wamebis Sedegebi; samedicino diagnostika, eqspertiza - empathy.ge

wameba; <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong>; <strong>samedicino</strong><br />

<strong>diagnostika</strong>, <strong>eqspertiza</strong>; mkurnaloba da<br />

reabilitacia<br />

mariam jiSkariani, msoflio fsiqiatrTa asociaciis seqciis<br />

“<strong>wamebis</strong> fsiqologiuri <strong>Sede<strong>ge</strong>bi</strong> da aRkveTa” wevri.<br />

<strong>wamebis</strong> msxverplTa reabilitaciis centri “empaTia”, (RCT/EMPATHY,<br />

Georgia)<br />

Address: 62 Chavchavadze Avenue, Tbilisi 0162, Georgia.<br />

Phone/Fax: + (995 32 ) 22 67 47<br />

E – mail : centre@<strong>empathy</strong>.<strong>ge</strong>, mjishkariani@yahoo.com<br />

Tbilisi, 2005<br />

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sarCevi<br />

Tavi I. wameba _____________________________________________gv. .3 - 5<br />

Tavi II. <strong>wamebis</strong> meTodebi ___________________________________gv. 5 - 13<br />

Tavi III. <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> __________________________________ gv. 13 - 46<br />

Tavi IV. <strong>diagnostika</strong> da <strong>eqspertiza</strong> _________________________ gv. 46 - 54<br />

Tavi V. mkurnaloba da reabilitacia _____________________-_ gv. 54 - 62<br />

danarTi 1. <strong>wamebis</strong> msxverplTa monitoringisa<br />

da reabilitaciis <strong>samedicino</strong> da<br />

fsiqo - socialuri programa _____________________________ gv. 63 - 75<br />

gamoyenebuli literatura ________________________________gv. 76 - 79<br />

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Tavi I. wameba<br />

<strong>wamebis</strong> ganmarteba (gaeros <strong>wamebis</strong> sawinaaRmdego konvencia muxli1).<br />

aRniSnuli konvenciis Tanaxmad <strong>wamebis</strong> definicia Semdegia:<br />

nawili I<br />

muxli 1.<br />

“am konvenciis miznebisaTvis gansazRvreba “wameba” niSnavs nebismier<br />

moqmedebas, romliTac romelime pirs ganzrax ayeneben tkivils an tanjvas,<br />

fizikurs an zneobrivs, raTa misgan an mesame pirisgan miiRon cnobebi an<br />

aRiareba, dasajon qmedebisaTvis, romelic man an mesame pirma Caidina an<br />

romlis CadenaSic igi eWvmitanilia, agreTve daaSinon an aiZulon igi an<br />

mesame piri an nebismieri mizeziT, romelsac safuZvlad udevs nebismieri<br />

xasiaTis diskriminacia, roca aseT tkivilsa da tanjvas ayenebs,<br />

saxelmwifos Tanamdebobis piri an sxva oficialuri piri, an maTi waqezebiT,<br />

nebarTviT da mdumare TanxmobiT.”<br />

wameba warmoad<strong>ge</strong>ns ara humanuri, adamianuri Rirsebis Semlaxavi<br />

mopyrobisa da dasjis ukidures formas.<br />

<strong>wamebis</strong> mizani<br />

jalaTebis mier mowodebuli axsna–ganmartebebis Tanaxmad, xSir<br />

SemTxvevaSi, isini Tavs imarTleben, rom wameba emsaxureba informaciis<br />

mopovebas, gansakuTrebiT ki isini amarTleben <strong>wamebis</strong> gamoyenebas im<br />

SemTxvevebSi, roca saqme exeba teroristebis dakavebas da<br />

sazogadoebisaTvis saSiS damnaSaveebs, sazogadoebis usafrTxoebisaTvis<br />

saWiro informaciis mopovebas; Tumca unda aRiniSnos, rom aseTi<br />

formulireba ar asaxavs <strong>wamebis</strong> WeSmarit mizans da mxolod Tavis<br />

marTlebis formaluri xasiaTis matarebelia.<br />

rogorc aCvena msoflioSi Catarebulma kvlevebma da aseve Cvens mier<br />

wlebis manZilze Seswavlili <strong>wamebis</strong> SemTxvevebis statistikurma Tu fsiqo–<br />

socialurma analizma, <strong>wamebis</strong> umTavres mizans Sead<strong>ge</strong>ns:<br />

pirovnebis saboloo gatexva–ganadgureba, misi momavlis sruli<br />

ganadgureba; misi fsiqo – socialuri funqcionirebis sruli moSla.<br />

zogadad sazogadoebis daSineba–terorizireba,<br />

xSir SemTxvevaSi, iseTi danaSaulis aRiareba, romelic aRniSnul<br />

pirovnebas ar Caudenia;<br />

iZuleba, gaxdes informatori, an miawodos informacia sxva<br />

adamianebze, xSirad ki imgvar faqtebze, romelic am sxva adamianebs ar<br />

CaudeniaT;<br />

xSir SemTxvevaSi wameba da sastiki mopyroba emsaxureba eTnikuri<br />

niSniT Seuracxyofisa da daTrgunvis moTxovnilebas; aseve<br />

aRmsareblobisa da ideologiis gamo pirovnebis damcirebasa da<br />

ganadgurebas;<br />

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xSir SemTxvevaSi, wameba rogorc Tavis Tavad arasamarTlebrivi<br />

qmedeba, xdeba saSualeba “kriminaluri samarTlis” damkvidrebisa,<br />

rogoric aris fulis gamoZalvis mizniT adamianTa dapatimreba, xSir<br />

SemTxvevaSi ukanono, Zalovani struqturebis mxridan reketireba da<br />

terorizireba;<br />

Zalze xSirad amgvari qmedeba dakavSirebulia jalaTTa sadistur<br />

tendenciebTan.<br />

da bolos, <strong>wamebis</strong> praqtika uryevi safuZveli xdeba avtoritaruli<br />

saxelmwifos urTierTobebisa da globalurad emsaxureba<br />

sazogadoebis ukidures daSinebasa da daTrgunvas, raTa maT ar<br />

mimarTon raime saxis protests da ver gabedon arsebuli reJimis<br />

winaaRmdeg galaSqreba.<br />

amgvarad, wameba ara marto pirovnebis fizikur da fsiqologiur<br />

ganadgurebas emsaxureba, aramed mas ufro farTo da zogadi daniSnuleba<br />

gaaCnia, iseTi rogoric aris socialuri da politikuri <strong>Sede<strong>ge</strong>bi</strong>, rogorc<br />

calkeuli qveynebisaTvis, aseve mTeli kacobriobisaTvis. igi mTels<br />

kacobriobaSi Tesavs SemaZrwunebeli SiSis, umweobisa da morCilebis<br />

gancdebs, romelic gadaecema mTel rig Taobebs da xSir SemTxvevaSi,<br />

aracnobierad ayalibebs qcevis stereotipebs, rogorc potenciur jalaTTa<br />

Soris (saxelmwifo manqanis warmomad<strong>ge</strong>nelni), aseve potenciur msxverplTa<br />

Sorisac da xdeba safuZveli mTel rig saxelmwifoebSi stabiluri da<br />

Znelad transformirebadi, myari avtokratuli mmarTvelobis stereotipis<br />

Camoyalibebisa.<br />

socialur-politikuri TvalsazrisiT, mTeli rigi avtorebi wamebas<br />

ganixilaven Semdegnairad:<br />

Lira (1995): “ufro farTod rom ganvixiloT, <strong>wamebis</strong> mizania daaSinos<br />

mesame mxareebi da sazogadoebaSi gamowvios SiSi, daTrgunva,<br />

paralizeba, uunaroba da morCileba. adamianis uflebebis darRveva ar<br />

unda ganvixiloT gancalkevebulad mxolod erTi pirovnebis uflebebis<br />

darRvevis gadmosaxedidan. maTi <strong>Sede<strong>ge</strong>bi</strong> mravlismomcvelia, radgan<br />

isini asaxaven ara marto konfliqtis mimarT sistemis reagirebas,<br />

aramed zogadad politikuri daSinebis garemos. es qmnis qronikuli<br />

SiSis atmosferos. aqedan gamomdinare, wameba warmoad<strong>ge</strong>ns<br />

sazogadoebisaTvis ara marto politikuri, aramed socialuri,<br />

zneobrivi, fsiqo-socialuri da fsiqikuri jamrTelobis problemas.<br />

<strong>wamebis</strong> faqtis gamoZieba niSnavs <strong>wamebis</strong>, rogorc movlenis ganxilvas,<br />

romelic gavlenas axdens mosaxleobaze da adamianebze, rogorc<br />

sazogadoebis socialur arsebebze.”<br />

Summerfield (1995): “sisastike xSirad miznad isaxavs msxveplis<br />

ekonomiuri, socialuri da kulturuli samyaros gamiznulad<br />

ganadgurebas. “<br />

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“am TvalsazrisiT, wamebam SeiZleba gamoiwvios Temis travmireba,<br />

romelmac Tavis mxriv SesaZloa gamoiwvios sxvadasxva formis<br />

sazogadoebrivi disfunqciis Camoyalibeba. wamebas SeuZlia terorSi<br />

amyofos mosaxleoba da Seqmnas iseTi wesrigi, romelic efuZneba<br />

moaxloebul, masStabur SiSs, muqaras, terors da daTrgunvas da ara<br />

damoukideblobasa da Tavisuflebas. mas SeuZlia Seqmnas represiuli<br />

garemo. es aris daucveli, teroris, undoblobis da socialuri cxovrebis<br />

gaxleCvis garemo. <strong>wamebis</strong> mimarT koleqtiuri SiSi xangrZlivi droiT<br />

axdens gavlenas koleqtiur qcevaze. ufro metic, kvlevam gvaCvena, rom<br />

<strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> SeiZleba gadaeces Taobebs, warmoqmnas istoriuli<br />

travma.”(Lira, 2002).<br />

Tavi II. <strong>wamebis</strong> meTodebi<br />

wameba aris dinamiuri procesi, romelic iwyeba dakavebiT an<br />

Tavisuflebis SezRudviT da romelic moicavs aRniSnulis Sedegad<br />

miyenebul erT an ramdenime travmas, romelic SeiZleba moxdes sxvadasxva<br />

drosa da sxvadasxva adgilas da dasruldes msxveplis gaTavisuflebiT an<br />

gardacvalebiT (Somnier, 1992). movlenebis es kaskadi SeiZleba isev daiwyos<br />

mokle droSi ise, rom ar dautovos pirovnebas gamojanmrTelobis dro.<br />

xSir SemTxvevaSi gamoiyeneba rogorc <strong>wamebis</strong> fizikuri meTodebi,<br />

aseve fsiqologiuri; Tumca unda aRiniSnos, rom amgvari dayofa pirobiTia:<br />

nebismier SemTxvevaSi wameba moicavs orive komponents: rogorc fizikurs,<br />

aseve fsiqikursac.<br />

<strong>wamebis</strong> meTodebi, romlebic ganimarteba rogorc fizikuri wameba _<br />

moicavs meTodebs, romlebic gulisxmobs msxverplis mimarT jalaTebis<br />

mier ganxorcielebul fizikur Zaladobas da tkivils an sxva piris mier<br />

ganxorcielebul nebismier sxva fizikur (sxeulis) travmirebas, da aqve<br />

gvinda SevitanoT fizikuri <strong>wamebis</strong> meTodebi, romlebic ar tovebs raime<br />

fizikur kvals (magaliTad gaziT mogudva-SeniRbva); ra Tqma unda, isev<br />

gavimeorebT, rom <strong>wamebis</strong> dayofa fizikur da fsiqologiur meTodebad<br />

Zalian Znelia da pirobiTia, radgan yvela fsiqologiur meTods aqvs<br />

fizikuri-somaturi <strong>Sede<strong>ge</strong>bi</strong>c (magaliTad, sicive, SimSiloba da sxva) da,<br />

raRa Tqma unda, fizikur meTodebs aqvT Semdgomi fsiqologiuri <strong>Sede<strong>ge</strong>bi</strong>c.<br />

zemoT aRniSnulidan gamomdinare, fsiqologiur meTodebad ganixileba<br />

pirobiTad iseTi meTodebi, romlebic upirveles yovlisa zians ayeneben<br />

msxverplis moralur da fsiqologiur mdgomareobas da ar moicavs sxva<br />

piris mxridan raime saxis fizikur Zaladobas.<br />

aRiarebulia, rom <strong>wamebis</strong> meTodebi, romelnic seriozul safrTxes<br />

uqmnian adamianis sicocxles an mis fizikur Tu fsiqikur funqcionirebas,<br />

iwveven SemaZrwunebeli SiSis gancdas, rac pirovnebisaTvis Rrma da<br />

xangrZlivi travmatizaciis mizezi xdeba.<br />

rogorc ukve iqna aRniSnuli, sakuTriv wamebas win uswrebs<br />

dapatimrebisa da egreT wodebuli « lomkis » (gatexvis) periodi, romelic<br />

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xasiaTdeba Semdegi zogadi Tu konkretuli fizikuri Tu fsiqologiuri<br />

sisastikiT, rogoric aris:<br />

zogadad sazogadoebaSi gavrcelebuli azri da sazogadoebis<br />

gamocdileba wamebasTan dakavSirebiT, rom nebismier dakavebas<br />

aucileblad mohyveba wameba;<br />

aseve <strong>wamebis</strong> wina periodi, romelic xasiaTdeba sxvadasxva saxis<br />

muqariT, rogorc pirovnebis, aseve misi ojaxis mimarT;<br />

aSkara TvalTvaliTa da devniT, aseve pirovnebis Tavisuflebis sxva<br />

saxis SezRudviT;<br />

xSiri dakiTxvebiT Tu dabarebebiT samarTaldamcav organoebSi;<br />

saxlSi SevardnebiTa da ojaxis dawiokebiT;<br />

yovelive aRniSnuli iwvevs adamianis ukidures gadaRlasa da<br />

daZabulobas, pirovnebis kompensatoruli funqciebis amowurvasa da fsiqo–<br />

emociur asTenizacias, uZilobas, gamouvali situaciis Seqmnas ; aRniSnuli<br />

viTarebiT xdeba « <strong>wamebis</strong>aTvis pirovnebis Semzadeba », pirovnebis<br />

winaswari erTgvari gatexva da daSineba. amgvar qmedebebs mosdevs<br />

dapatimrebis aqti, romelic Tavisi formebiT aseve damTrgunveli da<br />

sastikia : SeiaraRebuli niRbianebis Secvena ojaxSi an quCaSi Tavdasxma,<br />

TvalSisacemi sisastike, yvelafris damsxvreva – dalewva da pirovnebis<br />

sastiki cema dapatimrebis momentSive, rac SeiZleba ganxorcieldes CeqmebiT,<br />

muStebiT, iaraRis tarebiT Tu sxva blagvi sagnebiT, xelborkilebis dadeba<br />

da damamcirebeli mouxerxebeli poziT Setenva manqanaSi.<br />

amgvari <strong>wamebis</strong> wina periodi xels uwyobs pirovnebis Semzadebas<br />

gardauvali pirovnuli ganadgurebisaTvis da ukiduresi uimedobis gancdis<br />

Camoyalibebas.<br />

dapatimrebis periodi Tavdeba Tavisuflebis aRkveTiT policiis<br />

izolatorSi an cixeSi, sadac yvelaze xSirad adgili aqvs adamianis wamebas.<br />

dakavebis adgilze miyvanisTanave iwyeba autaneli tanjvisa da<br />

sistematuri cemis periodi, rac gamoixateba xangrZliv, momqancvel,<br />

damamcirebel dakiTxvebSi, pirovnebis bunebrivi moTxovnilebebis<br />

SezRudvaSi, kerZod ki wylisa da sakvebis ar micemaSi, sapirfareSoSi ar<br />

gaSvebaSi; aseve adgili aqvs cemas, sxvadasxva mxridan moulodnel<br />

dartymebs fexebiT, xelebiT, xelketebiT an sxva sagnebiT, rasac uwodeben<br />

msxverplis egreTwodebul « boqsirebas »; arcTu iSviaTad dakavebuls<br />

aiZuleben dakiTxvisa da <strong>wamebis</strong> molodinSi mdgomare pozaSi dahyos<br />

ramdenime dRis ganmavlobaSi (egreTwodebuli « planton » is poza).<br />

yvelaze xSirad gavrcelebuli fizikuri <strong>wamebis</strong> meTodebi Semdegia :<br />

cema, sistematizirebuli da ara sistematizirebuli ;<br />

“stomatologiuri” wameba;<br />

Camokideba;<br />

ara fiziologiuri mdebareoba;<br />

eleqtro deniT wameba;<br />

mogudva – moxrCoba;<br />

seqsualuri wameba;<br />

farmakologiuri wameba;<br />

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daRdasma;<br />

damwvroba;<br />

cema<br />

rogorc ukve iqna aRniSnuli, dakavebis adgilas miyvanisTanave, iwyeba<br />

dakavebulis usistemo cema sxvadasxva mxridan da sxvadasxva saSualebebiT,<br />

rogorc wesi, amgvar qmedebaSi monawileobs ramdenime jalaTi<br />

erTdroulad.<br />

sistematizirebuli cemis magaliTad SeiZleba gamoyenebul iqnas iseTi<br />

meTodebi, rogoric aris “falanga” an “telefoni”. “falanga” farTod aris<br />

gavrcelebuli axlo aRmosavleTSi, Tumca Ceveni kvlevebis Tanaxmad, igi<br />

farTod aris gavrcelebuli saqarTveloSic. am dros msxverpls urtyamen<br />

monotonurad an SiSvel terfebze an fexsacmlian terfze, ufro xSirad<br />

rezinis xelketiT, an xis magari sagniT an sxva myari blagvi sagniT, amave<br />

dros msxverplis fexebi aweulia da fiqsirebulia an skamis zurgze an sxva<br />

saSualebebiT aris Sekruli. amgvar mdgomareobaSi adamians ara aqvs<br />

Tavdacvis saSualeba, rac fsiqologiurad aZlierebs amgvari cemis efeqts<br />

da iwvevs panikuri SiSis mdgomareobas. xSirad, amis Semdeg msxverpls<br />

aiZuleben iaros SiSveli fexiT damsxvreul minebze an qvebze, id<strong>ge</strong>s yinulze<br />

da a.S., rac metismetad mtkivneulia da am dros saxis gamometyveleba<br />

auwerel tanjvas gamoxatavs.<br />

“falangis” uSualo <strong>Sede<strong>ge</strong>bi</strong>a – wvivebisa da terfis midamos<br />

tkivilebi, hematomebi da SeSupeba, siarulis SeuZlebloba, rac msxverpls<br />

aiZulebs gadaadgildes daCoqil mdgomareobaSi (skliuvi, 1992).<br />

“telefonis” gamoyenebisas erTdroulad xdeba dartymis miyeneba<br />

orive yuris midamoSi, Cvens mier aRweril SemTxvevebSi, es xorcieldeboda<br />

gaSilili xelis SemortymiT erTdroulad orive mxridan, ris Sedegadac<br />

xSir SemTxvevaSi adgili aqvs dafis apkis gaxeTqvas an dazianebas. amgvari<br />

dazianeba SemdegSi iwvevs smenis mxriv seriozul problemebs, xSirad<br />

garTulebas Cirqovani otitis saxiT da atarebs qronikul xasiaTs.<br />

xSir SemTxvevaSi blagvi mkvrivi sagniT xorcieldeba cema<br />

motexilobis adgilebSi an dazianebul midamoSi; xSiria dartymebi muclis<br />

areSi, gansakuTrebiT sayuradReboa cema Tavis midamoSi, rac Cvens mier<br />

sakmaod xSirad iqna aRwerili da rasac TiTqmis yovelTvis Tan axlavs<br />

Tavis tvinis daxuruli travma, gonebis dakargva da xSirad Tavis tvinis<br />

seriozuli travma _ tvinis Seryevis an daJeJilobis saxiT.<br />

“stomatologiuri” wameba<br />

amgvar SemTxvevebSi msxverpls ugdeben kbilebs, es xdeba cemisas an<br />

xSirad xdeba janmrTeli kbilebis amoReba stomatologiuri<br />

instrumentebiT, an sxva arasteriluri iaraRebiT, aseve xSiria kbilebis<br />

areSi eleqtro denis gatarebis SemTxvevebi.<br />

Camokideba<br />

xSir SemTxvevaSi am dros saubaria egreTwodebul “palestinur<br />

Camokidebaze”, rodesac msxverpls kideben ukan Sekruli xelebiT; ufro<br />

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xSirad ki post – sabWour qveynebSi gamoiyeneba egreTwodebuli “lastoCka”<br />

da misi modificirebuli variantebi, rodesac adamians, romelsac xelebi da<br />

fexebi ukan aaqvs Sekruli da am mdgomareobaSi mas Camokideben. aseve<br />

Camokidebis saxea “marao”, rodesac msxverpls hkideben fexebiT da<br />

atrialeben vertikalurad;<br />

<strong>wamebis</strong> amgvari meTodi xSirad Serwymulia sxva meTodebTan,<br />

rogoric aris eleqtro deniT wameba da arafiziologiuri mdebareoba (mag.<br />

“lastoCka” , rodesac msxverplis mdgomareoba arafiziologiuria da amave<br />

dros mas hkideben); eleqtro deniT <strong>wamebis</strong>as Camokidebul mdgomareobaSi<br />

myof msxverpls sxeulis mgrZnobiare adgilebze: yuris bibiloebze,<br />

<strong>ge</strong>nitalur midamoSi, enaze, kbilebze an TiTebis boloebze an dvrilebze _<br />

uerTeben eleqtrodebs da atareben eleqtro dens.<br />

amgvari meTodebi, saerTod naklebad toveben fizikur kvals, Tumca<br />

xangrZlivi droiT da xSirad qronikulad iwveven moZraobaTa darRvevas,<br />

sxeulis sxvadasxva midamoSi tkivilebs da xSirad tkivils mTeli sxeulis<br />

areSi, gansakuTrebiT ki Tavis, kisrisa da zurgis midamoSi.<br />

arafiziologiuri mdgomareoba<br />

aseTi mdgomareobis magaliTad SeiZleba moyvanil iqnas<br />

egreTwodebuli “ku”, adamians agdeben mcire zomis galiaSi, sadac mas ar<br />

SeuZlia gaimarTos, amave dros ar aZleven sakvebsa da wyals da igi am<br />

mdgomareobaSi imyofeba dReebis ganmavlobaSi; aseve SeiZleba Caagdon<br />

mcire zomis ormoSi an sardafSi, sadac igi iZulebulia dReebis<br />

ganmavlobaSi imyofebodes sibneleSi, sakvebisa da wylis gareSe, mdgomare<br />

poziciaSi; amave dros Cvens mier iqna aRwerili SemTxvevebi, rodesac Tavze<br />

asxamen eqskrementebs, an ormoSi amave dros aris Casxmuli didi<br />

raodenobiT wyali; amgvari wameba xSir SemTxvevaSi iwvevs organoTa<br />

seriozul qronikul dazianebas; gansakuTrebiT ki (magaliTad wylian<br />

ormoSi siciveSi Cagdeba) iwvevs reproduqciis funqciebisa da organoebis<br />

seriozul problemebs, uro – <strong>ge</strong>nitaluri sistemis dazianebas; rac jalaTTa<br />

mizniTa CanafiqriT, swored rom reproduqciis unaris dakargvas emsaxureba<br />

da am meTodebs xSirad mimarTaven eTno – konfliqtebis SemTxvevaSi.<br />

eleqtrodeniT wameba<br />

<strong>wamebis</strong> es saxe iwvevs gansakuTrebiT mtkivneul krunCxvebs, msxverpli<br />

am dros ikvnets enas, tuCebs an loyas. igi xSir SemTxvevaSi tardeba<br />

sxeulis mgrZnobiare areebSi eleqtrodebis dadebiTa da denis gatarebiT.<br />

<strong>wamebis</strong> aparatebi sxvadasxvagvaria, magaliTad eleqtrodenis joxi an<br />

maxvili fanqriseburi sagani; Cvens SemTxvevaSi xSirad iqna aRwerili<br />

“telefonis aparatiT” denis gatarebis meTodi, aseve eleqtrodebis dadeba<br />

dasvelebuli Rrublis SemoxveviT majebsa da wvivebze, rac xSir SemTxvevaSi<br />

krunCxviTi gantvirTvebis mizezi xdeba; am dros adamiani TiTqmis<br />

yovelTvis hkargavs gonebas, Semdeg mas asuliereben wlis dasxmiT da kvlav<br />

ganagrZoben amgvar wamebas; amgvari meTodi iwvevs Sokur mdgomareobas<br />

rogorc tkiviliT, aseve stresiT ganpirobebuls, Tumca kvalis datovebis<br />

8

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TvalsazrisiT, SesaZloa datovos mcire damwvrobis kvali, romelic Znelad<br />

SesamCnevia.<br />

gagudva – moxrCoba<br />

<strong>wamebis</strong> am meTodis erT – erT saxeobas ganekuTneba “submarino”, rac<br />

gamoixateba SemdegSi: adamians TaviT uSveben wyalSi da ase aCereben iqamde,<br />

sanam ar daiwyeba moxrCobis simptomebi, rac Sesabamisad iwvevs sikvdilis<br />

saSinel SiSs. amave dros, CarTuli aris televizori an radio, imis gamo,<br />

rom SemdgomSi mudmivad am nivTebis xilvis an xmebis ga<strong>ge</strong>bisas msxverpls<br />

mudmivad hqondes wamebasTan dakavSirebuli asociaciebi da mogonebani.<br />

seqsualuri wameba<br />

seqsualuri <strong>wamebis</strong> msxverplni SesaZloa gaxdnen rogorc qalebi,<br />

aseve mamakacebi, an bavSvebi. igi gamoixateba uSveri sityvebiT lanZRvasa da<br />

Seuracxyofis miyenebaSi; aseve iZulebiT an Zaladobriv gaSiSvlebaSi;<br />

damamcirebeli pozis miRebaSi; masturbaciasa da erTmaneTis gaupatiurebaSi<br />

monawileobaSi; gaupatiureba xdeba jalaTebis mxridanac da upiratesad<br />

atarebs jgufur xasiaTs. amgvari wameba xSirad mimdinareobs sxva<br />

patimrebis an tyveebis TandaswrebiT, xSir SemTxvevaSi ki – ojaxis wevrTa<br />

TandaswrebiT. amgvari saSineli mopyroba upirveles yovlisa emsaxureba<br />

adamianis damcirebasa da pirovnul ganadgurebas da iwvevs xangrZliv da<br />

dauviwyar sulier travmas.<br />

aseve seqsuluri <strong>wamebis</strong> dros xSirad xdeba sxvadasxva mWreli da<br />

mCxvletavi sagnebiT an eleqtro deniT sqesobrivi organoebis dazianeba,<br />

rac xSir SemTxvevaSi reproduqcuiis unaris mospobas emsaxureba. imave<br />

mizniT yinvaSi mamakacebsa da qalebs xSirad ayeneben dReebis ganmavlobaSi<br />

civ yinulian wyalSi. amgvari meTodebi, Cveni dakvirvebiT, ufro xSirad<br />

ixmareba eTnikuri wmendis zonebSi da safuZvlad eTnikuri an religiuri<br />

zizRi udevs.<br />

farmakologiuri wameba<br />

jalaTebi iZulebiT asmeven patimars tabletebs an ukeTeben ineqcias;<br />

xSir SemTxvevaSi am mizniT gamoiyeneba fsiqotropuli preparatebi,<br />

romelTa didi dozebiTa da arasaWiroebisamebr gamoyeneba iwvevs mZafr<br />

gverdiT movlenebs. xSir SemTxvevaSi ki iZulebiT ukeTeben narkotikul<br />

saSulebebs, rac iwvevs miCvevas da msxverpli xdeba damokidebuli jalaTze,<br />

narkotikuli preparatisTvis akeTebs yvelafers, xdeba informatori da a.S.<br />

sabWoTa periodis egreT wodebul “КГБ” - Si, farTod gamoiyeneboda<br />

farmakologiuri preparatebi informaciis misaRebad da dakiTxvis dros.<br />

daRis dasma, dasaxiCreba<br />

am mizniT gamoiyeneba mravali meTodi, rogoric aris frCxilebis<br />

daZroba, Tmebis amogleja, warziduli nawilebis mokveTa – magaliTad<br />

9

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yuris, Tvalis amoTxra, TiTis moWra, enisa an gare sasqeso organoebis<br />

amputireba.<br />

damwvroba<br />

am mizniT xSirad gamoiyeneba anTebuli sigaretis miwva,<br />

gansakuTrebiT ki sxeulis mgrZnobiare nawilebze; iyeneben aseve<br />

egreTwodebul “dauTovebis meTods” , roca cxel uTos adeben sxeulis<br />

sxvadasxva nawilebze; aseve akraven gisosebze, romelsac nel – nela<br />

acxeleben; iyeneben gavarvarebuli SanTiT dadaRvis meTodsac.<br />

<strong>wamebis</strong> upiratesad fsiqikuri meTodebi<br />

<strong>wamebis</strong> fsiqikuri meTodebi metad farTod gamoiyeneba da iwvevs<br />

adamianis seriozul travmirebas, romlis <strong>Sede<strong>ge</strong>bi</strong>c SesaZloa qronikulad<br />

mimdinareobdes. amgvari meTodebi gamoirCeva didi mravalferovnebiTa da<br />

daxvewilobiT, da droTa ganmavlobaSi isini ufro da ufro daxvewili<br />

xdeba, rac utyuarad miuTiTebs imaze, rom amgavari meTodebis, iseve<br />

rogorc fizikuri meTodebis, SemuSavebaSi monawileoben specialistebi. Cven<br />

aq moviyvanT ramdenime maTgans, raTa naTeli warmod<strong>ge</strong>na Seiqmnas amgvari<br />

meTodebis sisastikesa da pirovnebisaTvis damangrevel rolze.<br />

deprivacia<br />

xSir SemTxvevaSi patimars dapatimrebisTanave aTavseben<br />

izolirebulad marto da mas ara aqvs saSuleba hqondes kontaqti an sxva<br />

patimrebTan an ojaxis wevrebTan, aseve ar aZleven advokatTan dakavSirebis<br />

saSulebas. patimari am dros Tavs grZnobs gare samyarosagan mTlianad<br />

mowyvetilad, absoluturad daucvelad da umweod, igi mTlianad aris<br />

damokidebuli jalaTebis neba–survilze. mas ara aqvs informacia icis Tu<br />

ara vinmem misi dapatimrebis Sesaxeb, grZnobs, rom igi SesaZloa moklan,<br />

daikargos ugzo-ukvlod, ise, rom mis Sesaxeb veravin ver gaigos veraferi.<br />

mas am dros ara aqvs aranairi moraluri Tu iuridiuli daxmarebis<br />

saSualeba, arc imis saSualeba, rom sxva patimarTagan mainc miiRos<br />

Tanadgoma an raime saxis informacia. xSir SemTxvevaSi es meTodi<br />

Serwymulia sxva saxis tanjvasTanac, rogoric aris sibnele: sakanSi ar<br />

aris naTura, ar Semodis dRis sinaTle, ara aqvs saaTi an sxva piradi<br />

moxmarebis sagnebi; es, rogorc wesi, iwvevs dezorientacias drosa da<br />

garemoSi, xSirad ki dRe-Ramis riTmis myar darRvevas, rac SemdgomSi iRebs<br />

qronikul xasiaTs; amave dros, SesaZloa, amgvar viTarebaSi damatebuli<br />

iqnas sxvadasxva saxis stereotipuli ritmuli komponentebi, iseTi rogoric<br />

aris, magaliTad: gafuWebuli onkani kameraSi, romlidanac wyali<br />

monotonurad wveTavs da romelic ar iketeba, aseve naTura, romelic<br />

periodulad Tanabari intervalebiT inTeba da qreba, amgvari moqmedebebi<br />

iwvevs sakmaod mZime fsiqikur aSlilobebsa da aseve pirobiTi refleqsis<br />

gamomuSavevas ama Tu im moqmedebaze, an pirovnebis STagonebadobis gazrdas,<br />

rac SemdgomSi dakiTxvebisas gamoiyeneba “efeqtis” misaRwevad, vinaidan<br />

qveiTdeba TviTkontrolisa da yuradRebis koncentraciis unari.<br />

10

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xSirad es meTodi Serwymulia Zilis deprivaciasTan: adamians ar<br />

aZleven Zilis saSualebas sxvadasxva saxis xmauris meSveobiT. xSirad mas<br />

esmis sxva patimrebis <strong>wamebis</strong> xmebi an SemaZrwunebeli xmauri, an gahyavT<br />

