ვიტალი კაშიას სტატია "საქართველოს ფსიქიატრიის მოამბის" მე-6 ნომრიდან

rispoleptis efeqturobis Sefaseba SizofreniiT daavadebul avadmyofTa mkurnalobaSi

(preparatis gamoyenebis Teoria da praqtika)

v. S. kaSia

m. asaTianis saxelobis fsiqiatriis

s/k instituti

Tbilisi, saqarTvelo

tipiuri neiroleptikis gamoyenebiT Sizofreniis xangrZliv mkurnalobas garkveuli SezRudvebi gaaCnia: pacinetTa 25%-33% Catarebuli Terapiis mimarT rezistentulia (1,9). klasikuri neiroleptikebi iCenen SezRudul zemoqmedebas negatiur simptomatikaze: azrovneba Raribdeba, iqmneba socialuri gariyuloba, ikargeba emociuri gamomsaxveloba. es medikamentebi iwveven gamoxatul gverdiT movlenebs. iTvleba, rom atipiuri neiroleptikebi H. Meltzez (n) mier mowodebuli ganmartebis Tanaxmad, warmoadgenen preparatebs antifsiqozuri efeqtiT ise, rom ar iwveven gverdiT eqstrapiramidul movlenebs da aqveiTeben Sizofreniis negatiur gamovlinebebs. dReisaTvis atipiuri antifsiqozuri medikamentebi warmoadgenen pirveli rigis samkurnalwamlo preparatebs im pacientebisaTvis, romlebic cudad itanen tipiur neiroleptikebs, aseve pacientebisTvis, romlebic rezistentulebi arian klasikuri neiroleptikebiT mkurnalobis mimarT.

erT-erT cnobil atipiur neiroleptiks warmoadgens ristolepti. bolo ramdenime wlis ganmavlobaSi rispoleptma ara marto aRiareba miiRo  praqtikul fsiqiatriaSi, aramed moxda misi daniSvnis Cvenebis mniSvnelovani gafarToeba.

gamoiyeneboda ra Tavdapirvelad rogorc preparati SemanarCunebeli TerapiisaTvis, rispoleptma miiRo farTo gamoyeneba rogorc mwvave da qvemwvave endegonuri fsiqozebis mkurnalobisaTvis, aseve gaxangrZlivebuli dunedmavali mdgomareobisas, rogorc mozrdil pacientebSi, aseve bavSvTa,.mozardTa da moxucebulobis asakSi. dRevandel dRes rispolepti warmoadgens yvelaze xSirad daniSvnad axal Taobis neiroleptiks, ase magaliTad: aSS-Si receptebiT daniSnuli rispolepti Seadgens TiTqmis 25%-s yvela antifsiqozuli preparatis receptebisa. pacientTa gadayvana tipuri neiroleptikebidan rispoleptze Cveulebrivi Terapiuli praqtika gaxda. neiroleptikis cvlilebis mizezi klinicistisTvis SeiZleba gaxdes tradaciuli neiroleptikebis efeqturobiTa da usafrTxebiT daukmayofilebloba, rac ukavSirdeba pozitiuri simptomebis arasakmaris reduqcias da narCen negatiur aSlilobebs (apaTia, motivaciis daqveiTeba da kognituri darRvevebi da sxva).

avadmyofebic aseve xSirad arian motivirebuli neiroleptikebis Secvlis mimarT. tradiciuli neiroleptikebis mtanjveli gverdiTi efeqtebis, maTi arasakmarisi efeqturobis, aseve piradi arCevanis gamo. avadmyofTa tipiuri neiroleptikebi da rispoleptze gadayvanis mecnierul dasabuTebas warmoadgens mravalricxovani gamokvlevebi, romelSic ganxilulia preparatis sxvadasxva fsiqofarmakologiuri Tviseba, misi efeqturoba da usafrTxoeba tradicul antifsiqotikebTan SedarebiT. am monacemebiT, romlebic Cven eqimebs gvexmareba  miviRoT swori gadawyvetileba mtikcebiTi medicinis mocemulobaze dayrdnobiT, anu sworad mravalcentruli gamocdis rezultatebiT, Cven gavakeTeT mcire mimoxilva. Yyvela Catarebul gamokvlevaSi rispoleptma aCvena mniSvnelovani upiratesoba placebo TerapiasTan SedarebiT, xolo maT umravlesobaSi upiratesoba Sizofreniis pozitiuri aSlilobebis mkurnalobisas, tradiciul neiroleptikebTan SedarebiT.

R. Bozison gamoavlina simptomTa 60%-is reduqcia im pacintebSi, romlebic iRebdnen rispoleptis 10,0 mg.-s saSualo dReramuri doziT da mxolod 25% im pacintebSi, romlebic iRebdenen haloperidols (saSualo 20,0 mg. dR. doziT) gamokvleva tardeboda 6 kviris ganmavlobaSi.

8 kviriani gamokvlevisas Hoybez adarebda rispolepts (8,5 saSualo dRis doziT) perfenazins(saSualo dR. doza 28,0 mg) da armoaCina bodviTi da halucinatoruli aSlilobis sando reduqcia pacinetTa 78%-Si. 59% im pacientebTan SedarebiT, romlebic iRebdenen perferazins.

haloporidolis 10,0 mg dR. doziT miRebis Sedareba ripoleptis 1.0-4.0-8.0-12. an 16.0 mg dR. dozasTan, gamovlinda preparatis sakmarisi efeqturoba 4.0-8.0-12.0 mg. dRiur dozebze da ufro cxadi reduqcia pizitiuri sindromebisa haloperidolis gamoeynebasTan SedarebiT.

Davis da Jnikak Caatares ra meta analizi 5 ormagi brma kontolirebadi gamokvlevisas, daadastures, rom risolepti 6.0mg/ 12.0 mg dR. doziT mniSvnelovnad ufro efeqturia, vidre tipuri antifsiqotipebis standartuli dozebi, magaliTad: haloperidoli 10,-20,0md dR. doziT.

rispoleptma iseve rogorc sxva tipiurma medikamentebma, aCvena efeqturoba refraqteruli SizofreniiT daavadebul avadmyofTa mkurnalobisas. ormagi brma meTodiT gamokvlevisas rispoleptiT da klozapiliT im avadmyofebSi, romlebic iyvnen rezistentuli tradiciuli neiroleptikebisadmi, orive preparatma gamoavlina sarwmuno efeqturoba, amastan rispolepti avlenda moqmedebis ufro swraf dawyebas, vidre klozapini. rispoleptis (12,0 mg. dR doziT) da haoperidolis (10,0 mg. dR. doziT). 12-kviriani SedarebiTi gamokvlevisas refraqteruli Sizofreniis dros c. claus aRmoaCina Pa NSS–is SkaliT im avadmyofTa meti ricxvis gaumjobeseba, romlebic itarebdnen Terapias rispoleptiT im avadmyofTan SedarebiT, romlebic mkurnaloben Sedarebis preparatiT (24%).

