2.shizofrenia da sxva fsiqozuri ashlilobani-protokoli · hematologia sisxlis saerto analizi sisxlis...

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Sizofrenia da sxva fsiqozuri

aSlilobani

klinikuri mdgomareobis marTvis saxelmwifo

standarti

(protokoli)

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Sizofrenia da sxva fsiqozuri aSlilobani

daavadebaTa jgufSi _ “Sizofrenia da sxva fsiqozuri aSlilobani”

gaerTianebuli aSlilobebi xasiaTdebian klinikur suraTSi fsiqozuri

simptomebis, rogorc daavadebis ganmsazRvreli niSnebis arsebobiT. jgufs

saerTo ganmarteba ar gaaCnia, vinaidan sxvadasxva aSlilobis gaerTianeba

moxda fsiqozuri simptomatikis xazgasmis safuZvelze.

I. Sizofrenia F20 (protokoli)

1. definicia

Sizofrenia warmoadgens ZiriTad fsiqiatriul daavadebas, romelsac

axasiaTebs azrovnebisa da aRqmis Zireuli darRvevebi Seusabamo emociuri

reagirebiTa da/an emociuri sferos gasadavebiT. xSirad pirovnebis yvelaze

piraduli, intimuri azrebi, grZnobebi da qmedebani subieqtis mier

ganicdeba, rogorc sxvebisTvis cnobili, gaxsnili da SesaZloa

ganuviTardes zemoqmedebis bodva. Sizofreniuli aSilobisas

halucinaciebi ZiriTadad smeniTia, romelic komentars ukeTeben individis

qcevebsa da azrebs. dabneulobis fonze, romelic fsiqozis erT-erT

ZiriTad adreul niSans wamoadgens, pacienti midis iseT myar

Sexedulebamde, rom TiTqosda yoveldRiur situaciebs misTvis

gansakuTrebuli mniSvneloba gaaCnia. amdenad, azrovnebis procesi irRveva,

xdeba abneuli, Sesabamisad, metyvelebac Znelad misawvdomi da gasagebia. am

dros guneb-ganwyoba cvalebadia, gamRizianeblobis elferiT, zogjer

bodviTi azrebi Seusabamo, arakongruentuli. aseve, SesaZloa ganviTardes

ambivalentoba da darRvevebi nebelobiTi sferos mxriv, inertulobis,

negativizmis an stuporis da katatoniuri simptomebis saxiT.

Sizofreniuli aSliloba SeiZleba daiwyos mwvaved, qcevis mniSvnelovani

aSlilobiT, an Semparavad, ucnauri, odiozuri ideebis da qcevis

darRvevebis TandaTanobiTi ganviTarebiT.

2. daavadebis kriteriumebi:

Sizofreniis diagnostikuri kriteriumebi ganisazRvreba klinikuri simptomebiT,

socialuri disfunqciiT, daavadebis xangrZlivobiT, sxva aSlilobebis da

mdgomareoebebis gamoricxviT. amasTan, aRsaniSanavia, rom mas ar gaaCnia klinikur-

laboratiriuli kriteriumebi.

Sizofreniis ZiriTad klinikur simptomebs wamoadgens:

1. eqo-azrebi, azrebis Cadeba an warTmeva, azrebis gadacema;

2. zemoqmedebis bodva (kontrolis/gakontrolebis), ideatoruli,

sensoruli da motoruli avtomatizmi, bodviT aRqmasTan erTad;

3. smeniTi halucinaciebi _ pacientis qcevis an azrebis

persistentulad makomentirebeli xmebi, an ori/an meti `dialogSi

myofi xma~; an sxva tipis xmebi, romelic pacients `esmis~ sxeulis

sxvadasxva nawilidan;

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4. sxvadasxva Sinaarsis persistentuli bodviTi ideebi, romelic eTno-

kulturulad savsebiT miuRebelia (mag, religiuri, politikuri an

msoflmxedvelobrivi Sexedulebebi);

5. nebismieri modalobis (intensivobis) halucinaciebi, romelTac Tan

axlavT erTeuli arasistematizirebuli, Camouyalibebuli bodviTi

ideebi, TvalsaCino afeqturi datvirTvis gareSe, an persistiuli

zeRirebulovani ideebi, romlebic yoveldRiurad aRmocendeba

kvireebis an Tveebis manZilze;

6. wyvetili azrovneba an araTanamimdevruli asociaciebi, ris Sedegad

viTardeba inkoherentuloba, araarsebiTi metyveleba da

neologizmebi;

7. katatoniuri qceva, agzneba, Sekaveba, cvilisebri moqniloba,

negativizmi an stupori.

8. e.w. negatiuri anu deficituri simptomebi, rogoricaa: apaTia,

metyvelebis raodenobrivi da Sinaarsobrivi gaRaribeba, emociuri

reagirebis daClungeba, gasadaveba an Seusabamoba,

arakongruentuloba, rasac Tan sdevs socialuri izolacia da

socialuri funqcionirebis daqveiTeba. mniSvnelovania imis aRniSvna,

rom es ar aris neirolefsiuri medikamentebis moqmedebis an

depresiis Sedegi;

9. pirovnebis qcevis mniSvnelovnad myari Secvla vlindeba interesebis

daqveiTeba-SezRudvaSi, miznebisa da samomavlo gegmebis

ararsebobaSi, ideebis deficitSi, autizaciaSi da socialur

izolaciaSi.

Sizofreniis diagnozi ismeba, roca klinikur suraTSi mkafiodaa gamoxatuli

Tundac erTi, pirveli oTxi simptomebidan, an Semdegi oTxi simptomebidan ori

mainc, sul mcire erTi Tvis manZilze. mdgomareoba, roca es simptomebi

(mkurnalobis miuxedavad) erT Tveze naklebi xnis manZilzea warmodgenili,

Tavdapirvelad unda diagnoscirdes, rogorc mwvave Sizofreniismagvari

fsiqozuri aSlilooba (F23.2). am diagnozis Sizofreniad Secvla unda moxdes,

Tuki simptomebi warmodgenili iqneba meti xnis manZilze (sul mcire erTi

Tve). zemoT CamoTvlili simptomebidan mecxre warmoadgens mxolod martivi

Sizofreniis (F20.6) diagnostikur kriteriums, romelic unda iyos gamoxatuli

aranakleb erTi wlis manZilze.

retrospeqtrulad SesaZlebelia prodromaluri fazis gamoyofa. am periodSi

SeiZleba iyos iseTi klinkuri simptomebi, rogoricaa generalizebuli SfoTva,

msubuqi xarisxiT gamoxatuli depresia da zeRirebulovani azrebiT mocva,

aseve qcevis darRvevebi, rac gamoixateba interesebis, socialuri aqtivobis

daqveiTebiT, interpersonaluri urTierTobebis SezRudviT da/an sakuTari

Tavis movlis gauaresebiT. aRniSnuli simtomebi ramdenime kviriT an zogjer

TveebiTac ki win uZRvis fsiqozuri simptomebis dawyebas. vinaidan rTulia

prodromuli araspecifikuri simptomebis dawyebis momentis dazustebiT

gansazRvra, erTTviani periodi moicavs sakuTriv mwvave fazis simptomebs.

Sizofreniis diagnozi ar ismeba, roca fsiqozis aqtiuri fazis simptomebTan

erTad aRmocendeba didi depresiuli, maniakaluri, an Sereuli epizodi, an

guneb-ganwyobis aSlilobis epizodebi, magram maTi saerTo xangrZlivoba

gacilebiT xanmoklea aqtiuri da rezidualuri periodebis xangrZlivobasTan

SedarebiT. rodesac Sizofreniis da guneb-ganwyobis aSlilobis simptomebi

erTdroulad viTardeba Sizoafeqturi aSlilobis (F25.-) diagnozi ismeba.

aseve ar ismeba Sizofreniis diagozi, roca adgili aqvs zogadsamedicino

problemiT gamowveul fsiqozur mdgomareobas, mag. tvinis organul dazianebas (F06.2), an aSlilobis ganviTareba dakavSirebulia fsiqoaqtiuri nivTierebebis

(an sxva saSualebebis) gamoyenebasTan (F10-F19).

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Sizofreniis mimdinareobis Tavisebureba ganisazRvreba 5-niSna kodiT:

F20.0 uwyveti F20.1 epizoduri, defeqtis progredientuli ganviTarebiT

F20.2 epizoduri, stabiluri defeqtiT

F20.3 epizoduri, rezidualuri simptomebis ararsebobiT

F20.4 arasruli remisiiT

F20.5 sruli remisiiT

F20.8 sxva araspecifiuri SemTxveva

F20.9 dauzustebeli mimdinareoba, an simptomebis dawyebidan xanmokle

droa gasuli.

Sizofreniis ZiriTadi tipebis diagnostikuri kriteriumebia:

1. F-20.0 paranoiduli wamoadgens Sizofreniis tips, romlis drosac:

A. adgili aqvs Tundac erT (an meti) bodviT azrebs an smeniT

(intensiuri) halucianciebs;

B. qvemoT moyvanilidan arc erTi ar aris wamyvani: dezorganizebuli

metyveleba, uxeSad dezorganizebuli an katatoniuri qceva,

Seusabamo afeqti an emociuri gasadaveba.

2. F-20.1 dezorganizebuli (anu hebefreniuli) wamoadgens Sizofreniis

tips, romlis drosac:

A. yvela qvemoCamoTvlili wamyvania:

(1) dezorganizebuli metyveleba,

(2) uxeSad dezorganizebuli qceva,

(3) Seusabamo afeqti an emociuri gasadaveba.

B. kriteriumebi ar Seesabameba katatoniur tips.

3. F-20.2 katatoniuri wamoadgens Sizofreniis tips, romlis drosac:

A. klinkur suraTSi dominirebs sul cota ori niSani qvemoT

CamoTvlilidan:

(1) motoruli Sekaveba, katalefsiuri (cvilisebri

moqniloba) an stuporozuli;

(2) motoruli agzneba (romelic ar aris garemo stimulze

pasuxi da aSkarad umiznoa);

(3) ukiduresi negativizmi (yvela saxis instruqciisadmi

umotivo rezistentoba an rigidul pozaSi darCena,

miuxedavad misi amoZravebis mcdelobisa);

(4) specifikuri nebelobiTi moZraobebi, gamoxatuli

garkveuli poziT (ucnauri arabunebrivi pozis miReba),

stereotipuli moZraobebiT, TvalsaCino manerulobiT an

JestikulciiT;

(5) eqolalia da eqopraqsia.

4. F-20.3 aradiferencirebuli tipis izofreniis dros gvxvdeba A kriteriumis simptomebi, romlebic ar akamyofilebs paranoiduli,

dezorganizebuli da katatoniuri tipis Sesabamis (A) kriteriums.

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Sizofreniis danarCeni tipebis diagnostikuri kriteriumebi aris Semdegi:

5. F-20.4 postSizofreniuli depresis diagnozi ismeba, Tuki:

a) bolo 12 Tvis manZilze saxeze iyo Sizofreniis simptomebi,

romelic akmayofilebda Sizofreniis ZiriTad kriteriumebs (ix.

Sizofreniis ZiriTadi diagnostikuri kriteriumebi), magram ara

amJamad;

b) kvlav saxezea zogierTi Sizofreniuli simptomi;

g) wina planzea pacientisaTvis distresuli depresiuli simptomebi,

romelic akmayofilebs depresiuli epizodis kriteriumebs (ix.

depresiuli epizodis diagnostikuri kriteriumi) da romelic

saxezea sul cota 2 kviris manZilze.

Tuki pacients saerTod aRar aReniSneba Sizofreniuli simptomebi, maSin

diagnostirdeba depresiuli epizodi; xolo im SemTxvevaSi, roca

Sizofreniuli simptomatika gaSlilia da dominirebs klinikur suraTSi,

daismeba Sizofreniis oTxi ZiriTadi tipidan erT-erTis diagnozi.

6. F-20.5 rezidualuri Sizofreniis diagnozi ismeba, Tuki:

A. warsulSi, garkveuli drois maZilze saxeze iyo Sizofreniis

ZiriTadi kriteriumebi, magram amJamad aRar aris.

B. sul cota oTxi mainc qvemoT CamoTvlili `negatiuri

simptomebidan~ saxeze iyo bolo 12 Tvis manZilze:

1) fsiqomotoruli Seneleba an energiis daqveiTeba;

2) garkveulwilad emociebis gasadaveba;

3) pasiuroba da iniciativis nakleboba;

4) metyvelebis raodenobrivi da/an Sinaarsobrivi gaRaribeba;

5) cudi araverbaluri komunikacia saxis gaxevebuli

gamometyvelebis, mzeriTi kontaqtis simciris, vokaluri

gamoxatvis unaris naklebobis an Jestikulaciisa da

gamomsaxvelobiT moZraobaTa siRaribis gamo;

6) socialuri qcevis, Tavis movlisa da higienis dacvis gauareseba.

7. F-20.6 martivi Sizofreniis diagnozi ismeba, Tuki:

A. sul cota erTi wlis manZilze nela, magram progresulad,

xdeba qvemoT CamoTvlili sami simptomis ganviTareba:

1) pirovnebis qcevis zogierTi aspeqtis mniSvnelovani da myari Secvla,

rac vlindeba survilebisa da interesebis dakargvaSi; cxovrebis azris

da miznis dakargvaSi; sakuTar TavSi CaZirvaSi da socialur

izolaciaSi.

2) `negatiuri simptomebis~ TandaTanobiTi aRmoceneba da gaRrmaveba,

rogoricaa TvalsaCino apaTia, metyvelebis raodenobrivi gaRaribeba,

aqtiurobis donis daqveiTeba, emociuri gasadaveba, pasiuroba,

iniciativis da araverbaluri komunikaciis daqveiTeba (saxis

gamometyvelebis gaxeveba, mzeriTi kontaqtis, vokaluri gamoxatvis

unaris, Jestikulaciisa da gamomsaxvelobiT moZraobebis gaRaribeba);

3) socialuri, akademiuri da profesiuli funqcionirebis TvalsaCino

gauareseba.

3. simptomebi da niSnebi (ix. zemoT diagnostikuri kriteriumebi)

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mwvave faza

4. diagnostikur-laboratoriuli testebi da specialistTa

konsultaciebi

1.

mkurnalobis miznebia:

1. fizikuri dazianebis prevencia;

2. dezorganizebuli qcevis marTva;

3. fsiqozuri simptomebis simZimis (xarixis) Semcireba (mag, aJitaciis,

agresiis, negatiuri simptomebis, afeqturi simptomebis);

4. mwvave epizodis ganviTarebis xelSemwyobi faqtorebis dadgena da

maTi marTva;

5. pacientis funqcionirebis optimalur mdgomareobaSi dabruneba;

6. pacintTan da mis ojaxTan (Terapiuli) aliansis damyareba;

7. xanmokle da xangrZlivi mkurnalobis gegmis SemuSaveba;

1. am fazis mkurnalobis Semdgom, pacientis Sesabamis reabilitaciur

samsaxurebTan dakavSireba.

laboratoriuli gamoklvevebis Catareba (SizofreniiT daavadebul

pacientTa SefasebisaTvis saWiro laboratoriul da sxva

diagnostikur gamokvlevaTa sruli sqema ix. cxrili #1.)

im pacientebisTvis, romelTac aReniSnebaT axlad ganviTarebuli

fsiqozis niSnebi (an fsiqozi atipiurad vlindeba), mxedvelobaSi

iqnas miRebuli damatebiTi diagnostikuri kvlevebis Sedegebi

(rogoricaa CT da MRI), riTac SeiZleba diagnozis dadastureba (mag.

parkuWebis gafarToeba, qerqis moculobis Semcireba).

klinikuri mdgomareobis gasakontroleblad (monitoringisaTvis)

saWiroa Sefasebis obieqturi raodenobrivi skalebis gaTvaliswineba,

rogoricaa:

1. uneblie paTologiuri moZraobebis skala (AIMS);

2. fsiqiatriuli Sefasebis mokle skala (BPRS);

3. pozotiuri simptomebis Sefasebis skala (SAPS) da

4. negatiuri simptomebis Sefasebis skala (SANS).

(skalebis Semoklebuli da sruli variantebi ix. danarTebSi #1,

#2, #3, #4).