RameSi ramdenjerme dakiTxvaze; Zilis deprivacia iwvevs seriozul<br />

fsiqikur aSlilobebs da rogorc wesi Zilis funqciis myar darRvevas<br />

xSirad mTeli sicocxlis manZilze.<br />

xangrZilivi izolacia xSirad iwvevs halucinaciuri gancdebis<br />

Camoyalibebas, Zlierdeba “gagiJebis SiSi”, sxvadasxva saxis fobiebi da<br />

panikuri SfoTvis Setevebi.<br />

bunebrivi moTxovnilebebis dakmayofilebis SezRudva<br />

patimars ar aZleven saaTobiT an mTeli dRis ganmavlobaSi saSulebas<br />

daikmayofilos bunebrivi moTxovnilebebi, ar uSveben sapirfareSoSi, ara<br />

aqvs saSualeba daicvas piradi higiena, ar aZleven sakvebsa da sasmel wyals,<br />

amgvari qmedebebi mimdinareobs xSirad permanentuli dakiTxvis fonze da<br />

instruqciiT, Tu miiReben saWiro informacias an aRiarebas, mas micemen<br />

amgvari moTxovnilebebis dakmayofilebi saSualebas.<br />

a<strong>ge</strong>nti kameraSi<br />

amgvari meTodebi xSirad gamoiyeneboda sabWoTa cixeebsa da<br />

izolatorebSi, da xSirad dResac gamoiyeneba post - sabWoTa qveynebSi.<br />

meTodis arsi imaSi mdgomareobs, rom yvelam icis, rom erT-erTi sakanSi<br />

aris Sekruli a<strong>ge</strong>nti. es garemoeba iwvevs mudmivi daZabulobisa da eWvis<br />

safuZvels, urTierT agresias, TviTkontrolisa da moWarbebuli sifxizlis,<br />

mudmivi SiSis mdgomareobas, rom zedmeti araferi wamoscdes. amgvar<br />

situaciaSi xangrZlivi periodiT yofna umetes SemTxvevaSi iwvevs<br />

pirovnebis paranoialur ganviTarebas da literaturaSi farTod aRwerili<br />

“cixis paranoiis”, calkeul SemTxvevebSi, ki paranoiduli reaqtiuli<br />

fsiqozis, Camoyalibebas, rac praqtikulad sakmaod xSirad ganTavisuflebis<br />

Semdeg iRebs qronikul xasiaTs.<br />

wamebaze daswreba<br />

Cvens mier aRweril SemTxvevaTa umravlesobaSi patimars<br />

miyvanisTanave aswrebdnen “<strong>wamebis</strong>aTvis gankuTvnil oTaxSi”, sadac aseve<br />

igi uyurebs ganTavsebul specialur instrumentebs, sxvis wamebas, rac<br />

gamanadgurebel STabeWdilebas axdens pirovnebaze; xdeba identifikaciis<br />

gancdis Camoyalibeba da amiTi xSirad swrafad miiRweva “Sedegi”, adamiani<br />

tydeba da yvelaferze Tanaxmaa; xSirad ki amgvari meTodis sisastike<br />

matulobs, da pirovnebas ayurebineben ojaxis wevris an axlo megobris<br />

wamebas. aseve Seqmnilia specialuri filmebi wamebaze, romelTac<br />

ayurebineben patimrebs da ucxadeben, rom mas igive moelis; xSirad ki<br />

saxelmwifoSi gavrcelebuli wameba da amgvari meTodebis Sesaxeb<br />

informacia iwvevs mTeli mosaxleobis daSinebasa da wamebas; potenciurad<br />

yvela patimari ganixileba ukve rogorc <strong>wamebis</strong> msxverpli, vinaidan<br />

dakavebulma adamianma winaswarve icis, Tu ra elis da igi Tavidanve<br />

11

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moralurad gatexilia; amgvari sazogadoebis “informirebuloba” iwvevs<br />

mTeli Taobebisa da momdevno Taobebis travmirebas, daTrgunvas,<br />

damoukideblobisa da Tavisuflebis moTxovnilebis daqveiTebasa da SiSs,<br />

uazro da gaucnobierebel morCilebas totalitaruli reJimebisadmi.<br />

molodini<br />

patimarma xSir SemTxvevaSi ar icis Tu rodis gaiyvanen dakiTxvaze da<br />

rodis awameben; dakiTxvebs Soris intervali specialurad yovelTvis<br />

varirebs, raTa adamianma ar gansazRvros sworad _ Tu rodis miyavT<br />

dakiTxvaze da ver moaswros moralurad Semzadeba; amgvari permanentuli<br />

<strong>wamebis</strong> molodini iwvevs mudmivi SiSisa da daZabulobis gancdas, da msgavsi<br />

gancda SesaZloa mudmivad Tan sdevdes <strong>wamebis</strong> msxverpls.<br />

ararealuri arCevani<br />

am meTods Zalian xSirad mimarTaven jalaTebi. am dros saSineli<br />

muqaris qveS, magaliTad col – Svilis gaupatiureba an ojaxis daxocva,<br />

patimars eZleva winadadeba gasces informacia, anu igi d<strong>ge</strong>ba saSineli<br />

“arCevanis” winaSe, xSir SemTxvevaSi _ gasces megobrebi an gawiros ojaxi;<br />

es meTodi kidev ufro daixvewa sabWoTa periodSi da amgvar situaciaSi<br />

patimars aiZulebdnen gamxdariyo “Sekruli a<strong>ge</strong>nti – informatori”, daewera<br />

ararealuri saCivari an dasmenis werili mTavrobisaTvis arasasurvel<br />

pirovnebaze, damdgariyo cru mowmed da a.S. amgvari meTodebi<br />

gansakuTrebiT gamoiyeneboda stalinis reJimis periodSi da asaxva postsabWoTa<br />

periodSic hpova – cru mowmeebis gavrcelebuli instituti<br />

sasamarTloebze, saqmis Ziebisas da sxva. amgvari situacia iwvevs<br />

qronikulad mimdinare TviTdanaSaulis gancdis Camoyalibebas.<br />

muqara da “cru sikvdili”<br />

<strong>wamebis</strong>as farTod gamoiyeneba muqaris saxvadasxva da sastiki formebi.<br />

muqara ojaxis wevrebze; gaupatiurebis muqara, Cveni dakvirvebiT, amgvari<br />

muqara farTod da “efeqturad” gamoiyeneba kaci patimrebis mimarT; aseve<br />

arsebobs sikvdilis muqara, samudamo patimrobis muqara, ojaxis wevrebis<br />

<strong>wamebis</strong>a da Tvalwin gaupatiurebis muqara.<br />

gamoiyeneba “cru sikvdiliT dasjis” meTodic, dakavebuls ucxadeben,<br />

rom mas xval gamTeniisas daxvreten da sTavzoben daweros anderZi, an<br />

ramdenjerme safeTqelTan adeben iaraRs tyviebis gareSe (patimarma ar icis,<br />

rom iaraRSi tyviebi ar aris), da Caxmaxs gamokraven xels. amgvari qmedeba<br />

iwvevs gadaulaxavi SiSis gancdas, anadgurebs adamians pirovnulad, xSiria<br />

am dros uneblie Sardvisa da defekaciis movlenebi, rac SemdgomSi<br />

damatebiT iwvevs sircxvilis gancdasac.<br />

aseve unda aRiniSnos, rom xSirad mimarTaven iseTi <strong>wamebis</strong><br />

situaciebis fotografirebas an video – audio Caweras, romelic iwvevs<br />

mZafr sircxvilis gancdas, magaliTad gaupatiureba da seqsualuri <strong>wamebis</strong><br />

sxva saxeebi da amis gamJRavnebiT aSineben <strong>wamebis</strong> msxverpls da aiZuleben<br />

mudmivad iyos maT daqvemdebarebaSi, asrulos maTi gankargulebebi; amgvari<br />

12

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situaciisas gansakuTrebuli mniSvneloba eniWeba eTnokulturul faqtors;<br />

calkeul eTnikur jgufebSi gaupatiureba aRiqmeba saSinel codvad da<br />

amgvari situaciis Semdeg adamianma Tavi unda moiklas an Suri iZios da a.S.<br />

xSirad aseT situaciebSi pirovneba yvelaferze Tanaxmaa. erTis mxriv isini<br />

xdebian TviTon saxelmwifos mier inspirirebuli teroristuli dajgufebis<br />

wevrebi da awyoben teroristul aqtebs, romelic emsaxureba calkeuli<br />

saxelmwifoebis politikur zraxvebs, rogoricaa – qveynis dapyroba,<br />

<strong>ge</strong>nocidi da a.S., an meores mxriv, amgvari qalebi xdebian “Saxidebi”,<br />

sruliad brmad emorCilebian teroristTa moTxovnebs, maT amoZravebT<br />

mZafri SurisZiebisa da sircxvilis daZlevis gancda.<br />

Tavi III. <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong><br />

fsiqikuri da fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

unda aRiniSnos rom <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> gamoirCeva polimorfulobiT da<br />

waruSlel kvals tovebs rogorc adamianis fsiqikaze aseve mis fizikur<br />

janmrTelobaze. Zalzed Znelia moaxdino wamebiT gamowveul SedegTa<br />

diferencireba fsiqikur da fizikur simptomebad, vinaidan es simptomebi<br />

mWidrod arian gadajaWvuli erTmaneTze da axdenen urTierTzegavlenas,<br />

rac metwilad ganapirobebs darRvevaTa mravalferovnebasa da qronikuli<br />

mimdinareobis tendenciebs.<br />

aRniSnul naSromSi Cven, diagnostikis gaadvilebis mizniT, calke<br />

ganvixilavT <strong>wamebis</strong> fsiqikur da fizikur Sede<strong>ge</strong>bs, Tumca mowodebuli<br />

masalidan naTelia maTi mWidro da rTuli urTierTkavSiri.<br />

<strong>wamebis</strong> fsiqikuri <strong>Sede<strong>ge</strong>bi</strong><br />

rogorc cnobilia, wameba da gansakuTrebuli stresuli movlenebi,<br />

romelic seriozul saSiSroebas warmoad<strong>ge</strong>ns adamianis sicocxlisaTvis,<br />

iwveven seriozul stresul darRvevebs, romelTa simptomebic gamoirCeva<br />

polimorfulobiTa da mravalferovnebiT. amgvar travmul stresul<br />

movlenaTa Soris wamebas gansakuTrebuli roli eniWeba, vinaidan igi<br />

warmoad<strong>ge</strong>ns erTi admianis an jalaTTa jgufis mier meore adamianis an<br />

adamianebis jgufis mizandasaxul da <strong>ge</strong>gmazomier, winaswarganzraxul<br />

tanjvas, rac mniSvnelovan stress warmoad<strong>ge</strong>ns ara marto adamianis<br />

fizikuri arsebobisaTvis, rac upirates faqtors warmoad<strong>ge</strong>ns bunebrivi<br />

katastrofebis an omis dros, aramed fundamentur safrTxes uqmnis mis<br />

sulier arsebobasa da normalur fsiqikur funqcionirebas, Seicavs ra<br />

upiratesad moralurad gamanadgurebeli travmis faqtors, rac<br />

dakavSirebulia Seuracxyofisa da ususurobis, damokidebulebisa da<br />

momavlis mxriv sruli gaurkvevlobis gancdebTan.<br />

adamianis fsiqikur janmrTelobaze gansakuTrebiT mZime stresuli<br />

faqtorebis, maT Soris <strong>wamebis</strong>a da araadamianuri mopyrobis zegavlenis<br />

Seswavlas didi istoria aqvs. Tumca unda aRiniSnos, rom amgvari samecniero<br />

kvlevebi upiratesad warmoebulia omisa da bunebrivi katastrofebis dros<br />

13

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dazaralebulTa Soris, an <strong>wamebis</strong> msxverplTa Soris cixeebidan<br />

ganTavisuflebis Semdeg da ar aris farTod Catarebuli kvlevebi <strong>wamebis</strong><br />

mwvave Sede<strong>ge</strong>bTan dakavSirebiT, kvlevebi cixeebSi arsebul <strong>wamebis</strong><br />

msxverplTa Soris da aseve specsamsaxurebis mier sabWoTa periodSi<br />

wamebagamovlil pirTa Soris, vinaidan amgvari kvlevebis Catareba sabWoTa<br />

periodSi iyo SeuZlebeli da amJamadac sirTules warmoad<strong>ge</strong>ns im qveynebSi,<br />

sadac dRemde farTod aris gavrcelebuli <strong>wamebis</strong> praqtika. ase rom <strong>wamebis</strong><br />

fsiqikuri <strong>Sede<strong>ge</strong>bi</strong>s kvleva jerac ar aris srulyofili da saWiroebs<br />

mkvlevarTa seriozul Zalisxmevas misi gafarToebis mizniT.<br />

travmuli stresis faqtoris istoriuli mimoxilva<br />

1871 wlidan moyolebuli, franko - prusiis omidan dawyebuli, yvela<br />

gamokvleva miuTiTebda rom fsiqikuri aSlilobebis ricxvi omis dros<br />

sagrZnoblad matulobs. pirveli msoflio omis monacemebiT, ruseTis<br />

armiidan evakuirebuli iyo 35000 fsiqikuri problemebis mqone piri, maT<br />

Soris yvela fsiqiatriuli organizaciis statistikuri monacemebi<br />

miuTiTebda, rom fsiqozebis ricxvi ZiriTadad fsiqo<strong>ge</strong>niebis, reaqtiuli<br />

formebis xarjze matulobs, maSasadame daavadebebis, romelnic<br />

dakavSirebulia omis viTarebasTan (60% yvela evakuirebulidan).<br />

gamokvlevebis safuZvelze, romelic pirveli msoflio omis dros iyo<br />

Catarebuli, eWvs aRar iwvevda is garemoeba, rom: 1. omis dros fsiqikuri<br />

aSlilobebiT avadobis maCvenebeli mniSvnelovnad izrdeba; 2. sruliad<br />

cxadi gaxda, rom avadobis maCvenebeli izrdeba ara ZiriTadi fsiqozebis,<br />

aramed fsiqo<strong>ge</strong>nuri daavadebebis, e. i. nevrozebisa da reaqtiuli fsiqozebis<br />

xarjze. aseve, davas aRar iwvevda is garemoeba, rom araviTari specifiuri<br />

omis fsiqozi ar arsebobs, omis pirobebi iyeneben Cveulebriv paTologiur<br />

meqanizmebs. amaze miuTiTebda mSvidobian periodSi, miwisZvrebis dros,<br />

SemaZrwunebeli situaciebis Sedegad, ganviTarebuli fsiqo<strong>ge</strong>nuri reaqciebis<br />

Sesaxeb uamravi sailustaracio masala: miwisZvrebi SansiSi (1556w.),<br />

kalkutaSi (1667w.), mesinSi (1908w.), aseve _ 1916 wlis monacemebi Provence 11-26<br />

Tebervals <strong>ge</strong>mis CaZirvisas ganviTarebuli fsiqo<strong>ge</strong>nuri reaqciebis Sesaxeb,<br />

romelsac akvirdeboda Clunet, aqve unda aRiniSnos, rom reaqciebi,<br />

romelnic man ixila, isteriuls ar ganekuTvnebodnen.<br />

ase rom, 20-iani wlebisaTvis eWvs aRar iwvevda Zlieri<br />

matravmirebeli situaciebiT gamowveul fsiqikur aSlilobaTa mikuTvnebis<br />

sakiTxi fsiqo<strong>ge</strong>niebisadmi. rogorc cnobilia, termini "fsiqo<strong>ge</strong>nia"<br />

mowodebul iqna jer kidev gasuli saukunis miwurulSi Somer mier,<br />

romelic misi Sinaarsis Sesaxeb werda Semdegs: "fsiqo<strong>ge</strong>niis" saxelwodebis<br />

miRma me vgulisxmob daavadebaTa did jgufs, romelic aRniSnulia krebiTi<br />

saxelwodebiT "isteria"". aqve unda aRiniSnos, rom TviTon Somer uSvebda<br />

eTio<strong>ge</strong>nur faqtorTa kombinirebas fsiqo<strong>ge</strong>niis warmoSobaSi, rac ukve<br />

miuTiTebda im garemoebaze, rom axali cneba moicavda ara marto isterias,<br />

aramed mdgomareobebs mis farglebs miRmac. fsiqo<strong>ge</strong>nur faqtors cnobili<br />

<strong>ge</strong>rmaneli fsiqiatri Grisin<strong>ge</strong>r (1881w.) gadamwyvet rols aniWebda da<br />

miiCnevda rogorc "yvelaze mTavar da mdidar wyaros SeSlilobisa". magram<br />

am periodisaTvis jer kidev sadavo iyo fsiqo<strong>ge</strong>niaTa klasifikaciisa da<br />

nozologiis sakiTxebi. rogorc ukve iqna aRniSnuli, mravali mkvlevari<br />

14

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maT ganixilavda rogorc isteriis gamovlinebebs, Tumca ukve cxadi iyo<br />

araisteriuli, wminda emociuri aSlilobebis arsebobac, razedac<br />

TvalnaTliv miuTiTebs Clovis Vincent monacemebi, romelic omis wina xazze<br />

awarmoebda dakvirvebebs. igi wers: "iq, sadac didi raodenobiT ecema<br />

naRmebi, rac iwvevs sikvdilianobasa da Wrilobebs, arasodes minaxavs<br />

isteriuli gamovlinebebi krunCxvebis, kontraqturisa da erTi an<br />

ramodenime kiduris paraliCis saxiT, me iq vxvdebodi mxolod emociuri<br />

rigis gamovlinebebs, yvelaze xSirad: cremlebs; kankals; gaSeSebis Setevebs<br />

(Un etat d'hebetude), romlis drosac avadmyofi gaunZrevelia, kiTxvebze ar<br />

pasuxobs; taqikardias; sunTqvis gaxSirebas; abnevas."<br />

20-ian wlebSi klinikur fsiqiatriaSi aRiniSna mniSvnelovani etapi<br />

fsiqo<strong>ge</strong>niaTa im jgufis Seswavlisa, romelic cnobilia reaqtiuli<br />

fsiqozebis saxelwodebiT, rac dakavSirebulia Karl Jaspers-is saxelTan. misi<br />

koncefciis Tanaxmad, reaqtiuli fsiqozebi viTardeba pirovnebasa da<br />

misTvis gausaZlis realobas Soris konfliqtis safuZvelze da, amave dros,<br />

es realoba aucileblad aisaxeba daavadebis klinikur suraTSi. Jaspers<br />

mixedviT, gausaZlisi realoba SeiZleba iyos patimroba, ubeduri<br />

SemTxvevebi, miwisZvrebi da saerTod katastrofani, dardi samSobloze,<br />

seqsualuri Zaladoba, Zlieri SiSi, SeZrwuneba, samxedro samsaxuri,<br />

enobrivi izolacia da sxv. mizezis mixedviT, igi Sesabamisad ganasxvavebda<br />

situaciis mixedviT provocirebul fsiqozebs: cixis fsiqozi; nostalgiuri<br />

fsiqozi; "guvernantis" paranoia; miwisZvriT gamowveuli fsiqozi da a.S. igi,<br />

mizezTa garda, ganasxvavebda agreTve reaqciaTa struqturas: isteriuli,<br />

paranoiduli, depresiuli, cnobierebis Secvla, primitiuli da sxva.<br />

"WeSmariti reaqtiuli fsiqozebisgan, albaT, Cven unda ganvasxvavoT, garda<br />

spontanuri da inspirirebuli fsiqozebisa, aseve mxolod sulieri<br />

SeZrwunebiT kauzalurad ganpirobebuli normidan gadaxris mdgomareobani,<br />

yovelgvari gasa<strong>ge</strong>bi kavSiris gareSe, rogoric aris mag. vazomotoruli,<br />

nevrasTeniuri sindromi, Tanmxlebi SiSis gancdiT da a.S. katastrofis<br />

Semdeg." _ wers Jaspers naSromSi "swavleba reaqtiuli fsiqozebis Sesaxeb".<br />

mis mier mowodebuli reaqtiul mdgomareobaTa kliniko - diagnostikuri<br />

kriteriumebi: paTologiuri reaqciis kavSiri fsiqikur travmasTan misi<br />

warmoSobis drois, Sinaarsisa da mimdinareobis mixedviT, dRemde<br />

klinikuri fsiqiatriisaTvis Zalze mniSvnelovania.<br />

Tumca unda aRiniSnos, rom 60 -iani wlebisaTvis aRwerili iqna<br />

reaqtiul mdgomareobaTa mogvianebuli formebi, anu travmuli momentidan<br />

Zalze daSorebuli formebi, romelTa drosac irRveva Jaspers "drois<br />

kavSiris" kriteriumi, Tumca travmuli movlena sruliad aisaxeba klinikur<br />

suraTSi. mogvianebul reaqciaTa SemTxvevaSi "latenturi" dro fsiqikur<br />

travmasa da paTologiur reaqcias Soris Zalze gaxangrZlivebulia da<br />

SesaZloa ramodenime welsac ki aRwevdes. (Шувалов, Гиляровский, WiTava).<br />

amis mizezad ZiriTadad travmis intrafsiqikuri gadamuSavebisa da saboloo<br />

gacnobierebis gaxangrZlivebuli procesi miiCneva, "aseve misi Sedegis asaxva<br />

pirovnebis sayofacxovrebo situaciaSi, rodesac pirovneba yoveli fexis<br />

nabijze grZnobs ukve momxdari usiamovnebis, an ubedurebis Sedegs." (WiTava).<br />

Semdgomi mniSvnelovani etapi globaluri travmebiT gamowveuli<br />

fsiqo<strong>ge</strong>niebis Seswavlisa dakavSirebulia meore msoflio omTan (1939 _ 1945<br />

ww.) amerikeli da ingliseli avtorebis mier 1941-1945 ww. nervul -<br />

15

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fsiqiatriuli aSlilobebi warmod<strong>ge</strong>nilia umTavresad fsiqonevrozebis<br />

jgufiT, romelSic Sedis fsiqo<strong>ge</strong>niebis rogorc nevrozuli, aseve fsiqozuri<br />

formebi. farTod aris warmod<strong>ge</strong>nili omis periodis kvlevebi rusi<br />

avtorebis mier. fsiqo<strong>ge</strong>nuri aSlilobani maT mier ZiriTadad<br />

warmod<strong>ge</strong>nilia mwvave reaqtiuli fsiqozebiT: afeqto<strong>ge</strong>nuri stuporiTa da<br />

fugiformuli reaqciiT. ufro xSirad, vidre mwvave reaqciebi, gamovlenil<br />

iqna gaxangrZlivebuli reaqtiuli fsiqozebi. 1941 - 1945 ww. - Si maTi ricxvi<br />

ruseTSi samxedro mosamsaxureTa Soris Sead<strong>ge</strong>nda yvela reaqtiul<br />

fsiqozTa 93%. aRweril iqna Semdegi formebi: a) fsiqo<strong>ge</strong>nuri cnobierebis<br />

bindiseburi aSla (cnobierebis afeqturi Seviwroeba), Ф.И. Иванов<br />

monacemebiT, am jgufma Seadgina 16 - dan 27% - mde yvela reaqtiuli<br />

fsiqozisa. b) reaqtiuli depresia, romelic ganisazRvra rogorc omis<br />

drois wamyvani fsiqo<strong>ge</strong>nuri reaqcia (Е.О. Левикова, Е.Б. Мягкина, Н.И.<br />

Фелинская, Е.А. Попов, И.И. Веденский.). amave dros aRniSnavdnen, rom<br />

fsiqo<strong>ge</strong>nurad ganpirobebuli depresia xSirad gvxvdeboda rTuli<br />

sindromebis struqturaSi, mag. SiSis nevrozis dros, sadac adgili hqonda<br />

SfoTvis afeqts (А.Н. Молохов); gamoxatuli asTeniebisas, rac uflebas<br />

aZlevdaT gamoekveTaT asTeno - depresiuli mdgomareobani (Г.Е. Суханова,<br />

В.А. Гиляровский). reaqtiulma depresiebma Seadgina reaqtiul<br />

mdgomareobaTa 40% meore msoflio omis dros ruseTis armiaSi. g) aseve<br />

farTod iqna aRwerili da ganisazRvra rogorc wamyvani aSliloba<br />

reaqtiuli paranoidi, romelmac Seadgina 12% reaqtiuli mdgomareobebisa<br />

ruseTis armiaSi. igi gamoirCeoda mwvave dasawyisiT, simptomTa gamoxatuli<br />

fsiqoturobiTa da keTilsaimedo gamosavliT. С.Г. Жислин reaqtiuli<br />

paranoidis ganviTarebaSi gadamwyvet mniSvnelobas miakuTvnebda "droebiT<br />

Secvlil niadags", rac ganpirobebuli iyo egzo<strong>ge</strong>nuri da somato<strong>ge</strong>nuri<br />

faqtorebiT,. С.Г. Жислин naSromSi "mwvave paranoidebis Sesaxeb"<br />

gamoTqvamda Semdeg mosazrebebs: 1. ekzo<strong>ge</strong>nuri zegavlena (gadaRla,<br />

xangrZlivi uZiloba, araregularuli kveba, msubuqi gaciveba), rac droebiT<br />

cvlis pirovnebas adre misTvis araniSandoblivi mgrZnobiarobis<br />

mimarTulebiT, ganapirobebs situaciis diferencirebuli Sefasebis<br />

garTulebasa da rTuli konfliqtebis warmoqmnas. travmuli situaciis<br />

adgilas, romelic SesaZloa arc arsebobdes, Caenacvleba garegani viTareba,<br />

"gareSe gancdaTa mozRvaveba". 2. aseT pirobebSi ganviTarebuli mwvave<br />

paranoiduli reaqciebi _ garegani viTarebis paranoidi _ xasiaTdeba devnis<br />

bodviTi ideebiT, gamoxatuli SiSis afeqtiT, daavadebis mwvervalze<br />

cnobierebis SecvliT, mwvave movlenaTa gavlis Semdgomi amneziiT.<br />

meore msoflio omis SemaZrwunebel movlenaTa mravalferovnebam,<br />

rac dakavSirebuli iyo kolosalur msxverplTan da faSistur banakTa<br />

gamocdilebasTan, deportirebulTa did raodenobasTan, gamoiwvia<br />

fsiqopaTologiur aSlilobaTa iseTi saxeebi, romlebic warmoad<strong>ge</strong>ndnen<br />

gadatanili fsiqikuri travmatizaciis Soreul Sede<strong>ge</strong>bs.<br />

gadatanili fsiqikuri travmis Soreuli nervul - fsiqikuri <strong>Sede<strong>ge</strong>bi</strong><br />

yofil deportirebulTa Soris pirvelad, frangi eqimebis mier iqna<br />

Seswavlili. 1948 w. Dreifus da 1957w. Fishes miuTiTebdnen Seqcevad da<br />

Seuqcevad asTeniebze aRniSnul kontin<strong>ge</strong>ntSi. daavadebis ZiriTad niSnebs<br />

warmoad<strong>ge</strong>nda: wonaSi dakleba, naadrevi da swrafi dabereba,<br />

vazomotoruli aSlilobebi da darRvevebi saWmlis momnelebel sistemaSi.<br />

16

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1950 w. frangma fsiqiatrma Targowla aRwera asTeniis mZime forma<br />

paroqsizmuli, emociuri ekmneziis SetevebiT yofil deportirebulebSi.<br />

Setevebi xasiaTdeboda miwaze uecari dacemiTa da cnobierebis dakargviT:<br />

avadmyofi borgavda an iwva umoZraod, sxva SemTxvevebSi gamoxatuli iyo<br />

zomieri motoruli agzneba, saxviTi moZraobebiTa da garkveul wilad<br />

SezRuduli metyvelebiT. Setevebis Semdeg viTardeboda sruli amnezia.<br />

frangi eqimebi, danieli eqimebisagan gansxvavebiT, xazs usvamen<br />

upiratesad fsiqo<strong>ge</strong>nuri faqtoris rols msgavsi aSlilobebis<br />

ganviTarebaSi (Misere Morale). fiziologiur danaklisTa Serwyma moralur<br />

tanjvasTan aRweril iqna rogorc deportirebulTa asTeniuri sindromi,<br />

romelic iyo kvalificirebuli rogorc fsiqikuri travmis Soreuli Sedegi.<br />

Targowla mixedviT, yofil frang deportirebulTa Soris asTeniis<br />

sindromi aRiniSneboda 65-70% - Si. Fishes miuTiTebda deportirebulTa<br />

Soris sikvdilianobis maRal procentze mosaxleobis ukiduresad<br />

gaWirvebul fenebTan SedarebiTac ki. 38000 frang deportirebulTagan<br />

16000, TiTqmis 50%, gardaicvala repatriaciis Semdeg (Desual 1957 w.).<br />

ungreTSi ganTavisuflebis Semdeg gardaicvala yofil deportirebulTa<br />

20% - ze meti (В.М. Морозов 1958w.). Michel (1957w.) Tvlida, rom "postbanakuri<br />

asTenia" SesaZloa ganixilebodes rogorc garkveuli nozologiuri<br />

erTeuli.<br />

1952 - 1954 ww. danielma eqimebma P. Helweg-Larsen et al., (1952w.) da K.<br />

Herman, P. Thy<strong>ge</strong>sen (1954 w.) aRweres nevrasTeniuli mdgomareobani yofil<br />

deportirebul danielTa Soris, rac aReniSneboda eqspatimarTa 75%.<br />

travmuli stresisa da misgan gamowveuli fsiqikuri darRvevebis<br />

Seswavlis sakiTxTan dakavSirebiT SeuZlebelia ar aRiniSnos im fsiqiatrTa<br />

da fsiqoTerapevtTa Rvawli, romelnic TviTve aRmoCndnen sakoncentracio<br />

banakTa tyveebi da sakuTar Tavze gamoscades faSizmis mTeli rigi<br />

ubedurebani meore msoflio omis dros. gansakuTrebul yuradRebas<br />

imsaxurebs Viktor Frankl, Adler, Cohen da Kolle dakvirvebebi. naSromSi<br />

"fsiqologi sakoncentracio banakSi", V. Frankl sakuTari gancdebisa da<br />

gamocdilebis safuZvelze tyveobisas osvencimis, dahaus da terezienStadtis<br />

sakoncentracio banakebSi, aRniSnavs rom tyveTa reaqciebi SesaZloa daiyos<br />

sam fazad: 1. sakoncentracio banakSi moxvedris Soki; 2. banakSi xangrZlivad<br />

yofnisas xasiaTis tipiuri cvlilebebi; 3. ganTavisufleba. Cohen mixedviT<br />

gamoyofilia Semdegi stadiebi: 1. pirveladi reaqciis faza; 2. adaptaciis<br />

faza; 3. apaTiis faza.<br />

Sokis fazas Cohen aRwers Semdegnairad: "me mqonda SegrZneba, rom me<br />

araviTari kavSiri ar maqvs am yovelivesTan, ToTqos yvelaferi erTad<br />

aRebuli me ar mexeba. Cemi reaqcia mJRavndeboda subieqtisa da obieqtis<br />

disociaciaSi. Tumca, bolosdabolos, mdgomareoba midioda uZlieres<br />

fsiqikur travmamde, roca axalmosuli i<strong>ge</strong>bda gazis kamerebis Sesaxeb, rac<br />

iwvevda SeZrwunebis mwvave reaqcias." V. Frankl Sokis fazas miakuTvnebs<br />

anomalur gancdaTa reaqciebs, Tumca iqve dasZens: "amave dros ar unda<br />

daviviwyoT, rom iseT anomalur situaciaSi, romelsac warmoad<strong>ge</strong>ns<br />

sakoncentracio banaki amgvar gancdaTa anomaluri reaqciebi aris raRac<br />

normaluri." meore, xasiaTobrivi cvlilebebisa da adaptaciis faza<br />

xasiaTdeboda apaTiiTa da agresiiT; fsiqoanalitikosTa SefasebiT,<br />

fsiqologiuri regresiT; pirovnebis Sizoiduri tipiT xasiaTobrivi<br />

17

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cvlilebiT; xolo sakoncentracio banakSi yofnis uvadobis gancda iwvevda<br />

"momavlis dakargvis" SegrZnebas (Frankl, Cohen). Tumca Adler amis Sesaxeb<br />

werda: "ar SeiZleba ganvixiloT xasiaTis cvlileba rogorc pirovnebis<br />

azrebis saxecvlileba an moraluri dacema. Cveulebriv, uecrad ikar<strong>ge</strong>boda,<br />

TiTqos arc yofiliyos, mxolod garegnuli aRzrdiloba". Frankl exeba<br />

suicidebis problemasac sakoncentracio banakebSi, romelic, jer kidev<br />

pirveli msoflio omis droidan, cnobilia rogorc "mCxvletavi mavTulis<br />

(mavTulxlarTis) sindromi" (Vischer 1918w.). ganTavisuflebis fazis Sesaxeb<br />

Frankl werda: "banakidan ganTavisuflebuli jer isev ar aris gamosuli<br />

depersonalizaciis SegrZnebidan. mas jer kidev ar SeuZlia datkbes<br />

sicocxliT _ man jer unda iswavlos es, is amas gadaeCvia". aseve igi<br />

Hoffmeyer da Hertel-Wulff monacemebis gaTvaliswinebiT, aRniSnavs, rom<br />

ganTavisuflebis Semdeg damaxasiaTebeli simptomebi iyo: mousvenroba,<br />

daRlilobis SegrZneba, koncentraciis gauareseba, agznebadoba, erT<br />

adgilze yofnis garTuleba, mexsierebis daqveiTeba, gamRizianebloba,<br />

ve<strong>ge</strong>tatiuri simptomebi, depresiebi da Tavis tkivilebi. amgvari simptomebi<br />

aReniSneboda 78%; aqedan 47% uCioda "Ramis koSmarebs sakonctracio banakis<br />

saxiT". Kolle monacemebiT, farTod iyo warmod<strong>ge</strong>nili aRniSnul kontin<strong>ge</strong>ntSi<br />

qronikuli depresia. igi werda 1958 w.: "bevrs dResac ar SeuZlia daiviwyos<br />

TavianTi axloblebis dapatimrebasa da daxocvasTan dakavSirebuli<br />

gancdebi; es gancdebi sdevnian maT dRisiT da RamiT, sizmrebSic ki." jer<br />

kidev maSin igi eWvis qveS ayenebda am kontin<strong>ge</strong>ntSi depresiis qronikuli<br />

formisa da sxva fsiqoreaqtiul darRvevaTa mikuTvnebis sakiTxs "nevrozis"<br />

zogad krebiT mcnebasTan, vinaidan saxeze iyo am adamianTa cxovrebis sruli<br />

kraxi. maT depresiaze, Cveulebriv, naklebad moqmedebda ganTavisuflebis<br />

faqtic ki.<br />

posttravmul stresul aSlilobaTa warmoSobis preistoriaSi<br />

aRsaniSnavia E. Lindemann (1944w.) gamokvlevebi. igi miuTiTebda ra<br />

gaxangrZlivebuli stresis Semdgomi aSlilobebis garkveul<br />

Taviseburebebze, Semoitana "paTologiuri mwuxarebis" (Pathological Grief)<br />

cneba. misi azriT, am sindroms SesaZloa mivakuTvnoT subieqtis anomaluri<br />

reaqcia ubedurebaze, romlis Sedegadac viTardeba sxvadasxva fsiqikuri da<br />

fsiqosomaturi aSlilobani, maT Soris "sufTa nevrozebi". "paTologiuri<br />

mwuxarebis" sindromi, mkvlevaris azriT, SesaZloa ganviTardes uSualod<br />

ubedurebis Semdeg, an garkveuli drois gavlis Semdeg, SeiZleba mkafiod<br />

iyos gamoxatuli, an piriqiT Zalze sustad. avtorma es aSlilobebi<br />

daajgufa Semdegnairad: 1. fsiqo<strong>ge</strong>nurad ganpirobebuli somaturi<br />

aSlilobebi (yelSi moWeris SegrZneba, qoSini, amooxvra, mucelSi<br />

sicarielis SegrZneba, kunTovani sisuste, tanSi texvis SegrZneba, Tanmxlebi<br />

Tavis tkiviliT, <strong>ge</strong>movnebis moSla); 2. danaklisis mudmivi warmod<strong>ge</strong>niT<br />

