniSvnelovania Zaladobis faqtis detalurad aRwera Zaladoba samsaxurSi

dazianebebis dokumentirebis CaTvliT. fotoebTan
dakavSirebiT, werilobiTi Tanxmobis miRebaa saWiro. gaxSirda samsaxurSi Zaladobis SemTxvevaTa raode
im wyvilebma, romelTac gadawyvites erTmaneTTan noba, rac sul ufro metad iqcevs sazogadoebis
urTierTobis dasruleba, aucileblad unda mimarTon spe- yuradRebas. iTvleba, rom am tipis ZaladobaSi
cialists praqtikuli da sxva saxis daxmarebisTvis.
fizikur TavdasxmasTan erTad unda Sediodes muqara
seriozuli Zaladobis maRali riskis dros, riskis
qveS myofi piris usafrTxoebis uzrunvelsayofad da zewolis sxvadasxva formebi. (Fletcher et al., 2000).
policiasTan, sxva organoebsa da pirebTan unda gamJ- fsiqologiuri Sedegebi SeiZleba mZime aRmoCndes.
Ravndes Sesabamisi informacia da es detalur dagegmvas
bevr organizacias aqvs saxelmZRvanelo principebi
saWiroebs. es gegma srulad unda iyos SeTanxmebuli
potenciur msxverplTan. da satreningo programebi, romlebic mimarTulia
amgvari problemebis prevenciasa da Zaladobis Se
ara aqvT kriminaluri istoria, Tumca alkoholizmi degebTan gamklavebaze.
gavrcelebuli mizezia.
zogi adamiani moZaladea mxolod ojaxis SigniT, seqsualuri xasiaTis danaSauli
sxvebi ki Zaladoben ojaxis gareTac. ojaxSi Zaladobam
seqsualuri xasiaTis Zaladobrivi danaSuali
SeiZleba xangrZlivi negatiuri zegavlena iqonios
bavSvebis socialur da fsiqologiur ganviTarebaze, britaneTSi policiis mier dafiqsirebul sisxlis
iseve rogorc partnioris fsiqikur janmrTelobaze samarTlis yvela danaSauls Soris seqsualuri xa
(ix. Tavi 8). siaTis danaSauli 1%-ze naklebs Seadgens. am tipis
ojaxSi Zaladoba SeiZleba, aseve, mimarTuli damnaSaveebi im damnaSaveTa did nawils Seadgenen,
iyos bavSvebze (bavSvebze Zaladoba momoxilulia romelTa gadamisamarTeba fsiqiatrebTan xdeba,
?? gverdze) da asakovan naTesavebze (naTesavebze Tumca seqsualuri xasiaTis danaSaulSi braldebuli
Zaladoba _ ix. gv. ??). Zaladobis am formebs iSviaTad admianebis mxolod mcire nawils ikvleven fsiqiatrebi.
mohyveba mkvleloba. seqsualuri xasiaTis Zaladobriv danaSauls umetesad
saswrafo daxmarebis ganyofilebebi, pirveladi mamakacebi sCadian. am tipis danaSauli qalebSi iS
samedicino daxmarebis dawesebulebebi da pediatriuli viaTobas warmoadgens, im SemTxvevebis garda, rodesac
da sameano ganyofilebebi gansakuTrebul sifxizles xdeba prostituciis mizniT quCaSi adevneba.
unda iCendne ojaxuri Zaladobis faqtebis mimarT. seqsualuri xasiaTis danaSaulis Camdeni adamianebi
ojaxuri Zaladobis SemTxvevaSi intervencia rTuli ufro asakovanni arian sxva damnaSaveebTan SedarebiT.
gansaxorcielebelia da mraval eTikuri xasiaTis seqsualuri xasiaTis Zaladobis SemTxvevaSi ganme
sakiTxs warmoSobs (cxrili 26.4). orebiTi braldebis maCvenebelebi, rogorc wesi,
ufro dabalia, vidre, zogadad, sxva damnaSaulis
Zaladoba partniorebis winaaRmdeg SemTxvevaSi, magram seqsualuri xasiaTis Zaladobis
mamakacebis mxridan colebze Zaladoba bevrad ufro Camden recidivistTa umciresobis marTva Zalian
xSiria, vidre _ qalebis mier qmrebze Zaladoba. is rTulia (boqsi 26.2). britaneTSi, 1997 wlis aqti
ufro seriozulia fizikuri Sedegebis TvalsazrisiT seqsualuri Zaladobis Sesaxeb (nawili pirveli)
da ufro xSirad aris dafiqsirebuli. im mamakacebis moiTxovs, rom im pirebma, romlebic msjavrdebulni
umetesoba, vinc cols scems, agresiuli pirovnebaa. an gafrTxilebulni iyvnen seqsualuri xasiaTis
fsiqikuri daavadebis mqone pirebis mxolod mcire danaSaulis gamo, unda Seatyobinon policias sakuTari
nawilia moZalade (ZiriTadad depresiuli aSlilobis saxeli da gvari, misamarTi da am monacemebSi momxdari
mqone pirebi). moZalade mamakacebis gavrcelebuli nebismieri cvlilebebi. policia am monacemebs inaxavs
maxasiaTeblebia avadmyofuri eWvianoba da alkoho e.w. seqsualuri xasiaTis kanondarRvevis reestrSi.
lizmi. aseT mamakacebs SesaZloa, bavSvobaSi Tavad yvelaze gavrcelebuli seqsualuri xasiaTis dana
hqondeT gancdili Zaladoba da iseT garemoSi izr Sauli aris qalebze uxamsi Tavdasxma, uxamsi gaSiSvleba
debodnen, sadac Zaladoba xSiri da dasaSvebia. Tumca da 16 wlamde gogonebTan arakanonieri seqsualuri
msxverplma Tavis qceviT SeiZleba xeli Seuwyos aqti. zogierTi seqsualuri xasiaTis danaSauli ar
an provocireba gaukeTos (magram ar dasturdeba) Seicavs fizikur Zaladobas (mag., uxamsi gaSiSvleba,
Zaladobas, amis Sefaseba xSirad rTulia mxolod vuaierizmi da seqsualuri xasiaTis danaSaulis ume
_ 786 _
iyvenen da, ZiriTadad, Zaladoben iseT bavSvebze,
boqsi 26.3 zogierTi faqtori, romelic
romlebsac kargad ar icnoben. pedofilebs iSviaTad
dakavSirebulia seqsualuri xasiaTis
aqvT raime fsiqikuri daavadeba. xSirad, pedofilebis
danaSaulis Camden pirebSi danaSaulis
ganmeorebis gazrdil riskTan mier msxverplis mizanSi amoReba didi xnis ganmav
lobaSi xdeba. zogi pedofili SeiZleba ecados
w kriminaluri istoria
iSovos samsaxuri iseT adgilas, sadac bavSvebi misi
w seqsualuri xasiaTis danaSaulis maRali sixSire da
erTze meti tipis seqsualuri danaSauli mzrunvelobis qveS imyofebian.
w bavSvobaSi seqsualuri Zaladobis msxverplad yofna pedofilebis klasificireba rTulia, Tumca maTSi
w Zaladobrivi seqsualuri fantaziebi Semdegi jgufebia gamoyofili:
w qalebis mimarT negatiuri damokidebuleba w morcxvi da seqsualur sferoSi gamoucdeli pirebi
w rwmena, rom msxverpli Tanxmobas acxadebs seqsualur
aqtze an moswons es aqti w daswavlis darRvevis mqone adamianebi
w msxverplis xelmisawvdomobis gaadvileba Sesabamisi w isini, visac gamoucdia normaluri seqsualuri
adgilis da saqmianobis SerCeviT
urTierToba, magram amjobinebs seqsualur urTi
w sadomazoxisturi an pedofiluri pornografiis
gamoyeneba erTobas bavSvebTan
w fsiqotropuli nivTierebebis arasworad moxmareba w borotmoqmedTa jgufi, romelmac SeiZleba Zala
w daumorCilebloba mkurnalobis mimarT doba ixmaros.
Gordon and Grubin, 2004
pedofiluri seqsualuri aqtivoba iSviaTad mTavr
tesoba, romelic bavSvebTan aris dakavSirebuli). deba mkvlelobiT.
sxva saxis danaSauli SeiZleba Seicavdes Zaladobas rogorc zemoT iyo aRniSnuli, bavSvze seqsualuri
(mag., gaupatiureba). me-19 TavSi ganxilulia iseTi Zaladobis ganmxorcielebeli yvela adamiani ar
SemTxvevebis mkurnaloba, romlebic gulisxmobs aris pedofili, radgan maT did nawils ar aqvs
araZaladobriv seqsualuri xasiaTis danaSauls, xo seqsualuri interesi uSualod bavSvebis mimarT.
lo sasamarTlo aspeqtebi am TavSia ganxiluli. bevr bavSvze seqsualur moZalades aqvs `normaluri~
mimoxilvisTvis ix. Hale et al., 2000; Gordon, Grubin, 2004. heteroseqsualuri istoria da SeiZleba imyofebodes
seqsualuri xasiaTis Zaladobis fsiqologiuri Se kidec `normalur~ seqsualur kontaqtSi danaSaulis
degebi msxverplis poziciidan ?? gverdzea ganxiluli. Cadenis dros. pedofilebi, romlebic bavSvTan
seqsualuri Zaladoba bavSvebze qvemoTaa mimoxiluli. dakavSirebiT axorcieleben seqsualuri xasiaTis
danaSaulebriv aqts, rogorc wesi, bavSvebisTvis
seqsualuri Zaladoba bavSvebze ucnobi pirebi arian. maT xeli miuwvdebaT bavSvebze
sxvadasxva qveyanaSi seqsulur kontaqtze Tanxmobis garkveuli socialuri aqtivobis an maT mierve arCeuli
asaki gansxvavebulia. inglissa da uelsSi arakanonieria samsaxuris wyalobiT. Tumca, bavSvebTan dakavSirebuli
heteroseqsualuri aqtis ganxorcieleba 16 wladme seqsualuri xasiaTis danaSaulis umetesoba mainc
asakis adamianTan, an homoseqsualuri aqti 18 wlamde Cadenilia im mamakacebis mier, romlebic, bavSvTan,
asakis adamianTan (boqsi 26.3). xSirad registrirdeba garkveul naTesaur kavSirSi imyofebian. Zalian xSirad
bavSvebTan dakavSirebuli seqsualuri Zaladobis isini bavSvis maminacvals an gafarToebuli ojaxis
SemTxvevebi. am tipis Zaladoba, britaneTis masStabiT, wevrs warmoadgenen. aseTi mamakacebi, Cveulebriv,
daaxloebiT yvela registrirebuli seqsualuri ar arian pirveladi pedofilebi, Tumca arsebobs
xasiaTis danaSaulis naxevars Seadgens. danaSaulis mosazreba, rom zogierTi pirveladi pedofili
mravali SemTxveva SeiZleba ar dafiqsirdes. es cdilobs daqorwindes zrdasrul qalze, romelsac
gansakuTrebiT im SemTxvevebs exeba, romelic ojaxis Svilebi hyavs, raTa potenciuri msxverpli TavisTvis
SigniT aris Cadenili. danaSaulis SemTxvevebi xelmisawvdomi gaxados.
gansxvavdeba formis simZimiT (dawyebuli msubuqi zogierTi mkvlevari amtkicebs, rom mamakacebis
uxamsobiT da damTavrebuli seriozuli agresiuli nawili, romelic TiTqosda, intress iCens zrdasruli
qceviT), magram maTi ZiriTadi umetesoba ar moicavs qalebis mimarT, aseve maTi SvilebiTaa dainteresebuli.
Zaladobas. zogierTi Teoretikosis azriT, moZaladeebs aRel
zrdasruli pirebi, romlebic bavSvebis winaaRm vebT da izidavT bavSvebis mowyvladoba da gansxvaveba
deg seqsualur Zaladobas Cadian, SeiZleba warmo ZalaSi bavSvebsa da zrdasrulebs Soris da ara
adgendnen an ar warmoadgendnen pedofilebs. pedo bavSvebisTvis damaxasiaTebeli fizikuri Tvisebebi.
filebs aqvT pirveladi seqsualuri interesi pu ojaxis wevrebis mier bavSvebze seqsualuri Za
bertatis wina periodSi myofi bavSvebis mimarT. ladoba ganxilulia gv. ??.
pedofilebi TiTqmis yovelTvis mamakacebi arian. danaSaulis prognozireba rTulia. patimrobamisjil
isini, SeiZleba, homoseqsualebi an heteroseqsualebi pirebSi, recidivis maCvenebeli samidan erTia. miu
_ 787 _
xedavad imisa, rom damnaSaveebis umetesoba, naklebad nitur-bihevioruli Terapiis efeqturoba, romelic
seriozuli danaSaulis Cadenis Semdeg iSviaTad sCadis erTi wlis ganmavlobaSi danaSaulis ganmeorebis Sem
ufro mZime danaSauls, mcire nawili mainc amJRavnebs cirebaSi gamovlinda (NNT=6). (Kenworthy et al., 2004).
Zaladobrivi seqsualuri xasiaTis danaSaulebriv aseve, rekomendebulia antiandrogenebis gamoyeneba
qcevas, ris gamoc saintereso xdeba fsiqiatris azri, (ciproteroni da medroqsiprogesteroni), magram maT
Tu ramdenad saSiSia damnaSave. Tan axlavs mravali arasasurveli efeqti. naCvenebia
SedarebiT maRali tolerantoba maluTinizirebeli
gamokvleva rilizing hormonis agonistis mimarT, magram mimdi-
ZiriTadad moZaladisa da msxverplis gamokvleva nare kvlevebs meTodologiuri sisusteebi axasiaTebs
xdeba calcalke sxvadasxva pirovnebis mier. bavSvebis (Birken et al., 2003). garda amisa, am tipis mkurnaloba
interviuireba seqsualuri Zaladobis aqtis Semdeg eTikur sakiTxebs warmoSobs.
