fsiqikuri aSlilobebi, adreuli gamovlena, profilaqtika;

Carevis,zrunvisa da mkurnalobis meTodebi

neli maWaraSvili;“samSabaToba”; 02.02.10

ra aris fsiqikuri janmrTeloba?

fsiqikuri jamrTeloba ufro metia vidre fsiqikuri daavadebis

ar qona.

fsiqikuri jamrTeloba gulisxmobs keTildReobis mdgomareobas, rodesac:

• adamians SeuZlia sakuTari SesaZleblobebis realizacia;

• cxovrebiseul stresebTan gamklaveba; • nayofieri da produqtiuli muSaoba; • sazogadoebis cxovrebaSi wvlilis Setana.

• msoflioSi daaxloebiT 450 milion adamians aReniSneba Pfsiqikuri janmrTelobis problemebi; • fsiqikuri aSlilobebi yvelaze gavrcelebul

daavadebaTa ricxvSi Sedis;• depresia avadmyofobis da Sromisuunarobis

gamomwvev mizezTa Soris meoTxe adgilzea;• saSualo da dabal Semosavlian qveynebSi

daavadebaTa tvirTis 10-% swored fsiqikur daavadebebze modis;

• es ricxvi axlosaa gulsisxlZarRvTa daavadebebis Sesabamis maCvenebelTan;

invalidobis gamomwvevi 10 umTavresi mizezis naxevari fsiqikuri daavadebebiTaa gamowveuli, esenia:

1. depresia, 2. alkoholizmi, 3. maniakalur-depresiuli fsiqozi,4. Sizofrenia.

2020 wlisaTvis msoflioSi invalidobis uxSiresi mizezi depresia iqneba;

daavadebaTa klasifikaciis rigSi depresia gulsisxlZarRvTa daavadebebis Semdeg

meore adgils daikavebs.

• Hharvadis universitetis kvlevis Sedegebis Tanaxmad fsiqikurad seriozulad daavadebulTa 80_% umuSevaria;

• moxucTa da xandazmulTa depresiuli aSlilobebi 8-%ia;

• maTgan 63-% ver axerxebs mkurnalobas; • depresia am asakobriv jgufSi iwvevs: insultebis,parezebis,kardio-vaskularuli, infeqciuri daavadebis, maT Soris

tuberkulozis provocirebas

• zrdasruli martoxela usaxlkaro mosaxleobis 1/3-s seriozuli fsiqikuri daavadebebi awuxebs, rasac xSirad alkoholizmi da narkomania emateba.P

• pirveladi daxmarebis kabinetebSi misul pacientTa Civilebis 30-80 % daudgeneli xasiaTis fsiqikur aSlilobebs ganekuTvneba;

• aSS-Si sikvdilianobis mizezTa Soris TviTmkvleloba mecxre adgilzea.

kvlevis ”globaluri iniciativa fsiqiatriaSi” Sedegebis Tanaxmad fsiqikuri aSlilobis mqone

adamianebi erT-erT yvelaze daucvel jgufs miekuTvnebian

• maTi absoluturi umravlesoba (90-%) umuSevaria;

• fsiqikuri aSlilobis mqone pirTa socialuri urTierTobebi Raribia - 88-%-ze meti ZiriTadad saxlSia gamoketili; F

• fsiqikuri aSlilobis mqone pirTa 88-%-s konfliqti aqvs ojaxebSi;

• mzrunvelTa 68-% umuSevaria radgan dRis umetes nawils fsiqikuri aSlilobiT daavadebuli piris movlas uTmobs, 70-%-s ar dausvenia ramodenime wlis ganmavlobaSi

fsiqikuri statusis gamokvlevis mizani:

fsiqikuri aSlilobis simptomis dadgena;P

pacientis mxridan TviT an sxvisi dazianebis saSiSorebis Sefaseba;

Semdgomi mkurnalobis gegmis Sedgena.

arsebobs fsiqodiagnostikis sxvadasxva meTodi:1) fsiqo statusis gamokvleva (kognicia, koncentracia,

saxis gamometyveleba, intonacia, manerebi, TviT Sefaseba, laparakis manera, tonaloba, aRqma);

2) testireba (arsebobs msoflioSi miRebuli depresiis kiTxvarebi:bk-is,hopkin-si,luSeri-s,mmpa da a.S.)

testis Sedegebis damuSavebis Semdeg fsiqologi akeTebs daskvnas da isazRvreba mkurnalobis Semdegi taqtika, mZime depresiis SemTxvevaSi aucilebelia fsiqiatris CarTva da farmako Terapia;

mkurnalobis 14 dRis Semdeg saWiroa samkurnalo reJimis adeqvaturobis ganmeorebiTi Sefaseba

depresia laTinuri sityvaa da niSnavs daTrgunuls

depresia adamianis fsiqiuri aSlilobaa, romelsac axasiaTebs:

• negatiuri ganwyoba, • sevda, • daTrgunuloba • gunebisa da TviTSefasebis

gauareseba,• cxovrebis interesis dakargva.depresia advilad gankurnebadia _

pacientebis 80 %-sruliad ikurneba.