Sewuxebuloba (micvalebulis da a.S.); 3. mwuxarebis grZnoba; 4. mtruli<br />

damokidebulebisa da gamRizianeblobis reaqciebi; 5. adre damaxasiaTebeli<br />

qcevis stereotipebis darRveva<br />

SemdgomSi W. Niderland naSromSi "gadarCenilTa sindromis klinikuri<br />

mimoxilva" da R. Lifton statiaSi "gadarCenilni hirosimaSi", gakeTebulia<br />

daskvna imis Sesaxeb, rom stresuli movlenebi da katastrofani iwveven<br />

18

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xangrZliv fsiqikur aSlilobebs. aseTi mdgomareobani maT mier iqna<br />

kvalificirebuli rogorc "gadarCenilTa sindromi" (Survivor Syndrome).<br />

ufro mogvianebiT, A. Bur<strong>ge</strong>ss da L. Holmstrom Semoitanes<br />

"gaupatiurebulTa sindromis" (Rape-trauma Syndrome) cneba. am sindroms<br />

gansazRvravdnen rogorc specifiur fsiqosomatur sindroms, romelic<br />

uviTardeba gaupatiurebulTa daaxloebiT mesameds mogvianebiT periodSi<br />

da xasiaTdeba Cveuli emociurobis dakargviTa da "travmatofobiiT",<br />

momatebuli agznebadobiTa da gamRizianeblobiT, ganmeorebadi Ramis<br />

koSmarebiT.<br />

gasuli saukunis 70 - ian wlebSi klinicistTa gansakuTrebuli<br />

yuradReba kvlav miipyro adamianis fsiqikaze omis periodis stresebis<br />

gavlenis sakiTxma, rac dakavSirebuli iyo vietnamis omis masalebTan,<br />

romelTa safuZvelzec, C. Figley mier mowodebuli iqna termini<br />

"postvietnamis sindromi" (Post-Vietnam Syndrome), romelic Soreul<br />

periodSi xasiaTdeba upiratesad ganmeorebadi akviatebuli mogonebebiT,<br />

xSirad mkveTri warmosaxvebiT (Flashbacks), Tanmxlebi daTrgunulobisa da<br />

SiSis gancdiT, somaturi aSlilobebiT; gaucxoebisa da indiferentulobis<br />

mdgomareobiT, Cveuli interesebis dakargviTa da danaSaulis gancdiT;<br />

SemaSinebeli sizmrebiT, rac dakavSirebulia omis gamocdilebasTan;<br />

momatebuli agznebadobiT, gamRizianeblobiT, feTqebadobiT.<br />

amgvarad, 70 - iani wlebis bolosaTvis dagrovili masala miuTiTebda<br />

im garemoebaze, rom gansakuTrebuli travmuli stresiT gamowveuli<br />

fsiqikuri aSlilobani, matravmirebel faqtorTa sxvadasxvaobis miuxedavad,<br />

xasiaTdebian erTgvarovnebiTa da specifiurobiT da ar Tavsdebian<br />

fsiqikur aSlilobaTa arcerT sayovelTaod miRebul nozologiaSi. swored<br />

amitom, M. Horowitz da Tanaavtorebis mier es aSlilobebi gamoyofil iqna<br />

damoukidebel sindromad, saxelwodebiT "posttravmuli stresuli<br />

aSliloba" (Posttraumatic Stress Disorder - PTSD) da pirvelad 1980w. Setanil<br />

iqna amerikul diagnostikur klasifikaciaSi DSM - III - Si rogorc calke<br />

klinikuri forma; SemdgomSi, imave avtorTa mier, SemuSavebuli iqna am<br />

aSlilobis kliniko - diagnostikuri kriteriumebi, romlebic 1987w. Setanil<br />

iqna DSM - III - R - Si. amJamad es kriteriumebi farTod aris warmod<strong>ge</strong>nili<br />

DSM - IV - Si (rubrikaSi "SfoTviTi aSlilobani") da 1991w. - dan Setanilia<br />

rogorc calke klinikuri forma msoflio jandacvis organizaciis<br />

daavadebaTa saerTaSoriso klasifikaciis me - 10 gadasinjvaSi (ICD - 10),<br />

rubrikaSi "reaqcia mZime stresze da adaptaciis darRvevebi" da Seesabameba<br />

Semdegi kodi: F - 43.1.<br />

rogorc ukve iqna aRiniSnuli <strong>wamebis</strong> fsiqikuri <strong>Sede<strong>ge</strong>bi</strong> ara<br />

sakmarisad aris Seswavlili, maT Soris aRsaniSnavia, rom kvlavac<br />

daud<strong>ge</strong>nelia korelacia <strong>wamebis</strong> calkeul meTodebsa da maT mier gamowveul<br />

fsiqikur aSlilobebs Soris (Basoglu, 1992). aseve arsebobs azri da unda<br />

aRiniSnos, rom es azri figurirebs yvela gansakuTrebuli stresuli<br />

situaciiT gamowveuli aSlilobebis <strong>ge</strong>nezis analizSic, rom wamebiT<br />

gamowveuli fsiqikuri garTulebebi damokidebulia asakze, sqesze,<br />

eTnokulturul Taviseburebebsa da politikur Tu religiur Sexedulebebze<br />

(Somnier da sxva, 1992).<br />

19

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samecniero literaturaze dayrdnobiTa da Cveni gamokvlvebis<br />

analizis Sedegad cxadi gaxda, rom yvelaze metad gavrcelebul fsiqikur<br />

aSlilobas <strong>wamebis</strong> SemTxvevaSi warmoad<strong>ge</strong>ns posttravmuli stresuli<br />

aSliloba da aseve xSiria misi qronikuli da garTulebuli an<br />

kombinirebuli variantebi, romlis Sesaxebac SemdgomSi iqneba saubari.<br />

posttravmuli stresuli aSlilobis epidemiologiis sakiTxebi<br />

PTSD-is cnebis klinikuri Sinaarsis dad<strong>ge</strong>nisa da dazustebis Semdeg<br />

Seswavil iqna misi gavrcelebis xarisxi. dReisaTvis gamoqveynebulia<br />

mravali epidemiologiuri kvlevis monacemi, romelic PTSD-is gavrcelebis<br />

saorientacio suraTs gvaZlevs. Tumca aqve unda aRiniSnos, rom amgvari<br />

epidemiologiuri kvlevebi mwiria <strong>wamebis</strong> SemTxvevaSi.<br />

H.C. Archibald, R.D. Tuddenham (1965) mier Seswavlili iqna asakobrivi<br />

procesebis gavlena stresul reaqciaTa gamovlinebebze. meore msoflio<br />

omis dros travmirebulTa Soris gamokvlevebisas omidan 20 wlis Semdeg<br />

maT ivaraudes, rom posttravmuli stresuli darRvevebis simptomebi<br />

asakTan erTad ufro ikveTeba. meore msoflio omis damTavrebis 40 wlis<br />

Semdeg yofil samxedro tyveebSi PTSD aRiniSneboda 67% - Si (Kluznik J.C.,<br />

1986).<br />

PTSD-is gansakuTrebiT maRali xarisxi aRwerilia yofil<br />

deportirebulTa da sakoncentracio banakebis yofil tyveTa Soris, 90%-dan<br />

100%-mde. aRniSnuli kvlevebi Catarebuli iqna koreis omis yofil<br />

patimarTa Soris (P.B. Sutker, Daniel K. et al., 1988 - 1990), meore msoflio omis<br />

yofil patimarTa Soris (Z. Solomon, Y. Neria, O. Abraham et al., 1992-1993),<br />

aseve sparseTis yuris samxedro konfliqtis dros holokavis msxverplTa<br />

Soris (Z. Solomon, E. Pra<strong>ge</strong>r, 1991-1992). xolo amerikis samSvidobo misiis<br />

jarebSi sparseTis yuris konfliqtis dros PTSD aRweril iqna 8% - Si.<br />

(What Is PTSD? The American Jurnal of Psychiatry, Editorial, 1997)<br />

damwvrobiT hospitalizirebul pacientTa Soris Catarebuli<br />

gamokvlevebis Sedegad 2, 6 da 12 Tvis Semdeg, 1990 - 91 ww, Sesabamisad PTSD<br />

aRmoCenil iqna 35,2%, 40%, 45,2%. mniSvneloba eniWeboda damwvrobis<br />

farTobs, saxis dazianebasa da subieqtur prediqtorebs. (S. Perry, et al., 1992).<br />

seqsualuri Zaladobis msxverplTa Soris PTSD varirebs 46% - 66%<br />

farglebSi. (Becker I.V. et al., 1984, Browne A., Finkelhor D. 1986, Nadelson C.C.<br />

1989, Bowners I.T. et al., 1991).<br />

gansakuTrebiT maRalia PTSD-is gavrcelebis xarisxi ltolvilTa<br />

Soris. <strong>ge</strong>nocidis msxverpl kambojel ltolvilTa Soris PTSD aRmoCenil<br />

iqna 86%. (Carlson E.B., Rosser - Hogan R., 1991). indo-CineTis ltolvilTa<br />

Soris 322 pacientidan 226 aRweril iqna mimdinare PTSD, xolo kidev 15<br />

aSliloba ganuviTarda mogvianebiT (Kinril, Frederikson, Rath, Fleck, Karls.,<br />

1984). ltolvilTa Soris PTSD-is yvelaze maRali procenti, 93%, aRwerilia<br />

laosel mTis xalxSi (Main), xolo yvelaze dabali vietnamis ltolvilebSi<br />

_ 54% (R.C. McKelvey, J.A. Webb, 1996). "eTnikuri wmendis" msxverpl bosniel<br />

ltolvilTa Soris PTSD aRwerilia 65%, xolo SemTxvevaTa 35% _ depresia<br />

(S.M. Weine, D.F. Becker, et al., 1995).<br />

PTSD -is gavrcelebis xarisxi amerikelTa monacemebiT (C.S. North,<br />

E.M. Smith et al., 1994) saSualod varirebs 19%-dan _ 80%-mde.<br />

20

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amgvarad, epidemiologiuri monacemebi SesamCnevad varirebs 3,5% dan<br />

67% procentamde saSualod sxvadasxva faqtorebis gaTvaliswinebiT<br />

(travmis xasiaTi, asaki, sqesi, socio-kulturuli da eTno-kulturuli<br />

gansxvavebani da sxva). rig avtorTa azriT, aseTi sxvaobis mizezad erTiani<br />

zusti kriteriumebis ararseboba gvevlineba. mTeli rigi avtorebi miiCneven,<br />

rom gansakuTrebiT sastiki <strong>wamebis</strong> SemTxvevaSi posttravmul stresul<br />

aSlilobaTa simptomebi gvxvdeba praqtikulad 100 % SemTxvevaSi.<br />

posttravmuli stresuli aSlilobis etiologiisa da paTo<strong>ge</strong>nezis sakiTxebi<br />

gansakuTrebuli stresuli situaciiT ganpirobebuli fsiqikuri<br />

darRvevebis, reaqtiul mdgomareobaTa etiologiisa da paTo<strong>ge</strong>nezis sakiTxi<br />

pirveli msoflio omidan moyolebuli, farTo ganxilvis sagans<br />

warmoad<strong>ge</strong>nda. am sakiTxebTan dakavSirebiT mdidari masala mogvca pirveli<br />

da meore msoflio omis gamocdilebam, romlis drosac safuZvlianad iqna<br />

Seswavlili travmuli da omis periodis nevrozebi, aseve sxva<br />

fsiqoreaqtiuli darRvevebi.<br />

pirveli msoflio omis droidan moyolebuli im sakiTxis Sesaxeb, Tu<br />

ra roli eniWeba travmuli fsiqo-nevrozebis ganviTarebaSi fsiqikur<br />

travmas, aqvs Tu ara mas paTo<strong>ge</strong>nezuri mniSvneloba, Tu mxolod<br />

provokaciuli, arsebobda didi uTanxmoeba, romelic daiyvaneboda imaze, Tu<br />

romeli momenti _ egzo<strong>ge</strong>nuri Tu endo<strong>ge</strong>nuri _ aris gadamwyveti<br />

gansakuTrebuli stresiT gamowveul fsiqikur darRvevaTa warmoqmnaSi.<br />

1950 w. W. Sargant, E. Slater aRniSnavdnen travmuli nevrozis<br />

ganviTarebaSi garegani agresiis gadamwyvet mniSvnelobas da amtkicebdnen,<br />

rom garkveul viTarebaSi, roca adamianebi Zalzed travmirebulni arian,<br />

"aravis gaaCnia imuniteti".<br />

PTSD etiologiisa da paTo<strong>ge</strong>nezis Tanamedrove koncefciebi<br />

metnaklebad asaxaven travmul nevrozTan dakavSirebiT warsulSi arsebul<br />

koncefciaTa Soris konfliqts.<br />

mTel rig avtorTa mixedviT (Brett E.A., Spitzer R.L., Williams J.B.; Green<br />

B.L., Lindy J.D.; Horowitz M.J.; Millier T.W.), PTSD–is safuZvels warmoad<strong>ge</strong>ns<br />

fsiqikuri travma, romelic aRiniSneba rogorc gansakuTrebuli movlena<br />

(Life Stress Event) da romelic iwvevs mZime fsiqikur stress. aseTi "movlena"<br />

yvela SemTxvevaSi uCveuloa pirovnebisaTvis da Tan axlavs SiSi,<br />

SeZrwuneba da umweobis gancda.<br />

fsiqikuri travma _ "movlena" _ SesaZloa iyos rogorc piradi,<br />

individualuri: gaupatiureba, axlobeli adamianis daRupva, wameba,<br />

Zaladoba, aseve _ masobrivi, saerTo: omi, bunebrivi katastrofani da sxva.<br />

zogierTi travmuli movlena, mag. wameba, yovelTvis iwvevs PTSD, xolo<br />

sxva, mag. satransporto katastrofa, mxolod zogierT SemTxvevaSi. rac<br />

ufro xangrZlivia fsiqikuri travmis "movlenis" moqmedeba, miT ufro didia<br />

PTSD ganviTarebis albaToba (П.В. Каменченко).<br />

PTSD warmoSobis erT-erT yvelaze ufro mniSvnelovan da seriozul<br />

mizezad iTvleba admianis ZiriTad uflebaTa darRveva, rac Cveulebriv<br />

organizebuli Zaladobis saxiT vlindeba. (In<strong>ge</strong> Genefke; Lone Jacobsen, Knud<br />

Smidt-Nielsen, Rachel Yehuda, boasz Kahana, James Schmeidler, Steven M.<br />

Southwick, Skye Wilson, Earl l. Giller; Zahava Solomon, Yuval Neria, Abraham Ohry<br />

21

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et al.; Edward Pra<strong>ge</strong>r) es koncefcia farTod aris aRiarebuli msoflio<br />

jandacvis organizaciis mier. damkvidrebulia Semdegi gansazRvreba:<br />

"adamianTaSorisi miyeneba gamoxatuli tkivilisa da tanjvis, romelic ar<br />

warmoad<strong>ge</strong>ns aucileblobas, organizebuli jgufis mier deklarirebuli an<br />

nagulisxmebi strategiis Sesabamisad da/anu ideaTa da damokidebulebis<br />

sistemiT. es TavisTavSi moicavs yovelgvar Zaladobriv qmedebas, romelic<br />

miuRebelia zogadsakacobrio standartebis poziciidan da aqvs kavSiri<br />

msxverplis SegrZnebebTan." organizebuli Zaladoba, gaeros adamianis<br />

uflebaTa sayovelTao deklaraciis Sesabamisad, aseve moicavs "wamebas,<br />

sastik, arahumanur an damamcirebel mopyrobas an dasjas". sasamarTlos<br />

gareSe patimroba, cru ekzekuciebi, mZevalTa ayvana an sxva nebismieri forma<br />

Tavisuflebis Zaladobrivi warTmevisa agreTve ganxilulia organizebuli<br />

Zaladobis gansazRvrebaSi (Э. Хофф).<br />

faqtorTa mTeli rigi aZlierebs fsiqikur travmas. maT Soris<br />

upiratesad mniSvnelovania _ sikvdilis uSualo albaToba, msxverplTan<br />

identifikacia, socialuri kavSirebis dakargva, Soreuli <strong>Sede<strong>ge</strong>bi</strong>s mxriv<br />

gaurkvevloba, dagvianebuli mkurnaloba, an mkurnalobis ar arseboba,<br />

umweobis gancda, gancdebiT urTierTinducireba (Durham T.W., Horowitz M.J.,<br />

Wilner N., Kaltreider N., McDeniel E.G., Ковалев В.В., Асанова Н.К.).<br />

iyo mcdeloba ganesazRvraT travmis fizikuri da emociuri<br />

Semad<strong>ge</strong>nloba, Tumca aRmoCnda, rom xSir SemTxvevaSi PTSD uviTardebodaT<br />

pirebs, romelTac ar miuRiaT sxeulis dazianeba, magram romelnic<br />

intensiurad ganicdidnen fizikuri ganadgurebis potenciur risks. mravali<br />

mkvlevari fizikur da emociur travmas Soris amgvar dayofas miiCnevs<br />

xelovnurad da Tvlis, rom am or komponents Soris yovelTvis arsebobs<br />

mWidro urTierTkavSiri. (Padovoni L., 1950, Fenichel O., 1953; Kardiner A.,<br />

Karonyi E.K., 1977; Weil F., 1985).<br />

15 wlis, 1980 - 1995, ganmavlobaSi, warsulSi travmul nevrozTan<br />

dakavSirebiT Bonhoffer - Oppenheim davis msgavsad, arsebobda didi<br />

konfliqti PTSD eTiopaTo<strong>ge</strong>nezTan dakavSirebiT travmul da<br />

konstituciur koncefciebs Soris.<br />

mkvlevarTa erTi jgufi askvnis, rom PTSD ganviTarebaSi gadamwyveti<br />

roli ganekuTvneba konstitucias, ganviTarebis fiqsacias, an <strong>ge</strong>netikur<br />

predispozicias. kerZod ki pirovnebebs isteriuli pirovnuli<br />

organizaciiTa da warsulSi ganumuxtavi emociuri stresebiT, disociaciuri<br />

tendenciebiT ufro xSirad uviTardebaT PTSD, amitom isini PTSD<br />

ganixilaven, rogorc naklovani pirovnebis reaqcias (Ch.R. Marmar, D.S.<br />

Weiss, W.E. Schlen<strong>ge</strong>r, J.A. Fairbank, K. Jordan, R.A. Kulka, R.L. Hough). xolo<br />

Breslau N., Davis G.C., Andresski P., Peterson E. Tvlian, rom PTSD upiratesad<br />

uviTardebaT mamakacebs bavSvobaSi deviaciuri darRvevebiT da<br />

ganviTarebis dabali doniT, romelTa naTesavebSi gamovlenilia fsiqikuri<br />

paTologiisa da alkoholizmis SemTxvevebi.<br />

Andreasen N.C., Horowitz M.J., Figley C.R., Green B.L., Lindy J.D., Rahel<br />

Yehuda, Alexander C. McFarlane paTo<strong>ge</strong>nezur rols PTSD ganviTarebaSi<br />

eqstremalur travmul movlenas aniWeben (Extremely Traumatic Event) da<br />

miiCneven, rom PTSD warmoad<strong>ge</strong>ns adaptaciis bunebriv proces<br />

eqstraordinarul situaciaSi da misi simptomTa paterni ar aris<br />

damokidebuli konstituciur midrekilebaze. maTi azriT, PTSD warmoad<strong>ge</strong>ns<br />

22

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normaluri pirovnebis reaqcias aranormalur, araordinarul cxovrebis<br />

pirobebze.<br />

Resnick H.S., Kilpatric D.G., Kramer T.L., Best C.L.; Yehuda R., Pitman R.K.,<br />

Foy D.W. miiCneven, rom PTSD ganviTarebis riski ufro metia ganmeorebiTi<br />

travmatizaciis SemTxvevaSi, vidre pirveladi travmis SemTxvevaSi.<br />

aseve PTSD ganviTarebis riski metia premorbidulad alkoholizmiTa<br />

da narkotikuli nivTierebebiT datvirTul pirovnebebSi, rasac adasturebs<br />

rogorc vietnamis, aseve avRaneTis omis veteranTa Soris Catarebuli<br />

gamokvlevebi. (Tom Williams, Jelinek J.M., James Newman, П.И. Сидоров, М.Ф.<br />

Лукманов.)<br />

V. Charlot et al, aseve Краснянский А.Н., romelsac didi wvlili miuZRvis<br />

avRaneTis omis veteranTa kvlevaSi, did mniSvnelobas PTSD ganviTarebaSi<br />

stresis momentSi pirovnebis fiziologiur mdgomareobas aniWebs.<br />

"gansakuTrebiT mniSvnelovania fizikuri gamofitva, arasakmarisi Zili,<br />

sakvebisa da wylis ukmaroba (deficiti), anu yovelive, rac iwvevs<br />

daRlilobas brZolaSi" _ wers igi.<br />

Atkinson B., Henderson J.M., Sparr B.W., Deal R., vietnamis omis<br />

veteranebze dakvirvebis Sedegad miiCneven, rom erT-erTi wamyvani faqtori<br />

PTSD etiologiaSi aris travmirebulis araswori Sefaseba da<br />

arakeTilganwyobili damokidebuleba.<br />

mniSvnelovani roli PTSD etiopaTo<strong>ge</strong>nezSi eniWeba moralur da<br />

msoflmxedvelobriv faqtors, vinaidan axlad miRebuli eqstraordinaruli<br />

gamocdileba ar Tavsdeba pirovnebis adre arsebul sqemebSi da iwvevs<br />

faseulobaTa sistemis msxvrevas, iseTi bazisuri fenomenebis xelhyofas,<br />

romlis safuZvelzec pirovneba qmnis warmod<strong>ge</strong>nebs sakuTar Tavze,<br />

samyaroze da am samyaroSi Tavis adgilze. (Weil F., Jonathan Shay).<br />

mkvlevarTa nawili PTSD etiologiaSi mniSvnelovan rols aniWebs<br />

eTno-kulturul Taviseburebebs, Tumca es sakiTxebi dReisaTvis<br />

arasakmarisadaa Seswavlili (J. Marsella, Matthew J. Friedman).<br />

msoflio jandacvis organizaciis gadawyvetilebiT, PTSD<br />

gansakuTrebuli riskis jgufebs miekuTvneba:<br />

1. bavSvebi da mozardebi, romelTa mSoblebic iqnen moklulni, an oblebi,<br />

an bavSvebi da mozardebi, romelTa mSoblebic gaSorebulni arian,<br />

dangreuli ojaxebidan da romelnic cxovroben saomar zonaSi, an<br />

ltolvilni da iZulebiT gadaadgilebulni.<br />

2. martoxela moxucebi, mcxovrebni omis zonaSi, ltolvilni, an iZulebiT<br />

adgilnacvalni, romelTac esaWiroebaT socialuri daxmareba.<br />

3. qalebi, romelTac ganicades pirveladi travmatizacia (gaupatiureba,<br />

wameba), an meoradi travmatizacia (bavSvebis an qmris mokvla, ojaxis<br />

struqturis darRveva da cxovrebis socio-ekonomiuri pirobebis mkveTri<br />

gauareseba).<br />

4. mamakacebi, romelTac ganicades omis fsiqologiuri Tu fizikuri<br />

travmebi (moicavs sakoncentracio banakebSi yofnas, wamebas; agreTve<br />

ltolvilni da iZulebiT adgilnacvalni).<br />

5. pirovnebebi Sereuli eTnikuri warmoSobiT, an mcxovrebni Sereul<br />

ojaxebSi, Sereuli qorwinebebiT, eTnikuri wmendis msxverplni.<br />

aseve unda aRiniSnos, rom dazaralebulni SesaZloa iyos aramarto<br />

"movlenis" uSualo monawileni. msgavs gancdebSi erTvebian ojaxis wevrebi,<br />

23

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mezoblebi, maSvelni da sxv. (K. Cormie, J. Howell), aseve D. Jones azriT _<br />

savadmyofoebisa da prozeqturebis TanamSromelnic.<br />

amgvarad, PTSD eTiologiaSi dReisaTvis kauzaluri mniSvneloba<br />

eniWeba araordinarul travmas da es aSliloba ganixileba, rogorc<br />

kanonzomieri reaqcia aranormalur situaciaze da SeiZleba ganuviTardes<br />

nebismier individs. mniSvnelovan rols PTSD ganviTarebaSi TamaSobs:<br />

pirovnebis istoria, fsiqikuri Tu somaturi mdgomareoba travmatizaciis<br />

momentSi, msoflmxedveloba, faseulobebi da moraluri dayenebebi<br />

travmamde. aseve mniSvnelovani roli eniWeba "movlenis" Serwymas<br />

socialur-fsiqologiur problemebTan: uZiloba, SimSili, wylis nakleboba,<br />

sicive, ener<strong>ge</strong>tikuli problemebi da sxv., rac iwvevs pirovnebis damcavi<br />

meqanizmebis ganlevadobasa da qmnis paTologiurad Secvlil niadags. eTnokulturaluri<br />

Taviseburebani, tradiciuli, religiuri Sexedulebani,<br />

romelTa msxvrevac ganskuTrebiT mniSvnelovania ama Tu im eTnikuri<br />

jgufisa Tu pirovnebisaTvis, aseve garSemomyofi sociumis damokidebuleba,<br />

sazogadoebis reaqcia, socialuri pirobebi, meoradi travmebi "movlenis"<br />

damTavrebis Semdgom gansakuTrebiT moqmedeben PTSD mimdinareobasa da<br />

simptomTa simyareze.<br />

did sirTules warmoad<strong>ge</strong>ns PTSD paTo<strong>ge</strong>nezuri meqanizmebis<br />

gansazRvra, vinaidan dReisaTvis arsebobs sxvadasxva Sexedulebani am<br />

sakiTxisadmi da ramdenime principulad gansxvavebuli midgoma<br />

Seswavlisadmi. (П.В. Каменченко). aqedan gamomdinare E. Brett ganasxvavebs<br />

paTo<strong>ge</strong>nezis fsiqologiur, biologiur da kompleqsur modelebs.<br />

paTo<strong>ge</strong>nezis fsiqologiur modelebs Soris gansakuTrebiT<br />

sayuradRebo da dReisaTvis aRiarebulia M. Horowitz modeli, igi eyrdnoba<br />

Z. Freud ideebs, aseve sakuTar klinikur Tu eqsperimentul gamocdilebas.<br />

Z. Freud ikvlevda ra pirveli msoflio omis monawile jariskacebs,<br />

romelTac aReniSnebodaT Ramis koSmarebiT, ivarauda, rom es sizmrebi<br />

gamoxataven "travmul xatebs" pirvelad lokalizacias, xolo maTi<br />

ganmeorebadoba _ dacvis infantilur formas, roca ubedurebis mudmivi<br />

aracnobieri aRd<strong>ge</strong>na mexsierebaSi iwvevs damcavi gamocdilebis formirebas.<br />

sqematurad es gamoiyureba Semdegnairad: garegani zemoqmedeba _ mogonebebi<br />

_ avadmyofuri efeqti _ dacva. xolo am SemTxvevebSi gamovlenili<br />

darRvevebi mis mier kvalificirebul iqna rogorc nevrozuli _ "travmuli<br />

nevrozi". ufro mogvianebiT 1939 w., naSromSi "mose da monoTeizmi", Z. Freud<br />

aRniSnavs, rom travmuli nevrozis dros adgili aqvs negatiur da pozitiur<br />

reaqciebs. pirvelni, TiTqosda gandevnian travmas daTrgunviT, gaqceviTa da<br />

fobiebiT, xolo meoreni _ piriqiT, axseneben mas mogonebebis, xatebisa da<br />

fiqsaciebis saxiT. M. Horowitz reaqciaTa am jgufebs Seesabameba "uaryofisa"<br />

da "ganmeorebadi gancdis" simptomTa jgufebi. garegani zemoqmedebis<br />

faqtori M. Horowitz gansazRvra, rogorc "absoluturad axali informaciis<br />

Semcveli "travmuli stresuli movlena", romelis integraciac unda<br />

moaxdinos pirovnebam winamorbed cxovrebiseul gamocdilebaSi."<br />

mTlianobaSi M. Horowitz sqema gamoiyureba Semdegnairad: travmuli stresi<br />

_ uaryofa _ ganmeorebiTi gancda _ SeTviseba. klinikuri dakvirvebebisa da<br />

specialurad SemuSavebuli kiTxvaris safuZvelze M. Horowitz daaskvna, rom<br />

simptomurad "uaryofa" vlindeba amneziiT, yuradRebis darRveviT, zogadi<br />

fsiqikuri SeboWilobiT, SenelebiT, travmis momagonebeli nebismieri<br />

24

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movlenidan, an masTan dakavSirebuli asociaciebidan gaqcevis tendenciiT.<br />

"ganmeorebadi gancdis" simptomebi xasiaTdeba ganmeorebadi akviatebuli<br />

azrebiT, Zilis darRveviT, Ramis koSmarebiT, "Flashbacks" disociaciuri<br />

epizodebiT, SfoTvis SegrZnebiT.<br />

Z. Freud, M. Horowitz Sexedulebebma ganviTareba hpova E. Brett, R. Ostroff<br />

SromebSi, romelTac PTSD paTo<strong>ge</strong>nezuri meqanizmi warmoadgines, rogorc<br />

"gandevnisa" da "ganmeorebiTi gancdis" fsiqologiur movlenaTa<br />

urTierTobis Sedegi.<br />

ukanaskneli wlebis neirofiziologiuri da bioqimiuri gamokvlevebis<br />

<strong>Sede<strong>ge</strong>bi</strong> daedo safuZvlad PTSD biologiuri modelis Seqmnas (Davidson J.,<br />

Walker J.I., Kilts C., Mendelson G.), romelTa mixedviT PTSD paTo<strong>ge</strong>nezuri<br />

meqanizmi ganpirobebulia endokrinuli sistemis funqciis darRveviT, rac<br />

gamowveulia zezRurblovani stresuli zemoqmedebiT.<br />

dReisaTvis ufro metad perspeqtiulad iTvleba paTo<strong>ge</strong>nezis<br />

Teoriuli modelebi, romelnic iTvaliswineben PTSD ganviTarebis rogorc<br />

fsiqologiur, aseve biologiur aspeqtebs. am pirobebs yvelaze metad<br />

Seesatyviseba L. Kolb, B. Green, J. Lindy, T. Miller neirofsiqologiuri<br />

hipoTezebi. kerZod, vietnamis omis veteranebze Catarebuli<br />

fsiqofiziologiuri da bioqimiuri kvlevebis <strong>Sede<strong>ge</strong>bi</strong>s ganzogadebiT,<br />

miuTiTeben, rom intensivobiTa da xangrZlivobiT gansakuTrebuli<br />

mastimulirebeli zemoqmedebis Sedegad warmoiqmneba Tavis tvinis qerqis<br />

neironebSi cvlilebebi, sinafsur gadacemaTa blokireba da neironTa<br />

daRupvac ki. am dros, upirveles yovlisa, ziandeba tvinis zonebi, romlebic<br />

pasuxism<strong>ge</strong>belia agresiulobasa da Zilis ciklze. avtorTa klinikuri<br />

dakvirvebebi dadasturebuli iyo laboratoruli diagnostikis <strong>Sede<strong>ge</strong>bi</strong>T.<br />

<strong>wamebis</strong> fsiqikuri <strong>Sede<strong>ge</strong>bi</strong>s upiratesad gamovlenili<br />

klinikuri formebi:<br />

<strong>wamebis</strong> mwvave periodis <strong>Sede<strong>ge</strong>bi</strong>s Seswavla, rogorc ukve aRvniSneT<br />

Zalzed limitirebulia da am gancdaTa Sefaseba Tu analizi upiratesad<br />

eyrdnoba anamnezur da postfaqtum monacemebs.<br />

Cvens mier Catarebuli kvlevebis Sedegad fsiqo – reabilitaciis<br />

centri « empaTia »s monacemebiT, yvelaze xSirad mwvave periodSi gvxvdeba<br />

emociur – Sokuri reaqciebi (saerTo ricxvidan #255 amgvari reaqcia<br />

aReniSneboda 245 – 96 %), romelsac xSir SemTxvevaSi Tan sdevda suiciduri<br />

azrebi, an para – suiciduri qmedebani an TviT–dazianebis faqtebi (56<br />

SemTxvevaSi – 21,9 %), aqve unda aRiniSnos, rom fsiqikuri movlenebs Tan<br />

sdevda xSir SemTxvevaSi somaturi darRvevebi, romelic gamoixateboda:<br />

Tavis tvinis travmiT, gonebis dakargviT (146 SemTxveva – 57,30 % saerTo<br />

ricxvidan 255), sxvadasxva saxis hemoragiuli sindromi cemis an sxva saxis<br />

<strong>wamebis</strong> Sedegad ganviTarebuli (87 SemTxveva – 34,10 %) da tkiviliT<br />

gamowveuli travmuli Sokis sindromi (128 SemTxvevaSi – 50, 2 %).<br />

Cvens mier warmoebuli kvlevebis Sedegad cxadi gaxda, rom <strong>wamebis</strong><br />

mwvave periodSi vxvdebiT afeqtur – Sokuri reaqciebis rogorc<br />

stuporozul variants, aseve eqsploziur – agznebiT reaqciebs.<br />

stuporozuli variantis dros upiratesad warmod<strong>ge</strong>nili iqna iseTi<br />