?? gverdzea ganxiluli. aq mocemulia intervius
mimoxilva zrdasrul pirebTan. rodesac fsiqiatri uxamsi gaSiSvleba
cdilobs imis dadgenas, arsebobs Tu ara danaSaulis es iuridiuli termini aRniSnavs danaSauls, romelic
ganmeorebis Sansi da mosalodnelia Tu ara mo gulisxmobs genitaliebis uxamsad gaSiSvlebas meore
Zaladisgan ufro seriozuli danaSaulis Cadena, adamianis winaSe da moicavs gaSiSvlebis yvela formas.
man pirvel rigSi unda gaiTvaliswinos werilobiTi SeiZleba iTqvas, rom egzibicionizmi yvelaze ufro
Cvenebebi da msxverplis ganacxadi, raTa moipovos gavrcelebuli formaa, magram gaSiSvleba, SeiZleba,
informacia Semdeg sakiTxebze: aseve gulisxmobdes seqsualuri aqtis SeTavazebas,
w warsulSi ganxorcielebuli konkretuli xasiaTis seqsualuri Zaladobis preludias an Seuracmyofel
seqsualuri qmedebis xangrZlivoba da sixSire Jests. egzibicionizmi (ix. aseve gv. ??) aris im adami-
(unda gvaxsovdes rom pedofilebi xSirad uaryofen anis qcevis samedicino saxelwodeba, romelic iRebs
danaSauls). seqsualur kmayofilebas sawinaaRmdego sqesis adami-
anebis win ganmeorebiTi gaSiSvlebiT. inglissa da
w damnaSavis dominanturi seqsualuri prioritetebi.
uelsSi uxamsi gaSiSvleba yvelaze xSiri seqsualuri
Tu dadginda, rom pirovnebas mxolod pedofiluri
xasiaTis danaSaulia. igi gavrcelebulia 25-35 wlis
gadaxrebi da pedofiluri qceva axasiaTebs, es
mamakacebSi. amgvari qceva iSviaTad axasiaTebs fsiqi-
ganmeorebis maRal riskze miuTiTebs. asakovani
kuri aSlilobis mqone adamianebs an kriminalebs, Tum-
pedofilebi naklebad agresiulni arian.
ca egzibicionistebi SeiZleba xmarobdnen fsiqoaqti-
intervius dros unda ganisazRvros ur nivTierebebs maT SeiZleba kompulsuri aSliloba
w seqsualuri cxovrebis istoria axasiaTebdeT. egzibicionizmi DSM-IV-Si da ICD-10-Si
w miRebuli hqonda Tu ara pirovnebas alkoholi an fsiqikur aSlilobad ganixileba. miuxedavad imisa,
narkotikuli nivTiereba danaSaulis Cadenisas. rom mraval damnaSavesTan danaSaulebrivi qceva aRar
Tu es asea, mosalodnelia Tu ara, rom mocemuli meordeba, damnaSaveTa garkveul raodenobasTan is
pirovneba gaagrZelebs maT moxmarebas mainc ganmeorebiT iCens Tavs. es ukanakneli katego-
ria, SeiZleba, ufro seriozuli seqsualuri danaSau-
w sinanuli an danaSaulis grZnoba
lisaken gadaixaros.
w danaSaulTan dakavSirebuli stresuli garemoebebi
da imis albaToba, rom es garemoebebi momavalSic uxamsi Tavdasxma
iarsebebs es termini aRniSnavs qcevis farTo speqtrs, dawye-
w bavSvebze xelmisawvdomobis xarisxi buli ucxo adamianis TeZoebze xelis Sexebis mcde-
w fsiqikuri aSlilobis an Sesabamisi personologiuri lobiT, damTavrebuli seqsualuri TavdasxmiT, va-
Tvisebebis maniSneblebi. daskvnebis gakeTebisas ginaluri aqtis ganxorcielebis mcdelobis gareSe.
mniSvnelovania gvaxsovdes, rom fsiqiatriuli codna fsiqiatrebs yvelaze xSirad ekiTxebian profesiul
qcevis am formis Sesaxeb sakmaod SezRudulia. rCevas mozard biWebTan da mamakacebTan dakavSire-
biT, romlebic, warsulSi, bavSvebs dasxmian Tavs. mi-
mkurnaloba uxedavad imisa, rom mravali mozardi ymawvilis qce-
mkurnaloba mimarTulia nebismier asocirebul vas SeiZleba ùxamsi~ vuwodoT, seriozuli xasiaTis
fsiqikur aSlilobaze. seqsualuri qcevis pirdapiri uxamsi qceva asocirebulia pirovnebis agresiul Tvi-
mkurnaloba rTulia. jgufuri Terapia, romelic sebebTan, gaunaTleblobasTan, socialuri unarebis
xorcieldeba erToblivad fsiqikuri janmrTelobis naklebobasa da, zogjer, daswavlis sirTuleebTan.
da probaciis servisebis mier, SeiZleba Sedegiani mkurnaloba danaSaulTan dakavSirebul problemebze
aRmoCndes. bolo sistemurma mimoxilvam aCvena kog aris mimarTuli.
_ 788 _
devna an partniori hyavs. daaxloebiT naxevari ver axerxebs

Tavdasxmis dros seqsualuri aqtis ganxorcielebas.
araprofesiuli termini `devna~ gulisxmobs konkre-
moZaladeebi xSirad adrec yofilan msjavrdebul-
tuli msxverplis miznad amoRebas, misTvis arasasur-
ni araseqsualuri xasiaTis Zaladobrivi danaSaulis
vel da Tavs moxveul ganmeorebad devnas, rac gamoi-
gamo.
xateba adevnebiT an sxvagvari SeviwrovebiT (ix. Mullen
gaupatiurebis aqtebi gansxvavdeba moZaladesa da
et al., 2000). mdevaris qceva gviCvenebs, rom igi Sepyro-
msxverpls Soris urTierTobis mixedviT. moZalade-
bilia azrebiT msxverplis Sesaxeb. am qcevis speqtri
ebis umetesoba icnobs Tavis msxverpls da, farTod
vrcelia da moicavs
gavrcelebuli azris sawinaaRmdegod, ucnobi adami-
w ukan gayolasa da adevnebas;
anis gaupatiureba iSviaTad xdeba. ucxo adamianis
w komunikacias telefoniT, fostiT; eleqtronul gaupatiureba ufro xSirad fizikurad Zaladobrivia
komunikacias da SeiZleba iaraRis gamoyenebiT xorcieldebodes. es
w nivTebisa da momsaxurebis SekveTas msxverplis sa- SeiZleba asaxavdes im faqts, rom moZaladeebs, rom-
xeliT lebic icnoben TavianT msxverpls, ar sWirdebaT fi-
w agresiasa da muqaras, romelSic Sedis Zaladoba, sa- zikuri muqara maT samarTavad. samagierod, SesaZle-
kuTrebis dazianeba da ciliswameba. belia ojaxis wevrebis mimarT muqaris ganxorcieleba.
gaupatiureba umetesad ojaxSi xdeba (kidev erTi fa-
mdevarebi umetesad mamakacebi arian, xolo maTi
qti, romelic gavrcelebuli azris sawinaaRmdegoa).
msxverpli _ qalebi. msxverpli mudmivad ganicdis
(boqsi 26.4).
mwvave distress. aseTi SemTxvevebis marTva moiTxovs
sasamarTlo fsiqiatrebisa da kriminaluri marTlm- epidemiologia
sajulebis sistemis TanamSromlobas, raTa moxdes
gaupatiureba da qalebze mimarTuli seqsualuri
riskebis Sefaseba, am daavadebasTan dakavSirebuli
agresiis sxva formebi savaraudod bevrad aRemateba
nebismieri fsiqikuri aSlilobis (mag., erotomaniis)
policiis mier dafiqsirebul monacemebs (boqsi 26.3).
mkurnaloba da msxverplis mkurnaloba da dacva. (mi-
gaupatiurebis dafiqsirebuli SemTxvevebidan mxo-
moxilvisTvis ix. Mullen, 2000 da Tavi 13).
lod erTi mesamedis gamoZieba xdeba policiis mier
gaupatiureba da amaTgan mxolod erTi mesamedi ismineba uzenaes sa-
samarTloSi. maSinac ki, realurad arsebobs samidan
inglisis samarTlis mixedviT, pirovneba axorcielebs
mxolod erTi Sansi, rom savaraudo moZalade iqneba
gaupatiurebas Tu
msjavrdebuli. es ufro maSin aris mosalodneli, ro-
w is axorcielebs arakanonier seqsualur aqts (vagi-
desac gaupatiurebis aqti jdeba ucxo adamianis gau-
nalurs an analurs) qalTan an mamakacTan, romelic
patiurebis stereotipSi. nacnobi adamianis msxverp-
seqsualuri aqtis dros ar aris Tanaxma am aqtze
li, xSirad arc Tu ise usafuZvlod, miiCnevs, rom mas
w am saxis aqtis dros man (mamakacma) icis rom igi ar daujereben.
(qali) ar aris Tanaxma seqsualur aqtze an misTvis mamakacebis gaupatiurebis SemTxvevebis sixSire
(mamakacisTvis) sul erTia, Tanaxmaa Tu ara qali se- ucnobia. savaraudod, bevri mamakacis gaupatiureba
qsualur aqtze. ar fiqsirdeba, radgan mamakacs, romelic msxverplis
sxvadasxva qveynis kanonmdeblobiT, gaupatiure- rolSi imyofeba, SeiZleba ar undodes am faqtis gam-
ba ganixileba, rogorc qmedeba, rodesac moZalade JRavneba. iseve, rogorc qalebis gaupatiurebis SemTx-
amyarebs sqesobriv kavSirs msxverplis Tanxmobis ga- vevaSi, mamakacebis gaupatiureba dakavSirebulia meo-
reSe. yvela qveynis kanonmdebloba ar cnobs mamakacis
gaupatiurebas an masze seqsualur Tavdasxmas. zogi boqsi 26.4 qalebze seqsualuri Tavdasxma
qveyana (mag. aSS) damatebiT iTvaliswinebs arasakmaris - danaSaulis britanuli gamokvlevis
Tanxmobas asakis mixedviT (egreT wodebuli `kanoniT
Sedegebi. 2000 wlis gamokvleva
dadgenili gaupatiureba`). inglisis samarTali im mci- w qalebis daaxloebiT 1%-ma ganacxada, rom maTze, bolo
wlis ganmavlobaSi, ganxorcielda ama Tu im tipis
rericxovan samarTlebriv sistemebs miekuTvneba, ro-
seqsualuri Zaladoba
melic aRiarebs gaupatiurebis faqtebs col-qmrul w 0.4%-ma (did britaneTSi daaxloebiT 61000 adamiani)
urTierTobaSi. gaupatiureba Zaladobrivi aqtia. ganacxada, rom isini wina wels gaaupatiures
damnaSaveebi gansxvavdebian gamoyenebuli agresiis w gaupatiurebis SemTxvevebis 45%-Si, Tavdamsxmeli
amJamindeli partniori iyo, xolo SemTxvevebis 8%-Si
xarisxis mixedviT, aseve imiT, Tu ra xarisxiT gamoi- _ ucxo piri
yeneba agresia msxverplze kontrolis misaRwevad, an w policiaSi dafiqsirda seqsualuri Tavdasxmis
ramdenad aris agresia TavisTavad amaRelvebeli. xSi- SemTxvevebis 18%
rad moZalade adamianebis umetesoba daqorwinebulia Myhill and Allen, 2002
_ 789 _
re adamianis damcirebis an masze dominantobis sur- prognozi
vilTan. mamakacebis gamaupatiurebeli kacebi xSirad
britaneTSi gaupatiurebisTvis dapatimrebuli moZa
moZalade heteroseqsualebi arian. savaraudod, maT
ladeebi sasjelis mxolod naxevars ixdian cixeSi
axasiaTebT SfoTva sakuTar maskulinur identobasTan
da ganTavisuflebis Semdeg probaciis samsaxuris
dakavSirebiT. zogierTi kvlevis Tanaxmad, mamakacis an
zedamxedvelobis qveS imyofebian. ganmeorebiTi
qalis gaupatiureba dakavSirebulia moZaladis sqeso-
msjavrdebis maCvenebelia 30%. cixeSi maT sTavazoben
brivi identobis problemebTan (ix. Dunseith et al., 2004).
fsiqologiur mkurnalobas, romelic sapatimroSi
mizezebi ganxorcielebuli programis Semadgeneli nawilia
(seqsualur sferoSi damnaSaveTa mkurnalobis
gaupatiurebis fenomenis axsna, ZiriTadad, soci
programa) (SOTP). arsebuli uaxlesi monacemebis
okulturul konteqstSi xdeba, rac gulisxmobs
mixedviT, moZaladeebis mdgomareoba TiTqmis ar
mis ganxilvas mocemul kulturaSi qalis mimarT
gaumjobesebula am programaSi monawileobis Sedegad
damokidebulebisa da qalisa da mamakacis genderuli
(ix. Marques et al., 2005).
rolebis TvalsazrisiT. fsiqologiuri TvalsazrisiT,
mamakacebs, romlebic qalebze Zaladoben, aqvT qalis
bavSvebis gataceba
rolis myari da konservatuli, idealizirebuli xedva,
rasac Tan axlavs nebismieri qalis damcireba, Tu is am bavSvebis gataceba iSviaTi movlenaa. bavSvi SeiZleba
rolSi ar jdeba. moZaladeebi xSirad adanaSauleben moitacos erT-erTma mSobelma, mamakacma (seqsualuri
TavianT msxverpls da amarTleben gaupatiurebas motivi) an ufrosma bavSvma. patara bavSvebs
qalis qcevidan gamomdinare (mag. ìs imsaxurebda ZiriTadad itaceben qalebi, romlebsac samidan
gaupatiurebas, radgan X-s earSiyeboda~.) miuxedavad erT-erTi motivi amoZravebT: Tavisi sawadelis
imisa, rom bevr SemTxvevaSi moZalade icnobs miRweva, meore adamianiT manipulireba da bavSvis
msxverpls da, rogorc Cans, msxverpli Tavidan, raRac impulsurad motaceba, rac fsiqikurad arajansaR
saxiT, monawileobs kidec im movlenebSi, romlebsac qalebs axasiaTebT. sabednierod, motacebuli
danaSauli mohyveba bavSvebis umetesoba mzrunvelobis qveS imyofeba da
(yoveli mexuTe SemTxveva). es ar unda CaiTvalos, maT maleve pouloben.
