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.

            citirebuli literatura:

1. Александровскийб Ю.А.-Пограничные  психические  Расстроиства.

   М.Медицина, 2000

2. РУКОВОДСТО  ПО ПСИХИАТРИИ (Под редакцией А.С. Тига-

    нова)М.”Медицина”1999 т. 1 стр.636-676.

3. Ушаков,Г.К.-Пограничные  нервно-психические  расстроиства.

     М.Медицина,1987.

4. Akiskal,H.S., Chen, S.E.,Davis, G.C/et al-Borderline  an adjective in  sea

      lch of a noun  //J.Clin.Psychatry 1985; 46;2; 41-8//

5.  Akiskal,H.S.,Yerevanian,B.J.,Davis,G.C. et  al-The nozologic status of

      borderline  personaliti  Clinical and  polysomnographic  study/ //Amer.

       J.Psychiatr.1985;142;2;135-8//

6.  Bleuler,E.-Dementia  praecox  oder groupe  der Schizofrenia. Leipzig-

     Wien,1911.

7.  Hollander,E.-Obsessive-Compulsive  Spectrum dizorders:on overwiew

    //Psichiat.Ann/1993;23’355-8//

8.Hollander,E.,Wong,C.-Obsessive-Compulsive Spectrum disorders.//J/Clin.

   psychiatry,1995;suple 4:3-6//.

9. Hollander,E.,Risen, I.-Obsessive-Compulsive  Spectrum Disorders’ A  Re

    viev ( In:” Obsessive-Compulsive  Disorder” Editored by M.May.N.Sar

  torius,A.Okasha and  Z.Zohar.2000;203-41).

10. Kasanini,J-The  acute schisoaffective  psychoses -1933.

11.Kraepelin, E.-Psychiatrie. Leipcig.1896.

12.Kraepelin,E.-Die  Erscheinungsformen des  Irreseins //Z.ges Neurol. Psy

     chiat. 1920;52;1-20//.