მ.ბოკუჩავა, ნ.ბეიტრიშვილი, ე.თავაძე - ფსიქოსომატური აშლილობები

fsiqosomaturi aSlilobebi

m. bokuCava, n. beitriSvili, e. TavaZe.

m.asaTianis sax. fsiqiatriis s/k instituti

Ffsiqosomatika Seiswavlis fsiqologiuri faqtorebis gavlenas rigi somaturi daavadebebis warmoSobaSi (bronquli asTma, hipertonuli daavadeba, Tormetgoja nawlavis wylulovani daavadeba, neirodermiti, wylulovani koliti da a.S.). fsiqogenuri faqtorebi garkveul rols TamaSoben sxva daavadebebis ganviTarebaSic, rogoricaa: Sakiki, endokrinuli darRvevebi, avTvisebiani warmonaqmnebi da sxva.

pirvelad termini fsiqosomaturi gamoiyena Einrot-ma 1818w. uZilobasTan dakavSirebiT.

fsiqosomaturi aSlilobebi warmodgenilia somaturi sferos sindromebiTa da simptomebiT, romlebic ganpirobebulia pirovnebis individualur-fsiqologiuri TaviseburebebiT, dakavSirebulia adamianis qcevis stereotipebTan, stresze reaqciasa da intrapersonaluri konfliqtis gadamuSavebis gzebTan.

pirovnebis reaqcia stresze da frustraciaze SeiZleba iyos erTi mxriv nevrozuli aSlilobis saxiT, romlis drosac Warbobs fsiqologiuri da fsiqopaTologiuri gamovlinebebi da meore mxriv fsiqosomaturi aSlilobebi, romelic upiratesad vlindeba fsiqikuri aSlilobis somaturi eqvivalentebiT. nevrozuli aSlilobebi SeiZleba gamovlindes, rogorc mwvave, ise qronikuli stresis pirobebSi, xolo fsiqosomaturi aSlilobebi upiratesad qronikuli stresisa da frustraciis Sedegia. fsiqologiurad mniSvnelovani gamRizianeblebi da qvecnobieri konfliqtebi iwveven specifikuri fizikuri daavadebis (mag: revmatoiduli arTriti) an cnobili patofiziologiuri procesis (mag: Tavis tkivili) warmoSobas an gamwvavebas.

gamoyofen specifikur da araspecifikur stresebs. specifikuri stresi ganisazRvreba, rogorc specifikuri pirovnuli an aracnobieri konfliqti, romelic arRvevs homeostatur wonasworobas da xels uwyobs fsiqosomaturi aSlilobis ganviTarebas. specifikuri pirovnuli tipi da aracnobieri konfliqtebi fsiqosomaturi daavadebis specifikur eTiologiur faqtorebs miekuTvneba.

meore mxriv, qronikuli araspecifikuri stresi TandarTuli SfoTviT,  SeiZleba gaxdes fsiqosomaturi aSlilobis gamomwvevi genetikurad ganwyobil subieqtebSi. eseni arian adamianebi Raribi cxovrebiseuli warmosaxviT, romelnic acnobiereben TavianT emociur konfliqtebs, maTSi daavadeba SeiZleba iyos gamrizianeblobis kumulaciis Sedegi.F

F fsiqosomaturi darRvevebi aris avadmyofur mdgomereobaTa jgufi, romelic warmoiSoba somaturi da fsiqikuri faqtorebis  zemoqmedebis Sedegad. W. Rief-I da W. Hiller-i aigiveben somatoformul darRvevebs iseT cnebebTan, rogoricaa “funqciuri darRvevebi”, “fsiqovegetatiuri sindromi”, “globus hystericus”, “qronikuli daRlilobis sindromi” da a.S. smuleviCi (2005) gamoyofs fsiqosomatur darRvevaTa 4 jgufs: 1. fsiqosomaturi daavadebebi, maTi tradiciuli gagebiT; 2. somatoformuli darRvevebi da somatizirebuli fsiqikuri reaqciebi, romlebic yalibdeba nevrozuli da konstituciuri patologiebisas ( nevrozebi, neiropaTiebi); 3. nozogeniebi-somaturi daavadebis Sedegad warmoqmnili fsiqikuri reaqciebi. Ees ukanasknelni miekuTvnebian reaqtiul mdgomareobaTa jgufs; 4. somatogeniebi, romlebic miekuTvnebian egzogenur fsiqikur aSlilobaTa kategorias.

zogadad fsiqosomaturi medicina gamoyofs fsiqosomaturi aSlilobebis 3 jgufs :

1 konversiuli simptomebi; 2 funqcionaluri sindromebi (organuli nevrozebi); 3 fsiqosomaturi daavadebebi (fsiqosomatozebi).

Kkonversiuli simptomebis dros nevrozuli konfliqti ganicdis meorad somatur gadamuSavebas pasuxis saxiT (<. K.,fy-Gkjwwf D. Gtk]lbyuth A. Rhtuth.) simptoms aqvs simboluri xasiaTi, xolo simptomebis demonstracia SeiZleba ganxilul iqnas, rogorc konfliqtis gadaWris mcdeloba.Kkonversiuli simptomebi fsiqosomatur aSlilobebs miekuTvneba maSin, roca maT ar axlavT sxva disociaciuri (konversiuli) aSlilobebi (amnezia, fuga, transi), winaaRmdeg SemTxvevaSi isini ganixileba rogorc nevrozuli aSlilobebi.

Ffunqcionaluri sindromebi kargadaa nacnobi saerTo praqtikis eqimTaTvis. mag : gul-sisxlZarRvTa sistemis aSlilobebidan tipiuria “ gulis nevrozi”, gulis hiperkinetikuri sindromi, paroqsizmuli, supraventrikuluri taqikardia, vegetatiur-sisxlZarRvovani (neirocirkulatoruli) distonia. cnebaSi “gulis nevrozi” igulisxmeba kardiuli gamovlinebebi: gulis friali, taqikardia, xanmokle ariTmiebi, q oSini, haeris ukmarisoba, tkivili, zewolis SegrZneba gulis areSi, mravalferovani paresTeziebi.

farTodaa gavrcelebuli vegetatiur-sisxlZarRvovani distonia (neirocirkularuli asTenia, dakostas sindromi). vinaidan vegetatiuri nervuli sistema iyofa simpatikur da parasimpaTikur nawilebad, distonia gamovlindeba ori formis saxiT: simpaTikotonuri da vagoinsularuli. simpaTikotonuri formis dros aRiniSneba kanis simSrale, sifermkrTale, kidurebis gacieba, msubuqi egzofTalmi, meryevi temperatura, midrekileba taqikardiis, taqipnoes, arteriuli wnevis momatebisken, kankali, paresTeziebi, usiamovno SegrZnebebi gulis areSi.

vagoinsularuli Fformis dros damaxasiaTebelia civi, namiani kani, hiperhidrozi da hipersalivacia, mkveTri wiTeli dermografizmi, bradikardia, arteriuli hipotoniisken midrekileba, sunTqviTi ariTmia, gulis wasvlisa da masis momatebisken midrekileba.

fsiqovegetatiur simptomebs miekuTvneba Zilis ciklisa da Termoregulaciis darRvevebi. Zilis ciklis darRvevebia hipersomniis da agripniuli sindromebi. funqcionaluri (isteriuli) hipersomniis qveS igulisxmeba Zlieri emociuri gancdis Semdeg adamianis xangrZlivi Zilis mdgomareoba. Gairdner-ma aRwera yvelaze xangrZlivi SemTxveva isteriuli hipersomniis, romelic grZeldeboda 164 dRe. agripniuli sindromi xasiaTdeba xangrZlivi uZilobiT da masTan dakavSirebuli vegetatiuri gamovlinebebiT.

subfebriliteti adamianis reaqciaa fsiqoemociur stresze, temperaturis momatebiTa da aratipiuri temperaturuli mrudiT.

sasunTqi sistemis funqcionaluri sindromebia: hiperventilaciuri sindromi, CabJireba, “nevrozuli sunTqviTi sindromi”. “ sunTqva CasunTqviT”.

hiperventilaciis sindromi _ pacients aqvs haeris ukmarisobis SegrZneba, ris gamoc ramodenime wuTis ganmavlobasi aReniSneba sunTqvis gaxSireba da gaRrmaveba, rasac moyveba Tavbrusxveva, Semdeg gulis wasvla _ Tavis tvinis sisxlZarrvTa Seviwroebis da respiratoruli alkalozis gamo. amasTan erTad SeiZleba aRiniSnos moWeris SegrZneba gulis areSi, paresTeziebi.

