12 Sizofrenia

s aReniSneboda. xolo Tu pacientebi iRebdnen pacientebisa da maTi ojaxebis wevrebisTvis ar aris

daniSnulebas da ojaxSi 35 saaTze nakleb dros sakmarisi. britaneTis fsiqikuri jandacvis erovnuli
atarebdnen, mdgomareoba mxolod 15%-s umwvavdeboda. programis prioritetia pacientebis momvlelTa
Semdgom kvlevebSi lefma (Leff, 1976) gamoTqva servisis gaumjobeseba avadmyofTa mimarT Tanadgomis,
mosazreba, rom emociur eqspresias kauzaluri daxmarebis TvalsazrisiT (jandacvis departamenti,
mniSvneloba unda hqondes. man Seiswavla 24 1999). lefs (Leff, 1998) uweria:
ojaxi, romlebSic Sizofreniis mqone pacientebi
`pativi unda vceT pacientis naTesavebs im zrunvis
TavianT maRali eqspresiis mqone naTesavebTan
gamo, rasac isini dRe da Rame mravali wlis
intensiur kontaqtSi imyofebodnen. yovel maTgans
ganmavlobaSi ewevian. maT ar surT, rom ganixilavdnen
utardeboda mkurnaloba. 12 ojaxidan pacientebi
maT, rogorc paTogenur faqtors da miiCnevdnen
mxolod ambulatoriul daxmarebas Rebulobdnen.
mkurnalobis samizned, aramed, SizofreniasTan
danarCeni 12 ojaxis SemTxvevaSi _ medikamentur
brZolaSi maT mxolod partnioroba surT.~
mkurnalobasTan erTad, pacientebi da maTi ojaxis
wevrebi eswrebodnen mecadineobebs, romlebzec pacientis momvlelebTan muSaobis sakiTxebi
SizofreniasTan dakavSirebul informacias iRebdnen. ganxilulia amave TavSi, `daavadebis marTvis~ nawilSi
meore jgufSi gamosavali gacilebiT ukeTesi iyo. (gv. 306).
es Sedegi adasturebs, erTi mxriv, mdgomareobis
daskvna
gamwvavebisTvis emociuri eqspresiis mniSvnelobas da,
meore mxriv, xazs usvams kombinirebuli mkurnalobis, Seswavlili SemTxvevebis safuZvelze SeiZleba iTqvas,
e.i. medikamenturi da fsiqosocialuri intervenciis rom socialuri faqtorebi gavlenas axdens Sizofreniis
erToblivi gamoyenebis efeqturobas. dawyebasa da simptomatikis Taviseburebaze. axloblebis
emociuri eqspresiis mniSvneloba sakmaod farTod emociurma CarTulobam SeiZleba gaamwvavos mdgomareoba.
Seiswavles da daadgines, rom aseT ojaxebSi SesaZlebelia, rom ganviTarebad qveynebSi dabali
cxovrebisas, gamwvavebis sixSire 2-3-jeraa gazrdili. intensivobis emociuri eqspresia dadebiT gavlenas
Sesabamisad, dabali emociuri eqspresiis ojaxebSi axdendes daavadebis gamosavalze. zogadad, garemo
ufro adekvaturi damokidebulebaa Sizofreniisa faqtorebTan dakavSirebiT, unda gaviTvaliswinoT,
da daavadebasTan dakavSirebuli qcevis mimarT, rac rom zedmeti stimulacia xels uwyobs pozitiuri
TavisTavad gavlenas axdens gamosavalze (Barrowclough simptomebis ganviTarebas da mdgomareobis gamwvavebas,
et al., 1994) xolo aramastimulirebeli garemo auaresebs negatiur
simptomatikas.
Sizofreniis gavlena ojaxze
stacionarsgareTa fsiqiatriuli momsaxurebis da- mkurnaloba
nergvam ojaxebs garkveuli sirTuleebi Seuqmna. Sizofreniis mkurnaloba iTvaliswinebs rogorc
Sizofreniis mqone pacientebis naTesavebi ZiriTadad mwvave, ise qronikuli mdgomareobebis marTvas. zo-
ori saxis problemaze amaxvileben: pirvelia gadad, saukeTeso Sedegis miRweva SesaZlebelia
socialuri izolacia. pacienti gaurbis ojaxis sxva antifsiqozuri mkurnalobisa da garkveuli fsiqo-
wevrebTan urTierTobas. isini iSviaTad saubroben, socialuri RonisZiebebis kombinaciiT. am nawilSi
arian Senelebulebi, aqvT SezRuduli interesebi da ganvixilavT calkeuli mkurnalobis efeqturobas.
ar uvlian sakuTar Tavs. meore ZiriTadi problemaa TavSi _ `daavadebis marTva~, visaubrebT imis
aSkarad Semawuxebeli da socialurad miuRebeli Taobaze, Tu rogor gamoiyeneba mkurnalobis es
qcevebi da Zaladobis saSiSroeba. es problema xels saxeebi praqtikaSi. antifsiqozuri preparatebis
uwyobs ojaxis wevrebs Soris maRali emociuri farmakologiuri aspeqtebi ganxilulia 21-e TavSi,
eqspresiis ganviTarebas, rac, Tavis mxriv, auaresebs xolo Temze dafuZnebuli movla da daxmarebis
mdgomareobas. dagegmva _ 23-e TavSi.
pacientis axloblebs SeiZleba aReniSnebodeT mkurnalobis Tanamedrove midgomebi mocemulia
SfoTva, depresia, braleulobis gancda an klinikuri praqtikis erovnul rekomendaciasa (NICE)
dabneuloba. maT ar ician, rogor moiqcnen rTul da lemanis saxelmZRvaneloSi (Lehmann et al., 2004).
viTarebaSi an ra reaqcia hqondeT ucnaur qcevaze.
damatebiTi sirTuleebi SeiZleba gamoiwvios ojaxis antifsiqozuri preparatebi
wevrebs Soris gansxvavebulma damokidebulebam da
axloblebisa da mezoblebis mxridan Tanadgomis
mwvave Sizofrenia
ararsebobam. axloblebis cxovrebaze gavlena xSirad mwvave Sizofreniis dros antifsiqozuri prepa-
Zalian seriozulia. samwuxarod, TemSi momsaxureba ratebis efeqturoba kargadaa Seswavlili. maga-