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cxrili #1

SizofreniiT daavdebul pacientTa fizikuri da laboratoriuli Sefasebis sqema

Sefaseba sawyisi anu bazisuri Semdgomi (damatebiTi)

Sefasdes pacientis fizikuri

statusi da ganisazRvros (Tuki

aris) TandarTuli somaturi

daavadeba

organizmis somaturi mdgomareobis

ZiriTadi maCveneblebi (pulsi,

arteriuli sixlis wneva,

temperatura);

pulsi, sisxlis wneva, temperatura pulsi, sisxlis wneva,

temperatura, klinikuri

saWiroebis mixedviT, kerZod,

roca vumatebT medikamentis

dozebs.

sxeulis wona da simaRle sxeulis wona, simaRle da sxeulis

masis indeqsi (BMI)a sxeulis masis indeqsi (BMI) unda ganisazRvros yovel

vizitze pirveli 6 Tvis

ganmavlobaSi da SemdgomSi, sul

cota, kvartalurad (3 TveSi

erTxel)b

hematologia sisxlis saerTo analizi sisxlis saerTo analizi,

klinikuri saWiroebis mixedviT.

sisxlis qimiuri analizi 1. eleqtrolitebi,

2. Tirkmlis funqciuri analizi

(sisxlSi da SardSi

azotis/kreatininTan Sefardeba),

3. RviZlis funqciuri testi,

4. farisebri jirkvlis funqciuri

testi.

yovelwliurad da klinikuri

saWiroebis mixedviT

infeqciuri daavadebebi analizebi:

aTaSangze, C hepatitze da Sidsze,

klinikuri sWiroebis mixedviT

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orsuloba orsulobis testebis Catareba

Svilosnobis asakSi myofi

qalebisTvis

toqsikologia narkologiuri testireba da,

klinikuri saWiroebis mixedviT,

mZime liTonebis skriningi

narkologiuri testireba

eeg/radiografiuli gamokvleva klinkuri saWiroebis mixedviT eeg,

Tavis tvinis radiografiuli

gamokvleva (CT da MRI)

mkurnalobis gverdiT efeqtebTan

dakavSirebuli (damatebiTi)

Sefasebag

diabetid diabetis risk-faqtorebis skriningie;

sisxlSi glukozisv done, uzmoze

uzmoze sisxlSi glukozis an

hemoglobin A1-is done axali

mkurnalobis dawyebidan sul

cota 4 TveSi da SemdgomSi

yovelwliuradv.

hiperlipidemia lipidebis donez sul cota 5 weliwadSi erTxel

Q_T intervalis gaxangrZliveba ekg da sisxlSi kaliumis donis

gansazRvra TioridaziniT, mezori-

daziniT, pimozidiTYmkurnalobis

dawyebamde; ekg ziprazidoniT

mkurnalobis dawyebamde, kardialuri

risk-faqtorebis arsebobis

SemTxvevaSiT

hiperprolaqtinemia hiperprolaqtinemiis

simptomebisaTvis skriningii

yovel vizitze hiperprolaq-

tinemiis simptomebis skriningi,

vidre ar miaRwevs stabilur

dones; SedgomSi _ yovel-

wliurad, Tuki mkuranloba

mimdinareobs im antifsiqozuri

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klinikuri saWiroebis mixedviT

prolaqtinis done

medikamentebiT, romlebic

prolaqtinis dones zrdiani

klinikuri saWiroebis mixedviT

prolaqtinis done

eqstrapiramiduli gverdiTi

efeqtebi, akaTiziis da mogvianebiTi

diskineziis CaTvliT

eqstrapiramiduli gverdiTi

efeqtebis klinikuri Sefaseba

yovel 6 TveSi erTxel

Sefasdes paTologiuri

uneblie moZraobebi, pirveli

Taobis antifsiqozuri

saSualebebiT mkurnalobisas,

xolo meore Taobis antifsiqo-

zuri medikamntebiT ki _ yovel

12 TveSi erTxel.

maRali riskis pacientebis

Sefaseba Sesabamisad moxdes 3

da 6 TveSi erTxelk.

a. sxeulis masis indeqsis (BMI) gamoangariSeba xdeba formuliT wona kg-Si/(simaRle m-ebSi). adamians, romlis 25 < (BMI) <30 zedmeti wona aqvs, xolo (BMI) > 30 simsuqne awuxebs.

b. (BMI) < 18,5 mqone pacientebis garda, (BMI)-is yoveli erTeuliT Secvlisas pacentebi saWiroeben ufro xSir

Sefasebas da antifsiqozuri mkurnalobis Secvlas.

g. sazogadod, pacientTa Tavdapirveli bazisuri Sefaseba damokidebulia pacientis fizikur mdgomareobaze da

medikmentebTan dakavSirebul specifikur gverdiT efeqtebze. aRniSnulis Sesaxeb informacia adaptirebulia

2002 wlis oqtomberSi Mount Sinai-Si Catarebuli konferenciis mier mowodebuli rekomendaciebidan, romelic

Seexeboda SizofreniiT daavadebul pacintTa janmrTelobis monitorings.

d. marTalia, Znelia zustad ganisazRvros yvela medikamentis hiperglikemiis da Saqriani diabetis ganviTarebis

risk-faqtorebi, Tumca epidemiologiuri kvlevebiT dadgenilia meore Taobis antifsiqozuri mdikamentebiT

gamowveuli hiperglikemiis da masTan asocirebuli ketoacidozis, hiperosmolaruli komis da letaluri

gamosavlis Tavidan asacileblad gadaudebeli mkurnaloba.

e. aradiagnostirebuli diabetis maRal risk-faqtorebs miekuTvneba (BMI) > 25, diabetis arseboba pirveli rigis

naTesavebSi, dabali fizikuri aqtivoba, hipertenzia, qolesterinis maRali done da Semdegi simptomebi: xSiri

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Sardva, Zlieri wyurvilis da SimSilis grZnoba, wonis mniSvnelovani kargva, gamofitva, gaRizianebadoba,

mxedvelobis gauareseba.

v. sisxlSi uzmoze Saqris donis gansazRvra. am maCveneblebis paTologiuri Sedegebi (uzmoze sisxlSi Saqari >

110 mg/dl) miuTiTebs specialistis konsultaciis aucileblobaze.

z. pacientis SesaZlo lipiduri darRvevebis Sesaxeb damatebiTi konsultacia Sesabamis specialistTan.

T. kardialuri risk-fatorebia gul-sisxlZrTvTa daavadeba, sinkopes arseboba anamnezSi, uecari adreuli

gardacvalebis ojaxuri istoria da gaxangrZlivebuli Q_T-s intervali.

i. qalebSi: libidos, menstrualuri darRvevebi da galaqtorea. mamakacebSi: libidos, ereqciis da eakulaciis

disfunqcia.

k. uneblie paTologiuri moZraobebis ganviTarebis maRali risk-faqtirebs Seadgens: pacientTa xandazmuli asaki,

anamnezSi mwvave distonia, akatizia da sxva eqstrapiramiduli gverdiTi efeqtebi.

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5. mkurnaloba

a) I da b) II alternativa ix. cxrili 3.

antifsiqozuri medikamentebis gamoyeneba mwvave fazaSi

mkurnalobis dawyebamde (Tuki es SesaZlebelia) pacientTan

medikamenturi mkurnalobis pozitiuri da SesaZlo negatiuri

Sedegebis (mkurnalobisas ganviTarebuli gverdiTi efeqtebi:

orTostatiuli hipotenzia, Tavbrus xveva, distonia, uZiloba,

sedacia) awon-dawonva; im simptomebis dakonkreteba, romlebic

mkurnalobis mizans warmoadgens (mag. SfoTva, cudi Zili,

halucinacia(ebi) da bodva(ebi)).

antifsiqozuri medikamenturi mkurnalobis droulad dawyeba:

zogjer umjobesia medikamenturi mkurnalobis dawyebis gadavadeba,

sanam moxdeba pacientis mdgomareobis yovelmxrivi daignostikuri

Sefaseba.

antifsiqozuri medikamentebiT mkurnalobisas ganviTarebuli

gverdiTi efeqtebis minimumamde dayvana, romelic SesaZloa

gamoiwvios farmakologiur mkurnalobaze _ wamlis miRebaze da/an

miRebis gagrZelebaze uari.

im simptomebisa da laboratoriuli monacemebis ZiriTadi (bazisuri)

maCveneblebis Sefaseba, romlebic antifsiqozuri mkurnalobis

efeqtianobis gasakontroleblad gamodgeba (ix. cxrili 1.)

12

* - saqarTveloSi registrirebuli preparati

medikamentebis amorCeva iseTi faqtorebis gaTvaliswinebiT,

rogoricaa:

• samizne simptomze upiratesi moqmedeba;

• am medikamentis(ebis) gamoyenebisas maTi moqmedebis

gverdiTi efeqtebis gamocdileba warsulSi;

• mosalodneli gverdiTi moqmedebis efeqtebi (ix. cxrili 4);

• ama Tu im medikamentisTvis pacientis mier upiratesobis

miniWeba, maTi miRebis gzis CaTvliT;

• medikmentebis (da maTi gamoSvebis formis) xelmisawvdomoba

(mag. swrafadxsnadi tabletebi, wveTebi, xanmokle da

xangrZlivi moqmedebis ineqciebi)

roca mwvave fsiqozuri pacienti sakuTari Tavis an

irgvlivmyofebis mimarT amJRavnebs agresiul qcevas, gadaudebeli

mkurnalobis dauyovnebliv Catareba.

• pacientTan gasaubreba misi damSvidebis mizniT (gasaubrebis

mcdeloba);

• dasaSvebia pacientis fizikurad SezRudvis meTodebis

gamoyeneba, romelic unda Catardes usafrTxod, trenirebul

specialistTa mier.

• pirveli da meore Taobis antifsiqozuri medikamntebis

parenteraluri formis gamoyeneba, benzodiazepinebis

parenteralur miRebasTan erTad, an maT gareSe.

• an (alternatiulad) meore Taobis medikamentebis

swrafadxsnadi oraluri formis gamoyeneba (mag.

olanzapinis*, risperidonis*) an aqtiuri nivTierebis maRali

Semcvelobis mqone (maRalkoncentrirebuli) oraluri

formebis (mag. risperidonis, haloperidolis*) gamoyeneba.

ix. cxrilebi 2 da 2-1, 3 da 3-1.

13


gaxangrZlivebuli moqmedebis antifsiqozuri medikamentebis

ineqciebis gamoyeneba im pacientebisaTvis, romelTa mkurnaloba ar

iqna uzrunvelyofili, ris gamoc viTardeba xSiri gamwvavebebi.

umjobesia mkurnalobis dawyeba imave medikamentis tabletis

formiT (flufenazini*, haloperidoli, risperidoni)

(ix. cxrili 3. da 2-1.)

pirveli arCevis medikamentebad meore Taobis antifsiqozuri

saSualebebis gamoyeneba, eqstrapiramiduli gverdiTi efeqtebis da

mogvianebiTi diskineziis ganviTarebis dabali riskis gamo.

• im pacientTaTvis, romelTac gaaCniaT pirveli Taobis

medikamentebiT efeqtiani mkurnalobis warsuli gamocdileba,

an upiratesobas aniWeben maT, iyeneben imave wamlebs. agreTve,

zogierTi tipis pacientisaTvis pirveli Taobis wamlebi

warmoadgenen pirveli arCevis medikamentebs.

• garda klozapinisa* (romelic gamoiyeneba mkurnalobisadmi

rezistentuli simptomebis mqone pacientebisaTvis) pozitiuri

simptomebis mkurnalobisTvis antifsiqozuri medikamentebis

moqmedebis efeqtianoba praqtikulad erTnairia.

• zogad fsiqopaTologiur simptomatikaze, kognitur, negatiur

da guneb-ganwyobis aSlis simptomebze ufro xSirad ukeTesi

efeqti gaaCniaT meore Taobis antifsiqozur medikamentebs.

(ix. cxrili 3)

medikamentis dozis mateba Terapiul dozamde _ dasaSvebi drois

intervaliT (ZiriTadi gverdiT efeqtebi, rogoricaa sedacia,

orTostatiuli hipitenzia da taqikardia, zRudaven dozis matebas);

klinikuri mdgomareobis gakontroleba _ sul cota 2 _ 4 kviraSi,

rac arCeuli mkuranlobisadmi daqvemdebarebis dadgenis saSualebas

iZleva.

• pacientTa umravlesobisaTvis pirveli Taobis antifsiqozuri

medikamentebis optimaluri doza `eqstrapiramiduli

simptomebis~ (eps) zRurblTan axlosaa, da am (dozis) dros,

SesaZlebelia minimaluri rigidulobis ganviTareba;

• meore Taobis antifsiqozuri medikamentebisaTvis optimaluri

doza aris farmakofirmis mier gansazRvruli Terapiul

dozasa da anotaciaze (FDA-s mier damtkicebuli) miTiTebul

dozis sazRvrebSi.

14

roca pacientis mkurnaloba uzrunvelyofilia da medikamentis

plazmuri koncentaracia adeqvaturia, magram gaumjobesebas

adgili ara aqvs, dozis Semdgomi gazrda (Tuki, pacienti itans) an

sxva medikamentze gadasvla.

saWiroebis SemTxvevaSi, plazmaSi im medikamentebis koncentraciis

gansazRvra, romelTa plazmur koncentraciasTanaa dakavSirebuli

pacientis klinkuri mdgomareobis gaumjobeseba (mag.

haloperidoli, klozapini).

Tuki pacientis mdgomareoba ar umjobesdeba, mizezis dadgena, mag:

ar iqna uzrunvelyofili am medikamentiT zusti (sqemiT)

mkurnaloba, medikamenti swrafad metabolirdeba, an cudad

absorbirdeba.

15

cxrili #2

ZiriTadi antifsiqozuri medikamentebi

*- saqrTveloSi registrirebuli preparatebi

antifsiqozuri

medikamentebis

dasaxeleba

rekomendirebuli

dozebis

sazRvrebi

(mg/dR)a

qlorproma

zinis

ekvivalenti

(mg/dR) b

naxevar-

daSla

(sT-ebSi)

g

sisxlSi

Terapiuli

dozis

sazRvrebi

(ng/ml) (46)

pirveli Taobis:

fenoTiazinebi

qlorpromazini* 300–1000 100 6 30-100

flufenazini* 5–20 2 33 0.2-2.0

mezoridazini 150–400 50 36

perfenazini 16–64 10 10 0.8-2.4

Tioridazini 300–800 100 24 1-1.5

trifluoperazini* 15–50 5 24

levomepromazini

(44)

200-800

butirofenonebi

haloperidoli* 5–20 2 21 5-10

sxvebi

pimozidi (46) 1-10

loqsapini 30–100 10 4 30-100

molindoni 30–100 10 24

TioTiqseni 15–50 5 34 2-15

qlorprotiqseni

* (44) 10-600

sulpiridi* (45) 400-800-2400(max) (44)

meore Taobis:

aripiprazoli 10–30 75

klozapini* 150–600 12 >350

olanzapini* 10–30 33

quetiapini 300–800 6

risperidoni* 2–8 24

ziprazidoni 120–200 7

16

a rekomendirebuli dozebi adaptirebulia Semdegi gamocemebidan: 2003 Schizophrenia Patient Outcome Research Team recommendations (Lehman AF, Kreyenbuhl J, Buchanan RW, et al.: “The Schizophrenia Patient Outcomes Research Team (PORT): Updated Treatment Recommendations 2003.” Schizophr Bull [in press]).

b qlorpromazinis eqvivalenti daaxloebiT Seesabmeba 100 mg.

qlorpromazinis dozas. es eqvivalentebi SesabamisobaSi ar modis meore

Taobis antifsiqozur medikamentebTan, am SemTxvevaSi es maCvenebli ar

gamoiyeneba (Centorrino F, Eakin M, Bahk WM, et al.: “Inpatient Antipsychotic Drug Use in 1998, 1993, and 1989.” Am J Psychiatry 159:1932–1935, 2002).

g naxevardaSla aris drois periodi, romelic saWiroa plazmaSi wamlis

koncentraciis gasanaxevreblad; es maCvenebeli (naxevardaSlis periodi)

gamoiyeneba Sesabamisi dozirebis gansasazRvrad (Hardman JG, Limbird LE, Gilman AG (eds.): Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 10th ed. New York, McGraw-Hill Professional, 2001). wamlis naxevardaSlaSi ar Sedis misi

aqtiuri metabolitebis naxevardaSla.

17

cxrili #2-1

antifsiqozuri depo ineqciebi _ dozireba

wamlis

dasaxeleba

dozebis

sazRvrebi

(mg/kvira)

ineqciebs Soris

intervali

(kvira)

komentarebi

flupentiqsol

dekanoati

12.5-400 2-4 SesaZloa,

gamoiwvios guneb-

ganwyobis aweva;

aJitacia

gaaZlieros.

flufenazin

dekanoati*

12.5-50 2-5 umjobesia depresiis

da eps-is dros

Tavis arideba.

haloperidol

dekanoati

12.5-75 4 xSirad iwvevs eps-s

da iSviTad _ Zlier

sedacias.

pipoTiazin

dekanoati

12.5-50 4 _

zuklopentiqsol-

dekanoati

100-600 2-4 gamoiyeneba

aJitaciis da

agresiis dros.

risperidonis

depo-ineqcia (75)

25-50 2 efeqtianoba

iseTivea, rogorc

tabletirebuli

formis 2-6 mg/dR

18

cxrili #3

Sizofreniis mwvave fazis mkurnalobis pirveli arCvevis

medikamntebi

klinikuri suraTis

ganmsazRvreli niSnebi

jgufi 1:

pirveli

Taobis

medikame

ntebi

jgufi 2:

risperidoni*,

olanzapini*,

quetiapini,

ziprazidoni,

an aripiprazoli

jgufi

3:

kloza

pini*

jgufi 4:

antifsiqozuri

mediakmentebis

gaxangrZlivebu

li moqmedebis

ineqciebi

1. pirveli epizodi

2. myari (persistentuli)

suiciduri azrebi an

moqmedeba

3. myari (persistentuli)

agresiuloba

4. mogvianebiTi diskinezia

diax

diax

jgufi 2-is yvela

wamlis gamoyenebisas

mogvianebiTi

diskineziis

ganviTarebis riski

erTanairad dabali

ar aris

diax

diax

diax

5. midrekileba

eqstrapiramiduli

gverdiTi efeqtebis

ganviTarebisadmi.

6. midrekileba

prolaqtinis donis

momatebisadmi.

7. midrekileba wonis

momatebisadmi,

hiperglikemiisadmi,

hiperlipidemiisadmi.

roca SeuZlebelia farma-

kologiuri mkurnalobis

zusti sqemiT uzrunvel-

yofa (ganmeorebiTi)

diax.

garda risperidonis

Zalian maRali

dozebisa

diax.

garda

risperidonisa.

gamoiyeneba

ziprazidoni an

aripiprazoli

diax.