gaupatiurebis aqtSi msxverplis nebayoflobiT mo
nawileobad. Zalian mcire monacemebi arsebobs im
sakuTrebasTan dakavSirebuli danaSauli
gavrcelebuli mosazrebis dasamtkiceblad, rom maRaziidan nivTebis moparva (Sofliftingi)
gaupatiurebis msxverpli Tavad ubiZgebs moZalades am tipis qurdoba, sxva tipis qurdobis msgavsad,
gaupatiurebisaken an cvlis mis ganwyobas seqsualuri Cadenilia im adamianebis mier, romlebsac saerTod
urTierTobis damyarebasTan dakavSirebiT. gaupa ar aReniSnebaT fsiqikuri aSliloba. bevri mozardi
tiureba SeiZleba dakavSirebuli iyos mZime fsiqikur aRiarebs maRaziidan nivTebis periodulad moparvis
aSlilobebTan. am SemTxvevaSi, Cveulebriv, adgili faqts. dakvirvebis saxiT warmoebuli gamokvleva da
aqvs seqsualur ganmuxruWebas, rac maniakaluri maRaziebis mier dafiqsirebuli didi danakargebi
aSlilobisTvisaa damaxasiaTebeli an fsiqozur imaze miuTiTebs, rom maRaziidan nivTebis moparva
mdgomareobas pranoiduli bodvebiT. dadgenilia, gavrcelebulia zrdasrul pirebSi.
rom moZaladeebis minimum 50% gaupatiurebis aqtis Soflifterebis umciresobas axasiaTebs fsiqiat
dros fsiqoaqtiuri nivTierebebis zemoqmedebis qveS riuli aSliloba, Tumca, zogjer, Sofliftings,
imyofeba. gaupatiurebis bevr SemTxvevaSi, msxverpl depresiuli aSlilobis da sxva fsiqiatriuli diag
Tanac da moZaladesTanac dadgenilia narkotikebis nozebi ukavSirdeba (Lamontagne, 2000). fsiqikuri
an alkoholis gamoyenebis faqtebi. es SeiZleba daavadebis mqone nebismierma pacientma SeiZleba
imaze miuTiTebdes, rom gaupatiurebis mravali iqurdos ekonomikuri saWiroebidan gamomdinare.
scenari garkveul socialur situaciaSi iwyeba, es exeba gansakuTrebiT im adamianebs, romlebic
romelSic orive mxare monawileobs. zog mamakacs, fsiqoaqtiur nivTierebebs moixmaren. socialurad
romelic axorcielebs gaupatiurebas, mkvlelobas ganmuxruWebul pacientebs, metad axasiaTebT impu
an sxva Zaladobriv danaSauls, aReniSneba garkveuli lsuri qurdoba. kvebiTi aSlilobis mqone pacientebma
seqsualuri xasiaTis problemebi an eWvianoba seq SeiZleba saWmeli moiparon. sxva SemTxvevaSi, Sof
sualur niadagze. yvela am faqtoris gamo aseTi liftingi, SeiZleba, uyuradRebobis Sedegs war
mamakacebi sxvebisTvis saSiSroebis Semcvelni arian. moadgens (mag., organuli fsiqikuri aSliloba, romlis
mamakacebis mcire jgufi iRebs seqsualur siamovnebas drosac adamiani dabneuli an gulmaviwyia an panikis
sadisturi Tavdasxmebisgan im partniorebze, romlebic Seteva, romlis drosac adamiani SeiZleba maRaziidan
winaaRmdegobas uweven maT (ix. Dunseith et al., 2004). gaiqces nivTis safasuris gadauxdelad).
_ 790 _
danaSaulis msxverplad yofnis fsiqiatriuli aspeqtebi
SofliftingSi braldebuli adamianis gamokvleva fsiqiatriuli intervenciis speqtri SezRudulia.
iseve xdeba, rogorc nebismieri sxva adamianisa, xanZris gamCenTa marTva saavadmyofos SigniT moiTxovs
romelsac sxva saxis sasamarTlo problemebi gaaCnia. Tu detalur dakvirvebas da usafrTxo garemos.
braldebuls aqvs depresiuli aSliloba, gamokvlevis xanZris gaCenis problemebi bavSvebSic gvxvdeba.
dros fsiqiatrma unda daadginos, axasiaTebda Tu normaluri fsiqikis mqone bavSvebSi es qceva xandaxan
ara mas es aSliloba danaSaulis Cadenis dros, Tu is asaxavs gadaWarbebul sicelqes, zogjer jgufur
bralis wayenebis Semdeg ganviTarda. am dros yvelaze aqtivobas, zogjer ki fsiqikuri aramdgradobis
xSiri iuridiuli kiTxvaa, hqonda Tu ara braldebuls _ ufro xSirad ki qceviTi aSlilobis Sedegs
ganzraxuli qurdoba da SeeZlo Tu ara fsiqikur warmoadgens (Martin et al., 2004). im bavSvebSi, romlebic
daavadebas zegavlena moexdina am ganzraxvaze. braldebulni arian xanZris gaCenaSi, momdevno ori
wlis ganmavlobaSi am qcevis ganmeorebis maCvenebeli
xanZris mizanmimarTulad gaCena
10%-ze dabalia.
am danaSauls Zalian did mniSvnelobas aniWeben
ara mxolod imitom, rom man SeiZleba seriozuli
danaSaulis msxverplad yofnis
ziani miayenos sakuTrebas, aramed imitomac, rom is
sicocxlisTvisaa saSiSi. xanZris gamCenebi, ZiriTadad,
fsiqiatriuli aspeqtebi
mamakacebi arian. miuxedavad imisa, rom sasamarTlo kriminologiam da sazogadoebam mxolod cota
bevr maTgans agzavnis fsiqiatriul gamokvlevaze, xnis win miaqcia yuradReba msxverplis rolsa da
fsiqiatriuli literatura xanZris mizanmimarTulad saWiroebebs (mimoxilvisTvis ix. Mezey and Robbins,
gaCenaze mcirericxovania. am danaSaulis CamdenebSi 2000). zogadi populaciis gamokiTxva miuTiTebs, rom
ramdenime jgufs gamoyofen: danaSaulis msxverplad yofnis gamocdileba xSirad
dakavSirebulia geografiul regionTan, sqesTan,
w fsiqikuri aSlilobis armqone pirebi, romlebic
asakTan da socialur CvevebTan. Zalian bevri SemTxveva
xanZars aCenen finansuri an politikuri mizezebis
(gansakuTrebiT seqsualuri da ojaxuri Zaladobis
an SurisZiebis gamo; maT xandaxan moixsenieben,
SemTxvevebi) ar fiqsirdeba, radganac msxverpli
rogorc motivirebul xanZris gamCenebs.
ar amJRavnebs informacias maT Sesaxeb. qalebi da
w e.w. paTologiuri xanZris gamCenebi, romlebsac axa
mamakacebi gansxvavdebian erTmaneTisgan danaSaulis
siaTebT daswavlis sirTuleebi, aReniSnebaT fsi
msxverplad yofnis gamocdilebis TvalsazrisiT.
qikuri daavadeba an alkoholdamokidebuli pirebi
cxovrebiseuli mizezebidan gamomdinare, calkeuli
arian. es jgufi mocemuli populaciis daaxloebiT
pirovnebis mxridan Zaladobis riskis qveS gansa
10-15%-s Seadgens.
kuTrebiT axalgazrda mamakacebi imyofebian, xolo
w mesame jgufi, romelic DSM-IV-is piromaniis kri qalebi ufro xSirad ganicdian ojaxur da seqsualur
teriumebs akmayofilebs (gv. ??), Tumca am diag Zaladobas. britaneTSi azielebsa da afro-kari
nostikuri kriteriumis validuroba ar aris bielebze Zaladobis SemTxvevaTa daaxloebiT erTi
damtkicebuli. am adamianebs xanZris gaCena Zlier meeqvsedi rasizmiTaa motivirebuli.
siamovnebas aniWebs da daZabulobas uxsnis. msxverplis reaqcia mniSvnelovania imis dasadgenad,
Semdgomi grZelvadiani dakvirvebis kvlevebiT dafiqsirebulia Tu ara danaSauli policiaSi da
Sefasda ganmeorebiTi xanZris gaCenis riski (Soothill wayenebulia Tu ara damnaSavis mimarT brali.
et al., 2004). dadginda, rom damnaSaveTa 10%-s kvlav
asamarTleben xanZris gaCenis gamo, xolo daaxloebiT fsiqologiuri zemoqmedeba
naxevars sxva saxis danaSaulis CadenaSi edeba brali. bavSvze Zaladobas da bavSvobaSi Zaladobis gamoc
unda gvaxsovdes, rom xanZris gaCenaSi meored dilebas SeiZleba seriozuli Sedegebi mohyves zrda
msjavrdebul adamians danaSaulis xelaxla Cadenis srul cxovrebaSi (gv. ??).
bevrad ufro maRali riski aqvs. faqtorebi, romlebic danaSaulis zrdasruli msxverpli mravali fsiqo
miuTiTeben xanZris ganmeorebiT gaCenis gazrdil logiuri saxis riskis qveS imyofeba. esaa distresi,
riskze, Semdegia: romelic uSualod mosdevs danaSauls da SemdgomSi
w antisocialuri personologiuri aSliloba gancdili distresi, romelic dakavSirebulia gamo
w daswavlis sirTuleebi ZiebasTan da sasamarTlo mosmenebTan. Zalian xSirad
fiqsirdeba posttravmuli stresuli aSliloba (gv.
w mudmivi socialuri izolacia
??). Zaladobis Sedegebi ufro xSiri da mZimea uSu
w imis damadasturebeli niSani, rom xanZris gaCe alod danaSaulis Semdeg, magram isini, zogjer,
nis mizezi seqsualuri siamovnebis miReba an mravali wlis manZilze iCens Tavs.
daZabulobis moxsnaa.
_ 791 _
danaSaulis tipebi debrifingis meTodis gamoyenebiT ar aris sakmarisi

(Raphael and Wilson, 2000).
mkvleloba
danaSaulis msxverplTa mxardaWera SeiZleba gan
msxverplis naTesavebi Tavs izolirebulad grZnoben. xorcieldes sacxovrebeli adgilis mixedviT.
isini sircxvils ganicdian da ufro metad uWirT mag., britaneTSi houm ofisi (the Home Office _ bri
sxvisTvis sakuTari mZime mdgomareobis gaziareba, taneTSi asrulebs analogiur funqcias, rasac sxva
vidre sxva saxis danakargis SemTxvevaSi. iuridiuli saxelmwifoebis Sinagan saqmeTa saministroebi) afi
procesebis biurokratiuloba aZlierebs brazis gan nansebs msxverplTa mxardaWeris erovnul programas,
cdas da am samyarodan mowyvetilobis SegrZnebas romelic regularul kontaqtSi imyofeba im pirebTan,
(Rock, 1998). romlebic danaSaulis msxverpls warmoadgenen da
mxardaWeras sTavazobs maT. arsebobs, aseve, spe
gaupatiureba
cialuri mosaxureba im pirebis mxardasaWerad, rom
mravali mtkicebuleba metyvelebs imaze, rom gau lebic britaneTis `samefo sasamarTlos~ (Crown Court
patiurebis msxverplTan gaupatiurebis uaryofiTi _ umaRlesi sasamarTlo instancia britaneTSi) winaSe
efeqti SeiZleba Zalian xangrZlivi aRmoCndes (Mezey warsdgebian. aRsaniSnavia, rom es servisebi eyrdnoba
and Robbins, 2000). bolo periodis kvlevam aCvena moxaliseebs, romlebsac ar SeuZliaT xangrZlivi
intensiuri intruziuli azrebisa da sxva post daxmarebisa da specializebuli fsiqiatriuli inter
travmuli simptomebis arseboba gaupatiurebis Sem venciis SemoTavazeba. mag., gaupatiurebis krizisuli
dgomi kviris ganmalobaSi. gaupatiurebis msxverplis centrebis moxaliseTa jgufebi daxmarebas uweven seq
partniorebmac da ojaxis wevrebmac SeiZleba seri sualuri Tavdasxmis msxverpls. danaSaulis msxverpls
ozuli distresi ganicadon. kompensaciis moTxovna SeuZlia, kriminalur garemoSi
aSS-Si gaupatiurebis msxverplTaTvis krizisuli miRebuli dazianebebis sakompensacio sabWosgan
intervenciis mravali centri Seiqmna. es centrebi (Criminal Injuries Compensation Board), fsiqiatrebs SeiZ
multidisciplinuri gundebiTaa dakompleqtebuli. leba sTxovon angariSis momzadeba fsiqologiuri dis
kognitur-bihevioruli Terapiis gamoyeneba karg tresisTvis kompensaciis moTxovnasTan dakavSirebiT.