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 mkurnaloba
liTad, fsiqikuri janmrTelobis erovnuli ins- dacva. aqedan gamomdinare, sasurvelia atipiuri
titutis xelmZRvanelobiT Catarda kvleva, rom- antifsiqozuri preparatebis depo formebis arseboba;
lis drosac qlorpromazini, flufenazini da amJamad mxolod risperidonis depo variantia
Tioridazini Seadiares placebos (Cole et al., 1964). xelmisawvdomi.
6 Tvis ganmavlobaSi antifsiqozuri mkurnalobis
gansxvavebebi antifsiqozur preparatebs Soris
Sedegad pacientebis erTi meoTxedis mdgomareoba
gaumjobesda, placeboze myofi pacientebis naxevrisa tipiuri preparatebis efeqturoba erTmaneTisagan
ki _ gauaresda. metaanalizur kvlevaSi gaaanalizes mniSvnelovnad ar gansxvavdeba. klozapinis garda,
qlorpromazinze Catarebuli 42 randomizebuli atipiuri preparatebis SemTxvevaSic, atipiuri
kvlevis Sedegi. 8 kviris Semdeg qlorpromazini, antifsiqozuri medikamentebi TiTqmis erTnairad
placebosTan SedarebiT, ufro xSir SemTxvevaSi, moqmedebs.
iwvevda gaumjobesebas (55% vs. 37%, NNT=6). tipiur da atipiur preparatebs Soris gansxvaveba
medikamenturma mkurnalobam ufro kargi Sedegi mravalma kvlevam Seiswavla da xSirad urTierT-
gamoiRo pozitiuri (bodva da halucinacia) da naklebi gamomricxavi monacemebi miiRo. metaanalizuri
negatiuri da kognituri simptomebis mkurnalobis kvlevebis monacemebi mwvave fazis mkurnalobasa da
dros. sedatiuri efeqti Tavidanve iyo gamoxatuli, preparatis amtanobaze, aseve, gansxvavebis SemTxvevaSi,
Tumca, antifsiqozuri moqmedeba, romelic iTvleba, efeqtis zomasa da klinikur mizanSewonilobaze
rom dauyovnebliv unda gamovlindes (Agid et al., araerTgvarovania. magaliTad, gedesma (Geddes et
2003) Zalian nela, zogjer ramdenime kviris Semdeg, al., 2000) daaskvna, rom nebismieri upiratesoba
xdeboda SesamCnevi. umniSvneloa, xolo devisma (Davis et al., 2003) atipiuri
preparatebis mniSvnelovani efeqturoba aCvena. axali
mwvave fazis mkurnaloba grZelvadiani kvleviT, romlis drosac mravali
gamwvavebis profilaqtikisTvis xangrZlivi anti- atipiuri preparati Seadares tipiur antifsiqozur
fsiqozuri Terapia mravali kontrolirebadi kvle- medikaments perfenazins, mcire gansxvavebebi miiRes
viTaa dadasturebuli (Pasmanick et al., 1964., Gilbert et (Liberman et al., 2005). mkurnalobis saxelmZRvaneloSi
al., 1995). sistematurma analizma (Thornley et al., 1995) (gaidlaini), romelsac amJamad britaneTSi iyeneben,
aCvena, rom qlorpromazinis 6-24 Tvis ganmavlobaSi miTiTebulia, rom atipiuri antifsiqozuri
miRebisas, gamwvavebis riski mcirdeba (SedarebiTi preparati pirveli arCevis medikamentia Sizofreniis
riski = 0.65, NNT=3) da zogadi funqcionireba samkurnalod, Tumca, tipiuri antifsiqozuri
umjobesdeba (SedarebiTi riski = 0.76; NNT=7), preparatebis mniSvnelobac aRiarebulia (NICE., 2002).
preparatis wyvetilad, mxolod gamwvavebis niSnebis azrTa sxvadasxvaoba arsebobs gamwvavebebis pro-
gamovlenisas, micema nakleb efeqturia, vidre filaqtikis mizniT preparatebis gamoyenebasTan
profilaqtikis mizniT wamlis xangrZlivad miReba dakavSirebiTac, Tumca, unda iTqvas, rom monacemebi
(Jolley et al., 1990). mainc atipiuri preparatebis sasargeblod metyvelebs.
zogi qronikuli Sizofreniis mqone pacienti amasTan dakavSirebiT pirveli fundamenturi kvleva
rezistentulia xangrZlivi mkurnalobis mimarT, Catarda 2002 wels, romlis drosac 365 stabilur
xolo zogi _ TavisTavad gamodis mdgomareobidan. pacientze dakvirvebiT Seiswsvles haloperidolisa
samwuxarod, ar arsebobs validuri maCveneblebi, da risperidonis efeqturoba (Csernansky et al., 2002). 12
romlebic dagvexamreba sworad ganvsazRvroT, Tu Tvis ganmavlobaSi mdgomareoba gaumwvavda pacientebis
romel pacients esaWiroeba preparatis xangrZlivad 25%-s, romlebic risperidoniT mkurnalobdnen,
miReba da ramden xans unda gagrZeldes grZelvadiani xolo haloperidebis mimRebTagan _ 40%-s. gansxvaveba
profilaqtikuri mkurnaloba. zogadad Tanxmdebian, TvalsaCino da sarwmuno iyo rogorc klinikurad,
rom xangrZlivi remisiac ar iZleva imis garantias, ise statistikurad. axali, sistematuri mimoxilvis
rom wamlis Sewyvetis SemTxvevaSi mdgomareoba Sedegebis mixedviT (Leucht et al., 2003), gamwvavebis
ar gamwvavdeba (Cunningham and Johnstone, 2000). profilaqtikisTvis atipiuri preparatebi placeboze
antifsiqozuri preparatis moxsnisas, aucilebelia ufro efeqturi aRmoCnda (NNT=3-5). amasTan,
dozebis TandaTanobiT, nela Semcireba da Tveebis tipiurebTan SedarebiT, gamwvavebebis sixSire bevrad
manZilze xangrZlivi monitoringi. naklebi iyo (NNT =9-13). am kvlevis monacemebi
arsebobs mosazreba, romelic zogad klinikur safuZvlianad gaanalizda da dasabuTda (Csernansky et
STabeWdilebas eyrdnoba da romlis mixedviTac, al.,). aqve unda aRiniSnos, rom sxva kvlevebiT miRebuli
gamwvavebebis profilaqtikisTvis depo preparatebi monacemebi naklebad STambeWdavia.
ufro Sedegiania (Davis et al., 1994) SesaZloa imitom, klinikur praqtikaSi atipiuri preparatebi pirveladi
rom pacientebs uadvildebaT mkurnalobis reJimis SemTxvevebis samkurnalod gamoiyeneba, an iniSneba

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12 Sizofrenia
maSin, Tu Catarebuli mkurnaloba araefeqturia an sisxlis mudmivi monitoringi, vinaidan arsebobs
pacients tipiur preparatebze gverdiTi movlenebi agranulocitozis ganviTarebis saSiSroeba. pre-
uviTardeba. wamlebis individualur arCevans mTeli paratis miRebam SesaZlebelia gamoiwvios wonaSi
rigi faqtorebi ganapirobebs, rasac daavadebis mateba, sedacia da hipersalivacia (gv. 536). mosazreba,
marTvasTan dakavSirebul TavSi ganvixilavT (gv. 301). rom klozapinis gamoyeneba Sizofreniis adreul
mkurnalobis mimarT rezistentuli Sizofrenia stadiaze aumjobesebs gamosavals, ar dadasturda.
pacientebis 30% antifsiqozuri mkurnalobis mimarT magaliTad, erTwlianma kvlevam ar aCvena klozapinis
rezistentulia an, upiratesad, eqstrapiramiduli aSkara upiratesoba qlorpromazinTan, pirveli
garTulebebis gamo, preparatebis autanloba aRe- epizodisa da aranamkurnalebi pacientebis SemTxvevaSi
niSnebaT. aseTi mdgomareobebis samkurnalod erT- (Lieberman et al., 2003).
aderTi rekomendebuli preparatia klozapini, rezistentuli pacientebis mkurnalobasTan da-
romelic efeqts iZleva SemTxvevaTa mesameds an kavSirebiT, romlebsac sxvadasxva mizezis gamo
TiTqmis naxevarSi (Kane et al., 1999). es monacemebi klozapinis miReba ar SeuZliaT an visTvisac es
ramodenime kvlevam daadastura (Wahlbeck et al., 1999. preparati araefeqturia, Zalian cota monacemi
ix. suraTi 12.1). arc erTi sxva atipiuri preparati arsebobs. miRebuli strategiaa (romlis garkveuli
ar xasiaTdeba aseTi efeqturobiT (Chakos et al., 2001). mtkicebulebebi arsebobs) augmentacia D2 receptoris
klozapini unikaluria Sizofreniis dros suicidis mimarT gamoxatuli afinurobis mqone preparatebiT,
prevenciisTvisac (gv. 305). magaliTad, sulpiridiT, amisulpiridiT an ris-
klozapiniT mkurnalobis rekomendacia unda ga- peridoniT. es erTaderTi SemTxvevaa, rodesac anti-
ewios yvela im pacients, visTvisac ori sxvadasxva fsiqozuri polifarmacia dReisTvis gamarTlebulia
antifsiqozuri preparatiT mkurnaloba ar aRmoCnda (Freudenreich and Goff., 2002). arsebobs lamotrijiniTa
efeqturi an visac sxva preparatebis mimarT da valproatiT augmentaciis susti mtkicebulebebi
autanloba aReniSneba. xazi unda gaesvas imas, rom (mkurnalobis mimarT rezistentuli Sizofreniis
klozapinis gamoyeneba misi sxva gverdiTi efeqtebis mimoxilva ix. Barnes et al., 2003).
gamo SezRudulia. misi daniSvnisas aucilebelia

suraTi 12.1 klozapiniT (eqsperimentuli kgufi) an tipiuri antifsiqozuri preparatebiT (sakontrolo jgufi) xanmokle da
grZelvadiani mkurnalobis Sedegebi. analizi gakeTebulia 30 kvlevis monacemebis safuZvelze.
Sedegi modeli eqsperimentuli sakontrolo
sikvdili
relafsi
moklevadiani
grZelvadiani
klinikuri gaumjobesebis gareSe
moklevadiani
grZelvadiani
gaweras ar eqvemdebareba
moklevadiani
grZelvadiani
Sromisuunaro
moklevadiani
mkurnalobis miuRebloba
moklevadiani
grZelvadiani
pacientis ukmayofileba
moklevadiani
grZelvadiani
gverdiTi efeqtebi
sisxlis problemebi
hipersalivacia
sicxe
sedacia
gulyra
hipotenzia an Tavbrusxveva
wonaSi mateba
eqstrapiramiduli simptomebi
qserostomia

Odds ratio -Sansebis Tanafardoba, CL-sarwmunoebis intervali, NNT-mkurnalobisTvis saWiro raodenoba, NNH-zianisTvis
saWiro raodenoba. FEM-fiqsirebuli efeqtis modeli, REM-randomuli efeqtis modeli. svetebSi saTauriT „Experimental“
da `Control~ mocemulia pacientebis raodenoba jgufebSi. terminebisTvis ixileT Tavi 5.