Sizofreniis pozitiuri simptomebisagan gansxvavebiT, romlebic upiratesad iwveven avadmyofTa da maTi garemocvis daZabulobas, negatiuri simptomebi, iseve, rogorc kognituri funqciebi, dReisTvis ganixileba, rogorc daavadebis gamosavlis ZiriTadi prediqtorebi, ganapirobeben ojaxur da profesionalur prognozs, aseve, pacientTa socialuri adaptaciis xarisxs. praqtikulad Catarebul yevla kontrolirebad da gaxsnil gamokvlevebSi xazgasmuli iyo rispoleptis upiratesoba sxva tradiciul neiroleptikebTan: haloperiodlTa, qlorpomazilTan da perfenazimTan SedarebiT negatiur simptomebze gavlenis TvalsazrisiT. gamokvlevaTa metanalizis rezultatebiT, romlebic eZRvneboda rispleftiis (saSualo 4,0 mg. dR. doziT) gavlenas negatiur simptomatikaze (J. Carman), is didi albaTobiT (1,43-jer) amcirebs negatiur simptomebs, vidre konvencionaluri neiroleptikebi. atipiuri neiroleptikebi zogadad, ukeTesad gadaitaneba avadmyofebis mier, vidre tradiciuli anti fsiqotipebi, rac dadebiTad aisaxeba pacientTa mier preparatis miRebis reJimis dacvaze.

im pacientTa Soris romelbic iReben rispolefts 4,0-8.0 mg dR. doziT. EPC-is sixSire iyo naklebi, vidre im pacientebSi, romlebic imyofebodnen haloperidoliT Terapiaze da Seesabameboda am simptomatikis gavrcelebadobas placebo mkurnalobis dros.

gamokvlevis rezultatebma, romlebSic gamoiyeneboda rispoleptis mravaljeradi dozebi, cxadyo, rom preparati iwvevs dozadamokidebul efeqtebs, romlebic iwyeben momatebas 12.0 mg. dR. dozidan. atipiur neiroleptikTa ukeTesi  amtanoba ukavSirdeba antiqolinerguli Terapiis nakleb saWiroebas. Aamerikul-kanadur gamokvlevebSi avadmyofebi, romlebic iReben 6,0 mg. rispolepts (yvelaze efeqturi dR. doza) saWiroeben antiqolinergul Terapias SemTxevvaTa imave procentebSi, rogoric placebo Terapiisas.

rispoleptiT mkurnalobisas somatovegetatiuri gverdiTi efeqtebidan yvelaze xSirad SeiniSneboda umniSvnelo Zilianoba da orTostatiuli hipotenzia. orTostatiuli Tavbru amave gamokvlevebSi aRiniSneboda rispoleptiT mkurnalobaze myof pacientTa 18% da haloperidoliT mkurnalobaze myof pacientTa 33%-Si.

sxva gverdiT efeqtebs rispoleptiTa da haloperidoliT mkurnalobisas warmoadgenda sxeulis masis momateba 34%-25%-Si, seqsualuri interesis Semcireba 10% da 12%-Si, ereqciuli disfunqcia 9%-13%-Si. Sesabamisad, pacientTa cxovrebis xarisxis momateba atipuri neiroleptikebiT mkurnalobisas tradiciulTan SedarebiT warmoadgens erT-erT mniSvnelovan daskvnas Catarebul gamokvlevebSi. cxovrebis xarisxis dadebiTi dinamika dakavSirebulia pozitiuri simptomatikis reduqciasTan, romelic korelaciaSia socialuri urTierTqmedebis amaRlebasTan, pacientTa socialur garemoSi integraciis SenarCunebasTan, daavadebis ukeTes Soreul SedegebTan, xolo negatiuri simptomatikis reduqcia sifxizle-Zilis ciklis gaumjobesebasTan da energiisa da zogadi tonusis aRdgenasTan. samuSaos ZiriTadi amocanebi moicavda xsnaris formis (1,0 ml. = 1,0 mg) rispoleptis fsiqotropuli efeqtis profilis da misi gverdiTi efeqtebis Seswavlas klinikurad erTgvarovan SizofreniiT daavadebul pacientTa jgufze, halucinatorul- paranoiduli simptomebis upiratesi gamovlinebiT.

gamokvlevSi CarTuli iyvnen mamakacebi 21-da 47 wlamde mwvave fsiqozuri mdgomareobiT (fsiqomotoruli, bodviTi, halucinatoruli da maniakaluri agznebis CaTvliT), romelic Seesabameboda erT-erT qvemoT CamoTvlil diagnozs ISD-10-is mixedviT: paranoiduli Sizofrenia F20,0 -14 avadmyofi ,aradiferencirebuli Sizofrenia F20.3 – 6 vadmyofi, Sizoafeqturi aSliloba maniakaluri tipi da F25.0 – 4 avadmyofi.

avadmyofTa ZiriTadi daxasiaTeba

asaki	21-47 weli
mamakacebi	24 pacienti
diagnozi: -Sizofrenia paranoiduli F20.0 Sizofrenia aradiferencirebuli F20.3 Sizoafeqturi aSliloba maniakaluri tipiT	14 6 4
daavadebis xangrZlivoba	1Tve-33 weli
daavadebi mimdinareobis tipi: uwyveti SeteviT mimdinare	8 16
pirveladi hospitalizacia	4
ganmeorebiTi hospitalizacia	20
fsiqopaTologiurad datvriTuli     memkvidreoba	8
mimdinare debiutis gamravlebis      sindromaluri Sefaseba afeqtur- bodviTi sindromi halucinatorul- paranoiduli sindromi depresiul- paranoiduli sindromi parafreniuli sindromi	6 8 4 6

gamokvlevidan gamoiricxeboda pacientebi cns-is oragnuli dazienebiT, mwavve da qronikul somaturi daavadebiT. yvela av-ma mogvca informaciuli Tanxmoba gamokvlevaSi monawileobaze. monawileobas ar iRebdnen is pacientebi, romlebsac utardebodaT mkurnaloba prolongirebuli neiroleptikebiT  gamokvlevis dawyebis win.