*- saqarTveloSi registrirebuli preparatebi

cxrili #3-1

19

antifsiqozuri medikamentebis da sxva wamlebis urTierTqmedeba

(romelTa umetesoba metabolirdeba citoqrom P450 2D6 sistemiT) (46)


alkoholi iwvevs damatebiT sedacias, koordianciis

darRvevas.

haloperidoli* zrdis alkoholis dones.

antikonvulsantebi (garda

valproatisa*)

amcireben antifsiqozuri medikamntebis dones

sisxlSi.

Tambaqo amcirebs antifsiqozuri medikamntebis dones

sisxlSi.

eriTromicini zrdis klozapinis* dones.

fluvoqsamini zrdis klozapinis dones.

serotoninis seleqtiuri

ukumutacebis inhobitorebi

(ssui)

zrdian neiroleptikebis dones da auareseben

eqstrapiramidul sindroms.

tricikluri antidepresantebi zogierTi neiroleptiki zrdis maT dones;

zrdian antifsiqozuri medikamntebis dones

sisxlSi

antiqolinergiulebi iwvevs damatebiT antiqolinergiul efeqts.

liTiumi SesaZloa gamoiwvios qlorpromazinis* donis

gazrda.

disulfirami amcirebs qlorpromazinis dones.

antiariTmiulebi

meTildopa

guaneTidini

propranololi

iwvevs hipotenzias da cnobierebis Secvlas;

iwvevs antihiperTenziul efeqts;

zrdis antifsiqozuri medikamentebis dones

sisxlSi.

20

cxrili #4

antifsiqozuri medikamentebis ZiriTadi gverdiTi efeqtebi (a)

medikamenti eqstrapiramid

uli

geverdiTi

efeqtebi/mogvi

anebiTi

diskinezia

prolaqtin

is

donis

mateba/ele

vacia

wonis

mateba

gluko

zis

donis

mateba

lipidebis

donis

mateba

Q-T interva

lis

gaxangrZ

liveba

sedacia hipoten

zia

antiqolin

ergiuli

gverdiTi

efeqti

Tioridazini + ++ + +? +? +++ ++ ++ ++

perfenazini ++ ++ + +? +? 0 + + 0

haloperidoli* +++ +++ + 0 0 0 ++ 0 0

klozapini* (b)

0 (c)

0 +++ +++ +++ 0 +++ +++ +++

risperidoni* + +++ ++ ++ ++ + + + 0

olanzapini* 0 (c)

0 +++ +++ +++ 0 + + ++

qvetiapini (d)

0 (c)

0 ++ ++ ++ 0 ++ ++ 0

ziprazidoni 0 (c)

+ 0 0 0 ++ 0 0 0

aripiprazoli

(e)

0 (c)

0 0 0 0 0 + 0 0

qlorpromazini

*(45)

++ +++ _ _ _ _ +++ +++ +++

flupentiqsoli

(45)

++ +++ _ _ _ _ + + ++

metaboluri sindromi

21

a. 0 = gverdiTi efeqtebis ganviTarebis riski ar aris an Zalze iSviaTad viTardeba Terapiuli doziT. + = sustad

an iSviaTad iwvevs gverdiT efeqtebs Terapiuli doziT. ++ = zogjer iwvevs gverdiT efeqtebs Terapiuli

doziT. +++ = xSirad iwvevs gverdiT efeqtebs Terapiuli doziT. ?/_ = sarwmuno monacemebi ar aris.

adaptirebulia Semdegi gamocemidan: “Antipsychotic Agents,” in Current Psychotherapeutic Drugs, Second Edition. Edited by Quitkin FM, Adams DC, Bowden CL, et al. Philadelphia, PA, Current Medicine, 1998, pp. 120–154, with permission of Current Medicine, Inc. b. agreTve iwvevs agranulocitozs, krunCxvebs, miokarditebs.

g. gamonaklisis saxiT SesaZloa gamoiwvios akaTizia.

d. arsebobs kataraqtis ganviTarebis saSiSroeba.

e. SeiZleba gamoiwvios Rebineba da Tavis tkivili.


flufenazini*

(45)

+++ +++ _ _ _ _ + + ++

pimozidi (45) + +++ _ _ _ _ + + +

sulpiridi*

(45)

+ +++ _ _ _ _ 0 0 0

trifluoperaz

ini* (45)

+++ +++ _ _ _ _ + + +/_

zuklopentiqso

li (45)

++ +++ _ _ _ _ ++ + ++

22

g) gansakuTrebuli SemTxveva

damatebiTi medikamentebis gamoyeneba mwvave fazaSi

garda antifsiqozurisa sxva fsiqotropuli medikamentebis gamoyeneba:

• komorbiduli mdgomareobebis (mag. mZime depresiis, obsesiur-

kompulsiuri aSlilobis),

• fsiqozTan dakavSirebuli simptomebis (rogoricaa: aJitaciis,

agresiis, guneb-ganwyobis aSlis simptomebi)

• Zilis darRvevebis samkurnalod.

• aseve, antifsiqozuri medikamentebis gverdiTi efeqtebis

koregirebisaTvis.

mniSvnelovania imis gaTvaliswineba, rom zogierTi antidepresanti

(romelic kateqolaminebis ukumitacebis inhibitoria) zog SemTxvevaSi

fsiqozuri simptomebis gamwvavebas an SenarCunebas iwvevs.

mkurnalobis mwvave fazaSi benzodiazpinebis gamoyeneba efeqtiania

SfoTvisa da aJitaciis samarTavad.

guneb-ganwyobis stabilizatorebi da beta-blokatorebi efeqtianad

gamoiyeneba pacientis agresiis xarisxis Sesamcireblad.

garda zemoaRniSnulisa, eqstrapiramiduli simptomebis mkurnalobis

sxva strategiaa antifsiqozuri medikamentis dozis Semcireba, an sxva

antifsiqozur medikamentze gadasvla.

(ix. cxrili 5; 5-1)

eqstrapiramiduli gverdiTi efeqtebis profilaqtikisa da mkurnalobis

dawyebamde mxedvelobaSi unda iqnes miRebuli Semdegi faqtorebi:

• antifsiqozuri wamlis midrekileba eqstrapiramiduli

simptomebis gamowvevisadmi (ix. cxrili 4);

• pacientis mier upiratesobis miniWeba ama Tu im medikamentisaTvis;

• pacientis warsuli istoria eqstrapiramiduli simptomebis

ganviTarebis Sesaxeb;

• eqstrapiramiduli simptomebis ganviTarebis sxva risk-faqtorebis

arseboba (konkretulad distoniis ganviTarebis risk-faqtorebi);

• antiqolinergiuli gverdiTi efeqtebis ganviTarebis da SesaZlo

Sedegebis risk-faqtorebis arseboba.

23

cxrili #5

eqstrapiramiduli gverdiTi efeqtebi

distonia (uneblie) akaTizia parkinsonizmi mogvianebiTi

diskinezia

simptomi:

aRwera

enis, kisris, zurgis

da Tvalis kunTebis

uneblie SekumSva

motoruli mousvenroba da

kunTebis daWimulobis

subieqturi gancda (rac

SeZleba gamoixatos: win

da ukan siarulSi, adgoma-

dajdomaSi).

rigiduloba, tremori,

bradikinezia. ar

agerioT negatiur

simptomebsa da

depresiaSi.

tuCebis, enis an zemo

kidurebis uneblie

qoreaformuli

moZraobebi,

romlebic

mogvianebiT

viTardeba

ganviTarebis

riski • 40 wlamde asaki;

• maRal-potenciuri

neiroleptikebis

gamoyeneba

• ZiriTadad,AmaRal-

potenciuri

neiroleptikebis

gamoyenebisas

• doza-damokidebulia

• ZiriTadad,AmaRal-

potenciuri

neiroleptikebis

gamoyenebisas

• doza-damokidebulia.

• moxucebulobis

asaki;

• maRal dozebSi

neiroleptikebis

gamoyeneba 6 Tveze

metxans;

• anamnezSi: a)

gverdiT efeqtad

parkinsonizmi; b)

diabeti; g) guneb-

ganwyobis aSlis

simptomebi.

ganviTarebis

sixSirea weliwadSi

4-5 %.

mkurnaloba • profilaqtikurad:

30 wlamde

pacientebma,

romelTa

1. neiroleptikis dozis

Semcireba;

2. atipiur antifsiqozur

medikamentze gadasvla;

1. neiroleptikis dozis

Semcireba;

2. atipiur antifsiqozur

• regularulad,

weliwadSi 2-jer

aranormaluri

uneblie moZraobebis

24

mkurnalobas iwyebT

maRalpotenciuri

neiroleptikebiT,

paralelurad unda

miiRon benztropini

1-2 mg/dR (2

jeradad) 10 dRe,

SemdgomSi dozis

nel-nela

SemcirebiT.

• mwvave ditoniis dros:

1. benztropini 1-2 mg peroralurad an

kunTebSi;

2. difenilhidramini

25-50 mg.

peroralurad an

kunTebSi;

3. an diazepami* 5 mg. venaSi nela

Seyvana. (Semdgom ix.

profilaqtika)

3. beta-blokerebi, mag.

propranololi 20 mg.

dReSi 4-jer;

4. antiqolinergiuli saS-

ba, mag: benztropini 1

mg. dReSi 2-jer;

5. an benzodiazepini (mag.

lorazepami 0.5 mg.

dReSi 3-jer).

medikamentze gadasvla;

3. antiqolinergiuli

saS-ba, mag: benztropini

1-2 mg. dReSi 2-jer,

moxucebSi iwyeba 0,25

mg-iT da xangrZlivad

ar gamoiyeneba;

4. an amantadini 100-200 mg. dReSi 2-jer

gakontroleba,

skalis (AIMS) gamoyenebiT;

• atipiur antifsiqozur saS-

ebze gadasvla;

• E vitamini (alfa-

tokoferoli) 800- 1

200 erT/dR. 5 dRis

ganmavlobaSi


25

cxrili #5_1

avTvisebiani neirolefsiuri sindromi (ans) (45)

avTvisebiani neirolefsiuri sindromi

(ans)

ganviTarebis

riski

mkurnaloba (47)

neirolefsiuri mkurnalobis iSviaTi,

sicocxlisaTvis saSiSi garTulebaa,

romelic iwyeba cnobierebis SecvliT

(dezorientacia, fluqtuacia) da

axasiaTebs:

• klinikuri gamovlineba:

1. kunTovani rigiduloba;

2. distonia; 3. akaTizia;

4. mutizmi; 5. aJitacia; 6. hiperTermia;

7. diaforezi (oflianoba);

8. disfagia (ylapvis gaZneleba);

9. pulsis momateba

10. wnevis momateba

• laboratoriuli maCveneblebi:

2. kreatinfosfokinazis (CPK) mateba; 3. plazmaSi mioglobinis momateba;

4. mioglobinuria;

5. leikocitozi;

6. RviZlis enzimebis mateba;

6. Tirkmlis mw. ukmarisoba.

• premorbidulad

fsiqo-

motoruli

aJitacia;

• drois mcire intervalebiT

neiroleptikebi

s dozis mateba;

• didi raodenobiT

kunTovani

ineqciebi;

• antifsiqozur medikamentebTan

erTad

liTiumis

gamoyeneba.

I etapi (fsiqiatriul ganyofilebaSi):

1. antidofaminergiuli antifsiqozuri medikamentis

dauyovnebliv Sewyveta;

2. temperaturis, pulsis da sisxlis wnevis

gakontroleba;

3. gagrileba.

II etapi (gadaudebeli Terapiis ganyofilebaSi):

1. vitaluri funqciebis gakontroleba (monitoringi):

• rehidratacia da eleqtrolitebis balansi;

• Sardis gamoyofa da Tirkmlis funqcia;

2. dentroleni (pirdapiri moqmedebis miorelaqsanti,

1-3 mg/kg/dR, dReSi 4-jer intravenurad da rogorc ki

SeZlebs per os miRebas)+bromokriptini (dofamin-agnonisti, 2,5-5-10 mg/dR. dReSi 3-jer)+sedacia

(bezodiazepiniT) +filtvebis xelovnuri

velntialacia, saWiroebis mixedviT.

fsiqozis samkurnalod ki gamoiyeneba L-dopa, karbamazepini da ekT, saWiroebis mixedviT.

III etapi:

ans-s amowurvis Semdgom kidev erTi kvira (10 dR.)

grZeldeba zemoaRniSnuli mkurnaloba da Semdgom

Zalze frTxilad (dabali dozebiT da nel-nela

vzrdiT dozas) viwyebT dabalpotenciuri antifsqozuri

medikamentis gamoyenebas (klozapini*, quetiapini) *- saqarTveloSi registrirebuli preparatebi

26

eleqtro-konvulsiuri da sxva somaturi Terapiebis gamoyeneba mwvave

fazaSi

eleqtrokonvulsiuri Terapia gamoiyeneba upiratesad katatoniuri

simptomatikis mqone pirebisaTvis, romlebic lorazepamiT mkurnalobaze ar

reagirebdnen (mag, 1-2 mg./kunTebSi an intravenurad an 2-4 mg. tab-Si, yovel

48-72 sT-Si ganmeorebiT, saWiroebis mixedviT)

Sizofreniis da Sizoafeqturi aSlilobis mqone pirebisaTvis (romelTac

aReniSnebaT mZime persistentuli fsiqozi an suiciduri ideebi, an/da

qmedeba da manamade mkuranalobas, klozapinis CaTvliT, Sedegi ar

mohyolia) mizanSewonilia eleqtrokonvulsiuri Terapiis saWiroebis

ganxilva, medikamntur mkurnalobasTan erTad.

aseve, eleqtrokonvulsiuri Terapia sasargeblo SeiZleba iyos

SizofreniiT da TandarTuli depresiiT daavadebuli pacientTaTvis, Tuki

depresiuli simptomebi mkurnalobisadmi rezistentulia, an saxezea iseTi

simptomebi, rogoricaa fizikuri gamofitva, an suiciduri ideebi, an

qmedeba/mcdeloba, romlebic saWiroebs dauyovnebliv mkurnalobas.

27

pirveli epizodis mkurnalobasTan dakavSirebuli sakiTxebi

mTeli periodis ganmavlobaSi avadmyofuri niSnebis, simptomebis

warmoSobasa da ganviTarebaze detaluri dakvirveba da maTi werilobiTi

dafiqsireba _ Sesabamisi samedicino dokumentaciis warmoeba (vinaidan

fsiqozis pirveli epizodi SesaZloa iyos Zalze polimorfuli da

gamolindes sxvadasxva specifikuri aSlilobebis klinikuri suraTiT (mag,

Sizofreniismagvari aSliloba, bipolaruli aSliloba, Sizoafeqturi

aSliloba).

ix. sqema

pacientTan erTad gamwvevebis maRali risk-faqtorebis da im pozitiuri

faqtorebis ganxilva, romelTac SuZliaT minimumamde daiyvanos gamwvavebis

riski.

kanabisis da fsiqostimulatorebis gamoyenebis gamoricxva,

stresis marTvis gaumjobeseba da

SemanarCunebeli antifsiqozuri mkurnaloba.

remisiaSi myofi pacientis gamwvavebis riskis minimumamde dayvana, rasac

didi zegavlena gaaCnia klinikur, socialur da profesiuli saqmianobis

sferoebze.

pirveli epizodis mqone pacientebis 70%-ze meti aRweven fsiqozuri

simptomebis srul remisias 3-dan 4 TveSi, xolo 80%-ze meti_stabilur

remisias 1 wlis bolos.

mkurnalobisadmi cudad daqvemdebarebis prediqtorebia:

• sqesi _ mamakaci;

• cns-s pre- an perinataluri dazianeba;

• intensiurad gamoxatuli halucinaciebi da bodva;

• yuradRebis gauareseba, daqveiTeba;

• pacientis funqcionirebis dabali done premorbidSi;

• aranamkurnalevi fsiqozis xangrZlivoba;

• eqstrapiramiduli gverdiTi efeqtebis ganviTareba;

• pacientisaTvis distresuli emociuri garemo (mag. negatiuri da

kritikuli damokidebuleba mis mimarT, gadaWarbebuli mzrunveloba

irgvlivmyofisgan, emociurobis maRali done).

28

sqema

Sizofreniis pirveli epizodis mkurnalobis algoriTmi


• SeuTanxmeT pacients/mis axlobels

antifsiqozuri medikamentis arCevani,

• Tuki SeuZlebelia, daiwyeT atipiuri

antifsiqozuri medikamentiT mkunaloba.

gazardeT doza (axdenT titracias),

saWiroebis mixedviT, efeqtur

minimalur dozamde

daaregulireT doza, misi efeqtianobis da

mis mimarT amtanobis mixedviT

SeafaseT yovel 6-8 kviraSi

roca Sedegi

miiRweva, ganagrZeT

mkurnaloba

dadgenili

efeqturi doziT.

roca Sedegi ar

miiRweva, SecvaleT

medikmenti, zemoT

aRniSnuli miTiTebebis

mixedviT

roca Sedegi ar

miiRweva, gamoiyeneT

klozapini*

• roca mkurnalobis

uzrunvelyofa ar

xerxdeba, vinaidan

pacienti cudad

itans am

medikaments, masTan

erTad ganixileT

wamlis Secvlis

sakiTxi

• an roca mkurnalobis

uzrunvelyofa ar

xerxdeba sxva

faqtorebis gamo,

ganixileT depo-

preparatebis da/an

Tanxmobis

Terapiis

gamoyeneba.