“nevrozuli sunTqviTi sindromi”-s dros sunTqva xasiaTdeba wyvetili Rrma CasunTqviT da gaxangrZlivebuli xmauriani amosunTqviT. avadmyofi uCivis “mTeli mkerdiT” CasunTqvis SeuZleblobas, aRiniSneba e.w. “sunTqviTi korsetis” arseboba.

xvela M CabJirebiT gamovlindeba yoveli xveliTi aqtis Semdeg daukmayofileblobis grZnobiT. is SeiZleba gamovlindes CaxvelebiT- Taviseburi motoruli aqtebiT, romelTa mizans warmoadgens sasunTq gzebSi diskomfortis moxsna (“naxvelis amoReba”).

kuW_nawlavis sistema iyofa funqcionalur simptomebad da kvebiT mizidulobaTa  darRvevebad. pirvels miekuTvneba: aerofagia, meteorizmi, yabzoba da diarea. meores—anoreqsia da bulimia.

aerofagiis dros avadmyofi ylapavs didi raodenobiT haers, rasac Tan axlavs kuWis gadavsebis SegrZneba, amotom aerofagiis xSir simptoms warmoadgens xmauriani naZaladevi boyini haeriT.

meteorizmis dros aRiniSneba yuryuri, buybuyi mucelSi, rasac Tan axlavs diskomforti da tkivili epigastriumis areSi.

funqcionalur sindromebs miekuTvneba qavili da tkivilis sindromebi.

fsiqosomaturi tkivili SeiZleba gamovlindes fantomuri da fsiqogenuri tkivilis saxiT. fantomuri tkivili avadmyofs aReniSneba amputirebul kidurSi, amasTan erTad SeiZleba adgili qondes daWimvis, wvis, zewolis, sicivis SegrZnebebs.

qavili SeiZleba iyos generalizebuli an lokaluri (anogenitaluri) fsiqogenuri qavilis saxiT. misTvis damaxasiaTebelia uaryofiTi emociuri datvirTvis sapasuxod wvisa da qavilis warmoSoba. Sexeba da qavili xdeba TviTmizani, Tumca es qavilis simptomebs ar acilebs, aramed aZlierebs. iTvleba, rom generalizebuli pruritusis gamomwvevi represirebuli SfoTva da wyenaa.

fsiqosomaturi daavadebebis - fsiqosomatozebis jgufSi gaerTianebulia somaturi daavadebebi, romelTa eTiopaTogenezSi fsiqikur faqtors gadamwyveti, zogjer ki mTavari roli eniWeba.

Kklasikur fsiqosomatur daavadebebs e.w. “wminda Svideuls” ( holy seven) miekuTvneba :

1.        esenciuri hipertonia

2.       Tormetgoja naclavis wyluli

3.       wylulovani koliti

4.       bronquli asTma

5.       Saqriani diaabeti

6.       neirodermitebi

7.       revmatoiduli arTriti.

agreTve gulis iSemiuri daavadeba, hiperTireozi, saSvilosnos mioma da sxva.

literatura:

• Gcb[jcjvfnbxtcrbt hfccnhjqcndf

D. L. Njgjkzycrbq

V. D. Cnherjdcrfz     Vjcrdf 1986

• D. L. Vtyltktdbx

rkbybxtcrfz b vtlbwbycrfz gcb[jkjubz 1997

• D. L. Vtyltktdbx

Gcb[bfnhbxtcrfz ghjgtltdnbrf 1997

• ALFRED J.ZIEGLER

ARCHETYPAL

MEDICINE 2000

Department of psychiatry of Tbilisi State Medical  University

M.Bokuchava, N.Beitrishvili, E.Tavadze

summary

          Psycho-somatic disorders are groups of diseases. They are formed from somatic and psychical factors.

          Psycho-somatic medicine can be separated into 3 groups of psycho-somatic disorders. These are disorders with: 1. conversion symptoms; 2. functional syndromes (organic neurosis); 3 psycho-somatic diseases (psychosomatosis). psychosomatosis are diseases called “holy seven”:

1.    Essential hypertony

2.    Ulcer  of  duodenum

3.    Ulcer colitis

4.    Bronchial Astma

5.    Diabetis Mellitus

6.    Neirodermitis

7.    Rheumatoid  arthritis

Also heart ischemic disease, hypertireosis, Myoma Uterus and other.

არჩილ ბეგიაშვილის სტატია "საქართველოს ფსიქიატრიის მოამბის" მე-6 ნომრიდან

თემურ იოსებაძის სტატია "საქართველოს ფსიქიატრიის მოამბის" მე-6 ნომრიდან

problemebis gadawyvetis unar-Cvevis treningi zRaprebis daxmarebiT

T. iosebaZe

fsiqo-socialuri reabilitaciis centri

Tbilisi, saqarTvelo

`...qsanfi adga meore dRes diliT da moisurva xelebis dabanva. man daiZaxa: ezope! gismenT batono - upasuxa ezopem. wyali damisxi - uTxra qsanfma. ezopem aiRo jami wyliT da mivida Tavis batonTan. piris dabanisas, qsanfma SeamCnia, rom aRar hqonda TiTze beWedi. ezope, sad aris Cemi beWedi? - ikiTxa man. warmodgena ar maqvs - upasuxa  monam. dideba Senda RmerTo! - Tqva qsanfma. cudi ar iqneba batono, Tu Tqven moagrovebT da gadamalavT Tqveni qonebidan imas, risi gadamalvac SegiZliaT. exla xom Tqveni qoneba Tqven aRar gekuTvniT. ras Cmaxav? - Seuyvirebs mas qsanfi. saqme imaSia batono, rom guSin, roca magrad daiTveriT, Tqven ganacxadeT da niZlavi dadeT mTel Tqven qonebaze, rom SegiZliaT zRva SesvaT da swored am niZlavis garantad mieciT Tqveni Zvirfasi beWedi. zRva rogor unda Sevsva? - dabneulad Caiburtyuna qsanfma. batono, me fexebSi CagivardiT da gemudarebodiT - nu izamT amas, ras akeTebT batono, es xom SeuZlebelia. magram Tqven Cemi ar gesmodaT. amis gagonebaze qsanfi daeca muxlebze da Seevedra ezopes: gexvewebi hqeni rame. Sen xom Wkviani kaci xar. moifiqre rame. Tu ar movigeb niZlavs, qoneba mainc ar davkargo. mogeba, ra Tqma unda, SeuZlebelia. rac Seexeba qonebis SenarCunebas, amaSi me mgoni SemiZlia dagexmaroT. rogor SegiZlia? - hkiTxa qsanfma - amixseni. da ezopemac auxsna: rodesac TqvenTan movlen mosamarTle da Tqveni modave da gibrZaneben SeasruloT naTqvami, SesvaT zRva, Tqven ukan ar waiRoT simTvraleSi naTqvami sityvebi, gaimeoreT isini ... SeavseT Tasi zRvis wyliT, dadgiT is magidaze mosamarTlis win da ikiTxeT: niZlavis rogori pirobebi gvqonda Cven? is getyviT: Sen Tqvi, rom Sesvam zRvas. Tqven hkiTxavT mas: sul es aris? is gipasuxebT: ki, sul es aris. maSin Tqven mimarTavT yvela iq myofs: Zvirfaso moqalaqeno, zRvaSi Caedineba mravali mdinare...me niZlavi davde imaze, rom davlevdi zRvas da ara masSi Camdinare mdinareebs. dae, iman visTanac niZlavi davde gadaketos zRvaSi Camdinare mdinareebi da maSin Sevasruleb Cems danapirebs - Sevsvam zRvas. SeuZlebelia Camdinare mdinareebis gadaketva, iseve rogorc SeuZlebelia zRvis Sesma. ai ase, SeuZlebels daupirispirebT SeuZlebels da amiT Tavs daaRwevT dadebul niZlavs...” 

      rogorc vxedavT, TiTqosda gamouvali mdgomareobidan brZenma ezopem moZebna Wkvianuri gamosavali da Tavisi batoni gadaarCina sulelur niZlavSi wagebas. kidev kargi, rom qsanfs imis Wkua mainc eyo, rom brZen ezopes mimarTa TxovniT Tavisi problemis gadasawyvetad.