tabula 2

parametrebi	av-Ta raodenoba
wina antifsiqozuri Terapia -               ar Catarebula -               mxolod amJamindeli hospitalizaciis dros -               mxolod wina gamwvavebis dros	4 15 5
adre iRebdnen: -        klasikur neiroleptikebs -        atipiur neiroleptikebs -        benzodiazepinebs -        an antidepresantebs	20 0 6 7

rispolepti iniSneboda Semdegi sqemiT: IdR.-1,0 mg. II dR. – 2,0 mg. III dR. 3.0 mg da a.S. Semdeg dozebs cvlidnen Terapiuli efeqturobis mixedviT da yvelaze maRali dR. doza iyo 8,0 mg. or miRebaze. Zilis daRvevis, mousvenrobis, agresiuli qcevebis SemTxvevaSi, rogorc wesi, iniSneboda azaleptini 50,0-150.0 mg/dR. es doza iyofoda erT- or miRebaze. eqstapiramiduli atipiuri movlenebis ganviTarebisas iniSneboda koreqtori (triheqsafenidini) efeqtur dozebSi.

rispoleptiT mkurnalobisas Setevismagvari SizofreniiT daavadebul avadmyofebSi Setevis halucinatorul-bodviTi sturqturiT, (16 avadmyofi), roca klinikur suraTSi gamoxatulia verbaluri halucinozis gamovlinebebi imperatiuli an makomentirebeli Sinaarsis ganuwyveteli halucinatoruli monologis saxiT. GMmdgomareoba xasiaTdeba uxvi,SinaarsiTa da garegani proeqciiT ukiduresad cvalebadi WeSmariti verbraluri halucinaciebis arsebobiT. Aafeqturi aSliloba gamorCeulia SiSis SegrZnebiT, SfoTviT, depresiiT. avadmyofTa qceva damokidebulia  halucinatoruli aSlilobis Sinaarsze. bodviTi gamonaTqvamebi am grZnobadi bodvis sazRvrebSi gamorCeulia arasistematurobiT da warmoadgens halucinatoruli SegrZnebebis ukritiko Txrobas.                                                        

P pozitiuri dinamika aRiniSneboda pirveli ori kviris ganmavlobaSi saSualo 4.0-6.0 mg dR. dozaze. Ppirvel rigSi qreboda gafantuloba, daZabuloba, rig SemTxvevebSi aRiniSneboda reduqcia rogorc afeqturi,aseve halucinatorul-bodviTi aSlilobisa, halucinaciuri simptomatikis reduqciis garkveuli winswrebiT.

  dakvirvebaTa umetesobaSi ukuganviTareba iwyeboda afeqturi daZabulobis daqveiTebiT, xolo halucinatorul-bodviTi struqtura reducirdeboda TandaTanobiT, maTi formirebis ukuTanmimdevrobiT. bodviTi gamovlinebebi kargavda aqtualobas. Aucilebelia aRiniSnos mwvave grZnobadi bodvis intensivobis daqveiTeba, Semdgom mJRavndeba mentizmis reduqcia, gaxsnilobis ideis, azrTa wakiTxvis, naZaladeobis, maSin roca damokidebulebis devnis, ideebi, reduqciisadmi midrekili aris mkurnalobis me-3, me-4 kviridan. Aucilebelia xazgasma rogorc efeqtis miRebis siCqarisa, aseve antifsiqozuri zemoqmedebis globalurobisa. TvalSisacemia avadmyofTa qcevis SesamCnevi mowesrigeba, subieqturad preparatis kargi amtanoba, modunebisa da Sekavebis mcire gamovlinebiT.

  rispoleptma aCvena gansazRvruli efeqturoba aramarto mwvave bodviTi Setevis kupirebisas, aramed, rac gansakuTrebiT mniSvnelovania, qvemwvave  halucinatorul-bodviTi mdgomareobebis gamwvavebisas, uwyveti Sizofreniis farglebSi.

U upiratesad bodviTi variantebisas (6 SemTxveva) aRiniSneboda rogorc monoTemarturi aseve poliTematuri bodviTi ideebi sistematizaciis gansxvavebuli xarisxiT, rac gamoixateboda Zilis formulis cvlilebaSi. pirovnebis cvlileba atarebda sakmarisad gamokveTil xasiasiaTsa da gamovlenili iyo CaketilobiT , emociuri gasadavebiT da nebiTi potencialis daqveiTebiT.

M msgavsi mdgomareobebis kupirebisaTvis rispolepti amJRavnebda efeqtur zemoqmedebas 6,0-8,6 mg. dR. doziT. Mmdgomareobis ukureduqcia fiqsirdeboda Teraiis me-3, me-4 kvirisaTvis da misi efeqturoba ZiriTadad damokidebuli iyo simptomis dasrulebulobaze da negatiuri gamovlinebebis gamoxatulebaze.sinromi rac ufro mcired sistematizebuli iyo, xolo negatiuri gamovlinebebi ar atarebdnen totalur xasiaTs, miT warmatebuli iyo mocemuli gamwvavebebis kupireba. Aaucilebelia aRiniSnos kognituri funqciebis paraleluri aRdgenis tendecia, rac  Zalze mniSvnelovania.

P  paranoiduli Sizofreniis halucinatoruli variantebis (8 avadmyofi) SemTxvevaSi, gamoxatuli iyo  calkeuli verbaluri halucinacia CaZaxilebis saxiT, WeSmariti verbaluri falucinaciis Semdgomi ganviTarebiT “gakeTebulobaSi” swrafi gadasvliT. “xmebi” Cndebodnen TavSi, anu iRebdnen fsevdohalucinatoruli  aSlilobebis xasiaTs. erwymoda asociaciuri avtomatizmis gamovlinebebs, Tumca mainc inarCunebda upiratesobas. bodviTi aSliloba imyofeboda halucinaciebis mWidro kavSirSi.  rispolepti ukve pirveli ori kviris ganmavlobaSic 4,0-6.0 mg. dR. doziT iCenda dadebiT gavlenas bodviT, halucinaciur, afeqtur da negatiur simptomatikaze. aRiniSneboda halucinaciebis, bodvis fsiqomotorul agznebis harmoniuli reduqcia. im SemTxvevaSi sadac Cven ver viRebdiT sakmaris efeqts, mainc xdeboda bodvis da halucinaciebis dezaqtualizacia, qveiTdeboda fsiqikuri avtomatizmis gamovlenis intensivoba, mcirdeboda afeqturi aSlilobis simkveTre, pozitiuri produqcia kargavda aqtualobasa da SesamCnevad wesrigdeboda avadmyofTa qceva. Ddozis mcire Semcirebas me-4 kviris bolosaTvis rig dakvirvebaSi (3) kvlav mivyavdiT gamwvavebisaken, rac saWiroebda azaleptins 100.0-150.0mg. dR. dozamde Aucilebel gazrdas an aminazinis ineqciebis kunTebSi daniSvnasac ki 100.0mg. dR. doziT.