Sedegebs iZleva (gv. ??).
specialuri momsaxureba
Zarcva da yaCaRoba
danaSaulis msxverplTaTvis xelmisawvdomi unda
marTalia, Zarcvasa da yaCaRobaze reaqcia naklebad iyos specialuri fsiqiatriuli gamokvlevisa da
mwvavea, vidre Zaladobriv danaSaulze, Tumca, Se mkurnalobis iseTi servisebi, romlebsac msxverp
saZlebelia ganviTardes adaptaciis darRvevebi lisTvis specifikur problemebze muSaobis gamoc
da posttravmuli stresuli aSliloba. msxverpli dileba gaaCniaT. am tipis momsaxurebas SeiZleba
SeiZleba Sepyrobili gaxdes usafrTxoebis sakiTxiT. uzrunvelyofdes TemSi momqmedi araspecializebuli
samsaxurebi, travmaze momuSave specializebuli
teroristuli danaSauli
klinikebi an, zogjer, viwro specializaciis mqone
bevri angariSia gamoqveynebuli teroristuli dana
samsaxurebi (mag. klinikebi, romlebic gaupatiurebis
Saulis Sesaxeb (srola, dabombva, tyved ayvana). yvela
msxverplTan muSaoben).
maTganSi dafiqsirebulia mwvave distresi post
travmuli stresuli aSlilobiT, romelic uSualod rutinuli fsiqiatriuli samsaxuri
mosdevs teroristul aqts da sxva fsiqiatriuli pirovnebis Sefasebisas, fsiqiatriul servisebSi gag
Sedegebi, romlebic msxverplTa umciresobaSi per zavnis mizniT, aucilebelia, vkiTxoT mas msxverplad
sistentul xasiaTs atarebs. yofnis gamocdilebis Sesaxeb, vinaidan es informacia
mniSvnelovania rogorc daavadebis etiologiisTvis,
sxva saxis danaSauli
aseve mkurnalobis dagegmisTvis.
msxverplis distresi aseve Zlierad aris gamoxatuli
mravali sxva saxis danaSaulis dros, romelSic Sedis
ojaxuri Zaladoba, samsaxurSi Zaladoba da devna.
fsiqiatris roli sisxlis samarTlis
sasamarTloSi
marTva fsiqikuri mdgomareoba, ganzraxva da
fsiqologiuri problemebis simZime da stabiluroba pasuxismgebloba
miuTiTebs msxverplisTvis rogorc rutinuli, ise iurisdiqciebis umetesoba iTxovs danaSaulebrivi
specialuri daxmarebis gawevis saWiroebaze. mkur ganzraxvis mtkicebulebas imisaTvis, rom damnaSaves
nalobis Catareba mxolod kritikuli incidentis sasjeli miesajos. aqedan gamomdinare, fsiqiatrebs
_ 792 _
fsiqiatris roli sisxlis samarTlis sasamarTloSi
yvelaze xSirad ekiTxebian azrs imis Taobaze, iqonia sasamarTlo garCevaSi monawileobis miRebis
Tu ara zegavlena fsiqikurma daavadebam braldebulis unari
ganzraxvaze Caedina esa Tu is danaSauli. adamiani ar
es sakiTxi SeiZleba warmoiSvas nebismier braldebasTan
unda CaiTvalos damnaSaved, Tu mas ar SeeZlo sakuTari
dakavSirebiT. bevri iurisdiqcia iTxovs, rom bral
qcevis marTva da Tu mis mier Cadenili arakanonieri
debuli sakmarisad janmrTeli iyos, raTa moaxerxos
qmedeba mis arCevans ar warmoadgens. am sakiTxis
sakuTari Tavis dacva. inglisis kanonSi am sakiTxs
garkveva fsiqiatris konsultacias saWiroebs.
ewodeba ùnari warsdge sasamarTlos winaSe~ da misi
adamianis damnaSaveobis gasazRvrisTvis saWiroa
wamoweva SeuZlia damcav mxares, bralmdebel mxares
gaviTvaliswinoT misi fsiqikuri mdgomareoba da,
an mosamarTles. xolo gadawyveta mxolod nafic
gansakuTrebiT, misi ganzraxva Tavad aqtis gan
msajulebs SeuZliaT. aucileblad unda dadgindes,
xorcielebis dros. anglosaqsonur iurisdiqciebSi
Tu ramdenad Seswevs unari braldebuls:
ganzarxvis teqnikuri terminia mens rea (damnaSave
w gaigos braldebis arsi;
goneba). ganzraxva sxvadasxva mniSvnelobiT ixmareba,
magram misi arsi SemdegSi mdgomareobs: adamiani w esmodes gansxvaveba sakuTari Tavis damnaSved
aRiqvams da moelis, rom misi qmedeba arakanonier cnobasa da udanaSualod cnobas Soris;
Sedegebs gamoiwvevs. ganzraxvis sami sxva forma w gaacnos advokats saqmis viTareba;
damatebiT ganxilvas saWiroebs: w acileba misces nafic msajulebs;
1. arapirdapiri ganzraxva. rodesac piri midis ga w Tvali miadevnos sasamarTloSi warmodgenil
umarTlebel riskze, gulgrilad ekideba Sedegs. mtkicebulebas.
iTvaliswinebs marTlsawinaaRmdego Sedegis dad
braldebuls SeiZleba aReniSnebodes mZime fsiqikuri
gomis SesaZleblobas, Tumca ar surs es Sedegi.
aSliloba, magram mainc hqondes sasamarTlos winaSe
2. `daudevroba~ (negligence). mocemuli qmedeba gani wardgomis unari.
sazRvreba iseTi SedegiT, romelsac `moazrovne pirovneba SeiZleba cnon uunarod sasamarTlo
da frTxili~ adamiani winaswar ganWvretda da procesze dasaswrebad `kriminaluri procedurebisa
airidebda. da fsiqikuri daavadebis (sasamarTlo procesze
3. `SemTxveviToba~ (an ùdanaSaulo uyuradReboba~) daswrebis uunarobis) 1991 wlis aqtis~ pirobebis
(Accident or blameless inadvertence). mixedviT. Tu aRmoCndeba, rom pirovnebas ar SeuZlia
pasuximsgeblobasTan dakavSirebuli mTavari sakiTxi sasamarTloze daswreba, sasamarTlo gamarTavs
SemdegSi mdgomareobs: hqonda Tu ara braldebuls `faqtebis sasamarTlo process~ imis dasadgenad,
ganzraxvis Camoyalibebis unari an SeeZlo Tu ara Caidina Tu ara man danaSauli. Tu danaSauli ar
fsiqikur aSlilobas am unarze emoqmeda. xandaxan aris seriozuli, sasamarTlom SeiZleba gasces
pasuxi am kiTxvaze fsiqiatriuli eqspertizis an brZaneba, rom damnaSaves Cautardes mkurnaloba,
mtkicebulebis miRma imyofeba. fsiqiatrs, romelsac xSirad ambulatoriul pirobebSi. im SemTxvevebSi,
azris gamoTqmas sTxoven mocemuli sakiTxis Ta rodesac danaSauli seriozulia an gulisxmobs au
obaze, mWidro TanamSromloba uwevs samarTlis cilebel sasjels (mag., mkvleloba), sasamarTlo ga
specialistebTan. daamisamarTebs damnaSaves saavadmyofoSi mosaTav
seblad, ganusazRvreli vadiT. Tu pirovnebas aqvs
bavSvebi sasamarTloze daswrebis unari, igi SeiZleba kvlav
kanonmdeblobiT iTvleba, rom braldebulis asaki daaswron sasamarTlo mosmenaze. dakaveba, romelic
zemoqmedebs danaSaulebrivi qcevis ganzraxvis Ca mosdevs im faqtis dadgenas, rom pirovnebas ar aqvs
moayalibebis unarze. bevri qveynis kanonmdebloba sasamarTloze daswrebis unari (anu Seuracxadia _ ix.
ar akisrebs garkveul asakze mcirewlovan bav qvemoT) iseTive saxiT moqmedebs, rogorc dakaveba,
Svebs kriminalur msjavrdebas. mag., inglisis kanon romelic mohyveba gadaadgilebis akrZalvis brZanebas.
mdeblobaSi ar vrceldeba msjavrdeba 10 wlam
Seuracxadoba (udanaSauloa Seuracxadobis
de asakis bavSvebze, radgan iTvleba, rom maT ara
mizeziT)
aqvT kriminaluri ganzraxvis Camoyalibebis un
ari. Sesabamisi laTinuri terminia doli incapax am tipis dacva Seesabameba nebismier braldebas. is
(danaSaulisTvis uunaro). 10-dan 14 wlamde bavSvebs ZiriTadad eyrdnoba im debulebas, rom eWvmitanils
SeiZleba miesajoT sasjeli, Tu saqme gvaqvs mens rea-s braldebis wasayeneblad aklia mens rea, radgan
mtkicebulebasTan da, aseve, imis damadasturebeli igi Seuracxadia. am termins araferi aqvs saerTo
niSanic aSkaraa, rom bavSvma icoda _ danaSauli diagnostikur terminebTan da kategoriebTan, rom
iuridiulad an moralurad dauSvebelia. lebic, mag., ICD-10-Si an DSM-IV-Sia Setanili. Seu
_ 793 _
racxadoba sxvadasxva qveynis kanonmdeblobaSi sxva Tu adamiani klavs meore adamians an monawileobs
dasxvagvaradaa gasazRvruli da Seuracxadobis dad meore adamianis mkvlelobaSi, igi ar iqneba msjavr
genas, rogorc wesi, mosdevs cixis nacvlad bral debuli mkvlelobaSi, Tu mas aReniSneba iseTi
debulis moTavseba samkurnalo dawesebulebaSi. zo fsiqikuri paTologia (gamowveuli fsiqikuri
gierTi qveynis kanondeblobiT verdiqts ùdanaSauloa ganviTarebis SeferxebiT, an CamorCenilobiT, an
Seuracxadobis mizeziT~ SeiZleba ufro rbili Tandayolili mizezebiT an kidev daavadebiTa an
sasjeli mosdevdes. travmiT), romelmac mniSvnelovnad daaqveiTa misi
maknoTenis (MacNaughten) cnobili SemTxvevis Sem fsiqikuri unari agos pasuxi sakuTar qcevebze da
deg, inglisis kanonmdeblobaSi Seuracxadoba gan umoqmedobaze mkvlelobis Cadenisas an mkvlelobaSi
sazRvrulia maknoTenis wesebis mixedviT. maknoTenma monawileobis dros.
1843 wels gasroliT mokla edvard drumondi, am gansazRvrebas garkveuli sirTuleebi ukavSi
premier ministr ser robert pilis piradi mdivani. rdeba. `fsiqikur paTologias~ araferi aqvs saer
sasamarTlo procesze waradgines Seuracxadobis To diagnostikur kategoriasTan; es SeiZleba
mtkicebuleba, radgan maknoTens devnis bodviTi iyos nebismieri ram, rasac `moazrovne adamiani~
ideebi aReniSneboda. maknoTenma, romlis bodviTi aranormalurs uwodebda. igi sxvadasxvagvaradaa in
sistema Torebis partiaze iyo fokusirebuli, terpretirebuli. mogebul sasamarTlo procesebSi
gadawyvita moekla partiis lideri ser robert dacva miuTiTebs iseTi mdgomareobebis arsebobas,
pili (West, 1974). maknoTeni udanaSaulod cnes rogoricaa èmociuri moumwifebloba~, `fsiqikuri
Seuracxadobis safuZvelze da beTlemis hospitalSi arastabiluroba~, `fsiqopaTiuri pirovneba~, `reaq
moaTavses. radgan es sakamaTo gadawyvetileba tiuli depresiuli mdgomareoba~, `depresiis,
iyo, imdroindelma mosamarTleebma Seadgines imedgacruebis da risxvis Sereuli emociebi~ da
garkveuli wesebi, romlebic ar Sevida kanonSi, `premenstrualuri daZabuloba~.
magram Camoyalibda saxelmZRvanelo principebis kavSiri fsiqikur paTologias da pasuxismgeblobas
saxiT. imisaTvis, rom dacva aigos Seuracxadobis Soris ar aris empiriulad dadgenili da ar aris
safuZvelze, Zalian naTlad unda iyos damtkicebuli, aucilebeli, rom fsiqiatri am sferos eqsperti iyos.
rom aqtis ganxorcielebis dros braldebuli mxare samarTlebriv aspeqtze komentaris gakeTebisas xSirad
moqmedebda fsiqikuri daavadebiT gamowveuli iseTi gamoiTqmis mosazreba, rom pasuxismgeblobasTan
gonebrivi aSlilobis gavleniT, rom ar esmoda dakavSirebuli nebismieri daskvna nafici msajulebis
sakuTari qmedebis arsi da buneba, xolo Tuki esmoda gamosatania da rom es ar aris eqspertuli mtki
isini, ver acnobierebda Tavisi saqcielis simcdares. cebulebis sakiTxi. da mainc, fsiqiatrebs SeiZleba
ramdenime sxva iurisdiqcias (amerikis ramdenime sTxovon gamoTqvan sakuTari mosazreba am sakiTxis
Stati da avstralia), Seuracxadobis sakuTari ga garSemo.
sazRvrebis safuZvlad maknoTenis wesebi aqvs aRebuli.
gamokvleva
mravali kritikosis azriT, es wesebi zedmetad viwroa
da, realurad, fsiqikuri aSlilobis mqone Zalian cota im adamianebis umetesobas, romelsac brali edeba
adamiani akmayofilebs maT kriteriumebs. marTlac, mkvlelobaSi, fsiqiatriuli gamokvleva utardeba. mas
saeWvoa, ramdenad akmayofilebda Tavad maknoTeni xSirad atarebs sasamarTlo fsiqiatriis specialisti,
am kriteriumebs. zog qveyanaSi Seuracxadobaze zogjer ki zogadi fsiqiatri. dacvis advokatebi
agebul dacvas xSirad maSin iyeneben, roca fsiqikuri xSirad damoukidebel fsiqiatrs mimarTaven. mizan
daavadebis mqone adamiani braldebulia danaSaulSi, Sewonilia, rom am saqmeSi CarTuli eqimi, imis
gansakuTrebiT mkvlelobisa da Zaladobrivi qme miuxedvad, visi mxridan monawileobs dacvis Tu
debis gamo. inglisis kanonSi iSviaTad gamoiyeneba bralmdeblis, gaecnos saqmis viTarebas. iSviaTia,
Seuracxadobaze agebuli dacva, ZiriTadad SezRudul rom amaze Tanxmoba ver miiRos. angariSis aslebi
pasuxismgeblobaze agebuli alternatiuli dacvis urigdebaT mosamarTleebs, bralmdebel mxares da
arsebobis gamo (ix. qvemoT). dacvis advokatebs. igive procedurebi gamoiyeneba
sxva saxis danaSaulis drosac, romelic fsiqiatris
SezRuduli pasuxismgebloba mosazrebis mosmenas saWiroebs.