      amboben xolme, rom gamouvali mdgomareoba, gadauwyveteli problema ar arsebobs. magram rTuli problemebis gadawyveta rom yvelas ar SeuZlia da rom problemebis gadawyvetis unar-Cvevas varjiSi da ganviTareba sWirdeba, amas iSviaTad Tu vinme aRniSnavs. egreTwodebuli `pozitiuri fsiqoTerapiis~ Semqmneli n. pezeSkiani fsiqikur janmrTelobas, swored, problemebis gadawyvetis unars ukavSirebs - `janmrTeli is ki ar aris, visac araviTari problemebi ara aqvs, aramed is visac SeuZlia maTi gadawyveta~. `racionaluri fsiqoTerapiis~ Semoqmedi p. diubua `damarwmunebeli dialeqtikiT~ cdilobda fsiqonevrozebis mqone pacientebis gankurnebas. Tanamedrove kognituri da kognitur-bihevioristuli mimarTulebebi fsiqoTerapiaSi, gansakuTrebul aqcents akeTeben kognitur procesebze da kognitur warmonaqmnebze. Tumca, Cveni azriT, am fsiqoTerapiul mimarTulebaSi, azrovnebas da mis birTvs - problemebis gadawyvetis unars, saTanado, gansakuTrebuli yuradReba ar eqceva. aRsaniSnavia, rom dRes-dReobiT fsiqiatriaSi arsebul or wamyvan fsiqoreabilitaciur programaSi - `socialuri da damoukidebeli cxovrebis unar-Cvevebis varjiSis programa~  (”Social and Independent Living Skills Program”) da `integrirebuli fsiqologiuri Terapia Sizofreniis mqone pacientebisTvis~ (“Integrated Psychological Therapy for Schizophrenic Patients”) erT-erT mniSvnelovan komponents, `moduls~ problemebis gadawyvetis unar-Cvevis treningi Seadgens. `socialuri  da damoukidebeli cxovrebis unar-Cvevebis varjiSis programaSi~, problemebis gadawyvetis unar-Cvevis treningis moduli miznad isaxavs problemis gadawyvetis 7 safexuriani modelis daswavlas. es safexurebia: 1) gaCerdi da dafiqrdi imis Sesaxeb, Tu rogor wyvet mocemul problemas; 2) sakuTriv, raSi mdgomareobs Seni problema; 3) sxva ra gzebiT SeiZleba gadawydes es problema; 4) Seafase alternatiuli gadawyvetis gzebi; 5) SearCie am problemis gadawyvetis erTi an ramdenime alternatiuli gza da Seadgine maTi realizaciis gegma; 6) ra resursebi gWirdeba mocemuli problemis gadasawyvetad; 7) gansazRvre TariRi da dro dasaxuli gegmis realizaciisaTvis da Seudeqi mis ganxorcielebas. rac Seexeba `integrirebul fsiqologiur Terapias~, masSic mocemulia problemebis gadawyvetis 7 safexuriani modeli, romlis gamoyenebis unar-Cvevis SemuSavebasac cdilobs es programa. es safexurebia: 1) problemis identifikacia da misi analizi; 2) problemis kognituri gadamuSaveba; 3) problemis gadawyvetis strategiebis SemuSaveba; 4) mocemuli problemis gadawyvetis alternatiuli gzebis Taobaze diskusia; 5) problemis gadawyvetis alternatiuli variantebidan erTis SerCeva; 6) am alternatiuli variantis praqtikaSi realizacia; 7) problemis gadawyvetis warmatebuli Tu warumatebeli Sedegebis Sesaxeb ukukavSiris miReba. problemebis gadawyvetis unar-Cvevis ganviTarebis es ori programa udavod SesaniSnavi modelebia. magram isini, rogorc nebismieri arsebuli modeli, Seicaven arsebiT nakls. yoveli azrovnebis savarjiSo modeli CarCoebSi aTavsebs azrovnebis process da amiT winaaRmdegobaSi modis TviT azrovnebis arsebasTan - daamyaros axali mimarTebebi, gadawyvitos axali amocana (da ara ubralod gamoiyenos raRac Sablonebi, raRac `receptebi~). amitom, Cven im daskvnamde mivediT, rom problemebis gadawyvetis unar-Cvevis gasavarjiSeblad, erT-erT saukeTeso saSualebas unda warmoadgendes problemebis gadawyvetis arsebuli mravalferovani gamocdilebis gacnoba da analizi. amisaTvis mdidari da mravalferovani masala SeuZlia mogvawodos zRaparma (am sityvis farTe gagebiT - miTi, legenda, igavi, igav-araki, anekdoti da sxv.). unda aRiniSnos, rom miuxedavad imisa, rom fsiqologiasa da fsiqoTerapiaSi zRapars sakmao yuradReba eqceva, me ar Semxvedria mecnieruli naSromi, sadac laparaki iqneboda zRapris gamoyenebaze problemebis gadawyvetis unar-Cvevis savarjiSod. me SevimuSave proeqti - problemebis gadawyvetis unar-Cvevis treningi zRaprebis daxmarebiT, romelic erT-erT komponentad Sevitane jgufuri fsiqoTerapiis Cems komplementarul modelSi. am models me viyeneb qronikuli fsiqikuri aSlilobis mqone pirTa Tbilisis fsiqo-socialuri reabilitaciis centrSi (am cota xnis win aRniSnuli proeqtis rusul enaze mimdinare mecadineobebis audioCanawerebi ganTavsebul iqna internetSi, Cems saitebze).

     problemebis gadawyvetis TvalsazrisiT zRaprebis analizis Cems mier SemoTavazebuli modeli ar aris mkacrad struqturirebuli. amitom mis gasagebad, albaT, yvelaze saukeTeso saSualebaa saitze moTavsebuli konkretuli mecadineobebis gacnoba. Cemi midgoma zRaprebis analizisadmi, garkveuli gagebiT, martivicaa da rTulic. martivia imitom, rom mis arss Seadgens - zRaprisadmi Sexedva problemebis gadawyvetis TvalsazrisiT. xolo rTulia imitom, rom am TvalsazrisiT zRapris saTanado analizi saWiroebs garkveul codnasa da gamocdilebas. Cemi midgomis Sesaxeb zogadi warmodgenis Seqmnis mizniT, me minda aq Sevexo or mniSvnelovan sakiTxs: 1) zRapris analizis Cems mier gamoyofili ZiriTadi kriteriumebi, da 2)am midgomis ZiriTadi Rirsebebi.

zRaprebis analizis ZiriTadi kriteriumebi, problemebis gadawyvetis TvalsazrisiT: 1) ra problem(ebi)a aris warmodgenili mocemul zRaparSi; 2) ra gzebiT, ra saSualebebiT cdiloben zRapris personaJebi problem(eb)is gadawyvetas; 3) kidev ra gzebiT, ra saSualebebiT SeiZleba mocemuli problemebis gadawyveta; 4) sad eZeben zRapris personaJebi problemis gadawyvetis gzebs; 5) ra Secdomebi iqna daSvebuli da ra warmatebuli saSualebebi iqna gamoyenebuli personaJebis mier mocemul zRaparSi problemis gadawyvetisas; 6) ram ganapiroba problemis gaCena; 7) rogor SeiZleboda mocemuli problemis Tavidan acileba; 8) ra aris saWiro mocemuli problemis gadasawyvetad; 9) ra resursebs saWiroeben mocemuli zRapris personaJebi problemis gadasawyvetad (aqvT Tu ara maT es resursebi da ramdenad sworad, efeqturad iyeneben am resursebs); 10) ras emyareba mocemuli problemis gadawyveta; 11) problemis gadawyvetis ra strategiebs iyeneben personaJebi mocemul zRaparSi da xom ar ajobebda sxva strategiebis gamoyeneba; 12) problemis gadawyvetaze moqmedi faqtorebi (dadebiTi da uaryofiTi); 13) zRapris personaJebis azrovnebis procesis analizi; 14) azrovnebis ra tips iyenebs esa Tu is personaJi (asociaciuri azrovneba, autisturi azrovneba, sistemuri azrovneba, problemis gadawyvetaze orientirebuli azrovneba, Rirebulebaze damyarebuli azrovneba, avtoritetze damyarebuli azrovneba, abstraqtuli azrovneba, konkretuli azrovneba, praqtikuli azrovneba, analogiebze damyarebuli azrovneba, logikur-cnebiTi azrovneba, simboluri azrovneba, Sedegze orientirebuli azrovneba, paranoialuri azrovneba da sxv.); 15) ra sistemuri Sedegebi SeiZleba moyves problemis gadawyvetis mocemuli xerxis gamoyenebas (fsiqoekologiuri Sefaseba); 16) ras gvaswavlis mocemuli zRapari, problemebis gadawyvetis TvalsazrisiT; 17) paralelebis gavleba zRaparSi mocemul problemur situaciasa, misi gadawyvetis konkretul SemTxvevasa da pacientebis msgavs cxovrebiseul gamocdilebas Soris.

     bunebrivia, yvela aRniSnuli analizis kriteriumis gamoyeneba konkretuli zRapris analizis dros SeuZlebelia. Tu romeli da ramdeni analizis kriteriumi unda iqnas gamoyenebuli konkretuli zRapris analizis dros, es ZiriTadad damokidebulia zRapris Sinaarsze da kriteriumebis  aqtualobaze mocemuli pacientebisTvis.