rac Seexeba negatiur ganovlinebebs, iseTisa, rogoric aris emociuri gaRaribeba,  afeqtis daClungeba, ukve pirveli aTi dRis ganmavlobaSi avadmyofebi xdebodnen ufro cocxali da aqtiuri, gamoiyurebodnen ufro komunikalurad; SeiZleba es dakavSirebuli iyo sawyisi produqtiuli simptomatikis SesustebiT. Cvens dakvirvebaSi  veTanxmebiT rispoleptis negatiur simptomatikaze  ara gaSualebuli zemoqmedebis efeqts, aramed mis pirvelad zemoqmedebas  negatiur simptomebze.

6 dakvirvebaSi, sadac klinikur suraTSi prevalirebda parafreniuli da maniakalur-parafreniuli mdgomareobebi, fantastiuri an absurduli Sinaarsis bodviTi, aseve fsevdohalucinatoruli parafreniis SemTxvevaSi Terapiuli taqtika saWiroebda dozebis swraf zrdas 8,0 mg-mde dReSi. miuxedavad amisa, SesamCnevi dinamikis dafiqsireba ver moxerxda, aRiniSneboda mxolod parafreniuli gamonaTqvamebis kuTri wonis umniSvnelo Semcireba, Tumca am SemTxvevaSic wesrigdeboda avadmyofTa qceva. SesaZloa mocemuli mdgomareobebis reduqciisaTvis aucilebelia ufro xangrZlivi dro, Cveni dakvirveba da mkurnaloba ki mxolod 4 kvira grZeldeboda.

depresiul-bodviTi aSlilobebi 4 avadmyofSi gamovlinda TviTbraldebis, TviTdamcirebis ideebTan inscenirebis grZnobadi bodvis elementebis kombinaciiT, damokidebulebis, devnis bodviT, depresiul an SfoTviT-depresiul fonze.

Am SemTxvevebSi rispoleptma SedarebiT dabal dozebSi – 2,0-4,0 mg/dR. mogvca garkveuli dadebiTi efeqti ukve Terapiis pirveli ori kviris ganmavlobaSi – nivelirdeboda depresiuli afeqti, depresiuli Sinaarsis aqtualuri bodviTi ideebi iwyebdnen aqtualobis dakargvas; qreboda SiSi mdevnelTa mimarT, mcirdeboda grZnobadi bodvis gamovlenis intensivoba. aucilebelia aRiniSnos, rom rispolepti aqtiurad zemoqmedebs afeqtur darRvevebze, SfoTvis da depresiis gamovlinebebis sifarTovis CaTvliT. mocemul dakvirvebebSi erTdroulad rispoleptTan erTad daniSnuli iyo antidepresantebi, kerZod, amitriptilini 75,0 mg-dan 125 mg-mde dReRamuri doziT.

rispoleptis gverdiTi gamovlinebebi:

eqstrapiramiduli gverdiTi gamovlinebebi gamovlinda 3 avadmyofSi. 2 maTganSi tremoris, bradikineziis saxiT, moZraobis SekavebiT. rogorc wesi, is warmoiSoboda 4,0 – 6,0 mg/dR. doziT. kupirdeboda qolinolizuri (antiparkinsonuli) Terapiis daniSvnisas.

ZiriTadi eqstrapiramiduli gverdiTi efeqtebis gamovlenis sixSire mkurnalobis sxvadasxva vadisas.

	rispoleptis xsnari Sinagani miRebisTvis
simptomatika	sqemiT
	gamokvlevis dRe
X	3	7	14	21	28
siarulis SezRudva	2	2	0	0	0
kunTebis rigiduloba	2	2	2	0	0
tremori	0	2	2	0	0
neiroleptikuri depresia	0	0	0	1	0

gansakuTrebulad unda aRiniSnos 1 dakvirveba, romelic Cveni interpretaciiT iyo neiroleptikuri depresia. is xasiaTdeboda guneb-ganwyobis monotonuri daqveiTebiT,  upiratesi asTeniuri  gamovlinebebiT, garkveuli gafantulobiT,daZabulobiT.  msgavsi mdgomareoba warmoiSva mkurnalobis me-3 kviraze 6,0 mg/dR. dozis pirobebSi. damatebiT anafranilis (klomipraminis) 50,0 mg dRiuri dozis daniSvnam saSualeba mogvca rispoleptis dozis cvlilebis gareSe, mogvexdina msgavsi gamovlenis kupireba.

aucilebelia aRiniSnos, rom rispoleptiT mkurnalobisas gverdiTi gamovlinebebi da negatiuri efeqtebi atareben iSviaT xasiaTs, isini ar iyvnen gamoxatuli da rac metad mniSvnelovania, sakmarisad iolad kupirdebodnen antiqolinerguli preparatebis adeqvaturi dozebiT.

Sedegebi: Catarebulma gamokvlevam aCvena rispoleptis (xsnaris saxiT) didi efeqti SizofreniiT daavadebul avadmyofTa mwvave da qvemwvave mdgomareobis kupirebisas. preparati, miuxedavad mcired gamoxatuli sedatiuri efeqtisa, sakmarisad swrafad, 7-10 dRis gan-Si axdenda produqtiuli siptomatikis reducirebas, anu antifsiqozuri moqmedeba vlindeba mkurnalobis pirvelive dReebidanve. rispolepti axdens dadebiT zemoqmedebas ,rogorc halucinatorul, aseve bodviT siptomatikaze, pirvelze umniSvnelo upiratesobiT. garda amisa, is kargad axdens afeqturi gamovlinebebis – SiSis, SfoTvis, bodviTi depresiis kupirebas afeqtur-halucinatoruli da afeqtur-bodviTi sindromis farglebSi Setevismagvari Sizofreniisas.

  aucilebelia xazi gavusvaT, rom TviT fsiqikuri daavadebis xangrZlivoba mocemuli mimdinareobis farglebSi ar warmoadgens gansakuTrebul  winaRobas.

   aucilebelia, aseve, aRiniSnos rispoleptis swrafi zemoqmedeba avadmyofTa qcevaze, romelic xdeba ara marto mowesrigebuli, aramed matuliobs aqtiurobac. aseve xdeba agresiis gamovlinebebis kupireba,rbildeba gamRizianebadobisa da disforiis gamovlinebebi.

   rispolepts gaaCnia kargi amtanoba, ar iwvevs mniSvnelovan eqstrapiramidul da diskineziur aSlilobas, xolo maTi gamovlenis SemTxvevaSi, rogorc wesi, es gamoixateba mcire xarisxiT. gverdiTi movlenebi advilad kupirdeba  preparatebis dozis SemcirebiT an koreqtoris xanmokle daniSvniT.

   rispoleptiT Terapia ar arTulebda pacientTa resocializaciis Catarebas.

