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.
citirebuli literatura:
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