_ 316 _
 mkurnaloba
antidepresantebi da guneb-ganwyobis dros ekT-s gamoyenebasTan dakavSirebiT arsebuli
stabilizatorebi (normoTimikebi) mtkicebulebebi Zalian sustia (Thyrian and Adams.,
2000). amitom, sxva qveynebTan SedarebiT, britaneTSi
Sizofreniis xSiri Tanmxlebi simptomia depresia.
ekT-s iSviaTad mimarTaven.
gamomdinare iqidan, rom Znelia depresiuli da ne-
gatiuri simptomebis diferencireba, Sizofreniis
fsiqosocialuri midgomebi
dros antidepresantis efeqturad gamoyenebis Seswavla
sakmaod garTulebulia. ris gamoc am sakiTxTan Sizofreniis samkurnalod Temze dafuZnebuli ser-
dakavSirebiT mxolod ramdenime damakmayofilebeli visebis ganviTarebam fsiqosocialuri intervenciis
kvlevaa Catarebuli (Whitehead et al., 2003). mimarT interesi mniSvnelovnad gazarda. aq ga-
imipraminis placebo-kontrolirebadi kvleviT Se- erTianebulia sxvadasxva saxis intervencia, romlebsac
iswavles Sizofreniis mqone pacientebi, romlebsac saerTo miznebi aqvT:
daniSnuli hqondaT flufenazi da romlebsac 1 .socialuri da interpersonaluri funqcionirebis
fsiqozuri simptomebis nivelirebis Semdeg ganuvi- gaumjobeseba;
TardaT gamoxatuli depresiuli simptomebi. dep- 2. sazogadoebaSi damoukideblad cxovrebis xelSew-
resiuli guneb-ganwyobis gaumjobesebisTvis mni- yoba;
Svnelovnad efeqturi aRmoCnda imipramini, vidre
3. simptomebis simwvavis Sesusteba da komorbiduli
plaqcebo; amasTan, igi ar iwvevs fsiqozuri sim-
mdgomareobebis (magaliTad, wamalmoxmarebis) marTva;
ptomebis gamwvavebas (Plasky, 1991). serotoninis
ukumitacebis seleqciuri inhibitorebi farTod 4. sakuTari daavadebis marTvis unaris gaumjobeseba.
gamoiyeneba Sizofreniis dros depresiuli sim- arsebobs mTeli rigi mtkicebulebebisa, romle-
ptomebis samkurnalod, miuxedavad imisa, rom jerac bic ukavSirdeba garkveuli fsiqosocialuri inter-
ar momxdara maTi saTanadod Sefaseba. venciebis efeqturobas (cxrili 12.15).
ar aris dasabuTebuli liTiumisa da sxva nor-
ojaxuri Terapia
moTimikebis gamoyeneba Sizofreniis dros. arc
mtkicebulebebi arsebobs maT antifsiqozur moq- Sizofrenia mniSvnelovani tvirTia pacientis oja-
medebasTan dakavSirebiT. ramdenime kvleviT miRebuli xisTvis, amitom daavadebis sxvadasxva etapze xSi-
sasurveli Sedegi SeiZleba afeqtur simptomebze rad mimarTaven ojaxur Terapias. ojaxuri Terapia,
moqmedebiT aixsnas. magaliTad, norTvikis parkis romelic gamoiyeneba ojaxis wevrebs Soris emociis
funqciuri fsiqozebis (Northwick Park Functional eqspresiis Sesasusteblad, yvelaze kargadaa Ses-
Psychosis study) kvlevaSi, diagnozis miuxedavad, wavlili. procedura ZiriTadad moicavs fsiqo-
liTiumi efeqturi iyo aweuli guneb-ganwyobis ganaTlebas daavadebis niSnebisa da misi Sedegebis
dros, Tumca, aranairi gavlena ar mouxdenia Sesaxeb, aseve, rCevebs mdgomareobis marTvasTan
pozitiur an negatiur simptomebze (Johnstone et al., dakavSirebiT (cxrili 12.16). axlaxans Catarebulma
2004). axalma sistematurma mimoxilvam aCvena, rom metaanalizma daadastura, rom aseTi intervenciis
Sizofreniis dros liTiumis gamoyeneba mxolod dros mcirdeba hospitalizaciis SemTxvevebi (NNT=7)
afeqturi simptomebis (an Sizoafeqturi aSlilobis) da umjobesdeba mkurnalobis reJimis dacva; Tumca,
SemTxvevaSi iZleva dadebiT Sedegs. am simptomebis calkeuli kvlevebiT gansxvavebuli Sedegebia miRe-
gareSe, Sizofreniis dros liTiumis efeqturobis buli. magaliTad, SedarebiT axalma kvlevam (Pharoah
aSkara mtkicebulebebi ar arsebobs (Leuch et al.,
2004). klozapinis augmentaciisTvis guneb-ganwyobis cxrili 12.15 fsiqosocialuri intervenciebi,
stabilizatorebis gamoyenebis Sesaxeb zeviT iyo romlebic efeqturia Sizofreniis samkurnalod
saubari.
ojaxuri Terapia (fsiqoganaTleba)

eleqtrokrunCxviTi Terapia kognitur–bihevioruli Terapia

Sizofreniis dros ekT-s gamoyenebis tradiciuli socialuri unarebis daswavla

Cvenebaa katatonuri mdgomareoba da depresiuli dasaqmeba mxardaWeriT
simptomebi. orive mdgomareobisTvis ekT-s moqmedebis
daavadebis marTvis unarebi
efeqti xSirad Zalian swrafi da gasaocaria. arsebobs
garkveuli mtkicebulebebi, rom mwvave epizodebis integrirebuli mkurnaloba komorbiduli
mkurnalobisas ekT iZleva swraf efeqts da, aseve, wamalmoxmarebisTvis

aumjobesebs rezistentuli SemTxvevebis dros asertuli stacionargareSe mkurnaloba

antifsiqozur mkurnalobaze pasuxs. Sizofreniis
Mueser & McGurk (2004)