   Литература:

      1. Аведисова А.С. – Научные обоснования и практические рекомендации перевода  больных с типичных нейролептиков на рисполепт. «Психиатрия и психофармакотерапия», 2001, 6, 210-213

      2. Ильина Н.А. – Применение рисполепта при шизофрении. «Психиатрия и психофармакотерапия», 2005, 5, 142-144

      3. Калинин В.В., Сулимов Г.Ю. – Купирование острой психотической симптоматики у больных шизофренией атипичным нейролептиком рисполептом «Психиатрия и психофармакотерапия», 2001, 3, 69-71

      4. Молосов С.Н., Калинин В.В., Еремин А.В. и др.- Сравнительное рандомизированное исследование эффективности и толерантности респирдона и галоперидола при купировании острых состояний у больных шизофренией и шизоаффективнным психозом «Психиатрия и психофармакотерапия» 2000, Приложение №2,3-6.

      5. Раевский К.С. – Современные нейролептики : взаимодействие с системами нейротрансмиттеров мозга. «Психиатрия и психофармакотерапия» 2000, 5, 132-134.

      6. Точилов В.А., Снедков Е.В. – Раствор рисполепта для перорального применения: новые возможности купирования острых психотических сосотояний у больных. «Социальная и клиническая психиатрия», 2002, 2, 85-91.

      7. Beng – Choon H., Miiler D. – A  comparative effectiveness study of risperidone and olanzapine in the treatment of shizophrenia. J. Clin. Psychiatry – 1999, vol, N 10, pp. 658-663.

      8.  Key S.R., Fisbein A. – The Positive and Syndrome Scale (PANSS) for shizophrenia. Shizophrenia, Bull., 1987, vol. 13, p.261.

      9. Lieberman J. – Atypical antipsychotic drugs as a first line treatment of shizophrenia: a rational and hypothesis. J. Clin. Psychiatry, 1996, vol. 57, Suppl. 11, pp. 68-71.

      10. Marders  S., Meibach R. – Risperidone in the treatment of shizophrenia. Am. J. Psychiatry, 1994, vol. 151, N6, pp.825-835.

      11. Meltzer H. – The role of serotonine in shizphrenia and the place of serotonine-dopamine antagonist antipsychotics. J.Clin. Psychitary, 1989, vol. 40, N9, pp.921-927.

      12. Weiden P., Aqulia – Antypical antipsychotic drugs and long-term outcome in shizophrenia. J. Clin. Psychiaty. 1996, vol. 57, suppl. 11, pp. 5360

რეზო კორინთელის სტატია "საქართველოს ფსიქიატრიის მოამბის" მე-6 ნომრიდან

sulierebaze orientirebuli fsiqoTerapiis Sesaxeb

rezo korinTeli

ilias saxelmwifo universiteti

       XX saukuneSi samamulo fsiqiatria da fsiqoTerapia ganicdida  biologiuri mimarTulebis gadaWarbebul zegavlenas fsiqologiuri da socialuri faqtorebis nawilobriv zogjer ki sruli uaryofis xarjze.

 fsiqiatriisa da fsiqoTerapiis  ganviTarebis Tanamedrove etapze sul ufro meti yuradReba eTmoba aramarto fsiqo socialur aspeqtebs aramed pirovnebis sulier ganzomilebasa da pirovnebis zrdaze mimarTul midgomebs. amis damadasturebel TvalsaCino magaliTs warmoadgens fsiqikur daavadebaTa axali klasifikacia, romelic  globalizaciiT gamowveuli fsiqikuri xarvezebis aRmofxvrazea mimarTuli da romelic mzaddeba msoflio fsiqiatriuli asociaciis mier da pirovnebaze mimarTuli fsiqiatriis saxelwodebiT iqneba cnobili.

misi ZiriTadi postulatebi da principebi  Camoyalibebulia 2007 wlis  msoflio fsiqiatriuli asociaciis regionalur kongresze SanxaiSi am asociaciis prezidentis J.E. Mezzich- is  moxsenebaSi. 

Ppirovnebaze mimarTuli fsiqiatria Psychiatry for the Person efuZvneba Semdeg principebs (Mezzich J.E. 2007):

1. igi mimarTulia pacientis mTel pirovnebaze mis rogorc avadmyofur aseve jansaR nawilze da aramarto mis avadmyofur nawilze;

2. mkurnalobis procesSi CarTuli unda iyos fsiqiatris Mpirovneba mTeli misi adamianuri resursebiTa da potencialiT da aramarto misi is nawili romelic abstraqtul-ganyenebuli, saWiro informaciiT aRWurvil teqnikosTan asocirdeba; 

3. mkurnalobis procesi pirovnebaze unda iyos mimarTuli rac gulisxmobs imas, rom mkurnalobam xeli unda Seuwyos pacientis cxovrebis proeqtis ganxorcielebas, mis TviTrealizebas;

4. mkurnaloba pacientis pirovnebasTan erTad, samkurnalo procesSi misi aqtiuri CarTviT unda xorcieldebodes. rac gulisxmobs mkurnalobis procesSi pacientTan  pativiscemiT aRsavse TanamSromlobas da mis daxmarebas.

 Ees principebi aSkarad migvaniSnebs imaze, rom fsiqitria aRiarebs pirovnebaze mimarTul sulieri ganzomilebis momcvel models. A

antikuri da Suasaukuneebis medicina adamians ganixilavda holisturad anu pirovnebaSi aRiarebda  biologiuri, fsiqo-socialuri da sulieri aspeqtebis Tanaarsebobas da daavadebis eTiologiaSi yvela am aspeqtis monawileobas.