• gaimeoreT zemoT

aRwerili procesi.

29

stabilizaciis faza

stabilizaciis faza


• pacientisTvis stresis minimumamde dayvana da misi mxardaWeris

uzrunvelyofa, recidivis ganviTarebis Tavidan acilebis

mizniT;

• pacientis sociumSi (TemSi) cxovrebis adaptaciis gaumjobeseba;

• simptomebis TandaTanobiT reducireba (minimumamde dayvana) da

remisiis gamyareba.

stabilizaciis fazaSi, adeqvaturi Terapiuli efeqtis miRwevis Semdeg

(minimaluri gverdiTi efeqtebiT), Semdgomi 6 Tvis manZilze, Catardes

mkurnaloba (imave medikamentebiT da imave doziT) da mdgomareobis

monitoringi.

mwvave fazidan moyolebuli uwyvetad Sefasdes farmakoTerapis

gverdiTi efeqtebi da igi minimumamde iqnas dayvanili.

gagrZeldes mxardamWeri fsiqoTerapiuli intervencia.

pacients miewodos informacia:

• daavadebis mimdinareobis,

• gamosavlis da

• mkurnalobis uzrunvelyofis mniSvnelobis Sesaxeb (gagrZeldes

ojaxis wevrebis informireba).

pacientis hospitlidan gaweramde momzaddes Temze dafuZnebuli

uwyveti mkurnalobis servisebi (41, 42).

xSirad sasargebloa, jer kidev hospitalizebuli pacientebisaTvis

ambulatoriuli samsaxuris fsiqiatrTan Sexvedris organizeba; xolo

gasawerad momzadebuli pacientebisaTvis _ Temze dafuZnebuli

fsiqiatriuli samsaxuris fsiqiatrTan viziti.

gaweris Semdgom daxmareba gaewios pacients ojaxsa da sociumSi/TemSi

cxovrebaSi adaptirebaSi da realuri miznebis dasaxvaSi, raTa zedmetad

ar ecados samsaxurSi da sociumSi gadaWarbebulad aqtiur

funqcionirebas.

30

stabiluri faza

Sefaseba stabilur fazaSi

mdgomareobis Sefaseba da monitoringi, raTa GganisazRvros,

saWiroebs Tu ara pcienti mkurnalobis sqemis Secvlas.

pacientebs (romlebic iReben antifsiqozuri medikamentebs)

CautardeT eqstrapiramiduli simptomebis klinikuri Sefaseba,

fsiqiatrTan yovel vizitze.

pacientebs, romlebic iReben pirveli Taobis antifsiqozur

saSualebebs, yovel 6 TveSi erTxel, xolo pacientebs, romlebic

iReben meore Taobis saSualebebs, 12 TveSi erTxel, CautardeT

paTologiuri uneblie moZraobebis klinikuri Sefaseba.

6 Tvis ganmavlobaSi yovel vizitze da Semdgom, 3 TveSi erTxel,

gakontroldes pacientis wona da sxeulis masis indeqsi (BMI). im

pacientebs, romelTa sxeulis masis indeqsi aris 25 da meti, gegmiurad

CautardeT Warb wonasTan dakavSirebuli somaturi problemebis

monitoringi (kerZod, ganisazRvros sisxlis wneva, sisxlSi lipidebis

done, diabetis klinikuri simptomebi).

stabiluri fazis dawyebidan 4 Tvis bolos da Semdgom yovelwliurad,

uzmoze ganisazRvros sisxlSi glukozis done; aseve yovelwliurad

ganisazRvros (an ufro xSirad klinikuri saWiroebis mixedviT) _

sisxlSi eleqtrolitebis done, Tirkmlis, RviZlis da Tireoiduli

funqciebi; klinikuri Cvenebis Sesabamisad, Catardes sisxlis

narkologiuri analizi.

daniSnuli mkurnalobis specifikurobis gaTvliswinebiT, Catardes

sxva gamokvlevebi:

(ix. cxrili 1).

31

pacientis Tanaxmobis SemTxvevaSi viqonioT da SevinarCunoT mWidro

kavSiri im (mxardamWer) pirTan, vinc amCnevs calkeuli simptoms da

pacientisaTvis stresul movlenebs.

Sizofreniis (da sxva fsiqozis) mqone pacientTa umetesoba

antifsiqozuri mkurnalobis Sewyvetis SemTxvevaSi, xelaxali

gamwvavebis maRali riskis qveS arian. am riskis gansazRvris zusti

indikatori ar arsebobs. Tu pacients anamnezSi aReniSneba

gamwvavebis mravali an 5 wlis manZilze Tundac 2 epizodi,

mizanSewonilia misi uwyvet, SemanarCunebel antifsiqozur

mkurnalobaze daTanxmeba.

Tu antifsiqozuri mkurnalobis fonze remisia grZeldeba sul

cota 1 weli mainc, SesaZloa erToblivad miRebul iqnas

gadawyvetileba antifsiqozuri wamlebis miRebis Sewyvetaze, rac

yovelTviurad nel-nela dozis 10 %-iT SemcirebiT unda moxdes.


• simptomebis Semcireba an mdgomareobis xangrZlivad daregulireba.

• pacientis funqcionirebis da cxovrebis xarisxis SenarCuneba an

gaumjobeseba.

• simptomebisa da gamwvavebebis (mzardi) efeqtiani mkurnaloba.

• mkurnalobis gverdiTi efeqtebis gakontrolebis gagrZeleba

32

antifsiqozuri medikmentebis gamoyeneba stabilur fazaSi

antifsiqozuri saSualebebis gamoyenebiT SesaZlo gamwvavebis

riskis Semcireba.

pacientTa umravlesobas, romlebic pirveli Taobis antifsiqozuri

agentebiT mkurnaloben, medikamentebi daeniSnoT doziT, romelic

`eqstrapiramiduli simptomebis~ (eps) zRurblTan axlosaa (anu am

dros fizikuri gamokvleviT SesaZlebelia minimaluri

rigidulobis aRmoCena).

meore Taobis antifsiqozuri medikamentebis daniSvna SesaZlebelia

Terapiuli doziT, romelic ar iwvevs eqstrapiramidul gverdiT

efeqtebs.

uaRresad mniSvnelovania, fsiqiatrma kargad awonos erTis mxriv

antifsiqozuri medikamentebis dozis Semcireba `minimalur

efeqtur dozamde~ da meores mxriv, xSiri gamwvavebebis riski da

Sizofreniuli siptomatikis gauareseba.

Sefasdes, rezidualuri negatiuri simptomebi warmoadgens

parkisonizmis Tu aranamkurnalevi depresiis gamovlinebas da

daeiniSnos Sesabamisi mkurnaloba.

33

damatebiTi medikamentebis gamoyeneba stabilur fazaSi

eleqtro-konvulsiuri Terapiis (ekT) gamoyeneba stabilur fazaSi

stabilur fazaSi, garda antifsiqozurisa gamoiyeneba sxva

medikamentebic iseTi komorbiduli (Tanamdevi) mdgomareobebis

samkurnalod, rogiricaa agresia, SfoTva an guneb-ganwyobis aSlis

sxva simptomebi; isini aseve gamoiyeneba ZiriTadi medikamentebis

antifsiqozuri efeqtis gasaZliereblad da gverdiTi efeqtebis

sakoreqciod.

im pacientebisaTvis, romelTa mkurnloba mwvave fazaSi warimarTa

eleqtrokonvulsiuri TerapiiT, amasTan mxolod fsiqofarmako-

logiuri profilaqtika efeqtiani ar aris, an maT daqveiTebuli

aqvT amtanoba antifsiqozuri medikamentebis mimarT.

35

deficituri simptomebis mkurnaloba

6. reabilitacia da dakvirveba

fsiqosocialuri mkurnaloba stabilur fazaSi

pacientis Sefaseba im faqtorebis gamosavlenad, romelTac

SeuZliaT xeli Seuwyon meoradi negatiuri simptomebis

ganviTarebas.

Tu negatiuri simptomebi aris meoradi, mkurnaloba sWirdeba maT

uSualo mizezs:

• fsiqozur simptomebs _ antifsiqozuri medikamentebiT;

• depresias _ antidepresiuli medikamentebiT;

• SfoTvas _ anqsiolizuri saSulebebiT;

• eqstrapiramidul gverdiT efeqtebs _ antiparkinsonuli

medikamentebiT an antifsiqozuri medikamentebi dozis

SemcirebiT.

pirveladi persistentuli negatiuri simptomebis SemTxvevaSi,

dResdReobiT ar arsebobs mtkicebulebebze dafuZnebuli efeqtiani

mkurnaloba, magram klozapinis da sxva meore Taobis antifsiqozuri

agentebis gamoyeneba iZleva garkveul Sedegs.

pacientis individualuri saWiroebis da socialuri garemos

Sesabamisad, Sesaferisi fsiqosocialuri mkurnalobis SerCeva.

mniSvnelovan mtkicebulebebze dafuZnebul efeqtian fsiqosocialur

mkurnalobaSi (anu fsiqo-socialuri reabilitacia, romelic

xorcieldeba dRis movlis samsaxurSi, avt.SeniSvna) Sedis:

1. Temze dafuZnebuli mkurnalobis programa (PACT); 2. ojaxuri intervencia;

3. kognitur-bihevioruli Terapia;

4. socialuri unar-Cvevebis gamomuSaveba (Treiningi).

ix. ganmartebebi qvemoT

36

ganmartebebi:

1. Temze dafuZnebuli mkurnalobis programa gulisxmobs: integrirebuli

multidisciplinaruli gundis mier pacientis mkurnalobaSi aqtiur

Carevas da misi SemTxvevis marTvas. dasavleTSi es profesiuli gundi

muSaobs kviraSi 7 dRe, dRe-RameSi 24sT da uzrunvelyofs pacientis

daxmarebas saxlSi, TemSi (mikrosociumSi) da samuSao adgilze.

aRniSnuli programa individualurad afasebs pacientis mier stresis

damoukideblad daZlevis unaris deficits da exmareba Tavisi

moTxovnilebebis gansazRvrasa da dakmayofilebaSi; aseve afasebs da

exmareba iseTi yofiTi unar-Cvevebis gaumjobesebaSi, rogoricaa:

tansacmlis recxva, saxlis dalageba, sayidlebze siaruli, sakvebis

momzadeba, saxarjo fulis ganawileba, transportiT sargebloba da a.S;

2. ojaxuri intervencia aucilebelia pacientis ojaxis wevrebi droulad

iqnen CarTulni erToblivi mkurnalobis procesSi, rac mniSvnelovnad

aumjobesebs pacientis mdgomareobas, saboloo gamosavalis CaTvliT. am

momsaxurebam unda moaxdinos pacientisa da misi ojaxis wevrebis

fsiqoganaTleba (gaTviTcnobiereba), rac maT daexmareba klinicistebTan

erTad mkurnalobis dagegmvaSi, miznebis dasaxvasa da momsaxurebis

uzrunvelyofaSi. es programa aris mkacrad struqturirebuli da

grZeldeba 9 Tvidan 2-3 wlamde;

3. kognitur-bihevioruli Terapia: did britaneTsa da aSS-Si kbT farTod

gamoiyeneba SizofreniiT (da sxva fsiqozuri aSlilobebiT) daavadebuli

pacientebis mkurnalobaSi. kbT individualuri Terapiaa, romlis mizani

ar aris Teprapevtis mier fsiqozuri simptomebis uaryofa, pacintis

gadarwmuneba da fsiqozis iracionalur movlenad Sefaseba. am dros

Terapiuli intervenciis mizania simptomebis Sesaxeb pacientis

Sexedulebebis da miseuli daZlevis strategiebis gamovlena, masTan

erTad axali, ufro racionaluri da pacientisTvis nakleb distresuli

mosazrebebis SemuSaveba. es Terapia gulisxmobs: bodviTi azrebis da

halucienaciebis Sesaxeb pacientis rwmena-Sexedulebebis Secvlas,

`xmebis~ SemTxvevaSi maTze fokusirebas da warmoSobis wyaros xelaxal

reatribucias (mikuTvnebas), fsiqozuri gancdebis Sesaxeb pacientis

gaTviTcnobierebas. kognitur-bihevioruli Terapiis saxelmZRvanelo

xelmisawvdomia, magram Terapiis Casatareblad saWiroeba specialistis

trenireba da misi Semdgomi supervizia;

4. socialuri unar-Cvevebis treiningi: regularuli swavleba da

bihevioruli teqnikebis gamoyeneba daexmareba pacients SeiZinos da/an

gaaumjobesos komunikaciuri, sakuTari Tavis movlis da sociumSi

funqcionirebis unar-Cvevebi. Cveulebriv, es treiningi tardeba pacientTa

mcire jgufSi (6-8 kaci) da moicavs erTdroulad ara yvela socialur

unar-Cvevas, aramed mizanmimarTulia garkveuli funqcionirebis

sferosken, igi mkacrad struqturirebulia da sistematiurad aswavlis

pacientebs: sakuTari simptomebis amocnobas da marTvas, antifsiqozuri

medikamentebis sworad miRebas, SesaZlo gamwvavebis gamafrTxilebeli

niSnebis amocnobas, socialur urTierTobebs, rogoricaa Tavisufali

komunikaciebi (garegnuli ieri, gamometyveleba, xmis tembri), sakuTari

moTxovnilebebis gamoxatvas da uflebebis dacvas, aseve, samuSaoze

misaRebad intervius sworad warmarTvas.

37

danarTi #1

SANS (`minus-simptomatikis~ Sefasebis skala)

I afeqturi gasadaveba da gaRaribeba

afeqturi gasadaveba da siClunge manifestirdeba rogorc emociuri

gamoxatvis, emociuri reaqciis unaris da grZnobis damaxasiaTebeli

gaRaribeba.

qvemoTmoyvanili Temebi rom SevafasoT, Cveulebriv saWiroa vesaubroT

afeqturad mniSvnelovan Temebze.

1. saxis gaxevebuli gamometyveleba

pacientis saxe gamoiyureba gaxevebulad,

meqanikurad, gayinulad. saxis

gamometyveleba, saubris emociuri

Sinaarsis cvlilebis miuxedavad,

ucvlelia an odnav icvleba. radgan

neiroleptikebsac SeucliaT nawilobriv

aseTi efeqtis gamowveva, amitom zustad

unda davadginoT, iRebs Tu ara pacienti

neiroleptiks, magram ar unda SevecadoT,

rom es simptomi neiroleptikiT

gamowveul efeqtad CavTvaloT.

0= normaluri

1= SemCneuli fenomenis

paTologiuri xasiaTi

sakamaToa

2= mciredi paTologiuri

gamoxatuleba

3= zomieri paTologiuri

gamoxatuleba

4= gamoxatuli paTologia

5= mZimed gamoxatuli

paTologia

(saxe gaxevebulia an

odnav icvleba, Tu

icvleba, intervius

ganmavlobaSi)

2. spontanuri moZraobis Semcireba

pacienti saubris procesSi wynarad zis

da ar/an TiTqmis ar moZraobs. is

normalurad mosalodnelTan SedarebiT

ar/an naklebad amoZravebs xel-fexs, ar

icvlis jdomis pozas.

0= normaluri


paTologiuri xasiaTi

sakamaToa


gamoxatuleba


gamoxatuleba



paTologia (saxe

gaxevebulia an odnav

icvleba, Tu icvleba,

intervius ganmavlobaSi)

3. gamomsaxvelobiT moZraobaTa siRaribe

pacienti Tavis sxeuls, rogorc damxmare

saSualebas sakuTari Tavis gamosaxatavad

ver iyenebs. mag. rogoricaa xeliT

moZraobebi, skamidan win gadmoxra an

Tavisuflad ukan gadawola.

es aris damatebiT Sefaseba spontanuri

motorikis SemcirebasTan erTad.

0= normaluri


paTologiuri xasiaTi

sakamaToa

2= msubuqi, odnavi

daqveiTeba

3= zomiari, pacienti iyenebs

sxeuls

eqspresiisaTvis 3-4-jer

4= gamoxatuli, sxeuls

iyenebs 1-2-jer

5= mZime, ar iyenebs sxeuls

38

4. mzerTi kontaqtis simcire

pacienti saubris dros Tavs aridebs

mzeriT kontaqts, an TvalebiT aranairi

eqspresia ar gamoixateba. igi TiTqos

sivrces misCerebia, maSinac ki, roca

laparakobs.

0= normaluri


paTologiuri xasiaTi

sakamaToa


gamoxatuleba

3= zomieri, naxevarjer mainc

4= Zalian iSviaTia

5= arasodes ar iyenebs

5. afeqturi reagirebis ararseboba

(afeqturi gasadaveba)

pacienti ar/an arasakmarisad reagirebs

iseTi Sinaarsis saubrebze, romlebic

Cveulebriv iwveven gamxiarulebas an

damwuxrebas. interviuerma SeiZleba

TviTon gaicinos da SeekiTxos `xom ar

dagaviwyda rogor unda gaicino?~ (Tu

uyureb mis sapasuxo reaqcias)

0= normaluri


paTologiuri xasiaTi

sakamaToa

2= msubuqi, magram garkveuli

daqveiTeba

3= zomieri, zogjer TiTqos

ver pasuxobs

4= gamoxatuli, umetesad ver

pasuxobs

5= saerTod upasuxod

tovebs, provocirebis

SemTxvevaSic ki

6. Seusabamo afeti (paraTimia)

afeqturi reaqcia aris Seusabamo an

sawinaaRmdego. afeqturobis es aSliloba

imaSic gamoixateba, rom pacienti

seriozul an samwuxaro Temaze saubrisas

iRimeba, an iRebs miamitur (sulelur)

gamometyvelebas. uxerxulobis gamom-

xatveli Rimili ar unda Sefasdes

rogorc paraTimia.