25

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simptomebi rogoric aris : « fsiqikis gayinva » - gaSeSeba, rogorc<br />

fsiqikuri funqciebis, aseve fizikuri, rasac xSir SemTxvevaSi Tan axlda<br />

ukiduresi gamofitvisa da gadaRlis gancda, xSirad Tanmxlebi insomniiT;<br />

yovelive aRniSnuls xSirad Tan sdevda cnobierebis Seviwroebisa da<br />

dezorientaciis, depersonalizaciis gancdebi. amgvar situaciaSi <strong>wamebis</strong><br />

msxverplni veRar aRiqvamen Seqmnil situacias, ver wvdebian kargad<br />

SekiTxvis an saubris Sinaars, SezRudulia moqmedebebi da TviTkontrolis<br />

meqanizmebis funqcionireba, am dros igi meqanikurad advilad awers xels<br />

yovelgvar SemoTavazebas, ar swevs winaaRmdegobas araviTar qmedebaze ;<br />

ukiduresad Senelebulia, SezRuduli an ararsebulia reqciebi. amgvar<br />

mdgomareobas xSirad win uswrebs zezRurblovani fizikuri Tu fsiqikuri<br />

zemoqmedebis momenti, aseve ukiduresi umweobisa da situaciaze<br />

damokidebulebis gancda. amgvari aSlilobebi upiratesad vlindeba qalebSi,<br />

igi aseve farTod warmod<strong>ge</strong>nilia mozardebSi, Tumca sakmaod xSirad<br />

gvxvdeba mamakacebSic.<br />

msxverplis amgvari « gayinuli » mdgomareoba umeteswilad<br />

arasworad aRiqmeba jalaTebis mier da ganixileba « mdumare protestisa da<br />

winaaRmdegobis reaqciad», rac iwvevs maT kidev ufro gaRizianebasa da<br />

sisastikes.<br />

reaqciis agznebadi tipi xasiaTdeba eqsploziuri–brutaluri<br />

reaqciebiT, agzneba atarebs qaosur xasiaTs. xSiria am SemTxvevaSi suicidis<br />

mcdeloba an suicidi, Tan sdevs cnobierebis Seviwroeba, ar xdeba situaciis<br />

swori aRqma, daqveiTebulia TviTkontroli, mosalodnelia TviTdazianebis<br />

SemTxvevebi ; fsiqlogiuri meqmizmi am dros upiratesad Semdegia: autaneli<br />

tanjva, iwvevs fsiqikis zezRurblovan gaRizianebas, am yvelafridan Tavis<br />

daRwevis cnobier Tu aracnobier survilsa da xSirad situaciis Sewyvetis<br />

motiviT gauazrebel ukontrolo qmedebas, rasac mohyveba suicidi an<br />

TviTdazianeba; Tumca aqve unda aRiniSnos, rom xSirad amgvari qmedeba<br />

sruliad gacnobierebulia da mizanmimarTulia situaciis Sewyvetaze: <strong>wamebis</strong><br />

msxverpli amjobinebs sikvdils amgvari tanjvis gagrZelebas, vinaidan<br />

misTvis situacia, fizikuri Tu moraluri tkivili gausaZlisi xdeba. amgvari<br />

reaqcia Cvens mier upiratesad aRweril iqna mamakacebs Soris. raRa Tqma<br />

unda, igi iseve, rogorc stuporozuli varianti jalaTebis kidev ufro<br />

gasastikebas iwvevs.<br />

unda aRiniSnos, rom amgvari reaqciebi warmoad<strong>ge</strong>ns normaluri<br />

adamianis normalur reaqcias aranormalur da sastik movlenaze da mis<br />

ganviTarebaSi wamebas unda mieniWos gadamwyveti mniSvneloba.<br />

« stresze mwvave reaqciis » diagnostikuri kriteriumebi mocemulia<br />

daavadebaTa saerTaSoriso klasifikaciis me – 10 gadasinjvis (ICD – 10)<br />

TavSi F (fsiqiatria), kerZod ki F 43 – reaqcia mZime stresze da adaptaciis<br />

darRveva.<br />

aRniSnuli darRvevis kodia F 43.0.<br />

mwvave reaqcia stresze – klinikuri gamovlinebebi<br />

« es aris mniSvnelovani simZimis tranzitoruli aSliloba, romelic<br />

uviTardebaT pirebs, romelTac ara aqvT gamoxatuli fsiqikuri aSliloba,<br />

pasuxad gansakuTrebul fsiqikur an fsiqologiur stresze da romelic,<br />

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Cveulebriv, amoiwureba ramodenime saaTis an dRis ganmavlobaSi. amgvar<br />

stresul faqtorad SesaZloa gvevlinebodes Zlieri matravmirebeli<br />

garemoeba, romelic emuqreba adamianis an misTvis Zvirfasi adamianis<br />

usafrTxoebas, sicocxles, fizikur mTlianobas (mag. bunebrivi katastrofa,<br />

ubeduri SemTxveva, brZola, danaSaulebrivi qmedeba, gaupatiureba) an<br />

uCveulod mkveTri da SemaSinebeli socialuri mdgomareobis / an<br />

garemocvis cvlileba, magaliTad uamravi axloblis dakargva an saxlSi<br />

xanZari. aSlilobis ganviTarebis riski izrdeba fizikuri gamofitvisa da<br />

organuli faqtorebis arsebobisas »<br />

komentari : rogorc vxedavT, naklebad aris asaxuli <strong>wamebis</strong> faqtori da<br />

misi roli am daavadebis ganviTarebaSi, rac metyvelebs kvlevaTa<br />

naklebobaze.<br />

diagnostikuri kriteriumebi<br />

unda iyos gansazRvruli da mkafio kavSiri droSi uCveulo stresoris<br />

zegavlenasa da simptomTa gamovlinebas Soris; dasawyisi Cveulebriv ar<br />

aris TandaTanobiTi an iwyeba ramdenime wuTSi. amasTanave simptomebs:<br />

a) aqvT Sereuli xasiaTi da suraTi aris cvalebadi ; inicirebis stadiaze<br />

gabruebis simptomebTan erTad vlindeba depresia, SfoTva, sibraze,<br />

umweobis gancda, hiperaqtiuloba da gariyuloba, magram arcerTi maTgani<br />

ar prevalirebs xangrZlivad.<br />

b) amoiwureba swrafad (yvelaze didi ramodenime saaTSi) in SemTxvevebSi,<br />

sadac SesaZlebelia stresuli faqtoris moSoreba. im SemTxvevebSi, roca<br />

stresi xangrZlivdeba an Tavisi bunebidan gamomdinare ar SeiZleba Sewydes,<br />

simptomebi lagdeba 24 – 48 saaTidan sami dRis ganmavlobaSi TandaTanobiT.<br />

moicavs :<br />

krizisul mdgomareobas ;<br />

mwvave krizisul mdgomareobas ;<br />

sabrZolo gadaRlas ;<br />

fsiqikur Soks<br />

(ICD – 10 1999)<br />

rogorc ukve iqna aRniSnuli, fsiqikuri aSliloba, romelic upiratesad<br />

xSirad gvxvdeba <strong>wamebis</strong> msxverplTa Soris aris posttravmuli stresuli<br />

aSliloba, misi mwvave Tu qronikuli variantebi.<br />

posttravmuli stresuli aSlilobis klinika da <strong>diagnostika</strong><br />

rogorc cnobilia, PTSD pirvelad, mTeli rigi gamokvlevebis<br />

safuZvelze, M. Horowitz mier 1980 w. iqna SemoRebuli da amave wels igi iqna<br />

Setanili, rogorc calke klinikuri forma amerikul diagnostikur<br />

klasifikaciaSi _ DSM-III (Diagnostic and Statistical Manual of Mental Disorders _<br />

fsiqikur aSlilobaTa diagnostikuri da statistikuri saxelmZRvanelo).<br />

DSM-II gamoxatuli stresiT gamowveuli fsiqikuri aSlilobebi, gamoxatuli<br />

27

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stresuli reaqciebi da tranzitoruli situaciuri darRvevebi<br />

miekuTvneboda mwvave simptomatur distress, xolo gaxangrZlivebuli<br />

formebi SfoTvisa da depresiul nevrozebs. xolo wamyvani roli am<br />

darRvevaTa ganviTarebaSi ganekuTvneboda fiqsaciis movlenasa da<br />

<strong>ge</strong>netikur predispozicias, ekzo<strong>ge</strong>nur stresi ki miCneuli iyo, rogorc<br />

araspecifiuri faqtori, romelic avlenda, gamoaaSkaravebda da<br />

axangrZlivebda fsiqiatriul simptomTa mimarT diaTezs. filosofiuri,<br />

socialuri, fsiqologiuri da klinikuri mosazrebebisa da koncefciebis<br />

gaTvaliswinebiT, SemoRebuli iqna PTSD diagnozi, romlis ganviTarebaSic<br />

kauzaluri mniSvneloba eniWeba eqstraordinarul travmas, romelic<br />

ganisazRvreba rogorc travmuli stresuli movalena (Life Stress Event) da<br />

SesaZloa ganuviTardes nebismier normalur adamians. PTSD warmoad<strong>ge</strong>ns<br />

bunebriv process adptaciisa eqstraordinarul stresul situaciaSi da<br />

missi simptomTa paterni ar aris damokidebuli premorbidul<br />

konstituciaze. (M. Horowitz, Rachel Yehuda, Alexander McFarlane). James<br />

Neuman, Tomas Williams et al. aRniSnaven, rom PTSD aris bunebrivi, Seqcevadi<br />

procesi, normaluri reaqcia aranormalur SemTxvevaze 6 Tvis ganmavlobaSi<br />

da am periodSi igi ganixileba, rogorc mwvave aSliloba, xolo PTSD<br />

gadazrdisas qronikul procesSi monawileobs faqtorTa kompleqsi da maT<br />

Soris premorbiduli fsiqopaTologiuri ganwyoba. travmuli stresis<br />

Semswavleli sauniversiteto centris mier es faqtorebi identificirebuli<br />

iqna "sam WrilSi _ travmuli stresorebi, pirovnebis Taviseburebani da<br />

socialuri da garemomcveli faqtorebi _ romelTa mudmivi kompleqsuri<br />

urTierToba TamaSobs gadamwyvet rols aSlilobis gaxangrZlivebaSi."<br />

(Lindy, Grace, Green, 1984). amerikis fsiqiatrTa asociaciis mier 1980 wlidan<br />

PTSD gaxangrZlivebuli da qronikuli formebi ganixileba, rogorc<br />

"nevrotizaciis procesi". pirovnebebSi, romelTac ar aReniSnebodaT<br />

premorbidulad fsiqikuri aSlilobebi da gamoxatuli stresis Sedegad<br />

ganuviTardaT PTSD, igi ganixileba, rogorc "reaqtiuli nevrozi". im pirTa<br />

Siris, romelTac premorbiduli pirovnuli organizacia aris normaluri<br />

an mcired nevrotuli PTSD ganixileba, rogorc ZiriTadi diagnozi. James<br />

Newman "ZiriTad diagnozSi" gulisxmobs fsiqikur aSlilobas, romelzedac<br />

unda iqnas ZiriTadad fokusirebuli mkurnalobis strategia, aseT<br />

SemTxvevebSi PTSD ZiriTad simptomebad miCneulia travmuli movlenis<br />

mtkivneuli mogonebebi. xolo im pirTa Soris, romelTac premorbidulad<br />

aReniSnebodaT gamoxatuli nevrotuli organizacia PTSD ZiriTad<br />

simptomebTan erTad aReniSnebaT "fiqrebi travmamdel konfliqtebze. PTSD<br />

yovelTvis iwvevs amgvari intrapersonaluri konfliqtebis egzacerbacias,<br />

rac aqtualuri rCeba PTSD simptomTa reducirebis Semdegac. iTvleba, rom<br />

PTSD upiratesad uviTardebaT pirovnebebs Sesustebuli adaptaciis unariT.<br />

im pirTa Soris, romelTac aReniSnebaT ZiriTadi diagnozi PTSD,<br />

gamoyofen, am aSlilobis or umTavres faqtors: travmis pirovnebisaTvis<br />

aqtualuri movlenebis akviatebuli mtkivneuli mogonebani da xasiaTobrivi<br />

cvlilebebi, romelic uviTardeba pirovnebas am mogonebaTa gavleniT.<br />

mogonebani klinikurad gamoxatulia sxvadasxva formiT; romelTagan<br />

upiratesad gavrcelebulia: 1. akviatebuli fiqrebi, romelTa drosac<br />

uneblied kvlav ganicdeba travmuli movlena, an fiqrebi dakavSirebuli<br />

trvmul movlenasTan. 2. Ramis koSmarebi, romlis drosac travmuli movlena<br />

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xelaxla ganicdeba mkafiod da detalurad. Ramis koSmarebi epizodebis<br />

saxiT gansakuTrebiT vlindeba stresul situaciebSi, an rodesac axlovdeba<br />

travmuli movlenis saiubileo TariRebi. Zilis darRveva TiTqmis<br />

yovelTvis PTSD damaxasiaTebeli paternia, im SemTxvevebSic ki, roca ar<br />

vlindeba Ramis koSmarebi da igi gamoixateba CaZinebis gaZnelebasa da<br />

gamoRviZebisas gamouZinarobis SegrZnebaSi. es xSirad warmoad<strong>ge</strong>ns<br />

alkoholisa da narkotikebis gamoyenebis mizezs, "TviTmkurnalobis" mizniT,<br />

rac iwvevs "ukukavSiris efeqts", romlis gamoc Ramis koSmarebi vlindeba<br />

ufro intensiurad.<br />

akviatebuli mogonebebi vlindeba ufro iSviaTad, vidre Ramis<br />

koSmarebi da ZiriTadad realurad, naTeli cnobierebis fonze, Tumca<br />

SesaZlebelia gaxangrZlivebuli disociaciuri mdgomareobis ganviTarebac,<br />

romelic cnobilia "Flashbacks" epizodebis saxelwodebiT (disociaciuri<br />

epizodi, rodesac travmuli movlena an masTan dakavSirebuli situaciebi<br />

TiTqos kvlav meordeba). amgvari disociaciuri epizodebi damaxasiaTebelia<br />

metad Zlieri travmatizaciis SemTxvevaSi, rodesac travmul movlenas<br />

warmoad<strong>ge</strong>ns mZime fizikuri travma, wameba, incesti da sxva. "Flashbacks"<br />

epizodebi upiratesad uviTardebaT narkotizaciis, an alkoholizaciis, an<br />

sxva saxis intoqsikaciis fonze. disociaciis epizodebis arseboba miuTiTebs<br />

PTSD mkveTrad gamoxatul, mZime formaze.<br />

akviatebulobaTa simptomebi aseve vlindeba qcevaSic. travmis<br />

msxveplT aqvT mZime, usiamovno emociebi, rodesac isini fiqroben an<br />

gaixseneben travmul movlenas, rac iwvevs SfoTvis momatebas da amitom<br />

damaxasiaTebelia im situaciebisgan gaqceva, Tavisarideba, romelnic<br />

axseneben travmis Sesaxeb. qcevis es paterni amerikis fsiqiatrTa asociaciis<br />

mier ganixileba, rogorc "kontr-fobiuri" (Counter Phobic) qceva, romelic<br />

xSir SemTxvevaSi iwvevs pirovnebis ganmartoebisaken tendenciebis,<br />

garemosagan izolirebasa da TavisTavSi Caketvas, urTierTobebis<br />

problemebs.<br />

zemoT moyvanili simptomebi damaxasiaTebelia M. Horowitz mier<br />

mowodebuli ganmeorebis fazisaTvis (Intrusive/Repetive Phase).<br />

upiratesad PTSD qronikuli da rTuli formebisTvis<br />

damaxasiaTebelia M. Horowitz mixedviT gandevnis/uaryofis (Avoidance/Denial<br />

Phase) fazis simptomTa arseboba, romelic xasiaTdeba travmasTan<br />

dakavSirebuli, Tu mimdinare problemebis gandevniT, rac vlindeba<br />

depresiul an piriqiT agresiul reaqciaSi, gansakuTrebiT im situaciebSi,<br />

romelnic stimulacias uweven travmuli movlenis gaxsenebas. am SemTxvevaSi<br />

pacientebi Tavs arideben mkurnalobas, im motiviT, rom amaze saubari, ver<br />

Secvlis verafers, da acxadeben, rom maT ar gaaCniaT raime emocia.<br />

gandevnis, uaryofisa da emociuri "gayinvis" (Psychic Numbing)<br />

simptomebi mniSvnelovani da damaxasiaTebelia PTSD klinikuri<br />

suraTisaTvis. am simptomTa arsebobisas klinicistTa varaudiT saqme gvaqvs<br />

xasiaTobriv cvlilebebTan, risTvisac damaxasiaTebelia adaptaciis unaris<br />

daqveiTeba. aseTi xasiaTobrivi cvlilebebi premorbidulad arsebuli<br />

pirovnuli, xasiaTobrivi darRvevebisagan gansxvavebiT, gamoirCeva<br />

TviTkritikis maRali maCvenebliTa da danaSaulis, TviTgvemis gancdiT.<br />

PTSD erTerT centralur simptomad miCneulia TviTbraldebis<br />

gancda, rac gulisxmobs travmul situaciaSi pirovnebis sakuTari qceviT,<br />

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moqmedebiT ukmayofilebas. "me rom ase movqceuliyavi da a.S." amgvari<br />

TvTbraldebis "laqa" aReniSnebaT im pirT, romelTac ganicades Zalze mZime<br />

travma, romelnic gaxdnen adamianebis sikvdilis an damaxinjebis<br />

TviTmxilvelni. amgvari gancdebi farTod aris aRwerili masalebSi<br />

vietnamis omis veteranebis Sesaxeb, aseve holokavis msxverplTa Soris da<br />

sxva masobrivi travmatizaciis SemTxvevebisas. TviTbraldebis, danaSaulis<br />

gancada upiratesad vlindeba Semdegi postulirebiT _ "me ratom gadavrCi,<br />

roca sxva daiRupa". amgvari gancdis arseboba miuTiTebs depresiul<br />

simptomatikaze. depresia warmoad<strong>ge</strong>ns PTSD Tanmxleb Taviseburebas. (T.<br />

Williams).<br />

Semdgomi simptomi, romelic gvexmareba diferencialuri<br />

diagnostikisas, aris TviTkontrolis dakargvis SiSi, rac vlindeba<br />

momatebuli gamRizianeblobisa da agznebadobis simptomebSi, impulsur<br />

emociebsa da qcevaSi da iwvevs adaptaciis darRvevebs, urTierTobebis<br />

problemebs, rac ukidures SemTxvevaSi vlindeba eqsploziur xasiaTobriv<br />

cvlilebebSi, rac SesaZloa atarebdes gamudmebuli "feTqebadobis", an<br />

iSviaTi feTqebadobis xasiaTs.<br />

mravali avtoris azriT, PTSD ar warmoiqmneba "vakuumSi", yvela<br />

adamians axasiaTebs garkveuli premorbiduli pirovnuli Taviseburebani,<br />

magram iTvleba, rom janmrTelni avaddebian ufro iSviaTad, vidre<br />

premorbidulad fsiqikuri problemebis mqone pirebi, iseTi anamneziT,<br />

rogoric aris alkoholizmi da narkotikebis an sxva nivTierebebis<br />

gamoyeneba, Tavis qalas travmebi, pirovnuli aSlilobani da sxva. aqedan<br />

gamomdinare xSir SemTxvevaSi PTSD Serwymulia sxva darRvevebTan,<br />

alkoholizmi da narkomania, pirovnuli aSlilobani, da sxva fsiqikuri<br />

aSlilobani. aseT SemTxvevebSi iTvleba, rom PTSD ufro mZime xasiaTisaa.<br />

(Card J.J., Domash M.D., Sparr L.F., Figley C.R., Hedlin H. et al., Horowitz M.J.,<br />

Symonds M., Van Der Kolk et al.).<br />

unda aRiniSnos, rom rigi avtorebi PTSD klinikaSi upiratesobas<br />

aniWeben ara "akviatebul mogonebaTa", aramed "gandevnisa da uaryofis,<br />

emociuri gayinvis" simptomebs da maT miiCneven am aSlilobisaTvis<br />

paTognomurad, centralur fenomenad. (Edna B. Foa, Davis S. Riggs, Beth S.<br />

Gershuny, 1995).<br />

PTSD diagnostikuri kriteriumebi pirvelad 1987 w. iqna Setanili<br />

DSM-III damatebaSi DSM-III-R, xolo amJamad srulyofilad aris mocemuli<br />

DSM-IV, rubrikaSi "SfoTviTi aSlilobani, sadac Seesabameba kodi _ 309.81.<br />

DSM-IV mixedviT es kriteriumebi Semdegia:<br />

A. pirovneba ganicdis stresis zemoqmedebas, roca erTdroulad arsebobs<br />

Semdegi ori garemoeba: 1. pirovneba uSualod ganicdis an mxilveli da<br />

monawilea gansakuTrebuli stresuli movlenisa, es "movlena" SesaZloa<br />

iyos: sikvdili, sicocxlis safrTxe, seriozuli dazianeba, Seurachyofa,<br />

fizikuri ganadgurebis muqara. 2. pirovnebis sapasuxo reaqcia moicavs:<br />

intensiur SiSs, umweobisa da saSinelebis gancdas. SeniSvna: bavSvebSi<br />

SeiZleba gamovlindes dezorganizebuli da aJitirebuli qceva.<br />

B. matravmirebeli movlena mudmivad, persistentulad ganicdeba Semdegi<br />

gzebiT: 1. momxdaris xelmeore da daJinebuli ganmeoreba, warmod<strong>ge</strong>nebis,<br />

azrebisa da SegrZnebebis saxiT. SeniSvna: bavSvebSi ganmeorebad<br />

TamaSebSi vlindeba travmis Tema da aspeqtebi. 2. akviatebuli<br />

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damTrgunveli sizmrebi travmis Sesaxeb. Senisvna: bavSvebSi SesaZloa<br />

iyos gaucnobierebeli koSmaruli sizmrebi. 3. SegrZneba da qveva, TiTqos<br />

pirovneba kvlav imyofeba matravmirebel situaciaSi (gacocxlebuli<br />

warmod<strong>ge</strong>nebi, iluziebi, halucinaciebi, "Flashbacks" epizodebi). SeniSvna:<br />

bavSvebi TamaSSi aRad<strong>ge</strong>nen matravmirebel situacias. 4. intensiuri<br />

fsiqologiuri gancda im Sinagan an garegan mizezebze, romlebic<br />

axseneben, an simbolurad gamoxataven travmas. 5. intensiuri<br />

fsiqologiuri reaqcia im Sinagan an garegan gamRizianeblebze, romlebic<br />

axseneben, an simbolurad gamoxataven travmas.<br />

C. travmasTan asocirebul stimulTagan mudmivi gaqceva da ganurCevloba<br />

garSemo momdinare movlenebisadmi, rac pirovnebas travmamde ar<br />

aReniSneboda. es SesaZloa gamovlindes Semdegi sami /an meti/ saxiT: 1.<br />

travmasTan dakavSirebuli azrebis, gancdebisa an saubrisagan gaqcevis<br />

mcdeloba. 2. im saqmianobisagan, adgilebisa da adamianebisgan Tavis<br />

arideba, romelnic iwvevs mogonebebs travmis Sesaxeb. 3. travmis<br />

umniSvnelovanesi aspeqtebis aRd<strong>ge</strong>nis SeuZlebloba. 4. mniSvnelovan<br />

saqmianobaSi monawileobis, an interesTa gamoxatuli Sesusteba. 5.<br />

gaucxoebisa da sxvebisagan ganmartoebis SegrZneba. 6. afeqtebis SezRudva<br />

(siyvarulis grZnobis gancdis SeuZlebloba). 7. momavlis<br />

uperspeqtivobis gancda (fiqrebi, rom ar eyoleba ojaxi, Svilebi, ar<br />

eqneba kariera an normaluri adamianuri cxovreba).<br />

D. gamoRviZebis persistentuli simptomebi, romelic ar aRiniSneboda<br />

travmamde, rac vlindeba Semdegi ori an meti niSniT: 1. CaZinebis<br />

gaZneleba an Zilis daRveva. 2. gamRizianebloba an ganrisxeba. 3.<br />

koncentraciis gaZneleba. 4. sifxizlis momateba. 5. momatebuli SiSis<br />

grZnoba.<br />

E. B, C, D kriteriumTa simptomebis xangrZlivoba unda aRematebodes 1 Tves.<br />

F. aRelveba iwvevs klinikurad mniSvnelovan mdgomareobas an socialuri<br />

da adaptaciuri meqanizmebis moSlas, an funqcionirebis sxva<br />

mniSvnelovani mxareebis moSlas.<br />

DSM-IV mixedviT, PTSD mimdinareobis mixedviT, gamoyofilia mwvave,<br />

qronikuli da dagvianebuli formebi. mwvave _ diagnostirdeba, Tu<br />

simptomebi aRiniSneba araumetes 3 Tvisa. qronikuli _ Tu simptomebi<br />

grZeldeba 3 Tveze metxans. dagvianebuli: Tu stresul movlenasa da<br />

simptomatikis gamovlenas Soris gasulia ara nakleb 6 Tvisa.<br />

1991 wlidan PTSD diagnozi Setanil iqna msoflio jandacvis<br />

organizaciis daavadebaTa saerTaSoriso klasifikaciis me-10 gadasinjvaSi<br />

(ICD-10 /International Classification of diseasis - 10 Revision/), rubrikaSi reaqcia<br />

gamoxatul stresze da adaptaciuri aSlilobani da Seesabameba kodi _ F<br />

43.1., moicavs travmul nevrozs.<br />

ICD-10 mixedviT PTSD warmoad<strong>ge</strong>ns dagvianebul, gaxangrZlivebul<br />

reaqcias, gamowveuls mxolod da mxolod sicocxlisaTvis saSiSi stresuli<br />

movlenebiTa da situaciebiT, romelTac SesaZloa gamoiwvion zogadi<br />

distresi nebismier adamianSi.<br />

ICD-10 mixedviT tipiur, paTognomur simptomebad miCneulia travmis<br />

ganmeorebadi gancdis simptomebi, xolo "gandevnis" simptomebi ar aris<br />

miCneuli diagnostikisaTvis aucileblad, aseve ve<strong>ge</strong>tatiuri darRvevebi,<br />

emociuri aSlilobani da qcevis darRvevebi SesaZloa arsebobdes, magram ar<br />

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iTvleba pirvelxarisxovnad diagnostirebisas. latenturi periodi<br />

SesaZloa arsebobdes ramdenime kviridan 6 Tvemde, Tumca SesaZlebelia<br />

PTSD diagnostireba mogvianebiTac, Tu saqme gavaqvs tipiur niSnebTan.<br />

winaswarganwyobis faqtorebad miCneulia pirovnuli Taviseburebani,<br />

kerZod ki kompulsuri da asTeniuri, aseve nevrologiuri darRvevebi,<br />

Tumca ar iTvleba diagnozis ganviTarebis aucilebel pirobad.<br />

DSM-IV gansxvavebiT, ICD-10 mixedviT iTvleba, rom sxva simptomebTan<br />

erTad yovelTvis gvxvdeba SfoTva da depresia, mosalodnelia<br />

suicidaluri ideaciebis arseboba, gamoyofilia ve<strong>ge</strong>tatiuri komponentic,<br />

Tumca ar aris moCneuli paTognomurad. am or klasifikacias Soris<br />

gansxvaveba aris aseve mimdinareobis sakiTxebSi. ar aris gamoyofili mwvave<br />

da dagvianebuli formebi, xolo qronikuli forma aris droSi<br />

Semofargluli da Semotanilia Soreuli <strong>Sede<strong>ge</strong>bi</strong>s cneba. kerZod<br />

"pirovnebis damacarielebeli stresis Soreuli qronikuli <strong>Sede<strong>ge</strong>bi</strong>, anu<br />

isini, romelnic manifestirdebian stresuli zemoqmedebidan aTwleulebis<br />

Semdeg, unda ganisazRvros F 62.0.<br />

F 62.0. warmoad<strong>ge</strong>ns axal diagnozs, romelic ganisazRvreba, rogorc<br />

"pirovnebis qronikuli cvlilebebi katastrofis gadatanis Semdeg". es<br />

darRveva viTardeba im SemTxvevebSi, roca stresi imdenad Rrma aris, rom<br />

ar saWiroebs pirovnuli Taviseburebebis gaTvaliswinebas. amgvar stresebs<br />

miekuTvneba sakoncentracio banakSi yofna, wameba, stiqiuri ubedureba,<br />

sicocxlisaTvis saSiS garemoebaSi xangrZlivad yofna (mag. mZevali,<br />

tyveoba). da iTvleba, rom es aSliloba SesaZloa ganviTardes PTSD<br />

manifestirebuli, Sualeduri fazis gareSe. misTvis paTognomurad aris<br />

miCneuli Semdegi kriteriumebi, romlebic pirovnebas manamde ar<br />

aReniSneboda: 1. samyarosadmi mtruli damokidebuleba, undobloba. 2.<br />

socialuri gamijvna. 3. uimedobisa da sicarielis SegrZneba. 4. gamudmebuli<br />

mRelvarebis, ToTqosda gamudmebuli safrTxis , "ufskrulis piras<br />

arsebobis" qronikuli gancda. 5. gaucxoebis gancda.<br />

rigi avtorebis azriT, PTSD diagnostikur kriteriumebSi ar aris<br />

warmoCenili fsiqosomaturi komponentebi, rac iTvleba erT-erT<br />

damaxasiaTebel fenomenad gansakuTrebuli travmiT gamowveuli<br />

darRvevebisaTvis, iseTebi rogoric aris asTma, kuW-nawlavis da gulsisxlZarRvTa<br />

sistemis paTologia da sxva. (Jacob D. LIndy, Bonnie L. Green,<br />

Mary Grace).<br />

PTSD eTno-kulturaluri aspeqtebi arasrulyofilad aris<br />

Seswavlili, Tumca arsebuli eTno-kulturaluri kvlevebis safuZvelze<br />

gamovlenil iqna travmis ganmeorebadoba, magaliTad mravaljeradi<br />

seqsualuri Zaladoba bavSvebze, evro-amerikul kulturaSic ki, cema<br />

koreel diasaxlisebSi da sxva, ris safuZvelzec SemoRebul iqna "Complex<br />

PTSD" cneba. (Antony J. Marsella, Matthew J. Friedman).<br />

eTnikur wmenda gadatanil bosniel ltolvilebze Catarebuli<br />

gamokvlevebis Sedegad, avtorTa nawilis azriT, omis dros adgili aqvs<br />

mravaljerad travmatizacias, rac xSirad xdeba mizezi mravalferovani<br />

aSlilobebisa, romelic scildeba PTSD sazRvrebs, ris gamoc SemoRebuli<br />

iqna cneba "travmuli stresuli aSliloba" (TSD /Traumatic Stress Disorder/),<br />

rasac ganekuTvneba 1. medikamentebis, narkotikebisa da alkoholis<br />

gamoyeneba. alkoholizmis, narkomaniisa da toqsikomaniis ganviTareba. 2.<br />

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eqsploziur reaqciebi travmis msgavs, an situaciis simbolurad<br />

gamaxsenebel umniSvnelo stimulze, romelic amnezirdeba pirovnebis mier. 3.<br />

eqsploziuri reaqciebi kombinirebuli alkoholis, an narkotikebis<br />

xmarebasTan, rac iwvevs suicidur an asocialur qmedebebs an kriminalur<br />

Zaladobas ojaxis an sazogadoebis wevrebze. 4. sxva SemTxvevaSi TSD iwvevs<br />

qr. invalidizacias fsiqikuri aSlilobebiT. 5. fsiqo-somaturi simptomebi da<br />

daavadebani. 6. reaqtiuli fsiqozuri qmedeba. 7. travmis transmisia TaobebSi.<br />

TSD dros PTSD simptomebi xSirad Tan erwymis iseT aSlilobebs,<br />

rogoricaa depresia, disociaciuri fenomeni, pirovnebis Secvla,<br />

destruqciuli qmedebani, sxvadasxva usiamovno SegrZnebebi, agznebadoba da<br />

disforiuloba agresiul fantaziebTan kombinaciaSi. (Steven M. Weine, Daniel<br />

F. Becker et al.)<br />

Александровский miwiZvrebis <strong>Sede<strong>ge</strong>bi</strong>sa da Cernobilis avariis<br />

Sede<strong>ge</strong>bze dakvirvebis safuZvelze aRwers socialur-stresul darRvevebs da<br />

PTSD atipiur formebs, romelTaTvisac ar aris niSandoblivi TvalsaCino<br />

"ganmeorebadi gancdis" simptomTa arseboba.<br />

somxeTis miwisZvris (1988 w.) da baSkireTSi gazsadenze avariis (1989w.)<br />

Sedegad dazaralebulTa dakvirvebebis Sedegad В.В. Ковалев da Н.К. Асанова<br />

mier post-stresuli darRvevebi kvalificirebul iyo, rogorc "panikurdepresiuli<br />

aSlilobani".<br />

avRaneTis omis veteranebze Catarebuli dakvirvebebis Sedegad П.И.<br />

Сидоров., М.Ф. Лукманов askvnian, rom omis veteranTa Soris upiratesad<br />

damaxasiaTebelia pirovnuli aSlilobani.<br />

amgvarad, dReisaTvis PTSD klinikasTan da diagnostikis sakiTxebTan<br />

dakavSirebiT ar arsebobas erTiani midgoma. H. Glover azriT, PTSD<br />

klinikasTan dakavSirebuli farTo speqtris problemebis analizi<br />

miuTiTebs imaze, rom PTSD an warmoad<strong>ge</strong>ns aSlilobas polimorfuli<br />

klinikuri gamovlinebebiT, an unda vivaraudoT, rom arsebobs am<br />

aSlilobis sxvadasxva tipebi.<br />

unda aRiniSnos, rom <strong>wamebis</strong> SemTxvevebSi, xSirad posttravmuli<br />

stresuli daavadebis simptomebi Serwymulia sxva aSlilobebTan, iseTi<br />

rogoric aris fobikuri sindromi Tavisi sxvadasxva formiTa da<br />

gamovlinebebiT, gansakuTrebiT amgvari fobiebi asocirebuli <strong>wamebis</strong><br />

situaciebTan, magaliTad viTardeba klaustrofobia, sibnelis SiSi, marto<br />

yofnis SiSi da a. S.;<br />

xSiria <strong>wamebis</strong> msxverplTa Soris SfoTviT – panikuri aSlilobani,<br />

gansakuTrebiT ki situaciebSi, romelic agonebs <strong>wamebis</strong> faqtebs, magaliTad<br />

policiis danaxvisas, <strong>samedicino</strong> instrumentebis danaxvisas da a. S.<br />

<strong>wamebis</strong> Sedegad xSirad viTardeba depresiuli mdgomareoba.<br />

DSM – IV is mixedviT imisaTvis, rom Rrma depresiis diagnozi daisvas,<br />

aucilebelia ori kviris ganmavlobaSi yuradReba mieqces Tundac xuT<br />

qvemoTCamoTvlil faqtors :<br />

1) daTrgunuli ganwyoba; 2) interesis sagrZnobi daqveiTeba da interesis<br />

dakargva an TiTqmis dakargva cxovrebiseul siamovnebebze ; 3) wonis<br />

dakargva an madis Secvla ; 4) uZiloba an gadametebuli Zili ; 5)<br />

fsiqomotoruli agzneba an daqveiTeba ; 6) daRliloba an Zalis gamocla ; 7)<br />

usar<strong>ge</strong>blobis SegrZneba da zedmetad an usafuZvlod Tavis dadanaSauleba;<br />

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8) fiqris an azris mokrebis daqveiTebuli unari ; 9) akviatebuli fiqri<br />

sikvdilze an TviTmkvlelobaze.<br />

simZimis mixedviT depresiuli mdgomareoba SeiZleba iyos msubuqi,<br />

saSualo simZimisa da mZime, fsiqozuri simptomebis gareSe, Tumca aseve<br />

diagnostirdeba mZime depresia fsiqozuri simptomebiT. <strong>wamebis</strong> SemTxvevaSi<br />