depresiis klinikadepresiis gancda adamianisTvis damaxasiaTebeli

normaluri reaqciaa garegan movlenaze, an raime mniSvnelovan personalur danakargze. gaxangrZlivebuli reaqcia, romelic moicvas ara mxolod guneba-ganwyobis moSlas, aramed sxva cvlilebebsac, diagnostirdeba rogorc depresia

depresia moicavs:Secvlil guneba-ganwyobas (daqveiTebuli guneba-

ganwyoba an/da anhedonia, anu siamovnebisa da interesis dakargva);

fizikur simptomebs (darRveuli mada, Zili, seqsualuri ltolva da motoruli niSnebi: aJitacia an Seneleba, daRliloba);

kognitur siptomebs (negatiuri azrovneba, danaSaulis araadekvaturi gancda, gulmaviwyoba, yuradRebis koncentraciis daqveiTeba, suiciduri azrebi).

depresiis formebi:mZime depresiuli aSliloba -

ganmeorebiTi, sul cota 2 kviriani epizodebiT;

mcire depresia - vlindeba naklebi simptomebiT vidre didi depresiis forma;

disTimia – xasiaTdeba qronikuli mimdinareobiT, ara nakleb 2 wlis xangrZlivobiT;

depresiis statistika

• aSS-Si cxovrebis manZilze qalebis 10-24% da mamakecebis 5-12% imyofeba depresiis gamovlenis riskis qveS;

• yoveli rva qalidan erTs uviTardeba depresia;• samidan mxolod erTi mimarTavs eqims

daxmarebisaTvis;• mZime depresiis mqone hospitalizirebuli pacientebis 15

% sicocxles TviTmkvlelobiT asrulebs;• didi depresia iwyeba axalgazrda asakSi - meore

aTwleulis bolos;• qalebSi depresia piks aRwevs 25-44 wlis asakSi;• depresia xSirad Tanaarsebobs sxva qronikul

daavadebebTan.

tuberkulozi da depresia

TB pacientebSi gansakuTrebiT maRalia guneba-ganwyobis moSliT mimdinare mdgomareobebi, Semdegi faqtorebis gamo:

• stigma; • mgb+ mdgomareobiT gamowveuli

epidsaSiSroeba; • stacionaluri mkurnalobis periodSi specifiuri

reJimi;

MD

tuberkulozisa da filtvis daavadebaTa erovnuli centris 100 DR-TB (Poly, MDR da XDR) pacienti gamokiTxul iqna PQR-

11 skrining kiTxvariT.

Mmsubuqi depresia dafiqsirda 9 pacientTan

zomierad gamoxatuli depresia -11-Tan

mZime depresia 18 qalbatonTan

fsiqiatris daxmareba saWiro gaxda zomierad da mZimed gamoxatuli depresiebis dros

38 DR-TB qali pacienti

62 DR-TB mamakaci pacienti

msubuqi depresia dafiqsirda12 pacientTan

zomierad gamoxatuli 8 pacientTan

MmZime depresia32 pacientTan

fsiqiatris daxmareba saWiro gaxda zomierad da mZimed gamoxatuli depresiebis dros

depresiis TandarTva aqveiTebs TB pacientebis mkurnalobaze damyolobas da axangrZlivebs mkurnalobis vadebs;

daavadebis simZimis, mkurnalobis xangrZlivobis da reJimis gamo MDR-TB pacientebSi mZime da zomierad gamoxatuli depresiebi procentulad ufro metia, vidre regularuli TB-iT daavadebul pacientebSi;

PQR-11 skrining kiTxvariT gamoikiTxaHkvlevaSi CarTuli regularuli TB-iT daavadebuli 30 pacienti:

• msubuqi depresia dafiqsirda 12 pacientTan;

• zomierad gamoxatuli - 10 pacientTan (maT Soris 3 warsulSi namkurnalebi iyo);

• mZime depresia dafiqsirda 8 pacientTan - CarTulia fsiqiatri.

depresiis gamomwvevi mizezebi:

eqspertebi Tvlian, rom genetikur winaswarganwyobas udidesi mniSvneloba eniWeba cxovrebaSi mimdinare stresul situaciebTan erTad;

zogierT faqtorebs SeuZliaT konkretuli qimiuri nivTierebebis - Tavis tvinis e.w. neiromediatorebis, disbalansi gamoiwvion, rac iwvevs depresias.

depresiuli Setevebis maprovocirebeli faqtorebi;

medikamentozuri moqmedeba – Zlieri tkivilis moxsnis mizniT narkotikebis moxmareba da steroidebiT mkurnaloba (depresiuli simptomebi xSirad ukvalod qreba am faqtorebis moxsnis Semdeg);

hormonaluri sekreciis darRveva _ farisebri jirkvlis da Tirkmelzeda jirkvlis disbalansi.

qronikuli daavadebebi _ arTriti, gulis -sisxlZarRvTa paTologia, simsivneebi, virusuli da qronikuli infeqciuri daavadebebi.

depresiis mkurnalobis mizani:

depresiuli aSlilobis yvela niSnisa da simptomis Semcireba da moxsna;

asimptomuri mdgomareobis doneze avadmyofobis samsaxureobrivi da fsiqosocialuri aqtivobis aRdgena;

recidivis ganviTarebis albaTobis Semcireba;

depresiis mkurnalobis saxeobebi:

1. fsiqoTerapia;

2. farmakoTerapia.

gmadlobT yuradRebisTvis !