zogierT iurisdiqcias Semoaqvs SezRuduli pasuxis Tu fsiqiatriuli mtkicebuleba, romelic adas
mgeblobis kategoria, anu danaSauli SeiZleba Sem turebs SezRudul pasuxismgeblobas, miRebulia
subuqdes iseT SemTxvevaSi, Tu pirovnebas fsiqikuri sasamarTlos mier, maSin, savaraudod, braldebuli
daavadeba aReniSneba. inglisis kanonmdeblobaSi es msjavrdebuli iqneba sicocxlis mospobaSi gaufrTxi
kategoria mxolod mkvlelobaSi braldebas mie leblobiT da ara ganzrax mkvlelobaSi. Tuki
sadageba. msjavrdebas ganzrax mkvlelobaSi Sedegad mosdevs
_ 794 _
fsiqiatris roli sisxlis samarTlis sasamarTloSi
savaldebulo samudamo patimroba, braldebas si gamoikvlion damnaSaveebi da gansazRvron, arian
cocxlis mospobaSi gaufrTxileblobis gamo SeiZ Tu ara isini fsiqikurad sakmarisad janmrTelni,
leba mohyves sxvadasxva tipis sasjeli _ pir imisaTis, rom maT mimarT damsjelobiTi RonisZiebebi
obiTi sasjelidan, samudamo patimrobamde. sxva gamoiyenon. gamokvlevis Catarebis garda, fsiqiatrebs
iurisdiqciebSi fsiqiatriulma mtkicebulebam, rome SeiZleba sTxovon umkurnalon damnaSave pacientebs,
lic asabuTebs SezRudul pasuxismgeblobas, SeiZleba raTa maTi janmrTelobis mdgomareoba dasjis an
imoqmedos ganaCenze, miusjian Tu ara damnaSaves sikvdiliT dasjis Sesaferisi gaxadon. im qveynebSi,
sikvdils. sadac es sakiTxi aqtualuria (mag., aSS), sakmaod
britaneTSi, damnaSaveebi, romlebic msjavrdebulni seriozuli debatebia gamarTuli eTikuri dilemis
arian sicocxlis mospobaSi gaufrTxileblobis ga garSemo. zogi avtori Tvlis, rom fsiqiatrebis
mo, fsiqikuri janmrTelobis Sesabamisi kanonis mi CarTva amgvar procedurebSi araeTikuria.
xedviT SeiZleba iZulebiT gaamweson saavadmyofoSi.
Tu danaSauli gansakuTrebiT saSiSia da damnaSave kriminaluri sasamarTlosTvis
safrTxes warmoadgens sazogadoebisTvis, sasamarTlom mniSvnelovani sxva fsiqiatriuli sakiTxebi
SeiZleba gasces gadaadgilebis akrZalvis brZaneba,
amnezia
romlis Tanaxmadac, gaTavisuflebasTan dakavSirebul
seriozul danaSaulSi, gansakuTrebiT ki mkvlelobaSi
gadawyvetilebebSi Sinagan saqmeTa saministrom unda
braldebuli pirebis erT mesamedze mets, danaSaulTan
miiRos monawileoba.
dakavSirebul movlenebze garkveuli xarisxis amnezia
axalSobilis mkvleloba sicocxlis mospobis bral
aReniSneba. maT, aseve, uWirT momxdaris srulyofilad
debis konkretuli formaa. aseTi braldeba SeiZleba
gaxseneba. arsebobs mosazreba, rom mexsierebis da
waeyenos mxolod im qalebs, romlebmac mokles
kargva unda CaiTvalos sasamarTloze daswrebis
TavianTi axaldabadebuli Svili (erT wlamde asakis
SeuZleblobis (unfitness to plead) mtkicebulebad,
bavSvi). Tu arsebobs fsiqiatriuli mtkicebuleba, rom
magram es argumentebi yovelTvis warumatebeli
qali fsiqikurad daavadebuli iyo danaSaulis Cadenis
iyo. faqtorebi, romlebic yvelaze xSiradaa dakav
momentSi, maSin mas daedeba brali ara axalSobilis
Sirebuli amneziis arsebobis mtkicebulebasTan,
ganzrax mkvlelobaSi, aramed gaufrTxileblobiT
aris gadaWarbebuli emociuri agzneba, alkoholis
sicocxlis mospobaSi. aseT SemTxvevaSi sasamarTlom
moxmareba, intoqsikacia da mZime depresia. amnezia
SeiZleba gasces brZaneba mis hospitalizaciaze. aseT
unda gavarCioT simulaciisgan, rodesac SeiniSneba
dros gadaadgilebis amkrZalavi orderebi iSviaTad
danaSaulis Sedegebis Tavidan acilebis mcdeloba.
gamoiyeneba. es aris is iSviaTi magaliTi, rodesac
Tumca arsebobs danaSaulTan dakavSirebuli amneziis
inglisis kanonmdebloba oficialurad aRiarebs
realuri SemTxvevebi, zustad iseve, rogorc dana
fsiqikuri daavadebis (konkretulad ki mSobiarobis
Saulis msxverplisa da mowmis mier movlenebis araswori
Semdgomi fsiqozis) rols danaSaulis CadenaSi.
gaxseneba. ufro metic, damnaSavesTan da msxverplTan
ganzarxvis ararseboba (avtomatizmi) amneziasTan dakavSirebuli erTi da igive faqtorebi
garkveul SemTxvevebSi wamoyenebulia mtkicebuleba, moqmedebs. Sesabamisi neirofsiqiatriuli aSlilobis
rom braldebuls saerTod ar hqonda danaSaulis ararsebobis SemTxvevaSi, naklebad mosalodnelia,
Cadenis ganzraxva (mens rea-s ar arseboba), rasac rom amnezia, iuridiuli TvalsazrisiT, mniSvnelovan
avtomatizms uwodeben. amis magaliTia qmedebebi, rom faqtad CaiTvalos (ix. Johns, 2000).
lebic ZilSi siarulisas xorcieldeba. avtomatizmis
yalbi aRiarebebi
retrospeqtulad gansazRvra rTulia da dacva mas
sasamarTlo procesebis Canawerebi da sxva aRwe
iSviaTad emyareba. avtomatizmis sakiTxi SeiZleba
rilobiTi mtkicebuleba aCvenebs, rom zogjer xdeba
warmoiSvas im pacientebTan, romlebic moixmaren
kriminaluri qcevis yalbad aRiareba. miuxedavad imisa,
alkohols an narkotikebs da SesaZlebelia imis
rom aseTi aRiarebebis sixSire ucnobia, gudjonsonma
mtkiceba, rom maT aReniSnebodaT intoqsikacia da,
(Gudjonsson, 1992) SemogvTavaza yalbi aRiarebis sami
aqedan gamomdinare, ver eqnebodaT danaSaulis Cadena
ZiriTadi tipi:
ganzraxuli. kanoni intoqsikaciis Sesaxeb rTulia da
specialistis oficialur konsultacias moiTxovs. 1. nebayoflobiTi
2. iZulebiTi _ dayoliebiTi
janmrTelobis mdgomareoba, romelic iZleva
dasjis gamoyenebis SesaZleblobas 3. iZulebiTi _ internalizebuli
im iurisdiqciebSi, romlebic iTvaliswineben sxe nebayoflobiTi aRiareba SeiZleba momdinareobdes

ulebriv an sikvdiliT dasjas, fsiqiatrebs sTxoven avadmyofuri survilidan, gaiTqva saxeli cu
di saqcielis gamo, faqtebisa da fantaziis erT
_ 795 _
maneTisgan garCevis sirTulidan, danaSaulis grZno saavadmyofoSi, sadac usafrTxoebis zomebia da
bisgan ganTavisuflebis an meore adamianis dacvis culi. am tipis mkurnaloba aseve SeiZleba moi
survilidan. iZulebiTi-dayoliebiT aRiareba SeiZ cavdes iZulebiT ambulatorul mkurnalobas
leba Zaladobrivi dakiTxvis Sedegi iyos. rogorc (Swanson et al., 2000). mkurnalobis dagegmva
wesi, SemdgomSi maTi uaryofa xdeba. iZulebiTi- gulisxmobs ara mxolod Sesabamisi medikamentebis
internalizebuli aRiarebebi keTdeba maSin, roca daniSvnas, aramed, aseve, Sesabamisi fsiqologiuri
gamoyenebulia dakiTxvis iseTi meTodi, rom pirovneba intervenciis organizebas. es gansakuTrebiT exeba
eWvdeba Tavisi mogonebebis WeSmaritebaSi, SeiZleba pacientebs, romlebsac mwvave personologiuri
CaTvalos, rom arasworad axsovs movlenebi da aSliloba axasiaTebT. aseTi pacientebis marTva
daijeros, rom igi danaSaulis monawilea. faqtorebi, moiTxovs personalis specializebul trenings
romlebic xels uwyoben yalb aRiarebas, Semdegia: da sasamarTlo fsiqoTerapevtebis daxmarebas. is,
fsiqoaqtiuri nivTierebebis borotad moxmareba, aseve, damokidebulia sasamarTlo praqtikaSi mtki
qala-tvinis travma, mniSvnelovani danakargi, SfoTva cebulebaze dafuZnebuli fsiqiatriuli zrunvis
da danaSaulis gancda. danergvaze. bevr pacients aReniSneba personologiuri
yalbi aRiarebebis Sefaseba rTulia. es moiTxovs aSliloba. marTvis zogadi principebi aRwerilia me-7
dapatimrebis garemoebebis detalur Seswavlas, Tavad TavSi (aseve ix. Bateman and Tyrer, 2004a, b).
patimrobisa da dakiTxvis detalur Seswavlas, aseve, gankurneba Zalian xSiri ganxilvis sagania. per
pirovnuli Tvisebebis Sefasebas da eWvmitanilis sonologiuri aSlilobis mqone zogi pacienti
axlandeli fsiqikuri da fizikuri mdgomareobis gamoeTiSeba mkurnalobis process im mizeziT,
gamokvlevas. aseT SemTxvevaSi, ZiriTadad, saWiroa rom `ganukurnebelia~. amis mizezi, SesaZloa, per
klinikuri fsiqologiis specialistis daxmareba sonologiuri aSlilobis samkurnalo saSualebebis
neirofsiqologiuri gamokvlevis Casatareblad da, arasakmarisi codna iyos (Bateman and Tyrer, 2004a,
garkveul SemTxvevebSi, imis Sesafaseblad, Tu ram b). cneba `ganukurnebeli~ aseve gamoiyeneba mZime
denad eqvemdebareba STagonebas eWvmitanili. fsiqozuri daavadebis mqone pacientebis mimarT,
romlebic `mkurnalobisadmi rezistentulni~ arian
yalbi dadanaSauleba
da romelTa mdgomareoba droTa ganmavlobaSi
zogjer pirovneba amtkicebs, rom warmoadgens iseTi mniSvnelovnad ar umjobesdeba. `gankurnebis~ Sefaseba
danaSaulis msxverpls, romelic ar momxdara da amaSi rTulia da masze Zalian bevri faqtori zemoqmedebs
adanaSaulebs sxva adamians. amas yalbi dadanaSauleba (boqsi 26.5) (Adshead, 2001). iseve, rogorc riskebis
ewodeba. amis magaliTebia gaupatiurebaSi da dev Sefasebis SemTxvevaSi, is SeiZleba ganmeorebiT
naSi dadanaSauleba (Pathe et al., 1999). iuridiuli gamokvlevas saWiroebdes.
da klinikuri gamocdileba aseTi SemTxvevebis
simcireze miuTiTebs. bralmdeblebs, xSirad, mZime
personologiuri da sxva saxis problemebi axasiaTebT. boqsi 26.5 gankurnebis Sefaseba
pacientis fsiqopaTologiis simZime. interpersonaluri
fsiqikuri aSlilobis mqone disfunqciis xarisxi, sxvadasxva mxareebis CarTuloba,
Canaweri danaSaulis Sesaxeb.
damnaSaveebis mkurnaloba
w pacientis fsiqikuri janmrTelobis sxva aspeqtebi.
zogadi sakiTxebi dacviTi meqanizmebi an mowyvladobis faqtorebi.
pozitiuri mijaWvulobis istoria. samsaxuris Canaweri.
gamokvlevis Catarebisas, rac SeiZleba didi rao mkurnalobaSi CarTvis motivacia.
denobiT informacia unda movipovoT sxvadasxva w komorbidoba sxva aSlilobebTan. gankurneba rTuldeba
wyarodan. unda moviZioT samedicino Canawerebi, Tuki komorbiduli fsiqiatriuli daaavadebebis da,
gansakuTrebiT, fsiqoaqtiuri nivTierebebis borotad
es SesaZlebelia. sasamarTlo saqmeebis SemTxvevaSi moxmarebis dros.
naTesavebi, SeiZleba, arc arian yvelaze sando w Sesabamisi Terapiisa da Terapevtebis arseboba.
informatorebi, gansakuTrebiT imitom, rom isini ra xarisxiTaa SesaZlebeli mkurnaloba mxolod
xSirad Tavad warmoadgenen Zaladobis msxverpls. specializebul garemoSi. aseTi garemos arseboba.
didi yuradReba unda mivaqcioT rogorc fsiqikur w im specialistis gamocdileba da damokidebuleba,

vinc atarebs gamokvlevas da arsebuli mtkicebuleba.
daavadebas, ise personologiur aSlilobebs da mkurnalobis CatarebisaTvis arsebuli mtkicebuleba
fsiqoaqtiuri nivTierebebis gaxSirebul araswori da specialistis kompetenturoba Caataros mkurnaloba.