 Aam statiis mizania sulierebaze orientirebuli fsiqoTerapiis im ZiriTadi principebis ganxilva romelic aerTianebs am tipis FfsiqoTerapiis gansxvavebul  mimarTulebebs.

Gcnebebis AaRrevis Tavidan acilebis mizniT pirvel rigSi unda mkafiod ganisazRvros sulieri ganzomilebis cneba, romelic transpersonalur fsiqologiasa da fsiqoTerapiaSi gamoiyeneba. misi fsiqologiuri definicia mas unda ganasxvavebdes rogorc religiur-konfesiuri  sistemebis gansazRvrebisgan, aseve adamianis pirovnebis sxva aspeqtebisgan. igi Tanaarsebobs fizikur da fsiqo-socialur ganzomilebebTan da xasiTdeba J. Hiatt-is mixedviT (Hiatt J. 1986) Semdegi principebiTa da atributebiT:

1.        aqvs hermenevtikuli da noeturi funqcia. igi ganekuTvneba pirovnebis im instancias romelic sazrisisa da mniSvnelobis, WeSmaritebis da sagnebisa da movlenebis arsis wvdomiTaa dakavebuli; romelic absoluturis, maradiuli realobis ZiebaSia da im faseulobebisadmi erTgulebaSi vlindeba romelTac pirovneba absolutur Rirebulebebad miiCnevs;

2.       es sazrisi da mniSvneloba uxilavi da aracnobieri sferodan momdinareobs. fizikuri samyaro, misi suraTi da mis Sesaxeb warmodgena zedapiruli aRqmis Sedegia. xolo namdvili realoba eqstrasensoruli aRqmiT miiRweva; aq rwmena dominirebs “obieqturi Semowmebis” standartebze. es rwmena efuZvneba im darwmunebas, romelic Tvlis rom fizikuri realoba ar aris erTaderTi;

3.       es sulieri ganzomileba ZiriTadad gancdaSi gveZleva da mas  ufro intuiciuri, vidre cnebiT-logikuri, xasiaTi aqvs; is gulisxmobs arsebobis da yofierebis URrma, uSualo gancdas, mis  wvdomas gonebiT da ara gansjiTa da abstraqtul cnebiTi azrovnebiT. amis gamo is mecnierebis mier aRuwerel da amitom subieqtur movlenad miiCneoda;A

4.       is statikurobas moklebuli dinamikuri procesia da warmoadgens  ufro uwyvet nakads, vidre struqturas. igi organuli mTelis   moZrav nakads ufro asaxavs, vidre statikuri nawilakebis meqanikur urTierTobas da ganicdeba rogorc SedarebiT aradiferencirebuli energiis mdgomareoba;

5.       es nakadi evoluciuria, anu miiswrafis srulyofisaken.  gansxavavebiT adamianis fsiqo-fizikuri  ganviTarebis adrindeli paradigmebisagan mas aSkarad teleologiuri xasiaTi aqvs;

6.       sulieri ganzomileba vlindeba pirovnebis specifikur qcevasa da konceptualur sistemebSi. am gziT Cveni goneba zogjer cdilobs mis dakonktretebas. maTi specifikur Sinaarsze did wilad moqmedebs  adrindeli, ukve gancdili gamocdileba, ris gamoc  isini kargaven cocxal kavSirs da veRar asaxaven sulier realobas. isini universaluri procesis obieqtur manifestacias warmoadgenen da sulieri zrdis saSualebad SeiZleba iqcen. magram aq aris erTi saSiSroeba, kerZod, is, rom maTi dogmatizaciis SemTxvevaSi es obieqtivirebuli fsiqologiuri gancdebi sulieri zrdis ara mxolod saSualebad ganixileba, aramed WeSmaritebis saboloo instanciis saxes Rebulobs. Mmeore saSiSroeba maT sxva fsiqologiur procesebTan aRrevaSi mdgomareobs, rasac maTi gaqroba moyveba;

7.       pirovnebis sulier aspeqts individze zemoqmedebis maintegrirebeli sinTezuri funqcia aqvs. is aerTianebs pirovnebis gancalkevebul nawilebsa da Tavs uyris gancdaTa fragmentebs da maT erT mTelSi aqcevs. igi, agreTve, aRiqmeba rogorc pirovnebis srulyofisa da samyarosTan misi harmoniuli urTierTobisaken mimarTuli mamoZravebeli Zala. sazrisisa da mniSvnelobis masazrdoebeli gamTlianebis es unari izidavs adamians  da pirovnebac misken miiswrafis. amas aRwers erik eriqsoni me mTlianobis Ego integrity cnebaSi  (E.Ericson 1959) da mas k.g. iungis centriskenversiis cneba Seesabameba (C.G.Jung 1966)

sulieri ganzomilebis fenomenologiuri gamovlena xdeba am sferosTan  uSulo Sexeba-Sexvedris dros, romelic aris xanmokle da moulodneli da xSirad gamoucnobi rCeba. igi garkveuli wvrTnis (meditacia, locva) Sedegad  miiRweva, an SeiZleba mZafr emociurad damuxtul da egzistencialurad mniSvnelovan situaciebSi (sikvdilis saSiSroeba) gamovlindes. am dros  adgili aqvs cnobierebis Secvlil mdgomarebas, romlis drosac adamiani ganicdis droisa da sivrcis sazRvrebis an gafarToebas, an srul gaqrobas; paTosis da sixarulis, an Rrma neitralobis intensiur grZnobebs. am dros adamiani yofierebaSia CaZiruli. igi moculia arsebobiT da ara fiqriT am arsebobis Sesaxeb. es gancdebi gamouTqmelia sityvebis simwirisa da siRaribis gamo.

abraham maslous (Maslow A. 1968) Tanaxmad ordinaruli cnobiereba  sagnebze dakvirvebisas axdens maT klasificirebas adamianis  moTxovnilebebisa da interesebisadmi maTi  mimarTebisda mixedviT. mag adamiani SeiZleba daewafos xelovnebis romelime nawarmoebs sakuTari codnis gaRrmavebis, an sxvebze STabeWdilebis moxdenis mizniT. magram, dakvirvebisas saganma SeiZleba adamiani mTlianad moicvas, igi daikargos mis mSvenierebaSi da ganWvritos igi yovelgvari analizis da klasificirebis gareSe. aseT SemTxvevaSi mSvenierebis uSualo gancda TviTmizans warmoadgens. amgvar mdgomareobas maslou being cognition-s uwodebs. (Maslow A.1954, 1968).  