     zRaprebis daxmarebiT problemebis gadawyvetis unar-Cvevis ganviTarebis ZiriTadi Rirsebebi: 1) zRaprebSi warmodgenilia, faqtiurad, azrovnebis yvela (rogorc dabali, aseve maRali)  forma; 2) zRaprebi asaxaven adamianTa mraval, mravalferovan problemebsa da maTi gadawyvetis gzebs; 3) zRaprebis konkretuli fabula SesaZleblobas iZleva gamovavlinoT problemis gadawyvetaze moqmedi konkretuli faqtorebi; 4) zRaparSi warmodgenili dasrulebuli ambavi SesaZleblobas iZleva problemis gadawyvetis procesi konkretul konteqstsa da dinamikaSi ganvixiloT; 5) zRapari, garkveuli fsiqikuri mdgomareobis provocirebas axdens, romelic SesaniSnav niadags qmnis daswavlisa da problemebis gadawyvetis unar-Cvevis varjiSisaTvis; 6) zRapriT pirovnebis Sinagan samyaroSi  daxmarebis mizniT Sesvla ufro advilia, vidre mSrali mecnieruli cnebebiT, sqemebiTa da koncefciebiT; 7) zRaprebi, azrovnebis treningze daswrebis motivacias aZliereben; 8) zRapari SesaniSnavi instrumentia qronikuli fsiqikuri aSlilobis mqone pirTaTvis fsiqologiuri da fsiqoTerapiuli daxmarebis gasawevad; 9) zRapris daxmarebiT problemebis gadawyvetis unar-Cvevis treningi  SesaZleblobas aZlevs monawileebs ara mxolod avarjiSon azrovneba, aramed miiRon mniSvnelovani fsiqologiuri  da fsiqoTerapiuli  daxmareba.

     mocemuli midgomis Sesaxeb ufro farTo informacia, msurvels SeuZlia moiZios Cems saitebze: http://treniruitemishlen.mirtesen.ru/  da  http://sites.google.com/site/trainproblemsolving/main. am saitebze warmodgenilia problemebis gadawyvetis treningis mecadineobebis audio Canawerebi (rusul enaze) da Cemi statia.

                        l i t e r a t u r a

     1.Brener H.D., Roder V., Hodel B., Kienzle N., Reed D., LibermanR.P. Integrated Psychological Therapy for Schizophrenic Patients (IPT). Hogrefe & Huber Publishers, Bern Gottingen Seattle Toronto - 1994.

     2.Liberman R.P., Massell H.K., Mosk M., Wong S.E. Social skills training for chronic mental patients. Hospital & Community Psychiatry, 36:396-403, 1985.

     3.Эзоп. Басни. СПБ.: Изд. «Азбука классика», 2008.

PROBLEM SOLVING SKILLS TRAINING WITH THE HELP OF

FAIRY-TALE                                                                                                                                                 

                                                                                                T.IOSEBADZE                                                                                                                                                                    Center of Psycho-social Rehabilitation                                                                                                                                                                              Tbilisi, Georgia

     1.Both existing problem solving training models and various approaches in psychotherapy propose limited, one-sided and static strategies and ways of problem solving. Whereas problem solving is a dynamic process and it is influenced by various factors, it is impossible to put problem solving into the frame of one static model.

     1.Teaching of problem solving together with cognitive and situational-behavioral analysis constitutes a structural component of my Fairy-tale Cognitive Behavioral Therapy (FCBT) model. I believe that fairy-tales (in a broader sense of the notion which includes: myths, legends, parables, fables, etc.) have tremendous potentialities to learn how to solve our problems.

     2.In my approach to problem analysis of fairy-tale the following criterions have been distinguished: 1) what problems are presented in the fairy-tale; 2) by what ways, what means the characters of the fairy-tale try to solve the problems; 3)   what other ways of problem solving may be used in the case; 4) where do the characters of the fairy-tale look for ways of problem solving; 5) what mistakes have been made and what successful means of problem solving the characters of the fairy-tale used; 6) what has led to the origin of the problem; 7) how the problem could be avoided; 8)  what is needed to solve the problem; 9) what resources are needed for the characters of the fairy-tale to solve the problem; do they have these resources and do they use them rightly and effectively; 10)on what basis the characters of the fairy-tale try to solve the problem; 11) what strategies of problem solving are used in the fairy-tale and perhaps it is better to use other ones; 12) what factors influence the problem solving positively or negatively; 13) analysis of the thinking process of the characters; 14) what type of thinking does the character of the fairy-tale use ( associative thinking, autistic thinking, systemic thinking, thinking oriented to solve the problem, thinking based upon values, thinking based upon authority, abstract thinking, concrete thinking, practical thinking, thinking based upon analogy, logical-conceptual thinking, symbolic thinking, result-oriented thinking, paranoiac thinking etc.); 15)  to what systemic consequences may these or other ways of problem solving have led (psycho ecological assessment); 16)  what the fairy-tale teaches us concerning problem solving; 17)  drawing a parallel between problem situations, ways of their solving in the fairy-tale and similar life experience of the patients; etc.

      3. Main merits of the approach: 1)  actually all kinds of forms of thinking are presented in fairy-tales ( both high and low forms); 2) fairy-tales reflect many, diverse problem situations and ways of their solving; 3) the plots of  fairy-tales give an opportunity to identify concrete factors influencing the problem solving; 4) the completed story presented in fairy-tale gives an opportunity to consider the process of problem solving in the concrete context and dynamic; 5) fairy-tale provokes a certain mental state which creates a good ground for learning and training of problem solving skills; 6) with the help of fairy-tale it is easier to enter the inner world of the personality than by means of abstract scientific schemas, notions and conceptions; 7) fairy-tales strengthen the motivation to attend  the problem solving training courses; 8) fairy-tale is a good instrument to render psychological and psychotherapeutic help to patients with chronic mental disorders; 9) problem solving skills training with the help of fairy-tale gives an opportunity for the participants not only to train their thinking but get significant psychological and psychotherapeutic assistance. 

      4. Wider information about the approach may be found on my sites:  http://treniruitemishlen.mirtesen.ru/  and  http://sites.google.com/site/trainproblemsolving/main . Audio recordings of the problem solving training sessions ( in Russian) and my article are presented here.     

მარინა გეგელაშვილის სტატია "საქართველოს ფსიქიატრიის მოამბის" მე-6 ნომრიდან

Mmarina gegelaSvili, fsiqiatri, mmd.

zogierTi sakiTxiNneirofsiqologiuri disfunqciisa da qceviTi problemebis  asakobrivi dinamikis Sesaxeb mozardebSi

kvleva ganxorcielda fond ‘’Global Initiative on Psychiatry ‘’ mxardaWeriT

kvlevis ZiriTad mizans warmoadgenda saqarTveloSi mcxovrebi bavSvebisa Dda mozardebis qceviTi problemebis gavrcelebis gansazRvra da im bio-fsiqo-socialuri faqtorebis Seswavla, romlebic gavlenas axdenen qceviTi problemebis ganviTarebaze. raTa am monacemebze dayrdnobiT momxdariyo bavSvTa da mozardTa fsiqikuri janmrTelobis efeqturi fsiqoprevenciuli zomebis SemuSaveba.

Mmasala da meTodi kvleva Catarda zogadsaganmanaTleblo skolebsa da kvlevaSi moculi iyo saqarTvelos barisa da maRalmTianeTis regionebi, qalaqebisa da soflis mosaxleoba,. gamoklvleul iqna 12-17 wl amde asakis 1374 mozardi, rogorc qalaqis, aseve raionis mcxovrebi

deviaciebis speqtris Sefaseba ganxorcielda socialur-ekonomikuri, fsiqologiuri, neirofsiqologiuri maxasiaTeblebis gaTvaliswinebiT, ramac saSualeba mogvca safuZvlianad gagveazrebina qceviTi problemebi  iseTi informaciis moZiebiT, romelSic asaxuli iqneboda pirovnebis, rogorc, bio-fsiqo-socialuri arsebis  zogierTi maxasiaTebeli, rac esoden mniSvnelovania bavSvTa da mozardTa fsiqikuri janmrTelobis dacvis adreuli intervenciebis dagegmarebisaTvis .

gamokiTxva vawarmoeT specialurad SemuSavebuli test-batareis saSualebiT kerZod:

fsiqosocialuri kiTxvari, neirofsiqologiuri disfunqciis gamovlenis mizniT viyenebdiT rei-teiloris tests. igi warmoadgens neiro-fsiqologiuri meTodikas, romeliTac gamokvleul iqna mexsierebis, mxedvelobiT-sivrciTi aRqmis unaris funqcionireba da kognitiuri procesis siCqare.

debo-rubinSteinis TviTSefasebis testi: rokiCis RirebulebaTa orientaciis sakvlevi testi

kvlevaSi miRebuli monacemebis _ fsiqosocialuri deviaciebis, centraluri nervuli sistemis disfunqciis da mozardTa TviTSefasebisa da RirebulebebaTa sistemebis statistikuri analizisTvis gamoyenebul iqna X² testi da multivariaciuli logistikuri regresia.

mozardTa deviaciur qcevebad miviCnieT sazogadoebrivad miuRebeli qcevebi, maTi aRmocenebis sixSirisa da motivis gaTvaliswinebiT (anu mozardis mier fasdeboda Tu ara dadebiTad damokidebuleba  konkretuli antisazogadoebrivi  qcevis mimarT da atarebda Tu ara es qceva regularul xasiaTs). sazogadoebrivad saSiS delinqventur qcevebad CavTvaleT aseTis erTjeradi epizodic ki.