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12 Sizofrenia

socialuri unarebis treningi

cxrili 12.16 ojaxuri Terapiis elementebi
socialuri unarebis treningi gulisxmobs komp-
Sizofreniis mkurnalobis dros
leqsuri interpersonaluri unarebis daswavlas,
Sizofreniis Sesaxeb ganaTleba romlisTvisac bihevioruli Terapia, ukukavSiri,
komunikaciis gaumjobeseba interpersonaluri unarebis treningi da sxva in-
emociebis eqspresiis Sesusteba tervenciebi gamoiyeneba. SeiZleba, unarebis treningis
kombinireba fsiqoganaTlebasa da daavadebis marTvis
socialuri kavSirebis gazrda
treningTan, romelic iTvaliswinebs mkurnalobis
molodinis marTva reJimTan adaptaciasa da cxovrebis imdagvarad
dRiuri sakontaqto saaTebis Semcireba organizebas, rom Semawuxebeli simptomebis gavlena
minimaluri iyos. aseTi Terapiis efeqti zogadad
Leff., 1998
Zalian pozitiuria, Tumca bolomde naTeli araa,
ramdenad myaria es efeqti intevenciis dasrulebis
et al., 2003) gamoavlina ojaxuri Terapiis naklebi
Semdegac, an xom ar aris efeqturi mxolod im
efeqturoba. Tanamedrove midgomis Tanaxmad, fsi-
pacientebisTvis, romlebsac prognozulad ukeTesi
qoganaTleba da ojaxuri Terapia rekomendebulia
mdomareoba aqvT. dReisTvis arsebuli metaanaliziT
pacientebisTvis, romlebic cxovroben an axlo ur-
socialuri unarebis treningis TvalsaCino efeqti
TierTobaSi imyofebian TavianT ojaxebTan (Pilling et
dadasturebuli araa, amitom socialuri unarebis
al., 2002b; NICE., 2002).
treningis rutinulad gamoyeneba rekomendebuli ar
kognitur-bihevioruli Terapia aris (Pilling et al., 2002b).
is, rom Sizofreniis dros kognitur-bihevioruli kognituri daqveiTebis mkurnaloba
Terapiis (kbT) gamoyeneba mizanSewonilia, efuZneba
kognituri daqveiTeba Sizofreniis cudi gamosav-
mosazrebas, rom pozitiuri simptomebi struqturul
lis mniSvnelovani determinantia. dReisTvis ori-
msjelobasa da qceviT modifikacias eqvemdebareba.
ve midgoma, rogorc farmakologiuri, ise fsi-
magaliTad, bodviTi azrebis SemTxvevaSi ganixilaven
qologiuri, miznad isaxavs kognituri funqciebis
misi warmoSobis mizezebs da sTavazoben alternatiul
gaumjobesebasac.
axsnas. Tumca, bodviT azrebTan roca gvaqvs saq-
konvenciuri antifsiqozuri preparatebi mini-
me, pirdapiri konfrontacias unda moveridoT. amis
malurad moqmedeben kognitur simptomebze (Mishara
msgavsad, SesaZlebelia halucinaciebis yovlis-
and Goldberg, 2004), xolo maRali dozebiT miRebuli,
SemZleobaze, identurobasa da miznebze pacientis
gansakuTrebiT antiqolinerguli moqmedebis pre-
rwmenis modificireba. amiT SevZlebT am gancdis
paratebi, auareseben mdgomareobas. atipiuri anti-
Tanmxlebi distresisa da sixSiris Semcirebs.
fsiqozuri saSualebebi zogierTi funqciis umni-
ramdenime kontrolirebadma klevam aCvena, rom
Svnelo gaumjobesebas iwveven (Harvey and Keefe, 2001).
Sizofreniis dros kbT dadebiT Sedegebs iZleva.
dReisTvis gaurkvevelia da arc mtkicebulebebi
erT-erTis Tanaxmad (Tarrier et al., 1998), pozitiuri
arsebobs, Tu ra ganasxvavebs medikamentebs kognitur
simptomebis simwvavis Sesamcireblad kbT, mxardaWeriT
funqciebze moqmedebis TvalsazrisiT. mimdinareobs
TerapiasTan SedarebiT, ufro efeqturia. meore
sxvadasxva wamlis Seswavla da SemuSaveba im mizniT,
kvlevam gamoavlina, rom kbT-c da nakleb specifikuri
rom es wamlebi antifsiqozuri moqmedebisagan damo-
`megobruli~ intervenciac rogorc pozitiuri, ise
ukideblad, efeqturi iyos kognituri mdgomareobis
negatiuri simptomebis mniSvnelovan gaumjobesebas
gasaumjobeseblad.
iwvevda. mkurnalobis 9 Tvis manZilze kbT-s jgufSi
kognituri deficitis dasaZlevad mTeli rigi
efeqti ufro TvalsaCino iyo (Sensky et al., 2000).
fsiqologiuri mkurnalobis meTodebic gamoscades.
turkingtonma (Turkington et al., 2004) gamoTqva mosazreba,
ZiriTadi aqcenti gakeTda trenirebaze da praqtikis
rom kbT karg Sedegebs iZleva pozitiuri, negatiuri
saSualebiT Sesrulebis gaumjobesebaze. yvelaze
da, zogadad, Sizofreniis simptomebis mkurnalobisas
intensiurad Seiswavles kognituri aRdgenis Terapia,
da rom is fsiqiatriulma eqTanma unda Caataros. kbT-s
Tumca, Sedegebma aSkara suraTi ar mogvca. erTi
efeqturobis, mniSvnelobis, gansakuTrebiT, klinikaSi
metaanalizisa da Semdgomi grZelvadiani kvlevis
misi rutinulad gamoyenebis mimarT ufro frTxili
meSveobiT pozitiuri Sedegebi miiRes (Krabbendam
midgomac arsebobs (Pilling et al., 2002a; Turkington and
and Aleman, 2003; Hogarty et al., 2004), xolo meore me-
McKenna, 2003). miuxedavad amisa, Sizofreniis mqone
taanaliziT daaskvnes, rom es intervencia mniSvnelovan
pacientebisTvis kbT integrirebuli mkurnalobis
gaumjobesebas ar iwvevs (Pilling et al., 2002b)
paketis nawilad unda moiazrebodes.

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 daavadebis marTva

dinamiuri fsiqoTerapia daavadebis bunebidan gamomdinare, Zalian Znelia,

Tumca profesiuli unar-Cvevebisa da moTminebis
warsulSi, Sizofreniis dros dinamiuri fsiqoTerapia
wyalobiT SesaZlebelia am rTuli amocanis daZ-
Zalian xSirad gamoiyeneboda ufro metad aSS-Si, vidre
leva. mniSvnelovania realuri miznebis dasaxva (gan-
britaneTSi. miRebuli Sedegebi Zalian usistemoa,
sakuTrebiT mZime pacientebis SemTxvevaSi), romlebic
arc erTi ar metyvelebs am Terapiis Catarebis
misaRebi iqneba pacientisa da misi axloblebisTvisac.
mizanSewonilobaze. mei (May, 1968) darwmunda, rom
yovelTvis unda avuxsnaT maT, Tu riTia daniSnuli
fsiqoTerapia umniSvnelod aumjobesebda mdgo-
wamali sasargeblo da, aseve, unda mivawodoT
mareobas. Tumca, mis mier Seswavlili mkurnaloba iyo
informacia preparatis gverdiTi movlenebis Sesaxebac.
xanmokle da mas SedarebiT gamoucdeli fsiqiatrebi
ukanasknel wlebSi SemuSavebulma mkurnalobis axalma
atarebdnen. garda imisa, rom Sizofreniis dros
meTodebma mniSvnelovnad gaaumjobesa daavadebis
individualuri fsiqoTerapia araefeqturia, arsebobs
marTva, amitom aucilebelia am mimarTulebiT codnis
imis saSiSroebac, rom SeiZleba moxdes pirovnebis
mudmivi ganaxleba.
zedmetad stimulacia da fsiqozuri simptomebis
cxrilSi 12.17 Sejamebulia Sizofreniis marTvis
gamwvaveba (Malberg and Fenton, 2000).
ramdenime ZiriTadi sakiTxi (NICE) (zogadi mimoxilva
wamlebis urTierTqmedeba da fsiqosocialuri ix. Cunningham Owens and Johnstone, 2000).
mkurnaloba
fsiqosocialuri mkurnaloba upiratesad farmakoTe- mwvave mdgomareoba
rapiasTan erTad tardeba. orive intervencia amJamad stacionarSi moTavseba da mkurnaloba, Cveulebriv,
Sizofreniis mkurnalobis integrirebuli paketis saWiroa, rodesac saxezea Sizofreniis pirveli
ganuyofel nawils warmoadgens. Zneli saTqmelia, epizodi da gamwvavebis faza. Tumca, adekvaturi
ramdenad efeqturia fsiqosocialuri intervencia resursebis arsebobisas, SesaZlebelia saxlSi
damoukideblad, radgan igi, pirvel rigSi, aumjobesebs mkurnaloba, rasac Tavisi upirateosoba aqvs (maT
mkurnalobis reJimis dacvas. es ar aris mniSvnelovani Soris, pacientis survilis gaTvaliswineba) (Dedman,
argumenti fsiqosocialuri intervenciis sasargeblod, 1993). amis mxedvelobaSi miRebiT, Seiqmna krizisuli
radgan fsiqologiuri intervencia, romelic miznad intervenciis jgufi, romelic miznad isaxavs mwvave
isaxavs komplaenturobis (mkurnalobis reJimis dacvis) mdgomareobaSi myofi pacientis mkurnalobas binaze.
gaumjobesebas, rogorc Tanmxlebi mkurnaloba, Tumca, stacionarul mkurnalobas Tavisi upiratesoba
TavisTavadaa efeqturi (Kemp, 1996). aqvs: klinikaSi uzrunvelyofilia daculi garemo,
SesaZlebelia pacientze ufro safuZvliani dak-
daavadebis marTva virveba, da ojaxsac, romelic xangrZlivi drois
manZilze ganicdis distress, amosunTqvis saSualeba
daavadebis marTvis upirvelesi sawindaria paci-
eZleva.
entTan kargi urTierTobis damyareba. amis miRweva,
mniSvnelovania pacientze dakvirveba mkurnalobis
Catarebamde, magram es xSirad ver xerxdeba
cxrili 12.17 Sizofreniis marTvis principebi da saWiroa gadaudebeli Terapiis dawyeba. da-
da komponentebi kvirveba pacientze, romelic medikamentebs ar
Terapiuli partnioroba pacientsa da mis mzrunvelebTan iRebs, gvexmareba fsiqikuri statusisa da qcevis
srulyofil SeswavlaSi, diagnozis dasmasa da
integrirebuli, multidisciplinuri muSaoba, romelic
sxva daavadebebisagan, magaliTad, fsiqoaqtiuri
pirvelad da meorad jandacvas moicavs
nivTierebebiT gamowveuli mdgomareobisa da
antifsiqozuri preparatebiT mkurnaloba da organuli fsiqozebisagan, diferencirebaSi. SesaZloa,
profilaqtika _ minimaluri efeqturi dozebiT
saWiro iyos mkurnalobisagan Tavisufali pacientebis
kognitur bihevioruli Terapia specialurad Seswavla. praqtikaSi yvelaze rTulia
ojaxuri intervencia eWviani (interviueris mimarT ar aris ndobiT
ganwyobili) an sakuTar TavSi Caketili pacientis
adreuli intervencia
gamokvleva. diagnozis dasasmelad SeiZleba saWiro
mowyvladi pacientebis asertuli momsaxureba gaxdes ramdenime intervius Catareba, axloblebis
saWiroebebis regularulad Sefaseba gamokiTxva da eqTnebis dakvirvebiT miRebuli
monacemebis gaTvaliswineba.
krizisuli intervencia da Sin momsaxurebis gundi,
antifsiqozuri mkurnaloba Sizofreniisa da sxva
rogorc stacionirebis alternativa
fsiqozebis mkurnalobis mTavari saSualebaa, igi
realisturi Terapiuli optimizmis SenarCuneba
xSirad diagnozis dasmisTanave iwyeba da SesaZlebelia