0= normaluri


paTologiuri xasiaTi

sakamaToa


gamoxatuleba


gamoxatuleba



paTologia

7. vokaluri gamoxatvis unaris nakleboba

(monotonuri metyveleba)

pacients laparakisas ar gamosdis, rom

xmis intonacia normaluri hqondes.

mniSvnelovani sityvebi ar xasiaTdeba

tonis simaRlisa da siZlieris

cvalebadobiT. samwuxaro an zogadad

saintereso Temebze saubrisas ar gvaqvs

bgeraTa siZlieris modulacia.

0= normaluri


paTologiuri xasiaTi

sakamaToa

2= msubuqi

3= zomieri, zogjer aris

gasadaveba

4= gamoxatuli, TvalnaTeli

daqveiTeba

5= metyveleba aris

monotonuri

8. subieqturi Civilebi sicarielis

grZnobaze an SegrZnebis unaris

dakargvaze

pacienti aCvenebs rom verafers veRar

SeigrZnobs; mas SeuZlia aseve Tavi

aRweros rogorc grZnobebisagan

`daclilma~.

0= sruliad ara, pacienti

ambobs, rom normalurad

SeigrZnobs

1= fenomenis paTologiuri

xasiaTi sakamaToa

2= subieqturi SegrZnebebis

msubuqi, magram WeSmariti

Semcireba

39

3= zomieri Semcireba

4= aSkara Semcireba

5= pacienti aRniSnavs

grZnobebis SegrZnebis

uunarobas

9. afeqturi Semcirebis globaluri

Sefaseba

globaluri Sefaseba unda eyrdnobodes

afeqturi gasadavebisa da afeturi

siClungis zogad simZimes.

gansakuTrebuli mniSvneloba unda

mieniWos iseT ZiriTad niSnebs,

rogorebicaa: nakluli reagireba,

araadeqvaturoba da emociuri

intensiurobis zogadi Semcireba.

0= normaluri afeqti

1= afeqturi Semcireba

sakamaToa

2= msubuqi afeqturi

Semcireba

3= zomieri afeqturi

Semcireba

4= aSkara afeqturi

Semcireba

5= mZime afeqturi gasadaveba

da afeqturi siClunge

II alogia da paralogia

alogia aRwers azrovnebis da aRqmis gaRaribebas, rogorc es gvxvdeba

SizofreniiT daavadebul pacientebSi (a - niSnavs ararsebobas, logos –

azrs). azrovnebis procesi carielia, mouwesrigebeli an Senelebuli. alogia

pirvel rigSi gamoixateba Rarib, cariel metyvelebaSi (metyvelebis

siRaribe), an Cveulebrivi siWarbis, magram cariel metyvelebaSi (saubris

gaRaribeba) da/an pasuxis latenturi drois gazrdaSi.

10. saubris gaRaribeba

metyvelebis raodenobrivi gaRaribeba,

rasac amavdroulad Tan axlavs

formaluri dialogis CenarCunebis

uunaroba, an/da uinteresoba mag.

erTsiytviani pasuxebi, an kiTxvebis

upasuxod datoveba

0= gaRaribeba ar gvaqvs

pasuxTa arsobrivi da

Sesabamisi raodenoba

Seicaven damatebiT

informacias

1= gaRaribeba sakamaToa

2= msubuqi gaRaribeba

3= saubris zomieri

gaRaribeba;

zogierTi pasuxi Seicavs

damatebiT gamosadeg

informacias, bevri pasuxi

erTmarcvliania da

Zalian mokle (mag. xo;

ara; albaT; bolo kviras

da a. S.)

4= gamoxatuli gaRaribeba,

pasuxebi iSviaTad aris

ramdenime sityvaze

grZeli

5= mZime gaRaribeba, pacienti

Zalian cotas ambobs da

xSirad ar pasuxobs

11. metyvelebis Sinaarsobrivi gaRaribeba

saubari SeiZleba raodenobrivad

adeqvaturi iyos, magram uSinaarsoa an

umniSvnelo Sinaarsi aqvs, formaluri

dialogis unari SenarCunebulia, Tumca

Sinaarsobrivad gaRaribebulia.

0= gaRaribeba ar aris

1= gaRaribeba sakamaToa

2= msubuqi gaRaribeba,

SemTxveviTi pasuxebi

metad bundovania

imisaTvis, rom gavigoT

40

gansxvavdeba gaWianurebuli azrovnebisa-

gan, sadac subieqti gvaZlevs bevr

detals.

3= zomieri gaRaribeba,

pasuxTa umetesoba

bundovania

4= mniSvnelovani gaRaribeba,

sul mcire intervius

naxevari

5= mZime, TiTqmis mTeli

saubari bundovania da/an

gaugebari

12. azrebis wyveta, blokireba

metyvelebis mimdinareobis gawyveta –

sanam azri an idea damTavrdebodes.

pauzis Semdeg subieqti ver ixsenebs ras

ambobda. blokirebis konstatireba xdeba

mxolod maSin, rodesac subieqti TviTon

aRniSnavs azris Sewyvetas (gawyvetas) –

spontanurad, an eqimis SekiTxvaze

pasuxad.

0= ar aris

1= sakamaToa

2= 15 wuTis manZilze

erTxel aRmocendeba

3= 15 wuTis manZilze orjer

aRmocendeba

4= 15 wuTis manZilze samjer

aRmocendeba

5= 15 wuTis manZilze samze

metjer aRmocendeba

13. pasuxis latenturi drois gazrda

pacients pasuxis gasacemad Seusabamod

didi dro sWirdeba. ganmeorebiT

SekiTxvisas naTeli xdeba, rom pacientma

kiTxva gaigo, magram uWirs sakuTari

azrebis ganviTareba.

0= ar aris

1= sakamaToa

2= pasuxis win zogjer

mokle pauzebia

3= gamoxatuli pauzebi

4= latenturi drois

TvalsaCino gazrda

5= grZeli pasuxebi TiTqmis

yvela pasuxis win, an

pacienti TiTqmis ver

pasuxobs

14. alogiis subieqturi Sefaseba

pacienti aRniSnavs azrovnebis gaZnelebas

da/an siZneleebs Tanmimdevruli

azrovnebis gaSlaSi

0= saerTod ara

1= sakamaToa

2= msubuqi Semcireba

3= zomieri Semcireba

4= gamoxatuli Semcireba

5= pacienti aRniSnavs, rom

misi azrovneba metwilad

carielia da uWirs

sakuTari azrebis

ganviTareba

15. alogiuri azrovnebis globaluri

Sefaseba

unda Sefasdes metyvelebis gaRaribeba

da/an saubris Sinaarsis gaRaribeba.

paralogiuri azrovneba aris logikuri

azrovnebis uunarobis, an azrTa

TanmimdevrobaSi determinirebuli

tendenciis Sesustebis zogadi

gamoxatuleba, ris gamoc azrTa

Tanmimdevroba darRveulia.

0= ar aris

1= sakamaToa

2= umniSvnelo paTologia

3= paTologiuri gamoxatva

SesamCnevia

4= gamokveTili gaRaribeba

5= mZime gaRaribeba

15.a paralogia

paralogiuri azrovnebis Sefaseba unda

0= ar aris

1= sakamaToa

41

moxdes 5 gansxvavebis povnis kiTxviT

da/an andaziT.

2= 1 Secdoma pasuxSi



5= mniSvnelovani gamoxatva,

3 Secdomaze meti

III abulia-apaTia abulia Tavs iCens rogorc energiis, miswrafebebisa da interesebis

damaxasiaTebeli naklovaneba. zogjer pacientebi garedan stimulirdebian,

magram gamRizianeblis gaqrobis Semdeg stimuli swrafad qreba.

16. Tavis movla da higiena

pacienti sakuTari Tavis movlas da

higienas nakleb yuradRebas uTmobs; mas

unda aiZulo sxeulis movla. subieqts

SeiZleba hqondes WuWyiani, dauvarcxneli

Tma, WuWyiani xelebi, kbilebi, suni

piridan.

kiTxvebi: `ra sixSiriT iban tans?~;

`icvli tanisamoss, sacvlebs?~

0= ar aris

1= sakamaToa

2= msubuqi, magram

uyuradRebobis

aSkara niSani

3= mouwesrigebeli

garegnoba, pacients unda

mieTiTos, rom Tavs

mouaros

4= aSkarad mouwesrigebeli

garegnoba, pacients

mudmivad sWirdeba

miTiTeba Tavis movlaze

5= eqstremalurad

mouwesrigebeli

da mouvleli

17. araTanamimdevruloba profesiasa da

ganaTlebaSi

pacients ara aqvs regularuli samuSao

da/an am mimarTulebiT avlens

upasuxismgeblobas. stacionaris

pacientTan: igi ZaliT unda CavrToT

Sroma- an ergoTerapiaSi, an uars ambobs

iq wasvlaze. subieqts SeiZleba hqondes

samuSaos an swavlis mimarT midrekilebis

nakleboba – mis asakTan da sqesTan

SefardebiT.

0= ar aris

1= sakamaToa

2= araTanamimdevrulobis

msubuqi niSnebi

3= zomieri niSnebi, pacients

amaze unda mieTiTos

4= SesamCnevi niSnebi,

pacients sistematurad

unda mieTiTos

5= pacients Sroma an

ergoTerapiis Sesruleba

Tanmimdevrulad ar

gamosdis

18. fizikuri anergia

pacients aqvs midrekileba sxeulebrivi

moSvebulobisadmi. is saaTobiT zis

skamze da ar iZleva spontanur

aqtiurobas. igi met dros uTmobs pasiur

saqmianobas, mag. televizoris yurebas, an

is umoqmedoa.

kiTxvebi: `yofila Tu ar, rom mTeli dRe

wevxarT an zixarT umoqmedod?~; `es

gagrZelebula Tu ara erT dReze met

xans?~

0= ar aris

1= sakamaToa

2= msubuqi energiis dakargva

3= zomieri, pacients

periodulad unda

vaiZuloT iyos aqtiuri

4= pacients periodulad

unda vaiZuloT iyos

aqtiuri

5= pacienti metwilad

sruliad pasiuria

19. subieqturi Civilebi abuliasa da

apaTiaze

0= ar aris

1= sakamaToa

42

aq unda Sefasdes mxolod subieqturi

Civilebi energiisa da stimulebis

ararsebobaze.

2= msubuqi, magram sarwmuno

Civilebi

3= zomieri Civilebi

4= aSkara Civilebi

5= mZime Civilebi

20. globaluri Sefaseba

globalurma Sefasebam unda asaxos

apaTia-abuliis zogadi simZime sadac

gaTvaliswinebul unda iqnas pacientis

socialuri statusi da warmomavloba.

0= norma

1= sakamaToa

2= gamoxatulia mciredi

paTologia

3= paTologiuri

gamoxatuleba SesamCnevia

4= paTologiuri

gamoxatuleba TiToeli

damkvirveblisaTvis

SesamCnevia

5= mniSvnelovani gamoxatvis

done

IV anhedonia – asocialuroba es simptomokompleqsi moicavs pacientis siZneles, SeigrZnos interesi da/an

siamovneba, es SeiZleba gamoxatos sasiamovno aqtiurobebis mimarT interesTa

dakargvaSi, da/an amgvari qmedebebis dros, siamovnebis SegrZnebis uunarobaSi

da/an sxvadasxva tipis socialur urTierTobaTa ugulvebelyofaSi.

21. garToba da aqtiurobebi

pacients aqvs Zalian cota an aranairi

interesebi, aqtiuroba an hobi. Tumca es

simptomi SeiZleba nel-nela daiwyos,

saerTo jamSi mainc SesamCnevia aSkara

interesis dakargva adreul aqtiurobaTa

mimarT. aq ar unda Sefasdes pirveladi

SesaZlebeli Sizoiduri pirovneba,

romelsac aqvs dezinteresi socialuri

urTierTobebisadmi.

kiTxvebi: `Tu gaqvT interesi im

saqmianobisadmi, romelic Cveulebrivad

siamovnebas ggvridaT?~; `uyurebT Tu ara

televizors?~; `usmenT radios?~

0= normaluri

1= paTologiuri xasiaTi

sakamaToa


umniSvneloa


SesamCnevia


SesamCnevia TiToeuli

damkvirveblisaTvis


done

22. seqsualuri interesebi

fasdeba pacientis interesi da mzaoba

seqsualuri kontaqtebis mimarT.

0= normaluri


sakamaToa


umniSvneloa


SesamCnevia



damkvirveblisaTvis


done

43

23. unari, igrZnos intimuroba da siaxlove

Sefasdeba imis unari, rom garkveul

pirovnebasTan pirovnuli urTierToba

daamyaros da SeinarCunos.

kiTxvarebi: `xom ar gqoniaT problemebi

Tqveni ojaxis wevrTan an meuRlesTan?~;

`rogor grZnobT Tavs, roca xvdebiT

Tqvens ojaxs, meuRles da a. S?~

0= normaluri


sakamaToa


umniSvneloa

3= zomieri, siamovnebs,

magram TviTon ar iCens

iniciativas

4= SesasmCnevi, neitraluria

vizitebis mimarT

damkvirveblisaTvis

5= urCevnia ar hqondes

kontaqti, an aris

mtrulad ganwyobili

axloblebis mimarT

24. damokidebuleba naTesavebTan,

megobrebTan da TanatolebTan (autizmi)

fasdeba sakuTar socialur wreSi

kontaqtebis damyarebis unari. autisturi

pacientebi spontanur kontaqtebs ar

amyareben; Tu vinme mas amisken ubiZgebs,

isini aRniSnulze an gaRizianebiT

reagireben, an stimulis gaqrobis Semdeg

CaiZirebian Zvel mdgomareobaSi.

kiTxvebi: `Tu atarebT bevr dros Tqvens

megobrebTan?~; `Tu gsiamovnebT

martooba?~; `ra ufro gsiamovnebT,

martooba Tu megobrebTan urTierToba?~

0= normaluri


sakamaToa


umniSvneloa


SesamCnevia



damkvirveblisaTvis


done

25. anhedonia – asocialurobis subieqturi

gacnobiereba

pacienti TviTon aRwers, rom es Tvisebebi

dakarga.

0= ar aris

1= sakamaToa

2= msubuqi, magram sarwmuno

gacnobiereba

3= zomieri gacnobiereba

4= SesamCnevi gacnobiereba

5= mZime gacnobiereba

26. anhedonia – asocialurobis globaluri

Sefaseba

globalurma Sefasebam unda asaxos

zogadi simZime anhedonia –

asocialurobis kompleqsisa.

0= norma

1= sakamaToa

2= msubuqi

3= zomieri

4= gamoxatuli, SesamCnevia

yvelasaTvis

5= mZime gamoxatvis done

V yuradReba yuradReba SizofrenikebSi xSirad darRveulia. pacients uWirs yuradRebis

raime gansazRvrulze koncentrireba da/an mas mxolod is SeuZlia, rom

koncentrireba sporadulad an naxtomiseburad moaxdinos. TviT subieqts

SeiZleba hqondes an ar hqondes gacnobierebuli Tavisi yuradRebis

koncentraciis deficiti.

27. socialuri uyuradReboba

pacienti Tavis mxridan socialuri

aqtiurobebis mimarT araviTar interess

0= ar aris

1= sakamaToa

2= msubuqi, magram

44

ar amJRavnebs. es uyuradReboba SeiZleba

gamomJRavndes, mag. negatiur qcevebSi

da/an socialuri aqtiurobebisagan Tavis

aridebis mcdelobaSi, naklul

koncentrirebis unarSi – rodesac

kiTxulobs, TamaSobs, uyurebs

televizors.

uyuradRebobis

garkveuli niSnebi

3= zomieri, subieqts

drodadro gamorCeba Tu

ra xdeba garemoSi

4= gamoxatuli, subieqti

xSirad ver amCnevs Tu ra

xdeba garemoSi, aqvs

siZneleebi kiTxvis dros

5= mZime, subieqts ar ZaluZs

miiRos monawileoba

saubarSi, daimaxsovros

ras kiTxulobs, an

gaerkves satelevizio

gadacemis siuJetSi

28. uyuradReboba fsiqologiuri testirebis

mimdinareobisas

Skalis erTjeradi gamoyenebisas unda

Catardes MMS. es testi SeiZleba

ganmeordes 3-4 kviris Semdeg.

mravaljeradi gamoyenebisas da Terapiis

Sedegebis SefasebisaTvis Semdegnairad

unda moviqceT:

erTi kviris Semdeg gameorebisas

gamovaklebinoT 100-dan 7.

ori kviris Semdeg gameorebisas oTxniSna

ricxvi ukuRma.

sami kviris Semdeg gameorebisas

gamovaklebinoT 100-dan 9.

gamokvlevis damTavrebisas: MMS.

0= uSecdomo

1= sakamaTo (pacienti

davalebas yoymaniT

akeTebs da/an uSvebs erT

Secdomas, romelsac

maSinve asworebs)

2= erTi Secdoma

3= ori Secdoma

4= sami Secdoma

5= sam Secdomaze meti

29. subieqturi Civilebi uyuradRebobaze

pacienti SeniSnavs rom mas

koncentrirebisas garkveuli siZneleebi

aqvs da/an uWirs yuradReba mimarTos

raime garkveulze.