SesaZloa ganviTardes sxvadasxva simZimis depresia. diagnostikuri<br />

kriteriumebi, romelTa mixedviTac SeiZleba vixelmZRvaneloT depresiis<br />

simZimisa da tipis gansazRvrisaTvis mocemulia ICD – 10 – Si, TavSi afeqturi<br />

aSlilobebi ; msubuq depresias Seesabameba Semdegi kodi: F 32.0 msubuqi<br />

depresiuli epizodi. saSualo depresiul epizods Seesabameba kodi F 32.1;<br />

mZime depresiul epizods fsiqozuri simptomebis gareSe F 32.2 ; xolo mZime<br />

depresiul epizods fsiqozuri simptomebiT, iseTi rogoric aris bodva,<br />

halucinaciebi, stuporis mdgomareoba, Seesabameba kodi F 32.2; simZimis<br />

gansazRvra Semdegi sami depresiisaTvis damaxasiaTebeli kriteriumis<br />

gamoxatvis xarisxiT xdeba: 1) guneba – ganwyobis daqveiTeba; 2) fsiqikuri<br />

funqciebis Seneleba; 3) motoruli funqciebis Seneleba; amave dros depresia<br />

SesaZloa mimdinareobdes somaturi komponentis TanxlebiT, an Tanxlebis<br />

gareSe; aseve SesaZlebelia ganviTardes Sereuli – depresiuli sindromebi<br />

SfoTviT - depresiuli; disforiuli komponentiT, aseve aJitirebuli<br />

depresia motoruli Senelebis komponentis gareSe, maskirebuli depresia<br />

somatoformuli da hipoqondriuli gamovlinebebiT da sxva;<br />

unda aRiniSnos, rom <strong>wamebis</strong> SemTxvevaSi ganviTarebuli depresia<br />

umetes SemTxvevaSi ganekuTvneba reaqtiul mdgomareobebs da igi Tavisi<br />

registriT SesaZloa iyos rogorc nevrozuli, aseve fsiqozuri.<br />

<strong>wamebis</strong> msxverplTa SemTxvevaSi aseve mosalodnelia mwvave<br />

reaqtiuli paranoidis ganviTareba, romelic xasiaTdeba mwvave afeqturi<br />

gancdebiTa da bodviTi aRqmiT; qronikuli travmatizaciis Sedegad an<br />

<strong>wamebis</strong> qronikul Sede<strong>ge</strong>bs SesaZloa mivakuTvnoT qronikuli<br />

paranoialuri sindromis ganviTareba; aseve <strong>wamebis</strong> SemTxvevaSi<br />

niSandoblivia qronikuli depresiuli aSlilobis ganviTarebac.<br />

unda aRiniSnos, rom reaqtiuli mdgomareobebis ganviTarebisas<br />

travma aisaxeba gancdebSi, mas wamyvani roli mieniWeba darRvevaTa<br />

ganviTarebaSi da bodviTi azrebi an sxva gancdebi da gamonaTqvamebi ar<br />

scildeba matravmirebeli situaciis farglebs.<br />

aseve unda aRiniSnos, rom <strong>wamebis</strong> Sedegad ganviTarebuli fsiqikuri<br />

aSlilobebi gamoirCeva mravalferovnebiT da isini SesaZloa iyos rogorc<br />

nevrozuli aseve fsiqozuri registris.<br />

wameba xSir SemTxvevaSi xels uwyobs endo<strong>ge</strong>nuri fsiqozebis<br />

manifestaciasac, iseTi rogoric SeiZleba iyos Sizofreniuli fsiqozebi an<br />

depresiul – maniakaluri mdgomareoba, aseve am daavadebaTa gamwvavebas;<br />

xSir SemTxvevaSi ki igi xdeba qronikuli pirovnuli cvlilebebis an<br />

pirovnul aSlilobaTa ganviTarebis mizezi, gansakuTrebiT ki im<br />

SemTxvevebSi, roca fsiqikuri travma Serwymulia Tavis tvinis organul<br />

dazianebasTan; igi SeiZleba gaxdes aseve travmuli epilefsiis mizezi,<br />

fsiqikuri da nevrologiuri komponentebis mkafio gamoxatulebiT.<br />

fsiqikur aSlilobaTa xasiaTi Tu mimdinareoba da xangrZlivoba<br />

damokidebulia <strong>wamebis</strong> simZimesa da xangrZlivobaze, aseve garemo socialur<br />

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situaciaze da mTel rig damatebiT stresul faqtorebze, romelsac<br />

gansakuTrebuli travma iwvevs adamianis cxovrebaSi;<br />

fsiqikur aSlilobebs <strong>wamebis</strong> dros Tan sdevs xSirad<br />

wamaldamokidebulebisa da alkoholizmis movlenebi, romelTa miRebasac<br />

xSirad safuZvlad udevs akviatebul gancdaTa da mogonebebisagan Tavis<br />

daRwevis survili an myari uZilobis problema;<br />

<strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> aisaxeba ara marto fsiqikur funqciebze, aramed<br />

xSirad mas Tan sdevs seqsualuri disfunqciis komponenti, rac SeiZleba<br />

gamowveuli iyos rogorc fizikuri, aseve fsiqikuri zemoqmedebiT da<br />

TiTqmis yovelTvis, uviTardebaT seqsualuri <strong>wamebis</strong> msxverplebs.<br />

unda aRiniSnos, rom fsiqikuri problemebi, romelic <strong>wamebis</strong><br />

msxverpls uviTardeba, aisaxeba mis ojaxsa da garemocvaze; socialuri<br />

TvalsazrisiT vlindeba konfliqtebi ojaxSi, zogadi xasiaTis sirTuleebi<br />

interpersonaluri urTierTobebis mxriv, Sromis unaris daqveiTeba da<br />

sxva, rac kompleqsSi warmoad<strong>ge</strong>ns fsiqo–socialur problemaTa<br />

erTobliobas, romelic safrTxes uqmnis rogorc <strong>wamebis</strong> msxverplis, aseve<br />

misi ojaxisa da sazogadoebis normalur funqcionirebas. aqedan<br />

gamomdinare, es problema ara marto <strong>samedicino</strong>–fsiqologiuri xasiaTis,<br />

aramed socialuri Tu politikuri da zogadsakacobrio xasiaTisaa.<br />

centri « empaTia »s mier Catarebuli kvlevebis Sedegad gamovlenil iqna<br />

calkeul riskis jgufebSi klinikuri Taviseburebani da damatebiTi<br />

stresorebi, romelic safuZveli xdeba kompleqsuri polimorfuli da<br />

qronikul darRvevaTa ganviTarebisaTvis.<br />

<strong>samedicino</strong> daxmarebis nakleboba, umetes SemTxvevaSi <strong>wamebis</strong><br />

msxverplTa mimarT arahumanuri mopyroba da damokidebuleba iwvevs mwvave<br />

fizikur da fsiqikur darRvevebs. aRniSnul darRvevebs kidev ufro<br />

aRrmavebs Tanmxlebi araadamianuri cxovrebis pirobebi, rasac adgili aqvs<br />

rogor winaswari dakavebis saknebsa da sapyrobileebSi, aseve ltolvilTa<br />

da iZulebiT adgilnacval pirTa Sorisac. yovelive amgvari situacia,<br />

warsulis matravmirebel stresul SemTxvevebTan erTad iwvevs kompleqsuri<br />

travmuli stresuli sindromis qronizacias, Tanmxlebi somaturi da fsiqo –<br />

somaturi darRvevebiT, rac vlindeba pirovnebis qronikuli<br />

cvlilebebisadmi tendenciebis CamoyalibebaSi.<br />

yovelive aRniSnuli iwvevs socialur sferoSi adaptaciis darRvevebs,<br />

xSir konfliqtebs da aZlierebs agresiul reaqciebs. araswori<br />

damokidebuleba da Seusabamo <strong>samedicino</strong> daxmareba, cixeebSi reabilitaciis<br />

sistemis ar arseboba da specifikuri daxmarebis ar arseboba <strong>wamebis</strong><br />

msxverplTaTvis aris mizezi Semdegi fsiqikuri da fsiqologiuri<br />

darRvevebisa :<br />

<strong>wamebis</strong> mimdinare da qronikuli <strong>Sede<strong>ge</strong>bi</strong><br />

<strong>wamebis</strong> fsiqikuri (fsiqologiuri) <strong>Sede<strong>ge</strong>bi</strong> (ICD - 10-is Sesabamisad) da<br />

gamoyenebul fsiqologiur testebze dayrdnobiT.<br />

35

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zrdasrulebisaTvis (sul raodenoba 204)<br />

diagnozi kodi<br />

(ICD –<br />

10)<br />

F -<br />

Code<br />

patimrebi<br />

yofili<br />

patimrebi<br />

109/<br />

sixSire<br />

ltolvile<br />

bi<br />

CeCneTidan<br />

24<br />

/ sixSire<br />

iZulebiT galis<br />

adgalinacvali regioni<br />

pirebi<br />

afxazeTidan<br />

da samxreT 42<br />

oseTidan<br />

29 / sixSire<br />

nomeri./ /<br />

sixSire<br />

204-s Soris<br />

mwvave stresuli reaqcia 43.0. 6 / 0, 05 0 - 1 / 0, 02 7 / 0, 03<br />

PTSD 43.1. 17 / 0, 15 8 / 0, 33 10 / 0, 34 12 / 0, 28 47 / 0, 23<br />

PTSD<br />

depresiiT<br />

PTSD somaturi<br />

aSlilobiT<br />

PTSD post komociuri S<br />

sindromiT<br />

qronikuli pirovnuli<br />

cvlilebebi<br />

(<strong>wamebis</strong> Semdeg)<br />

emociuri pirovnuli<br />

aSlilobebi PTSD-Tan<br />

erTad<br />

pirovnuli organuli<br />

aSliloba<br />

(epilefsia PTSD-sTan<br />

erTad)<br />

PTSD fsiqozuri<br />

sindromiT<br />

konversiul-disociaciuri<br />

aSliloba PTSD-Tan<br />

erTad<br />

demencia (Tavis tvinis<br />

travmiT gamowveuli<br />

(<strong>wamebis</strong> dros miRebuli<br />

travmis Sedegad)<br />

Sizofrenia<br />

disocialuri pirovnuli<br />

aSliloba<br />

43.1 ;<br />

43.22.<br />

43.1<br />

45.<br />

43.1.<br />

07.2.<br />

15 / 0, 14 8 / 0, 33 10 / 0, 34 11 / 0, 26 44 / 0, 21<br />

11 / 0, 10 2 / 0, 08 2 / 0, 07 10 / 0, 24 25 / 0, 12<br />

23 / 0, 21 3 / 0, 12 2 / 0, 07 - 28 / 0, 14<br />

62.0. 13 / 0, 12 3 / 0, 12 4 / 0, 14 4 / 0, 09 24 / 0, 12<br />

60.3.<br />

43.1.<br />

07.0.<br />

43.1.<br />

7 / 0, 06 - - 1 / 0, 02 8 / 0, 04<br />

3 / 0, 03 - - 1 / 0, 02 4 / 0, 02<br />

43.1 ? 8 / 0, 07 - - 1 / 0, 02 9 / 0, 04<br />

44<br />

43.1<br />

2 / 0, 02 - - - 2 / 0, 009<br />

03. 0 - 1 / 0, 03 1 / 0, 02 2 / 0, 009<br />

20.0x0<br />

3 / 0, 03 - - - -<br />

60.2 1 / 0, 009 - - - -<br />

rogorc cxrilebidan Cans, yvelaze gavrcelebuli diagnozi iyo<br />

posttravmuli stresuli sindromi, romelic vlindeboda “ganmeorebiTobis<br />

fazis” simptomebSi: (travmuli stresuli movlenis – <strong>wamebis</strong> - Sesaxeb<br />

akviatebuli gancdebis, mogonebebis, Ramis koSmarebisa da Zilis darRvevaSi)<br />

da “gaqcevis fazisaTvis” damaxasiaTebel simptomebSi depresiiTa da fsiqo –<br />

somaturi, ve<strong>ge</strong>tatiuri reaqciebiT. unda aRiniSnos, rom umetes SemTxvevaSi<br />

gamovlinda sxvadasxva fsiqo-somaturi sindromi, rogoric aris: qronikuli<br />

tkivilis sindromi (Tavis, zurgis, kisris areSi): 204 SemTxveva _ 82,93%;<br />

centraluri nervuli sistemis fuqnciuri darRvevebi: 142 SemTxveva _ 56,34%;<br />

arteriuli wnevis cvalebadoba (88-34,92%) da tkivili gulis areSi (139-<br />

36

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55,16%); rogorc specifikuri darRveva qal patimrebSi – dismenorea,<br />

mozardebSi ki _ enurezi.<br />

zogierTi Taviseburebani, romelic gamovlinda mozard <strong>wamebis</strong><br />

msxverplTa Soris :<br />

mozardebisaTvis (sul 43)<br />

diagnozi kodi F TavSi<br />

pirebi (sul 35 )<br />

patimrebi<br />

35 / s<br />

galis<br />

raioni<br />

8 / s<br />

patimari<br />

/ sixsire<br />

sul 43/ s<br />

araorganuli enurezi PTSD – isTan<br />

erTad<br />

98.0. 43.1. 2 / 0, 06 2 / 0, 25 4 / 0, 09<br />

socialurad integrirebuli qceviTi 91.2. 43.1. 8 / 0, 23 - 8 / 0, 19<br />

aSliloba PTSD - sTan erTad<br />

socialurad dezintegrirebuli 91.1. 43.1. 9 / 0, 26 - 9 / 0, 21<br />

aSliloba PTSD - sTan erTad<br />

PTSD depresiasTan erTad 43.1. 43.22. 12 / 0, 34 - 12 / 0, 28<br />

epilefsia PTSD -sTan erTad, enureziT 07.0. 43.1. 3 / 0, 08 - 3 / 0, 07<br />

qcevis depresiuli aSliloba 92.0 - 3 / 0, 37 3 / 0, 07<br />

PTSD 43.1 1 / 0, 03 3 / 0, 37 4 / 0, 09<br />

toqsikomania – arasrulwlovan patimrebSi - 20 SemTxveva.<br />

unda aRiniSnos, rom mozardebSi gamovlenili patimrobamde arsebuli<br />

problemebi: ojaxSi da quCaSi Zaladobis maRali done, hipokontroli,<br />

ganaTlebisa da elementaruli socialuri unar-Cvevebis nakleboba,<br />

toqsokomaniis maRali done da narkotikebis moxmareba an alkoholis<br />

gamoyeneba, cixeSi cud damokidebulebasTan erTad xSir SemTxvevaSi iwvevs<br />

gamoxatul pirovnul cvlilebebs, rac umetes SemTxvevebSi vlindeba<br />

stabiluri saxis socialur qceviT aSlilobaSi da adaptaciis<br />

SesaZleblobebis SesustebaSi.<br />

mozardebSi zemoT moyvanil sindromebs aReniSneba zogierTi<br />

mniSvnelovani Tavisebureba, romelsac Cven vuwodeT “ bavSvi – didis<br />

fenomeni”, rac gulisxmobs konfliqts bavSvis fsiqo-fizikur<br />

SesaZleblobebsa da bavSvebis garSemo arsebuli sastiki realobis<br />

obieqtur moTxovnebs Soris. socialuri dacvis sistemis ararseboba da<br />

adeqvaturi sasamarTlo sistemis deficiti Sans ar utovebs<br />

arasrulwlovan “damnaSaveebs” ganviTardnen da daiwyon axali cxovreba<br />

gaTavisuflebis Semdeg.<br />

patimrebs Soris Catarebulma kvlevebma aCvena, rom cixeebisaTvis<br />

damaxasiaTebeli bunebrivi Taviseburebani: Tavisuflebis SezRudva, ojaxis<br />

wevrebisagan izolacia, arCevanisa da interesTa sferos SezRudva,<br />

sasamarTlos gadawyvetilebis molodini winaswari patimrobis<br />

izolatorSi yofnis dros _ mudmivi faqtorebia, romlebic amZafrebs<br />

pirovnebis daZabulobas da iwvevs pirovnebis kompensatoruli meqanizmebis<br />

Sesustebas. post-sabWoTa, cixeebSi cixeTa bunebriv negatiur faqtorebs<br />

emateba “post – sabWoTa cixis specifiuri negatiuri faqtorebi”, rogoric<br />

aris banakis sistema, cixeebis gadavsebuloba, kriminaluri garemo,<br />

pirovnuli SesaZleblobebis realizaciis nakleboba, operatiuli-saa<strong>ge</strong>nto<br />

sistema da patimrebis mimarT aradamianuri damokidebuleba, xSirad<br />

arakvalificirebuli <strong>samedicino</strong> daxmareba da <strong>samedicino</strong> eTikis normebis<br />

37

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uxeSi darRveva, rac kidev ufro Rrma matravmirebeli faqtori xdeba<br />

pirovnebisaTvis.<br />

es faqtorebi uaryofiT gavlenas axdenen pirovnebis adaptaciis<br />

SesaZleblobebze da, wamebasa da araadamianur an Rirsebis Semlaxav<br />

mopyrobasa da dasjasTan erTad, umetes SemTxvevaSi, iwveven pirovnebis<br />

qronikul cvlilebebs, rac upiratesad vlindeba pirovnebis izolaciaSi,<br />

fsiqologiur autizaciaSi, undoblobasa da samyarosadmi ukiduresad<br />

mtrul damokidebulebaSi. yovelive zemoT moyvanili xSir SemTxvevaSi<br />

mizezi xdeba myari “mtris xatis” fenomenis Camoyalibebisa, rac xdeba mizezi<br />

reabilitaciis garTulebisa.<br />

Cveni dakvirvebis Sesabamisad, ltolvilebis SemTxvevaSi mZime fsiqofizikuri<br />

aSlilobebis warmoqmnaze mniSvnelovan gavlenas axdens<br />

damatebiTi (travmis Semdgomi) stresuli faqtorebi, romlebic ganviTarebad<br />

da Ratak qveynebSi metad TvalsaCino xdeba, rogoric aris:<br />

• arsebuli saomari mdgomareobani;<br />

• msoflio sazogadoebis mxridan ltolvilebis tra<strong>ge</strong>diis mimarT<br />

yuradRebis nakleboba;<br />

• sazogadoebis am nawilisaTvis dacvis meqnizmebis ararseboba;<br />

• sikvdilis an gaurkvevlobis mudmivi SiSi, saSineli informaciis<br />

molodini (ojaxis wevris an axlo naTesavis gardacvaleba; maTi<br />

dapatimreba; vinmes gaupatiureba da wameba);<br />

• daucvelobis, usar<strong>ge</strong>blobisa da uZlurebis SegrZneba, eTnikuri<br />

devna – Seviwroeba, samyarosagan da sazogadoebisagan gariyul<br />

mdomarebaSi yofna.<br />

• adamianis gatacebisa da dakargvis SemTxvevebi.<br />

• socialuri moTxovnebisa da pirovnuli motivaciebis SezRudva<br />

• ukiduresad SezRuduli humanitaruli daxmareba, romelic<br />

ganxiluli unda iyos, rogorc araadamianuri cxovrebis<br />

pirobebi.<br />

unda aRiniSnos, rom aseTi dramatuli situacia iwvevs pirovnebis<br />

qronikul sulier da fizikur travmirebas, rac vlindeba qronikul<br />

posttravmul stresul aSlilobaSi an somatur daavadebebSi, qronikul<br />

depresiasa da SiSSi, romelsac Tan axlavs sxva samyaros da garemos mimarT<br />

undobloba da mtruli ganwyoba, interpersonaluri da intrapersonaluri<br />

konfliqtebi da sirTuleebi. ukiduresad krizisuli mdgomareoba qmnis<br />

adaptaciasa da reabilitaciasTan dakavSirebul sirTuleebs.<br />

garda amisa, umetes SemTxvevebSi ltolvilebs gaaCniaT Zlieri<br />

undobloba da autoizolaciis an TavianT TemSi izolaciis tendenciebi.<br />

Cveni azriT, es aris Sedegi Zlieri da xangrZlivi distresisa da momavlis<br />

gaurkevlobisa. aseve unda aRiniSnos, rom mimdinare konfliqtis zonebSi<br />

<strong>wamebis</strong> msxverplTa Soris <strong>wamebis</strong> Sede<strong>ge</strong>bs Tan erTvis farTod<br />

gamovlenili permanentuli SfoTviT – fobikuri sindromi, romelsac Tan<br />

sdevs relaqsaciis mizniT alkoholisa da narkotikebisadmi ltolva. Cveni<br />

azriT, amis mizezi aris mudmivi saSiSroebis molodinis mdgomareoba da<br />

usafrTxoebis garantiebis ararseboba.<br />

38

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<strong>wamebis</strong> fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

<strong>wamebis</strong> mwvave fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

rogorc ukve wina TavSi mokled iqna aRniSnuli, metad xSiria<br />

sxvadasxva saxis hemoragiuli sindromis arseboba, aseve Tavis tvinis mwvave<br />

travma gonebis dakargviT, aseve xSiria sxvadasxva lokalizaciis<br />

motexilobani da amovardnilobani, tkiviliT gamowveuli an sisxldeniT<br />

gamowveuli travmuli Soki; sxvadasxva saxis mwvave sqesobrivi gziT<br />

gadamdebi infeqciebi.<br />

centri « empaTia »s mier 2004 – 2005 wlebSi Catarebuli kvlevebis<br />

Sedegad dad<strong>ge</strong>nil iqna, rom <strong>wamebis</strong> mwvave Sede<strong>ge</strong>bs Soris upiratesad<br />

gvxvdeba Semdegi darRvevebi Semdegi TanafardobiT :<br />

<strong>wamebis</strong> mwvave fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

fizikuri travma sul # 535 sixSire F<br />

kranialuri travma gonebis<br />

dakargviT<br />

318 0.594<br />

Wriloba 185 0.346<br />

damwvroba 54 0.101<br />

mwvave sisxldena, hemoragia 169 0.316<br />

motexilobani<br />

amovardnilobani<br />

da 80 0.149<br />

gul – sisxlZarRvTa mwvave<br />

ukmarisoba<br />

242 0.452<br />

travmuli Soki 107 0..2<br />

sasunTqi<br />

darRvevebi<br />

sistemis mxriv 166 0.31<br />

infeqciuri daavadebebi : TB,<br />

faRaraTi, mwave prostatiti<br />

da sxva.<br />

40 0.075<br />

uro – <strong>ge</strong>nitaluri sistemis<br />

mwvave dazianeba<br />

93 0.174<br />

Tirkmlis dazianeba 92 0.172<br />

daJeJiloba, hematoma 242 0.452<br />

nevrologiouri darRvevebi<br />

parezi, paraliCi, krunCxviTi<br />

movlenebi da sxva<br />

115 0..215<br />

okularuli sistemis mwvave<br />

dazianeba<br />

68 0.127<br />

oto – laringologiuri 105 0.196<br />

sistemis mwvave dazianeba<br />

rogorc mocemuli cxrilidan Cans, xSiria sxvadasxva organos mxriv<br />

sxvadasxva darRvevebi, rac upiratesad ukavSirdeba <strong>wamebis</strong> gamoyenebul<br />

meTodebs, ase magaliTad : yel – yur – cxviris sistemis dazianebaTagan<br />

yvelaze xSiria dafis apkis dazianeba – gaxeTqva « telefonis » meTodis<br />

gamoyenebisas. amgvari dazianebani upiratesad aRwerili iqna patimrebSi.<br />

damwvroba Tavisi lokalizaciisa da formis mixedviT miuTiTebs<br />

gamoyenebul <strong>wamebis</strong> meTodze; magaliTad sigaretiT damwvrobis kvali an<br />

uToTi damwvrobis kvali da a.S. okularuli sitemis mxriv xSiria cemis<br />

Sedegad mxedvelobis mwvave moSla an baduris CamoSlis Sedegad erT an<br />

39

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orive TvalSi mxedvelobis dakargva; Tirkmelebis saproeqcio areSi cemis<br />

Sedegad xSiria pasternackis dadebiTi sindromis arseboba, hematuriiT,<br />

Sardvis gaZneleba an SexuTva. fizikuri cemis Sedegad sxvadasxva blagvi<br />

sagnebiT TiTqmis yovelTvis gvxvdeba sxeulis sxvadasxva nawilis<br />

daJeJiloba da sisxlnaJRenTebi, xSiria sxeulis universaluri daJeJilobac.<br />

mWreli an mCxvletavi sagniT dazianebisas xSiria sxvadasxva areSi<br />

Wrilobebi; Zalzed xSirad, rogorc ukve iqna aRniSnuli, gvxvdeba<br />

hemoraguli sindromi da travmuli Soki, rac dakavSirebulia cemasTan an<br />

sxva saxis <strong>wamebis</strong> meTodebis gamoyenebasTan : motexilobebi,<br />

amovardnilobani an sxva Zlieri tkiviliT gamowveuli Soki; aRweril iqna<br />

SemTxvevebi kombinirebulad TavSi cemisa da eleqtro–Sokis meTodebis<br />

gamoyenebisas krunCxviTi movlenebisa da gulyris ganviTarebisaTvis, rac<br />

SemdgomSi Camoyalibebul iqna travmuli epilefsiis diagnozad; agreTve<br />

aRsaniSnavia, rom xSiria eleqtrodenze SeerTebiT da airwinaRiT mogudvamoxrCobis<br />

kombinirebuli <strong>wamebis</strong> SemTxvevebi.<br />

<strong>wamebis</strong> mogvianebiTi da qronikuli fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

<strong>wamebis</strong> gamoyenebuli meTodebis mravalferovnebidan gamomdinare,<br />

fizikuri <strong>Sede<strong>ge</strong>bi</strong>c gamoirCeva mravalferovnebiT da xSirad erTsa da imave<br />

<strong>wamebis</strong> msxverpls aReniSneba sxvadasxva organoTa sistemis mxriv<br />

darRvevebi. aqedan gamomdinare, xSirad ismeba kombinirebuli diagnozi<br />

(ramodenime erTdroulad) da diagnostiksaTvis gamoiyeneba sxvadasxva<br />

meTodi.<br />

amave dros, unda aRiniSnos, rom iseTi zogadi xasiaTis arahumanuri<br />

da araadamianuri mopyrobis meTodebi, romelnic farTod aris danergili<br />

im qveynebis sapatimroebSi, sadac intensiurad gamoiyeneba <strong>wamebis</strong> praqtika,<br />

aqveiTebs organizmis reaqtiulobas an TviTonve xdeba calkeul qronikul<br />

daavadebaTa mizezi. amgvar pirobebs SesaZloa mivakuTvnoT : sanitarul–<br />

higienuri pirobebis arqona da moTxovnilebaTa dakmayofilebis xSiri<br />

SezRudva, rac sxvadasxva saxis infeqciuri daavadebebisa Tu kanis<br />

daavadebebis safuZveli xdeba; ase magaliTad Cvens mier farTod iqna<br />

gamovlenili munis SemTxvevebi, aseve xSiria tuberkulozis am gziT<br />

gavrcelebis SemTxvevebi, romelsac xels uwyobs sakanTa gadavsebuloba,<br />

rodesac erT 20 adgilian sakanSi mori<strong>ge</strong>obiT sZinavs 60 patimars; raRa<br />

Tqma unda, amgvari situaciebi iwvevs agresiulobis zrdasa da Zaladobas<br />

TviTon patimrebs Sorisac ; sakanSi xSirad ar aRwevs dRis sinaTle,<br />

patimrebi ver xedaven mzes, aris gadaWarbebuli sineste da a.S amgvar<br />

pirobebSi xangrZlivad moxvedrili pirovneba arc erT SemTxvevaSi ar<br />

rCeba janmrTeli da miuxedavad imisa, rom SesaZloa raime daavadeba<br />

mwvaved ar iqnas gamovlenili, amgvar pirobebSi moxvedrili adamiani<br />

cixidan gamosvlis Semdeg qronikulad xdeba daavadebuli, SeiZleba iTqvas,<br />

rom misi TiTqmis yvela organo da organoTa sistema met – naklebad<br />

gamosulia mwyobridan, iseve rogorc misi fsiqika.<br />

sxvadasxva sistemis mxriv gamovlenili dazianebebi :<br />

mxedvelobis sistema<br />

okularuli sistemis mxriv, rogorc aRvniSneT, xSiria dazianebebi<br />

mwvave periodSi, Tumca es dazianebani ukuganviTarebas ganicdis; qronikul<br />

40

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formebSi upiratesad gvxvdeba koniunqtivitebi, aseve SesaZloa mxedvelobis<br />

gauareseba. Tumca xSirad pacientebi uCivian TvalebSi gaorebas da<br />

akomodaciis darRvevas, okulistis konsultaciisa da gamokvlevis Semdeg<br />

naTeli xdeba, rom aq organul dazianebas ara aqvs adgili. aseT SemTxvevaSi<br />

unda vivaraudoT, rom saqme gvaqvs egreT wodebul « Soltis sindromTan »,<br />

romelic SemdegSi iqneba aRwerili.<br />

yel – yur – cxviris sistema<br />

yvelaze xSiria am SemTxvevaSi dafis apkis gaxeTqva – dazianeba, rac<br />

mizezi xdeba Cirqovani otitebisa da smenis qronikuli dazianebisa. otiti<br />

atarebs qronikul xasiaTs da mimdinareobs xSiri gamwvavebebiT. xSiria<br />

Zgidis gamrudebis SemTxvevebi, rac xdeba cxviriT sunTqvis gaZnelebis,<br />

Zilis problemebis warmoqmnis mizezi. aRsaniSnavia aseve Tavbrusxvevis<br />

movlenebi. yovelive aRniSnuli dazianeba dgindeba otolaringologis<br />

konsultaciis Sedegad. aucilebelia smenadobis gansazRvrisaTvis<br />

timpanitometriuli da audiometriuli gamokvlevebis Catareba, aseve<br />

srulfasovani surdologiuri gamokvleva. im SemTxvevaSi Tuki adgili ara<br />

aqvs raime organul dazianebas, an nevrologiuri xasiaTis dazianebas<br />

SesaZloa vivaraudoT « Soltis sindromis » arseboba.<br />

kbilebi<br />

vinaidan Zalzed xSirad gamoiyeneba cema saxis midamoSi, xSiria<br />

kbilebis dazianebis SemTxvevebi, rac gamoixateba kbilebis amogdebaSi,<br />

CalewvaSi; aseve unda aRiniSnos, rom aRwerilia <strong>wamebis</strong> meTodebi, rodesac<br />

gautkivarebis gareSe ara stomatologiuri da ara steriluri<br />

instrumentebiT, magaliTad « ploskogufcis»(brtyeltuCas) an « gazis »<br />

meSveobiT, xdeba kbilebis amoReba ; rac xSir SemTxvevaSi xdeba qronikuli<br />

infeqciis mizezi, viTardeba RrZilebis qronikuli anTeba, kariesi, rasac<br />

xels uwyobs sanitarul – higienuri pirobebis ar qona da normebis<br />

darRveva. amgvarad, TiTqmis yvela <strong>wamebis</strong> msxverpls aReniSneba<br />

stomatologiuri problemebi, rac saWiroebs stomatologiur<br />

meTvalyureobas mudmivad, da xSirad amgvari problema xdeba dispefsiur<br />

darRvevaTa mizezic.<br />

sasunTqi sistema<br />

respiratoruli daavadebebis mxriv zogadi reaqtiulobis daqveiTebis<br />

fonze xSiria respiratoruli infeqciebi, adamiani xSirad civdeba, xSirad<br />

emarTeba surdo, filtvebis anTeba. aseve am TvalsazrisiT xSirad vxvdebiT<br />

tuberkulozis SemTxvevebsac, ris gavrcelebasac ganapirobebs is<br />

araadamianuri pirobebi, romelSic <strong>wamebis</strong> msxverpli an zogagad patimari<br />

xvdeba, gansakuTrebiT ki iseT cixeTa sistemaSi, romelic gavrcelebulia<br />

post–sabWoTa qveynebSi.<br />

gul – sisxlZarRvTa sistema<br />

<strong>wamebis</strong> msxverplTa Soris TiTqmis yoveli gadarCenili warmoad<strong>ge</strong>ns<br />

Civilebs gul – sisxlZarRvTa sistemis mxriv, rac metwilad fsiqo –<br />

somaturi xasiaTisaa da Sedegia gadatanili mZime stresisa an SesaZloa<br />

ganvixiloT maskirebuli depresiis sindromSi, rac gansakuTrebiT<br />

niSandoblivia mamakacebSi.<br />

Tumca aucilebelia Catarebul iqnas srulfasovani kardiologiuri<br />

gamokvleva organuli dazianebis gamoricxvis mizniT.<br />

41

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gulsisxlZarRvTa paTologiis mxriv sakmaod gavrcelebulia iseTi<br />

daavadebebis SemTxvevebi, rogoric aris hipertonuli daavadeba, aseve<br />

gulis qronikuli iSemiuri daavadeba, miokardiodistrofia. amgvari<br />

daavadebebis ganviTarebaSi mravali faqtori monawileobs da igi erT–erTi<br />

wamyvania xangrZlivad araadamianur pirobebSi, yovelgvari ukmarisobis<br />

pirobebSi adamianis yofnisas ganviTarebul sxvadasxva organoTa mxriv<br />

ganviTarebul qronikul disfunqciaTa Soris. Tumca arsebobs<br />

gavrcelebuli azric, rom gamokvleulTa 72 % - Si 0% aRmoaCnda organuli<br />

cvlilebebi gul – sisxlZarRvTa sistemis mxriv (Juler, Shmidt-Nielsen, 1995).<br />

amis gamo xSirad amgvar Civilebs miakuTvneben « Soltis sindroms ».<br />

kuW – nawlavis sistema<br />

literaturul monacemebze dayrdnobiT, gamokvleulTa 70%<br />

warmoad<strong>ge</strong>ns Civilebs kuW – nawlavis sistemis mxriv, Tumca amgvari<br />

darRvevebi obieturi kvlevis Sedegad ar dasturdeba, mxolod<br />

gamokvleulTa 30% aReniSneba obieqturad dadasturebuli darRvevebi<br />

(Juler, Shmidt-Nielsen, 1995).<br />

upiratesad warmod<strong>ge</strong>nilia wylulovani daavadebisaTvis<br />

damaxasiaTebeli Civilebi: tkivili epigastriumis midamoSi, mSieri tkivilis<br />

simptomi, boyini, gulisrevis SegrZneba, Tumca statistikurad<br />

gastroskopiuli gamokvleva mxolod 2 % - Si avlens darRvevebs.<br />

centri « empaTia »s monacemebiT, farTod aris warmod<strong>ge</strong>nili<br />

gastritebi, dispepsiuri movlenebi, kolitebi, xSirad dgindeba<br />

disbaqteriozis diagnozic. infeqciur daavadebaTa Soris vlindeba<br />

qronikuli hepatitebi (gadatanili A hepatitis Sedegad) aris SemTxvevebi B<br />

da C hepatitebis diagnostirebisa.<br />

kuW – nawlavis sistemis mxriv darRvevaTa ganviTarebis mniSvnelovan<br />

safuZvels rogorc gaxangrZlivebuli stresuli situacia, aseve<br />

araadmianuri yofiTi pirobebi, ara kondiciuri kveba, usufTaoba da sxva<br />

faqtorebi warmoad<strong>ge</strong>ns.<br />

Sard – sasqeso sistema<br />

gamokvleulTa umravlesoba warmoadens am sistemaTa mxriv Civilebs.<br />

upiratesad amgvari darRvevebis mizezi xdeba cema Tirkmelebisa da muclis<br />

an welis areSi, seqsualuri Zaladoba, eleqtro – Sokis gamoyeneba<br />

<strong>ge</strong>nitalur midamoSi.<br />

centri “empaTia”s monacemebiT xSiria Tirkmelebis saproeqcio areSi<br />

tkivilebi, dadebiTi pasternackis sindromiT. Sardis laboratoruli<br />

gamokvlevisas dgindeba mikrohematuriis sindromi; eqoskopiuri<br />

gamokvlevisas aRmoCenil iqna Tirkmlis dawevis sindromic, rac<br />

dakavSirebulia aseve cemasTan.<br />

devnilTa SemTxvevaSi metad xSirad iqna gamovlenili qronikuli<br />

prostatitebi mamakacebSi, seqsualuri da reproduqciuli unaris<br />

daqveiTebiT; aseve qalebSi qronikuli anTebiTi movlenebi Sard – sasqeso<br />

sistemis mxriv; aRmoCenil iqna saSvilosnos fibromiomis SemTxvevebi,<br />

romelic metad xSiria patimar qalTa Soris, Tumca aRniSnuli<br />

daavadebebis pirdapiri kavSiris dad<strong>ge</strong>na wamebasTan metad rTulia. xSiria<br />

sakvercxeebis qronikuli anTebis klinikuri gamovlineba; metad xSirad<br />

patimar qalTa Soris gamovlenil iqna dismenoreis SemTxvevebi; naadrevi<br />

42

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klimaqsi; amgvari darRvevebi upiratesad SeiZleba mivakuTvnoT fsiqo –<br />

somatur daRvevaTa ricxvs.<br />

seqsualuri Zaladoba Tavis fsiqikuri Tu fizikuri komponentebiT,<br />

usaTuod iwvevs libidos daqveiTebas, seqsualur disfunqciasa da<br />

urTierTobebis darRvevas.<br />

mamakacebSi gaupatiurebis Sedegad xSirad viTardeba swori nawlavis<br />

midamoSi sxvadasxva saxis darRvevebi: naxeTqebi, Wrilobebi; aseve xSiria<br />

yabzoba, nawlavuri disfunqciis movlenebi.<br />

zogadi monacemebiT am sistemaTa disfunqciaze Civilebi Sead<strong>ge</strong>ns 10 % ,<br />