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12 Sizofrenia
mTeli cxovrebis manZilze gagrZeldes. amdenad, nalobis mniSvneloba da miviRoT misgan sruli
fsiqofarmakoTerapiaze gadawyvetilebis miReba Tanxmoba, radgan arsebobs mogvianebiTi seriozuli
da pacientisa da axloblebis adekvaturi CarTvis garTulebis, tardiv (mogvianebiTi) diskineziis
uzrunvelyofa Sizofreniis marTvis umniSvnelovanes ganviTarebis riski (ix. gv. 530_8). im SemTxvevaSi, Tu
aspeqts warmoadgens. mwvave fazaSi unda Sesustdes pacients ar SeuZlia gacnobierebuli gadawyvetilebis
pozitiuri simptomebi da agznebis kontroli. miReba, mkurnaloba unda warimarTos `fsiqiatriuli
amasTan, maqsimalurad unda aviciloT Tavidan daxmarebis Sesaxeb~ kanonis sruli dacviT. pacientis
gverdiTi efeqtebis ganviTareba, gansakuTrebiT, naTesavebi, ramdenadac es SesaZlebelia, unda Ca-
mwvave distonia. amis misaRwevad sasurvelia, ben- erTon mkurnalobis Sesaxeb gadawyvetilebis miRebis
zodiazepinebTan erTad, antifsiqozuri prepa- procesSi ori mizezis gamo: (1) amas SeiZleba kanoni
ratebis saSualo dozebiT daniSvna (magaliTad, moiTxovdes da (2) pacientis mier mkurnalobis
haloperidoli 2-6 mg/dRe an risperidoni 2-6 mg/ reJimis dacva SeiZleba mniSvnelovnad waaxalison
dRe plus lorazepami 2 mg, saWiroebis dros, yovel axloblebma. SesaZloa, saWiro gaxdes pacientis
saaTSi erTxel). haloperidolic da lorazepamic advokatis daxmarebac.
SeiZleba mivceT intramuskulurad, Tu amis saWiroeba simptomebis nivelirebis Semdeg, mkurnalobaSi Car-
arsebobs. alternatiuli daniSnulebis saxiT, SeiZ- Tulma gundma, daavadebis Semdgomi marTvisTvis,
leba gamoviyenoT ufro sedatiuri antifsiqozuri unda SeimuSaos mkurnalobis grZelvadiani gegma,
preparatebi, rogorebicaa olanzapini (10-20 mg/dRe) an romelic socialur Sefasebas efuZneba. marTalia,
qlorpromazini (200-400mg/dRe). umjobesia oraluri Znelia mdgomareobis samomavlo prognozi, magram
medikamentebis gamoyeneba, Tumca, im SemTxvevaSi, aucilebelia daskvnis gakeTeba axlo periodis gamo-
Tu pacienti Zalian agznebulia an ar emorCileba savalze. daskvna keTdeba mkurnalobaze pasuxis
mkurnalobas, saWiroa wamlis ineqciis gziT Seyvana. xarisxisa da xangrZlivobis mixedviT, aseve, wina
Tu eWvi gvepareba, rom pacienti ar ylapavs abebs, maSin epizodebisa da sxva faqtorebis gaTvaliswinebiT,
unda mivceT suspenziis an pirSi xsnadi tabletis saxiT. romlebic cxrilSia (cxrili 12.14) CamoTvlili.
SesaZlebelia xanmokle periodis depo preparatebis
gamoyeneba, magaliTad zuklopentiqsol acetatis an antifsiqozuri preparatebis arCeva
olanzapinis. aucilebelia depo preparatebis didi sxvadasxva antifsiqozuri preparatebis efeqturobisa
sifrTxiliT xmareba. zuklopentiqsol acetati ar da maT Soris arsebuli msgavsebis Sesaxeb ukve
unda davniSnoT, Tu ar viciT antifsiqozur mkur- visaubreT, aqedan gamomdinare, medikamentis Ser-
nalobaze pacientis amtanoba (fsiqiatrTa samefo Cevisas sxva faqtorebi unda gaviTvaliswinoT, kerZod:
koleji, 1993). antiqolinerguli preparatebi iniSneba warsulSi pacientis pasuxi mkurnalobaze, misi ar-
parkinsonuli niSnebis gamovlenis Semdeg. ar SeiZleba Cevani, preparatis forma (abebi, suspenzia, xsnadi
maTi rutinulad an xangrZlivad gamoyeneba. sakiTxebi, tabletebi, depo) da mosalodneli gverdiTi efeqtebi,
romlebic exeba imas, Tu ramdenad itans pirovneba riTac, farmakologiuri moqmedebis Sesabamisad,
individualurad antifsiqozur preparatebs, Semdeg wamlebi mniSvnelovnad gansxvavdeba erTmaneTisagan
nawilSi iqneba ganxiluli. (gv. 530). preparatis arCevisas, gasaTvaliswinebelia
mosalodnelia, rom agzneba, mousvenroba, gaRi- Semdegi gverdiTi efeqtebi:
zianebadoba, insomnia, stacionirebidan ramdenime
♦ eqstrapiramiduli sindromi: yvela metaanaliziT
dReSi alagdeba. bodviTi azrebi, halucinaciebi
eqstrapiramiduli gverdiTi movlenebi ufro nak-
da sxva fsiqozuri simptomebi ufro nela, xSirad,
lebad viTardeba atipiuri antifsiqozuri pre-
ramdenime kviris Semdeg, emorCileba mkurnalobas.
paratebis miRebisas. tardiv (mogvianebiTi) dis-
Tu mdgomareoba ar umjobesdeba, savaraudoa, rom
kineziis ganviTarebac ufro iSviaTia atipiuri
pacienti an ar iRebs wamals, an iRebs arasakmarisi
preparatebiT mkurnalobis dros (Correll et al., 2004).
doziT. pacientebis mxolod Zalian mcire nawilia
♦ hiperprolaqtinemias iwvevs D2 receptoris mi-
rezistentuli yvelanairi mkurnalobis mimarT.
marT gamoxatuli afinurobis mqone preparatebi.
mas Semdeg, rac TvalsaCino gaumjobeseba eWvs
maT miekuTvneba tipiuri da ramdenime atipiuri
aRar iwvevs, simptomebis mudmivi monitoringis
antifsiqozuri preparati (magaliTad, amisulpi-
qveS (raTa mdgomareoba ar gamwvavdes) SegviZlia
ridi, rispiridoni). danarCenebi naklebad moq-
dozebis frTxilad Semcireba. dozebis dakleba xdeba
medeben prolaqtinze, xolo aripiprazoli ki
TandaTanobiT, xangrZlivi drois ganmavlobaSi (ix.
amcirebs prolaqtinis dones. prolaqtinis momateba
qveviT).
yuradsaRebia rogorc swrafi efeqtis gamo, rac
Tu pacientis fsiqikuri mdgomareoba amis saSualebas
menstrualuri ciklis darRvevebsa da galaqtoreaSi
iZleva, aucilebelia avuxsnaT medikamenturi mkur-