0= Civilebi ara aqvs

1= sakamaToa

2= msubuqi Civilebi

3= zomieri Civilebi

4= SesamCnevi Civilebi

5= mniSvnelovani Civilebi

30. globaluri Sefaseba

fasdeba yuradReba da koncertraciis

unari, romlis drosac yuradReba eqceva

rogorc klinikur suraTs, iseve

davalebaTa Sesrulebas.

0= norma

1= fenomenTa paTologiuri

xasiaTi sakamaToa


gamoxatva

3= SesamCnevi paTologiuri

gamoxatva


yvela mkvlevarisaTvis

SesamCnevia


done

45

danarTi #2

"SAPS" halucinaciebi

1) smenoTi halucinaciebi. pacients

esmis laparaki, sxva saxis xmebi, an

xmauri, romelic sxvas aravis esmis.

0 normaluri

1 SemCneuli fenomenis

paTologiuri xasiaTi sakamaToa

2 mciredi paTologiuri

gamoxatuleba

3 zomieri paTologiuri

gamoxatuleba

4 gamoxatuli paTologia

5 mZimed gamoxatuli paTologia

2) makomentirebeli xmebi. pacients esmis

xmebi, romlebic mis azrebs da qcevas

ukeTeben komentars.

0, 1, 2, 3, 4, 5

3) xmebi dialogis saxiT. pacients esmis

ori an meti erTmaneTSi mosaubere

xma.

0, 1, 2, 3, 4, 5

4) somaturi an taqtiluri

halucinaciebi. pacienti gadmogvcems

sxeulis sxvadasxva nawilebSi

subieqturi SegrZnebebis Sesaxeb.

0, 1, 2, 3, 4, 5

5) ynosviTi halucinaciebi. pacienti

gadmoqvcems arabunebrivi sunis

Sesaxeb.

0, 1, 2, 3, 4, 5

6) mxedvelobiTi halucinaciebi.

pacienti xedavs xalxs, sagnebs, an

raRac konturebs, Tumca obieqturad

aRniSnuli ar dasturdeba.

0, 1, 2, 3, 4, 5

7) halicinaciebis globaluri Sefaseba.

es Sefaseba unda eyrdnobodes

halucinaciebis simwvaves, xangrZli-

vobas, da pacientis cxovrebaze maT

zegavlenas.

0, 1, 2, 3, 4, 5

46

bodva

8) persekutoruli bodva. pacienti

darwmunebulia rom mas devnian an mis

winaaRmdeg SeTqmuleba mzaddeba.

0, 1, 2, 3, 4, 5

9) Razvianobis bodva. pacienti

darwmunebulia rom meuRle mas

Ralatobs meuRle.

0, 1, 2, 3, 4, 5

10) codvianobis da TviTdanaSaulis

bodva. pacienti darwmunebulia, rom

mas didi codva aqvs an raime

danaSauli miuZRvis.

0, 1, 2, 3, 4, 5

11) gandidebis bodva. pacienti darwmunebulia, rom is flobs did

Zalas, gansakuTrebul unars,

talants da simdidres.

0, 1, 2, 3, 4, 5

12) religiuri bodva. pacienti moculia

religiis arsis Sesaxeb mcdari

ideebiT.

0, 1, 2, 3, 4, 5

13) somaturi bodva. pacienti darwmunebulia, rom misi sxeuli

Secvlilia an daavadebuli.

0, 1, 2, 3, 4, 5

14) damokudebulebis bodva. pacienti

darwmunebulia, rom umniSvnelo

SeniSvna an raime movlena kavSirSia

masTan da gansakuTrebuli

mniSvneloba aqvs.

0, 1, 2, 3, 4, 5

15) zemoqmedebis (kontrolis) bodva.

pacienti darwmunebulia raRac

gareSe Zala mis emociebs da

moqmedebebs akontrolebs.

0, 1, 2, 3, 4, 5

16) gaxsnilobis bodva. pacienti grZnobs,

rom xalxi mis azrebs kiTxulobs.

0, 1, 2, 3, 4, 5

17) azrTa gadacema. pacienti

darwmunebelia, rom SesaZlebelia

distanciaze misi azrebis gadacema.

0, 1, 2, 3, 4, 5

18) azrTa Cadeba. pacienti

darwmunebulia, rom azrebi mas ki ar

ekuTvnis aramed gare Zalis mier aris

Cadebuli masSi.

0, 1, 2, 3, 4, 5

19) azrTa amoReba. pacienti

darwmenebulia, rom misi Tavidan

gareSe Zalis mier azrebi iqna

amoRebuli.

0, 1, 2, 3, 4, 5

20) bodviTi ideebis globaluri

Sefaseba unda eyrdnobodes bodvis

intensiobis da mdgradobis Sefasebas,

da maT gavlenas pacientis

cxovrebaze.

0, 1, 2, 3, 4, 5

47

ucnauri qceva

21) Cacmuloba da Sesaxedaoba. pacienti

Cacmulia ucnaur maneraSi, an

ucnaurad iqceva.

0, 1, 2, 3, 4, 5

22) socialuri da seqsualuri qceva.

pacients arsebuli

sociokulturaluri qceviTi

normebisgan mniSvnelovnad

gadaxril qcevebs avlens,

(magaliTad masturbacia xalxSi).

0, 1, 2, 3, 4, 5

23) agresiuli da aJitaciuri qceva.

pacienti iqceva

gauTvaliswineblad, agresiulad,

an SfoTvian-aJitaciur maneraSi.

0, 1, 2, 3, 4, 5

24) ganmeorebadi an stereotipuli

qceva. pacienti avlens erT wyeba,

ganmeorebad aqtiurobas an

rituals.

0, 1, 2, 3, 4, 5

25) qcevis ucnaurobis globaluri

Sefaseba. es Sefaseba asaxavs

qcevis tipis socialuri

normebidan gadaxris xarisxs.

0, 1, 2, 3, 4, 5

48

azrovnebis formis aSlis pozitiuri paTologia

26) metyvelebis katastrofiuli daSla.

metyvelebis paterni, romlis drosac

xdeba ideaTa mocureba, mosxleta, ris

gamoc saubari inacvlebs Temidan Temaze,

da xdeba daukavSirebeli.

0, 1, 2, 3, 4, 5

27) tangencialoba. SekiTxvaze gacemuli

mcdari, irelevanturi pasuxi.

0, 1, 2, 3, 4, 5

28) inkoherentuloba. metyvelebis paterni,

rodesac msjeloba arsebiTad gaugebaria.

0, 1, 2, 3, 4, 5

29) alogikuroba. metyvelebis magaliTi,

rodesac msjeloba alogikuria.

0, 1, 2, 3, 4, 5

30) detalizacia. metyvelebis magaliTi,

rodesac arsebiTi ideis gamoyofis gza

metismetad aramizanmimarTuli dawvril-

manebuli da arapirdapiria.

0, 1, 2, 3, 4, 5

31) aCqarebuli, SemWidrovebuli metyveleba.

pacientis metyveleba metad swrafia

Znelia misi SeCereba. metyvelebis

produqcia gacilebiT ufro didia vidre

amas norma saWiroebs.

0, 1, 2, 3, 4, 5

32) cvladi, dabneuli metyveleba. pacientis

metyveleba advilad gadadis axlomyofi

stimulis gavleniT erTi Temidan

meoreze.

0, 1, 2, 3, 4, 5

33) JReradoba. metyvelebis forma, rodesac

saubars warmarTavs ara misi Sinaarsi,

aramed xmovani msgavseba.

0, 1, 2, 3, 4, 5

34) azrovnebis formis aSlis pozitiuri

paTologiis globaluri Sefaseba. es

Sefaseba asaxavs azrovnebis normidan

gadaxris sixSires, xarisxs da im

zegavlenas, rasac es paTologia axdens

avadmyofis komunikaciis unarze.

0, 1, 2, 3, 4, 5

Seusabamo afeqti

35) Seusabamo afeqti. pacientis afeqti aris

Seusabamo, inkoherentuli, gasdavebuli da

blagvi.

0, 1, 2, 3, 4, 5

49

danarTi #3 uneblie paTologiuri moZraobebis skala* (AIMS)

pacientis saxeli, gvari ______________________________________;

gamokvlevis TariRi _____________________________;

daakvirdiT pacients gamokvlevamde an gamoklvevis Semdeg mosvenebis

mdgomareobaSi (mag., mosacdel oTaxSi).

skami, romelsac gasinjvisas gamoiyenebT, unda iyos magari da myari,

saxelurebis gareSe.

pacientis gamokvlevis damTavrebis Semdeg, TiToeuli simptomis simZime

unda Sefasdes skalaze 0 (ar aRiniSneba), 1 (minimaluria), 2 (saSualo

simZimisaa), 4 (mZimea).

SeekiTxeT pacients, raime xom ar udevs piris RruSi (kanfeti, an saReWi

rezini), Tu ki, sTxoveT, gamoiRos.

hkiTxeT pacients, rogoria misi kbilebis mdgomareoba: atarebs Tu ara

proTezs, amJamad Tu awuxebs kbilebi an proTezi?

hkiTxeT pacients, Tavad Tu uCivis piris, saxis, xelebis an fexebis uneblie

moZraobebs. Tu ki, maSin sTxoveT, aRweros - ramdenad awuxebs an uSlis

raime saxis saqmianobaSi.

sTxoveT pacients, dajdes skamze sworad, xelebi daiwyos muxlebze da

terfebiT daeyrdnos iataks (daakvirdiT am pozaSi mTlianad sxeulis

mdgomareobas).

pacients sTxoveT, xelebi CamouSvas, Tu mamakacia _ muxlebs Soris da

Tu qalia da kaba acvia, muxlebis gaswvriv (daakvirdiT xelebs da

sxeulis sxva nawilebs).

sTxoveT pacients, gaaRos piri (daakvirdiT enas mosvenebisas). es

gaakeTeT orjer.

sTxoveT pacients, ena gamoyos (daakvirdiT enis paTologiur

moZraobebs). es gaakeTeT orjer.

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

50

sTxoveT pacients, daakakunos jer marjvena, Semdeg marcxena xelis

ceriT, rac SeuZlia swrafad, 10-15 wm.-is ganmavlobaSi (daakvirdiT am

dros misi saxis gamometyvelebas da fexebis moZraobas).

moaxrevineT da gaaSlevineT marjvena da marcxena mklavi, rig-rigobiT.

sTxoveT pacients, adges (daakvirdiT mTel sxeuls profilSi).

sTxoveT pacients, mklavebi win ise gaiSviros, rom mtevnebi qvemoT

hqondes CaSvebuli (am dros daakvirdiT mis tans, fexebs da pirs)a.

sTxoveT pacients, gaiaros ramdenime nabiji, Semotrialdes da

dabrundes ukan skamisken (daakvirdiT mis siaruls da xelebs). gaakeTeT

es orjera.

a. moZraobis gaaqtiveba.

* Synopsis of psychiatry Behavioral science/Clinical psychiatry. 9-th edition Harold I. Kaplan, MD and Benjamin J. Sadock, MD p.424.

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

51

danarTi #4

pacientis saxeli da gvari _______________________________________;

gamokvlevis TariRi _______________________;

fsiqiatriuli Sefasebis mokle skala (BPRS)

SeitaneT qula, romelic yvelaze saukeTesod Seesabameba pacientis

mdgomareobis aRweras: 0=ar aRiniSneba, 1=Zlier susti, 2=susti, 3=saSualo,

4=zomieri siRrmis, 5=Rrma, 6=ukiduresad Rrma.

1. somaturi Civilebi

pacientis fizikur janmrTelobasTan dakavSirebuli ipoqondriuli

Civilebi. SeafaseT sakuTar fizikur janmrTelobaze pacientis Sexeduleba,

miuxedavad imisa, arsebobs Tu ara am Civilebis realuri safuZvli.

2. SfoTva

pacientis gadaWarbebuli Relva, wuxili an SiSi awmyosa da/an momavalze.

SeafaseT pacientis gancdebi mxolod misi naTqvamis safuZvelze. daskvna ar

gaakeToT SfoTvis fizikuri niSnebis, an nevrotuli dacviTi meqanizmebis

safuZvelze.

3. emociuri deficiti

pacientis emociuri deficiti garemos, intervius an interviueris mimarT.

pacientis susti emociuri kavSiris mixedviT SeafaseT izolacia.

4. konceptualuri dezorganizacia

pacientis wyvetili azrovneba da/an dezorganizaciis xarisxi. Sefaseba

moaxdineT pacientis metyvelebiTi produqciis safuZvelze. misi

funqcionirebis xarisxze daskvnas nu gaakeTebT pacientis Sexedulebis

mixedviT.

5. braleulobis gancda

pacientis gadaWarbebuli wuxili an sinanulis gancda warsulSi Cadenili

saqcielis gamo. SeafaseT pacientis braleulobis subieqturi gancda,

romelsac is emociurad gadmogvcems. daskvnas nu gaakeTebT pacientis

depresiis, SfoTvis an nevrotuli dacviTi qcevis mixedviT.

6. daZabuloba

pacientis ‘nevrotuli’ daZabuloba, romelic fizikurad vlindeba sxeulis

poziT, gamometyvelebiT, mousvenrobiT an sxvadasxva moZraobiT.

daZabuloba fasdeba mxolod fizikuri niSnebis da motoruli qcevis

safuZvelze da ara daZabulobis subieqturi gancdiT, romelsac Tavad

pacienti aRniSnavs.

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

52

7. maneruloba da poza

fsiqikuri problemis mqone zogierTi pacientis arabunebrivi poza da

uCveulo motoruli aqtivoba, riTac igi normaluri adamianisgan

gansxvavdeba. SeafaseT mxolod paTologiuri moZraobebi. aq ar SeafasoT

motoruli aqtivobis raodenobrivi mateba.

8. grandiozulobis (gandidebis) gancda

pacientis gadaWarbebuli TviTSefaseba, misi rwmena sakuTar gansakuTrebul

SesaZleblobebsa an ZalauflebaSi. SeafaseT sakuTar Tavze pacentis

gamonaTqvamebis da ara imis mixedviT, Tu rogor uWiravs mas Tavi

intervius procesSi.

9. depresiuli guneb-ganwyoba

pacientis sevdianoba, sasowarkveTileba. SeafaseT misi pesimisturi

gamonaTqvamebis da ara pacientis moZraobebis Senelebis, an

depresiuli/somaturi Civilebis mixedviT.

10. negatiuri ganwyobileba

pacientis gaboroteba, siZulvili, agresiuloba, zizRi sxva adamianebis

mimarT. SeafaseT mxolod pacientis gamonaTqvamebi imis Sesaxeb, Tu ras

gZnobs is, an rogor eqceva sxvebs. ar gaakeToT daskvna pacientis

negatiuri ganwyobis Sesaxeb misi nevrotuli qcevebis, SfoTvis an somaturi

Civilebis safuZvelze. (interviueris mimarT damokidebuleba SeafaseT

grafaSi `TanamSromlobis arqona~).

11. eWvianoba

pacientis (bodviTi) azrebi, rom sxvebs mis mimarT cudi ganzraxva an

boroti Canafiqri aqvT (an warsulSi hqoniaT). SeafaseT mxolod pacientis

mier gamoTqmuli eWvebi da ara misi wuxili warsuli an amJamindeli

situaciis gamo.

12. halucunaciuri qceva

aRqma, romelic ar Seesabameba realurad arsebul gareTa (eqsternalur)

stimuls. SeafaseT mxolod is gancda, romelsac pacienti aRwers

normaluri adamianebis warmosaxvisgan aSkarad gansxvavebul fenomenad,

romelic mas bolo kviris ganmavlobaSi aReniSneba.

13. motoruli Seferxeba

pacientis energiis daqveiTeba, rac vlindeba mis Senelebul qcevaSi.

SeafaseT mxolod pacientze dakvirvebis da ara pacientis sakuTari

energiis donis Sesaxeb Sexedulebis safuZvelze.

14. TanamSromlobis arqona

1; 2; 3;4;5;6;

1; 2; 3;4;5;6;

1; 2; 3; 4;5;6;

1; 2; 3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

53

pacientis SewinaaRmdegeba, gaRizianeba, ganawyeneba interviuerisadmi da

TanamSromlobis nakleboba. SeafaseT interviusadmi pacientis

damokidebulebis da misi pasuxebis safuZvelze; ar SeafasoT intervius

gareT gamRizianebloba da TanamSromlobis arqona.

15. uCveulo azrebi

pacientis uCveulo, odiozuri, ucnauri an eqscentruli azrebi. SeafaseT

mxolod ucnaurobis xarsixi da ara azrovnebis procesis dezorganizaciis

xarisxi.

16. emociuri gasadaveba

pacientis emociuri gamoxatulebis daqveiTeba, adekvaturi emociurobis da

emociuri urTierTobebis TvalsaCino deficiti.

17. agzneba

pacientis aweuli gamRizianebloba, aJitacia, momatebuli reagireba garegan

faqtorebze.

18 dezorientacia

pacientis adekvaturi orientaciis arqona adgilSi, droSi, garemoSi da

sakuTar vinaobaSi.

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

1; 2;3;4;5;6;

54

qronikuli bodviTi aSlilobani F22.0 (protokoli)

1. definicia

qronikuli bodviTi aSliloba ewodeba iseT aSlilobas, roca pirovnebas

aReniSneba xangrZlivad arsebuli myari araeqscentiuli Sinaarsis bodva,

romelic ar miekuTvneba sxva fsiqiatriul aSlilobas, xolo xangrZlivoba

sul cota, erTi Tve mainc aris. am aSlilobis Zveli saxelwodebaa

paranoia anu paranoiduli aSliloba.