Tumca monacemebi ar SeiZleba CaiTavlos zustad, vinaidan xSir SemTxvevaSi<br />

eTnokulturuli Taviseburebebidan gamomdinare, xdeba gaupatiurebisa da<br />

seqsualuri Zaladobis Sesaxeb informaciis damalva <strong>wamebis</strong> msxverplis<br />

mxridan, es upiratesad gamovlenilia aRmosavleTis kulturebSi, musulman<br />

qalebSi. centri “empaTia”-s monacemebiT amgvari informaciis damalva<br />

gansakuTrebiT xdeba mamakacebSi; aseve es informacia imaleba<br />

arasrulwlovan <strong>wamebis</strong> msxverpl mamarobiTi sqesis mamakacebSi, da xSirad<br />

amis Sesaxeb varaudiT xvdeba eqimi klinikuri da paraklinikuri<br />

gamokvlevebis Sedegad; sakiTxis dazusteba pacientTan moiTxovs Zalze<br />

delikatur midgomas, Tavisufali arCevanis uflebisa da konfidencialobis<br />

aucilebel dacvas.<br />

simsivnuri daavadebani<br />

centri “empaTia”s mier gansakuTrebiT qal patimrebSi aRweril iqna<br />

simsivnuri daavadebebis ganviTarebis SemTxvevebi, gansakuTrebiT ki<br />

saSvilosnosa da mkerdis sxvadasxva saxis simsivnis saxiT. anamnezuri<br />

monacemebiT adgili hqonda cemas muclisa da mkerdis areSi; Tumca<br />

pirdapiri kavSirisa da kanonzomierebis dad<strong>ge</strong>na, ra Tqma unda, amgvari<br />

mwiri gamokvleveiT ar xerxdeba. unda aRiniSnos, rom mniSvnelovani iqneba<br />

am mimarTulebiT kvlevebis gaxSireba da gafarToeba.<br />

centraluri da periferiuli nervuli sistema<br />

samecniero literaturidan da Cvens mier Catarebuli kvlevebis<br />

Sedegad naTeli gaxda, rom <strong>wamebis</strong> Sedegad Zalian xSirad vlindeba<br />

nevrologiuri darRvevebi, rac SeiZleba Sedegi iyos <strong>wamebis</strong> sxvadasxva<br />

meTodebis gamoyenebisa, gansakuTrebiT ki iseTi meTodebisa, rogoric aris<br />

TavSi cema, eleqtrodeniT wameba da a.S.<br />

zogierTi mkvlevaris azriT 85 % SemTxvevaSi <strong>wamebis</strong> msxverplebs<br />

aReniSnebaT centraluri nervuli sistemis mxriv darRvevebi, aqedan<br />

TiTqmis naxevarSi es darRvevebi obieqturadac dasturdeba;<br />

centri “empaTia”s monacemebiT, 2004 – 2005 ww. gamokvleul 535 <strong>wamebis</strong><br />

msxverplTa Soris 347 pirovnebas – 65 % aRmoaCnda klinikur –<br />

paraklinikuri kvlevis Sedegad dadasturebuli c.n.s. darRveva. xolo c.n.s.<br />

funqciuri darRvevis niSnebi: Tavbrusxvevis, Tavis tkivilebis, Zilis<br />

darRvevis saxiT, gamovlinda praqtikulad yvela SemTxvevaSi; aseve<br />

praqtikulad yvela SemTxvevaSi iqna gamovlenili periferiuli funqciuri<br />

moSlilobani ve<strong>ge</strong>tatiuri disregulaciisa da tremoris saxiT.<br />

yvelaze xSiria Civlebi gaRizianebadobisa da agznebadobis momatebaze,<br />

Tavis tkivilebze, Zilis darRvevaze, aseve yuradRebis koncentraciis<br />

unarisa da mexsierebis daqveiTebaze, ganlevadobasa da advilad daRlaze.<br />

diagnostikuri TvalsazrisiT yvelaze xSirad gavrcelebuli diagnozi qala<br />

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– tvinis travmis myari narCeni movlenebia. paraklinikuri gamokvlevebis<br />

safuZvelze (Tvalis fskeris gamokvleva, CT, Ro – grafia) gvxvdeba<br />

intrakranialuri hipertenziisaTvis damaxasiaTebeli gamovlinebani, aseve<br />

atrofiuli kerebi; rogorc ukve iqna aRniSnuli eleqtroSokisa da TavSi<br />

cemis an mZime, rkinis sagnis Cartymis (magaliTad oTxkuTxedi formis<br />

boqlomi) Sedegad rig SemTxvevebSi adgili aqvs konvulsiur sindroms,<br />

diagnostiredeba travmuli epilefsiis sindromi, romelic dasturdeba e.e.g.<br />

gamokvleviTac.<br />

fizikuri wameba xSir SemTxvevaSi iwvevs periferiuli tipis<br />

darRvevebsac, rac iwvevs senso – motorul disfunqcias. xSirad igi<br />

vlindeba mWreli an mCxvletavi sagniT miyenebuli Wrilobebisas,<br />

“Camokidebisas”, mizanmimarTuli travmebis Sedegad. ZiriTadad pacienetebi<br />

uCivian nawilobriv paresTezias, romelic mgrZnobelobis daqveiTebaSi<br />

gamoixateba (Rasmussen, 1990).<br />

xSiria neiro<strong>ge</strong>nuli tkivilebis ganviTarebis SemTxvevebic.<br />

gansakuTrebiT ki samwvera nervis midamoSi, aseve adgili aqvs xSir<br />

SemTxvevaSi sajdomi nervis qronikuli anTebis ganviTarebasa da sxvadasxva<br />

saxis nevralgiebs, rasac ganapirobebs ara marto <strong>ge</strong>gmazomieri dartymebi,<br />

aramed araadamianur pirobebSi yofna, sicive, sineste da a.S. Zalian xSiria<br />

radikulopaTiebi. yovelive aRniSnuli atarebs qronikul xasiaTs da<br />

saWiroebs periodul mkurnalobas, SesaZloa mTeli sicocxlis manZilezec;<br />

aseve sayuradReboa, rom aRniSnuli mdgomareobani SesaZloa periodulad<br />

gaumjobesdes mkurnalobis fonze; xSiria sezonuri gamwvavebebic.<br />

sayrden – mamoZravebeli sistema<br />

rogorc cnobilia, sayrden – mamoZravebeli sistema <strong>wamebis</strong> Sedegad<br />

mniSvnelovnad ziandeba. daniis <strong>wamebis</strong> msxverplTa reabilitaciis<br />

saerTaSoriso sabWos monacemebis Tanaxmad, gamokvleul pacientTa 90 % - Si<br />

aRiniSneba am sistemis mxriv Civilebi, romlebic (86 % - dan 74 % - Si)<br />

mtkicdeba obieqturadac (Juler, Shmidt-Nielsen, 1995); centri “empaTia”s<br />

monacemebiT, 2004 – 2005 wlebSi gamokvleul 535 <strong>wamebis</strong> msxverplTa Soris<br />

20 % aRmoaCnda obieqturad dadasturebuli Zval – saxsrovani sistemis<br />

mxriv dazianeba, xolo Civilebs kunTebisa da saxsrebis qronikuli<br />

tkivilebis Sesaxeb warmoad<strong>ge</strong>nda 89 %. aseve unda aRiniSnos, rom Cvens mier<br />

Catarebuli kvlevebis Sedegad upiratesad gamovlinda xerxemlis malebis<br />

motexilobebi da diskozebi an mankieri Sexorcebis Sedegad ganviTarebuli<br />

tkivilisa da moZraobis SezRudvis mdgonmareobani, rac xSir SemTxvevaSi<br />

gamowveuli iyo xerxemlis, gansakuTrebiT ki welis midamoSi <strong>ge</strong>gmazomieri<br />

dartymebiT. gamovlenili iqna aseve muxlis saxsris dazianebebi, rac<br />

klinikurad tkivilSi, muxlis saxsris Sesivebasa da SewiTlebaSi, moZraobis<br />

SezRudvaSi vlindeboda. //<br />

unda aRiniSnos, rom xSirad Zvalsaxsrovani sistemis mxriv<br />

darRvevebi Serwymulia nevralgiebTan, radikulopaTiasa da sxva<br />

nevrologiur darRvevebTan.<br />

aseve aRsaniSnavia is garemoeba, rom TiTqmis yvela SemTxvevaSi<br />

pacients aReniSneba fizikuri <strong>wamebis</strong> Sedegad qronikulad mimdinare<br />

tkivilis, daZabulobisa da daRlilobis sindromi, gansakuTrebiT kisris,<br />

Tavisa da zeda kidurebis midamoSi, Tumca xSirad igi vrceldeba mTels<br />

sxeulSi. amave dros, obieqturi dazianebis niSnebi wamebidan mogvianebiT<br />

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periodSi ar vlindeba. amgvari sindromi cnobilia “Soltis sindromis”<br />

saxelwodebiT da warmoiqmneba gansakuTrebiT avtokatastrofebis dros<br />

horizontaluri daWimvis Sedegad. amgvari sindromi xSirad warmoiqmneba<br />

uknidan TavSi cemis Sedegad da misi qronikuli <strong>Sede<strong>ge</strong>bi</strong> vlindeba sakmaod<br />

gamoxatul simptomokompleqsSi, vinaidan ziandeba ara marto xerxemlis<br />

kisris midamo diskebiTa da myesebiT, aramed aseve Tavis tvinisaken mimavali<br />

nervebi, sisxlZarRvebi da rbili qsovilebi. aqedan gamomdinare, kisris<br />

midamos tkivilebis garda, romelic xSirad iradirdeba zemo kidurebSi,<br />

pacients aReniSneba mxedvelobis daqveiTeba, Tavbrusxveva, yurebSi Suilis<br />

SegrZneba, Sakikis magvari Tavis tkivilebi, saxis nervTa paresTezia, kbilis<br />

tkivili, tkivili gulmkerdis areSi, gansakuTrebiT gulis areSi, kuW –<br />

nawlavis sistemis mxriv darRevevebi da sxva. Tuki aRniSnul simptomebs<br />

obieqturad dadasturebuli sxva safuZveli ar gaaCniaT, isini metyveleben<br />

“Soltis sindromis” Camoyalibebaze.<br />

kani<br />

xSirad Ria Wrilobebis Sedegad rCeba nawiburebi da Sramebi, aseve<br />

xSiria nawiburebi miyenebuli damwvrobis Sedegad. magram unda aRiniSnos,<br />

rom xSirad araadamianur pirobebSi moxvedris Sedegad, viTardeba kanis<br />

qronikuli infeqciebi, romelnic xangrZliv mkurnalobas saWiroebs, iseTebi<br />

rogoric aris piodermia; xSiria stresul niadagze da Secvlili<br />

reaqtiulobis fonze alergiuli dermatitebisa da neirodermitis<br />

ganviTarebis SemTxevebic. Cvens mier Seswavlil pacientTa Soris,<br />

gansakuTrebiT ki arasrulwlovan patimrebSi,, aRmoCenil iqna qronikuli<br />

piodermitebi, romelic ganviTarda xangrZlivad muniT daavadebis<br />

SemTxvevebSi.<br />

endokrinuli sistema<br />

unda aRiniSnos, rom Cvens mier Catarebul kvlevebSi 535 <strong>wamebis</strong><br />

msxverplidan 42 adamians (7 %) aRmoaCnda endokrinuli darRvevebi. isini<br />

aRniSnavdnen, rom msgavsi darRvevebi maT adre ar aReniSnebodaT; Cveni<br />

dakvirvebebiT Zalzed xSiria <strong>wamebis</strong> Sedegad an <strong>wamebis</strong> procesSive sisxlSi<br />

glukozis donis momateba, rac SemdgomSi rig SemTxvevebSi yalibdeba<br />

Saqriani diabetis saxiT; aseve gamovlenil iqna Tireotoqsikozis an<br />

farisebri jirkvlis funqcionirebis sxva darRvevebi, endokrinopaTiuli<br />

simsuqne da sxva. Tumca Zalze Znelia zustad gansazRvro am darRvevaTa<br />

zusti mizez – Sedegobrivi kavSiri wamebasTan, SesaZloa vivaraudioT<br />

faruli formebis an midrekilebebis manifestireba <strong>wamebis</strong> Sedegad.<br />

fsiqo – somaturi darRvevebi<br />

unda aRiniSnos, rom xSir SemTxvevebSi <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> fsiqo –<br />

somaturi warmoSobisaa da miuTiTebs mZime da qronikuli stresuli<br />

situaciis Sedegad ganviTarebul somatizaciaze. centri “empaTias” mier<br />

Catarebuli kvlevebis Sedegad fsiqosomatur simptomTa Soris upiratesad<br />

farTod iqna gamovlenili somato–ve<strong>ge</strong>tatiuri disregulaciis movlenebi:<br />

simptomuri hipertenziis, pulsis aCqrebis, oflianobis, hipersalivaciis,<br />

libidos cvlilebis, madis moSlisa da sxva gamovlinebaTa saxiT, rac<br />

Serwymuli iyo xSirad c.n.s. funqciur darRvevebTan – Tavbrusxvevis,<br />

koordinaciis moSlis, Zilis darRvevis, Tavis tkivilebis saxiT. <strong>wamebis</strong><br />

msxverpl qalTa Soris specifiurad gamovlinda dismenorea da naadrevi<br />

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klimaqsi, xolo bavSvebsa da mozardebSi – funqciuri enurezis SemTxvevebi.<br />

xSirad amave tipis aSlilobebs SesaZloa mivakuTvnoT kuW – nawlavis<br />

sistemis mxriv gamovlenili darRvevebi, romelnic upiratesad yabzobis, an<br />

piriqiT, xSiri diareebis saxiT iqna gamovlenili.<br />

Tavi IV. <strong>diagnostika</strong> da <strong>eqspertiza</strong><br />

rogorc ukve iqna aRwerili, <strong>wamebis</strong> fizikuri Tu fsiqikuri <strong>Sede<strong>ge</strong>bi</strong><br />

SesaZloa gamoirCeodes mravalferovnebiT, rac safuZveli xdeba<br />

diagnostikisaTvis mravali meTodis gamoyenebisa.<br />

pirveladi interviu<br />

metad sayuradReboa <strong>wamebis</strong> msxverplTan intervius dros Semdegi<br />

principebis dacva, raTa SeZlebisdagvarad <strong>wamebis</strong> msxverpls SeuqmnaT<br />

usafrTxo garemo da movipovoT misi ndoba:<br />

konfidencialobis principis sruli dacva<br />

moTxovnis SemTxvevaSi anonimurobis sruli dacva<br />

profesiuli damoukidebloba da miukerZoebloba<br />

informirebuli Tanxmoba<br />

piveladi intervius Catarebisas, mTavari mizania urTierTndobaze<br />

dafuZnebuli kontaqtis damyareba. amisaTvis aucilebelia <strong>wamebis</strong> msxverpls<br />

zedmiwevniT aexsnas gamokvlevis <strong>ge</strong>gma, meTodebi, momsaxurebis saxeebi da<br />

mosalodneli SesaZlo <strong>Sede<strong>ge</strong>bi</strong>. wamyvani sakiTxi <strong>wamebis</strong> msxverplis<br />

gamokvlevisas da gansakuTrebiT ki pirveladi intervius Catarebisas aris<br />

SeZlebisdagvarad usafrTxo garemos Seqmna; am mizniT aucilebelia, rom<br />

interviu Tu <strong>samedicino</strong> gamokvleva mimdinareobdes konfidencialurad,<br />

mxedvelobisa da smeniTi distanciis aris miRma, yovelgvari<br />

samarTaldamcavi struqturebis warmomad<strong>ge</strong>nelTa Tu ucxo pirTa gareSe.<br />

usafrTxo garemos Seqmna im qveynebSi, sadac <strong>wamebis</strong> praqtikas aqvs adgili,<br />

met–naklebad Znelia. raRa Tqma unda, amgvari garemos Seqmna policiis<br />

izolatorSi, sadac wamebas hqonda adgili, Zalzed Znelia. amitom<br />

<strong>samedicino</strong> intervius dros eqimma unda moiTxovos sruli konfidenciuroba,<br />

da Tuki ar arsebobs patimris Tanxmoba an situaciis Sefasebisas<br />

usafrTxoebis garantiebi ver moiZebneba, Tavi unda Seikavos yovelgvari<br />

komentarisagan da sagamomZieblo organoebs unda ganucxados, rom isini<br />

werilobiT daskvnas miiReben mxolod oficialuri momarTvis Semdeg da,<br />

patimris Tanxmobis SemTxvevaSi, igi mogvianebiT gaegzavnebaT.<br />

<strong>samedicino</strong> gamokvlevebi da <strong>eqspertiza</strong> unda mimdinareobdes<br />

<strong>samedicino</strong> dawesebulebaSi, sadac pacienti met-naklebad usafrTxod<br />

igrZnobs Tavs, Tumca totalitaruli reJimebis pirobebSi <strong>wamebis</strong> msxverpli<br />

<strong>wamebis</strong> praqtikis mqone qveyanaSi yovelTvis daucvelad grZnobs Tavs.<br />

aseve sayuradReboa, rom <strong>wamebis</strong> Sesaxeb detaluri informaciis<br />

misaRebad erTi viziti SesaZloa sakmarisi ar iyos, unda iqnas<br />

gaTvaliswinebuli <strong>wamebis</strong> saxe da eTnokulturuli Taviseburebanic, ase<br />

magaliTad gaupatiurebis SemTxvevaSi, xSirad <strong>wamebis</strong> msxverplebs ar surT<br />

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am Temaze saubari da gaxmaureba, isini moiTxoven am faqtis damalvas ojaxis<br />

wevrebisganac. amisaTvis Terapevts, romelic uSualo kontaqtSi imyofeba<br />

<strong>wamebis</strong> msxverplTan, unda hqondes mosmenis unari da moTmineba, raTa<br />

pacientma SeZlos bolomde gaxsna da, amave dros, ar iqnas ganmeorebiT<br />

travmirebuli.<br />

zemoT moyvanilidan gamomdinare, aucilebelia aRiniSnos, rom <strong>wamebis</strong><br />

msxverplis <strong>samedicino</strong> – fsiqologiuri eqspertizis SemTxvevaSi, sakiTxi<br />

unda dad<strong>ge</strong>s reabilitaciis Sesaxebac, vinaidan pacientma miiRos pozitiuri<br />

stimuli da daxmareba, aucilebelia saeqsperto daskvna moicavdes<br />

rekomendaciebsac da pacients mieces informacia, Tu sad SeuZlia daxmarebis<br />

miReba, amave dros, unda iqnas ganmartebuli, rom saeqsperto daskvna mas<br />

moexmareba sasamarTlo davis gadawyvetasa da <strong>wamebis</strong> mtkicebulebebis<br />

dokumentirebaSi.<br />

Zalze mniSvnelovania <strong>wamebis</strong> msxverplis zusti diagnostireba. amas<br />

mniSvneloba aqvs rogorc swori mkurnalobisa da reabilitaciis <strong>ge</strong>gmis<br />

Sed<strong>ge</strong>nisa da CatarebisaTvis, aseve eqspertizisa da sasamarTlosTvisac.<br />

rogorc zemoT araerTxel iqna moyvanili, <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> gamoirCeva<br />

mravalferovnebiT da moicavs rogorc fizikur, aseve fsiqikur<br />

komponentsac, amis gaTvaliswinebiT <strong>eqspertiza</strong>, iseve rogorc <strong>samedicino</strong><br />

<strong>diagnostika</strong>, Catarebul unda iqnas specialistTa multidisciplinuri<br />

jgufis mier; aucilebelia masSi monawileobdes rogorc zogadi profilis<br />

Terapevti, aseve fsiqiatri, nevrologi, travmatologi, fsiqologi, da<br />

klinikur simptomTa analizis gaTvaliswinebiT _ sxva calkeuli dargis<br />

specialistebi: kardiologi, stomatologi, otolaringologi, ginekologi<br />

da sxva; sasamarTlo <strong>samedicino</strong> eqspertizis Catarebisas igive jgufs unda<br />

daematos sasamarTlo eqspertebic. Sesabamisad, paraklinikuri gamokvlevebi<br />

aseve gamoirCeva mravalprofilurobiT da amgvari gamokvlevebis <strong>ge</strong>gmas<br />

erTad ad<strong>ge</strong>ns SemTxevis mmarTvelis TaosnobiT specialistTa<br />

multidisciplinuri jgufi.<br />

amgvarad, <strong>diagnostika</strong> moicavs:<br />

pirvelad intervius<br />

klinikur gamokvlevas, romelsac, rogorc ukve iqna<br />

aRwerili, atarebs specialistTa multidisciplinuri<br />

jgufi. igi moicavs garegnul daTvalierebas, klinikur<br />

gasinjvas sxvadasxva specialistTa mier, pacientis<br />

komentarebis Sesabamisad cal–calke unda iqnas<br />

ganxiluli adrindeli dazianebebis mdebareoba da<br />

gamomwvevi mizezebi da is dazianebebi, romelic pacientis<br />

mier aRiwereba, rogorc <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong>; klinikuri<br />

gamokvleva Terapiuli da sxva specialistTa<br />

konsultaciebis garda unda moicavdes pacientis fsiqikur<br />

statuss da aseve nevrologiur statuss;<br />

fsiqikuri statusis aRwerisas sayuradReboa<br />

fsiqologiuri gamokvlevis <strong>Sede<strong>ge</strong>bi</strong>s CarTvac;<br />

fsiqologiuri gamokvleva SesaZloa mimdinareobdes<br />

sxvadsaxva subieqturi da obieqturi kiTxvarebis<br />

47

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dokumentacia<br />

gamoyenebiT; amisaTvis xSirad gamoiyeneba posttravmuli<br />

stresuli aSlilobis simptomTa Sefasebis sxvadasxva<br />

kiTxvari, aseve depresiisa da SfoTvis Skalebi, agresiisa<br />

da pirovnuli profilis Semswavleli testebi,<br />

mniSvnelovania proeqciuli testebis gamoyenebac,<br />

magaliTad, bavSvebSi xelis testis; rezidualuri da<br />

klinikurad Znelad gamosavleni Tavis qalas travmebis<br />

narCeni movlenebis gamosavlenad xSirad gamoiyeneba<br />

neirofsiqologiuri testebi.<br />

sruli anamnezuri monacemebis Segroveba, rogorc<br />

wamebamde periodze, aseve <strong>wamebis</strong> faqtebTan dakavSirebiT<br />

da <strong>wamebis</strong> Semdgom periodTan dakavSirebiT;<br />

anamnezi unda moicavdes informacias yvela gadatanili<br />

daavadebis Sesaxeb wamebamde, aseve im daavadebebisa Tu<br />

dazianebebis Sesaxeb, rac <strong>wamebis</strong> Sedegad ganviTarda;<br />

<strong>wamebis</strong> istoria SeZlebisdagvarad detalurad unda<br />

moicavdes informacias Tu sad, vis mier, rodis da ra<br />

meTodebiT iqna nawamebi adamiani, aucilebelia misive<br />

frazebi iqnas moyvanili am istoriis aRwerisas.<br />

laboratoriuli da instrumentuli kvlevebi, iseTi,<br />

rogoric aris Tavis qalas encefalografia,<br />

gansakuTeebiT ki gulyriTi movlenebis SemTxvevaSi;<br />

komputeruli tomografia, rodesac pacienti acxadebs,<br />

rom adgili hqonda TavSi cemas, gonebis dakargviT,<br />

rent<strong>ge</strong>nologiuri gamokvleva, sxvadasxva organoTa<br />

eqoskenireba, kardiografia da sxva kardiologiuri<br />

sfecifikuri gamokvlevebi, ginekologiuri gamokvlevebis<br />

Catareba mniSvnelovani xdeba gaupatiurebis da sxva<br />

sasqeso organoebis dazianebis dros.<br />

<strong>wamebis</strong> mtkicebulebebis miRebisaTvis da misi <strong>Sede<strong>ge</strong>bi</strong>s<br />

aRmofxvrisaTvis mniSvnelovani roli eniWeba <strong>samedicino</strong> dokumentaciis<br />

srulad da sworad Sed<strong>ge</strong>nasa da momzadebas.<br />

gansakuTrebiT mniSvnelovania <strong>wamebis</strong> msxverplis pirveladi <strong>samedicino</strong><br />

Semowmebis monacemebi. amgvarad, im eqimTa pirveladi Semowmebis daskvnas,<br />

romelTac pirveladi Sexeba aqvT <strong>wamebis</strong> riskis jgufebTan,<br />

gansakuTrebuli roli eniWeba. eqimTa amgvar kategorias pivel rigSi<br />

ganekuTvnebian cixis eqimebi, vinaidan maT aqvT pirveladi Sexeba<br />

policiidan Semosul patimrebTan.<br />

CPT rekomendaciis Tanaxmad, yoveli patimari cixeSi SesvlisTanave da<br />

SemdgomSi yovelTvis, adgilis cvlilebisas, unda iqnas gasinjuli eqimis<br />

mier, unda Cautardes piveladi <strong>samedicino</strong> gamokvleva. rekomendaciebis<br />

Sesabamisad amgvari gamokvleva unda tardebodes mkacrad konfidecialurad<br />

da sxva pirebisaTvis smeniTi distanciis miRma, aseve mxedvelobiTi<br />

48

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distanciis miRma im SemTxvevebis garda, Tuki meTvalyureobas ar iTxovs<br />

eqimi. aseve unda aRiniSnos, rom pirveladi <strong>samedicino</strong> SemowmebisaTvis<br />

saxelmZRvanelo principebad SesaZloa gamoyenebul iqnas stambolis<br />

protokolis principebi, romelic warmoad<strong>ge</strong>ns saxelmZRvanelo principebs<br />

<strong>wamebis</strong> msxverplis eqspertizisaTvis.<br />

ras unda moicavdes pirveladi <strong>samedicino</strong> dakvna?<br />

daskvnaSi unda iqnas miTiTebuli gamosakvlevi piris<br />

monacemebi;<br />

unda iqnas miTiTebuli Tu vis mier da sad tardeba<br />

pirveladi <strong>samedicino</strong> Semowmeba;<br />

SeZlebisdagvarad unda iqnas aRwerili oTaxi, ganaTeba<br />

da sxva sayuradRebo detalebi, sadac tardeba gamokvleva;<br />

aucileblad unda iqnas miTiTebuli Tu vin eswreba<br />

gamokvlevas;<br />

arsebobs Tu ara raime saxis zewola an SezRudva<br />

pirveladi <strong>samedicino</strong> Semowmebis Catarebisas;<br />

dakvna unda moicavdes fizikuri da fsiqikuri klinikuri<br />

gasinjvis monacemebs ;<br />

detalurad unda iqnas aRwerili yoveli dazianeba, rac<br />

sxeulis garegnuli daTavlierebiT vlindeba, maTi feri,<br />

formebi, zomebi, aseve palpatoruli gasinjvis monacemebi,<br />

mtkivneuloba da a.S.<br />

aseve detalurad klinikuri gasinjvisas unda iqnas<br />

aRwerili Sinagani organoebis mdgomareoba;<br />

unda aRiweros fsiqikuri statusi;<br />

aseve nevrologiuri statusi;<br />

aucilebelia aRiweros gamosakvlevi piris Civilebi misi<br />

janmrTelobis mdgomareobis Sesaxeb da detaluri<br />

komentarebi yovelgvar xilul Tu uxilav darRvevasTan<br />

dakavSirebiT;<br />

aucilebelia gakeTebul iqnas <strong>samedicino</strong> daskvna<br />

savaraudo an sindromuli diagnozis miTiTebiT;<br />

da Sesabamisi rekomendaciebiT: Tu ra saxis specialistTa<br />

konsultaciebia saWiro, ra saxis gamokvlevebia saWiro da<br />

ra saxis pirveladi daxmareba an Semdgomi daxmareba<br />

aris mizanSewonili;<br />

amgvari daskvna unda moicavdes specialur<br />

rekomendaciebsac, magaliTad gansakuTrebuli yuradRebis<br />

Sesaxeb suicidaluri tendenciebis gamovlenis<br />

SemTxvevaSi;<br />

daskvna aseve unda moicavdes pirveladi daxmarebis<br />

RonisZiebebsac, Tuki amgvari Cautarda gamosakvlev pirs;<br />

aucielebelia amgvari daskvna gaecnos TviTon<br />

gamosakvlev pirs an mis warmomad<strong>ge</strong>nels da<br />

dafiqsirebul iqnas maTi komentarebic;<br />

49

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daskvnas aucileblad xels unda awerdes gamokvlevis<br />

Camtarebeli eqimi da unda iqnas dafiqsirebuli<br />

gamokvlevis TariRi da dro;<br />

aucileblobisa da saWiroebis SemTxvevaSi cixis eqims<br />

unda hqondes saSuleba gamoiZaxos sxva specialobis eqimi<br />

– konsultanti an moiTxovos saswrafod raime saxis<br />

gamokvleva, an gamosakvlevi pirisaTvis stacionaruli<br />

mkurnaloba, an sxva saxis gadaudebeli daxmareba;<br />

aseve, gamosakvlevi piris Tanxmobis SemTxvevaSi,<br />

<strong>samedicino</strong> eqspertizis Catareba qveynis kanonmdeblobis<br />

gaTvaliswinebiT.<br />

aseve aucilebelia moxdes yovelgvari dazianebis<br />

fotografireba da SesaZloa diqtofonze gakeTdes audio<br />

Canaweri (gamosakvlevi piris Tanxmobis SemTxvevaSi).<br />

aqve unda aRiniSnos, rom specialurad <strong>samedicino</strong> eqspertizisaTvis<br />

mowodebulia “stambolis protokolis” principebi, romlis mixedviTac<br />

standartuli gamokvlevis sqema Semdegia:<br />

“ danarTi IV<br />

<strong>wamebis</strong>a da sastiki mopyrobis mimarT <strong>samedicino</strong> eqspertizis Catarebis<br />

saxelmZRvanelo principebi<br />

qvemoT moyvanili saxelmZRvanelo principebi <strong>wamebis</strong>a da sastiki, araadamianuri<br />

an adamianis Rirsebis Semlaxavi mopyrobisa da dasjis efeqtiani gamokvlevisa da<br />

dokumentirebis principebis saxelmZRvanelos efuZneba (stambulis oqmi). es<br />

principebi uryev miTiTebas ar niSnavs da maTi gamoyeneba, eqspertizis miznebidan<br />

gamomdinare, arsebuli saSualebebis Sefasebis Semdegaa SesaZlebeli. <strong>wamebis</strong>a da<br />

sastiki mopyrobis fizikuri da fsiqologiuri mkicebulebebis <strong>eqspertiza</strong> SeiZleba<br />

Caataros, maTi kvalifikaciidan gamomdinare, erTma an ramdenime eqimma.<br />

I. informacia gamosakvlev SemTxvevaze<br />

gamokvlevis TariRi: ________ Catarebulia moTxovniT (gvari/Tanamdeboba): _________<br />

avadmyofobis istoria/angariSi #: ______ gamokvlevis xangrZlivoba ____ sT. __ wT.__<br />

gamosakvlevis saxeli: _________ dabadebis TariRi: _______ dabadebis adgili: ______<br />

gamosakvlevis gvari: ________________________________-_______ sqesi: mamr./mdedr.<br />

gamokvlevis Catarebis mizani: ________________________________________________<br />

gamosakvlevis saidentifikacio # (ИН): ________________________________________<br />

eqimis gvari: ___________________ Tarjimnis monawileobiT (diax/ara), gvari: ______<br />

warmod<strong>ge</strong>nili informaciis safuZvelze Tanxmoba miRebulia: diax/ara _______________<br />

Tu ar aris miRebuli, ra mizeziT? _____________________________________________<br />

gamosakvlevs Tan axlavs (gvari/Tanamdeboba): ___________________________________<br />

<strong>eqspertiza</strong>ze damswre pirebi (gvari/Tanamdeboba): ________________________________<br />

gamokvlevis dros dasakiTxi piri imobilizebuli iyo: diax/ara; Tu “diax”, maSin ra<br />

saxiT/ra mizeziT? ___________________________________________________________<br />

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<strong>samedicino</strong> daskvna gagzavnilia (gvari/Tanamdeboba/ ИН): __________________________<br />

gagzavnis TariRi: ___________________ gagzavnis dro: __________________________<br />

<strong>samedicino</strong> <strong>eqspertiza</strong>/gamokvleva SezRudvebis gareSea Catarebuli (patimrebis mimarT):<br />

diax/ara __________________________________________________________________<br />

aRwereT dawvrilebiT nebismieri SezRudva: _____________________________________<br />

II. eqimis kvalifikacia (sasamarTloze CvenebisaTvis)<br />

<strong>samedicino</strong> ganaTleba da klinikuri momzadeba<br />

fsiqologiuri/fsiqiatriuli momzadeba<br />

<strong>wamebis</strong>a da sastiki mopyrobis mtkicebulebebis dokumentirebis gamocdileba<br />

regionSi adamianis uflebebis dacvis sferoSi mocemul gamokvlevasTan<br />

dakavSirebuli specialobis codna da gamocdileba<br />

publikaciis kvlevasTan dakavSirebuli sajaro gamosvlebi da profesiuli<br />

momzadebis kursebi<br />

mokle biografia<br />

III. gancxadeba Cvenebebis utyuarobis Sesaxeb (sasamarTloze CvenebisaTvis)<br />

magaliTad: “piradad CemTvis qvemoT moyvanili faqtebi nacnobia, da vTvli<br />

sarwmunod im informaciis garda, romlis sisworis Sesaxebac aq varaudi<br />

gamoiTqva. CemTvis nacnobi da sarwmuno informaciidan gamomdinare, mzad var<br />

davamowmo zemoT naTqvami”.<br />

IV. sawyisi informacia<br />

saerTo monacemebi (asaki, saqmianobis saxe, ganaTleba, ojaxis Semad<strong>ge</strong>nloba da a.S.)<br />

wamZRvarebuli <strong>samedicino</strong> anamnezi<br />

<strong>wamebis</strong>a da sastiki mopyrobis wina<strong>samedicino</strong> eqspertizis ganxilva<br />

fsiqosocialuri anamnezi dapatimrebamde<br />

(i) gancxadeba <strong>wamebis</strong>a da sastiki mopyrobis Sesaxeb<br />

1. dakavebisa da sastiki mopyrobis mokle aRwera<br />

2. dakavebisa da dapatimrebis garemoebebi<br />

3. patimrobis Tavdapirveli da momdevno adgilebi (TariRebi,<br />

transportirebisa da cxovrebis pirobebi)<br />

4. sastiki mopyrobisa da <strong>wamebis</strong> Sesaxeb Tavisufali Txroba (cixeSi yofnis<br />

yvela adgilze)<br />

5. <strong>wamebis</strong> meTodebis ganxilva<br />

(ii) fizikuri simptomebi da Sromisunarianobis moSla<br />

aRwereT mwvave da qronikuli simptomebisa da Sromisunarianobis moSlis<br />

ganviTarebisa da gamojanmrTelebis momdevno procesebi.<br />

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1. mwvave simptomebi da Sromisunarianobis moSla<br />