Tumca `paleatiuri zrunvis~ (mxardaWera da gageba)
moxmarebis istorias. gamoyeneba yovelTvis SesaZlebelia.
sasamarTlo fsiqiatriuli mkurnaloba, ZiriTadad,
w gamokvlevis drois gansazRvra. SeiZleba pacientebi,
moicavs zogadi fsiqiatriuli daavadebebis mkur drois romelime monakveTSi, ufro met mzaobas iCendnen
nalobas specializebul garemoSi, ganyofilebas an TerapiaSi CarTvisTvis.
_ 796 _
fsiqikuri aSlilobis mqone damnaSaveebis mkurnaloba
samkurnalo garemo SesaZlebelia, magram arsebobs damnaSaveebis mcire

nawili, romelsac esaWiroeba saavadmyofoSi gadayvana
msjavrdebis Semdeg, damnaSaves SeiZleba Cautardes
(boqsi 26.6).
iZulebiTi an nebayoflobiTi mkurnaloba. brita
cixis samedicino serviss Zalian rTul pirobebSi
neTSi, fsiqikurad arajanmrTeli damnaSaveebis
uwevs fsiqiatriuli daxmarebis aRmoCena. gamoTq
mkurnaloba, ZiriTadad, uzrunvelyofilia Sinagan
mulia mosazreba, rom cixeebSi samedicino daxmarebis
saqmeTa saministros (cixis samedicino samsaxuri da
uzrunvelyofisas mniSvnelovnad unda gaizardos
probaciis samsaxuri) da janmrTelobis departamentis
fsiqiatrebis wvlili. ramdenime cixeSi SesaZlebelia
(specialuri saavadmyofoebi, specialuri sasamarTlo
patimrebis fsiqologiuri mkurnaloba. mkurnaloba,
da zogadi fsiqiatriuli samsaxurebi) mier. Tumca,
ZiriTadad, mimarTulia personologiur aSlilobasa
bevr fsiqikurad arajanmrTel damnaSaves ar utardeba
da seqsualuri xasiaTis danaSaulze. erT-erTi aseTi
iseTi fsiqiatriuli mkurnaloba, rogoric mas
cixea grendon andervudi (Grendon Underwood) inglisSi.
esaWiroeba, Sesaferisi dawesebulebebis naklebobis
miuxedavad imisa, rom cixeebs SigniT, udavod, saWiroa
gamo da, aseve, imis gamo, rom aseTi pacientebi
fsiqiatruli daxmarebis uzrunvelyofa, sistema,
warmoSoben problemebs menejmentis TvalsazrisiT.
romelic ubiZgebda sasamarTloebs fsiqikurad ara
da bolos, sasamarTlo fsiqiatriaSi ar tardeba
jansaRi adamianebis saavadmyofos nacvlad cixeSi
sakmarisi raodenobis gamokvlevebi, rac imas niSnavs,
moTavsebas, seriozuli xarvezis mqoned unda CaiT
rom efeqtur mkurnalobas susti empiriuli baza
valos.
gaaCnia. sasamarTlo fsiqiatriuli samsaxurebis
organizebis zogadi mimoxilvisTvis ix. Bluglass, 2000.
damnaSaveebi saavadmyofoSi
uSualod damnaSaveebTan bevrs muSaoben zogadi
profilis fsiqiatrebi, romlebic gamokvlevas uta bevri iurisdiqcia iTvaliswinebs fsiqikurad ara
reben pacientebs da sasamarTlosTvis angariSebs jansaRi damnaSaveebis dakavebas usafrTxo fsi
amzadeben. zogadi profilis fsiqiatrebi, iseve, qiatriul dawesebulebaSi moTavsebas. inglissa da
rogorc sasamarTlo fsiqiatriis specialistebi, uelsSi msjavrdebuli damnaSaves SeiZleba adgili
mkurnaloben iseT damnaSveebs, romlebsac miRebuli mieCinos saavadmyofoSi, iZulebiTi fsiqiatriuli
aqvT arasapatimro sasjeli. sasamarTlo fsiqiatrebi mkurnalobisTvis saavadmyofos fsiqikuri janmrTe
calke struqturul erTeulebSi muSaoben. isini lobis aqtis Tanaxmad (Mental Health Act). kanoni,
atareben specialur gamokvlevas da sasamarTlosTvis aseve, uzrunvelyofs patimris gadayvanas cixidan
asruleben samuSaos. bevrgan arsebobs saTemo fsiqiatriul saavadmyofoSi. erTi mniSvnelovani
sasamarTlo samsaxurebi, romlebic uzrunvelyofen aspeqti is aris, rom saavadmyofos SeiZleba ar
pacientebis gamokvlevasa da mkurnalobas. sasamarTlo hqondes gansazRvruli drois limiti, im dros
fsiqiatrebi SeiZleba zrunavdnen iseT pacientebze, roca cixis sasjelTa umetesobas aqvs fiqsirebuli
romlebic moiTxoven usafrTxoebis zomebis dac xangrZlivobis sasjeli. stacionirebis periodi
vas Cveulebriv fsiqiatriul saavadmyofoebSi SeiZleba iyos sasjelze xangrZlivi an xanmokle.
moTavsebisas.
britaneTis specialuri saavadmyofoebi da
usafrTxoebis sxvadasxva xarisxis ganyofilebebi
fsiqikurad arajansaRi adamianebi cixeSi
britaneTSi, fsiqikurad arajanmrTeli damnaSaveebis
gamokiTxvebi aCvenebs, rom msjavrdebuli patimrebis
dakaveba da ganTavseba SeiZleba ganxorcieldes
daaxloebiT mesameds aReniSneba fsiqikuri aSliloba,
adgilobriv fsiqiatriul saavadmyofoSi, saSualo
xolo 4% _ fsiqozi (ix. Fazel and Danesh, 2002).
usafrTxoebis ganyofilebaSi an maqsimalurad usa
am aSlilobebis umetesobis mkurnaloba cixeSi
frTxo saavadmyofoSi (`specialuri saavadmyofo~).
inglisSi fsiqiurad daavadebuli damnaSaveebisTvis
boqsi 26.6 fsiqikuri aSlilobis mqone specialuri garemos Seqmna 1800 wels daiwyes. mas Semdeg,
patimrebis saavadmyofoSi gadayvanis rac sasamarTlom Seuracxadobis gamo udanaSualod
mizezebi cno hedfildi (Hadfield), romelmac esrola mefe jorj
III-s, beTlemis saavadmyofoSi Seiqmna specialuri
w fsiqozi;
ganyofileba. 1863 wels, Sinagan saqmeTa saministros
w mkurnalobis gaumjobesebis SeuZlebloba cixis pirobebSi;
mmarTvelobis qveS gaixsna specialur savadmyofoTa
w patimris mier uaris Tqma seriozuli fsiqikuri Soris uZvelesi saavadmyofo _ brodmuri (Broadmoor).
daavadebis mkurnalobaze;
inglissa da uelsSi amJamad oTxi mkacri reJimis
w sicocxlisaTvis saSiSi TviTdazianeba;
specialuri saavadmyofo moqmedebs.
w Zaladobis riski. specialur saavadmyofoebSi pacientebis dato
_ 797 _
veba, ZiriTadad, ganusazRvreli droiT xdeba. im sasamarTloebs, aseve, SeuZliaT gamoiyenon ara
pacientebis SemTxvevaSi, romlebsac aqvT fsiqikuri sapatimro sasjeli, romlis drosac damnaSave pacients
daavadeba (umetesad Sizofrenia), dakavebis xangrZ daxmarebas uwevs probaciis samsaxuri da, romlis
livoba dakavSirebulia fsiqikuri aSlilobis simZimesa drosac mas eniSneba fsiqiatriuli mkurnaloba.
da qronikulobasTan da ara danaSaulis xasiaTTan. xandaxan, fsiqiatriuli mkurnalobis gavla SeiZleba
personologiuri aSlilobis mqone pacientebis Sem warmoadgendes probaciis mier wayenebul pirobas,
TxvevaSi saavadmyofoSi yofnis xangrZlivobis romelsac damnaSave aucileblad unda daeTanxmos.
mTavari gamnsazRvrelia danaSaulis samomavlo riskis fsiqikuri problemis mqone damnaSavis mkurnaloba
Sefaseba. iseTive wesiT xdeba, rogorc imave fsqikuri aSlilobis
britaneTSi didi fsiqiatriuli saavadmyofoebis mqone pacientis mkurnaloba, romelsac ar Caudenia
daxurvam dauSvebeli Sedegebi gamoiwvia fsiqikuri danaSauli. qronikuli fsiqikuri aSlilobis mqone
problemis mqone pirebze zrunvis TvalsazrisiT. axal pacientebisTvis, romlebic ganmeorebiT umniSvnelo
fsiqiatriul ganyofilebebsa da saavadmyofoebSi danaSauls Cadian, xSirad rTulia fsiqiatriuli
naklebi xarisxis fizikuri usafrTxoebaa da saavad daxmarebis aRmoCena. warsulSi maT xanrgZlivi droiT
myofos personalic da sxva pacientebic nakleb aTavsebdnen fsiqiatriul saavadmyofoSi, magram axla,
tolerantobas iCenen mwvave qceviTi aSlilobebis rodesac isini mkurnlobas TemSi gadian, maT SeiZleba
mqone pacientebis mimarT. amis Sedegad damnaSaveebis ar moisurvon mkurnalobis Catareba. garda amisa, maTi
saavadmyofoebSi moTavseba Zalian garTulda, gans midevneba rTulia, radgan isini icvlian misamarTs
akuTrebiT, iseTi pacientebis, romlebsac gamoxatuli an sacxovrebels kargaven. aseTi pacientebisTvis
qceviTi aSlilobebi aReniSnebaT. garda amisa, Sem SeiZleba sasargeblo gamodges asertuli mkurnaloba
cirda hospitalizaciis xangrZlivoba, ramac kidev (Assertive Community Treatment). (gv. ??).
ufro gaarTula qronikuli pacientebisa da mwvave
qceviTi aSlilobebis mqone pirebis mkurnaloba am Zaladobis marTva samedicino
sakiTxis gadasaWrelad SemuSavda ori alternatiuli
dawesebulebebSi
midgoma:
Zaladobis SemTxvevebi ar ukavSirdeba mxolod im
1. Cveulebriv fsiqiatriul saavadmyofoebSi Seiqmna
pacientebs, romlebsac sasamarTlo fsiqiatriuli
kargad SerCeuli personalisgan Semdgari usafrTxo
problemebi aqvT. marTalia, Zaladoba saavadmyofoebSi
zonebi, sadac aseTi mdgomareobebis mqone,
xSiri ar aris, Tumca maTi SemTxvevebi izrdeba. amis
SedarebiT naklebad saSiSi pacientebis mkurnalobaa
SesaZlo mizezebia:
SesaZlebeli;

cvlilebebi fsiqikuri janmrTelobis dacvis po
2. Seiqmna specialuri usafrTxo ganyofilebebi, rom
litikaSi, ris Sedegadac, stacionirebis yvelaze
lebic fsiqiatriul saavadmyofoebTanaa dakavSi
xSiri mizezi, safrTxis Semcveli mdgomareobebi
rebuli. es ganyofilebebi uzrunvelyofen usaf
gaxda. (aramoZalade pacientebi ufro xSirad
rTxoebis iseT dones, romelic ufro maRalia
mkurnalobas TemSi gadian);
zogad saavadmyofoebTan SedarebiT, magram nakleb

gadaWedili saavadmyofoebi;
mkacria, vidre specialuri reJimis saavadmyofoebSi
(anu Seiqmna saSualo xarisxis usafrTxoebis
kvalificiuri kadris nakleboba;
ganyofilebebi). amasTan, Seiqmna am ganyofilebebSi
fsiqoaqtiuri nivTierebebis gazrdili moxmareba.
pacientis moTavsebis kriteriumebTan dakavSirebiT yvela fsiqiatrma unda icodes, stacionarul
garkveuli problemebi. aseve, gaugebaria misi garemoSi Zaladobrivi incidentebis marTva. arse
roli zogad da specializebul fsiqiatriul biTad mniSvnelovania am sferoSi personalis
saavadmyofoebTan kavSirSi. es, nawilobriv, imitom miRebuli Sesaferisi ganaTleba da gavlili treningi.
moxda, rom saSualo usafrTxoebis ganyofilebebis klinikuri daxelovnebis erovnulma institutma Seqmna
Seqmna britaneTSi gadaeca adgilobriv organoebs, specialuri saxelmZRvanelo principebi (National
rasac, zog SemTxvevaSi, mohyva momsaxurebis Institute for Clinical Excellence, 2005c) (suraTi 26.3). mni
cudi koordinacia da resursebis arasamarTliani Svnelovania, rom personals hqondes Zaladobrivi
ganawileba (Coid et al., 2001). incidentebis marTvis gamokveTili politika da gawa
fuli iyos mis ganxorcielebaSi. es politika moiTxovs
TemSi mkurnaloba yuradRebis gamaxvilebas palatebis dizainze, saWi
SesaZloa damnaSave pacientebi ar warmoadgendnen roebis SemTxvevaSi, daxmarebis mimarTvasa da
sazogadoebisTvis sakmaris risks, an ar iyvnen personalis adekvatur treningze. riskis Sefasebis
sakmarisad avad saavadmyofoSi mkurnalobisTvis. zogadi procesi qvemoTaa aRwerili.