_ 320 _
 daavadebis marTva
gamoixateba, ise mogvianebiTi garTulebis Tval- kardiogramaze QTc intervalis gazrdas, rac
sazrisiTac, vinaidan zrdis simsivneebisa da kardialuri ariTmiis saSiSroebas qmnis. amis gaT-
osteoporozis ganviTarebis risks (Wieck and valiswinebiT, pirovnebas, romelsac aReniSneba
Haddad., 2004). unda gvaxsovdes, rom orive gverdiTi kardialuri an vaskuluri movlenebi, unda mivceT
efeqti dakavSirebulia dozasTan da ufro mwvavdeba iseTi antifsiqozuri preparati, romelsac am
Terapiul dozaze meti doziT miRebisas (Kapur et cvlilebebis gamowvevis yvelaze naklebi potencia
al., 1999). maTi ganviTareba miuTiTebs preparatis aqvs. aseve, saWiroa xandazmuli pirebisTvis anti-
zedmet dozaze. Tu Terapiuli pasuxi ar aris fsiqozuri wamlebis didi sifrTxiliT daniSvna (me-
damakmayofilebeli, saWiroa preparatis Secvla 20 Tavi).
naklebi gverdiTi efeqtebis mqone medikamentiT. yvela am faqtoridan gamomdinare, klinicisti Za-
♦ sedacia. zog antifsiqozur preparats gamoxatuli lian kargad unda erkveodes tipiur da atipiur
sedaciuri efeqti aqvs. upiratesad im medikamentebs, preparatebsa da gverdiTi efeqtebis mixedviT maT
romlebsac histaminuri da muskarinuli recep- Soris gansxvavebaSi. aseve, mniSvnelovania preparatis
torebisadmi gamoxatuli afinuroba axasiaTebT, oraluri da parenteraluri formebisa da sxva
magaliTad, qlorpromazini, olanzapini da klo- wamlebTan urTierTqmedebis codna.
zapini. am preparatebis es Tviseba xSirad saWiroc
aris, gansakuTrebiT, fsiqomotoruli agznebis `Semdgomi movla~ kargi prognozis
SemTxvevaSi, Tumca xangrZlivi gamoyenebis dros SemTxvevaSi
SeiZleba zogadi funqcionirebis daqveiTeba gamo- Sizofreniis pirveli epizodis Semdeg, efeqturi
iwvios. mkurnalobis SemTxvevaSi, rodesac axlo periodis
♦ wonaSi mateba mravali tipiuri da atipiuri prognozi dadebiTia, mniSvnelovania ori principis
antifsiqozuri preparatis mniSvnelovani gverdiTi dacva: (1) mdgomareobidan gamosvlis Semdeg, ramdenime
efeqtia. gansakuTrebiT damaxasiaTebelia im wam- Tvis ganmavlobaSi, umciresi efeqturi doziT
lebisTvis, romlebic histaminisa da 5-HT2C medikamenturi mkurnalobis gagrZeleba da (2) aSkara
receptorebs blokaven da nawilobriv 5-HT2C stresuli situaciisTvis Tavis arideba.
receptorebis genetikur variaciasTan arian pacienti TemSi momuSave multidisciplinuri
dakavSirebulni. magaliTad, olanzapiniT sami gundis wevrma, ZiriTadad fsiqiatriulma eqTanma,
kviris mkurnalobis Semdeg wonaSi saSualo mateba regularulad unda moinaxulos. dakvirveba mkur-
5 kg-ia. atipiuri preparatebidan amisulpirids, nalobis Sewyvetidan ramdenime Tve grZeldeba.
aripiprazolsa da risperidons yvelaze naklebad miuxedavad dadebiTi da optimisturi prognozisa,
axasiaTebs wonaSi momateba. ojaxis wevrebs unda ecnobos, rom dauyovnebliv
♦ II tipis Saqriani diabeti xSirad problemuri mimarTon specialists, Tu mdgomareobis gauaresebis
xdeba. bolomde naTeli ar aris, es antifsiqozuri raime eWvi gaCndeba. mkurnalobis am etapze ojaxis
mkurnalobiTaa gamowveuli, Tu dakavSirebulia eqims gansakuTrebuli roli akisria.
daavadebis faqtorebTan (magaliTad, saerTo `cudi prognozis~ mqone pacientebis, romlebsac
genetikuri winaganwyoba, cxovrebis stili). aseve, ar aqvT gamoxatuli daqveiTeba, Semdgomi movla
naklebadaa cnobili, Tu romeli antifsiqozuri umravles SemTxvevaSi savaraudoa momavali
preparatia metad negatiuri sxvasTan SedarebiT. gamwvavebebis ganviTarebis fonze, rasac dasWirdeba
zogi gamokvleva gviCvenebs, rom riski gansakuTrebiT grZelvadiani zrunva.
momatebulia klozapinisa da olanzapinis miRebisas aseT viTarebaSi antifsiqozuri preparatebis
(Lieberman et al., 2005). gamomdinare iqidan, rom xangrZlivad gamoyeneba daavadebis marTvis mniS-
arsebobs azrTa sxvadasxvaoba, antifsiqozuri vnelovani komponentia. SesaZloa, ukeTesi iyos depo
mkurnalobisas aucilebelia diabetze rutinuli preparatebis daniSvna, vinaidan pacientebis did
gamokvlevis Catareba. aseve, unda gavakontroloT nawils uWirs xangrZlivi mkurnalobis reJimis dacva.
lipidebis done sisxlSi da pacientis wona (amerikis Tumca, am SemTxvevaSi, risperidonis garda, sxva
diabetis asociacia da sxvebi, 2004). atipiuri preparatebis miReba gamoricxulia. wamlis
dozis (simptomebis SemcirebisTvis minimaluris)
♦ kardiovaskuluri risk-faqtorebi. antifsiqozuri
regulireba pacientis klinikur mdgomareobaze
preparatebis miReba dakavSirebulia kardiovas-
dakvirvebiTaa SesaZlebeli. Tu pirvelad arCeuli
kuluri da cerebrovaskuluri garTulebebis maR-
antifsiqozuri wamlis maqsimaluri doza saTanado
al riskTan, rac nawilobriv ganpirobebulia maTi
Sedegs ar iZleva, saWiroa preparatis gamocvla.
gavleniT wonis matebaze, insulin-rezistentobasa
sasurvelia sxva receptorebze moqmedi medikamentebis
da dislipidemiaze. zogi preparati iwvevs