2. qronikuli simptomebi da Sromisunarianobis moSla<br />

(iii) fizikuri gamokvleva<br />

1. saerTo garegnuli ieri<br />

2. kanis safari<br />

3. saxe da Tavi<br />

4. Tvalebi, yurebi, cxviri da yeli<br />

5. piris Rru da kbilebi<br />

6. gulmkerdi da muceli (sasicocxlo mniSvnelobis funqciebis maCveneblebis<br />

CaTvliT)<br />

7. Sard-sasqeso sistema<br />

8. Zvlovan-kunTovani sistema<br />

9. centraluri da periferiuli nervuli sistemebi<br />

(iv) fsiqologiuri anamnezi/gamokvleva<br />

1. Sefasebis meTodebi<br />

2. fsiqologiuri xasiaTis Civilebi gamokvlevis dros<br />

3. anamnezi <strong>wamebis</strong> Semdeg<br />

4. anamnezi wamebamde<br />

5. Tavdapirveli fsiqologiuri/fsiqiatriuli anamnezi<br />

6. alkoholisa da narkotikebis xmarebisa da maTi borotad gamoyenebis<br />

anamnezi<br />

7. fsiqikuri mdgomareobis gamokvlevis <strong>Sede<strong>ge</strong>bi</strong><br />

8. socialuri funqcionirebis Sefaseba<br />

9. fsiqologiuri testireba (Cvenebebi da SezRudvebi ix. nawili VI. C 1)<br />

10. neirofsiqologiuri testireba (Cvenebebi da SezRudvebi ix. nawili VI. C 4)<br />

(v) fotosuraTebi<br />

(vi) diagnostikuri gamokvlevis <strong>Sede<strong>ge</strong>bi</strong> (Cvenebebi da SezRudvebi ix. danarTi<br />

II)<br />

(vii) konsultaciebi<br />

(viii) mocemuli gamokvlevis intergretacia<br />

1. fizikuri monacemebi<br />

a) daadgineT mwvave da qronikuli simptomebisa da Sromisunarianobis<br />

moSlisa da sastiki mopyrobis Sesaxeb gancxadebebis Sesabamisobis<br />

xarisxi.<br />

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) daadgineT fizikuri gamokvlevebis monacemebisa da sastiki<br />

mopyrobis Sesaxeb gancxadebebis Sesabamisobis xarisxi (SeniSvna:<br />

fizikuri monacemebis ararseboba ar gamoricxavs wamebasa da sastik<br />

mopyrobas).<br />

c) daadgineT pacientis gamokvlevis <strong>Sede<strong>ge</strong>bi</strong>sa da konkretul regionSi<br />

<strong>wamebis</strong> meTodebsa da maT momdevno Sede<strong>ge</strong>bs Soris Sesabamisobis<br />

xarisxi.<br />

2. fsiqologiuri monacemebi<br />

a) daadgineT fsiqologiuri gamokvlevis <strong>Sede<strong>ge</strong>bi</strong>sa da viTomda <strong>wamebis</strong><br />

Sesaxeb cnobis Sesabamisobis xarisxi.<br />

b) SeafaseT, eqstremaluri stresis dros tipur an mosalodnel<br />

reaqciad miRebuli fsiqologiuri monacemebi aris Tu ara<br />

gamosakvlevi piris kulturuli da socialuri wris konteqstSi.<br />

c) miuTiTeT gamosakvlevi piris faqtobrivi mdgomareoba fsiqikuri<br />

moSlilobis dinamikis mimarT, romelic dakavSirebulia travmasTan,<br />

anu gamokvlevis momenti drois mixedviT ra TanafardobaSia <strong>wamebis</strong><br />

momentTan da gamojansaRebis ra etapze imyofeba gamosakvlevi.<br />

d) daadgineT paralelurad arsebuli stresis faqtorebis zemoqmedeba<br />

gamosakvlev pirze (magaliTad, gaxangrZlivebuli devna, iZulebiTi<br />

migracia, gasaxleba, ojaxis dakargva, socialuri rolis dakargva da<br />

a.S.).<br />

e) miuTiTeT fizikuri mdgomareobis aspeqtebze, romelic SesaZlebelia<br />

aisaxos klinikur suraTze da romelic gansakuTrebulad aris<br />

dakavSirebuli <strong>wamebis</strong> an patimrobis periodSi miRebuli Tavis<br />

travmis SesaZlebel monacemebTan.<br />

(ix) daskvnebi da rekomendaciebi<br />

1. mogveciT daskvna yvela zemoT dasaxelebuli wyaroebis monacemebis<br />

Sesabamisobis Sesaxeb.<br />

2. daamowmeT simptomebi da Sromisunarianobis moSla, romelic savaraudo,<br />

sastiki mopyrobis Sedegad, gamosakvlev pirTan kvlav SeiniSneba.<br />

3. rekomendaciebSi CarTeT gamosakvlevi piris Semdgomi <strong>eqspertiza</strong> da<br />

mkurnaloba.<br />

(x) gancxadeba simarTlis Cvenebis Sesaxeb (sasamarTloze CvenebisaTvis)<br />

magaliTad: “vici ra, crumowmeobis pasuxism<strong>ge</strong>blobis Sesaxeb kanonis Tanaxmad<br />

______ (qveyana) vacxadeb, rom zemoT naTqvami simarTles Seesabameba da zustia da<br />

rom warmod<strong>ge</strong>nili Cveneba ficis qveS iyo micemuli ____ (TariRi) ____ (qalaqi)<br />

_____ (Stati an olqi)”.<br />

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(xi) gancxadeba <strong>samedicino</strong> <strong>eqspertiza</strong>/gamokvlevis Catarebis dros arsebuli<br />

SezRudvebis Sesaxeb (patimrobaSi myof pirTaTvis)<br />

magaliTad: “qvemore xelis momweri eqimebi amowmeben, rom hqondaT Tavisufali da<br />

damoukidebeli moqmedebis saSualeba, SeeZloT esaubraT (gamosakvlevTan) da<br />

gaesinjaT yovelgvari SezRudvebis gareSe daxurul kars miRma da sapatimro<br />

dawesebulebis Tanamdebobis pirTa mxridan araviTari formis iZuleba ar<br />

hqondaT”, an “qvemore xelis momweri eqimi iZulebuli var <strong>eqspertiza</strong> Cavataro<br />

Semdegi SezRudvebiT”.<br />

(xii) eqimis xelis mowera, TariRi, adgili<br />

(xiii) Sesabamisi danarTi<br />

eqimis namsaxurobis nusxis asli, anatomiuri ilustraciebi <strong>wamebis</strong>a da sastiki<br />

mopyrobis dokumentirebisaTis, fotosuraTebi, konsultaciisa da diagnostikuri<br />

gamokvlevebis <strong>Sede<strong>ge</strong>bi</strong> da a.S. « (stambolis protololi, 2001) «<br />

damatebiTi informaciis miReba SesaZlebelia adamianis uflebaTa dacvis gaerTianebuli erebis<br />

organizaciis umaRlesi komisris sammarTvelodan, erebis sasaxle, 1211 Jeneva 10, Sveicaria<br />

tel.: (+41-22) 917 90 00 faqsi: ((+41-22) 917 02 12<br />

E-mail: webadmin.hchr@unog.ch interneti: www.unhchr.ch<br />

"<br />

Tavi V. mkurnaloba da reabilitacia<br />

rogorc zemoT iqna moyvanili da aRniSnuli, <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong><br />

gamoirCeva polimorfulobiTa da mravalferovnebiT da moicavs, rogorc<br />

fsiqikur/fsiqologiur, aseve somatur-nevrologiur komponentebsac. aqedan<br />

gamomdinare iseve rogorc <strong>diagnostika</strong>, mkurnaloba da reabilitaciac unda<br />

emyarebodes multidisciplinarul midgomas da gadamwyveti mniSvneloba<br />

unda eniWebodes <strong>wamebis</strong> msxverplis kompleqsur mkurnalobasa da<br />

reabilitacias.<br />

metad mniSvnelovania multidisciplinaruli reabilitaciisaTvis<br />

calkeuli SemTxvevis marTva – menejmenti. swori menejmentis warmoebas<br />

gadamwyveti mniSvneloba eniWeba xarjTefeqturi da zogadad efeqturi<br />

mkurnalobisa da reabilitaciisaTvis. SemTxvevis menejmenti gulisxmobs<br />

calkeuli klientis saWiroebebze orientirebuli RonisZiebebis da<strong>ge</strong>gmvasa<br />

da ganxorcielebas specialistTa multidisciplinaruli gundis mier.<br />

SemTxvevis marTva warmoad<strong>ge</strong>ns process an meTods, romlis<br />

saSualebiTac uzrunvelyofilia klientisaTvis saWiro servisebis<br />

koordinirebuli, efeqturi da racionaluri gziT miwodeba.<br />

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SemTxvevis marTva xorcieldeba sistemuri midgomis safuZvelze,<br />

klientis moTxovnilebebze orientirebuli servisebis integraciis<br />

(urTierTdakavSirebuli servisebis) miwodebiT<br />

sistemur operaciebs axasiaTebs: 1) Senatani (Semavali) monacemebi (Input); 2)<br />

gamtanunarianoba – gamoyenebis koeficienti (throughtput) 3) gamomavali<br />

monacemebi an/da produqti (output) 4) ukukavSiri (feed back)<br />

pirobiTad SeiZleba gamoiyos SemTxvevis marTvis, rogorc sistemis<br />

Semdegi ZiriTad funqciebi:<br />

Sefaseba – klientis saWiroebebis, moTxovnilebebis da<br />

individualuri resursebis Sefaseba.<br />

da<strong>ge</strong>gmva _ momsaxurebis srulyofili, kompleqsuri <strong>ge</strong>gmis SemuSaveba.<br />

miwodeba – <strong>ge</strong>gmiT gaTvaliswinebuli servisebis miwodeba.<br />

monitoringi – miwodebuli servisebis monitoringi da Sefaseba.<br />

evaluacia – momsaxurebis efeqturobis Sefaseba.<br />

<strong>wamebis</strong> msxverplTa reabilitaciisas gamoiyeneba klientze centrirebuli<br />

midgoma. egzistencialuri TvalTaxedvis gaTvaliswinebiT, upriania<br />

TviToeul SemTxvevaSi individualuri midgoma da individualuri<br />

reabilitaciisa da mkurnalobis <strong>ge</strong>gmis Sed<strong>ge</strong>na da ganxorcieleba.<br />

multiprofiluri diagnostikis Semdeg reabilitaciis <strong>ge</strong>gmas SemTxvevis<br />

marTvaSi monawile specialistebis gundi ad<strong>ge</strong>ns jgufuri konsultaciebis<br />

Sedegad. aRniSnuli <strong>ge</strong>gmis Sed<strong>ge</strong>naSi monawileobs klientic. aucilebelia<br />

miRebul iqnas misi informirebuli Tanxmoba gansaxorcielebel<br />

RonisZiebebze.<br />

wameba ara marto pirovnebaze aisaxeba, aramed aisaxeba fsiqo –<br />

socialur da <strong>samedicino</strong> problemebze mTlianad ojaxSi; amitomac<br />

aucilebelia, ra Tqma unda maTi TanxmobiT, reabilitaciis procesSi ojaxis<br />

wevrebis CarTva.<br />

reabilitacia gulisxmobs kompleqsur RonisZiebebs, romelnic Semdegia:<br />

(Tumca gansakuTrebiT SevniSnavT rom, klinentis saWiroebebis da<br />

moTxovnilebebis prioritetulobis mixedviT, ar eqvemdebareba<br />

limitirebas da SezRudvebs)<br />

<strong>samedicino</strong> momsaxureba, sxvadasxva saxis <strong>samedicino</strong> manipulaciebisa<br />

da medikamentozuri mkurnalobis gaTvaliswinebiT: <strong>samedicino</strong><br />

momsaxurebis saxeebi da medikamentozuri mkurnaloba ganisazRvreba<br />

im paTologiiT an paTologiaTa jgufiT, romelic gamovlenil iqna<br />

calkeul SemTxvevaSi; <strong>wamebis</strong> SemTxvevaSi xSiria Zval – saxsrovani<br />

paTologiebi, aseve nevrologiuri, stomatologiuri, ginekologiuri<br />

problemebi, aseve Sardsasqeso sistemis; gulsisxvlZarRvTa sistemisa<br />

da saWmlis momnelebeli sistemis mxriv paTologiebi; xSirad amgvari<br />

paTologiebi urTierTSerwymulia, aseT SemTxvevaSi mkurnalobisa da<br />

reabilitaciis <strong>ge</strong>gmis Sed<strong>ge</strong>naSi aucilebelia calkeuli<br />

specialistebis erToblivi monawileoba.<br />

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metad mniSvnelovani da xSirad reabilitaciis aucilebeli meTodia<br />

fizioTerapia da masaJi, romelic gansakuTrebiT Zval – saxsrovani<br />

da nevrologiuri paTologiebis dros aris aqtulauri.<br />

fsiqikuri/fsiqologiuri reabilitacia da mkurnaloba<br />

travmuli stresis sxvadasxva klinikuri gamovlinebebis dros<br />

mkurnalobaSi mniSvnelovan rols TamaSobs farmakoTerapia. rigi<br />

avtorebis azriT (F. Weil et al.), PTSD qronizaciis Tavidan acilebis mizniT,<br />

aucilebelia fsiqo-travmis Semdeg dauyovnebeli mkurnaloba. yvelaze<br />

efeqtur saSualebebad, gansakuTrebiT SfoTvis maRali xarisxis dros,<br />

miCneulia benzodiazepinis rigis preparatebi, rogoricaa<br />

qlordiazepoqsidi (libriumi), diazepami (valiumi), flurazepami (dalmani)<br />

da oqsazepami (seraqsi). es preparatebi iTvleba naklebad toqsiurad da ar<br />

iwveven damokidebulebis warmoqmnas. (Swon<strong>ge</strong>r A., Constantine L., BassuckE.,<br />

Shchoonover S., Shader R.). zogierTi avtori mizanSewonilad miiCnevs beta -<br />

adrenoblokatorebis gamoyenebas (propranoli, inderali, anaprilini),<br />

gansakuTrebiT im SemTxvevebSi, rodesac SfoTva da fsiqo-fiziologiuri<br />

stresuli aSlilobebi vlindeba pirvel rigSi periferiuli avtonomiuri<br />

simptomatikiT. (Kolb, Burris, et al). PTSD mkurnalobaSi warmatebiT<br />

gamoiyeneba tricikliuri antidepresantebi, gansakuTrebiT SfoTvisa da<br />

depresiuli komponentis mosaxsnelad. (amitriptilini, melipramini). umetesi<br />

mkvlevarebis azriT, tricikliuri antidepresantebi efeqturia momatebuli<br />

agznebadobis, akviatebuli gancdebisa da koSmarebis, disociaciuri<br />

epizodebis mosaxsneladac. preparatis saSualo dozaa 140 mg. dReSi, xolo<br />

mkurnalobis saSualo xangrZlivoba _ 8 kviridan 6 Tvemde. sxva monacemebiT<br />

upiratesoba eniWebaT maos inhibitorTa jgufis antidepresantebs, kerZod<br />

fenelzins. preparatis doza 75 mg. dan 45 mg. mde. meryeobs. Zlieri agznebis<br />

mosaxsnelad gamoiyeneba fenoTiazinis jgufis preparatebi qlorpromazini<br />

(aminazini, Torazini) da Tioridazini (melerili) mcire dozebiT. M. Wolf et<br />

al. did mniSvnelobas aniWeben antikonvulsant karbamazepins.<br />

PTSD mkurnalobis ZiriTad meTods warmoad<strong>ge</strong>ns fsiqoTerapia.<br />

gamoiyeneba individualuri, ojaxuri da jgufuri fsiqoTerapiis sxvadasxva<br />

meTodi.<br />

mwvave mdgomareobebis da PTSD qronizaciis profilaqtikis mizniT,<br />

umniSvnelovanesia sami klasikuri principi (Coleman, Butcher, Carson,<br />

Kentsmith). es principebia: gadaudebloba, daaxloeba da imedi. gadaudebloba<br />

gulisxmobs adreul <strong>diagnostika</strong>sa da mkurnalobas. daaxloeba moicavs<br />

Terapiis Catarebas saomari moqmedebebisa da masiuri katastrofebis<br />

zonasTan axlos; da bolos, imedi gulisxmobs « gamamxnevebel<br />

damokidebulebas », roca dazaralebuls STaegoneba momavlis rwmena.<br />

R. Grincer omisSemdgomi reaqciebis samkurnalod SemogvTavaza<br />

individualuri fsiqoTerapiis dros natriumis pentonalis gamoyeneba, rac<br />

xels uwyobs pirovnebis gaxsnas da ganapirobebs emociuri ganmuxtvisa da<br />

kaTarzisis swrafad miRwevas.<br />

eqstremalur situaciebSi, individualuri da jgufuri fsiqoTerapiis<br />

saxiT, warmatebiT gamoiyeneba travmaze orientirebuli neirolingvisturi<br />

programirebis meTodi, aseve hipnoTerapia, msubuqi transis mdgomareoba<br />

da STagoneba. farTo gavrceleba hpova Mitchel meTodma, rac gulisxmobs<br />

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travmirebulTagan homo<strong>ge</strong>nuri urTierTTanadgomis jgufebis Seqmnas<br />

emociuri ganmuxtvis mizniT. mocemul etapze mniSvnelovania<br />

dazaralebulTan srul ndobaze damyarebuli kontaqtis damyareba, romlis<br />

mizania stresTan dakavSirebuli emociebisagan gantvirTvisa da stresidan<br />

disociaciis miRweva, rac metad mniSvnelovania "ganmeorebadi gancdis"<br />

simptomTa mosaxsnelad da PTSD qronizaciis profilaqtikisaTvis. mocemul<br />

etapze aseve mnivnelovania socialuri Tanadgoma da daxmareba. //<br />

PTSD qronikuli mimdinareobisas individualuri fsiqoTerapiis<br />

saxeoba ZiriTadad damokidebulia fsiqoTerapevtis orientaciaze. farTod<br />

gamoiyeneba bihevioristuli (qceviTi) da kognitiuri (SemecnebiTi) Terapiis<br />

meTodebi. iseTi meTodebi, rogoricaa sistematiuri desensibilizacia da<br />

rekurentuli matravmirebeli mogonebebisaTvis azrovnebis damuxruWeba<br />

(Miller T. 1981).<br />

rigi avtorebis azriT, PTSD dros umTavresia, matravmirebeli<br />

movlenebis Sedegad aRmocenebuli intrafsiqikuri, Sinagani konfliqti, rac<br />

xSirad iwvevs faseulobaTa sistemis msxvrevasa da cxovrebiseuli krizisis<br />

SegrZnebas; ris gamoc aucileblad miiCneven, rom dazaralebulma<br />

gaacnobieros misi problemis Sinaarsi da <strong>ge</strong>nezi. am midgomis safuZvelze<br />

SemuSavebulia Terapiuli midgoma (Meichenbaum, Novaco, Everly, Girdano et<br />

al.), romelic 6 safexurisagan Sed<strong>ge</strong>ba: 1. stresuli reaqciebis Sesaxeb<br />

yvelaze xSirad gavrcelebuli warmod<strong>ge</strong>nebis koreqcia; 2. stresuli<br />

reaqciebis Sesaxeb, mis bunebaze pacientisaTvis informaciis miwodeba; 3.<br />

aSlilobis ganviTarebaSi gansakuTrebuli stresis rolze fokusireba; 4.<br />

pacientis miyvana stresuli reaqciebisa da misi simptomebis gamovlinebis<br />

damoukidebel Secnobamde; 5. pacientSi TviTanalizis unaris ganviTareba,<br />

misTvis niSandoblivi stresorebis identifikaciis mizniT; 6. klinicistis<br />

mier pacientisaTvis im mniSvnelovani rolis gansazRvra, romelsac es<br />

ukanaskneli asrulebs mniSvnelovani stresis TerapiaSi.<br />

rogorc cnobilia, PTSD qronikuli formebisaTvis erTerTi<br />

umTavresi komponentia adaptaciis darRveva, realobis sworad Sefasebis<br />

unaris daqveiTeba, aseve interpersonaluri urTierTobebis daRveva, rig<br />

SemTxvevaSi arakontrolirebadi agresiuloba da mrisxaneba, gaucxoeba,<br />

emociuri gamijnva. am darRvevaTa koreqciisaTvis aucilebelia<br />

interpersonalur urTierTobebze orientirebuli jgufuri fsiqoTerapiis<br />

gamoyeneba. jgufuri fsiqoTerapiis meTodi dReisaTvis iTvleba PTSD<br />

mkurnalobis wamyvan meTodad (William, Brende, Walker, Nash).<br />

jer kidev 70-iani wlebis dasawyisSi samecniero literaturaSi<br />

gamoCnda calkeuli rekomendaciebi jgufuri fsiqoTerapiis Casatareblad<br />

erTgvarovani jgufebis Seqmnis Sesaxeb (Archibald, Lomg, Miller), magram<br />

vietnamis omamde am meTodma ver hpova farTo gamoyeneba. 70-ian wlebSi<br />

Lifton, muSaobda ra vietnamis omis veteranebTan, Camoayaliba<br />

"urTierTga<strong>ge</strong>bis jgufebi". maTi saqmianobis gaanalizebiT igi mivida<br />

daskvnamde, rom jgufSi swrafad xdeba urTierTndobisa da<br />

SekavSirebulobis Camoyalibeba, ris Sedegadac viTardeba erTianoba<br />

cnebebisa "is, rasac vgrZnob me" da "is, rasac vgrZnobT Cven", magram<br />

amasTanave gamoxatulad ikveTeba mtruli ganwyoba maT mimarT, visac ar<br />

gaaCnia identuri travmuli gamocdileba, ris gamoc TvalsaCinoa jgufSi<br />

Caketvis tendencia. am faqtis gaTvaliswinebiT Parson mier SemuSavebul iqna<br />

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PTSD jgufuri fsiqoTerapiis samfaziani modeli. pirvel fazaSi iqmneba<br />

"urTierTga<strong>ge</strong>bis jgufebi" mxolod erTnairi darRvevebis mqone, identur<br />

mdgomareobaSi myofi pacientebisgan (veteranebi, ltolvilebi, Zaladobis<br />

msxverplni da a.S.). meore fazaSi jgufSi emateba aranakleb ori axali<br />

wevri araidenturi travmuli gamocdilebiTa da ramdenadme gansxvavebuli<br />

problemebiT. warmoqmnil jgufs ewodeba "fsiqoTerapiuli jgufi". axali<br />

wevrebis Seyvana xels uwyobs travmirebuli "me"-Ti yvelaze ufro metad<br />

dezorganizebul pacientebSi emociur afeTqebas, ris Sedegadac iwyeba<br />

jgufis wevrebSi gamaRizianebeli qcevebi, « Cven vgrZnobT cnebis Sesustebas<br />

da gaRizianebas da mrisxanebas "realobasTan" Sejaxebis gamo. Terapevtis<br />

xelmZRvanelobiT jgufis wevrebi swavloben TavianTi emociebis marTvasa<br />

da gancdaTa analizs ». amis Semdeg iwyeba mesame faza, anu "fsiqoanalizurad<br />

orientirebuli jgufi".<br />

Lindy, Green, Grace azriT, somatizaciisa da fsiqo-somatur simptomTa<br />

samkurnalod aucilebelia "pirovnebaze orientirebuli fokusuri fsiqoanalizis<br />

gamoyeneba. fokusuri fsiqoanalizi zogadad moicavs Semdeg fazebs:<br />

"gaxsnis fazas", romelic moicavs pacientsa da Terapevts Soris ndobis<br />

kontaqtis da Terapevtis mimarT rwmenis Camoyalibebas, travmis im<br />

detalebis gacnobas TerapevtisaTvis, rac wamyvan rols TamaSobs da<br />

mniSvnelovania da gantvirTvis miRwevas. meore, "Sualedur" fazaSi,<br />

Terapevti exmareba pacients identficireba moaxdinos da gamokveTos<br />

travmuli movlenis specifiuri konfiguraciis konturebi: « movlenis<br />

romeli sakvanZo detalebi agondeba mimdinared da romeli arsebobs<br />

gamudmebiT, myarad ». mesame, bolo fazaSi, Seqmnili wyvili muSaobs travmis<br />

gaazrebasa da pirovnebis mier sakuTari pirovnuli organizaciis<br />

gacnobierebaze da momavalisaTvis gamosadegi jansaRi azris SemuSavebaze.<br />

iugoslaviis omis Sedegad ltolvilTa Soris warmatebiT iyenebdnen<br />

"realobiT Terapiis" models, romelic SemuSavebulia Glasser mier. es<br />

meTodi mniSvnelobas aniWebs adamianis qcevas mimdinare momentSi da misi<br />

qcevis efeqturobas sasurveli miznebis misaRwevad. aqcenti keTdeba<br />

"arCevanze". Glasser mixedviT, Cveni qcevebi, gansakuTrebiT ki Cveni<br />

moRvaweobis saxeebi da fiqrebi xasiaTdeba arCeviTobiT. es meTodi<br />

SesaZloa gamoyenebul iqnas rogorc individualurad, aseve jgufurad da<br />

moicavs ramdenime etaps. pirveli etapi moicavs jgufis Serwymas,<br />

koncentrirebas jgufSi urTierTndobisa da megobruli atmosferos<br />

Sesaqmnelad. meore stadia warmoad<strong>ge</strong>ns individis mier sakuTari Sinagani<br />

samyaros gamokvlevas. mesame stadiaSi aqcenti keTdeba qcevaze mTlianobaSi.<br />

meoTxe stadiaSi fsiqoTerapevti exmareba pacients da<strong>ge</strong>gmos da SeimuSaos<br />

qcevis efeqturi formebi.<br />

gansakuTrebiT mniSvnelovania PTSD dazaralebulTa Soris ojaxuri<br />

fsiqoTerapiis gamoyeneba, radgan Zalian xSiria ojaxis wevrTa Soris<br />

urTierTobebSi cvlilebebi travmis Sedegad, aseve damaxasiaTebelia<br />

ojaxis wevrTa Soris gancdebiT urTierTinducireba, ris Sedegadac pirvel<br />

rigSi zaraldebian bavSvebi. ojaxuri fsiqoTerapia gulisxmobs<br />

fsiqoTerapiul muSaobas mTel ojaxTan, rogorc jgufTan. fsiqoTerapevti<br />

exmareba mis wevrebs aRmoaCinon Tavisi funqcionirebis axali<br />

SesaZleblobebi, rac mimarTulia ojaxis SigniT urTierTobebis<br />

gaumjobesebaze. mniSvnelovania, rom ojaxis yvela wevrma miaRwios emociur<br />

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gantvirTvas. igi orientirebulia ojaxis Sida urTierTobebsa da ojaxis<br />

urTierTobebze garemomcvel adamianebTan, samyarosTan.<br />

xSirad PTSD ganapirobebs urTierTobebis darRvevebs meuRleebsa da<br />

wyvilebs Soris, rac ganpirobebulia travmis SinaarsiT. aqedan gamomdinare<br />

mkurnalobisas didi yuradReba eTmoba wyvilebis Terapias, rac ZiriTadad<br />

fokusirebulia aratravmirebuli meuRlis mier damxmaris rolis sakuTar<br />

Tavze aRebaze, Tumca dazaralebulis gamojansaRebis Semdeg mosalodnelia<br />

damxmaris rolis dakargvasTan dakavSirebiT frustraciisa da depresiis<br />

gancdebi, ris gamoc fsiqoTerapevti exmareba wyvilebs axali rolebis<br />

gansazRvraSi, axali <strong>ge</strong>gmebis SemoSavebasa da miRwevaSi.<br />

ojaxuri da wyvilebis fsiqoTerapiis dros farTod gamoiyeneba<br />

"rolebiT Terapiis" meTodi.<br />

SeuZlebelia ar aRiniSnos travmuli stresis mkurnalobaSi<br />

egzistencialuri analizis roli, romelsac Viktor Frankl warmatebiT<br />

mimarTavda TviT sakoncentracio banakSic ki. es meTodi gansakuTrebiT<br />

efeqturia, vinaidan travmuli stresis dros xSirad vlindeba depresiuli<br />

simptomatika, adgili aqvs msoflmxedvelobis msxvrevasa da xSir<br />

SemTxvevaSi suicidur tendenciebs. egzistencialuri analizis meTodi<br />

damyarebulia faseulobaTa sami ZiriTadi sistemis: 1. SemoqmedebiTi<br />

faseulobani; 2. gancdis faseulobani; 3. damokidebulebis faseulobani,<br />

mixedviT cxovrebis sazrisis aRmoCenaze da am faseulobaTa sistemebis<br />

realizaciaze. aseve unda aRiniSnos, rom Viktor Frankl akviatebulobaTa<br />

mosaxsnelad warmatebiT iyenebda logoTerapiis paradoqsuli intenciis<br />

meTods.<br />

mniSvnelovania aRiniSnos, rom dReisaTvis ar arsebobs erTiani<br />

midgoma PTSD mkurnalobis sakiTxisadmi, an raime specifiuri mkurnaloba,<br />

ris gamoc PTSD mkurnaloba atarebs simptomur xasiaTs. fsiqoTerapiis<br />

meTodis da mkurnalobis taqtikis arCevisas aucilebelia pirovnebis<br />

individualuri Taviseburebebis, misi msoflmxedvelobis, faseulobaTa<br />

sistemis, ganviTarebis donis, aseve eTno-kulturuli Tu socio-kulturuli<br />

maxasiaTeblebis, asakis, sqesisa da fsiqotravmis xasiaTis gaTvaliswineba.<br />

fsiqologiur reabilitaciaSi mniSvnelovani roli eniWeba art-<br />

Terapias – rac sayuradReboa ori mimarTulebiT: 1) igi mniSvnelovan<br />

warmod<strong>ge</strong>nas gvaZlevs pirovnebis SigniT arsebul, dafarul<br />

konfliqtebsa da tendenciebze, aseve fsiqo–travmis pirovnebiseul<br />

warmod<strong>ge</strong>naze, 2) amave dros, dinamikaSi warmod<strong>ge</strong>nas gvaZlevs Tu<br />

rogor viTardeba zogadad reabilitacia, ra iqna miRweuli da ra<br />

rCeba sayuradRebod. amave dros art-Terapiis meTodi<br />

umniSvnelovanesia travmuli stresisagan emociuri ganmuxtvisaTvis;<br />

igi mniSvnelovan rols TamaSobs akviatebuli mogonebebisa da<br />

gancdebisagan Tavis daRwevis procesSi.<br />

socialuri reabilitacia da garemoSi daxmareba, iuridili<br />

konsultacia:<br />

<strong>wamebis</strong> msxverplTa reabilitaciis sakiTxebi moicavs mravalferovan<br />

kompleqsur RonisZiebebs, romelTa Sorisac erTerTi mniSvnelovani<br />

adgili uWiravs socialur reabilitacias, rac pirvel rigSi<br />

gulisxmobs socialur Tanadgomas. socialuri Tanadgoma moicavs<br />

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Semdeg komponentebs: 1. TviTdaxmarebis jgufebis organizacia<br />

dazaralebulTa Soris, bunebrivi lideris gamovleniT. aseTi<br />

jgufebis umTavresi amocanaa TanagrZnobisa da Tanadgomis<br />

atmosferos miRweva, emociuri urTierTkeTilsaimedo ganwyoba, rac<br />

mniSvnelovania emociuri ganmuxtvisa da Seqmnili rTuli<br />

mdgomareobidan Tavis daRwevisaTvis _ momavlis da<strong>ge</strong>gmva arsebuli<br />

realobis swori SefasebiT. 2. materialuri daxmarebis organizeba<br />

yvelaze ufro metad gaubedurebuli adamianebisaTvis. 3. dasaqmebisa<br />

da funqciebis ganawilebis organizeba. 4. sainformacio samsaxuris<br />

organizacia da urTierTobebis damyareba sxvadasxva organizaciebTan<br />

da struqturebTan, raTa moxdes dazaralebulTa informireba<br />

sakuTari uflebebisa da Tavisuflebebis Sesaxeb, aseve movaleobebis<br />

Sesaxeb, adgilobriv da saerTaSoriso sakanonmdeblo aqtebs, rac<br />

warmoad<strong>ge</strong>ns pirovnebis dacvis erT-erT umTavres pirobas. 5.<br />

bavSvebisa da mozardebis reabilitaciis sakiTxSi travmuli stresiT<br />

gamowveuli iseTi specifiuri problemebidan gamomdinare, rogoric<br />

aris yuradRebis koncentraciis unaris daqveiTeba, swavlaSi<br />

CamorCena, interpersonaluri urTierTobebis problemebi,<br />

mniSvnelovania specialuri programebis SemuSaveba, romlebic<br />

moicaven unarebis ganviTarebisa da aRmzrdelobiT-saganmanaTleblo<br />

jgufebis formirebas, kulturul-sportuli da samkurnaloprofilaqtikuri,<br />

Tu gamajansaRebeli RonisZiebebis SemuSavebas.<br />

gamomdinare <strong>wamebis</strong> situaciebis specifikidan aucilebelia garemoSi<br />

socialuri daxmarebis organizeba, raTa SeZlebisdagvarad daculi<br />

iqnas <strong>wamebis</strong> msxverplisa da misi ojaxis wevrTa usafrTxoeba,<br />

amgvari qmedebebi gulsixmobs fasilitatorul aqtivobas calkeul<br />

saxelmwifoebriv organoebTan, maT Soris Zalovani struqturebis<br />

warmomad<strong>ge</strong>nlebTan;<br />

reabilitaciis aucilebel komponents warmoad<strong>ge</strong>ns <strong>wamebis</strong><br />

msxverplis iuridiuli konsultireba, daxmareba sasamarTloebSi<br />

saqmis msvlelobisas; amave daxmarebis umniSvnelovanes <strong>samedicino</strong> –<br />

iuridiul komponents Sead<strong>ge</strong>ns <strong>wamebis</strong> msxverplisaTvis <strong>samedicino</strong><br />

daskvnis momzadeba da gacema; amgvari daskvnis gadacema<br />

sasamarTloebisa Tu prokuraturisaTvis, aseve <strong>wamebis</strong> msxverplis<br />

advokatisaTvis.<br />

amgvarad, reabilitaciisaTvis aucilebelia kompleqsuri midgoma, rac<br />

gulisxmobs janmrTelobis dacvisa da socialuri uzrunvelyofis<br />

organizaciebis, ganaTlebis sistemis, adgilobrivi Tu saerTaSoriso<br />

samarTaldamcavi da sakanonmdeblo institutebis, samTavrobo da<br />

arasamTavrobo saerTaSoriso Tu adgilobrivi struqturebis aqtiur<br />

koordinirebul Cabmas reabilitaciis procesSi.<br />

samkurnalo-profilaqtikuri da reabilitaciuri RonisZiebebis<br />

efeqturad ganxorcielebisaTvis aucilebelia kvalificiuri daxmarebis<br />

samsaxuris organizacia.<br />

aseTi samsaxuris umTavres rgols warmoad<strong>ge</strong>ns eqstremaluri<br />

daxmarebis jgufebis Seqmna, romelic yalibdeba Semdegi specialistebisagan:<br />

zogadi profilis eqimebi, fsiqiatrebi, fsiqolo<strong>ge</strong>bi, <strong>samedicino</strong> debi,<br />