2. kriteriumebi

qronikuli bodviTi aSlilobebis diagnostikuri kriteriumebia:

A. araeqscentriuli Sinaarsis bodva (amaSi Sedis realuri

cxovrebiseuli situaciebi, agreTve devnis, mowamvlis, erotomaniuli

anu siyvarulis, Razoianobis, ipoqondriuli bodva), romlis

xangrZlivoba sul cota, 1 Tvea;

B. arasodes aRiniSneba Sizofreniis kriteriumi. SeniSvna: SesaZloa

ynovis (olfaqtoruli) an taqtiluri halucinaciebis arseboba, Tuki

isini dakavSirebuli arian bodvis TematikasTan;

C. Tu es ar Seexeba bodvis Tematikas, pacientis funqcionireba

mniSvnelovanad ar irRveva da misi qceva TvalsaCinod odiozuri an

eqscentriuli ar aris;

D. Tu bodvasTan erTdroulad guneb-ganwyobis darRvevis epizodi

aRmocenda, igi ufro xanmoklea, vidre bodvis periodis

xangrZlivoba;

E. aSlilobis ganviTareba ar aris dakavSirebuli fsiqoaqtiuri

nivTierebebis (an sxva farmakologiuri saSualebebis) gamoyenebasTan

an/da zogadsamedicino problemiT gamowveul mdgomareobasTan.

dasazustebelia tipi (bodvis dominanturi Tematikis mixedviT Semdegi

tipebi arsebobs):

erotomaniuli tipi: bodva, rom viRacis, ZiriTadad masze maRali statusis

pirovnebis siyvarulis obieqtia;

gandidebis tipi: bodva, rom aris gansakuTrebuli Rirsebis,

individualobis, Zalauflebis, codnis mqone; aqvs piradi urTierToba

RmerTTan an saxelganTqmul adamianTan(ebTan);

Razoianobis tipi: bodva, rom misi seqsualuri partniori Ralatobs;

devnis tipi: bodva, rom mas (an mis uaxloes adamians) devnian;

somaturi tipi: bodva, rom mas aqvs raRac fizikuri defeqti/nakli, an

raRac avadmyofobiT aris daavadebuli;

Sereuli tipi: ar aris dominanturi bodvis mxolod erTi romelime tipi,

aramed ramdenime tipia Sereuli;

dauzustebeli tipi.

55

3. simptomebi da niSnebi

qronikuli bodviTi aSlilobebis es jgufi xasiaTdeba xangrZlivad

arsebuli myari bodviT, romlis klinikuri niSnebis klasifikacia ar

xerxdeba organul, Sizofreniul an guneb-ganwyobis aSlilobebis jgufSi.

bodviTi aSlilobis dros klinikur suraTSi saxezea monoTematuri bodva

an urTierTdakavSirebuli bodviTi azrebis erToblioba, romelic

arsebobs xangrZlivad, SesaZloa, mTeli sicocxlis ganmavlobaSi. es

bodvebi Zlier variabeluria da xSirad warmodgenilia devnis,

ipoqondriuli da gandidebis saxiT. aseve, bodviTi azrebis Sinaarsi

SesaZloa iyos pirovnebis Razoianobis, sakuTari sxeulis formis Secvlis

(dismorfofobia) da sxvebis mier misi negetiurad (mag, homoseqsualuri

orientaciis an specifikuri sunis mqone adamianad) Sefasebis ideebi. am

aSlilobis dros sxva fsiqopaTologiuri simptomebi ar aRiniSneba, garda

periodulad ganviTarebuli depresiisa da erTeul SemTxvevebSi

aRmocenebuli ynosviTi (olfaqtoruli) da taqtiluri halucinaciebisa.

iSviaTad, ZiriTadad moxucebSi, aseve SesaZloa erTeuli `xmebis~ arseboba.

ZiriTadad, es aSliloba iwyeba Sua xnis asakSi Tumca, zog SemTxvevaSi,

saxeldobr dismorfofobiis dros, adreul asakSic SeiZleba daiwyos.

xSirad, bodvis Sinaarsi da misi aRmocenebis dro dakavSirebulia

garkveul cxovrebiseul situaciasTan, mag. devnis bodva arcTu iSviaTad

gvxvdeba eTnikuri (an sxva) umciresobis wevrebSi. Tuki ar Seexeba bodviT

azrebs, pirovnebis emociuri sfero, metyveleba da qceva normis

farglebSia.

56

qronikuli bodviTi aSlilobebis diagnostikur-laboratoriuli testebis

Catareba (4) da mkurnaloba (5) xdeba mwvave da qvemwvave mdgomareobebis

mixedviT

4. gamokvlevis da 5. mkurnalobis sqema


Cveulebriv, qronikuli bodviTi aSlilobis mqone pacientTa

mkurnaloba tardeba dispanserulad. magram arsebobs ramdenime

mizezi, roca hospitalizacia aucilebelia:

1. sruli samedicino gamokvlevis mizniT (gansakuTrebiT

nevrologiuri da somaturi mizezebi);

2. pacientis agresiuli qceva (suiciduri an homociduri

qcevis impulsebi);

3. pacientis gamoxatuli disfunqciuri qceva ojaxSi da

samsaxurSi, rac bodvis SinaarsTan aris dakavSirebuli. am

dros socialuri da samsaxureobrivi urTierTobebis

stabilizaciisaTvis saWiroa profesiuli Careva.

antifsiqozuri medikameturi mkurnaloba:

• wamlis arCeva ganpiroebebulia warsulSi simptomebis ama Tu

im preparatisadmi karg daqvemdebarebaze;

• mkurnaloba unda daiwyos nel-nela, mzardi dabali doziT

(mag. 2 mg. haloperidoli);

• SesaZloa, efeqturi iyos pimozidi, gansakuTrebiT somaturi

bodvis dros;

• antifsiqozur mkurnalobisadmi daqvemdebarebis dros

SemanarCunebeli dozebi Terapiulze dabali unda iyos;

• antifsiqozuri medikamentebis araefeqtianobis SemTxvevvaSi

mkurnalobis unda Sewydes;

• am dros SesaZloa efeqtiani iyos antidepresantebis, liTiumis

da antikonvulsantebis (karbamazepini* da valproatis*)

gamoyeneba, gansakuTrebiT maSin, roca pacients aqvs guneb-

ganwyobis aSlilobis simptomebi an guneb-ganwyobis aSlilobis

ojaxuri istoria.

57

Sizotipuri aSliloba F21 (protokoli)

1. definicia

Sizotipuri aSliloba xasiaTdeba eqscentriuli qceviT, azrovnebis da

emociuri sferos Sizofreniis msgavsi darRvevebiT, romlebic SesaZloa

nebismier stadiaze ganviTardes. am aSliloisTvis aseve damaxasiaTebelia

e.w. `meeqvse grZnobis~ arseboba, zogjer damokidebulebis azrebi, iluziebi,

iSviTad derealizaciis epizodebi.

2. diagnostikuri kriteriumebi

Sizotipuri aSlilobis dros SeiZleba ganviTardes sxvadasxva klinikuri

simptomebi, Tumca yvela maTgani ar aris am aSlilobisTvis tipiuri. es

simptomebia:

1. Seusabamo an Sekavebuli emociuri reagireba (emociuri `sicive~ da

indiferentuloba);

2. ucnauri, eqscentriuli an Taviseburi garegnoba da qceva;

3. irgvlivmyofebTan urTierTobis damyarebisa da SenarCunebis unaris

gauareseba da socialuri izolaciisadmi midrekileba;

4. ucnauri (odiozuri) myari Sexedulebebi an rwmena, romelic

gavlenas axdens pirovnebis qcevaze da ar Seesabameba eTnokulturul

normebs;

5. iWvneuloba an paranoiduli ideebi;

6. Sinagani winaaRmdegobis gareSe dismorfofobiuli, seqsualuri an

agresiuli Sinaarsis azrebis akviateba;

7. uCveulo somatosensoruli percefciuli gancdebi an sxva iluziebi,

depersonalizacia da derealizacia;

8. bundovani, metaforuli, detalur-skrupulozuri, an stereotipuli

azrovneba, rac vlindeba ucnauri metyvelebiT, Tumca aSkara

alogikuroba ar aRiniSneba;

9. epizoduri tranzitoruli (kvazi)fsiqozuri epizodebi _ intensiuri

iluziebis, smeniTi an sxva halucinaciebis, bodvismagvari ideebisa,

romlebic umetesad garegani trigeris (biZgi) gareSe aRmocendebian.

Sizotipur aSlilobas axasiaTebs qronikuli mimdinareobis da gamwvavebis

epizodebis fluqtuacia.

3. simptomebi da niSnebi Sizotipuri aSliloba xasiaTdeba eqscentriuli qceviT, azrovnebisa da

emociur sferoebSi darRvevebiT (romelic msgavsia Sizofreniulisa), kerZod:

emociuri indiferntuloba an araadeqvaturoba, anhedonia, socialuri

izolaciisadmi midrekileba, paranoiduli an ucnauri azrebi, romlebic

bodvis xarisxs ar aRweven, akviatebuli azrebi, azrovnebiTi coxna (умственная жвачка), aRqmis sferos darRvevebi, ZiriTadad iluzoruli, SesaZloaHsmeniTi

an sxva saxis halucinaciebis ganviTarebac. aSlilobis dawyebis zusti drois

gansazRvra Zalze rTulia, xolo mimdinareoba iseTivea, rogoric pirovnuli

58

aSlilobebis dros. aRniSnulis dasturia is faqtic, rom DSM-IV-TR

klasifikaciaSi es aSliloba Setanilia Sizotipuri pirovnuli aSlilobis

saxeliT, pirovnuli aSlilobebis A jgufSi (A cluster). Sizotipuri aSlilobis diagnostikur-laboratoriuli testebis Catareba

(4) da mkurnaloba (5) xdeba mwvave da qvemwvave mdgomareobebis mixedviT


efeqtiani mkurnalobisaTvis erTdroulad gamoiyeneba farmakoTerapia

(ix. Sizofreniis mkurnaloba) da fsiqoTerapia. medikamentebidan

iyeneben:

1. antifsiqozur medikamentebs, roca pacients aReniSneba

damokidebulebis azrebi, iluziebi da sxva fsiqozuri

simptomebi;

2. antidepresantebs, roca saxezea depresiuli simptomatika.

efeqtiani mkurnalobisTvis mniSvnelovania Semdegis

gaTvaliswineba:

1. diagnozis dazusteba;

2. Sesaferisi intervenciis Sesaxeb gadawyvetilebis miReba;

3. SesaZlo garTulebebis marTva.

ZiriTadad gamoiyeneba individualuri fsiqoTerapia. am dros

dasaZlevia iseTi seriozuli problema, rogoricaa pacientis

undobloba, ris gamoc udidesi mniSvneloba aqvs Terapevtis

profesionalizms da moTminebas (tolerantobas);

Sizotipuri aSlilobis mqone pacientebs uWirT jgufur

fsiqoTerapiaSi CarTva. Tumca, pacientis socialuri unar-Cvevebis

gasavarjiSeblad da misi iWvneulobis Sesamcireblad (roluri

TamaSebis gamoyenebiT) igi efeqtiania.

59

Sizoafeqturi aSliloba F25 (protokoli)

1. definicia

saxelwodebis Sesabamisad, Sizoafeqtur aSlilobas axasiaTebs rogorc

Sizofreniis, aseve guneb-ganwyobis aSlilobis damaxasiaTebli niSnebi. igi

warmoadgens Setevebis saxiT ganviTarebul aSlilobas, roca klinikur

suraTSi erTdrouladaa saxeze guneb-ganwyobis aSlis da Sizofreniuli

simptomebi. Sizoafeqturi aSlilobis Setevebi xasiaTdeba simwvaviT,

cvalebadobiT da didi polimorfizmiT. amasTan, klinikur suraTSi

yovelTvis mniSvnelovani adgili uWiravs afeqtur darRvevebs.


Sizoafeqturi aSlilobis diagnostikuri kriteriumebia:

A. daavadebis periodis ganmavlobaSi uwyvetad saxezea, xan didi

depresiuli epizodi, xan maniis epizodi, an Sereuli epizodi,

fsiqozur simptomebTan erTad, romlebic Seesamabeba

Sizofeniis A kriteriums;

SeniSvna: didi depresiuli epizodi unda moicavdes A1 kriteriums: pacienti (an irgvlivmyofebi) aRniSnavs depresiul

guneb-ganwyobas (sevdas, sicarielis grZnobas) mTeli dRis, an

dRis umetesi nawilis ganmavlobaSi).

B. daavadebis garkveuli periodis ganmavlobaSi, sul cota, 2

kviris manZilze mainc, aRiniSneba bodva(ebi) an halucinaciebi,

TvalsaCinod gamoxatuli guneb-ganwyobis aSlis simptomebis

gareSe;

C. TiTqmis mTeli daavadebis aqtiuri da rezidualuri

periodebis ganmavlobaSi saxezea simptomebi, romlebic

Seesabameba guneb-ganwyobis aSlis epizodis simptomebs;

D. aSlilobis ganviTareba ar aris dakavSirebuli fsiqoaqtiuri

nivTierebebis (an sxva farmakologiuri saSualebebis)

gamoyenebasTan an/da zogadsamedicino problemiT gamowveul

mdgomareobasTan.

dasazustebelia tipi:

bipolaruli tipi: roca aSliloba moicavs maniis an Sereul epizods

(an maniis an Sereul epizods da did depresiul epizods);

depresiuli tipi: roca aSliloba moicavs did depresiul epizods.

60


Sizoafeqturi aSliloba warmoadgens Setevebis saxiT ganviTarebul

aSlilobas, roca klinikur suraTSi erTdroulad wina planzea guneb-

ganwyobis aSlis da Sizofreniuli simptomebi, amasTan, TiToeuli maTgani

sul cota ramdenime dRe mainc grZeldeba. vinaidan, es aSliloba ar

warmoadgens guneb-ganwyobis tipiur aSlilobas da Sizofrenias,

ganixileba damoukidebel kategoriad, sakmaod xSirad gvxvdeba da misi

diagnostikuri ignorireba ar SeiZleba.

sxva mdgomareobebi, romlis drosac guneb-ganwyobis aSlis simptomebi: a)

gadafarulia an warmoadgens nawils klinikur suraTSi ukve arsebuli

Sizofreniuli daavadebisa; b) Tanaarsebobs an monacvleobs sxva tipis

persistiul (myar) bodviT aSlilobasTan, Sesabamis kategoriaSi, anu

`Sizofrenia da Sizotipuri aSliloba~-Si klasificirdeba.

aseve, guneb-ganwyobis arakongruentuli bodva(ebi) an halucinaciebi,

TavisTavad, ar gulisxmobs Sizoafeqturi aSlilobis diagnozs. guneb-

ganwyobis am aSlilobebs miekuTvneba: a) mania fsiqozuri simptomebiT; b)

bipolaruli afeqturi aSliloba mimdinare epizodSi maniiT, fsiqozuri

simptomebiT; g) bipolaruli afeqturi aSliloba mimdinare epizodSi mZime

depresiiT, fsiqozuri simptomebiT; d) mZime depersiuli epizodi fsiqozuri

simptomebiT; e) rekurentuli depresiuli aSliloba mimdinare epizodSi

mZime fsiqozuri simptomebiT.

pacientebi, romelTac aReniSnebaT rekurentuli Sizoafeqturi aSlilobis

epizodebi, upiratesad maniis tipiT (naklebad depresiuli tipi),

Cveulebriv srul remisias aRweven da Zalze iSviaTad uviTardebaT

defeqti.

Sizoafeqturi aSlilobis diagnostikur-laboratoriuli testebis


mixedviT

61


farmakoTerapia:

1. guneb-ganwyobis stabilizatorebi (ix. guneb-ganwyobis

aSlilobis mkurnaloba) _ gamoiyeneba maniis epizodis

samkurnalod. guneb-ganwyobis aSlilobis bipilaruli tipis

mkurnalobisas liTiumisa da karbamazepinis efeqtianoba

erTnairia, maSin roca Sizoafeqturi aSlilobis depresiuli

tipis dros karbamazepinis efeqtianoba aRemateba liTiumisas.

SemanarCunebeli Terapiisas, gverdiTi efeqtebis (Tireoidul

jirkvalze da Tirkmelebze potenciuri moqmedebis) Tavidan

asacileblad, dozebi nel-nela mcirdeba. amave mizniT,

periodulad xdeba monitoringi: plazmaSi wamlis

koncentraciis, sisxlis, Tireoiduli jirkvlis da Tirkmlis

funqciis laboratoriuli gamoklvevebi.

2. antidepresantebi (ix. depresiis mkurnaloba) gamoiyeneba

depresiuli epizodis samkurnalod zustad ise, rogorc

bipolaruli depresiis dros. medikamentis amorCeva xdeba

winandeli mkurnalobis Sedegebis gaTvaliswinebiT. Cveulebriv,

pirveli arCevis medikamentebia serotoninis ukumitacebis

seleqtiuri inhibitorebi (SSRI), Tumca, agznebisa da uZilobis

SemTxvevaSi efeqtiania gamoiyeneba tricikluri

antidepresantebi.

