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.