Cveni kvlevis amocanis Sesabamisad, Semdgom etapze ganvixileT is bio-fsiqo da socialuri faqtorebi, romlebmac SeiZleba gazardon  qceviTi problemis aRmocenebis riski. Aaseve Seswavlil iqna deviaciuri qceveis asakobrivi dinamika; 

Sedegebi

Kkvlevam gamoavlina, rom qceviTi problemebi sarwmuno kavSirSia neirofsiqologiur disfunqciasTan. Amitom Cvns statiaSi mimovixilavT neirofsiqologiuri disfunqciis rols mosazrebebs qceviTi problemebis aRmocenebaSi.

problemuri qcevis dinamika gogonebsa da vaJebSi asakTan mimarTebaSi:

problemuri qcevebis maCveneblebi asakTan erTad icvleba araerTgvarovnad. saxeldobr, piks aRwevs vaJebSi 14 ,xolo gogonebSi 15 wlis asakSi. gogonebsa da vaJebSi es maCvenebeli asakobrivi jgufebis mixedviT sakmaod gansxvavebulia, gogonebSi problemuri qcevis procentuli maCvenebeli izrdeba nela, Tan 13 wlis asakisaTvis aRemateba deviaciuri qcevis maCvenebels vaJebSi, Semdeg mrudi nela izrdeba da piks aRwevs 15 wlis asakisaTvis, xolo Semdeg nela eSveba qveviT. rac Seexeba vaJebs es maCvenebeli mkveTrad imatebs, 14 wlis asakisaTvis aRwevs piks da  Semdeg eSveba qvemoT. aRsaniSnavia, rom 16-17 wlis asakSi gogonebSi problemuri qcevebis maCvenebeli isev aRemateba igive asakis vaJebSi problemuri qcevebis maCvenebels.

aRsaniSnavia agreTve qceviTi problemebis maCveneblis  dinamikis mrudi da maTi daxloebiT erTnairi done pubertatis dasawyisSi da boloSi:; es garemoeba kidev erTxel adasturebs gavrcelebul azrs imis Sesaxeb, rom qceviTi problemebi, romlebic gamoxatuli da damaxasiaTebelia pubertatuli asakisaTvis, xSir SemTxvevaSi ganicdian reducirebas pu vinaidan Cveni kvleva ar moicavs mozardebs 17 wlis zeviT, is , Tu ra xdeba SemdgomSi, SesaZlebelia mxolod vivaraudoT. rodesac vakvirdebiT #1 grafiks,  grafikis ganxilvisas iqmneba STabeWdileba, rom  17 wlis asakisaTvis SemTxvevaTa  umravlesobaSi xdeba ‘’normaluri qcevebisaken’’ dabruneba. Mmagram nawilisa ki  grZeldeba da Sesabamisad, zRvari normalur da problemur qcevebs Soris xdeba ufro mkveTri. Ees exebaDdelinqventur, suicidur,adiqtiur, qcevebis gamovlinebebs. romelTa mrudic 17 wlis asakidan mkveTrad iwevs zeviT.

statistikurma analizma cxadyo, rom mozardebs, romlebsac gamouvlindaT kognitiuri funqciebis siCqaris Seneleba, sarwmunod ufro xSirad aReniSnebaT qceviTi problemebi.( (X²=3.750, P<0.05)

igive SeiZleba iTqvas mozardebze, romlebsac gamouvlindaT problemebi mexsierebaSi, (X²=11.080 P<0.02), isini deviaciuri qcevebis mimarT specifiurobiT xasiaTdebian.  

  seriozuli qceviTi problemebis matarebel mozardebSi neirodisfunqciis sixSire sarwmunod ufro metia, vidre deviaciebis armqone mozardebSi. (Pearson Chi-Square=8.71   P<0.01).

neirofsiqologiuri disfunqcia aReniSneba gamokvleuli mozardebis 30%-s, xolo 70%-is parametrebi normas ar scildeba. neirofsiqologiuri disfunqciis maCvenebeli piks aRwevs 13 wlis asakSi, Semdgom eSveba qveviT da 16 wlis asakidan kvlav izrdeba. aseTi dinamikis axsna am etapze SesaZleblad ar migvaCnia da vfiqrobT saWiroa damatebiTi multidisciplinaruli neirobiologiuri da fsiqosocialuri kvlevis

grafiki 2 neirofsiqologiuri maCvenebeli mozardTa asakobrivi jgufebis mixedviT

sxvanairad rom vTqvaT, arasasurveli qceva, romelic warmoiSoba bavSvobaSi, an 12 wlis asakSi,rogorc grafikzea#1 warmodgenili, piks aRwevs 14-15 wlis asakSi, maSin rodesac, neirodisfunqciis piki modis 13wlis asakSi, xolo Semdeg klebulobs, SesaZloa, asakobrivi kompensaciis xarjze. e.i savaraudoa, rom swored am asakobriv SualedSi 13-14 xdeba problemuri qcevebis aqtiuri formireba.  Tumca, rogorc adre aRvniSneT, es sakiTxi moiTxovs damatebiT kvlevas.

dRes dReobiT  udidesi mniSvneloba eniWeba im meqanizmebis Seswavlas, romlebiTac xdeba devianturi qcevebis aRmoceneba-ganviTareba. Tanamedrove yvelaze gavrcelebuli hipoTezis  Tanaxmad, agresiuli da zogadad deviantur qcevebis erT erT safuZvels warmoadgens mozardebis da bavSvebis mier socialuri signalebis araswori interpretacia; bavSvebi romelTac aReniSnebaT qceviTi darRvevebi da agresia, arasworad axdenen irgvlivmyofTa qmedebebis interpretirebas.saxeldobr, urTierTobas aRiqvamen rogorc mtruls da Sesabamisad, gaaCniaT problemebi socialur urTierTobebSi. sxvanairad rom vTqvaT, socialuri informaciis Semecneba da gadamuSaveba xdeba Taviseburad/arasworad. Aamdenad marTebulia sarwmuno dinamiuri kvlevis Catareba, romelic saSualebas mogvcemda Segvefasebina da ukeT gagvego is meqanizmebi, da neirodisfunqciis da sxva risk faqtorebis wvlili am meqanizmebis aRmocenebaSi romelTa meSveobiTac mozardebi myarad iTviseben deviaciuri qvevebs.

Marina Gegelashvili psychiatrist MD. Ph.D

Issues of neuropsychological disfunction and behavioral problems age dynamic in adolescents.

The purpose of the study was to determine the prevalence of behavioral problems in children and adolescents in Georgia, and to define the bio-psycho-social factors affecting and facilitating in development of behavioral problems in terms of   effectively and purposefully planning children and adolescents Mental Health psycho-preventive measures.

Materials and Methods:

                      The present study represents the research focusing on psychosocial problems in adolescents’ behavior. The study was carried out in public schools – in total 1374 children and adolescents between 12-17,(males 42%, females-48%)

specially elaborated Psychosocial questionnaire ,– Rey- Tailor Complex Test and Recognition Trial (RCFT),Rubinstein Self-Evaluation Test  (standardized for Georgian population),Rokich Value Test (standardized for Georgian population)

Statistics Sampling method was used.. The data was analyzed by the univariative tests - X² test, multivariate (Dispersive) analysis, logistic regression

Results Statistical analysis revealed that the adolescents, who have impaired speed of cognitive function, have behavioral problems more often. (X²=3.750, P<0.05). The same is shown in adolescents who reveal disrupted memory pattern - they evidently frequently have behavioral problems.  (X²=11.080 P<0.02), Iin the adolescents who have serious behavioral problems, frequency of neurodysfunction is higher than in the adolescents not having deviations  (Pearson Chi-Square=8.71   P<0.01).

undesirable behavior, that develops in the childhood or at the age of 12 – as it is shown culminates at the age of 14-15; as for the neurodysfunction, it culminates at the age of 13 and then declines – it might be due to the age compensation, i.e. we might assume that at this age period (13-14) behavior disorder develops; though, as it has been mentioned above, this problem needs further research.

To reveal the mechanisms of behavioral problems in terms of incorrect interpretation of social signals and neuropsychological disfunction s contribution in this mechanisms, further research is needed

შოთა გამყრელიძჳს სტატია "საქართველოს ფსიქიატრიის მოამბის" მე-6 ნომრიდან

fsiqiatriaSi klasikuri nozologizmis krizisi  da “obsesur-kompulsuri speqtris” daavadebebi, rogorc “mosazRvre fsiqikuri aSlilobebi.”