3. antifsiqozuri medikamntebi gamoiyeneba fsiqozuri simptomebis

koregirebisaTvis (ix. Sizofreniis mkurnaloba)

fsiqosocialuri mkurnaloba mniSvnelovnad aumjobesebs am

aSlilobis gamosavals. gamoiyeneba Semdegi meTodebi:

1. ojaxuri Terapia;

2. socialuri unar-Cvevebis gamomuSaveba (treningi).

3. kognituri reabilitacia.

62

mwvave da tranzitoruli fsiqozuri

aSlilobani F23 (protokoli)

1. definicia

mwvave da tranzitoruli fsiqozuri aSliloba ewodeba iseT aSlilobas,

roca pirovnebas garkveuli fsiqo-socialuri stresoris(ebis) sapasuxod

uviTardeba Sizofreniis msgavsi simptomebi _ bodva da halucinaciebi,

romelTa xangrZlivoba erTi dRidan erT Tvemdea.


mwvave da tranzitoruli fsiqozuri aSlilobebis diagnozi ismeba,

roca:

A. saxezea Tundac erTi Semdegi simptomebidan:

(1) bodva;

(2) halucinaciebi;

(3) dezorganizebuli metyveleba (asociaciebis kargva/wyveta an

inkoherentuloba);

(4) mniSvnelovnad/uxeSad dezorganizebuli an katatoniuri

qceva.

SeniSvna: simptomebSi ar Seva subkulturulad miRebuli

qcevis tipi.

B. aSlilobis xangrZlivoba aranakleb erTi dRe da ara umetes

erTi Tvea da premorbiduli funqcionirebis donis sruli

aRdgeniT mTavrdeba.

C. aSliloba zustad ar Seesabameba guneb-ganwyobis aSlilobas

fsiqozuri simptomebiT, Sizoafeqtur aSlilobas, an

Sizofrenias da ar aris dakavSirebuli fsiqoaqtiuri

nivTierebebis (an sxva farmakologiuri saSualebebis)

gamoyenebasTan an/da zogadsamedicino problemiT gamowveul

mdgomareobasTan.

dasazustebelia, Tuki dawyeba:

ukavSirdeba TvalaCino stresors(ebs) (xanmokle reaqtiuli fsiqozi);

ar ukavSirdeba TvalsaCino stresors(ebs);

ukavSirdeba mSobiarobis Semdgom periods.


mwvave da tranzitoruli fsiqozuri aSlilobis dros adgili aqvs iseTi

mwvave fsiqozuri simptomebis uecrad dawyebasa da ganviTarebas,

rogoricaa bodva(ebi), halucinaciebi, gaugebari an inkoherentuli

metyveleba, an aRniSnul simptomTa nebismieri kombinacia. pirveli

fsiqozuri gamovlinebis dawyebasa da klinikuri suraTis srul gaSlas

Soris drois intervali 2 kviras ar aRemateba. niSandoblivia am

63

aSlilobis xSiri kavSiri mwvave stresTan, romelsac aqvs adgili pirvel

fsiqozur gamovlinebamde 2 kviriT (an naklebi droiT) adre. fsiqozuri

epizodis xangrZlivoba meryeobs 1 dRidan 1 Tvemde da sabolood

premorbiduli funqcionirebis donis aRdgeniT sruldeba.

mwvave da tranzitoruli fsiqozuri aSlilobis diagnostikur-

laboratoriuli testebis Catareba (4) da mkurnaloba (5) xdeba mwvave da

qvemwvave mdgomareobebis mixedviT


mkurnalobis strategiebi:

1. hospitalizacia;

2. farmakoTerapia;

3. fsiqoTerapia.

mwavave tranzitoruli fsiqozis mqone pacientebis

hospitalizaciis mizania Sefaseba da gakontroleba:

1. fsiqozuri simptomebis da

2. agresiuli qcevis (suiciduri an homociduri qcevis

impulsebi)

farmakoTerapiisTvis gamoiyeneba fsiqotropuli medikamentebis

ori ZiriTadi jgufi:

1. antifsiqozuri (mag. haloperidoli, risperidoni, Terapiul

dozebSi) da

2. anqsiolizuri (benzodiazepinebi). gasaTvaliswinebelia, rom

maT gamoyenebasTan dakavSirebulia iSviaTad pacientis

agzneba da ufro iSviaTad, xanagrZlivad maRali dozebiT

mkurnalobis Semdeg, wamlis moxsnisas ganviTarebuli

krunCxvebi. medkamenturi mkurnalobis ZiriTadi startegiaa xanmokle

Careva. maSin, roca saWiro xdeba SemanarCunebeli Terapia,

mizanSewonilia diagnozis gadaxedva.

fsiqoTerapia (kognituri Terapia) warmoadgens xangrZlivi Carevis

ZiriTad strategias, romelic fokusirdeba iseTi sakiTxebze,

rogoricaa:

1. stresorebi (fsiqozis maprovocirebeli matravmirebeli

situacia),

2. fsiqozuri epizodi,

3. stresis daZlevis strategiebi,

4. pacientis TviTSefaebis gaumjobeseba.

agreTve, Zalze mniSvnelovania ojaxis wevrebis CarTva pacientis

mkurnalobis procesSi.

64

Sizofreniismagvari aSliloba F20.8 (protokoli)

1. definicia

Sizofreniismagvari (schizofreniform) aSlilobis gamovlineba Sizofreniis

msgavsia da grZeldeba aranakleb erTi Tve da araumetes eqvsi Tvisa. am

aSlilobis mqone pacientebi (gansxvavebiT SizofreniiT daavadebuli

pacientebisgan) epizodis amowurvis Semdgom ubrundebian funqcionirebis

premorbidul dones.

2. diagnostikuri kriteriumebi, 3. simptomebi da niSnebi

Sizofreniismagvari (Sizofreniis sxva formebi) aSliloba

A. saxezea Sizofreniis A, D, E kriteriumebi (ix. Sizofreniis

diagnostikuri kriteriumebi).

B. aSlilobis epizodi (prodromuli, aqtiuri da rezidualuri

fazebis CaTvliT) grZeldeba sul cota, 1 da maqsimum 6 Tve

(roca saWiroa diagnozis dasma pacientis gamojanmrTelebamde,

kvalificirdeba `winaswar diagnozad~).

ganisazRvros, roca aris keTilsaimedo prognozuli niSnebi:

1) normaluri qcevis da funqcionirebis Secvlis pirveli

gamovlinebidan 4 kviris ganmavlobaSi viTardeba dominanturi

fsiqozuri simptomi(ebi);

2) abneva (an cnobierebis sxva Secvla) fsiqozuri epizodis pikze;

3) socialuri funqcionirebis maRali premorbiduli xarisxi;

4) guneb-ganwyobis daClungebis an gasadavebis ararseboba.

Sizofreniismagvari aSlilobis diagnostikur-laboratoriuli testebis


mixedviT


am aSlilobis mkurnalobis strategia iseTivea, rogorc Sizofreniisa

(ix. Sizofreniis mkurnaloba). am ukanasknelisgan gansxvavebiT

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

mkurnalobas 8 dReSi.

65

inducirebuli fsiqozuri aSliloba F24 (protokoli)

1. definicia

inducirebuli fsiqozuri aSliloba warmoadgens iseT aSlilobas,

romelic aReniSneba emociurad mWidro kavSiriSi myof or (an met) adamians.

am dros mxolod erT maTgania daavadebuli genuinuri fsiqoziT, xolo

meore piri inducirebulia. am aSlilobis SemTxvevebis 95% erTi ojaxis

or wevrs moicavs, roca erT-erTi maTgani dominanturia da avadaa

SizofreniiT (an sxva fsiqozuri aSlilobiT), xolo meore mimRebia da

xSirad Tavad aris fizikurad araSromisunariani (mag, smenadaqveiTebuli,

aqvs cerebrovaskularuli aSliloba an sxva mizeziTaa damokidebuli

dominantur pirovnebaze). ufro xSirad gvxvdeba dabal socio-ekonomikur

fenebSi da umetesad qalebSi.

2. daignostikuri kriteriumebi

inducirebuli fsiqozuri aSlilobis kriteriumebia:

A. pirovnebas bodva uviTardeba iseT situaciaSi, roca mas aqvs mWidro

kavSiri meore pirovnebasTan, xolo am ukanasknels aReniSneba

Camoyalibebuli bodva;

B. SinaarsiT bodva msgavsia im pirovnebis bodvisa, romelsac ukve

Camoyalibebuli bodva aqvs;

C. aSliloba zustad ar Seesabmeba sxva fsiqozur aSlilobas (mag.

Sizofrenias) an guneb-ganwyobis aSlilobas fsiqozuri simptomebiT da

ar aris dakavSirebuli fsiqoaqtiuri nivTierebebis (an sxva

farmakologiuri saSualebebis) gamoyenebasTan an/da zogadsamedicino

problemiT gamowveul mdgomareobasTan.


am aSlilobis mqone pirovnebis(ebebis) uaxloesi adamiani, mag. ojaxis

wevri, daaavadebulia SizofreniiT, Sizotipuri aSlilobiT, qronikuli

bodviTi aSlilobiT, mwvave an tranzitoruli fsiqozuri aSlilobiT,

romelTanac mWidro kavSiriSi imyofeba es pirovneba (mimRebi).

imavdroulad igi izolirebulia sxva adamianebisgan. Cveulebriv,

inducirebuli fsiqozuri aSliloba reducirdeba, rogorc ki e.w. mimRebi

piri gancalkevdeba dominanturi genuinuri fsiqozuri aSlilobis mqone

pirisgan.

inducirebuli aSlilobis diagnostikur-laboratoriuli testebis


mixedviT

66



gaTvaliswineba:




mkurnalobis ZiriTadi strategia:

• pacientis (mimRebis) gancalkeveba dominanturi (genuinuri

fsiqozis mqone) pirisgan;

• Tuki aucilebelia hospitalizacia, maTi moTavseba xdeba

sxvadasxva ganyofilebaSi;

• Cveulebriv, pacientis (mimRebis) bodviTi azrebi

reducirdeba antifsiqozuri medikamenturi Carevis gareSe.

67

sxva araorganuli fsiqozuri aSliloba F28 da dauzustebeli (araspecifikuri) araorganuli

fsiqozi F29 (protokoli)

1. definicia

am saxelwodebis qveS aerTianeben fsiqozur simptomebs (halucinaciebs,

bodvas(ebs), dezorganizebul metyvelebas da qcevas), romelic ar

akamyofilebs sxva romelime fsiqozuri aSlilobis diagnostikur

kriteriumebs.

am aSlilobebis erT-erTi tipis, autoskopiuri fsiqozis mizezi cnobili

ar aris. etiologiiis biologiuri hipoTezis mixedviT, Tavis tvinis

safeTqel-Txemis wilebSi paTologiuri cvlilebebi (romelic

pasuxismgebelia TviTSegZnebaze), romelic kombinaciaSia mxedvelobis

qerqis paTologiur aqtivobasTan, ganapirobeben am aSlilobis ganviTrebas.

es, fsiqologiuri TvalsazrisiT, dakavSirebulia personologiur

aSlilobebTan (ZiriTadad, narcistul personologiur aSlilobasTan).

swored aseT adamianebs, romelTac axasiaTebT warmosaxva da vizualuri

sensitiuroba, maTTvis stresul periodebSi aReniSnebaT autoskopiuri

halucinaciebis epizodebi.

am aSlilobebis sxva tips warmoadgens mSobiarobisSemdgomi fsiqozi

(zogjer samSobiaro fsiqozs uwodeben), romelic uviTardebaT

axladnamSobiarev qalebs. misi gavrceleba udris daaxloebiT 1-s 1000

axladnamSobiarevze. aSlilobis mqone qalTa daaxloebiT 5-60%-s fsiqozi

uviTardebaT pirveli Svilis yolis Semdeg, aseve 50%-s aReniSnebaT

perinataluri arafsiqiatriuli garTulebebi, rogoricaa infeqcia,

intoqsikacia (mag, skopolaminiT), toqsemia da didi raodenobiT sisxlis

dakargva. mTeli rigi monacemebis mixedviT, mSobiarobisSemdgomi fsiqozi

warmoadgens guneb-ganwyobis aSlilobis epizods.

2. diagnostikuri kriteriumi

es kategoria moicavs fsiqozur simptomatikas: bodvas, haluciancias,

dezorganizebul metyvelebas, uxeSad dezorganizebul an katatoniur

qcevas, roca garkveuli diagnozis dasasmelad ar aris sakmarisi (an aris

urTierTgamomricxvi) informacia an/da ar akmayofilebs romelime

fsiqozuri aSlilobis kriteriumebs.

magaliTebia:

1. mSobiarobis Semdgomi fsiqozi, romelic ar Seesabmeba guneb-

ganwyobis aSlilobas fsiqozuri simptomebiT, xanmokle fsiqozur

aSlilobas da ar aris dakavSirebuli fsiqoaqtiuri nivTierebebis

(an sxva farmakologiuri saSualebebis) gamoyenebasTan an/da

zogadsamedicino problemiT gamowveul mdgomareobasTan;

2. fsiqozi, romelic grZeldeba 1 Tveze nakleb xans, magram jer

gaumjobesebas adgili ara aqvs;

68

3. persistentuli smeniTi halucinaciebi, sxva simptomebis gareSe;

4. persistentuli araeqscentriuli, mcire gaqanebis yofiTi Sinaarsis

bodva(ebi), romelic faravs bodviTi aSlilobis ZiriTadi

periodis ganmavlobaSi arsebul guneb-ganwyobis aSlis epizodebs;

5. situaciebi, roca klinicistisTvis naTelia, rom saxezea fsiqozi,

magram ver gansazRvravs es pirveladia, Tu dakavSirebulia

fsiqoaqtiuri nivTierebebis (an sxva farmakologiuri

saSualebebis) gamoyenebasTan an/da zogadsamedicino problemiT

gamowveul mdgomareobasTan.


sxva araorganuli fsiqozuri aSlilobis da dauzustebeli

(araspecifikuri) araorganuli fsiqozis klinikuri simptomebia:

fsiqozuri simptomebi: bodva(ebi) da halucinaciebi), an maTi kombinacia

(bodva plus katatonia), dezorganizebuli metyveleba da qceva, romelic

arcerTi fsiqozuri aSlilobis diagnostikur kriteriumSi ar jdeba, sxva

araorganul fsiqozur aSlilobebSi aerTianeben (mag. qronikuli

halucinaciuri fsiqozi). garda aRniSnulisa, mSobiarobisSemdgomi

fsiqozis klinikur suraTSi wamyvani bodviTi azrebi gulisxmobs sakuTari

Tavis an axalSobilis dazianebis ideebs.


Cveulebriv, mkurnaloba simptomaturia.

mag. mSobiarobis Semdgomi fsiqozis dros

fsiqofarmakoTerapiisTvis (romlis dawyebamde axalSobilis

ZuZuTi kveba unda Sewydes) gamoiyeneba:

1. antidepresantebi da liTiumi,

2. antifsiqozuri medikamentebi.

roca aucilebelia hospitalizacia (pacienti amJRavnebs suicidur

an homocidur agresiul qcevas bavSvis mimarT),

gasaTvaliswinebelia misi bavSvis naxvis survili, magram vizitis

dros savaldebuloa mkacri kontroli.

mwvave fsiqozis amowurvis Semdeg gamoiyeneba fsiqoTerapia,

romelic mimarTulia pacientis mier axali socialuri _ dedis

rolis gaTavisebisken da ojaxis wevrebis (meuRlis) mier

mxardaWeris gaZlierebisken.


gaTvaliswineba:




69

gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “Sizofrenia da sxva fsiqozuri aSlilobani”

adamianuri da materialur-teqnikuri resursi

• fsiqiatriuli menejmenti saWiroebs:

1. multiprofesiul midgomas _ mkurnalobis gatareba xdeba gunduri

principiT: SemTxvevis mmarTveli, fsiqiatri, klinikuri fsiqologi,

fsiqoTerapevti, eqTani, socialuri muSaki;

2. fsiqikuri aSlilobis mkurnaloba saerTaSorisod aprobirebuli

fsiqotropuli saSualebebiT da mtkicebulebiTi medicinis Sesabamisi

paternebiT;

3. diagnostirebis da mkurnalobis gverdiTi efeqtebis marTvis procesSi

zogadi profilis specialistebis CarTvas _ nevropaTologi, Terapevti,

kardiologi, endokrinologi da sxv;

4. pacientis fsiqikuri da fizikuri statusis gamokvlevas

Tanamedrove teqniqiT aRWurvil klinikur laboratoriebSi _

RviZlis, renaluri da farisebri jirkvlis funqciebis gansazRvra,

sisxlSi eleqtrolitebis da samkurnalo preparatebis koncentraciis

gansazRvra, eleqtroencefalografia da eleqtrokardiografia, MRI_ tomografia, sisixlis da Sardis saerTo analizi da sxva;

5. garda medikamenturi mkurnalobisa aqcenti unda gakeTdes

fsoqosocialur intervenciaze;

6. fsiqiatriuli daxmarebis xelmisawvdomobis da uwyvetobis mizniT

fsiqiatriuli daxmarebis samsaxurebi, rogorc ambulatoriuli,

aseve stacionaruli ganTavsebuli unda iyos

regionuli/komunaluri/ principiT;

7. Tanamedrove moTxovnebis Sesababis saswavlo programebis

Sedgenas da fsiqiatriuli samsaxuris specialistebis

momzadeba/gadamzadeba/trenirebas.

2.shizofrenia da sxva fsiqozuri ashlilobani-protokoli · hematologia sisxlis saerto analizi sisxlis...

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