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12 Sizofrenia
gamoyeneba. Tumca, aseTi situaciebis marTvis Sesaxeb unda gakeTdes reabilitaciaze, fsiqosocialur
naklebi informacia arsebobs. klozapini erTaderTi intervenciasa da socialur Tanadgomaze, rac
preparatia, romlis efeqturoba pacientTa am konkretuli pirovnebis saWiroebebzea iqneba
jgufisTvis dadasturebulia, magram aucilebelia morgebuli. aseve, mniSvnelovania okupaciuri
am wamlis miRebasTan dakavSirebuli riskis gaT- Terapevtisa da klinikuri fsiqologis wvlili.
valiswineba (gv. 238). suicidis riskis arsebobac sakiTxebi, romlebic gansakuTrebul yuradRebas
klozapinis adreuli gamoyenebis Cvenebaa (gv. 503). saWiroeben:
Tuki kognitur-bihevioruli Terapia xelmisawvdomia, sacxovrebeli garemo pirobebi _ SeuZlia pacients
mizanSewonilia rezidualur pozitiur simptomebze damoukideblad cxovreba? SeiZleba pacienti
mimarTuli kbT-s Catareba (gv. 300). dabrundes Tavis mSoblebTan an naTesavebTan? xom ar
mkurnalobis grZelvadiani gegma unda moicavdes aris saWiroa sacxovrebelSi (sacxovrisSi) gadayvana?
pacientis fsiqikuri mdgomareobis, mkurnalobis, w dasaqmeba _ SeuZlia pirovnebas raime anazRaurebadi
socialuri adaptaciisa da saqmianobis regularul an voluntaruli samuSaos Sesruleba?
Semowmebas. SesaZloa, sasargeblo aRmoCndes
w yoveldRiuri unar-Cvevebi _ pacienti xSirad
stresul da ojaxur problemebTan dakavSirebiT
saWiroebs bazisuri unar-Cvevebis aRdgenas,
rCevebis micema; agreTve, ojaxisTvis specifikuri
magaliTad, saWmlis momzadeba, Tanxis gadanawileba,
daxmarebis gaweva, raTa ojaxis wevrebs hqondeT
sayidlebis gakeTeba, binis dasufTaveba da piradi
ufro realuri molodini pacientis mdgomareobis
higienis dacva;
mimarT, ukeT gaerkvnen daavadebaSi da, saWiroebis
w socialuri unar-Cvevebi da is, Tu rogor atarebs
SemTxvevaSi, moxerxdes emociuri damokidebulebis
pacienti Tvisufali dros;
Semcireba. aseTi moculobis samuSaos Sesruleba
SesaZlebelia TemSi momuSve fsiqiatriuli eqTnis, w socialuri da kognituri funqciebis aRdgena
socialuri muSakis, fsiqiatrisa da ojaxis eqimis _ rodesac SesaZlebelia, zeviT ganxiluli,
erToblivi ZalisxmeviT. zogi pacienti, gasagebi Tanamedrove Terapiebis gamoyeneba socialuri da
mizezebis gamo, xSirad anebebs Tavs mkurnalobas kognituri funqciebis gasaumjobeseblad;
da mxolod mdgomareobis gaumjobesebis Semdeg w antifsiqozuri mkurnalobis optimizacia saukeTeso
ubrundeba. iseT SemTxvevebSi, rodesac gamwvavebebi wamlisa da saTanado dozis SerCevis gziT.
xSiria, asertul stacionargareSe mkurnalobas im SemTxvevaSi, Tu pacients aReniSneba gamo-
gansakuTrebuli roli eniWeba (ix. 23-e Tavi) (Marshall xatuli qcevis problemebi, misi ojaxis wevrebi
and Lockwood, 2000). gansakuTrebul zrunvas saWiroeben. naTesavebisTvis
garkveul SemTxvevebSi, pozitiuri simptomebis SesaZloa mizanSewonili iyos jgufebSi gaerTianeba
nivelirebis miuxedavad, pacientebi veRar ubrun- da Sexvedra maTTan, vinc msgavsi problemebis
debian funqcionirebisa da aqtivobis Zvel dones. daZleva iswavla. maT unda hqondeT imis imedi, rom
amis mizezi SeiZleba iyos negatiuri, depresiuli mdgomareobis garTulebis SemTxvevaSi, miiReben
an kognituri simptomebis arseboba, an sedaciuri profesiul daxmarebas. axloblebs unda vurCioT,
an antiqolinerguli preparatebis miReba. yvela Tu rogor unda upasuxon anomaliur qcevas da
es faqtori unda gaviTvaliswinoT da Sesabamisi avuxsnaT, ras unda elodon pacientis mxridan.
zomebi miviRoT. es problemebi SeiZleba nawilobriv aseT SemTxvevebSi saukeTeso rCevebis micema TemSi
mogvardes medikamentebis optimizaciisa da fsiqo- momuSave fsiqiatriul eqTans SeuZlia (Gournay,
socialuri intervenciis meSveobiT. 2000). axloblebis darigebisa da daxmarebis saqmeSi
socialur muSaksac mniSvnelovani roli eniWeba.
gamoxatuli daqveiTebis mqone `cudi
prognozis~ pacientebis Semdgomi movla daavadebis marTvis sxva sakiTxebi
pacientebs romlebsac aqvT gamoxatuli negatiuri
zrunvis gegma
simptomebi, cudi socialuri adaptacia da qcevis
fsiqiatriuli daavadebis marTvisas, Zalian didi
problemebi, rac qronikuli SizofreniisTvisaa
mniSvneloba aqvs zrunvis gegmis SemuSavebas, raTa
damaxasiaTebeli, ufro metad organizebuli da
sworad warimarTos multidisciplinuri gun-
SeuzRudavi zrunva sWirdebaT. qronikuli Sizof-
dis koordinirebuli muSaoba da riskis marTva.
reniis mqone pirebisTvis gaTvaliswinebuli, Temze
masSi detaluradaa gawerili gundis wevrebis
dafuZnebuli fsiqiatriuli zrunvis komponentebi
movaleobebi da servisis miwodebis saSualebebi
23-e TavSia aRwerili.
(23-e Tavi). aseTi midgoma gansakuTrebiT saWiroa
medikamenturi mkurnaloba daavadebis marTvis
rTuli da grZelvadiani momsaxurebis dros, Tumca
mniSvnelovani Semadgeneli nawilia, Tumca, aqcenti

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 daavadebis marTva
mizanSewonilia yvela Sizofreniis mqone pacientis wamalmoxmareba
SemTxvevaSic. zrunvis gegmis mTavari Semadgeneli
Sizofreniis mqone bevri pacienti borotad moixmars
komponentebia Semdegi sakiTxebis identificireba da
rogorc legalur, aseve aralegalur fsiqoaqtiur
dokumentireba:
nivTierebebs. magaliTad, aSS-Si, gansazRvrul raionSi
w samedicino da socialuri saWiroebebis sistematuri Catarebulma epidemiologiurma kvlevam aCvena, rom
Sefaseba; fsiqoaqtiur nivTierebaTa avadmoxmarebis riski
w mkurnalobis gegma, romelic SeTanxmebulia Sesa- Sizofreniis mqone pacientebSi 4-5-jer iyo gazrdili.
bamis StatTan, pacientTan da mis axloblebTan; amas mravali mizezi unda hqondes; gamovyofT
w ZiriTadi personalis CamonaTvali, romlebsac ramodenimes:
aqvT pcientTan kontaqti, uweven monitorings ♦ meti sensitiuroba socioekonomikuri faqtorebis
da uzrunvelyofen mkurnalobis programis Ses- mimarT, rac wamalmoxmarebasTan dakavSirebiT
rulebas; janmrTeli populaciisTvisac mniSvnelovania;
w pacientis mdgomareobis progresisa da misi saWi- ♦ pirovnuli distresis, romelic fsiqikuri simp-
roebebis regularuli mimoxilva. tomebiTa an mkurnalobiTaa gamowveuli, Semsu-
buqebis mcdeloba;
adreuli intervencia
♦ saerTo/gaziarebuli genetikuri winaganwyoba.
sul ufro izrdeba interesi im mosazrebis mimarT, rom
wamalmoxmarebis SemTxvevaSi Sizofreniis mim-
Sizofreniis mkurnalobis adreul stadiaze dawyeba
dinareoba simptomaturad mZimdeba da aseTi pacientebis
aumjobesebs gamosavals. am mxriv, gansakuTrebiT
mkurnalobaSi CarTva nelia. wamalmoxmareba aso-
mniSvnelovania avstraliaSi Catarebuli kvleva
cirebulia usaxlkarobasTan, Zaladobriv qcevasa da
(McGorry and Killackey, 2002). es mosazreba Semdeg
zogadi janmrTelobis gauaresebasTan. Tanamedrove
faqtebs efuZneba:
kvlevebiT dadginda, rom dadebiTi Sedegis miRweva
w xangrZlivad aranamkurnaleb pacientebs mniSvne-
SeiZleba kompleqsuri ambulatoriuli da asertuli
lovnad uaresi gamosavali aqvT (Marshall et al., 2005);
Terapiis programebiT, rac orive mdgomareobis
w yoveli momdevno epizodis mkurnalobas meti dro (wamalmoxmarebisa da fsiqozis) integrirebulad
esaWiroeba; mkurnalobas iTvaliswinebs (Drake et al., 1998). aseve, am
w socialuri daqveiTeba yvelaze intensiurad di- jgufisTvis SeiZleba efeqturi iyos kbT.
agnozis dasmidan pirveli ori wlis manZilze vi-
moZalade pacienti
Tardeba;
Sizofreniis dros xSirad gvxvdeba qcevis darRvevebi
am monacemebidan gamomdinare, miiCneven, rom mni-
da mousvenroba. marTalia, sxvebis mimarT Zaladobrivi
Svnelovania fsiqozis mqone pacientebis, ramdenadac
qceva SizofreniisTvis damaxasiaTebeli ar aris,
SesaZlebelia, adreuli gamovlena da mkurnalobis
magram arc gamoricxulia. magaliTad, rodesac
dawyeba. amJamad mimdinareobs adreuli intervenciis,
Seiswavles 253 pacienti Sizofreniis pirveli
rogorc dabali dozebiT antifsiqozuri mkurnalobis,
epizodis dros, naxes, rom 52 pacienti Tavisi qceviT
ise fsiqologiuri intervenciis efeqturobis
sxvebis sicocxles safrTxes uqmnida (Humphreys and
Seswavla da, winaswari monacemebiT Tu vimsjeleT,
Johnstone, 1992). amasTan, daaxloebiT SemTxvevaTa
misi upiratesoba aSkaraa (Marshall and Lockwood, 2004).
naxevarSi Zaladobrivi qceva fsiqozuri simptomebiT,
umravlesoba eTanxmeba mosazrebas, rom adre dawye-
upiratesad bodviT iyo ganpirobebuli. Zaladobrivi
buli mkurnaloba prognozis TvalsazrisiT ukeTesia.
qcevis saSiSroebas wamalmoxmarebac zrdis (Citrome
Tumca, zogi Tvlis, rom mkurnalobis dawyeba sa-
andVolodka, 1999).
survelia daavadebis prodromul periodSi, rodesac
moZalade pacientebis daavadebis marTvis zogadi
fsiqozuri simptomebi jer kidev ar aris gamovleni-
principebi igivea, rac Sizofreniis mqone sxva
li an, rodesac pirovneba janmrTelia, magram Sizo-
pacientebisa, Tumca, SesaZloa, ufro xSirad ara-
freniis maRali riskis mqonea (magaliTad, Sizofre-
nebayoflobiTi mkurnalobis Catareba iyos saWiro.
niis mqone mSoblebis Svilebi). es mosazreba dReisT-
aseT SemTxvevebSi, mdgomareobis gakontrolebis
vis seriozuli kamaTis sagans warmoadgens, radgan
mizniT, medikamenturi mkurnalobis dauyovnebliv
gaurkvevelia, rogor SeiZleba `usimptomo pacientis~
dawyebasTan erTad aucilebelia didi Zalisxmeva
sworad amocnoba. amasTan, gasaTvaliswinebelia im
mSvidi da stabiluri garemos Sesaqmnelad, romelSic
pirebis mkurnalobisa da stigmatizaciis riski, rom-
Zaladobis provocireba Tavidan iqneba acilebuli.
lebsac arasdros ganuviTardebaT Sizofrenia (Warner,
Zaladobis saSiSroebas saTanado yuradReba un-
2002; Pelosi and Birchwood, 2003).
da mivaqcioT. gansakuTrebiT yuradsaRebia ise-