_ 798 _
Zaladobis marTva samedicino dawesebulebebSi
prognozi
riskebis uwyveti
Sefaseba
saswrafo daxmarebis
ganyofilebebi
prevencia
daxmarebis miReba
deeskalaciis teqnikebis
gamoyeneba multidisciplinuri
fsiqiatriuli gundis
morige wevrisagan
riskis mudmivad Sefaseba da deeskalacia
Semdgomi marTvis intervenciebi

zemoaRniSnulTan erTad, gaiTvaliswineT Semdegidan
erTi an ramdenime saSualebis gamoyeneba
swrafi trankvilizacia izolacia fizikuri intervencia
medikamenti saWiroa gamoiyeneba xangrZlivi kargia, Tu swrafi efeqti
qceviTi aSlilobebis mqone fizikuri intervenciis eqneba. gamoiyeneba
pirovnebis dasamSvideblad
fsiqozuri an arafsiqozuri asacileblad; pacientis swrafad
mdgomareobebis SemTxvevaSi damSvidebis mizniT
gamoiyeneba xangrZlivi
fizikuri intervenciis
asacilelbad
intervneciis ukuCveneba
roca servisis Tu es meTodi gaxangrZlivebuli
momxmarebels manamde efeqturia, pirovnebis fizikuri intervencia
miRebuli aqvs damSvidebisTanave unda
medikamenti Sewydes.
Tu sxva intervenciebi
gamoyenebuli ar yofila
incidentis Semdgomi Sefaseba
suraTi 26.3 agznebuli an Zaladobrivi qcevis moklevadiani marTvis algoriTmi samedicino dawesebulebebSi.
National Institute for Clinical Excellence (2005 w).
rodesac mosalodnelia Zaladoba, an Zaladoba ladobrivi an muqaris Semcveli qcevis dajildoveba

ukve xdeba, personali sakmarisi raodenobiT unda garkveul daTmobebze wasvliT an Tvalis daxuWva pa-
iyos warmodgenili adgilze. aseve, adgilze unda cientis iseT qcevaze, romelic palatis wesebis dar-
iyos saWiro medikamentebi (mag., lorazepami kunTSi Rvevas gulisxmobs, magram yvelaferi unda viRonoT
Sesayvanad da haloperidoli), magram, pacientisTvis imisaTvis, rom pacients mivceT saSualeba konfliqti-
SeumCnevel adgilas unda iyos moTavsebuli. saWiroa dan gamovides damcirebis gareSe. medikamentebis gam-
aqcentis gadatana Zaladobis prvenciaze (boqsi 26.7). oyenebas unda mohyves Sesabamisi monitoringi (rCeva
potenciurad saSiSi adamianebi xSirad mSviddebian, medikamentebis gamoyenebis Sesaxeb gadaudebel viTa-
Tu davawynarebT da TanagrZnobiT davelaparakebiT rebaSi mocemulia gv. ??).
maT. umjobesia, maT gaesaubros iseTi pirovneba, vi- incidentis Semdeg specialistTa gundi unda Sei-
sac isini icnoben da endobian. mniSvnvelovania, rom kribos Semdegi sakiTxebis gansaxilvelad:
wyobidan ar gamoviyvanoT pacienti. miuRebelia Za- w samomavlo zrunva pacientze. fsiqikurad arajansa-
_ 799 _
raTa gaumklavdes sirTuleebs, aRmoaCinos Zaladobis
boqsi 26.7 deeskalaciis teqnikebi, romle-
seriozuli safrTxe da marTos igi. safrTxisa da ris-
bic gamoiyeneba Zaladobis prevenciisaTvis
kis mimoxilva Semdeg wyaroSia mocemuli: Mullen, 2000.
w personalis erTma wevrma mTlianad unda aiRos situ- fsiqiatrs SeiZleba dasWirdes riskis Sefaseba yovel-
aciis marTva sakuTar Tavze;
dRiur fsiqiatriul praqtikaSi da, aseve, sasamarTlo
w gadaiyvaneT agznebul mdgomareobaSi myofi pacienti Se-
saferis oTaxSi an adgilas, raTa daamSvidoT igi; SemTxvevebze muSaobisas.
w adgilze personali unda imyofebodes sakmarisi rao- yoveldRiur praqtikaSi safrTxis Semcveli Sei-
denobiT; Zleba aRmoCndnen, rogorc stacionaruli, ise ambu-
w pacients unda avuxsnaT, Tu ras akeTebs personali da
rogor fiqrobs situaciis mogvarebas;
latoruli pacientebi. riskis detaluri Sefaseba
w ecadeT raportis damyarebas. aCveneT pacients, rom imisaTvisaa saWiro, rom maqsimalurad adekvaturi
gawuxebT misi mdgomareoba da yuradRebiT mousmineT nabijebi gadaidgas, rogorc pacientis, ise sxva ada-
mas. dasviT Ria kiTxvebi. akontroleT sakuTari ver-
baluri da araverbaluri qceva. zedmet zrunvas nu mianebis interesTa dasacavad. sxvebisTvis zianis miy-
iCenT pacientis mimarT anu nu cdilobT misi wuxilis enebis riski mniSvnelovani kriteriumia saavadmyofo-
Semcirebas;
Si iZulebiTi moTavsebisTvis.
w iaraRis monawileobis SemTxvevaSi, moiTxoveT misi mo-
Tavseba neitralur adgilas da ar dauSvaT misi xelidan sasamarTlosTvis samuSaos Sesrulebisas sasamarT-
xelSi gadacema. lom SeiZleba moiTxovos fsiqiatris daskvna bral-
National Institute for Clinical Excellence, 2005 debulTan dakavSirebuli safrTxis Sesaxeb, imisaTvis,
rom Sesaferisi sasjeli iqnas gamoyenebuli. fsiqi-
Ri pacientis SemTxvevaSi unda gadaixedos gamower-
atrs, SeiZleba, agreTve sTxovon komentari peniten-
ili wamlebi da maTi dozireba. rodesac Zaladobas
ciur dawesebulebaSi dakavebuli damnaSaveebis Ses-
Cadis personologiuri aSlilobis mqone pirovneba,
axeb, romelTa gaTavisufleba dgas dRis wesrigSi.
sagangebo situaciaSi, SeiZleba, saWiro gaxdes medi-
orive SemTxvevaSi saqme gvaqvs eTikur dilemasTan.
kamentebis daniSvna, magram, ZiriTadad, umjobesia,
erTis mxriv, saubaria sazogadoebis dacvaze iseTi
Tu Tavidan avicilebT maT regularul gamoyenebas.
adamianisgan, romelmac SeiZleba Zaladoba Caidinos,
sxva zomebi gulisxmobs im faqtorebis Sesustebas,
meores mxriv, arsebobs valdebuleba, rom pativi sce
romlebic iwveven Zaladobas an kidev pacientisTvis
damnaSavis adamianis uflebebs.
ufro konstruqciuli saSualebebis uzunrvelyo-
riskebis Sefasebisas ori farTo midgoma gamoiy-
fas, raTa man moaxerxos daZabulobis marTva (mag.
eneba:
fizikuri varjiSi an personalisTvis mimarTva dax-
1. klinikaSi momuSave fsiqiatrebma scades im faq-
marebis saTxovnelad).
torebis identificireba, romlebic dakavSirebulia
w mxardamWeri fsiqologiuri intervencia. misi gam-
individualuri pacientis saSiSroebasTan. miuxe-
oyeneba SeiZleba saWiro iyos iseT pacientebTan an
davad imisa, rom Zaladobis zogadi prediqtorebi
personalTan, romlebic Zaladobrivi Tavdasxmis
(mag. antisocialuri personologiuri aSliloba da
msxvepls warmoadgenen (ix. zemoT teqsti danaSau-
fsiqotropuli nivTierebebis moxmareba) am mxriv
lis msxveplis Sesaxeb).
gamosadegi faqtorebia, maT akliaT specifikuroba
w unda moxdes Tu ara policiis informireba. ar unda riskis qveS myofi calkeuli individis identifika-
dagvaviwydes, rom aseTi Tavdasxmebi meore adamian- ciis TvalsazrisiT (Dolan and Doyle, 2000).
ze Zaladobis formebia, romlebic SeiZleba krimi-
2. damnaSaveebsa da sxva jgufebSi (mag., fsiqikuri
naluri xasiaTisa iyos.
problemebis mqone pirebi) kriminaluri qcevis
w SesaZlo zegavlena pacientTa jgufze. sxva pacien- prognozisTvis aqtualur meTodebs iyeneben. zoga-
tebs SeiZleba dasWirdeT mxardaWera, ganurCevlad dad, winaswar/prediqtul qcevasa da ganviTare-
imisa, Seeswrnen Tu ara isini incidents. bul mdgomareobas Soris dabali korelaciaa, rac
w ganyofilebis/palatis zogad politikaSi cvlile- imas niSnavs, rom es meTodebi prognozisTvis ar
bebis Setanis saWiroeba. Zaladobrivma incidentma gamodgeba. miuxedavad imisa, rom axlad SemuSave-
SeiZleba ganapirobos ganyofilebis/palatis poli- bul instrumentebs SedarebiT maRali sizustiT
tikisa da procedurebis Secvla. SeuZliaT Zaladobrivi qcevis winaswar gansazRvra,
maTi gamoyeneba bevr dros moiTxovs (Monahan et al.,
riskebis Sefaseba 2000).
umniSvnelo danaSaulis SemTxvevebi da iSviaTi Za- ar arsebobs fiqsirebuli klinikuri wesebi riskebis
ladobis faqtebi ufro TvalsaCino gaxada saTemo Sesafaseblad, magram arsebobs avtoritetuli sare
momsaxurebaze gadasvlam da mosaxleobis SfoTva gaa- komendacio publikaciebi. riskis Sefasebisas unda
Zliera. fsiqiatriul servisebs sWirdeba resursebi, moxdes Zaladobrivi qcevis istoriis safuZvliani
_ 800 _
fsiqiatris daskvna
mimoxilva, unda SeviswavloT Cadenili danaSaulis
maxasiaTeblebi da garemoeba, romelSic danaSauli
cxrili 26.5 xifaTTan dakavSirebuli faqtorebi
ganxorcielda, iseve rogorc damnaSavis fsiqikuri istoria
mdgomareoba (suraTi 26.4). mimoxilvisas sasargebloa
w warsulSi Cadenili Zaladobis erTi an meti epizodi;
Semdegi ZiriTadi sakiTxebis gaTvaliswineba: w ganmeorebadi impulsuri qceva;
w stresTan gamklavebis sirTulis maCveneblebi;
w SeimCneva Tu ara qcevis myari paterni; w warsulSi pacienti ar iwuxebda Tavs survilebis Sekave-
biT;
w iyo Tu ara raime garemoebebi, romlebmac gamoiwvies
w antisocialuri maxasiaTeblebi da socialuri mxardaWe-
Zaladoba da mosalodnelia Tu ara maTi gameoreba ris nakleboba.
momavalSi; danaSauli
w arsebobs Tu ara myari mtkicebuleba imisa, rom w ucnauri Zaladoba;
braldebuls aqvs survili Secvalos Tavisi qceva; w provokaciis nakleboba;
w sinanulis nakleboba;
w eqneba Tu ara Sedegi braldebulis mkurnalobas w mudmivi uaryofa.
(suraTi 26.4). fsiqikuri mdgomareoba
am prediqtorebidan yvelaze sasargeblo Zalado- w avadmyofuri eWvianoba;
brivi qcevis istoriaa (Mullen, 2000). antisocialuri w paranoiduli ideebi sxvebisTvis zianis miyenebis
azrebiT;
personologiuri aSlilobis an daswavlis darRvevis w motyuebis mcdeloba;
mqone pirebis mxridan safrTxis Sefaseba SeiZleba w TviTkontrolis nakleboba;
w muqara Zaladobis gameorebis Sesaxeb;
garkveul sirTuleebTan iyos dakavSirebuli. orive w mkurnalobisadmi damokidebuleba - ar icavs
SemTxvevaSi es pirebi naklebad arian motivirebuli, daniSnulebas.
rom Seasrulon eqimis daniSnuleba. kidev erT sir- garemoebebi
Tules qmnis pirovneba, romelic imuqreba, rom Caid-
w mosalodnelia maprovocirebeli an precipitatuli
ens Zaladobriv qcevas, mag. mkvlelobas. am SemTx- faqtoris xelaxali aRmoceneba;
vevaSi TiTqmis iseTive gamokvleva tardeba, rogorc w alkoholis an narkotikis moxamreba;
w socialuri sirTuleebi da mxardaWeris nakleboba.
TviTmkvlelobasTan dakavSirebuli muqaris dros (gv.