maslou aRwers agreTve e.w. pikur gancdebs (Maslow A.1954 1968). am gancdisas adgili aqvs dauinteresebel Wvretas (being cognition), romlis drosac Cven sagnebsa da adamianebs uangarod, yovelgvari piradi dainteresebis gareSe vuyurebT. am dros pirovnebas  ukiduresi bednierebis gancda eufleba.Mam gancdebs adgili SeiZleba hqondes religiur-mistikuri, an esTetikuri gancdebis, SemoqmedebiTi aRmafrenisa da inteleqtualuri insaitebis da sxva dros. pikur gancdebs xSirad Tan axlavs sakuTari mes sazRvrebis dakargva. am dros adamiani sakuTar Tavs, Tavis identurobas droebiT iviwyebs.

yvela egzaltirebuli gancda rodi miekuTvneba pikur gancdas. magaliTad, sportsmenis sixaruli da egzaltacia didi gamarjvebis gamo ar warmoadgens pikur gancdas, radganac is aRiarebis  moTxovnilebis dakmayofilebiT aris gamowveuli.

pikuri gancdisas aRqmuli obieqti  ganicdeba rogorc unikaluri da dasrulebuli.  igi aRiqmeba mzrunveli siyvaruliT da misi sxvasTan mimarTebisa da Sedarebis araviTari saWiroeba ar arsebobs.

 pikuri gancda erTianobis tipiur gancdas warmoadgens, romlis drosac Cven sakuTar Tavs erTi mTlianis calkeul aspeqtad aRviqvamT, im mTlianis, romlis calkeuli nawilebi harmoniul urTierTkavSirSia erTmaneTTan. erTianobis am mdgomareobaSi yvela aSkara diqotomia gadalaxulia da Serigebul TanxmobaSi imyofeba. uiliam jeimss rom davesesxoT am dros samyaroSi arsebuli yvela dapirispireba, winaaRmdegoba da konfliqti, romelic yvela Cveni ubedurebis mizezia TiTqos erT gamTlianebul realobaSi lRveba. maslous dakvirvebiT, pikuri gancdebi rCeulTa xvedri rodia. isini xSiria, magram rigiTi adamianebisaTvis isini SeumCneveli rCeba. xolo TviTrealizebadi adamianebi maT gansakuTrebul yuradRebas aqceven.

 sulieri ganzomilebis mqone adamianis axali modelis da reduqcionisturi samedicino modelis SeTanxmeba, maTi Tanaaraseboba garkveul siZneleebs qmnis. dasavluri mecnieruli midgoma im postulats eyrdnoba, romelic Tvlis, rom obieqturi dakvirveba SesaZlebelia,  romelic aSkarad ganasxvavebs damkvirvebelsa da dakvirvebis obieqts da maT Soris gamyof zols aRiarebs. es midgoma samyaros absolutur drosa da sivrceSi meqanikuri kanonebiT moqmed manqanad aRiqvavs, romelSic nawilakebi erTmaneTisgan carieli sivrciTaa gancalkevebuli.  miuxedavad imisa, rom kvanturi fizika da fardobiTobis Teoria abaTilebs da  aqarwylebs am postulatebs mecniereba da medicina mainc eyrdnoba maT. subatomur da varsklavTaSoris doneze dro da sivrce absoluturi aRaraa, mizez-Sedegobrivi kavSiri linearuli araa, elementaruli nawilakebis nacvlad adgili aqvs procesebs, xolo materia energias warmoadgens.  

samyaro warmoadgens uwyveti energiis moZrav vels, romelSic materia, am energiis kondensaciis gziT, ganuwyvetliv iqmneba, transformirdeba da SemdgomSi qreba. Aam samyaroSi nawilebi urTierTkdakavSirebulia, sadac damkvirvebeli,subieqti ganuyofelia dakvirvebis obieqtisgan. aqedan gamomdinare  damkvirvebeli moqmedebs sakvlev obieqtze.

 Tanamedrove mecnieruli hipoTezis mixedviT  samyaro cnobierebisgan damoukideblad ar arsebobs. amitom nebismieri Teoria fizikuri samyaros Sesaxeb cnobierebis Teoriasac unda iTvaliswinebdes. siRrmis fsiqologiaSi aracnobieri warmoadgens gonebis da fsiqikis im nawils, romelzec evkliduri sivrce, linearuli dro da kauzaloba, subieqt obieqtis gansxvaveba ar vrceldeba da romelSic adgili aqvs obieqtTa identurobisa da urTierTcvlilebis ganuwyvetel nakads.

 Kkvantur-fardobiTobis, fsiqodinamikuri da sulier modelebis Tanxvedra migviTiTebs imaze rom fenomenalur samyaros safuZvlad udevs energiis dinamikuri veli. aRmosavluri da dasavluri antikuri sulieri tradiciebi iziarebdnen am TvalTaxedvas da Tvlidnen rom xiluli samyaros safuZvelSi RvTaebrivi energiaa.

 sulierebaze orientirebul fsiqoTerAPias Cveni me-s,  TviTobis (Self), daavadebis bunebis, Terapiuli procesisa da meTodebis GANsxvavebuli xedva aqvs.  

igi Semdeg principebs eyrdnoba:

1.        Yyovel CvenTagans sulieri momwifebis, TviTrealizaciis (Maslow 1954) , individuaciis ( Jung 1966 ) unari  aqvs;

2.       sulieri simwife da zrdasruloba gulisxmobs Cvens identificirebas sakuTar autentur mes-Tan, TviTobasTan;

3.       adrindeli fsiqoanalitikuri modelisgan gansxvavebiT, romelic me-s konfliqtur da nevrotul instanciad ganixilavda, sulierebaze orientirebuli modelis Tanaxmad Cveni autenturi Mme  ukonfliqto, janmrTel, gamTlianebul centrs warmoadgens;

4.       adrindeli fsiqoanalitikuri modelisgan gansxvavebiT, romelic  mes funqcionirebas cnobier da aracnobier doneebze aRiarebs sulierebaze orientirebuli modelis mixedviT, Cveni ordinaruli me arsebobs da funqcionirebs cnobier, aracnobier  da ufro Rrmad gandevnili autenturi me-s doneze; 

5.       Zveli modelisgan  gansxvavebiT, romelic miiCnevs rom daavadeba gamowveulia konfliqtiT, axali modelis Tanaxmad, avadmyofoba gamowveulia autenturi me-sgan daSorebiT da masTan identificirebis gaZnelebiT;

6.       mkurnalobis procesi mdgomareobs pacientis mcdar me-sTan ganSorebis, dezidentificirebis da autentur mesTan identificirebis procesis xelSewyobaSi.

mkurnalobis axali da Zveli meTodis SedarebiTi analizi mocemulia  qvemoTmoyvanil sqemaze

Zveli modeli                            mkurnalobis axali modeli

                                      

Terapiuli procesi mimarTulia       Terapiuli procesi mimarTulia                      konfliqturi nevrotuli mes           autenturimesTan identificirebaze  

adaptaciaze.                        rac xels uwyobs ordinaruli mesgan                                                          

                                          dezidentificirebis process.