60

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socialuri muSakebi. isini gadaudebel daxmarebas aRmouCenen<br />

dazaralebulebs krizisul situaciebSi (magaliTad cixeebSi). aseTi jgufebis<br />

mTavari amocanaa: swori da swrafi diagnostireba, gadaudebeli daxmarebis<br />

aRmoCena da dazaralebulTa Semdgomi ganawileba klinikur-dinamiuri<br />

gamovlinebebis gaTvaliswinebiT.<br />

Semdgom rgols warmoad<strong>ge</strong>ns specialuri programebis SemuSaveba<br />

kvalificiuri <strong>samedicino</strong> da fsiqo–socialuri reabilitaciis aRmosaCenad<br />

da moicavs ambulatorul da stacionarul daxmarebasa da mkurnalobas.<br />

amgvari programebis gansaxorcieleblad aucilebelia specialstebis<br />

momzadeba, vinaidan <strong>wamebis</strong> dros xSirad adgili aqvs fsiqikuri da fizikuri<br />

travmebis Serwymas, aseve fsiqo-somatur darRvevebs, mniSvnelovania<br />

sxvadasxva profilis specialistTa gaTviTcnobiereba travmuli stressa da<br />

mis mier gamowveul darRvevebis sakiTxebSi.<br />

xSir SemTxvevaSi wamebiT gamomwveuli ubedurebebis polimorfuli<br />

xasiaTidan gamomdinare mniSvnelovania araspecifiuri daxmarebis<br />

aRmosaCenad moxaliseTa CarTva reabilitaciur RonisZiebebSi; amisaTvis<br />

aucilebelia maTi gaTviTcnobiereba travmuli stresisa da masTan<br />

dakavSirebuli fsiqikuri Tu fizikuri problemebis Sesaxeb.<br />

kompleqsuri midgomis aucilebelobis gaTvaliswinebiT,<br />

mniSvnelovania specialistebis mier im organizaciebisa da struqturebis<br />

informireba, romelnic imyofebian mWidro kavSirSi dazaralebulebTan.<br />

eseni SesaZloa iyvnen: pedago<strong>ge</strong>bi, aRmzrdelebi, masobrivi sainformacio<br />

saSualebebis warmomad<strong>ge</strong>nelni, sazogadoebisa da oficialuri<br />

struqturebis warmomad<strong>ge</strong>nelni da sxvani; yovelive es aucilebelia, raTa<br />

SemuSavdes swori midgoma dazaralebulTa problemebisadmi, mimdinare<br />

stresuli situaciebis Semcirebis mizniT.<br />

<strong>wamebis</strong> msxverplTa reabilitaciaSi mniSvnelovani roli eniWeba<br />

<strong>wamebis</strong> prevenciuli RonisZiebebis SemuSavebasac, vinaidan zogadad<br />

qveyanaSi <strong>wamebis</strong> prevenciaze yuradRebis gamaxvileba da saTanado klimatis<br />

Seqmna aadvilebs <strong>wamebis</strong> msxverplTaTvis usafrTxo garemos Seqmnas da<br />

aseve aadvilebs samarTlebrivi Sefasebebis miRwevas, rac Tavis mxriv<br />

mniSvnelovani komponentia <strong>wamebis</strong> msxverplis sruli reabilitaciisaTvis.<br />

multtidisciplinaruli jgufi, romelic aris aucilebeli reabilitaciis<br />

gansaxorcieleblad :<br />

zogadi profilis eqimi (Terapevti)<br />

eqimi-fsiqiatri<br />

nevrologi<br />

travmatolgi<br />

fizioTerapevti<br />

fsiqoTerapevti<br />

art Terapevti<br />

fsiqologi<br />

socialuri muSaki<br />

eqTani<br />

61

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sxadasxva konsultantebi (ginekologi, narkologi, kardiologi,<br />

dermato–venerologi, otolaringologi, oftalmologi, qirurgi,<br />

pulmonologi da sxva saWiroebisda mixedviT).<br />

iuristi<br />

bavSvebTan muSaobisaTvis aucilebelia reabilitaciaSi CarTuli iqnan :<br />

bavSvTa fsiqiatri<br />

bavSvTa fsiqoTerapevti da fsiqologi<br />

pediatri<br />

pedagogi<br />

danarTi # 1:<br />

warmod<strong>ge</strong>nilia gamokvlevisa da reabilitaciis anketa, romelic<br />

SemuSavebulia centri « empaTia »s mier da asaxavs identifikaciis,<br />

monitoringisa da reabilitaciis yvela komponents:<br />

62

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danarTi #1<br />

<strong>wamebis</strong> msxverplTa monitoringisa da reabilitaciis <strong>samedicino</strong><br />

da fsiqo - socialuri programa<br />

I. anketuri monacemebi<br />

1. saxeli, gvari ____________________________________<br />

anonimurobis SemTxvevaSi gadadiT 2 punqtze.<br />

2. kodi _____________________________ G - XX - 000N<br />

3. gamokvlevis TariRi __________________________________<br />

4. sqesi ______________mdedr. / mamr.<br />

5. asaki _____________________________________________<br />

6. erovneba: ______________________________________________<br />

7. moqalaqeoba ____________________________________________<br />

8. amJamindeli adgilsamyofeli ________________________________<br />

9. mudmivi sacxovrebeli adgili _______________________________<br />

10. amJamindeli statusi ____10.1. devnili. 10.2. patimari. 10.3. yofili<br />

patimari. 10.4. sxva (miuTiTeT) ________________________________<br />

II. <strong>wamebis</strong> istoria<br />

1. <strong>wamebis</strong> msxvepli / 1.1. aris. 1.2. ara. 1.3. eswreboda naTesavebis an ojaxis<br />

wevrebis wamebas. 1.4. eswreboda sxvis wamebas.<br />

2. <strong>wamebis</strong> adgili / 2.1. policiis izolatori. 2..2. cixis izolatori. 2.3.<br />

uSiSroebis izolatori. 2.4. jaris izolatori. 2.5. samxedro konfliqtis<br />

zonaSi yofnisas. 2.6. sxa (miuTiTeT) __________________________<br />

3. <strong>wamebis</strong> TariRi da xangrZlivoba _______________________________<br />

4. <strong>wamebis</strong> intensivoba / 4.1. sistematiuri. 4.2. erTjeradi.<br />

5. vis mier iqna ganxorcielebuli / 5.1. policiis mxridan. 5.2. Zalovani sxva<br />

struqturis mxridan (romeli miuTiTeT) _____________ 5.3. erTi<br />

adamianis mier. 5.4. jgufis mier (jalaTebis jgufi Tu sxva miuTiTeT). __<br />

6. saxelmwifo moxelis davalebiT _______________________________<br />

7. sxva (miuTiTeT vis mier da ra viTarebaSi) ________________________<br />

8. eswreboda Tu ara eqimi an sxva <strong>samedicino</strong> personali _______________<br />

9. iRebda Tu ara monawileobas <strong>samedicino</strong> personali ________________<br />

10. <strong>wamebis</strong> mizani / 10.1. informaciis miReba. 10.2. danaSaulis aRiareba. 10.3.<br />

damatebiTi danaSaulis (an romelic ar Caudenia) aRiareba. 10.4. fulis<br />

gamoZalva. 10.5. pirovnuli damcireba. 10.6. pirovnebis damorCileba,<br />

daTrgunva. 10.7. ideologiuri Sexedulebebi. 10.8. aRmsarebloba. 10.9<br />

eTnikuri kuTvnileba 10.10. mwamebelTa sadisturi tendenciebi. 10.11. sxva<br />

(aRwereT) _____________<br />

damatebiTi informacia aRwereT<br />

1. fizikuri meTodebi<br />

III. gamoyenebuli meTodebi<br />

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1.1.<br />

1.2.<br />

cema ("dubinkebiT", CeqmebiT, iaraRis tariT, sxva blagvi<br />

sagniT, xeliT sxva) - gaxazeT romeli.<br />

a) sistematizirebuli<br />

b) arasistematizirebuli<br />

eleqtrodeniT wameba<br />

a) piris Rrudan<br />

b) sasqeso organoebidan (an mkerdi)<br />

g) kidurebidan (falan<strong>ge</strong>bi)<br />

1.3.<br />

d) sxva (miuTiTeT) --------------------------------------<br />

Camokideba<br />

1.4. arafiziologiuri mdebareoba<br />

1.5. seqsualuri wameba<br />

a) gaupatiureba<br />

b) gaSiSvleba<br />

g) iZulebiTi ananizmi<br />

d) iZulebiT monawileoba sxvis gaupatiurebaSi<br />

e) damamcirebeli pozis miReba<br />

ki ra<br />

1.6.<br />

v) sasqeso organoebis dazianeba<br />

z) sxva (miuTiTeT) -------------------------------------------------------<strong>samedicino</strong><br />

- stomatologiuri wameba (kbilebis daZroba<br />

da a.S.)<br />

1.7. moxrCoba (airwinaRi an wyalSi Cayuryumalaveba TaviT -<br />

aRniSneT romeli)<br />

1.8. farmakologiuri wameba (narkotikiT an sxva preparatiT<br />

- SeZlebisdagvarad miuTiTeT, an ar icis riTi)<br />

_______________________________________________<br />

1.9. daRis dasma (frCxilebis daZroba, falangis moWra,<br />

yuris moWra, Tvalis amoTxra, xorcebis aTla, sxva<br />

(miuTiTeT romeli an aRwereT sxva)<br />

1.10.<br />

_______________________________________________<br />

damwvroba (sigaretiT, cxeli SanTiT, gavarvarebul<br />

"reSotkaze" dakvra, sxva - miuTiTeT romeli an aRwereT<br />

sxva -----------------------------------------------------------------------------------<br />

1.11. cxovelebiT wameba (ZaRlebis miseva da a.S.)<br />

1.12. sxva (aRwereT) ------------------------------------------------------------------<br />

1.13. miuTiTeT damatebiTi informacia<br />

1.14. miuTiTeT, iqna Tu ara gamoyenebuli iseTi meTodebi, romelnic ar<br />

toveben fizikur kvals, romeli aRwereT<br />

2. fsiqologiuri meTodebi<br />

2.1. deprivacia, izolacia ki ara<br />

2.2. sibnele, Jangbadis nakleboba, sicive<br />

2.3. cxovelebi (mRrRnelebi), mwerebi izolatorSi.<br />

2.4. sanitaruli pirobebis uqonloba<br />

2.5. sakanSi a<strong>ge</strong>ntis arseboba<br />

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2.6. sxva <strong>wamebis</strong> msxverplebTan yofna<br />

2.7. sxvisi <strong>wamebis</strong> xmebis ga<strong>ge</strong>ba<br />

2.8. sxvis wamebaze daswreba<br />

2.9. megobris an ojaxis wevris wameba<br />

2.10. Zilisi deprivacia<br />

2.11. <strong>wamebis</strong> gaurkveveli molodini<br />

2.12. muqara: 1. gaupatiurebis. 2. ojaxis darbevis. 3. ojaxis<br />

wevris <strong>wamebis</strong>. (aRniSneT romeli an daamateT da<br />

aRwereT sxva -----------------------------------------------------------------<br />

2.13. sityvieri Seurachyofa, daSineba, damcireba<br />

2.14. cru sikvdiliT dasja<br />

2.15. sasmeli wylisa da sakvebis ar micema<br />

2.16. bunebrivi moTxovnilebebis dakmayofilebis SezRudva<br />

2.17. ararealuri arCevani (aRiareba, gacema, Sekvra muqaris<br />

qveS - miuTiTeT romeli an daamateT) ------------------------------<br />

2.18. <strong>samedicino</strong> daxmarebis uqonloba<br />

2.19. sxva (aRwereT) ------------------------------------------------------------------<br />

2.20. damatebiTi informacia aRwereT<br />

IV. mwvave <strong>Sede<strong>ge</strong>bi</strong><br />

1. fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

1.1. Tavis tvinis mwvave travma gonebis dakargviT ki ara<br />

1.2. Wriloba (Tavis areSi, saxisa da kisris areSi, mkerdis<br />

areSi, zurgis areSi, kidurebze sxva - miuTiTeT) -------------<br />

1.3. damwvroba (Tvais areSi, saxisa da kisris midamoSi,<br />

mkerdis areSi, zurgis areSi, kidurebze, falan<strong>ge</strong>bze,<br />

kanze Tu lorwovan garsze an sxva areSi miuTiTeT) -------<br />

-------------------------------------------------------------------------------------------<br />

------------------------------------------------------------------------------------------<br />

1.4. mwvave sisxldena (miuTiTeT saidan) ---------------------------------<br />

1.5. motexiloba (saxis Zvlebis, kidurebis, falan<strong>ge</strong>bis, sxva -<br />

miuTiTeT) -------------------------------------------------------------------------<br />

1.6. tkiviliT gamowveuli Soki<br />

1.7. gul - sisxlZarRvTa mwvave ukmarisoba (infarqti,<br />

stenokardia)<br />

1.8. sunTqvis ukmarisoba<br />

1.9. Tirkmlis mwvave ukmarisoba<br />

1.10. infeqciuri daavadeba<br />

1.11. sasqeso organoebis dazianeba<br />

1.12. nerv - kunTovani dazianeba (parezi, krunCxva, myesebis<br />

dazianeba) --------------------------------------------------------------------------<br />

1.13. daJeJiloba (miuTiTeT midamo) ----------------------------------------<br />

-------------------------------------------------------------------------------------------<br />

1.14. mxedvelobis dazianeba<br />

1.15. smenis aparatis dazianeba<br />

1.16. sxva (aRwereT) ------------------------------------------------------------------<br />

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1.17. miuTiTeT mwvave fazis xangrZlivoba<br />

2. fsiqikuri reaqciebi<br />

2.1.<br />

afeqtur - Sokuri reaqcia<br />

a) stuporozuli varianti (Sekaveba, garindebuli yofna<br />

erT pozaSi, umweobisa da sicarielis SegrZneba,<br />

Zilis darRveva - miuTiTeT da aRwereT ---------------------<br />

--------------------------------------------------------------------------------------<br />

--------------------------------------------------------------------------------------<br />

--------------------------------------------------------------------------------------<br />

b) mwvave agzneba (aJitaciiT, suiciduri aqtivobiT,<br />

parasuicidi, TviTdazianeba - mcdeloba Tu survili,<br />

Zilis darRveva, fsiqo - motoruli agzneba - aRwereT<br />

--------------------------------------------------------------------------------------<br />

--------------------------------------------------------------------------------------<br />

-------------------------<br />

g) cnobierebis Secvla (gabrueba, Seviwroeba, Secvla<br />

sxva - aRwereT -------------------------------------------------------------<br />

-------------------------------------------------------------------------------------<br />

-------------------------------------------------------------------------------------<br />

2.2. gamyaviT calke _ suicidis mcdeloba, suicidaluri<br />

azrebi, TviTdazianebis mcdeloba, TviTdazianebis faqti,<br />

TviTdazianebis azrebi - (aRniSneT romeli da aRwereT) -<br />

-------------------------------------------------------------------------------------------<br />

-------------------------------------------------------------------------------------------<br />

2.3. sxva (aRwereT gancdebi) ----------------------------------------------------<br />

-------------------------------------------------------------------------------------------<br />

-------------------------------------------------------------------------------------------<br />

-------------------------------------------------------------------------------------------<br />

-------------------------------------------------------------------------------------------<br />

--------------<br />

ki ara<br />

2.4. miuTiTeT mwvave fazis xangrZlivoba ---------------------------------------------------------<br />

V. <strong>samedicino</strong> daxmareba mwvave periodSi<br />

1.1. <strong>samedicino</strong> daxmareba aRmoeCina <strong>wamebis</strong>Tanave<br />

1.2. <strong>samedicino</strong> daxmareba aRmoeCina kvalis dafarvis mizniT<br />

1.3. <strong>samedicino</strong> daxmareba aRmoeCina im mizniT, rom SeeSindaT ar<br />

momkvdariyo<br />

1.4. <strong>samedicino</strong> daxmareba ar aRmoCenia<br />

1.5. arakvalificirebuli daxmareba aRmouCines sxva patimrebma an sxva<br />

adamianebma<br />

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1.6. iqna Tu ara gaformebuli <strong>samedicino</strong> dokumentaciaSi misi<br />

mdgomareobis Sesaxeb da Tu ris Sedegad ganviTarda aRniSnuli<br />

dazianeba<br />

1.7. patimrebis SemTxvevaSi: cixeze gadmoyvanis Semdeg inaxula Tu ara<br />

<strong>samedicino</strong> komisism da aRiwera Tu ara maTi mdgomareoba <strong>samedicino</strong><br />

dokumentaciaSi<br />

1.8. visgan Sed<strong>ge</strong>boda <strong>samedicino</strong> komisia, eswreboda Tu ara fsiqiatri<br />

1.9. ganacxada Tu ara vinmesTan, rom igi <strong>wamebis</strong> msxverplia<br />

1.10. Tu ganacxada visTan da ra reagireba mohyva Tu ar ganacxada, ra<br />

mizeziT ra saxis gamokvlevebi an mkurnaloba iqna Catarebuli da ra<br />

periodSi<br />

VI. <strong>wamebis</strong> qronikuli <strong>Sede<strong>ge</strong>bi</strong><br />

1. fizikuri <strong>Sede<strong>ge</strong>bi</strong><br />

1.1. aReniSneba Tu ara pacients Srami an nawiburi an sisxlnaJRenTi<br />

1.2. Tu aReniSneba, ra midamoSi<br />

saxe<br />

Tavis are<br />

kisris midamo<br />

mkerdi<br />

zurgi<br />

sasqeso organoebi<br />

piris Rru<br />

muceli<br />

kidurebi<br />

falan<strong>ge</strong>bi<br />

sxva<br />

1.3. aReniSneba Tu ara pacients motexilobis kvali (moZraobis SezRudva<br />

da a.S)<br />

1.4. Tu aReniSneba ra midamoSi<br />

saxis Zvlebi<br />

xerxemlis malebi<br />

kidurebi<br />

falan<strong>ge</strong>bi<br />

sxva<br />

1.5. aReniSneba Tu ara amputaciis kvali<br />

1.6. Tu aReniSneba ra midamoSi<br />

cxviri<br />

yuri<br />

TiTebi<br />

kidurebi<br />

kbilebi<br />

frCxilebi<br />

sasqeso organoebi<br />

sxva<br />

1.7. aReniSneba Tu ara pacients nevrologiuri darRvevebi<br />

1.8. Tu aReniSneba ra saxis<br />

67

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Tavis tkivili<br />

moZraobis SezRudva<br />

nevralgia<br />

parezi<br />

paresTezia, mgrZnobelobis daqveiTeba<br />

paTologiuri refleqsebi<br />

miuTiTeT ra midamoSi<br />

1.9. aReniSneba Tu ara qronikuli tkivilis sindromi<br />

1.10. Tu aReniSneba ra midamoSi<br />

saxis areSi<br />

kisris, zurgisa da Tavis midamo<br />

mkerdis areSi<br />

muclis areSi<br />

Tirkmelebis saproeqcio areSi<br />

sasqeso organoebis midamoSi<br />

mTels sxeulSi<br />

sxva<br />

1.11. tkivili mwvavdeba amindis cvlilebisas<br />

1.12. tkivili mwvavdeba sezonurad<br />

1.13. tkivili mwvavdeba travmasTan asocirebulad (travmis mogoneba,<br />

travmasTan dakavSirebuli TariRebi da a.S.)<br />

1.14. miuTiTeT sxva somaturi darRvevebi ganviTarebuli <strong>wamebis</strong> Semdeg<br />

gul - sisxlZarRvTa sistema<br />

sasunTqi sistema<br />

alergiuli daavadebebi<br />

infeqciuri daavadebebi<br />

simsivneebi<br />

saWmlis momnelebeli sistema<br />

Sard - sasqeso sistema<br />

mxedvelobis sistema<br />

yel - yur - cxviri<br />

endokrinuli sistema<br />

sxva<br />

1.15. mimarTa Tu ara <strong>samedicino</strong> daxmarebisaTvis vinmes<br />

1.16. Tu mimarTa an mimarTvis gareSe Cautarda Tu ara <strong>samedicino</strong><br />

daxmareba<br />

1.17. ra saxis <strong>samedicino</strong> daxmareba Cautarda (operacia, konservatoruli<br />

mkurnaloba Tu sxva)<br />

1.18. aris Tu ara asaxuli <strong>samedicino</strong> dokumentaciaSi sadme misis<br />

mdgomareoba<br />

1.19. Cautarda Tu ara obieqturi gamokvlevebi<br />

1.20. Tu Cautarda sad, rodis da ra saxis saWiroebs Tu ara damatebiT<br />

gamokvlevasa da mkurnalobas (operacias an sxva)<br />

2. fsiqo - somaturi darRvevebi<br />

2.1. arteriuli wnevis labiloba (hipertenzia, hipotonia)<br />

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2.2. tkivilebi gulis areSi<br />

2.3. haeris ukmarisoba periodulad<br />

2.4. menstrualuri ciklis darRveva<br />

2.5. naadrevi klimaqsi<br />

2.6. libidos daqveiTeba an sxva cvlileba<br />

2.7. wonaSi dakleba an momateba<br />

2.8. oflianoba<br />

2.9. hipersalivacia an piriqiT hiposalivacia (piris gaSroba)<br />

2.10. Zilis darRveva<br />

2.11. Tavbrusxveva, koordinaciis darRveva<br />

2.12. kunTovani daZabulobis SegrZneba<br />

2.13. smenis daqveiTeba, yurebSi Suili<br />

2.14. mxedvelobis daqveiTeba<br />

2.15. advilad daRla<br />

2.16. zogadi saerTo sisuste<br />

2.17. kankali<br />

2.18. cieb - cxeleba<br />

2.19. hiperhidrozi<br />

2.20. Sardis gamoyofis gaZliereba an Semcireba<br />

2.21. diarea an yabzoba<br />

2.22. sxva<br />

3. fsiqikuri simptomebi<br />

3.1. uZiloba da Ramis koSmarebi<br />

3.2. depresia<br />

3.3. agresia<br />

3.4. disforia<br />

3.5. emociuri labiloba<br />

3.6. SiSebi<br />

3.7. SfoTva<br />

3.8. daZabuloba<br />

3.9. moWarbebuli sifxizle<br />

3.10. yuradRebis koncentraciis unaris daqveiTeba<br />

3.11. mexsierebis daqveiTeba<br />

3.12. akviatebuli mogonebebi, warmod<strong>ge</strong>nebi<br />

3.13. afeqturi reaqciebi travmasTan asocirebuli situaciebisa da<br />

mogonebebis dros<br />

3.14. pirovnuli cvlilebebi (samyarosadmi mtruli ganwyoba, undobloba,<br />

kontaqtebis garTuleba, xmauris autanloba, martoobis survili,<br />

Caketiloba, TviTdazianebisaken midrekileba, suiciduri azrebi an qmedebebi,<br />

sircxvilis an sakuTari pirovnebisadmi pativiscemis dakargva, umweobis<br />

gancda, sxva) miuTiTeT da aRwereT<br />

3.15. gamoRviZebisas gancda, rom kvlev meordeba matravmirebeli movlena<br />

3.16. halucinaciuri gancdebi matravmirebeli movlenis asaxviT<br />

3.17.sxva<br />

69

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VII. damatebiTi travmebis istoria (es Tavi ivseba <strong>wamebis</strong> ar<br />

arsebobis SemTxvevaSic, an ojaxis wevris SemTxvevaSic)<br />

damatebiTi travmebi aRniSvna, komentari sad da rodis<br />

omis travmebi<br />

axloblebis daRupva<br />

ojaxis wevrebis<br />

daRupva<br />

saxlis<br />

mitoveba/dakargva<br />

ojaxis<br />

devna/Seviwroeba<br />

axloblis an ojaxis<br />

wevris gauCinareba<br />

mZime socialuri<br />

pirobebi migraciis<br />

Sedegad<br />

ucxo garemoSi<br />

moxvedra/migracia<br />

samsxuris<br />

dakargva/socialuri<br />

rolis dakargva<br />

ojaxis wevrebTan<br />

deprivacia<br />

daqvriveba, daobleba,<br />

Svilis daRupva<br />

patimroba, tyveoba<br />

izolacia, kontaqtebis<br />

SezRudva<br />

xSiri konfliqtebi<br />

ojaxSi<br />

<strong>samedicino</strong> daxmarebis<br />

nakleboba<br />

gadavsebul kameraSi<br />

yofna<br />

konfliqtebi<br />

cixeSi/kameraSi<br />

socialuri samsaxurebis<br />

uyuradReboba<br />

sxva<br />

VIII. Civilebi<br />

8.1 fizikuri/somaturi<br />

8.2. fsiqikuri<br />

8.3. socialuri/iuridiuli problemebi<br />

70

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IX. anamnezi<br />

(yvela daavadebis miTiTebiT, rac warsulSi hqonda gadatanili, miuTiTeT<br />

daavadebis an travmis dro, saxeoba da sxva detalebi; aseve unda<br />

miTiTebuli iyos vis mier aris mowodebuli anamnezi)<br />

X. obieqturi statusi pirveladi gasinjvisas<br />

10.1. somaturi statusi: P _________T/A __________T______________<br />

10.2. fsiqikuri statusi:<br />

10.3. aris Tu ara misi mdgomareoba asaxuli warsulSi arsebul <strong>samedicino</strong><br />

dokumentaciaSi sakmarisad (miuTiTeT dokumentebi da sakmarisi iyo Tu ara<br />

Catarebuli gamokvlevebi da mkurnaloba)<br />

XI. fsiqologiuri kvlevis <strong>Sede<strong>ge</strong>bi</strong><br />

mozrdilTaTvis<br />

1. harvardis travmis Sefasebis kiTxvari<br />

2. PTSD kiTxvarebi (Watson; Mississipi Civilian PTSD)<br />

3. hamiltonis depresiis kiTxvari<br />

4. bekis depresiis kiTxvari<br />

5. Sixanis SfoTvis Skala<br />

6. baas - darkis agresiis kiTxvari<br />

7. MMPI<br />

8. saWiroebis SemTxvevaSi sxva kiTxvarebi<br />

bavSvebSi<br />

1. PTSD<br />

2. xelis testi<br />

3. luSeris testi<br />

4. saWiroebis SemTxvevaSi sxva<br />

5.<br />

XII. pirveladi gamokvlevis daskvna da<br />

winaswari diagnozi<br />

daskvna:<br />

winaswari diagnozi:<br />

somaturi:<br />

fsiqologiuri/fsiqikuri<br />

XIII. rekomendaciebi<br />

1. fsiqoTerapia (individualuri, jgufuri, ojaxuri)<br />

2. arT Terapia<br />

3. socialuri Terapia<br />

71

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4. specialistTa konsultaciebi (miuTiTeT romeli)<br />

5. laboratoriuli da paraklinikuri gamokvlevebi (miuTiTeT romeli)<br />

6. damatebiT konsultaciaTa da gamokvlevaTa winaswari ganfaseba<br />

(lari/dolari)<br />

7. winaswari diagnostirebisa da konsultaciebis Catarebisas<br />

ganxoecielebuli vizitebis raodenoba:<br />

7.1. SemTxvevis marTveli (fsiqiatri/TerapevTi)<br />

7.2. Terapevti an fsiqiatri<br />

7.3. nevrologi<br />

7.4. travmatologi<br />

7.5. sxva miuTiTeT romeli<br />

7.6. socialuri muSaki<br />

7.7. eqTani<br />

xelmowera: SemTxvevis marTveli / /<br />

centris xelmZRvanelebi:<br />

XIV. Catarebul konsultaciaTa da gamokvlevaTa <strong>Sede<strong>ge</strong>bi</strong><br />

1. konsultaciaTa <strong>Sede<strong>ge</strong>bi</strong>: (CaakariT damatebiTi furceli)<br />

2. laboratoriul da paraklinikur gamokvlevaTa <strong>Sede<strong>ge</strong>bi</strong> (CaakariT<br />

daskvnebi)<br />

3. SemTxvevis marTvelis ganmeorebiTi konsultacia da SemTxvevaze<br />

momuSave jgufis daskvna (vin iRebda monawileobas da ra iqna wamyvani<br />

simptomebidan gamovlenili)<br />

XV. daskvna fsiqo - fizikuri mdgomareobis Sesaxeb<br />

XVI. saboloo diagnozi<br />

somaturi/nevrologiuri<br />

fsiqikur/fsiqologiuri<br />

XVII. daniSnuleba (saWiroebis SemTxvevaSi CaakariT damatebiTi<br />

furceli)<br />

1. farmakoTerapiuli mkurnaloba (CaakariT daniSnulebis /dinamikaSi)<br />

furceli<br />

2. ganmeorebiTi konsultaciebi (specialistTa miTiTebiT)<br />

3. fsiqoTerapia (individualuri, jgufuri, ojaxuri)<br />

72

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4. art Terapia<br />

5. socialuri Terapia<br />

6. gansazRvreT mkurnalobisa da reabilitaciis kursis xangrZlivoba<br />

TariRi: ____________________<br />

xelmowera: SemTxvevis marTveli / /<br />

centris xelmZRvanelebi:<br />

XVIII. mkurnaloba da reabilitacia<br />

1. SemTxvevis wamyvanis Canawerebi (saWiroebis SemTxvevaSi CaakariT<br />

damatebiTi furceli), aseve saWiroebis SemTxvevaSi CaakariT<br />

damatebiToi kvlevebisa da konsultaciebis <strong>Sede<strong>ge</strong>bi</strong>)<br />

1 viziti<br />

2 viziti<br />

3 viziti<br />

4 viziti<br />

5 viziti<br />

6 viziti<br />

7 viziti<br />

8 viziti<br />

2. fsiqoTerapiis sessiebis raodenoba da Canawerebi (CaakariT damatebiTi<br />

furceli)<br />

3. art Terapiis sesiebis raodenoba da Canawerebi (CaakariT damatebiTi<br />

furceli)<br />

4. socialuri Terapiis RonisZiebebi da Canawerebi (CaakariT damatebiTi<br />

furceli)<br />

5. fsiqologis konsultaciebi (raodenoba, CaakariT Canawerebi)<br />

6. iuridiuli konsultaciebi (raodenoba, CaakariT Canaweri)<br />

XIX. evaluacia (Sefaseba)<br />

XIX.1 ganmeorebiTi fsiqologiuri konsultacia<br />

mozrdilebSi<br />

1. PTSD (Watson)<br />

2. Beck Depression Inventory<br />

3. Mississipi Civilian PTSD:<br />

4. Baas – Durk Aggressive Test<br />

73

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5. Shikhan Anxiety Test<br />

6. Hamilton Depression Questionnaire<br />

7. MMPI<br />

8. Other --<br />

bavSvebSi<br />

1. PTSD<br />

2. Lusher Test<br />

3. Hand Test<br />

XIX.2. pacientis subieqturi Sefasebis kiTxvari (gTxovT CaakraT)<br />

XIX.3. SemTxvevis marTvelisa da SemTxvevaSi monawile jgufis<br />

wevrTa daskvna pacientis fsiqo – fizikur mdgomareobaze<br />

mkurnalobis Semdeg<br />

XX. Semdgomi rekomendaciebi<br />

Terapiuli<br />

fsiqologiuri<br />

socialuri/iuridiuli<br />

sxva (miuTiTeT ra saxis)<br />

TariRi: ____________________<br />

xelmowera: SemTxvevis marTveli / /<br />

centris xelmZRvanelebi: / /<br />

XXI. Catarebuli mkurnaloba da reabilitacia (epikrizi)<br />

SemTxveva:<br />

klientis kodi:<br />

Semosvlisa da gaweris TariRi:<br />

(sqesi, asaki, erovneba/moqalaqeoba, statusi)<br />

1. msxverplis personaluri istoria<br />

_ ra konteqstSi iyo nawamebi<br />

- vin uyo Cabmuli am wamebaSi<br />

- ra meTodebi iqna gamoyenebuli (fizikuri, fsiqologiuri)<br />

- <strong>wamebis</strong> <strong>Sede<strong>ge</strong>bi</strong> (fizikuri, fsiqikuri/fsiqologiuri)<br />

2. organizaciis mier gaweuli daxmareba<br />

- rogor moxvda am organizaciaSi<br />

- ra saxis daxmareba gaewia<br />

fsiqiatris konsultacia (ramdeni)<br />

74

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fsiqologis konsultacia (ramdeni)<br />

fsiqoTerapia (saxeoba, ramdeni sessia)<br />

socialuri Terapia (saxeoba – ra gaukeTda, sesiaTa raodenoba)<br />

Terapevtis konsultacia (ramdeni)<br />

travmatologis konsultacia<br />

nevrologis konsultacia<br />

farmakoTerapia<br />

Catarebuli gamokvlevebi<br />

damatebiTi sxva saxis konsultaciebi<br />

- SemTxvevis marTvis wevrebis (Tanamdebobebi)<br />

- sad Cautarda mkurnaloba (miuTiTeT dawesebulebebic sadac damatebiTi<br />

gamokvlevebi da konsultaciebis iqna Catarebuli)<br />

- Catarebuli RonisZiebebis saboloo ganfaseba (xelfasiani Statebis garda)<br />

lari/dolari/evro<br />

3. <strong>Sede<strong>ge</strong>bi</strong><br />

- ra <strong>Sede<strong>ge</strong>bi</strong> iqna miRweuli<br />

4. momavali daxmarebis <strong>ge</strong>gma<br />

- apirebs Tu ara Semdgomi daxmarebis gagreZelebas organizacia<br />

- ra saxis daxmareba aris rekomendirebuli da i<strong>ge</strong>gmeba<br />

- ra xangrZlivobis daxmarebaa rekomendirebuli<br />

- ra <strong>Sede<strong>ge</strong>bi</strong>a mosalodneli<br />

TariRi: ____________________<br />

xelmowera: SemTxvevis marTveli : / /<br />

centris xelmZRvanelebi: / /<br />

komentarebis furceli<br />

75

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79

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