  

   fsiqiatriis, rogorc  samedicino dargis  aRiarebis gariJraJze  Sotlandielma swavlulma eqimma W.Cullen-ma moaxdina nervuli sistemis daavadebebis - nevritis, nevromis da nevrozis diferencireba da darwmunda, rom maT Soris iyo principuli gansxvaveba. misTvis gasagebi iyo, rom cocxal organizmSi nervuli sistema warmoadgenda sasicocxlo procesebis ZiriTad maregulirebel faqtors, romelic gamovlindeba 2 ZiriTadi mdgomareobis  daZabulobas an piriqiT mis dasustebaSi. am  avtoris azriT nevrozi, rogorc daavadeba ukavSirdeba am ori sawyisi procesis urTierT damokidebulebas.  avtorma nevrozis, rogorc  daavadebis jgufSi, pirvel rigSi, igulisxma isteria (ipoqondriasTan erTad). zogadad ki cneba “nevrozi”kulenis mixedviT moicavs nervuli  sistemis ZiriTadi Semadgenlis SegrZnebebis da motorikis aSlilobas, romelic ar  ukavSirdeba ciebcxelebas da romelime organos dazianebas e,i,  nevrozi  warmoadgens  im meqanizmebis dazianebas romelic  warmarTavs adamianis moqmedebas da  azrovnebas.

   cneba “nevrozi” gulisxmobs nervuli  sistemis  funqciur aSlilobas, rac misi ganusazRvrelobisa da naklebad diferencirebis miuxedavad momdevno  2  saukunis ganmavlobaSi myarad iyo aRiarebuli. amasTan  erTad amave periodis manZilze nevrozebis SemadgenlobaSi erTiandebodnen sruliad  aranevrozuli formebi, romelTa eTiopaTogenezic  ucnobi iyo.

   sainteresoa. rom cneba “fsiqozi” rogorc fsiqikuri   aSlilobis ZiriTadi forma gacilebiT ufro gvian 1845 wels iqna SemoRebuli  q. venis universitetis samedicino fakultetis dekanis fsiqiatr Baron von Feutersleben-is mier. fsiqikuri funqciebis aSlilobaSi nevrozuli da fsiqozuri formebis diferencirebisaTvis pirvel xanebSi SesaZlebeli Seiqna SemuSavebuliyo nevrozuli da fsiqozuri donis  aSlilobebs Soris diferencirebisaTvis obieqturi argumentebi, magram SemdegSi es sakiTxi  arc ise ioli aRmoCnda, radgan TviT cneba “fsiqozi”, iseve, rogorc cneba “nevrozi” rCeboda aradiferencirebuli da dauzustebeli. momdevno Taobis fsiqiatrebis kvlevebi swored fsiqikuri aSlilobis am ori donis Semdeg diferencirebul kvlevebs mieZRvna.    

   1880 wels amerikelma  fsiqiatrma Beard-ma aRwera  nevrozuli donis  Taviseburi  davadeba gamRizianeblobis sisuste, fizikurad gadaqancul mSromelebSi da uwoda  “nevrasTenia”, ,ramac didi interesi gamoiwvia evropis fsiqiatrebs  Soris da nevrasTeniam  isteriasTn erTad daiWira ZiriTadi nevrozis  meore adgili.

   1977 wels germanelma Westfphal-ma aRwera akviatebis nevrozi, romelsac 1903 wels frangma P.Janet-m uwoda fsiqasTenia da aRiarebuli iqna mesame ZiriTad nevrozad. momdevno periodSi nevrozebis nairsaxeobebis ricxvi izrdeboda organizmis sxvadasxva Sinagan organoebis funqciuri aSlilobebis aRweris kvaldakval, manamde sanam  fsiqiatriis ganviTarebaSi dadgeboda fsiqofa rmakologiuri anu biologiuri fsiqiatriis era. swored sxvadasxva fsiqotropuli aqtivobis preparatebis sinTezirebiT da maTi fsiqikur funqciebze zemoqmedebiT Seiqmna fsiqikuri funqciebis xelovnuri marTvis SesaZlebloba, romelmac SemdegSi mniSvnelodnad Secvala Sexeduleba nevrozuli donis aSlilobebis nozologiuri principiT Sefasebisa da dayofis TvalsazrisiT.

rac Seexeba fsiqozuri donis fsiqikuri daavadebebis  Seswavlas, nozologiuri principiT somaturi daavadebebis diferencirebis warmatebiT  moxiblulma germanelma E. Kraepelin-ma, imis miuxedavad, rom endogenur fsiqikur daavadebebis  eTiologia, paTogenezi da paTologiuri anatomia ar iyo dadgenili (daavadebis nozologiur erTeulad aRiarebisaTvis aucilebeli argumentebi)  maTi  dadgena gadado uaxloesi momavlisaTvis da endogenuri fsiqozebis nozologia daafuZna fsiqikuri daavadebis gamosavalze. man principulad morCenad formas uwoda maniakalur-depresiuli fsiqozi, xolo principulad mourCenel da progredientulad mimdinares naadrevi Wkuasustoba. miuxedavad imisa, rom krepelins fsiqiatrebis umravlesoba ar eTanxmeboda endogenur daavadebebis nozologiur principiT dayofaSi XX saukunis dasawyisSi S.Freud-is  fsiqoanalizuri moZRvrebis gabatonebam xeli Seuwyo Sveicareli E.Bleuler-is mier krepeliniseuli naadrevi Wkuasustobis damoukidebel nozologiur erTeulad damkvidrebas. axali saxelwodebis - Sizofreniis saxiT, cxadia maniakalur-depresiul fsiqozTan erTad. endogenuri fsiqozebis diferencirebis erTaderT prioritetul meTodad momdevno 40-50 wlis ganmavlobaSi rCeboda mxolod  fenomenologiuri meTodi, romelmac imave e. krepelinis 1920 wlis aRiarebiT amowura Tavisi SesaZleblobani,  endogenuri fsiqozebis diqotomiuri dayofis da ori damoukidebeli nozologiuri erTeulis urTierT  gamijvnaSi. krepelinma mouwoda fsiqiatrebis axal  Taobebs ufro zusti meTodebis SemuSavebisaken, romelic  fsiqikuri daavadebebis eTiopaTogenezur meqanizmebs ufro Rrmad Cawvdeboda. krepelinis mowodebis aRsrulebis perspeqtivebi kvlav gamoCnda fsiqiatriis ganviTarebaSi fsiqofarmakologiuri (biologiuri) epoqis dawyebiT gasuli XX saukunis 50-ani wlebidan da Znelad, magram Tanmimdevrulad zustdeboda ara marto fsiqikuri funqciebis natifi meqanizmebi neirotransmiterebis, neiroreceptorebisa da sxva profilis ultramolekuluri meqanizmebis doneze, aramed agreTve fsiqotropuli medikamentebis zemoqmedebis monawileoba fsiqikuri fenomenebis paTomorfozSi, ris zegavleniTac fsiqikuri daavadebebis, rogorc nevrozuli, ise fsiqozuri donis aSlilobebs Soris fenomenologiurad mTeli rigi atipuri, Sereuli, legirebuli, Suamdebare formebis gamoCenam sruliad waSala nozologiuri  sazRvrebi da xeli Seuwyo fsiqikuri da qceviTi aSlilobebis ara nozologiuri principiT, aramed speqtraluri proncipiT diferencirebas. endogenuri fsiqozebi iyofian “Sizofreniuli speqtris” da “afeqturi  speqtris” aSlilobebad, xolo nevrozebi, rogorc fsiqikuri daavadebis funqciuri formebi saerTod iqna amoRebuli nomenklaturisa da klasifikaciidan.

ismeba kiTxva, yvela daavadebebze gavrcelebuli da sazogadoebaSi  metad popularuli daavadeba - nevrozi sinamdvileSi arsebobs TuAara?

msgavs kiTxvaze kategoriuli pasuxis gacema gaZnelebulia, radgan gasuli saukunis 50-ani wlebidan biologiuri (fsiqofarmakologiuri) kvlevebis Sedegad  dRemde “nevrozis” da nevrozuli registris daavadebebis  nozologiuri principis TvalsazrisiT Sexeduleba Seicvala, saukunis manZilze nevrasTeniis Sesaxeb warmodgena aseve Seicvala. misi  erTi  nawili ganixileba, rogorc fsiqofizikuri asTenia, xolo meti nawili gaerTianda fsiqosomatur aSlilobebSi. romelTa didi umravlesoba dadebiTad reagirebs fsiqoTerapiaze, trankvilizatorebiTa da mcire da saSualo Zalis aqtivobis antidepresantebiT mkurnalobaze.