??). fsiqiatrma unda hkiTxos pacients Tavisi ganz- kargi iqneba, Tu fsiqiatri ar daeyrdnoba safrTxis
raxvis, motivis da potenciuri msxverplis Sesaxeb saSiSroebis xarisxis mxolod sakuTar Sefasebas da am
da unda Caataros fsiqikuri mdgomareobis sruli sakiTxs ganixilavs fsiqiatrebTan, zogadi profilis
gamokvleva. pacientebs, romlebic imuqrebian, Sesa- eqimebTan, socialur muSakebTan da pacientis naTe-
Zlebelia, ambulatoriulad gauwioT mxardaWera da savebTan erTad (Mullen, 2000).
mkurnaloba, magram Tu riski maRalia, saWiroa maTi
gadaudebeli stacionireba. SeiZleba saWiro gaxdes
fsiqiatris daskvna
potenciuri msxverplis gafrTxileba.
sisxlis samarTlis danaSaulis SemTxvevaSi sasamarT-
losTvis momzadebuli fsiqiatris daskvna sayur-
winaswar arsebuli adRebo dokumentia da igi unda efuZnebodes amom-
mowyvladoba
wurav fsiqiatriul da socialur gamokvlevas. mniS-
socialuri da
fsiqikuri
interpersonaluri
vnelovania, rom fsiqiatrma waikiTxos yvela mowmis
aSliloba amJamindeli stresorebi Cveneba, braldebulis gancxadebebi da yvela wina sa-
fsiqikuri
mdgomareoba medicino Canaweri, socialuri angariSebi. unda mox-
fsiqotropuli
nivTierebebis des ojaxis wevrTa interviuireba. Tu mtkicebulebebi
socialuri da
arasworad wina danaSaulis Sesaxeb validurad ar miiCneva (mag.
moxmareba interpersonaluri
situaciuri proteqtorebi inglisis kanonmdeblobaSi), fsiqiatris daskvna ar
trigerebi
(impulsis unda Seicavdes am faqtebs. aman fsiqiatrs SeiZleba
mimcemebi)
problemebi Seuqmnas, radgan misi azri xSirad xSirad
emyareba damnaSvis warsul qcevas. sasamarTlosTvis
dawerili fsiqiatriuli daskvna mihyveba boqs 26.6-Si
gaTvalis Zaladobrivi qcevis gauTvalis
winebuli albaToba winebeli aRweril formats da unda Seicavdes fsiqikuri md-
gomareobis Sefasebas danaSaulis Cadenis momentSi da
suraTi 26.4 im sakiTxebis sqematuri gamosaxuleba, romlebic aseve sasamarTlo procesze daswrebis SesaZleblobis
unda gaviTvaliswinoT Zaladobrivi qcevis safrTxis
Sefasebas. cxrilSi 26.6 naCvenebia fsiqiatris roli
Sefasebisas [After Mullen, P. (2000). Dangerousness, risk and the
prediction of probability. In The new Oxford textbook of psychiatry ( eds. inglissa da uelsSi mimdinare sasamarTlo procesis
M.G. Gelder, J.J. Lopez-Ibor Jr and N.C. Andreasen), Chapter 11.4.3. sxvadasxva safexurze.
Oxford University Press, Oxford. Reproduced with permission]
_ 801 _
fsiqiatris roli sasamarTlosTan 3. gaakeTeT detaluri Canawerebi; CaiwereT bralde-
mimarTebaSi bulis mier gamoTqmuli nebismieri mniSvnelovani
komentari. intervius romelime safexurze (ara
fsiqiatrs moeTxoveba gamoiyenos Tavisi profesiu-
aucileblad dasawyisSi) unda ganixiloT bralde-
li codna da daexmaros sasamarTlo process. igi ar
bulis danaSauli. braldebulma SeiZleba aRiaros
uTiTebs, Tu ra unda gaakeTos sasamarTlom. brita-
an ar aRiaros danaSauli, Tumca fsiqiatri ar aris
neTSi mowmed gamoZaxebuli samedicino eqsperti mTe-
valdebuli amasTan dakavSirebiT komentari gaake-
li sasamarTlos winaSea pasuxismgebeli. zogjer, Zne-
Tos.
lia neitralitetis SenarCuneba. fsiqiatrs SeiZleba
gauWirdes movlenebis sxvagvarad warmoCena, vidre 4. SekribeT detaluri anamnezi somaturi daavade-
dainteresebul mxares sWirdeba. es Zalian rTulia, bebis Sesaxeb. gansakuTrebuli yuradReba miaqcieT
vinaidan fsiqiatrTa umravlesoba Tavis profesiul nevrologiur aSlilobebs, rogoricaa qala-tvinis
unar-Cvevebs pacientis ndobis mosapoveblad iyenebs, travma da epilefsia.
romlis mdgomareobazec sasamarTloSi angariSi unda 5. moipoveT wina fsiqiatriuli aSlilobisa da mkur
waradginos. fsiqiatrma unda icodes, rom sasamarTlo nalobis detaluri istoria. srulad gamoikvlieT
naxavs mis angariSs da SeiZleba xmamaRlac waikiTxon amJamindeli fsiqikuri statusi. saWiroebis Sem-
sasamarTos darbazSi. iuristebis mier SekveTili da TxvevaSi, SeiZleba aucilebeli gaxdes specialuri
anazRaurebuli eqimis angariSi sasamarTlos sakuTre- gamokvlevis Catareba. Tu braldebulis inteleqtis
baa. done eWvs badebs, klinikuri fsiqologiis special-
istma unda Caataros calke gamokvleva.
gamokvleva 6. Tu es SesaZlebelia, moipoveT damatebiTi informa-
braldebuli an msjavrdebuli adamianis fsiqiatri- cia naTesavebisgan da sxva informatorebisgan. Tu
uli gamokvlevisas ramdenime mniSvnelovani punqtia braldebuli winaswar patimrobaSi imyofeba, sap-
gasaTvaliswinebeli: atimros personals masTan xangrZlivi urTierTo-
1. rac SeiZleba guldasmiT moemzadeT interviusTvis. bis saSualeba eZleva da, Sesabamisad, SeuZlia Rire-
iqonieT Camoyalibebuli azri gamokvlevis mizanze buli informaciis mowodeba.
da, gansakuTrebiT, nebismier kiTxvasTan dakavSire-
biT, romelic exeba msjavrdebulis unars, warsdges daskvnis/angariSis momzadeba
sasamarTlos winaSe. moipoveT detaluri informa- sasamarTlosTvis angariSis momzadebaze gavlena aqvs
cia mimdinare da warsul danaSaulebze, braldebu- konkretuli SemTxvevis garemoebebs da advokatebis
lisa da mowmeebis mier gakeTebuli gancxadebebis mier mocemul instruqciebs. sasamarTlosTvis
aslebTan erTad. SeiswavleT angariSebi braldebu- momzadebuli angariSebi samoqalaqo da sisxlis
lis socialuri istoriis Sesaxeb. intervius dros samarTlis SemTxvevebSi SeiZleba Zalian gansxvavebuli
gaecaniT maT braldebulTan erTad da SeamowmeT aRmoCndes. SesaZlo monaxazi mocemulia boqsSi 26.8.
maTi sizuste. ufro detaluri informaciisTvis ix. Grounds (2000).
2. pirvel rigSi, auxseniT klients referalis (gad- anagariSis momzadebisas fsiqiatrs unda axsovdes,
amisamarTebis) mizezi; ganumarteT mas, Tu ratom rom mas waikiTxaven adamianebi, romlebsac ara aqvT
moxda gadamisamarTeba. klientma unda icodes, rom samedicino ganaTleba. ase rom angariSi unda iyos
fsiqiatris daskvna SeiZleba sasamarTlos winaSe dawerili martivi inglisuriT da masSi ar unda iyos
iyos wardgenili da rom braldebuls ufleba aqvs gamoyenebuli Jargoni. Tu gamoiyeneba teqnikuri
Tavi Seikavos kiTxvebze pasuxis gacemisgan. terminebi, isini maqsimalurad zustad unda iyos
gansazRvruli. garda amisa, angariSi mokle unda iyos.
cxrili 26.6 fsiqiatris monawileoba did britaneTSi mimdinare sasamrTlo procesis sxvadasxva etapze
safexuri I safexuri II safexuri III safexuri IV
dakaveba sasamarTlomde sasamarTloze sasamarTlos Semdeg
usafrTxo adgilas daskvna sasamarTlosaTvis specifikuri problemebi mkurnaloba saavadmyofos

gadayvana (policiis winsawari dakaveba stacio mzaoba sasamarTlos winaSe orderis an meurveobis qveS
ganyofileba, saavadmyofo, naruli gamokvlevisaTvis an warsadgenad; SezRuduli
samedicino gamokvleva) mkurnalobisaTvis pasuxismgebloba
gamokvleva dapatimrebis cixidan gadayvana rCeva Semdgomi marTvis cixidan gadayvana;

Semdeg; gamokvlevisaTvis Taobaze gadawyvetileba
sasamarTlos acileba ganTavisuflebis Sesaxeb
mkurnaloba TemSi
_ 802 _
fsiqiatris daskvna
unda gaiaros konsultacia kolegebTan, socialur
boqsi 26.8 sasamarTlosTvis momzadebuli
muSakebTan da a.S. Tu rekomendebulia hospitaluri
daskvnis ramdenime punqti
mkurnaloba, sasamarTlo unda iyos informirebuli
fsiqiatris saxeli da gvari, kvalifikacia, axlandeli imis Sesaxeb, SesaZlebelia Tu ara braldebulis
Tanamdeboba (inglissa da uelsSi _ damowmebulia Tu ara
fsiqikuri janmrTelobis aqtis me-12 paragrafiT) Sesabamisi saxiT ganTavseba.
sad da rodis Catarda interviu da eswreboda Tu ara mas
aq mniSvnelovania riskebis Sefaseba (gv. ??).
mesame piri. fsiqiatrma unda gasces rekomendacia mxolod da
informaciis wyaroebi, Seswavlili dokumentebis CaTvliT. mxolod mkurnalobis Taobaze. miuxedavad amisa,
braldebulis/mosarCles ojaxuri da piradi istoria. sasamarTlo xSirad keTilganwyobiT iRebs fsiqiatris
misi detaluri wardgena ar aris saWiro, gansakuTrebiT mier Sesaferisi formiT gamoTqmul komentars SesaZlo
im SemTxvevaSi, Tu sasamarTlosaTvis xelmisawvdomia
sasjelis adekvaturobis Sesaxeb, gansakuTrebiT maSin,
angariSi socialuri mdgomareobis Sesaxeb. yuradReba
mimarTuli unda iyos diagnozze da informaciaze, rodesac saqme axalgazrda damnaSaveebs exeba.
romelic exeba braldebulis unars wardges sasamarTlos
winaSe.
fsiqiatri, romelic warsdgeba sasamarTlos
amJamindeli fsiqikuri mdgomareoba. warmodgenili unda
iyos mxolod TvalsaCino amJamindeli niSnebi; simptomebi, winaSe
romlebic ar aRiniSneba, unda gamovtovoT. diagnozis fsiqiatri, romelic sasamarTlos winaSe gamodis
formulirebisTvis unda gamoviyenoT fsiqikuri
janmrTelobis aqtis terminebi (fsiqikuri daavadeba, kargad unda iyos momzadebuli. mas xelT unda
fsiqikuri darRvevebi an pirovnuli aSliloba). SemdgomSi, hqondes yvela angariSisa da saWiro dokumentis asli.
SeiZleba, diagnozis dakonkreteba. sasamarTlo, pacientis
mdgomareobaze ufro zust da mkafio ganmartebebs sasargebloa, saqmeSi monawile advokatTan winaswar
moiTxovs, vidre diagnozis niuansebis ganxilvas. gasaubreba, raTa gairkvas yvela sakiTxi, romelic
fsiqikuri mdgomareoba Sesabamisi movlenebis dros. es SeiZleba sasamarTloze aRmocendes. sasamarTloSi
xSirad Zalian mniSvnelovani sakiTxia, gansakuTrebiT
nebismier kiTxvaze pasuxis gacemisas mniSvnelovania
sisxlis samarTlis saqmeebis dros. da mainc, am SemTxvevaSi
mxolod retrospeqtul mosazrebebs SegviZlia mokle da naTeli pasuxebis gacema. fsiqiatri
daveyrdnoT. Sefasebas SeiZleba daexmaros mowmeebis pasuxebis gacemisas fsiqiatruli mtkicebulebiT
Cvenebebi, romlebmac naxes damnaSave danaSaulis Cadenis
dros an uSualod mis Semdeg. amJamindel fsiqiatriul unda ifarglebodes da unda eridos spekulacias.
diagnozs SeuZlia mogvawodos informacia savaraudo arsebobs bevri specialuri satreningo programebi
fsiqikuri mdgomareobis Sesaxeb danaSaulis dros.
magaliTad, Tu braldebuls aqvs qronikuli Sizofrenia an eqspert mowmeTaTvis, romlebic, SeiZleba, sasargeblo
qronikuli organuli fsiqikuri sindromi, misi fsiqikuri gamodges fsiqiatrebisTvis, romlebsac xSirad iwveven
mdgomareoba, savsebiT SesaZlebelia, iseTive yofiliyo
danaSaulis dros, rogorc gamokvlevisas. Tumca, Tu eqspertebad.
braldebuls aqvs depresiuli aSliloba (amJamad an bolo
periodSi) an iseTi epizoduri aSliloba, rogoricaa
epilefsia, ufro rTulia daskvnis gakeTeba imis Sesaxeb,
Tu ra mdgomareobaSi imyofeboda igi danaSaulis Cadenisas. damatebiTi literatura
kidev erTi sirTule imaSi mdgomareobs, rom maSinac ki, Tu
dadginda rom braldebuls hqonda fsiqikuri aSliloba, Gelder, MG, Lpez-Ibor, JJ Jr and andreasen, NC (eds) (2000)
Semdgomi gamokvlevaa saWiro danaSaulis Cadenis periodSi
mens rea-s dasadgenad. Teh new Oxford textbook of psychiatry, Part 11: Forensic
daskvnebi: ZiriTadi monacemebis Sejameba psychiatry. Oxford University Press, Oxford.
Maguire, M. Morgan, M and Reiner R (2002) The Oxford
rCeva samedicino mkurnalobis Taobaze handbook of criminology. Oxford University Press, Oxford.
fsiqiatris erT-erTi mTavari funqciaa gamoTqvas (mimoxilviTi xasiaTis naSromi kriminologiaSi. Sei-
azri imis Taobaze, aris Tu ara fsiqiatriuli cavs Tavebs, romlebic sainteresoa sasamarTlo
mkurnaloba naCvenebi. fsiqiatrma unda izrunos fsiqiatriis TvalsazrisiT.)
imaze, rom mkurnalobaze rekomendaciebi realurad Gunn, J and Taylor P (2006) Forensic psychiatry, Hodder Arnold,
gansaxorcielebeli iyos. man saWiroebis SemTxvevaSi London. (detaluri da sasargeblo saxelmZRvanelo.)
_ 803 _
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