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12 Sizofrenia
Ti SemTxvevebi, rodesac warsulSi pacients (avad- (1) daavadebis dawyebis asaki _ krepelinis droidan
myofobis arseboba_ararsebobis miuxedavad) Zala- moyolebuli, mravalma kvlevam, qalebSi Sizofreniis
dobrivi qmedeba aqvs Cadenili. mwvave simptomebis dawyebis mogvianebiTi asaki daadastura SedarebiT
gakontrolebasTan erTad, Zaladobis saSiSroeba naklebi maCvenebeli cxovrebis meore da mesame
ixsneba. pacientebis mxolod Zalian mcire nawili aTwleulSi, xolo meore piki, upiratesad, mexuTe
didi xnis manZilze rCeba sazogadoebisTvis saSiS aTwleulSi aRiniSneba;
pirovnebad. Zaladobis marTva ganxilulia 26-e TavSi. (2) Sizofreniis sixSire qalebTan SedarebiT mama-
kacebSi metia (SemTxvevaTa riskis Tanafardoba
suicidis riski
1.42; 95% sarwmunoebis intervaliT 1.3-1.56; Aleman
kvlevebidan Cans, rom Sizofreniis dros suicidis
el al., 2003); mamakacebSi daavadeba ufro mZimed
riski mniSvnelovnadaa gazrdili. iseve, rogorc
da mwvaved midis. es ar aris dakavSirebuli arc
sxva fsiqikuri aSlilobebis dros, Sizofreniis Sem-
daavadebis asakTan da arc imasTan, mimarTa Tu
TxvevaSic demografiuli risk-faqtorebia: mamrobiTi
ara pacientma eqims. amis mizezad estrogenebis
sqesi, socialuri izolacia, umuSevroba da warsulSi
neiroproteqtoruli bunebaa miCneuli, Tumca,
suiciduri qcevis arseboba.
sakmarisi damatkicebeli monacemebi ar gvaqvs;
sxva risk-faqtorebs miekuTvneba:
sqesTa Soris gansxvavebas, SesaZloa, genetikuri da
♦ depresia da uimedoba; epigenetikuri risk-faqtorebic ganapirobebs;
♦ fsiqozuri mdgomareobis xSiri gamwvavebebi; (3) sikvdilianobis maCvenebeli Sizofreniis mqone
♦ premorbidulad kargi funqcionireba; mamakacebSi, qalebTan SedarebiT, 2-jer metia.
♦ daavadebis adreuli stadia; genderuli faqtorebi gavlenas axdens mkurnalobis
♦ stacionarSi yofnis an stacionirebis Semdgomi proceszec (Seeman, 2004):
periodi. (1) wamlebis farmakokinetika, maT Soris kloza-
gamoxatuli negatiuri simptomebis mqone pacients pinisTvisac, mamakacebsa da qalebSi gansxvavebulia;
suicidis mcdeloba naklebad aReniSneba. suicidi (2) hiperprolaqtinemia da estrogenebis Semcireba,
ufro metad asocirebulia pozitiuri simptomebis rac antifsiqozuri mkurnalobis xSiri gverdiTi
simwvavesTan, rogoricaa auditoruli halucinaciebi movlenebia, ufro negatiurad moqmedebs qa-
da kontrolis bodva. daavadebis arafsiqozur pe- lebze, vidre mamakacebze. es saSiSia ara marto
riodSi TviTmkvlelobis faqtebs ufro xSirad menstrualuri ciklis darRvevebis TvalsazrisiT,
vxvdebiT ganaTlebis maRali donis mqone pacientebSi. aramed zrdis osteoporozisa da zogierTi simsivnis
aseTi pacientebis depresias da daqveiTebul TviT- ganviTarebis risksac (Wieck and Haddad, 2003).
Sefasebas ganapirobebs is, rom avadmyofobamde pa-
cients hqonda maRali molodinisa da perspeqtiuli rasobrivi gansxvaveba da Sizofrenia
momavlis gancda, rac daavadebis gamo ganadgurda da eTnikuri umciresobebis aranebayoflobiTi
daingra. mkurnalobis gazrdili maCvenebeli azrTa
Sizofreniis dros suicidis riskis Semcireba niSnavs sxvadasxvaobas iwvevs. gansakuTrebiT, afro-
suicidis risk-faqtorebis karg codnasa (De hert and karibuli populaciis SemTxvevaSi, romelic did
Peuskens, 2000) da depresiuli simptomebis aqtiur brtaneTSi cxovrobs (gv. 290; Morgan et al., 2005).
mkurnalobas. randomizebuli kvlevebiT dadgenilia, ramdenime avtoris mier es, rogorc `instituciuri
rom Sizofreniis dros klozapini mniSvnelovnad rasizmi, ~ ise Sefasda (Sashidharan, 2001). Tumca, ar
amcirebs suicidis risks (Meltzer et al., 2003), Tumca aris saubari am populaciis mimarT siZulvilze.
efeqtis zomisa da meqanizmis gansazRvrisTvis dama- diagnozi yovelTvis unda efuZnebodes ICD-10-sa
tebiTi kvlevebia saWiro (Hennen and Baldessarini, 2005). da DSM-IV-is kriteriumebs, eTnokulturaluri
Taviseburebebis gaTvaliswinebiT, rogorc am
sxva sakiTxebi klasifikaciebSia miTiTebuli (gv. 8). qceviTi
manifestacia (magaliTad, agresia), romelic
qalebi da Sizofrenia
SecdomiT SeiZleba rasobriv gansxvavebas mivaweroT,
Sizofreniis zogierTi aspeqtisa da misi mkurnalobis ar ganixileba sxva simptomebisagan damoukideblad.
TvalsazrisiT, qalebsa da mamakacebs Soris mni- medikamentebis gamoyeneba da aranebayoflobiTi
Svnelovani gansxvavebebi arsebobs (ix. Castle et al., mkurnalobis principebi yvela erovnebisa da rasis
2000). warmomadgenlisTvis erTnairi unda iyos. (eTnikuri
epidemiologiuri kvlevebis meSveobiT dadginda variaciebis mimoxilva ix. Bhui et al., 2003).
Semdegi gansxvavebebi:

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