klasikuri nevrozuli donis daavadebebi isteria da fsiqasTenia arsebiTad ganixilebian pirovnuli aSlilobebis farglebSi. fsiqogenuri faqtorebis zemoqmedebis Sedegad isteriuli pirovneba iZleva konversiul aSlilobebs, xolo fsiqasTeniuri pirovneba  obsesur-kompulsur aSlilobas.

amgvari Sexedulebis gauziarebloba swori ar unda iyos, magram isic xom  aris gasaTvaliswinebeli, rom yvela saxis nevrozis eTiopaTogenezSi wamyvania fsiqogenia, romelzedac pirovneba reagirebs ZiriTadad im fenomenologiuri TaviseburebiT, romelic individis qaraqterologiisTvis aris damaxasiaTebeli. amasTan erTad samive daavadebis ZiriTadi simptomebi metnaklebi intensivobiT dadebiTad reagireben fsiqoTerapiul da farmakoTerapiul zemoqmedebaze. am SemTxvevebSi ukeTes Terapiul efeqts uzrunveluofen benzodiazepinuri trankvilizatorebi da vegetotropuli medikamentebi, rac Tavisrigad gvarwmunebs, rom sanam endogenuri fsiqozebis da e.w. mosazRvre fsiqikur aSlilobebis eTiopaTogenezi ar dadgindeba nomenklaturidan nevrozis cnebis amoReba naCqarevia. nevrozebs, “mosazRvre” formebsa da endogenur fsiqozebs Soris mxolod nevrozebis  etiologia da paTogenetikuri meqanizmebia sarwmuno da amitom, Cveni azriT, kvlav fenomenologiuri argumentebiT fsiqikuri da qceviTi  aSlilobebis klasifikaciidan da nomenklaturidan nevrozebis amoReba naklebad  argumentirebulia. kidev ufro sadavod migvaCnia rusulenovani fsiqiatriis, e.w. “mcire fsiqiatriis”  wamyvani mkvlevarebis Г.К.Ушаков-is (1987) da Ю.А. Александровский-s (2000) monografiebSi nevrozebis gaerTianeba “mosazRvre” fsikikuri aSlilobebis SemadgenlobaSi.  ukve yavlgasuli fenomenologiuri argumentebiT nevrozebisa da ‘mosazRvre” fsiqikur aSlilobebis gaerTianeba, saerTod ara marto nevrozebis uaryofaze miuTiTebs, aramed gaugebars xdis TviT “mosazRvre”fsiqikuri aSlilobis realobas. gasagebia, rom marcxnidan am formebs esazRvrebian fsiqozebi, xolo marjvnidan sazRvari Tu nevrozuli donis daavadebasTan ar aris, maSin raRa rCeba maT  mosazRvred? Tu aq igulisxmeba mxolod fsiqikuri janmrTeloba es uazrobaa da umjobesi iqneba Tu gaviziarebT inglisurenovani amerikeli somexi fsiqiatrebis- H.S.Akiskal-is, B.J. Yerevanian-is da maTi  TanamSromlebis mtkicebas, (1985-a da 1985-b), rom cneba “mosazRvre” fsiqikuri aSlilobis realobis aRiareba miuTiTebs fsiqiatr klinicistis umweobaze gaerkves daavadebis WeSmarit simptomatikaSi, xolo is SemTxvevebi, romlebic diagnoscirdebian “mosazRvre” fsiqikur daavadebad, sxva araferia Tu  ara afeqturi aSlilobebis variantebio. msgavsi kategoriuli Sexeduleba sakmaod didi  xnis win, msoflio maStabis mqone klasikosi klinicisti fsiqiatrebis  mier SemuSavebuli Sexeduleba “mosazRvre” fsiqikuri aSlilobebis realuri arsebobis Sesaxeb, rac Cven isev miuReblad migvaCnia, ise rogorc nevrozebis “mosazRvre” fsiqikur aSlilobebTan gaigiveba. rac mocemulia zemoT naxsenebi rusulenovani avtorebis monografiebSi. “mosazRvre mdgomareobebSi gaerTianebulia rogorc nevrozuli ise fsiqozuri donis afeqturi aSlilobis mwvave da qronikulad mimdinare, mSfoTvare  fobikuri, panikuri obsesur-kompulsuri. disociaciuri (konversiuli), somatoformuli, qceviTi, CveviTi. seqsualuri aSlilobebi da a.S arsebiTad fsiqikuri da qceviTi  aSlilobis yvela nairsaxeobebi, e.w. endogenur da toqsiorganuli fsiqozebis garda, rogorc  es  mocemulia fsiqikuri da qceviTiDaSlilobebis klasifikaciis da nomenklaturis me-10 gadasinjvaSi. klasifikacia 1994-1995 wlebSi SemuSavda da misi adaptirebuli varianti rusulenovan qveynebSi 1998 wels iqna SemoRebuli. msgavsi voluntaruli gadawyvetilebis gameoreba momaval me-11 gadasinjvaSi Cveni  Rrma rwmeniT iTamaSebs klinikur fsiqiatriul azrovnebaSi ara progresul, aramed regresul rols.

E.Kraepelin-is mier 1896 wels damkvidrebuli endogenuri fsiqozebis diqotomour nozologiur erTeulebad dayofam da EE.Bleuler-is mier fsiqoanalizuri swavlebis gamoyenebiT endogenuri fsiqozebis nozologiuri damoukideblobis aRiarebam mTeli XX saukunis ganmavlobaSi SeinarCuna gabatonebuli pozicia, imis miuxedavad, rom es koncefcia aRmoCnda uZluri raime Rirebuli siaxle Seetana endogenuri fsiqozebis eTiopaTogenezSi.  vinaidan am or ZiriTad endogenur fsiqozs  Soris  dayofis principma ar gaamarTla da Sizofreniasa da maniakalur-depresiul fsiqozs Soris ganlagda mTeli rigi atipuri, gardamavali, formebi, romlebic fsiqiatrebis subieqturi gemovnebis mixedviT xan Sizofreniad da xan  ki atipur ciklofreniad diagnostirdeboda. am TvalsazrisiT verc J.Kasanin-is (1933) koncefciam Sizoafeqturi fsiqozis Sesaxeb gadaWra problema. orTodoqsuli, nozologiis mimdevari moskovis fsiqiatriuli skolis axalma xelmZRvanelobam, Tavisi maswavleblis akademikos А.В.Снежневский-s mier damkvidrebuli Sizofreniis erTianobis Sesaxeb koncefciis mixedviT, 1999 wels gamocemul 2 tomian saxelmZRvaneloSi, endogenuri fsiqozebis diqotomiuri dayofa uaryo da SizofreniasTan da afeqtur aSlilobasTan erTad  aRiara damoukidebel nozologiur erTeulebad mesame - Sizoafeqturi da meoTxe - mogvianebuli asakis endogenuri fsiqozi. rac naklebad damajerebelia ara marto paTogenetikurad, rac kvlav rCeba  daudgeneli, aramed fenomenologiuradac Sizoafeqturi fsiqozis damoukidebel nozologiur erTeulad aRiareba Cvenis azriT saerTod fsiqiatriuli nozologiis uaryofaa, radgan fenomenologiurad igi mxolod  da mxolod Sizofreniisa da afeqturi fsiqozis simptomatiur naerTs warmoadgens da  es fsiqozi avtorebis mixedviT iyofa kvlav or nawilad erTi uaxlovdeba Sizofrenias, xolo meore afeqtur fsiqozs. msgavsi mdgomareoba kvlav naTlad miuTiTebs fsiqiatriaSi nozologiuri proncipis mxolod fenomenologiuri argumentebis sfuZvelze diferencirebis SeuZleblobaze.

amrigad endogenuri fsiqozebis diqotomiurma dayofam arsebiTad dakarga diagnostikuri mniSvneloba, gansakuTrebiT fsiqiatriis ganviTarebis fsiqofarmakologiur epoqaSi, rodesac adamianis yovelgvari daavadebebi ganicdian  paTomorfozs sxvadasxva Sinagani da garegani  faqtorebis da pirvel rigSi samkurnalo meTodebisa da medikamentebis zemoqmedebiT. paTomorfozi pirvel rigSi demonstratiulia fsiqiatriul fenomenologiaSi. exlandeli studenti an axalgazrda eqimi Zlier iSviaTad Tu naxavs fsiqikur avadmyofebs katatoniur pozebSi, mutizmSi, haerovani baliSis pozaSi, mwvave maniakalur fsiqofizikur agznebaSi da a.S., rac Cveni Taobis fsiqiatrebisaTvis iyo Cveulebrivi da yoveldRiuri zrunvis sakiTxi. mniSvnelovnad Semcirda Sizofreniis klasikuri avTvisebiani manifesturi SemTxvevebi da gamravlda atipuri, Sereuli naklebad madementirebeli formebi. cxadia, fsiqofarmakologiur epoqamdec iyo problematiuri SemTxvevebi, romelic moiTxovda diferencirebas nevrozuli da fsiqozuri donis aSlilobebs  Soris da swored amis gamo inglisuri klinikuri fsiqiatriis fuZemdebelma UU.H.Moudsley-m Semoitana cneba “mosazRvre fsiqikuri aSlilobebi”. igulisxmeboda fsiqikuri daavadebebi, romlebic fenomenologiuradac ki (rom araferi iTqvas eTiopaTogenezur argumentebze) iyo  gaZnelebuli.