------------------------------------------------------------------------------------------------------------------------------

fokusirebulia                         Terapia fokusirebulia ara daavadebaze,               

paTologiaze.                           aramed  ganviTarebisa da sulieri                                     

                                        srulyofis gzaze da am gzaze arsebuli

                                        krizisis integrirebaze.                                                                                                    

                                        paTologiis  cnebebiT operireba                                         

                                        sargeblobis momtani aRaraa.  yvela

                                        problemuri situacia ganixileba, ara rogorc                                                                                                                                                                                                                                                                                                                                                                                                                                                          

                                        garTuleba da paTologia, aramed

                                        rogorc sulieri zrdisTvis gankuTvnili                     

                                        Semecnebis SesaZlebloba.

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Terapia ganixileboda                    Terapia mimarTulia cxovrebis autentur, rogorc qmedebaze,                         formebze, kerZod autentur realobaze                                             

rogorc samuSao                         dafuZnebuli yofierebisa da qmedebis

procesi, mimarTuli nevrotul          wvdomasa da swavlaze.

me-Si zrdasruli siyvarulisa

da Semoqmedebis unaris miRwevisaken.

------------------------------------------------------------------------------------------------------------------------------samkurnalo efeqti miiRweva           samkurnalo efeqti ZiriTadad miiRweva

insaitis gacnobierebis                Terapevtis da pacientis autenturi mes

empaTiisa da jansaRi                  urTierTobiT da meditaciuri cnobierebis

urTierTobebis damyarebis            ganviTarebiT. agreTve insaitis empaTiis   

gziT.                                   da Terapiuli urTierTobebis gamoyenebiT.

-------------------------------------------------------------------------------------------------------------------------------------------------------

gancdebis Sefaseba xdeba               gancdebisadmi  meditaciuri cnobierebiT    

grZnobiTa da  gagebiT.                 midgoma - Rrma TanagrZnoba Tanaarsebobs

                                         mijaWvulobas moklebul sulier simSvidesTan. 

-------------------------------------------------------------------------------------------------------------------------------------------------------

Super Ego-s Serbilebas                   Super Ego ganixileba rogorc     

aqvs adgili.                             usargeblo struqtura,

                                          Canacvlebulia autenturiMme-Ti.

                                               

sulierebaze orientirebuli fsiqoTerapiis teqnikebSi yvelaze ufro mniSvnelovania Semdegi:

1.        Terapevtis cnobierebis done misi sulieri simwifis xarisxi;

2. Terapevtis sakuTar autentur me-sTan identificirebis unari da done;
3. meditaciuri gacnobierebis done, romelic gulisxmobs sxeulis SegrZnebebis, emociebisa da azrebis srul gancdas, magram amave dros, maTgan dizidentificirebas, maTi gankiTxvisa da moqmedebaSi moyvanis (acting out) gareSe;
4. mkurnalobis procesis ganmavlobaSi Terapevti ar unda iyos orientirebuli rezultatze, anu Terapevti ar unda cdilobdes pacientis “awyoba-SekeTebas”;
5. mkurnalobis procesSi winaswari codnisa da gegmis ar arseboba xels uwyobs Rrma SemoqmedebiTi samkurnalo spontanuri procesis aRmocenebas;
6. ganixilavs sulieri zrdis gzaze krizisul mdgomareobas da ara paTologias;
7. Terapevts arasodes unda daaviwydes, rom is Tavisi pacientis msgavsia. Terapia urTierTaRmoCeniskenaa mimarTuli. igi TanamSromlobaze dafuZnebuli mogzaurobaa da ara avtoritarul urTierTobebze agebuli procesi, sadac fsiqoTerapevti warmoadgens avtoritets, romelic urCevs pacients da eubneba mas, Tu rogor unda moiqces.

    amgvarad sulieri ganzomileba warmoadgens pirovnebis im aspeqts,  romelic hermenevtikul-sinTezuri da noeturi funqciis matarebelia da romelic miiswrafis absoluturi WeSmaritebisaken, Tumca arcerT religiur sistemas ar miekuTvneba. sulierebaze orientirebuli fsiqoTerapia avsebs im xarvezs romelic warmoSva erTis mxriv, biologiurma fsiqiatriam da meores mxriv reduqcionistulma fsiqoTerapiulma midgomebma.

Reference

1.      Eriksen E. identity and Life Cycle.Psychological Issues New York,international University Press.,Vol. 1 No 1 1959

2.      Hiatt j. Spirituality ,Medicine and Healing Southern Medical Journal Vol 79 N 6  736-743

3.      James W.  the Varieties of Religious Experiences Newyork Longmans green and Co,1902

4.      Jung C.G.  Two Essays On Analytical Psychology. The Collected Work of Carl Gustav Jung Princeton NJ Princeton University Press,Vol 7 ,1966

5.      Jung C.G. Conscious , Unconscious, and Individuation The Archetypes and the Collective Unconscious The Collected Work of Carl Gustav Jung Princeton NJ Princeton University Press,Vol 9 ,1966

6.      Maslow A. Motivation and Personality (2 nd ed.) New York; Harper & Row 1954

7.      Maslow A. Toward a Psychology of Being ( 2^nd Ed.) Princeton ,N.J.:van Nostrand,1968

8.      Mezzich J.E. Globalization and Psychiatry for the Person. WPA regional Conference/CSP Annual Congress Shanghai 2007

On Spiritually Oriented Psychotherapy

R.Korinteli

Ilia StateUniversity

Tbilisi Georgia

The article describes spiritual dimension of human experience and the main characteristics of spiritually oriented psychotherapy. It shows how spiritually-oriented psychotherapy differs from classical psychodynamic psychotherapy. The main features of spiritually oriented psychotherapy, its new model of self, therapeutic process and therapeutic techniques are discussed.