sainteresoa, rom saerTaSoriso maStabiT “mosazRvre” fsiqikuri aSlilobebisadmi miZRvnili publikaciebi gansakuTrebiT gaxSirda  fsiqiatriis ganviTarebis  fsiqofarmakologiuri epoqis gafurCqvnis xanaSi, gasuli saukunis 80-an da momdevno  wlebSi da diskusiebi grZeldeba dRemde. msgavsi kategoriis aSlilobebi gamoirCevian fenomenologiuri mravalferovnebiT, sadac ZiriTadi simptomebi warmoadgenen nevrozuli registris aSlilobas da mxolod mimdinareobis qronikuli xasiaTi da dadebiTi  xarisxis reagireba serotoninul antidepresantebiT mkurnalobaze ganasxvavebs maT nevrozuli registris daavadebebisagan. meores mxriv “mosazRvre” aSlilobebis xangrZlivi,  ufro intermisiuli mimdinareobis  fonze ganviTarebuli pirovnuli cvlilebebi xasiaTdeba upiratesad fsiqikuri funqciebis raodenobrivi da ara Tvisobrivi cvlilebebiT, es ki damaxasiaTeblad miiCneva procesualuri daavadebisaTvis.

daavadebebi, romlebic erTiandebian “mosazRvre” fsiqikur aSlilobebSi moqmedi nomenklaturis da klasifikaciis me-10 gadasinjvaSi, TavianTi fenomenologiuri mravalferovnebis gamo gabneuli arian sxvadasxva diagnostikur jgufebSi, rogorc eqstranozologiuri erTeulebi. isini fenomenologiurad gansxvavdebian, rogorc Sizofreniisagan, ise afeqturi aSlilobebisagan, Tumca garkveul niuansebSi maT Soris mxolod erTeuli simptomebis msgavseba vlindeba.

endogenur fsiqikur aSlilobebs Soris sayovelTaod misaRebi nozologiuri sazRvrebis  daudgenlobam ufro misaRebad miiCnia  maTi  speqtraluri dayofis taqtika, ris Sedegadac am jgufis aSlilobebi iyofian “Sizofreniuli  speqtris” da ‘afeqturi speqtris” aSlilobebad, rac sadaod xdis Sizofreniis da afeqturi aSlilobebis damoukidebel nozologiur erTeulebad  aRiarebas. amasTan erTad mTeli rigi  avtorebi aerTianeben da  Cvenc Cvens NnaSromebSi  (2007 wels gamoqveynebul monografiaSi “akviatebis aSlilobebi da maTi mkurnalobis sakiTxebi”) viziarebT E.Hollander-is (1993, 1995, 2000) da misi mravali TanamSromlisa da mimdevris koncefcias “obsesur-kompulsuri speqtris” aSlilobebis Sesaxeb, romlebic aseve gafantulia, moqmedi klasifikaciisa da nomenklaturis me-10 gadasinjvis sxvadasxva struqturis daavadebebSi.

   pirvel rigSi SemoqmedebiT interess iwvevs “obsesur-kompulsur speqtris” SemadgenlobaSi gaerTianebuli daavadebebi dawyebuli impulsuri aSlilobebidan da damTavrebuli kompulsuri AaSlilobebiT da aq erTiandeba 15-mde eqstranozologiuri aSliloba: 1. klasikuri formis obsesur-kompulsuri aSliloba; 2. sxeulis dismorfuli aSliloba; 3. kvebiTi  qcevis aSlilobebi (nervuli anoreqsia  da bulimia; 4. depersonalizaciuri aSliloba; 5. ipoqondriul-senestopaTiuri aSliloba; 6. turetis sindromi vokaluri tikebiT; 7. triqotilomania (Tmis, warbebis an wamwamebis amoglejvis gadaulaxavi qceva  da zogierTi  dermatitebi; 8. permanentuli qeifisa da drostarebis Znelad gadasalaxavi miswrafeba: 9. kompulsuri Sopogolizmi - fulis xarjvis Znelad gadasalaxavi mudmivi miswrafeba, xSirad ara saWiro sagnebis SesaZenad; 10. kleptomania, piromania da sxva saxis impulsuri qcevebi; 11. azartomania (banqos, lotos, komputeris an internetis da a.S. TamaSebisadmi kompulsuri damokidebulebis gamomuSaveba; 12. sxeulis romelime nawilis (kanis, tuCebis anFfrCxilebis kvnetis an sxva nawilebis  TviTdazianebis gadaulaxavi survili da qmedeba; 13. seqsualuri kompulsiebi, impulsiebi, gaukuRmarTebebi da parafiliebi; 14. antisocialuri personologiuri darRvevebi da 15. mosazRvre personologiuri aSlilobani.

   obsesur-kompulsuri speqtris SemadgenlobaSi gaerTianebuli, fenomenologiurad gansxvavebuli aSlilobebis urTierTmsgavsebaSi igulisxmeba: 1. daavadebis eTiopaTogenezSi genetikurad determinirebuli winaswarganwyoba, analogiuri an imave obsesur-kompulsur speqtrSi Semavali aSlilobebiT datvirTva memkvidreobaSi; 2. amave speqtrSi Semavali aSlilobebis manifestireba ufro xSirad egzogenuri stresogenuri faqtorebis zemoqmedebiT, im TaviseburebiT, rom Cveulebriv da yvelasaTvis advilad asatani stresogenuri faqtorebis zemoqmedebaze, genetikurad winaswarganwyobili pirovnebebi ufro xSirad reagireben swired obsesur-kompulsur speqtrSi gaerTianebuli aSlilobebisaTvis damaxasiaTebeli simptomatikis ganviTarebiT; 3. daavadebisaTvis damaxasiaTebeli simpomebis nevrozuli registri da fsiqozuri donis simptomebis ganuviTarebloba; 4. mimdinareobis qronikuli xasiaTi, rodesac Terapiuli zemoqmedeba (kognitur-qceviTi fsiqoTerapia an ufro metad farmakoTerapia) uzrunvelyofs obsesuri, impulsuri da kompulsuri simtomebis reducirebas, srul an mniSvnelovan ukuganviTarebamde; 5. fsiqotropuli medikamentebidan am jgufSi Semavali klinikuri formebis yvelaze ufro naTlad gamovlenili dadebiTi  reagireba serotoninis ukumitacebis seleqtiuri inhibitorebiT mkurnalobaze; 6. yvela 15 nairsaxeobis mimdinareobis qronikuli xasiaTi, adeqvaturi mkurnalobis gareSe sruliad SesaZlebelia ganviTardes raodenobrivi (da ara Tvisobrivi) pirovnuli  cvlilebebi, rac saerTod aris damaxasiaTebeli qronikulad mimdinare somatoformuli daavadebebisaTvis.       

    am rigad fsiqikuri da qceviTi aSlilobebis  saerTaSoriso klasifikaciisa  da nomenklaturis morigi me-11 gadasinjvisaTvis migvaCnia mizanSewonilad aRdgenili iqnas nevrozuli donis fsiqogenuri reaqciebis anu nevrozebis realoba, romelic diametralurad gansxvavdeba WeSmariti endogenuri fsiqozebisagan. amasTan erTad  mizanSewonilad migvaCnia klasifikaciasa da nomenklaturaSi ganisazRvros “mosazRvre” fsiqikuri aSlilobebis cneba, rogorc fenomenologiurad nevrozuli registris, xolo mimdinareobiT qronikuli da mkurnalobisadmi sxvadasxva xarisxis da xangrZlivobis rezistentobis mqone. Sesabamisad, e.w. “obsesur-kompulsuri speqtris” SemadgenlobaSi Mmoyvanili daavadebebis jgufi ganisazRvros “mosazRvre” fsiqikur aSlilobebad, “nevrozuli speqtris”, “afeqturi speqtris’ da “Sizofreniuli seqtris” aSlilobebTan erTad.

Crisis of classical nosologism in psychiatry and disorders of “obsessive-compulsive spectrum” as “borderline mental disorders”.

We suppose, that for the future ICD-11 it is recommended to include “Neurosis” in International Classification.

There are disorders which are characterized – from phenomenological side with traits of neurotic disorders, but have chronic course and resistance to treatment. Such disorders, we suggest, to call “obsessive-compulsive spectrum” disorders, that in fact are also “borderline”. We propose to create a separate niche for them in ICD-11.

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